SUPERVISED SELF-STUDY COURSES FROM BENCO DENTAL Toothpaste Ingredients ® Make a Difference: PATIENT- SPECIFIC RECOMMENDATIONS ACCEPTED NATIONAL PROGRAM PROVIDER FAGD/MAGD CREDIT 2 CONTINUING EDUCATION CREDITS Howard E. Strassler, D.M.D., F.A.D.M., F.A.G.D. These courses have been designed specifically Professor and Director of Operative Dentistry to meet the needs of busy professionals like Department of Endodontics, Prosthodontics and Operative Dentistry yourself, who demand efficiency, convenience University of Maryland Dental School and value. Begin your Benco educational ex- 666 West Baltimore Street, Baltimore, Maryland 21201 perience with this course today and watch the Phone: 410-706-7047 Fax: 410-486-2363 mail for live CE events in your area. e-mail: [email protected] COURSE OBJECTIVES Benco Dental, Attn: Education Department, 295 At the completion of this program the participant: CenterPoint Boulevard, Pittston, PA 18640. WHY TAKE will be able to: THIS COURSE? • List and describe ingredients in toothpastes PARTICIPANT COMMENTS Abrasives in toothpastes • List the different broad categories of toothpastes Any participant wishing to contact the author can have an efficacious • Compare abrasives in toothpastes with feedback regarding this course may do so role in the treatment of gin- • List the therapeutic agents in toothpastes givitis and caries preven- through the course director: Dr. Rick Adelstein, tion. It is the responsibility • Understand recommendations for toothpastes 3401 Richmond Rd., Suite 210, Beachwood, OH of the oral care professional need to be patient specific 44122. Fax: (216) 595-9300. Phone: (216) 591- to understand the ingre- 1161. email: [email protected] dients in toothpastes and COURSE SPONSOR direct patients to different Benco Dental is the course sponsor. Benco’s ADA/ RECORD KEEPING products based upon their CERP recognition runs from November 2009 individual needs. To obtain a report detailing your continuing educa- through December 2013. Please direct all course tion credits, mail your written request to: Dr. Rick PATIENT CARE—Under- questions to the director: Dr. Rick Adelstein, 3401 Adelstein, 3401 Richmond Rd., Suite 210, Beach- Richmond Rd., Suite 210, Beachwood, OH 44122. stand recommendations wood, OH 44122. Fax: (216) 595-9300. Phone: for toothpastes need to be Fax: (216) 595-9300. Phone: (216) 591-1161. (216) 591-1161. email: [email protected] email: [email protected] patient specific. CONVENIENCE—Contin- SCORING & CREDITS IMPORTANT INFORMATION ue your education without Upon completion of the course, each participant Any and all statements regarding the efficacy or value of products or companies mentioned traveling, taking time away scoring 80% or better (correctly answering 16 from work and family, or of the 20 questions) will receive a certificate of in the course text are strictly the opinion of the paying high tuition, regis- completion verifying two Continuing Dental authors and do not necessarily reflect those of tration, and material costs. Education Units. The formal continuing educa- Benco Dental. This course is not intended to be CUT ALONG DOTTED LINE CUT ALONG tion program of this sponsor is accepted by the a single, comprehensive source of information CE CREDITS—Successful AGD for FAGD/MAGD credit. Term of accep- on the given topic. Rather, it is designed to be completion of this course tance: November 2009 through December 2013. taken as part of a wide-ranging combination of earns you 2 Continuing Dental Education Units. Continuing education credits issued for partici- courses and clinical experience with the objec- pation in this CE activity may not apply toward tive being to develop broad-based knowledge of, and expertise in, the subject matter. HIGH QUALITY— license renewal in all states. It is the responsibil- Authored for dental profes- ity of participants to verify the requirements of sionals, by dental profes- their licensing boards. COURSE ASSESSMENT sionals, Dental U® continu- Your feedback is important to us. Please com- ing education courses are COURSE FEE/REFUNDS plete the brief Course Evaluation survey at the engaging, concise, and The fee for this course is $54.00. If you are not com- end of your booklet. Your response will help us user-friendly. pletely satisfied with this course, you may obtain a to better understand your needs so we can tailor full refund by contacting Benco Dental in writing: future courses accordingly. WHO SHOULD TAKE THIS COURSE? Dentists, Dental Assistants, and Dental Hygienists. incisal edge 101 Toothpaste Ingredients Make a Difference: Patient specific recommendations ABSTRACT to make the therapeutic claim of anticaries. In recent Toothpastes contain active ingredients or additives that years there has been an increased