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Clinical effectiveness of some fluoride-containing toothpastes.

Comparisons were made of the clinical effectiveness of two small groups of fluoride-containing toothpastes on the basis of published and unpublished information available to the group. One comparison showed that particular sodium fluoride/silica and stannous fluoride/calcium pyrophosphate formulations were effective in reducing the incidence of dental caries in schoolchildren and that the former toothpaste was more effective than the latter. A separate comparison showed that certain toothpastes containing sodium monofluorophosphate formulated with either an alumina or an insoluble metaphosphate abrasive were also effective in reducing and controlling caries. The group recommended that there was a need for additional field trials in which direct comparisons could be made between a wide variety of formulations, and that further research should be carried out to develop improved formulations. Extension of the use of adequately formulated fluoride-containing toothpastes is recommended as a valuable public health measure to reduce the incidence of dental caries.

Calcium Pyrophosphate↗

Effect of a lactoperoxidase containing toothpaste in radiation-induced xerostomia.

Fractioned irradiation of the oral region may cause xerostomia and an increased infection risk. The aim of this study was to evaluate, in a single blind, cross-over trial, the effectiveness of a test toothpaste containing the lactoperoxidase system, compared to a normal fluoridated toothpaste. Twelve patients with pronounced xerostomia were examined during a 52-day period. The following parameters were observed: plaque and gingivitis index, bleeding on probing, probing pocket depth, attachment level, and quality of subgingival plaque (phase contrast microscopy). The test toothpaste reduced the rate of supragingival plaque formation over a longer period. Furthermore, gingival inflammation was lower in the test group. For the other parameters, time-dependent changes were not significant. This pilot-study demonstrates the efficacy of the lactoperoxidase system administered by a toothpaste, on supragingival plaque control in xerostomic patients.

Adult↗

Cleaning effect of toothbrushing with three different toothpastes and water.

The cleaning effect of three different toothpastes and water was studied in vivo using a laser reflexion technique. Ten healthy persons formed the test group. Light reflexion measurements on the upper front teeth were performed before and after the removal of a 72-hour plaque-pellicle. The results suggest that the toothpaste containing sodium bicarbonate as abrasive was less effective than a toothpaste containing aluminium silicate, calcium carbonate and dicalcium-phosphate dihydrate or silicon dioxide and dicalcium phosphate dihydrate. The abrasivity of the toothpastes was compared in vitro. The in vitro results correspond quite well to the in vivo findings.

Acrylic Resins↗

[The effect of rare earth metal-containing toothpastes on dental enamel solubility in vitro].

The effect of different REE containing toothpastes has been studied on human dental enamel, in an experimental model, using diluted suspensions of toothpastes. The grade of remineralization has been characterised by the amount of dissolved phosphorus from the enamel samples. All the investigated-, REE containing toothpastes decreased the acid-solubility of dental enamel, the best results were found in the group of samarium-containing toothpastes.

Dental Enamel Solubility↗

Effect of an antibacterial varnish and amine-fluoride/stannous fluoride (AmF/SnF2) toothpaste on Streptococcus mutans counts in saliva and dental plaque of children.

The purpose of this study was to evaluate the effect of the simultaneous application of a chlorhexidine and thymol-containing varnish (Cervitec) and an amine fluoride/stannous fluoride containing toothpaste (Meridol) on Streptococcus mutans counts in saliva and dental plaque of school children 12-14 years of age, during a six-week period. The children were separated into group 1 (Cervitec varnish + fluoride-containing toothpaste), group 2 (Cervitec varnish + Meridol toothpaste), and group 3 (Meridol toothpaste alone). Over the six weeks the greatest improvement in salivary Streptococcus mutans count occurred in group 2. Overall, a statistically significant decrease in total microbiological count, and Streptococcus mutans was found in all three groups.

Adolescent↗

The effect of two toothpastes on plaque and gingival inflamation.

