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Item Effectiveness and mechanisms of action of whitening dentifrices on enamel extrinsic stains(2012) Alshara, Salem A.; Hara, Anderson T.; Lippert, Frank; Matis, Bruce A.; Platt, Jeffrey A., 1958-; Zandoná, Andréa G. Ferreira (Andréa Gonçalves Ferreira,), 1969-Whitening dentifrices use different mechanisms for stain removal and prevention. These approaches are abrasives, oxidizing agents, and chemical cleaning agents. The objectives of this in-vitro study were: 1) To compare the whitening effect of commercial whitening and non-whitening dentifrices; 2) To verify the mechanism of action of whitening dentifrices by contrasting two experimental models: chemical model (toothpaste exposure only) and chemo-mechanical (toothpaste exposure with tooth-brushing abrasion). The 256 bovine enamel specimens (10 mm x10 mm) were prepared and partially stained. They were assigned to 8 groups: 6 whitening dentifrices, 1 non-whitening reference dentifrice and deionized water (control); and they were further divided in 2 subgroups (n = 16), chemical and chemo-mechanical. Specimens were exposed to dentifrice slurries 2X/day for 1 min and brushed or not, according to each model. In between dentifrice treatments, specimens were exposed to the staining solution for 5 h. This protocol was repeated for 5 consecutive days and enamel color changes (∆E, ∆L) were measured by spectrophotometry after each day. The abrasivity of the toothpastes was determined using a standard test (ISO 11609). Significantly higher ∆E values (whitening effect) were observed for all groups (p < 0.05), except for the control, when tested in the chemo-mechanical model. In this model, the whitening ability of the toothpastes was mainly determined by their abrasive levels. For the chemical model, no significant differences were observed among groups (p > 0.05). Whitening dentifrices can be effective in preventing and removing enamel surface staining, when associated with tooth-brushing abrasion. This was modulated by the abrasive level of the tested toothpastes, with no chemical action attributed to the chemical agents.Item The Impact of Mouthrinses on the Efficacy of Fluoride Dentifrices in Preventing Enamel and Dentin Erosion/ Abrasion(2018) Albeshir, Ebtehal; Lippert, Frank; Cook, Norman B.; Hara, AndersonObjective: Toothbrushing with fluoride toothpaste followed by rinsing with mouthwash is a routine procedure to maintain good oral hygiene. It is unknown to what extent these rinses can modulate the effect of fluoride in its ability to prevent erosion/abrasion.The aim of this in-vitro study was to investigate and compare the impact of chlorhexidine (CHX), essential oils (EO) and cetylpyridinium chloride (CPC) mouthrinses on erosive tooth wear protection afforded by conventional fluoride toothpastes. Materials and Methods: The following experimental factors were considered: five rinses: CHX, EO, CPC, a fluoride rinse, and deionized water, two fluoride toothpastes: stannous fluoride (SnF2) or sodium fluoride (NaF) and two models: (erosion/ erosion+abrasion). Slabs of bovine enamel and dentin were prepared and embedded in resin blocks and generated 10 enamel and dentin testing groups (n = 8). UPVC tapes were placed on the sides of each slab leaving 1mm area exposed in the center. The blocks were subjected to a five-day cycling model. Then, the blocks were placed in a brushing machine and exposed to fluoride toothpaste slurry (one side was brushed and the other wasn’t). The blocks were then exposed to rinse treatments. Artificial saliva was used to remineralize the specimens after erosions and treatment challenges, and as storage media. After the fifth day of cycling, surface loss (in micrometers) was determined by profilometer. Data were analyzed using ANOVA (α = 0.05). Results: There was no interaction among the three factors (type of toothpaste, mouthrinse and abrasion or not (dentin p = 0.0520, enamel p = 0.4720). There were no significant two-way interactions as SL was only affected by toothpaste and mouthrinse. NaF caused less SL than SnF2 (4.60 vs. 5.83 μm; p < 0.0001) in dentin, whereas the opposite was found in enamel (5.20 vs. 3.56 μm; p < 0.0001). Toothbrushing abrasion caused comparatively more SL in enamel (6.53 vs. 2.23 μm; p < 0.0001) than in dentin (6.06 vs. 4.38 μm; p < 0.0001). None of the tested mouthrinses affected SL. Conclusion: Commonly used mouthrinses containing antimicrobial agents or additional fluoride, do not impair the erosion/abrasion protection afforded by fluoride toothpastes. Tested SnF2 dentifrice offered greater protection against enamel surface loss and NaF dentifrices showed more protection for the dentin