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The anti-caries effect of fluoride is well established and it has been used as an ingredient in dentifrices for decades. Extensive studies have demonstrated the main effects of fluoride are to promote remineralization of early caries and prevent demineralization.

FluoriDe
Research into this remarkable mineral continues in the 21st century. Scientists continue to investigate mode of action and the effects of different fluoride formulations are constantly being explored. Read on for a summary of recent data comparing the release of fluoride from different sources and advances in fluoride uptake from dentifrices. Although SnF2 and AmF are used in dentifrices, the majority of formulations use either NaF or MFP as fluoride sources. Comparing these two, Bowen’s Journal of the Royal Society of Medicine paper (1995) has indicated that fluoride ions are freely available in NaF; however, MFP needs to be broken down by salivary phosphatases in order to release fluoride.
Na+ Na+ O OP F Sn ONa F

Sources of fluoride in dentifrices
There are four sources of fluoride used in dentifrices, which include: • • • • sodium fluoride (NaF) sodium monofluorophosphate (MFP) stannous fluoride (SnF2) amine fluoride (AmF).

F

F

Sodium monofluorophosphate
FO N+ FN+

Stannous fluoride

Sodium fluoride

O

O

Amine fluoride

Differences in fluoride uptake
While there have been numerous studies to compare anti-caries effects between the two most common sources of fluoride in dentifrices – NaF and MFP – there is some debate regarding their respective mechanisms of anti-caries action. Two recent GSK caries model studies demonstrate that NaF provides greater remineralization and increased fluoride uptake than MFP. The studies compared a) changes in surface microhardness and fluoride uptake using a 20-day in vitro caries cycling model and b) the remineralization potential and fluoride uptake of NaF and MFP dentifrices using an in situ caries model.

Different fluoride sources, pH and the choice of other ingredients in the formulation can affect fluoride delivery – and not all fluoride dentifrices are equally effective, even if they contain equivalent concentrations of fluoride.

‘Two recent GSK caries model studies demonstrate that NaF provides greater remineralization and increased fluoride uptake than MFP’

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Surface microhardness changes and fluoride uptake with naf and MfP in an in vitro caries cycling model
This study, published in Caries Research, was undertaken by Newby et al (2007) with the objectives of determining the relative efficacies of marketed dentifrices to: • promote enamel fluoride uptake • promote lesion remineralization • diminish subsequent demineralization under dynamic conditions simulating in vivo caries formation. The study compared MFP-containing dentifrices with different formulations of NaF-containing pastes, including Aquafresh Advanced (NaF in silica base A, 1100ppm fluoride) and an experimental GSK formulation (NaF in silica base B, 1100ppm fluoride). Artificial lesions were formed in human enamel specimens and subjected to a daily

cycling regimen. Surface microhardness was measured at baseline, 10 and 20 days. Fluoride uptake in the enamel specimens was measured at 20 days using the microdrill technique. After 20 days of treatment significantly greater surface microhardness was observed with Aquafresh Advanced than with both MFP pastes and the other NaF paste, as a result of improved remineralization and increased fluoride uptake (figure 1). This study by Newby demonstrates that dentifrices with similar available fluoride and the same fluoride source can be formulated to provide increased enamel hardness and fluoride uptake. This was demonstrated by the fact that Aquafresh Advanced (NaF in silica base A, 1100ppm fluoride) was associated with greater surface microhardness and fluoride uptake after 20 days of treatment (p<0.05) than the experimental Aquafresh variant (NaF in silica base B) (figure 1).

Figure 1: Results after 20 days of treatment [Newby, 2007] Surface hardness changes changes Surface hardness Surface hardness changes
80 80
Enamel Fluoride Uptake (µgF/cm3)

Enamel fluoride uptake fluoride uptake Enamel Enamel fluoride uptake
6000 6000 5000 5000 4000 4000 3000 3000 2000 2000 1000 1000 20 20
1 1

70 70
Vickers Hardness Number Vickers Hardness Number

60 60 50 50
1 1

40 40 30 30 20 20

FF FF MFdi MFch MFdi MFch B

Enamel Fluoride Uptake (µgF/cm3)

