Stannous Fluoride Gel Research Articles

Effects of CO2 Laser Irradiation on Treatment of Hypersensitive Dental Necks: Results of an in Vitro Study

Various methods for treatment of hypersensitive dental necks have been developed during the past few decades. The exposure of dentinal tubules to chemical, thermal, and mechanical influences in the oral environment is considered the cause of dentin hypersensitivity. Stimuli can be transmitted as far as the sensitive nerve endings by dentinal tubules. As a result treatment methods are based on the attempt to seal exposed dentinal tubules permanently. The main sealing materials are fluoride preparations, strontium chloride, and hydroxyapatite. They must be applied periodically to achieve permanent freedom from pain. A new method to treat hypersensitive dental necks is laser irradiation. In our in vitro study, we treated extracted human teeth with a CO2 laser in the cervical region. The necks of these teeth had been exposed prior to extraction thereby causing dentin hypersensitivity. Scanning electron microscopy after treatment revealed almost complete closure of the dentinal tubules. We applied a thin layer of stannous fluoride gel to 10 teeth prior to laser treatment. Electron probe microanalysis (EPMA) revealed that tin was present within the sealed tubular openings. Subsequent temperature measurements showed that laser treatment caused a maximum increase in temperature within the pulp cavity by 2.5°C.

Effect of 0.4% stannous fluoride gel on the clinical signs and the number of Streptococcus mutans in saliva

Effect of 0.4% stannous fluoride gel on the clinical signs and the number of Streptococcus mutans in saliva

Cariogenic microflora in patients with Hodgkin's disease before and after mantle field radiotherapy

Because mantle field radiotherapy is associated with partial xerostomia in patients with Hodgkin's disease, the purpose of this study was to evaluate their cariogenic microflora before and after completion of radiotherapy. We obtained samples of oral saline solution rinse from 40 patients with Hodgkin's disease before radiotherapy and from 31 patients with Hodgkin's disease who had survived 1 to 24 years after radiotherapy. We also evaluated caries experience and history of fluoride gel use for caries prevention in these patients. Mutans streptococci and lactobacilli levels were significantly higher in the postradiotherapy patients with carious teeth, particularly in those with limited home use of fluoride gels. In the postradiotherapy group, caries parameters were significantly higher ( p < 0.05) than in the preradiotherapy group. Within the postradiotherapy group, both caries and microbial parameters tended to be higher in patients who were less compliant about using the recommended 0.4% stannous fluoride “brush-in” technique than in those who used the gel regularly at home. This study indicates that for patients with Hodgkin's disease who receive mantle field irradiation during the management of their disease, a sustained brush-in program with stannous fluoride gel can be of benefit for caries prevention and for limitation of oral levels of cariogenic mutans streptococci.

Eighteen-month evaluation of the effects of a 0.4% stannous fluoride gel on gingivitis in orthodontic patients

The purpose of this study was to determine whether conventional toothbrushing and twice daily use of a brush-on 0.4% stannous fluoride (SnF2) gel containing more than 90% available Sn2+ would be more effective for controlling plaque accumulation and gingivitis in the presence of orthodontic appliances than conventional toothbrushing alone. Consecutively treated adolescents who were to receive full-mouth fixed orthodontic appliances were assigned to one of two groups according to age and sex criteria. The first group (control, n = 35) used toothbrushing with a standard fluoride toothpaste, whereas the second group (treatment, n = 30) used toothbrushing supplemented with a 0.4% SnF2 gel used twice daily for the entire 18-month study period. Clinical assessments (Plaque Index, Gingival Index, bleeding tendency, and coronal staining) were made single blind before appliances were placed and 1, 3, 6, 9, 12, and 18 months after appliances were placed. Complete data were obtained for 32 control and 23 SnF2 gel subjects. The results indicated that the SnF2 gel group had significantly lower scores for plaque index (p < 0.01), gingival index (p < 0.001), and bleeding tendency (p < 0.001) at all examinations than did the control group. In the SnF2 group, one subject developed mild coronal staining, and two subjects developed moderate staining. We conclude that the use of a 0.4% SnF2 gel containing more than 90% available Sn2+ is an effective adjunct to mechanical tooth cleaning in preventing gingivitis in adolescents undergoing orthodontic treatment with fixed appliances.

