Effect of treatment with phosphate, casein phosphopeptide and fluoride on the remineralization: in vitro study.

This study aimed to evaluate in vitro the effect protocols and anticaries agents containing casein amorphous calcium fluoride phosphopeptide-phosphate (CPP-ACPF, MI Paste Plus), sodium trimetaphosphate (TMP) and fluoride (F), in remineralization of caries lesions. Bovine enamel blocks with initial caries lesions were divided into groups (n = 12): 1) Toothpaste without F-TMP-MI Plus (Placebo); 2) Toothpaste 1100 ppm F (1100F), 3) 1100F + MI Paste Plus (1100F-MI Paste Plus), 4) Toothpaste with 1100F + Neutral gel with 4,500 ppm F + 5%TMP (1100F + Gel TMP) and 5) Toothpaste with 1100F + Neutral gel with 9,000 ppm F (1100F + Gel F). For the 4 and 5 groups the gel was applied only once for 1 minute, initially to the study. For the 3 group, after treatment with 1100F, MI Paste Plus was applied 2x/day for 3 minute. After pH cycling, the percentage of surface hardness recovery (%SHR); integrated loss of subsurface hardness (ΔKHN); profile and depth of the subsuperficial lesion (PLM); concentrations of F, calcium (Ca) and phosphorus (P) in enamel was determined. The data were analyzed by ANOVA (1-criterion) and Student-Newman-Keuls test (p < 0.001). Treatment with 1100F alone led to ~ 28% higher remineralization when compared to treatment with 1100F associated with MI Paste Plus (p < 0.001). The 1100F and 1100F + Gel F groups showed similar values for %SHR (p = 0.150). 1100F + Gel TMP treatment also remineralized the enamel surface by ~ 30% and 20% when compared to the 1100F + Gel F and 1100F groups (p < 0.001). The lower lesion depth (ΔKHN) was observed for the 1100F + Gel TMP group (p < 0.001), where it was 54% and 44% lower in comparison to the 1100F and 1100F + Gel F groups (p < 0.001). Polarized light microscopy photomicrographs showed subsurface lesions in all groups, but these lesions were present to a lower extent in the 1100F + Gel TMP group (p < 0.001). Treatment with 1100F + Gel TMP promoted an increase in the concentration of Ca in the enamel by ~ 57% and ~ 26% when compared to the 1100F and 1100F + MI Paste Plus groups (p < 0.001), respectively. There were no significant differences between the 1100F, 1100F + MI Paste Plus and 1100F + Gel F groups (p > 0.001). Similar values of P in the enamel were observed in the 1100F, 1100F + MI Paste Plus and 1100F + Gel F groups (p > 0.001), except for the 1100F + Gel TMP group, which presented a high concentration (p < 0.001). We conclude that the 1100F+TMP gel treatment/protocol led to a significant increased remineralization when compared to the other treatments/protocols and may be a promising strategy for patients with early caries lesions.

The use of mouthwash containing trimetaphosphate as an adjunct therapy to fluoridated toothpaste reduces enamel demineralization.

INTRODUCTION: The decline in dental caries has been attributed to the widespread use of fluoride (F). Two forms of presentation are fluoridated toothpaste (FT) and mouthwash (MW), widely used by the population. MATERIALS AND METHODS: This study aimed to evaluate in vitro the effects of combining FT and MW, whether supplemented with sodium trimetaphosphate (TMP) or not, on dental enamel demineralization. Bovine enamel blocks (n = 60) were selected based on initial surface hardness (SHi) and divided into 5 experimental groups (n = 12 each): I) Placebo Toothpaste (without F/TMP); II) 1100 ppm F Toothpaste (FT); III) 1100F associated with a MW at 100 ppm F (FT + MW 100F); IV) 1100F associated with a MW at 225 ppm F (FT + MW 250F); and V) 1100F associated with a MW at 100 ppm F supplemented with 0.4 % TMP (FT + MW 100F-TMP). The blocks were treated twice a day, undergoing 5 pH cycles over 7 days. Thus, the percentage change in surface hardness (%SH), integrated subsurface hardness loss (ΔKHN), and the concentration of F, phosphorus (P), and calcium (Ca) in the enamel were determined. The data were submitted to ANOVA and Student-Newman-Keuls test (p < 0.001). RESULTS: The 1100F group was statistically inferior to the groups associated with MW for %SH, ΔKHN, and the concentration of P and Ca in the enamel (p < 0.001). Blocks treated with FT + MW 225F and FT + MW 100F-TMP showed significantly lower %SH compared to the other groups (p < 0.001). The FT + MW 100F - TMP group exhibited the lowest depth mineral loss (ΔKHN), and higher concentration de P in enamel (p < 0.001). CONCLUSION: The adjunct use of MW with FT produces a greater protective effect in inhibiting enamel demineralization, and the supplementation of TMP to the MW with 100F provides a superior effect compared to MW with 225F. CLINICAL SIGNIFICANCE: This combination of treatments could be regarded as one of several alternative fluoride supplements for subjects at elevated risk of caries.

