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Choosing a Toothpaste: What’s the Big Deal?

Course Number: 565

Dental Erosion

When the enamel surface is pathologically challenged by acidic insult and demineralized, erosive toothwear is the result. This is different from dental caries because dental erosion is generated by non-bacterial acids (often dietary) that can dissolve the fluorapatite structure. 114 This condition has linkages to dentinal hypersensitivity due to acid exposure of dentin tubules and similar estimated prevalence rates.115As with hypersensitivity, the exact number of individuals with erosive toothwear is difficult to specify with exactness but is estimated to be high and appears to be growing – especially in younger adults – because of high dietary acid exposure, e.g., erosive sugary energy drinks, sports beverages, and sodas.116-119It is important to strive for erosion prevention, because the condition is often not diagnosed until a later stage, and lost tooth structure is not reversible and thus costly to address via restorative dentistry.120

To that end, one of the three commonly utilized fluoride agents in dentifrices – stannous fluoride – has been shown to be uniquely advantageous in preventing erosive toothwear. The mechanism of action is the deposition on the enamel pellicle surface of an acid-resistant protective barrier layer.121 In situ investigations of bioavailable SnF2 exposure have found up to 80% greater enamel erosion protection benefits compared to a control.122-124 The 2021 West et al. sensitivity and erosion meta-analysis found that bioavailable gluconate-chelated SnF2 toothpastes provided an 83% superior erosion benefit versus arginine or NaF dentifrices, as measured by surface profilometry.113

In seeking a toothpaste with SnF2 anti-erosion benefits, the choices will be the same as those described previously in the course for other conditions where a stabilized stannous fluoride multi-indication dentifrice has demonstrated proven therapeutic benefits (caries, gingivitis, dentinal hypersensitivity); for example Crest Pro-Health Densify and Sensodyne Repair & Protect. See also Figure 3.