In vitro effect of low-fluoride toothpaste supplemented with sodium trimetaphosphate, xylitol, and erythritol on enamel demineralization

Abstract Regular use of toothpaste with fluoride (F) concentrations of ≥ 1000 ppm has been shown to contribute to reducing caries increment. However, when used by children during the period of dental development, it can lead to dental fluorosis. Objective: In this study, we aimed to evaluate the in vitro effect of a toothpaste formulation with reduced fluoride (F) concentration (200 ppm) supplemented with sodium trimetaphosphate (TMP: 0.2%), Xylitol (X:16%), and Erythritol (E: 4%) on dental enamel demineralization. Methodology: Bovine enamel blocks were selected according to initial surface hardness (SHi) and then divided into seven experimental toothpaste groups (n=12). These groups included 1) no F-TMP-X-E (Placebo); 2) 16% Xylitol and 4% Erythritol (X-E); 3) 16% Xylitol, 4% Erythritol and 0.2%TMP (X-E-TMP); 4) 200 ppm F (no X-E-TMP: (200F)); 5) 200 ppm F and 0.2% TMP (200F-TMP); 200 ppm F, 16% Xylitol, 4% Erythritol, and 0.2% TMP (200F-X-E-TMP); and 7) 1,100 ppm F (1100F). Blocks were individually treated 2×/day with slurries of toothpastes and subjected to a pH cycling regimen for five days (DES: 6 hours and RE: 18 hours). Then, the percentage of surface hardness loss (%SH), integrated loss of subsurface hardness (ΔKHN), fluoride (F), calcium (Ca), and phosphorus (P) in enamel were determined. The data were analyzed by ANOVA (1-criterion) and the Student-Newman-Keuls test (p<0.001). Results: We found that the 200F-X-E-TMP treatment reduced %SH by 43% compared to the 1100F treatments (p<0.001). The ΔKHN was ~ 65% higher with 200F-X-E-TMP compared to 1100F (p<0.001). The highest concentration of F in enamel was observed on the 1100F treatment (p<0.001). The 200F-X-E-TMP treatment promote higher increase of Ca and P concentration in the enamel (p<0.001). Conclusion: The association of 200F-X-E-TMP led to a significant increase of the protective effect on enamel demineralization compared to the 1100F toothpaste.

Efeito da associação de tratamentos com fosfopeptídeo de caseína-fosfato de cálcio amorfo e trimetafosfato de sódio sobre a desmineralização e remineralização do esmalte: estudos in vitro / Effect of the combination of treatments with casein phosphopeptide-amorphous calcium phosphate and sodium trimetaphosphate on desmineralization and enamel remineralization: in vitro studies

