The anti-caries efficacy of calcium carbonate-based fluoride toothpastes

A Dive into Delivery of Oral Hygiene Advice Based on the Personalized Oral Hygiene Advice Model

Oral health's impact on overall well-being highlights the importance of preventive measures through effective oral hygiene practices. Currently, there is growing recognition of the need for customized oral hygiene advice depending on the patient's unique needs and circumstances. This narrative review addresses the gap in understanding the significance of personalized guidance through the proposal of the Personalized Oral Hygiene Advice Model (POHAM) as a comprehensive guide for oral health professionals. This model was developed to adapt to evolving patient demographics and diverse challenges, promoting a patient-centric and effective oral health approach. The POHAM comprises a flow chart of strategies from establishing a good rapport with patients, conducting comprehensive assessment through history-taking, psychosocial and technology proficiency evaluation, tailored education modules, and customized oral care product recommendations until the reassessment. These strategies aim to enhance patient engagement and adherence, as well as act as a guide for oral health professionals to use in the clinical setting before and during the course of oral treatment. Nevertheless, continued research, education, and technological advancements are needed to realize the full potential of personalized oral hygiene strategies, ensuring a transformative and sustainable oral healthcare landscape.

Nanotechnology in toothpaste: Fundamentals, trends, and safety

Several studies have revealed that healthcare nanomaterials are widely used in numerous areas of dentistry, including prevention, diagnosis, treatment, and repair. Nanomaterials in dental cosmetics are utilized to enhance the efficacy of toothpaste and other mouthwashes. Nanoparticles are added to toothpastes for a variety of reasons, including dental decay prevention, remineralization, hypersensitivity reduction, brightening, and antibacterial qualities. In this review, the benefits and uses of many common nanomaterials found in toothpaste are outlined. Additionally, the capacity and clinical applications of nanoparticles as anti-bacterial, whitening, hypersensitivity, and remineralizing agents in the treatment of dental problems and periodontitis are discussed.

Inorganic Compounds as Remineralizing Fillers in Dental Restorative Materials: Narrative Review

Secondary caries is one of the leading causes of resin-based dental restoration failure. It is initiated at the interface of an existing restoration and the restored tooth surface. It is mainly caused by an imbalance between two processes of mineral loss (demineralization) and mineral gain (remineralization). A plethora of evidence has explored incorporating several bioactive compounds into resin-based materials to prevent bacterial biofilm attachment and the onset of the disease. In this review, the most recent advances in the design of remineralizing compounds and their functionalization to different resin-based materials' formulations were overviewed. Inorganic compounds, such as nano-sized amorphous calcium phosphate (NACP), calcium fluoride (CaF₂), bioactive glass (BAG), hydroxyapatite (HA), fluorapatite (FA), and boron nitride (BN), displayed promising results concerning remineralization, and direct and indirect impact on biofilm growth. The effects of these compounds varied based on these compounds' structure, the incorporated amount or percentage, and the intended clinical application. The remineralizing effects were presented as direct effects, such as an increase in the mineral content of the dental tissue, or indirect effects, such as an increase in the pH around the material. In some of the reported investigations, inorganic remineralizing compounds were combined with other bioactive agents, such as quaternary ammonium compounds (QACs), to maximize the remineralization outcomes and the antibacterial action against the cariogenic biofilms. The reviewed literature was mainly based on laboratory studies, highlighting the need to shift more toward testing the performance of these remineralizing compounds in clinical settings.

Bioavailable fluoride in calcium-containing dentifrices

Calcium added to dentifrices can complex with fluoride ions to reduce intra-oral bioavailability and therefore efficacy in preventing dental caries. Six commercially available dentifrices containing different types of calcium and fluoride were analyzed for total and bioavailable fluoride levels by adding 10 g of dentifrice to 30 mL of distilled deionized water and mixing vigorously for 1 min to simulate toothbrushing. One milliliter of the dentifrice/water slurry was immediately centrifuged and the supernatant removed for bioavailable fluoride analysis and the mixed slurry prior to centrifugation used for total fluoride analysis using a modified microdiffusion method. The concentration of fluoride was determined using a fluoride ion-selective electrode calibrated with internal fluoride standards. All the dentifrices had similar total fluoride concentrations to those indicated on their labels (94% to 105%). However, only one dentifrice that contained calcium in the form of casein phosphopeptide amorphous calcium phosphate (CPP-ACP) had almost 100% (97%) of fluoride in bioavailable form. The other dentifrices contained calcium carbonate and they exhibited significantly (p < 0.001) lower bioavailable fluoride levels (27% to 61%), through the generation of poorly soluble fluoride phases. The saliva biomimetic CPP, as CPP-ACP, in a dentifrice stabilised calcium and fluoride ions to maintain fluoride's bioavailability.

