Combined use of stannous fluoride-containing mouth rinse and toothpaste prevents enamel erosion in vitro

Abstract

Objective To compare the protective effect of commercial stannous-containing mouth rinses on enamel erosion in a simulated 5-day in vitro cycling model. Materials and methods 81 human enamel specimens were embedded in resin blocks and divided into nine groups as follows; group 1: stannous fluoride (1000SnF2) toothpaste; groups 2,3, and 4 were the same as group 1 plus Elmex®, PerioMed™, and Meridol®, respectively, group 5: stannous fluoride (1450SnF2) toothpaste, groups 6, 7, and 8 were the same as group 5 plus Elmex®, PerioMed™, and Meridol®, respectively, group 9: negative control. An erosive challenge was induced with a 1 min hydrochloric acid (0.01 M, pH 2.2) treatment 3 times per day. Each cycle included immersing in the toothpaste slurry twice for two minutes and a one-minute rinse. The enamel slabs were immersed in artificial saliva between each erosive cycle and incubated overnight at 37 °C. Surface hardness loss and enamel loss were determined by Knoop surface hardness and non-contact profilometry, respectively. Finally, enamel surfaces were analyzed by scanning electron microscopy and X-ray energy dispersive spectroscopy (SEM/EDS). Results All three mouth rinses had similar protective effects against erosion when using adjunct with 1000 SnF2 toothpaste (p > 0.05). With 1450 SnF2 toothpaste, Elmex® presented significantly lower surface hardness loss than Meridol® (p < 0.05). The combined use of Elmex® or PerioMed™ with toothpaste provided significantly better erosion protection than toothpaste alone, either 1000 or 1450 SnF2. In addition, 1000SnF2 toothpaste adjunct with mouth rinse is comparable to 1450 SnF2 toothpaste alone in preventing enamel erosion. Conclusion All three mouth rinses reduced enamel erosion. The additional use of a high concentration stannous containing mouth rinse with 1450 SnF2 toothpaste increases the protective effect against enamel erosion in vitro. Clinical significance To date, no standard protocol for preventing dental erosion is available. There are three stannous-containing mouth rinses on the market; however, no study compared their efficacy or indicated whether using adjuncts with anti-erosion toothpaste provides additional benefits. This study found that adding stannous mouth rinse to twice-daily toothpaste increases erosion protection.

Tooth Wear in Older Adults: A Review of Clinical Studies

“…Some in vitro studies have also demonstrated positive results for using products containing polyvalent metal ions (tin or titanium) or products with added amino acids, peptides, or proteins in preventing dental erosion [ 42 ]. Fluoridated products containing metal cations, such as stannous was found to be a better option than other fluoride solutions in controlling dental erosion [ 43 ].…”

“…The tin-rich deposition was more resistant to an acid attack, and hence, it prevented the underlying tooth substance from dental erosion [ 42 ]. An in vitro study found that the combined use of stannous fluoride-containing mouth rinses and toothpastes can increase their protective effect against dental erosion [ 43 ]. Toothpastes with added polymers such as sodium hexametaphosphate and chitosan, which adsorb to dental surfaces and create an additional protective layer, may protect against dental erosion [ 8 ].…”