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PubMed2003

Fluoride uptake by enamel and dentin from bonding agents and composite resins: a comparative study.

The present study was performed to compare the amount of in vitro fluoride uptake by enamel and dentin from fluoridated bonding agent with non-fluoridated composite (Group I), non-fluoridated bonding agent with fluoridated composite (Group II) and fluoridated bonding agent with fluoridated composite resin (Group III). Sixty extracted premolars were selected and divided into three groups of 20 teeth each. Restorative materials were applied according to manufacturer's instructions into standard windows created in the teeth, cured and placed in de-ionised water for three months. The fluoride content of successive acid etch biopsy was determined by specific ion-electrode analysis. Although significant amount of fluoride uptake occurred in all the test groups, fluoride uptake was found to be highly significant in dentin when compared to enamel in Group, I, II and III (P<0.001). The fluoride uptake was greater by both enamel and dentin in Group III ie fluoridated bonding agent with fluoridated composite resin.

Acid Etching, Dental↗
PubMed2005

Monitoring salt fluoridation programs through urinary excretion studies.

This paper reviews problems associated with urinary collection for the estimation of fluoride exposure and recent findings in this context. After intake of a salted meal at noon, children aged 9 to 14 excreted on average 45 microgF/h. Morning and nocturnal excretions were only 16 microgF/h with the exception of those children who ate bread made with fluoridated salt (25 microF/h). Fluoride excretions in children consuming drinking water with 0.6 to 0.8 ppmF were similar, but the variations within the 24 h period were smaller. When it is not feasible to obtain reliable 24 h urinary collections, fairly precise extrapolations of 24 h excretions can be obtained from three separate collections lasting about 16 hours, which should cover morning, early afternoon and the whole night. Three- to six-year-old children benefitting from optimal fluoride supply through water or milk excreted approximately 0.35 to 0.40 mgF/24 h; this range seems to correspond to an optimal usage of fluorides. Studies on urinary fluoride excretion, like those on total fluoride intake, cannot be carried out on random samples. Due to the necessity of close cooperation of parents and children, such studies were done with "convenience" samples. In westernized countries with now low caries prevalence, intermittent high urinary excretions occur frequently. Possible sources are fluoride intake from concentrated oral care products (fluoride gels, fluoride chewing gums) or from dentifrices (containing 1000 to 1500 ppmF), mineral waters, industrial tea preparation or fluoride tablets (or other supplements). These problems do not affect the amount of fluoride in fingernail clippings which appear to be suitable for the routine monitoring of fluoride exposure.

Adolescent↗
PubMed1991

Studies of fluoride varnishes in Finland.

Despite the artificial fluoridation of drinking water in Kuopio, part of the children have high caries incidence. We therefore started our studies on fluoride varnishes in 1977 in an attempt to find a feasible means of applying fluoride topically in children at high risk of caries. In our first trial, the sodium fluoride varnish Duraphat was found to be effective in preventing caries, but the effectiveness of the silane fluoride varnish Fluor Protector could not be unequivocally established, despite the fact that Fluor Protector deposited markedly more fluoride in enamel than Duraphat. In a second study in children in a low-fluoride area, use of Duraphat was found to be more effective than fortnightly fluoride rinses or Fluor Protector. Increasing the frequency of application from two to four times a year did not increase the effectiveness of Duraphat even in highly caries-prone children in a 2-year trial. On the basis of peak values of fluoride in parotid saliva after application, use of either fluoride varnishes was considered safe. Although the fluoride content of the enamel remained elevated for at least two years after discontinuation of treatment with both varnishes, the caries preventive effect did not continue after the applications were stopped. This shows that increasing the fluoride content of enamel is not the main mechanism by which fluoride varnishes prevent caries, and that the applications need to be continued as long as caries is a problem.

Adolescent↗
PubMed1991

[Evaluation of commercially available fluoride containing toothpastes].

