*COMPARATIVE ANALYSIS OF EFFECT OF DIFFERENT TOOTHPASTES
ON THE CARIES-RESISTANCE OF DENTAL ENAMEL
Kunin AA, Kupets TV, Belenova IA, Kasim Vasim, Kobtseva EG, Kravchuk PS, Kalyakin AV
This study aimed to compare the influence of
toothpaste
containing
sodium
fluoride
(concentration of fluoride ions 1500 ppm) and a
toothpaste without fluoride, containing calcium,
phosphate and magnesium, on the structural and
functional caries-resistance of dental enamel and
remineralizing potential of oral fluid.

Materials and methods
Materials received during routine dental
examinations were used in series of clinicalanamnestic, clinical, and clinical-laboratory
studies.
To obtain scientific data in accordance with the
aims and purposes of the study, subjects were
randomly divided into 2 groups, 30 subjects each.
In the first group, subjects used a dentifrice
without fluoride (ROCS), containing the active
complex MINERALIN and being a source of
calcium, phosphorus and magnesium.
In the second group, subjects used a commercially
available toothpaste containing 0,32 sodium
fluoride in the silicon dioxide base.
Sixty subjects of both genders participated in the
study. They had to comply with the following
criteria: age 18 to 45 (i.e. with the completed
mineralization of hard dental tissues); at least 20
natural crowns conserved; absence of industrial
harmfulness in history, absence of significant
concomitant diseases, including that of digestive
tract, heart-vascular system and metabolic
disorders.
The investigation of the toothpastes was doubleblind. The subjects were given unmarked samples
of the dentifrices and standardized toothbrushes
(medium rigidity). They were recommended to
brush only with the given toothpaste till the end of
trial (during three months).
Examinations were performed at the following
points: at the baseline, after one week, two weeks,
one month, and at the end of the study (three
months).
The subjects in both groups were given the same
recommendations: to brush their teeth twice daily
(morning and evening) during 3 minutes, using
the given dentifrice and toothbrush. During the
study no other oral care means were permitted.
The examinations were performed using following
clinical and laboratory methods:
 Visual examination and probing – to establish
preliminary diagnosis.




Index CFE (caries – filling – extraction) as a
sum of teeth affected by caries, filled and
extracted.
Level of oral hygiene by means of the index of
Fyodorov and Volodkina (1976).
Periodontal examination and, later, the
dynamic changes were registered by the index
CPITN.
CERRE-test (clinical evaluation of the rate of
remineralization of enamel) is necessary for
the evaluation of structural and functional
caries-resistance of enamel, as well as of
remineralizing properties of oral fluid during
toothbrushing with investigated toothpastes.
During the test a drop of muriatic buffer (pH
0,3 – 0,6; constant volume) is applied to the
cleaned and dried vestibular surface of a tooth
by semiautomatic dropper. The demineralizing
solution is rinsed off after 60 seconds. A
cotton pellet moistured with 2% solution of
methylene blue is applied to the etched surface
for one minute. The excess of methylene blue
is removed. The intensity of coloring of the
etched site of enamel is used to evaluate the
process of demineralization. After 24 hours
the etched site is exposed to the dye once
more. If there is any coloring, the procedure is
to be repeated.
Method of Acid Biopsy of Enamel (Leontyev
VK, Distel VA, 1975) includes application of
strictly defined volume of demineralizing
solution to the enamel, its taking after defined
period of time and following measurement of
level of calcium in acidic solution. It allows to
measure the rate of acidic solubility of enamel.
The qualitative analysis of calcium content in
the acidic biopsy material is made by means of
spectrophotometry.
Results and discussion
The indices CFE and CPITN characterize in detail
the intensity of caries and demand for periodontal
treatment; by means of them, it is possible to
evaluate not only an individual patient, but also a
whole group. The mean indices CFE and CPITN
for both study groups are presented in the Table 1.
Table 1. Results of the evaluation of caries
intensity and demand for periodontal treatment in
two groups of subjects aged 18 to 45.
Indices
Groups
Group 1: the
Group 2: a
dentifrice ROCS
toothpaste with
without fluoride
sodium fluoride
(n=30)
(n=30)
CFE
8,3 – 0,8
8,7 – 1,2
CPITN
3,2 – 0,7
2,8 – 0,8
There was no significant difference between the
indices CFE and CPITN in two compared groups,
which demonstrates equivalence of populations.
One of the most important characteristics of oral
care means is cleaning capacity, because hygienic
condition of oral cavity plays a key role in the
beginning and development of caries, as well as
creates conditions for mineral metabolism in the
system
enamel/saliva,
influencing
remineralization and structural resistance of dental
enamel (2, 3).
