Synergistic effect of fluoride and sodium hexametaphosphate in toothpaste on enamel demineralization in situ

To evaluate the effect of a fluoride dentifrice containing sodium hexametaphosphate (HMP) on enamel demineralization in situ. This double-blind and cross-over study consisted of 3 phases (7 days each) in which 12 volunteers wore intraoral appliances containing four enamel bovine blocks. Specimens were treated (3×/day) with placebo (no F or HMP), 1100ppm F (1100F) and 1100F plus HMP1% (1100F-HMP1%) toothpastes, and the cariogenic challenge was performed using a 30% sucrose solution (6×/day). Final surface hardness, the percentage of surface hardness loss (%SH), the integrated loss of subsurface hardness (ΔKHN), as well as enamel calcium (Ca), phosphorus (P) and firmly-bound fluoride (F) were determined. Also, biofilm formed on the blocks were analyzed for F, Ca, P and insoluble extracellular polysaccharide (EPS) concentrations. Data were submitted 1-way ANOVA, followed by Student-Newman-Keuls' test (p<0.05). 1100F-HMP1% promoted the lowest %SH and ΔKHN among all groups (p<0.001). The addition of HMP1% to 1100F did not enhance enamel F uptake, but significantly increased enamel Ca concentrations (p<0.001). Similar EPS concentrations were seen for 1100F-HMP1% and 1100F groups (p>0.05). All the groups were supersaturated with respect to HA. However, only 1100F-HMP1% group was supersaturated with respect to CaF2 (p<0.05). The ionic activities of F(-), CaF(+) and HF(0) for the 1100F-HMP1% group were the highest among all groups (p<0.001). The addition of HMP1% to a conventional toothpaste significantly reduces enamel demineralization in situ when compared to 1100F. This dentifrice could be a viable alternative to patients at high risk of caries.

Effectiveness of a toothpaste with low fluoride content combined with trimetaphosphate on dental biofilm and enamel demineralization in situ

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Titanium surface topography after brushing with fluoride and fluoride-free toothpaste simulating 10 years of use

Objectives: To conduct a controlled study contrasting titanium surface topography after procedures that simulated 10 years of brushing using toothpastes with or without fluoride. Methods: Commercially pure titanium (cp Ti) and Ti-6Al-4V disks (6 mm circle divide x 4 mm) were mirror-polished and treated according to 6 groups (n = 6) as a function of immersion (I) or brushing (B) using deionised water (W), fluoride-free toothpaste (T) and fluoride toothpaste (FT). Surface topography was evaluated at baseline (pretreatment) and post-treatment, using atomic force microscope in order to obtain three-dimensional images and mean roughness. Specimens submitted to immersion were submerged in the vehicles without brushing. For brushed specimens, procedures were conducted using a linear brushing machine with a soft-bristled toothbrush. Immersion and brushing were performed for 244 h. IFT and BFT samples were analysed under scanning electron microscope with Energy-Dispersive X-ray Spectroscopy (EDS). Pre and post-treatment values were compared using the paired Student T-test (alpha = .05). Intergroup comparisons were conducted using one-way ANOVA with Tukey post-test (alpha = .05). Results: cp Ti mean roughness (in nanometers) comparing pre and post-treatment were: IW, 2.29 +/- 0.55/2.33 +/- 0.17; IT, 2.24 +/- 0.46/2.02 +/- 0.38; IFT, 2.22 +/- 0.53/1.95 +/- 0.36; BW, 2.22 +/- 0.42/3.76 +/- 0.45; BT, 2.27 +/- 0.55/16.05 +/- 3.25; BFT, 2.27 +/- 0.51/22.39 +/- 5.07. Mean roughness (in nanometers) measured in Ti-6Al-4V disks (pre/post-treatment) were: IW, 1.79 +/- 0.25/2.01 +/- 0.25; IT, 1.61 +/- 0.13/1.74 +/- 0.19; IFT, 1.92 +/- 0.39/2.29 +/- 0.51; BW, 2.00 +/- 0.71/2.05 +/- 0.43; BT, 2.37 +/- 0.86/11.17 +/- 2.29; BFT, 1.83 +/- 0.50/15.73 +/- 1.78. No significant differences were seen after immersions (p > .05). Brushing increased the roughness of cp Ti and of Ti-6Al-4V (p < .01); cp Ti had topographic changes after BW, BT and BFT treatments whilst Ti-6Al-4V was significantly different only after BT and BTF. EDS has not detected fluoride or sodium ions on metal surfaces. Conclusions: Exposure to toothpastes (immersion) does not affect titanium per se; their use during brushing affects titanium topography and roughness. The associated effects of toothpaste abrasives and fluorides seem to increase roughness on titanium brushed surfaces. (C) 2012 Elsevier Ltd. All rights reserved.