The role of fluorides in caries prevention has been well established in the epidemiological studies of fluoridated areas. Without water fluoridation, dentists in Taiwan face the challenge to optimize the use of other forms of fluoride products to reduce caries incidence. Toothpaste containing fluoride constitutes an effective and practical way of exposing teeth to fluoride on a regular basis. The present study evaluated 62 commercially available toothpaste products, of which 35 lacked a proper Chinese label and product information. Forty-one products contained fluorides which were sodium fluoride and/or sodium monofluorophosphate. Half of the children's toothpastes did not contain fluoride. The statement of CNS 439 only indicated that the fluoride concentration of the toothpaste was below 1000 ppm. More information about type of fluoride and its concentration must be provided for the user or dental professionals to make a proper selection. Parental supervision of their children's toothbrushing needs to be reinforced. Certain products used for dental hypersensitivity contained high concentrations of fluoride. Young children must be guarded from accidentally ingesting an overdose of fluoride.

Evaluation Studies as Topic↗
PubMed1985

Diagnosis and treatment of acute fluoride toxicity.

The literature has shown overwhelmingly that fluoride used for dental prophylaxis presents minimal risks if used appropriately. However, there is an increasing potential for ingestion of toxic doses of fluoride because of the increasing use of pleasant-tasting fluoride products. The ADA has recommended that no more than 120 mg fluoride (264 mg NaF) be dispensed at any one time. As with any medication, fluoride preparations should be prescribed in child-resistant containers, and patients or parents (or both) should be instructed as to the proper daily treatment regimens and the potential for toxic overdoses. Possibly the greatest risk of fluoride intoxication relates to the concentrated fluoride preparations used for professionally applied fluoride treatment (Table 3). Therefore, patients receiving professional topical fluoride treatments should have well-fitting trays with the minimal amount of fluoride necessary to contact the teeth. These patients should be provided with a saliva ejection system, and they should never be left unobserved during the topical application. Health professionals should be aware of the potential toxic effects of fluoride in addition to the well-known caries preventive effects. It is necessary to know how to calculate the amount of fluoride ingested and the emergency treatment recommended to prevent toxic effects in suspected overdose cases.

Child↗
PubMedDate not supplied

Fluoride uptake around cavity walls; two-dimensional mapping by electron probe microanalysis.

This study reports fluoride uptake around the cavity wall of teeth by two-dimensional mapping. Fluoride concentration was measured using the wavelength dispersive x-ray analysis (WDX) method. The buccal cavity wall of a human tooth was coated five times with 2% sodium fluoride solution at three-day intervals for 12 days, and then immersed in a normal saline solution at 37 degrees C. After one month, the tooth was bisected longitudinally through the center of the cavity surface perpendicular to the axial wall. On the polished surface of the cut tooth, the fluoride concentration was measured. Fluoride distribution maps around the cavity wall were drawn using a bundle of the observed analytical lines. Fluoride uptake from fluoride-releasing materials (conventional glass-ionomer cement, light-cured glass-ionomer cement, light-cured composite resin, light-cured bonding agent) around the cavity wall was investigated using the same method. The maps showed higher fluoride uptake in dentin than in enamel and a strong location dependence of fluoride uptake in a tooth, especially in the dentin. Fluoride uptake from the resin was greater than that from the cement. It was summarized from these results that a two-dimensional map of fluoride uptake can provide valuable information on the cariostatic properties of fluoride-releasing materials.

Acid Etching, Dental↗
PubMed2001

Recommendations for using fluoride to prevent and control dental caries in the United States. Centers for Disease Control and Prevention.

Widespread use of fluoride has been a major factor in the decline in the prevalence and severity of dental caries (i.e., tooth decay) in the United States and other economically developed countries. When used appropriately, fluoride is both safe and effective in preventing and controlling dental caries. All U.S. residents are likely exposed to some degree to fluoride, which is available from multiple sources. Both health-care professionals and the public have sought guidance on selecting the best way to provide and receive fluoride. During the late 1990s, CDC convened a work group to develop recommendations for using fluoride to prevent and control dental caries in the United States. This report includes these recommendations, as well as a) critical analysis of the scientific evidence regarding the efficacy and effectiveness of fluoride modalities in preventing and controlling dental caries, b) ordinal grading of the quality of the evidence, and c) assessment of the strength of each recommendation. Because frequent exposure to small amounts of fluoride each day will best reduce the risk for dental caries in all age groups, the work group recommends that all persons drink water with an optimal fluoride concentration and brush their teeth twice daily with fluoride toothpaste. For persons at high risk for dental caries, additional fluoride measures might be needed. Measured use of fluoride modalities is particularly appropriate during the time of anterior tooth enamel development (i.e., age <6 years). The recommendations in this report guide dental and other health-care providers, public health officials, policy makers, and the public in the use of fluoride to achieve maximum protection against dental caries while using resources efficiently and reducing the likelihood of enamel fluorosis. The recommendations address public health and professional practice, self-care, consumer product industries and health agencies, and further research. Adoption of these recommendations could further reduce dental caries in the United States and save public and private resources.

