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The effect of a 2% zinc citrate, 0.3% Triclosan dentifrice on plaque acid production following consumption of a snackfood.

OBJECTIVES: A) To assess plaque lactate production following consumption of three foods (cake, chocolate/caramel bar, sweetened coffee), and B) To measure the effect of a fluoride dentifrice containing 2% zinc citrate and 0.3% Triclosan on plaque lactate and pH drop following consumption of cake. METHODS: A) 10 subjects completed the first study. Plaque samples taken before and at 8,15 and 30 minutes after eating. Samples were analysed for lactate via Capillary Electrophoresis. B) 30 subjects completed the second study. Plaque samples were taken before and after cake and use of test dentifrice or no treatment control. Plaque pH and lactate content were assessed. RESULTS: A) Plaque lactate levels increased after all three foods; peak lactate levels occurred 8 minutes after eating. B) Plaque lactate concentrations after eating cake were 39.2mM for the control treatment and a significantly lower value, 23.6mM, for the test 2% zinc citrate, 0.3% Triclosan dentifrice. After food challenge, pH values were 5.53 for the no treatment group and a significantly higher value of 5.79 for the test dentifrice group. CONCLUSIONS: A toothpaste containing 2% zinc citrate, 0.3% Triclosan can significantly reduce plaque lactate generation and pH drop induced by cake, compared to no treatment control.

Adolescent↗

Reversal of primary root caries using dentifrices containing 5,000 and 1,100 ppm fluoride.

This study compared the ability of two sodium fluoride dentifrices, one containing 5,000 ppm fluoride (Prevident 5000 Plus) and the other 1,100 ppm fluoride (Winterfresh Gel), to reverse primary root caries lesions (PRCLs). A total of 201 subjects with at least one PRCL each entered the study and were randomly allocated to use one of the dentifrices. After 6 months, 186 subjects were included in statistical analyses. At baseline and after 3 and 6 months, the lesions were clinically assessed and their electrical resistance measured using an electrical caries monitor. After 3 months, 39 (38.2%) of the 102 subjects in the 5,000 ppm F- group and 9 (10.7%) of 84 subjects using the 1,100 ppm F- dentifrice, had one or more PRCLs which had hardened (p = 0.005). Between baseline and 3 months, the log10 mean +/- SD resistance values of lesions for subjects in the 1,100 ppm F- group had decreased by 0.06+/-0.55, whereas those in the 5,000 ppm F- group had increased by 0.40+/-0.64 (p<0.001). After 6 months, 58 (56.9%) of the subjects in the 5,000 ppm F- group and 24 (28.6%) in the 1,100 ppm F- group had one or more PRCLs that had become hard (p = 0.002). Between baseline and 6 months, the log10 mean +/- SD resistance values of lesions for subjects in the 1,100 ppm F- group decreased by 0.004+/-0.70, whereas in the 5,000 ppm F- group, they increased by 0.56+/-0.76 (p<0.001). After 3 and 6 months, the distance from the apical border of the root caries lesions to the gingival margin increased significantly in the 5,000 ppm F- group when compared with the 1,100 ppm F- group. The plaque index in the 5,000 ppm F- group was also significantly reduced when compared with the 1,100 ppm F- group. The colour of the lesions remained unchanged. It was concluded that the dentifrice containing 5,000 ppm F- was significantly better at remineralising PRCLs than the one containing 1,100 ppm F-.

Adult↗

Fingernails and toenails as biomarkers of subchronic exposure to fluoride from dentifrice in 2- to 3-year-old children.

This work evaluated the use of fingernails and toenails as biomarkers of subchronic exposure to fluoride (F) from fluoride dentifrice (FD) in 2- to 3-year-old children. Ten 2- to 3-year-old children used a placebo dentifrice (without F) for 28 days, FD (1,570 ppm F as monofluorophosphate) for the following 28 days, and then placebo dentifrice for an additional 28 days, then returned to their usual dentifrices. Fingernails and toenails were clipped every 2 weeks, during the experimental period and for an additional 22 weeks. Nail F was analyzed by electrode following hexamethyldisiloxane-facilitated diffusion. There were no significant differences between fingernail and toenail F concentrations. Mean peak F concentrations occurred 16 weeks after starting the use of FD. Results suggest that fingernails and toenails may be suitable biomarkers of subchronic exposure to F from FD in small children.

Analysis of Variance↗

Effect of a calcium carbonate-based dentifrice on in situ enamel remineralization.

