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Hygiene Tribune Middle East & Africa Edition No.1, 2016

hygiene tribune Dental tribune Middle East & Africa Edition | January-February 2016 2D < Page 1D “Toothpaste app?” > Page 3D Figure 2. Left: SEM shows open tubules after treat- ment with a nonsensitivity luoride toothpaste. Right: SEM shows closed tubules after treatment with CPH dentifrice. (Courtesy of Compend. Cont. Educ Dent1) Figure 3. Bacterial activity of CPH dentifrice remains strong after 16 hours in a live/dead assay. The CPH dentifrice (right) killed 90 to 99% of the salivary bac- teria 16 hours after a single 60-second exposure to the product compared to a water control (left), which still shows virtually all live cells. Green-stained cells rep- resent live microbial cells; red-stained cells represent dead cells. (Courtesy of Compend. Cont. Educ Dent1) Stannous luoride has a long history of use in oral products for protection against caries, sensitivity, plaque, gingivi- tis, and oral malodor.1 Crest with Fluoristan, introduced by Procter & Gamble (P&G) in 1955, contained SnF2 and was the irst dentifrice to receive the American Dental Associa- tion (ADA) Seal of Acceptance for the therapeutic prevention of caries. Stannous luoride is the only luoride source to provide beneits against car- ies, sensitivity, and plaque/gin- givitis. It was the potential of this multi-beneit therapeutic agent that motivated P&G sci- entists to work for more than three decades to overcome the early limitations of SnF2- based dentifrices. These limi- tations included formula sta- bility, an astringent taste, and mild extrinsic staining of teeth in some patients. One breakthrough along the way was the discovery of poly- phosphates, such as NaHMP, as cosmetic agents. Pyrophos- phates were used in Crest Tartar Control dentifrices to provide tartar control beneits. Compared to pyrophosphate, NaHMP is a larger polymer with more potential attach- ment sites to the tooth sur- face. This larger size improves adsorption to tooth enamel, which provides surface stain removal and interferes with calciication of plaque to pro- vide tartar control beneits. NaHMP was successfully used in Crest toothpastes to improve whitening beneits. The suc- cessful formulation of NaHMP and stabilized SnF2 in a single dentifrice formulation is the key breakthrough leading to the introduction of CPH denti- frice in 2005. how does CPh dentifrice perform? CPH dentifrices containing a system of stabilized SnF2 and NaHMP have been shown to provide a full range of thera- peutic and cosmetic beneits (see Figure 1). The eficacy of CPH dentifrice has been demonstrated in randomized, blinded, controlled, and inde- pendent clinical studies. Based on these clinical stud- ies, CPH dentifrice has been awarded the Seal of Accep- tance from the ADA in ive cat- egories: cavities; gingivitis and plaque; oral malodor; sensitiv- ity; and whitening. In fact, CPH dentifrice is the only tooth- paste on the market to earn ac- ceptance in all ive categories. Eficacy demonstrated in technical studies, clinical tri- als Over 80 publications and re- search presentations support the eficacy of CPH dentifrice. The results show CPH denti- frice is: 1. Effective in preventing and reducing the incidence of car- ies. Use of a luoride-contain- ing dentifrice is known to be effective in reducing caries and reversing early carious le- sions by promoting remineral- ization and preventing demin- eralization.2 In addition, luoride may also limit the production of acid as- sociated with cariogenic bac- teria.3 Stookey et al. conducted a two-year clinical trial with 955 subjects. A dual-phase pro- totype of CPH provided 17% to 25% fewer caries relative to a standard sodium luoride (NaF) dentifrice.4 Anticaries beneits were also demonstrat- ed by Wefel et al. in an in situ study.5 2. Effective in building pro- tection against dentinal hyper- sensitivity. Labo- ratory studies show SnF2 reacts to form precipi- tates, which oc- clude dentinal tu- bules and provide sensitivity relief. Figure 2 shows high magniica- tion scanning electron micro- graphs (SEM) of dentinal tubules before and after the use of CPH dentifrice.1 Figure 4. Stain reductions after 2 weeks of use of CPH dentifrice. Example subject images above: Baseline (row A) and two-week images (Row B). (Courtesy of American Journal of Dentistry24) Independent clinical studies showed signiicant fast6,7,8 and long-term sensitivity re- lief as measured by tactile and thermal methods compared to standard luoride negative controls. Results from one clinical study showed a 44% decrease in thermal sensitivity and up to a two times greater tolerance to tactile sensitivity after eight weeks of use.6 3. Effective in reducing plaque and gingivitis. These beneits are due to the broad spectrum antibacterial action of SnF2. By killing and inhibiting bacteria associated with plaque, CPH dentifrice reduces the develop- ment of gingivitis. Gingivitis, if left untreated, can lead to peri- odontitis, which can eventual- ly lead to tooth loss. Emerging research suggests that poor gingival health may be linked to systemic conditions.9 Figure 3 demonstrates that the anti- bacterial activity of CPH den- tifrice remains strong for 16 hours compared to a control in a live/dead assay.10 Numerous clinical studies, ranging from short-term stud- ies to six-month clinical tri- “It helped with my sensitivity and has a nice, refreshing taste. It’s also good for the gums.” als, have shown signiicant reductions in plaque, gingival inlammation, and bleeding after use of CPH dentifrice rel- ative to positive and negative controls.11-17 4. Effective in reducing breath malodor. The antibacterial ac- tion of SnF2 inhibits the break- down of residual proteins in the mouth to form volatile sul- fur compounds responsible for oral malodor.18 Two indepen- dent clinical studies involving a total of 75 subjects showed signiicant reductions in hali- tosis overnight after using CPH dentifrice compared to a stan- dard NaF control.19 A longer-term study20 of 71 subjects showed signiicant re- ductions in halitosis after one week and three weeks of CPH use compared to a standard NaF control. 