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NMR studies of a novel calcium, phosphate and fluoride delivery vehicle-alpha(S1)-casein(59-79) by stabilized amorphous calcium fluoride phosphate nanocomplexes.

The repair of early tooth enamel lesions has been recently demonstrated by tryptic phosphopeptides derived from milk caseins that associate with amorphous calcium phosphate (ACP) forming stable complexes. These casein phosphopeptides (CPP), containing the cluster sequence-Ser(P)-Ser(P)-Ser(P)-Glu-Glu-, form calcium phosphate delivery vehicles that retard enamel demineralization and promote remineralization. Recently, we have shown that these peptides also stabilize calcium fluoride phosphate as soluble complexes. These complexes designated CPP-ACFP, have the potential to provide superior clinical efficacy in preventing dental caries and treating and repairing early stages of disease. In an approach to determine the ultrastructure of the casein phosphopeptide-amorphous calcium fluoride phosphate complexes, we have studied the structure of the predominant peptide alpha(S1)-CN(59-79) bound to ACFP using nuclear magnetic resonance (NMR) spectroscopy and X-ray diffraction. The alpha(S1)-CN(59-79) peptide stabilized calcium fluoride phosphate as amorphous nanocomplexes with a hydrodynamic radius of 2.12+/-0.26 nm. The nanocomplexes exhibited stoichiometry of one peptide to 15 calcium, nine phosphate and three fluoride ions. Sequence-specific resonance assignments were determined for the peptide alpha(S1)-CN(59-79) complexed to the ACFP. The secondary structure of the peptide alpha(S1)-CN(59-79) was characterized by sequential (i, i+1), medium-range (i, i+2) nOes and H alpha chemical shifts. The spectral data were compared with that of the peptide alpha(S1)-CN(59-79) bound to calcium ions, revealing that the structurally significant secondary NH and alpha-chemical shifts were similar.

Amino Acid Motifs↗

A continuous flow system for assessing fluoride release/uptake of fluoride-containing restorative materials.

OBJECTIVES: The aim of this study was to develop a continuous flow system to mimic the kinetics of salivary flow in the mouth and to study the fluoride (F) release/uptake characteristics of both a conventional (Fuji IX) and a resin-modified glass ionomer (Vitremer) in such system. METHODS: Five discs were made for each material. The disc was suspended in a drip chamber sustaining 2 ml of deionized water. The flow rate was controlled at 20 ml/h by an infusion pump. The F release in the drip chamber was assessed at designated time points for up to 6 days. The discs were subjected to 1 min exposures of 0.2% sodium fluoride (NaF); the F re-release was assessed for another 12 h. RESULTS: Following a brief initial burst of F release, the rate decreased rapidly. Vitremer reached a steady low after 8 h, while Fuji IX reached a steady low after 90 min. Cumulative F release was measured from both the effluence and the drip chamber and showed that Vitremer released and took up more F than Fuji IX, both before and after F treatment. Cumulative amounts of fluoride in the drip chamber were much less than that in the effluence. The daily release rate patterns from the two materials were parallel. However, the hourly release rate of Vitremer decreased more gradually than Fuji IX. After sodium fluoride (NaF) treatment, F can be recharged easily and re-released rapidly within 90 min. CONCLUSION: This study indicates that the continuous flow method can be used to assess F release/uptake of the material. This method may represent a closer model to in vivo conditions.

Cariostatic Agents↗

Effect on plaque growth and salivary micro-organisms of amine fluoride-stannous fluoride and chlorhexidine-containing mouthrinses.

Amine fluoride-stannous fluoride mouthrinse was tested in a double-blind cross-over clinical trial on 16 healthy subjects. Chlorhexidine mouthrinse prepared in the same colour and taste was used as the control. After a preparatory phase of 2 weeks, during which the subjects' plaque and gingival indices were reduced to zero by professional cleaning, 1-week test periods without mechanical cleaning were started in random order. The fluoride test solution did not prevent plaque accumulation and growth of salivary S. mutans and lactobacilli as did chlorhexidine. Furthermore, the plaque wet weight was statistically highly significantly greater during test periods of fluoride rinsing than during the chlorhexidine phase. The cleansing effect, as subjectively estimated by questionnaire, was in favour of chlorhexidine, but discolorations of teeth were assessed as significantly worse during chlorhexidine periods. Neither of the test solutions showed any effect on salivary flow rate, pH, buffering capacity, or lysosomal enzyme activity.

