Gingival hypersensitivity reactions to toothpastes: A case series and scoping review.

BACKGROUND: Hypersensitivity reactions to toothpastes are rare. The objective of this study was to present the authors' clinical cases in the past 10 years and perform a scoping review of gingival hypersensitivity responses to toothpastes. TYPES OF STUDIES REVIEWED: The authors reviewed records of documented gingival hypersensitivity reactions to dentifrices at the Postgraduate Clinic of Oral Medicine, Complutense University, Madrid, Spain, from January 2013 through December 2022. Furthermore, the authors conducted a search in PubMed with no date limit for articles reporting these hypersensitivity responses up through October 18, 2023. RESULTS: Eleven cases were collected from the clinic. Eight gingival hypersensitivity reactions occurred in women, and 6 were associated with cinnamon. The most frequent lesions diagnosed were red gingiva. The discontinuation of the toothpaste led to the disappearance of the lesions. The search yielded 643 references. Thirteen articles were included in the scoping review, all of them case series and case reports, reporting 32 cases. Lesions affected middle-aged women most frequently, the most common hypersensitivity reaction was gingival redness, and the cases implicated toothpastes containing cinnamon and herbal composition. PRACTICAL IMPLICATIONS: This study provides clues for diagnosing and treating hypersensitivity reactions to toothpastes, which may improve the identification, management, and reporting of these cases.

Longterm abrasive and erosive effect of whitening toothpaste on dentin surface.

PURPOSE: To evaluate the amount of dentin loss following immersion in or toothbrushing with whitening toothpaste (WT) containing hydrogen peroxide (HP) and citric acid (CA). Additionally, the amount of dentin loss after brushing with a WT alone or in combination with a conventional toothpaste was assessed, and the effects of HP and CA solutions on the dentin surface were investigated. METHODS: Bovine dentin specimens (n= 350) were randomly assigned to seven solutions of various compositions as toothpaste: The specimens assigned to each solution were then further divided into five treatment groups (n=10 each) : Group A = 1-hour immersion in each solution (ES); Group B = 10,000 brushing in ES; Group C = 1-hour immersion in ES + 10,000 brushing in ES; Group D = 1-hour immersion in ES + 10,000 brushing in reference slurry (RS); Group E = 10,000 brushing in ES + 10,000 brushing in RS. The amount and pattern of dentin loss were determined, and the surfaces were observed using noncontact profilometry. RESULTS: The WT (pH 5.0) caused lower dentin loss than RS after a single brushing cycle; however, the extent of dentin loss after 1 hour of immersion in the WT was significantly greater than that in the RS. Among the specimens treated with WT, a significant difference in dentin loss was observed between Group C and Groups D and E (P< 0.05) but not between Groups D and E. The surfaces exposed to CAS1, CAPB, and WT exhibited U-shaped patterns of dentin loss after brushing or immersion, whereas a wedge-shaped pattern was observed in those that underwent brushing with the RS. CLINICAL SIGNIFICANCE: The effects (dentin abrasion) of a whitening toothpaste containing hydrogen peroxide and citric acid when used in combination with a conventional toothpaste were similar to those seen with the continuous use of a conventional toothpaste alone.

Toothpaste ingestion-evaluating the problem and ensuring safety: systematic review and meta-analysis.

This systematic review and meta-analysis aimed to evaluate the ingestion of toothpaste and its sequelae. The study adhered to the PRISMA guidelines and was registered in the PROSPERO database. A comprehensive search strategy was conducted across multiple databases, resulting in the inclusion of 18 relevant publications. Eligible studies encompassed various designs and included both children and adults as the study population. Data extraction was carried out systematically, and relevant information on study characteristics, interventions, and outcomes were collected. The assessment of bias was performed using the Joanna Briggs Institute's Critical Appraisal Tools showing variations of bias among the included studies. The overall risk of systemic toxicity was found to be low, and no severe or life-threatening events were reported in the included studies. Furthermore, some toothpaste formulations containing higher concentrations of fluoride were associated with an increased risk of dental fluorosis. These findings have several implications for practice and policy. Healthcare providers and dental professionals should emphasize the importance of promoting safe toothpaste use, especially in vulnerable populations such as young children who are more prone to accidental ingestion. Public health campaigns and educational initiatives should aim to raise awareness about appropriate toothpaste usage and the potential risks. In addition, toothpaste manufacturers and regulatory bodies should consider revising guidelines and regulations to ensure the safety of oral care products, including the appropriate concentration of active ingredients. Future research should focus on investigating the long-term effects of toothpaste ingestion, exploring potential interactions between different active ingredients, and evaluating the efficacy of current preventive measures.

