Calcium Prerinse before Fluoride Rinse Reduces Enamel Demineralization: An in situ Caries Study

A calcium (Ca) prerinse before a fluoride (F) rinse has been shown to increase oral F levels. We tested the anticaries effect of this combination in a dose-response in situ caries model. In a double-blind, crossover experiment, 10 volunteers carried enamel slabs in palatal appliances for 14 days, during which they rinsed twice/day with one of four rinse combinations: (1) a placebo prerinse (150 mM sodium lactate) followed by a distilled water rinse (negative control); (2) a placebo prerinse followed by a 250 ppm F rinse; (3) a placebo prerinse followed by a 1,000 ppm F rinse, or (4) a Ca prerinse (150 mM Ca, as calcium lactate) followed by a 250 ppm F rinse. Sucrose solution was dripped onto the slabs 8×/day to simulate a high cariogenic challenge. The percent surface hardness loss (%SHL) was significantly lower in the Ca prerinse used with the 250 ppm F rinse group (%SHL = 38.0 ± 21.0) when compared with the F rinse alone (%SHL = 59.5 ± 24.1) and similar to the 1,000 ppm F rinse group (%SHL = 42.0 ± 18.3). Compared with the 250 ppm F rinse, the Ca prerinse increased biofilm fluid F only twice (nonsignificant). However, it greatly increased F in biofilm solids (∼22×). The Ca prerinse had little effect on loosely or firmly bound enamel F. The results showed an increased level of protection against demineralization by the use of a Ca prerinse, which seems to be caused by the enhancement of F concentration in the biofilm.

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Frequency of Fluoride Dentifrice Use and Caries Lesions Inhibition and Repair

Caries Research ◽

10.1159/000444223 ◽

2016 ◽

Vol 50 (2) ◽

pp. 133-140 ◽

Cited By ~ 7

Author(s):

Diego Figueiredo Nóbrega ◽

Constanza Estefany Fernández ◽

Altair Antoninha Del Bel Cury ◽

Livia Maria Andaló Tenuta ◽

Jaime Aparecido Cury

Keyword(s):

Sucrose Solution ◽

Surface Hardness ◽

Relative Effect ◽

Double Blind ◽

In Situ Study ◽

Enamel Caries ◽

Fluoride Dentifrice ◽

The Relationship ◽

Caries Lesions

The clinical relevance of the frequency of fluoride dentifrice (FD) use on enamel caries is based on evidence. However, the relative effect of FD on reduction of demineralization or enhancement of remineralization is unknown and the effect of frequency on root dentine caries has not been explored. The aim of this double-blind, crossover, in situ study, which was conducted in 4 phases of 14 days each, was to evaluate the relationship between the frequency of FD use and enamel and root dentine de- and remineralization. Eighteen volunteers wore palatal appliances containing enamel and root dentine slabs, either sound or carious. Biofilm accumulation on the slab surface was allowed, and 20% sucrose solution was dripped 3 or 8 times per day on the carious and sound slabs, respectively. Volunteers used FD (1,100 μg F/g) in the frequencies 0 (fluoride-placebo dentifrice), 1, 2 and 3 times per day. The demineralization and remineralization that occurred in sound or carious slabs was estimated by the percentage of surface hardness loss (%SHL) or recovery (%SHR). Loosely (CaF2) and firmly (FAp) bound fluoride concentrations were also determined. The relationship between the variables was analyzed by linear regression. The %SHL, CaF2 and FAp concentrations were a function of the frequency of FD use for enamel and dentine, but the %SHR was a function of the frequency of FD use only for enamel (p < 0.05). The results suggest that demineralization in enamel and root dentine is reduced in proportion to the frequency of FD use, but for remineralization the effect of the frequency of FD use was relevant only to enamel.

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The Addition of Propylene Glycol Alginate to a Fluoride Solution to Control Enamel Wear: An in situ Study

Caries Research ◽

10.1159/000511261 ◽

2020 ◽

Vol 54 (5-6) ◽

pp. 517-523

Author(s):

Letícia Oba Sakae ◽

Samira Helena Niemeyer ◽

Sávio José Cardoso Bezerra ◽

Alessandra Buhler Borges ◽

Cecilia Pedroso Turssi ◽

...