Dental Caries↗
PubMedDate not supplied

Fluoride exchange from glass ionomer preventive resin restorations.

The purposes of this in vivo study were to determine if placing a sealant over a glass ionomer restoration modifies its fluoride release, and to examine the effect on glass ionomer of a 4-min application of topical fluoride. Fluoride release from glass ionomer preventive resin restorations placed in 21 bovine teeth was measured before and after removing their sealants. Fuji II, Ketac Silver, and Fuji LC were evaluated, representing the three generations of glass ionomers. Fluoride was extracted from the restorations by incubating the specimens in 5 ml deionized water and was measured by specific ion electrodes at 1 and 2 days, then once weekly for 7 weeks. The results indicated that fluoride release was not significantly different in pattern or quantity in the three types of ionomer (P > 0.05). A significant reduction in fluoride release occurred when the restorations were covered with a sealant when compared with control restorations of the same materials (P < 0.001). After removing the sealant from the glass ionomer preventive resin restorations, a significant release of fluoride occurred when compared with sealed restorations (P < 0.001). After 63 days in water, the unsealed restorations were subjected to a 4-min topical APF treatment and reimmersed in water for an additional 27 days to examine the ability of the various materials to absorb fluoride. The fluoride-depleted restorations treated with fluoride released significantly more fluoride than fresh, untreated ionomer restorations (P < 0.001) or amalgam restorations. As a result of fluoride release, the glass ionomer preventive resin restoration may afford chemical protection to the tooth if sealant loss occurs.

Absorption↗
PubMed1999

Inflammatory responses of rat alveolar macrophages following exposure to fluoride.

Inhalation exposure to fluoride compounds has been associated with respiratory failure. We have addressed effects of fluoride on alveolar macrophages and lung responses to intratracheally (i.t.) instilled fluoride in rats. I.t. instillation of fluoride at doses of 200 and 400 microg F/rat caused significant polymorphonuclear leukocyte (PMN) infiltration in the rat lung at 20 h post-administration, while 100 microg fluoride did not recruit a significant number of PMNs in the alveolar space. Total RNA was extracted from the lung lavage cells obtained from 5 h post i.t. instillation and mRNA levels of chemokines and proinflammatory cytokines were semi-quantitatively evaluated by reverse transcriptase-polymerase chain reaction (RT-PCR). I.t. instillation of fluoride significantly enhanced mRNA expression of cytokines such as interleukin-1beta (IL-1beta), tumor necrosis factor-alpha, cytokine-induced neutrophil chemoattractant, and macrophage inflammatory proteins-1alpha and -2. Fluoride-induced augmentation in IL-1beta mRNA expression was also examined by Northern hybridization following in vitro exposure of alveolar macrophages to fluoride. However, the enhancement of IL-1beta mRNA expression following in vitro exposure to fluoride was observed only at 500 microM, a dose higher than the 50% lethal concentration (LC(50)). Non-specific adhesion of alveolar macrophages to the plastic dish was significantly increased following in vitro exposure to fluoride. The fluoride-induced non-specific adhesion was significantly reduced by anti-CD18, suggesting that beta(2) integrin played a role in the increase of adherence. Those results suggest that fluoride activates alveolar macrophages, enhances the production of chemokines and proinflammatory cytokines, and causes PMN infiltration in the lung.

Animals↗
PubMed1999

Usefulness of the assessment of urinary enzyme leakage in monitoring acute fluoride nephrotoxicity.

