Strengthening of tooth enamel by a remineralizing toothpaste after exposure to an acidic soft drink.

The effect of remineralizing and conventional toothpaste treatments on the hardness of intact and acid soft drink-etched enamel were assessed in a laboratory study. The remineralizing toothpaste (Enamelon Toothpaste) used in the study contains NaF, and simultaneously provides dissolved calcium, phosphate and fluoride ions. The conventional toothpaste contains NaF in a silica base. Sound extracted maxillary human incisors, mounted in epoxy resin with the facial incisal two-thirds exposed, were polished with 0.3 mu alumina. Groups of ten teeth were exposed to either twenty 5-minute treatments with an acid soft drink (pH 2.4), remineralizing or conventional fluoride toothpaste, or to twenty alternating cycles of a 5-minute protective treatment with either the remineralizing or conventional toothpastes, followed by 5-minute exposures to the acid soft drink, or to 20 five-minute exposures to the acid soft drink followed by 20 five-minute restorative treatments with the remineralizing or conventional toothpastes. Knoop Hardness measurements were made before and after treatment using a 500 g load and 15-second dwell time. Acid soft drink exposure produced a 15.4% drop in hardness compared with 4.9% and 1.6% hardness increases due to treatments of intact enamel with the remineralizing and conventional toothpastes, respectively. Protective treatments using the remineralizing and conventional toothpastes significantly reduced the drop in hardness due to acid soft drink exposure to 3.3% and 6.2%, respectively. Restorative treatments by the remineralizing and conventional toothpastes significantly increased the hardness of the acid soft drink-weakened enamel by 12.1% and 7.3%, respectively. Both toothpastes were effective in inhibiting damage due to acid soft drink exposure, but the remineralizing toothpaste was more effective in hardening intact and decalcified enamel than the conventional toothpaste (p < 0.05).

Cariostatic effect of a two-part fluoride dentifrice in rats.

This study compared the cariostatic effect of a two-part, fluoride-calcium-phosphate-containing prototype dentifrice (containing 1100 ppm F) to a conventional, clinically proven effective "gold standard" (1100 ppm F, USP Standard) and an Enamelon placebo dentifrice (0 ppm F) using a rat model. Three groups of 18 Crl:CDR(SD)BR rats were inoculated with S. sobrinus 27352 and fed MIT-200 for 35 days in a programmed feeder. Double-deionized water (DDW) was given ad libitum. The rats were treated twice daily with one two-part dentifrice. Just prior to treatment, each of the two parts of dentifrice were mixed 1:1 and applied undiluted. The rats were euthanized and their mandibular molars scored for caries using the Keyes quantification method. Shrestha SNP caries scores were then calculated. Non-parametric comparisons were done among treatments at the 0.05 level of significance using analyses based on ranks. The mean Shrestha SNP Caries Scores +/- standard deviations for the prototype dentifrice, USP standard and Enamelon placebo were 84.9 +/- 62.8, 101.3 +/- 66.3, and 181.2 +/- 100.1, respectively. Scores for the 1100 ppm F prototype treatment were significantly lower than the USP Standard and the Enamelon placebo. These results indicate that the new prototype dentifrice, containing fluoride-calcium-phosphate, increased the anti-caries efficacy in a rat model when compared with a fluoride-containing USP Standard dentifrice.

An in vitro assessment and a pilot clinical study of electrical resistance of demineralized enamel.

