Dentine hypersensitivity. II. Effects produced by the uptake in vitro of toothpastes onto dentine

Toothpastes arguably are the most common preparations used in the treatment of dentine hypersensitivity. Evidence for efficacy largely comes from clinical trials, and supports the role of the contained so-called "active" ingredient. How such compounds produce therapeutic benefit has received limited attention. This study measured the availability and uptake onto dentine of fluoride and metal ions contained in commercial and test toothpastes. The effects of exposure of dentine sections to these toothpastes, and abrasive only pastes in particular, was investigated by scanning electron microscopy and X-ray microanalysis. Aqueous extracts of the different toothpastes contained measurable concentrations of the incorporated metal and or fluoride, but usually considerably below that incorporated by the manufacturer. Extraction of dentine sections exposed to toothpaste slurries revealed levels of fluoride and metal ions, although post-treatment washing in water reduced these levels. Surface changes at 1 and 10 h were not consistent with the uptake of fluoride or metals. These changes were almost certainly produced by the contained abrasives, including calcium carbonate, dicalcium phosphate, alumina and silica. In particular fume silica progressively accumulated on the dentine surface to narrow and occlude dentinal tubules. Unlike other abrasives fume silica was resistant to removal by washing. It would appear that insufficient attention has been given to the therapeutic potential of toothpaste ingredients, particularly abrasives, to produce benefit by occlusion of dentinal tubules.