Comparative evaluation of four treatments for postorthodontic white spot lesions: a randomized controlled trial

OBJECTIVES

To evaluate the treatment efficacy of fluoride toothpaste alone and those of adjunctive use of resin infiltration, sodium fluoride varnish, and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on white spot lesions (WSLs).

MATERIALS AND METHODS

Seventy-nine patients (356 teeth) with WSLs after orthodontic treatment were randomly allocated into four groups. The WSLs of the participants received resin infiltration only at baseline, and the other groups received fluoride varnish, CPP-ACP mousse, and placebo treatment every 6 months, respectively. A toothpaste containing 1400 ppm fluoride and toothbrushes were distributed to all participants, and oral hygiene instructions were provided. Photos of the teeth with WSL were taken to compare the change between groups which was measured by ImageJ software.

RESULTS

Twelve months later, different degrees of reduction in the area of WSLs were observed in all groups. The percentage of lesion area reduction in WSLs in the resin infiltration group was 46.6%, which was significantly higher than that in fluoride varnish group (26.6%), CPP-ACP group (28.6%), and control group (29.8%), and the differences were statistically significant (p < 0.001).

CONCLUSIONS

This study shows that after 1-year follow-up, the use of fluoride toothpaste, with or without the use of fluoride varnish or CPP-ACP, can reduce the area of WSLs. While resin infiltration can immediately improve dental aesthetics and continuously improved in 12 months, resin infiltration group showed much better results than other groups.

TRIAL REGISTRATION

Clinical Trials Registration Number: ChiCTR2000032516.

CLINICAL SIGNIFICANCE

The use of fluoride toothpaste, with or without adjunctive use of fluoride varnish and CPP-ACP, can reduce the area of WSLs, while resin infiltration treatment has additional effect and can immediately improve dental aesthetics.

The efficacy of combined arginine and probiotics as an add-on to 1450 ppm fluoride toothpaste to prevent and control dental caries in children - A randomized controlled trial

OBJECTIVES

To determine how daily consumption of a lozenge combining arginine and two probiotic strains affects the Relative Risk Reduction (RRR) in children regarding dental caries transitions and lesion activity at tooth surface level during 10-12 months.

METHODS

A total of 21,888 tooth surfaces in 288 children were examined. The intervention group (n = 141) received a lozenge containing 2% arginine, Lacticaseibacillus rhamnosus, LGG® (DSM33156), and Lactobacillus paracasei subsp. paracasei, L. CASEI 431® (DSM33451). The placebo group (n = 147) received a placebo lozenge. Both groups received 1,450 ppm F- toothpaste. Primary canines, molars, and first permanent molars were examined clinically (ICDAS0-6) and radiographically (R0-6) at baseline and follow-up. Sealed, filled, and missing surfaces were also included. Caries activity was computed as a sum of each caries lesion's location, color, texture, cavitation, and gingival bleeding. RRRs were computed with cluster effect on surface level. ICH-GCP was followed, including external monitoring.

RESULTS

A total of 19,950 surfaces were analyzed after excluding 1,938 tooth surfaces. No statistically significant differences were found between the groups. The RRRs showed less caries progression (13.6%, p = 0.20), more regression (0.3%, p = 0.44), and fewer active caries lesions (15.3%, p = 0.15) in the intervention group.

CONCLUSION

Daily consumption of a lozenge combining arginine and probiotics for 10-12 months given to 5-9-years-old children characterized being with low caries risk demonstrated a marked, though not statistically significant RRR for caries progression, regression, and number of active lesions in the intervention group compared to the placebo-group.

CLINICALTRIALS

gov (NCT03928587).

CLINICAL SIGNIFICANCE

Since all the RRRs were in favor of the intervention group and the PF of combined arginine and probiotics is high (81.6%) compared to fluoride toothpaste (24.9%) and arginine-fluoride toothpaste alone (19.6%) the combined pre-and probiotics approach may be a future additional tool regarding caries prevention and control.

A qualitative study of barriers and facilitators to the implementation of a pilot school-based, toothbrushing programme

Background

While supervised toothbrushing programmes have been established in many countries of the world, little is known about different perspectives on their implementation. The aim of the study was to explore stakeholders' barriers and facilitators to implementation of a school-based toothbrushing programme in Taiwan.

