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.

Do commercial whitening dentifrices increase enamel erosive tooth wear?

Abstract Objective This in vitro study evaluated the effect of commercial whitening dentifrices on erosive tooth wear (ETW) of bovine enamel samples, in comparison with commercial regular dentifrices. Methodology Sixty bovine crowns were embedded in acrylic resin, polished and then had their baseline profile determined. They were randomly assigned to 5 groups (n=12/group), according to the type of commercial dentifrice to be tested: GI - Crest Anti-cavity Regular; GII - Crest 3D White; GIII - Colgate Total 12 Clean Mint; GIV - Colgate Optic White; GV - Placebo (negative control, fluoride-free dentifrice). The samples were submitted to daily erosive and abrasive challenges for 3 days. The erosive challenges were performed 3 times a day by immersing the specimens in 0.1% citric acid solution (pH 2.5) for 90 s. Each day after the first and last erosive challenges, the specimens were subjected to the abrasive challenge for 15 s, using a toothbrushing machine (Biopdi, São Carlos, SP, Brazil), soft toothbrushes and slurry (1:3 g/ml) of the tested toothpastes (1.5 N). The specimens were kept in artificial saliva between the challenges. The final profile was obtained and the ETW (µm) was calculated. Data were analyzed by Kruskal-Wallis and Dunn's tests (p<0.05). Results All dentifrices tested significantly reduced the enamel wear in comparison with the Placebo, except GIII. The median (95% CI) ETW was 1.35 (1.25-1.46)bc for GI, 1.17 (1.01-1.34)cd for GII, 1.36 (1.28-1.45)ab for GIII, 1.08 (1.04-1.14)d for GIV and 2.28 (2.18-2.39)a for GV. Conclusion When dentifrices from the same manufacturer were compared, the whitening dentifrices led to similar or less wear than the regular ones.

Efecto de una Pasta Dental Comercial Conteniendo Xilitol Sobre el Recuento de Streptococcus Mutans en Saliva de Gestantes: Ensayo Clínico Controlado Aleatorizado / Effect of a Commercial Toothpaste Containing Xylitol on the Count of Streptococcus Mutans in Saliva of Pregnant Women: Randomized Controlled Clinical Trial

RESUMEN: El objetivo del presente trabajo fue determinar el efecto de una pasta dental comercial conteniendo xilitol sobre el recuento de Streptococcus mutans en saliva de gestantes. El presente fue un 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, distribuyéndolas en dos grupos: 25 gestantes usaron pasta dental con 10 % de xilitol y 25 gestantes usaron pasta dental sin xilitol. Se les tomó y procesó 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 (UFC) 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 %. No se encontró diferencia entre las gestantes que emplearon pasta dental con xilitol en comparación con las que utilizaron pasta sin xilitol (p=0,062). Se concluyó que el efecto de la pasta dental comercial conteniendo xilitol es similar a una pasta sin xilitol sobre el recuento de Streptococcus mutans en saliva de gestantes.

ABSTRACT: The objective of the present study was to determine the effect of a commercial toothpaste containing xylitol on the counts of Streptococcus mutans in saliva of pregnant women. The present was a double-blind clinical trial performed at the "José Olaya" health Centre (Chiclayo Peru) in January 2017. We worked with a sample population of 50 pregnant in the second trimester that met the established criteria, distributing in two groups: 25 pregnant women used toothpaste with 10 % xylitol and 25 pregnant used toothpaste without xylitol. They were taken and microbiologically processed a sample of saliva before the start of the study and 14 days after the use of the respective toothpastes. The Colony-forming units (CFU) of Streptococcus mutans in saliva were counted with a highly significant reliability through the intraclass correlation coefficient, Intra-and Interexaminer calibration (1.000 and 0.999, respectively). Data analysis was performed using the Mann-Whitney U test, considering a 5 % significance level. No difference was found among the pregnant women who used xylitol toothpaste compared to those who used toothpaste without xylitol (p = 0,062). It was concluded that the effect of xylitol containing commercial toothpaste is similar to a toothpaste without xylitol on the count of Streptococcus mutans in the saliva of pregnant women.

