1. Anti-Caries Benefit

Anti-Caries Benefit

Dental caries is endemic globally (Beaglehole et al. 2009). The prevalence of dental caries in the general population is significant throughout the world and particularly affects people in regions where consumption of refined sugar is high. Figure 4 shows caries prevalence for the 6–19 year-old age group in a number of countries (Beaglehole 2009).

Cariogenic bacteria in supragingival dental plaque, predominantly Mutans streptococci and Lactobacilli, metabolize fermentable carbohydrates to produce acids that cause demineralization of the dental hard tissues. Without adequate remineralization the caries balance is disturbed, resulting in net mineral loss that will eventually lead to cavitation. Fluoride is the most frequently used chemotherapeutic agent to combat dental caries.

Mechanisms of action of fluorides

Twice daily use of fluoride dentifrices is well-established as being effective in reducing caries and reversing early carious lesions (Marinho et al. 2003) Interventions that increase the amount of fluoride available to alter the plaque/tooth surface interaction are the most successful for caries prevention:

  • When the fluoride ion is present at the tooth surface and in plaque following use of a fluoride dentifrice, it is available to promote remineralization and to help prevent demineralization during acid attacks
  • When incorporated into the tooth mineral structure, it results in a more resistant, less soluble mineral than the original carbonated hydroxyapatite (Figure 5)

Higher concentrations of fluoride generally offer greater protection:

  • 2,800 ppm sodium fluoride dentifrice has demonstrated 20.4% greater caries reduction compared to a regular 1,100 ppm sodium fluoride dentifrice (Biesbrock et al. 2001)
  • 2,500 ppm sodium monofluorophosphate dentifrice has demonstrated a 16–20% greater reduction in caries (DMFS) compared to 1,000 ppm (Stephen et al. 1988)

Figure 4. Prevalence of dental caries

Prevalence of dental caries across the world

Figure 5. Mechanism of action in fluoride

Demineralization by acid in plaque

Mechanism of action of stannous fluoride

The caries demineralization-remineralization balance described above is valid for all fluoride compounds which allow dissociation of the fluoride ion in the oral cavity. Stabilized stannous fluoride may offer additional anti-caries benefits through the anti-bacterial actions of stannous which reduce the production of plaque acids (Kasturi et al. 1995).

Stannous fluoride protects against caries
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