Fluoride varnishes containing calcium glycerophosphate: fluoride uptake and the effect on in vitro enamel erosion

The Remineralization Effect of Calcium Glycerophosphate in Fluoride Mouth Rinse on Demineralized Primary Enamel: An in vitro Study

Aim

To evaluate the remineralization effect of a fluoride mouth rinse containing calcium glycerophosphate in fluoride mouth rinse based on the surface microhardness of demineralized primary enamel.

Materials and Methods

40 sound primary incisors were placed into self-curing acrylic resin and subjected to a demineralizing solution for 5 days, resulting in the formation of artificial caries. The teeth were categorized into four groups (n = 10): group I artificial saliva, group II sodium fluoride, group III sodium fluoride + sodium monofluorophosphate, and group IV sodium monofluorophosphate + calcium glycerophosphate. The specimens received a pH cycling procedure and were submerged twice in their assigned groups for 7 days. The baseline, after demineralization, and after remineralization surface microhardness values were determined. One-way analysis of variance (ANOVA) was used to analyze the mean surface microhardness between groups and one-way repeated measures ANOVA for the mean surface microhardness within each group and Bonferroni's for multiple comparisons at 95% confidence level. The percentage recovery surface microhardness was determined by calculating the average surface microhardness.

Results

After demineralization, the mean surface microhardness in all groups significantly decreased. After remineralization, group I had the lowest surface microhardness values and the percentage recovery surface microhardness (P value < 0.001), and group IV had the highest surface microhardness values and the percentage recovery surface microhardness (P value < 0.001). No significant difference was found between groups II and III (P value = 0.365).

Conclusions

Fluoride mouth rinse containing calcium glycerophosphate has a remineralization effect on demineralized primary enamel.

Effect of silver diamine fluoride/potassium iodide treatment on the prevention of dental erosion in primary teeth: an in vitro study

INTRODUCTION

Dental erosion has a great effect on oral health, when diagnosed it is irreversible, this sets the importance of different preventive measures being investigated against dental erosion.

AIM

This in vitro study aims to evaluate the effectiveness of silver diamine fluoride and Potassium iodide (SDF-KI) in comparison to casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF) varnish, sodium fluoride (NaF) varnish, silver diamine fluoride (SDF) alone and deionized water as a control group in the prevention of dental erosion in primary teeth and assessing its staining effect.

MATERIALS AND METHODS

Forty deciduous teeth enamel specimens were randomly allocated into the five study groups. Tested materials were applied. An erosive challenge was done by immersing the specimens in a citric acid-containing soft drink with pH 2.85, for 5 min, 4 times/day, for 5 days. Changes in surface microhardness, mineral loss, and color change were evaluated besides recording of the surface topography and surface roughness for selected specimens.

RESULTS

The highest decrease in surface microhardness was recorded in the control group (-85.21 ± 10.60%), with a statistically significant difference (p = 0.002). SDF-KI group (-61.49 ± 21.08%) showed no statistically significant difference when compared to CPP-ACPF, NaF, and SDF groups. For calcium and phosphorous loss, control group was statistically significantly higher compared to the treatment groups (p = 0.003) and (p < 0.001) respectively, while there was no statistically significant difference between the tested treatment groups. The highest mean value for color change was recorded in SDF group (26.26 ± 10.31), followed by SDF-KI group (21.22 ± 12.87) with no statistically significant difference between groups.

CONCLUSIONS

SDF-KI is as effective as CPP-ACPF, NaF varnishes and SDF in the prevention of dental erosion in primary teeth, there was no statistically significant difference regarding its staining potential.

Remineralization Effect of Calcium Glycerophosphate in Fluoride Mouth Rinse on Eroded Human Enamel: An In Vitro Study

Aims and Objectives

The aim of this in vitro study was to evaluate the remineralization effect of calcium glycerophosphate (CaGP) in fluoride mouth rinse on permanent enamel eroded by a soft drink.

Materials and Methods

Forty sound permanent premolars were embedded in self-curing acrylic resin and immersed in Coca-Cola to create erosive lesions. The teeth were divided into four groups (n = 10): Group I artificial saliva; Group II sodium fluoride; Group III sodium fluoride + sodium monofluorophosphate; and Group IV sodium monofluorophosphate + CaGP. The specimens in the assigned groups underwent pH cycling for ten days. The baseline, after erosion, and after remineralization surface microhardness (SMH) values were determined. The data were analyzed by one-way analysis of variance (ANOVA). The mean SMH value between groups and one-way repeated measures ANOVA for the mean SMH value within each group and Bonferroni's for multiple comparisons at a 95% confidence level were determined. The average SMH was used and calculated as the percentage recovery of SMH.