Electrical resistance measurement was evaluated in vitro and in vivo as a method for comparing the remineralizing performance of toothpastes. In the in vitro study, areas of sound enamel on 12 unrestored, mature, extracted human molars and bicuspids, with electrical resistance readings greater than 99.99 M omega, were demineralized to an electrical resistance of 1 to 4 M omega. The teeth were divided into three groups. The change in electrical resistance was measured following a 15 cycle regimen of treatment, demineralization and salivary soaking. Treatments were five-minute exposures to either a 1:2 slurry in saliva of Enamelon (E), a remineralizing fluoride-toothpaste also containing soluble calcium and phosphate ions, a 1:2 slurry in saliva of Crest (C), a conventional fluoride toothpaste (P), or to saliva alone. Demineralization was performed with a 30-minute exposure to 0.1 M lactic acid 50% saturated with calcium hydroxyapatite. The salivary soaking was 1 hour in duration. The mean electrical resistance of the E, C and the saliva treated sites was 63.9 +/- 4.3, 37.6 +/- 9.5 and 2.1 +/- 0.7 M omega, respectively. The final resistance was statistically different for each group (p < 0.05). A pilot clinical study was then conducted to assess the electrical resistance technology in vivo. Eighteen adult subjects with at least one site of early enamel caries with an electrical resistance between 1.0 M omega and 20.00 M omega were randomly assigned to either Enamelon, Crest, or a non-fluoride placebo toothpaste and asked to brush twice daily. After three months, the mean resistance of the test sites was 23.57 M omega for E, 9.61 M omega for C and 13.24 M omega for P. However, the mean resistance changes did not proceed consistently over time. At the end of the study, the electrical resistance measurements on four sites out of twelve in Group E were suggestive of remineralization, whereas measurements on one site out of ten were suggestive of remineralization in Group C and two or three sites out of twelve were suggestive of remineralization in Group P. Progression of demineralization was possibly indicated in only one site, which was in Group C. There were insufficient subjects for statistical significance in the pilot clinical study. There were apparent problems with the variability of some measurements between visits in the in vivo study. Overall, however, the results of both studies indicate that with modifications to the equipment, electrical resistance measurements may be a means of comparing the remineralization performance of toothpastes.

Treatment of orthodontic white spot lesions with a remineralizing dentifrice applied by toothbrushing or mouth trays.

This pilot study investigated the effect of a remineralizing fluoride dentifrice (Enamelon) on newly formed incipient carious lesions using two methods of application. Teenage orthodontic patients with obvious white spot lesions on their teeth were selected to begin treatment within 30 days after debanding. At baseline, the surface enamel of the test teeth was cleaned by air etching with 50 microns alumina at 150 psi. Lesion size (mm2) was measured using a calibrated periodontal probe and surface appearance was quantified as shiny (0), dull (1), or chalky (2). Twice daily for 3 months, one group with a total of 27 lesions brushed with the remineralizing dentifrice, while a second group with 41 total lesions brushed and used a mouth tray to apply the paste directly to the lesions for 5 min. In order to promote treatment compliance, test group assignment was based on subject and parental preference. After 1, 2, and 3 months, lesion size was reduced by 5% (ns), 10% (p < 0.05) and 22% (p < 0.01), respectively, for the brushing group, and 16% (p < 0.05), 37% (p < 0.01) and 30% (p < 0.01) for the combined brushing and tray group, respectively. The dull appearance of the lesions treated by brushing improved slightly over 3 months. However, the lesions receiving combined brushing and tray applications became significantly (p < 0.01) less dull by 28%, 44% and 61% after 1, 2, and 3 months, respectively, indicating the formation of a shiny, intact surface layer. In conclusion, brushing with a remineralizing dentifrice significantly reduced the size of new orthodontic white spots within 2 months, while brushing combined with topical tray applications reduced lesion size within 1 month with concomitant formation of a shiny enamel surface layer. Thus, the combined brushing and mouth tray treatment significantly accelerated the remineralization process.

Clinical evaluation of the effect of a remineralizing toothpaste on dentinal sensitivity.

Dentinal hypersensitivity is a common dental problem without a satisfactory solution. Most therapies have focused on either trying to block the stimulation of dentinal nerves or on sealing open dentinal tubules. This study evaluated, in a double blind clinical trial, the effect of Enamelon, a dentifrice containing sodium fluoride, calcium salts and phosphate salts (calcium separated from the phosphate and fluoride by a plastic divider in the tube to prevent interaction) on dentinal hypersensitivity over an 8-week period. A conventional OTC dentifrice containing NaF without calcium and phosphate enhancement served as the control. A third dentifrice, containing sodium monofluorophosphate enhanced by calcium and phosphate salts, was also tested. Based upon subjective anecdotal information, net numbers of sensitive teeth which became non-sensitive, and a logit analysis of the change in the proportion of sensitive teeth over the study time period, Enamelon was the most effective product, and the OTC control the least effective.