Fluoride-doped amorphous calcium phosphate nanoparticles as a promising biomimetic material for dental remineralization

Demineralization of dental hard tissue is a widespread problem and the main responsible for dental caries and dentin hypersensitivity. The most promising strategies to induce the precipitation of new mineral phase are the application of materials releasing gradually Ca2+ and PO43- ions or mimicking the mineral phase of the host tissue. However, the design of formulations covering both processes is so far a challenge in preventive dentistry. In this work, we have synthesized innovative biomimetic amorphous calcium phosphate (ACP), which has been, for the first time, doped with fluoride ions (FACP) to obtain materials with enhanced anti-caries and remineralizing properties. Significantly, the doping with fluoride (F) did not vary the physico-chemical features of ACP but resulted in a faster conversion to the crystalline apatite phase in water, as observed by in-situ time-dependent Raman experiments. The efficacy of the as synthesized ACP and FACP samples to occlude dentinal tubules and induce enamel remineralization has been tested in vitro in human molar teeth. The samples showed good ability to partially occlude the tubules of acid-etched dentin and to restore demineralized enamel into its native structure. Results demonstrate that ACP and FACP are promising biomimetic materials in preventive dentistry to hinder demineralization of dental hard tissues.

Amorphous Calcium Carbonate Constructed from Nanoparticle Aggregates with Unprecedented Surface Area and Mesoporosity

Amorphous calcium carbonate (ACC), with the highest reported specific surface area of all current forms of calcium carbonate (over 350 m² g^-1), was synthesized using a surfactant-free, one-pot method. Electron microscopy, helium pycnometry, and nitrogen sorption analysis revealed that this highly mesoporous ACC, with a pore volume of ∼0.86 cm³ g^-1 and a pore-size distribution centered at 8-9 nm, is constructed from aggregated ACC nanoparticles with an estimated average diameter of 7.3 nm. The porous ACC remained amorphous and retained its high porosity for over 3 weeks under semi-air-tight storage conditions. Powder X-ray diffraction, large-angle X-ray scattering, infrared spectroscopy, and electron diffraction exposed that the porous ACC did not resemble any of the known CaCO₃ structures. The atomic order of porous ACC diminished at interatomic distances over 8 Å. Porous ACC was evaluated as a potential drug carrier of poorly soluble substances in vitro. Itraconazole and celecoxib remained stable in their amorphous forms within the pores of the material. Drug release rates were significantly enhanced for both drugs (up to 65 times the dissolution rates for the crystalline forms), and supersaturation release of celecoxib was also demonstrated. Citric acid was used to enhance the stability of the ACC nanoparticles within the aggregates, which increased the surface area of the material to over 600 m² g^-1. This porous ACC has potential for use in various applications where surface area is important, including adsorption, catalysis, medication, and bone regeneration.

In-vitro apatite formation capacity of a bioactive glass - containing toothpaste

OBJECTIVES

The in-vitro dissolution of bioactive glass-based toothpastes and their capacity to form apatite-like phases in buffer solutions have been investigated.

MATERIALS AND METHODS

The commercial toothpaste samples were tested on immersion in artificial saliva, Earle's salt solution and Tris buffer for duration from 10min to four days. The powder samples collected at the end of the immersion were studied using solid-state ³¹P and ¹⁹F nuclear magnetic resonance spectroscopy (NMR), X-ray powder diffraction and Fourier transform infrared (FTIR) spectroscopy. The fluoride concentration in the solution remained after the immersion was measured.