Effect of whitening toothpaste on titanium and titanium alloy surfaces

Dental implants have increased the use of titanium and titanium alloys in prosthetic applications. Whitening toothpastes with peroxides are available for patients with high aesthetic requirements, but the effect of whitening toothpastes on titanium surfaces is not yet known, although titanium is prone to fluoride ion attack. Thus, the aim of the present study was to compare Ti-5Ta alloy to cp Ti after toothbrushing with whitening and conventional toothpastes. Ti-5Ta (%wt) alloy was melted in an arc melting furnace and compared with cp Ti. Disks and toothbrush heads were embedded in PVC rings to be mounted onto a toothbrushing test apparatus. A total of 260,000 cycles were carried out at 250 cycles/minute under a load of 5 N on samples immersed in toothpaste slurries. Surface roughness and Vickers microhardness were evaluated before and after toothbrushing. One sample of each material/toothpaste was analyzed by Scanning Electron Microscopy (SEM) and compared with a sample that had not been submitted to toothbrushing. Surface roughness increased significantly after toothbrushing, but no differences were noted after toothbrushing with different toothpastes. Toothbrushing did not significantly affect sample microhardness. The results suggest that toothpastes that contain and those that do not contain peroxides in their composition have different effects on cp Ti and Ti-5Ta surfaces. Although no significant difference was noted in the microhardness and roughness of the surfaces brushed with different toothpastes, both toothpastes increased roughness after toothbrushing.

Clinical and antibacterial effect of an anti-inflammatory toothpaste formulation with Scutellaria baicalensis extract on experimental gingivitis

It was the aim of the study to evaluate the clinical and antibacterial effect of a dentifrice containing an anti-inflammatory plant extract (SB) versus a placebo (PLA) using an experimental gingivitis model. Forty subjects (20 per group) discontinued all oral hygiene measures for four teeth for a period of 21 days using a shield (to generate a possible gingivitis) while they could brush the other teeth normally. After brushing, the shield was removed and teeth were treated with the randomly assigned toothpaste slurry for 1 min. Löe and Silness gingival index (GI), Silness and Löe plaque index (PI), and biofilm vitality (VF%) were assessed at days 0, 14, and 21, respectively. Subjects of the PLA group developed a GI of 0.82?±?0.342 (day 14) and 1.585?±?0.218 (day 21), while the data of the SB group were significantly reduced (0.355?±?0.243 and 0.934?±?0.342, p?toothpaste formulation was able to significantly reduce the extent of gingivitis, plaque development, and vital flora.

Randomised in situ study on the efficacy of a tin/chitosan toothpaste on erosive-abrasive enamel loss

Tin is a notable anti-erosive agent, and the biopolymer chitosan has also shown demineralisation-inhibiting properties. Therefore, the anti-erosive/anti-abrasive efficacy of the combination of both compounds was tested under in situ conditions. Twenty-seven volunteers were included in a randomised, double-blind, three-cell crossover in situ trial. Enamel specimens were recessed on the buccal aspects of mandibular appliances, extraorally demineralised (6 × 2 min/day) and intraorally treated with toothpaste slurries (2 × 2 min/day). Within the slurry treatment time, one-half of the specimens received additional intraoral brushing (5 s, 2.5 N). The tested toothpastes included a placebo toothpaste, an experimental NaF toothpaste (1,400 ppm F(-)) and an experimental F/Sn/chitosan toothpaste (1,400 ppm F(-), 3,500 ppm Sn(2+), 0.5% chitosan). The percentage reduction of tissue loss (slurry exposure/slurry exposure + brushing) compared to placebo was 19.0 ± 47.3/21.3 ± 22.4 after use of NaF and 52.5 ± 30.9/50.2 ± 34.3 after use of F/Sn/chitosan. F/Sn/chitosan was significantly more effective than NaF (p ≤ 0.001) and showed good efficacy against erosive and erosive-abrasive tissue loss. This study suggests that the F/Sn/chitosan toothpaste could provide good protection for patients who frequently consume acidic foodstuffs.

