Recent Development of Active Ingredients in Mouthwashes and Toothpastes for Periodontal Diseases.

Periodontal diseases like gingivitis and periodontitis are primarily caused by dental plaque. Several antiplaque and anti-microbial agents have been successfully incorporated into toothpastes and mouthwashes to control plaque biofilms and to prevent and treat gingivitis and periodontitis. The aim of this article was to review recent developments in the antiplaque, anti-gingivitis, and anti-periodontitis properties of some common compounds in toothpastes and mouthwashes by evaluating basic and clinical studies, especially the ones published in the past five years. The common active ingredients in toothpastes and mouthwashes included in this review are chlorhexidine, cetylpyridinium chloride, sodium fluoride, stannous fluoride, stannous chloride, zinc oxide, zinc chloride, and two herbs-licorice and curcumin. We believe this comprehensive review will provide useful up-to-date information for dental care professionals and the general public regarding the major oral care products on the market that are in daily use.

Quantitative assessment of dentine mineralization and tubule occlusion by NovaMin and stannous fluoride using serial block face scanning electron microscopy.

Dentine hypersensitivity (DH) is one of the most common dental conditions affecting most adults during their lifetime. Tubule occlusion is a widely accepted method for treating DH. Current in-vitro techniques such as focused ion beam, scanning electron microscopy (SEM), or hydraulic conductance that are used to determine tubule occlusion do not provide the depth of occlusion, are time-consuming, expensive and the volume of dentine tested is limited. The presented study aimed to assess the ability of serial block-face SEM (SBF-SEM) to section dentine, to quantify the number of occluded tubules including the depth of penetration by NovaMin and stannous fluoride (SnF2 ) and to compare mineral density between the control and treated dentine. Results demonstrated that NovaMin provided a better occlusion with 100% of the tubules blocked at the surface compared to 83% for SnF2 . The grayscale value (230.42) was significantly higher (p ≤ 0.05) after treatment with NovaMin compared to SnF2 (222.06) and the control (196.37), indicating increased mineral density and dentine mineralization. SBF-SEM has the potential to be used for large volume analysis of bone-like materials at high resolution with minimal sample preparation over a short period. It can be significantly useful in the development and research of new biomaterials.

An in vitro study on the influence of viscosity and frequency of application of fluoride/tin solutions on the progression of erosion of bovine enamel.

OBJECTIVE: To evaluate the influence of the viscosity and frequency of application of solutions containing fluoride (F) and stannous chloride (SnCl2) on enamel erosion prevention. DESIGN: Bovine enamel specimens were randomly distributed into 12 groups (n = 10), according to the following study factors: solution (C: deionized water; F: 500 ppm F-; F + Sn: 500 ppm F- + 800 ppm Sn2+); viscosity (low and high); and frequency of application (once and twice a day). Specimens were submitted to an erosive cycling model, consisting of 5 min immersion in 0.3% citric acid, followed by 60 min exposure to a mineral solution. This procedure was repeated 4×/day, for 5 days. Treatment with the experimental solutions was performed for 2 min, 1×/day or 2×/day. Enamel surface loss (SL) was determined by optical profilometry. Data were analyzed by 3-way ANOVA and Tukey tests (α = 0.05). RESULTS: There were significant differences between the levels of the factor solution (p < .001), viscosity (p < .001) and in the interaction between solution and viscosity (p = .01). Regarding solution, the mean SL ±â€¯standard deviation for the groups was F + Sn (4.90 ±â€¯1.12) < F (7.89 ±â€¯1.19) < C (14.20 ±â€¯1.69). High viscosity solutions demonstrated less SL than low viscosity; however, only when applied once a day (p < .001). Applying the solutions twice a day yielded lower SL than once a day, but only for the low viscosity solutions (p = .003). CONCLUSIONS: Under the conditions of this short-term in vitro experiment, it could be concluded that increasing the viscosity of the oral rinse solutions reduced enamel loss by erosion; however, this effect was small and only observed when the solutions were applied once a day.

