Pomegranate extract in polyphosphate-fluoride mouthwash reduces enamel demineralization.

OBJECTIVES: To evaluate the anti-demineralizing effect of a mouthwash comprising pomegranate peel extract (PPE 3%), sodium trimetaphosphate (TMP 0.3%), and fluoride (F 225 ppm) in an in situ study, and to assess its irritation potential in an ex vivo study. METHODS: This double-blind crossover study was conducted in four phases with 7 days each. Twelve volunteers used palatal appliances containing enamel blocks, which were subjected to cariogenic challenges. The ETF formulation (PPE + TMP + F, pH 7.0), TF formulation (TMP + F, pH 7.0), deionized water (W, pH 7.0), and essential oil commercial mouthwash (CM, 220 ppm F, pH 4.3) were dropped onto the enamel twice daily. The percentage of surface hardness loss, integrated loss of subsurface hardness, calcium, phosphorus, and fluoride in enamel and biofilms were determined. In addition, alkali-soluble extracellular polysaccharide concentrations were analyzed in the biofilms. The irritation potential was evaluated using the hen's egg chorioallantoic membrane test through the vascular effect produced during 300-s of exposure. RESULTS: ETF was the most efficacious in preventing demineralization. It also showed the highest concentrations of calcium and phosphorus in the enamel and in the biofilm, as well as the lowest amount of extracellular polysaccharides in the biofilm. In the eggs, ETF produced light reddening, whereas CM led to hyperemia and hemorrhage. CONCLUSIONS: The addition of PPE to formulations containing TMP and F increased its anti-demineralizing property, and this formulation presented a lower irritation potential than the CM. CLINICAL RELEVANCE: ETF can be a promising alternative alcohol-free mouthwash in patients at high risk of caries.

Biomineralization and remineralizing potential of toothpastes containing nanosized ß-calcium glycerophosphate: an in vitro study.

To evaluate the effect of 1100 ppm F toothpastes supplemented with micrometric or nanosized ß-CaGP (ß-CaGPm/ß-CaGPn) on artificial enamel remineralization, using a pH cycling model. Enamel blocks with artificial caries were randomly allocated into ten groups (n = 10), according to the toothpastes: without fluoride/ß-CaGPm/ß-CaGPn (negative control); 1100 ppm F (1100F); 1100F plus 0.125%, 0.25%, 0.5%, and 1.0% of ß-CaGPm or ß-CaGPn. The blocks were treated 2×/day with slurries of toothpastes. After pH cycling, the percentage of surface hardness recovery (%SHR); integrated loss of subsurface hardness (ΔKHN); integrated mineral loss (ΔIMR); fluoride (F), calcium (Ca), and phosphorus (P) concentrations in the enamel; polydispersity index (PdI); and zeta potential (Zp) were determined. The data were analyzed by ANOVA (p < 0.001). For Zp/PdI, no significance was observed when comparing the means (p > 0.001). The treatment with 1100F-0.25%ß-CaGPn led to %SHR ∼57 higher when compared to the 1100F group (p < 0.001). The lowest ΔKHN was observed for the 1100F-0.25%ß-CaGPn group (p < 0.001). The ΔIMR was lower (∼201%) for the 1100F-0.25%ß-CaGPn when compared to 1100F (p < 0.001). The association of ß-CaGPm and ß-CaGPn to 1100F did not influence its F concentration (p > 0.001). The highest increase in Ca and P was observed for 1100F-0.25%ß-CaGPn (p < 0.001). The addition of 0.25%ß-CaGPn to 1100F toothpaste was able to promote an additional remineralizing effect of artificial caries lesions.

Evaluation of bleaching efficacy, microhardness, and trans-amelodentinal diffusion of a novel bleaching agent for an in-office technique containing hexametaphosphate and fluoride.

