Remineralization of Early Enamel Lesions with Apatite-Forming Salt.

OBJECTIVES: This study sought to evaluate the remineralization of ex vivo human teeth using commercially available artificial saliva, SalivaMAX®, a supersaturated calcium phosphate rinse (SSCPR). METHODS: early enamel lesions were artificially induced on ex vivo human teeth by chemical means. The teeth were exposed to the SSCPR for two minutes (experimental) or dH2O (control) four times per day for a total of 35 days. At time points of 0, 2.5, 21, and 35 days, micro-CT was utilized to determine the mineral density profile across the lesion and evaluate lesion depth. The relative percent remineralization was calculated from the initial lesion depth (Time 0) at each evaluation time. Student's t-test was used to compare the extent of remineralization between the SSCPR and control groups for statistical significance at each time. To evaluate the changes in percent remineralization over time, a two-way ANOVA was used. RESULTS: At Time 0 and 2.5 days, there was no difference in the percent remineralization between the SSCPR and control groups (p > 0.05). After 21 days, the teeth exposed to the SSCPR remineralized 56.7 ± 3.7%, while the control only remineralized 10.7 ± 11.0% (p < 0.0001). At day 35, the remineralization was 73.7 ± 5.4% and 18.2 ± 10.8% (p < 0.0001) for the SSCPR and control groups, respectively. CONCLUSIONS: A marked increase in remineralization occurred with the use of the SSCPR. Notably, the remineralization of the SSCPR occurred deep within the tooth and progressed toward the surface over time.

Assessment of simulated vs actual orthodontic tooth movement with a customized fixed lingual appliance using untreated posterior teeth for registration and digital superimposition: A retrospective study.

INTRODUCTION: With the advancement of computer-aided design and computer-aided manufacturing (CAD-CAM), digital setups that simulate the outcome of orthodontic treatment are frequently used. Incognito appliance system is a lingual orthodontic system that uses digital setups. A limitation to previous studies evaluating CAD-CAM simulated outcomes is the lack of stable reference points to superimpose on. The purpose of this study was to compare the simulated vs actual outcomes with the Incognito Lite appliance system. METHODS: Thirty-four final models were compared with their corresponding setup models exported from the Incognito Web site. Final surface 3-dimensional imaging software was used to digitally measure differences between the simulated and actual treatment outcomes using a digital registration and superimposition method that utilizes the unmoved posterior teeth as reference points. RESULTS: Differences between simulated and actual tooth movement were significant in the translational parameter, with a maximum average discrepancy in the maxillary central incisors of 1.0 ± 0.6 mm (P <0.0001) and 0.8 ± 0.4 mm (P <0.0001) for mandibular central incisors. Discrepancies between simulated and actual tooth movements decreased from anterior to posterior. The first bicuspids moved the least for both maxillary and mandibular teeth (range of 0.4 mm-0.7 mm). The differences for rotational parameters were statistically insignificant with a mesiodistal tip of 1.6°-3.6°, buccal-palatal torque 2.3°-4.4° and rotation around the tooth axis 2.3°-5.0°. CONCLUSIONS: Incognito Lite simulated tooth movements were achieved for rotation, tip, and torque (±3°). However, significant discrepancies were found between simulated and actual tooth position for translation (0.6-1.0 mm).

Inter-method reliability for determining total and soluble fluorides in child low-fluoride formula dentifrices.

The study aimed to compare three methods for determining total (TF) and total soluble fluorides (TSF) in 5 child formula dentifrices (CFD) using Inter-method reliability (IMR) statistical approach. The methods were direct acid-hydrolysis (DM), the least-time-consuming method; Modified direct acid-hydrolysis with standard-addition method (MDM), ISO 19448:2018 method; and modified Taves acid-HMDS diffusion analysis (TAD), the claimed gold standard method. A significant difference in the mean difference was observed for all methods at all levels (p < 0.001), except DM and TAD for TF (p = 0.622). A proportional bias was discerned in the agreement distribution between DM and TAD for TF (p < 0.001). The ICC analysis identified significant reliability between all measurements, irrespective of the model, measure, and fluoride type (p < 0.001). For TF and TSF, the IMR between DM and TAD was lower than MDM and TAD for consistency/absolute agreement reliability at single/average measures. The reliability measure for DM and MDM was higher than MDM and TAD for TSF, but was lower than MDM and TAD for TF. The ICC measure for DM-TAD was significantly lower than DM-MDM and MDM-TAD (p < 0.05). The ISO 19448:2018 MDM is a reliable test that can be used as an alternative to TAD/DM for determining TF/TSF in CFD.

