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Dental caries is a widespread oral health issue in Asia, affecting an estimated 30% to 90% of children and adults. Many caries cases remain untreated, resulting in pain and infection. In response, the Asian Academy of Preventive Dentistry (AAPD) emphasises comprehensive caries management and organised a fluoride workshop at the 15th International Conference of the AAPD in 2023. The AAPD invited a group of experts to form a fluoride working group to review existing literature and develop fluoride recommendations for stakeholders across Asian countries and regions. The working group assessed caries risk and identified commonly used topical fluoride products for home care, professional, and community settings in Asia. The working group concluded that fluoride is a safe and highly effective strategy to reduce caries prevalence and incidence. The working group provided key recommendations based on successful regional caries management practices: (1) use topical fluoride for prevention and control of dental caries; (2) encourage the use of fluoride toothpaste with a concentration of at least 1,000 ppm for effective caries reduction; (3) advise a 0.05% fluoride mouth rinse as soon as children can spit it out to prevent early childhood caries; (4) deliver professionally administered fluoride, such as 5% sodium fluoride varnish, 2% fluoride gel, or 1.23% acidulated phosphate fluoride preparations, to decrease dental caries in at-risk individuals; and (5) apply 38% silver diamine fluoride to arrest cavitated caries. These recommendations aim to help practitioners, health care providers, and parents/caregivers make informed decisions about fluoride use as part of comprehensive oral health care in the region., Competing Interests: Conflict of interest None disclosed., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Consensus guidelines support non-operative preventives for dental caries management; yet, their use in practice is far from universal. The purpose of this study was to evaluate the effectiveness of non-operative anti-caries agents in caries prevention among high caries risk adults at a university clinic where risk-based caries management is emphasized., Methods: This retrospective observational study drew data from the electronic patient records of non-edentulous adult patients deemed to be at high risk for dental caries during baseline oral evaluations that were completed between July 1, 2007 and December 31, 2012 at a dental university in the United States. We calculated and compared adjusted mean estimates for the number of new decayed or restored teeth (DFT increment) from baseline to the next completed oral evaluation (N = 2,724 patients with follow-up) across three categories of delivery of non-operative anti-caries agents (e.g., high-concentration fluoride toothpaste, chlorhexidine rinse, xylitol products): never, at a single appointment, or at ≥2 appointments ≥4 weeks apart. Estimates were adjusted for patient and provider characteristics, baseline dental status, losses-to-follow-up, and follow-up time., Results: Approximately half the patients did not receive any form of non-operative anti-caries agent. Most that received anti-caries agents were given more than one type of product in combination. One-time delivery of anti-caries agents was associated with a similar DFT increment as receiving no such therapy (difference in increment: -0.04; 95% CI: -0.28, 0.21). However, repeated, spaced delivery of anti-caries agents was associated with approximately one decayed or restored tooth prevented over 18 months for every three patients treated (difference in increment: -0.35; 95% CI: -0.65, -0.08)., Conclusions: These results lend evidence that repeatedly receiving anti-caries agents can reduce tooth decay among high-risk patients engaged in regular dental care.

