Effect of a third application of toothpastes (1450 and 5000 ppm F), including a 'massage' method on fluoride retention and pH drop in plaque

Delivery of Low-Diluted Toothpaste during Brushing Improves Enamel Acid Resistance

Toothpaste viscosity decreases rapidly when diluted with saliva during brushing, potentially causing premature washout of high-risk caries areas and reducing the uptake of dental fluoride ions. However, no reports have examined the acid resistance of enamel from the perspective of the toothpaste's physical properties. This study aimed to elucidate the impact of toothpaste dilution on the acid resistance of the enamel, using bovine enamel as the subject. Five diluted toothpaste groups were created: a control group without toothpaste, and 100% (1.00×), 67% (1.50×), 50% (2.00×), and 25% (4.00×) dilution groups. Acid resistance was evaluated through pH cycling after toothpaste application. The results revealed a significant increase in substantial defects, compared to 67% (1.50×) at dilutions of 50% (2.00×) or higher, accompanied by a decrease in Vickers hardness. Moreover, the mineral loss increased with dilution, and a significant difference was observed between 67% (1.50×) and 50% (2.00×) (p < 0.01). This study revealed that the acid resistance of the enamel decreased when the dilution of toothpaste during brushing exceeded 67% (1.5×). Therefore, delivering toothpaste with a lower dilution to high-risk caries areas, including interproximal spaces and adjacent surfaces, could maintain a higher concentration of active ingredients in the toothpaste, thereby enhancing its medical effects.

Salivary fluoride levels after daily brushing with 5000 ppm fluoride toothpaste: A randomised, controlled clinical trial

This study explored salivary fluoride levels following toothbrushing with 5000 and 1450 ppm fluoride toothpaste and determined the decline in salivary fluoride levels following the return from 5000 to 1450 ppm fluoride toothpaste. The study was a randomised, controlled double-blind parallel clinical trial (n = 24/group) measuring salivary fluoride five times during a 3-week trial phase involving 2×/day use of 5000 or 1450 ppm fluoride toothpaste, and five times during an ensuing 2-week wash-out phase where all participants used 1450 ppm toothpaste. Salivary fluoride was measured using a fluoride electrode and data were analysed using multilevel mixed-effects linear regression. Baseline salivary fluoride geometric means were 0.014 and 0.016 ppm for the 1450 and 5000 ppm groups, while the values at the end of the trial phase were 0.023 and 0.044 ppm, respectively. During the trial phase, except at baseline, differences between groups were statistically significant. The salivary fluoride levels for the 5000 ppm group remained statistically significantly higher than for the 1450 ppm group only at the first measurement in the wash-out phase (≈30 h after the last 5000 ppm brushing), indicating that higher salivary fluoride levels resulting from use of 5000 ppm are sustained only as long as the brushing habit continues.

Effect of high-fluoride dentifrice and bracket bonding composite material on enamel demineralization adjacent to orthodontic brackets in vitro

Background

There is a lack of information about the association of high-fluoride dentrifrice and fluoride-containing bonding material to prevent enamel white spot lesions development adjacent to brackets. The aim of this in vitro study was to evaluate the effect of high-fluoride dentifrice and fluoride-containing bonding material on enamel demineralization adjacent to orthodontic brackets.

Material and Methods

Forty-eight enamel specimens with 7x7x2 mm were obtained from bovine incisors. Orthodontic brackets were bonded with fluoride-containing resin composite (OrthoCem®) or fluoride-free low viscosity resin. The specimens were submitted to an 8-day pH cycling that consisted in the daily immersion of specimens in the demineralizing solution for 4 h and in artificial saliva for 20 h in an incubator at 37° C. The treatments consisted in 5 min-immersion between the cycles of fluoride (F) suspensions containing 275 µg F/mL, 1,250 µg F/mL or distilled water (negative control). The 275 and 1,250 µg F/mL concentrations were used to simulate salivary dilution of 1,100 and 5,000 µg F/g dentifrices during toothbrushing. After the experiment, cross-sectional hardness was performed to analyze the lesion area of the specimens. Tukey post hoc test after two-way ANOVA with p at 5% was used as statistical analysis.

Results

The specimens treated with high-fluoride dentifrice showed significantly less demineralization in comparison with the other treatments (p>0.05). There was a significant difference in the cross-sectional hardness values for the specimens bonded with OrthoCem when compared to the low viscosity resin (p>0,05).

Conclusions

The use of high-fluoride dentifrice associated with fluoride-containing bonding material promoted a greater reduction of enamel demineralization adjacent to orthodontic brackets.

Key words:Demineralization, dentifrice, fluoride, bonding materials, orthodontic brackets.

