Ppm Fluoride Research Articles

Relationships between parental education, choice of child dentifrice, and their children's caries experience.

The influence of parental education, choice of child dentifrice, and its impact on their children's dental caries experience remain unclear. To investigate (a) dentifrice types used by Australian pre-school children, (b) demographic factors that influence parents' dentifrice choice, and (c) whether dentifrice type is related to pre-schooler's caries experience. 155 parent-child dyads were recruited from five random metropolitan childcare centres. Parents completed a questionnaire recording relevant demographics and child dietary preferences, oral hygiene practice, and dental visits. One calibrated operator performed a clinical examination of their pre-schooler for evidence of carious lesions. Data were analysed, and comparisons between variables made using chi-square tests and regression models. 50% of pre-schoolers used <1000ppm fluoride dentifrice and 29% used non-fluoridated dentifrice. Higher parental education level was associated with the use of non-fluoridated dentifrice (P=.02, χ2 =0.034). Children with higher brushing frequency were more likely to use fluoridated dentifrice (P=.03, χ2 <0.001). The proportion of Australian pre-schoolers using non-fluoridated dentifrice was higher than in other world regions. Higher parental education level was strongly associated with choosing non-fluoridated toothpaste, which warrants further qualitative analysis to assess determinants for parents' choice of child dentifrice.

A randomised oral fluoride retention study comparing intra-oral kinetics of fluoride-containing dentifrices before and after dietary acid exposure

ObjectiveThis exploratory, randomised, single-blind, crossover, study evaluated fluoride and calcium ion concentrations and pH following use of one of two 1450 ppm fluoride (NaF), 5% w/w KNO3 dentifrices: (1) test dentifrice (with cocamidopropyl betaine) with an orange juice (OJ) rinse; (2) test dentifrice with a deionized (DI) water rinse or (3) comparator dentifrice (with sodium lauryl sulphate and tetrasodium pyrophosphate) with an OJ rinse. DesignEighteen participants used their assigned dentifrice, rinsed with DI water, then expectorate was collected. Sixty min post-brushing, participants rinsed with OJ or DI water then expectorate was collected. Saliva samples were collected pre-brushing and at 1, 5, 10, 15, 30 and 60 min post-brushing and following the 60 min OJ/DI water rinse. The pH of samples was taken. ResultsSignificant differences (p < 0.05) were found in salivary fluoride ion concentrations between test and comparator dentifrices at 30 and 60 min and following the 60 min OJ rinse, favouring the former. Significant differences were also found between test and comparator dentifrices for salivary calcium ion concentration at 1, 5 and 10 min (p < 0.0001), favouring the former, and between test or comparator + OJ rinse and test + water rinse (p < 0.005), favouring the latter. No pH differences were shown prior to OJ/water rinse. Products were generally well-tolerated. ConclusionsResults confirmed that acid-labile fluoride is released from the oral cavity following a dietary acid challenge and showed that formulation excipients may impact on retention of such.

The association of fluoride in drinking water with serum calcium, vitamin D and parathyroid hormone in pregnant women and newborn infants.

Chronic exposure to fluoride in drinking water causes an increase in plasma fluoride levels that is related to a reduction in calcium transport across the renal tubule endoplasmic reticulum and plasma membrane. In the present study, it was hypothesised that varying levels of fluoride present in drinking water are associated with serum levels of calcium and the related hormones vitamin D and parathyroid hormone in pregnant women and newborn infants. This cross-sectional study included two groups based on the fluoride concentration in drinking water. One group was considered low/optimum in which the fluoride concentration in drinking water was <1 ppm, and the other group was considered a high fluoride group with ≥1 ppm fluoride in drinking water. In each group, 90 pregnant women were recruited at the hospital during delivery. The participants were given a questionnaire regarding their medical history, sunshine exposure duration, and supplement use and a food frequency questionnaire (FFQ). Fluoride was measured in drinking water, urine, maternal serum and cord blood. Serum calcium, vitamin D, and parathyroid hormone were measured in a fully automated analyser. In pregnant women, drinking water that contained fluoride was significantly positively correlated with urine and blood serum. Low mean concentrations of vitamin D and deficient (<10 ng/ml) vitamin D were more prevalent among the high fluoride group irrespective of diet, sunshine exposure and supplementation. Serum calcium and parathyroid hormone (PTH) levels were significantly lower in the high fluoride group than in the low/optimum fluoride group in both pregnant mothers' blood and cord blood. Drinking water with high fluoride levels was significantly associated with calcium and the related hormones vitamin D and parathyroid hormone.