Adult↗

Comparison of the antimicrobial effect of the application of chlorhexidine gel, amine fluoride gel and stannous fluoride gel in debrided periodontal pockets.

The clinical and microbiological effect of locally-applied chlorhexidine gel 2%, amine fluoride gel 1.25%, stannous fluoride gel 4% or placebo gel in 40 periodontal pockets of 10 patients were studied. The gels were applied 3 x within 10 min. after mechanical debridement of the pockets. The treatment effect on the subgingival microflora was evaluated by microscopic and culture studies of the subgingival plaque samples. In addition, supragingival plaque, bleeding after probing and probing pocket depth were scored. Examination were carried out before and during a period of 36 weeks after treatment. At the start, the cultured microflora consisted mainly of anaerobic Gram-positive bacteria. Following treatment, the clinical parameters were significantly reduced. Concomitantly, the %s of spirochetes, motile rods and non-motile rods decreased significantly. A significant decrease was also found in the total anaerobic count, whereas the facultative counts remained at the same level found before treatment. This suggested that the treatment resulted in a mainly facultative subgingival microflora. The % Gram-negative rods showed a significant reduction after treatment, but returned to base line at week 12. Statistical analysis of the bacteriological and clinical examinations failed to demonstrate any significant differences between the 4 treatment groups. Thus, in comparison to the placebo gel, subgingival application of chlorhexidine gel 2%, amine fluoride gel 1.25% or stannous fluoride gel 4% did not augment the effect of mechanical debridement on bacteriological and clinical parameters during the experimental period of 36 weeks. However the indicated treatments resulted in a facultative subgingival microflora which is compatible with the host.

Adult↗

Antibacterial activity of dental gels containing combinations of amine fluoride, stannous fluoride, and chlorhexidine against cariogenic bacteria.

The in vitro susceptibility of Streptococcus mutans, S. sobrinus and Lactobacillus casei to dental gels containing various combinations of amine fluoride (AmF 297), stannous fluoride (SnF2), and chlorhexidine (CHX) was studied. The combination of AmF-SnF2 with a total fluoride content of 1.2% was the most effective against mutans streptococci but not against L. casei. At notably lower total fluoride concentration (0.4%), AmF as such or combined with SnF2, was significantly less effective against mutans streptococci than CHX or CHX-AmF-SnF2 combinations. CHX-AmF combination was a slightly more potent inhibitor of streptococcal growth than CHX-NaF. With L. casei the differences between various gels were small but CHX alone seemed to be the most effective. Of the studied agents, CHX seemed to be the most potent individual chemotherapeutic compound whose activity against S. mutans could be enhanced by combining it with AmF. However, clinical experiments are required to test the in vivo antibacterial efficacy of CHX-AmF and AmF-SnF2 combinations which were most effective in our in vitro experiments.

Amino Alcohols↗

Fluoride concentrations in dental plaque and saliva after the use of a fluoride dentifrice preceded by a calcium lactate rinse.

Plaque fluoride concentrations ([F]) are directly related to plaque calcium concentrations [Ca]. Attempts to increase plaque F uptake from dentifrices or rinses have used methods designed to increase plaque [Ca] but with inconsistent results. This double-blind, double-crossover study tested the effect of a 150 mM calcium lactate rinse used prior to brushing with placebo or fluoridated dentifrices (1030 p.p.m. as NaF) on plaque and salivary [F] and [Ca]. Sixteen children (8-10 yr of age) were randomly assigned to four different groups according to the four treatments (placebo dentifrice or fluoridated dentifrice preceded by calcium lactate or deionized water prerinses). Plaque and saliva were collected 1 and 12 h after brushing on day 7 after starting to use the dentifrices. F was determined using the electrode and Ca was determined using atomic absorption spectrometry. Plaque and salivary [Ca] were not significantly increased after use of the calcium lactate prerinse, except for plaque [Ca] 1 h after the use of the placebo dentifrice. A significant increase in salivary [F] was associated with the calcium lactate prerinse only at 1 h after the use of the fluoridated dentifrice. The the calcium lactate prerinse did not significantly affect plaque [F] under any condition.