In this study on 60 adult subjects, the effective of Parodontax, a dentifrice containing herbal ingredients and sodium bicarbonate abrasive, was compared to a non-marketed new toothpaste containing herbal ingredients and calcium hydrogen phosphate as the abrasive. Plaque, gingivitis and gingival bleeding parameters were scored. The periodontal probe bleeding index of Ainamo and Bay was modified to score slight and moderate bleeding. In this first four-week period all subjects used the new toothpaste. After this period the new toothpaste produced a significant decrease (p<0.01) in gingivitis and bleeding on probing, but no effect on plaque was observed. During the second period of eight weeks the subjects were randomly divided into two groups, one using Parodontax and the other group continuing with the new toothpaste. The study design was a double-blind procedure. At the end of the 12-week study period the plaque index showed no changes in both groups. The gingivitis and bleeding indices decreased significantly (p<0.001) by 40% in both groups compared to the baseline examination.

Adult↗

Developments in fluoride toothpastes--an overview.

OBJECTIVE: This paper reviews current issues in the development of fluoride toothpastes as a public health measure. DESIGN: The issues examined included low concentration formulations, delivery systems, dispensing instructions and labelling, oral clearance. effect on root caries, additional therapeutic agents and marketing and manufacturing issues. RESULTS: Lower fluoride formulations may carry a lower risk of fluorosis but this must be balanced against a higher risk of caries. Risk factors for fluorosis include inappropriate fluoride supplements but the age at which toothbrushing began, frequency of brushing and residence in an optimum fluoride area have also been implicated. CONCLUSIONS: The dental profession should: clarify the most appropriate fluoride concentration in toothpastes used for children; ensure that other sources of fluoride do not increase the risk of dental fluorosis: investigate the effectiveness of fluoride toothpaste in inhibiting root surface caries in adults. Manufacturers should: continue to improve the performance of fluoride toothpaste; ensure that all pastes maximise fluoride bioavailability; develop active agents to help reduce oral disease; label products clearly with ppm F; review the delivery systems so as to reduce the risk of dental fluorosis.

Adult↗

Strong evidence that daily use of fluoride toothpaste prevents caries.

DATA SOURCES: Medline, Cochrane Library, reference lists of identified articles and selected textbooks were used to source studies. STUDY SELECTION: Selected studies were randomized or controlled clinical trials of at least 2 years' duration with caries increment in the permanent (DMFS/T) or primary (dmfs/t) dentition as the endpoint. Reports published in Danish, English, French, German, Italian, Norwegian, Spanish or Swedish were included. For multiply reported trials the one with the longest follow-up period was included. DATA EXTRACTION AND SYNTHESIS: Inclusion decisions and grading of the studies was performed independently by two of the authors. The main outcome was prevented fraction (PF). A pooled estimate was calculated for included studies. RESULTS: Fifty-four studies were included. There was strong evidence for a caries-preventive effect of daily use of fluoride toothpaste compared with placebo in the young permanent dentition (PF, 24.9%; standard deviation, +/-11.5%). Toothpastes containing 1500 ppm of fluoride had a superior preventive effect (additional PF, 9.7%; range 0-22%) compared with standard dentifrices of 1000 ppm fluoride. There was also strong evidence for higher caries reductions with supervised toothbrushing compared with unsupervised brushing. There was incomplete evidence regarding the effect of fluoride toothpaste in the primary dentition. CONCLUSIONS: This review reinforces the importance of daily toothbrushing with fluoridated toothpastes for preventing dental caries, although long-term studies in age groups other than children and adolescents are still lacking.

Comment↗

Intravasal "toothpaste" in men with obstructive azoospermia is derived from vasal epithelium, not sperm.

PURPOSE: Men undergoing vasectomy reversal many years after vasectomy are at increased risk for secondary epididymal obstruction. When this occurs the intravasal fluid is often a thick, white, toothpaste-like material devoid of sperm. In this study we characterize the vasal fluid found in men with a newly described entity, segmental dysplasia of the vas deferens, in which at least 2 distinct sites of vasal obstruction are present. We determine the significance of this fluid in men with obstructive azoospermia. MATERIALS AND METHODS: Three men who underwent scrotal exploration for obstructive azoospermia due to segmental dysplasia of the vas deferens were evaluated. Each underwent scrotal exploration including bilateral vasotomy and testicular biopsy. Intravasal fluid was collected, evaluated microscopically and sent for cytopathological evaluation. RESULTS: All men had isolated segments of the vas 2 to 5 cm in length that were not connected to the epididymis or ejaculatory ducts. We have named this condition segmental dysplasia of the vas deferens. Vasotomy was performed between aplastic segments, revealing thick, white, toothpaste-like material identical to that seen in men with secondary epididymal obstruction undergoing vasectomy reversal. Cytopathological evaluation of this fluid revealed proteinaceous concretions and rare clusters of degenerated columnar epithelial cells, but no sperm or sperm products. CONCLUSIONS: Thick, white, toothpaste-like material is produced between 2 obstructed segments as seen in men with segmental dysplasia of the vas deferens and with secondary epididymal obstruction. Our findings in men with segmental dysplasia of the vas deferens indicate that vasal "toothpaste" must be derived from vasal epithelium, not sperm.

