Effectiveness and safety of oral care products

The article presents the classification of the main antiseptic chemotherapeutic active substances used in personal oral care products. The efficiency and safety of active ingredients of toothpastes and rinses was analyzed. The review of literature sour-ces on the clinical effectiveness of the combination of amine fluoride with tin fluoride in the prevention of plaque formation and inflammatory processes of the oral cavity is presented.

Evaluation of antibacterial and antifungal properties of selected mouthwashes: in vitro studies

Introduction. Mouthwashes should include antimicrobial compounds to inhibit microorganism multiplication, thus the formation and development of dental plaque. Aim. The aim of the study was to evaluate the antibacterial and antifungal effectiveness of mouthwashes depending on their active ingredients. Material and methods. In the study, the effect of antibacterial and antifungal properties of mouthwashes on reference bacterial and yeast-like fungi strains was examined. The first type of the assessed mouthwashes contained only sodium fluoride or sodium fluoride and amine fluoride as active ingredients, while the second type contained sodium fluoride and cetylpyridinium chloride. In the study, a well diffusion method was used to test microorganisms constituting natural or pathogenic microflora of oral mucosa. The used reference microorganisms came from the ATCC: L. acidophilus ATCC 4356, Lactobacillus rhamnosus ATCC 53103, S. mutans ATCC 25175, and Candida yeasts: C. albicans ATCC 2091, C. albicans ATCC 10231, Candida parapsilosis ATCC 22019, Candida glabrata ATCC 90030, Candida krusei ATCC 14243. Results. The mouthwashes containing sodium fluoride and cetylpyridinium chloride showed an inhibitory effect against a greater number of reference strains used in the study than did mouthwashes that contained only sodium fluoride (or sodium fluoride and amine fluoride) as active ingredients. Against the four reference strains of Candida genus, the mouthwashes with an inorganic and organic fluoride compound showed no or minimum inhibitory effect or were much less effective than the mouthwashes that also contained cetylpyridinium chloride. Conclusion. Mouthwashes containing multiple ingredients with different antimicrobial mechanisms show synergistic action against the bacterial and fungal microflora responsible for the accumulation of dental plague.

Efficacy of Experimental Mouth Rinses on Caries-Related Biofilms in vitro

This study assessed the efficacy of tin and Polyethylenglycol (PEG-3) tallow aminopropylamine in different concentrations on Streptococcus mutans (S. mutans) biofilms to establish a new screening process for different antimicrobial agents and to gain more information on the antibacterial effects of these agents on cariogenic biofilms. Isothermal microcalorimetry (IMC) was used to determine differences in two growth parameters: lag time and growth rate; additionally, reduction in active biofilms was calculated. Experimental mouth rinses with 400 and 800 ppm tin derived from stannous fluoride (SnF2) revealed results (43.4 and 49.9% active biofilm reduction, respectively) similar to meridol mouth rinse (400 ppm tin combined with 1,567 ppm PEG-3 tallow aminopropylamine; 55.3% active biofilm reduction) (p > 0.05), while no growth of S. mutans biofilms was detected during 72 h for samples treated with an experimental rinse containing 1,600 ppm tin (100% active biofilm reduction). Only the highest concentration (12,536 ppm) of rinses containing PEG-3 tallow aminopropylamine derived from amine fluoride (AmF) revealed comparable results to meridol (57.5% reduction in active biofilm). Lower concentrations of PEG-3 tallow aminopropylamine showed reductions of 16.9% for 3,134 ppm and 33.5% for 6,268 ppm. Maximum growth rate was significantly lower for all the samples containing SnF2 than for the samples containing control biofilms (p < 0.05); no differences were found between the control and all the PEG-3 tallow aminopropylamine (p > 0.05). The growth parameters showed high reproducibility rates within the treated groups of biofilms and for the controls; thus, the screening method provided reliable results.

Demineralization Inhibitory Effects of Highly Concentrated Fluoride Dentifrice and Fluoride Gels/Solutions on Sound Dentin and Artificial Dentin Caries Lesions in vitro

