STOMATOLOGIYA
BIOAVAILABILITY OF FLUORIDE FROM 3
DIFFERENT TOOTHPASTES IN VIVO
P. Bottenberg, O. Jamcikova
Department of Oral Health Sciences, Vrije Universiteit
Brussel, Brussels, Belgium
Abstract
The aim of the present 3-leg crossover study was to assess
the oral bioavailability of fluoride delivered with two NaF
toothpastes (one longer marketed 1350 ppm and one recently
introduced 1450ppm F), and a MFP toothpaste (1450 ppm F). Ten
adult volunteers brushed their teeth for 1 min, followed by
rinsing with 10 ml de-ionised purified water for 10 s. Samples of
about 2mL of whole mixed unstimulated saliva were collected
1,5,10, 20, 30, 60,180 min after brushing. Individual salivary
fluoride-time plots were established and the area under the
curve (AUG) calculated. Стах and AUC of MFP were significantly
(p<0.05) lower than that of the NaF formulations, but not
difference was shown between both NaF formulations
(p>0.05).The newly introduced NaF toothpaste had a sufficient
bioavailability of fluoride comparable to that of standard NaF
toothpaste. The MFP toothpaste showed a lower availability of
ionisable fluoride.
Key words:
sodium fluoride, sodium monofluorophos-
phate, toothpaste, saliva
Publication history: this work was based on the master thesis
of O. Jamcikova (2008, VUB)
Introduction
Fluoride-containing toothpastes are thought to be the
reason of decline of caries in many countries [Bowen, 1995].
However, erosion poses a new threat to dental hard tissues
[Truin et al., 2005]. There is debate whether fluoride is able to
prevent erosion [Larsen and Richards, 2004; Lussi et al., 2008] and
whether toothpastes present a suitable vehicle to deliver fluoride
in this context. Recently, toothpastes have been marketed with
the claim of protecting enamel against erosion. One of these is
claimed to contain an adapted abrasive system and show a high
bioavailability of fluoride. The aim of the present study was to
evaluate fluoride bioavailability in human volunteers and
compare it to a conventional sodium fluoride (NaF) and sodium
monofluorophosphate (MFP) toothpaste.
Materials and Methods
The study design was a simplified version of that described
by Issa and Toumba [2004]. Ten healthy adult volunteers
participated in this 3-leg crossover study. Inclusion criteria were:
absence of oral health problems, presence of at least 24 natural
teeth (including fixed prosthesis), no removable prosthesis or
orthodontic appliances. The permission of the medical ethics
committee of the medical school and academic hospital of the
VUB was obtained. Volunteers gave written informed consent
prior to the study.
The toothpastes used were:
Pronamel (Pronamel, GSK, Genval, Belgium, batch number
037A L2) containing 1450 ppm of fluoride as NaF, potassium
nitrate and silica as abrasive.
Previon (Sensodyne Previon Fluor, GSK, Genval, Belgium,
batch number BN 4170T2), containing 1350 ppm of fluoride as
NaF, potassium chloride and triclosan in a base of silica.
MFP (Signal Protection Caries-Blancheur, Unilver, Brussels,
Belgium, batch number 718561WA) containing 1450 ppm of
fluoride as sodium monofluorophosphate, sodium bicarbonate
in a base of calcium carbonate and silica.
The volunteers were given a fluoride-free toothpaste
(Sensodyne Previon Classic, GSK, Genval, Belgium, batch number
377 AT2) to be used 1 week prior to the experiment and in the 1-
week washout periods between experiments. The morning of the
experiment, no tea and sea-food was permitted to exclude their
influence on the baseline salivary fluoride concentration.
