This document discusses common oral health problems and their causes and treatments. It covers dental plaque, calculus, gingivitis, periodontitis, dental caries, hypersensitivity, staining, malodor, dry mouth, ulcers, and types of oral preparations like toothpastes and mouthwashes. Dental plaque builds up and leads to calculus formation, which can cause gum disease. Tooth decay occurs when acids from plaque dissolve tooth enamel. Periodontitis is a serious gum infection causing bone loss. Various formulations are provided as examples to address issues like cavities, plaque, sensitivity, and breath freshening.

1. PROBLEMS ASSOCIATE WITH
ORAL CAVITY

2. Content:-
 Introduction
 Dental plaque
 Dental calculus
 Peridontal disease
 Dental caries
 Dental hypersensitivity
 Dental staining
 Oral malodor
 Dry mouth
 Aphathous ulcer
 Type of oral preparation
 Reference

3. Introduction
The major oral problem associate that concern consumer can be
broadly categories as medical or cosmetics or both.
Medical concern for oral health includes dental decay, gum disease,
dental hypersensitivity, and dry mouth.
Cosmetic concern includes dental staining, oral malodor, and dental
calculus.

4. 1. Dental plaque:-
 Dental plaque is not a actually problem, as it is ubiquitous in
individual exibiting both dental health and dental disease.
The microorganism in dental plaque play a major role in causation of
dental decay and gum disease.
Gram –ve bacteria present in dental plaque produce a toxic substance
(metabolites) such as sulfur compound, short chain fatty acid, or
bacterial toxins.
This substance damage and irritate
gum tissue leads to pathogenic
chance in the gum tissue.

5. 2. Dental calculus:-
Calculus is a form of hardened dental plaque.
It is caused by precipitation of mineral from saliva and gingival
crevicular fluid in plaque on the teeth.
The commonly accepted theory is that calculus irritates the gingival
tissue and encourages the formation of pockets between tooth and
gingivae, in which food debris and bacteria may lodge.
Mechanical treatment i.e. Brushing and flossing can be very effective
in removing calculus formation by removing plaque matrix required to
initiate calculus calcification.

6. 3. Peridontal disease
Teeth are attached to the basal bones of the jaw through the peridontal
tissue and are surrounded by gingival tissue.
The gingival and peridontal tissue are susceptible to a variety of
inflammatory disease, which are generally classified as periodontal
disease.
A. Gingivitis:-
It is a reversible inflammation of the gums that is not accompanied by
irreversible destruction of the periodontal support tissue.
Gingivitis is associated with increased dental plaque accumulation and
high population of Gram – ve bacteria in the plaque and characterized by
inflamed and bleeding gums.
Chlorhexidine, by preventing the growth of microorganism, are use to
prevent gingivitis.

7. B. Periodontitis
Periodontitis is a more serious form of peridontal disease.
characterised by severe inflammation, increase pockets depth, and
irreversible loss of avleolar bone supporting teeth.
Etiology:-
Peridontitis are result from interaction between pathogenic
microorganism and patient specific and non specific inflammatory
defense mechanism.
Pathogenic species such as porphyromonas gingivalis and
bacteroides forsythus.

8. 4. Dental caries (tooth decay)
Dental caries, commonly known as tooth decay.
Dental caries are widely distributed and is associated with consumption
of foods containing sugars and refined starches.
Mostly occure in children
Dental decay occure as a result of demineralization by acid produce
during carbohydrate fermentation especialy sugars, causing a pH level
drop to level ranging from about 5.5 to under 4.5. below the critical pH
for enamel demineralization.
Consumption of carbohydrate always result in production of plaque
acid but not a tooth decay due to neutralization of acid by saliva.

9. Stages of dental caries
Stage 1:- Spot
Stage 2 :-Enamel deterioration
Stage 3:-Dentin decay
Stage 4:-Abscess formation
Control of caries
Reduction of fermentable carbohydrate intake and removal of
fermentable debris from mouth.
Rinsing and brushing of the teeth.
Reduction in bacterial activity and plaque pathogenicity.
Decrease the susceptibility of tooth to acid attack.
Remineralization.

10. 5. Dental hypersensitivity
Dental hypersensitivity, in which variety of stimuli (eg. Heat or cold,
pressure or high sugar food) can trigger discomfort ranging from a mild
to severe pain.
It is more severe forms this condition can be debilitating, affecting the
dietary and oral hygiene habits of the patients.
Common cause of sensitive teeth

11. Hydrodynamic theory for dental hypersensitivity:-
Exposed dentinal tubules provide a channel from outer surface of tooth
to nerve in the pulp.
Physical and chemical stimuli affect the pressure on fluid within
the dental tubule.
These changes in hydrodynamic pressure are transmitted to the pulp
nerve and interpreted as pain signal.
Dentifrices containing agents that promote blockage of open dentinal
tubule. (eg. Strontium chloride or stannous fluoride) OR
Reduce the sensitivity of pulp nerve by depolarizing the nerve
membrane. (eg. Potassium nitrate, potassium chloride, potassium citrate
How to treat:-

12. 6. Dental staining
This is not contributed as a dental disease and commonly known as
discoloration of teeth.
Dental strain can be categorized as
1) Intrinsic discoloration :- Exist within the tooth structure itself.
Discoloration are laid down during tooth formation, thinning of tooth
enamel or loss of tooth vitality.
2) Extrinsic discoloration:- Result from deposition of exogenous colored
material (chromogen) eg. Pigment from tea coffee or tobacco. To the
tooth surface.
Bleaching and abrasive system are helpful to remove stain from teeth
surface.