Results

After being eroded by the cola soft drink, the mean SMH values in all groups were significantly decreased. After remineralization, Group I had the lowest %SMHR. The %SMHR of Groups II, III, and IV were significantly higher than Group I (P < 0.001). However, there were no significant differences among Groups II, III, and IV (P > 0.05).

Conclusions

Fluoride mouth rinse with and without CaGP showed similar efficacies in remineralizing eroded permanent enamel.

Methods of Primary Clinical Prevention of Dental Caries in the Adult Patient: An Integrative Review

AIM

Preventive approaches to oral health diseases, mainly dental caries, require individual and collective policies. Thus, this review was conducted to identify the primary prevention methods of dental caries in adults to improve oral health at the clinical and community levels.

METHODS

This review followed the PICO strategy with the research question: "What are the methods of primary prevention of dental caries, in adults, for improving and maintaining oral health integrating clinical and community-based strategies?" Electronic screening was carried out by two independent reviewers in five databases (MedLine/PubMed, SciELO, Web of Science, Cochrane Library, and LILACS) to find relevant publications between 2015-2022. We applied eligibility criteria for selection of the articles. The following MeSH terms were used: "Primary Prevention"; "Adult"; "Oral Health"; "Dental Caries"; "Fluorides, Topical"; "Fluoride Varnishes"; "Pit and Fissure Sealants"; "Preventive Dentistry". Although the term "Prevention strategy" is not a MeSH descriptor, several correlated terms appeared and were used in the search engines: "Preventative Care", "Disease Prevention, Primary", and "Prevention, Primary". The tool provided by the JBI organization (Joanna Briggs Institute) was used to assess the quality of the included studies.

RESULTS

Nine studies were included. Overall, it was found that the main primary prevention methods applied in dentistry in adults are the application of pit and fissure sealants, topical application of fluoride performed in the dental clinic, use of fluoridated toothpaste, mouthwash with chlorhexidine at home, use of xylitol, the recommendation for regular appointments with the dentist, and the need to inform patients about the saliva buffer capacity and adoption of a non-cariogenic diet. For that purpose, preventive policies should be taken to prevent dental caries. These include three major challenges: providing the adult population with more knowledge regarding their oral health, empowering patients through adopting healthy lifestyles, and developing new preventive strategies and awareness campaigns aimed at the adult population to promote proper oral health habits.

CONCLUSIONS

A small number of studies were found whose participants were adult patients. There was some consistency regarding primary prevention methods in our studies. However, good quality randomized control studies are still required to define the best intervention strategies for adult caries prevention.

Effect of whitening products on sound enamel and on artificial caries lesions during a cariogenic challenge

OBJECTIVE

To investigate the effect of fluoride-containing whitening products on sound enamel and on artificial caries lesions during a cariogenic challenge.

MATERIALS AND METHODS

Bovine enamel specimens (n = 120) with three areas [non-treated sound enamel (NSE), treated sound enamel (TSE), and treated artificial caries lesion (TACL)] were randomly assigned to the four groups: whitening mouthrinse (WM: 2.5% hydrogen peroxide-100 ppm F-), placebo mouthrinse (PM: 0% hydrogen peroxide-100 ppm F-), whitening gel (WG: 10% carbamide peroxide-1130 ppm F-), and deionized water (negative control; NC). The treatments (2 min for WM, PM, and NC, and 2 h for WG) were carried out during a 28-day pH-cycling model (6 × 60 min demineralization/day). Relative surface reflection intensity (rSRI) and transversal microradiography (TMR) analyses were performed. Fluoride uptake (surface and subsurface) was measured in additional enamel specimens.

RESULTS

For TSE, a higher value of rSRI was observed in WM (89.99% ± 6.94), and a greater decrease in rSRI was observed for WG and NC, and no sign of mineral loss was verified for all groups (p > 0.05). For TACL, rSRI significantly decreased after pH-cycling for all experimental groups with no difference between them (p < 0.05). Higher amounts of fluoride were found in WG. WG and WM exhibited intermediate values of mineral loss, similar to PM.

CONCLUSIONS

The whitening products did not potentialize the enamel demineralization under a severe cariogenic challenge, and they did not exacerbate mineral loss of the artificial caries lesions.

CLINICAL RELEVANCE

Low concentrated hydrogen peroxide whitening gel and mouthrinse containing fluoride do not intensify the progression of caries lesions.

