Arginine-Based Toothpaste Induces Calcium-Phosphates Deposits on Dentin Surface and Tubules

Objective: To test the ability of a calcium carbonate-containing toothpaste for dentinal hypersensitivity to occlude the exposed open tubules of dentin surface. Method: Dentine slices (0.9±0.1 thick) and crown segments (1.5±0.3 cm thick) from human third molars were used. Elmex Sensitive Professional toothpaste (GABA Int AG, Therwill, Switzerland) containing as main active ingredients arginine (8%), sodium monofluorophosphate (1450 ppm Fˉ) and calcium carbonate, was applied (3 min) on coronal dentin surface. Fluid flow/permeation through the dentin thickness (i.e. permeability or hydraulic conductance, Lp in microliters/min) was evaluated using a digital fluid flow-meter after smear layer formation, after EDTA treatment, after Elmex toothpaste treatment (t=0) and after soaking for 1, 7, 28 days in simulated body fluid (HBSS). Tubules occlusion, elemental analysis and mineral content were studied by ESEM-EDX. Toothpaste penetration inside dentinal tubules was analyzed by laser confocal microscopy using calcein as tracer. Result: Lp of EDTA-treated dentin significantly decreased after treatment with Elmex toothpaste (-73,32% at t=0) and after soaking in HBSS the Lp values further decreased (-77,69% at 24h, -78,18% at 7d, -83,01% at 28d). After 24h and 7d in HBSS, ESEM on Elmex-treated dentin showed the presence of precipitates on dentin surface and in the dentinal tubules; EDX revealed N (from arginine) and F (from monofluorophosphate) of the toothpaste. Lp remained significantly lower (-78,18%) than EDTA- treated control dentin. After 28d in HBSS, a calcium phosphate layer was detected on dentin surface so tubules were not visible. EDX detected F and no N. No CaP deposits were found on EDTA-treated dentin soaked in HBSS. Confocal microscopy showed an average penetration depth of the toothpaste into the dentinal tubules of ~85 microns. Conclusion: Elmex sensitive toothpaste can reduce the fluid movement into the exposed dentinal tubules and favour the formation of calcium phosphate minerals.