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Ramos-Oliveira TM, Silva CV, Nunes PMA, Turssi CP, Rechmann P, Freitas PMD. AmF/NaF/SnCl2 solution reduces in situ enamel erosion - profilometry and cross-sectional nanoindentation analysis. Braz Oral Res 2017; 31:e20. [PMID: 28273206 DOI: 10.1590/1807-3107bor-2017.vol31.0020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 01/24/2017] [Indexed: 11/22/2022] Open
Abstract
This in situ study aimed to investigate the effect of a tin-containing fluoride solution in preventing enamel erosion. Also, its effects on the partly demineralized zone were assessed for the first time. Thirteen volunteers participated in this 2-phase study, wearing removable intra-oral appliances containing four sterilized bovine enamel slabs, for 8 days, where 2 treatment protocols were tested using samples in replicas (n = 13): CO - no treatment (negative control) and FL - AmF/NaF/SnCl2 solution (500 ppm F-, 800 ppm Sn2+, pH = 4.5). Samples were daily exposed to an erosive challenge (0.65% citric acid, pH 3.6, 4 min, 2x/day). In the 2nd phase, volunteers switched to the other treatment protocol. Samples were evaluated for surface loss using a profilometer (n = 13) and a cross-sectional nanohardness (CSNH) test (n = 13) was carried out in order to determine how deep the partly demineralized zone reaches below the erosive lesion. The data were statistically analyzed by two-way ANOVA. Erosive challenges lead to smaller enamel surface loss (p < 0.001) in the FL group when compared to group CO. Data from CSNH showed that there was no significant difference in demineralized enamel zone underneath erosion lesions between the groups. An amorphous layer could be observed on the surface of enamel treated with tin-containing solution alone. Under the experimental conditions of this in situ study, it can be concluded that AmF/NaF/SnCl2 solution prevents enamel surface loss but does not change the hardness of the partly demineralized zone near-surface enamel.
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Affiliation(s)
| | - Camila Vieira Silva
- Universidade de São Paulo - USP, School of Dentistry, Department of Restorative Dentistry, São Paulo, SP, Brazil
| | | | - Cecília Pedroso Turssi
- São Leopoldo Mandic Institute and Dental Research Center, Department of Restorative Dentistry, Campinas, SP, Brazil
| | - Peter Rechmann
- University of California San Francisco, School of Dentistry, Department of Preventive and Restorative Dental Sciences, São Francisco, CA, United States
| | - Patricia Moreira de Freitas
- Universidade de São Paulo - USP, School of Dentistry, Department of Restorative Dentistry, São Paulo, SP, Brazil
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Pini NIP, Schlueter N, Sundfeld D, Semper Hogg W, Santos-Silva AR, Lopes MA, Aguiar FHB, Lovadino JR, Lima DANL. Efficacy of Stannous Ions on Enamel Demineralization under Normal and Hyposalivatory Conditions: A Controlled Randomized in situ Pilot Trial. Caries Res 2017; 51:543-553. [PMID: 28977796 DOI: 10.1159/000479041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 06/25/2017] [Indexed: 11/19/2022] Open
Abstract
The study aim was to investigate the effect of antierosive agents on enamel under normal and hyposalivatory conditions. This double-blind crossover in situ pilot study evaluated 4 toothpastes: placebo (0 ppm F), sodium fluoride (NaF, 1,450 ppm), stannous/sodium fluoride (SnF/NaF, 1,450 ppm F-, 1,090 ppm Sn2+), and sodium fluoride, stannous chloride and chitosan (NaF/Sn/Ch, 1,450 ppm F-, 3,500 ppm Sn2+, 0.5% Ch). Twenty participants were assigned to 2 groups (n = 10 each): normal and low salivary flow. Participants wore palatal appliances holding 4 bovine enamel specimens previously eroded in vitro (D1) for 20 min prior to an in situ phase after which they were eroded again (D2). Surface microhardness was determined at baseline (BL), after D1, in situ phase and D2 to assess hardness loss (%SMH), residual hardness loss (%RHL) and erosion resistance (%RER). Additional specimens were evaluated by scanning electron microscopy after the in situ phase. ANOVA and a factorial analysis for between-subject effects were performed. Sn-based toothpastes showed the best effects (p < 0.05). Under normal flow, SnF/NaF showed higher efficacy, with a significant difference compared to NaF/Sn/Ch, NaF, and placebo (p < 0.05). Under low flow, SnF/NaF and NaF/Sn/Ch were comparable (p > 0.05); NaF and placebo were statistically similar. Comparing salivary conditions, there were significant differences for SnF/NaF for %SMH after the in situ phase (%SMHtotal)), %RHL and for all toothpastes in case of %RER. Factorial analysis revealed interactions between toothpaste and saliva flow for %SMHtotal and %RHL. Salivary flow can influence the efficacy of the antierosive toothpastes; however, Sn2+ preparations show even under low salivary flow conditions the highest efficacy in the prevention of enamel erosion.
