Effect of fluoride gels with nano-sized sodium trimetaphosphate on the in vitro remineralization of caries lesions

Abstract Objective To evaluate the effects of fluoride (F) gels supplemented with micrometric or nano-sized sodium trimetaphosphate (TMPmicro and TMPnano, respectively) on the in vitro remineralization of caries-like lesions. Methodology Bovine enamel subsurface lesions (n=168) were selected according to their surface hardness (SH) and randomly divided into seven groups (n=24/group): Placebo (without F/TMP), 4,500 ppm F (4500F), 4500F + 2.5% TMPnano (2.5% Nano), 4500F + 5% TMPnano (5% Nano), 4500F + 5% TMPmicro (5% Micro), 9,000 ppm F (9000F), and 12,300 ppm F (Acid gel). The gels were applied in a thin layer for one minute. Half of the blocks were subjected to pH cycling for six days, whereas the remaining specimens were used for loosely- (calcium fluoride; CaF2) and firmly-bound (fluorapatite; FA) fluoride analysis. The percentage of surface hardness recovery (%SHR), area of subsurface lesion (ΔKHN), CaF2, FA, calcium (Ca), and phosphorus (P) on/in enamel were determined. Data (log10-transformed) were subjected to ANOVA and the Student-Newman-Keuls' test (p<0.05). Results We observed a dose-response relation between F concentrations in the gels without TMP for %SHR and ΔKHN. The 2.5% Nano and 5% Micro reached similar %SHR when compared with 9000F and Acid gels. For ΔKHN, Placebo and 5% Nano gels had the highest values, and 5% Micro, 2.5% Nano, 9000F, and Acid gels, the lowest. All groups had similar retained CaF2 values, except for Placebo and Acid gel. We verified observed an increase in Ca concentrations in nano-sized TMP groups. Regarding P, TMP groups showed similar formation and retention to 9000F and Acid. Conclusion Adding 2.5% nano-sized or 5% micrometric TMP to low-fluoride gels lead to enhanced in vitro remineralization of artificial caries lesions.

New insights into the anti-erosive property of a sugarcane-derived cystatin: different vehicle of application and potential mechanism of action

Abstract A new sugarcane-derived cystatin (CaneCPI-5) showed anti-erosive properties when included in solutions and strong binding force to enamel, but the performance of this protein when added to gel formulations and its effect on surface free energy (SFE) requires further studies. Objective 1) to evaluate the protective effect of gels containing different concentrations of CaneCPI-5 against initial enamel erosion (Experiment 1); and 2) to analyze the SFE (γS) after treating the enamel surface with CaneCPI-5 solution (Experiment 2). Methodology In Experiment 1, 75 bovine enamel specimens were divided into five groups according to the gel treatments: placebo (negative control); 0.27%mucin+0.5%casein (positive control); 0.1 mg/mL CaneCPI-5; 1.0 mg/mL CaneCPI-5; or 2.0 mg/mL CaneCPI-5. Specimens were treated with the gels for 1 min, the AP was formed (human saliva) for 2 h and the specimens were incubated in 0.65% citric acid (pH=3.4) for 1 min. The percentage of surface hardness change (%SHC) was estimated. In Experiment 2, measurements were performed by an automatic goniometer using three probing liquids: diiodomethane, water and ethylene glycol. Specimens (n=10/group) remained untreated (control) or were treated with solution containing 0.1 mg/mL CaneCPI-5, air-dried for 45 min, and 0.5 µL of each liquid was dispensed on the surface to measure contact angles. Results Gels containing 0.1 and 1.0 mg/mL CaneCPI-5 significantly reduced %SHC compared to the other treatments (p<0.05). Treated enamel showed significantly lower γS than control, without changes in the apolar component (γSLW), but the polar component (γSAB=Lewis acid-base) became more negative (p<0.01). Moreover, CaneCPI-5 treatment showed higher γS - (electron-donor) values compared to control (p<0.01). Conclusions Gels containing 0.1 mg/mL or 1.0 mg/mL CaneCPI-5 protected enamel against initial dental erosion. CaneCPI-5 increased the number of electron donor sites on the enamel surface, which may affect AP formation and could be a potential mechanism of action to protect from erosion.

