The maintenance of adequate fluoride (F) concentration in the public water supply is fundamental for ensuring that the community use of F can reach the maximum benefit for caries control and minimum risk for dental fluorosis. Thus, surveillance systems must use accurate and valid analytical methods to determine F concentration and, according to the literature, give preference to the ion-specific electrode (F- ISE) analysis. Aim The objective of this study was to compare the accuracy of the ISE and SPADNS methods in the determination of the F concentration in the same water sample. Methods Duplicate water samples were taken from 30 sampling sites in the municipality of Maringá, state of Paraná, monthly for 12 months, totaling 276 samples. An aliquot was analyzed by the FOP-UNICAMP Oral Biochemistry laboratory, using the F- ISE method, and the other one, by the SANEPAR laboratory in Maringá/PR, using the SPADNS method. Descriptive analysis and Pearson’s correlation test were applied, with a significant level of p<0.05. Results Results were expressed as ppm F (mg F/L), and a very strong positive correlation (r= 0.91; p<0.001) was detected between the two methods of analysis. Conclusion Our findings suggest that the determination of fluoride concentration in water can be made with accuracy by the SPADNS method, a standardized analysis protocol. (F fluorosis Thus literature ionspecific ion specific sample 3 Maringá Paraná 1 months 27 FOPUNICAMP FOP UNICAMP method one MaringáPR PR Maringá/PR Pearsons Pearson s applied p005 p 0 05 p<0.05 mg F/L, FL F/L , L F/L) r= r (r 0.91 091 91 p<0.001 p0001 001 protocol 2 p00 p<0.0 0.9 09 9 p<0.00 p000 00 p0 p<0. 0. p<0 p<

Resumo A espuma tem sido utilizada mundialmente como veículo para aplicação profissional de fluoreto e hipoteticamente deveria ter o mesmo potencial anticárie que o gel fluoretado convencional (F-gel) em termos de formação de produtos de reação com o esmalte. Assim, a capacidade da espuma Flúor Care® (FGM, Joinville, SC, Brasil, 12.300 ppm F, acidulada) de reagir com o esmalte foi avaliada em comparação com o Flúor gel® (DFL, Rio de Janeiro, RJ, Brasil 12.300 ppm F, acidulado). Foram utilizados blocos (n=10/grupo) de esmalte hígido e com lesão de cárie, nos quais foram determinadas as concentrações de flúor total (FT), e os tipos de flúor fracamente (tipo-CaF2) e firmemente (FAp) ligados ao esmalte. A importância da agitação durante a aplicação foi previamente testada. As determinações foram feitas com eletrodo íon específico para fluoreto e os resultados foram expressos em μg F/cm² da área tratada do esmalte. A diferença entre os tratamentos foi analisada por ANOVA e Tukey (α=5%), independentemente para esmalte hígido e cariado. A agitação dos produtos durante a aplicação aumentou significativamente a reatividade da espuma (p<0,05), mas não a do gel (p>0,05). A espuma não diferiu do F-gel (p>0,05) quanto à formação de FT e tipo-CaF2 no esmalte hígido ou cariado. Em relação à FAp, a espuma não diferiu do F-gel (p>0,05) no esmalte cariado, mas a concentração no hígido foi menor (p<0,05). Os resultados mostram que esta espuma fluoretada comercial testada precisa ser agitada durante a aplicação para melhorar sua reatividade com o esmalte, o que levanta questão sobre outras marcas. Fgel F (F-gel Assim Care FGM, FGM (FGM Joinville SC 12300 12 300 12.30 acidulada DFL, DFL (DFL Janeiro RJ acidulado. acidulado . acidulado) n=10/grupo n10grupo ngrupo n 10 grupo (n=10/grupo cárie FT, , (FT) tipoCaF2 tipoCaF tipo CaF2 CaF (tipo-CaF2 FAp (FAp Fcm² Fcm cm² cm F/cm α=5%, α5 α α=5% 5 (α=5%) cariado p<0,05, p005 p p<0,05 0 05 (p<0,05) p>0,05. p>0,05 (p>0,05 tipo-CaF p<0,05. marcas 1230 1 30 12.3 (FT (tipo-CaF α=5 (α=5% p00 p<0,0 (p<0,05 p>0,0 (p>0,0 123 3 12. α= (α=5 p0 p<0, (p<0,0 p>0, (p>0, (α= p<0 (p<0, p>0 (p>0 (α p< (p<0 p> (p> (p< (p

Abstract Foam has been used worldwide as a vehicle for the professional application of fluoride and hypothetically should have the same anticaries potential as conventional fluoride gel (F-gel) in terms of the formation of reaction products with enamel. Thus, the ability of Flúor Care® foam (FGM, Joinville, SC, Brazil, 12,300 ppm F, acidulated) to react with enamel was evaluated in comparison with Flúor gel® (DFL, Rio de Janeiro, RJ, Brazil, 12,300 ppm F, acidulated). Slabs (n=10/group) of sound enamel and with caries lesion were used, in which the concentrations of total fluoride (TF), and loosely (CaF2-like) and firmly (FAp) bound types were determined. The importance of agitation during application was previously tested. The determinations were made with fluoride ion-specific electrode and the results were expressed in μg F/cm² of the treated enamel area. ANOVA and Tukey tests were used to analyze the difference among treatments, independently for sound and carious enamel. The agitation of the products during application significantly increased the reactivity of the foam (p<0.05), but not that of the gel (p>0.05). The foam did not differ from F-gel (p>0.05) concerning the formation of TF and CaF2-like in sound or carious enamel. Regarding FAp, the foam did not differ from F-gel (p>0.05) in the carious enamel, but the concentration in the sound was lower (p<0.05). The results show that this commercial fluoride foam tested needs to be agitated during application to improve its reactivity with enamel, which raises a question about other brands. Fgel F (F-gel Thus Care FGM, FGM (FGM Joinville SC Brazil 12300 12 300 12,30 acidulated DFL, DFL (DFL Janeiro RJ acidulated. . n=10/group n10group ngroup n 10 group (n=10/group TF, , (TF) CaF2like CaFlike CaF2 like CaF (CaF2-like FAp (FAp determined ionspecific ion specific Fcm² Fcm cm² cm F/cm area treatments p<0.05, p005 p p<0.05 0 05 (p<0.05) p>0.05. p>0.05 (p>0.05 p<0.05. brands 1230 1 30 12,3 (TF p00 p<0.0 (p<0.05 p>0.0 (p>0.0 123 3 12, p0 p<0. (p<0.0 p>0. (p>0. p<0 (p<0. p>0 (p>0 p< (p<0 p> (p> (p< (p