Efetividade de dentifrícios clareadores sobre esmalte de dentes bovinos / Effectiveness of whitening dentifrices on bovine teeth enamel

Introdução: devido à insatisfação relatada pelos pacientes com a coloração dos dentes e a busca por procedimentos que envolvam estética do sorriso associado com o desenvolvimento de técnicas e materiais amplamente propagados na mídia, as empresas responderam com a oferta no mercado de uma variedade de opções de dentifrícios que propõem efeito clareador prático e rápido. Objetivo: avaliar a efetividade de dentífricos clareadores em diferentes formas de apresentação sobre esmalte de dentes bovinos. Material e Métodos: quinze dentes bovinos foram imersos diariamente por um período de 1 hora em refrigerante a base de cola e em seguida foram divididos equitativamente em três grupos, onde cada grupo foi escovado com um dentifrício especifico por 2 minutos. O grupo A foi escovado com dentifrício Colgate Luminous White (Colgate ­ Palmolive), em forma de pasta, o grupo B com dentifrício Closeup Diamond Attraction Delicate White (Unilever) em forma de gel e o grupo C com dentifrício Oral-B Complete (Procter & Gamble) em forma de pasta. Resultados: as diferentes formas de apresentação estudadas foram efetivas na remoção das manchas extrínsecas em dentes bovinos; O dentifrício Colgate Luminous White na forma de apresentação pasta clareador apresentou-se mais efetivo na remoção das manchas extrínsecas; O dentifrício Oral ­ B Complete na forma de pasta foi efetivo, porém em menor intensidade em comparação aos dentifrícios clareadores estudados. Conclusão: as diferentes formas de apresentação dos dentifrícios utilizados foram efetivas na remoção de manchas extrínsecas.

Introduction: due to dissatisfaction reported by patients with tooth staining and the search for procedures involving smile aesthetics associated with the development of techniques and materials widespread on social medias, companies responded by offering to the market a variety of toothpaste choices in order to provide practical and fast bleaching effects. However, these dentifrices appear to have a limited efficiency since they only contain abrasives for the removing of extrinsic tooth stain. Objective: his research aimed to assess the effectiveness of different forms of presentation of bleaching agents on bovine teeth enamel. Methods: daily, fifteen bovine teeth were immersed in cola soft drink for a period of 1 hour and then they were divided into three groups (each group containing five bovine teeth). Each group was brushed with a specific dentifrice for 2 minutes: the group A was brushed with Colgate Luminous White in paste form (Colgate ­ Palmolive); the Group B with Diamond Closeup Attraction Delicate White in gel form (Unilever), and the group C with Oral-B complete in paste form (Procter & Gamble). Results: color change was observed through photographs and analysis of the interpreted samples based on the theoretical background. Conclusion: the dentifrices used were able to remove extrinsic stains and the bleaching dentifrice Colgate Luminous White was more effective as a result in this connection.

Fluorose dentaria em criancas de Sao Paulo, SP, 1998-2010 / Fluorosis dentaria en ninos de Sao Paulo, SP, 1998-2010 / Dental fluorosis in children from Sao Paulo, Southeastern Brazil, 1998-2010

OBJETIVO: Analisar a tendência de prevalência de fluorose dentária em crianças de 12 anos em contexto de exposição a múltiplas fontes de flúor. MÉTODOS: Realizou-se análise de tendência da prevalência de fluorose dentária no período de 1998 a 2010 na cidade de São Paulo, SP. As prevalências foram calculadas para diferentes anos (1998, 2002, 2008 e 2010), a partir de dados secundários obtidos em levantamentos epidemiológicos com amostras representativas da população de 12 anos de idade. A ocorrência de fluorose foi avaliada sob luz natural utilizando o índice de Dean, preconizado pela Organização Mundial da Saúde e categorizada em normal, questionável, muito leve, leve, moderada e severa. Em 1998 foram examinadas 125 crianças; 249 em 2002; 4.085 em 2008; e 231 em 2010. RESULTADOS: Em 1998 a prevalência de fluorose foi de 43,8% (IC95%35,6;52,8), em 2002 de 33,7% (IC95% 28,2;39,8), de 40,3% (IC95% 38,8;41,8) em 2008 e de 38,1% (IC95% 32,1;44,5) em 2010. As categorias muito leve + leve registraram 38,4% (IC95%30,3;47,6) em 1998, 32,1% (IC95% 26,6;38,2) em 2002, 38,0% (IC95% 36,5;39,5) em 2008 e 36,4% (IC95%30,4;42,7) em 2010. Não se observou fluorose severa com significância estatística. CONCLUSÕES: A prevalência de fluorose dentária em crianças paulistanas pode ser classificada como estacionária no período de 1998 a 2010, tanto em geral quanto ao se considerarem apenas as categorias muito leve + leve. .