In the morning, a baseline saliva sample was obtained by
drooling during 5 minutes in a graduated 50 mL centrifuge tube
(Falcon, Becton-Dickinson, Franklin Lakes, USA). Thereafter,
volunteers brushed during 1 minute with 1 gram of toothpaste
applied on a new toothbrush. The excess toothpaste/saliva slurry
was expectorated in another graduated centrifuge tube, followed
by a short rinse with 10 mL of purified water, which was also
collected. Further salivary samples were obtained after
2,5,10,20,30,60 and 180 minutes after the brushing stopped.
Fluoride in saliva was assessed after addition of 100 mL TISAB
III to 900mL saliva. The solution was stirred after addition of
TISAB. The toothpaste slurry and rinsing solutions were analyzed
after 2-fold dilution and addition of TISAB. Fluoride was then
analyzed electrochemically.The electrode
20
ТЕРАПЕВТИЧЕСКАЯ СТОМАТОЛОГИЯ
was calibrated before each series of measurements against a
standard series of NaF (Merck, Darmstadt, Germany) in ul-
trapurified water with 10%TISAB III added. Millivolt readings
were obtained after 5 minutes eguilibration under constant
stirring. The fluoride concentration was determined using the
"standard curve" option of the computer software Prism (Graph
Pad, USA) and corrected for dilution. The same program was
used to calculate the area under the fluoride-time curve (AUG)
after subtracting the baseline values. The maximum
concentration (Стах) was derived from the curves.
AUG and Стах values were compared statistically using the
Friedman test for related samples followed by comparisons with
the Wilcoxon test with Bonferroni correction for multiple
comparisons. The individual fluoride concentrations were
compared to baseline with a paired Wilcoxon test. Statistical
significance was accepted at a p-value of < 0.05. Calculations
were performed using the SPSS software package, version 16.
Post-hoc power was determined using g*power 3.1.9.2.
Resultsand Discussion
All volunteers completed the study without adverse effects
and all samples could be processed as planned. Figure 1 shows
the fluoride-time graphs of the different toothpaste experiments.
Pronamel had a slightly higher AUC and Стах value than Previon,
but not to a significant extent (p>0.05), due to a somewhat
higher fluoride concentration. MFP showed significantly (p<0.05)
lower AUC and Стах values than both NaF toothpastes (table 1).
All toothpastes achieved a significant elevation of salivary
fluoride levels compared to baseline (Wilcoxon test, p<0.05) at
all measuring points.
At an effect size (Hedges' G) above 3.0 between both NaF
toothpastes and MFP, power was 1.0 at the given sample size.
For a comparison between both NaF toothpastes (effect size
0.55), a theoretical sample size of 45 volunteers was calculated in
order to achieve a power of 0.8.
Table 1. Synopsis of the parameters derived from thefluo-
ride-time curves. AUC: area under the curve, Стах: maximum
concentration. Superscript letters designate groups not
significantly (p>0.05) different from each other.
Toothpaste
AUC(ppm*min)
C„JPPm)
median
range
median
range
Pronamel
27?
257-471
235
a
167-377
Previon
25?
145-398
213
a
111-270
Signal
6?
38-75
3?
13-46
In this study we could show that a newly introduced NaF-
containing toothpaste had a comparable bioavailability of
inonisable fluoride to a product already introduced on the
market but higher than a MFP toothpaste. Bioavailability is
known to be influenced by formulation of a toothpaste
[Hattab, 1989] and should be assessed regularly. When we
compare the present data to a previous study with comparable
experimental conditions [Issa and Toumba, 2004], we obtained
comparable results. A difference could be found in the post-rinse
fluoride concentration since in the present study rinsing was
preceded by expectoration of toothpaste slurry. This could be
seen as a "worst-case"situation, since it is reported to eliminate
about 50% of the administered fluoride [Sjogren et al., 1994].
Expectoration of toothpaste slurry after brushing was reported in
about 40% of the subjects in a Brazilian study on fluoride
retention [Oliveira et al., 2006].
