Fluoride toothpastes of different concentrations for

preventing dental caries in children and adolescents.

Walsh T1, Worthington HV, Glenny AM, Appelbe P, Marinho VC, Shi X.
Author information
1
School of Dentistry, The University of Manchester, Higher Cambridge Street, Manchester, UK,
M15 6FH.

Update in

 Fluoride toothpastes of different concentrations for preventing dental caries.  [Cochrane Database
Syst Rev. 2019]

Abstract
BACKGROUND:
Caries (dental decay) is a disease of the hard tissues of the teeth caused by an imbalance, over
time, in the interactions between cariogenic bacteria in dental plaque and fermentable carbohydrates
(mainly sugars). The use of fluoride toothpaste is the primary intervention for the prevention of
caries.

OBJECTIVES:
To determine the relative effectiveness of fluoride toothpastes of different concentrations in
preventing dental caries in children and adolescents, and to examine the potentially modifying
effects of baseline caries level and supervised toothbrushing.

SEARCH STRATEGY:
A search was undertaken on Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE
and several other databases. Reference lists of articles were also searched. Date of the most recent
searches: 8 June 2009.

SELECTION CRITERIA:
Randomised controlled trials and cluster-randomised controlled trials comparing fluoride toothpaste
with placebo or fluoride toothpaste of a different concentration in children up to 16 years of age with
a follow-up period of at least 1 year. The primary outcome was caries increment in the permanent or
deciduous dentition as measured by the change in decayed, (missing), filled tooth surfaces
(D(M)FS/d(m)fs) from baseline.

DATA COLLECTION AND ANALYSIS:

Inclusion of studies, data extraction and quality assessment were undertaken independently and in
duplicate by two members of the review team. Disagreements were resolved by discussion and
consensus or by a third party. The primary effect measure was the prevented fraction (PF), the
caries increment of the control group minus the caries increment of the treatment group, expressed
as a proportion of the caries increment in the control group. Where it was appropriate to pool data,
network meta-analysis, network meta-regression or meta-analysis models were used. Potential
sources of heterogeneity were specified a priori and examined through random-effects meta-
regression analysis where appropriate.

MAIN RESULTS:
75 studies were included, of which 71 studies comprising 79 trials contributed data to the network
meta-analysis, network meta-regression or meta-analysis.For the 66 studies (74 trials) that
contributed to the network meta-analysis of D(M)FS in the mixed or permanent dentition, the caries
preventive effect of fluoride toothpaste increased significantly with higher fluoride concentrations
(D(M)FS PF compared to placebo was 23% (95% credible interval (CrI) 19% to 27%) for
1000/1055/1100/1250 parts per million (ppm) concentrations rising to 36% (95% CrI 27% to 44%) for
toothpastes with a concentration of 2400/2500/2800 ppm), but concentrations of 440/500/550 ppm
and below showed no statistically significant effect when compared to placebo. There is some
evidence of a dose response relationship in that the PF increased as the fluoride concentration
increased from the baseline although this was not always statistically significant. The effect of
fluoride toothpaste also increased with baseline level of D(M)FS and supervised brushing, though
this did not reach statistical significance. Six studies assessed the effects of fluoride concentrations
on the deciduous dentition with equivocal results dependent upon the fluoride concentrations
compared and the outcome measure. Compliance with treatment regimen and unwanted effects was
assessed in only a minority of studies. When reported, no differential compliance was observed and
unwanted effects such as soft tissue damage and tooth staining were minimal.

AUTHORS' CONCLUSIONS:
This review confirms the benefits of using fluoride toothpaste in preventing caries in children and
adolescents when compared to placebo, but only significantly for fluoride concentrations of 1000
ppm and above. The relative caries preventive effects of fluoride toothpastes of different
concentrations increase with higher fluoride concentration. The decision of what fluoride levels to
use for children under 6 years should be balanced with the risk of fluorosis.

Link: https://www.ncbi.nlm.nih.gov/pubmed/20091655/?
fbclid=IwAR0tADpDTfpBNB4Yl_tg1OjcpCdRLbI8hJyogeyougpriokREEiSszWr8to
Comparing the Effectiveness of Probiotic, Green Tea, and
Chlorhexidine- and Fluoride-containing Dentifrices on
Oral Microbial Flora: A Double-blind, Randomized Clinical
Trial.
Prabakar J1, John J1, Arumugham IM1, Kumar RP1, Sakthi DS1.
Abstract
INTRODUCTION:
Oral cavity harbors wide variety of microorganisms; these are considered crucial for the dental caries
initiation and progression. Plaque-induced caries is a local disease; therefore, dentifrices are the
most ideal vehicle for the daily delivery of antibacterial agents. In recent years, alternatives to
fluorides such as green tea, probiotic, and chlorhexidine (CHX) toothpastes have been proposed to
possess antiplaque and anticariogenic properties.

AIM:
To compare the effectiveness of probiotic, green tea, and CHX- and fluoride-containing dentifrices
on oral microbial flora.

MATERIALS AND METHODS:

A double-blinded, parallel group, randomized controlled clinical trial was conducted among healthy
adults. Fifty-two individuals were randomly allocated to four groups (n = 13): Group I - green tea
dentifrice, Group II - fluoridated dentifrice, Group III - CHX dentifrice, and Group IV - probiotic
dentifrice. Plaque and saliva samples were evaluated for Streptococcus mutans and Lactobacillus at
baseline and 15th and 30th days of follow-up. Paired t-test and one-way ANOVA were used to
compare the mean differences of plaque and salivary S. mutans counts at two and three time
periods. Wilcoxon signed-rank and Kruskal-Wallis tests were used to compare the
mean Lactobacillus count in plaque and saliva samples at two and three time periods, respectively.

RESULTS:
The mean S. mutans and Lactobacillus counts in plaque and saliva samples were significantly
reduced by all the treatment groups at the 30th day of follow-up. However, Group III showed the
highest reduction and was found to be statistically significant (P < 0.05).

