Randomized Controlled Trials Assessing Exposure Frequency Effects of Stannous Fluoride on Gingivitis.

OBJECTIVE: To evaluate the exposure frequency effect of 0.454% stannous fluoride (SnF2) toothpaste in controlling gingivitis. METHODS: Two randomized controlled trials enrolled generally healthy adults with gingivitis. The study duration was 1 mo (study 1) and 3 mo (study 2). Gingivitis was assessed using the Löe-Silness Gingival Index (LSGI) at baseline, 1 mo (both studies), and 3 mo (study 2); bleeding scores were derived from the LSGI. Study groups consisted of positive control (twice-daily use of 0.454% SnF2 toothpaste), experimental group (brushing in the morning with SnF2 toothpaste and in the evening with 0.76% sodium monofluorophosphate [SMFP] toothpaste), and negative control (twice-daily use of SMFP toothpaste). The primary endpoint was number of bleeding sites. RESULTS: Study 1 and study 2 each enrolled and randomized 90 participants; 86 and 89 participants, respectively, completed the trials. At baseline, the mean (SD) number of bleeding sites was 47.6 (18.54) in study 1 and 41.5 (17.84) in study 2. At 3 mo (study 2), the positive control produced 51.3% fewer bleeding sites, and the experimental group produced 32.5% fewer bleeding sites versus the negative control (P < 0.001 for both). At 1 mo, the positive control produced 45.1% (study 1) and 45.8% (study 2) fewer bleeding sites versus the negative control (P < 0.001 for both), and the experimental group produced 33.0% (study 1) and 24.8% (study 2) fewer bleeding sites, respectively, versus the negative control (P ≤ 0.002 for both). The benefit was observed as early as 1 mo and was consistent with 3-mo results. CONCLUSION: This research is to our knowledge the first to demonstrate a gingivitis-reduction response effect for the frequency of bioavailable SnF2 toothpaste use, with maximum benefit from twice-daily use, followed by a single-daily exposure versus the negative control. Clinical trial registration numbers: NCT05916508 and NCT05916521. KNOWLEDGE TRANSFER STATEMENT: The results of this study can be used by dental professionals to guide their recommendations for therapeutic toothpaste for gingival health. Emphasis on the importance of twice-daily brushing with bioavailable stannous fluoride dentifrice will help patients optimize gingival health benefits achieved via self-care.

Influence of using different toothpaste during bleaching with violet LED light (405 nm) on the colour and roughness of dental enamel: an in vitro study.

This in vitro study aimed to investigate potential changes in the color and roughness of dental enamel resulting from the use of different toothpaste formulations during bleaching with violet LED light (405 nm). Sixty specimens of bovine incisors, each measuring 6 × 6 × 3 mm, were segregated into six distinct experimental groups based on their respective treatments (n = 10): C + VL: Brushing with Colgate® Total 12 + bleaching with violet LED; LB + VL: Brushing with Colgate® Luminous White Brilliant + bleaching with violet LED; LI + VL: Brushing with Colgate® Luminous White Instant + violet LED bleaching; C: Brushing with Colgate® Total 12; LB: Brushing with Colgate® Luminous White Brilliant; LI: Brushing with Colgate® Luminous White Instant. The examined variables included alterations in color (∆L*, ∆a*, ∆b*, ∆Eab, and ∆E00), surface roughness (Ra), and scanning electron microscopy observations. No statistically significant distinctions emerged in total color variations (∆E00 and ∆E) among the groups under scrutiny. Notably, the groups that employed Colgate® Luminous White Instant displayed elevated roughness values, irrespective of their association with violet LED, as corroborated by scanning electron microscopy examinations. It can be concluded that whitening toothpastes associated to violet LED do not influence the color change of dental enamel in fifteen days of treatment. Toothpastes with a higher number of abrasive particles showed greater changes in enamel roughness, regardless of the use of violet LED.

Effectiveness of desensitizing toothpastes in reducing tooth sensitivity after tooth bleaching: a systematic review.