Radionuclide activity concentration in soil, granites and water in a fluorosis endemic area of India: An oral health perspective

BackgroundThe idea that hilly areas have a high background radiation which in turn is linked to dental fluorosis is widely held by many in India. There is little evidence to confirm this. ObjectiveThe study aimed to investigate the level of environmental radionuclide in order to determine any interrelationship between radionuclide and dental fluorosis in Pavagada, a fluorosis endemic area of Karnataka, India. MethodsGamma radionuclides (Th232, Ra226 and K40) were determined by high purity germanium (HPGe) gamma-ray spectrometer (Bq Kg-1) using a 50% relative efficiency p-type broad energy HPGe detector. Fluoride was estimated using fluoride Ion-selective electrode (ISE). Fluorosis was assessed using WHO diagnostic criteria. ResultsThe average mean +_SD activity concentration in soil for K40 was detected between 416.6 ± 9.3 and 769.1 ± 15.0. Th232 was estimated between 13.6 ± 0.6 and 57.6 ± 1.3; and Ra226 was found between 6.4 ± 0.4 and 21.6 ± 0.7. Similarly, the mean activity concentration detected (Bq kg-1) in granite for K40 ranged between 259.8 ± 6.9 and 1608.5 ± 26.9. The activity concentration of Th232 ranged between 26.4 ± 0.8 and 57.6 ± 1.3: and that of Ra226 was between 6.6 ± 0.3 and 21.6 ± 07. Drinking water contains 2.98 ppm of fluoride. Dental fluorosis was diagnosed as mild to moderate. ConclusionThe radionuclide activity in water, soil and granites were below the detection limit. Hence, the study revealed no association of fluorosis and radionuclide level in Pavagada, Karnataka, India. This helps resolve an ambiguity.

Knowledge and attitude among dental practitioners regarding the use of fluoride toothpaste for children

Aim: To evaluate the knowledge and attitude among dental practitioners in Kerala regarding the use of fluoride toothpastes for children. Materials and Methods: A cross sectional descriptive, questionnaire based online survey was conducted among 300 dental practitioners in Kerala. A Self-administered, structured online questionnaire was send to them for the assessment of their knowledge and attitude regarding the use of fluoride toothpastes in children and the data was analyzed using SPSS 18 software. Results: Among the study subjects, 40 % of the respondents considered that it is very important to brush child’s teeth with fluoride toothpaste. Whereas 66 % of them knew that 1000 ppm fluoride should be present in toothpaste for getting its benefit.70 % of the respondents recommended Kid’s fluoride toothpastefor childrenand about 20.3 % of them think kid’s toothpaste contains 1000 ppm fluoride. Only 18% of them recommended regular fluoride toothpaste for children. 60.7 % of the respondents knew about the symptoms seen when high amounts of fluoridated toothpaste were ingested. 52.3 % knew how to manage a child who had ingested high amounts of fluoride toothpaste and 64.7 % knew how to reduce the intake of toothpaste by children. 66 % of the respondents suggested twice daily brushing with fluoride toothpaste and 55 % of them suggested pea sized toothpaste for children below 3 years. Conclusion: Dental practitioners had less knowledge and attitude regarding the use of fluoridated toothpastes for children. Keywords: Attitude, Knowledge, Fluoride Toothpaste, Dental practitioner.

