Eficacia de la arginina al 8% y nitrato potásico al 5% en el tratamiento de la hipersensibilidad dentinaria: ensayo clínico aleatorio / Efficacy of 8% arginine and 5% potassium nitrate in dentin hypersensitivity therapy: a randomized clinical trial

RESUMEN: Objetivo: Comparar la eficacia clínica de dentífricos en base a arginina al 8%/ monofluorfosfato de sodio 1450 ppm versus nitrato de potasio al 5%/fluoruro de sodio 2500 ppm en la terapia de la hipersensibilidad dentinaria (HSD). Materiales y método: Ensayo clínico, aleatorio, controlado, doble ciego, de grupos paralelos. Treinta y cuatro voluntarios de 18 a 70 años, con HSD en escala Visual Análoga (EVA) ≥4 en 2 ó más dientes no molares, fueron distribuidos aleatoriamente en 2 grupos: grupo T1 (n=16): dentífrico de Arginina al 8%/ monofluorfosfato de sodio 1450 ppm; y grupo T2 (n=18): dentífrico de nitrato de Potasio al 5%/fluoruro de sodio 2500 ppm. Se evaluó HSD en EVA con estímulos evaporativos y térmicos, y se compararon sus valores, así como el grado promedio de HSD y su reducción (∆HSD), intra e intergrupal, al inicio y a las 4 semanas de tratamiento. Resultados: Ambos dentífricos disminuyeron el grado promedio de HSD entre el inicio y las 4 semanas de tratamiento (T1: 5.03 ± 1.23 versus 2.60 ± 1.27, p<0.05; T2: 4.73 ± 1.51 versus 2.71 ± 1.17, p<0.05). No hubo diferencias estadísticamente significativas entre ambos dentífricos al comparar el grado promedio de reducción de HSD durante la terapia (∆HSD T1: -2.43 ± 1.22 versus ∆HSD T2: -2.27 ± 1.42). Los datos fueron analizados en Stata versión 11. Conclusiones: Ambos dentífricos fueron clínicamente eficaces en reducir la HSD a las 4 semanas, sin existir diferencias estadísticamente significativas entre ambos.

ABSTRACT: Aim: To compare the clinical efficacy of 8% arginine/1450ppm sodium monofluorophosphate and 5% potassium nitrate/2500 ppm sodium fluoride dentifrices in the treatment of dentin hypersensitivity (DH). Methods: Parallel-design, double-masked, randomized controlled clinical trial. Thirty four volunteers aged 18 to 70 years, with DH and a visual analog scale (VAS) score ≥4 at least in two or more non-molar teeth, were randomized in two groups: T1 (n=16): 8% arginine/1450 ppm sodium monofluorophosphate dentifrice; and T2 (n=18): 5% potassium nitrate/2500 ppm sodium fluoride dentifrice. DH was assessed with evaporative and thermal stimuli; and their VAS measurements, mean DH value and DH reduction (∆DH) were compared, inside and between the groups at baseline and 4-week follow-up. Data were analysed through Stata® V11 program. Results: Both toothpastes decreased mean DH value between baseline and 4 weeks (T1: 5.03 ± 1.23 versus 2.60 ± 1.27, p<0.05; T2: 4.73 ± 1.51 versus 2.71 ± 1.17, p<0.05). There were no statistical differences between both dentifrices in mean DH reduction values during therapy (∆HSD T1: -2.43 ± 1.22 versus ∆HSD T2:-2.27 ± 1.42). Conclusions: Both dentifrices had clinical efficacy in decreasing DH in a 4- week therapy, without statistical differences between both of them.

Hipersensibilidad dentinaria posterior al tratamiento periodontal quirúrgico / Dentine hypersensitivity after surgical periodontal treatment

El objetivo de esta investigación fue evaluar el nivel de información que poseen los odontólogos periodoncistas con respecto a la aparición de hipersensibilidad dentinaria posterior a los procedimientos quirúrgicos, identificar cuál es la cirugía que más la genera, así como los tratamientos más utilizados en el manejo de la entidad. Materiales y métodos: Se realizó un estudio de campo, de tipo descriptivo y transversal. La muestra estuvo conformada por 86 periodoncistasque corresponden al 30 por cienot de la población que integra la Sociedad Venezolana de Periodontología. La información se recolectó con un instrumento tipo encuesta. Resultados: El 89,53 por ciento manifestó que sus pacientes refieren hipersensibilidaddentinaria posterior a la realización de procedimientos quirúrgicos periodontales. La cirugía para reducción de sacos ocupó el primer lugar en generar hipersensibilidaddentinaria con un 57,14 por ciento. Un 96.10 por ciento de los especialistas entrevistados confirmó la utilización de algún tratamiento para la hipersensibilidad dentinaria. En relación a el tratamiento más utilizado, el 53,24 por ciento aplicó pastas desensibilizantes posterior a la fase periodontal quirúrgica. Conclusiones: Los resultados obtenidos en esta investigación indican que el nivel de información que poseen los profesionales de la periodontología en relación a la hipersensibilidaddentinaria posterior a la cirugía periodontal es elevado debido a la alta prevalencia de esta afección en la población tratada. El procedimiento quirúrgico más asociado a la hipersensibilidad dentinaria fue la cirugía para reducción de sacos. La aplicación de pastas desensibilizantes fue el tratamiento más utilizado paracontrolarla.

