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To evaluate the effectiveness of a calcium silicate/phosphate fluoridated tooth paste and a serum compared with a toothpaste containing hydroxyapatite on protecting the enamel after interproximal reduction against demineralization. 3 sets of eleven incisors were created. The teeth underwent interproximal enamel reduction (IER) of 0.5 mm. Each set was allocated to one of three groups: (1) Brushing without toothpaste (control group); (2) Vitis toothpaste + Remin Pro; (3) Regenerate toothpaste + Regenerate Serum. The agents were applied three times a day and specimens subjected to demineralization cycles for 30 days. The weight percentages of calcium (Ca) and phosphorous (P) were quantified by X-ray microfluorescence spectroscopy. Surface microhardness measurements and electron scanning microscopy (SEM) observations were made. Ca data and the Ca/P ratio were significantly higher in Group 3 than the other groups (p < 0.017), while P was significantly lower in Group 3 (p < 0.017). No significant differences were found between Groups 1 and 2 (p > 0.017). Group 3 showed significantly higher microhardness values (p < 0.05) than Group 1. No significant differences were found for other comparisons between groups (p < 0.05). SEM images showed less demineralization in Group 3. The application of a calcium silicate/phosphate fluoridated tooth paste (Regenerate advance) and a dual serum (Regenerate advance enamel serum) protect the enamel with interproximal reduction against demineralization. Therefore, this treatment could be used to prevent the dissolution of hydroxyapatite after IER.

Background: Plaque-induced gingivitis can be prevented and treated with regular effective oral hygiene, principally via mechanical cleaning with regular toothbrushing. To complement the mechanical plaque removal, antimicrobial ingredients can be incorporated into dentifrices to inhibit the growth of plaque. This study aimed to evaluate and compare gingivitis and the proportion of subjects moving between gingivitis severity (< 10, > 10 < 30, > 30% bleeding sites), and plaque reduction, following twice daily use of an experimental non-aqueous 0.454% weight/weight (w/w) stannous fluoride (SnF 2 ) dentifrice, compared to a negative control dentifrice over 12 and 24 weeks., Method: This was a single-center, examiner-blinded, randomized, stratified, two-treatment arm, parallel group, 24-week clinical study in healthy adult volunteers with moderate gingivitis. At baseline, after abstaining from toothbrushing overnight, subjects underwent MGI (modified gingival index), BI (bleeding index) and PI (plaque index) assessments. Eligible subjects, who met the inclusion/exclusion criteria, were stratified based on gender and baseline mean MGI score (Low ≤2.00 /High > 2.00) and randomized to treatment. Following randomization, subjects underwent a thorough dental prophylaxis and flossing. After 12 and 24 weeks of twice daily brushing with their allocated treatment, subjects returned to the site (with overnight plaque, having abstained from oral hygiene procedures for 8 h prior to visit) for MGI, BI and PI assessments. Treatment effect was evaluated by comparing the MGI, BI and PI scores., Results: One hundred and twenty-nine subjects were screened; 98 subjects were randomized and 90 subjects completed the study. Statistically significant differences between treatments, in favour of the 0.454% stannous fluoride dentifrice were observed, compared to the negative control dentifrice, for all outcome measures (MGI, BI, bleeding sites and PI at weeks 12 and 24 p < 0.0001). At 24 weeks, 71% of subjects in the 0.453% SnF 2 treatment group demonstrated < 10% of bleeding sites., Conclusion: A dentifrice containing 0.454% w/w SnF 2 was shown to be superior to a standard dentifrice in controlling gingivitis and supra-gingival plaque, over a 24-week period. Over two thirds of subjects in the 0.454% SnF 2 treatment group demonstrated a level of bleeding sites potentially representative of "clinical periodontal health" (< 10%) following a dental prophylaxis and 24 weeks of product use., Trial Registration: This study was retrospectively registered at ClinicalTrials.gov, on 11th Oct. 2019 (NCT04123665).

Aim: To estimate gingivitis effects of a bioavailable gluconate chelated 0.454% stannous fluoride (SnF 2 ) family of dentifrices in adult subjects versus positive (triclosan) and negative (NaF or MFP) controls when used ≤3 months., Materials and Methods: A meta-analysis evaluated bioavailable gluconate chelated SnF 2 dentifrices versus a negative or positive control for gingival bleeding., Results: In 18 randomized controlled trials (RCTs) with 2,890 subjects assessing SnF 2 paste versus a negative or positive control, the average number of bleeding sites was reduced by 51% and 31%, respectively. The average change (95% CI) in number of bleeding sites was -16.3 (-27.8, -4.9) versus the negative control and -3.6 (-5.4, -1.8) versus the positive control. Subjects with localized or generalized gingivitis had 3.7 times better odds (95% CI [2.8, 5.0]) of shifting to generally healthy using SnF 2 versus a negative control and 2.8 times better odds (95% CI [2.1, 3.9]) of shifting to generally healthy using SnF 2 versus a positive control. The individual study risk of bias was deemed to be low in all categories of bias., Conclusion: This meta-analysis demonstrates significant gingivitis benefits of bioavailable SnF 2 dentifrices when used ≤3 months versus positive (triclosan) and negative (NaF or MFP) controls., (© 2019 John Wiley & Sons A/S. published by John Wiley & Sons Ltd.)

This 4-year randomized controlled trial (RCT) aimed at investigating whether routine home use of both a SnCl 2 /AmF/NaF-containing mouth rinse and toothpaste has a preventive effect on oral health. Fifty-four test subjects were examined in biannual intervals. The primary endpoint "dental erosion" was determined by the Basic Erosive Wear Examination (BEWE). The secondary endpoints were "saliva pH", "dentin hypersensitivity" generated by Visual Analogue Scale (VAS), and "discoloration" measured by the Lobene Stain Index (LSI). A mixed model for repeated measures (MMRM) was used to analyze the primary endpoint "dental erosion". Primary analysis showed a significant intervention effect of the SnCl 2 /AmF/NaF-containing test product (p 1  = 0.0242). This result was confirmed by two additional MMRM-based sensitivity analyses. Comparison of all models showed "dental erosion" values of the intervention group  below values of the control group. Discoloration of the teeth was significantly higher in the intervention than in the control group at all time points. Saliva pH and dentin hypersensitivity were not significantly different between groups over four years. In summary, this RCT is the first to indicate a possible preventive effect of SnCl 2 /AmF/NaF-containing oral hygiene products on dental erosion over a follow-up period of four years.

Objectives: The aim of this systematic review was to establish in studies with human participants the effect of a regular fluoride dentifrice compared to water or saline on dental plaque inhibition., Methods: MEDLINE-PubMed, Cochrane-CENTRAL, EMBASE and other electronic databases were searched, up to April 2018. The inclusion criteria were controlled clinical trials among participants aged ≥18 years with good general health. Papers that evaluated the effect of dentifrice slurry compared with water or saline on plaque regrowth during a 4-day nonbrushing period were included. Data were extracted from the eligible studies, the risk of bias was assessed, and a meta-analysis was performed where feasible., Result: The search retrieved eight eligible publications including 25 comparisons. The estimated potential risk of bias was low for all studies. Based on three different indices, overall plaque regrowth was significantly (P < 0.01) inhibited for 0.25 or more by the use of a dentifrice slurry as compared to water. All subanalysis on specific dentifrice ingredients and the overall descriptive analysis supported these findings., Conclusion: The results of this review demonstrate moderate-quality evidence for a weak inhibitory effect on plaque regrowth in favour of the use of a dentifrice intended for daily use., (© 2018 The Authors. International Journal of Dental Hygiene Published by John Wiley & Sons Ltd.)