Effects of dentifrices differing in fluoride compounds on artificial enamel caries lesions in vitro.

The aim of this study was to compare the caries-preventive effect of a stabilized stannous fluoride/sodium fluoride dentifrice containing sodium hexametaphosphate with those of a regular, solely sodium fluoride-containing and amine fluoride-containing dentifrice on pre-demineralized bovine enamel specimens using a pH-cycling model. Bovine enamel specimens with two artificial lesions each were prepared. Baseline mineral loss of both lesions was analyzed using transversal microradiography (TMR). Eighty-five specimens with a mean (SD) baseline mineral loss of 3393 (683) vol% × µm were selected and randomly allocated to five groups (n = 13/15). Treatments during pH-cycling (28 days and 2 × 20 min demineralization/day) were: brushing twice daily with slurries of AmF (1400 ppm F-), NaF (1450 ppm F-), SnF2/NaF (1100 ppm F-/350 ppm F-), and fluoride-free (FF) dentifrices or they were immersed in distilled water and remained unbrushed (NB). Subsequently, from each specimen one lesion was covered with acid-resistant varnish, while the remaining lesion was demineralized for another 14 days. Differences in integrated mineral loss (∆∆Z) were calculated between values before and after pH-cycling (∆∆Z E1) as well as before pH-cycling and after second demineralization (∆∆Z E2) using TMR. Treatments AmF and NaF induced a significantly higher mineral gain (∆∆Z E1/∆∆Z E2) compared to treatments FF and NB (p < 0.05; ANOVA test). Except for treatments AmF and NaF no significant differences in mineral loss between before and after pH-cycling could be observed (p < 0.05; t test) [∆∆Z E1: AmF:1563 (767); NaF:1222 (1246); SnF2/NaF:258 (1259); FF:-52 (1223); NB:-151 (834)]. Both dentifrices with either AmF or NaF promoted remineralization, whereas SnF2/NaF dentifrice did not promote remineralization in a biofilm-free pH-cycling model.

A study of radiogallium aqueous chemistry: in vitro and in vivo characterisation of (67) Ga-hydrolysed-stannous fluoride particles.

The objective of this study was to explore the aqueous chemistry of gallium using (67) Ga-chloride starting material, by radiolabelling hydrolysed(h)-stannous fluoride particles and then characterising the optimal formulation for radiochemical purity (RCP) and radioactive particle size distribution in vitro. The pilot reactions determined stannous fluoride was added to (67) Ga-acetate under nitrogen and then heated at 100 °C for 20 min to achieve ≥95% RCP and (67) Ga-particles were >3 µm in diameter. A high radioactive concentration of (67) Ga-h-SnF2 particles could be prepared similarly in ≥97% RCP with 74% as 3-5 µm and 26% >5 µm in diameter. The latter formulation had larger particles than (99m) Tc-h-SnF2 colloid (96% of 1-3 µm), and it resulted in a rat biodistribution of 41% in the lungs, 41% in the liver plus spleen and 18% in the carcass at 20 min after injection. The carcass activity was attributed to bone marrow and some (67) Ga-transferrin formed in blood. Isolated mixed human leucocytes were radiolabelled with (67) Ga-h-SnF2 particles in 100% efficiency, and the (67) Ga-cells did not release soluble (67) Ga(3+) at room temperature over 3 h. The (67) Ga-h-SnF2 particle formulation could find a use in labelling leucocyte cells for in vivo homing studies when delayed animal imaging is required.

Sequence of stannous and sodium fluoride solutions to prevent enamel erosion.