Background and Objectives: High caries prevalence in occlusal pits and fissures warrants novel prevention methods. An 86% reduction in dental enamel smooth surface demineralization in-vivo following short-pulsed 9.6 µm-CO(2) -laser irradiation was recently reported. The objective of this study was to conduct a blinded 12-month-pilot clinical trial of occlusal pit and fissure caries inhibition using the same CO(2) -laser irradiation conditions., Study Design/materials and Methods: Twenty subjects, average age 14 years, were recruited. At baseline, second molars were randomized into test and control groups, assessed by International Caries Detection & Assessment System (ICDAS-II), SOPROLIFE light-induced fluorescence evaluator in daylight and blue-fluorescence mode and DIAGNOdent. An independent investigator irradiated test molars with a CO(2) -laser, wavelength 9.6 µm, pulse-duration 20 µs, pulse-repetition-rate 20 Hz, beam diameter 800 µm, average fluence 4.5 ± 0.5 J/cm(2), 20 laser pulses per spot. At 3-, 6- and 12-month recall teeth were assessed by ICDAS, SOPROLIFE and DIAGNOdent. All subjects received fluoride varnish applications at baseline and 6-month recall., Results: All subjects completed the 3-month, 19 the 6-month and 16 the 12-month recall. At all recalls average ICDAS scores had decreased for the test and increased for the control fissures (laser vs. control, 3-month: -0.10 ± 0.14, 0.30 ± 0.18, P > 0.05; 6-month: -0.26 ± 0.13, 0.47 ± 0.16, P = 0.001; 12-month: -0.31 ± 0.15, 0.75 ± 0.17, P < 0.0001; mean ± SE, unpaired t-test) being statistically significantly different at 6- and 12-month recalls. SOPROLIFE daylight evaluation revealed at 6- and 12-months statistically significant differences in changes between baseline and recall for test and control molars, respectively (laser vs. control, 6-month: 0.22 ± 0.13, 0.17 ± 0.09, P = 0.02; 12-month: 0.28 ± 0.19, 0.25 ± 0.17, P = 0.03). For SOPROLIFE blue-fluorescence evaluation mean changes in comparison to baseline for the control and the laser treated teeth were also statistically significant for the 6- and 12-month recall., Conclusion: Specific microsecond short-pulsed 9.6 µm CO(2) -laser irradiation markedly inhibits caries progression in pits and fissures in comparison to fluoride varnish alone over 12 months., (Copyright © 2013 Wiley Periodicals, Inc.)

The first ICNARA conference (International Conference on Novel Anticaries and Remineralizing Agents) was held in Chile in January, 2008, and the proceedings were published in Advances in Dental Research (Volume 21, 2009). That issue of Advances summarized the state of the science and set a research agenda for the future for two key components of caries management, namely, antibacterial agents and remineralizing agents. The second conference (ICNARA 2, January 2012) provided an update on science and new directions for research and clinical practice. Over the past decade, renewed efforts have been made across the world to establish proven methods of caries risk assessment and to provide direction for improved methods of caries management based upon risk levels. Evidence-based caries risk assessment tools are now available. The need for improved therapy to reduce the bacterial challenge that initiates the caries process, and to enhance remineralization, is now very clear. Fluoride therapy alone is insufficient to control the caries process in high-risk individuals. New remineralizing and anticaries products and new delivery systems are in development, and ICNARA 2 presents future technology for the management of dental caries.

The aim of the study was to investigate the efficacy of the use of xylitol-containing tooth-wipes in preventing dental caries in young children. In a double-blinded randomized controlled clinical trial, 44 mothers with active caries and their 6- to 35-month-old children were randomized to xylitol-wipe or placebo-wipe groups. The children's caries scores were recorded at baseline and 1 year. Salivary levels of mutans streptococci and lactobacilli were enumerated at baseline, 3, 6, and 12 months. Data were analyzed by intent-to-treat modeling with imputation for caries lesions and a linear mixed-effect model for bacterial levels. Significantly fewer children in the xylitol-wipe group had new caries lesions at 1 year compared with those in the placebo-wipe group (P < 0.05). No significant differences between the two groups were observed in levels of mutans streptococci and lactobacilli at all time-points. Daily xylitol-wipe application significantly reduced the caries incidence in young children as compared with wipes without xylitol, suggesting that the use of xylitol wipes may be a useful adjunct for caries control in infants (Clinicaltrials.gov registration number CT01468727).

Background: Mexican-American children have a higher caries prevalence than the U.S. average. The Mothers and Youth Access (MAYA) study was a randomized clinical trial initiated to address this problem., Aim: Comparison of the efficacy of two prevention interventions in reducing early childhood caries (ECC)., Design: All 361 randomized mother-child dyads received oral health counselling. Beginning at 4 months postpartum, intervention mothers received chlorhexidine (CHX) mouthrinse for 3 months beginning 4 months postpartum and children received fluoride varnish (FV) every 6 months from age 12-36 months. Control group children received FV if precavitated lesions developed. Salivary mutans streptococci (MS) and lactobacilli were assessed., Results: No significant difference in children's 36-month caries incidence between groups; 34% in each group developed caries [(d(2+) fs) > 0]. About half of control group developed precavitated lesions and received therapeutic FV. Maternal MS levels declined during CHX use, but increased when discontinued., Conclusions: Maternal postpartum CHX regimen, oral health counselling and preventive child FV applications were not more efficacious than maternal counselling with child therapeutic FV for precavitated lesions for ECC prevention. FV for young children with brief maternal CHX use and oral health counselling may need to be combined with additional or longer-term therapies to significantly reduce ECC in high-risk populations., (© 2011 The Authors. International Journal of Paediatric Dentistry © 2011 BSPD, IAPD and Blackwell Publishing Ltd.)