Color stability and surface roughness of artificial teeth brushed with an experimental Ricinus communis toothpaste

To evaluate, in vitro, the effect of brushing with a Ricinus communis-based experimental toothpaste on color stability and surface roughness of artificial teeth. Methods: Ninety artificial teeth (maxillary central incisors) in different shades, light and dark (NatusDent Triple Pressing, Dentbras) were used. Initial color (Spectrophotometer Easyshade, VITA) and surface roughness (Rugosimeter Surfcorder SE 1700, Kosakalab) readouts were performed. After baseline measurements, samples were assigned to 10 groups (n=9) according to the artificial tooth shade and type of toothpaste used during the mechanical brushing test (Pepsodent, MAVTEC): Sorriso Dentes Brancos - SDB, Colgate Luminous White - CLW (Colgate-Palmolive), Close up White Now - CWN (Unilever), Trihydral - THL (Perland Pharmacos) and Ricinus communis - RCE (Experimental). After 29,200 cycles of brushing, corresponding to 2 years of brushing by a healthy individual, new color and roughness readouts of the specimens were performed. Data (before and after the tests) were statistically analyzed (2-way repeated measures ANOVA, Tukey, p<0.05). Results: RCE toothpaste produced the greatest color stability for dark tooth shade and the second best color stability for light tooth shade. For surface roughness alteration, there was no difference (p>0.05) for any tested toothpaste regardless of tooth shade. Conclusions: The experimental Ricinus communis toothpaste did not cause color and surface roughness alteration in the artificial teeth, and it may be considered a suitable option for denture cleaning...

Eficacia del uso concomitante de dentífrico con Triclosán a 0.3 por ciento y copolímero PVM/MA a 2.0 por ciento, enjuague bucal a base de cloruro de cetilpiridinio a 0.05 por ciento y terapia de raspado/alisado radicular en pacientes con gingivitis / Efficacy of concomitant use of dentifrice with 0.3 per cent Triclosan and 2.0 per cent PVM/MA copolymer, 0.05 per cent cetylpyridinium chloride mouthrinse and scaling/root planning therapy in patients with gingivitis

Introducción: La placa dentobacteriana es el principal factor etiológico en el desarrollo y progresión de la gingivitis. Comúnmente se han sugerido productos de cuidado oral como cremas dentales y/o enjuagues bucales como adyuvante en la terapia mecánica. Objetivo: Evaluar la eficacia del uso combinado de un dentífrico a base de Triclosán a 0.3 por ciento y copolímero PVM/MA a 2.0 por ciento (Colgate Total 12®) y enjuague bucal a base de cloruro de cetilpiridinio a 0.05 por ciento (Colgate Plax®) en pacientes con gingivitis marginal crónica después de una terapia de raspado y alisado radicular comparado con un grupo control. Material y métodos: Se realizó un ensayo clínico controlado, aleatorizado y doble ciego en 50 pacientes sanos con diagnóstico sistemático de gingivitis marginal crónica. Se dividieron en grupo A experimental y grupo B control. Se evaluó índice gingival de Lõe y Silness e índice de placa de Quigley Hein modifi cado por Turesky al inicio y al fi nal del estudio; el periodo de estudio fue de seis semanas. Al inicio se realizó a cada paciente tratamiento de raspado y alisado radicular y se le instruyó sobre el uso correcto de los productos. Al concluir la sexta semana se tomaron mediciones finales bajo las mismas condiciones que las iniciales...

Introduction:Dental plaque is considered to be the main etiological factor in the development and progression of gingivitis. Oral care products such as toothpaste and mouthwash have commonly been rec-ommended as an adjunct to mechanical periodontal therapy. Objective:To evaluate the effi cacy of using a dentifrice containing 0.3% triclosan and 2.0% PVM/MA copolymer (Colgate Total 12®) in combination with a 0.05% cetylpyridinium chloride mouthwash (Colgate Plax®) in patients with chronic marginal gingivitis following scaling and root-planing therapy compared to a control group. Material and methods:A randomized double-blind controlled clinical study was performed on 50 systemically healthy patients diagnosed with chronic marginal gingivitis. These were divided into two groups: A (experimental) and B (control). The Lõe and Silness gingival index and the Turesky modifi ca-tion of the Quigley-Hein plaque index were recorded at baseline and after 6 weeks (the duration of the study). Patients were treated with scaling and root-planning, and all received instructions on the proper use of the oral care products. Final measurements were taken at the end of the six-week assessment under the same conditions as those at the time of the baseline assessment...

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

Dentifrício fluoretado suplementado com hexametafosfato de sódio sobre o processo de desmineralização do esmalte: estudos in vitro e in situ / Dentifrice fluoride supplemented with sodium hexametaphosphate on the process of demineralization of the enamel. In vitro and in situ

