Effect of different citrus sweets on the development of enamel erosion in vitro

The increased consumption of citrus sweets can contribute to the development of erosive tooth wear (ETW).Objective: This in vitro study evaluated the erosive potential of citrus sweets on bovine enamel samples regarding the quantification of wear. Methodology: Ninety bovine crowns were prepared and samples were randomly distributed into 6 groups (n=15): 0.1% citric acid solution (pH 2.5); Coca-Cola ® Soft Drink (pH 2.6); Fini ® Diet (lactic and citric acid, pH 3.3); Fini ® Jelly Kisses (lactic and citric acid, pH 3.5); Fini ® Fruit Salad Bubblegum (maleic acid, pH 2.6); Fini ® Regaliz Acid Tubes (maleic and citric acid, pH 3.1). Sweets were dissolved in the proportion of 40 g/250 mL of deionized water. Enamel samples were submitted to erosive challenges for 7 days (4 daily acid immersion cycles for 90 s each). Enamel wear was measured using contact profilometry (μm), and data (median values [interquartile range]) were submitted to Kruskal-Wallis/Dunn’s test (p<0.0001). Results: All citrus sweets tested present a high erosive potential, Fini Diet ® (2.4 [1.2]) and Fini Regaliz Tubs ® (2.2 [0.5]) show the highest erosive potential, similar to 0.1% citric acid (2.3 [0.7]); Fini Regaliz Tubs ® is more erosive than Coca-Cola ® (1.4 [0.9]). Conclusion: The evaluated citrus sweets have great erosive potential and play a key role in the development of ETW

Avaliação do efeito de uma pasta experimental com nanopartículas de hidroxiapatita e fluoreto sobre a desmineralização e remineralização dentária in situ

