Epidemiology of plaque-induced gingivitis among 12-15-year-old Chinese schoolchildren: A study based on the 2018 case definition

AIM

To explore the epidemiology of plaque-induced gingivitis and related factors among Chinese adolescents.

MATERIALS AND METHODS

This cross-sectional survey comprised 118,601 schoolchildren in the 12-15-year age group. Data came from the National Oral Health Survey in mainland China. The field investigation was conducted according to the World Health Organization guidelines. The new 2018 case definition for plaque-induced gingivitis was used. Participants underwent clinical examinations and completed a structured questionnaire. Bleeding on probing (BOP) was performed on all teeth. Multinomial logistic regression was used to explore the factors related to the extent of gingivitis.

RESULTS

Nearly half of the study population (47.3%) had plaque-induced gingivitis; 23.9% and 23.3% presented with localised and generalised gingivitis, respectively. The first molars were the most affected by BOP. Well-established factors, such as demographic characteristics, socioeconomic status, local factors and smoking habits, were significantly associated with the extent of gingivitis. Odds ratios for localised and generalised gingivitis increased with the decrease in frequency of toothbrushing with a fluoride dentifrice.

CONCLUSIONS

The study population had high plaque-induced gingivitis prevalence. The extent of gingivitis appeared to have a dose-response relationship with the frequency of toothbrushing with a fluoride dentifrice.

Is the whitening effect of charcoal-based dentifrices related to their abrasive potential or the ability of charcoal to adsorb dyes?

OBJECTIVES

To evaluate if tooth color alteration of activated charcoal-based dentifrices may be attributed to the dye adsorption potential of charcoal (chemical action - C - slurry only) or to the association of dye adsorption with abrasion (chemo-mechanical action - CM- slurry/toothbrushing). Potential adverse effects in surface roughness, gloss, and wear were also assessed.

METHODS

Bovine enamel/dentin specimens were randomly allocated into the groups according to treatments and test model (n = 15): deionized water (negative control- NC); Colgate Maximum Anticaries Protection (conventional toothpaste- positive control- PC); Colgate Luminous White Activated Charcoal (LW); Oral-B 3D White Therapy Charcoal (WT); Curaprox Black is White (BW); Dermavita Whitemax (Activated charcoal powder- WP). Specimens were exposed to the C or CM models, in 28-day staining-treatment cycling. Color change (ΔE00), whiteness index (ΔWID), percentage of alteration of surface roughness (%Raalt), and gloss (%GUalt) were calculated. Additional specimens (n = 9) were indented with a Knoop diamond and subjected to 100,000 abrasion cycles. Enamel wear was determined by calculating the decrease in indentations geometry. Data were analyzed by ANOVA/Tukey tests (α = 0.05).

RESULTS

The CM-model produced lower color change (staining) than C (p = 0.0001). PC, LW, WT, BW, and WP showed similar color results for both models, differing from NC (p < 0.05).%Ra and%GU did not differ among the C-model groups (p > 0.05) and WP exhibited the highest variation (%Ra and%GU) under CM-model. Enamel wear values were lowest in the NC and PC groups, intermediate for LW, WT, BW, and highest for the WP (p < 0.05).

CONCLUSION

Activated charcoal-based dentifrices have a similar ability to minimize tooth staining as the conventional toothpaste, with increased enamel wear potential in the long term (after 100,000 cycles). The activated charcoal powder damaged the enamel surface, showing a higher deleterious effect on enamel roughness, gloss, and wear.

CLINICAL SIGNIFICANCE

Dentifrices containing activated charcoal do not provide superior results to minimize tooth staining compared to conventional toothpaste. Charcoal powder should be used with caution because it promotes higher superficial alterations on the enamel surface.

Longevity of extrinsic stains on monolithic zirconia restorations: An in vitro study

STATEMENT OF PROBLEM

Three-mol% yttria-stabilized tetragonal zirconia polycrystal (3Y-TZP) has been commonly used for fixed prosthodontic restorations. The opacity of 3Y-TZP may be masked with external staining, although the longevity of extrinsic stains applied to monolithic zirconia is unclear.

PURPOSE

The purpose of this in vitro study was to analyze the color and surface roughness of extrinsically stained zirconia specimens after thermocycling and toothbrushing.

MATERIAL AND METHODS

Monolithic Ø12.5×1.25-mm zirconia disks were milled from 3Y-TZP blocks, sintered according to manufacturer instructions, and then divided into 3 groups (C, J, and O; n=16) for application of stain and glaze. All specimens underwent 10 000 thermocycles in distilled water before being further divided into 2 dentifrice groups (n=8): normal grit, low relative dentin abrasivity (RDA) (Subgroup N) and abrasive grit, high RDA (Subgroup A). Specimens were brushed in a multistation brushing machine under 1.47 N of force using a 5:8 toothpaste and distilled water slurry for 10 000 cycles with a straight (American Dental Association Standard) toothbrush to simulate 1 year of toothbrushing. Color and surface roughness measurements were obtained at 3 time points: baseline, after thermocycling, and after brushing. A 2-way repeated measures ANOVA was used to independently assess changes in color and surface roughness with respect to thermocycling and brushing (α=.05).

RESULTS

Group J displayed no significant change in color for either dentifrice system (P>.05). However, a significant change in surface roughness was observed for both dentifrice subgroups (P<.001). Group C specimens displayed significant changes in color (P<.001) and surface roughness (P<.001) for both dentifrice systems. Group O specimens displayed significant changes in color (P<.025) for both dentifrice systems and significant changes in surface roughness (P<.004) for subgroup A, but no significant changes for subgroup N (P=.075).

CONCLUSIONS

Artificial aging of monolithic zirconia resulted in changes in color and surface roughness that did not surpass the thresholds for perceptibility and acceptability. This study failed to establish durability limits for extrinsic stains applied to 3Y-TZP.

Is there an acceptable surrogate for caries clinical trials? Evidence from a systematic review of primary studies

BACKGROUND

There is currently a lack of evidence supporting the use of valid surrogates in caries clinical trials. This study aimed at examining the validity of two surrogate outcomes used in randomized clinical trials for caries prevention, pit and fissure sealants and fluoridated dentifrices, according to the Prentice criteria.

METHODS

A systematic review was conducted in MEDLINE (PubMed), LILACS and Scopus databases up to 05 October 2022. The grey literature and the list of eligible studies' references were also screened. The search was conducted, selecting randomized clinical trials focussed on dental caries prevention using pit and fissure sealants or fluoridated dentifrices and with at least one surrogate endpoint for cavitated caries lesions. The risk of each surrogate endpoint and for the occurrence of cavitated caries lesions was calculated and compared. The association between each surrogate and the presence of cavitation was quantified, and each outcome was assessed graphically for validity according to the Prentice criteria.

RESULTS

For pit and fissure sealants, from 1696 potentially eligible studies, 51 were included; while for fluoridated dentifrices, of 3887 potentially eligible studies, four were included. Possible surrogates assessed were retention of sealants, presence of white spot lesions, presence of plaque or marginal discoloration around the sealants, oral hygiene index, radiographic and fluorescence caries lesion assessments. However, only the retention of sealants and the presence of white spot lesions could be evaluated for their validity according to the Prentice criteria.

CONCLUSION

Loss of retention of sealants and the presence of white spot lesions do not fulfil all of the Prentice criteria. Therefore, they cannot be considered valid surrogates for caries prevention.

Comparison of interproximal delivery and flow characteristics by dentifrice dilution and application of prepared toothpaste delivery technique

In home care, the toothpaste technique, which can enhance the caries-preventive effect without changing the amount of dentifrice and fluoride ion concentration, is of great significance. This study aimed to construct a model and experimental system that reproduces the interdental part and to clarify the relationship between the change in dentifrice viscosity due to dilution and washout in the high-risk approximal area of caries. Additionally, the effectiveness of the toothpaste technique and appropriate devices for delivering dentifrice to the interdental area at a low dilution were investigated. Diluted toothpaste samples were prepared (: ×1.00, ×1.25, ×1.50, ×1.75, ×2.00, ×3.00, and ×4.00). An acrylic interproximal model was created for this experiment. The flow characteristics and viscosity by dentifrice dilution were measured. In the case of low dilution of 57% (1.75×) or more, it was shown that the dentifrice in the high-risk area may be washed out early because of the decrease in viscosity, and the caries-preventive effect may be reduced. It was also suggested that to keep the dentifrice in the interdental area for 120 s at the end of brushing, a dilution must be devised to a concentration of at least 50% (2.00×). The prepared toothpaste delivery (PTD) method of delivering dentifrice to the interdental area while maintaining it at a low dilution is an effective toothpaste technique in terms of dentifrice dilution and viscosity. The use of finger brushes in the PTD method could increase the efficiency of dentifrice delivery.

Activated Charcoal Dental Products: Evidence of Effectiveness Is Lacking

With society trending toward the avoidance of artificial components, so-called "natural" products have been gaining space and people's attention in recent years. Activated charcoal-based dental products are a prominent example of this movement because of their promise of removal of extrinsic stains or whitening of teeth by a natural means. Such products have gained popularity among patients, and companies have explored this market, launching charcoal-based and activated charcoal-based dentifrices, mouthrinses, toothbrushes, and whitening products that can be easily found at nearby stores and on the internet.1.