Enamel subsurface caries-like lesions induced in human teeth by different solutions: a TMR analysis

Abstract This study assessed the effectiveness of models for developing subsurface caries lesions in vitro and verified mineral changes by transverse microradiography (TMR). Enamel blocks from permanent (n=5) and deciduous teeth (n=5) were submitted to lesion induction by immersion in demineralizing solutions during 96 h, followed by pH cycles of demineralization (de) and remineralization (re) for 10 days. Two de-/re solutions were tested. Demineralizing solution "A" was composed by 2.2 mM CaCl2, 2.2 mM KH2PO4, 0.05 M acetic acid, with pH 4.4 adjusted by 1 M KOH. Demineralizing solution "B" was composed by 2.2 mM CaCl2, 2.2 mM NaH2PO4, 0.05 M acetic acid and 0.25 ppmF, with pH 4.5 adjusted by 1M KOH. Solution "A" produced cavitated lesions in permanent teeth, whereas solution "B" led to subsurface lesions in deciduous teeth. Solution "B" was then tested in enamel blocks from permanent teeth (n=5) and subsurface lesions were obtained, so that solution "B" was employed for both substrates, and the blocks were treated with slurries of a fluoride dentifrice (1450 ppm F, as NaF, n=5) or a fluoride-free dentifrice (n=5). Solution "B" produced subsurface lesions in permanent and primary teeth of an average (±SD) depth of 88.4µm (±14.3) and 89.3µm (±15.8), respectively. TMR analysis demonstrated that lesions treated with fluoride-free dentifrice had significantly greater mineral loss. This study concluded that solution "B" developed subsurface lesions after pH cycling, and that mineral changes were successfully assessed by TMR.

Resumo Este estudo avaliou a efetividade de modelos para o desenvolvimento de lesões de cárie subsuperficiais in vitro e verificou alterações minerais por microradiografia transversal (TMR). Blocos de esmalte de dentes permanentes (n = 5) e decíduos (n = 5) foram submetidos à indução de lesão por imersão em soluções desmineralizadoras durante 96h, seguido de ciclos de pH de desmineralização e remineralização por 10 dias. Duas soluções des-/re foram testadas. A solução desmineralizadora "A" foi composta por 2,2 mM de CaCl2, 2,2 mM de KH2PO4, 0,05 M de ácido acético, com pH de 4,4 ajustado por 1 M de KOH. A solução desmineralizadora "B" foi composta por 2,2 mM de CaCl2, 2,2 mM de NaH2PO4, 0,05 M de ácido acético e 0,25 ppmF, com pH de 4,5 ajustado por 1 M de KOH. A solução "A" produziu lesões cavitadas em dentes permanentes, enquanto a solução "B" apresentou lesões subsuperficiais em dentes decíduos. Portanto, a solução "B" foi posteriormente usada em blocos de esmalte de dentes permanentes (n = 5) e lesões subsuperficiais foram obtidas. Portanto, a solução "B" foi empregada para ambos os substratos, sendo metade deles tratada com dentifrício fluoretado e a outra metade com dentifrício livre de flúor. A solução "B" produziu lesões subsuperficiais de cárie com profundidade de 88.4µm (14.3) em dentes permanentes e com 89.3 µm (15.8) em dentes decíduos e TMR demonstrou que lesões tratadas com dentifrício sem flúor tiveram maior perda mineral. Este estudo concluiu que a solução "B" desenvolveu lesões subsuperficiais após o ciclo de pH e as alterações minerais foram avaliadas com sucesso por TMR.

Clinical and radiographic evaluation of a new stain-free tricalcium silicate cement in pulpotomies

Abstract The aim of this study was to evaluate and compare the clinical and radiographic success rates of pulpotomies in primary molars using a new stain-free tricalcium silicate cement (Bio-C Pulpo) versus a conventional white MTA (MTA Angelus) as a pulpotomy medicament for primary teeth. Seventy primary teeth in 33 patients were randomly divided into two groups, MTA Angelus (n = 34) and Bio-C Pulpo (n = 36). Clinical and radiographic follow-up examinations were conducted at seven days (except radiographic follow-up), and at one, three, six and 12 months. At 12 months, the clinical success rate of the MTA Angelus group was 100 percent (28 out of 28), and the radiographic success rate was 100 percent (28 out of 28). In comparison, the clinical success rate for the Bio-C Pulpo group was 100 percent (29 out of 29), and the radiographic success rate was 100 percent (29 out of 29). No significant differences were found between the groups at any follow-up evaluation. According to Fisher´s exact test, a significant difference was observed between the pulpotomy agent and tooth discoloration (p < 0.001). The success rates were 100% for the Bio-C Pulpo group, with no case of discoloration, and 10.31% for the MTA Angelus group. Both MTA Angelus and Bio-C Pulp pulpotomy medicaments are appropriate options for pulpotomies in primary teeth, and enable high clinical and radiographic success rates. However, more long-term studies are required to test the new Bio-C Pulpo medicament.

