Adjunctive use of fluoride rinsing and brush-on gel increased incipient caries-like lesion remineralization compared with fluoride toothpaste alone in situ

Objective: To evaluate the remineralizing potential of a conventional toothpaste (1,100 ppm F) supplemented with nano-sized sodium hexametaphosphate (HMPnano) in artificial caries lesions in situ. Design: This double-blinded crossed study was performed in 4 phases of 3 days each. Twelve subjects used palatal appliances containing 4 bovine enamel blocks with artificial caries lesions. Volunteers were randomly assigned into the following treatment groups: no F/HMP/HMPnano (Placebo); 1,100 ppm F (1100F); 1100F plus 0.5% micrometric HMP (1100F/HMP) and 1100F plus 0.5% nano-sized HMP (1100F/HMPnano). Volunteers were instructed to brush their natural teeth with the palatal appliances in the mouth for 1 min (3 times/day), so that blocks were treated with natural slurries of toothpastes. After each phase, surface hardness post-remineralization (SH2), integrated recovery of subsurface hardness (ΔIHR), integrated mineral recovery (ΔIMR) and enamel F concentration were determined. Data were submitted to analysis of variance and Student-Newman-Keuls’ test (p < 0.001). Results: Enamel surface became 42% harder when treated with 1100F/HMPnano in comparison with 1100F (p < 0.001). Treatment with 1100F/HMP and 1100F/HMPnano promoted an increase of ∼23 and ∼87%, respectively, in ΔIHR when compared to 1100F (p < 0.001). In addition, ΔIMR for the 1100F/HMPnano was ∼75 and ∼33% higher when compared to 1100F and 1100F/HMP respectively (p < 0.001). Enamel F uptake was similar among all groups except for the placebo (p < 0.001). Conclusion: The addition of 0.5% HMPnano to a conventional fluoride toothpaste was able to promote an additional remineralizing effect of artificial caries lesions.

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Sodium fluoride mouthrinse used twice daily increased incipient caries lesion remineralization in an in situ model

Journal of Dentistry ◽

10.1016/j.jdent.2013.12.012 ◽

2014 ◽

Vol 42 (3) ◽

pp. 271-278 ◽

Cited By ~ 11

Author(s):

Siriporn Songsiripradubboon ◽

Hidenori Hamba ◽

Chutima Trairatvorakul ◽

Junji Tagami

Keyword(s):

Sodium Fluoride ◽

Caries Lesion ◽

Incipient Caries

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In situ effect of fluoride toothpaste supplemented with nano-sized sodium trimetaphosphate on enamel demineralization prevention and biofilm composition

Archives of Oral Biology ◽

10.1016/j.archoralbio.2018.09.019 ◽

2018 ◽

Vol 96 ◽

pp. 223-229 ◽

Cited By ~ 5

Author(s):

Nayara Gonçalves Emerenciano ◽

Alberto Carlos Botazzo Delbem ◽

Juliano Pelim Pessan ◽

Gabriel Pereira Nunes ◽

Francisco Nunes Souza Neto ◽

...

Keyword(s):

Fluoride Toothpaste ◽

Sodium Trimetaphosphate ◽

Enamel Demineralization ◽

Demineralization Prevention

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Comparative efficacy of a hydroxyapatite and a fluoride toothpaste for prevention and remineralization of dental caries in children

BDJ Open ◽

10.1038/s41405-019-0026-8 ◽

2019 ◽

Vol 5 (1) ◽

Cited By ~ 12

Author(s):

Bennett T. Amaechi ◽

Parveez Ahamed AbdulAzees ◽

Dina Ossama Alshareif ◽

Marina Adel Shehata ◽

Patrícia Paula de Carvalho Sampaio Lima ◽

...

