Publications by authors named "Taís Scaramucci"

51 Publications

Hesperidin reduces dentin wear after erosion and erosion/abrasion cycling in vitro.

Arch Oral Biol 2021 Sep 19;129:105208. Epub 2021 Jul 19.

Department of Restorative Dentistry, School of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Rua Monsenhor Furtado, s/nº, Fortaleza, CE, Brazil. Electronic address:

Objective: To evaluate the action of hesperidin (HPN) at different concentrations to prevent dentin erosive wear, associated or not to abrasion.

Methods: A study with 6 experimental groups (n = 10) for erosion (experiment 1) and another 6 for erosion + abrasion (experiment 2). The treatments were: distilled water (DW), DW with collagenase (DW + Col), 0.46% epigallocatechin-3-gallate (EGCG) and 0.1%, 0.5% or 1% HPN. The specimens were submitted to a cycle (3x/day) for 5 days that consisted of immersion on 1% citric acid (5 min), artificial saliva (60 min), treatment (5 min), brushing (150 movements only in experiment 2), and artificial saliva (60 min / overnight). Collagenase was added in artificial saliva for all groups except DW-group. Dentin changes were assessed with optical profilometry and scanning electron microscopy. Data were submitted to one-way analysis of variance and Tukey tests (α = 0.05).

Results: For experiment 1, DW showed the lowest wear and did not significantly differ from EGCG. DW + Col showed the highest wear, being significantly different from HPN at 1%. In experiment 2, DW showed the lowest wear and DW + Col the highest. EGCG showed less wear than the three groups treated with HPN. In addition, for both cycling models, there were no significant differences among the three concentrations of HPN analyzed. In micrographs of HPN-treated groups, it could be observed the formation of a barrier on the dentin that promoted the obliteration of the tubules.

Conclusions: HPN was able to preserve the demineralized organic matrix layer but did not overcome the effect of EGCG.
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http://dx.doi.org/10.1016/j.archoralbio.2021.105208DOI Listing
September 2021

Erosive tooth wear inhibition by hybrid coatings with encapsulated fluoride and stannous ions.

J Mater Sci Mater Med 2021 Jul 1;32(7):83. Epub 2021 Jul 1.

Department of Restorative Dentistry, University of São Paulo, School of Dentistry, São Paulo, São Paulo, Brazil.

This study aimed to formulate a hybrid coating material (HC) and to modify this HC with fluoride (NaF) and stannous (SnCl) ions, directly or encapsulated in nano containers, testing the effects of these materials against dental erosion and erosion-abrasion. Enamel and dentin specimens were treated with the HCs, and then tested in erosion or erosion-abrasion cycling models of 5 days (n = 10 for each substrate, for each model). Deionized water was the negative control, and a fluoride varnish, the positive control. Surface loss (SL, in µm) was evaluated with an optical profilometer, and data were statistically analyzed (α = 0.05). For enamel, in erosion, the positive control and HC without additives showed significantly lower SL than the negative control (p = 0.003 and p = 0.001). In erosion-abrasion, none of the groups differed from the negative control (p > 0.05). For dentin, in erosion, the positive control, HC without additives, HC with non-encapsulated F, and HC with encapsulated F + Sn showed lower SL than the negative control (p < 0.05). In erosion-abrasion, none of the groups differed significantly from the negative control (p < 0.05). HC without additives showed a promising potential for protecting the teeth against dental erosion (with upward trend for improved protection on dentin), but not against erosion-abrasion. The presence of additives did not improve the protective effect of the HC, on both substrates.
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http://dx.doi.org/10.1007/s10856-021-06554-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8249257PMC
July 2021

Activated charcoal toothpastes do not increase erosive tooth wear.

J Dent 2021 06 23;109:103677. Epub 2021 Apr 23.

Department of Restorative Dentistry, School of Dentistry, University of São Paulo, 2227 Professor Lineu Prestes Avenue, 05508-000, São Paulo, SP, Brazil. Electronic address:

Objectives: To assess the effect of activated charcoal toothpastes on enamel and dentin erosive wear.

Methods: Ninety enamel and dentin slabs were randomly distributed into 9 experimental groups (n = 10/substrate): Artificial saliva (negative control); Elmex Caries (EXC - 1400 ppm F as AmF, reference toothpaste without charcoal); Colgate Luminous White Activated Charcoal (CLW - 1000 ppm F as MFP); Colgate Natural Extracts (CNE - 1450 ppm F- as NaF); Oral-B 3D White Mineral Clean (OMC - 1100 ppm F as NaF); Curaprox Black is White (CBW - 950 ppm F as MFP); Bianco Carbon (BIC - no F); Natural Suavetex (NSX - no F); Oralgen Nupearl Advanced (ONA - no F). Specimens were submitted to a 5-day erosion-toothbrushing abrasion cycling. Surface loss (SL) was determined with an optical profilometer. pH and concentration of available fluoride in the slurries were also assessed. Data were statistically analyzed (α = 0.05).

Results: For both substrates, CBW, CNE and EXC had significantly lower SL values than the control. CLW and OMC promoted significantly less dentin wear than the control. All the other groups did not differ significantly from the control. There was a strong negative correlation between SL and concentration of fluoride in the slurries for enamel (r = -0.77) and dentin (r = -0.91), and a strong positive correlation (r = 0.77) between enamel SL and pH.

Conclusions: For both substrates, none of the activated charcoal-based toothpastes resulted in higher SL than brushing with artificial saliva. Only two of the charcoal toothpastes and the reference toothpaste were able to provide further protection against SL.

Clinical Significance: Activated charcoal-containing toothpastes are becoming popular, despite the absence of evidence supporting their safety for use by individuals with erosive tooth wear. These products did not pose an additional risk for these subjects. However, it would be preferable to use products that exhibits further protective effect.
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http://dx.doi.org/10.1016/j.jdent.2021.103677DOI Listing
June 2021

Association of Nd:YAG laser and calcium-phosphate desensitizing pastes on dentin permeability and tubule occlusion.

J Appl Oral Sci 2021 31;29:e20200736. Epub 2021 Mar 31.

Universidade de São Paulo, Instituto de Pesquisas Energéticas e Nucleares (IPEN/CNEM), São Paulo, SP, Brasil.

Objective: To evaluate the efficacy of Nd:YAG laser associated with calcium-phosphate desensitizing pastes on dentin permeability and tubule occlusion after erosive/abrasive challenges.

Methodology: Dentin specimens were exposed to 17% ethylene diamine tetra-acetic acid (EDTA) solution for 5 min and randomly allocated into five groups: G1, control (no treatment); G2, Nd:YAG laser (1 W, 10 Hz, 100 mJ, 85 J/cm2); G3, Laser + TeethmateTM Desensitizer; G4, Laser + Desensibilize Nano P; and G5, Laser+Nupro®. Specimens underwent a 5-day erosion-abrasion cycling. Hydraulic conductance was measured post-EDTA, post-treatment, and post-cycling. Post-treatment and post-cycling permeability (%Lp) was calculated based on post-EDTA measurements, considered 100%. Open dentin tubules (ODT) were calculated at the abovementioned experimental moments using scanning electron microscopy and ImageJ software (n=10). Data were analyzed using two-way repeated measures ANOVA and Tukey's test (α=0.05).

Results: G1 presented the highest %Lp post-treatment of all groups (p<0.05), without significantly differences among them. At post-cycling, %Lp significantly decreased in G1, showed no significant differences from post-treatment in G3 and G4, and increased in G2 and G5, without significant differences from G1 (p>0.05). We found no significant differences in ODT among groups (p>0.05) post-EDTA. At post-treatment, treated groups did not differ from each other, but presented lower ODT than G1 (p<0.001). As for post-cycling, we verified no differences among groups (p>0.05), although ODT was significantly lower for all groups when compared to post-EDTA values (p<0.001).

Conclusion: All treatments effectively reduced dentin permeability and promoted tubule occlusion after application.