Aim This study aimed to evaluate if there is a dose-response relationship between toothpaste chemically soluble fluoride absorbed in the gastrointestinal tract and fluoride secreted by saliva, giving support to the use of saliva as surrogate for plasma fluoride. Methods A 4-phase single blind study was conducted, in which 10 participants were subjected in each phase to one of the assigned treatment groups: group I: fresh sample of a Na2FPO3/CaCO3-based toothpaste with 1,334 μg F/g of total soluble fluoride (TSF) and groups II–IV: aged samples of this toothpaste presenting TSF concentrations of 1,128, 808, and 687 μg F/g, respectively. In all phases, the participants ingested an amount of toothpaste equivalent to 70.0 μg F/Kg body weight, as total fluoride (TF). Saliva and blood samples were collected before (baseline) and up to 180 min after toothpaste ingestion as indicator of fluoride bioavailability. F concentration in saliva and blood plasma was determined with a fluoride ion-specific electrode. The areas under the curve (AUC) of F concentration versus time (AUC = ng F/mL × min) and the peaks of fluoride concentration (Cmax) in saliva and plasma were calculated. Results A significant correlation between mg of TSF ingested and the AUC (r=0.47; p<0.01), and Cmax (r=0.59; p<0.01) in saliva was found; for TF, the correlation was not significant (p>0.05). In addition, the correlations between plasma and saliva fluoride concentrations were statistically significant for AUC (r=0.55; p<0.01) as for Cmax (r=0.68; p<0.01). Conclusion The findings support that saliva can be used as a systemic biomarker of bioavailable fluoride present in Na2FPO3/CaCO3-based toothpaste. doseresponse dose response 4phase 4 conducted 1 I Na2FPO3/CaCO3based Na2FPO3CaCO3based NaFPOCaCObased Na2FPO3/CaCO3 based Na2FPO3 CaCO3 Na FPO CaCO 1334 334 1,33 Fg g (TSF II–IV IIIV II IV 1128 128 1,128 808 68 respectively phases 700 70 0 70. FKg Kg weight TF. TF . (TF) baseline (baseline 18 bioavailability ionspecific ion specific electrode FmL mL (Cmax calculated r=0.47 r047 r 47 (r=0.47 p<0.01, p001 p p<0.01 , 01 r=0.59 r059 59 (r=0.59 found p>0.05. p005 p>0.05 05 (p>0.05) addition r=0.55 r055 55 (r=0.55 r=0.68 r068 (r=0.68 p<0.01. CaCO3based Na2FPO3CaCO3 NaFPOCaCO Na2FPO3/CaCO NaFPO Na2FPO 133 33 1,3 112 12 1,12 80 6 7 (TF r=0.4 r04 (r=0.4 p00 p<0.0 r=0.5 r05 5 (r=0.5 p>0.0 (p>0.05 r=0.6 r06 (r=0.6 CaCObased Na2FPO3CaCO 13 3 1, 11 1,1 8 r=0. r0 (r=0. p0 p<0. p>0. (p>0.0 r=0 (r=0 p<0 p>0 (p>0. r= (r= p< p> (p>0 (r (p> (p

RESUMO OBJETIVO Determinar o potencial anticárie dos dentifrícios distribuídos pelas unidades básicas de saúde (UBS) de Manaus-AM. MÉTODOS Noventa e nove bisnagas de dentifrícios de quatro marcas comerciais foram coletadas de 7 de outubro de 2019 a 11 de outubro de 2019 em 16 UBS, que foram codificados por marca e UBS de origem. De acordo com a embalagem, os dentifrícios das quatro marcas e seus lotes foram formulados com monofluorofosfato de sódio (Na2FPO3) e a maioria (91%) tinha carbonato de cálcio (CaCO3) como abrasivo. Foram determinadas as concentrações de fluoreto total (FT = FST + Fins) e de fluoreto solúvel total (FST = íons F- ou FPO32-), para certificar se atendiam à resolução ANVISA RDC Nº 530 (máximo de 1.500 ppm de FT) e se tinham potencial anticárie (mínimo de 1.000 ppm de FST). As análises foram feitas com eletrodo íon específico. RESULTADOS As concentrações (ppm F) de FT [média; desvio padrão (DP); n] encontradas nos dentifrícios A (1.502,3; DP = 45,6; n = 33), B (1.135,5; DP = 52,7; n = 48) e D (936,8; DP = 20,5; n = 8) foram próximas ao descrito na embalagem, 1.500, 1.100 e 1.000 ppm F, respectivamente. No dentifrício C, foi encontrada média de 274,1 ppm (DP = 219,7; n = 10) de FT, divergindo da concentração declarada de 1.500 ppm F. Em acréscimo, as cinco bisnagas do lote no 11681118 do dentifrício C não foram fluoretadas. Quanto ao FST, à exceção do dentifrício D (937,9; DP = 40,29), os demais apresentaram concentração inferior ao seu respectivo FT. CONCLUSÃO Observou-se problemas graves de quantidade e qualidade do fluoreto nos dentifrícios distribuídos pelo SUS em Manaus, mostrando a necessidade de vigilância desses produtos e ratificando a urgência da revisão da resolução ANVISA RDC Nº 530.

