L18: Drugs & Cosmetics Flashcards

1
Q

What is Minoxidil?

A

First cosmeceutical to treat male pattern baldness.

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2
Q

What is fluoride?

A

In toothpaste, drug to prevent tooth decay and gum disease by getting rid of microorganisms. It’s also a cosmetic to keep your teeth looking nice.

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3
Q

What is the largest organ of the body? Why is this dangerous for children?

A

The skin. Babies have a high surface to volume ratio of skin therefore we must be careful about the compounds we put on babies.

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4
Q

What is the structure of the skin?

A

The skin has three layers:

  1. The epidermis – the outermost layer of the skin, it’s a superficial layer, vasculature does not go there. Hair that is above the epidermis does not contain alive cells anymore.
  2. The dermis – contains blood vessels, hair follicles, various glands like sweat glands and sebaceous glands, muscles that pull hair shafts straight when we are afraid or cold and makes us shiver, and nerve endings.
    - The sebaceous gland is located beside hair follicles and it secretes sebum which lubricates the surface of the skin. Nerve ending is connected to sensory receptors to sense touch, pain, and temperature.
  3. Hypodermis: fat and connective tissue
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5
Q

What is the main difference between different peoples’s skin?

A

The chemical structure of melanin in the skin is different.

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6
Q

What do melanocytes do?

A

Melanocytes produce melanin and insert them into keratinocytes (primary cell in the epidermis to form. protective barrier).

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7
Q

How does UV exposure change the skin?

A
  • Sunburns (excessive exposure to UV light) cause melanocytes to increase production and insertion of melanin (pigment granules) into keratinocytes. This causes a darker skin colour because of increased pigment in an attempt to block UV light which is damaging and carcinogenic.
  • Sunburn is the reaction to UV injury.
  • Causes premature wrinkling, broken blood vessels, pigmental changes and blotches in the skin, and skin cancer.
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8
Q

What are the receptors in the skin? What’s the turnover rate of skin cells?

A

There are receptors in the skin for cold, heat, pain, touch, and pressure. The skin cells have a fast turnover rate so it can continually repair itself and replace deficits.

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9
Q

Give an examples of how skin structure is adapted to location.

A

Skin behind the ear is thin while skin on the palm of the hand and soles of the feet is thick. The number and types of glands also vary (ex: on scalp, different oils are secreted and the amounts secreted are different in different locations).
Normally, the skin is a barrier that does not absorb compounds, however, behind the ear is a good place to apply patches to prevent motion sickness (abdomen is another). It allows fast absorption so the drug can be distributed systemically.

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10
Q

What is psoriasis?

A

Psoriasis is characterized by patches of abnormal skin. Psoriasis is a second layer of keratinocytes with plaque. Skin turnover is very rapid, so many more skin cells are made, and the skin becomes thicker, and sells rise to the surface and flake off.

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11
Q

What can be used to treat psoriasis and acne?

A
  1. Topical (preferred) ex: corticosteroids, Vitamin D3
  2. Systemic methods ex: retinoids (for more serious cases)
  3. Phototherapy ex: UV light or other light sources
  4. Biologic ways ex: monoclonal antibodies (last set of choices)
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12
Q

What is photosensitivity and what can cause it?

A
  • Photosensitivity is caused by an allergic reaction to certain drugs. Being out in the sun without sunscreen can cause skin damage (sun burn) at very low exposure which normally does not happen.
  • Antibiotics, diuretics, antipsychotics, NSAIDs, and many plants and herbal mixtures can elicit photosensitivity.
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13
Q

What is tanning? What are the side effects? Why are tanning machines banned in certain areas?

A

The skin’s reaction to UV injury. It is never safe.
It increases the risk of cancer and causes wrinkles earlier.
Tanning beds have been banned because they increase the risk of melanoma (deadliest skin cancer) by 59%.

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14
Q

What makes up UV light?

A

UVB & UVA rays in the 290-400nm range.

