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A selection of commercially available products containing stannous fluoride (SnF2 )/sodium fluoride (NaF), SnF2 /amorphous calcium phosphate (ACP), SnF2 /NaF/ACP, tin (Sn)/fluorine (F)/chitosan were compared with phytosphingosine (PHS) with respect to their anti-erosive properties in vitro. One-hundred and twenty bovine enamel specimens were immersed in the respective product slurries for 2 min, twice daily. The formulations were diluted with either remineralization solution or artificial saliva. After each treatment, an erosive challenge was performed for 10 min, twice daily, using citric acid, pH 3.4. The specimens were stored in remineralization solution or artificial saliva until the next treatment-erosion challenge. After 10 d, tissue loss was determined using profilometry. Enamel softening was determined through surface microhardness measurements. Tissue-loss values (measured in μm and expressed as mean ± SD) for PHS, SnF2 /NaF, SnF2 /ACP, SnF2 /ACP/NaF, and Sn/F/chitosan treatment groups and for the negative-control group, were, respectively, 35.6 ± 2.8, 15.8 ± 1.8, 22.1 ± 2.0, 22.9 ± 1.8, 16.2 ± 1.2, and 51.2 ± 4.4 in the presence of remineralization solution and 31.7 ± 3.3, 15.6 ± 2.9, 16.5 ± 2.7, 16.8 ± 2.1, 13.1 ± 3.0, and 50.7 ± 2.8 in the presence of artificial saliva. There were no significant differences in surface microhardness measurements between the treatment groups. In conclusion, PHS resulted in a significant reduction of tissue loss compared with the negative control, but in comparison, the toothpastes containing Sn(2+) and F(-) ions were significantly more effective compared with PHS., (© 2016 Eur J Oral Sci.)

A cost-effectiveness evaluation was conducted with a randomised controlled clinical trial of caries prevention measures among 6-year-old children who were assigned to either a control group or 1 of 2 experimental groups (IPFA: 2 extra professionally-delivered fluoride applications per year, or NOCTP: a non-operative caries treatment programme, like the one that was previously carried out in Nexø, Denmark. In order to determine the cost of the prevention of 1 DMFS in comparison with the control practice information on expenses incurred was collected for 3 years. The prevention of a single DMFS - depending on whether costs of dental treatment only were taken into consideration or also other social costs - were, in the IPFA programme, 269 and 1,369 euro respectively and, in the NOCTP programme, 30 and 100 euro respectively. On the basis of these results, it can be concluded that from both a dental and cost-effective perspective the NOCTP programme produces the most favourable results. Following the NOCTP strategy - during the 3-year period - just like following the IPFA approach was, however, more expensive than the standard approach.

Caries develops when the equilibrium between de- and remineralization is unbalanced favoring demineralization. De- and remineralization occur depending on the degree of saturation of the interstitial fluids with respect to the tooth mineral. This equilibrium is positively influenced when fluoride, calcium and phosphate ions are added favoring remineralization. In addition, when fluoride is present, it will be incorporated into the newly formed mineral which is then less soluble. Toothpastes may contain fluoride and calcium ions separately or together in various compounds (remineralization systems) and may therefore reduce demineralization and promote remineralization. Formulating all these compounds in one paste may be challenging due to possible premature calcium-fluoride interactions and the low solubility of CaF2. There is a large amount of clinical evidence supporting the potent caries preventive effect of fluoride toothpastes indisputably. The amount of clinical evidence of the effectiveness of the other remineralization systems is far less convincing. Evidence is lacking for head to head comparisons of the various remineralization systems., (Copyright © 2013 S. Karger AG, Basel.)