A single oral dose of sodium fluoride (NaF) in aqueous solution was given to male Wistar rats. Twenty-four-hour urine samples were collected and examined to evaluate fluoride-induced acute renal damage. The following parameters were measured in 24-h urine: urine volume and urinary excretion of fluoride, N-acetyl-beta-d-glucosaminidase (NAG), alpha-glutathione-S-transferase (alpha-GST), and creatinine (CR). Fluoride exposure produced specific, dose-dependent changes of these parameters. Significant increases of fluoride and fluoride-induced polyuria were observed. NAG as specific marker of proximal convoluted tubule (PCT) function showed a significant increase when the lowest dose of fluoride was administered. At this minimal dose, alpha-GST, a specific marker for the S3 segment, did not show a significant increase but presented the strongest relationship (r = 0. 83) to fluoride dose. No significant changes were measured for CR excretion, which showed a low correlation coefficient (r = 0.36) to administered fluoride. The specific differences in the increase pattern of these parameters show that the PCT is more susceptible to damage by low-dose fluoride than the S3 segment or the glomerulus. We concluded that both NAG and alpha-GST are useful for the diagnosis of fluoride-induced acute nephrotoxicity. Proper evaluation of these urinary indices may be of help to establish the site and extent of kidney injury in acute fluoride toxicity.

Acetylglucosaminidase↗
PubMed1992

Cariostatic effect and fluoride release from a visible light-curing adhesive for bonding of orthodontic brackets.

This study was designed to investigate the cariostatic potential in vivo of a visible light-curing adhesive for the bonding of orthodontic brackets. The fluoride release of the adhesive in water and saliva was also measured. Ten orthodontic patients with premolars to be extracted participated. One bracket with Heliosit-Orthodontic (no fluoride) was positioned on the buccal surface of one premolar (control), and another bracket with Orthodontic cement VP 862 (containing fluoride) was positioned on the experimental contralateral premolar. The adhesives were cured with a Heliolux II lamp, and the teeth were extracted after 4 weeks. The patients used a fluoride toothpaste during the experiment. The mineral content of the enamel adjacent to the brackets was determined by quantitative microradiography. The fluoride release from disk-shaped plates of the fluoride adhesive was measured in water for a 6-month period and in human saliva for 24 hours. The fluoride adhesive reduced lesion depths by about 48% than the nonfluoride adhesive (P less than 0.05, t test). The largest release of fluoride from the plates in water was observable within the first week. However, a significant amount of fluoride was still released after 6 months. The fluoride release in saliva was significantly lower in human saliva at pH 7 than in water (P less than 0.01, t test). When salivary pH was lowered to 4, to mimic a cariogenic challenge, the amount of fluoride released increased up to the value measured in water. It was concluded that the regular use of fluoride toothpastes is insufficient to inhibit lesion development around orthodontic brackets.(ABSTRACT TRUNCATED AT 250 WORDS)

Adhesives↗
PubMed2000

Dental fluorosis in permanent incisor teeth in relation to water fluoridation, social deprivation and toothpaste use in infancy.

OBJECTIVES: To determine the prevalence and severity of fluorosis in permanent incisor teeth in young children in a fluoridated and a fluoride-deficient community and to establish what relationship, if any, there was between the occurrence of dental fluorosis and the reported use of fluoride toothpaste in childhood. DESIGN: A prevalence study of children aged 8-9 years who had been continuous residents in fluoridated Newcastle or fluoride-deficient Northumberland. METHOD: The permanent maxillary central incisor teeth were examined clinically and photographically by one examiner using the Thylstrup-Fejerskov index; the photographs were read blind to child identity and clinical score. A closed-response questionnaire enquired into the child's early experiences of toothbrushing and use of fluoride toothpastes. Social deprivation was measured by a Jarman score. The study took place in 1998. OUTCOME MEASURE: Prevalence of dental fluorosis measured by the Thylstrup-Fejerskov index. RESULTS: Complete data were available for 78% (n = 409) and 79% (n = 403) of eligible sampled children in the two areas, respectively. Clinical and photographic results agreed closely and had high reproducibility. The prevalence of fluorosis was 54% in the fluoridated area and 23% in the fluoride-deficient area when all grades (> 0) of fluorosis were included; percentage prevalence of mild to moderate fluorosis (> or = 3) was 3% and 0.5% in the two areas, respectively. Multivariate analysis indicated that area of residence (odds ratio = 4.5), Jarman score (odds ratio = 0.99 per Jarman unit) and type of toothpaste (odds ratio = 1.6) were statistically significantly related to presence or absence of fluorosis: the risk factors were--fluoridated area, affluence, and use of adult toothpaste. CONCLUSIONS AND RECOMMENDATIONS: The prevalence of aesthetically important dental fluorosis was low, although higher in the fluoridated area. Use of a child's toothpaste (with lower fluoride concentration) could decrease risk in a fluoridated area. Adherence to the guidelines published by the British Society of Paediatric Dentistry is recommended.