UVB and UVA have different wavelengths that can damage the skin and cause injury. This causes them to penetrate the skin to different extents. UVA penetrates deeper into the skin, UVB cannot penetrate as deep but its exposure is greater.
- It’s also important to wear sunglasses in the Sun as you can damage your eyes and cause cataracts

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15
Q

Who is particularly vulnerable to sun?

A
  • Children are the most vulnerable, especially the ones with light skin. Every sunburn increases the risk of cancer in children.
  • People with freckles because there’s very little pigment in between freckles, and pigments are the ones protecting against skin damage.
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16
Q

What is photoaging? What is a vulnerable area?

A

Skin damage caused. by prolonged sun exposure.

- The back of the neck

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17
Q

What is the biggest risk of sunburn?

A

Skin cancer:

  • Basal cell carcinoma: can be removed before the carcinoma becomes large
  • Melanoma: can lead to death
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18
Q

What is sunscreen? What is SPF?

A
  • Sunscreens are creams that protect skin from UV light damages and contain SPF (sun protective factors).
  • SPF is a measure of efficacy and is used to compare potency of different sun blocks. It determines how long you can stay in the sun vs if you have no protection.
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19
Q

What is broad spectrum sunscreen?

A

Blocks both UVA and UVB rays.

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20
Q

Why do you need to wear higher SPF when skiing or swimming?

A

Because water and snow can reflect light back. Snow can reflect up to 85% of UV radiation. Therefore, you will experience greater UV exposure when swimming and skiing so you need to wear higher SPF.

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21
Q

What can cause acne?

A
  • Occlusion of the pilosebaceous duct where hair follicles normally come out.
  • Bacterial colonization in the duct, releasing inflammatory mediators.
  • Increase sebum secretion as often occurs during adolescence. Sebum is a lubricant that lubricates the hair shaft and the hair to keep it shiny, some comes out and lubricate the skin and the scalp.
  • Inflamed sebaceous glands. In severe cases, the comedo (excessive accumulation of sebum filling the pore of the skin) may rupture and release contents into the dermis.
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22
Q

What are the stages of acne? Describe them.

A

Acne- abnormal keratinocytes

  1. Normal hair follicle
  2. Oxidized sebum: When duct is blocked, sebum accumulates at the surface of the open pore and becomes oxidized to form blackheads. Blackheads are not dirt, but they’re an open follicle with oxidized sebum which blocks the opening of the pore.
  3. Trapped sebum: When sebum is trapped below the surface of the skin, they form of whiteheads. Contains bacteria and leukocytes. Closed comedo.
  4. Bacteria & leukocytes: Bacteria accumulates in the sebum which attracts the white blood cells therefore, there is a mixture of bacteria, leukocytes, and sebum. In more severe cases, the comedo will rupture and spread to become larger which forms and inflamed red circle around the original site and a bump on the surface of the skin. Both blackheads (open) and whiteheads (closed) comedo can accumulate bacteria and increase sebum accumulation.
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23
Q

What is Hyperkeratosis?

A

accumulation of keratin and sebum which causes bacteria to proliferate, causes inflammation, and rupture.

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24
Q

What is mild acne? severe acne? cystic acne?

A

Mild acne: dead skin cell, trapped sebum, blackheads (sometimes white heads).
Severe acne: pus (bacteria + WBCs), inflamed tissue, and rupture.
Cystic acne: most serious type of acne

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25
Q

How did we learn to treat acne.

A

We learned how to treat acne on humans through trial and error because no animal model is known to get acne.

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26
Q

Who is more vulnerable to acne?

A

Males are more vulnerable than women because acne is caused by androgens, especially testosterone, which causes increased sebum during puberty. Males have more testosterone.

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27
Q

What are the 4 hallmarks of acne?

A

Increase sebum, increase keratin, increased bacteria, and inflammation.

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28
Q

What are the 4 targets to reduce acne?

A
  1. Normalize follicular keratinization
  2. Reduce bacteria
  3. Inhibit sebaceous glands
  4. Decrease inflammation
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29
Q

What can be used to normalize follicular keratinization in acne?

