The use of mouthwash containing trimetaphosphate as an adjunct therapy to fluoridated toothpaste reduces enamel demineralization

Amanda Scarpin Gruba; Gabriel Pereira Nunes; Marcelle Danelon; Francyenne Maira Castro Gonçalves; Priscila Toninatto Alves de Toledo; Mayra Fernanda Ferreira; Maria Clara Faria Poli; Alberto Carlos Botazzo Delbem

doi:10.1016/j.jdent.2024.104966

The use of mouthwash containing trimetaphosphate as an adjunct therapy to fluoridated toothpaste reduces enamel demineralization

J Dent. 2024 Mar 29:145:104966. doi: 10.1016/j.jdent.2024.104966. Online ahead of print.

Authors

Amanda Scarpin Gruba¹, Gabriel Pereira Nunes¹, Marcelle Danelon¹, Francyenne Maira Castro Gonçalves¹, Priscila Toninatto Alves de Toledo¹, Mayra Fernanda Ferreira¹, Maria Clara Faria Poli¹, Alberto Carlos Botazzo Delbem²

Affiliations

¹ Department of Preventive and Restorative Dentistry, Araçatuba School of Dentistry, São Paulo State University - UNESP, Araçatuba, SP, Brazil.
² Department of Preventive and Restorative Dentistry, Araçatuba School of Dentistry, São Paulo State University - UNESP, Araçatuba, SP, Brazil. Electronic address: alberto.delbem@unesp.br.

PMID: 38554802
DOI: 10.1016/j.jdent.2024.104966

Abstract

Introduction: The decline in dental caries has been attributed to the widespread use of fluoride (F). Two forms of presentation are fluoridated toothpaste (FT) and mouthwash (MW), widely used by the population.

Materials and methods: This study aimed to evaluate in vitro the effects of combining FT and MW, whether supplemented with sodium trimetaphosphate (TMP) or not, on dental enamel demineralization. Bovine enamel blocks (n = 60) were selected based on initial surface hardness (SHi) and divided into 5 experimental groups (n = 12 each): I) Placebo Toothpaste (without F/TMP); II) 1100 ppm F Toothpaste (FT); III) 1100F associated with a MW at 100 ppm F (FT + MW 100F); IV) 1100F associated with a MW at 225 ppm F (FT + MW 250F); and V) 1100F associated with a MW at 100 ppm F supplemented with 0.4 % TMP (FT + MW 100F-TMP). The blocks were treated twice a day, undergoing 5 pH cycles over 7 days. Thus, the percentage change in surface hardness (%SH), integrated subsurface hardness loss (ΔKHN), and the concentration of F, phosphorus (P), and calcium (Ca) in the enamel were determined. The data were submitted to ANOVA and Student-Newman-Keuls test (p < 0.001).

Results: The 1100F group was statistically inferior to the groups associated with MW for %SH, ΔKHN, and the concentration of P and Ca in the enamel (p < 0.001). Blocks treated with FT + MW 225F and FT + MW 100F-TMP showed significantly lower %SH compared to the other groups (p < 0.001). The FT + MW 100F - TMP group exhibited the lowest depth mineral loss (ΔKHN), and higher concentration de P in enamel (p < 0.001).

Conclusion: The adjunct use of MW with FT produces a greater protective effect in inhibiting enamel demineralization, and the supplementation of TMP to the MW with 100F provides a superior effect compared to MW with 225F.

Clinical significance: This combination of treatments could be regarded as one of several alternative fluoride supplements for subjects at elevated risk of caries.

Keywords: Dental enamel; Fluorine; Mouthwashes; Phosphates; Tooth demineralization; Toothpastes.