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.

Concentração do fluoreto em dentifrícios distribuídos pelo serviço público em Salvador, Bahia / Fluoride concentration in dentifrices distributed by the public service in Salvador, Bahia

Introdução: de acordo com a legislação brasileira, um dentifrício não pode conter mais que 1.500 ppm de flúor total (FT), e o fabricante deve declarar na embalagem a concentração e o tipo de sal de flúor que o produto contém. No entanto, para que possa exercer um efeito anticárie, o produto deve conter pelo menos 1.000 ppm F (mgF/kg) na forma quimicamente solúvel. Objetivo: avaliar as concentrações de flúor total (FT) e flúor solúvel total (FST) em dentifrícios distribuídos pelo serviço público de saúde da cidade de Salvador, Bahia. Materiais e métodos: três amostras de um dentifrício (MFP/CaCO3, 1.500 ppm F como FT) que estava sendo distribuído pelo serviço público de saúde de Salvador, BA, foram obtidas. Como controle, foi utilizado um dentifrício com a mesma formulação (1.450 ppm de FT) encontrado no comércio da cidade de Piracicaba, SP. As análises foram realizadas com eletrodo específico para fluoreto, empregando metodologia já validada e os resultados expressos em ppm F (mg F/kg). Resultados: em todas as amostras avaliadas, foram encontrados apenas 61,8 ppm F de FT, evidenciando que não foram fluoretadas, fato este nunca antes relatado no Brasil. De outro modo, no dentifrício utilizado como controle, havia 1404,7 ppm F de FT, do qual 1.270,0 ppm estavam solúveis (FST). Conclusão: os cremes dentais avaliados nesta pesquisa não são capazes de exercer um efeito anticárie, uma vez que não foram fluoretados. Esses dados mostram a urgência de modificação da regulamentação brasileira vigente e a necessidade de maior controle de qualidade desses produtos.(AU)

Introduction: according to Brazilian legislation, a toothpaste cannot contain more than 1500 ppm of total fluoride (TF), as well as the manufacturer must provide on the packaging the concentration and type of fluoride salt that the product contains. However, to have an anti-caries effect, it must contain at least 1,000 ppm F (mgF/kg) in its chemically soluble form. Research Aim: To evaluate the total fluoride (TF) and total soluble fluoride (TSF) concentrations in dentifrices distributed by the public health service in the city of Salvador, Bahia. Materials and methods: for the analyses, three samples of a dentifrice (MFP/CaCO3, 1,500 ppm F as TF) that was being distributed by Salvador's public health system were obtained. As a control, it was used a dentifrice of the same formulation (1,450 ppm of TF) found in commerce of the city of Piracicaba- -SP. The analyses were performed with a specific fluoride electrode using a validated methodology and the results were expressed in ppm F (mg F/ kg). Results: In all the samples evaluated, only 61.8 ppm F of TF were found, showing that it was not fluoridated, a fact that was never reported in Brazil before. On the other hand, in the dentifrice used as a control, there were 1404.7 ppm F of TF, of which 1270.0 ppm were soluble (TSF). Conclusion: the samples evaluated in this research are not able to exert an anti-caries effect, since they were not fluoridated. These data show the urgency to change the current Brazilian regulation and the need for a greater quality control of these products.(AU)

Dispensing Device to Deliver Small and Standardized Amount of Fluoride Dentifrice on the Toothbrush

Abstract Objective: To evaluate the efficacy of a dispensing device specially developed to standardize the amount of fluoride dentifrice to be delivered on the toothbrush. The amount and variability of dentifrice applied using this device were compared with recommendations to apply dentifrice amounts equivalent to "rice size" or "pea-size". Material and Methods: Two dentifrices, one used by children (NaF/Silica-based) and one used by the entire family (MFP/CaCO3-based), and five methods to apply them on the toothbrush (pea and rice sizes, and three different amounts using the developed device) were tested by 12 volunteers. The amount of dentifrice placed on the toothbrush was weighed, and the experiment was repeated three times. Data were analyzed by two-way ANOVA and Tukey test. Results: No differences were observed between the dentifrices used (p>0.05), but the method of application significantly affected the amount of dentifrice applied (p<0.05). Smaller amounts (p<0.05) and less variability were observed when the volunteers used the dispenser device than when they were asked to apply a pea or rice size. Conclusion: The device can help parents and caregivers to safely use fluoride dentifrice on children.