A
  • During acne, there is too much keratinocyte turnover (comedogenesis)
  • Topical retinoids like acutane can allow the follicles to stop being plugged.
  • Systemic retinoids an be used if acne is more severe
  • Benzoyl peroxide
  • Sulfur
  • Azelaic acid
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30
Q

What can be used to reduce bacteria in acne?

A

Without bacteria, there is no infection and no inflammation.

  • Benzoyl peroxide can be topical to reduce bacteria around the follicle (local)
  • Antibiotics (topical and oral)
  • Retinoids (ex: isotretinoin) have indirect antibacterial effects.
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31
Q

What can be used to Inhibit sebaceous glands in acne?

A

Sebum is the medium for bacterial growth and it also plugs the duct. By inhibiting the sebaceous gland, sebum excretion can be reduced.

  • Accutane
  • Hormonal therapy: corticosteroids in low doses, anti-androgens (Spironolactone)
  • Estrogen in oral contraceptives ex: low dose birth control pills
  • Retinoids: isoretinoin
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32
Q

What can be used to decrease inflammation in acne?

A
  • Corticosteroids (intralesional and oral)
  • NSAIDs: effects sebaceous glands
  • Oral antibiotics: prevents neutrophil chemotaxis
  • Retinoids
33
Q

What are different retinoids? Why are retinoids a powerful acne treating drug?

A
  • Tretinoin
  • Isotretinoin
  • Retinoids are powerful because they can attack multiple targets.
34
Q

What is a retinoid?

A

Retinoids are vitamin A derivatives. Vitamin A is the generic term for retinal, retinaldehyde, retinoic acid, and related compounds. Retinoids act as hormones and alter gene expression. They have a major role in cellular differentiation. There are natural and synthetic retinoid derivatives that are effective in treating acne.

35
Q

What cells do retinoids have most effect on?

A

They have a major role in cellular differentiation. Cells in fetus and cells that are continuously turning over in adults are particularly affected. This is why it can possibly be used to treat concer.

36
Q

What are natural retinoids? Synthetic retinoids?

A
  • Natural retinoids include retinol, retinaldehyde, and all trans retinoic acid.
  • Synthetic retinoids are mostly aromatic compounds.
37
Q

What are the different generations of retinoids?

A
  1. First generation:
    - Tretinoin, also called Retino-A.
    - Cheap, used to treat moderate acne
  2. Second generation:
    - Etretinate
    - Acitretin
    - Synthetic, less toxic, and more selective
  3. Third generation:
    - Arotinoid
38
Q

What are the 2 most effective retinoids?

A

Tretinoin cream and Adalpene (Differin)

39
Q

How do retinoids alter gene expression?

A
  1. Retinol is not water-soluble. It has to bind to proteins to be transported within the circulation or within the cell.
  2. In the circulation, retinol is bound to the retinol binding protein for movement.
  3. It then interacts with the retinal receptor, frees itself from the binding protein, and enters the cell.
  4. Inside the cell, it is bound by cellular retinoid binding protein, and then converted to retinaldehyde, and eventually retinoic acid, by cytoplasmic enzymes.
  5. Retinoic acid binds to retinoic acid binding proteins to be taken to the nucleus.
  6. In the nucleus, two molecules of retinoic acid then bind to dimer receptors (RXR and RAR) in the nucleus.
  7. Once both dimer receptors are bound (RAR and RXR) to the agonist (retinoic acid), the receptors dimerize and trigger retinoic acid response element to alter gene expression. Depending on the particular cell type, the combination of dimers, and the agonist, it can either decrease or increase the production of proteins.
40
Q

What is RAR and RxR?

A
  • They are receptors in the nuclear hormone receptor family.
  • RAR: retinoic acid receptors. Bound by trans-retinoids.
  • RxR: retinoid x receptor. Bound by cis-retinoids.
  • RAR and RXR form a heterodimer
41
Q

What can the change in gene expression due to retinoic acid lead to?

A

Overall, leads to a decrease in acne by:

  1. Decreasing sebum production and activity of keratinocytes.
  2. Decreasing inflammation with antibacterial effect.
  3. Changing composition of sebum so it no longer fosters the overgrowth of bacteria.
42
Q

What are the side effects of retinoids?

