Anticaries potential of a fluoride foam

Abstract Foam has been used worldwide as a vehicle for the professional application of fluoride and hypothetically should have the same anticaries potential as conventional fluoride gel (F-gel) in terms of the formation of reaction products with enamel. Thus, the ability of Flúor Care® foam (FGM, Joinville, SC, Brazil, 12,300 ppm F, acidulated) to react with enamel was evaluated in comparison with Flúor gel® (DFL, Rio de Janeiro, RJ, Brazil, 12,300 ppm F, acidulated). Slabs (n=10/group) of sound enamel and with caries lesion were used, in which the concentrations of total fluoride (TF), and loosely (CaF2-like) and firmly (FAp) bound types were determined. The importance of agitation during application was previously tested. The determinations were made with fluoride ion-specific electrode and the results were expressed in μg F/cm² of the treated enamel area. ANOVA and Tukey tests were used to analyze the difference among treatments, independently for sound and carious enamel. The agitation of the products during application significantly increased the reactivity of the foam (p<0.05), but not that of the gel (p>0.05). The foam did not differ from F-gel (p>0.05) concerning the formation of TF and CaF2-like in sound or carious enamel. Regarding FAp, the foam did not differ from F-gel (p>0.05) in the carious enamel, but the concentration in the sound was lower (p<0.05). The results show that this commercial fluoride foam tested needs to be agitated during application to improve its reactivity with enamel, which raises a question about other brands.

Resumo A espuma tem sido utilizada mundialmente como veículo para aplicação profissional de fluoreto e hipoteticamente deveria ter o mesmo potencial anticárie que o gel fluoretado convencional (F-gel) em termos de formação de produtos de reação com o esmalte. Assim, a capacidade da espuma Flúor Care® (FGM, Joinville, SC, Brasil, 12.300 ppm F, acidulada) de reagir com o esmalte foi avaliada em comparação com o Flúor gel® (DFL, Rio de Janeiro, RJ, Brasil 12.300 ppm F, acidulado). Foram utilizados blocos (n=10/grupo) de esmalte hígido e com lesão de cárie, nos quais foram determinadas as concentrações de flúor total (FT), e os tipos de flúor fracamente (tipo-CaF2) e firmemente (FAp) ligados ao esmalte. A importância da agitação durante a aplicação foi previamente testada. As determinações foram feitas com eletrodo íon específico para fluoreto e os resultados foram expressos em μg F/cm² da área tratada do esmalte. A diferença entre os tratamentos foi analisada por ANOVA e Tukey (α=5%), independentemente para esmalte hígido e cariado. A agitação dos produtos durante a aplicação aumentou significativamente a reatividade da espuma (p<0,05), mas não a do gel (p>0,05). A espuma não diferiu do F-gel (p>0,05) quanto à formação de FT e tipo-CaF2 no esmalte hígido ou cariado. Em relação à FAp, a espuma não diferiu do F-gel (p>0,05) no esmalte cariado, mas a concentração no hígido foi menor (p<0,05). Os resultados mostram que esta espuma fluoretada comercial testada precisa ser agitada durante a aplicação para melhorar sua reatividade com o esmalte, o que levanta questão sobre outras marcas.

Chemically soluble fluoride in toothpastes marketed in Colombia / Fluoruro químicamente soluble en cremas dentales distribuidas en Colombia / Fluoreto químico solúvel em cremos dentários distribuídos na Colômbia