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Ganss C, Möllers M, Schlueter N. Do Abrasives Play a Role in Toothpaste Efficacy against Erosion/Abrasion? Caries Res 2016; 51:52-57. [DOI: 10.1159/000452867] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 10/19/2016] [Indexed: 11/19/2022] Open
Abstract
Abrasives may counteract the efficacy of anti-erosion toothpastes either due to physical effects or due to interaction with active agents. This study aimed to investigate whether the amount of abrasives is a determinant for the efficacy of Sn2+-containing toothpastes with or without chitosan additive. Enamel samples were eroded (0.50 wt% citric acid, pH 2.5; 6 × 2 min/day) on a shaking desk - 30/min in experiment 1 (E1) and 35/min in experiments 2 (E2) and 3 (E3) - and immersed in toothpaste slurries (2 × 2 min). Half of the samples were additionally brushed (15 s, load 200 g) within the immersion time. The toothpastes contained 0, 5, 10, 15, and 20% silica. In E1 and E2 the active ingredients were F- (700 ppm as amine fluoride, 700 ppm as NaF) and Sn2+ (3,500 ppm as SnCl2); in E3 chitosan (0.5%) was additionally added. The placebo contained 20% silica. Tissue loss was determined profilometrically. In E1, slurries completely inhibited tissue loss; distinct surface deposits occurred. With brushing, tissue loss significantly increased up to an abrasive content of 10%, but decreased significantly with higher amounts; 20% silica revealed similar values as the abrasive-free formulation. In E2, all slurries inhibited tissue loss distinctly irrespective of the amounts of abrasives. With brushing, a similar trend as in E1 was observed but with much less efficacy. The chitosan-containing formulations in E3 were much more effective; similar results as in E1 were found. In conclusion, the amount of abrasives had no effect when toothpastes were applied as slurries, but played an important role with brushing.
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Ganss C, Marten J, Hara A, Schlueter N. Toothpastes and enamel erosion/abrasion – Impact of active ingredients and the particulate fraction. J Dent 2016; 54:62-67. [DOI: 10.1016/j.jdent.2016.09.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/14/2016] [Accepted: 09/17/2016] [Indexed: 11/30/2022] Open
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Bradna P, Vrbova R, Fialova V, Housova D, Gojisova E. Formation of protective deposits by anti-erosive toothpastes-A microscopic study on enamel with artificial defects. SCANNING 2016; 38:380-388. [PMID: 26492940 DOI: 10.1002/sca.21281] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 10/12/2015] [Indexed: 06/05/2023]
Abstract
This study investigated formation of protective deposits on the enamel surface after application of several anti-erosive toothpastes with different active ingredients. NaF-containing Sensodyne Pronamel, SnCl2 /F-based Elmex Erosion Protection and calcium phosphate-based BioRepair Plus Sensitivity Control, SensiShield and Enamel Care toothpastes with claimed anti-erosive properties were tested. Artificial saliva and Elmex Erosion Protection mouth rinse served as control groups. The toothpastes were applied 30 times by a toothbrush for 2 min per day, mouth rinse for 30 s on polished enamel of thirty five human molars (n = 5) with series of five rhomboid-shaped indents of various length prepared by a Knoop indentor. After 15 and 30 applications, the shape of the indents and surface morphology was characterised using light and scanning electron microscopy. At the end of treatment, the samples were exposed to 0.2 wt. % citric acid (pH 3.30) to test resistance of the treated enamel to erosion. Pronounced differences were observed between protective properties of the toothpastes. While Sensodyne Pronamel and BioRepair Plus Sensitivity Control did not produce any protective deposits, Enamel Care formed a compact layer of deposits which protected the enamel surface against erosion. With Elmex Erosion Protection and SensiShield fractured indent edges and scratches on the treated enamel suggested that their abrasive properties prevailed over ability of active ingredients to form deposits. These results revealed that toothpastes with strong potential to form acid-resistant deposits on the enamel surface and of low abrasivity should be used for effective prevention of enamel erosion. SCANNING 38:380-388, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Pavel Bradna
- School of Dental Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
- Department of Stomatology, Third Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
| | - Radka Vrbova
- School of Dental Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Vlasta Fialova
- School of Dental Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Devana Housova
- School of Dental Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Eva Gojisova
- Department of Stomatology, Third Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
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West NX, He T, Macdonald EL, Seong J, Hellin N, Barker ML, Eversole SL. Erosion protection benefits of stabilized SnF 2 dentifrice versus an arginine-sodium monofluorophosphate dentifrice: results from in vitro and in situ clinical studies. Clin Oral Investig 2016; 21:533-540. [PMID: 27477786 PMCID: PMC5318474 DOI: 10.1007/s00784-016-1905-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 07/07/2016] [Indexed: 11/26/2022]
Abstract
Objectives The aim of these investigations was to assess the ability of two fluoride dentifrices to protect against the initiation and progression of dental erosion using a predictive in vitro erosion cycling model and a human in situ erosion prevention clinical trial for verification of effectiveness. Materials and methods A stabilized stannous fluoride (SnF2) dentifrice (0.454 % SnF2 + 0.077 % sodium fluoride [NaF]; total F = 1450 ppm F) [dentifrice A] and a sodium monofluorophosphate [SMFP]/arginine dentifrice (1.1 % SMFP + 1.5 % arginine; total F = 1450 ppm F) [dentifrice B] were tested in a 5-day in vitro erosion cycling model and a 10-day randomized, controlled, double-blind, two-treatment, four-period crossover in situ clinical trial. In each study, human enamel specimens were exposed to repetitive product treatments using a standardized dilution of test products followed by erosive acid challenges in a systematic fashion. Results Both studies demonstrated statistically significant differences between the two products, with dentifrice A providing significantly better enamel protection in each study. In vitro, dentifrice A provided a 75.8 % benefit over dentifrice B (p < 0.05, ANOVA), while after 10 days in the in situ model, dentifrice A provided 93.9 % greater protection versus dentifrice B (p < 0.0001, general linear mixed model). Conclusion These results support the superiority of stabilized SnF2 dentifrices for protecting human teeth against the initiation and progression of dental erosion. Clinical relevance Stabilized SnF2 dentifrices may provide more significant benefits to consumers than conventional fluoride dentifrices.