Objectives: This study assessed total and free fluoride concentrations in samples of toothpaste from Brunei, Cambodia, Laos, the Netherlands and Suriname, and investigated the labelling practices of the respective manufacturers., Materials and Methods: Convenience samples were bought in the five countries and sent for analysis to the Netherlands. Levels of total and free available fluoride were measured. Details of the information declared on the packaging about type of fluoride and abrasives were recorded, and manufacturing and expiry dates were noted., Results: A total of 119 samples of toothpaste were analysed. With one exception, all samples from the Netherlands complied with ISO (International Organisation for Standardisation) labelling requirements and there were no differences between the fluoride content declared and that found to be present on analysis. In samples purchased in the other countries, sodium monofluorophosphate (SMFP) toothpastes predominantly showed a low percentage of free available fluoride and the majority of toothpastes did not follow standard labelling guidelines., Discussion: This study is not representative of any of the brands analysed, yet it highlights problematic discrepancies in products across countries. These may be related to the lack of a generally accepted methodology for analysing total and free fluoride content, absence of an agreement on the minimum concentration of fluoride required to ensure efficacy, weak regulating institutions that are unable to control labelling and consumer information, as well as a possible influx of counterfeit low-quality toothpaste., Conclusions: Renewed international focus should be directed towards closing gaps in guidelines and standards. Consumers should use only non-expired toothpaste, which should preferably be silica-based fluoride toothpaste that does not include abrasives containing calcium and that is properly labelled., (© 2012 FDI World Dental Federation.)

Objective: The aim of this study was to systematically review the present literature on the effect of chlorhexidine varnish (CHX-V) on root caries., Materials and Methods: The MEDLINE-PubMed, the Cochrane-CENTRAL and EMBASE databases were searched through December 2010 to identify any appropriate studies. Root caries incidence and root caries activity were selected as outcome variables., Results: An independent screening of the unique titles and abstracts of 24 MEDLINE-PubMed, 14 Cochrane-CENTRAL and 18 EMBASE papers resulted in 6 publications that met the eligibility criteria. Data extraction provided no conclusive evidence that the application of CHX-V is effective in patients when regular professional oral prophylaxis is performed. If effective, the 40% CHX-V was found to provide a benefit over a control or fluoride varnish. CHX-V at lower concentrations (1 and 10%) may provide protection against root caries in high-risk patients (such as geriatric and xerostomia patients) in the absence of regular professional oral prophylaxis., Conclusion: Within the limitations of this review, it may be concluded that in the absence of regular professional tooth cleaning and oral hygiene instructions, CHX-V may provide a beneficial effect in patients in need of special care. The strength of this recommendation is graded as 'weak'., (Copyright © 2011 S. Karger AG, Basel.)

For the dental care of parents and children, people in the Netherlands rely especially on the advice of the Ivory Cross. The basis of this advice is plaque removal with fluoride toothpaste. When this offers insufficient protection, one usually finds irregular and careless dental hygiene. Information and instruction concerning daily and careful dental hygiene should receive the highest priority of dental care professionals. If a patient's own dental care cannot be brought up to standard or if this cannot be done immediately, then (temporary) support can be provided by dental professionals in the form of preventive treatment. Doing this, however, without improving the self care of patients has to be regarded an inadequate treatment modality.

It is often claimed that 3 fluoride moments a day significantly reduce the caries risk compared to 2 daily fluoride moments. However, previous research is not conclusive. Therefore, the aim of this study was to compare the effect on lesion progression of 2 versus 3 fluoride moments a day. A double-blind, randomized, cross-over in situ experiment was designed. The experiment comprised 2 in situ periods of 3 weeks with a washout period of 3 weeks in between. Sixteen participants wore an enamel and a dentine specimen with a preformed lesion placed buccally in their partial prosthesis. The participants brushed twice a day with a 1,400 ppm F (amine fluoride) toothpaste and rinsed once a day with either 250 ppm F (amine F/NaF) or a placebo rinse. At the end of the experiment the specimens were retrieved for fluoride analysis and the assessment of integrated mineral loss with transversal microradiography. The fluoride analysis showed a statistically significant increase in structurally bound fluoride in dentine, but not in enamel, when comparing the fluoride mouthrinse group with the placebo rinse group. The amounts of loosely bound, KOH-soluble fluoride were not different between both groups neither for enamel nor for dentine. In dentine IML gain was significantly (p < 0.05) higher for the fluoride mouthrinse group than for the placebo mouthrinse group. In enamel no statistically significant differences in IML gain were found. For dentine a third fluoride moment may be beneficial in enhancing remineralisation, even under the remineralising conditions as in this study., (Copyright 2010 S. Karger AG, Basel.)