O objetivo deste estudo foi avaliar a capacidade de dentifrícios convencionais (1100 ppm F) suplementados com hexametafosfato de sódio (HMP), em reduzir a desmineralização do esmalte in vitro e in situ. No estudo in vitro blocos de esmalte bovino (n = 60) selecionados pela dureza de superfície inicial (SHi) foram divididos em cinco grupos de dentifrícios (n = 12): sem fluoreto e sem HMP (Placebo); um convencional de 1100 ppm F (1100F); 1100 ppm F associado 0.5% de HMP (1100FHMP0.5%), 1100 ppm F associado a 1% de HMP (1100FHMP1%) e 1100 ppm F associado a 2% HMP (1100FHMP2%). Os blocos foram submetidos a ciclagem de pH durante cinco dias, sendo o tratamento com os respectivos dentifrícios realizados 2x/dia. A seguir, determinou-se a dureza de superfície final (SHf) e a perda de dureza de superfície (%SH), perda da dureza integrada de subsuperfície (ΔKHN), a dureza diferencial integrada (ΔIH) e fluoreto (F) no esmalte. Os resultados foram submetidos à análise de variância seguida pelo teste Student-Newman-Keuls (p < 0,001). O grupo 1100FHMP1% apresentou a menor perda mineral (%SH, ΔKHN e ΔIH) seguido pelo grupo 1100FHMP0.5% (p < 0,001). O grupo 1100FHMP1% apresentou a mesma concentração de F no esmalte do grupo 1100. Para o estudo in situ, blocos de esmalte bovinos (n = 144) foram selecionados pela dureza de superfície e divididos em três grupos experimentais: Placebo (placebo), 1100 ppm F (1100F), 1100 ppm F associado a 1% de HMP (1100FHMP1%). Doze voluntários utilizaram dispositivos palatinos, com quatro blocos de esmalte, durante sete dias para cada fase, sendo a escovação realizada 3x/dia com o dispositivo palatino no interior da cavidade bucal e o desafio cariogênico com sacarose 30% em horários pré-estabelecidos. Após o período de 7 dias determinou-se %SH, ΔKHN e os níveis de fluoreto (F), cálcio (Ca) e fósforo (P) no esmalte. No biofilme formado sobre os blocos foram determinados para a concentração de F, Ca, P e polissacarídeo extracelular (EPS)...

The objective of this study was to evaluate the ability of conventional dentifrices (1100 ppm F) supplemented with sodium hexametaphosphate (HMP), in reducing enamel demineralization in vitro and in situ. In the study of demineralization of bovine enamel blocks (n = 60) selected by the initial surface hardness (SHI) were divided into five groups of dentifrices (n = 12) without fluoride and HMP without (Placebo); conventional dentifrice 1100 ppm F (1100F); 1100 ppm F associated 0.5% of HMP (1100FHMP0.5%), 1100 ppm F associated 1% of HMP (1100FHMP1%) and 1100 ppm F associated 2% of HMP (1100FHMP2%). The blocks were subjected to pH cycling for five days, and then treatment performed with the respective dentifrices 2x / day. Next, we determined final surface hardness (SHf), surface hardness loss (% SH), integrated differential hardness (ΔIH) and integrated loss of subsurface hardness (ΔKHN) and fluoride (F) in the enamel. The results were submitted to one-way ANOVA followed by the Student-Newman-Keuls test (p <0.001). The group 1100FHMP1% had the lowest mineral loss (SH%, ΔKHN and ΔIH) followed in 1100FHMP0.5% (p <0.001). 1100FHMP1% group had the same concentration of 1100 ppm F in group F. For the study of enamel in situ bovine enamel blocks (n = 144) were selected for the surface hardness and divided into three groups: Placebo (placebo), 1100 ppm F (1100F), 1100 ppm F associated 1% of HMP (1100FHMP1%). Twelve volunteers wore palatal appliances with four enamel blocks for seven days, and brushing performed 3x / day with the palatal device within the oral cavity and the cariogenic challenge with sucrose 30% at pre-established times. After 7 days, SH% was determined, ΔKHN and fluoride (F), calcium (Ca) and phosphorus (P) in enamel. The biofilms formed were analyzed for the concentration of F, Ca, P and extracellular polysaccharide (EPS). Data were subjected to the tests one-way ANOVA and Newman-Keuls post-hoc (p<0.001). The group 1100FHMP1% presented fluoride...

Efficacy of a triclosan formula in controlling early subgingival biofilm formation: a randomized trial

The aim of this study was to determine the efficacy of rinses with slurries of a dentifrice containing triclosan (TCS), as compared with rinses with slurries from a control dentifrice, in controlling early subgingival biofilm formation. A double-blind, randomized and cross-over clinical trial was designed, and 26 dental students were included. In the first period, participants were randomized to rinse with a TCS slurry or a control slurry, in a 12 h interval, and to refrain from mechanical cleaning. A Plaque Free Zone Index was assessed at 24 h, 48 h, 72 h and 96 h. After a washout period of 10 days, the second experimental period was conducted, following the same protocol as the first period, except that the slurry groups were switched. Use of the TCS slurry resulted in a significantly higher percentage of plaque-free surfaces, both at 24 h and at 72 h (p < 0.01). In the of 48-72 h interval, the triclosan slurry showed a lower percentage of sites converted to a score of 2 (38.1% for the testversus 40% for the control product, p = 0.015). In conclusion, rinsing with slurries of dentifrice containing TCS retards the down growth of bacterial biofilms from the supra- to the subgingival environment.

Use of dentifrices to prevent erosive tooth wear: harmful or helpful?

Dental erosion is the loss of dental hard tissues caused by non-bacterial acids. Due to acid contact, the tooth surface becomes softened and more prone to abrasion from toothbrushing. Dentifrices containing different active agents may be helpful in allowing rehardening or in increasing surface resistance to further acidic or mechanical impacts. However, dentifrices are applied together with brushing and, depending on how and when toothbrushing is performed, as well as the type of dentifrice and toothbrush used, may increase wear. This review focuses on the potential harmful and helpful effects associated with the use of dentifrices with regard to erosive wear. While active ingredients like fluorides or agents with special anti-erosive properties were shown to offer some degree of protection against erosion and combined erosion/abrasion, the abrasive effects of dentifrices may increase the surface loss of eroded teeth. However, most evidence to date comes from in vitro and in situ studies, so clinical trials are necessary for a better understanding of the complex interaction of active ingredients and abrasives and their effects on erosive tooth wear.

