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PubMed2002

Dental fluorosis decline after changes to supplement and toothpaste regimens.

UNLABELLED: In 1989/90, in 659 12-year-olds in Perth (F 0.8 mg/L) and the Bunbury region of Western Australia (WA) (F approximately 0.25 mg/L), dental fluorosis prevalences were 40.2% and 33.0%. Fluoride supplements (OR 4.63) and extended residence in a fluoridated area (OR 4.06) were significant risk factors; toothpaste ingestion variables had ORs greater than unity; in 1990, DMFT for this age group was 0.84. School Dental Service took steps to discourage supplement and toothpaste ingestion and to promote low fluoride toothpaste for children < 6 years of age. OBJECTIVES: To evaluate the effect of this campaign on fluorosis and caries. METHODS: Between May-July 2000, 582 10-year-olds were examined for dental fluorosis (TF index) and dental caries (DMFT) in school dental clinics. RESULTS: Fluorosis prevalence was 22.2% in Perth and 10.8% in the Bunbury region. Overall prevalence was 18.0% and of this, 80.2% was TF 1, 17.9% was TF 2 and just 1.9% was TF 3. In 1989/90, 79 children had used supplements before the age of 4 year; in 2000 only 40 had done so (P < 0.001). Mean DMFT values in Perth and Bunbury were 0.32 and 0.28 (P > 0.05). Low F toothpaste, unavailable in 1989/90, had been used by 24.5%. The only significant risk factor was residence, OR 2.0. CONCLUSIONS: Fluorosis prevalence seems to have fallen in parallel with a reduction in discretionary intake from supplements and toothpaste. No increase in dental caries experience was recorded. Because the teeth examined in this study were at risk of fluorosis in 1992-95, very soon after policies changed, and because people are slow to change health habits, it seems reasonable to expect a further improvement when teeth mineralised in the late 1990s become visible.

Analysis of Variance↗

PubMed2000

Dental fluorosis in permanent incisor teeth in relation to water fluoridation, social deprivation and toothpaste use in infancy.

OBJECTIVES: To determine the prevalence and severity of fluorosis in permanent incisor teeth in young children in a fluoridated and a fluoride-deficient community and to establish what relationship, if any, there was between the occurrence of dental fluorosis and the reported use of fluoride toothpaste in childhood. DESIGN: A prevalence study of children aged 8-9 years who had been continuous residents in fluoridated Newcastle or fluoride-deficient Northumberland. METHOD: The permanent maxillary central incisor teeth were examined clinically and photographically by one examiner using the Thylstrup-Fejerskov index; the photographs were read blind to child identity and clinical score. A closed-response questionnaire enquired into the child's early experiences of toothbrushing and use of fluoride toothpastes. Social deprivation was measured by a Jarman score. The study took place in 1998. OUTCOME MEASURE: Prevalence of dental fluorosis measured by the Thylstrup-Fejerskov index. RESULTS: Complete data were available for 78% (n = 409) and 79% (n = 403) of eligible sampled children in the two areas, respectively. Clinical and photographic results agreed closely and had high reproducibility. The prevalence of fluorosis was 54% in the fluoridated area and 23% in the fluoride-deficient area when all grades (> 0) of fluorosis were included; percentage prevalence of mild to moderate fluorosis (> or = 3) was 3% and 0.5% in the two areas, respectively. Multivariate analysis indicated that area of residence (odds ratio = 4.5), Jarman score (odds ratio = 0.99 per Jarman unit) and type of toothpaste (odds ratio = 1.6) were statistically significantly related to presence or absence of fluorosis: the risk factors were--fluoridated area, affluence, and use of adult toothpaste. CONCLUSIONS AND RECOMMENDATIONS: The prevalence of aesthetically important dental fluorosis was low, although higher in the fluoridated area. Use of a child's toothpaste (with lower fluoride concentration) could decrease risk in a fluoridated area. Adherence to the guidelines published by the British Society of Paediatric Dentistry is recommended.

Child↗

PubMed2003

Caries-preventive effect of fluoride toothpaste: a systematic review.