OBJECTIVE: This study evaluated in vitro the effects of calcium gluconate (CaGlu), sodium fluoride (NaF), sodium hexametaphosphate (HMP), and NaF/TMP added to a 35% hydrogen peroxide (H2O2) bleaching gel on the color change, enamel hardness, and trans-amelodentinal diffusion. MATERIALS AND METHODS: Enamel discs/bovine dentin (n = 150) were divided according to the bleaching gel: 35% H2O2 (H2O2); 35% H2O2 + 0.1% NaF (H2O2/NaF); 35% H2O2 + 1% HMP (H2O2/HMP); 35% H2O2 + 0.1% NaF + 1% HMP (H2O2/NaF/HMP), and 35% H2O2 + 2% CaGlu (H2O2/Caglu). The bleaching gels were applied three times (40 min/session) at 7-day intervals between each application. Then, color alteration (ΔE), whitening index (ΔWID), percentage of surface hardness loss (% SH), cross-sectional hardness (ΔKHN), and trans-amelodentinal diffusion were determined. Data were submitted for analysis of variance (ANOVA), followed by the Student-Newman-Keuls test (p < 0.05). RESULTS: All bleaching gels showed significant color changes after treatment (p < 0.001). ΔE and ΔWID were similar among the evaluated gels. Mineral loss (% SH and ΔKHN) and trans-amelodentinal diffusion of hydrogen peroxide were lower for H2O2/NaF/HMP; the H2O2/CaGlu group presented the highest values about the other groups (p < 0.001). CONCLUSION: It is possible to conclude that the addition of NaF/HMP to the in-office bleaching agent did not interfere with the bleaching efficacy and reduced enamel demineralization and H2O2 diffusion. CLINICAL SIGNIFICANCE: The association of NaF/HMP to the bleaching gel can be used as a novel approach for minimizing the adverse effects of H2O2 by-products and with similar clinical efficacy.

Effect of glaze and chlorhexidine on physical and mechanical properties of bis-acryl resin: An in situ study.

BACKGROUND: Temporary prosthesis protects the oral tissues, in addition to providing aesthetic look and masticatory function until a definitive prosthesis is manufactured. OBJECTIVES: To evaluate the effect of glaze and 0.12% chlorhexidine (CHX) on the physical and mechanical properties of bis-acryl, and to evaluate the antimicrobial efficacy of CHX. MATERIAL AND METHODS: Eighty specimens of bis-acryl resin were made. Over 40 of them the glaze was applied. One specimen with and 1 specimen without glaze were placed in niches of an appliance manufactured for each patient. Each of the 20 volunteers received 2 devices. Initially, the volunteers used one device and treated it with sucrose for 7 days (control), and later they used the other device and treated it with sucrose and CHX for 7 days (test). Color, microhardness, roughness, surface energy, and insoluble extracellular polysaccharides (EPS) tests were performed. All results were submitted to the Tukey's test, with the exception of the EPS results, which were submitted to the Student's t test. RESULTS: The ΔE00 of the unglazed control group was significantly higher than that of the unglazed test group. In all groups, a significant decrease in microhardness occurred over time. At both times, the glaze significantly increased the microhardness of the specimens (in all the glazed groups). At the final time, the test glaze group showed significantly higher microhardness compared with the control glaze group. Roughness in the groups without glaze increased significantly with CHX treatment over time. At both times, the glaze generated a significant reduction in roughness in the control and test groups. There was a significant reduction in surface energy over time in all groups. In most comparisons, the glazed groups showed significantly higher surface energy values compared with the unglazed control group. At the final time point, the unglazed test group showed a significantly higher surface energy value than the unglazed control group; and the glazed test group showed a significantly higher surface energy value compared with the glazed control group. The resins that received CHX had a significantly lower amount of biofilm. CONCLUSIONS: Color values were clinically acceptable in all tested groups. At both time points, the roughness values were clinically acceptable only in the glazed groups. Glaze increased the microhardness of the specimens. Microhardness and surface energy were reduced over time in all groups. Chlorhexidine can help prevent microhardness degradation. Glaze and CHX can increase surface energy. Chlorhexidine reduced the amount of bacterial biofilm.

Surface Free Energy, Interaction, and Adsorption of Calcium and Phosphate to Enamel Treated with Trimetaphosphate and Glycerophosphate.

