Effect of Toothpaste Fluoride Concentration on Color Stability of Resin Composites: An In Vitro Study

ABSTRACT Objective: To investigate the effects of two different dentifrice fluoride concentrations on the color stability of the composite. Material and Methods: Twenty-seven specimens (2×4×5 mm) each of microfilled (Gradia, GC, Japan) and nanohybrid (Grandio, VOCO, Germany) composites were prepared. The specimens were randomly divided into six groups (control, Fluoflor caries protection toothpaste with 1450ppm Fluoride (EXW, France), and Fluoflor kids toothpaste with 500ppm Fluoride (EXW, France) (n = 9). The specimens were immersed in a mixture of artificial saliva and toothpaste in a ratio of 1:3 and applied for 60 seconds every 12 hours for 42 days. The control samples were incubated in artificial saliva at 37°C. Primary and secondary color measurements were performed using color parameters (L∗a∗b) with a spectrophotoshade (MHT Optic Research AG, Niederhasli, Switzerland). Data were analyzed using a two-way analysis of variance at a significance level of 0.05. Results: According to the two-way ANOVA analysis, there was no significant difference in color change between the composites and no difference in the level of discoloration between different fluoride concentrations(p>0.05). Also, None of the dentifrices caused clinically significant color changes(∆E˂3.3). Conclusion: No clinically unacceptable color changes were observed in the microfilled and nanofilled composites with different concentrations of fluoride toothpaste.

Does the combination of whitening toothpaste and hydrogen peroxide bleaching increase the surface roughness and change the morphology of a nanofilled composite?

Aim: To evaluate changes in the surface roughness and morphology of a nanofilled composite following toothbrushing with a whitening (WT) or regular toothpaste (RT), alone or combined with 35% hydrogen peroxide bleaching (HP). Methods: Seventy disc-shaped nanofilled composite (Filtek Z350XT) specimens were randomly divided into groups (n=10): WT, RT, TB (without toothpaste ­ control) or the combinations WT/ HP, RT/HP, TB/HP and HP. All groups underwent toothbrushing simulation (60,000 cycles) and bleaching treatment (4 sessions). Mean surface roughness (Ra, µm) was measured before (T0) and after treatments (TB). Surface morphology was assessed by scanning electron microscopy (SEM) at TB. Mean Ra was analyzed using general mixed models and multiple comparisons by the Tukey-Kramer test (α=5%). Results: HP caused no surface roughness changes on the nanofilled composite after treatment (p>0.05). RT toothbrushing, combined or not with HP, increased the surface roughness (p<0.05). WT and WT/ HP protocols had no effect on the surface roughness of the composite (p>0.05). The nanofilled composite submitted to RT toothbrushing combined with HP (RT/HP) presented substantial surface alterations under SEM, showing deep depressions and round-shaped defects. Toothbrushing with RT combined with the bleaching agent increased exposure of the inorganic fillers. Conclusion: WT toothbrushing, regardless of HP combination, or the single HP protocol had no effect on the surface roughness of the nanofilled composite. However, RT combined with HP negatively affected surface roughness and presented the most noticeable surface changes among groups

At-home bleaching versus whitening toothpastes for treatment of tooth discoloration: a cost-effectiveness analysis

Abstract Objectives This study aimed to analyze the cost-effectiveness of whitening toothpastes and at-home bleaching for the treatment of tooth discoloration. Methodology A cost-effectiveness economic analysis was conducted, and eight randomized clinical trials were selected based on the whitening agent product used: blue covarine dentifrices (BCD), hydrogen peroxide dentifrices (HPD), dentifrices without bleaching agents (CD, negative control), and 10% carbamide peroxide (CP10, positive control) for at-home bleaching. The consumer/patient perspective was adopted, macro-costing techniques were used and a decision tree model was performed considering the costs in the American and Brazilian markets. The color change evaluation (ΔE*ab) was used to calculate the effectiveness of tooth bleaching. A probabilistic analysis was performed using a Monte Carlo simulation and incremental cost-effectiveness ratios were obtained. Results CP10 resulted in the highest cost-effectiveness compared to the use of dentifrices in both markets. In Brazil, HPD was more cost-effective than BCD and CD. In the US, the increased costs of HPD and BCD did not generate any whitening benefit compared to CD. Conclusions CP10 was more cost-effective than BCD and HPD for tooth bleaching from the perspectives of the Brazilian and American markets. Decision-making should consider the use of CP10 for treating tooth discoloration.

Determination of bioavailable fluoride in toothpastes marketed in Medellín, Colombia, through capillary electrophoresis / Fluoruro biodisponible en cremas dentales comercializadas en Medellín ­ Colombia mediante electroforesis capilar

Currently, the FDI recommendation (World Dental Federation) for fluoride concen­tration in toothpastes is that the total fluoride content declared by manufacturers be between 1,000 and 1,500 ppm, and of this amount, at least 800 ppm should be bioavai­lable fluoride. The aim of this study was to describe the market of toothpastes marketed in Medellín and to measure the concentration of bioavailable fluoride by capillary elec­trophoresis to verify their compliance with the FDI recommendation for the prevention of dental caries. After sampling the toothpastes available for sale in the 16 communes of the city of Medellin, a single operator measured in triplicate the concentration of bioavailable fluoride in 36 samples of previously blinded toothpastes using the capi­llary electrophoresis (EC) technique. Most of the evaluated toothpastes that declared a content of 1,000­1,500 ppm fluoride met the recommendation of presenting at least 800 ppm bioavailable fluoride. Measurement of bioavailable fluoride in toothpastes with MFP (sodium monofluorophosphate) is recommended, as it is known that binding to the abrasive can decrease its concentration over time.

