Dispensing Device to Deliver Small and Standardized Amount of Fluoride Dentifrice on the Toothbrush

Abstract Objective: To evaluate the efficacy of a dispensing device specially developed to standardize the amount of fluoride dentifrice to be delivered on the toothbrush. The amount and variability of dentifrice applied using this device were compared with recommendations to apply dentifrice amounts equivalent to "rice size" or "pea-size". Material and Methods: Two dentifrices, one used by children (NaF/Silica-based) and one used by the entire family (MFP/CaCO3-based), and five methods to apply them on the toothbrush (pea and rice sizes, and three different amounts using the developed device) were tested by 12 volunteers. The amount of dentifrice placed on the toothbrush was weighed, and the experiment was repeated three times. Data were analyzed by two-way ANOVA and Tukey test. Results: No differences were observed between the dentifrices used (p>0.05), but the method of application significantly affected the amount of dentifrice applied (p<0.05). Smaller amounts (p<0.05) and less variability were observed when the volunteers used the dispenser device than when they were asked to apply a pea or rice size. Conclusion: The device can help parents and caregivers to safely use fluoride dentifrice on children.

Impact of sense of coherence on oral health-related quality of life among Brazilian adults

Abstract It has been postulated that oral health-related quality of life (OHRQoL) may be affected by the sense of coherence (SOC), but there are no epidemiological studies investigating this association in Brazilian adults. The present study was conducted among adults of a mid-sized Brazilian city, with the aim of looking into this association. The probability sampling consisted of 342 adults aged 35-44 years old, from a mid-sized Brazilian city, who were examined at their homes for caries (Decayed, Missing and Filled Teeth [DMFT] Index) and periodontal disease (Community Periodontal Index - CPI), according to WHO criteria. The questionnaire applied included demographic factors, socioeconomic information, use of dental services, behavior, SOC and the Oral Health Impact Profile (OHIP). The OHIP outcome, measured by prevalence of the impact, was analyzed by binary logistic regression using a hierarchical approach, a conceptual model, and a 5% significance level. A total of 67.9% of the respondents had one or more impacts on OHRQoL, and 54.4% showed a high SOC. The impact on OHRQoL was more prevalent in adults who had a manual occupation (PR = 2.47, 95%CI 1.24-4.93), those who perceived the need for dental treatment (PR = 2.93, 95%CI 1.67-5.14), and those who had untreated caries (PR = 1.93, 95%CI 1.07-3.47). Those with a low SOC had a twofold higher prevalence of impact on OHRQoL (PR = 2.19, 95%CI 1.29-3.71). This impact on OHRQoL was associated with a low SOC, even after adjusted by socioeconomic, behavioral and clinical factors. Future studies should consider the SOC in determining the oral health impact on quality of life.

Anticaries Potential of Low Fluoride Dentifrices Found in The Brazilian Market

Abstract Low-fluoride (F) dentifrices (<600 µg F/g) are widely available worldwide, but evidence to recommend the use of such dentifrices, with either regular or improved formulations, is still lacking. Therefore, the aim of this study was to evaluate the anticaries potential of low-F dentifrices found in the Brazilian market, using a validated and tested pH-cycling model. Enamel blocks were selected by surface hardness (SH) and randomized into four treatment groups (n=12): non-F dentifrice (negative control), low-F dentifrice (500 μg F/g), low-F acidulated dentifrice (550 μg F/g) and 1,100 μg F/g dentifrice (positive control). The blocks were subjected to pH-cycling regimen for 8 days and were treated 2x/day with dentifrice slurries prepared in water (1:3, w/v). The pH of the slurries was checked, and only the acidulated one had low pH. After the pH cycling, SH was again determined and the percentage of surface hardness loss was calculated as indicator of demineralization. Loosely- and firmly-bound F concentrations in enamel were also determined. The 1,100 μg F/g dentifrice was more effective than the low-F ones to reduce enamel demineralization and was the only one that differed from the non-F (p<0.05). All F dentifrices formed higher concentration of loosely-bound F on enamel than the non-F (p<0.05), but the 1,100 μg F/g was the only one that differed from the non-F in the ability to form firmly-bound F. The findings suggest that the low-F dentifrices available in the Brazilian market, irrespective of their formulation, do not have anticaries potential.

