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

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.

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

Efeito de dentifrícios com alta concentração de flúor na remineralização de substrato dentário com cárie artificial / Effect of toothpaste with high fluoride concentration on remineralization of dental substrate with artificial caries

Introduction: fluoride toothpaste is widely used by the population. Objective: dentifrices with a high concentration of sodium fluoride and the presence of tricalcium phosphate were developed, providing additional protection to patients vulnerable to the development of caries. This study aimed to evaluate the influence of different dentifrices on the surface and internal hardness and enamel wear after artificial caries, pH cycling, and toothbrushing. Material and method: enamel blocks (4x4 mm) were obtained from 20 bovine teeth. The specimens were submitted to artificial caries lesion and then to pH cycling and brushing according to the dentifrice: Colgate Total 12 and Clinpro + Tricalcium Phosphate. Result: after this period, they were submitted to analysis of superficial and internal hardness and profilometry. Scanning Electron Microscopy (SEM) was performed. The data obtained were evaluated by one-way Analysis of Variance (ANOVA) to evaluate the mineral recovery and profilometry, and two-way repeated measures ANOVA to evaluate the superficial and internal hardness. Conclusion: analyzing the surface hardness, after caries induction, there was a significant reduction in hardness that was partially recovered regardless of the dentifrice used. For internal hardness, Clinpro obtained lower values on the control side and up to 90 micrometers on the test side. As for profilometry, Colgate Total 12 showed greater wear when compared to Clinpro. It was concluded that Clinpro promoted lower internal hardness, however, Colgate Total 12 resulted in greater surface wear of tooth enamel.

Introdução: dentifrícios fluoretados são amplamente utilizados pela população. Foram desenvolvidos dentifrícios com alta concentração de fluoreto de sódio e presença de tricálcio fosfato, fornecendo proteção adicional a pacientes vulneráveis ao desenvolvimento da cárie. Objetivo: o objetivo deste estudo foi avaliar a influência de diferentes dentifrícios na dureza superficial, interna e desgaste do esmalte após cárie artificial, ciclagem de pH e escovação. Material e método: blocos de esmalte (4x4 mm) foram obtidos a partir de 20 dentes bovinos. Os espécimes foram submetidos à lesão de cárie artificial e, em seguida, à ciclagem de pH e escovação de acordo com o dentifrício: Colgate Total 12 e Clinpro + Tricálcio Fosfato. Após este período, foram submetidos à análise de dureza superficial e interna e perfilometria. Foi realizada microscopia eletrônica de varredura. Resultado: os dados obtidos foram avaliados por ANOVA um critério para avaliar a recuperação mineral e perfilometria, ANOVA dois critérios medidas repetidas para avaliar a dureza superficial e interna. Conclusão: analisando a dureza superficial, após a indução da cárie houve uma redução significativa na dureza que foi parcialmente recuperada independente do dentifrício utilizado. Para dureza interna, Clinpro obteve valores menores no lado controle e até 90 micrômetros no lado teste. Quanto à perfilometria, o Colgate Total 12 apresentou maior desgaste quando comparado ao Clinpro. Concluiu-se que Clinpro promoveu menor dureza interna, porém, o Colgate Total 12 resultou em maior desgaste superficial do esmalte dentário.

A comparative study to evaluate the effects of antibiotics, plant extracts and fluoride-based toothpaste on the oral pathogens isolated from patients with gum diseases in Pakistan / Um estudo comparativo para avaliar os efeitos de antibióticos, extratos vegetais e creme dental à base de flúor sobre os patógenos orais isolados de pacientes com doenças gengivais no Paquistão