With a questionnaire addressed to general dental practitioners in Sweden, the Swedish Council on Technology Assessment in Health Care launched a project group in 1999 to systematically review and evaluate the existing literature on various caries preventive methods. The aim of this article was to report findings concerning the caries preventive effect of fluoride toothpastes in various age groups, with special emphasis on fluoride concentration and supervised versus non-supervised brushing. A systematic search in electronic databases for articles published between 1966 and April 2003 was conducted with the inclusion criteria of a randomized or controlled clinical trial, at least 2 years follow-up and caries increment in the permanent (deltaDMFS/T) or primary (deltadmfs/t) dentition as endpoint. Out of 905 articles originally identified, 54 met the inclusion criteria. These studies were assessed independently by at least two reviewers and scored A-C according to predetermined criteria for methodology and performance. The measure of effect was the prevented fraction (PF), expressed as percent. The results revealed strong evidence (level 1) (i) for the caries preventive effect of daily use of fluoride toothpaste compared to placebo in the young permanent dentition (PF 24.9%), (ii) that toothpastes with 1,500 ppm of fluoride had a superior preventive effect compared with standard dentifrices with 1,000 ppm F in the young permanent dentition (PF 9.7%), and (iii) that higher caries reductions were recorded in studies with supervised toothbrushing compared with non-supervised (PF 23.3%). However, incomplete evidence (level 4) was found regarding the effect of fluoride toothpaste in the primary dentition. In conclusion, this review reinforced 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.

Adolescent↗

PubMed2004

Development of methods to enhance extrinsic tooth discoloration for comparison of toothpastes. 2. Two-product clinical study.

BACKGROUND: Extrinsic staining of teeth is considered to be unsightly and a number of 'whitening' toothpastes have been formulated to inhibit or remove such tooth discoloration. The aim of this study was to compare the stain prevention of two toothpastes. METHOD: The study was a single-blind, randomised, placebo-controlled, crossover design, balanced for residual effects involving 24 healthy dentate volunteers. The treatments were as follows: (1) a whitening toothpaste product, (2) an experimental toothpaste formulation and (3) water. For each 4-day rinse period, subjects were rendered stain free on the teeth and tongue. Approximately on the hour from 09:00 to 16:00 hours, subjects rinsed with chlorhexidine mouth rinse for 1 min followed by warm black tea for 1 min. The treatment interventions were at 09:00 and 16:00 hours and before the chlorhexidine rinse. The toothpastes were rinsed as 3 g/10 ml water slurries and water as a 10 ml rinse each for 2 min. On day 5, subjects were scored for tooth and tongue stain intensity and area, and the product of these was calculated. The washout period was at least 9 days. RESULTS: Treatment differences for the teeth were highly significant but not for the tongue. Paired contrasts for tooth stain intensity, area and product were mostly all significantly in favour of reduced staining by the experimental formulation compared with water and the whitening product. There were no significant differences between water and the whitening product. CONCLUSIONS: Using a forced dietary staining method, the data support a tooth stain-inhibitory/-removal action for the experimental formulation, but not the whitening product.

Adult↗

PubMed1993

A 6-month home usage trial of a 1% chlorhexidine toothpaste (1). Effects on plaque, gingivitis, calculus and toothstaining.

Research and development has been aimed towards the development of toothpastes for oral hygiene and gingival health benefits. The most effective antiplaque agent to date, chlorhexidine, is difficult to formulate into active toothpaste products. Despite some encouraging findings for experimental chlorhexidine toothpastes, there are to date no commercially available products. Based on positive findings from an experimental gingivitis study, this investigation evaluated 2 chlorhexidine toothpastes, one with fluoride, as adjuncts to oral hygiene. The study was a double-blind controlled, parallel, balanced group design, extending over 6 months. A total of 297 volunteers commenced the study after screening for a minimum acceptance level of gingivitis. At baseline, 6, 12 and 24 weeks, stain, gingival, bleeding and plaque indices were recorded, together with a calculus index at 6, 12 and 24 weeks. After a baseline prophylaxis, volunteers used the allocated product 2 x per day, with no other oral hygiene instructions given. Plaque, gingival and bleeding scores improved in all 3 groups, but to an overall significantly greater extent in the active groups. However, staining and calculus indices were significantly increased in the active compared to the control group. If the local side-effects of chlorhexidine are considered to be acceptable, these chlorhexidine toothpastes could be recommended for the same clinical applications as other chlorhexidine products. The apparent compatibility of fluoride with chlorhexidine in the one product may be pertinent to caries prevention.

Adolescent↗

PubMed1995

The use of plaque area and plaque index to measure the effect of fluoride and chlorhexidine toothpastes on 24-h plaque regrowth.