RESULTS

In artificial saliva and in presence of sodium monofluorophosphate (MFP), the bioactive glass and bioactive glass-based toothpastes formed fluoridated apatite-like phases in under 10min. A small amount of apatite-like phase was detected by ³¹P NMR in the toothpaste with MFP but no bioactive glass. The toothpaste with bioactive glass but no fluoride formed an apatite-like phase as rapidly as the paste containing bioactive glass and fluoride. By contrast, apatite-like phase formation was much slower in Earle's salt solution than artificial saliva and slower than Tris buffer.

CONCLUSIONS

The results of this lab-based study showed that the toothpaste with MFP and bioactive glass formed a fluoridated apatite in artificial saliva and in Tris buffer, as did the mixture of bioactive glass and MFP.

CLINICAL SIGNIFICANCE

The presence of fluoride in bioactive glass-containing toothpastes can potentially lead to the formation of a fluoridated apatite, which may result in improved clinical effectiveness and durability. However, this should be further tested intra-orally.

Effect of whitening dentifrices: a double-blind randomized controlled trial

The aim of this clinical study was to evaluate tooth color changes (ΔE) and tooth sensitivity (TS) associated with whitening dentifrices. Sixty participants were selected according to inclusion and exclusion criteria and then allocated to three groups (n = 20): Colgate Luminous White (G1), Close Up White Now (G2) and Sorriso dentifrice (G3-control). The participants were instructed to use only the provided dentifrice and toothbrush in standardized oral hygiene procedures for 4 weeks. ΔE was assessed by spectrophotometry (CIELab System) whereas TS was determined by a visual analog scale at baseline and weekly using four assessment points. The data were analyzed by two-way ANOVA and Tukey's post-hoc test and Friedman test (α = 0.05). ΔE (baseline-assessment point 4) showed no significant difference (p>0.05) across the groups: G1 (ΔE = 5.1), G2 (ΔE = 6.8), and G3 (ΔE = 4.4). Δb (baseline-assessment point 4) was significantly different (p < 0.05) in G2 (3.8) when compared to G1 (-0.2) and G3 (0.3). There was no significant difference (p > 0.05) in TS at baseline. Both the control and whitening dentifrices caused similar tooth color changes (ΔE). There was no significant TS during the study period.

Loss on drying, calcium concentration and pH of fluoride dentifrices

Introduction:

Fluoride dentifrices containing calcium carbonate have advantages such as control of dental plaque and progression of dental caries, also contributing to oral hygiene, represent most dentifrices marketed in Brazil.

Aim:

To evaluate the physicochemical properties of seven fluoride dentifrices containing calcium carbonate in relation to hydrogen potential (pH), loss on drying and calcium concentration.

Materials and Methods:

Data collection was performed using the potentiometric method for pH ranges, gravimetric analysis for loss on drying and atomic absorption spectrometry for the concentration of calcium ions. All tests were performed in triplicate and the analysis was performed entirely at random according to one-way analysis of variance at 5% significance level.

Results:

The pH values were alkaline and ranged from 8.67 (Oral-B 123^®) to 10.03 (Colgate Máxima Proteção Anticáries^®). The results of loss on drying ranged from 33.81% (Oral-B 123^®) to 61.13% (Close Up^®), with significant differences between brands tested. In relation to the calcium content, the highest and lowest concentrations were found in dentifrices Even^® (155.55 g/kg) and Colgate Ultra Branco^® (129 g/kg), respectively, with significant difference (P < 0.05).

Conclusion:

Fluoride dentifrices analyzed showed alkaline pH and high levels of loss on drying and calcium concentration. However, these physicochemical characteristics differed according to the different brands tested.

Interaction between biopolyelectrolytes and sparingly soluble mineral particles

We investigate the complex physicochemical behavior of dispersions containing calcium carbonate (CaCO(3)) particles, a sparingly soluble mineral salt; and carrageenans, negatively charged biopolyelectrolytes containing sulfate groups. We reveal that the carrageenans suspend and stabilize CaCO(3) particles in neutral systems by absorbing on the particle surface which provides electrosteric stabilization. In addition, carrageenans provide a weak apparent yield stress which keeps the particles suspended for several months. The absorption measurements of carrageenan on the CaCO(3) particle indicate that more carrageenan is removed from the solution than expected from the case of a simple monolayer adsorption. Confocal laser scanning microscopy observations confirm that polyelectrolyte-containing precipitate is formed in both CaCO(3)-carrageenan and CaCl(2)-carrageenan mixtures. On the basis of these results, we confirm that in the presence of carrageenan some CaCO(3) dissolves and the Ca(2+) ions interact with the sulfate groups leading to aggregation and formation of particle-like structures. These new insights are important for fundamental understanding of other mineral-polyelectrolyte systems and have important implications for various industrial applications where calcium carbonate is used.