Keyword(s):

Protective Effect ◽

Propylene Glycol ◽

Fluoride Concentration ◽

Negative Control ◽

Solution Ph ◽

Double Blind ◽

Propylene Glycol Alginate ◽

Enamel Erosion ◽

Enamel Wear

The aim of this study was to evaluate the protective effect of propylene glycol alginate (PGA) associated with sodium fluoride (NaF) against enamel erosion and erosion-abrasion. A 4-phase, split-mouth, double-blind, crossover in situ trial was conducted with the following solutions: F + PGA (225 ppm F– + 0.1% PGA), F (225 ppm F–), F + Sn (225 ppm F– + SnCl2, 800 ppm Sn2+), and negative control (distilled water). In each phase, 12 subjects wore removable mandibular appliances containing 4 enamel specimens, which were submitted either to erosion or to erosion-abrasion challenges for 5 days. Acquired salivary pellicle was formed in situ for 2 h. Erosion-abrasion consisted of acid challenge (1% citric acid solution, pH 2.3, 5 min, 4×/day), exposure to saliva in situ (2 h, 4×/day), brushing (5 s, total 2 min exposure to the slurry), and treatment with the solutions (2 min, 2×/day). For erosion, the same procedures were performed, without brushing. At the end, surface loss (SL; in μm) was evaluated by means of optical profilometry. KOH-soluble fluoride was quantified for erosion-only groups using extra specimens. For both challenges, the SL values found for F + PGA did not differ significantly from those of F and the negative control, and the SL value shown for F + Sn was significantly the lowest. Erosion-abrasion promoted significantly higher SL values than erosion. KOH-soluble fluoride analysis showed that F + Sn had a higher fluoride concentration in comparison with the negative control and F, while F + PGA did not differ from any of the other groups. In conclusion, PGA was not able to improve the protective effect of NaF against erosive enamel wear.

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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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Effectiveness of a Toothpaste with Low Fluoride Content Combined with Trimetaphosphate on Dental Biofilm and Enamel Demineralization in situ

Caries Research ◽

10.1159/000381960 ◽

2015 ◽

Vol 49 (4) ◽

pp. 394-400 ◽

Cited By ~ 14

Author(s):

Eliana M. Takeshita ◽

Marcelle Danelon ◽

Luciene P. Castro ◽

Kikue T. Sassaki ◽

Alberto C.B. Delbem

Keyword(s):

Sucrose Solution ◽

Blind Study ◽

Double Blind Study ◽

Oral Appliances ◽

Double Blind ◽

Sodium Trimetaphosphate ◽

Dental Biofilm ◽

Enamel Demineralization ◽

Mineral Loss

Objective: The aim of the present study was to evaluate in situ whether a toothpaste with low fluoride associated with sodium trimetaphosphate (TMP) would provide similar effect to that of a 1,100 ppm F toothpaste. Design: This crossover double-blind study consisted of 4 phases (14 days each), during which 10 volunteers wore oral appliances containing 4 enamel bovine blocks. The cariogenic challenge was performed by the application of a 20% sucrose solution (6×/day). The toothpaste treatments (2×/day) were: placebo, 500 ppm F, 500 ppm F plus 1% TMP, and 1,100 ppm F. At the end, enamel mineral loss and biofilm composition were analyzed. Results: The toothpaste with 500 ppm F plus 1% TMP showed the lowest mineral loss (p < 0.05). Regarding the fluoride and calcium concentrations in the enamel and in the biofilm, there were no significant differences between 500 ppm F plus 1% TMP, and 1,100 ppm F toothpastes (p > 0.569), but they were significantly different when compared to toothpaste with 500 ppm F (p < 0.050). Conclusion: The addition of 1% TMP to a low-fluoride toothpaste reduces enamel demineralization in situ similar to a 1,100 ppm F toothpaste.

