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Use of stabilized stannous fluoride in the dental diseases prevention in young people
Marchenko Natalia Serheyevna, Private Higher Education Establishment "Kyiv Medical University of UAFM" Postgraduate student, the Faculty of Therapeutic Dentistry
E-mail: Natasha_email@ukr.net
Use of stabilized stannous fluoride in the dental diseases prevention in young people
Abstract: The author investigated and presented the literature deals with the use of stabilized stannous fluoride which includes oral care products, their effectiveness of prevention and treatment of common dental diseases.
Keywords: stabilized stannous fluoride, dentifrice, dental caries, periodontal disease, dentine
hypersensitivity, prevention.
Introduction. Nowadays one of the current problem is to preserve dental health of young people, namely keeping children and youth's teeth healthy, which determines their status in the following age periods [1, 285-287; 2, 52-53]. At present, the degree of prevalence of dental caries and periodontal diseases take the top spot among all dental diseases, they affect about 92-98% of the population of Ukraine [3].
The WHO has available data on the incidence of dental epidemiology and organization of dental services in most countries of the world. It has also highlighted the key ages [3; 6; 12; 15, 35-44, 6574 years old], at which the survey for the dental status is conducted under special program in different countries. According to the UNO definition, youth is the age group of 16-25. This category also includes students. The WHO states it is not attributed to groups of key epidemiological survey. According to the data of Kytsul Y. S. (2006) and Casas M. J. (2003), maximum morbidity and loss of dental health is still developed at the age of 15-35. Therefore, data on the prevalence and intensity of caries should be included into a group of important parameters for designing methods of prevention and assessment of oral health. It is the prevention which remains a priority and cost-effective way to maintain dental health in terms of economic reforms. The most appropriate option in this case can be a rational oral hygiene with the use of directed action agents that is one of the effective methods of mass and individual prevention of dental caries.
The aim of the research was to study the literature, to search and analyze the sources regarding clinical efficiency of treatment and prevention of major dental diseases with agents of oral care, such as toothpastes containing stabilized stannous fluoride.
Materials and methods. Literature search has been conducted among the library sources, searching systems PubMed, Google Scholar, Cyber Leninka, as well as electronic archives of domestic and foreign medical publications.
The results of the study. Caries and periodontal disease are the most common dental diseases of our time. Studying the causes of high prevalence of dental diseases is a subject of a number of local and foreign scientists' researches [4, 109-117]. The main etiological factors are: oral microflora, nutrition, fluoride contents in water, quantitative and qualitative composition of saliva, overall health, and extreme effects on the body [5, 25-26].
Taking into account that the main cause of dental caries and periodontal tissues disease is a soft plaque — the product of oral microflora, the most effective are preventive methods affecting the cause of the disease. Therefore, the focus of prevention should be directed to individual oral hygiene, aimed at eliminating the causes of oral diseases [6, 2-32; 7, 7-808; 8, 27-30].
Regular individual hygiene provides oral health by 85-90% and is an important component in the prevention of dental diseases [9, 66-69]. After investigation and determining the index of hygiene, it's necessary to amend it, to manage
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an additional training, to recommend specific toothbrushes and to hold the control.
Today toothpaste is the most common means of oral care. Particularly noteworthy are fluoride toothpastes, which usage in 2000 increased by 29.7% throughout the world. In the USA fluoride toothpastes use is 95% [12, 1-9]. In some countries (the Netherlands) to sell toothpaste containing no fluoride is even forbidden.
According to the data, with regular using fluoride toothpastes caries reduction growth is 25-40%. Fluoride in a toothpaste composition shows its effect not only through direct contact with the surface of the tooth — it also accumulates in dental plaque, where Str. mutans is known to accumulate, thus compensating the insufficient cleaning the tooth surface.