Salivary fluoride concentration and retention after rinsing with 0.05 and 0.2% sodium fluoride (NaF) compared with a new high F rinse containing 0.32% NaF

OBJECTIVE

To compare salivary fluoride (F) concentration and F retention after rinsing with a new 0.32% sodium fluoride (NaF) rinse and conventional 0.05 and 0.2% NaF rinses.

METHODS

Seventeen subjects (aged 22-26 years), with normal salivary secretion rates, participated in a double blind, cross-over study. In three separate sessions with a minimum washout period of 48 h, they rinsed for 1 min with 10 ml of 0.05, 0.2 or 0.32% NaF mouthrinse. Unstimulated whole saliva was collected before (baseline: 0 min) and after 1, 3, 5, 10, 20, 30, 45 and 60 min. The F concentration was plotted against time, and the area under the curve (AUC) calculated. Salivary F concentration and F retention for the three mouthrinses were compared by a randomized block test, followed by Tukey's test and a paired 2-tailed test.

RESULTS

There was a clear dose-response for AUC 3-60 min; 0.32% > 0.2% > 0.05% (p < .05). The mean F retention was 0.25 mg for 0.05% NaF, 0.86 mg F for 0.2% Na and 1.31 mg F for 0.32% NaF, (p < .05).

CONCLUSIONS

The higher salivary F concentration over time and the higher F retention after rinsing with an 0.32% NaF solution suggests a potential application in prevention of caries and dental erosion.

Effects of 1450-ppm Fluoride-containing Toothpastes Associated with Boosters on the Enamel Remineralization and Surface Roughness after Cariogenic Challenge

OBJECTIVES

 This in vitro study investigated the remineralization potential of 1450 ppm, fluoride-containing toothpastes containing different active remineralization agents after cariogenic challenge with pH cycling. The enamel surface roughness after brushing and the chemical and physical characteristics of the toothpastes tested were also analyzed.

MATERIALS AND METHODS

 Fifty-six bovine enamel blocks were obtained (4 × 4 × 6 mm) and divided into three thirds: intact (untreated), demineralized (artificial caries lesion), and treated (caries lesion, pH cycling, and brushing with dentifrices). Seven commercially available fluoride toothpastes (1450 ppm F): three with anti-erosion claims (Candida Professional [CPP], Colgate Total 12 Daily Repair [CDR], Regenerate Enamel Science [RES]); three with desensitizing claims (Bianco Pro Clinical [BPP], Elmex Sensitive [ESS], and Regenerador Diário DentalClean [RDC]); and one standard regular-fluoride toothpaste Colgate Total 12 (CTT) were selected. During pH cycling (demineralization 6 h/remineralization 18 h) for 7 days, the treated third was brushed with the different dentifrices for 10 minutes in a brushing machine before immersion in a remineralizing solution. The Knoop hardness (25 g, 10 second of the surface, and longitudinal section were then evaluated at eight depths (10 to 330 μm). Mean and percentage of surface hardness recovery (% SHR) were calculated. Surface enamel roughness (Ra) was also evaluated. The pH, %weight of particles, zeta potential, and polydispersity index of toothpaste slurries were also evaluated.

STATISTICAL ANALYSIS

 Data were statistically analyzed (ANOVA/Tukey, 5%).

RESULTS

 The %SHR of CPP was significantly lower than the others (p < 0.05). The enamel subsurface was more effectively remineralized when treated with BPP, ESS, and RDC. The surface roughness was higher when the demineralized third was treated with CTT, RDC, and RES and after the cariogenic challenge (p < 0.05). For some of the products tested, there was no relationship between surface remineralization and subsurface remineralization. Although toothpastes CPP and RDC present the lowest %SHR means, both products effectively remineralize within the subsurface carious lesion. Regression analysis demonstrated no strong correlations of the enamel surface roughness with the chemical and physical parameters.

CONCLUSIONS

 Most but not all the fluoride toothpastes were able to remineralize the enamel surface. No specific chemical or physical parameter alone correlated with the surface roughness.

Effect of high-fluoride dentifrice and bracket bonding composite material on enamel demineralization in situ

OBJECTIVE

This in situ study evaluated the effect of high-fluoride dentifrice (5000 μg F^-/g) and fluoride-containing bonding composite resin on enamel demineralization adjacent to orthodontic brackets.

METHODS

Ten volunteers wore palatal appliances containing bovine enamel blocks with metallic brackets bonded with fluoride-free or fluoride-containing composite resin. During three phases of 14 days each, three dentifrices with different fluoride concentrations (0, 1100, and 5000 μg F^-/g) were tested. The cariogenic challenge consisted of 20% sucrose solution dripped 8x/day onto the dental blocks. At the end of each phase, biofilm formed was collected for fluoride analysis. Cross section hardness was performed in enamel blocks, and the lesion area was calculated. Data were analyzed by two-way ANOVA followed by Tukey post hoc test (α = 5%).