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Effects on Demineralization of Enamel by Fluoridated Sucrose: A Pilot Study in an in Situ Caries Model

Advances in Dental Research ◽

10.1177/08959374950090011301 ◽

1995 ◽

Vol 9 (1) ◽

pp. 9-13 ◽

Cited By ~ 1

Author(s):

P. Carlsson ◽

B. Angmar-Mansson ◽

I.-M. Redmo-Emanuelsson ◽

K. Anderssén

Keyword(s):

Pilot Study ◽

Sucrose Solution ◽

Sugar Content ◽

Dry Weight ◽

Thin Sections ◽

Human Enamel ◽

Caries Model ◽

Weight One ◽

Mineral Loss

Blocks of human enamel, placed in removable partial dentures, were allowed to acquire natural plaque for seven days and were exposed extra-orally to a cariogenic challenge by repeated periods in a fluoride-sucrose solution. As a control, enamel blocks were exposed extra-orally to a sucrose solution. After two weeks of cariogenic challenge, the blocks were examined for mineral loss by quantitative microradiography on thin sections of the enamel. The results from six subjects showed that no significant effect on demineralization could be detected by the addition of fluoride corresponding to fluoride/sugar content of 1 mg/kg, 5 mg/kg, or 10 mg/kg (dry weight). One subject did not develop lesions at all, either with fluoride-sucrose or with sucrose exposure alone.

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Concomitant caries and calculus formation from in situ dentin caries model

F1000Research ◽

10.12688/f1000research.2-3.v1 ◽

2013 ◽

Vol 2 ◽

pp. 3

Author(s):

Frederico B de Sousa ◽

Pablo J Mangueira ◽

David R Tames ◽

Sandra S Vianna ◽

Neriede S Santos-Magalhaes

Keyword(s):

Sucrose Solution ◽

Dental Calculus ◽

Backscattered Electrons ◽

Dental Tissues ◽

Dentin Caries ◽

Caries Model ◽

Calculus Formation ◽

Hard Dental Tissues ◽

Short Time

The aim of this study was to test the possibility of the concomitant formation of calculus deposits and caries fromin situdentin caries model for short time periods. Six volunteers wore palatal removal appliances with four polished dentin specimens protected from intra-oral mechanical forces for up to 14 days. Each volunteer applied a 50% sucrose solution (four times a day) on the specimens and performed a daily mouthwash with 0.05% NaF. Samples were removed after 2, 5, 9 and 14 daysin situ. Demineralization was analyzed by stereomicroscopy and SEM (secondary electrons and backscattered electrons modes) and calculus was analyzed by energy dispersive spectroscopy and fluorescence spectroscopy. Seventeen samples, at least one sample from each volunteer, presented dental calculus on both carious and non-carious ones, detected in all time intervals. Ca/P ratios of dental calculus ranged from 1.1 to 1.7. Some large calculus deposits on carious surfaces were confirmed by fluorescence. In conclusion, concomitant caries and calculus formation can be found in dentin caries formedin situ. This has important repercussions on the study of surface phenomena on the interface between hard dental tissues and dental plaque.

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In situ Effect of Arginine-Containing Dentifrice on Plaque Composition and on Enamel Demineralization under Distinct Cariogenic Conditions

Caries Research ◽

10.1159/000488212 ◽

2018 ◽

Vol 52 (6) ◽

pp. 588-597 ◽

Cited By ~ 3

Author(s):

Angel Y. Sanchez ◽

Caroline L. de Oliveira ◽

Thais C. Negrini ◽

Lina N. Hashizume ◽

Anderson T. Hara ◽

...

Keyword(s):

