Caries-preventing effect of a hydroxyapatite-toothpaste in adults: a 18-month double-blinded randomized clinical trial

BackgroundDental caries is a worldwide challenge for public health. The aim of this 18-month double-blinded, randomized, clinical trial was to compare the caries-preventing effect of a fluoride-free, hydroxyapatite toothpaste (test) and a toothpaste with sodium fluoride (1450 ppm fluoride; positive control) in adults.MethodsThe primary endpoint was the percentage of subjects showing no increase in overall Decayed Missing Filled Surfaces (DMFS) index. The study was designed as non-inferiority trial. Non-inferiority was claimed if the upper limit of the exact one-sided 95% confidence interval for the difference of the primary endpoint DMFS between test and control toothpaste was less than the predefined margin of non-inferiority (Δ ≤ 20%).ResultsIn total, 189 adults were included in the intention-to-treat (ITT) analysis; 171 subjects finished the study per protocol (PP). According to the PP analysis, no increase in DMFS index was observed in 89.3% of subjects of the hydroxyapatite group and 87.4% of the subjects of the fluoride group. The hydroxyapatite toothpaste was not statistically inferior to a fluoride toothpaste with regard to the primary endpoint.ConclusionHydroxyapatite was proven to be a safe and efficient anticaries agent in oral care.Clinical trial registrationNCT04756557

Tooth Whitening with Hydroxyapatite: A Systematic Review

A steadily increasing public demand for whiter teeth has resulted in the development of new oral care products for home use. Hydroxyapatite (HAP) is a new ingredient to whiten teeth. This systematic review focuses on the evidence of whether HAP can effectively whiten teeth. A systematic search using the PICO approach and PRISMA guidelines was conducted using PubMed, Scopus, Web of Science, SciFinder, and Google Scholar as databases. All study designs (in vitro, in vivo) and publications in foreign language studies were included. Of the 279 study titles that the searches produced, 17 studies met the inclusion criteria. A new “Quality Assessment Tool For In Vitro Studies” (the QUIN Tool) was used to determine the risk of bias of the 13 studies conducted in vitro. Moreover, 12 out of 13 studies had a low risk of bias. The in vivo studies were assigned Cochrane-based GRADE scores. The results in vitro and in vivo were consistent in the direction of showing a statistically significant whitening of enamel. The evidence from in vitro studies is rated overall as having a low risk of bias. The evidence from in vivo clinical trials is supported by modest clinical evidence based on six preliminary clinical trials. It can be concluded that the regular use of hydroxyapatite-containing oral care products effectively whitens teeth, but more clinical trials are required to support the preliminary in vivo evidence

Risk Assessment of Fluoride Intake from Tea in the Republic of Ireland and its Implications for Public Health and Water Fluoridation

The Republic of Ireland (RoI) is the only European Country with a mandatory national legislation requiring artificial fluoridation of drinking water and has the highest per capita consumption of black tea in the world. Tea is a hyperaccumulator of fluoride and chronic fluoride intake is associated with multiple negative health outcomes. In this study, fifty four brands of the commercially available black tea bag products were purchased and the fluoride level in tea infusions tested by an ion-selective electrode method. The fluoride content in all brands tested ranged from 1.6 to 6.1 mg/L, with a mean value of 3.3 mg/L. According to our risk assessment it is evident that the general population in the RoI is at a high risk of chronic fluoride exposure and associated adverse health effects based on established reference values. We conclude that the culture of habitual tea drinking in the RoI indicates that the total cumulative dietary fluoride intake in the general population could readily exceed the levels known to cause chronic fluoride intoxication. Evidence suggests that excessive fluoride intake may be contributing to a wide range of adverse health effects. Therefore from a public health perspective, it would seem prudent and sensible that risk reduction measures be implemented to reduce the total body burden of fluoride in the population

Black Tea Source, Production, and Consumption: Assessment of Health Risks of Fluoride Intake in New Zealand