Disparities in Caries Experience and Socio-Behavioural Risk Indicators Among Private School Children in Lagos, Nigeria

Abstract Objective: To determine the prevalence and socio-behavioural risk factors for dental caries among children at selected LGAs in Lagos State. Material and Methods: This was a descriptive study of 592 school children in four Local Government Areas of Lagos, Nigeria. The presence of caries was recorded using the World Health Organization criteria. Descriptive statistics were reported for analysis of comparative DMFT and SiC scores in relation to age, gender, and other socio-demographic variables. Logistic regression analysis was used to analyze the differential impact of the variables on the probability of being in the high caries prevalence group. Results: The prevalence of dental caries was 16.0% with mean dmft for age 6 being 1.3 ± 1.57 while the mean DMFT for age 12 was 0.15 ± 0.67. The mean Sic for age 6 was 1.5 ± 0.53 while the mean SiC for age 12 was 1.09 ± 0.29. The mean SiC values was significantly higher in the primary and permanent dentition among those who had never visited the dentist, female students, those who don't use fluoridated toothpaste and those who eat sweets and candy several times a day. After logistic regression analysis, those with no previous dental visit (OR=3.05; CI: 1.72-4.67) and females (OR=1.55; CI: 1.16-1.62) still had significantly higher SiC Values. Conclusion: The prevalence of caries was low in the study population. Being female, non-use of fluoride-containing toothpaste and not visiting the dentist were significant predictors of dental caries among children attending private schools.

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.

Cepillado dental y niveles de flúor en pastas dentales usadas por niños peruanos menores de 12 años / Tooth brushing and fluoride levels in toothpaste used by peruvian children under 12 years old

RESUMEN Análisis secundario de los datos de 41 330 niños de uno a 11 años de la Encuesta Demográfica y de Salud Familiar (ENDES) 2018. Se reportó la frecuencia de cepillado y el uso de pasta dental según el nivel de flúor (no cepillado, adecuado, inadecuado, no mostró/no usa pasta, e ilegible), según variables socioeconómicas y geográficas. Un 7,8% de los niños evaluados no se cepillaba los dientes, se evidenció diferencias porcentuales significativas (p <0,001) en el uso de pasta dental con concentración inadecuada de flúor entre las categorías extremas de las variables edad (12,3%), uso de servicios odontológicos (7,7%), nivel educativo del responsable (20,4%), índice de riqueza (17,8%), dominio geográfico (11,3%) y área de residencia (9,1%). Un porcentaje considerable de niños peruanos no se cepilla los dientes; además, un gran número de niños que se cepillan emplean pastas dentales con contenidos de flúor sin efecto preventivo.

ABSTRACT Secondary analysis of data on 41,330 children aged one to 11 from the Demographic and Family Health Survey (ENDES) carried out in 2018. The frequency of brushing and the use of toothpaste were reported according to the level of fluoride (no brushing, adequate, inadequate, did not show/did not use toothpaste, and illegible), according to socioeconomic and geographical variables. The evaluation showed that 7.8% of children did not brush their teeth; there were significant percentage differences (p <0.001) in the use of toothpaste with inadequate fluoride concentration between the extreme categories of the variables: age (12.3%), use of dental services (7.7%), educational level of the person responsible (20.4%), wealth index (17.8%), geographical domain (11.3%), and area of residence (9.1%). A considerable percentage of Peruvian children do not brush their teeth; in addition, a large number of children who brush use toothpastes with a fluoride content that has no preventive effect.