Abstract Oral diseases caused by various microorganisms are common around the world. Scientific research has now been focusing on novel medicines to overcome bacterial resistance and antibiotics side effects; therefore, the current study was designed to assess the efficacy of certain antibiotics, toothpaste, and medicinal plant extracts (Ajuga bracteosa and Curcuma longa) versus the bacterial pathogens isolated from the human oral cavity. A total of 130 samples were collected from Khyber Teaching Hospital Peshawar, Pakistan, among those 27 species isolated, and eight bacterial species were identified from the samples. Among all the bacterial species, Staphylococcus aureus (29.62%) and Proteus mirabilis (22.2%) were found to be more prevalent oral pathogens. In comparison, the least pervasive microbes were Proteus vulgaris, Shigella sonnei, Escherichia coli and Aeromonas hydrophila. The study also suggested that dental problems were more prevalent in males (41-50 years of age) than females. Among the eight antibiotics used in the study, the most promising results were shown by Foxicillin against A. hydrophila. The survey of TP1 revealed that it showed more potent antagonist activity against Proteus vulgaris as compared TP2 and TP3 that might be due to the high content of fluoride. The Curcuma longa showed more significant activity than Ajuga bracteosa (Stem, leaves and root) extracts. The data obtained through this study revealed that antibiotics were more effective for oral bacterial pathogens than toothpaste and plant extracts which showed moderate and low activity, respectively. Therefore, it is suggested that the active compounds in individual medicinal plants like Curcuma longa and Ajuga bracteosa could replace the antibiotics when used in daily routine as tooth cleansers or mouth rinses.

Resumo As doenças bucais causadas por vários microrganismos são comuns em todo o mundo. A pesquisa científica agora tem se concentrado em novos medicamentos para superar a resistência bacteriana e os efeitos colaterais dos antibióticos; portanto, o presente estudo foi desenhado para avaliar a eficácia de certos antibióticos, pasta de dente e extratos de plantas medicinais (Ajuga bracteosa e Curcuma longa) contra os patógenos bacterianos isolados da cavidade oral humana. No total, 130 amostras foram coletadas do Khyber Teaching Hospital Peshawar, Paquistão, entre essas, 27 espécies foram isoladas e oito espécies bacterianas foram identificadas a partir das amostras. Entre todas as espécies bacterianas, Staphylococcus aureus (29.62%) e Proteus mirabilis (22.2%) foram os patógenos orais mais prevalentes. Em comparação, os micróbios menos difundidos foram Proteus vulgaris, Shigella sonnei, Escherichia coli e Aeromonas hydrophila. O estudo também sugeriu que os problemas dentários eram mais prevalentes em homens (41-50 anos de idade) do que em mulheres. Entre os oito antibióticos usados ​​no estudo, os resultados mais promissores foram mostrados pelo Foxicillin contra A. hydrophila. A pesquisa de TP1 revelou que ele mostrou atividade antagonista mais potente contra Proteus vulgaris em comparação a TP2 e TP3, o que pode ser devido ao alto teor de flúor. A Curcuma longa apresentou atividade mais significativa em relação aos extratos de Ajuga bracteosa (caule, folhas e raiz). Os dados obtidos neste estudo revelaram que os antibióticos foram mais eficazes para os patógenos bacterianos orais do que os dentifrícios e os extratos vegetais que apresentaram atividade moderada e baixa, respectivamente. Portanto, sugere-se que os compostos ativos em plantas medicinais individuais como Curcuma longa e Ajuga bracteosa possam substituir os antibióticos quando usados ​​na rotina diária como limpadores de dentes ou enxaguatórios bucais.

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.

Development and Validation of an Educational Comic Book for Guidance on the Safe Use of Fluoride Toothpaste by Children

ABSTRACT Objective: To describe the elaboration and content validation of a comic book for guidance on the safe use of fluoride toothpaste by children. Material and Methods: Study on the development of educational technology carried out in four phases: 1 - literature review and script; 2 - elaboration of the material (illustrations, layout and design), 3 - validation (Content Validity Index = CVI and Flesch Readability Index = FI), 4 - pilot test to legitimize the material with the target population. Thirty-one individuals participated in the validation, being 07 expert judges and 24 representatives of the lay population, responsible for the daily care of preschool and school-age children. Results: In the validation, CVI= 0.97 (97%), indicating high agreement of the judges' answers; and FI = 92%, which corresponds to "very easy to understand" reading. In the pilot test carried out with the lay population, the 3 assessment blocks had CVI=1.0 (100%). Conclusion: The comic book proved to be valid regarding appearance and content and can be used for health education activities for adults on the use of fluoride toothpaste for oral hygiene in children.

