Comparative Evaluation of Remineralization and Antimicrobial Efficacy of Maximum Fluoride Containing Toothpastes Available in India - In-Vivo Study

Abstract

Background: Early childhood caries (ECC) is a common type of dental caries with an overall prevalence of 49.6% in India. Dentifrices- containing 1000-1500ppm concentration of fluorides and certain remineralizing agents are known to be effective in reversal of early enamel lesions and reduction of dental caries prevalence. However, in India, the mean fluoride content of dentifrices available for children is only 449.5 ± 26.1 ppm. Only very few toothpastes with the recommended concentration of fluoride is available in the Indian market, for children below the age of 6 years. Aims: To compare and evaluate the remineralization potential and antimicrobial efficacy of toothpaste with highest amount of fluoride, available in India for children below 6years of age, with non-fluoridated remineralizing children’s toothpaste. To assess the Total Soluble Fluoride (TSF) concentration of fluoridated toothpastes. Methodology: 95 extracted or naturally exfoliated human primary teeth were decoronated and sectioned mesiodistally. Specimens were demineralized and randomly divided into six groups (3 fluoridated and 3 non-fluoridated remineralising toothpaste groups): group 1: Omnident®- 917ppm, group 2: AquaFresh®™ little teeth- 1450ppm, group 3: Colgate kids®- 1000ppm, group 4: Enafix® (Ca. orthophosphate + Ca. Sucrose phosphate), group 5: Aclaim® (Nano HAP) and group 6: Shy-NM® (Novamin). The samples were placed in the demineralizing solution for 48h and subjected to Vickers hardness test (VHT) and SEM to obtain the baseline values. Then the samples were remineralized using the respective toothpastes and were subjected to SEM and VHT at 21days, 3months and 6months intervals. Antimicrobial activity of all the dentifrices was determined by agar well diffusion method and selective ion electrode analysis was used to evaluate the Total Fluoride (TF) and Total Soluble Fluoride (TSF) concentrations among the three fluoridated toothpastes. The data obtained were statistically analysed. Results: SEM images showed mineral deposition in all the groups obliterating the defects caused due to demineralization at various intervals. Remineralising agents showed significantly higher remineralisation especially SHY-NM when compared to Fluoridated toothpastes. However they did not show any antimicrobial efficacy. Fluoridated toothpastes showed antimicrobial efficacy against S. mutans and the highest antimicrobial efficacy was seen with Aquafresh followed by Omnident and Colgate Kids which was directly proportional to the TSF concentration of the toothpastes. Conclusions: Highest remineralisation of artificial enamel lesions was shown by non- fluoridated remineralising toothpaste, however, the fluoridated dentifrices displayed both antimicrobial and remineralising properties. The Total Soluble Fluoride (TSF) concentration of fluoride toothpastes were generally slightly less than the Total Fluoride (TF) concentration (TSF/F (%): 97%- AquaFresh®TM, 61.1%-Colgate kids® and 96.5% in Omnident®), which can be correlated to the dose-dependant antimicrobial efficacy as well as remineralisation of the fluoridated toothpastes. Keywords: remineralization potential, antimicrobial efficacy, toothpaste with highest amount of fluoride, dental caries.