Full virtual patient generated by artificial intelligence-driven integrated segmentation of craniomaxillofacial structures from CBCT images

OBJECTIVES

To assess the performance, time-efficiency, and consistency of a convolutional neural network (CNN) based automated approach for integrated segmentation of craniomaxillofacial structures compared with semi-automated method for creating a virtual patient using cone beam computed tomography (CBCT) scans.

METHODS

Thirty CBCT scans were selected. Six craniomaxillofacial structures, encompassing the maxillofacial complex bones, maxillary sinus, dentition, mandible, mandibular canal, and pharyngeal airway space, were segmented on these scans using semi-automated and composite of previously validated CNN-based automated segmentation techniques for individual structures. A qualitative assessment of the automated segmentation revealed the need for minor refinements, which were manually corrected. These refined segmentations served as a reference for comparing semi-automated and automated integrated segmentations.

RESULTS

The majority of minor adjustments with the automated approach involved under-segmentation of sinus mucosal thickening and regions with reduced bone thickness within the maxillofacial complex. The automated and the semi-automated approaches required an average time of 1.1 min and 48.4 min, respectively. The automated method demonstrated a greater degree of similarity (99.6 %) to the reference than the semi-automated approach (88.3 %). The standard deviation values for all metrics with the automated approach were low, indicating a high consistency.

CONCLUSIONS

The CNN-driven integrated segmentation approach proved to be accurate, time-efficient, and consistent for creating a CBCT-derived virtual patient through simultaneous segmentation of craniomaxillofacial structures.

CLINICAL RELEVANCE

The creation of a virtual orofacial patient using an automated approach could potentially transform personalized digital workflows. This advancement could be particularly beneficial for treatment planning in a variety of dental and maxillofacial specialties.

Optimization of a Validated Protocol That Determines Bioavailable Fluoride in Toothpastes

A validated protocol used to determine how much of total fluoride is bioavailable in toothpaste formulations was evaluated if it could be simplified regarding the following parameters: (1) concentration of the slurry (0.25-4%), (2) centrifugation speed (1,000-12,000 g) and time (1-10 min), and (3) incubation time for FPO32- ion hydrolysis and insoluble-F dissolution (15-60 min). Fresh and aged Na2FPO3/CaCO3 and fresh NaF/SiO2-based toothpastes were analyzed (n = 9). The improvements were the centrifugation at 1,000 g for 5 min is enough to separate insoluble-F and the time for FPO32- ion hydrolysis and insoluble-F dissolution can be shortened to 30 min.

Three-dimensional maxillary virtual patient creation by convolutional neural network-based segmentation on cone-beam computed tomography images

OBJECTIVE

To qualitatively and quantitatively assess integrated segmentation of three convolutional neural network (CNN) models for the creation of a maxillary virtual patient (MVP) from cone-beam computed tomography (CBCT) images.

MATERIALS AND METHODS

A dataset of 40 CBCT scans acquired with different scanning parameters was selected. Three previously validated individual CNN models were integrated to achieve a combined segmentation of maxillary complex, maxillary sinuses, and upper dentition. Two experts performed a qualitative assessment, scoring-integrated segmentations from 0 to 10 based on the number of required refinements. Furthermore, experts executed refinements, allowing performance comparison between integrated automated segmentation (AS) and refined segmentation (RS) models. Inter-observer consistency of the refinements and the time needed to create a full-resolution automatic segmentation were calculated.

RESULTS

From the dataset, 85% scored 7-10, and 15% were within 3-6. The average time required for automated segmentation was 1.7 min. Performance metrics indicated an excellent overlap between automatic and refined segmentation with a dice similarity coefficient (DSC) of 99.3%. High inter-observer consistency of refinements was observed, with a 95% Hausdorff distance (HD) of 0.045 mm.

CONCLUSION

The integrated CNN models proved to be fast, accurate, and consistent along with a strong interobserver consistency in creating the MVP.

CLINICAL RELEVANCE

The automated segmentation of these structures simultaneously could act as a valuable tool in clinical orthodontics, implant rehabilitation, and any oral or maxillofacial surgical procedures, where visualization of MVP and its relationship with surrounding structures is a necessity for reaching an accurate diagnosis and patient-specific treatment planning.

Anticaries potential of a fluoride foam

Foam has been used worldwide as a vehicle for the professional application of fluoride and hypothetically should have the same anticaries potential as conventional fluoride gel (F-gel) in terms of the formation of reaction products with enamel. Thus, the ability of Flúor Care® foam (FGM, Joinville, SC, Brazil, 12,300 ppm F, acidulated) to react with enamel was evaluated in comparison with Flúor gel® (DFL, Rio de Janeiro, RJ, Brazil, 12,300 ppm F, acidulated). Slabs (n=10/group) of sound enamel and with caries lesion were used, in which the concentrations of total fluoride (TF), and loosely (CaF2-like) and firmly (FAp) bound types were determined. The importance of agitation during application was previously tested. The determinations were made with fluoride ion-specific electrode and the results were expressed in μg F/cm² of the treated enamel area. ANOVA and Tukey tests were used to analyze the difference among treatments, independently for sound and carious enamel. The agitation of the products during application significantly increased the reactivity of the foam (p<0.05), but not that of the gel (p>0.05). The foam did not differ from F-gel (p>0.05) concerning the formation of TF and CaF2-like in sound or carious enamel. Regarding FAp, the foam did not differ from F-gel (p>0.05) in the carious enamel, but the concentration in the sound was lower (p<0.05). The results show that this commercial fluoride foam tested needs to be agitated during application to improve its reactivity with enamel, which raises a question about other brands.

Fluoride toothpaste, sanitary surveillance and the SUS: the case of Manaus-AM, Brazil

OBJECTIVE

To determine the anticaries potential of toothpastes distributed by the primary health care public clinics (UBS) of Manaus, AM.

METHODS

Ninety-nine tubes of toothpaste from four commercial brands were collected from October 7, 2019 to October 11, 2019 in 16 UBS. They were assigned a code by brand and source UBS. According to the information on the packaging, the four brands and their batches were formulated with sodium monofluorophosphate (Na₂FPO₃) and most (91%) had calcium carbonate (CaCO₃) as an abrasive. We determined the concentrations of total fluoride (TF = TSF + InsF) and total soluble fluoride (TSF = F ions^- or FPO₃^2-), to certify whether they were in compliance with resolution ANVISA RDC No. 530 (maximum of 1,500 ppm TF) and whether they had anticaries potential (minimum of 1,000 ppm TSF). The analyses were performed with a ion- specific electrode.