CONCLUSION:
All the four groups exhibited antimicrobial activity by bringing about a significant reduction in the
mean S. mutans and Lactobacillus colony counts at the 30th day of follow-up. Among all the
preventive modalities, Group III (CHX dentifrice) showed better results compared to other groups.

Copyright: © 2019 Contemporary Clinical Dentistry.

Link: https://www.ncbi.nlm.nih.gov/pubmed/31772463?fbclid=IwAR3BTE8rJRNGlO7e49hxJCp--
ujSLqZWUwQbHz8CjyHYbL3VmbmxnRSH6eQ
Influence of Toothpaste pH on Its Capacity to Prevent
Enamel Demineralization.
Gavic L1, Gorseta K2, Borzabadi-Farahani A3, Tadin A1, Glavina D2.
Abstract
AIM:
This study evaluated in vitro the remineralization capacity of commercial toothpastes with different
fluoride (F) concentrations and their effectiveness when they are acidified.

MATERIALS AND METHODS:

One hundred and twelve caries-free teeth were used to prepare enamel specimens, and the
specimens were divided into 16 groups (n = 7). Baseline surface Vickers microhardness was
measured for all the specimens and all the tested groups were subjected to the pH-cycling regime
involved five demineralization challenges each day for 10 days, and surface Vickers microhardness
was then measured. Once daily, specimens were exposed for 30 min after last demineralization
challenge of the day to the slurry of each toothpaste containing 1450 ppm F, 1000 ppm F, 450 ppm
F, and 0 ppm F. The slurry was in original pH or acidulated on 6.5, 6.0, or 5.5 pH. The difference
among tested group was assessed by analysis of variance and Newman-Keuls test (P < 0.05).

RESULTS:
The highest increase in microhardness was detected after treatment with toothpaste containing 1450
ppm fluoride (percentage of increase in microhardness was 6.20%), and the biggest loss was
detected after treatment with toothpaste containing no fluoride (percentage of decrease was 6.82%),
but there was no significant difference between tested groups.

CONCLUSIONS:
The highest increase in microhardness was detected after treatment with toothpaste containing more
fluorides (1450 ppm F) regardless of the acidity.

Copyright: © 2019 Contemporary Clinical Dentistry.

Link: https://www.ncbi.nlm.nih.gov/pubmed/31772462?
fbclid=IwAR2tgULbr4wGOsNMgy1PBjK_Gq7SimGLbK-8O7Tzd0t-KG3B1gvWyI8mJ1M
Fluorides for preventing early tooth decay (demineralised
lesions) during fixed brace treatment.
Benson PE1, Parkin N1, Dyer F1, Millett DT2, Germain P3.
Author information
1

University of Sheffield School of Clinical Dentistry, Academic Unit of Oral Health, Dentistry &
Society, Claremont Crescent, Sheffield, UK, S10 2TA.

Cork University Dental School and Hospital, Oral Health and Development, University College,
Cork, Ireland.

North Cumbria University Hospitals NHS Trust, Newton Road, Carlisle, Cumbria, UK, CA2 7JH.

Abstract
BACKGROUND:
Early dental decay or demineralised lesions (DLs, also known as white spot lesions) can appear on
teeth during fixed orthodontic (brace) treatment. Fluoride reduces decay in susceptible individuals,
including orthodontic patients. This review compared various forms of topical fluoride to prevent the
development of DLs during orthodontic treatment. This is the second update of the Cochrane
Review first published in 2004 and previously updated in 2013.

OBJECTIVES:
The primary objective was to evaluate whether topical fluoride reduces the proportion of orthodontic
patients with new DLs after fixed appliances. The secondary objectives were to examine the
effectiveness of different modes of topical fluoride delivery in reducing the proportions of orthodontic
patients with new DLs, as well as the severity of lesions, in terms of number, size and colour.
Participant-assessed outcomes, such as perception of DLs, and oral health-related quality of life
data were to be included, as would reports of adverse effects.

SEARCH METHODS:
Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral
Health's Trials Register (to 1 February 2019), the Cochrane Central Register of Controlled Trials
(CENTRAL; 2019, Issue 1) in the Cochrane Library (searched 1 February 2019), MEDLINE Ovid
(1946 to 1 February 2019), and Embase Ovid (1980 to 1 February 2019). The US National Institutes
of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization
International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were
placed on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA:
Parallel-group, randomised controlled trials comparing the use of a fluoride-containing product
versus a placebo, no treatment or a different type of fluoride treatment, in which the outcome of
enamel demineralisation was assessed at the start and at the end of orthodontic treatment.
DATA COLLECTION AND ANALYSIS:
At least two review authors independently, in duplicate, conducted risk of bias assessments and
extracted data. Authors of trials were contacted to obtain missing data or to ask for clarification of
aspects of trial methodology. Cochrane's statistical guidelines were followed.