Objectives: Fluoride mouthrinses provide advantages for fluoride delivery by maintaining elevated intra-oral fluoride concentrations following fluoride dentifrice use. This in situ caries study investigated potential anti-caries efficacy of a 220 ppm fluoride mouthrinse., Methods: This was an analyst-blinded, four-treatment, randomised, crossover study using partially demineralised, gauze-wrapped, human enamel samples mounted in a mandibular partial denture. Participants brushed twice daily for 14 days with either a 1150 ppm fluoride or a fluoride-free placebo dentifrice and either rinsed once daily with the 220 ppm fluoride mouthrinse or not. Following each treatment period, percent surface microhardness recovery (%SMHR) and enamel fluoride uptake (EFU) were assessed., Results: Fifty three participants completed the study. Compared with the placebo dentifrice/no rinse treatment, the fluoride-containing regimens demonstrated greater enamel remineralisation (%SMHR) and fluoridation (EFU): fluoride dentifrice/fluoride rinse (%SMHR difference: 21.55 [95% CI: 15.78,27.32]; EFU difference 8.35 [7.21,9.29]); fluoride dentifrice/no rinse: 19.48 [13.81,25.15]; 6.47 [5.35,7.60]; placebo dentifrice/fluoride rinse: 16.76 [11.06,22.45]; 5.87 [4.72,7.00] (all P < .0001). There were no significant differences in%SMHR between fluoride regimens. The fluoride dentifrice/fluoride rinse regimen was associated with higher EFU than the fluoride dentifrice/no rinse (1.88 [0.75,3.01], P = .0013) and placebo dentifrice/fluoride rinse regimens (2.48 [1.34,3.62], P < .0001). Treatments were generally well-tolerated., Conclusions: The in situ caries model demonstrated that the fluoride mouthrinse is effective in promoting enamel caries lesion remineralisation and fluoridation whether used following a fluoride or non-fluoride dentifrice. Additive (potential) anti-caries benefits of a fluoride rinse after a fluoride dentifrice were confined to enhancements in lesion fluoridation (EFU)., Clinical Significance: In conjunction with a fluoride dentifrice, fluoride mouthrinses enhance enamel fluoridation, which may be useful in caries prevention., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: This study evaluated the colour changes of demineralized enamel after treatment with coloured fluoride gel., Materials and Methods: Enamel blocks obtained from bovine incisors were submitted to artificial caries induction by pH cycling followed by fluoride gel applications (2% sodium fluoride, pH 6.8) using a colourless gel (control group), pink or blue gels. The enamel optical properties were evaluated by spectrophotometry, using the CIE L*a*b* system at baseline (sound enamel), after artificial caries induction (demineralised enamel) and after each of the five fluoride gel applications (weekly intervals). Changes in enamel optical properties (ΔE) were analysed by two-way ANOVA and Tukey's test (α = 0.05)., Results: No significant differences were found among fluoride gels (p = 0.476) regardless of the presence of pigments in the gel. ΔE values were significantly different (p < 0.001) between baseline evaluation and treated enamel (after fluoride gel application)., Conclusion: This in vitro study demonstrated that colour changes in enamel do not occur during fluoride gel treatment, regardless of the presence or absence of coloured pigments in the gel.

Objective: Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) complexes are anticariogenic and capable of remineralizing the early stages of enamel lesions. The use of fluoride prevents dental decay and the association of CPP-ACP with fluoride can increase remineralization. To evaluate the effect of CPP-ACP and CPP-ACPF creams associated with a fluoride dentifrice to prevent enamel demineralization in a pH cyclic model., Material and Methods: Previously selected by surface microhardness (SH) analysis, human enamel blocks (n = 56) were submitted to daily treatment with dentifrice in a pH-cycling model. The enamel blocks were divided into four groups; G1: Crest™ Cavity Protection - Procter & Gamble (1,100 ppmF of NaF); G2: Crest™ +MI Paste (MP) - Recaldent™ GC Corporation Tokyo, Japan); G3: Crest™ + MI Paste Plus (MPP) - Recaldent™ 900 ppm as NaF, GC Corporation Tokyo, Japan), and G4: control, saliva. Specimens were soaked alternatively in a demineralizing solution and in artificial saliva for 5 d. The fluoride dentifrice, with proportion of 1:3 (w/w), was applied three times for 60 s after the remineralization period. The undiluted MP and MPP creams were applied for 3 m/d. After cycling, SH was re-measured and cross section microhardness measurements were taken., Results: The SH values observed for the groups G3 (257±70), G1 (205±70), and G2 (208±84) differed from the G4 group (98±110) (one-way ANOVA and Tukey's post hoc test). There were no differences between the groups G1xG2, G2xG3, and G1xG3 for demineralization inhibition. The percentage of volume mineral showed that, when applied with fluoride dentifrice, MPP was the most effective in preventing enamel demineralization at 50 µ from the outer enamel surface (Kruskal-Wallis and Mann Whitney p<0.05)., Conclusion: Fluoride dentifrice associated with CPP-ACPF inhibited subsurface enamel demineralization.

Objectives: This study evaluated the effect of conventional (CD, 1100ppm F) and low-fluoride (LFD, 550ppm F) dentifrices, applied in different quantities, on enamel demineralization, and on fluoride (F) concentrations in the dental biofilm formed in situ., Methods: Five combinations of dentifrices and quantities were tested: placebo (P-F-free) applied on all brush bristles; LFD applied by the transversal technique (0.3g-T1) or on all bristles (0.6g-T2); and CD applied in a pea-sized amount (0.15g-T3) or by the transversal technique (0.3g-T4), in order to produce comparable intensities (F concentration in the dentifrice×amount applied to the brush). Volunteers (n=13, 20-36 years old) wore palatal devices containing 4 bovine enamel blocks, and performed cariogenic challenges (30% sucrose solution) 6×/day, and brushing 3×/day, following a double-blind, cross-over and randomized protocol. On the 8th day, biofilm was collected 5 and 60min after brushing. The percentage of surface hardness loss (%SH), integrated loss of subsurface hardness (ΔKHN) and biofilm F concentrations (solid and fluid phases) were determined. Data were analyzed by repeated-measures ANOVA, Student-Newman-Keuls test, and Pearson's correlation coefficient (p<0.05)., Results: Significantly lower ΔKHN was observed for treatments with higher intensity (T2 and T4) in comparison with the lower intensity (T1 and T3). A strong correlation was observed between ΔKHN and F concentrations in total biofilm (r=-0.71) and biofilm fluid (r=-0.72) 5min after brushing., Conclusions: The treatment intensity has a significant influence on the development of caries lesions in situ., Clinical Significance: The intensity of treatment (amount of dentifrice×concentration) during brushing seems to be a more relevant parameter of clinical efficacy than simply observing the F concentration of the product. The use of a small amount of CD significantly reduced the protective effects against enamel demineralization., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objectives: To explore relative efficacy of six negative-control dentifrices utilised as controls in clinical studies compared with two dentine hypersensitivity (DH)-relief dentifrices used 2×/day for 8 weeks., Methods: Six control dentifrices differing in terms of fluoride source (sodium fluoride/sodium monofluorophosphate), abrasive base (silica/dicalcium phosphate), relative dentine abrasivity (RDA) (∼17 to ∼180) and colour (white/blue/multicoloured stripes) were compared with a depolarising dentifrice (5% KNO 3 ; RDA ∼70-97; 'Test 1') and an occlusion-technology dentifrice (0.454% SnF 2 ; RDA ∼160-180; 'Test 2'). DH was assessed using tactile and evaporative (air) (measured by Schiff Sensitivity Scale and a visual rating scale [VRS]) stimuli., Results: In total 249 subjects were randomized. All dentifrices yielded statistically significant improvements from baseline on all endpoints. The two DH-relief dentifrices ranked highest in terms of improvement in scores over the control dentifrices. While there was a clear differentiation between Test 1 and control dentifrices on both measures at 4/8 weeks, for Test 2, statistically significant improvements in Schiff scores were observed over all controls at Week 4 but only over three at Week 8. At Week 4 none of the controls separated from Test 2 on tactile threshold; all separated by Week 8. VRS scores did not separate test and control dentifrices. Dentifrices were generally well-tolerated., Conclusions: The six negative-control dentifrices can be used to assess dentifrices considered to be effective in reducing DH. Although response ranges for commercially available negative controls varied, these results may begin to set acceptable performance ranges for control dentifrices in DH trials., (Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: No published studies exist on the remineralizing potential of Tooth Mousse Plus ® (TMP) when applied for less than 3 min., Aim: To evaluate (i) the remineralizing potential of TMP on artificial carious lesions, when applied thrice daily for 60 s, and (ii) the benefit of using a fluoridated dentifrice prior to TMP application., Design: Carious lesions, 120-200 μm deep, were produced by placing molars in demineralizing solution for 96 h, and sections 100-150 μm thick were then randomly assigned to four groups. Specimens were treated thrice daily with a non-fluoridated (Group A), or 1000 ppm F dentifrice (Group B), or TMP (Group C), or a 1000 ppm F dentifrice followed by TMP application (Group D), and then subjected to a 10-day pH cycling model. Lesion evaluation involved polarizing light microscopy and microradiography., Results: Post-treatment maximum mineral content at the surface zone (V max ) was significantly increased and lesion depth (LD) significantly decreased in Group C, while only the V max increased in Group D. Increase in LD was observed in Group B; however, no significant differences were noted in percentage LD changes between groups B, C, and D (P > 0.05)., Conclusions: TMP applied for 60 s significantly remineralized the artificial carious lesions. No additional benefit was evident when TMP was preceded by treatment with 1000 ppm F dentifrice., (© 2016 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The aim of this study was to evaluate the influence of an extended use of desensitizing toothpastes (DTs) on dentin bonding, microhardness and roughness. One hundred and twenty bovine incisor teeth were randomly divided into four groups: G1, distilled water (WATER); G2, Colgate Total 12 (CT12); G3, Colgate Sensitive Pro-Relief (CSPR); and G4, Sensodyne Repair ?αμπ; Protect (SRP). Dentin surfaces were etched with 17% EDTA and 2 years of simulated tooth brushing (20,000 cycles) was performed on their surfaces. Knoop microhardness, surface roughness and scanning electron microscopy (SEM) were performed before and after the simulated tooth brushing. For microshear bonding test, a 2-step self-etching adhesive system (Clearfil SE Bond) was used and 0.8 mm diameter composite resin (Filtek Z350 XT) cylinders were built. Microshear test was performed with an orthodontic wire and with a crosshead speed of 0.5 mm/min. The data were analyzed for: 1) bond strength (one-way ANOVA), 2) microhardness intra-group (Student's test) and inter-group (one-way ANOVA/Tukey's test) comparisons, 3) roughness intra-group (Student's test/Wilcoxon's test) and inter-group (Kruskal-Wallis/Student-Newman-Keuls test) comparisons. The extended use of both dentifrices (conventional and for sensitive teeth) did not affect the bond strength and produced a significant increase in microhardness and roughness of the dentin, except for the microhardness of the SRP group. The simulated tooth brushing technique with water produced an increase in roughness, without reducing significantly the dentin microhardness.

