INTRODUCTION:

Dental products include

(a) Anticaries

(b) Cleaning and polishing agents.

1) DENTINE- its surrounds the pulp cavity and extends throughout the entire portion of teeth

2) CEMENTUM –it is a layer covering the portion of tooth lying buried in the gum and

3) ENAMEL-it is a white hard material covering the portion of tooth projecting above the gum

Dentine having the 75% of mineral is hard and dense. Enamel having 98% mineral, is even more dense It is hardest substance present in the body. The organic matrix of dentine and cementum is bone like in the fully form enamel the hydroxyapatite crystal are quite large as compared to that of bone. Vitamins A C and D are necessary for the proper tooth formation. Vitamin A deficiency causes hypoplastic enamel. Vitamin C deficiency affects calcification of dentine. Vitamin D not only helps the absorption of calcium from GIT, but also for the proper deposition of calcium and phosphorous in tooth .others ion like mg2+, Cl- and citrate are also present in tooth like bones. A large variety of inorganic compound are used as dental products in dental care and treatment. Most dental products are non-prescription and over the counter products. A pharmacist is expected to be well- versed with common dental terms including local dental product and specialists terminologies so that he can advice a direct the patient accordingly.^[1-3]

ANTICARIES AGENTS:

Dental caries or tooth decay is more or less a disease of the teeth caused by acids produced by the action of microorganisms on carbohydrates. This disease is characterized by decalcification of tooth accompanied by foul mouth odor. The exact cause and mechanism of dental caries is not known with certainty. However, it is accepted that dental caries first of all starts on the surface of the teeth. Acids produced by bacterial metabolism of fermenting carbohydrates act on teeth, produce lesions where bacteria’s get localized and dental caries gets produced.

To prevent dental caries and to maintain clean and healthy teeth, it becomes necessary to use dentifrices. Primary function of dentifrice is to clean the accessible surface of the teeth. There are substances having known therapeutic value. Use of ammoniated toothpaste, urea ammonia containing powders, antibiotic containing mixtures and anti-enzyme compounds has been in use. These compounds are having their advantages and limitations.

Role of fluoride in preventing dental caries has been well accepted. Administration f traces of fluoride having salts or their use in topical use to the teeth have been reported to give encouraging results.

Fluoride ion is a trace material which occurs in our body. It is generally adequately obtained from food and water. In some parts of the world, ground water is totally lacking fluoride. In such places occurrence of dental caries has been becoming in alarming proportions. Addition of fluoride to the municipal water supply, known as fluoridation is able to help in reducing the preventing dental caries. This is not true because those who receive slow continued ingestion of fluoride may suffer from mottling of teeth, increased density of bones, gastric disturbances, muscular weakness, convulsions and even heart failure. Due to beneficial effects in treating dental caries and in some types of osteoporosis, fluorides find use in dental practice.

When a fluoride having salt or solution is taken internally, it is readily absorbed, transported and deposited in the bone or developing teeth and remainder gets excreted by the kidneys. The deposited fluoride on the surface of teeth does not allow the action of acids or enzymes in producing lesions. A small quantity of fluoride thus becomes necessary to prevent caries. However, if more quantity of fluoride is ingested it is carried to bones and teeth and gives rise to mottled enamel known as dental fluorosis.

It is possible to administer fluoride by two routes (i) orally and (ii) topically. The use of fluoridation of public water supply has been the most common and effective way of oral administration. Water supply containing about 0.5 to 1 ppm is provided which is sufficient. Alternatively, it can be given in drinking water or fruit juice in such a concentration to have about 1 ppm per day. Sodium fluoride tablets or solution of sodium fluoride in a dose of 2.2 mg per day are used. For topical application 2 percent solution is generally used on teeth.

Besides fluorides, inorganic phosphate salts have been found to be useful in reducing the dental caries. Phosphate ions are needed for stronger bones as well healthy teeth. Phosphate salts both in soluble and insoluble forms normal diets. The phosphates are normally given in deficiency. Role of phosphates as cleaning agent is also important.

1.SodiumFluoride:

Formula:NaF:

It is having not less than 98.0 percent of NaF, calculated with reference to the dried substance.