MAIN RESULTS:
This update includes 10 studies and contains data from nine studies, comparing eight interventions,
involving 1798 randomised participants (1580 analysed). One report contained insufficient
information and the authors have been contacted. We assessed two studies as at low risk of bias,
six at unclear risk of bias, and two at high risk of bias. Two placebo (non-fluoride) controlled studies,
at low risk of bias, investigated the professional application of varnish (7700 or 10,000 parts per
million (ppm) fluoride (F)), every six weeks and found insufficient evidence of a difference regarding
its effectiveness in preventing new DLs (risk ratio (RR) 0.52, 95% confidence interval (CI) 0.14 to
1.93; 405 participants; low-certainty evidence). One placebo (non-fluoride) controlled study, at
unclear risk of bias, provides a low level of certainty that fluoride foam (12,300 ppm F),
professionally applied every two months, may reduce the incidence of new DLs (12% versus 49%)
after fixed orthodontic treatment (RR 0.26, 95% CI 0.11 to 0.57; 95 participants). One study, at
unclear risk of bias, also provides a low level of certainty that use of a high-concentration fluoride
toothpaste (5000 ppm F) by patients may reduce the incidence of new DLs (18% versus 27%)
compared with a conventional fluoride toothpaste (1450 ppm F) (RR 0.68, 95% CI 0.46 to 1.00; 380
participants). There was no evidence for a difference in the proportions of orthodontic patients with
new DLs on the teeth after treatment with fixed orthodontic appliances for the following comparisons:
- an amine fluoride and stannous fluoride toothpaste/mouthrinse combination versus a sodium
fluoride toothpaste/mouthrinse, - an amine fluoride gel versus a non-fluoride placebo applied by
participants at home once a week and by professional application every three months, - resin-
modified glass ionomer cement versus light-cured composite resin for bonding orthodontic brackets,
- a 250 ppm F mouthrinse versus 0 ppm F placebo mouthrinse, - the use of an intraoral fluoride-
releasing glass bead device attached to the brace versus a daily fluoride mouthrinse. The last two
comparisons involved studies that were assessed at high risk of bias, because a substantial number
of participants were lost to follow-up. Unfortunately, although the internal validity and hence the
quality of the studies has improved since the first version of the review, they have compared different
interventions; therefore, the findings are only considered to provide low level of certainty, because
none has been replicated by follow-up studies, in different settings, to confirm external validity. A
patient-reported outcome, such as concern about the aesthetics of any DLs, was still not included as
an outcome in any study. Reports of adverse effects from topical fluoride applications were rare and
unlikely to be significant. One study involving fluoride-containing glass beads reported numerous
breakages.
AUTHORS' CONCLUSIONS:
This review found a low level of certainty that 12,300 ppm F foam applied by a professional every 6
to 8 weeks throughout fixed orthodontic treatment, might be effective in reducing the proportion of
orthodontic patients with new DLs. In addition, there is a low level of certainty that the patient use of
a high fluoride toothpaste (5000 ppm F) throughout orthodontic treatment, might be more effective
than a conventional fluoride toothpaste. These two comparisons were based on single studies.
There was insufficient evidence of a difference regarding the professional application of fluoride
varnish (7700 or 10,000 ppm F). Further adequately powered, randomised controlled trials are
required to increase the certainty of these findings and to determine the best means of preventing
DLs in patients undergoing fixed orthodontic treatment. The most accurate means of assessing
adherence with the use of fluoride products by patients and any possible adverse effects also need
to be considered. Future studies should follow up participants beyond the end of orthodontic
treatment to determine the effect of DLs on patient satisfaction with treatment.

Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Link: https://www.ncbi.nlm.nih.gov/pubmed/31742669?
fbclid=IwAR1OOay6K9K_Q7eJdIBuUKh8UN6AqCGGKvQHb5psPt_YyVruKM3kdfdWxCI
[The increased sensitivity of dentin: the mechanisms of
remineralization using toothpaste with tin fluoride].
[Article in Russian; Abstract available in Russian from the publisher]

Elovikova TM1, Ermishina EY1, Uvarova LV2, Koshcheev AS3.

Abstract
in English, Russian

The purpose of the study was clinical and laboratory analysis of the remineralizing properties and
clinical efficacy of the course application of the Sensodyne Rapid Relief therapeutic and prophylactic
toothpaste for sensitive teeth with tin fluoride. The study involved 50 overwise healthy patients aged
from 18 to 25 years diagnosed with a localized form of hyperesthesia of hard dental tissues and no
signs of acute inflammation of periodontal tissues. After 7 days of clinical observation and daily use
of the toothpaste the hygienic condition of the oral cavity in all patients improved: oral hygiene index
was 1.02±0.2 units; gum inflammation index (PMA) - 8.0±1.5%; the absence of hyperesthesia was
diagnosed (1 point, p≤0.05). Examination of patients after 14 and 28 days confirmed the absence of
pain in 100%, the organoleptic properties of the toothpaste under investigation were also highly
appreciated by the participants. A laboratory study showed that patients have an increase in the pH
value of mixed saliva and a decrease in its buffer capacity by 13.4±2.25%, which contributes to a
more effective remineralizing effect of calcium ions by calcium-binding proteins of mixed saliva. The
concentration of fluoride ions in the saliva of patients of both groups increased by average rate of
34±0.5% per week. The combination of tin and fluoride is more effective than fluoride alone. The
presence of tin ions causes a higher ability of fluorides to bind with calcium ions on the surface of the
dentin and dentinal tubules, inhibits the process of demineralization, enhances the additive
interaction of the ions forming the acid-resistant layer on the surface of the dentin and dentinal
tubules, leading to a decrease in hyperesthesia of the teeth.

Link: https://www.ncbi.nlm.nih.gov/pubmed/31701932?
fbclid=IwAR0aCAIyhXHxRDVu9B7LIGlcX0Jnt7FMZN5pnZHou4scX67UegFYP5GuZDU
Impact of toothpaste on oral health-related quality of life
in people with dentine hypersensitivity.
Mason S1, Burnett GR2, Patel N2, Patil A3, Maclure R4.
Author information
1

GSK Consumer Healthcare, St George's Avenue, Weybridge, Surrey, KT13 0DE, UK.
stephen.x.mason@gsk.com.

GSK Consumer Healthcare, St George's Avenue, Weybridge, Surrey, KT13 0DE, UK.

Syneos Health, Commerzone, Building No. 4, 6th Floor, Survey No. 144/145, Samrat Ashok Path,
Yerwada Jail Road, Pune, 411006, India.

Intertek CRS Ltd., 119 Station Road, Ellesmere Port, Cheshire, CH65 4BW, UK.

Abstract
BACKGROUND:
Dentine hypersensitivity can impact functional status and everyday activities such as eating and
talking. This study aimed to assess changes in oral health-related quality of life measures in
individuals with dentine hypersensitivity following long-term use (24 weeks) of a commercially
available toothpaste marketed for dentine hypersensitivity relief.

