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Cleaning power and abrasivity of a new toothpaste based on ion-exchange resins.

PURPOSE: To compare the stain removal efficacy and enamel abrasivity of a new experimental dentifrice based on an ion-exchange resin mixture that releases calcium, fluoride, phosphate and zinc ions (named NMTD1), to four commercially available dentifrices: Crest Extra-whitening toothpaste, Crest Tartar Protection toothpaste, Crest Cavity Protection toothpaste and Colgate Fluoride Cavity Protection toothpaste. Calcium pyrophosphate was used as a control for the efficacy of the staining removal experiment. METHODS: Cleaning power evaluation was made following the method developed by Stookey et al. The abrasion of the toothpastes was determined by means of a brushing machine, using 2000, 4000 and 8000 strokes and a 250g toothbrush load. Bovine specimens were prepared and abrasion was measured by a surface profilometer system. RESULTS: The new experimental dentifrice did not remove stains whereas Crest Extra-whitening and Crest Cavity Protection dentifrices produced statistically significant stain removal when compared with the calcium pyrophosphate control. Abrasion studies demonstrated that abrasion was linearly correlated to the number of strokes and the abrasion rates proved to be non significant for Colgate and the new experimental dentifrices, but significant for Crest Extra-whitening, Crest Tartar Protection and Crest Cavity Protection. CLINICAL SIGNIFICANCE: This study demonstrated that the use of a dentifrice based on an ion-exchange mixture was not effective at removing stains and abrasion was most insignificant when compared to other commercially available toothpastes.

Animals↗

[Microradiographic study of iliac bone biopsies taken after treatment of postmenopausal osteoporosis with sodium fluoride. Histomorphometric correlations].

Thirty seven female patients with osteoporosis underwent iliac bone biopsy after 10 to 23 months of continuous or discontinuous treatment with sodium fluoride, calcium, and vitamin D. Microradiographs of the biopsies from 13 patients showed one or--more often--several of the characteristic appearances of bone fluorosis: defects in periosteocytic mineralization, unmineralized strips inside the trabeculae of spongy bone, construction of fibrous bone, hypercalcified periosteal apposition. The occurrence of these microradiographic signs of fluorosis does not seem to be linked either to the age of the patients, to the interval elapsed since ovarian function ceased, or to the degree of bone remodelling at the time that treatment was started. Moreover, none of these patients showed signs of even moderate renal insufficiency. Should the development of this fluorosis, which is most frequently clinically asymptomatic, be considered as a condition or as a factor in therapeutic efficacy? Or are the effects detrimental and therefore to be avoided by a reduction in dosage or a change in therapeutic methods?

Adult↗

Effect of acid-etching on fluoride-treated caries-like lesions of enamel: a SEM study.

Etching patterns by 20 percent phosphoric acid on caries-like lesions of enamel (white spot) untreated and treated with 0.4 APF were studied at 30, 60, 120 seconds of etch-times using the Scanning Electron Microscope (SEM). The surface topography of acid-etched teeth varied according to the etch time. Acid etching of caries-like lesions treated with fluoride showed etching patterns similar to sound enamel. Based on Silverstone's classification, thirty seconds etch-time produced type III pattern of surface morphology, while type I and type II were observed with 60 and 120 seconds of etch time. Fluoride treated lesions showed increased porosity and in addition to a surface coating of numerous small globules of calcium fluoride. Low level of topical fluoride before sealant application should be beneficial, since this allows a more rapid rate and increased degree of remineralization and possible arrest in the progress of caries lesions.

Acid Etching, Dental↗

Novel topical fluoride delivery system I: remineralization of ground bovine teeth.

Laboratory studies were carried out on a newly conceived fluoride-containing remineralizing system with bovine teeth. The prototype fluoride delivery device involved micronized calcium fluoride maintained at the tooth surface with a cellulose film. Together with salivary calcium and phosphate (or simulated saliva), this system was able to generate and maintain the appropriate thermodynamic activity driving force for significant fluorapatite deposition in a reasonably short time (approximately 48 hr).

Animals↗

Sudden cardiac death from acute fluoride intoxication: the role of potassium.

The mechanism of sudden cardiac death following acute fluoride intoxication has been thought to result from profound hypocalcemia produced by the precipitation of calcium fluoride salts. In studies of a canine model, the onset of lethal ventricular arrhythmias was temporally more associated with an elevation of serum potassium than with a drop in serum calcium. Fluoride-induced hyperkalemia could not be prevented with glucose, insulin, or bicarbonate. In the erythrocytes, a five-minute exposure to 10 mM NaF caused a 50% increase in extracellular potassium concentrations after 12 hours compared to control erythrocyte suspensions (P less than .001). The total potassium efflux after 12 hours of incubation was linearly related to the log of fluoride contact time (r, 0.886; P less than .001). The treatment of fluoride-induced hyperkalemia may depend on removal of fluoride and potassium.