Calcium↗

Tooth-surface progression and reversal changes in fluoridated and no-longer-fluoridated communities over a 3-year period.

OBJECTIVE: To compare permanent tooth surface-specific progression/reversal changes between fluoridation-ended (F-E) and still-fluoridated (S-F) communities in British Columbia, Canada, over a 3-year period. METHODS: D1D2MFS examinations were contrasted for 2,964 schoolchildren in 1993/94 (grades 2, 3, 8 and 9) and 1996/97 (grades 5, 6, 11 and 12). Generalized Estimating Equation (GEE) models explored the relation between progression/reversal changes and fluoridation status, age, gender, socioeconomic status, and dietary/fluoride histories. RESULTS: Within a scenario of low levels of caries overall, few children had multiple surfaces progressing. At least one smooth surface progressed in 31.4% of subjects; at least one pit-and-fissure (PF) surface progressed in 43.1% of subjects. At least one smooth surface reverted in 89% of subjects who had reversible stages; at least one PF surface reverted in 23.8% of subjects who had reversible stages. GEE (smooth) indicated that odds ratios of progression were twice as large in the F-E site compared to the S-F site, and slightly increased in older participants and in participants exposed to more fluoride technologies. GEE (PF) also indicated that progression was slightly more common in the F-E site; more frequent snacking and lower parental educational attainment had modest associations with increased progression in PF surfaces. For the two types of surfaces, GEE models demonstrated that unerupted surfaces were less likely to progress than sound surfaces. No associations were found between reversals and independent variables. CONCLUSION: Progressions were found to be weakly linked to socio-demographic factors; baseline surface statuses were better predictors of progression. Using the current definitions for disease transitions, F-E communities had more frequent progressions than a S-F community.

Adolescent↗

Evaluation of the effects of a pyrophosphate-fluoride anticalculus dentifrice on remineralization and fluoride uptake in situ.

Enamel slabs and thin sections with artificially formed caries lesions were placed in the removable dentures of 15 subjects who brushed them three times daily for 2 weeks with a 1.3% pyrophosphate/1,100 ppm F/1.5% Gantrez dentifrice, a 1,100-ppm F dentifrice without pyrophosphate or Gantrez, or a placebo dentifrice in a double-blind, crossover study. Analysis of the thin sections by quantitative microradiography showed that the pyrophosphate/F dentifrice remineralized the lesions 15.9% (p less than 0.05) and the fluoride dentifrice 11.2%, whereas the placebo produced 4.4% demineralization. Fluoride uptake by the enamel slabs was similar for both fluoride dentifrices and significantly greater from the placebo dentifrice (p less than 0.05). The findings suggest that the anticaries mechanisms of fluoride include not only the prevention of demineralization, but also the promotion of remineralization.

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↗

Relationship between dental caries experience and surface enamel fluoride concentration in young men from three optimally fluoridated cities.

An in vivo enamel biopsy technique was used to determine relationships between dental caries experience and surface enamel fluoride levels in a group of young men from three fluoridated cities on the east coat of the U.S. A significant inverse relationship between enamel thickness and fluoride concentration was observed, and a weak but statistically significant inverse relationship between caries scores and enamel fluoride concentration was noted. The effect was most pronounced in biopsies which did not exceed 5.9 micron in depth.

Adolescent↗

Fluoride uptake by artificial caries lesions from fluoride dentifrices in vivo.

Artificial caries lesions were implanted in removable dentures and were brushed for two wk or two mo with several fluoride-containing dentifrices. An analysis of thin layers of enamel removed from the lesions showed that more fluoride was deposited after two mo of brushing, and that fluoride deposition from the sodium monofluorophosphate was similar to deposition from the sodium fluoride dentifrice.

