A calcium (Ca) prerinse before a fluoride (F) rinse has been shown to increase oral F levels. We tested the anticaries effect of this combination in a dose-response in situ caries model. In a double-blind, crossover experiment, 10 volunteers carried enamel slabs in palatal appliances for 14 days, during which they rinsed twice/day with one of four rinse combinations: (1) a placebo prerinse (150 mM sodium lactate) followed by a distilled water rinse (negative control); (2) a placebo prerinse followed by a 250 ppm F rinse; (3) a placebo prerinse followed by a 1,000 ppm F rinse, or (4) a Ca prerinse (150 mM Ca, as calcium lactate) followed by a 250 ppm F rinse. Sucrose solution was dripped onto the slabs 8×/day to simulate a high cariogenic challenge. The percent surface hardness loss (%SHL) was significantly lower in the Ca prerinse used with the 250 ppm F rinse group (%SHL = 38.0 ± 21.0) when compared with the F rinse alone (%SHL = 59.5 ± 24.1) and similar to the 1,000 ppm F rinse group (%SHL = 42.0 ± 18.3). Compared with the 250 ppm F rinse, the Ca prerinse increased biofilm fluid F only twice (nonsignificant). However, it greatly increased F in biofilm solids (∼22×). The Ca prerinse had little effect on loosely or firmly bound enamel F. The results showed an increased level of protection against demineralization by the use of a Ca prerinse, which seems to be caused by the enhancement of F concentration in the biofilm.

1.
Bradshaw DJ, Marsh PD, Hodgson RJ, Visser JM: Effects of glucose and fluoride on competition and metabolism within in vitro dental bacterial communities and biofilms. Caries Res 2002;36:81-86.
2.
Bratthall D, Hänsel-Petersonn G, Sundberg H: Reasons for the caries decline: what do experts believe? Eur J Oral Sci 1996;104:416-422.
3.
Benelli EM, Serra MC, Rodrigues AL Jr, Cury JA: In situ anticariogenic potential of glass ionomer cement. Caries Res 1993;27:280-284.
4.
Calvo AF, Tabchoury CP, Del Bel Cury AA, Tenuta LM, da Silva WJ, Cury JA: Effect of acidulated phosphate fluoride gel application time on enamel demineralization of deciduous and permanent teeth. Caries Res 2012;46:31-37.
5.
Caslavska V, Moreno EC, Brudevold F: Determination of calcium fluoride formed from in vitro exposure of human enamel of fluoride solutions. Arch Oral Biol 1975;20:333-339.
6.
Ccahuana-Vásquez RA, Tabchoury CPM, Tenuta LMA, Del Bel Cury AA, Vale GC, Cury JA: Effect of frequency of sucrose exposure on dental biofilm composition and enamel demineralization in the presence of fluoride. Caries Res 2007;41:9-15.
7.
Chen MS, Strömberg E, Vogel GL, Sandborgh-Englund G: A randomized controlled trial: the efficacy of fluoride rinse combined with calcium pre-rinse to increase overnight salivary fluoride. Acta Odontol Scand 2014;72:557-560.
8.
Cury JA, do Amaral RC, Tenuta LMA, Del Bel Cury AA, Tabchoury CPM: Low-fluoride toothpaste and deciduous enamel demineralization under biofilm accumulation and sucrose exposure. Eur J Oral Sci 2010;118:370-375.
9.
Cury JA, Francisco SB, Simões GS, Del Bel Cury AA, Tabchoury CPM: Effect of a calcium carbonate-based dentifrice on enamel demineralization in situ. Caries Res 2003;37:194-199.
10.
Cury JA, Hashizume LN, Del Bel Cury AA, Tabchoury CP: Effect of dentifrice containing fluoride and/or baking soda on enamel demineralization/remineralization: an in situ study. Caries Res 2001;35:106-110.
11.
Cury JA, Rebelo MAB, Del Bel Cury AA: In situ relationship between sucrose exposure and the composition of dental plaque. Caries Res 1997;31:356-360.
12.
Cury JA, Rebelo MAB, Del Bel Cury AA, Derbyshire MTVC, Tabchoury CPM: Biochemical composition and cariogenicity of dental plaque formed in the presence of sucrose or glucose and fructose. Caries Res 2000;34:491-497.
13.
Furlani TA, Magalhães AC, Iano FG, Cardoso VES, Delbem ACB, Buzalaf MAR: Effect of calcium pre-rinse and fluoride dentifrice on enamel and on dental plaque formed in situ. Oral Health Prev Dent 2009;7:23-28.
14.
Hara AT, Queiroz CS, Paes Leme AF, Serra MC, Cury JA: Caries progression and inhibition in human and bovine root dentine in situ. Caries Res 2003;37:339-344.
15.
Kassebaum NJ, Bernabé E, Dahiya M, Bhandari B, Murray CJ, Marcenes W: Global burden of untreated caries: a systematic review and metaregression. J Dent Res 2015;94:650-658.
16.
