DYNACARE TOOTHPASTE COMBINATION PRODUCT PASTE

Dosage

Children: Refer to specific product information or consult a healthcare professional for appropriate dosing guidance.

Adults: Refer to specific product information or consult a healthcare professional for appropriate dosing guidance.

Pregnancy

Consult healthcare provider before use, as safety during pregnancy is not well established.

Breast-feeding

Consult healthcare provider before use, as it is unclear if the drug is excreted in human milk.

Storage

Store in a cool, dry place away from direct sunlight, and keep out of reach of children.

Indications

• Dermatitis
• Eczema
• Psoriasis
• Wound care
• Skin infections
• Burns
• Irritation or inflammation of the skin

Dosage

Children: For paediatric use, apply a thin layer of paste to the affected area as needed, following guidance from a healthcare professional or as directed in pediatric dosing guidelines.

Adults: Apply a thin layer of paste to the affected area as needed, ensuring to follow the specific instructions provided with the formulation or as directed by a healthcare professional.

Mechanism of action

The mechanism of action of paste depends on its active ingredients. Generally, pastes provide a protective barrier, reduce moisture loss, and may deliver anti-inflammatory or antimicrobial agents to the skin. The combination of ingredients can enhance the therapeutic effect, leading to improved healing and symptom relief.

Pharmacodynamics

Pharmacodynamics of paste formulations involves the interaction of its components with skin receptors and the local environment. Active ingredients may exert anti-inflammatory, antimicrobial, or soothing effects. The occlusive nature of pastes can enhance drug absorption and prolong the action of therapeutic agents, leading to improved efficacy in treating skin conditions.

Pharmacokinetics

Pastes are primarily applied topically, and their absorption can vary based on the formulation, the condition of the skin, and the presence of occlusive agents. Systemic absorption is generally minimal, although it can occur, especially with certain active ingredients. The onset of action can vary, typically providing localized effects within a short period after application.

Pregnancy

Safety during pregnancy has not been established; consult a healthcare provider before use.

Breast-feeding

Consult a healthcare provider before use during breastfeeding, as safety is not well-established.

Storage

Store in a cool, dry place, away from direct sunlight and moisture.

Indications

• Prevention of dental caries
• Strengthening of tooth enamel
• Treatment of dental fluorosis

Dosage

Children: Refer to the BNF for Children. Generally, a rice-sized amount of fluoridated toothpaste is recommended for children under 3 years old, while a pea-sized amount is suggested for children aged 3 to 6 years.

Adults: Topical application as directed by a dentist or healthcare provider, usually in the form of varnishes, gels, or toothpaste containing sodium fluoride.

Mechanism of action

Sodium fluoride prevents dental caries through multiple mechanisms. It kills caries-causing bacteria like Streptococcus mutans by disrupting their metabolic activities that lead to lactic acid formation. Fluoride ions inhibit glycolytic and other enzymes in bacterial metabolism, alter cell membrane permeability, and reduce cytoplasmic pH. At low topical doses, it protects healthy tooth enamel from demineralization and aids in remineralizing previously demineralized teeth. At higher doses, fluoride forms a protective layer on enamel, releasing fluoride when pH drops due to bacterial activity, thus interfering with bacterial metabolism and promoting remineralization.

Pharmacodynamics

Sodium fluoride enhances tooth resilience against acid-induced demineralization while simultaneously preventing tooth decay caused by bacteria. However, excessive fluoride exposure during the mineralization phase in children aged 1-3 years can lead to dental fluorosis, characterized by enamel discoloration and pitting. The risk of fluorosis can be mitigated by limiting the amount of fluoridated toothpaste used in young children.

Pharmacokinetics

Sodium fluoride is rapidly absorbed through the oral mucosa and gastrointestinal tract. Once absorbed, it is distributed throughout the body, particularly in bones and teeth, where it becomes incorporated into hydroxyapatite crystals, enhancing their resistance to demineralization. The elimination of fluoride occurs primarily through renal excretion, and the half-life can vary based on the individual and the amount of fluoride consumed.