Enhanced Fluoride Bioavailability with Incorporation of Arginine in Child Dentifrices.

OBJECTIVE(S): To: 1) examine the fluoride concentrations in commercial child formula dentifrices (CFD)s; and 2) investigate the effect of arginine incorporation in CFDs on fluoride bioavailability. STUDY DESIGN: Five commercial CFDs were examined for fluoride concentrations. Total, total soluble, and insoluble fluorides in CFDs were determined by the modified Taves acid-diffusion method (TAD). Ionic F and MFP were estimated by modified direct method with standard addition technique. L-arginine (L-Arg)/L-arginine monohydrochloride (L-Arg.HCl) were incorporated at 2% w/w in the commercial CFDs. The pH of the toothpaste slurries, buffer capacity of the added Arg, potentially available fluorides (PAF) and 1-min PAF by TAD were determined. RESULTS: The CFDs had 4 to 32% of insoluble fluorides. Addition of L-Arg/L-Arg.HCl significantly improved the fluoride bioavailability in CFDs (p<0.05). Incorporation of L-Arg significantly increased the pH of toothpaste slurries (p<0.05); while L-Arg.HCl decreased the pH. Principal component analysis showed that L-Arg.HCl decreased the pH of toothpaste slurries due to the presence of Cl in the form of HCl; whereas the inherent elements/molecules (Na/P/Pi/F) remain distinct with unidentified influence on the variables. CONCLUSION(S): The CFDs containing NaF only have higher concentrations of bioavailable fluoride. Incorporating arginine (L-arginine or L-arginine monohydrochloride) at 2% w/w improves fluoride bioavailability of the child formula dentifrices.

Patient perceptions in quality of care: report from university veterans clinic.

BACKGROUND: The Heroes Clinic is a unique dental clinic housed at the University of Colorado School of Dental Medicine that offers military veterans dental care at no or minimal cost. The aim of this study is to collect patient feedback on their perception of the quality of care they receive at the Heroes clinic. METHODS: A cross-sectional study design was used to gather patient feedback on empathy and quality of care using Service Quality Measures (SERVQUAL) and Dental Satisfaction Questionnaire (DSQ) frameworks. Mean scores were calculated to determine the average of positive or negative responses. Fisher's exact test was conducted to test any significant differences between the patients' perception of quality of care they receive at the Heroes clinic (outcome variable) and the SERVQUAL and DSQ independent variables. RESULTS: One hundred and seventy-seven veterans responded to the survey with a response rate of 35%. Over 50% of patients were between the ages of 20-35 years and 63% were students. The mean scores demonstrated high levels of all variables. Bivariate analysis for SERVQUAL data determined that veterans agreed to conditions demonstrated by four scales of empathy and all scales of responsiveness (p < 0.05). DSQ bivariate analysis revealed that veterans agreed to conditions demonstrated by four scales of quality of care, two scales of pain management, one scale of accessibility, and also general satisfaction pertaining to the received dental care (p < 0.05). CONCLUSIONS: Heroes clinic has provided quality dental care to veterans as attested by the patients.

Increasing Dental Students' Understanding of Population Surveillance Through Data Mining.

