Dentine surface modification and remineralization induced by bioactive toothpastes.

OBJECTIVE: In this study, dentine surface was analysed through Environmental-scanning-electron-microscopy (ESEM) with energy-dispersive-X-ray-spectrometry (EDX) and Fourier-transform-infrared-spectroscopy (FTIR) with attenuated total-reflectance (ATR) to assess the morpho-chemical changes and variations in mineralization degree after demineralizing treatment, after five toothpastes application (HA & Citrate toothpaste, Zinc-HA toothpaste, Calcium Sodium Phosphosilicate toothpaste, Arginine & Calcium carbonate toothpaste, Colgate-Triple-Action, and Control toothpaste), after soaking in artificial saliva and after citric acid attack. METHODS: Ca/P, Ca/N and P/N ratios were calculated from EDX atomic data to evaluate the mineralization degree of dentine surface. The IR calcium phosphate (CaP)/collagen and carbonate/collagen ratios has been evaluated to assess the remineralization changes in dentine; the carbonate/collagen IR ratio was calculated to identify the nucleation of B-type-carbonated apatite and calcium carbonate. RESULTS: ESEM-EDX and ATR-FTIR showed residuals of toothpastes after the treatments in all cases, with a general increase in the mineralization degree after soaking in artificial saliva and a decrease after acid attack. Treatment with Arginine & Calcium carbonate toothpaste showed the highest Ca/P value after treatment (Ca/P 1.62) and acid attack (Ca/P 1.5) in confirmation, IR showed the highest amount of carbonate after treatment and soaking in artificial saliva. Arginine and calcium carbonate toothpaste and HA and citrate toothpaste remained to a higher extent on the dentine surface and revealed a higher remineralization activity. These formulations showed higher resistance to demineralization attack, as demonstrated by a higher ICaP /IAmide II intensity ratio than those obtained after EDTA treatment. CONCLUSIONS: Toothpastes that remained to a higher extent on dentine surface (arginine and calcium carbonate toothpaste in particular) were more able to promote remineralization. The formed calcium phosphate (CaPs) phase was intimately bound to dentine rather than a simple deposit.

Modificaciones en la microbiota y los factores inflamatorios después de la utilización de un dentífrico con aceite de oliva virgen, betaina y xilitol, desarrollado para el cuidado del microbioma oral: estudio clínico piloto / Modifications in the microbiota and inflammatory factors with the use of a toothpaste with virgin olive oil, betaine and xylitol, developed for the care of the oral microbiome: pilot clinical study

Introducción: La correcta homeostasis oral, asociada a una buena higiene oral, es necesaria para disminuir la de patógenos cariogénicos y la inhibición de patógenos periodontales, así como modular la respuesta inflamatoria. El objetivo de este estudio es evaluar los efectos de un dentífrico para la protección del microbioma oral, en pacientes atendidos en el Hospital Odontológico Universidad de Barcelona (HOUB). Material y métodos: Ensayo Clínico Randomizado doble ciego y placebo en pacientes atendidos en el HOUB. En el Grupo estudio [GE] se utiliza una pasta dentífrica específica [PDE], que contiene como ingredientes activos aceite de oliva virgen extra, betaina y xilitol además de monofluorofosfato de sodio (1,450 ppm F-) + Excipientes. Y en el Grupo control [GC] se utiliza una pasta placebo sin ingredientes activos. A todos los pacientes se les realiza una exploración oral con parámetros clínicos periodontales, medición de pH, flujo salival (no estimulado y estimulado), recuento de citoquinas (TNF, IL-1 e IL-4.) y de carga total bacteriana, mediante PCR cuantitativa, al inicio y al mes del tratamiento. Resultados: Se incluyen un total de 26 pacientes, 17 mujeres y 9 hombres con una edad media de 48,76 años. El nivel de pH se mantuvo estable entre el inicio y final del estudio en ambos grupos, sin diferencias entre ellos. 11 pacientes indicaron la sensación subjetiva de encontrar la boca mejor, 7 eran test y 4 control (p=0.1); 10 pacientes encontraron la boca igual y solo uno (placebo) la encontró peor. En el análisis de la carga bacteriana mediante determinación de PCR cuantitativa de gen16S solo se analizaron 10 pacientes: 5 GE y 5 GC. En el grupo test bajó en todos los casos la carga de patógenos periodontales y en el grupo control, disminuyó en 4 aumentando en 1. En los 16 pacientes que se analizaron las citoquinas no se observaron diferencias estadísticamente significativas. (AU)