Keyword(s):

Pairwise Comparison ◽

Oral Appliance ◽

Comparable Efficacy ◽

Double Blind ◽

Fluoride Toothpaste ◽

Initial Caries ◽

Significant Difference ◽

Post Test ◽

Amine Fluoride

Abstract Objective This in situ study compared the effectiveness of two toothpastes containing hydroxyapatite or 500 ppm fluoride in promoting remineralization and inhibiting caries development. Materials and methods Two enamel blocks (human primary teeth), one sound and one with artificially-produced caries lesion, were exposed to toothpaste containing either 10% hydroxyapatite or 500 ppm F− (amine fluoride) via intra-oral appliance worn by 30 adults in two-arm double blind randomized crossover study lasting 14 days per arm (ClinicalTrials.gov: NCT03681340). Baseline and post-test mineral loss and lesion depth (LD) were quantified using microradiography. One-sided t-test of one group mean was used for intragroup comparison (baseline vs. post-test), while two-sided t-test of two independent means was used to compare the two toothpaste groups. Results Pairwise comparison (baseline vs. test) indicated significant (p < 0.0001) remineralization and LD reduction by either toothpaste; however, when compared against each other, there was no statistically significant difference in remineralization or LD reduction between the two toothpastes. No demineralization could be observed in sound enamel blocks exposed to either toothpaste. While F− induced lesion surface lamination, HAP produced a more homogenous lesion remineralization. Conclusions 10% hydroxyapatite achieved comparable efficacy with 500 ppm F− in remineralizing initial caries and preventing demineralization. Thus the HAP toothpaste is confirmed to be equal to the fluoride toothpaste in this study.

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Efficacy of Fluoride Toothpaste in Preventing Demineralization of Smooth Dentin Surfaces and Narrow Grooves in situ under Frequent Exposures to Sucrose or Bananas

Caries Research ◽

10.1159/000083156 ◽

2005 ◽

Vol 39 (2) ◽

pp. 116-122 ◽

Cited By ~ 2

Author(s):

E. Zaura ◽

C. van Loveren ◽

J.M. ten Cate

Keyword(s):

Fluoride Toothpaste

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Remineralizing Potential of a Low Fluoride Toothpaste with Sodium Trimetaphosphate: An in situ Study

Caries Research ◽

10.1159/000449358 ◽

2016 ◽

Vol 50 (6) ◽

pp. 571-578 ◽

Cited By ~ 8

Author(s):

Eliana M. Takeshita ◽

Marcelle Danelon ◽

Luciene P. Castro ◽

Robson F. Cunha ◽

Alberto C. B. Delbem

Keyword(s):

Oral Cavity ◽

Repeated Measures ◽

Surface Hardness ◽

Repeated Measures Anova ◽

Treatment Groups ◽

Fluoride Toothpaste ◽

Sodium Trimetaphosphate ◽

In Situ Study ◽

Bovine Enamel

Objective: To evaluate the effect of a low-fluoride (F) toothpaste supplemented with sodium trimetaphosphate (TMP) on enamel remineralization in situ. Design: Bovine enamel blocks were selected on the basis of their surface hardness (SH) after caries-like lesions had been induced, and randomly divided into 4 treatment groups, according to the toothpastes used: without F or TMP (placebo); 500 ppm F; 500 ppm F plus 1% TMP; and 1,100 ppm F. The study design was blinded and crossover and performed in 4 phases of 3 days each. Eleven subjects used palatal appliances containing 4 bovine enamel blocks which were treated 3 times per day during 1 min each time, with natural slurries of saliva and toothpaste formed in the oral cavity during toothbrushing. After each phase, the percentages of surface (%SHR) and subsurface hardness recovery (%ΔKHNR) were calculated. F, calcium (Ca), and phosphorus (Pi) contents in enamel were also determined. Data were analyzed by 1-way, repeated-measures ANOVA, followed by the Student-Newman-Keuls test (p < 0.05). Results: Toothpaste with 500 ppm F + TMP and 1,100 ppm F showed similar %SHR and %ΔKHNR as well as enamel F, Ca, and Pi concentrations. Conclusion: The addition of TMP to a low-fluoride toothpaste promoted a similar remineralizing capacity to that of a standard (1,100 ppm F) toothpaste in situ.

