Rinsing solutions containing natural extracts and fluoride prevent enamel erosion in vitro

Polyphenols interact with salivary proteins and thus can improve the pellicle’s erosion protective properties. This effect could be exploited to create rinsing solutions with polyphenols as active ingredients for erosion prevention. Different from the current gold standard for erosion protective rinsing solutions, these rinses would not rely on stannous ions. This would offer alternatives for patients with concerns regarding the composition of rinsing solutions and preferring bio-products. Objective: To develop an erosion-preventive rinsing solution containing natural polyphenol-rich extracts. Methodology: Solutions were prepared with polyphenols from either grapeseed extract or cranberry extract, 500 ppm fluoride added, and additionally flavors and sweeteners. Controls were deionized water, 500 ppm fluoride solution, and the gold standard rinse in the field (Sn2+/F-). In total, 135 enamel specimens (n=15/group) were subjected to five cycles of salivary pellicle formation (30 min, 37°C), modification with the solutions (2 min, 25°C), further salivary pellicle formation (60 min, 37°C), and erosive challenge (1 min, 1% citric acid, pH 3.6). Relative surface microhardness (rSMH), surface reflection intensity (rSRI), and amount of calcium release (CaR) were investigated. Data were analyzed with Kruskal-Wallis and Wilcoxon rank sum tests (α=0.05). Results: The polyphenol solutions containing fluoride, as well as additional flavors, protected enamel better than fluoride alone, and similar to the Sn2+/F- solution, when investigating both rSMH and CaR. When measuring rSRI, Sn2+/F- showed the best protection, while the polyphenol solutions were similar to fluoride. Conclusion: For two of the three assessed parameters (rSMH and CaR), both developed polyphenol-rich rinsing solutions were able to protect enamel from erosion, improving/potentializing the effect of fluoride and matching the protection offered by the current gold standard rinsing solution

Rinsing solutions containing natural extracts and fluoride prevent enamel erosion in vitro.

BACKGROUND Polyphenols interact with salivary proteins and thus can improve the pellicle's erosion protective properties. This effect could be exploited to create rinsing solutions with polyphenols as active ingredients for erosion prevention. Different from the current gold standard for erosion protective rinsing solutions, these rinses would not rely on stannous ions. This would offer alternatives for patients with concerns regarding the composition of rinsing solutions and preferring bio-products. OBJECTIVE To develop an erosion-preventive rinsing solution containing natural polyphenol-rich extracts. METHODOLOGY Solutions were prepared with polyphenols from either grapeseed extract or cranberry extract, 500 ppm fluoride added, and additionally flavors and sweeteners. Controls were deionized water, 500 ppm fluoride solution, and the gold standard rinse in the field (Sn2+/F-). In total, 135 enamel specimens (n=15/group) were subjected to five cycles of salivary pellicle formation (30 min, 37°C), modification with the solutions (2 min, 25°C), further salivary pellicle formation (60 min, 37°C), and erosive challenge (1 min, 1% citric acid, pH 3.6). Relative surface microhardness (rSMH), surface reflection intensity (rSRI), and amount of calcium release (CaR) were investigated. Data were analyzed with Kruskal-Wallis and Wilcoxon rank sum tests (α=0.05). RESULTS The polyphenol solutions containing fluoride, as well as additional flavors, protected enamel better than fluoride alone, and similar to the Sn2+/F- solution, when investigating both rSMH and CaR. When measuring rSRI, Sn2+/F- showed the best protection, while the polyphenol solutions were similar to fluoride. CONCLUSION For two of the three assessed parameters (rSMH and CaR), both developed polyphenol-rich rinsing solutions were able to protect enamel from erosion, improving/potentializing the effect of fluoride and matching the protection offered by the current gold standard rinsing solution

In vitro evaluation of the erosive potential of orange juice modified by food additives in enamel and dentine

