Niveles de fluoruro en dentífricos y colutorios / Fluoride levels in toothpaste and mouthwashes

INTRODUCCIÓN: El uso de dentífricos y enjuagues bucales o colutorios que tienen fluoruro en su composición se ha ampliado ya que se ha demostrado que este elemento tiene una alta actividad contra las bacterias cariogénicas. Sin embargo, una ingesta excesiva de cualquiera de estos productos, puede producir intoxicaciones que conducen a diversas patologías a largo plazo. OBJETIVOS: El objetivo de este estudio es determinar el contenido de fluoruro de productos dentales (dentífricos y colutorios) para evaluar si existe algún tipo de riesgo al ingerir accidentalmente grandes cantidades de estos en ciertos grupos de población y comparar los niveles experimentales con los declarados en el etiquetado. MATERIAL Y MÉTODOS: Se han analizado un total de 117 muestras de productos dentales mediante potenciometría con electrodo de ion selectivo de fluoruro. RESULTADOS Y DISCUSIÓN: Se ha registrado la mayor concentración de fluoruro (18412±0.009 mg/kg) en el dentífrico Vitis® junior sabor tutti frutti. El mayor nivel de fluoruro encontrado en los colutorios (2703±38.4 mg/L) ha sido registrado en la marca Lacer® Oros. CONCLUSIONES: No existe ningún tipo de riesgo si el cepillado se realiza correctamente y, en el caso de los niños, de forma supervisada para evitar ingestiones accidentales. No obstante, de producirse, se necesitarían cantidades muy altas de estos productos para desencadenar un efecto tóxico a corto y largo plazo

INTRODUCTION: The use of dentifrices and mouthwashes or mouthwashes that have fluoride in their composition has been extended since it has been shown that this element has a high activity against cariogenic bacteria. However, excessive intake of any of these products can cause poisoning that leads to various long-term pathologies. OBJECTIVES: The objective of this study is to determine the fluoride content of dental products (dentifrices and mouthwashes) to assess whether there is any type of risk by accidentally ingesting large amounts of these in certain population groups and comparing the experimental levels with those declared in the labelling. MATERIAL AND METHODS: A total of 117 samples of dental products have been analyzed by potentiometry with fluoride selective ion electrode. RESULTS AND DISCUSSION: The highest concentration of fluoride (18412±0.009 mg/kg) has been recorded in the Vitis® junior tutti frutti flavor toothpaste. The highest level of fluoride found in mouthwashes (2703±38.4 mg/L) has been registered under the Lacer® Oros brand. CONCLUSIONS: There is no risk if brushing is done correctly and, in the case of children, in a supervised way to avoid accidental ingestion. However, if produced, very high amounts of these products would be needed to trigger a toxic effect in the short and long term

Acute toxicity of ingested fluoride.

This chapter discusses the characteristics and treatment of acute fluoride toxicity as well as the most common sources of overexposure, the doses that cause acute toxicity, and factors that can influence the clinical outcome. Cases of serious systemic toxicity and fatalities due to acute exposures are now rare, but overexposures causing toxic signs and symptoms are not. The clinical course of systemic toxicity from ingested fluoride begins with gastric signs and symptoms, and can develop with alarming rapidity. Treatment involves minimizing absorption by administering a solution containing calcium, monitoring and managing plasma calcium and potassium concentrations, acid-base status, and supporting vital functions. Approximately 30,000 calls to US poison control centers concerning acute exposures in children are made each year, most of which involve temporary gastrointestinal effects, but others require medical treatment. The most common sources of acute overexposures today are dental products - particularly dentifrices because of their relatively high fluoride concentrations, pleasant flavors, and their presence in non-secure locations in most homes. For example, ingestion of only 1.8 ounces of a standard fluoridated dentifrice (900-1,100 mg/kg) by a 10-kg child delivers enough fluoride to reach the 'probably toxic dose' (5 mg/kg body weight). Factors that may influence the clinical course of an overexposure include the chemical compound (e.g. NaF, MFP, etc.), the age and acid-base status of the individual, and the elapsed time between exposure and the initiation of treatment. While fluoride has well-established beneficial dental effects and cases of serious toxicity are now rare, the potential for toxicity requires that fluoride-containing materials be handled and stored with the respect they deserve.