OBJECTIVES: Investigate the timing of stannous (SnF2) and sodium fluoride (NaF) application with and without salivary pellicle to prevent enamel erosion. METHODS: Human buccal molar enamel samples (n=120, REC ref 12/LO/1836) were randomly assigned to three groups testing SnF2 and NaF basic fluoride formulation and commercial mouthrinses with and without the presence of human saliva. Samples were randomly allocated to 2 subgroups: immersion in either fluoride for 1 min either before or after citric acid immersion (0.3%, pH 3.2, 10 min), and the cycle repeated 5 times. For human saliva group, samples were immersed in 80 ml of natural saliva for 24 h prior to the experiment. Analysis was done using non-contacting profilometry and microhardness change. Data were not normal and were log transformed. A linear model tested statistical differences between the groups. RESULTS: SnF2 application before erosion statistically reduced step height compared to application after erosion for all groups (solutions: 6.5 µm (±1.2), 7.5 µm (±0.8); p=0.01, mouthrinses: 3.2 µm (±0.6), 4.2 µm (±0.7); p<0.0001, mouthrinses with saliva: 2.5 µm (±0.4), 3.1 µm (±0.6); p=0.002, before and after respectively). In contrast, application of NaF before erosion increased step height compared to application after, but this was only statistically significant for the saliva group (before: 5.6 µm (±0.3) and after: 4.9 µm (±0.3); p=0.023). Presence of saliva increased microhardness change (p<0.0001). Within this group, greatest microhardness change was observed when SnF2 was applied before erosion and when NaF was applied after erosion (SnF2: 156.6KHN (±32.8), 123KHN (±20.1); p=0.02. NaF: 119.5KHN (±33.5), 218KHN (±24.9), before, and after respectively). CONCLUSION: SnF2 reduced step height formation overall when compared to NaF, but particularly when applied before citric acid immersion. In contrast, NaF reduced step height when applied after citric acid immersion, but only in the presence of saliva. CLINICAL SIGNIFICANCE: Stannous fluoride can be recommended over sodium fluoride to patients at risk of dental erosion and is optimally applied before erosion occurs. If sodium fluoride is to be used in the presence of saliva it is optimally applied after erosion has occurred.

Fluoride ion release and solubility of fluoride enriched interim cements.

STATEMENT OF PROBLEM: Interim and definitive restorations cemented with interim cements for a prolonged interval are susceptible to bacterial infiltration and caries formation. PURPOSE: The purpose of this in vitro study was to evaluate the long-term fluoride release and solubility of aged ZnO-based interim cements enriched separately with 0.4% NaF and SnF2. MATERIAL AND METHODS: Four different brands of cements (Tempbond, Tempbond NE, Procem, and Freegenol) were tested for fluoride release and solubility. For every test, 6 disk specimens of each cement with NaF and SnF2, and 6 with no fluoride enrichment (control) were fabricated, for a total of 72 specimens. The disks were incubated in deionized water. Fluoride ion release was recorded at 1, 7, 14, 21, 63, 91, and 182 days. Solubility was calculated as weight percent after 90 days of incubation. The data were analyzed by analysis of variance with repeated measures and the Tukey honestly significant difference post hoc test (P<.05). RESULTS: Cements mixed with fluorides released fluoride ions for at least 182 days. Cements mixed with NaF released more fluoride ions than those mixed with SnF2 (P<.001). The cumulative release rates from all the tested cements mixed with either NaF or SnF2 were linear with respect to t(½) (r>.97), indicating a diffusion-controlled fluoride release. Cement and fluoride types were the main affecting factors in fluoride ion release. The addition of fluorides slightly increased the solubility of the cements. CONCLUSIONS: Given their long-term sustained and diffusive controlled release, these fluorides, particularly NaF when mixed with ZnO-based interim cements, may be useful for caries prevention under provisionally cemented restorations.

Protective effects of SnF2 - Part I. Mineral solubilisation studies on powdered apatite.