Combining Nd: YAG laser with calcium-phosphate pastes did not improve the laser effect. After erosive-abrasive challenges, treatments presented no differences when compared to the control.
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http://dx.doi.org/10.1590/1678-7757-2020-0736DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8011944PMC
April 2021

Protective Effect of Solutions Containing Polymers Associated with Fluoride and Stannous Chloride on Hydroxyapatite Dissolution.

Caries Res 2021 27;55(2):122-129. Epub 2021 Jan 27.

Department of Restorative Dentistry, Institute of Science and Technology, São Paulo State University, UNESP, São José dos Campos, Brazil,

This study investigated the protective effect of experimental solutions containing 4 polymers (polyoxirane, hydroxypropylmethylcellulose [HPMC], pectin, and an amino methacrylate copolymer [AMC]) in 2 concentrations (low and high) associated or not with sodium fluoride (F; 225 ppm F-) or sodium fluoride plus stannous chloride (FS; 800 ppm Sn2+) on the dissolution of hydroxyapatite crystals (HA). Deionized water was the control. The pretreated HA was added to a 0.3% citric acid solution (pH 3.8). An automatic titrant machine added aliquots of 0.1 N HCl at a rate of 28 μL/min, in a total reaction time of 5 min. Groups were compared with 2-way ANOVA and Tukey's test, and concentrations with Student t test (5%). The zeta potential of the HA treated with the solutions was measured. Significant differences were found for both factors and interaction (p < 0.0001). The treatments with F and FS solutions resulted in a lower amount of dissolved HA than the control. Among the polymers' solutions, only AMC was able to reduce the amount of dissolved HA, changing the surface charge of HA to positive. AMC improved the protective effect of F, but it did not affect FS. Polyoxirane and HPMC reduced the protective potential of the FS solution. No differences were found between the concentrations of the polymers. It was concluded that F and FS reduced the amount of dissolved HA. The protective effect of the experimental solutions against HA dissolution was polymer dependent. The F effect was enhanced by its combination with AMC, but the protection of FS was impaired by polyoxirane and HPMC.
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http://dx.doi.org/10.1159/000513444DOI Listing
May 2021

Interplay between different manual toothbrushes and brushing loads on erosive tooth wear.

J Dent 2021 02 31;105:103577. Epub 2020 Dec 31.

Department of Restorative Dentistry, University of São Paulo, School of Dentistry, Av. Prof. Lineu Prestes 2227, Cidade Universitária, São Paulo, SP, 05508-000, Brazil. Electronic address:

Objective: To investigate the effect of different types of manual toothbrushes and brushing loads on the progression of erosive tooth wear (ETW) on enamel.

Methods: Bovine enamel specimens (n = 10) were submitted to a 5-day erosive-abrasive cycling model (0.3 % citric acid for 5 min, artificial saliva for 60 min, 4x/day). Toothbrushing was carried out 2x/day for 15 s, according to the toothbrushes tested (ultra-soft (a): Curaprox 5460; ultra-soft (b): Sensodyne Repair & Protect; soft (a): Colgate Slim Soft; soft (b): Oral-B Indicator Plus; medium: Johnson's Professional; hard: Tek) and brushing loads (1.5 N, 3 N). Surface loss (SL, in μm) was assessed by optical profilometry on conclusion of the cycling. Some of the toothbrush characteristics were evaluated. Data were statistically analyzed (α = 0.05).

Results: For the 1.5 N load, the hard brush showed the highest SL value, with statistical significance. The other toothbrushes did not differ significantly, except that ultra-soft (a) caused significantly higher SL than ultra-soft (b). For the 3 N load, hard and soft (a) exhibited the highest SL. Soft (b) and medium had the lowest SL value, with statistical significance. Only soft (a) and ultra-soft (b) showed significant difference between loads, with lower SL for the load of 1.5 N. None of the toothbrush characteristics were significantly correlated with SL.

Conclusions: Although different degrees of enamel surface loss were observed with use of the different toothbrushes, no association was found between the toothbrush characteristics and SL. Depending on the toothbrush, the force of brushing was capable of modulating the ETW of enamel. Based on the brushing loads usually applied by healthy individuals, hard brushes are not recommended for use by patients with ETW.

Clinical Significance: The use of hard bristle brushes is not recommended for use by individuals who exert healthy forces when brushing their teeth. The toothbrush characteristics are of secondary importance in terms of causing enamel loss in ETW.
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http://dx.doi.org/10.1016/j.jdent.2020.103577DOI Listing
February 2021

Salivary pellicle modification with polyphenol-rich teas and natural extracts to improve protection against dental erosion.

J Dent 2021 02 30;105:103567. Epub 2020 Dec 30.

Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, CH-3010, Bern, Switzerland. Electronic address:

Objective: To investigate the modification of the salivary pellicle with different polyphenol-rich teas and natural extracts for the protection against dental erosion.

Methods: We performed two experiments: one with teas (Green tea, Black tea, Peppermint tea, Rosehip tea, negative control [NC]) and other with natural extracts (Grape seed, Grapefruit seed, Cranberry, Propolis, NC), where NC was deionized water. A total of 150 enamel specimens were used (n = 15/group). Both experiments followed the same design, consisting of 5 cycles of: salivary pellicle formation (30 min, 37 °C), modification with the solutions (30 min, 25 °C), further salivary pellicle formation (60 min, 37 °C) and erosive challenge (1 min, 1% citric acid, pH 3.6). Relative surface microhardness (rSMH), relative surface reflection intensity (rSRI) and amount of calcium release (CaR) were evaluated. Data were analysed with Kruskal-Wallis and Wilcoxon rank sum tests with Bonferroni correction (α = 0.05).

Results: Regarding teas, Black and Green teas showed the best protection against dental erosion, presenting higher rSMH and lower CaR than NC. Peppermint tea was not different to NC and Rosehip tea caused erosion, showing the highest CaR and greatest loss of SMH and SRI. Regarding natural extracts, Grape seed and Grapefruit seed extracts presented the best protective effect, with significantly higher rSMH and lower CaR. Cranberry caused significantly more demineralization; and Propolis did not differ from NC.

Conclusion: Green tea, Black tea, Grape seed extract and Grapefruit seed extract were able to modify the salivary pellicle and improve its protective effect against enamel erosion, but Rosehip tea and Cranberry extract caused erosion.

Clinical Relevance: Some some bio-products, such as teas and natural extracts, improve the protective effect of the salivary pellicle against enamel erosion. More studies should be performed in order to test the viability of their use as active ingredients for oral care products.
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http://dx.doi.org/10.1016/j.jdent.2020.103567DOI Listing
February 2021

Protective effect of anti-erosive solutions enhanced by an aminomethacrylate copolymer.

J Dent 2021 02 26;105:103540. Epub 2020 Nov 26.

Institute of Science and Technology, Department of Restorative Dentistry, São Paulo State University - UNESP, São José dos Campos, SP, Brazil. Electronic address:

Objective: To investigate if an aminomethacrylate copolymer (AMC) could potentiate the anti-erosive effect of solutions containing sodium fluoride -F (225 ppm F) and sodium fluoride associated to stannous chloride -FS (800 ppm Sn).

Methods: The experimental solutions (F, FS, AMC, AMC + F, AMC + FS, and deionized water-DW as negative control) were tested in the presence of acquired pellicle. Polished bovine enamel specimens (n = 13/group) were submitted to an erosion-rehardening cycle (2 h immersion in human saliva, 5 min in 0.3 % citric acid, 1 h in human saliva, 4×/day, 5 days). Treatment with the solutions was performed for 2 min, 2×/day. The rehardening (%Re) and protective (%Prot) potential of the solutions were assessed in the beginning of the experiment, and the surface loss (SL) by contact profilometry after 5 days. Additional bovine specimens (n = 5/group) were prepared to evaluate the contact angle on the treated enamel surface. The zeta potential of the dispersed hydroxyapatite (HA) crystals after the treatment with the solutions was also measured (n = 3/group). Data were statistically analyzed (α = 0.05).