OBJETIVO: Analizar la tendencia de prevalencia de fluorosis dentaria en niños de 12 años en contexto de exposición a múltiples fuentes de flúor. MÉTODOS: Se realizó análisis de tendencia de la prevalencia de fluorosis dentaria en el período de 1998 a 2010 en la ciudad de Sao Paulo, SP, Brasil. Las prevalencias fueron calculadas para diferentes años (1998, 2002, 2008 y 2010), a partir de datos secundarios obtenidos en pesquisas epidemiológicas con muestras representativas de la población de 12 años de edad. La ocurrencia de fluorosis fue evaluada bajo la luz natural utilizando el índice de Dean, recomendado por la Organización Mundial de la Salud y, categorizada como normal, cuestionable, muy leve, leve, moderada y severa. En 1998 fueron examinadas 125 niños; 249 en 2002; 4.085 en 2008 y 231 en 2010. RESULTADOS: En 1998 la prevalencia de fluorosis fue de 43,8% (IC95%35,6;52,8), en 2002 de 33,7% (IC95% 28,2;39,8), de 40,3% (IC95% 38,8;41,8) en 2008 y de 38,1% (IC95% 32,1;44,5), en 2010. Las categorías muy leve+leve registraron 38,4% (IC95%30,3;47,6) en 1998, 32,1% (IC95% 26,6;38,2) en 2002, 38,0% (IC95% 36,5;39,5) en 2008 y 36,4% (IC95%30,4;42,7) en 2010. No se observo fluorosis severa con significancia estadística. CONCLUSIONES: La prevalencia de fluorosis dentaria en niños paulistanos pudo ser clasificada como estacionaria en el período de 1998 a 2010, tanto en general como al considerar sólo las categorías muy leve+leve. .

OBJECTIVE: To assess the trend of dental fluorosis prevalence in 12-year-old children, in the context of exposure to multiple sources of fluoride. METHODS: An analysis was carried out of the trends in prevalence of dental fluorosis in the city of São Paulo, Southeastern Brazil, between 1998 and 2010. The rates of prevalence were calculated for different years (1998, 2002, 2008 and 2010) using secondary data obtained from epidemiological surveys of representative samples of 12-year-old children. Occurrence of fluorosis was assessed in natural light using the Dean index, recommended by the World Health Organization and categorized into normal, questionable, very mild, mild, moderate and severe. In 1998, 125 children were examined, 249 in 2002, 4,085 in 2008 and 231 in 2010. RESULTS: In 1998 the prevalence of fluorosis was 43.8% (95%CI 35.6;52.8) in 2002 it was 33.7% (95%CI 28.2;39.8), it was 40.3% (95%CI 38.8;41.8) in 2008 and 38.1% (95%CI 32.1;44.5) in 2010.The categories very mild + mild totaled 38.4% (95%CI 30.3;47.6) in 1998, 32.1% (95%CI 26.6;38.2) in 2002, 38.0% (95%CI 36.5;39.5) in 2008 and 36.4% (95%CI 30.4;42.7) in 2010. Severe fluorosis was not observed, with statistical significance, in the analyzed period. CONCLUSIONS: The prevalence of dental fluorosis in children from São Paulo can be classified as stationary between 1998 and 2010, both when considering all categories, and when considering only the categories very mild + mild. .

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

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

Mouthwashes with hydrogen peroxide are carcinogenic, but are freely indicated on the internet: warn your patients!