This randomized parallel group clinical trial assessed whether combined antibacterial and fluoride therapy benefits the balance between caries pathological and protective factors. Eligible, enrolled adults (n = 231), with 1-7 baseline cavitated teeth, attending a dental school clinic were randomly assigned to a control or intervention group. Salivary mutans streptococci (MS), lactobacilli (LB), fluoride (F) level, and resulting caries risk status (low or high) assays were determined at baseline and every 6 months. After baseline, all cavitated teeth were restored. An examiner masked to group conducted caries exams at baseline and 2 years after completing restorations. The intervention group used fluoride dentifrice (1,100 ppm F as NaF), 0.12% chlorhexidine gluconate rinse based upon bacterial challenge (MS and LB), and 0.05% NaF rinse based upon salivary F. For the primary outcome, mean caries increment, no statistically significant difference was observed (24% difference between control and intervention groups, p = 0.101). However, the supplemental adjusted zero-inflated Poisson caries increment (change in DMFS) model showed the intervention group had a statistically significantly 24% lower mean than the control group (p = 0.020). Overall, caries risk reduced significantly in intervention versus control over 2 years (baseline adjusted generalized linear mixed models odds ratio, aOR = 3.45; 95% CI: 1.67, 7.13). Change in MS bacterial challenge differed significantly between groups (aOR = 6.70; 95% CI: 2.96, 15.13) but not for LB or F. Targeted antibacterial and fluoride therapy based on salivary microbial and fluoride levels favorably altered the balance between pathological and protective caries risk factors., (Copyright © 2012 S. Karger AG, Basel.)

Purpose: To demonstrate the robustness of the Featherstone pH cycling model when tested in three independent laboratories and to evaluate the use of "non-inferiority" testing at those laboratories., Methods: The fundamental principles for the Featherstone laboratory pH cycling model to be an appropriate alternative to animal testing is that it must demonstrate equivalent accuracy to the "Gold Standard" (rat caries model) by: (1) providing a meaningful representation of the caries process; (2) demonstrating a proportionate response to fluoride dose (or concentration); (3) being able to show that clinically proven formulations perform similarly relative to the controls; and (4) differentiating products that have attenuated fluoride activity., Results: This cross-validation study confirmed the ability of the three independent laboratories to discriminate between various concentrations of fluoride-containing dentifrice formulations, demonstrated that clinically proven formulas perform as expected and identified an attenuated fluoride formulation (NaF/CaCO3 dentifrice - 1100 ppm NaF) as inferior compared to the 1100 ppm F (NaF/silica) positive control.

Purpose: As a requirement of the Food & Drug Administration's final monograph on "Anticaries drug products for over-the-counter human use", the toothpaste industry has been conducting animal caries tests on every fluoride-containing toothpaste introduced into the U.S. market since 1996. The practice of testing in animals, although required by law, is in stark conflict with the corporate policy of many U.S. and global toothpaste manufacturers, in which, if possible, alternatives to animal testing are utilized. A provision does exist within the regulation which allows the use of an alternative method to demonstrate efficacy. However, to take advantage of this provision, a petition must be submitted to the FDA and in this petition data demonstrating the alternative provides results of "equivalent accuracy" must be included. After many years of research, model development and model comparisons, we have identified one particular laboratory model that demonstrated excellent correlation with the currently accepted animal caries models. This model, known as the Featherstone pH cycling model, is discussed in this paper., Methods: The Featherstone pH cycling model has been shown to produce results of equivalent accuracy to the animal caries model by: (1) demonstrating a clinically relevant fluoride dose response similar to that shown in the animal caries model (including 1100 ppm F, 250 ppm F and placebo); (2) demonstrating similar results to the animal caries model for clinically proven dentifrice formulations relative to positive and negative controls; (3) demonstrating discriminating ability in strong agreement with the animal caries model for differentiating between a dentifrice formulation with attenuated fluoride activity and a USP standard; and (4) providing a clinically relevant representation of the caries process, as demonstrated by orthodontic banding studies. In addition, the model sufficiently addresses both salivary and abrasive/anticalculus agent interference concerns., Results: For more than 50 years, fluoride has been the first defense in the fight against dental caries. The clinical effectiveness of fluoride is well accepted and documented extensively in the literature. The mechanism through which fluoride provides its benefit is very straightforward and well understood. The proposed laboratory model effectively simulates the effect of the caries process and has been shown to demonstrate equivalent accuracy to animal caries. This indicates that there are strong scientific grounds for the use of this model as an alternative to the animal caries test. Based on the strength of the data and the correlations noted between the two models, we recommend that the scientific community and the toothpaste industry broadly accept the Featherstone laboratory pH cycling model as an appropriate alternative to animal testing, particularly for ionic fluoride based dentifrices.