&lt;p&gt;Remineralising Dentine Caries Using Sodium Fluoride with Silver Nanoparticles: An In Vitro Study&lt;/p&gt;

ObjectiveTo investigate the remineralizing and staining effects of sodium fluoride (NaF) solution with polyethylene glycol-coated silver nanoparticles (PEG-AgNPs) on artificial dentine caries.Materials and MethodsDemineralized human dentine blocks were allocated to three groups. The blocks in group 1 underwent a topical application of a 12% silver diamine fluoride (SDF, 14,150 ppm fluoride) solution. The blocks in group 2 received a topical application of a 2.5% NaF (11,310 ppm fluoride) with PEG-AgNPs (400 ppm silver). The blocks in group 3 received deionized water. All blocks were subjected to pH cycling for 8 days. The surface morphology and cross-sectional features were investigated using scanning electron microscopy (SEM). The color parameters, crystal characteristics, lesion depth, and collagen degradation of the blocks were assessed using digital spectrophotometry, X-ray diffraction (XRD), micro-computed tomography, and spectrophotometry with a hydroxyproline assay, respectively.ResultsThe SEM showed that dentine collagen was exposed in group 3 but not in groups 1 and 2. The mean lesion depths in groups 1 to 3 were 118±7 µm, 121±14 µm, and 339±20 µm, respectively (groups1,2<3; p<0.001). The data indicated that fluoridated PEG-AgNPs introduced no significant color effect on dentine, but SDF caused distinct discoloration. The XRD indicated that silver chloride was formed in group 1, and fluorapatite was detected in groups 1 and 2. The concentration of hydroxyproline liberated from collagen was significantly less in groups 1 and 2 than in group 3.ConclusionThe use of NaF solution with PEG-AgNPs can remineralize artificial dentine caries and inhibit collagen degradation without causing significant tooth staining.

Effect of Remineralizing Agents on Initial Caries Lesions - Clinical Pilot Study on School-Children

Purpose: Enamel remineralization can be improved by increasing salivary calcium and phosphate ion concentration. Dentiplus® lozenges and Remin Pro® -mousse include these components and may have a positive effect on remineralization process. The study investigated if using these additional agents for a month improves dental remineralization compared to tooth brushing using fluoride tooth paste alone. Methods: Twenty-two patients were included in the final study and all participants had initial caries lesions. They were randomly divided into two test groups (A and B) and a control group. All groups brushed their teeth twice a day with a toothpaste (1500 ppm fluoride). In addition, patients in group A used Dentiplus® -lozenges three times a day and patients in group B used Remin Pro®-mousse once a week. The patients in the control group only brushed their teeth. Lesions were diagnosed by using ICDAS classification, Nyvad’s modified criteria and DIAGNOdent-Pen® scanning. Results: One third of the lesions in incisors/canines became inactive in both intervention groups, whereas in the control group the respective figure was 15.6%. There was a decrease in LF values in the Dentiplus® group whereas in Remin Pro® group the change was controversial in other except the 1st molar teeth. Both decrease and increase of the LF values was seen in the control group. There were only minor changes as for ICDAS values in this study. Conclusion: Remineralization of initial lesions by tooth brushing alone can be improved by remineralizing agents especially lozenges rich in calcium and phosphate used regularly. Laser fluorescence is excellent in monitoring change n remineralization with short monitoring periods.

Comparative evaluation of the efficacy of three commercially available toothpastes on dentin hypersensitivity reduction: an 8-week clinical study

Objective: The objective of this 8-week, single-center, double-blind, three-cell, randomized, clinical study was to compare the efficacy in reducing the dentin hypersensitivity of three commercially available toothpaste: Group A toothpaste containing 8.0% arginine, calcium carbonate, and 1450 ppm fluoride as sodium monofluorophosphate; Group B toothpaste containing 8% strontium acetate and 1040 ppm fluoride as sodium fluoride; and Group C toothpaste containing 5% potassium nitrate and 917 ppm fluoride as sodium monofluorophosphate. Materials and Methods: One hundred and fifty subjects, who reported to the department having teeth sensitive to tactile and air blast hypersensitivity, were assigned to one of the three study groups (50/group). Subjects were then asked to brush their teeth for 1 min, twice daily, with the given toothpaste. The dentin hypersensitivity of the two selected teeth was evaluated at baseline, 2 weeks, 4 weeks, and 8 weeks. Comparison of the treatment groups was conducted using the VAS analysis. Results: All 150 subjects complied with the protocol and completed the 8-week clinical study; there were no adverse events on the soft or hard tissues of the oral cavity. Group A resulted in more improvement in the reduction of sensitivity at 2, 4, and 8 weeks compared to the other groups. Conclusions: Group A toothpaste containing 8.0% arginine, calcium carbonate, and 1450 ppm fluoride as sodium monofluorophosphate significantly reduces dentin hypersensitivity and more effective than Group B and Group C toothpaste. Group A toothpaste is the latest new tool in the armament of the modern dentist.

