Gingival health status in individuals using different types of toothpaste.

OBJECTIVES: To examine the relationship between the medium term use (>1 year) of a toothpaste containing natural enzymes and proteins (Zendium™) upon gingival index, plaque index and bleeding index compared to medium term use of toothpastes without antimicrobial/antiinflammatory ingredients. METHODS: A total of 305 participants eligible for inclusion were grouped according to their toothpaste use and matched with regard to gender and age (18-30, 31-55 and 56+ years of age). A total of 161 persons were using a toothpaste which contained enzymes and proteins (Zendium™, test group), and 144 persons were using a toothpaste without these ingredients (control group). The amount of dental plaque and the gingival condition were assessed at six sites of each tooth using the modified gingival index (MGI), plaque index (Modified Quigley and Hein plaque index, PI), and bleeding index (BI). Mean values of MGI, PI and BI were compared using analysis of covariance. RESULTS: The test group had significantly less gingival inflammation than the control group (adjusted mean scores (SD); 1.80 (0.65) vs. 2.27 (0.63),p < 0.0001), as well as lower levels of plaque (2.03 (0.33) vs. 2.12 (0.33), p = 0.0168) and gingival bleeding (0.74 (0.45) vs. 1.08 (0.45), p < 0.0001). Females had significantly less gingival inflammation (p < 0.0001), plaque (p = 0.0005) and bleeding (p = 0.0118) than males. Participants aged 18-30 years had significantly higher levels of inflammation and bleeding than the older age groups (p < 0.001), and also higher plaque levels compared to participants aged 31-55 years (p = 0.0069). Potential confounding factors including oral hygiene practices and consistency of dental visits did not differ between groups. CONCLUSIONS: Our findings indicate that medium term use of fluoride toothpaste containing enzymes and proteins (Zendium™) is associated with a better gingival health than the use of other types of fluoride toothpastes without antimicrobial active ingredients. CLINICAL SIGNIFICANCE: Medium term (> 1 year) use of toothpaste containing naturally occurring enzymes and proteins (Zendium™) in an unsupervised home setting is associated with better gingival health compared to the unsupervised use of other commercially available toothpastes without antimicrobial/antiinflammatory active ingredients.

Inhibition of enamel erosion and promotion of lesion rehardening by fluoride: a white light interferometry and microindentation study.

OBJECTIVE: The primary aim of the present in vitro studies was to investigate fluoride as an inhibitor of citric acid-mediated demineralization of human enamel and promoter of lesion repair using a combination of white light interferometry, scanning electron microscopy, and microindentation. Secondary aims included investigation of the importance of brushing on bulk tissue loss, and comparison of the relative efficacy of commercially available toothpastes on inhibiting enamel surface softening and rehardening of incipient erosive lesions. METHODS: Resin-mounted polished enamel specimens were prepared from extracted human molars and pre-molars. Mean surface roughness (Sa) and bulk tissue loss following exposure to an erosive challenge, or an erosive challenge plus brushing were investigated using a MicroXAM ADE PhaseShift white light interferometer. Surface morphology was determined using a Zeiss Evo 50 scanning electron microscope (SEM). The utility of fluoride-based treatments to protect against subsequent acid demineralization and to promote remineralization of pre-formed incipient lesions was determined using microindentation-based enamel surface softening and enamel lesion rehardening models. RESULTS: Treating human enamel specimens with Sensodyne Pronamel conferred a clear protective benefit against a subsequent 300-second citric acid challenge as evidenced by the interferometry and SEM data. The increase in Sa and bulk tissue loss caused by an erosive challenge followed by brushing was markedly reduced by pre-treatment with sodium fluoride (NaF) in a concentration-dependent manner. Sensodyne Pronamel statistically outperformed Colgate Sensitive Enamel Protect both in the enamel surface softening model and lesion rehardening model, and conferred statistically superior enamel fluoride uptake. Treatment of erosive lesions with Sensodyne Pronamel resulted in statistically superior rehardening versus two Crest Pro-Health formulations containing stannous fluoride (SnF2) and sodium hexametaphosphate (NaHMP); the latter did not differ significantly from the fluoride-free negative control paste. Sensodyne Pronamel exhibited statistically significant superiority in a human saliva-based lesion rehardening model compared to Zendium Sensitive containing nominally comparable concentrations of NaF, as well as Colgate Sensitive and Colgate Sensitive Multi Protection containing sodium monofluorophosphate (NaMFP). CONCLUSION: The utility of NaF, whether delivered from simple solution or toothpaste, to reduce citric acid-mediated surface roughening and bulk tissue loss has been clearly demonstrated. The effectiveness of Sensodyne Pronamel as an anti-erosion toothpaste has also been demonstrated in various microhardness models. Crest Pro-Health toothpastes containing SnF2 and NaHMP were not statistically differentiable from a fluoride-free control paste in the lesion rehardening model. The latter result indicates that the benefit of fluoride to promote mineral formation is outweighed by the effect of NaHMP as a mineralization inhibitor in this model.

Fluoride penetration from toothpastes into incipient enamel erosive lesions investigated using dynamic secondary ion mass spectrometry.

OBJECTIVE: The primary aim of this study was to assess the utility of dynamic secondary ion mass spectrometry (DSIMS) as a convenient and sensitive technique for determining fluoride uptake and distribution into incipient human enamel erosive lesions in vitro. A secondary aim was to correlate the extent of lesion rehardening following treatment with a toothpaste slurry, with relative fluoride uptake determined by DSIMS. The final aim was to compare fluoride uptake by incipient lesions treated with toothpastes containing different sources of fluoride using DSIMS. METHODS: Relative fluoride uptake into the surface and body of enamel erosive lesions was monitored by DSIMS as a function of fluoride concentration in a series of formulation-matched experimental pastes. Fluoride uptake into lesions that had been subjected to treatment with different toothpaste slurries in a single-treatment enamel lesion rehardening model was also determined, and its relationship with regard to the extent of rehardening and also the fluoride source investigated. RESULTS: Fluoride uptake by incipient erosive lesions treated with toothpastes containing NaF was quantitatively compared by DSIMS and found to be directly proportional to the fluoride concentration over the studied range (0-1400 ppm). Lesion repair observed in a single-treatment lesion rehardening model was positively correlated with the extent of fluoride uptake by the treated lesions. DSIMS was also able to show differences between commercial toothpastes containing different sources of fluoride and their ability to deliver the fluoride into the body of the lesion. The detrimental effect of sodium hexametaphosphate (NaHMP) present in Crest Pro-Health formulations previously reported in the single-treatment lesion rehardening model was also evident from the DSIMS elemental line scans obtained from the lesion cross-sections. CONCLUSION: DSIMS has been shown to be a powerful selective technique for quantifying relative fluoride uptake into enamel erosive lesions, and determining the extent and depth of lesion penetration. The relative efficacy of toothpastes containing fluoride from a variety of sources in the single-treatment lesion rehardening study is positively correlated with fluoride uptake and penetration determined by DSIMS.