RESULTS

The only signicant factor for all the variables under study was the dentifrice. Smaller lesion area and higher fluoride concentration on biofilm were found in 5000 μg F^-/g group, irrespective of bonding composite resin (p < 0.001). Neither bracket-bonding composite resin nor the interaction between the factors was statistically significant (p > 0.05) for all the variables.

CONCLUSION

High-fluoride dentifrice is effective in reducing demineralization on enamel adjacent to orthodontic brackets, while the fluoride-containing bonding composite resin does not influence it.

CLINICAL SIGNIFICANCE

Since high-fluoride dentifrice was able to reduce demineralization adjacent to brackets, it can be an option to caries management in orthodontics patients.

Adjunctive use of fluoride rinsing and brush-on gel increased incipient caries-like lesion remineralization compared with fluoride toothpaste alone in situ

Objective: The objective of this study was to compare the remineralizing effect of sodium fluoride (NaF) mouth rinse or NaF gel as an adjunct to NaF dentifrice on incipient caries-like lesions in an in situ cross-over design study, with three sessions of 30 days each. Materials and methods: Orthodontic brackets with artificial demineralized enamel slabs were attached to the upper first molars of 12 participants. A set of 3 test specimens from the same tooth was randomly assigned to each participant and allocated into three 30-day sessions: 1) brushing with 0.22% NaF dentifrice 2 times/day (F dentifrice), 2) brushing with 0.22% NaF dentifrice 2 times/day+ rinsing with 0.05% NaF before bedtime (F mouth rinse), 3) brushing with 0.22% NaF dentifrice 2 times/day + brushing with 1.1% NaF gel before bedtime (F brush-on gel). The mineral gain and lesion depth of the specimens were evaluated by micro-computed tomography. Results: The mean mineral gain from the NaF mouth rinse and the NaF brush-on gel was similar, but greater than that from the NaF dentifrice (p < .05). The NaF brush-on gel yielded the greatest mean depth of remineralization (168 µm), followed by the NaF mouth rinse (144 µm). Both depths were significantly greater than that of the NaF dentifrice (84 µm) (p < .05). Conclusions: Both 0.05% NaF mouth rinse and 1.1% NaF brush-on gel, used at bedtime, increased incipient caries-like lesion remineralization in situ in combination with brushing with NaF dentifrice twice a day.

Challenges in the local delivery of peptides and proteins for oral mucositis management

Oral mucositis, a common inflammatory side effect of oncological treatments, is a disorder of the oral mucosa that can cause painful ulcerations, local motor disabilities, and an increased risk of infections. Due to the discomfort it produces and the associated health risks, it can lead to cancer treatment restrains, such as the need for dose reduction, cycle delays or abandonment. Current mucositis management has low efficiency in prevention and treatment. A topical drug application for a local action can be a more effective approach than systemic routes when addressing oral cavity pathologies. Local delivery of growth factors, antibodies, and anti-inflammatory cytokines have shown promising results. However, due to the peptide and protein nature of these novel agents, and the several anatomic, physiological and environmental challenges of the oral cavity, their local action might be limited when using traditional delivering systems. This review is an awareness of the issues and strategies in the local delivery of macromolecules for the management of oral mucositis.

Buccal Dosage Forms: General Considerations for Pediatric Patients

The development of an appropriate dosage form for pediatric patients needs to take into account several aspects, since adult drug biodistribution differs from that of pediatrics. In recent years, buccal administration has become an attractive route, having different dosage forms under development including tablets, lozenges, films, and solutions among others. Furthermore, the buccal epithelium can allow quick access to systemic circulation, which could be used for a rapid onset of action. For pediatric patients, dosage forms to be placed in the oral cavity have higher requirements for palatability to increase acceptance and therapy compliance. Therefore, an understanding of the excipients required and their functions and properties needs to be particularly addressed. This review is focused on the differences and requirements relevant to buccal administration for pediatric patients (compared to adults) and how novel dosage forms can be less invasive and more acceptable alternatives.

Whole-Saliva Fluoride Levels and Saturation Indices in 65+ Elderly during Use of Four Different Toothpaste Regimens

BACKGROUND

Elderly individuals suffering from subnormal saliva secretion combined with inadequate oral hygiene may develop rampant caries and caries in parts of the dentition not normally affected by caries if preventive measures are not undertaken. Such measures include elevating fluoride levels at the saliva/biofilm/tooth interface.

