Impact of toothbrush head configuration and dentifrice abrasivity on non-carious cervical lesions in-vitro.

OBJECTIVE: To investigate the effect of toothbrush head configuration and dentifrice slurry abrasivity on the development of simulated non-carious cervical lesions (NCCLs) in vitro. METHODS: Extracted premolars were randomly allocated into 15 groups (n = 16) generated by the association between toothbrush head configuration (flat-trimmed, rippled, cross-angled/multilevel/rubbers added, cross-angled/multilevel/flex head, feathered) and dentifrice slurry abrasivity (low/medium/high). Teeth were mounted on acrylic blocks and had their roots partially covered with acrylic resin, leaving 2-mm root surfaces exposed. Toothbrushing was performed for 35,000 and 65,000 double-strokes. Specimens were analyzed using non-contact profilometry for dental volume loss (mm3) and lesion morphology. Data was analyzed using ANOVA with pairwise comparisons and Kruskal-Wallis tests. RESULTS: The two-way interaction between toothbrush head configuration and slurry abrasivity was significant (p = 0.02). At 35,000 strokes, the flat-trimmed and cross-angled/multilevel/rubbers added toothbrushes caused the highest loss, when associated to the high-abrasive slurry (p<0.05); whereas cross-angled/multilevel/flex head showed the least loss, when associated to the low-abrasive (p<0.05). At 65,000, more dental loss was observed for all toothbrushes when associated to the high-abrasive slurry, with flat-trimmed causing the highest loss (p < 0.05). Lower dental loss rates were observed for cross-angled/multilevel/flex head associated to the low-abrasive slurry when compared to the other toothbrushes (p < 0.05), except to feathered (p = 0.14) and rippled (p = 0.08). Flat lesions (mean internal angle ± standard-deviation: 146.2°± 16.8) were mainly associated with low-abrasive slurry, while wedge-shaped lesions (85.8°± 18.8) were more frequent with medium- and high-abrasive slurries. CONCLUSION: The development, progression and morphology of simulated NCCLs were modulated by both toothbrush head configuration and dentifrice abrasivity. CLINICAL SIGNIFICANCE: Dental professionals should consider both the type of toothbrush and dentifrice abrasivity in the management plan of patients at risk of developing NCCLs.

Qualitative Analysis of Opinions and Beliefs Associated with the Use of Tobacco Dentifrice among Individuals Attending a Tobacco Counselling Session.

BACKGROUND: Smokeless tobacco (SLT) use is positively associated with oral, oesophageal, and pancreatic cancers. The tobacco dentifrice is a type of SLT which is applied to the teeth and gums. It is available in different forms which include mishri, gul/gulmanjan, gudhaku, snuff, red tooth powder, and creamy snuff. This qualitative study aims to explore the opinions and beliefs associated with the harmful effects of tobacco dentifrice use. METHODOLOGY: Thirty in-depth interviews were conducted among tobacco dentifrice users visiting a dental hospital. The data were coded and analysed using thematic analysis in ATLAS.ti software 8. RESULTS: A total of 11 codes and six categories were generated which comprised of the reason for the initiation, awareness of health effects, perception of oral tobacco application, perception of quitting, the reason for continued use, and use in society. Family, peers, access to the product, curiosity were important factors to initiate the tobacco dentifrice use. Participants believed in the myth that tobacco dentifrice was beneficial for the teeth, gums, and bowel movements. The participants considered tobacco dentifrice to be less harmful than other forms of tobacco. However, some participants were aware of its adverse effects on health and have tried to quit in the past. None of the participants had taken any professional help for quitting. CONCLUSION: There were strong beliefs and myths among the participants that tobacco dentifrice was beneficial for oral and general health. There is a need to create awareness and improve the standard of the health warning of such products.