Child↗
PubMed1982

Role of fluoride in formation of urinary calculi: studies in rats.

The effect of fluoride on urinary calculi formation in young rats was investigated. Two studies, in which rats received diets that included either higher calcium (9 g/kg diet) or normal calcium (5 g/kg diet), were conducted At each level of calcium, one group of rats received a high level of fluoride and another a low level of fluoride in the diet. Rats ingesting high fluoride diets exhibited a higher incidence of crystalluria and bladder stones compared with those receiving low fluoride diets. However, compared with higher calcium diets, normal calcium diets delayed the appearance of crystalluria and produced smaller calculi. Calcium and oxalate were the major components of the calculi. Calculi of rats fed the higher calcium and high fluoride diet contained relatively less protein and more calcium compared with calculi formed in rats ingesting the higher calcium and low fluoride diet. The concentration of fluoride in calculi from rats fed high fluoride diets was significantly higher than that of calculi from rats fed low fluoride diets. A significant positive correlation between calcium and fluoride concentration of calculi was observed in rats fed the higher calcium diet only. These studies indicate that ingestion of excess fluoride facilities calcium oxalate crystalluria and promotes the formation of bladder stones in rats, under the experimental conditions used.

Animals↗
PubMed2001

Effect of long-term exposure to fluoride in drinking water on risks of bone fractures.

Findings on the risk of bone fractures associated with long-term fluoride exposure from drinking water have been contradictory. The purpose of this study was to determine the prevalence of bone fracture, including hip fracture, in six Chinese populations with water fluoride concentrations ranging from 0.25 to 7.97 parts per million (ppm). A total of 8266 male and female subjects > or =50 years of age were enrolled. Parameters evaluated included fluoride exposure, prevalence of bone fractures, demographics, medical history, physical activity, cigarette smoking, and alcohol consumption. The results confirmed that drinking water was the only major source of fluoride exposure in the study populations. A U-shaped pattern was detected for the relationship between the prevalence of bone fracture and water fluoride level. The prevalence of overall bone fracture was lowest in the population of 1.00-1.06 ppm fluoride in drinking water, which was significantly lower (p < 0.05) than that of the groups exposed to water fluoride levels > or =4.32 and < or =0.34 ppm. The prevalence of hip fractures was highest in the group with the highest water fluoride (4.32-7.97 ppm). The value is significantly higher than the population with 1.00-1.06 ppm water fluoride, which had the lowest prevalence rate. It is concluded that long-term fluoride exposure from drinking water containing > or =4.32 ppm increases the risk of overall fractures as well as hip fractures. Water fluoride levels at 1.00-1.06 ppm decrease the risk of overall fractures relative to negligible fluoride in water; however, there does not appear to be similar protective benefits for the risk of hip fractures.

Aged↗
PubMed2004

Comparison of short-term in vitro fluoride release and recharge from four different types of pit-and-fissure sealants.

OBJECTIVE: The purpose of this in vitro study was to assess the effects of four commercial fluoride-containing pit-and-fissure sealants on caries prevention. MATERIALS AND METHODS: Four sealants containing fluoride, Fuji III, Fuji III LC (GC Co., Tokyo), Teethmate F-1 (Kuraray Medical Co., Osaka) and Helioseal F (Vivadent Co., Liechtenstein) were used to investigate fluoride release and recharge. Disk-shaped specimens prepared from each material were immersed in distilled water at a temperature of 37 degrees C. After seven days, acidulated phosphate fluoride solution (APF) was applied to each specimen, and it was then again immersed in distilled water for 14 days. We then determined how much fluoride had been released into the immersing water. Fuji III LC was used with APF solution to investigate the fluoride uptake. RESULTS: Fuji III had the highest fluoride release, and Fuji III LC had the highest fluoride recharge. Helioseal F and Teethmate F-1 had almost no fluoride recharge. Fuji III LC/APF had a higher fluoride uptake to enamel than Fuji III LC. CONCLUSIONS: These results suggest that GIC-sealants in the oral cavity can serve as a fluoride reservoir and contribute to retaining a low fluoride level in oral fluids, thereby preventing caries.