Biomineralization and remineralizing potential of toothpastes containing nanosized ß-calcium glycerophosphate: an in vitro study.

To evaluate the effect of 1100 ppm F toothpastes supplemented with micrometric or nanosized ß-CaGP (ß-CaGPm/ß-CaGPn) on artificial enamel remineralization, using a pH cycling model. Enamel blocks with artificial caries were randomly allocated into ten groups (n = 10), according to the toothpastes: without fluoride/ß-CaGPm/ß-CaGPn (negative control); 1100 ppm F (1100F); 1100F plus 0.125%, 0.25%, 0.5%, and 1.0% of ß-CaGPm or ß-CaGPn. The blocks were treated 2×/day with slurries of toothpastes. After pH cycling, the percentage of surface hardness recovery (%SHR); integrated loss of subsurface hardness (ΔKHN); integrated mineral loss (ΔIMR); fluoride (F), calcium (Ca), and phosphorus (P) concentrations in the enamel; polydispersity index (PdI); and zeta potential (Zp) were determined. The data were analyzed by ANOVA (p < 0.001). For Zp/PdI, no significance was observed when comparing the means (p > 0.001). The treatment with 1100F-0.25%ß-CaGPn led to %SHR ∼57 higher when compared to the 1100F group (p < 0.001). The lowest ΔKHN was observed for the 1100F-0.25%ß-CaGPn group (p < 0.001). The ΔIMR was lower (∼201%) for the 1100F-0.25%ß-CaGPn when compared to 1100F (p < 0.001). The association of ß-CaGPm and ß-CaGPn to 1100F did not influence its F concentration (p > 0.001). The highest increase in Ca and P was observed for 1100F-0.25%ß-CaGPn (p < 0.001). The addition of 0.25%ß-CaGPn to 1100F toothpaste was able to promote an additional remineralizing effect of artificial caries lesions.

Effect of nanometric ß-calcium glycerophosphate supplementation in conventional toothpaste on enamel demineralization: An in vitro study.

The aim of this study was to evaluate the effects of supplementing toothpastes containing 1100 ppm F with micrometric or nanometric [beta]-calcium glycerophosphate (ß-CaGPm/ß-CaGPn) on artificial enamel demineralization, using a pH cycling model. Bovine enamel blocks (4 mm × 4 mm, n = 120) selected using initial surface hardness were randomly allocated to ten toothpaste groups (n = 12): without fluoride or ß-CaGPm or ß-CaGPn (Negative control), 1100 ppm F (1100 F), and 1100 ppm F plus 0.125%, 0.25%, 0.5%, and 1.0% of ß-CaGPm or ß-CaGPn. Blocks were treated two times per day with toothpaste slurry and subjected to five pH cycles (demineralizing and remineralizing solutions) at 37 °C. The final surface hardness, percentage of surface hardness loss (%SH), cross-sectional hardness (ΔKHN), and profile analysis and lesion depth subsurface were analysed using polarized light microscopy (PLM). Fluoride (F), calcium (Ca), and phosphorus (P) concentrations were also measured. Data were analysed using ANOVA and Student-Newman-Keuls tests ([alpha] = 0.001). Blocks treated with 1100 F toothpaste containing 0.5%ß-CaGPm or 0.25%ß-CaGPn showed with reduced %SH values when compared with those treated with 1100 F alone (p < 0.001). Reduced lesion depths (ΔKHN and PLM) were observed for the slurry made up of 1100 F and 0.25%ß-CaGPn (p < 0.001). The addition of ß-CaGPm and ß-CaGPn did not influence the enamel F concentration, with the 1100 F/0.25%ß-CaGPn group exhibiting the highest Ca and P enamel concentrations (p < 0.001). Based on the findings of this in vitro study, we can conclude that the fluoride toothpaste produced a superior effect when combined at an appropriate ß-CaGP molar ratio. This effect was achieved with a lower proportion of ß-CaGP in the form of nanometric particles.

Effect of the association of microparticles and nano-sized ß-calcium glycerophosphate in conventional toothpaste on enamel remineralization: In situ study.