This study aimed to evaluate the surface (γs) and interaction (ΔGiwi) free energy and calcium (Ca2+) and phosphate (PO43-) adsorption to dental enamel treated with sodium trimetaphosphate (TMP) or calcium glycerophosphate (CaGP) that had or had not been exposed to CaPO4-containing solutions. Bovine enamel blocks (n = 192; 24 blocks/group) were treated (2 mL/block; 2 min) with TMP (0%, 1%, 3%, and 9%) and CaGP (0, 0.25, 0.5, and 1%) or exposed to a CaPO4-containing solution. The adsorption of these compounds by enamel was assessed before and after treatment. γs and ΔGiwi and their apolar (γsLW and ΔGiwiLW) and polar (γsAB and ΔGiwiAB) components and acid-base interactions (γs+/γs-) were determined by the contact angles. The data were subjected to ANOVA, followed by the Student-Newman-Keuls test (p < 0.05). The adsorption of TMP was dose dependent (p < 0.001), and it reduced γs and γsAB and increased ΔGiwiAB (ΔGiwi > 0) and γs- when compared with the group without TMP (p < 0.001). The immersion in CaPO4-containing solution increased γs and γsAB and reduced ΔGiwiAB (ΔGiwi > 0) and γs- (p < 0.001). There was a correlation between the adsorption of TMP and Ca2+ (r = 0.916; p < 0.001) and PO43- (r = 0.899; p < 0.001). The adsorption of CaGP on the enamel was dose dependent (p < 0.001), reducing γs, ΔGiwiAB (ΔGiwi < 0), γsLW, and γs- when compared to the group without CaGP (p < 0.001). When exposed to the CaPO4-containing solution, there was an increase in ΔGiwiAB (ΔGiwi > 0), γsLW, and γs- and a decrease in γsAB (p < 0.001) without adsorption of Ca2+ by enamel. It may be concluded that TMP and CaGP were adsorbed onto the enamel, producing hydrophilic and hydrophobic surfaces, respectively. TMP produces electron donor sites that induce Ca2+ adsorption, while CaGP releases Ca2+ into the medium.

Effect of daily use of fluoridated dentifrice and bleaching gels containing calcium, fluoride, or trimetaphosphate on enamel hardness: an in vitro study.

OBJECTIVE: This study evaluated the effects of calcium gluconate (CaGlu), sodium fluoride (NaF), sodium trimetaphosphate (TMP), and NaF/TMP added to a 35% hydrogen peroxide (HP) bleaching gel for the reduction in enamel demineralization in vitro, with and without the use of a fluoridated dentifrice. DESIGN: Enamel blocks (n = 100) were obtained from bovine incisors (n = 200) after flattening and subjected to initial surface hardness (SH) analysis. The blocks were divided according to the bleaching gel (35% HP; 35% HP + 0.05% NaF; 35% HP + 0.25% TMP; 35% HP + 0.05% NaF + 0.25% TMP; 35% HP + 2% CaGlu) and were treated with ether non-fluoridated or fluoridated (1100 ppm) dentifrice. The bleaching gels were applied thrice (40 min/session) at the intervals of 7 days between each application. After 21 days, the final SH for the calculation of the percentage of SH loss (%SH) and cross-sectional hardness for the evaluation of the integrated hardness area (IH) were determined. RESULTS: Bleaching containing HP + NaF + TMP presented lowest %SH (p < 0.001), regardless of the dentifrice used. HP + NaF + TMP bleaching gel led to lower subsurface enamel mineral loss (IH) compared to the other groups (p < 0.001), and these did not differ from each other (p > 0.05). Daily use of fluoride dentifrice led to higher IH values (p < 0.001), regardless of the bleaching gels. CONCLUSION: The addition of NaF/TMP to a 35% HP bleaching gel remarkably reduced the mineral loss compared to the cases of the other bleaching gels, regardless of dentifrice. CLINICAL RELEVANCE: The association of TMP/NaF can be used as a strategy for reducing mineral loss during the bleaching procedure, even without the daily use of fluoride dentifrice.

Combined effect of casein phosphopeptide-amorphous calcium phosphate and sodium trimetaphosphate on the prevention of enamel demineralization and dental caries: an in vitro study.

OBJECTIVE: To evaluate the effect of treatment with fluoridated toothpaste supplemented with a combination of sodium trimetaphosphate (TMP) and casein phosphopeptide-amorphous calcium phosphate (MI Paste Plus®) on the demineralization of dental enamel. METHODS: Bovine enamel blocks selected by initial surface hardness (SHi) were randomly allocated into six groups (n = 12), according to the test toothpastes: (1) without F-TMP-MI Paste Plus® (Placebo); (2) 1100 ppm F (1100F); (3) MI Paste Plus®; (4) 1100F + MI Paste Plus® (1100F-MI Paste Plus), (5) 1100F + 3 % TMP (1100F-TMP); and (6) 1100F-TMP + MI Paste Plus® (1100F-TMP-MI Paste Plus). Blocks were treated two times per day with slurries of toothpaste (1 min), and groups 4 and 6 received an application of MI Paste Plus (3 min). Next, the samples were subjected to five pH cycles (demineralizing/remineralizing solutions) at 37 °C, to produce subsurface enamel lesions.Thereafter, the blocks were maintained for 2 days in fresh remineralizing solution. After pH cycling, the following were obtained: percentage of surface hardness loss (%SH); integrated loss of subsurface hardness (ΔKHN); profile analysis and lesion depth subsurface through polarized light microscopy (PLM); scanning electron microscopy (SEM); and fluoride (F), calcium (Ca), and phosphorus (P) in the enamel. The data were subjected to ANOVA (1-criterion), followed by the Student-Newman-Keuls test (p < 0.001). RESULTS: The 1100F-TMP-MI Paste Plus group showed better results for SHR, ΔKHN, and PLM (p < 0.001). The F concentration was similar among all groups (p > 0.001). The 1100F-TMP-MI Paste Plus group showed the highest concentration of Ca and P in the enamel (p < 0.001). CONCLUSION: The application of 1100F-TMP-MI Paste Plus promoted a higher inhibitory effect against enamel demineralization. CLINICAL SIGNIFICANCE: The combination of treatments with F, TMP, and MI Paste Plus® can be an effective alternative to improve the oral health of individuals, especially those with high activity of dental caries and at high risk for its development.