An understanding of population surveillance is important for predoctoral dental students, so they will comprehend the health needs of the population in order to provide needed care and promote overall health. The aim of this study was to teach data mining and surveillance methodologies to dental students and to assess the association between systemic health factors and tooth loss in patients visiting the University of Colorado School of Dental Medicine clinics. The students were calibrated to using the data mining methodologies from the Electronic Health Record (EHR) using a rubric and presentation by a faculty member. The EHR was reviewed for age, gender, race/ethnicity, number of natural teeth present, systemic diseases reported including cardiovascular disease and diabetes, and history of any form of tobacco use. A total of 1,338 patients who visited the clinics in spring 2017 were included in the study; of those, 354 (27%) had <20 teeth. The results showed greater odds of having <20 teeth for those who reported cardiovascular disease (OR=2.1, 95% CI 1.6, 2.7), diabetes (OR=1.7, 95% CI 1.2, 2.3), tobacco use (OR=1.4, 95% CI 1.0, 1.9), and being Hispanic (OR=1.4, 95% CI 1.0, 1.9). After adjusting for age, gender, and ethnicity, the odds of having <20 teeth for patients with tobacco use were found to be twice that of patients with no tobacco use (OR=2.1, 95% CI 1.5, 3.0). Understanding population surveillance could be beneficial in designing evidence-based interventions at the dental school and community levels.

European Organization for Caries Research Workshop: Methodology for Determination of Potentially Available Fluoride in Toothpastes.

Toothpastes are the most universally accepted form of fluoride delivery for caries prevention. To provide anti-caries benefits, they must be able to release fluoride during the time of tooth brushing or post brushing into the oral cavity. However, there is no standard accepted procedure to measure how much fluoride in a toothpaste may be (bio) available for release. The European Organization for Caries Research proposed and supported a workshop with experts in fluoride analysis in toothpastes and representatives from industry. The objective of the workshop was to discuss issues surrounding fluoride analysis in toothpaste and reach consensus on terminology and best practices, wherever the available evidence allowed it. Participants received a background paper and heard presentations followed by structured discussion to define the problem. The group also reviewed evidence on the validity, reliability and feasibility of each technique (namely chromatography and fluoride electroanalysis) and discussed their strengths and limitations. Participants were able to reach a consensus on terminology and were also able to identify and summarize the advantages and disadvantages of each technique. However, they agreed that most currently available methods were developed for regulatory agencies several decades ago, utilizing the best available data from clinical trials then, but require to be updated. They also agreed that although significant advances to our understanding of the mechanism of action of fluoride in toothpaste have been achieved over the past 4 decades, this clearly is an extraordinarily complex subject and more work remains to be done.

Insufficient Evidence within a Systematic Review and Meta-Analysis of Powered Toothbrushes over Manual Toothbrushes for Soft Tissue Health During Orthodontic Treatment.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Short-term and long-term effectiveness of powered toothbrushes in promoting periodontal health during orthodontic treatment: A systematic review and meta-analysis. Al Makhmari SA, Kaklamanos EG, Athanasiou AE. Am J Orthod Dentofacial Orthop 2017;152(6):753-66.e7. SOURCE OF FUNDING: None identified TYPE OF STUDY/DESIGN: Systematic review with meta-analysis.

As an Adjunct to Mechanical Oral Hygiene, Essential Oil-containing Mouthwash, Compared to Floss, Cetylpryidinium Chloride, or Placebo may be more Effective in Reduction of Plaque and Gingitivitis.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Essential oils-containing mouthwashes for gingivitis and plaque: Meta-analysis and meta-regression. Haas AN, Wagner TP, Muniz FWMG, Fiorini T, Cavagni J, Celeste, RK. J Dent 2016;55:7-15. SOURCE OF FUNDING: No specific funding for this systematic review TYPE OF STUDY/DESIGN: Meta-analysis and meta-regression.

Comparison of Orthodontic Medicaid Funding in the United States 2006 to 2015.