interest by patients perform specific functions. These additives are abra- and dental professionals on tooth whitening and tooth sives, fluorides, desensitizing agents, antiplaque agents, stain removal with different chemical additives and and antitartar ingredients. Toothpastes also contain de- abrasives being mixed into toothpaste formulas. The tergents, humectants, thickeners, preservatives, flavor- therapeutic claim by toothpastes that have fluoride to ing agents, sweeteners, and coloring agents. This article help prevent dental caries is well proven and accepted. will review the common ingredients in toothpastes and the role abrasives play in plaque and stain removal. Also, In many cases, toothpastes that contain fluorides will abrasives in toothpastes can have an efficacious role in have the American Dental Association seal of accep- the treatment of gingivitis and caries prevention. It is tance. “Accepted” is the designation for toothpastes the responsibility of the oral care professional to under- by the ADA that the product fulfills the claims that stand the ingredients in toothpastes and direct patients are being made on the product packaging based upon to different products based upon their individual needs. evidence that has been presented. Usually the seal is awarded for preventing tooth decay, having antitar- TOOTHPASTE INGREDIENTS MAKE A tar effects preventing gingivitis, desensitizing teeth or DIFFERENCE- THE ROLE OF ABRASIVES tooth whitening. The “Accepted” seal is for oral care IN TOOTHPASTES products while for oral care devices the ADA seal Among the many oral care products that are available would be “Acceptable.” to patients, the most often used are toothbrushes and TOOTHPASTE INGREDIENTS toothpastes. In a 2003 Lemelson-Masschusetts Insti- DOTTED LINE CUT ALONG tute of Technology study of what products can you Toothpastes contain active ingredients or additives that not live without, the toothbrush beat out the personal perform specific functions. These additives are abrasives, computer, automobile, microwave oven and cell phone. fluorides, desensitizing agents, antiplaque agents, and In fact, 34% of teenagers and 42% of adults cited the antitartar ingredients.(1) Toothpastes also contain deter- toothbrush. The corollary to this survey is that tooth- gents, humectants, thickeners, preservatives, flavoring pastes are used with toothbrushes. Most people brush agents, sweeteners, and coloring agents.(2-5) their teeth at least once a day. • Abrasives perform the primary functions of remov- All toothpastes (dentifrices) contain an abrasive in the ing plaque and stain from teeth. (3,4) paste or gel to keep teeth clean. A toothpaste needs only • Common fluorides in toothpastes include stannous an abrasive and a foaming agent to keep teeth clean of fluoride, sodium monophosphate fluoride and sodi- bacterial plaque and a fluoride to help prevent dental um fluoride. Fluoride’s primary action is to be incor- caries. However, there are many other ingredients that porated into the tooth substrate (enamel and dentin) can be added to a toothpaste that are specific to tasks making the tooth more resistant to acid attack by that toothpastes can accomplish. Depending on how cariogenic bacteria. Fluoride is also bactericidal and you define toothpastes, there are currently as many as has additional antiplaque effects. (6-8) 9 to 12 separate categories from which a patient can • Desensitizing agents are active ingredients, usually select. Many of the categories overlap—desensitizing potassium nitrate, in toothpaste that reduce dentin toothpastes with whitening or gingivitis toothpastes hypersensitivity through a depolarizing effect on the with caries protection or baking soda toothpastes with odontoblastic processes in the dentinal tubules. The peroxide for gum care. nerve endings of the odontoblastic processes then re- polarize and have a reduced pain sensing ability. (9-11) Advertising and packaging claims made by toothpastes Also, desensitizing effects of arginine bicarbonate/ are based upon their ingredients. When a therapeutic calcium carbonate complex and stabilized stannous claim is made by a toothpaste, e.g., reducing caries, fluoride have been demonstrated to provide a dentin desensitizing teeth or for the treatment of gingivitis, it desensitizing effect.(12,13) must be substantiated using controlled research studies • Antiplaque agents reduce plaque growth. This can that are submitted to the FDA to make this claim. There have a positive effect in reducing plaque growth on is an FDA monograph that specifies the types and per- teeth, reducing gingivitis, and potentially reducing centage of fluoride that must be present in a toothpaste caries.(14) Some antiplaque agents include triclosan, 102 incisal