Objectives: This study aimed to investigate whether addition of an octadecene/maleic anhydride copolymer (O/MA) to a potassium nitrate (KNO 3 ) dentifrice could facilitate delivery of potassium to dentine and enhance its efficacy in dentine hypersensitivity relief., Methods: This was a randomised, examiner-blind, controlled, parallel group study in 139 healthy subjects with at ≥2 sensitive teeth. Assessment of dentine hypersensitivity to tactile (Yeaple probe) and evaporative (air) stimuli (Schiff Sensitivity Scale, visual analogue scale [VAS]) was carried out at baseline and after 1, 2, 4 and 8 weeks twice daily treatment with an experimental 5% KNO 3 /3% O/MA dentifrice, a comparator 5% KNO 3 dentifrice (active comparator), a 0% KNO 3 /3% O/MA dentifrice (placebo) and a regular fluoride dentifrice (negative control). This study was not powered to detect statistically significant differences between treatments., Results: Across the treatment period an improvement in sensitivity to evaporative air stimulus was observed for all products and to a tactile stimulus for the potassium-containing treatments, with the greatest reductions for the experimental dentifrice (5% KNO 3 /3% O/MA). Reductions in sensitivity observed for the potassium-containing dentifrices compared to the placebo and negative control dentifrices were statistically significantly for Schiff sensitivity score and tactile threshold at all time-points and for VAS at Weeks 4 and 8. Trends in the study data also favoured the experimental dentifrice, compared to the active comparator dentifrice, for all clinical measures. Study treatments were generally well tolerated., Conclusion: This study provides initial clinical evidence to suggest that addition of a polymer excipient may enhance the anti-sensitivity efficacy of potassium-containing dentifrices., Clinical Significance: Daily use potassium-containing dentifrices are established as efficacious for the relief of dentine hypersensitivity. Inclusion of a polymer excipient in such formulations may facilitate delivery of potassium to the dentine surface and so enhance clinical efficacy. Further clinical studies are required to confirm this hypothesis., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Remineralizing agents represent a new frontier in dentistry. They may be classified as fluoride agents, calcium and phosphate based agents, herbal agents or combinations. The modes of delivery of remineralizing agents may be as dentifrices, mouth rinses, lozenges or chewing gums. The applications of remineralizing agents may be extrapolated to virtually every branch of dentistry ranging from pediatric to geriatric dentistry.

This 12-week clinical study evaluated the impact of 10% CPP-ACP and 5% sodium fluoride varnish regimes on the regression of nonorthodontic white spot lesions (WSLs). The study included 21 children with 101 WSLs who were randomised into four treatment regimes: weekly clinical applications of fluoride varnish for the first month (FV); twice daily self-applications of CPP-ACP paste (CPP-ACP); weekly applications of fluoride varnish for the first month and twice daily self-applications of CPP-ACP paste (CPP-ACP-FV); and no intervention (control). All groups undertook a standard oral hygiene protocol and weekly consultation. Visual appraisals and laser fluorescence (LF) measurements were made in weeks one and twelve. The majority of WSLs in the control and FV groups exhibited no shift in appearance, whereas, in the CPP-ACP and CPP-ACP-FV groups, the lesions predominantly regressed. The visual and LF assessments indicated that the extent of remineralisation afforded by the treatments was of the following order: control ~ FV < CPP-ACP ~ CPP-ACP-FV. Self-applications of CPP-ACP paste as an adjunct to standard oral hygiene significantly improved the appearance and remineralisation of WSLs. No advantage was observed for the use of fluoride varnish as a supplement to either the standard or CPP-ACP-enhanced oral hygiene regimes.

Objectives: The aim of this exploratory double-blinded, randomized, cross-over, in situ study was to compare the effects of various model parameters ('intervention', 'brushing', 'position') on enamel caries lesions in a dose-response model., Methods: In each of four experimental legs of four weeks 16 participants wore intraoral mandibular appliances with four 'plaque-retaining' and four 'easily cleanable' positioned pre-demineralized bovine enamel specimens in the vestibular flanges mimicking proximal and buccal surfaces, respectively (n=512). The four randomly allocated interventions (either application only or brushing) included the following dentifrices: AlF3 1360ppmF(-)+chlorhexidine 0.05% (Lacalut aktiv, LA1360), NaF 1,450ppmF(-)(Blend-a-Med ProExpert), NaF 500ppm F(-) and 0ppm F(-) as negative control (NC) (both experimental, based on Blend-a-Med ProExpert)., Results: Differences in integrated mineral loss (ΔΔZ) and lesion depth (ΔLD) were calculated between values before and after the in situ period using transversal microradiography. Significant differences for ΔΔZ [adjusted mean (95% CI))] were found between NC, NaF500 and LA1360for both 'plaque-retaining' [-1830 (-2371;1289); -986 (-1530;442); -2 (-548;544)vol%×μm] as well as 'easily cleanable' specimens [-399 (-682; -116); -391 (-672; -110); -16 (-302;270)vol%×μm]. Values for NaF1450 revealed a similar dose-response as LA1360.Values for LA1360 and NaF1450 did not differ significantly (p>0.05; ANCOVA)., Conclusion/clinical Significance: The design of the present in situ study was able to reveal a fluoride dose-response to hamper further demineralization of enamel specimens for 'easily cleanable' and 'plaque-retaining' sites being brushed or not. Particularly 'plaque-retaining' sites seem to be recommendable for measuring potential anticaries efficacy in situ., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Objectives: To evaluate the efficacy of experimental proposals of desensitizing agents during tooth bleaching., Methods: 140 participants without tooth sensitivity (TS) received 16% carbamide peroxide (14 days-04 h each) (T1) or 35% hydrogen peroxide (single session-45 min) (T2). Participants used concomitantly (10 per group): desensitizing dentifrices (D1-experimental bioactive glass-ceramic; D2-commercial potassium nitrate; D3-commercial calcium and sodium phosphosilicate) in-home, daily and, desensitizing pastes (D4-experimental bioactive glass-ceramic; D5-experimental Bioglass type 45S5; D6-commercial calcium phosphate), in-office, immediately after the treatment and more 4 times. Participants in the control group did not use any desensitizing agent. We assessed TS with Visual Analogue Scale. Assessment point 1 was immediately after the first participant's exposure to the treatments; and points 2, 3, 4, and 5 were every 72 h along the period of the study. Two-way ANOVA (considering time and desensitizing as factors) and post-hoc Tukey test (α=0.05) analyzed the data., Results: In the control group treated with 35% hydrogen peroxide, TS increased significantly on assessment points 1 and 2. The participants who used a 5% potassium nitrate dentifrice and in-office experimental pastes did not experience TS because of the 35% in-office bleaching treatment., Conclusions: TS caused by 35% hydrogen peroxide in-office tooth bleaching was controlled by experimental products prepared as pastes D4-experimental bioactive glass-ceramic and D5-experimental Bioglass type 45S5, but not by D1-experimental dentifrice containing bioactive glass-ceramic., Clinical Significance: There is no a gold standard protocol for TS caused by tooth bleaching. The study of novel desensitizing agents that can obliterate the dentinal tubules in a faster-acting and long-lasting way may help meet this clinical need., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Objective: The objective was to evaluate the ability of fluoride in a conventional, non-specialised sodium fluoride-silica dentifrice to promote tooth remineralisation and enamel fluoride uptake (EFU), and assess the resistance of the newly formed mineral to attack by dietary acid, across the concentration range used in mass-market dentifrices., Methods: Subjects wore a palatal appliance containing eight polished bovine enamel specimens, each including an early erosive lesion. In a randomised full-crossover sequence, 62 healthy subjects were treated with dentifrices containing four different fluoride concentrations: no fluoride; 250ppm, 1150ppm and 1426ppm fluoride. At each treatment visit, under supervision, subjects brushed with 1.5g dentifrice and rinsed once while wearing the appliance; the appliance was removed after a 4-h remineralisation period and effects on the enamel specimens determined. The primary efficacy variable was surface microhardness recovery (SMHR); others included EFU, relative erosion resistance (RER) and comparative erosion resistance., Results: Highly significant linear and, with the exception of SMHR, quadratic dose-response relationships were observed between all efficacy variables and fluoride concentration. For SMHR, EFU and RER, values for the different fluoride concentrations were statistically resolved from one another, with the exception of the two highest fluoride concentrations. The degree of remineralisation and the acid resistance of enamel after treatment were closely related to EFU., Conclusion: After a single brushing, conventional non-specialised sodium fluoride-silica dentifrices promoted remineralisation of early enamel lesions, and imparted increased acid-resistance to the enamel surface, in a dose-dependent manner at least up to 1500ppm fluoride., Clinical Significance: Enamel erosive tissue loss is an increasing concern, associated with modern diets. This study demonstrated that sodium fluoride, in a conventional non-specialised dentifrice formulation, can promote repair of the earliest stages of enamel erosion after a single application, in a dose-dependent fashion across the fluoride concentration range used in mass-market dentifrices. This study is registered in the GlaxoSmithKline Study Register (ID RH01299), available at: www.gsk-clinicalstudyregister.com/study/RH01299., (Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The effect of brushing with two abrasive levels on the fluoride release of high-viscosity glass ionomers (GIs) was investigated. Forty-eight GI discs were fabricated and randomly assigned to one of the four groups. Treatments, performed for 30 days, included exposure to a carboxymethylcellulose (CMC) solution without fluoride (CMC-F), CMC with 275 ppm fluoride (CMC+F), CMC with fluoride plus brushing with a low abrasive slurry (relative enamel abrasivity = 4; L-ab), and CMC with fluoride plus brushing with a high abrasive slurry (relative enamel abrasivity = 7; H-ab). Fluoride release was measured after 1, 2, 3, 4, 5, 10, 15, 20, 25, and 30 days. Surface analysis was performed using optical profilometry in addition to scanning electron microscopy. Data were compared using one-way analysis of variance (α = 0.05). Fluoride release was significantly different among groups, with group H-ab showing the highest rates. Cumulative fluoride release was 10% and 30% greater in groups L-ab and H-ab than in group CMC+F. High surface roughness values were associated with H-ab as well as greater exposure of silica fillers, as observed by scanning electron microscopy. Fluoride release from conventional GIs is enhanced by brushing with high abrasive slurries.

