Conventional Fluoride Toothpaste Research Articles

Dental aesthetic perception of patients submitted to activated charcoal-based bleaching agents: A randomized clinical trial

ObjectiveTo evaluate the effects of activated charcoal-based products used in two presentation forms (powder or toothpaste), compared to 10 % carbamide peroxide and conventional toothpaste on aesthetic perception and psychosocial impact before and after treatment. MethodsFifty-six participants were divided into 4 experimental groups (n = 14). Activated charcoal-based powder (PW); Activated charcoal-based dentifrice (AC); Conventional fluoride toothpaste (CD) and 10 % carbamide peroxide (CP). All products were used for 14 days. Psychosocial impact on dental esthetics (PIDAQ), oral health impact profile (OHIP- Esthetics) and orofacial esthetics scale (OES) questionnaires were applied before and after treatment. Descriptive and exploratory data analyses were performed and analyzed using linear mixed models for repeated measures over time considering significance level of α = 0.05. ResultsFor PIDAQ, the CP group showed significant decrease in psychological impact, aesthetic perception domains and overall score, while in the PW group, there was only a significant decrease in the psychological impact domain. Decrease in OHIP was observed for the functional limitation domain scores for treatments with CP and PW, in the psychological discomfort domain, decrease was observed for all groups, while for the OES questionnaire, significant increase in the color domain was observed for the CP group. ConclusionActivated charcoal-based products showed lower scores in all questionnaires when compared with carbamide peroxide; thus, charcoal-based products promoted lower impact on quality of life and aesthetic perception. Clinical relevanceIn this randomized clinical trial, charcoal-based OTC products had inferior quality of life and aesthetic perception results compared to conventional carbamide peroxide bleaching.

Fluoride Intake and Salivary Fluoride Retention after Using High-Fluoride Toothpaste Followed by Post-Brushing Water Rinsing and Conventional (1400-1450 ppm) Fluoride Toothpastes Used without Rinsing.

This study aimed to compare the fluoride intake and salivary fluoride levels after brushing with conventional (1400–1450 ppm) fluoride toothpaste containing different fluoride agents: amine fluoride (AmF), sodium fluoride (NaF), sodium monofluorophosphate (SMFP), potassium fluoride (KF), and a high-fluoride (5000 ppm) toothpaste containing NaF. Fourteen volunteers took part in the study. They were instructed to brush and spit without rinsing after using conventional toothpaste or brush and rinse with water after using a high-fluoride toothpaste. Fluoride concentrations were determined using ion-selective fluoride (09-37 type) in the saliva samples before and after procedures. Fluoride intake was estimated based on fluoride recovered after brushing. Additionally, the amount of fluoride present in the oral fluids and lost during the rapid clearance phase after toothbrushing was calculated based on salivary fluoride levels and saliva flow immediately after brushing. Salivary fluoride after using high-fluoride toothpaste was significantly higher than those observed after conventional products. Two hours after brushing, salivary fluoride concentrations did not differ significantly from baseline values (p > 0.05) unless a high-fluoride product was used. Results indicate that by refraining from rinsing after brushing with conventional toothpaste, we cannot obtain fluoride retention in saliva as with high-fluoride toothpaste. Fluoride ingestion was higher after using a high-fluoride product.

Home Oral Care with Biomimetic Hydroxyapatite vs. Conventional Fluoridated Toothpaste for the Remineralization and Desensitizing of White Spot Lesions: Randomized Clinical Trial.

Introduction: Biomimetic hydroxyapatite-based toothpastes have been investigated in recent years for their remineralizing activity on dental surfaces. The aim of the present study was to evaluate the efficacy of toothpaste containing biomimetic hydroxyapatite versus a 1450 pppm fluoride one in promoting the remineralization and desensitization of white spot lesions. Methods: 40 patients were randomly assigned to two different domiciliary oral hygiene treatments: toothpaste containing 1450 ppm of fluoride (control group) and toothpaste containing biomimetic hydroxyapatite (experimental group). Dental sensitivity/pain and dental erosion were assessed at baseline and after 15, 30, and 90 days using the following indexes: Schiff Air Index (SAI), Visual Analogue Scale (VAS), and Basic Erosive Wear Examination (BEWE). Results: Data were submitted for statistical analysis. SAI significantly decreased after 3 months (T3) of treatment only in the Trial group (p < 0.05). VAS values significantly decreased at T2 in the trial group (p < 0.05) with a further significant reduction at T3 (p < 0.05). BEWE scores did not significantly vary during the follow up neither in the trial nor in the control group. Conclusions: The hydroxyapatite-based toothpaste tested caused a reduction of hypersensitivity/pain values higher than conventional fluoride toothpaste.