OBJECTIVE: To evaluate the effectiveness of desensitizing toothpastes in reducing post-bleaching tooth sensitivity. MATERIALS AND METHODS: A systematic review of randomized clinical trials was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Electronic searches were conducted in the PubMed/MEDLINE, Scopus, Web of Science, The Cochrane Library and Embase databases, using the following terms: (dentifrices OR toothpaste) AND (sensitive OR sensitivity OR dental sensitivity) AND (dental bleaching OR tooth bleaching OR dental whitening OR tooth whitening). RESULTS: Five studies involving 387 individuals undergoing in-office or at-home teeth bleaching were reviewed. Desensitizing toothpastes reduced sensitivity effectively after home bleaching with 22% carbamide peroxide and single-session in-office bleaching with 35% hydrogen peroxide. However, they were ineffective for home bleaching with 16% carbamide peroxide and in-office bleaching across two sessions with 35% or 38% hydrogen peroxide. CONCLUSION: Desensitizing toothpastes are effective for home bleaching with high concentration carbamide peroxide and single-session in-office bleaching with highly concentrated hydrogen peroxide, but ineffective for home bleaching with low concentration carbamide peroxide and two-session in-office bleaching with concentrated hydrogen peroxide.

Whitening toothpastes with hydrogen peroxide concentrations vs. at-home bleaching.

OBJECTIVES: To evaluate the effect of whitening toothpastes with different hydrogen peroxide (HP) concentrations on HP permeability, color change, and physicochemical properties, compared to at-home bleaching treatment. MATERIALS AND METHODS: Forty-nine premolars were randomized into seven groups (n = 7): untreated (control); at-home bleaching with 10% carbamide peroxide gel (AH; 10% CP) with 14 and 28 applications of 180 min each (AH [14 × 180 min] and AH [28 × 180 min]); three whitening toothpastes (3% HP; 4% HP and 5% HP) and 10% CP brushed 28 times for 90 s each (TB [28 × 90 s]). HP permeability was measured using a UV-VIS spectrophotometer and color change by a digital spectrophotometer (ΔEab, ΔE00, and ΔWID). Initial concentration, pH, and viscosity were measured through titration, digital pH meter, and rheometer, respectively. Statistical analysis included one-way ANOVA, Tukey's test, and Dunnett's test (α = 0.05). RESULTS: 4% HP group showed acidic pH, the lowest viscosity and the highest HP concentration into the pulp chamber (p < 0.05). The 10% CP groups had lower HP in the pulp chamber and greater color change than other groups (p < 0.05), except the 5% HP group in ΔEab and ΔE00. For ΔWID, the 10% CP AH groups showed greater whitening than other groups (p < 0.05). CONCLUSIONS: Whitening toothpaste with up to 5% HP resulted in higher HP permeability and less color change compared to 10% CP. Higher HP commercial concentrations in toothpaste increased whitening effect; however, acidic pH toothpastes exhibited greater HP permeability. CLINICAL RELEVANCE: Whitening toothpastes with high hydrogen peroxide concentrations were less effective than at-home bleaching, resulting in less color change and greater permeability of hydrogen peroxide, potentially increasing the risk of tooth sensitivity.

Effect of whitening dentifrices on dental enamel: an analysis of color, microhardness, and surface roughness in vitro.

OBJECTIVES: This study aimed to evaluate the influence of different whitening toothpastes on color change and alteration in enamel surface roughness and microhardness compared to a conventional toothpaste. METHOD AND MATERIALS: Fifty bovine incisors were selected, cleaned, and stored before being divided into five groups: a conventional toothpaste group (C) and three whitening toothpaste groups containing different abrasive agents: silica (S), hydrogen peroxide (PH), and activated charcoal (CA). Specimens underwent simulated brushing, staining with black tea solution, and subsequent analyses of color, surface roughness, and microhardness. Statistical analysis was performed using three-way ANOVA and Tukey post-hoc tests (P < .05). RESULTS: The results showed that the color analysis revealed similar whitening potential among all toothpastes. Otherwise, showed significant differences in surface roughness (P < .001) and microhardness (P < .001) after simulated brushing. While all toothpastes caused a decrease in microhardness, the charcoal-based toothpaste showed a significant increase in surface roughness compared to the initial condition. CONCLUSION: All toothpastes demonstrated whitening capability. Surface roughness changed after brushing with activated charcoal-based whitening toothpaste, but final roughness was similar across all groups. Whitening toothpastes led to a decrease in enamel microhardness, with similar final performance across all toothpastes analyzed.

Enhancing Intraoral Fluoride Retention in Older Adults: A Randomized Crossover Study.