INTRODUCTION: Orthodontic treatment is reimbursed by Medicaid based on orthodontic and financial need with qualifiers determined by individual states. Changes in Medicaid-funded orthodontic treatment following the "Great Recession" in 2007 and the enactment of the Affordable Care Act in 2010 were compared for the 50 United States and the District of Columbia to better understand disparities in access to care. The results from this 2015 survey were compared to data gathered in 2006 (1). MATERIALS AND METHODS: Medicaid officials were contacted by email, telephone, or postal mail regarding the age limit for treatment, practitioner type who can determine eligibility and provide treatment, records required for case review, and rate and frequency of reimbursement. When not attained by direct contact, the information was gleaned from online websites, provider manuals, and state orthodontists. RESULTS: Information gathered from 50 states and the District of Columbia documents that Medicaid program characteristics and expenditures continue to vary by state. Expenditures and reimbursement rates have decreased since 2006 and vary widely by geographic region. Some states have tightened restrictions on qualifiers and increased submission requirements by providers. CONCLUSION: The variation and lack of uniformity that still exists among Medicaid orthodontic programs in different states creates disparities in orthodontic care for US citizens. Barriers to care for Medicaid-funded orthodontic treatment have increased since 2006.

Medicaid Adult Dental Benefit Impact on Dental Utilization: A University Clinic Setting.

INTRODUCTION: In 2014, the state of Colorado initiated new dental coverage benefits for adults in the Colorado Medicaid program. The goal of this study was to investigate the utilization and impact of this new dental coverage at the University of Colorado School of Dental Medicine. The utilization of dental services delivered and the numbers of patients in this program were compared before and after the implementation of the benefit. MATERIALS AND METHODS: This retrospective study compared the utilization of services provided 2 years prior and 2 years after the Medicaid adult benefit was made available. Through the University of Colorado School of Dental Medicine (CU-SODM) electronic dental record, all adult Medicaid dental patients' (ages 21+) charts were extracted for zip code, CDT dental procedure codes, with a focus on tooth extraction compared to tooth saving procedures. Graphical analysis and Pearson's chi-squared tests were applied to assess the statistical significance of procedure utilization changes over time. RESULTS: After implementation of the Medicaid adult benefit, the number of patients seen at the school under this program increased by a factor of 4.5. The geographic range (zip code) increased with some patients coming from further distances to receive dental care. The number of patients from local zip codes increased by as much as 235%. There was a 51% increase in tooth saving procedures, which was statistically significant (P = 0.0013). Additionally, there was a 22% decrease in extractions, while not statistically significant (P = 0.0992), a downward trend was clear. DISCUSSION: The focus was on the utilization of Medicaid adult benefits at the dental school, which was only a small proportion of the state-wide Medicaid population. Therefore, these data are not generalizable for statewide assessments of the program. However, based on the findings at the school clinics, more adult patients utilized the benefits; and chose to receive more tooth saving procedures and less extractions after implementation of the Medicaid adult benefit. This Medicaid study conducted at the CU-SODM 2 years after the adult dental coverage can be used as a baseline for future studies.

Dentin Erosion: Method Validation and Efficacy of Fluoride Protection.

The aging population experiences more gingival recession and root exposure which increases the opportunity for dentin erosion. This study tested the use of transverse microradiography (TMR) methods to assess dentin erosion and the interaction between fluoride and citric acid on the amount of erosion in the dentin samples. In a 4 × 3 interaction experimental design, four fluoride concentrations (0.00, 25.0, 50.0, and 100.0 mg/L) and three citric acid concentrations (0.0, 0.25, and 1.00%) were combined to form 12 experimental solutions. Forty-eight dentin samples were placed in the experimental solutions for 1 and 4 h and the amount of surface lost was determined by TMR methods. The resolution of the TMR method was 0.9 µm per pixel with a 0.1% and a 5% confidence interval of ±4.2 µm. Dentin erosion increased with the concentration of citric acid and time, the erosion decreased when concentration of fluoride was increased. Effects due to fluoride and citric acid concentrations individually, and their interaction on the amount of erosion observed was statistically significant (p < 0.0001). This study found that TMR methods are appropriate and that 25.0 mg/L was the optimal fluoride concentration to protect dentin from a 1.00% citric acid challenge.

Acceptance of Minimally Invasive Dentistry Among US Dentists in Public Health Practices.

