Int. J. Odontostomat., 10(3):433-441, 2016.
Protocol of Toothbrushing Based on Bioavailability of Fluoride in Toothpaste: A Systematic Review Protocolo de Cepillado Basado en la Biodisponibilidad del Flúor en Dentífricos: Una Revisión Sistemática
Moreno-Radic, V.* & Sanchez Gonzalez, J.*
MORENO-RADIC, V. & SANCHEZ GONZALEZ, J. Protocol of toothbrushing based on bioavailability of fluoride in toothpaste: a systematic review. Int. J. Odontostomat., 10(3):433-441, 2016. ABSTRACT: The objective of the study is to propose a protocol for the appropriate use of fluorides in dentifrices (Dt), based on its bioavailability in saliva (Bs) and / or plaque (Bp) through a systematic review (SR). SR of the literature from 2005 to 2015 in PubMed, Cochrane and SciELO. Inclusion criteria: clinical studies in vivo, Spanish and English, made only with Dt that measured Bs and Bp. The results were evaluated in relation to: 1) Concentration of fluoride in Dt, 2) Brushing time with Dt, 3) Frequency of brushing, 4) Rinse post-brushing and 5) Amount of Dt on the brush. Twelve (12) studies were selected. 1) Bs increases 241 % when using a 5000 ppm of Dt compared to 1450 ppm. 2) Bs is increased by 55 % by increasing the duration of brushing 40 s to 120 s 3) Bp increases by 68 % when brushing 3 times a day compared to 2 times. 4) Not rinsing or rinsing with <10 ml for <10 s increases Bs to 270 % compared to rinses higher volume / time. 5) By increasing the amount of Dt of 0.5 g to 1.5 g, Bs increases up to 266 %. The use of 1.5 g of Dt ≥1450 ppm of fluoride for ≥ 120 s, 3 times a day is recommended and once brushing is complete avoiding oral rinse with water or non fluoride mouthwash . KEY WORDS: saliva, plaque, dentifrice, calculus, caries treatment, dental public health.
INTRODUCTION
Despite continuous efforts in dentistry to prevent action as well as for its social acceptability (Marinho et dental caries, 17 % of 2 year olds were found to have al., 2003). A recent Cochrane review concluded that obvious dental decay affecting their primary teeth and higher relative caries preventive effects were associated gradually increasing to nearly 100 % in the adult with increased Dt fluoride concentrations (Walsh et al., population according to the Ministry of Health in Chile 2010), but the effectiveness depends on bioavailability (MINSAL 2010). There are several prevention systems of the active ingredient (fluorine), which may vary available, however, the use of fluoride (F) still remains according to the concentration of fluoride Dt, amount, the most effective caries prevention tool, with frequency and duration of brushing, and rinsing protocol overwhelming evidence of anti-cariogenic effect. post-brushing (Parnell & O'Mullane, 2013). Fis a preventive element that due to its protective By analyzing the frequency of daily brushing action of enamel and dentin helps prevent according to the study by Koerber et al. (2005) in demineralization, promotes remineralization, and re- children 5º and 8º grade, 47 % brush their teeth 1-2 duces bacterial activity in dental plaque; but to achieve times a day, 42 % more than 2 times daily, and 11 % these effects constant contact with tooth structure is less than 1 time per day, indicating that there is still a required. (Pacuar et al. 2007). lack of knowledge or habit in relation to the frequency of daily brushing and actual preventive effect on ca- Among the methods of self-administration of ries lesions. About a third of the studies observed by fluoride dentifrice (Dt) is considered the most effective Macgregor & Rugg-Gunn (1985) indicated that the intervention for prevention, both for its proven clinical average brushing time was <56 s, while two-thirds
* Universidad del Desarrollo, Faculty of Medicine, School of Dentistry. Avenida Vicuña Mackenna 9630 La Florida, Santiago, Chile. 433 MORENO-RADIC, V. & SANCHEZ GONZALEZ, J. Protocol of toothbrushing based on bioavailability of fluoride in toothpaste: a systematic review. Int. J. Odontostomat., 10(3):433-441, 2016. reported a brushing time ≥ 56 s and 70 s. The best "dentifrice Saliva" and their equivalents in Spanish. estimate of the real time appears to vary between 30 2. Sources of secondary information (PubMed and to 60 seconds (Van der Weijden et al., 1993). As for SciELO): (MeSH) "fluoride" or "fluorides" and post-brushing rinses, most people rinse with potable "toothpaste" or "toothpastes" and "attention" or water as final part of the oral hygiene routine, generally "concentration". "Fluorides" or "fluoride" and practiced subconsciously (Parnell & O'Mullane). "dentifrices" or "dentifrice" and "salivary" and "level". "Salivary" and "fluorides" or "fluoride" and "level" Currently there is no protocol for tooth brushing and their equivalents in Spanish. associated with increased bioavailability of fluoride, 3. Sources of primary information: review of relevant thereby achieving greater efficacy against the in each of the items selected in the previous appearance of carious lesions. Therefore, the aim of literature search. this article is to conduct a systematic review of studies on bioavailability in saliva and plaque using fluoride Screening and Selection criteria: The inclusion and Dt by variations of tooth brushing in order to establish exclusion criteria are shown in detail in Table I. a protocol for brushing greater benefits for oral hygiene. Step 1: Titles and abstracts were reviewed by 2 authors (VM. and J.S.) and selected for further review if they met the inclusion criteria (304 potential eligible articles), MATERIAL AND METHOD considering the selection criteria established, reviewed and excluded articles that did not reach the minimum quality threshold for its design according to the Spanish Type of study: Narrative review based on a systematic version "Critical Appraisal Skills Program” (CASPe). search of the literature on tooth brushing with fluoride dentifrice considering factors aimed at increasing the Step 2: Abstracts were independently reviewed by 2 bioavailability of fluoride. authors (VM. and J.S.) and selected per their consensus according to the same inclusion criteria Search Date: May 2015 used in step 1. If consensus was not reached, the abstract was set aside for further evaluation. Studies: Clinical studies, meta-analyzes and systematic reviews. Step 3: Full-text articles of abstracts selected in step 2 were retrieved and reviewed by 1 author (V.M.). Information sources: structured search in different Inclusion was based on the consensus between 2 sources of bibliographic information (tertiary, secondary investigators (VM. and J.S). The reference lists of all and primary), with the following structure results: articles selected in step 3 were reviewed, and the full texts of potentially interesting studies were examined. 1. Source of tertiary information (Cochrane Library Plus). Preferred Search Advanced Search, and Data Extraction. Data extraction was conducted used the following keywords Medical Subject independently by 2 reviewers (V.M and J.S) using a Headings (MeSH): "fluoride concentration" or data extraction form.
Table I. Inclusion and Exclusion Criteria. Inclusion criteria Studies using only Dentifrices, with measurement of fluoride concentration in plaque and saliva. • Spanish and English. • Studies in humans. • Articles and reviews published between 2005 - 2015. Exclusion criteria • Exclude measurements made using other fluoride sources as tablets, rinses, solutions, etc. • Exclude studies in languages other than English or Spanish. • Exclude studies conducted over 10 years ago.
434 MORENO-RADIC, V. & SANCHEZ GONZALEZ, J. Protocol of toothbrushing based on bioavailability of fluoride in toothpaste: a systematic review. Int. J. Odontostomat., 10(3):433-441, 2016.