Modificaciones en la microbiota y los factores inflamatorios después de la utilización de un dentífrico con aceite de oliva virgen, betaina y xilitol, desarrollado para el cuidado del microbioma oral: estudio clínico piloto / Modifications in the microbiota and inflammatory factors with the use of a toothpaste with virgin olive oil, betaine and xylitol, developed for the care of the oral microbiome: pilot clinical study

Introducción: La correcta homeostasis oral, asociada a una buena higiene oral, es necesaria para disminuir la de patógenos cariogénicos y la inhibición de patógenos periodontales, así como modular la respuesta inflamatoria. El objetivo de este estudio es evaluar los efectos de un dentífrico para la protección del microbioma oral, en pacientes atendidos en el Hospital Odontológico Universidad de Barcelona (HOUB). Material y métodos: Ensayo Clínico Randomizado doble ciego y placebo en pacientes atendidos en el HOUB. En el Grupo estudio [GE] se utiliza una pasta dentífrica específica [PDE], que contiene como ingredientes activos aceite de oliva virgen extra, betaina y xilitol además de monofluorofosfato de sodio (1,450 ppm F-) + Excipientes. Y en el Grupo control [GC] se utiliza una pasta placebo sin ingredientes activos. A todos los pacientes se les realiza una exploración oral con parámetros clínicos periodontales, medición de pH, flujo salival (no estimulado y estimulado), recuento de citoquinas (TNF, IL-1 e IL-4.) y de carga total bacteriana, mediante PCR cuantitativa, al inicio y al mes del tratamiento. Resultados: Se incluyen un total de 26 pacientes, 17 mujeres y 9 hombres con una edad media de 48,76 años. El nivel de pH se mantuvo estable entre el inicio y final del estudio en ambos grupos, sin diferencias entre ellos. 11 pacientes indicaron la sensación subjetiva de encontrar la boca mejor, 7 eran test y 4 control (p=0.1); 10 pacientes encontraron la boca igual y solo uno (placebo) la encontró peor. En el análisis de la carga bacteriana mediante determinación de PCR cuantitativa de gen16S solo se analizaron 10 pacientes: 5 GE y 5 GC. En el grupo test bajó en todos los casos la carga de patógenos periodontales y en el grupo control, disminuyó en 4 aumentando en 1. En los 16 pacientes que se analizaron las citoquinas no se observaron diferencias estadísticamente significativas. (AU)

Introduction: Correct oral homeostasis, associated with good oral hygiene, is necessary to decrease the bacterial load of cariogenic pathogens and the inhibition of periodontal pathogens, as well as to modulate inflammatory response. The objective of this study is to evaluate the effects of a toothpaste for the protection of the oral microbiome, in patients treated at the Hospital Odontológico Universidad de Barcelona (HOUB).Material and methods: Randomized double-blind clinical trial with placebo in patients treated at HOUB. In the Study Group [SG] a specific toothpaste [PDE] is used, which contains as active ingredients extra virgin olive oil, betaine and xylitol, as well as sodium monofluorophosphate (1,450 ppm F-) + Excipients. In the control group [CG] a placebo paste without active ingredients is used. All patients underwent an oral examination with periodontal clinical parameters, pH measurement, salivary flow (stimulated and unstimulated), cytokine count (TNF, IL-1 and IL-4.) and total bacterial load by qPCR16S at the beginning and one month after treatment.Results: A total of 26 patients were included, 17 women and 9 men, with a mean age of 48.76 years. The pH level remained stable between the beginning and the end of the study in both groups, with no differences between them. 11 patients felt their mouth was in a better state, 7 of which were test and 4 control (p=0.1); 10 patients felt their mouth was in the same as before the treatment; and only one (placebo) felt it was worse. For the 16S analysis, only 10 patients were analyzed: 5 SG and 5 CG. In the test group, the total bacterial load decreased in all cases, and in the control group, it decreased in 4 and increased in 1. Among the 16 patients whose cytokines were analyzed, no statistically significant differences were observed. (AU)

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.

Progress and limitations of current surface registration methods when measuring natural enamel wear.