ABSTRACT OBJECTIVE To determine the anticaries potential of toothpastes distributed by the primary health care public clinics (UBS) of Manaus, AM. METHODS Ninety-nine tubes of toothpaste from four commercial brands were collected from October 7, 2019 to October 11, 2019 in 16 UBS. They were assigned a code by brand and source UBS. According to the information on the packaging, the four brands and their batches were formulated with sodium monofluorophosphate (Na2FPO3) and most (91%) had calcium carbonate (CaCO3) as an abrasive. We determined the concentrations of total fluoride (TF = TSF + InsF) and total soluble fluoride (TSF = F ions- or FPO32-), to certify whether they were in compliance with resolution ANVISA RDC No. 530 (maximum of 1,500 ppm TF) and whether they had anticaries potential (minimum of 1,000 ppm TSF). The analyses were performed with a ion- specific electrode. RESULTS The concentrations (ppm F) of TF [mean; standard deviation (SD); n] found in toothpaste brands A (1,502.3; SD = 45.6; n = 33), B (1,135.5; SD = 52.7; n = 48) and D (936.8; SD = 20.5; N = 8) were close to those stated on the package, 1,500, 1,100 and 1,000 ppm F, respectively. In toothpaste C, we found a mean of 274.1 ppm (SD = 219.7; n = 10) of TF, which diverges from the declared concentration of 1,500 ppm F. In addition, the five tubes of lot no. 11681118 of toothpaste C did not contain fluoride. Regarding TSF, with the exception of toothpaste D (937.9; SD = 40.29), the others had a lower concentration than their respective TF. CONCLUSION We found serious problems of quantity and quality of fluoride in toothpaste distributed by the SUS in Manaus, which shows the need for surveillance of these products and confirms the urgency of revising resolution RDC No. 530.

RESUMO OBJETIVO Determinar o potencial anticárie dos dentifrícios distribuídos pelas unidades básicas de saúde (UBS) de Manaus-AM. MÉTODOS Noventa e nove bisnagas de dentifrícios de quatro marcas comerciais foram coletadas de 7 de outubro de 2019 a 11 de outubro de 2019 em 16 UBS, que foram codificados por marca e UBS de origem. De acordo com a embalagem, os dentifrícios das quatro marcas e seus lotes foram formulados com monofluorofosfato de sódio (Na2FPO3) e a maioria (91%) tinha carbonato de cálcio (CaCO3) como abrasivo. Foram determinadas as concentrações de fluoreto total (FT = FST + Fins) e de fluoreto solúvel total (FST = íons F- ou FPO32-), para certificar se atendiam à resolução ANVISA RDC Nº 530 (máximo de 1.500 ppm de FT) e se tinham potencial anticárie (mínimo de 1.000 ppm de FST). As análises foram feitas com eletrodo íon específico. RESULTADOS As concentrações (ppm F) de FT [média; desvio padrão (DP); n] encontradas nos dentifrícios A (1.502,3; DP = 45,6; n = 33), B (1.135,5; DP = 52,7; n = 48) e D (936,8; DP = 20,5; n = 8) foram próximas ao descrito na embalagem, 1.500, 1.100 e 1.000 ppm F, respectivamente. No dentifrício C, foi encontrada média de 274,1 ppm (DP = 219,7; n = 10) de FT, divergindo da concentração declarada de 1.500 ppm F. Em acréscimo, as cinco bisnagas do lote no 11681118 do dentifrício C não foram fluoretadas. Quanto ao FST, à exceção do dentifrício D (937,9; DP = 40,29), os demais apresentaram concentração inferior ao seu respectivo FT. CONCLUSÃO Observou-se problemas graves de quantidade e qualidade do fluoreto nos dentifrícios distribuídos pelo SUS em Manaus, mostrando a necessidade de vigilância desses produtos e ratificando a urgência da revisão da resolução ANVISA RDC Nº 530.

ABSTRACT OBJECTIVE To determine the anticaries potential of toothpastes distributed by the primary health care public clinics (UBS) of Manaus, AM. METHODS Ninety-nine tubes of toothpaste from four commercial brands were collected from October 7, 2019 to October 11, 2019 in 16 UBS. They were assigned a code by brand and source UBS. According to the information on the packaging, the four brands and their batches were formulated with sodium monofluorophosphate (Na2FPO3) and most (91%) had calcium carbonate (CaCO3) as an abrasive. We determined the concentrations of total fluoride (TF = TSF + InsF) and total soluble fluoride (TSF = F ions- or FPO32-), to certify whether they were in compliance with resolution ANVISA RDC No. 530 (maximum of 1,500 ppm TF) and whether they had anticaries potential (minimum of 1,000 ppm TSF). The analyses were performed with a ion- specific electrode. RESULTS The concentrations (ppm F) of TF [mean; standard deviation (SD); n] found in toothpaste brands A (1,502.3; SD = 45.6; n = 33), B (1,135.5; SD = 52.7; n = 48) and D (936.8; SD = 20.5; N = 8) were close to those stated on the package, 1,500, 1,100 and 1,000 ppm F, respectively. In toothpaste C, we found a mean of 274.1 ppm (SD = 219.7; n = 10) of TF, which diverges from the declared concentration of 1,500 ppm F. In addition, the five tubes of lot no. 11681118 of toothpaste C did not contain fluoride. Regarding TSF, with the exception of toothpaste D (937.9; SD = 40.29), the others had a lower concentration than their respective TF. CONCLUSION We found serious problems of quantity and quality of fluoride in toothpaste distributed by the SUS in Manaus, which shows the need for surveillance of these products and confirms the urgency of revising resolution RDC No. 530.