INTRODUCTION: Previous studies have shown that a calcium prerinse can increase intraoral fluoride retention from a fluoride rinse. To explore the potential of this approach to control root caries, we assessed intraoral fluoride bioavailability after a calcium prerinse in older adults with normal to low salivary flow rates. METHODS: In a 2-period crossover trial (NCT04239872), 20 participants (65-80 y old), with low or normal salivary flow rate, rinsed for 1 min with a 0.05% NaF mouth rinse (226 ppm F, F only) or with this rinse immediately after a 1-min rinse with 150 mM calcium lactate (Ca→F). Dental biofilm and saliva samples were collected before and up to 2 h after the rinse(s). Fluoride concentrations in saliva (whole and clarified) and dental biofilm (fluid and solid phases) were blindly determined. Data were statistically analyzed by a mixed-effects model for the effect of treatment, time, and their interaction (α = 5%). RESULTS: The Ca→F group resulted in significantly higher fluoride concentrations in all variables analyzed, for almost all of the collection time points. The effect was greater in the biofilm solids and whole saliva (compatible with the formation of calcium fluoride deposits) and still significant (P < 0.001) after 2 h in the biofilm fluid and clarified saliva, suggesting that fluoride stored in insoluble particles was released, increasing free fluoride. CONCLUSION: The use of a calcium prerinse before a fluoride rinse was able to prolong intraoral fluoride bioavailability in older adults. KNOWLEDGE TRANSFER STATEMENT: A calcium prerinse increased intraoral fluoride bioavailability in older individuals. This approach could be used to improve root caries control without the need to increase the fluoride concentration in dental products.

Evaluation of total, soluble and ionic fluoride concentration in whitening and desensitizing toothpastes.

PURPOSES: Due to the popularity and increasing launch of toothpastes with whitening and sensitivity properties on the market, this study aimed to evaluate the fluoride concentrations in these products, since the concentrations of fluoride directly interfere with the anti-caries potential. METHODS: This is an experimental, in vitro study, where 37 samples from different batches (n = 3) purchased in different countries, were analysed in duplicate, via the ion-selective electrode technique to verify the concentration (µg/g or ppm F-) of total fluoride (TF), total soluble fluoride (TSF) and ionic fluoride (IF). For a comparative data analysis, ANOVA was applied followed by a Tukey's test for multiple comparisons. The level of confidence adopted was 95%. RESULTS: In the 37 assessed toothpastes, 45.9% contained NaF and 54.1% sodium monofluorophosphate (MFP). The TF found in the formulations ranged from 902.8 to 1539.4 ppm of F (mean: 1165.2 ± 179.3); fluoride concentration in the TSF fraction ranged from 708.8 to 1306.7 ppm of F (mean: 959.5 ± 162.4); IF results ranged from 101.9 to 1162.3 ppm of F (642.2 ± 294.1). Significant differences (p < 0.05) were found in the concentrations of the 59.5% assessed toothpastes in comparisons between declared and measured total fluoride (TF) concentrations, as well as in 62.2% when total fluoride (TF) and total soluble fluoride (TSF) were compared. CONCLUSIONS: In this study, most of the samples evaluated showed discrepancies when compared to the information declared by the manufacturers. In addition, the soluble concentrations found in half of the samples were lower than total concentrations and this may affect anti-caries effectiveness.

Dynamics of Dental Enamel Surface Remineralization under the Action of Toothpastes with Substituted Hydroxyapatite and Birch Extract.

To address tooth enamel demineralization resulting from factors such as acid erosion, abrasion, and chronic illness treatments, it is important to develop effective daily dental care products promoting enamel preservation and surface remineralization. This study focused on formulating four toothpastes, each containing calcined synthetic hydroxyapatite (HAP) in distinct compositions, each at 4%, along with 1.3% birch extract. Substitution elements were introduced within the HAP structure to enhance enamel remineralization. The efficacy of each toothpaste formulation was evaluated for repairing enamel and for establishing the dynamic of the remineralization. This was performed by using an in vitro assessment of artificially demineralized enamel slices. The structural HAP features explored by XRD and enamel surface quality by AFM revealed notable restorative properties of these toothpastes. Topographic images and the self-assembly of HAP nanoparticles into thin films on enamel surfaces showcased the formulations' effectiveness. Surface roughness was evaluated through statistical analysis using one-way ANOVA followed by post-test Bonferroni's multiple comparison test with a p value < 0.05 significance setting. Remarkably, enamel nanostructure normalization was observed within a short 10-day period of toothpaste treatment. Optimal remineralization for all toothpastes was reached after about 30 days of treatment. These toothpastes containing birch extract also have a dual function of mineralizing enamel while simultaneously promoting enamel health and restoration.