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Affiliation(s)
- N X West
- School of Oral and Dental Sciences, Bristol Dental School and Hospital, Lower Maudlin Street, Bristol, BS1 2LY, UK.
| | - T He
- Procter and Gamble, Cincinnati, OH, USA
| | - E L Macdonald
- School of Oral and Dental Sciences, Bristol Dental School and Hospital, Lower Maudlin Street, Bristol, BS1 2LY, UK
| | - J Seong
- School of Oral and Dental Sciences, Bristol Dental School and Hospital, Lower Maudlin Street, Bristol, BS1 2LY, UK
| | - N Hellin
- School of Oral and Dental Sciences, Bristol Dental School and Hospital, Lower Maudlin Street, Bristol, BS1 2LY, UK
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Influence of Calcium Phosphate and Apatite Containing Products on Enamel Erosion. ScientificWorldJournal 2016; 2016:7959273. [PMID: 27430013 PMCID: PMC4939184 DOI: 10.1155/2016/7959273] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 05/16/2016] [Indexed: 11/18/2022] Open
Abstract
For the purpose of erosion prevention the present study aimed to compare the efficacy of two biomimetic products and a fluoride solution to optimize the protective properties of the pellicle. After 1 min of in situ pellicle formation on bovine enamel slabs, 8 subjects adopted CPP-ACP (GC Tooth Mousse), a mouthwash with hydroxyapatite microclusters (Biorepair), or a fluoride based mouthwash (elmex Kariesschutz) for 1 min each. Afterwards, samples were exposed in the oral cavity for 28 min. Native enamel slabs and slabs exposed to the oral cavity for 30 min without any rinse served as controls. After oral exposure, slabs were incubated in HCl (pH values 2, 2.3, and 3) for 120 s and kinetics of calcium and phosphate release were measured photometrically; representative samples were evaluated by SEM and TEM. The physiological pellicle reduced demineralization at all pH values; the protective effect was enhanced by fluoride. The biomimetic materials also reduced ion release but their effect was less pronounced. SEM indicated no layer formation after use of the different products. However, TEM confirmed the potential accumulation of mineral components at the pellicle surface. The tested products improve the protective properties of the in situ pellicle but not as effectively as fluorides.
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Yönel N, Bikker FJ, Lagerweij MD, Kleverlaan CJ, van Loveren C, Özen B, Çetiner S, van Strijp AJP. Anti-erosive effects of fluoride and phytosphingosine: an in vitro study. Eur J Oral Sci 2016; 124:396-402. [DOI: 10.1111/eos.12283] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Nermin Yönel
- Department of Paediatric Dentistry; Faculty of Dentistry; Near East University; Nicosia Cyprus
- Department of Cariology Endodontology Pedodontology; Academic Centre for Dentistry Amsterdam (ACTA); University of Amsterdam and VU University; Amsterdam the Netherlands
| | - Floris J. Bikker
- Department of Oral Biochemistry; Academic Centre for Dentistry Amsterdam (ACTA); University of Amsterdam and VU University; Amsterdam the Netherlands
| | - Maxim D. Lagerweij
- Department of Cariology Endodontology Pedodontology; Academic Centre for Dentistry Amsterdam (ACTA); University of Amsterdam and VU University; Amsterdam the Netherlands
| | - Cees J. Kleverlaan
- Department of Dental Materials Science; Academic Centre for Dentistry Amsterdam (ACTA); University of Amsterdam and VU University; Amsterdam the Netherlands
| | - Cor van Loveren
- Department of Cariology Endodontology Pedodontology; Academic Centre for Dentistry Amsterdam (ACTA); University of Amsterdam and VU University; Amsterdam the Netherlands
| | - Bugra Özen
- Department of Cariology Endodontology Pedodontology; Academic Centre for Dentistry Amsterdam (ACTA); University of Amsterdam and VU University; Amsterdam the Netherlands
| | - Serap Çetiner
- Department of Paediatric Dentistry; Faculty of Dentistry; Near East University; Nicosia Cyprus
| | - Augustinus J. P. van Strijp
- Department of Cariology Endodontology Pedodontology; Academic Centre for Dentistry Amsterdam (ACTA); University of Amsterdam and VU University; Amsterdam the Netherlands