Aim: Based on the existing scientific literature, the effect of chlorhexidine (CHX) dentifrice/gel as compared to a regular or placebo dentifrice/gel is established in healthy adults on the primary outcome parameters of plaque and gingivitis scores. As secondary parameter, tooth surface discoloration was evaluated as a side effect., Materials and Methods: MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials were searched up to July 2013 to identify eligible studies. Included were (randomized) controlled clinical trials, regarding self-performed brushing by adults without periodontitis with a minimum duration of 4 weeks., Results: Independent screening of 389 unique titles and abstracts resulted in 16 comparisons. Of these, nine evaluated CHX dentifrice (0.4-1.0%) and 7 CHX gel (0.2-2.0%). It was not possible to perform a meta-analysis; therefore, a descriptive analysis was carried out. Regarding plaque score reduction, the majority of the experiments using a CHX dentifrice provided a significant positive effect. All studies assessing gingival bleeding as parameter for gingivitis observed a significant reduction in favour of CHX dentifrice over placebo dentifrice. Tooth surface discoloration was more pronounced with CHX dentifrice. The combined data concerning parameters of interest for CHX gel compared with a placebo did not show a trend towards a beneficial effect on plaque and bleeding scores., Conclusions: Within the limitations of this analysis, it may be concluded that toothbrushing with a CHX gel does not provide conclusive evidence. Brushing with a CHX dentifrice can be effective with regard to the control of plaque and gingivitis. Tooth surface discoloration was observed as side effect, which potentially can have a negative impact on patients' compliance., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Unlabelled: The aim of this study was to compare the ability of quantitative light-induced fluorescence (QLF) and surface microhardness (SMH) to measure the remineralization of enamel subsurface lesions, using a pH-cycling model including treatment with 0-ppm, 550-ppm or 1,100-ppm sodium fluoride (NaF) dentifrices., Methods: Subsurface lesions were created in human enamel specimens (n = 36) and exposed to a remineralization pH-cycling model for 14 days. The pH-cycling model was performed in an automated system where specimens were subjected to a demineralizing solution for 20 min and treatment for 1 min and were then remineralized for 7 h 39 min, 3 times daily. The treatments consisted of 3 NaF, silica-containing dentifrices (0 ppm F; 550 ppm F; 1,100 ppm F). The outcome variables were: change from baseline in surface hardness and percentage change from baseline in fluorescence. An ANCOVA explored differences between different treatment groups (at the p < 0.05 level). Associations between QLF and SMH were evaluated using Spearman's correlation coefficient., Results: The percentage SMH changes were 14.9 ± 2.1%, 56.6 ± 9.6% and 103.9 ± 14.6% for the 0-, 550- and 1,100-ppm F dentifrices, respectively. The percentage fluorescence changes were 15.6 ± 7.1%, 59.8 ± 11.9% and 85 ± 13.2%, respectively. The differences between all pairwise comparisons were statistically significant for both methods (p = 0.001). QLF correlated with SMH (r = 0.67)., Conclusions: Both the SMH and QLF methods demonstrated a significant F dose response for toothpaste in this in vitro remineralization model, and both methods were able to distinguish treatments with different F levels.

Purpose: This double-blind, crossover study evaluated whole plaque fluoride concentration (F), as well as whole plaque calcium concentrations (Ca) after brushing with a placebo (PD - fluoride free), low-fluoride (LFD, 513 microg F/g) and conventional (CD, 1,072 microg F/g) dentifrices., Methods: Children (n=20) were randomly assigned to brush twice daily with one of the dentifrices, during 7 days. On the 7th day, samples were collected at 1 and 12 hours after brushing. F and Ca were analyzed with an ion-selective electrode and with the Arsenazo III method, respectively. Data were analyzed by ANOVA, Tukey's test and by Pearson correlation coefficient (P< 0.05)., Results: The use of the fluoridated dentifrices significantly increased plaque [F]s 1 hour after brushing when compared to PD, returning to baseline levels 12 hours after. Positive and significant correlations were found between plaque [F] and (Ca) under most of the conditions evaluated. The mean increase in plaque [F] observed 1 hour after brushing with the CD were only about 47% higher than those obtained for the LFD. The use of a LFD promotes proportionally higher increases in plaque [F] when compared to a CD. Plaque F concentrations were also shown to be dependent on plaque Ca concentrations.

To provide optimal fluoride effectiveness against caries while minimising risk of negative effects from excessive ingestion from toothbrushing, the fluoride dose delivered at each occasion is critical. This is particularly important for young children, so using a 'pea-sized amount' is generally recommended. However, there appears little guidance regarding what this means in practice, although it has been indicated to be 0.25 g. This study investigated, using conventional toothpastes and toothbrushes in Germany, the USA and the UK, how much toothpaste parents dispense for their 3- to 6 year-old children, and their interpretation of a 'pea-sized' amount of toothpaste. When asked to dispense the amount they would normally for their child, the majority of parents dosed substantially more than 0.25 g; in Germany, all parents over-dispensed. The amount dispensed varied widely: those parents at the 75th centile dispensed approximately twice the amount dispensed by those at the 25th centile, irrespective of country. When asked to dispense a pea-sized amount, the mean amount dosed decreased significantly in all countries. In the USA, electric toothbrush users dispensed about 0.1 g more than manual toothbrush users. While over-dispensing of fluoride toothpaste remains a cause for concern, it may be argued that the general recommendation to use a pea-sized amount of toothpaste generally works well in practice to balance the conflicting demands of risk and benefit from toothbrushing with fluoride toothpaste in young children., (© 2013 FDI World Dental Federation.)

Aim: This single blind, randomized clinical trial evaluated the relationship between frequency of mechanical removal of plaque (MRP) and gingival inflammation., Materials & Methods: Fifty-two patients (maximum 5% of sites with gingival bleeding and no history of periodontitis) were randomized to different frequencies of MRP: 12, 24, 48 and 72 h. Plaque index (PlI) and gingival index (GI) were evaluated at baseline, 15 and 30 days. Intra- and inter-group differences were determined by repeated measures anova and mixed models anova, respectively, both followed by Tukey's test., Results: The mean GI between baseline and 30 days remained statistically unchanged in the 12 h (0.51 ± 0.17 versus 0.63 ± 0.23, p = 0.137) and 24 h (0.43 ± 0.19 versus 0.59 ± 0.21, p = 0.052) groups, but increased significantly in the 48 h (0.48 ± 0.18 versus 0.84 ± 0.21, p = 0.001) and 72 h (0.55 ± 0.20 versus 0.94 ± 0.25, p = 0.000) groups. At 30 days, the average percentage of sites with GI scores of 1 and 2 was significantly higher in the 48 and 72 h than in the 12 and 24 h groups (p < 0.05)., Conclusions: Frequencies of mechanical removal plaque up to 24 h may prevent an increase in the severity of gingival inflammation over a period of 30 days in patients with no history of periodontitis., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Purpose: To evaluate the effects of experimental xylitol dentifrices with and without fluoride on in vitro root caries formation., Methods: Root surfaces from caries-free human permanent teeth (n = 10) underwent debridement and a fluoride-free prophylaxis. The tooth roots were sectioned into quarters, and acid-resistant varnish was placed with two sound root surface windows exposed on each tooth quarter. Each quarter from a single tooth was assigned to a treatment group: (1) No treatment control; (2) Aquafresh Advanced (0.15% F = 1,150 ppm F); (3) Experimental xylitol dentifrice without fluoride (0.45% xylitol); and (4) Diamynt fluoride dentifrice with xylitol (0.83% sodium monofluorophosphate = 1,100 ppm F and 0.20% xylitol). Tooth root quarters were treated with fresh dentifrice twice daily (3 minutes) followed by fresh synthetic saliva rinsing over a 7-day period. Controls were exposed twice daily to fresh synthetic saliva rinsing daily over a 7-day period. In vitro root caries were created using an acidified gel (pH 4.25, 21 days). Longitudinal sections (three sections/tooth quarter, 60/group) were evaluated for mean lesion depths (water inhibition, polarized light, ANOVA, DMR)., Results: Mean lesion depths were 359 +/- 37 microm for the control Group; 280 +/- 28 microm for Aquafresh Advanced; 342 +/- 41 microm for the experimental xylitol dentifrice without fluoride; and 261 +/- 34 microm for Diamynt. Aquafresh Advanced and Diamynt had mean lesion depths significantly less than those for the no treatment control and the experimental xylitol without fluoride dentifrice (P< 0.05). There were minimal non-significant differences in mean lesion depths between Aquafresh Advanced and Diamynt (P > 0.05).