OBJECTIVES: This in situ study aimed to assess the remineralizing effect of a fluoride toothpaste supplemented with ß-calcium glycerophosphate in both micro (ß-CaGPm) and nano-sized forms (ß-CaGPn). METHODS: This blind and cross-over study was performed in 4 phases, each spanning 3 days. Twelve volunteers utilized palatal appliances containing four bovine enamel blocks with artificial caries lesions. Volunteers were randomly assigned to the following treatment groups: Placebo (no F-ß-CaGPm-ß-CaGPn); 1100 ppm F alone (1100F); 1100F plus 0.5% micrometric ß-CaGP (1100F-0.5%ß-CaGPm); and 1100F plus 0.25%nano-sized ß-CaGP (1100F-0.25%ß-CaGPn). Participants were instructed to brush their natural teeth with the palatal appliances in the mouth for 1 min (3 times/day), ensuring that the enamel blocks were exposed to the natural toothpaste slurries. Following each phase, evaluations were conducted to determine the percentage of surface hardness recovery (%SHR), integrated recovery of subsurface hardness (ΔIHR), profile subsurface lesion through polarized light microscopy (PLM), as well as fluoride (F), calcium (Ca), and phosphorus (P) concentrations within the enamel. Data were analyzed by ANOVA and Student-Newman-Keuls test (p < 0.001). RESULTS: Treatment with 1100F-0.25%ß-CaGPn resulted in %SHR ∼69 % and ∼40 % higher when compared to 1100F and 1100F-0.5%ß-CaGPm (p < 0.001). The reduction in lesion body (ΔIHR; PLM) was ∼40 % higher with 1100F-0.25%ß-CaGPn (p < 0.001) compared to 1100F. The addition of ß-CaGPm and ß-CaGPn did not influence enamel F concentration (p > 0.001). Treatment with 1100F-0.25%ß-CaGPn led to an increase in the concentration of Ca and P in the enamel (p < 0.001). CONCLUSION: The addition of 0.25%ß-CaGPn into 1100F formulation increased the bioavailability of calcium and phosphate, promoting a higher remineralizing effect. CLINICAL SIGNIFICANCE: Toothpaste containing 1100F-0.25%ß-CaGPn showed a potential of higher remineralization to 1100 ppm F and 1100 ppm F micrometric ß-CaGP could be a strategy for patients at caries activity.

In vitro effect of low-fluoride toothpaste supplemented with sodium trimetaphosphate, xylitol, and erythritol on enamel demineralization.

OBJECTIVE: Regular use of toothpaste with fluoride (F) concentrations of ≥ 1000 ppm has been shown to contribute to reducing caries increment. However, when used by children during the period of dental development, it can lead to dental fluorosis. In this study, we aimed to evaluate the in vitro effect of a toothpaste formulation with reduced fluoride (F) concentration (200 ppm) supplemented with sodium trimetaphosphate (TMP: 0.2%), Xylitol (X:16%), and Erythritol (E: 4%) on dental enamel demineralization. METHODOLOGY: Bovine enamel blocks were selected according to initial surface hardness (SHi) and then divided into seven experimental toothpaste groups (n=12). These groups included 1) no F-TMP-X-E (Placebo); 2) 16% Xylitol and 4% Erythritol (X-E); 3) 16% Xylitol, 4% Erythritol and 0.2%TMP (X-E-TMP); 4) 200 ppm F (no X-E-TMP: (200F)); 5) 200 ppm F and 0.2% TMP (200F-TMP); 200 ppm F, 16% Xylitol, 4% Erythritol, and 0.2% TMP (200F-X-E-TMP); and 7) 1,100 ppm F (1100F). Blocks were individually treated 2×/day with slurries of toothpastes and subjected to a pH cycling regimen for five days (DES: 6 hours and RE: 18 hours). Then, the percentage of surface hardness loss (%SH), integrated loss of subsurface hardness (ΔKHN), fluoride (F), calcium (Ca), and phosphorus (P) in enamel were determined. The data were analyzed by ANOVA (1-criterion) and the Student-Newman-Keuls test (p<0.001). RESULTS: We found that the 200F-X-E-TMP treatment reduced %SH by 43% compared to the 1100F treatments (p<0.001). The ΔKHN was ~ 65% higher with 200F-X-E-TMP compared to 1100F (p<0.001). The highest concentration of F in enamel was observed on the 1100F treatment (p<0.001). The 200F-X-E-TMP treatment promote higher increase of Ca and P concentration in the enamel (p<0.001). CONCLUSION: The association of 200F-X-E-TMP led to a significant increase of the protective effect on enamel demineralization compared to the 1100F toothpaste.

In vitro effect of low-fluoride toothpaste supplemented with sodium trimetaphosphate, xylitol, and erythritol on enamel demineralization