Preparation:

It may be prepared by neutralizing hydrofluoric acid with sodium carbonate.

Another method involves the double decomposition of calcium fluoride with sodium carbonate wherein insoluble calcium carbonate can be removed by filtration.

Properties:

It forms colorless, odorless crystals or as white powder. It is soluble in water but is insoluble in alcohol. Its aqueous solutions corrode ordinary glass bottles and hence the solution should be prepared in distilled water and stored in dark, Pyrex bottles.

On acidification of salt solution, hydrofluoric acid is produced. This is weak acid and is poisonous. Aqueous solution of salt yields alkaline reaction.

Action and uses:

Sodium fluoride due to its fluoride ion is an important agent in dental practice for retarding or preventing dental caries.

Sodium fluoride in 2 percent aqueous solution is widely used topically; occasionally the solution is applied to the surface of dry teeth periodically over several times in a year. Fluoride ion enters the enamel of teeth and becomes part of enamel structure and thus becomes effective.

Approximately 2.2 mg of NaF contains 1 mg of fluoride ion and each g of NaF is equivalent to 23.8 m mol of sodium and fluoride. Sodium fluoride and other soluble fluorides are readily absorbed from GIT. Fluoride also gets absorbed slowly from gums when applied as paste and incorporated into the teeth. Fluoridised teeth have the resistant to microorganisms causing dental caries. It also decreases microbial acid production. Sodium fluoride can be administered as solution, tablet, oral gel or varnish for systemic use or as mouth wash for local use in the mouth.

A modification of sodium fluoride application is the use of acidified phosphate-sodium fluoride gels. These preparations usually contain the equivalent of approximately 1.23 percent fluoride and 1 percent phosphoric acid.

A 2% solution of sodium fluoride in water may be applied to children’s teeth, after preliminary cleansing, 3 times at the interval of one week of 3, 7, 10, and 13 years of age to correspond with the tooth eruption. Alternatively, a paste containing75% of sodium fluoride and 25% of glycerol is applied to the teeth, rubbed in for 1 minute and removed by a mouthwash.

Usual Dose: 2.2 mg once a day.

Application: 1.5 to 3 ppm in drinking water, topically as a 2% solution to the teeth.

Caution:

When consumed in larger doses, sodium fluoride as poisonous. High fluoride water brings about mottling of teeth, gastric disturbances, etc. Stiller larger doses may lend to systemic toxicities effecting central nervous, cardiovascular, musculo-skeletal and respiratory systems. Sometimes, sodium fluoride is used as domestic insecticide. Great precaution is to be taken to prevent children getting access to such preparations.

Assay:

It is assayed by complexometric titration method using disodium edetate.

A weighed quantity is dissolved in water. To it a small amount of sodium chloride and alcohol is added. Now contents are heated to boiling and drop wise excess lead nitrate is added with stirring. On cooling, coagulated precipitate is filtered, residue washed with dilute alcohol and the combined filtrate and washings are made to titrate with disodium edentate using xylenol orange as indicator.

Stannous fluoride is a valuable adjunct in the prevention of caries and is considered to be superior to sodium fluoride for two reasons (i) simplified application; and (ii) greater effectiveness. The first advantage is supported by the fact that a single application of 8% aqueous solution to the tooth surface is enough for every 6 months to 1 year, while, a 2% sodium fluoride is applied 4 times during a 10 days a period. The second advantage derives from the fact that the stannous ion increases the anticariogenic action of fluoride ion so that both ions contribute towards clinical effectiveness.

It is for topical use only.

Storage: It is kept in well-closed containers.

2. Sodium monofluorophosphate (U.S.P)

It is also known as SMFP. It corresponds to the formula (mole mass 143.9). It is a white odorless powder. It is freely soluble in water, yielding near neutral solution. It is also used for fluoride supplement of diets, fluoridation of municipal water supply and in mouth washes. It is preferred to be included in dentifrices, particularly toothpastes. It is believed SMFP is able to induce better fluoridation of dental enamel and decreases its demineralization, than sodium fluoride.

3. Stannous fluoride

Formula: SnF2

Tin fluoride solution is obtained from using tin fluoride capsules by dissolving in water. A fresh solution finds use in dentistry.