RESULTS

The concentrations (ppm F) of TF [mean; standard deviation (SD); n] found in toothpaste brands A (1,502.3; SD = 45.6; n = 33), B (1,135.5; SD = 52.7; n = 48) and D (936.8; SD = 20.5; N = 8) were close to those stated on the package, 1,500, 1,100 and 1,000 ppm F, respectively. In toothpaste C, we found a mean of 274.1 ppm (SD = 219.7; n = 10) of TF, which diverges from the declared concentration of 1,500 ppm F. In addition, the five tubes of lot no. 11681118 of toothpaste C did not contain fluoride. Regarding TSF, with the exception of toothpaste D (937.9; SD = 40.29), the others had a lower concentration than their respective TF.

CONCLUSION

We found serious problems of quantity and quality of fluoride in toothpaste distributed by the SUS in Manaus, which shows the need for surveillance of these products and confirms the urgency of revising resolution RDC No. 530.

Fluoride bioavailability on demineralized enamel by commercial mouth rinses

The ability of mouth rinses, available in the international market, to form reaction products on demineralized enamel (bioavailability test) was evaluated in vitro. Nine mouth rinses purchased in Chile were evaluated; eight formulated with NaF (one containing 100 µg F/mL and seven containing 226) and one with Na2FPO3 (226 µg F/mL as ion F). Demineralized enamel slabs (n=15 per mouth rinse) were sectioned; one half was subjected to the assigned mouth rinse treatment for 10 min and the other half was used to obtain baseline data. Loosely bound and firmly bound fluoride formed on enamel were determined with an ion-specific electrode and the values were expressed in µg F/cm2. The concentration of fluoride and the pH of the mouth rinses were previously determined. Concentrations of loosely bound and firmly bound fluoride formed on enamel were independently analyzed by ANOVA and Tukey's test (α=5%). The loosely bound and firmly bound fluoride concentrations (µg F/cm2) formed ranged from 3.2 to 36.2 and 0.4 to 1.7, respectively. Loosely bound fluoride formed on enamel was significantly more effective in discriminating the effect of different commercial mouth rinses than firmly bound fluoride. Mouth rinses with 226 ppm F as NaF and low pH presented significantly greater bioavailability of fluoride on enamel than those with higher pH or lower NaF concentration. The mouth rinse with Na2FPO3 showed low reactivity. Although further studies are necessary, the findings showed that commercial fluoride-containing mouth rinses have important variations in enamel fluoride bioavailability, which may result in differences on anticaries efficacy.

Effect of fluoridated water on dental caries and fluorosis in schoolchildren who use fluoridated dentifrice

This cross-sectional study evaluated the prevalence and severity of dental caries and fluorosis in children and adolescents using fluoridated toothpaste, from areas with and without fluoridated water. Parents of 5-year-old children and 12-year-old adolescents from neighbourhoods that are supplied with and without fluoridated water answered questionnaires for determining socio-economic and demographic characteristics and habits related to oral health. The individuals were examined, and dental caries and fluorosis were measured by dmft/DMFT and TF indexes, respectively. Descriptive, bivariate and logistic regression analyses were performed (p < 0.05). Of 692 participants, 47.7% were 5-year-olds and 52.3% were 12-year-olds. The mean dmft/DMFT in the 5-year-olds/ 12-year-olds from Exposed and Not Exposed fluoridated water groups was 1.53 (± 2.47) and 3.54 (± 4.10) / 1.53 (± 1.81) and 3.54 (± 3.82), respectively. Children (OR = 2.86, 95% CI = 1.71-4.75) and adolescents (OR = 1.95, 95% CI = 1.24-3.05), who did not consume fluoridated water, had greater caries experience. Among adolescents, there was an association between fluoridated water and the prevalence of very mild/mild fluorosis (OR = 5.45, 95% CI: 3.23-9.19) and moderate fluorosis (OR = 11.11, 95% CI = 4.43-27.87). Children and adolescents, who consumed fluoridated water, presented lower prevalence and severity of dental caries compared to those who used only fluoridated toothpaste as the source of fluoride. There is an association between water fluoridation and very mild/mild and moderate fluorosis in adolescents.

Fluoride bioavailability on demineralized enamel by commercial mouthrinses

The ability of mouthrinses, available in the international market, to form reaction products on demineralized enamel (bioavailability test) was evaluated in vitro. Nine mouthrinses purchased in Chile were evaluated; eight formulated with NaF (one containing 100 µg F/mL and seven containing 226) and one with Na2FPO3 (226 µg F/mL as ion FPO3 ). Demineralized enamel slabs (n=15 per mouthrinse) were sectioned; one half was subjected to the assigned mouthrinse treatment for 10 min and the other half was used to obtain baseline data. Loosely bound and firmly bound fluoride formed on enamel were determined with an ion-specific electrode and the values were expressed in µg F/cm2. The concentration of fluoride and the pH of the mouthrinses were previously determined. Concentrations of loosely bound and firmly bound fluoride formed on enamel were independently analyzed by ANOVA and Tukey's test (α=5%). The loosely bound and firmly bound fluoride concentrations formed ranged from 3.2 to 36.2 and 0.4 to 1.7, respectively. Loosely bound fluoride formed on enamel was significantly more effective in discriminating the effect of different commercial mouthrinses than firmly bound fluoride. Mouthrinses with 226 ppm F as NaF and low pH presented significantly greater bioavailability of fluoride on enamel than those with higher pH or lower NaF concentration. The mouthrinse with Na2FPO3 showed low reactivity. Although further studies are necessary, the findings showed that commercial fluoride-containing mouthrinses have important variations in enamel fluoride bioavailability, which may result in differences on anticaries efficacy.

Fluoride concentration in mouth rinses marketed in Chile and Brazil, and a discussion regarding their legislations

For fluoride to be effective in controlling caries, it should be bioavailable in commercial products, so that it can be released into the mouth in the products it contains. We chemically determined the available fluoride and pH in nine mouth rinses marketed in Chile, and eleven, in Brazil, and then discussed the legislation in force in both countries, regarding the anticaries potential of these oral hygiene products. The fluoride was analyzed with an ion-selective electrode (F-ISE), using the direct technique. The determinations were made in duplicate, and the results were expressed in ppm F (μg F/mL). The total fluoride concentration found in all the mouth rinses evaluated ranged from 94.7 to 233.5 ppm F, and closely matched what was declared by the manufacturers (100.0 to 226.2 ppm F). However, some mouth rinses showed lower fluoride concentrations (90 and 180 ppm F) in both countries. A Na2FPO3-formulated mouth rinse was found only in Chile, with 216.8 ppm F as the FPO32- ion, and 4.9 ppm F as the F-. The findings show that fluoride was potentially bioavailable in all the mouth rinses evaluated. Regarding the national legislations, although the mouthwashes sold in Brazil comply with the Brazilian legislation, discrepancies were found for Chile. However, neither country had a legislation matching the best available evidence on fluoride mouthwash efficacy for caries control. Thus, some products with low fluoride concentrations (below 226 ppm F), or manufactured with a fluoride salt other than NaF (Na2FPO3) are being sold in the Brazilian and Chilean markets.

