oral delivery of proteins and peptides and carrier-based

Pharmaceutical sciences

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Development Team Principal Investigator

Dr. Vijaya KhaderFormer Dean, Acharya N G Ranga Agricultural University

Prof. Farhan J Ahmad Jamia Hamdard, New Delhi

Paper Coordinator Dr. Javed Ali Jamia Hamdard, New Delhi

Content Writer Sana Khan Jamia Hamdard, New Delhi

Content Reviewer Dr. Javed Ali Jamia Hamdard, New Delhi

Medicated Cosmetics 2017


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CONTENT

1. Background

2. Medicated Cosmetics : Introduction

3. Medicated Herbal Cosmetics

4. Medicated Skin Care Products

i. Antibacterial creams

ii. Anti-acne creams

iii. Anti-aging creams

5. Medicated Hair care products

i. Anti-Dandruff Shampoos

ii. Shampoos for Colored hair

iii. Gluten-free or wheat-free Shampoos

iv. All-natural Shampoos

v. Baby Shampoos

vi. Veterinary Shampoos

vii. Solid Shampoos

viii. Jelly and gel Shampoos

ix. Paste and cream shampoos

x. Antibacterial shampoos

6. Cosmetic Dentistry

i. Medicated tooth paste

ii. Medicated Mouthwash



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1. Background

Traditionally, American drug stores have carried beauty, personal care and hygiene products

along with pharmaceutical products. Ingredients like dried herbs, fragrant essential oils and

extracts were used in the preparation of medicines. Thus, perfumes were among one of the first

few products to be available in American pharmacies. Eventually as the industry expanded

personal care products and cosmetic products like make-up, razors, hair dyes and deodorants also

found a place on the shelves of many drugists’.

The inclusion of beauty products in pharmacies highlights the age old belief about health,

hygiene and physical beauty being interconnected. The manufacturers of beauty products these

days claim that apart from making our body parts beautiful their products also help improve their

health. These claims have become so common that we don’t even notice them anymore. Sample

this: make-up that claims to purify and cleanse our skin, hair dye that claims to give our hair a

‘natural’ shine, flower scented feminine hygiene products, mouthwashes and toothpastes that

claim to give us better breath and scented soaps. The marketing of beauty products that claim to

make us “healthier” rather than just making us attractive make the distinction between medicine

and cosmetics difficult.

Passing of the Food, Drug and Cosmetics Act in 1938 by the Congress further reinforced the

interrelation between cosmetics, drugs and medicine. The act also acted in providing an

oversight to the Food and Drug Administration of the cosmetics industry. The Personal Care

Products Safety Act is in consideration in the Congress today which is amendment to the 1938

act and will also strengthen it further.



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2. Introduction

Medicated oils, creams, shampoos, soaps, moisturizers, gels are some of the examples of

medicated personal care product. Little or no distinction is made between medicated cosmetics

(including natural cosmetics) and personal hygiene items. The list of personal care products

listed above is mostly used for maintaining personal hygiene and also to enhance beauty. The

medicated cosmetics are uniquely used for beautification purposes. However, there is no

distinction between the personal hygiene products and the medicated cosmetics in a store aisle.

Another reason for there being no distinction between the two is that both these products are

used for both beautifying purposes and also for personal hygiene. Henna hair dye, neem cream,

antibacterial soaps, anti-wrinkle creams, herbal body massage oils are some of the frequently

used medicated personal care products.

Figure 1. Medicated Cosmetic products



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There are about 750 companies with annual combined revenue of $40 billion that make up the

medicated personal care product industry. Apart from the major exporters there are also many

small scale exporters and traders who engage in the business of wholesale medicated cosmetics.

3. Medicated Herbal Cosmetics

Herbal extracts such as, mints, basil, bay leaves, rose petals, fennel seeds, chervil leaves etc are

utilized in the preparation of several personal hygiene and herbal cosmetic products. These

herbal extracts are considered to be one of the best skin care products. Moreover, each of these

products has a number of other uses. For example, a product that contains cooling and soothing

agents can also be used curing pain and aches. Manufacturers also sell many innovative natural

or herbal cosmetics in the global wholesale market. Products belonging to the medicinal product

categories that are also sold at the wholesale market include neem soap, herbal face pack, aloe

vera body lotions, aloe vera soap, herbal face cream, herbal shampoo, herbal skin toner and

fairness creams etc.

