A Clinical Study on the Decreasing Rate of Caries Related Oral Micro-Organisms by a Time of Tooth-Brushing with Sodium Fluoride Contained Dentifrice

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1 Original Article Int J Clin Prev Dent 2018;14(2): ㆍ ISSN (Print) ㆍ ISSN (Online) A Clinical Study on the Decreasing Rate of Caries Related Oral MicroOrganisms by a Time of ToothBrushing with Sodium Fluoride Contained Dentifrice Hee Ja Na 1, JiYeon Kwak 2 1 Department of Dental Hygiene, Honam University, Gwangju, 2 Department of Medical Welfare, Kyungbok University, Namyangju, Korea Objective: In order to know how much decrease the oral microorganisms related with the dental caries by a time of toothbrushing, a clinical study was performed. Methods: Thirty adults age 30 to 60 years of the volunteers with compensation were collected and checked such examination as modified caries activity test with modified Snyder test, the amounts of cocci typed oral microorganism examined by use of the phase contrast microscope and real time polymerase chain reaction test with sending the gaggled samples to professional institute of oral microorganisms with genetic analysis method. Results: A total of 71.9% of decreasing rate of caries activity on Snyder test and 58.5% of decreasing rate on the amounts of cocci typed oral microorganism by a time of toothbrushing with the experimental dentifrice. 32.9% and 42.2% of decreasing rate of the amounts of Streptococcus mitis and after a time of toothbrushing with the experimental dentifrice. Conclusion: A time of toothbrushing could be diminished the caries related oral microorganisms as 30% to 40% and the information could be used for toothbrushing instruction. Keywords: oral microorganism, toothbrushing, fluoride dentifrice Introduction The aim of toothbrushing is to eliminate the dental plaque which has contained lots of oral microorganisms [1]. It is Corresponding author Hee Ja Na Department of Dental Hygiene, Honam University, 417 Eodeungdaero, Gwangsangu, Gwangju 62399, Korea. Tel: , Fax: , artnahe@ hanmail.net Received May 9, 2018, Revised June 11, 2018, Accepted June 13, 2018 wellknown that the most of the main oral diseases as dental caries and periodontal disease are caused by some specific oral microorganisms and it is easy to imagine preventing both of the diseases through the oral microorganism control by proper toothbrushing [2]. So, it has been introduced and recommended as to use for the fluoride contained dentifrice to inhibition of caries active oral microorganisms and Allantoides components deliveries contained dentifrice to use for the subside the early stage of the gingivitis [3,4]. It has been certain that the amounts of oral microorganisms should be decrease by toothbrushing, but not so many studied about how much decrease the amount of oral microorganisms with a time of toothbrushing. Moreover, it might be different Copyright c Korean Academy of Preventive Dentistry. All rights reserved. This is an Open Access article distributed under the terms of the Creative Commons Attribution NonCommercial License ( bync/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 140

2 Hee Ja Na and JiYeon Kwak:Decreasing Rate of Caries Related Oral MicroOrganisms by a Time of ToothBrushing decreasing rate of the amounts of oral microorganisms with the use of specific components contained dentifrice, as fluoride or Allenton components. It might be certain that the influence of the toothbrushing could be more than the fluoride contained in the dentifrice to eliminate the dental plaque and decreasing the amounts of oral microorganisms, by sweeping and washing the tooth surface. But a little difference might be expected as inhibition effect for the caries related oral microorganisms by use of fluoride contained dentifrice [5]. This study showed how much decrease the caries related oral microorganisms with a time of toothbrushing with the fluoride contained dentifrice, in clinical. Table 1. The components of the mouth gaggle solution for real time polymerase chain reaction test Sodium fluoride Poloxamer 407 Hydro citric acid Angelica extract Glycerin Peony extract Ethanol Birch extract Distilled water Dried clove buds extract Sodium saccharide Tocopherol acetate Blue no.1 coloring agent Sodium citric acid Poly oxy ethylene castor oil Mint flavor #20 Materials and Methods 1. Subject Thirty adult volunteers age 40 to 60 years who had attended a church at Daegu area were participated for this study, after submitting the written agreement for clinical test for toothbrushing, caries activity test and oral microorganism examination with real time polymerase chain reaction (PCR). 2. Method International Review Board was achieved for the clinical test as number as DKU And then, collect the volunteers with the compensation at the church in Daegu region, after received the written agreement sheet from them one, by one with the explanation for the process of the clinical test. Dental plaque was checked by oral examination with the use of disclosing agent for tooth surface dying, and simplified patient hygiene performance index (SPHP) was checked for each subjects, one by one, before toothbrushing [6]. Real time PCR test by use of Easy Perio gaggle solution (WiDa Bio Science Co., Seoul, Korea) which contained the following substances shown in Table 1, was performed through the mouthwash for 30 seconds with the gaggle solution served by Table 2. The components for the dentifrice (antiocean salt) used in this study Ingredient Usage Standardization Silicon dioxide Main component NF Sodium fluorphosphate Main component USP Sodium chloride Main component KP Silicon di hydrate Viscosity control Specific standardization Poly ethylene glycol 1500 Humectants KP Titanium oxide Coloring agent KP Enzymatically modified stevia Sweetener Korea Food & Drug Agent Xylitol Sweetener KP Dsorbitol Humectants KP Concentrated glycerin Humectants KP Sodium carboxymethyl cellulose Viscosity control KP Sodium lauryl sulfate Foaming agent KP Ecklonia cava extract Flavoring agent Specific standardization Green tea extract Flavoring agent KQC Sage extract Flavoring agent KQC Grape fruit extract Flavoring agent Korea Food & Drug Agency Propolis extract Flavoring agent Specific standardization Lmentol Flavoring agent KP Spearmint Flavoring agent Specific standardization Peppermint Flavoring agent Specific standardization Opt mint Flavoring agent Specific standardization Distilled water Dissolution KP NF: no funds, USP: United States Pharmacopeia, KP: knight of pythia, KQC: Korea quasidrugs codex