Actualmente la recomendación de la FDI (Federación Dental Internacional) sobre la concentración de fluoruro en cremas dentales es que el contenido de fluoruro total de­clarado por los fabricantes sea entre 1.000 y 1.500 ppm, y que de esta cantidad al menos 800 ppm sea fluoruro biodisponible. El objetivo de este estudio fue describir el mercado de las cremas dentales comercializadas en Medellín y medir en estas la concentración de fluoruro biodisponible por electroforesis capilar para verificar su cumplimiento de la recomendación de la FDI para la prevención de la caries dental. Luego de realizar un mues­treo en las 16 comunas de la ciudad de Medellín sobre las cremas dentales disponibles a la venta, un solo operador midió por triplicado la concentración de fluoruro biodisponible en 36 muestras de cremas dentales previamente cegadas, mediante la técnica de electroforesis capilar (EC). La mayoría de las cremas dentales evaluadas que declaraban contenido de 1.000 a 1.500 ppm de fluoruro, cumplieron la recomendación de presentar al menos 800 ppm de fluoruro biodisponible. Se recomienda realizar la medición del fluoruro biodisponible en las cremas con MFP, ya que se conoce que la unión al abrasivo puede disminuir su concentración en el tiempo.

Qualitative Characterization of the Abrasive Component of Charcoal-Containing Toothpastes and the Effect on Dentin Roughness / Caracterización Cualitativa del Componente Abrasivo de las Pastas Dentales que Contienen Carbón Vegetal y la Rugosidad de la Dentina

This study investigated the effect of commercially available whitening toothpastes containing charcoal on dentin. Nine charcoal-containing toothpastes were compared with 3 whitening toothpastes (positive control) and distilled water (negative control). Periodontally hopeless molars were cleaned and washed and the occlusal table removed to expose dentin. The teeth were mounted in auto-polymerizing resin and exposed dentine surfaces polished with water-cooled decreasing grits of silica carbide paper up to 1500 grit. Baseline average roughness (Ra) measurements were taken. Specimens were then mounted in an automatic tooth-brushing machine and brushed for 5000 cycles. Repeat Ra measurements were taken. Specimens were brushed in 5000-cycle increments up to 25,000 cycles with Ra measurements being taken at each time point. Between abrasive challenges specimens were stored in distilled water. All toothpaste samples were sputter coated and examined under a scanning electron microscope to qualify the shape and size of the abrasive components of the formulations. Data were analyzed using a two-way analysis of variance with post hoc Bonferroni. The results demonstrated that the abrasive effect, in terms of increasing Ra, on dentin was noted as early as 5000 cycles for all the tested toothpastes (p<0.05). The effect of continued brushing showed an overall cumulative effect on dentine roughness up to 25000 cycles. When toothpastes were compared between groups at each time-point, dentin specimens brushed with Pursito were statistically similar to the control group. At 25,000 cycles all dentin samples were significantly rougher compared to Pursito and the control groups. It may be concluded that all the tested toothpastes have an abrasive effect on dentin surfaces.

Este estudio investigó el efecto sobre la dentina de las pastas dentales blanqueadoras disponibles en el mercado que contienen carbón vegetal. Se compararon nueve dentífricos que contenían carbón vegetal con 3 dentífricos blanqueadores (control positivo) y agua destilada (control negativo). Los molares sin material periodontal se limpiaron y lavaron y se retiró la tabla oclusal para exponer la dentina. Los dientes se montaron en resina autopolimerizable y las superficies expuestas de la dentina se pulieron con papel de carburo de sílice de grano decreciente enfriado con agua hasta grano 1500. Se tomaron medidas de rugosidad promedio (Ra) de referencia. Luego, las muestras se montaron en una máquina automática de cepillado de dientes y se cepillaron durante 5000 ciclos. Se tomaron medidas repetidas de Ra. Las muestras se cepillaron en incrementos de 5000 ciclos hasta 25 000 ciclos y se tomaron medidas de Ra en cada punto de tiempo. Entre periodos abrasivos, las muestras se almacenaron en agua destilada. Todas las muestras de pasta de dientes se recubrieron por pulverización catódica y se examinaron bajo un microscopio electrónico de barrido para calificar la forma y el tamaño de los componentes abrasivos de las formulaciones. Los datos se analizaron utilizando un análisis de varianza de dos vías de Bonferroni post hoc. Los resultados demostraron que el efecto abrasivo, en términos de aumento de Ra, sobre la dentina se notó ya en 5000 ciclos para todas las pastas dentales probadas (p<0,05). El efecto del cepillado continuo mostró un efecto acumulativo general sobre la rugosidad de la dentina hasta 25.000 ciclos. Cuando se compararon las pastas dentales entre los grupos en cada momento, las muestras de dentina cepilladas con Pursito fueron estadísticamente similares al grupo de control. A los 25.000 ciclos, todas las muestras de dentina eran significativamente más ásperas en comparación con Pursito y los grupos controles. Se puede concluir que todas las pastas dentales probadas tienen un efecto abrasivo sobre las superficies dentinarias.

The effect of whitening toothpastes on colour change and surface roughness of restorative materials

To examine the colour change and surface roughness of giomer, microhybrid composite and nanohybrid composite after brushing with whitening toothpastes. Disc-shaped samples of giomer, microhybrid composite and nanohybrid composite were divided into three subgroups(n=10), with the initial colour measured with a spectrophotometer and the surface roughness measured with a mechanical profilometer. The samples, which were immersed in coffee solution were brushed once a day with whitening toothpastes (Opalescence Cool Mint (OCM), Colgate Optic White Extra Power (COW) and Signal White Now Gold (SWN)) for 12 days. Colour change and surface roughness were measured again after the colouring-brushing cycle. All of the analyses were performed using appropriate statistical hypothesis tests. The highest increase in surface roughness was seen in the microhybrid composite group applied with SWN (p<0.05). The group with the least increase was the giomer group applied with SWN (p<0.05). While the least colour change was observed in the COW applied nanohybrid composite group (ΔE00=1,814), the most colour change occurred in the COW applied giomer group (ΔE00=5.943). After the use of whitening toothpastes, the roughness of giomer, microhybrid composite and nanohybrid composite surfaces was increased and a colour change above the clinically accepted value was observed.