PURPOSE: Little is known about use or acceptance of minimally invasive dentistry (MID) in the USA, particularly in public health settings. The purpose of this study was to assess opinions concerning MID among dentists in public-health practices. MATERIALS AND METHODS: A cross-sectional study was conducted to assess the views of dentists in public-health practices concerning MID using an online survey instrument among National Network for Oral Health Access (NNOHA) and American Association of Community Dental Programs (AACDP) members. Specific questions focused on diagnostic and preventive techniques, and whether MID was considered to meet the standard of care in the US Results: Overall, 86% believed that MID met the standard of care for primary teeth, and 77% did so for permanent teeth. The majority of respondents also agreed that fluoride varnish prevents caries and atraumatic restorative techniques (ART) are an effective caries treatment for children and adults. According to logistic regression results, dentists who had continuing education courses in MID and agreed that ART was an effective treatment for adults were more likely to report that MID met the standard of care for permanent teeth. Subjects who believed that fluoride varnish was effective as caries prevention for children were more likely to view MID as meeting the standard of care for primary teeth. CONCLUSIONS: There appears to be a paradigm shift toward a MID philosophy, and most responding public health dentists believed that MID meets the standard of care for primary and permanent teeth in the US.

Comparison of pain perception during miniscrew placement in orthodontic patients with a visual analog scale survey between compound topical and needle-injected anesthetics: A crossover, prospective, randomized clinical trial.

INTRODUCTION: The use of a compound topical anesthetic (CTA) instead of an injection of a local anesthetic for placing miniscrew implants offers advantages to both the clinician and the patient. The purpose of this crossover, prospective, randomized clinical trial was to compare the clinical effectiveness of a CTA with that of a needle injection of local anesthetic for miniscrew placement. METHODS: Twenty-four orthodontic patients in a university clinic were recruited; they required bilateral buccal miniscrews for orthodontic anchorage. Eligibility criteria included healthy patients with no special needs; over 8 years of age and 25 pounds; not taking sulfonamides, monoamine oxidase inhibitors, tricyclic antidepressants, or phenothiazines; and not allergic to ester-type local anesthetics or any of the other materials used in the study. A computer generated a randomization list. The allocation was randomized by anesthetic protocol and side of the mouth, and was restricted to achieve balance by treatment and side of the mouth. No allocation concealment was applied. Associated with each randomized number was the subjects' assignment into 1 of 4 groups divided by the side of first miniscrew placement and the type of anesthetic. Blinding was done only for data analysis because of clinical limitations. Each patient received a CTA on one side and an injection of anesthetic on the other before miniscrew placement in a crossover study design. The outcome was assessed by measuring pain levels with a 100-mm visual analog scale at 5 time points. Anesthetic failures occurred when the miniscrew could not be fully comfortably placed with a given anesthetic. Data were organized by visual analog scale time points, and descriptive statistics were calculated. A factorial repeated-measures analysis of variance was used to determine any differences. RESULTS: Twenty-seven patients were assessed for eligibility, and 24 agreed to participate in the study. Patients did not distinguish any differences in pain between the application of the CTA and the injection before or during anesthetic placement, but they experienced more pain with the CTA during miniscrew placement. The mean difference for the entire procedure between the 2 anesthesia types was 24.6 units, and the 95% confidence interval was 18.8 to 30.4, a statistically significant finding (P = 0.0002). The CTA was still viewed as more painful 1 month after the procedures. Significantly more anesthetic failures occurred with the CTA (41.6%) than with the injection (0%). No serious harm was observed in any patient; when significant pain was observed with the CTA, a needle injection of local anesthetic was administered. CONCLUSIONS: CTAs provided less predictable, often inadequate, and less comfortable anesthesia than an injection of a local anesthetic for managing patient discomfort during miniscrew placement in buccal sites. REGISTRATION: This trial was not registered. PROTOCOL: The protocol was determined and approved by the research committee and institutional review board before the trial. FUNDING: No external funding was used other than the donation of the miniscrews from Rocky Mountain Orthodontics, and no conflict of interest was declared.

Subcellular localization and Ser-137 phosphorylation regulate tumor-suppressive activity of profilin-1.