Abstract Regular use of toothpaste with fluoride (F) concentrations of ≥ 1000 ppm has been shown to contribute to reducing caries increment. However, when used by children during the period of dental development, it can lead to dental fluorosis. Objective: In this study, we aimed to evaluate the in vitro effect of a toothpaste formulation with reduced fluoride (F) concentration (200 ppm) supplemented with sodium trimetaphosphate (TMP: 0.2%), Xylitol (X:16%), and Erythritol (E: 4%) on dental enamel demineralization. Methodology: Bovine enamel blocks were selected according to initial surface hardness (SHi) and then divided into seven experimental toothpaste groups (n=12). These groups included 1) no F-TMP-X-E (Placebo); 2) 16% Xylitol and 4% Erythritol (X-E); 3) 16% Xylitol, 4% Erythritol and 0.2%TMP (X-E-TMP); 4) 200 ppm F (no X-E-TMP: (200F)); 5) 200 ppm F and 0.2% TMP (200F-TMP); 200 ppm F, 16% Xylitol, 4% Erythritol, and 0.2% TMP (200F-X-E-TMP); and 7) 1,100 ppm F (1100F). Blocks were individually treated 2×/day with slurries of toothpastes and subjected to a pH cycling regimen for five days (DES: 6 hours and RE: 18 hours). Then, the percentage of surface hardness loss (%SH), integrated loss of subsurface hardness (ΔKHN), fluoride (F), calcium (Ca), and phosphorus (P) in enamel were determined. The data were analyzed by ANOVA (1-criterion) and the Student-Newman-Keuls test (p<0.001). Results: We found that the 200F-X-E-TMP treatment reduced %SH by 43% compared to the 1100F treatments (p<0.001). The ΔKHN was ~ 65% higher with 200F-X-E-TMP compared to 1100F (p<0.001). The highest concentration of F in enamel was observed on the 1100F treatment (p<0.001). The 200F-X-E-TMP treatment promote higher increase of Ca and P concentration in the enamel (p<0.001). Conclusion: The association of 200F-X-E-TMP led to a significant increase of the protective effect on enamel demineralization compared to the 1100F toothpaste.

Effect of fluoride, casein phosphopeptide-amorphous calcium phosphate and sodium trimetaphosphate combination treatment on the remineralization of caries lesions: An in vitro study.

OBJECTIVE: To evaluate the effects of combination of treatments with fluoridated toothpastes supplemented with sodium trimetaphosphate (TMP) and casein phosphopeptide-amorphous calcium phosphate (MI Paste Plus®), on the remineralization of dental enamel. DESIGN: Enamel blocks with artificial caries were randomly allocated into six groups (n = 12), according to the toothpastes: 1) without F-TMP-MI Paste Plus® (Placebo); 2) 1100 ppm F (1100 F), 3) MI Paste Plus®, 4) 1100 F + MI Paste Plus® (1100 F-MI Paste Plus®), 5) 1100 F + 3% TMP (1100 F-TMP) and 6) 1100 F-TMP + MI Paste Plus® (1100 F-TMP-MI Paste Plus®). Blocks were treated 2×/day with slurries of toothpastes (1 min). Furthermore, groups 4 and 6 received the application of MI Paste Plus® for 3 min. After pH cycling, the percentage of surface hardness recovery (%SHR); integrated loss of subsurface hardness (ΔKHN); profile analysis and lesion depth subsurface through polarized light microscopy (PLM), confocal laser scanning microscopy (LSCM), scanning electron microscopy (SEM), fluoride (F), calcium (Ca), phosphorus (P) concentrations in the enamel were determined. The data were analyzed by ANOVA (1-criterion) and Student-Newman-Keuls test (p < 0.001). RESULTS: 1100 F-TMP-MI Paste Plus® group showed the best results of %SHR, ΔKHN and PLM (p < 0.001). F concentration was similar between the 1100 F, 1100 F-MI Paste Plus®, and 1100 F-TMP-MI Paste Plus® groups (p > 0.001). 1100 F-TMP-MI Paste Plus® group showed the highest concentration of Ca and P in the enamel (p < 0.001). CONCLUSION: The association of 1100 F-TMP and MI Paste Plus® led to a significant increase in the remineralization of initial carious lesions.

Combined effect of casein phosphopeptide-amorphous calcium phosphate and sodium trimetaphosphate on the prevention of enamel demineralization and dental caries: an in vitro study.

OBJECTIVE: To evaluate the effect of treatment with fluoridated toothpaste supplemented with a combination of sodium trimetaphosphate (TMP) and casein phosphopeptide-amorphous calcium phosphate (MI Paste Plus®) on the demineralization of dental enamel. METHODS: Bovine enamel blocks selected by initial surface hardness (SHi) were randomly allocated into six groups (n = 12), according to the test toothpastes: (1) without F-TMP-MI Paste Plus® (Placebo); (2) 1100 ppm F (1100F); (3) MI Paste Plus®; (4) 1100F + MI Paste Plus® (1100F-MI Paste Plus), (5) 1100F + 3 % TMP (1100F-TMP); and (6) 1100F-TMP + MI Paste Plus® (1100F-TMP-MI Paste Plus). Blocks were treated two times per day with slurries of toothpaste (1 min), and groups 4 and 6 received an application of MI Paste Plus (3 min). Next, the samples were subjected to five pH cycles (demineralizing/remineralizing solutions) at 37 °C, to produce subsurface enamel lesions.Thereafter, the blocks were maintained for 2 days in fresh remineralizing solution. After pH cycling, the following were obtained: percentage of surface hardness loss (%SH); integrated loss of subsurface hardness (ΔKHN); profile analysis and lesion depth subsurface through polarized light microscopy (PLM); scanning electron microscopy (SEM); and fluoride (F), calcium (Ca), and phosphorus (P) in the enamel. The data were subjected to ANOVA (1-criterion), followed by the Student-Newman-Keuls test (p < 0.001). RESULTS: The 1100F-TMP-MI Paste Plus group showed better results for SHR, ΔKHN, and PLM (p < 0.001). The F concentration was similar among all groups (p > 0.001). The 1100F-TMP-MI Paste Plus group showed the highest concentration of Ca and P in the enamel (p < 0.001). CONCLUSION: The application of 1100F-TMP-MI Paste Plus promoted a higher inhibitory effect against enamel demineralization. CLINICAL SIGNIFICANCE: The combination of treatments with F, TMP, and MI Paste Plus® can be an effective alternative to improve the oral health of individuals, especially those with high activity of dental caries and at high risk for its development.