This study evaluated the potential of an experimental paste containing nano- HA/fluoride on the reduction of dental demineralization and on the increase of dental remineralization in situ. Thirteen subjects took part in this crossover and double-blind study performed in 4 phases (14 days each). Four sound (S) and 4 predemineralized (WS) specimens were worn intraorally at each phase corresponded to the following treatments: Nanop plus (10% hydroxyapatite + 900 ppm F), MI Paste Plus (CPP-ACP + 900 ppm F), F (900 ppm F) and placebo (without active ingredients). For that, 480 specimens (240 enamel and 240 dentin) were selected by using surface microhardness; half of the samples were subjected to demineralization (WS, demineralizing solution at pH 5, for 6 and 7 days, respectively) and the other half remained sound (S). S specimens were protected from disturbance by using plastic mesh to allow biofilm accumulation; while on WS no biofilm accumulation was allowed to facilitate remineralization. S specimens were further exposed to severe cariogenic challenge (20% sucrose, 8x5min/day for enamel and 4x5min/day for dentin). The treatments were done 2x4 min/day, extraorally. The de-remineralization was quantified by transversal microradiography. The data were statistically analyzed using Repeated-Measures ANOVA followed by Tukeys test (p<0.05). In respect to dentin demineralization, Nanop Plus had the best effect on the reduction of Z (%minxm), while all treatments were similarly able to reduce to the lesion depth (m) compared with placebo: Nanop Plus (780.5 ± 212.0, 98.8 ± 26.2); MI Paste Plus (876.0 ± 268.4; 95.7 ± 30.5); F (900.5 ± 236.3; 96.0 ± 26.1); Placebo (1188.2 ± 502.5; 142.7 ± 28.0), respectively (p<0.05). For enamel demineralization, no treatment was able to reduce Z and lesion depth compared to placebo: Nanop Plus (1000.9 ± 249.5, 45.0 ± 15.3); MI Paste Plus (883.6 ± 431.7; 60.7 ± 26.4); F (985.5 ± 313.4, 53.4 ± 21.1); Placebo (1369.6 ± 988.3, 57.2 ± 30.6), respectively. In respect to dentin remineralization, all treatments were similarly able to improve mineral uptake (Z) compared to placebo: Nanop Plus (910.1 ± 328.8); MI Paste Plus (964.2 ± 446.4); F (902.1 ± 606.8); Placebo (337.9 ± 408.2) (p<0.05). For enamel, only the Nanop Plus and F were effective in increasing mineral uptake (Z) compared to placebo: Nanop Plus (549.9 ± 405.4); MI Paste Plus (370.8 ± 230.6); F (555.5 ± 264.1); Placebo (200.4 ± 186.8) (p<0.05). Nanop Plus is more effective than MI Paste Plus on the reduction of dentin demineralization and the increase of enamel remineralization. No treatments were able to reduce enamel demineralization, while for dentin remineralization all treatments were effective.Este estudo avaliou o potencial de uma pasta experimental contendo nano- HAP/fluoreto sobre a redução da desmineralização e o aumento da remineralização dentária in situ. Treze indivíduos participaram de 4 fases cruzadas e duplo cegas (14 dias cada). Quatro amostras hígidas (H) e quatro pré-desmineralizadas (MB) foram utilizadas intraoralmente por fase correspondente aos seguintes tratamentos: Nanop Plus (10% de hidroxiapatita + 900 ppm F), MI Paste Plus (CPP-ACP + 900 ppm F) , F (900 ppm F) e placebo (sem ingrediente ativos). Para isso, 480 amostras (240 de esmalte e 240 de dentina) foram selecionadas com base nos valores de microdureza de superfície, sendo a metade submetida à desmineralização (MB, solução desmineralizante com pH 5, durante 6 dias e 7 dias, respectivamente) e a outra metade permaneceu hígida (H). As amostras H foram protegidas por tela plástica para o acúmulo de biofilme; enquanto sobre as amostras MB, biofilme não foi acumulado para possibilitar a remineralização. As amostras H foram posteriormente expostas a um desafio cariogênico (20% de sacarose, 8x5min/dia para esmalte e 4x5min/dia para dentina). Os tratamentos foram feitos 2x4 min/dia, extra-oralmente. A des-remineralização foi quantificada por microradiografia transversal. Os dados foram analisados estatisticamente por ANOVA de medida repetidas seguida pelo teste de Tukey (p <0,05). Em relação à desmineralização de dentina, a Nanop Plus apresentou o melhor efeito sobre a redução da Z (% minxm), enquanto que todos os tratamentos foram capazes de reduzir similarmente a profundidade da lesão (m) em comparação ao placebo: Nanop Plus (780,5 ± 212,0; 98,8 ± 26,2); MI Paste Plus (876,0 ± 268,4; 95,7 ± 30,5); F (900,5 ± 236,3; 96,0 ± 26,1); Placebo (1188,2 ± 502,5; 142,7 ± 28,0), respectivamente (p<0,05). Para a desmineralização do esmalte, nenhum tratamento foi capaz de reduzir o Z e a profundidade da lesão em comparação ao placebo: Nanop Plus (1.000,9 ± 249,5; 45,0 ± 15,3); MI Paste Plus (883,6 ± 431,7; 60,7 ± 26,4); F (985,5 ± 313,4; 53,4 ± 21,1); Placebo (1369,6 ± 988,3; 57,2 ± 30,6), respectivamente. No que diz respeito à remineralização da dentina, todos os tratamentos foram igualmente capazes de aumentar o ganho mineral (Z) em comparação ao placebo: Nanop Plus (910,1 ± 328,8); MI Paste Plus (964,2 ± 446,4); F (902,1 ± 606,8); Placebo (337,9 ± 408,2) (p<0,05). No esmalte, entretanto, apenas os tratamentos com Nanop Plus e F foram eficazes no aumento do ganho mineral (Z) em comparação ao placebo: Nanop Plus (549,9 ± 405,4); MI Paste Plus (370,8 ± 230,6); F (555,5 ± 264,1); Placebo (200,4 ± 186,8) (p<0,05). A Nanop Plus é mais eficiente que a MI Paste Plus na redução da desmineralização na dentina e no aumento da remineralização do esmalte. Nenhum tratamento foi capaz de reduzir a desmineralização no esmalte, enquanto todos os tratamentos aumentaram a remineralização da dentina

