# Effects of Stannous Fluoride Toothpaste and Chios Mastiha Toothpaste on the Prevention of Enamel Erosion

## TL;DR

This study compares stannous fluoride and mastic toothpaste in preventing enamel erosion, finding stannous fluoride more effective.

## Contribution

The study introduces a novel in vitro model to evaluate the preventive effects of stannous fluoride and mastic toothpaste on enamel erosion.

## Key findings

- Stannous fluoride toothpaste significantly reduced enamel surface roughness and hardness loss compared to control and mastic groups.
- Mastic toothpaste did not provide significant protection against enamel erosion, despite potential antimicrobial benefits.
- SEM analysis showed better preservation of enamel structure with stannous fluoride, indicating resistance to acid damage.

## Abstract

Erosive tooth wear (ETW) is an increasingly prevalent condition characterised by the loss of dental hard tissue due to repeated effects and interactions of acids and mechanical forces. The aim of this study was to investigate the primary preventive effect of salivary pellicle combined with either stannous fluoride (SnF2) toothpaste or mastic toothpaste against ETW in permanent teeth.

Using a three-arm invitro model, 54 enamel samples (18 in each group) were prepared with a salivary pellicle alone (control), salivary pellicle with SnF2 toothpaste, or salivary pellicle with mastic toothpaste. The experimental design consisted of 5 cycles of salivary pellicle formation (30 min, 37°C), modification with the solutions (30 min, 25°C), further salivary pellicle formation (2 h, 37°C) and erosive challenge (2 min, 1% citric acid, pH 3.6). Subsequently, the samples were evaluated by optical profilometry, Vickers hardness (VH), and scanning electron microscopy coupled with energy-dispersive X-ray spectroscopy (SEM/EDX).

SnF₂ group exhibited significantly reduced surface roughness (Sa, Sq, Sc, Sm, Sv parameters) compared to other groups and lower total hardness loss (ΔVH: SnF2 23%, control 26%, mastic 36%) than the mastic group. SEM analysis revealed better preservation of the prismatic enamel structure in the SnF2 group, indicating resistance to acid-induced demineralisation. Mastic toothpaste did not provide significant protection against erosion, raising questions about its suitability for preventing ETW in acidic environments. EDX analysis showed no significant differences in elemental composition among the groups.

This study confirmed the use of SnF2 as an effective agent for protecting enamel against ETW. While natural extracts like mastic may have antimicrobial benefits, their protective role against ETW appears limited, emphasising the need for further research to explore their promising potential applications in oral prevention as well as their limitations. The future of ETW prevention may lie in the synergy between natural and synthetic agents, combining efficacy with biocompatibility and patient acceptance.