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

Geographical barriers to the use of toothpaste containing ≥1000 ppm fluoride in peruvian children / Barreras geográficas para el uso de pasta dental con fluoruro ≥1000 ppm en niños peruanos

Objective: The aim of this was to determine the geographical barriers for the use of equal or more than 1000 (≥1000) parts per million (ppm) of toothpaste with fluorine (F) in children aged 1 to 11 years in Peru in 2018. Material and Methods: This is a cross-sectional study, the database of Demographic and Family Health Survey (ENDES, for its Spanish acronym) of Peru in 2018 was used; the final sample was 25660 records of children between 1 and 11 years old. The variables evaluated were the use of ≥1000 ppm fluoride toothpaste, place of residence, natural region, area of residence, region, wealth index, access to dental service, whether information was received about oral hygiene, daily tooth brushing, age and sex. A descriptive, bivariate (Chi square) and multivariate (log-linear Poisson regression) analysis was performed. Results: An association was found between the use of toothpaste ≥1000 ppm F with place of residence: small city vs capital-large city with an adjusted prevalence ratio (RPa): 0.94; 95% confidence interval (95% IC): 0.90-0.98, town and country vs. capital-large city both with an RPa: 0.95; 95% CI: 0.91-0.99. With natural region: rest of the Coast vs Lima with RPa: 0.94; 95% CI: 0.91-0.98, Sierra vs Lima with RPa: 0.95; 95% CI: 0.92-0.99 and Jungle vs Lima with RPa: 0.94; 95% CI: 0.90-0.98). Conclusion: The place of residence and the natural region are geographic barriers to the use ≥1000 ppm fluoride toothpaste in children aged between 1 and 11 years in Peru in 2018.

Objetivo: El objetivo de este fue determinar las barreras geográficas para el uso de igual o más de 1000 (≥1000) partes por millón (ppm) de pasta dental con flúor (F) en niños de 1 a 11 años en Perú en 2018. Material y Métodos: Se trata de un estudio transversal, la base de datos de la Encuesta Demográfica y de Salud Familiar (ENDES) del Perú en 2018 fue usada con una muestra de 25 660 registros de niños entre 1 y 11 años. Las variables evaluadas fueron el uso de pasta dental ≥1000 ppm F, lugar de residencia, región natural, área de residencia, región, índice de riqueza, acceso al servicio odontológico, si se recibió información sobre higiene bucal, cepillado diario de dientes, edad y sexo. Se realizó un análisis descriptivo, bivariado (Chi cuadrado) y multivariado (regresión loglineal de Poisson). Resultados: Se encontró una asociación entre el uso de pasta dental ≥1000 ppm F con el lugar de residencia: ciudad pequeña vs ciudad capital-grande con una razón de prevalencia ajustada (RPa): 0,94; intervalo de confianza de 95% (IC 95%): 0,90-0,98, ciudad y campo vs. capital-grande ciudad ambos con un RPa: 0,95; IC 95%: 0,91-0,99. Con región natural: resto de la Costa vs Lima con RPa: 0,94; IC 95%: 0,91-0,98, Sierra vs Lima con RPa: 0,95; IC 95%: 0,92-0,99 y Selva vs Lima con RPa: 0,94; 95% % CI: 0,90-0,98. Conclusión: El lugar de residencia y la región natural son barreras geográficas para el uso de pasta dental fluorada ≥1000 ppm en niños de 1 a 11 años en Perú en 2018.