Resumo Os enxaguatórios bucais comerciais fluoretados diferem na concentração e tipo de sal de fluoreto, no pH e têm alguns ingredientes que podem interferir na reatividade do fluoreto com o esmalte desmineralizado. A capacidade de enxaguatórios bucais comerciais de formar produtos de reação em esmalte desmineralizado (teste de biodisponibilidade) foi avaliada in vitro. Nove enxaguatórios bucais adquiridos no Chile foram avaliados, oito formulados com NaF (um contendo 100 µg F/mL e sete contendo 226) e um com Na2FPO3 (226 µg F/mL como íon F). Os blocos de esmalte desmineralizados (n=15 por grupo) foram seccionados, uma metade foi submetida ao tratamento com o enxaguatório designado por 10 min e a outra metade foi usada para dados baseline. Fluoreto fracamente e firmemente ligados formados no esmalte foram determinados com um eletrodo íon-específico e os valores foram expressos em µg F /cm2. A concentração de fluoreto e o pH dos enxaguatórios foi previamente determinada. As concentrações de fluoreto tipo fluoreto fracamente ligado e fortemente ligado formadas no esmalte foram analisadas independentemente por ANOVA e teste de Tukey (α=5%). As concentrações de fluoreto fracamente ligado e fortemente ligado formados variaram de 3,2 a 36,2 e 0,4 a 1,7, respectivamente. O fluoreto fracamente ligado formado no esmalte foi significativamente mais eficaz para discriminar o efeito dos diferentes enxaguatórios bucais comerciais do que o fluoreto firmemente ligado. Enxaguatórios bucais com 226 ppm F na forma de NaF e baixo pH apresentaram significativamente maior biodisponibilidade de fluoreto no esmalte do que aqueles com maior pH ou menor concentração de NaF. O enxaguatório com Na2FPO3 apresentou reatividade muito baixa. Embora mais estudos sejam necessários, os resultados mostraram que os enxaguatórios bucais comerciais contendo fluoreto apresentam variações importantes na biodisponibilidade do fluoreto, o que poderia resultar em diferenças na eficácia anticárie.

Abstract The ability of mouth rinses, available in the international market, to form reaction products on demineralized enamel (bioavailability test) was evaluated in vitro. Nine mouth rinses purchased in Chile were evaluated; eight formulated with NaF (one containing 100 µg F/mL and seven containing 226) and one with Na2FPO3 (226 µg F/mL as ion F). Demineralized enamel slabs (n=15 per mouth rinse) were sectioned; one half was subjected to the assigned mouth rinse treatment for 10 min and the other half was used to obtain baseline data. Loosely bound and firmly bound fluoride formed on enamel were determined with an ion-specific electrode and the values were expressed in µg F/cm2. The concentration of fluoride and the pH of the mouth rinses were previously determined. Concentrations of loosely bound and firmly bound fluoride formed on enamel were independently analyzed by ANOVA and Tukey’s test (α=5%). The loosely bound and firmly bound fluoride concentrations (µg F/cm2) formed ranged from 3.2 to 36.2 and 0.4 to 1.7, respectively. Loosely bound fluoride formed on enamel was significantly more effective in discriminating the effect of different commercial mouth rinses than firmly bound fluoride. Mouth rinses with 226 ppm F as NaF and low pH presented significantly greater bioavailability of fluoride on enamel than those with higher pH or lower NaF concentration. The mouth rinse with Na2FPO3 showed low reactivity. Although further studies are necessary, the findings showed that commercial fluoride-containing mouth rinses have important variations in enamel fluoride bioavailability, which may result in differences on anticaries efficacy.

Resumo Este estudo transversal avaliou a prevalência e severidade de cárie dentária e fluorose em crianças de 5 anos e adolescentes de 12 anos usuários de dentifrício fluoretado, em áreas com e sem água fluoretada. Os responsáveis pelas crianças e adolescentes responderam questionários para determinação de características socioeconômicas e demográficas e hábitos relacionados à saúde. Os indivíduos foram examinados e a cárie e a fluorose foram mensuradas pelos índices ceo-d / CPOD e TF, respectivamente. Foram realizadas análises descritivas, bivariadas e de regressão logística (p <0,05). Dos 692 participantes, 47,7% tinham 5 anos e 52,3% tinham 12 anos. A média de ceod / CPOD em crianças de 5/12 anos dos grupos de exposto e não exposto à água fluoretada foi 1,53 (± 2,47) e 3,54 (± 4,10) / 1,53 (± 1,81) e 3,54 (± 3,82), respectivamente. Crianças (OR = 2,86, IC 95% = 1,71-4,75) e adolescentes (OR = 1,95, IC 95% = 1,24-3,05) que não consumiram água fluoretada tiveram maior experiência de cárie. Entre os adolescentes, houve associação entre a água fluoretada e a prevalência de fluorose muito leve / leve (OR = 5,45, IC 95%: 3,23-9,19) e fluorose moderada (OR = 11,11, IC 95% = 4,43-27,87). Crianças e adolescentes que consumiram água fluoretada apresentaram menor prevalência e severidade de cárie dentária em comparação com aqueles que usaram apenas dentifrício fluoretado como fonte de flúor. Houve uma associação entre a fluoretação da água e fluorose muito leve / leve e moderada em adolescentes.

