Anti-erosive properties of solutions containing fluoride and different film-forming agents

Effect of combining aminomethacrylate and fluoride against erosive and abrasive challenges on enamel and dentin

This study evaluated the effect of solutions containing aminomethacrylate copolymer (AA) and sodium fluoride (F; 225 ppm F-) or fluoride plus stannous chloride (FSn; 225 ppm F-, 800 ppm Sn2+) against enamel and dentin erosion/abrasion. Solutions F, FSn, AA, F+AA, FSn+AA, and deionized water as negative control were tested. Bovine enamel and dentin specimens (n = 13/solution/substrate) underwent a set of erosion-abrasion cycles (0.3% citric acid [5 min, 4×/day], human saliva [1 h, 4×/day], brushing [15 s, 2×/day], and treatments [2 min, 2×/day]) for each of five days. Initial enamel erosion was evaluated using Knoop microhardness after the first and second acid challenge on day 1, and surface loss with profilometry after day 5. KOH-soluble fluoride was assessed. Data were analyzed with ANOVA/Tukey tests. The combination of fluoride and AA resulted in higher protection against enamel erosion, whereas this was not the case for the combination of AA and FSn. All treatments protected against enamel and dentin loss. The lowest surface loss values were observed with F+AA and FSn+AA. The polymer did not significantly influence the KOH-soluble fluoride formation on enamel/dentin specimens. The aminomethacrylate copolymer effectively enhanced the efficacy of sodium fluoride against initial erosion and improved the control of enamel and dentin wear of F and FSn solutions.

Investigation of the constituents of commercially available toothpastes

OBJECTIVES

Toothpaste plays a pivotal role in oral and dental hygiene. This cross-sectional study not only investigates the constituents of toothpastes available in the market and their frequency across different brands but also delves into the potential side effects, irritations, or unfavourable outcomes of these constituents, emphasizing the broader health and environmental implications.

METHODS

The largest of the five major chain markets in each district of Istanbul was visited, and adult toothpastes were included in this study. All the constituents that make up the toothpaste were individually recorded in an Excel database. Subsequently, literature regarding the purposes, toxic and potential side effects of each ingredient was gathered using databases such as Google Scholar, PubMed and ScienceDirect. The percentages of these ingredients' occurrence among all the toothpastes were calculated, and the ingredients were categorized into 15 distinct groups based on their usage purposes.

RESULTS

There were 160 different varieties of toothpaste belonging to 19 different brands on the market shelves. Although a total of 244 different ingredients were identified, only 78 of them were included in the study. Among the analysed toothpaste types, 105 of them were found to contain 1450 ppm fluoride, whilst 26 toothpaste variants were discovered to have fluoride levels below this value. Among the various ingredients analysed, particular attention was drawn to commonly debated compounds in oral care products. Specifically, titanium dioxide was found in 68% (n = 111) of the varieties, sodium lauryl sulphate in 67% (n = 108) and paraben in 2% (n = 4), respectively.

CONCLUSION

Whilst certain ingredients may raise concerns for potential side effects and health considerations within the human body, the toothpaste has long been regarded as an indispensable tool for maintaining optimal oral and dental health. However, gaining a deeper understanding and conducting research on each constituent that comprises the toothpaste, as well as raising awareness in this regard, holds significant importance for human health.

Characteristics of tin-containing fluoride toothpastes related to erosive tooth wear protection

OBJECTIVES

To assess the effect of different tin-containing toothpastes on the control of erosive tooth wear in enamel and dentin.

METHODS

Enamel and dentin slabs were randomly distributed into 7 experimental groups (n = 10/substrate): C-: negative control (Artificial saliva); AmF (regular fluoridated toothpaste without tin); Sn-1 (SnF2/NaF); Sn-2 (SnF2/NaF/SnCl2); Sn-3 (SnCl2/NaF); Sn-4 (SnF2/SnCl2); Sn-5 (SnCl2/AmF/NaF/chitosan). Specimens were submitted to 5-day erosion-abrasion cycling. Surface loss (SL) was determined with an optical profilometer. Tin deposition on the tooth surfaces and some characteristics of the toothpastes (pH, potentially available F-, %weight of solid particles, and RDA) were also assessed. Data were statistically analyzed (α = 0.05).

RESULTS

For enamel, the Sn-2 presented the lowest SL, not differing significantly from AmF, C+, and Sn-3. The SL of these groups was significantly lower than the C-, except for Sn-3. Sn-1 and Sn-4 were also not significantly different from C-. For dentin, C- significantly showed the highest SL values, whilst, Sn-1 presented the lowest SL, not differing significantly from AmF, Sn-2, C+, and Sn-3. There was a significant positive association between enamel SL and the pH and tin deposition. Dentin SL was significantly negatively associated with the %weight of solid particles and RDA.

CONCLUSIONS

Most of the tin-toothpastes were able to exhibit some protection against ETW. In this process, the toothpastes characteristics play a role, as lower enamel SL was significantly associated with lower pH values and tin deposition; and lower dentin SL was associated with higher %weight of solid particles and RDA of the toothpastes.

CLINICAL SIGNIFICANCE

Tin-containing toothpastes can be used for erosive tooth wear protection, but our study showed that their effect depends on the pH, amount of tin deposition, % weight of solid particles and RDA of the toohpastes.