Avaliação da fluoretação da água de abastecimento público da 15ª Regional de Saúde do Paraná

A fluoretação da água é uma estratégia de saúde coletiva fundamentada no ajuste da concentração de fluoreto (F) na água para se obter o máximo benefício anticárie com o mínimo de risco de fluorose dentária. O objetivo deste trabalho foi realizar o heterocontrole do F nas águas de abastecimento público dos 30 municípios que compõem a 15ª Regional de Saúde do Paraná, conhecer o processo de fluoretação e sensibilizar gestores e profissionais para a importância e vigilância da fluoretação. Foi aplicado um questionário aos coordenadores de saúde bucal de cada município e para o heterocontrole, foram feitas coletas de água durante três meses. Apesar de 58% das amostras de água apresentaram a melhor faixa de relação benefício/risco do F, de acordo com a classificação proposta pelo CECOL/USP, poucos municípios fazem sistematicamente o monitoramento e a avaliação da concentração de fluoreto nas águas.

Fluoridated water impact on tooth decay and fluorosis in 17-20-year-olds exposed to fluoride toothpaste

OBJECTIVE

To determine the impact of water fluoridation on the prevalence and severity of dental caries and fluorosis in individuals aged 17-20 years exposed to fluoride toothpaste.

METHODS

The study population consisted of 660 students from public schools, residents of areas supplied with fluoridated water (exposed group) or not (not exposed group). Students from both groups had access to fluoride toothpaste throughout life. A questionnaire about socioeconomic demographic aspects, conditions related to access and exposure to fluoridated water, and habits related to oral health was applied. Dental caries was measured by the DMFT index and dental fluorosis by the TF index. The chi-square test, t test, and subsequently logistic regression were applied for data analysis.

RESULTS

Caries experience (DMFT≠0) was significantly higher in students from areas not exposed to fluoridated water, after adjustments to clinical conditions, demographic socioeconomic profile, and hygiene habits. The DMFT mean (±SD) was significantly higher in students from areas not exposed to fluoridated water than exposed (3.83 [±3.28] and 2.48 [±2.71] respectively). The prevalence of very mild/mild and moderate fluorosis was 41.1% and 21% for students either exposed to fluoridated water or not, respectively.

CONCLUSION

Exposure to fluoridated water was associated with a lower prevalence and severity of tooth decay, in spite of the use of fluoridated toothpaste. The prevalence of dental fluorosis at all levels was higher in fluoridated areas, however, in both groups, there were few cases with esthetic implications.

simplified protocol to determine total fluoride concentration in NaF/ silica-based toothpastes

Aim: To determine total fluoride (TF) concentration in Na2FPO3/Ca-based toothpastes, using fluoride ion selective electrode (F-ISE) by the direct technique, it is necessary to use acid (Ac+) to hydrolyze the FPO3 2- ion and to dissolve insoluble fluoride salts bound to the abrasive. For NaF/silicabased toothpastes, the use of acid is not necessary (Ac-) and a simplified protocol could be followed. Methods: Thus, we evaluated TF concentration in seven brands of NaF/silicabased toothpastes, following the validated conventional Cury’s protocol (Ac+) or a simplification of this protocol (Ac-). Fluoride was analyzed with ISE calibrated with fluoride standard solutions prepared in the same conditions as the samples (Ac+ or Ac-). Results: The mean (±SD; n=21) of TF concentrations (μg F/g) found by Ac+ (971.3±191.2) and Ac- (982.4±201.3) protocols were not statistically different (t test, p=0.22). The TF concentrations found agree with those declared by the manufacturers, except for one toothpaste imported from China. Conclusion: The findings suggest that the determination of fluoride in NaF/silica-based toothpastes can be accurately made using a simplified protocol of analysis.

Development of an Experimental Dentifrice with Hydroxyapatite Nanoparticles and High Fluoride Concentration to Manage Root Dentin Demineralization

Background

High-fluoride dentifrice is used to manage root caries, but there is no evidence whether its association with nanohydroxyapatite could provide an additional protection for root caries. Therefore, this study aimed to develop and evaluate the effect of an experimental dentifrice with high fluoride (F⁻) concentration and nanohydroxyapatite (nano-HA) on root dentin demineralization.

Materials and Methods

After formulation of dentifrices, root dentin specimens were randomly assigned to six groups (n = 10) using different dentifrice treatments: placebo; nano-HA without F⁻; 1,100 µg F⁻/g; 1,100 µg F⁻/g + nano-HA; 5,000 µg F⁻/g; and 5,000 µg F⁻/g + nano-HA. A pH cycling model was performed for 10 days, in which treatments were performed twice a day. After that period, the longitudinal hardness was evaluated and the area of demineralization (ΔS) was calculated. The formulated dentifrices were evaluated for primary stability, cytotoxicity, and other technical parameters. Two-way ANOVA and Tukey’s test with p set at 5% were used for data analysis.

Results

The experimental dentifrices were stable and had no cytotoxicity. Regarding dentin demineralization, the placebo group significantly increased ΔS compared to all other treatment groups (p<0.001). The dentifrices containing 5,000 µg F⁻/g, regardless of the presence of nano-HA, led to a smaller lesion area in relation to the other treatments (p<0.001).

Conclusion

The findings of this study suggest that nano-HA reduced dentin demineralization, and dentifrice with 5,000 µg F⁻/g dentifrices, regardless of the presence of nano-HA, showed a greater reduction in root dentin demineralization.

DENTIFRÍCIOS FLUORETADOS E O SUS-BRASIL: O QUE PRECISA SER MUDADO?