Surface Roughness of Prefabricated Pediatric Zirconia Crowns Following Simulated Toothbrushing

Purpose: The purpose of this study was to evaluate the surface roughness of three different brands of prefabricated pediatric zirconia crowns (ZRCs) following simulated toothbrushing with a variety of dentifrices. Methods: Ninety-six total maxillary right central incisor prefabricated pediatric ZRCs (n equals 32 ZRCs/brand) were obtained from the manufacturers: Kinder Krowns^®, NuSmile^®, and Sprig^®. ZRCs were equally assigned to dentifrices (n equals eight/dentifrice) with a variety of Relative Dentin Abrasion (RDA) values: Tom's of Maine Children's; Crest Kid's; Prevident 5000; and Crest^® Pro-Health. ZRCs were brushed 10,000 strokes with a V-8 Toothbrushing Machine using the assigned dentifrices. Pre- and post-intervention data for the surface roughness of ZRCs, represented in Ra (average roughness) and Rz (mean roughness depth), were obtained using a stylus profilometer. Data were analyzed independently using two-way repeated measures analysis of variance with the Holm- Sidak method (α equals 0.05). Results: Baseline versus brushed Ra Kinder Krowns^® with Prevident and Sprig^® with Crest Kid's indicated statistically significant differences. Sprig^® versus NuSmile^® utilizing Crest Kid's were different in change in roughness. Both baseline and brushed NuSmile^® dentifrice options were different versus all Sprig^® and Kinder^® ZRCs. Conclusions: Despite statistical significance, changes in surface roughness were small in scale. Although this study did not address toothbrushing and different dentifrices may affect the mechanical properties, durability, and/or retention properties of ZRCs, the study's results provide confidence to clinicians when using prefabricated pediatric ZRCs as a sustainable treatment option along with other restorative options, such as strip crowns and stainless steel crowns.

Effect of whitening dentifrices on toothbrush abrasion on composites

PURPOSE

To evaluate the laboratory long-term effect of various whitening dentifrices on the surface roughness of two brands of resin composite (TPH ST, Filtek Bulk Fill One) using a mechanical toothbrushing simulation.

METHODS

Thirty-two samples each of Filtek and TPH were fabricated in ring molds 10 x 1 mm. Samples were randomly grouped (n=8; four groups), according to dentifrice used; Crest 3D, Optic White, Hello (charcoal), and Aim as control. Samples were brushed in mixed solutions containing deionized water and dentifrice at 150 gf for 10,000x with rotation to ensure uniform brushing. Surface roughness was measured both before (baseline) and after the mechanical toothbrushing simulation using a stylus profilometer. Data collected was compared independently for each treatment using two-way ANOVA and SNK with α< 0.05 for significance.

RESULTS

The data showed that TPH was more susceptible to the abrasive nature of three of the whitening dentifrices tested [Crest 3D, Optic White, and Hello (charcoal) ]. Filtek also exhibited significant susceptibility to the abrasive nature of Hello. Aim showed the least or minimal amount of abrasion.

CLINICAL SIGNIFICANCE

TPH ST composite was more susceptible to the abrasive nature of the three whitening dentifrices tested [Crest 3D, Optic White, and Hello (charcoal)]. Filtek also exhibited significant susceptibility to the abrasive nature of Hello. Aside from the data supporting the clinical efficacy of TPH compared to Filtek, clinicians should inform patients of the abrasive capacity of all whitening dentifrices, especially those that are charcoal based.

[What is the functioning of tin in stannous fluoride?]

Stannous fluoride is one of the first fluoride compounds that were added to dentifrices. Besides the well-known effect of fluoride, the presence of tin could also have an effect on dental health by its anti-microbial activity and the ability to form insoluble metal salts. The functioning of stannous fluoride has been studied extensively in many scientific publications. On the basis of the available literature, the use of stannous fluoride instead of sodium fluoride could be advantageous in case of gingivitis, halitosis, dentine hypersensitivity, or erosion. The effects that were found are statistically significant, albeit rather small, which makes it harder to predict the actual gain in dental health or the clinical relevance for an individual patient.

Virucidal Activity of Over-the-Counter Oral Care Products Against SARS-CoV-2

PURPOSE

The oral cavity is an important entry point for SARS-CoV-2 infection. This study tested whether four commercially available mouthrinses and dentifrices have in vitro virucidal activity against SARS-CoV-2 (=4 log10 reduction in viral titer).

MATERIALS AND METHODS

One part of stock SARS-CoV-2 virus plus one part 0.3 g/l bovine serum albumin were mixed with eight parts of test product solution. After 30 s for the rinses, or 60 s for the dentifrices, the mixture was quenched in an appropriate neutralizer, serially diluted, and inoculated onto Vero E6 cells to determine viral titer. Triplicate runs were performed for each test condition with appropriate controls for test product cytotoxicity, viral interference, and neutralizer effectiveness. Test products included: 1.5% hydrogen peroxide (H2O2) rinse; 0.07% cetylpyridinium chloride (CPC) rinse; 0.454% stannous fluoride (SnF2) dentifrice A; and 0.454% SnF2 dentifrice B.

RESULTS

?The 1.5% H2O2 rinse, 0.07% CPC rinse, SnF2 dentifrice A, and SnF2 dentifrice B all produced > 4 log10 reduction in SARS-CoV-2 titer.

CONCLUSION

All four test products displayed potent virucidal activity in vitro. Clinical studies are warranted to determine what role, if any, these oral care products might play in preventing transmission of SARS-CoV-2 or in the management of patients currently diagnosed with COVID-19 illness.

Nocturnal Salivary Fluoride Bioavailability After Brushing with a High-fluoride Dentifrice

The use of fluoridated dentifrices is recognized as the main reason for the decline of dental caries and its effect is associated with the bioavailability of fluoride (F) in the oral cavity. High-fluoride dentifrice has been indicated for patients at high risk of caries and management of root lesions. This study aimed to evaluate the bioavailability of F in saliva after the use of high-fluoride dentifrice during the nocturnal period. Fifteen healthy adults participated in this is in vivo and crossover study in which the concentration of F in their saliva was determined after brushing with the tested dentifrices: a conventional (1450 ppm F) or with high-fluoride concentration (5000 ppm F). Before brushing, the participants collected the non-stimulated saliva (baseline), immediately after brushing (time zero) and after 5min, 2h, 4h, and 8h, during the nocturnal period (between 10:00 pm and 06:00 am). The salivary F concentration was determined using a specific F ion electrode. Regarding statistical analysis, a paired t-test was used to compare dentifrices with p fixed at 5%. At baseline, there was no significant difference between groups (p>0.001). Immediately after brushing, both dentifrices increased the F salivary concentration, with the highest concentration reached in time zero; however, the use of 5000 ppm F dentifrice maintained the higher F salivary concentration at all times evaluated (p<0.001), remaining higher until 8 h after brushing. Furthermore, this treatment showed higher F bioavailability in relation to time, evaluated by the area under the curve (p<0.001). Thus, it can be concluded that the high-fluoride dentifrice increased the bioavailability of salivary F during the nocturnal period in comparison with conventional dentifrice.

Effect of charcoal dentifrices on tooth whitening and enamel surface roughness

PURPOSE

To evaluate tooth color change and surface roughness after the use of charcoal dentifrices.

METHODS

Bovine teeth (n= 64) used for color measurements were stained in tea solution and embedded in acrylic resin. Specimens were randomized into four groups of 16 specimens each. Cavity Protection (Colgate-Palmolive) was the negative control. Whitening dentifrices used were Black is White (Curaden AG); and My Magic Mud (Carbon and Clay Company) containing activated charcoal and Optic White (Colgate-Palmolive) containing hydrogen peroxide. Instrumental color measurements were performed at baseline, 1-week post-brushing, 30-day post-brushing, and 1-month follow-up. Another set of bovine teeth (n= 64) used for roughness measurements were embedded in acrylic resin and the surface ground flat. The experimental groups and brushing protocol were the same as for the color evaluation part. Surface roughness was measured with a contact type profilometer at baseline and after the last brushing session. Kruskal-Wallis procedure tested changes in color and surface roughness among the different groups. All post-hoc comparisons were conducted with Bonferroni corrections. Tests of hypotheses were two-sided with an alpha level at 0.05.

RESULTS

Overall color change was not significantly different among groups at 1-week post-brushing and at 1-month follow-up. However, the hydrogen peroxide group had a significantly higher reduction in chroma in the yellow-blue axis when compared to negative control group at 30-day post-brushing and 1-month follow-up (P< 0.05). There was no significant difference in roughness among the groups at baseline (P= 0.2973) and post treatment (P= 0.8169).

CLINICAL SIGNIFICANCE

The use of charcoal dentifrices did not have the claimed whitening effect but did not increase enamel surface roughness.