Short-term methodologies have been developed to screen chemical agents for plaque inhibitory effects. Most measure inhibition of plaque regrowth over several days. A method was described to study agents over 16-24 h periods, although some difficulties with the index used were reported. The aim of this study was to determine whether more conventional plaque scoring methods could be used. These 2 crossover studies measured plaque regrowth over 24 h in 20 subjects and in response to single brushings with either a chlorhexidine and minus active toothpaste or to a fluoride toothpaste product and water. Significantly less plaque had reformed after brushing with the chlorhexidine toothpaste compared with its control and with the fluoride toothpaste compared with water. 18 subjects participated in both studies and using their data for an interstudy comparison, less plaque developed with the chlorhexidine compared with the fluoride toothpaste. These studies had the advantage that longer-term trials already demonstrated the same differences. This permits one to conclude with some certainty that the 24-h plaque regrowth study design, using conventional measures of plaque accumulation, could be a useful and rapid method of screening potential plaque inhibitory agents and formulations.

Anti-Infective Agents, Local↗

PubMed1997

Studies on stannous fluoride toothpaste and gel (1). Antimicrobial properties and staining potential in vitro.

Stannous fluoride (SF) in a toothpaste vehicle has the potential to provide anticaries and plaque inhibitory benefits through the fluoride and antimicrobial stannous moieties respectively. Dental staining, however, can occur by precipitation of dietary chromogens onto the tooth surface by stannous ions. These studies in vitro compare the antimicrobial profile and propensity to cause tea staining of a number of stannous fluoride formulations. The formulations used were 2 SF toothpaste products (SF1, SF2), 2 experimental SF plus stannous pyrophosphate toothpastes (SFSP1, SFSP2), a SF gel (G) and a NaF toothpaste (C). Maximum inhibitory dilution values against a range of oral bacteria were determined by agar dilution. Tea staining was measured spectrophotometrically on saliva coated clear acrylic blocks exposed to slurries of the paste or gel. All formulations showed antimicrobial activity with the order of greatest activity downwards being C, SF2, SF1, SFSP1, SFSP2 and G. Tea staining at 10 exposures was in the following descending order of optical density SFSP1, SFSP2, G. C, SF1, SF2, water control. The antimicrobial profile of G was similar to that of SF, whereas that of the other formulations were varied but similar to a detergent profile. The difference in staining suggested considerable variation in availability of stannous ions in the formulations. However, the propensity for stannous ions to stain must be balanced against the stain removal propensity of the contained detergents in the toothpaste formulations. In conclusion, the variation in antimicrobial activity and more particularly staining activity of the formulations suggest the products will vary in activity in vivo.

Anti-Infective Agents, Local↗

PubMed2005

The prevention of plaque re-growth by toothpastes and solutions containing block copolymers with and without polypeptide.

BACKGROUND/AIMS: Chemicals which have a direct effect at inhibiting or reducing bacterial adherence to tooth surfaces may subsequently inhibit plaque growth and reduce gingival inflammation. This study investigated whether two anti-adherent systems could inhibit plaque re-growth in the mouth when rinsed as a solution or as a toothpaste slurry. METHODS: A total of 21 subjects took part in a partially blind, seven cell cross-over study which compared the effects on plaque re-growth of a binary system containing block copolymers, a ternary system containing block copolymers and polypeptide, both used as toothpaste slurry rinses, their corresponding solution rinses, a conventional fluoride toothpaste rinse, a positive control chlorhexidine rinse and a negative water control. Following a dental prophylaxis subjects then rinsed with 10 ml of one of the test products for 1 min. twice a day over a 4-day period. Throughout each trial period the subjects were not permitted to use any other forms of oral hygiene. On the fifth day (96 h), the volunteers returned to the clinic, and plaque was assessed by (1) plaque index and (2) plaque area following disclosing with a food dye. The test phase of the trial was repeated for each agent and was followed by a 10-day "washout" period. RESULTS: Essentially neither of the anti-adherent systems inhibited plaque re-growth, whether administered in a toothpaste slurry or solution compared with the controls. If anything, neither of the test pastes were as effective as the marketed commercial paste (p<0.001). As expected plaque recorded following use of the chlorhexidine rinse was significantly less than that seen with any of the other rinses (p<0.001). CONCLUSIONS: Using this 4-day plaque re-growth model, the findings of this study failed to show any benefit in using the anti-adherent systems, either in a rinse or toothpaste, with the aim of inhibiting or reducing plaque formation.

Adult↗

PubMed2005

A study into the plaque-inhibitory activity of experimental toothpaste formulations containing antimicrobial agents.

