Volume 7 • 2020 • Issue 4

Does toothpaste matter? Does it really make a difference with oral health outcomes? There are many misconceptions when it comes to choosing a toothpaste. Historically, the use of sodium fluoride (NaF) toothpastes have proven to be highly effective for treatment of dental caries and are an important part of caries risk management systems (CAMBRA). 1 More recently, however, the inclusion of stannous fluoride (SnF2) in toothpaste formulations has been shown to provide multiple oral health benefits in addition to those found in NaF dentifrices. For ex- ample, in addition to anti-caries treatment, SnF2 also helps in the management of plaque toxicity, gingivitis and bleeding gums, erosive tooth wear, hypersensitivity and even bad breath. The focus of this short report will be on SnF2 benefits related to periodontal disease and erosive tooth wear. Misconception # 1: Toothpastes containing NaF and SnF2 provide the same oral health benefits The introduction of NaF into toothpaste formulations more than 60 years ago has provided incredible oral health benefits worldwide. However, over the last decade SnF2 dentifrices have been introduced and with the use of Crest Gum & ProHealth products, patients can achieve more benefits over the use of regular NaF product. In addition to the prevention and control of dental caries, these benefits include improvement in periodontal bleeding sites associated with gingivitis, decreases in the amount of erosive tooth wear, control of hypersensitivity and control of bad breath. Misconception # 2: The main benefit of toothpastes containing fluorides is to manage dental caries To highlight the benefits noted above, it should be noted that a recent meta-analysis showed that using a stabilized SnF2 product (vs. a positive control NaF product) resulted in a 51% benefit in bleeding sites and also generally improved periodontal health, including gingivitis. 2 Another study showed that a stabilized SnF2 toothpaste reduced plaque toxicity, thus improving gingival health. 3 These benefits of the above studies were similar to what patients would achieve with 2 weeks of flossing (40% reduction in bleeding)† 4 and what their condition would be one week after a prophylaxis treatment (40–66% decrease in bleeding sites). 5 There are also important benefits in the prevention of dental erosion, as the stannous material provides a protective coating against acid attacks on both enamel and dentin. 6 Misconception #3: Relative Dentin Abrasiveness (RDA) values are primarily related to dental wear Today’s acidic diet continues to be a leading cause of dental wear for patients. Regarding Relative Dentin Abrasiveness (RDA) values, stabilized SnF2 products are well below the recommended RDA maximum of 250. In fact, with everyday brushing in the presence of saliva and the biofilm coating on the teeth, it has been suggested that over a lifetime, differences in tooth wear, if RDA values of the dentifrice are less than 250, are minimal. 7 Conclusion Toothpaste matters and the use of a stabilized SnF2 dentifrice will provide multiple oral health benefits to our patients. †Does not replace flossing References: 1. Young D, et al . Curing the Silent Epidemic: Caries Management in the 21st Century and Beyond. J Calif Dent Asso. 2010;54:507-525. 2. Biesbrock A, et al. The Effects of Bioavailable Gluconate Chelated Stannous Fluoride Dentifrice on Gingival Bleeding: Meta-Analysis of Eighteen Randomized Controlled Trials. J Clin Periodontol , Dec 2019. 3. Klukowska MA et al . Subgingival uptake and retention of stannous fluoride from dentifrice: Gingival crevicular fluid concentrations in sulci post-brushing. Am J Dent 2018;31(4):184-188. 4. Biesbrock A, et al. Assessment of treatment responses to dental flossing in twins. J Periodontol, 2006; 77, 1386-1391. 5. McClanahan SF, et al. Identification and consequences of distinct Löe-Silness Gingival Index examiner styles for the clinical assessment of gingivitis. J Periodontol , 2001; 72: 383-392. 6. Carvalho TS, et al. Consensus Report of the European Federation of Conservative Dentistry: Erosive Tooth Wear-Diagnosis and Management. Clin Oral Investig. 2018; 39(3):1-5. 7. Maragliano-Muniz. Setting the record straight about toothpaste abrasivity. RDH, Dec. 2016, pp. 2-6. ©2020 P&G ORAL-26419 PGOCA-20138 40-66% REDUCTION IN BLEEDING 1 WEEK POST-PROPHY Dr. Ward Noble, Prosthodontist DISPELLING MISCONCEPTIONS – NOT ALL FLUORIDE TOOTHPASTES ARE EQUAL