OBJECTIVES: Our ability to detect dental wear on sequential scans is improving. This experiment aimed to determine if widely used surface registration methods were sufficiently accurate to distinguish differences between intervention groups on early wear lesions. METHODS: Baseline measurements were taken on human molar buccal enamel samples (n = 96) with a confocal scanning profilometer (Taicaan, UK). Samples were randomly assigned to subgroups of brushing (30 linear strokes 300 g force) before or after an acid challenge (10 min citric acid 0.3% immersion) for four test dentifrices (medium abrasivity NaF, medium abrasivity SnF2, low abrasivity NaF and a water control). Post-experimental profilometry was repeated. 3D step height was analysed using WearCompare (www.leedsdigitaldentistry.co.uk/wearcompare, UK). Percentage Sa change was calculated using Boddies (Taicaan Technologies, Southampton, UK). Data were analysed in SPSS (IBM, USA). RESULTS: The mean 3D step height (SD) observed when samples were brushed before the erosive challenge was -2.33 µm (3.46) and after was -3.5 µm (5.6). No significant differences were observed between timing of toothbrushing or dentifrice used. The mean % Sa change for the low abrasivity group (water control and low abrasivity NaF) was -10.7% (16.8%) and +28.0% (42.0%) for the medium abrasivity group (medium abrasivity NaF and SnF2). CONCLUSIONS: Detectable wear scars were observed at early stages of wear progression. However standard deviations were high and the experiment was underpowered to detect significant changes. Brushing with a low abrasivity dentifrice or water control produced a smoother surface whereas brushing with a high abrasivity dentifrice produced a rougher surface. CLINICAL SIGNIFICANCE: The methodology currently used to align sequential scans of teeth and measure change is too imprecise to measure early wear on natural enamel surfaces unless a large sample size is used. Further improvements are required before we can fully assess early wear processes on natural teeth using profilometry.

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.

Evaluation of Antimicrobial Effect of Air-Polishing Treatments and Their Influence on Human Dental Pulp Stem Cells Seeded on Titanium Disks.

Dental implants are one of the most frequently used treatment options for tooth replacement, and titanium is the metal of choice due to its demonstrated superiority in resisting corrosion, lack of allergic reactions and mechanical strength. Surface roughness of titanium implants favors the osseointegration process; nevertheless, its topography may provide a suitable substrate for bacterial biofilm deposition, causing peri-implantitis and leading to implant failure. Subgingival prophylaxis treatments with cleansing powders aimed to remove the bacterial accumulation are under investigation. Two different air-polishing powders-glycine and tagatose-were assayed for their cleaning and antimicrobial potential against a Pseudomonas biofilm and for their effects on human dental pulp stem cells (hDPSCs), seeded on sandblasted titanium disks. Immunofluorescence analyses were carried out to evaluate cell adhesion, proliferation, stemness and osteogenic differentiation. The results demonstrate that both the powders have a great in vitro cleaning potential in the early period and do not show any negative effects during hDPSCs osteogenic differentiation process, suggesting their suitability for enhancing the biocompatibility of titanium implants. Our data suggest that the evaluated cleansing systems reduce microbial contamination and allow us to propose tagatose as an adequate alternative to the gold standard glycine for the air-polishing prophylaxis treatment.

Acción antibacteriana in vitro de dentífricos sin flúor frente a cepas de Streptococcus mutans / In vitro antibacterial activity of fluoride-free toothpastes against Streptococcus mutans strains

RESUMEN Introducción: Los dentífricos con ingredientes activos previenen la caries dental en niños. Objetivo: Determinar la actividad antibacteriana in vitro de tres dentífricos sin flúor y dos soluciones control frente a cepas estándares de Streptococccus mutans. Métodos: Se realizó un estudio transversal, prospectivo y experimental a doble ciego. Se utilizó agar tripticasa de soya con el método de difusión a 37 °C durante 24 h. Se observó el tamaño de los halos de crecimiento inhibitorio en cada grupo. El análisis de los datos se realizó con el software SPSS15, mediante pruebas estadísticas de corroboración de distribución gaussiana de Shapiro-Wilk, prueba de Kruskal-Wallis y de Mann-Whitney. Resultados: El diámetro de inhibición en gluconato de clorhexidina al 0,12 por ciento fue de 26,69 mm (± 1,85), en el agua destilada de 6 mm (± 0) y para las pastas dentífricas de 6 mm (± 0) y 22,93 mm (± 3,39). Al comparar los diámetros obtenidos por la acción del gluconato de clorhexidina 0,12 por ciento y del agua destilada con los dentífricos libre de flúor, sólo en uno de los casos se obtuvieron diferencias estadísticamente significativas (p< 0,05). Conclusiones: No todos los dentífricos para la higiene bucal del bebé estudiados presentan actividad antibacteriana frente a la cepa de Streptococcus mutans ATCC 25175(AU)