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The Effect of Study Design on in situ Treatment of Carious Enamel Lesions

Journal of Dental Research ◽

10.1177/002203459207100s04 ◽

1992 ◽

Vol 71 (3_suppl) ◽

pp. 814-818 ◽

Cited By ~ 4

Author(s):

P.G. Vernon ◽

S.J. Raven ◽

R.J. Gilbert ◽

T.A. Parr ◽

K.A. Dundon

Keyword(s):

Mineral Content ◽

Included Study ◽

Caries Experience ◽

Length Frequency ◽

Fluoride Toothpaste ◽

Human Enamel ◽

Mineral Levels ◽

Adult Volunteers ◽

Mineral Changes

The aim of this exploratory study was to investigate the influence of several factors on changes in the mineral content of carious enamel lesions treated in situ. The study involved 36 adult volunteers who used either a non-fluoride toothpaste or one of two fluoride toothpastes (1000 or 1500 ppm F). Human enamel specimens were prepared and attached to partial dentures as described previously (Schäfer, 1989) and treated in situ for between three and six weeks. The mineral content of lesions was determined by microradiography and computerized densitometry. The factors investigated in this study included study length, frequency of treatment, trial design, patient compliance, patient diet, and previous caries experience of the patient. The effects observed were small, relative to that of the treatment, and not statistically significant (p > 0.05). However, the trends in the data were all as would be intuitively predicted. Study duration correlated positively with observed lesion mineral content. Lesions worn by panelists using a fluoride toothpaste for six weeks contained greater levels of mineral with respect to placebo than did those in panelists on a three-week study. The residual variations in the three phases of the study were found to be similar, suggesting that there is no advantage in these studies having a cross-over design. Brushing frequency also correlated positively with observed lesion mineral content, with panelists brushing three times per day with a fluoridated dentifrice having lesions with greater levels of mineral, with respect to placebo, than those brushing twice per day. Overall, no clear relationship between reported diet and changes in lesion mineral levels was apparent. However, increased frequency of sugar intake was associated with lower levels of mineral in lesions. No correlation was seen in this study between lifelong caries experience of panelists (DMFT) and observed mineral changes during the test period.

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Toothpaste with Nanosized Trimetaphosphate Reduces Enamel Demineralization

JDR Clinical & Translational Research ◽

10.1177/2380084416683913 ◽

2016 ◽

Vol 2 (3) ◽

pp. 233-240 ◽

Cited By ~ 5

Author(s):

M.D.B. Souza ◽

J.P. Pessan ◽

C.S. Lodi ◽

J.A.S. Souza ◽

E.R. Camargo ◽

...

Keyword(s):

Protective Effect ◽

Surface Hardness ◽

Extracellular Polysaccharide ◽

Degree Of Saturation ◽

Double Blind ◽

Cross Sectional ◽

Fluoride Toothpaste ◽

Sodium Trimetaphosphate ◽

Enamel Demineralization

This double-blind crossover study assessed the effects of a low-fluoride (low-F) dentifrice containing nanosized sodium trimetaphosphate (TMP) on enamel demineralization in situ. Nineteen subjects wore palatal appliances containing 4 blocks of bovine enamel and were randomly assigned to brush their teeth with placebo (without F/TMP), 250-ppm F (250F), 250F plus 0.05% nanosized TMP (250F-TMPnano), and 1,100-ppm F (1,100F) dentifrices during 7 d, under cariogenic challenge. Enamel surface hardness and cross-sectional hardness (ΔKHN [Knoop hardness number]), as well as F, calcium (Ca), and phosphorus (P) concentrations, were determined. Also, biofilm that formed on the blocks was analyzed for F, Ca, P, and insoluble extracellular polysaccharide concentrations. Data were submitted to analysis-of-variance models and Student-Newman-Keuls test ( P < 0.05). The 250F-TMPnano dentifrice promoted the lowest ΔKHN among all groups ( P < 0.001), while the percentage of surface hardness loss was similar to 1,100F. Also, similar F, Ca, and P concentrations in enamel were observed for 1,100F and 250F-TMPnano. In the biofilm, the highest F content was observed for 1,100F; Ca content was similar between 1,100F and 250F-TMPnano; and P content was similar among all groups. Similar extracellular polysaccharide values were observed for 250F-TMPnano and 1,100F ( P < 0.001), ionic activity of CaHPO40, CaF+, and HF0 ( P < 0.05) and degree of saturation of hydroxyapatite and CaF2 ( P < 0.05). It was concluded that the protective effect of 250F-TMPnano dentifrice was similar to a conventional dentifrice for most of the variables studied, having a more pronounced effect on the subsurface lesion when compared with the conventional toothpaste (1,100F). Knowledge Transfer Statement: Although toothpastes containing ≥1,000-ppm fluoride are more effective than low-fluoride formulations against dental caries, their early use can lead to side effects. This has prompted intensive research on alternatives to increase the anticaries effect of low-fluoride toothpastes. The present in situ study demonstrated that the addition of sodium trimetaphosphate nanoparticles to toothpastes containing 250-ppm fluoride significantly enhances the protective effect of this formulation against enamel demineralization to levels comparable to a 1,100-ppm fluoride toothpaste in terms of most of the variables studied. Most important, this formulation promoted the lowest loss of subsurface hardness among all groups, suggesting that caries lesions would take longer to develop under clinical conditions when compared with a conventional (1,100-fluoride) toothpaste.