Body Fluids↗

[An in vitro study of anti acidic etching effect of polypeptide-containing toothpaste on dental enamel]

OBJECTIVE:The present study was to investigate the anti-acidic etching effect of a kind of toothpaste containing biotin-polypeptide. METHODS:28 enamel slabs were treated with polypeptide-containing toothpaste in the pH-cycle environment,and then were analyzed by micro-hardness detector and polarized light microscope.RESULTS:The dental enamel treated with polypeptide-containing toothpaste was harder than the control group (P<0.0001);and the degree of demineralization in treated group was also less than the control one.CONCLUSION:There was certain acid resistant effect using the polypeptide containing toothpaste to treat the dental enamel.

Journal Article↗

Topical fluoride (toothpastes, mouthrinses, gels or varnishes) for preventing dental caries in children and adolescents.

BACKGROUND: Topical fluoride therapy (TFT) in the form of varnish, gel, mouthrinse or toothpaste has been used extensively as a caries-preventive intervention for over three decades. OBJECTIVES: To determine the effectiveness and safety of fluoride varnishes, gels, mouthrinses, and toothpastes in the prevention of dental caries in children and to examine factors potentially modifying their effect. SEARCH STRATEGY: We searched the Cochrane Oral Health Group's Trials Register (May 2000), CENTRAL (The Cochrane Library Issue 2, 2000), MEDLINE (1966 to January 2000), plus several other databases. We handsearched journals, reference lists of articles and contacted selected authors and manufacturers. SELECTION CRITERIA: Randomized or quasi-randomized controlled trials with blind outcome assessment, comparing fluoride varnish, gel, mouthrinse, or toothpaste with placebo or no treatment in children up to 16 years during at least 1 year. The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces (D(M)FS). DATA COLLECTION AND ANALYSIS: Inclusion decisions, quality assessment and data extraction were duplicated in a random sample of one third of studies, and consensus achieved by discussion or a third party. Authors were contacted for missing data. The primary measure of effect was the prevented fraction (PF) that is the difference in mean caries increments between the treatment and control groups expressed as a percentage of the mean increment in the control group. Random effects meta-analyses were performed where data could be pooled. Potential sources of heterogeneity were examined in random effects metaregression analyses. MAIN RESULTS: There were 144 studies included. For the 133 that contributed data for meta-analysis (involving 65,169 children) the D(M)FS pooled prevented fraction estimate was 26% (95% CI, 24% to 29%; p < 0.0001). There was substantial heterogeneity, confirmed statistically (p < 0.0001), but the direction of effect was consistent. The effect of topical fluoride varied according to type of control group used, type of TFT used, mode/setting of TFT use, initial caries levels and intensity of TFT application, but was not influenced by exposure to water fluoridation or other fluoride sources. D(M)FS PF was on average 14% (95% CI, 5% to 23%; p = 0.002) higher in non-placebo controlled trials, 14% (95% CI, 2% to 26%; p = 0.25) higher in fluoride varnish trials compared with all others, and 10% (95% CI, -17% to -3%; p = 0.003) lower in trials of unsupervised home use compared with self applied supervised and operator-applied. There was a 0.7% increase in the PF per unit increase in baseline caries (95% CI, 0.2% to 1.2%; p = 0.004). REVIEWER'S CONCLUSIONS: The benefits of topical fluorides have been firmly established on a sizeable body of evidence from randomized controlled trials. While the formal examination of sources of heterogeneity between studies has been important in the overall conclusions reached, these should be interpreted with caution. We were unable to reach definite conclusions about any adverse effects that might result from the use of topical fluorides, because data reported in the trials are scarce.

