No abstract

Saliva may affect dental erosion-abrasion by reducing demineralization, enhancing remineralization, and acting as lubricant. This study tested the effect of human saliva substitutes in an erosion-abrasion cycling model designed for enamel and root dentin. Specimens were randomly assigned into the following groups (n = 8): artificial saliva (AS), artificial saliva + mucin (AS+M), deionized water (DIW, negative control), and pooled human saliva (HS, clinical reference). Each group was submitted to a cycle of 5 min in 1% citric acid (pH 3.75), 30 min in the testing solutions, and toothbrushing (enamel, 500 strokes; dentin, 150 strokes, approximately 200 g load) in fluoridated dentifrice (1,100 p.p.m. NaF) slurry. Specimens were rinsed and dried after each procedure. This cycle was repeated three times each day, for 3 d. Substrate loss was measured daily using optical profilometry. Analysis of variance (anova) and Tukey tests (alpha=0.05) showed a significant increase in enamel and dentin wear throughout the experiment for all groups. At the end of the experiment, enamel wear for each group was ranked as: (AS)<(AS+M) and (HS)<(DIW), with AS+M not differing from HS. For dentin, groups AS and AS+M did not differ from each other or from DIW, but showed significantly higher wear than HS. The artificial saliva with mucin showed promise as a potential substitute for human saliva in the enamel erosion-abrasion cycling model. For dentin, none of the artificial salivas performed similarly to human saliva.

Antiplaque agents delivered from toothpastes, gels, or mouthrinses can augment mechanical oral hygiene procedures to control the formation of supragingival plaque and the development of early periodontal disease. Clinically effective antiplaque agents are characterized by a combination of intrinsic antibacterial activity and good oral retention properties. The overall oral retention of an antiplaque agent is determined by the strength and rate of association of the agent with its receptor sites and the accessibility of these sites. The substantivity of an antiplaque agent and its clearance from the oral cavity are determined by the rate of dissociation of the agent from the receptor sites and the salivary composition and flow rate. Positively charged and non-charged organic molecules, metal ions, enzymes, and surface-active agents have all been considered as antiplaque agents. To exert clinical antiplaque activity, an antimicrobial agent must be formulated in a chemically compatible delivery vehicle to give optimal release and uptake to the sites of action in a biologically active form during its time of application. In principle, antiplaque activity may be enhanced by combining antimicrobial agents with broadly similar, but complementary, modes of action. Alternatively, the activity of a single agent may be increased by use of a retention aid to enhance oral substantivity. Substantial evidence exists to demonstrate the validity of the first approach. However, there are few data, as yet, to support the effectiveness of the second. The oral mucosa is the bulk retention site for all clinically proven antiplaque agents. Plaque, the pellicle-coated tooth surface, and saliva are probably all sites of biological action. A detailed understanding of the interactions between agents and the various receptor sites, and of the importance of these receptor sites to biological activity, is generally lacking.

To provide optimal fluoride effectiveness against caries while minimising risk of negative effects from excessive ingestion from toothbrushing, the fluoride dose delivered at each occasion is critical. This is particularly important for young children, so using a ‘pea‐sized amount’ is generally recommended. However, there appears little guidance regarding what this means in practice, although it has been indicated to be 0.25 g. This study investigated, using conventional toothpastes and toothbrushes in Germany, the USA and the UK, how much toothpaste parents dispense for their 3‐ to 6 year‐old children, and their interpretation of a ‘pea‐sized’ amount of toothpaste. When asked to dispense the amount they would normally for their child, the majority of parents dosed substantially more than 0.25 g; in Germany, all parents over‐dispensed. The amount dispensed varied widely: those parents at the 75th centile dispensed approximately twice the amount dispensed by those at the 25th centile, irrespective of country. When asked to dispense a pea‐sized amount, the mean amount dosed decreased significantly in all countries. In the USA, electric toothbrush users dispensed about 0.1 g more than manual toothbrush users. While over‐dispensing of fluoride toothpaste remains a cause for concern, it may be argued that the general recommendation to use a pea‐sized amount of toothpaste generally works well in practice to balance the conflicting demands of risk and benefit from toothbrushing with fluoride toothpaste in young children.

While the clinical anticaries efficacy of fluoride toothpaste is now without question, our understanding of the relation of fluoride efficacy to brushing time and dentifrice quantity is limited. The aim of this in situ study was to determine how differences in brushing time and dentifrice quantity influence (i) fluoride distribution immediately after brushing, (ii) clearance of fluoride in saliva, (iii) enamel fluoride uptake (EFU) and (iv) enamel strengthening, via the increase in surface microhardness. The study compared brushing times of 30, 45, 60, 120 and 180 s with 1.5 g of dentifrice containing 1,100 µg/g fluoride as sodium fluoride. In addition, 60 s of brushing with 0.5 g dentifrice was evaluated. A longer brushing time progressively reduced retention of dentifrice in the brush, thereby increasing the amount delivered into the mouth. A longer brushing time also increased fluoride concentrations in saliva for at least 2 h after the conclusion of brushing, showing that increased contact time promoted fluoride retention in the oral cavity. There was a statistically significant positive linear relationship between brushing time and both enamel strengthening and EFU. Compared to 0.5 g dentifrice, brushing with 1.5 g dentifrice more than doubled the fluoride recovered in saliva after brushing and increased EFU. In conclusion, the results of this preliminary, short-term usage study suggest for the first time that both brushing time and dentifrice quantity may be important determinants both of fluoride retention in the oral cavity and consequent enamel remineralization.