PURPOSE: To compare the ability of two active ingredients - sodium fluoride (NaF) and stannous fluoride (SnF2 ) - to inhibit hydroxyapatite (HAP) dissolution in buffered acidic media. METHODS: Two in vitro studies were conducted. HAP powder, which is representative of tooth mineral, was pretreated with: test solutions of NaF or SnF2 , 10 g solution per 300 mg HAP powder (Study 1); or NaF or SnF2 dentifrice slurry supernatants, 20 g supernate per 200 mg HAP powder for 1 minute followed by three washes with water, then dried (Study 2). About 50 mg of pretreated HAP was exposed to 25 ml of acid dissolution media adjusted to and maintained at pH 4.5 in a Metrohn Titrino reaction cell. Exposure of HAP to the media results in dissolution and release of hydroxide ion, increasing the pH of the solution. The increase in pH is compensated for by automatic additions of acid to maintain the original pH (4.5) of the reaction cell. Total volume of titrant added after 30 minutes was used to calculate the percentage reduction in dissolution versus non-treated HAP control. RESULTS: Both F sources provided protection against acid dissolution; however, in each study, SnF2 -treated HAP was significantly more acid-resistant than the NaF treated mineral. In study 1, at 280 ppm F, representing concentrations of F found in the mouth after in vivo dentifrice use, the reduction in HAP dissolution was 47.7% for NaF and 75.7% for the SnF2 -treated apatite (extrapolated). In study 2, the reduction in HAP dissolution was 61.3% for NaF and 92.8% for SnF2 -treated samples. Differences in percentage reduction were statistically significant (Paired-t test). CONCLUSIONS: Results of these studies demonstrate that both of the fluoride sources tested enhance the acid resistance of tooth mineral and that resistance is significantly greater after treatment with SnF2 compared with treatment of tooth mineral with NaF.

Stannous fluoride dentifrices.

PURPOSE: Stannous fluoride has a long history of use in the improvement of oral health, and was the fluoride source first proven to provide anti-caries benefits when delivered from a dentrifrice formulation. This paper provides an account of the early use of stannous fluoride, primarily for an anti-caries benefit, and the subsequent attempts to formulate stannous fluoride into stable formulations where additional benefits of the stannous cation can be realized.

Physical and chemical characterization of the surface layers formed on dentin following treatment with an experimental anhydrous stannous fluoride dentifrice.

PURPOSE: To characterize, in vitro, the mode of action of stannous fluoride containing formulations in occluding dentin tubules, by means of high resolution microscopy techniques. METHODS: Focused ion beam scanning electron microscopy (FIB SEM) was used to site-specifically prepare cross sections for SEM and TEM imaging and analysis of dentin samples treated with either a stannous fluoride dispersion in glycerol or an experimental stannous fluoride dentifrice. RESULTS: An experimental stannous fluoride dentifrice formed a protective layer over the dentin surface and occluded dentin tubules. Additional supporting data derived from a stannous fluoride dispersion in glycerol suggest that stannous fluoride is a key component of this occluding system. Multiple SEM images obtained from sequential FIB cross-sections were reconstructed into 3-dimensional tomograms that showed a formed layer and tubule occlusion. Sections thinned by FIB techniques were observed by transmission electron microscopy (TEM) and related methods and showed that the coating, which was up to 3 microm-thick, consisted of a tin containing precipitate. Chemical analysis by energy dispersive x-ray spectroscopy (EDS) mapping that used scanning TEM (STEM) methods showed interdiffusion of tin up to 200 nm into the dentin structure.

Tin(II) fluoride vs. tin(II) chloride--a comparison of their coordination chemistry with neutral ligands.