Efeito de um verniz de TiF4 na prevenção e remineralização de lesões cariosas na dentição permanente de crianças residentes em área fluoretada: estudo clínico randomizado de 18 meses

This randomized-controlled clinical trial compared the effect of TiF4 and NaF varnishes in the treatment of non-cavitated caries lesions and in the prevention of new lesions in permanent teeth. Sixty children (6-7 y/o) from 5 municipal schools of Bauru-SP (Brazil), according to the caries activity (at least 1 active white spot lesion), were selected and randomly divided into the following treatments (varnishes): 4% TiF4 (2.45% F-, FGM); 5% NaF (2.26% F-, Duraphat®-Colgate) or placebo (without F-, FGM). Varnishes were applied on permanent teeth, once a week (4 weeks); after the 6th and 12th month. Clinical examination (Nyvad/ICDAS) and quantitative fluorescence changes analysis (QLF) were performed after 1 month of the treatment and after 6, 12 and 18 months after the beginning of the study. Patients satisfaction degree was reported after each varnish application by visual scale. Visual plaque index (VPI) was calculated and measured after the 3rd, 9th and 15th months. The 1st paper of this thesis was published in the JMIR Research Protocols showing the experimental design model. Two-way RM-ANOVA, ANOVA/Tukey and 2 were performed. No differences were found between treatments with respect to carious lesions regression/progression using Nyvad/ICDAS (p>0.05). Only TiF4 varnish was able to reduce the mean fluorescence loss significantly after 18 months (-14.6 ± 4.0%) compared to the baseline value (-17.5 ± 3.9%, p=0.003). Regarding the prevention of new lesions, only TiF4 (99.2 ± 1.7%) presented a significantly higher percentage of sound surfaces at the end of the 18 months compared to placebo (94.9 ± 7.9%), while the NaF did not differ from the two groups (98.5 ± 2.1, p=0.014%). Around 97% of the participants reported being satisfied with treatments, regardless of varnish. The VPI percentage decreased significantly after 9 and 15 months compared to 3 months (p0,05). Apenas o TiF4 foi capaz de reduzir significativamente a perda média de fluorescência após 18 meses (-14,6 ± 4,0%) em comparação aos valores iniciais (- 17,5 ± 3,9%, p=0,003). Em relação à prevenção de novas lesões, somente o TiF4 (99,2 ± 1,7%) apresentou uma porcentagem significativamente maior de superfícies hígidas ao final dos 18 meses comparado ao placebo (94,9 ± 7,9%), enquanto o NaF não diferiu dos dois grupos (98,5 ± 2,1%, p=0,014). Uma média de 97% dos participantes relataram estar satisfeitos com os tratamentos, independentemente do grupo. A % de IPV reduziu significativamente após 9 e 15 meses em comparação aos 3 meses do estudo para todos os grupos (p<0,001). O verniz de TiF4 foi o único tratamento capaz de mostrar efeito benéfico neste modelo de estudo. O 2o artigo desta tese aborda os resultados obtidos e será enviado à revista International Journal of Paediatric Dentistry

Effect of titanium tetrafluoride/sodium fluoride solutions containing chitosan at different viscosities on the protection of enamel erosion in vitro.