METHODS:
This study was conducted across two sites and enrolled 75 adults with ≥2 non-adjacent sensitive
teeth. Participants were assigned to twice-daily brushing with toothpaste containing 0.454% w/w
stannous fluoride (1100 ppm fluoride). Every 4 weeks, participant-reported outcomes were assessed
using the Dentine Hypersensitivity Experience Questionnaire (DHEQ), a condition specific oral
health-related quality of life scale that has five domains and includes questions on social and
emotional impact, restrictions, adaptations and effect on life overall. Responses to a clinically applied
evaporative (air) stimulus were assessed using the examiner-observed Schiff sensitivity scale and
Labelled Magnitude Scales (LMS), which included dentine hypersensitivity-specific descriptors of
intensity, duration, tolerability and descriptive qualities of the participant's response.

RESULTS:
Participant-reported outcomes demonstrated reduction of the impact of dentine hypersensitivity over
time on health-related quality of life, as measured by the DHEQ. This reached statistical significance
from Week 8 onwards (p < 0.0001 versus baseline) for the Total DHEQ score, with scores
continually decreasing at each timepoint. Most domain scores followed a similar pattern. Statistically
significant reductions were also detected for the examiner-observed Schiff Sensitivity Scale scores
at all timepoints (including at 4 weeks) (p < 0.05), which were mirrored by LMS responses. The
toothpaste was generally well-tolerated.
CONCLUSIONS:
These results show that long-term use of a sensitivity toothpaste containing 0.454% w/w stannous
fluoride has a beneficial, ongoing, impact on the oral health-related quality of life of people with
dentine hypersensitivity.

Link: https://www.ncbi.nlm.nih.gov/pubmed/31640741?
fbclid=IwAR0wEjUPJvDVnBKgBIVvJ8OMRemuHK-UjSBA2jhqZUnUdVje-UtJ2BEXDpM
What concentration of fluoride toothpaste should dental
teams be recommending?
Levine RS1.
Author information
1

Hon. Senior Research Fellow in Child Health Academic Unit of Obstetrics, Gynaecology and
Paediatrics University of Leeds; Department of Oral Surgery University of Leeds, Leeds, UK.

Abstract
Data sources A total of 96 studies reported in peer reviewed journals between 1955 and 2014 Study
selection The systematic review selected randomised controlled trials that compared toothbrushing
with fluoride toothpaste with toothbrushing with a non-fluoride toothpaste or toothpaste of a different
fluoride concentration, with a follow-up period of at least one year. The primary outcome was caries
increment measured by the change from baseline in all permanent or primary teeth. Data extraction
and synthesis Two members of the review team, independently and in duplicate, undertook the
selection of studies, data extraction, and risk of bias assessment. They graded the certainty of the
evidence through discussion and consensus. The primary effect measure was the mean difference
or standardised mean difference caries increment. Where it was appropriate to pool data, they used
random-effects pairwise or network meta-analysis. Results In the primary dentition of young children,
1500 ppm fluoride toothpaste was found to reduce caries increment when compared with non-
fluoride toothpaste. In the adult permanent dentition, 1000 or 1100 ppm fluoride toothpaste was
found to reduce DMFS increment when compared with non-fluoride toothpaste in adults of all ages,
however, the evidence for DMFT was of low certainty. Conclusions This Cochrane Review supports
the benefits of using fluoride toothpaste in preventing caries when compared to non-fluoride
toothpaste. Evidence for the effects of different fluoride concentrations was found to be more limited,
but a dose-response effect was observed for D(M)FS in children and adolescents. For many
comparisons of different concentrations the caries-preventive effects and the confidence in these
effect estimates are uncertain and could be challenged by further research.

Link: https://www.ncbi.nlm.nih.gov/pubmed/31562404?
fbclid=IwAR2tHU5DWcxBxEQZUjt5_7NZqblV0F9fbf2cmwEE6jWU6Z_Ud9M4zenb3Iw
The effect of commercial whitening toothpastes on
erosive dentin wear in vitro.
Vertuan M1, de Souza BM2, Machado PF3, Mosquim V4, Magalhães AC5.
Abstract
OBJECTIVES:
This study evaluated the erosive tooth wear promoted by commercial whitening toothpastes on
eroded dentin in vitro.

DESIGN:
Ninety bovine roots were embedded, polished and subjected to the baseline profile analysis. The
samples were protected in 2/3 of the dentin surface and were randomly assigned to 6 groups
(n = 15/group): Oral-B 3D White; Close-up Diamond Attraction Power White; Sorriso Xtreme White
4D; Colgate Luminous White; Crest and erosion only. All samples were submitted to erosive pH
cycles (4 × 90 s in 0.1% citric acid, pH 2.5, per day) and abrasive challenges (2 × 15 s, per day) for 7
days. The samples were subjected to abrasion, using toothbrushing machine, soft toothbrushes and
slurries of the tested toothpastes (1.5 N, 1:3 water). Between the challenges, the samples were
immersed in artificial saliva. The final profile was overlaid to the baseline profile for the calculation of
the erosive dentin wear (μm). The data were subjected to Kruskal-Wallis/Dunn tests (p < 0.05).

RESULTS:
Colgate Luminous White (4.7 μm) and Sorriso Xtreme White 4D (4.0 μm) promoted the highest wear,
similarly to Oral-B 3D White (2.3 μm). Oral-B 3D White promoted similar wear compared to Crest
(1.1 μm) and Close-up Diamond Attraction Power White (1.2 μm); however, it induced significant
higher dentin wear compared to erosion only (1.0 μm). Close-up Diamond Attraction Power White
and Crest did not increase the erosive wear compared to erosion only.

CONCLUSION:
Some whitening toothpastes increase the wear of eroded dentin, which should be considered by the
dentist when prescribing them to patient with root exposure.

Link: https://www.ncbi.nlm.nih.gov/pubmed/31593890?
fbclid=IwAR1CmC6P192W0gT3I9yx5C_dkyJXJmdNZUO7Tla8_o4c0oWBtwZ1LINqOHY
Using fluoride mouthrinses before or after toothbrushing:
effect on erosive tooth wear.
Machado AC1, Bezerra SJC1, João-Souza SH2, Caetano TM1, Russo LC1, Carvalho
TS3, Scaramucci T4.
Author information
1

Department of Restorative Dentistry, University of São Paulo School of Dentistry, Av. Prof Lineu
Prestes 2227, São Paulo, SP, 05508-000, Brazil.