Figure 2. Essential aroma oil containing mint intended for therapeutic use



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The increasing demand of these herbal products is mostly led on by consumer concerns about the

harmful effects and toxicity of the ingredients used in cosmetics and other such products. People

are increasingly moving from medicated cosmetics to herbal products; suggest recent findings, as

herbal products are perceived as causing fewer side effects to the skin. Products like garlic and

Echinacea are said to have antibiotic properties but cause fewer side effects when compared to

conventional anti-infective agents like ceftazidime, pencillion, ceftiofur or ceftoxitin. One of the

most traditionally used forms of medicines include herbal remedies from flowers, leaves and

other parts of a plant, the popularity of which is still on the rise. Using natural or herbal products

as cosmetics is not a new concept but has been in existence since the past 3000 years, Egyptians

were known to use rose and fenugreek to prevent wrinkles. The growth of herbal cosmetics

worldwide has been phenomenal in the past few years with around US $ 83 billion earned in

sales. Countries like Canada, Germany, France, Japan, United States, United Kingdom and

Brazil are the leaders in supply of herbal based cosmetics. The industry is growing multifold

with almost a large number of Americans are now spending US $4.2 billion on buying herbs and

botanical plants. The market share of herbal lotions, creams, soaps, perfumes, mouthwashes, face

packs are a real hit in the market.

4. Medicated Skin Care products

Skin care personal hygiene products are used for moisturizing, toning, cleaning and nourishing

the skin. Skin care toiletries are known to have healing and anti-inflammatory properties. Anti-

aging cream, anti-cavity toothpastes, dental floss, mouth washes, antiseptic lotions, conditioners,

medicated socaps, anti-bacterial lotions, gels, facial scrubs, anti-acne cream, face washes, body

washes, cleansers, medicated creams, body talc and many other products are examples of natural

skin care products that are available in as wholesale medicated or herbal cosmetic. Thus a

medicinal skin care product can be found in a variety of different wholesale medicated

cosmetics.



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The skin care product industry is currently worth US $250 billion and is expected to grow at 6%

annual average rate. The major suppliers of the skin care products in the industry are Proctor and

Gamble, Beiersdorf, Johnson and Johnson.

One of the signs of a healthy human being is his/her skin; wrinkles, acne, pimples, scars are all

considered as unhealthy and thus personal skin care has become an integral part of the global

health and beauty industry. People are now turning to mainstream skin care products to avoid the

above mentioned disorders. A good skin is reminiscent to a beautiful body. There are a plethora

of products to choose from for a healthy and beautiful skin including lotions, shampoos,

conditioners, oils, gels, creams, moisturizers, cleansers etc.



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i. Antibacterial Soaps

Anti-bacterial soaps are a sort of cleaning products that often include chemicals like triclosan,

triclocarban and chloroxylenol. These chemical products help in killing off the bacteria on the

skin.

Though the ability of anti-bacterial soaps to kill bacteria and viruses found on the skin has been

under the scanner many times. Studies have found that the chemicals found in antibacterial soaps

do not have the desired effect anymore, i.e., these chemicals do not kill the bacteria and viruses

than any other detergent of soap. Reports by the US Food and Drug Administrative (FDA) have

also claimed that triclosan is not effective in reducing the transmission of respiratory or

gastrointestinal infections. The FDA even banned the use of nineteen chemicals in September

2016 used frequently in antibacterial products due ot lack of information about their long-term

effects.

Ingredient

As mentioned earlier, Triclosan and Triclocarbon are the most commonly used compounds in

antibacterial soaps, though there are other compounds that are used as well.

Although there have been studies examining the purported use of antibacterial soaps, no

consensus can be found over the results. Studies also claim that washing off with plain soap is

enough to make the bacteria ineffective. Whereas there also have been studies that found that

antibacterial soaps are more successful in killing bacteria and deactivating viruses present on the

skin. A study conducted by Dr. Elaine Larson of the School of Nursing of Columbia University

stated that no distinguishable effects over a period of 48-weeks could be found over the use of

antibacterial soaps. Reports published by the US Food and Drug Administration questioned the

usage of antibacterial soaps and hand sanitizers claiming that no medical studies were found

showing a connection between the decline in infection rates and a specific consumer antibacterial

product.



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Figure 3. Gel Soaps with antibacterial activity

These studies were also cited by Stuart Levy, a microbiologist at the Tufts University in an effort

to compare the antibacterial action with the antibiotic resistance - "Dousing everything we touch

with antibacterial soaps and taking antibiotic medications at the first sign of a cold can upset the

natural balance of microorganisms in and around us, leaving behind only the 'superbugs'." It has

also been proven that methods used by Levy were not effective while predicting bacterial

resistance for biocides like triclosan. Not only that, there are a minimum of seven studies

including a study coauthored by Levy himself that demonstrate the ineffectiveness of triclosan

while dealing with skin bacteria over a short term.

A latest research study from the Levy’s lab stated that the study does not “implicate the use of

antibacterial cleaning and hygiene products as an influential factor in carriage of antimicrobial

drug-resistant bacteria on the hands of household members”. Even so, a recent review of

literature by Levy states – “the lack of an additional health benefit associated with the use of

triclosan-containing consumer soaps over regular soap, coupled with laboratory data

demonstrating a potential risk of selecting for drug resistance, warrants further evaluation by



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governmental regulators regarding antibacterial product claims and advertising”. The authors of

the paper has requested for continued research in the area.