Reaction of SnF2 in MeOH with the appropriate neutral N- or O-donor ligands produces [SnF(2,2'-bipy)]2SnF6, [SnF(1,10-phen)]2SnF4 and [SnF2(L)] L = Me3PO, dmso or pyNO). The X-ray structures of [SnF(2,2'-bipy)]2SnF6, [SnF(1,10-phen)]2SnF4 and [SnF2(dmso)], reveal trigonal pyramidal Sn(II) cores with longer fluorine bridges completing distorted 5- or 6-coordination. Attempts to prepare SnF2 adducts with various phosphine or diphosphine ligands in MeCN failed, whilst in CH2Cl2 solution complex reactions involving the solvent occurred. The NHC, 1,3-(2,6-di-isopropylphenyl)imidazol-2-ylidene (IDiPP) and SnF2 produced the imidazolium salt, [IDiPPH]SnF3, the crystal structure of which revealed the first example of a discrete trifluorostannate(II) ion. In contrast, diphosphine complexes of tin(II) chloride formed readily, including [SnCl2{Me2P(CH2)2PMe2}], [SnCl2{o-C6H4(PMe2)2}], [SnCl2{o-C6H4(PPh2)2}] and [(SnCl2)2(µ-Ph2P(CH2)2PPh2)], which were characterised by X-ray crystallography. The structures of [SnCl2{Me2P(CH2)2PMe2}] and [SnCl2{o-C6H4(PMe2)2}] reveal chloride-bridged dimers, but [SnCl2{o-C6H4(PPh2)2}], although also dimeric, has very asymmetric diphosphine coordination best described as κ(1). The structures of [(SnCl2)2(µ-Ph2P(CH2)2PPh2)] and of [SnCl{o-C6H4(AsMe2)2}]SnCl3 reveal trigonal pyramidal cores, but with longer Sn···Cl bridges affording polymeric structures. The synthesis of [SnCl2(R3EO)2] (R = Ph, E = P or As; and R = Me, E = P) are also reported, along with the structure of [SnCl2(Me3PO)2], which contains distorted tetragonal pyramidal Sn(II) coordination. X-ray structures are also reported for [(PMe3)2CH2][SnCl3]2 and [Ph2P(H)(CH2)2P(H)Ph2][SnCl3]2, obtained as by-products from the attempts to synthesise phosphine complexes, as well as [(o-C6H4(PMe2)2CH2]I2. All complexes were characterised by microanalysis, IR and multinuclear NMR spectroscopy ((1)H, (19)F{(1)H}, (31)P{(1)H } and, where solubility allowed, (119)Sn). Comparisons are drawn with corresponding Sn(IV) and Ge(II) complexes.

Efficacy of different mouthrinse formulations in reducing oral malodour: a randomized clinical trial.

AIMS: The aim of this study was to assess the efficacy of mouthrinses formulations in oral malodour. MATERIAL & METHODS: This single-centre, double-blind, randomized, parallel group clinical trial compared the efficacy of Halita™ and meridol(®) with and without zinc lactate versus negative and positive control. Volunteers with confirmed oral malodour (18/group) rinsed with one mouthrinse during 7 days (15 ml, 2x/day for 1 min.). 15 min. after a first rinse (masking effect), and after 7 days (therapeutic effect) the change in organoleptic scores and level of sulphur compounds was recorded. RESULTS: All rinses showed a masking effect (OLS 1 to 2 values reduced), only the rinses with antimicrobial ingredients showed a therapeutic effect (OLS 1 to 1.5 value less). The addition of zinc resulted in a more pronounced masking effect. Halita™ and meridol(®) with zinc showed the best therapeutic effect. CONCLUSION: Although the masking effect of the rinses can be attributed partially to a dilution and the effect of aromas, the therapeutic effect should be linked to the anti-microbial action of active ingredients and counter action of zinc ions on VSC. A complete resolution of the unpleasant breath by additional mechanical intervention remains to be proven.

The effect of a tin-containing fluoride mouth rinse on the bond between resin composite and erosively demineralised dentin.

OBJECTIVES: To evaluate the effect of a tin-containing fluoride (Sn/F) mouth rinse on microtensile bond strength (µTBS) between resin composite and erosively demineralised dentin. MATERIALS AND METHODS: Dentin of 120 human molars was erosively demineralised using a 10-day cyclic de- and remineralisation model. For 40 molars, the model comprised erosive demineralisation only; for another 40, the model included treatment with a NaF solution; and for yet another 40, the model included treatment with a Sn/F mouth rinse. In half of these molars (n = 20), the demineralised organic matrix was continuously removed by collagenase. Silicon carbide paper-ground, non-erosively demineralised molars served as control (n = 20). Subsequently, µTBS of Clearfil SE/Filtek Z250 to the dentin was measured, and failure mode was determined. Additionally, surfaces were evaluated using SEM and EDX. RESULTS: Compared to the non-erosively demineralised control, erosive demineralisation resulted in significantly lower µTBS regardless of the removal of demineralised organic matrix. Treatment with NaF increased µTBS, but the level of µTBS obtained by the non-erosively demineralised control was only reached when the demineralised organic matrix had been removed. The Sn/F mouth rinse together with removal of demineralised organic matrix led to significantly higher µTBS than did the non-erosively demineralised control. The Sn/F mouth rinse yielded higher µTBS than did the NaF solution. CONCLUSIONS: Treatment of erosively demineralised dentin with a NaF solution or a Sn/F mouth rinse increased the bond strength of resin composite. CLINICAL RELEVANCE: Bond strength of resin composite to eroded dentin was not negatively influenced by treatment with a tin-containing fluoride mouth rinse.