Resumo Dentifrícios de baixa concentração de fluoreto (F) (< 600 µg F/g) estão amplamente disponíveis no mundo, mas ainda não há evidência para recomendar seu uso, quer seja em formulações regulares ou melhoradas. Assim, o objetivo deste estudo foi avaliar o potencial anticárie de dentifrícios de baixa concentração de fluoreto encontrados no mercado brasileiro, utilizando um modelo de ciclagens de pH validado e testado. Blocos de esmalte bovinos foram selecionados pela dureza de superfície e randomizados em quatro grupos (n=12): dentifrício sem fluoreto (controle negativo), dentifrício de baixa concentração de fluoreto (500 μg F/g), dentifrício acidulado de baixa concentração de fluoreto (550 μg F/g) e dentifrício de 1100 μg F/g (controle positivo). Os blocos foram submetidos ao regime de ciclagem de pH por 8 dias e tratados 2 x/dia com suspensões aquosas dos dentifrícios (1:3 p/v). O pH das suspensões foi checado, e apenas o acidulado tinha baixo pH. Após a ciclagem de pH, a dureza de superfície foi novamente determinada e a porcentagem de perda de dureza foi calculada como indicador de demineralização. As concentrações de fluoreto fracamente e firmemente ligado ao esmalte também foram determinadas. O dentifrício de 1.100 μg F/g foi mais efetivo do que os de baixa concentração na redução da desmineralização do esmalte e foi o único que diferiu significativamente do não fluoretado (p<0,05). Todos os dentifrícios fluoretados foram capazes de formar maiores concentrações de fluoreto fracamente ligado ao esmalte do que o não fluoretado (p<0,05), mas o de 1.100 μg F/g foi o único que diferiu do não fluoretado na capacidade de formar fluoreto firmemente ligado ao esmalte. Os resultados sugerem que dentifrícios de baixa concentração de fluoreto disponíveis no mercado brasileiro, independentemente da formulação, não têm potencial anticárie.

Concentração de fluoreto nos dentifrícios a base de MFP/CaCO3 mais vendidos no Brasil, ao final dos seus prazos de validade / Fluoride concentration in most sold MFP/CaCO3 -based Brazilian toothpastes at the expiration time

Dentifrício fluoretado deve conter pelo menos 1.000 ppm (mg F/kg) do seu flúor total (FT) na forma quimicamente solúvel (FST) para ter o potencial máximo de interferir com o processo de cárie. Em formulações de dentifrícios contendo cálcio no abrasivo, a concentração de FST (íon flúor + íon MFP) diminui em função do tempo de armazenamento. Os quatro dentifrícios a base de MFP/CaCO3 mais vendidos no Brasil são capazes de manter 1.000 ppm de FST nos produtos pelo prazo de um ano de fabricação, mas não é conhecido o que ocorre até o final do prazo de validade. Assim, o objetivo deste estudo foi avaliar a concentração de FST nesses dentifrícios ao final do seu prazo de validade. Após as análises iniciais realizadas em 2010, os cremes dentais (n=30) foram armazenados à temperatura laboratorial (25°C) e as concentrações de FT e FST foram novamente determinadas em 2012, próximo a data de vencimento (36 meses). As análises foram feitas utilizando protocolo validado de extração, as determinações foram feitas com eletrodo íon específico e os resultados expressos em ppm F (mg F/kg). A concentração (média±dp;n=30) de FT encontrada (1.415,2±62,8) estava de acordo com o declarado pelo fabricante (1.450 ppm F), porém a de FST foi 44% menor (814,7±74,7). Ao final do prazo de validade, os dentifrícios brasileiros mais vendidos não mantêm uma concentração de FST máxima desejável, mostrando tanto a importância do Cirurgião-Dentista na orientação do paciente como a necessidade da revisão da resolução Anvisa nº 79 que regulamenta a matéria sobre dentifrícios

Fluoride toothpaste should contain at least 1,000 ppm (mg F/kg) of fluoride chemically soluble to have the maximum potential to interfere with the caries process. In formulations containing calcium--based abrasives, the concentration of total soluble fluoride (TSF = fluoride ion + MFP ion) decreases according to the storage time. The four MFP/CaCO3-based toothpastes most consumed in Brazil are able to maintain 1,000 ppm of TSF throughout one year of manufacturing, but it is not known if it would be maintained up to the expiration date. Thus, this study evaluated the concentration of TSF in these toothpastes at the end of expiration date. As control, the total fluoride (TF) concentration was also determined. After the analysis of fresh samples conducted in 2010, the toothpastes tube (n=30) were stored at temperature of 25°C and the determinations of TF and TSF concentrations were again assessed in 2012, close to the expiration date of the toothpastes (3 years). The analyses were made using a validated protocol of extraction, the determinations were made with an ion specific electrode and the results were expressed in ppm F (mg F/kg). The concentration (mean±SD;n=30) of TF found (1.415.2±62.8) was according to the declared by the manufacturer (1.450 ppm), but the TSF was 44% lower (814.7±74.7). At expiration, the most sold MFP/CaCO3-based brazilian toothpastes do not maintain the maximum TSF concentration required, showing not only the relevance of the Dentist to advise the patients about this subject, but also the necessity to review the Brazilian regulation about toothpastes

