Potential risk of dental fluorosis associated with different baby formulas and water brands marketed in Spain.

Despite efforts to promote breastfeeding, many babies aged <6 months receive only baby formula reconstituted with bottled water. The intake of high levels of fluoride during amelogenesis has been associated with hypomineralization of the tooth enamel, with aesthetic and mechanical repercussions. The objective of this study was to determine the potential risk of dental fluorosis associated with baby formulas marketed in Spain. We measured 26 baby formulas frequently consumed in Spain; 17 brands for babies aged <6 months, 5 for those aged >6 months, and 4 ready-to-use brands. They were prepared with 4 types of water: distilled water and three brands of bottled water with different levels of fluoride. The fluoride concentration (mg/L or ppm F) was measured with an ion-specific electrode coupled to an ion analyzer. Each sample was prepared according to the manufacturer's instructions and analyzed in triplicate. A descriptive analysis was carried out. The minimum fluoride level found was 0.04 mg/L and the maximum was 1.02 mg/L. Considering the daily intake of these formulas, none exceeded the clinically-acceptable daily dose limit risk for fluorosis (0.07 mg F/day/kg body weight) when mixed with bottled water with a low level of fluoride (0.1 mg/L). However, when the same brands of formula were reconstituted with bottled water with a higher fluoride content (0.99 mg/L), they all exceeded the daily dose limit for the risk of fluorosis. As the potential risk of dental fluorosis associated with the formulas tested depends exclusively on the fluoride concentration of the waters used for reconstitution, formula packaging should contain a warning.

Effect of pH and titratable acidity on enamel and dentine erosion.

OBJECTIVES: The relative effect of pH and titratable acidity on tooth erosion remains unclear. We determined the effect of both properties on in vivo salivary pH recovery and on enamel and dentine early erosion in situ. METHODS: Solutions simulating acidic beverages with different pHs (2.5 or 3.5) and titratable acidities (0, 25, or 100 mM citric acid) were tested. In an in vivo study (n = 20 participants), the salivary pH was determined before, during, and up to 2 min after exposure to the tested solutions. In situ, 12 participants exposed enamel and root dentine slabs to the tested solutions simulating a beverage consumption; early erosion was assessed by percentage of surface hardness loss (%SHL). Groups were compared by ANOVA (p < 0.05). RESULTS: Saliva pH was lower after exposure to solutions at pH 2.5, irrespective of titratable acidity; pH recovery took longer for solutions with higher titratable acidities, irrespective of their pHs. In situ, the highest %SHL was observed for the solution with lower pH and higher titratable acidities. The addition of citric acid increased the %SHL by 2.5-3 times in enamel, and at least 5 times in dentine. CONCLUSIONS: Both pH and titratable acidity may play a role on the erosive potential of acidic beverages. CLINICAL RELEVANCE: Acidic beverages with lower pHs promote erosion by an initial acid etching of the surface; those with a higher titratable acidity slow down the salivary pH recovery. Both properties contribute to the overall erosive potential.

Cariogenic Potential of Human and Bovine Milk on Enamel Demineralization.

The higher cariogenicity of human milk when compared with bovine milk is still a debatable subject. Therefore, we evaluated the effect of human or bovine milk exposure on biofilm composition and enamel demineralization using a validated cariogenic biofilm model. Streptococcus mutans UA159 biofilms (n = 8) were grown on human saliva-coated bovine enamel slabs of known surface hardness. The biofilms were exposed 8×/day to 0.9% NaCl (negative control), human milk, bovine milk, 7.0% lactose (active human milk control), 4.5% lactose (active bovine milk control), or 10% sucrose (positive control). The culture medium was changed twice daily, and the pH was analyzed as an indicator of biofilm acidogenicity. After 120 h of growth, biofilms were harvested to evaluate viable cells, and soluble and insoluble extracellular polysaccharides (EPS). Enamel demineralization was assessed by the percentage of surface hardness loss (%SHL). Data were analyzed by one-way ANOVA/Tukey's test (α = 5%). In terms of %SHL, negative control (7.7 ± 3.1), human milk control (13.3 ± 7.5), bovine milk control (15.3 ± 8.2), human milk (7.5 ± 5.0), and bovine milk (8.7 ± 6.3) did not differ among them (p > 0.05) but differed (p < 0.05) from sucrose (55.1 ± 5.4). The findings of enamel demineralization (%SHL) were statistically supported by the data of biofilm acidogenicity, bacterial counts and EPS biofilm composition. This experimental study suggests that human and bovine milk have low cariogenic potential to provoke caries lesions in enamel.

