Conventional Toothpaste Research Articles

Analysis of Heavy Metal Content in Conventional and Herbal Toothpastes Available at Maltese Pharmacies

Although toothpastes are considered as topical cosmetics that are not normally ingested, it is evident that they may contribute to the introduction of heavy metals and xenobiotics through buccal and gastrointestinal absorption. The purpose of this study was to determine the potential presence of metals and polyphenols in conventional, children’s and herbal toothpastes. Metal analysis was conducted by using the Microwave Plasma-Atomic Emission Spectrometer and the total polyphenolic content was determined by using the Folin–Ciocalteu test. Results showed that cadmium and mercury were absent in all toothpastes while zinc and tin exhibited high values. This was because the latter two metals are incorporated as part of the ingredients. In the case of polyphenols, the highest value was obtained in one of the samples from the children’s toothpaste category while the lowest value was obtained from the conventional toothpaste category. Lead and nickel were two other metals that fell outside the limits for EU and US standards. Most of these limits are usually applicable to topical cosmetic products or food products. However, these may not adequately cover oral hygiene products, such as toothpastes.

Clinical Assessment of Rosemary-based Toothpaste (Rosmarinus officinalis Linn.): A Randomized Controlled Double-blind Study.

The present study was to investigate the action of a toothpaste made from the extract of Rosmarinus officinalis Linn. (rosemary) in a clinical randomized, controlled, open and double-blind trial. One hundred and ten volunteers fulfilled the inclusion criteria and were randomly separated into two groups according to the toothpastes used: Group A (experimental) and Group B (control). They were assessed at baseline and 30 days after the study using the gingival bleeding index (GBI) and the plaque index (PI). Data analysis was conducted to calculate the effects of the two toothpastes on gingival bleeding and plaque, using measurements such as the excess relative risk (ERR), the Relative Risk Reduction (RRR), the Absolute Risk Reduction (ARR) and the Number Needed for Treatment (NNT). The two toothpastes provided similar results in terms of the reduction in the risk of gingival bleeding (relative and absolute): a reduction of 38% in Group A, ERR=0.38; a reduction of 29.3% in Group B, ERR=0.293; A and B reduced by 18% ARR=0.18). The reductions in bacterial plaque were also similar (22.7% reduction in Group A, RRR=0.227; 28% reduction in Group B, RRR= 0.28). The number needed for treatment values for bleeding and plaque were A and B NNT=5 and A and B NNT=7, respectively. The rosemary-based toothpaste effectively treated gingival bleeding and reduced bacterial plaque, when compared with conventional toothpaste.

Whitening toothpaste containing activated charcoal, blue covarine, hydrogen peroxide or microbeads: which one is the most effective?

The efficacy of whitening toothpastes is questionable and controversial. Clinicians, patients and researchers have expressed concern with whitening toothpastes due to the risk of wearing the dental structure and the potential for disappointment if the advertised cosmetic results are not achieved. Objective: This study compared the whitening performance of toothpastes with different whitening technologies after initial and continued use. Material and Methods: Ninety bovine incisors were stained using a concentrated solution of black tea. They were randomly distributed into 6 groups, according to the toothpaste whitening technology: activated charcoal (B&W), blue covarine (WAD), hydrogen peroxide (LWA), microbeads (Oral B 3D White Perfection – 3DW) and optimized abrasives (XW4D). They were compared to a traditional toothpaste without a whitening agent (TA – control). Specimens underwent a brushing machine with controlled pressure, time and temperature. A calibrated examiner measured the color using a VITA-Classical scale before the first brushing cycle (T0), after the first brushing cycle (TI), and after a brushing cycle that simulates continuous use (TCU). Whitening performance was evaluated by the difference of shades (ΔSGU) between T0–TI and T0–TCU timepoints, using the Kruskal-Wallis and Dunn's non-parametric test. The Wilcoxon test was used to evaluate the cumulative effect (α=0.05). Results: Statistically significant differences were observed between toothpastes in both TI and TCU (p<0.05). The time of use also had a significant effect (p<0.05). Conclusion: Only WAD and 3DW showed whitening performance after the first use (TI). The greatest whitening performance after continuous use was obtained by WAD, followed by LWA and 3DW. The use of conventional toothpaste (TA) promotes no tooth whitening. Clinical relevance: Microbead abrasives (3DW) and blue covarine (WAD) were the active technology tested that presented the best global tooth whitening performance.