Perfil odontológico de pacientes com necessidades especiais assistidos em hospital pediátrico de uma universidade pública brasileira / Dental Profile of Special Needs Patients in a Pediatric Hospital of a Brazilian Public University

Objetivo: Traçar o perfil odontológico dos pacientes com necessidades especiais que são assistidos no ambulatório odontológico em um hospital pediátrico de uma universidade pública. Método: Foi realizado estudo descritivo e retrospectivo, pela análise de 186 prontuários odontológicos dos pacientes com Necessidades Especiais, provenientes do Hospital de Pediatria Professor Heriberto Ferreira Bezerra, Natal/RN. Coletaram-se os dados relativos ao sexo, faixa etária, hábitos parafuncionais, forma de higiene oral, presença de cárie, mancha branca ativa, doença periodontal, e uso de medicação. Os dados foram analisados no programa SPSS por meio da estatística descritiva e analítica. Resultados: Observou-se maior prevalência do sexo masculino (55,9%) e da faixa etária de nove a 11 anos (26,9%). Das necessidades especiais, as mais registradas foram as anomalias congênitas (54,3%) e doenças sistêmicas crônicas (45,7%). Dentre eles, 53,8% usam medicamentos, sendo hormônio 15,6%, vitaminas 12,4%, antibiótico 9,1%, anti-hipertensivo 9,1% e anticonvulsivante 9,1%. Entre os hábitos deletérios, destacaram-se a respiração bucal (41,4%) e a onicofagia (31,2%). A higiene oral é realizada com escova e dentifrício em 96,8% dos pacientes, sendo que o dentifrício com flúor é usado por 78,5% da amostra. O uso do fio dental foi identificado em apenas 12,4% e a condição de higiene oral foi insatisfatória em 86% das PNEs. Constatou-se presença de mancha branca ativa (14%), necessidade de selamento dentário (31,7%) e exodontia (57%). 87,1% dos pacientes apresentam lesões cariosas, 35,5% gengivite, e 29,6% cálculo dentário.Conclusões: As necessidades especiais mais comuns foram fenda labial e/ou palatina, síndrome de Down, diabetes, epilepsia, doença renal crônica e cardiopatia. A respiração bucal é um hábito deletério recorrente. Apesar da utilização de escova dental regularmente e dentifrício fluoretado, a higiene oral é insatisfatória e há alta incidência de cárie, presença de gengivite e necessidade de exodontias múltiplas.

Objective: To outline the dental profile of special needs patients treated in the dental outpatient clinic in a pediatric hospital of a Brazilian public university.Method: A descriptive retrospective study of 186 dental charts of special needs patients referred from the Prof. Heriberto Ferreira Bezerra Pediatric Hospital in Natal, RN, Brazil. Data were collected on sex, age group, parafunctional habits, oral hygiene method, caries, active white spots, periodontal disease and use of medication. The collected data were analyzed by descriptive and analytical statistics using the SPSS software.Results: There was prevalence of males (55.9%) and the 9-11 year-old (26.9%) age group. Among the special needs, the most frequent were congenital anomalies (54.3%) and chronic systemic diseases (45.7%). Medication was used by 53.8% of the sample; 15.6% were hormones, 12.4% vitamins, 9.1% antibiotics, 9.1% anti-hypertensive drugs and 9.1% were anticonvulsant drugs. The main deleterious habits were mouth breathing (41.4%) and nail biting (31.2%). Oral hygiene was performed with dentifrice and toothbrushing by 96.8% of the patients and fluoridated dentifrice is used by 78.5% of the subjects. Dental floss was used only by 12.4% and poor oral hygiene conditions were observed in 86% of the special needs patients. The analyses also revealed active white spots (14%), need of restoration by 31.7% and extraction by 57%. As much as 87.1% presented carious lesions, 35.5% presented gingivitis, and 29.6% had dental calculi.Conclusions: The most common special needs were cleft lip/palate, Down syndrome, diabetes, epilepsy, chronic renal disease and cardiopathy. Mouth breathing was a recurrent deleterious habit. Despite regular toothbrushing and use of fluoridated dentifrice, poor oral hygiene was observed and there was a high incidence of caries, presence of gingivitis and need of multiple extractions.

The influence of desensitizing dentifrices on pain induced by in-office bleaching

The purpose of this study was to evaluate whether the use of desensitizing dentifrices used 15 days prior to and after in-office tooth bleaching could eliminate or reduce tooth sensitivity. After institutional review board approval and informed consent, 45 subjects were selected and divided into 3 groups according to the dentifrice selected: Colgate Total (CT), Colgate Sensitive Pro-Relief (CS) or Sensodyne ProNamel (SP). The subjects used toothpaste and a toothbrush provided to them for 15 days prior to bleaching. They were then submitted to two in-office bleaching sessions (Whiteness HP Blue Calcium). Their tooth sensitivity was assessed using the Visual Analog Scale (VAS) for a week after each session. Their tooth shade alteration was measured with a Vitapan Classical shade guide to determine if the dentifrices could influence the effectiveness of the bleaching agent. The data were submitted to Wilcoxon, Kruskal-Wallis and Mann-Whitney tests (α = 0.05). The use of desensitizing dentifrices did not affect the bleaching efficacy. In regard to tooth sensitivity, there was a statistically significant difference between the results of the Control Group and Group T2 after the first session (p = 0.048). There was no statistically significant difference in the results for the other groups after the first session. In regard to the second session, there was no statistically significant difference in the results for all the groups. The use of a desensitizing dentifrice containing nitrate potassium reduced tooth sensitivity during the bleaching regimen. Dentifrices containing arginine and calcium carbonate did not reduce tooth sensitivity. Color change was not influenced by the dentifrices used.