It all began in Ancient Egypt where people used to bleach their teeth with antiseptic mouthwashes made of urea from human urine. Teeth harmony is promoted by expression of feelings, communication, a real window of the brain and its content! Tooth bleaching products are medicines, not cosmetics! Mouth washing with hydrogen peroxide is an illogical and dangerous procedure! Hydrogen peroxide must be used in one's mouth only when employed by a dentist who has been properly instructed to protect the mucosa, preventing it from receiving these products. How and for how long these products are going to be used require caution in order to avoid or decrease any adverse effects on the tissues. Many websites instruct people on how to purchase and prepare hydrogen peroxide so that it is used as an antiseptic mouthwash and tooth bleaching agent. Some websites even refer to dentists as "exploiters", accusing them of not instructing patients properly. In this article, we aim at providing evidence and information upon which dentists and assistants may base their thinking as well as their opinion and procedures regarding "the indiscriminate and free use of hydrogen peroxide in the mouth, on teeth and oral mucosa". Those websites, blogs and social network profiles trespass the limits of public trust and should be immediately sued by the government for committing a crime against public health.

Tudo começou no Egito antigo, onde procurava-se clarear os dentes com bochechos antissépticos com ureia da urina humana. Os dentes se harmonizam com expressões de sentimentos, na comunicação, como uma verdadeira vitrine do cérebro e seus conteúdos! Clareadores dentários são medicamentos, e não cosméticos! Bochecho com água oxigenada representa um procedimento improcedente e perigoso! O uso do peróxido de hidrogênio ou água oxigenada na boca deve ser feito diretamente pelo profissional da Odontologia, treinado para proteger as mucosas contra o contato desses produtos. O tempo e a forma de uso requerem cuidados, para se proteger ou diminuir os efeitos indesejáveis sobre os tecidos. Vários websites "ensinam" como adquirir e preparar água oxigenada para fazer bochechos antissépticos e clarear os dentes. Alguns websites se referem ao profissional da Odontologia como um "explorador", por não ensinar isso ao paciente. No presente artigo, procuraremos informar e dar fundamentos para que os profissionais da Odontologia e auxiliares possam embasar suas reflexões, opiniões e condutas relacionadas ao tema "uso indiscriminado e livre de peróxido de hidrogênio na boca sobre os dentes e mucosa bucal". Esses websites, blogs e perfis em redes sociais abusam da fé pública e deveriam ser acionados judicialmente, imediatamente, pelas autoridades públicas, pelo crime contra a saúde das pessoas.

Influência de diferentes cremes dentais na rugosidade e atrito dos braquetes ortodônticos / Influence of different toothpastes in roughness and friction of orthodontic brackets

Introdução: avaliar, in vitro, a rugosidade, a morfologia e os níveis de atrito oferecidos pelos braquetes antes e após a escovação com diferentes cremes dentais. Métodos: cento e dez braquetes metálicos foram aleatoriamente distribuídos em 11 grupos: 1 grupo controle (saliva artificial) e 10 grupos experimentais (n = 10). Após colagem dos braquetes em dispositivo específico, esses foram submetidos a três escovações diárias com diferentes tipos de cremes dentais durante um período de 28 dias. Os cremes dentais avaliados foram: Close Up Ação Profunda, Close Up Triple, Colgate Luminous White, Colgate Tripla Ação, Oral B Pró Saúde, Oral B Pró-Saúde Whiteness, Sensodine Fresh, Sensodine Original, Sorriso Fresh Plus e Sorriso Original. Entre as escovações, os braquetes foram lavados em água corrente e acondicionados em recipiente contendo saliva artificial e mantidos em estufa à temperatura de 37ºC. Para a avaliação da rugosidade foi utilizada microscopia eletrônica de varredura. As imagens obtidas foram avaliadas quantitativamente por meio de análise de imagem em histogramas. Os níveis de atrito foram medidos por uma máquina de dobramento. Os dados foram comparados estatisticamente por meio da ANOVA, utilizando o teste t de Student. Resultados: observou-se presença de ranhuras, sobretudo no grupo Colgate Luminous White. Houve diferenças estatísticas nos níveis de atrito entre os grupos Close Up Ação Profunda, Close Up Triple e Colgate Luminous White. Conclusão: o creme dental Colgate Luminous White apresentou maior rugosidade de superfície e maior nível de atrito; a menor rugosidade foi observada nos grupos Close Up Ação Profunda e Sorriso Fresh Plus.