Results: The association with AMC improved the %Re and the %Prot for W and F, but not for FS. The results of SL were: AMC + F = AMC + FS < AMC < FS < F < DW. The presence of AMC significantly reduced the contact angle on enamel surfaces. The HA presented a strong negative surface charge after the treatment with DW, F and FS, whereas after the treatment with the solutions containing AMC it became positive.

Conclusion: AMC has potential to enhance the anti-erosive effect of fluoride solutions.

Clinical Significance: The aminomethacrylate copolymer (AMC) may be a promising agent to be added to oral care products for the prevention of erosive tooth wear.
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http://dx.doi.org/10.1016/j.jdent.2020.103540DOI Listing
February 2021

The Addition of Propylene Glycol Alginate to a Fluoride Solution to Control Enamel Wear: An in situ Study.

Caries Res 2020 11;54(5-6):517-523. Epub 2020 Nov 11.

Department of Restorative Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil,

The aim of this study was to evaluate the protective effect of propylene glycol alginate (PGA) associated with sodium fluoride (NaF) against enamel erosion and erosion-abrasion. A 4-phase, split-mouth, double-blind, crossover in situ trial was conducted with the following solutions: F + PGA (225 ppm F- + 0.1% PGA), F (225 ppm F-), F + Sn (225 ppm F- + SnCl2, 800 ppm Sn2+), and negative control (distilled water). In each phase, 12 subjects wore removable mandibular appliances containing 4 enamel specimens, which were submitted either to erosion or to erosion-abrasion challenges for 5 days. Acquired salivary pellicle was formed in situ for 2 h. Erosion-abrasion consisted of acid challenge (1% citric acid solution, pH 2.3, 5 min, 4×/day), exposure to saliva in situ (2 h, 4×/day), brushing (5 s, total 2 min exposure to the slurry), and treatment with the solutions (2 min, 2×/day). For erosion, the same procedures were performed, without brushing. At the end, surface loss (SL; in μm) was evaluated by means of optical profilometry. KOH-soluble fluoride was quantified for erosion-only groups using extra specimens. For both challenges, the SL values found for F + PGA did not differ significantly from those of F and the negative control, and the SL value shown for F + Sn was significantly the lowest. Erosion-abrasion promoted significantly higher SL values than erosion. KOH-soluble fluoride analysis showed that F + Sn had a higher fluoride concentration in comparison with the negative control and F, while F + PGA did not differ from any of the other groups. In conclusion, PGA was not able to improve the protective effect of NaF against erosive enamel wear.
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http://dx.doi.org/10.1159/000511261DOI Listing
April 2021

Protective effect of fluorides on erosion and erosion/abrasion in enamel: a systematic review and meta-analysis of randomized in situ trials.

Arch Oral Biol 2020 Dec 16;120:104945. Epub 2020 Oct 16.

São Paulo State University - UNESP, Institute of Science and Technology, Department of Restorative Dentistry, Avenida Engenheiro Francisco José Longo, 777, Jardim São Dimas, São José dos Campos, ZIP code: 12245-000, SP, Brazil. Electronic address:

Objectives: To evaluate the effects of different fluoride types and vehicles when compared to water or placebo, on prevention of enamel erosion and erosive tooth wear progression.

Design: A systematic review followed by meta-analysis of randomized in situ trials was conducted. PubMeb, Scopus, Web of Science, LILACS, BBO, Scielo, EMBASE and CENTRAL electronic databases were searched. Studies with fluoride compounds (NaF, AmF, Sn, TiF) and vehicles (toothpaste, mouth rinse, gel, and varnishes) compared to control (water or placebo) for control of enamel loss progression were included. Reviewers independently screened potentially eligible articles, extracted data, and assessed risk of bias. GRADE approach was used to rate the overall certainty of evidence for toothpastes and rinses under erosive/abrasive challenges.

Results: Thirty-two studies were elegible. Under erosive/abrasive challenges, enamel loss was significantly lower than control for NaF toothpastes [Mean difference(MD) -1.14; Confidence Interval(CI) -1.89 to -0.40] and Sn/associations [-6.02; -11.09 to -0.95], while no difference was found for AmF [-13.59; -39.7 to -12.52]. For mouth rinses, Sn/associations solutions were effective [-11.49; -16.62 to -6.37], but NaF showed no significant effect [-2.83; -8.04 to 2.38].

Conclusion: Overall, fluoride products are able to reduce enamel loss when compared to control, but results must be interpreted with caution. For toothpastes, NaF provided limited protection, with moderate evidence, while Sn/associations exhibited protective effect with low certainty of evidence. For rinses, NaF was not effective, with very low evidence, while the stannnous enriched fluorides offered higher protection regarding enamel erosion and erosive wear, with moderate certainty of evidence.
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http://dx.doi.org/10.1016/j.archoralbio.2020.104945DOI Listing
December 2020

Enhancing the Anti-Erosive Properties of Fluoride and Stannous with the Polymer Carbopol.

Caries Res 2020 3;54(3):250-257. Epub 2020 Sep 3.

Department of Restorative Dentistry, Institute of Science and Technology, São Paulo State University - UNESP, São José dos Campos, Brazil,

This in vitro study investigated whether Carbopol 980 polymer could potentiate the anti-erosive effect of solutions containing sodium fluoride (F) and sodium fluoride associated with stannous chloride (FS). The dissolution of hydroxyapatite treated with the experimental solutions (F [500 ppm F-], F + Carbopol [0.1%], FS [500 ppm F- + 800 ppm Sn2+], FS + Carbopol) was evaluated. Deionized water was the negative control, and a commercial mouth rinse (AmF/NaF/SnCl2; 500 ppm F + 800 ppm Sn2+; Elmex® Erosion Protection) was the positive control. The solutions were also evaluated in an erosion-rehardening protocol, with two treatments per day, using bovine enamel specimens (n = 15) and human saliva. The acid challenge was performed using 0.3% citric acid (pH 2.6) for 2 min. Microhardness was measured at different times: baseline, after the first erosive challenge, after treatment, and after the second erosive challenge. Based on microhardness values, the demineralization, rehardening, and protective potentials were calculated. The alkali-soluble fluoride on enamel surfaces was also measured. Data were analyzed using ANOVA and Tukey tests (α = 0.05). Groups treated with FS + Carbopol showed the lowest hydroxyapatite dissolution and the highest rehardening and protective potentials. The measurement of alkali-soluble fluoride on enamel surfaces was also higher in the FS + Carbopol group. Carbopol was able to significantly increase the protective effect of the fluoridated solutions in addition to optimizing the adsorption of fluoride on the enamel surface.
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http://dx.doi.org/10.1159/000506467DOI Listing
January 2021

Chemical and mechanical resistance of novel experimental hybrid coatings on dentin permeability.

Microsc Res Tech 2021 Feb 1;84(2):163-170. Epub 2020 Sep 1.

Department of Restorative Dentistry, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil.