This clinical study evaluated the effect of different oral hygiene protocols on the bacterial composition of dental plaque. After a 2-week period of using fluoride-free toothpaste, 30 participants followed three 1-week experimental protocols, each followed by 2-week fluoride-free washout periods in a randomized crossover examiner-blind controlled trial. The 1-week experimental protocols comprised the use of AmF/SnF(2) toothpaste twice daily, after which participants either (1) rinsed with tap water, (2) did not rinse but only spat out the toothpaste, or (3) rinsed with an AmF/SnF(2) mouthwash. In the fluoride-free washout periods, the participants brushed their teeth with fluoride-free toothpaste without further instructions. Six hours after the last brushing (+/- rinsing) of each period, buccal plaque samples in the upper molar region were taken. The microbiota composition of the plaque samples was analyzed by checkerboard DNA:DNA hybridization. A statistically significant reduction was found in the total amount of DNA of the 39 major plaque species measured, and in the proportions of some acid-producing bacterial strains after the period having used the AmF/SnF(2) toothpaste + AmF/SnF(2) mouthrinsing. The results indicate that using the AmF/SnF(2) toothpaste and rinse combination could result in plaque of lower cariogenicity., (Copyright 2009 S. Karger AG, Basel.)

Enolase and ATPase are sensitive to fluoride. It is unclear whether this sensitivity differs for F-sensitive and F-resistant cells or for different types of fluoride. Permeabilized cells of the fluoride-sensitive strain Streptococcus mutans C180-2 and its fluoride-resistant mutant strain C180-2 FR were preincubated at pH 7 or 4 with NaF, the amine fluorides Olaflur and Dectaflur and amine chloride controls. After preincubations, enolase and ATPase activities of the cells were assessed. Enolase activity was more inhibited after preincubation at pH 7 with NaF than with Olaflur. Amine chloride stimulated, although not with statistical significance, the enolase activity of both strains. After preincubation at pH 4 the enolases were strongly inactivated, but the fluoride-resistant strain's enolase to a lesser extent. The results suggested that amine acts to protect enolase activity against the detrimental low pH effect. Gene sequencing showed that the enolase genes of the fluoride-resistant and fluoride-sensitive strain were identical. ATPase activity was not reduced after NaF preincubation at either pH 7 or pH 4. The amine fluorides and their chloride controls in the preincubation mixture reduced the ATPase activity significantly at both pH values. In conclusion, our results showed that preincubation with amine fluoride did not inhibit enolase activity more effectively than NaF. The amine part of the molecule may protect enolase activity against preincubations at low pH. ATPase activity was not inhibited by NaF preincubation but was significantly inhibited after preincubation with amine fluorides and amine chlorides., ((c) 2008 S. Karger AG, Basel.)

Background: Clinical studies on the caries-preventive properties of chlorhexidine mouthrinses are limited and the results are inconclusive., Aim: The aim of this study was to elucidate the contribution of a 0.2% chlorhexidine mouthrinse to the protection of enamel and dentine against demineralization., Methods: In this randomized two-treatment, two-leg study 14 individuals wearing partial prostheses were enrolled. Sound enamel and dentine specimens were placed in situ for 4 weeks. Twice daily, a mouthrinse was performed with either chlorhexidine or saline (control) depending on the experimental group the participant was allocated to. After the experimental period, plaque samples were collected from the surface of the specimens and from natural tooth surfaces to assess the organic acid production upon a sucrose challenge. The specimens were analyzed for mineral loss by transversal microradiography., Results: This study could not demonstrate a significantly better protection of enamel and dentine against demineralization by the chlorhexidine treatment compared to saline. No differences in acid production of plaque samples from the chlorhexidine-treated and control groups were observed. This result was also found for plaque samples originating from the natural tooth surfaces., Conclusion: Mouth rinsing with 0.2% chlorhexidine did not prevent demineralization of dentine and enamel in situ., ((c) 2008 S. Karger AG, Basel.)

The aim of this study was to determine the effects of 3 wk of daily rinsing with amine fluoride/stannous fluoride (AmF/SnF(2)) mouthrinse on plaque formation at buccal and interproximal sites, and on the acid production in plaque, in a randomized clinical trial with 30 participants. The amount of plaque was scored according to Turesky's modification of the Quigley and Hein index. Plaque samples were collected, before and after sucrose rinsing, from the buccal and interproximal surfaces of upper (pre)molars at two baseline visits and on days 2 and 7 after the discontinuation of 3 wk of daily rinsing. Metabolic acid ions were determined by capillary electrophoresis. The results at baseline showed higher lactic acid concentrations in resting interproximal plaque than in buccal plaque, and a higher acid production in response to sucrose challenge in buccal plaque than in interproximal plaque. After 3 wk of use of the AmF/SnF(2) mouthrinse, no significant differences in plaque scores were observed, and the alleged reduction in acidogenicity of dental plaque was not significant on the second day after the last mouthrinse. We conclude that 3 wk of use of AmF/SnF(2) rinse once daily does not result in a reduction of plaque formation or in a reduction of sucrose metabolism in buccal and interproximal plaque after discontinuing the rinse.