Caracterización del tipo de sensibilidad dental de pacientes con periodontitis y su respuesta a los dentífricos / Characterization of the type of dental sensitivity of patients with periodontitis and their response to dentifrices

La hipersensibilidad de la dentina surge ante la exposición de esta y en respuesta a estímulos de diverso tipo, fundamentalmente de origen térmico, evaporativo, táctil, osmótico o químico. Se realizó una investigación abocada a caracterizar la hipersensibilidad dental de pacientes atendidos en consulta de odontología y la respuesta a determinado dentífrico utilizado. En el análisis de estimulación dental se tomaron 308 mediciones de la sensibilidad dental para todos los participantes (n=22), con 7 factores de tiempo (T0 antes del uso del producto, T3 días, T5 días, T8 días, T22 días y T29 días después del uso del dentífrico). Se realizó la prueba paramétrica regresión lineal simple para identificar la tendencia y el ajuste de los datos, al considerar dichas variables como una serie temporal. Se utilizaron 22 tratamientos. Casi el 91,0% expreso que el dentífrico había cumplido sus expectativas, fundamentalmente por la reducción de la hipersensibilidad a corto plazo, mientras que aproximadamente 91,0% de los casos afirmó que compraría el dentífrico (20 casos, IC 95%: 72,2% y 97,5%), respectivamente(AU)

Dentin hypersensitivity arises when exposed to it and in response to various types of stimuli, mainly of thermal, tactile evaporative, osmotic or chemical origin. An investigation was carried out aimed at characterizing the dental hypersensitivity of patients seen in the dental office and the response to a certain toothpaste used. In the dental stimulation analysis, 308 measurements of tooth sensitivity were taken for all participants (n = 22), with 7 time factors (T0 before use of the product, T3 days, T5 days, T8 days, T22 days and T29 days after using the toothpaste). The simple linear regression parametric test was performed to identify the trend and the fit of the data, considering these variables as a time series. 22 treatments were used. Almost 91.0% believed that the toothpaste had met their expectations, mainly due to the reduction in hypersensitivity in the short term, while approximately 91.0% of the cases stated that they would buy the toothpaste (20 cases, 95% CI: 72 , 2% and 97.5%), respectively(AU)

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.

Efecto de una pasta dental con xilitol sobre Streptcococcos mutans en pacientes con ortodoncia fija / Effect of a toothpaste with xylitol on Streptcococcus mutans in patients with fixed orthodontics / Efeito de um creme dental xilitol sobre Streptcococcus mutans em pacientes com ortodontia fixa

La terapia ortodóntica produce una mayor acumulación de placa bacteriana en los pacientes, observándose cambios ecológicos orales que causan aumento del número de estreptococos mutans, por lo que es importante una adecuada higiene bucal que ayude a disminuir las bacterias y prevenir la caries. Objetivo. El propósito fue comparar el efecto del uso de una pasta dental con xilitol, en el recuento de Streptcococcos mutans en pacientes con aparatología ortodóntica fija. Material y métodos. Se realizó un estudio cuasiexperimental de cegamiento simple. La muestra estuvo constituida por 34 pacientes adolescentes con aparatología ortodontica fija de ambo sexos que cumplieron los criterios establecidos, todos fueron instruidos en una técnica de cepillado y designados al azar a uno de los dos grupos: grupo experimental 17 pacientes que usaron una pasta dental con xilitol y 17 pacientes en el grupo control que utilizaron una pasta dental convencional con flúor. A ambos grupos se les tomó y procesó microbiológicamente placa bacteriana al inicio del estudio y a las 3 y 5 semanas para evaluar el recuento de streptococos mutans. Resultados. La prueba T-Student demostró que hubo menos unidades formadoras de colonias en los pacientes que utilizaron pasta dental con xilitol siendo significativa la diferencia en la quinta semana de uso (˂ 0.0001). Conclusiones. Existe mayor efectividad de la pasta dental con xilitol, en relación a la pasta dental solo con flúor en el recuento de Streptococos mutans, sin embargo, los pacientes de ambos grupos tuvieron menos unidades formadoras de colonias.