Evaluation of new compositions of 10% hydrogen peroxide-based bleaching agents containing trimetaphosphate and fluoride on enamel demineralization.

This study evaluated the effect on enamel demineralization of 10% hydrogen peroxide (H2 O2 ) gels containing different concentrations of sodium trimetaphosphate (TMP) and sodium fluoride (NaF) combined with the daily use of fluoridated or placebo dentifrice. Bovine enamel blocks were selected by surface hardness (n = 72) and randomly assigned to one of the following experimental treatments: 10% H2 O2 ; 10% H2 O2  + 3% TMP + 0.1% NaF; and 10% H2 O2  + 0.3% TMP + 0.05% NaF, each with or without fluoridated dentifrice. H2 O2 -based gels were applied for 30 min d-1 followed by treatment with dentifrice (1 min). Enamels blocks were stored in artificial saliva at 37°C between sessions during the 14 days of experiment. Percentage of surface hardness loss (%SH) was calculated, and the blocks were cut into halves to analyze cross-sectional hardness (ΔKHN). Polarized light microscopy images were obtained of the longitudinal sections of the samples. Enamel treated with fluoridated dentifrice presented lower hardness loss than those treated with placebo dentifrice (%SH and ΔKHN). Use of TMP- and NaF-based gels, regardless of concentration, led to the lowest %SH values. Specimens treated with 10% H2 O2 gel had the highest %SH and ΔKHN values. Gels with 10% H2 O2  + 3% TMP + 0.1% NaF showed the lowest ΔKHN values. Microscopy images clearly showed that the addition of TMP and NaF to the H2 O2 -based gels was effective in reducing the loss of hardness, and the fluoridated dentifrice helped minimize it in all treatments.

Amount of Dentifrice and Fluoride Concentration Influence Salivary Fluoride Concentrations and Fluoride Intake by Toddlers.

The present study evaluated fluoride (F) concentrations in saliva of toddlers after brushing with dentifrices containing different F concentrations, applied in different quantities, and estimated F intake from toothbrushing. The study comprised a double-blind, crossover protocol, in which toddlers (n = 18, 2-3 years old) were randomly assigned into six groups, according to possible combinations of dentifrices (0/550/1,100 ppm F, as NaF) and amounts (rice grain, pea size, and transverse technique). Volunteers used a F-free dentifrice during 1 week. On the 7th day, saliva samples were collected before (baseline), and at 5/15/30/60 min after toothbrushing. All dentifrice expectorated after brushing was collected. F concentrations (saliva and expectorate) were determined with an ion-specific electrode. Data were submitted to ANOVA or Kruskal-Wallis test, followed by Fisher's LSD or Student-Newman-Keuls' tests (p <0.05). Brushing with 550 ppm F dentifrice (pea size or transversal technique) increased the area under the curve (AUC) at similar levels compared to 1,100 ppm F (rice grain). The highest AUC and salivary F at 5 min after brushing were achieved by 1,100 ppm F (pea size), followed by 550 ppm F (transversal technique). Regarding F intake, the highest values were observed for 550 ppm F (transversal technique), followed by 1,100 ppm F (pea size). It is possible to conclude that the amount of dentifrice and F concentration in the product significantly affected both salivary F concentrations and F intake during toothbrushing.

Protective Effect of Fluoride Varnish Containing Trimetaphosphate against Dentin Erosion and Erosion/Abrasion: An in vitro Study.

