Newton D Johnson BDS(Hons) FDSRCS
JANINA LIQUID TOOTHPASTE SPRAY
A Further Development of The Janina Opale Whitening Toothpaste a new and exciting aid to dental health
There has been considerable interest in the remarkable Janina Opale Whitening Toothpaste after its launch to the dental profession some months ago. There has been keen interest in the product from across the spectrum of people who have tried the product. I thought after the development of such a unique toothpaste John Mehmet, the enthusiastic inventor, could not surprise me further, but he has. The indefatigable John has now come along with a further development of the formula. He asked himself some simple questions such as: "How many people find the act of tooth brushing a problem?"
"Am I right in thinking that the majority of adults are concerned about bad breath?"
"How can we help those people who are ‘at high risk’ of dental diseases?"
The answers to such questions may be obvious, but has anything actually been done to address these issues in a simple, but effective way? The technique of truly effective tooth brushing and flossing is a complex one, involving a considerable amount of precision movements of the hand and fingers. People who are involved in dentistry and oral health education know only too well how difficult enough it is to clean our own dentitions! We deceive ourselves if we expect our average patient to acquire the dexterity and oral ‘awareness’ to manipulate the toothbrush bristles into every nook and cranny of the teeth and around the gingivae.
Breaking down the ‘simple’ act of brushing and flossing into what is mechanically required to carry out the procedure is quite staggering in its complexity. Occupational Therapists use what they call ‘Task Analysis’ to examine in depth the processes involved in carrying out human activities. One of the key areas they work are within the day-to- day procedures we all take for granted, such as washing, dressing, preparing food and so on. They call these the ‘activities of daily living’. If we were to interpose some sort of barrier or problem into these routine activities, such as a stroke, arthritis, blindness, multiple sclerosis, spinal injury and so on, these simple everyday tasks become an enormous difficulty. If we apply Task and Activity Analysis to effective oral hygiene measures such as brushing and flossing, we find the physical techniques required are sophisticated and complex, for the able as well as the disabled. It is little wonder that try as we might, the teaching of oral hygiene to our patients is often a thankless enterprise.
One of the great advances of the recent past is toothpaste containing fluoride, and in the very recent past, toothpaste with other active ingredients. So the mere act of placing some of this toothpaste in the mouth and working the paste around the mouth with the tongue would have a beneficial and therapeutic effect. Indeed, given the choice I would guess most of us would rather have access to a fluoridated toothpaste and no toothbrush than access to a brush and no paste; we have come to understand that the mere act off brushing off the plaque alone is far from the answer.
Mouthwashes and rinses have been around in various formulations for generations. Many have been claimed to work miracles. In recent years there has been a re-introduction of the oral rinse concept as an important supplement to oral health and there has been several products launched in recent years with expensive advertising across the media, not least the television, (remember being bombarded with the cry, "Still Working" in reference to a new anti-plaque rinse?" An effective oral rinse or some sort of topical application would be an excellent method of assisting conventional mouth care methods, in particular for those people at risk and for all those who find traditional brushing a problem. We know that the majority of mouthwashes, rinses and sprays are little more than breath fresheners, oral nosegays, strong in fragrance to mask the pong of bad breath! Few are actually therapeutic in action. Certainly, Chlorhexidine has shown over the years to be an effective agent in the war against plaque and remains a significant tool for us to call upon. The topical fluoride rinses are also important, especially in the high risk groups. We have seen the introduction of many other therapeutically active rinses hitting the market place in recent years, but all of these have a rather narrow band of activity, many do not taste too good and one at least produces staining of the teeth and restorations. The is also some evidence that several of the most popular rinses have a pH that causes the enamel to be under threat of dissolution. So, the Janina company has been up with a modification of its multi-active toothpaste and has developed an oral spray version of the Janina Opale Whitening Toothpaste that they have called the Janina Liquid Toothpaste Spray.
This spray contains all the goodies that are to be found in the toothpaste, i.e. twenty three ingredients, of which fourteen are classified as being ‘active’.
Most people are concerned about halitosis. It has been demonstrated that people with active periodontitis have an extremely high level of production of volatile sulphur compounds with the resulting foul smelling sulphides and mercaptans being generated. People with good periodontal health can also be affected by oral malodour - we are, most of us, victims of the ‘stale coffee breath’ during the working day and also the halitosis that can affect us when several hours have elapsed since we last had a meal. The excellent textbook, ‘Clinical and Biological Aspects of Denitrifies’ by Embury and Rolla, (Oxford Medical Publications), states that in general halitosis caused by local factors may be treated and relieved by:
(1) attacking the bacteria,
(2) by removing or blocking the substances that produce sulphur,
(3) by increasing salivary flow.