Objective: To investigate the bacteriostatic and cariostatic effect of a novel povidone-iodine/fluoride foam in children at high risk for caries., Method and Materials: Sixty-one 6- to 9-year-old children with at least 1 active dental caries lesion were randomly assigned to 2 groups and treated weekly with either povidone-iodine/fluoride foam (n = 30, experimental group) or placebo fluoride foam (n = 31, control group) for 4 weeks. Stimulated saliva samples were collected for bacteriostatic assessment before each treatment and at 2 and 6 months during the experiment. In addition, laser fluorescence readings of the permanent first molars were taken for the evaluation of cariostatic effect before the treatment and at 2, 6, and 12 months during the experiment., Results: Both groups showed a constant decrease of salivary mutans streptococci over 6 months. Significantly lower laser fluorescence readings were observed for both groups at the 6th month, although with a slight reverse at the 12th month. However, no statistically significant difference was achieved between the 2 groups either for salivary bacteria levels over 6 months or laser fluorescence readings within 1 year., Conclusion: As far as bacteriostatic and cariostatic effects are concerned, clinical application of povidone-iodine/fluoride foam shows no superiority over the regular fluoride foam during a 1-year period. Evidence is still lacking for the combination use of povidone-iodine and fluoride to achieve a better caries-prevention effect in a high-caries-risk population.

Abstract Dental caries is a transmissible bacterial disease process caused by acids from bacterial metabolism diffusing into enamel and dentine and dissolving the mineral. The bacteria responsible produce organic acids as a by-product of their metabolism of fermentable carbohydrates. The caries process is a continuum resulting from many cycles of demineralization and remineralization. Demineralization begins at the atomic level at the crystal surface inside the enamel or dentine and can continue unless halted with the end-point being cavitation. There are many possibilities to intervene in this continuing process to arrest or reverse the progress of the lesion. Remineralization is the natural repair process for non-cavitated lesions, and relies on calcium and phosphate ions assisted by fluoride to rebuild a new surface on existing crystal remnants in subsurface lesions remaining after demineralization. These remineralized crystals are acid resistant, being much less soluble than the original mineral.

An in vitro pH cycling model was used to test the hypothesis that the effects of 3 different fluoride compounds on de/remineralization are a function of the free fluoride ion concentration. Groups of 10 human enamel specimens were treated with one of: (a) amine fluoride (AmF), 1250 ppm F; (b) sodium monofluorophosphate (NaMFP), 1000 ppm F; (c) sodium fluoride (NaF), 1100 ppm F; (d) NaF, 250 ppm F; (e) Placebo (< 1 ppm F) dentifrices; or with aqueous solutions (f) NaF 900 ppm F or (g) NaF 30 ppm F. Lesions were assessed by cross-sectional microhardness. Mean +/- SEM DeltaZ (vol.% x microm) values of 3 dentifrices were: (a) 344 +/- 155, (b) 4259 +/- 257, and (c) 591 +/- 83. The AmF (1250 ppm F) was not statistically significantly different from the NaF (1100 ppm F) dentifrice in this model. The NaMFP (1000 ppm F) dentifrice, without hydrolysis, had only the same efficacy as the NaF (30 ppm F) aqueous solution.