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 fundamental study of antimicrobial activity of Piper betle extract in commercial toothpastes

Piper betle L., also known as betel leaf, has been shown to possess many medicinal properties and has a long history of traditional use, especially its application in the improvement of oral health. In recent years, extracts of Piper betle have gained attention for their ability to inhibit microbial growth. The effective extraction of the phytochemicals responsible for this antimicrobial activity is essential if their properties are to be utilized in real life applications. In this study, the effects of different solvents (ethanol and water) on the extraction of the bioactive compounds were investigated. 95% ethanol was found to recover the highest phenolic content of 840 mg GAE/g, followed by 50% ethanol with 460 mg GAE/g and water with the lowest at 200 mg GAE/g. With its high phenolic content, the 95% ethanol extract was blended into 3 existing, commercially available, toothpastes to evaluate its antimicrobial activity. The extract combined with conventional toothpastes, each with different active ingredients, were subjected to four oral bacterial pathogens, Escherichia coli, Staphylococcus aureus, Streptococcus mutans and Streptococcus salivarius, as well as the oral fungal pathogen Candida albicans, via agar well diffusion assay. A statistically significant increase in the zone of inhibition after the addition of the P.betle extract was observed with all 3 toothpastes in all bacterial and fungal pathogens tested. The greatest increase in ZOI was 24.6% for the bacterial pathogens and 20.3% for the fungal pathogen, showcasing the potential use of Piper Betle extract as an effective antimicrobial agent for use in oral products.

Effect of Over-the-counter Whitening Products associated or Not with 10% Carbamide Peroxide on Color Change and Microhardness: in vitro Study

Aim: The purpose of this in vitro study was to evaluate the color and microhardness of teeth subjected to different over-the-counter (OTC) whitening products in association or not with 10% carbamide peroxide (10% CP). Materials and methods: Enamel-dentin specimens (n = 210) were obtained from bovine incisors and stained. Half of the specimens were then subjected to daily cycles of staining (5 minutes), 10% CP bleaching (8 hours) in association with OTC products, and artificial saliva storage until complete 24 hours, for 2 weeks; the other half was subjected to daily cycles of staining, OTC treatment, and storage in artificial saliva for 12 weeks. The specimens were divided into 14 groups according to the OTC: CP-Water and Water (deionized water); CP-Listerine and Listerine (whitening mouth rinse); CP-Brushing and Brushing (mechanical brushing); CP-Colgate and Colgate (conventional toothpaste), CP-ColgateW and ColgateW, CP-OralBW and OralBW, and CP-CloseUpW and CloseUpW (whitening toothpaste). After staining and whitening, color and microhardness were measured. Data were submitted to analysis of variance (ANOVA) and the Tukey's test for multiple comparisons for color analysis and the paired t-test for microhardness analysis. Results: The CP and CloseUpW groups had the largest color change (AE00). The teeth treated with Colgate increased significantly in microhardness after whitening. Conclusion: The association of 10% CP with OTC whitening agents did not increase the whitening effect or microhardness. The OTC agents containing hydrogen peroxide and abrasives had a similar effect to one another but were not as effective as the CP groups and the subgroup brushed only with blue covarine toothpaste. Clinical significance: The current study provides information about the mechanism of OTC whitening products. None of the whitening agents evaluated damaged the enamel when used according to the manufacturers' instructions. The use of toothpaste containing hydrogen peroxide or abrasives cannot provide a whitening effect similar to at-home bleaching, and this does not improve with the association with 10% CP. However, toothpaste containing blue covarine has a satisfactory whitening effect immediately after brushing. Keywords: Laboratory research, Mouthwashes, Tooth bleaching, Toothpaste.

The In vitro Evaluation of the effect of xyliwhite, probiotic, and the conventional toothpastes on the enamel roughness and microhardness.