Department of Restorative Dentistry, University of São Paulo School of Dentistry, Av. Prof Lineu
Prestes 2227, São Paulo, SP, 05508-000, Brazil; Department of Restorative, Preventive and
Pediatric Dentistry, University of Bern, Freiburgstrasse 7 CH-3010, Bern, Switzerland.

Department of Restorative, Preventive and Pediatric Dentistry, University of Bern,

Freiburgstrasse 7 CH-3010, Bern, Switzerland.

Department of Restorative Dentistry, University of São Paulo School of Dentistry, Av. Prof Lineu
Prestes 2227, São Paulo, SP, 05508-000, Brazil. Electronic address: tais.sca@usp.br.

Abstract
OBJECTIVES:
1. To evaluate the use of fluoridated mouthrinses before or after toothbrushing on erosive tooth
wear. 2. To compare the anti-erosive effect of the combination toothpaste and mouthrinse containing
fluoride, with or without stannous chloride.

DESIGN:
Enamel and dentin specimens were randomly distributed into groups (n = 10 of each
substrate/group): B-brushing, B + R-brushing + rinsing, and R + B-rinsing + brushing. The treatments
were performed using a fluoride toothpaste (BF: 1400 ppm fluoride, as amino fluoride-AmF)
combined or not with a fluoride mouthrinse (RF: 250 ppm fluoride, as AmF and sodium fluoride-NaF)
or fluoride and stannous toothpaste (BF+Sn: 1400 ppm fluoride, as AmF and NaF, 3500 ppm stannous,
as stannous chloride-SnCl2 and 0.5% chitosan) combined or not with fluoride and stannous
mouthrinse (RF+Sn: 500 ppm fluoride, as AmF and NaF, 800 ppm stannous, as SnCl2). As control,
brushing was performed with artificial saliva (BC). Specimens were submitted to a 5-day erosive-
abrasive cycling model. Treatments were performed twice daily. Surface loss (SL) was determined
by optical profilometry. Data were analyzed by ANOVA and Games-Howell tests (α = 0.05).

RESULTS:
For enamel, RF+BF and RF+Sn+BF+Sn presented significantly lower SL than the control, with RF+BF being
significantly lower than RF+Sn+BF+Sn. For dentin, BC had the lowest SL, not differing from
BF+Sn+RF+Sn, RF+Sn+BF+Sn and BF. Groups RF+BF and BF+RF showed highest SL, not differing from
BF+Sn and BF+Sn.
CONCLUSIONS:
For enamel, the use of a mouthrinse before brushing was able to reduce erosive wear for both
fluoride and stannous products. For dentin, the use of stannous-containing products, irrespective of
the order of application, presented superior effects.

Link: https://www.ncbi.nlm.nih.gov/pubmed/31445424?fbclid=IwAR27bZg3ccV5a-
U3THbARc2FDSjER2_4SC8oAe8IobZzXv0JYjqrVjEr82Q
Effects of Active Oxygen Toothpaste in Supragingival
Biofilm Reduction: A Randomized Controlled Clinical
Trial.
Cunha EJ1, Auersvald CM1, Deliberador TM1, Gonzaga CC1, Esteban Florez FL2, Correr
GM1, Storrer CLM1.
Abstract
Gingivitis is still considered a major risk factor for the occurrence and progression of periodontal
disease. The aim of the present study was to compare the long-term (1, 12, and 18 weeks)
antiplaque and antigingivitis efficacies of two commercially available toothpastes, Colgate
Total® (CT) and BlueM® (BM), against attached supragingival dental plaque and gingival
inflammation in an experimental gingivitis model. A parallel double-blinded randomized clinical trial
including 39 dental students who refrained from all plaque control methods (manual or chemical) for
7 days was conducted. After the establishment of clinical gingivitis, participants were randomized
into two experimental groups (CT and BM). Plaque index (PI) and gingival index (GI) were then
calculated according to Turesky's modified Quigley and Hein index. Participants were assessed in
four time periods (preclinical trial phase (W -1), gingivitis phase (W0), one week (W1), twelve weeks
(W12), and eighteen weeks (W18)). Participants' stimulated saliva was collected and cultured (either
aerobically or anaerobically, 37°C, 48 hours) in each time period (W -1, W0, W1, W12, and W18) for
the count of viable colonies. Obtained data were analyzed using 2-way ANOVA and Tukey's test (α 
= 0.05). No significant differences were found (p > 0.05) between experimental groups at W -1.
Significant differences between groups were observed at W0 (p < 0.05) for the parameter time
period, but not for the interaction between parameters (time period  ∗ toothpastes). Lower bacterial
counts were observed in both groups after one week of toothbrushing; however, no significant
differences were found between investigated dentifrices. Intra- and intergroup comparisons revealed
that significant differences were not found (p > 0.05) between dentifrices at W1, W12, and W18 for
both GI and PI. The present study demonstrated that toothpastes containing active oxygen and
lactoferrin (BM) have comparable antiplaque and antigingivitis efficacies with triclosan-containing
toothpastes (CT).

Link: https://www.ncbi.nlm.nih.gov/pubmed/31354823?
fbclid=IwAR2tHU5DWcxBxEQZUjt5_7NZqblV0F9fbf2cmwEE6jWU6Z_Ud9M4zenb3Iw
Antimicrobial activity and volatile constituent analysis of
three commercial herbal toothpastes containing Aloe
vera L. and Fragaria vesca L. extracts.
Korkmaz FM1, Ozel MB2, Tuzuner T3, Korkmaz B4, Yayli N4.
Abstract
AIMS:
This work was designed to evaluate the antimicrobial activity of three different commercial herbal
(Aloe vera L. and Fragaria vesca L. extracts) toothpastes [LR Aloe vera (HTP1), ESI Aloe fresh
(HTP2) and ROCS Teens (HTP3)] against two microorganisms that cause tooth infections.