Effect of whitening dentifrices on color, surface roughness and microhardness of dental enamel in vitro

PURPOSE

To evaluate the color, surface roughness and microhardness of human dental enamel subjected to brushing with whitening dentifrices.

METHODS

The enamel samples (4 x 4 x 2 mm) were darkened using 0.2% chlorhexidine and black tea, and were randomly divided into seven groups (n= 15) for brushing cycles with only water; control; conventional dentifrice (Colgate Maximum Anticaries Protection); dentifrice containing 2% hydrogen peroxide (Colgate Luminous White Advanced); dentifrice containing sodium tripolyphosphate (Sensodyne True White); dentifrice containing activated charcoal (Black is White); and dentifrice containing blue covarine (Close Up White Now). The samples were submitted to 1,000 and 30,000 brushing cycles. The color values (CIE L*a*b*), surface roughness (Ra) and microhardness (Knoop) were recorded at four time points: baseline, after staining, after 1,000 and after 30,000 brushing cycles. The data were submitted to statistical analyses using paired t-test, ANOVA and Tukey.

RESULTS

The color analysis, roughness and microhardness results showed interaction between the effect of the dentifrices and the time point (P< 0.001). The bleaching dentifrices brought about color changes (ΔE) significantly greater than those obtained with conventional dentifrices and the control; however, there were no significant color changes among the bleaching dentifrices. When the color coordinates were evaluated individually, the L* values increased and the a* and b* values decreased throughout the experiment. The conventional toothpaste and the toothpastes containing blue covarine, activated charcoal or hydrogen peroxide promoted a statistically significant increase in the surface roughness of the samples after the last brushing cycle. The sodium tripolyphosphate dentifrice caused a progressive reduction in roughness. The microhardness increased statistically after 30,000 cycles for the conventional toothpaste, blue covarine and hydrogen peroxide. It was concluded that the whitening dentifrices lightened the samples, which evidenced greater luminosity and reduction in reddish and yellow tones. Moreover, they did not have deleterious effects on microhardness, and caused acceptable changes in surface roughness.

CLINICAL SIGNIFICANCE

Dentifrices with different whitening strategies changed the color of the samples, resulting in samples with greater luminosity and reduced reddish and yellowish tones. They also caused changes in surface roughness within the acceptable clinical limit and did not have a deleterious effect on the microhardness of dental enamel.

Anti-gingivitis and Anti-plaque Efficacy of an Oral Hygiene System: Results From a 12-Week Randomized Controlled Trial

The objective of this study was to compare the antigingivitis and antiplaque efficacy of an oral hygiene system versus a control regimen. This was a single-center, randomized, examiner-blind, two-treatment, 12-week parallel group study in adults with evidence of gingivitis and plaque. Eligible subjects were stratified by baseline gingivitis and plaque scores, number of bleeding sites, and tobacco use and randomized to one of two treatment groups: (1) oral hygiene system (test group) involving a novel smart-connected Oral-B® iO oscillating-rotating (O-R) electric toothbrush, 0.454 percent stabilized stannous fluoride (SnF2) dentifrice, 0.07 percent cetylpyridinium chloride (CPC) rinse, and floss, or (2) control regimen involving a manual toothbrush and 0.243 percent sodium fluoride dentifrice. Gingivitis (modified gingival index, gingival bleeding index) and plaque (Rustogi modification of the navy plaque index) were assessed at Baseline, Week 1, and Week 12.

Gloss Retention on Enamel and Resin Composite Surfaces After Brushing Teeth with Commercial and Modified Dentifrices

OBJECTIVES

We examined the surface gloss and roughness of a dental composite and human enamel after brushing with a new bioactive glass (BCF201) additive designed to treat dentine hypersensitivity.

METHODS

We prepared 2 cohorts of samples: a resin-based composite (RBC) and human enamel. Each cohort received 20 000 brushing cycles with Colgate Optic White Enamel (Colgate Optic), Sensodyne Whitening Repair and Protect (Sensodyne), Colgate Enamel Health Sensitivity Relief (Colgate-EN) with and without BCF201 added or Germiphene Gel 7 HT (Gel 7) with and without BCF201 added. The average gloss and roughness of the enamel and RBC surfaces were measured before brushing and after 20 000 back-and-forth brushing cycles. A linear regression function was applied to the gloss results, and the data were analyzed using ANOVA and a Tukey post-hoc test (α = 0.05).

RESULTS

After 20 000 brushing cycles, the control (Gel 7) had no significant effect on the gloss or roughness of the RBC. However, the choice of dentifrice had a significant effect on both gloss and roughness (p < 0.001). With respect to RBC, after brushing, surface roughness was ranked from smoothest to roughest: Gel 7 = Gel 7 plus BCF201 > Colgate-EN plus BCF201 = Colgate Optic = Colgate-EN > Sensodyne. With respect to enamel, the smoothest to the roughest surfaces after brushing were: Gel 7 plus BCF201 = Sensodyne = Colgate-EN plus BCF201 > Gel 7 = Colgate Optic = Colgate-EN.

CONCLUSION

The bioactive glass additive had no adverse effect on the surface roughness or gloss of human enamel or RBC.

SIGNIFICANCE

The addition of BCF201 appears to have a polishing effect on RBC and enamel and reduced the abrasive effects of Colgate-EN on RBC and enamel.

Exogenous Intake of Fluorides in Caries Prevention: Benefits and Risks

Caries incidence and prevalence have decreased significantly over the last few decades due to widespread use of fluoride. However, an increase in the prevalence of dental fluorosis has been reported in both fluoridated and non-fluoridated communities. Care must be taken to ensure that a balance between the optimal fluoride preventive effect at the individual and community level and minimal risk of dental fluorosis is maintained. This review describes the main sources of fluoride intake that have been identified: fluoridated drinking water, dietary fluoride supplement, and topical forms comprising toothpastes, rinses, gels and varnishes. The cited data were taken from meta-analytic studies and reports from Cochrane database systematic reviews up to December 2019. Efficiency, but safety, of topically applied fluorides in individual home care is dependent on the degree of compliance of individuals/parents and on the level of competence of providers of preventive counselling. The broad spectrum of these resources allows individualization of fluoride prevention based on risk analysis of caries attack and taking into consideration other preventive measures.

The relative clinical efficacy of three 0.454% stannous fluoride dentifrices for the treatment of gingivitis over 3 months

PURPOSE

To assess the safety and efficacy of three stannous fluoride (SnF2) dentifrices in the reduction of gingivitis versus a negative control dentifrice.

METHODS

This was a randomized, controlled, double-blind, four-treatment parallel group study. 120 healthy adult volunteers with established gingivitis were enrolled and randomly assigned to one of four dentifrice treatment groups (30/group): 0.454% SnF2 + citrate dentifrice A; 0.454% SnF2 + sodium hexametaphosphate dentifrice B; 0.454% SnF2 + pyrophosphate dentifrice C; or 0.76% sodium monofluorophosphate negative control group. Subjects brushed with their assigned dentifrice and an assigned regular manual toothbrush (Oral-B Indicator) for 1 minute twice daily for 12 weeks. Number of gingival bleeding sites and Löe-Silness Gingival Index (LSGI) scores were assessed at baseline and at Weeks 2, 4 and 12.

RESULTS

120 subjects were enrolled and 112 completed the trial. Subjects had an average age (SD) of 39.31 (14.5) years; 67% of subjects were female. Overall baseline means (SD) were 81.2 (25.6) for number of bleeding sites and 1.51 (0.197) for mean LSGI score. Baseline disease levels were balanced across all treatment groups. At Week 2, SnF2 dentifrices A and B demonstrated a significant reduction in gingival bleeding sites versus the negative control; however, SnF2 dentifrice C was not significantly different from the negative control (P= 0.15). At Weeks 4 and 12, all SnF2 dentifrices demonstrated a significant gingival bleeding site reduction versus the negative control (P< 0.001). At Weeks 2, 4 and 12, the SnF2 dentifrices were rank ordered dentifrice A > dentifrice B > dentifrice C for reduction in gingival bleeding sites (P< 0.001). The same trends were seen for LSGI scores.

CLINICAL SIGNIFICANCE

In this 12-week clinical study, all 0.454% SnF2 dentifrices delivered statistically significant reductions in the number of gingival bleeding sites relative to the negative control. Importantly, statistically significant efficacy differences were observed among the three 0.454% SnF2 dentifrices, demonstrating the important role that differences in formulation have on clinical efficacy.

Efficacy of a Stannous-containing Dentifrice for Protecting Against Combined Erosive and Abrasive Tooth Wear In Situ

PURPOSE

The in-situ efficacy of an experimental stannous (Sn)-containing sodium fluoride (NaF) dentifrice against erosion and erosive tooth wear was compared with a conventional NaF dentifrice.