El objetivo del presente estudio fue evaluar el cambio de color y la rugosidad de la superficie de giomer, resina compuesta microhíbrida y resina compuesta nanohíbrida posterior al cepillado con dentífricos blanqueadores. Las muestras en forma de disco de cada material se dividieron en tres subgrupos (n=10), con el color inicial medido con un espectrofotómetro y la rugosidad de la superficie medida con un perfilómetro mecánico. Las muestras, que se sumergieron en una solución de café, se cepillaron una vez al día con pastas dentales blanqueadoras (Opalescence Cool Mint (OCM), Colgate Optic White Extra Power (COW) y Signal White Now Gold (SWN)) durante 12 días. El cambio de color y la rugosidad de la superficie se midieron nuevamente después del ciclo de coloración-cepillado. El mayor aumento en la rugosidad de la superficie se observó en el grupo de la resina compuesta microhíbrida al que se le aplicó SWN (p<0,05). El grupo de menor incremento fue el grupo de giomer aplicado con SWN (p<0.05). Mientras que el menor cambio de color se observó en el grupo de resina compuesta nanohíbrida aplicado con COW (ΔE00=1,814), el mayor cambio de color ocurrió en el grupo de giomer con COW (ΔE00=5,943). Posterior al uso de pastas dentales blanqueadoras, la rugosidad del giomer, y de las resinas compuestas microhíbridas y nanohíbridas aumentó, siendo que se observó un cambio de color por encima del valor clínicamente aceptado.

Whitening Effect of Different Toothpastes on Bovine Dental Enamel: an in situ study

Abstract The aim of this in situ study was to evaluate color change, surface roughness, gloss, and microhardness in tooth enamel submitted to whitening and remineralizing toothpastes. Fifteen healthy adults (REBEC - RBR-7p87yr) (with unstimulated salivary flow ≥ 1.5 ml for 5 minutes, pH=7) wore two intraoral devices containing four bovine dental fragments (6 x 6 x 2 mm). Participants were randomly assigned and instructed to toothbrush the devices with the tested toothpastes (30 days): CT: conventional; WT: whitening; WTP: whitening with peroxide, and RT: remineralizing toothpaste. A washout period of 7 days was established. Readouts of color, gloss, surface roughness, and microhardness were performed before and after brushing. The results demonstrated no color, gloss, and microhardness differences (p>0.5). The samples brushed with WTP (0.2(0.7) showed higher surface roughness (p=0.0493) than those with WT (-0.5(1.0). The toothpastes did not alter the properties of the dental enamel, except for the roughness. Toothpaste with an abrasive system based on sodium bicarbonate and silica, and that contains sodium carbonate peroxide increased the surface roughness of the enamel.

Resumo O objetivo deste estudo in situ foi avaliar a alteração de cor, rugosidade superficial, brilho e microdureza em esmalte dentário submetido a dentifrícios clareadores e remineralizantes. Quinze adultos saudáveis (REBEC - RBR-7p87yr) (com fluxo salivar não estimulado ≥ 1.5 mL por 5 minutos, pH = 7) usaram dois dispositivos intrabucais contendo quatro fragmentos dentários bovinos (6 x 6 x 2 mm). Os participantes foram aleatoriamente designados e instruídos a escovar os aparelhos com os dentifrícios testados (30 dias): CO: convencional; CL: clareador; CLP: clareador com peróxido e RE: remineralizante. Foi estabelecido um período de washout de 7 dias. Leituras de cor, brilho, rugosidade superficial e microdureza foram realizadas antes e após a escovação. Os resultados não demonstraram diferenças na cor, brilho e microdureza. As amostras escovadas com CLP apresentaram maior rugosidade superficial (p=0,0493) do que aquelas com CL. Os dentifrícios não alteraram as propriedades do esmalte dental, exceto a rugosidade. O dentifrício com sistema abrasivo à base de bicarbonato de sódio e sílica, e que contém peróxido de carbonato de sódio aumentou a rugosidade de superfície do esmalte.

Efetividade da ação clareadora dos dentifrícios no clareamento dental: uma revisão Integrativa / Effectiveness of teeth whitening action in dental bleaching: an Integrative review

Objetivo: Avaliar a efetividade dos dentifrícios categorizados como do tipo clareadores no clareamento dental, por meio de um levantamento da evidência científica. Métodos: Foram utilizadas as bases de dados eletrônicas Pubmed, Embase, Web of Science e Scopus para a busca dos estudos até o mês de agosto de 2021. Estudos clínicos que compararam os dentifrícios mencionados como clareadores com os dentifrícios não clareadores na mudança de cor dos dentes foram incluídos. As palavras-chaves utilizadas na estratégia de busca foram: "whiteningtoothpastes", "whiteningdentifrice", "toothpastes", "dentifrice", "color change", "colorationanalysis" e "toothbleaching". Os dados foram analisados por meio de uma síntese qualitativa, detalhando os principais resultados dos estudos incluídos. Após a etapa de leitura e seleção dos artigos, foram incluídos 5 artigos para essa revisão integrativa. Resultados: O creme dental mais utilizado foi o Close Up White Now (n = 3). A metodologia de cor mais utilizada foi a espectrofotometria, o tipo de estudo que predominou foi o ensaio clínico randomizado, avaliando o esmalte dental humano. No que se refere ao RDA (Relative Dentin Abrasitity), os dentifrícios clareadores apresentam um índice entre 60-100, por vezes superior à 100, sendo considerados abrasivos. Conclusão: Nos resultados de alguns estudos incluídos, os dentifrícios clareadores não apresentaram efeito de clareamento intrínseco, apenas o efeito de remoção de manchas extrínsecas foi observado.

Aim: To evaluate the effectiveness of dentifrices categorized as whitening in tooth whitening, through a survey of scientific evidence. Methods: The Pubmed, Embase, Web of Science, and Scopus electronic databases were used to search for studies up to August 2021. Clinical studies that compared dentifrices mentioned as whitening with non-whitening dentifrices in the change of tooth color were also included. The keywords used in the search strategy were: "whiteningtoothpastes", "whiteningdentifrice", "toothpastes", "dentifrice", "color change", "colorationanalysis", and "toothbleaching". Data were analyzed using a qualitative synthesis, detailing the main results of the included studies. After reading and selecting the articles, five articles were included in this integrative review. Results: The most used widely toothpaste was Close Up White Now (n = 3). The most commonly used color methodology was spectrophotometry, while the predominant type of study was the randomized clinical trial, evaluating human dental enamel. Regarding the RDA (Relative Dentin Abrasitity), whitening toothpastes have an index between 60-100, sometimes higher than the 100, and are considered abrasive. Conclusion: In the results of some of the included studies, whitening dentifrices did not have an intrinsic whitening effect; only the effect of removing extrinsic stains was observed.