On the release of fluoride from biofilm reservoirs during a cariogenic challenge: an in situ study.

Biofilm fluoride reservoirs may be a source of fluoride to the fluid phase during a sugar challenge reducing tooth mineral loss. However, the evidence for that is conflicting and has not been studied in biofilms containing different fluoride levels. In order to test fluoride release from biofilms with distinct fluoride concentrations, biofilms were grown in situ exposed to a combination of placebo, calcium and fluoride rinses forming biofilms with no (fluoride-free rinses), low (fluoride-only rinses) or high (calcium followed by fluoride rinses) fluoride concentrations, and collected before and 5 min after a sucrose challenge. Rinsing with fluoride increased fluoride concentration in the biofilm (p < 0.05), mainly when a calcium pre-rinse was used before the fluoride (p < 0.05). However, after a sugar challenge, no significant increase in the biofilm fluid fluoride concentration was observed, even in the fluoride-rich biofilms (p > 0.05). Fluoride-rich biofilms do not release fluoride to the fluid phase during a sugar challenge.

Fluoride Increase in Saliva and Dental Biofilm due to a Meal Prepared with Fluoridated Water or Salt: A Crossover Clinical Study.

Knowledge about fluoride delivery to oral fluids from foods cooked with fluoridated water and salt is scarce, and no study has evaluated fluoride concentrations in saliva or biofilm during meal consumption. In this randomized double-blind crossover study, 12 volunteers ingested meals (rice, beans, meat, and legumes) prepared with nonfluoridated water and salt (control group), fluoridated water (0.70 mg F/L; water group), and fluoridated salt (183.7 mg F/kg; salt group). Whole saliva was collected before meal ingestion, during mastication, and up to 2 h after meal ingestion. Dental biofilm was collected before and immediately after meal ingestion. Fluoride concentrations in saliva and dental biofilm were determined by an ion-specific electrode. The mean (±standard deviation; n = 4) fluoride concentrations in meals prepared for the control, water, and salt groups were 0.039 ± 0.01, 0.43 ± 0.04, and 1.71 ± 0.32 µg F/g, respectively. The three groups had significantly different fluoride concentrations in saliva collected during mastication (p < 0.0001) and after meal ingestion (p < 0.04; salt > water > control). The fluoride concentration in saliva returned to baseline 30 min after meal ingestion in the water group but remained high for up to 2 h in the salt group (p = 0.002). The fluoride concentration in biofilm fluid differed only between the salt and control groups (p = 0.008). The mastication of foods cooked with fluoridated water and salt increases fluoride concentrations in oral fluids and may contribute to the local effect of these community-based fluoride interventions on caries control.

Candida albicans Increases Dentine Demineralization Provoked by Streptococcus mutans Biofilm.

Streptococcus mutans are considered the most cariogenic bacteria, but it has been suggested that Candida albicans could increase their cariogenicity. However, the effect of this dual-species microorganisms' combination on dentine caries has not been experimentally evaluated. Biofilms of C. albicans, S. mutans and C. albicans + S. mutans (n = 12/biofilm) were grown in ultra-filtered tryptone yeast extract broth culture medium for 96 h on root dentine slabs of known surface hardness and exposed 8 times per day for 3 min to 10% sucrose. The medium was changed 2 times per day (after the 8 cariogenic challenges and after the overnight period of famine), and aliquots were analyzed to determinate the pH (indicator of biofilm acidogenicity). After 96 h, the biofilms were collected to determine the wet weight, colony-forming units, and the amounts of extracellular polysaccharides (soluble and insoluble). Dentine demineralization was assessed by surface hardness loss (% SHL). The architecture of the biofilms was analyzed by confocal laser scanning microscopy (CLSM) and transmission electron microscopy (TEM). Data were analyzed by ANOVA followed by Tukey's test (α = 0.05). The dual-species C. albicans + S. mutans biofilm provoked higher % SHL on dentine (p < 0.05) than the S. mutans and C. albicans biofilm. This was supported by the results of biofilm acidogenicity and the amounts of soluble (6.4 ± 2.14 vs. 4.0 ± 0.94 and 1.9 ± 0.97, respectively) and insoluble extracellular polysaccharides (24.9 ± 9.22 vs. 18.9 ± 5.92 and 0.7 ± 0.48, respectively) (p < 0.05). The C. albicans biofilm alone presented low cariogenicity. The images by CLSM and TEM, respectively, suggest that the C. albicans + S. mutans biofilm is more voluminous than the S. mutans biofilm, and S. mutans cells interact with C. albicans throughout polysaccharides from the biofilm matrix. These findings show that C. albicans enhances the cariogenic potential of the S. mutans biofilm, increasing dentine demineralization.