Animals↗

Comparison of a dual-phase fluoride toothpaste containing calcium, phosphate, and sodium bicarbonate with a regular fluoride toothpaste on calculus formation.

This clinical study compared the effect on dental calculus formation of a dual-phase fluoride dentifrice containing sodium bicarbonate, calcium, and phosphate with that of a regular dentifrice using a short-term clinical model in which calculus formation was facilitated. A total of 87 adult volunteers completed this study, which was a double-blind, parallel-group design, consisting of 2-week pretrial and trial periods separated by a washout period. A partial-mouth technique was used wherein the lower anterior teeth were protected from brushing by a custom-fitted toothshield, which doubled as an applicator for an undiluted dentifrice, twice daily. Calculus was measured on the labial/lingual surfaces of six lower anterior teeth by the Volpe-Manhold Index (V-MI). Subjects used a non-tartar-control dentifrice during the pretrial period to determine calculus formation rates, and these V-MI scores were used as baseline data for random allocation to either a control or test product for the trial period. Subjects who were accepted into the study, based on existing tartar deposits, readily formed calculus during the pretrial period using the toothshield method. During the trial period, subjects who were assigned the test dentifrice had comparable amounts of calculus accumulation to those who used the control dentifrice. However, subjects in the test dentifrice group had significantly lower (16%) calculus scores on lingual surfaces than those in the control group. Intragroup comparisons of V-MI data from the pretrial period with those from the trial period provided similar overall results to the comparisons between groups. This study demonstrated that a dual-phase baking soda dentifrice containing calcium and phosphate did not increase calculus accumulation relative to a regular dentifrice when used by adults with a propensity for developing calculus.

Adult↗

Fluoridated hydroxyapatites synthesized with organic phosphate ester.

Fluoridated hydroxyapatites with various fluoride contents were synthesized with organic phosphate ester monomer as a source of P at pH 9.5 and 80 degrees C. The a-axis dimensions of the fluoridated hydroxyapatites decreased with the increase of the fluoride content in the same way as the fluoridated hydroxyapatites synthesized with inorganic phosphate under the same conditions. However, for the same calculated degree of fluoridation in the feed solution, fluoridated hydroxyapatites synthesized with organic P had higher fluoride contents than those synthesized with inorganic P. The crystallinity of the former decreased initially, then increased with increasing fluoride content; but on the whole it was lower than that of the latter. The apparent solubility at pH 4.0 and 37 degrees C decreased dramatically and monotonically with increasing fluoride content and approached an almost constant value at a fluoride content above that of fluorapatite, at which value calcium fluoride was detected.

Calcium↗

Risk-benefit ratio of sodium fluoride treatment in primary vertebral osteoporosis.

The risk-benefit ratio of combined fluoride-calcium therapy in primary vertebral osteoporosis was examined prospectively in patients with at least one vertebral fracture. 257 patients were randomised to receive sodium fluoride 25 mg twice daily plus elemental calcium 1 g daily and a vitamin D2 supplement, and 209 received one of the alternative therapies usually prescribed in France. After a follow-up of 24 months the fluoride-calcium group showed a significantly lower rate of new vertebral fractures, the main adverse effect of the regimen being a higher incidence of osteoarticular pains in the ankle and foot; the risk of non-vertebral fractures was not increased, and digestive disorders arose with equal frequency in the two groups. Sodium fluoride 50 mg daily seems to represent a reasonable compromise in terms of anti-fracture effectiveness and side-effects.

Administration, Oral↗

Effect of amine fluoride on enamel surface morphology.

In this in vitro study, examination of the enamel surface morphology after topical application of an amine fluoride solution with different fluoride (F) content was carried out. Sound human enamel slabs were treated with an amine fluoride solution containing either 1.0, 0.5 or 0.25% F for 3 min. during 3 days. All slabs were examined using scanning electron microscopy and energy-dispersive spectroscopy (SEM/EDS) qualitative analysis. The globular precipitates were revealed in all treated specimens, regardless of F content. The distribution of the deposits was more homogeneous in groups treated with higher concentrations; however, the globules were larger and more cubical in groups treated with lower fluoride concentrations. These larger globules could be less soluble and thus serve as a fluoride reservoir for a more extended period and so they could contribute to the caries preventive effect in professional topical products with lower fluoride concentration. Following the 24-hour treatment with KOH the precipitates could be removed; however, the enamel surfaces covered with the precipitates were less degraded than the untreated enamel. The EDS qualitative analysis showed that the intensities of fluoride signals were increased with the higher concentration of fluoride in an amine fluoride solution, while the intensities of calcium signals were decreased. The enamel surface precipitates were alkali-soluble, but we were not able to demonstrate that they are pure calcium fluoride.

