When I was a boy I used to like to try and be helpful in doing various tasks around the home and garden. However, I so often seemed to hear my mother say ‘I don’t know, you do one job and make five others’. It was said kindly (usually). I think I understood what she meant and it is a sentiment that has stayed with me in my adult life, especially in relation to medical and health science and to oral health care in particular. It often seems that we manage to solve one problem but in doing so create others, raising more questions as we simultaneously provide answers.
The advent of fluoride-containing toothpastes seems to me to be a good example. Keeping in mind the very positive contribution that they have made to oral health worldwide, they have certainly ‘done’ one job very effectively. The reductions in caries and the consequent increase in the number of healthy teeth retained by more people for longer means that there are more teeth to be cared for now than previously. Arguably too, the improvement in oral health and general health has spurred more of us to take greater care of our own health, part of which concerns diet. In turn we have moved towards more fresh foods including fruits and fruit juices, the acid nature of which has lead to problems of tooth surface loss, or erosion as it is often rather loosely termed. However, it is not only ‘healthy’ acid dietary changes that have brought this about, the huge increase in consumption of carbonated beverages is also thought to be having a major impact.
Over the last 25 or so years that I have been associated editorially with the International Dental Journal I have followed the developments in dentifrice research and technology with great interest and have been pleased that we have been able to publish many important papers in the journal pertinent to continual improvements in this vital area of oral health. Throughout that time stannous fluoride has had an interesting career. Beginning in the 1950s, with P&G, Crest stannous fluoride dentifrice was the first to show significant anti-caries benefits, but over the following decades it found less favour than other fluoride formulations. However, following continual research, it re-emerged in a stabilised form that is showing enormous promise in a variety of ways. One such application is in its ability to provide an enhanced protective effect to tooth surfaces against dietary, erosive acid challenges. Although most fluoride-based products do provide some measurable level of benefit in this context, it seems that stabilised stannous fluoride is unique in creating a deposition of a tin-rich surface layer on tooth enamel, thereby enhancing its protective effect.
The papers in this supplement detail the various research techniques that are being used to confirm the positive effects of stabilised stannous fluoride on tooth erosion and demonstrate very comprehensively the detailed methods of doing so by in vitro and in situ studies. As with my memories from childhood, I am also encouraged that the quest for further knowledge does not stop here, as in more than one of the papers there is a call for continuing research in this area. I commend the science in this supplement to you and keep in mind that once you have read one paper, you may be encouraged to read at least five more.