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. 2024 Dec 4;24:1471. doi: 10.1186/s12903-024-05260-z

Effects of different toothpastes against erosive tooth wear of enamel and dentine in vitro

Betül Kübra Kurucu Karadeniz 1, Emel Karaman 2,✉
PMCID: PMC11619264  PMID: 39633331

Abstract

Background

The increase in the prevalence of erosion lesions worldwide has led researchers to develop effective toothpastes with different ingredients to prevent erosion that can protect the tooth surface against acid attacks. There remains a lack of consensus in the literature regarding which toothpaste formulation exhibits the most effective preventive action against erosive tooth wear, highlighting the necessity for further investigation in this field. This study aimed to evaluate the preventive effect of brushing with toothpastes with different ingredients on enamel and dentine erosion.

Methods

The crowns and roots of ninety recently extracted bovine incisors were seperated and ground flat to obtain enamel and dentine surfaces. The obtained specimens were then divided into six groups: Curaprox Enzycal Zero Flouride (fluoride-free), Colgate Total 12 (1450 ppm NaF), Splat Biocalcium (fluoride-free and Nano-HAP), Colgate ProRelief (1450 ppm NaF and arginine), Sensodyne Repair and Protection (1450 ppm NaF and novamin), Opalescence Whitening (1100 ppm NaF). The specimens were immersed in a demineralizing solution for 2 min and in an artificial saliva for 60 min 4 times a day for 5 days. Brushing was performed with the aid of a charged toothbrush immediately after the first and last erosive attacks. Initial and final surface roughness (at the end of fifth day) were measured using a 3D profilometer. The Wilcoxon test was used to compare initial and final roughness values (p < 0.05).

Results

Opalescence Whitening and Curaprox Enzycal Zero Fluoride significantly increased both enamel and dentine surface roughness compared to baseline, demonstrating rougher surfaces than all other groups except Colgate ProRelief (p < 0.001). Sensodyne Repair and Protection and Colgate Total 12 resulted in the smoothest enamel and dentine surfaces, respectively. The increase in surface roughness was significantly higher for enamel samples compared to dentine samples in the Opalescence Whitening group (p < 0.001).

Conclusions

Whitening toothpastes may exacerbate dental erosion by increasing surface roughness. The protective properties of fluoride-free toothpastes vary depending on their active ingredient.

Keywords: Remineralization, Tooth brushing, Tooth wear, Toothpastes, Abrasion

Introduction

Dental erosion is chemically induced surface loss of mineralized tooth substance provoked by chronic exposure to non-bacterial acids, such as dietary or gastric acids [1]. Tooth wear is considered a multi-factorial process caused by interactions between distinct mechanisms. The interactions between the processes of chemical and mechanical wear are the most common ones [2]. As a result of chemical acid dissolution a demineralized and softened surface occurs which is more vulnerable to remove by mechanical forces [3] advancing the loss of tooth hard substance which is called erosive tooth wear (ETW) [2].

While the rate of hard tissue loss due to dental caries is decreasing in developed countries, the rate of hard tissue loss due to dental erosion is rapidly increasing [4]. The increase in the prevalence of erosion, especially in the young population, is striking. A pan-European study found that an average of 29% of young adults (18–35 years old) had dental erosion [5], while in an American and Japanese study the prevalence was detected 25% and 26.1%, respectively [6, 7]. So it is important to considering the importance of recognizing the early signs of ETW so that effective strategies and protocols can be implemented to prevent its progression and reduce the need for extensive restorative dentistry.

Toothpastes are established part of oral hygiene practices and are used all over the world. In recent years, researchers have been working on the development of effective toothpastes to prevent erosion that can protect the tooth surface against acid attacks and contribute to oral health [8–14].