Film-Forming Polymers for Inhibition of Hydroxyapatite Dissolution: A Screening Study

The aim of this study was to evaluate the effect of film-forming polymer solutions of different concentrations and pH values, either associated or not with sodium fluoride (F; 225 ppm F-), when applied during the initial stage of salivary pellicle formation, to prevent the dissolution of hydroxyapatite (HA), which was determined by the pH-stat method. Polyacrylic acid (PA), chitosan, sodium linear polyphosphate (LPP), polyvinyl methyl ether/maleic anhydride (PVM/MA), and propylene glycol alginate (PGA) were tested in three concentrations (lower, medium, and higher), two pH values (native or adjusted), and either associated or not with F. Distilled water, F, and stannous ion+fluoride (Sn/F; 225 ppm F- and 800 ppm Sn2+, as SnCl2) solutions were the controls, totalizing 63 groups. HA crystals were pretreated with human saliva for 1 min to allow pellicle formation, then immersed in the experimental solutions (1 min), and exposed to saliva for another 28 min. Subsequently, they were added to a 0.3% citric acid solution (pH = 3.8), connected to a pH-stat system that added aliquots of 28 μL 0.1 N HCl for a total reaction time of 5 min. Data were analyzed with one-way ANOVA and Tukey's tests (α = 0.05). For PA alone, the concentrations of 0.1% (native pH), 0.06%, and 0.08% (both pH adjusted) showed significantly lower HA dissolution than the negative control. PA concentrations of 0.1% and 0.08%, of both pH values, improved the effect of F against HA dissolution to a near-identical value as Sn/F. All solutions containing chitosan and LPP significantly reduced HA dissolution in comparison with the control. For chitosan, the concentration of 0.5% (in both pH values) improved the effect of F. LPP at 0.5% (native pH) and all associations of LPP with F outperformed the effect of F. Some PVM/MA solutions significantly reduced HA dissolution but PVM/MA could not improve the protection of F. PGA was incapable of reducing HA dissolution or improving F effect. It was concluded that chitosan, LPP, and some PA and PVM/MA solutions used alone were capable of reducing HA dissolution. Only PA, chitosan, and LPP were able to enhance fluoride protection, but for PA and chitosan, this was influenced by the polymer concentration.

Film-Forming Polymers for Tooth Erosion Prevention

Different agents have been proposed to prevent the progression of acid induced dental substance losses, which are called erosive tooth wear (ETW), such as fluorides, calcium, and phosphate-based products; however, there is a need for a further increase in efficacy. Recently, the ability of polymers to interact with the tooth surface, forming acid resistant films, has come into the focus of research; nevertheless, there is still the need for a better understanding of their mode of action. Thus, this article provides an overview of the chemical structure of polymers, their mode of action, as well as the effect of their incorporation into oral care products, acid beverages, and antacid formulations, targeting the prevention of ETW. Recent evidence indicates that this may be a promising approach, however, additional studies are needed to confirm their efficacy under more relevant clinical conditions that consider salivary parameters such as flow rate, composition, and clearance. The standardization of methodological procedures such as acid challenge, treatment duration, and combination with fluorides is necessary to allow further comparisons between studies. In conclusion, film-forming polymers may be a promising cost-effective approach to prevent and control erosive demineralization of the dental hard tissue.

Topical Agents for Nonrestorative Management of Dental Erosion: A Narrative Review

A nonrestorative approach to the management of dental erosion is the foremost option: controlling dental erosion. The objectives of this study are to provide an overview and to summarise the effects and properties of topical anti-erosive agents as a nonrestorative treatment of dental erosion. A literature search was conducted on five databases of peer-reviewed literature—Cochrane Library, EMBASE, PubMed, Scopus and Web of Science—to recruit articles published between 1 January 2000 and 31 December 2021. The literature search identified 812 studies; 95 studies were included. Topical anti-erosive agents can be broadly categorised as fluorides, calcium phosphate-based agents, organic compounds and other anti-erosive agents. In the presence of saliva, fluorides promote the formation of fluorapatite on teeth through remineralisation. Calcium phosphate-based agents supply the necessary minerals that are lost due to the acid challenge of erosion. Some organic compounds and other anti-erosive agents prevent or control dental erosion by forming a protective layer on the tooth surface, by modifying salivary pellicle or by inhibiting the proteolytic activity of dentine collagenases. Topical anti-erosive agents are promising in managing dental erosion. However, current evidence shows inconsistent or limited results for supporting the use of these agents in clinical settings.

Effect of high-fluoride dentifrice on root dentine de-remineralization exposed to erosion challenge in vitro

Background

High-fluoride dentifrice can be used to manage dental erosion; however, little is known about it effect on root dentine previously demineralized. This study evaluated the effect of high-fluoride treatment on dentin de/remineralization exposed to an erosion challenge in vitro.

Material and Methods

Sound and demineralized dentine blocks were submitted to a 5-days-erosive challenge in soft drink (4/day during 90 s) and treated with fluoride solutions (0, 1,100, or 5,000 µg F/mL). After this, the percentage of surface hardness loss (%SHL) or recovery (%SHR) was calculated. Data were analyzed by one-way ANOVA and Tukey post hoc test with p fixed at 5%.

Results

High-fluoride treatment was able to reduce dentine remineralization and increase mineral recovery of previously demineralized dentine compared to other treatments tested (p<0.05).

Conclusions

High-fluoride treatment was able to increase the remineralization and reduce the demineralization of root dentine submitted to an erosive challenge in vitro, being an option for the erosion prevention/treatment.

Key words:Fluorides, root caries, tooth erosion, toothpastes.

Development of a sodium fluoride and stannous chloride-containing gel for treatment of dental erosion

This study synthesized and tested experimental gels containing fluoride (F-) and stannous (Sn2+) ions for the control of dental erosion. Enamel and dentin polished specimens were eroded (1% citric acid solution, 10 min) and randomly allocated into 5 groups (n=10): Placebo - Hydroxypropyl Methylcellulose (HMC) gel; F+Sn+HMC - 7,500 ppm F- / 15,000 ppm Sn2+; F+HMC - 7,500 ppm F-; Commercial acidulated phosphate fluoride gel (12,300 ppm F-); and Control - no treatment. After treatment (applied for 60 s), specimens underwent an erosion-remineralization cycling (5 min in 0.3% citric acid solution, 60 min in artificial saliva, 4×/day, 20 days). Surface loss (SL, in µm) was determined after the 5th, 10th and 20th days of cycling (α=0.05). For enamel, after 5 and 10 days, F+Sn+HMC presented the lowest SL, which did not differ from the commercial gel. After 20 days, no differences were found between commercial, F+HMC, and F+Sn+HMC groups. Placebo did not differ from the control at any time points, and both groups presented the highest SL when compared to the other groups. For dentin, on the 5th day, F+Sn+HMC, F+HMC and commercial did not differ significantly, showing lower SL than the control and the placebo. On the 10th day, F+Sn+HMC and commercial presented the lowest SL compared to control and placebo. After 20 days, only the commercial gel showed lower SL than the control and placebo. Thus, the experimental F+Sn+HMC gel was able to control the progression of tooth erosion.