Both from scientific and practical point of view, tin fluoride is of greatest interest of all fluoride compounds. Tin fluoride is a source of fluoride, endorsed by the US Food and Drug Administration, FDA. SnF2 is a single fluoride product with anticaries, antibacterial and hyposensitive properties able to fight plaque, periodontal disease and caries of tooth enamel [14, 742-748]. The forms of the first products containing SnF2 in its composition had several disadvantages: they caused astringent sensation in the patients' mouth and stained teeth enamel into brown or even black, as tin fluoride has a low stability and is easily hydrolyzed. These drawbacks limited the widespread use of fluoride tin for decades. With the advent of new technologies and systems based on dry hydrolysis, the ability to stabilize the divalent tin fluoride (II) in the composition of oral care agents by preventing its hydrolysis, oxidation and avoiding loss of bioavailability, by adding ether of organic acid, appeared. In 2004 Procter & Gamble Company received a licence for stabilizing tin fluoride in the tooth paste by adding sodium hexametaphosphate. In 2005 tin fluoride sodium hexametaphosphate (SFSH) was introduced into the composition of the toothpaste as a separate ingredient to combat surface staining and reduced formation of bacterial plaque [15, 1-4]. By stabilizing tin fluoride with polypyrophosphates, pronounced clinical effect and
antibacterial properties are evident. In this regard, in recent years broad opportunities for the introduction of this compound into clinical practice have been offered [16, 24-28].
It is a combination of physic, chemical and antimicrobial effects of SnF2 which is a basis of anti-caries action [17, 122-128]. Stannous fluoride (II) in conjunction with enamel hydroxyapatite Ca5 (PO4) 3OH forms more resistant to acidic environment fluorapatite by rapid forming deposits of tin enamel Sn2 (PO4) OH, which inhibits the superficial demineralization and promotes remineralization of damaged enamel structures. In addition, tin fluoride has an ability to inhibit the activity of cariogenic microorganism Streptococcus Mutans. Before the introduction of tin fluoride sodium hexametaphosphate (SFSH) into the toothpaste composition a lot of clinical studies were made confirming the high efficiency of tin fluoride to fight tooth decay. Stookey G. K. with co-authors (2004) conducted a large clinical trial of955 people to study anti-caries effect compared with early prototype of divalent SFSH toothpaste with positive control of standard feed sodium fluoride with high fluoride content (2800 ppm F) and its low content (500 ppm F). Using clinical and radiographic methods of investigation at the beginning, after 12 and 24 months of use reduction of caries using toothpaste with SFSH by 17% and 25% respectively, and toothpaste with high fluoride content — by 13% and 23%, compared with the control group with low fluoride, was found out.
In the research of mineralization and demineralization in situ Wheel J. S. (2002) determines that the bivalent tin fluoride/sodium hexametaphosphate in the toothpaste has an excellent anti-caries action, while hexametaphosphate sodium does not reduce an anti-caries action of tin fluoride.
A series of studies of Pfarrer I. M. (2005) in vitro claims on anti-caries potential of tin fluoride due to its absorption and accumulation in the demineralized enamel. In experimental and clinical study of pH-cycle components of tin fluoride/sodium hexametaphosphate toothpastes have a strong protective effect against comprehensive primary demineralized enamel lesions and their subsequent
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Use of stabilized stannous fluoride in the dental diseases prevention in young people
progression [18, 41-46].
Goriacheva V. V. (2013), in the study of the toothpaste containing stabilized sodium hexametaphosphate stannous fluoride (0.454%) in children older than 12, established the remineralization of demineralized areas of enamel, after a month average index of demineralization lesions, stained with a solution of methylene blue, reached 20 points, DMF index decreased from 0.9 ± 0.28 to 0.1 ± 0.05 (p = 0.004).
Foreign researches by Arhilla L. (2005), Mankodi S. (2005), Makin [19] show antimicrobial properties of stannous fluoride and its ability to inhibit the metabolism of plaque microorganisms either related to cariogenic or parodontopathogenic oral microflora [19, 3-9]. The antibacterial effect of fluoride compounds is realized due to reducing the amount of organic acids formation by microorganisms, by hindering the regulation of intracellular metabolism and membrane transport impair and the adhesion of microorganisms on the surface of teeth.
