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Salivary fluoride concentration following toothbrushing with and without rinsing: a randomised controlled trial.Abstract
Background: Caries prevalence has declined significantly since the introduction of fluoridated toothpaste. There have been several developments regarding specific active fluoride ingredients but not enough evidence to support one over the other. The purpose of this double-blind randomized controlled trial was to compare salivary fluoride concentrations of different fluoride formulations in the form of toothpaste with and without post-brushing water rinsing in adults.
Methods: The study included 120 participants who were randomly assigned to one of 12 groups (10 participants/group). The toothpaste formulas investigated included (1) fluoride-free (0 ppmF); (2) sodium fluoride (1450 ppmF); (3) sodium monofluorophosphate (1450 ppmF); (4) sodium fluoride and monofluorophosphate combined (1450 ppmF); (5) stannous fluoride and sodium fluoride combined (1450 ppmF); and (6) amine fluoride (1400 ppmF). Block randomisation was used to assign each participant to one of the 12 groups. Participants brushed with 1.0 g of one of the six different toothpaste formulations either with or without post-brushing water rinsing. Saliva was collected at six different times (baseline and at 1, 15, 30, 60, and 90 min/s post-brushing). Samples were analysed using a fluoride ion-specific sensitive electrode connected to an ion analyser.
Results: The demographic characteristics of the participants were not significantly different among the groups (P > 0.05). Time, toothpaste formulation, and post-brushing rinsing routines had significant effects on saliva fluoride retention (P < 0.05). Amine fluoride-containing toothpaste was the only formula that showed statistically significantly higher concentrations of salivary fluoride at 90 min in both the rinsing and non-rinsing groups. Sodium monofluorophosphate toothpaste did not result in a significant difference compared to the control group at any time point, in both rinsing and non-rinsing groups.
Conclusions: Based on the results from this study, no rinsing after toothbrushing in adults can be recommended when sodium monofluorophosphate containing toothpaste formula is used. It also concludes that amine fluoride resulted in a significantly higher saliva fluoride concentration at 90 min in both the rinsing and non-rinsing groups compared to other fluoride toothpaste formulations. Registry: Protocol Registration and Results System (ClinicalTrials.gov).
Clinical trial registration number: NCT02740803 (15/04/2016).
*Original abstract online at https://bmcoralhealth.biomedcentral.com/articles/10.1186/s12903-022-02086-5
Excerpt:
References
-
Marinho VC, Higgins JP, Sheiham A, Logan S. Fluoride toothpastes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2003;(1):CD002278.
-
Marinho VCC. Cochrane reviews of randomized trials of fluoride therapies for preventing dental caries. Eur Arch Paediatr Dent. 2009;10(3):183–91.
-
Levine RS. What concentration of fluoride toothpaste should dental teams be recommending? Evid Based Dent. 2019;20(3):74–5.
-
Khan IM, Mani SA, Doss JG, Danaee M, Kong LYL. Pre-schoolers’ tooth brushing behaviour and association with their oral health: a cross sectional study. BMC Oral Health. 2021;21(1):283.
-
Twetman S, et al. Caries-preventive effect of fluoride toothpaste: a systematic review. Acta Odontol Scand. 2003;61(6):347–55.
-
Smaïl-Faugeron V, Fron-Chabouis H, Courson F. Methodological quality and implications for practice of systematic Cochrane reviews in pediatric oral health: a critical assessment. BMC Oral Health. 2014;14:35.
-
Walsh T, Worthington HV, Glenny AM, Marinho VC, Jeroncic A. Fluoride toothpastes of different concentrations for preventing dental caries. Cochrane Database Syst Rev. 2019;3(3): CD007868.
-
Beiswanger BB, Gish CW, Mallatt ME. A three-year study of the effect of a sodium fluoride-silica abrasive dentifrice on dental caries. Pharmacol Ther Dent. 1981;6(1–2):9–16.
-
Hirose M, et al. Fluoride retention in saliva following toothbrushing using different types of fluoridated dentifrices containing 1500 ppmF of NaF and MFP. Ped Dent J. 2015;25(2):45–9.
-
Creeth JE, et al. In situ efficacy of an experimental toothpaste on enamel rehardening and prevention of demineralisation: a randomised, controlled trial. BMC Oral Health. 2020;20(1):118.
-
Attin T, Hellwig E. Salivary fluoride content after toothbrushing with a sodium fluoride and an amine fluoride dentifrice followed by different mouthrinsing procedures. J Clin Dent. 1996;7(1):6–8.
