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

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.

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.

Efecto antibacteriano de una pasta dental con xilitol sobre Streptococcus mutans en saliva de gestantes / Antibacterial effect of a toothpaste with xylitol on Streptococcus mutans in pregnant women's saliva

RESUMEN Introducción: Durante la gestación, algunos cambios fisiológicos en la mujer propician un incremento de la placa dental y de la microbiota cariogénica. Esta condición unida a una modificación de la dieta y a una inadecuada higiene bucal condicionarían desfavorablemente la salud oral tanto de la madre como del bebé. Objetivo: Determinar el efecto antibacteriano de una pasta dental con xilitol sobre el recuento de Streptococcus mutans en saliva de gestantes. Métodos: Ensayo clínico, a doble ciego, que se realizó en el Centro de Salud "José Olaya" (Chiclayo Perú), en enero de 2017. Se trabajó con una población muestral de 50 gestantes en el segundo trimestre que cumplieron con los criterios establecidos. Se crearon dos grupos: 25 gestantes usaron dentífrico con 10 por ciento de xilitol y 25 gestantes usaron dentífrico sin xilitol. Se les tomó y proceso microbiológicamente una muestra de saliva antes del inicio del estudio y 14 días después del uso de las respectivas pastas. Se realizó el recuento de unidades formadoras de colonias de Streptococcus mutans en saliva con una confiabilidad altamente significativa mediante el coeficiente de correlación intraclase, calibración intra e interexaminador (1,000 y 0,999, respectivamente). El análisis de los datos se realizó mediante la prueba U de Mann-Whitney, considerando un nivel de significancia del 5 por ciento. Resultados: No se encontró diferencia significativa entre las gestantes que emplearon pasta dental con xilitol en comparación con las que utilizaron pasta dental sin xilitol (p= 0,062). Conclusiones: El efecto antibacteriano de la pasta dental comercial con xilitol es similar a una pasta dental sin xilitol sobre el recuento de Streptococcus mutans en saliva de gestantes(AU)

ABSTRACT Introduction: Some physiological changes occur in women during pregnancy which cause an increase in dental plaque and cariogenic microbiota. This situation, alongside a modification in the diet and inadequate oral hygiene, negatively affect the oral health of both the mother and the baby. Objective: Determine the antibacterial effect of a toothpaste with xylitol on the count of Streptococcus mutans in pregnant women's saliva. Methods: A double-blind clinical trial was conducted in José Olaya Health Center (Chiclayo, Peru) in January 2017. The sample population was 50 women in the second trimester of pregnancy who met the established inclusion criteria. Two groups were formed: 25 pregnant women used a toothpaste with 10 percent xylitol and the other 25 used a toothpaste without xylitol. A saliva sample was taken and processed microbiologically before the start of the study and 14 days after use of the two toothpastes. A count was performed of colony-forming units for Streptococcus mutans in saliva with highly significant reliability, using the intraclass correlation coefficient, and intra- and inter-rater calibration (1.000 and 0.999, respectively). Data analysis was based on the Mann-Whitney U Test, with a significance level of 5 percent. Results: No significant difference was found between the pregnant women who used the toothpaste with xylitol and those who used the toothpaste without xylitol (p= 0.062). Conclusions: The antibacterial effect of the commercial toothpaste with xylitol is similar to that of a toothpaste without xylitol in terms of the Streptococcus mutans count in pregnant women's saliva(AU)

Influence of the Extended Use of Desensitizing Toothpastes on Dentin Bonding, Microhardness and Roughness

Abstract The aim of this study was to evaluate the influence of an extended use of desensitizing toothpastes (DTs) on dentin bonding, microhardness and roughness. One hundred and twenty bovine incisor teeth were randomly divided into four groups: G1, distilled water (WATER); G2, Colgate Total 12 (CT12); G3, Colgate Sensitive Pro-Relief (CSPR); and G4, Sensodyne Repair ?αμπ; Protect (SRP). Dentin surfaces were etched with 17% EDTA and 2 years of simulated tooth brushing (20,000 cycles) was performed on their surfaces. Knoop microhardness, surface roughness and scanning electron microscopy (SEM) were performed before and after the simulated tooth brushing. For microshear bonding test, a 2-step self-etching adhesive system (Clearfil SE Bond) was used and 0.8 mm diameter composite resin (Filtek Z350 XT) cylinders were built. Microshear test was performed with an orthodontic wire and with a crosshead speed of 0.5 mm/min. The data were analyzed for: 1) bond strength (one-way ANOVA), 2) microhardness intra-group (Student's test) and inter-group (one-way ANOVA/Tukey's test) comparisons, 3) roughness intra-group (Student's test/Wilcoxon's test) and inter-group (Kruskal-Wallis/Student-Newman-Keuls test) comparisons. The extended use of both dentifrices (conventional and for sensitive teeth) did not affect the bond strength and produced a significant increase in microhardness and roughness of the dentin, except for the microhardness of the SRP group. The simulated tooth brushing technique with water produced an increase in roughness, without reducing significantly the dentin microhardness.