This in vitro study evaluated the protective effect of fluoride varnishes containing sodium trimetaphosphate (TMP) against dentin erosion and abrasion. Specimens of coronal dentin were divided into: placebo, 2.5% NaF, 5% NaF, 2.5% NaF + 5% TMP, and 5% NaF + 5% TMP groups (n =24/group). After single application of the varnishes, the samples were immersed in citric acid (0.05 mol/L, pH = 3.2, 5 min) followed or not by brushing, and the dentin wear was assessed after 5 days. Varnishes containing fluoride + TMP led to the lowest wear. TMP varnishes showed a superior effect against dentin erosive wear.

Effect of Fluoride Toothpaste Containing Nano-Sized Sodium Hexametaphosphate on Enamel Remineralization: An in situ Study.

OBJECTIVE: To evaluate the remineralizing potential of a conventional toothpaste (1,100 ppm F) supplemented with nano-sized sodium hexametaphosphate (HMPnano) in artificial caries lesions in situ. DESIGN: This double-blinded crossed study was performed in 4 phases of 3 days each. Twelve subjects used palatal appliances containing 4 bovine enamel blocks with artificial caries lesions. Volunteers were randomly assigned into the following treatment groups: no F/HMP/HMPnano (Placebo); 1,100 ppm F (1100F); 1100F plus 0.5% micrometric HMP (1100F/HMP) and 1100F plus 0.5% nano-sized HMP (1100F/HMPnano). Volunteers were instructed to brush their natural teeth with the palatal appliances in the mouth for 1 min (3 times/day), so that blocks were treated with natural slurries of toothpastes. After each phase, surface hardness post-remineralization (SH2), integrated recovery of subsurface hardness (ΔIHR), integrated mineral recovery (ΔIMR) and enamel F concentration were determined. Data were submitted to analysis of variance and Student-Newman-Keuls' test (p < 0.001). RESULTS: Enamel surface became 42% harder when treated with 1100F/HMPnano in comparison with 1100F (p < 0.001). Treatment with 1100F/HMP and 1100F/HMPnano promoted an increase of ∼23 and ∼87%, respectively, in ΔIHR when compared to 1100F (p < 0.001). In addition, ΔIMR for the 1100F/HMPnano was ∼75 and ∼33% higher when compared to 1100F and 1100F/HMP respectively (p < 0.001). Enamel F uptake was similar among all groups except for the placebo (p < 0.001). CONCLUSION: The addition of 0.5% HMPnano to a conventional fluoride toothpaste was able to promote an additional remineralizing effect of artificial caries lesions.

Anticaries effect of toothpaste with nano-sized sodium hexametaphosphate.

OBJECTIVE: To evaluate the effect of a fluoride toothpaste containing nano-sized sodium hexametaphosphate (HMPnano) on enamel demineralization on the biochemical composition and insoluble extracellular polysaccharide (EPS) in biofilm formed in situ. METHODS: This crossover double-blind study consisted of four phases (7 days each), in which 12 volunteers wore intraoral appliances containing four enamel bovine blocks. The cariogenic challenge was performed using 30% sucrose solution (6×/day). Blocks were treated 3×/day with the following toothpastes: no F/HMP/HMPnano (Placebo), conventional fluoride toothpaste, 1100 ppm F (1100F), 1100F + 0.5% micrometric HMP (1100F/HMP), and 1100F + 0.5% nano-sized HMP (1100F/HMPnano). The percentage of surface hardness loss (%SH), integrated loss of subsurface hardness (ΔKHN), and enamel calcium (Ca), phosphorus (P), and fluoride (F) were determined. Moreover, biofilms formed on the blocks were analyzed for F, Ca, P, and insoluble extracellular polysaccharide (EPS) concentrations. Data were analyzed using one-way ANOVA, followed by Student-Newman-Keuls' test (p < 0.001). RESULTS: 1100F/HMPnano promoted the lowest %SH and ΔKHN among all groups (p < 0.001). The addition of HMPnano to 1100F significantly increased Ca concentrations (p < 0.001). The 1100F/HMPnano promoted lower values of EPS when compared with 1100F (~ 70%) (p < 0.001) and higher values of fluoride and calcium in the biofilms (p < 0.001). CONCLUSION: 1100F/HMPnano demonstrated a greater protective effect against enamel demineralization and on the composition of biofilm in situ when compared to 1100F toothpaste. CLINICAL RELEVANCE: This toothpaste could be a viable alternative to patients at high risk of caries.