Alterations in human enamel surface morphology following vital bleaching

Extracted intact human teeth ( n = 4) were treated for 30 days by three protocols: Home 1 (Proxigel, n = 4) for 8 hours daily, Home 2 (White & Bright, n = 4) for 24 hours with 3 minutes of stannous fluoride gel, or an Office protocol ( n = 4) using 30% hydrogen peroxide (Superoxol) warmed by a high-intensity light while the controls remained untreated. “Home” bleaching agents contain approximately 10% carbamide peroxide. After treatment, the coronal surfaces were examined with a scanning electron microscope (SEM) at 2000 power magnification, and the surface topography was measured by a profilometer. The SEM photomicrographs of the controls and office-treated groups were similar to previously reported descriptions, while the home bleached surfaces appeared similar to each other. Profilometric analysis was used to examine surface roughness and surface waviness. Mean surface roughness in microns was: control, 1.9; Home 1, 0.6; Home 2, 0.9; and Office, 0.6. Surface waviness was ranked control > office > Home 1 = Home 2. Enamel surface alterations were evident after the three bleaching methods. The differences between the office and home-treated surfaces were unrelated to the pH of the bleaching agents.

Comparison of the antimicrobial effect of the application of chlorhexidine gel, amine fluoride gel and stannous fluoride gel in debrided periodontal pockets

The clinical and microbiological effect of locally-applied chlorhexidine gel 2%, amine fluoride gel 1.25%, stannous fluoride gel 4% or placebo gel in 40 periodontal pockets of 10 patients were studied. The gels were applied 3 x within 10 min. after mechanical debridement of the pockets. The treatment effect on the subgingival microflora was evaluated by microscopic and culture studies of the subgingival plaque samples. In addition, supragingival plaque, bleeding after probing and probing pocket depth were scored. Examination were carried out before and during a period of 36 weeks after treatment. At the start, the cultured microflora consisted mainly of anaerobic Gram-positive bacteria. Following treatment, the clinical parameters were significantly reduced. Concomitantly, the %s of spirochetes, motile rods and non-motile rods decreased significantly. A significant decrease was also found in the total anaerobic count, whereas the facultative counts remained at the same level found before treatment. This suggested that the treatment resulted in a mainly facultative subgingival microflora. The % Gram-negative rods showed a significant reduction after treatment, but returned to base line at week 12. Statistical analysis of the bacteriological and clinical examinations failed to demonstrate any significant differences between the 4 treatment groups. Thus, in comparison to the placebo gel, subgingival application of chlorhexidine gel 2%, amine fluoride gel 1.25% or stannous fluoride gel 4% did not augment the effect of mechanical debridement on bacteriological and clinical parameters during the experimental period of 36 weeks. However the indicated treatments resulted in a facultative subgingival microflora which is compatible with the host.

Short‐term bactericidal activity of chlorhexidine gel, stannous fluoride gel and amine fluoride gel tested in periodontal pockets

The short-term bactericidal effect of 2% chlorhexidine gel, 4% stannous fluoride gel or amine fluoride gel containing 1.25% fluoride on the subgingival microflora was determined in 40 periodontal pockets of 10 patients. The antimicrobial gels or placebo gel were applied in 5-9 mm deep periodontal pockets 3 times within 10 min. Before and 30 min after the applications, samples were taken of the subgingival microflora for determination of the total number of bacteria as well as the number of black pigmented Bacteroides. Reductions of the total number of bacteria were found in all test groups. The reductions found in the pockets treated with chlorhexidine gel or stannous fluoride gel were significantly greater than the reduction found in the pockets treated with a placebo gel. A significant reduction of black-pigmented Bacteroides was found after treatment with chlorhexidine gel or amine fluoride gel. It is concluded that 2% chlorhexidine gel or 4% stannous fluoride gel has a more than 99% reduction effect on the microflora of periodontal pockets within 30 min after application.