The data in the literature about the effect of fluoride toothpastes on ETW is controversial. Some studies reported protective effect of fluoride against dental erosion [8], while some studies reporting that it does not have a fully protective effect [15, 16]. As a result to order to design more effective formulations, active ingredients such as nano-HAP particules [10], novamin [11, 12] and arginin [13, 14], in addition to, or other than, fluorides have been suggested. However, there is still no consensus on which toothpaste formulation has the best preventive action against ETW.

In the initial stage the effect of ETW is only limited to enamel, but can further extend to dentine. That is why not only enamel, but also dentine is an important target tissue for anti- erosion strategies, although much less information is available about the role of such toothpastes in preventing dentine erosion [9, 12]. Considering the difference between enamel and dentine tissue, and the lack of information about the effect of some commercial toothpastes with respect to ETW, the aim of the present study is to evaluate the effect of toothpastes with different ingredients in an erosion-abrasion model. The null hypotheses tested were; (1) preventive effect of toothpastes tested is similar, (2) enamel and dentine are similar with respect to surface roughness change.

Materials and methods

Using G*Power software, sample size determination and power analysis were conducted with a 95% confidence level (1-α) and 95% test power (1-β), setting the effect size (f) at 0.78. The calculations indicated that a minimum of 10 samples per group would be required. However, to account for potential experimental losses, the sample size for each group was set at 15.

Specimen preparation

Ninety recently extracted bovine incisors, collected from animals that had been slaughtered at a licensed abattoir and free from cracks or caries, were used in this study. Tartar, debris, and soft tissues were meticulously removed using hand tools. The teeth were preserved in a 0.1% thymol solution (pH 7.0) until required. The crowns of the bovine incisors were separated from the roots using double-sided diamond discs (KG Sorensen; Barueri, SP, Brazil) and embedded in acrylic resins (Varidur, Buehler). The test surfaces of the crowns and roots were ground flat and polished (Phoenix Beta, Buehler, Lake Bluff, IL, USA) under water cooling, employing Al2O3 papers in the sequence of 400-, 1200-, 2400-, and 4000-grit to achieve enamel and dentine surfaces. Specimens were rinsed under tap water between different abrasive papers and at the end of the polishing process. Prior to the erosive- abrasive challenge, all specimens were incubated in distilled water at 37 °C in an incubator (NUVE EN 55, Esetron, Ankara, Turkey) for one week.

The specimens were randomly allocated into six treatment groups, each comprising 15 enamel and 15 dentine specimens: Group 1: Curaprox Enzycal Zero Fluoride (CEZ) (fluoride-free), Group 2: Colgate Total 12 (CT) (1450 ppm NaF), Group 3: Splat Biocalcium (SB) (Hydroxyapatite, fluoride-free), Group 4: Colgate ProRelief (CPR) (1450 ppm NaF and Arginine Bicarbonate 8%), Group 5: Sensodyne Repair and Protection (SRP) (1450 ppm NaF and Calcium Sodium Phosphosilicate [NovaMin]), Group 6: Opalescence Whitening (OW) (1100 ppm NaF and Silica). The toothpastes used in the study are detailed in Table 1. The RDA value of SB was provided by the manufacturer [17] and the RDA values of CEZ [18], CT [18, 19], CPR [19], SRP [19] and OW [20] were provided by previous studys.

Table 1.

Toothpastes used in the study

Toothpastes/Code Ingredients RDA Code
Curaprox Enzycal Zero Fluoride (Curaden International, Switzerland) Aqua, Hydrated Silica, Sorbitol, Glycerin, Steareth-20, Argilla, Titanium Dioxide, Disodium Phosphate, Carrageenan, Sodium Chloride, Aroma, Citric Acid, Sodium Benzoate, Limonene, Amyloglucosidase, Potassium Thiocyanate, Glucose Oxidase, Sodium Bisulfite, Lactoperoxidase, without Fluoride 60 CEZ
Colgate Total 12 (Colgate-Palmolive Company, İstanbul, Turkey)

Glycerin, Aqua, Hydrated Silica, Sodium Lauryl Sulphate, Arginine, Aroma, Zinc Oxide, Cellulose Gum, C 77,891, Poloxamer 407,