Desenvolvimento de uma formulação de verniz fluoretado suplementado com trimetafosfato de sódio: ação sobre a cárie e erosão dentária em protocolos in vitro, in situ e in vivo / Development of a fluoride varnish formulation containing sodium trimetaphosphate: effect on dental caries and erosion in in vitro, in situ and in vivo protocols

O presente estudo avaliou o efeito de vernizes fluoretados contendo trimetafosfato de sódio (TMP) sobre a desmineralização, remineralização e desgaste erosivo do esmalte dentário, utilizando protocolos in vitro e in situ, bem como sobre o desenvolvimento de lesões de cárie em criançase adolescentese, m um protocolo longitudinal randomizadoe controlado. O estudo foi realizado em 6 fases distintas. As etapas 1 a 5 foram realizadas utilizando espécimes de esmalte dental bovino, sobre os quais os vernizes foram aplicados uma única vez, pennanecendo em contato durante 6 horas. Na 1ª etapa, foram testados vernizes contendo 5% NaF (controle positivo), 2,5% NaF contendo O, 3,5, 5,0 e 10,0% TMP, além de uma formulação sem F ou TMP (PLA, placebo), em um protocolo in vitro. Os espécimes foram submetidos a desafios erosivos (ERO -Sprite Zero®, 5 min, 4x/dia, 5 dias), associados ou não a abração por escovação (ERO+ABR). Na 2ª etapa, o efeito dos vernizes PLA, 5% NaF e 2,5% NaF (suplementado ou não com 5% TMP) sobre ERO e ERO+ABR foram analisados em um protocolo in situ, duplo-cego e cruzado. Voluntários (n=10) usaram dispositivos acrílicos palatinos contendo 4 blocos de esmalte. ERO foi produzida ex vivo (ácido cítrico, 5 min, 4x/dia, 5 dias), enquanto ERO+ABR foi produzida por escovação de 2 blocos (15 s, dentifrício sem F). Em ambas as etapas, os vernizes contendo TMP promoveram desgaste e perda em profundidade no esmalte (∆KHN) significativamente menores quando comparados aos demais vernizes, para ERO e ERO+ABR. Na 3ª e 4ª etapas, vernizes contendo 2.5% NaF e 5% NaF (suplementados ou não com 5% TMP), PLA, uma formulação comercial (Duraphat®, 5% NaF) e um verniz contendo 5% TMP, foram avaliados quanto a seu efeito remineralizador (lesões artificiais de cárie) e protetor (esmalte hígido), em modelos de ciclagem de pH (7 dias). Um efeito sinérgico foi observado entre F e TMP sobre a porcentagem de recuperação (3ª etapa) e sobre a porcentagem de perda (4ª etapa) de dureza de superfície, bem como sobre ∆KHN (3ª e 4ª etapas). Na 5ª etapa, o efeito remineralizador dos vernizes PLA, 5% NaF e 5% TMP foi avaliado em um protocolo in situ, duplo-cego e cruzado, confirmando os achados da 3ª etapa, em indivíduos utilizando dentifrício fluoretado. Por fim, na 6ª etapa, os vernizes PLA, 5% NaF e 5% NaF + 5% TMP foram avaliados em um estudo clínico randomizado e controlado, conduzido em crianças (n=390, 3-4 anos de idade) e adolescentes (n=570, 11-15 anos de idade) residentes em Boa Vista (RR), os quais receberam aplicações trimestrais dos vernizes e foram acompanhados durante 12 meses. O menos incremento nos índices ceo-s e CPO-S foram observados para o grupo tratado com o verniz 5% NaF + 5% TMP, seguido por 5% NaF e PLA. Concluiu-se que a adição de TMP a vernizes fluoretados é uma alternativa promissora na prevenção e tratamento de lesões de cárie, com potencial aplicação na redução do desgaste dental erosivo(AU)

The present study assessed the effect of fluoridated varnishes containing sodium trimetaphosphate (TMP) on the demineralization, remineralization and erosive wear of dental enamel, using in vitro and in situ protocols, as well as on the development of caries lesions in children and adolescents, in a randomized and controlled clinical protocol. The study was conducted in 6 different phases. Phases 1 to 5 were performed using bovine dental enamel specimens, over which the varnishes were applied only once, remaining in contact for 6 hours. In the first phase, varnishes containing 5% NaF (positive control), 2.5% NaF supplemented with O, 3.5, 5.0 and 10.0% TMP, and also a formulation without F or TMP (PLA, placebo) were tested in an in vitro protocol. The specimens were submitted to erosive challenges (ERO -Sprite Zero®, 5 min, 4x/ day, 5 days), followed or not by brushing (ERO+ABR). In the second phase, the effect of PLA, 5% NaF and 2.5% NaF varnishes (supplemented or not with 5% TMP) on ERO and ERO+ABR were analyzed in situ. Volunteers (n=10) used acrylic palatal devices containing 4 blocks of enamel. ERO was performed ex vivo (immersion in citric acid, 5 min, 4x/day, 5 days), while ERO+ABR was produced by brushing 2 of the blocks (15 s, F-free dentifrice). In both phases, the varnishes containing TMP promoted significantly lower wear and integrated hardness loss in depth (∆KHN) when compared to the other varnishes, both for ERO and ERO+ABR. In the 3rd and 4th phases, varnishes containing 2.5% NaF and 5% NaF, supplemented or not with 5% TMP, PLA, a commercial formulation (Duraphat®, 5% NaF) and a varnish containing 5% TMP were assessed regarding their remineralizing (artificial caries lesions) and protective (sound enamel) effects, using pH cycling models (7 days). A synergistic effect between F and TMP was observed on the percentage of surface hardness recovery (3rd phase), on the percentage of surface hardness loss (4th stage), as well as on ΔKHN (3rd and 4th stages). In the 5th stage, the remineralizing effect of PLA, 5% NaF and 5% NaF + 5% TMP varnishes was evaluated using a short-term (3 days) in situ protocol, confirming the findings of the 3rd phase, in individuals using fluoridated dentifrice. Finally, in the 6 th phase, PLA, 5% NaF and 5% NaF + 5% TMP varnishes were evaluated in a randomized controlled trial conducted in children (n = 390, 3-4 years of age) and adolescents (n = 570, 11-15 years of age) living in Boa Vista (northern region of Brazil), who received quarterly applications of the varnishes and were examined along a 12-month period. The lowest dmfs and DMFS increments were observed for the groups treated with 5% NaF + 5% TMP varnish, followed by 5% NaF and PLA. It was concluded that the addition of TMP to fluoride varnishes is a promising alternative in the prevention and treatment of caries lesions, with potential application in the reduction of erosive dental wear(AU)