The actin-binding protein profilin-1 (Pfn1) inhibits tumor growth and yet is also required for cell proliferation and survival, an apparent paradox. We previously identified Ser-137 of Pfn1 as a phosphorylation site within the poly-l-proline (PLP) binding pocket. Here we confirm that Ser-137 phosphorylation disrupts Pfn1 binding to its PLP-containing ligands with little effect on actin binding. We find in mouse xenografts of breast cancer cells that mimicking Ser-137 phosphorylation abolishes cell cycle arrest and apoptotic sensitization by Pfn1 and confers a growth advantage to tumors. This indicates a previously unrecognized role of PLP binding in Pfn1 antitumor effects. Spatial restriction of Pfn1 to the nucleus or cytoplasm indicates that inhibition of tumor cell growth by Pfn1 requires its nuclear localization, and this activity is abolished by a phosphomimetic mutation on Ser-137. In contrast, cytoplasmic Pfn1 lacks inhibitory effects on tumor cell growth but rescues morphological and proliferative defects of PFN1 null mouse chondrocytes. These results help reconcile seemingly opposed cellular effects of Pfn1, provide new insights into the antitumor mechanism of Pfn1, and implicate Ser-137 phosphorylation as a potential therapeutic target for breast cancer.

Plasticizer Effects in the PVC Membrane of the Dibasic Phosphate Selective Electrode.

The PVC membrane of an ion-selective electrode (ISE) sensitive to dibasic phosphate ions (HPO4-ISE) has not been optimized for maximum selectivity, sensitivity, and useable ISE lifetime and further work was necessary to improve its performance. Two areas of investigation are reported here: include the parameters for the lipophilicity of the plasticizer compound used and the amount of cyclic polyamine ionophore incorporated in the PVC membrane. Six candidate plasticizers with a range of lipophilicity were evaluated for their effect on the useable lifetime, sensitivity, and selectivity of the ISE against 13 different anions. Selectivity was determined by a modified fixed interferent method, sensitivity was determined without interferents, and the usable lifetime evaluated at the elapsed time where 50% of the HPO4-ISE failed (L50). The results show that choosing a plasticizer that has a lipophilicity similar to the ionophore's results in the best selectivity and sensitivity and the longest L50.

Comparison of four methods to assess erosive substance loss of dentin.

Erosion of dentin results in a complex multi-layered lesion. Several methods have been used to measure erosive substance loss of dentin, but were found to have only limited agreement, in parts because they assess different structural parameters. The present study compared the agreement of four different methods (transversal microradiography [TMR], Confocal Laser Scanning Microscopy [CLSM], Laser Profilometry [LPM] and modified Knoop Hardness measurement [KHM]) to measure erosive substance loss in vitro. Ninety-six dentin specimens were prepared from bovine roots, embedded, ground, polished and covered with nail-varnish except for an experimental window. Erosion was performed for 1 h using citric acid concentrations of 0.00% (control), 0.07%, 0.25% and 1.00% (n=24/group). Adjacent surfaces served as sound reference. Two examiners independently determined the substance loss. After 1 h erosion with 1% citric acid solution, substance losses (mean ± SD) of 12.0 ± 1.3 µm (TMR), 2.9 ± 1.3 µm (LPM), 3.9 ± 1.3 µm (KHM) and 17.0 ± 2.6 µm (CLSM) were detected. ROC curve analysis found all methods to have high accuracy for discriminating different degrees of erosive substance loss (AUC 0.83-1.00). Stepwise discriminatory analysis found TMR and CLSM to have the highest discriminatory power. All methods showed significant relative and proportional bias (p<0.001). The smallest albeit significant disagreement was found between LPM and KHM. No significant inter-rater bias was detected except for KHM. LPM is prone to underestimate erosive loss, possibly due to detection of the organic surface layer. KHM was not found suitable to measure erosive loss in dentin. TMR and CLSM detected the loss of mineralised tissue, showed high reliability, and had the highest discriminatory power. Different methods might be suitable to measure different structural parameters.

Tooth whitening: what we now know.