Abstract This cross-sectional study evaluated the prevalence and severity of dental caries and fluorosis in children and adolescents using fluoridated toothpaste, from areas with and without fluoridated water. Parents of 5-year-old children and 12-year-old adolescents from neighbourhoods that are supplied with and without fluoridated water answered questionnaires for determining socio-economic and demographic characteristics and habits related to oral health. The individuals were examined, and dental caries and fluorosis were measured by dmft/DMFT and TF indexes, respectively. Descriptive, bivariate and logistic regression analyses were performed (p < 0.05). Of 692 participants, 47.7% were 5-year-olds and 52.3% were 12-year-olds. The mean dmft/DMFT in the 5-year-olds/ 12-year-olds from Exposed and Not Exposed fluoridated water groups was 1.53 (± 2.47) and 3.54 (± 4.10) / 1.53 (± 1.81) and 3.54 (± 3.82), respectively. Children (OR = 2.86, 95% CI = 1.71-4.75) and adolescents (OR = 1.95, 95% CI = 1.24-3.05), who did not consume fluoridated water, had greater caries experience. Among adolescents, there was an association between fluoridated water and the prevalence of very mild/mild fluorosis (OR = 5.45, 95% CI: 3.23-9.19) and moderate fluorosis (OR = 11.11, 95% CI = 4.43-27.87). Children and adolescents, who consumed fluoridated water, presented lower prevalence and severity of dental caries compared to those who used only fluoridated toothpaste as the source of fluoride. There is an association between water fluoridation and very mild/mild and moderate fluorosis in adolescents.

Resumo Os enxaguatórios bucais comerciais fluoretados diferem na concentração e tipo de sal de fluoreto, no pH e têm alguns ingredientes que podem interferir na reatividade do fluoreto com o esmalte desmineralizado. A capacidade de enxaguatórios bucais comerciais de formar produtos de reação em esmalte desmineralizado (teste de biodisponibilidade) foi avaliada in vitro. Nove enxaguatórios bucais adquiridos no Chile foram avaliados, oito formulados com NaF (um contendo 100 µg F/mL e sete contendo 226) e um com Na2FPO3 (226 µg F/mL como íon F). Os blocos de esmalte desmineralizados (n=15 por grupo) foram seccionados, uma metade foi submetida ao tratamento com o enxaguatório designado por 10 min e a outra metade foi usada para dados baseline. Fluoreto fracamente e firmemente ligados formados no esmalte foram determinados com um eletrodo íonespecífico e os valores foram expressos em µg F /cm2. A concentração de fluoreto e o pH dos enxaguatórios foi previamente determinada. As concentrações de fluoreto tipo fluoreto fracamente ligado e fortemente ligado formadas no esmalte foram analisadas independentemente por ANOVA e teste de Tukey (α=5%). As concentrações de fluoreto fracamente ligado e fortemente ligado formados variaram de 3,2 a 36,2 e 0,4 a 1,7, respectivamente. O fluoreto fracamente ligado formado no esmalte foi significativamente mais eficaz para discriminar o efeito dos diferentes enxaguatórios bucais comerciais do que o fluoreto firmemente ligado. Enxaguatórios bucais com 226 ppm F na forma de NaF e baixo pH apresentaram significativamente maior biodisponibilidade de fluoreto no esmalte do que aqueles com maior pH ou menor concentração de NaF. O enxaguatório com Na2FPO3 apresentou reatividade muito baixa. Embora mais estudos sejam necessários, os resultados mostraram que os enxaguatórios bucais comerciais contendo fluoreto apresentam variações importantes na biodisponibilidade do fluoreto, o que poderia resultar em diferenças na eficácia anticárie

Abstract The ability of mouthrinses, available in the international market, to form reaction products on demineralized enamel (bioavailability test) was evaluated in vitro. Nine mouthrinses purchased in Chile were evaluated; eight formulated with NaF (one containing 100 µg F/mL and seven containing 226) and one with Na2FPO3 (226 µg F/mL as ion FPO3 ). Demineralized enamel slabs (n=15 per mouthrinse) were sectioned; one half was subjected to the assigned mouthrinse treatment for 10 min and the other half was used to obtain baseline data. Loosely bound and firmly bound fluoride formed on enamel were determined with an ion-specific electrode and the values were expressed in µg F/cm2. The concentration of fluoride and the pH of the mouthrinses were previously determined. Concentrations of loosely bound and firmly bound fluoride formed on enamel were independently analyzed by ANOVA and Tukey’s test (α=5%). The loosely bound and firmly bound fluoride concentrations formed ranged from 3.2 to 36.2 and 0.4 to 1.7, respectively. Loosely bound fluoride formed on enamel was significantly more effective in discriminating the effect of different commercial mouthrinses than firmly bound fluoride. Mouthrinses with 226 ppm F as NaF and low pH presented significantly greater bioavailability of fluoride on enamel than those with higher pH or lower NaF concentration. The mouthrinse with Na2FPO3 showed low reactivity. Although further studies are necessary, the findings showed that commercial fluoride-containing mouthrinses have important variations in enamel fluoride bioavailability, which may result in differences on anticaries efficacy.

Abstract For fluoride to be effective in controlling caries, it should be bioavailable in commercial products, so that it can be released into the mouth in the products it contains. We chemically determined the available fluoride and pH in nine mouth rinses marketed in Chile, and eleven, in Brazil, and then discussed the legislation in force in both countries, regarding the anticaries potential of these oral hygiene products. The fluoride was analyzed with an ion-selective electrode (F-ISE), using the direct technique. The determinations were made in duplicate, and the results were expressed in ppm F (μg F/mL). The total fluoride concentration found in all the mouth rinses evaluated ranged from 94.7 to 233.5 ppm F, and closely matched what was declared by the manufacturers (100.0 to 226.2 ppm F). However, some mouth rinses showed lower fluoride concentrations (90 and 180 ppm F) in both countries. A Na2FPO3-formulated mouth rinse was found only in Chile, with 216.8 ppm F as the FPO32- ion, and 4.9 ppm F as the F-. The findings show that fluoride was potentially bioavailable in all the mouth rinses evaluated. Regarding the national legislations, although the mouthwashes sold in Brazil comply with the Brazilian legislation, discrepancies were found for Chile. However, neither country had a legislation matching the best available evidence on fluoride mouthwash efficacy for caries control. Thus, some products with low fluoride concentrations (below 226 ppm F), or manufactured with a fluoride salt other than NaF (Na2FPO3) are being sold in the Brazilian and Chilean markets.