MATERIALS AND METHODS

This was a randomised, controlled, double-blind, parallel-group clinical trial. Mandibular appliances containing four enamel specimens (2 per side [L/R] of the appliance) were worn by 60 generally healthy adult subjects. Subjects were randomised to treatment based on age and gender. Treatments included a Sn-containing NaF or conventional NaF dentifrice. Conditions of erosion (dentifrice slurry treatment) and erosion/tooth wear (dentifrice slurry plus brushing) were compared. Dentifrices were used twice per day for 30 s of lingual brushing, followed by 90 s of slurry exposure. In addition, the two specimens on the left side of the mouth were brushed for 5 s each, using a power toothbrush. All specimens were exposed to four daily erosive challenges with commercial orange juice (pH 3.6). Tooth wear was measured as enamel loss using non-contact profilometry on day 10.

RESULTS

At the day 10 visit, the adjusted mean (SE) enamel loss for specimens receiving slurry (erosion) treatment was 4.7 µm (0.61) [Sn-containing NaF] and 8.73 µm (1.12) [NaF control], with results demonstrating a statistically significant benefit for the Sn-containing dentifrice (46.2% benefit; p = 0.009). For specimens exposed to erosion/tooth wear conditions, enamel loss = 6.68 µm (1.29) (Sn-containing NaF) and 10.99 µm (1.29) (NaF group), with results statistically significant (p = 0.048; 39.2% better, favouring the Sn-containing dentifrice). When data were combined, enamel loss (SE) for all specimens subjected to erosion + erosion/tooth wear was 5.61 µm (0.77) (Sn-containing NaF]) and 9.9 µm (1.3) (NaF group). The difference again was statistically significant, favouring the Sn-containing group (p = 0.022; 43.4% better).

CONCLUSIONS

The Sn-containing dentifrice demonstrated significantly better protection than did NaF under erosive and erosive/tooth wear conditions.

Stabilized stannous fluoride dentifrice in relation to dental caries, dental erosion and dentin hypersensitivity: A systematic review

PURPOSE

To review the scientific evidence for the efficacy of stabilized stannous fluoride (SnF₂) dentifrice in relation to dental caries, dental erosion and dentin hypersensitivity.

METHODS

Medline OVID, Embase.com, and the Cochrane Library were searched until January 2018. Two researchers independently selected studies according to inclusion and exclusion criteria, data were extracted, the risk of bias in eligible studies was assessed and a meta-analysis was performed wherever feasible.

RESULTS

Three studies on dental caries, eight studies on dental erosion and 11 on dentin hypersensitivity were included. Risk of bias was judged as high for most of the caries and erosion studies and low or medium for the hypersensitivity studies. A similar or slightly higher anti-caries activity compared with non-stannous fluoride dentifrices was observed. Stannous fluoride showed a greater anti-erosive potential in seven of the eight studies. A mean difference score in favor of stannous fluoride dentifrices compared with controls was found in a meta-analysis including six 8-week hypersensitivity studies.

CLINICAL SIGNIFICANCE

The use of stabilized stannous fluoride dentifrices to relieve dentin hypersensitivity and to prevent the initiation of dental erosion speaks in favor of this treatment strategy.

The effects of charcoal dentifrices on Streptococcus mutans biofilm development and enamel demineralization

PURPOSE

To evaluate the in vitro effects of commercially available charcoal dentifrices on Streptococcus mutans biofilm development and their ability to prevent enamel demineralization.

METHODS

Streptococcus mutans biofilm was formed on polished bovine enamel specimens (n= 9 per treatment), and treated twice-daily for 120 seconds over the course of 5 days with: charcoal dentifrice containing fluoride (1,000 ppm F) (CF+), fluoride-free charcoal dentifrice (CF-), regular fluoride (1,100 ppm F) dentifrice (F+ ), or regular fluoride-free dentifrice (F-). Chlorhexidine (CHX, 0.12%) and deionized water (DIW) were used as positive and negative controls, respectively. Biofilms were analyzed for bacterial viability (colony-forming units, CFU). The pH of the medium was measured daily. Enamel specimens were analyzed using Vickers microhardness ( HV) and transversal microradiography (TMR). Data were analyzed using one-way ANOVA followed by post-hoc tests (α= 0.05).

RESULTS

F+ showed higher pH values than CF+ and CF-, and CF- presented higher pH than CF+, showing that CF+ did not have inhibitory effects on the acidogenicity of cariogenic biofilms. CFU was significantly decreased when specimens were treated with CF+, CF- and F+, compared to specimens treated with DIW (P≤ 0.035) or F- (P≤ 0.001), respectively. However, the reduction observed was minimal (approximately 1 log). CF+ and CF- were less effective than F+ in preventing enamel demineralization as determined using HV (P= 0.041 and P= 0.003, respectively) and TMR ( P≤ 0.001). Both charcoal dentifrices (CF+, CF-) did not show relevant inhibition of S. mutans biofilm growth. Additionally, neither product prevented enamel demineralization compared to a regular fluoride-containing dentifrice.

CLINICAL SIGNIFICANCE

The tested charcoal dentifrices did not exhibit anticaries potential.

Effect of stannous fluoride and zinc phosphate dentifrice on dental plaque and gingivitis: A randomized clinical trial with 6-month follow-up

OBJECTIVE

The objective of this study was to compare a stabilized stannous fluoride (SnF₂) dentifrice with zinc phosphate (Colgate Total^SF) with SnF₂ with zinc lactate and control fluoride dentifrices for gingivitis and plaque control over a 6-month period.

METHODS

A total of 135 adult participants were enrolled in this study. After randomization and blinding of examiners and patients, enrolled participants were provided instructions for use of assigned dentifrice. At 3 visits (0, 3, and 6 months), various gingival and plaque indexes were collected to determine the clinical efficacy of a stabilized SnF₂ dentifrice. These results were compared with a SnF₂ with zinc lactate dentifrice and with a control fluoride dentifrice.

RESULTS

A total of 135 participants completed the study. All groups reported statistically significant reductions in gingival inflammation and improvement in plaque control at 3- and 6-month follow-up. Both SnF₂ dentifrices showed statistically significant reductions in all indexes compared with the control dentifrice (P < .001). However, the test dentifrice showed higher but nonsignificant improvements in plaque and gingival indexes compared with the other SnF₂ dentifrice.

CONCLUSIONS

This study reports similar efficacy of a test dentifrice to a commercial SnF₂-containing dentifrice for plaque control and reduction in gingival inflammation and provides supporting evidence that the test dentifrice maintains its clinical efficacy with change of formulation.

PRACTICAL IMPLICATIONS

This newly formulated SnF₂ stabilized with zinc phosphate dentifrice may be of benefit to patients in controlling plaque biofilm and gingivitis.

Solving the problem with stannous fluoride: Extrinsic stain

BACKGROUND

This article highlights a stabilized stannous fluoride (SnF₂) dentifrice that, in addition to being efficacious against caries, gingivitis, and dentin hypersensitivity, demonstrates high-performing stain prevention and removal efficacy.

METHODS

An in vitro stain prevention model evaluated the efficacy of Colgate Total^SF containing 0.454% SnF₂ and 1% zinc phosphate compared with Crest Pro-Health Whitening Power (The Procter & Gamble Company) and a nonabrasive SnF₂ gel. L*, a*, and b* values were measured to assess whiteness comparing untreated and stained teeth, and with statistical analysis. A stain removal clinical study was conducted as a randomized, double-blind, 2-cell, parallel-group design using Colgate Total^SF and nonwhitening regular fluoride toothpaste. Participants were instructed to brush twice daily for 6 weeks and were examined for Lobene Composite Stain Index scores, with statistical analysis used at a significance of P < .001.

RESULTS

In an in vitro stain prevention study, Colgate Total^SF performed 26% and 35% better than a competitor paste and nonabrasive SnF₂ gel, respectively. In a clinical study, Colgate Total^SF use showed statistically significant extrinsic tooth stain reductions by 17.5% (3 weeks) and 27.8% (6 weeks) relative to regular fluoride toothpaste. No adverse effects were reported.

CONCLUSIONS

The results indicate that the stabilized Colgate Total^SF performed statistically better than other SnF₂ pastes in an in vitro study, and statistically better than a regular fluoride toothpaste in a clinical study.

PRACTICAL IMPLICATIONS

Colgate Total^SF offers an SnF₂-based therapeutic dentifrice with notable performance in stain prevention and removal.