Fluoride toothpastes containing micrometric or nano-sized sodium trimetaphosphate reduce enamel erosion in vitro.

OBJECTIVE: To evaluate the effect of fluoride toothpastes supplemented with micrometric or nano-sized sodium trimetaphosphate (TMP or TMPnano, respectively) on enamel erosion in vitro, as well as the influence of salivary acquired pellicle and saliva. MATERIAL AND METHODS: Bovine enamel blocks (n = 120) were randomly assigned into the following experimental toothpastes: no F/TMP/TMPnano (Placebo); 1100 ppm F (1100 ppm F); 1100 ppm F plus 3% TMP or 3% TMPnano (1100 TMP or 1100 TMPnano, respectively) and 5000 ppm F (5000 ppm F). Erosive challenge was performed by immersion of the blocks in citric acid for 5 min, followed by 2 h immersion in human or artificial saliva, 4×/day, during 5 days. After each erosive challenge, blocks were exposed to slurries of the toothpastes. Enamel erosion (µm), surface hardness (SHf) and cross-sectional hardness (ΔKHN) were analyzed as response variables and the data were submitted to two-way ANOVA, followed by the Student-Newman-Keuls test (p < .05). RESULTS: 1100 TMPnano significantly reduced enamel loss when compared to 1100 TMP (p = .002), reaching values similar to those promoted by 5000 ppm F (p = .96). 1100 ppm F presented significantly lower enamel loss than Placebo (p < .001), and higher than 1100 TMP (p < .001). Significantly higher SHf and lower ΔKHN was observed for 1100 TMPnano and 5000 ppm F when compared with the other groups (p < .001). The type of saliva did not influence enamel erosion, SHf and ΔKHN for the groups treated with TMP-containing toothpastes. CONCLUSION: The addition of 3% TMPnano to 1100 ppm F toothpastes significantly increases the protective effect against enamel erosion in vitro when compared with its counterparts with micrometric TMP or without TMP. This effect was not influenced by the presence of acquired enamel pellicle and saliva.

KR-12-a5 is a non-cytotoxic agent with potent antimicrobial effects against oral pathogens.

This study evaluated the cytotoxicity and antimicrobial activity of analogs of cationic peptides against microorganisms associated with endodontic infections. L-929 fibroblasts were exposed to LL-37, KR-12-a5 and hBD-3-1CV and chlorhexidine (CHX, control), and cell metabolism was evaluated with MTT. The minimal inhibitory concentration (MIC) and the minimal bactericidal/fungicidal concentration (MBC/MFC) of the peptides and CHX were determined against oral pathogens associated with endodontic infections. Enterococcus faecalis and Streptococcus mutans biofilms were cultivated in bovine dentin blocks, exposed to different concentrations of the most efficient antimicrobial peptide and analyzed by confocal laser scanning microscopy. CHX and peptides affected the metabolism of L-929 at concentrations > 31.25 and 500 µg ml-1, respectively. Among the peptides, KR-12-a5 inhibited growth of both the microorganisms tested with the lowest MIC/MBC/MFC values. In addition, KR-12-a5 significantly reduced E. faecalis and S. mutans biofilms inside dentin tubules. In conclusion, KR-12-a5 is a non-cytotoxic agent with potent antimicrobial and anti-biofilm activity against oral pathogens associated with endodontic infections.

Effect of the addition of nano-sized sodium hexametaphosphate to fluoride toothpastes on tooth demineralization: an in vitro study.

OBJECTIVE: This study evaluated the effect of toothpastes containing 1100 ppm F associated with nano-sized sodium hexametaphosphate (HMPnano) on enamel demineralization in vitro using a pH-cycling model. DESIGN: Bovine enamel blocks (4 mm × 4 mm, n = 72) selected by initial surface hardness (SHi) were randomly allocated into six groups (n = 12), according to the test toothpastes: without fluoride or HMPnano (Placebo), 550 ppm F (550F), 1100 ppm F (1100F), 1100F plus HMPnano at concentrations of 0.25% (1100F/0.25%HMPnano), 0.5% (1100F/0.5%HMPnano), and 1.0% (1100F/1.0%HMPnano). Blocks were treated 2×/day with slurries of toothpastes and submitted to five pH cycles (demineralizing/remineralizing solutions) at 37 °C. Next, final surface hardness (SHf), integrated loss subsurface hardness (ΔKHN), integrated mineral loss (gHAp × cm-3), and enamel fluoride (F) concentrations were determined. Data were analyzed by ANOVA and Student-Newman-Keuls test (p < 0.001). RESULTS: Toothpaste with 1100F/0.5%HMPnano led to the lowest mineral loss and the highest mineral concentration among all groups, which were 26% (SHf) and 21% (ΔKHN) lower and ~58% higher (gHAp × cm-3) when compared to 1100F (p < 0.001). Similar values of enamel F were observed for all fluoridated toothpastes (p > 0.001). CONCLUSION: The addition of 0.5%HMPnano to a 1100 F toothpaste significantly enhances its effects against enamel demineralization when compared to its counterpart without HMPnano in vitro. CLINICAL SIGNIFICANCE: Toothpaste containing 1100 ppm F associated with HMPnano has a higher potential to reduce the demineralization compared to 1100 ppm F. This toothpaste could be a viable alternative to patients at high risk of caries.