In countries with fluoridation of public water, it is imperative to determine other dietary sources of fluoride intake to reduce the public health risk of chronic exposure. New Zealand has one of the highest per capita consumption rates of black tea internationally and is one of the few countries to artificially fluoridate public water; yet no information is available to consumers on the fluoride levels in tea products. In this study, we determined the contribution of black tea as a source of dietary fluoride intake by measuring the fluoride content in 18 brands of commercially available products in New Zealand. Fluoride concentrations were measured by potentiometric method with a fluoride ion-selective electrode and the contribution of black tea to Adequate Intake (AI) and Tolerable Upper Intake Level (UL) was calculated for a range of consumption scenarios. We examined factors that influence the fluoride content in manufactured tea and tea infusions, as well as temporal changes in fluoride exposure from black tea. We review the international evidence regarding chronic fluoride intake and its association with chronic pain, arthritic disease, and musculoskeletal disorders and provide insights into possible association between fluoride intake and the high prevalence of these disorders in New Zealand.Peer Reviewe

Risk Assessment of Fluoride Intake from Tea in the Republic of Ireland and its Implications for Public Health and Water Fluoridation

The Republic of Ireland (RoI) is the only European Country with a mandatory national legislation requiring artificial fluoridation of drinking water and has the highest per capita consumption of black tea in the world. Tea is a hyperaccumulator of fluoride and chronic fluoride intake is associated with multiple negative health outcomes. In this study, fifty four brands of the commercially available black tea bag products were purchased and the fluoride level in tea infusions tested by an ion-selective electrode method. The fluoride content in all brands tested ranged from 1.6 to 6.1 mg/L, with a mean value of 3.3 mg/L. According to our risk assessment it is evident that the general population in the RoI is at a high risk of chronic fluoride exposure and associated adverse health effects based on established reference values. We conclude that the culture of habitual tea drinking in the RoI indicates that the total cumulative dietary fluoride intake in the general population could readily exceed the levels known to cause chronic fluoride intoxication. Evidence suggests that excessive fluoride intake may be contributing to a wide range of adverse health effects. Therefore from a public health perspective, it would seem prudent and sensible that risk reduction measures be implemented to reduce the total body burden of fluoride in the population

Doses of fluoride toothpaste for children up to 24 months

Abstract Aim The aim of this study was to test the dose of fluoride toothpaste by parents for their children aged up to 24 months. Methods Parents who use fluoride toothpastes for their children were asked to dose two commercially available toothpastes (A and B) with 1000 ppm fluoride each for their children as they would normally do at home. The toothpaste amounts were weighed, and as reference, the weight of an ‘optimal’ grain of rice-size amount of each toothpaste was used. Results 61 parents dosed a mean of 0.263 ± 0.172 g toothpaste A and 0.281 ± 0.145 g toothpaste B. The parents’ mean doses were 5.9 times higher for toothpaste A and 7.2 times higher for toothpaste B than an ‘optimal’ grain of rice-size amount (the reference dose as recommended). The difference between parent’s and reference dose was statistically significant (p < 0.001). Moreover, 39.3% of parents were not aware about conditions of use and warnings that have to be printed on the package of fluoride toothpastes. Conclusion In this study, parents significantly overdosed the toothpaste for their children. To avoid fluoride intake from toothpaste, parents can choose fluoride-free alternatives for the oral care of their infants and toddlers

Relação entre fluorose dental e a concentração de flúor no dente – um estudo em área endêmica - doi:10.5020/18061230.2011.p355