Fluoride Retention in Root Dentin following Surface Coating Material Application

This study aimed to use an in-air micro-particle-induced X-ray/gamma emission (in-air µPIXE/PIGE) system to evaluate tooth-bound fluoride (T-F) in dentin following the application of fluoride-containing tooth-coating materials. Three fluoride-containing coating materials (PRG Barrier Coat, Clinpro XT varnish, and Fuji IX EXTRA) and a control were applied to the root dentin surface of human molars (n = 6, total 48 samples). Samples were stored in a remineralizing solution (pH 7.0) for 7 or 28 days and then sectioned into two adjacent slices. One slice of each sample was immersed in 1M potassium hydroxide (KOH) solution for 24 h and rinsed with water for 5 min for the T-F analysis. The other slice did not undergo KOH treatment and was used to analyze the total fluoride content (W-F). The fluoride and calcium distributions were measured in all the slices using an in-air µPIXE/PIGE. Additionally, the amount of fluoride released from each material was measured. Clinpro XT varnish demonstrated the highest fluoride release among all the materials and tended to show high W-F and T-F and lower T-F/W-F ratios. Our study demonstrates that a high fluoride-releasing material shows high fluoride distribution into the tooth structure and low conversion from fluoride uptake by tooth-bound fluoride.

Effect of casein phosphopeptide amorphous calcium fluoride phosphate and calcium glycerophosphate on incisors with molar-incisor hypomineralization: A cross-over, randomized clinical trial

BACKGROUND: Within the scope of minimally invasive dentistry, the use of different biocompatible remineralization agents on incisors affected by molar-incisor hypomineralization (MIH) gains importance. OBJECTIVE: To evaluate the effect of casein phosphopeptide amorphous calcium fluoride phosphate (CPP-ACFP) and calcium glycerophosphate (CaGP) in mineral density (MD) of white/creamy and yellow/brown demarcated opacities on incisors affected by MIH by means laser fluorescence (LF). METHODS: As a cross-over, randomized trial, twenty-two children with 167 incisors affected by MIH were recruited and randomly assigned to one of the two different agents and crossed over to other agents with two weeks washout in between. Incisors were examined by using LF at all before and after three months periods. RESULTS: The results of the paired t-tests for determining the period effect between the baseline findings showed significant difference in white/creamy and yellow/brown demarcated opacities of LF values for both groups (p < 0.05). The difference between both groups according to after categorization of 20% increasing in MD in the percent of change before and after application on LF values; was not found statistically significant in white/creamy (p = 0.970) and yellow/brown (p = 0.948) opacities. CONCLUSIONS: The primary outcome was CPP-ACFP and CaGP had a positive effect in decreasing hypomineralization on MIH-affected enamel for three months period.

Effects of Different Doses of Calcium on the Mitochondrial Apoptotic Pathway and Rho/ROCK Signaling Pathway in the Bone of Fluorosis Rats

For this study, we investigate more deeply the effect calcium (Ca) develops on the mechanism underlying fluoride-triggered osteocyte apoptosis. We detected the morphology of osteocytes by HE staining, mitochondrial microstructure by using the transmission electron microscope, and the biochemical indexes related to bone metabolism and the expression of apoptosis-related genes. These results showed that NaF brought out the reduced osteocytes and ruptured mitochondrial outer membrane, with a significantly increased StrACP activity by 10.414 IU/L at the 4th week (P < 0.05), markedly upregulating the mRNA expression of Bax, Cyto-C, Apaf-1, caspase-7, ROCK-1, BMP-2, and BGP (P < 0.01), as well as caspase-6 (P < 0.05), while downregulating Bcl-2 by 61.3% (P < 0.01). Through immunohistochemical analysis, we also found that NaF notably increased the protein expression of ROCK-1 (P < 0.05) and Cyto-C, BMP-2, and BGP (P < 0.01), suggesting that NaF triggered the activation of the mitochondrial apoptotic pathway and Rho/ROCK signaling pathway. Nevertheless, 1% Ca supplementation in diet notably enhanced the mRNA expression of Bcl-2 by 39.3% (P < 0.01), thus blocking the increment of the expression of mitochondrial apoptotic pathway-related genes and ROCK-1. Meanwhile, Ca could attenuate the StrACP activity by 10.741 IU/L at the 4th week (P < 0.05) and protect the integrity of the mitochondrial outer membrane. These findings strongly suggest that 1% Ca abated the mitochondrial apoptosis pathway by increasing the anti-apoptotic gene Bcl-2 expression, and effectively inhibited the hyper-activation of ROCK-1, dually protecting the structural integrity of the mitochondrial outer membrane and maintaining normal cellular metabolic function.

In vitro effect of children's toothpaste on brushing abrasion of eroded primary enamel

PURPOSE

Emerging data have suggested that acid erosion has become an increasing clinical problem in pediatric dentistry. This study aimed to investigate the abrasive effects of two commercial toothpastes on primary enamel eroded by orange juice using an in vitro model.