This study aimed to evaluate the capacity of novel experimental hybrid coatings (HC) to reduce dentin permeability and to verify their resistance to erosive and abrasive challenges. Dentin disc specimens (1 mm thick) were treated with 0.5 M EDTA solution and randomly allocated into three experimental groups (n = 10): Control (Saliva); Concentrated Hybrid Coating (TEOS/GPTMS/Y-APS); and Diluted Hybrid Coating (1:3 ratio with distilled water). Dentin permeability was assessed by hydraulic conductance in the following experimental time periods: post-EDTA, post treatment, post erosion (5 min in 0.05 M citric acid solution, pH = 3.8), and post abrasion (toothbrushing for 3,900 cycles). Dentin permeability percent was calculated with respect the values of post-EDTA for each experimental time. The morphology of the surface of extra dentin specimens was examined by scanning electron microscopy (SEM) in the same time periods (n = 3). Permeability data were analyzed by two-way repeated measures ANOVA and Tukey tests (p < .05). Both HC presented significantly lower dentin permeability than control post treatment and post erosion (p < .05), without difference between them (p > .05). Post abrasion, there were no significant difference among groups (p > .05). Post treatment and post erosion, the HC seemed to flow into the tubules, occluding them, while the tubules in control remained opened. Post abrasion, the tubules appear to be occluded in all groups. In conclusion, the experimental hybrid coatings were capable of reducing dentin permeability after treatment. They were also able to resist to erosive and abrasive challenges, with the advantage of forming thinner and colorless films that can be potentially used to treat dentin hypersensitivity.
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http://dx.doi.org/10.1002/jemt.23574DOI Listing
February 2021

Anti-erosive effect of rinsing before or after toothbrushing with a Fluoride/Stannous Ions solution: an in situ investigation: Application order of Fluoride/Tin products for erosive tooth wear.

J Dent 2020 10 13;101:103450. Epub 2020 Aug 13.

Department of Restorative Dentistry, University of São Paulo School of Dentistry. Av. Prof Lineu Prestes 2227, São Paulo 05508-000, SP, Brazil. Electronic address:

Objective: To evaluate the impact of the application of a F/Sn-containing mouthrinse before or after toothbrushing with a F/Sn/chitosan toothpaste on the progression of erosion/abrasion on enamel and dentin.

Methods: This crossover in situ study had five arms: Control (toothbrushing without toothpaste), Brushing (toothbrushing with toothpaste), Brushing + Rinsing, Rinsing + Brushing, and Rinsing (without toothbrushing). Fifteen subjects used removable mandibular appliances containing 3 enamel and 3 dentin specimens, which were subjected to erosion-abrasion cycling of 60 min salivary pellicle formation followed by 5 min extra-oral erosion with 1% citric acid (4x/day for 5 days). Treatments were performed in situ after first and last erosive challenges with rinse (10 ml; 30 s) and/or toothbrushing with/without toothpaste (with electric toothbrush; 5 s per specimen; total 2 min contact with slurry). Surface loss (SL) was evaluated with an optical profilometer. Data were analyzed by two-way repeated measures ANOVA and Tukey tests (α = 0.05).

Results: The Control showed the highest SL (mean ± SD for enamel: 24.58 ± 11.32; dentin: 32.32 ± 10.10; all μm). Rinsing alone resulted in significantly lower SL value (enamel: 8.30 ± 4.96; dentin: 16.15 ± 8.29) compared with arms that applied toothpaste, except Brushing + Rinsing. None of the arms that underwent toothbrushing with the toothpaste differed from each other (p > 0.05). Dentin specimens showed significantly higher SL values than enamel (p < 0.001).

Conclusion: The order of treatment applications had no influence on their anti-erosive effect; however, toothbrushing with F/Sn/chitosan toothpaste reduced enamel surface loss. Additional rinsing with F/Sn mouthrinse did not offer improved protection.

Clinical Significance: The use of fluoride- and stannous- containing toothpastes and mouthrinses is an important approach in the prevention of erosive tooth wear. Further evidence is needed to support the benefit of combining these products against this condition.
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http://dx.doi.org/10.1016/j.jdent.2020.103450DOI Listing
October 2020

Bleaching of severely darkened nonvital tooth case report-48 months clinical control.

J Esthet Restor Dent 2021 Mar 8;33(2):314-322. Epub 2020 Jun 8.

Department of Restorative Dentistry, University of São Paulo, São Paulo, Brazil.

Objective: To record in detail, the long-term success of a bleaching treatment employing hydrogen peroxide in a severely darkened tooth.

Clinical Considerations: Tooth discoloration is an important aesthetic complain of patients. Because it is a relatively common condition, different materials and techniques capable of restoring the tooth color in a minimally invasive, conservative, and longstanding manner were developed. In this case, it was used the association between mediate (walking bleach) and immediate (internal/external) bleaching techniques using hydrogen peroxide as the main agent.

Conclusion: The association of techniques was a conservative therapeutic solution to restore the natural color of the right upper central incisor, which was darkened after an endodontic treatment performed more than twenty years ago. The bleaching protocol used presented no risk to the patient, such as cervical resorption and the color was stable over a 48 months period, showing the success of the protocol proposed for this case.

Clinical Significance: There is a possibility to severely darkened teeth receive an adequate bleaching treatment protocol, which can successfully restore the aesthetics and natural color in a conservative and long lasting way.
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http://dx.doi.org/10.1111/jerd.12609DOI Listing
March 2021

Role of desensitizing/whitening dentifrices in enamel wear.

J Dent 2020 08 31;99:103390. Epub 2020 May 31.

Department of Restorative Dentistry, University of São Paulo, School of Dentistry, Av. Prof. Lineu Prestes 2227, São Paulo, SP, 05508-000, Brazil. Electronic address:

Objectives: To analyze the impact of desensitizing (D) and/or whitening (W) dentifrices on erosion and erosion-abrasion.

Methods: Enamel specimens were allocated into 10 groups (n = 20): 1. Artificial saliva (control); 2. Sensodyne Repair&Protect (SRP-D); 3. Sensodyne Repair&Protect Whitening (SRP-W); 4. Colgate Sensitive Pro-Relief (CSPR-D); 5. Colgate Sensitive Pro-Relief Real White (CSPRR-W); 6. Colgate Total 12 (CT); 7. Colgate Total 12 Professional Whitening (CTP-W); 8. Sensodyne True White (ST-W); 9. Curaprox Black is White (CB-W); 10. Oral-B 3D White Perfection (OB3D-W). For abrasion (n = 10), 30,000 brushing strokes were performed and surface roughness (SR) was evaluated. Erosion-abrasion (n = 10) consisted of 1 % citric acid (2 min), artificial saliva (60 min); 6×/day; 5 days. Toothbrushing was carried out 2×/day (45 strokes). Surface loss (SL) was determined with an optical profilometer. Data were statistically analyzed (α = 0.05).

Results: Relative to SR, only OB3D-W had a significantly rougher surface than the control (p = 0.014). SRP-D, CSPR-D and ST-W showed no difference from the baseline. High SL was observed for ST-W, OB3D-W and CTP-W, without significant differences from the control. CT showed the lowest SL, not differing from SRP-D and SRP-W. There was a weak negative correlation between SL and concentration of free fluoride in the slurries, SL and SR, and SL and pH, all p > 0.05.

Conclusions: Only one dentifrice increased surface roughness of enamel to a higher degree than brushing with saliva. Brushing with the test dentifrices did not cause higher enamel erosive wear than brushing with saliva.

Clinical Significance: This study enhances our knowledge on the effect of desensitizing and whitening dentifrices, indicating that they do not worsen enamel loss due to abrasion and they might be a safe option for individuals with erosive tooth wear.
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http://dx.doi.org/10.1016/j.jdent.2020.103390DOI Listing
August 2020

Randomized in situ trial on the efficacy of Carbopol in enhancing fluoride / stannous anti-erosive properties.

J Dent 2020 10 19;101:103347. Epub 2020 Apr 19.

Department of Restorative Dentistry, Institute of Science and Technology, São Paulo State University-UNESP, São Paulo, Brazil. Electronic address:

Objective: To evaluate if the bioadhesive polymer (Carbopol 980) could potentiate the protective effect of sodium fluoride with stannous chloride (FS) solution on the control of enamel erosive wear.