MATERIALS AND METHODS:

An agar disk diffusion method was used to test the antimicrobial activity of three herbal gel
toothpastes in the amount of 100 μL against Streptococcus mutans and Staphylococcus aureus. In
the second part of the work, the volatile organic compounds of three different commercial herbal
toothpastes (HTP1-3) were determined by solid-phase microextraction/gas chromatography-mass
spectrometry-flame ionization detection (SPME/GC-MS-FID).

RESULTS:
The sensitivity of the tested herbal toothpastes toward each microorganism was expressed as the
mean of the clear zone within the range of 6-16 mm diameters. HTP1 and HTP2 were found to be
more effective against both bacteria compared with HTP3. Oxygenated monoterpenes (99.34%,
91.44%, and 83.48%) were the most abundant groups in the SPME of HTP1-3, respectively.
Menthol (25.41%, 35.82%, and 31.15%) and anethole (52.01%, 23.62%, and 38.79%) were the
major compounds identified in the SPME analysis of HTP1-3, respectively. Carvone was found only
in HTP3 (0.49%) in a small quantity.

CONCLUSION:
The commercial herbal toothpastes could have advantages in decreasing bacterial accumulation on
teeth with protection of the oral cavity.

Link: https://www.ncbi.nlm.nih.gov/pubmed/31089029?fbclid=IwAR2tmuc0L3-
1exGTVpyruHNBDUd6Jk02S8_3u4MtyeRGp66fPreNMTmiXZA
What is the effect of active ingredients in dentifrice on
inhibiting the regrowth of overnight plaque?
Valkenburg C1,2, Slot DE2, Van der Weijden F2.
Abstract
OBJECTIVES:
The aim of this systematic review was to establish the adjuvant clinical effect of brushing with a
dentifrice containing purported active-ingredients as compared to a regular sodium fluoride dentifrice
with respect to inhibition of overnight dental plaque regrowth from studies with human participants.

METHODS:
MEDLINE-PubMed, EMBASE and Cochrane-CENTRAL were searched, up to June 2019. The
inclusion criteria were controlled clinical trials with participants aged ≥18 years in good general
health. Studies were included that evaluated the effect of toothbrushing with a dentifrice on the
inhibition of overnight dental plaque regrowth when an active ingredient was added to the dentifrice
as compared to a common sodium fluoride product. Data were extracted from the eligible studies,
the risk of bias was assessed, and a meta-analysis was performed where feasible.

RESULT:
Independent screening of 213 unique papers resulted in 10 eligible publications that provided 14
comparisons. Stannous fluoride and triclosan dentifrices were found as the active ingredients. The
descriptive analysis indicated that all, but two comparisons demonstrated an additional effect on the
active-ingredient dentifrice. The meta-analysis supported and strengthened these findings. The
meta-analysis supported and strengthened these findings. It showed that when plaque was scored
digitally a DiffM of -3.15(95%CI[-4.61:-1.69],p<0.001,prediction interval[-5.07;-1.24]). When plaque
was scored clinically the DiffM was -0.33(95%CI[-0.49:-0.16],p<0.001, prediction interval[-
0.87;0.21]).

CONCLUSION:
The results of this review demonstrate moderate-quality evidence that brushing with an active-
ingredient dentifrice with stannous fluoride or triclosan does provide an added clinically relevant
effect concerning plaque inhibition capabilities that surpass the effect of a regular sodium fluoride
dentifrice.

Link : https://www.ncbi.nlm.nih.gov/pubmed/31675470
Metabolic Profile of Supragingival Plaque Exposed to
Arginine and Fluoride.
Nascimento MM1, Alvarez AJ2,3, Huang X4,5, Browngardt C4, Jenkins R6, Sinhoreti MC7, Ribeiro
APD1, Dilbone DA1, Richards VP8, Garrett TJ9, Burne RA4.
Abstract
Caries lesions develop when acid production from bacterial metabolism of dietary carbohydrates
outweighs the various mechanisms that promote pH homeostasis, including bacterial alkali
production. Therapies that provide arginine as a substrate for alkali production in supragingival oral
biofilms have strong anticaries potential. The objective of this study was to investigate the metabolic
profile of site-specific supragingival plaque in response to the use of arginine (Arg: 1.5% arginine,
fluoride-free) or fluoride (F: 1,100 ppm F/NaF) toothpastes. Eighty-three adults of different caries
status were recruited and assigned to treatment with Arg or F for 12 wk. Caries lesions were
diagnosed using International Caries Detection and Assessment System II, and plaque samples
were collected from caries-free and carious tooth surfaces. Taxonomic profiles were obtained by
HOMINGS (Human Oral Microbe Identification using Next Generation Sequencing), and plaque
metabolism was assessed by the levels of arginine catabolism via the arginine deiminase pathway
(ADS), acidogenicity, and global metabolomics. Principal component analysis (PCA), partial least
squares-discriminant analysis, analysis of variance, and random forest tests were used to distinguish
metabolic profiles. Of the 509 active lesions diagnosed at baseline, 70 (14%) were inactive after 12
wk. Generalized linear model showed that enamel lesions were significantly more likely to become
inactive compared to dentin lesions (P < 0.0001), but no difference was found when treatment with
Arg was compared to F (P = 0.46). Arg significantly increased plaque ADS activity (P = 0.031) and
plaque pH values after incubation with glucose (P = 0.001). F reduced plaque lactate production
from endogenous sources (P = 0.02). PCA revealed differences between the metabolic profiles of
plaque treated with Arg or F. Arg significantly affected the concentrations of 16 metabolites,
including phenethylamine, agmatine, and glucosamine-6-phosphate (P < 0.05), while F affected the
concentrations of 9 metabolites, including phenethylamine, N-methyl-glutamate, and agmatine (P <
0.05). The anticaries mechanisms of action of arginine and fluoride are distinct. Arginine metabolism
promotes biofilm pH homeostasis, whereas fluoride is thought to enhance resistance of tooth
minerals to low pH and reduce acid production by supragingival oral biofilms.

