In Vitro Analysis of Fluoride Release from Toothpastes Used in Public Health Caries Prevention Programs

ABSTRACT

Introduction:

A major worldwide health concern still is dental cavities, and fluoride is acknowledged as a successful preventive tool. Public health campaigns widely distribute toothpastes enriched with fluoride to lower caries prevalence.

Materials and Methods:

The fluoride release capability of various compositions determines their efficiency. The purpose of this study is to investigate the fluoride release from different readily available toothpastes used in these initiatives.

Results:

To track fluoride leakage over time, an in vitro experiment was conducted.

Conclusion:

The data clarify how well these formulations stop cavities.

INTRODUCTION

Recent studies on dental caries in several developed nations show a declining frequency, mostly due to the many kinds of fluorides’ administration.[1,2] Still, dental caries is a common condition in many undeveloped and emerging countries in Africa and Asia, including India, caused by changing dietary patterns, inadequate public understanding and motivation, and limited dental care resources.[3] One of the most successful approaches for caries prevention still is the use of fluorides in several forms.[2]

Public health campaigns meant to lower dental cavities depend on fluoride toothpaste as a basic component.[4] Emphasizing their bioavailability and likely efficacy, this study evaluates the fluoride release from numerous toothpaste formulations used in caries prevention programs.

Only toothpaste with 1000 ppm fluoride or higher shows an anti-caries effect, according to a recent comprehensive review of the literature. This has made the criterion that toothpaste must have soluble fluoride in its formulas.[2] By means of in vitro techniques, the study investigated fluoride levels and release mechanisms, therefore providing an understanding of their relevance for public health needs.

MATERIALS AND METHODS

Five commercially sold fluoride toothpastes—often used in public health caries prevention programs—were chosen. An ion-selective electrode helped to evaluate the fluoride concentration. The samples were produced by dissolving toothpaste slabs in deionized water under 37°C. Over one hour, 24 hours, and seven days, fluorine leakage was measured.

RESULTS

Table 1 captures the fluoride release data from many toothpaste companies.

Table 1.

Fluoride release (ppm) across time from various toothpaste brands

Toothpaste brand	1 Hour	24 Hours	7 Days
Pepsodent germicheck	977	1090	1114
Colgate total 12	890	1200	1300
Colgate cavity protection	1567	1656	1690
Close up	978	1098	1200
Pepsodent gum care	879	900	910

The results show very different fluoride release among the several toothpaste brands under evaluation.

DISCUSSION

The extensive use of fluorides in both systemic and topical formulations has contributed to a substantial decrease in dental caries in industrialized nations over the past few decades.[5,6] Fluoride toothpaste is the most frequently used topical delivery vehicle. The utilization of fluoride toothpaste for tooth cleansing has become an essential public health strategy for the prevention of dental caries.[5] Fluoride toothpaste is the primary topical fluoride delivery mechanism, with an estimated 500 million individuals worldwide utilizing it.[7]

Fluoride is incorporated into a variety of products, such as toothpastes and oral rinses, due to its the ability to prevent dental cavities. The topical action of fluoride on dental surfaces provides protection through the consistent use of toothpaste. Fluoride primarily interacts with the plaque/tooth system through four mechanisms: promoting the remineralization of early lesions, diminishing enamel solubility, preventing mineral dissolution, and inhibiting acid generation by plaque bacteria.[7,8,9] A sufficient concentration of soluble fluoride is required for fluoridated toothpaste to effectively reduce dental cavities. However, the toothpaste’s total fluoride content is not wholly accessible due to the potential for certain fluoride compounds to form a bond with the abrasives in the formulation.[10] The evaluation of fluoride in toothpastes is germane due to potential discrepancies between manufacturer-reported and physiologically active fluoride levels for caries prevention.[11]

The dubious anti-caries efficacy of fluoridated toothpaste has been demonstrated in prior research from multiple global regions, which is attributable to the insufficient amount of free, accessible fluoride. Inconsistencies were observed in the assessment of total and free fluoride concentrations in toothpaste that was accessible in Gambia (West Africa).[12] In a similar study, it was found that the free fluoride concentrations in toothpaste produced in Tanzania were below the optimal range for the prevention of dental cavities.[13] The effectiveness of anti-caries will be compromised by the discrepancy between the fluoride concentrations reported by the manufacturer and the actual fluoride concentrations. Consequently, it is imperative to implement consistent monitoring and regulation of products such as toothpaste.[11]

Colgate cavity protection exhibited the highest fluoride emission, which could potentially increase the efficacy of its anticaries. Pepsodent gum care has implemented the lowest fluoride concentrations, which may undermine its preventive efficacy. Variations in formulation, including pH, fluoride source, and excipients, may account for the observed discrepancies.

In contrast to toothpastes with 250 ppm fluoride, Wong et al.[14] discovered evidence supporting the caries-preventive effect of toothpaste with 1000 ppm fluoride or higher in a Cochrane review. Consequently, it is essential that fluoride toothpastes contain a sufficient amount of free, accessible fluoride to ensure their efficacy.[15] Our investigation suggests that the efficacy of certain toothpaste samples in reducing dental cavities may be compromised due to their insufficient fluoride concentrations. This will increase the vulnerability of our population to a public health issue, particularly in areas where the consumption of fluoride through potable water is unbalanced.

To address the inadequate quality control and noncompliance among toothpaste manufacturers, it is imperative that a robust national regulatory authority for drugs and consumer products be established in our country. Additionally, these entities may be responsible for ensuring that fluoride products available on the market comply with minimal labeling and packaging standards.

CONCLUSION

The study emphasizes the differences in fluoride release among the toothpaste products sold in the market used in public health campaigns. The choice of toothpaste should give fluoride bioavailability top priority above just the suggested fluoride concentration. Further studies are needed to study other elements influencing fluoride release and retention in the oral cavity and to evaluate the long-term effects of these formulations on caries prevention. Given the inadequate available fluoride, several toothpaste samples in our study may show questionable anti-caries efficacy. This emphasizes the need for regulation over the evaluation of fluoride levels in dental products in underdeveloped countries like India.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.