Fluorosed enamel is more porous and less mineralized, possibly related to altered amelogenin-modulated crystal growth. The purpose of this study was to examine the role of fluoride in interactions between amelogenin and apatite crystals. Recombinant human amelogenin (rh174) was bound to carbonated hydroxyapatite containing various amounts of fluoride, and analyzed by protein assay, SDS PAGE, and AFM. Interactions between rh174 and fluoride were assayed by isothermal titration calorimetry (ITC). The initial binding rate of rh174, as well as total amount of rh174 bound to fluoride-containing carbonated hydroxyapatite, was greater than that in the control carbonated hydroxyapatite. Fluoride in solution at physiologic (5.3 micromolar, or 0.1 ppm) concentrations showed no significant effect on binding, but higher fluoride levels significantly decreased protein binding. ITC showed no interactions between fluoride and rh174. These results suggest that fluoride incorporation into the crystal lattice alters the crystal surface to enhance amelogenin binding, with no direct interactions between fluoride and amelogenin.

Laser and fluoride treatments have been shown to inhibit enamel demineralization in the laboratory. However, the intra-oral effects of this association have not been tested. This study assessed in situ the effect of a Transversely Excited Atmospheric CO2 laser (lambda = 9.6 mum) and the use of pressure fluoridated dentifrice on enamel demineralization. During two 14-day phases, 17 volunteers wore palatal appliances containing human enamel slabs assigned to treatment groups, as follows: (1) non-fluoride dentifrice, (2) CO2 laser irradiation plus non-fluoride dentifrice, (3) fluoride dentifrice, and (4) CO2 laser irradiation plus fluoride dentifrice. A 20% sucrose solution was dripped onto the slabs 8 times per day. The specimens treated with laser and/or fluoridated dentifrice presented a significantly lower mineral loss when compared with those from the non-fluoride dentifrice group. The results suggested that CO2 laser treatment of enamel inhibits demineralization in the human mouth, being more effective when associated with fluoride.

To determine the efficacy of fluoride varnish (5% NaF, Duraphat, Colgate) added to caregiver counseling to prevent early childhood caries, we conducted a two-year randomized, dental-examiner-masked clinical trial. Initially, 376 caries-free children, from low-income Chinese or Hispanic San Francisco families, were enrolled (mean age +/- standard deviation, 1.8 +/- 0.6 yrs). All families received counseling, and children were randomized to the following groups: no fluoride varnish, fluoride varnish once/year, or fluoride varnish twice/year. An unexpected protocol deviation resulted in some children receiving less active fluoride varnish than assigned. Intent-to-treat analyses showed a fluoride varnish protective effect in caries incidence, p < 0.01. Analyzing the number of actual, active fluoride varnish applications received resulted in a dose-response effect, p < 0.01. Caries incidence was higher for 'counseling only' vs. 'counseling + fluoride varnish assigned once/year' (OR = 2.20, 95% CI 1.19-4.08) and 'twice/year' (OR = 3.77, 95% CI 1.88-7.58). No related adverse events were reported. Fluoride varnish added to caregiver counseling is efficacious in reducing early childhood caries incidence.

The objective of this research was to evaluate the anticaries potential of stabilized stannous fluoride and sodium hexametaphosphate dentifrice using a series of laboratory studies. In a study of fluoride uptake into demineralized enamel, the stannous fluoride/sodium hexametaphosphate dentifrice exhibited fluoride uptake comparable to the clinically proven stannous fluoride and silica dentifrice. Under lesion progression pH-cycling conditions, the stabilized stannous fluoride/sodium hexametaphosphate dentifrice was shown to protect teeth against lesion initiation and progression almost completely, and was comparable to conventional, clinically proven dentifrices. This series of well-controlled and validated in vitro studies demonstrates the anticaries potential of the stabilized stannous fluoride/sodium hexametaphosphate dentifrice. These in vitro results suggest that the stabilized stannous fluoride/sodium hexametaphosphate dentifrice may provide enhanced anticaries performance relative to a sodium fluoride control dentifrice. These results are reflective of the clinical benefits previously reported for stabilized stannous fluoride/sodium hexametaphosphate dentifrices.