Back in September 2016, the US Food and Drug Administration administered a ban on 19

chemicals that were commonly used in antibacterial products. The FDA claimed that there has

neither been any proven record of these chemicals having antibacterial properties nor any

findings proving them to be better than standard soaps and detergents. The Food and Drug

Administrative agency also declared that it did not receive any satisfactory data from the

manufacturers of antibacterial products about the long term effects of these chemicals. The ban

did not apply to hand sanitizers.

ii. Anti-aging creams

Anti-aging creams are primarily cosmeceutical skin care products that claim to make the user

look younger than his/her age by reducing, masking or preventing signs of aging. The common

signs of aging include poor skin texture, sagging skin (laxity), wrinkles (rhytids) and photoaging.

Photoaging usually includes redness of the skin (erythema), brown discolorations

(dyspigmentation), yellowing of skin (solar elastosis) and abnormal growths (keratoses).

Regardless of the increasing demand of anti-aging products, most of them have not been proven

to have the long lasting effects they claim to have. A study found that the best perfoming anti -

wrinkle creams reduce wrinkles by 10% in 12-weeks which is hardly noticeable to the human

eye. Another study stated that moisturizers that cost less were equally effective as high-priced

products. A study done at Manchester University in 2009 claimed that certain ingredients can

have the desired effect.

Anti-aging creams have been traditionally aimed at women consumers but a rise in products

marketed at men can be seen in the recent years.



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Figure 4. A woman applying anti-aging cream

Ingredients

Anti-aging creams primarily contain conventional moisturizing ingredients but also use

certain anti-aging ingredients like Retinol, mostly in the form of retinyl palmitate. The

chemical has been scientifically proven to reduce fine lines and pores.

Epidermal growth factor is used to stimulate collagen production in the skin and also for

cell renewal. It also helps in strengthening elasticity and structure. Stenley Cohen and

Rita Levi-Montalcini won a Nobel Prize in Physiology and Medicine in 1986 for the

discovery of epidermal growth factor. Studies have shown that epidermal growth factor is

known to reduce sagging, fine lines and wrinkles. It also has healing (wounds and burns)

and anti-inflammatory properties.

Alpha Hydroxy Acids (AHAs) and Beta Hydroxy Acids or other chemical peels, that

facilitate the dissolving of intracellular “glue”. This glue is responsible for holding

together the dead cells on the skin. Regular use of this product is known to gradually

enhance the exfoliation of epidermis which exposes the new skin cells and helps in



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improved appearance. AHAs are also known to irritate some skin types thus causing

redness and flaking.

Peptides, such as Matryxil and copper peptides.

Coenzyme Q10

Argireline (also known as acetyl hexapeptide-3), which is responsible for relaxing facial

muscles thus preventing wrinkles and fine lines. Anti-oxidants help in protecting the cells

from damage caused by free radicals. The studies in the area of anti-oxidants are not

known to prove anything. Although there is a lack of evidence against antioxidants

having an impact on diseases.

Sunscreens are known to protect the skin from effects of the UVA radiation, including

wrinkles.

Vitamin C is known to be an efficient ingredient in wrinkle creams which is also though

to help the healing process.

iii. Anti-acne creams

A long term skin disease, also known as acne vulgaris, acne is characterized by blackheads or

whiteheads, pimples and scarring in some cases. Clogging of hair follicles with dead skin cells

and oil from the skin is the cause of acne. Acne affects areas of the skin which have relatively

high number of oil glands, which includes the face, upper part of chest and back. As a result,

acne could lead to low self-esteem and anxiety, and depression and suicide in extreme cases.

In almost 80% of the cases the primary cause of acne is said to be genetics. Although, widely

believed that smoking and diet of a person plays a role in acne, studies have not been able to

prove anything. No concrete proof about the role of exposure to sunlight and cleanliness in

causing acne has been found. Acne is most commonly found in both the sexes during puberty

years because of an increase in hormones. Another possible cause for causing of acne is

excessive growth of bacterium Propionibacterium acnes, which is most commonly found on the

skin.



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Acne is treatable and options like medications, lifestyle changes and other medical procedures

are suggested to people suffering from it. Eating fewer carbohydrates such as sugar helps in

preventing acne. Moreover, treatments that include application of formulations such as azelaic

acid, benzoyl peroxide and salicylic acid containing topical formulations on the affected skin are

also known to help.