13. 7. Oral malodor
The oral malodor ( bad breath or halitosis) are another major oral
health problem.
Oral malodor are classified into intrinsic and extrinsic.
1. Intrinsic:-
 Most commonly caused by bacteria in the oral cavity.
 Malodor substance produced by anaerobic bacteria are volatile
sulfur compound, vol. organic acid.
 Variety of systemic disease or disorder that result in the exalation
of malodorous substance in lungs.
2. Extrinsic:-
Extrinsic oral malodor originates from the ingestion of substance
such as garlic, cheese, tobacco etc..
.

14. The duration of extrinsic oral malodor is proportional to the amount
and frequency of ingestion of the offering substance and the amount of
time required to “wash out” the malodorous substance.
Treatment
Mechanical means of removing oral malodor include rinsing the mouth
and brushing or scraping the teeth and tongue.
Numerous products are employed to cover up bad breath; this include a
variety of cosmetic mouthrinses, toothpaste, mints, chewing gum, and
breath spray.

15. 8. Dry mouth
Reduced saliva flow leading to dry mouth. It is also called as
xerostomia.
This can be originated from no. of sources including systemic disease,
destruction of salivary gland tissue by radiation or chemotherapeutic
cancer treatment and medicinal drug use.(antidepressant,
antihypertensive and antihistaminic)
If Xerostomia is severe loss of ability to taste, discomfort due to
pronounced, sense of dryness, and irritation of oral soft tissue.
Management of patient with dry mouth generally involves first
reducing their susceptibility to oral disease.

16. 9. Aphthous ulcer (canker sores)
Canker sore most commonly arise on the tongue and buccal mucosa.
Various bacteria, virus and autoimmune factor cause ulcer.
Canker sore are characterised by shallow crater – like lesions
approximately 2-10 mm in diameter with sunken, grayish centre and
slightly raised borders.
this commonly includes daily use of fluoride mouthrinses or gel and
use of antifungal drugs when necessary.
The artificial saliva are also available to increase patient comfort by
reducing the sensation of oral dryness which contain humectant, and
lubricant as well as buffer to increase moistness.

17. Treatments:-
Several anaesthetic such as benzocain or lidocain reduce the
discomfort.
Diphenhydramine and corticosteroids to reduce inflammatory
response.

20. Type of oral preparation:-
1. Dentifrices
A)Tooth powder
B)Tooth paste
2. Mouth wash
3. Tooth paste
1 dentifrices:-
Dentifrices are preparation intended for use with a toothbrush for the
purpose of cleaning the accessible surface of the teeth.
 In addition to enhancing personal appearance by maintain cleaner
teeth, brushing with a dentifrice, reduce the incidence of tooth decay,
help maintain healthy gingivae, and reduces the intensity of mouth odors.

21. Tooth paste:-
Minimum requirements for a dentifrices, are
When use with tooth brush it should adequetly clean teeth of food
debris, plaque and stain.
It should leave a sensation of cleanliness & freshness in mouth.
Should be stable.
Economical.
Formulation
1) Abrasive :-
 Use to remove food debris and residual stain of the teeth and polish
the teeth surface.
 Eg. Precipitated calcium carbonate, tricalcium phosphate, diabasic
calcium phosphate dihydrate.

22. 2) Detergent and other foaming agents:-
 This material use to cleansing the teeth surface by lowering the
surface tension thereby promote penetration of paste and help in
removal of deposite and debris.
 Eg. Sodium lauryl sulphate, sodium lauryl sulphoacetate
3) Humectants:-
 Humectants in tooth paste are use to prevent their drying out. They
also impart some plasticity to toothpaste.
 Eg. Glycerin, propylene glycol, sorbitol.
4) Binding agent:-
 This agents promote the binding of solid and liquid phase. All binding
agents are hydrophilic colloids. Binding agent swell and absorb water
to form viscous liquid phase.
 Eg. gum tragacanth, gum arabic, carboxymethyl cellulose.

23. .
5) Miscellaneous agents:-
 This includes preservatives, astringent, antibacterial agents,
sweeteners, flavor.
 Mostly used preservatives:- propyl parahydroxy benzoate, methyl
parahydroxy benzoate.
Astringent:- Zinc chloride
6) Corrosion inhibitors:- Sodium silicate.
7) Colorants:- Titanium dioxide.
8) Bleaches :-
 To inhance whitening effect of toothpaste. and to assist in the removal
of stains, oxidizing agents have been added to toothpaste.
 Eg. Hydrogen peroxide, urea peroxide.

