Toothpaste Technologies

A Short History of Toothpaste

500 BC Toothpowders used by ancient Greeks

400 AD Romans added astringents and other “therapeutics“ to the

abrasives ( chrushed bones ) - the start of "formulation„

1892 Dr W Sheffield – “Cream Dentrifice” in collapsible tube

1900-1950s Improvements in aesthetics were made including foaming,

flavouring and sweetening and replacement of toothpowders with

toothpastes

1955 P&G launched first mass market Fluoride toothpaste

1985 P&G launched the first mass market Tartar Control

toothpaste

1990s P&G, Colgate, Lever, SKB etc. launched anti-microbial,

Triclosan-containing toothpastes

Statement of FDI (International Dental Association) and WHO

 Widespread use of fluoride toothpaste*

 Preventive dental education

 Availability of regular dental visits

Main reasons for caries reduction in the

industrialized western countries:

* toothpaste consumption at proper dental hygiene:

12 tubes/person/year

in Hungary: ~ 2,4 tube/person/year

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Fluoride toothpaste is the most frequently used topical fluoride agent

Modified from the World Health Organization, 1994

Estimate of the numbers of people in the world using various types of fluoride

therapy.

CLINICAL

TOPICALS MOUTHRINSES DROPS/TABLETS SALT

FLUORIDATION

WATER FLUORIDATION FLUORIDATED

TOOTHPASTE

0 10

0

20

0

30

0

40

0

500 MILLION

S

20

20

20

40

210

450

Current understanding of fluoride action:

predominant caries inhibitory effect of

fluoride is the topical, posteruptive effect

inhibition of demineralization enhancement of remineralization fluoride incorporation into the enamel

J.M. ten Cate, J.B. Featherstone: Fluoride in Dentistry, Munksgaard, 1996

posteruptively important

during the tooth development (little effect)

Fluoride dentrifice should be used daily for

toothcleaning to control development and

progression of dental caries lesion

at all ages, but young children should be

supervised

enamel caries

root caries

50 % reduction 67 % reduction

European Academy of Pediatric Dentistry ( EADP) 2000

Age Fluoride

conc

(ppm)

Frequency of

brushing

daily

Amount of toothpaste

6 mont -2year

low F

toothpaste

max 500 ppm

1x small, film layer

2 – 6 year max. 500 2 x small pea size - or nail

Above 6 year 1000-1450 2 x 1/3 – 1/2 brush head

* Oulis, Raadal, OuMartens. Guidelines on the use of fluoride in children: an EAPD policy document.

European Journal of Pediatric Dentistry;1/2000: 7-12

Use of fluoride toothpaste

Recommendations*

Age group

Fluoride concentration (ppm)

Daily use Amount to be used

6 month-2years 500 ppm twice Pea- size

2 – 6 years 1000 (+) ppm twice Pea- size

6 years and overl 1000-1450 twice 1-2 cm

European Archives of PEDIATRIC DENTISTRY

Fluoride Symposium EAPD F guidelines

Volume 10 (Issue 3) Sept. 2009

Transformation of active - inactive lesion

effect of 3 month active oral hygiene

Textbook of Clinical Cariology

Thylstrup & Fejerskov

Munksgaard 1999

Toothpaste Technologies

Typical Toothpaste Composition

Humectants

34%

Water

34%

Actives

5%

Binder

1%

Surfactant

2%

Buffers

2%

Flavour

1% Colourants

1%

Abrasives

20%

Toothpaste Technologies

Acives

5%

Anti-cavity e.g. Fluoride salts

Tartar control e.g.

Pyrophosphate

Antimicrobial e.g. Triclosan,

CPC, Zinc salts, Stannous salts

Ingredients : Actives

Fluoride in Toothpaste – Mode of Action

Ca

P P

P

P P

P

P

P

Ca

Ca Ca

Ca

Ca

Ca

Ca Ca

Ca

Ca10(PO4)6(OH)2

Saliva

Free fluoride promotes

from dentifrice retention / formation

Role of Fluoride • Enhance the remineralization process

• Decrease enamel solubility

17

More free fluoride

Faster More

Enamel Fluoride uptake

Smaller initial lesions

Less clinical caries

NaF

Healthy tooth enamel before bacteria acid attack

Demineralized enamel- bacteria acid breaks tooth enamel down

Remineralized enamel- fluoride and minerals in saliva build tooth enamel up

F- F- F-

20

Fluoride Rebuilds Enamel Every Time You Brush

Fluorides

Nátriumfluorid Nátrium

monofluorofoszfát Ónfluorid Aminfluorid

Type of Fluoride Toothpaste

Sodium Fluoride (NaF) blend-a-med EXPERT Enamel Protection, blend-a-

med EXPERT Gums Protection, blend-a-med EXPERT

Sensitive, Oral-B Sensitive, Colgate Total, Sensodyne

F, Odol Med 3, Signal, Parodontax,

,

Sodium Monofluorophosphate

(SMFP) (Na 2 FPO

3 )

Aronal, several Colgate variants (Cavity Protection,

Sensitive)

Stannous Fluoride (SnF 2 ) blend-a-med EXPERT Gums Protection, Meridol,

Amine fluoride (AmF)

(primarily in Europe)

Elmex orange, Meridol

Aluminium Fluoride (AlF3) Lacalut Active

Are all Fluorides The Same?

NaF

Na 2 FPO

3

(SMFP)

SnF 2

AmF AlF 3

Stops de-mineralization

 







Enhances re-

mineralization











Mechanism

creates F-

apatite

creates F-

apatite

creates F-

apatite

creates F-

apatite

No data

Fluoride delivered directly or

chemically changed to release

F -

directly Hydrolysis

(enzyme

action)

directly Indirect

(complex

reaction)

directly

Anti-bacterial properties

none none 



none

Anti hypersensitivity

properties

none

none 

none none

Sodium Fluoride (NaF) - Results

NaF results in better cavity protection than SMFP 2

A v e r a g

e %

c a r i e s r e d

u c t i o

n v s p

l a c e b

o

0

10

20

30

40

50

NaF SMFP

2 Stookey,G. et al: A Critical Review of the Relative Anticaries Efficacy of Sodium Fluoride and

Sodium Monofluorophosphate Dentifrices. Caries Res 1993;27(4):337-60.

Nachnani J Dent Res 2008 87 (Spec Issue B) Abstract 2864

* p

Common agents used for plaque and gingivitis in global toothpaste

SF= Stannous Fluoride

CHX = Chlorhexidine

CPC = Cetylpyridinium chloride

SF T

T

SF T T CHX

CPC

T = Triclosan

T

Toothpaste Technologies

Abrasives

20%

Removes stain, increases

“solidity”

e.g. Silica, Alumina, Calcium

Carbonate etc. (not baking

soda)

Ingredients : Abrasives

Toothpaste Technologies

 Silica – Mechanism of Action

 Particles of silica move with bristles of toothbrush

 Particles penetrate the protein layer (pellicle) in which extrinsic stain is located

 Brushing action drags the silica particles across the enamel and remove the stained pellicle

 Abrasivness/Cleaning Effects depends on silica level

 (grittyness)

Toothpaste Technologies

 Enamel Safe Stain Removal

 Hand brush acrylic lenses with toothpaste for 2-4 minutes

 When held up to light scratching may be seen if toothpaste is

abrasive

Abrasive Whitening

toothpaste (alumina)

Complete 7

Toothpaste Technologies

 Active Ingre