BACKGROUND/AIMS: The use of specific antimicrobial agents in toothpastes may help reduce plaque and gingivitis. There would also appear to be some value in formulating products that contain combinations of such agents that may potentiate any activity present. The aims of this exploratory and pragmatic study were twofold: (1) Exploratory: to compare the effects on plaque re-growth of two zinc citrate/triclosan formulations, one of which contained bromochlorophene and hence demonstrate any additional beneficial effects produced by the addition of the phenol. (2) Pragmatic: to assess whether both pastes were significantly better than a benchmark control, proprietary fluoride toothpaste at inhibiting plaque formation. METHODS: Following an initial prophylaxis to remove all plaque and calculus, toothpaste slurry rinses were used over a 96 h period by 24 volunteers, while omitting all other oral hygiene procedures. After 24, 48 and 96 h, plaque was measured by plaque area and by plaque index. For comparative purposes, a conventional commercial fluoride toothpaste rinse was also used as a benchmark control in this triple cross-over double-blind study. RESULTS: With one exception, comparisons between the three pastes failed to show any significant differences in plaque accumulation at 96 h whether assessed by plaque index or area. At this time period, significantly more plaque was seen with the zinc citrate paste without bromochlorophene, compared with that of the control paste. CONCLUSIONS: The findings from this study failed to demonstrate a plaque-inhibitory action from the two novel formulations beyond that of a conventional benchmark toothpaste, although overall levels of plaque formed by the volunteers, especially on the control paste were generally lower than in previous studies. Nevertheless, it remains to be determined whether the test formulations could exert a direct anti-inflammatory action against gingivitis by way of the triclosan delivery system. Neither test formulation was subsequently marketed.

Adult↗

PubMed2006

Effect of triclosan/copolymer-containing toothpaste on the association between plaque and gingival bleeding: a randomized controlled clinical trial.

AIM: To study longitudinal associations between plaque and gingival bleeding and multilevel variance/covariance structures after introducing triclosan-containing toothpaste. MATERIAL AND METHODS: A 10-week, randomized, two-arm, double-masked, controlled clinical trial was conducted in 34 healthy, non-smoking females with plaque-induced gingivitis. Clinical periodontal examinations were repeated every other week. At week 4, test toothpaste containing 0.24% sodium monofluorophosphate, 0.3% triclosan, and 2% polyvinyl-methyl ether maleic acid; or control toothpaste containing 0.76% sodium monofluorophosphate and 0.1% sodium fluoride, were randomly distributed. RESULTS: Multivariate multilevel models indicated that, after introducing experimental toothpastes, subject random error was reduced from 0.6 to below 0.2. The odds ratio (OR) of bleeding on probing (BOP) was about 30% less in the test than in the control group (p<0.01). At the end of the experiment, ORs for BOP and plaque index scores 1-3 (reference 0) were 2.1-2.4 in the control group, but 1.1-1.9 in the test group (p<0.05). No effects on plaque levels and calculus were observed. CONCLUSIONS: Multivariate multilevel modelling allows the study of fixed and random effects of experimental toothpastes on gingival inflammation in small sample. Triclosan appears to attenuate the causal association between supragingival plaque and gingival bleeding in gingivitis.

Adult↗

PubMed1976

Antimicrobial effect of four different toothpastes.

The study was undertaken to evaluate the antimicrobial effect of a commercial toothpaste, claimed to contain active chlorhexidine gluconate. Two traditional toothpastes and a 0.5% chlorhexidine gel were used as negative and positive control pastes. To exclude the effect of mechanical cleaning, all the agents were applied twice daily to the tooth surfaces by means of individually constructed acrylic cap splints. Ten dental students used each paste in a 4-week cross-over double-blind study comprising four test periods of 4 d duration. The students were allowed normal mechanical oral hygiene during the 3 d between the test periods. At the beginning and the end of each test period the tooth surfaces in the right halves of the jaws were scored for the Plaque Index, after which disclosing solution was used and the teeth of the left halves of the jaws were scored for stained plaque. Of all the toothpastes tested, only the chlorhexidine gel exhibited an antimicrobial effect comparable to that of efficient mechanical oral hygiene measures. The effect of the toothpaste with claimed chlorhexidine content did not differ from that of the two traditional toothpastes.

Bacteria↗

PubMed1992

Acquisition of alkali-soluble fluoride by enamel through treatment with NaF-containing toothpastes in vitro.