Objectives: This study examined the concentration of fluoride in whole saliva over time following the application of a fluoride varnish or a single rinse with a fluoride solution., Methods: A two-period, two-treatment randomized cross-over experimental trial with a 2-week washout period was used with 16 adult subjects. In the first period, eight subjects rinsed once with a 0.05% NaF solution and 8 subjects had 5.0% NaF varnish applied to facial and lingual surfaces of 20 teeth. Stimulated whole saliva was collected at baseline, 5 and 15 min, 1, 2, 4, 8, 12, 24, 32, 48, 56, 72, 80, 96, 104 h. After the washout period each subject was switched to the other treatment and saliva was collected at the same intervals. Salivary fluoride content was measured with the micro-diffusion method., Results: The NaF levels peaked at 5 min after application for both varnish (mean +/- SE 24.5 +/- 5.0 ppm) and rinse (3.2 +/- 0.8 ppm). Mean NaF levels returned to baseline, on average, within 2 h for the rinse and within 24 h for the varnish. The maximum fluoride levels were significantly greater (P < 0.01) with the varnish than with the rinse and remained above baseline levels for a longer duration., Conclusions: Salivary fluoride levels with the rinse returned to baseline, on average, in 2 h while they remained elevated for, on average, 24 h with the varnish. Salivary fluoride levels from the varnish were found to be comparable with those in previous studies for 1.1% neutral NaF.

Demineralization around orthodontic appliances is a problem. Suboptimal oral hygiene, long intervals between appointments, and potentially poor patient cooperation with using fluoride dentifrices and mouth rinses necessitate a compliance-free means of preventing tooth decay. The hypothesis of this study was that fluoride released by glass ionomer cement inhibits the formation of carious lesions around orthodontic brackets in vivo. Brackets were bonded on 2 first premolars in 21 randomized, consecutively selected patients 11 to 18 years old. Eleven test-group subjects were bonded with fluoride-releasing glass ionomer cement, and 10 control subjects were bonded with composite resin (no fluoride). The teeth were extracted after 4 weeks, sectioned, and evaluated quantitatively by cross-sectional microhardness testing. Fluoride levels in patient saliva were measured by the Taves diffusion method in samples taken at days 0 (baseline), 1, 2, 3, 7, 14, 21, and 28 to determine whether fluoride from the glass ionomer cement influenced the overall intraoral fluoride levels. The results demonstrated significantly more demineralization around the brackets of the control patients (P <.01, Wilcoxon signed rank test). For whole-mouth salivary fluoride levels, no significant overall difference between the groups (P >.05) and no noticeable trend within groups (P >.05) were found. These results indicate that using fluoride-releasing glass ionomer cement for bonding orthodontic brackets successfully inhibited caries in vivo. This cariostatic effect was localized to the area around the brackets and was statistically significant after 4 weeks.

Enamel fluorosis is characterised by increased porosity and a delay in the removal of enamel matrix proteins as the enamel matures. Amelogenin is the primary matrix protein in secretory-stage dental enamel. As enamel matures, amelogenins are hydrolysed by a number of enamel proteinases, including matrix metalloproteinase-20 (MMP-20 or enamelysin) and serine proteinase. Here, the effect of ingested fluoride on the relative activity of proteinases in the enamel matrix and the specific effect of fluoride on MMP-20 activity were examined. Proteinase activity relative to total enamel matrix protein was measured by fluorescence assay of enamel matrix dissected from rats given 0, 50, or 100 parts per 10(6) fluoride in their drinking water. To determine the specific effect of fluoride on the activity of MMP-20, the hydrolysis of a full-length recombinant human amelogenin by recombinant MMP-20 (rMMP-20) in the presence of 0, 2, 5, 10 or 100 microM fluoride was compared by sodium dodecyl sulphate (SDS)-polyacrylamide gel electrophoresis (PAGE). In addition, a fluorescent peptide assay was developed to quantify enzyme activity against the tyrosine-rich amelogenin peptide cleavage site. In the late maturation stage, total proteinase activity per unit protein was lower in the fluoride-exposed rats than in the control rats. This in vivo finding indicates that fluoride ingestion can alter the relative amount of active proteinase in mature enamel. Hydrolysis of amelogenin at neutral pH by rMMP-20 was reduced in the presence of 100 microM F. In the peptide assay, rMMP-20 activity was significantly reduced by concentrations of fluoride as low as 2 microM at pH 6, with no significant effect at pH 7.2. These in vitro assays show that micromolar concentrations of fluoride can alter metalloproteinase activity, particularly when the pH is reduced to 6.0. These studies suggest that the effects of fluoride on enamel matrix proteinase secretion or activity could be involved in the aetiology of fluorosis in enamel and other mineralising tissues.