90Y-labeled tin fluoride colloid as a promising therapeutic agent: preparation, characterization, and biological study in rats.

In this study, tin fluoride colloid (SnF-c) was prepared, labeled with yttrium-90 ((90)Y), and characterized with respect to its physicochemical properties and biological behavior in an animal model. Particle size of SnF-c, at constant concentration of SnF(2), was dependent on pH, concentration of sodium fluoride (NaF), temperature, and time. The particle size of SnF-c decreased with an increase in NaF concentration and a decrease in reaction mixture pH. Radiolabeling yield of (90)Y-SnF-c at higher temperature increased and it was greater than 98% for the preparation at 95 °C. The (90)Y-SnF-c demonstrated high in vitro stability both in human serum and human synovial fluid at 37 °C up to 7 days. In vivo distribution studies in healthy male Wistar rats of (90)Y-SnF-c (particles <1 µm), following intravenous administration, revealed that the localization takes place preferably in the liver. The (90)Y-SnF-c (particles >1 µm) was well retained in the synovial space for 96 h after intra-articular injection, whereas leakage of (90)Y from the joint was 1.96% over this period. Because of high labeling yield and stability, (90)Y-SnF-c might be a promising agent for radiosynovectomy or therapy of liver malignancies.

Surface thermodynamic homeostasis of salivary conditioning films through polar-apolar layering.

Salivary conditioning films (SCFs) form on all surfaces exposed to the oral cavity and control diverse oral surface phenomena. Oral chemotherapeutics and dietary components present perturbations to SCFs. Here we determine the surface energetics of SCFs through contact angle measurements with various liquids on SCFs following perturbations with a variety of chemotherapeutics as well as after renewed SCF formation. Sixteen-hour SCFs on polished enamel surfaces were treated with a variety of chemotherapeutics, including toothpastes and mouthrinses. After treatment with chemotherapeutics, a SCF was applied again for 3 h. Contact angles with four different liquids on untreated and treated SCF-coated enamel surfaces were measured and surface free energies were calculated. Perturbations either caused the SCF to become more polar or more apolar, but in all cases, renewed SCF formation compensated these changes. Thus, a polar SCF attracts different salivary proteins or adsorbs proteins in a different conformation to create a more apolar SCF surface after renewed SCF formation and vice versa for apolar SCFs. This polar-apolar layering in SCF formation presents a powerful mechanism in the oral cavity to maintain surface thermodynamic homeostasis--defining oral surface properties within a narrow, biological range and influencing chemotherapeutic strategies. Surface chemical changes brought about by dietary or chemotherapeutic perturbations to SCFs make it more polar or apolar, but new SCFs are rapidly formed compensating for changes in surface energetics.

Hypervalent neutral O-donor ligand complexes of silicon tetrafluoride, comparisons with other group 14 tetrafluorides and a search for soft donor ligand complexes.