The in vitro remineralizing effect of CPP-ACP and CPP-ACPF after 6 and 12 weeks on initial caries lesion

Abstract Objective: The aim of this in vitro study was to determine the effects of remineralization promoting agents containing casein phosphopeptide-stabilized amorphous calcium phosphate (CPP-ACP), or CPP-ACP in combination with fluoride (CPP-ACPF) on artificial white spot lesions (WSLs) after 6 and 12 weeks. Methodology: White spot lesions were created on 123 sectioned premolars (246 specimens) with a demineralization solution during a 96 hours pH-cycling regime. Two experimental groups were created: a CPP-ACP group (Tooth Mousse™), and a CPP-ACPF group (Mi Paste Plus™). Additionally, two control groups were created, one using only a conventional toothpaste (1450 ppm fluoride) and another one without any working agents. All teeth were also daily brushed with the conventional toothpaste except the second control group. Tooth Mousse™ and Mi Paste Plus™ were applied for 180 seconds every day. The volume of demineralization was measured with transverse microradiography. Six lesion characteristics regarding the lesion depth and mineral content of WSLs were also determined. Results: The application of CPP-ACP and CPP-ACPF had a significant regenerative effect on the WSLs. Compared to Control group 1 and 2 the volume of demineralization after 6 weeks decreased significantly for CPP-ACP (respectively p<0.001 and p<0.001) and CPP-ACPF (respectively p=0.001 and p=0.003). The same trend was observed after 12 weeks. For the CPP-ACPF group, WSL dimensions decreased significantly between 6 and 12 weeks follow-up (p=0.012). The lesion depth reduced significantly after application of CPP-ACP and CPP-ACPF but increased significantly in the Control groups. Mineral content increased for CPP-ACP and CPP-ACPF after an application period of 12 weeks, but this was only significant for CPP-ACP. Conclusions: Long-term use of CPP-ACP and CPP-ACPF in combination with a conventional tooth paste shows beneficial effects in the recovery of in vitro subsurface caries lesions.

Whitening toothpaste containing activated charcoal, blue covarine, hydrogen peroxide or microbeads: which one is the most effective?

Abstract The efficacy of whitening toothpastes is questionable and controversial. Clinicians, patients and researchers have expressed concern with whitening toothpastes due to the risk of wearing the dental structure and the potential for disappointment if the advertised cosmetic results are not achieved. Objective: This study compared the whitening performance of toothpastes with different whitening technologies after initial and continued use. Material and Methods: Ninety bovine incisors were stained using a concentrated solution of black tea. They were randomly distributed into 6 groups, according to the toothpaste whitening technology: activated charcoal (B&W), blue covarine (WAD), hydrogen peroxide (LWA), microbeads (Oral B 3D White Perfection - 3DW) and optimized abrasives (XW4D). They were compared to a traditional toothpaste without a whitening agent (TA - control). Specimens underwent a brushing machine with controlled pressure, time and temperature. A calibrated examiner measured the color using a VITA-Classical scale before the first brushing cycle (T0), after the first brushing cycle (TI), and after a brushing cycle that simulates continuous use (TCU). Whitening performance was evaluated by the difference of shades (ΔSGU) between T0-TI and T0-TCU timepoints, using the Kruskal-Wallis and Dunn's non-parametric test. The Wilcoxon test was used to evaluate the cumulative effect (α=0.05). Results: Statistically significant differences were observed between toothpastes in both TI and TCU (p<0.05). The time of use also had a significant effect (p<0.05). Conclusion: Only WAD and 3DW showed whitening performance after the first use (TI). The greatest whitening performance after continuous use was obtained by WAD, followed by LWA and 3DW. The use of conventional toothpaste (TA) promotes no tooth whitening. Clinical relevance: Microbead abrasives (3DW) and blue covarine (WAD) were the active technology tested that presented the best global tooth whitening performance.