The effect of theobromine on the in vitro de- and remineralization of enamel carious lesions

ObjectivesThis in vitro study investigated the effect of theobromine on the de- and remineralization of enamel carious lesions under plaque fluid-like conditions. MethodsEarly carious lesions were created in 272 bovine enamel specimens and assigned to sixteen groups (n=17) based on Knoop surface microhardness (SMH). Lesions were demineralized again under plaque fluid-like conditions in the presence of fluoride (0.2 or 1ppm) and theobromine (0; 10; 100 or 200ppm) at different pH values (5.5 or 7.0) in a factorial design. SMH was determined again and percent SMH recovery (%SMHr) calculated. Three-way ANOVA was used for the fixed effects of fluoride, theobromine and pH levels to compare the differences between each level. ResultsThe three-way interaction was not significant (p=0.712). The two-way interaction between fluoride and pH was significant (p=0.030), whereas those between fluoride and theobromine as well as that for pH and theobromine were not (p=0.478 and p=0.998, respectively). Theobromine did not affect %SMHr at any of the tested concentrations. There were trends for the higher fluoride concentration and the higher pH resulting in more rehardening with the lesions exposed to 0.2ppm fluoride at pH 5.5 displaying significantly less rehardening than those exposed to 0.2ppm fluoride at pH of 7.0 and lesions exposed to 1ppm fluoride at pH of 5.5. ConclusionTheobromine, when continuously present in a plaque fluid-like medium at various concentrations and at different pH values, does not affect de- or remineralization of enamel carious lesions under the presently studied conditions. Clinical significanceBased on the presently available evidence, theobromine cannot be recommended as an anticaries agent.

Comparative efficacy of a hydroxyapatite and a fluoride toothpaste for prevention and remineralization of dental caries in children

ObjectiveThis in situ study compared the effectiveness of two toothpastes containing hydroxyapatite or 500 ppm fluoride in promoting remineralization and inhibiting caries development.Materials and methodsTwo enamel blocks (human primary teeth), one sound and one with artificially-produced caries lesion, were exposed to toothpaste containing either 10% hydroxyapatite or 500 ppm F− (amine fluoride) via intra-oral appliance worn by 30 adults in two-arm double blind randomized crossover study lasting 14 days per arm (ClinicalTrials.gov: NCT03681340). Baseline and post-test mineral loss and lesion depth (LD) were quantified using microradiography. One-sided t-test of one group mean was used for intragroup comparison (baseline vs. post-test), while two-sided t-test of two independent means was used to compare the two toothpaste groups.ResultsPairwise comparison (baseline vs. test) indicated significant (p < 0.0001) remineralization and LD reduction by either toothpaste; however, when compared against each other, there was no statistically significant difference in remineralization or LD reduction between the two toothpastes. No demineralization could be observed in sound enamel blocks exposed to either toothpaste. While F− induced lesion surface lamination, HAP produced a more homogenous lesion remineralization.Conclusions10% hydroxyapatite achieved comparable efficacy with 500 ppm F− in remineralizing initial caries and preventing demineralization. Thus the HAP toothpaste is confirmed to be equal to the fluoride toothpaste in this study.