Fluoride and sodium trimetaphosphate (TMP) release from fluoride varnishes supplemented with TMP

Abstract This study assessed fluoride (F) and sodium trimetaphosphate (TMP) release into artificial saliva from varnishes containing 0%, 2.5%, and 5% NaF, supplemented or not with 5% TMP. The varnishes were applied on polyester sheets (n = 8/group), and F and TMP released into artificial saliva were measured for up to 24 hours. The amount of F and TMP released were directly related to NaF and TMP concentrations in the varnishes. The highest F release was seen for 5% NaF and 5% NaF + 5% TMP, whereas 5% TMP released the highest amount of TMP. However, the simultaneous addition of NaF and TMP to varnishes significantly reduced the amount of F and TMP released from the products.

In situ protocol for the determination of dose-response effect of low-fluoride dentifrices on enamel remineralization

No in situ protocol has assessed the dose-response effects of fluoride dentifrices involving low-fluoride formulations. Objective: To assess the ability of an in situ remineralization model in determining dose-response effects of dentifrices containing low fluoride concentrations ([F]) on bovine enamel. Material and Methods: Volunteers wore palatal appliances containing demineralized enamel blocks and brushed their teeth and devices with the dentifrices supplied (double-blind, crossover protocol) separately for 3 and 7 days. Surface hardness (SH), integrated subsurface hardness (ΔKHN) and [F] in enamel were determined. Data were analyzed by ANOVA, Tukey's test and Pearson's correlation (p<0.05). Results: Dose-response relationships were verified between [F] in dentifrices and SH, ΔKHN and enamel [F]. Higher correlation coefficients between enamel [F] and SH and ΔKHN were obtained for the 3-day period. Significant differences in SH and ΔKHN were observed among all groups for the 3-day period, but not between 0-275, 275-550, and 550-1,100 µg F/g dentifrices for the 7-day period, nor between 3- and 7-day periods for the 1,100 µg F/g groups. Conclusions: Considering that the peak remineralization capacity of the conventional dentifrice (1,100 µg F/g) was achieved in 3 days, this experimental period could be used in future studies assessing new dentifrice formulations, especially at low-fluoride concentrations. .

Supplementation of soft drinks with metallic ions reduces dissolution of bovine enamel

OBJECTIVE: The aim of this study was to evaluate the effect of the addition of metallic ions to carbonated drinks on their erosive potential. MATERIAL AND METHODS: Powdered enamel was added to carbonated beverages (Coca-ColaTM or Sprite ZeroTM and shaken for 30 s. The samples were then immediately centrifuged and the supernatant removed. This procedure was repeated 5 times with the beverages containing Cu2+, Mg2+, Mn2+ or Zn2+ (1.25-60 mmol/L). For Coca-ColaTM, the concentration of each ion that exhibited the highest protection was also evaluated in combination with Fe2+. The phosphate or calcium released were analyzed spectrophotometrically. Data were analyzed using ANOVA and Tukey's test (p<0.05). RESULTS: For Coca-ColaTM, the best protective effect was observed for Zn2+ alone (10 mmol/L) or in combination (1 mmol/L) with other ions (12% and 27%, respectively, when compared with the control). Regarding Sprite ZeroTM, the best protective effect was observed for Cu2+ at 15 and 30 mmol/L, which decreased the dissolution by 22-23%. Zn2+ at 2.5 mmol/L also reduced the dissolution of powdered enamel by 8%. CONCLUSIONS: The results suggest that the combination of metallic ions can be an alternative to reduce the erosive potential of Coca-ColaTM. Regarding Sprite ZeroTM, the addition of Cu2+ seems to be the best alternative. .