It contains not less than 71.2% of stannous ions and not less than 22.3% and not more than 25.5% of fluoride, calculated on the dried basis.

Properties:

It is a while crystalline powder having unpleasant astringent salty taste. It is soluble in water but insoluble in alcohol and organic solvents. Aqueous solution of stannous fluoride deteriorates rapidly on standing because of oxidation of stannous cation to stannic form causing turbidity. Thus, stannous fluoride solution must be freshly made.

Uses:

It is used to prevent dental caries, similar to sodium fluoride and SMFP in the form of solution, gel, mouth wash or dentifrice. It has an unpleasant taste and may cause discoloration of teeth on over usage.

Because of instability of prepared aqueous solutions, fresh solutions are prepared at the time of application. A freshly prepared 8 percent solution of stannous fluoride is applied to the cleaned dry teeth. A single application has been reported to be sufficient for six to twelve months.

Assay for stannous ion:

250 mg of stannous fluoride is accurately weighed and then transferred to a conical flask. To this flask, 300 ml of hot, recently boiled hydrochloric acid is added. The flask is shaken to dissolve the stannous fluoride.

Now the flask is kept so that it gets cooled to room temperature. To this flask, 5 ml of potassium iodide is added and the contents in the flask are titrated with 0.1N potassium iodate using starch as an indicator.

Other fluorides used in dentifrices and oral hygiene products include aluminum fluoride ammonium fluoride, calcium fluoride and potassium fluoride. Sodium silicofluoride is employed for fluoridation of water.^[4-5]

Tooth polishing:

Is the act of smoothing the tooth surface. The purpose of polishing is to make it difficult for plaque to accumulate on the tooth surface area. Common practice is to use a prophy cup—a small motorized rubber cup—along with an abrasive polishing compound.

Equipment:-

1. Rubber cup:

Fig.1. Rubber Cup

2. Prophy cups:

Rubber cups as shown in Fig.1, also called prophy cups, are used in the hand-piece. Polishing paste, prophylactic paste, usually containing fluoride, is used with the rubber cups for polishing. Rubber cups should not be used over the cementum area as it may remove a layer of cementum at the cervical area. There are two popular types of prophy cups: 4 webs and 6 webs.

3. Bristle brush:

Fig.2 Bristle brush

4. Prophy brushes:

Bristle brushes as shown in fig.2 are used in the prophylaxis angle with a polishing paste. The use of the brush should be confined to the crown to avoid injury to the gingiva and cementum.

Fig.3. Prophy brushes

5. Prophy angles:

Currently, the most commonly used tool for tooth polishing is prophy angle. It integrates a rubber cup as shown in fig.3 into a high torque gear, which can be plugged into a low speed handpiece and drive rubber cup to polish teeth.

6. Dental tape:

Dental tape is used for polishing the proximal surfaces of teeth that are inaccessible to other polishing instruments. It is also used with polishing paste. Particular care should be taken to avoid injury to the gingiva. The area should be cleaned with warm water to remove all remnants of the paste.^[6-7]

7. Air-powder polishing:

Air-powder polishing is used with a specially designed handpiece. This device is called Prophy-jet. It delivers an air-powder slurry of warm water and sodium bicarbonate for polishing. It is very effective for the removal of extrinsic stains and soft deposits. It is contraindicated in patients with respiratory illness, hemodialysis and hypertension

Intention of preventing cavities (dental caries), gingivitis, and periodontal disease. People routinely clean their own teeth by brushing and interdental cleaning, and dental hygienists can remove hardened deposits (tartar) not removed by routine cleaning. Those with dentures and natural teeth may supplement their cleaning with a denture cleaner.

Brushing, scrubbing and flossing:

Tooth brushing and Dental floss:

Brushingand frequent brushing with a toothbrush helps to prevent build-up of plaque bacteria on the teeth. Electric toothbrushes were developed, and initially recommended for people with strength or dexterity problems in their hands, but they have come into widespread general use. The effectiveness of electric toothbrushes at reducing plaque formation and gingivitis is superior to that of conventional manual toothbrushes.