Influence of pure fluorides and stannous ions on the initial bacterial colonization in situ

The present clinical-experimental study aims to examine the effect of pure experimental fluoride solutions and stannous chloride on the initial oral bioadhesion under in situ conditions. After 1 min of pellicle formation on bovine enamel slabs, 12 subjects rinsed with 8 ml of the fluoride test solutions (NaF, Na2PO3F, AmF, SnF2,) with 500 ppm fluoride concentration each for 1 min. Additionally, rinsing without a solution (control) and rinsing with 1563 ppm SnCl2 solution took place for 1 min. Afterwards, fluorescence microscopy took place to visualize bacterial adhesion and glucan formation (8 h oral exposition) with DAPI and ConA and the BacLight method. TEM was performed to visualize the pellicle ultrastructure together with EDX to detect stannous ions. The rinsing solutions with pure SnF2 and SnCl2 reduced significantly the initial bacterial colonization (DAPI). While, NaF and Na2PO3F showed no significant effect compared to the control. There was no significant difference between AmF, SnF2 and SnCl2. All tested experimental solutions showed no reducing effect on the glucan formation. Considerable alterations of the pellicle ultrastructure resulted from rinsing with the Sn-containing solutions. SnF2 appears to be the most effective type of fluoride to reduce initial bacterial colonization in situ. The observed effects primarily have to be attributed to the stannous ions’ content.

The effect of temperature and ionic solutes on the fluoride release and recharge of glass-ionomer cements

ObjectiveTo determine the effect of storage temperature and the presence of sodium chloride in solution on the fluoride uptake and release of glass-ionomer cements. MethodsSeveral commercial brands were used, and stored at either room temperature (21–23°C) or 37°C, in KF solution at a concentration of 1000ppm F− with and without 0.9% NaCl present. Fluoride levels in the storage solutions after 24h were measured using a fluoride-ion selective electrode. Specimens were then stored in water, and fluoride release after 24h was determined. Studies were also carried out to determine chloride levels when specimens were stored in 0.9% NaCl, with or without 1000 ppm fluoride, again using an ion selective electrode. ResultsAll glass-ionomer specimens took up fluoride, and most of the fluoride was retained over the next 24 h when the specimens were stored in water. There was a slight variation in the amount of fluoride taken up with storage temperature and with the presence of sodium chloride. All specimens also took up chloride, with greater uptake at higher temperatures, but little or no effect when KF was also present in solution. SignificanceThe substantial retention of fluoride after 24h in deionised water confirms previous findings and suggests that an insoluble species, possibly SrF2, forms in situ. Chloride uptake has not been reported previously, and its significance requires further investigation. Fluoride and chloride uptake were apparently independent of each other, which suggests that the ions are taken up at different sites in the cement. This may relate to differences in the respective sizes and hydration states of F− and Cl− ions.

Morphological and chemical effects of in-office and at-home desensitising agents containing sodium fluoride on eroded root dentin

ObjectiveThe aim of this study was to evaluate the morphological and chemical effect of in-office and at-home desensitising agents containing sodium fluoride (NaF) on eroded root dentine in vitro. MethodsFifty bovine dentine samples were pre-eroded and randomised into five groups (n = 10): G1 (Control) - milli-Q water; G2 - fluoride varnish containing NaF 22,500 ppm; G3 - desensitising cream containing NaF 9,000 ppm associated with 20% nanohydroxyapatite; G4 - toothpaste with NaF 5,000 ppm associated to tricalcium phosphate; G5 - toothpaste containing NaF 900 ppm and casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF). The specimens were submitted to erosive challenge for three days. The analyses were performed using non-contact profilometry for volumetric (Sa) and linear roughness (Ra) followed by scanning electron microscopy (SEM) and Energy Dispersive X-ray Spectrometry (EDS). The data were analysed by Kruskal-Wallis and Wilcoxon tests (α = 0.05). ResultsThere was a significant reduction of Ra and Sa for the eroded samples from the G2 and G5 (p < 0.05) after an erosive challenge. The dentine surface topography pattern showed partially or totally occluded dentinal tubules after treatments, except in the control group. The control, G4 and G3 groups showed a reduction in the dentine inorganic content percentage of Ca (Calcium) and P (Phosphorus) minerals. ConclusionThe fluoride varnish and CPP-ACPF toothpaste were able to prevent morphological changes and were the only materials that showed the Ca and P content increased after treatment. These materials may be promising alternatives in the clinical control of dentin erosion.