Antimicrobial efficacy of antiplaque agents of common toothpastes against Porphyromonas gingivalis and Streptococcus oralis: An in vitro study.

Background: This study was designed to evaluate the antimicrobial activity of common gum protection and antiplaque toothpastes against Porphyromonas gingivalis (P. gingivalis) and Streptococcus oralis (S. oralis) as important periodontal pathogens. Materials and Methods: This experimental study investigated the antimicrobial activity of 15 commonly used toothpastes from different companies on the two common types of periopathogens, S. oralis and P. gingivalis . The antimicrobial activity of toothpaste was evaluated at three concentrations of 100%, 50%, and 25% and analyzed by agar well diffusion plate method and zone of inhibition. The obtained data were compared and statistically analyzed by SPSS software using one-way ANOVA and the least significant difference post hoc tests (α = 0.05). Results: One-way ANOVA showed that the mean diameter of the two-bacterial zone of inhibition was significantly different at 100%, 50%, and 25% concentrations of toothpastes (P < 0.001). In general, the mean diameter of the zone of inhibition was greater at 100% concentration than the other two concentrations in all toothpastes. The highest zone of inhibition of the S. oralis was in the toothpastes containing tin. Further, the highest zone of inhibition of P. gingivalis was found in the triclosan-containing toothpastes. Conclusion: Toothpastes containing triclosan had the most antimicrobial activity against P. gingivalis . Moreover, toothpastes containing tin compounds had the most antimicrobial effect against S. oralis .

Effect of a Nano-hydroxyapatite Toothpaste on Enamel Erosive Lesions of Third Molars Induced by Exposure to Orange Juice.

Objectives: This study aimed to assess the effect of a nano-hydroxyapatite (nano-HA) toothpaste on erosive enamel lesions of third molars induced by exposure to orange juice. Materials and Methods: In this in vitro, experimental study, the microhardness of 24 sound-extracted third molars was measured by a Vickers tester. The teeth were then randomly assigned to three groups (n = 8) of nano-HA toothpaste (Pharmed), 1.23% sodium fluoride gel, and artificial saliva. The teeth were exposed to orange juice for 5 min daily for 7 days and were then exposed to nano-HA toothpaste, fluoride gel, or artificial saliva (depending on their group allocation) for 10 min a day. The microhardness of the teeth was measured again after 7 days. Data were analyzed using paired t-test, analysis of variance, and Bonferroni test (alpha = 0.05). Results: Within-group comparisons showed a significant reduction in microhardness of the teeth after the intervention in artificial saliva (P = 0.000), and fluoride gel (P = 0.002) groups. However, no significant reduction occurred in the microhardness of the nano-HA group, compared with the baseline (P = 0.132). Between-group comparisons revealed no significant difference in the microhardness of the three groups at baseline (P > 0.05). However, after the intervention, the microhardness of the nano-HA group was significantly higher than that of other groups (P < 0.05). However, the difference in secondary microhardness between fluoride gel and artificial saliva groups was not significant (P = 1.00). Conclusion: Pharmed toothpaste containing nano-HA has optimal efficacy for remineralization of enamel erosive lesions induced by exposure to orange juice.

Whitening toothpastes effect on enamel surface morphology, chemical profile and color: An In Vitro study / Efecto de las pastas dentales blanqueadoras sobre la morfología, el perfil químico y el color de la superficie del esmalte: un estudio In Vitro

Abstract To assess the effect of different whitening toothpastes on enamel surface morphology, chemical profile and their whitening efficiency. Sixty teeth were divided into 5 groups (12 teeth/group); Gp I: brushed with no toothpaste. Gp II: brushed with Pearl-based toothpaste. Gp III: brushed with Charcoal- based toothpaste. Gp IV: brushed with Alumina-based toothpaste. Gp V: brushed with salt and lemon- based toothpaste. Each tooth was brushed with a bean sized toothpaste wetted with distilled water twice daily by using standard electronic toothbrush for four weeks. Enamel surface morphology, chemical profile and color of each tooth were investigated. Chemical profile results and color measurements were analyzed statistically. Gp I revealed normal enamel surface morphology and chemical profile. Gp II and Gp III demonstrated surface morphology close to Gp I with insignificant reduction in mineral content. Gp IV showed obvious shallowing of perikymata ridges, exposure of fish-scale appearance, with pits and depressions, alongside to the significant reduction in mineral content. Gp V presented the most enamel surface alteration with widening of prism sheath and depressions all over the surface, besides the highest significant reduction in mineral content. Gp V, followed by Gp IV, demonstrated the highest color and whiteness changes, followed by Gp III, then Gp II, while the lowest value was in Gp I. Salt & lemon-based toothpaste, followed by Alumina-based, exerted the most considerable changes in the morphology and chemical profile of the enamel surface, beside to the higher whitening effects on teeth than the others.