Remineralizing Potential of a Low Fluoride Toothpaste with Sodium Trimetaphosphate: An in situ Study.

OBJECTIVE: To evaluate the effect of a low-fluoride (F) toothpaste supplemented with sodium trimetaphosphate (TMP) on enamel remineralization in situ. DESIGN: Bovine enamel blocks were selected on the basis of their surface hardness (SH) after caries-like lesions had been induced, and randomly divided into 4 treatment groups, according to the toothpastes used: without F or TMP (placebo); 500 ppm F; 500 ppm F plus 1% TMP; and 1,100 ppm F. The study design was blinded and crossover and performed in 4 phases of 3 days each. Eleven subjects used palatal appliances containing 4 bovine enamel blocks which were treated 3 times per day during 1 min each time, with natural slurries of saliva and toothpaste formed in the oral cavity during toothbrushing. After each phase, the percentages of surface (%SHR) and subsurface hardness recovery (%ΔKHNR) were calculated. F, calcium (Ca), and phosphorus (Pi) contents in enamel were also determined. Data were analyzed by 1-way, repeated-measures ANOVA, followed by the Student-Newman-Keuls test (p < 0.05). RESULTS: Toothpaste with 500 ppm F + TMP and 1,100 ppm F showed similar %SHR and %ΔKHNR as well as enamel F, Ca, and Pi concentrations. CONCLUSION: The addition of TMP to a low-fluoride toothpaste promoted a similar remineralizing capacity to that of a standard (1,100 ppm F) toothpaste in situ.

Fluoride toothpaste supplemented with sodium hexametaphosphate reduces enamel demineralization in vitro.

OBJECTIVE: The aim of this study was to evaluate the effect of fluoride dentifrices combined with sodium hexametaphosphate (HMP) on enamel demineralization in vitro. MATERIAL AND METHODS: Enamel bovine blocks were selected by initial surface hardness (SHi) and then divided into five experimental groups (n = 12): placebo (without fluoride and without HMP); 1100 ppm F (1100F); and 1100F associated with HMP at 0.5 % (1100HMP0.5%), 1 % (1100HMP1%), and 2 % of HMP (1100HMP2%). Blocks were submitted to five pH cycles (demineralizing/remineralizing solutions) at 37 °C. After pH cycling, final surface hardness (SHf), percentage of surface hardness loss (%SH), integrated differential hardness (ΔIH), integrated loss of subsurface hardness (ΔKHN), and enamel firmly bound fluoride (F) were determined. Data were submitted to one-way ANOVA, followed by Student-Newman-Keuls test (p < 0.05). RESULTS: Significant differences were observed among all groups regarding %SH and ΔKHN. 1100HMP1% promoted the lowest mineral loss among all groups (p < 0.001), and led to significantly lower demineralization in the deeper regions of the subsurface lesion when compared with the other HMP-containing toothpastes (p < 0.001). Significantly higher mineral loss was observed for 1100HMP2% when compared to the other fluoridated dentifrices, mainly in the outer part of the lesion (p < 0.001). Enamel F uptake was similar for 1100F and 1100HMP1% but significantly reduced for other HMP concentrations. CONCLUSION: The supplementation of a 1100-ppm F dentifrice with 1 % HMP promoted a higher inhibitory effect against enamel demineralization when compared to a dentifrice containing the same amount of fluoride in vitro. CLINICAL RELEVANCE: This dentifrice could potentially be indicated to patients at high risk of caries.

Effectiveness of a Toothpaste with Low Fluoride Content Combined with Trimetaphosphate on Dental Biofilm and Enamel Demineralization in situ.

