Effectiveness of a Toothpaste with Low Fluoride Content Combined with Trimetaphosphate on Dental Biofilm and Enamel Demineralization in situ

Abstract

Objective: The aim of the present study was to evaluate in situ whether a toothpaste with low fluoride associated with sodium trimetaphosphate (TMP) would provide similar effect to that of a 1,100 ppm F toothpaste. Design: This crossover double-blind study consisted of 4 phases (14 days each), during which 10 volunteers wore oral appliances containing 4 enamel bovine blocks. The cariogenic challenge was performed by the application of a 20% sucrose solution (6×/day). The toothpaste treatments (2×/day) were: placebo, 500 ppm F, 500 ppm F plus 1% TMP, and 1,100 ppm F. At the end, enamel mineral loss and biofilm composition were analyzed. Results: The toothpaste with 500 ppm F plus 1% TMP showed the lowest mineral loss (p < 0.05). Regarding the fluoride and calcium concentrations in the enamel and in the biofilm, there were no significant differences between 500 ppm F plus 1% TMP, and 1,100 ppm F toothpastes (p > 0.569), but they were significantly different when compared to toothpaste with 500 ppm F (p < 0.050). Conclusion: The addition of 1% TMP to a low-fluoride toothpaste reduces enamel demineralization in situ similar to a 1,100 ppm F toothpaste.

Remineralizing Potential of a Low Fluoride Toothpaste with Sodium Trimetaphosphate: An in situ Study

“…This higher mineral content promoted by 500 ppm F + TMP produced an increase in enamel remineralization which was similar to that obtained with the 1,100 ppm F toothpaste ( table 1 ). The present findings are in agreement with previous data using demineralization models, in which it was possible to observe increases in enamel Ca and F when a TMPcontaining fluoride toothpaste was used [Takeshita et al, 2009[Takeshita et al, , 2011[Takeshita et al, , 2015. All the above taken together reinforces the concept that although the adsorption of TMP on enamel results in a barrier against acid diffusion [Takeshita et al, 2015], this does not hinder ion diffusion into enamel, which ultimately results in a more marked effect on deeper regions of the subsurface lesion.…”

“…The present study has proposed a well-established methodology for testing the efficacy of fluoridated toothpastes on preexisting carious lesions. As for the concentration of TMP tested in this study, it was based on the F/TMP ratio from previous data showing that the addition of TMP at 1% significantly increased the anticaries effect of a 500 ppm F toothpaste to levels comparable to those of a 1,100 ppm F toothpaste [Takeshita et al, 2009[Takeshita et al, , 2015.…”

“…For F analysis, a specific electrode Orion 9609 connected to an ion analyzer (Orion 720A plus ) and TISAB III (total ionic strength adjustment buffer) at a 1: 10 ratio (TISAB:sample) were used. Ca concentrations were determined by the cresoftalein colorimetric method (Katal, Belo Horizonte, Brazil) [Takeshita et al, 2015], while inorganic phosphorus was determined as described by Fiske and Subbarow [1925].…”

“…Sodium trimetaphosphate (TMP) is a condensed inorganic phosphate that was shown to increase the effects of a low-F toothpaste against enamel demineralization [Takeshita et al, 2009[Takeshita et al, , 2011Delbem et al, 2012;Takeshita et al, 2015] as well as to promote significantly lower caries increments in children when compared with a conventional (1,100 ppm F) toothpaste [Freire et al, 2016]. Although the effect of TMP upon an acid challenge is based on its capacity to adsorb on enamel and increase calcium, phosphate and fluoride incorporation [Takeshita et al, 2009[Takeshita et al, , 2011Delbem et al, 2012;Takeshita et al, 2015], few data are available on the effects of TMP on enamel remineralization.…”

“…Although the effect of TMP upon an acid challenge is based on its capacity to adsorb on enamel and increase calcium, phosphate and fluoride incorporation [Takeshita et al, 2009[Takeshita et al, , 2011Delbem et al, 2012;Takeshita et al, 2015], few data are available on the effects of TMP on enamel remineralization. This is paramount from a clinical point of view, given that toothpastes are used not only as a preventive measure (i.e.…”