Flossing:

In addition to brushing, cleaning between teeth may help to prevent build-up of plaque bacteria on the teeth. This may be done with dental floss or interdental brushes.

80% of cavities occur in the grooves, or pits and fissures, of the chewing surfaces of the teeth however, there is no evidence currently showing that normal at-home flossing reduces the risk of cavities in these areas.

Special appliances or tools may be used to supplement toothbrushing and interdental cleaning. These include special toothpicks, oral irrigators, and other devices.

Scrubbing:

Teeth can be cleaned by scrubbing with a twig instead of a toothbrush. Plant sap in the twig takes the place of toothpaste In many parts of the world teeth are used. In the Muslim world the miswak or siwak is made from twigs or roots that are said to have an antiseptic effect when used for cleaning teeth. ^[6-7]

Professional teeth cleaning :-

Fig. 4 Dental hygienist polishing a patient's teeth

Teeth cleaning (also known as prophylaxis, literally a preventive treatment of a disease) is a procedure for the removal of tartar (mineralized plaque) that may develop even with careful brushing and flossing as shown in Fig.4, especially in areas that are difficult to reach in routine tooth brushing. It is often done by a dental hygienist. Professional cleaning includes tooth scaling and tooth polishing and debridement if too much tartar has accumulated. This involves the use of various instruments or devices to loosen and remove deposits from the teeth.

As to the frequency of cleaning, research on this matter is inconclusive. That is, it has neither been shown that more frequent cleaning leads to better outcomes nor that it does not. A review of the research literature on the question concluded "The research evidence is not of sufficient quality to reach any conclusions regarding the beneficial and adverse effects of routine scaling and polishing for periodontal health and regarding the effects of providing this intervention at different time intervals"^[5] This conclusion was reaffirmed when the 2005 review was updated in 2007.^[6]Thus, any general recommendation for a frequency of routine cleaning (e.g. every six months, every year) has no empirical basis.^[7] Moreover, as economists have pointed out, private dentists (or other dental professionals) have an economic incentive to recommend frequent cleaning, because it increases their revenues.

Most dental hygienists recommend having the teeth professionally cleaned every six months More frequent cleaning and examination may be necessary during treatment of dental and other oral disorders. Routine examination of the teeth is recommended at least every year.

Information from around the globe is presented in this bimonthly publication featuring approximately 50 abstracts from key articles in dentistry. Dental Abstracts keeps dentists informed of developments and advances in general dentistry and its specialties in an easy-to-read, abstract format. Graphs, tables, and figures that have appeared in original articles are also included. This time-saving publication covers topics such as guided tissue regeneration, treatments for anterior single tooth implants, clinical evaluation of dentin bonding agents, and more.^[7-8]

Source articles for Dental Abstracts are selected primarily from a list of over 120 journals covering not only world dental literature but also related health care disciplines with practical relevance to oral health professionals. Many factors are considered including scientific validity, utility to the readership, international diversity, topic variety, and timeliness. In addition to systematic reviews, randomized-controlled trials, cohort and case-control studies, selections by the Editor-in-Chief also include clinical guidelines, review articles, case reports, expert opinions, editorials, dental practice management topics, and original commentaries. The Dental Abstracts Editorial Board provides an important collaborative resource to the editor and publisher regarding developing and assessing journal content as well as submitting article and commentary suggestions.

8. Teeth Cleaning:

Teeth cleaning is the removal of dental plaque and tartar from teeth to prevent cavities, gingivitis, gum disease, and tooth decay. Severe gum disease causes at least one-third of adult tooth loss.

Tooth decay is the most common global disease. Over 80% of cavities occur inside fissures in teeth where brushing cannot reach food left trapped after every meal or snack and saliva or fluoride have no access to neutralise acid and remineralise demineralised teeth, unlike easy-to-clean parts of the tooth, where fewer cavities occur.