O presente estudo aborda as mudanças necessárias que devem ser implementadas para que toda a população brasileira possa ser beneficiada pelo uso de dentifrícios fluoretados em termos de prevenção de cárie dentária. Foi realizada uma busca da literatura sobre concentração de fluoreto em dentifrícios brasileiros, nas bases de dados Lilacs, PubMed, SciELO e nos arquivos do laboratório de Bioquímica Oral da FOP-UNICAMP. Os resultados mostram que desde o início da década de 1980, quando se iniciou o acompanhamento das concentrações de fluoreto em dentifrícios brasileiros, muitos dentifrícios não são capazes de manter uma concentração mínima de fluoreto solúvel para fornecer benefício anticárie. Este é um problema recorrente não só com os dentifrícios de livre venda presentes no comércio, mas principalmente com aqueles comprados por licitação pública pelo SUS e distribuídos para a população. A regulamentação brasileira vigente (Resolução 79, Anvisa, 28/08/2000) estabelece apenas a concentração máxima de fluoreto total que um dentifrício deve conter, mas não a mínima solúvel necessária para garantir o benefício anticárie da formulação. Uma mudança, estabelecendo a concentração mínima de fluoreto solúvel que um dentifrício deveria manter por determinado tempo após sua fabricação, não só beneficiaria o consumidor brasileiro, mas principalmente todos os usuários do SUS, porque poderia ser referendada nos editais de licitação de compra de dentifrícios.

Use of sonic waves in bubble formation, microhardness and fluoride release of a high-viscosity glass-ionomer cement

AIM

High-viscosity glass-ionomer cements (HV-GIC) are indicated for restorations but their viscosity favors the inclusion of bubbles within it. This study aimed to evaluate the use of ultrasonic and sonic waves in bubble formation, microhardness and fluoride release in a HV-GIC, also considering a different powder:liquid ratio (P/L).

METHODS

Twenty-four molars with occlusal cavities were divided into four groups (N = 6): CG, HV-GIC with manual insertion; UG, application of ultrasonic waves; SG, application of sonic waves; and FG, HV-GIC fluid (1:2 P/L) with manual insertion. After 24 hours, bubbles and microhardness (50 g/5 s) were measured. Fluoride release (N = 10) was evaluated in CG, SG and UG after cariogenic challenge for 11 days. Microhardness, total area and number of bubbles, and fluoride release were submitted to ANOVA and Tukey's test. The average size of bubbles was analyzed by Kruskal-Wallis test (α = 5%).

RESULTS

FG presented the lowest value of microhardness and higher average size for bubbles (P < .05). Differences concerning total number, total area occupied by bubbles and fluoride release were not found (P > .05).

CONCLUSION

The use of sonic and ultrasonic waves had no influence on bubble formation, microhardness and fluoride release of a HV-GIC. Changing the P/L is not recommended.

Decomposition Rate, pH, and Enamel Color Alteration of At-Home and In-Office Bleaching Agents

Abstract This study evaluated the decomposition rate (DR), pH, enamel color alteration (DE) and whiteness index (DWI) promoted by at-home and in-office bleaching. Enamel surface was submitted to (n=10): at-home (10%, 15%, 20% carbamide peroxide - CP, 6% hydrogen peroxide -HP) and three 35% HP agents with light irradiation (LED, laser, and halogen) or no treatment (control). The DR and pH of agents were measured after 0, 2, 4, 6 and 8 h (at-home) or after 5, 15, 20, 30 and 40 min (in-office). Color parameters (L*, a*, b*, DE, DWI) were determined at baseline and after bleaching. DR, pH, L*, a*, b* data were analyzed by one-way (at-home) or two-way (in-office) repeated measures ANOVA and Tukey test. DE and DWI, by one-way (at-home) or two-way (in-office) ANOVA and Tukey test. DR of at-home agents was similar after 6 and 8 h (p>0.05), with pH close to neutral (6.5 to 6.9, CP) or acid 5.9 (6% HP). From 4 to 8 h, DE was higher for 15% and 20% CP compared with 10% CP (p<0.05). After 40 min, DR of 35% HP agents was similar and all exhibited significant DE in one application (p<0.05), regardless light irradiation. DWI indicated whitening effect with no differences among groups (p>0.05). One 35% HP showed alkaline pH, and the others, pH < 5.5. At-home agents could be applied for 2 h (15%, 20% CP, 6% HP) and 4 h (10% CP) and the in-office agents, up to 40 min in one application, without light.

Fluoride Ion Release of Self-Adhesive Resin Cements and Their Potential to Inhibit In Situ Enamel and Dentin Demineralization

Objective

This study evaluated in situ the potential of a glass ionomer and self-adhesive resin cements to inhibit enamel and dentin demineralization around indirect restorations exposed to cariogenic challenge. The cumulative fluoride release (CFR) of materials was measured in water and acid. Methods: Seventy blocks cut from human molars received two indirect composite restorations (one in enamel and another in dentin) luted with Ketac Cem EasyMix (GIC, positive control), SeT (SeT), Maxcem Elite (Max), Smart Cem2 (Smart), and RelyX Unicem 2 (Unicem2). Fourteen volunteers wore palatal appliances containing five blocks exposed to a cariogenic challenge (20% sucrose solution, eight times per day, seven days). Knoop microhardness (KH) at two distances from the margins and three depths from the outer surface determined enamel and dentin demineralization. Disc-shape specimens of materials were immersed in daily-replaced deionized water or lactic acid solutions. KH and CFR data were analyzed by analysis of variance, Games-Howell test, and Tukey test (α=0.05). Results: The overall KH ranking was GIC &gt; SeT &gt; Max &gt; Smart = Unicem2 in both enamel and dentin (“&gt;” means p&lt;0.05). SeT was the only resin cement that resulted in enamel and dentin KH comparable to that of GIC at most distances and depths. In water, CFR rank of materials was GIC &gt; SeT = Max &gt; Smart = Unicem2. In acid, the rank was similar, except that Set was significantly superior to Max. Conclusion: SeT inhibited demineralization in enamel and dentin quite comparably to GIC. All resin cements released lower cumulative amounts of fluoride than the glass ionomer cement.

Comparison of cone beam computed tomography and digital intraoral radiography performance in the detection of artificially induced recurrent caries-like lesions

OBJECTIVES

The aim of this study was to compare the performance of cone beam computed tomography (CBCT) and digital radiography in the detection of artificial recurrent caries-like lesions under amalgam and composite fillings.

STUDY DESIGN

The study included class II cavities in 30 molars that had been filled with amalgam. Fifteen of those molars had the restoration-enamel interface artificially demineralized. Phantoms were prepared, and CBCT images were acquired with 2 units in 3 voxel sizes (K9000, 0.076 mm; i-CAT, 0.2 mm and 0.4 mm). Intraoral radiographs were obtained with 3 systems (Digora, VistaScan, and RVG-6100). Amalgam fillings were then replaced by composite, and new images were obtained. Three examiners assessed all of the images. Sensitivity, specificity, accuracy, and receiver operating characteristic curve were calculated and verified through analysis of variance and the Tukey test.

RESULTS

There were no significant differences in sensitivity and specificity when the same restorative material was present or when the restorative materials were compared with the imaging technique as a constant. As for accuracy and receiver operating characteristic curve, there were statistically significant differences when the 2 materials were compared, and there were differences in the amalgam group when the imaging modalities were compared.