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

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

Efficacy of 1.23% APF gel applications on incipient carious lesions: a double-blind randomized clinical trial

The aim of this double-blind randomized clinical trial was to evaluate the efficacy of 1.23% APF gel application on the arrest of active incipient carious lesions in children. Sixty 7- to 12-year-old children, with active incipient lesions were included in the study. Children were divided randomly into 2 groups: 1.23% APF gel and placebo gel applications. Each group received 8 weekly applications of treatment. The lesions were re-evaluated at the 4th and 8th appointments. Poisson regression analysis was used to estimate relative risks of the presence of active white spot lesions. Groups showed similar results (PR = 1.67; CI 95% 0.69–3.98). The persistence of at least 1 active lesion was associated with a higher number of lesions in the baseline (PR = 2.67; CI 95% 1.19–6.03), but not with sugar intake (PR = 1.06; CI 95% 0.56–2.86) and previous exposure to fluoride dentifrice (PR = 1.26; CI 95% 0.49–2.29). The trial demonstrates the equivalence of the treatments. The use of the APF gel showed no additional benefits in this sample of children exposed to fluoridated water and dentifrice. The professional dental plaque removal in both groups may also account for the resulting equivalence of the treatments.

Factores de riesgo en lesiones incipientes de caries dental en niños / Risk factors for incipient dental caries lesions in children

Introducción: las lesiones de caries pueden ser detenidas en cualquier etapa de su desarrollo, con mayor éxito cuando aún es una lesión incipiente o mancha blanca; para lograrlo es imprescindible conocer bien los factores y las condiciones del surgimiento de esta enfermedad. Objetivos: determinar la frecuencia de lesiones incipientes de caries dental y su relación con factores de riesgo a caries en escolares de 6-11 años. Métodos: se realizó un estudio observacional descriptivo de corte transversal donde el universo estuvo integrado por todos los niños matriculados en la escuela primariaJosé A Echeverría, municipio Plaza de la Revolución en el período de enero a diciembre del 2006, para un total de 236, los cuales fueron examinados al aire libre y con luz natural, utilizando el método visual- táctil suave. Los dientes se limpiaron con algodón y se secaron con peras de aire para detectar la presencia de lesiones incipientes de caries, las cuales fueron señalizadas en el dentigrama, en el lugar correspondiente a la superficie afectada. La higiene bucal se calculó según el índice de O'Leary. Resultados: se halló que el 22,5 por ciento de los escolares presentaba estas lesiones, el 74,6 por ciento una higiene bucal deficiente, de ellos el 52,7 por ciento lesiones incipientes de caries, el 32,2 por ciento refirió ingerir alimentos azucarados 4 o más veces al día y desarrollaron mayor número de lesiones incipientes. De los escolares que utilizan dentífricos fluorados solo el 18 por ciento presentaron estas lesiones; los niños con índice COP- D o COE-d igual a 0 y los que presentaron dos o más caries resultaron igualmente afectados por lesiones incipientes. Conclusiones: los niños con deficiente higiene bucal presentaron mayor número de lesiones incipientes al igual que los que ingieren alimentos azucarados cuatro o más veces al día. Los que utilizan dentífricos fluorados diariamente resultaron menos afectados(AU)

Introduction: caries lesions can be arrested at any stage of development, with best results when it is an incipient lesion or a white spot; to achieve it, it is necessary to know the factors and conditions for the development of this disease. Objectives: to determine the frequency of incipient dental caries lesions and its relation with risk factors of caries in schoolchildren from 6 to 11 years of age. Methods: an observational descriptive cross-sectional study was conducted. The universe was composed of all children enrolled in José A Echeverría Primary School, Plaza de la Revolución Municipality during the period January-December 2006, for a total of 236 children, who were examined in the open-air, with natural light, using the visual-tactile method. The teeth were cleaned with cotton and dried with air bulbs to detect the presence of incipient dental caries, which were recorded in the dental chart, in the part corresponding to the affected surface. Buccal hygiene was calculated according to O'Leary index. Results: it was found that the 22.5 percent of the schoolchildren presented these lesions; the 74.6 percent had a deficient buccal hygiene, of them, the 52.7 percent had incipient caries lesions; the 32.2 percent reported to consume sweetened food 4 or more times a day who developed a higher number of incipient lesions. Of the schoolchildren who used fluoride toothpaste, only the 18 percent presented these lesions; children with DMFT index equal to 0 and those who presented two or more caries, resulted to be equally affected by incipient lesions. Conclusions: children with deficient buccal hygiene presented a higher number of incipient lesions, similarly to the ones who consumed sweetened food four or more times a day. The ones who used fluoride toothpaste daily resulted to be less affected(AU)