Tetrasodium Pyrophosphate, Zinc Citrate, Benzyl Alcohol, Xanthan Gum, Cocamidopropyl Betaine, sodium fluoride (1450ppm), Sodium Acid,

Phosphoric, Sucralose

 70 CT
Splat Biocalcium (Splat Cosmetica, LTD Moscow, Russia) Aqua, Hydrated Silica, Hydrogenated Starch Hydrolysate, Peg-8, Sodium Coco-Sulfate, Cellulose Gum, Aroma, Calcium Lactate, CI 77,891, Sodium Bicarbonate, Sodium Methylparaben, Hydroxapatite, PVP, Sodium Saccharin, Fish Oil, Papain, Limonene, without Fluoride 158 SB
Colgate Pro-Relief (Colgate Palmolive, Osasco, SP, Brazil.) Calcium Carbonate, Water, Sorbitol, Arginine Bicarbonate 8%, Hydrated Silica, Sodium Lauryl Sulfate, Flavor, Cellulose Gum, Sodium Monofluorophosphate, Sodium Bicarbonate, Tetrasodium Pyrophosphate, CI 77,891, Benzyl Alcohol, Sodium Saccharin, Xanthan Gum, sodium fluoride (1450 ppm) 125–135 CPR
Sensodyne Repair and Protection (GlaxoSmithKline, Brentford, Middlesex, UK) Glycerin, Peg-8, Hydrated Silica, Calcium Sodium Phosphosilicate (NovaMin), Cocamidopropyl Betaine, Sodium Methyl Cocoyl Taurate, Titanium Dioxide, Aroma, Carbomer, Sodium Fluoride, Isodium Saccharin, Limonene, sodium fluoride (1450 ppm) 104 SRP

Opalescence Whitening

(Ultradent Products, Inc. Utah, ABD)

Glycerin, distilled water, silica, sorbitol, xylitol,

poloxamer sodium lauryl sulfate, carbomer,

sodium benzoate, sodium fluoride (1100 ppm), sodium hydroxide

sucralose, xanthine gum

 90 OW
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Erosion-tooth brushing-abrasion challenges

The erosive challenges involved immersing the specimens in 0.3% citric acid solution (pH 2.6) for 120 s. After the first and last erosive challenges, abrasion was applied for 15 s using a rechargeable toothbrush (Oral-B Genius 8000, Oral-B Corp, Procter &.

Gamble, Cincinnati, OH, USA) and a slurry of toothpaste (1:3 artificial saliva) under standardized force (2 N) [21]. Following brushing, the specimens were rinsed with distilled water for 5 s and then immersed in artificial saliva (0.213 g/l CaCl22H2O; 0.738 g/l KH2PO4; 1.114 g/l KCl; 0.381 g/l NaCl; 12 g/l Tris buffer, pH adjusted to 7.0 with KOH). Specimens were soaked in artificial saliva overnight after each cycle, which was repeated four times daily for five days [21, 22]. The acid and artificial saliva were replaced after each exposure. All procedures were conducted at room temperature (~ 24 °C), and specimens were stored at 4 °C with relative humidity overnight.

Enamel and dentine surface roughness measurements

Initial and final surface roughness analyzes of all specimens were performed with the 3D surface profilometer New View 7200 (Zygo Corporation, Chicago, USA). The device used in surface roughness analysis is an optical system that performs high-resolution interferometric measurements. This system is equipped with an optical interferometry-based sensor technology capable of detecting surface height variations with micron and nanometer precision. A Gauss filter, compliant with the ISO 16610-21 standard, was used to distinguish the microstructural and macrostructural features of the surface. The cut-off length used in the current study was 0.8 mm. Measurements were taken from 3 points on the long axis of the surface to be examined (long axis of the material and 500 lm bilaterally), and the average of the obtained values was used.