The aim of this study was to evaluate the effect of fluoride, Xylitol, Probiotic, and Whitening toothpastes on the permanent teeth enamel roughness and microhardness. One hundred and twenty teeth were randomly divided into 2 groups, each group having 60 samples. G1: The group in which enamel roughness was examined (n = 60). G2: The group in which enamel microhardness was examined (n = 60). Then, these groups were randomly divided into 4 groups among themselves (n = 15). Each group was brushed using four different toothpastes for 1 week with a battery-powered toothbrush in the morning and evening for 2 min. Vicker's hardness tester was used to measure the changes in microhardness, and the profilometer was used to measure the changes in surface roughness. No statistically significant differences were found on surface roughness and microhardness values measured after tooth brushing process in group brushed with Colgate MaxFresh toothpaste (P > 0.01). Statistically significant decrease was observed on Vicker's hardness values measured after tooth brushing process in groups brushed with Ipana White Power Carbonate toothpaste, Xyliwhite Toothpaste Gel, and Periobiotic Probiotic Toothpaste (P < 0.01). Statistically significant increase was observed on surface roughness values in groups brushed with Ipana White Power Carbonate toothpaste, Xyliwhite Toothpaste Gel, Periobiotic Probiotic Toothpaste (P < 0.01). As a result, Colgate MaxFresh abrasive-free toothpaste with fluoride has no effect on permanent tooth enamel surface roughness and microhardness. Xyliwhite, Periobiotic, and Ipana White Power Carbonate-containing abrasive toothpastes led to changes negatively on permanent tooth enamel surface roughness and microhardness.

Comparison of two commercial dentifrices in the reduction of gingivitis and plaque: A pilot study

Objectives: Chlorhexidine (CHX) and triclosan are the most used chemical agents in dentistry. However, the combination of these products has never been tested. We hypothesize that the addition of CHX to a triclosan dentifrice formulation may offer additional benefits in the reduction of plaque and gingivitis. Thus, the aim of this study was to compare a commercial dentifrice containing 0.05% chlorhexidine and 0.3% triclosan, with conventional toothpaste containing 0.3% triclosan, in the treatment of gingivitis and plaque reduction. Material and Methods: Thirty volunteers were randomly assigned to receive a dentifrice containing 0.05% CHX and 0.3% triclosan (CHX/triclosan group) or a dentifrice containing basically 0.3% triclosan (Triclosan group). Subjects received clinical evaluation such as gingival index (GI) and plaque index (PI) at baseline, 30 and 60 days. Results: After 60 days, both treatments led to a significant improvement in GI and PI. There was no significant difference between groups as regards change in GI and PI (p&gt;0.05). Conclusion: The combination of 0.05% CHX with 0.3% triclosan did not offer further benefits to gingival inflammation and plaque control when compared with a dentifrice containing 0.3% triclosan.KeywordsChlorhexidine; CHX dentifrice; Triclosan; Plaque; Gingivitis.

Assessment of cytotoxic and genotoxic effects of conventional and whitening kinds of toothpaste on oral mucosa cells

Objective: This study aimed to evaluate possible DNA damages to oral epithelial cells exposed to whitening kinds of toothpaste considering the effect of conventional non-whitening toothpaste.Materials and methods: Sixty volunteers were assigned into three experimental groups, each of them using a different regular toothpaste for the initial 2 months, followed by the use of whitening kind of toothpaste of the same brand for next 2 months. The oral epithelial cells were sampled prior and 30, 60, 90 and 120 days after the beginning of the use of tested kinds of toothpaste. Chromosomal damages were analyzed by micronucleus assay.Results: For just one kind of tested whitening toothpaste was observed the significant increase in the number of micronucleated cells after 60 days of use compared values obtained 60 days of usage of conventional non-whitening toothpaste (6.35 ± 3.67 and 2.8 ± 1.91; p < .05). There was no statistically significant difference in other micronucleus assay endpoints between tested types of toothpaste at either of the sampling times during the period of toothpaste application.Conclusions: Based on the results, it can be concluded that the use of certain whitening kinds of toothpaste may cause a limited biologically insignificant genotoxic effect on buccal epithelial cells.

Effect of fluoride toothpaste with nano-sized trimetaphosphate on enamel demineralization: An in vitro study

