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ORIGINAL ARTICLE
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Assessment of total and soluble fluoride content in commercial dentifrices and mouthwashes available in the Indian market: An in vitro study


1 Surveen Dental Clinic, Ahmedabad, Gujarat, India
2 Department of Public Health Dentistry, Karnavati University, Gandhinagar, Gujarat, India
3 Department of Dentistry, Community Health Centre, Mehsana, Gujarat, India
4 Department of Dentistry, Rewards Dental, Burien, Washington, USA
5 Department of Oral and Maxillofacial Pathology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, Gujarat, India
6 Department of Dentistry, Smile N Shine Family Dentistry, Belleville, New Jersey, USA

Date of Submission28-Mar-2022
Date of Acceptance29-Apr-2022
Date of Web Publication07-Sep-2022

Correspondence Address:
Anuj Vasantray Mansata,
1594/2, Sector 2C, Gandhinagar, Gujarat
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aihb.aihb_63_22

  Abstract 


Introduction: Dental caries is the most common dental problem across the globe. Due to the increase in the use of refined sugars and lack of fluoride exposure, dental caries is becoming a serious issue for public health. The present study was conducted to determine the total fluoride (TF) concentration and soluble fluoride concentration in different dentifrices and mouthwashes available in the Indian market. Materials and Methods: Ion-specific electrode and fluoride ion metre were used to determine the soluble fluoride, as well as the TF concentration of seven dentifrices and five mouthwashes, and the findings were recorded in particle per million of fluoride. Descriptive statistic was used, and mean ± standard deviation of TF and soluble fluoride content of dentifrices and mouthwashes were reported. Results: Nine samples contained sodium fluoride and three samples contained sodium monofluorophosphate Na MFP as the fluoride compound. The TF and soluble fluoride levels showed variations from the fluoride concentration mentioned on the packaging. Conclusions: This study found that the concentration of total soluble fluoride and TF was lower than the fluoride level mentioned on the packaging.

Keywords: Fluoride, mouthwashes, sodium fluoride, sodium monofluorophosphate, toothpastes



How to cite this URL:
Keswani AH, Thakkar PK, Mansata AV, Shah JJ, Patel AM, Shah KK. Assessment of total and soluble fluoride content in commercial dentifrices and mouthwashes available in the Indian market: An in vitro study. Adv Hum Biol [Epub ahead of print] [cited 2022 Dec 1]. Available from: https://www.aihbonline.com/preprintarticle.asp?id=355696




  Introduction Top


Dental infections, particularly dental caries, are among the most common infirmities worldwide. Dental caries can be considered a significant general medical issue, particularly in Asian and Latin American nations.[1] The chief explanations behind this increase in cases are a rise in sugar usage in different forms and lacking exposure to fluorides.[2] In India also, dental caries is one of the significant oral health problems.[3]

The vital factor for effective caries deterrence is the use of fluorides. Fluorides are likewise successful as remedial means in non-restorative caries treatment for the inactivation or halt of the spread of carious lesions.[4]

The cariostatic impact of fluoride is wielded in most cases by its topical effect.[5] The systemic fluorides have a lesser impact compared to the topical form. This impact may be more prominent when combined with good oral hygiene practices like brushing of teeth using fluoridated toothpaste and fluoridated mouthwash.[6]

It has additionally been demonstrated that the early introduction to a fluoride toothpaste or fluoride mouthwash may likewise be a hazard factor due to the unpremeditated consumption of toothpaste or mouthwash.[7],[8] Studies that have summed up the dangers of dental fluorosis have presumed that the hazard is most noteworthy when the introduction of fluoride happens in both the secretory and the maturation phases of enamel formation.[8],[9]

For a fluoridated dentifrice/mouthwash to be compelling in controlling dental caries, a sufficient amount of fluoride must be solvent, guaranteeing fluoride bioavailability in the oral cavity for the duration of toothbrushing.[10]

Different brands of dentifrices and mouthwashes proclaim the data with respect to the absolute fluoride total fluoride (TF) only and not the active soluble fluoride levels.[11] since total soluble fluoride (TSF) ought to be viewed as conceivably dynamic against caries, knowing the level of TSF is significant, especially when an individual in buying a dentifrice or mouthwash containing different types of fluorides.[12]

This study is therefore aimed at assessing the TF content and bioavailability of fluoride in selected commercially available dentifrices and mouthwashes in the market and to compare the measured concentrations of fluoride with the concentrations written on the packaging of dentifrices and mouthwashes.


  Materials and Methods Top


The present study assessed the soluble fluoride and TF content in twelve different commercial dentifrices and mouthwashes available in the Indian market. Necessary ethical clearance was taken from the Karnavati School of Dentistry Ethics Committee (KSD/ETH/2021/092).

Sampling procedure

In the present study, seven fluoride-containing dentifrices belonging to nine different brands and five fluoride-containing mouthwashes belonging to five different brands were purchased based on their popularity among people. Each dentifrice and mouthwash were coded with a number to do blind.

