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PubMed1990

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↗
PubMed2004

Using survival methodologies in demonstrating caries efficacy.

Exploiting recent advances in statistical methods, particularly for correlated intra-subject data, could increase the efficiency of caries clinical trials. Methods of analysis using the tooth surface as the unit should be investigated. Whole-mouth measures such as the DMFS increment ignore the variation in the number of surfaces at risk between subjects and within a subject over time. The use of "survival time" for each surface as the outcome measure--i.e., the time from the start of the trial to when a surface is recorded as decayed or filled--is proposed. Data from caries clinical trials could be described as clustered survival data, where clustering of tooth surfaces exists such that survival times within the same cluster or subject are correlated. Advances in the analysis of clustered survival data, such as the use of marginal models with robust variance estimators, have recently been exploited in the analysis of caries clinical trials. The analysis produced results similar to those achieved by conventional DMFS-based analysis. The results using survival analysis are easily interpreted-for example, the median survival time of tooth surfaces in female subjects using a toothpaste with a higher level of fluoride (1500 ppm F) is 1.07 times the median survival time of surfaces in female subjects using toothpaste with less fluoride (1000 ppm F). Further research is required to investigate if survival analysis is a more sensitive method of analysis, i.e., whether causative factors can be identified with fewer subjects than with the conventional method of analysis.

Cariostatic Agents↗
PubMed2005

Maxillary incisor palatal erosion: no correlation with dietary variables?

The objectives of the study were to examine a relationship between tooth erosion affecting the palatal aspects of permanent maxillary central incisors with dietary, behavioral and medical variables. The methods included, 251 schoolchildren aged 11 to 13 years were recruited to participate. Each subject had dental impressions of the palatal aspects of both upper central incisors recorded at baseline, 9 and 18 months intervals. From these, electroconductive replicas were fabricated, mapped and compared using a surface matching technique. At the end of the study all participants underwent a structured interview that sought to assay the level of potential erosive dietary, behavioral and medical risk factors. Correlation analyses of the responses given in the final structured interview with the degrees of palatal tooth substance loss (both previous and measured) were under taken. The results showed: (1) The degree of previous erosion did not predict the level of measured ongoing erosion. (2) Brushing the teeth more frequently with fluoridated toothpaste correlated significantly with lower levels of ongoing erosion (P = 0 011). It was concluded that: (1) Evidence of previous palatal erosion did not predict future erosion. (2) The application of topical fluoride as a by-product of tooth brushing may provide an element of protection against palatal erosion. (3) In view of the lack of correlation between exposure to potential risk factors and the level of ongoing palatal tooth surface loss in this study, other factors (such as an individual's susceptibility and salivary buffering power) may well be more important predictors. The clinical relevance included: Preventive advice to patients with dental erosion should not only include the use of topical fluoride, in the form of toothpaste, but recognize individual susceptibility to this condition.

Adolescent↗
PubMed1996

The substantivity of a number of oral hygiene products determined by the duration of effects on salivary bacteria.

The persistence of action, or substantivity, of antimicrobial agents in the mouth appears to be a major variable influencing plaque inhibition. Such substantivity can be assessed by measuring the duration and magnitude of suppression of salivary bacterial numbers produced by antimicrobial agents. Although this has been determined for some agents, there is little information on the substantivity of the numerous products which contain these and other antimicrobial agents. This study was commissioned on the basis that efficacy cannot be assumed merely because a product contains a known active agent. Nine formulations or products were chosen: 2 rinses containing chlorhexidine or C31G, 4 rinses containing cetylpyridinium chloride (CPC) (with and without fluoride and/or alcohol), a minus-CPC control rinse, and 2 toothpastes with and without stannous fluoride. Additionally, water was used as a placebo control. Twenty health dentate volunteers took part in this blind, 10 cell randomized, single rinse, cross-over study, which was balanced for carryover. Mouthrinses were 15 ml volumes and toothpastes 3 gm in 10 ml water slurries rinsed for 60 seconds. On the day of each study volunteers suspended oral hygiene habits and at approximately 9:00 a.m. rinsed with the allocated formulation. Unstimulated saliva samples were obtained immediately before and 30, 60, 180, 300, and 420 minutes after rinsing. The samples were immediately processed for total anaerobic bacterial counts. All rinses except water and the minus CPC control rinse produced significant falls in counts to 30 minutes. Of more relevance in this inter-treatment comparison-designed study, the C31G rinse showed significant substantivity compared to water only for 60 minutes. C31G was highly significantly less substantive than chlorhexidine from 30 minutes to 420 minutes. The CPC rinses were similar and significantly more substantive than their control rinse to between 180 and 300 minutes. The stannous fluoride and control pastes were similarly substantive to 300 minutes, with the stannous fluoride paste remaining substantive compared to water to 430 minutes. Based on antimicrobial action these formulations varied considerably in substantivity and this is likely to reflect their comparative plaque inhibitory properties.