Efeito do pH e da concentração de fluoreto presente em dentifrícios líquidos no controle de cárie em área fluoretada: estudo clínico randomizado / Effect of liquid dentifrices pH and fluoride concentration on caries control in a region with fluoridated water: randomized clinical trial

Os dentifrícios de baixa concentração de fluoreto têm sido sugeridos como alternativa para reduzir o risco de fluorose dentária, embora não haja consenso quanto a sua eficácia clínica, a qual pode ser aumentada quando o pH é ácido. Este estudo clínico randomizado teve como objetivo avaliar o efeito anti-cárie do pH e da concentração de fluoreto presente em dentifrícios líquidos, em crianças com diferentes status de atividade cariosa. Crianças de 2-4 anos de idade residentes em uma área fluoretada (0,6-0,8 ppm F), com (A) e sem (I) lesões de cárie ativa foram distribuídas aleatoriamente em três grupos de acordo com o tipo de dentifrício utilizado: Grupo 1 (n=48-A/56-I): 550 ppm F pH 4,5, Grupo 2 (n=56-A/48-I) 1100 ppm F pH 7,0, Grupo 3 (n=52-A/55-I): 550 ppm F pH 7,0. O número de lesões tornando-se ativas/cavidades ou inativas, respectivamente, foi avaliado clinicamente após 12 meses, podendo-se determinar se as lesões progrediram ou regrediram. Além disso, as lesões de mancha branca foram avaliadas através da técnica de quantificação de fluorescência induzida por luz (Quantitative Light-Induced Fluorescence - QLF) em uma subamostra de 75 crianças. A concentração de fluoreto nas unhas dos pés e no biofilme dentário também foi avaliada após 6 meses de uso dos dentifrícios. A progressão de cárie seguiu um padrão decrescente de acordo com o dentifrício utilizado (G3>G2>G1), independentemente da atividade de cárie da criança, mas diferenças significativas foram detectadas apenas para a progressão e o incremento de cárie (G1 < G3) no grupo de crianças cárie-ativas, quando avaliadas por inspeção visual. Para a regressão de cárie, os valores encontrados para os 3 grupos foram mais parecidos entre si, não havendo diferenças significativas entre osgrupos. Por outro lado, a análise com o QLF não detectou diferença significativa entre os Grupos 1 e 2, mas eles tiveram um desempenho significativamente melhor que o Grupo 3. Concentrações de fluoreto...

Low-F dentifrices have been suggested as an alternative to reduce the risk of dental fluorosis, although there is no consensus on their clinical efficacy, which may be increased when the pH is acidic.The present randomized clinical trial evaluated the anticaries effect of low-F acidic liquid dentifrice in children at different caries activity status. Two-to-four-year-old schoolchildren living in a fluoridated area (0.6 0.8 ppm F), with (A) or without (I) active caries lesions were randomly allocated into 3 groups differing according to the type of dentifrice used over 12 months: Group 1 (n=48-A/56-I): 550 ppm F pH 4.5, Group 2 (n=56-A/48-I) 1100 ppm F pH 7.0, Group 3 (n=52-A/55-I): 550 ppm F pH 7.0. The number of lesions becoming active/cavities or inactive was clinically evaluated determining progression or regression. Additionally, the white spot lesions were evaluated by the quantitative light-induced fluorescence (QLF) method in a subsample of 75 children. Toenail and plaque fluoride concentration were also evaluated 6 months after the use of the dentifrices. Plaque samples were collected 5 and 60 minutes after the last use of the dentifrices. Caries net increment followed a decreasing pattern according to the dentifrice used (G3>G2>G1) regardless caries activity, but significant differences were detected only for caries progression and net increment (G1 < G3) for the cariesactive group when evaluated through visual inspection. For the regression, the values found for the three groups were more similar, without significant differences. QLF analysis detected no significant difference between Groups 1 and 2, but they performed significantly better than Group 3. Toenail fluoride concentration significantly lower was observed when children used the low-fluoride dentifrices. Plaque F concentration was significantly higher for Group 2 compared to group 3, egardless the time, while Group 1 did not significantly differ Group 2, but was...

Efeito do pH e da concentração de fluoreto presente em dentifrícios líquidos no controle de cárie em área fluoretada: estudo clínico randomizado / Effect of liquid dentifrices pH and fluoride concentration on caries control in a region with fluoridated water: randomized clinical trial

Os dentifrícios de baixa concentração de fluoreto têm sido sugeridos como alternativa para reduzir o risco de fluorose dentária, embora não haja consenso quanto a sua eficácia clínica, a qual pode ser aumentada quando o pH é ácido. Este estudo clínico randomizado teve como objetivo avaliar o efeito anti-cárie do pH e da concentração de fluoreto presente em dentifrícios líquidos, em crianças com diferentes status de atividade cariosa. Crianças de 2-4 anos de idade residentes em uma área fluoretada (0,6-0,8 ppm F), com (A) e sem (I) lesões de cárie ativa foram distribuídas aleatoriamente em três grupos de acordo com o tipo de dentifrício utilizado: Grupo 1 (n=48-A/56-I): 550 ppm F pH 4,5, Grupo 2 (n=56-A/48-I) 1100 ppm F pH 7,0, Grupo 3 (n=52-A/55-I): 550 ppm F pH 7,0. O número de lesões tornando-se ativas/cavidades ou inativas, respectivamente, foi avaliado clinicamente após 12 meses, podendo-se determinar se as lesões progrediram ou regrediram. Além disso, as lesões de mancha branca foram avaliadas através da técnica de quantificação de fluorescência induzida por luz (Quantitative Light-Induced Fluorescence - QLF) em uma subamostra de 75 crianças. A concentração de fluoreto nas unhas dos pés e no biofilme dentário também foi avaliada após 6 meses de uso dos dentifrícios. A progressão de cárie seguiu um padrão decrescente de acordo com o dentifrício utilizado (G3>G2>G1), independentemente da atividade de cárie da criança, mas diferenças significativas foram detectadas apenas para a progressão e o incremento de cárie (G1 < G3) no grupo de crianças cárie-ativas, quando avaliadas por inspeção visual. Para a regressão de cárie, os valores encontrados para os 3 grupos foram mais parecidos entre si, não havendo diferenças significativas entre osgrupos. Por outro lado, a análise com o QLF não detectou diferença significativa entre os Grupos 1 e 2, mas eles tiveram um desempenho significativamente melhor que o Grupo 3. Concentrações de fluoreto...

