Although preventable, dental caries is one of the most prevalent chronic disease among children worldwide, and the most common unmet healthcare need among disadvantage children. Fluoride (usually via toothpaste) has the most consistent benefit in preventing caries development and re- mineralizing initial lesions. One of the new caries remineralizing technologies is the synthetic hydroxyapatite (HA) (Ca10(PO4)3(OH)2) as a bioactive-compatible material with similar chemical composition to the apatite crystals of human enamel, inserted as micro-cluster or nanocrystalline forms in different oral care products. A toothpaste containing ion-doped hydroxyapatite (Sr-Mg- CO3-HA) and HA partially substituted with fluoride (HAF) embedded in a chitosan matrix showed, in-vitro, a promising capacity of restore demineralized enamel.
In this conference, we would like to present the data of a recent RCT aimed to compare the caries preventive efficacy of toothpastes containing fluoride biomimetic hydroxyapatite (HA) complex compared to sodium monofluorophosphate fluoridated toothpastes in schoolchildren. Four toothpastes, two containing fluoride-substituted hydroxyapatite (H.A.F.) (1000 and 1450 ppmF) and two Mono fluoridated toothpastes (1000 and 1450 ppmF) were randomly administered during 24 months to two younger children groups (Gyoung) and to two older children groups (Gold). ICDAS was used to score lesions as initial, moderate and severe. Caries examination was repeated at 12 and 24 months. The efficacy of the treatment was assessed as the reduction in risk ratio (RR) and the number needed to treat (NNT).
Results; 518 patients (Gyoung=268; Gold=250) concluded the trial. The caries increment at 24-month evaluation was statistically lower in the primary dentition in the H.A.F. arms versus the traditional fluoridated arms (0.18 vs 0.27 p=0.04 in Gyoung and 0.16 vs 0.30 p=0.01 in Gold for severe lesions). In the permanent dentition, caries increase was statistically lower in the H.A.F. arm, both for initial and severe lesions (0.09 vs 0.17 p=0.02 and 0.18 vs 0.28 p=0.01, respectively). In primary dentition, children receiving H.A.F. Toothpaste had a RR of 39% (Gyoung), a NNT of 3.97 and a RR of 38% and NNT of 4.43 (Gold), compared to children receiving traditional Toothpastes. The RR in the permanent dentition was 29% in children treated with H.A.F. toothpaste; while NNT was 5.68.
Conclusions. Toothpastes with new compounds with remineralizing and antibacterial properties might contribute together with fluoride to reduce a dental caries.