Abstract Introduction and objective: Toothpastes should contain chemically soluble fluoride to have anti-caries efficacy. This study aimed at determining how much of the total fluoride (TF) concentration in the five top-selling children/family Colombian-toothpaste brands corresponds to total chemically soluble fluoride (TSF). Materials and methods: a convenience sample of three tubes of each of the following five toothpaste brands were obtained from three different chain stores, one-per-store, in five Colombian cities (n=3/brand/city): Colgate-Smiles-6+, Kolynos-Super-Blanco, Fortident-Cuatriacción, Colgate-Triple-Acción, Fluocardent. TF (sum of all toothpaste's fluoride) and TSF (toothpaste's chemically soluble fluoride) concentrations were determined in each fresh toothpaste sample (before expiry date) using a standardized ion-specific electrode direct-technique protocol. TF concentration was compared with the manufacturers' declared concentration. The difference between TF and TSF's concentrations purchased in different cities was compared with a one-way ANOVA (5%). Results: Most toothpastes' TF concentration complied with what was declared in the label. One toothpaste had a non-compatible fluoride/abrasive fluoride formulation and TSF < TF; however, it still complied with the minimum TSF requirement to exert a caries-preventive effect (>1000 ppm). Toothpastes' TF and TSF concentrations did not differ between cities (p>0.05). Conclusion: Fresh samples of highly distributed toothpaste brands sold in five Colombian-cities contain chemically available fluoride concentrations with the potential to control and prevent dental caries.

Resumen Introducción y objetivo: las cremas dentales requieren de la disponibilidad de fluoruro químicamente soluble para tener efecto anticaries. Este estudio tuvo como objetivo determinar qué parte de la concentración total de fluoruro (FT) en las cinco marcas de pastas dentales colombianas para niños/familias más vendidas corresponde al fluoruro total químicamente soluble (FTS). Materiales y métodos: se recolectaron tres tubos de cinco marcas diferentes en tres supermercados de cadena; una por tienda, en cinco ciudades colombianas (n=3/marca/ciudad): Colgate-Smiles-6+, Kolynos-Super-Blanco, Fortident-Cuatriacción, Colgate-Triple-Acción, Fluocardent. Las concentraciones de FT y FST se determinaron en cada una de las muestras frescas utilizando técnica directa con electrodo específico y un protocolo estandarizado. La concentración de FT se comparó con la concentración declarada por el fabricante. Se compararon las diferencias entre las concentraciones de FT y FST de la misma marca compradas en diferentes ciudades a con un análisis ANOVA (α=5%). Resultados: La mayoría de las cremas dentales cumplió con la concentración de FT declarada en la etiqueta. Una de las cremas dentale tenía una formulación de fluoruro/abrasivo no compatible y TSF <TF; sin embargo, aún cumplía con el requisito mínimo de TSF para ejercer un efecto preventivo de caries (> 1000 ppm). Las concentraciones de TF y TSF de las pastas de dientes no difirieron entre las ciudades (p> 0.05). Conclusión: Las muestras frescas de cremas dentales de las marcas más vendidas en cinco ciudades colombianas contienen concentraciones de fluoruro químicamente disponibles con el potencial de controlar y prevenir la caries dental.

Resumo Introdução e objetivo: os cremes dentais requerem a disponibilidade de fluoreto quimicamente solúvel para ter um efeito anticárie. O presente estudo determinou a proporção de fluoreto total (FT) que corresponde ao fluoreto total quimicamente solúvel (FST) em cinco marcas de creme dental amplamente distribuídas na Colômbia. Materiais e métodos: três tubos de cinco marcas diferentes foram coletados em três supermercados da rede; uma por loja, em cinco cidades colombianas (n = 3 / marca / cidade): Colgate-Smiles-6 +, Kolynos-Super-Blanco, Fortident-Quad, Colgate-Triple-Action, Fluocardent. As concentrações de FT e FST foram determinadas em cada uma das amostras frescas, utilizando a técnica direta com eletrodo específico e um protocolo padronizado. A concentração de FT foi comparada com a concentração declarada pelo fabricante. As diferenças entre as concentrações de FT e FST da mesma marca comprada em diferentes cidades foram comparadas com a análise ANOVA (α = 5%). Resultados: a maioria das marcas possui concentrações de flúor que atendem à concentração declarada pelo fabricante. Uma marca contém uma formulação de sal abrasivo e fluoreto quimicamente não compatível e FST menor que FT; no entanto, as amostras frescas atenderam à concentração necessária para exercer um efeito anticárie (> 1000 ppm). As concentrações de FT e TSF não foram significativamente diferentes entre amostras da mesma marca compradas em diferentes cidades (p> 0,05). Conclusão: as amostras frescas (analisadas antes do prazo de validade) das cinco marcas de creme dental com maior distribuição na Colômbia contêm concentrações de fluoreto quimicamente solúvel, com potencial para controlar e prevenir a cárie dentária.