Resumo O objetivo deste estudo foi avaliar a influência do uso prolongado de dentifrícios dessensibilizantes (DTs) na adesão, microdureza e rugosidade da dentina. Cento e vinte dentes incisivos bovinos foram divididos aleatoriamente em quatro grupos: G1, água destilada (WATER); G2, Colgate Total 12 (CT12); G3, Colgate Sensitive Pro-alívio (CSPR); e G4, Sensodyne Repair ?αμπ; Protect (SRP). As superfícies dentinárias foram condicionadas com EDTA a 17% e foram realizados 2 anos de escovação dental simulada (20.000 ciclos) em suas superfícies. A microdureza Knoop, rugosidade de superfície e microscopia eletrônica de varredura (MEV) foram realizadas antes e após escovação dental simulada. Para o teste de adesão por microcisalhamento, foi aplicado um sistema adesivo auto condicionante de 2 passos (Clearfil SE Bond) e foram construídos cilindros de resina composta (Filtek Z350 XT) de 0,8 mm de diâmetro. O teste de microcisalhamento foi realizado com um fio ortodôntico e com velocidade de 0,5mm/min. Os dados foram analisados para: 1) resistência de união (ANOVA 1 fator), 2) comparações de microdureza intra grupo (teste t de Student) e inter grupo (ANOVA 1 fator / teste de Tukey), 3) comparações de rugosidade intra grupo (teste t de Student / teste de Wilcoxon) e inter grupo (Kruskal Wallis / teste de Student-Newman-Keuls). O uso prolongado de ambos dentifrícios (convencional e para dentes sensíveis) não interferiu na resistência de união e produziu um aumento significativo na microdureza e rugosidade da dentina, exceto para a microdureza do grupo SRP. A técnica de escovação dental simulada com água promoveu aumento na rugosidade, sem reduzir significativamente a microdureza da dentina.

Protocol of toothbrushing based on bioavailability of fluoride in toothpaste: a systematic review / Protocolo de cepillado basado en la biodisponibilidad del flúor en dentífricos: una revisión sistemática

The objective of the study is to propose a protocol for the appropriate use of fluorides in dentifrices (Dt), based on its bioavailability in saliva (Bs) and / or plaque (Bp) through a systematic review (SR). SR of the literature from 2005 to 2015 in PubMed, Cochrane and SciELO. Inclusion criteria: clinical studies in vivo, Spanish and English, made only with Dt that measured Bs and Bp. The results were evaluated in relation to: 1) Concentration of fluoride in Dt, 2) Brushing time with Dt, 3) Frequency of brushing, 4) Rinse post-brushing and 5) Amount of Dt on the brush. Twelve (12) studies were selected. 1) Bs increases 241 % when using a 5000 ppm of Dt compared to 1450 ppm. 2) Bs is increased by 55 % by increasing the duration of brushing 40 s to 120 s 3) Bp increases by 68 % when brushing 3 times a day compared to 2 times. 4) Not rinsing or rinsing with <10 ml for <10 s increases Bs to 270 % compared to rinses higher volume / time. 5) By increasing the amount of Dt of 0.5 g to 1.5 g, Bs increases up to 266 %. The use of 1.5 g of Dt 1450 ppm of fluoride for 120 s, 3 times a day is recommended and once brushing is complete avoiding oral rinse with water or non fluoride mouthwash.