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.

Role of microbial biofilms in the maintenance of oral health and in the development of dental caries and periodontal diseases. Consensus report of group 1 of the Joint EFP/ORCA workshop on the boundaries between caries and periodontal disease.

BACKGROUND AND AIMS: The scope of this working group was to review (1) ecological interactions at the dental biofilm in health and disease, (2) the role of microbial communities in the pathogenesis of periodontitis and caries, and (3) the innate host response in caries and periodontal diseases. RESULTS AND CONCLUSIONS: A health-associated biofilm includes genera such as Neisseria, Streptococcus, Actinomyces, Veillonella and Granulicatella. Microorganisms associated with both caries and periodontal diseases are metabolically highly specialized and organized as multispecies microbial biofilms. Progression of these diseases involves multiple microbial interactions driven by different stressors. In caries, the exposure of dental biofilms to dietary sugars and their fermentation to organic acids results in increasing proportions of acidogenic and aciduric species. In gingivitis, plaque accumulation at the gingival margin leads to inflammation and increasing proportions of proteolytic and often obligately anaerobic species. The natural mucosal barriers and saliva are the main innate defence mechanisms against soft tissue bacterial invasion. Similarly, enamel and dentin are important hard tissue barriers to the caries process. Given that the present state of knowledge suggests that the aetiologies of caries and periodontal diseases are mutually independent, the elements of innate immunity that appear to contribute to resistance to both are somewhat coincidental.

Stability of chemically available fluoride in Chilean toothpastes.

BACKGROUND: Storage time may reduce the amount of soluble fluoride (F) in toothpastes. Although we previously studied the type and concentration of F in fresh samples of commercial Chilean toothpastes, their stability was not determined. AIM: To evaluate the stability of soluble F in Chilean toothpastes after 1 year of storage. DESIGN: All the toothpastes (n = 30) previously used were re-analyzed after 1 year of storage time at room temperature (±22°C). Total F (TF = soluble F + insoluble F) and total soluble F (TSF = F ion + MFP ion) were assessed using an ion-specific electrode, through a validated methodology. Data were expressed in ppm of F (mg F/kg). RESULTS: Mean (±SD; n = 30) TF and TSF concentrations after storage were 1049 ± 427 and 987 ± 411 ppm F, respectively. Five toothpastes showed between 30% and 50% of insoluble F, four of them formulated with MFP/calcium-based abrasive. In two products, there was a reduction in TSF below the evidence-based anticaries effectiveness threshold of 1000 ppm F. CONCLUSIONS: Although most of the toothpastes tested kept their original TSF content after 1 year of storage, some products evidenced an important reduction, which may compromise their anticaries efficacy. Reductions in TSF may be explained by an incorrect F salt-abrasive formulation.

Effect of Fluoride-Containing Toothpastes on Enamel Demineralization and Streptococcus mutans Biofilm Architecture.

This study aimed to explore the effect of fluoridated toothpastes on biofilm architecture and enamel demineralization in an in vitro biofilm model. Streptococcus mutans was grown on enamel and treated with slurries of commercial toothpastes, containing SnF2 or NaF. Water and chlorhexidine were used as negative and positive controls, respectively. The developed biofilms were imaged and enamel demineralization was measured. SnF2 and NaF toothpaste treatments significantly reduced enamel demineralization, but SnF2 toothpaste was more effective. Only SnF2 toothpaste and chlorhexidine treatments caused reductions on biofilm mass and thickness. In conclusion, this biofilm model was able to differentiate the effects of the SnF2 and NaF toothpastes on biofilm architecture and enamel demineralization.