Morphological and chemical changes in the attached cells of Pseudomonas aeruginosa as primary biofilms develop on aluminium and CaF2 plates

AIMS

To investigate the morphological and chemical changes in attached cells of Pseudomonas aeruginosa (ATCC 14886) at different stages of biofilm development on two different types of substrata.

METHODS AND RESULTS

The development of primary biofilm on aluminium plates representing metals and on CaF(2) discs representing dielectric materials was monitored by FTIR microscopy, ESEM, EDAX and protein analysis by SDS-PAGE. A unique cellular feature similar in morphology to pili was observed on the surface of P. aeruginosa adhering on aluminium but not on CaF(2). Results derived from FTIR analysis confirm on both substrata the successive importance of polysaccharides and proteins during the biofilm development. These results also revealed that the increase of the ratio of carboxylates to amide I was higher with the aluminium plates than with the CaF(2) discs. The number of cells adhered and the amount of oxygen incorporated in adhered cells on the latter materials were, respectively, less and almost nil in comparison with the former. Protein analysis of the lysates of cells by SDS-PAGE revealed that expression of one protein with a molecular weight of 45 kDa, was greatly enhanced in attached cells on both substrata. However, expression of another protein with molecular weight of 35 kDa was up-regulated only in cells adhering on CaF(2) but not in those on aluminium.

CONCLUSION

Depending on the nature of the surface, new proteinaceous complexes and cellular features were formed in the attachment process of P. aeruginosa.

SIGNIFICANCE AND IMPACT OF THE STUDY

The pattern of P. aeruginosa cells adhering onto CaF(2) discs and aluminium plates is different. Formation of biofilm is more difficult on CaF(2) than on aluminium.

Review of the extrinsic stain removal and enamel/dentine abrasion by a calcium carbonate and perlite containing whitening toothpaste

There has been an increase in the demand from consumers and patients for products that whiten teeth. To meet this demand, a whitening toothpaste containing calcium carbonate and perlite as the abrasive system and an efficacious fluoride source has recently been launched. The aim of the current paper is to review the toothpaste's stain removal efficacy and its effects on enamel and dentine wear. It has been shown to be effective at removing model extrinsic stain in vitro. Further, it has been shown to be more effective in removing naturally occurring extrinsic tooth stain than a silica non-whitening control toothpaste after two weeks of twice daily brushing in a parallel group, double-blind clinical study using 152 adult volunteers. In addition, the enhanced whitening effect did not give a clinically relevant level of wear to enamel or a significant increase in dentine wear compared to marketed non-whitening toothpaste formulations, as shown by using an in situ type model with ex vivo brushing.

In vitro efficacy of a whitening toothpastecontaining calcium carbonate and perlite

OBJECTIVES

The studies described in this paper aimed to assess the stain removal efficacy, fluoride efficacy and abrasivity to enamel and dentine of a new whitening toothpaste containing calcium carbonate and perlite, using appropriate in vitro models.

METHODS

Stain removal efficacy was assessed using the pellicle cleaning ratio (PCR) method. Fluoride efficacy was assessed using remineralisation, demineralisation and fluoride-uptake methods. Abrasivity was assessed using an enamel and dentine wear method.

RESULTS

The results showed that the new whitening toothpaste was able to remove extrinsic tooth stain more effectively than three commercially available toothpaste formulations. The fluoride efficacy was superior to a non-fluoridated control and was not significantly different to a clinically tested fluoride-containing toothpaste. The abrasivity data showed that the calcium carbonate/perlite toothpaste is no more abrasive to enamel or dentine than two other commercially available whitening toothpastes.

CONCLUSIONS

The studies show that the new whitening toothpaste is effective in extrinsic stain removal, has an efficacious fluoride source and does not have an undue degree of abrasivity to enamel or dentine compared to other relevant commercially available products.