Benzoyl peroxide

A first line-treatment drug for the treatment of mild acne, Benzoyl Peroxide (BPO) is known for

its effectiveness and mild side effects (mainly skin irritation). BPO is said to kill P. acnes in the

skin follicles. This is done by the formation of oxygen free radicals and benzoic acid in the skin

follicles. These free radicals affect the bacteria’s metabolism and the ability to create proteins.

The chemical can also be occasionally paired with topical antibiotic or retinoid such as benzoyl

peroxide/clindamycin and benzoyl peroxide/adapalene as well. Benzoyl Peroxide is also known

to have properties that can break down comedones and also inhibits inflammation.

Photosensitivity, dryness, redness and occasional peeling are among the side effects caused by

benzoyl peroxide. Thus, use of sunscreen is advised during treatment with benzoyl peroxide to

prevent sunburn. Benzoyl peroxide is not known to generate bacterial antibiotic resistance and

lower concentrations of BPO are considered to be as effective as higher concentrations in

treating acne.

Retinoids

Structurally similar to vitamin A, Retinoids are known to reduce inflammation, normalize the

follicle cell life cycle and also reduce sebum production. Retinoids alter the cell life cycle in the

follicle lining that further prevents the accumulation of skin cells within the hair follicle that can

cause a blockage. Retinoids are known as first-line acne treatments and is known to help in the

faster improvement of postinflammatory hyperpigmentation. Retinoids are known to be most

effective for darker skin.



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Adapalene, isotretinoin, retinol, tazarotene, and tretinoin are the most commonly used topical

retinoids. These chemicals are known to cause a flare-up of acne and also facial flushing which

can further cause skin irritation. Retinoids work by increasing the skin’s sensitivity to sunlight

and are thus advised to use at night. Tretinoin, the cheapest retinoid is known to cause most skin

irritation while Adapalene, the costliest of retinoid causes least skin irritation. Retinol, that is a

form of Vitamin A has milder effects and is commonly used in over-the-counter moisturizers and

other topical products. On the other hand, Tazarotene, the most effective of all Retinoids costs

the most.

Azelaic acid

Azelaic acid is known to an effective anti-acne chemical when treating mild to moderate acne

and applied topically at a concentration of 20%. It is advisable to continue the treatment with

azelaic acid for atleast 6 months, proving to be as effective as benzoyl peroxide 5%, isotretinion

0.05% and erythromycin 2%. Another reason why Azelaic acid is said to be effective is due to its

ability to decrease skin accumulation in the skin follicle and also due to it s antibacterial and

anti-inflammatory properties. Azelaic acid also has skin lightening properties which are a result

of its ability to inhibit melanin synthesis. As a result, azelaic acid is used for treatment of

postinflammatory hyperpigmentation. It may cause skin irritation but is considered safe. Azalaic

acid is known to be less effective but is more expensive than retinoids.

Salicylic acid

Salicylic acid, a topically applied beta-hydroxy acid, is known to have keratolytic properties and

also stops bacteria from reproducing. It helps in opening of obstructed skin cells and thus

promotes in shelling of epithelial cells. Known to be less effective than retinoid, its topical

application is known to cause dry skin. Darkening of skin is another side effect seen in

individuals with darker skin.

Other medications



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Alternative medications of acne include topical and oral preparations of nicotinamide, which is

the amide form of Vitamin B3. Nicotinamide is said to heal acne as it has the ability to produce

sebum and promote wound healing. Its anti-inflammatory properties can prove to be useful while

healing acne. Other alternative medications include oral and topical preparations of zinc because

of its capacity to reduce inflammation and sebum production and also inhibit P. acnes, though

there is not much evidence to support the claim. Antihistamines can also help improve symptoms

of acne among those already taking isotretinoin.

5. Medicated Hair Cosmetic

i. Anti-Dandruff Shampoos

The shedding of dead skin cells from the scalp is commonly known as dandruff. One of the most

common and biggest skin problems, caused mainly during winters, dandruff causes itching and

discomfort. Studies have not been able to point out to a single factor causing dandruff, dry skin

on scalp, oily skin on scalp, not combing enough or mental stress, anything can cause dandruff.

Cosmetic companies have come up with shampoos with dandruff prone scalps. These shampoos

generally consists of fungicides for example zinc pyrithione andketoconazole, that helps in

reducing loose dander by killing Malassezia furfur. Other elements used in anti-dandruff

shampoos are coal tar and salicylate derivates. Nizoral anti-dandruff shampoo, Head &

Shoulders, Neutrogena T/Gel Therapeutic shampoo and DHS Shampoo are among some of the

commonly known anti-dandruff shampoo.

Though anti-dandruff and medicated shampoos are a huge hit with consumers, there are other

alternatives for people who do not like to use chemicals. Organic and natural shampoos that used

tea tree oil and extracts are a feasible option.

ii. Shampoos for Colored hair

Companies have also come up with shampoos for protecting coloured hair. These shampoos

claim to have gentle cleaners so as to cause less harm to colored hair.