Effect of a chitosan additive to a Sn(2+)-containing toothpaste on its anti-erosive/anti-abrasive efficacy-a controlled randomised in situ trial

OBJECTIVES It is well known that Sn(2+) is a notable anti-erosive agent. There are indications that biopolymers such as chitosan can enhance the effect of Sn(2+), at least in vitro. However, little information exists about their anti-erosive/anti-abrasive in situ effects. In the present in situ study, the efficacy of Sn(2+)-containing toothpastes in the presence or absence of chitosan was tested. METHODS Ten subjects participated in the randomised crossover study, wearing mandibular appliances with human enamel specimens. Specimens were extraorally demineralised (7 days, 0.5 % citric acid, pH 2.6; 6 × 2 min/day) and intraorally exposed to toothpaste suspensions (2 × 2 min/day). Within the suspension immersion time, one half of the specimens were additionally brushed intraorally with a powered toothbrush (5 s, 2.5 N). Tested preparations were a placebo toothpaste (negative control), two experimental toothpastes (F/Sn = 1,400 ppm F(-), 3,500 ppm Sn(2+); F/Sn/chitosan = 1,400 ppm F(-), 3,500 ppm Sn(2+), 0.5 % chitosan) and an SnF2-containing gel (positive control, GelKam = 3,000 ppm Sn(2+), 1,000 ppm F(-)). Substance loss was quantified profilometrically (μm). RESULTS In the placebo group, tissue loss was 11.2 ± 4.6 (immersion in suspension) and 17.7 ± 4.7 (immersion in suspension + brushing). Immersion in each Sn(2+)-containing suspension significantly reduced tissue loss (p ≤ 0.01); after immersion in suspension + brushing, only the treatments with GelKam (5.4 ± 5.5) and with F/Sn/chitosan (9.6 ± 5.6) significantly reduced loss [both p ≤ 0.05 compared to placebo; F/Sn 12.8 ± 6.4 (not significant)] CONCLUSION Chitosan enhanced the efficacy of the Sn(2+)-containing toothpaste as an anti-erosive/anti-abrasive agent. CLINICAL RELEVANCE The use of Sn(2+)- and chitosan-containing toothpaste is a good option for symptomatic therapy in patients with regular acid impacts.

Combined effect of a fluoride-, stannous- and chitosan-containing toothpaste and stannous-containing rinse on the prevention of initial enamel erosion-abrasion.

OBJECTIVES The aim of this study was to assess the preventive effect of a fluoride-, stannous- and chitosan-containing (F/Sn/chitosan-) toothpaste (TP) on initial enamel erosion and abrasion. METHODS In total, 150 human premolar enamel specimens were ground, polished and divided into 5 toothpaste/rinse groups (n=30): (G1) placebo-TP/tap water, (G2) sodium fluoride (NaF-) TP/tap water, (G3) F/Sn/chitosan-TP/tap water, (G4) F/Sn/chitosan-TP/Sn-rinse, (G5) NaF-TP/NaF-rinse. The 8-day erosion-abrasion cyclic treatment (one cycle/day) consisted of incubating the samples in artificial saliva (30min), then submitting the samples to toothbrush abrasion (2min incubation in toothpaste slurry; brushing with 20 toothbrush strokes) and rinsing (2min; 10ml) with the respective solution: tap water (G1-G3), Sn-rinse (G4) or NaF-rinse (G5). Afterwards, the samples were submitted to erosion (2min; 30ml 1% citric acid, pH=3.6). Surface microhardness (SMH) was measured initially and after every abrasion and erosion treatment. Enamel substance loss was calculated after each abrasion. Non-parametric ANOVA followed by Wilcoxon rank tests were used for analysis. RESULTS G1 presented the greatest SMH decrease, while G4 presented the least SMH decrease (p<0.001). G3 had a similar SMH decrease to G2 and G5. Substance loss was significantly lower in G4 than all other groups (p<0.05), closely followed by G3. Both G2 and G5 showed similar calculated enamel substance loss to G1. CONCLUSION The treatment with F/Sn/chitosan-TP and tap water provided a similar SMH decrease to both NaF-TP groups, but significantly lower substance loss. F/Sn/Chitosan-TP and Sn-rinse showed a better preventive effect, which promoted less SMH decrease and reduced substance loss. CLINICAL SIGNIFICANCE The toothpaste containing fluoride, stannous and chitosan shows promising results in reducing substance loss from erosion and abrasion. The combination of this toothpaste with the stannous-containing rinse showed even better prevention against erosion-abrasion.