Adolescent↗

Long-term clinical evaluation of toothpaste and oral rinse containing sanguinaria extract in controlling plaque, gingival inflammation, and sulcular bleeding during orthodontic treatment.

A sanguinaria-containing toothpaste and oral rinse regimen was evaluated during a 6-month period to determine its effectiveness in controlling plaque, gingival inflammation, and sulcular bleeding. Oral hygiene instructions and a 1-month prestudy brushing period failed to produce a significant improvement in health among the 24 subjects as determined by the three evaluation parameters. After the oral hygiene period, the subjects were randomly assigned to the active treatment (marketed Viadent toothpaste and oral rinse) or the placebo treatment (same base formulas without sanguinaria). Treatments were evaluated using the Löe and Silness gingival index, the Silness and Löe plaque index, and the Mühlemann and Son sulcular bleeding index at baseline and monthly through 6 months. The sanguinaria regimen reduced plaque by 57%, gingival inflammation by 60%, and sulcular bleeding by 45% from baseline compared with placebo group reductions of 27% (plaque) and 21% (gingival inflammation), and an increase of 30% in bleeding index. Repeated-measures analysis of covariance with baseline scores used as covariates showed statistically significant differences at 6 months for plaque (active 0.39; placebo 0.68, p less than 0.01), gingival inflammation (active 0.32; placebo 0.76, p less than 0.001), and sulcular bleeding (active 0.34; placebo 0.70, p less than 0.002). Results of this study demonstrated that the combined use of the sanguinaria-containing toothpaste and oral rinse controls and reduces plaque and gingival inflammation in an orthodontic population.

Adolescent↗

A comparison of a reformulated potassium citrate desensitising toothpaste with the original proprietary product.

OBJECTIVES: The recent tendency for toothpaste manufacturers to combine active ingredients for benefits to a number of oral problems requires that such combinations do not vitiate the action of any one agent. The aim of this study was to compare the desensitising effects of a modified formulation with the established product. MATERIALS AND METHODS: The study was a randomised, double blind, two treatment parallel design comparing an existing potassium citrate toothpaste product (Positive Control) with the same formulation to which triclosan and zinc citrate had been added (Test). A total of 56 subjects with dentine hypersensitivity (DH) completed the 8 week study period. At baseline, days 14 and 56 visual analogue scale scores were recorded by the subjects in response to air evaporative and cold water stimuli. RESULTS: Both groups showed improvements, mostly statistically significant, from baseline to day 14 and through to day 56. Most data favoured the Test paste but differences were, for the most part, not significant. CONCLUSIONS: It is concluded that the addition of known anti-plaque agents to an established potassium salt based desensitising toothpaste did not adversely affect the activity of the product in the treatment of DH.

Anti-Infective Agents, Local↗

In vitro investigation of the liberation of fluoride ions from toothpaste compounds in a permeation model.

The most important requirement for effective topical fluoride prophylaxis from toothpaste containing fluoride is that the active fluoride agent must be chemically free, and the rapid spread of the dissolved fluoride ions over the tooth surface. Abrasive compounds in the toothpastes and the brief residence time at the site of action, the oral cavity and tooth surface must not prevent the liberation. Using a two-chamber diffusion cell and an ion-selective fluoride electrode, the content of fluoride ions in five different fluoride-containing toothpastes was determined by direct potentiometry as a function of time and the different abrasive compounds employed. The investigation has demonstrated that a reduction of the release rate of fluoride ions by nearly 50% is seen when calcium carbonate and calcium hydrogen phosphate dihydrate are used as abrasive compounds and combined with sodium fluoride.

Fluorides↗

A double-blind crossover trial of Oral Balance gel and Biotene toothpaste versus placebo in patients with xerostomia following radiation therapy.

Following therapeutic irradiation of the head and neck, patients with profound xerostomia have complaints associated with oral dryness, effects upon use of oral prosthesis, speech, and taste. In addition, xerostomia may lead to risk of oral infections and rampant demineralization of teeth. The use of topical Oral Balance gel and Biotene toothpaste (Laclede Professional Products, Gardena, CA) versus carboxymethylcellulose gel and commercial toothpaste applications was assessed in a 2-week double-blind, crossover design. The palliative effects of Oral Balance gel and Biotene toothpaste were superior to the effects of a placebo. No effect on oral colonization by Candida species and cariogenic oral microflora was seen with use of the topical agents.