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iii. Gluten-free or wheat-free Shampoos

Wheat and gluten free shampoos are also offered by cosmetic companies these days. There are

people who suffer from eczema on their palms and head. This is caused due to wheat or gluten (a

protein found in many foods including protein) allergy. Most people with wheat or gluten allergy

are sensitive to foods containing these proteins, for example, celiac disease wheat allergy.

Shampoos have the tendency to make contact with the mouth while washing hair, thus people

with gluten allergy prefer gluten free shampoo. The manufacturers have tried to tap into this

section of the market as well and thus there are more and more options available for gluten and

wheat free products.

Wheat derivatives and other gluten grains are used as binders and emollients in many shampoos.

Although most of the below mentioned ingredients do not technically contain any wheat

proteins, but there may be leftover wheat proteins due to incomplete processing and

contamination:

Wheat, oats,barleyand rye, including any oil, protein, hydrosylate, or other extract from

any part of the plant.

Vitamin E(tocopherol), which is derived from wheat

Hydrolyzed vegetable protein

Cyclodextrin, which is produced from starch

Maltodextrin, dextrin, dextrin palmitate, or (hydrolyzed) malt extract

Phytosphingosine extract

Amino peptide complex

Disodium wheat Germamido PEG-2-Sulfosuccinat

Fermented grain extract

AMP-Isostearoyl

PG-Propyl Silanetriol

PVP crosspolymer



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Yeast extract

iv. All-natural Shampoos

Some companies also claim to use “all-natural”, “botanical”, “organic” or “plant-derived”

ingredients. These mostly include extracts or oils. These natural ingredients are used in addition

with one or more ingredients. The use of the term ‘natural’ is often used to mislead or ‘green-

wash’ the consumers. Green-wash is a common term used to trick the consumers into buying

shampoos that are harsher without their knowledge. Companies also retort to changing the names

of a surfactant to an acceptable form.

Figure 5. Shampoos with herbal ingredients

v. Baby Shampoos



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Baby shampoos meant for infants and young children are built around the idea that they are less

irritating and do not produce stinging or burning sensation in the eyes. Johnson baby’s shampoo

that is marketed under the tagline of “No More Tears” is the biggest example. Less irritating or

shampoos that do not cause burning or stinging are accomplished by the following methods:

Dilution – the product is diluted in case the shampoo runs off the top of the head and

comes in contact with the kid’s eyes.

Adjusting pH- the pH level of shampoos is adjusted to be around 7, which is considered

neutral and do not cause tears;

Use of surfactants which are less irritating than those otherwise used in shampoos.

Non-ionic surfactants that counteract eye sting are also used in such shampoos.These

surfactants usually include polyethoxulated synthetic glycolipids and polyethoxylated

synthetic monoglycerides.

The use of non-ionic surfactants mentioned above does not overcome the controversy

surrounding the use of shampoo ingredients reduce the eye sting that is produced by other

ingredients. As a result, there is at times much greater quantity of surfactants used in baby

shampoos as compared to other shampoos which affect the foaming of these products. The

monoanionic sulfonated surfactants and viscosity enhancers that are a common ingredient in

other shampoos are less frequent in the baby shampoos.

vi. Veterinary Shampoos

Shampoos intended for the use by animals contain insecticides or other medications that are

useful for the treatment of infestations or skin conditions unique to animals. These shampoos

must not be used on human skins. Human haircare products that contain ingredients like zinc are

fatal when ingested by animals and thus human shampoos should never be used on animals. Cats

are the most easily affected animals by human haircare products as they are used to grooming

their fur by licking thus increasing the chances of ingestation. Shampoos intended for pets serve



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more than one purpose. These shampoos are not only meant for cleaning the pet’s skin or coat

but are also made to treat skin conditions in animals or fight fleas or other allergies. The primary

ingredients in animal shampoos can be broadly grouped under antimicrobial,

insecticidals,emollients, emulsifiers and humectants. While many of these ingredients are

believed to be efficient in dealing with skin conditions in animals it is always better to take the

veterinian’s recommendations into consideration before using these products on animals.

Figure 6. Shampoos for animal hair care

Traditionally, insecticidal pet shampoos consist of pyrethrin, pyrethroids and carbaryl. These

ingredients are meant to fight against parasitic infections in pets. Pets with yeast or ringworm

infections require the use of antifungal shampoos.

Similarly, antibacterial shampoos are used for combating bacterial infections in pets.

Theingredients used in these antibacterial shampoos include benzoyl peroxide, povidone iodine,

or chlorhexidine.



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For relief from itching conditions like atopy and other allergies Antipuritic shampoos containing

ingredients as oatmeal, hydrocortisone,menthol, and diphenhydramine are usedto reduce

inflammation, cure the condition and also provide comfort to the pet.

