Xylitol has been shown to reduce plaque acids, but its topical cariostatic effect has been equivocal. The purpose of the studies reported here was to optimise the xylitol/NaF combination in dentifrices for an improved anticaries activity. In the first study, the combination of 10 per cent xylitol with 1100 ppm F (NaF), 1100 ppm F (NaF), and placebo dentifrices were tested in a rat caries model to assess the cariostatic effect. The combination was significantly more effective than fluoride by itself (P = 0.05). The xylitol/NaF combination provided significantly more remineralisation of dentine than fluoride by itself. Collectively, results of these investigations confirm the improved anticaries effectiveness of the xylitol/NaF combination in a variety of animal and intra-oral models. A three-year clinical study confirmed these findings.

A series of studies was conducted to clarify the role of DCPD in improving the effects of fluoride in the mouth. We performed plaque fluid studies to see if the use of DCPD dentifrices increases the levels of free Ca2+ ions and the DSenamel in plaque fluid. The results of these studies showed that plaque fluid was undersaturated with respect to DCPD; therefore, DCPD would dissolve in the mouth. The Ca2+ activity in plaque fluid measured 12 hours post-treatment was significantly elevated with the use of DCPD dentifrices in comparison with silica dentifrices. The use of DCPD dentifrices also increased the DSenamel of plaque fluid in comparison with a NaF/silica dentifrice. To determine whether Ca from DCPD could be detected in demineralized enamel and whole plaque after in vivo usage of a DCPD/ fluoride dentifrice, we conducted a 44Ca labeling study. Secondary Ion Mass Spectrometry (SIMS) was used to detect and measure changes in 44Ca levels in enamel before and after 6 days of in vivo treatment with a 44DCPD/fluoride dentifrice. The results showed that 44Ca from DCPD was incorporated into enamel and detected in plaque 18 hours post-treatment. The findings from these studies show that brushing with a DCPD dentifrice introduces additional, exogenous Ca into the oral environment, which fosters improved remineralization of teeth in combination with fluoride.

The uptake of calcium by a polysaccharide (agarose) gel used as a model for plaque from a two-step treatment (consisting of a calcium rinse followed by a fluoride treatment) and the effect of the deposited calcium in model plaque on caries lesion formation in enamel were determined. Calcium uptake was measured by treatment of the model plaques with [45Ca]-CaCl2 solutions with or without NaF. A two-step treatment consisting of calcium followed by fluoride produced a 100% increase in calcium content of model plaque, presumably due to the formation of CaF2, compared with a treatment with artificial saliva followed by calcium alone. The effects of these increased plaque minerals on caries lesion formation were studied by subjecting model-plaque-covered enamel blocks to a cyclic demineralization-remineralization treatment. Artificial-plaque-covered enamel blocks were treated daily with 180 ppm calcium for ten min, then 100 ppm fluoride for ten min, followed by demineralization for 16 h, and finally, remineralization for seven h and 40 min. After five days, the blocks were sectioned, and lesion formation was determined by microradiography-microdensitometry. Artificial plaque treated with a calcium rinse followed by a fluoride rinse reduced lesion size by 90%, compared with a 68% reduction by a fluoride rinse alone. When the experiment was repeated with a simulated pre-brush calcium rinse (180 ppm calcium) followed by a fluoride dentifrice suspension (110 ppm fluoride), lesion size was reduced by 46%, compared with a 32% reduction by the fluoride dentifrice suspension alone.

An in situ study was conducted to evaluate the effect of a dentifrice containing 1100 ppm F (NaF) and triclosan, an anti-plaque agent, on remineralization of artificially-formed caries lesions in thin sections of human enamel. The thin sections were placed in mandibular partial dentures of 15 subjects and covered with a steel mesh to provide an area for plaque accumulation. The subjects brushed their teeth and dentures three times daily for two-week periods in a cross-over design, after which the specimens were removed and analyzed by quantitative microradiography for changes in mineral content. Results showed that lesions treated with the triclosan-fluoride product were remineralized 18.0 +/- 23.4% compared with 19.0 +/- 32.3% from a 1100-ppm F (NaF) positive control. Use of a placebo dentifrice resulted in 71.9% demineralization. The findings showed that triclosan neither enhanced nor interfered with the promotion of remineralization by fluoride.

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