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Pini N, Lima D, Lovadino J, Ganss C, Schlueter N. In vitro Efficacy of Experimental Chitosan-Containing Solutions as Anti-Erosive Agents in Enamel. Caries Res 2016; 50:337-45. [DOI: 10.1159/000445758] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 03/22/2016] [Indexed: 11/19/2022] Open
Abstract
The present study evaluated the effect of chitosans with different viscosities, dissolved in an AmF/SnCl2 solution, against erosion or erosion/abrasion. A total of 192 specimens were assigned to 2 × 6 groups (n = 16 specimens each): negative control, 4 chitosan solutions (groups Ch50, Ch500, Ch1000, and Ch2000, with viscosity of 50, 500, 1,000, or 2,000 mPas, respectively, 0.5% chitosan, 500 ppm F-, 800 ppm Sn2+, pH 4.4), and positive control (500 ppm F-, 800 ppm Sn2+, pH 4.3). One half of the groups was demineralized (experiment 1, E1; 10 days, 6 × 2 min/day, 0.5% citric acid, pH 2.8) and exposed to solutions (2 × 2 min/day); the other half was additionally brushed (15 s, 200 g) with non-fluoridated toothpaste before solution immersion (experiment 2, E2). Treatment effects were investigated by profilometry, energy-dispersive X-ray spectroscopy and scanning electron microscopy (SEM). In E1, all the chitosan-containing solutions reduced enamel loss by 77-80%, to the same extent as the positive control, except for Ch2000 (p ≤ 0.05), which completely inhibited tissue loss by the formation of precipitates. In E2, Ch50 and Ch500 showed best performance, with approximately 60% reduction of tissue loss compared to the negative control group (p ≤ 0.05 compared to other groups). SEM analysis showed differences between negative control and the other groups but only minor differences amongst the groups treated with active agents. In both E1 and E2, treatment with active agents resulted in surface enrichment of carbon and tin compared to negative control (p ≤ 0.001); brushing removed parts of carbon and tin (p ≤ 0.001). Chitosan shows different properties under erosive and erosive/abrasive conditions. Under erosive conditions high viscosity might be helpful, whereas lower viscosity seems to be more effective in cases of chemo-mechanical challenges.
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Schlueter N, Lussi A, Tolle A, Ganss C. Effects of Erosion Protocol Design on Erosion/Abrasion Study Outcome and on Active Agent (NaF and SnF2) Efficacy. Caries Res 2016; 50:170-9. [DOI: 10.1159/000445169] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 03/01/2016] [Indexed: 11/19/2022] Open
Abstract
There is no standard for testing anti-erosive/anti-abrasive agents, making the assessment and comparison of study results difficult. Factors which are varied in study designs are amongst others the erosive medium regarding concentration and pH or movement type of acid. The present study therefore investigated the impact of these factors on dimension of tissue loss and on efficacy of active agents used as anti-erosive/anti-abrasive therapeutics. In 8 experiments, consisting of 8 groups each (n = 20 each), resulting in a total of 64 groups, enamel specimens were demineralised (10 days, 6 × 2 min/day) using different acids (1, 0.5 and 0.3% citric acid at native pH 2.3, 2.5 and 2.8, respectively, and 0.3% citric acid adjusted to pH 3.6) with two different movement types (jerky or smooth). Specimens were immersed (2 × 2 min/day) in slurries of 1,450 ppm F- toothpaste (NaF), 1,450 ppm F- and 3,436 ppm Sn2+ toothpaste (NaF/SnF2), 970 ppm F- and 3,000 ppm Sn2+ gel (SnF2) or placebo, or were additionally brushed during immersion (15 s, 200 g). All groups were in between stored in a mineral salt solution. Tissue loss was determined profilometrically. Movement type, pH and concentration of acid had a substantial impact on study outcome. The combination of jerky movement and concentrated acid masked, to some extent, differences between erosive and erosive-abrasive tissue loss. The acid at low concentration (0.3%), independent of pH, was too mild to produce any tissue loss. The model with the best ability to demonstrate effects of abrasive impacts and active agents used the 1% acid concentration combined with smooth acid movements.