Anti-seborrheic shampoos are meant for animals with scales or excessively oily coat. The

chemicals mentioned earlier are helpful in treating or the prevention of seborrhea oleosa, a

condition caused by excess of oils in an animal’s coat.

Emollient shampoos that mostly contain oils such as corn, almond, olive, coconut, safflower,

Persia, peanut, lanolin, sesame, mineral or paraffin are a god remedy for treating dry and itchy

skin in animals. These shampoos are generally used with emulsifiers. Stearyl alcohol, carboxylic

acid, lactic acid, cetyl alcohol, or polyvinylpyrrolidone are some of the common ingredients in

emollient shampoos.

The pet shampoos available in the market can be both highly effective and less effective. Though

there are natural pet shampoos available in the nature they are said to cause irritation to the

animal. Eucalyptus, lemon extracts, orange extracts or tea tree oil can cause allergies in animals.

Moreover, oatmeal is among the most commonly used skin friendly ingredient found in animal

shampoos. It is important for most animal shampoos to be animal safe as most pets will lick their

coats. Shampoos containing fragrances, deodorants or colours are harmful for the skin of the

animal causing inflammation or irritation. Hypoallergenic shampoos, that is, shampoos which do

not contain any unnatural additives are increasingly becoming popular.

vii. Solid Shampoos

Solid shampoos, also known as shampoo bars are spill-proof. These shampoos use surfactants

that are formulated as solids and are easy to apply. The bar shampoo can be simply rub over wet

hair and lather can be then worked into.



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viii. Jelly and gel Shampoos

Shampoos in the form of jelly and gels can be obtained by increasing the shampoo’s viscosity.

ix. Paste and cream shampoos

These types of shampoos apply faster than solids and also dissolve quickly, and are mostly

marketed in jars or tubes.

x. Antimicrobial shampoos

These kinds of shampoos are widely used as medicines in animals for various purposes, as well

before surgeries in humans.

Table1. Ingredients of Medicated OTC Shampoos (Reference: Jeannette Y. Wick, RPh, MBA, FASCP.

Medicated Shampoos: Washing Away Childhood Complaints. Pharmacy Times.2013)

Ingredients Clinical application

Coal tar Antipuritic

Ketoconazole Antifungal

Menthol Provides a secondary neurological stimulus to create antipuritic

sensation

Povidone-iodine complex Topical antiseptic

Salicylic acid Keratolytic

Selenium sulfide Able to reduce epidermal cell turnover, also has local irritant, anti-

bacterial and mild antifungal activity

Sulfur Antibacterial/antifungal and keratolytic

Zinc pyrithione Antibacterial/ antifungal



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6. Cosmetics dentistry

Dental work that is aimed at improving the appearance (not necessarily the functionality) of teeth

gums and/or bite is known as Cosmetic Dentistry. Cosmetic Dentistry typically focuses on

improving the color, position, shape, size, alignment or just the overall appearances of a set of

dentures. Many dentists these days refer to themselves as cosmetic dentists irrespective of their

training or experience in the field. This could be seen as an unethical practice as its dentists use

this to market themselves to patients. Interestingly, cosmetic dentistry is not recognized as a

formal specialty by the American Dental Association.

Cosmetic dentistry mainly involves:

Addition of dental material to teeth or gums – examples: bonding, porcelain veneers

(laminates), crowns (caps), gum grafts

Removal of tooth structure or gums – examples: enameloplasty, gingivectomy

Neither adding nor removing dental materials, tooth structure, or gums – examples: teeth

whitening (bleaching), laser whitening, gum depigmentation

Straightening of teeth accompanied by improvement in appearance of face – orthodontics

The most commonly practiced dental cosmetic procedure is whitening, also known as ‘tooth

bleaching’. Although, many whitening products are also available in the market these days,

dentists still prefer the recommended dentist supervised procedures for lightening of discolored

teeth.

Teeth reshaping or sculpting and bonding is one of the most common dental cosmetic procedure

that can be completed in one visit.

There are also teeth whitening using laser. The procedure includes gums being covered with

rubber while a bleaching chemical is applied on teeth. It is followed by projecting of a beam of

argon laser onto the teeth which is supposed to fasten the bleaching process. The laser works by



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activating the bleaching chemical and in turn lightening the teeth color. This procedure is

considered to be six times more effective than other teeth whitening procedures.

Tooth reshaping that is also a common cosmetic dental procedure is aimed that removing part of

the enamel to improve the appearance of the tooth. This procedure can be used to correct a minor

chip or even help in alteration of length, shape or position of teeth. Tooth reshaping is also used

to correct Tooth Size Discrepancy. The enamel that is removed cannot be replaced and can lead

to exposure of dentin. This is also known as enameloplasty, odontoplasty, contouring,

recontouring, slenderizing, stripping. The procedure is known to produce quick results and can

also be used as a substitute for braces at times.