Exposição a fluoreto por crianças na faixa etária crítica para fluorose dentária, residentes no semiárido brasileiro / Exposure to fluoride of children during the critical age for dental fluorosis, in the semiarid region of Brazil

Resumo Há uma preocupação com o aumento da prevalência de fluorose dentária, que depende da dose de fluoreto (F) a que as crianças são submetidas durante a formação dos dentes. A temperatura ambiental afeta a ingestão de água e, portanto, seria importante avaliar se as crianças que vivem em uma região de clima semiárido estão expostas a uma dose excessiva de F. Assim, o objetivo do presente estudo foi determinar a dose total de F a que as crianças são expostas durante a idade crítica para a fluorose dentária, tendo dieta (água e alimentos) e dentifrício como fontes de F, em uma região de clima semiárido no Brasil. Metodologia: foram selecionadas 26 crianças com idade de 25,2 ± 9,1 meses, residentes em Feira de Santana-BA. Foram coletadas amostras de dieta-duplicada, água, produtos de escovação e dentifrícios. A concentração de F foi determinada após o devido preparo das amostras, utilizando um eletrodo específico. Resultados: a média e o desvio padrão de dose (mg F / kg / dia) em função da dieta, dentifrício e total foram, respectivamente: 0,016 ± 0,010; 0,030 ± 0,039 e 0,047 ± 0,043. Conclusões: as crianças avaliadas, residentes em uma região de clima semiárido, não estão expostas a uma dose de risco de fluorose dentária.

Abstract There is a concern about the increasing prevalence of dental fluorosis, which depends on the dose of fluoride (F) to which children are subjected during tooth formation. Environmental temperature affects water intake and therefore it would be important to assess whether children living in the semiarid region are exposed to an excessive dose of F. Therefore, the objective of this study was to determine the total dose of F to which children are exposed during the critical age for dental fluorosis, with diet (water and food) and toothpaste as F sources, in the semiarid region of Brazil. Methodology: 26 children aged 25.2 ± 9.1 months, residents in Feira de Santana, State of Bahia (with F in the public water supply) were selected. Duplicate-diet, water, products from toothbrushing and toothpaste samples were collected. F concentration was determined using an ion-specific electrode, after proper sample preparation. Results: the mean and standard deviation of dose (mg F/kg/day) from diet, toothpaste and total were respectively: 0.016 ± 0.010; 0.030 ± 0.039 and 0.047 ± 0.043. Conclusions: the children evaluated living in the semiarid region are not exposed to a risk dose for dental fluorosis.

Is the fluoride intake by diet and toothpaste in children living in tropical semi-arid city safe?

Abstract: Data about total fluoride intake in children living in a tropical semi-arid climate city is scarce, thus we conducted this study. Fifty-eight children aged two to five years, living in a Brazilian tropical city with optimally fluoridated water were selected. Dietary samples were collected using the duplicate diet method on two non-consecutive days in the children's home toothpaste was determined by subtracting the amount of fluoride recovered after brushing from the amount placed on the toothbrush. The mean total dose (SD) of fluoride intake was 0.043(0.016) mg F·kg-1·d-1, with the major (60.6%) contribution from water. The factors associated with the ingestion of fluoride from toothpaste were fluoride concentration of the toothpaste (p = 0.03) and the use of kids toothpaste (p = 0.02). The findings suggest that children have a low fluoride intake, measured by at-home meals and use of fluoride toothpaste; drinking water is the main source of fluoride ingestion.

Caries lesion remineralization with fluoride toothpastes and chlorhexidine - effects of application timing and toothpaste surfactant