AbstractObjectivesTo evaluate the erosive potential of orange juice modified by food additives in enamel and dentine.MethodsCalcium lactate pentahydrate (CLP), xanthan gum (XG), sodium linear polyphosphate (LPP), sodium pyrophosphate tetrabasic (PP), sodium tripolyphosphate (STP) and some of their combinations were added to an orange juice. Pure orange juice and a calcium-modified juice were used as negative (C−) and positive (C+) controls, respectively. In phase 1, 15 modified orange juices were tested for erosive potential using pH-stat analysis. In phase 2, the additives alone and the combination with good results in phase 1 and in previous studies (CLP+LPP) were tested in an erosion–remineralization cycling model. In phase 3, the erosion and remineralization episodes were studied independently. Enamel was analysed by surface microhardness (SMH) and profilometry, whilst dentine by profilometry.ResultsIn phase 1, reduction of the erosive potential was observed for all additives and their combinations, except XG alone. In phase 2, no detectable enamel loss was observed when CLP, LPP and CLP+LPP were added to the juice. XG, STP and PP had enamel loss similar to C− (p>0.05). Amongst additives, the combination CLP+LPP showed the highest SMH values followed by CLP (p<0.05). All the other groups presented SMH values similar to C− (p>0.05). For dentine, only CLP+LPP lead to surface loss values lower than C− (p<0.05). In phase 3, CLP, LPP and CLP+LPP seemed to protect against erosion; whilst none of the tested compounds seemed to interfere with the remineralization process.ConclusionsCLP and LPP reduced erosion on enamel and this effect was enhanced by their combination. For dentine, only the combination CLP+LPP reduced erosion

In-vitro evaluation of the anti-cariogenic effect of a hybrid coating associated with encapsulated sodium fluoride and stannous chloride in nanoclays on enamel

Objective: The aim of this study is to test, in vitro, the anti-cariogenic effect of experimental hybrid coatings, with nano clays of halloysite or bentonite, loaded with sodium fluoride or with a combination of sodium fluoride and stannous chloride, respectively. Methodology: The varnish Fluor Protector (1,000 ppm of F-) was used as positive control and no treatment was the negative control. Enamel specimens (5 mm × 5 mm) were obtained from bovine teeth. The specimens (n=10) had their surfaces divided into two halves (5 mm × 2.5 mm each), in which one half received one of the treatments (Hybrid; Hybrid + NaF; Hybrid + NaF + SnCl2; Hybrid + NaF Loaded; Hybrid + NaF + SnCl2 Loaded). The specimens were submitted to a cariogenic challenge using a biofilm model (S. mutans UA159, for 5 days). Enamel surfaces both under and adjacent to the treated area were analyzed for mineral loss and lesion depth, by transverse microradiography. The pH of the medium was measured twice a day, and the fluoride release was analyzed. Additional specimens were submitted to confocal analysis. Results: Data were statistically analyzed by two-way ANOVA followed by Tukey test (α=0.05). None of hybrid groups were able to reduce the lesion depth; the Hybrid + NaF group, however, was able to reduce mineral loss differing from the negative control (p=0.008). The groups showed no significant difference in the pH measurement and fluoride release. Confocal analysis confirmed that for all groups the biofilm growth was similar. Conclusion: None of the hybrid groups reduced lesion depth, but the Hybrid + NaF group was able to promote protection against mineral loss

Association of Nd:YAG laser and calcium-phosphate desensitizing pastes on dentin permeability and tubule occlusion

Objective: To evaluate the efficacy of Nd:YAG laser associated with calcium-phosphate desensitizing pastes on dentin permeability and tubule occlusion after erosive/abrasive challenges.&nbsp;Methodology: Dentin specimens were exposed to 17% ethylene diamine tetra-acetic acid (EDTA) solution for 5 min and randomly allocated into five groups: G1, control (no treatment); G2, Nd:YAG laser (1 W, 10 Hz, 100 mJ, 85 J/cm2); G3, Laser + TeethmateTM Desensitizer; G4, Laser + Desensibilize Nano P; and G5, Laser+Nupro®. Specimens underwent a 5-day erosion-abrasion cycling. Hydraulic conductance was measured post-EDTA, post-treatment, and post-cycling. Post-treatment and post-cycling permeability (%Lp) was calculated based on post-EDTA measurements, considered 100%. Open dentin tubules (ODT) were calculated at the abovementioned experimental moments using scanning electron microscopy and ImageJ software (n=10). Data were analyzed using two-way repeated measures ANOVA and Tukey’s test (α=0.05).&nbsp;Results: G1 presented the highest %Lp post-treatment of all groups (p&lt;0.05), without significantly differences among them. At post-cycling, %Lp significantly decreased in G1, showed no significant differences from post-treatment in G3 and G4, and increased in G2 and G5, without significant differences from G1 (p&gt;0.05). We found no significant differences in ODT among groups (p&gt;0.05) post-EDTA. At post-treatment, treated groups did not differ from each other, but presented lower ODT than G1 (p&lt;0.001). As for post-cycling, we verified no differences among groups (p&gt;0.05), although ODT was significantly lower for all groups when compared to post-EDTA values (p&lt;0.001). Conclusion: All treatments effectively reduced dentin permeability and promoted tubule occlusion after application