Orthodontic therapy produces a greater accumulation of bacterial plaque in patients, with oral ecological changes that cause an increase in the number of mutans streptococci, so it is important to have an adequate oral hygiene that helps to reduce bacteria and prevent caries. Objective. The purpose was to compare the effect of the use of a toothpaste with xylitol on the Streptococcus mutans count in patients with fixed orthodontic appliances. Material and methods. A single-blinded quasi-experimental study was carried out. The sample consisted of 34 adolescent patients with fixed orthodontic appliances of both sexes who met the established criteria. All were instructed in a brushing technique and randomly assigned to one of two groups: 17 patients in the experimental group used a toothpaste with xylitol and 17 patients in the control group used a conventional toothpaste with fluoride. Both groups had bacterial plaque taken and processed microbiologically at the beginning of the study and at 3 and 5 weeks to evaluate the streptococcus mutans count. Results. The T-Student test showed that there were fewer colony-forming units in patients who used xylitol toothpaste with the difference being significant at the fifth week of use (˂ 0.0001). Conclusions. There is greater effectiveness of toothpaste with xylitol in relation to toothpaste with fluoride alone in the Streptococcus mutans count; however, patients in both groups had fewer colony-forming units.

A terapia ortodôntica produz um maior acúmulo de placa bacteriana nos pacientes, com alterações ecológicas orais causando um aumento no número de estreptococos mutantes, razão pela qual uma higiene oral adequada é importante para ajudar a reduzir as bactérias e prevenir cáries. Objetivo. O propósito era comparar o efeito do uso de uma pasta de dentes com xilitol na contagem de Streptococcus mutans em pacientes com aparelhos ortodônticos fixos. Material e métodos. Foi realizado um estudo quase-experimental mono-cego. A amostra consistiu de 34 pacientes adolescentes com aparelhos ortodônticos fixos de ambos os sexos que preenchiam os critérios estabelecidos. Todos foram instruídos em uma técnica de escovação e distribuídos aleatoriamente em um dos dois grupos: 17 pacientes do grupo experimental que usaram uma pasta de dentes com xilitol e 17 pacientes do grupo controle que usaram uma pasta de dentes convencional com flúor. Ambos os grupos tiveram a placa bacteriana retirada e processada microbiologicamente na linha de base e com 3 e 5 semanas para avaliar a contagem de estreptococos mutantes. Resultados. O teste T-Student mostrou que havia menos unidades formadoras de colônias em pacientes que usavam pasta de dentes de xilitol, sendo a diferença significativa na quinta semana de uso (˂ 0,0001). Conclusões. A pasta de dente com xilitol é mais eficaz do que a pasta de dente com flúor apenas no Streptococcus mutans, entretanto, os pacientes de ambos os grupos tinham menos unidades formadoras de colônias.

Design and evaluation of dental pastes Containing anti-inflammatory drugs

Abstract Periodontitis is an oral disease associated with inflammation and pain with swollen and bleeding gums. In the present study, dental pastes containing NSAIDs, namely, diclofenac sodium and nimesulide (1 % w/w) were prepared to treat periodontitis. Dental pastes of diclofenac sodium and nimesulide (1 % w/w) were prepared with/without mucoadhesive hydrocolloid polymers such as sodium carboxy methyl cellulose (NaCMC), hydroxyl ethyl cellulose (HEC) and methyl cellulose (MC) by conventional trituration method. The pH, drug content, viscosity, tube spreadability and tube extrudability of these prepared dental pastes were measured. These dental pastes of diclofenac sodium and nimesulide (1 % w/w) were characterized by FTIR analyses for drug-excipient compatibility. The in vitro drug releases from these dental pastes in 6.4 pH phosphate buffer solution displayed sustained release over longer period and the drug release rate was found to be decreased when the concentration of mucoadhesive polymer was increased. These dental pastes displayed good adhesion to the oral mucosa revealing more retention time in mouth when tested for ex vivo mucoadhesion using bovine cheek pouch. The stability study results reveal that the DC3 and NC3 dental paste formulations were found stable enough over a longer period in different storage conditions. The present study revealed that the prepared mucoadhesive dental pastes of diclofenac sodium and nimesulide (1 % w/w) had good adhesion with the oral mucosa to maintain consistent release of drugs over prolonged time.