Resumen El objetivo del presente estudio fue evaluar el efecto de diferentes pastas dentales blanqueadoras sobre la morfología y el perfil químico de la superficie del esmalte y su eficacia blanqueadora. Sesenta dientes se dividieron en 5 grupos (12 dientes/grupo); Grupo I: cepillado sin pasta de dientes. Grupo II: cepillado con pasta de dientes a base de perlas. Grupo III: cepillado con pasta de dientes a base de carbón. Grupo IV: cepillado con pasta de dientes a base de Alúmina. Grupo V: cepillado con sal y pasta de dientes a base de limón. Cada diente se cepilló con una pasta de dientes del tamaño de un frijol humedecida con agua destilada dos veces al día utilizando un cepillo de dientes electrónico estándar durante cuatro semanas. Se investigaron la morfología de la superficie del esmalte, el perfil químico y el color de cada diente. Los resultados del perfil químico y las mediciones de color se analizaron estadísticamente. El Grupo I reveló una morfología de la superficie del esmalte y un perfil químico normales. Los Grupos II y III demostraron una morfología de superficie cercana a la del Grupo I con una reducción insignificante en el contenido mineral. El grupo IV mostró una evidente reducción de las crestas perikymatas, exposición de apariencia de escamas de pez, con hoyos y depresiones, junto con una reducción significativa en el contenido mineral. El grupo V presentó la mayor alteración de la superficie del esmalte con ensanchamiento de la vaina del prisma y depresiones en toda la superficie, además de una significativa reducción en el contenido mineral. El grupo V, seguido del grupo IV, demostró los mayores cambios de color y blancura, seguido del grupo III, luego el grupo II, mientras que el valor más bajo se presentó en el grupo I. Las pastas dentales a base de sal y limón, seguidas de las de alúmina, ejercieron los cambios más considerables en la morfología y el perfil químico de la superficie del esmalte, además de tener mayores efectos blanqueadores sobre los dientes que las demás.

Evaluation of toothpastes for treating root carious lesions - a laboratory-based pilot study.

BACKGROUND: Root caries is preventable and can be arrested at any stage of disease development. The aim of this study was to investigate the potential mineral exchange and fluorapatite formation within artificial root carious lesions (ARCLs) using different toothpastes containing 5,000 ppm F, 1,450 ppm F or bioactive glass (BG) with 540 ppm F. MATERIALS AND METHODS: The crowns of each extracted sound tooth were removed. The remaining roots were divided into four parts (n = 12). Each sample was randomly allocated into one of four groups: Group 1 (Deionised water); Group 2 (BG with 540 ppm F); Group 3 (1,450 ppm F) and Group 4 (5,000 ppm F). ARCLs were developed using demineralisation solution (pH 4.8). The samples were then pH-cycled in 13 days using demineralisation solution (6 h) and remineralisation solution (pH 7) (16 h). Standard tooth brushing was carried out twice a day with the assigned toothpaste. X-ray Microtomography (XMT) was performed for each sample at baseline, following ARCL formation and after 13-day pH-cycling. Scanning Electron Microscope (SEM) and 19F Magic angle spinning nuclear magnetic resonance (19F-MAS-NMR) were also performed. RESULTS: XMT results showed that the highest mineral content increase (mean ± SD) was Group 4 (0.09 ± 0.05), whilst the mineral content decreased in Group 1 (-0.08 ± 0.06) after 13-day pH-cycling, however there was evidence of mineral loss within the subsurface for Groups 1, 3 and 4 (p < 0.05). SEM scans showed that mineral contents within the surface of dentine tubules were high in comparison to the subsurface in all toothpaste groups. There was evidence of dentine tubules being either partially or completely occluded in toothpaste groups. 19F-MAS-NMR showed peaks between - 103 and - 104ppm corresponding to fluorapatite formation in Groups 3 and 4. CONCLUSION: Within the limitation of this laboratory-based study, all toothpastes were potentially effective to increase the mineral density of artificial root caries on the surface, however there was evidence of mineral loss within the subsurface for Groups 1, 3 and 4.