Clinical efficacy of hydroxyapatite toothpaste containing Polyol Germanium Complex (PGC) with threonine in the treatment of dentine hypersensitivity

IntroductionThis study aims to evaluate the clinical efficacy of a hydroxyapatite toothpaste containing a Polyol Germanium Complex with threonine in treating dentine hypersensitivity. The study also seeks to monitor the quality of life of the treated dentine hypersensitivity sufferers. Materials and methodsThis study is a randomized clinical trial with a total of 120 patients with dentine hypersensitivity. All participants were divided into three groups: patients assigned to the GARDA SILK toothpaste; patients receiving the conventional fluoride toothpaste for comparison purposes, and patients asked to brush their teeth without toothpaste. The modified Quigley-Heine Plaque Index was assessed at the baseline and after treatment. Sensitivity was assessed at baseline, 3, 7 and 14 days using the air stimulus (Schiff Index). The impact of dentine hypersensitivity on the quality of life was assessed before and after the treatment with the Russian version of the Dentine Hypersensitivity Experience Questionnaire (DHEQ). ResultsAfter 14 days of treatment, the mean Plaque Index scores in Groups 1 and 2 did not exceed 1 and averaged 0.72 ± 0.249 and 0.86 ± 0.213, respectively. In Group 3, the mean Plaque Index was significantly higher (1.04 ± 0.070, p < 0.05). The mean Schiff sensitivity scores in Group 1 decreased to 2.45 ± 0.42 at 3 days, 1.84 ± 0.26 at 7 days, and 1.02 ± 0.34 at 14 days. Group 2 exhibited smaller reductions in the Schiff index at all time points. In this group, Schiff scores dropped to 2.67 ± 0.28 after 3 days, 2.34 ± 0.44 after 7 days, and 1.93 ± 0.36 after 14 days. ConclusionThe GARDA SILK hydroxyapatite toothpaste with a threonine-containing Polyol Germanium Complex (PGC) is effective in maintaining good oral hygiene, reducing dentine hypersensitivity, and improving the quality of life of dentine hypersensitivity sufferers.

Evaluation of the Antibacterial and Anti-Inflammatory Effects of a Natural Products-Containing Toothpaste.

Fluoride-containing toothpaste is daily used in toothbrush. Some compounds derived from natural herbs that have antibacterial and anti-inflammatory activities has attracted increasing attention as potential supplements for the control of oral diseases. In this paper, a natural product mixture (NPM-8) containing eight herbs extracts was added to toothpaste, and its antibacterial and anti-inflammatory effects were investigated. The results showed that NPM-8-containing toothpaste exhibited superior and faster inhibitory and bactericidal effects against S. mutans, S. sanguinis and P. gingivalis than that of the NPM-8-free toothpaste. NPM-8-containing toothpaste significantly reduced the biomass of single-species or three-species biofilms. The cytotoxicity of the NPM-8-containing toothpaste was similar to that of the conventional fluoride toothpaste and CHX. The NPM-8-containing toothpaste could significantly inhibit IL-1β and IL-6 production in HGE cells and exhibited a better anti-inflammatory effect than that of the NPM-8-free toothpaste. In conclusion, NPM-8-containing fluoride toothpaste is superior to conventional fluoride toothpaste in regard to their antibacterial, antibiofilm, and anti-inflammatory properties. NPM-8-containing toothpaste also has good biocompatibility and is safe for daily use. It indicates that NPM-8 is a promising natural product mixture in oral health.

Effect of mouth rinses on tooth enamel surface

This study aims to evaluate the effect of mouth rinses on the color, microhardness, and surface roughness of tooth enamel. Sixty dental blocks were collected from human third molars and divided in five groups (n = 12): the control group (CG) without immersion in mouth rinse, Listerine Zero, Colgate Plax Fresh Mint, Listerine Whitening, and Colgate Luminous White. The groups were subjected to initial color analysis; the microhardness and roughness of the enamel surfaces were evaluated. Next, the samples were subjected to immersion in mouth rinses or brushing with conventional fluoride toothpaste (CG) according to the manufacturer's instructions; after a 12-week treatment, the color, microhardness, and roughness were once again assessed and compared with the initial analysis. Data were tabulated and analyzed through a two-way analysis of variance (ANOVA) (color and roughness) followed by Tukey's test. Microhardness was analyzed through the Kruskal-Wallis test followed by Dunn's test; the level of significance was 5%. All groups immersed in mouth rinses had a higher level of microhardness loss than CG; additionally, all groups showed changes in the enamel surface. Enamel surface loss was observed using a roughness test, and the mouth rinses promoted a higher level of color changes than CG. Given the results, it can be concluded that the mouth rinses led to significant changes in tooth enamel.