Calcium Prerinse before Fluoride Rinse Reduces Enamel Demineralization: An in situ Caries Study.

A calcium (Ca) prerinse before a fluoride (F) rinse has been shown to increase oral F levels. We tested the anticaries effect of this combination in a dose-response in situ caries model. In a double-blind, crossover experiment, 10 volunteers carried enamel slabs in palatal appliances for 14 days, during which they rinsed twice/day with one of four rinse combinations: (1) a placebo prerinse (150 mM sodium lactate) followed by a distilled water rinse (negative control); (2) a placebo prerinse followed by a 250 ppm F rinse; (3) a placebo prerinse followed by a 1,000 ppm F rinse, or (4) a Ca prerinse (150 mM Ca, as calcium lactate) followed by a 250 ppm F rinse. Sucrose solution was dripped onto the slabs 8×/day to simulate a high cariogenic challenge. The percent surface hardness loss (%SHL) was significantly lower in the Ca prerinse used with the 250 ppm F rinse group (%SHL = 38.0 ± 21.0) when compared with the F rinse alone (%SHL = 59.5 ± 24.1) and similar to the 1,000 ppm F rinse group (%SHL = 42.0 ± 18.3). Compared with the 250 ppm F rinse, the Ca prerinse increased biofilm fluid F only twice (nonsignificant). However, it greatly increased F in biofilm solids (∼22×). The Ca prerinse had little effect on loosely or firmly bound enamel F. The results showed an increased level of protection against demineralization by the use of a Ca prerinse, which seems to be caused by the enhancement of F concentration in the biofilm.

Effect of the Probiotic Lactobacillus rhamnosus LB21 on the Cariogenicity of Streptococcus mutans UA159 in a Dual-Species Biofilm Model.

Despite promising results using probiotics, evidence of the preventive effect on enamel demineralization is insufficient and the cariogenic potential of probiotics is still controversial. Probiotics could affect biofilm formation and interfere with adherence, growth or coaggregation with Streptococcus mutans in biofilms. However, most of the studies have been conducted using planktonic bacteria. Hence, the aim of the study was to assess the effect of probiotic bacteria on the cariogenicity of S. mutans using an in vitro biofilm caries model on enamel. Single-species biofilms (S. mutans UA159, SM or Lactobacillus rhamnosus LB21, LB) or dual-species biofilms simultaneously inoculated (SM + LB) or LB inoculated 8 h after SM (SM x2192; LB) were grown for 96 h. Biofilms were formed on bovine enamel saliva-coated slabs of known surface hardness (SH) and immersed in culture media. Biofilms were exposed 8 times per day to 10% sucrose. Medium pH was monitored twice daily as a biofilm acidogenicity indicator. After 96 h, biofilms were collected to determine biomass and bacteria viability. Slab demineralization was calculated as percentage of SH loss (%SHL). Additionally, the model was tested with different concentrations of the initial inoculum (103, 106, 108 cells/ml) and different adhesion times (2 or 8 h). The dual-species biofilm revealed no LB effects on SM cariogenicity, without changes in acidogenicity or %SHL among groups (p > 0.05, n = 12). Lack of activity of LB on SM cariogenicity persisted even when 105 times higher concentration of the probiotic was tested. Coaggregation was not observed. In conclusion, findings suggest that LB does not reduce cariogenicity of SM in a validated experimental caries model.

Total Fluoride Intake by Children from a Tropical Brazilian City.