Análise dos fatores de risco ou de proteção para fluorose dentária em crianças de 6 a 8 anos em Fortaleza, Brasil / Analysis of protection or risk factors for dental fluorosis in 6 to 8 year-old children in Fortaleza, Brazil

OBJETIVO: Investigar os fatores de risco ou de proteção para a fluorose dentária na dentição permanente de crianças de 6 a 8 anos em um bairro no Município de Fortaleza, Brasil. MÉTODOS: Este estudo de caso-controle incluiu 67 crianças com fluorose nos incisivos superiores e inferiores permanentes erupcionados, conforme o índice de Dean, e 57 controles. A presença de fluorose foi determinada como variável dependente. Os dados acerca das variáveis independentes foram obtidos através de entrevistas com os pais das crianças. O teste exato de Fisher foi utilizado para verificar a existência de associação entre fluorose e as variáveis independentes. Foi calculada a razão de chances (odds ratio, OR) para verificar a associação e a probabilidade de fluorose no grupo-caso, ambos com significância de 95 por cento. RESULTADOS: Houve associação significativa da fluorose com tipo de moradia (própria, alugada ou ocupada), mas não com fonte de água para consumo ou uso de dentifrícios fluoretados e suplementos de flúor. Na análise univariada, o risco de fluorose foi maior em crianças que iniciaram o consumo de leite em pó reconstituído com água antes dos 2 anos de idade (OR = 4,53; IC95 por cento: 1,07 a 26,74) e nas que não mamaram (OR = 6,66; IC95 por cento: 1,61 a 38,62). Na análise multivariada, somente a amamentação apresentou associação com a fluorose (4,54; IC95 por cento: 1,21 a 16,66). CONCLUSÕES: A amamentação se configurou como fator de proteção contra a fluorose. É preciso estabelecer critérios de classificação mais específicos para permitir a investigação de relações entre fluorose e classe socioeconômica.

OBJECTIVE: To investigate protection or risk factors for dental fluorosis in permanent teeth of 6 to 8 year-old children in a neighborhood of Fortaleza, Brazil. METHODS: This case-control study included 57 controls and 67 children with fluorosis affecting superior and inferior incisors teeth as determined by the Dean classification criteria. Presence of fluorosis was considered as the dependent variable. Data concerning independent variables were obtained through interviews with the parents. Fisher's exact test was used to determine associations between fluorosis and the independent variables. Odds ratios (OR) were calculated to investigate associations and likelihood of fluorosis in the case group, with 95 percent significance level. RESULTS: Fluorosis was significantly associated with type of housing (owned, rented or squatted), but not with the source of drinking water or use of fluoridated toothpaste and fluoride supplements. Univariate analysis showed that the risk of fluorosis was higher in children who began drinking powdered milk mixed with water before 2 years of age (OR = 4.53; IC95 percent: 1.07-26.74) and in those who did not breastfeed (OR = 6.66; IC95 percent: 1.61-38.62). In the multivariate analysis, only breastfeeding was associated with fluorosis (4.54; IC95 percent: 1.21-16.66). CONCLUSIONS: Breastfeeding was a protection factor against fluorosis. More specific categorization criteria must be established to investigate relationships between fluorosis and socioeconomic class.

Dental fluorosis and its association with the use of fluoridated toothpaste among middle school students of Delhi.