Little Ironweed and Java Tea in Herbal Toothpaste Reduced Dentine Permeability: An In Vitro Study.

Aim: To determine the effect of an herbal toothpaste containing Little Ironweed and Java Tea, on reducing dentine permeability in vitro. Materials and Methods: Dentine discs from human mandibular third molars were divided into three groups and brushed with herbal toothpaste, nonherbal toothpaste, or deionized water. Each group was immersed in artificial saliva (AS) or 6% citric acid. The permeability of each dentine disc was evaluated before and after saliva or acid challenge using a fluid filtration system. The morphology of dentine discs after treatment was observed using scanning electron microscopy (SEM). The mean permeabilities were statistically analyzed using analysis of variance and Tukey's test. Results: The nonherbal and herbal toothpaste groups demonstrated reduced dentine permeability. AS immersion decreased dentine permeability in both toothpaste groups with values lower than the control group. Dentine permeability values increased after acid immersion in the toothpaste groups and were similar to each other. SEM revealed small granular crystal-like and round particles on the dentine surface and opening of dentinal tubules of both toothpaste groups. More dentinal tubules were opened after brushing with deionized water. Conclusions: The reduction of dentine permeability caused by the herbal toothpaste was similar to that of the nonherbal toothpaste after brushing and the simulated oral conditions. Both herbal plants have the possibility to alleviate clinical hypersensitivity by reducing dentine permeability. Little Ironweed and Java Tea in the toothpaste composition is a potential choice for treating hypersensitive dentine.

The use of mouthwash containing trimetaphosphate as an adjunct therapy to fluoridated toothpaste reduces enamel demineralization.

INTRODUCTION: The decline in dental caries has been attributed to the widespread use of fluoride (F). Two forms of presentation are fluoridated toothpaste (FT) and mouthwash (MW), widely used by the population. MATERIALS AND METHODS: This study aimed to evaluate in vitro the effects of combining FT and MW, whether supplemented with sodium trimetaphosphate (TMP) or not, on dental enamel demineralization. Bovine enamel blocks (n = 60) were selected based on initial surface hardness (SHi) and divided into 5 experimental groups (n = 12 each): I) Placebo Toothpaste (without F/TMP); II) 1100 ppm F Toothpaste (FT); III) 1100F associated with a MW at 100 ppm F (FT + MW 100F); IV) 1100F associated with a MW at 225 ppm F (FT + MW 250F); and V) 1100F associated with a MW at 100 ppm F supplemented with 0.4 % TMP (FT + MW 100F-TMP). The blocks were treated twice a day, undergoing 5 pH cycles over 7 days. Thus, the percentage change in surface hardness (%SH), integrated subsurface hardness loss (ΔKHN), and the concentration of F, phosphorus (P), and calcium (Ca) in the enamel were determined. The data were submitted to ANOVA and Student-Newman-Keuls test (p < 0.001). RESULTS: The 1100F group was statistically inferior to the groups associated with MW for %SH, ΔKHN, and the concentration of P and Ca in the enamel (p < 0.001). Blocks treated with FT + MW 225F and FT + MW 100F-TMP showed significantly lower %SH compared to the other groups (p < 0.001). The FT + MW 100F - TMP group exhibited the lowest depth mineral loss (ΔKHN), and higher concentration de P in enamel (p < 0.001). CONCLUSION: The adjunct use of MW with FT produces a greater protective effect in inhibiting enamel demineralization, and the supplementation of TMP to the MW with 100F provides a superior effect compared to MW with 225F. CLINICAL SIGNIFICANCE: This combination of treatments could be regarded as one of several alternative fluoride supplements for subjects at elevated risk of caries.

Whitening efficacy of activated charcoal-based products: A single-blind randomized controlled clinical trial.