Seven years of external control of fluoride levels in the public water supply in Bauru, São Paulo, Brazil

Fluoridation of the public water supplies is recognized as among the top ten public health achievements of the twentieth century. However, the positive aspects of this measure depend on the maintenance of fluoride concentrations within adequate levels. Objective: To report the results of seven years of external control of the fluoride (F) concentrations in the public water supply in Bauru, SP, Brazil in an attempt to verify, on the basis of risk/benefit balance, whether the levels are appropriate. Material and Methods: From March 2004 to February 2011, 60 samples were collected every month from the 19 supply sectors of the city, totaling 4,641 samples. F concentrations in water samples were determined in duplicate, using an ion-specific electrode (Orion 9609) coupled to a potentiometer after buffering with TISAB II. After the analysis, the samples were classified according to the best risk-benefit adjustment. Results: Means (±standard deviation) of F concentrations ranged between 0.73±0.06 and 0.81±0.10 mg/L for the different sectors during the seven years. The individual values ranged between 0.03 and 2.63 mg/L. The percentages of the samples considered “low risk” for dental fluorosis development and of “maximum benefit” for dental caries prevention (0.55-0.84 mg F/L) in the first, second, third, fourth, fifth, sixth, and seventh years of the study were 82.0, 58.5, 37.4, 61.0, 89.9, 77.3, and 72.4%, respectively, and 69.0% for the entire period. Conclusions: Fluctuations of F levels were found in the public water supply in Bauru during the seven years of evaluation. These results suggest that external monitoring of water fluoridation by an independent assessor should be implemented in cities where there is adjusted fluoridation. This measure should be continued in order to verify that fluoride levels are suitable and, if not, to provide support for the appropriate adjustments.

Urinary fluoride output in children following the use of a dual-fluoride varnish formulation

OBJECTIVE: This study evaluated the bioavailability of fluoride after topical application of a dual-fluoride varnish commercially available in Brazil, when compared to DuraphatTM. MATERIAL AND METHODS: The urinary fluoride output was evaluated in seven 5-year-old children after application of the fluoride varnishes, in two different phases. In the first phase (I), children received topical application of the fluoride varnish Duofluorid XII (2.92 percent fluorine, calcium fluoride + 2.71 percent fluorine, sodium fluoride, FGM TM). After 1-month interval (phase II), the same amount (0.2 mL) of the fluoride varnish Duraphat (2.26 percent fluorine, sodium fluoride, ColgateTM) was applied. Before each application all the volunteers brushed their teeth with placebo dentifrice for 7 days. Urinary collections were carried out 24 h prior up to 48 h after the applications. Fluoride intake from the diet was also estimated. Fluoride concentration in diet samples and urine was analyzed with the fluoride ion-specific electrode and a miniature calomel reference electrode coupled to a potentiometer. Data were tested by ANOVA and Tukey's post hoc test (p<0.05). RESULTS: There were significant differences in the urinary fluoride output between phases I and II. The use of Duofluorid XII did not significantly increase the urinary fluoride output, when compared to baseline levels. The application of Duraphat caused a transitory increase in the urinary fluoride output, returning to baseline levels 48 h after its use. CONCLUSIONS: The tested varnish formulation, which has been shown to be effective in in vitro studies, also can be considered safe.

Incorporação de flúor no biofilme dentário e fluido do biofilme após o uso de dentifrícios convencional e com concentração reduzida de flúor, em comunidades com diferentes níveis de flúor na água de abastecimento / Fluoride uptake by dental biofilm and biofilm fluid after the use of conventional and low-fluoride dentifrices in communities with different fluoride levels in the drinking water

Avaliou-se a incorporação de flúor (F) no biofilme dentário e fluido do biofilme após o uso de dentifrícios convencional(DC) e com concentração reduzida de F(DCR). A hipótese do estudo foi de que o uso do DCR levaria a uma incorporação proporcionalmente mais alta no biofilme, principalmente nas camadas mais profundas do mesmo, e que estes aumentos seriam refletidos no fluido do biofilme. Na primeira etapa, foram comparadas as concentrações de F e cálcio (Ca) presentes no biofilme após o uso de dentifrícios contendo 0 (dentifrício placebo–DP), 513(DCR) e 1.072(DC) ppm F, em crianças residentes em comunidades contendo 0,04(A), 0,72(B) e 3,36(C) ppm F na água de abastecimento. Seguindo um protocolo duplo-cego e cruzado, as crianças escovaram seus dentes 2 vezes ao dia, durante 7 dias. Amostras de biofilme foram coletadas 1 e 12 horas após a última escovação. Na segunda e terceira etapas, conduzidas somente na comunidade B, avaliou-se a incorporação de F em secções seriais de biofilme formado utilizando “dispositivos in situ de Leeds”, bem como a concentração de F no fluido do biofilme, respectivamente, empregando o protocolo descrito anteriormente. As análises de F foram realizadas após extração ácida (biofilme total), por cromatografia iônica (secções de biofilme) e após tamponamento com TISAB III (fluido do biofilme). As análises de Ca foram realizadas por espectrometria de absorção atômica (primeira e segunda etapas) e por método colorimétrico (terceira etapa). Os dados foram analisados por ANOVA, testes de Tukey e Bonferroni e Análise de Regressão Linear (p<0,05). Na primeira etapa, as concentrações de F estavam diretamente relacionadas às concentrações de F na água de abastecimento, independentemente do dentifrício utilizado. O uso dos dentifrícios fluoretados levou a aumentos significativos nas concentrações de F no biofilme 1h após o uso dos mesmos nas comunidades A e B apenas. Aumentos virtualmente idênticos foram observados 1h após a escovação com o DCR...