Resumo O objetivo deste estudo in vitro foi determinar a concentração de fluoreto nos produtos de diamino fluoreto de prata (DFP) e sua biodisponibilidade com dentina desmineralizada. Os produtos avaliados (concentrações esperadas de flúor) foram: I: Saforide 38% (45.283 ppm F); II: Advantage Arrest 38,3 a 43,2% (45.283 a 51.013 ppm F); III: Ancárie 12% (14.100 ppm F); IV: Ancárie 30% (35.400 ppm F), V: Cariestop 12% (14.100 ppm F) e VI: Cariestop 30% (35.400 ppm F). A concentração de fluoreto foi avaliada utilizando um eletrodo íon-específico (EIE) por técnica direta, que foi confirmada após microdifusão. O pH dos produtos foi determinado com uma tira de teste de pH. Para o teste de biodisponibilidade, blocos de dentina desmineralizada foram tratados com um dos produtos por 1 min. Fluoreto fracamente (tipo CaF2) e firmemente ligado (FAp) foram determinados. A concentração de fluoreto encontrada nos produtos (média±DP; ppm F) pela técnica direta com EIE foi: I: 53.491±554; II: 57.249±1.851; III: 4.814±268; IV: 5.726±43; V: 10.145±468; VI: 11.858±575; esses valores foram confirmados após microdifusão (teste t; p>0,05) e discordam dos declarados pelos fabricantes. O pH do Ancárie 12 e 30% foi de 6,0 e 4,5, respectivamente, em desacordo com o pH alcalino esperado para a solução de DFP e encontrado nos demais produtos avaliados. Não houve correlação entre CaF2 (r=0,221; p=0,337) ou FAp (r=-0,144; p=0,830) formados na dentina desmineralizada e concentração de fluoreto encontrada nos produtos. Os problemas de pH e concentração de fluoreto encontrados nos produtos comerciais profissionais disponíveis de DFP sugerem que eles não estão sob vigilância sanitária.

Abstract The aim of this in vitro study was to determine the fluoride concentration in silver diamine fluoride (SDF) products and their bioavailability with demineralized dentine. The products evaluated (expected fluoride concentrations) were: I: Saforide 38% (45,283 ppm F); II: Advantage Arrest 38.3 to 43.2% (45,283 to 51,013 ppm F); III: Ancárie 12% (14,100 ppm F); IV: Ancárie 30% (35,400 ppm F), V: Cariestop 12% (14,100 ppm F) and VI: Cariestop 30% (35,400 ppm F). The fluoride concentration was evaluated using an ion-specific electrode (ISE) by direct technique, which was confirmed after microdiffusion. The pH of the products was determined with a pH test strip. For the bioavailability test, demineralized dentine slabs were treated with one of the products for 1 min. Loosely (CaF2-like) and firmly-bound fluoride (FAp) were determined. The fluoride concentration found in the products (mean±SD; ppm F) by the ISE direct technique was: I:53,491±554; II:57,249±1,851; III:4,814±268; IV:5,726±43; V:10,145±468; VI:11,858±575; these values were confirmed after microdiffusion (t-test; p>0.05) and disagree with the declared by the manufacturers. The pH of Ancárie 12 and 30% was 6.0 and 4.5, respectively, in disagreement with the alkaline pH expected for SDF solution and found in the other products evaluated. There was no correlation between either CaF2-like (r=0.221; p=0.337) or FAp (r=-0.144; p=0.830) formed in demineralized dentine and fluoride concentration found in the products. The problems of pH and fluoride concentration found in available professional commercial SDF products suggest that they are not under sanitary surveillance.

Abstract Objective This study evaluated the clinical effect of violet LED light on in-office bleaching used alone or combined with 37% carbamide peroxide (CP) or 35% hydrogen peroxide (HP). Methodology A total of 100 patients were divided into five groups (n=20): LED, LED/CP, CP, LED/HP and HP. Colorimetric evaluation was performed using a spectrophotometer (ΔE, ΔL, Δa, Δb) and a visual shade guide (ΔSGU). Calcium (Ca)/phosphorous (P) ratio was quantified in the enamel microbiopsies. Measurements were performed at baseline (T 0 ), after bleaching (T B ) and in the 14-day follow-up (T 14 ). At each bleaching session, a visual scale determined the absolute risk (AR) and intensity of tooth sensitivity (TS). Data were evaluated by one-way (ΔE, Δa, ΔL, Δb), two-way repeated measures ANOVA (Ca/P ratio), and Tukey post-hoc tests. ΔSGU and TS were evaluated by Kruskal-Wallis and Mann-Whitney, and AR by Chi-Squared tests (a=5%). Results LED produced the lowest ΔE (p<0.05), but LED/HP promoted greater ΔE, ΔSGU and Δb (T 14 ) than HP (p<0.05). No differences were observed in ΔE and ΔSGU for LED/CP and HP groups (p>0.05). ΔL and Δa were not influenced by LED activation. After bleaching, LED/CP exhibited greater Δb than CP (p>0.05), but no differences were found between these groups at T 14 (p>0.05). LED treatment promoted the lowest risk of TS (16%), while HP promoted the highest (94.4%) (p<0.05). No statistical differences of risk of TS were found for CP (44%), LED/CP (61%) and LED/HP (88%) groups (p>0.05). No differences were found in enamel Ca/P ratio among treatments, regardless of evaluation times. Conclusions Violet LED alone produced the lowest bleaching effect, but enhanced HP bleaching results. Patients treated with LED/CP reached the same efficacy of HP, with reduced risk and intensity of tooth sensitivity and none of the bleaching protocols adversely affected enamel mineral content.

