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Monographs in Oral Science 23


Bearbeitet von
C. van Loveren, M.C.D.N.J.M. Huysmans, A. Lussi, H.-P. Weber

1. Auflage 2013. Buch. VIII, 158 S. Hardcover

ISBN 978 3 318 02206 3
Gewicht: 660 g

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Monographs in Oral Science
Vol. 23

Series Editors

M.C.D.N.J.M Huysmans Nijmegen

A. Lussi Bern
H.-P. Weber Boston, Mass. - 7/11/2013 1:05:25 PM

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Volume Editor

Cor van Loveren Amsterdam

18 figures, 9 in color, and 20 tables, 2013

Basel · Freiburg · Paris · London · New York · New Delhi · Bangkok ·

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Cor van Loveren
Department of Preventive Dentistry
Academic Center for Dentistry Amsterdam (ACTA)
University of Amsterdam and VU University
Gustav Mahlerlaan 3004
NL–1081 LA Amsterdam (The Netherlands)

This volume received generous financial support from

Library of Congress Cataloging-in-Publication Data

Toothpastes / volume editor, Cor van Loveren.

p. ; cm. -- (Monographs in oral science, ISSN 0077-0892 ; vol. 23)
Includes bibliographical references and indexes.
ISBN 978-3-318-02206-3 (hard cover : alk. paper) -- ISBN 978-3-318-02207-0
I. Loveren, Cor van, editor of compilation. II. Series: Monographs in oral
science ; v. 23. 0077-0892
[DNLM: 1. Toothpastes. 2. Tooth Diseases--therapy. 3. Toothbrushing.
W1 MO568E v.23 2013 / WU 113]

Bibliographic Indices. This publication is listed in bibliographic services, including MEDLINE/Pubmed.

Disclaimer. The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of
the publisher and the editor(s). The appearance of advertisements in the book is not a warranty, endorsement, or approval of the products or
services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or
property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
Drug Dosage. The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord
with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations,
and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for
any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a
new and/or infrequently employed drug.
All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means electronic
or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing
from the publisher.
© Copyright 2013 by S. Karger AG, P.O. Box, CH–4009 Basel (Switzerland)
Printed in Switzerland on acid-free and non-aging paper (ISO 9706) by Reinhardt Druck, Basel
ISSN 0077–0892
e-ISSN 1662–3843
ISBN 978–3–318–02206–3
e-ISBN 978–3–318–02207–0 - 7/11/2013 1:05:25 PM
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VII Preface
van Loveren, C. (Amsterdam)

1 An Introduction to Toothpaste – Its Purpose, History and Ingredients

Lippert, F. (Indianapolis, Ind.)
15 Fluorides and Non-Fluoride Remineralization Systems
Amaechi, B.T. (San Antonio, Tex.); van Loveren, C. (Amsterdam)
27 Antiplaque and Antigingivitis Toothpastes
Sanz, M.; Serrano, J.; Iniesta, M.; Santa Cruz, I.; Herrera, D. (Madrid)
45 The Role of Toothpastes in Oral Malodor Management
Dadamio, J.; Laleman, I.; Quirynen, M. (Leuven)
61 Anti-Calculus and Whitening Toothpastes
van Loveren, C. (Amsterdam); Duckworth, R.M. (Newcastle upon Tyne)
75 The Role of Toothpaste in the Aetiology and Treatment of Dentine Hypersensitivity
Addy, M.; West, N.X. (Bristol)
88 Toothpaste and Erosion
Ganss, C.; Schulze, K.; Schlueter, N. (Giessen)
100 Abrasivity Testing of Dentifrices – Challenges and Current State of the Art
González-Cabezas, C. (Ann Arbor, Mich.); Hara, A.T. (Indianapolis, Ind.); Hefferren, J. (Lawrence, Kans.);
Lippert, F. (Indianapolis, Ind.)
108 Laboratory and Human Studies to Estimate Anticaries Efficacy of Fluoride Toothpastes
Tenuta, L.M.A.; Cury, J.A. (Piracicaba)
125 Pharmacokinetics in the Oral Cavity: Fluoride and Other Active Ingredients
Duckworth, R.M. (Newcastle upon Tyne)
140 After-Brush Rinsing Protocols, Frequency of Toothpaste Use: Fluoride and Other Active
Parnell, C.; O’Mullane, D. (Cork)