The first aim of the present study was to examine if alkali-soluble fluoride (calcium fluoride-like material and adsorbed fluoride) forms when a NaF-containing toothpaste is applied on human enamel surface in vitro. The centrifuged supernatants of toothpastes dissolved in distilled water were used and four different commercial NaF-containing toothpastes were tested. The second aim was to investigate if pyrophosphate would interfere with the deposition of alkali soluble fluoride. The formation of alkali-soluble fluoride was determined by chemical analysis and visualized by scanning electron microscopy (SEM). It was ascertained that all tested toothpastes contained free fluoride according to the manufacturers' specifications. It was shown that they promoted deposition of alkali soluble fluoride on the enamel surface. The amount of deposited material increased with the time of exposure. The clinical effect of a NaF-containing toothpaste may thus well depend on an initial formation of alkali-soluble fluoride. Fluoride from this reservoir may adsorb onto the enamel crystals and inhibit further demineralization or increase the rate of remineralization during cariogenic challenges. It was also demonstrated that pyrophosphate did not interfere with the deposition of alkali soluble fluoride.

Adsorption↗

PubMed1998

Anti-calculus activity of a toothpaste with microgranules.

OBJECTIVE: The objective of the trial was to determine the efficacy of the proven anticalculus active system (zinc citrate trihydrate [ZCT] and triclosan), when the ZCT is delivered from microgranules incorporated in a silica-based toothpaste containing 1450 ppm F as sodium fluoride. DESIGN: A monadic, single-blind, two phase design clinical trial was used to compare the effect of the test and a negative control fluoridated toothpaste on the formation of supragingival calculus. SUBJECTS AND METHODS: Male and female calculus-forming volunteers, aged 18 or over, were recruited for the study following a 2-week screening phase. All subjects were given a scale and polish of their eight lower anterior teeth at the start of both the pre-test and test phases. Subjects were supplied with a silica-based 1450 F ppm fluoridated toothpaste with no anti-calculus active for use during an 8-week pre-test phase. Calculus was assessed at the end of the pre-test and test phases using the Volpe-Manhold index (VMI). Subjects were stratified according to their pre-test VMI score (8-10, 10.5-12, > 12) and gender and then allocated at random to test or negative control toothpaste groups. Subjects with < 8 mm of calculus were excluded from further participation. MAIN OUTCOME MEASURE: The outcome variable was the mean VMI score for the test and negative control groups. RESULTS: The test toothpaste caused a statistically significant 30% reduction in calculus compared with the control paste after a 13-week use. No adverse events were reported during the study. CONCLUSION: The incorporation of the ZCT in microgranules did not adversely affect the anticalculus activity of the new formulation.

Adolescent↗

PubMed2003

The effect of a toothpaste containing 2% zinc citrate/0.3% Triclosan on the glycolysis of plaque bacteria ex vivo after food intake.

OBJECTIVE: To develop an ex vivo plaque pH method to assess the efficacy of a new zinc citrate/Triclosan formulation. METHODS: Study (1) focussed on method development. Study (2) examined the effect of a toothpaste containing 2% zinc citrate/0.3% Triclosan on the pH of plaque after product use and consumption of pizza. Study (3) investigated the effect of the same formulation and a fluoride toothpaste on the pH of plaque without an 'eating occasion'. The pH of plaque samples was measured over 10 minutes in the presence of glucose. RESULTS: The test product significantly reduced the amount of acid produced 30 minutes (p = 0.0035) and 3 hours (p = 0.0018) after brushing (study (2)). In study (3) use of the test product significantly reduced the amount of acid produced 3 hours after brushing (p = 0.0023). No significant benefit was found for the fluoride toothpaste. CONCLUSION: An ex vivo plaque pH method has been developed which can detect changes in acid produced following brushing with different toothpastes. A toothpaste containing 2% zinc citrate/0.3% Triclosan significantly reduced the total acid produced for at least 3 hours after product use. Moreover it has been demonstrated that this effect is detectable even after eating.

Adult↗

PubMed2004

Antiplaque and antigingivitis efficacy of toothpastes containing Triclosan and fluoride.