METHODS

Thirty enamel slabs were obtained from primary teeth and then randomly assigned to three groups (n = 8) comprising two different toothpastes: G1-control-distilled water; G2-Dentifrice A (containing no fluoride); and G3-Dentifrice B (1.100 ppmF-NaF). Each slab had one half protected to provide a control side, and the other one was subjected to treatments. The slabs were submitted to daily erosive challenges (3×/day, 2 min) in concentrated orange juice (pH 3.38) associated with abrasive challenges using a tooth-brushing machine (150 brush movements for each cycle). During the experimental period, the slabs were kept in 37 °C artificial saliva, and the experiment was carried out for 5 days. The depths of the resulting eroded areas were measured by stylus profilometry. The data were analyzed using ANOVA and the Tukey-Kramer test (α = 5%).

RESULTS

Tooth loss (µm, mean ± SD) was 2.46 ± 1.18 for G1, 3.32 ± 2.12 for G2 and 2.14 ± 1.03 for G3. Therefore, the NaF dentifrice (Dentifrice B) produced significantly less mineral loss (p = 0.04) than dentifrice A.

CONCLUSIONS

The findings suggest that fluoride toothpaste could protect primary enamel against erosion.

The use of fluoride for the prevention of dental erosion and erosive tooth wear in children and adolescents

BACKGROUND

Erosive tooth wear (ETW) has gained increasing clinical relevance. It is estimated that worldwide 30-50% of deciduous and 20-45% of permanent teeth are affected. One of the most important nutritional factors causing ETW is the overconsumption of soft drinks, but also patient-related factors like reflux or eating disorders can lead to erosive lesions. Whether acids lead to erosive demineralisation depends on their degree of saturation with respect to tooth mineral at their actual pH.

REVIEW

Fluoride compounds like sodium or amine fluoride seem to be of limited efficacy against erosion, the main reason for this is the missing biofilm in the erosive process as well as the lower pH of the acids compared to bacterial acids. This means that to achieve some kind of preventive effect it would be necessary to use products with higher fluoride concentration, which is not an appropriate option for small children, and/or to increase the frequency of application. In addition, the fluoride compound plays a role as promising effects were found when fluoride is combined with titanium or stannous ions. TiF₄ can cause acid-resistant surface coatings and when Sn²⁺/F^- formulations are applied, Sn is not only found on the surface but is also incorporated into enamel and dentine. Both effects make the tooth surface more resistant against acid demineralisation. Different fluoride-containing vehicles have been tested to prevent erosion/ETW, such as toothpastes, rinses, gels and varnishes. Toothpastes offer some degree of protection, especially Sn²⁺-containing formulations, but effects of the active ingredients are sometimes counteracted by the presence of abrasives.

CONCLUSION

Detecting associated factors and influencing them is the main instrument in arresting erosive tooth wear. Additionally, patients at risk for dental erosion should always use an additional fluoride source preferably containing Sn²⁺.

The Influence of Calcium Glycerophosphate (GPCa) Modifier on Physicochemical, Mechanical, and Biological Performance of Polyurethanes Applicable as Biomaterials for Bone Tissue Scaffolds Fabrication

In this paper we describe the synthesis of poly(ester ether urethane)s (PEEURs) by using selected raw materials to reach a biocompatible polyurethane (PU) for biomedical applications. PEEURs were synthesized by using aliphatic 1,6-hexamethylene diisocyanate (HDI), poly(ethylene glycol) (PEG), α,ω-dihydroxy(ethylene-butylene adipate) (Polios), 1,4-butanediol (BDO) as a chain extender and calcium glycerolphosphate salt (GPCa) as a modifier used to stimulate bone tissue regeneration. The obtained unmodified (PURs) and modified with GPCa (PURs-M) PEEURs were studied by various techniques. It was confirmed that urethane prepolymer reacts with GPCa modifier. Further analysis of the obtained PURs and PURs-M by Fourier transform infrared (FTIR) and Raman spectroscopy revealed the chemical composition typical for PUs by the confirmed presence of urethane bonds. Moreover, the FTIR and Raman spectra indicated that GPCa was incorporated into the main PU chain at least at one-side. The scanning electron microscopy (SEM) analysis of the PURs-M surface was in good agreement with the FTIR and Raman analysis due to the fact that inclusions were observed only at 20% of its surface, which were related to the non-reacted GPCa enclosed in the PUR matrix as filler. Further studies of hydrophilicity, mechanical properties, biocompatibility, short term-interactions, and calcification study lead to the final conclusion that the obtained PURs-M may by suitable candidate material for further scaffold fabrication. Scaffolds were prepared by the solvent casting/particulate leaching technique (SC/PL) combined with thermally-induced phase separation (TIPS). Such porous scaffolds had satisfactory pore sizes (36–100 μm) and porosity (77–82%) so as to be considered as suitable templates for bone tissue regeneration.

The Future of Fluorides and Other Protective Agents in Erosion Prevention

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.