ObjectiveThis study evaluated the effect of toothpastes containing 1100ppm F associated or not with micrometric or nano-sized sodium trimetaphosphate (TMP) on enamel demineralization in vitro, using a pH cycling model. DesignBovine enamel blocks (4mm×4mm, n=96) were randomly allocated into eight groups (n=12), according to the test toothpastes: Placebo (without fluoride or TMP); 1100ppm F (1100F); 1100F plus micrometric TMP at concentrations of 1%, 3% or 6%; and 1100F plus nanosized TMP at 1%, 3% or 6%. Blocks were treated 2×/day with slurries of toothpastes and submitted to a pH cycling regimen for five days. Next, final surface hardness (SHf), integrated hardness loss (IHL), differential profile of integrated hardness loss (ΔIHL) and enamel fluoride (F) concentrations were determined. Data were analyzed by ANOVA and Student-Newman-Keuls’ test (p<0.05). ResultsThe use of 1100F/3%TMPnano led to SHf 30% higher (p<0.001) and IHL∼80% lower (p<0.001) when compared to 1100F. This toothpaste also resulted in ∼64% reduction of mineral loss (ΔIHL) when compared to 1100F. Moreover, the addition of nano-sized TMP promoted increases in enamel F uptake of 90%, 160% and 100%, respectively for the concentrations of 1%, 3% and 6%, when compared to 1100F (p<0.001). ConclusionThe addition of nano-sized TMP at 3% to a conventional toothpaste significantly decreased enamel demineralization when compared to its counterparts without TMP or supplemented with micrometric TMP.

Toothpaste with Nanosized Trimetaphosphate Reduces Enamel Demineralization.

This double-blind crossover study assessed the effects of a low-fluoride (low-F) dentifrice containing nanosized sodium trimetaphosphate (TMP) on enamel demineralization in situ. Nineteen subjects wore palatal appliances containing 4 blocks of bovine enamel and were randomly assigned to brush their teeth with placebo (without F/TMP), 250-ppm F (250F), 250F plus 0.05% nanosized TMP (250F-TMPnano), and 1,100-ppm F (1,100F) dentifrices during 7 d, under cariogenic challenge. Enamel surface hardness and cross-sectional hardness (ΔKHN [Knoop hardness number]), as well as F, calcium (Ca), and phosphorus (P) concentrations, were determined. Also, biofilm that formed on the blocks was analyzed for F, Ca, P, and insoluble extracellular polysaccharide concentrations. Data were submitted to analysis-of-variance models and Student-Newman-Keuls test ( P < 0.05). The 250F-TMPnano dentifrice promoted the lowest ΔKHN among all groups ( P < 0.001), while the percentage of surface hardness loss was similar to 1,100F. Also, similar F, Ca, and P concentrations in enamel were observed for 1,100F and 250F-TMPnano. In the biofilm, the highest F content was observed for 1,100F; Ca content was similar between 1,100F and 250F-TMPnano; and P content was similar among all groups. Similar extracellular polysaccharide values were observed for 250F-TMPnano and 1,100F ( P < 0.001), ionic activity of CaHPO40, CaF+, and HF0 ( P < 0.05) and degree of saturation of hydroxyapatite and CaF2 ( P < 0.05). It was concluded that the protective effect of 250F-TMPnano dentifrice was similar to a conventional dentifrice for most of the variables studied, having a more pronounced effect on the subsurface lesion when compared with the conventional toothpaste (1,100F). Knowledge Transfer Statement: Although toothpastes containing ≥1,000-ppm fluoride are more effective than low-fluoride formulations against dental caries, their early use can lead to side effects. This has prompted intensive research on alternatives to increase the anticaries effect of low-fluoride toothpastes. The present in situ study demonstrated that the addition of sodium trimetaphosphate nanoparticles to toothpastes containing 250-ppm fluoride significantly enhances the protective effect of this formulation against enamel demineralization to levels comparable to a 1,100-ppm fluoride toothpaste in terms of most of the variables studied. Most important, this formulation promoted the lowest loss of subsurface hardness among all groups, suggesting that caries lesions would take longer to develop under clinical conditions when compared with a conventional (1,100-fluoride) toothpaste.

Sodium trimetaphosphate enhances the effect of 250 p.p.m. fluoride toothpaste against enamel demineralization in vitro.