The antimicrobial effectiveness of tin fluoride toothpaste has been investigated for its effect on the activity of microorganisms using confocal scanning laser microscopy (CSLM). According to Busscher (2008), the total number of non-vital plaque after using toothpaste with SnF2 (0,454%) has become 71%.
Bellamy (2008, 2014) investigated comparative study of antibacterial action of the toothpaste with SnF2 and the toothpaste with chlorhexidine. Due to modern method of the digital analysis of the dental deposit (DPIA), which is used for quantative evaluation of deposit formation in vivo, it has been proved the decrease of dental plaque was in 25,6% by using toothpaste with SnF2, than with chlorhexidine one. It has been known antimicrobial action of chlorhexidine in the toothpaste was decreased or absent that contains sodium lauryl ether sulfate [20, 117-123].
Also Gunsolley J. C. (2006) defined the intensity of stannous fluoride on bacteria metabolism [21, 1649-1657]. Bellamy PJ. with co-author (2014) in randomizated clinical research of comparative evaluation of an effectiveness of inhibition of dental
plaque by using toothpaste with fluoride sodium or potassium and toothpaste with stabilized stannous fluoride sodium hexametaphosphate manifested that to use a toothpaste with SnF2/SHMP enamel covering of dental plaque is smaller in 23,0%, than with with NaF/KNO3.
Eversole S. L. with co-author (2014) compared modern means for teeth cleaning and brushing with stabilized stannous fluoride, sodium, and sodium monofluorophosphate in order to prevent erosions on the surface of enamel, produced in lab conditions at 1% acidic etching by citric acid, potentially dangerous acid that contains in products and drinks. Authors defined that means with stabilized stannous fluoride have increased enamel protection in comparison with other toothpastes [22, 22-28].
Petersson L. G. (2013) determined high activity of toothpaste with stannous fluoride to inhibit the demineralization of the tooth root. Besides, SnF2 prevents wedge-shaped defects of the enamel of the tooth neck, during cleaning deminiralized surfaces of dentin [23, 1505-1514].
Archilla L. (2005), Boyd R. L. (1994), Beiswanger B. B. (1995), Ciancio S. G. (1992), Chitke U. M. (1991), Mallat M. (2007), Mankodi S. (2005), Perlich M. A. (1995), TinanoffN. (1989), Williams C. (1997) manifested the influence 0,454% of stannous fluoride on the reduction of dental plaque, gingivitis and gum bleeding and they demonstrated that during three, six, twelve and eighteen months the reduction of gingivitis contains from 20,5% to 54%, dental plaque from 3% to 55%, bleeding gums from 27,4% to 57% (according to author’s researches).
Papas A. (2007) in researches manifested high level ofan effectiveness ofthe stannous fluoride in the prevention main dental diseases among 330 people, that suffer from xerostomia or have increased dryness from different reasons (drug-induced xerostomia), and also its ability to remineralize the caries of the root.
Results demonstrated means with stabilized stannous fluoride (sodium hexametaphosphate) which are used daily twice per day, demonstrate the advantages in the reduction of the depth of periodontal pockets, recession, bleeding gums,
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and also better indices of caries remineralization in comparison with з fluoride triclosan toothpaste. So, saliva content changes due to the increase of acidity in the oral cavity, it causes the risk of caries and leads to candidiasis in patients who suffer from xerostomia [24]. Villa A. and Abati S. (2011) defined xerostomia in 19,6% (117 people) among 601 examined people, that it is manifested by dryness of the mucous membrane of the oral cavity, lips, skin and eyes. It has been established that these symptoms appear with the age and during the intake of drugs and the usage of removable dentures [25, 811-816].
Researches of scanning electronic microscope demonstrated there are dental plaques in dentinal tubules in the result SnF2 reaction with the dentine surface.
