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Abrasivity of toothpastes. An in vitro study of toothpastes marketed in Norway.

The purpose of this study was to measure the abrasivity of 23 toothpastes available on the Norwegian market. Additionally, the pH was registered. The testing was based on The British Standards Institution's specification for toothpastes, using a profilometer technique to evaluate the abrasion. The results showed that the abrasivity ranged from 0.049 to 1.367 relative to a standard reference paste. The products were classified as having 'none/slight', 'medium', or 'high' abrasivity. The pH varied between 3.7 and 10.1. Products with low pH showed evidence of a combined erosive/abrasive effect. For some brands there were statistically significant differences between the fluoride and the nonfluoride version.

Dentifrices↗

[Should toothpastes foam? Sodium lauryl sulfate--a toothpaste detergent in focus].

Sodium lauryl sulfate is one of the most widely used synthetic detergents in toothpaste. Generally, surface active agents lower the surface tension, penetrate and loosen surface deposits and emulsify or suspend the debris which the dentifrice removes from the tooth. The concentration in dentifrices usually ranges from 0.5-2.0%. It has previously been shown that sodium lauryl sulfate has the potential to initiate hypersensitivity to metal ions. Furthermore, the mucosal permeability will be increased to oil and water soluble compounds. Experiments from this laboratory indicate that sodium lauryl sulfate will interact with the deposition of fluoride on dental enamel. It is furthermore suggested that this interaction may have the potential to decrease the cariostatic effect of fluorides. Clinical studies from Denmark give support to this statement. In conclusion, sodium lauryl sulfate has some side effects, and future work should therefore be concentrated on finding other possible toothpaste detergents without these side effects.

Dentifrices↗

Comparison of a dual-phase fluoride toothpaste containing calcium, phosphate, and sodium bicarbonate with a regular fluoride toothpaste on calculus formation.

This clinical study compared the effect on dental calculus formation of a dual-phase fluoride dentifrice containing sodium bicarbonate, calcium, and phosphate with that of a regular dentifrice using a short-term clinical model in which calculus formation was facilitated. A total of 87 adult volunteers completed this study, which was a double-blind, parallel-group design, consisting of 2-week pretrial and trial periods separated by a washout period. A partial-mouth technique was used wherein the lower anterior teeth were protected from brushing by a custom-fitted toothshield, which doubled as an applicator for an undiluted dentifrice, twice daily. Calculus was measured on the labial/lingual surfaces of six lower anterior teeth by the Volpe-Manhold Index (V-MI). Subjects used a non-tartar-control dentifrice during the pretrial period to determine calculus formation rates, and these V-MI scores were used as baseline data for random allocation to either a control or test product for the trial period. Subjects who were accepted into the study, based on existing tartar deposits, readily formed calculus during the pretrial period using the toothshield method. During the trial period, subjects who were assigned the test dentifrice had comparable amounts of calculus accumulation to those who used the control dentifrice. However, subjects in the test dentifrice group had significantly lower (16%) calculus scores on lingual surfaces than those in the control group. Intragroup comparisons of V-MI data from the pretrial period with those from the trial period provided similar overall results to the comparisons between groups. This study demonstrated that a dual-phase baking soda dentifrice containing calcium and phosphate did not increase calculus accumulation relative to a regular dentifrice when used by adults with a propensity for developing calculus.

Adult↗

[Relative abrasion of toothpastes--a toothpaste for everyone].

Since our last publication in this Journal in February 1988, many new dentifrices have appeared on the market, prompting us to revise our scale of relative abrasion for the most current ones. This relative abrasion scale is determined by weight loss of mechanically brushed specimens (methyl methacrylate) with a slurry from each dentifrice.

Materials Testing↗

Strengthening of tooth enamel by a remineralizing toothpaste after exposure to an acidic soft drink.

The effect of remineralizing and conventional toothpaste treatments on the hardness of intact and acid soft drink-etched enamel were assessed in a laboratory study. The remineralizing toothpaste (Enamelon Toothpaste) used in the study contains NaF, and simultaneously provides dissolved calcium, phosphate and fluoride ions. The conventional toothpaste contains NaF in a silica base. Sound extracted maxillary human incisors, mounted in epoxy resin with the facial incisal two-thirds exposed, were polished with 0.3 mu alumina. Groups of ten teeth were exposed to either twenty 5-minute treatments with an acid soft drink (pH 2.4), remineralizing or conventional fluoride toothpaste, or to twenty alternating cycles of a 5-minute protective treatment with either the remineralizing or conventional toothpastes, followed by 5-minute exposures to the acid soft drink, or to 20 five-minute exposures to the acid soft drink followed by 20 five-minute restorative treatments with the remineralizing or conventional toothpastes. Knoop Hardness measurements were made before and after treatment using a 500 g load and 15-second dwell time. Acid soft drink exposure produced a 15.4% drop in hardness compared with 4.9% and 1.6% hardness increases due to treatments of intact enamel with the remineralizing and conventional toothpastes, respectively. Protective treatments using the remineralizing and conventional toothpastes significantly reduced the drop in hardness due to acid soft drink exposure to 3.3% and 6.2%, respectively. Restorative treatments by the remineralizing and conventional toothpastes significantly increased the hardness of the acid soft drink-weakened enamel by 12.1% and 7.3%, respectively. Both toothpastes were effective in inhibiting damage due to acid soft drink exposure, but the remineralizing toothpaste was more effective in hardening intact and decalcified enamel than the conventional toothpaste (p < 0.05).