Analysis of Variance↗
PubMed2026

Effect of Various Types of Remineralizing Agents on the Remineralization of Mild and Moderate Defects Caused by Molar-Incisor Hypomineralization in Mexican Schoolchildren: A 12-month Follow-up Randomized Clinical Trial.

PURPOSE: Using Laser-Induced Fluorescence (LIF), this study aimed to evaluate the effect of three remineralizing agents on permanent molars and incisors with both mild and moderate Molar-Incisor Hypomineralization (MIH) in 8-to-12-year-old Mexican schoolchildren. MATERIALS AND METHODS: In this randomized clinical trial, 104 children were selected to participate and then divided randomly into four groups: Group I: control, Oral-B kids (toothpaste); Group II: Fluor Protector (varnish); Group III: Clinpro White Varnish; and Group IV: MI Paste (CCP-ACP). Both varnishes were applied once every four weeks for twelve months for each group. Remineralization was evaluated by LIF at intervals of 1, 3, 6, 9, and 12 months. Paired-sample t-tests and repeated-measures ANOVA were performed, while the Greenhouse-Geisser correction was used to evaluate sphericity. RESULTS: The three test agents used increased the level of remineralization observed at the site of mild and moderate MIH defects over the course of twelve months (p0.001). A similar decrease in average LIF values was observed across the three treatment groups. CONCLUSIONS: The use of both fluoride varnishes and the CPP-ACP toothpaste was observed to promote the remineralization of both mild and moderate MIH defects.

Humans↗
PubMedDate not supplied

Dentinal hypersensitivity?--Can this agent be the solution?

AIM: To test the efficacy of desensitizing tooth paste containing EMS salts in alleviating dentinal hypersensitivity, reducing plaque accumulation, and reducing gingivitis. METHODS: A randomised, single blind, parallel placebo controlled study was conducted in 40 cases. The cases were randomly assigned to test and control groups. The test group was instructed to use the test tooth paste (containing EMS salts) and control group a placebo tooth paste (without any therapeutic agents) for a period of 6 weeks. The hypersensitivity levels were measured with scratchometer and verbal rating scale. Student t test and wilcoxon's Mann-Whitney test were used to compare the test and control groups. RESULTS AND CONCLUSION: The results indicated that both the test as well as the control toothpastes were effective in alleviating dentinal hypersensitivity as well as reducing gingivitis. However, the test toothpaste was superior in alleviation of dentinal hypersensitivity.

Adult↗
PubMed1998

[Mechanism of action of fluorides in local/topical application].

The marked caries reduction in many countries over the last two decades is thought to be mainly the result of the widespread and frequent use of low concentrations of fluorides mainly via toothpastes. This article gives a review on fluoride sources in the oral cavity and discusses the physiochemical mechanisms by which fluoride interacts with enamel during the caries process and its reversal. From this review it becomes clear that fluoride incorporated into the enamel mineral during tooth development has little effect on the caries process. It is the fluoride incorporated posteruptively and in the aqueous phase during the caries challenge that is of primary importance. The most effective caries preventive fluoride regimen, both from a theoretical perspective and as proved clinically, is the frequent (daily) low concentration application of fluoride from toothpastes and/or mouthrinses. High concentrations, however, used at intervals of months or years and administered by the dentist, work initially not only on both de- and remineralisation, but also by providing fluoride as calcium-fluoride or absorbed in early lesions which is subsequently available over prolonged periods.