White D. J. (2007) confirms SnF2 has the ability to protect open dentinal tubules by chemical precipitation, which prevents its opening at acidic etching in the research in vitro [26, 55-9]. So the mechanism of analgesic action of SnF2 is connected with the obturation of dentinal tubules that excludes the ability to irritate mechanoreceptors that cause the pain during the hyperesthesia. SnF2 toothpaste prevents the uncovering of dentinal tubules in the dentin layer and its softening at acidic factor. SchiffT. (2006), noted in order to achieve clinical improvement of teeth hypersensitivity it is necessary and enough to use toothpaste with SnF2 during several weeks. Не Т. (2011) in randomizated research which was done in China determined and proved the effectiveness of hyposensitizated action of toothpaste with fluoride after three days. [27, 46-50]. Such scientists as Qaqish J. and Sharma N. (2014) determined the next factors: according to the tactile sensitivity (Yeaple Probe) and the temperature sensitivity of dentine (Schiff Air Index), during two and eight months toothpaste use with 0,454% SnF2 and 0,32%
NaF/triclosan, in 97 people. Means with 0,454% SnF2 demonstrated high clinical effectiveness of tactile (184%) and temperature sensitivity of dentine decrease (68%) according to the statistic data (p<0,0001), in comparison with NaF/triclosan [28, 13-18].
SnF2 helps to reduce bacteria in the oral cavity that causes bad breath. Halitosis is caused by gram-negative anaerobic bacteria of oral cavity, which are located on the tongue. In the process of decomposition by bacteria of food amino acid, there are different volatile compounds of sulfur. Van den Broek A.M (2007), Farrell S. (2007), Zhang Y (2008), He T. (2010), Nachnani S. (2008) manifested the inhibition of these bacteria by stabilized stannous fluoride causes minimal formation ofvolatile compounds of sulfur that leads to the breath freshness. [29].
Nowadays there is the market demand to teeth bleaching means and SFSH. It has advantages not only as main dental disease fighter and also it is an effective means in the bleaching of superficial spots at external enamel staining and continued inhibition of new chromogenic adsorption [30, 309-314]. The effectiveness of stained spots on the enamel surface contains 96,6% in researches of vestibular and oral surfaces of the twelfth frontal teeth after two-week SnF2 usage due to clinical evaluation in the modification Loben. In general it is necessary to indicate stannous fluoride sodium hexametaphosphate for oral hygiene has not only advantages to save oral health and also responds to cosmetic needs of patients.
Conclusion: Considering peculiarities of ethiopathogenetic and the influence of toothpastes with stabilized stannous fluoride on the development main dental diseases and marked clinical effect there are wide aspects of their usage for caries and periodontal diseases prevention among young people.
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Ponomarev Sergey Borisovich, Research Institute of the Federal Penitentiary Service of Russia, head of the branch (Izhevsk), MD, Professor E-mail: docmedsb@mail.ru Burt Albina Anasovna, Research Institute of the Federal Penitentiary Service of Russia, Leading Researcher of the branch (Izhevsk), PhD E-mail: albinaburt@mail.ru
Description of the prison social deprivation syndrome: clinical aspects
Abstract: Research prison health correlates of stress lead to the statistically valid conclusion: in a prison social isolation, along with deep mental disorder of convicted person also observed global changes in basic physiological regulatory systems. Changes to such a specific, have been described as independent syndrome, called by us the syndrome of prison social deprivation.
Keywords: prisoners, prison social deprivation, penitentiary stress, maladjustment.
As you know, the conditions of detention of prisoners in the penal system are characterized by strict regulation of behavior, coupled with the continuous influence of criminal society, restriction of freedom — social deprivation, isolation from family and convict the usual social environment of existence.
Influenced by significant strength and duration of internal and external stimuli, or more precisely, under chronic stress are consistently condemned in all its development stage adaptation syndrome. And if in the life around us influence of external stimuli on the body are often short and ends, mostly, his functional rehabilitation on some new level
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