A proposição geral do presente estudo foi avaliar in vitro a associação de tratamentos com dentifrícios fluoretados e suplementados com trimetafosfato de sódio (TMP) e fosfopeptídeo de caseína-fosfato de cálcio amorfo (CPP-ACP) (MI Paste Plus®) em promover a remineralização e reduzir a desmineralização, respectivamente, do esmalte dentário. Blocos de esmalte bovinos (12/grupo) foram selecionados através da dureza de superfície inical (SH) e divididos em 5 grupos experimentais: 1) Dentifrício sem F (Placebo); 2) Dentifrício com 1100 ppm F (1100F), 3) MI Paste Plus®, 4) Dentifrício com 1100 ppm F associado a MI Paste Plus® (1100F-MI Paste Plus®) e 5) Dentifrício com 1100 ppm F + 3%TMP associado a MI Paste Plus® (1100F-TMPMI Paste Plus®). Para o Artigo 1 de Remineralização (RE>DES), blocos de esmalte bovino foram selecionados pela dureza de superfície pós-lesão de cárie artificial (SH1) e submetidos a 6 ciclagens de pH por 6 dias. Após as ciclagens de pH, foram determinadas dureza de superfície final (SH2), para o cálculo da porcentagem de recuperação de dureza de superfície (%SHR), perda integrada de dureza de subsuperfície (ΔKHN), análise do perfil e profundidade das lesões de subsuperfície através da microscopia de luz polarizada (PLM), microsopia confocal de varredura à laser (MCVL), microscopia eletrônica de varredura (MEV), espectroscopia de energia dispersiva (EDS), concentração de fluoreto (F), cálcio (Ca) e fósforo (P) no esmalte. Os dados foram submetidos à ANOVA (1-critério), seguido pelo teste StudentNewman-Keuls (p < 0,001). Os grupos 1100F e 1100F-TMP-MI Paste Plus® apresentaram valores semelhantes de %SHR (p = 0,150). A menor profundidade de lesão (ΔKHN e PLM) foi observada para o grupo 1100F-TMP-MI Paste Plus® quando comparado aos demais (p < 0,001). O grupo 1100F-TMP-MI Paste Plus® apresentou superfície mais uniforme e íntegra em relação aos demais tratamentos (MCVL e MEV). A concentração de F foi similar entre os grupos 1100F, 1100F-MI Paste Plus® e 1100F-TMP-MI Paste Plus® (p > 0,001). O tratamento com 1100F-TMP-MI Paste Plus® promoveu um aumento na concentração de Ca no esmalte em ⁓ 51% e ⁓ 21% respectivamente, quando comparado aos grupos 1100F e MI Paste Plus® (p < 0,001). Valores semelhantes de P no esmalte foram observados nos grupos MI Paste Plus®, 1100F-MI Paste Plus® (p > 0,001), exceto o grupo 1100F-TMP-MI Paste Plus®, que apresentou alta concentração (p < 0,001). Para o Artigo 2 de Desmineralização (DES>RE), blocos de esmalte bovino foram selecionados pela dureza de superfície inicial (SHi) e a seguir submetidos a 5 ciclagens de pH por 7 dias. Após determinou-se dureza de superfície final (SHf), porcentagem de perda de dureza de superfície (%SH), perda integrada de dureza de subsuperfície (ΔKHN), análise do perfil e profundidade das lesões de subsuperfície através da microscopia de luz polarizada (PLM), microsopia confocal de varredura à laser (MCVL), microscopia eletrônica de varredura (MEV), espectroscopia de energia dispersiva (EDS), concentração de fluoreto (F), cálcio (Ca) e fósforo (P) no esmalte. Os dados foram submetidos à ANOVA (1-critério), seguido pelo teste Student-Newman-Keuls (p < 0,001). Para a %SHR, o grupo Placebo apresentou os menores valores (p > 0,001). O grupo 1100F-TMP-MI Paste Plus® remineralizou a superfície do esmalte em ~ 38% em relação ao MI Paste Plus® (p < 0,001). A menor profundidade da lesão (ΔKHN) foi observada para o grupo 1100F-TMP-MI Paste Plus® quando comparado aos demais (p < 0,001), sendo inferior em 32% quando comparado ao grupo 1100F. A concentração de F, Ca e P foi maior para o grupo 1100F-TMP-MI Paste Plus® (p > 0,001). Diante dos resultados parciais obtidos, é possível concluir que a associação de tratamentos com dentifrícios fluoretados e suplementados com trimetafosfato de sódio (TMP) e fosfopeptídeo de caseína-fosfato de cálcio amorfo (CPP-ACP) (MI Paste Plus®) (1100F-TMPMI Paste Plus®) promoveu um efeito adicional significativo no processo de desremineralização, podendo ser uma alternativa de tratamento para pacientes em risco e atividade de cárie(AU)