Introduction: Fluorosis can manifest as dental fluorosis (seen mostly in secondary dentition), skeletal fluorosis, and systemic fluorosis. Groundwater with high fluoride concentrations, diet rich in fish and tea, indoor air-pollution, and use of fluoride toothpastes may contribute considerably to total exposure. Objective: To assess the prevalence of dental fluorosis and associated factors particularly fluoridated toothpastes, among middle school children of a resettlement colony in Delhi. Materials and Methods: This survey was conducted among the middle school students (VI th -VIII th ) studying in three government schools of Sangam Vihar, South Delhi. Students were examined for dental fluorosis by experts. A pre-structured questionnaire was used to obtain data regarding age, source of drinking water, toothpaste used, etc. Height, weight, and hemoglobin were recorded. Two repeat visits were made. Out of 432 students enrolled in these schools, 413 students were examined. Statistics: Descriptive and chi-square statistics were used. Results: Dental fluorosis was prevalent in 121 (29.3%) study subjects. It was significantly more in children of age 13 years or above, in those who used fluoridated toothpaste for dental cleaning (P=0.033) and in anemic children (P<0.001). However, there was no significant association of disease with gender (P=0.02), source of drinking water (P=0.417), and with BMI (P=0.826). Conclusion: As dental fluorosis is very common (in about one-fourth) among the middle school children, in this resettlement colony of Delhi, various control measures e.g. discouraging the fluoridated toothpastes, educating parents about fluorosis, de-fluoridation of water in the high risk areas, etc may help to tackle this situation.

Is there a need of extra fluoride in children.

The issues related to fluoridation of water or fortification of tooth paste with compounds of fluorides are controversial. Fluoride is stored mainly in the bones, where it increases the density and changes the internal architecture, makes it osteoporotic and more prone to fractures. Fluoride consumption by human beings increases the general cancer death rate, disrupts the synthesis of collagen and leads to the breakdown of collagen in bone, tendon, muscle, skin, cartilage, lungs, kidney and trachea, causing disruptive effect on various tissues in the body. It inhibits antibody formation, disturbs immune system and makes the child prone to malignancy. Fluoride has been categorized as a protoplasmic poison and any additional ingestion of fluoride by children is undesirable.

Evaluation of some biological aspects of the presence of abrasive silica and thickening silica in basic formulations of dentifrices / Evaluación de algunos aspectos biológicos de la presencia de sílice abrasivo y sílice espesante en formulaciones básicas de dentífricos

The aim of this study was to evaluate some biological characteristics and toxicity of basic formulations of dentifrices containing such substances, and to compare them with two existing products in market which also contains silic in their formulations. In this way, it was evaluated some biological parameters: weight of the animals, oral toxicity, hematological parameters, urinary analysis, and histological evaluation. The thrombocytes were also statistically at normal levels. The glutamate-pyruvate transaminase (TGP) showed normal aspect in 5 of the tested groups, as in control. Meanwhile, the oxalacetic transaminase (AST) in one group had a small increase in the control group. Regarding urine, in exception the rats of one group, the rats of the 4 other experimental groups showed leukocytosis urinary statistically higher than the control group. The histological evaluation of the animals showed that specimens from liver, stomach, kidney and submandibular gland presented normal aspects for these organs, without significant characteristics related to inflammatory infiltrates in any of the 6 samples tested in their respective groups.

El objetivo del estudio fue evaluar algunas características biológicas y de toxicidad provenientes de las formulaciones básicas de dentífricos que contienen sílice en su composición y compararlos con dos dentífricos disponibles comercialmente que también presentan sílice. El análisis hematológico no mostró diferencias entre los grupos evaluados. Los niveles de trombocitos presentados por los grupos fueron también normales. La transaminasa gluámico pirúbica se mostró un aspecto normal en 5 de los grupos estudiados, así como en el grupo control. La transaminasa glutámico oxaloacética en uno de los grupos tuvo un pequeño incremento. En relación a la orina, 4 grupos presentaron leucocitosis urinaria significativamente mayor que el grupo de control. La evaluación histológica del hígado, estómago, riñones y glándulas submandibulares se presentó con aspecto normal, sin presencia de infiltrado inflamatorio.