Titratable acidity of beverages influences salivary pH recovery

A low pH and a high titratable acidity of juices and cola-based beverages are relevant factors that contribute to dental erosion, but the relative importance of these properties to maintain salivary pH at demineralizing levels for long periods of time after drinking is unknown. In this crossover study conductedin vivo, orange juice, a cola-based soft drink, and a 10% sucrose solution (negative control) were tested. These drinks differ in terms of their pH (3.5 ± 0.04, 2.5 ± 0.05, and 5.9 ± 0.1, respectively) and titratable acidity (3.17 ± 0.06, 0.57 ± 0.04 and < 0.005 mmols OH- to reach pH 5.5, respectively). Eight volunteers with a normal salivary flow rate and buffering capacity kept 15 mL of each beverage in their mouth for 10 s, expectorated it, and their saliva was collected after 15, 30, 45, 60, 90, and 120 s. The salivary pH, determined using a mini pH electrode, returned to the baseline value at 30 s after expectoration of the cola-based soft drink, but only at 90 s after expectoration of the orange juice. The salivary pH increased to greater than 5.5 at 15 s after expectoration of the cola drink and at 30 s after expectoration of the orange juice. These findings suggest that the titratable acidity of a beverage influences salivary pH values after drinking acidic beverages more than the beverage pH.

Necessity to review the Brazilian regulation about fluoride toothpastes / Necessidade de revisão da regulamentação brasileira sobre dentifrícios fluoretados

The aim of this study was to evaluate the adequacy of the Brazilian legislation about fluoride toothpaste. A search was conducted in LILACS, Medline and SciELO databases about the fluoride concentration found in Brazilians toothpastes, using descriptors on health. Publications since 1981 have shown that some Brazilian toothpastes are not able to maintain, during their expiration time, a minimum of 1,000 ppm F of soluble fluoride in the formulation. However, the Brazilian regulation (ANVISA, Resolution 79, August 28, 2000) only sets the maximum total fluoride (0.15%; 1,500 ppm F) that a toothpaste may contain but not the minimum concentration of soluble fluoride that it should contain to have anticaries potential, which according to systematic reviews should be 1,000 ppm F. Therefore, the Brazilian regulation on fluoride toothpastes needs to be revised to assure the efficacy of those products for caries control.

O presente estudo analisou a adequação da regulamentação brasileira vigente sobre dentifrícios fluoretados. Foi realizada busca da literatura sobre a concentração de flúor nos dentifrícios brasileiros, tendo como fontes Lilacs, Medline e SciELO, com uso de descritores em saúde. Publicações sobre a composição de dentifrícios fluoretados brasileiros têm mostrado desde 1981 que nem todos os dentifrícios são capazes de manter durante o prazo de validade uma concentração mínima de 1.000 ppm F. Esse problema ocorre não só com dentifrícios adquiridos no mercado como com aqueles distribuídos por serviços públicos de saúde. Entretanto, a legislação brasileira (Resolução 79, Anvisa, 28/8/2000) apenas estabelece que um dentifrício não pode conter mais que 0,15% (1.500 ppm F) de flúor total, sem estabelecer o mínimo de flúor solúvel que ele deveria conter para ter potencial anticárie, a qual de acordo com revisões sistemáticas deve ser igual ou maior que 1.000 ppm F. Concluiu-se que a regulamentação brasileira sobre dentifrícios fluoretados necessita ser revisada, garantindo a eficácia desses produtos para o controle da cárie.

Insoluble NaF in Duraphat® May Prolong Fluoride Reactivity of Varnish Retained on Dental Surfaces

There is no consensus about the clinical recommendation of the time that Duraphat® varnish should be maintained on enamel surfaces without suffering mechanical disturbance by the patient. Considering the importance of calcium fluoride (CaF2)-like reservoirs on the anticaries effect of professional fluoride application, an in vitro study was designed to test the reactivity of Duraphat® varnish with enamel forming these reservoirs as a function of time. Since most fluoride in Duraphat® varnish is insoluble to react and form products on enamel, the relative contribution of the varnish soluble and insoluble fluoride fractions to the reactivity was also evaluated. For this, whole-varnish, containing soluble and insoluble fluoride (total fluoride concentration of 23699±384 µg F/g), or centrifuged varnish, containing only soluble fluoride (fluoride concentration of 258±97 µg F/g), were applied in a standardized manner on enamel slabs (n=8/varnish group/time), which were immersed in continuously renewed artificial saliva for up to 36 h. CaF2-like reservoirs formed on enamel by varnish application were extracted using 1 M KOH and fluoride concentration was measured with ion specific electrode. The results were expressed as µg F/cm2 of enamel area. Whole varnish formed significantly higher fluoride concentration on enamel than centrifuged varnish, reaching maximum concentration at 24 h (22.0±4.5 µg F/cm2). Centrifuged varnish reached maximum concentration at 6 h (3.20±0.81 µg F/cm2). In conclusion, a longer varnish retention time than the usually recommended could improve the anticaries effect of Duraphat® varnish, allowing that NaF particles, initially insoluble in the varnish matrix, prolong the reactivity with enamel.