Previous work showed that a single application of 40% chlorhexidine varnish, EC40, reduced plaque acidogenicity upon sucrose challenge during less than 3 weeks. It was questioned whether lactic acid production could be reduced significantly longer when the treatment was intensified. Therefore, the effects of three consecutive EC40 applications on plaque acidogenicity were evaluated. Nine subjects who participated in the previous study received three full mouth EC40 applications within 1 week. Before the first application and up to 9 weeks after the third application, plaque samples were taken after a 10% sucrose rinse and analyzed for organic acids with capillary electrophoresis. At baseline, the mean provoked lactic acid concentration was 1.64 (+/-0.69) micromol/mg protein. At the first and seventh day after the third application, there was too little plaque to measure acid concentrations. At 2 weeks after the third application, lactic acid concentrations were significantly reduced (p < 0.05). The acid concentrations 3 weeks after the third application (1.61 (+/-0.99) micromol/mg protein) did not differ from the values at baseline (paired T test, p > 0.05). We conclude that a triple 40% chlorhexidine varnish treatment did not affect plaque acidogenicity for more than 3 weeks. From comparison with a previous study, we conclude that the triple treatment with EC40 within 1 week was not more effective in reducing plaque acidogenicity than the single one.

The aim of this clinical study was to evaluate the effect of various rinsing protocols on oral acid production 6 h after tooth brushing with an amine fluoride/stannous fluoride (AmF/SnF2) toothpaste. After a 14-day period of using F-free toothpaste, 30 participants followed three experimental protocols each, followed by F-free washout periods in a randomized crossover trial. They used AmF/SnF2 toothpaste twice daily for 1 week, and after brushing, they either rinsed with tap water, omitted the post-brush rinse, or rinsed with an AmF/SnF2 mouthwash. In the F-free washout periods, the participants brushed their teeth without further instructions. Six hours after the last brushing (+/-rinsing) of each period, subjects rinsed with 10 ml 10% sucrose solution for 2 min. A tongue film sample and a buccal plaque sample were taken 4 and 8 min after the sucrose challenge, respectively. Metabolic acid ions were determined by capillary electrophoresis. The results show that (1) omitting the post-brush water rinse did not reduce the production of lactic, acetic or minor acids in plaque, nor on the tongue, and that (2) the additional use of AmF/SnF2 mouthwash after brushing reduced the acid production in plaque and tongue samples for at least 6 h. The distributions of acids produced in the plaque or tongue samples were not statistically different between experimental periods. It is concluded that an increase in the antimetabolic effect of AmF/SnF2 toothpaste in between two daily brushing exercises is not achieved by omitting the post-brush water rinse. The additional use of AmF/SnF2 mouthwash after brushing is effective in reducing the acid metabolism in dental plaque and tongue flora., (Copyright (c) 2006 S. Karger AG, Basel)

The aim of the present study was to assess fluoride concentrations in unstimulated saliva and buccal dental plaque 6 h after an oral hygiene procedure that consisted of brushing with an AmF/SnF2 dentifrice and different post-brush rinsing protocols: expectorating the excess of dentifrice foam and rinsing with tap water, expectorating only, or rinsing with 10 ml AmF/SnF2 mouthwash. The fluoride concentrations in plaque and saliva were increased after all three experimental protocols compared to F-free periods. The increase of the fluoride concentration in saliva was more pronounced after AmF/SnF2 mouthrinse as compared to rinsing with water and expectorating the excess of dentifrice foam. Such an effect was not seen in dental plaque. It is concluded that the potentially beneficial effect of not rinsing or fluoride rinsing after tooth brushing is not reflected in an increased fluoride concentration in newly formed dental plaque 6 h after brushing., (Copyright 2006 S. Karger AG, Basel.)