The process in which an enamel like dental composite substance is applied and then sculpted into

a tooth’s surface and is then hardened and polished is called Bonding.

Devices used in replacing one or more missing teeth are called dental bridges. The process

includes the preparation of the teeth on both sides of the missing teeth for the bridge. The bridge

consists of abutments (the teeth that are prepped up) and pontics (the false teeth). This is a

common procedure used to replace one or more missing teeth. Bridges consists of more than

three teeth in general and the feasibility of a bridge is calculated using the Ante’s law and the

position of the teeth in the mouth. The bridges are usually fixed and cannot be taken out in the

same way that partial dentures can. Cantilever bridges are used in areas of the mouth that are

under less stress, for example the front teeth. Also known as Maryland bridges, these are used for

replacing missing front teeth. Although minimally invasive the chances of failure are high in

cantilever bridges. Dental bridges require strict dental hygiene and usually have a lifespan of

nearly ten years.

Veneers, that are ultra thin porcelain laminates, are used to close gaps, enhance shape or change

the color of the teeth that are otherwise non-responsive to whitening procedures. In most of the

above mentioned procedures, some amount of tooth reduction is a necessity.



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Dental implants are the equivalent to prosthetic limbs, i.e., they are used as replacement to

missing teeth. International Congress of Oral Implatologists or ICOI recognize three parts of an

implant: the implant device which is commonly made of titanium and is interred unto the bone,

he abutment and a dental crown which is connected to the implant with the help of the abutment.

Gum Lift is another cosmetic dental procedure that raises or sculpts the gum line. The procedure

of gum lift usually consists of giving new shape to the tissue and/or underlying bones so as to

produce more symmetrical looking teeth.

An alternative to traditional metal braces is the invisalign treatment which is mainly used for

treatment for spacing between teeth, crowding of teeth or overlapping teeth, also clear aligners

are easy to clean and comfortable. The invisalign treatment has been around for more than a

decade and is used to create a smile that the patients desire.

People who have altered vertical dimensions of teeth due to grinding or acid reflux can opt for

Bite Reclamation. This process gives the patient a closed or shorter look to their face and smile.

A qualified professional can correct the vertical dimension of a set of teeth by opening up the

patient’s bite.

Decayed and cracked teeth are repaired using inlays and onlays. When a filling is too small to

correct a damaged teeth and a crown would be excessive, this process is then used for correction

of teeth

Materials for cosmetic dentistry

Earlier, dental fillings and other tooth restorations were mostly made of gold, amalgam and other

metals. Some of these were also coated with porcelain. Nowadays, most dental work is made up

of porcelain or materials that are closer to the appearance of a natural tooth. These materials are

then joined to the tooth structure with the help of resin adhesives. Cosmetic Dentistry is an ever

growing branch that is constantly evolving and introducing new procedures.



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i. Medicated Toothpaste

Medicated toothpastes are one of the preferred remedies for teeth and gum related issues like

tooth decay, cavities, sensitive teeth etc. To deal with these dental problems, dentists have come

up with toothpastes that contain active ingredients like Potassium Nitrate, Triclosan, Fluoride&

Tannic Acid.

Figure 7. Potassium nitrate toothpaste for Cavities, Sensitivity, Gingivitis, Bad Breath, Plaque

and Cleaning.

(Source:https://www.alibaba.com/product-detail/medicated-toothpaste_148890425.html)

Potassium Nitrate is a proven and suggested medication for tooth sensitivity. These toothpastes

also carry a number of other ingredients including herbal extracts. Use of herbal ingredients like

roots, barks, and flowers facilitate the tightening of loosened gums and also benefit the teeth and

gum in many other ways. The fact that these natural products have no harsh abrasives and

artificial ingredients, they leave the mouth with a pleasant and fresh sensation.`



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ii. Medicated Mouthwashes

The major classification of medicated mouthwashes includes mainly two types: cosmetic and

therapeutic.

Therapeutic mouthwashes are easily available in the market in pharmacies or by prescription of

dentists, depending on the formula of ingredients in the toothpaste. These toothpastes further

help in reduction or control of plaque, gingivitis, tooth decay and bad breath, though these

mouthwashes are not recommended for children under the age of 6 until recommended by the

dentist as children swallow it in large quantities.