Fluorides for preventing early tooth decay (demineralised lesions) during fixed brace treatment.

Fluorides for preventing early tooth decay (demineralised lesions) during fixed brace treatment.

How to Intervene in the Root Caries Process? Systematic Review and Meta-Analyses

The aim of this review as part of the preparation for a workshop organized by the European Federation of Conservative Dentistry (EFCD) in conjunction with the European Organisation for Caries Research (ORCA) was to systematically analyze available evidence of non-, micro- as well as invasive interventions for root caries lesions (RCLs). For each treatment strategy, a separate systematic review was either performed (micro-invasive and choice of restorative material) or updated (non-invasive and excavation technique) each of them following PRISMA guidelines, and if possible meta-analyses were performed. Besides the general advice to improve tooth brushing with fluoride toothpaste main findings for non-invasive interventions in RCLs, the use of dentifrices containing 5,000 ppm F^– as well as professionally applied chlorhexidine varnish or silver diamine fluoride seemed to be more efficacious to arrest root caries compared to conventional fluoride toothpaste or placebo respectively. However, this conclusion is based only on a few randomized clinical trials. For micro-invasive treatments, only 2 studies focusing on sealants were available without clear conclusions. A recent review on the comparison of atraumatic restorative treatment compared with conventional treatment concluded that there is insufficient data to clearly rule out if any difference with regard to restoration longevity between both techniques exists. When restoring coventionally, composites performed better than resin-modified and glass ionomer cements. However, all materials showed rather high annual failure rates in the majority of the studies and evidence is based on a low number of prospective studies with a rather high risk of bias.

Anticaries effect of toothpaste with nano-sized sodium hexametaphosphate.

To evaluate the effect of a fluoride toothpaste containing nano-sized sodium hexametaphosphate (HMPnano) on enamel demineralization on the biochemical composition and insoluble extracellular polysaccharide (EPS) in biofilm formed in situ. This crossover double-blind study consisted of four phases (7days each), in which 12 volunteers wore intraoral appliances containing four enamel bovine blocks. The cariogenic challenge was performed using 30% sucrose solution (6×/day). Blocks were treated 3×/day with the following toothpastes: no F/HMP/HMPnano (Placebo), conventional fluoride toothpaste, 1100ppmF (1100F), 1100F + 0.5% micrometric HMP (1100F/HMP), and 1100F + 0.5% nano-sized HMP (1100F/HMPnano). The percentage of surface hardness loss (%SH), integrated loss of subsurface hardness (ΔKHN), and enamel calcium (Ca), phosphorus (P), and fluoride (F) were determined. Moreover, biofilms formed on the blocks were analyzed for F, Ca, P, and insoluble extracellular polysaccharide (EPS) concentrations. Data were analyzed using one-way ANOVA, followed by Student-Newman-Keuls' test (p < 0.001). 1100F/HMPnano promoted the lowest %SH and ΔKHN among all groups (p < 0.001). The addition of HMPnano to 1100F significantly increased Ca concentrations (p < 0.001). The 1100F/HMPnano promoted lower values of EPS when compared with 1100F (~ 70%) (p < 0.001) and higher values of fluoride and calcium in the biofilms (p < 0.001). 1100F/HMPnano demonstrated a greater protective effect against enamel demineralization and on the composition of biofilm in situ when compared to 1100F toothpaste. This toothpaste could be a viable alternative to patients at high risk of caries.