In situ evaluation of fluoride-, stannous- and polyphosphate-containing solutions against enamel erosion

Objective To evaluate the anti-erosive effect of solutions containing sodium fluoride (F: 225 ppm of fluoride), sodium fluoride + stannous chloride (F + Sn: 225 ppm of fluoride + 800 ppm of stannous), sodium fluoride + stannous chloride + sodium linear polyphosphate (F + Sn + LPP: 225 ppm of fluoride + 800 ppm of stannous + 2% of sodium linear polyphosphate), and deionized water (C: control), using a four-phase, single-blind, crossover in situ clinical trial. Methods In each phase, 12 volunteers wore appliances containing 4 enamel specimens, which were submitted to a 5-day erosion-remineralization phase that consisted of 2 h of salivary pellicle formation with the appliance in situ, followed by 2 min extra-oral immersion in 1% citric acid (pH 2.4), 6x/day, with 90 min of exposure to saliva in situ between the challenges. Treatment with the test solutions was performed extra-orally for 2 min, 2x/day. At the end of the experiment, surface loss (SL, in μm) was evaluated by optical profilometry. Data were analyzed using ANOVA and Tukey tests (α = 0.05). The surface of additional specimens was evaluated by x-ray diffraction after treatments (n = 3). Results C (mean SL ± standard-deviation: 5.97 ± 1.70) and F (5.36 ± 1.59) showed the highest SL, with no significant difference between them (p > 0.05). F + Sn (2.68 ± 1.62) and F + Sn + LPP (2.10 ± 0.95) did not differ from each other (p > 0.05), but presented lower SL than the other groups (P < 0.05). Apatite and stannous deposits on specimen surfaces were identified in the x-ray analysis for F + Sn and F + Sn + LPP. Conclusions Sodium fluoride solution exhibited no significant anti-erosive effect. The combination between sodium fluoride and stannous chloride reduced enamel erosion, irrespective of the presence of linear sodium polyphosphate. Clinical significance Under highly erosive conditions, sodium fluoride rinse may not be a suitable alternative to prevent enamel erosion. A rinse containing sodium fluoride and stannous chloride was shown to be a better treatment option, which was not further improved by addition of the sodium linear polyphosphate

In vitro and in situ evaluation of the erosive potential of the orange juice modified with calcium and some food-approved polimers