The hypervalent adducts of SiF(4), trans-[SiF(4)(R(3)PO)(2)] (R = Me, Et or Ph), cis-[SiF(4){R(2)P(O)CH(2)P(O)R(2)}] (R = Me or Ph), cis-[SiF(4)(pyNO)(2)] and trans-[SiF(4)(DMSO)(2)] have been prepared from SiF(4) and the ligands in anhydrous CH(2)Cl(2), and characterised by microanalysis, IR and VT multinuclear ((1)H, (19)F, (31)P) NMR spectroscopy. The NMR studies show extensive dissociation at ambient temperatures in non-coordinating solvents, but mixtures of cis and trans isomers of the monodentate ligand complexes were identified at low temperatures. Crystal structures are reported for trans-[SiF(4)(R(3)PO)(2)] (R = Me or Ph), and cis-[SiF(4)(pyNO)(2)]. The GeF(4) analogues cis-[GeF(4){R(2)P(O)(CH(2))(n)P(O)R(2)}] (R = Me or Ph, n = 1; R = Ph, n = 2) were similarly characterised and the structures of cis-[GeF(4){R(2)P(O)CH(2)P(O)R(2)}] (R = Me or Ph) determined. The reaction of R(3)AsO (R = Me or Ph) with SiF(4) does not give simple adducts, but forms [R(3)AsOH](+) cations as fluorosilicate salts. SiF(4) adducts of some ether ligands (including THF, 12-crown-4) were also characterised by (19)F NMR spectroscopy in solution at low temperatures (∼190 K), but are fully dissociated at room temperature. Attempts to isolate, or even to identify, SiF(4) adducts with phosphine or thioether ligands in solution at 190 K were unsuccessful, contrasting with the recent isolation and detailed characterisation of GeF(4) analogues. The chemistry of SiF(4) with these oxygen donor ligands, and with soft donors (P, As, S or Se), is compared and contrasted with those of GeF(4), SnF(4) and SiCl(4). The key energy factors determining stability of these complexes are discussed.

In vitro staining effects of stannous fluoride and sodium fluoride on ceramic material.

STATEMENT OF PROBLEM: Long-term fluoride application on the teeth of patients receiving radiation therapy for head and neck tumors results in excessive staining and roughening of ceramic restorations. PURPOSE: The purpose of this in vitro study was to compare the staining effects of 2 fluoride treatments on ceramic disks by simulating 1 year of clinical exposure at 10 minutes per day. In addition, 2 different surface preparations were tested. MATERIAL AND METHODS: Eighty ceramic disks (IPS Empress), 20 x 2 mm, were fabricated. Half of the disks were glazed, and the remaining disks were polished. All disks were brushed for 3 minutes with a soft-bristle power toothbrush and mild dentifrice (baseline) and were immersed in 1 of the 2 fluoride products (0.4% SnF(2), Gel-Kam Gel, or 1.1% NaF, Prevident 5000) for 10 days (n=20). Means and standard deviations of color change (Delta E), surface roughness (Ra, um), and surface gloss (GU) of the ceramic material were measured with a reflection spectrophotometer, a profilometer, and a gloss meter, respectively, at baseline and after fluoride treatment. Two- and 3-way ANOVA (alpha=.05), with surface preparation (polished vs. glazed) and fluoride treatment (0.4% SnF(2) or 1.1% NaF) as independent variables and condition (baseline vs. after fluoride treatment) as a repeated measure, was used to analyze the data. Fisher's PLSD intervals (alpha=.05) were calculated for comparisons among the means. RESULTS: The polished specimens had significantly higher Delta E values, significantly higher surface gloss values, and significantly lower surface roughness values than the glazed specimens before fluoride treatment (P<.001). After both fluoride treatments, ceramic disks exhibited significantly higher surface roughness values when polished and significantly lower surface gloss values when glazed or polished (P<.001). The glazed specimens presented significantly higher surface roughness (P<.001) and lower surface gloss values (P<.001) when treated with 0.4% SnF(2) as compared to NaF. For the polished specimens, there was no significant difference in surface roughness and surface gloss values between the 2 fluoride treatments. CONCLUSIONS: Use of 0.4% SnF(2) and 1.1% NaF gels, in vitro, caused significant color change in the polished IPS Empress ceramic disks. Polishing of the ceramic surface before immersion in either fluoride agent caused the ceramic tested to be more resistant to etching by the 2 solutions tested. The NaF caused less deterioration of the porcelain surface and was less stain inducing than SnF(2).