Effects of a commercial whitening toothpaste containing hydrogen peroxide and citric acid on dentin abrasion and erosion.

BACKGROUND: Hydrogen peroxide (HP) and citric acid (CA), key contributors to toothpaste acidity, can lead to dental loss. This study aimed to compare the amount of abrasion or loss of dentin based on pH, buffering, and concentration of HP and CA in commercial and experimental toothpastes after toothbrushing or immersion. METHODS: Bovine dentin specimens were randomly assigned to nine solutions. The prepared solutions included two commercial toothpastes (whitening toothpaste [WT] with HP and CA; conventional toothpaste [CT] without HP and CA), reference slurry (RS), two CA solutions (1.92%, CAS1; 0.001%, CAS2), basic solution (7.16% sodium phosphate dibasic [SPDS]), CA phosphate buffer solution (3.58% SPDS and 0.96% CA [CAPB]), HP solution (4%, HPS), and distilled water (DW). Dentin specimens were performed in two treatments: one with only abrasion (10,000 brushings) and one with only immersion (1 h). After treatments, the amount of dentin loss and surface images were measured and observed using noncontact profilometry. Data were analyzed using an one-way analysis of variance and the Tukey test as a post hoc analysis (p < 0.05). RESULTS: WT with pH 5.0 had lower dentin abrasion than CT and RS after brushing but had higher dentin loss than both after immersion. The dentin surfaces of CAS1, CAPB, and WT were damaged after immersion, whereas HPS, CAS2, CT, SPDS, RS, and DW remained intact after soaking. CAS2 and HPS, which had a pH of 5.0 like WT, did not significantly differ from those of DW after brushing. CONCLUSIONS: WT containing HP and CA did not cause significant dentin abrasion but may cause additional dentin loss even without brushing. After brushing or immersion, the CA concentration may affect the dentin surface more than the HP concentration included in WT. The amount of abrasion or loss of dentin after brushing or soaking can vary based on the composition, concentration, and buffer in the solution, even if the pH of the solution is similar to pH 5.0.

[Dental materials and oral care products that can cause contact allergies]. / Tandheelkundige materialen en mondverzorgingsproducten die contactallergieën kunnen geven.

Various restorative and prosthetic materials, dental implants, medicines and cosmetic materials, such as toothpaste and denture cleaning products, are used in oral care. In principle, these materials can cause contact allergies, which can manifest as lichenoid reaction, cheilitis and angioedema. It is usually a local reaction of the oral mucosa and surrounding tissues, but a systemic reaction can also occur elsewhere in the body. If a patient develops complaints from dental materials that could be due to an allergy, it makes sense to investigate this allergologically, although these do not yet show full specificity or sensitivity. After a positive allergological examination, it is possible to examine more specifically whether the patient's complaints match the test result and it can be decided whether it is sensible to replace the dental material and, if so, which material could be an alternative. After removal of the causative allergens, the complaints should disappear completely.

Use test with l-carvone in toothpaste on sensitized individuals.

BACKGROUND: The mint flavour carvone (l-carvone) is considered a weak contact allergen. However, contact allergy to carvone is more prevalent in patients with oral lichen planus or oral lichenoid lesions (OLP/OLL). OBJECTIVE: Our aim was to investigate how carvone affects sensitized individuals through a use test with toothpaste containing carvone. Non-flavoured toothpaste served as control. METHODS: Subjects were patch tested prior to the use test-14 subjects allergic to carvone (11 with OLP/OLL), 20 subjects with OLP/OLL and 3 healthy controls. The month-long use test comprised of using toothpaste twice daily. Subjects were examined fortnightly. Clinical signs were assessed with a mucosal scoring system. The subjects' oral health-related quality of life was measured with the oral health impact profile (OHIP-49). RESULTS: Local reactions to the carvone toothpaste presented as aggravated OLL (7/10) and peri-oral eczema (2/10) in allergic subjects. They also had significantly higher mucosal and OHIP scores compared with those receiving non-flavoured toothpaste. CONCLUSION: In sensitized individuals, oral exposure to carvone gives aggravated oral lesions and/or peri-oral eczema. The lesions mimic OLP and allergic individuals are therefore at risk of not being assessed with regard to flavour contact allergy.