Adult↗

Qualitative and quantitative analysis of tocopherols in toothpastes and gingival tissue employing HPLC NMR and HPLC MS coupling.

Gingival samples treated with toothpastes containing tocopherols (vitamin E) were investigated employing HPLC chromatography. The aim was to verify that vitamin E is actually enriched in the tissue, which could have beneficial effects on oral health. After determination of the tocopherols available in the toothpastes, control samples from healthy test persons and subjects suffering from gingivitis were analyzed. Subsequently, gingival tissues from diseased test persons who treated their teeth with the toothpastes containing tocopherols using various kinds of concentrations or applications were investigated. The first step of the analysis was a fast and careful extraction employing matrix solid-phase dispersion (MSPD). Afterward, the separation of the different tocopherol homologues existing was performed by HPLC chromatography on highly selective C30 RP phases. The identification of the tocopherol homologues was performed using the on-line coupling of HPLC with NMR spectroscopy and mass spectrometry.

Antioxidants↗

Plaque removal with the uninstructed use of electric toothbrushes: comparison with a manual brush and toothpaste slurry.

BACKGROUND: Individuals purchasing electric toothbrushes for the 1st time will mostly only have the manufacturer's instructional leaflet for information of usage. AIMS: This study was designed to simulate the 1st-time purchase and early use of an electric toothbrush with the aim of comparing plaque removal with a manual toothbrush. Secondary aims were to assess chemical plaque removal effects of a toothpaste slurry and to compare between 2 electric brushes which differed only in head speed. METHODS: A group of 16 dentate subjects participated in this single-examiner blind, randomised, crossover design balanced for residual effects. Subjects had "average" oral hygiene and had never used an electric toothbrush previously. 7 days prior to the study, all subjects received the slower oscillating rotating toothbrush under test to use at home as they wished. The test treatments were brushing with 2 oscillating rotating electric toothbrushes, a manual toothbrush and a rinse with a toothpaste slurry (3 g/10 ml water). On day 1 of each study period, subjects were rendered plaque-free, suspended oral hygiene and returned on day 5. Plaque was scored at baseline by index and area and after 30 s, 30 s (total 60 s) and 60 s (total 120 s) of the cleaning treatments. Washout periods were at least 2 1/2 days. RESULTS: Highly significant treatment differences were found between the 4 treatments because the toothpaste slurry was totally without effect. Analyses between the 3 brush treatments overall revealed no consistent significant differences. The data suggest that in the early days of electric toothbrush use, subjects perform no better than using a manual brush. CONCLUSIONS: The present study, taken with results from others showing greater benefits from the use of electric brushes, supports the idea that dental professionals should, where possible, provide advice and instruction in the use of such devices.

Analysis of Variance↗

The relationship between reported toothpaste usage in infancy and fluorosis of permanent incisors.

OBJECTIVE: To examine a possible relationship between reported toothbrushing habits in infancy and fluorosis of permanent maxillary incisors at age 8-9 years. DESIGN: Comparison of clinical findings with retrospective survey data. SETTING: Five primary schools in the City of Birmingham where the water is fluoridated at 1.0 mg F/l. SUBJECT AND METHODS: Results of clinical examinations were compared with historical data collected via parental questionnaires. Maxillary central incisors of 325 consecutive children were examined for fluorosis clinically and photographically according to the criteria of the Modified Thylstrup and Fejerskov Index. 112 children had fluorosis and 213 did not. Information concerning toothbrushing habits in infancy was obtained via a questionnaire to parents who were also asked to add paste to a brush in a similar way to when the children were small. From a combination of questionnaire replies and paste weights the amount of fluoride that each child may have ingested from toothpaste each day was then estimated. RESULTS: Highly significant associations were found between estimated fluoride ingestion from toothpaste and fluorosis. The mean DMF score of the fluorosis group was half that of the fluorosis-free children. The prevalence of fluorosis among children in ACORN group A-C was significantly greater than in groups D-F. CONCLUSIONS: The results of the study suggest that toothpaste swallowing may be a factor in the production of fluorosis.

Child↗