This in vitro study investigated the effect of sodium trimetaphosphate (TMP), added to toothpaste containing 250 p.p.m. fluoride, on enamel demineralization. Bovine enamel blocks (n = 96) were subjected to five pH cycles over a 7-d period and treatment with suspensions of toothpastes containing 0, 250, 500, and 1,100 p.p.m. fluoride (as sodium fluoride), as well as with 250 p.p.m. fluoride containing TMP at 0.25, 0.5, 1.0, and 3.0%. Treatment with toothpaste suspensions was performed under agitation twice a day, for 1 min. Surface and cross-sectional hardness, and fluoride firmly bound to enamel, were quantified. Data were subjected to one-way anova, followed by Tukey's test. Low-fluoride toothpastes containing TMP at 0.25-1.0% resulted in enamel mineral loss similar to that seen for the toothpaste containing 1,100 p.p.m. fluoride. Also, the addition of TMP to the toothpaste containing 250 p.p.m. fluoride promoted enamel fluoride concentrations similar to those obtained for the 500 p.p.m. fluoride group. The toothpaste containing 250 p.p.m. fluoride and 0.25% TMP led to the lowest mineral loss among all groups. It was concluded that the addition of as little as 0.25% TMP to a toothpaste containing 250 p.p.m. fluoride can reduce enamel demineralization to levels similar to those seen for a conventional toothpaste containing 1,100 p.p.m. fluoride, in vitro.

Effect of Whitening Dentifrice on Micro Hardness, Colour Stability and Surface Roughness of Aesthetic Restorative Materials

Whitening agents present in the novel whitening dentifrices may have deleterious effects over the aesthetic restorations. The present study evaluated the invitro effect of whitening dentifrice on micro hardness, colour stability and surface roughness on aesthetic restorative materials. Forty specimens each of compomer and of composite were prepared using brass mould. Specimens were equally divided into 4 groups. Group I (20 disks of compomer are subjected to brushing with conventional tooth paste) Group II (20 disks of composite subjected to brushing with conventional tooth paste), Group III (20 disks of compomer subjected to brushing with whitening tooth paste). Group IV (20 disks of composite subjected to brushing with whitening toothpaste). Each group was further divided into two subgroups, where 10 sample were subjected for two weeks of brushing with respective tooth paste and other 10 were subjected for four weeks of brushing. For the evaluation of micro hardness, colour stability and surface roughness, micro hardness testing machine, spectrophotometer and surface testing machine were used respectively. Initial and final readings were taken for each specimen and difference obtained was subjected to statistical analysis. One-way ANOVA was used for multiple group comparison followed by post-hoc Tukey's-test. The paried t-test was used for intra group comparison and unpaired t-test for comparing independent sample groups. The compomer and composite showed no significant difference in micro hardness either with conventional or whitening tooth paste both at two and four weeks. Although there was a highly significant colour change observed after using whitening tooth paste for both compomer and composite. Regarding surface roughness, there was a significant change in roughness in both conventional and whitening tooth paste with compomer and composite. However, whitening tooth paste had a significant change in surface roughness compared with conventional tooth paste. Roughness further increased at four weeks interval when compared to two weeks. Colour, surface-roughness and micro-hardness are the inherent properties of the aesthetic restorative materials. Use of whitening tooth paste will cause colour change and surface roughness of restorative material making it prone to deformation and also affects the clinical success of restoration.

Effectiveness of a miswak extract‐containing toothpaste on gingival inflammation: a randomized clinical trial

In this study, the efficacy of a miswak extract-containing toothpaste (Salvadora persica) on gingival inflammation was compared with that of a herbal and a conventional toothpaste. Non-smoking outpatients with sulcus bleeding index (SBI) ≥25% and with periodontal pocket depths ≤3 mm were randomly selected and divided into three groups: M-group, miswak extract-containing toothpaste; P-group, herbal toothpaste; and C-group, conventional toothpaste. After instructing the patients to brush their teeth twice a day for 3 weeks with the assigned toothpaste using a flat-trimmed manual toothbrush, a thorough oral examination was performed by a calibrated examiner (EH). The primary outcome was the SBI after 21 days. Furthermore, the amount of plaque was measured by approximal plaque index (API). Sixty-six patients with a mean age of 57.8 ± 10.2 years were recruited and enrolled. After 3 weeks of brushing, all three patient groups showed a significant reduction in SBI. The P-group (SBI reduction: 17.1% ± 9.1) and the M-group (14.5% ± 8.1) showed the strongest effect followed by the C-group (9.4% ± 7.8). All three groups showed a significant reduction in API without significant differences between the groups. The use of each of the three tested toothpastes caused a significant reduction in gingival inflammation and amount of plaque. The miswak extract-containing toothpaste showed a similar effect as the herbal toothpaste and can be safely used for domestic oral hygiene in patients with gingivitis.