Link : https://www.ncbi.nlm.nih.gov/pubmed/31454264?
fbclid=IwAR24ga64bXYp2PEGKPSZJC_Slh75pV4prqVCyeaxcw9Cbh2aGDQRVElPbrU
Comparative evaluation of neodymium-doped yttrium
aluminum garnet laser with nanocrystalline
hydroxyapatite dentifrices and herbal dentifrices in the
treatment of dentinal hypersensitivity.
Yadav RK1, Verma UP2, Tiwari R1.
Abstract
BACKGROUND:
The aim of this study was to compare and evaluate the efficacy of neodymium-doped yttrium
aluminum garnet laser with and without herbal and nanohydroxyapatite dentifrices in management of
dentinal hypersensitivity (DH).

MATERIALS AND METHODS:

A total of 180 patients who responded to air-blast test and cold-water test using verbal rating scale
(VRS) were included in this study. The patients were randomly assigned to six groups (n = 30):
control group (CG), scaling and root planning (SRP) + nanocrystalline hydroxyapatite dentifrices,
SRP + nanocrystalline hydroxyapatite dentifrices + laser, SRP + herbal dentifrices, SRP +
herbal dentifrices + laser, and SRP + laser. Each group was evaluated at baseline, 1 week, 1 month,
and 6 months. In every visit of each patient, their clinical examination was done.

RESULTS:
Among all groups', repeated ANOVA measures and Kruskal-Wallis test was performed in which
laser groups showed maximum reduction in DH in all indices while the CG showed minimum
reduction in DH. The VRS values showed maximum reduction in SRP + nanocrystalline
hydroxyapatite dentifrices + laser group with mean of 0.3 ± 0.5 and minimum reduction in CG with
mean of 3.0 ± 0.5 (P < 0.001).

CONCLUSION:
Among all the groups, SRP + Nanocrystalline hydroxyapatite + Laser can be an effective treatment
modality for DH.

Link: https://www.ncbi.nlm.nih.gov/pubmed/31205393
Fluoride Levels in Saliva and Plaque following the Use of
High Fluoride and Conventional Dentifrices- a Triple
Blinded Randomised Parallel Group Trial.
Vincent S1, Thomas AM1.
Abstract
CONTEXT:
The comparison of fluoride levels in saliva and plaque following the use of conventional, 2800 and
5000 ppm dentifrices for different time intervals up to 24 hours has not been explored.

AIM:
The aim of the present study was to assess salivary and plaque fluoride levels at different time
intervals following the use of high fluoride dentifrices.

STUDY DESIGN:
This randomised control trial was conducted on sixty adolescents between the age group of 16 and
18 years divided into three groups A, B, and C.

INTERVENTION:
Subjects were asked to brush the occlusal surfaces of posterior teeth with one of the dentifrices for 2
min. Unstimulated whole saliva and plaque samples were collected at different time intervals.
Fluoride levels were determined using SPADNS method. Data was collected and statistically
analyzed using SPSS 20 Inc. by mixed repeated measure ANOVA.

RESULTS:
A significant difference in fluoride levels was observed at different time intervals in both saliva
(p=0.048) and plaque (p=0.03). The variance was low with time and concentration of the dentifrice
used in saliva, whereas the magnitude of treatment was large for time (>0.25) but small for (<0.09)
concentration in plaque.

CONCLUSION:
A significant difference in fluoride levels was observed at different time intervals in both saliva and
plaque among the three groups. There was a positive correlation between fluoride levels in saliva
and plaque. Both high fluoride dentifrices were effective in maintaining higher intraoral fluoride levels
up to 12 hours and 5000 ppm up to 24 hours compared to conventional dentifrice.

Link: https://www.ncbi.nlm.nih.gov/pubmed/31186619
Evaluation of the effect of a toothpaste containing Pudilan extract on
inhibiting plaques and reducing chronic gingivitis: A randomized,
double-blinded, parallel controlled clinical trial.
Cheng L1, Liu W2, Zhang T3, Xu T4, Shu YX5, Yuan B6, Yang YM7, Hu T8.
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE:
Pudilan is a famous traditional Chinese medicine compound which contains several Chinese herbal
ingredients, and has been wildly used to treat a variety of inflammatory diseases in China. Recently,
it was reported that Pudilan extract had been used in the oral field, especially in the treatment of
minor oral ulcers for its anti-inflammatory, pain relieving, antibacterial, clearing heat, and detoxifying
effects.
AIM OF THE STUDY:

To evaluate the effectiveness and safety of Pudilan extract-containing toothpaste in controlling

plaques and reducing chronic gingivitis.

MATERIALS AND METHODS:

A total of 120 patients with chronic gingivitis were randomized into an experiment group and a
control group (n = 60 patients per group) based on a double-blinded method. Patients in the
experiment group used a Pudilan extract-containing toothpaste, whereas patients in the control
group used a Pudilan toothpaste simulator, which were identical as the toothpaste used by the
experiment group, except for not containing the Pudilan extract. The Plaque Index (PI), Gingival
Index (GI), Bleeding Index (BI), and Bleeding On Probing proportion (BOP%) were recorded at
baseline, 4 weeks, 8 weeks and 12 weeks after using the toothpaste.

RESULTS:
After using the toothpaste for 8 and 12 weeks, PI, BI, GI, and BOP% of the experiment group were
significantly lower when compared to the control group (both p < 0.001). Moreover, after using
the toothpaste for 4, 8, and 12 weeks, the decline of the PI and GI in the experiment group were
significantly higher than the control group (p < 0.001, except 4weeks PI p = 0.011). After 12 weeks,
the PI of the experiment group decreased 35.73% (p < 0.001) whereas the GI decreased 29.04%
(p < 0.001). BI and BOP decline rates were statistically significant when compared to those of the
control group at 8 and 12 weeks (both p < 0.001). Moreover, at 12 weeks, the BI of the experiment
group decreased 34.33% (p < 0.001) and BOP% decreased 54.71% (p < 0.001).