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

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

Fluoride Release from Two High-Viscosity Glass Ionomers after Exposure to Fluoride Slurry and Varnish.

The effect of brushing with different fluoride slurries on the fluoride release (FR) of different high-viscosity glass ionomer cements (GICs) was investigated. Fifty-eight discs were fabricated from two high-viscosity GICs (GC Fuji IX (F9) and 3M ESPE Ketac-fil (KF)). Five specimens from each brand were used to measure Vickers microhardness and the remaining were randomly assigned to one of four groups (n = 6) based on two-factor combinations: (1) fluoride concentration in the abrasive slurry (275 or 1250 ppm fluoride as NaF) and (2) immersion in a 22,500 ppm fluoride-containing solution. Specimens were brushed for a total of 20,000 strokes over 4 days with daily FR measurement. Data were analyzed using analysis of variance and Bonferroni tests (α = 0.05). Baseline FR and microhardness values were different between the two tested material brands. Exposure to a 22,500 ppm solution was associated with higher FR but not the exposure to 1250 ppm slurries. Brushing and immersion of glass ionomer cements in a 22,500 ppm F solution led to higher FR that was more sustained for KF. Type of the glass ionomer, progressive brushing, and fluoride varnish affected FR but not the fluoride content in the abrasive slurry.

Effects of a toothpaste containing 0.3% triclosan on periodontal parameters of subjects enrolled in a regular maintenance program: A secondary analysis of a 2-year randomized clinical trial.

The triclosan-containing dentifrices are effective in controlling biofilm formation and maintaining gingival health; however, there is limited information on their effects during the periodontal maintenance phase. Therefore, the aim of this study was to evaluate the clinical effects of a toothpaste containing 0.3% triclosan on the periodontal parameters of subjects that have been treated for peri-implantitis and were enrolled in a regular maintenance program. Subjects presenting at least one implant with peri-implantitis and received surgical anti-infective therapy were selected. Sixty days post-surgery (baseline), subjects were randomized into two groups: (1) toothpaste containing 0.3% triclosan + 2.0% PVM/MA copolymer + 1450ppm fluoride (test) or (2) toothpaste containing 1450ppm fluoride (control), and were instructed to brush with the assigned toothpaste twice/day for 2 years. They received clinical monitoring at baseline, 3, 6, 12, 18, and 24 months, and professional maintenance every 3 months. Eighty-eight subjects with natural teeth were enrolled in the study (Test, n = 39; Control, n = 49). The test group showed a greater reduction in the percentage of sites exhibiting bleeding on probing (primary outcome) and lower levels of plaque in comparison with the control group after 24 months (P<0.05). The mean percentage of sites with probing depth ≥5mm was reduced over the course of the study only in the test group (P<0.05). A toothpaste containing 0.3% triclosan was more effective than a regular fluoride toothpaste in improving the periodontal clinical condition around natural teeth of periodontally healthy subjects enrolled in a regular maintenance program for 2 years.

Silver Diamine Fluoride: What Does the Current Evidence Say?

Silver Diamine Fluoride (SDF) is a colorless alkaline liquid containing silver particles and 38% (44,800 ppm) fluoride ion. SDF consists of 25% silver, 8% ammonia, 5% fluoride, and 62% water at pH 10. This is ultimately referred to as 38% SDF. Silver Diamine Fluoride is a clinically applied treatment that helps in controlling active dental caries and aids in preventing further progression of the disease [1].

What concentration of fluoride toothpaste should dental teams be recommending?