El objetivo de este studio es proponer un protocolo para el uso adecuado de fluoruros en dentífricos (Dt), basado en su biodisponibilidad en saliva (Bs) y/o placa (Bp) mediante una revisión sistemática (RS). RS de la literatura 2005- 2015 en PubMed, Cochrane y SciELO. Criterios de inclusión: estudios clínicos in vivo, español e inglés, realizados únicamente con Dt que midieran Bs y Bp. Los resultados fueron evaluados en relación a: 1) Concentración de flúor en el Dt, 2) Tiempo de cepillado con Dt, 3) Frecuencia de cepillado, 4) Enjuague post-cepillado y 5) Cantidad de Dt en el cepillo. Fueron seleccionados 12 estudios. 1) La Bs aumenta en un 241 % al utilizar un Dt de 5000 ppm en comparación con un 1450 ppm. 2) Bs aumenta en un 55 % al aumentar la duración del cepillado de 40 s a 120 s, 3) La Bp aumenta en un 68 % al cepillarse 3 veces al día en comparación a 2 veces. 4) No enjuagarse o enjuagues de <10 ml por <10 s puede aumentar la Bs hasta en un 270 % en comparación a enjuagues con mayor volumen/tiempo. 5) Al aumentar la cantidad de Dt de 0,5 g a 1,5 g, la Bs aumenta hasta en un 266 %. Se recomienda utilizar 1,5 g de Dt 1450 ppm de flúor por 120 s, 3 veces al día, y evitar enjuague oral con agua o colutorios sin flúor una vez finalizado el cepillado.

Comparación de barnices y dentífrico con flúor en la prevención de caries en escolares / Comparison of varnishes and fluoridated toothpaste for the prevention of dental caries in school children

Objetivo Comparar el efecto preventivo de caries dental de dos frecuencias de aplicación de barniz fluorado (BF) con un grupo que utilizó instrucciones de cepillado con dentífrico fluorado. Materiales y Método Se siguieron durante 22 meses a 203 niños de una escuela primaria en la delegación Tláhuac, Ciudad de México, quienes fueron asignados aleatoriamente a uno de los siguientes grupos: 1) instrucciones de cepillado con dentífrico fluorado 3 veces al año, 2) BF semestral, 3) BF tres aplicaciones semanales al año. El BF contenía fluorosilano (1000 ppm F), el dentífrico NaF (1450 ppm F). Se registró el índice de caries CPOD y la presencia de manchas blancas usando los criterios del ICDAS (International Caries Detection and Assessment System). Resultados Al inicio del estudio, el promedio de edad fue 9,3 (DE 0,76) años, el promedio de lesiones blancas 0,63 (DE 1,48) y del CPOD 0,70 (DE 1,11). CPOD inicial y final en los tres grupos fueron: instrucciones de cepillado usando dentífrico fluorado 0,67 y 1,17, BF semestral 0,77 y 1,46 y grupo BF 3 aplicaciones 0,67 y 1,03, respectivamente.. De acuerdo a los resultados del modelo GEE (Generalized Estimating Equations), no se detectaron diferencias significativas en el incremento de lesiones blancas o en el CPOD para el índice de caries (CPOD) entre los tres grupo; para el CPOD las aplicaciones semestrales mostraron RR=1,24 (p=0,178) y para 3 aplicaciones RR=0,83, (p=0,298), comparando con el grupo de instrucciones de cepillado con dentífrico fluorado, controlando por edad, sexo, cpod inicial y frecuencia de cepillado. Conclusiones Los escolares mostraron una baja incidencia de caries utilizando cualquiera de los tres regímenes preventivos aplicados.(AU)

Objective To compare preventive effect on dental caries of two frequencies of fluoridated varnish (FV) applications and a group given brushing instructions and using fluoridated toothpaste. Materials and Methods Follow-up study of 203 children attending an elementary school in the municipality of Tláhuac, Mexico City. The children were followed for 22 months. The students were randomly assigned to one of the following groups: 1) brushing instructions with fluoridated toothpaste, 2) FV every six months, 3) three FV applications per week per year. The FV contained fluorosilane (1000 ppm F) and NaF dentifrice (1450 ppm F). The DMFT-caries index and the presence of white spots were recorded (ICDAS, International Caries Detection and Assessment System). Results At baseline, the mean age of the children was 9.3 (SD 0.76) years, white lesions 0.63 (SD 1.48) and DMFT =0.70 (SD 1.11). Averages of the initial and final DMFT scores in the three groups were 0.67 and 1.17 for the toothpaste group, 0.77 and 1.46 for FV twice a year group, and 0.67 y 1.03 for the three-applications-FV group. According to the results of the GEE (Generalized-Estimating Equations) model, there were no significant differences in the rate of white lesions or the increase of the DMFT index. The results for the DMFT were: for bi-annual applications of FV, RR=1.24 (p=0.178) and for the three consecutive applications of FV, RR=0.83, (p=0.298) in comparison with the brushing-instructions group using fluoridated toothpaste, among the three treatment groups, controlling for age, sex, and initial-caries index in primary teeth and brushing frequency. Conclusions Schoolchildren showed a low incidence of caries using any of the three preventive regimens applied.(AU)