Abrasive Enamel and Dentin Wear Resulting from Brushing with Toothpastes with Highly Discrepant Relative Enamel Abrasivity (REA) and Relative Dentin Abrasivity (RDA) Values.

PURPOSE: To investigate the absolute wear caused by toothpastes with highly discrepant REA (Relative Enamel Abrasivity) and RDA (Relative Dentin Abrasivity) values on both enamel and dentin: Candida Peppermint (CP; REA: 1; RDA: 42), Colgate Total Original (CTO; REA: 4; RDA: 100), Signal White System (SWS; REA: 8; RDA: 143), and Candida White Diamond (CWD; REA 244; RDA: 12). MATERIALS AND METHODS: Eighty (80) bovine enamel samples and 80 dentin samples were divided into four groups each (n = 20) and investigated after a 6-h brushing procedure (21,600 cycles, 60 cycles/min, load of 2.5 N) with the four toothpastes. The abrasive enamel and dentin wear were registered using a contact profilometer. The median and interquartile range (IQR) of the abrasive enamel and dentin wear were calculated for each group. Pairwise comparisons were conducted using the Wilcoxon signed-rank exact test, and the p-value was adjusted according to Holm (statistical significance set at 0.05). RESULTS: CWD led to the highest abrasive enamel wear (9.86 µm [5.77]). CTO caused the highest abrasive dentin wear (166.70 µm [69.90]), being statistically significantly higher than the wear for CP (54.20 µm [24.00]) and CWD (17.00 µm [7.80]) (p = 0.00001). The abrasive dentin wear for CWD was statistically significantly lower in comparison to all other groups (p = 0.00001). CONCLUSION: Toothpastes with highly discrepant REA and RDA values presented statistically significantly different absolute wear on enamel and dentin. REA and RDA values should both be declared for every toothpaste.

Relative dentin and enamel abrasivity of charcoal toothpastes.

OBJECTIVES: Very little data are known about charcoal toothpastes. The aim of this study was to counteract the missing data by determining the relative dentin abrasivity (RDA) and relative enamel abrasivity (REA) values of charcoal toothpastes. METHODS: Radioactively charged dentin and enamel samples were randomly divided into groups of eight specimens. Each group was brushed with two of total 12 charcoal toothpaste slurries and with a standard abrasive with a known RDA and REA value. The measured radioactivity in counts per minute within the slurries corresponds to the amount of dentin or enamel abraded. RDA and REA values of the charcoal toothpastes were expressed relative to the known value of the standard slurry. RESULTS: The RDA and REA values of the charcoal toothpastes have a broad range of 24-166 and 0-14, respectively. CONCLUSIONS: The RDA and REA values do not differ significantly from previously tested commercially available toothpastes. However, the lack of fluoride compounds in many of the investigated charcoal toothpastes can have a less beneficial effect for the consumers. It is very important to educate patients accordingly.

The in vitro Effect of Dentifrices With Activated Charcoal on Eroded Teeth.