Não há consenso sobre a recomendação clínica do tempo que o verniz Duraphat® deve ser mantido nas superfícies de esmalte sem ter perturbação mecânica pelo paciente. Considerando a importância dos reservatórios tipo fluoreto de cálcio (“CaF2”) no efeito anticárie da aplicação profissional de fluoreto, um estudo in vitro foi delineado para testar a reatividade do verniz Duraphat® com o esmalte na formação desses reservatórios em função do tempo. Como a maioria do fluoreto no verniz Duraphat® é insolúvel para reagir e formar produtos no esmalte, também se avaliou a contribuição relativa das frações solúvel e insolúvel do verniz na reatividade. Assim, verniz total, contendo fluoreto solúvel e insolúvel (concentração total de 23699±384 µg F/g), ou verniz centrifugado, contendo somente o fluoreto solúvel (concentração de 258±97 µg F/g), foram aplicados de maneira padronizada sobre blocos de esmalte (n =8/grupo de verniz/tempo), os quais foram imersos em saliva artificial com renovação continua por até 36 h. Os reservatórios tipo “CaF2” formados no esmalte pela aplicação do verniz foram extraídos com KOH 1 M e a concentração de F foi medida utilizando um eletrodo específico. Os resultados foram expressos como µg F/cm2. O verniz total formou significativamente maior concentração de fluoreto no esmalte que o verniz centrifugado, atingindo concentrações máximas após 24 h (22,0±4,5 µg F/cm2 de área de esmalte). O verniz centrifugado apresentou a máxima formação após 6 h (3,20 ± 0,81 µg F/cm2). Em conclusão, um tempo maior de retenção do que habitualmente recomendado poderia melhorar o efeito anticárie do verniz Duraphat®, pois partículas de NaF, inicialmente insolúveis na matriz do mesmo, possibilitam uma reatividade prolongada do verniz com o esmalte em função do tempo.

The effect of fluoride toothpaste on root dentine demineralization progression: a pilot study

The anticaries effect of fluoride (F) toothpaste containing 1100 µg F/g in reducing enamel demineralization is well established, but its effect on dentine has not been extensively studied. Furthermore, it has been shown that toothpaste containing a high F concentration is necessary to remineralize root dentine lesions, suggesting that a 1100 µg F/g concentration might not be high enough to reduce root dentine demineralization, particularly when dentine is subjected to a high cariogenic challenge. Thus, the aim of this pilot study was to evaluate in situ the effect of F toothpaste, at a concentration of 1100 µg F/g, on dentine demineralization. In a crossover and double-blind study, conducted in two phases of 14 days, six volunteers wore a palatal appliance containing four slabs of bovine root dentine whose surface hardness (SH) was previously determined and to which a 10% sucrose solution was applied extra-orally 8×/day. Volunteers used a non-F toothpaste (negative control) or F toothpaste (1100 µg F/g, NaF/SiO2) three times a day. On the 10th and 14th days of each phase, two slabs were collected and SH was determined again. Dentine demineralization was assessed as percentage of SH loss (%SHL). The effect of toothpaste was significant, showing lower %SHL for the F toothpaste group (42.0 ± 9.7) compared to the non-F group (62.0 ± 6.4; p < 0.0001), but the effect of time was not significant (p > 0.05). This pilot study suggests that F toothpaste at 1100 µg F/g is able to decrease dentine caries even under a high cariogenic challenge of biofilm accumulation and sugar exposure.

Evidence-based recommendation on toothpaste use

Toothpaste can be used as a vehicle for substances to improve the oral health of individuals and populations. Therefore, it should be recommended based on the best scientific evidence available, and not on the opinion of authorities or specialists. Fluoride is the most important therapeutic substance used in toothpastes, adding to the effect of mechanical toothbrushing on dental caries control. The use of fluoride toothpaste to reduce caries in children and adults is strongly based on evidence, and is dependent on the concentration (minimum of 1000 ppm F) and frequency of fluoride toothpaste use (2'/day or higher). The risk of dental fluorosis due to toothpaste ingestion by children has been overestimated, since there is no evidence that: 1) fluoride toothpaste use should be postponed until the age of 3-4 or older, 2) low-fluoride toothpaste avoids fluorosis and 3) fluorosis has a detrimental effect on the quality of life of individuals exposed to fluoridated water and toothpaste. Among other therapeutic substances used in toothpastes, there is evidence that triclosan/copolymer reduce dental biofilm, gingivitis, periodontitis, calculus and halitosis, and that toothpastes containing stannous fluoride reduce biofilm and gingivitis.