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

Estimación cualitativa del peso de la crema dental en niños / Qualitative estimate of the weight of the toothpaste in children

Introducción: para el control de la fluorosis dental, se realizan estudios en la población para investigar la cantidad de crema dental que se utiliza en el cepillado de forma fácil y rápida. Este es un indicador importante para identificar posibles factores que se estén relacionando con la fluorosis. Objetivo: diseñar un instrumento cualitativo para estimar el peso de la crema dental que utilizan los niños entre dos y seis años durante el cepillado y describir el uso y manejo de la crema dental de los niños. Métodos: se realizó un estudio descriptivo transversal. La muestra estuvo conformada por el total de niños que asistieron a las clínicas durante seis meses (N=143); se evaluó variables sociodemográficas y el manejo de la crema dental. Se le pidió al padre/acudiente o el niño, según quien dispensa la crema, colocarla en un cepillo dental y se determinó el peso de la crema dental, luego se seleccionó una de las cuatro figuras del cepillo dental con crema. Resultados: el promedio de edad fue de 4,8 años. El 76,9 por ciento de los padres no conocen sobre la cantidad de crema dental que deben utilizar los niños. La cantidad promedio de crema que utilizan los niños fue de 0,514g ± 0,27g. El modelo utilizado para la estimación del peso de la crema dental, resultó estadísticamente adecuado (p=0,000). La estimación de la crema dental por medio del diagrama explica un 31 por ciento (R2) la variabilidad de la cantidad de crema dental que utilizan los niños. Conclusiones: los niños utilizan el doble de la cantidad de crema dental recomendada. Los esquemas gráficos con cuatro figuras de cepillos dentales con diferentes cantidades de crema, es un buen instrumento de medición para estimar la cantidad de crema dental real que utilizan los niños en edad de riesgo de fluorosis(AU)

Introduction: it has been necessary to perform population studies where indicated the amount of toothpaste used in brushing quickly and easily in the control of the fluorosis, considering that the amount of toothpaste is an important factor to identify the possible factors associated with fluorosis. Objectives: designing a qualitative tool to estimate the weight of toothpaste used by children between 2 and 6 years during brushing and describe the use and management of children's toothpaste. Methods: a cross sectional descriptive study was made; the sample consisted of the total number of children who attended the clinic for 6 months (N = 143), it was evaluated sociodemographic variables and the toothpaste handling. The parents or children were asked to dispense the normal among of toothpaste in the toothbrush, the weight was determined, and then they had to select one of the 4 figures of the toothbrush with toothpaste in a diagram. Results: the mean of age was 4, 8 years. The 76, 9 percent of the parents don't know the proper amount of tooth paste that they should use. The average of toothpaste weight was 0,514 g ± 0,27g, the selected weight estimation model was statistically significant (p=0.000). The toothpaste weight estimation through diagram represents in the 31 percent of the cases with the real amount of tooth paste used. Conclusions: children use twice the amount of recommended toothpaste. The graphic diagrams with 4 toothbrushes with different toothpaste amounts is considered a good measurement tool to estimate the real amount of tooth paste used by risk aged children, with statistical correlation(AU)

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

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

Evidence-based recommendation on toothpaste use

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

Estimation of Toothpaste Fluoride Intake in Preschool Children

The objective of this study was to estimate the intake of toothpaste fluoride used by children aged 2 to 6 years (n=87) treated at a hospital of a medium-sized city (Campina Grande, PB) in the Northeastern region of Brazil. Data regarding sociodemographic characteristics of families and children's toothbrushing were collected from questionnaire-based interviews with parents/guardians, and the amount of fluoride used during toothbrushing was estimated using a precision scale for assessment of the risk of dental fluorosis, considering a cutoff value of 0.07 mgF/kg body weight/day. Fluoride content in the toothpastes was analyzed using a specific fluoride electrode. Data were analyzed using descriptive and inferential statistics using the chi-square and Fisher's exact tests (α=0.05). Considering the use of the derice, the risk of fluorosis in the children was 19.5%. There was significant association (p<0.05) between the risk of fluorosis, brushing frequency, type of derice and who performed the child's oral hygiene. It was concluded that a high percentage of children in the studied sample used toothpaste inappropriately and were at risk of developing dental fluorosis.