Effect of whitening toothpastes and activated charcoal powder on enamel wear and surface roughness

Abstract This study aimed to evaluate surface roughness (Sa), roughness profile (Rv), and enamel wear after brushing with different whitening toothpastes and charcoal powders. Sixty (n = 10) bovine enamel blocks (6 × 6 × 3 mm) were randomly distributed into six groups according to toothpaste type: regular toothpaste (CONT), toothpaste containing 2% hydrogen peroxide (HP), toothpaste containing titanium dioxide (TiO2), toothpaste containing charcoal (COAL), toothpaste containing charcoal and TiO2 (COAL+TiO2), and activated charcoal powder (COAL_PWD). Each block was subjected to 30,000 reciprocal cycles at a 1:3 proportion slurry. After brushing, the blocks were analyzed using an optical profilometer to determine Sa, Rv, and enamel wear. In addition, representative 3D images of each group and wear profiles were obtained. Sa was analyzed using generalized linear models followed by Bonferroni correction, whereas Rv was analyzed using one-way analysis of variance. After brushing, COAL and COAL+TiO2 showed higher Sa values than COAL_PWD. However, no significant difference was observed in Sa between whitening toothpaste and COAL_PWD, and CONT (p > 0.05). In addition, no differences were observed among the groups in Rv (p > 0.05). Conversely, enamel wear was higher for TiO2, COAL, COAL+TiO2, and COAL_PWD than for CONT. CONT showed the least enamel wear, whereas HP showed intermediate values. Representative 3D images and line profiles showed lower step-height and lower mean surface losses for the CONT and HP groups than for the other groups. Whitening toothpastes and COAL_PWD did not increase Sa or Rv compared with CONT, while CONT demonstrated lower enamel wear.

Toothpaste-related interests of Google users from different countries

Abstract The Internet is a growing source of knowledge and can provide information about oral health. This ecological study aimed to characterize the interests in toothpaste among Google users from different countries. Our hypothesis was that there would be an increase in Google users' interest in information about toothpaste. This retrospective longitudinal ecological study analyzed the toothpaste-related interest of Google users from 10 countries between January 2004 and December 2020. The monthly variation in relative search volume (RSV) and the main related queries were determined using Google Trends. Autoregressive integrated moving average (ARIMA) forecasting models were built to establish the predictive RSV values for toothpaste for an additional 12 months. Autocorrelation plots and the generalized additive model (GAM) were used to diagnose trends and seasonality in RSV curves. Additionally, the influence of social isolation related to the outbreak of COVID-19 was analyzed. Although not detected by autocorrelation function (ACF) and partial autocorrelation function (PACF) analyses, the heuristic analysis showed an increase in the interest in toothpaste-related information in all countries, with a stable trend observed in the 12-month forecasts, except for the increases in the United Kingdom and South Africa. Also, GAM analyses demonstrated a non-significant monthly or quarterly seasonal influence on data. In addition, social isolation during the COVID-19 pandemic did not influence the online information-seeking behavior of Google Search users linked to this topic. We confirmed the hypothesis that the interest of Google Search users in information about toothpaste increased in all of the 10 assessed countries.

Dose-response relationship between toothpaste soluble fluoride absorbed in the gastrointestinal tract and saliva fluoride secretion

Aim: This study aimed to evaluate if there is a dose-response relationship between toothpaste chemically soluble fluoride absorbed in the gastrointestinal tract and fluoride secreted by saliva, giving support to the use of saliva as surrogate for plasma fluoride. Methods: A 4-phase single blind study was conducted, in which 10 participants were subjected in each phase to one of the assigned treatment groups: group I: fresh sample of a Na2FPO3/CaCO3-based toothpaste with 1,334 µg F/g of total soluble fluoride (TSF) and groups II­IV: aged samples of this toothpaste presenting TSF concentrations of 1,128, 808, and 687 µg F/g, respectively. In all phases, the participants ingested an amount of toothpaste equivalent to 70.0 µg F/Kg body weight, as total fluoride (TF). Saliva and blood samples were collected before (baseline) and up to 180 min after toothpaste ingestion as indicator of fluoride bioavailability. F concentration in saliva and blood plasma was determined with a fluoride ion-specific electrode. The areas under the curve (AUC) of F concentration versus time (AUC = ng F/mL × min) and the peaks of fluoride concentration (Cmax) in saliva and plasma were calculated. Results: A significant correlation between mg of TSF ingested and the AUC (r=0.47; p<0.01), and Cmax (r=0.59; p<0.01) in saliva was found; for TF, the correlation was not significant (p>0.05). In addition, the correlations between plasma and saliva fluoride concentrations were statistically significant for AUC (r=0.55; p<0.01) as for Cmax (r=0.68; p<0.01). Conclusion: The findings support that saliva can be used as a systemic biomarker of bioavailable fluoride present in Na2FPO3/CaCO3-based toothpaste

Effects of different toothpaste formulations on erosive tooth wear prevention: systematic review / Efeitos de diferentes dentifrícios na prevenção do desgaste dentário erosivo: revisão sistemática de literatura

Objective: erosive tooth wear is a multifactorial condition that results in loss of dental hard tissue, caused by a chemical and mechanical process. This paper aims to carry out a systematic review presenting the effects of different toothpaste formulations on the loss of dental enamel surface in vitro. Material and Methods: the searches were performed in the databases PubMed, Web of Science, LILACS and Scielo. Articles published from 2010 to 2020 were filtered, without language restriction. Articles that included abrasion and erosion protocols were searched, as they were more similar to clinical reality, since toothpaste is applied through tooth brushing. The searches with descriptors and free terms on the topic resulted in 992 articles, however only 12 were within the search criteria. Results: the selected studies appointed that association of conventional fluorides (NaF) with metallic fluorides can be a promising strategy for the reduction of surface loss by erosive tooth wear. Toothpastes containing sodium fluoride, as well as tin without chitosan, showed a reduction in surface loss, considered sufficient for individuals with medium exposure to acids. In children's toothpastes, the one containing sodium fluoride showed a reduction in surface loss when compared to non-fluoride dentifrices. Conclusion: different protocols may result in less or greater loss of enamel surface, and methodological differences should be considered. To clarify the effects of dentifrices on erosive tooth wear, other properties of dentifrices should be investigated. (AU)