The main sources of fluoride intake by children are fluoridated water and toothpaste. Little has been studied regarding fluoride intake from these sources in regions with tropical climates and high temperatures throughout the year. This study aimed to determine the amount of fluoride ingested from diet and tooth brushing by children who live in a city with a tropical climate. Sixty-seven children from Teresina, Piauí, Brazil, took part in this study. The city's water supply was optimally fluoridated. The duplicate-diet method was used to determine the fluoride intake from diet. The intake of fluoride from dentifrice was determined by subtracting the amount of fluoride placed on the toothbrush and that recovered after brushing. The concentration of fluoride was measured using an ion-specific electrode and is expressed as milligrams/kilogram of body weight/day. The mean (±SD) total amount was 0.071 ± 0.036 mg F/kg body weight/day, and the relative contributions of diet and toothpaste were 0.025 ± 0.010 and 0.046 ± 0.035, respectively. The factors associated with fluoride intake from toothpaste were: use of children's toothpaste (p = 0.003), use of large amounts of toothpaste (p < 0.001), and a high frequency of tooth brushing (p = 0.003). Sixty-four percent of children had an intake of less than 0.07 mg F/kg body weight/day, which is considered the upper limit for an aesthetically tolerable fluorosis risk. The results suggest that the amount of fluoride ingested by most children who live in a Brazilian city with a tropical climate is considered safe in terms of the risk of dental fluorosis.

[Fluoride concentration in bottled waters sold in Chile]. / Concentración de fluoruro en aguas embotelladas comercializadas en Chile: importancia en caries y fluorosis dental.

BACKGROUND: Bottled water consumption has currently increased and their fluoride (F) concentration may not be ideal in terms of caries benefit or risk of fluorosis. While low concentrations would have little anticaries effect, high F concentration would increase the risk of dental fluorosis. AIM: To measure F concentration in bottled waters sold in Chile. MATERIAL AND METHODS: Thirty bottles of water were purchased (15 sold as mineral water, six sold as purified water and nine as favored water). Samples were analyzed in duplicate with a previously calibrated ion-specific electrode. Mean F concentration of each product was calculated and expressed as ppm F (mg F/L). RESULTS: A mean (± SD) concentration of 0.39 ± 0.42, 0.02 ± 0.006 and 0.11 ± 0.18 ppm F for mineral, purified and favored waters respectively, was found. Three samples were within the optimal F concentration recommended for drinking water in Chile, which ranges from 0.6 to 1.0 ppm F. Two were above such concentration and the others below. Only two waters displayed F concentration information in the label, which was corroborated by the analysis. CONCLUSIONS: Only 10% of the bottled waters commercialized in Chile have potential to prevent caries. The F concentration in most of them does not represent an increased risk of fluorosis.

Fluoride content in toothpastes commercialized for children in Chile and discussion on professional recommendations of use.

BACKGROUND: In Chile, no information is available regarding the soluble fluoride (F) content in the toothpastes commercialized for children and the country's guidelines recommend the use of F in toothpastes in an age-dependent concentration. No global consensus has been reached on this subject. AIM: To determine the soluble F concentration in dentifrices for children sold in Chile and to discuss Chilean guidelines and professional recommendations of use. DESIGN: Three samples of twelve different dentifrices were purchased from drugstores. Toothpastes were analysed in duplicate using an ion-specific electrode. The concentrations of total F (TF) and total soluble F (TSF) were determined (µg F/g). RESULTS: Measured TF was consistent with that declared by the manufacturer in eight products. Two dentifrices showed lower TF and two higher F concentrations than declared. A toothpaste, marketed as low-F (450 ppm), showed F concentration threefold higher. Most dentifrices exhibited TSF concentrations similar to the TF content, except one sample that displayed considerably lower TSF than TF. Recommendations on F toothpastes use in children widely vary from country to country. CONCLUSIONS: Most dentifrices for children match F content in the labelling, but recommendations are not supported by the best evidence available on the benefit/risk of F toothpastes use.

Chapter 5.1: Physicochemical Interactions between Enamel and Oral Fluids.

Despite all the current knowledge in cariology, research is still being carried out nowadays trying to make dental enamel resistant to dental caries. Since enamel is mainly composed by a mineral, efforts have been put together to make it more resistant to acids produced by dental biofilm when exposed to dietary sugars. Fluoride was once thought to be a micronutrient that impacted caries resistance when incorporated in the tooth mineral, but we now know that the complex interactions at the mineral surface are most important. Every slightly soluble mineral, and enamel is no exception, has a behavior that is determined by the environment where it is located, and in the case of the dental crown, saliva and biofilm fluid play an important role. Enamel can keep in balance or lose its minerals, but it can gain them back. These processes, equilibrium, and loss or gain follow Le Chatelier's principle, and physicochemically, they are known as saturating, undersaturating, and supersaturating conditions, respectively. Saliva, and even the biofilm fluid, is supersaturated with calcium (Ca2+) and phosphate (PO43-) in relation to enamel solubility, and thus the natural tendency of enamel is to gain mineral, conferring saliva with a remineralizing property. However, the decrease in pH and the presence of free fluoride ion (F-) will determine what will happen to the enamel. While lowering the pH of the medium is an imbalance factor, fluoride at micromolar concentration reduces the acid impact. This chapter provides an updated, evidence-based understanding of the interactions between enamel and oral fluids.