ABSTRACT Introduction: Toothpastes with active ingredients prevent dental caries in children. Objective: Determine the in vitro antibacterial activity of three fluoride-free toothpastes and two control solutions against standard Streptococccus mutans strains. Methods: A prospective cross-sectional experimental double-blind study was conducted. Trypticase soy agar was used applying the diffusion method at 37 °C for 24 h. The size of the growth inhibition haloes of each group was examined. Data analysis was based on SPSS15 software, using Shapiro-Wilk Gaussian distribution corroboration statistical tests, and the Kruskal-Wallis and Mann-Whitney tests. Results: Inhibition diameter was 26.69 mm (± 1.85) for 0.12 percent chlorhexidine gluconate, 6 mm (± 0) for distilled water, and 6 mm (± 0) and 22.93 mm (± 3.39) for the toothpastes. Comparison of the diameters obtained by the action of 0.12 percent chlorhexidine gluconate and distilled water with the fluoride-free toothpastes revealed statistically significant differences in only one of the cases (p< 0.05). Conclusions: Not all the baby toothpastes studied display antibacterial activity against the Streptococcus mutans strain ATCC 25175(AU)

Effect of sodium lauryl sulfate on recurrent aphthous stomatitis: A systematic review.

The present systematic review sought to evaluate the effects of Sodium Lauryl Sulfate (SLS)-free compared to SLS-containing dentifrices on (Recurrent) aphthous stomatitis (RAS) in patients with this condition. Cochrane, Medline (PubMed) and Embase databases, and some trial registries were searched through December 2017. There was no language, nor publication year restrictions. We included double-blinded randomized controlled trials that compared the effects of dentifrices with and without SLS on RAS in humans. Data extraction was compliant with PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. PROSPERO 2018:CRD42018086001. Four trials were included in this review (all crossover studies; n = 124 participants) and two contributed to the main meta-analysis based on the random-effect model. SLS-free dentifrice, when compared to SLS-containing statistically significantly, reduced the number of ulcers, duration of ulcer, number of episodes, and ulcer pain. Sensitivity analysis of the four studies as parallel-group trials shows a consistent direction of effect in favor of SLS-free dentifrice usage. In conclusion, the qualitative and quantitative synthesis of the eligible trials for this review showed that use of SLS-free consistently reduced all four parameters of ulcers measured. The available evidence suggests that patients with RAS may benefit from using SLS-free dentifrices for their daily oral care. However, future well-designed trials are still required to strengthen the current body of evidence.

An exploratory study to investigate stain build-up with long term use of a stannous fluoride dentifrice.

PURPOSE: To monitor extrinsic stain formation over 24 weeks with twice-daily use of an anhydrous 0.454% SnF2 dentifrice containing 5% sodium tripolyphosphate (STP) ('Test'), compared to a standard fluoride dentifrice (0.76% fluoride as sodium monofluorophosphate [SMFP\) ('Comparator') following a professional prophylaxis. METHODS: Primary efficacy variables were between-treatment differences in extrinsic dental stain of anterior teeth after 4, 8, 12, and 24 weeks' use using mean area and intensity scores of the MacPherson modification of the Lobene stain index (MLSI), and to monitor oral tolerability. RESULTS: Overall, 214 subjects were randomized to treatment. The Test dentifrice group demonstrated statistically significantly less stain compared with the Comparator at each timepoint for all outcome variables (MLSI - Area × Intensity, Area only, and Intensity only) with the exception of MLSI (Area × Intensity) at Week 12. Products were generally well tolerated with 26 treatment-related adverse events (TRAEs) reported (10 with Test, 16 with Comparator). Five subjects withdrew from the 24-week study due to TRAEs, three in the Test group, two in the Comparator group. Statistically significantly less anterior tooth staining was observed with up to 24 weeks twice-daily brushing with a 0.454% SnF2/5% STP anhydrous dentifrice compared to a marketed fluoride dentifrice with 0.76% SMFP. CLINICAL SIGNIFICANCE: Long term use of a SnF2/STP dentifrice demonstrated minimal stain build-up after 24 weeks, twice-daily use; products were generally well-tolerated.