The in vitro impact of toothpaste extracts on cell viability.

Toothpastes contain three main components: detergents, abrasives, and fluoride. Detergents, particularly sodium lauryl sulfate, have been proposed as components that enable toothpastes to produce cytotoxic effects in vitro. However, not all toothpastes contain sodium lauryl sulfate, and almost no studies have found an association between detergents and the in vitro cytotoxicity of toothpastes. The present study examined the in vitro cytotoxicity of nine commercially available toothpastes containing four different detergents. Toothpastes were diluted in serum-free medium, centrifuged, and filter sterilized. The half-lethal concentration of the toothpaste-conditioned medium (TCM) was calculated based on the formation of formazan by gingival fibroblasts, oral squamous cell carcinoma HSC-2 cells, and L929 cells. Cell proliferation was analyzed, and live-dead staining was performed, after exposure of cells to conditioned medium prepared with 1% toothpaste (1% TCM). It was found that toothpastes containing sodium lauryl sulfate and amine fluoride strongly inhibited cell viability with the half-lethal concentration being obtained with conditioned medium prepared with approximately 1% toothpaste (1% TCM). Toothpastes containing cocamidopropyl betaine and Steareth-20 showed higher half-lethal concentration values, with the half-lethal concentration being obtained with conditioned medium prepared with 10% (10% TCM) and 70% (70% TCM) toothpaste, respectively. Proliferation and live-dead data were consistent with the cell-viability analyses. These results demonstrate that the type of detergent in toothpastes can be associated with changes in in vitro cell toxicity.

Color stability and surface roughness of artificial teeth brushed with an experimental Ricinus communis toothpaste

Aim: To evaluate, in vitro, the effect of brushing with a Ricinus communis -based experimental toothpaste on color stability and surface roughness of artificial teeth. Methods: Ninety artificial teeth (maxillary central incisors) in different shades, light and dark (NatusDent Triple Pressing, Dentbras) were used. Initial color (Spectrophotometer Easyshade, VITA) and surface roughness (Rugosimeter Surfcorder SE 1700, Kosakalab) readouts were performed. After baseline measurements, samples were assigned to 10 groups (n=9) according to the artificial tooth shade and type of toothpaste used during the mechanical brushing test (Pepsodent, MAVTEC): Sorriso Dentes Brancos – SDB, Colgate Luminous White - CLW (Colgate-Palmolive), Close up White Now - CWN (Unilever), Trihydral - THL (Perland Pharmacos) and Ricinus communis - RCE (Experimental). After 29,200 cycles of brushing, corresponding to 2 years of brushing by a healthy individual, new color and roughness readouts of the specimens were performed. Data (before and after the tests) were statistically analyzed (2-way repeated measures ANOVA, Tukey, p<0.05). Results: RCE toothpaste produced the greatest color stability for dark tooth shade and the second best color stability for light tooth shade. For surface roughness alteration, there was no difference (p>0.05) for any tested toothpaste regardless of tooth shade. Conclusions: The experimental Ricinus communis toothpaste did not cause color and surface roughness alteration in the artificial teeth, and it may be considered a suitable option for denture cleaning.