Abstract Habitual toothbrushing with fluoridated toothpaste followed by rinsing with antibacterial mouthwashes is a method to maintain good oral hygiene and to diminish the occurrence and severity of dental caries and periodontal disease. However, our understanding of how antimicrobial agents in mouthwashes affect fluoride-mediated caries lesion remineralization is still poor. Objective: The objectives of this in vitro study were a) to determine the effects of the waiting period of chlorhexidine (CHX) rinsing after fluoride toothpaste use and b) to further determine the effect of the type of toothpaste surfactant [sodium dodecyl sulfate (SDS) or cocamidopropyl betaine (CAPB)] on caries lesion remineralization associated with CHX rinsing. Material and Methods: Caries lesions were formed in bovine enamel specimens and assigned to 10 treatment groups (n=18) based on Vickers surface microhardness (VHN). Lesions were then pH-cycled for 10 days with daily regimen comprised of twice daily toothpaste slurry treatments (1150 ppm fluoride, with SDS or CAPB), followed by CHX solution treatments [0, 15, 30 or 60 minutes following slurry treatment or no CHX treatment (negative control)]. VHN was measured again and the extent of lesion remineralization calculated (∆VHN). Results: ∆VHN with SDS-toothpaste was significantly lower than with CAPB-toothpaste, indicating more remineralization for the CAPB-toothpaste. ∆VHN with 0-minute waiting time was significantly lower than with 30-minute waiting time and with negative control. Conclusions: The absence of CHX as an adjunct to fluoride toothpastes led to greater remineralization of enamel lesions compared with the immediate use of CHX treatment for both SDS- and CAPB-toothpastes. CAPB-toothpastes indicated significantly greater remineralization than SDS-toothpastes, and can be suggested for patients at high risk of caries. A 30-minute waiting time for CHX treatment is recommended after brushing.

Can whitening toothpastes maintain the optical stability of enamel over time?

Abstract Besides the effects on the health of individuals, cigarette smoking can also interfere with the appearance of their teeth. Objective: To evaluate the effect of cigarette smoking-toothbrushing-cycling (CSTC) with whitening toothpastes on the roughness and optical behavior of bovine enamel for eight weeks. Material and Methods: Thirty bovine dentin/enamel discs, 8.0 mm in diameter and 2.0 mm thick, were randomly divided into three groups according to the toothpastes: whitening (Colgate Luminous White - CW and Oral B 3D White - OW), and a non-whitening (Colgate - C). The roughness, color (CIE L*a*b* system), translucency and gloss were measured before and after the specimens were submitted to CSTC. The topography of the specimens was analyzed by scanning electron microscopy. During the first week, the specimens were daily subjected to the consumption of 20 cigarettes and brushed (40 strokes/100 g) with the toothpastes' slurries. Thereafter, the CSTC was weekly applied in an accumulated model (140 cigarettes/280 strokes) for seven weeks. The data were submitted to two-way ANOVA, Tukey's HSD test, and paired-t test (α=0.05). Results: The three toothpastes produced significant changes in roughness, color, translucency and gloss (p<0.05). After eight weeks, the roughness and the gloss produced by the three toothpastes were similar (p>0.05), while OW produced the lowest color change and the translucency of C was lower than that of CW (p<0.05). The three toothpastes produced a significant decrease in L* values and a significant increase in a* values after eight weeks (p<0.05). No significant difference in the b* coordinate was found for OW (p=0.13) There were topographic changes in the enamel surfaces. Conclusions: The whitening toothpastes increased the roughness, changed the topography and were not able to maintain the optical stability of enamel exposed over eight weeks.

In vitro and in situ evaluation of the effects of high-fluoride and arginine-based toothpastes to control root caries / Avaliação in vitro e in situ do efeito de dentifrícios fluoretados de alta concentração de fluoreto e a base de arginina no controle da cárie radicular

The focus of our studies has been the root substrate dentin, once root caries prevalence has been reported as increasing in part due to people living longer and maintaining their natural teeth into old age. Furthermore, this condition is highly prevalent in patients undergoing head-and-neck radiotherapy (HNR). To better understand the effect of different toothpastes in sound and non-irradiated root dentin, this research was developed in 3 parts with specific objectives, involving both in nonirradiated and irradiated substrates. In study 1, high-F toothpaste (5,000 µg F/g) associated or not with f tri-calcium phosphate (f TCP) were compared in vitro with conventional one (1,450 µg F/g) to control bovine root caries development. The study 2 was conducted to evaluate if the in vitro performance would be similar in a closer clinical situation. An in situ design was performed and the effect of high-F toothpaste combined or not with f TCP comparing to 1,450 µg F/g combined or not with argininebased toothpastes in reducing the net demineralization of sound root dentin and on the remineralization in initial artificial caries lesions was verified. In study 3, the effects of radiation exposure on human root dentin composition, structure and mechanical properties were evaluated. In the first study, our findings highlight the importance of using high-F toothpastes to prevent root caries development. In the second one, the results showed great performance of high-F toothpastes and arginine-based toothpastes, in clinical situations. The results of study 3 showed that radiation exposure changed the composition and structure of human root dentin, which may detrimentally affect its mechanical properties. Overall, the studies suggest that at high-risk population, such as elderly people and patients undergoing HNR, it is important to develop protocols to minimize damages caused by carious lesions, inhibiting the net demineralization of root caries. The current results can clarify the effects of radiation on root dentin to help further studies in this area. We also could observe that conventional toothpaste is not as effective as high-F toothpastes to prevent this condition, in non-irradiated root dentin. This knowledge is of special interest to determine the quality of life of high-risk population to dental caries presenting available tools that can be of at-home use with beneficial effects on demineralization protection and reversion.(AU)