In the past there was much discussion about the eguiv-
alence of sodium fluoride and sodium monofluorophosphate in
terms of bioavailability and caries preventive potential [Stookey
et al., 1993; Saporito et al., 2000]. It was shown that the amount
of ionisable fluoride was lower in MFP toothpastes [Issa and
Toumba, 2004]. Bruun et al. [1984] showed that the total salivary
fluoride, measured with gas chromatography was eguivalent
between NaF and MFP toothpastes but inonizable fluoride
availability was lower in MFP, although some MFP hydrolysis
occurred after 20-30 minutes in saliva. Klimek et al [1997] showed
that in volunteers with higher plague levels or open cavities
hydrolysis of MFP occurred faster and on a higher level.
Whereas the caries protective effect of both NaF or MFP
toothpastes is widely accepted, their efficacy to prevent erosion
is subject to debate. Spectroscopic studies showed no protective
effect of fluoride against erosion in vitro [Wang et al., 2008].
Larsen and Richards [2004] came to the conclusion that acidic
beverages even when supplemented with high amounts of
fluoride could not prevent the dissolution of enamel and CaF2.
Studies involving toothpastes [Lussi et al., 2008; Rees et al., 2007]
demonstrated a certain protective effect of toothpaste slurry,
especially if administered before the acidic challenge. Not only
NaF but also MFP seemed to provide some, but not complete
protection against acid [Bartlett et al., 1994]. Next to the fluoride
compound, properties of the toothbrush itself [Lippert et al.,
2017] and other constituents of the toothpaste, such as abrasives
and cleaning agents [Ganss et al., 2016; Danelon et al, 2017] have
an influence on post-erosive tissue loss. Attin et al. [2001]
recommended not to brush immediately after acidic challenge to
prevent the removal of softened minerals from the enamel
surface. Since the present study only demonstrated a sufficient
level of fluoride in saliva after use of a toothpaste of which an
erosion protection is claimed, this claim could neither be
confirmed nor rejected.
References
1.
Attin
J
Knofel S, Buchcttia futtincii fl: Insitu evaluation of
different remineralization periods to decrease brushing
abrasion of demineralized enamel Caries Res 2001; 35:216-
222.
2.
Bartlett DW, Smith BGN, Wilson RF: Comparison of the effect
of fluoride and non-
fluoride toothpaste on tooth wear in vitro and the influence of
enamel fluoride concentration on the hardness of enamel.
BrDentJ 1994; 176:346-348.
21
STOMATOLOGIYA
7.
Bowen WH: The role of fluoride toothpaste in the prevention
of dental caries. J fl Soc Med 1995; 88:505-507.
8.
Bruun C, Giskov H, Thylstrup A: Whole saliva fluoride after
toothbrushing with NaF and MFP dentifrices with diferent F
concentrations. Caries Res 1984; 18: 282-288.
9.
Danelon M, Pelirn Pessana J, Francisco Nunes Souza-Neto F,
Rodrigues de Camargo E, Botazzo Delbem AC: Effect of
fluoride toothpaste with nano-sized trimetaphospha te on
enamel demineralization: An in vitro study Archs Oral Biol
2007;78:82-87.
10.
Ganss C Marten J, Hara AT, Schlueter N: Toothpastes and
enamel erosion/ abrasion - Impact of active ingredients and
the particulate fraction J Dent 2016; 54:62-67.
11.
Hattab TN: The state of fluorides in toothpastes. J Dent 1989;
17:47-54.
12.
Issa Al, Fournba KJ: Oral fluoride retention in saliva following
toothbrushing with child and adult dentifrices with and
without water rinsing. Caries Res 2004; 38: 15-19.
13.
Klimek J, Jung M, Jung S: Interindividual differences in
degradation of sodium monofluorophosphate by saliva in
relation to oral health status. Archs oral Biol 1997; 42:181-
184.
14.
Larsen MJ, Richards A: Fluoride is unable to reduce dental
erosion from soft drinks. Caries Res 2002; 36:75-80.
15.