Data analysis

Data were analyzed using IBM SPSS V23 (BM Corp., Armonk, N.Y., USA). Normal distribution was assessed with the Shapiro-Wilk test. The Mann-Whitney U test compared non-normally distributed data between binary groups. The Kruskal-Wallis test compared non- normally distributed data among three or more groups, followed by Bonferroni-corrected multiple comparisons. The Wilcoxon test compared initial and final roughness values. Results were presented as mean ± standard deviation (s.d.) and median (minimum – maximum). Given the non-normal distribution, statistical comparisons used median values with a significance level of p < 0.050.

Results

The initial and final enamel and dentine roughness values were presented in Tables 2 and 3, respectively. Changes in roughness were calculated by subtracting initial values from final values, and are summarized in Table 4. Following the erosive-abrasive cycles, the 3D images that exhibited the most homogeneous wear on the enamel and dentine surfaces, accurately reflecting the experimental conditions, are presented in Figs. 1 and 2, respectively.

Table 2.

Initial and final surface roughness values of the enamel samples

Initial Final
Mean ± SD Median (min. - max.) Mean ± SD Median (min. - max.) p
CEZ 0.959 ± 0.139 0.964 (0.750–1.290) 1.039 ± 0.131 1.001 (0.840–1.310)a 0.008
CT 0.964 ± 0.103 0.961 (0.820–1.210) 0.849 ± 0.077 0.856 (0.710–0.980)b 0.001
SB 0.953 ± 0.055 0.962 (0.870–1.040) 0.855 ± 0.086 0.881 (0.700–0.990)b 0.001
CPR 0.931 ± 0.066 0.946 (0.800–1.010) 0.911 ± 0.063 0.925 (0.760–0.990)ab 0.001
SRP 0.934 ± 0.082 0.965 (0.770–1.030) 0.797 ± 0.119 0.812 (0.630–0.990)b 0.001
OW 0.931 ± 0.105 0.964 (0.760–1.130) 1.043 ± 0.175 1.115 (0.540–1.220)a 0.011
p 0.917 < 0.001
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Different superscript letters indicate statistically significant difference.

Table 3.

Initial and final surface roughness values of the dentine samples

Initial Final
Mean ± SD Median (min. - max.) Mean ± SD Median (min. - max.) p
CEZ 1.716 ± 0.264 1.762 (1.080–1.970) 1.848 ± 0.244 1.941 (1.160–2.070)ac 0.001
CT 1.772 ± 0.155 1.743 (1.450–1.980) 1.634 ± 0.114 1.645 (1.430–1.810)b 0.001
SB 1.802 ± 0.099 1.832 (1.620–1.970) 1.688 ± 0.108 1.673 (1.520–1.910)bc 0.001
CPR 1.735 ± 0.202 1.762 (1.120–1.970) 1.754 ± 0.117 1.765 (1.580–1.950)ab 0.023
SPR 1.780 ± 0.117 1.743 (1.610–1.980) 1.669 ± 0.107 1.660 (1.460–1.860)b 0.001
OW 1.809 ± 0.089 1.808 (1.680–1.960) 1.862 ± 0.089 1.900 (1.710–1.990)a 0.001
p 0.853 < 0.001
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Different superscript letters indicate statistically significant difference.

Table 4.

Roughness change values of different paste groups in enamel and dentine tissue

Enamel Dentine
Mean ± SD Median (min. - max.) Mean ± SD Median (min. - max.) p
CEZ 0.079 ± 0.083 0.100 (-0.160–0.200)a 0.132 ± 0.093 0.110 (0.010–0.340)a 0.285
CT -0.115 ± 0.068 -0.100 (-0.290 - -0.030)b -0.139 ± 0.082 -0.160 (-0.240–0.110)c 0.074
SB -0.098 ± 0.053 -0.100 (-0.190 - -0.010)b -0.114 ± 0.072 -0.090 (-0.270 - -0.020)bc 0.713
CPR -0.021 ± 0.022 -0.010 (-0.090–0.000)ab 0.020 ± 0.198 -0.020 (-0.080–0.730)ab 0.595
SRP -0.137 ± 0.107 -0.120 (-0.340–0.010)b -0.111 ± 0.059 -0.110 (-0.210 - -0.020)bc 0.683
OW 0.112 ± 0.138 0.140 (-0.340–0.270)a 0.053 ± 0.028 0.050 (0.020–0.100)a < 0.001
p < 0.001 < 0.001
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Different superscript letters indicate statistically significant difference.