Effect of Fluoride Toothpaste Containing Nano-Sized Sodium Hexametaphosphate on Enamel Remineralization: An in situ Study

Objective: To evaluate the remineralizing potential of a conventional toothpaste (1,100 ppm F) supplemented with nano-sized sodium hexametaphosphate (HMPnano) in artificial caries lesions in situ. Design: This double-blinded crossed study was performed in 4 phases of 3 days each. Twelve subjects used palatal appliances containing 4 bovine enamel blocks with artificial caries lesions. Volunteers were randomly assigned into the following treatment groups: no F/HMP/HMPnano (Placebo); 1,100 ppm F (1100F); 1100F plus 0.5% micrometric HMP (1100F/HMP) and 1100F plus 0.5% nano-sized HMP (1100F/HMPnano). Volunteers were instructed to brush their natural teeth with the palatal appliances in the mouth for 1 min (3 times/day), so that blocks were treated with natural slurries of toothpastes. After each phase, surface hardness post-remineralization (SH2), integrated recovery of subsurface hardness (ΔIHR), integrated mineral recovery (ΔIMR) and enamel F concentration were determined. Data were submitted to analysis of variance and Student-Newman-Keuls’ test (p < 0.001). Results: Enamel surface became 42% harder when treated with 1100F/HMPnano in comparison with 1100F (p < 0.001). Treatment with 1100F/HMP and 1100F/HMPnano promoted an increase of ∼23 and ∼87%, respectively, in ΔIHR when compared to 1100F (p < 0.001). In addition, ΔIMR for the 1100F/HMPnano was ∼75 and ∼33% higher when compared to 1100F and 1100F/HMP respectively (p < 0.001). Enamel F uptake was similar among all groups except for the placebo (p < 0.001). Conclusion: The addition of 0.5% HMPnano to a conventional fluoride toothpaste was able to promote an additional remineralizing effect of artificial caries lesions.

The effect of a triclosan/copolymer/fluoride toothpaste on plaque formation, gingivitis, and dentin hypersensitivity: A single-blinded randomized clinical study.

The daily removal of supragingival dental plaque is a key factor in the prevention of gingivitis. The aim of the study was to compare the gingival health benefits of a triclosan/copolymer/fluoride toothpaste (Colgate Total, a fluoride toothpaste containing an antiseptic) to a commercially available toothpaste containing 0.243% sodium fluoride in a silica base (Colgate Herbal, a conventional fluoride toothpaste with herbal extracts). A total of 50 patients with gingivitis and at least one sensitive tooth were included. The subjects were randomly stratified into two groups: Colgate Total toothpaste, and Colgate Herbal toothpaste. After a 4-week pre-experimental phase, baseline Plaque Index (Quigley-Hein Index) (PI), Gingival Index (GI), Gingival Bleeding Index (GBI), and Visual Analog Scale (VAS) were assessed. The PI, GI, GBI, and VAS were reexamined at weeks 4, 12, and 24 after the baseline. Fifty subjects complied with the protocol and completed the study. The conventional fluoride toothpaste with herbal extracts group and the fluoride toothpaste containing an antiseptic group exhibited significant reductions in PI, GI, GBI, and VAS over time. The amount of reduction after 6 months of the treatment was higher in the Total group compared to Herbal group (1.82 vs 1.39, P = .015 for PI; 0.67 vs 0.37, P < .005 for GI; and 56.64% vs 34.26%, P < .005 for GBI). No significant difference was seen for VAS. Twice daily brushing with a toothpaste containing 0.3% triclosan and polyvinyl methyl ether and maleic acid copolymer provides a more effective level of plaque control and gingival health with no effect on decreasing dentin hypersensitivity compared to conventional fluoride toothpaste. Toothpastes containing triclosan/copolymer, in addition to fluoride, result in a higher reduction in plaque, gingival inflammation, and gingival bleeding when compared with fluoride toothpastes without triclosan/copolymer.

Dental caries, fluorosis, oral health determinants, and quality of life in adolescents.

This study aimed to assess the extent to which dental caries and fluorosis, in addition to sociodemographic and oral health behavior determinants, impact the oral health-related quality of life (OHRQoL) of adolescents. All adolescents attending from sixth to eighth grades in the Region of Itapoã, Federal District of Brazil (n=1122), were screened, and 618 10-15-year-olds were selected. Parents answered a questionnaire about their family's socioeconomic status. Adolescents answered a questionnaire about demographic and oral health behavior determinants in addition to the Child Perception Questionnaire. Cavitated dentine lesions and fluorosis were observed in 39.5 and 48.5%, respectively. The outcome was a high score on OHRQoL (median split >9). The prevalence of adolescents with at least one domain being impacted "often" or "every day/almost every day" was 34.8%. Adolescents with tooth brushing frequency ≤once per day and with moderate or severe cavitated dentine lesions reported a significant impact on their OHRQoL (p=0.002; p=0.001). Fluorosis did not impact daily life performances (p=0.545). Increased impact on OHRQoL was related to the severity of cavitated dentine lesions, but fluorosis resulting from combined fluoride exposure from early ages was not of concern for the adolescents. Combined fluoride exposure from fluoridated drinking water, consumption of food prepared with fluoridated water, and daily twice brushing with conventional fluoride toothpaste from early ages may be recommended to control caries progression at population level without impact on OHRQoL. This information is particularly relevant for supporting oral health police for disadvantaged populations.