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Caries-preventive effect of anti-erosive and nano-hydroxyapatite-containing toothpastes in vitro. Clin Oral Investig 2016; 21:291-300. [PMID: 26993660 DOI: 10.1007/s00784-016-1789-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 03/07/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The aim of the study was to investigate the caries-preventive effect of newly developed fluoride and fluoride-free toothpastes specially designed for erosion prevention. The hypothesis was that these products might also show superior caries-inhibiting effect than regular fluoride toothpastes, since they were designed for stronger erosive acid challenges. MATERIALS AND METHODS Enamel specimens were obtained from bovine teeth and pre-demineralized (pH = 4.95/21 days) to create artificial caries lesions. Baseline mineral loss (ΔZB) and lesion depth (LDB) were determined using transversal microradiography (TMR). Ninety specimens with a median ΔZB (SD) of 6027 ± 1546 vol% × μm were selected and randomly allocated to five groups (n = 18). Treatments during pH-cycling (14 days, 4 × 60 min demineralization/day) were brushing 2×/day with AmF (1400 ppm F-, anti-caries [AC]); AmF/NaF/SnCl2/Chitosan (700 ppm F-/700 ppm F-/3500 ppm Sn2+, anti-erosion [AE1]); NaF/KNO3 (1400 ppm F-, anti-erosion [AE2]); nano-hydroxyapatite-containing (0 ppm F-, [nHA]); and fluoride-free toothpastes (0 ppm F-, negative control [NC]). Toothpaste slurries were prepared with mineral salt solution (1:3 wt/wt). After pH-cycling specimens presenting lesion, surface loss (mainly by NC and nHA) were discarded. For the remaining 77 specimens, new TMR analyses (ΔZE/LDE) were performed. Changes in mineral loss (ΔΔZ = ΔZB - ΔZE) and lesion depth (ΔLD = LDB - LDE) were calculated. RESULTS All toothpastes caused significantly less demineralization (lower ΔΔZ) than NC (p < 0.05, ANOVA) except for nHA. The fluoride toothpastes did not differ significantly regarding ΔΔZ and ΔLD (p > 0.05, ANOVA). CONCLUSION/CLINICAL RELEVANCE While both anti-erosive and anti-caries toothpastes reduced mineral loss to a similar extent, the fluoride-free nano-hydroxyapatite-containing toothpaste seemed not to be suitable for inhibition of caries demineralization in vitro.
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Azadi-Schossig P, Becker K, Attin T. Chelating effect of citric acid is negligible for development of enamel erosions. Clin Oral Investig 2015; 20:1577-87. [PMID: 26572529 DOI: 10.1007/s00784-015-1634-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 10/22/2015] [Indexed: 11/28/2022]
Abstract
AIM Citric acid (CA) is a component in beverages responsible for dental erosion. The aim of this study was to examine the influence of CA with different pH, titratable acid and buffer capacity (ß), and the impact of the chelating effect of CA on development of enamel erosions. MATERIAL AND METHODS In a superfusion model, hydroxy apatite (HAp) dissolution of bovine enamel was measured in four experiments (EXP 1-4) with 27 experimental groups (n = 8 per group). The samples were superfused with different CA variations and respective controls. EXP-1: Dilution series of HCl (pH 2.15-3.02). EXP-2: Dilution series of natural CA (56-1.75 mmol l(-1); pH 2.15-3.02). EXP-3: CA solutions (56 and 14 mmol l(-1), ß: 39.7 and 10.2 mmol l(-1) pH(-1), respectively) with different titratable acidity at equal pH values. EXP-4: CA concentrations (56-1.75 mmol l(-1)) neutralized to pH 7. RESULTS CA led to higher HAp-dissolution than HCl. With higher pH, the difference in HAp-dissolution rate between the two acids became increasingly smaller. At equal pH, HAp-dissolution was higher for the CA with the higher amount of titratable acid. However, no clear correlation between erosion and titratable acid or ß could be found. Only minimal amounts of HAp were dissolved by neutralized CA compared to CA with natural pH. CONCLUSION Under the chosen conditions chelating effects of CA do not have a relevant influence of HAp-dissolution of enamel. Moreover, amount of HAp-dissolution by CA is not attributed to a single factor alone. The interplay between the different parameters of CA seems to be responsible for its erosive potential. CLINICAL RELEVANCE The erosive potential of solutions containing citric acid with unknown concentrations could not be predicted using a single parameter alone, and should at best determined in experimental set-ups.
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Affiliation(s)
- Parastu Azadi-Schossig
- Center of Dentistry, Clinic for Preventive Dentistry, Periodontology and Cariology, University of Zürich, Plattenstrasse 11, 8032, Zürich, CH, Switzerland
| | - Klaus Becker
- Center of Dentistry, Clinic for Preventive Dentistry, Periodontology and Cariology, University of Zürich, Plattenstrasse 11, 8032, Zürich, CH, Switzerland
| | - Thomas Attin
- Center of Dentistry, Clinic for Preventive Dentistry, Periodontology and Cariology, University of Zürich, Plattenstrasse 11, 8032, Zürich, CH, Switzerland.