Riscos do uso do dentifrício fluoretado na prevenção e controle de cárie na primeira infância / Risks of fluoride dentifrice in the prevention and control of dental caries in the primary childhood

Dentifrício fluoretado tem sido considerado responsável pelo declínio de carie dentária ocorrida tanto em países desenvolvidos quanto nos em desenvolvimento, como o Brasil. Entretanto, como as crianças involuntariamente ingerem certa quantidade de dentifrício quando escovam os dentes, há preocupação com a fluorose decorrente. Entretanto, o risco em potencial do dentifrício provocar fluorose tem sido estimado com base na dose de ingestão de fluoreto, considerando como limite a dose de 0,07 mg F/dia/kg de peso e não na fluorose decorrente. A dose de ingestão de fluoreto por dentifrícios tem sido superestimada, porque não considera quanto do fluoreto ingerido está biodisponível para ser absorvido e provocar fluorose. A falta de associação entre dose de ingestão e fluorose tem sidomostrada experimentalmente e comprovada epidemiologicamentepelo grau não preocupante de fluorose encontrado, possibilitandoratificar a importância da recomendação do uso de dentifríciofluoretado para o controle de cárie, sem grandes preocupações compossíveis efeitos colaterais.

Fluoride toothpaste has been considered responsible for the cariesdecline which occurred either in developed or in developing countries, such as Brazil. However, since children inadvertently ingest a certain amount of toothpaste while brushing their teeth, there is a concern on the subsequent fluorosis. Nevertheless, the potential risk of fluorosis from fluoride toothpaste has been overestimated based on the dose offluoride ingested, considering as limit the dose of 0.07 mg F/kg bodyweight/day, and not on the actual fluorosis outcome. The dose offluoride ingestion from toothpastes has been overestimated because Itdoes not consider how much of fluoride is bioavailable to be absorbed and cause fluorosis. The lack of association between ingestion dose and fluorosis has been shown experimentally and observed epidemiologically by the mild degree of fluorosis found, which enables us to ratify the importance of the recommendation of fluoride toothpaste for caries control in young children, with few concerns on possible side effects.

Calcium binding to S. mutans grown in the presence or absence of sucrose

Sucrose is the most cariogenic dietary carbohydrate because it is a substrate for insoluble extracellular polysaccharide (IEPS) production in dental biofilms, which can proportionally decrease bacterial density and, consequently, the number of biofilm calcium (Ca) binding sites. Ca bound to bacterial cell walls can be released into the biofilm fluid during a cariogenic challenge, reducing the driving force for mineral dissolution provoked by the pH drop. Thus, we investigated the effect of an IEPS-rich extracellular matrix on bacterial Ca binding after treatment with Ca solutions. Streptococcus mutans Ingbritt 1600 was cultivated in culture broths supplemented with 1.0% sucrose or 0.5% glucose + 0.5% fructose. The IEPS concentration in bacterial pellets was determined after alkaline extraction. Bacterial pellets were treated with 1 mM or 10 mM Ca++ solutions at 37ºC for 10 to 60 min. Ca binding to bacterial pellets, determined after acid extraction using the Arsenazo III reagent, was fast and concentration dependent. Although the IEPS concentration was approximately ten times higher in bacterial pellets cultivated in sucrose as compared to its monossaccharides, bound Ca concentration after Ca treatment was similar in both conditions. These results suggest that IEPS may not influence the amount of Ca bound to reservoirs of dental biofilms.

Fluoride concentration in the top-selling Brazilian toothpastes purchased at different regions

To be relevant in terms of public health, widely-used toothpastes should have at least 1,000 ppm of soluble fluoride (F) concentration. Thus, the concentrations of total fluoride (TF) and total soluble fluoride (TSF) in the top-selling Brazilian toothpastes were evaluated. Samples (n=3) from toothpastes Colgate Anti-cáries®, Colgate Total 12 Clean Mint®, Colgate Tripla Ação Menta Original®, Colgate Tripla Ação Menta Suave® and Sorriso Dentes Brancos® were obtained from each of the five regions of the country. The concentrations of TF and TSF were analyzed with ion-specific electrode calibrated with F standards and the results were expressed in ppm (µg F/g). All toothpastes showed TF concentration lower than 1,500 ppm F (1,388.2 ± 25.8 to 1,483.2 ± 98.2). The TSF values were higher than 1,000 ppm F and ranged from 1,035.5 ± 61.5 to 1,221.8 ± 35.2 for calcium carbonate/monofluorophosphate-based toothpastes and from 1,455.6 ± 12.5 to 1,543.0 ± 147.3 for silica/sodium fluoride-based toothpaste. Top-selling Brazilian toothpastes presented available fluoride concentration to control caries regardless of the region where they are purchased.