A
  1. Retinoids are teratogen even at low doses, with powerful effects at even the first month of pregnancy:
    - Vitamin A plays a huge role in cell differentiation therefore it affects the growth of the foetus.
    - Vitamin A derivatives cannot be given to pregnant women.
    - It causes malformations of the face, skull, pallet, ears, kidney, and heart in fetus.
    - Leads to psychological and intellectual development impairment.
  2. Retinoic acid (Accutane) for acne treatment has affected thousands of children because it may cause GI disorders.
  3. Isotretinoin has been associated with inflammatory bowel disease in patients without a prior history of intestinal disorders.
  4. There is a possible interaction between NSAIDs and acetaminophen with retinoids that produce GI distress.
43
Q

What kind of soap should we use? What is it used for?

A

There is no need to use antibacterial soap when washing faces because humans have natural bacteria present in their follicles. However, we should wash your hands with normal soap, it doesn’t need to be antibacterial, because that’s where superficial bacteria and viruses are located and can be transmitted. Soap can reduce transmission of colds.

44
Q

What does moisturizer do?

A
  • It lubricates dry skin and makes skin softer but it does not repair anything and it is not magical so there is no need to buy expensive creams.
  • Moisturizer does not make people look younger. Sunblock is the only compound in cream that could claim to reduce the sign of Aging over time because it reduces skin damage due to uv-light not aging.
45
Q

What are the components of skin cream/moisturizer?

A

Skin cream is a mixture of liquid (mostly water), powder (an active ingredient), and grease (oil) to easily spread. Depending on the relative combination of the ingredients in the product, it can have different thicknesses:

  • Creams: have higher levels of powder
  • Liquid creams: have higher levels of water
46
Q

Why are Collagen and Elastin often put on moisturizer advertisements?

A

Because they sound scientific and related to the skin therefore people assume that they are good for you. In fact, humans cannot absorb collagen and elastin since the epidermis is a good barrier and does not allow them to go through.

47
Q

What is cellulite? Can it be cured by creams?

A

Cellulite is fibrous tissue that is laid down when you gain fat. In between the fat globules there is more fibrous tissue and it becomes bumpy. They cannot be broken down by moisturizers.

48
Q

What can be potentially harmful about cosmeceuticals?

A
  1. Trace metals can be found in small quantities in cosmeceuticals.
    - If the Skin Barrier is damaged you can get more absorption Shan family which can have negative effects.
  2. Phthalates can be present in some cosmeceuticals like perfumes, lotions, nail polish, hair products. Phthalates can damage the liver, kidney’s, lungs, and reproductive system.
  3. There are a lot of preservatives (parabens) and fragrances in some of them that can cause allergic reactions, can be carcinogenic, can disrupt the endocrine system and the immune system.
49
Q

What are cold sores? How do you get them?

A

Cold sores are caused by the reactivation of the herpes virus which is a DNA virus.

  • Children usually get exposed to the virus and it enters somewhere on the face, travels up the sensory neurons, and stays latent in the ganglia.
  • It can then get triggered by a variety of features like stress which causes the virus to reactivate.
  • When the virus reactivates, it comes back down through the nerve ending and causes a lesion in areas of skin.
  • The immune system’s antibodies recognizes it and contains it keeping it just in this region. If you’re immunocompromised this can be problematic.
  • There is herpes simplex and genital herpes both viruses are related.
50
Q

What can be used to treat herpes? How?

A

Antiviral drugs that inhibit viral proliferation such as:
- Acyclovir (AcycloGTP): inhibits viral DNA polymerase so the virus can’t reproduce and can’t cause damage or spread to nearby cells.

51
Q

What parts of our body are NOT covered in hair?

A
  1. Palms

2. Soles of the feet

52
Q

What do sebaceous glands do for the hair?

A

Releases sebum that lubricates the hair and skin surface.

53
Q

What do melanocytes do for the hair?

A

Inserts pigment into the hair.