-
Campus G, Lallai MR, Carboni R. Fluoride concentration in saliva after use of oral hygiene products. Caries Res. 2003;37(1):66–70.
-
Issa AI, Toumba KJ. Oral fluoride retention in saliva following toothbrushing with child and adult dentifrices with and without water rinsing. Caries Res. 2004;38(1):15–9.
-
Arnold WH, Dorow A, Langenhorst S, Gintner Z, Bánóczy J, Gaengler P. Effect of fluoride toothpastes on enamel demineralization. BMC Oral Health. 2006;6:8.
-
Chestnutt IG, Schafer F, Jacobson AP, Stephen KW. The influence of toothbrushing frequency and post-brushing rinsing on caries experience in a caries clinical trial. Community Dent Oral Epidemiol. 1998;26(6):406–11.
-
Nazzal H, Duggal MS, Kowash MB, Kang J, Toumba KJ. Comparison of residual salivary fluoride retention using amine fluoride toothpastes in caries-free and caries-prone children. Eur Arch Paediatr Dent. 2016;17(3):165–9.
-
Duckworth RM, Morgan SN. Oral fluoride retention after use of fluoride dentifrices. Caries Res. 1991;25(2):123–9.
-
Scottish Intercollegiate Guidelines Network. 2014. Dental Interventions to Prevent Caries in Children: A national clinical guideline. [SIGN 138]. [Online] Edinburgh: Scottish Intercollegiate Guidelines Network. https://www.scottishdental.org/wp-content/uploads/2014/04/SIGN138.pdf. Accessed 12 Oct 2021.
-
Twetman S. Caries prevention with fluoride toothpaste in children: an update. Eur Arch Paediatr Dent. 2009;10(3):162–7.
-
Reich E. How to measure the effects of fluoride treatments in clinical trials? The role of caries prevalence and caries assessment. Caries Res. 2001;35(Suppl 1):34–9.
-
Twetman S. Prevention of dental caries as a non-communicable disease. Eur J Oral Sci. 2018;126(Suppl 1):19–25.
-
Parnell C, O’Mullane D. After-brush rinsing protocols, frequency of toothpaste use: fluoride and other active ingredients. Monogr Oral Sci. 2013;23:140–53.
-
Ekstrand KR. High fluoride dentifrices for elderly and vulnerable adults: does it work and if so, then why? Caries Res. 2016;50(Suppl 1):15–21.
-
Naumova EA, et al. Fluoride bioavailability in saliva and plaque. BMC Oral Health. 2012;12:3.
-
Tenuta LMA, Cury JA. Laboratory and human studies to estimate anticaries efficacy of fluoride toothpastes. Monogr Oral Sci. 2013;23:108–24.
-
Toumba KJ, et al. Guidelines on the use of fluoride for caries prevention in children: an updated EAPD policy document. Eur Arch Paediatr Dent. 2019;20(6):507–16.
-
Mystikos C, Yoshino T, Ramberg P, Birkhed D. Effect of post-brushing mouthrinse solutions on salivary fluoride retention. Swed Dent J. 2011;35(1):17–24.
-
Creeth J, Zero D, Mau M, Bosma ML, Butler A. The effect of dentifrice quantity and toothbrushing behaviour on oral delivery and retention of fluoride in vivo. Int Dent J. 2013;63(Suppl 2):14–24.
-
Bruun C, Givskov H, Thylstrup A. Whole saliva fluoride after toothbrushing with NaF and MFP dentifrices with different F concentrations. Caries Res. 1984;18(3):282–8.
-
Priyadarshini Sh, Raghu R, Shetty A, Gautham P, Reddy S, Srinivasan R. Effect of organic versus inorganic fluoride on enamel microhardness: an in vitro study. J Conserv Dent. 2013;16(3):203–7.
-
Sensabaugh C, Sagel ME. Stannous fluoride dentifrice with sodium hexametaphosphate: review of laboratory, clinical and practice-based data. J Dent Hyg. 2009;83(2):70–8.
-
ten Cate JM, Featherstone JD. Mechanistic aspects of the interactions between fluoride and dental enamel. Crit Rev Oral Biol Med. 1991;2(3):283–96.
-
Toumba KJ, Curzon ME. A clinical trial of a slow-releasing fluoride device in children. Caries Res. 2005;39(3):195–200.
Acknowledgements
The authors thank Mrs. G. Dukanovic for her outstanding assistance during all clinical sessions. We also appreciate all the participants in the current study. This study was conducted as part of M.M.A.’s Professional Doctorate of Paediatric Dentistry (DPaedDent) degree dissertation project at the University of Leeds.
Funding
None.