Resumo Este estudo avaliou a taxa de decomposição (DR), pH, alteração da cor do esmalte (∆E) e índice de clareamento (DWI) promovido por agentes clareadores caseiros e de consultório. A superfície do esmalte foi submetida a (n=10): agentes caseiros (10%, 15%, 20% de peróxido de carbamida - CP e 6% de peróxido de hidrogênio - HP) e três agentes a base de HP a 35% comirradiação por luz (LED, laser e halógena) ou sem tratamento (controle). A DR e pH dos agentes foi mensurada após 0, 2, 4, 6 e 8h (agentes caseiros) e após 5, 15, 20, 30 e 40 min (agentes de consultório). Parâmetros de cor (L*, a*, b*, DE e DWI) foram determinados inicialmente e após clareamento. Os dados da DR, pH, L*, a*, b* foram analisados por ANOVA um fator (agentes caseiros) ou dois fatores (agentes de consultório) de medidas repetidas e teste Tukey. ΔE e DWI por ANOVA um fator (agentes caseiros) e dois fatores (agentes de consultório) e teste Tukey. A DR dos agentes clareadores caseiros foi similar após 6 e 8 h (p>0.05), com pH próximo ao neutro (6,5 a 6,9 - CP) ou ácido (5,9- HP 6%). De 4 a 8 h, a ∆E foi maior para CP 15% e 20% comparado ao CP 10% (p<0.05). Após 40 min, a DR dos agentes HP 35% foi similar e todos exibiram ∆E significante em uma aplicação (p<0.05), independente da aplicação de luz. DWI indicou efeito clareador, sem diferenças entre os grupos (p>0.05). Um agente HP 35% exibiu pH alcalino, e os outros, pH<5.5. Os agentes clareadores caseiros poderiam ser aplicados por 2 h (15%, 20% CP e 6% HP) e 4 h (CP 10%), e os agentes clareadores de consultório, até 40 min em uma aplicação, sem luz.

Abstract This study evaluated the decomposition rate (DR), pH, enamel color alteration (DE) and whiteness index (DWI) promoted by at-home and in-office bleaching. Enamel surface was submitted to (n=10): at-home (10%, 15%, 20% carbamide peroxide - CP, 6% hydrogen peroxide -HP) and three 35% HP agents with light irradiation (LED, laser, and halogen) or no treatment (control). The DR and pH of agents were measured after 0, 2, 4, 6 and 8 h (at-home) or after 5, 15, 20, 30 and 40 min (in-office). Color parameters (L*, a*, b*, DE, DWI) were determined at baseline and after bleaching. DR, pH, L*, a*, b* data were analyzed by one-way (at-home) or two-way (in-office) repeated measures ANOVA and Tukey test. DE and DWI, by one-way (at-home) or two-way (in-office) ANOVA and Tukey test. DR of at-home agents was similar after 6 and 8 h (p>0.05), with pH close to neutral (6.5 to 6.9, CP) or acid 5.9 (6% HP). From 4 to 8 h, DE was higher for 15% and 20% CP compared with 10% CP (p<0.05). After 40 min, DR of 35% HP agents was similar and all exhibited significant DE in one application (p<0.05), regardless light irradiation. DWI indicated whitening effect with no differences among groups (p>0.05). One 35% HP showed alkaline pH, and the others, pH < 5.5. At-home agents could be applied for 2 h (15%, 20% CP, 6% HP) and 4 h (10% CP) and the in-office agents, up to 40 min in one application, without light.

Abstract: Iontophoresis is a noninvasive technique, based on the application of a constant low-intensity electric current to facilitate the release of a variety of drugs, whether ionized or not, through biological membranes. The objective of this research was to evaluate the effect of iontophoresis using different electric current intensities on the uptake of fluoride in dental enamel with artificial caries lesions. In this in vitro operator-blind experiment, bovine enamel blocks (n = 10/group) with caries-like lesions and predetermined surface hardness were randomized into 6 groups: placebo gel without fluoride applied with a current of 0.8 mA (negative control), 2% NaF gel without application of any current, and 2% NaF gel applied with currents of 0.1, 0.2, 0.4 and 0.8 mA. Cathodic iontophoresis was applied for 4 min. The concentration of loosely bound fluoride (calcium fluoride) and firmly bound fluoride (fluorapatite) was determined. The results were analyzed by the nonparametric Kruskal-Wallis and Dunn tests. Iontophoresis at 0.8 mA, combined with the application of fluoridated gel (2% NaF), increased fluoride uptake in enamel with caries-like lesions, as either calcium fluoride or fluorapatite.

Resumo O fluoreto presente em dentifrícios de 1,100 µg/g é considerado efetivo no controle de cárie dental. No entanto, sob alto desafio cariogênico devido ao aumento da exposição ao açúcar, maior concentração de fluoreto (5.000 µg/g) poderia ser necessária para compensar o desequilíbrio no processo de cárie. Isso foi testado em um modelo de ciclagens de pH, que avaliou o efeito da concentração do fluoreto, relacionada ao dentifrício, na redução da desmineralização do esmalte dental sob condição de dois níveis de desafio cariogênico. Blocos de esmalte (n=20) foram submetidos a dois regimes de ciclagens de pH, simulando 8 e 16 exposições diárias ao açúcar, e foram tratados com soluções contendo: 0 (sem flúor), 275 ou 1.250 µg F/mL, resultando em 6 grupos de tratamento: 4-h/0-F; 8-h/0-F; 4-h/275-F; 8-h/275-F; 4-h/1.250-F e 8-h/1.250-F. As concentrações de 275 e 1.250 µg F/mL simularam uma diluição salivar na cavidade bucal quando dentifrícios de 1100 e 5000 µg F/g são usados. A desmineralização do esmalte foi avaliada na superfície (%PDS) e dureza em corte. Fluoreto incorporado pelo esmalte também foi determinado. Os dados foram analisados por Análise de Variância e teste de Tukey. O tratamento com 1.250 µg F/mL reduziu significativamente %PDS comparado ao de 275 µg F/mL (p<0,05), independente do nível do desafio cariogênico (comparações 4-h/1,250-F x 4-h/275-F e 8-h/1,250-F x 8-h/275-F, respectivamente). Esses resultados foram suportados pela concentração de fluoreto encontrada no esmalte. Os resultados sugerem que maior concentração de fluoreto pode parcialmente compensar um maior risco de cárie sob um maior desafio cariogênico provocado pelo aumento de exposição ao açúcar.