Dental sealants, which are applied by dentists, cover and protect fissures and grooves in the chewing surfaces of back teeth, preventing food from becoming trapped thus halting the decaying process. An elastomer strip has been shown to force sealant deeper inside opposing chewing surfaces and can also force fluoride toothpaste inside chewing surfaces to aid in remineralising demineralised teeth

Since before recorded history, a variety of oral hygiene measures have been used for teeth cleaning. This has been verified by various excavations done throughout the world, in which chew sticks, tree twigs, bird feathers, animal bones and porcupine quills were recovered. Many people used different forms of teeth cleaning tools. Indian medicine (Ayurveda) has used the neem tree, or daatun, and its products to create teeth cleaning twigs and similar products; a person chews one end of the neem twig until it somewhat resembles the bristles of a toothbrush, and then uses it to brush the teeth. In the Muslim world, the miswak, or siwak, made from a twig or root, has antiseptic properties and has been widely used since the Islamic Golden Age. Rubbing baking soda or chalk against the teeth was also common, however this can have negative side effects over time.

Generally, dentists recommend that teeth be cleaned professionally at least twice per year Professional cleaning includes tooth scaling, tooth polishing, and, if tartar has accumulated, debridement; this is usually followed by a fluoride treatment. However, the American Dental Hygienists' Association (ADHA) publicly stated in 1998 that there is an absence of evidence that scaling and polishing provides therapeutic value The Cochrane Oral Health Group reviewed nine studies but found them to be of insufficient quality and not enough evidence to support the claims of the benefits of regular tooth scaling or tooth polishing. Between cleanings by a dental hygienist, good oral hygiene is essential for preventing tartar build-up which causes the problems mentioned above. This is done through careful, frequent brushing with a toothbrush, combined with the use of dental floss to prevent accumulation of plaque on the teeth.

Dentist and dental hygienist are about preventing tooth loss and gum disease. The patient needs to be aware of the importance of brushing and flossing their teeth daily. New parents need to be educated to promote a healthy life and mouth for their children. At any age; a person should be notified about how to take care of their teeth and how they will be able to keep their teeth and not need dentures.

9. Removing plaque

Plaque is a yellow sticky film that forms on the teeth and gums and can be seen at gum margins of teeth with disclosing tablets. The bacteria in plaque convert carbohydrates in food (such as sugar) into acid that demineralises teeth, eventually causing cavities. Daily brushing with toothpaste and flossing removes plaque.

Plaque can also cause inflammation of the gum (gingivitis), making it red, tender and can easily bleed when flossing or brushing your teeth. If this is not treated, bones around the teeth can be affected by the various inflammatory factors, eventually leading to periodontitis. If not treated, the loss of bone structure may cause teeth to become mobile. The treatment is to remove plaque inside the deep pockets between the tooth surface and the soft tissues using specialized dental equipment. If the treatment is not successful, the gum will pull away from the teeth (receding gums) as a result of the cessation of the inflammatory swelling.

10. Flossing

The use of dental floss is an important element of oral hygiene, since it removes plaque and decaying food remaining between the teeth. This food decay and plaque cause irritation to the gums, allowing the gum tissue to bleed more easily. Acidic foods left on the teeth can also demineralise teeth, eventually causing cavities.

Flossing for a proper inter-dental cleaning is recommended at least once per day, preferably before brushing so fluoride toothpaste has better access between teeth to help remineralise teeth, prevent receding gums, gum disease, and cavities on the surfaces between the teeth.

Fig.5 A dental hygienist demonstrates dental flossing.

It is recommended to use enough floss to enable easy use, usually ten or more inches with three to four inches of taut floss to put between teeth. Floss is then wrapped around the middle finger and/or index finger, and supported with the thumb on each hand.

It is then held tightly to make taut, and then gently moved up and down between each tooth. It is important to floss under visible areas by curving the floss around each tooth instead of moving up and down on gums, which are much more sensitive than teeth.

Bleeding gums are normal upon first usage of floss, but will stop as gums become healthier with use.

One should use an unused section of the floss when moving around different teeth. Removing floss from between teeth requires using the same back-and-forth motion as flossing, but gently bringing the floss up and out of gaps between teeth as shown in the fig.5.