Abrasive effects of diamond dentifrices on dentine and enamel

This study was to analyse the abrasive wear of differently composed diamond dentifrices loaded with 2.4 µm diamond particles on dentine and enamel surfaces in vitro. Bovine specimens were brushed with a diamond-loaded dentifrice (DD2; 2 g particles/kg), a diamond-loaded dentifrice (1.5 g/kg) containing 20% hydrated silica as extra abrasive (DD1.5+S), or a diamond-loaded dentifrice (3 g/kg) containing 20% hydrated silica abrasive (DD3+S). Values were compared to those obtained with Colgate Total (CT) and Elmex Sensitive plus (ES). Brushing was performed using a cross brushing machine (F = 2.5 N; 120 brushing strokes/min). Abrasive wear [µm] of specimens (n = 12) was measured profilometrically and adjusted to 10,000 brushing strokes (10 kBS). Data were compared between groups using one-way ANOVA and post-hoc pairwise tests with Tukey correction, alpha = 0.05. Diamond dentifrices and ES showed no difference on dentine specimens: DD2 7.7 ± 2.6 µm/10 kBS; DD1.5+S 10.1 ± 2.3 µm/ 10 kBS; DD3+S 10.1 ± 2.6 µm/10 kBS; ES 7.4 ± 1.1 µm/10 kBS, while CT­brushed specimens exhibited significantly higher dentinal abrasion compared to all other groups: CT 31.0 ± 7.7 µm/ 10 kBS. Diamond loading significantly influenced enamel wear (mean ± SD µm/10 kBS): DD2 1.8 ± 0.5 µm/10 kBS. Conversely, addition of the silica abrasive reduced these values: DD1.5+S 1.1 ± 0.3 µm/10 kBS; DD3+S 1.6 ± 0.3 µm/10 kBS. CT and ES revealed similarly low values: CT 0.3 ± 0.1 µm/10 kBS; ES 0.2 ± 0.1 µm/10 kBS. These data suggest that abrasion caused by diamond particles in experimental toothpastes is differentially affected by diamond particle load, additional abrasives, and the type of hard tissue.

[A PhD completed. Trauma to the gingiva by oral hygiene aids and oral piercings]. / Tandvleesschade door mondhygiënemiddelen en mondpiercings.

Maintaining healthy teeth and soft oral tissue is important. Clinical research has shown manual toothbrushes with end-rounded filaments to cause significantly less gingival abrasions than those without end-rounding. Tapered filaments are an alternative to end-rounded filaments, but there is no solid evidence for their effectiveness. For the interdental spaces that the toothbrush doesn't reach, the use of special oral hygiene aids is advised. Clinical studies of gingivitis patients have shown that both interdental brushes and plastic-rubber bristles reduce gingivitis after 4 weeks of use. Plastic-rubber bristles result in a significant improvement in the tendency for interdental bleeding compared with interdental brushes, and they cause less abrasion of the gingiva. Other factors that can potentially traumatise soft and hard oral tissue are oral piercings. Wearing oral piercings is not without risk. Tongue and lip piercings are associated with the risk of gingival recession, and tongue piercings are associated with tooth fractures. To prevent the risk of complications, patients should be discouraged from wearing oral piercings.

A Profilometry-Based Dentifrice Abrasion Method for V8 Brushing Machines Part III: Multi-Laboratory Validation Testing of RDA-PE.