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The Evaluation of Different Treatments of Incipient Caries Lesions: An in Situ Study of Progression Using Fluorescence-based Methods

Operative Dentistry ◽

10.2341/19-268-l ◽

2021 ◽

Vol 46 (1) ◽

pp. 87-99

Author(s):

M Diniz ◽

P Campos ◽

M Souza ◽

R Guaré ◽

C Cardoso ◽

...

Keyword(s):

Sucrose Solution ◽

Adhesive System ◽

Treatment Modalities ◽

Treatment Protocols ◽

Caries Lesion ◽

Diagnodent Pen ◽

Incipient Caries ◽

Caries Lesions ◽

Mineral Loss

Clinical Relevance Effective methods to control incipient caries lesions are needed. In this investigation, several methods provide encouraging results. SUMMARY This study aimed to evaluate in situ the inhibition of incipient caries lesion progression using different treatment protocols and to evaluate the effectiveness of fluorescence-based methods (DIAGNOdent, DIAGNOdent pen, and VistaProof fluorescence camera [FC]) in monitoring this process. The research was conducted in four phases: (1) at baseline, (2) after a first cariogenic challenge, (3) after treatment modalities, and (4) after a second cariogenic challenge. Sixteen volunteers used intraoral acrylic palatal appliances, each containing six enamel blocks (n=96). The cariogenic challenge was performed using a 20% sucrose solution over a 14-day period. The appliances were removed eight times a day and, upon removal, two drops of the solution were placed onto each enamel block. The enamel blocks were randomly assigned to three treatment groups: fluoride varnish ([FV] Duraphat; n=32), resin infiltrant ([RI] Icon; n=32), and adhesive system ([AS] Scotchbond; n=32). At the end of each phase, the surface microhardness (SMH) was measured, and two trained examiners evaluated the specimens using fluorescence-based methods. In addition, integrated mineral loss (ΔΔZ; vol%.min x μm) and lesion depth (ΔLD; μm) were evaluated using transverse microradiography. A two-way analysis of variance and a Tukey post hoc test were calculated (α=5%). Significant differences in SMH were observed according to the treatment, phases, and interaction of factors (p<0.001). Treatment with FV resulted in significantly higher SMH values in phases 3 and 4 compared to RI and AS, with the last two treatments resulting in similar values (p>0.05). The ΔΔZ value was similar for FV and AS but significantly higher for RI (p=0.016). ΔLD was not significantly different among the groups (p=0.126). Significant differences in the measurement of fluorescence for each fluorescence-based method were observed between each phase of the study (p<0.05). It can be concluded that all treatments were effective in inhibiting the in situ progression of incipient lesions, although to different degrees, with minor mineral loss changes observed for the AS and FV. Besides, all fluorescence-based methods tested, except for that using the FC device, were effective in monitoring caries lesion progression.

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