Synergistic effect of fluoride and sodium hexametaphosphate in toothpaste on enamel demineralization in situ

ObjectiveTo evaluate the effect of a fluoride dentifrice containing sodium hexametaphosphate (HMP) on enamel demineralization in situ. MethodsThis double-blind and cross-over study consisted of 3 phases (7 days each) in which 12 volunteers wore intraoral appliances containing four enamel bovine blocks. Specimens were treated (3×/day) with placebo (no F or HMP), 1100ppm F (1100F) and 1100F plus HMP1% (1100F-HMP1%) toothpastes, and the cariogenic challenge was performed using a 30% sucrose solution (6×/day). Final surface hardness, the percentage of surface hardness loss (%SH), the integrated loss of subsurface hardness (ΔKHN), as well as enamel calcium (Ca), phosphorus (P) and firmly-bound fluoride (F) were determined. Also, biofilm formed on the blocks were analyzed for F, Ca, P and insoluble extracellular polysaccharide (EPS) concentrations. Data were submitted 1-way ANOVA, followed by Student–Newman–Keuls’ test (p<0.05). Results1100F-HMP1% promoted the lowest %SH and ΔKHN among all groups (p<0.001). The addition of HMP1% to 1100F did not enhance enamel F uptake, but significantly increased enamel Ca concentrations (p<0.001). Similar EPS concentrations were seen for 1100F-HMP1% and 1100F groups (p>0.05). All the groups were supersaturated with respect to HA. However, only 1100F-HMP1% group was supersaturated with respect to CaF2 (p<0.05). The ionic activities of F−, CaF+ and HF0 for the 1100F-HMP1% group were the highest among all groups (p<0.001). ConclusionThe addition of HMP1% to a conventional toothpaste significantly reduces enamel demineralization in situ when compared to 1100F. Clinical relevanceThis dentifrice could be a viable alternative to patients at high risk of caries.

In Vitro Evaluation of the Efficacy of Different Over-the-Counter Products on Tooth Whitening

This in vitro study evaluated the whitening effect of four different over-the-counter products compared with a 10% carbamide peroxide (CP) bleaching gel. Specimens obtained from bovine incisors were stained in a tea solution and randomly divided into six groups according to the product used (n=10): CT: conventional toothpaste (negative control); CWT: Crest 3D White toothpaste; CWR: Crest 3D White mouth rinse; CWS: Crest 3D White strips; DW: Dazzling White (paint-on gel); and OP: Opalescence PF 10% CP (at-home bleaching gel, positive control). Over-the-counter products and 10% CP were used according to the manufacturer's recommendations. Color measurements were performed according to the CIELab system using spectrophotometer after staining, and after 4 and 8 weeks of the treatment procedure. The ∆E, ∆L, ∆a, and ∆b values were calculated. The data obtained were analyzed by repeated-measures ANOVA. Tukey's test for multiple comparisons was applied (p<0.05). All groups, except CWT, were effective in tooth whitening in comparison with conventional toothpaste. There was no significant difference in tooth whitening between CWT and CT (p=0.93). CWS, DW and OP groups presented significantly higher color changes than the CWR group. DW and CWS showed similar tooth whitening to OP.

Effect of toothpaste with nano-sized trimetaphosphate on dental caries: In situ study

ObjectivesThis in situ study was to evaluate the remineralizing effect of a fluoride toothpaste supplemented with nano-sized sodium trimetaphosphate (TMP). MethodsThis blind and cross-over study was performed in 4 phases of 3 days each. Twelve subjects used palatal appliances containing four bovine enamel blocks with artificial caries lesions. Volunteers were randomly assigned into the following treatment groups: Placebo (without F and TMP); 1100ppm F (1100), 1100 supplemented with 3% micrometric TMP (1100 TMP) and with nano-sized TMP (1100 TMPnano). Volunteers were instructed to brush their natural teeth with the palatal appliances in the mouth during 1min (3 times/day), so that blocks were treated with natural slurries of toothpastes. After each phase, the percentage of surface hardness recovery (%SHR), integrated mineral recovery (IMR) and integrated differential mineral area profile (ΔIMR) in enamel lesions were calculated. F in enamel was also determined. Data were analyzed by ANOVA and Student–Newman–Keuls test. ResultsEnamel surface became 20% harder when treated with 1100 TMPnano in comparison with 1100 (p<0.001). 1100 TMPnano showed remineralizing capacity (IMR; ΔIMR) 66% higher when compared with 1100 TMP (p<0.001). Enamel F uptake in the 1100 TMPnano group was 2-fold higher when compared to its counterpart without TMP (p<0.001). ConclusionThe addition of 3% TMPnano to a conventional toothpaste was able to promote an additional remineralizing effect of artificial caries lesions. Clinical significanceToothpaste containing 1100ppm F associated with TMPnano showed a potential of higher remineralization to 1100ppm F and 1100ppm F micrometric TMP.