O foco de nossos estudos tem sido o substrato dentinário radicular, uma vez que há relatos do aumento da prevalência de cárie radicular, devido principalmente ao aumento da expectativa de vida da população e a manutenção dos dentes naturais nos idosos. Além disso, essa condição é altamente prevalente em pacientes submetidos à radioterapia de cabeça e pescoço (RCP). Para melhor entendimento do efeito de diferentes dentifrícios em dentina radicular não-irradiada e irradiada, essa pesquisa foi desenvolvida em 3 partes, com objetivos específicos. No estudo 1, dentifrícios de alta concentração de F (5000 µg F/g) associado ou não com tri cálcio fosfato (f TCP) foram comparados in vitro com dentifrícios convencionais (1450 µg F/g) no controle do desenvolvimento de cárie radicular bovina. O estudo 2 foi conduzido para avaliar se os resultados do in vitro seria o mesmo diante de uma situação mais próxima da clínica. Um desenho in situ foi realizado e o efeito de dentifrício de alta concentração de F combinado ou não com f TCP e comparado com dentifrícios convencionais 1450 µg F/g combinado ou não com dentifrícios a base de arginina na redução da desmineralização de dentina radicular hígida e na remineralização de lesões cariosas previamente desenvolvidas foi avaliado. No estudo 3, os efeitos da exposição da dentina humana à radiação na sua composição, estrutura e propriedades mecânicas foram avaliados. No primeiro estudo, os resultados destacam a importância do uso de dentifrícios de alta concentração de F para prevenir o desenvolvimento de cárie radicular. No segundo, os resultados mostraram boa performance clínica dos dentifrícios de alta concentração de F e a base de arginina. O estudo 3 mostrou que a exposição à radiação altera a composição e estrutura da dentina radicular humana. De modo geral, os estudos sugerem que em população de alto risco, como os idosos e pacientes submetidos à RCP, é importante desenvolver protocolos para minimizar danos causados pelas lesões de cárie, inibindo a desmineralização líquida da cárie radicular. Os presentes resultados podem clarificar os efeitos da radiação na dentina radicular e ajudar em estudos posteriores nessa área. Também é possível observar que dentifrícios convencionais não são tão efetivos como os de alta concentração para prevenir essa condição, em dentina radicular não irradiada. Tal conhecimento é de especial interesse para garantir a qualidade de vida da população de alto risco à cárie, apresentando ferramentas disponíveis que podem ser usadas em casa com efeito benéfico na proteção da desmineralização.(AU)

Preventive effect of toothpastes with MMP inhibitors on human dentine erosion and abrasion in vitro