Adverse effects

• Dental fluorosis
• Gastrointestinal discomfort
• Hypersensitivity reactions

Precautions

• Use with caution in children under 6 years to prevent fluorosis.
• Supervise children during toothpaste use to avoid excess ingestion.

Pregnancy

Fluoride is generally considered safe during pregnancy, but excessive exposure should be avoided.

Breast-feeding

Fluoride is excreted in breast milk; consult a healthcare professional for advice on supplementation.

Storage

Store in a cool, dry place away from direct sunlight. Keep out of reach of children.

Formulations

• Toothpaste containing sodium fluoride
• Fluoride varnishes
• Fluoride gels

Mechanism of action

The prevention of dental caries by topical fluoride is achieved by various mechanisms. Sodium fluoride kills bacteria that cause caries, such a Streptococcus mutans and lactobacilli by interfering with their metabolic activities that result in the formation of lactic acid. Fluoride ions cause the inhibition of glycolytic and other enzymes involved in bacterial metabolism. It changes the permeability of cell membranes, lowering the pH in the cytoplasm of the cell, leading to a decrease in acidity, which is normally implicated in tooth decay. When administered at low topical doses, fluoride in both saliva and plaque and saliva prevent the demineralization of healthy tooth enamel while remineralizing teeth that have previously been demineralized. Sodium fluoride is absorbed by the surface of hydroxyapatite crystals on the teeth, which are necessary for mineralization. This renders the teeth more resistant to demineralization by changing the apatite crystal solubility. Sodium fluoride inhibits the demineralization of teeth in a pH-related manner. When used in high doses, in formulations such as the fluoride varnishes or gels, sodium fluoride forms a layer on the surface of tooth enamel. When the pH of the mouth is reduced due to acid production by bacteria such as S.mutans, fluoride is released, interfering with bacterial metabolism, and then acts to remineralize the teeth. Fluoride ion becomes incorporated into and stabilizes the apatite crystal of bone and teeth. Fluoride acts primarily to promote remineralization of decalcified enamel and may interfere with growth and development of dental plaque bacteria. Deposition of fluoride ion in the enamel surface of teeth increases resistance to acid and to development of caries. In fluorosis uncomplicated by systemic illness, fluoride ion appears to be deposited in place of hydroxyl ion in the hydroxyapatite of bone. There is little or no change in the calcium ... or phosphate ... content of the bone. A part of the fluorine deposited in bone is readily excreted after fluoride feeding is stopped, but another part is more firmly held. /Fluorosis/ Fluoride is very reactive and capable of inhibiting a number of enzymes, incl preglycolytic enzymes, phosphatases, and cholinesterase. The result is inhibition of cellular glucose phosphorylation (hence subsequent glycolysis) and respiration and incr sensitivity of cholinergic mechanisms to acethycholinesterase. Inhibition of one or more enzymes controlling cellular glycolysis (& perhaps resp) may result in a critical lesion. ... binding or precipitation of calcium as calcium fluoride ... suggested as mechanism underlying many diverse signs & symptoms in fluoride poisoning, particularly if death is delayed. ... at least in some species fluoride interferes with both contractile power of heart and the mechanism of beat in a way that cannot be ascribed to hypocalcemia. /Fluoride/

Pharmacodynamics

Sodium fluoride protects the teeth from acid demineralization while preventing tooth decay by bacteria while strengthening tooth enamel. It is important to note that excess fluoride exposure during tooth mineralization, especially in children 1-3 years old, may cause fluorosis. It is a condition manifested by white lines, pitting, or discoloration of teeth resulting from changes in tooth enamel. The risk of fluorosis can be decreased by the use of a rice-size amount of fluoridated toothpaste in children younger than 3 years old. It is recommended that no more than a pea-sized quantity of fluoridated toothpaste should be used for children from 3 to 6 years old. The American Dentistry Association (ADA) recommends that children should be closely supervised during toothpaste use to prevent excess fluoride ingestion.