Sucrose Solution ◽

Surface Hardness ◽

Extracellular Polysaccharide ◽

Experimental Phase ◽

Enamel Demineralization ◽

Bovine Enamel ◽

Adult Volunteers ◽

Mineral Loss ◽

In Situ Split

There is limited evidence that arginine-containing fluoridated dentifrices (AFD) have a better anticaries effect than regular fluoridated dentifrices (FD), especially in subjects at a higher risk for caries development. This study aimed to assess the effect of AFD on enamel demineralization and on the microbial and biochemical compositions of biofilm formed under different frequencies of sucrose exposure. It consisted of an in situ split-mouth design, where 12 adult volunteers who used FD for at least 2 months prior to the beginning of this study wore acrylic palatal appliances containing 4 bovine enamel specimens (1 pair at each side of the appliance) during 2 phases of 14 days each. FD slurry (3×/day) and 20% sucrose solution (4× and 8×/day) were dripped on the specimens during the first experimental phase. The same volunteers then used AFD during a 2-month washout period, followed by a second experimental phase where the AFD slurry and sucrose solution were applied onto a new subset of specimens. The percentage of enamel surface hardness loss (%SHL), the lesion depth (LD), the integrated mineral loss (IML), microbial counts on biofilms, the biomass, and inorganic and insoluble extracellular polysaccharide (IEPS) biofilm concentrations were determined. Higher %SHL, biomass, and IEPS and lower fluoride values were found at sucrose 8×/day exposure. Lower IEPS were found in the presence of AFD compared to FD. Similar %SHL, LD, and IML values were found between FD and AFD, irrespectively of the cariogenic challenge. The results suggest that AFD have an anticaries effect similar to that of regular FD.

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Dose-Response Effect of Fluoride Dentifrices on De-/Remineralization of Root Dentine in situ

Caries Research ◽

10.1159/000510535 ◽

2020 ◽

Vol 54 (5-6) ◽

pp. 502-508

Author(s):

José Leal ◽

Robson Ferreira ◽

Cinthia Tabchoury ◽

Peter Lingström ◽

Glauber Vale

Keyword(s):

Dose Response ◽

Sucrose Solution ◽

Fluoride Concentration ◽

Surface Hardness ◽

Significant Difference ◽

High Fluoride ◽

Fluoride Dentifrice ◽

Mineral Replacement ◽

Dose Response Effect

The present study aimed to evaluate the effect of fluoride (F) dentifrice with different F concentrations on root dentine de-/remineralization. Ten healthy volunteers took part in this randomized, double-blinded, cross-over, and split-mouth in situ experimental study. During 4 phases of 7 days, they wore a palatal appliance containing 4 bovine dentine blocks (2 sound and 2 with caries) of 4 × 4 × 2 mm. Treatments were performed with silica-based dentifrices containing 0, 700, 1,300, and 5,000 µg F/g (F as NaF). To provide a cariogenic challenge, a 20% sucrose solution was dripped 3 and 8 times daily on the carious-like and sound blocks, respectively. After each experimental phase, the percentage of surface hardness loss (%SHL) or recovery (%SHR) was calculated and the fluoride concentration in the biofilm was determined. The statistical analysis was performed using ANOVA and the Tukey post hoc test with p at 5%. The relationship between variables was analyzed by linear regression. The results showed a lower %SHL when 5,000 µg F/g dentifrice was used but without a statistically significant difference from the conventional one (1,300 µg F/g). Regarding remineralization and F in biofilms, the high-fluoride dentifrice was expressively superior in mineral replacement on the surface and in the F concentration in the biofilms, respectively, compared to the other 3 products (p < 0.05). Also, a significant linear fit between mineral loss/gain, F in biofilms, and fluoride concentration in the dentifrices could be observed. In conclusion, a dose-response F effect was observed, and the high-fluoride dentifrice was effective in enhancing root dentine remineralization in this short-term in situ study.

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Remineralizing Efficacy of a CPP-ACP Cream on Enamel Caries Lesions in situ

Caries Research ◽

10.1159/000363073 ◽

2014 ◽

Vol 49 (1) ◽

pp. 56-62 ◽

Cited By ~ 18

Author(s):

Hendrik Meyer-Lueckel ◽

Richard J. Wierichs ◽

Timo Schellwien ◽

Sebastian Paris

Keyword(s):