Total and soluble fluoride content in commercial dentifrices in Chile.

OBJECTIVE: Regardless of the total amount of fluoride (F) in a dentifrice, only the soluble fraction presents anti-caries activity and its concentration must be above 1000 ppm. No information regarding the quality of F in Chilean toothpastes is available. The aim of this study, therefore, was to determine the F concentration present in commercially-available toothpastes in Chile. MATERIALS AND METHODS: Eighteen toothpastes of five different brands were tested, each purchased from three different chain drugstores in Chile. For each toothpaste, total, total soluble and ionic F concentrations were assessed and expressed as ppm of F (µg F/g). RESULTS: Among the dentifrices evaluated, 77.8% contained NaF (sodium fluoride), 16.7% MFP (monofluorphosphate) and 5.6% both types of F salts; 77.2% of the dentifrices showed similar total F content to that declared by the manufacturer in the labeling with only five with lower concentration than expected, beyond a 5% disagreement tolerance range. Total soluble F ranged from 958.8-1496.3 ppm (mean ± SD: 1270.5 ± 183.7). Five toothpastes showed lower total soluble F than total F. Only one toothpaste showed soluble salt levels below the recommended dose for this type of dentifrice. CONCLUSION: Most Chilean dentifrices evaluated contained soluble F within the range of 1000-1500 ppm and, therefore, may have anti-caries activity.

Validation of a cariogenic biofilm model by evaluating the effect of fluoride on enamel demineralization.

In vitro biofilm models have been extensively used, but only few of the models available to date had been validated in terms of the dose-response effect of anti-caries and/or antimicrobial substances. Additionally, none of the validated models allow the use of microliter volumes of the treatment solutions, needed mainly to test (screen) novel but expensive substances under development. This study aimed at modifying an in vitro cariogenic Streptococcus mutans biofilm model and validating it by assessing the dose-response effect of fluoride on enamel demineralization. S. mutans cariogenic biofilms were developed on saliva-coated enamel slabs previously bonded to acrylic holders fixed to a lid of a culture plate. Biofilms were incubated 8 h/day in culture medium supplemented with 1% sucrose and then overnight in culture medium with glucose 0.1 mM. Biofilms were also treated 2×/day with 2.0 mL of solutions containing 0, 125, 275 and 1250 µg F/mL (n = 10/group). The replaced culture medium was used to: determine the biofilm acidogenicity; estimate the demineralization of enamel; and monitor the fluoride concentration. At 144 h, biofilms were collected for fluoride concentration analyses, and the fluoride uptake by enamel was determined in each slab. The model showed a dose-response effect of fluoride (R2 = 0.96, p < 0.001) between enamel demineralization and the fluoride concentration of the treatments. Water-soluble and bound biofilm fluoride concentrations (p < 0.007), as well as the firmly-bound fluoride concentration found in enamel (p < 0.0001), increased in a dose-dependent manner. Our model constitutes a validated approach that would allow the assessment of the anticaries potential of novel biotechnological strategies, as in the case of expensive salivary peptides, because it would allow to test the treatment solutions using smaller volumes.

Added Sugar and Oral Health: A Position Paper of the Brazilian Academy of Dentistry.

Excessive sugar consumption is the main cause of dental caries. Dental caries is highly prevalent and negatively impacts the quality of life at all stages. Furthermore, sugar consumption is associated with other noncommunicable conditions and diseases, such as obesity, diabetes, and cardiovascular diseases. The aim of this paper is to propose recommendations at the individual and population levels for health professionals, families, educators, stakeholders, and public officials to reduce the burden of dental caries and other noncommunicable diseases that are caused by the excessive sugar intake. A systematic search was performed in PubMed and Cochrane databases to investigate the effectiveness of strategies and policies aiming to reduce sugar consumption as well as the impact of different patterns of sugar consumption on the occurrence of dental caries. Reference list of the identified papers and practice guidelines were manually reviewed as well. Based on the best evidence available, the Brazilian Academy of Dentistry recommends not to offer sugars to children younger than 2 years of age, and to limit total sugar consumption to <25 g per day after 2 years of age. Furthermore, families should be informed to limit sugar exposure, sugar-free areas should be available, content of food labels and advertisement should be regulated, taxation of products with sugar should be introduced, and reformulation of foods and drinks to reduce concentrations of sugars should be considered.