CONCLUSION:
Toothpaste with Pudilan extract demonstrated good effect on relieving symptoms of
chronic gingivitis by inhibiting plaque formation, reducing gingival inflammation and the degree of
bleeding, and the bleeding rate. Toothpaste containing Pudilan extract has prospective application
potentials in the prevention and treatment of chronic gingivitis.

Link: https://www.ncbi.nlm.nih.gov/pubmed/30980892
Clinical Assessment of Rosemary-
based Toothpaste (Rosmarinus officinalis Linn.): A
Randomized Controlled Double-blind Study.
Valones MAA1, Silva ICG1, Gueiros LAM1, Leão JC1, Caldas AF Jr1, Carvalho AAT1.
Abstract
The present study was to investigate the action of a toothpaste made from the extract of Rosmarinus
officinalis Linn. (rosemary) in a clinical randomized, controlled, open and double-blind trial. One
hundred and ten volunteers fulfilled the inclusion criteria and were randomly separated into two
groups according to the toothpastes used: Group A (experimental) and Group B (control). They were
assessed at baseline and 30 days after the study using the gingival bleeding index (GBI) and the
plaque index (PI). Data analysis was conducted to calculate the effects of the two toothpastes on
gingival bleeding and plaque, using measurements such as the excess relative risk (ERR), the
Relative Risk Reduction (RRR), the Absolute Risk Reduction (ARR) and the Number Needed for
Treatment (NNT). The two toothpastes provided similar results in terms of the reduction in the risk of
gingival bleeding (relative and absolute): a reduction of 38% in Group A, ERR=0.38; a reduction of
29.3% in Group B, ERR=0.293; A and B reduced by 18% ARR=0.18). The reductions in bacterial
plaque were also similar (22.7% reduction in Group A, RRR=0.227; 28% reduction in Group B,
RRR= 0.28). The number needed for treatment values for bleeding and plaque were A and B NNT=5
and A and B NNT=7, respectively. The rosemary-based toothpaste effectively treated gingival
bleeding and reduced bacterial plaque, when compared with conventional toothpaste.

Link: https://www.ncbi.nlm.nih.gov/pubmed/30970057
Effect of toothpaste containing amine fluoride and
stannous chloride on the reduction of dental plaque and
gingival inflammation. A randomized controlled 12-week
home-use study.
Lorenz K1, Hoffmann T1, Heumann C2, Noack B1.
Abstract
OBJECTIVES:
This single-centre, controlled, randomized, double-blinded clinical study in parallel groups was
performed to assess the efficacy of an experimental toothpaste on plaque and gingivitis.

METHODS:
In adult subjects with gingivitis, amine fluoride/stannous chloride toothpaste (test) and
monofluorophosphate toothpaste (control) were applied twice daily by regular toothbrushing at
home. Evaluations of plaque index (PI), gingival index (GI), modified sulcus bleeding index (mSBI)
and safety took place at baseline and after 3 and 12 weeks of study product use. After study
completion, all subjects received a dental prophylaxis. A descriptive statistical analysis included
means and standard deviations. Unpaired t tests compared index reductions between groups at a
significance level of 0.05.

RESULTS:
Intention-to-treat analysis included 240 out of 241 subjects. Baseline mean PI was reduced by
0.87 ± 0.35 in the test group and by 0.65 ± 0.41 in the control group. Within-group differences and
between-group differences in index reduction were statistically significant (P < 0.001). Mean GI and
mSBI were reduced significantly over time (P < 0.001) with no clinically meaningful differences
between groups.

CONCLUSIONS:
Both toothpastes reduced plaque and gingivitis statistically significant and clinically meaningful over
12 weeks. Compared to the control toothpaste, application of the amine fluoride/stannous
chloride toothpaste led to a clinically meaningful and more pronounced plaque reduction.

Link: https://www.ncbi.nlm.nih.gov/pubmed/30803137
The efficacy of baking soda dentifrice in controlling
plaque and gingivitis: A systematic review.
Valkenburg C1, Kashmour Y1, Dao A1, Fridus Van der Weijden GA1, Slot DE1.
Abstract
OBJECTIVE:
To test the efficacy of a dentifrice containing baking soda (BS), compared with dentifrice without BS
for controlling plaque and gingivitis.

MATERIALS AND METHODS:

MEDLINE-PubMed and Cochrane-CENTRAL were searched. The inclusion criteria were
randomized controlled clinical trials including healthy participants aged 18 years or older. Studies
were selected that compared the effect of toothbrushing with a dentifrice with and without BS on the
clinical parameters of plaque and gingivitis. Data were extracted from the selected studies, and a
meta-analysis was performed.

RESULTS:
The search retrieved 21 eligible publications. Among these papers, 43 comparisons were provided,
with 23 involving a single-use design and 20 being evaluations with a follow-up. Negative controls
were found, or positive controls for which various active ingredients had been used. The included
studies showed a moderate overall potential risk of bias and considerable heterogeneity. The meta-
analysis of plaque scores from the single-brushing experiments showed that BS dentifrice (BS-DF)
was associated with significantly better outcomes than the negative control dentifrices (DiffM -0.20;
P < 0.0001; 95% CI: [-0.27; -0.12]) or the positive control dentifrices (DiffM -0.18; P < 0.0001; 95%
CI: [-0.24; -0.12]). This finding was only confirmed in studies that used a follow-up design as
compared to a negative control (DiffM -0.19; P = 0.01; 95% CI: [-0.34; -0.04]). The indices of gingival
bleeding also improved when the comparison was a negative control (DiffM -0.08; P = 0.02; 95% CI:
[-0.16; -0.01] and (DiffM -0.13; P < 0.001; 95% CI: [-0.18; -0.08]. However, for the gingival index
scores, the meta-analysis did not reveal any significant differences.

CONCLUSION:
BS-DF showed promising results with respect to plaque removal in single-use studies. However, the
finding was partially substantiated in follow-up studies. Studies that assessed bleeding scores
indicated that a small reduction can be expected from BS, relative to a control product.

Link: https://www.ncbi.nlm.nih.gov/pubmed/30734996