Conventional and whitening toothpastes: Cytotoxicity, genotoxicity and effect on the enamel surface

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Effects of copper vapor laser irradiation (λ = 510.6 nm) on the enamel and dentine of human teeth: An ultra-structural morphologic study

Objective: A morphological and ultra-structural study of copper vapor laser (λ = 510.6 nm) effects on enamel and dentine was performed to show the effects of this radiation. Methods: A total of 15 human molars were cut in half; 15 pieces were separated for irradiation on enamel and 15 for dentine. These two groups were further divided into five experimental groups, including a control group, comprised of three half-sections each, irradiated by a CVL laser with a power of 7 W, a repetition rate of 15,000 pulses/sec and exposed at 500, 600, and 800 msec and 1 sec irradiation times with a 5-sec interval between irradiations. Results: In an ultra-structural SEM exam, we observed that on the enamel surfaces irradiated for 1 sec there was morphological alteration that consisted of catering, flaking, and melting on the surfaces. There was no alteration for the other exposure times. On the dentine teeth irradiated for 1 sec, we observed an evident ultra-structural alteration of melted tissue and loss of morphological characteristics. In the dentine group irradiated by 800 msec, we observed ablation and a partial loss of morphological characteristics. In the dentine groups irradiated by 500 and 600 msec, no alteration was observed. Conclusions: The results showed that irradiation with CVL promoted morphologic changes in the enamel as well as in the dentine and demonstrated a need for future studies in order to establish a safe protocol for further use in the odontological practice.

Resin tag length of one-step and self-etching adhesives bonded to unground enamel

Length of resin tags yielded by utilization of an one-step conventional adhesive system and self-etching adhesive system on unground enamel was observed. In study Groups I and III, the enamel surface was etched for 60 seconds with 35% phosphoric acid gel and adhesive systems PQ1 (Ultradent Products, Inc) and Adper Prompt L Pop (3M/ESPE) were applied. Adper Prompt L Pop (3M/ESPE) was also applied in Group II in accordance with the manufacturer's recommendations. After application of these adhesive systems to dental enamel, specimens were prepared for light microscopy analysis to ascertain degree of penetration (x400). The results were submitted to an analysis of variance at the 5% level; whenever there was significance, the Tukey test was applied at the 5% level. It was found that acid etching prior to application of conventional and self-etching adhesive materials provided higher penetration of the adhesive into the unground enamel surface compared to that achieved solely by application of self-etching adhesive.

Evaluation of the bleached human enamel by scanning electron microscopy

Since bleaching has become a popular procedure, the effect of peroxides on dental hard tissues is of great interest in research. Purpose: The aim of this in vitro study was to perform a qualitative analysis of the human enamel after the application of in-office bleaching agents, using Scanning Electron Microscopy (SEM). Materials and Methods: Twenty intact human third molars extracted for orthodontic reasons were randomly divided into four groups (n=5) treated as follows: G1- storage in artificial saliva (control group); G2- four 30-minute applications of 35% carbamide peroxide (total exposure: 2h); G3- four 2-hour exposures to 35% carbamide peroxide (total exposure: 8h); G4- two applications of 35% hydrogen peroxide, which was light-activated with halogen lamp at 700mW/cm2 during 7min and remained in contact with enamel for 20min (total exposure: 40min). All bleaching treatments adopted in this study followed the application protocols advised by manufacturers. Evaluation of groups submitted to 35% carbamide peroxide was carried out after two time intervals (30 minutes and 2 hours per session), following the extreme situations recommended by the manufacturer. Specimens were prepared for SEM analysis performing gold sputter coating under vacuum and were examined using 15kV at 500x and 2000x magnification. Results: Morphological alterations on the enamel surface were similarly detected after bleaching with either 35% carbamide peroxide or 35% hydrogen peroxide. Surface porosities were characteristic of an erosive process that took place on human enamel. Depression areas, including the formation of craters, and exposure of enamel rods could also be detected. Conclusion: Bleaching effects on enamel morphology were randomly distributed throughout enamel surface and various degrees of enamel damage could be noticed. Clinical significance: In-office bleaching materials may adversely affect enamel morphology and therefore should be used with caution.