Educação e motivação em saúde bucal: prevenindo doenças e promovendo saúde em pacientes sob tratamento ortodôntico

INTRODUÇãO: os cirurgiões-dentistas têm a responsabilidade de prevenir doenças, minimizar riscos e promover saúde. Os pacientes também precisam ser despertados sobre o seu papel nos cuidados com a saúde bucal. No caso de pacientes em tratamento ortodôntico, é particularmente difícil manter uma higiene bucal satisfatória devido à presença de bandas, fios e ligaduras. Torna-se, então, indispensável a instituição de métodos preventivos de motivação e orientação para o controle mecânico da placa dentária. OBJETIVO: verificar os efeitos de ações educativas, preventivas e motivacionais sobre a saúde bucal de pacientes em tratamento ortodôntico fixo. MéTODOS: os participantes receberam gratuitamente dentifrício e escova dental durante todo o estudo e instruções sobre higiene bucal foram fornecidas e reforçadas no decorrer dos 6 meses da pesquisa. Foram realizados exames clínicos baseline e após 6, 12 e 24 semanas, para verificação dos índices de Placa, Gengival e Sangramento. RESULTADOS: as condições de saúde bucal dos participantes, que inicialmente eram insatisfatórias, melhoraram significativamente no decorrer do estudo, considerando-se todos os índices. As ações preventivas, educativas e motivacionais realizadas foram estatisticamente eficazes na melhora da saúde bucal dos pacientes ortodônticos. CONCLUSõES: a promoção de saúde e a prevenção de doenças devem fazer parte do atendimento que os ortodontistas direcionam aos seus pacientes, sendo que a orientação e motivação quanto aos cuidados com a saúde bucal devem estar presentes antes e durante o tratamento.

Novo protocolo para as ações de saúde bucal coletiva: padronização no armazenamento, distribuição e uso do material de higiene bucal

Este trabalho avaliou o material de higiene bucal usado em escolas para estabelecer um protocolo às ações de higiene bucal coletiva. O estudo foi dividido em duas etapas: 1ª- 20 responsáveis pelos procedimentos coletivos com escolares de Bauru e São José dos Campos - SP responderam a dois questionários sobre o uso de cinco kits de higiene bucal coletiva. A análise estatística foi realizada através do teste Wilcoxon (p < 0,05); 2ª - 178 escolares de 4 a 8 anos de Bauru e Bariri-SP dispensaram na escova uma quantidade de creme dental e dentifrício líquido para a prática da escovação, a qual foi pesada através de uma balança portátil. A análise estatística foi obtida através do coeficiente de correlação de Pearson e a análise de covariância (p< 0,05). O kit 5 obteve graus de satisfação e muita satisfação quando comparado aos kits 1 a 4. A quantidade de creme dental dispensada pelos escolares foi em média 0,41g (Bauru) e 0,48g (Bariri). Não houve diferença estatística entre os escolares de Bauru e Bariri em relação ao dentifrício líquido (média de 0,15g). O dentifrício líquido, através da "técnica da gota", foi considerado prático, dispensando uma pequena quantidade padronizada. O kit 5 demonstrou ser uma boa alternativa ao estabelecimento de um protocolo de ações em saúde bucal coletiva no SUS.

Assessment in vitro of brushing on dental surface roughness alteration by laser interferometry

Noncarious cervical lesions (NCCLs) are considered to be of multifactorial origin, normally associated with inadequate brushing. This study assessed the influence in vitro of simulated brushing on NCCL formation. Fifteen human premolars were submitted to brushing in the cementoenamel junction region, using hard-, medium- and soft-bristled brushes associated with a toothpaste of medium abrasiveness under a 200 g load, at a speed of 356 rpm for 100 minutes. The surface topography of the region was analyzed before and after brushing, by means of a laser interferometer, using "cut-off" values of 0.25 and considering roughness values in mm. The initial roughness (mm) results for dentin (D / bristle consistency: 1 - soft, 2 - medium and 3 - hard) were as follows: (D1) 1.25 ± 0.45; (D2) 1.12 ± 0.44; (D3) 1.05 ± 0.41. For enamel (E / bristle consistency: 1 - soft, 2 - medium and 3 - hard), the initial results were: (E1) 1.18 ± 0.35; (E2) 1.32 ± 0.25; (E3) 1.50 ± 0.38. After brushing, the following were the values for dentin: (D1) 2.32 ± 1.99; (D2) 3.30 ± 0.96; (D3) Over 500. For enamel, the values after brushing were: (E1) 1.37 ± 0.31; (E2) 2.15 ± 0.90; (E3) 1.22 ± 0.47. Based on the results of the ANOVA and Tukey statistical analyses (a = .05) it was concluded that soft, medium and hard brushes are not capable of abrading enamel, whereas dentin showed changes in surface roughness by the action of medium- and hard-bristled brushes.