Efeito da associação de tratamentos com fosfopeptídeo de caseína-fosfato de cálcio amorfo e trimetafosfato de sódio sobre a desmineralização e remineralização do esmalte: estudos in vitro / Effect of the combination of treatments with casein phosphopeptide-amorphous calcium phosphate and sodium trimetaphosphate on desmineralization and enamel remineralization: in vitro studies

A proposição geral do presente estudo foi avaliar in vitro a associação de tratamentos com dentifrícios fluoretados e suplementados com trimetafosfato de sódio (TMP) e fosfopeptídeo de caseína-fosfato de cálcio amorfo (CPP-ACP) (MI Paste Plus®) em promover a remineralização e reduzir a desmineralização, respectivamente, do esmalte dentário. Blocos de esmalte bovinos (12/grupo) foram selecionados através da dureza de superfície inical (SH) e divididos em 5 grupos experimentais: 1) Dentifrício sem F (Placebo); 2) Dentifrício com 1100 ppm F (1100F), 3) MI Paste Plus®, 4) Dentifrício com 1100 ppm F associado a MI Paste Plus® (1100F-MI Paste Plus®) e 5) Dentifrício com 1100 ppm F + 3%TMP associado a MI Paste Plus® (1100F-TMPMI Paste Plus®). Para o Artigo 1 de Remineralização (RE>DES), blocos de esmalte bovino foram selecionados pela dureza de superfície pós-lesão de cárie artificial (SH1) e submetidos a 6 ciclagens de pH por 6 dias. Após as ciclagens de pH, foram determinadas dureza de superfície final (SH2), para o cálculo da porcentagem de recuperação de dureza de superfície (%SHR), perda integrada de dureza de subsuperfície (ΔKHN), análise do perfil e profundidade das lesões de subsuperfície através da microscopia de luz polarizada (PLM), microsopia confocal de varredura à laser (MCVL), microscopia eletrônica de varredura (MEV), espectroscopia de energia dispersiva (EDS), concentração de fluoreto (F), cálcio (Ca) e fósforo (P) no esmalte. Os dados foram submetidos à ANOVA (1-critério), seguido pelo teste StudentNewman-Keuls (p < 0,001). Os grupos 1100F e 1100F-TMP-MI Paste Plus® apresentaram valores semelhantes de %SHR (p = 0,150). A menor profundidade de lesão (ΔKHN e PLM) foi observada para o grupo 1100F-TMP-MI Paste Plus® quando comparado aos demais (p < 0,001). O grupo 1100F-TMP-MI Paste Plus® apresentou superfície mais uniforme e íntegra em relação aos demais tratamentos (MCVL e MEV). A concentração de F foi similar entre os grupos 1100F, 1100F-MI Paste Plus® e 1100F-TMP-MI Paste Plus® (p > 0,001). O tratamento com 1100F-TMP-MI Paste Plus® promoveu um aumento na concentração de Ca no esmalte em ⁓ 51% e ⁓ 21% respectivamente, quando comparado aos grupos 1100F e MI Paste Plus® (p < 0,001). Valores semelhantes de P no esmalte foram observados nos grupos MI Paste Plus®, 1100F-MI Paste Plus® (p > 0,001), exceto o grupo 1100F-TMP-MI Paste Plus®, que apresentou alta concentração (p < 0,001). Para o Artigo 2 de Desmineralização (DES>RE), blocos de esmalte bovino foram selecionados pela dureza de superfície inicial (SHi) e a seguir submetidos a 5 ciclagens de pH por 7 dias. Após determinou-se dureza de superfície final (SHf), porcentagem de perda de dureza de superfície (%SH), perda integrada de dureza de subsuperfície (ΔKHN), análise do perfil e profundidade das lesões de subsuperfície através da microscopia de luz polarizada (PLM), microsopia confocal de varredura à laser (MCVL), microscopia eletrônica de varredura (MEV), espectroscopia de energia dispersiva (EDS), concentração de fluoreto (F), cálcio (Ca) e fósforo (P) no esmalte. Os dados foram submetidos à ANOVA (1-critério), seguido pelo teste Student-Newman-Keuls (p < 0,001). Para a %SHR, o grupo Placebo apresentou os menores valores (p > 0,001). O grupo 1100F-TMP-MI Paste Plus® remineralizou a superfície do esmalte em ~ 38% em relação ao MI Paste Plus® (p < 0,001). A menor profundidade da lesão (ΔKHN) foi observada para o grupo 1100F-TMP-MI Paste Plus® quando comparado aos demais (p < 0,001), sendo inferior em 32% quando comparado ao grupo 1100F. A concentração de F, Ca e P foi maior para o grupo 1100F-TMP-MI Paste Plus® (p > 0,001). Diante dos resultados parciais obtidos, é possível concluir que a associação de tratamentos com dentifrícios fluoretados e suplementados com trimetafosfato de sódio (TMP) e fosfopeptídeo de caseína-fosfato de cálcio amorfo (CPP-ACP) (MI Paste Plus®) (1100F-TMPMI Paste Plus®) promoveu um efeito adicional significativo no processo de desremineralização, podendo ser uma alternativa de tratamento para pacientes em risco e atividade de cárie(AU)