Resumo O objetivo do presente trabalho foi estimar a ingestão de flúor de derícios utilizados por crianças de 2 a 6 anos de idade (n=87) atendidas em um hospital de médio porte (Campina Grande, PB) na região nordeste do Brasil. Os dados envolveram características sócio-demográficas e escovação dentária das crianças através de uma entrevista com formulário específico, aplicado aos pais/responsáveis, e a quantidade de flúor utilizada na escovação da criança, por meio de balança de precisão, para avaliação do risco de fluorose dentária, considerando o ponto de corte 0,07 mgF/kg peso corporal/dia. O conteúdo de flúor nos cremes dentais foi analisado utilizando eletrodo específico. Os dados foram trabalhados sob a forma de estatística descritiva e inferencial usando o testes do Qui-quadrado de Pearson e Exato de Fisher (α= 0,05). Levando-se em consideração o uso do derício, o risco de fluorose das crianças pesquisadas foi 19,5%. Houve associação significativa entre o risco de fluorose, a frequência de escovação, o tipo de derício e quem realiza a higiene bucal da criança (p<0,05). Concluiu-se que elevada parcela das crianças usavam o derício de forma inadequada e apresentaram risco de fluorose. .

Frequency of tooth brushing and associated factors in mexican schoolchildren six to nine years of age / Frecuencia del cepillado dental y factores asociados en escolares mexicanos de seis a nueve años de edad

OBJECTIVE: To determine the prevalence of daily tooth brushing and evaluate some variables associated. SUBJECTS AND METHODS: A cross-sectional study was carried out in 320 schoolchildren six to nine years old in Campeche, Mexico. Information on sociodemographic and socio-economic variables, oral hygiene practices and attitudes were collected through a questionnaire. The frequency of tooth brushing was categorized as "0" = fewer than seven times/week, "1" = at least once a day. In the analysis, nonparametric tests were used. RESULTS: Mean age was 6.99 ± 1.00 years, 52.5% were boys. The prevalence of daily tooth brushing was 81.6%. In bivariate analysis, the prevalence of tooth brushing was higher (p < 0.05) among the children of mothers with higher schooling (9.80 years vs 8.47 years, p < 0.05), and in younger children (84.6% in 6-7-year olds vs 71.2% in 8-9-year olds, p < 0.05). A slight, non-significant association (p < 0.10) was noted between the current frequency of tooth brushing and an earlier age when the child first started brushing with toothpaste. There were no statistically significant differences (p > 0.05) in the frequency of tooth brushing by gender or by the mother's attitude toward the oral health of her child. CONCLUSIONS: The prevalence of daily tooth brushing was high compared to other studies. Mother's maximum level of schooling (as an indicator of socio-economic position) was associated with higher frequency of tooth brushing. Maternal characteristics are associated with the oral health behaviour of their children.

OBJETIVO: Determinar la prevalencia del cepillado dental diario y evaluar algunas de las variables asociadas. SUJETOS Y MÉTODOS: Se llevó a cabo un estudio transversal en 320 escolares de seis a nueve años de edad en Campeche, México. La información sobre las variables sociodemográficas y socio-económicas, las prácticas higiénicas orales y las actitudes, fue recopilada mediante un cuestionario. La frecuencia de cepillado dental fue clasificada con las siguientes categorías: "0" = menos de siete veces por semana, "1" = por lo menos una vez al día. En el análisis, se usaron pruebas no paramétricas. RESULTADOS: La edad promedio fue 6.99 ± 1.00 años, 52.5% fueron varones. La prevalencia del cepillado dental diario fue 81.6%. En el análisis bivariante, la prevalencia del cepillado dental fue más alta (p < 0.05) entre los niños de madres con mayor escolaridad (9.80 años frente a 8.47 años, p < 0.05), y en los niños de menor edad (84.6% en los de 6 a 7 años frente a 71.2% en los de 8 a 9 años, p < 0.05). Una ligera asociación no significativa (p < 0.10) fue observada entre la frecuencia actual del cepillado dental, y la existente en una edad más temprana, cuando el niño comenzara por primera vez a cepillarse con crema dental. No hubo ninguna diferencia estadísticamente significativa (p > 0.05) en la frecuencia del cepillado dental por género o por la actitud de la madre hacia la salud oral de su niño. CONCLUSIONES: La prevalencia del cepillado dental diario fue alta en comparación con la de otros estudios. El máximo nivel escolar de las madres predominio (como indicador de posición socio-económica) estuvo asociado con una mayor frecuencia del cepillado dental. Las características maternas se encuentran asociadas con la conducta en la relación con la salud oral de sus hijos.