Protective effect of green tea catechins on eroded human dentin: an in vitro/in situ study

The present study sought to evaluate the protective effect of Epigallocatechin-3-gallate (EGCG) and commercial green tea (GT) on eroded dentin using in vitro and in situ experimental models. For the in vitro experiment, matrix metalloproteinases (MMPs) were extracted from demineralized human coronary dentin powder (citric acid, pH 2.3) and assessed via a colorimetric assay and electrophoresis in gelatin. The gels were exposed to buffers with: control (no treatment), 0.05% sodium fluoride (NaF), 0.12% chlorhexidine digluconate (CHX), GT infusion, and 0.1% EGCG, and their respective activity was analyzed by zymography. For the in situ experiment, 20 healthy volunteers (aged 20-32 years) participated in this single-center, blind, crossover study. The subjects wore upper removable devices containing four human dentin blocks. Erosive challenge (coke-1 min) was performed four times/day/5 days. Blocks were treated for 1 min with: control (No treatment), 0.05% NaF, 0.1% EGCG, and GT. Thereafter, the specimens were subjected to stylus profilometry and SEM. ANOVA was used to evaluate dentin roughness and wear, with a significance level of 5%. In the zymography analysis, 0.12% CHX, GT, and 0.1% EGCG were found to inhibit the action of MMPs; however, in the colorimetric assay, only green tea inhibited the activity of MMPs. There were no significant differences observed in dentin roughness or wear (p > 0.05). Herein, EGCG and GT inhibited the activity of endogenous proteases, resulting in protection against erosion-induced dentin damage; however, they could not prevent tooth tissue loss in situ.

Tooth Age Impact on Dental Erosion Susceptibility and Treatment Efficacy

This laboratory study investigated the impact of tooth age on dental erosion susceptibility and preventive treatment efficacy. Extracted human premolars were selected and had their age estimated (∼10-100 years old) using established dental forensic methods. Enamel and root dentin slabs were prepared, embedded in acrylic blocks, flattened, and polished. The specimens were randomly assigned to one of three treatments (n = 93): Sn+F (800 ppm Sn as SnCl2 and 250 ppm F as NaF, pH 4.5), NaF (250 ppm F, pH 4.5), or deionized water (DIW). Each specimen was subjected for 10 days to a daily cycling protocol consisting of six 5-min erosive challenges (0.3% citric acid, pH 2.6), six 60-min remineralization periods (artificial saliva), and three 2-min treatments with the test solutions. Surface loss (SL) was measured after 3, 5, and 10 days, using optical profilometry. Effects of tooth age, antierosive treatment, and time on SL were evaluated using linear mixed effects regression analysis. SL increased with age for all substrate-treatment-time combinations (p < 0.0001). Sn+F and NaF solutions significantly reduced SL compared to DIW, regardless of substrate, time, or age (p < 0.0001), with best results shown for Sn+F. Efficacy of Sn+F increased with tooth age on enamel, but tooth age did not affect the efficacy of NaF on enamel. For dentin, increased efficacy was observed with age after 5 (for Sn+F) and 10 days (for Sn+F and NaF). In conclusion, increase of tooth age rendered enamel and root dentin more susceptible to dental erosion. NaF preventive efficacy improved with tooth age for dentin, in advanced erosion simulation. Sn+F reduced enamel SL due to erosion regardless of tooth age.

Erosive tooth wear inhibition by hybrid coatings with encapsulated fluoride and stannous ions

This study aimed to formulate a hybrid coating material (HC) and to modify this HC with fluoride (NaF) and stannous (SnCl₂) ions, directly or encapsulated in nano containers, testing the effects of these materials against dental erosion and erosion-abrasion. Enamel and dentin specimens were treated with the HCs, and then tested in erosion or erosion-abrasion cycling models of 5 days (n = 10 for each substrate, for each model). Deionized water was the negative control, and a fluoride varnish, the positive control. Surface loss (SL, in µm) was evaluated with an optical profilometer, and data were statistically analyzed (α = 0.05). For enamel, in erosion, the positive control and HC without additives showed significantly lower SL than the negative control (p = 0.003 and p = 0.001). In erosion-abrasion, none of the groups differed from the negative control (p > 0.05). For dentin, in erosion, the positive control, HC without additives, HC with non-encapsulated F, and HC with encapsulated F + Sn showed lower SL than the negative control (p < 0.05). In erosion-abrasion, none of the groups differed significantly from the negative control (p < 0.05). HC without additives showed a promising potential for protecting the teeth against dental erosion (with upward trend for improved protection on dentin), but not against erosion-abrasion. The presence of additives did not improve the protective effect of the HC, on both substrates.

Recent Development of Active Ingredients in Mouthwashes and Toothpastes for Periodontal Diseases

Periodontal diseases like gingivitis and periodontitis are primarily caused by dental plaque. Several antiplaque and anti-microbial agents have been successfully incorporated into toothpastes and mouthwashes to control plaque biofilms and to prevent and treat gingivitis and periodontitis. The aim of this article was to review recent developments in the antiplaque, anti-gingivitis, and anti-periodontitis properties of some common compounds in toothpastes and mouthwashes by evaluating basic and clinical studies, especially the ones published in the past five years. The common active ingredients in toothpastes and mouthwashes included in this review are chlorhexidine, cetylpyridinium chloride, sodium fluoride, stannous fluoride, stannous chloride, zinc oxide, zinc chloride, and two herbs—licorice and curcumin. We believe this comprehensive review will provide useful up-to-date information for dental care professionals and the general public regarding the major oral care products on the market that are in daily use.