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.

In vitro determination of potentially bioavailable fluoride in diet and toothpaste after ingestion

Aim: To propose a new method to determine in vitro potentially bioavailable fluoride (F) in diet and toothpaste after ingestion. Methods: Diet samples (D) were obtained from 15 portions of a meal served to children in a day care centre. To simulate the ingestion of toothpaste during brushing after meals, a specific amount of toothpaste was added to the diet samples (D + T). F was determined in D and D + T after incubation in a solution that simulated "gastric juice" (0.01 M hydrochloric acid) at 37oC for 30, 60 and 120 min. Microdiffusion facilitated by HMDS was used to determine the total F concentrations in samples D and D + T. The analyses were performed using an ion specific electrode. Results: For D samples, incubation in "gastric juice" for 30, 60 and 120 min resulted in F concentrations (µg F/mL) of 0.75 ± 0.06c, 0.77 ± 0.07c and 0.91 ± 0.09b, corresponding to 75.3, 77.3 and 90.7% of the total F (1.02 ± 0.12a), respectively (p = 0.0001; ANOVA + Tukey). For D + T samples, these values of F concentrations (µg F/mL) were 2.55 ± 0.46b, 2.83 ± 0.44ab and 3.15 ± 0.37a, corresponding to 86.9, 94.8 and 106.7% of the total F (2.99 ± 0.34a), respectively (p = 0.0023; ANOVA + Tukey). Conclusion: Then, it can be concluded that the proposed method of "gastric juice" is a promising protocol for determining potentially bioavailable fluoride in the diet and toothpaste after ingestion. However, additional studies are desirable

Fluorose por ingestão voluntária de pasta fluoretada após os 5 anos de idade: relato de caso e discussão da importância da educação em saúde bucal na 1a infância / Fluorosis from voluntary ingestion of fluoride paste after 5 years of age: case report and discussion of the importance of health education in early childhood

Introdução: Preocupações com a ingestão de pasta fluoretada por crianças se limita à primeira infância devido ao risco de fluorose nos dentes permanentes anteriores, mas o processo educativo para garantir uma segurança para toda a dentição tem sido negligenciado. Objetivo: Relatar um caso de fluorose dentaria em dentes caninos, pré-molares e 2o molares por ingestão voluntária de pasta fluoretada Relato do caso: Paciente de 12 anos, 65 kg, procurou atendimento odontológico devido a insatisfação com a coloração dos dentes posteriores. Constatou-se que os dentes caninos, pré-molares e segundo molares, superiores e inferiores apresentavam opacidades tipo fluoróticas, estando os demais normais. Entre as possíveis causas, a principal recaiu sobre o modo que a criança passou a escovar os dentes após os 5 anos de idade. Foi relatado que ela voluntariamente escovava seus dentes 6x/dia sem cuspir. Foram feitas análises da concentração de fluoreto da água consumida pela paciente e nas pastas usadas. Também foi feito teste de excreção de fluoreto urinário pela paciente, solicitando para ela escovar os dentes cuspindo ou engolindo toda a pasta em uso. Resultados: Na água foi encontrado 0,74 mg F/L e nas pastas usadas 1.357 e 1.426 mg F solúvel/ kg. Na urina foi encontrado 0,90 e 1,35 mg F, respectivamente, cuspindo ou engolindo a pasta após as escovações. Foi estimado que a partir dos 5 anos de idade, a criança se submeteu à dose de 0,17 mg F/dia/kg de peso corpóreo, a qual é 2,4 vezes maior que o limite superior de risco de fluorose. Conclusão: O caso relatado sugere ser uma consequência de falha do processo de educação em saúde na 1a infância quanto ao uso racional de dentifrício fluoretado.