Adult↗

Fluoride uptake and retention in vitro following topical fluoride applications.

Fluoride uptake and retention on maxillary and mandibular incisors were compared using a conventional APF gel, a thixotropic gel, and a new pluronic-based fluoride gel. Based on the results of in vivo acid-etch biopsies, significant fluoride uptake was obtained with each of the three agents. The highly viscous pluronic gel may provide an alternative to conventional topical fluoride gels for subjects--e.g., handicapped persons--with whom a tray system is not feasible.

Adolescent↗

Studies of fluoride retention by oral soft tissues after the application of home-use topical fluorides.

Previous studies have focused on enamel and plaque as the primary sites of fluoride (F) retention in the mouth. The present study was undertaken to evaluate the role of oral soft tissue as a site of F retention by comparing an edentulous subject panel (n = 9) with a fully dentate panel (n = 10). Unstimulated whole saliva samples were collected by having subjects pool saliva for two min. Samples were collected over a 24-hour period after application of a placebo dentifrice (PD; 0.4 ppm F), fluoride dentifrice (FD; 1100 ppm F), fluoride rinse (FR; 226 ppm F), or fluoride gel (FG; 5000 ppm F) delivered in custom trays. There was no statistically significant difference in salivary flow rate between the two panels for any of the treatments. The edentulous panel had higher salivary F levels than the dentate panel, which reached statistical significance (p less than 0.05) for the FD and FG treatments. In a separate study involving the same treatments, F levels at specific soft-tissue sites were measured over a one-hour period by use of absorbent discs placed in different soft-tissue areas of the mouth. The tongue and lower posterior vestibule retained the highest F levels, followed by the upper posterior buccal vestibule and upper anterior labial vestibule, with the lowest F levels retained in the lower anterior vestibule and the floor of the mouth. There was a strong-to-moderate correlation between whole saliva F concentration and F levels at specific soft-tissue sites. This study establishes the importance of oral soft tissue as the major site of F retention in the mouth.

Analysis of Variance↗

A comparison of fluoride bioavailability from a sustained-release NaF preparation (Neosten) and other fluoride preparations.

Twelve normal subjects completed a crossover study with sustained-release sodium fluoride (Neosten, 11.3 mg F), monofluorophosphate (MFP, 10 mg F), and plain sodium fluoride (P-NaF, 11.3 mg F). After each preparation was given with 400 mg calcium, serum fluoride (Fser) was measured for 24 hours, and pharmacokinetic data were calculated. Fluoride absorption in the Neosten group, as measured by change in the area under the curve (delta AUC) of Fser, was less than 33% of that in the MFP and P-NaF treated groups. Both peak Fser (Cmax) and peak-basal variation in the Neosten group were 25% that found in the other groups. t1/2 was nearly twofold greater after Neosten. MFP and P-NaF showed greater bioavailability than Neosten and much higher Cmax that exceeded the toxic threshold of Fser (190 ng/ml). These findings could explain the ineffectiveness of MFP and P-NaF observed in recent clinical trials.

Adult↗

[Fluoride mouth-rinsing to prevent dental caries in a Brazilian municipality with fluoridated drinking water].

