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PubMed1997

Studies on stannous fluoride toothpaste and gel (2). Effects on salivary bacterial counts and plaque regrowth in vivo.

There has been a resurgence of interest in stannous fluoride (SF) products in particular to provide oral hygiene and gingival health benefits. The aim of this study was to assess the persistence of antimicrobial action of a number of SF formulations in the mouth and relate these to plaque inhibitory activity. The formulations were 2 SF toothpastes (SF1, SF2), 2 SF plus stannous pyrophosphate toothpastes (SFSP1, SFSP2), a SF gel (G), a NaF toothpaste (C) and saline (S) as control. Both studies involve 2 different groups of 21 healthy dentate volunteers. The studies were single, blind, randomised, crossover designs balanced for residual effects, with a minimum 2 1/2 day washout period. Salivary bacterial counts were determined before and to 7 h after a single rinse with the formulations. Plaque regrowth from a zero baseline (day 1) was measured by index and area on day 5, after 2x daily rinsing with slurries of the formulations or saline. For bacterial counts, highly significant treatment differences were found. Bacterial counts were variably reduced by all treatments to 30 min then showed a variable rate of return towards baseline. All test agents were significantly better than S at some timepoints. The order for greatest persistence of action downwards was; (1) SFSP2; (2) SFSP1, G, and SF1; (3) SF2; (4) C; (5) S. Highly significant differences in plaque regrowth between treatments were found with similar mean ordering of efficacy as for salivary bacterial counts from most effective downwards namely; (1) SFSP1 and SFSP2; (2) SF1; (3) SF2; G and C; (4) S. The results were consistent with a parallel study measuring tea staining in vitro, whereby formulations causing the most staining produced the greatest persistence of action and plaque inhibitory activity. This suggests the availability of stannous ions was important for the clinical effects. It is concluded that stannous ions can enhance the plaque inhibitory action of toothpaste via a persistent antimicrobial action.

Analysis of Variance↗

PubMed1983

Caries preventive effects of toothpastes containing monofluorophosphate and trimetaphosphate: a 3-year clinical trial.

The caries-preventive effects of two toothpastes were tested in a 3-year clinical trial involving 1319 children aged 11-13 years. The test toothpastes were: 1) a low abrasion paste containing 0.8% sodium monofluorophosphate (MFP), and 2) a paste containing 3% sodium trimetaphosphate (TMP). The control toothpaste was a conventional, moderately abrasive paste containing 0.8% sodium monofluorophosphate. The children were examined clinically and radiologically each year. Toothpaste was supplied to the children's homes, and its use was unsupervised. Caries increments after 3 years, in terms of DMF teeth and DMF surfaces, showed no significant differences between the MFP test group (444 children) and the MFP control group (450 children). However, the TMP test group (425 children) had significantly higher caries increments than the MFP control group. All three groups of children showed some improvement in oral hygiene and in gingival health, but there were no significant differences between the groups.

Adolescent↗

PubMed1978

Contact allergy to toothpaste flavors.

Toothpaste flavors are fragrance mixtures. Oil of peppermint and spearmint, carvone and anethole are ingredients with a low sensitizing potential, but they are used in almost every brand of toothpaste and caused seven cases of contact allergy in a 6-year period at Gentofte Hospital. Toothpaste reactions are rare due to several reasons; local factors in the mouth, the low sensitizing potential of the flavors generally used, and the lack of recognition. It is emphasized that the toothpaste battery for patch testing has to be relevant and changed according to the consumers' and manufacturers' taste and fashion.

Anethole Trithione↗

PubMed1995

Contact allergens in toothpastes and a review of their hypersensitivity.

The present study summarizes information on toothpaste composition as supplied by the manufacturers. The survey covered 48 items, virtually all toothpastes offered for sale in Finland. It was concluded that the toothpastes are not entirely safe to use, because almost 50% of the products studied contained a total of some 30 compounds widely recognized as allergens. According to the literature, the most common allergens in toothpastes are flavours (e.g., cinnamic aldehyde, cinnamon oil and peppermint) and preservatives. Symptoms include stomatitis, cheilitis, glossitis, gingivitis, perioral dermatitis and immediate hypersensitivity.

Allergens↗

PubMed1983

Effect of zendium toothpaste on recurrent aphthous stomatitis.