Efficacy and Adverse Effects of Whitening Dentifrices Compared With Other Products: A Systematic Review and Meta-analysis

Whitening dentifrices (WDs) are widespread and accessible worldwide, claiming to whiten teeth. Therefore, this systematic review aimed to assess the extrinsic stain removal (ESR), the whitening potential, and the adverse effects of WDs. Randomized controlled trials comparing WDs with regular dentifrices (RDs) and other home-based whitening products were searched at NCBI-PubMed, Cochrane-CENTRAL, EBSCO-Host, and clinicaltrials.gov. The studies were screened and had data extracted by two independent researchers. Eligible studies presented outcomes of ESR, color change, and adverse effects, with no restriction of publication date. Data were meta-analyzed using RevMan 5.3, and the level of evidence was rated according to GRADE criteria. Eleven studies (n=1962) assessed reduction of stain area and intensity through Lobene Stain index, with a mean difference (MD) of -0.33 ([-0.41;-0.25]; p=0.00001) and -0.34 ([-0.44;-0.25]; p=0.00001), respectively. When the modified Lobene Stain index was used (six studies; n=2576), MD was -0.42 ([-0.58;-0.25]; p=0.00001) and -0.30 ([-0.39;-0.21]; p=0.00001), respectively. Mean color change through shade guide tabs (three studies; n=1322) was -1.80 ([-2.33;-1.26]; p=0.00001). All differences were in favor of the WDs, which also produced a risk of adverse effects (RR=1.74; [1.20, 2.52]; p=0.003; four studies; n=1322). The comparison of WDs with paint-on gel (two studies; n=58) yielded similar efficacy and adverse effects (p>0.05), whereas the comparison of WDs with white strips (two studies; n=87) yielded higher efficacy of the latter (p=0.00001) and similar adverse effects (p=0.52). The quality of evidence varied from low to moderate. WDs are more effective in reducing extrinsic stain and producing a whitening-like effect in teeth than RDs, although they also produce more adverse effects. Whitening efficacy of WDs is similar to paint-on gel and lower than white strips. Higher-quality evidence demands larger, well-conducted, independent studies.

Development of New Experimental Dentifrice of Peruvian Solanum tuberosum (Tocosh) Fermented by Water Stress: Antibacterial and Cytotoxic Activity

AIM

"Tocosh" is a potato that has undergone a process of hydraulic oxidation that enhances its antimicrobial properties so that this natural resource can be used in medical sciences. The aim of this study was to develop and evaluate the antibacterial and cytotoxic activity of a new experimental tooth based on Solanum tuberosum "Tocosh" on the cell lines 3T3 and DU145.

MATERIALS AND METHODS

To evaluate the cytotoxicity, cell cultures 3T3 and DU145 were used. Cell viability was determined by the MTT assay (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) in a medium containing 10% calf serum where the cells were preincubated at a concentration of 1 × 10⁶ cells/mL in culture medium for 3 hours at 37°C and 6.5% CO₂. Then, the absorbance was measured using a microplate reader where the formazan crystals were diluted with acidic and cold isopropanol, and quantified in an ELISA reader. To evaluate the antibacterial effect, the Kirby Bauer inhibition halos method was used on strains of S. aureus (ATCC 25923), S. mutans (ATCC 25175), and S. mitis (ATCC 49456).

RESULTS

Solanum tuberosum (tocosh) was not cytotoxic because it only had one CC₅₀ at the concentration of 0.26927 mg/mL and 0.26845 mg/mL for the cell lines 3T3 and DU145, respectively. Tocosh toothpaste (TD) has an antibacterial effect against S. aureus and S. mutans.

CONCLUSION

The new ecological dentifrice was not cytotoxic since it did not alter cell viability because its CC₅₀ was only 0.268 and 0.269 μg/mL for the 3T3 and DU145 cell lines, respectively; however, it presented an optimal antimicrobial activity against the oral strains evaluated.

CLINICAL SIGNIFICANCE

This research has great potential for clinical use because this new dentifrice has antimicrobial activity against different oral germs. How to cite this article: Mayta-Tovalino F, Sedano-Balbin G, Romero-Tapia P, et al. Development of New Experimental Dentifrice of Peruvian Solanum tuberosum (Tocosh) Fermented by Water Stress: Antibacterial and Cytotoxic Activity. J Contemp Dent Pract 2019;20(10):1206-1211.

Randomized in situ clinical trial evaluating erosion protection efficacy of a 0.454% stannous fluoride dentifrice

OBJECTIVES

To assess the protective effects of a 0.454% stabilized stannous fluoride dentifrice and a marketed triclosan dentifrice against enamel erosion in a 10-day in situ model.

METHODS

This was a double-blind, randomized, 2-treatment, 4-period, crossover in situ trial involving healthy adult participants. Participants were randomized to a treatment sequence involving the following products: a highly bioavailable 0.454% stannous fluoride dentifrice (Procter & Gamble) and a marketed dentifrice control containing 0.24% sodium fluoride and 0.3% triclosan (Colgate-Palmolive). Each study period took place over 10 days. Participants wore an intra-oral appliance retaining two polished human enamel samples for 6 hours per day. Two times per day they swished with the assigned dentifrice slurry and four times per day they swished with 250 mL of orange juice (25 mL per minute) over a 10-minute period. Contact profilometry measurements were made for each sample at baseline and day 10 to determine surface change.

RESULTS

Thirty-six participants were enrolled and 33 completed the study (mean age = 40.5 years). The stannous fluoride dentifrice demonstrated 93.5% less enamel loss than the NaF/triclosan dentifrice (P < 0.001) at Day 10, with median enamel loss of 0.097 µm and 1.495 µm, respectively. Both products were well tolerated.

CONCLUSION

The stannous fluoride dentifrice demonstrated significantly greater erosion protection efficacy relative to the NaF/triclosan dentifrice in this randomized in situ clinical trial.

In vitro dentin tubule occlusion by an arginine-containing dentifrice

PURPOSE

To evaluate the ability of an arginine-containing dentifrice to occlude dentin tubules.

METHODS

Dentin discs were divided equally into premolar and molar groups, which were then utilized in three treatment groups: a blank control group (distilled water treatment), a negative control group (common dentifrice with calcium carbonate) and an experimental group [dentifrice with 8% (w/w) arginine]. Each dentin disk was brushed with the dentifrice twice daily for 7 consecutive days. After this period, each disc was separated into two equal halves. One half was used for scanning electron microscopy (SEM) and energy-dispersive spectrometer (EDS) examinations, while the other half was brushed with distilled water twice daily for another 7 days prior to SEM observation.

RESULTS

The plugging rate in the arginine dentifrice group was significantly higher and more sustainable than in the negative control group. The surface deposition of calcium and phosphorus on the dentin discs in the arginine dentifrice group was also significantly higher.

CLINICAL SIGNIFICANCE

This study provided evidence that using arginine as an active ingredient in dentifrice can improve its ability to occlude dentin tubules, thus supporting future efforts to improve dentin hypersensitivity.

[Clinical evaluation of the effect of reducing tooth sensitivity caused by in office bleaching using dentifrices]

OBJECTIVE

To evaluate tooth sensitivity and the efficacy of in-office bleaching when using different desensitizing dentifrices.

METHODS

In total, 150 eligible individuals were recruited and randomized by computer-generated block randomization into three groups: potassium nitrate group (n=50), stannous fluoride group (n=50), and placebo group (n=50). Participants were asked to use a desensitizing dentifrice and toothbrush 15 days prior to and after the in-office bleaching. Each patient received a one-session in-office bleaching with 35% hydrogen peroxide whitening gel. The in-office bleaching included three 15 min operations, totally 45 min. Tooth sensitivity was evaluated by 100 mm visual analog scale (VAS) scores immediately 0 d and 1 d, 2 d, 7 d, 14 d, and 30 d after in-office bleaching. In total, 48 (96%), 45 (90%), and 46 (92%) individuals in the potassium nitrate, stannous fluoride, and placebo groups, respectively, completed the follow-up observations.

RESULTS

Data were analyzed using analysis of covariance (ANOVA). For tooth sensitivity produced by in-office bleaching, the mean VAS values of the three groups were analyzed. At 0 d immediately after surgery, the mean VAS of the potassium nitrate group was 39.22±15.08, which was lower than that of the stannous fluoride group (47.18±12.59) and the placebo group (52.53±14.05), and the difference was statistically significant (P<0.05). The results of the stannous fluoride group and the placebo group were similar, and the difference was not statistically significant (P>0.05). On 1 day postoperatively, the mean VAS of the potassium nitrate group was 38.27±16.52, which was lower than that of the stannous fluoride group (44.69±14.92) and the placebo group (44.45±13.54), P<0.05. The results of the stannous fluoride group and the placebo group were similar, and the difference was not statistically significant (P>0.05). The mean values of VAS were similar 2 d, 7 d, 14 d and 30 d after operation, and the difference was not statistically significant (P>0.05).

CONCLUSION

Compared with the stannous fluoride group and the placebo group, the use of potassium nitrate desensitizing toothpaste 15 days before surgery can effectively alleviate the tooth sensitivity during and after in-office bleaching.

[Clinical evaluation of the effect of reducing tooth sensitivity caused by in office bleaching using dentifrices]

OBJECTIVE

To evaluate tooth sensitivity and the efficacy of in-office bleaching when using different desensitizing dentifrices.

METHODS

In total, 150 eligible individuals were recruited and randomized by computer-generated block randomization into three groups: potassium nitrate group (n=50), stannous fluoride group (n=50), and placebo group (n=50). Participants were asked to use a desensitizing dentifrice and toothbrush 15 days prior to and after the in-office bleaching. Each patient received a one-session in-office bleaching with 35% hydrogen peroxide whitening gel. The in-office bleaching included three 15 min operations, totally 45 min. Tooth sensitivity was evaluated by 100 mm visual analog scale (VAS) scores immediately 0 d and 1 d, 2 d, 7 d, 14 d, and 30 d after in-office bleaching. In total, 48 (96%), 45 (90%), and 46 (92%) individuals in the potassium nitrate, stannous fluoride, and placebo groups, respectively, completed the follow-up observations.