OBJECTIVE: The aim of the present study was to evaluate in situ whether a toothpaste with low fluoride associated with sodium trimetaphosphate (TMP) would provide similar effect to that of a 1,100 ppm F toothpaste. DESIGN: This crossover double-blind study consisted of 4 phases (14 days each), during which 10 volunteers wore oral appliances containing 4 enamel bovine blocks. The cariogenic challenge was performed by the application of a 20% sucrose solution (6×/day). The toothpaste treatments (2×/day) were: placebo, 500 ppm F, 500 ppm F plus 1% TMP, and 1,100 ppm F. At the end, enamel mineral loss and biofilm composition were analyzed. RESULTS: The toothpaste with 500 ppm F plus 1% TMP showed the lowest mineral loss (p < 0.05). Regarding the fluoride and calcium concentrations in the enamel and in the biofilm, there were no significant differences between 500 ppm F plus 1% TMP, and 1,100 ppm F toothpastes (p > 0.569), but they were significantly different when compared to toothpaste with 500 ppm F (p < 0.050). CONCLUSION: The addition of 1% TMP to a low-fluoride toothpaste reduces enamel demineralization in situ similar to a 1,100 ppm F toothpaste.

In vitro effect of sodium trimetaphosphate additives to conventional toothpastes on enamel demineralization.

OBJECTIVE: The aim of this study was to evaluate the ability of conventional toothpastes (1100 ppm F) supplemented with sodium trimetaphosphate (TMP) in demineralization. MATERIAL AND METHODS: Blocks of enamel were selected and then divided into seven experimental groups of 12: toothpaste without F and TMP (placebo), toothpaste with 1100 ppm F (1100), and toothpaste with 1100 ppm F supplemented with TMP-1 % (1100 1 % TMP), 3 % (1100 3 % TMP), 4.5 % (1100 4.5 % TMP), 6 % (1100 6 % TMP), and 9 % (1100 9 % TMP). Blocks were subjected to five pH cycles (demineralizing/remineralizing solutions) at 37 °C and treated with toothpaste slurries twice daily, after which the blocks were maintained for 2 days in fresh remineralizing solution. Following treatments, surface hardness (SHf) and cross-sectional hardness were determined for calculating the integrated loss of subsurface hardness (ΔKHN). The fluoride present in the enamel was also measured. RESULTS: The SHf and ΔKHN measurements showed that supplementation with 3 % TMP was the most effective (p < 0.001) and showed greater concentration of F in the enamel (p < 0.001). CONCLUSION: Addition of 3 % TMP to a conventional toothpaste (1100 ppm F) showed greater efficacy in reducing enamel demineralization. CLINICAL RELEVANCE: Fluoride toothpastes containing trimetaphosphate possess good anticaries potential required to reduce the prevalence of dental caries in high-risk patients.

Effect of fluoride gels supplemented with sodium trimetaphosphate in reducing demineralization.

OBJECTIVES: The objective of this study was to evaluate the in vitro effect of low-fluoride (F) gels supplemented with sodium trimetaphosphate (TMP) on enamel demineralization. MATERIALS AND METHODS: Bovine enamel blocks (n = 160) were selected based on surface hardness (SH) and divided into eight treatment groups (n = 20 per group): no F or TMP (placebo), 3 % TMP (3 %TMP), 5 % TMP (5 %TMP), 4,500 µg F/g (4,500), 4,500 µg F/g + 3 % TMP (4,500 3 %TMP), 4,500 µg F/g + 5 % TMP (4,500 5 %TMP), 9,000 µg F/g (9,000), and 12,300 µg F/g (acid gel). Blocks were subjected to demineralization/remineralization cycling for 5 days. Subsequently, surface hardness (SH1) and integrated loss of subsurface hardness (ΔKHN) were assessed, and the concentrations of loosely bound (CaF2-like) and firmly bound (FA-like) formed and retained F were determined. RESULTS: The 4,500 5 %TMP and acid gel groups showed similar results and had the lowest mineral loss (SH1 and ∆KHN). The acid gel group had the highest concentration of CaF2-like F, but the formation and retention of FA-like F was greater in the 4,500 5 %TMP group than in the acid gel group (p < 0.05). CONCLUSION: It is possible to inhibit enamel demineralization with low-F gels supplementing these gels with 5 % TMP. CLINICAL RELEVANCE: The low-F gel containing TMP can be regarded as a safer alternative for clinical use from a toxicological point of view since it contains half of the amount of a conventional formulation while promoting similar anticaries effect.