This crossover study evaluated the effect of calcium carbonate (CaCO(3))-based monofluorophosphate dentifrice on enamel remineralization. Ten volunteers wore palatal appliances containing four enamel blocks with caries-like lesions, two of them covered by a test plaque of mutans streptococci. The following treatments were evaluated: a negative control, a silica-based or a CaCO(3)-based dentifrice, and the percentage of enamel surface microhardness recovery was determined. The CaCO(3)-based dentifrice was more effective than the negative control on the enhancement of enamel remineralization, either in the presence or absence of test plaque. This efficacy was also shown by the silica-based dentifrice but only in the presence of test plaque.

Analysis of Variance↗

Influence of fluoride dentifrice on brushing abrasion of eroded human enamel: an in situ/ex vivo study.

This in situ/ex vivo study assessed the effect of fluoride dentifrice on eroded enamel subjected to brushing abrasion. In a crossover study performed in 2 phases, 10 volunteers wore acrylic palatal appliances, each containing 3 human enamel blocks. Dentifrice was used to brush the volunteers' teeth and the specimens subjected to abrasion. In phases A and B the dentifrices used had the same formulation, except for the absence or presence of fluoride, respectively. The blocks were subjected to erosion by immersion of the appliances in a cola drink for 5 min, 4 times a day. Then the blocks were brushed, and the appliance was replaced into the mouth. Enamel alterations were determined using profilometry and percentage change in surface microhardness (%SMHC) tests. The data were tested using the paired t test. The mean wear values (+/-SD, microm) were: group A 6.84 +/- 1.72 and group B 5.38 +/- 1.21 (p = 0.04). The mean %SMHC values (+/-SD) were: group A 54.6 +/- 16.2 and group B 45.7 +/- 6.8 (p = 0.04). Fluoride dentifrice had a protective effect on eroded enamel subjected to brushing abrasion.

Adult↗

Effect of different fluoride levels in dentifrice on the development of approximal caries.

The development of approximal carious lesions was monitored on annual bite-wing radiographs obtained from 315 children, participating in a controlled dentifrice trial; 157 of these children had used a dentifrice containing 250 ppm F and 158 a dentifrice containing 1,000 ppm F (both as NaF) during a 3-year period as the sole fluoride supplement. The total number of surfaces recorded was 6,099 at the baseline and 7,358 at the final examination. In the 250-ppm F group 393 approximal lesions (297 in the outer half, 96 in the inner half of the enamel) and in the 1,000-ppm F group 399 lesions (319 and 80, respectively) were diagnosed at the baseline examination. After 3 years the fraction of sound surfaces had decreased from 79% at baseline in both groups to 54% in the low-F group and to 58% in the high-F group. Concurrently, the relative number of enamel lesions had increased from 13% in both groups to 26% in the low-F group and 24% in the high-F group. 66% of the surfaces in the low-F group and 60% in the high-F group remained sound, and the relative proportion of static enamel lesions was 26 and 28%, respectively. The differences did not reach statistical significance. The results imply that higher fluoride levels in the dentifrice are more effective in retarding the initiation of caries, while they do not differ with respect to the progression of radiographically detectable approximal carious lesions.

Bicuspid↗

Effect of mouthrinsing after toothbrushing with a fluoride dentifrice on human salivary fluoride levels.

In a recent clinical trial of sodium monofluorophosphate dentifrices, oral rinsing habits were found to influence dental caries. Thus an oral fluoride clearance study has been undertaken which was designed to test a possible mechanism for the observed effects. Eight subjects brushed with one of the trial dentifrices and then rinsed using 1 of 8 procedures of varying thoroughness. The salivary fluoride concentration measured 5 min after dentifrice application decreased significantly with increasing rinse volume, rinse duration, and rinse frequency (p less than 0.01, analysis of variance). The area under the clearance curve determined over a further 3 h was significantly higher (300%; p less than 0.01) following use of the least thorough rinsing procedure (5 ml x 2 s once) as compared with the corresponding area under the clearance curve following the most thorough procedure (20 ml x 10 s twice). These findings indicate that rinsing habits may play an important role in the oral retention of fluoride from dentifrices which may, in turn, affect their clinical efficacy.

Adult↗

Effect of dentifrices containing either xylitol and glycerol or sorbitol on mutans streptococci in saliva.

In 76 adults, randomly distributed between two groups, a comparison was made of the effect on the level of mutans streptococci in saliva between two dentifrices containing: (1) xylitol (9.9%) and glycerol (20%) or (2) sorbitol (28%) as humectants. After the use of the dentifrices twice daily for 3 months, the levels of mutans streptococci had not changed significantly in the sorbitol-treated group, whereas a significant reduction (p less than 0.0005) was found in subjects using the xylitol/glycerol dentifrice. The difference between the two dentifrice groups based on the changes observed during the 3-month period was also significant (p less than 0.02).

Adult↗

High resolution fluoride profiles of artificial in vitro lesions treated with fluoride dentifrices and mouthrinses during pH cycling conditions.