Para ter relevância em termos de saúde pública, os cremes dentais amplamente utilizados pela população devem ter fluoreto (F) solúvel numa concentração mínima de 1.000 ppm F. Assim, as concentrações de fluoreto total (FT) e flureto solúvel total (FST) nos cremes dentais mais vendidos no Brasil foram avaliados. Os cremes dentais (n=3) Colgate Anti-cáries®, Colgate Total 12 Clean Mint®, Colgate Tripla Ação Menta Original®, Colgate Tripla Ação Menta Suave® e Sorriso Dentes Brancos® foram obtidos nas cinco regiões do país. As concentrações de FT e FST foram analisadas com eletrodo íon-específico calibrado com padrões de F e os resultados foram expressos em ppm (µg F/g). Todos os cremes dentais apresentaram concentração de FT inferior a 1.500 ppm F (1.388,2 ± 25,8 a 1.483,2 ± 98,2). Os valores de FST foram superiores a 1.000 ppm F e variaram de 1.035,5 ± 61,5 a 1.221,8 ± 35,2 para cremes dentais a base de carbonato de cálcio/monofluorfosfato e de 1.455,6 ± 12,5 a 1.543,0 ± 147,3 para o creme dental à base de sílica/fluoreto de sódio. Os cremes dentais mais vendidos no Brasil apresentaram concentração de fluoreto solúvel para controlar cárie, independentemente da região onde foram comprados.

Timing of fluoride toothpaste use and enamel-dentin demineralization

It is well established that fluoride (F) prevents caries development by inhibiting demineralization and enhancing remineralization processes. However, it is not known which of these protective mechanisms is more important. In this double-blind, crossover in situ study conducted in three phases of 14 days each, 12 volunteers wore palatal appliances containing enamel and root dentin slabs, on which biofilm was allowed to accumulate under exposure to 20 percent sucrose solution 8×/day. F toothpaste was used once a day, either before the daily demineralizing episodes (in the morning) or after them (at night). Non-F placebo toothpaste was used in the control group. F toothpaste significantly reduced enamel and dentin demineralization compared with the control (p < 0.05). F toothpaste was more effective when used after the demineralization episodes than before, and this difference was statistically significant for dentin (p < 0.05). The results suggest that brushing with F dentifrice at night to remineralize daily mineral losses may be preferable to brushing in the morning to inhibit the demineralizing episodes of the day.

Dentifrícios: muito além de anticárie / Dentifrices: beyond the anticaries effect

O presente estudo é o terceiro de uma série em que aspectos vinculados aos dentifrícios são abordados. Os efeitos além da cárie são revisados pelo artigo, em especial, efeitos antiplaca, anticálculo, anti-inflamatório, anti-halitose, anti-hipersensibilidade dentinária, removedor de manchas e preventivo da erosão dental. São apresentadas substâncias presentes para atingir os objetivos propostos, seus mecanismos de ação, e uma revisão de seus potenciais efeitos é realizada. Considerando-se as amplas possibilidades de efeitos dos dentifrícios, é responsabilidade do profissional da odontologia indicá-los corretamente para seus pacientes...

The present study is the third of a series addressing issues about dentifrices. The outcomes other than anticaries effects are reviewed in the article, especially antiplaque, anticalculus, anti-inflammatory, anti-halitosis, anti-hipersensitivity, staining removal and anti-erosive potential. The substances involved in these properties are addressed, their mechanisms of action and potential side effects are reviewed. The dentist is responsible for the correct indication of dentifrices to the patients, considering the broad range of indication...

Quality of drinking water fluoridation of Capão Bonito, SP, Brazil, evaluated by operational and external controls / Qualidade da fluoretação da água de Capão Bonito, SP, Brasil, avaliada pelos controles operacional e heterocontrole

PURPOSE: To evaluate the quality of drinking water fluoridation of Capão Bonito, SP, Brazil, whose optimal fluoride concentration should be between 0.6 to 0.8 ppm F, considering the balance benefits/risks. METHODS: Historical records (n=1,964) from 2005 to 2009 of the water treatment plant (operational control) were evaluated. Also, from July 2009 to June 2010, 120 samples of the network water were collected for analysis and the fluoride concentrations found (external control) were compared with records of operational control of the same period. RESULTS: According to the historical records, 76.3% of the samples had acceptable fluoride concentration and this value was confirmed by the external control done during one year, which found that 80.8% of samples were within the optimal range. However, considering the samples out the optimal range, while the records of the operational control showed values below the minimum, the results of the external control found higher percentage of samples above the maximum. CONCLUSION: The data show the relevance to have a quality control of drinking water fluoridation because at same time the operational control analysis suggests that certain percentage of the population would not be receiving anticaries benefits, the external control indicates that it would be in increased risk of fluorosis.