Introduction: Correct oral homeostasis, associated with good oral hygiene, is necessary to decrease the bacterial load of cariogenic pathogens and the inhibition of periodontal pathogens, as well as to modulate inflammatory response. The objective of this study is to evaluate the effects of a toothpaste for the protection of the oral microbiome, in patients treated at the Hospital Odontológico Universidad de Barcelona (HOUB).Material and methods: Randomized double-blind clinical trial with placebo in patients treated at HOUB. In the Study Group [SG] a specific toothpaste [PDE] is used, which contains as active ingredients extra virgin olive oil, betaine and xylitol, as well as sodium monofluorophosphate (1,450 ppm F-) + Excipients. In the control group [CG] a placebo paste without active ingredients is used. All patients underwent an oral examination with periodontal clinical parameters, pH measurement, salivary flow (stimulated and unstimulated), cytokine count (TNF, IL-1 and IL-4.) and total bacterial load by qPCR16S at the beginning and one month after treatment.Results: A total of 26 patients were included, 17 women and 9 men, with a mean age of 48.76 years. The pH level remained stable between the beginning and the end of the study in both groups, with no differences between them. 11 patients felt their mouth was in a better state, 7 of which were test and 4 control (p=0.1); 10 patients felt their mouth was in the same as before the treatment; and only one (placebo) felt it was worse. For the 16S analysis, only 10 patients were analyzed: 5 SG and 5 CG. In the test group, the total bacterial load decreased in all cases, and in the control group, it decreased in 4 and increased in 1. Among the 16 patients whose cytokines were analyzed, no statistically significant differences were observed. (AU)

Improved Enamel Acid Resistance by Highly Concentrated Acidulated Phosphate Sodium Monofluorophosphate Solution.

Sodium monofluorophosphate (MFP) is a component of fluoride-containing dentifrices and is more biosafe than the conventional sodium fluoride (NaF). MFP can respond not only on the tooth surface layer but also deep into the enamel. We aim to confirm that high concentrations of acid phosphate MFP (AP-MFP, 9000 ppmF), used in professional care, could lead to a highly biosafe fluoride application method that acts through the deep enamel layers. Sample groups were respectively treated in vitro with NaF, acidulated phosphate fluoride (APF), MFP, and AP-MFP, and the samples were compared against an untreated group. Characterizations after fluoride application confirmed that MFP and AP-MFP treatments improved the acid resistance of enamel compared to that of conventional methods. Furthermore, the acid resistance of highly concentrated MFPs improved by using phosphoric acid. Although the acid resistance from the AP-MFP method is not as good as that using APF, AP-MFP can act both on the surface layer and deep into the enamel. Moreover, AP-MFP retains fluoride ions as much as APF does on the tooth surface. The proposed fluoride application method using AP-MFP introduces a dental treatment for acid resistance that is highly biosafe and penetrates deep layers of the enamel.

Soluble Fluoride in Na2FPO3/CaCO3-Based Toothpaste as an Indicator of Systemically Bioavailable Fluoride.

Fluoride chemically soluble in toothpaste is an indicator of fluoride bioavailability when the teeth are brushed, and the same should be expected systemically when toothpaste is ingested. A 4-phases study was conducted, in which 8 participants were subjected in each phase to one of the assigned treatment groups: group I: fresh sample of a Na2FPO3/CaCO3 toothpaste with 1,334 µg F/g of total soluble fluoride (TSF) and groups II-IV: aged samples of toothpaste presenting TSF concentrations of 1,128, 808, and 687 µg F/g, respectively. In all phases, the participants ingested an amount of toothpaste equivalent to 70.0 µg F/kg body weight, as total fluoride (TF). Blood was collected before (baseline) and up to 180 min after toothpaste ingestion as indicator of fluoride bioavailability. Total urine (24 h before and 24 h after ingestion) was collected as indicator of absorbed fluoride that was excreted. F concentration in blood plasma and urine was determined with a fluoride ion-specific electrode. The areas under the curve (AUC) of F concentration versus time (AUC = ng F/mL × min) and the peaks of fluoride concentration in blood plasma (Cmax) were calculated. The net amount of fluoride excreted (mg/day) was calculated by subtraction. A significant correlation of the amount (mg) of TSF ingested was found between the AUC (r = 0.76; p < 0.01) and Cmax (r = 0.86; p < 0.01) in plasma, and the fluoride excreted (r = 0.65; p < 0.01). For TF, no statistical correlations were found (p > 0.05). Data suggest that the concentration of TSF found in Na2FPO3/CaCO3-based toothpastes is a useful predictor of how much fluoride will be systemically bioavailable when this type of formulation is ingested.