Low-F dentifrices have been suggested as an alternative to reduce the risk of dental fluorosis, although there is no consensus on their clinical efficacy, which may be increased when the pH is acidic.The present randomized clinical trial evaluated the anticaries effect of low-F acidic liquid dentifrice in children at different caries activity status. Two-to-four-year-old schoolchildren living in a fluoridated area (0.6 0.8 ppm F), with (A) or without (I) active caries lesions were randomly allocated into 3 groups differing according to the type of dentifrice used over 12 months: Group 1 (n=48-A/56-I): 550 ppm F pH 4.5, Group 2 (n=56-A/48-I) 1100 ppm F pH 7.0, Group 3 (n=52-A/55-I): 550 ppm F pH 7.0. The number of lesions becoming active/cavities or inactive was clinically evaluated determining progression or regression. Additionally, the white spot lesions were evaluated by the quantitative light-induced fluorescence (QLF) method in a subsample of 75 children. Toenail and plaque fluoride concentration were also evaluated 6 months after the use of the dentifrices. Plaque samples were collected 5 and 60 minutes after the last use of the dentifrices. Caries net increment followed a decreasing pattern according to the dentifrice used (G3>G2>G1) regardless caries activity, but significant differences were detected only for caries progression and net increment (G1 < G3) for the cariesactive group when evaluated through visual inspection. For the regression, the values found for the three groups were more similar, without significant differences. QLF analysis detected no significant difference between Groups 1 and 2, but they performed significantly better than Group 3. Toenail fluoride concentration significantly lower was observed when children used the low-fluoride dentifrices. Plaque F concentration was significantly higher for Group 2 compared to group 3, egardless the time, while Group 1 did not significantly differ Group 2, but was...

Efeito da utilização de dentifrícios com diferentes compostos bioativos nas propriedades superficiais do esmalte dental clareado / Effect of toothpastes with different bioactive compounds on dental bleached enamel superficial properties

O presente estudo teve como objetivo realizar uma revisão da literatura para verificar se os novos compostos bioativos presentes no mercado, como CPP-ACP, fosfosilicato de cálcio e sódio e o nitrato de potássio são eficazes na remineralização do esmalte dental clareado. As alterações ocorridas na superfície dental devido ao clareamento são diversas. Dentre elas, pode-se citar a rugosidade, dureza, perda de conteúdo mineral e alterações morfológicas como as mais estudadas. Muitas formas de análises tem sido utilizadas para essas avaliações, porém duas novas técnicas demonstram-se promissoras: o QLF e a nanoidentação. O QLF relaciona-se com a auto fluorescência dental, possuindo vantagens relacionadas a sua especificidade, simples manuseio e preservação do espécime. Já a nanoidentação é capaz de mensurar a dureza em sítios específicos, em uma escala nanométrica, permitindo uma criteriosa seleção da área a ser analisada. Os resultados obtidos não necessitam da mensuração visual da área demarcada pelo identador, o que se torna mais uma vantagem da técnica. Foi conclusivo que a literatura diverge quanto aos resultados apresentados até o momento relacionados aos efeitos do clareamento dental na superfície dental, e os estudos que avaliaram os diversos compostos bioativos apresentam diferentes metodologias que não permitem o estabelecimento de um protocolo de aplicação dos mesmos. Sendo assim, faz-se necessária a realização de novos estudos para avaliar os possíveis efeitos dos diferentes compostos quando da utilização destes como dentifrícios de uso terapêutico após o tratamento clareador.

This study aimed to review the literature and verify if the new bioactive compounds, like CPP-ACP, calcium sodium phosphosilicate and potassium nitrate are effective on the remineralization of the bleached dental enamel. There are several alterations occurred on the dental surface owing to the bleaching procedure. Among them: roughness, microhardness, mineral content loss and morphologic alterations are the most evaluated. Many different analysis have been used to assess the changes in the dental structure, however two of them have shown to be promising: the QLF and the nanoindentation. The QLF is related with the auto fluorescence of the teeth and has advantages related to its specificity, simple manipulation and it is not a destructive technique. On the other hand, the nanoindentation is capable to measure the surface hardness in very specific sites, in a nanometric scale, enabling a criterious selection of the area which will be analyzed. The results obtained by this equipment do not require the visual measure of the impressed area of the indentation, which is one advantage of the methodology. It was conclusive that the literature disagrees of the results presented about the effects of dental bleaching on the enamel surface and the researches that evaluated the bioactive compounds have demonstrated differences in their methodologies. These inconclusive findings interfere on the establishment of an application protocol to those new dentifrices. Thus, it is necessary to develop new researches to better understand the possible effects of the bioactive compounds when the use of these dentifrices are related to a therapeutic use after treatment with bleaching agents.