The use of mouthwash, also known as mouthrinse is a necessary addition to maintaining daily

oral hygiene. This is no replacement for daily brushing and flossing though. One of the biggest

benefits of mouthwash is the ability to reach into areas of the dental cavity that is not easily

accessible by a toothbrush. The choice of using the mouthwash before or after brushing is on the

user but different mouthwash may have different ways to maximize results. For instance,

mouthwash containing ingredients like calcium hydroxide or aluminiumhyrdroxide can form a

complex compound when it comes in contact with fluoride ions thus reducing the mouthwash’s

end results. Thus, rinsing with water or before brushing the teeth may be recommended for such

mouthwash.As mentioned earlier, mouthwash is not advisable for use by children under 6 years

of age. This is due to the under developed swallowing reflexes in young children.It is advisable

to verify the product label for specific precautions and age recommendations.

Types of Mouthwash

Cosmetic mouthwash is mainly used to control bad breath, though they have no otter chemical or

biological effect. A product that is unable to kill bacteria related to bad breath will inadvertently

fall under cosmetic mouthwash. On the other hand, therapeutic mouthwash intends to help or

control the bacteria or help rectifying conditions such as bad breath, plaque, tooth decay and

gingivitis.



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Table1. List of Ingredients of therapeutic mouthwashes with their uses

S.No Active Ingredient Use in therapeutic mouthwash

1. Cetylpyridinium chloride fight bad breath

2. Essential oils control plaque and gingivitis

3. Chlorhexidine control plaque and gingivitis

4. Peroxide Whitening

5. Fluoride prevent decay

Availability of therapeutic mouthwash depends on the formulation of the mouthwash, like

mouthwash containing essential oils can be easily found in a pharmacy while a mouthwash

containing chlorhexidine is only available by prescription.

Clinical Considerations

Mouthwashes are designed to combat the following conditions:

Bad Breath

The major factor responsible for bad breath or halitosis are thevolatile sulphur compounds

(VSCs), that are caused due to a number of factors such as dental plaque and bacteria allied with

oral disease. Cosmetic mouthwash is used for temporarily dealing with bad breath, these

mouthwashes are provide a pleasing flavor but do not fight the bacteria that is responsible for

bad breath. Whereas, therapeutic mouthwash that contain ingredients like antimicrobials have

long term effects while dealing with bad breath. Zinc salts, ketone, terpene and ionone are some

of the compounds used in mouthwash to counter the odor causing compounds.The combination

of ingredients like chlorhexidine, cetylpyridinium chloride plus zinc lactate is known to reduce

bad breath but it is also known to contribute to tooth staining.



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Plaque and Gingivitis

Antimicrobial ingredients such asessential oils, cetylpyridinium and chlorhexidine are helpful in

mitigating plaque and gingivitis when used in mouthwashes. Some studies found that

chlorhexidine gave better results to control plaque, no considerable difference has been found

with mouthwash containing essential oils. Cetylpyridinium and chlorhexidine are also founds to

be associated with staining of teeth and tongue.

Tooth Decay

Certain mouthwashes also promote remineralization which is facilitated by the presence of

fluoride ions in a mouthwash. Regular use of fluoride mouthwash is found to have reduces tooth

decay in children, said a Chochrane systematic review, even when the children were exposed to

other sources of fluoride.

Topical Pain Relief

Mouthwashes are also used to relieve the pain.Lidocaine, benzocaine hydrochloride, dyclonine

hydrochloride, or phenol constitutes the ingredients of these mouthwashes. Pain relief is

provided by components such as sodium hyaluronate, and glycyrrhetinic acid.

Whitening

Carbamide peroxide or hydrogen peroxide facilitate stain reduction when present as active

ingredients in a mouthwash. Around 1.5 to 2 percent hydrogen peroxide may be available in

mouthwashes that claim to whiten the teeth. A study found that usage of mouth wash containing

hydrogen peroxide for 12 weeks produced similar results as using mouthwash that contained 10

percent carbamide peroxide for 2 weeks.

Xerostomia



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Xerostomia is defined as the lowering in the quantity of saliva bathing the oral mucous

membranes. The lack of saliva may further facilitate the increase in the risk of caries. Thus a

mouthwash containing fluoride is used to deal with the problem. These mouthwashes commonly

contain alcohol as well and as alcohol can lead to dryness a non-alcoholic mouthwash can be

recommended.

Oral Cancer

Consumption of alcohol as well as tobacco are known causes of oral cancer. Thus, it raises the

question of whether the use of alcohol in mouthwash facilitates the risk of cancer. A recent study

although has failed to find a connection between the use alcohol in mouthwash and oral cancer.

Patient Information

It is important to use the mouthwash/rinse as per the prescription. For example, if a dose is

skipped the rinse should be used instantly as daubing the dose will not have increased effect. One

must also keep in mind the ADA Seal of Acceptance while buying mouthwash from a pharmacy.

The seal is proof that the product is tested and safe. Mouthwash cannot replace regular brushing

and flossing, they are used for additional benefits such as mouth refresher, and reducing cavities,

gum disease.

oral delivery of proteins and peptides and carrier-based

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