Safety profile of a new liquid whitening gel.

Colgate Simply White Clear Whitening Gel, an at-home tooth-whitening product purchased over the counter, contains 18% carbamide peroxide (equivalent to 6.5% hydrogen peroxide) as the active ingredient in a brush-applied liquid gel. The excipients include ingredients commonly used in dentifrices. The potential for effects on the tooth pulp, oral soft tissue irritation, enamel damage, and tooth sensitivity with this peroxide-containing product have been evaluated. An in vitro study demonstrated that pulpal chamber hydrogen peroxide levels are well below those considered to cause an effect on pulpal tissue. An exaggerated-use (4 applications per day for 3 weeks) clinical study showed that no oral irritation occurred during 3 weeks of use. A study measuring peroxide salivary concentration after use of Colgate Simply White Clear Whitening Gel showed that the concentration of peroxide in the saliva after use of the product was extremely low, further supporting the position that this product has a low potential for causing oral irritation. Additional studies demonstrate that Colgate Simply White Clear Whitening Gel does not harm the enamel surface or produce demineralization after exposure equivalent to 3 weeks of normal use and over 6 weeks of exaggerated use. Colgate Simply White Clear Whitening Gel has not produced oral irritation (hard and soft tissues) or tooth hypersensitivity in a clinical subject population of 141 individuals using varying treatment regimens. These studies prove that Colgate Simply White Clear Whitening Gel is safe for daily use as directed.

Triclosan: cytotoxicity, mode of action, and induction of apoptosis in human gingival cells in vitro.

The in vitro cytotoxicology of triclosan, the active ingredient in some mouthrinses and dentifrices used in the prevention and treatment of gingivitis and plaque, was studied using the Smulow-Glickman (S-G) human gingival epithelial cell line. The 24 h midpoint cytotoxicity value was 0.05-0.06 mM triclosan as assessed with the neutral red (NR) assay. Triclosan is used in dentifrices in combination with either zinc citrate or sodium fluoride (NaF). The sequence of potencies of these test agents, as assessed with the NR assay, was triclosan>zinc citrate>>NaF; combinations of triclosan + zinc citrate and triclosan + NaF were additive in their toxicities. Damage to the integrity of the plasma membrane, as assessed by the leakage of lactic acid dehydrogenase during a 3-h exposure, was initially evident with 0.1 mM triclosan. When exposed to triclosan for 3 d, a lag in the growth kinetics of the S-G cells was first observed at 0.01 mM triclosan. A reduction in attachment of S-G cells to dentin chips, previously exposed to triclosan for 1 h, was noted at 0.25 mM triclosan and greater. Triclosan-induced cell death was apparently by apoptosis, as noted by fluorescence microscopy and DNA agarose gel electrophoresis of extracted oligonucleosomal fragments.

Safety evaluation of toothpaste containing chloroform. III. Long-term study in beagle dogs.

Beagle dogs were given chloroform in a toothpaste base orally in gelatin capsules on 6 d/wk for 7 1/2 yr, followed by a 20-24 wk recovery period. Groups of 16 males and females received 0.5 ml/kg/d of the vehicle (toothpaste without chloroform) and 8 dogs of each sex remained untreated. Treated groups comprised 8 dogs of each sex remained untreated. Treated groups comprised 8 dogs of each sex, receiving doses equivalent to 15 and 30 mg CHCl3/kg/d in the toothpaste vehicle; another group of the same size received an alternative non-chloroform toothpaste (0.5 ml/kg/d). Eleven of the 96 dogs died during the study, only two of these being in the CHCl3-treated groups. The only significant toxic response during treatment was a moderate rise in serum enzyme levels (e.g. SGPT), reaching a peak in the sixth year of the study and probably corresponding to minimal liver damage. Few Palpable growths were noted while the dogs were alive. "Fatty cysts" were seen in the liver of several dogs at post mortem possibly associated with the chloroform treatment but the distribution of a nodular change in the liver was not obviously dose related. A small number of macroscopic and microscopic neoplasms were seen; one dog in each chloroform-treated group had a malignant tumour but there were no tumours in the liver or kidney of any dog. Overall, exposure to chloroform in a toothpaste base was not associated with any effect on the incidence of any kind of neoplasm. From this and related studies in mice and rats, it is concluded that repeated exposure to chloroform (3.5 percent) in toothpaste is unlikely to result in any hazard to human health.