Negative values indicate a decrease in surface roughness and positive values indicate an increase in surface roughness.

Fig. 1.

Fig. 1

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3D images of enamel specimens after erosive-abrasive cycles

Fig. 2.

Fig. 2

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3D images of dentine specimens after erosive-abrasive cycles

Surface roughness of the enamel specimens

The initial surface roughness of groups were statistically similar (p = 0.917) and showed a significant change in all groups after the erosion/abrasion cycle (p < 0.001).

The highest final roughness values were obtained in the OW group (mean 1.115), while the lowest final roughness values were obtained in the SRP group (mean 0.812).

The highest change in enamel surface roughness was observed in the OW group (0.140 μm increase), and this value was significantly different from those obtained in the CT, SB, and SRP groups (p < 0.001).

The most reduced roughness values were observed in the SRP group (0.120 μm decrease) and this value was significantly different from those obtained in the CEZ and OW groups (p < 0.001).

Surface roughness of the dentine specimens

The statistical analysis showed that the initial dentine roughness values of the groups were similar (p = 0.853) and showed statistically significant change after the erosion/abrasion cycle p < 0.001) decreasing in the CT, SB, and SRP groups and increasing in the groups brushed using other toothpastes.

The highest final roughness values were obtained in the CEZ group (mean 1.941), and this value was significantly different from those obtained in the CT and SRP groups (p = 0.001).

The lowest final roughness value was obtained in the CT group (mean 1.645), and this value was significantly different from those obtained in the SB, CPR, and SRP groups (p = 0.001).

The highest change in dentine surface roughness was observed in the CEZ group (0.110 μm increase), and this value was significantly different from those obtained in the CT, SB, and SRP groups (p < 0.001).

CT group was the one which reduced the surface roughness most (0.160 μm decrease) and showed significantly different values from those obtained in the CEZ, CPR and OW groups (p < 0.001).

Comparison of the enamel and dentine specimens

OW caused a statistically significantly greater increase in roughness on the enamel surfaces than on the dentine surfaces (p < 0.001). The other toothpastes caused statistically similar roughness changes on enamel and dentine surfaces.

Discussion

The current study assessed the impact of different toothpaste formulations on enamel and dentine ETW in vitro. To assess potential clinical scenarios, the toothpastes used in the current study were selected from commercially available products with varying compositions. Particular emphasis was placed on selecting toothpastes that do not specifically claim anti-erosion properties but are frequently preferred by patients. Roughness analysis is recognized as an effective method for detecting early changes in surface texture. Studies indicate that surface roughness can provide valuable insights into alterations in the enamel surface, particularly when exposed to erosive processes [23, 24]. For instance, it has been established that roughness measurements can serve as indicators of initial surface modifications that may occur before significant surface loss is detectable [25]. While surface loss remains a significant parameter in long-term studies, roughness analysis is more applicable for identifying early-stage surface changes and evaluating immediate protective effects in short-term investigations [24, 25]. This assertion is further supported by findings that emphasize the relevance of roughness analysis in assessing early-stage erosive effects [26]. Since the current study was designed as a short-term evaluation, roughness testing was selected to align with the objectives of this research.