*

*

*

*

B A

A

FF FF MFdi MFch MFdi MFch B

B A

A

1. Aquafresh Cavity Protection. Data expressed as as 1. Aquafresh Cavity Protection. Data expressed mean mean ± s.e.mean n=18 ± s.e.mean n=18 All dentifrices tested contained a nominal 1100ppm F All dentifrices tested contained a nominal 1100ppm F * p<0.05 compared with all other other dentifrices tested * p<0.05 compared with all dentifrices tested

FF FF = Fluoride free free = Fluoride MFdi MFdi MFP dicalcium phosphate = = MFP dicalcium phosphate MFch MFch MFP calcium carbonate = = MFP calcium carbonate B B = Experimental NaF/silica B = Experimental NaF/silica B A A = Experimental NaF/silica A (Aquafresh Advanced) = Experimental NaF/silica A (Aquafresh Advanced)

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Remineralization potential and fluoride uptake from a naf dentifrice compared with an MfP dentifrice using an in situ caries model
In this randomised, controlled in situ clinical study by Zero et al, published in Caries Research (2007), the change in mineral content of partially demineralized enamel specimens was assessed using the surface microhardness test after 14 days of twice-daily brushing with test dentifrices (Aquafresh Advanced, which is NaF 1100ppm fluoride, silica base; and MFP 1100ppm fluoride, dicalcium phosphate base). Fluoride uptake was evaluated using the microdrill enamel biopsy technique.
Surface hardness recovery
60 % Surface Hardness Recovery % Surface Hardness Recovery 50 40 30 20 10 0 60 50

This study used two gauze-covered, partially demineralized human enamel blocks that were placed in subjects’ partial dentures. Subjects then brushed using the test dentifrices twice a day for 14 days. Changes in mineral content of enamel specimens were assessed using the surface microhardness test and fluoride uptake was assessed using the microdrill enamel biopsy technique. Results showed that surface hardness recovery and fluoride uptake were significantly greater (p<0.001) with Aquafresh Advanced than MFP after 14 days of treatment (figure 2).

Figure 2: Results after 14 days of treatment [Zero, 2007]
Surface hardness recovery recovery Surface hardness

Fluoride uptake
30 25 Fluoride Uptake (µgF/cm2) 30 25 Fluoride Uptake (µgF/cm2) 20 15 10 5 0

Fluoride uptake uptake Fluoride

*

*

40 30 20 10 0

20 15 10 5 0

*

*

Further reading
Bowen WH. The role of fluoride toothpastes in the prevention of dental caries. J Royal Soc Med 1995; 88: 505–507. ten Cate JM. Eur J Oral Sci 1997; 105: 461–465. Zero DT, et al. Comparison of Marketed NaF and MFP dentifrice products using and In Situ Caries Model. Caries Res 2007; 41: 268–334. Zero DT, Proskin HM, Buch RM, et al. 0502 Efficacy of Marketed Dentifrices Using an In situ Caries Model. Presented at the 85th General Session & Exhibition of the International Association for Dental Research (IADR), New Orleans, USA, 2007. Newby EE, et al. Caries Res 2007; 41: 328 (abs 173).

Fluoride Dose response Dose responseAquafresh Fluoride 1100ppm 1100ppm free control free control Advanced MFP MFP (0ppm MFP) (250ppm F, (0ppm MFP) (250ppm F, NaF silica base)NaF silica base)

Aquafresh Advanced

Fluoride Dose response Dose responseAquafresh Fluoride 1100ppm 1100ppm free control free control Advanced MFP MFP (0ppm MFP) (250ppm F, (0ppm MFP) (250ppm F, NaF silica base)NaF silica base)

Aquafresh Advanced

Data expressed asData expressed as least square n=39 ± s.e.mean n=39 least square mean ± s.e.mean mean * p<0.001 compared with 1100ppm MFP 1100ppm MFP * p<0.001 compared with

Conclusion
The studies by Newby and Zero, detailed above, demonstrate that Aquafresh Advanced provides greater remineralization and increased fluoride uptake compared to MFP toothpastes. Interestingly, it has also been demonstrated that different formulations of NaF, with similar available fluoride, can provide increased enamel hardness and fluoride uptake, illustrated by the fact that Aquafresh Advanced is superior to another NaF formulation (figure 1).

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