CONCLUSIONS

CBCT performed similarly to intraoral radiography in detecting demineralization under restorations. However, the voxel size and the type of restorative material influenced its performance.

Effect of Adhesive Restoration and Bleaching Technique on the Concentration of Hydrogen Peroxide In the Pulp Chamber

This study aimed to quantify the concentration of hydrogen peroxide into the pulp chamber in the presence or absence of adhesive enamel restorations and to analyze the resin-dentin interface of bleached groups. Bovine incisors (120) were randomly divided into three groups according to enamel treatment (n=40 each): (1) enamel without restoration (control); (2) enamel cavities (3 mm diameter × 1.5 mm depth) restored with a silorane-based (SB) system; or (3) enamel cavities (3 mm diameter × 1.5 mm depth) restored with a dimethacrylate-based (DB) system. Restorations were thermocycled, and all groups were submitted to one application of 35% hydrogen peroxide (HP) agent for 45 minutes and subjected to four light activation methods (n=10 each): without light, light-emitting diode (LED), LED/diode laser, or halogen light. Acetate buffer solution was placed into the pulp chamber before bleaching, and this solution was collected to spectrophotometrically determine the concentration of HP that reached the pulp chamber after bleaching. Rhodamine B was added to the HP agent and applied on additional enamel samples of each group for 24 hours. Samples were sectioned mesiodistally, and the bleaching agent was traced using confocal microscopy. According to two-way analysis of variance and Tukey test (α=0.05), the HP concentration in the pulp chamber of the control group was significantly lower than that of the SB group (p&lt;0.05), regardless of light activation. No differences were observed between DB and SB groups and between control and DB groups, except for the DB halogen light activated group, which exhibited higher HP intrapulpal concentration (p&lt;0.05). Confocal microscopy exhibited HP diffusion through the interface of the SB and DB restored groups as well as enamel prisms in the control group. The SB restorative system increased the HP diffusion into the pulp chamber, but HP was able to diffuse even in the absence of enamel restorations.

In situ Effect of Frequent Sucrose Exposure on Enamel Demineralization and on Plaque Composition after APF Application and F Dentifrice Use

Since the effect of the combination of methods of fluoride use on enamel demineralization and on plaque composition is not clearly established, this study examined the effect of the combination of acidulated phosphate fluoride (APF) application and F dentifrice on enamel demineralization and on plaque composition. In this crossover study, 16 volunteers, wearing a palatal appliance containing bovine enamel blocks, were subjected to 4 treatment groups: non-fluoridated dentifrice (PD), FD, APF+PD, and APF+FD. The APF was applied to the enamel before the 14-day experimental period. During the experimental period, test dentifrices were applied 3×/day, and a 20% sucrose solution was applied 4× and 8×/day by being dripped on the blocks. Although APF application was able either to increase F concentration in plaque or to reduce the % of mutans streptococci, its combination with F dentifrice use neither reduced enamel mineral loss nor changed any other measured plaque variable with respect to the FD group alone.

Effect of Toothpaste Application Prior to Dental Bleaching on Whitening Effectiveness and Enamel Properties

OBJECTIVE

The purpose of this study was to investigate the effects on the enamel properties and effectiveness of bleaching using 35% hydrogen peroxide (HP) when applying toothpastes with different active agents prior to dental bleaching.

METHODS

Seventy enamel blocks (4 × 4 × 2 mm) were submitted to in vitro treatment protocols in a tooth-brushing machine (n=10): with distilled water and exposure to placebo gel (negative control [NC]) or HP bleaching (positive control [PC]); and brushing with differing toothpastes prior to HP bleaching, including potassium nitrate toothpaste (PN) containing NaF, conventional sodium monofluorophosphate toothpaste (FT), arginine-based toothpastes (PA and SAN), or a toothpaste containing bioactive glass (NM). Color changes were determined using the CIE L*a*b* system (ΔE, ΔL, Δa, and Δb), and a roughness (Ra) analysis was performed before and after treatments. Surface microhardness (SMH) and cross-sectional microhardness (CSMH) were analyzed after treatment. Data were analyzed with repeated measures ANOVA for Ra, one-way ANOVA (SMH, ΔE, ΔL, Δa, and Δb), split-plot ANOVA (CSMH), and Tukey post hoc test (α<0.05). The relationship between the physical surface properties and color properties was evaluated using a multivariate Canonical correlation analysis.

RESULTS

Color changes were statistically similar in the bleached groups. After treatments, SMH and CSMH decreased in PC. SMH increased significantly in the toothpaste groups vs the negative and positive control (NM > PA = SAN > all other groups) or decreased HP effects (CSMH). Ra increased in all bleached groups, with the exception of NM, which did not differ from the NC. The variation in the color variables (ΔL, Δa, and Δb) explained 21% of the variation in the physical surface variables (Ra and SMH).

CONCLUSION

The application of toothpaste prior to dental bleaching did not interfere with the effectiveness of treatment. The bioactive glass based toothpaste protected the enamel against the deleterious effects of dental bleaching.

Hydrogen peroxide penetration into the pulp chamber and dental permeability after bleaching

This study sought to quantify the concentration of hydrogen peroxide (HP) in the pulp chamber and evaluate changes on dental permeability after bleaching with 3 HP concentrations (10%, 35%, and 50%). This study was divided into 2 experiments and the bleaching treatments consisted of 3 applications of HP for 30 minutes during a single session. The first experiment tested HP penetration into the pulp chamber of 4 experimental groups (n = 10) of bovine crowns, which were divided by HP concentration: an unbleached control group (0% HP), 10% HP, 35% HP, and 50% HP. Acetate buffer solution was placed into the pulp chamber and after each application of HP. This solution was collected to determine spectrophotometrically the concentration of HP that reached the pulp chamber. The second experiment evaluated dental permeability. Bovine crowns were divided into 3 groups (n = 10). The crowns were connected to a permeability device and the initial permeability was measured at 10 psi. Three different concentrations of HP gels (10%, 35% and 50%) were applied to the buccal enamel surfaces and the dental permeability was measured after the first, second, and third applications of HP. The data were analyzed by 2-way ANOVA and Tukey test (P ≤ 0.05). All concentrations of HP reached the pulp chamber, although no significant differences were noted between the 3 concentrations tested (P > 0.05). However, the increase of dental permeability in the group that received 50% HP was significantly higher than the 10% HP group (P < 0.05). The results indicate that the HP bleaching treatments increased dental permeability.