A pH cycling model which incorporated a severe demineralization component was used to evaluate fluoride uptake and lesion progression for each of a NaF-based dentifrice, NaF-based mouthrinse and a monofluorophosphate (MFP)-based dentifrice. Simultaneous transverse fluoride and calcium profiles across the resulting artificial lesions were obtained using a proton microprobe technique with a resolution of approximately 10 microns. Longitudinal microhardness testing and proton microprobe calcium profiles were used to determine the extent of lesion progression (delta Z) with respect to untreated controls. Under the pH cycling conditions of the present study, the NaF dentifrice and mouthwash were observed to have a considerably higher uptake of fluoride in the lesion than the MFP dentifrice. Although the mineral content profiles of the lesions differed for treatments with each of the fluoride products, the differences were not significantly different in this model.

Calcium↗

A critical review of the relative anticaries efficacy of sodium fluoride and sodium monofluorophosphate dentifrices.

While there is broad consensus in the research community that fluoride dentifrices provide important anticaries benefits, debate still remains as to the most efficient form of fluoride used in toothpastes. Recently, the authors of this paper collaborated as part of a scientific advisory group whose objective was to comprehensively review all clinical information available comparing the anticaries efficacy of the two agents most widely used in fluoridated toothpastes, sodium fluoride (NaF) and sodium monofluorophosphate (SMFP). This review included a detailed analysis of each published study pertinent to the question, a comprehensive meta-analysis of all available clinical findings, and an epidemiological assessment of how anticaries benefits of dentifrices may be anticipated to propagate with time. Overall, the use of meta-analysis of head-to-head clinical comparisons between the two fluoride-active systems was found to be the most valid means for comparing the relative efficacy of NaF and SMFP dentifrices. Results of this analysis demonstrated that NaF was significantly more effective than SMFP in preventing caries (p < 0.01). While the numerical difference in efficacy between NaF and SMFP measured between 5 and 10% (total DMFS) over a 2- to 3-year clinical period, this could be expected, on theoretical grounds, to propagate to substantially larger differences (e.g. 10-20%) over 10-20 years. Hence, the difference in efficacy between these two actives was judged to be clinically important as well as statistically significant. Based upon these findings the authors recommend that NaF be used as the active system in fluoridated dentifrices whenever practically feasible. However, the authors caution that this recommendation pertains to the formulation of NaF in highly compatible abrasive systems, which must be demonstrated by critical evaluation of ionic fluoride within formulations for stability, availability and bioavailability. One additional recommendation emanating from this review is that important improvements must be made in the design, execution and reporting of future caries clinical trials in order to bring these important methods up to scientifically acceptable standards.

Adolescent↗

Influence of an experimental sodium fluoride dentifrice on dental caries incidence in children.

Schoolchildren residing in a fluoride-deficient area were provided either a sodium fluoride (0.1% F) or a nonfluoride dentifrice for home use. About half the children provided each type of dentifrice were also given an initial prophylaxis. Combining the data with regard to the type of dentifrice indicated that the sodium fluoride dentifrice resulted in dental caries reductions of 24 and 26% as noted by the two examiners, respectively.

Adolescent↗

Influence of alkaline pH on the effectiveness of sodium fluoride dentifrices.

Two similar sodium fluoride dentifrices, one neutral and one alkaline, were compared to a placebo for clinical effectiveness in reducing caries. The neutral dentifrice contained 35% less soluble fluoride than the alkaline dentifrice. Both fluoride dentifrices were significantly effective but were not different from each other.

Child↗

In situ fluoride uptake from fluoride dentifrices by carious enamel.

A series of studies was performed to measure fluoride deposition in incipient caries-like lesions in enamel specimens contained in functional partial dentures in panelists who used fluoride dentifrices for periods ranging from two to nine weeks. The studies demonstrated the ability of the model to replicate the fluoride-uptake results obtained with a series of three dentifrices in two different panels of subjects. All fluoride dentifrices resulted in significant fluoride deposition, although significantly greater deposition was observed with a NaF-SiO2 dentifrice.

Adolescent↗

Dentifrice usage among Danish children.

The usage of dentifrice was studied in 179 Danish children of approximate ages 3, 7, 9, and 16 years. The usage was assessed by measurement of the aggregated quantities used at home during a two-week period. Information was also obtained on toothbrushing habits. The mean daily usage with the same brand of dentifrice increased from 1.1 g among 3-year-olds to 1.5, 2.3, and 3.4 g among 7-, 9-, and 16-year-olds, respectively. The amount used showed a significant, positive relationship to the orifice diameter of the tube. However, the lengths of ribbon of paste squeezed out per brushing were quite similar, regardless of tube orifice diameter. When the usage data were considered in light of the fact that young children swallow an average of 15 to 30% of the dentifrice used for brushing, it became obvious that a notable number of the 3- and 7-year-olds can be expected to ingest fluoride from 1000- and 1500-ppm-F dentifrices in quantities exceeding recommended daily doses.