Calcium↗

Remineralization by fluoride enhanced with calcium and phosphate ingredients.

The effectiveness of fluoride ions provided by toothpastes and mouthrinses in promoting remineralization can be limited by the low concentrations of calcium and phosphate ions in saliva. The purpose of this study was to determine whether improved remineralization can be obtained from toothpastes or mouthrinses that simultaneously deliver fluoride, calcium, and phosphate ions from dual-dispensing systems. Enamel specimens with artificial lesions between 60 and 90 microns deep were cycled 15 times through demineralization for 30 minutes, treated for 5 minutes with an experimental or control fluoride toothpaste or mouthrinse, and remineralized for 60 minutes. In the toothpaste study, surface hardness increased by 11.5 +/- 9.2 and 2.7 +/- 3.6 Vickers hardness units, and enamel fluoride content was 5984 +/- 521 ppm and 3971 +/- 531 ppm for the experimental and control fluoride toothpastes, respectively. Remineralization was confirmed by x-ray microradiography. In the mouthrinse study, surface hardness increased by 8.8 +/- 7.7 and 2.2 +/- 3.7 Vickers hardness units, and enamel fluoride content was 6111 +/- 1078 ppm and 3160 +/- 364 ppm for the experimental and control fluoride mouthrinses, respectively. Use of a non-fluoride control mouthrinse led to a decrease in surface hardness of 3.7 +/- 5.2 Vickers hardness units despite a fluoride content of 402 ppm. The results demonstrate that calcium and phosphate supplementation in a toothpaste or mouthrinse can improve remineralization and increase fluoride uptake.

Calcium Phosphates↗

Clinical evaluation of the effect of a remineralizing toothpaste on dentinal sensitivity.

Dentinal hypersensitivity is a common dental problem without a satisfactory solution. Most therapies have focused on either trying to block the stimulation of dentinal nerves or on sealing open dentinal tubules. This study evaluated, in a double blind clinical trial, the effect of Enamelon, a dentifrice containing sodium fluoride, calcium salts and phosphate salts (calcium separated from the phosphate and fluoride by a plastic divider in the tube to prevent interaction) on dentinal hypersensitivity over an 8-week period. A conventional OTC dentifrice containing NaF without calcium and phosphate enhancement served as the control. A third dentifrice, containing sodium monofluorophosphate enhanced by calcium and phosphate salts, was also tested. Based upon subjective anecdotal information, net numbers of sensitive teeth which became non-sensitive, and a logit analysis of the change in the proportion of sensitive teeth over the study time period, Enamelon was the most effective product, and the OTC control the least effective.

Analysis of Variance↗

Varying the mechanical properties of bone tissue by changing the amount of its structurally effective bone mineral content.

The effect of fluoride ions on the mechanical properties of bone tissue in tension was investigated with an in vitro model. Structurally effective Bone Mineral Content (BMC) of bovine bone tissue was changed by fluoride ion treatment. First, bovine cortical bone specimens were treated with a detergent solution in order to increase the diffusion rates of the treatment ions across the samples. After the initial treatment, different ion solutions were used to treat the tension samples (fluoride, sodium and chloride). Ionic strength and pH were varied. Experimental results showed that the sodium chloride solutions of different ionic strengths, at physiological and high pH, do not affect the mechanical properties of bone tissue in tension. However, uniform fluoride treatment across the samples reduced the mechanical strength of bone tissue by converting small amounts of bone mineral to mostly calcium fluoride. This action reduces the structurally effective BMC and also possibly effects the interface bonding between the bone mineral and the organic matrix of the bone tissue.

Animals↗

Determination of fluoride from fluoride-releasing elastomeric ligature ties.

Unaesthetic white spot lesions or larger unsightly areas of decalcification around orthodontic brackets remain a significant problem during fixed appliance treatment. This study determined the in vitro fluoride release from 200 fluoride-containing elastomeric ligature ties. With the potentiometric analytic method, the fluoride release was determined in distilled water, for 10 groups of 20 elastomerics, representing the clinical usage in a patient. Readings were taken every 24 hours for 5 days and then every second week for 6 months. The data were analyzed with the Wilcoxon matched pairs signed ranks test. Fluor-I-Ties (Ortho Arch Company Inc., Hoffman Estates, III.) released significant amounts of fluoride compared with the control readings. The fluoride release was characterized by an initial burst of fluoride during the first day and second day, followed by a logarithmic decrease. By the end of the second week 88% of the total fluoride had been leached from the elastomerics, but adequate magnitudes of fluoride were released over the remainder of the test period to aid theoretically in the prevention of demineralization and enhance remineralization of enamel through calcium fluoride and fluorapatite formation. For optimum clinical benefit, Fluor-I-Ties should be replaced monthly. Future prospective longitudinal clinical studies are indicated.