Protective Effect of Solutions Containing Polymers Associated with Fluoride and Stannous Chloride on Hydroxyapatite Dissolution

This study investigated the protective effect of experimental solutions containing 4 polymers (polyoxirane, hydroxypropylmethylcellulose [HPMC], pectin, and an amino methacrylate copolymer [AMC]) in 2 concentrations (low and high) associated or not with sodium fluoride (F; 225 ppm F-) or sodium fluoride plus stannous chloride (FS; 800 ppm Sn2+) on the dissolution of hydroxyapatite crystals (HA). Deionized water was the control. The pretreated HA was added to a 0.3% citric acid solution (pH 3.8). An automatic titrant machine added aliquots of 0.1 N HCl at a rate of 28 μL/min, in a total reaction time of 5 min. Groups were compared with 2-way ANOVA and Tukey's test, and concentrations with Student t test (5%). The zeta potential of the HA treated with the solutions was measured. Significant differences were found for both factors and interaction (p < 0.0001). The treatments with F and FS solutions resulted in a lower amount of dissolved HA than the control. Among the polymers' solutions, only AMC was able to reduce the amount of dissolved HA, changing the surface charge of HA to positive. AMC improved the protective effect of F, but it did not affect FS. Polyoxirane and HPMC reduced the protective potential of the FS solution. No differences were found between the concentrations of the polymers. It was concluded that F and FS reduced the amount of dissolved HA. The protective effect of the experimental solutions against HA dissolution was polymer dependent. The F effect was enhanced by its combination with AMC, but the protection of FS was impaired by polyoxirane and HPMC.

Interplay between different manual toothbrushes and brushing loads on erosive tooth wear

OBJECTIVE

To investigate the effect of different types of manual toothbrushes and brushing loads on the progression of erosive tooth wear (ETW) on enamel.

METHODS

Bovine enamel specimens (n = 10) were submitted to a 5-day erosive-abrasive cycling model (0.3 % citric acid for 5 min, artificial saliva for 60 min, 4x/day). Toothbrushing was carried out 2x/day for 15 s, according to the toothbrushes tested (ultra-soft (a): Curaprox 5460; ultra-soft (b): Sensodyne Repair & Protect; soft (a): Colgate Slim Soft; soft (b): Oral-B Indicator Plus; medium: Johnson's Professional; hard: Tek) and brushing loads (1.5 N, 3 N). Surface loss (SL, in μm) was assessed by optical profilometry on conclusion of the cycling. Some of the toothbrush characteristics were evaluated. Data were statistically analyzed (α = 0.05).

RESULTS

For the 1.5 N load, the hard brush showed the highest SL value, with statistical significance. The other toothbrushes did not differ significantly, except that ultra-soft (a) caused significantly higher SL than ultra-soft (b). For the 3 N load, hard and soft (a) exhibited the highest SL. Soft (b) and medium had the lowest SL value, with statistical significance. Only soft (a) and ultra-soft (b) showed significant difference between loads, with lower SL for the load of 1.5 N. None of the toothbrush characteristics were significantly correlated with SL.

CONCLUSIONS

Although different degrees of enamel surface loss were observed with use of the different toothbrushes, no association was found between the toothbrush characteristics and SL. Depending on the toothbrush, the force of brushing was capable of modulating the ETW of enamel. Based on the brushing loads usually applied by healthy individuals, hard brushes are not recommended for use by patients with ETW.

CLINICAL SIGNIFICANCE

The use of hard bristle brushes is not recommended for use by individuals who exert healthy forces when brushing their teeth. The toothbrush characteristics are of secondary importance in terms of causing enamel loss in ETW.

Protective effect of anti-erosive solutions enhanced by an aminomethacrylate copolymer

OBJECTIVE

To investigate if an aminomethacrylate copolymer (AMC) could potentiate the anti-erosive effect of solutions containing sodium fluoride -F (225 ppm F^-) and sodium fluoride associated to stannous chloride -FS (800 ppm Sn²⁺).

METHODS

The experimental solutions (F, FS, AMC, AMC + F, AMC + FS, and deionized water-DW as negative control) were tested in the presence of acquired pellicle. Polished bovine enamel specimens (n = 13/group) were submitted to an erosion-rehardening cycle (2 h immersion in human saliva, 5 min in 0.3 % citric acid, 1 h in human saliva, 4×/day, 5 days). Treatment with the solutions was performed for 2 min, 2×/day. The rehardening (%Re) and protective (%Prot) potential of the solutions were assessed in the beginning of the experiment, and the surface loss (SL) by contact profilometry after 5 days. Additional bovine specimens (n = 5/group) were prepared to evaluate the contact angle on the treated enamel surface. The zeta potential of the dispersed hydroxyapatite (HA) crystals after the treatment with the solutions was also measured (n = 3/group). Data were statistically analyzed (α = 0.05).

RESULTS

The association with AMC improved the %Re and the %Prot for W and F, but not for FS. The results of SL were: AMC + F = AMC + FS < AMC < FS < F < DW. The presence of AMC significantly reduced the contact angle on enamel surfaces. The HA presented a strong negative surface charge after the treatment with DW, F and FS, whereas after the treatment with the solutions containing AMC it became positive.

CONCLUSION

AMC has potential to enhance the anti-erosive effect of fluoride solutions.

CLINICAL SIGNIFICANCE

The aminomethacrylate copolymer (AMC) may be a promising agent to be added to oral care products for the prevention of erosive tooth wear.

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.

Enhancing the Anti-Erosive Properties of Fluoride and Stannous with the Polymer Carbopol

This in vitro study investigated whether Carbopol 980 polymer could potentiate the anti-erosive effect of solutions containing sodium fluoride (F) and sodium fluoride associated with stannous chloride (FS). The dissolution of hydroxyapatite treated with the experimental solutions (F [500 ppm F-], F + Carbopol [0.1%], FS [500 ppm F- + 800 ppm Sn2+], FS + Carbopol) was evaluated. Deionized water was the negative control, and a commercial mouth rinse (AmF/NaF/SnCl2; 500 ppm F + 800 ppm Sn2+; Elmex® Erosion Protection) was the positive control. The solutions were also evaluated in an erosion-rehardening protocol, with two treatments per day, using bovine enamel specimens (n = 15) and human saliva. The acid challenge was performed using 0.3% citric acid (pH 2.6) for 2 min. Microhardness was measured at different times: baseline, after the first erosive challenge, after treatment, and after the second erosive challenge. Based on microhardness values, the demineralization, rehardening, and protective potentials were calculated. The alkali-soluble fluoride on enamel surfaces was also measured. Data were analyzed using ANOVA and Tukey tests (α = 0.05). Groups treated with FS + Carbopol showed the lowest hydroxyapatite dissolution and the highest rehardening and protective potentials. The measurement of alkali-soluble fluoride on enamel surfaces was also higher in the FS + Carbopol group. Carbopol was able to significantly increase the protective effect of the fluoridated solutions in addition to optimizing the adsorption of fluoride on the enamel surface.