Adolescent↗

Fluoride in plaque following use of dentifrices containing sodium monofluorophosphate.

Previous work showed that plaque fluoride increased with increasing NaF content of mouthwashes following daily use. The main aim of this study was to test whether a similar relationship was detectable after regular use of dentifrices containing amounts of sodium monofluorophosphate equivalent to 1000, 1500, and 2500 micrograms F/g. Plaque was collected from three groups, each consisting of approximately 80 children, who had each used one of the dentrifrices for one year. Plaque fluoride increased significantly with increasing Na2FPO3 content of the dentifrices. For the 1000-micrograms-F/g group, plaque fluoride also increased significantly with increasing frequency of dentifrice use, but did not correlate with amount of dentifrice applied per brushing. The inverse correlation observed between mean plaque fluoride concentrations and mean three-year caries increments suggests that oral fluoride measurements may prove valuable in estimating the likely anti-caries efficacy of fluoride-containing dental products.

Adolescent↗

Reduction of calculus accumulation in domestic ferrets with two dentifrices containing pyrophosphate.

Work performed by King et al. in the 1940's and 1950's, as well as recent studies by our group, have shown that the domestic ferret is a suitable model for the study of calculus formation, offering several advantages over the rodent and dog models in current use. We have demonstrated that mineral supplementation of a moist diet accelerates calculus accumulation, and that twice-daily application of a regular dentifrice slows the initial rate of calculus formation, but permits significant accumulation by the eighth week. The present study compared calculus accumulation in female ferrets receiving mineral-supplemented cat food and a twice-daily application of either Regular Crest toothpaste (Crest), Anti-tartar Crest (Crest-AT), or Anti-tartar Colgate Gold toothpaste (Colg-AT). Animals received an ultrasonic prophylaxis, then were fed once daily for eight weeks with moist canned cat food supplemented with sucrose and mineral salts, and were scored for area and extent of calculus accumulation at four and eight weeks after prophylaxis. The data show that the groups treated with the anti-calculus dentifrices produced significantly less calculus than the group treated with regular dentifrice; the Colg-AT group also exhibited lower scores than did the Crest-AT group, especially at four weeks. These results, similar to those seen in human studies, demonstrate that the ferret is a suitable model for the study of anti-calculus dentifrices.

Analysis of Variance↗

In situ effect of frequent sucrose exposure on enamel demineralization and on plaque composition after APF application and F dentifrice use.

Since the effect of the combination of methods of fluoride use on enamel demineralization and on plaque composition is not clearly established, this study examined the effect of the combination of acidulated phosphate fluoride (APF) application and F dentifrice on enamel demineralization and on plaque composition. In this crossover study, 16 volunteers, wearing a palatal appliance containing bovine enamel blocks, were subjected to 4 treatment groups: non-fluoridated dentifrice (PD), FD, APF+PD, and APF+FD. The APF was applied to the enamel before the 14-day experimental period. During the experimental period, test dentifrices were applied 3x/day, and a 20% sucrose solution was applied 4x and 8x/day by being dripped on the blocks. Although APF application was able either to increase F concentration in plaque or to reduce the % of mutans streptococci, its combination with F dentifrice use neither reduced enamel mineral loss nor changed any other measured plaque variable with respect to the FD group alone.

Acidulated Phosphate Fluoride↗

A new desensitizing dentifrice: preliminary report.

Dentin sensitivity is one of the most painful, ubiquitous, and least satisfactorily treated chronic problems of the teeth. The purpose of this clinical trial was to test the sensitivity-reducing effectiveness of five dentifrices over a six-week period. For the study, 176 adults, ages 18 to 63, exhibiting a total of 486 hypersensitive surfaces, were randomly allocated to five experimental groups to use one of the following: a strontium chloride dentifrice, a 0.4% stannous fluoride gel, a pluronic F-127-sodium citrate gel, a pluronic F-127 gel, or a control dentifrice. No specific instructions were provided as to the frequency or method of toothbrushing; thus, the participants brushed their teeth in their usual manner. The analysis of the data was limited to 168 persons who complied with study procedures. Chi-square analysis examined the statistical differences between the four test agents and the control formulation. The desensitizing effect of the pluronic plus sodium citrate gel was highly significant, and the plain pluronic F-127 preparation was effective to a lesser degree. Patients using the strontium chloride or stannous-fluoride-containing dentifrices did not exhibit a significant improvement over the control group. This study demonstrated that a pluronic polyol gel containing sodium citrate is highly effective in controlling tooth hypersensitivity.

Adult↗