Effects of dental bleaching on the color, translucency and fluorescence properties of enamel and dentin

The objective of this study was to evaluate the color, translucency and fluorescence of bovine enamel and dentin submitted to different bleaching modalities. Pairs of enamel and dentin discs (3 mm in diameter) were obtained from 150 bovine teeth. In 75 of the pairs, one specimen had the enamel removed (Dentin Group). The dentin was removed from one specimen of the remaining 75 pairs (Enamel Group) and the other specimen was left unaltered (Enamel + Dentin). The evaluation of color, translucency and fluorescence was performed with a spectrophotometer using the CIE L* a* b*. Each group was subdivided into three subgroups: Control, composed of specimens that were not bleached, and two experimental subgroups, bleached with either 10% carbamide peroxide (CP10%) or 35% hydrogen peroxide (HP35%). The CP10% bleaching gel was applied 2 h/day for 14 days. The HP35% bleaching agent was applied using two applications of 30 min each, with a one week interval between each application. When not being bleached, the specimens were immersed in artificial saliva. The color, translucency and fluorescence ratings were assessed using spectrophotometry 7 days after the treatment. Regarding color, significant differences were found between bleaching techniques in the groups Enamel and Enamel + Dentin, with a higher color difference for HP35%. Bleaching did not change the translucency of the dental tissues. There were significant differences for fluorescence for the HP35% subgroups of Dentin and Enamel + Dentin, and for the CP10% subgroup of Enamel. Dental bleaching changed the color and fluorescence of the dental tissues, however translucency was not affected.

In vitro effect of sodium trimetaphosphate additives to conventional toothpastes on enamel demineralization

The aim of this study was to evaluate the ability of conventional toothpastes (1100 ppm F) supplemented with sodium trimetaphosphate (TMP) in demineralization. Blocks of enamel were selected and then divided into seven experimental groups of 12: toothpaste without F and TMP (placebo), toothpaste with 1100 ppm F (1100), and toothpaste with 1100 ppm F supplemented with TMP-1 % (1100 1 % TMP), 3 % (1100 3 % TMP), 4.5 % (1100 4.5 % TMP), 6 % (1100 6 % TMP), and 9 % (1100 9 % TMP). Blocks were subjected to five pH cycles (demineralizing/remineralizing solutions) at 37 °C and treated with toothpaste slurries twice daily, after which the blocks were maintained for 2 days in fresh remineralizing solution. Following treatments, surface hardness (SHf) and cross-sectional hardness were determined for calculating the integrated loss of subsurface hardness (ΔKHN). The fluoride present in the enamel was also measured. The SHf and ΔKHN measurements showed that supplementation with 3 % TMP was the most effective (p < 0.001) and showed greater concentration of F in the enamel (p < 0.001). Addition of 3 % TMP to a conventional toothpaste (1100 ppm F) showed greater efficacy in reducing enamel demineralization. Fluoride toothpastes containing trimetaphosphate possess good anticaries potential required to reduce the prevalence of dental caries in high-risk patients.

In situ remineralizing effect of fluoride varnishes containing sodium trimetaphosphate

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

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.

Amoxicillin diminishes the thickness of the enamel matrix that is deposited during the secretory stage in rats

The use of amoxicillin during early childhood has been associated with molar incisor hypomineralization. The objective of this study was to determine whether the use of amoxicillin interferes with enamel development, during secretion and early mineralization stages. Fifteen pregnant rats were randomly assigned to three groups that received physiological solution (sham group), 100 mg/kg/day amoxicillin (A100G), and 500 mg/kg/day amoxicillin (A500G). After birth, the pups in each group received the same treatment until post-natal day 7 or 12. The upper first molars were analyzed histomorphometrical and immunostaining with amelogenin on day 7, and MMP-20 on day 12 was performed using a semiquantitative method (H-score). At 7 days, several vacuolar structures were observed in the ameloblasts in the A100G and A500G groups. A significant reduction of the enamel thickness (P < 0.001) was found in amoxicillin-treated rats compared with the sham group. Significant differences were not observed in enamel thickness (P > 0.05) between the groups of 12-day-old rats. Moreover, significant differences were not observed in the number of amelogenin- and MMP-20-immunolabeled ameloblasts (P > 0.05) between groups. The present results suggest that amoxicillin interferes with the initial stages of amelogenesis by causing structural changes in the ameloblasts and a reduction of the enamel matrix.

Responses of human dental pulp cells after application of a low-concentration bleaching gel to enamel

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Effect of home-bleaching gels modified by calcium and/or fluoride and the application of nano-hydroxyapatite paste on in vitro enamel erosion susceptibility