Methods: Cylindrical bovine enamel specimens were polished and randomly allocated into three groups (n = 60): FS (500 ppm F +800 ppm Sn - positive control), FS + Carbopol (0.1% Carbopol), and ultrapure water (negative control). A randomized double-blind cross-over in situ model with three phases was used. In each phase, volunteers (n = 15) used a palatal appliance containing 4 specimens: two were submitted to an erosion model (2 h of pellicle formation; immersion in 1% citric acid, pH 2.3, for 5 min, 4x/day; 1 h intervals of saliva exposure; and treatment with the test solutions for 1 min, 2x/day). Besides erosion, the other two specimens were also subjected to abrasion (2x/day, 15 s) with active electric toothbrush, before the treatment with the solutions. After 5 days, enamel surface loss (μm) was evaluated by profilometry. Data were analyzed by two-way RM-ANOVA and Tukey tests (5%).

Results: There were significant differences for both challenge and treatment factors. Erosion/abrasion challenge resulted in significantly higher enamel loss than erosion only (p < 0.05). The surface loss values for the erosion/remineralization model were (means ± SL): C = 14.7 ± 5.8b; FS = 9.0 ± 7.5ab; FS + Carbopol = 5.9 ± 3.8a; and for erosion/abrasion: C = 26.6 ± 10.1c; FS = 15.0 ± 8.8b; FS + Carbopol = 12.3 ± 7.9ab.

Conclusion: The association of Carbopol to the FS solution significantly protected the enamel against erosive wear, but it was not significantly superior to FS only.

Clinical Significance: Under highly erosive and abrasive conditions, rinsing with solutions containing sodium fluoride plus stannous chloride, associated or not with the Carbopol polymer, is an effective approach to control enamel erosive wear.
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http://dx.doi.org/10.1016/j.jdent.2020.103347DOI Listing
October 2020

Novel fluoride and stannous -functionalized β-tricalcium phosphate nanoparticles for the management of dental erosion.

J Dent 2020 01 12;92:103263. Epub 2019 Dec 12.

Department of Restorative Dentistry, University of São Paulo, School of Dentistry, Av. Prof. Lineu Prestes 2227, São Paulo, SP, 05508-000, Brazil. Electronic address:

Objective: To evaluate the anti-erosive effect of solutions containing β-tricalcium phosphate (β-TCP) nanoparticles functionalized with fluoride or with fluoride plus stannous on enamel and dentin.

Methods: β-TCP nanoparticles were synthesized and characterized by X-ray diffraction (XRD) and transmission electron microscopy (TEM). Sixty enamel and dentin specimens were randomly allocated into the groups (n = 10): Control (water); F (NaF, 225 ppm F); F + Sn (NaF + SnCl 800 ppm Sn); F+β-TCP (F+40 ppm β-TCP); F + Sn+β-TCP (F + Sn+40 ppm β-TCP); F + Sn+100β-TCP (F + Sn+100 ppm β-TCP). Specimens underwent erosion-remineralization cycling (5 min immersion into 1 % citric acid solution and 60 min exposure to artificial saliva, 4×/day, 5 days). Immersion in the test solutions was performed for 2 min, 2×/day. Surface loss (SL, in μm) was determined by optical profilometry at the end of cycling. Data were analyzed using one way-ANOVA and Tukey's tests (α = 0.05).

Results: XRD confirmed the β-TCP phase. TEM micrographs showed differences between the bare nanoparticle and the β-TCP functionalized with F and Sn. All enamel groups presented lower SL than the control, with F + Sn, F + Sn+β-TCP, and F + Sn+100β-TCP showing the lowest values. For dentin, all the groups had lower SL than the control. F+β-TCP presented the lowest SL, significantly differing from all the other groups.

Conclusion: β-TCP nanoparticles functionalized with fluoride showed improved anti-erosive effect compared to the fluoride solution on dentin. There was no significant effect of the β-TCP nanoparticles functionalized with fluoride plus stannous in both substrates.

Clinical Relevance: β-TCP nanoparticles are a promising agent to be added to oral health products to improve the protective effect of fluoride against dentin erosion.
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http://dx.doi.org/10.1016/j.jdent.2019.103263DOI Listing
January 2020

Toothpaste factors related to dentine tubule occlusion and dentine protection against erosion and abrasion.

Clin Oral Investig 2020 Jun 17;24(6):2051-2060. Epub 2019 Oct 17.

Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, CH-3010, Bern, Switzerland.

Objectives: To investigate the effect of toothpastes on dentine surface loss and tubule occlusion, and the association of toothpaste-related factors to each of the outcomes.

Materials And Methods: One hundred and sixty human dentine specimens were randomly distributed into 10 groups, according to different toothpastes. The specimens were submitted to artificial saliva (60 min), citric acid (3 min), and brushing abrasion (25 s; totalizing 2 min in toothpaste slurries). This was repeated five times and two outcome variables were analyzed: dentine surface loss (dSL; μm) and tubule occlusion by measurement of the total area of open tubules (Area-OT; μm). Data were analyzed with Kruskal-Wallis and Mann-Whitney tests (α = 0.05); bivariate and multivariate regressions were used to model the association of the chemical (pH, concentration of F, Ca, and PO and presence of Sn) and physical (% weight of solid particles, particle size, and wettability) factors of the toothpastes to both outcome variables.

Results: Toothpastes caused different degrees of dSL and did not differ in Area-OT. All chemical and physical factors, except the presence of Sn, were associated with dSL (p < 0.001). Area-OT was associated only with the presence of Sn (p = 0.033).

Conclusion: Greater dSL was associated with lower pH, lower concentration of F, higher concentration of Ca and PO, greater % weight of solid particles, smaller particle size, and lesser wettability, whereas tubule occlusion was associated with the presence of Sn.

Clinical Relevance: Depending on their chemical and physical composition, toothpastes will cause different degrees of dentine tubule occlusion and dentine surface loss. This could, in turn, modulate dentine hypersensitivity.
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http://dx.doi.org/10.1007/s00784-019-03069-7DOI Listing
June 2020

Enamel surface loss after erosive and abrasive cycling with different periods of immersion in human saliva.

Arch Oral Biol 2020 Jan 5;109:104549. Epub 2019 Sep 5.

Department of Restorative Dentistry, School of Dentistry, University of São Paulo, Av. Prof. Lineu Prestes, 2227 Cidade Universitária, São Paulo, 05508-000, SP, Brazil. Electronic address:

Objective: This in vitro study aimed to evaluate different periods of exposure to clarified human saliva for the ability to protect enamel against erosive tooth wear.

Methods: For this purpose, sixty specimens (4 × 4 × 1.5 mm) were prepared from third human molars. For all groups, the period before abrasion was performed by remineralisation with human saliva (except in G1). The specimens were randomly divided into six groups (n = 10) according to the different remineralisation times of exposure to clarified human saliva: no exposure to saliva (G1) and 30 min (G2), 60 min (G3), 90 min (G4), 120 min (G5), and 240 min (G6) of exposure to human saliva. A 5-day cycling was performed with 5 min of erosion (1% citric acid; pH 2.3), 4x/day. After the first and last erosive episodes, the abrasion challenge was performed with slurry of fluoride toothpaste (1450 ppm F as sodium monofluorophosphate) plus human saliva (1:3), with an electric toothbrush (15 s, with a total of 120 s of slurry immersion). Surface loss (SL) was determined using an optical profilometer (n = 10) and for qualitative analysis, environmental scanning electron microscopy (ESEM) was performed (n = 3). The SL data were statistically analysed by one-way analysis of variance (α = 0.05).

Results: No significant differences were detected among the groups for SL (p > 0.05), and ESEM showed similar aspects of eroded enamel.

Conclusions: The period of in vitro exposure to clarified human saliva was not able to protect against enamel erosion.
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http://dx.doi.org/10.1016/j.archoralbio.2019.104549DOI Listing
January 2020

Using fluoride mouthrinses before or after toothbrushing: effect on erosive tooth wear.

Arch Oral Biol 2019 Dec 9;108:104520. Epub 2019 Aug 9.

Department of Restorative Dentistry, University of São Paulo School of Dentistry, Av. Prof Lineu Prestes 2227, São Paulo, SP, 05508-000, Brazil. Electronic address:

Objectives: 1. To evaluate the use of fluoridated mouthrinses before or after toothbrushing on erosive tooth wear. 2. To compare the anti-erosive effect of the combination toothpaste and mouthrinse containing fluoride, with or without stannous chloride.

