A 12-Week Assessment of the Treatment of White Spot Lesions with CPP-ACP Paste and/or Fluoride Varnish.

This 12-week clinical study evaluated the impact of 10% CPP-ACP and 5% sodium fluoride varnish regimes on the regression of nonorthodontic white spot lesions (WSLs). The study included 21 children with 101 WSLs who were randomised into four treatment regimes: weekly clinical applications of fluoride varnish for the first month (FV); twice daily self-applications of CPP-ACP paste (CPP-ACP); weekly applications of fluoride varnish for the first month and twice daily self-applications of CPP-ACP paste (CPP-ACP-FV); and no intervention (control). All groups undertook a standard oral hygiene protocol and weekly consultation. Visual appraisals and laser fluorescence (LF) measurements were made in weeks one and twelve. The majority of WSLs in the control and FV groups exhibited no shift in appearance, whereas, in the CPP-ACP and CPP-ACP-FV groups, the lesions predominantly regressed. The visual and LF assessments indicated that the extent of remineralisation afforded by the treatments was of the following order: control ~ FV < CPP-ACP ~ CPP-ACP-FV. Self-applications of CPP-ACP paste as an adjunct to standard oral hygiene significantly improved the appearance and remineralisation of WSLs. No advantage was observed for the use of fluoride varnish as a supplement to either the standard or CPP-ACP-enhanced oral hygiene regimes.

Efeito do extrato do romã (Punica granatum) sobre bactérias cariogênicas: estudo in vitro e in vivo / Effect of pomegranate extract (Punica granatum) on cariogenic bacteria: in vitro and in vivo study

Objetivo: O objetivo deste trabalho foi avaliar o efeito inibitório de extratos de plantas sobre cepas de Streptococcus mutans in vitro e avaliar in vivo o potencial inibitório de dentifrício incorporado com o extrato de maior potencial sobre estreptococos do grupo mutans e sobre o índice de biofilme. Materiais e Métodos: Em meio de cultura inoculado com S. mutans (ATCC25175), depositaram-se extratos etanólicosde 32 plantas. Posteriormente, avaliaram-se os halos de inibição. As capacidades inibitórias foram: Ocimumgratissimum (flor) com 08 mm; Moringa oleífera (folha) 10 mm; Copaífera langsdorffi (folha) 16 mm e Punicagranatum (pericarpo desidratado) com 18 mm. Uma vez que este último extrato apresentou o maior halo de inibição, foi utilizado na fase seguinte. O extrato de romã (Punica granatum) foi incorporado em dentifrício, nas concentrações de 1% e 3% após determinação da concentração inibitória mínima. Estes foram testados em 30 voluntários divididos em 3 grupos (um para cada extrato e um grupo controle). Os voluntários fizeram uso dos dentifrícios durante 08 dias. A atividade antimicrobiana foi avaliada através da determinação do índice de biofilme e contagem de estreptococos do grupo mutans (UFC/ml). Resultados: Houve redução (p < 0,05) no índice de biofilme para o extrato a 3%, porém não houve diferença na contagem de microrganismos (p > 0,05). Conclusão: Conclui-se que a Punica granatum L. foi o extrato que apresentou maior atividade inibitória in vitro contra S. mutans. A formulação do dentifrício mostrou eficiência após oito dias de uso diminuindo significativamente o índice de biofilme, porém, não apresentou redução do número de estreptococos do grupo mutans.

Preventive effects of dentifrice containing 5000ppm fluoride against dental erosion in situ.

OBJECTIVE: To evaluate the effectiveness of a dentifrice with 5000ppm fluoride in preventing dental erosion by orange juice in situ in comparison to a control dentifrice with 1450ppm fluoride. METHODS: This was a double-blind and randomized clinical study with a cross-over design. Sixteen subjects wore an intra-oral appliance containing two enamel disks with an exposed surface of approximately 2mm×5mm. Enamel disks in the study group were treated with a dentifrice with 5000ppm fluoride and in the control group with 1450ppm fluoride. The subjects rinsed with slurries of study dentifrices for one minute before immersing the enamel disks in 250ml orange Juice four times in an 8-h period daily. The treatment procedure was repeated for three 5-day phases for each dentifrice. Enamel erosion was measured after each 5-day treatment phase using a focus-variation 3D scanning microscopy. Medians and inter-quartile ranges (IQR) of mean erosion depth were compared between the groups. RESULTS: The mean erosion depths of enamel varied greatly amongst the subjects. Enamel treated with 5000ppm fluoride had less erosion (median 5.7µm, IQR 4.5µm) as compared to the control (median 12.6µm, IQR 12.3µm) after 15 days of fluoride treatment and erosive challenge cycles (p<0.05). CONCLUSIONS: Enamel treated with 5000ppm fluoride had significantly improved resistance to erosion by orange juice. Periodic application of 5000ppm fluoride may be beneficial in individuals at risk of acidic erosion associated with soft drink consumptions.

Associations between fluorosis of permanent incisors and fluoride intake from infant formula, other dietary sources and dentifrice during early childhood.