Role of desensitizing/whitening dentifrices in enamel wear

OBJECTIVES

To analyze the impact of desensitizing (D) and/or whitening (W) dentifrices on erosion and erosion-abrasion.

METHODS

Enamel specimens were allocated into 10 groups (n = 20): 1. Artificial saliva (control); 2. Sensodyne Repair&Protect (SRP-D); 3. Sensodyne Repair&Protect Whitening (SRP-W); 4. Colgate Sensitive Pro-Relief (CSPR-D); 5. Colgate Sensitive Pro-Relief Real White (CSPRR-W); 6. Colgate Total 12 (CT); 7. Colgate Total 12 Professional Whitening (CTP-W); 8. Sensodyne True White (ST-W); 9. Curaprox Black is White (CB-W); 10. Oral-B 3D White Perfection (OB3D-W). For abrasion (n = 10), 30,000 brushing strokes were performed and surface roughness (SR) was evaluated. Erosion-abrasion (n = 10) consisted of 1 % citric acid (2 min), artificial saliva (60 min); 6×/day; 5 days. Toothbrushing was carried out 2×/day (45 strokes). Surface loss (SL) was determined with an optical profilometer. Data were statistically analyzed (α = 0.05).

RESULTS

Relative to SR, only OB3D-W had a significantly rougher surface than the control (p = 0.014). SRP-D, CSPR-D and ST-W showed no difference from the baseline. High SL was observed for ST-W, OB3D-W and CTP-W, without significant differences from the control. CT showed the lowest SL, not differing from SRP-D and SRP-W. There was a weak negative correlation between SL and concentration of free fluoride in the slurries, SL and SR, and SL and pH, all p > 0.05.

CONCLUSIONS

Only one dentifrice increased surface roughness of enamel to a higher degree than brushing with saliva. Brushing with the test dentifrices did not cause higher enamel erosive wear than brushing with saliva.

CLINICAL SIGNIFICANCE

This study enhances our knowledge on the effect of desensitizing and whitening dentifrices, indicating that they do not worsen enamel loss due to abrasion and they might be a safe option for individuals with erosive tooth wear.

Randomized in situ trial on the efficacy of Carbopol in enhancing fluoride / stannous anti-erosive properties

OBJECTIVE

To evaluate if the bioadhesive polymer (Carbopol 980) could potentiate the protective effect of sodium fluoride with stannous chloride (FS) solution on the control of enamel erosive wear.

METHODS

Cylindrical bovine enamel specimens were polished and randomly allocated into three groups (n = 60): FS (500 ppm F^- +800 ppm Sn²⁺ - positive control), FS + Carbopol (0.1% Carbopol), and ultrapure water (negative control). A randomized double-blind cross-over in situ model with three phases was used. In each phase, volunteers (n = 15) used a palatal appliance containing 4 specimens: two were submitted to an erosion model (2 h of pellicle formation; immersion in 1% citric acid, pH 2.3, for 5 min, 4x/day; 1 h intervals of saliva exposure; and treatment with the test solutions for 1 min, 2x/day). Besides erosion, the other two specimens were also subjected to abrasion (2x/day, 15 s) with active electric toothbrush, before the treatment with the solutions. After 5 days, enamel surface loss (μm) was evaluated by profilometry. Data were analyzed by two-way RM-ANOVA and Tukey tests (5%).

RESULTS

There were significant differences for both challenge and treatment factors. Erosion/abrasion challenge resulted in significantly higher enamel loss than erosion only (p < 0.05). The surface loss values for the erosion/remineralization model were (means ± SL): C = 14.7 ± 5.8b; FS = 9.0 ± 7.5ab; FS + Carbopol = 5.9 ± 3.8a; and for erosion/abrasion: C = 26.6 ± 10.1c; FS = 15.0 ± 8.8b; FS + Carbopol = 12.3 ± 7.9ab.

CONCLUSION

The association of Carbopol to the FS solution significantly protected the enamel against erosive wear, but it was not significantly superior to FS only.

CLINICAL SIGNIFICANCE

Under highly erosive and abrasive conditions, rinsing with solutions containing sodium fluoride plus stannous chloride, associated or not with the Carbopol polymer, is an effective approach to control enamel erosive wear.

Novel fluoride and stannous -functionalized β-tricalcium phosphate nanoparticles for the management of dental erosion

OBJECTIVE

To evaluate the anti-erosive effect of solutions containing β-tricalcium phosphate (β-TCP) nanoparticles functionalized with fluoride or with fluoride plus stannous on enamel and dentin.

METHODS

β-TCP nanoparticles were synthesized and characterized by X-ray diffraction (XRD) and transmission electron microscopy (TEM). Sixty enamel and dentin specimens were randomly allocated into the groups (n = 10): Control (water); F (NaF, 225 ppm F^-); F + Sn (NaF + SnCl_2, 800 ppm Sn²⁺); F+β-TCP (F+40 ppm β-TCP); F + Sn+β-TCP (F + Sn+40 ppm β-TCP); F + Sn+100β-TCP (F + Sn+100 ppm β-TCP). Specimens underwent erosion-remineralization cycling (5 min immersion into 1 % citric acid solution and 60 min exposure to artificial saliva, 4×/day, 5 days). Immersion in the test solutions was performed for 2 min, 2×/day. Surface loss (SL, in μm) was determined by optical profilometry at the end of cycling. Data were analyzed using one way-ANOVA and Tukey's tests (α = 0.05).

RESULTS

XRD confirmed the β-TCP phase. TEM micrographs showed differences between the bare nanoparticle and the β-TCP functionalized with F and Sn. All enamel groups presented lower SL than the control, with F + Sn, F + Sn+β-TCP, and F + Sn+100β-TCP showing the lowest values. For dentin, all the groups had lower SL than the control. F+β-TCP presented the lowest SL, significantly differing from all the other groups.