The aim was to study remineralization in dentin underneath a biofilm. This was done in a constant depth film fermentor (CDFF) which was modified so that two treatments can be applied simultaneously in one experiment. Forty-five Streptococcus mutans biofilms were grown in grooves in dentin. Growth medium (3.7 g/l BHI, 1.5 mM calcium and 25 mM PIPES) was administered alternately with 2% sucrose pulsing 4 x 30 min/day. Fluoride at 135 ppm as NaF only or in a mixture with 0.2% chlorhexidine was applied for 2 x 5 min/day. The treatments started 5 days after inoculation and lasted 15 days. Five specimens per group were removed at various time points. The biofilms were checked for viability (by plating) and acid content (by capillary electrophoresis). The dentin specimens were analysed for mineral loss and lesion depth (by transversal microradiography). Fluoride treatment had no effect on the viability but reduced lactic acid production by 75%. The mixture treatment reduced the viability by 80% and the lactic acid content by 93% on the first day and later reduced the two parameters to below the detection limits. Significant differences in changes in mineral loss and lesion depth were observed between the treatment groups. Partial remineralization but deeper lesions were observed in the fluoride group, while nearly complete remineralization was seen in the mixture group. In conclusion, the CDFF S. mutans biofilm model can be used as a de- and remineralization biofilm model, and the split mode is particularly suitable for testing caries-preventive agents., (Copyright (c) 2005 S. Karger AG, Basel.)

In 101 fluoride toothpastes, bought in local shops in Burkina Faso (n = 3), China (n = 5), Myanmar (n = 22), Nepal (n = 19), Philippines (n = 13), Syria (n = 22), Togo (n = 7) and Vietnam (n = 10), the total and free ionisable fluoride concentrations were established. The total fluoride concentration of the toothpastes was determined by gas liquid chromatography. The amount of soluble fluoride was measured after dilution in artificial saliva and treatment of the supernatants with acidic phosphatase. The free fluoride concentration in this mixture was measured with a fluoride electrode. Twenty-five percent of all toothpastes contained less than 738 ppm total fluoride, and another 25% contained between 738 and 977 ppm fluoride. Regarding free ionisable fluoride the 25th, 50th, and 75th percentile contained < or =275, 780 and 990 ppm fluoride, respectively. Of the 61 toothpastes with declared fluoride concentration, 75% contained a total F concentration of > or =89% of the declared concentration. In 25% of these toothpastes the free ionisable fluoride was < or =55% of the declared fluoride, and in another 25% of the pastes the free ionisable fluoride concentration was > or =89% of the declared fluoride. In conclusion, deficiencies were found regarding the total as well as the free ionisable fluoride concentration of toothpastes bought in non-established market economy countries. Unclear labelling concerning the type and concentration of fluoride was often encountered. A need for quality control of fluoride toothpastes is recommended., (Copyright (c) 2005 S. Karger AG, Basel.)

The use of models simulating fissures allows studying demineralization at sites that are most prone to caries in vivo. In practice, most in situ models use flat surfaces. Our objectives were: (1) to compare the demineralizing potential of sucrose solution with that of bananas and (2) to study the effect of fluoride toothpaste on demineralization in situ in an easily accessible site and a plaque stagnation site. Four volunteers wore bovine dentin specimens with narrow grooves and a smooth surface for two 1-week in situ periods, with eight 1-min sugar exposures daily: either by a rinse with 10% sucrose, or by consumption of a piece of banana. Twice daily, the appliance was dipped in toothpaste slurry of a control (fluoride-free) toothpaste at one side and a fluoride toothpaste at the contralateral side. Demineralization was assessed by transversal microradiography. We found no difference in dentin demineralization after frequent exposure to either sucrose solution or bananas. Fluoride toothpaste effectively protected dentin only at the smooth surface. In the grooves, fluoride affected the demineralization pattern; it drove lesions towards the bottom of the groove. We conclude that assessing only smooth surfaces in intraoral tests might lead to underestimated food cariogenicity and to overestimated efficacy of fluoride-containing toothpaste., (Copyright (c) 2005 S. Karger AG, Basel.)