A double-blind clinical trial with cross-over was conducted for a period of 12 months in 25 patients with recurrent aphthous stomatitis (RAS). The effect of the amyloglucosidase and glucoseoxidase containing Zendium toothpaste on the discomfort, number of exacerbations, duration of exacerbation, number of ulcers and number of days with pain caused by RAS was studied. The use of Zendium significantly reduced the sensation of discomfort from RAS as compared to the use of placebo toothpaste (0.025 greater than p greater than 0.01). However, the patients were unable to discriminate significantly between Zendium and placebo when asked to choose one of the toothpastes (0.10 greater than p greater than 0.05) and no significant differences were demonstrated as far as the above mentioned parameters of disease severity were concerned. Therefore, it is concluded that the reducing effect of Zendium containing amyloglucosidase and glucoseoxidase on RAS is weak as compared to a similar toothpaste without these enzymes.

Adolescent↗

PubMed1997

Are sodium lauryl sulfate-containing toothpastes suitable vehicles for xylitol?

The hypothesis to be tested in this study was that toothpastes containing sodium lauryl sulfate (SLS) is unsuitable vehicles for xylitol. The bacteriostatic (and cariostatic) effect of xylitol is assumed to be caused by intracellular accumulation of xylitol-5-P in plaque bacteria. Experiments were designed to investigate whether presence of SLS would affect the uptake of xylitol by interacting with the bacterial membranes and thus inhibit xylitol-5-P formation. It was shown in an in vitro study that even very low concentrations of the strong anionic detergent SLS inhibited uptake of xylitol and xylitol-5-phosphate formation by dental plaque totally. The mild nonionic detergent ethoxylated stearyl alcohol (30x EO) had no such effect. In vivo experiments with toothpastes containing xylitol and either the strong or the mild detergent, showed that xylitol in toothpaste with SLS was not available for the plaque bacteria and gave no adaptation to xylitol, whereas in the presence of 30x EO it was available, and a xylitol adaptation was observed. Glucose metabolism, which was also studied for the plaque samples, was not significantly affected by presence of any of the 2 detergents, indicating that the amounts of xylitol in toothpastes were presumably too low to give clinical significant effects, even when mild detergents are used.

Acetates↗

PubMed2003

Plaque antibacterial levels following controlled food intake and use of a toothpaste containing 2% zinc citrate and 0.3% Triclosan.

OBJECTIVES: To measure the levels of zinc and Triclosan present in plaque 12 hours post-brushing and following two weeks home use of a toothpaste formulation containing 2% zinc citrate and 0.3% Triclosan. To measure the levels of zinc and Triclosan in plaque following two weeks home use of the test toothpaste formulation together with a further morning's brushing and a day of controlled food intake. METHODS: A total of 104 subjects completed the study. Plaque samples were taken before use of the test toothpaste and again after a specified regime of product use and food intake. The samples were analysed for zinc or Triclosan. RESULTS: Levels of zinc and Triclosan in plaque 12 hours after last brushing and following a 2-week home usage of product, were 149.1 microg/g and 8.6 microg/g respectively. Following a morning brushing and a day of controlled food intake zinc and Triclosan levels were 94.7 microg/g and 4.1 microg/g respectively. These levels of agents were found to reduce pH drop in vitro. CONCLUSIONS: Regular use of a toothpaste containing 2% zinc citrate and 0.3% Triclosan can lead to a build-up of antibacterial agents in plaque that continue to work even after controlled food intake.

Anti-Infective Agents, Local↗

PubMed2004

Low-levels of fluoride in plaque and saliva and their effects on the demineralisation and remineralisation of enamel; role of fluoride toothpastes.

AIM: To summarise support for current consensus on the likely means by which fluoride toothpastes reduce caries and review some relevant studies of the effect of low levels of fluoride on the demineralisation and remineralisation of enamel. The major anti-caries effect of fluoride toothpastes is thought to result from small but protracted elevations in levels of fluoride in plaque and saliva. Fluoride incorporated into enamel systemically does not reduce enamel solubility sufficiently to exert an anti-caries effect. Fluoride has the potential to exert an anti-caries benefit largely through three mechanisms; inhibition of demineralisation, promotion of remineralisation and interference with bacterial growth and metabolism. However, the low levels of fluoride thought to influence caries are insufficient to have a significant effect via the latter mechanism. Thus reductions in caries resulting from the use of fluoride toothpastes can be linked to modification of the demineralisation/remineralisation balance by direct effects on dental mineral exerted topically by low levels of fluoride. Numerous in vitro studies have shown that low levels of fluoride, typical of those found after many hours in resting plaque and saliva, and resulting from the regular use of fluoride toothpastes, can have a profound effect on enamel demineralisation and remineralisation.