OBJETIVO: Avaliar a qualidade da fluoretação da água de Capão Bonito, SP, Brasil, cuja concentração de fluoreto deveria estar entre os limites de 0,6 e 0,8 ppm F, considerando o equilíbrio benefícios/riscos. METODOLOGIA: Foram consultados 1964 registros feitos de 2005 a 2009 pela empresa responsável pelo tratamento da água (controle operacional). De 07/2009 a 06/2010, 120 amostras de água foram coletadas e as concentrações de fluoreto encontradas (heterocontrole) foram comparadas com as registradas pelo controle operacional do mesmo período. RESULTADOS: De acordo com os registros históricos, 76% das amostras tinham concentrações aceitáveis de fluoreto e este valor médio foi confirmado pelo heterocontrole feito, o qual encontrou um valor de 81%. Entretanto, considerando as amostras abaixo e acima dos limites aceitáveis, enquanto os registros do controle operacional mostraram maior porcentagem de valores abaixo do mínimo, os resultados do heterocontrole detectaram maior porcentagem acima do limite máximo. CONCLUSÃO: O relatado mostra a importância de haver um controle de qualidade da fluoretação da água de abastecimento publico, porque enquanto as análises feitas pelo controle operacional sugerem que uma porcentagem da população não estaria recebendo os benefícios da fluoretação, o heterocontrole aponta que ela estaria sob risco aumentado de fluorose dentária.

Dentifrícios fluoretados: balanceando benefício anticárie e risco de fluorose dental / Fluoride dentifrices: balancing anticaries benefits and fluorosis risk

Dentifrício fluoretado tem sido responsável pelo declínio de cárie ocorrido tanto em países desenvolvidos quanto em desenvolvimento, como o Brasil. No entanto, devido ao fato de que inadvertidamente crianças acabam ingerindo certa quantidade de crede dental toda vez que escovam seus dentes, seu uso tem sido preocupação quanto à fluorose dental. Toda vez que os dentes são escovados com dentifrício fluoretado, está-se usando flúor para controle de cárie, o desafio é maximizar os benefícios anticárie do flúor e minimizar os riscos de ocorrer fluorose dental. Embora a fluorose dental decorrente da ingestão de flúor durante a escovação não afete a estética dental, equilíbrio pode ser obtido simplesmente se usando pequena quantidade de creme dental de concentração igual ou superior a 1000ppmF para escovar os dentes...

Fluoride dentifrices have been responsible the reduction of dental caries in both developed and developing countries, such as Brazil. However, concerns have been raised about fluorosis because young children ingest part of the dentifrice. The challenge is maximizing the anticaries benefits of fluoride while minimizing the risks of dental fluorosis. Although dental fluorosis resulting from ingestion of fluoride during brushing does not affect dental esthetics, the balance between benefits and risks of using fluoride dentifrices can be achieved simply by recommending the use of small amounts of fluoride dentifrice containing 1000ppmF or more...

Dentifrícios são todos iguais? / Dentifrices: are them all the same?

Dentre todos os produtos disponíveis para a promoção de saúde bucal, os dentifrícios são, sem sombra de dúvida, os mais poderosos aliados do profissional da odontologia na manutenção da saúde bucal de seus pacientes. No entanto, apesar do grande arsenal de produtos com ingredientes ativos e eficientes, dentre os quais o fluoreto é apenas um, pouquíssimos profissionais prescrevem dentifrícios de forma individual a seus pacientes. Assim, dentifrícios não são todos iguais, e prescreve-los individualmente, com base no conhecimento do profissional sobre o mecanismo de ação de cada diferente produto e as necessidades dos pacientes, reforça a importância dos dentifrícios como aliados do cirurgião-dentista na manutenção da saúde bucal. Nesta série de artigos sobre dentifrícios, discorre-se sobre os ingredientes essenciais a todos os dentifrícios (detergentes, abrasivos, flavorizantes) (artigo1), o uso de dentifrícios fluoretados, considerando-se o benefício anticárie e o potencial risco de causar fluorose dental (artigo 2), e finalmente sobre outros benefícios, além do efeito anticárie, que têm sido pouco explorado pelos profissionais da odontologia (artigo 3).

Amongst all products available for oral health care, the dentifrices are undoubtedly the most important ally of the dentist in oral health promotion. However, in spite of the great amount of commercially available therapeutic dentifrices with proven efficacy, and considering that the fluoride is only one of them, very few dentists recommended dentifrices in an individual basis to their patients. Dentifrices are not all the same! The individual prescription, based on the mechanism of action of each product reinforces the importance of toothpastes to help dentists in oral health promotion. In this article series on toothpastes, we will address the essential constituents for all dentifrices (detergents, abrasives, flavoring agents…) (Article1), the use of fluoride-containing dentifrices in terms of anticaries benefits and risk of dental fluorosis (Article 2), and finally about other benefits which are not commonly explained by dental professionals. We wish you a good reading.