Positive Control ◽

Negative Control ◽

Double Blind ◽

Fluoride Toothpaste ◽

Enamel Caries ◽

Before And After ◽

Casein Phosphopeptide ◽

Caries Lesions ◽

Mineral Loss

The aim of this double-blind, randomized, cross-over in situ study was to compare the remineralizing effects induced by the application of casein phosphopeptide-stabilized amorphous calcium phosphate complexes (CPP-ACP)-containing cream (without fluoride) after the use of fluoride toothpaste with the prolonged use of fluoride toothpaste on enamel caries lesions in situ. During each of three experimental legs of 4 weeks, 13 participants wore intra-oral mandibular appliances with 8 pre-demineralized bovine enamel specimens in the vestibular flanges mimicking either ‘easily cleanable' or ‘proximal' surfaces (n = 312). The three randomly allocated treatments were as follows: (1) application of CPP-ACP-containing cream (GC Tooth Mouse, non-fluoride) after the use of fluoride toothpaste (1,400 ppm NaF; TM), (2) prolonged application of fluoride toothpaste (1,400 ppm NaF; positive control, PC) and (3) prolonged application of fluoride-free toothpaste (negative control, NC). Additionally, one of each of the two flanges was brushed twice daily with the respective toothpaste. The differences in integrated mineral loss as assessed by transversal microradiography were calculated between values before and after the in situ period. Changes in mineral loss were analysed for those pairs of subgroups differing in only one of the three factors (intervention, brushing and position). The PC treatment induced a significantly higher mineral gain compared with the TM and NC treatments. No significant differences between TM and NC for both positions were observed. In conclusion, the additional use of a CPP-ACP-containing cream seems to be less efficacious in remineralizing caries lesions than the prolonged application of fluoride toothpaste. © 2014 S. Karger AG, Basel

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Safety and In Situ Antierosive Effect of CaneCPI-5 on Dental Enamel

Journal of Dental Research ◽

10.1177/00220345211011590 ◽

2021 ◽

pp. 002203452110115

Author(s):

V.T. Pelá ◽

J.G.Q. Lunardelli ◽

C.K. Tokuhara ◽

C.C. Gironda ◽

N.D.G. Silva ◽

...

Keyword(s):

Dental Enamel ◽

Erosive Wear ◽

Tooth Wear ◽

Positive Control ◽

Negative Control ◽

Mitochondrial Activity ◽

Double Blind ◽

Enamel Erosion ◽

Bovine Enamel

The sugarcane cystatin (CaneCPI-5) was recently cloned and showed strong binding force to dental enamel and protection against initial erosion. However, evaluations on its safety and efficacy in a situation closer to the clinical condition are necessary. In the present study we analyzed 1) the cytotoxicity of CaneCPI-5 on human gingival fibroblasts (HGFs); 2) the ability of CaneCPI-5 to reduce enamel erosion and erosion+abrasion in situ. In part 1, HGFs were treated with CaneCPI-5 (0.025, 0.05, 0.1, 0.5 or 1.0 mg/mL) or no treatment (control). The cytotoxicity was assessed after 60 s and 24 h by mitochondrial activity (MTT), confocal microscopy, and hematoxylin/eosin staining. In part 2, 15 volunteers participated in a double-blind crossover protocol consisting of 3 phases, according to the following treatments: 1) 0.1 mg/mL CaneCPI-5; 2) SnCl2/NaF/AmF (Elmex; positive control); 3) water (negative control). The volunteers wore an appliance containing 4 bovine enamel specimens for 5 d. Each day, the specimens were individually treated with 50 µL of the tested solutions per 60 s and then subjected to erosive challenges (0.1% citric acid, pH 2.5, for 90 s, 4 times per day). After the first and last erosive challenge each day, 2 samples were abraded (toothbrushing, 15 s). Enamel wear was measured by contact profilometry. One or two-way analysis of variance (ANOVA)/Tukey’s or Sidak’s tests ( P < 0.05) were applied. Regardless of the concentration and the experimental time, CaneCPI-5 did not decrease the cell viability compared to the negative control ( P < 0.05). Erosion+abrasion led to significantly greater wear compared to erosion only. For both conditions, the lowest wear was found for SnCl2 and CaneCPI-5, which did not differ significantly from each other, but showed significant protection when compared to the negative control. In conclusion, CaneCPI-5 is safe on HGFs and reduces enamel erosive wear to the same extent as a commercial solution used to control erosive tooth wear (ETW).

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