24. 9) Anticaries actives:-
Sodium fluoride, sodium monofluorophosphate, and stannous fluorides
are most commonly used anticaries agents.
10) Anticalculus agents:-
Zinc chloride and zinc citrate are use as anticalculus agents. it also
posess antiplaque activity.
11) Desensitizing agents:-
Potassium nitrate(5%) use as a new desensitizing agents.
12) Antimicrobial / antiplaque / antigingivities agents:-
Triclosan is most widely use for this purpose.

25. Sr no. Ingredients Quantity given (% by
wt)
1 Glycerin 22.0
2 CMC 1.1
3 Na4p2o7 0.2
4 MFP 0.5
5 NaF 0.76
6 Dicalcium Phosphate 48.0
7 SLS 1.5
8 Flavour 0.8
9 Water To 100
Examples of anticaries toothpaste

26. Sr no. Ingredients Quantity % by
wt
1 Sorbitol (70%) 45.5
2 Silica Abrasive 10.0
3 Silica Thickner 8.0
4 SLS 2.4
5 CMC 0.8
6 Zinc Citrate Trihydrate 1.0
7 Triclosan 0.3
8 Flavour 1.2
9 Sodium Chloride 1.0
10 Na MFP 1.12
11 Sodium saccharin 0.3
12 water To 100
Toothpaste for the control of plaque and gingivitis

27. Sr no. Ingredients Quantity taken% by wt
1 Potassium Nitrate 10.0
2 Glycerin 25.0
3 HEC 1.6
4 Polyoxyethylene
Sorbitan
2.0
5 Monolaurate Silica 24.0
Toothpastes for sensitivity

28. Mouthwashes:-
Mouthwashes are generally liquid dentifrices and can formulated in
concentrated form.
Mouthwashes have been defined as pleasant testing solution
(containing germicide) that are use for freshening the mouth.
Types of mouthwashes
1.Antibacterial mouthwashes.
2.Fluoride, which help strengthen the enamel of teeth.
3. Cosmetic which freshen the breath.
4. Prebrushing rinses, which loosen plaque to render it easier to remove
with a toothbrush and toothpaste.

29. Mouthwashes perform three functions
Rinsing of food debris from the mouth.
Reduction in total bacterial count in mouth.
Imparting flavour to mouth cavity and thereby imparting flavour to
breath.
Deodorizing effect can be achieved by one or more of the
following ways
Mechanical removal of fermentative and putrefactive debris between
teeth and other tissue.
Inhibition of bacterial and enzymatic activity in mouth.
Chemical reaction between the chemical substance used and odorous
substance in mouth.
Masking the unpleasant odors with pleasant odors.

30. Formulation
1. Solvent:-
Water and alcohol are most widely use as a solvent. Alcohol helps
to deliver the freshness to mouth and also improve the solublization
and emulsification of flavour. alcohol also help to stabilize the product
against the microbial growth.
2. Flavour:-
To mask the malodor, flavour are use.eg. Spearmint, peppermint,
wintergreens.
3. The phenolics:-
The phenolics include thymol, eucalyptol, methyl salicylate. This
agents are use to kill the germs that cause bad breath, plaque, gum
infection like gingivitis.

31. 4. Humectants:-
 These are added to solublization of flavours, to modify mouth feel, to
add sweetness, and to increase the osmotic pressure of mouthwashes
to decrease the risk of microbial growth.
 Eg. Glyceline, sorbitol, hydrogenated starch hydrolysate.
5. Solublizers/ emulsifyers:-
 In order to obtain clear end product, solublizer or emulsifyer are
added to mouthwashes.
 Emulsifyer includes, polysorbate 20, polysorbate 80, PEG-40.
solublizer includes, sodium lauryl sulfate, sodium lauryl sulfoacetate.
6. Antimicrobials:- It kill the germs to decrease bad breath, plaque and
gingivitis.

32. 7. Buffers :-
 Buffers are used in some product to maintain the pH within a narrow
range to help stabilize or to improve the efficacy of certain products.
 Eg. Benzoic acid, sodium benzoate, sodium phosphate, disodium
phosphate.

33. Sr.no Ingredients Quantity given (% by
wt)
1 Alcohol 5.0
2 Glycerin 7.5
3 Sorbitol (75%) 7.5
4 Plutonic F-127 1.0
5 Pluronic F-108 1.0
6 Na Saccharin 0.02
7 NaF 0.05
8 Flavour 0.08
9 Colour qs.
10 Water To 100
Anti-cavity mouthrinses

34. Sr no. Ingredient Quantity given
% by wt
1 Ethanol 12.5
2 Glycerin 10.0
3 PVM/MA
Copolymer
0.2
4 PEG 5.0
5 SLS 0.2
6 Flavour 0.4
7 Triclosan 0.03
8 Sodium
Sachharin
0.2
9 Colour, fluoride,
water
To 100
Plaque and gingivitis mouthrinses