Performance of a photostimulable storage phosphor digital system with or without the sharpen filter and cone beam CT for detecting approximal enamel subsurface demineralization

OBJECTIVES

The aim of this study was to assess the performance of photostimulable storage phosphor (PSP) radiographs with or without using the sharpen filter and cone beam CT (CBCT) for detecting enamel subsurface demineralization.

METHODS

Enamel subsurface demineralization was induced on one of the approximal surfaces of 120 sound human teeth. Standardized images of all teeth were acquired after the demineralization phase using the Digora(®) Optime (Orion Corp./Soredex, Helsinki, Finland) (PSP) and the i-CAT™ (Imaging Sciences International, Hatfield, PA) (CBCT) systems. Three calibrated observers interpreted the images using a five-point scale (1, demineralization definitely absent; 2, demineralization probably absent; 3, unsure; 4, demineralization probably present; and 5, demineralization definitely present). Diagnoses were validated by cross-sectional microhardness profiling in the test areas of the approximal surfaces. Interobserver agreement was analysed using kappa statistics. Accuracy was estimated by the areas under the receiver operating characteristic curves (Az), which were compared using the Kruskal-Wallis test (α = 5%).

RESULTS

Interobserver agreement was higher for CBCT (κ = 0.7-0.8), followed by sharpen-filtered (κ = 0.6-0.7) and original (κ = 0.5-0.6) images. CBCT presented the highest accuracy value (Az = 0.897) compared with the original (Az = 0.792) and sharpen-filtered (Az = 0.712) images. However, no statistical differences were observed between the imaging modalities (p = 0.0794).

CONCLUSIONS

It can be concluded that PSP radiographs with or without using the sharpen filter and the CBCT images may be useful adjuncts for detecting subtle approximal enamel demineralization.

APF and dentifrice effect on root dentin demineralization and biofilm

Because dentin is more caries-susceptible than enamel, its demineralization may be more influenced by additional fluoride (F). We hypothesized that a combination of professional F, applied as acidulated phosphate F (APF), and use of 1100-ppm-F dentifrice would provide additional protection for dentin compared with 1100-ppm-F alone. Twelve adult volunteers wore palatal appliances containing root dentin slabs, which were subjected, during 4 experimental phases of 7 days each, to biofilm accumulation and sucrose exposure 8x/day. The volunteers were randomly assigned to the following treatments: placebo dentifrice (PD), 1100-ppm-F dentifrice (FD), APF + PD, and APF+FD. APF gel (1.23% F) was applied to the slabs once at the beginning of the experimental phase, and the dentifrices were used 3x/day. APF and FD increased F concentration in biofilm fluid and reduced root dentin demineralization, presenting an additive effect. Analysis of the data suggests that the combination of APF gel application and daily regular use of 1100-ppm-F dentifrice may provide additional protection against root caries compared with the dentifrice alone.

Mechanism of fluoride dentifrice effect on enamel demineralization

Although the anticaries effect of fluoride (F) dentifrices is clearly established, the relative importance of F taken up by dental plaque not removed by brushing and of F products (CaF(2)-like) formed on totally cleaned enamel for the subsequent inhibition of demineralization is not known. Both effects were evaluated using conventional (1,100 microg F/g) and low-F concentration (500 microg F/g) dentifrices in a randomized, crossover, double-blind in situ study. Enamel blocks not treated or pretreated with the dentifrices to form CaF(2)-like deposits were mounted in palatal appliances in contact with a Streptococcus mutans test plaque. Volunteers brushed with non-F (negative control), low-F or conventional dentifrices and inserted the appliance in the mouth. F concentration in the fluid and solid phases of the test plaque was determined after 30 min, and a rinse with 20% sucrose solution was performed. After additional 45 min, plaque was collected and the loss of surface hardness at different test-plaque depths was measured. CaF(2)-like deposition on enamel and F taken up by plaque due to the use of F dentifrices were able to significantly increase F concentration in the fluid phase of the test plaque, but only the latter significantly reduced the loss of hardness because of the 20-30 times higher F concentration. Also, significant differences between the low-F and conventional dentifrices were observed for F on enamel, in plaque and on the subsequent loss of hardness. The results suggest that uptake of F by dental plaque not removed by brushing may be the main cause of the anticaries effect of F dentifrices.

Temporal relationship between sucrose-associated changes in dental biofilm composition and enamel demineralization

The aim of this study was to investigate the temporal relationship between changes in biofilm composition and enamel demineralization following exposure to sucrose. A crossover blind study was conducted in situ in three phases, during which 12 volunteers, divided into three groups, subjected enamel slabs 8 times/day to water (negative control), 10% glucose + 10% fructose (active control) or 20% sucrose solution. Biofilms accumulated for 3, 7 and 14 days were collected and analyzed biochemically and microbiologically, and mineral loss from enamel (deltaZ) was evaluated. Significantly higher deltaZ was found in the sucrose group after 7 days. However, on the 3rd day, lactobacilli, insoluble extracellular polysaccharide (EPS) and intracellular polysaccharide were significantly higher, and the calcium, inorganic phosphorus and fluoride concentrations in the biofilm were significantly lower in the sucrose group than in the negative controls. The only significant difference compared to glucose + fructose treatment was a higher insoluble EPS concentration. The data suggest that, although sucrose induces significant enamel demineralization only after 7 days of biofilm accumulation, changes in the biofilm composition are observed earlier.

Effect of Frequency of Sucrose Exposure on Dental Biofilm Composition and Enamel Demineralization in the Presence of Fluoride

It has been suggested that enamel would resist higher frequencies of sucrose exposure if fluoride from water or dentifrice is being used. However, the effect of increasing frequencies of sugar on dental biofilm composition is not well known. Ten volunteers living in a fluoridated area wore palatal appliances bearing human enamel slabs during 14 days. The slabs were exposed to 20% sucrose solution 0 (control), 2, 4, 6, 8 or 10 times/day and the volunteers used fluoride dentifrice 3 times/day. Enamel demineralization was significantly greater than control for sucrose frequencies higher than 6 times/day. However, biofilm mass, total microbiota, total streptococci, lactobacilli counts and insoluble extracellular polysaccharide concentration increased, while Ca, P(i) and F concentration in whole biofilm decreased significantly, with frequencies of sucrose exposure lower than 6 times/day. The findings confirm that fluoride can reduce enamel demineralization if sucrose consumption is not higher than 6 times/day, but changes in the biochemical and microbiological composition of the biofilm are observed with lower frequencies of sucrose use.