Results showed that Curaprox Enzycal Zero Flouride (CEZ) and Opalescence Whitening (OW) increased surface roughness on both enamel and dentine, while Colgate Total 12 (CT), Splat Biocalcium (SB), Colgate ProRelief (CPR), and Sensodyne Repair and Protection (SRP) decreased it. Significant differences among toothpaste groups led to the rejection of the first null hypothesis. The second null hypothesis was also rejected due to statistically significant differences between enamel and dentine in the OW group.

SRP (1450 ppm NaF and novamin) was the toothpaste that reduced enamel and dentine surface roughness the most. Similar to our results, it was reported that fluoride + novamin-containing toothpaste provided statistically similar but higher levels of enamel remineralization than the fluoride-only toothpaste [11]. Novamin accumulates high concentrations of Ca and PO4 on the enamel surface and forms a hyroxycarbonate apatite (HCA) layer. After brushing, novamin particles adhere to the tooth surface and continue to release ions for hours, providing remineralization of enamel and dentine [12]. Novamin has been also reported to reduce dentine permeability, increase mineral content, and improve resistance to acid attacks [27]. Matsuyoshi et al. [28] reported increased microhardness with novamin application, since the deposits filled the enamel prisms and interprismatic spaces. Burwell et al. [29] reported that novamin-containing toothpaste protects dentine against demineralization by forming a tight layer on the enamel surface, that 1000–5000 ppm fluoride alone cannot effectively repair demineralized dentine, but novamin-containing toothpaste (with or without fluoride) repairs and rehardens the lesion. Our study’s success with NovaMin-containing paste aligns with these findings.

According to the results of our study, CPR (1450 ppm NaF and 8% arginine) was the toothpaste that reduced the enamel and dentine surface roughness the least, although the difference between CPR and CT was statistically significant for only dentine tissue. CPR contains arginine which has been reported to help remineralization of tooth surface by ensuring calcium carbonate particles adhere to the enamel and dentine surfaces and allowing them to dissolve slowly [13]. The synergistic effects of arginine with fluorides and calcium in enamel remineralization have also been reported previously [14]. Contrary to our findings, Lavender et al. [30] evaluated the effects of arginine in an in situ study and reported that the use of 1.5% arginine + 1450 ppm fluoride was more effective in preventing demineralization and supporting remineralization than the paste containing only 1450 ppm fluoride.

Researchers explained this fınding by the metabolization of arginine by arginolytic bacteria and the ammonia released by neutralizing the acidic environment that causes demineralization, but this is not the case for in vitro studies. Cheng et al. [14] reported similar remineralization effect of 2.5% arginine with 500-ppm NaF solution than that of control 500- ppm NaF solution on artificial enamel carious lesion; while the enamel fluoride uptake for the arginine-F solution was significantly higher. Bijle et al. [31] examined the remineralization potential of different concentrations of arginine (2, 4 and 8%) in NaF toothpastes and reported incorporation of 2% arginine in NaF toothpaste significantly increased remineralization compared to NaF toothpaste and higher arginine concentrations. Researchers attributed this result to the fact that the increasing chlorine dose with the increase in arginine concentration keeps the arginine in its original form, L-arginine monohydrochloride, and this prevents the necessary interaction with NaF and limits the release of free fluoride ions. The fact CPR used in our study similar, however, it reduced the surface roughness less than other groups could be explained by the high arginine concentration.

Based on the results of our study, CT which contains 1450 ppm fluoride reduced both enamel and dentine surface roughness and had the lowest dentine surface roughness values, while CEZ, which contains no fluoride, increased the surface roughness on the enamel and dentine surfaces, and caused the highest dentine surface roughness values. CEZ contains no fluoride and provides its protective effect against caries by enzymes strengthening the natural defense of saliva. This toothpaste may not have been effective against ETW because it increased the antimicrobial effectiveness by the enzymes rather than improving the resistance of teeth to caries attacks. Moda et al. detected significantly lower calcium and phosphorus concentrations with CEZ compaired to fluoride-containing toothpastes under erosive–abrasive conditions [32]. Ramoz et al. [33] showed a high percentage of open dentinal tubules after the erosive-abrasive challenge with CEZ, mainly because toothpaste CEZ does not contain functional agents capable of inducing tubular occlusion or intratubular mineralization.