OBJECTIVE The aim of this in vitro study was to evaluate the protective effect against enamel erosion of experimental solutions containing TiF4/NaF and Chitosan compared to a commercial SnCl2/NaF/AmF solution. DESIGN Bovine enamel samples were divided (n = 15/group) into: (1) commercial solution SnCl2/NaF/AmF (500 ppm F-, positive control); (2) NaF/TiF4 (490 ppm F-); (3) similar to 2 plus 0.5 % chitosan (Ch) (500 mPas), (4) similar to 2 plus 0.5 % chitosan (2000 mPas), (5) negative control (water), (6) 0.5 % chitosan (500 mPas) and (7) 0.5 % chitosan (2000 mPas). The samples were submitted to a pH cycling (0.1 % citric acid, 4 × 90 s/day, interposed by artificial saliva) and daily treatment application (after the last erosive challenge, 1 × 30 s/day) for seven days. After the first day, the surface reflection intensity changes (% rSRI) were measured. After 7 days, the erosive enamel loss was quantified by contact profilometer. The % rSRI and the enamel loss (μm) were compared using ANOVA/Tukey and Kruskal-Wallis/Dunn, respectively (p < 0.05). RESULTS The solution containing TiF4/NaF plus Ch 500 mPas was the only able to reduce the early erosive demineralization compared to negative control (p = 0.003). However, it did not differ from the other solutions. Enamel samples treated with SnCl2/NaF/AmF presented the lowest median loss value [0.72 (0.18) μm] followed by both TiF4 + Ch [1.24 (0.49) and 1.28 (0.25)]; which significantly differed from the negative control [1.70 (0.27)]. CONCLUSION The experimental solution containing TiF4/NaF plus chitosan (2000 mPas) has comparable effect to SnCl2/NaF/AmF on the protection against enamel erosion

Evaluation of fluoride release from experimental TiF4 and NaF varnishes in vitro

Fluoride varnishes play an important role in the prevention of dental caries, promoting the inhibition of demineralization and the increase of remineralization. Objective: This study aimed to analyze the amount of fluoride released into water and artificial saliva from experimental TiF4 and NaF varnishes, with different concentrations, for 12 h. Material and Methods: Fluoride varnishes were applied on acrylic blocks and then immersed in 10 ml of deionized water and artificial saliva in polystyrene bottles. The acrylic blocks were divided in seven groups (n=10): 1.55% TiF4 varnish (0.95% F, pH 1.0); 3.10% TiF4 varnish (1.90% F, pH 1.0); 3.10% and 4% TiF4 varnish (2.45% F, pH 1.0); 2.10% NaF varnish (0.95% F, pH 5.0); 4.20% NaF varnish (1.90% F, pH 5.0); 5.42% NaF varnish (2.45% F, pH 5.0) and control (no treatment, n=5). The fluoride release was analyzed after 1/2, 1, 3, 6, 9 and 12 h of exposure. The analysis was performed using an ion-specific electrode coupled to a potentiometer. Two-way ANOVA and Bonferroni's test were applied for the statistical analysis (

In situ effect of chewing gum containing CPP–ACP on the mineral precipitation of eroded bovine enamel

Objectives: Stimulation of salivary flow is considered a preventive strategy for dental erosion. Alternatively, products containing calcium phosphate, such as a complex of casein phosphopeptide–amorphous calcium phosphate (CPP–ACP), have also been tested against dental erosion. Therefore, this in situ study analyzed the effect of chewing gum containing CPP–ACP on the mineral precipitation of initial bovine enamel erosion lesions. Methods: Twelve healthy adult subjects wore palatal appliances with two eroded bovine enamel samples. The erosion lesions were produced by immersion in 0.1% citric acid (pH 2.5) for 7 min. During three experimental crossover in situ phases (1 day each), the subjects chewed a type of gum, 3 times for 30 min, in each phase: with CPP–ACP (trident total), without CPP–ACP (trident), and no chewing gum (control). The Knoop surface microhardness was measured at baseline, after erosion in vitro and the mineral precipitation in situ. The differences in the degree of mineral precipitation were analyzed using repeated measures (RM-) ANOVA and post hoc Tukey’s test ( p < 0.05). Results: Significant differences were found among the remineralizing treatments ( p < 0.0001). Chewing gum (19% of microhardness recovery) improved the mineral precipitation compared to control (10%) and the addition of CPP–ACP into the gum promoted the best mineral precipitation effect (30%). Conclusions: Under this protocol, CPP–ACP chewing gum improved the mineral precipitation of eroded enamel. Clinical significance: Since the prevalence of dental erosion is steadily increasing, CPP–ACP chewing gum might be an important strategy to reduce th eprogression of initial erosion lesions