AIM: The objective of this research was to compare the abrasive potential of dentifrices containing activated charcoal with those of a conventional dentifrice on the development of erosive tooth wear (ETW) in vitro. METHODS: Enamel and dentin samples were divided into toothpastes (n = 12): group (G)1-Colgate Triple Action (1450 ppm F) (positive control); G2-Colgate Natural Extracts (1450 ppm F); G3-Colgate Luminous White Activated Carbon (1450 ppm F); G4-Oral-B Whitening Therapy Charcoal (1100 ppm F); G5-Oral-B 3D White Mineral Clean (1100 ppm F); G6-Curaprox Black Is White (950 ppm F); and G7-erosion only (no abrasion, negative control). All samples were submitted to erosive pH cycles and G1 to G6 to abrasive challenges (15 seconds) using toothpastes' slurries plus 45 seconds of treatment for 7 days. The final profile was overlaid to the baseline one for the ETW calculation (µm). The data were subjected to analysis of variance/Tukey or Kruskal-Wallis/Dunn tests (P < .05). RESULTS: Oral-B 3D White (13.0 ± 1.0, 9.37 [1.36] µm), Oral-B Whitening Therapy (15.1 ± 1.2, 8.58 [1.71] µm), and Colgate Luminous White (13.6 ± 1.0, 7.46 [0.94] µm) toothpastes promoted the greatest enamel and dentin wear. On the other hand, Colgate Triple Action (12.2 ± 1.2, 5.30 [1.26] µm), Colgate Natural Extracts (10.8 ± 1.1, 4.16 [1.11] µm), and Curaprox Black Is White (11.5 ± 1.5, 4.06 [0.92] µm) toothpastes promoted lower wear values, similar to erosion only (4.16 [0.94] µm) in the case of dentin but not enamel (7.1 ± 0.8 µm). CONCLUSIONS: Toothpastes containing charcoal combined with pyrophosphate may have a high abrasive effect on eroded tooth surfaces. Many patients influenced by digital marketing use toothpastes containing activated charcoal with the aim of bleaching their teeth. However, care should be taken when using these products, as they may have a high abrasive effect.

Green dentistry: Organic toothpaste formulations. A literature review.

Dentistry as a profession should take into account the goals of sustainable development in daily practice and encourage the transition to a green economy. Consumers are becoming more conscious about the impact of self-care products, including toothpastes, on the environment. Organic toothpastes are considered very safe. A broad literature review was conducted to: (i) identify the ingredients in available organic toothpastes; (ii) classify them into active and inactive; and (iii) evaluate each ingredient's purpose and the adverse events that may be associated with its use. A comprehensive list of available organic toothpastes and their ingredients was compiled based on the products from the largest Italian organic supermarket chain (NaturaSì®) that is representative of the European market. Then, PubMed, Scopus and Google Scholar databases were searched to identify, classify and evaluate each ingredient. The final sample consisted of 46 organic toothpastes that included 156 ingredients; 139 (89.1%) and 17 (10.9%) were classified as active and inactive, respectively. Overall, 32 (20.5%) ingredients were associated with known adverse events. The results of this study indicate that organic toothpastes are highly biocompatible with oral cavity tissues. Careful product selection may help consumers avoid potential adverse effects that can be caused by ingredients such as polymers (e.g., polyethylene glycol) and carbomers, detergent agents (e.g., sodium lauryl sulfate), and triclosan. The lack of clinical studies should encourage the development of sufficient evidence to provide consumers with recommendations for daily use, based on both efficacy and biocompatibility.

Diamond particles in toothpastes: in-vitro effect on the abrasive enamel wear.

BACKGROUND: Diamond particles have recently been used as abrasives in toothpastes, which raises questions about its abrasive behaviour towards enamel. This study was carried out to investigate the abrasive enamel wear caused by three diamond-loaded toothpastes (Candida White Diamond: CWD, Swiss Smile Diamond Glow: SSDG, Emoform F Diamond: EFD) and to compare it with a traditional toothpaste with silica abrasive (Colgate Total Original CTO). METHODS: Eighty bovine enamel samples were divided into four groups (n = 20) and brushed for 21,600 cycles (60 cycles/min) for 6 h at 2.5-N brushing force. The abrasive enamel wear was recorded with a contact profilometer. The median and interquartile range (IQR) of the abrasive enamel wear was calculated in each group. Pairwise comparisons were conducted using Wilcoxon signed rank exact test and the p value was adjusted according to Holm. Significance level was set at 0.05. RESULTS: Diamond-loaded toothpastes caused statistically significantly higher abrasive wear than the traditional toothpaste (p < 0.0001). SSDG caused statistically significantly higher enamel wear (19.0 µm (11.2)) than CWD (8.4 µm (4.6)) and EFD (7.3 µm (3.9)) (p < 0.0001). CONCLUSIONS: Diamond-loaded toothpastes cause higher enamel wear than toothpastes with traditional abrasives and also exhibit different abrasivity behaviour compared to each other.