Objective: To determine the applicability of a modified US FDA Caries Monograph test method for measuring the protective benefits of fluoride (F) against erosive, dietary acids., Methods: Acid-challenged teeth were treated in two studies with a dentifrice, rinsed, and then re-challenged in a series of tests using three dietary acids. Study 1 included dentifrices containing 1450 ppm F as sodium fluoride (NaF) + triclosan [A], 1450 ppm F (NaF) + potassium nitrate (KNO3) [B], 1000 ppm F as sodium monofluorophosphate (SMFP) [C], and 0 ppm F (placebo) [D]. Study 2 included dentifrices containing 1450 ppm F (NaF) [A]; and 0 ppm F (placebo) [B]. Acids were analyzed for phosphate removed during tooth challenges, with post-treatment results compared to baseline. Results were averaged and reported as a % protection value for each product, with higher values indicating greater protection., Results: Study 1: % protection for A = 16.4; B = 13.0; C = 7.1; and D = -5.2. Study 2: A = 15.2; B = -10.5, with A = B > C > D: Study 1; and A > B: Study 2. In each study, p < 0.05, ANOVA., Conclusions: The model provides a viable tool for initially assessing the potential for fluoride-containing oral care products to protect teeth against erosive, dietary acids. This can then lead to further and more elaborate testing with reasonable expectations for outcomes.

Background: Studies of dentifrices containing strontium chloride or potassium nitrate have documented the clinical efficacy of these formulations for dentin hypersensitivity (DH), but few studies have evaluated dentifrices containing both active ingredients., Objective: The objective of this study was to compare the effects on DH of a dentifrice containing 2% strontium chloride and 5% potassium nitrate in a silica base (experimental dentifrice) with those of a dentifrice containing the same silica base without any active ingredient (control dentifrice)., Methods: Male and female patients aged 20 to 65 years with DH were eligible to participate in this randomized, double-blind, placebo-controlled study in China. Patients were assigned to receive the experimental or control dentifrice. At baseline, immediately after topical dentifrice use, and after 3 days, patients received an oral examination of their hard and soft tissues, followed by an evaluation of DH that used the Yeaple Probe to measure tactile hypersensitivity and the Schiff Cold Air Scale to measure the perception of pain from an air blast stimulus. Adverse events (in particular, discomfort while brushing or alteration in taste) in the oral hard or soft tissues were monitored throughout the study., Results: A total of 81 patients were enrolled (40 in the experimental group; 41 in the control group), of whom 79 (55 women; 24 men) completed the study. After topical use, the experimental group had a significantly higher mean (SD) tactile hypersensitivity score (19.47 [14.69] vs 14.27 [5.76]; P = 0.047) and a significantly lower mean air blast hypersensitivity score (1.93 [0.51] vs 2.22 [0.60]; P = 0.026) than did the control group. After 3 days, the experimental group had a significantly higher mean tactile hypersensitivity score (19.87 [14.95] vs 14.51 [6.00]; P = 0.045) and a significantly lower air blast hypersensitivity score (1.80 [0.56] and 2.13 [0.60]; P = 0.014) than the control group. After topical use and after 3 days, the experimental group had increases from baseline in tactile scores of 54.04% and 56.67%, respectively (both, P = 0.001) and reductions from baseline in air blast scores of 18.51% and 24.21% (both, P < 0.001); the control group had increases in tactile scores of 21.14% and 21.54% (P = 0.022 and P = 0.007) and reductions in air blast scores of 10.24% and 13.41% (P = 0.001 and P < 0.001). No adverse events were reported throughout the study., Conclusion: In these patients with DH in China, the dentifrice containing 2% strontium chloride and 5% potassium nitrate was efficacious in reducing DH when used instantly after topical dentifrice use and after 3 days of use., (Copyright © 2012 Elsevier HS Journals, Inc. All rights reserved.)

Purpose: To evaluate the efficacy of a dentifrice containing 0.454% stannous fluoride (SnF2) in the reduction of dentin hypersensitivity immediately after use, after 3 days and after a 2-week use period as compared to a positive control dentifrice containing 8.0% arginine, calcium carbonate and 1450 ppm fluoride as sodium monofluorophosphate., Methods: 80 healthy adult subjects with moderate dentin hypersensitivity were enrolled in this clinical study, which had a controlled, randomized, examiner-blind, two-treatment (40 subjects per treatment group), parallel group design. For each subject, two sensitive bicuspid or cuspid teeth in different quadrants demonstrating reproducible sensitivity to thermal stimuli (Schiff air sensitivity score of > 1) were chosen for evaluation. Subjects were randomized to treatment with either the SnF2 dentifrice or the positive control dentifrice. At the baseline visit, subjects were assessed for sensitivity to thermal stimuli, received an oral soft tissue examination, and were instructed to brush with their assigned dentifrice according to manufacturers' usage instructions. Immediately after brushing, sensitivity to thermal stimuli for each enrolled tooth was assessed by an experienced dental examiner using the Schiff air sensitivity index and by study subjects based on air visual analog scale (VAS). After using their assigned dentifrice for 3 days and for 2 weeks, thermal sensitivity was re-assessed by both examiner and subject, and each subject received an oral soft tissue examination., Results: 40 subjects in the SnF2 dentifrice group and 38 subjects in the control group completed all study procedures. Both dentifrice groups showed significant sensitivity relief relative to baseline (P < 0.01). The SnF2 dentifrice provided a statistically significant (P = 0.005) 7.4% reduction in sensitivity relative to the positive control dentifrice immediately after first use and an even more significant (P = 0.001) 20% reduction at Week 2 based on the Schiff air sensitivity scale. Based on the VAS, the SnF2 dentifrice provided statistically significant (P < 0.0001) reduction in sensitivity relative to the positive control dentifrice immediately after first use, at Day 3, and Week 2, with percent reductions of 7.2%, 15.8% and 28.2%, respectively. No adverse events were reported with either dentifrice.

Objective: This study assessed the percentage of the amount of dentifrice loaded onto the toothbrush that is ingested by children, taking into account age, the amount of dentifrice used during toothbrushing, and the dentifrice flavor., Methods: The sample consisted of 155 children of both genders attending public kindergartens and schools in Bauru, Brazil, divided into 5 groups (n = 30-32) of children aged 2, 3, 4, 5 and 6 years old. The dentifrices used were Sorriso™ (1219 ppm F, peppermint-flavored) and Tandy™ (959 ppm F, tutti-frutti-flavored). The assessment of fluoride intake from dentifrices was carried out six times for each child, using 0.3, 0.6, and 1.2 g of each dentifrice, following a random, crossover distribution. Brushing was performed by the children or their parents/caregivers according to the home habits and under the observation of the examiner. Fluoride present in the expectorant and on toothbrush was analyzed with an ion-specific electrode after HMDS-facilitated diffusion. Fluoride ingestion was indirectly derived. Results were analyzed by 3-way repeated-measures anova and Tukey's tests (P < 0.05) using the percent dentifrice ingested as response variable., Results: Age and percent dentifrice ingested for both dentifrices, and the three amounts used were inversely related (P < 0.0001). Percent dentifrice ingested was significantly higher after the use of Tandy™ under all conditions of the study when compared with Sorriso™ (P < 0.0001). Significant differences were observed when brushing with 0.3 g when compared with 1.2 g, for both dentifrices tested (P < 0.05)., Conclusions: The results indicate that all variables tested must be considered in preventive measures aiming to reduce the amount of fluoride ingested by young children., (© 2011 John Wiley & Sons A/S.)