ABSTRACT The use of gels and mouthrinses with MMP inhibitors (chlorhexidine, and green tea extract) was shown to prevent erosive wear. The aim of this study was to analyze the protective effect of toothpastes containing MMP inhibitors on dentine loss induced by erosion in vitro. Material and Methods Five groups each containing 12 specimens of human root dentine were prepared. The specimens were subjected to 1 min erosion by immersion in a cola drink, 4 times a day, for 5 d. Each day, after the first and last erosive challenges, the specimens were brushed for 15 s with a slurry of dentifrice and water (1:3) containing placebo, 1,100 ppm fluoride, 0.61% green tea extract, 0.12% chlorhexidine or 0.004% chlorhexidine (commercial toothpaste). Between the acid challenges, the specimens were stored in artificial saliva with remineralizing potential until the next treatment. Dentine loss was determined using profilometry. Data were analyzed using one-way ANOVA after log transform (p<0.05). Results The mean wear values (μm) were as follows: placebo 1.83±0.53; 0.61% green tea extract 1.00±0.21; fluoride 1.27±0.43; 0.12% chlorhexidine 1.19±0.30; and 0.004% chlorhexidine 1.22±0.46. There was a significant difference in wear between placebo and all the treatment toothpastes, which did not differ from each other. Conclusion The results suggest that toothpastes containing MMP inhibitors are as effective as those based on NaF in preventing dentine erosion and abrasion.

Does a toothpaste containing blue covarine have any effect on bleached teeth? An in vitro, randomized and blinded study

Abstract The objective of this study was to analyze the effect of bleaching toothpastes, both conventional and those containing the new whitening agent Blue Covarine, on teeth previously bleached by conventional techniques (in-office and at-home). Squared bovine enamel/dentin blocks (6.0 x 6.0 x 2.0 mm) were randomly distributed in 6 groups (n = 15), according to the technique used to bleach them (in-office: HP35%; at-home: PC10%) and the type of bleaching toothpaste (none: control; Blue Covarine containing: BC; and without Blue Covarine: NBC). Experimental groups denominated HP35%, HP35%BC and HP35%NBC received in-office tooth bleaching before toothbrushing, and groups PC10%, PC10%BC and PC10%NBC were subjected to at-home tooth bleaching prior to toothbrushing. After bleaching treatment, groups HP35%BC, PC10%BC, HP35%NBC and PC10%NBC underwent daily tooth brushing in a brushing machine for 3 minutes (150 strokes/min, with a load of 375 g). Tooth color alteration was measured by reflectance spectroscopy (Vita EasyShade, Vident, Brea, CA, USA) at: T0 (baseline) - after in-office or at-home bleaching treatment; T1 - immediately after tooth brushing; T2 - 7 days and T3 - 14 days after tooth brushing. Data was analyzed by repeated measures mixed ANOVA and the Bonferroni post hoc test, with a significance level of 5%. Statistically significant differences were found between different experimental groups, evaluation times and for the interaction between them (p < 0.001). Tooth brushing using either bleaching toothpaste (conventional or with Blue Covarine) showed no color alteration on teeth previously bleached by in-office and at-home tooth bleaching. The use of bleaching toothpastes on previously bleached teeth did not produce a color alteration.

Can a bleaching toothpaste containing Blue Covarine demonstrate the same bleaching as conventional techniques? An in vitro, randomized and blinded study

ABSTRACT Objective The purpose of this in vitro study was to compare the efficacy of a bleaching toothpaste containing Blue Covarine vs. conventional tooth bleaching techniques using peroxides (both in-office and at-home). Material and Methods Samples were randomly distributed into five experimental groups (n=15): C - Control; BC – Bleaching toothpaste containing Blue Covarine; WBC – Bleaching toothpaste without Blue Covarine; HP35 - In-office bleaching using 35% hydrogen peroxide; and CP10 – At-home bleaching with 10% carbamide peroxide. The dental bleaching efficacy was determined by the color difference (ΔE), luminosity (ΔL), green-red axis (Δa), and blue-yellow axis (Δb). The CIELab coordinates were recorded with reflectance spectroscopy at different times: T0 - baseline, T1 – immediately after bleaching, T2 - 7 days, T3 - 14 days, and T4 - 21 days after the end of treatments. Data were analyzed by a repeated measures mixed ANOVA and post hoc Bonferroni test, with a significance level of 5%. Results No significant differences were found between the treatment groups C, BC, and WBC. The groups HP35 and CP10 showed significantly higher whitening efficacy than groups C, BC, and WBC. Conclusions There were no significant differences in the whitening efficacy between a Blue Covarine containing toothpaste, a standard whitening toothpaste, and a control. Neither of the whitening toothpastes tested were as effective as in-office or at-home bleaching treatments.