Koo RH, Cury JA: Soluble calcium/SMFP dentifrice: effect on enamel fluoride uptake and remineralization. Am J Dent 1998;11:173-176.
17.
Kusano SC, Tenuta LM, Cury AA, Cury JA: Timing of fluoride toothpaste use and enamel-dentin demineralization. Braz Oral Res 2011;25:383-387.
18.
Magalhães AC, Furlani TA, Italiani FM, Iano FG, Delbem ACB, Buzalaf MAR: Effect of calcium pre-rinse and fluoride dentifrice on remineralisation of artificially demineralised enamel and on the composition of the dental biofilm formed in situ. Arch Oral Biol 2007;52:1155-1160.
19.
Margolis HC, Moreno EC: Physicochemical perspectives on the cariostatic mechanisms of systemic and topical fluorides. J Dent Res 1990;69:606-613.
20.
Marthaler TM: Changes in dental caries 1953-2003. Caries Res 2004;38:173-181.
21.
Nadanovsky P, Sheiham A: Relative contribution of dental services to the changes in caries levels of 12-year-old children in 18 industrialized countries in the 1970s and early 1980s. Community Dent Oral Epidemiol 1995;23:331-339.
22.
Narvai PC, Frazão P, Roncalli AG, Antunes JL: Dental caries in Brazil: decline, polarization, inequality and social exclusion (in Portuguese). Rev Panam Salud Publica 2006;19:385-393.
23.
Paes Leme AF, Dalcico R, Tabchoury CP, Del Bel Cury AA, Rosalen PL, Cury JA: In situ effect of frequent sucrose exposure on enamel demineralization and on plaque composition after APF application and F dentifrice use. J Dent Res 2004;83:71-75.
24.
Proskin HM: Statistical considerations related to the use of caries model systems for the determination of clinical effectiveness of therapeutic agents. Adv Dent Res 1995;9:270-278.
25.
Rose RK, Shellis RP, Lee AR: The role of cation bridging in microbial fluoride binding. Caries Res 1996;30:458-464.
26.
Tenuta LM, Cerezetti RV, Del Bel Cury AA, Tabchoury CP, Cury JA: Fluoride release from CaF2 and enamel demineralization. J Dent Res 2008;87:1032-1036.
27.
Tenuta LM, Del Bel Cury AA, Bortolin MC, Vogel GL, Cury JA: Ca, Pi, and F in the fluid of biofilm formed under sucrose. J Dent Res 2006;85:834-838.
28.
Vale GC, Tabchoury CP, Del Bel Cury AA, Tenuta LM, ten Cate JM, Cury JA: APF and dentifrice effect on root dentin demineralization and biofilm. J Dent Res 2011;90:77-81.
29.
Vogel GL: Oral fluoride reservoirs and the prevention of dental caries. Monogr Oral Sci 2011;22:146-157.
30.
Vogel GL, Carey CM, Chow LC, Tatevossian A: Micro-analysis of plaque fluid from single-site fasted plaque. J Dent Res 1990;69:1316-1323.
31.
Vogel GL, Carey CM, Ekstrand J: Distribution of fluoride in saliva and plaque fluid after a 0.048 mol/l NaF rinse. J Dent Res 1992;71:1553-1557.
32.
Vogel GL, Chow LC, Brown WE: A microanalytical procedure for the determination of calcium, phosphate and fluoride in enamel biopsy samples. Caries Res 1983;17:23-31.
33.
Vogel GL, Chow LC, Carey CM: Calcium pre-rinse greatly increases overnight salivary fluoride after a 228 ppm fluoride rinse. Caries Res 2008b;42:401-404.
34.
Vogel GL, Schumacher GE, Chow LC, Takagi S, Carey CM: Ca pre-rinse greatly increases plaque and plaque fluid F. J Dent Res 2008a;87:466-469.
35.
Vogel GL, Shim D, Schumacher GE, Carey CM, Chow LC, Takagi S: Salivary fluoride from fluoride dentifrices or rinses after use of a calcium pre-rinse or calcium dentifrice. Caries Res 2006;40:449-454.
36.
Vogel GL, Tenuta LM, Schumacher GE, Chow LC: No calcium-fluoride-like deposits detected in plaque shortly after a sodium fluoride mouthrinse. Caries Res 2010;44:108-115.
37.
Vogel GL, Tenuta LM, Schumacher GE, Chow LC: A calcium pre-rinse required to form calcium fluoride in plaque from a sodium fluoride rinse. Caries Res 2014;48:174-178.
38.
Vogel GL, Zhang Z, Chow LC, Carey CM, Schumacher GE, Banting DW: Effect in vitro acidification on plaque fluid composition with and without a NaF or a controlled-release fluoride rinse. J Dent Res 2000;79:983-990.
39.
Zero DT, Fu J, Espeland MA, Featherstone JD: Comparison of fluoride concentrations in unstimulated whole saliva following the use of a fluoride dentifrice and a fluoride rinse. J Dent Res 1988;67:1257-1262.
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