Design: Enamel and dentin specimens were randomly distributed into groups (n = 10 of each substrate/group): B-brushing, B + R-brushing + rinsing, and R + B-rinsing + brushing. The treatments were performed using a fluoride toothpaste (B: 1400 ppm fluoride, as amino fluoride-AmF) combined or not with a fluoride mouthrinse (R: 250 ppm fluoride, as AmF and sodium fluoride-NaF) or fluoride and stannous toothpaste (B: 1400 ppm fluoride, as AmF and NaF, 3500 ppm stannous, as stannous chloride-SnCl and 0.5% chitosan) combined or not with fluoride and stannous mouthrinse (R: 500 ppm fluoride, as AmF and NaF, 800 ppm stannous, as SnCl). As control, brushing was performed with artificial saliva (B). Specimens were submitted to a 5-day erosive-abrasive cycling model. Treatments were performed twice daily. Surface loss (SL) was determined by optical profilometry. Data were analyzed by ANOVA and Games-Howell tests (α = 0.05).

Results: For enamel, R+B and R+B presented significantly lower SL than the control, with R+B being significantly lower than R+B. For dentin, B had the lowest SL, not differing from B+R R+B and B. Groups R+B and B+R showed highest SL, not differing from B and B.

Conclusions: For enamel, the use of a mouthrinse before brushing was able to reduce erosive wear for both fluoride and stannous products. For dentin, the use of stannous-containing products, irrespective of the order of application, presented superior effects.
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http://dx.doi.org/10.1016/j.archoralbio.2019.104520DOI Listing
December 2019

Influence of desensitizing and anti-erosive toothpastes on dentine permeability: An in vitro study.

J Dent 2019 10 24;89:103176. Epub 2019 Jul 24.

Department of Restorative Dentistry, School of Dentistry, University of São Paulo, Av. Prof. Lineu Prestes 2227, Cidade Universitária, São Paulo, Brazil. Electronic address:

Objective: This study analyzed the effect of desensitizing and/or anti-erosive toothpastes on dentine permeability.

Methods: One-mm dentin discs were prepared from human molars and exposed to EDTA solution (5 min, 17%). Initial dentine permeability was measured, under constant pressure. Specimens were randomly allocated into 10 groups: four anti-erosive toothpastes (calcium silicate + sodium phosphate, potassium nitrate, stannous chloride + chitosan, oligopeptide-104); four desensitizing toothpastes (arginine + calcium carbonate, calcium sodium phosphosilicate, strontium acetate, stannous fluoride); and two controls (regular fluoridated toothpaste, and human saliva). They were submitted to a 5-day erosion-abrasion cycling model. Erosion consisted of immersion in citric acid (2 min, 0.3%, natural pH ˜ 2.6, 4x/day), followed by 1 h exposure to human saliva. Specimens were brushed for 15 s (2 N, 45 strokes) with the toothpaste slurries (total exposure time of 2 min). After 5 cycles, the final dentine permeability was determined. Dentine permeability change was calculated as a percentage of the initial hydraulic conductance (%Lp). Data were analyzed with one-way ANOVA and Tukey tests (α=0.05).

Results: The toothpastes calcium silicate + sodium phosphate and potassium nitrate, showed significant decrease in %Lp, with no difference between them. The regular fluoridated toothpaste also decreased the %Lp, not differing from potassium nitrate. No desensitizing toothpaste showed change in %Lp. Human saliva, oligopeptide-104 and stannous chloride + chitosan presented significant increase in %Lp, without difference between them.

Conclusion: Calcium silicate + sodium phosphate, potassium nitrate, and the regular fluoridated toothpaste decreased dentine permeability, whereas the desensitizing toothpastes tested did not.

Clinical Relevance: Toothpastes had distinct impacts on dentine permeability, which may reflect a variable effect on the treatment of dentine hypersensitivity. Within the limitations of a laboratory-based study, toothpastes with an anti-erosive claim could also be effective in reducing the pain in dentine hypersensitivity.
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http://dx.doi.org/10.1016/j.jdent.2019.07.014DOI Listing
October 2019

Effect of in-office desensitizers containing calcium and phosphate on dentin permeability and tubule occlusion.

J Dent 2019 07 22;86:53-59. Epub 2019 May 22.

Department of Restorative Dentistry, University of São Paulo School of Dentistry, Av. Prof Lineu Prestes 2227, São Paulo, SP, 05508-000, Brazil. Electronic address:

Objectives: To evaluate the performance of calcium/phosphate desensitizing agents when used for dentin permeability and tubule occlusion.

Methods: 1 mm-thick dentin specimens were immersed in 17% EDTA solution and allocated into 7 groups: 1. Clinpro White Varnish, 2. Clinpro XT Varnish, 3. Teethmate Desensitizer, 4. Desensibilize Nano P, 5. Nupro prophylaxis paste, 6. Duraphat (reference product), and 7. Control (no treatment). After treatment, specimens were submitted to erosion-abrasion cycling for 5 days. Dentin permeability was assessed by hydraulic conductance (n = 10) and environmental scanning electron microscopy ESEM (n = 8) post-EDTA, post- treatment and post-cycling. The percentage of permeability (%Lp) was calculated post-treatment and post-cycling. ImageJ software was used to obtain the number of open dentin tubules (ODT) in the micrographs. Data were statistically analyzed (α = 0.05).

Results: Post-treatment, the %Lp values of all treatments were significantly lower than the control, with Nupro presenting higher %Lp values than Duraphat. All the groups presented significantly lower %Lp values in the post-treatment in comparison with the post-cycling period, except the control. Post-treatment, all groups showed lower numbers of ODTs than the control, except Nupro. Clinpro WV, Clinpro XT, Duraphat and Nano P presented the best results. Post-cycling, there was no significant difference among groups. Clinpro WV and Duraphat presented lower numbers of ODTs post-treatment than they had post-cycling, and the control had a higher number of ODTs post-treatment than they had post-cycling.

Conclusions: Most treatments were efficient in reducing both dentin permeability and number of ODTs after treatment; however, none of the products were able to resist the erosive-abrasive challenges.
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http://dx.doi.org/10.1016/j.jdent.2019.05.025DOI Listing
July 2019

Effect of Er,Cr:YSGG laser associated with fluoride on the control of enamel erosion progression.

Arch Oral Biol 2019 Mar 17;99:156-160. Epub 2019 Jan 17.

Special Laboratory of Lasers in Dentistry (LELO), Department of Restorative Dentistry, School of Dentistry, University of São Paulo, Av. Prof. Lineu Prestes 2227, São Paulo, SP, 05508-000. Electronic address:

Objective: To evaluate the effect of Er,Cr:YSGG laser associated or not with acidulated phosphate fluoride (APF) on the control of enamel erosion progression.

Design: Enamel slabs (4 mm × 4 mm × 2 mm) from bovine incisors were flattened, polished, and received a tape on their test surfaces, leaving a 4 mm × 1 mm area exposed. Specimens were eroded (10 min in 1% citric acid solution) and randomly assigned into 8 experimental groups (n = 10): Control (no treatment); F (APF gel, 1.23% F, pH 3.6-3.9); Er,Cr:YSGG laser irradiation (P1: 0.25 W, 20 Hz, 2.8 J/cm, 56 W/cm); Er,Cr:YSGG laser irradiation (P2: 0.50 W, 20 Hz, 5.7 J/cm, 1136 W/cm); Er,Cr:YSGG laser irradiation (P3: 0.75 W, 20 Hz, 8.5 J/cm, 1704 W/cm); F + Laser P1; F + Laser P2; F + Laser P3. Specimens were then subjected to erosive cycling (5 min immersion in 0.3% citric acid solution, followed by immersion in artificial saliva for 60 min; 4×/day for 5 days). At the end of cycling, surface loss (SL, in μm) was determined with optical profilometry. Selected specimens were further evaluated by environmental scanning electron microscopy (n = 3). Data were analyzed using Kruskal-Wallis and Tukey tests (α = 0.05).