Percepción de ingesta de flúor a través del cepillado dental en niños colombianos / Perception of fluoride ingestion by dental brushing in Colombian children

Objetivo: describir la percepción de los padres sobre la ingesta de flúor a través del cepillado dental en los niños residentes en la ciudad de Cartagena de Indias, Colombia. Métodos: el universo del estudio lo constituyeron todos los padres residentes en la ciudad de Cartagena de Indias, con hijos en edades entre uno y cinco años. La muestra estuvo integrada por 420 individuos. Se utilizó un cuestionario estructurado, diligenciado por los participantes, con el cual se midieron tópicos relacionados con el uso de las cremas dentales a través del cepillado. Además se tuvieron en cuenta la edad, el género y el estrato socioeconómico. Los datos fueron analizados a través de pruebas de frecuencia; se asumieron intervalos de confianza al 95 por ciento. Para encontrar significación estadística se utilizó la prueba de X². Resultados: el 88,0 por ciento de los padres encuestados refiere usar el cepillado con crema dental. La edad promedio de cepillado es de 2,3 años (DE= 1,6). El 46 por ciento se cepilla dos veces al día; el tipo de crema dental más usada es la de adultos. La mayoría de los encuestados afirma que los niños han ingerido la pasta durante el cepillado. Con respecto al análisis bivariado, se encontraron diferencias entre el cepillado con crema dental y la edad (p= 0,0001), y con el estrato (p= 0,04). Además, el tipo de crema dental con la edad, (p= 0,0001) y la cantidad de pasta utilizada con la edad (p= 0,0001) y el estrato (p= 0,01). Conclusión: se perciben hábitos poco favorables, asociados al cepillado con pasta dental, los cuales pueden ser responsables de la ingestión de cantidades de flúor consideradas nocivas para la salud(AU)

Objective: To describe the parents perception on the fluoride ingestion with the use of dental brushing in the children residents in the city of Cartagena de Indias. Methods: Study universe included al parents residents in the city above mentioned whose children were aged 1-5. Sample included 420 subjects. A structural questionnaire was used headed by the participants allowing measurement of clichés related to the use of toothpastes ans brushes. Also, the gender and the socioeconomic status were took into account. Data were analyzed by frequency tests with 95 percent CI. For statistical significance we used the X2. Results: The 88 percent of parents polled refers on the use of toothpaste brushing. Mean age of brushing is of 2.3 years (SD= 1.6). The 46 percent use toothbrush twice a day, the more used toothpaste is that of adult persons. Most of polled confirms that children has ingested the toothpaste during brushing. Regarding the bivariant analysis there were differences between he brushing with toothpaste and the age (p= 0.0001) and with stratus (p= 0.04). Also, the type of toothpaste with age (p= 0.0001) and the quantity of toothpaste used according to age (p= 0.0001) and the stratum (p= 0.01). Conclusions: On note not much favourable associated with toothpaste brushing, which may account for ingestion of significant amounts of fluoride harmful for health(AU)

Fingernail may not be a reliable biomarker of fluoride body burden from dentifrice

Fingernail has been suggested as a biomarker of fluoride (F) body burden, but there is no consensus if it would be a reliable indicator of F exposure from dentifrice. Therefore, the present study was conducted to investigate if fingernails would have sensitivity to detect F exposure from dentifrice in young children. Twenty-three 1-3-year-old children living in the city of Piracicaba (0.72 ppm F in water), Brazil, were enrolled in two phases of different F exposure: in phase A (1st to 11th week), they were exposed to the combination of F from diet (solids and liquids) and dentifrice (1,500 µg F/g as MFP), and in phase B (12th to 29th week), only to F from diet (the use of F dentifrice was interrupted). Fingernails were weekly clipped during 35 weeks for F determination. F intake from diet and dentifrice in each phase was also determined. Both analyses were made with ion-specific electrode. F intake (Mean ± SD) was significantly higher (p<0.01) when the children were exposed to F from diet+dentifrice than only to F from diet (0.086 ± 0.032 and 0.040 ± 0.009 mg F/day/kg body weight, respectively). However, F concentrations in nails collected during the whole experimental period of 35 weeks presented great variation with no trend of decreasing after F dentifrice intake interruption. The findings suggest that fingernail may not be a reliable F biomarker of body burden from dentifrice.

