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  • 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

    http://www.animationfactory.com/en/search/close-up.mc?&oid=4950294&s=1&sc=1&st=3&category_id=E1&q=toothpaste&spage=1&hoid=e9976adee24627d1ee0de25afe060801

  • 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