Results: Group F + Laser P2 had the lowest SL value, differing significantly from the control; however, with no significant difference from the other groups. All groups, except F + Laser P2, showed no significant difference in SL when compared with the control. An irregular and rough surface, suggestive of a melting action of laser, was observed on enamel in Laser P2 and F + Laser P2 groups.

Conclusions: Association of the Er,Cr:YSGG laser in parameter 2 with fluoride was the only treatment capable of controlling the progression of enamel erosion.
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http://dx.doi.org/10.1016/j.archoralbio.2019.01.011DOI Listing
March 2019

Optical coherence tomography and polarized light microscopy for the evaluation of artificial caries: a preliminary study.

Gen Dent 2019 Jan-Feb;67(1):e1-e6

This study was designed to investigate whether there is a correlation between the findings of optical coherence tomography (OCT) and polarized light microscopy (PLM) when these techniques are used to evaluate standard enamel white-spot lesions developed by distinct cariogenic challenges. Bovine enamel fragments (N = 168) were randomly allocated into 6 experimental groups according to the microbiologic model (Streptococcus mutans UA159, Streptococcus sobrinus ATCC 33478, or mixed S mutans and S sobrinus) and carbohydrate sources (1% sucrose or combined 1% sucrose and 1% starch). Specimens were examined by OCT and PLM every day within a period of 7 days. Five measurements of demineralization depth were recorded for each specimen, and means were calculated. Data were analyzed with analysis of variance and Tukey tests (α = 0.05), and a correlation test was performed. All cariogenic challenges created sub-superficial lesions. In both the OCT and PLM analyses, the demineralization depth reached its peak between days 6 and 7 of the cariogenic challenge, except for the group challenged with S sobrinus supplemented with combined sucrose and starch; for that group, demineralization peaked on day 5 in the OCT analysis. There was a significant correlation between OCT and PLM (P = 0.00; r = 0.842). This preliminary study suggests that OCT is a reliable, nondestructive method to measure the demineralization depth of enamel white-spot lesions, which can be useful for the laboratory and has potential for clinical studies. Using the 1% sucrose and S mutans model for 6 days is a simple and effective method to induce enamel caries-like lesions without compromising the depth and morphologic features of the obtained lesions.
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November 2019

Nd:YAG laser and calcium sodium phosphosilicate prophylaxis paste in the treatment of dentin hypersensitivity: a double-blind randomized clinical study.

Clin Oral Investig 2019 Aug 30;23(8):3331-3338. Epub 2018 Nov 30.

Special Laboratory of Lasers in Dentistry (LELO), Department of Restorative Dentistry, School of Dentistry, University of São Paulo, Av. Prof. Lineu Prestes, 2227, São Paulo, SP, 05508-000, Brazil.

Aim: This double-blind, placebo-controlled, randomized clinical trial evaluated the effectiveness of Nd:YAG laser and a calcium sodium phosphosilicate-containing paste (NovaMin®) in the treatment of cervical dentin hypersensitivity (CDH).

Materials And Methods: Seventy patients were randomly allocated into the following experimental groups: control-placebo, calcium sodium phosphosilicate paste (NovaMin®), and Nd:YAG laser (1 W, 10 Hz, 85 J/cm). Pain was evaluated by means of a visual analog pain scale (VAS) after evaporative stimulation with a jet of air and tactile stimulation with an exploratory probe, before treatment (baseline) and after 5 min, 1week, and 4 weeks. When patients presented more than one tooth with CDH, the mean of the values obtained was calculated. Irradiation with Nd:YAG laser was performed twice in the mesial-distal and twice in the occlusal-gingival direction. The NovaMin®-containing paste was applied with a rubber cup at low speed for 60 s. Patients of the placebo group received simulations of the two treatments. As the data presented normal distribution, the two-way ANOVA repeated measures test was used.

Results: In all the experimental times, reduction in pain was demonstrated in comparison with baseline for all treatments (p < 0.05); however, there was no difference among the experimental groups in any of the time intervals evaluated (p > 0.05).

Conclusion: All treatments were equally effective in reducing the pain of CDH.

Clinical Relevance: Nd:YAG laser irradiation and the calcium sodium phosphosilicate paste could reduce the symptoms of CDH; thus, they stand out as viable alternatives for the treatment of this condition.
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http://dx.doi.org/10.1007/s00784-018-2759-5DOI Listing
August 2019

Anti-Erosive Effect of Solutions Containing Sodium Fluoride, Stannous Chloride, and Selected Film-Forming Polymers.

Caries Res 2019 25;53(3):305-313. Epub 2018 Oct 25.

Department of Restorative Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil,

The aim of this study was to evaluate the anti-erosive effect of solutions containing sodium fluoride (F: 225 ppm F-), stannous chloride (Sn: 800 ppm Sn2+), and some film-forming polymers (Gantrez: Poly [methylvinylether-alt-maleic anhydride]; PGA: propylene glycol alginate; Plasdone: poly[vinylpyrrolidone]; and CMC: carboxymethylcellulose). Solutions were tested in an erosion-remineralization cycling model, using enamel and dentin specimens (n = 10, for each substrate). Distilled water was the negative control. Cycling consisted of 120 min immersion in human saliva, 5 min in 0.3% citric acid solution, and 120 min of exposure to human saliva, 4×/day, for 5 days. Treatment with solutions (pH = 4.5) was carried out 2×/day, for 2 min. Surface loss (SL) was evaluated with optical profilometry. Zeta potential of hydroxyapatite crystals was determined after treatment with the solutions. Data were statistically analyzed (α = 0.05). For enamel, all polymers showed significantly lower SL (in µm) than the control (11.09 ± 0.94), except PGA (10.15 ± 1.25). PGA significantly improved the protective effect of F (4.24 ± 0.97 vs. 5.64 ± 1.60, respectively). None of the polymers increased the protection of F+Sn (5.13 ± 0.78). For dentin, only Gantrez (11.40 ± 0.97) significantly reduced SL when compared with the negative control (12.76 ± 0.75). No polymer was able to enhance the effect of F (6.28 ± 1.90) or F+Sn (7.21 ± 1.13). All fluoridated solutions demonstrated significantly lower SL values than the control for both substrates. Treatment of hydroxyapatite nanoparticles with all solutions resulted in more negative zeta potentials than those of the control, except Plasdone, PGA, and F+Sn+PGA, the latter two presenting the opposite effect. In conclusion, Gantrez, Plasdone, and CMC exhibited an anti-erosive effect on enamel. PGA increased the protection of F. For dentin, only Gantrez reduced erosion.
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http://dx.doi.org/10.1159/000493388DOI Listing
July 2020

Effectiveness and acid/tooth brushing resistance of in-office desensitizing treatments-A hydraulic conductance study.

Arch Oral Biol 2018 Dec 12;96:130-136. Epub 2018 Sep 12.

Department of Restorative Dentistry, University of São Paulo, School of Dentistry, Av. Prof. Lineu Prestes 2227, Cidade Universitária, São Paulo, SP, 05508-000, Brazil. Electronic address:

Objective: To evaluate dentin permeability and tubule occlusion of in-office desensitizing treatments, and to analyze their resistance to erosive/abrasive challenges.