5. Effective in reducing for- mation of calculus. Labora- tory studies have shown that NaHMP signiicantly reduces the crystal growth and min- eralization of plaque either in aqueous solution or in a den- tifrice compared to a conven- tional anti-tartar dentifrice containing pyrophosphate.21 These indings were support- ed by results of two indepen- dent six-month clinical trials in which CPH dentifrice and a CPH prototype showed a 56% and 55% reduction in calculus formation, respectively, com- pared to marketed controls at six months.22,23 6. Effective in whitening teeth by removal and prevention of stains. The combined action of NaHMP and an advanced, high cleaning silica system results in stain removal and whiten- ing beneits. The surface activ- ity of NaHMP competes with stains for surface sites, effec- tively preventing the buildup of new stains. Figure 4 shows the removal of surface stains after only two weeks of CPH use. Four separate clinical trials, summarized in two publi- cations, compared the stain removal eficacy of CPH den- tifrice with that of a positive control whitening dentifrice at two different time points: base- line and two weeks;24 and base- line, three, and six weeks.25 In all cases, a highly signiicant improvement in stain removal was measured from baseline for both the CPH and positive control whitening dentifrice. In addition, the whitening ben- eits of the CPH dentifrice were not signiicantly different from the positive control. What do patients and profes- sionals think about CPh? The eficacy of CPH dentifrice is supported by an extensive body of clinical evidence. However, its success ultimate- ly depends upon its effective- ness and acceptability to us- ers in the home environment. The question is do the beneits measured or observed in a con- trolled clinical environment by clinical specialists translate into product acceptability? In other words, are dental ben- eits observed by patients and dental professionals in clinical studies evident when used in the home environment? These questions have been addressed in two recent home-use stud- ies. These studies showed that CPH dentifrice is effective for and acceptable to both patients and dental professionals who used it at home as part of their normal oral hygiene routine. Practice-based assessment. A practice-based assessment of CPH dentifrice was conduct- ed among patients across the USA.26 In this study, both pa- tients and their dental profes- sionals answered a question- naire at the beginning and at the end of the three- to four- month use period (up to six months in 25% of cases). Of the 1,078 patients who re- sponded: •88% rated the product “excel- lent/very good” or “good” •77% of those who noticed im- provements in their oral health planned to continue using the product •83% rated CPH positively for reducing surface stains •9 out of 10 patients rated the product positively in the areas of “keeping mouth healthy,” “cleaning teeth thoroughly,” “making gums healthier,” and “freshening breath” (see Fig- ure 5) Of the 1,267 responses from dental hygienists and dentists: •68% noted improvement in their patients’ gingival bleed- ing/inlammation and a re- duction in the formation of calculus •61% noted reduced sensitivity •57% noticed reduced staining Eighty percent of the dental professionals indicated they would recommend CPH den- tifrice to their other patients. That jumped to 91% of dental professionals who noted im- provements in their patients’ oral health or staining. Usage study among dental professionals. Recently, a CPH usage experience study was conducted among dental pro- fessionals.27 After receiving a tube of Crest Pro-Health (Clin- ical Gum Protection variant) for their personal use, approxi- mately 2,100 dental profes- sionals completed an optional online survey about their ex- perience using the product: •99% of dental professionals rated their experience with the product as “excellent/very good/good” •96% indicated they would continue to use the product •92% agreed that dentifrices containing SnF2 can beneit their patients more than other toothpastes •81% said they had recom- mended CPH dentifrice to pa- tients in the past and 96% said they would recommend CPH to more patients now that they had experienced the product themselves (see Figure 6). When asked why they would recommend CPH to more of their patients, some responses given were: •”I believe patients can beneit from this product.” •”I can only vouch for a prod- uct I have personally used and liked.” •”I believe this is the best prod- uct on the market right now.” •”Ortho patients need that ex- tra level of protection.” •”It feels clean, and there was noticeable plaque reduction in my mouth.” •”It helped with my sensitiv- ity and has a nice, refresh- ing taste. It’s also good for the gums.” •”I have seen a clinical im- provement with Crest Pro- Health.” Clinical studies demonstrate that CPH dentifrice puts the power and convenience of an eficacious, multi-beneit toothpaste in the palm of your hand, providing seven thera- peutic and cosmetic beneits with each use. Real-world, in- home studies show the eficacy of CPH dentifrice established

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