CONCLUSION

β-TCP nanoparticles functionalized with fluoride showed improved anti-erosive effect compared to the fluoride solution on dentin. There was no significant effect of the β-TCP nanoparticles functionalized with fluoride plus stannous in both substrates.

CLINICAL RELEVANCE

β-TCP nanoparticles are a promising agent to be added to oral health products to improve the protective effect of fluoride against dentin erosion.

Using fluoride mouthrinses before or after toothbrushing: effect on erosive tooth wear

OBJECTIVES

1. To evaluate the use of fluoridated mouthrinses before or after toothbrushing on erosive tooth wear. 2. To compare the anti-erosive effect of the combination toothpaste and mouthrinse containing fluoride, with or without stannous chloride.

DESIGN

Enamel and dentin specimens were randomly distributed into groups (n = 10 of each substrate/group): B-brushing, B + R-brushing + rinsing, and R + B-rinsing + brushing. The treatments were performed using a fluoride toothpaste (B_F: 1400 ppm fluoride, as amino fluoride-AmF) combined or not with a fluoride mouthrinse (R_F: 250 ppm fluoride, as AmF and sodium fluoride-NaF) or fluoride and stannous toothpaste (B_F+Sn: 1400 ppm fluoride, as AmF and NaF, 3500 ppm stannous, as stannous chloride-SnCl₂ and 0.5% chitosan) combined or not with fluoride and stannous mouthrinse (R_F+Sn: 500 ppm fluoride, as AmF and NaF, 800 ppm stannous, as SnCl₂). As control, brushing was performed with artificial saliva (B_C). Specimens were submitted to a 5-day erosive-abrasive cycling model. Treatments were performed twice daily. Surface loss (SL) was determined by optical profilometry. Data were analyzed by ANOVA and Games-Howell tests (α = 0.05).

RESULTS

For enamel, R_F+B_F and R_F+Sn+B_F+Sn presented significantly lower SL than the control, with R_F+B_F being significantly lower than R_F+Sn+B_F+Sn. For dentin, B_C had the lowest SL, not differing from B_F+Sn+R_F+Sn, R_F+Sn+B_F+Sn and B_F. Groups R_F+B_F and B_F+R_F showed highest SL, not differing from B_F+Sn and B_F+Sn.

CONCLUSIONS

For enamel, the use of a mouthrinse before brushing was able to reduce erosive wear for both fluoride and stannous products. For dentin, the use of stannous-containing products, irrespective of the order of application, presented superior effects.

Effect of toothpaste containing amine fluoride and stannous chloride on the reduction of dental plaque and gingival inflammation. A randomized controlled 12-week home-use study

OBJECTIVES

This single-centre, controlled, randomized, double-blinded clinical study in parallel groups was performed to assess the efficacy of an experimental toothpaste on plaque and gingivitis.

METHODS

In adult subjects with gingivitis, amine fluoride/stannous chloride toothpaste (test) and monofluorophosphate toothpaste (control) were applied twice daily by regular toothbrushing at home. Evaluations of plaque index (PI), gingival index (GI), modified sulcus bleeding index (mSBI) and safety took place at baseline and after 3 and 12 weeks of study product use. After study completion, all subjects received a dental prophylaxis. A descriptive statistical analysis included means and standard deviations. Unpaired t tests compared index reductions between groups at a significance level of 0.05.

RESULTS

Intention-to-treat analysis included 240 out of 241 subjects. Baseline mean PI was reduced by 0.87 ± 0.35 in the test group and by 0.65 ± 0.41 in the control group. Within-group differences and between-group differences in index reduction were statistically significant (P < 0.001). Mean GI and mSBI were reduced significantly over time (P < 0.001) with no clinically meaningful differences between groups.

CONCLUSIONS

Both toothpastes reduced plaque and gingivitis statistically significant and clinically meaningful over 12 weeks. Compared to the control toothpaste, application of the amine fluoride/stannous chloride toothpaste led to a clinically meaningful and more pronounced plaque reduction.

Anti-Erosive Effect of Solutions Containing Sodium Fluoride, Stannous Chloride, and Selected Film-Forming Polymers

The aim of this study was to evaluate the anti-erosive effect of solutions containing sodium fluoride (F: 225 ppm F–), stannous chloride (Sn: 800 ppm Sn2+), and some film-forming polymers (Gantrez: Poly [methylvinylether-alt-maleic anhydride]; PGA: propylene glycol alginate; Plasdone: poly[vinylpyrrolidone]; and CMC: carboxymethylcellulose). Solutions were tested in an erosion-remineralization cycling model, using enamel and dentin specimens (n = 10, for each substrate). Distilled water was the negative control. Cycling consisted of 120 min immersion in human saliva, 5 min in 0.3% citric acid solution, and 120 min of exposure to human saliva, 4×/day, for 5 days. Treatment with solutions (pH = 4.5) was carried out 2×/day, for 2 min. Surface loss (SL) was evaluated with optical profilometry. Zeta potential of hydroxyapatite crystals was determined after treatment with the solutions. Data were statistically analyzed (α = 0.05). For enamel, all polymers showed significantly lower SL (in µm) than the control (11.09 ± 0.94), except PGA (10.15 ± 1.25). PGA significantly improved the protective effect of F (4.24 ± 0.97 vs. 5.64 ± 1.60, respectively). None of the polymers increased the protection of F+Sn (5.13 ± 0.78). For dentin, only Gantrez (11.40 ± 0.97) significantly reduced SL when compared with the negative control (12.76 ± 0.75). No polymer was able to enhance the effect of F (6.28 ± 1.90) or F+Sn (7.21 ± 1.13). All fluoridated solutions demonstrated significantly lower SL values than the control for both substrates. Treatment of hydroxyapatite nanoparticles with all solutions resulted in more negative zeta potentials than those of the control, except Plasdone, PGA, and F+Sn+PGA, the latter two presenting the opposite effect. In conclusion, Gantrez, Plasdone, and CMC exhibited an anti-erosive effect on enamel. PGA increased the protection of F. For dentin, only Gantrez reduced erosion.