Influence of desensitizers agents on the dentin bond strength after one-year water storage

Aim: Evaluate the effect of adhesives systems combined with desensitizer agents on the microtensile bond strength (µTBS) of a composite resin to dentin. Methods: Cervical dentin of thirty-two human molars were used to simulate hypersensitivity areas. The teeth were divided into four groups (n=8), according to the type of adhesive system and desensitizer agents. No desensitizer was used in the control (Clearfil SE Bond ­ CS). Two experimental groups were pretreated with either MS Coat Bond (MS) or Biofluorid 12 (BF) immediately prior to bonding with CS. The last group corresponded to Gluma Comfort Bond + Desensitizer (GC) application. After dentin treatments, a composite block was built-up on dentin surface and after 24 hours teeth were serially sectioned to obtain bonded bean specimens. Beams were stored in water for 24 hours or one year. Subsequently, the specimens were submitted to the µTBS test. Data were analyzed by two-way mixed ANOVA and Bonferroni's test (α = 0.05). Results: At 24 hours, there was no significant difference in µTBS among groups. However, at one year, dentin treated with MS or BF demonstrated significantly lower µTBS of CS to dentin compared to control and GC, which kept their µTBS stable. Conclusion: The effect of MS and BF desensitizer agents on the µTBS of CS to dentin did not reduce the µTBS at 24 hours, but it decreases significantly after one year

Effect of iontophoresis on fluoride uptake in enamel with artificial caries lesion

Abstract: Iontophoresis is a noninvasive technique, based on the application of a constant low-intensity electric current to facilitate the release of a variety of drugs, whether ionized or not, through biological membranes. The objective of this research was to evaluate the effect of iontophoresis using different electric current intensities on the uptake of fluoride in dental enamel with artificial caries lesions. In this in vitro operator-blind experiment, bovine enamel blocks (n = 10/group) with caries-like lesions and predetermined surface hardness were randomized into 6 groups: placebo gel without fluoride applied with a current of 0.8 mA (negative control), 2% NaF gel without application of any current, and 2% NaF gel applied with currents of 0.1, 0.2, 0.4 and 0.8 mA. Cathodic iontophoresis was applied for 4 min. The concentration of loosely bound fluoride (calcium fluoride) and firmly bound fluoride (fluorapatite) was determined. The results were analyzed by the nonparametric Kruskal-Wallis and Dunn tests. Iontophoresis at 0.8 mA, combined with the application of fluoridated gel (2% NaF), increased fluoride uptake in enamel with caries-like lesions, as either calcium fluoride or fluorapatite.

Effect of fluoride dentifrice and casein phosphopeptide-amorphous calcium phosphate cream with and without fluoride in preventing enamel demineralization in a pH cyclic study

Abstract Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) complexes are anticariogenic and capable of remineralizing the early stages of enamel lesions. The use of fluoride prevents dental decay and the association of CPP-ACP with fluoride can increase remineralization. Objective: To evaluate the effect of CPP-ACP and CPP-ACPF creams associated with a fluoride dentifrice to prevent enamel demineralization in a pH cyclic model. Material and Methods: Previously selected by surface microhardness (SH) analysis, human enamel blocks (n = 56) were submitted to daily treatment with dentifrice in a pH-cycling model. The enamel blocks were divided into four groups; G1: Crest™ Cavity Protection - Procter & Gamble (1,100 ppmF of NaF); G2: Crest™ +MI Paste (MP) - Recaldent™ GC Corporation Tokyo, Japan); G3: Crest™ + MI Paste Plus (MPP) - Recaldent™ 900 ppm as NaF, GC Corporation Tokyo, Japan), and G4: control, saliva. Specimens were soaked alternatively in a demineralizing solution and in artificial saliva for 5 d. The fluoride dentifrice, with proportion of 1:3 (w/w), was applied three times for 60 s after the remineralization period. The undiluted MP and MPP creams were applied for 3 m/d. After cycling, SH was re-measured and cross section microhardness measurements were taken. Results: The SH values observed for the groups G3 (257±70), G1 (205±70), and G2 (208±84) differed from the G4 group (98±110) (one-way ANOVA and Tukey's post hoc test). There were no differences between the groups G1xG2, G2xG3, and G1xG3 for demineralization inhibition. The percentage of volume mineral showed that, when applied with fluoride dentifrice, MPP was the most effective in preventing enamel demineralization at 50 µ from the outer enamel surface (Kruskal-Wallis and Mann Whitney p<0.05). Conclusion: Fluoride dentifrice associated with CPP-ACPF inhibited subsurface enamel demineralization.