As unhas têm sido consideradas um biomarcador para a exposição ao flúor (F), mas não há consenso se é um indicador confiável para exposição ao F a partir do dentifrício. Vinte e três crianças, com idade entre 1 a 3 anos, moradoras de Piracicaba (0,72 ppm F na água), Brasil, foram submetidas a duas fases de diferentes exposição ao F: fase A (1a a 11a semanas), as crianças foram expostas à combinação de F a partir da dieta (sólidos e líquidos) e dentifrício (1500 µg F/g como MFP); e na fase B (12ª a 29ª semanas), apenas ao F da dieta, uma vez que usaram dentifrício não fluoretado. As unhas das mãos foram coletadas semanalmente durante 35 semanas para determinação de F. A exposição ao F a partir da dieta e dentifrício foi também determinada. Ambas análises foram feitas com eletrodo específico para F. A exposição ao F foi significativamente maior (p<0,001) quando as crianças foram expostas ao F da dieta + dentifrício que ao F da dieta (0,086 ± 0,032 e 0,040 ± 0,009 mg F/kg corpóreo/dia, respectivamente). Entretanto, a concentração de F nas unhas coletadas durante todo o período experimental não diminuiu após a interrupção da ingestão do F a partir do dentifrício. Os resultados sugerem que as unhas das mãos não são um biomarcador confiável para refletir a exposição ao F pelo dentifrício.

Over-the-counter whitening agents: a concise review

Tooth discoloration is commonly found in the dental clinic and tooth bleaching has been considered the preferred esthetic alternative, being more conservative, safe and with predictable results. Supervised home-use of 10 percent Carbamide Peroxide (CP) bleaching with custom-trays is the most common bleaching procedure dispensed by dentists to their patients. The good results obtained with this technique stimulated the flourishing of new products and techniques. Over-the-counter (OTC) bleaching products appeared as a low-cost alternative to bleach discolored teeth without dentist supervision. Different OTC products are available in supermarkets, drug stores or on the Internet, including rinses, paint-on brushes, toothpastes, chewing guns, dental floss, and whitening strips. There is lack of clinical evidence regarding the safety and effectiveness of these products, being most of the studies supported by the manufacturers'. Basically, toothpastes, chewing gums, and dental floss are removal agents of superficial stains. Rinses and paint-on brushes with low levels of hydrogen peroxide have some whitening effect, but without clinical relevance. Strips present similar esthetic results and side-effects, compared to bleaching with 10 percent CP using trays; however, the studies have financial support from the manufacturers and were based on short term evaluations. Legislation varies widely in different countries regarding OTC dental bleaching. Concerns have appeared due to the potential abusive use of these self-medication agents, especially in young patients, with potential harmful results. Dentists should be acquainted with this kind of products to be able to inform their patients. In conclusion, there is a need for independent clinical trials to provide sufficient evidence regarding the use of OTC bleaching products.

Avaliação clínica do efeito adicional do verniz fluoretado sobre a inativação de lesões iniciais de cárie em dentes decíduos / Clinical evaluation of the additional effect of fluoride varnish on the arrestment of initial caries lesions in primary teeth

O objetivo deste ensaio clínico foi avaliar o efeito adicional do verniz fluoretado sobre a inativação de lesões iniciais de cárie em dentes decíduos submetidos a 6 sessões de escovação profissional com dentifrício fluoretado. Critério de inclusão: mancha branca ativa (MBA) na face vestibular de incisivo/canino decíduo superior. Participaram 12 crianças(9 a 48 meses de idade), totalizando 29 MBA. As crianças foram alocadas aleatoriamente em 2 grupos: sem vernizfluoretado (SF) e com verniz fluoretado (CF). Ambos receberam 6 sessões de escovação dentária profissional com dentifrício fluoretado com intervalo médio de 1,2 semanas. O grupo CF recebeu aplicação de verniz fluoretado após cada escovação. Um único examinador cego, calibrado para cárie dentária (k=0,71) e biofilme dental (BF) (k=0,71) e treinadopara sangramento gengival (SG), avaliou os dentes em: baseline, intermediário e final. Os dados foram analisados no SPSS, utilizando os testes χ2 e exato de Fisher. Ao final, 22 (75,7%) lesões foram consideradas inativas e não houve diferença entre os grupos (p=0,295). A combinação dos dados de BF e SG originou o padrão de higiene da superfície dentária (PHD) que esteve associado à inativação das lesões (p=0,010). Clinicamente, não se observou efeito adicional do verniz fluoretado na inativação das lesões de cárie. Esta esteve associada à melhora do PHD, uma vez que a maiorproporção de inativação ocorreu dentre as superfícies que apresentaram melhor qualidade de higiene.