OBJECTIVES: The authors describe associations between dental fluorosis and fluoride intakes, with an emphasis on intake from fluoride in infant formula. METHODS: The authors administered periodic questionnaires to parents to assess children's early fluoride intake sources from beverages, selected foods, dentifrice and supplements. They later assessed relationships between fluorosis of the permanent maxillary incisors and fluoride intake from beverages and other sources, both for individual time points and cumulatively using area-under-the-curve (AUC) estimates. The authors determined effects associated with fluoride in reconstituted powdered infant formulas, along with risks associated with intake of fluoride from dentifrice and other sources. RESULTS: Considering only fluoride intake from ages 3 to 9 months, the authors found that participants with fluorosis (97 percent of which was mild) had significantly greater cumulative fluoride intake (AUC) from reconstituted powdered infant formula and other beverages with added water than did those without fluorosis. Considering only intake from ages 16 to 36 months, participants with fluorosis had significantly higher fluoride intake from water by itself and dentifrice than did those without fluorosis. In a model combining both the 3- to 9-months and 16- to 36-months age groups, the significant variables were fluoride intake from reconstituted powder concentrate formula (by participants at ages 3-9 months), other beverages with added water (also by participants at ages 3-9 months) and dentifrice (by participants at ages 16-36 months). CONCLUSIONS: Greater fluoride intakes from reconstituted powdered formulas (when participants were aged 3-9 months) and other water-added beverages (when participants were aged 3-9 months) increased fluorosis risk, as did higher dentifrice intake by participants when aged 16 to 36 months. CLINICAL IMPLICATIONS: Results suggest that prevalence of mild dental fluorosis could be reduced by avoiding ingestion of large quantities of fluoride from reconstituted powdered concentrate infant formula and fluoridated dentifrice.

In vitro comparison of self versus professionally applied remineralizing materials.

OBJECTIVE: To compare the effect of 4 remineralizing materials on the incipient artificial carious lesion and its proximal sound enamel when used with fluoride dentifrice. STUDY DESIGN: Models mimicking proximal contact were made, each of which was placed with an artificial carious specimen in contact with a sound enamel specimen. Each carious specimen was treated with one of four materials: glass ionomer cement (GIC), resin modified glass ionomer cement (RMGIC), 5000 ppm sodium fluoride (F-gel), and casein phosphopeptide amorphous calcium phosphate (CPP-ACP). The GIC and RMGIC specimens were thermocycled. Then all specimens were pH-cycled for 5 days with twice a day soaking in 1,000 ppm NaF dentifrice solution. Specimens were examined by polarized light microscopy and lesion area quantified by image analysis. RESULTS: RMGIC significantly yielded smaller areas of lesion than CPP-ACP and GIC (p < 0.05). F-gel reduced more area of lesion than CPP-ACP significantly (p < 0.05). In the associated contact, RMGIC significantly reduced the area of lesion better than CPP-ACP (p < 0.05). CONCLUSIONS: The most effective remineralizing material in reducing the carious lesion areas was RMGIC followed by F-gel, GIC and CPP-ACR The demineralization inhibitory effects on the associated sound contact enamel followed the same trend.

In vivo antiplaque efficacy of combined antimicrobial dentifrice and rinse hygiene regimens.

PURPOSE: To evaluate using digital plaque image analysis the antiplaque efficacy of oral care regimens including use of antimicrobial toothpaste in combination with antimicrobial mouthrinse. METHODS: 16 subjects completed the study protocol including: (1) initial treatment phase, all subjects used a standard sodium fluoride dentifrice with 2x/day brushing, (2) second treatment phase, subjects were randomized to two treatment groups: stannous fluoride/sodium hexametaphosphate dentifrice or sodium fluoride triclosan/copolymer dentifrice; (3) third treatment phase, the group using stannous fluoride dentifrice rinsed with alcohol-free cetylpyridinium chloride mouthrinse and the group using triclosan dentifrice rinsed with essential oil mouthrinse. During each phase, plaque levels were assessed in the morning before toothbrushing (AM), post-brushing in the morning (PB) and in the afternoon (PM). RESULTS: Stannous fluoride dentifrice was superior to triclosan dentifrice in plaque growth inhibition between toothbrushing. Both mouthrinses provided additional plaque prevention benefits when used with antimicrobial dentifrices. The cetylpyridinium chloride mouthrinse and stannous fluoride dentifrice regimen was particularly effective, building accretive efficacy over time. Average plaque reductions exceeded 50% vs. sodium fluoride dentifrice alone. Chemotherapeutic dentifrices and rinses increase plaque control used alone and particularly in combination. The stannous fluoride-cetylpyridinium chloride regimen showed the greatest benefits.

Low-fluoride dentifrice and the effect of postbrushing rinsing on fluoride availability in saliva.