The general purpose of this study was to evaluate in vitro the association of treatments with fluoridated toothpastes and supplemented with sodium trimetaphosphate (TMP) and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) (MI Paste Plus®) in promoting remineralization and reduce demineralization, respectively, of tooth enamel. Bovine enamel blocks (12/group) were selected through the initial surface hardness (SH) and divided into 5 experimental groups: 1) Toothpaste without F (Placebo); 2) Toothpaste with 1100 ppm F (1100F), 3) MI Paste Plus®, 4) Toothpaste with 1100 ppm F associated with MI Paste Plus® (1100F-MI Paste Plus®) and 5) Toothpaste with 1100 ppm F + 3% TMP associated with MI Paste Plus® (1100F-TMP-MI Paste Plus®). For Remineralization Manuscript 1 (RE>DES), blocks of bovine enamel were selected for the surface hardness after artificial caries lesion (SH1) and subjected to 6 pH cycles for 6 days. After pH cycling, final surface hardness (SH2) was determined to calculate the percentage of surface hardness recovery (%SHR), integrated loss of subsurface hardness (ΔKHN), profile analysis and depth of the lesions of subsurface through polarized light microscopy (PLM), confocal laser scanning microscope (MCVL), scanning electron microscopy (SEM), dispersive energy spectroscopy (EDS), fluoride (F), calcium (Ca) and phosphorus (P) concentration in the enamel. The data were submitted to ANOVA (1-criterion), followed by the Student-Newman-Keuls test (p<0.001). 1100F and 1100F-TMP-MI Paste Plus® groups showed similar values of %SHR (p = 0.150). The lowest depth of lesion (ΔKHN and PLM) was observed for the 1100F-TMP-MI Paste Plus® group when compared to the others (p<0.001). The 1100F-TMP-MI Paste Plus® group showed a more uniform and complete surface in relation to the other treatments (MCVL and SEM). The F concentration was similar between the 1100F, 1100F-MI Paste Plus® and 1100F-TMP-MI Paste Plus® groups (p>0.001). The treatment with 1100F-TMP-MI Paste Plus® promoted an increase in the concentration of Ca in the enamel by ⁓ 51% and ⁓ 21% respectively, when compared to the 1100F and MI Paste Plus® groups (p<0.001). Similar values of P in the enamel were observed in the MI Paste Plus®, 1100F-MI Paste Plus® groups (p>0.001), except for the 1100F-TMP-MI Paste Plus® group, which presented high concentration (p<0.001). For demineralization Manuscript 2 (DES> RE), bovine of enamel blocks were selected for their initial surface hardness (SHi) and then subjected to 5 pH cycles for 7 days. After final surface hardness (SHf), percentage of loss of surface hardness (%SH), integrated loss of subsurface hardness (ΔKHN), analysis of the profile and depth of subsurface lesions through polarized light microscopy ( PLM), confocal laser scanning microscopy (MCVL), scanning electron microscopy (SEM), dispersive energy spectroscopy (EDS), fluoride (F), calcium (Ca) and phosphorus (P) concentration in the enamel. The data were submitted to ANOVA (1-criterion), followed by the Student-Newman-Keuls test (p<0.001). For %SHR, the Placebo group had the lowest values (p>0.001). The 1100F-TMP-MI Paste Plus® group remineralized the enamel surface by ~ 38% compared to MI Paste Plus® (p<0.001). The lowest depth of the lesion (ΔKHN) was observed for the 1100F-TMP-MI Paste Plus® group when compared to the others (p<0.001), being 32% lower when compared to the 1100F group. The F, Ca and P concentration was higher for the 1100F-TMP-MI Paste Plus® group (p>0.001). In view of the partial results obtained, it is possible to conclude that the combination of treatments with fluoridated toothpastes and supplemented with sodium trimetaphosphate (TMP) and amorphous calcium phosphate casein-phosphate (CPP-ACP) (MI Paste Plus®) (1100F-TMP -MI Paste Plus®) promoted a significant additional effect in the de-remineralization process, and could be an alternative treatment for patients at risk and caries activity(AU)