This study evaluated fluoride (F) uptake by dental biofilm and biofilm fluid after the use of conventional (CD) and low-fluoride (LFD) dentifrices. The hypothesis of the study was that the use of LDF would lead to a proportionally higher F uptake by the biofilm, mainly in the deepest layers of it, and that such increases would be reflected in the biofilm fluid. In the first phase, F and calcium (Ca) concentrations in the biofilm were compared after the use of dentifrices containing 0 (placebo dentifrice–PD), 513 and 1,072 ppm F, in children living in communities containing 0.04(A), 0.72(B) and 3.36(C) ppm F in the drinking water. Following a double-blind, crossover protocol, children brushed their teeth twice daily, during seven days. Samples of biofilm were collected on the seventh day, 1 and 12 h after the last use of the dentifrices. In the second and third phases, which were conducted only in the community B, we evaluated F uptake in serial sections of biofilms formed using the “Leeds in situ devices”, as well as in the biofilm fluid, respectively, following the same protocol described for the first phase. F analyses were carried out after acid extraction (whole biofilm), by ion chromatography (sections of biofilm) and after buffering with TISAB III (biofilm fluid). Analyses of Ca were done by atomic absorption spectrometry (first and second phases) and colorimetrically (third phase). Results were analyzed by ANOVA, Tukey’s and Bonferroni’s tests, by linear regression analysis and by Pearson’s correlation (p<0.05). For the first phase, mean biofilm F concentrations were directly related to F concentrations in water, regardless of the dentifrice used. The use of the fluoridated dentifrices led to significant increases in F concentrations in the biofilm 1 h after their use, in the communities A and B only. Virtually identical increases were observed 1 h after brushing with CD (ca.1.9 mmolF/kg) and LFD (ca.2.4 mmolF/kg) in the communities A and B when...

Incorporação de flúor no biofilme dentário e fluido do biofilme após o uso de dentifrícios convencional e com concentração reduzida de flúor, em comunidades com diferentes níveis de flúor na água de abastecimento / Fluoride uptake by dental biofilm and biofilm fluid after the use of conventional and low-fluoride dentifrices in communities with different fluoride levels in the drinking water

Avaliou-se a incorporação de flúor (F) no biofilme dentário e fluido do biofilme após o uso de dentifrícios convencional(DC) e com concentração reduzida de F(DCR). A hipótese do estudo foi de que o uso do DCR levaria a uma incorporação proporcionalmente mais alta no biofilme, principalmente nas camadas mais profundas do mesmo, e que estes aumentos seriam refletidos no fluido do biofilme. Na primeira etapa, foram comparadas as concentrações de F e cálcio (Ca) presentes no biofilme após o uso de dentifrícios contendo 0 (dentifrício placebo–DP), 513(DCR) e 1.072(DC) ppm F, em crianças residentes em comunidades contendo 0,04(A), 0,72(B) e 3,36(C) ppm F na água de abastecimento. Seguindo um protocolo duplo-cego e cruzado, as crianças escovaram seus dentes 2 vezes ao dia, durante 7 dias. Amostras de biofilme foram coletadas 1 e 12 horas após a última escovação. Na segunda e terceira etapas, conduzidas somente na comunidade B, avaliou-se a incorporação de F em secções seriais de biofilme formado utilizando “dispositivos in situ de Leeds”, bem como a concentração de F no fluido do biofilme, respectivamente, empregando o protocolo descrito anteriormente. As análises de F foram realizadas após extração ácida (biofilme total), por cromatografia iônica (secções de biofilme) e após tamponamento com TISAB III (fluido do biofilme). As análises de Ca foram realizadas por espectrometria de absorção atômica (primeira e segunda etapas) e por método colorimétrico (terceira etapa). Os dados foram analisados por ANOVA, testes de Tukey e Bonferroni e Análise de Regressão Linear (p<0,05). Na primeira etapa, as concentrações de F estavam diretamente relacionadas às concentrações de F na água de abastecimento, independentemente do dentifrício utilizado. O uso dos dentifrícios fluoretados levou a aumentos significativos nas concentrações de F no biofilme 1h após o uso dos mesmos nas comunidades A e B apenas. Aumentos virtualmente idênticos foram observados 1h após a escovação com o DCR...