Analysis of Variance↗

Intraoral evaluation of mineralization of cosmetic defects by a toothpaste containing calcium, fluoride, and sodium bicarbonate.

New dual-phase fluoride toothpastes that contain soluble calcium, phosphate, and baking soda have recently been introduced into the market. These toothpastes are designed to fill in small surface defects in tooth enamel and thereby enhance tooth esthetics such as gloss. This two-part study was designed to assess these superficial mineralizing effects from using one of these products compared with an experimental calcium-containing, bicarbonate-free formulation and a conventional fluoride toothpaste using an intraoral model. Enamel specimens with 4 types of defects were mounted into an intraoral appliance and placed in the mouths of volunteers for 1 month. The four types of defects were whitening toothpaste abrasion, coarse abrasion, natural dimpling, and acid etching. Before and after intraoral exposure, scanning electron microscope photographs of the specimens were made. The surface microhardness of the acid-etched specimens also was determined. The volunteers brushed their specimens twice daily with one of three randomly assigned toothpastes. The toothpastes were a two-phase, calcium-containing, bicarbonate-based toothpaste; an experimental, two-phase, calcium-containing, bicarbonate-free toothpaste; and a conventional toothpaste. Only the calcium-containing toothpastes showed unequivocal signs of mineral deposition into surface defects, leading to smoothing of the enamel. All three products significantly increased the hardness of the etched enamel, presumably because of fluoride. However, only the two calcium-containing toothpastes gave significantly greater hardness increases than the conventional toothpaste; the specimens treated with a conventional toothpaste were indistinguishable from those treated with saliva.

Calcium↗

Effect of toothpaste with natural calcium carbonate/perlite on extrinsic tooth stain.

OBJECTIVE: The current study was designed to determine the effect of natural calcium carbonate toothpaste containing Perlite and microgranules (Whitening toothpaste) on extrinsic tooth stain compared to a standard commercial toothpaste formulation with precipitated calcium carbonate (PCC) as abrasive and a commercial toothpaste with dicalcium phosphate dihydrate (DCPD) as abrasive. METHODS: The toothpastes were evaluated in a double blind, three-cell, stratified (tobacco use; baseline tooth stain level), parallel group design study involving 600 subjects with extrinsic tooth stain. Subjects brushed twice daily with their allocated toothpaste for four weeks. Extrinsic tooth stain was measured using the Macpherson modification of the Lobene stain index. RESULTS: ANCOVA showed significant differences between toothpastes (p=0.037). Subsequent multiple comparisons using pairwise t-tests, showed the Whitening toothpaste to be superior to the DCPD toothpaste (p=0.014) and the PCC toothpaste (p=0.067). When a Box-Cox transformation was made to the data (y0.6) to improve normality, these two differences were more accurately estimated at p=0.004 and p=0.03 respectively. CONCLUSION: The Whitening toothpaste has been shown to be significantly more effective in tooth stain removal than the two standard commercial toothpaste formulations.

Adult↗

Fluoride ingestion from toothpaste by young children.

OBJECTIVE: To investigate the reported and observed brushing habits of young children and their ingestion of fluoride from toothpaste. DESIGN: In 1997, a random sample of 50 children, aged 30 months, from three districts in the North West region of England, were visited at home. METHODS: The reported and observed toothbrushing behaviour was determined and the weight of toothpaste applied to the toothbrush was measured. The amount of fluoride retained in the mouth after brushing with either a 400 ppm F or 1,450 ppm F toothpaste was determined. RESULTS: All parents claimed that their children's teeth were being brushed with a fluoride toothpaste at least once daily. The mean amount of toothpaste applied on the brush was 0.36 g of which 0.27 g (72%) was retained in the mouth. The mean amount of fluoride ingested per brushing was 0.42 mg when using the 1,450 ppm F toothpaste and 0.10 mg when using the 400 ppm F toothpaste. Although most parents applied a small amount of toothpaste a small minority applied a large amount. If using the 400 ppm F toothpaste twice daily no children of average weight would have exceeded ingestion of 0.05 mgF/kg body weight whereas 14 average weight children would have exceeded this value if using the 1450 ppm F toothpaste. CONCLUSIONS: It is essential that parents of children aged less than 7 years apply a small (pea-sized) amount of fluoride toothpaste on the toothbrush and discourage swallowing.