The general purpose of this study was to evaluate in vitro the association of treatments with fluoridated toothpastes and supplemented with sodium trimetaphosphate (TMP) and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) (MI Paste Plus®) in promoting remineralization and reduce demineralization, respectively, of tooth enamel. Bovine enamel blocks (12/group) were selected through the initial surface hardness (SH) and divided into 5 experimental groups: 1) Toothpaste without F (Placebo); 2) Toothpaste with 1100 ppm F (1100F), 3) MI Paste Plus®, 4) Toothpaste with 1100 ppm F associated with MI Paste Plus® (1100F-MI Paste Plus®) and 5) Toothpaste with 1100 ppm F + 3% TMP associated with MI Paste Plus® (1100F-TMP-MI Paste Plus®). For Remineralization Manuscript 1 (RE>DES), blocks of bovine enamel were selected for the surface hardness after artificial caries lesion (SH1) and subjected to 6 pH cycles for 6 days. After pH cycling, final surface hardness (SH2) was determined to calculate the percentage of surface hardness recovery (%SHR), integrated loss of subsurface hardness (ΔKHN), profile analysis and depth of the lesions of subsurface through polarized light microscopy (PLM), confocal laser scanning microscope (MCVL), scanning electron microscopy (SEM), dispersive energy spectroscopy (EDS), fluoride (F), calcium (Ca) and phosphorus (P) concentration in the enamel. The data were submitted to ANOVA (1-criterion), followed by the Student-Newman-Keuls test (p<0.001). 1100F and 1100F-TMP-MI Paste Plus® groups showed similar values of %SHR (p = 0.150). The lowest depth of lesion (ΔKHN and PLM) was observed for the 1100F-TMP-MI Paste Plus® group when compared to the others (p<0.001). The 1100F-TMP-MI Paste Plus® group showed a more uniform and complete surface in relation to the other treatments (MCVL and SEM). The F concentration was similar between the 1100F, 1100F-MI Paste Plus® and 1100F-TMP-MI Paste Plus® groups (p>0.001). The treatment with 1100F-TMP-MI Paste Plus® promoted an increase in the concentration of Ca in the enamel by ⁓ 51% and ⁓ 21% respectively, when compared to the 1100F and MI Paste Plus® groups (p<0.001). Similar values of P in the enamel were observed in the MI Paste Plus®, 1100F-MI Paste Plus® groups (p>0.001), except for the 1100F-TMP-MI Paste Plus® group, which presented high concentration (p<0.001). For demineralization Manuscript 2 (DES> RE), bovine of enamel blocks were selected for their initial surface hardness (SHi) and then subjected to 5 pH cycles for 7 days. After final surface hardness (SHf), percentage of loss of surface hardness (%SH), integrated loss of subsurface hardness (ΔKHN), analysis of the profile and depth of subsurface lesions through polarized light microscopy ( PLM), confocal laser scanning microscopy (MCVL), scanning electron microscopy (SEM), dispersive energy spectroscopy (EDS), fluoride (F), calcium (Ca) and phosphorus (P) concentration in the enamel. The data were submitted to ANOVA (1-criterion), followed by the Student-Newman-Keuls test (p<0.001). For %SHR, the Placebo group had the lowest values (p>0.001). The 1100F-TMP-MI Paste Plus® group remineralized the enamel surface by ~ 38% compared to MI Paste Plus® (p<0.001). The lowest depth of the lesion (ΔKHN) was observed for the 1100F-TMP-MI Paste Plus® group when compared to the others (p<0.001), being 32% lower when compared to the 1100F group. The F, Ca and P concentration was higher for the 1100F-TMP-MI Paste Plus® group (p>0.001). In view of the partial results obtained, it is possible to conclude that the combination of treatments with fluoridated toothpastes and supplemented with sodium trimetaphosphate (TMP) and amorphous calcium phosphate casein-phosphate (CPP-ACP) (MI Paste Plus®) (1100F-TMP -MI Paste Plus®) promoted a significant additional effect in the de-remineralization process, and could be an alternative treatment for patients at risk and caries activity(AU)

Evaluation of Dental Caries Behavior in Childhood: Health Promotion and Control / Avaliação do Comportamento da Cárie Dentária na Infância: Controle e Promoção de Saúde

Dental caries is still the most common pathology in childhood, caused mainly by lack of adequate prevention. The aim of this project was to evaluate the dental caries profile in children and the importance of multidisciplinary practice in dental caries. Material and methods: 1st stage- meetings were held with the teachers of the child education network and conferences addressed to parents and those responsible for the children. 2nd stage- Assessment and examination of oral health with education process and motivation for dental hygiene. Results: A total of 3390 children were analyzed, of which 859 had carious teeth, that is, 25.34% of the children had caries disease. There is a large presence of caries in the PRE II level, whose highest prevalence of caries is 41.73%, and the lowest recorded in Kindergarten I with 3.11%. This is mainly due to age, directly related to the period in which the basic oral health care program began in day care centers, as older children already had high caries rates when the preventive program was institutionalized to control the occurrences of caries and health promotion. Conclusion: The prevalence of caries in preschool children is still high, but the multidisciplinary approach has shown to be effective and able to reach the levels recommended by ONU 2030 appointment book for dental caries control. (AU)

A cárie dentária é a enfermidade mais comum na infância, causada essencialmente pela falta de prevenção adequada. O objetivo deste estudo foi avaliar o perfil da cárie dentária em crianças e a importância da ação multidisciplinar no controle da mesma. Na primeira fase, foram realizadas reuniões com os professores da rede de educação infantil e conferências dirigidas aos pais e responsáveis das crianças. Na 2ª fase: avaliação e exame de saúde bucal com orientação e motivação para higiene bucal. Foram analisadas 3390 crianças, das quais 859 apresentaram cárie dentária (25,34%). Obervou-se grande presença de cárie no nível PRE II, cuja maior prevalência de cárie é de 41,73%, e a menor registrada no Jardin I com 3,11%. Isso se deve principalmente à idade, relacionada diretamente ao período em que iniciou o Programa Básico de Atenção a Saúde Bucal nas creches, uma vez que as crianças mais velhas já apresentavam altas taxas de cárie quando o programa preventivo foi institucionalizado para controlar ocorrências de cárie e promoção da saúde bucal. Ainda existe alta prevalência de cárie em pré-escolares, entretanto, a abordagem multidisciplinar mostrou-se efetiva e capaz de alcançar os índices preconizados pela Agenda 2030 da ONU para o controle e prevenção da cárie dentária. (AU)