Data sources A total of 96 studies reported in peer reviewed journals between 1955 and 2014 Study selection The systematic review selected randomised controlled trials that compared toothbrushing with fluoride toothpaste with toothbrushing with a non-fluoride toothpaste or toothpaste of a different fluoride concentration, with a follow-up period of at least one year. The primary outcome was caries increment measured by the change from baseline in all permanent or primary teeth. Data extraction and synthesis Two members of the review team, independently and in duplicate, undertook the selection of studies, data extraction, and risk of bias assessment. They graded the certainty of the evidence through discussion and consensus. The primary effect measure was the mean difference or standardised mean difference caries increment. Where it was appropriate to pool data, they used random-effects pairwise or network meta-analysis. Results In the primary dentition of young children, 1500 ppm fluoride toothpaste was found to reduce caries increment when compared with non-fluoride toothpaste. In the adult permanent dentition, 1000 or 1100 ppm fluoride toothpaste was found to reduce DMFS increment when compared with non-fluoride toothpaste in adults of all ages, however, the evidence for DMFT was of low certainty. Conclusions This Cochrane Review supports the benefits of using fluoride toothpaste in preventing caries when compared to non-fluoride toothpaste. Evidence for the effects of different fluoride concentrations was found to be more limited, but a dose-response effect was observed for D(M)FS in children and adolescents. For many comparisons of different concentrations the caries-preventive effects and the confidence in these effect estimates are uncertain and could be challenged by further research.

Fluoride in drinking water in Madagascar and the development of a strategy for salt fluoridation.

To update current knowledge of the distribution of drinking water fluoride content in Madagascar, in an effort to develop a strategy for the distribution of fluoridated salt to prevent tooth decay. In accordance with a strict protocol, water samples were collected from all the country's 22 regions. Fluoride concentration in ppm fluoride (F) was determined by use of a F ionselective electrode coupled with a pH/ion meter. A total of 651 sources of drinking water were sampled, of which 94% were found to have fluoride concentrations ≤ 0.7 ppm. The two regions with the highest number of water supplies with fluoride concentrations ⟩ 0.7 ppm are situated in the south and south-west of Madagascar. 87% of thermal springs have fluoride levels ⟩ 0.7 ppm, with a mean value of 2.21 ± 1.64 ppm. These findings confirm that, with the exception of certain districts in the extreme south of Madagascar, fluoridated salt distribution would be appropriate for most regions in the country. This could be achieved by encouraging salt producers in the north and west of Madagascar, who are responsible for over 88% of national salt production, to fluoridate their salt. Most of this salt is distributed throughout the north and centre of the country, whereas very little is distributed to the extreme south.

Using fluoride mouthrinses before or after toothbrushing: effect on erosive tooth wear

Objectives1. To evaluate the use of fluoridated mouthrinses before or after toothbrushing on erosive tooth wear. 2. To compare the anti-erosive effect of the combination toothpaste and mouthrinse containing fluoride, with or without stannous chloride. DesignEnamel and dentin specimens were randomly distributed into groups (n = 10 of each substrate/group): B–brushing, B + R–brushing + rinsing, and R + B–rinsing + brushing. The treatments were performed using a fluoride toothpaste (BF: 1400 ppm fluoride, as amino fluoride-AmF) combined or not with a fluoride mouthrinse (RF: 250 ppm fluoride, as AmF and sodium fluoride-NaF) or fluoride and stannous toothpaste (BF+Sn: 1400 ppm fluoride, as AmF and NaF, 3500 ppm stannous, as stannous chloride-SnCl2 and 0.5% chitosan) combined or not with fluoride and stannous mouthrinse (RF+Sn: 500 ppm fluoride, as AmF and NaF, 800 ppm stannous, as SnCl2). As control, brushing was performed with artificial saliva (BC). Specimens were submitted to a 5-day erosive-abrasive cycling model. Treatments were performed twice daily. Surface loss (SL) was determined by optical profilometry. Data were analyzed by ANOVA and Games-Howell tests (α = 0.05). ResultsFor enamel, RF+BF and RF+Sn+BF+Sn presented significantly lower SL than the control, with RF+BF being significantly lower than RF+Sn+BF+Sn. For dentin, BC had the lowest SL, not differing from BF+Sn+RF+Sn, RF+Sn+BF+Sn and BF. Groups RF+BF and BF+RF showed highest SL, not differing from BF+Sn and BF+Sn. ConclusionsFor enamel, the use of a mouthrinse before brushing was able to reduce erosive wear for both fluoride and stannous products. For dentin, the use of stannous-containing products, irrespective of the order of application, presented superior effects.