The analysis of samples was carried out in duplicate for better results, and all samples were analysed before their date of expiry. Two groups of investigators were involved in this study. One group comprising four investigators selected the dentifrices and mouthwashes from the commercial shops, and another group of four investigators did the analysis of selected samples.

Two different fluoride fractions were analysed:

  • TSF, represents ionic fluoride (IF), i.e., IF + fluoride as monofluorophosphate (MFP) ion
  • TF, TF relates to TSF + insoluble fluoride (InF). InF is fluoride bound to the abrasive agent.[13]


Chemical assays were carried out in duplicates. Before beginning the testing, each sample is adjusted to the temperature of deionised water (±1°C) before the addition of the reagent sodium arsenite. Using a high precision pipette, 10 ml of deionised water is added to one cell, and 10 ml of sample to be tested is added to another cell. Using another high precision pipette, 2 ml of reagent solution sodium arsenite is added to each cell.

The mixture of reagent and sample is swirled and placed in a fluoride ion metre. The 1-min reaction timer starts, and the blank sample cell is cleaned when the timer expires. The blank cell is inserted into the cell holder, and the zero button is pushed. As a result, the display will show the result of 0.00 mg/L F. Now the prepared sample cell is cleaned and inserted into the cell holder, and the read button is pushed to get the results of the sample in mg/L F¯.

This method of fluoride determination involves the reaction of fluoride with a red zirconium-dye solution. The fluoride associates with a fragment of the zirconium to produce a colourless complex, thus decolourising the red colour in quantity equivalent to fluoride concentration.[14]

Analysis of all twelve samples was carried out using above-mentioned standard method, and data were reported as mean ± standard deviation (SD).


  Results Top


TF found in the fluoride toothpaste had a mean of 661.86 with a SD of 115.46. TSF had fluoride concentration in the range of 530–840 with a mean of 652.86 and a SD of 117.31 [Table 1].
Table 1: Concentration of total fluoride and total soluble fluoride of tested dentifrices

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Of all the seven dentifrices that were examined and analysed, five contained sodium fluoride (NaF) and two contained sodium monofluorophosphate (Na MFP) as the fluoride compound as mentioned on the packaging. Samples had lower TSF as compared to TF, and this may be due to soluble fluoride (InF), which is attached to the abrasive agents present in the toothpaste.[15] Out of seven kinds of toothpaste, one contained silica, two samples had silica and hydrated silica and four samples had hydrated silica as an abrasive agent.

TF found in the mouthwashes had a mean of 217.40 with a SD of 51.94. TSF had fluoride concentration in the range of 146–275 with a mean of 207.00 and a SD of 56.67 [Table 2].
Table 2: Concentration of total fluoride and total soluble fluoride of tested mouthwashes

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Of all the five types of mouthwash that were examined and analysed, four contained NaF and one contained Na MFP as the fluoride compound as mentioned on the packaging. Samples of mouthwashes also had lower TSF as compared to TF.


  Discussion Top


The impact of fluoridated toothpaste and mouthwashes in lessening dental caries is unassailable.[4] Very few studies have been carried out across the globe that gauged the fluoride content of the readily available dentifrices and mouthwashes, and only a few studies in India have tested fluoride concentration in the commercially available dentifrices and mouthwashes.[13],[15],[16],[17],[18],[19]

The results of this study have shown that all the seven dentifrices and five types of mouthwash did meet the fundamental requirement of 1000 particle per million (PPM) of fluoride concentration, but there is no mention of the soluble or insoluble fluoride content of the dentifrices and mouthwashes, which is clinically more relevant.

Fluoride has to be in soluble form in dentifrices and mouthwashes to play an active role.[16] A significant amount of fluoride available in the dentifrices might have reacted with abrasive agents. Thereby, the whole purpose of caries prevention or increasing remineralisation may get affected. In the past also, several studies have shown calcium fluoride as a reaction end product when abrasive agents such as calcium carbonate or dicalcium phosphate dehydrate have been used in the dentifrices, ultimately reducing the fraction of soluble fluoride. The TSF content of 1000 PPM was not present in all twelve samples, and the study results are in contrast to results of studies carried out in Japan, Brazil and Chile, suggesting that all seven dentifrices and five types of mouthwash were although not having 1000 PPM fluoride but were found to be operational as anti-caries agents.[16],[17],[19]

NaF or MFP are the two chemical compounds from which IF is made available to the tooth surface for remineralisation and caries prevention. To halt the caries progression, fluoride is required to be available in soluble form, especially during tooth brushing, and hence all dentifrices and mouthwashes should be able to supply soluble formula in their chemical composition.[20],[21]

The total concentration of fluoride available in the oral cavity is dependent on the chemical compatibility of abrasive agents and the fluoride agent being used (NaF or MFP). Usually, it is observed that dicalcium phosphate dihydrate is used as an abrasive while MFP is used as a fluoride agent in toothpaste. The reason behind using this combination of fluoride agent and the abrasive agent is that MFP undergoes hydrolysis, leading to IF being released, which binds to dicalcium phosphate dehydrate, which makes the bound fluoride inactive and does not offer any caries protection.[13] Our study had NaF as a fluoride source, an abrasive agent used was hydrated silica in most of the samples that were tested. The concentration of the soluble form of fluoride declines over a span of a few months, particularly during the storage phase of these dentifrices.[22] Further, studies on a larger scale with a greater number of dentifrices and mouthwashes as well as a multicentric, multinational approach are required for better accurate results.