Cariostatic Agents↗

PubMed2005

The measurement in vitro of enamel and dentine wear by toothpastes of different abrasivity.

OBJECTIVES: To investigate the in vitro enamel and dentine wear by toothpastes with a range of Relative Dentine Abrasivity (RDA) and Relative Enamel Abrasivity (REA) values. METHODS: Human enamel/dentine (approximately 50:50) blocks (approximately 4 x 4 mm) were polished and the enamel indented with four Knoop indents. The step across the enamel-dentine junction was measured by interference microscopy. Specimens were brushed in vitro with toothpastes with a range of RDA/REA values using a flat trim toothbrush mounted in a Wira brushing machine for 360 s and a load of 375 g. After brushing the Knoop indent length and the enamel-dentine step were remeasured and the amount of wear to the enamel and dentine was calculated. RESULTS: The mean enamel wear ranged from 0.05 to 0.40 microns, with the highest wear for the highest REA product. The mean dentine wear for all toothpaste products tested was positively correlated with RDA value (R2 = 0.897). The correlation was further improved if median wear values were used (R2 = 0.930). CONCLUSIONS: This study has demonstrated a rapid technique for the simultaneous investigation of the abrasive wear of toothpaste on enamel and dentine. There was a good correlation between median dentine wear and RDA values.

Dental Enamel↗

PubMed2005

The effects of child formula toothpastes on enamel caries using two in vitro pH-cycling models.

AIMS/OBJECTIVES: To compare, using two pH-cycling models, the de/remineralisation effects of children's toothpastes on primary teeth. DESIGN: In vitro single-section and pH-cycling models. METHODS: Primary teeth were placed in demineralising solution for 96 hours to produce artificial carious lesions 60-100 microm deep. They were cut into 100 microm thick sections and assigned to 6 groups. Sections in Groups A and D were exposed to a non-fluoridated toothpaste, those in Groups B and E to half-pea-sized (0.16g) and those in Groups C and F to pea-sized portions (0.32g) of a 500ppm F toothpaste. pH-cycling Model I (Groups A, B, C), without added fluoride, ran for 7 days, while Model II (Groups D, E, F), with 0.25ppm F, ran for 10 days. OUTCOME MEASUREMENTS: Lesions were evaluated using polarised light microscopy and microradiography. RESULTS: Lesions in Groups B and E progressed by 64% and 61%, respectively, while those in Groups C and F progressed by only 19% and 23% respectively. CONCLUSIONS: Both 10-day and 7-day pH-cycling models were suitable for studying carious lesion progression in primary teeth (the demineralising and remineralising solutions of the 10-day cycling model contained 0.25ppm F). A pea-sized portion (0.32g) of 500ppm F toothpaste slowed down the demineralisation progression better than a half-pea-sized portion.

Cariostatic Agents↗

PubMed2006

Review of the extrinsic stain removal and enamel/dentine abrasion by a calcium carbonate and perlite containing whitening toothpaste.

There has been an increase in the demand from consumers and patients for products that whiten teeth. To meet this demand, a whitening toothpaste containing calcium carbonate and perlite as the abrasive system and an efficacious fluoride source has recently been launched. The aim of the current paper is to review the toothpaste's stain removal efficacy and its effects on enamel and dentine wear. It has been shown to be effective at removing model extrinsic stain in vitro. Further, it has been shown to be more effective in removing naturally occurring extrinsic tooth stain than a silica non-whitening control toothpaste after two weeks of twice daily brushing in a parallel group, double-blind clinical study using 152 adult volunteers. In addition, the enhanced whitening effect did not give a clinically relevant level of wear to enamel or a significant increase in dentine wear compared to marketed non-whitening toothpaste formulations, as shown by using an in situ type model with ex vivo brushing.

Adult↗

PubMed2006

Gains in oral health and improved quality of life of 12-13-year-old Nepali schoolchildren: outcomes of an advocacy project to fluoridate toothpaste.