Objetivo: o desgaste erosivo é uma condição multifatorial que resulta em perda de tecido duro dentário, causado por um processo químico e mecânico. Este trabalho tem como objetivo realizar uma revisão sistemática de literatura apresentando os efeitos de diferentes formulações de dentifrícios na perda de superfície de esmalte dentário in vitro. Material e Métodos: a busca foi realizada nas bases de dados PubMed, Web of Science, LILACS e Scielo. Foram filtrados artigos publicados no intervalo de 2010 a 2020, sem restrição de idioma. Buscou-se artigos que incluíssem protocolos de abrasão e erosão, por mais se assemelhar a realidade clínica, uma vez que o dentifrício é aplicado através da escovação dentária. A busca com descritores e termos livres sobre o tema encontrou 992 artigos, entretanto somente 12 estavam dentro dos critérios da pesquisa. Resultados: os estudos selecionados apontaram que associação dos fluoretos convencionais (NaF) com os metálicos pode ser uma estratégia promissora para a redução de perda de superfície pelo desgaste dentário erosivo. Dentifrícios contendo fluoreto de sódio, assim como estanho sem quitosana, apresentaram redução na perda de superfície, sendo considerada suficiente para indivíduos com exposição média aos ácidos. Em dentifrícios infantis, aquele que continha fluoreto de sódio apresentou uma redução de perda de superfície quando comparado com dentifrícios sem fluoreto. Conclusão:diferentes protocolos podem resultar em menor ou maior perda de superfície de esmalte e as diferenças (AU)

The influence of the CIELAB parameters on the perception of color after the use of whitening toothpastes

Aim: To evaluate the influence of the parameters L* a* b* on the variation of the color of bovine tooth enamel submitted to artificial darkening, after simulated brushing, with whitening toothpastes containing blue covarine. Methods: To undertake this study in vitro, 60 specimens (SP) were divided into 6 groups (n=10): control group (CGwater) and 5 test groups (GT1-Colgate Total 12, GT2-Oral-B 3D White Perfection, GT3- Colgate Luminous Instant White, GT4-CloseUp White Diamond Attraction, GT5-Sorriso Xtreme White). The specimens were darkened with coffee and submitted to simulated brushing for 6, 12, and 24 months. The alteration in the color was evaluated using CIELAB parameters and the ΔL, Δa, Δb and ΔE were calculated. The data was analyzed through generalized linear models using the R program and considering a level of significance of 5%. Results: The parameters L*, a* and the ΔL, Δa obtained better results in the test group than in the control group. There were no statistical differences between CG and the test groups for the evaluation of the b* parameter. In the evaluation of the Δb, the GT3 differed statistically from the CG. In relation to the ΔE, all the group tests showed a variation in color statistically greater than that of the CG and the GT4 showed the greatest variation, not differing from the GT3 during the periods studied. Conclusion: The mechanical and optical whitening agents positively influenced the values L*a* and b*, as well as in its variations and in the ΔE. It is important to emphasize, however, that to analyze tooth whitening it is necessary to evaluate their parameters together

The Cleaning and Whitening Ability of Charcoal Containing Toothpastes and Homeopathic Remedies on Human Tooth Enamel

ABSTRACT: The purpose of this research was to determine the cleaning and whitening ability of two charcoal containing toothpastes compared with baking soda, activated charcoal and a hydrogen peroxide containing whitening toothpaste. Tea-stained enamel/dentin slices were mounted dentin side down in cylinders of auto-polymerizing acrylic and subjected to simulated brushin g. Total color, ΔE, and stained area were measured using a reflectance spectrophotometer and ImageJ software using a Hue, Chroma, and Brightness color threshold method; respectively, at prescribed brushing intervals of baseline, months 1, 6 and 12. A two- w ay repeated measure analysis of variance was performed, with included factors being toothpaste group and time. Statistical analys is revealed the included factor of brushing time interval was significant (p<0.05) for both ΔE and stained area. There was significant interaction for both main effects (p<0.05) for the dependent variable of stained area alone. Significant reduction in ΔE values occurred in all groups except Optic White at the 1-month interval. Statistically significant reduction in stained area occurred at 1-mon th for the baking soda group only. Post-hoc Tukey HSD tests revealed there was significant group*time interaction for baking soda at month 1 for the variable stained area. The charcoal containing (Crest 3D with Charcoal and Colgate Essentials) and non-charcoal contai ning toothpastes (Optic White) only produced a significant stain removal at the 6-month interval.

RESUMEN: El propósito de esta investigación fue determinar la capacidad de limpieza y blanqueamiento de dos pastas dentales que contienen carbón en comparación con bicarbonato de sodio, carbón activado y una pasta dental blanqueadora que contiene peróxido de hidrógeno. Los cortes de esmalte/dentina teñidos con té se montaron con el lado de la dentina hacia abajo, en cilindros de acrílico autopolimerizable y se sometieron a un cepillado simulado. El color total, ΔE y el área teñida se midieron usando un espectrofotómetro de reflectancia y el software ImageJ usando un método de umbral de color de tono, croma y brillo; respectivamente, en los intervalos de cepillado prescritos al inicio, los meses 1, 6 y 12. Se realizó un análisis de varianza de medidas repetidas de dos vías, con factores incluidos como el grupo de pasta de dientes y el tiempo. El análisis estadístico reveló que el factor incluido del intervalo de tiempo de cepillado fue significativo (p<0,05) tanto para ΔE como para el área manchada. Hubo interacción significativa para ambos efectos principales (p<0,05) para la variable dependiente del área teñida sola. Se produjo una reducción significativa en los valores de ΔE en todos los grupos excepto Optic White en el intervalo de 1 mes. Se produjo una reducción estadísticamente significativa en el área manchada al mes solo para el grupo de bicarbonato de sodio. Las pruebas post-hoc Tukey HSD revelaron que hubo una interacción significativa entre grupo y tiempo para el bicarbonato de sodio en el mes 1 para el área manchada variable. Las pastas dentales que contenían carbón (Crest 3D con Charcoal y Colgate Essentials) y las pastas de dientes que no contenían carbón (Optic White) solo produjeron una eliminación significativa de las manchas en el intervalo de 6 meses.