Objective: To evaluate the effectiveness of a dentifrice with 5000ppm fluoride in preventing dental erosion by orange juice in situ in comparison to a control dentifrice with 1450ppm fluoride., Methods: This was a double-blind and randomized clinical study with a cross-over design. Sixteen subjects wore an intra-oral appliance containing two enamel disks with an exposed surface of approximately 2mm×5mm. Enamel disks in the study group were treated with a dentifrice with 5000ppm fluoride and in the control group with 1450ppm fluoride. The subjects rinsed with slurries of study dentifrices for one minute before immersing the enamel disks in 250ml orange Juice four times in an 8-h period daily. The treatment procedure was repeated for three 5-day phases for each dentifrice. Enamel erosion was measured after each 5-day treatment phase using a focus-variation 3D scanning microscopy. Medians and inter-quartile ranges (IQR) of mean erosion depth were compared between the groups., Results: The mean erosion depths of enamel varied greatly amongst the subjects. Enamel treated with 5000ppm fluoride had less erosion (median 5.7μm, IQR 4.5μm) as compared to the control (median 12.6μm, IQR 12.3μm) after 15 days of fluoride treatment and erosive challenge cycles (p<0.05)., Conclusions: Enamel treated with 5000ppm fluoride had significantly improved resistance to erosion by orange juice. Periodic application of 5000ppm fluoride may be beneficial in individuals at risk of acidic erosion associated with soft drink consumptions., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: Oral lichen planus (OLP) decreases the quality of life because it can cause spontaneous pain during eating and tooth-brushing and an uncomfortable feeling in the mouth. In addition, OLP may be associated with HCV-related liver disease.We investigated the visual analogue scale (VAS) and effects of oral care gel, REFRECARE-H®, on patients with OLP associated with HCV infection., Results: Nine OLP patients (mean age 67.9 ± 7.6 years) with HCV-related liver diseases were recruited and their VAS score determined along with a biochemical examination of the blood. Types of OLP included erosive (6 patients) and reticular (3). REFRECARE-H®, an oral care gel (therapeutic dentifrice) containing hinokitiol, was applied by each patient as a thin layer on the oral membrane, after each meal and at bedtime for 30 days. Application of REFRECARE-H® improved the quality of life in all terms of dry mouth, breath odor, oral freshness, oral pain during rest, oral pain at a mealtimes, taste disorder, loss of appetite, sleep disorder, depressive mood and jitteriness. VAS scores of dry mouth, breath odor, oral freshness, and sleep disorder were significantly increased 30 days after application of REFRECARE-H® (P = 0.01, P = 0.05, P = 0.03, P = 0.04). VAS scores of oral pain at a mealtimes and taste disorder were increased 30 days after application of REFRECARE-H® (P = 0.06). There was an absence of side effects., Conclusions: REFRECARE-H® improved the quality of life for OLP. It is necessary for the hepatologist to educate patients regarding oral hygiene, as well as provide treatment of liver disease.

Background: Although child formula fluoridated dentifrices can be used safely by young children their remineralizing capability remains questionable., Aims: To evaluate the remineralizing potential of child formula dentifrices on primary teeth., Design: In vitro single-section technique utilizing a 7 days pH-cycling model., Methods: Primary teeth were placed in demineralizing solution for 96 h to produce artificial carious lesions 100 μm deep, and then cut longitudinally into 50 sections 100-150 μm thick and randomly assigned to five groups. Sections in Groups A to D were treated with dentifrices containing 500 ppm AmF, 500 ppm MFP, 500 ppm MFP and xylitol, or 500 ppm NaF, respectively. Group E sections were treated with a nonfluoridated dentifrice., Outcome Measurements: Lesions were evaluated using polarized light microscopy and microradiography., Results: Group D (500 ppm NaF) sections exhibited a significant decrease in lesion depth, whereas those in Group E (nonF) showed a significant increase in depth (P<0.05, paired t-test). Decrease in lesion progression was observed in Groups A, B and C., Conclusions: The 500 ppm NaF dentifrice demonstrated remineralization of carious lesions by virtue of a significant decrease in lesion depth; whereas dentifrices that contained AmF, MFP and MFP with xylitol decelerated the progression of demineralization., (© 2010 The Authors. International Journal of Paediatric Dentistry © 2010 BSPD, IAPD and Blackwell Publishing Ltd.)

Objective: The in vitro effects of two commercial sensitivity relief dentifrices, one containing 8.0% arginine, calcium carbonate, and 1450 ppm fluoride as sodium monofluorophosphate (MFP), and the other containing 8% strontium acetate and 1040 ppm fluoride as sodium fluoride, in occluding dentin tubules and reducing dentin fluid flow were compared in a blinded study using hydraulic conductance (Flodec)., Methods: Human dentin segments were cut from extracted molars, mounted on acrylic blocks, etched, and connected to a Flodec to measure hydraulic conductance. Segments were divided into two groups (n = 6) and treated for one minute with either the arginine/calcium carbonate dentifrice or the strontium acetate dentifrice. The blocks were rinsed, connected to the Flodec, and the conductance was measured. Blocks were rinsed again and incubated in phosphate-buffered saline (PBS) for at least two hours before the next treatment. The cycle was repeated for a total of three treatments (one using a fingertip and the next two using a toothbrush). After the third treatment, the blocks were incubated in PBS overnight and conductance was re-measured. The two groups were further divided into three sets of two segments each, which were challenged for one minute with either 6% citric acid, orange juice, or grapefruit juice., Results: The hydraulic conductance study showed that the dentifrice containing 8.0% arginine, calcium carbonate, and 1450 ppm fluoride provided a significantly higher percentage reduction in fluid flow immediately after fingertip application, as well as after two brushing cycles, compared to the dentifrice containing 8% strontium acetate and 1040 ppm fluoride. After various acid challenges, the percentage reduction in fluid flow of dentin treated with the arginine/calcium carbonate dentifrice remained significantly higher than that of the strontium acetate dentifrice. These results are highly consistent with the results from an independent clinical study which showed that the arginine/calcium carbonate dentifrice provided dentin hypersensitivity relief immediately after direct topical application with a fingertip and massage for one minute per sensitive tooth, whereas the strontium acetate dentifrice did not., Conclusion: Based on this in vitro hydraulic conductance study, the dentifrice containing 8.0% arginine, calcium carbonate, and 1450 ppm fluoride was significantly more effective in reducing fluid flow through dentin tubules as a result of occlusion than the dentifrice containing 8% strontium acetate and 1040 ppm fluoride. Further, the superior occlusion obtained with the arginine/calcium carbonate dentifrice was resistant to acid challenge.

Objective: The objective of this study was to evaluate the relative level of dentin tubule occlusion afforded by two dentifrices specifically developed to occlude dentin tubules, following finger-applied dab-on application and by repeated brushing, in a longitudinal acid-challenge-based dentin disk model. The impact of a dietary acid alone (grapefruit juice) on the level of dentin tubule occlusion conferred by each product following dab-on application was also explored in a separate short-term stand-alone exploratory dentin disk-based in vitro study., Methods: For the longitudinal study, 120 bovine dentin discs, polished and etched in citric acid for two minutes to provide a smooth dentin surface with patent tubules, were divided into three treatment groups and subjected to a finger application of the dentifrice only, or a combination of finger application and brushing. Prior to and between treatments, the dentin samples were stored in saliva (for > 60 minutes). The test products were an 8% w/w strontium acetate dentifrice (currently marketed as Sensodyne Rapid Relief), an arginine-based dentifrice (marketed as Colgate Sensitive Pro-Relief), and deionized water. For the exploratory acid resistance study, 24 dentin samples were divided into two treatment groups. Treatment consisted of a single dab-on application with the test dentifrices to the hydrated surface of dentin, followed by exposure to either a 30-second or 10-minute grapefruit juice acid challenge. For both models, at the end of each treatment period, the samples were removed for scanning electron microscopy analysis and graded on a categorical visual scale. All data were analyzed statistically by unpaired t-test comparison., Results: In the longitudinal (four-day) model, the strontium acetate-based dentifrice occluded dentin tubules significantly better than the currently marketed arginine-based dentifrice post-dab-on treatment and grapefruit juice challenge (p < 0.0001). At all other time points, the strontium acetate dentifrice demonstrated significantly better occlusion than the arginine-based dentifrice (p < or = 0.0001). In the exploratory acid resistance model, the level of occlusion observed for the strontium acetate dentifrice was statistically significantly greater when compared to the arginine dentifrice following 10-second and 10-minute (p < 0.0001) exposures to grapefruit juice., Conclusion: A strontium acetate dentifrice is observed to deliver statistically significantly greater levels of dentin tubule occlusion when compared to the arginine dentifrice following dab-on and brushing application under dietary acid-challenge conditions in this in vitro model. This study suggests that the arginine-containing dentifrice may be more susceptible to acid-mediated dissolution than the strontium-based dentifrice under the conditions employed in this in vitro model.