Side effects of sodium lauryl sulfate applied in toothpastes: A scoping review.

PURPOSE: To perform a scoping review on the available literature regarding the side effects of sodium lauryl sulfate (SLS) used in toothpastes. METHODS: A scoping review was performed according to the PRISMA extension using PubMed. The electronic search was supplemented with a manual search for a complete overview. A customized data collection form was used to map data which was developed to register the extracted relevant data. The results of the selected articles were classified according to effects in the mouth, on the mucous membrane or elsewhere in the body and the healing effects of SLS-free toothpaste on aphthous ulcers. The outcomes from each category were reported in separate data forms and the studies with incomplete information were excluded from the assessment. RESULTS: Possible harmful effects of SLS were reported as mucosal desquamation, irritation or inflammation of oral mucosa or the dorsal part of the tongue, ulcerations, and toxic reactions in the oral cavity. CLINICAL SIGNIFICANCE: There is limited evidence that patients with recurrent aphthous ulcers can benefit from the use of SLS-free toothpastes in terms of decrease in the number of ulcerations, duration of the ulcerations and the intensity of the pain caused by the ulcerations. It is essential to create awareness for the side effects of SLS in toothpastes but further research is needed on its effect on oral and gastrointestinal systems when used in toothpastes.

Allergic contact stomatitis due to desensitizing toothpastes.

Toothpastes are one of the most common personal care products among people of all ages. The various toothpaste types and their complex ingredients could cause irritation or allergic reactions. Allergic contact stomatitis has been often seen in clinical practice; however, desensitizing toothpastes as a trigger are often unrecognized. Here, we report three cases of allergic contact stomatitis due to stannous chloride-containing desensitizing toothpastes. General dentists and other professionals should pay more attention to the safety and adverse effects of toothpastes.

Micro computed tomography analysis of abrasivity of toothpaste tablets compared to conventional toothpaste.

PURPOSE: To evaluate with microCT dentin and enamel abrasion depth caused by toothpaste tablets when compared to conventional toothpastes. METHODS: Dentin (N= 64) and enamel blocks (N=64) were randomized into four experimental groups of 16 specimens each for dentin and enamel. CP: Colgate Cavity Protection, served as the low abrasive toothpaste; AW: Colgate Total Advanced Whitening was used to represent a highly abrasive toothpaste. Two different types of toothpaste tablets were used. DT: Denttabs and BT: Bite tabs. To prepare the slurries, 40 mL of water was added to 25 g of each toothpaste and 4.4 g of each toothpaste tab. Blocks were brushed for a total of 10,000 and 40,000 strokes for dentin and enamel, respectively following ISO standard 11609. On completion of brushing, specimens were scanned with a microCT system. Tomographic 3D reconstruction followed by abrasion depths measurements were performed. Kruskal-Wallis procedure tested abrasion depths among the different groups. Tests of hypotheses were two-sided with an alpha level at 0.05. RESULTS: There was a statistically significant difference in dentin abrasion depth among the groups (P< 0.001). The mean dentin/enamel abrasion depths in microns were 25.3/4.4, 36.8/4.4, 66.8/3.0, and 230.3/15.5 for DT, BT, CP, and AW respectively. Dentin and enamel abrasion depth of AW was the highest and was different from all other groups after multiple comparisons (P< 0.05). CLINICAL SIGNIFICANCE: Dentin abrasivity of toothpaste tabs is negligible as determined with microCT.

Biomarkers for the Assessment of Exposure to Fluoride in Adults.