RESULTS

Data were analyzed using analysis of covariance (ANOVA). For tooth sensitivity produced by in-office bleaching, the mean VAS values of the three groups were analyzed. At 0 d immediately after surgery, the mean VAS of the potassium nitrate group was 39.22±15.08, which was lower than that of the stannous fluoride group (47.18±12.59) and the placebo group (52.53±14.05), and the difference was statistically significant (P<0.05). The results of the stannous fluoride group and the placebo group were similar, and the difference was not statistically significant (P>0.05). On 1 day postoperatively, the mean VAS of the potassium nitrate group was 38.27±16.52, which was lower than that of the stannous fluoride group (44.69±14.92) and the placebo group (44.45±13.54), P<0.05. The results of the stannous fluoride group and the placebo group were similar, and the difference was not statistically significant (P>0.05). The mean values of VAS were similar 2 d, 7 d, 14 d and 30 d after operation, and the difference was not statistically significant (P>0.05).

CONCLUSION

Compared with the stannous fluoride group and the placebo group, the use of potassium nitrate desensitizing toothpaste 15 days before surgery can effectively alleviate the tooth sensitivity during and after in-office bleaching.

Current Concepts and Best Evidence on Strategies to Prevent Dental Erosion

Dental erosion is a multifactorial condition associated with chemical, biological, and behavioral factors whereby a non-bacterial chemical process leads to an irreversible loss of dental structure. Consequences of this erosive process include painful sensitivity, susceptibility to further erosion, mechanical wear, changes in occlusion, exposure of dental pulp, and poor esthetics. Substantial evidence has revealed new insights to diagnosing early stages of dental erosion and enabling novel preventive approaches to control its progression. In the context of outpatient medical/dental practice, clinicians often encounter patients with progressive dental erosion. This article summarizes published research in this area of dentistry to suggest guidelines that are clinically oriented but scientifically fundamental. It is aimed at helping clinicians effectively integrate this information into their professional evaluations of dental erosion with regard to diagnosis, risk factors, clinical signs, assessment, and clinical preventive strategies and treatment. Clinicians should address patient diet habits, educate patients on prevalence data, and inform them regarding potential acidic interactions, such as medically induced acidic conditions, that may ultimately lead to tooth destruction. Prevention of dental erosion, including the recognition of initial erosive lesions and the implementation of the early intervention, involves the clinical expertise of both the dentist and physician.

Crossover Clinical Trial of Tablets Containing Sodium Tripolyphosphate on Dental Stain Formation

OBJECTIVES

The purpose of this clinical investigation was to evaluate the effectiveness of sugar-free tablets containing sodium tripolyphosphate 2% or sodium tripolyphosphate 0.65%, compared to a no-tablet control in preventing the formation of extrinsic stains over a 12- week period of regular unsupervised use preserving daily oral hygiene with dentifrice and usual tooth brushing.

METHODS

This was a single-center, examiner-blind, randomized, 12-week crossover clinical trial. Sixty-six adult participants were enrolled in the study and were submitted to a professional cleaning to have a stain-free baseline. They either consumed two sugar-free tablets four times per day or not for 12 weeks. At the crossover, all procedures were repeated and subjects were assigned to another group. Extrinsic stain was measured at each 12-week period by the Modified Lobene Stain Index (MLSI).

RESULTS

After the three legs of 12 weeks, 60 subjects completed the trial, their MLSI stain scores showed a significant 35.5% reduction (p < 0.001) in new stain formation for those using the sodium tripolyphosphate 2% tablets, and a significant 23.3% reduction (p < 0.001) in new stain formation for those using the sodium tripolyphosphate 0.65% tablets versus the control group.

CONCLUSIONS

This clinical study showed that regular use of sugar-free tablets added with sodium tripolyphosphate 2% or 0.65% can reduce stain formation on the anterior teeth respectively by 35.5% (p < 0.001) or 23.3% (p < 0.001), both on facial and lingual/palatal surfaces.

Development of a Screening Method to Establish if pH of Oral Care Products Affects Hard Tissues

OBJECTIVES

To develop a transferable, simple screening method to evaluate the effect of pH of oral care products on oral hard tissues.

METHODS

The method reported here is based on the assessment of oral hard surface changes produced by oral care products measured via Vickers Surface Microhardness (SMH). Two variations of this screening test method were developed, one including the use of salivary pellicle and human teeth and a second using bovine substrates with artificial saliva. The test method using bovine substrates and artificial saliva was replicated in a second laboratory in Beijing, China to verify reproducibility and transferability of the technique.

RESULTS

Both approaches confirmed changes on surface hardness with 1% citric acid. All tested marketed products, including those formulated at pH < 5.5, showed no significant %SMH difference from the positive control (water), and demonstrated a significant difference from the negative control (1% citric acid). The two laboratories produced similar results (pH effects, standard deviation, and statistical rank-ordering of treatments).

CONCLUSIONS

This simple screening method accurately assesses the influence of positive and negative controls, regardless of the source of hard tissue (human vs. bovine) and saliva (human vs. artificial). It correctly shows that marketed products with pH below 5.5 that demonstrate favorable in vivo safety profiles do not contribute to detrimental hard tissue changes. The method is easily transferable and shows potential as a tool for the safety profile assessment of oral care products.

Effect of whitening mouthrinses on enamel toothbrush abrasion

PURPOSE

To evaluate the effect of whitening mouthrinses used before toothbrushing on enamel microhardness and wear.

METHODS

80 polished bovine enamel specimens were randomly assigned into four groups according to the mouthrinses tested (n=20): PW: Plax Whitening - 1.5% hydrogen peroxide (HP); LW: Listerine Whitening Pre-Brush Rinse - 2% HP; U: Ultradex - Chlorine dioxide; C: Control - Artificial saliva. The specimens were immersed in the mouthrinses for 1 minute and brushed with 10 strokes, using a dentifrice containing sodium fluoride. After treatments, they were immersed in artificial saliva for 30 minutes. A total of 540 cycles were performed simulating 9 months of use. Enamel surface was assessed with a Knoop microhardness tester and by a contact profilometer before and after treatments to obtain the surface microhardness (KHN) and enamel loss (µm) values. The specimens were immersed in artificial saliva for an additional 30 days and microhardness was measured again. Data were analyzed by ANOVA and Tukey's tests (5%).

RESULTS

Significant differences were observed in KHN (P= 0.0001) and wear (P= 0.0001). Results of Tukey's for KHN: U-320.08±13.86a, PW-323.58±32.75a, LW-331.66±24.74a, C-354.24±16.40b. Wear (µm) : PW-10.03±0.94a, LW-9.92±0.81a, U-8.88±1.02b, C-6.56±0.91c. Groups followed by the same letters do not present significant differences. After 30 days in saliva, there was no significant difference for SMH among the groups.

CLINICAL SIGNIFICANCE

The continuous use of whitening mouthrinses can increase the enamel abrasion potential promoted by daily toothbrushing; therefore, they should be used with caution.

Knowledge of primary care professionals about fluoride topics

BACKGROUND

Scientific evidence on the benefits of fluoride was responsible for an important change in dental practice. Individual and collective actions have been planned to impact the epidemiology of oral health. However, questions around this topic persist, making discussions and researches still necessary. In this regard, the aim of this study was to verify the fluoride-related knowledge of pediatricians (PP) and dentists (DS) working in primary care, comparing related aspects such as its multiple sources of intake and dental fluorosis.

METHODS

A group of PP and DS answered as self-administered questionnaire related to fluoride knowledge. PP group presented a lower level of adherence (34%) in comparison to the DS group (70%).

RESULTS

Fluoride-related topics were learnt at undergraduate courses by 95,95% of dentists and 38.46% of pediatricians. Ninety-two per cent of DS and 78.57% of PP claimed to know the clinical aspects of dental fluorosis. Pediatricians tend to indicate the use of fluoridated dentifrices at any age but advise less about the right amount to be placed on the toothbrush in comparison to DS.

CONCLUSIONS

Dentists and pediatricians presented limited fluoride-related knowledge. Continued education/training is encouraged and necessary at this level in order to deliver the benefits of fluoride use to populations.

The Effects of Two New Dual Zinc plus Arginine Dentifrices in Reducing Oral Bacteria in Multiple Locations in the Mouth: 12-Hour Whole Mouth Antibacterial Protection for Whole Mouth Health

OBJECTIVES

To compare the effects of two new fluoride toothpastes with Dual Zinc plus Arginine to the effects of a fluoride control toothpaste in reducing bacteria in oral biofilm on teeth and in multiple soft tissue locations, as well as in saliva, 12 hours after 14 and 29 days of product use.