Laboratory evaluations of three dentifrices with polishing or brushing.

The purpose of this study was to determine the depth of deposit removal of three dentifrices using a dental felt polishing tip or an Oral-B P 35 toothbrush. The dentifrices were compared using a laboratory method which simulates clinical tooth polishing or toothbrushing procedures, and utilizes a pressure-sensitive paper that records the depth of deposit removal. Each polishing time was conducted for five seconds; toothbrushing time was 15 seconds. Both polishing and toothbrushing were performed at a weight of 250 grams. Depth of Deposit Removal (DDR) was recorded using a 0-4 scale from a comparative color chart. The dentifrices evaluated were Arm & Hammer Dental Care, Colgate Regular, and Crest Regular. Twenty-four replicates of each dentifrice, tested undiluted, were performed. Results indicated that dentifrice efficacy was ranked numerically as Arm & Hammer Dental Care > Colgate Regular > Crest Regular. In all of the assays the Arm & Hammer Dental Care dentifrice had significantly (p < 0.01-0.001) higher DDR mean values compared to the Colgate Regular and Crest Regular dentifrices. The Colgate Regular dentifrice was significantly (p < 0.01-0.001) superior to the Crest Regular dentifrice in the assays conducted.

Comparison of the clinical anticaries efficacy of a 1500 NaF silica-based dentifrice containing triclosan and a copolymer to a 1500 NaF silica-based dentifrice without those additional agents: a study on adults in Israel.

Recent years have seen much work in the development of dentifrices containing the antimicrobial agent triclosan, a broad spectrum antibacterial agent manufactured for use in oral products by the Ciba-Geigy Corporation. Studies have shown that the incorporation of this agent into dental products, in combination with a PVM/MA copolymer (the non-proprietary designation for a polyvinylmethyl ether/maleic acid copolymer), can provide several important dental therapeutic benefits, including an antigingivitis effect. A considerable amount of the research on the therapeutic benefits of such dentifrices has been reported in the literature. The present study is a component of a large-scale program of clinical research to investigate the anticaries effectiveness of fluoride dentifrices containing 0.3% triclosan and 2.0% PVM/MA copolymer. The study included two treatment groups, each consisting of adults living near the Kiryat Gat area in Israel, who were assigned to the use of one of the following sodium fluoride (NaF) dentifrices: 1) a dentifrice containing 0.3% triclosan and 2.0% PVM/MA copolymer in a 0.331% NaF/silica (1500 ppm F) base; or 2) a dentifrice containing 0.331% NaF/silica (1500 ppm F). Conducted in accordance with the guidelines for caries clinical studies published by the Council on Dental Therapeutics of the American Dental Association, the study employed clinical diagnostic criteria as described in the August, 1987 National Institute of Dental Research (NIH/NIDR) publication. Dental radiographs were not employed. Principal comparisons of the dentifrices tested were implemented through the construction of 90% confidence intervals for the ratio of mean 3-year caries increments using Fieller's Theorem. Of those subjects who met the initial inclusion/exclusion criteria for this study, 1,296 were available for the 36-month examination. DFS (resp., DFT) increments over this period were 5.21 (1.30) for the triclosan/copolymer dentifrice, and 5.23 (1.39) for the dentifrice without those additives. The confidence interval calculations for both incremental DFS and DFT support the conclusion that a dentifrice containing 0.3% triclosan and 2.0% PVM/MA copolymer in a 0.331% NaF/silica (1500 ppm F) base provides a level of anticaries efficacy which is "at least as good as" that provided by a dentifrice containing 1500 NaF/silica, without those additive agents. As such, the results of this clinical study clearly indicate that the addition of triclosan and a copolymer to a 1500 NaF/silica dentifrice does not compromise its anticaries efficacy.

Comparison of the clinical anticaries efficacy of an 1100 NaF silica-based dentifrice containing triclosan and a copolymer to an 1100 NaF silica-based dentifrice without those additional agents: a study on adults in California.