Objective: To determine the relationship between dental fluorosis (DF) severity and fluoride [F] concentration in tooth and water in DF endemic areas. Methods: Life-long residents from two DF endemic communities were studied. Forty-five extracted teeth were collected and analyzed for DF severity and tooth [F]. Thylstrup-Ferjeskov Index (TFI) was used to measure DF severity and instrumental neutron activation analysis (INAA) for tooth [F] concentration. Water from regional wells was also collected (n=9) and analyzed for F content using specific ion F electrode. Results: Water [F] varied between 0.2ppm and 4.7ppm. TFI scores ranged from 0 to 6; [F] from 120ppm to 2,140ppm in enamel and 304ppm to 4,800ppm in dentin. No correlation was found between DF severity and [F] in enamel (rs=0.22,p=0.15) and dentin (rs=-0.19,p=0.20), nor between water [F] and [F] in enamel (rs=-0.09,p=0.65) and dentin (rs=-0.11,p=0.56). Weak correlation between DF severity and water [F] (rs=0.38,p=0.04) was found. Linear regression analysis showed that TFI couldn’t be predicted from a linear combination of the independent variables (age, enamel and dentin [F]). When enamel, dentin and water [F] were used as independent variables in the linear regression (predict DF severity), only water [F] showed influence in DF severity (p=0.013;t=2.67). Conclusion: Even in areas of endemic DF, tooth [F] didn’t correlate with DF severity and the relationship between water [F] and DF severity was very weak. Therefore, tooth [F] may not be a good predictor/indicator of DF severity.Objetivo: Determinar a relação entre severidade de fluorose dental (FD), e concentração de flúor [F] no dente e água em áreas endêmicas de FD. Métodos: Residentes de duas comunidades endêmicas de FD foram estudados. 45 dentes foram coletados e analisados para severidade de FD e concentração de flúor. O índice de Thylstrup-Ferjeskov (TFI) foi utilizado para medir a severidade de FD e análise por ativação com nêutrons (AAN) para concentração de [F] dental. Águas de poços da região foram coletadas (n=9) e analisadas para [F], utilizando eletrodo específico de flúor. Resultados: Concentração de [F] da água variou entre 0,2 e 4,7ppm. Os escores do TFI variaram entre 0 e 6; [F] no esmalte entre 120 e 2140ppm e na dentina entre 304 e 4800ppm. Não se observou correlação entre severidade de DF e [F] no esmalte (rs=0,22,p=0,15) e dentina (rs=-0,11,p=0,56). Encontrou-se correlação fraca entre FD e [F] na água (rs=0,38,p=0,04). Análise de regressão linear demonstrou que TFI não podia ser predito por uma combinação linear das variáveis (idade, e concentração de flúor no esmalte e dentina). Quando a concentração de flúor no esmalte, dentina e água foram analisadas de forma independente na regressão linear, apenas flúor na água demonstrou influência na severidade de FD (p=0,013;t=2,67). Conclusão: Mesmo em áreas endêmicas de FD, concentração de flúor dental não se correlaciona com severidade de FD, e a relação entre este e a concentração de flúor nas águas foi fraca. Assim, concentração de flúor dental pode não ser um bom preditor/indicador de severidade de FD

Image_1_Caries-preventing effect of a hydroxyapatite-toothpaste in adults: a 18-month double-blinded randomized clinical trial.JPEG

BackgroundDental caries is a worldwide challenge for public health. The aim of this 18-month double-blinded, randomized, clinical trial was to compare the caries-preventing effect of a fluoride-free, hydroxyapatite toothpaste (test) and a toothpaste with sodium fluoride (1450 ppm fluoride; positive control) in adults.MethodsThe primary endpoint was the percentage of subjects showing no increase in overall Decayed Missing Filled Surfaces (DMFS) index. The study was designed as non-inferiority trial. Non-inferiority was claimed if the upper limit of the exact one-sided 95% confidence interval for the difference of the primary endpoint DMFS between test and control toothpaste was less than the predefined margin of non-inferiority (Δ ≤ 20%).ResultsIn total, 189 adults were included in the intention-to-treat (ITT) analysis; 171 subjects finished the study per protocol (PP). According to the PP analysis, no increase in DMFS index was observed in 89.3% of subjects of the hydroxyapatite group and 87.4% of the subjects of the fluoride group. The hydroxyapatite toothpaste was not statistically inferior to a fluoride toothpaste with regard to the primary endpoint.ConclusionHydroxyapatite was proven to be a safe and efficient anticaries agent in oral care.Clinical trial registrationNCT04756557.</p