Arginine promotes fluoride uptake into artificial carious lesionsin vitro

This study focused on the interaction of arginine and fluoride on the remineralization of artificial enamel carious lesions in vitro. Human enamel blocks with artificial carious lesions were prepared and randomly divided into six treatment groups (n=30 for each group): deionized water, arginine solution, NaF solution, arginine/NaF solution, arginine-free fluoride toothpaste slurry and arginine-containing fluoride toothpaste slurry. After a pH-cycling regimen for 10 days, subsets of specimens from each group were subjected to independent analysis, including surface microhardness (n=8/30), cross-sectional microhardness (n=8/30), enamel fluoride uptake (n=8/30) and polarized light microscopy (n=6/30). The samples tested for surface microhardness were further subjected to simulated plaque acid challenge before surface microhardness was remeasured. Arginine solution promoted remineralization compared with deionized water control (p<0.05). When used in combination with fluoride, arginine significantly increased fluoride uptake compared with fluoride alone (p<0.05). In addition, lesions treated with arginine-containing toothpaste also showed superior fluoride uptake compared with those treated with conventional fluoride toothpaste (p<0.05). Arginine promoted enamel fluoride uptake when used in combination with fluoride, thereby contributing to resistance of enamel to carious demineralization.

Prevention of dentine erosion by brushing with anti-erosive toothpastes

ObjectiveThis in vitro study aimed to investigate the preventive effect of brushing with anti-erosive toothpastes compared to a conventional fluoride toothpaste on dentine erosion. Materials and methodsBovine dentine specimens (n=12 per subgroup) were eroded in an artificial mouth (6 days, 6×30s/day) using either citric acid (pH:2.5) or a hydrochloric acid/pepsin solution (pH:1.6), simulating extrinsic or intrinsic erosive conditions, respectively. In between, the specimens were rinsed with artificial saliva. Twice daily, the specimens were brushed for 15s in an automatic brushing machine at 2.5N with a conventional fluoride toothpaste slurry (elmex, AmF) or toothpaste slurries with anti-erosive formulations: Apacare (NaF/1% nHAP), Biorepair (ZnCO3-HAP), Chitodent (Chitosan), elmex Erosionsschutz (NaF/AmF/SnCl2/Chitosan), mirasensitive hap (NaF/30% HAP), Sensodyne Proschmelz (NaF/KNO3). Unbrushed specimens served as control. Dentine loss was measured profilometrically and statistically analysed using two-way and one-way ANOVA followed by Scheffe‘s post hoc tests. RDA-values of all toothpastes were determined, and linear mixed models were applied to analyse the influence of toothpaste abrasivity on dentine wear (p<0.05). ResultsDentine erosion of unbrushed specimens amounted to 5.1±1.0μm (extrinsic conditions) and 12.9±1.4μm (intrinsic conditions). All toothpastes significantly reduced dentine erosion by 24–67% (extrinsic conditions) and 21–40% (intrinsic conditions). Biorepair was least effective, while all other toothpastes were not significantly different from each other. Linear mixed models did not show a significant effect of the RDA-value of the respective toothpaste on dentine loss. ConclusionToothpastes with anti-erosive formulations reduced dentine erosion, especially under simulated extrinsic erosive conditions, but were not superior to a conventional fluoride toothpaste.