Lippert E Arrageg MA, Eckert GJ, Hara AE Interaction between
toothpaste abrasivity and toothbrush filament stiffness on the
development of erosive/ abrasive lesions in vitro. Int Dent J
2017; 67:344-350.
16.
Lussi A, Megert B, Eggenberger D, Jaeggi E Impact of different
toothpastes on the
prevention of erosion. Caries Res 2008; 42:62-67.
17.
Oliveira MJ, Paiva SM, Martins LH, Pordeus I A, Lima /В, Сигу
JA: Influence of rinsing and expectoration after toothbrushing
on fluoride dose and ingested amount by use of conventional
and children's fluoride dentifrices. Braz Dent J. 2006; 17:100-
105.
18.
Rees J, Loyn
J
Chadwick B:Pronarnel and tooth mousse: an
initial assessment of erosion prevention in vitro. J Dent 2007;
35:355-357.
19.
Saporito RA, Elias Boneta AR, Feldman CE, Cinotti W, Sintes JL,
Stewart B, Volpe
AR, Proskin HM: Comparative anticaries efficacy of sodium
fluoride and sodium monofluorophosphate dentifrices. A two-
year caries clinical trial on children in New Jersey and Puerto
Rico. Am J Dent 2000; 13:221-226.
20.
Sjogren K, Ekstrand J, Birkhed D: Effect of water rinsing after
toothbrushing on fluoride absorption and ingestion. Caries
Res 1994; 28:455-459.
21.
Stookey GK, DePaola PF, Featherstone JDB; Fejerskov 0, Moller
IJ, Rotberg S, Stephen KW, Wefel JS: A critical review of the
relative anticaries efficacy of sodium fluoride and sodium
monofluorophosphate dentifrices. Caries Res 1993; 27:337-
360.
22.
Twin GJ, Van Rijkom HM, Mulder J, Van’t Hof MA. Caries trends
1996-2002 among 6- and 12-year old children and erosive
wear prevalence among 12-year-old children in the Hague.
Caries Res 2005; 39:2-8.
23.
Wang X, Klocke A, Mihailova B, Fosheva L, Bismayer L: New
insights into structural alteration of enamel apatite induced
by citric acid and sodium fluoride solutions. J Phys Chern В
2008; 112:8840-8848.
ОСОБЕННОСТИ АРХИТЕКТОНИКИ
ПРЯМЫХ РЕСТАВРАЦИЙ
ФРОНТАЛЬНОЙ ГРУППЫ ЗУБОВ
Д.м.н., профессор
П.А. Гасюк
1
к.м.н., ассистент
А.Б.
Воробец
1
,
к.м.н., ассистент
У.А. Холбаев
2
,
к.м.н.,
ассистент
С.Г. Зубченко
3
ТВУЗ «Тернопольский государственный
медицинский университет имени
И.Я. Горбачевского М3 Украины», Тернополь,
Украина
2
Самаркандский Государственный медицинский
институт, Самарканд, Узбекистан
3
ВГУЗ
«Украинская медицинская стоматологическая
академия», Полтава, Украина
Работа является фрагментом исследования по инициативной
тематике, которая выполняется сотрудниками кафедры орто-
педической стоматологии ГВУЗ «Тернопольский государственный
медицинский университет имени И. Я. Торбачевского М3 Украины» -
«Патогенетические подходы к лечению основных стоматологических
заболеваний на основе изучения механизмов повреждения тканей
полости рта на фоне сопутствующей соматической патологии» (№
госрегистрации 0116U005076).
Введение
Эстетика зубов во все времена волновала человечество,
а в современном мире красивая и здоровая улыбка стала
неотъемлемой
частью
успешного
человека,
его
своеобразной «визитной карточкой». В настоящее время в
клинической практике встречаются различные дефекты
коронковой части фронтальной группы зубов. Кариозные и
некариозные поражения (патологическая стираемость),
травматический отлом являются частыми причинами
повреждения режущего края фронтальной группы зубов
[1,5,6].
22