Design: Ninety-one 1mm-thick dentin discs were immersed in EDTA solution for 5 min. After analyzing the maximum dentin permeability, the specimens were randomly allocated into 7 experimental groups (n = 10): Control (no treatment); Er,Cr:YSGG laser; Nd:YAG laser; Gluma Desensitizer; Duraphat; Pro-Argin toothpaste; Calcium Sodium Phosphosilicate (CSP) paste. The post-treatment permeability was assessed and then the specimens were subjected to a 5-day erosion-abrasion cycling protocol: 4x/day of immersion in citric acid solution (5 min;0.3%), followed by exposure to clarified human saliva (60 min). After the first and last acid challenges, specimens were brushed for 15 s, with exposure to the toothpaste slurry for total time of 2 min. Dentin permeability was re-measured (post-cycling). Percentage of dentin permeability for each experimental time was calculated in relation to the maximum permeability (%Lp). Data were analyzed with 2-way repeated measures ANOVA and Tukey tests (α = 0.05). Surface modifications were analyzed by scanning electron microscopy.

Results: In both experimental time CSP paste and Gluma Desensitizer did not differ from each other (p = 0.0874), and were the only groups that presented significantly lower %Lp than the Control (p = 0.026 and p = 0.022, respectively). After treatment, they were able to reduce dentin permeability in 82% and 72%, respectively. The %Lp post-cycling was higher than post-treatment value for all groups (p = 0.008). Dentin permeability increased 21% for CSP paste and 12% for Gluma, but they remained significant different from Control. Deposits on the surface were observed for CSP paste; and for Gluma, tubule diameters were shown to be smaller.

Conclusions: CSP paste and Gluma Desensitizer were the only treatments able to decrease dentin permeability post-treatment and to sustain low permeability post-cycling.
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http://dx.doi.org/10.1016/j.archoralbio.2018.09.004DOI Listing
December 2018

Er,Cr:YSGG laser associated with acidulated phosphate fluoride gel (1.23% F) for prevention and control of dentin erosion progression.

Lasers Med Sci 2019 Apr 13;34(3):449-455. Epub 2018 Sep 13.

Department of Restorative Dentistry, School of Dentistry, University of São Paulo, Av. Prof. Lineu Prestes 2227, São Paulo, SP, 05508-000, Brazil.

To evaluate the effect of Er,Cr:YSGG laser, associated with fluoride application, on the prevention/control of dentin erosion. Dentin slabs were embedded in acrylic resin, flattened, and polished. Half of the specimens were previously eroded (10 min immersion in 1% citric acid solution) and half were kept sound. The specimens (n = 10 each substrate) were randomly allocated into the experimental groups, according to the following treatments: control (no treatment); APF gel (1.23% F, 1 min); Er,Cr:YSGG laser irradiation (P1: 0.25 W, 20 Hz, 2.8 J/cm, tip S75, beam diameter of 750 μm, 1 mm away from the surface); Er,Cr:YSGG laser irradiation (P2: 0.50 W, 20 Hz, 5.7 J/cm, tip S75, beam diameter of 750 μm, 1 mm away from the surface); APF gel + Er,Cr:YSGG laser P1 and; APF gel + Er,Cr:YSGG laser P2. Afterwards, the specimens underwent an erosion-remineralization cycling, consisting of a 5-min immersion into 0.3% citric acid, followed by 60-min exposure to artificial saliva. This procedure was repeated 4×/day, for 5 days. Surface loss (SL, in μm) was determined by optical profilometry. Specimens from each group were analyzed by environmental scanning electron microscopy (n = 3). Data were statistically analyzed (α = 0.05). For the eroded specimens, APF gel presented the lowest SL, being different from the control. For the sound specimens, none of the groups differed from the control, except for Er,Cr:YSGG laser P2, which presented the highest SL. When substrates were compared, only the eroded specimens of the control and APF + Er,Cr:YSGG laser P1 Groups showed higher SL. Selective structure removal was observed for the laser-treated groups. None of the Er,Cr:YSGG laser parameters were effective in the prevention/control dentin erosion. The laser was also unable to enhance the protection of fluoride against dentin erosion.
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http://dx.doi.org/10.1007/s10103-018-2609-3DOI Listing
April 2019

Effect of desensitizing toothpastes on dentin erosive wear and tubule occlusion. An in situ study.

Am J Dent 2018 Aug;31(4):177-183

Department of Restorative Dentistry; School of Dentistry, University of São Paulo, São Paulo, Brazil,

Purpose: To evaluate the effect of desensitizing dentifrices on dentin wear and tubule occlusion using a three-phase, single blind, crossover in situ trial.

Methods: The dentifrices containing Arginine and calcium carbonate (1,450 ppmF) and Novamin, (~1,426 ppmF) were tested in two conditions: A: abrasion and B: erosion/abrasion. A dentifrice without desensitizing agents was used as control (1,450 ppmF). In each study phase, 10 volunteers used intra-oral appliances containing dentin specimens (pre-treated with EDTA, to simulate hypersensitive dentin), which were either submitted to erosion with a cola-like drink (pH 2.6), 4×/day (2 minutes), followed by toothbrushing, using electric toothbrushes, with standard pressure (2×/ day, 5 seconds), or toothbrushing only. Dentin surface loss (SL, in µm) was determined with optical profilometry at the 3rd and 5th days of cycling. Dentin surface was analyzed with environmental scanning electron microscopy (ESEM), post EDTA and post cycling, and the dentin tubules were counted using Image J software. Data were statistically analyzed (α= 0.05).

Results: For condition A and B, there were no significant differences in SL among toothpastes in both experimental times. There were also no significant differences between times within groups. For ESEM, in A, Toothpaste with Novamin was the only dentifrice that showed significantly less opened tubules post cycling than post EDTA. In B, Toothpaste with Novamin and control toothpaste presented less opened tubules post cycling. In conclusion, toothbrushing with the tested dentifrices promoted similar levels of dentin loss; however, for tubule occlusion, the toothpaste with Novamin was the only toothpaste effective for both conditions, abrasion and erosion/abrasion.

Clinical Significance: Ideally, desensitizing dentifrices should promote obliteration of the dentin tubules or nerve desensitization, without further contributing to the progression of dentin wear.
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August 2018

An in vitro study on the influence of viscosity and frequency of application of fluoride/tin solutions on the progression of erosion of bovine enamel.

Arch Oral Biol 2018 May 3;89:26-30. Epub 2018 Feb 3.

Department of Restorative Dentistry, University of São Paulo, School of Dentistry, Av. Prof. Lineu Prestes 2227, Cidade Universitária, São Paulo, SP, 05508-000, Brazil. Electronic address:

Objective: To evaluate the influence of the viscosity and frequency of application of solutions containing fluoride (F) and stannous chloride (SnCl) on enamel erosion prevention.

Design: Bovine enamel specimens were randomly distributed into 12 groups (n = 10), according to the following study factors: solution (C: deionized water; F: 500 ppm F; F + Sn: 500 ppm F + 800 ppm Sn); viscosity (low and high); and frequency of application (once and twice a day). Specimens were submitted to an erosive cycling model, consisting of 5 min immersion in 0.3% citric acid, followed by 60 min exposure to a mineral solution. This procedure was repeated 4×/day, for 5 days. Treatment with the experimental solutions was performed for 2 min, 1×/day or 2×/day. Enamel surface loss (SL) was determined by optical profilometry. Data were analyzed by 3-way ANOVA and Tukey tests (α = 0.05).

Results: There were significant differences between the levels of the factor solution (p < .001), viscosity (p < .001) and in the interaction between solution and viscosity (p = .01). Regarding solution, the mean SL ± standard deviation for the groups was F + Sn (4.90 ± 1.12) < F (7.89 ± 1.19) < C (14.20 ± 1.69). High viscosity solutions demonstrated less SL than low viscosity; however, only when applied once a day (p < .001). Applying the solutions twice a day yielded lower SL than once a day, but only for the low viscosity solutions (p = .003).

Conclusions: Under the conditions of this short-term in vitro experiment, it could be concluded that increasing the viscosity of the oral rinse solutions reduced enamel loss by erosion; however, this effect was small and only observed when the solutions were applied once a day.
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http://dx.doi.org/10.1016/j.archoralbio.2018.01.017DOI Listing
May 2018
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