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Esteves-Oliveira M, Witulski N, Hilgers RD, Apel C, Meyer-Lueckel H, de Paula Eduardo C. Combined Tin-Containing Fluoride Solution and CO2 Laser Treatment Reduces Enamel Erosion in vitro. Caries Res 2015; 49:565-74. [DOI: 10.1159/000439316] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 08/10/2015] [Indexed: 11/19/2022] Open
Abstract
The aim of this in vitro study was to evaluate the effect of combined CO2 laser and tin-containing fluoride treatment on the formation and progression of enamel erosive lesions. Ninety-six human enamel samples were obtained, stored in thymol solution and, after surface polishing, randomly divided into 6 different surface treatment groups (n = 16 in each group) as follows: no treatment, control (C); one CO2 laser irradiation (L1); two CO2 laser irradiations (L2); daily application of fluoride solution (F); combined daily fluoride solution + one CO2 laser irradiation (L1F), and combined daily fluoride solution + two CO2 laser irradiations (L2F). Laser irradiation was performed at 0.3 J/cm2 (5 µs/226 Hz/10.6 µm) on day 1 (L1) and day 6 (L2). The fluoride solution contained AmF/NaF (500 ppm F), and SnCl2 (800 ppm Sn) at pH 4.5. After surface treatment the samples were submitted to an erosive cycling over 10 days, including immersion in citric acid (2 min/0.05 M/pH = 2.3) 6 times daily and storage in remineralization solution (≥1 h) between erosive attacks. At the end of each cycling day, the enamel surface loss (micrometers) was measured using a 3D laser profilometer. Data were statistically analyzed by means of a 2-level mixed effects model and linear contrasts (α = 0.05). Group F (-3.3 ± 2.0 µm) showed significantly lower enamel surface loss than groups C (-27.22 ± 4.1 µm), L1 (-18.3 ± 4.4 µm) and L2 (-16.3 ± 5.3 µm) but higher than L1F (-1.0 ± 4.4 µm) and L2F (1.4 ± 3.2 µm, p < 0.05). Under the conditions of this in vitro study, the tin-containing fluoride solution caused 88% reduction of enamel surface loss, while its combination with CO2 laser irradiation at 0.3 J/cm2 hampered erosive loss almost completely.
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Ganss C, Lussi A, Peutzfeldt A, Naguib Attia N, Schlueter N. Impact of Sn/F Pre-Treatments on the Durability of Protective Coatings against Dentine Erosion/Abrasion. PLoS One 2015; 10:e0123889. [PMID: 26075906 PMCID: PMC4468142 DOI: 10.1371/journal.pone.0123889] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 03/05/2015] [Indexed: 11/18/2022] Open
Abstract
For preventing erosive wear in dentine, coating with adhesives has been suggested as an alternative to fluoridation. However, clinical studies have revealed limited efficacy. As there is first evidence that Sn2+ increases bond strength of the adhesive Clearfil SE (Kuraray), the aim of the present study was to investigate whether pre-treatment with different Sn2+/F− solutions improves the durability of Clearfil SE coatings. Dentine samples (eight groups, n=16/group) were freed of smear layer (0.5% citric acid, 10 s), treated (15 s) either with no solution (control), aminefluoride (AmF, 500 ppm F−, pH 4.5), SnCl2 (800/1600 ppm Sn2+; pH 1.5), SnCl2/AmF (500 ppm F−, 800 ppm Sn2+, pH 1.5/3.0/4.5), or Elmex Erosion Protection Rinse (EP, 500 ppm F−, 800 ppm Sn2+, pH 4.5; GABA International), then rinsed with water (15 s) and individually covered with Clearfil SE. Subsequently the specimens were subjected to an erosion/abrasion protocol consisting of 1320 cycles of immersion in 0.5% citric acid (5°C/55°C; 2 min) and automated brushing (15 s, 200 g, NaF-toothpaste, RDA 80). As the coatings proved stable up to 1320 cycles, 60 modified cycles (brushing time 30 min/cycle) were added. Wear was measured profilometrically. After SnCl2/AmF, pH 4.5 or EP pre-treatment all except one coating survived. In the other groups, almost all coatings were lost and there was no significant difference to the control group. Pre-treatment with a Sn2+/F− solution at pH 4.5 seems able to improve the durability of adhesive coatings, rendering these an attractive option in preventing erosive wear in dentine.
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Affiliation(s)
- Carolina Ganss
- Department of Conservative and Preventive Dentistry, Dental Clinic of the Justus-Liebig-University Giessen, Giessen, Germany
- * E-mail:
| | - Adrian Lussi
- Department of Preventive, Restorative and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Anne Peutzfeldt
- Department of Preventive, Restorative and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Nader Naguib Attia
- Department of Conservative and Preventive Dentistry, Dental Clinic of the Justus-Liebig-University Giessen, Giessen, Germany
| | - Nadine Schlueter
- Department of Conservative and Preventive Dentistry, Dental Clinic of the Justus-Liebig-University Giessen, Giessen, Germany
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Kwek SXR, Mian M, Hall C, Xie Z, Yong R, Kaidonis J, Townsend GC, Ranjitkar S. Nanoscratch testing for the assessment of enamel demineralization under conditions simulating wine erosion. Aust Dent J 2015; 60:12-7. [PMID: 25721274 DOI: 10.1111/adj.12277] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Erosive tooth wear and dentinal hypersensitivity are common problems affecting professional wine tasters. By using nanoscratch testing, the aim of this in vitro study was to assess enamel softening under conditions simulating 10 one-minute episodes of wine erosion. METHODS Ten enamel specimens were bathed in artificial saliva for 2 hours before being eroded for 10 episodes, with each episode comprising one minute of wine erosion followed by one minute of remineralization in artificial saliva. Nanoscratches were placed with a spherical tip (20 μm radius) in a nanoindenter under a load of 100 mN at baseline (stage 1), after a one-erosion episode (stage 2) and after 10-erosion episodes (stage 3). RESULTS There were significant effects of erosion stages on both scratch depth (p<0.001) and surface roughness (p<0.001). Post hoc tests showed significant differences in both scratch depths and surface roughness between stages 1 and 3 (p<0.001), and between stages 2 and 3 (p<0.01). CONCLUSIONS Enamel softening occurs at an early stage of wine tasting, emphasizing the need to implement early preventive strategies in professional wine tasters. Further research elucidating the fundamental mechanisms involved in early stages of erosion has the potential to lead to development of more effective preventive strategies.