3 International Journal of Clinical Preventive Dentistry PCR analysis institute and 30 samples were sent to the analysis company before toothbrushing, and ask them for checking the count for Streptococcus mitis and. The relative amounts of cocci and bacilli on the dental plaque which were imagined as related with the dental caries were checked by use of the phase contrast microscope by recording the mobile image for 10 seconds on the monitor, before toothbrushing. Modified Snyder test was done for all subjects by smearing the saliva in the plaque at the lingual surface of the lower first molar, before toothbrushing, too [7,8]. The toothbrush and fluoride toothpaste with the following components shown in Table 2 was shared to all subject and let them toothbrushing with rolling method for 3 minutes. Oral examination for PHP index check by a dentist and the oral microorganism examination focusing on the cocci typed microorganism and it was examined one more times by recording the image for 10 seconds, on 5 minutes after toothbrushing. Modified Snyder test and real time PCR were also performed together for all subjects again, after 5 minutes later for toothbrushing and then sent 30 samples to PCR analysis institute. The rate of the pathogenic oral microorganism was also checked through the PCR checking, both in time before and after toothbrushing. The comparison for all items between at before and the after toothbrushing were analyzed in such items as the amounts of,, the cocci typed and the bacillus typed oral microorganisms observed by the phase contrast microscope and the caries activity test as Snyder test or the rate of the pathogenic oral microorganism and tested with the paired ttest, by use of IBM SPSS ver computer program (IBM Co., Armonk, NY, USA). The relationship between each result was estimated with the Pearson s corelation coefficient. Results The results of this study are as follows. It revealed about 40% of decreasing rate for cocci typed caries related oral microorganisms with one time of toothbrushing, with sodium fluoride dentifrice and that was more than decreasing rate in plaque index and less than in caries activity test. And it was considered that one type of cocci, caries related oral microorganism could influence to other cocci typed oral microorganism, before and after toothbrushing. It could be changed as decreasing the rate of pathogenicoral microorganism versus nonpathogenic by toothbrushing with sodium fluoride dentifrice. And toothbrushing with sodium fluoride toothpaste could decrease the cocci typed caries related and the virulent oral microorganisms and recommended to use for the prevention of dental caries. Discussion Dental caries is processed by acid etching process which come from the oral microorganisms had produced in the dental plaque [9]. Toothbrushing has been the best way to eliminate the dental plaque and oral microorganisms in there effectively, so it has been emphasized for oral health education for toothbrushing instruction, in order to promote the oral health even in young children [1012]. Dental plaque was checked before and after toothbrushing, in order to estimate how much eliminate the dental plaque in average for one time of toothbrushing. It revealed only 16.2% of the decreasing rate as a little bit diminish of dental plaque with one time of toothbrushing. It might because that it was relatively clean of the mouth for the most of the subjects before toothbrushing and not so much decreasing the plaque score after tooth brushing. But the amounts of the cocci estimated by use of the phase contrast microscope were more in decreasing Table 3. The changes of the amounts of the oral microorganism by type observed with the phasecontrast microscope and modified snyder test Item Before TB After TB Decreasing rate pvalue SPHP (n=30) 2.65± ± ** Cocci (n=30) 2.00± ± ** Snyder test (n=30) 2.60± ± ** Values are presented as mean±standard deviation or percent only. SPHP: simplified patient hygiene performance index, TB: toothbrushing. **p<0.01. Table 4. The changes of the amounts of the caries related oral microorganism, checked by real time polymerase chain reaction method (unit: 10 3 ) Microorganism Before TB After TB Decreasing rate pvalue Streptococcus mitis (n=30) 5,884.73±6, ,946.57±7, ** Streptococcus mutans (n=30) 5,240.50±7, ,027.97±5, ** Pathogenic microorganism (n=30) 13.36± ± * Values are presented as mean±standard deviation or percent only. TB: toothbrushing. *p<0.05, **p< Vol. 14, No. 2, June 2018