Calcium Fluoride↗
PubMed1998

Laboratory assessment of tooth whitening by sodium bicarbonate dentifrices.

The increasing emphasis on dental aesthetics has made tooth whitening an important function of a dentifrice. This laboratory study investigated the whitening effect of toothbrushing with sodium bicarbonate-based dentifrices compared with standard dentifrices that do not contain sodium bicarbonate. Six dentifrices and a distilled water control were tested for their ability to whiten teeth with intrinsic stain. The dentifrices contained different abrasive systems: (1) 45% NaHCO3; (2) 65% NaHCO3 (Arm and Hammer Dental Care); (3) 94% NaHCO3; (4) 94% NaHCO3 + 1.5% H2O2; (5) silica (Crest Regular Toothpaste); and (6) dicalcium phosphate (Colgate Regular Toothpaste). After a thorough rubber cup cleaning with a pumice slurry, the intrinsic color of the test teeth with a Vita shade of A3 or darker was measured with a spectrophotometer using the standard L*a*b* color scale. Measurements were taken on a total of 12 teeth per test dentifrice before treatment, and after 30, 60, 90 and 120 minutes of mechanical toothbrushing. No changes in L* (lightness/brightness) or a* (red-green hue) occurred, but significant differences in b* (yellow-blue hue) were observed over time. Compared to baseline tooth color, all four sodium bicarbonate-based dentifrices were significantly effective in removing the yellow intrinsic tooth stain, while the water control, silica dentifrice, and dicalcium phosphate dentifrice demonstrated no significant change. Between-group comparisons showed that the four dentifrices containing sodium bicarbonate were significantly more effective than the water and dicalcium phosphate dentifrice groups. The commercial dentifrice containing 65% sodium bicarbonate was also more effective than the commercial silica dentifrice. Although continued toothbrushing from 30 to 120 minutes resulted in additional stain removal, most of the tooth whitening by the sodium bicarbonate-based dentifrices occurred in the first 30 minutes of brushing. In the studies conducted, dentifrices containing high concentrations of sodium bicarbonate were more effective at removing intrinsic tooth stain than dentifrices that do not contain sodium bicarbonate.

Dentifrices↗
PubMed1999

The in vitro demineralization potential of a sodium fluoride, calcium and phosphate ion-containing dentifrice under various experimental conditions.

While fluoride has had a dramatic effect in reducing the rate of caries, it has failed to provide complete protection against caries development, and tooth decay is still widely prevalent. The objective of this study was to determine the demineralization prevention potential of a remineralizing dentifrice with fluoride (Enamelon), and an assured supply of calcium and phosphate ions on bovine enamel in a cyclic remin/demin regimen using various experimental conditions. A conventional fluoride toothpaste, Crest, and a placebo dentifrice were used as controls. One-hundred and forty-four ground and polished 4 mm bovine enamel cores were prepared and assigned to various test treatments using six specimens per treatment group. They were subjected to six cyclic treatments consisting of one-minute exposures at room temperature to the test product diluted 1:2 in water, remineralization for a specified time at 37 degrees C, and demineralization for a specified time at 37 degrees C. The enamel specimens were tested for micro-hardness initially, and after the first, third and sixth treatment, remineralization and demineralization cycles using a Buehler Micro-hardness Tester with a 200 g load. Differences in micro-hardness between the test groups were analyzed for significance by performing multiple pair-wise comparisons using Bonferroni significance levels at the 95% confidence level. The results of this study showed that Enamelon Toothpaste was generally more effective in preventing demineralization of enamel than the fluoride dentifrice at 0.5 and 1.5 hours, and the non-fluoride control dentifrice at all time measurements. Prevention of enamel demineralization by the dentifrices was affected by changes in demineralization time and pH, but not by changes in remineralization time.

Animals↗
PubMed1999

The clinical anticalculus efficacy of a tartar control whitening dentifrice for the prevention of supragingival calculus in a three-month study.