Fluoride stability in dentifrices stored in schools in a town of northern Brazil

The aim of this study was to analyze fluoride stability in dentifrices stored during nine months in schools from Careiro da Várzea, State of Amazonas, Brazil. Analysis of total fluoride concentration, total soluble fluoride, and ionic fluoride in the dentifrice samples was performed in four different time periods: at the time of purchase (baseline); after three months, after six months, and after nine months of storage. Fluoride concentration was determined using a specific electrode (Orion 96-09) connected to an ion analyzer (Orion A-720) and calibrated with fluoride standard solutions containing 2.0 to 32.0 ppm F. The results obtained during the measurements were analyzed by analysis of variance (one-way ANOVA), followed by Tukey’s test for comparison of the means. After nine months of storage, total soluble fluoride, the active form of fluoride, decreased by 21.9%. As total soluble fluoride was below the minimum required for anticaries efficacy (1,000 ppm F) in the fourth analysis, it may be concluded that anticaries potential decreased with storage time.

Choice of toothpaste for the elderly: an in vitro study

Hyposalivation and dental root exposure in the elderly are problems that require special oral care. In this context, the characteristics of certain toothpastes are of particular importance. Thus, the aim of this study was to evaluate the cytotoxicity and dentin wear caused by seven different toothpastes. For dentin wear analysis, 40 root dentin specimens were submitted to 20,000 brushing cycles with the different toothpastes and distilled water (control group-CG), using a brushing machine. Dentin surface loss (SL) was measured by contact profilometer. The cytotoxicity of each toothpaste was tested using cultured fibroblasts submitted to a cell-culture-conditioned medium. Fresh medium served as the control. Cell viability was assessed by MTT assay after 24 h of contact with the conditioned media. The data were analyzed statistically by ANOVA, followed by Tukey’s test (p < 0.05). The SL of the CG was minimal and significantly lower than that of the Oral B Pro Health (OBPH) group (p < 0.05). All other groups presented SL in between that of the CG and the Oral B Pro Health OBPH group, except for the Sensodyne (SEN) group, which presented SL similar to that of CG (p = 0.05). The SEN group presented a percentage of viable cells similar to that of CG: between 60-89%. All the other toothpastes showed high cytotoxicity, with cell viability less than 50% of the CG. Considering study limitations, we concluded that only one of the seven tested toothpastes exhibited the most desirable toothpaste characteristics for the worldwide growing elderly population (e.g. low cytotoxicity and low-abrasive potential).

Effect of whitening toothpaste on titanium and titanium alloy surfaces

Dental implants have increased the use of titanium and titanium alloys in prosthetic applications. Whitening toothpastes with peroxides are available for patients with high aesthetic requirements, but the effect of whitening toothpastes on titanium surfaces is not yet known, although titanium is prone to fluoride ion attack. Thus, the aim of the present study was to compare Ti-5Ta alloy to cp Ti after toothbrushing with whitening and conventional toothpastes. Ti-5Ta (%wt) alloy was melted in an arc melting furnace and compared with cp Ti. Disks and toothbrush heads were embedded in PVC rings to be mounted onto a toothbrushing test apparatus. A total of 260,000 cycles were carried out at 250 cycles/minute under a load of 5 N on samples immersed in toothpaste slurries. Surface roughness and Vickers microhardness were evaluated before and after toothbrushing. One sample of each material/toothpaste was analyzed by Scanning Electron Microscopy (SEM) and compared with a sample that had not been submitted to toothbrushing. Surface roughness increased significantly after toothbrushing, but no differences were noted after toothbrushing with different toothpastes. Toothbrushing did not significantly affect sample microhardness. The results suggest that toothpastes that contain and those that do not contain peroxides in their composition have different effects on cp Ti and Ti-5Ta surfaces. Although no significant difference was noted in the microhardness and roughness of the surfaces brushed with different toothpastes, both toothpastes increased roughness after toothbrushing.