Caries lesion remineralization with fluoride toothpastes and chlorhexidine - effects of application timing and toothpaste surfactant

Abstract

Habitual toothbrushing with fluoridated toothpaste followed by rinsing with antibacterial mouthwashes is a method to maintain good oral hygiene and to diminish the occurrence and severity of dental caries and periodontal disease. However, our understanding of how antimicrobial agents in mouthwashes affect fluoride-mediated caries lesion remineralization is still poor.Objective:The objectives of this in vitro study were a) to determine the effects of the waiting period of chlorhexidine (CHX) rinsing after fluoride toothpaste use and b) to further determine the effect of the type of toothpaste surfactant [sodium dodecyl sulfate (SDS) or cocamidopropyl betaine (CAPB)] on caries lesion remineralization associated with CHX rinsing.Material and Methods:Caries lesions were formed in bovine enamel specimens and assigned to 10 treatment groups (n=18) based on Vickers surface microhardness (VHN). Lesions were then pH-cycled for 10 days with daily regimen comprised of twice daily toothpaste slurry treatments (1150 ppm fluoride, with SDS or CAPB), followed by CHX solution treatments [0, 15, 30 or 60 minutes following slurry treatment or no CHX treatment (negative control)]. VHN was measured again and the extent of lesion remineralization calculated (∆VHN).Results:∆VHN with SDS-toothpaste was significantly lower than with CAPB-toothpaste, indicating more remineralization for the CAPB-toothpaste. ∆VHN with 0-minute waiting time was significantly lower than with 30-minute waiting time and with negative control.Conclusions:The absence of CHX as an adjunct to fluoride toothpastes led to greater remineralization of enamel lesions compared with the immediate use of CHX treatment for both SDS- and CAPB-toothpastes. CAPB-toothpastes indicated significantly greater remineralization than SDS-toothpastes, and can be suggested for patients at high risk of caries. A 30-minute waiting time for CHX treatment is recommended after brushing.

Current uses of chlorhexidine for management of oral disease: a narrative review

“…The interval between tooth brushing and CHX mouthwash, should also be greater than 30 minutes, and ideally more than 2 hours [ 43 ]. This not only because a mouthwash could potentially wash the fluoride from toothpaste away, but because CHX rinses may interact with the anionic components of many toothpastes, such as SLS and sodium monoflurophosphate, and reduce the beneficial effects of fluoride on the remineralisation of enamel lesions [ 44 ].…”

Comparative evaluation of four different remineralizing agents on dentin surface topography: an invitro study

“…It also provides high-resolution, three-dimensional images and topographical information. ESEM has been used in many previous investigations for the effect of desensitizing toothpaste on dentin tubule diameter and occlusion (15) . ESEM was used in the study for qualitative assessment and ultramorphological examination for the treated surfaces of dentin (16) .…”

Effect of Galla Chinensis on Remineralization of Early Dentin Lesion

“…25 Previous reports have shown a major role of many commercially available products in enhancement of dental remineralization. [26][27][28] But none of these agents in spite of being effective in dentin remineralization proved to be an ideal, highlighting an urgent need to seek novel and alternative strategies. 14,22,28 Recently, there has been a worldwide interest in active compounds derived from natural products which may have potential therapeutic uses in dentistry.…”