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Mechanical & Chemical Plaque
Removal: Understanding the
Different Efficacies for Patient Education
Ohio Dental Hygienists Association
Total Development Weekend
May 31, 2019
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Dr. Cyndee StegemanEdD, RDH, RD, CDE, FAND
Procter & GambleCrest + Oral BScientific Relations Managerstegeman.ca@pg.com
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Evolution of Toothpaste – Fluoride Systems
Caries (fluoride)
Multi-Benefit
Caries + AntibacterialCaries + CosmeticCaries + Sensitivity
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Focus: Gingival Health
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Why toothpaste matters…
❖ Manual brushing removes 42% of plaque biofilm
❖ Average brushing is 46 seconds
❖ Only 10% of patients adhere to correct brushing methods.
❖ Toothpaste with SnF offers comprehensive benefits
J of Clinical Dentistry, 2017
5
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Therapeutic DentifricesMonographs regulate OTC dentifrices
Monograph Active Ingredients Mode of Action Examples
Sodium Fluoride
Monofluorophosphate
Stannous Fluoride
Sub-surfaceRemineralization
Aquafresh Extreme Clean
Colgate Cavity Protection
Crest Gum Detoxify
Anti-plaque
Anti-gingivitis
Triclosan
Stannous Fluoride
Bactericidal
Bacteriostatic
Colgate Total
Crest Gum Detoxify
Dentinal
Hypersensitivity
Strontium Chloride
Potassium Nitrate
Stannous Fluoride
Occludes Tubules
Numbs the Nerve
Original Sensodyne
Sensodyne
Crest Gum Detoxify
US Federal Food, Drug, & Cosmetic Act. Accessed 1/4/2019, US FDA Monograph System. Accessed 1/4/2019, US Food & Drug Administration
Anti-caries
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❖ Phone Calls
❖ Text Messages
❖ Take Pictures & Video
❖ Surf the Internet
❖ Store/Listen to Music & Movies
❖ GPS
❖ Flashlight
❖ Caries Control
❖ Anti-Gingivitis
❖ Sensitivity Relief
❖ Plaque Control
❖ Calculus Control
❖ Whitening
❖ Fresh Breath
❖ Protection Against Acid Erosion
Stannous FluorideSmart Phone
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What makes Stannous different?
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Actions
⎢ Kills and slows bacteria
⎢ Helps occlude dentin
⎢ Blocks harmful toxins
Benefits Net Effect
Anti-Cavity
Anti-Erosion
Anti-Sensitivity
Anti-Gingivitis
⎢ Slows acid damage
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Targeting the Microbe/Host Interaction
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Stain Mitigating Factors
Zinc Citrate, SilicaAlso inhibits the formation of calculus and plaque
Hydrogen Peroxide
Bleaches surface stains
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In VITRO DATA COMPARING TO SENSODYNE STANNOUS
FLUORIDE TOOTHPASTE DEMONSTRATED THAT CREST
STABILIZED STANNOUS FLUORIDE TOOTH PASTE DELIVERS:
* With twice daily brushing † P&G calculation based on Nielsen US reported sales for year ending w/o 8/10/2013 ‡ Colgate® Cavity Protection toothpaste †† Crest® PRO-HEALTH™ toothpaste
¶ Sensodyne® Repair & Protect toothpaste ** Zsiska M, White DJ. Dentinal tubule occlusion with stannous fluoride dentifr ices. J Dent Res 2014; 93 (Spec Iss A): Abstract 579.
▪ Greater deposition
▪ Greater tubule protection after a mechanical and acid resistance challenge
Crest Stabilized Stannous Fluoride toothpaste demonstrated
better tubule occlusion efficiency and durability
Control‡
After treatment
After Mechanical
Challenge
After Acid
Challenge
Crest® stabilized
stannous fluoride‡‡
Sensodyne
stannous Fluoride¶
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Crest Gum and Sensitivity
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Titanium Implants
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Mucositis Two weeks of good oral hygiene
Source: Dr. Amit Patel BDS MSc MclinDent RCSEng, UK
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Proper formulation is critical to deliver all the benefits of stannous fluoride
Stabilize Sn+2
Mitigate the stain of bioavailable Sn+2
Make Sn+2
bioavailable
Make the Sn+2
And stain mitigatorcompatible for long-term
stability
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Stannous Fluoride
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Extremely complex chemistry: SnF2
• It’s not on Wikipedia
SnF2→ Sn+2 and F-…just like NaCl →Na+ and Cl-
Right?
WRONG!!!
Sn+2
F-
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SnF2 forms complexes with all ionic and polar species in the formulation
SnF+
SnF3-
SnO(OH)2 SnO2
Sn:Silica
Sn[Polyphosphates]Zn+2
Sn+2
Sn[Glconate]
Sn[Gluconate][polyphosphate]
SnF[Gluconate]
N!
F-SnF3
+SnF2
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Stannous Fluoride
• Binds to toxins (e.g., lipopolysaccharides)
• Blocks endotoxins’ reactivity with toll-like receptors
• Blunts inflammatory destruction to reduce/prevent gingivitis
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Manual Toothbrushes
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CrissCross Bristles
Oral-B – The only brush with Cross Action bristles angled at 16° to actively penetrate deep between teeth
Removes up to 99% of plaque in hard-to reach areas
CrissCross bristlesAngled bristles
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Professionally inspired small, round designed, to follow tooth anatomy
and morphology
Oscillating-Rotating-Pulsating Technology“Round for a Reason”
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Power Brushes
Oscillating
move back and forth at a regular speed
Pulsating
a regular throbbing sensation
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Handle + 8 Brush Head Refillsfor Improved Patient-Based Solutions
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Whitening Strip with Light Technology
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dentalcare.com structure – Professional Education
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