11. Interdental brushes

An interdental brush, also called an inter proximal brush or a proxy brush, is a small brush, typically disposable, either supplied with a reusable angled plastic handle or an integral handle, used for cleaning between teeth and between the wire of dental braces and the teeth. Brushes are available in a range of widths, color coded as per ISO 16409. Interdental brushes are classified according to ISO standard 16409:2006. The ISO brush sizes range from 1 to 7. The ISO brush size is determined by the PHD or Passage Hole Diameter in mm. This PHD is the minimum diameter of a hole that the interdental brush will pass through without deforming the brush wire stemA peer-reviewed clinical study has found that using a toothbrush and an interdental brush more effectively removes plaque than using a toothbrush and dental floss.

Oral irrigation

Some dental professionals recommend oral irrigation as a way to clean teeth and gums Oral irrigators reach 3–4 mm under the gum line. Oral irrigators use a pressured, directed stream of water to disrupt plaque and bacteria.

Food and drink

Foods that help muscles and bones also help teeth and gums. Breads and cereals are rich in vitamin B while fruits and vegetables contain vitamin C, both of which contribute to healthy gum tissue Lean meat, fish, and poultry provide magnesium and zinc for teeth.

Eating a balanced diet and limiting snacks can prevent tooth decay and periodontal disease. The Fédération Dentaire Internationale (FDI World Dental Federation) has promoted foods such as raw vegetables, plain yogurt, cheese, or fruit as dentally beneficial—this has been echoed by the American Dental Association (ADA).

Beneficial foods

Some foods may protect against cavities by naturally containing fluorine, from which fluoride is derived. Fluoride is naturally present in all water. Community water fluoridation is the addition of fluoride to adjust the natural fluoride concentration of a community's water supply to the level recommended for optimal dental health, approximately 1.0 ppm (parts per million). One ppm is the equivalent of 1 mg/L, or 1 inch in 16 miles. Fluoride is a primary protector against dental cavities. Fluoride makes the surface of teeth more resistant to acids during the process of remineralisation. Drinking fluoridated water is recommended by some dental professionals while others say that using toothpaste alone is enough. Milk and cheese are also rich in calcium and phosphate, and may also encourage remineralisation. All foods increase saliva production, and since saliva contains buffer chemicals this helps to stabilize the pH to near 7 (neutral) in the mouth. Foods high in fiber may also help to increase the flow of saliva and a bolus of fibre like celery string can force saliva into trapped food inside pits and fissures on chewing surfaces where over 80% of cavities occur, to dilute carbohydrate like sugar, neutralise acid and remineralise tooth like on easy to reach surfaces.^[9-10]

Harmful foods

Sugars are commonly associated with dental cavities. Other carbohydrates, especially cooked starches, e.g. crisps/potato chips, may also damage teeth, although to a lesser degree (and indirectly) since starch has to be converted to sugars by salivary amylase (an enzyme in the saliva) first. Sugars that are higher in the stickiness index, such as toffee, are likely to cause more damage to teeth than those that are lower in the stickiness index, such as certain forms of chocolate or most fruits.

Sucrose (table sugar) is most commonly associated with cavities. The amount of sugar consumed at any one time is less important than how often food and drinks that contain sugar are consumed. The more frequently sugars are consumed, the greater the time during which the tooth is exposed to low pH levels, at which point demineralisation occurs (below 5.5 for most people). It is important therefore to try to encourage infrequent consumption of food and drinks containing sugar so that teeth have a chance to be repaired by remineralisation and fluoride. Limiting sugar-containing foods and drinks to meal times is one way to reduce the incidence of cavities. Sugars from fruit and fruit juices, e.g., glucose, fructose, and maltose seem equally likely to cause cavities.

Acids contained in fruit juice, vinegar and soft drinks lower the pH level of the oral cavity which causes the enamel to demineralize. Drinking drinks such as orange juice or cola throughout the day raises the risk of dental cavities tremendously.

Another factor which affects the risk of developing cavities is the stickiness of foods. Some foods or sweets may stick to the teeth and so reduce the pH in the mouth for an extended time, particularly if they are sugary. It is important that teeth be cleaned at least twice a day preferably with a toothbrush and fluoride toothpaste, to remove any food sticking to the teeth. Regular brushing and the use of dental floss also remove the dental plaque coating the tooth surface.