Introduction: Concerns about children's intake of fluoride toothpaste are limited to infancy due to the risk of fluorosis in the permanent anterior teeth, but the educational process to ensure safety for the entire dentition has been neglected. Objective: To report a case of dental fluorosis in canine, premolar and 2nd molar teeth caused by voluntary ingestion of fluoride toothpaste. Case report: A 12- year-old patient, 65 kg, search dental care due to dissatisfaction with the color of the posterior teeth. It was diagnosticated that the superior and inferior canine, premolar and second molar teeth had fluorotic opacities, and the other teeth are sound. Among the possible causes, the main one was the way the child started brushing their teeth after 5 years of age. It was reported that she voluntarily brushed her teeth 6x/day without spitting. Analyzes of the fluoride concentration in the water consumed by the patient and in the toothpastes used were performed. A urinary fluoride excretion test by the patient, requesting her to brush her teeth by spitting out or swallowing all the toothpaste in use, was made. Results: Fluoride concentration in the water was 0.74 mg F/L and 1,357 and 1,426 mg F/kg in the toothpastes pastes used. In urine test, 0.90 and 1.35 mg F were found, respectively, spitting or swallowing the toothpaste after brushing. It was estimated that from 5 years of age, the child was submitted a dose of 0.17 mg F/day/kg of body weight, which is 2.4 times the upper limit for an acceptable fluorosis. Conclusion: The reported case suggests that it is a consequence of the failure of the health education process in early childhood regarding the rational use of fluoride toothpaste.

Systematization of oral hygiene in a pediatric patient: case report / Sistematización de la higiene oral en un paciente pediátrico: reporte de caso

Oral hygiene is an important step in the control of the biofilm, a factor related to diseases such as gingivitis and tooth decay. The systematization of oral hygiene in children is a set of measures that seeks to achieve sequential learning, thus guaranteeing a better elimination of the biofilm. Objetive: To show a sequence of systematized steps in oral hygiene in a pediatric patient with a definitely positive behavior. Case Report: Six year old female patient, without relevant medical history. On clinical intraoral examination presented biofilm accumulation and swollen gums. The presumptive diagnosis was marginal gingivitis associated with biofilm, the treatment included a preventive phase with motivation and education. The control of the disease evolution was carried out with a card of Systematization Technique of Oral Hygiene, the methodology included the recording of the educational sessions using videos and photographs. Results: the adequate use of the amount of toothpaste was achieved, the integrity was improved to 100%, the brushing time increased from 24 to 120 seconds and it was possible to add tongue brushing and not rinsing after brushing within the oral hygiene routine. Conclusion: The patient was able to clean all dental surfaces, using homogeneous times for each surface, following an orderly sequence in toothbrushing, as well as to acquire knowledge regarding the amount of toothpaste to use, tongue brushing and not rinsing after toothbrushing. The systematization of oral hygiene allowed us to achieve these achievements in six sessions.