Bactericidal concentrations of chlorhexidine‐digluconate, amine fluoride gel and stannous fluoride gel for subgingival bacteria tested in serum at short contact times

In vitro inhibitory and bactericidal concentrations in serum of chlorhexidine-digluconate, amine fluoride gel, stannous fluoride gel, stannous fluoride, metronidazole and amoxicillin were determined against Bacteroides gingivalis, Bacteroides intermedius, Fusobacterium nucleatum, Actinobacillus actinomycetemcomitans and Capnocytophaga sputigena. The minimal inhibitory concentration was assessed by the agar dilution technique. The killing curves and minimal bactericidal concentration of the antimicrobial agents in inactivated bovine serum were determined after 5, 10, 20 and 60 minutes contact time. The minimal inhibitory concentration varied amongst the tested bacteria. A concentration of 128 micrograms/ml chlorhexidine digluconate, 20 mg/ml amine fluoride gel, 1 mg/ml stannous fluoride, 128 micrograms/ml metronidazole and 4 micrograms/ml amoxicillin inhibited the growth of the tested species. The minimal bactericidal concentration in serum for B. gingivalis, B. intermedius, F. nucleatum, A. actinomycetemcomitans and C. sputigena after 10 min contact time was 5 mg/ml for chlorhexidine digluconate and 100 mg/ml for amine fluoride gel. A concentration of 200 mg/ml stannous fluoride gel in serum was bactericidal for the tested species after 10 min contact time, with exception of F. nucleatum.

Is 0.4% stannous fluoride gel an effective agent for the prevention of oral diseases?

Research does not support the concept that 0.4% stannous fluoride gels are the preferred preventive or treatment agents for hypersensitivity, plaque, gingivitis, or periodontitis. The only clinically proved, cost-beneficial indications for use of these materials are for the prevention of enamel decalcification in patients wearing banded orthodontic appliances and for the prevention of dental caries in patients who have had head and neck radiation therapy. Even for these applications, other fluoride products may have equal effectiveness.

Control of Streptococcus mutans with topical fluorides in patients undergoing orthodontic treatment

Subjects undergoing orthodontic treatment were asked to brush their teeth twice a day for 6 weeks with stannous fluoride gel or acidulated phosphate-fluoride gel. A reduction in salivary Streptococcus mutans levels was evident in subjects who brushed with the stannous fluoride.

Effects of two fluoride gels on fluoride uptake and phosphorus loss during artificial caries formation.

Blocks of human enamel were cycled through a demineralization--F-treatment-remineralization procedure and then analyzed for fluoride and the presence of caries-like lesions. Treatments with a sodium fluoride gel (5000 ppm F) increased the enamel fluoride concentration to 6500 ppm F, whereas a stannous fluoride gel (1000 ppm F) increased enamel fluoride to about 1200 ppm F. Although a control treatment (water) allowed caries-like lesions to form, as observed by microradiography, no lesions were found in either of the fluoride-treated groups. When the experiment was repeated with radioactive teeth, mineral loss, as determined by release of 32P, was again greatest in the water-treated control group, but some loss was observed in the fluoride treatment groups. The least loss was found in the sodium fluoride group. It was concluded that the fluoride treatments not only increased enamel resistance but also enhanced remineralization so that calcium phosphate was replaced during the subsequent remineralization phase. Because of the probability that stannous ions were deposited during the stannous fluoride treatments, some of the apparent calcium phosphate re-deposition in this group was probably stannous compounds.

In vitro effect of topical fluoride on dental porcelain

Fifty-seven porcelain samples were randomly subjected to a variety of topical fluorides for time intervals of 4 to 64 minutes. Half of each porcelain surface was masked to prevent contact with the fluoride. Measurements of roughness were made for the fluoride-treated and the untreated porcelain surfaces to evaluate the effect of the different fluoride preparations over time. The resulting surfaces were also examined using an SEM. Conclusions from this study include the following. Statistically significant differences in roughness were found among surfaces exposed to 1.23% acidulated phosphate fluoride gel, 8% stannous fluoride, and the control surfaces. There were no significant differences in roughness between the test and control surfaces with 0.05%, 0.2%, and 2% sodium fluoride solutions or 0.4% stannous fluoride gel. The dentist should be aware of the potentially deleterious effects of prescribing or administering a topical fluoride for patients with porcelain/metal restorations.