Because dentin is more caries-susceptible than enamel, its demineralization may be more influenced by additional fluoride (F). We hypothesized that a combination of professional F, applied as acidulated phosphate F (APF), and use of 1100-ppm-F dentifrice would provide additional protection for dentin compared with 1100-ppm-F alone. Twelve adult volunteers wore palatal appliances containing root dentin slabs, which were subjected, during 4 experimental phases of 7 days each, to biofilm accumulation and sucrose exposure 8x/day. The volunteers were randomly assigned to the following treatments: placebo dentifrice (PD), 1100-ppm-F dentifrice (FD), APF + PD, and APF+FD. APF gel (1.23% F) was applied to the slabs once at the beginning of the experimental phase, and the dentifrices were used 3x/day. APF and FD increased F concentration in biofilm fluid and reduced root dentin demineralization, presenting an additive effect. Analysis of the data suggests that the combination of APF gel application and daily regular use of 1100-ppm-F dentifrice may provide additional protection against root caries compared with the dentifrice alone.

Aim: The purpose of the study was to compare the effects of four treatments on 'de novo' plaque accumulation. Treatments included tray application of 1% chlorhexidine gel (CHX-Gel), 0.12% chlorhexidine dentifrice-gel (CHX-DFG), a regular dentifrice (RDF) tray application, or 0.2% chlorhexidine mouthwash (CHX-MW) in a 3-day non-brushing model., Material and Methods: The study was designed as a single blind, randomized parallel clinical trial. After professional prophylaxis, subjects abstained from all other forms of oral hygiene during a 3-day non-brushing period. Subjects were randomly assigned to one of the four test groups (CHX-Gel, CHX-DFG, RDF applied in a fluoride gel tray or rinsing with a CHX-MW). After 3 days, the Quigley & Hein plaque index (PI) and Bleeding on Marginal Probing (BOMP) index was assessed. Subsequently, all subjects received a questionnaire to evaluate their attitude, appreciation and perception towards the products used employing a Visual Analogue Scale., Results: After 3 days, the full-mouth PI means were 0.88 for the CHX-gel regimen, 0.79 for CHX-MW, 1.16 for CHX-DFG and 1.31 for the RDF regimen. The two dentifrices (CHX-DFG and RDF) were significantly less effective than the CHX-Gel or the CHX-MW., Conclusion: Within the limitations of the present 3-day non-brushing study design, it can be concluded that the effect of a 1% CHX-Gel application tray is significantly greater than that of 0.12% CHX-DFG or RDF in inhibiting plaque accumulation. The 1% CHX-Gel applied via a tray and 0.2% CHX-MW rinse were comparably effective., (© 2010 John Wiley & Sons A/S.)

The effect of a combination of topical fluoridation methods for inhibition of enamel demineralization in the face of a cariogenic challenge has not been clearly established. This in situ crossover study aimed to assess whether the addition of daily use of fluoride mouthrinse (FR) to that of fluoride dentifrice (FD) is equivalent to increasing the frequency of FD application in terms of the effect on enamel demineralization and fluoride content. Over 3 phases of 14 days each, 12 volunteers wore appliances containing enamel blocks exposed to a 20 % sucrose solution 8 times/day. During each phase the blocks underwent one of the following treatments: 2x/day FD, 2x/day FD + 1x/day FR, and 3x/day FD. The blocks were assessed for hardness and fluoride content. Three x/day FD did not differ from 2x/day + 1x/day FR, however it enhanced demineralization protection when compared to 2x/day FD. All treatments produced an increase in enamel fluoride content compared to no treatment (sound blocks) (p < 0.05), but the differences between them were not significant. The results of this study suggest that the daily use of fluoride mouthrinse combined with that of fluoride dentifrice has similar effects on enamel demineralization and fluoride content when compared to increasing the frequency of fluoride dentifrice use.

Objectives: The authors describe associations between dental fluorosis and fluoride intakes, with an emphasis on intake from fluoride in infant formula., Methods: The authors administered periodic questionnaires to parents to assess children's early fluoride intake sources from beverages, selected foods, dentifrice and supplements. They later assessed relationships between fluorosis of the permanent maxillary incisors and fluoride intake from beverages and other sources, both for individual time points and cumulatively using area-under-the-curve (AUC) estimates. The authors determined effects associated with fluoride in reconstituted powdered infant formulas, along with risks associated with intake of fluoride from dentifrice and other sources., Results: Considering only fluoride intake from ages 3 to 9 months, the authors found that participants with fluorosis (97 percent of which was mild) had significantly greater cumulative fluoride intake (AUC) from reconstituted powdered infant formula and other beverages with added water than did those without fluorosis. Considering only intake from ages 16 to 36 months, participants with fluorosis had significantly higher fluoride intake from water by itself and dentifrice than did those without fluorosis. In a model combining both the 3- to 9-months and 16- to 36-months age groups, the significant variables were fluoride intake from reconstituted powder concentrate formula (by participants at ages 3-9 months), other beverages with added water (also by participants at ages 3-9 months) and dentifrice (by participants at ages 16-36 months)., Conclusions: Greater fluoride intakes from reconstituted powdered formulas (when participants were aged 3-9 months) and other water-added beverages (when participants were aged 3-9 months) increased fluorosis risk, as did higher dentifrice intake by participants when aged 16 to 36 months., Clinical Implications: Results suggest that prevalence of mild dental fluorosis could be reduced by avoiding ingestion of large quantities of fluoride from reconstituted powdered concentrate infant formula and fluoridated dentifrice.

Previous studies have indicated that the use of low-fluoride dentifrices could lead to proportionally higher plaque fluoride levels when compared with conventional dentifrices. This double-blind, randomized, crossover study determined the effects of placebo, low-fluoride, and conventional dentifrices on plaque fluoride concentrations ([F]) in children living in communities with 0.04, 0.72, and 3.36 ppm F in the drinking water. Children used the toothpastes twice daily, for 1 wk. Samples were collected 1 and 12 hrs after the last use of dentifrices and were analyzed for fluoride and calcium. Similar increases were found 1 hr after the children brushed with low-fluoride (ca. 1.9 mmol F/kg) and conventional (ca. 2.4 mmol F/kg) dentifrices in the 0.04- and 0.72-ppm-F communities. Despite the fact that the increases were less pronounced in the 3.36-ppm-F community, our results indicate that the use of a low-fluoride dentifrice promotes a proportionally higher increase in plaque [F] when compared with that achieved with a conventional dentifrice, based on dose-response considerations.

Objective: To compare the effect of 4 remineralizing materials on the incipient artificial carious lesion and its proximal sound enamel when used with fluoride dentifrice., Study Design: Models mimicking proximal contact were made, each of which was placed with an artificial carious specimen in contact with a sound enamel specimen. Each carious specimen was treated with one of four materials: glass ionomer cement (GIC), resin modified glass ionomer cement (RMGIC), 5000 ppm sodium fluoride (F-gel), and casein phosphopeptide amorphous calcium phosphate (CPP-ACP). The GIC and RMGIC specimens were thermocycled. Then all specimens were pH-cycled for 5 days with twice a day soaking in 1,000 ppm NaF dentifrice solution. Specimens were examined by polarized light microscopy and lesion area quantified by image analysis., Results: RMGIC significantly yielded smaller areas of lesion than CPP-ACP and GIC (p < 0.05). F-gel reduced more area of lesion than CPP-ACP significantly (p < 0.05). In the associated contact, RMGIC significantly reduced the area of lesion better than CPP-ACP (p < 0.05)., Conclusions: The most effective remineralizing material in reducing the carious lesion areas was RMGIC followed by F-gel, GIC and CPP-ACR The demineralization inhibitory effects on the associated sound contact enamel followed the same trend.

The mechanical properties of dentin and enamel affect the reliability and wear properties of a tooth. This study investigated the influence of clinical dental treatments and procedures, such as whitening treatments or etching prior to restorative procedures. Both autoclaved and non-autoclaved teeth were studied in order to allow for both comparison with published values and improved clinical relevance. Nanoindentation analysis with the Oliver-Pharr model provided elastic modulus and hardness across the dentin-enamel junction (DEJ). Large increases were observed in the elastic modulus of enamel in teeth that had been autoclaved (52.0 GPa versus 113.4 GPa), while smaller increases were observed in the dentin (17.9 GPa versus 27.9 GPa). Likewise, there was an increase in the hardness of enamel (2.0 GPa versus 4.3 GPa) and dentin (0.5 GPa versus 0.7 GPa) with autoclaving. These changes suggested that the range of elastic modulus and hardness values previously reported in the literature may be partially due to the sterilization procedures. Treatment of the exterior of non-autoclaved teeth with Crest Whitestrips, Opalescence or UltraEtch caused changes in the mechanical properties of both the enamel and dentin. Those treated with Crest Whitestrips showed a reduction in the elastic modulus of enamel (55.3 GPa to 32.7 GPa) and increase in the elastic modulus of dentin (17.2 GPa to 24.3 GPa). Opalescence treatments did not significantly affect the enamel properties, but did result in a decrease in the modulus of dentin (18.5 GPa to 15.1 GPa). Additionally, as expected, UltraEtch treatment decreased the modulus and hardness of enamel (48.7 GPa to 38.0 GPa and 1.9 GPa to 1.5 GPa, respectively) and dentin (21.4 GPa to 15.0 GPa and 1.9 GPa to 1.5 GPa, respectively). Changes in the mechanical properties were linked to altered protein concentration within the tooth, as evidenced by fluorescence microscopy and Fourier transform infrared spectroscopy., (Published by Elsevier Ltd.)