In vitro effect of sodium trimetaphosphate additives to conventional toothpastes on enamel demineralization.

The aim of this study was to evaluate the ability of conventional toothpastes (1100ppm F) supplemented with sodium trimetaphosphate (TMP) in demineralization. Blocks of enamel were selected and then divided into seven experimental groups of 12: toothpaste without F and TMP (placebo), toothpaste with 1100ppm F (1100), and toothpaste with 1100ppm F supplemented with TMP-1% (1100 1% TMP), 3% (1100 3% TMP), 4.5% (1100 4.5% TMP), 6% (1100 6% TMP), and 9% (1100 9% TMP). Blocks were subjected to five pH cycles (demineralizing/remineralizing solutions) at 37°C and treated with toothpaste slurries twice daily, after which the blocks were maintained for 2days in fresh remineralizing solution. Following treatments, surface hardness (SHf) and cross-sectional hardness were determined for calculating the integrated loss of subsurface hardness (ΔKHN). The fluoride present in the enamel was also measured. The SHf and ΔKHN measurements showed that supplementation with 3% TMP was the most effective (p < 0.001) and showed greater concentration of F in the enamel (p < 0.001). Addition of 3% TMP to a conventional toothpaste (1100ppm F) showed greater efficacy in reducing enamel demineralization. Fluoride toothpastes containing trimetaphosphate possess good anticaries potential required to reduce the prevalence of dental caries in high-risk patients.

Antimicrobial activity of toothpastes containing natural extracts, chlorhexidine or triclosan.

The objective of this in vitro study was to evaluate the antimicrobial effect of toothpastes containing natural extracts, chlorhexidine or triclosan. The effectiveness of toothpastes containing natural extracts (Parodontax®), 0.12% chlorhexidine (Cariax®), 0.3% triclosan (Sanogil®) or fluoride (Sorriso®, control) was evaluated against yeasts, Gram-positive and Gram-negative bacteria using the disk diffusion method. Water was used as a control. Disks impregnated with the toothpastes were placed in Petri dishes containing culture media inoculated with 23 indicative microorganisms by the pour plate method. After incubation, the inhibition growth halos were measured and statistical analyses (α=0.05) were performed. The results indicated that all formulations, except for conventional toothpaste (Sorriso®), showed antimicrobial activity against Gram-positive bacteria and yeasts. The toothpaste containing natural extracts (Parodontax®) was the only product able to inhibit the growth of Pseudomonas aeruginosa. The toothpastes containing chlorhexidine, triclosan or natural extracts presented antimicrobial activity against Gram-positive bacteria and yeasts.

The primary and mixed dentition, post-eruptive enamel maturation and dental caries: a review

To provide optimal fluoride effectiveness against caries while minimising risk of negative effects from excessive ingestion from toothbrushing, the fluoride dose delivered at each occasion is critical. This is particularly important for young children, so using a 'pea-sized amount' is generally recommended. However, there appears little guidance regarding what this means in practice, although it has been indicated to be 0.25 g. This study investigated, using conventional toothpastes and toothbrushes in Germany, the USA and the UK, how much toothpaste parents dispense for their 3- to 6 year-old children, and their interpretation of a 'pea-sized' amount of toothpaste. When asked to dispense the amount they would normally for their child, the majority of parents dosed substantially more than 0.25 g; in Germany, all parents over-dispensed. The amount dispensed varied widely: those parents at the 75th centile dispensed approximately twice the amount dispensed by those at the 25th centile, irrespective of country. When asked to dispense a pea-sized amount, the mean amount dosed decreased significantly in all countries. In the USA, electric toothbrush users dispensed about 0.1 g more than manual toothbrush users. While over-dispensing of fluoride toothpaste remains a cause for concern, it may be argued that the general recommendation to use a pea-sized amount of toothpaste generally works well in practice to balance the conflicting demands of risk and benefit from toothbrushing with fluoride toothpaste in young children.