Low-Fluoride Acidic Dentifrice: A Randomized Clinical Trial in a Fluoridated Area

Background: Low-fluoride dentifrices have been suggested as alternatives to reduce dental fluorosis risk, but there is no consensus regarding their clinical effectiveness, which has been suggested to be increased when their pH is acidic. Aims: This single-blind randomized clinical trial evaluated the caries increment during the use of a low-fluoride acidic liquid dentifrice. Methods: Four-year-old schoolchildren (n = 1,402) living in a fluoridated area (0.6-0.8 ppm F) were randomly allocated to 4 groups differing according to the type of dentifrice used over a 20-month period. Group 1 (n = 345): liquid dentifrice, 1,100 ppm F, pH 4.5. Group 2 (n = 343): liquid dentifrice, 1,100 ppm F, pH 7.0. Group 3 (n = 354): liquid dentifrice, 550 ppm F, pH 4.5. Group 4 (n = 360): toothpaste, 1,100 ppm F, pH 7.0. At baseline and after 20 months, clinical examinations were conducted (dmfs index) and caries increment was calculated. Data were analysed by GLM procedure using classrooms (cluster) as unit of analysis (p < 0.05). Results: The mean +/- SD (95% CI) net increments found were as follows. Group 1: 2.06 +/- 2.38 (1.8-2.3); group 2: 2.08 +/- 2.87 (1.7-2.4); group 3: 2.05 +/- 2.79 (1.7-2.4), and group 4: 2.08 +/- 2.34 (1.8-2.4). No significant differences were detected among the groups. Conclusion: In a population with high caries risk living in a fluoridated area, as the selected sample, and according to the present protocol, the low-fluoride acidic liquid dentifrice seems to lead to similar caries progression rates as conventional 1,100 ppm F toothpaste. Copyright (C) 2010 S. Karger AG, Basel

Preventive Effect of Commercial Desensitizing Toothpastes on Bovine Enamel Erosion in vitro

This study evaluated in vitro commercial desensitizing toothpastes with respect to the prevention of erosion and explored the effect of their agents alone or in combination with fluoride. Bovine enamel blocks were randomly allocated to five groups of 20 and exposed to: Sensodyne ProNamel (1,425 ppm F as NaF, 5% KNO(3)), Sensodyne Original (no fluoride, 10% SrCl(2)), Colgate Sensitive (1,450 ppm F as sodium monofluorophosphate, 5% K citrate), Crest (fluoride-only toothpaste, 1,100 ppm F as NaF) and water (negative control). A second experiment was conducted with experimental dentifrices containing fluoride (NaF, 1,100 ppm F), 10% SrCl(2), 5% KNO(3) or 5% K citrate alone or the latter three combined with F. The samples were submitted to four cycles, alternating demineralization (cola, 10 min) and remineralization (artificial saliva, 1 h). Before and between cyclic de- and remineralization, blocks were treated with slurries of the respective toothpastes or water (1 min). Erosive tissue loss was analyzed by profilometry. Data were analyzed by Kruskal-Wallis and Dunn`s tests (p < 0.05). The mean erosion depth (+/- SE, mu m) was significantly less for Colgate Sensitive (0.04 +/- 0.00), Sensodyne Original (0.06 +/- 0.01) and Crest (0.07 +/- 0.01) than for Sensodyne ProNamel (2.36 +/- 0.25) or water (2.92 +/- 0.24), which did not significantly differ from each other. Both F and the desensitizing agents alone reduced erosion, but no additive effect was found. In addition, the combination of F and KNO(3) did not reduce erosion. These in vitro results suggest that the presence of fluoride or desensitizing substances in toothpastes, alone or in combination, can reduce erosion of enamel, but this is not valid for all the formulations. Copyright (C) 2010 S. Karger AG, Basel