Methods

Focus groups and interviews were used to explore the views of elementary school students, teachers, staff, and nurses in a piloted school-based toothbrushing programme. The topic guides were developed according to the Theoretical Domains Framework (TDF) to cover the behavioural factors systematically and comprehensively. Data were analysed with content analysis.

Results

Overall, 36 students, 29 teachers/staff, and five school nurses (N = 65) were included. The overarching theme was the importance of habit formation for both staff and children to ensure that toothbrushing as part of the programme was embedded into the school schedule and routine. While children did not necessarily appear to retain the dental knowledge which was taught in the programme, the provision of fluoride toothpaste and toothbrush for their use in schools allowing teachers and staff to choose the timing of the brushing and engaging classmates to supervise each other were found to be key factors.

Conclusions

Implementing a school-based toothbrushing programme with the support of staff and active engagement of children can help children to develop a toothbrushing habit. Classmate-supervised toothbrushing may reduce the burden on teachers and staff to implement the programme.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02494-7.

Salivary fluoride concentration following toothbrushing with and without rinsing: a randomised controlled trial

Background

Caries prevalence has declined significantly since the introduction of fluoridated toothpaste. There have been several developments regarding specific active fluoride ingredients but not enough evidence to support one over the other. The purpose of this double-blind randomized controlled trial was to compare salivary fluoride concentrations of different fluoride formulations in the form of toothpaste with and without post-brushing water rinsing in adults.

Methods

The study included 120 participants who were randomly assigned to one of 12 groups (10 participants/group). The toothpaste formulas investigated included (1) fluoride-free (0 ppmF); (2) sodium fluoride (1450 ppmF); (3) sodium monofluorophosphate (1450 ppmF); (4) sodium fluoride and monofluorophosphate combined (1450 ppmF); (5) stannous fluoride and sodium fluoride combined (1450 ppmF); and (6) amine fluoride (1400 ppmF). Block randomisation was used to assign each participant to one of the 12 groups. Participants brushed with 1.0 g of one of the six different toothpaste formulations either with or without post-brushing water rinsing. Saliva was collected at six different times (baseline and at 1, 15, 30, 60, and 90 min/s post-brushing). Samples were analysed using a fluoride ion-specific sensitive electrode connected to an ion analyser.

Results

The demographic characteristics of the participants were not significantly different among the groups (P > 0.05). Time, toothpaste formulation, and post-brushing rinsing routines had significant effects on saliva fluoride retention (P < 0.05). Amine fluoride-containing toothpaste was the only formula that showed statistically significantly higher concentrations of salivary fluoride at 90 min in both the rinsing and non-rinsing groups. Sodium monofluorophosphate toothpaste did not result in a significant difference compared to the control group at any time point, in both rinsing and non-rinsing groups.

Conclusions

Based on the results from this study, no rinsing after toothbrushing in adults can be recommended when sodium monofluorophosphate containing toothpaste formula is used. It also concludes that amine fluoride resulted in a significantly higher saliva fluoride concentration at 90 min in both the rinsing and non-rinsing groups compared to other fluoride toothpaste formulations.

Registry: Protocol Registration and Results System (ClinicalTrials.gov).

Clinical trial registration number: NCT02740803 (15/04/2016).

Effect of Different Toothbrushing Routines on Interproximal Fluoride Concentration

This study aimed to evaluate the effect of different toothbrushing routines and different kinds of toothpaste on the interproximal fluoride concentration after toothbrushing and its clinical relevance to the recommendations given to patients regarding the process of toothbrushing. Eight adults participated a total of 8 times in order to test different toothbrushing routines with different amounts of toothpaste (1 or 2 cm), durations (1 or 2 min) and amounts of water after toothbrushing (10 or 20 mL). An additional 8 adults participated 6 times in total to test different forms of toothpaste administration (paste, gel and foam) with different amounts of water after toothbrushing (no rinsing or 10 mL). Interdental saliva samples were collected from proximal sites 25/26 and 46/45 using small paper points, before and up to 60 min after toothbrushing. The fluoride concentration was measured by an ion-specific electrode. The area under the curve, saliva fluoride concentration versus time, was calculated. Differences between the groups were tested by ANOVA with Tukey's multiple comparisons test. An increase in fluoride concentration of 47.2% was observed when the amount of toothpaste increased from 1 to 2 cm (p < 0.01), 26.8% when increasing the duration from 1 to 2 min (p < 0.01) and 41.2% when reducing the amount of water rinsing from 20 to 10 mL (p < 0.01). The paste and gel resulted in higher fluoride concentration (p < 0.01) compared with foam. These findings suggest that the amount of toothpaste, the duration and the amount of water have a significant effect on fluoride concentration after toothbrushing. Furthermore, despite the lower amount of fluoride, the gel gives almost the same fluoride concentration after toothbrushing as the toothpaste. The results confirm the importance of giving clear advice to patients regarding the process of toothbrushing.