OBJECTIVES: We have previously reported on progress toward the refinement of profilometry-based abrasivity testing of dentifrices using a V8 brushing machine and tactile or optical measurement of dentin wear. The general application of this technique may be advanced by demonstration of successful inter-laboratory confirmation of the method. The objective of this study was to explore the capability of different laboratories in the assessment of dentifrice abrasivity using a profilometry-based evaluation technique developed in our Mason laboratories. In addition, we wanted to assess the interchangeability of human and bovine specimens. METHODS: Participating laboratories were instructed in methods associated with Radioactive Dentin Abrasivity-Profilometry Equivalent (RDA-PE) evaluation, including site visits to discuss critical elements of specimen preparation, masking, profilometry scanning, and procedures. Laboratories were likewise instructed on the requirement for demonstration of proportional linearity as a key condition for validation of the technique. Laboratories were provided with four test dentifrices, blinded for testing, with a broad range of abrasivity. In each laboratory, a calibration curve was developed for varying V8 brushing strokes (0, 4,000, and 10,000 strokes) with the ISO abrasive standard. Proportional linearity was determined as the ratio of standard abrasion mean depths created with 4,000 and 10,000 strokes (2.5 fold differences). Criteria for successful calibration within the method (established in our Mason laboratory) was set at proportional linearity = 2.5 ± 0.3. RDA-PE was compared to Radiotracer RDA for the four test dentifrices, with the latter obtained by averages from three independent Radiotracer RDA sites. Individual laboratories and their results were compared by 1) proportional linearity and 2) acquired RDA-PE values for test pastes. RESULTS: Five sites participated in the study. One site did not pass proportional linearity objectives. Data for this site are not reported at the request of the researchers. Three of the remaining four sites reported herein tested human dentin and all three met proportional linearity objectives for human dentin. Three of four sites participated in testing bovine dentin and all three met the proportional linearity objectives for bovine dentin. RDA-PE values for test dentifrices were similar between sites. All four sites that met proportional linearity requirement successfully identified the dentifrice formulated above the industry standard 250 RDA (as RDA-PE). The profilometry method showed at least as good reproducibility and differentiation as Radiotracer assessments. It was demonstrated that human and bovine specimens could be used interchangeably. CONCLUSIONS: The standardized RDA-PE method was reproduced in multiple laboratories in this inter-laboratory study. Evidence supports that this method is a suitable technique for ISO method 11609 Annex B.

Baking soda as an abrasive in toothpastes: Mechanism of action and safety and effectiveness considerations.

BACKGROUND: Toothpastes can be formulated with different abrasive systems, depending on their intended clinical application. This formulation potentially affects their effectiveness and safety and, therefore, requires proper understanding. In this article, the authors focused on abrasive aspects of toothpastes containing sodium bicarbonate (baking soda), which have gained considerable attention because of their low abrasivity and good compatibility, while providing clinical effectiveness (further detailed in the other articles of this special issue). The authors first appraised the role of toothpaste abrasivity on tooth wear, exploring some underlying processes and the existing methods to determine toothpaste abrasivity. TYPES OF STUDIES REVIEWED: The authors reviewed the available data on the abrasivity of toothpastes containing baking soda and reported a summary of findings highlighting the clinical implications. CONCLUSIONS: On the basis of the collected evidence, baking soda has an intrinsic low-abrasive nature because of its comparatively lower hardness in relation to enamel and dentin. Baking soda toothpastes also may contain other ingredients, which can increase their stain removal effectiveness and, consequently, abrasivity. PRACTICAL IMPLICATIONS: Even those formulations have abrasivity well within the safety limit regulatory agencies have established and, therefore, can be considered safe.

Abrasion of eroded and sound enamel by a dentifrice containing diamond abrasive particles

Eroded enamel is more susceptible to abrasive wear than sound enamel. New toothpastes utilizing diamond particles as abrasives have been developed. The present study investigated the abrasive wear of eroded enamel by three commercially available toothpastes (one containing diamond particles) and compared it to the respective wear of sound enamel caused by these toothpastes. Seventy-two bovine enamel samples were randomly allocated to six groups (S1­S3 and E1­E3; n=12). Samples were submitted to an abrasive (S1­S3) or erosion plus abrasion (E1­E3) cycling. Per cycle, all samples were brushed (abrasion; 20 brushing stokes) with the following toothpastes: S1/E1: Signal WHITE SYSTEM, S2/E2: elmex KARIESSCHUTZ and S3-E3: Candida WHITE DIAMOND (diamond particles). Groups E1­E3 were additionally eroded with HCl (pH 3.0) for 2 min before each brushing procedure. After 30, 60 and 90 cycles enamel wear was measured by surface profilometry. Within the same toothpaste and same number of cycles, enamel wear due to erosion plus abrasion was significantly higher than due to mere abrasion. After 30, 60 and 90 cycles, no significant difference in the wear in groups S1 and S2 was observed while the wear in group E1 was significantly (p<0.05, ANOVA, Scheffecyc) lower than that in group E2. After 90 cycles, wear in group S3 was about 5 times higher than that in group S2, while wear in group E3 was about 1.3 times higher than that in group E2. As compared to the other two investigated toothpastes, the dentifrice containing diamond particles caused slightly higher abrasive wear of eroded enamel and distinctly higher wear of sound enamel compared to the conventional toothpastes under investigation.