Acidulated Phosphate Fluoride↗
PubMed2001

Patterns of dental caries following the cessation of water fluoridation.

OBJECTIVES: To compare prevalence and incidence of caries between fluoridation-ended and still-fluoridated communities in British Columbia, Canada, from a baseline survey and after three years. METHODS: At the baseline (1993/4 academic year) and follow-up (1996/7) surveys, children were examined at their schools. Data were collected on snacking, oral hygiene, exposure to fluoride technologies, and socio-economic level. These variables were used together with D1D2MFS indices in multiple regression models. RESULTS: The prevalence of caries (assessed in 5,927 children, grades 2, 3, 8, 9) decreased over time in the fluoridation-ended community while remaining unchanged in the fluoridated community. While numbers of filled surfaces did not vary between surveys, sealed surfaces increased at both study sites. Caries incidence (assessed in 2,994 life-long residents, grades 5, 6, 11, 12) expressed in terms of D1D2MFS was not different between the still-fluoridating and fluoridation-ended communities. There were, however, differences in caries experienced when D1D2MFS components and surfaces at risk were investigated in detail. Regression models did not identify specific variables markedly affecting changes in the incidence of dental decay. CONCLUSIONS: Our results suggest a complicated pattern of disease following cessation of fluoridation. Multiple sources of fluoride besides water fluoridation have made it more difficult to detect changes in the epidemiological profile of a population with generally low caries experience, and living in an affluent setting with widely accessible dental services. There are, however, subtle differences in caries and caries treatment experience between children living in fluoridated and fluoridation-ended areas.

Adolescent↗
PubMed2003

Successes and drawbacks in the caries-preventive use of fluorides--lessons to be learnt from history.

Water fluoridation was the first breakthrough in the practice of preventive cariology on a community level and has remained one of the cornerstones of prevention in dentistry. The concepts regarding the mechanisms of the caries-inhibitory effect, however, have changed in several respects. Today there is general agreement that topical effects on the erupted enamel are most important. The contention that there is no pre-eruptive effect whatsoever has created confusion; there is in fact evidence for a minor pre-eruptive protective effect. Around 1980 many experts believed that fluorides should not be used in high concentrations, for instance above those in dentifrices, because this could block remineralisation in the body of pre-cavity lesions. However, it is now known that such undesirable effects are negligible or non-existent. In the fifties and sixties, fluoride tablets were widely used in Europe and helped to make the concept of caries prevention popular. From 1980 onwards, fluoride dentifrices were found to have a much greater impact and were recognized as being able to lead to a decline of caries prevalence in entire countries, and fluoride tablets gradually lost their importance. Antifluoridationists were unable to delay or hinder the widespread use of fluoride toothpastes but in many cases have successfully opposed public health measures such as fluoridation of water or of salt. The spread of these methods, beneficial for all social strata, might have been more rapid if some of the experts had not propounded the erroneous supposition that fluoride dentifrice will be sufficient for caries prevention. Sale of fluoridated salt has been authorized in several countries on a nationwide scale. However, only Latin American countries have introduced salt fluoridation for entire populations. In Central and Eastern Europe where caries prevalence continues to be high and where the level of usage of topical fluorides including dentifrices will presumably remain at a low level for many years, salt fluoridation would be beneficial.

Cariostatic Agents↗
PubMedDate not supplied

Evidence-based use of fluoride in contemporary pediatric dental practice.

Fluoride is an important and effective means of reducing the caries incidence in children. Multiple fluoride products are available to dentists for use with their patients at risk for dental caries. The purposes of this paper are to: (1) review clinically salient evidence, primarily systematic reviews and meta-analyses, for the effectiveness of fluoride options and, where possible, combinations of fluoride exposures; and (2) make recommendations to dental practitioners based on the available evidence for the use of these various approaches in contemporary practice, particularly regarding the use of multiple fluoride sources. The available data suggest that therapeutic use of fluoride for children should focus on regimens that maximize topical contact, preferably in lower-dose, higher-frequency approaches. Current best practice includes recommending twice-daily use of a fluoridated dentifrice for children in optimally fluoridated and fluoride-deficient communities, coupled with professional application of topical fluoride gel, foam, or varnish. The addition of other fluoride regimens should be based on periodic caries risk assessments, recognizing that the additive effects of multiple fluoride modalities exhibit diminishing returns.

Cariostatic Agents↗