Child↗

A 3-month home use study comparing the oral hygiene and gingival health benefits of triclosan and conventional fluoride toothpastes.

A number of triclosan toothpastes are available which have been shown to benefit gingival health when compared to triclosan free control formulations. There have been few studies to compare such active products with conventional fluoride toothpaste products. The aim of this study was to compare, in home use, a triclosan product with conventional fluoride products already found to show slightly less plaque inhibition in a short term plaque regrowth study. The study was a single-blind, parallel design with a total of 129 healthy dentate volunteers (32 male, 97 female) who toothbrushed with one of 4 toothpaste products at home, twice a day over a period of 12 weeks. At the beginning of the trial, each volunteer was scored for plaque and gingivitis and then received a through prophylaxis. Each volunteer was allocated a toothpaste according to a predetermined randomisation scheme. The volunteers were re-examined after 6 and 12 weeks. The volunteers refrained from using any other oral hygiene products during the period of the trial. The toothpastes tested were two conventional fluoride toothpastes, a children's fluoride toothpaste and a triclosan/copolymer toothpaste. Results indicated that there were no overall significant treatment differences for either plaque index or gingival index and ordering of toothpastes was not possible. All volunteers' oral hygiene and gingivitis improved following the 6-week period and continued to improve to the 12th week. This is a feature of most oral hygiene trials and presumably arises from the initial prophylaxis and a Hawthorne response of improved toothcleaning by the subjects. It must be concluded from this study that in normal home use the triclosan/copolymer toothpaste provides oral hygiene and gingival health benefits no greater than achievable with conventional toothpaste products.

Adolescent↗

Fluoride exposure from ingested toothpaste in 4-5-year-old Malaysian children.

OBJECTIVE: The aim of this study was to assess (by direct determination) the fluoride (F) exposure from ingested toothpaste among 4-5-year-old Malaysian children. METHODS: This was part of a larger study to determine fluorosis status and F exposures. A total of 1343 10-11-year-old subjects were sampled by two-stage systematic random sampling for assessment of fluorosis. Two hundred 4-5-year-old siblings of these index subjects were sub-sampled for determination of F exposures from ingested toothpastes and other sources. Estimations of F ingested from toothpaste (FI) was made by the method of difference between 'F in toothpaste taken for use' and the 'F in toothpaste used but not swallowed', by the duplicate technique under normal home conditions. F ions were determined with the combination selective ion electrode. RESULTS: The subjects ingested 32.9% of the toothpaste placed on the brush. Fluoride exposure from ingested toothpaste was highly variable and the mean was 426.9 +/- 505.5 microg (SEM 38.9)/48 h, or 213.5 microg/day and 131.9 microg per brushing. CONCLUSIONS: The amount of ingested fluoride (FI) per brushing in this study was the lowest of all studies reporting this parameter and was within the pea-size range of 125-250 microg. Because of the highly statistically significant correlations between the FI from toothpaste and the amount of toothpaste dispensed (Pearson's correlation coefficient 0.647, P = 0.000), parents should assume responsibility for placement of toothpaste and limit the amount of toothpaste used.

Analysis of Variance↗

In vitro evaluation of acidified toothpastes with low fluoride content.

Fluoride toothpastes are a risk factor for the development of dental fluorosis. Products with low fluoride content offer a higher security, but their effectiveness must be proven. The aim of this in vitro study was to compare two acidified toothpastes with low fluoride concentration (412 and 550 microg F/g) with neutral toothpastes. Bovine enamel blocks were selected by surface microhardness (SMH) and randomized to twelve groups of 13, according to the fluoride concentration in toothpaste (placebo, 275, 412, 550 or 1,100 microg F/g) and pH (7.0 or 5.5). Two commercially available toothpastes were also studied: a 1,100-microg F/g, pH 7.0 paste (positive control) and a children's paste (500 microg F/g, pH 7.0). The blocks were subjected to pH cycling for 7 days. The toothpaste treatment was done twice daily. Surface and cross-sectional microhardnesses were assessed to calculate the percentage change of SMH (%SMH) and the mineral loss (DeltaZ). The amount of fluoride, calcium and phosphorus in the solutions after the pH cycling was also analyzed. Compared to neutral toothpastes, the acidified toothpastes reduced the %SMH in all F concentrations. Higher F and lower Ca and P concentrations were found in solutions for the acidified toothpastes. Regarding DeltaZ, only the positive control, 1,100-microg F/g (acidified and neutral) groups were not statistically different. The acidified toothpastes showed a dose-response relationship with all variables. For the low-fluoride toothpastes evaluated, only the 550-microg F/g acidified paste had the same anticariogenic action as the 1,100-microg F/g neutral paste.

Animals↗