4 Hee Ja Na and JiYeon Kwak:Decreasing Rate of Caries Related Oral MicroOrganisms by a Time of ToothBrushing Table 5. The relationship between the amounts of Streptococcus mitis and, before and after toothbrushing (TB) *p<0.05, **p< * ** rate as 58.5% and the most as 71.9% of decreasing rate on the caries activity test as modified Snyder test, shown in Table 3. It might be more decreasing the oral microorganisms rather than the amounts of the decreasing of the dental plaque. It was considered that it should be important not for the amounts of the plaque but for the cocci typed as caries causative microorganism, to cause the dental caries [13]. It has been well known that a specific oral microorganism can produce the specific oral disease as a communicable disease such as dental caries or periodontal disease. Dental caries has been known as produced by such cocci typed microorganism as or, although it can expended easily by Lactobacillus acidophilus [13]. and were checked through the real time PCR method by gene analysis for each oral microorganism in this study, before and after one time of toothbrushing, shown in Table 4. A total of 33.9% of decreasing rate in and 42.2% of decreasing rate in were revealed in this study. It was estimated that about 40% of decreasing rate in cocci typed caries related oral microorganisms with one time of toothbrushing with sodium fluoride contained dentifrice. It meant that toothbrushing should be important to prevent the dental caries by controlling the caries related cocci typed microorganisms. Moreover, the pathogenic virulent microorganisms were decreased as 14.4% with one time of toothbrushing. It seemed less of the decreasing rate because there were many kinds of virulent oral microorganisms in the oral cavity, and cocci typed caries related oral microorganisms might be a part of them. It was estimated that the amounts of pathogenic virulent oral microorganisms could be decreased through the frequent times of toothbrushing. So it was recommended to do the frequent times of toothbrushing to decrease the caries activity and pathogenic oral microorganisms [7]. It showed that there was high relationship for amounts of cocci typed oral microorganism between in and, both in before (p<0.05) and after (p<0.01) toothbrushing, even though there were no relationship with each other in other groups as each cocci typed microorganism with before or after toothbrushing (p>0.05), shown in Table 5. It was considered that one type of cocci, caries related oral microorganism could influence to other cocci typed oral microorganism, before and after toothbrushing [13]. It was certain that toothbrushing with sodium fluoride dentifrice could decrease the cocci typed caries related oral microorganisms more than to diminish the dental plaque in clinical. Conclusion The authors have experimented in clinical, in order to know how much decrease the caries related cocci typed oral microorganisms with one time toothbrushing with sodium fluoride dentifrice. Thirty adults volunteers age 40 to 60 years were participated in this study and SPHP, cocci typed oral microorganism check by use of the phase contrast microscope and real time PCR for checking the amounts of, and the rate of the pathogenic microorganism were performed both before and after toothbrushing with sodium fluoride dentifrice. The data were collected and compared between before and after toothbrushing and paired ttest was done for the statistical evaluation. Pearson s correlation coefficient was estimated for each group of oral microorganism before and after toothbrushing. The obtained results were as followings. 1. It revealed about 40% of decreasing rate for cocci typed caries related oral microorganisms with one time of toothbrushing, with sodium fluoride dentifrice and that was more than decreasing rate in plaque index and less than in caries activity test. 2. It was considered that one type of cocci, caries related oral microorganism could influence to other cocci typed oral microorganism, before and after toothbrushing. 3. It could be changed as decreasing the rate of pathogenic oral microorganism versus nonpathogenic by toothbrushing with sodium fluoride dentifrice. 4. Toothbrushing with sodium fluoride toothpaste could decrease the cocci typed caries related and the virulent oral microorganisms and recommended to use for the prevention of dental caries. References 1. Chun JA, Cho MJ. The standardization of toothbrush form for Korean adult. Int J Clin Prev Dent 2014;10: Bergenholtz A, Hugoson A, Sohlberg F. An evaluation of the plaque removing ability of some aids to oral hygiene. Sven Tandlak 143

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