54
Q

What do the arrector pili muscles do?

A

Give you goose bumps and raises the hair.

55
Q

What are the different layers of a strand of hair?

A
  1. Cuticle: consists of dead cells
  2. Cortex
  3. Medulla
56
Q

Where are live hair cells found?

A

At the base of the follicle under the surface of the skin. The matrix is where the cells are growing.

57
Q

What is the hair shaft? What types of cells are on the side of it?

A

The hair shaft is the hair that projects from the surface. The stem cells are on the side of hair shafts which can initiate the growth of new follicles after old ones fall out.

58
Q

What is the fibrous structure of hair?

A

Microfibrils made of protofibrils are wound together to make macrofibrils. Those macrofibrils are packed together to make one strand of hair.

59
Q

Explain how moisture affects hair?

A
  • Hair retains moisture.
  • Depending on the season or where you are, moisture content will change.
  • Curly hair becomes less curly when you dry it, part of the crew is related to hydrogen bonds of water.
  • Water content of the hair is different at different relative humidity. More humid weathers, more water is retained in the hair, which makes the hair curl more.
  • Heat dried hair retains a lower moisture content, which could explain why once hair might look different in the summer and in the winter.
60
Q

Why is the max length of hair usually 3 feet?

A

Because hair falls off after a certain time which does not allow it to reach longer lengths. Some people are able to grow it longer, but it is unusual.

61
Q

What is the cycle of hair growth?

A

Bulge stem cells go to the bottom of the hair follicle to be able to create new hairs. Hair continually grows. The part below his skin is alive and the hair that extends out is dead.
1. Anagen active growth phase: follicles usually grow for 2 to 6 years.
2. The catagen or transition phase: The follicle stops growing and shrivels up. This happens for 1 to 2 weeks.
3. Telogen or resting phase: hair is ready to fall out this last 5 to 6weeks.
New germ cells are now ready to propagate and start new growth. As the old hair follicle falls out it returns to the anagen phase and a new hair follicle will start to grow. This is why hair regularly falls out.

62
Q

What alters hair growth?

A
  1. The season: beard growth increases in July while scalp hair sheds in the summer
  2. Hormones:
    - Higher levels of estrogen and progesterone during pregnancy leave causes hair to stay in the anagen phase so they keep growing. During pregnancy, the growth of the hair on the head gets thicker and healthy looking.
    - When you get the drop of hormones after delivery, all of the retained follicles in anagen go into the telogen phase. You lose all the hair you would have lost if you were not pregnant, plus a few more, as hair normally falls out regularly. It can be fairly dramatic but goes back to normal after some time.
63
Q

What can damage hair? Explain.

A
  1. Sun
  2. Backcombing/teasing: The normal cuticle lies flat and ordinary combing doesn’t ruffle the cells on the cuticle. Backcombing goes against the cuticle grain, lifts, and tears the cells. It also causes the hair to tangle. This causes the shaft to become seriously damaged.
  3. Chlorine: damages outer layer of the hair (cuticle) creating little bulges. Wear a swimming cap.
  4. Heat: In order to go from one texture of hair to another you have to break the hydrogen bonds with heat and then reform them. Heating hair cannot break the disulfide bonds. Heating hair can melt the hair if it’s too hot, therefore you should use medium heat when blow-drying not high heat.
  5. Bleaching: by the sun or by peroxide causes damage of melanin which causes a structural shift and a change in refraction of light and colour.
64
Q

Where is hair more likely to be damaged? Why?

A

More likely to be damaged at the distal end than the proximal end. Because it has been exposed to heat, brushing, etc.

65
Q

Does hairspray damage hair?

A

No. It coats and thickens the hairs, stiffening them, but it does not actually damage the hair as it stays on the surface to keep your hair in position and leaves when you wash them.

66
Q

What happens to the hair bonds when you wet your hair?

A

When you wet your hair, it makes the hydrogen bonds of keratin in the cortex come apart. This can allow for temporary curling or straightening of hair.

67
Q

How can you achieve permanent curling or straightening of hair?