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Affiliation(s)
- S X R Kwek
- School of Dentistry, The University of Adelaide, South Australia
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Lussi A, Carvalho TS. The Future of Fluorides and Other Protective Agents in Erosion Prevention. Caries Res 2015; 49 Suppl 1:18-29. [DOI: 10.1159/000380886] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The effectiveness of fluoride in caries prevention has been convincingly proven. In recent years, researchers have investigated the preventive effects of different fluoride formulations on erosive tooth wear with positive results, but their action on caries and erosion prevention must be based on different requirements, because there is no sheltered area in the erosive process as there is in the subsurface carious lesions. Thus, any protective mechanism from fluoride concerning erosion is limited to the surface or the near surface layer of enamel. However, reports on other protective agents show superior preventive results. The mechanism of action of tin-containing products is related to tin deposition onto the tooth surface, as well as the incorporation of tin into the near-surface layer of enamel. These tin-rich deposits are less susceptible to dissolution and may result in enhanced protection of the underlying tooth. Titanium tetrafluoride forms a protective layer on the tooth surface. It is believed that this layer is made up of hydrated hydrogen titanium phosphate. Products containing phosphates and/or proteins may adsorb either to the pellicle, rendering it more protective against demineralization, or directly to the dental hard tissue, probably competing with H+ at specific sites on the tooth surface. Other substances may further enhance precipitation of calcium phosphates on the enamel surface, protecting it from additional acid impacts. Hence, the future of fluoride alone in erosion prevention looks grim, but the combination of fluoride with protective agents, such as polyvalent metal ions and some polymers, has much brighter prospects.
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67
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Anti-erosive properties of solutions containing fluoride and different film-forming agents. J Dent 2015; 43:458-65. [DOI: 10.1016/j.jdent.2015.01.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 11/10/2014] [Accepted: 01/20/2015] [Indexed: 11/21/2022] Open
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Hayasaki H, Saitoh I, Nakakura-Ohshima K, Hanasaki M, Nogami Y, Nakajima T, Inada E, Iwasaki T, Iwase Y, Sawami T, Kawasaki K, Murakami N, Murakami T, Kurosawa M, Kimi M, Kagoshima A, Soda M, Yamasaki Y. Tooth brushing for oral prophylaxis. JAPANESE DENTAL SCIENCE REVIEW 2014. [DOI: 10.1016/j.jdsr.2014.04.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Aykut-Yetkiner A, Attin T, Wiegand A. Prevention of dentine erosion by brushing with anti-erosive toothpastes. J Dent 2014; 42:856-61. [DOI: 10.1016/j.jdent.2014.03.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 03/24/2014] [Accepted: 03/25/2014] [Indexed: 10/25/2022] Open
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Three-dimensional profilometric assessment of early enamel erosion simulating gastric regurgitation. J Dent 2014; 42:1411-21. [PMID: 24995810 DOI: 10.1016/j.jdent.2014.06.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 06/24/2014] [Accepted: 06/25/2014] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES A priority research area in minimal intervention dentistry is the characterization of the early stages of dental erosion. The aim of this in vitro study was to assess the effect of short, repetitive erosive challenges to human enamel over 2 min at pH 1.5 and 3.0 under conditions simulating gastric regurgitation. METHODS Enamel surfaces were subjected to erosive challenges at pH 1.5 (Group 1, n=10) and pH 3.0 (Group 2, n=9) for periods of 30s (stage 1), 60s (stage 2) and 120 s (stage 3). Quantitative changes were assessed longitudinally by measuring the 3D average surface roughness (Sa) values using 3D confocal microscopy. Qualitative micrographic assessment of surface changes was also conducted by using environmental scanning electron microscopy. RESULTS Linear mixed model analysis showed significant effects of the pH values (p<0.001) and the stages (p<0.001) on the observed Sa values. Post hoc tests showed significant increases in the Sa values between baseline and other stages in both groups (p<0.01). The mean Sa values also increased significantly from stage 1 to stage 2 in Group 1 (p<0.05). Micrographic analysis displayed severely etched enamel rods in Group 1, but only subtle changes in Group 2. CONCLUSIONS The complexity of the enamel surface is influenced by both acid concentration (pH value) and duration of acid exposure during early stages of erosion. Erosion occurring under conditions simulating GORD can be detected in its initial stages, opening up the possibilities of early diagnosis and management of this condition. CLINICAL SIGNIFICANCE Erosive tooth wear occurs progressively and insidiously, often creating complex treatment challenges. This emphasizes the need for early diagnosis and management in accordance with minimal intervention philosophy. Our findings provide a foundation for further research that could lead to the development of highly-sensitive clinical diagnostic tools and preventive strategies.