The most widely used sugar alcohols are: xylitol, sorbitol, mannitol, maltitol, lactitol and the products Lycasin and Palatinit. It is often claimed that xylitol is superior to the other sugar alcohols for caries control. This paper examines clinical studies on the caries-preventive and therapeutic effects of sugar alcohols with emphasis on sorbitol and xylitol. It is concluded that chewing sugar-free gum 3 or more times daily for prolonged periods of time may reduce caries incidence irrespective of the type of sugar alcohol used. It may be sufficient to do this only on school days. Sucking xylitol-containing candies or tablets may have a similar effect as chewing xylitol chewing gum. Clinical trials suggest greater caries reductions from chewing gums sweetened with xylitol than from gums sweetened with sorbitol. However, the superiority of xylitol was not confirmed in 2 out of 4 clinical trials comparing the caries-preventive effect of xylitol- with sorbitol-sweetened gums. The caries-preventive effects of polyol-containing gums and candies seem to be based on stimulation of the salivary flow, although an antimicrobial effect cannot be excluded. There is no evidence for a caries-therapeutic effect of xylitol. These conclusions are in line with those of recent reviews and with the conclusions of the Scientific Committee on Medicinal Products and Medical Devices of the EU Commission., (Copyright 2004 S. Karger AG, Basel)

Objectives: To develop a standardized method for measuring the variables affecting fluoride ingestion from toothpaste in young children between the ages of 1.5 and 3.5 years, and to use the method at seven European sites., Methods: Random samples of children were invited to take part in the study. Parents who gave consent were visited at home. The children brushed their teeth using the toothpaste brand and toothbrush type currently in use. The difference between the fluoride dispensed onto the toothbrush and the fluoride recovered after accounting for losses was deemed to be the fluoride ingested. Details of other oral health-care habits were collected by questionnaire. For each child, the fluoride concentration of the toothpaste used was measured in the laboratory, from which an estimate of total daily fluoride ingestion was made., Results: There was considerable variation between countries in the types of toothpaste used and in the amounts of toothpaste applied and ingested. The amount of fluoride ingested ranged from 0.01 to 0.04 mg fluoride per kg of body weight per day., Conclusion: The amount of fluoride ingested that is likely to be a risk factor for the development of dental fluorosis during tooth formation is equivocal and was found to vary widely between European countries. There appears to be a need for clearer health messages regarding the use of fluoridated toothpaste by young children.

An important challenge encountered in this multicentred project was the need to take account of the different cultural and legal differences between the seven sites when agreeing the protocol. Examples such as access to registers of births and subject consent dictated that there were some differences in the methods used in the different sites. The data presented showed that it was possible to train and calibrate a number of examiners in a standardized photographic method for recording enamel fluorosis. This method has a number of important advantages for the objective monitoring of enamel fluorosis over time. There were considerable differences between the seven sites in the formulations of the toothpaste used and in the pattern of their use. The results indicate that it is possible to agree and adopt a standardized method for measuring fluoride ingestion from toothpaste. The aesthetic impact of enamel fluorosis seemed low in the populations included in this project, but further work is required on this issue.

Objectives: To develop a standardized method for measuring the variables affecting fluoride ingestion from toothpaste in young children between the ages of 1.5 and 3.5 years, and to use the method at seven European sites., Methods: Random samples of children were invited to take part in the study. Parents who gave consent were visited at home. The children brushed their teeth using the toothpaste brand and toothbrush type currently in use. Variables measured were: type of toothpaste used, fluoride concentration of toothpaste used, weight of toothpaste used, frequency of brushing and body weight of the child., Results: It was not possible to follow the agreed protocol in all seven countries and in three countries appropriate alternative methods were employed. There was considerable variation between countries in the variables investigated. Use of children's toothpaste ranged from 69% in Ireland to 98% in Portugal. In the Netherlands up to 60% of the children were using toothpaste containing <400 ppm F and in Finland up to 27% of children were using toothpaste containing >1200 ppm F. Over half of the children used <0.25 g of toothpaste per brushing and the majority of children brushed once or twice per day., Conclusion: Although adherence to the agreed protocol was not possible at all study sites there was a clear picture of considerable variation in the oral hygiene practices of young children throughout Europe.