Nobody would argue that effective brushing with a modern toothpaste each day is going to go a long way towards safeguarding dental health and reducing the likelihood of halitosis, however, the supplemental use of an effective rinse or spray would go a considerable distance in enhancing the traditional brushing and flossing, especially for our most ‘at risk’ patients. The idea, it seems, is to have all the benefits of the multiple-active Janina Opale Whitening Toothpaste and be able to take a shot of this in a spray form, into the mouth three or four times a day and thereby dispersing a small dose of active ingredients with the benefits of a ‘depot’ action and stimulate the production of saliva.
Janina Liquid Toothpaste Spray has many agents which fight dental plaque and also contains 1,450 parts per million of sodium fluoride, which is claimed to be the optimum and best fluoride level for protection against dental caries. All of the studies agree that caries control for high risk individuals may be dramatically enhanced by products which can deliver fairly low levels of fluoride over frequent applications so that therapeutic levels can be maintained in the plaque and saliva for long enough periods of time to be effective. The use of Janina Liquid Toothpaste Spray will result in a ‘depot’ effect for many of its active ingredients.
The role of fluoride is easily understood, but what about the metal ions in relation to oral health, for example zinc? It is now recognised that zinc has the ability to inhibit plaque formation, inhibit the glycolytic sequence of oral anaerobic bacteria and to restrict the ability of plaque bacteria to convert urea to ammonia. The clinical benefit is, in general related to time of retention in the mouth and this is where the concept of using a spray formulation at frequent intervals should be effective. The combination of zinc ions and sodium lauryl sulphate has been found to have a synergistic role, i.e. the detergent action of the sodium lauryl sulphate exhibits certain antibacterial effects and in combination zinc in even more effective.
Triclosan has been demonstrated as an effective anti-plaque agent, and it is there in the spray in optimum concentrations.
Peroxyl complexes are able to deliver oxygen radicals that have a clear antibacterial effect against the Gram negative anaerobic organisms. The Janina Liquid Toothpaste Spray contain peroxyl compounds that have a profound anti-bacterial effect and are important in the oxidative consumption of the compounds that play a major part in the cause of oral malodour.
In addition to the anti-carious, anti-plaque and anti-halitosis effects of this spray the product also contains pyrophosphate, a substance known for its ability to inhibit calculus formation. Pyrophosphate has a high affinity for hydroxyapatite surfaces together with the ability to inhibit calcium phosphate crystal formation.
Pyrophosphate is known to be susceptible to enzymatic hydrolysis and therefore by the regular use of Janina Liquid Toothpaste Spray this could deliver small amounts of this at regular intervals of time.
Yet further uses for the spray could be as an anti-sensitivity agent. The product contains sodium citrate that can help to occlude open dentinal tubules and thereby reduce sensitivity.
It may be worth emphasising that the Janina Liquid Toothpaste Spray, just as its parent, paste, has a neutral pH of 7 and therefore, does not cause any erosion of dental tissues.
In general, the use of Janina Liquid Toothpaste Spray at frequent intervals would seem to offer our patients a significant advance in disease control as well as a method of protection against halitosis.
One could imagine prescribing such a spray for a significant number of patients, from ‘ everyday’ patients, to teenagers with uncontrolled caries, to patients who are at special risk, in particular those with a reduced salivary flow rate and the elderly or the patient with special needs. The spray might also be a major aid in plaque control for patients undergoing advanced restorative treatment and are having to cope with multiple temporary crowns and bridges, and perhaps those undergoing periodontal surgical therapy.
I understand that the next development would be the further modification of the formula and the container to allow the direct professional application of the medicament. This would allow the delivery of the agents exactly where they could exert the maximum therapeutic effects.
One could imagine the development of this excellent and unique product for site-specific application by trained personnel such as hygienists, hospital nurses, community nurses, carers of all descriptions, parents and so on. It could prove to be a major advance in the oral care for people with special needs.
There can be little doubt that the Janina Opale Whitening Toothpaste is an exciting advance. The production of an oral spray of exactly the same therapeutic components as the paste must be welcomed. We have to wait and see the results of the clinical trials currently underway to scientifically quantify the efficacy of these new products, but the anecdotal evidence, and the simple logic behind the rationale of the formula that has been developed in the production of the paste and the spray is difficult to criticise. The multi-national companies who produce all the household names of toothpaste’s have not attempted to offer a truly significant, multi-component agent that will produce an advance in oral health, even though they market their products under the banner headline names such as Total and Complete. I have to give credit to John Mehmet for having the courage and the ingenuity to do something that perhaps would otherwise have taken many years to come to the dental profession namely the development and production of a truly therapeutic, multi-component aid to oral health. There is nothing that can compare with excellent plaque removal, sensible use of sucrose and the hands-on advice of the dentist and his team for good oral health measures, but if we are honest, we in the front-line of dental care could do with all the help we can get and I am looking forward with interest to see how the Janina family of products impact on us in the months ahead.
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