The objective of this double-blind clinical study was to compare the effect of a new dentifrice (Colgate Tartar Control Plus Whitening Fluoride Toothpaste) for the prevention of supragingival calculus, with that of a commercially available calculus-inhibiting dentifrice (Crest Tartar Control Toothpaste). The study involved adult male and female subjects who had pre-qualified for participation by developing sufficient supragingival calculus (greater than 7.0 on the Volpe-Manhold Calculus Index) during an eight-week screening period. Subjects received a full oral prophylaxis, and were stratified into two treatment groups balanced for age, sex and qualifying calculus score. Subjects were instructed to brush their teeth twice daily (morning and evening) for one minute with their assigned dentifrice using a soft-bristled toothbrush. Examinations for dental calculus were performed after twelve weeks' use of the study dentifrices, using the Volpe-Manhold Calculus Index, Fifty-eight (58) subjects complied with the protocol and completed the entire study. The Colgate Tartar Control Plus Whitening group exhibited a statistically significant (p < 0.001) 34.6% reduction in mean calculus score compared to the Crest Tartar Control group.

Adult↗
PubMed2001

[The erosive potential of various oral care products compared to foodstuffs and beverages].

The purpose of the present study was to investigate the erosive potential of various oral care products and to compare the results with those of various foodstuffs and beverages. Furthermore, the chosen method of surface hardness measurements was compared with scanning electron microscopy. Seven oral care products (toothpastes and mouth rinses), three foodstuffs and one beverage (as positive control) were tested for their erosive potential. After initial hardness testing 110 enamel specimens were distributed into 11 groups of 10 specimens each in such a way as to have a homogenous hardness distribution per group. The erosive potential of the products was tested by immersing the enamel specimens into solutions of the various products for 10 and 20 minutes. After the experimental period Knoop hardness was measured on the enamel specimens and the differences between before and after were calculated. The micromorphology of native enamel surfaces before and after immersion was determined by SEM on further enamel specimens treated identically for 20 minutes. Apple puree and orange juice produced the most marked losses of hardness after 10 and 20 minutes, respectively. Among the dental hygiene products only the fluoride-free Weleda toothpaste produced a significant reduction of hardness after 10 as well as after 20 minutes. With the exception of Elmex-Gel, all tested dental hygiene products led to a significant (p<0.05) increase of enamel hardness. The results of the hardness measurements corresponded with the micromorphological findings. It may, therefore, be concluded that the tested fluoride-containing oral care products do not exhibit any erosive potential which could be measured with the methodology used in this investigation.

Beverages↗
PubMed2001

Clinical effectiveness of a potassium chloride containing chewing gum in the treatment of hypersensitive teeth.

Dental hypersensitivity has been observed in an increasing number of younger patients over the past few decades. The reasons for this include forced or false tooth-brushing techniques, and abrasions caused by bruxism or orthodontic procedures. The aim of the present study was to assess the possible benefits of a potassium chloride (KCl) containing chewing gum in dental hypersensitivity. The study population consisted of 59 selected university students (age: 25 +/- 4.4 years). Each subject suitable for entry into the study had more than 3 teeth sensitive to thermal stimulation (air stimulus range of 30-80 mm on a 100mm visual analogue scale (VAS), and showed signs of facial/cervical erosion, abrasion and/or gingival recession. Exclusion criteria were daily doses of medication, teeth with deep restorations, a gingival score of > 2, or periodontal surgery within the past 6 months. The total number of hypersensitive teeth was 217. Over a period of 3 weeks the subjects brushed with a non-desensitising toothpaste and, in addition, used the KCl chewing gum up to 6 times daily for 10 min on each occasion. This was followed by a period of 3 weeks of non-desensitising toothpaste use alone. The subjects were questioned on the severity of intraoral pain and asked to indicate the intensity of the pain on the VAS (baseline, 1, 3 and 6 weeks). Mean thermal sensitivity at baseline was 54.5 +/- 9 mm. There was a drop to 40.8 mm ( 1.9) after 1 week and to 28.6 mm (+/- 2) after 3 weeks. The reduction was statistically significant (p <0.001) at both measurement points. The mean rating increased to 29.1 mm after 6 weeks. The results of this study demonstrate that the daily use of a KCl containing chewing gum is a useful non-invasive method of reducing dental hypersensitivity over an extended period of time.