This in vitro study compared the effect of bleaching agents modified by the addition of calcium and/or fluoride and the application of a nano-hydroxyapatite paste after bleaching, on the susceptibility of enamel to erosion. Bovine enamel cylindrical samples (3 mm diameter) were assigned to six groups (n = 20 specimens/group) according to the bleaching agent: no bleaching (C-control), 7.5% hydrogen peroxide gel (HP), HP with 0.5% calcium gluconate (HP+Ca), HP with 0.2% sodium fluoride (HP+F), HP with calcium and fluoride (HP+Ca+F) and HP followed by the application of a nano-hydroxyapatite agent (HP+NanoP). The gels were applied on the enamel surface (1 h) followed by cyclic erosive challenges (Sprite Zero®-2 min), for 14 days. The paste was applied after bleaching for 5 min (HP+NanoP). The enamel surface alteration was measured by contact profilometry (µm) (after 7 and 14 days). C-control (mean ± SD: 2.29 ± 0.37 at 7 days/4.86 ± 0.72 at 14 days) showed significantly lower loss compared to the experimental groups. HP+Ca (3.34 ± 0.37/6.75 ± 1.09) and HP+F (4.49 ± 0.92/7.61 ± 0.90) presented significantly lower enamel loss than HP (4.18 ± 0.50/10.30 ± 1.58) only for 14 days and HP+Ca+F (4.92 ± 1.03/8.12 ± 1.52) showed values similar to the HP+F group. The HP+NanoP (5.51 ± 1.04/9.61 ± 1.21) resulted in enamel loss similar to the HP after 14 days. It was found that 7.5% hydrogen peroxide increased the susceptibility of enamel to erosion. The addition of calcium or fluoride to the bleaching gel reduced the erosion effect, while the nano-hydroxyapatite agent did not provide any protective effect.

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)

Fluoride gel supplemented with sodium hexametaphosphate reduces enamel erosive wear in situ

This study evaluated the effect of fluoride gels, supplemented or not with sodium hexametaphosphate (HMP), on enamel erosive wear in situ. Twelve healthy volunteers wore palatal appliances containing four bovine enamel discs. Subjects were randomly allocated into four experimental phases (double-blind, crossover protocol) according to the gels: Placebo (no fluoride or HMP), 1% NaF, 2% NaF, and 1% NaF+9% HMP. Enamel discs were selected after polishing and surface hardness analysis, and treated only once with the respective gels prior to each experimental phase. Erosion (ERO) was performed by extra-oral immersion of the appliance in 0.05M citric acid, pH 3.2 (four times/day, five minutes each, 5 days). Additional abrasion (ERO+ABR) was produced on only two discs by toothbrushing with fluoridated dentifrice after ERO (four times/day, 30s, 5 days). The specimens were submitted to profilometry and hardness analysis. The results were analyzed by two-way ANOVA and the Student-Newman-Keuls test (p<0.05). The 1% NaF+9% HMP gel promoted significantly lower enamel wear for ERO compared to the other groups, being statistically lower than 1% NaF and Placebo for ERO+ABR. Similarly, the lowest values of integrated lesion area were found for 1% NaF+9% HMP and 2% NaF, respectively, for ERO and ERO+ABR. The addition of HMP to the 1% NaF gel promoted greater protective effect against ERO and ERO+ABR compared to the 1% NaF gel, achieving similar protective levels to those seen for the 2% NaF gel. Gel containing 1% NaF+9% HMP showed a high anti-erosive potential, being a safer alternative when compared to a conventional 2% NaF gel.

In vitro effect of low-fluoride toothpastes containing sodium trimetaphosphate on enamel erosion

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Effect of Er:YAG laser on CaF2 formation and its anticariogenic action on human enamel: An in vitro study

Objective: The objective of this study was to evaluate the effect of Er: YAG laser on the formation of CaF2, after the application of acidulated phosphate fluoride (APF), and its influence on the anti-cariogenic action in human dental enamel. Background Data: Er:YAG laser was designed to promote ablation of the enamel. However, the possibility of using this energy to increase the enamel's resistance to caries has hardly been explored, and neither has its interaction with the use of fluorides. Materials and Methods: One hundred and twenty blocks of enamel were allocated to four groups of 30 blocks each: (1) C, control group; (2) Er:YAG, laser; (3) APF; and (4) Er:YAG+APF. Of these, 80 blocks were submitted to pH cycling for 14 days. In the other 40 blocks, fluoride (CaF2) was measured before cycling. After pH cycling, surface microhardness (SMH), microhardness in cross-section (converted to mineral contents % vol. min.), and fluoride after cycling (40 blocks) were also determined. Results: SMH decreased in all groups. The control group showed the highest decrease, and Er:YAG+APF showed the lowest decrease (p < 0.05). Groups APF and Er:YAG showed the same results (p > 0.05). Mineral content at depths 10, 20, and 40 μm was lower in the control and Er:YAG groups, and higher in groups APF and Er:YAG+APF. CaF2 (μgF/cm2) deposited before pH cycling was higher in the APF group when compared to the Er:YAG+APF group. Control and Er:YAG groups showed the lowest values (p > 0.05). Conclusion: It was concluded that Er:YAG laser influenced the deposition of CaF2 on the enamel and showed a superficial anti-cariogenic action, but not in depth.