Oral and peri-oral signs and symptoms of herbal dentifrices in patients in two oral medicine clinics in Lagos—A preliminary study

Background: Herbal dentifrices appear to have become an attractive alternative for some consumers and its use has gained appreciable acceptance in Nigeria. This could be partly due to the perception that herbal toothpastes like other herbal products are “natural”, devoid of chemicals and therefore superior to regular toothpastes. Aggressive advertisement of the products may also contribute to this new trend. Mucosal symptoms such as glossitis and intolerance to spicy foods seen in patients attending the oral diagnosis clinic are usually associated with anaemia and nutritional deficiency states. The disturbing trend of an increasing number of patients presenting with such oral mucosal symptoms associated with the use of herbal dentifrices prompted this study. This trend was observed in two isolated oral medicine clinics. Objective: To sensitize oral health, allied professionals and consumers on the possible adverse effects of regular use of some herbal dentifrices sold in Nigeria. Materials and Methods: Routine patients of two oral medicine clinics in Lagos, namely the Randle General Hospital and the Lagos University Teaching Hospital who complained of some adverse mucosal signs and symptoms following the regular use of two identified herbal toothpastes made up the study population. The study was conducted between April 2010-April 2011. A detailed history and examination was carried out on these patients and clinical photographs of oral signs observed was taken in consenting patients. Data analysis was done using the Epi-info 6 software. P values ≤ 0.05 was considered statistically significant and data was presented in table format. Results: A total of 45 patients, 9 (20%) males and 36 (80%) fe-males were seen. The age range of patients was 14 - 78 years; mean age 45.5 ± 14.9 years. The duration of use of herbal dentifrices ranged from 2 weeks - 84 months (mean 24 ± 11.5 months). Oral signs and symptoms seen include, burning mouth and peppery sensation, mucosal erythema, lichenoid reaction, xerostomia, loss of taste sensation, angio-oedema and oral and peri-oral pigmentation. In many patients, resolution of symptoms was progressive within 2 weeks of withdrawal of the herbal toothpaste and its replacement with a conventional fluoride toothpaste. Most of the patients however required further treatment. A statistically significant association was found between the use of the identified herbal dentifrices and the following mucosal signs and symptoms namely, burning mouth and peppery sensation ,loss of taste sensation, soreness, erythema and lichenoid straie (p value ≤ 0.05). There was no statistically significant association between the use of herbal toothpaste and mucosal signs and symptoms of xerostomia, angular cheilitis, mucosal itching, angio-oedema and numbness (p value > 0.0.5) Conclusion: The regular use of the herbal dentifrices identified in this study can result in oral signs and symptoms affecting taste , nutrition, aesthetics and general oral physiology in some consumers. These findings suggest that further long term clinical trials need to be conducted on the herbal dentifrices to identify the noxious agents causing these symptoms. The formulation and use of these dentifrices need to be standardized and regulated. There is also a need to formulate a treatment protocol for these patients.

A study to assess the plaque inhibitory action of herbal-based toothpaste: A double blind controlled clinical trial

Incorporating herbal extracts in the formulation of toothpastes is becoming an accepted mode of chemical plaque control. This study has been conducted to determine whether an herbal-based toothpaste would inhibit de novo plaque formation beyond that of a conventional fluoride Toothpaste. Fifteen adult volunteers, meeting the inclusion criteria (age range19 - 22) participated in a double-blind, cross-over controlled clinical trial, based on a variation of a 4 day plaque regrowth model. After professional tooth cleaning, subjects were asked to refrain from all mechanical hygiene measures for the next 96 h, and to use two rinses (1 min) a day as the only oral hygiene measure. At day 4, teeth were stained to assess the whole mouth plaque index (PI) using Turesky modification of Quigley Hein PI (TMQH), and to evaluate the PI for anterior teeth using a 10 scaled method of plaque scoring (NMPS). Herbal-based toothpaste provided statistically significant plaque inhibitory action measured by whole mouth plaque index, over control toothpaste (P = 0.032). There was no significant difference between test and control dentifrices in plaque index for anterior teeth using NMPS index. Pearson´s correlation coefficient showed significant values indicating close similarity between the two indices (r = 0.962, P < 0.0001). This study demonstrated the effectiveness of herbal-based toothpaste in the control of dental plaque formation over control paste. Further investigation into the potential value of this formulation among target population is recommended. Key words: Plaque inhibition, herbal based toothpaste, clinical trial, plaque index.

The Anticaries Effects of Low Fluoride Formulations of Toothpaste may be Different in Caries-Active and Caries-Inactive Children

Article Title and Bibliographic Information Low-fluoride dentifrice and caries lesion control in children with different caries experience: a randomized clinical trial. Lima TJ, Ribeiro CC, Tenuta LM, Cury JA. Caries Res 2008;42(1):46-50. Level of Evidence Level 2: Limited-quality, patient-oriented evidence. Strength of Recommendation Grade Not applicable. Purpose/Question How does caries status compare in caries-active and caries-inactive children aged 2 to 4 after using low-fluoride (500 μg F/g) or conventional fluoride (1100 μg F/g) toothpaste for 12 months in an area with low levels of fluoride in the water Source of Funding Not stated but toothpaste and brushes for the study provided by Colgate-Palmolive. Type of Study/Design Randomized controlled trial.