Objectives: The aim of this study was to collate data on national policies for the use of fluoride in the seven European countries participating in the FLINT project., Methods: Policies on the use of fluoride were obtained for each of the study areas. Data collected included the presence of water fluoridation and regulations governing fluoride toothpaste and fluoride supplements., Results: In Ireland 74% of the population had a fluoridated water supply but in all the other countries fluoride toothpaste was the principal form of delivering fluoride, usually recommended as a dose of a pea-sized amount. Fluoride supplement use varied considerably between countries. The Netherlands had the clearest regulations covering the use of fluoride supplements and definition of at-risk individuals. Most countries, even if they recognized particular caries-risk did not define the term clearly. In Iceland all children were regarded as being at high risk of developing caries., Conclusion: Considerable variation exists between European countries in their policies for fluoride use and no clear definitions of high-caries-risk individuals were found. The results show that there is even a lack of coherent thought and planning within the different countries, let alone between them.

Objectives: The aim of this study was to determine the effects of rinsing and spitting on fluoride ingestion from toothpaste during normal oral-hygiene procedures of younger children, and hence to make recommendations on rinsing during toothbrushing., Methods: The brushing habits of 166 Dutch and 185 Irish children between 1.5 and 3.5 years were observed during home visits. The weight of the toothpaste tube was determined before and after use. After brushing, the toothbrush and any associated expectorate and rinses, combined with any toothpaste spilled during the brushing procedures, were collected. The amounts of fluoride retained on the toothbrush and in the associated expectorate and rinses were measured., Results: Over 90% of the Dutch children used a special toddlers' toothpaste with < or =500 ppm F. Eleven per cent of the younger (<2.5 years) Dutch children and 22% of the older children rinsed after brushing. Of the Irish children approximately 52% used a children's toothpaste containing around 500 ppm F. Of the younger Irish children 31% spat without rinsing, while another 31% rinsed during or after brushing. For the older Irish children, these percentages were 14 and 70%, respectively. On average, 22% of the fluoride dispensed on the toothbrush was retained on the brush after brushing irrespective of the rinsing and spitting behaviour of the children. The maximum ingestible amount of fluoride from toothpaste assuming no rinsing or spitting was calculated., Conclusions: Fluoride ingestion from toothpaste is significantly reduced by rinsing and/or spitting during toothbrushing. Recommendations that younger children use small amounts of toothpaste (< 0.5 g) and that children using toothpaste with > or = 1000 ppm F rinse their mouths after brushing continue to be valid.

Objective: To measure and compare 24-h urinary fluoride excretion in children aged 1.5-3.5 years from European study sites and to use these data to estimate the 24-h fluoride intake., Method: Twenty-four-hour urine samples were collected from 3-year-old children (n = 86) who were already participating in a European multicentre study. Samples were collected from Cork, Ireland (n = 19) where the water is fluoridated to a concentration between 0.8 and 1.0 ppm and from five sites with a water fluoride concentration <0.15 ppm: Knowsley, England (n = 18); Oulu, Finland (n = 18); Reykjavik, Iceland (n = 4); Haarlem, the Netherlands (n = 6); Almada/Setubal, Portugal (n = 21). The volume of the samples was measured; they were analysed for fluoride concentration and the 24-h urinary fluoride excretion was calculated. From this an estimate of the daily fluoride intake was made., Results: It was found that the mean fluoride excretion in response to the usual conditions of fluoride intake in the children in the nonfluoridated areas ranged from 0.16 mg (+/-0.08) in Oulu to 0.33 mg (+/-0.27) in Almada/Setubal with an overall mean of 0.23 mg (+/-0.19). The mean 24-h fluoride excretion in fluoridated Cork was 0.37 mg (+/-0.11). There was a significant difference between the fluoride excretion in the nonfluoridated areas and that in the fluoridated areas, and the data were broadly in agreement with WHO standards., Conclusions: The daily urinary fluoride excretion and estimated fluoride intake in these children appeared to be within acceptable limits.

This manuscript discusses the antimicrobial activity of fluoride and its in vivo importance in order to identify research questions. There is a lot of information on mechanisms by which fluoride may interfere with bacterial metabolism and dental plaque acidogenicity. The antimicrobial activity of fluoride products is enhanced when fluoride is associated with antimicrobial cations like Sn(2+) and amine. It is not clear whether the antimicrobial mechanisms of fluoride are operating in vivo or even to what extent antimicrobial activity can contribute to caries prevention. This latter question may be the most important one in research., (Copyright 2001 S. Karger AG, Basel.)