To monitor deficient or excessive intakes of biologically available fluoride (F), various biological samples have been tested for use as biomarkers of human exposure to F. Most such studies have concerned children and often have only involved measurement of F in 1 or 2 types of sample. The present study investigated the relationships of F concentrations in biomarkers of F exposure; including plasma, saliva, hair, finger- and toenails, and daily urinary F excretion (UFE) with the total daily F intake (TDFI) of adults. TDFI was assessed in 60 healthy adults, aged ≥20 years; 31 lived in a low-F water area (LFA, 0.04 mg F/L) and 29 in a high-F water area (HFA, 3.05 mg F/L) of Nigeria. All volunteers provided at least 1 biomarker sample from the above list and completed a questionnaire to evaluate F intake from the diet and toothpaste ingestion. TDFI, UFE and F concentrations of biomarkers were statistically significantly higher in the HFA than in the LFA. There were strong statistically significant positive correlations between TDFI and UFE (ρ = 0.730, p < 0.001); plasma F (ρ = 0.729, p < 0.001); fasting whole saliva F (ρ = 0.653, p < 0.001) and hair F (ρ = 0.603, p < 0.001). The statistically significant positive correlations between TDFI and fingernail F (ρ = 0.502, p < 0.001) and between TDFI and toenail F (ρ = 0.556, p < 0.001) were moderate. In conclusion, this study has indicated the usefulness of 24-h UFE as well as F concentration in plasma, fasting whole saliva and hair as biomarkers of contemporary or sub-chronic F exposure in groups of adults. However, they do not appear to have the necessary sensitivity to predict F exposure in individuals.

Effect of a sonic toothbrush on the abrasive dentine wear using toothpastes with different abrasivity values.

OBJECTIVE: This in vitro study aimed to investigate the effect of a sonic toothbrush on the resulting abrasive dentine wear using toothpastes with different abrasivities compared to the use of a manual toothbrush. METHODS: Ninety-six bovine dentine samples were divided into six groups and subjected to a brushing sequence (sonic: 20 min, 0.9 N, 10 strokes/min; manual: 20 min, 1.6 N, 60 strokes/min) as follows: group 1: Elmex Sensitive Plus (RDA = 28) + manual toothbrush; group 2: Elmex Sensitive + sonic toothbrush; group 3: Elmex Kariesschutz (RDA = 65) + manual toothbrush; group 4: Elmex Kariesschutz +sonic toothbrush; group 5: Colgate Total Original (RDA = 121) + manual toothbrush; and group 6: Colgate Total Original +sonic toothbrush. The abrasive dentine wear was measured profilometrically. RESULTS: The median (IQR) abrasive dentine wear was as follows: Elmex Sensitive Plus (manual toothbrush: 2.7 µm (0.8), sonic toothbrush: 3.1 µm (1.9)); Elmex Kariesschutz (manual toothbrush: 4.9 µm (1.4), sonic toothbrush: 6.4 µm (2.1)); and Colgate Total Original (manual toothbrush: 5.2 µm (1.1), sonic toothbrush: 9.0 µm (3.1)). Differences in dentine wear between sonic and manual toothbrushes were statistically significant only in the groups brushed with Elmex Kariesschutz and Colgate Total Original (p ≤ 0.05). CONCLUSION: Brushing with a sonic toothbrush could result in a higher abrasive dentine wear compared to manual toothbrush when combined with toothpastes with high abrasivity values.

Fluorose por ingestão voluntária de pasta fluoretada após os 5 anos de idade: relato de caso e discussão da importância da educação em saúde bucal na 1a infância / Fluorosis from voluntary ingestion of fluoride paste after 5 years of age: case report and discussion of the importance of health education in early childhood