Background: Low-fluoride dentifrices have been suggested as alternatives to reduce dental fluorosis risk, but there is no consensus regarding their clinical effectiveness, which has been suggested to be increased when their pH is acidic., Aims: This single-blind randomized clinical trial evaluated the caries increment during the use of a low-fluoride acidic liquid dentifrice., Methods: Four-year-old schoolchildren (n = 1,402) living in a fluoridated area (0.6-0.8 ppm F) were randomly allocated to 4 groups differing according to the type of dentifrice used over a 20-month period. Group 1 (n = 345): liquid dentifrice, 1,100 ppm F, pH 4.5. Group 2 (n = 343): liquid dentifrice, 1,100 ppm F, pH 7.0. Group 3 (n = 354): liquid dentifrice, 550 ppm F, pH 4.5. Group 4 (n = 360): toothpaste, 1,100 ppm F, pH 7.0. At baseline and after 20 months, clinical examinations were conducted (dmfs index) and caries increment was calculated. Data were analysed by GLM procedure using classrooms (cluster) as unit of analysis (p < 0.05)., Results: The mean ± SD (95% CI) net increments found were as follows. Group 1: 2.06 ± 2.38 (1.8-2.3); group 2: 2.08 ± 2.87 (1.7-2.4); group 3: 2.05 ± 2.79 (1.7-2.4), and group 4: 2.08 ± 2.34 (1.8-2.4). No significant differences were detected among the groups., Conclusion: In a population with high caries risk living in a fluoridated area, as the selected sample, and according to the present protocol, the low-fluoride acidic liquid dentifrice seems to lead to similar caries progression rates as conventional 1,100 ppm F toothpaste., (Copyright © 2010 S. Karger AG, Basel.)

Objective: The objective of this clinical study was to evaluate and compare the efficacy in reducing dentin hypersensitivity of an 8% strontium acetate, 1040 ppm sodium fluoride dentifrice to a marketed control 8% arginine, calcium carbonate, 1450 ppm sodium monofluorophosphate dentifrice after twice-daily brushing for two, four, and eight weeks., Methods: This was a randomized, examiner-blind, two-arm parallel group, eight-week longitudinal clinical study with seventy-nine subjects, stratified based on baseline tooth sensitivity (Schiff score, Yeaple). Subjects brushed with either an 8% strontium acetate-based dentifrice or a marketed 8% arginine calcium carbonate dentifrice twice daily for approximately one minute. At screening, baseline, weeks two, four, and eight, subjects' tooth sensitivity was determined through both evaporative (Schiff and Visual Analogue Scale [VAS]) and tactile stimuli (Yeaple probe). Subject assessments using each stimulus were performed by the same examiner throughout the study., Results: Seventy-seven subjects completed this clinical study. Both subject groups exhibited significant cumulative reductions from baseline to Days 14, 28, and 56 in dentin hypersensitivity as measured by Schiff, Yeaple, and VAS (for the 8% strontium acetate group, p < or = 0.0001 for all time points; for the 8% arginine calcium carbonate group, p = 0.0031 for Yeaple at Day 14, p = 0.0015 for VAS at Day 14, and p < 0.0001 for all remaining measures and time points). No significant differences (p > 0.05) were observed between treatments for any of the time points and measures except for tactile sensitivity at Day 56, for which the 8% strontium acetate-based dentifrice was statistically superior (p = 0.0391) to the control 8% arginine calcium carbonate dentifrice., Conclusion: The 8% strontium acetate, 1040 ppm sodium fluoride dentifrice provided significant reductions in dentin hypersensitivity (p < 0.0001) after two, four, and eight weeks of product use. Comparisons to a control 8% arginine calcium carbonate dentifrice showed no significant differences (p > 0.05) apart from tactile (Yeaple) sensitivity at week 8, where the 8% strontium acetate-based dentifrice showed significant improvement over the control (p = 0.0391).

While the clinical anticaries efficacy of fluoride toothpaste is now without question, our understanding of the relation of fluoride efficacy to brushing time and dentifrice quantity is limited. The aim of this in situ study was to determine how differences in brushing time and dentifrice quantity influence (i) fluoride distribution immediately after brushing, (ii) clearance of fluoride in saliva, (iii) enamel fluoride uptake (EFU) and (iv) enamel strengthening, via the increase in surface microhardness. The study compared brushing times of 30, 45, 60, 120 and 180 s with 1.5 g of dentifrice containing 1,100 microg/g fluoride as sodium fluoride. In addition, 60 s of brushing with 0.5 g dentifrice was evaluated. A longer brushing time progressively reduced retention of dentifrice in the brush, thereby increasing the amount delivered into the mouth. A longer brushing time also increased fluoride concentrations in saliva for at least 2 h after the conclusion of brushing, showing that increased contact time promoted fluoride retention in the oral cavity. There was a statistically significant positive linear relationship between brushing time and both enamel strengthening and EFU. Compared to 0.5 g dentifrice, brushing with 1.5 g dentifrice more than doubled the fluoride recovered in saliva after brushing and increased EFU. In conclusion, the results of this preliminary, short-term usage study suggest for the first time that both brushing time and dentifrice quantity may be important determinants both of fluoride retention in the oral cavity and consequent enamel remineralization., ((c) 2010 S. Karger AG, Basel.)

It has been suggested that fluoride products are able to reduce erosive tooth wear. Thus, the purpose of this in vitro study was to evaluate the effect of dentifrices with different fluoride concentrations as well as of a low-fluoridated dentifrice supplemented with trimetaphosphate (TMP) on enamel erosion and abrasion. One hundred twenty bovine enamel blocks were assigned to the following experimental dentifrices: placebo, 1,100 microg F/g, 500 microg F/g plus 3% TMP and 5,000 microg F/g. The groups of enamel blocks were additionally subdivided into conditions of erosion (ERO) and of erosion plus abrasion (ERO + ABR). For 7 days, the blocks were subjected to erosive challenges (immersion in Sprite 4 times a day for 5 min each time) followed by a remineralizing period (immersion in artificial saliva between erosive challenges for 2 h). After each erosive challenge, the blocks were exposed to slurries of the dentifrices (10 ml/sample for 15 s). Sixty of the blocks were additionally abraded by brushing using an electric toothbrush (15 s). The alterations of the enamel were quantified using the Knoop hardness test and profilometry (measurements in micrometers). The data were analyzed using a 2-way ANOVA test followed by a Bonferroni correction (p < 0.05). In in vitro conditions, the 5,000 microg F/g and 500 microg F/g plus 3% TMP dentifrices had a greater protective effect when compared with the 1,100 microg F/g dentifrice, under both ERO and ERO + ABR conditions. The results suggest that dentifrices alone are not capable of completely inhibiting tooth wear., ((c) 2010 S. Karger AG, Basel.)

There is a lack of clinical studies comparing dentifrices with high fluoride (F) concentration. The aim was to evaluate a dentifrice containing 5,000 ppm F compared to a dentifrice containing 1,450 ppm F in caries-active adolescents. The design was a 2-year, single-blind randomized controlled trial and 211 adolescents of 279 (76%) completed the trial. The subjects were divided into two groups and were given one of the assigned F dentifrices for daily unsupervised toothbrushing: (1) Duraphat 5,000 ppm F and (2) Pepsodent Superfluor 1,450 ppm F, both as NaF. The outcome variables were caries incidence and progression of proximal and occlusal caries. The subjects were asked to fill in a questionnaire to evaluate their compliance and they were divided into two subgroups: subgroup A, excellent compliance, and subgroup B, poor compliance. The latter group (28%) comprised the subjects who did not brush twice a day or did not use the dentifrice regularly. Adolescents using 5,000 ppm F toothpaste had significantly lower progression of caries compared to those using 1,450 ppm F toothpaste (A: p < 0.01, B: p < 0.001), with a prevented fraction of 40%. Subjects using 5,000 ppm F toothpaste had significantly lower caries incidence for compliance B compared to those using 1,450 ppm F toothpaste (p < 0.05); the prevented fraction was 42%. This may indicate that 5,000 ppm F toothpaste has a greater impact on individuals who do not use toothpaste regularly or do not brush twice a day. Thus, 5,000 ppm F toothpaste appears to be an important vehicle for caries prevention and treatment of adolescents with a high caries risk., (Copyright 2010 S. Karger AG, Basel.)

An 8% strontium acetate, 1040 ppm sodium fluoride-based dentifrice has been demonstrated in in vitro and in situ studies to provide deep and acid-resistant tubule occlusion. Clinical efficacy studies have shown instant and lasting dentin hypersensitivity relief from this dentifrice, which has recently been launched by GlaxoSmithKline Consumer Healthcare as Sensodyne Rapid Relief.