O objetivo deste trabalho foi avaliar in vitro e in situ o potencial erosivo do suco de laranja modificado por cálcio e alguns polímeros alimentares. Este estudo foi dividido em quatro fases. Na primeira, as seguintes substâncias: lactato de cálcio (Ca), goma xantana (XG), hexametafosfato de sódio (HMP), tripolifosfato de sódio (STP), pirofosfato de sódio (PP) e suas combinações, foram adicionadas a um suco de laranja, disponível comercialmente, criando 15 sucos modificados. O suco sem aditivos foi utilizado como controle negativo (C-), e um suco de laranja modificado com cálcio (disponível comercialmente), como controle positivo (C+). Os sucos tiveram o seu potencial erosivo avaliado com o método do pH-stat. A variável resposta foi o volume de titulador necessário para manter o pH dos sucos nos valores iniciais. Após, seis sucos foram selecionados e testados na segunda fase, com um modelo de ciclagem de erosão-remineralização. Na terceira fase, os episódios de erosão e de remineralização foram estudados independentemente. A variável resposta para essas duas fases foi a microdureza de superfície (MDS) para esmalte, e a perfilometria ótica, para esmalte e dentina. Na quarta fase, os sucos Ca, Ca+HMP e HMP, mais os controles, foram testados com um modelo de erosão in situ, crossover, cego, de 5 fases, envolvendo 10 voluntários. Em cada fase, os voluntários inseriam aparelhos palatinos contendo espécimes de esmalte na boca e, após 5min, realizavam os desafios erosivos nos tempos experimentais de 0 (controle), 10, 20 e 30min. Dois espécimes eram aleatoriamente removidos dos aparelhos, após cada tempo. A variável resposta foi a alteração da microdureza de superfície (em %). Antes dos procedimentos clínicos, em cada fase, os voluntários realizaram um teste cego de sabor, onde o suco modificado designado a aquela fase foi comparado cegamente com C-. Na primeira fase, todos os aditivos foram capazes de reduzir o potencial erosivo do suco, com exceção da adição de XG isoladamente. Na segunda fase, não houve perda de estrutura de esmalte detectável quando Ca, HMP e Ca+HMP foram adicionados ao suco; XG, STP e PP apresentaram uma perda de esmalte similar ao grupo C-. Ca+HMP apresentaram a menor redução da MDS, seguido por Ca; todos os outros grupos apresentaram uma redução da MDS similar ao grupo C-. Para dentina, somente Ca+HMP apresentou uma redução na perda de estrutura. Na terceira fase, Ca, HMP e Ca+HMP protegeram contra erosão e nenhum dos compostos interferiu com o processo de remineralização. Na quarta fase, Ca e Ca+HMP reduziram a erosão, sem diferenças significantes entre esses grupos; o HMP não apresentou efeito protetor. 5/10 voluntários notaram uma diferença no sabor de C+, 4/10 para Ca e 2/10 para C-. Conclui-se que, in vitro, tanto o HMP, quanto o Ca, nas concentrações testadas, reduziram a erosão causada pelo suco em esmalte e a combinação desses aditivos aumentou seus efeitos protetores. Para dentina, apenas a combinação Ca+HMP reduziu a erosão. In situ, Ca reduziu a erosão provocada pelo suco, porém, alterações no sabor foram notadas por alguns voluntários. HMP não apresentou efeito protetor.The aim of this study was to evaluate in vitro and in situ the erosive potential of the orange juice modified with calcium and some food-approved polymers. This study was divided into four fases. In the first, the following substances: calcium lactate (Ca), xanthan gum (XG), sodium hexametaphosphate (HMP), sodium trypoliphosphate (STP), sodium pyrophosphate (PP) and some of their combinations were added to a commercially available orange juice, creating 15 modified juices. The juice without additives was used as a negative control (C-) and a commercially available calcium-modified juice as positive control (C+). These juices were tested for erosive potential using pH-stat. The response variable was the volume of titrant needed to maintain the pH of the juices in their baseline values. After, six selected juices were tested in the second phase with an erosion-remineralization cycling model. In the third phase, the erosion and remineralization episodes were tested independently. The reponse variable for these phases was surface microhardness for enamel and optical perfilometry for enamel and dentin. In the fourth phase, the juices Ca, Ca+HMP and HMP, plus the controls were tested with an erosion in situ model, consisting of a 5-phase, single blind crossover clinical trial involving 10 subjects. In each phase, subjects inserted custom-made palatal appliances containing enamel specimens in the mouth and, after 5 min equilibration period, performed erosive challenges for total of 0 (control), 10, 20, and 30 min. Two specimens were randomly removed from the appliances, after each challenge period. The reponse variable was the percentage of surface microhardness change. Before the procedures, in each phase, the subjects performed a taste test, where the modified juice assigned to that phase was blindly compared to C-. In first phase, all the additives were able to reduce the erosive potential of the juice, except the addition of XG alone. In the second phase, no detectable enamel loss was observed when Ca, HMP and Ca+HMP were added to the juice; XG, STP and PP had enamel loss similar to C-. Ca+HMP showed the lowest reduction in the surface microhardness, followed by Ca;all the other groups presented a reduction in the surface microhardness similar to C-. For dentin, only Ca+HMP reduced surface loss. In the third phase, Ca, HMP and Ca+HMP protected against erosion; and none of the tested compounds seemed to interfere with the remineralization process. In the fourth phase, Ca and Ca+HMP reduced erosion, with no difference between them. HMP did not show any protective effect. 5/10 subjects noticed a difference in the taste of C+; 4/10 for Ca; and 2 /10 for C-. In conclusion, in vitro, HMP and Ca, in the concentrations tested, reduced erosion on enamel and this effect was enhanced by their combination. For dentin, only the combination Ca+HMP caused a significant reduction. In situ, Ca reduced the erosion caused by the juice; however, taste changes were noticed by some volunteers. HMP did not show any protective effect

Salivary pellicle modification with polyphenol-rich teas and natural extracts to improve protection against dental erosion.