[Total and soluble fluoride concentration in children´s toothpastes in Spain.] / Concentración de fluoruro total y soluble en pastas dentales de uso infantil en España.

OBJECTIVE: The use of fluoridated toothpastes is considered the most rational method in dental caries control, and it is recommended for all ages people, but for this they must be established at a minimum concentration of 1,000 ppm of total soluble fluoride, in pediatric patients. The objective of the study was to determine the concentration of total and soluble fluoride present in toothpastes marketed in Spain for pediatric use. METHODS: A descriptive and cross-sectional study was carried out throughout 2019, analyzing 11 toothpastes for pediatric use marketed in Murcia, Spain. The concentration of fluoride (ppm F=mg F/Kg) total (FT), soluble (FTS) and fluoride ion (F) and MFP (FPO32-) was analyzed using an ion-specific electrode coupled to an ion analyzer. A descriptive study was carried out to determinate mean and standard deviations for each variable analyzed. RESULTS: Among the analyzed toothpastes, 45% contained NaF (sodium fluoride), 45% MFP (sodium monofluorophosphate) and 10% both types of salts. The abrasive used was silica. 98% of the analyzed toothpastes showed total fluoride contents similar to those described by the manufacturer, only 3 toothpastes had fluoride concentrations lower than those described. The range obtained from FT oscillated between 398 -1,474.6 ppm F, and 100% of the toothpastes did not show differences between values of total fluoride and soluble fluoride. CONCLUSIONS: Most of the analyzed toothpastes contain a concentration of soluble fluoride between 1,000-1,500 ppm Fluoride, corresponding to the values described by the manufacturers However, there are still toothpastes with values lower than those recommended, minimum 1,000 ppm F, that do not allow effective anticaries activity from a public health point of view.

OBJETIVO: El uso de pastas dentales fluoradas es considerado el método más racional en el control de caries dental, y es recomendado para personas de todas las edades, pero para ello han de establecerse en una concentración mínima de 1.000 ppm de fluoruro total soluble, en pacientes pediátricos. El objetivo del estudio fué determinar la concentración de fluoruro total y soluble presente en pastas dentales comercializadas en España para uso pediátrico. METODOS: Se realizó un estudio descriptivo y transversal durante el año 2019, analizando 11 pastas dentales de uso pediátrico comercializadas en Murcia, España. Se analizó la concentración de fluoruro (ppm F=mg F/kg) total (FT), soluble (FTS) e ión de Flúor (F) y de MFP (FPO32-) mediante un electrodo ion-específico acoplado a un analizador de iones. Se llevó a cabo un estudio descriptivo determinando las medias y desviaciones estándar para cada variable. RESULTADOS: Entre las pastas dentales analizadas, el 45% contenían NaF (fluoruro sódico), 45% MFP (monofluorofosfato de sodio) y un 10 % ambos tipos de sales. El abrasivo de todas era sílice. El 98% de las pastas dentales analizadas mostraban contenidos de flúor total similares a los descritos por el fabricante, solamente 3 pastas presentaban concentraciones de flúor inferiores a las descritas por el fabricante. El rango obtenido de FT oscilaba entre 398-1.474,6 ppm F, y el 100% de las pastas dentales no mostraron diferencias entre valores de flúor total y flúor soluble. CONCLUSIONES: La mayoría de las pastas dentales analizadas contienen una concentración de flúor soluble entre 1.000-1.500 ppm F, correspondiéndose con los valores descritos por los fabricantes. Sin embargo, todavía existen pastas dentales con valores inferiores a los recomendados de mínimo de 1.000 ppm F que no permiten tener la actividad anticaries efectiva desde el punto de vista de salud pública.