Nivel de conocimiento de los padres sobre el uso de pastas dentales en asociación con la ingesta estimada de fluoruro en niños / Level of knowledge in parents about the use of toothpaste in association with estimated fluoride intake in children

Resumen Introducción: Diversos estudios han demostrado que los padres aún no cuentan con el conocimiento suficiente sobre el uso de pastas dentales que deben consumir sus hijos. Muchos de ellos desconocen desde que edad se debe empezar con el uso de pastas dentales, la cantidad exacta que se debe colocar en el cepillo y sobre todo con qué frecuencia se deben cepillar. Objetivo: Asociar el nivel de conocimiento de los padres sobre el uso de pastas dentales con las características asociadas a la ingesta estimada de fluoruro en niños entre los 6 meses a 8 años de Lima Metropolitana y Callao. Materiales y métodos: Estudio de tipo observacional, descriptivo y transversal. Se realizó el cuestionario a 264 padres de familia residentes en Lima Metropolitana y Callao durante los meses de julio a septiembre del 2020. Se calcularon las frecuencias absolutas y relativas. Para el análisis bivariado, se utilizó la prueba de Chi cuadrado de El nivel de significancia estadística fue de 0.05. Resultados: Se observa que el 52.94% de los padres, así como el 60.41% de las madres presentan un nivel medio de conocimiento sobre el uso de pastas dentales con flúor. Además, se obtuvo que el 56.25% de los padres que afirmaron que sus hijos no se enjuagan con agua después del cepillado presentan un nivel alto de conocimiento sobre el uso de pastas dentales con flúor. Conclusión: Se obtuvo que el 57.58% de los padres tenían un nivel medio de conocimiento sobre el uso de pastas dentales con flúor. Se encontró asociación entre el nivel de conocimiento sobre el uso de pastas dentales con flúor y las características asociadas a la ingesta estimada de fluoruro.

Abstract Introduction: Various studies have shown that parents still do not have sufficient knowledge about the use of toothpastes that their children should consume. Many of them do not know from what age to start using toothpastes, the exact amount to be placed on the brush and especially how often they should be brushed. Aim: To associate the level of knowledge of parents about the use of toothpastes with the characteristics associated with the estimated intake of fluoride in children between 6 months to 8 years of Metropolitan Lima and Callao. Materials and methods: An observational, descriptive, and crosssectional study. The questionnaire was carried out on 264 parents residing in Metropolitan Lima and Callao during the months of July to September 2020. The absolute and relative frequencies were calculated. For the bivariate analysis, the Chi-square test of the level of statistical significance was used was 0.05. Results: It is observed that 52.94% of the fathers, as well as 60.41% of the mothers present a medium level of knowledge about the use of fluoride toothpastes. In addition, it was found that 56.25% of parents who stated that their children do not rinse with water after brushing have a high level of knowledge about the use of fluoride toothpastes. Conclusion: It was found that the 57.58% of parents had a median level of knowledge about the use of fluoride toothpastes. An association was found between the level of knowledge about the use of fluoride toothpastes and the characteristics associated with the estimated fluoride intake.

Determination of the whitening effect of toothpastes on human teeth / Determinación del efecto blanqueador de los dentífricos en dientes humanos

Abstract The desire of individuals to have whiter teeth increases the interest in tooth whitening products. Our aim was to in vitro study the whitening effect of hydrogen peroxide, blue covarine and active charcoal containing whitening toothpastes on human teeth. A total of 40 extracted human incisor teeth were used in the study. To measure the whitening effect of toothpastes, the teeth were divided into four subgroups and placed in the phantom tooth jaw model. Then, daily brushing was done with an electric toothbrush. The colors of the teeth were measured initially using the spectrophotometer (single point and bleached shade mode) and at the end of 7th, 14th and 28th days. Whitening effectiveness of toothpastes were studied according to CIEDE2000 formula (ΔE00) and shade guide units (SGU). One- way analysis of variance (ANOVA) and Tukey test were used in the statistical analysis of the data. (p0.05). Blue covarine containing toothpaste had statistically the lowest whitening effect (p<0.05). All toothpastes showed a whitening effect on the teeth after 7 days of use. Activated charcoal containing toothpaste showed more whitening effect after 28 days of use than hydrogen peroxide, blue covarine and traditional toothpaste.

Resumen El deseo de los individuos de tener unos dientes más blancos aumenta el interés por los productos de blanqueamiento dental. Nuestro objetivo fue estudiar el efecto blanqueador de las pastas dentales blanqueadoras que contienen peróxido de hidrógeno, covarina azul y carbón activo en dientes humanos in vitro. En el estudio se utilizaron un total de 40 dientes incisivos humanos extraídos. Para medir el efecto blanqueador de los dentífricos, los dientes se dividieron en cuatro subgrupos y se colocaron en el modelo de diente fantasma en mandíbula. A continuación, se realizó un cepillado diario con un cepillo eléctrico. El color de los dientes se midió inicialmente con un espectrofotómetro (modo de punto único y tono blanqueado) y al final de los días 7, 14 y 28. Se estudió la eficacia blanqueadora de los dentífricos según la fórmula CIEDE2000 (ΔE00) y las unidades de guía de color (SGU). En el análisis estadístico de los datos se utilizó el análisis de varianza de una vía (ANOVA) y la prueba de Tukey. (p0,05). El dentífrico que contiene covarina azul tuvo estadísticamente el menor efecto blanqueador (p<0,05). Todos los dentífricos mostraron un efecto blanqueador en los dientes después de 7 días de uso. Los dentífricos con carbón activado mostraron un mayor efecto blanqueador tras 28 días de uso que el peróxido de hidrógeno, la covarina azul y el dentífrico tradicional.