[Assessing the abrasive ability of three different domestic pediatric toothpastes]

The abrasive quality of children's toothpaste has long been the concern of dental professionals. On the other hand, manufacturers have tried to improve the quality and establish ingredient standards. This study was designed to compare the abrasiveness of three locally produced toothpastes, namely Darugar, Pooneh and Kam with Oral-B standard. This experimental study was conducted using 24 samples of composite blocks imbedded in acrylic material. The weight of each specimen was measured by a digital scale at 0.0001gr accuracy. Each specimen was brushed with 200gr force along with the selected tooth paste solutions using V8 cross brushing machine. The weight of each specimen was measured after 5000, 10000, 15000 and 20000 strokes. The mean weight-loss as well as their standard deviations were calculated for each group. The collected data was then analyzed using ANOVA and Tukey statistical tests. No significant difference was detected between four types of toothpastes after 5000 and 10000 strokes. However, significant differences were observed between Darugar toothpaste and the rest [Kam, Pooneh and Oral-B] after 15000 and 20000 strokes. Darugar pediatric toothpaste showed higher abrasive rate when compared with other toothpastes. The amount of wear was shown to be similar in Kam, Pooneh and Oral-B

In vitro evaluation of the abrasiveness of a commercial low-abrasive dentifrice and an experimental dentifrice containing vegetable oil

Toothpastes usually contain detergents, humectants, water, colorant, fluoride and thickeners (e.g.: silica). Tooth wear has a multi-factorial etiology and the use of abrasive dentifrices is related to abrasion of dental tissues during toothbrushing. This study evaluated in vitro the abrasiveness of a commercial silica gel low-abrasive dentifrice compared to an experimental dentifrice containing vegetable (almond) oil. Distilled water served as a control group. Acrylic specimens (8 per group) were submitted to simulated toothbrushing with slurries of the commercial dentifrice, experimental dentifrice, almond oil and water in an automatic brushing machine programmed to 30,000 brush strokes for each specimen, which is equivalent to 2 years of manual toothbrushing. Thereafter, surface roughness (Ra) of the specimens was analyzed with a Surfcorder SE 1700 profilometer. Data were analyzed statistically by ANOVA and Tukey’s test at 5% significance level. There was no statistically significant difference (p>0.05) in the surface roughness after brushing with water, almond oil or experimental dentifrice. The commercial dentifrice produced rougher surfaces compared to the control and abrasive-free products (p<0.05). Further studies are necessary to confirm the potential benefits of using vegetable oil in toothpastes as an alternative to abrasives in an attempt to minimize the tooth wear caused by toothbrushing.

Assessment in vitro of brushing on dental surface roughness alteration by laser interferometry

Noncarious cervical lesions (NCCLs) are considered to be of multifactorial origin, normally associated with inadequate brushing. This study assessed the influence in vitro of simulated brushing on NCCL formation. Fifteen human premolars were submitted to brushing in the cementoenamel junction region, using hard-, medium- and soft-bristled brushes associated with a toothpaste of medium abrasiveness under a 200 g load, at a speed of 356 rpm for 100 minutes. The surface topography of the region was analyzed before and after brushing, by means of a laser interferometer, using "cut-off" values of 0.25 and considering roughness values in mm. The initial roughness (mm) results for dentin (D / bristle consistency: 1 - soft, 2 - medium and 3 - hard) were as follows: (D1) 1.25 ± 0.45; (D2) 1.12 ± 0.44; (D3) 1.05 ± 0.41. For enamel (E / bristle consistency: 1 - soft, 2 - medium and 3 - hard), the initial results were: (E1) 1.18 ± 0.35; (E2) 1.32 ± 0.25; (E3) 1.50 ± 0.38. After brushing, the following were the values for dentin: (D1) 2.32 ± 1.99; (D2) 3.30 ± 0.96; (D3) Over 500. For enamel, the values after brushing were: (E1) 1.37 ± 0.31; (E2) 2.15 ± 0.90; (E3) 1.22 ± 0.47. Based on the results of the ANOVA and Tukey statistical analyses (a = .05) it was concluded that soft, medium and hard brushes are not capable of abrading enamel, whereas dentin showed changes in surface roughness by the action of medium- and hard-bristled brushes.

