OTC Dentifrices
Whitening
Hypersensitivity
Triclosan
Ghazaleh Bazyar, Vanessa Cook, Jane Hoffmann
Whitening Toothpastes
 Two factors impact tooth color:
 Intrinsic color of the tooth
 Extrinsic stains
 Whitening products work either by:
 Removing stains
 Bleaching of the teeth
Whitening Toothpaste
Ingredients
 Whitening toothpastes are usually
made of two ingredients:
 Abrasives for polishing
 Chemical additives for breaking down stains
 Optical additives providing whiteness
appearance optically.
Whitening toothpaste
ingredients
Tooth whitening agents
Abrasives
Hydrated silica
Calcium carbonate
Dicalcium phosphate dihydrate
Calcium pyrophosphate
Alumina
Perlite
Sodium bicarbonate
Chemical
Hydrogen peroxide
Calcium peroxide
Sodium citrate
Sodium pyrophosphate
Sodium tripolyphosphate
Sodium hexametaphosphate
Papain
Optical
Blue covarine
Abrasives Effectiveness
 Effectiveness of abrasives depends on
properties of their constituent particles such
as:
 Hardness
 Shape
 Size
 Size distribution
 Concentration
 Optimized to reduce hard tissue wear while
increasing the level and speed of whitening
Chemical Agents: Peroxides
Difficult to achieve effectiveness
due to short exposure time.
However, still see improvements
with peroxide formulations
1% hydrogen peroxide/sodium
bicarbonate
0.5% calcium peroxide
Chemical Agents: Proteases
Proteases could be effective in
breaking down pellicle.
Recent successful formulation:
Papain (protease enzyme), aluminia,
and sodium citrate
Optical Methods
 Blue covarine deposits on the tooth.
 Creates a yellow to blue shift in tooth color and
increase general appreance of whitness.
 Combined with silica-based toothpastes can
affect both extrinsic and intrinsic tooth color.
 Since blue covarine product creates the optical
illusion of whitening it works almost immediately.
Conclusions
Whitening toothpastes are
effective, however, they require
some time to show their effect.
For example, when used twice a
day, it usually takes 2-4 weeks to
see the effect of whitening.
Excessive use might damage tooth
enamel.
Dentinal Hypersensitvity Research
According to the literature,
toothpastes containing
potassium citrate are
effective for reducing dentin
hypersensitivity in 85% of
cases.
Potassium compounds are
considered to prevent
triggering of the intradental
nerves by blocking their
action potentials.
OTC Hypersensitivity
Dentifrices
Vanessa M. Cook
Foothill College
Dental Hygiene
How dentifrices combat
hypersensitivity
 Over the counter dentifrices:
 Are self applied for mild to moderate
sensitivity.
 Must be applied regularly for
therapeutic effects.
 Tubule Occlusion.
 Nerve Hyperpolarization
 Rx dentifrices:
 Fluoride Varnish w/ 5% Sodium Fluoride
What Causes Hypersensitivity?
 Inadequate smear layer.
 Increased number of dentinal
tubules.
 Exposed dentin.
 Enamel loss.
 Gingival recession.
 Hydrodynamic Theory:
Sensations are transmitted to the
nerves in the pulp via fluid in
tubules.
Nerve Hyperpolarization
 Nerves are bombarded with
Potassium ions making nerve less
sensitive to future stimulus.
Active ingredient:
• Potassium Nitrate
• Potassium Chloride
Varieties available:
Aquafresh Sensitive Maximum Strength
Colgate Sensitive Fresh
Sensodyne
Tubule Occlusion
 Reduces the radius of dentinal
tubules:
 Active Ingredients
 Stannous Fluoride
 Calcium Phosphate compounds.
 Silica
 Use of Polymethyl vinyl ether maleic acid
as a adhesive
 Saliva testing and acid challenge
testing.
 Importance of particle size in tubule
occlusion
Triclosan In
Dentifrice:
Does It Deserve
Our Professional
Recommendation?
2,4,4’-trichloro-2’-hydroxydiphenyl Ether
(Triclosan)
Some Interesting Facts
That We Should Know
As Hygienists:
 Mostly antibacterial properties, some antifungal and antiviral
 Used for over 30 years, originally confined to health care settings in
surgical scrubs in 1972.
 Marketed under the trade name Microban® when used in
plastics/clothing.
 Used to kill bacteria on skin and other surfaces
 Found in soaps, cosmetics, deodorants, and office products.
Glaser, Aviva. The ubiquitous triclosan, a common antibacterial agent exposed. Pesticides and You; Beyond Pesticides/Natiional
Coalition Against the Misuse of Pesticides, Vol. 24 No. 3, 2004. Web Aritcle.
Mechanism of Action:
 Blocks the active site on bacteria
necessary for building cell membranes and
reproducing.
 Works for up to 12 hours
 Last year, Colgate-Palmolive announced it
will remove triclosan from its product line of
dish/hand soaps.
 Colgate Total brand dentifrice not
included in this plan.
Author not listed. Johnson & Johnson to phase out triclosan, regulators remain unresponsive. Washington (DC): Beyond
Pesticides/National Coalition Against the Misuse of Pesticides. 17 August, 2012. Source: CBS News. Available from:
www.beyondpesticides.org/dailynewsblog
Effects of Triclosan On Human
Health:

As of August 2012, evidence on safe exposure levels unclear.

Studies show impaired muscle function in fish/mice

Shown to be an endocrine disruptor; affects male/female reproductive hormones and
possible fetal development. Possible links to breast cancer.

Alters thyroid function

Evidence of contamination of waterways, present in fish, umbilical cord blood, and
human milk.

Present in urine of 75% of U.S. population

FDA has expressed concern over antibiotic resistance

CDC states unknown health effects at this time

EPA accelerating review to 2013, ten years ahead of schedule
What Are the Benefits of Triclosan in
Dentifrice?
 Effective in the reduction of gingivitis and
stabilization of periodontal disease.
 Non-ionic properties, blends well in dentifrice
 Colgate Total introduced in 1990’s, 0.3% triclosan
 Approved by FDA, endorsed by ADA
 Provides effective level of plaque control
How About Some Statistics?
Many studies have been done on the effects
of triclosan in dentifrice. I chose a few to
review and the results are as follows:
 6 month clinical studies showed up to 58.9%
reduction in plaque scores, and up to 41.9%
reduction in gingivitis.
 Slower plaque re-growth
 Provided a reduction in clinical attachment loss of
50% when compared with a control dentifrice.
 Reduced the likelihood of gingivitis progressing to
periodontitis
 Reduction in oral malodor
 Significant reduction in the number of bleeding
sites
 Slows progression of periodontal disease
 Inhibitor of lab grown bacteria and harvested
plaque
QUIZ TIME!!!
What does PVM/MA do?
A: Acts as a “glue” to help occlude dentinal tubules
QUIZ TIME!!!
What is considered the safest level of exposure
to Triclosan in humans?
A: Evidence at this time is unclear as to what
is safe.
Ouiz Time!!!!
What chemical additive gives the
illusion of instant whiteness to teeth?
A: Blue Covarine. It creates a yellow to blue
shift in tooth color making the tooth appear
white.
FIN