METHODS

A randomized, single-center, three-cell, double-blind, parallel-group design was employed. The study protocol was approved by an Institutional Review Board. One hundred eighty adult subjects who met inclusion and exclusion criteria and signed an informed consent form were enrolled in the study. Subjects were randomly assigned to one of the three study products: 1) 0.96% zinc (zinc oxide, zinc citrate), 1.5% L-arginine and 1450 ppm fluoride as sodium fluoride in a silica base, Test 1; 2) 0.96% zinc (zinc oxide, zinc citrate), 1.5% L-arginine and 1000 ppm fluoride as sodium fluoride in a silica base, Test 2; and 3) 1450 ppm fluoride as sodium fluoride in a silica base, Control, for twice-daily use during tooth brushing. Oral samples were collected from the teeth, tongue, oral buccal mucosa, gingiva, and saliva at baseline and 12 hours after 14 and 29 days of assigned product use and were processed, serially diluted, plated, incubated, and scored for viable bacteria. Statistical analyses were performed separately for each sample site using ANOVA and ANCOVA for within- and between-treatment comparisons, respectively.

RESULTS

One hundred seventy-three subjects completed the study. Relative to subjects in the Control group, subjects in the two Test groups exhibited statistically significant reductions of 29-41% in numbers of bacteria in each of the five sample areas, 12 hours after 29 days of product use. Similar results were seen after 14 days of product use, but some differences were not statistically significant, indicating that the effects of these zinc-based toothpastes build over time with continued use. The two Test toothpastes were shown to be clinically equivalent using the Fieller's confidence interval test.

CONCLUSIONS

Toothpastes containing 0.96% zinc (zinc oxide, zinc citrate), 1.5% L-arginine and either 1450 ppm or 1000 ppm fluoride as sodium fluoride in a silica base provide statistically significant reductions in oral bacteria on the teeth, tongue, cheeks, and gums, as well as in saliva, compared to toothpaste with fluoride alone, 12 hours after 29 days of twice-daily tooth brushing. The results demonstrate that regular and continued twice-daily use of these new toothpastes provide 12-hour whole mouth antibacterial protection for whole mouth health.

Comparison of Whitening Dentifrices on the Effectiveness of In-office Tooth Bleaching: A Double-blind Randomized Controlled Clinical Trial

OBJECTIVES:

To investigate the effect of whitening dentifrices on the effectiveness of in-office tooth bleaching.

METHODS AND MATERIALS:

A double-blind randomized controlled clinical trial was performed. The participants were randomly allocated into three groups according to the different dentifrices used during this clinical trial: regular dentifrice (group C), conventional whitening dentifrice (group CW), and whitening dentifrice containing blue covarine (group CU). All participants received in-office tooth bleaching for the maxillary anterior teeth (two sessions conducted at a one-week interval). Tooth color was measured with a spectrophotometer at baseline (T1), after the first bleaching session (T2), after the second bleaching session (T3); one week after the completion of in-office bleaching (T4); and three weeks after the completion of in-office bleaching (T5). The data were statistically analyzed through repeated analysis of variance and the Tukey test (α=0.05).

RESULTS:

Sixty participants completed the study (n=20 per group). At T3, group CU exhibited the lowest ΔE values ( p=0.008). The ΔE values increased from T4 to T5 in the CW and CU groups, whereas a decrease in ΔE values was observed for group C.

CONCLUSIONS:

The use of a whitening dentifrice containing blue covarine during in-office bleaching reduced color changes. After tooth bleaching, brighter tooth colors were observed in the participants who brushed with whitening dentifrices compared to those who brushed with a regular dentifrice.

Effect of desensitizing toothpastes on dentin erosive wear and tubule occlusion. An in situ study

PURPOSE

To evaluate the effect of desensitizing dentifrices on dentin wear and tubule occlusion using a three-phase, single blind, crossover in situ trial.

METHODS

The dentifrices containing Arginine and calcium carbonate (1,450 ppmF) and Novamin, (~1,426 ppmF) were tested in two conditions: A: abrasion and B: erosion/abrasion. A dentifrice without desensitizing agents was used as control (1,450 ppmF). In each study phase, 10 volunteers used intra-oral appliances containing dentin specimens (pre-treated with EDTA, to simulate hypersensitive dentin), which were either submitted to erosion with a cola-like drink (pH 2.6), 4×/day (2 minutes), followed by toothbrushing, using electric toothbrushes, with standard pressure (2×/ day, 5 seconds), or toothbrushing only. Dentin surface loss (SL, in µm) was determined with optical profilometry at the 3rd and 5th days of cycling. Dentin surface was analyzed with environmental scanning electron microscopy (ESEM), post EDTA and post cycling, and the dentin tubules were counted using Image J software. Data were statistically analyzed (α= 0.05).

RESULTS

For condition A and B, there were no significant differences in SL among toothpastes in both experimental times. There were also no significant differences between times within groups. For ESEM, in A, Toothpaste with Novamin was the only dentifrice that showed significantly less opened tubules post cycling than post EDTA. In B, Toothpaste with Novamin and control toothpaste presented less opened tubules post cycling. In conclusion, toothbrushing with the tested dentifrices promoted similar levels of dentin loss; however, for tubule occlusion, the toothpaste with Novamin was the only toothpaste effective for both conditions, abrasion and erosion/abrasion.

CLINICAL SIGNIFICANCE

Ideally, desensitizing dentifrices should promote obliteration of the dentin tubules or nerve desensitization, without further contributing to the progression of dentin wear.

Efficacy of Teeth Whitening with a Mouthwash: In Vitro and In Vivo Approaches

OBJECTIVES

Two different studies were conducted to evaluate the whitening efficacy of a mouthwash versus a placebo using in vitro and in vivomodels. The tested mouthwash was formulated with no oxidizing or abrasive agents containing chlorhexidine (CHX) and polyvinylpyrrolidone (PVP).

METHODS

The purpose of the in vitro study was to determine whether the mouthwash formulation OC15AB could reduce the accumulation of staining in an accepted stain model. Bovine central incisors were cut to obtain enamel specimens of ~8 × 8 mm2. The specimens were then immersed in human saliva (room temperature, slight stirring) for one hour to allow a pellicle film to form. They were then placed in contact with a staining solution containing coffee and tea. The amount of stain (tooth color) was quantified photometrically (Minolta C221 colorimeter) using the L* value of the L*a*b* scale. The purpose of the in vivo study was to evaluate the whitening power and tolerability of OC15AB versus a placebo mouthwash in a double-blind, randomized clinical study. In total, 40 subjects were divided randomly into two homogeneous groups. Each group used a different mouthwash (OC15AB or placebo) for 56 consecutive days. During this period, clinical and instrumental parameters, namely variations in tooth color and mucosal and gum alterations, were evaluated. The in vivo study analyses used a two-sided Student's t-test. Evaluations within groups used t-tests for paired data.

RESULTS

From the in vitro test, OC15AB had a significant effect in reducing stain accumulation over the entire treatment period. The in vivo test showed that OC15AB was well tolerated and had whitening power in the subjects. OC15AB demonstrated a statistically significant reduction in extrinsic tooth staining from baseline and versus the placebo.

CONCLUSIONS

The in vitro and in vivo methods used to investigate the whitening efficacy of the mouthwash formulation produced similar and consistent results. The experimental model used is an important tool in the search for new technologies for teeth whitening. Our preliminary experimental data confirm the possibility of achieving a whitening effect using a mouthwash formulation with no oxidizing or abrasive agents containing CHX and PVP. The formulation tested demonstrated a significant reduction, in vitro and in vivo, in extrinsic tooth staining from baseline and versus the placebo.

[Evaluation of the effectiveness of cold-light whitening technique on tetracycline pigmentation teeth and aged extrinsic stain teeth]

PURPOSE

To evaluate the clinical effectiveness of cold-light whitening technique on tetracycline pigmentation teeth and aged extrinsic stain teeth.

METHODS

One hundred and fifty-two cases bleached by cold-light whitening technique were included in this study. The patients' teeth were divided into 3 groups: aged extrinsic stain teeth, mild tetracycline pigmentation teeth and moderate tetracycline pigmentation teeth. Visual determination of shade and Olympus crystaleye spectrophotometer were used to measure the tooth discoloration after bleaching. SPSS17.0 software package was used for statistical analysis.

RESULTS

Visual determination showed that the efficiency of aged extrinsic stain teeth was significantly higher than that of mild and moderate tetracycline teeth group (P<0.05). Colorimetric method showed that the △E of moderate tetracycline teeth was significantly lower than aged extrinsic teeth and mild tetracycline teeth (P<0.05) . The △E of cervix changed more significantly than that of central and incisal edge in both mild and moderate tetracycline teeth group (P<0.05).

CONCLUSIONS

The effect of cold-light whitening technique on aged extrinsic stain teeth is better than that of the tetracycline pigmentation teeth. Cold-light whitening technique can improve pigmentation of tetracycline teeth cervix．.

Impact of dentifrice abrasivity and remineralization time on erosive tooth wear in vitro

PURPOSE

To investigate the in vitro effects of simulated dentifrice slurry abrasivity (L-low, M-medium and H-high) and remineralization time (0, 30, 60 and 120 minutes) on erosive tooth wear.