In-vitro apatite formation capacity of a bioactive glass - containing toothpaste.

OBJECTIVES: The in-vitro dissolution of bioactive glass-based toothpastes and their capacity to form apatite-like phases in buffer solutions have been investigated. MATERIALS AND METHODS: The commercial toothpaste samples were tested on immersion in artificial saliva, Earle's salt solution and Tris buffer for duration from 10min to four days. The powder samples collected at the end of the immersion were studied using solid-state 31P and 19F nuclear magnetic resonance spectroscopy (NMR), X-ray powder diffraction and Fourier transform infrared (FTIR) spectroscopy. The fluoride concentration in the solution remained after the immersion was measured. RESULTS: In artificial saliva and in presence of sodium monofluorophosphate (MFP), the bioactive glass and bioactive glass-based toothpastes formed fluoridated apatite-like phases in under 10min. A small amount of apatite-like phase was detected by 31P NMR in the toothpaste with MFP but no bioactive glass. The toothpaste with bioactive glass but no fluoride formed an apatite-like phase as rapidly as the paste containing bioactive glass and fluoride. By contrast, apatite-like phase formation was much slower in Earle's salt solution than artificial saliva and slower than Tris buffer. CONCLUSIONS: The results of this lab-based study showed that the toothpaste with MFP and bioactive glass formed a fluoridated apatite in artificial saliva and in Tris buffer, as did the mixture of bioactive glass and MFP. CLINICAL SIGNIFICANCE: The presence of fluoride in bioactive glass-containing toothpastes can potentially lead to the formation of a fluoridated apatite, which may result in improved clinical effectiveness and durability. However, this should be further tested intra-orally.

Efficacy of desensitizing agents on postoperative sensitivity following an in-office vital tooth bleaching: A randomized controlled clinical trial.

AIM: To assess and compare the incidence and intensity of experienced after an in-office vital tooth bleaching in case of dental fluorosis using two different types of desensitizing agents, at different time periods. MATERIALS AND METHODS: Sixty-nine subjects with mild-to-moderate fluorosis were randomly divided into three groups of 23 each. Group I - control group (placebo), group II-potassium nitrate 5% and sodium monofluorophosphate 0.7% (Sensodent KF), and group III-Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP) (Tooth Mousse). In-office vital tooth bleaching was done using 35% hydrogen peroxide liquid (Pola office) in two sessions. Desensitizing agent was applied for 10 min after each session. Postoperative sensitivity was recorded after 24 h and 7 days. The statistical analysis was done using chi-square test, analysis of variance (ANOVA), and post hoc Tukey's test. RESULTS: The experimental groups showed significantly less incidence and intensity of sensitivity compared to control group, whereas there was no difference between them. CONCLUSION: The desensitizing agents used in the study show effective reduction after an in-office vital tooth bleaching.

Evaluation of the Oral Tolerance of Three Fluoride Toothpaste Formulations in a Dry Mouth Population: Results from Two Randomized Studies.

OBJECTIVES: To evaluate the oral tolerance of three experimental toothpaste formulations containing sodium fluoride (NaF), compared with two marketed sodium monofluorophosphate (SMFP)-containing biotène® toothpastes, in a dry mouth population after 14 days (primary objective) and 7 days (secondary objective) of use. METHODS: Toothpastes were tested in two separate dual-site, examiner-blind, randomized, parallel group studies in subjects (35-84 years) with self-reported dry mouth. Oral soft tissue (OST) and oral hard tissue (OHT) examinations were performed at screening, followed by a 7- to 28-day wash-in period using a control toothpaste. Subjects were randomized to receive a NaF-containing toothpaste (Study 1: commercially available toothpaste Pronamel® for Children, n = 82; Study 2: experimental plaque biofilm-loosening formula [PBF] toothpaste, n = 79; or experimental Gentle Mint toothpaste, n = 78) or a reference toothpaste (Study 1: biotène® Fresh Mint Original toothpaste [previously marketed formulation], n = 82; Study 2: biotène® Gentle Mint Gel toothpaste [previously marketed formulation], n = 77) during the 14-day treatment phase. Subjects brushed their teeth twice daily for one timed minute with a ribbon of toothpaste to cover the head of the toothbrush provided. Subjects received further OST and OHT examinations at Day 1 and Day 15, and an additional OST examination at Day 8. Adverse events (AEs) and serious AEs (SAEs) were reported throughout the study. RESULTS: Study 1: At Day 15, 42 oral treatment-emergent AEs (TEAEs) were reported in 33 subjects, of which seven in five subjects (commercially available toothpaste Pronamel for Children: n = 2; control: n = 3) were considered to be treatment-related. One SAE (dyspnea) was reported in a participant who was randomized but withdrew from the study before receiving the allocated toothpaste. Study 2: At Day 15, 41 oral TEAEs were reported in 38 subjects, of which two in two subjects (experimental Gentle Mint toothpaste: n = 1; control: n = 1) were considered treatment-related, according to the investigator. No SAEs were reported. CONCLUSIONS: In both studies, the experimental and reference toothpastes were well tolerated after 7 and 14 days of use. The experimental NaF-containing toothpastes offer potential alternatives to individuals with dry mouth.

