The Addition of Propylene Glycol Alginate to a Fluoride Solution to Control Enamel Wear: An in situ Study

The aim of this study was to evaluate the protective effect of propylene glycol alginate (PGA) associated with sodium fluoride (NaF) against enamel erosion and erosion-abrasion. A 4-phase, split-mouth, double-blind, crossover in situ trial was conducted with the following solutions: F + PGA (225 ppm F- + 0.1% PGA), F (225 ppm F-), F + Sn (225 ppm F- + SnCl2, 800 ppm Sn2+), and negative control (distilled water). In each phase, 12 subjects wore removable mandibular appliances containing 4 enamel specimens, which were submitted either to erosion or to erosion-abrasion challenges for 5 days. Acquired salivary pellicle was formed in situ for 2 h. Erosion-abrasion consisted of acid challenge (1% citric acid solution, pH 2.3, 5 min, 4×/day), exposure to saliva in situ (2 h, 4×/day), brushing (5 s, total 2 min exposure to the slurry), and treatment with the solutions (2 min, 2×/day). For erosion, the same procedures were performed, without brushing. At the end, surface loss (SL; in μm) was evaluated by means of optical profilometry. KOH-soluble fluoride was quantified for erosion-only groups using extra specimens. For both challenges, the SL values found for F + PGA did not differ significantly from those of F and the negative control, and the SL value shown for F + Sn was significantly the lowest. Erosion-abrasion promoted significantly higher SL values than erosion. KOH-soluble fluoride analysis showed that F + Sn had a higher fluoride concentration in comparison with the negative control and F, while F + PGA did not differ from any of the other groups. In conclusion, PGA was not able to improve the protective effect of NaF against erosive enamel wear.

Effect of Fluoride Treatment on the Acid Resistance of Hydroxyapatite

The etching behavior of polycrystalline synthetic hydroxyapatite samples has been evaluated to explore the protective impact of fluoride on a tooth-like model system. Etching rates before and after fluoridation with a NaF solution at pH 6 were determined by atomic force microscopy. Despite a very low F concentration of ca. 0.2 atom % in the hydroxyapatite surface, a very strong effect on the acid resistance can be observed. Depending on the crystal orientation, etching in a NaAc buffer at pH 4.5 was completely inhibited for at least 5 min. The major part of the surface withstood etching even for more than 23 min. These results give new insights into how the amount of incorporated fluoride in hydroxyapatite correlates with its protective impact.

Protective Effect of Phosphates and Fluoride on the Dissolution of Hydroxyapatite and Their Interactions with Saliva

This study aimed to investigate the effect of phosphates and fluoride, alone or in combination, and the influence of salivary pellicle on hydroxyapatite (HA) dissolution. The baseline dissolution rate of HA discs was measured using a pH-stat system (0.3% citric acid, pH 3.2). In the first series of experiments, HA discs (n = 8/group) were treated with: a placebo solution (PLA, deionised water); sodium trimetaphosphate (TMP), sodium tripolyphosphate (TRI) and sodium pyrophosphate (PYRO) at 1 or 8%; 500 ppm F; 1,100 ppm F; 1,100 ppm F/1% TMP; 1,100 ppm F/8% TMP; 1,100 ppm F/1% TRI; 1,100 ppm F/8% TRI. In the second phase, HA discs were immersed in pooled human saliva (37°C/2 h) and treated with PLA, 1,100 ppm F/1% TMP, 1,100 ppm F/8% TMP, 1,100 ppm F/1% TRI, and 1,100 ppm F/8% TRI. After treatments, final dissolution rates were measured from 3 consecutive 30-min assays. Statistical analyses were performed using 2-way ANOVA followed by the Fisher test (α = 0.05). The type and concentration of phosphate tested significantly influenced HA dissolution; 8% TRI showed the highest reduction (36.9%) among all treatment solutions. Fluoride alone (1,100 ppm F) significantly reduced HA dissolution by 20.7%. When fluoride and phosphates were associated, 1,100 ppm F/1% TMP, 1,100 ppm F/8% TMP, and 1,100 ppm F/8% TRI showed the highest percentage reductions of dissolution (40.3-46.1%). Salivary pellicle led to a greater and more sustained protective effect of the treatment solutions compared to their counterparts without salivary coating. It was concluded that the association of phosphate and fluoride enhanced their protective effect against HA dissolution when compared with these compounds alone, especially in the presence of salivary pellicle.

Effects of polyphosphates and fluoride on hydroxyapatite dissolution: A pH-stat investigation

OBJECTIVES

This study investigated the immediate and sustained effect of sodium trimetaphosphate (TMP) and sodium hexametaphosphate (HMP) associated or not with fluoride (F) on hydroxyapatite (HA) dissolution using an erosion-like model, considering as well as the influence of salivary coating.

DESIGN

Baseline dissolution rates were determined for HA discs using a pH-stat system. In the first set of experiments, HA discs were treated with 1100μgF/mL, 1% or 8% of HMP, 1% or 8% of TMP and 1100μgF/mL associated with 1% or 8% of HMP or TMP, totaling 9 groups (n=8). In a second phase, HA discs were kept in pooled human saliva at 37°C for 2h before treatment with deionised water and 1100μgF/mL associated with 1% or 8% of HMP or TMP, totaling 5 groups (n=8). The post-treatment dissolution rate was determined from three consecutive 30-min assays. Data were analysed using 2 and 3-way ANOVA followed by Fisher and Holm-Sidak methods, respectively (α=0.05).

RESULTS

All test solutions promoted reduction in HA dissolution rate when compared to baseline control in the first post-treatment run (p<0.001). However, a synergistic effect was only observed between fluoride and 1% HMP. Moreover, the duration of inhibitory effect was greater when 8% HMP and 1 or 8% HMP associated with F were assessed (p<0.001). The presence of salivary coating led to higher protection for all groups when compared to discs without coating (p<0.001).

CONCLUSION

The reduction of HA dissolution rate, as well as the duration of this effect were influenced by fluoride, type and concentration of phosphate salt and the presence of a salivary coating.

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

OBJECTIVE

To evaluate the effect of a low-fluoride dentifrice (LFD) containing sodium trimetaphosphate (TMP) on enamel erosion in vitro.

DESIGN

Bovine enamel blocks (n=144) were selected by surface hardness (SH) and subjected to erosive challenges, in two sets of experiments for 2 and 5 days. Blocks were randomly assigned to groups treated with slurries (5mL/block, for 15s) of following dentifrices: Placebo (no fluoride or TMP); LFD (250ppm F); LFD plus 0.25, 0.5, or 1.0% TMP; and a commercial positive control (1,425ppm F). The erosive challenge was produced by immersion in a soft drink (pH 2.8) for 5min, four times/day, interspersed by immersion in artificial saliva for 1h. SH and surface wear were analyzed as response variables. Data were submitted to 2-way ANOVA, followed by Student-Newman-Keuls test (p<0.05).

RESULTS

All groups treated with LFDs containing TMP had significantly lower enamel wear when compared with the other groups tested (p<0.001). Also, the LFDs containing TPM at lower concentrations promoted SH similar to the commercial positive control, both being significantly higher than the LFD without TMP and Placebo (p<0.001).

CONCLUSION

The supplementation of LFDs with TMP is able to significantly increase the anti-erosive potential of these formulations in vitro.

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.