A team of researchers has presented research into the development of a toothpaste containing titanium tetrafluoride and chitosan to reduce erosive tooth wear (ETW.) Currently posted to the preprint server Research Square* in submission to Scientific Reports, the study has demonstrated the superior effectiveness of this novel toothpaste in protecting tooth enamel and helping to avoid costly and complex dental intervention.
Study: The Protective Effect of the Experimental TiF4 and Chitosan Toothpaste on Erosive Tooth Wear in Vitro. Image Credit: Tasha Cherkasova/Shutterstock.com
Erosive Tooth Wear
ETW is a common dental problem categorized by physical or physiochemical processes, leading to the superficial loss of mineralized tooth materials and the need for dental treatment. This is a cumulative effect, leading to dental problems over a person’s lifespan, and can impact the individual’s quality of life in terms of pain, impaired dental function, and aesthetic self-worth.
ETW has been a growing problem in recent decades. Whilst gradual wear is common over an individual’s life span, modern lifestyles and diets can cause it to accelerate, leading to pathological effects. Increasing prevalence and detection of the condition has led to an increased focus on strategies to limit it. This problem is especially prevalent in older age groups.
![Box Plot of enamel wear (µm) after the experimental protocol according to each treatment group [median (interquartile range-II)]. Q1 - quartile1, Q3 - quartile 3. Kruskal-Wallis/Dunn test (p < 0.0001). Different letters show significant differences among the groups.](https://d12oja0ew7x0i8.cloudfront.net/images/news/ImageForNews_58302_16455242576444926.png)
Box Plot of enamel wear (µm) after the experimental protocol according to each treatment group [median (interquartile range-II)]. Q1 - quartile1, Q3 - quartile 3. Kruskal-Wallis/Dunn test (p < 0.0001). Different letters show significant differences among the groups. Image Credit: Francese, M et al., Research Square
Preventative Strategies
Whilst there are several dental interventions commonly used to protect tooth enamel or repair damaged teeth, the main strategy employed both domestically and by dental professionals is the application of fluorides, particularly ones containing Sn2+ and Ti4+. These are polyvalent metals that interact with the structure of teeth and form a protective layer against plaque acids. Compared to conventional fluorides, they are more effective at protecting against enamel erosion.
Recent research has indicated that, compared to commercial fluoridated solutions, daily application of TiF4/NaF solutions displays promising results for protection against ETW in both in situ and in vitro models. Additionally, studies have indicated that this solution is more promising than the professional applications of TiF4 varnish. Incorporating it into toothpaste has also shown promise for protecting against ETW caused by brushing and other abrasive challenges.
Chitosan is another promising compound that can protect against ETW. This is a natural polymer derived from the deacetylation of chitin, which has been explored for numerous clinical and industrial applications. The advantage of this natural polymer for protecting tooth enamel is in the ability to electrostatically interact with the structure of teeth and the formation of a protective layer via adsorption.
There are already several commercially available toothpastes, which include chitosan as an active ingredient, but the protective properties of this organic polymer are impacted by manual brushing. To overcome this problem, toothpastes have been developed which contain both fluoridated compounds and chitosan. Fluoridated toothpastes, which contain tin and chitosan, possess better protective properties than those which only contain fluoride. The retention of tin to enamel can be improved with the addition of chitosan.
![Box plot of dentin wear (µm) after the experimental protocol according to each treatment group [median (interquartile range-II)]. Q1 - quartile1, Q3 - quartile 3. Kruskal-Wallis/Dunn test (p < 0.0001). Different letters show significant differences among the groups.](https://d12oja0ew7x0i8.cloudfront.net/images/news/ImageForNews_58302_16455242639344602.png)
Box plot of dentin wear (µm) after the experimental protocol according to each treatment group [median (interquartile range-II)]. Q1 - quartile1, Q3 - quartile 3. Kruskal-Wallis/Dunn test (p < 0.0001). Different letters show significant differences among the groups. Image Credit: Francese, M et al., Research Square
The Research
Currently in pre-proof before final publication in Scientific Reports, the study by Francese et al. has explored the protective properties of toothpaste containing chitosan and TiF4 in vitro against ETW. The authors made a null hypothesis that there is no difference between toothpastes containing TiF4 with or without chitosan being added in respect to its protective effects.
The research randomly assigned bovine samples to toothpastes with pure chitosan, pure TiF4, a combination of TiF4 and chitosan, a placebo, and commercially available toothpaste with erosion protection (Elmex®.) It was discovered that TiF4 toothpastes, regardless of their chitosan content, significantly reduced the instance of wear compared to the placebo samples. Chitosan alone displayed similar results to the placebo sample.
The TiF4 containing toothpastes displayed superior performance to Elmex® (which was also different to the placebo sample.) Compared to the other groups studied, the TiF4 and Elmex® toothpastes displayed significantly better protection against tooth wear from brushing. The team concluded that, regardless of their chitosan content, TiF4 toothpastes are effective in minimizing enamel damage from erosion and abrasion in vitro. Enamel and dentin wear was reduced by >80%.
Additionally, the results of testing on TiF4 toothpastes containing chitosan demonstrated that they presented a higher pH than toothpaste only containing TiF4. Whilst this is a desirable result for neutralizing the acidic nature of plaque, the study demonstrated that chitosan did not improve the toothpaste’s protective effect, at least not in the model that the authors used in this research.
The authors have identified that the absence of human saliva is a limitation in the research study, which was justified due to the difficulty of collecting adequate amounts for the 7-day period of pH cycling model used in the study. They have stated that the model will be confirmed with the presence of human saliva in an in situ model, which is closer to the real-life in vivo situation.
*Important Notice
Research Square publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.
Further Reading
Francese, M et al. (2022) The Protective Effect of the Experimental TiF4 and Chitosan Toothpaste on Erosive Tooth Wear in Vitro [pre-proof] Scientific Reports | researchsquare.com. Available at: https://www.researchsquare.com/article/rs-1314986/v1
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