This study evaluated fluoride (F) uptake by dental biofilm and biofilm fluid after the use of conventional (CD) and low-fluoride (LFD) dentifrices. The hypothesis of the study was that the use of LDF would lead to a proportionally higher F uptake by the biofilm, mainly in the deepest layers of it, and that such increases would be reflected in the biofilm fluid. In the first phase, F and calcium (Ca) concentrations in the biofilm were compared after the use of dentifrices containing 0 (placebo dentifrice–PD), 513 and 1,072 ppm F, in children living in communities containing 0.04(A), 0.72(B) and 3.36(C) ppm F in the drinking water. Following a double-blind, crossover protocol, children brushed their teeth twice daily, during seven days. Samples of biofilm were collected on the seventh day, 1 and 12 h after the last use of the dentifrices. In the second and third phases, which were conducted only in the community B, we evaluated F uptake in serial sections of biofilms formed using the “Leeds in situ devices”, as well as in the biofilm fluid, respectively, following the same protocol described for the first phase. F analyses were carried out after acid extraction (whole biofilm), by ion chromatography (sections of biofilm) and after buffering with TISAB III (biofilm fluid). Analyses of Ca were done by atomic absorption spectrometry (first and second phases) and colorimetrically (third phase). Results were analyzed by ANOVA, Tukey’s and Bonferroni’s tests, by linear regression analysis and by Pearson’s correlation (p<0.05). For the first phase, mean biofilm F concentrations were directly related to F concentrations in water, regardless of the dentifrice used. The use of the fluoridated dentifrices led to significant increases in F concentrations in the biofilm 1 h after their use, in the communities A and B only. Virtually identical increases were observed 1 h after brushing with CD (ca.1.9 mmolF/kg) and LFD (ca.2.4 mmolF/kg) in the communities A and B when...

Slow-release fluoride devices: a literature review

Although the prevalence of caries has decreased dramatically over the past decades, it has become a polarised disease, with most of subjects presenting low caries levels and few individuals accounting for most of the caries affected surfaces. Thus it become evident for the need of clinical approaches directed at these high-risk patients, in order to overcome problems related to compliance and low attendance at dental care centres. Slow-release fluoride devices were developed based on the inverse relationship existing between intra-oral fluoride levels and dental caries experience. The two main types of slow-release devices - copolymer membrane type and glass bead - are addressed in the present review. A substantial number of studies have demonstrated that these devices are effective in raising intra-oral F concentrations at levels able to reduce enamel solubility, resulting in a caries-protective effect. Studies in animals and humans demonstrated that the use of these devices was able to also protect the occlusal surfaces, not normally protected by conventional fluoride regimens. However, retention rates have been shown to be the main problem related to these devices and still requires further improvements. Although the results of these studies are very promising, further randomised clinical trials are needed in order to validate the use of these devices in clinical practice. The concept of continuously providing low levels of intra-oral fluoride has great potential for caries prevention in high caries-risk groups.

Concentração de flúor em águas engarrafadas comercializadas no município de São Paulo / Fluoride concentration in bottled water on the market in the municipality of São Paulo

O objetivo do estudo foi avaliar a concentração de flúor na água engarrafada comercializada, comparando-a aos valores impressos no rótulo da embalagem. Foram coletadas 229 amostras de água das 35 marcas disponíveis em diversos supermercados, mercearias e lanchonetes de grande circulação nas diferentes regiões do município de São Paulo, em 2006. A concentração de flúor foi determinada por análise em duplicata, utilizando o eletrodo íon-específico. A concentração de flúor variou entre 0,01 e 2,04 mg/l, com diferenças significantes entre os valores estipulados nos rótulos e os encontrados com a análise. Esses resultados reforçam a importância do controle dos níveis de flúor na água engarrafada por parte da vigilância sanitária.

The objective of the study was to evaluate the fluoride concentration in bottled water available on the market, in comparison with the values printed on the bottle label. Two hundred and twenty-nine water samples were collected from 35 brands available in several supermarkets, grocery stores and snack bars with high turnover in different regions of the municipality of São Paulo, Southeastern Brazil, in 2006. Fluoride concentrations were determined by duplicate analysis using an ion-specific electrode. The fluoride concentrations ranged from 0.01 to 2.04 mg/l, with significant differences between the values stipulated on labels and those found in the analyses. These results emphasize the importance of controls over fluoride levels in bottled water enforced by the sanitary surveillance agency.