The prevention of plaque re‐growth by toothpastes and solutions containing block copolymers with and without polypeptide

Chemicals which have a direct effect at inhibiting or reducing bacterial adherence to tooth surfaces may subsequently inhibit plaque growth and reduce gingival inflammation. This study investigated whether two anti-adherent systems could inhibit plaque re-growth in the mouth when rinsed as a solution or as a toothpaste slurry. A total of 21 subjects took part in a partially blind, seven cell cross-over study which compared the effects on plaque re-growth of a binary system containing block copolymers, a ternary system containing block copolymers and polypeptide, both used as toothpaste slurry rinses, their corresponding solution rinses, a conventional fluoride toothpaste rinse, a positive control chlorhexidine rinse and a negative water control. Following a dental prophylaxis subjects then rinsed with 10 ml of one of the test products for 1 min. twice a day over a 4-day period. Throughout each trial period the subjects were not permitted to use any other forms of oral hygiene. On the fifth day (96 h), the volunteers returned to the clinic, and plaque was assessed by (1) plaque index and (2) plaque area following disclosing with a food dye. The test phase of the trial was repeated for each agent and was followed by a 10-day "washout" period. Essentially neither of the anti-adherent systems inhibited plaque re-growth, whether administered in a toothpaste slurry or solution compared with the controls. If anything, neither of the test pastes were as effective as the marketed commercial paste (p<0.001). As expected plaque recorded following use of the chlorhexidine rinse was significantly less than that seen with any of the other rinses (p<0.001). Using this 4-day plaque re-growth model, the findings of this study failed to show any benefit in using the anti-adherent systems, either in a rinse or toothpaste, with the aim of inhibiting or reducing plaque formation.

In vitro chemical stain removal by 'whitening' toothpastes

This paper: Background A considerable number of toothpastes are available as tooth whitening products. Most appear to contain ingredients that might remove extrinsic stains rather than change natural tooth colour. Extrinsic stain removal could be achieved by physical or chemical means. Aim The purpose of this study was to measure the chemical stain removal properties of a range of whitening toothpaste products and experimental formulations using a standardised method in vitro. Materials and method 5 separate studies were conducted involving a total of 39 agents of which 28 were whitening products, 7 were experimental formulations, 2 were oxidising mouthrinses used as positive controls, 1 was a popular fluoride toothpaste product as a benchmark control, and 1 was water as the negative control. The formulations and controls varied in each study. The stain model was saliva/chlorhexidine/tea stain developed on optically clear acrylic to an optical density of at least 2.0. Groups of stained specimens were exposed to standard slurries or solutions of each test agent for 1 minute periods up to 5 minutes. Optical density readings were taken at each 1 minute time point. Analyses were based on per cent stain remaining after 5 minutes and time to 75% stain remaining. Results 3 toothpaste products achieved 100% stain removal by 5 minutes; 2 of these in 3 out of 4 studies in which they were used. 4 experimental formulations also achieved 100% stain removal. In general agents with high total stain removal also had short times to 75% stain remaining. The majority of agents tested had low total chemical stain removal and prolonged times to 75% stain remaining. A few agents were little different from water and several similar in effect to the conventional fluoride toothpaste. This method in vitro tests agents under the best case scenario conditions for chemical stain removal. Conclusion Only a small number of the whitening toothpaste products have good chemical stain removal potential; the majority are unlikely to achieve their claimed benefits through chemical stain removal. There is clearly a need for further data on the actual effects of such products using both methods in vitro and particularly in vivo or in situ.

Improvement of oral hygiene in patients with rheumatoid arthritis

Programs in power toothbrushing, manual toothbrushing with conventional fluoride toothpaste and with a chlorhexidine/fluoride gel has been evaluated for plaque removal in an observer blind cross-over clinical trial on 14 rheumatoid arthritis patients. All three regimens lead to considerable improvement in oral hygiene. The use of an electric toothbrush was slightly more effective than a manual brush. Brushing with a chlorhexidine/fluoride gel gave the best results, but its clinical use is limited by unacceptable taste, discoloration and possibly adverse soft tissue effects.