The fluoride content of toothpastes is effective in protecting against erosion. The anti-erosive effect of traditional fluorides such as NaF, AmF and SMFP found in toothpastes is associated with the formation of a thick and stable protective CaF2 layer on the enamel surface [34]. Supporting the findings of our study, Hellwig et al. [35] also reported that toothpastes containing fluoride provide higher mineral recovery in enamel and have higher remineralization potential than non-fluorided toothpaste. Gavic et al. [36] evaluated the enamel remineralization capacities of toothpastes with different fluoride concentrations (450.

ppm, 1000 ppm, 1450 ppm fluoride and fluoride-free) and stated that fluoride-free toothpastes reduced microhardness while fluoride-containing ones increased.

It has been shown that the remineralization effect of fluoride-containing compounds is greater on the dentine surface than on the enamel surface. Matrix metalloproteinases (MMP) found in dentine and saliva can chemically degrade the organic matrix of dentine. MMPs are secreted as inactive precursors (pro-forms) that require activation to degrade extracellular matrix components. MMP is activated when pH decreases due to acids. This effect is thought to be effective through inhibition of the MMPs enzyme [37].

Fluoride, known as an MMP inhibitor, reduces the loss of pathological substances by chelating the active parts of enzymes with its electronegativity and taking part in the prevention of collagen destruction [38]. This explains why CEZ is the toothpaste that increases the roughness on the dentine surface more distinct. In addition, the fact that CEZ contains citric acid may be another reason why it is not effective in protecting against ETW. Although several acids have been implicated in dental erosion, it is well established that the demineralization potential of citric acid, which possesses chelating properties, is significantly higher than that of other acids [39]. More studies are needed to clarify this situation.

According to the findings of our study, unlike CEZ, the other non-fluorided toothpate tested, SB reduced enamel and dentine surface roughness. This fact may be attributed to nano-HAP ingredient of SB. Nano-HAPs has been reported to repair microscopic defects by filling the microspaces on the surface and subsurface of the erosive enamel layer. It also provides remineralization by increasing Ca and PO4 mineral density [40]. As to nano-HAP and its association with enamel remineralization, it has been demonstrated that interprismatic and prismatic enamel structures are completely covered by a thick homogeneous apatitic structure consisting of nano-HAP crystals, and cracks and grooves are filled with new apatitic mineral accumulation may be promising to prevent erosive tooth wear [10]. Consistent with our findings, Vyavhare et al. [41] and Daas et al. [42] reported that nano-HAP showed similar remineralization potential with fluoride in the remineralization of initial enamel caries and nano-HAP could be an alternative to fluoride.

Whitening toothpaste OW (1100 ppm fluoride) caused an increase in the roughness of enamel and dentine tissue, but this increase was statistically significantly higher on the enamel surface. This interesting result was also observed by previous studies which showed that collagen- containing dentine may be less susceptible to erosive tooth wear than more highly mineralized enamel, but this prominent difference between enamel and dentine tissue must be further investigated [43, 44].

The abrasive potential of toothpastes may be increased due to the high amount of abrasive particles they contain. Whitening toothpastes may contain more abrasive ingredients than conventional ones to mechanically remove plaque and remove external stains [45]. OW toothpaste shows its whitening effect through an abrasive mechanism (silica). Although its abrasive content is similar to the other pastes used in our study, it is known that the particle size, shape, number, distribution and concentration of the abrasive affect the amount of wear that occurs [46]. However, the manufacturer did not provide any information about these. Joiner et al. [47] compared the abrasive effects of two silica-containing whitening toothpastes and non-whitening toothpaste on enamel and dentine in-vitro and reported that whitening toothpastes had higher but similar abrasiveness compared to toothpaste without whitening effect. Vieira et al. [48] compared different toothpastes in terms of dentine abrasion and showed that whitening toothpastes had a higher abrasive potential than conventional ones.