A

You have to break the disulfide bonds of keratin in the cortex of the hair using chemicals. Then, you can reform them in a different configuration using other chemicals.

68
Q

How do people have different natural hair colours?

A

Tyrosine (amino acid) is transormed into eumelanin or pheomelanin (melanins) which can be inserted into the hair shaft separately or as a mixture to cause different pigmentations.

69
Q

Why do people get gray/white hair?

A

Through time and age, people may stop making melanin, so melanin stops getting put into the hair shaft, and you lose the colour.

70
Q

How do hair dyes work? What are the different types?

A

When you apply something to the surface of hair, it normally will not get into the cortex because you have the layer of cuticle which is condensed keratin to keep things out of the centre of the hair. So surface dyes do not damage the hair because they don’t penetrate it. Transcellular diffusion is an unlikely way to go about changing the colour of your hair.

  • The simplest way to change hair colour is to put on a temporary dye where the dye sticks to the cuticle and will eventually wash off.
  • Semi-permanent dye lies mostly on the cuticle but some permeates the cortex so it lasts for a bit longer.
  • Permanent dye lies in the ventral shaft and the cuticle has to be raised to get the guy into the core.
  • Bleach destroys natural hair colour pigments and raises the cuticle.
71
Q

What is baldness?

A
  • Normally we lose 50 to 100 hairs per day.
  • In males with baldness, terminal hairs are replaced by vellus (soft little thin hairs) and there are less of them therefore, most hairs are lost.
  • Baldness takes years to develop and there are different patterns of male baldness (sometimes starts in the front and sometimes in the back).
  • A similar phenomenon can happen in women but it’s thinning of the hair rather than complete loss of hair.
72
Q

What can be used to treat baldness?

A
  1. Rogaine Minoxidil: Increases follicular size and prolongs the anagen phase of hair growth. The first drug to be used exclusively for cosmetic reasons.
  2. Transplantation: Susceptibility to loss is different at different parts of the head. Plugs of hair from the back of the head are transplanted to the bald patch. The new hair is sparse but permanent.
  3. Finasteride (Propecia): alters 5-alpha-reductase which is the enzyme that converts testosterone from dihydrotestosterone. It is a systemic treatment that blocks DHT production to prevent baldness. It is more efficient if used before baldness becomes extensive. Should not be taken by pregnant women because it is teratogenic.
73
Q

What is the hormonal cause of baldness?

A

Baldness is induced by testosterone which is why baldness occurs more frequently in men than women. The spurt of testosterone in puberty triggers the beginning of baldness in males who are susceptible to it. Dihydrotestosterone, a derivative of testosterone, acts on the nucleus of follicles to cause changes.

74
Q

What is fluoride used for? Where is it found?

A

Fluoride has been added to toothpaste to prevent cavities and gingivitis. The lack of fluoride can cause huge cavities in early adulthood leading to severe tooth decay. It is an antimicrobial compound that should be used twice daily. Fluoride strengthens the mineral lattice of teeth against bacterial erosion and it is found naturally in various foods and in sources of water.

75
Q

What can an overdose of fluoride cause?

A
  • Mild overdose: white spots on teeth

- Severe overdose: fluorosis

76
Q

What can happen if women take tetracycline during pregnancy?

A

The kids get tooth discolouration because tetracyclin accumulates in teeth.

77
Q

What is gingival hyperplasia? What is it caused by?

A

It is when gums grow over teeth which is caused by phenytoin therapy (drug used to treat seizures).

78
Q

What is the ratio of gum disease in the population? What are the 2 types?

A
  • Ratio: 3 out of 4 people
    1. Periodontal disease: makes gums susceptible to bacteria. Bacteria grow around the teeth and cause the teeth to loosen at the base. Causes gum and teeth problems.
    2. Gingivitis: Inflammation of the gingiva which causes red and swollen gums that tend to bleed easily.
79
Q

How can you treat gingivitis?

A

You can treat gingivitis by using mouthwash or toothpaste that contain phenols as an active ingredient. Phenols interfere with bacteria that cause gingivitis.