Recent years have seen much work in the development of dentifrices containing the antimicrobial agent triclosan, a broad spectrum antibacterial agent manufactured for use in oral products by the Ciba-Geigy Corporation. Studies have shown that the incorporation of this agent into dental products, in combination with a PVM/MA copolymer (the non-proprietary designation for a polyvinylmethyl ether/maleic acid copolymer), can provide several important dental therapeutic benefits, including an antigingivitis effect. Much research on the therapeutic benefits of such dentifrices has been reported in the literature. The present study is a component of a large-scale program of clinical research to investigate the anticaries effectiveness of fluoride dentifrices containing 0.3% triclosan and 2.0% PVM/MA copolymer. The study included two treatment groups, each consisting of adults living within a 50 mile radius of Loma Linda, California, who were assigned to the use of one of the following sodium fluoride (NaF) dentifrices: 1) a dentifrice containing 0.3% triclosan and 2.0% PVM/MA copolymer in a 0.243% NaF/silica (1100 ppm F) base; or 2) a dentifrice containing 0.243% NaF/silica (1100 ppm F). Conducted in accordance with the guidelines for caries clinical studies published by the Council on Dental Therapeutics of the American Dental Association, the study employed clinical diagnostic criteria as described in the August, 1987 National Institute of Dental Research (NIH/NIDR) publication. Dental radiographs were not employed. Principal comparisons of the dentifrices tested were implemented through the construction of 90% confidence intervals for the ratio of mean 3-year caries increments, using Fieller's theorem. Of those subjects who met the initial inclusion/exclusion criteria for this study, 1,542 were available for the 36-month examination. DFS (resp., DFT) increments over this period were 2.07 (0.63) for the triclosan/copolymer dentifrice, and 2.16 (0.68) for the dentifrice without those additives. The confidence interval calculations for both incremental DFS and DFT support the conclusion that a dentifrice containing 0.3% triclosan and 2.0% PVM/MA copolymer in a 0.243% NaF/silica (1100 ppm F) base provides a level of anticaries efficacy which is "at least as good as" that provided by a dentifrice containing 1100 NaF/silica without those additive agents. As such, the results of this clinical study clearly indicate that the addition of triclosan and a copolymer to a 1100 NaF/silica dentifrice does not compromise its anticaries efficacy.

Clinical study of the anticaries efficacy of three fluoride dentifrices containing anticalculus ingredients: three-year (final) results.

A 3-year double blind clinical trial was conducted to compare the caries inhibition of an A.D.A.-accepted fluoride dentifrice to the caries inhibitions provided by three fluoride dentifrices containing anticalculus agents. All dentifrices used a compatible silicon dioxide abrasive system. The initial mean age of the subjects was 9.9 yrs and they resided in F-deficient (F less than 0.3 ppm) communities on Long Island, NY. Caries activity in all groups was low with the average annual increment being less than one surface. There were no statistically significant differences in any of the dental parameters tested, DMFS, DMFT, and buccolingual, mesiodistal and occlusal surface increments. It was concluded that the presence of anticalculus agents, specifically soluble pyrophosphates, zinc chloride and zinc oxide, do not interfere with the caries inhibition benefits of fluoride in a compatible dentifrice formulation.

Caries and treatment patterns in children related to school lunch program eligibility.

This article presents the caries prevalence and treatment patterns of children relative to a classification of family economic status, based on the child's eligibility for the free or reduced-cost school lunch program. Dental caries prevalence is reported for children aged 8-11 years at the beginning of a longitudinal clinical trial in the nonfluoridated city of Tampa, Florida. These children were placed into one of three school lunch subsidy categories--poverty, near-poverty, and nonpoverty--using federal government income eligibility guidelines for the school lunch program. The results support an inverse relation of caries prevalence to economic status, as well as the expected direct relation of family income to treatment needs met. The nonpoverty group exhibited the lowest number of decayed surfaces and had nearly 70 percent of their treatment needs met. The poverty group had significantly higher scores both for total caries experience (DMFS) and decayed surfaces (DS) than either of the other groups. Filled surfaces (FS) scores were not significantly different for any of the groups. This method of classifying children by school lunch program eligibility is considered valid because of the rigorous requirements used in determining family income, as well as the thorough verification procedure that is applied. The method is easy to use once officials have been convinced that confidentiality will be maintained.