Taking this into consideration, the oral care level
was controlled during the whole study by means
of the index by Fyodorov and Volodkina. To
improve quality of toothbrushing, the brushing
technique was corrected as needed. As a result, a
level of oral hygiene increased in all subjects and
was steadily high due to regular hygiene until the
end of the study.
But the dynamics of hygienic status was
significantly different in two groups. In subjects
who used the dentifrice ROCS (group 1) the
unsatisfactory indices changed to good in one
week. In the 2nd group (dentifrice, containing
sodium fluoride) corresponding results were
achieved only by the end of the first month (figure
1).
The obtained results could be partially explained
by the fact, that the dentifrice ROCS is able to
inhibit growth of dental plaque. This effect was
confirmed in a special study, results of which are
to be published in future.
Functional condition of the enamel can be
evaluated according to the composition of hard
dental tissues, their hardness, resistance to acid
and other parameters. In our work we preferred
most informative and easy methods:
CERRE-test (clinical evaluation of the rate of
remineralization of enamel).
To measure the rate of acidic solubility of enamel
calcium and phosphorus, we used a method of
acid biopsy. Results of conducted studies show
the ability of both investigated toothpastes to
increase the resistance of enamel against acidic
exposure, but to a variable degree (figure 2).
For example, release of calcium decreased in both
groups. In the first group (the dentifrice ROCS
with calcium, phosphorus and magnesium,
without fluoride) the release of calcium decreased
to 38%, then in the second group (toothpaste with
sodium fluoride) it decreased to 23,5%. At the
same time, the release of phosphorus ions
decreased almost equal in the two groups and was,
correspondingly, 31% and 32% in the 1st and 2nd
groups. The obtained results demonstrate positive
influence of both dentifrices on caries-resistance
of enamel with full mineralization. This confirms
that the effect can be achieved by two ways. First
of them is using active fluorides, which
significantly increases resistance to acids. The
second way is saturation of enamel by structural
elements (calcium and phosphorus), at the
background of regular hygiene, i.e. due to the
ability of the dentifrice ROCS to inhibit formation
of dental plaque.
The CERRE-test was used as a clinical index to
visualize resistance of enamel to acidic exposure
and remineralizing properties of saliva. During the
study, results of the CERRE-test tended to
decrease. This fact demonstrates some increase of
resistance of enamel under the influence of all
investigated toothpastes, and confirms results of
acid biopsy of enamel. The following trend (figure
3) was discovered during the study.
magnesium into the oral cavity, time of
remineralization became 1,9 times shorter; after
the usage of the toothpaste with sodium fluoride
this index decreased significantly less (1,2 times).
Thus, the investigated toothpastes had positive
influence on mineral metabolism of teeth.
Conclusion
1. The investigated toothpastes help to increase
the level of oral hygiene significantly, in case
of regular use.
2. Due to its ability to inhibit growth of dental
plaque, the dentifrice ROCS allows to achieve
good hygiene level in a week.
3. As a result of this study, the dentifrice ROCS
with calcium, phosphorus, magnesium, and
without fluoride, can increase caries-resistance
at least such effectively, as a toothpaste with
high level of sodium fluoride (1500 ppm of
fluoride); this effect may be related to other
components of the dentifrice ROCS (xylitol
and bromeline).
4. The toothpaste ROCS can significantly
increase the rate of remineralization after
acidic exposure.
5. The existence of a toothpaste without fluoride,
which has significant positive influence on
mineral metabolism of enamel, gives a dentist
great possibilities for individual administration
of hygiene means, with regard to general
condition and regional specifics.
The figure 3a shows that in volunteers who used
the dentifrice without fluoride (group #1), the
level of acid-resistance increased up to 3,9 times,
and in the 2ng group – up to 3,6 times. This
demonstrates capability of the toothpastes to
increase structural resistance of the enamel. At the
same time, rate of remineralization (figure 3b) was
different for different sites exposed to acid. After
the toothbrushing with the dentifrice ROCS,
which releases calcium, phosphorus and
References:
1. Kunin A.A., Individual'naja profilaktika kariesa u
vzroslyh. Voronezh –2005; 178 str.
2. Fedorov Ju.A., Sto sem' voprosov k stomatologu.
SPb: «Nevskij prospekt» – 2001; 128 str.
3. Borovskij E.V., Leont'ev V.K.; Biologija polosti
rta. N.Novgorod: Izdatel'stvo NGMA – 2001
A. A. Kunin et al. COMPARATIVE
ANALYSIS OF EFFECT OF
DIFFERENT TOOTHPASTES
ON THE CARIES-RESISTANCE OF
DENTAL ENAMEL. “Clinical Dentistry”
№ 4, 2005