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Friday, June 30, 2000

Periodontics MCQ Answer 01 and 02

Friday, June 30, 2000

Answers: (b)

Anti-Tartar Products: One of the first products to venture beyond fluoride was tartar control toothpaste. The major anti-calculus strategy developed by researchers in the 1970s was to inhibit crystal growth, thus preventing the mineralization of developing plaque and the transition of the plaque into calculus. The most effective agents in vitro were the pyrophosphates, but in the oral cavity these were rapidly broken down by bacterial and salivary pyrophosphatase enzymes. In the 1980s, formulations were created using high concentrations of pyrophosphates (and other polyphosphate salts) that could be combined with sodium fluoride to both reduce tartar buildup (not preformed tartar) and retain anti-caries potency. The concentration of sodium fluoride was high enough to serve as an anti-enzyme and help inhibit the limiting pyrophosphatase enzymes in the mouth.

(Other anti-tartar formulations have not applied for nor received the ADA Seal. One such product, a toothpaste containing Citroxain -- a mixture of the enzyme papain, sodium citrate and alumina -- has some supporting published data and is marketed primarily as a whitening toothpaste.)

Mandel ID, Calculus update: Prevalence, pathogenicity and prevention. J Am Dent Assoc 126:573-80, 1995.

Tetrapotassium Pyrophosphate, Inhibits crystalline matrix

The addition of 1 percent of a copolymer of methoxy-ethylene and maleic acid (Gantrez, GAF Corp.) appears to improve the effectiveness of some anti-tartar products.

Schiff TG, Comparative clinical study of two anti-calculus dentifrices. Compend Cont Educ Dent (Suppl 8):S275-7, 1987.

The tartar control products that have received the ADA Seal have been shown in appropriately designed clinical studies to be effective decay preventives as well as to significantly reduce the formation of tartar above the gum line. A caveat is included on the label that such products have not been shown to have a therapeutic effect on periodontal disease. The anti-tartar ingredients are considered by both the ADA and FDA to be primarily cosmetic, not therapeutic. They do not affect the already hardened deposits.

Tartar control dentifrice containing 7.0% sodium hexametaphosphate (5% hexametaphosphate anion) Has been shown to demonstrate anti-tartar properties, but it is new, not approve and only one dentifrice lists it in it’s ingredients

A 0.5 percent zinc citrate combined with 0.2 percent triclosan – is an effective anti-bacterial agent;5 triclosan and the polymer Gantrez;7 and pyrophosphate and triclosan.8 The triclosan/Gantrez combination is part of a multibenefit product that has been approved by the ADA and FDA and is awaiting marketing in the United States.

Total brand toothpaste is essentially a sodium fluoride dentifrice containing the broad-spectrum antibacterial agent triclosan (0.3 percent) and the copolymer PVM/MA (polyvinyl methyl ether malic acid), also marketed under the trade name Gantrez (2 percent). Triclosan has been used in soaps and deodorants for more than 20 years. Its broad spectrum of activity encompasses a large range of oral bacteria, and it is compatible with other ingredients in oral products. The combination of triclosan and PVM/MA inhibits crystal growth and is effective as an antitartar agent, but not the most common.

Fairbrother KJ, Kowolik MJ et al, The comparative clinical efficacy of pyrophosphate/triclosan, copolymer/triclosan and zinc citrate triclosan dentifrices for the reduction of supragingival calculus formation. J Clin Dent 8 (Special Issue):62-6, 1997.

Common Active Ingredients: contains: Sodium Monofluorophosphate (0.14%), Zinc Citrate Trihydrate, Sodium Fluoride 0.243% (Anticavity Toothpaste)

Common Inactive Ingredients: , Tetrasodium Pyrophosphate, Sodium Lauroyl Sarcosinate, Flavor, Sodium Saccharin, Cellulose Gum, Sodium Lauryl Sulfate, Titanium Dioxide, FD&C Blue #1, FD&C Yellow #5 Sorbitol, Water, Hydrated Silica, Sodium Gluconate, Stannous Chloride, Flavor, Sodium Carrageenan, Hydroxyethylcellulose, Sodium Saccharin, Sodium Hydroxide, Glycerin, Sorbitol, Hydrated Silica, Sodium Bicarbonate, Propylene Glycol, Water, Pentasodium Triphosphate, Tetrapotassium Pyrophosphate, Sodium Hydroxide, Calcium Peroxide,FD&C Green #3

Pentasodium triphosphate acts as a preservative and an unproven remineralization aid.


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