AIM

To analyse whole-saliva fluoride levels and mineral saturation indices during different fluoride toothpaste regimens in home-living elderly.

MATERIALS AND METHODS

Whole saliva was collected from 27 subjects (7 males and 20 females, mean age 73.5±6.1 years) at ten time points covering the whole day during five 2-week periods. During the first period, participants used their normal toothpaste without instructions (baseline). This was followed by TP1: 1,450-ppm NaF toothpaste; TP2: 1,450-ppm monofluorophosphate (MFP) toothpaste with addition of calcium; TP3: 5,000-ppm NaF toothpaste, and TP4: the same toothpaste with additional 'smearing' of toothpaste on the teeth, twice daily. During TP1-TP4, the participants were instructed to brush 3 times per day using 1.5 g of toothpaste without rinsing.

RESULTS

Salivary fluoride levels increased with toothpaste fluoride content (p<0.001), although major interindividual and intraindividual variations were observed. The highest fluoride values appeared in the morning and at night (p<0.001). Saturation indices for calcium fluoride were affected by the fluoride content in pastes (p<0.05). Concerning hydroxyapatite and fluorapatite, indices were highest with the MFP toothpaste and extra calcium (NS to p<0.05).

CONCLUSIONS

Use of a high-fluoride toothpaste resulted in significantly increased fluoride levels in whole saliva and mineral saturation indices were indeed influenced by choice of toothpaste.

Intraoral fluoride levels after use of conventional and high-fluoride dentifrices

OBJECTIVES

This study aimed to evaluate saliva and plaque as indicators of intraoral fluoride (F) levels after the use of conventional and high-fluoride dentifrices.

MATERIALS AND METHODS

Subjects were randomly assigned to brush their teeth with conventional (1000 ppm F), high-fluoride (5000 ppm F), and placebo dentifrices (fluoride free) for 10 days, following a double-blind, crossover protocol. Saliva and plaque samples were collected on the morning of the 5(th) and 10th days, respectively at 1 and 12 h after brushing, and analyzed with an ion-selective electrode after HMDS-facilitated diffusion. Data were analyzed by two-way repeated measures ANOVA, Tukey's test and Spearman's correlation coefficient (p < 0.05).

RESULTS

Plaque and salivary F levels were significantly increased after the use of conventional and high-fluoride dentifrices when compared to values obtained for placebo, except plaque 12 h after the use of conventional dentifrice. A positive and significant correlation was found between fluoride concentrations in plaque and saliva for both times of sample collection.

CONCLUSION

Both indicators assessed were able to detect significant differences among treatments and between times after brushing. The use of a high-fluoride dentifrice is able to significantly increase intraoral fluoride levels throughout the day, being therefore a useful therapy for patients at high caries risk.

CLINICAL RELEVANCE

A dentifrice with high fluoride concentration could be regarded as a useful therapy of F delivery for high caries-risk patients, since intraoral F levels were sustained throughout most of the day after using this formulation.

Enhancing Fluoride Mediated Dentine Sensitivity Relief through Functionalised Tricalcium Phosphate Activity

Background. To assess the clinical efficacy of a dentifrice containing fluoride and functionalised tricalcium phosphate (fTCP) in reducing dentine sensitivity. Methods. A 10-week parallel blind randomised control trial was conducted. Subjects were assigned to one of four groups and instructed to brush twice daily: A: Colgate Cavity Protection (1000 ppmF-MFP); B: Sensodyne Total Care (1000 ppmF-NaF + 19300 ppmK⁺-KNO3); C: Clinpro Tooth Crème (950 ppmF-NaF + fTCP); and D: Clinpro Tooth Crème (brushing + additional topical application). Seventy-one patients were assessed at baseline, 6 weeks, and 10 weeks for cold, tactile, and hypertonic sensitivity using the NRS-11 pain rating scale. A combined modalities sensitivity score (CMS) was calculated. Results. At 6 weeks, patients reported the following reduction in CMS: A (20%); B (30%); C (42%); D (52%). At 10 weeks, patients reported the following reduction in CMS: A (18%), B (40%), C (24%), and D (54%). The only CMS comparisons to show a significant difference (P < 0.05) were between Groups A and D (6 and 10 weeks). Conclusions. Addition of fTCP to a dentifrice enhances the ability of dentifrice fluoride in reducing dentine sensitivity. Using Clinpro Tooth Crème twice daily for brushing can be as effective to reduce dentine sensitivity as twice daily brushing using Sensodyne Total Care. However, additional nightly topical application of fTCP, in addition to twice daily brushing, showed an enhanced reduction in dentine sensitivity.