Evaluation of Dental Caries Behavior in Childhood: Health Promotion and Control / Avaliação do Comportamento da Cárie Dentária na Infância: Controle e Promoção de Saúde

Dental caries is still the most common pathology in childhood, caused mainly by lack of adequate prevention. The aim of this project was to evaluate the dental caries profile in children and the importance of multidisciplinary practice in dental caries. Material and methods: 1st stage- meetings were held with the teachers of the child education network and conferences addressed to parents and those responsible for the children. 2nd stage- Assessment and examination of oral health with education process and motivation for dental hygiene. Results: A total of 3390 children were analyzed, of which 859 had carious teeth, that is, 25.34% of the children had caries disease. There is a large presence of caries in the PRE II level, whose highest prevalence of caries is 41.73%, and the lowest recorded in Kindergarten I with 3.11%. This is mainly due to age, directly related to the period in which the basic oral health care program began in day care centers, as older children already had high caries rates when the preventive program was institutionalized to control the occurrences of caries and health promotion. Conclusion: The prevalence of caries in preschool children is still high, but the multidisciplinary approach has shown to be effective and able to reach the levels recommended by ONU 2030 appointment book for dental caries control. (AU)

A cárie dentária é a enfermidade mais comum na infância, causada essencialmente pela falta de prevenção adequada. O objetivo deste estudo foi avaliar o perfil da cárie dentária em crianças e a importância da ação multidisciplinar no controle da mesma. Na primeira fase, foram realizadas reuniões com os professores da rede de educação infantil e conferências dirigidas aos pais e responsáveis das crianças. Na 2ª fase: avaliação e exame de saúde bucal com orientação e motivação para higiene bucal. Foram analisadas 3390 crianças, das quais 859 apresentaram cárie dentária (25,34%). Obervou-se grande presença de cárie no nível PRE II, cuja maior prevalência de cárie é de 41,73%, e a menor registrada no Jardin I com 3,11%. Isso se deve principalmente à idade, relacionada diretamente ao período em que iniciou o Programa Básico de Atenção a Saúde Bucal nas creches, uma vez que as crianças mais velhas já apresentavam altas taxas de cárie quando o programa preventivo foi institucionalizado para controlar ocorrências de cárie e promoção da saúde bucal. Ainda existe alta prevalência de cárie em pré-escolares, entretanto, a abordagem multidisciplinar mostrou-se efetiva e capaz de alcançar os índices preconizados pela Agenda 2030 da ONU para o controle e prevenção da cárie dentária. (AU)

Conducta clínica frente a la fractura de corono-esmalte y subluxación en dientes primarios: reporte de caso / Conduta clínica frente à fratura corono-esmalte e subluxação em dentes decíduos: relato de caso / Clinical management of corono-enamel fracture and subluxation in deciduous teeth: case report

Introducción: Los traumatismos en los dientes decimales son comunes de ocurrir, siendo su primer episodio normalmente en los niños cuando están aprendiendo a caminar. Los traumas nuevos o repetidos pueden ocurrir a lo largo del crecimiento y desarrollo del niño, siendo importante su diagnóstico, seguimiento y tratamiento cuando sea necesario. Objetivo: El objetivo del presente estudio fue relatar un caso clínico de fractura corono-esmalte y subluxación en dentición decidua, bien como sus complicaciones clínicas, radiográficas y conducta clínica. Relato de caso: Paciente de sexo femenino, 2 años y 8 meses de edad, compareció a la clínica de Odontopediatría de la Facultad de Odontología de Araçatuba (FOA/UNESP), Brasil, cuya mamá relataba la aparición de una "bolita" en la región superior del diente 51 y fractura corono-esmalte. Durante la anamnesis la mamá relato que la niña se había caído hace un mes y golpeado el diente 51 presentando sangramiento, leve movilidad y fractura corono-esmalte, y que según el odontopediatría que atendió la niña en el momento del trauma le informo que se trataba de un traumatismo tipo subluxación, y que la conducta clínica, debería ser acompañamiento. Al examen clínico se observó alteración en la coloración del diente 51 y presencia de fistula en la región. Al examen radiográfico fue posible observar inicio de reabsorción radicular y lesión periapical denotando necrosis pulpar. El plan de tratamiento instaurado fue endodoncia del diente 51, seguido por acompañamiento clínico y radiográfico del mismo. Después de 8 días, la niña retorno sin la presencia de fistula, mostrando la eficacia del tratamiento instaurado. Conclusión: Se concluye, por tanto que aunque la subluxación pueda traer daños al diente deciduo, cuando es diagnosticada precozmente, la alteración es susceptible de tratamiento efectivo y satisfactorio, llevando a la preservación del diente hasta el momento de su exfoliación(AU)