Abstract Fluoride present in toothpaste at 1,100 µg/g is considered effective on caries control. However, under high cariogenic challenge due to increasing sugar exposure, higher fluoride concentration (5,000 µg/g) could be necessary to compensate the unbalance on caries process. This was tested in a pH-cycling regimen, which evaluated the effect of fluoride concentration relative to toothpaste on reduction of enamel demineralization under conditions of two levels of cariogenic challenge. Enamel slabs (n=20) were subjected to two pH-cycling regimens, simulating 8x and 16x/day sugar exposure and were treated with solutions containing: 0 (no fluoride), 275 or 1,250 µg F/mL, resulting in 6 treatment groups: 4-h/0-F; 8-h/0-F; 4-h/275-F; 8-h/275-F; 4-h/1,250-F and 8-h/1,250-F. The 275 and 1,250 µg F/mL concentrations simulate mouth salivary dilution when 1,100 and 5,000 µg/g toothpastes are used. Enamel demineralization was assessed by surface (%SHL) and cross-sectional hardness. Fluoride taken up by enamel was also evaluated. Data were analyzed by ANOVA one-way and Tukey's test. The treatment with 1,250 µg F/mL significantly reduced %SHL compared with 275 µg F/mL (p<0.05), irrespective the level of cariogenic challenge (4-h/1,250-F vs. 4-h/275-F and 8-h/1,250-F vs 8-h/275-F comparisons, respectively). These data were supported by fluoride concentration found in enamel. These findings suggest that higher fluoride concentrations could partly compensate the greater caries risk under higher cariogenic challenge due to increasing sugar exposure.

Resumo Dentifrícios de baixa concentração de fluoreto (F) (< 600 µg F/g) estão amplamente disponíveis no mundo, mas ainda não há evidência para recomendar seu uso, quer seja em formulações regulares ou melhoradas. Assim, o objetivo deste estudo foi avaliar o potencial anticárie de dentifrícios de baixa concentração de fluoreto encontrados no mercado brasileiro, utilizando um modelo de ciclagens de pH validado e testado. Blocos de esmalte bovinos foram selecionados pela dureza de superfície e randomizados em quatro grupos (n=12): dentifrício sem fluoreto (controle negativo), dentifrício de baixa concentração de fluoreto (500 μg F/g), dentifrício acidulado de baixa concentração de fluoreto (550 μg F/g) e dentifrício de 1100 μg F/g (controle positivo). Os blocos foram submetidos ao regime de ciclagem de pH por 8 dias e tratados 2 x/dia com suspensões aquosas dos dentifrícios (1:3 p/v). O pH das suspensões foi checado, e apenas o acidulado tinha baixo pH. Após a ciclagem de pH, a dureza de superfície foi novamente determinada e a porcentagem de perda de dureza foi calculada como indicador de demineralização. As concentrações de fluoreto fracamente e firmemente ligado ao esmalte também foram determinadas. O dentifrício de 1.100 μg F/g foi mais efetivo do que os de baixa concentração na redução da desmineralização do esmalte e foi o único que diferiu significativamente do não fluoretado (p<0,05). Todos os dentifrícios fluoretados foram capazes de formar maiores concentrações de fluoreto fracamente ligado ao esmalte do que o não fluoretado (p<0,05), mas o de 1.100 μg F/g foi o único que diferiu do não fluoretado na capacidade de formar fluoreto firmemente ligado ao esmalte. Os resultados sugerem que dentifrícios de baixa concentração de fluoreto disponíveis no mercado brasileiro, independentemente da formulação, não têm potencial anticárie.

Abstract Low-fluoride (F) dentifrices (<600 µg F/g) are widely available worldwide, but evidence to recommend the use of such dentifrices, with either regular or improved formulations, is still lacking. Therefore, the aim of this study was to evaluate the anticaries potential of low-F dentifrices found in the Brazilian market, using a validated and tested pH-cycling model. Enamel blocks were selected by surface hardness (SH) and randomized into four treatment groups (n=12): non-F dentifrice (negative control), low-F dentifrice (500 μg F/g), low-F acidulated dentifrice (550 μg F/g) and 1,100 μg F/g dentifrice (positive control). The blocks were subjected to pH-cycling regimen for 8 days and were treated 2x/day with dentifrice slurries prepared in water (1:3, w/v). The pH of the slurries was checked, and only the acidulated one had low pH. After the pH cycling, SH was again determined and the percentage of surface hardness loss was calculated as indicator of demineralization. Loosely- and firmly-bound F concentrations in enamel were also determined. The 1,100 μg F/g dentifrice was more effective than the low-F ones to reduce enamel demineralization and was the only one that differed from the non-F (p<0.05). All F dentifrices formed higher concentration of loosely-bound F on enamel than the non-F (p<0.05), but the 1,100 μg F/g was the only one that differed from the non-F in the ability to form firmly-bound F. The findings suggest that the low-F dentifrices available in the Brazilian market, irrespective of their formulation, do not have anticaries potential.