This article discusses fluoride mechanisms in relation to dental caries. The authors specifically address firmly bound versus loosely bound fluoride; different fluoride active ingredients; fluoride and demineralization and remineralization; fluoride slow-release devices and F-releasing dental materials; antimicrobial effects of fluoride; the uptake of fluoride by oral bacteria; inhibition of enolase, protein-intruding ATPase and sugar transport; the various aspects of plaque as it relates to fluoride; and the rational use of fluoride.

Objective: To assess the prevalence of fluorosis at the age of 8, 14 and 20 years; to evaluate the prevalence of caries and fluorosis at the age of 8 and 14 years in relation tot the use of fluoride tablets during the first 5 years of age., Design: Retrospective study., Setting: The investigation was carried out in four cities in the Netherlands., Methods: Caries and fluorosis data were obtained in 8-, 14- and 20-year-old persons by clinical examination. For 8- and 14-year-olds results were compared with data about the use of fluoride tablets during the first 5 years of life. These data were obtained by questionnaires completed by the parents when the child was 5 years old., Results: Prevalence of fluorosis in permanent teeth of 8-, 14 and 20-year-olds was 16%, 31% and 26% respectively. Univariate analysis revealed a statistically significant relation between the frequency of the use of fluoride tablet and caries prevalence in deciduous and permanent teeth on the age of 8. Prevalence of fluorosis and fluoride tablet use did not show such a relation. These findings were confirmed by logistic regression analysis, using frequency of tooth brushing on the age of 5 as possible confounding factor., Conclusion: In this group of children the use of fluoride tablets during the first 5 years of life does not seem to increase the prevalence of fluorosis.

Bovine enamel and dentin specimens were overlaid with acidogenic Streptococcus mutans suspensions in agarose. In this model, the minimal demineralisation-inhibiting concentrations (MDIC) of hexetidine was determined in the presence of fluoride. A commercially available mouthwash containing 0.1% (2.9 mmol/l) hexetidine was diluted serially and added to the bacterial suspensions together with 0, 5.3, or 26.3 mumol/l fluoride (NaF). After 22 h of incubation at 37 degrees C the bacterial suspensions were removed and assessed for calcium and lactate. The results showed significant inhibitory effects of hexetidine on the demineralisation of the enamel specimens with a MDIC between 15 and 31 mumol/l hexetidine. In the presence of fluoride, approximately fourfold higher concentrations of hexetidine were needed for a significant additional protection of the enamel. No synergistic effect between hexetidine and fluoride was observed. For the demineralisation of the dentin specimens, the MDIC of hexetidine had a value between 31 and 61 mumol/l. At both these concentrations the dentin specimens were relatively less protected in the presence than in the absence of fluoride, and some synergistic effect between hexeditine and fluoride was observed.

The cariostatic effect of fluoride is well documented, but the exact mechanisms of action are still subject of many studies. Re-evaluations of the clinical data of water fluoridation studies have confirmed that fluoride can have a pre-eruptive effect. But in general, the post-eruptive effects of low concentrations of fluoride on the de- and remineralisation processes are regarded to be of greater importance. Infrequent applications of concentrated fluoride solutions may only be effective in demineralised enamel. The Dutch national recommendations for the use of fluorides correspond well with the present views on the mechanisms of action of fluoride.

In an in vitro demineralization experiment with a plaque of S. mutans C180-2 over enamel, the effect of 0.5 mmol fluoride/L was compared with that of 10 nmol nigericin/L. Since the effects of both substances on the acid production in a dense cell suspension were of the same magnitude, and since nigericin did not affect the enamel solubility, the present demineralization experiment may differentiate between the effect of fluoride on bacterial metabolism alone and the combined effect of fluoride on both the bacterial metabolism and enamel solubility. In our experiments, the effect on bacterial metabolism accounted for 75% of the caries-inhibiting effect of fluoride. Microradiographic data showed subsurface lesions in the control and nigericin group and a slight surface-softening in the fluoride group. In addition, the effects of fluoride and nigericin on the cellular internal pH during glycolysis were studied. Analysis of these data suggested that glycolysis was inhibited when the intracellular pH reached about pH 5.2, which supports the view that acidification of the cell cytoplasm is a mechanism by which fluoride inhibits glycolysis.