Chewing gum

Chewing gum assists oral irrigation between and around the teeth, cleaning and removing particles, but for teeth in poor condition it may damage or remove loose fillings as well. Dental chewing gums claim to improve dental health. Sugar-free chewing gum stimulates saliva production, and helps to clean the surface of the teeth

Smoking is one of the leading risk factors associated with periodontal diseases It is thought that smoking impairs and alters normal immune responses, eliciting destructive processes while inhibiting reparative responses promoting the incidence and development of periodontal diseases Regular vomiting, as seen in bulimia nervosa, also causes significant damage by drinking fresh water after a caffeinated drink and also at the dentist by surface cleaning. Mouthwash or mouth rinse with saline (salty water), fluoridated solution or the antiseptic solution chlorhexidine gluconate can improve oral hygiene by removing some tooth decaying materials. In particular, it may help to remove some foods that were recently eaten. Retainers can be cleaned in mouthwash or denture cleaning fluid. Dental braces may be recommended by a dentist for best oral hygiene and health. Dentures, retainers, and other appliances must be kept extremely clean. This includes regular brushing and may include soaking them in a cleansing solution such as a denture cleaner. Oral hygiene and systemic diseases. Several recent clinical studies suggest oral disease and inflammation (oral bacteria & oral infections) may be a potential risk factor for serious systemic diseases, such as Cardiovascular Disease (Heart attack and Stroke), Bacterial Pneumonia, Low birth weight/Extreme High Birth Weight, Diabetes complications Osteoporosis.^[9-10]

REFERENCES:-

1. A.H.Beckett and J.B.Stenlake, Practical pharmaceutical chemistry, Part-I. The Athtone press, University of London, London.

2. P. Gundu Rao, Inorganic pharmaceutical chemistry; Vallabh Prakashan, Delhi.

3. Advanced Inorganic Chemistry by Satya Prakash, G.D. Tuli

4. Jolly-Modern Inorganic Chemistry

5. Pharmaceutical Inorganic Chemistry textbook by Alagarsamy.

6. L.M. Atherden, Bentley and Driver’s Textbook of Pharmaceutical Chemistry Oxford University Press, London.

7. Indian Pharmacopoeia 1996, 2006.

8. J.H Block, E. Roche, T.O Soine and C.O. Wilson, Inorganic Medical and Pharmaceutical Chemistry Lea & Febiger Philadelphia PA.

9. Pharmaceutical inorganic chemistry by S. Chand, R.D. Madan, Anita Madan

10. Pharmaceutical Inorganic Chemistry by Soma Shekar Rao

Received on 08.12.2016 Accepted on 08.01.2017

Asian J. Pharm. Tech. 2017; 7(1): 11-18.

DOI: 10.5958/2231-5713.2017.00003.4

1) DENTINE- its surrounds the pulp cavity and extends throughout the entire portion of teeth

2) CEMENTUM –it is a layer covering the portion of tooth lying buried in the gum and

3) ENAMEL-it is a white hard material covering the portion of tooth projecting above the gum

ANTICARIES AGENTS:

Role of fluoride in preventing dental caries has been well accepted. Administration f traces of fluoride having salts or their use in topical use to the teeth have been reported to give encouraging results.

1.SodiumFluoride:

Formula:NaF:

It is having not less than 98.0 percent of NaF, calculated with reference to the dried substance.

Preparation:

It may be prepared by neutralizing hydrofluoric acid with sodium carbonate.

Another method involves the double decomposition of calcium fluoride with sodium carbonate wherein insoluble calcium carbonate can be removed by filtration.

Properties:

It forms colorless, odorless crystals or as white powder. It is soluble in water but is insoluble in alcohol. Its aqueous solutions corrode ordinary glass bottles and hence the solution should be prepared in distilled water and stored in dark, Pyrex bottles.

On acidification of salt solution, hydrofluoric acid is produced. This is weak acid and is poisonous. Aqueous solution of salt yields alkaline reaction.

Action and uses:

Sodium fluoride due to its fluoride ion is an important agent in dental practice for retarding or preventing dental caries.

Sodium fluoride in 2 percent aqueous solution is widely used topically; occasionally the solution is applied to the surface of dry teeth periodically over several times in a year. Fluoride ion enters the enamel of teeth and becomes part of enamel structure and thus becomes effective.