OBJECTIVE: This randomized controlled clinical trial evaluated the whitening efficacy, tooth sensitivity (TS), and volunteers' satisfaction following the use of activated charcoal powder and toothpaste. METHODS: Fifty-six volunteers were randomly allocated into 4 groups (n = 14) according to a 14-day toothbrushing or whitening treatment with activated charcoal powder (ACPW), activated charcoal toothpaste (ACT), regular fluoridated toothpaste (RT), and 10 % carbamide peroxide (CP). Objective (ΔE00) and subjective (ΔSGU) color and whiteness index (ΔWID) changes were calculated. Patients self-reported the risk and intensity of TS using a visual analogue scale and the volunteer's satisfaction was determined by a questionnaire. Color assessments were analyzed by Kruskal-Wallis followed by Dwas-Steel-Crithlow-Fligner, and absolute TS risk and volunteer's satisfaction by Fisher exact test (p < 0.05). RESULTS: ACPW and ACT promoted similar effects in ΔE00, ΔSGU, and ΔWID to that observed for RT. No significant difference was found in terms of TS risk intensity. TS risk became high after 7 and 14 days, with higher TS prevalence in CP. Volunteers reported that ACPW exhibited the lowest ease-of-use, comfort, and whitening satisfaction among groups (p < 0.05). CONCLUSION: Activated charcoal-based products presented a minor and unsatisfactory whitening effect while CP resulted in optimal tooth whitening and the highest level of satisfaction among volunteers. Risk was higher from 7 days onwards and was more pronounced in the CP. CLINICAL RELEVANCE: Based on the whitening effect and patient satisfaction, this controlled-randomized clinical evidence supports that the use of activated charcoal-based products should be discouraged.

Remineralisation of enamel and dentine with stabilised stannous fluoride dentifrices in a randomised cross-over in situ trial.

OBJECTIVES: To compare the remineralisation efficacy and ion bioavailability of two novel SnF2-containing dentifrices in a blinded, cross-over, randomised in situ clinical study. METHODS: Six participants wore removal palatal appliances holding human enamel and dentine blocks with subsurface lesions. Appliances were worn for two treatment periods of 14 consecutive days each, with a one-week washout period in-between. Participants were randomly allocated to rinse with a 1:5 diluted coded slurry of one of two dentifrices containing either 5 % casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) +1100 ppm F as SnF2 [MIPOP], or 1100 ppm F as SnF2 [CT], for 1 min, four times a day. Saliva was collected post-treatment and analysed for tin, calcium, inorganic phosphate and fluoride ions using atomic absorption spectrophotometry and ion chromatography. Enamel and dentine lesions were analysed for percent remineralisation (%R) using transverse microradiography and percent surface microhardness recovery (%SMHR). RESULTS: MIPOP released significantly higher F (3.00 ± 0.27 mM), Ca (15.23 ± 3.23 mM) and Sn (1.18 ± 0.13 mM) into saliva whereas CT released 2.89 ± 0.32 mM F and only 0.84 ± 0.11 mM Ca and 0.28 ± 0.10 mM Sn. MIPOP produced significantly higher %R than CT: 25.6 ± 1.5 % compared to 15.2 ± 0.7 % in enamel, and 33.6 ± 3.1 % compared to 20.6 ± 1.1 % in dentine. Additionally, MIPOP produced significantly higher %SMHR (18.2 ± 7.9 %) compared to CT (4.1 ± 0.6 %). CONCLUSIONS: Both dentifrices promoted remineralisation, but the MIPOP dentifrice with added CPP-ACP and the ion-stabilising effects of CPP released higher amounts of bioavailable tin and produced significantly higher remineralisation and surface microhardness recovery. CLINICAL SIGNIFICANCE: Modern dentifrices contain SnF2 for a range of oral health benefits. Challenges associated with stability of these formulations can affect ion bioavailability, reducing efficacy. Two dentifrices with SnF2 promoted remineralisation in situ, however the dentifrice with the added saliva biomimetic CPP-ACP was superior and therefore may produce greater health benefits.

Description of a new laboratory evaluation method of interdental brush abrasion as a clinical hazard.

OBJECTIVES: To simulate the abrasive potential of an interdental brush when applied with toothpastes and prophylactic gels/solutions in a novel laboratory brushing simulation set-up. METHODS: A brushing device was customized to treat dentin samples mimicking a simplified interdental space with an interdental brush (ISO 2). The brushing, that is, 7200 strokes for 1 h, was performed with artificial saliva (control), a povidone-iodine solution, and slurries of chlorhexidine and fluoride gels as well as three toothpastes with different RDA values ranging from 29 to 100, respectively. The loss of dentin was profilometrically assessed and compared with ANOVA and Fishers LSD. RESULTS: While artificial saliva as control, the solution and the gel slurries showed no measurable dentin loss, toothpastes resulted in a measurable linear surface damage with respect to the actual intrinsic RDA values and ranged from 12.6 to 26.5 µm (p < 0.001). CONCLUSIONS: Any interdental cleaning product should be tailored and carefully instructed. Any over- and misuse should be avoided, which applies especially to the use of interdental brushes in combination with abrasive toothpastes.