Fluoride intake from regular and low fluoride dentifrices by 2-3-year-old children: influence of the dentifrice flavor

This study evaluated the fluoride intake from dentifrices with different fluoride concentrations ([F]) by children aged 24-36 months, as well as the influence of the dentifrice flavor in the amount of fluoride ingested during toothbrushing. Thirty-three children were randomly divided into 3 groups, according to the [F] in the dentifrices: G-A (523 μgF/g), G-B (1,062 μgF/g) and G-C (1,373 μgF/g). Dentifrices A and B are marketed for children, while dentifrice C is a regular product. The amount of F ingested was indirectly obtained, subtracting the amount expelled and the amount left on the toothbrush from the amount initially loaded onto the brush. The results were analyzed by ANOVA, Tukey's test and linear regression analysis (p < 0.05). Children ingested around 60 percent of the dentifrice loaded onto the brush, but no significant differences were seen among the groups (p > 0.05). Mean daily fluoride intake from dentifrice for G-A, G-B and G-C was 0.022ª, 0.032ª and 0.061b mg F/kg body weight, respectively (p < 0.01). There was a strong positive correlation (r = 0.86, p < 0.0001) between the amount of dentifrice used and the amount of fluoride ingested during toothbrushing. The results indicate the need for instructing children's parents and care givers to use a small amount of dentifrice (< 0.3 g) to avoid excessive ingestion of fluoride. The use of low-[F] dentifrices by children younger than 6 years also seems to be a good alternative to minimize fluoride intake. Dentifrice flavor did not influence the percentage of fluoride intake.

Avaliou-se a ingestão de flúor após uso de dentifrícios contendo diferentes concentrações de flúor ([F]) por crianças entre 24-36 meses de idade, além da influência do sabor do dentifrício na quantidade de flúor ingerida durante a escovação. Dividiram-se 33 crianças aleatoriamente em 3 grupos, de acordo com a [F] nos dentifrícios: G-A (523 μgF/g), G-B (1.062 μgF/g) e G-C (1.373 μgF/g). Os dentifrícios A e B são infantis, e o C, convencional. A quantidade de flúor ingerida foi indiretamente obtida subtraindo-se a quantidade de flúor expelida e a quantidade que restou na escova daquela inicialmente carregada na escova. Os resultados foram analisados por ANOVA, teste de Tukey e análise de regressão linear (p < 0,05). Aproximadamente 60 por cento do dentifrício carregado na escova foi ingerido pelas crianças, embora sem diferenças significativas entre os grupos (p > 0,05). A ingestão média diária de flúor para G-A, G-B e G-C foi 0,022ª, 0,032ª e 0,061b mg F/kg de peso corporal, respectivamente (p < 0,01). Houve uma forte correlação positiva (r = 0,86, p < 0,0001) entre a quantidade de dentifrício utilizada e a quantidade de flúor ingerida durante a escovação. Os resultados indicam a necessidade de se instruir pais e cuidadores de crianças a utilizarem uma quantidade pequena de dentifrício (< 0,3 g) para se evitar ingestão excessiva de flúor. O uso de dentifrícios com [F] reduzida por crianças menores de 6 anos também se constitui numa boa alternativa para se minimizar a ingestão de flúor. O sabor do dentifrício não influenciou na porcentagem de ingestão deste íon.

Consideraçöes gerais sobre a prevençäo de cárie na primeira infância / General considerations about caries prevention in childhood

A presente revisäo enfatiza a primeira infância como a época ideal para se prevenir a doença cárie. Os hábitos alimentares, higiênicos e outras medidas preventivas säo discutidos, como também a importância da conscientizaçäo e interaçäo de obstetra, pediatra, odontopediatria, pais e responsáveis pelos cuidados da criança