Effect of sucralfate against hydrochloric acid-induced dental erosion

OBJECTIVE

Devising effective measures for the prevention of hydrochloric acid (HCl)-induced erosion is of great significance. This is even more important in dentine, in which products have limited diffusion. Therefore, agents that can bind to proteins forming an acid-resistant gel-like coat, such as sucralfate, may stand out as a promising alternative. This study investigated the protective effect of sucralfate suspensions against HCl-induced dental erosion.

MATERIALS AND METHODS

In the first experiment, hydroxyapatite (HAp) crystals were pre-treated with a commercial sucralfate suspension (CoSS, pH 5.9), a stannous-containing sodium fluoride solution (NaF/SnCl₂ pH 4.5), two prepared sucralfate suspensions (PrSS, pH 5.9 and 4.5), or deionized water (DI, control). HAp dissolution was measured using a pH-stat system. In a subsequent experiment, embedded/polished enamel and root dentine slabs were allocated into five groups to be treated with one of the tested substances prior to and during erosion-remineralization cycles (HCl-2 min + artificial saliva 60 min, two times per day, 5 days). Surface loss was assessed profilometrically. Data were analyzed by ANOVA and Tukey's tests.

RESULTS

HAp dissolution was as follows: NaF/SnCl₂ < CoSS < PrSS/pH 4.5, while PrSS/pH 5.9 = DI and both did not differ from CoSS and PrSS/pH 4.5. In enamel, surface loss did not differ between CoSS and PrSS/pH 4.5, with both having lower surface loss than PrSS/pH 5.9 and DI and NaF/SnCl₂ differing only from DI. In root dentine, surface loss was as follows: CoSS < PrSS/pH 5.9 < (NaF/SnCl₂ = DI), while PrSS/pH 4.5 = CoSS = PrSS/pH 5.9.

CONCLUSION

Sucralfate suspension provided anti-erosive protection to HCl-induced erosion.

CLINICAL RELEVANCE

Sucralfate may protect teeth against erosion caused by gastric acid.

Er,Cr:YSGG laser associated with acidulated phosphate fluoride gel (1.23% F) for prevention and control of dentin erosion progression

To evaluate the effect of Er,Cr:YSGG laser, associated with fluoride application, on the prevention/control of dentin erosion. Dentin slabs were embedded in acrylic resin, flattened, and polished. Half of the specimens were previously eroded (10 min immersion in 1% citric acid solution) and half were kept sound. The specimens (n = 10 each substrate) were randomly allocated into the experimental groups, according to the following treatments: control (no treatment); APF gel (1.23% F, 1 min); Er,Cr:YSGG laser irradiation (P1: 0.25 W, 20 Hz, 2.8 J/cm², tip S75, beam diameter of 750 μm, 1 mm away from the surface); Er,Cr:YSGG laser irradiation (P2: 0.50 W, 20 Hz, 5.7 J/cm², tip S75, beam diameter of 750 μm, 1 mm away from the surface); APF gel + Er,Cr:YSGG laser P1 and; APF gel + Er,Cr:YSGG laser P2. Afterwards, the specimens underwent an erosion-remineralization cycling, consisting of a 5-min immersion into 0.3% citric acid, followed by 60-min exposure to artificial saliva. This procedure was repeated 4×/day, for 5 days. Surface loss (SL, in μm) was determined by optical profilometry. Specimens from each group were analyzed by environmental scanning electron microscopy (n = 3). Data were statistically analyzed (α = 0.05). For the eroded specimens, APF gel presented the lowest SL, being different from the control. For the sound specimens, none of the groups differed from the control, except for Er,Cr:YSGG laser P2, which presented the highest SL. When substrates were compared, only the eroded specimens of the control and APF + Er,Cr:YSGG laser P1 Groups showed higher SL. Selective structure removal was observed for the laser-treated groups. None of the Er,Cr:YSGG laser parameters were effective in the prevention/control dentin erosion. The laser was also unable to enhance the protection of fluoride against dentin erosion.

In situ evaluation of fluoride-, stannous- and polyphosphate-containing solutions against enamel erosion

OBJECTIVE

To evaluate the anti-erosive effect of solutions containing sodium fluoride (F: 225ppm of fluoride), sodium fluoride+stannous chloride (F+Sn: 225ppm of fluoride+800ppm of stannous), sodium fluoride+stannous chloride+sodium linear polyphosphate (F+Sn+LPP: 225ppm of fluoride+800ppm of stannous+2% of sodium linear polyphosphate), and deionized water (C: control), using a four-phase, single-blind, crossover in situ clinical trial.

METHODS

In each phase, 12 volunteers wore appliances containing 4 enamel specimens, which were submitted to a 5-day erosion-remineralization phase that consisted of 2h of salivary pellicle formation with the appliance in situ, followed by 2min extra-oral immersion in 1% citric acid (pH 2.4), 6x/day, with 90min of exposure to saliva in situ between the challenges. Treatment with the test solutions was performed extra-orally for 2 min, 2x/day. At the end of the experiment, surface loss (SL, in μm) was evaluated by optical profilometry. Data were analyzed using ANOVA and Tukey tests (α=0.05). The surface of additional specimens was evaluated by x-ray diffraction after treatments (n=3).

RESULTS

C (mean SL±standard-deviation: 5.97±1.70) and F (5.36±1.59) showed the highest SL, with no significant difference between them (p>0.05). F+Sn (2.68±1.62) and F+Sn+LPP (2.10±0.95) did not differ from each other (p>0.05), but presented lower SL than the other groups (P<0.05). Apatite and stannous deposits on specimen surfaces were identified in the x-ray analysis for F+Sn and F+Sn+LPP.

CONCLUSIONS

Sodium fluoride solution exhibited no significant anti-erosive effect. The combination between sodium fluoride and stannous chloride reduced enamel erosion, irrespective of the presence of linear sodium polyphosphate.

CLINICAL SIGNIFICANCE

Under highly erosive conditions, sodium fluoride rinse may not be a suitable alternative to prevent enamel erosion. A rinse containing sodium fluoride and stannous chloride was shown to be a better treatment option, which was not further improved by addition of the sodium linear polyphosphate.