Introdução: Os traumatismos em dentes decíduos são comuns de ocorrer, sendo seu primeiro episódio normalmente nas crianças quando estão aprendendo a andar. Traumas novos ou repetidos podem ocorrer ao longo do crescimento e desenvolvimento da criança, sendo importante seu diagnóstico, acompanhamento e tratamento quando necessário. Objetivo: O objetivo do presente estudo foi relatar um caso clínico de fratura corono-esmalte e subluxação na dentição decídua, bem como suas complicações clínicas, radiográficas e conduta clínica. Relato de caso: Paciente do sexo feminino, 2 anos e 8 meses de idade, compareceu à clínica de Odontopediatria da Faculdade de Odontologia de Araçatuba (FOA/UNESP), Brasil, cuja mãe relatava o aparecimento de "bolinha" na região superior do dente 51 e fratura corono-esmalte. Durante a anamenese mãe relatou que a criança havia caído há 1 mês e batido o dente 51 apresentando sangramento, leve mobilidade e fratura corono-esmalte, e que segundo a odontopediatra que atendeu a criança no momento do trauma a informou que tratava-se de um traumatismo do tipo subluxação, e que como conduta clínica, deveria ser o acompanhamento. Ao exame clínico observou-se alteração na coloração do dente 51 e presença de fístula na região. Ao exame radiográfico foi possível observar início de reabsorção radicular e lesão periapical denotando necrose pulpar. O plano de tratamento instituído foi o tratamento endodôntico do dente 51, seguido pelo acompanhamento clínico e radiográfico do mesmo. Após 8 dias, a criança retornou sem a presença da fístula, mostrando a eficácia do tratamento insituído. Conclusão: Conclui-se, portanto que embora a subluxação possa trazer danos ao dente decíduo, quando diagnosticada precocemente, a alteração, é passível de tratamento efetivo e satisfatório, levando à preservação do dente até o momento de sua exfoliação(AU)

Introduction: Trauma to primary teeth is common, and is the first episode usually seen in children when they are learning to walk. New or repeated traumas may occur throughout the child's growth and development, and their diagnosis, follow-up and treatment are important when necessary. Aim: The aim of the present study was to report a clinical case of corono-enamel fracture and subluxation in the deciduous dentition, as well as its clinical, radiographic and clinical complications. Case report: A 2-year, 8-month-old female patient attended the Pediatric Dentistry Clinic of the Faculty of Dentistry of Araçatuba (FOA/UNESP), Brazil, whose mother reported the appearance of a "ball" on the upper tooth 51 and a corono-enamel fracture. During the anamnesis, the mother reported that the child had fallen for 1 month and beat the 51 tooth presenting bleeding, mild mobility and corono-enamel fracture, and according to the pediatric dentist who attended the child at the time of the trauma informed her that it was a traumatic type of subluxation, and that as a clinical course, it should be the follow-up. Clinical examination revealed a change in tooth color 51 and presence of fistula in the region. Radiographic examination revealed the beginning of root resorption and periapical lesion denoting pulp necrosis. The treatment plan was the endodontic treatment of tooth 51, followed by clinical and radiographic follow-up. After 8 days, the child returned without the presence of the fistula, showing the efficacy of the treatment. Conclusion: It is concluded, therefore, that although the subluxation can bring damage to the deciduous tooth, when it is diagnosed early, the alteration is capable of effective and satisfactory treatment, leading to the preservation of the tooth until the moment of its exfoliation(AU)

Remineralizing effect of a fluoridated gel containing sodium hexametaphosphate: An in vitro study.

OBJECTIVES: To evaluate in vitro the effect of neutral pH topical gels with reduced fluoride concentration (F), supplemented or not with sodium hexametaphosphate (HMP) on the remineralization of dental enamel, using a pH-cycling model. Materials and methods Bovine enamel blocks with caries-like lesions were randomly treated with five gels (n = 24/group): without F/HMP (Placebo); 4500 ppm F (4500F), 4500F plus 9% HMP (4500F + HMP); 9000 ppm F (9000F); and 12,300 ppm F (Acid gel). After pH-cycling, the percentage of surface hardness recovery (%SHR), integrated loss of subsurface hardness (ΔKHN), and concentrations of loosely- (CaF2) and firmly-bound (FA) fluoride formed and retained in/on enamel were determined. The results were analyzed by ANOVA followed by the Student-Newman-Keuls test (p < 0.001). RESULTS: The 4500F + HMP gel promoted the highest %SHR among all groups; the lowest ΔKHN was achieved by 4500F + HMP and Acid gel, without significant differences between these. The Acid gel group presented the highest CaF2 and FA formed and retained on/in enamel (p < 0.001). CONCLUSION: Based on the present results, the addition of 9% sodium hexametaphosphate to a gel with reduced fluoride concentration (4500F) was able to significantly enhance the remineralization of artificial carious lesions in vitro when compared to 4500F, reaching protective levels similar to an acidic formulation with ∼3-fold higher fluoride concentration.