Clinical effect of oxaliplatin,calcium tolinate and tegafur in the chemotherapy of rectal cancer patients / 中国基层医药

Objective To observe the effect and toxicity of oxaliplatin combined with calcium folinate and tegafur in the treatment of rectal cancer patients,in order to provide a safe and effective clinical program for rectal cancer treatment.Methods 117 rectal cancer patients conforming to the selection criteria were randomly divided into treatment group 59 cases and control group 58 cases by using random number method,treatment group were received chemotherapy of Oxaliplatin,calcium folinate and tegafur;control group were received FOLFOX4 program.After imple-mentation of two treatment plans,solid tumor curative effect evaluation standard from WHO was referenced to evaluate the curative effect.And toxicity classification was reached according to the WHO cancer drug toxicity assessment standard.Results Total effective rate of treatment group was 27.1%,total effective rate of control group was 29.3%,the comparative difference of two rates was not statistically significant (χ2 =0.069,P >0.05).The main symptoms of adverse reactions of two treatment plans were decreased of leukopenia,hemoglobin and thrombocytopenia of the blood system;nausea,vomiting,weak and abnormal liver function of the digestive system;,and limb numbness or pain of the nervous system.Adverse reactions difference in two groups was not significant (χ2 =0.106,0.158, 0.000,0.563,0.001,0.284,0.068,0.000,all P >0.05).After treatment,the median surial time was 15.5 months in treatment group and 16.5 months in control group,the difference of the median surial time in two groups was not statistically significant (P =0.781,P >0.05).Conclusion Combination of Oxaliplatin,calcium fluoride and tegafur is another safe and effective plan after the FOLFOX4 program in the treatment of rectal cancer drug application.

Insoluble NaF in Duraphat® May Prolong Fluoride Reactivity of Varnish Retained on Dental Surfaces

There is no consensus about the clinical recommendation of the time that Duraphat® varnish should be maintained on enamel surfaces without suffering mechanical disturbance by the patient. Considering the importance of calcium fluoride (CaF2)-like reservoirs on the anticaries effect of professional fluoride application, an in vitro study was designed to test the reactivity of Duraphat® varnish with enamel forming these reservoirs as a function of time. Since most fluoride in Duraphat® varnish is insoluble to react and form products on enamel, the relative contribution of the varnish soluble and insoluble fluoride fractions to the reactivity was also evaluated. For this, whole-varnish, containing soluble and insoluble fluoride (total fluoride concentration of 23699±384 µg F/g), or centrifuged varnish, containing only soluble fluoride (fluoride concentration of 258±97 µg F/g), were applied in a standardized manner on enamel slabs (n=8/varnish group/time), which were immersed in continuously renewed artificial saliva for up to 36 h. CaF2-like reservoirs formed on enamel by varnish application were extracted using 1 M KOH and fluoride concentration was measured with ion specific electrode. The results were expressed as µg F/cm2 of enamel area. Whole varnish formed significantly higher fluoride concentration on enamel than centrifuged varnish, reaching maximum concentration at 24 h (22.0±4.5 µg F/cm2). Centrifuged varnish reached maximum concentration at 6 h (3.20±0.81 µg F/cm2). In conclusion, a longer varnish retention time than the usually recommended could improve the anticaries effect of Duraphat® varnish, allowing that NaF particles, initially insoluble in the varnish matrix, prolong the reactivity with enamel.