UNLABELLED: Current research about tooth whitening shows that it is safe and effective when manufacturer's protocol is followed, yet there are risks of which the profession and users should be aware. This update provides a summary of current research and assessment of the safety and efficacy of tooth whitening regimens. BACKGROUND: Tooth whitening has become one of the most frequently requested dental procedures by the public. The public has come to demand whiter, more perfect smiles and in response many choices for tooth whitening have been made available. These include home-based products such as toothpastes, gels, and films, as well as in-office based systems where products containing highly concentrated bleaching agents are applied under professional supervision. The profession and public have been aware of certain risks related to tooth whitening such as increased tooth sensitivity and gingival irritation. New research has shown that there are other risks such as tooth surface roughening and softening, increased potential for demineralization, degradation of dental restorations, and unacceptable color change of dental restorations. The new research is also focused on optimizing whitening procedures to reduce tooth sensitivity and to increase the persistence of the whitening. METHODS: Current reports in the literature are reviewed that are related to the use of peroxide based whitening methods. These reports include in vitro studies for method optimization and mechanism as well as clinical studies on effects of various whitening regimens. CONCLUSIONS: When manufacturer's instructions are followed, hydrogen peroxide and carbamide peroxide based tooth whitening is safe and effective. Patients should be informed of the risks associated with tooth whitening and instructed on identification of adverse occurrences so that they may seek professional help as needed.

Focus on fluorides: update on the use of fluoride for the prevention of dental caries.

UNLABELLED: Improving the efficacy of fluoride therapies reduces dental caries and lowers fluoride exposure. BACKGROUND: Fluoride is delivered to the teeth systemically or topically to aid in the prevention of dental caries. Systemic fluoride from ingested sources is in blood serum and can be deposited only in teeth that are forming in children. Topical fluoride is from sources such as community water, processed foods, beverages, toothpastes, mouthrinses, gels, foams, and varnishes. The United States Centers for Disease Control and Prevention (CDC) and the American Dental Association (ADA) have proposed changes in their long standing recommendations for the amount of fluoride in community drinking water in response to concerns about an increasing incidence of dental fluorosis in children. Current research is focused on the development of strategies to improve fluoride efficacy. The purpose of this update is to inform the reader about new research and policies related to the use of fluoride for the prevention of dental caries. METHODS: Reviews of the current research and recent evidence based systematic reviews on the topics of fluoride are presented. Topics discussed include: updates on community water fluoridation research and policies; available fluoride in dentifrices; fluoride varnish compositions, use, and recommendations; and other fluoride containing dental products. This update provides insights into current research and discusses proposed policy changes for the use of fluoride for the prevention of dental caries. CONCLUSIONS: The dental profession is adjusting their recommendations for fluoride use based on current observations of the halo effect and subsequent outcomes. The research community is focused on improving the efficacy of fluoride therapies thus reducing dental caries and lowering the amount of fluoride required for efficacy.

Analysis of 1-Minute Potentially Available Fluoride from Dentifrice.

Previous reports found that some fluoride-containing dentifrices do not release effective concentrations of fluoride during brushing. Failure to release fluoride can be due to dentifrice matrix components that interfere with the solubilization of the fluoride salts during brushing. A new generation of dentifrices has the capability to precipitate beneficial fluoride salts during tooth brushing. Therefore, a method that assesses the potentially available fluoride during the 1-minute brushing is needed. A new filter-paper absorption method to assess the 1-min bioavailable fluoride concentration was developed to meet this need. This method utilizes coiled filter paper that rapidly absorbs the aqueous phase of the dentifrice slurry followed by centrifugation to recover that fluid for fluoride measurement via fluoride ion-selective electrode. The analytical method was used to successfully determine the total fluoride and 1-min bioavailable fluoride in eight dentifrice products containing sodium fluoride (NaF), disodium monofluorophosphate (Na2FPO3, MFP), stannous fluoride (SnF2), or NaF with amorphous calcium phosphate (NaF + ACP). The results showed that some of the dentifrices tested had significantly lower potentially available fluoride than the total fluoride. For a MFP-containing sample, aged seven years past its expiry date, there was significant reduction in the bioavailable fluoride compared to MFP products that were not aged. Other than the aged MFP and the SnF2-containing samples the bioavailable fluoride for all products tested had at least 80 % of the label fluoride concentration. The filter paper absorption method yielded reproducible results for the products tested with MFP samples showing the largest variations.