Fluoride content of toothpastes available in South Africa

A high dental caries burden coupled with a lack of water or salt fluoridation make it imperative that toothpastes available to the South African consumer demonstrate adequate potential for caries control and contain between 1000ppm and 1500ppm total fluoride (TF), with at least 1000ppm F in free available/soluble form.

METHODS

The objective was to determine TF, total soluble fluoride (TSF) and insoluble fluoride (IF) concentrations in 22 fluoride toothpastes commercially available in South Africa. Samples were purchased from a major pharmaceutical and food retailer located in the two metropolitan areas in South Africa. TF and TSF concentrations were determined potentiometrically, in quadruplicate, following acid hydrolysis of the samples using a calibrated Combination Fluoride Ion Selective Electrode. IF was calculated by subtracting TSF from TF.

RESULTS

Although TF content was found to be statistically significantly lower than manufacturer declaration (3.2x10-⁷; p≤0.05), 77.3% of the samples still contained adequate free, available/soluble F levels. Relative mean TSF content for toothpastes formulated with a calcium-based abrasive was 85% (sd ±14.5; n=6) as opposed to 98.6% (sd ±2.6; n=16) for those containing silica.

CONCLUSIONS

The total fluoride concentration of all the toothpastes was lower than that declared by the manufacturers, with one in four having TSF concentrations of less than 1000ppm F. The relative TSF concentrations for the calcium-containing toothpastes were lower than for the silica-based products, reducing their preventive and protective potential. The results call for strengthened regulation and quality control of fluoride toothpastes in South Africa, as well as international efforts to improve related norms.

Effects of various remineralizing agents on the outcome of post-orthodontic white spot lesions (WSLs): a clinical trial

Background

One of the most undesirable side effects of comprehensive orthodontic treatment is white spot lesions (WSLs). Despite many attempts at prevention of WSLs, its prevalence remains very high on debonding. There are many agents like fluoride toothpastes, fluoride varnishes, and fluoride mouth rinses, and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) is frequently used for the remineralization of WSLs. However, there is no consensus in the literature with respect to the success rates of these agents. Thus, the present study was designed to evaluate the efficacy of fluoride toothpaste alone and in combination with fluoride varnish and CPP-ACP plus crème in the remineralization of post-orthodontic WSLs.

Methods

Forty-five subjects in the age range of 16–25 years having at least one post-orthodontic WSL were included in the study. All the subjects were randomly divided into three groups (toothpaste group, varnish group, and CPP-ACP group). The efficacy of various remineralizing agents on the remineralization of WSLs was evaluated clinically and by DIAGNOdent immediately after debonding and subsequently after 1, 3, and 6 months of their use.

Results

Twice daily use of fluoride toothpaste alone had no significant effect on remineralization of WSLs at various intervals of observations (P = 0.078). Application of fluoride varnish along with twice daily use of fluoride toothpaste for 6 months significantly decreased the severity of WSLs (P < 0.01). Twice daily use of CPP-ACP plus crème along with fluoride toothpaste had significant effect on remineralization of WSLs at the end of 6 months of observation (P < 0.05). Between the group comparison showed that the mean visual and DIAGNOdent scores at various time intervals of observations were decreased more when fluoride varnish and CPP-ACP crème were used in addition to daily use of fluoride toothpaste, but the differences were not statistically significant (P > 0.05).

Conclusions

The use of fluoride varnish and CPP-ACP plus crème in addition to twice daily use of fluoride toothpaste had no additional benefit in the remineralization of post-orthodontic WSLs.