Antimicrobial efficacy of amine fluoride based tooth gels compared to a toothpaste in a phase 2/step 2 in-vitro test model.

INTRODUCTION: The aim of the present study was to determine the antimicrobial effect of various gel formulations on plaque formation; different tooth gels were compared to a toothpaste containing comparable antimicrobial ingredients with regard to its microbiocidal activity. The study was conducted under the assumption, that a chief requirement for the prevention of plaque formation is the combination of mechanical removal and antimicrobial activity, and not the sole capability of mechanical plaque removal. METHODS: Ledermix(®) fluoride gel as commercially available with preservative, and without preservative and perfume oils, Elmex(®) gelée, and Meridol(®) toothpaste were tested in a standardized in-vitro test modification of the quantitative suspension test EN 1040. Instead of testing in a suspension, the respective product was directly placed on a standardized contaminated sterile stainless steel disk without adding any bio-burden. 50% egg yolk in Aqua dest. was used as a neutralizer. RESULTS: Within 1 min, Elmex(®) gelée showed a RF >5 log(10) against S. pyogenes and S. sanguinis. Against S. mutans, a log(10) RF of ≥5 was achieved after 2 min, against C. albicans after 5 min, and against P. aeruginosa after 10 min S. aureus was the most difficult organisms to be reduced. After an application time of 10 min, only a log(10) RF of 2.4 was achieved. Ledermix exceeded the antimicrobial efficacy of Elmex(®) gelée against S. mutans and C. albicans and was already effective against these organisms after 1 min, but did not show the same antimicrobial efficacy as Elmex(®) gelée against P. aeruginosa. Similar to Elmex(®) gelée, a required reduction of >5 log(10) for antimicrobials under no organic challenge was not achieved against S. aureus. Ledermix(®) fluoride gel without preservatives and Ledermix(®) fluoride gel without preservatives and perfume oil did not show the antimicrobial efficacy of the standard Ledermix(®) fluoride gel formulation, indicating that the observed antimicrobial efficacy is chiefly based on the preservative, and possibly the perfume oil. Compared to the tested gels, Meridol(®) toothpaste was less effective and reached any antimicrobial effect >5 log(10) only against S. sanguinis after 10 min. CONCLUSION: All unmodified tested gels showed an antimicrobial effect. Because no relevant antimicrobial efficacy against plaque forming bacteria was achieved within 2 min, in practice, an anti-plaque forming effect based on the antimicrobial action of gels cannot be assumed when used in the oral cavity. However, the results of the present study indicate that the antimicrobial efficacy of gels is determined by their formulation and that for the prevention of plaque formation the combination of mechanical removal and antimicrobial activity is not the chief requirement only, but a sustained antimicrobial effect may be of greater importance.

Comparative efficacy of dentifrice containing sodium monofluorophosphate + calcium glycerophosphate and non-fluoridated dentifrice: A randomized, double-blind, prospective study.