At-home bleaching versus whitening toothpastes for treatment of tooth discoloration: a cost-effectiveness analysis

Abstract Objectives This study aimed to analyze the cost-effectiveness of whitening toothpastes and at-home bleaching for the treatment of tooth discoloration. Methodology A cost-effectiveness economic analysis was conducted, and eight randomized clinical trials were selected based on the whitening agent product used: blue covarine dentifrices (BCD), hydrogen peroxide dentifrices (HPD), dentifrices without bleaching agents (CD, negative control), and 10% carbamide peroxide (CP10, positive control) for at-home bleaching. The consumer/patient perspective was adopted, macro-costing techniques were used and a decision tree model was performed considering the costs in the American and Brazilian markets. The color change evaluation (ΔE*ab) was used to calculate the effectiveness of tooth bleaching. A probabilistic analysis was performed using a Monte Carlo simulation and incremental cost-effectiveness ratios were obtained. Results CP10 resulted in the highest cost-effectiveness compared to the use of dentifrices in both markets. In Brazil, HPD was more cost-effective than BCD and CD. In the US, the increased costs of HPD and BCD did not generate any whitening benefit compared to CD. Conclusions CP10 was more cost-effective than BCD and HPD for tooth bleaching from the perspectives of the Brazilian and American markets. Decision-making should consider the use of CP10 for treating tooth discoloration.

Does the combination of whitening toothpaste and hydrogen peroxide bleaching increase the surface roughness and change the morphology of a nanofilled composite?

Aim: To evaluate changes in the surface roughness and morphology of a nanofilled composite following toothbrushing with a whitening (WT) or regular toothpaste (RT), alone or combined with 35% hydrogen peroxide bleaching (HP). Methods: Seventy disc-shaped nanofilled composite (Filtek Z350XT) specimens were randomly divided into groups (n=10): WT, RT, TB (without toothpaste ­ control) or the combinations WT/ HP, RT/HP, TB/HP and HP. All groups underwent toothbrushing simulation (60,000 cycles) and bleaching treatment (4 sessions). Mean surface roughness (Ra, µm) was measured before (T0) and after treatments (TB). Surface morphology was assessed by scanning electron microscopy (SEM) at TB. Mean Ra was analyzed using general mixed models and multiple comparisons by the Tukey-Kramer test (α=5%). Results: HP caused no surface roughness changes on the nanofilled composite after treatment (p>0.05). RT toothbrushing, combined or not with HP, increased the surface roughness (p<0.05). WT and WT/ HP protocols had no effect on the surface roughness of the composite (p>0.05). The nanofilled composite submitted to RT toothbrushing combined with HP (RT/HP) presented substantial surface alterations under SEM, showing deep depressions and round-shaped defects. Toothbrushing with RT combined with the bleaching agent increased exposure of the inorganic fillers. Conclusion: WT toothbrushing, regardless of HP combination, or the single HP protocol had no effect on the surface roughness of the nanofilled composite. However, RT combined with HP negatively affected surface roughness and presented the most noticeable surface changes among groups

Effect of Toothpaste Fluoride Concentration on Color Stability of Resin Composites: An In Vitro Study

ABSTRACT Objective: To investigate the effects of two different dentifrice fluoride concentrations on the color stability of the composite. Material and Methods: Twenty-seven specimens (2×4×5 mm) each of microfilled (Gradia, GC, Japan) and nanohybrid (Grandio, VOCO, Germany) composites were prepared. The specimens were randomly divided into six groups (control, Fluoflor caries protection toothpaste with 1450ppm Fluoride (EXW, France), and Fluoflor kids toothpaste with 500ppm Fluoride (EXW, France) (n = 9). The specimens were immersed in a mixture of artificial saliva and toothpaste in a ratio of 1:3 and applied for 60 seconds every 12 hours for 42 days. The control samples were incubated in artificial saliva at 37°C. Primary and secondary color measurements were performed using color parameters (L∗a∗b) with a spectrophotoshade (MHT Optic Research AG, Niederhasli, Switzerland). Data were analyzed using a two-way analysis of variance at a significance level of 0.05. Results: According to the two-way ANOVA analysis, there was no significant difference in color change between the composites and no difference in the level of discoloration between different fluoride concentrations(p>0.05). Also, None of the dentifrices caused clinically significant color changes(∆E˂3.3). Conclusion: No clinically unacceptable color changes were observed in the microfilled and nanofilled composites with different concentrations of fluoride toothpaste.