OBJECTIVES: To report on gains in oral health and improved quality of life of 12-13-year-old Nepali schoolchildren five and six years after the introduction of fluoride toothpaste in 1999. DESIGN: Cross sectional baseline surveys in 1999 and 2001, and follow up surveys in 2004 and 2005 were multi-stage cluster sampling in design. SETTING: Urban and rural schools in Central, Far Western, Mid Western and Western Developmental Regions of Nepal. PARTICIPANTS: 2,770, 12-13-year-olds in 1999 and 1,001, 12-13-year-olds in 2004 were examined regionally. 637 12-13-year-olds from Kathmandu valley and 448 12-13-year-olds from Tansen municipality were examined in 1999. The same schools in Kathmandu valley and Tansen were visited in 2005 and 761 and 482 12-13-years from Kathmandu valley and Tansen were examined. 6,064 8-15-year-olds in 2001 and 1,001 12-13-year-olds in 2004 participated in the collection of information on oral hygiene practice and quality of life. METHOD: Examinations were carried out by trained and calibrated examiners using the WHO diagnostic criteria for caries and questionnaires were interview administered by trained interviewers. INTERVENTION: Advocacy for fluoride toothpaste between 1997 and 2002. RESULTS: There was a 26.6% decline in caries prevalence and 38.0% decrease in 12-13-year old DMFT from 1999 to 2004 throughout four of five regions of Nepal. Approximately 65-75% of the 12-13-year-olds used fluoride toothpaste from 1999 to 2004. School specific data reveals a reduction in DMFT of 43.8% in Tansen and 53.6% in the Kathmandu valley from 1999 to 2005. From 2001 to 2004, report of oral pain decreased by 10%. CONCLUSIONS: The most likely reason for the decline in dental caries and reduction in oral pain is the widespread consumption of fluoride toothpaste by the 12-13-year-old schoolchildren.

Adolescent↗

PubMedDate not supplied

Effect of amine fluoride toothpaste and gel in high risk groups of Hungarian adolescents: results of a longitudinal study.

The aim of the study was to establish a preventive program with the combined use of amine fluoride toothpaste and gel in groups of adolescents living in different locations in Hungary. Caries and oral hygiene examinations were performed at the beginning of the study and repeated after 1 and 2 years. The adolescents were divided into 3 groups: 1 control and 2 test groups. The control group continued its usual oral care habits. One of the test groups received Elmex toothpaste for unsupervised home use daily and Elmex gel for use once a week, and the other test group received Elmex toothpaste and only placebo gel. The combined use of amine fluoride-containing toothpaste and gel provided a significant reduction in DMFS mean values (38% including white spot lesions, 34% not including white spot lesions, p < 0.05) and in visible plaque index values (18%, p < 0.05) compared to the control group.

Adolescent↗

PubMed2006

The prevalence and severity of fluorosis in children who received toothpaste containing either 440 or 1,450 ppm F from the age of 12 months in deprived and less deprived communities.

This study compared fluorosis in the upper central incisors of children from socially diverse backgrounds who had received either 440- or 1,450-ppm F toothpaste from 12 months of age. The children were resident in non-fluoridated districts in the north-west of England. They received either 440- or 1,450-ppm F toothpaste and advice regarding its use until the age of 5-6 years. Dental fluorosis (TF index) was assessed on digital images of dried teeth when the children (n = 1,268) were 8-10 years old. In the less deprived districts the prevalences of fluorosis (TF >or=0) for the 1,450- and 440-ppm F groups were 34.5 and 23.7% (p = 0.006). In the deprived districts the prevalences of fluorosis were 25.2 and 19.5% (p = 0.2). Overall the prevalences of TF >or=2 were 7 and 2.1% for the 1,450- and 440-ppm F groups and 2.2 and 0.2% for TF >or=3. These differences were statistically significant (p < 0.003). There was a strong association between the deprivation status of wards and fluorosis. Only 1 subject with a TF score of 3 was identified in the two most deprived quintiles of the Townsend score. It is concluded that careful targeting of programmes of this type to children living in high caries risk deprived communities carries only a small risk of aesthetically objectionable fluorosis (TF >2) whether low or high fluoride toothpastes are used. High fluoride (1,450 ppm F) toothpastes should not be provided on a community basis to very young children in less deprived communities.

Cariostatic Agents↗

PubMed2006

Effects of various rinsing protocols after the use of amine fluoride/stannous fluoride toothpaste on the acid production of dental plaque and tongue flora.

