Comparison of the incipient lesion enamel fluoride uptake from various prescription and OTC fluoride toothpastes and gels.

OBJECTIVE The objective of this in vitro study was to compare the fluoride uptake into incipient enamel lesions of a novel 970 ppm F- ion SnF2 over-the-counter (OTC) gel (Enamelon Preventive Treatment Gel) and a novel 1150 ppm F- ion OTC toothpaste (Enamelon), each delivering amorphous calcium phosphate (ACP), to the uptake from two different prescription strength, 5000 ppm F- ion dentifrices containing tri-calcium phosphate (TCP) and a prescription 900 ppm F- ion paste containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP). METHODS The test procedure followed method #40 in the US-FDA Anticaries Drug Products for OTC Human Use, Final Monograph testing procedures. Eight sets of twelve incisor enamel cores were mounted in Plexiglas rods and the exposed surfaces were polished. The indigenous fluoride levels of each specimen were determined prior to treatment. The treatments were performed using slurries of a negative control (water) and the following products applied to a set of sound enamel cores: 5000 ppm F- ion, sodium fluoride (NaF) prescription (Rx) dentifrice "A" containing TCP; 5000 ppm F- ion, NaF Rx dentifrice "B" containing TCP; 900 ppm F- ion, NaF Rx paste with CPP-ACP; 1150 ppm F- ion, NaF OTC toothpaste; 1150 ppm F- ion, stannous fluoride (SnF2) OTC toothpaste delivering ACP (Enamelon); 1100 ppm F- ion, SnF2 OTC toothpaste; and 970 ppm F- ion, SnF2 OTC gel delivering ACP (Enamelon Preventive Treatment Gel). The twelve specimens of each group were immersed into 25 ml of their assigned slurry with constant stirring (350 rpm) for 30 minutes. Following treatment, one layer of enamel was removed from each specimen and analyzed for fluoride and calcium. The pre-treatment fluoride (indigenous) level of each specimen was subtracted from the post-treatment value to determine the change in enamel fluoride due to the test treatment. RESULTS The increase in the average fluoride uptake for treated enamel cores was: 10,263 ± 295 ppm for the 970 ppm F- ion, Enamelon Preventive Treatment Gel; 7,016 ± 353 ppm for the 1150 ppm F- ion Enamelon Toothpaste; 4,138 ± 120 ppm for the 5000 ppm F- ion, NaF prescription dentifrice "A" with TCP; 3801 ± 121 ppm for the 5000 ppm F- ion, NaF prescription dentifrice "B" with TCP; 2,647 ± 57 ppm for the 1100 ppm F- ion, SnF2 OTC toothpaste; 1470 ± 40 ppm for the 1150 ppm F- ion, NaF OTC toothpaste; and 316 ± 9 ppm for the 900 ppm F- ion, NaF paste with CPP-ACP. The differences among all the products tested were statistically significant (p < 0.05), except for the two 5000 ppm F- ion products with TCP that were not statistically different from one another, and the 900 ppm F ion, NaF paste with CPP-ACP that was not statistically different from the negative water control. CONCLUSION The Enamelon products (970 ppm and 150 ppm F ion, SnF2OTC dentifrices) delivering ACP provide statistically significantly more fluoride to incipient enamel lesions than two prescription strength 5000 ppm F- ion toothpastes containing TCP, the 900 ppm F- ion prescription paste containing CPP-ACP, and the other OTC toothpastes compared in this study.