Efficacy of products for bleaching and whitening under orthodontic brackets

ABSTRACT Introduction: Many patients wearing orthodontic appliances request alterations in the shade of their teeth during orthodontic treatment. Objective: This study aimed to evaluate the efficacy of different products for bleaching and whitening under orthodontic brackets. Methods: Seventy bovine incisors were randomly divided into five groups (n = 14): C) non-whitening toothpaste (control); WTsi) hydrated silica whitening toothpaste; WThp) 2% hydrogen peroxide whitening toothpaste; OB) in-office bleaching; and HB) at-home bleaching. Two buccal surface areas were evaluated using the Easyshade spectrophotometer: under the metal bracket (experimental) and around the bracket (control). The paired t-test, ANOVA, and Tukey tests were applied for statistical analysis. Results: Intragroup comparisons showed that in groups C, WThp and HB, there were statistically significant differences in the enamel color changes (ΔEab) between under and around the bracket areas (C - under bracket = 7.97 ± 2.35, around bracket = 2.86 ± 0.81, p< 0.01; WThp - under bracket = 4.69 ± 2.98, around bracket = 2.05 ± 1.41, p< 0.01; HB - under bracket = 7.41 ± 2.89, around bracket: 9.86 ± 3.32, p= 0.02). Groups WTsi, OB and HB presented similar perception of tooth whiteness (ΔWID) between the tested areas. Intergroup comparisons demonstrated that under the bracket area, the color change (ΔEab) was similar for all groups, except WThp (C = 7.97 ± 2.35; WTsi = 8.54 ± 3.63; WThp = 4.69 ± 2.98; OB = 9.31 ± 4.32; HB = 7.41 ± 2.89; p< 0.01). Conclusions: The dental color changes were effective for the products tested in groups WTsi, OB and HB in the presence of metallic orthodontic brackets.

RESUMO Introdução: Durante o tratamento ortodôntico, muitos pacientes solicitam, também, alteração na cor dos seus dentes. Objetivo: O presente estudo avaliou diferentes produtos clareadores e branqueadores, quanto à sua eficácia sob os braquetes ortodônticos. Métodos: 70 incisivos bovinos foram aleatoriamente divididos em cinco grupos (n = 14): C) dentifrício não branqueador (controle); WTsi) dentifrício branqueador com sílica hidratada; WThp) dentifrício branqueador com peróxido de hidrogênio a 2%; OB) clareamento no consultório e HB) clareamento caseiro. Usando um espectrofotômetro Easyshade, foram avaliadas duas áreas na superfície vestibular dos dentes: sob o braquete (experimental) e ao redor do braquete (controle). Para análise estatística, foram usados os testest pareado, ANOVA e Tukey. Resultados: As comparações intragrupos demonstraram que, nos grupos C, WThp e HB, ocorreram diferenças estatisticamente significativas nas alterações de cor do esmalte (ΔEab) entre as áreas sob o braquete e ao redor do braquete (C: sob o braquete = 7,97 ± 2,35, ao redor do braquete = 2,86 ± 0,81, p< 0,01; WThp: sob o braquete = 4,69 ± 2,98, ao redor do braquete = 2,05 ± 1,41, p< 0,01; HB: sob o braquete = 7,41 ± 2,89, ao redor do braquete = 9,86 ± 3,32, p= 0,02). Os grupos WTsi, OB e HB demonstraram semelhanças na percepção do clareamento (ΔWID) entre as áreas avaliadas. As comparações intergrupos demonstraram que, nas áreas sob os braquetes, as alterações de cor (ΔEab) foram semelhantes para os grupos, com exceção do WThp (C = 7,97 ± 2,35; WTsi = 8,54 ± 3,63; WThp = 4,69 ± 2,98; OB = 9,31 ± 4,32; HB = 7,41 ± 2,89; p< 0,01). Conclusões: As alterações na cor dos dentes foram efetivas para os procedimentos testados nos grupos WTsi, OB e HB na presença de braquetes metálicos ortodônticos.

Fluoride toothpaste, sanitary surveillance and the SUS: the case of Manaus-AM, Brazil / Dentifrício fluoretado, vigilância sanitária e o SUS: o caso de Manaus-AM

ABSTRACT OBJECTIVE To determine the anticaries potential of toothpastes distributed by the primary health care public clinics (UBS) of Manaus, AM. METHODS Ninety-nine tubes of toothpaste from four commercial brands were collected from October 7, 2019 to October 11, 2019 in 16 UBS. They were assigned a code by brand and source UBS. According to the information on the packaging, the four brands and their batches were formulated with sodium monofluorophosphate (Na2FPO3) and most (91%) had calcium carbonate (CaCO3) as an abrasive. We determined the concentrations of total fluoride (TF = TSF + InsF) and total soluble fluoride (TSF = F ions- or FPO32-), to certify whether they were in compliance with resolution ANVISA RDC No. 530 (maximum of 1,500 ppm TF) and whether they had anticaries potential (minimum of 1,000 ppm TSF). The analyses were performed with a ion- specific electrode. RESULTS The concentrations (ppm F) of TF [mean; standard deviation (SD); n] found in toothpaste brands A (1,502.3; SD = 45.6; n = 33), B (1,135.5; SD = 52.7; n = 48) and D (936.8; SD = 20.5; N = 8) were close to those stated on the package, 1,500, 1,100 and 1,000 ppm F, respectively. In toothpaste C, we found a mean of 274.1 ppm (SD = 219.7; n = 10) of TF, which diverges from the declared concentration of 1,500 ppm F. In addition, the five tubes of lot no. 11681118 of toothpaste C did not contain fluoride. Regarding TSF, with the exception of toothpaste D (937.9; SD = 40.29), the others had a lower concentration than their respective TF. CONCLUSION We found serious problems of quantity and quality of fluoride in toothpaste distributed by the SUS in Manaus, which shows the need for surveillance of these products and confirms the urgency of revising resolution RDC No. 530.