Regional odontodysplasia: case report

Regional odontodysplasia (RO) is a rare developmental anomaly involving both mesodermal and ectodermal dental components in a group of contiguous teeth. It affects the primary and permanent dentitions in the maxilla and mandible or both jaws. Generally it is localized in only one arch. The etiology of this dental anomaly is uncertain. Clinically, affected teeth have an abnormal morphology, are soft on probing and typically discolored, yellow or yellowish-brown. Radiographically, the affected teeth show a "ghostlike" appearance. This paper reports the case of a 5-year-old girl presenting this rare anomaly on the left side of the maxillary arch, which crossed the midline. The primary maxillary left teeth (except for the canine) and the primary maxillary right central incisor were missing due to previous extractions. The permanent teeth had a "ghostlike" appearance radiographically. The treatment performed was rehabilitation with temporary partial acrylic denture and periodic controls. In the future, the extraction of affected permanent teeth and rehabilitation with dental implants will be evaluated. The presentation of this case adds valuable information to pediatric dentists to review special clinical and radiographic features of RO, which will facilitate the diagnosis and treatment of patients with this condition.

Liberação e recarga de flúor de uma nova formulação de ionômero de vidro / Fluoride release and recharge of a new glass ionomer cement formulation

Avaliou-se a liberação de flúor de uma nova formulação de cimento de ionômero de vidro convencional (Maxxion R®), comparando-o a outros materiais restauradores (Fuji II LC®, Vidrion R® e Dyract AP®) durante dois períodos: 15 dias antes e sete dias após a aplicação tópica de flúor-fosfato acidulado 1,23% (FFA). Foram confeccionados para cada material sete corpos de prova que foram imersos em 4 mL de água deionizada. As dosagens da concentração de flúor das soluções foram realizadas em intervalos de 24 horas, durante 15 dias. Após este período, os corpos de prova de cada material receberam tratamento com gel de FFA durante um minuto. O flúor liberado foi analisado em intervalos de 24 horas durante sete dias. A análise de variância e o teste de Tukey mostraram que o Maxxion R® liberou mais flúor que os demais materiais testados durante todos os dias (p< 0,05). Após a recarga com flúor fosfato acidulado 1,23%, o Maxxion R® mostrou padrão de liberação de flúor superior ao Vidrion R® e Dyract AP® em todos os dias, com diferenças estatisticamente signifcativas (p<0,05). Quando comparado ao Fuji II LC®, o Maxxion R® mostrou maior liberação de flúor nos dias 1, 5 e 7, (p<0,05). Concluiu-se que a nova formulação de ionômero de vidro (Maxxion R®) apresentou melhor padrão de liberação de flúor antes e após a recarga.

Fluoride concentrations in industrialized beverages consumed by children in the city of Bauru, Brazil

The increasing consumption of juices, soft drinks and teas among children has increased significantly fluoride ingestion at the age range of risk for development of dental fluorosis. Objective: The purpose of this study was to evaluate fluoride concentrations in some brands of industrialized beverages consumed by children in the city of Bauru, SP, Brazil. Material and Methods: 98 brands of beverages were analyzed, divided into 3 lots, comprising 36, 32 and 30 brands, respectively, for the first, second and third lots. Fluoride concentrations were determined by HMDS-facilitated diffusion, using a fluoride ion-specific electrode (Orion 9409). Results: Fluoride concentrations ranged between 0.04 and 1.76 µg F/mL. It was observed a wide variation in fluoride concentrations among the different brands, as well as the different lots of the same brand. There was no information on fluoride concentrations on the labels of any product. Conclusions: Some of the products analyzed could contribute significantly to the total fluoride intake and, thus, be important risk factors for development of dental fluorosis, which indicates the need of controlling the production of these beverages with respect to fluoride concentration.

Prevalence of dental fluorosis in Bauru, São Paulo, Brazil

OBJECTIVE: To evaluate the prevalence of dental fluorosis in scholars aging 12 to 15 years old, residents in the city of Bauru, State of São Paulo, Brazil. METHODS: 1318 volunteers were enrolled in this study and examined in 18 public schools of the State of São Paulo. The examinations were performed in the schools' court by three dentists (with a Master's degree in Public Health), after toothbrushing supervised by another dentist. The teeth were dried with cotton pellets and examined under natural light by visual inspection, using an explorer as recommended by the WHO, a plane mirror and a tongue depressor. The Thylstrup-Fejerskov (TF) index was used for rating fluorosis. Intra and inter-examiner reproducibility was calculated and data were submitted to descriptive analysis. RESULTS: Approximately 36 percent of the children presented dental fluorosis, of which 28 percent was diagnosed as TF1 while the remaining received scores between TF2 and TF4. CONCLUSION: The prevalence of dental fluorosis in Bauru is within the expected range, based on previous studies. Although fluoride is an important resource for caries control, its use must be adequate to the needs of each specific population.