La higiene oral es un paso importante para el control de la biopelícula, la cual es un factor relacionado con enfermedades como gingivitis y caries dental. La sistematización de la higiene oral en niños es un conjunto de medidas que buscan lograr un aprendizaje secuencial, garantizando así una mejor eliminación del biofilm. Objetivo: Mostrar una secuencia de pasos sistematizados en la higiene oral en un paciente pediátrico con comportamiento definitivamente positivo. Reporte de un Caso: Paciente femenino de 6 años, sin antecedentes médicos relevantes. Al examen clínico intraoral presentó acumulación de biofilm y encías inflamadas. El diagnóstico presuntivo fue gingivitis marginal asociada a biofilm, el tratamiento incluyó una fase preventiva con motivación y educación. El control de la evolución se realizó con una ficha sobre la Técnica de Sistematización de Higiene oral, la metodología incluye el registro de las sesiones educativas usando vídeos y fotografías. Resultados: se logró el uso adecuado de la cantidad de dentífrico, se mejoró la integridad al 100%, el tiempo de cepillado pasó de 24 a 120 segundos y se consiguió integrar el cepillado de la lengua y el no enjuague post cepillado dentro de su higiene oral. Conclusión: La paciente consiguió realizar la limpieza de todas las superficies dentales, tiempos homogéneos para cada superficie, una secuencia ordenada en su cepillado dental, así como adquirir conocimientos en la cantidad de dentífrico utilizado, el cepillado de la lengua y el no enjuagarse después del cepillado dental. La sistematización de la higiene oral permitió conseguir estos logros en 6 sesiones.

Tara Gum as a Controlled Delivery System of Fluoride in Toothpaste: In Vitro Enamel Remineralization Study

ABSTRACT Objective: To evaluate the remineralizing potential of a hydrocolloid-based, controlled fluoride-releasing system added to dentifrice formulas. Material and Methods: Sixty-five human enamel blocks were prepared and the surface microhardness (SH0) values were determined. The artificial caries lesions were induced and the demineralization surface microhardness (SH1) was evaluated. The blocks were randomly allocated into five groups (n = 13): (1) 100-TGF (100% NaF with Tara gum added); (2) 50-TGF (50% free NaF + 50% NaF with Tara gum added); (3) 100% TG (100% Tara gum without fluoride); (4) 100% NaF (positive control); and (5) placebo (without Tara gum and NaF). The blocks were submitted to 7 days pH cycling and treated with dentifrice slurries twice a day. Finally, surface hardness (SH2) was assessed and the percentage of surface hardness recovery (%SMHR) was calculated. Analysis of variance (ANOVA) followed by Bonferroni test was used for statistical analysis. Results: A positive %SMHR was found in the 100% NaF (5.07) and 50-TGF (0.64) groups, while the 100-TGF (-1.38), 100% TG (-3.88) and placebo (-0.52) did not undergo remineralization. Statistically significant differences were observed between 100% NaF and all the groups except for 50-TGF (p<0.05). Conclusion: The presence of hydrocolloid (Tara gum) promoted minimal remineralization when associated with NaF. In the applied model, Tara gum may have compromised remineralization, preventing free fluoride from acting effectively in the carious lesion.

Toxicity and effect of whitening toothpastes on enamel surface

Abstract This in vitro study evaluated the biocompatibility and abrasivity of whitening and conventional toothpastes. Samples of conventional (non-whitening) - Edel White Infant (EWI) - and whitening toothpastes - Edel White Whitening (EWW), Edel White CAREFORTE (EWC), Colgate Total 12 Ò Professional (C), and Oral-B Whitening (OB) - were dissolved in culture medium (0.2 g sample weight per mL). Human gingival fibroblasts (hGF) were placed in contact with different dilutions of culture media that had been previously exposed to these toothpastes. Cytotoxicity was then assessed using the methyl tetrazolium test (MTT) and the cell survival rate was determined. Genotoxicity was assessed by the micronucleus test (MNT) and the number of micronuclei was determined before and after exposure to the toothpaste solutions. The enamel surface roughness was evaluated in specimens of bovine teeth (n = 10 per group) before and after 10,000 brushing cycles, using the investigated toothpastes. The results were statistically analyzed using the Mann-Whitney U test and two-way ANOVA (p < 0.05). According to the MTT assay, EWW and OB presented significant cytotoxicity (p < 0.01), but no genotoxic (MNT) effects (p > 0.05). C toothpaste was statistically significantly abrasive to the enamel surface (p < 0.01). The findings of this study may be helpful for individualized selection of commercial toothpastes, as some whitening toothpastes present significant cytotoxicity and conventional toothpaste cause significant surface changes.