RESUMO OBJETIVO Determinar o potencial anticárie dos dentifrícios distribuídos pelas unidades básicas de saúde (UBS) de Manaus-AM. MÉTODOS Noventa e nove bisnagas de dentifrícios de quatro marcas comerciais foram coletadas de 7 de outubro de 2019 a 11 de outubro de 2019 em 16 UBS, que foram codificados por marca e UBS de origem. De acordo com a embalagem, os dentifrícios das quatro marcas e seus lotes foram formulados com monofluorofosfato de sódio (Na2FPO3) e a maioria (91%) tinha carbonato de cálcio (CaCO3) como abrasivo. Foram determinadas as concentrações de fluoreto total (FT = FST + Fins) e de fluoreto solúvel total (FST = íons F- ou FPO32-), para certificar se atendiam à resolução ANVISA RDC Nº 530 (máximo de 1.500 ppm de FT) e se tinham potencial anticárie (mínimo de 1.000 ppm de FST). As análises foram feitas com eletrodo íon específico. RESULTADOS As concentrações (ppm F) de FT [média; desvio padrão (DP); n] encontradas nos dentifrícios A (1.502,3; DP = 45,6; n = 33), B (1.135,5; DP = 52,7; n = 48) e D (936,8; DP = 20,5; n = 8) foram próximas ao descrito na embalagem, 1.500, 1.100 e 1.000 ppm F, respectivamente. No dentifrício C, foi encontrada média de 274,1 ppm (DP = 219,7; n = 10) de FT, divergindo da concentração declarada de 1.500 ppm F. Em acréscimo, as cinco bisnagas do lote no 11681118 do dentifrício C não foram fluoretadas. Quanto ao FST, à exceção do dentifrício D (937,9; DP = 40,29), os demais apresentaram concentração inferior ao seu respectivo FT. CONCLUSÃO Observou-se problemas graves de quantidade e qualidade do fluoreto nos dentifrícios distribuídos pelo SUS em Manaus, mostrando a necessidade de vigilância desses produtos e ratificando a urgência da revisão da resolução ANVISA RDC Nº 530.

S-PRG-based toothpastes compared to NaF toothpaste and NaF varnish on dentin permeability in vitro

Abstract Objectives To analyze the effect of 5 toothpastes containing different percentages of S-PRG fillers compared to NaF toothpaste and NaF varnish on the dentin hydraulic conductance (Lp). Methodology Dentin disks (1.0±0.2 mm thickness) were cut from third molars, and their Lp values were evaluated using Flodec. The specimens were allocated into 7 groups (n=8). The minimum (smear layer) and the maximum (after acid etching) Lp values were recorded. Lp was also assessed after treatment with either a 0wt.%, 1wt.%, 5wt.%, 20wt.%, or 30wt.% S-PRG toothpaste, a NaF toothpaste, or a NaF varnish. Toothpastes were applied by brushing for 15 s, allowing it to settle for 1 min, and rinsing with deionized water. The NaF varnish was applied for 4 min and was removed with a probe. Specimens were exposed to citric acid (6%, pH 2.1, 1 min) and their final Lp was recorded. The pH of all products was recorded (n=3) and specimens from each group were analyzed by Laser Scanning Confocal Microscopy (LSCM). Data were subjected to 2-way repeated measures ANOVA and post-hoc Bonferroni (a=0.05). Results The highest Lp reduction was noticed for the 5wt.% S-PRG toothpaste, NaF toothpaste, and NaF varnish. However, the toothpastes containing 5wt.%, 20wt.%, and 30wt.% of S-PRG were similar to all toothpastes but differed from the NaF varnish. After erosion, all groups retrieved their maximum Lp values, except for the NaF varnish. The LSCM evidenced deposits on the surface of specimens treated with 5%, 20%, and 30% S-PRG-based toothpastes and NaF toothpaste. Even more deposits were observed for the NaF varnish. After the erosive challenge, the deposits were diminished in all groups. Conclusion Toothpastes containing 5wt.%, 20wt.%, and 30wt.% of S-PRG fillers behaved similarly to a conventional NaF toothpaste, even after an erosive challenge. The NaF varnish promoted better reduction of the Lp, but its effect was also diminished after erosion.

Comportamiento del Midazolam administrado con tres diferentes vehículos para sedación consciente Estudio retrospectivo / ehavior of Midazolam administered with three different vehicles for conscious sedation: Retrospective study

Ante situaciones de miedo y ansiedad algunos pacientes requieren tratamientos bajo sedación consciente con midazolam, el cual requiere de ser mezclado con algún vehículo para su administración, sin embargo existe poca información de cómo este podría afectar su absorción. Objetivo: evaluar el nivel de sedación consciente en relación a la administración oral de midazolam con tres vehículos diferentes. Material y métodos: estudio observacional, retrospectivo y comparativo de 45 reportes de sedación consciente de los cuales, 20 cumplieron con los criterios de inclusión. Los datos fueron tomados de las histórias clínicas y analizados evaluando edad, sexo, comparando el nivel de sedación a traves de la escala de Houpt y los vehículos empleados (Paracetamol, jugo de frutas y azucar con jugo en cuchara). Se empleó el programa estadístico SPSS para la prueba chí cuadrado, analisis de frecuencia, moda y media para el análisis de los datos, con un nivel de significancia de 5%. Resultados: En cuanto a la somnolencia la mayoría de los pacientes presentó Houpt nivel 3 (somnoliento). En cuanto al movimiento no se encontró diferencia significativa según el vehículo utilizado. En cuanto al llanto, la mayoría de los pacientes presentó un nivel 3 y 4. Conclusión: La dilución del midazolam en jugo mostró mejores resultados en cuanto a somnolencia y llanto, pero estas diferencias no fueron estadísticamente significativas mostrando que los tres vehículos podrían ser útiles para la administración del midazolam vía oral.

When facing fear or anxiety situations some patients require treatments under conscious sedation with mida-zolam, which require to be mixed with a vehicle for its administration, however there is few information about how it could affect its absorption. Aim: to assess the conscious sedation level in relation to the administration of midazolam with three di-fferent vehicles. Material and Methods: observational, retrospective and comparative study of 45 conscious sedation files of which 20 met the inclusion criteria. Data was taken from the medical records and analyzed evaluating the age, gender, comparing the sedation level according to the Houpt scale and vehicle used (Paracetamol, fruit juice and brown sugar with juice in a spoon). The SPSS statistics program for the chi square test, frequen-cy analysis, mode and mean was used to analyze de data, with a significance level of 5%. Results: Regarding the somnolence the majority of the patients showed a level 3 (drowsy). Regarding the movement there were no significant differences found according to the vehicle used. Regarding the crying the majority of the patients showed a level 3 and 4. Conclusion: The dilution of midazolam in juice showed better results regarding somnolence and crying, these differences were not statistically significant showing that the three vehicles could be useful for the administra-tion of midazolam orally.