Nd:YAG laser irradiation associated with fluoridated gels containing photo absorbers in the prevention of enamel erosion

This study evaluated the combined effect of Nd:YAG laser irradiation and fluoridated gels containing photo absorbers against enamel erosion. Enamel specimens from bovine teeth were polished, eroded (10 min, with 1% citric acid, pH = 2.6), and randomly allocated into the experimental groups (n = 8), according to the different surface treatments: fluoridated gels (F: 9047 ppm F and F + Sn: 9047 ppm F and 3000 ppm Sn), with or without photo absorbers (E: erythrosine and MB: methylene blue), and associated or not with Nd:YAG laser irradiation (in contact; 0.5 W; 50 mJ; ~41.66 J/cm²; 10 Hz; 40 s; pulse duration of 120 μs). A placebo gel (PLA) associated or not with laser was used as control. All gels had pH = 4.5 and were applied for 2 min. Laser irradiation was performed during gel application. The specimens were then submitted to a 5-day erosion-remineralization cycling model using 0.3% citric acid (pH = 2.6), 4×/day. Enamel surface loss (SL) was analyzed by optical profilometry in the end of the cycling (in μm). Data were analyzed by ANOVA and Tukey tests (α = 0.05). Means (SD) of SL for the groups were the following (different superscript letters imply significant difference among groups): PLA (21.02 ± 1.28)^a, PLA + laser (19.20 ± 0.96)^ab, laser (17.47 ± 1.50)^b, F + Sn + E + laser (13.69 ± 0.62)^c, F + E + laser (13.52 ± 1.16)^c, F (13.10 ± 1.08)^c, F + laser (11.94 ± 1.44)^cd, F + Sn + MB + laser (11.90 ± 4.02)^cd, F + MB + laser (11.42 ± 1.42)^cd, F + Sn (11.12 ± 1.20)^cd, and F + Sn + laser (10.35 ± 0.89)^d. In conclusion, all fluoridated gels and the Nd:YAG laser irradiation reduced erosion development, but the combination of treatments did not promote further protection. The addition of photo absorbers to the fluoridated gels did not influence the anti-erosive effect of the combination of laser plus fluoridated gels.

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.

Influence of bioadhesive polymers on the protective effect of fluoride against erosion

OBJECTIVE

This study investigated if the incorporation of the bioadhesive polymers Carbopol 980, Carboxymethyl cellulose (CMC), and Aristoflex AVC in a fluoridated solution (NaF-900ppm) would increase the solution's protective effect against enamel erosion.

METHODS

Enamel specimens were submitted to a 5-day de-remineralization cycling model, consisting of 2min immersions in 0.3% citric acid (6x/day), 1min treatments with the polymers (associated or not with fluoride), and 60min storage in artificial saliva. Ultrapure water was used as the negative control and a 900ppm fluoride solution as positive control. The initial Knoop microhardness (KHN1) was used to randomize the samples into groups. Another two microhardness assessments were performed after the first (KHN2) and second (KHN3) acid immersions, to determine initial erosion in the first day. The formula: %KHN_alt=[(KHN3-KHN2)/KHN2]*100 was used to define the protective effect of the treatments. After the 5-day cycling, surface loss (SL, in μm) was evaluated with profilometry. Data were analyzed with 2-way ANOVA and Tukey's tests (p<0.05).

RESULTS

For %KHN_alt, the polymers alone did not reduce enamel demineralization when compared to the negative control, but Carbopol associated with NaF significantly improved its protective effect. The profilometric analysis showed that Carbopol, associated or not with NaF, exhibited the lowest SL, while CMC and Aristoflex did not exhibit a protective effect, nor were they able to improve the protection of NaF.

CONCLUSIONS

It is concluded that Carbopol enhanced NaF's protection against initial erosion. Carbopol alone or associated with NaF was able to reduce SL after several erosive challenges.

CLINICAL SIGNIFICANCE

Carbopol by itself was able to reduce the erosive wear magnitude to the same extent as the sodium fluoride, therefore, is a promising agent to prevent or control enamel erosion.

Influence of Toothbrushing on the Antierosive Effect of Film-Forming Agents

This study evaluated the influence of toothbrushing on the antierosive effect of solutions containing sodium fluoride (225 ppm/F), stannous chloride (800 ppm/Sn), sodium linear polyphosphate (2%/LPP), and their combinations, and deionized water as negative control (C). Solutions were tested in a 5-day erosion-remineralization-abrasion cycling model, using enamel and dentin specimens (n = 8). Erosion was performed 6 times/day for 5 min, exposure to the test solutions 3 times/day for 2min, and toothbrushing (or not) with toothpaste slurry 2 times/day for 2 min (45 strokes). Surface loss (SL) was determined by noncontact profilometry. Data were analyzed using three-way ANOVA (α = 0.05). Brushing caused more SL than no brushing for enamel (mean ± SD, in micrometers: 52.7 ± 6.6 and 33.0 ± 4.5, respectively), but not for dentin (28.2 ± 1.9 and 26.6 ± 1.8, respectively). For enamel without brushing, F+LPP+Sn showed the lowest SL (23.8 ± 3.4), followed by F+Sn (30.6 ± 4.9) and F+LPP (31.7 ± 1.7), which did not differ from each other. No differences were found between the other groups and C (37.8 ± 2.1). When brushing, F+LPP+Sn exhibited the lowest SL (36.7 ± 2.4), not differing from F+LPP (39.1 ± 1.8). F, F+Sn and LPP+Sn were similar (46.7 ± 2.9, 42.1 ± 2.8 and 45.3 ± 4.6, respectively) and better than C (52.7 ± 4.3). Sn (55.0 ± 2.4) and LPP (51.0 ± 4.3) did not differ from C. For dentin, neither groups differed from C, regardless of brushing. In conclusion, toothbrushing did not affect the antierosive effect of F+Sn, F+LPP and F+LPP+Sn on enamel, although overall it led to more erosion than nonbrushing. F and LPP+Sn showed a protective effect only under brushing conditions, whereas Sn and LPP did not exhibit any protection. For dentin, neither toothbrushing nor the test solutions influenced the development of erosion.