Supragingival plaque removal with and without dentifrice: a randomized controlled clinical trial

The aim of this study was to compare the efficacy of dental plaque removal by brushing with and without conventional dentifrice. Twenty-four students aged 17 to 28 years participated in this randomized controlled clinical trial. Quadrants 1-3 or 2-4 were randomly allocated to the test group (brushing without dentifrice) or control group (brushing with dentifrice). After 72 h of cessation of oral hygiene, Quigley & Hein (Turesky) plaque index was assessed before and after brushing by a calibrated and blind examiner. Overtime and intergroup comparisons were performed by Student's paired sample t-test at 5% significance level. The results showed that both groups after toothbrushing presented statistically significant reductions in plaque, with no differences between them (from 3.06 ± 0.54 to 1.27 ± 0.26 versus from 3.07 ± 0.52 to 1.31 ± 0.23). A separate analysis of the buccal and lingual aspects also showed no significant differences between groups. It may be concluded that the use of a conventional dentifrice during toothbrushing does not seem to enhance plaque removal capacity.

O objetivo deste estudo foi comparar a eficácia de remoção mecânica da placa dental através da escovação com e sem dentifrício. Vinte e quatro estudantes com idade de 17 a 28 anos participaram deste ensaio clínico randomizado. Os quadrantes 1-3 ou 2-4 foram randomizados para alocação no grupo teste (escovação sem dentifrício) ou grupo controle (escovação com dentifrício). Após 72 h de cessação de higiene bucal, o índice de placa de Quigley & Hein (Turesky) foi avaliado antes e após a escovação por um examinador cego e calibrado. Comparações intra e intergrupo foram realizadas pelo teste t pareado, a um nível de significância de 5%. Os resultados demonstraram que, após a escovação, ambos os grupos apresentaram redução significativa de placa, porém sem diferenças intergrupos (3,06 ± 0,54 a 1,27 ± 0,26 versus 3,07 ± 0,52 a 1,31 ± 0,23). Uma análise separada das faces vestibulares e linguais também não revelou diferenças entre os grupos. Conclui-se que a utilização de dentifrícios associado ao controle mecânico parece não contribuir para a remoção da placa dental.

Factors associated with changes in self-reported dentifrice consumption in a brazilian group from 1996 and 2009

The aim of the study was to determine factors associated with changes in self-reported dentifrice consumption in an urban population group over 13 years. This study evaluated two surveys of 671 and 688 households sampled in the urban area of a city from Southern Brazil in 1996 and 2009, respectively. The mother of the family was asked to answer a structured questionnaire about demographics, socioeconomic and behavioral variables. The primary outcome was obtained by questioning "how long does a dentifrice tube last in your house?" The cut-off point of duration was less than 1 month. It was used to determine high consumption of dentifrice (HCD). Associations between HCD and independent variables were evaluated by multivariable Poisson regression. There was a significant decrease of 20% (81.2% to 61.2%) in the prevalence of HCD between 1996 and 2009, resulting in a crude annual decrease of 1.54%. Mother's age, family income, dental assistance, mother's brushing frequency and number of household members that use a toothbrush were significantly associated with HCD independent from the year of survey. The prevalence ratio (PR) of HCD for the year of survey was 0.75, indicating an overall decrease of 25% in the probability of HCD from 1996 to 2009. Probabilities of HCD also decreased over the 13 years among the strata of education, number of household members and reason for choice of dentifrice. It may be concluded that the factors associated with the observed decrease were higher educational levels, larger number of household members and reasons for choosing a dentifrice related to preventive/therapeutic effects.

O objetivo deste estudo foi determinar fatores associados com mudanças no consumo auto-reportado de dentifrício em um grupo populacional urbano ao longo de 13 anos. Este estudo avaliou dois levantamentos de 671 e 688 domicílios selecionados na área urbana de uma cidade do sul do Brasil em 1996 e 2009, respectivamente. A mãe da família respondeu a um questionário estruturado sobre variáveis demográficas, socioeconômicas e comportamentais. O desfecho primário foi obtido questionando "quanto tempo um tubo de dentifrício dura na sua casa?". O ponto de corte de duração foi menor que um mês. Este foi utilizado para determinar alto consumo de dentifrício (ACD). Associações entre ACD e variáveis independentes foram avaliadas por regressão de Poisson multivariada. Houve uma diminuição significativa de 20% (81,2% para 61,2%) na prevalência de ACD entre 1996 e 2009, resultando em um decréscimo anual não ajustado igual a 1,54%. Idade da mãe, renda familiar, assistência odontológica, frequência de escovação da mãe e número de membros no domicílio que escovam os dentes estiveram significativamente associados com ACD independentemente do ano de levantamento. A razão de prevalência (RP) do ACD para ano de levantamento foi 0,75, indicando uma diminuição geral de 25% na probabilidade de ACD entre 1996 para 2009. As probabilidades de ACD também diminuíram ao longo de 13 anos entre os estratos de educação, número de membros da família e razões para escolha do dentifrício. Pode-se concluir que os fatores associados com a diminuição observada foram maior nível educacional da mãe, maior número de membros da família e razões para escolha do dentifrício relacionadas a efeitos preventivo/terapêuticos.