Adult↗
PubMed2002

Intentional use of the Hawthorne effect to improve oral hygiene compliance in orthodontic patients.

The purpose of this study was to evaluate whether the home care of noncompliant adolescent orthodontic patients with "poor" oral hygiene could be improved through the use of a deception strategy designed to intentionally induce the Hawthorne effect. This effect is often cited as being responsible for oral health improvements of control groups that receive placebo treatments. It is thought that participating in and fulfilling the requirements of a study alters subjects' behavior, thereby contributing to the improvement. Forty patients with histories of poor oral hygiene were assigned, in a quasi-random fashion, to two groups. Experimental subjects (n = 20) were presented with a situation that simulated participation in an experiment. These included the use of a consent form; distribution of tubes of toothpaste labeled "experimental"; instructions to brush twice a day for two minutes using a timer; and a request to return unused toothpaste. Control subjects (n = 20) had no knowledge of study participation. Tooth surface area covered with plaque was used as a proxy measure of home care behavior. It was measured at baseline, three months, and six months. Mean percentages of tooth surface covered with plaque for the experimental and control groups were 71 (+/- 11.52) and 74 (+/- 11.46) at baseline; 54 (+/- 13.79) and 78 (+/- 12.18) at three months; and 52 (+/- 13.04) and 79 (+/- 10.76) at six months. No statistically significant difference (p > .05) was obtained between groups at baseline. Statistically significant differences (p < .05) were found between groups at three and six months. Significant differences (p < .05) were also found only for the experimental subjects between baseline and each of the two subsequent observation periods. The efficiency and potential effectiveness of this strategy suggest that additional research be conducted to assess oral health improvements and possible applications to the private practice setting.

Adolescent↗
PubMed1992

Reduction in the levels of oral malodor precursors by hydrogen peroxide: in-vitro and in-vivo assessments.

The potential of hydrogen peroxide to reduce the levels of salivary thiol precursors of oral malodor was investigated in-vitro and in-vivo. In both cases the concentration of thiol groups was determined colorimetrically by quantitative reaction with 4,4'-bis (dimethylamino) diphenyl carbinol. Addition of volumes of hydrogen peroxide solution (containing between 0.18 and 0.90 mmol) to premeasured aliquots of saliva in-vitro, resulted in reductions in salivary thiol levels of between 53% and 75% compared to controls. This positive indication prompted an in-vivo investigation. The efficacy of a fluoride-containing test toothpaste also containing 0.67% hydrogen peroxide and 5.48% sodium bicarbonate was evaluated in a crossover study using ten male and female subjects (non-smokers). All subjects used the test product and a control fluoride dentifrice, in a random order. For the duration of the study subjects used a standard silica based toothpaste containing 1500 ppm F (as sodium monofluorophosphate) exclusively for their normal oral hygiene. On each sampling morning they refrained from oral hygiene and eating and drinking on rising. At the test facility they generated a background saliva sample stimulated by chewing unflavored, unsweetened gum. Subjects brushed for 1 minute with 1.50 (+/- 0.05) g test or control paste and generated another saliva sample as before, 30 minutes after product application. Using the same analytical procedures the mean (+/- SEM) percent reduction in salivary thiol levels post treatment compared to baseline was found to be 59.0 (+/- 7.0)% for the test product compared with 12.5 (+/- 5.2)% for the fluoride control paste.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗
PubMed2004

Stain reduction of an integrated oral hygiene system.