Effect of whitening dentifrices on the surface hardness of tooth coloured restorative material

The present study aims to measure the surface hardness of Z-250 composite resin material and Fuji 11 LC RMGIC after brushing for 15 days and 30 days using 3 different brands of toothpaste each having two forms, regular and whitening. The study was conducted using six different groups for each material. Each group has five disc specimens obtained from [3mm x 8mm diameter] mold. Universal testing machine [Micromet 2100 series microhardness tester] was used for testing Vicker's surface hardness. All groups were stored in distilled water at room temperature. The VHN of the control groups were measured after 24 hours, 15 days and 30 days. All data were statistically analyzed with ANOVA and Tukey's Post Hoc analysis [P=0.05]. Water storage [24 hours, 15 days and 30 days] had no significant difference of surface hardness on Z-250, with Fuji II LC there was an increase in VHN between 24 hours, 15 days and 30 days groups. Signal 2 regular toothpaste showed significant increase in VHN for both Z-250 and Fuji II LC over the control group after 15 days. Although after thirty days, the toothpastes regardless whitening or regular had no effect on surface hardness of Fuji II LC, while, they all increased the surface hardness of Z-250. There was no difference in surface hardness of 250 composite resin and Fuji 11 LC RMGIC due to whitening and regular toothpastes

Racciones alérgicas a las pastas dentales: reporte de casos / Allergic reactions to toothpastes: case reports

El presente documento reporta tres casos de pacientes con historia de alergia crónica, que sorpresivamente desarrollan cuadros de dermatitis por contacto a nivel bucal asociados al cambio de diferentes marcas de pastas dentífricas. Las áreas afectadas son tanto la mucosa intraoral, lengua, labios y piel de la zona peribucal. Se presenta una recopilación con los datos contribuyentes en sus historias clínicas, así como la descripción de los principales signos y síntomas bucales, y el tratamiento para cada caso. Es importante resaltar que muchas veces estas manifestaciones son tratadas sintomáticamente, sin eliminar el probable agente causal. Por ello, el facultativo debe ser capaz de reconocer en la anamnesis aquellos datos significativos que pudieran contribuir al diagnóstico, con el fin de poder descartar cualquier tipo de reacción alérgica en el paciente

Riesgo de fluorosis dental en niños menores de 6 años por uso de dentífricos fluorados / Risk of enamel fluorosis by ingestion of fluoride dentifrices in children under 6 years

En la actualidad, el notable aumento de la disponibilidad de productos fluorados de alcance masivo, y su consiguiente consumo, ha evidenciado un uso inapropiado y excesivo a la luz del aumento de la fluorosis dental. Esta patología se ha definido como la alteración del esmalte dentario por ingestión crónica de fluoruros, en dosis excesiva, durante un periíodo del desarrollo dentario, específicamente en los primeros 5 años de vida. Dentro de los factores más determinantes de la fluorosis dental se ha postulado el uso e ingestión de dentífrico fluorado durante el cepillado de niños preescolares. El propósito de esta investigación fue determinar el riesgo de fluorosis dental en menores de 6 años por ingesta de dentífricos fluorados durante el cepillado. Se realizó une studio experimental en 64 niños preescolares divididos en 3 grupos etarios (rango: 2 años, 11 meses - 5 años, 10 meses), cada niño se cepilló en 2 ocasiones con 1 g de dentífrico (1100 ppm Naf). durante 1 minuto. Aplicando el método gravimétrico de Hargreaves, se cuantificó la ingesta de flúor en base a lo recuperado del cepillado, utilizando en fluorímetro de electrodos específicos. El riesgo de fluorosis dental se determinó de acuerdo a un nivel preestablecido por Ericcson, 1969 y Salama, 1989, de 0.240 mg de flúor por cepillado. El promedio de ingesta para los 64 niños fue de 0,249 mg de flúor por cepillado (3 años: 0,299 mg; 4 años: 0,243 mg; 5 años: 0,206 mg), evidenciándose riesgo de fluorosis dental para el grupo estudiado. Aunque el promedio de ingesta disminuyó a mayor edad, esto no fue significativo (p < 0,052). El 45,3 por ciento de los niños alcanzó niveles de riesgo de fluorosis dental, siendo el grupo de 3 años el de mayor riesgo. Se concluye que la ingesta de dentífricos fluorados en niños menores de 6 años constituye un factor importante de riesgo de fluorosis dental el que aumenta a medida que disminuye la edad del niño