Effects of Hydroxyapatite-Containing Toothpastes on Some Caries-Related Variables: A Randomised Clinical Trial

Guglielmo Campus; Fabio Cocco; Richard Johannes Wierichs; Thomas Gerhard Wolf; Claudia Salerno; Antonella Arghittu; Marco Dettori; Maria Grazia Cagetti

doi:10.1016/j.identj.2024.01.028

Effects of Hydroxyapatite-Containing Toothpastes on Some Caries-Related Variables: A Randomised Clinical Trial

Int Dent J. 2024 Mar 6:S0020-6539(24)00054-6. doi: 10.1016/j.identj.2024.01.028. Online ahead of print.

Authors

Guglielmo Campus¹, Fabio Cocco², Richard Johannes Wierichs³, Thomas Gerhard Wolf⁴, Claudia Salerno⁵, Antonella Arghittu², Marco Dettori², Maria Grazia Cagetti⁵

Affiliations

¹ Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Bern, Switzerland; Department of Surgery, Microsurgery and Medicine Sciences, School of Dentistry, University of Sassari, Sassari, Italy; Department of Cariology, Saveetha Dental College and Hospitals, SIMATS, Chennai, India. Electronic address: guglielmo.campus@unibe.ch.
² Department of Surgery, Microsurgery and Medicine Sciences, School of Dentistry, University of Sassari, Sassari, Italy.
³ Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Bern, Switzerland.
⁴ Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Bern, Switzerland; Department of Periodontology and Operative Dentistry, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
⁵ Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.

PMID: 38453554
DOI: 10.1016/j.identj.2024.01.028

Abstract

Objectives: This randomised clinical trial was designed and carried out with the aim to evaluate the capacity of fluoride-substituted hydroxyapatite (HAF) toothpaste to modulate oral microflora composition and biofilm acidogenicity in schoolchildren.

Methods: In all, 610 children (4 to 5 and 6 to 7 years) were enrolled. Four toothpastes were randomly administered during 24 months: 2 contained fluoride-substituted hydroxyapatite (HAF₁₀₀₀ and HAF₁₄₅₀; 1000 and 1450 ppmF) and magnesium-, strontium-, and carbonate-substituted hydroxyapatite in a chitosan matrix, and 2 were monofluorophosphate fluoridated toothpastes (F₁₀₀₀ and F₁₄₅₀; 1000 and 1450 ppmF). Caries lesions were assessed by International Caries Detection and Assessment System scores, supragingival plaque was sampled from the approximal sites between primary molars using sterile Gracey curettes for microbiological analysis, and plaque pH curves after sucrose challenge were assessed at baseline and reevaluated after 1 year and after 2 years. The minimum and maximum pH decrease was calculated for caries-free patients and participants with a caries lesion(s) at baseline and at the end of the experimental period (24 months). Differences amongst measurements were analysed with 1-way analysis of variance.

Results: During the trial, the minimum pH value increased statistically significantly in all groups; in HAF₁₀₀₀ and HAF₁₄₅₀, the increase was greatest. At the end of trial, in the 2 HAF groups all primary cariogenic bacteria were statistically significantly lower with respect to F groups (P = .03 for Streptococcus mutans and sobrinus, for Lactobacillus casei, and for Lactobacillus fermentum).

Conclusions: The trial provides robust but still inconclusive evidence on the efficacy of HAF toothpastes compared to traditional fluoridated toothpastes to reduce caries risk factors and to prevent caries lesions.

Keywords: Caries; Children; Fluoride; Nano-hydroxyapatite; Randomised clinical trial; Toothpaste.