Introdução: Preocupações com a ingestão de pasta fluoretada por crianças se limita à primeira infância devido ao risco de fluorose nos dentes permanentes anteriores, mas o processo educativo para garantir uma segurança para toda a dentição tem sido negligenciado. Objetivo: Relatar um caso de fluorose dentaria em dentes caninos, pré-molares e 2o molares por ingestão voluntária de pasta fluoretada Relato do caso: Paciente de 12 anos, 65 kg, procurou atendimento odontológico devido a insatisfação com a coloração dos dentes posteriores. Constatou-se que os dentes caninos, pré-molares e segundo molares, superiores e inferiores apresentavam opacidades tipo fluoróticas, estando os demais normais. Entre as possíveis causas, a principal recaiu sobre o modo que a criança passou a escovar os dentes após os 5 anos de idade. Foi relatado que ela voluntariamente escovava seus dentes 6x/dia sem cuspir. Foram feitas análises da concentração de fluoreto da água consumida pela paciente e nas pastas usadas. Também foi feito teste de excreção de fluoreto urinário pela paciente, solicitando para ela escovar os dentes cuspindo ou engolindo toda a pasta em uso. Resultados: Na água foi encontrado 0,74 mg F/L e nas pastas usadas 1.357 e 1.426 mg F solúvel/ kg. Na urina foi encontrado 0,90 e 1,35 mg F, respectivamente, cuspindo ou engolindo a pasta após as escovações. Foi estimado que a partir dos 5 anos de idade, a criança se submeteu à dose de 0,17 mg F/dia/kg de peso corpóreo, a qual é 2,4 vezes maior que o limite superior de risco de fluorose. Conclusão: O caso relatado sugere ser uma consequência de falha do processo de educação em saúde na 1a infância quanto ao uso racional de dentifrício fluoretado.

Introduction: Concerns about children's intake of fluoride toothpaste are limited to infancy due to the risk of fluorosis in the permanent anterior teeth, but the educational process to ensure safety for the entire dentition has been neglected. Objective: To report a case of dental fluorosis in canine, premolar and 2nd molar teeth caused by voluntary ingestion of fluoride toothpaste. Case report: A 12- year-old patient, 65 kg, search dental care due to dissatisfaction with the color of the posterior teeth. It was diagnosticated that the superior and inferior canine, premolar and second molar teeth had fluorotic opacities, and the other teeth are sound. Among the possible causes, the main one was the way the child started brushing their teeth after 5 years of age. It was reported that she voluntarily brushed her teeth 6x/day without spitting. Analyzes of the fluoride concentration in the water consumed by the patient and in the toothpastes used were performed. A urinary fluoride excretion test by the patient, requesting her to brush her teeth by spitting out or swallowing all the toothpaste in use, was made. Results: Fluoride concentration in the water was 0.74 mg F/L and 1,357 and 1,426 mg F/kg in the toothpastes pastes used. In urine test, 0.90 and 1.35 mg F were found, respectively, spitting or swallowing the toothpaste after brushing. It was estimated that from 5 years of age, the child was submitted a dose of 0.17 mg F/day/kg of body weight, which is 2.4 times the upper limit for an acceptable fluorosis. Conclusion: The reported case suggests that it is a consequence of the failure of the health education process in early childhood regarding the rational use of fluoride toothpaste.

In vitro three-dimensional organotypic culture models of the oral mucosa.

Three-dimensional, organotypic models of the oral mucosa have been developed to study a wide variety of phenomena occurring in the oral cavity. Although a number of models have been developed in academic research labs, only a few models have been commercialized. Models from academic groups offer a broader range of phenotypes while the commercial models are more focused on the oral and gingival mucosa. The commercialized models are manufactured under highly controlled conditions and meet the requirements of quality standards, which leads to high levels of reproducibility. These in vitro models have been used to evaluate the irritancy of oral care products such as toothpastes, mouthwashes, and mucoadhesives. The effects of cigarette smoke on oral cavity tissues have been studied and compared to those of e-cigarettes. Oral tissue models have facilitated investigation of the mechanisms of oral mucositis and oral candidiasis and have been used to examine transbuccal drug delivery rates and the absorption of nanoparticles. Infection studies have investigated the effects of HIV-1 along with the effects of commensal and pathogenic bacteria. More recently, a differentiated oral tissue model has been shown to express the ACE2 receptor, which is known to be important for the receptor-mediated entry of the SARS-CoV-2 coronavirus into human cells and tissues. Hence, oral mucosal models may find application in determining whether viral infection of the oral mucosa is possible and whether such infection has implications vis-a-vis the current COVID-19 pandemic. As is apparent, these models are used in a broad variety of applications and often offer advantages versus animal models in terms of reproducibility, avoiding species extrapolation, and the ethical concerns related to human and animal experimentation. The goals of this paper are to review commercially available models of the human buccal and gingival mucosa and highlight their use to gain a better understanding of a broad range of phenomena affecting tissues in the oral cavity.