  Conclusions Top


TF concentration was not found to be as per the mentioned concentration on toothpaste/mouthwash boxes or bottles. The concentration of TSF and TF was found to be lower than the fluoride level of 1000 PPM mentioned on most of the dentifrices. Further research is required to gain a better insight into different kinds of toothpaste and mouthwashes available in India and across the globe.

Limitation of the study

Only twelve dentifrices and mouthwashes were studied here, and hence a generalised statement cannot be issued for every dentifrice of mouthwash available in the Indian market.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Marinho VC. Cochrane reviews of randomized trials of fluoride therapies for preventing dental caries. Eur Arch Paediatr Dent 2009;10:183-91.  Back to cited text no. 4
    
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Featherstone JD. Prevention and reversal of dental caries: Role of low level fluoride. Community Dent Oral Epidemiol 1999;27:31-40.  Back to cited text no. 5
    
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Rølla G, Ogaard B, Cruz Rde A. Clinical effect and mechanism of cariostatic action of fluoride-containing toothpastes: A review. Int Dent J 1991;41:171-4.  Back to cited text no. 6
    
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Levy SM, Kiritsy MC, Warren JJ. Sources of fluoride intake in children. J Public Health Dent 1995;55:39-52.  Back to cited text no. 7
    
8.
Wong MC, Glenny AM, Tsang BW, Lo EC, Worthington HV, Marinho VC. Topical fluoride as a cause of dental fluorosis in children. Cochrane Database Syst Rev. 2010;2010(1):CD007693.  Back to cited text no. 8
    
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DenBesten PK. Biological mechanisms of dental fluorosis relevant to the use of fluoride supplements. Community Dent Oral Epidemiol 1999;27:41-7.  Back to cited text no. 9
    
10.
Zero DT. Dentifrices, mouthwashes, and remineralization/caries arrestment strategies. BMC Oral Health 2006;6 Suppl 1:S9.  Back to cited text no. 10
    
11.
ADA. Council of Scientific Affairs. Acceptance Program Guidelines: Fluoride Containing Dentifrices. American Dental Association, 2005. (https://www.ada.org/resources/research/science-and-research-institute/ada-seal-of-acceptance). [Last accessed on 2021 Dec 30].  Back to cited text no. 11
    
12.
Cury JA, Tenuta LM. How to maintain a cariostatic fluoride concentration in the oral environment. Adv Dent Res 2008;20:13-6.  Back to cited text no. 12
    
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Veeresh DJ, Wadgave U. Assessment of total and soluble fluoride content in commercial dentifrices in Davangere: A cross sectional survey. J Indian Assoc Public Health Dent 2014;12:320-2.  Back to cited text no. 13
  [Full text]  
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Available from: https://www.hach.com/asset-get.download-en. jsa?id=7639983712. [Last accessed on 2021 Jun 22].   Back to cited text no. 14
    
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Farooq I, Ali S, Al-Khalifa KS, Alhooshani K. Total and soluble fluoride concentration present in various commercial brands of children toothpastes available in Saudi Arabia – A pilot study. Saudi Dent J 2018;30:161-5.  Back to cited text no. 15
    
16.
Carrera CA, Giacaman RA, Muñoz-Sandoval C, Cury JA. Total and soluble fluoride content in commercial dentifrices in Chile. Acta Odontol Scand 2012;70:583-8.  Back to cited text no. 16
    
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Cury JA, Oliveira MJ, Martins CC, Tenuta LM, Paiva SM. Available fluoride in toothpastes used by Brazilian children. Braz Dent J 2010;21:396-400.  Back to cited text no. 17
    
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Jordan RA, Markovich L, Gaengler P, Zimmer S. Total and free fluoride concentrations of African dentifrices marketed in West Africa. Oral Health Prev Dent 2011;9:53-8.  Back to cited text no. 18
    
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Hashizume LN, Lima YB, Kawaguchi Y, Cury JA. Fluoride availability and stability of Japanese dentifrices. J Oral Sci 2003;45:193-9.  Back to cited text no. 19
    
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Wong MC, Clarkson J, Glenny AM, Lo EC, Marinho VC, Tsang BW, et al. Cochrane reviews on the benefits/risks of fluoride toothpastes. J Dent Res 2011;90:573-9.  Back to cited text no. 20
    
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Therapeutics, Council. Guidelines for the acceptance of fluoride-containing dentifrices. Council on Dental Therapeutics. J Am Dent Assoc. 1985;110:545-7.   Back to cited text no. 21
    
22.
Hattab FN. The state of fluorides in toothpastes. J Dent 1989;17:47-54.  Back to cited text no. 22
    



 
 
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