BACKGROUND: The efficacy of fluoridated dentifrices in caries prevention has been well documented and research into various formulations continues for a more effective dentifrice. This study evaluated the anti-caries and anti-plaque efficacy of a dentifrice containing sodium monofluorophosphate (1000 ppm) and calcium glycerophosphate, and compared it with a non-fluoridated dentifrice. MATERIALS AND METHODS: A total of 595 school children (12-15 years) were divided into test (302 children) and control (293 children) groups. The test group used the dentifrice containing sodium monofluorophosphate (1000 ppm) and calcium glycerophosphate, whereas the control group was given a placebo dentifrice. Oral examination for dental caries and plaque assessment was carried out at the start of the study and the children were followed up semiannually up to 18 months. Data were analyzed using repeated-measure analysis of variance (ANOVA) followed by one-way ANOVA. RESULTS: The values for decayed missing filled teeth (DMFT) increased from baseline to 18 month examination from 4.43±2.03 and 4.67±2.25 (P=0.175) to 5.84±2.29 and 5.13±2.30 (P=0.001) for control and test groups, respectively. Similarly, the increase in decayed missing filled surface (DMFS) values were from 6.42±4.10 and 7.06±4.77 (P=0.082) to 8.64±4.51 and 7.92±5.07 (P=0.095) for test and control groups, respectively. The mean DMFT and DMFS values increased for both the groups; however, the increase was less in test group as compared to control group. The baseline plaque score reduced from 2.94±0.72 and 2.91±0.72 (P=0.679), respectively, for control and test groups to 1.33±0.46 and 0.91±0.38 (P<0.001), respectively, at 18 month examination. CONCLUSION: Results revealed that the test dentifrice was effective in inhibiting the progression of plaque and control of dental caries as compared to the placebo dentifrice.

Assessment of antifungal activity of herbal and conventional toothpastes against clinical isolates of Candida albicans.

OBJECTIVE: To detect the anticandidal activity of nine toothpastes containing sodium fluoride, sodium monofluorophosphate and herbal extracts as an active ingredients against 45 oral and non oral Candida albicans (C. albicans) isolates. METHODS: The antifungal activity of these toothpaste formulations was determined using a standard agar well diffusion method. Statistical analysis was performed using a statistical package, SPSS windows version 15, by applying mean values using one-way ANOVA with post-hoc least square differences (LSD) method. A P value of less than 0.05 was considered significant. RESULTS: All toothpastes studied in our experiments were effective in inhibiting the growth of all C. albicans isolates. The highest anticandidal activity was obtained from toothpaste that containing both herbal extracts and sodium fluoride as active ingredients, while the lowest activity was obtained from toothpaste containing sodium monofluorophosphate as an active ingredient. Antifungal activity of Parodontax toothpaste showed a significant difference (P< 0.001) against C. albicans isolates compared to toothpastes containing sodium fluoride or herbal products. CONCLUSIONS: In the present study, it has been demonstrated that toothpaste containing both herbal extracts and sodium fluoride as active ingredients are more effective in control of C. albicans, while toothpaste that containing monofluorophosphate as an active ingredient is less effective against C. albicans. Some herbal toothpaste formulations studied in our experiments, appear to be equally effective as the fluoride dental formulations and it can be used as an alternative to conventional formulations for individuals who have an interest in naturally-based products. Our results may provide invaluable information for dental professionals.

Assessment of antifungal activity of herbal and conventional toothpastes against clinical isolates of Candida albicans

Objective: To detect the anticandidal activity of nine toothpastes containing sodium fluoride, sodium monofluorophosphate and herbal extracts as an active ingredients against 45 oral and non oral Candida albicans (C. albicans) isolates. Methods: The antifungal activity of these toothpaste formulations was determined using a standard agar well diffusion method. Statistical analysis was performed using a statistical package, SPSS windows version 15, by applying mean values using one-way ANOVA with post-hoc least square differences (LSD) method. A P value of less than 0.05 was considered significant. Results: All toothpastes studied in our experiments were effective in inhibiting the growth of all C. albicans isolates. The highest anticandidal activity was obtained from toothpaste that containing both herbal extracts and sodium fluoride as active ingredients, while the lowest activity was obtained from toothpaste containing sodium monofluorophosphate as an active ingredient. Antifungal activity of Parodontax toothpaste showed a significant difference (P< 0.001) against C. albicans isolates compared to toothpastes containing sodium fluoride or herbal products. Conclusions: In the present study, it has been demonstrated that toothpaste containing both herbal extracts and sodium fluoride as active ingredients are more effective in control of C. albicans, while toothpaste that containing monofluorophosphate as an active ingredient is less effective against C. albicans. Some herbal toothpaste formulations studied in our experiments, appear to be equally effective as the fluoride dental formulations and it can be used as an alternative to conventional formulations for individuals who have an interest in naturally-based products. Our results may provide invaluable information for dental professionals.