This article discusses research to determine the efficacy of a prototype integrated power toothbrush and toothpaste dispensing system, the IntelliClean System from Sonicare and Crest, in the removal of extrinsic stain. The prototype integrated system and a positive control, the Sonicare Elite with conventional toothpaste, were evaluated in 2 randomized, single-blinded, parallel 4-week controlled clinical trials. There was a low dropout rate, with 28 subjects of the 31 randomized in study 1 completing the study (10% loss to follow-up) and 26 subjects of the 28 randomized in study 2 completing the study (7% loss to follow-up). Lobene stain scores were used to assess the extent and intensity of stain for all teeth meeting the criteria for inclusion in the studies. Lobene stain scores were assessed at baseline and after 4 weeks in both studies. A survey also was conducted at the conclusion of each study to determine user attitude toward the integrated system. The prototype integrated system was found to significantly reduce overall extrinsic stain over time, performing not significantly differently from the positive control. Overall, the prototype integrated system reduced the composite measure of stain that encompasses both the extent and intensity of stain by 60%. This research demonstrates that the IntelliClean System from Sonicare and Crest is highly effective in reducing extrinsic stain.

Adult↗
PubMed2005

Primary tooth fluorosis in 5-year-old schoolchildren in Ireland.

AIM: This was to determine the prevalence of primary tooth fluorosis in the dentitions of 5-year-old schoolchildren. A subsidiary aim was to investigate whether an association existed between the presence of primary tooth fluorosis, fluoridation status, infant feeding practices or the oral hygiene practices of the child. STUDY DESIGN: A cross-sectional and stratified by fluoridation status study. METHODS: Fluorosis was recorded using a modification of the Tooth Surface Index of Fluorosis (TSIF). Demographic data, information on infant feeding practices and oral hygiene practices were collected via a parental questionnaire. STATISTICS: Stepwise logistic regression analysis. RESULTS: Fluorosis prevalence in the fluoridated group (n=208) was 32%; 29.3% (n=61) had a modified TSIF score of 1; 2.4% (n=5) had a modified TSIF score of 2; and 1% (n=1) had a modified TSIF score of 5. In the non-fluoridated group (n=86) one child had a modified TSIF score of 1. Primary tooth prevalence of fluorosis in the entire sample (n=294) was 23%. Factors that were associated with primary tooth fluorosis were: fluoridation status (p= 0.0003, 95% CI = 5-281) and the age at which toothbrushing with toothpaste commenced (p = 0.016, 95% C.I. 1.1 - 3.8). No association with infant feeding practices was identified. CONCLUSION: The overall prevalence of primary tooth fluorosis was 23%. Lifetime residence in a fluoridated area and commencement of toothbrushing with toothpaste between 12 and 18 months of age were associated with primary tooth fluorosis. No association with infant feeding practices was identified.

Bottle Feeding↗
PubMedDate not supplied

[Prevalence of dental fluorosis and additional sources of exposure to fluoride as risk factors to dental fluorosis in schoolchildren of Campeche, Mexico].

OBJECTIVE: To determine the prevalence and severity of dental fluorosis, and to evaluate supplementary fluoride sources as potential risk factors to fluorosis in school children aged 6-9. MATERIAL AND METHODS: A cross-sectional study was carried out in 320 children attending elementary schools protected by a public preventive dental program in the city of Campeche, Mexico. A self-administered questionnaire directed to the mothers was delivered through the schools and collected in the same way. The examiners were trained and calibrated (kappa > 0.90) in modified Dean's Index. The fluorosis community index (FCI) was calculated. Bivariate analyses were made with Chi2 test; odds ratios (OR) and 95% confidence intervals were calculated. Logistic regression was used in the final model. RESULTS: Fluorosis prevalence was 56.3%, with very mild fluorosis present in 45% of children, mild in 10%, and severe in just 1.3%. The FCI was 0.7. The multivariate model showed that the effect of the supplementary fluoride sources was different between children that started brushing with toothpaste before two years of age (OR = 6.15; IC 95% = 2.03-18.67) and after (OR = 2.14; IC 95% = 1.16-3.94). CONCLUSIONS: Fluorosis prevalence was high for mild modalities, and low for more severe levels. According to FCI the dental fluorosis constitute a public health problem in the studied sample. Exposure to diverse fluoride sources -above and beyond the fluoridated salt program- was a risk factor for dental fluorosis in this community. Results suggest that toothpaste use in children two years of age and younger should be cautious, limited to follow current guidelines, and supervised by parents to minimize the risk of dental fluorosis.

Attitude to Health↗