Fluorosis in rats exposed to oscillating chronic fluoride doses

Considering that blood fluoride concentration varies according to fluoride exposure and that dental fluorosis is related to the amount of enamel formed under a given fluoride dose, the present study investigated whether the fluorosis produced by an oscillating chronic fluoride dose would be similar to that caused by exposure to a constant dose, representing the mean of the oscillation during a given time. Rats received during 78 days water with fluoride concentrations of 0, 12.5, 25 or 37.5 µg F/mL, or oscillating concentrations of 12.5 and 37.5 µg F/mL every 72 h (mean exposure=25 µg F/mL). The concentrations of fluoride in the plasma, femur and incisors of the rats were determined at the end of the experimental period. Also, the enamel dental fluorosis index was determined in the incisors using a quantitative method developed by our research group named Dental Fluorosis by Image Analysis (DFIA). Fluoride concentrations in plasma, femur and teeth, and DFIA increased linearly for constant fluoride concentrations in water (p<0.0001, r values=0.87-0.98). The results of the oscillating group and the groups receiving 25 µg F/mL did not differ significantly (p>0.05). The findings of this study suggest that in animals chronically exposed to symmetrically oscillating fluoride doses, the resulting dental fluorosis reflects the metabolic effect of the mean of the oscillating doses.

Considerando que a concentração de fluoreto no sangue varia de acordo com a exposição ao fluoreto, e que a fluorose dental está relacionada com a quantidade de esmalte formado sob determinada dose de fluoreto, este estudo avaliou se a fluorose resultante da exposição a doses oscilantes de fluoreto seria semelhante àquela causada pela exposição a uma dose constante, representativa da média das oscilações durante um determinado tempo. Durante 78 dias, ratos receberam água com concentrações constantes de fluoreto de 0; 12,5; 25 ou 37,5 µg F/mL, ou concentrações oscilantes de 12,5 e 37,5 µg F/mL alternados a cada 72 h (média de exposição = 25 µg F/mL). Concentrações de fluoreto no plasma, fêmur e dentes incisivos dos ratos foram determinadas após o período experimental. O índice de fluorose, observado nos incisivos dos ratos, foi quantificado usando um método de análise de imagem desenvolvido para essa pesquisa, denominado de índice de fluorose por análise de imagem (DFIA, em Inglês). A concentração de fluoreto no plasma, fêmur e incisivo dos ratos, assim como o DFIA, aumentaram de forma linear para as concentrações constantes de fluoreto na água (p<0,0001, r=0,87-0,98). Não houve diferença significativa entre o grupo que recebeu doses oscilantes e o grupo que recebeu 25 µg F/mL (p>0,05). Os resultados sugerem a fluorose dental decorrente de exposição crônica de animais a doses de fluoreto oscilantes e simétricas reflete o efeito metabólico da média da oscilação.

Available fluoride in toothpastes used by Brazilian children

Toothpastes should have a minimum concentration of 1000 ppm of fluoride (F) to control caries and also the active F agent must be chemically free (soluble) in the formulation. Thus, the aim of this study was to evaluate the concentration of soluble F in dentifrices used by 206 Brazilian children. The concentrations of total fluoride (TF), total soluble fluoride (TSF) and fluoride ion were determined. From these analyses, the concentrations of F as sodium monofluorophosphate (MFP) and percent of insoluble F were calculated. F was analyzed with an ion specific electrode in duplicates. The majority of dentifrices used (96 percent) contained F and in 84 percent of them, TF concentration was according to that declared by the manufacturers. In the F-toothpastes, 78 percent showed TSF concentration ≥1000 ppm, varying from 422.3 to 1432.3 ppm F (mean ± SD of 1017.6 ± 239.4). These findings suggest that most dentifrices used by Brazilian children present available fluoride concentration for caries control.

O requerimento mínimo para que um creme dental tenha potencial anticárie é ele ter fluoreto (F) na concentração de 1000 ppm, o qual porém deve estar solúvel na formulação. Assim, este estudo teve como objetivo conhecer a concentração de F solúvel em dentifrícios usados por 206 crianças brasileiras. Foram determinadas as concentrações de flúor total (FT), o qual representa a soma das concentrações de flúor solúvel (iônico e ionizável) mais o insolúvel (ligado ao abrasivo); de flúor solúvel total (FST), representando o iônico mais o ionizável na forma de monofluorfosfato de sódio (MFP) e de flúor solúvel na forma iônica (FI). A partir destas análises foram calculadas as concentrações de MFP e a por cento de F insolúvel (Fins). As análises foram feitas em duplicatas com eletrodo específico. A maioria dos dentifrícios usados (96 por cento) continham fluoreto e em 84 por cento desses a concentração de FT encontrada estava de acordo com a declarada na embalagem. Em 78 por cento dos cremes dentais fluoretados, a concentração de FST encontrada foi igual ou superior a 1000 ppm, variando de 422,3 a 1432,3 ppm F (média ± DP de 1017,6 ± 239,4). Os dados mostram que a maioria dos cremes dentais usados pela amostra de crianças brasileiras possui concentração de F potencialmente ativo para controlar cárie.