OBJECTIVE: To compare the reduction of plaque and gingivitis from the following three toothpaste formulations containing: 0.3% Triclosan, 1,000ppm fluoride and 0.13% calcium glycerophosphate in a natural calcium carbonate base (a new paste); 0.2% Triclosan and 1,000ppm fluoride in a precipitated calcium carbonate base; 0.3% Triclosan, 1,000ppm fluoride and Gantrez in a silica base. A control group was maintained, which used commercially available toothpastes without the above actives. METHODS: A double-blind, four-cell, stratified, parallel group design study. Subjects brushed twice daily with their allocated toothpaste for 12 weeks. Plaque, MGI and gingival bleeding assessments were carried out at baseline, after 6 and 12 weeks of product use. RESULTS AND CONCLUSION: An analysis of covariance of the 12-week results showed significant differences between products [p<0.0001] for plaque, MGI and gingival bleeding. The new toothpaste formulation containing 0.3% Triclosan, 1,000ppm fluoride and 0.13% calcium glycerophosphate in a natural calcium carbonate base was shown to be significantly more effective in reducing plaque and gingivitis than the other toothpaste formulations in the study.

Adolescent↗

PubMed1989

Evaluation of the anticaries benefit of fluoride toothpastes using an enamel insert model.

The remineralization potential of fluoride toothpastes was studied using an in situ enamel insert model. Matched blocks of artificially demineralized human enamel were attached to partial dentures of 16 adult volunteers who brushed their teeth with either a toothpaste containing 1,500 ppm F or one containing 2,500 ppm F for a period of 6 weeks in a balanced, randomized crossover experiment. Computerized image analysis of microradiographs was used to measure the mineral density distribution in the enamel before and after in situ treatment. Both toothpastes demonstrated remineralization of artificial carious lesions. Significantly more remineralization was observed in enamel samples treated with the toothpaste containing 2,500 ppm F compared to that containing 1500 ppm F. This result is consistent with the outcome of a recent caries clinical trial testing the same toothpastes and finding enhanced anticaries efficacy from the higher fluoride level.

Adult↗

PubMed1997

Comparative three-year caries protection from an aluminum-containing and a fluoride-containing toothpaste.

In the present study, 2,087 fifth-graders (mean age: 12 years) from two cohorts entered a 3-year clinical toothpaste trial. The study subjects were randomly allocated to two groups: one group was a positive control using a 0.83% NaFPO3 toothpaste, while the other group brushed with a test toothpaste containing 1.77% KAl(SO4). Both toothpastes were used unsupervised at home. One set of bite-wing radiographs was obtained at the beginning of the trial and another at the 3-year follow-up. Clinical registrations of caries were performed by the municipal dentists responsible for the child's dental care. After 3 years, the mean caries increment was significantly higher in the group using the aluminum-containing toothpaste measured both clinically and radiographically.

Alum Compounds↗

PubMed1997

A three-year clinical trial of a combination of trimetaphosphate and sodium fluoride in silica toothpastes.

The relative efficacy of NaF silica toothpastes containing 1000 ppm fluoride and 1500 ppm fluoride in the control of dental caries is not clear-cut. Also, it has not been established that incorporation of trimetaphosphate (TMP) improves the anticaries activity of NaF toothpastes. A three-year clinical trial was conducted to test the hypotheses that: (i) the anticaries activity of NaF toothpastes containing 1500 ppm F was greater than that of NaF toothpastes containing 1000 ppm F, and (ii) inclusion of TMP improved the efficacy of NaF silica pastes. Subsidiary aims included determination of whether frequency of toothbrushing and method of rinsing after brushing were correlated with caries increments. The study involved 4196 children aged 11 to 12 years at outset. These participants had been selected from a pool of 7374 potential subjects on the basis of caries experience and dental eruption pattern. They were stratified by sex, examiner, and presence of calculus and caries, and were allocated at random to one of the four toothpastes under study. Using mirror and probe and also FOTI, we carried out clinical examinations at baseline and annually thereafter for 3 yrs. Bitewing radiographs of a subset of children were taken at baseline and at the end of the study. The outcome measure for the study, DMFS increment, was defined as the increase in caries over 3 yrs, taking into account changes occurring on individual tooth surfaces. Data for 3467 subjects were available for analyses at both baseline and year 3 examinations. Radiographs were taken for 1942 subjects at both baseline and year 3 examinations. The mean three-year clinical-only DMFS increment for the subjects using 1500-ppm-NaF pastes was 3.93, which was 6% lower than the corresponding mean of 4.19 for the 1000-ppm-NaF pastes. There was no significant difference between the mean DMFS increment for those using paste with or without TMP. Subjects who claimed to brush more frequently or who claimed not to use a tumbler to rinse after toothbrushing had lower three-year DFMS increments.

Analysis of Variance↗