154 Author Index

155 Subject Index - 7/11/2013 1:05:25 PM

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The editors of the Monographs in Oral Science ity. The cosmetic effect of toothpastes improved as
series asked me whether it would be worthwhile a result of tailored abrasives to clean and whiten
to produce a volume on toothpaste. I could only teeth, ingredients to facilitate removal and preven-
give a resounding ‘Yes!’ because I always notice tion of extrinsic stain, flavours for the purpose of
that most dentists and many dental researchers breath freshening and dyes for better visual appeal.
are unaware of the complexity of toothpastes and The development and promotion of these latter
the science that goes into them. Questions about ‘cosmetic’ toothpastes fits into a switch in empha-
the relative effectiveness of different toothpastes sis in dental practice and among patients to cos-
are often vaguely answered. Furthermore, the last metic dentistry and may therefore have an impor-
comparable publication dated from 1992. tant function in stimulating consumers to use the
Although used for several thousand years, den- pastes. However, this shift in emphasis from thera-
tifrices have evolved rapidly over the last century peutic toothpastes to ones marketed for their cos-
from suspensions of crushed egg shells or ashes metic benefits should not lead to the notion that
used by the ancient Egyptians and toothpowders such cosmetic benefits are more important than
of the 19th century to the complex toothpaste for- the therapeutic ones. Consumers should continue
mulations of today. A landmark was the wide- to realize that the first and global goal of using
spread mass-marketed introduction of fluoride in toothpaste is to fight caries: still the most prevalent
toothpaste in the 1950s. From then on, tooth- oral disease. Other functions should not jeopar-
brushing with fluoridated toothpaste became in- dize this important task.
dispensable for good oral health. The use of tooth- Toothpastes have become truly multi-func-
pastes had no longer only a cosmetic but also a tional due to the incorporation of a range of active
therapeutic effect. Fancy packaging, a variety of ingredients that aim to combat a variety of oral
flavours and colours and commercials emphasis- diseases and conditions and to provide cosmetic
ing the benefits made oral hygiene attractive for benefits. To be effective, such ingredients need to
consumers, with a pivotal role for toothpaste as it be delivered to the mouth and ideally be retained
combines the delivery of active ingredients with at target sites for as long as possible. Effective
the mechanical removal of dental plaque and food toothpastes are those that are formulated for max-
debris during use. Manufacturers have continu- imum bioavailability of their actives. This, how-
ously improved formulations for better fluoride ever, can be challenging as compromises have to
bioavailability, and also included other active be made when several different actives are formu-
‘therapeutic’ ingredients to fight gum disease, mal- lated in one phase. Toothpaste development is by
odour, calculus, erosion and dentin hypersensitiv- no means complete as many challenges and espe- - 7/11/2013 1:05:25 PM

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cially sub-optimal oral substantivity of active in- proper understanding of the wider validity of these
gredients are yet to be overcome. Therefore, trans- outcomes is of paramount importance. For thera-
parent quality control of manufacture to confirm peutic claims that cannot be directly checked by
the bioavailability of the ingredients is essential to consumers themselves, scientific evidence is es-
support the credibility of efficacy claims. In this sential; for cosmetic claims, subjective experience
respect, established brands may be preferred over and appreciation may be overriding.
generic products. The intra-oral retention or sub- As editor of this monograph, I was lucky to
stantivity of active ingredients in toothpastes is find so many distinguished colleagues willing to
not only influenced by product-related but also by contribute their time and expertise. On behalf of
user-related factors. The latter factors include bio- myself and all readers, I would like to thank them
logical aspects such as salivary flow and salivary for their hard labour and their willingness to
clearance, and behavioural aspects, such as fre- share their knowledge with us. The monograph is
quency and duration of brushing, amount of structured such that after a general introduction
toothpaste used and post-brushing rinsing behav- on the purpose, history and composition of tooth-
iour. Whilst product-related factors are funda- paste, six chapters deal mainly with the clinical
mental to the intrinsic efficacy of toothpaste, the evidence of effectiveness in caries prevention, in
user-related factors have the potential to signifi- reducing and preventing plaque, gingivitis, and
cantly enhance or reduce effectiveness. halitosis, in preventing calculus formation, in fa-
Dentists are often asked about which tooth- cilitating removal and prevention of extrinsic
pastes are the best or about the benefits of specific stain, and in preventing dentine hypersensitivity
ingredients. Furthermore, dentists want to advise and erosion. Later chapters deal with important
their patients on the best way to use toothpaste. issues that contribute to our understanding of
After reading this book the dentist, and more gen- why toothpastes do what they do. The relevant
erally all those who want to advise on the use of topics are the abrasiveness of the pastes, the sub-
toothpaste, will be able to do so in an evidence- stantivity of active ingredients in the oral cavity
based manner. There are head-to-head compari- and the possible models to study effectiveness
sons of the effectiveness of toothpaste, but such when full-scale clinical trials are not possible. The
comparisons are not available for all possible com- last chapter focuses on two of the user-related fac-
parisons. It is not realistic to expect or demand tors that have been most widely studied: frequen-
head-to-head comparisons on all possible claims. cy of toothbrushing and post-brushing rinsing
Furthermore, head-to-head comparisons can be behaviour.
outdated because by the time the results are pub- Whether for those new to the field or for the
lished manufacturers may have changed a poorly established worker, this monograph will prove to
performing formulation. The limited number of be a most valuable resource of the available
such comparisons in relation to the large number knowledge on toothpaste effectiveness.
of brands, types and claims of toothpastes implies Finally, I would like to thank Colgate and
that many answers will have to be given based on GABA for supporting the release of this book.
short-term clinical studies (e.g. 4-day plaque
growth studies) or on model in vitro studies. A Cor van Loveren, Amsterdam - 7/11/2013 1:05:25 PM

VIII Preface
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