Contrary to studies [49, 50], which reported that the use of toothpastes with high RDA values may cause loss of dental hard tissues and that there is a positive correlation between the increase in the RDA value of toothpastes and dentine wear, our study did not find a relationship between the RDA values of toothpastes and their abrasiveness. Similar to our results Aykut et al. [51] also reported that the RDA value of toothpaste did not have a significant effect on dentine abrasion.

Since tooth wear is multifactorial and sensitive measurements cannot be made in vivo, it is difficult to predict what RDA values mean in in vitro studies [8]. The remineralization potential of artificial saliva has been previously demonstrated [52]. In our study, specimens were stored in artificial saliva between erosion-abrasion cycles. Regardless of the RDA value, remineralization may have occurred with the ions in artificial saliva and as a result, surface roughness may have decreased.

This study has several limitations that should be considered in the interpretation of the results. It should be noted that this study is an in vitro study and cannot mimic the complex intraoral conditions that lead to erosive tooth wear (ETW). Patient-related factors, such as the pH and buffer capacity of the patient’s saliva and nutritional habits, may influence the amount of ETW that occurs. Additionally, while the application duration and method of toothpaste used in the study were standardized, real-world usage of toothpaste may vary. Factors such as.

individuals’ brushing habits, duration, and pressure may affect the outcomes. Thus, the results of the current study can be used to plan further in situ and clinical studies.

Despite these limitations, our study has important clinical implications. By demonstrating the efficacy of fluoride-containing toothpastes in preventing ETW, the inclusion of novel active ingredients such as nano-HAP and novamin in toothpaste formulations may offer additional benefits in remineralization and strengthening of tooth structure. These findings can guide dental practitioners in recommending appropriate toothpaste formulations for patients at risk of ETW.

Conclusion

Within the limitations of this in vitro study it can be concluded that;

  1. Whitening toothpaste increased enamel and dentine surface roughness,

  2. Whitening toothpaste caused a greater increase in enamel surface roughness than dentine,

  3. Toothpastes containing fluoride, fluoride + novamine, fluoride + arginine have demonstrated efficacy in the prevention of dental erosion.

  4. The protective properties of fluoride-free toothpastes vary depending on their active ingredient,

  5. Toothpastes containing Nano-HAP demonstrate potential efficacy in preventing ETW, even if they contain no fluoride. However, fluoride remains the gold standard in the prevention of ETW. Therefore, Nano-HAP toothpastes may serve as an alternative for patients for whom fluoride use is not indicated and who are skeptical of fluoride use.

Author contributions

B.K.K.K. contributed to conception, design, data acquisition and interpretation, drafted and critically revised the manuscript. E.K. contributed to conception, design, data acquisition and interpretation, and critically revised the manuscript. All authors reviewed the manuscript.

Funding

Financial support for the study was provided by the authors.

Data availability

All data on the initial and final surface roughness values of the enamel and dentine samples supporting the findings of this study are included in the following link: https://1drv.ms/x/s!AqAfktYsmTmJgvVNlyXPUhwpEev_Aw. The data is securely stored on the Microsoft OneDrive platform and can be accessed via the provided link.

Declarations

Ethics approval and consent to participate

Since the study protocol is an in vitro study, it does not require ethical approval.

Competing interests

The authors declare no competing interests.

Footnotes

This thesis study was presented orally at the Turkish Dental Association 27th International Dental Congress, 26–29 October 2023, Ankara, Turkey.

Publisher’s note

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References

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

All data on the initial and final surface roughness values of the enamel and dentine samples supporting the findings of this study are included in the following link: https://1drv.ms/x/s!AqAfktYsmTmJgvVNlyXPUhwpEev_Aw. The data is securely stored on the Microsoft OneDrive platform and can be accessed via the provided link.

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