METHODS

Enamel and root dentin specimens were prepared from bovine incisors (n= 8) and submitted to a cycling protocol including erosion, remineralization at the test times, and brushing with each of the tested slurries, for 5 days. Dental surface loss (SL) was determined by optical profilometry. Data was analyzed using mixed-model ANOVA and Fisher's PLSD tests (alpha= 0.05).

RESULTS

SL generally increased along with the increase in slurry abrasive level, with significance dependent upon the specific substrate and remineralization times. H showed the highest SL on both enamel and dentin; remineralization for 30 minutes reduced SL significantly (P< 0.05), but only for enamel. M showed intermediate SL values, with remineralization benefit clearly seen only after 120 minutes of remineralization (P< 0.05). L caused the least SL for both enamel and dentin, which was further reduced after remineralization for 120 and 30 minutes, respectively (both P< 0.05). Overall, root dentin had significantly higher SL than enamel. Less abrasive dentifrice slurries were able to reduce toothbrushing abrasion on both enamel and root dentin. This protection was enhanced by remineralization for all abrasive levels on enamel, but only for L on root dentin.

CLINICAL SIGNIFICANCE

High-risk erosion patients should avoid highly abrasive toothpastes, as remineralization can only partially compensate for their deleterious effects on eroded dental surfaces. Lower abrasive toothpastes are recommended.

In Vitro and In Vivo Evaluations of the Anticalculus Effect of a Novel Stabilized Stannous Fluoride Dentifrice

OBJECTIVES

To evaluate the effect of a novel stannous fluoride dentifrice with zinc citrate on calculus inhibition using both in vitro and clinical models.

METHODS

Each investigation tested a novel stabilized 0.454% stannous fluoride dentifrice with zinc citrate as an anticalculus agent (Crest® Pro-Health™ smooth formula) compared to a negative control fluoride dentifrice. The in vitro study used the modified Plaque Growth and Mineralization Model (mPGM). Plaque biofilms were prepared and mineralized by alternate immersion of glass rods in human saliva and artificial mineralization solution. Treatments of 25% w/w dentifrice/water slurries were carried out for 60 seconds daily for 6 days, between saliva and mineralization solution immersions. Plaque calcium levels were determined by digestion and inductively coupled plasma optical emission spectroscopy. Student's t-test (p < 0.05) was used for statistical analysis. The clinical study was a parallel group, double-blind, randomized, and controlled trial. Following a dental prophylaxis, subjects entered a two-month run-in phase. At the end, they received a Volpe-Manhold Index (V-MI) calculus examination. Eighty (80) qualified subjects who had formed at least 9 mm of calculus on the linguals of the mandibular anterior teeth were re-prophied and randomly assigned to either the stannous fluoride dentifrice or the negative control. Subjects brushed twice daily, unsupervised, during the three-month test period, returning at Weeks 6 and 12 for safety and V-MI examinations. Statistical analyses were via ANCOVA.

RESULTS

In vitro mPGM: The stabilized stannous fluoride dentifrice showed 20% less in vitro tartar formation, measured as calcium accumulation normalized by biofilm mass, versus the negative control (106.95 versus 133.04 µg Ca/mg biofilm, respectively, p < 0.05). Clinical Trial: Seventy-eight (78) subjects completed with fully evaluable data. The stannous fluoride dentifrice group had 15.1% less adjusted mean calculus at Week 6 compared to the negative control group (p = 0.05) and 21.7% less calculus at Week 12 (p < 0.01). Both dentifrices were well-tolerated.

CONCLUSIONS

The stannous fluoride dentifrice produced significant anticalculus benefits in vitro and in a clinical trial compared to a negative control.

The Case for Stabilized Stannous Fluoride Dentifrice: An Advanced Formulation Designed for Patient Preference

Oral diseases, particularly caries and gingivitis, continue to be widespread. Incorporating a stabilized stannous fluoride dentifrice into patients' daily oral hygiene routine is a convenient, cost effective approach to improve and protect their oral health and the appearance of their smile. Unlike other common fluorides that only provide anti-caries benefits (e.g., sodium fluoride and sodium monofluorophosphate), stabilized stannous fluoride formulations have demonstrated broader and significantly greater protection, also reducing plaque, gingivitis, erosion, sensitivity, and halitosis. To deliver the full range of benefits and simultaneously deliver whitening and tartar control benefits, stannous fluoride requires careful formulation. Procter & Gamble is the only dentifrice manufacturer with decades of patented innovations to overcome these formulation challenges, resulting in a large portfolio of stannous fluoride-containing dentifrice products marketed under the Crest® Pro-Health™ name that are available today. The most recent innovation is a "smooth texture" variant of Crest Pro-Health, containing stabilized stannous fluoride with zinc citrate as the anti-calculus agent. This product was developed to deliver a patient preferred brushing experience with the full range of benefits offered by Crest Pro-Health. This article discusses two common misconceptions about dentifrice, describes the history of key Crest stannous fluoride innovations, and outlines the research in this issue demonstrating health and cosmetic benefits of the new Crest Pro-Health smooth texture variant.

Fluoride Uptake Profiles of Selected European Toothpastes into Hard Tissues and Plaque

OBJECTIVES

To compare the fluoridating potential of selected European toothpastes using a combination of enamel, dentin, and plaque in vitromodels.

METHODS

Four in vitromodels were included: 1) Enamel Fluoride (F) Uptake (EFU); 2) Dentin F Uptake (DFU); 3) Enamel Solubility Reduction (ESR); and 4) Plaque F Uptake (PFU). A core set of marketed products was included in all studies, plus a standard toothpaste (1100 ppm F as NaF/silica) and placebo control (the PFU study did not include a placebo control). Test dentifrices: [A] Fluocaril® Bi-Fluoré 250 (1500 ppm F as NaF+1000 ppm F as SMFP); [B] LacerAnticaries (2500 ppm F as SMFP); [C] Elmex® Caries Professional™ (1450 ppm F as SMFP+1.5% arginine); [D] Colgate® Triple Action (1450 ppm F as SMFP); [E] Placebo (0 ppm F); and [F] standard toothpaste (1100 ppm as NaF/silica). In all studies (EFU, DFU, ESR, and PFU), assessments were compared for each pair using the Tukey-Kramer HSD test (p < 0.05).

RESULTS

In all studies of fluoride uptake, the Fluocaril dentifrice [A] provided the greatest numerical benefit, regardless of the substrate. Statistical groupings were EFU: A > F = B = C = D > E; DFU: A > F = B = C = D = E; PFU: A = B > F = C = D). In demineralization prevention, the Fluocaril dentifrice [A] also provided the greatest benefit (ESR: A = F = C = B = D > E). In all studies that included a placebo control, all of the F-containing dentifrices performed better than the placebo control.

CONCLUSIONS

While these results demonstrate that all of the marketed products tested provide effective anticaries benefits, the Fluocaril Bi-Fluoré 250 dentifrice consistently delivered unsurpassed performance. It delivered the highest level of F to plaque, provided greater measures of efficacy in both remineralization and inhibition of demineralization, and delivered substantial improvement in fluoridation of dentin, suggesting the potential for delivering both coronal and root caries benefits.

A Comparative Study of Laboratory Dentifrice Abrasion Measuring Methods

OBJECTIVES

Recently, a profilometry-based method for measuring toothpaste dentin abrasivity has been proposed to be equivalent to the traditional radiotracer RDA (relative dentin abrasion) procedure. This review outlines the findings and comparative assessment of laboratory studies used to measure the abrasivity of commercially available whitening dentifrices on human dentin. Traditional radiotracer and profilometry RDA-PE (Profilometry Equivalent) methods were assessed, with the objective of determining how they compare, and also to learn if the two techniques yield RDA values that are consistent with each other, specifically in ranking and potential for discrimination of three commercially available silica-based products. Chosen were regular toothpaste and two whitening dentifrices having abrasive properties against dentin ranging from medium to high.

METHODS

Dentin specimens underwent standard preparation, preconditioning, and abrasivity testing according to the ISO 11609 requirements for radiotracer method and RDA-PE. Three test dentifrices were used, each product containing various abrasive and polyphosphate agents, namely: Whitening Product A: Hydrated silica with disodium pyrophosphate (Crest® 3D Luxe); Product B: Hydrated silica (Crest® Cavity Protection); and Whitening Product C: Hydrated silica with tetrasodium pyrophosphate (Colgate® Ultrabrite Advanced Whitening). The products were chosen since they gave a range of RDA values from mid to high when compared with an ADA reference material that is given a value of 100.

RESULTS

The data were subjected to statistical and SNK (Student-Newman-Keuls) analyses. Both procedures yielded numerical RDA values that permitted a ranking of the three test dentifrices. However, there was no direct correlation of the RDA values obtained by profilometry with those from the conventional radiotracer method. Significantly, one dentifrice rated as most abrasive using the radiotracer method was rated as moderately abrasive using profilometry. Additionally, there was loss of statistical significance and discrimination between products with RDA-PE.

CONCLUSIONS

Given the lack of agreement between radiotracer and profilometry for the products tested in this study,it would appear that the RDA-PE method may not be equivalent to the traditional RDA radiotracer method, specifically in the higher abrasivity range.