Anticaries Potential of a Sodium Monofluorophosphate Dentifrice Containing Calcium Sodium Phosphosilicate: Exploratory in situ Randomized Trial

Abstract

Calcium sodium phosphosilicate (CSPS) is a bioactive glass material that alleviates dentin hypersensitivity and is postulated to confer remineralization of caries lesions. This single-centre, randomized, single (investigator)-blind, placebo-controlled, crossover, in situ study explored whether the addition of 5% CSPS to a nonaqueous fluoride (F) such as sodium monofluorophosphate (SMFP)-containing dentifrice affects its cariostatic ability. Seventy-seven subjects wore 4 gauze-covered enamel specimens with preformed lesions (2 surface-softened and 2 subsurface) placed buccally on their mandibular bilateral dentures for up to 4 weeks. Subjects brushed twice daily with 1 of the 5 study dentifrices: 927 ppm F/5% CSPS, 927 ppm F/0% CSPS, 250 ppm F/0% CSPS, 0 ppm F/5% CSPS, or 0 ppm F/0% CSPS. Specimens were retrieved after either 21 (surface-softened lesions; analyzed by Knoop surface microhardness [SMH]) or 28 days (subsurface lesions; analyzed by transverse microradiography). The enamel fluoride uptake was determined for all specimens using a microbiopsy technique. The concentrations of fluoride and calcium in gauze-retrieved plaque were also evaluated. Higher dentifrice fluoride concentrations led to greater remineralization and fluoridation of both lesion types and increased plaque fluoride concentrations. CSPS did not improve the cariostatic properties of SMFP; there were no statistically significant differences between 927 ppm F/5% CSPS and 927 ppm F/0% CSPS in percent SMH recovery (p = 0.6788), change in integrated mineral loss (p = 0.5908), or lesion depth (p = 0.6622). Likewise, 0 ppm F/5% CSPS did not provide any benefits in comparison to 0 ppm F/0% CSPS. In conclusion, CSPS does not negatively impact nor does it improve the ability of an SMFP dentifrice to affect remineralization of caries lesions.

State of the Art Enamel Remineralization Systems: The Next Frontier in Caries Management

“…Calcium sodium phosphosilicate was initially incorporated into a dentifrice for the treatment of dentine hypersensitivity but there have been suggestions it could be useful for enamel remineralization too [Wefel, 2009]. However, evidence from in vitro and in situ data is weak and contradictory [Parkinson et al, 2017;Wang et al, 2016], while there are no clinical data from RCTs to prove its remineralizing efficacy.…”

Overview of Calcium Phosphates used in Biomimetic Oral Care

“…This mineral was originally developed as bone-regenerative material because of its high biocompatibility and the ability to release calcium and phosphate ions [ 86 , 87 ]. Besides occluding dentinal tubules and consequently desensitizing effects of this calcium phosphosilicate, there are also studies describing remineralizing potential as well as caries prevention and antiplaque-characteristics [ 64 , 85 , 88 - 95 ]. The active mechanism seems to be the delivery and deposition of calcium- and phosphate-ions that form a crystalline carbonated-apatite layer [ 31 , 85 ].…”

“…Additionally, two in situ studies both from Parkinson et al from 2017 used sodium monofluorophosphate with different concentrations as positive control and 5% CSPS as test dentifrice. They used also different concentrations of sodium monofluorophosphate in both studies (ranged from 0% to 0.15%) [ 94 , 95 ]. The authors conclude in both studies no detectable improvements of 5% CSPS (alone or in comparison with sodium monofluorphosphate) compared to the positive (0.15 ppm sodium monofluorphosphate, 0% CSPS) or the negative control (0 ppm sodium monofluorphosphate, 0% CSPS) [ 94 , 95 ].…”

Recent Advances in Remineralization Therapies for Caries Lesions

“…For this current review, no published clinical data were found for remineralization, and the level of evidence of in vitro and in situ data is weak and controversial. For example, NovaMin was superior to CPP-ACP mousse in enhancing enamel remineralization in vitro (Wang et al 2016), but the addition of 5% CSPS to sodium monofluorophosphate toothpaste did not improve the remineralization of enamel specimens in situ (Parkinson et al 2017).…”