Scientific Article Review:

Comparative Efficacy of a Hydroxyapatite and a Fluoride Toothpaste for Prevention and Remineralization of Dental Caries in Children

Published In: British Dental Journal
Year: 2019

Study Design

The study is a double-blind, randomized, crossover, controlled in situ trial. It was designed to evaluate and compare the effectiveness of a toothpaste containing 10% hydroxyapatite (HAP) with a toothpaste containing 500 ppm fluoride for remineralizing initial caries lesions and preventing demineralization.

Funding

The study does not explicitly mention funding sources but acknowledges statistical assistance and declares no competing interests.

PICO Framework - what was studied and how?

• Population: Children’s enamel surfaces (artificially produced caries and sound enamel) in an in situ model.
• Intervention: Toothpaste containing 10% hydroxyapatite (nHA).
• Comparison: Toothpaste containing 500 ppm fluoride as amine fluoride (AMF).
• Outcome: Remineralization of caries lesions and prevention of enamel demineralization.

In Paragraph Format:
This study investigated whether a hydroxyapatite toothpaste is as effective as a fluoride toothpaste in promoting remineralization of artificially created caries lesions and preventing demineralization of sound enamel in children's teeth using an in situ model.

Inclusion and Exclusion Criteria

Inclusion Criteria:

• Adults aged 18–60 years.
• Normal salivary function (unstimulated flow ≥ 0.2 ml/min, stimulated flow ≥ 0.7 ml/min).
• No active caries and at least 20 natural teeth.
• Willingness to use only assigned products during the study period.

Exclusion Criteria:

• Periodontal disease or oral pathology.
• Antibiotic use one month prior to or during the study.
• Pregnancy or breastfeeding.
• Tobacco use.

Demographics and Cohorts

• Participants: 30 adults (19 females, 11 males).
• Mean Age: 39.5 years.
• Ethnic Distribution: 57% Hispanic, 23% White, 10% Black, 3% Asian, 7% other.

The study used 30 participants in a crossover design, each exposed to both intervention and comparison toothpastes over distinct phases.

Results

1. Remineralization:
   • Hydroxyapatite toothpaste: 55.8% mean remineralization (SD: 13.8).
   • Fluoride toothpaste: 56.9% mean remineralization (SD: 14.9).
   • Statistical Comparison: No significant difference (p = 0.81).
2. Lesion Depth Reduction:
   • Hydroxyapatite toothpaste: 27.1% mean reduction (SD: 10.6).
   • Fluoride toothpaste: 28.4% mean reduction (SD: 9.8).
   • Statistical Comparison: No significant difference (p = 0.68).

Both toothpastes showed significant remineralization and lesion depth reduction compared to baseline (p < 0.0001 for both).

Conclusions

The study confirmed that toothpaste containing 10% hydroxyapatite is non-inferior to fluoride toothpaste in remineralizing early caries and preventing enamel demineralization. Hydroxyapatite toothpaste offers an effective alternative to fluoride, with the potential for higher dosing without safety concerns such as fluorosis.

Discussion

Strengths:

• Controlled Design: The crossover model minimized inter-individual variability.
• In Situ Relevance: Human enamel samples in real-life conditions provide meaningful insights.

Weaknesses:

• The study is limited by its in situ nature and short duration (14 days per phase).
• The findings need confirmation in broader and longer-term clinical trials involving children.

Citation

Amaechi BT, AbdulAzees PA, Alshareif DO, et al. Comparative efficacy of a hydroxyapatite and a fluoride toothpaste for prevention and remineralization of dental caries in children. BDJ Open. 2019;5:18. PubMed Link