surface. Clinical relevance: The understanding of the interaction between commonly used rinses and fluoride dentifrices will help dentists provide better recommendations to patients with erosive lesions.Item Influence of dentrifice abrasivity and toothbrush stiffness on the development of non-carious cervical lesions(2016) Binsaleh, Fahad; Hara, Anderson T.; Lippert, Frank; Bottino, Marco; Cook, Norman Blaine; Diefenderfer, Kim EdwardBackground: Non-carious cervical lesions (NCCLs) can be defined as the loss of dental hard tissue near the cemento-enamel junction without bacterial involvement. Abrasion, erosion and abfraction have been mentioned as common etiological factors of NCCLs. Abrasion is the loss of tooth structure due to friction by materials such as toothbrushes or abrasives in toothpaste. In contrast, dental erosion is the loss of tooth structure driven by acids. Abfraction, on the other hand, starts due to the weakening of the tooth structure in areas of concentrated stress as a result of cuspal flexure from heavy and repeated occlusal loading, which progresses to dental hard-tissue loss. Purpose: The present study focused on the abrasion aspect of NCCLs. Specifically, it aimed to investigate the influence of dentifrice abrasivity and toothbrush stiffness on the development of NCCLs in vitro Hypothesis: NCCL development is affected by both the abrasive level of the dentifrice and the stiffness of the toothbrush, as well as their interaction. Materials and Methods: A total of 288 extracted human upper first premolars, free of any dental caries and root defects, were selected. The teeth were be cleaned with a hand periodontal scaler and randomly assigned into twelve groups (total of 24 teeth/group). Specimens were brushed in an automated toothbrushing machine, using simulated toothpaste slurries of varying abrasivity and toothbrushes of varying stiffness. This study examined three experimental factors: 1. Toothpaste abrasivity, at four levels: high, medium, low, and non-abrasive slurry (as negative control); 2. Toothbrush stiffness, at three levels: soft, medium, and hard; 3. Toothbrushing cycles at three levels: baseline, 35k, and 65k strokes. Specimens were analyzed by optical profilometry at baseline and after each brushing level. The response variable was the dentin volumetric loss, in mm3. All toothbrushes caused significantly higher tooth wear when associated to the high abrasive slurry, compared to medium- and low-abrasive slurries. Medium- caused more tooth wear than low-abrasive slurry, which in turn led to more tooth wear than the control. Hard and medium toothbrushes were not significantly different, but both caused significantly higher volumetric loss than Soft toothbrushes. There were no differences among toothbrushes, when used with the non-abrasive (control) and low- abrasive slurries. Overall, 35k strokes resulted in significantly less tooth volumetric loss than 65k.Item Self-application of an anticariogenic prophylaxis paste as a technique for the partial reduction of dental caries performed on a mass treatment basis(1967) Nazhat, Nehal Yahya; Gish, Charles W., 1923-; Hansen, Niles McKendra, 1922-; McDonald, Ralph E., 1920-It has been shown repeatedly that the partial control of dental caries is possible through the use of fluoride compounds, either systemically or topically. Almost all the different treatments, beside water fluoridation, need be conducted by the dentist or dental hygienist. The high ratio of dentist to population, the cost and the time factor limits their uses. The demand for a new method to control dental caries was utilized in which the benefit of the available anticariogenic agents could be given on mass scale, with low cost and which could be conducted with fewer trained personnel. A clinical study was designed to evaluate the feasibility and effectiveness of self-application of a new anticariogenic prophylactic paste on dental caries by means of toothbrush. The self-prophylaxis was conducted each six months, by six-grade school children under supervision after thorough demonstration on proper toothbrushing by the hygienist. After one year the results showed that the self-application of the anticariogenic prophylactic paste resulted in 73.1 and 58.5 per cent reductions in DMFT and DMRS, respectively. Also, the instruction and practice of proper toothbrushing by the children twice a year motivated them to improve their oral hygiene and periodontal condition by 40.0 and 42.0 per cent, respectively. It appears that the partial control of dental caries achieved on mass basis, at low cost and conducted by fewer trained personnel is as effective as the treatment given by the trained personnel.