Effect of 0.4% stannous fluoride gel on the gingival health of overdenture abutments

W hile overdentures have been used successfully for many years, close clinical observations indicate that the supporting teeth are prone to both caries and periodontal disease.“’ A regular application of sodium fluoride reduces the incidence of caries in these teeth3 but does not appear to help the periodontium. Stannous fluoride (SnFJ will likewise reduce caries4x ’ and may also reduce bacterial colonization within dental plaque,6 thereby inhibiting the progress of periodontal disease. This study was designed to observe the therapeutic effect of a 0.4% SnF, gel on the periodontium and tooth structure of overdenture abutments.

A new desensitizing dentifrice: preliminary report

Dentin sensitivity is one of the most painful, ubiquitous, and least satisfactorily treated chronic problems of the teeth. The purpose of this clinical trial was to test the sensitivity-reducing effectiveness of five dentifrices over a six-week period. For the study, 176 adults, ages 18 to 63, exhibiting a total of 486 hypersensitive surfaces, were randomly allocated to five experimental groups to use one of the following: a strontium chloride dentifrice, a 0.4% stannous fluoride gel, a pluronic F-127-sodium citrate gel, a pluronic F-127 gel, or a control dentifrice. No specific instructions were provided as to the frequency or method of toothbrushing; thus, the participants brushed their teeth in their usual manner. The analysis of the data was limited to 168 persons who complied with study procedures. Chi-square analysis examined the statistical differences between the four test agents and the control formulation. The desensitizing effect of the pluronic plus sodium citrate gel was highly significant, and the plain pluronic F-127 preparation was effective to a lesser degree. Patients using the strontium chloride or stannous-fluoride-containing dentifrices did not exhibit a significant improvement over the control group. This study demonstrated that a pluronic polyol gel containing sodium citrate is highly effective in controlling tooth hypersensitivity.

Chemical protection against postirradiation dental caries

Experience with dental caries in twenty-four patients receiving irradiation for malignant lesions of the head and neck demonstrates the critical importance of cooperation by the patient, a program of strict oral hygiene, and daily self-treatment with 0.4 per cent stannous fluoride gel. The ravaging form of dental caries associated with the postirradiation period can be essentially eliminated in cooperating patients. In nine patients who were uncooperative, fifty-seven crowns were amputated and an additional seventy-five carious surfaces were found 3.75 years after irradiation. In six patients who cooperated and used the gel on a daily basis, no crowns were amputated and only one carious area was found over the same time period.

Reduction of enamel solubility by daily use of a 0.4 per cent stannous fluoride gel.

Changes in solubility and fluoride uptake by enamel were measured after daily use of a 0.4% stannous fluoride gel by an adult population. Enamel surface fluoride concentration increased as calcium and phosphorus solubility was reduced. Daily use of a 0.4% SnF2 gel provided significant enamel protection in adults.

Control of decalcification in orthodontic patients by daily self-administered application of a water-free 0.4 per cent stannous fluoride gel

Self-application of a water-free 0.4 per cent SnF 2 gel, daily at bedtime, was practiced by ninety-nine orthodontic patients over a treatment period of 18 to 24 months. Incidence of decalcification in these patients was compared to that found for 110 control patients who were managed in the same fashion but did not use the gel. Incidence of decalcification in the control group was 58 per cent, with the bulk of the lesions being classified as localized mild and located in the gingival area. Decalcification was found in only 2 per cent of the fifty-one patients who applied the gel as directed on a daily basis. Those who used the gel less regularly experienced higher degrees of decalcification. These results suggest that frequent self-applications of low concentrations of SnF 2 provide very high levels of protection. It is also clear that “frequent” in this sense, means daily treatment.

Protective effectiveness of a stannous fluoride gel.

Protective effectiveness of a stannous fluoride gel.