OBJECTIVE To investigate the modification of the salivary pellicle with different polyphenol-rich teas and natural extracts for the protection against dental erosion. METHODS We performed two experiments: one with teas (Green tea, Black tea, Peppermint tea, Rosehip tea, negative control [NC]) and other with natural extracts (Grape seed, Grapefruit seed, Cranberry, Propolis, NC), where NC was deionized water. A total of 150 enamel specimens were used (n = 15/group). Both experiments followed the same design, consisting of 5 cycles of: salivary pellicle formation (30 min, 37 °C), modification with the solutions (30 min, 25 °C), further salivary pellicle formation (60 min, 37 °C) and erosive challenge (1 min, 1% citric acid, pH 3.6). Relative surface microhardness (rSMH), relative surface reflection intensity (rSRI) and amount of calcium release (CaR) were evaluated. Data were analysed with Kruskal-Wallis and Wilcoxon rank sum tests with Bonferroni correction (α = 0.05). RESULTS Regarding teas, Black and Green teas showed the best protection against dental erosion, presenting higher rSMH and lower CaR than NC. Peppermint tea was not different to NC and Rosehip tea caused erosion, showing the highest CaR and greatest loss of SMH and SRI. Regarding natural extracts, Grape seed and Grapefruit seed extracts presented the best protective effect, with significantly higher rSMH and lower CaR. Cranberry caused significantly more demineralization; and Propolis did not differ from NC. CONCLUSION Green tea, Black tea, Grape seed extract and Grapefruit seed extract were able to modify the salivary pellicle and improve its protective effect against enamel erosion, but Rosehip tea and Cranberry extract caused erosion. CLINICAL RELEVANCE Some some bio-products, such as teas and natural extracts, improve the protective effect of the salivary pellicle against enamel erosion. More studies should be performed in order to test the viability of their use as active ingredients for oral care products

Causes of Dental Erosion: Intrinsic Factors

The consequences of the severe wear caused by intrinsic erosion, in addition to the high cost and complexity of the treatment to restore severely worn dentition, support the importance of early diagnosis and implementation of preventive/therapeutic measures. Dental professionals must be aware of the signs and symptoms of the disease, as well as all the conditions that may lead to the presence of gastric juice in the mouth, so they can make the referral to the appropriate medical specialist. In this chapter, the main clinical conditions associated with intrinsic erosion are presented and its clinical signs and symptoms discussed from a clinical perspective

Anti-erosive effect of rinsing before or after toothbrushing with a Fluoride/Stannous Ions solution: an in situ investigation: Application order of Fluoride/Tin products for erosive tooth wear.

OBJECTIVE To evaluate the impact of the application of a F-/Sn2+-containing mouthrinse before or after toothbrushing with a F-/Sn2+/chitosan toothpaste on the progression of erosion/abrasion on enamel and dentin. METHODS This crossover in situ study had five arms: Control (toothbrushing without toothpaste), Brushing (toothbrushing with toothpaste), Brushing + Rinsing, Rinsing + Brushing, and Rinsing (without toothbrushing). Fifteen subjects used removable mandibular appliances containing 3 enamel and 3 dentin specimens, which were subjected to erosion-abrasion cycling of 60 min salivary pellicle formation followed by 5 min extra-oral erosion with 1% citric acid (4x/day for 5 days). Treatments were performed in situ after first and last erosive challenges with rinse (10 ml; 30 s) and/or toothbrushing with/without toothpaste (with electric toothbrush; 5 s per specimen; total 2 min contact with slurry). Surface loss (SL) was evaluated with an optical profilometer. Data were analyzed by two-way repeated measures ANOVA and Tukey tests (α = 0.05). RESULTS The Control showed the highest SL (mean ± SD for enamel: 24.58 ± 11.32; dentin: 32.32 ± 10.10; all μm). Rinsing alone resulted in significantly lower SL value (enamel: 8.30 ± 4.96; dentin: 16.15 ± 8.29) compared with arms that applied toothpaste, except Brushing + Rinsing. None of the arms that underwent toothbrushing with the toothpaste differed from each other (p > 0.05). Dentin specimens showed significantly higher SL values than enamel (p < 0.001). CONCLUSION The order of treatment applications had no influence on their anti-erosive effect; however, toothbrushing with F-/Sn2+/chitosan toothpaste reduced enamel surface loss. Additional rinsing with F-/Sn2+ mouthrinse did not offer improved protection. CLINICAL SIGNIFICANCE The use of fluoride- and stannous- containing toothpastes and mouthrinses is an important approach in the prevention of erosive tooth wear. Further evidence is needed to support the benefit of combining these products against this condition