Evaluation of radioprotective effect of vitamin E in salivary dysfunction in irradiated rats

The aim of this study was to evaluate the radioprotective effect of vitamin E in salivary gland function, as well as analyse the total protein concentration. For this purpose 90 male rats were used and randomly divided into five experimental groups: control (I), in which animals received olive oil solution but were not irradiated; irradiated-olive oil (II), in which animals received olive oil solution and were irradiated with a single exposure dose of 15 Gy of gamma rays to the head and neck region; irradiated (III), in which animals were only irradiated with a single exposure dose of 15 Gy of gamma rays; vitamin E (IV), in which animals received alpha tocopherol acetate solution but were not irradiated; irradiated-vitamin E (V), in which animals received alpha tocopherol acetate solution before irradiation with a single exposure dose of 15 Gy gamma rays. The animals were sacrificed 4, 8 h and 30 days after the irradiation procedure. No differences were observed in salivary volumes between the groups at 4 and 8 h. At 30 days, the salivary volume in the animals pertaining to the irradiated-olive oil group was significantly reduced in relation to the control group. The only irradiated group (III) presented significantly diminished salivary volume. In the salivary composition, no significant differences were observed in the total protein content between the groups studied. It was concluded that radiation had no effect on the total protein content and that vitamin E protected the salivary function 30 days after irradiation. Thus, vitamin E can be considered as a potential radioprotective substance.

Effect of Sucrose Concentration on Dental Biofilm Formed in situ and on Enamel Demineralization

The relationship between sucrose concentration and cariogenic potential was studied in situ. Adult volunteers wore intraoral palatal appliances containing human dental enamel blocks, which were extraorally submitted 8 times a day for 14 days, to the treatments: deionized distilled water and sucrose solutions from 1 to 40%. The biofilm formed was analyzed with respect to acidogenicity and biochemical composition; enamel demineralization was evaluated by microhardness. The results showed that 1% sucrose is less cariogenic than 5% or higher concentrations, although sucrose solution at 40% was still able to increase the concentration of insoluble polysaccharide in the biofilm formed. The findings suggest that the threshold of sucrose solution concentration for the formation of a cariogenic biofilm is 5%, which provided the same cariogenic potential as that observed for 10 and 20% sucrose solution.

Effect of a Calcium Carbonate-Based Dentifrice on in situ Enamel Remineralization

This crossover study evaluated the effect of calcium carbonate (CaCO(3))-based monofluorophosphate dentifrice on enamel remineralization. Ten volunteers wore palatal appliances containing four enamel blocks with caries-like lesions, two of them covered by a test plaque of mutans streptococci. The following treatments were evaluated: a negative control, a silica-based or a CaCO(3)-based dentifrice, and the percentage of enamel surface microhardness recovery was determined. The CaCO(3)-based dentifrice was more effective than the negative control on the enhancement of enamel remineralization, either in the presence or absence of test plaque. This efficacy was also shown by the silica-based dentifrice but only in the presence of test plaque.

Linear and logarithmic subtraction for detecting enamel subsurface demineralization

OBJECTIVE

To compare the diagnostic performance of linear and logarithmically contrast-enhanced subtraction images, acquired with digital and digitized radiographs, in detecting approximal enamel subsurface demineralization.

METHODS

Fifty caries-free human third molars were immersed in a demineralizing solution for 60, 75, 90, and 120 days, in order to induce artificial enamel subsurface demineralization. The teeth were coated with nail varnish, leaving only a circular window of approximately 7 mm2 in one of the approximal surfaces, allowing contact with the solution. Standardized radiographs of the teeth were taken prior to and after the demineralization period with three digital systems, CygnusRay MPS, DenOptix and DIGORA, and InSight film. Conventional, digital and digitized radiographs were assessed by three experienced radiologists. Linear and logarithmically contrast-enhanced subtraction images were acquired and then examined by a fourth independent radiologist. For the validation of the radiographic diagnosis, the enamel test areas were submitted to Knoop microhardness profiling. Radiographic interpretation data was evaluated using ROC analysis. The areas under the ROC curves (Az) were compared by the chi-squared test. The level of significance was set at P=0.05.

RESULTS

No significant differences were found between linear and logarithmically contrast- enhanced subtraction images, acquired with the four studied modalities: CygnusRay MPSlinear (Az=0.95), CygnusRay MPSlog (Az=0.98), DenOptixlinear (Az=0.97), DenOptixlog (Az=0.99), DIGORAlinear (Az=0.98), DIGORAlog (Az=0.98), digitized radiographylinear (Az=0.99), digitized radiographylog (Az=0.99).

CONCLUSION

Linear and logarithmically contrast-enhanced subtraction images, acquired with digital and digitized radiographs, were diagnostically comparable for assessing enamel subsurface demineralization.

Effect of Sucrose Containing Iron (II) on Dental Biofilm and Enamel Demineralization in situ

Since the effect of iron (Fe) on the cariogenicity of sucrose in humans is unexplored, this study assessed in situ the effect of Fe co-crystallized with sucrose (Fe-sucrose) topically applied in vitro on the acidogenicity, biochemical and microbiological composition of the dental biofilm formed in vivo and on the demineralization of the enamel. During two phases of 14 days each, 16 volunteers wore palatal appliances containing blocks of human enamel, which were submitted to four groups of separate treatments: (1) water; (2) 20% sucrose; (3) 20% (w/v) sucrose plus 18 microg Fe/ml, and (4) 20% (w/v) sucrose plus 70 microg Fe/ml. The solutions were dripped onto the blocks 8 times per day. The biofilms formed on the blocks were analyzed with respect to acidogenicity, biochemical and microbiological composition. Mineral loss was determined on enamel by surface and cross-sectional microhardness. Lower demineralization was found in the blocks subjected to Fe-sucrose (70 microg Fe/ml) than in those treated with sucrose (p < 0.05). This concentration of Fe also reduced significantly the populations of mutans streptococci in the biofilm formed on the blocks. In conclusion, our data suggest that Fe may reduce in situ the cariogenic potential of sucrose and the effect seems to be related to the reduction in the populations of mutans streptococci in the dental biofilm formed.

Effect of luting cement on dental biofilm composition and secondary caries around metallic restorations in situ

Since the importance of luting cement on secondary caries in enamel and dentin is unknown, an in situ crossover study was conducted in three phases over 21 days using a fluoride-containing toothpaste. One hundred and twenty-six metallic restorations were cemented into the dentinoenamel junction of slabs of human teeth with zinc phosphate (ZP), resin-modified glass ionomer (GI) or resinous cement (RC). The slabs were inserted onto flanges of the removable partial acrylic dentures of 14 volunteers and covered with gauze to enhance dental plaque accumulation. The volunteers used fluoride toothpaste (1.100 microg F/g, w/w). After 21 days, the biofilm that formed on the slabs was collected for biochemical and microbiological analyses, and the demineralization in enamel-dentin around the restorations was evaluated. The fluoride concentration of biofilm in the GI group was higher (p<0.05) than the ZP and RC groups. Also, the concentration of Zinc in biofilm formed on the slabs cemented with ZP was higher (p<0.05) than the other groups. However, the effect of the luting material on enamel or dentin demineralization was not statistically significant (p>0.05). The data suggest that when fluoride toothpaste is used, the anticariogenic property of the luting cement may not be relevant to the reduction of secondary caries.