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Bakry AS, Marghalani HY, Amin OA, Tagami J. The effect of a bioglass paste on enamel exposed to erosive challenge. J Dent 2014; 42:1458-63. [PMID: 24907559 DOI: 10.1016/j.jdent.2014.05.014] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 05/24/2014] [Accepted: 05/27/2014] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The current study is evaluating the effect of using a 45S5 bioglass paste and topical fluoride application on the cross sectional micro-hardness and the chemical surface changes of eroded enamel. METHODS Enamel discs were obtained from the buccal surface of one hundred extracted human non-carious third molars. The enamel surfaces were ground flat and each disc was coated with two layers of acid resistant nail varnish except for an exposed treatment window (3mm×2mm) on the buccal surface of the tooth. All specimens were challenged for 60 min by orange juice (Tropicana, Chicago, USA) pH 3.85+0.5. The specimens were divided into four groups: the 45S5 bioglass paste group, fluoride gel group (5 min application), fluoride gel group (24h application) while the rest of specimens served as control. The cross-sectional micro-hardness of 20 specimens from each group was measured. Five specimens from each group had their top eroded enamel surfaces examined by SEM-EDS. One-way ANOVA was used to compare the cross-sectional micro-hardness of the three groups p<0.05. RESULTS 45S5 bioglass paste application significantly improved the sub-surface eroded enamel when compared to fluoride and control specimens (p<0.05). CONCLUSION 45S5 bioglass paste can efficiently improve the micro-hardness of the sub-surface eroded enamel surface. CLINICAL SIGNIFICANCE The use of the 45S5 Bioglass paste can be used efficiently as a potent remineralizing agent for the sub-surface enamel lesions resulting from erosive challenges.
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Affiliation(s)
- Ahmed Samir Bakry
- Operative Dentistry Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudia Arabia; Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Egypt; Japan Society for the Promotion of Science, Cariology and Operative Dentistry, Department of Restorative Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8549, Japan.
| | - Hanadi Y Marghalani
- Operative Dentistry Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudia Arabia
| | - Omayma A Amin
- Pharmaceutical Chemistry Department, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudia Arabia; Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Alexandria University, Egypt
| | - Junji Tagami
- Cariology and Operative Dentistry Department, Global Center of Excellence Program, Tokyo Medical and Dental University, Japan
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Maia AMA, Longbottom C, Gomes ASL, Girkin JM. Enamel erosion and prevention efficacy characterized by confocal laser scanning microscope. Microsc Res Tech 2014; 77:439-45. [DOI: 10.1002/jemt.22364] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 03/12/2014] [Accepted: 03/21/2014] [Indexed: 11/10/2022]
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Carvalho T, Lussi A. Combined effect of a fluoride-, stannous- and chitosan-containing toothpaste and stannous-containing rinse on the prevention of initial enamel erosion–abrasion. J Dent 2014; 42:450-9. [DOI: 10.1016/j.jdent.2014.01.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 12/20/2013] [Accepted: 01/06/2014] [Indexed: 01/13/2023] Open
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Ganss C, Klimek J, Schlueter N. Erosion/Abrasion-Preventing Potential of NaF and F/Sn/Chitosan Toothpastes in Dentine and Impact of the Organic Matrix. Caries Res 2014; 48:163-9. [DOI: 10.1159/000354679] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 07/24/2013] [Indexed: 11/19/2022] Open
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Schlueter N, Klimek J, Ganss C. Randomised in situ study on the efficacy of a tin/chitosan toothpaste on erosive-abrasive enamel loss. Caries Res 2013; 47:574-81. [PMID: 23969953 DOI: 10.1159/000351654] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 04/09/2013] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- N Schlueter
- Department of Conservative and Preventive Dentistry, Dental Clinic, Justus Liebig University, Giessen, Germany
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A new optical detection method to assess the erosion inhibition by in vitro salivary pellicle layer. J Dent 2013; 41:428-35. [DOI: 10.1016/j.jdent.2013.02.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 02/15/2013] [Accepted: 02/16/2013] [Indexed: 11/18/2022] Open
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Schlueter N, Klimek J, Ganss C. Effect of a chitosan additive to a Sn2+-containing toothpaste on its anti-erosive/anti-abrasive efficacy--a controlled randomised in situ trial. Clin Oral Investig 2013; 18:107-15. [PMID: 23417572 DOI: 10.1007/s00784-013-0941-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 02/01/2013] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- N Schlueter
- Department of Preventive, Restorative and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland,
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