Não há consenso sobre a recomendação clínica do tempo que o verniz Duraphat® deve ser mantido nas superfícies de esmalte sem ter perturbação mecânica pelo paciente. Considerando a importância dos reservatórios tipo fluoreto de cálcio (“CaF2”) no efeito anticárie da aplicação profissional de fluoreto, um estudo in vitro foi delineado para testar a reatividade do verniz Duraphat® com o esmalte na formação desses reservatórios em função do tempo. Como a maioria do fluoreto no verniz Duraphat® é insolúvel para reagir e formar produtos no esmalte, também se avaliou a contribuição relativa das frações solúvel e insolúvel do verniz na reatividade. Assim, verniz total, contendo fluoreto solúvel e insolúvel (concentração total de 23699±384 µg F/g), ou verniz centrifugado, contendo somente o fluoreto solúvel (concentração de 258±97 µg F/g), foram aplicados de maneira padronizada sobre blocos de esmalte (n =8/grupo de verniz/tempo), os quais foram imersos em saliva artificial com renovação continua por até 36 h. Os reservatórios tipo “CaF2” formados no esmalte pela aplicação do verniz foram extraídos com KOH 1 M e a concentração de F foi medida utilizando um eletrodo específico. Os resultados foram expressos como µg F/cm2. O verniz total formou significativamente maior concentração de fluoreto no esmalte que o verniz centrifugado, atingindo concentrações máximas após 24 h (22,0±4,5 µg F/cm2 de área de esmalte). O verniz centrifugado apresentou a máxima formação após 6 h (3,20 ± 0,81 µg F/cm2). Em conclusão, um tempo maior de retenção do que habitualmente recomendado poderia melhorar o efeito anticárie do verniz Duraphat®, pois partículas de NaF, inicialmente insolúveis na matriz do mesmo, possibilitam uma reatividade prolongada do verniz com o esmalte em função do tempo.

Comparative evaluation of remineralization potential of casein phosphopeptide-amorphous calcium phosphate and casein phosphopeptide-amorphous calcium phosphate fluoride on artificial enamel white spot lesion: An in vitro light fluorescence study.

Background: World-wide, the contribution of dental caries to the burden of oral diseases is about 10 times higher than that of periodontal disease, the other common oral condition. Owing to its globally high prevalence, dental caries is a "pandemic" disease characterized by a high percentage of untreated carious cavities causing pain, discomfort and functional limitations. Untreated carious cavities; furthermore, have a significant impact on the general health of children and on the social and economic well-being of communities. A surgical approach to the elimination of carious lesion was developed a century ago; this approach was necessary at that time, because there was no valid alternative. The focus in caries has recently shifted to the development of methodologies for the detection of the early stages of caries lesions and the non-invasive treatment of these lesions. The non-invasive treatment of early lesions by remineralization has the potential to be a major advance in the clinical management of the disease. Remineralization of white-spot lesions may be possible with a variety of currently available agents containing fluoride, bioavailable calcium and phosphate and phosphate. This concept bridges the traditional gap between prevention and surgical procedures, which is just what dentistry needs today. Aims and Objectives: The aim of this in vitro study was to evaluate and to compare the remineralization potential of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and casein phosphopeptide-amorphous calcium fluoride phosphate (CPP-ACFP) on artificial white spot enamel lesions using the quantitative light fluorescence (QLF). Materials and Methods: A total of 45 caries-free extracted maxillary first premolars were embedded in acrylic resin. The samples were randomly divided into three groups namely control group, CPP-ACP group and CPP-ACFP group with 15 samples in each group. The samples of each group were subjected to demineralization process for a period of 96 h. The samples were then mounted in the artificial mouth model and subjected to remineralization and pH cycling for a period of 21 days. QLF readings were recorded at the end of demineralization (1 st , 7 th , 14 th and 21 st day) and were statistically analyzed. Results: As compared with artificial saliva both CPP-ACP and CPP-ACFP produced significant amount of remineralization of the artificial enamel white spot lesion (P < 0.001), however when the remineralizing effect of CPP-ACP was compared with the remineralizing effect of CPP-ACFP there was no significant difference. Significant amount of remineralization was produced by CPP-ACP and CPP-ACFP only after the 7 th day. After the 14 th day, the remineralization produced by both CPP-ACP and CPP-ACFP as compared to artificial saliva was non-significant.