OBJECTIVE: To compare the prevalence of dental caries in two groups of schoolchildren: (1) schoolchildren participating in a weekly 0.2% sodium fluoride mouth-rinsing program and (2) schoolchildren not participating in the program. METHODS: This cross-sectional study was conducted in the city (municipality) of Londrina, in the state of Paraná, Brazil; the city has fluoridated drinking water. We examined 367 12-year-old children: 190 participants in the weekly mouth-rinsing program (51.8%) and 177 nonparticipants (48.2%). The prevalence of caries was determined based on the scores for decayed, missing, and filled teeth and for decayed, missing, and filled surfaces. The examinations were performed by three examiners, with nearly perfect agreement in their diagnosis of caries (kappa = 0.90). The dependent variable was dental caries. The independent variables were: participation or nonparticipation in the mouth-rinsing program, attending a private school or a public school, frequency of tooth-brushing, amount of toothpaste used, consumption of sweets between meals, and visits to the dentist. RESULTS: The decayed, missing, and filled teeth score (mean and standard deviation) at 12 years of age was 0.85 +/- 0.059 overall, 1.0 +/- 0.058 for program participants, and 0.70 +/- 0.060 for nonparticipants. The decayed, missing, and filled surfaces score (mean and standard deviation) was 1.16 +/- 0.017, with it ranging from a low of 0.34 in one private school to a high of 1.66 in one public school. Bivariate analysis showed an association between caries (P < 0.05) and the following variables: attending a public school, participating in the mouth-rinsing program, and consuming sweets between meals more than once a day. In the multivariate analysis, attending a public school (P = 0.0004) and consuming sweets (P = 0.001) remained associated with the presence of caries. CONCLUSIONS: The weekly mouth-rinsing program was not associated with a decreased prevalence of caries, in either the public schools or the private schools. However, additional research is needed to assess the cost-effectiveness of fluoride mouthrinsing programs in populations with a higher prevalence of caries. Given the caries prevalence that we found in the schoolchildren whom we studied, the resources allocated to the fluoride mouth-rinsing program for them should probably be used to pay for other health-promotion activities with them.

Child↗

Attitudes to water fluoridation in South Africa 1998. Part III. An analysis of pro- and anti-fluoridation attitudes in South Africa.

A survey on attitudes to water fluoridation in the South African population (N = 2,220) was undertaken in 1998. The purpose of this study was to evaluate responses to, and underlying reasons for pro- and anti-fluoridation attitudes. In response to a structured questionnaire, 61.9% of respondents were in favour of fluoride being added to drinking water and 9% were against it. Reasons supporting and opposing this measure were as follows. Of those who favoured the measure, 30% of respondents said it was because it would reduce tooth decay and 30% said it 'affects health', presumably positively. Other reasons include, 'it purifies water' (10.3%), 'more people will be reached' (9.8%), 'it strenghtens bones' (6%), 'it prevents plaque' (4.6%) and it 'improves the taste of water' (3.1%). There was a 1.3% 'don't know' response. Those opposed to the measure said, 'water should stay as it is' (26.1%), 'if it stays in the system it will create other problems' (15.6%), it 'affects health', presumably negatively (12.3%) and 'it will increase the cost of water' (8.8%). The 'don't know' response was 10.5%. When asked to give reasons for their 'don't know' response in the 'uncertain' category, 90% said they did not know. Given the contradictory and variable responses in both 'yes' and 'no' categories, the possible reasons for these findings could include: the differences between knowledge and beliefs, alternative health and lifestyle practices, levels of education, resistance to change and personality factors, among others. Understanding the assumption people make about fluoridation would help to structure education programmes to provide accurate and comprehensive information.

Attitude to Health↗

[Fluoride concentration and enamel solubility of deciduous and young permanent teeth after application of topical fluoride solutions].

The aim of this article was to compare, through the distillation method, the incorporated amount of fluoride and the reduction of solubility in the enamel of both deciduous and young permanent teeth, following topical application of a 2% neutral sodium fluoride solution, according to the Knutson's technique and a 1.23% of acidulated solution, according to the Wellock & Brudevold's technique. The greatest fluoride incorporation was observed in the deciduous teeth after the usage of the 2% neutral solution. The amount of calcium and phosphorus liberation by the acid solution was greatest in the control group, followed by the group of teeth treated in acidulated solution and, finally, by those treated in 2% sodium fluoride solution.

Acidulated Phosphate Fluoride↗

Changes of acid solubility and fluoride content of the enamel surface in children consuming fluoridated milk.

Changes of the acid solubility and fluoride content of the surface layer of the enamel of the first incisor of seventy-nine 9 to 10-year-old children living in a closed community were measured by the method of enamel biopsy at the 6th and 12th months of the consumption of fluoridated milk. Half-year after the beginning of consumption of fluoridated milk the acid solubility decreased significantly, while one-year-long consumption led to significant increase of the fluoride content of the enamel surface.

Animals↗