AIM: Post-brushing water rinsing may reduce the risk of fluoride (F) ingestion from dentifrice, however the decreased salivary F bioavailability may compromise any consequent anticaries benefits. As the use of low-F concentration dentifrices is still a matter of debate, a comparison was made between the salivary F bioavailability after brushing with a conventional F dentifrice followed by a water rinse and after brushing with a low-F dentifrice without post-brushing rinse. STUDY DESIGN AND METHODS: In a crossover, blind study, F concentration in saliva of 5 adult volunteers was determined after brushing with a low-F dentifrice (500 microg F/g) or with a conventional F concentration dentifrice (1100 microg F/g), followed or not by a 15-mL water rinse. RESULTS: Salivary F bioavailability was reduced by 2.5 times when a water rinse was used (p<0.05), irrespective of dentifrice concentration, and it was 2 times lower for the low-F dentifrice (p<0.05). The salivary F bioavailability was similar when the low-F dentifrice was used without post-brushing rinse and the conventional F dentifrice was followed by a rinse (p>0.05). CONCLUSION: Habits of post-brushing rinse should be taken into account on the recommendation of dentifrice use by young children, considering the risks and benefits balance of F use.

Caries and plaque inhibition in rats by five topically applied dentifrices.

The effectiveness of 5 different brands of dentifrices on caries and plaque were tested in rats in 2 experiments. 10 litters of rats each were infected with Streptococcus sobrinus OMZ-176 and Actinomyces viscosus Ny1. The rats were offered the diet 2000a containing either 40% of sucrose (study I) or 10% of sucrose (study II). The following products were tested topically: (1) H2O, (negative control); (2) chlorhexidine diacetate, (positive control); (3) Parodontax NF; (4) Meridol; (5) Colgate Total; (6) Mentadent C; (7) Dent Xpress. Comparisons with the water control in study I showed that plaque extent was decreased by chlorhexidine diacetate, Dent Xpress and by Mentadent C only. All fluoride-containing dentifrices tested reduced caries. In study II, comparisons with the water control showed that plaque extent was reduced by chlorhexidine diacetate, Parodontax, Meridol, Dent Xpress and by Mentadent C. All dentifrices reduced caries, however, the incidence was low. These 2 studies confirm that fluorides incorporated in dentifrices decrease dental caries in the rat. Differences in the effectiveness of caries inhibition between the 5 dentifrices could not be explained either by the form of fluoride utilized or by the antimicrobials added. Rather, the performance of a given dentifrice depended upon the concerted action of the particular ingredients. It appears that the effect of antiplaque agents should be evaluated in the rat model using a diet containing sucrose at a low level.

An evaluation of a pre-scaling gel (SofScale) on the ease of supragingival calculus removal.

SofScale is a pre-scaling gel, containing disodium EDTA and sodium lauryl sulphate, which is claimed to soften calculus and therefore facilitate its removal. 31 subjects were treated in a double blind randomised placebo controlled split mouth study to evaluate this product. Test or placebo gels were applied to the lingual surfaces of the mandibular teeth for 4 min and the time taken to complete the removal of supragingival calculus recorded. The operator recorded on which side the calculus was considered easier to remove and the patient indicated how comfortable the scaling had been. The mean calculus index was 1.99 for the SofScale group and 1.97 for the placebo. The mean time taken to complete scaling was 5.31 min for both groups. Using the Student t-test, there were no statistically significant differences (p > 0.7) between either the calculus index or time taken to complete the scaling between the groups. The operator did not consider SofScale to facilitate calculus removal and patients did not find calculus removal more comfortable when SofScale had been used. There was no increased sensitivity in the SofScale group following scaling. The results of this study do not support the use of SofScale as an adjunct to scaling.

Brushing-induced effects with and without a non-fluoride abrasive dentifrice on remineralization of enamel surfaces etched with phosphoric acid.

The remineralization of acid-etched enamel after brushing with and without a non-fluoride abrasive dentifrice was investigated using scanning electron microscopy after sodium hypochlorite (NaOCl) or ethylenediamine tetra-acetic acid treatment, of the specimens. Ground enamel pieces were etched with 30% phosphoric acid for 60 s and attached to resin plates. They were exposed to the oral environment of 4 subjects for 8 weeks and brushed for 1 min daily. Paste and brushing caused the acid-etched enamel to erode selectively, i.e., deep grooves were formed in the prism peripheral regions, while projections of the prism bodies showing a relatively low density of crystallites were retained. Brushing without dentifrice, on the other hand, caused about 0.5 micron thick pellicle with tag-like structures to cover the etched enamel. Fine mineral granules, presumably derived from saliva and minute fragments of etched crystallites, were precipitated on the enamel surface as a thin layer with the pellicle. These results indicate that daily brushing without dentifrice induces the remineralization of acid-etched enamel by depositing salivary components, while paste brushing will lead to abrasion of the weakened enamel.

Uptake of 45Ca from a topically-applied monofluorophosphate sodium fluoride calcium hydroxide dentifrice by rat enamel.

Relative 45Ca-uptake in vivo was determined by etchings after dentifrice application between 18 and 22 days of age; uptake increased and the Ca and P that dissolved decreased with application time. The mechanism of 45Ca-uptake from the dentifrice may be due to either isotopic exchange or to the precipitation or crystal growth of calcium and phosphate.