Charcoal and charcoal-based dentifrices: A literature review.

BACKGROUND: Sales of charcoal dentifrices and powders have rapidly emerged into the Internet marketplace. The authors conducted a literature review to examine the efficacy and safety of charcoal and charcoal-based dentifrices. METHODS: The authors searched the MEDLINE and Scopus databases for clinical studies on the use of charcoal and charcoal-based dentifrices and laboratory investigations on the bioactivity or toxicity of charcoal and charcoal-based dentifrices, published through February 2017. The authors used a defined search strategy to identify randomized, controlled clinical trials with a follow-up duration of 3 months or longer. In addition, the authors selected the first 50 consecutive charcoal dentifrices from Google.com and Amazon.com for ascertainment of product assortment and advertising promotions. RESULTS: The authors' literature search identified 118 potentially eligible articles. Thirteen studies reported brushing the teeth with raw charcoal or soot; however, none of these studies met the inclusion criteria. Two studies offered nonspecific caries reductions, 3 studies reported deleterious outcomes (increased caries, enamel abrasion, nonquantified negative impact), and 1 study indicated only that brushing with raw charcoal had no adverse effects on oral hygiene. Seven other studies reported only on the use of charcoal for oral hygiene. Internet advertisements included unsubstantiated therapeutic claims-such as antibacterial, antifungal, antiviral, and oral detoxification, as well as potentially misleading product assertions. One-third of the charcoal dentifrices contained bentonite clay, and 1 contained betel leaves. CONCLUSIONS: The results of this literature review showed insufficient clinical and laboratory data to substantiate the safety and efficacy claims of charcoal and charcoal-based dentifrices. Larger-scale and well-designed studies are needed to establish conclusive evidence. PRACTICAL IMPLICATIONS: Dental clinicians should advise their patients to be cautious when using charcoal and charcoal-based dentifrices with unproven claims of efficacy and safety.

Interaction between toothpaste abrasivity and toothbrush filament stiffness on the development of erosive/abrasive lesions in vitro.

OBJECTIVES: To investigate the loss of enamel and dentin surface caused by the interaction between abrasives in toothpaste and toothbrush filament stiffness. METHODS: The study followed a 2 (high-level or low-level abrasive; silica) × 3 (filament stiffness; soft, medium or hard) × 2 (cycling time; 3 or 5 days) factorial design. Polished bovine enamel and dentin specimens (n = 8 each per group) were subjected to 5 days of erosion/abrasion cycling: erosion (5 minutes, four times daily, 0.3% citric acid, pH 3.75); abrasion (15 seconds, twice daily, 45 strokes each, 150 g load, automated brushing machine); and fluoride treatment [15 seconds with abrasion and 45 seconds without abrasion; 275 p.p.m. fluoride (F- ) as sodium fluoride (NaF) in abrasive slurry]. Enamel and dentin specimens were exposed to artificial saliva between erosion and abrasion/F- treatment (1 hour) and at all other times (overnight). Non-contact profilometry was used to determine surface loss (SL) after 3 and 5 days of cycling. Data were analysed using three-way analysis of variance (ANOVA) (factors: abrasive/filament stiffness/time), with separate analyses conducted for enamel and dentin. RESULTS: For enamel, only 'cycling time' was found to affect SL, with 5 days of cycling resulting in a greater SL than 3 days of cycling. Overall, there was little SL for enamel (range: 0.76-1.85 µm). For dentin (SL range: 1.87-5.91 µm), significantly higher SL was found for 5 days of cycling versus 3 days of cycling, with particularly large differences for hard stiffness/high-level abrasive and medium stiffness/low-level abrasive. For high-level abrasive, after 5 days of cycling hard stiffness resulted in significantly higher SL than did medium stiffness, with no other significant differences according to stiffness. Overall, high-level abrasive resulted in significantly higher SL than did low-level abrasive, with strong effects for all combinations, except medium stiffness after 5 days. CONCLUSION: The interplay between abrasivity and filament stiffness appears to be more relevant for dentin than for enamel.