A modification of sodium fluoride application is the use of acidified phosphate-sodium fluoride gels. These preparations usually contain the equivalent of approximately 1.23 percent fluoride and 1 percent phosphoric acid.

Usual Dose: 2.2 mg once a day.

Application: 1.5 to 3 ppm in drinking water, topically as a 2% solution to the teeth.

Caution:

Assay:

It is assayed by complexometric titration method using disodium edetate.

It is for topical use only.

Storage: It is kept in well-closed containers.

2. Sodium monofluorophosphate (U.S.P)

3. Stannous fluoride

Formula: SnF2

Tin fluoride solution is obtained from using tin fluoride capsules by dissolving in water. A fresh solution finds use in dentistry.

It contains not less than 71.2% of stannous ions and not less than 22.3% and not more than 25.5% of fluoride, calculated on the dried basis.

Properties:

Uses:

It is used to prevent dental caries, similar to sodium fluoride and SMFP in the form of solution, gel, mouth wash or dentifrice. It has an unpleasant taste and may cause discoloration of teeth on over usage.

Because of instability of prepared aqueous solutions, fresh solutions are prepared at the time of application. A freshly prepared 8 percent solution of stannous fluoride is applied to the cleaned dry teeth. A single application has been reported to be sufficient for six to twelve months.

Assay for stannous ion:

250 mg of stannous fluoride is accurately weighed and then transferred to a conical flask. To this flask, 300 ml of hot, recently boiled hydrochloric acid is added. The flask is shaken to dissolve the stannous fluoride.

Now the flask is kept so that it gets cooled to room temperature. To this flask, 5 ml of potassium iodide is added and the contents in the flask are titrated with 0.1N potassium iodate using starch as an indicator.

Other fluorides used in dentifrices and oral hygiene products include aluminum fluoride ammonium fluoride, calcium fluoride and potassium fluoride. Sodium silicofluoride is employed for fluoridation of water.[4-5]

Tooth polishing:

Is the act of smoothing the tooth surface. The purpose of polishing is to make it difficult for plaque to accumulate on the tooth surface area. Common practice is to use a prophy cup—a small motorized rubber cup—along with an abrasive polishing compound.

Equipment:-

1. Rubber cup:

Fig.1. Rubber Cup

2. Prophy cups:

3. Bristle brush:

Fig.2 Bristle brush

4. Prophy brushes:

Bristle brushes as shown in fig.2 are used in the prophylaxis angle with a polishing paste. The use of the brush should be confined to the crown to avoid injury to the gingiva and cementum.

Fig.3. Prophy brushes

5. Prophy angles:

Currently, the most commonly used tool for tooth polishing is prophy angle. It integrates a rubber cup as shown in fig.3 into a high torque gear, which can be plugged into a low speed handpiece and drive rubber cup to polish teeth.

6. Dental tape:

7. Air-powder polishing:

Brushing, scrubbing and flossing:

Tooth brushing and Dental floss:

Flossing:

In addition to brushing, cleaning between teeth may help to prevent build-up of plaque bacteria on the teeth. This may be done with dental floss or interdental brushes.

80% of cavities occur in the grooves, or pits and fissures, of the chewing surfaces of the teeth however, there is no evidence currently showing that normal at-home flossing reduces the risk of cavities in these areas.

Special appliances or tools may be used to supplement toothbrushing and interdental cleaning. These include special toothpicks, oral irrigators, and other devices.

Scrubbing:

Professional teeth cleaning :-

Fig. 4 Dental hygienist polishing a patient's teeth

Most dental hygienists recommend having the teeth professionally cleaned every six months More frequent cleaning and examination may be necessary during treatment of dental and other oral disorders. Routine examination of the teeth is recommended at least every year.

8. Teeth Cleaning:

Teeth cleaning is the removal of dental plaque and tartar from teeth to prevent cavities, gingivitis, gum disease, and tooth decay. Severe gum disease causes at least one-third of adult tooth loss.

9. Removing plaque

Other fluorides used in dentifrices and oral hygiene products include aluminum fluoride ammonium fluoride, calcium fluoride and potassium fluoride. Sodium silicofluoride is employed for fluoridation of water.^[4-5]