<b><i>Objectives:</i></b> The aim of this in vitro study was to compare the demineralization inhibitory effect of gels/solutions used in combination with either standard or highly fluoridated dentifrices on sound dentin as well as on artificial dentin caries-like lesions. <b><i>Methods:</i></b> Bovine dentin specimens (<i>n</i> = 240) with two different surfaces each (sound [ST] and artificial caries lesion [DT]) were prepared and randomly allocated to twelve groups. Weekly interventions during pH-cycling (28 days, 6 × 120 min demineralization/day) were: the application of gels/solutions containing amine fluoride/sodium fluoride (12,500 ppm F [ppm]; pH = 4.4; AmF); NaF (12,500 ppm; pH = 6.6; NaF1); NaF (12,500 ppm; pH = 6.3; NaF2); silver diamine fluoride (14,200 ppm; pH = 8.7; SDF); acidulated phosphate fluoride (12,500 ppm; pH = 3.8; APF), and no intervention (standard control; S). Furthermore, half of the specimens in each group were brushed (10 s; twice per day) with dentifrice slurries containing either 1,450 ppm (e.g., AmF₁₄₅₀) or 5,000 ppm (e.g., AmF₅₀₀₀). Differences in integrated mineral loss (ΔΔZ) and lesion depth (ΔLD) were calculated between values before and after pH-cycling using transversal microradiography. <b><i>Results:</i></b> After pH-cycling Ss showed significantly increased ΔZ_DT and LD_DT values, indicating further demineralization. In contrast, except for one, all groups including fluoride gels/solutions showed significantly decreased ΔZ_DT values. Additional use of most fluoride gels/solutions significantly enhanced mineral gain, mainly in the surface area; however, acidic gels/solutions seemed to have negative effects on lesion depths. <b><i>Significance:</i></b> Under the present pH-cycling conditions the highly fluoridated dentifrice significantly reduced caries progression and additional application of nearly all of the fluoride gels/solutions resulted in remineralization. However, there was no difference in the remineralizing capacity of fluoride gels/solutions when used in combination with either standard or highly fluoridated dentifrices.

Mouthwash Effects on LGG-Integrated Experimental Oral Biofilms

In order to investigate the effects of mouthwashes on oral biofilms with probiotics, we compared in biofilms the susceptibility to mouthwashes of probiotic Lactobacillus rhamnosus GG (LGG) and oral pathogens Streptococcus mutans, Streptococcus sanguinis, and Candida albicans. We also evaluated these pathogens’ susceptibility to the mouthwashes and their recovery after mouthwash-rinsing in biofilms with/without LGG. First, 1-day-/3-day-old LGG-integrated multi-species biofilms were exposed for 1 min to mouthwashes containing chlorhexidine, essential oils, or amine fluoride/stannous fluoride. Cells were plate-counted and relative survival rates (RSRs) of LGG and pathogens calculated. Second, 1-day-/3-day-old multispecies biofilms with and without LGG were exposed for 1 min to mouthwashes; cells were plate-counted and the pathogens’ RSRs were calculated. Third, 1-day-old biofilms were treated for 1 min with mouthwashes. Cells were plate-counted immediately and after 2-day cultivation. Recovery rates of pathogens were calculated and compared between biofilms with/without LGG. Live/Dead® staining served for structural analyses. Our results showed that RSRs of LGG were insignificantly smaller than those of pathogens in both 1-day and 3-day biofilms. No significant differences appeared in pathogens’ RSRs and recovery rates after treatment between biofilms with/without LGG. To conclude, biofilm LGG was susceptible to the mouthwashes; but biofilm LGG altered neither the mouthwash effects on oral pathogens nor affected their recovery.

Desensitizing Toothpastes for Dentin Hypersensitivity: A Network Meta-analysis

The goal of this systematic review and network meta-analysis was to compare the relative effects of toothpaste formulations for dentin hypersensitivity (DH), tested in randomized controlled trials (RCTs). We searched 7 databases to February 2019. Paired reviewers independently screened studies, extracted data, and performed risk of bias assessment. The outcome of interest was painful response measured through tactile, cold, and air stimuli. We conducted a random-effects Bayesian network meta-analysis using standardized mean difference (SMD) and their credible intervals (CIs) as the measure of effect for each pain stimuli. We assessed certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. We included 125 RCTs (12,541 patients). For tactile stimulus, the following active ingredients showed large beneficial effects compared to fluoride with moderate certainty of evidence (SMD; 95% CI): potassium + stannous fluoride (SnF2) (3.05; 1.69–4.41), calcium sodium phosphosilicate (CSP) (2.14; 0.75–3.53), SnF2 (2.02; 1.06–2.99), potassium + hydroxyapatite (2.47; 0.3–4.64), strontium (1.43; 0.46–2.41), and potassium (1.23; 0.48–1.98). For cold stimulus, CSP showed large beneficial effects compared to fluoride (3.93; 0.34–7.53) with moderate certainty; for air stimulus, arginine (2.22; 1.45–2.99), potassium + hydroxyapatite (2.44; 0.33–4.55), potassium + SnF2 (2.28; 0.87–3.69), CSP (1.98; 0.99–2.98), and SnF2 (1.9; 1.03–2.77) showed large beneficial effects compared to fluoride with moderate to high certainty. Most toothpaste formulations showed evidence of superiority against placebo or fluorides (amine fluoride, sodium monofluorophosphate, or sodium fluoride). CSP was most beneficial for all 3 stimuli with high to moderate certainty. SnF2 alone and potassium combined with SnF2 or hydroxyapatite were beneficial for tactile and air stimulus with high to moderate certainty. Arginine was beneficial for air stimulus, and strontium and potassium were beneficial for tactile stimulus, with moderate certainty.