Safety evaluation of toothpaste containing chloroform. I. Long-term studies in mice.

In three experiments, chloroform was administered to mice by gavage in a toothpaste base or in arachis oil, in doses up to 60 mg/kg/d on 6 days/wk for 8 wks. Control groups were left untreated or given vehicle only. In general, there were more survivors in chloroform-treated groups than in the controls. In the case of the males of three strains (C57BL, CBA and CF/1), treatment was associated with no adverse affect on the incidence of any type of neoplasm or any other parameter. In the males but not the females of a fourth strain (ICI) and in doses of 60 mg/kg/d but not of 17 mg/kg/d, exposure to chloroform in toothpaste base as a vehicle was associated with increased incidence of epithelial tumours of the kidney. A more pronounced effect of the same kind was seen in mice given 60 mg CHCl3/kg/d in an archis oil vehicle. This treatment was also associated with a higher incidence and severity of non-neoplastic renal disease. The mechanisms underlying the peculiar strain- and sex-specific susceptibility of ICI male mice to develop renal tumours when exposed to chloroform remain obcure; spontaneous renal tumours were also seen in vehicle control mice and possible ways in which this tendency may be enhanced by chloroform treatment are discussed. At the dose levels tested, namely 113 and 400 times average human exposure levels from the use of toothpaste (with 3.5 percent chloroform content), no adverse affect was seen in the liver and there was no increased incidence of liver tumours even in the higher liver tumour susceptible CBA strain. At the 17 mg CHCl3/kg/d level, equivalent to 113 times average human exposure from toothpaste use, no excess of renal tumours was seen even in males of the peculiarly susceptible ICI strain.

Safety evaluation of toothpaste containing chloroform. II. Long term studies in rats.

The results of a preliminary rangefinding 13-wk oral toxicity study and of two longer term studies on chloroform in toothpaste base are reported. Significant changes in serum enzymes and certain haemotological parameters were seen at the higher dose-levels in the rangefinding study. Intercurrent disease made it necessary to terminate the first long-term experiment prematurely after 1 yr. No evidence of serious toxicity was recorded. In the second long-term experiment, groups of 50 caesarian-derived SPF Sprague-Dawley rats of each sex received either the equivalent of 60 mg CHCl3/kg/d in toothpaste base or the vehicle only, by gavage on 6 d/wk for 80 wk and were then observed for up to a further 15 wk. Chloroform-treated rats of both sexes survived better than the controls, though both groups had a high incidence of non-neoplastic respiratory and renal disease. Female rats gave a consistent finding of decrease in plasma cholinesterase, shown to be related to activity against butyrylcholine but not acetyl-beta-methylcholine. Tumours of various sites were seen in 39 percent of chloroform-treated rats of both sexes examined histologically, compared with 38 percent of vehicle controls. There were no treatment-related effects on the incidence of liver or kidney tumours. Histologically-malignant mammary tumours were reported in more treated than control rats, but the difference in incidence was not statistically significant.

Potential biological hazards of commercially available cleansers for dentures.

Thirteen representative denture cleansers were selected from among more than 32 retail products to be tested for potential hazard and toxicity to humans. Products were subjected to toxicological analyses by using the biological tests (acute oral toxicity in rats, eye and skin irritation in rabbits) specified in the Federal Hazardous Substances Act Regulations. All products were eye irritants with ranges from slight to severe. Three produced a primary skin irritation response (one was corrosive), while five of the denture cleansers produced oral LD50 values below 5 g/kg. Furthermore, a provisional upper gastrointestinal irritancy test used in rabbits indicated that eight of the denture cleansers produced upper gastrointestinal irritation, which was, in general, dose-related.