Apatites↗

Meswak: the natural toothbrush.

The use of a wood stick (meswak or chewing stick) for brushing the teeth continues to be an important tool for oral hygiene care in many Afro-Asian communities. It is inexpensive, customary and used for religious reasons as well. Despite the wide use of meswak, information on its chemical and pharmaceutical contents are scant, particularly in regard to an anticaries effect. In the present study, sticks from Salvadora persica, the most common source for meswak, were analyzed for their soluble and total content of fluoride, calcium, phosphorus and silica. Results showed that the fluoride released from meswak soaked in water was negligible (< 0.07 microgram/ml). Approximately 39% of the total fluoride in the sticks was in a form that could be leached out. The leached calcium and phosphorus averaged 582 micrograms/ml and 34 g/ml, respectively, representing 19.6% and 26.4% of their total content in the sticks. There was a substantial amount of silica in the ashes of meswak. It appears that meswak is probably not particularly active against caries through its fluoride content, but it does act as a brush for removing dental plaque and polishing the teeth.

Calcium↗

Fluoride varnishes in caries prevention.

The first fluoride varnishes were developed during the 1960s (Duraphat) sodium fluoride varnish) and 1970s (Fluor Protector) silane fluoride varnish) to prolong the contact time between fluoride and enamel. Fluoride varnishes adhere to enamel, and calcium fluoride formed after application acts as a long-term reservoir of fluoride. Currently Duraphat varnish is the most widely used topical fluoride for professional application in Europe, and the use of fluoride varnishes is increasing in the USA. Duraphat varnish has been effective in three decades of clinical studies, but the results of Fluor Protector varnish are inconclusive. The percent caries reductions found in the 1990s have generally been lower than those reported in earlier studies, probably because of the higher exposure to other preventive measures in the more recent studies. In studies comparing Duraphat varnish and APF gel, Duraphat varnish was equally or more effective than APF gel. Sealants were most effective in preventing occlusal caries. Four applications per year, or three weekly applications once a year, have been found to be effective. However, several studies have shown that two applications per year may provide comparable results. Application is fast and easy. Professional prophylaxis is not necessary, and the patient can leave immediately after the treatment. No acute toxicity has been reported after using any fluoride varnish.

Acidulated Phosphate Fluoride↗

Effects of N-acetylcysteine on histamine release by sodium fluoride and compound 48/80 from isolated rat mast cells.

N-acetylcysteine (NAC) enhances the release of histamine induced by the fluoride-calcium system but not by compound 48/80. After preincubation of the cells for 2 h at room temperature (RT) as well as at 37 degrees C, NAC was found to enhance histamine release also when induced by compound 48/80. Both fluoride treatment and prolonged incubation at 37 degrees C (but not at RT) for 2 h decreased the ATP content of the cells. NAC was found to counteract the fall in ATP caused by prolonged incubation of the cells at 37 degrees C but not when induced by exposure to sodium fluoride. The results do not favor the concept that free radicals generated by fluoride treatment are responsible for the subsequent sensitivity of the cells to the secretory action of calcium. On the other hand, it cannot be excluded that free radicals generated during prolonged incubation of the cells at 37 degrees C might be involved in the decrease of the sensitivity of the cells to the secretory action of the fluoride-calcium system and of compound 48/80. This is supported by the finding that the presence of NAC not only activated the secretory response but also counteracted the decrease of the cellular ATP content noted following preincubation of the cells for 2 h at 37 degrees C.

Acetylcysteine↗

Fluoride released from orthodontic bonding agents alters the enamel surface and inhibits enamel demineralization in vitro.

In this study, we examined two fluoride-releasing orthodontic agents in respect to fluoride release, enamel demineralization inhibition, as well as alterations observed on the enamel surface after their use. Fluoride release was found to occur in the highest concentrations within the first 24 hours for both materials examined. After this period, a dramatic decline in fluoride release was observed in both adhesives, and after 90 days no fluoride was detectable. Both fluoride-releasing materials showed significant differences on enamel demineralization around the brackets when compared with a conventional adhesive, and the agent with the initial higher amounts of fluoride release showed the best results. Scanning electron microscopy of the enamel surface revealed particle depositions of microglobular form, after the examined adhesives were used. These particles most likely represent deposition of calcium fluoride, a salt with clearly cariostatic properties. The results of this in vitro study show that certain fluoride-releasing orthodontic bonding systems may provide an additional degree of safety against caries susceptibility in patients with fixed appliances for a limited period.

Adhesives↗