A series of pH cycling "profile" laboratory studies was conducted to confirm the anticaries potential of an enhanced cleaning and whitening dentifrice based on a novel abrasive polishing silica and pyrophosphate tartar control source, with sodium fluoride as the anticaries ingredient. Under pH cycling remineralization conditions, the whitening dentifrice produced lesion fluoridation comparable to a conventional tartar control dentifrice containing combinations of pyrophosphate anion and a NaF fluoride ion source. Under pH cycling lesion progression conditions, the whitening dentifrice produced enamel protection against caries development, comparable to control dentifrices containing NaF alone or in combination with tartar control pyrophosphate anion. These results are consistent with clinical data supporting the effectiveness of NaF dentifrices combined with anionic tartar control inhibitors such as pyrophosphate. These results support the anticaries effectiveness of the enhanced cleaning and whitening dentifrice based upon "Stain-Specific Soft Silica."

Dental caries is a bacterially based disease that progresses when acid produced by bacterial action on dietary fermentable carbohydrates diffuses into the tooth and dissolves the mineral, that is, demineralization. Pathological factors including acidogenic bacteria (mutans streptococci and lactobacilli), salivary dysfunction, and dietary carbohydrates are related to caries progression. Protective factors which include salivary calcium, phosphate and proteins, salivary flow, and fluoride in saliva can balance, prevent or reverse dental caries. Fluoride works primarily via topical mechanisms which include (1) inhibition of demineralization at the crystal surfaces inside the tooth, (2) enhancement of remineralization at the crystal surfaces (the resulting remineralized layer is very resistant to acid attack), and (3) inhibition of bacterial enzymes. Fluoride in drinking water and in fluoride-containing products reduces tooth decay via these mechanisms. Low but slightly elevated levels of fluoride in saliva and plaque provided from these sources help prevent and reverse caries by inhibiting demineralization and enhancing remineralization. The level of fluoride incorporated into dental mineral by systemic ingestion is insufficient to play a significant role in caries prevention. The effect of systemically ingested fluoride on caries is minimal. Fluoride "supplements" can be best used as a topical delivery system by sucking or chewing tablets or lozenges prior to ingestion.

The objectives of this review are to compare the models that are used to simulate the caries process in cardiology research and to suggest how these models might be used to assess caries-inhibitory properties of dental materials. Available caries-simulation models fall into the following classifications: 1) in vitro demineralization using acid buffers, 2) in vitro demineralization using bacterially generated acids, 3) in vitro demineralization/remineralization using a pH-cycling system, 4) an artificial mouth where a bacterially generated acid challenge is interspersed with a "saliva" treatment, 5) in vivo animal model (generally with rats), 6) in situ demineralization and/or remineralization using enamel or dentin blocks or slices in the human mouth, and 7) in vivo studies using teeth scheduled for extraction in the human mouth. Most dental materials studies have used simple in vitro demineralization models or component release experiments, each of which is inadequate to answer the questions that are being asked about the caries-inhibitory properties of the material being tested. Experimental methods must be chosen with care to ensure that the material to be tested is examined in an appropriate mode. The ultimate goal is to correctly predict clinical outcomes. The design or redesign of a model must eventually be tied to documented clinical outcomes to improve the model and allow for future successful development of new materials.

A series of laboratory and animal studies were conducted to confirm the anticaries potential of a new, stabilized stannous fluoride (SnF2) dentifrice relative to clinically proven SnF2 controls. Included in this series of assessments were fluoride uptake into demineralized human enamel, remineralization/inhibition of demineralization for both human enamel and roots, and animal caries studies. Each of these studies demonstrate the new, stabilized SnF2 dentifrice (Crest Gum Care toothpaste) is effective at inhibiting and reversing the caries process. These data confirm that this new dentifrice, formulated with a combination of SnF2, and hydrated silica, is predicted to be highly effective against caries. These tests predict that this new stabilized SnF2 dentifrice (Crest Gum Care toothpaste) provides a level of anticaries activity that is equivalent to Crest Regular toothpaste, a sodium fluoride (NaF)/silica product. The data suggest that this new formulation provides enhanced anticaries efficacy relative to previous, unstabilized SnF2 formulations as a result of improved fluoride bioavailability.