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

• Published in: Clinical oral investigations Vol. 27; no. 9; pp. 5189 - 5201
• Main Authors: Jiemkim, Apichaya, Tharapiwattananon, Thipawan, Songsiripradubboon, Siriporn
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2023; Springer Nature B.V
• Subjects: Dental enamel; Dental erosion; Dentifrices; Dentistry; Enamel; Fluoride treatments; Fluorides; Hydrochloric acid; Medicine; Mouth; Mouthwashes; Saliva; Scanning electron microscopy; Slurries; Spectroscopy; Stannous fluoride; Toothpaste; Toothpaste; Stannous fluoride; Mouth rinse; Enamel; Erosion
• ISSN: 1436-3771; 1432-6981; 1436-3771
• DOI: 10.1007/s00784-023-05138-4

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 (1000SnF 2 ) toothpaste; groups 2,3, and 4 were the same as group 1 plus Elmex®, PerioMed™, and Meridol®, respectively, group 5: stannous fluoride (1450SnF 2 ) 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 SnF 2 toothpaste ( p  > 0.05). With 1450 SnF 2 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 SnF 2 . In addition, 1000SnF 2 toothpaste adjunct with mouth rinse is comparable to 1450 SnF 2 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 SnF 2 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.