A modified pH-cycling model to evaluate fluoride effect on enamel demineralization

Since in vitro pH-cycling models are widely used to study dental caries, they should allow evaluations of fluoride effect on early stages of caries development. Therefore, acid etching on enamel surface must be avoided, enabling surface microhardness (SMH) analysis. In the present study, the pH-cycling model originally described by Featherstone et al.9 (1986) was modified to preserve the enamel surface and to produce early carious lesions that could be evaluated using SMH and cross-sectional microhardness (CSMH) measurements. In order to validate this modified model, a dose-response evaluation with fluoride was made. Human enamel blocks with known SMH were submitted to such regimen with the following treatments: distilled deionized water (DDW; control) and solutions containing 70, 140 and 280 ppm F. Data from %SMH change and deltaZ (mineral loss) showed a statistically significant negative correlation between F concentration in treatment solutions and mineral loss. In conclusion, the modified pH-cycling model allowed the evaluation of changes on the outermost enamel layer during caries development, and a dose-response effect of fluoride reducing enamel demineralization was observed.

Effect of a calcium carbonate-based dentifrice on enamel demineralization in situ

Since the effect of calcium carbonate (CaCO(3)) based dentifrice on enamel demineralization is not clearly established, it was evaluated using the IEDT model described by Zero's group in 1992. This study had a crossover design and 10 volunteers were submitted to 3 treatment groups: a negative control, brushing without dentifrice; an active control, brushing with silica-based dentifrice (SiO(2)/MFP group), and the experimental group, brushing with CaCO(3)-based dentifrice (CaCO(3)/MFP). Both dentifrices contained 1,500 microgram F/g (w/w) as sodium monofluorophosphate (MFP). Enamel surface microhardness was determined in the dental blocks and the percentage change in relation to baseline was calculated. Fluoride uptake in enamel and its concentration in 'test plaque' were determined. The results showed that the dentifrice containing CaCO(3)/MFP was more effective than SiO(2)/MFP in reducing enamel demineralization (p < 0.05). A higher concentration of fluoride ion was found in 'test plaque' treated with CaCO(3)/MFP than in the negative control (p < 0.05). The results suggest that CaCO(3) abrasive may enhance the effect of fluoride present in dentifrice on dental caries control.

Effect of fluoridated dentifrice and acidulated phosphate fluoride application on early artificial carious lesions

PURPOSE

To evaluate the effect of a combination of fluoride dentifrice and acidulated phosphate fluoride (APF) on enamel with incipient caries lesions.

MATERIALS AND METHODS

Bovine dental enamel blocks with artificial caries lesions were divided into four treatment groups and submitted to a pH-cycling model: (1) Placebo non-fluoridated dentifrice (PD); (2) Fluoridated dentifrice (FD), 1,100 ppm F; (3) APF (12,300 ppm F, pH 3.5) + PD; 4) APF+FD. APF was applied to enamel blocks of groups APF+PD and APF+FD before the pH-cycling regimen and all of them were exposed to dentifrice during the cycling.

RESULTS

The results showed that 61-81% of the fluoride previously deposited in enamel by APF was released to the media during the pH-cycling. The final concentration of fluoride in enamel in the group APF+PD was lower than that before the cycling (P < 0.05), but in the group APF+FD the reduction was not significant (P> 0.05). FD treatment was significantly more efficient than PD in rehardening the enamel surface and increasing the hardness of the caries lesions. APF+PD treatment was not more efficient than PD in increasing enamel hardness and an additive effect of APF+FD was not observed.

Effect of triclosan dentifrices on mouth volatile sulphur compounds and dental plaque trypsin-like activity during experimental gingivitis development

BACKGROUND

The objective of this study was to evaluate the effect of three commercial anti-plaque dentifrices containing 0.3% triclosan + 2% pvm/ma (Colgate Total), 0.3% triclosan + 0.75% Zn (Signal Global) and 0.3% triclosan + 5% PPi (Crest Complete) in comparison with an experimental dentifrice (0.3% triclosan + 2% pvm/ma + 0.75% Zn + 4% PPi) and a control dentifrice without anti-plaque agents on trypsin-like activity in dental plaque (detected by the hydrolysis of [Na-Benzoyl-DL-Anginine p-Nitroanilide (BAPNA)] and volatile sulphur compounds (VSCs) in mouth air during experimental gingivitis development.

METHOD

A 5-step double blind, crossover experimental gingivitis study was conducted on 19 volunteers during a 21-day period. The volunteers refrained from brushing an experimental quadrant of teeth. The dentifrices were applied to those teeth via toothshield three times per day; simultaneously they brushed the other teeth with the same dentifrice. After each period, VSCs in mouth air and BAPNA hydrolysis by dental plaque accumulated in the experimental quadrant were determined.

RESULTS

There was an increase (p < 0.05) in VSCs in mouth air when experimental gingivitis was induced in only one quadrant of teeth. None of the dentifrices was able to avoid the increase of VSCs during the experimental gingivitis development. The majority of the antiplaque dentifrices evaluated reduced the increase of VSC formation in comparison with the control (p < 0.05). There was no relationship between the ability of the dentifrices in reducing VSC formation and the inhibition of trypsin-like activity in dental plaque.

CONCLUSIONS

Anti-plaque dentifrices reduce the increase of VSCs that occurs during the development of experimental gingivitis.

Effect of a lactose-containing sweetener on root dentine demineralization in situ

Since lactose has been used as an excipient in powdered sweeteners, we evaluated its effect on dentine demineralization, in an in situ crossover study. Twelve adult volunteers wore palatal appliances containing 4 blocks of bovine root dentine, which were submitted 4 times a day to: distilled water (negative control), aqueous solution of powdered sweetener (Zero Cal); experimental group), 1.5% lactose solution (active group), 1.5% sucrose solution (positive control). After 15 days, microhardness was determined on dentine surface (SMH) and on the sectioned blocks (CSMH). All groups presented statistical differences in SMH before and after the treatments; water increased, while sweetener, lactose and sucrose decreased SMH. By CSMH, the only significant difference was observed after sucrose treatment. The data suggest that sweeteners containing lactose as a bulking agent may be cariogenic for root dentine.