The aim of this clinical study was to evaluate the effect of various rinsing protocols on oral acid production 6 h after tooth brushing with an amine fluoride/stannous fluoride (AmF/SnF2) toothpaste. After a 14-day period of using F-free toothpaste, 30 participants followed three experimental protocols each, followed by F-free washout periods in a randomized crossover trial. They used AmF/SnF2 toothpaste twice daily for 1 week, and after brushing, they either rinsed with tap water, omitted the post-brush rinse, or rinsed with an AmF/SnF2 mouthwash. In the F-free washout periods, the participants brushed their teeth without further instructions. Six hours after the last brushing (+/-rinsing) of each period, subjects rinsed with 10 ml 10% sucrose solution for 2 min. A tongue film sample and a buccal plaque sample were taken 4 and 8 min after the sucrose challenge, respectively. Metabolic acid ions were determined by capillary electrophoresis. The results show that (1) omitting the post-brush water rinse did not reduce the production of lactic, acetic or minor acids in plaque, nor on the tongue, and that (2) the additional use of AmF/SnF2 mouthwash after brushing reduced the acid production in plaque and tongue samples for at least 6 h. The distributions of acids produced in the plaque or tongue samples were not statistically different between experimental periods. It is concluded that an increase in the antimetabolic effect of AmF/SnF2 toothpaste in between two daily brushing exercises is not achieved by omitting the post-brush water rinse. The additional use of AmF/SnF2 mouthwash after brushing is effective in reducing the acid metabolism in dental plaque and tongue flora.

Acids↗

PubMed1990

In vitro screening of Chinese medicinal toothpastes: their effects on growth and plaque formation of mutans streptococci.

Many plant extracts or derivatives have been incorporated into commercial toothpastes to treat oral diseases related to caries or periodontal diseases in China. However, no information is available concerning their in vitro effects on oral bacteria. Thirty-one Chinese medicinal toothpastes were selected for this study. Their ability to inhibit growth, in vitro plaque formation and glucosyltransferase (GTF) activity of Streptococcus sobrinus B13 and Streptococcus mutans 3209 were examined. Eighty-seven percent of the tested toothpastes inhibited the growth of the mutans streptococci, with zones ranging from 0.8 to 2.5 cm. At 10 mg/ml, 74% of the toothpastes inhibited in vitro plaque formation by S. mutans. Among these, 60% completely suppressed water-insoluble glucan synthesis from sucrose by GTF. Based on data obtained from our study, the incorporation of natural plant products or their derivatives into dentifrices seems a feasible means of promoting oral health and controlling dental diseases.

Dental Plaque↗

PubMed1990

Estimation of fluoride absorption from swallowed fluoride toothpastes.

Eight adults ingested five different toothpastes with and without 1,000 ppm (1 microgram/g) fluoride added as NaF or Na2PO3F. The systemic fluoride absorption was estimated by by comparing the areas under salivary fluoride concentration curves produced after the toothpaste ingestion. Of the toothpastes investigated--chalk, dicalcium phosphate dihydrate, silica or alumina with sodium monofluorophosphate, and silica with sodium fluoride--the fluoride absorption was found to be statistically significantly lower only from the dicalcium phosphate dihydrate toothpaste. Measuring changing fluoride levels in saliva appears to be an acceptable non-invasive technique for following systemic fluoride absorption.

Absorption↗

PubMed1994

An in vitro mouth model to test antiplaque agents: preliminary studies using a toothpaste containing chlorhexidine.

The development of an in vitro model simulating the oral cavity has allowed the antiplaque activity of a toothpaste containing 0.004% chlorhexidine to be tested. The model is based on the continuous irrigation of bovine tooth samples with artificial saliva. Scanning electron microscopy showed homogeneous colonization of monobacterial plaque by Streptococcus mutans on dental surfaces under these model conditions. The enamel was colonized with regular cell clusters showing a globular appearance. The globules coalesced with increasing plaque thickness. Treatment with toothpaste containing 0.004% chlorhexidine showed a more marked inhibition of bacterial colonization on enamel surfaces than placebo paste lacking this antimicrobial agent. These results indicate that the toothpaste formulation is compatible with chlorhexidine. It is concluded that the in vitro model developed in this study is suitable for the testing of the antiplaque activity of antimicrobial agents, particularly when in a semisolid form such as in a toothpaste.

Animals↗