Effect of acidulated phosphate fluoride gel application time on enamel demineralization of deciduous and permanent teeth

Although the effect of acidulated phosphate fluoride gel (APF gel) on caries reduction in permanent teeth is based on evidence, the relevance of the clinical application time is still under debate. Also, the effect of 4- versus 1-min application has not been evaluated in deciduous enamel. In a blind, crossover, in situ study of 14 days, 16 adult volunteers wore palatal appliances containing slabs of human permanent and deciduous enamel. At the beginning of each phase, the slabs were submitted to one of the following treatments: no APF application (negative control); APF gel (1.23% F) application for 1 or 4 min. Biofilm accumulation on the slab surface was allowed and the slabs were subjected eight times a day to 20% sucrose, simulating a high cariogenic challenge condition. On the 15th day of each phase, fluoride retained as CaF(2) and fluorapatite (FAp) was determined on the enamel of the slabs and demineralization was assessed by cross-sectional microhardness. Fluoride as CaF(2) and FAp, formed by APF gel application on the enamel slabs not subjected to the cariogenic challenge, was also determined. APF gel reduced demineralization in both enamel types (p < 0.05), but the difference between 1 and 4 min was not statistically significant (p > 0.05). CaF(2) and FAp formed and retained on deciduous and permanent enamel was significantly higher in APF gel groups (p < 0.05), but no significant difference was found between 1 and 4 min (p > 0.05). The findings suggest that 1 min of APF gel application provides a similar effect on inhibition of demineralization as 4 min, for both permanent and deciduous enamel.     

Effect of Er,Cr:YSGG Laser and Professional Fluoride Application on Enamel Demineralization and on Fluoride Retention

This study evaluated the effect of Er,Cr:YSGG laser irradiation and professional fluoride application on enamel demineralization and on fluoride formation and retention. In a blind in vitro study, 264 human enamel slabs were distributed into 8 groups: G1 - untreated; G2 - treated with acidulated phosphate fluoride gel (APF gel, 1.23% F) for 4 min; G3, G4 and G5 - irradiated with Er,Cr:YSGG at 2.8, 5.6 and 8.5 J/cm(2), respectively; G6, G7 and G8 - preirradiated with Er,Cr:YSGG at 2.8, 5.6 and 8.5 J/cm(2), respectively, and subjected to APF gel application. Twenty slabs of each group were submitted to a pH-cycling regimen, and enamel demineralization was evaluated in 10 slabs of each group. In the other 10 slabs, CaF(2)-like material was determined. To evaluate F formed, 10 additional slabs of each group, not subjected to the pH cycling, were submitted to analysis of CaF(2)-like material and fluorapatite, while the other 3 slabs of each group were evaluated by scanning electron microscopy. The F content was also measured in all pH-cycling solutions. Laser at 8.5 J/cm(2) and APF treatment reduced enamel demineralization compared to the control (p < 0.05), but the combination of these treatments was not more efficient than their isolated effect. A higher concentration of retained CaF(2)-like material was found in laser groups followed by APF in comparison with the APF gel treatment group. The findings suggest that laser treatment at 8.5 J/cm(2) was able to decrease hardness loss, even though no additive effect with APF was observed. In addition, laser treatment increased the formation and retention of CaF(2) on dental enamel.     

Anticaries potential of a fluoride mouthrinse evaluated in vitro by validated protocols

This blind and randomized study tested in vitro, using validated protocols, the anticaries potential of an experimental fluoride mouthrinse. One-hundred enamel slabs, half sound and half with caries-like lesions (carious), all with known surface microhardness (SMH), were submitted to 3 treatment groups: A) a placebo mouthrinse (negative control); B) a positive control mouthrinse containing 0.05% NaF; and C) an experimental formulation containing 0.05% NaF and cetylpyridinium chloride as an antibacterial substance. To evaluate the formation of F products on enamel, sound (n=10) and carious (n=10) slabs were treated with the formulations during 10 min and loosely and firmly-bound F formed in enamel were determined after extraction with alkali and acid, respectively. To evaluate the inhibition of enamel demineralization, sound enamel slabs (n=10) were treated with the mouthrinse formulations 2x/day during 1 min and subjected to a pH-cycling regimen simulating a cariogenic challenge (demineralization). To evaluate enamel remineralization, the carious slabs (n=10) were submitted to the treatments 3x/day and subjected to a pH-cycling model simulating a remineralizing condition. After 8 days, enamel SMH was determined again and the percentage of SMH loss or SMH recovery was calculated for the sound and carious slabs, respectively. The experimental formulation was superior to the negative control (p<0.05) and equivalent to the positive control (p>0.05) in the formation of F products in enamel, and in the inhibition of enamel demineralization and enhancement of remineralization. These data suggest that the tested experimental fluoride mouthrinse has anticaries potential.     

Combination effect of fluoride dentifrices and varnish on deciduous enamel demineralization

The aim of this study was to evaluate the anticaries potential of 500 or 1100 ppm F dentifrices combined with fluoride varnish using a pH-cycling regimen. Seventy primary canines were covered with nail polish, leaving a 4×4 mm window on their buccal surface, and randomly assigned into 7 groups (n = 10): S: sound enamel not submitted to the pH-cycling regimen or treatment; N: negative control, submitted to the pH-cycling regimen without any treatment; D1 and D2: subjected to the pH-cycling regimen and treated twice daily with 1100 or 500 ppm F dentifrice, respectively; VF: fluoride varnish (subjected to F-varnish before and in the middle of the pH-cycling regimen); and VF+D1 and VF+D2. After 10 days, the teeth were sectioned, and enamel demineralization was assessed by cross-sectional hardness at different distances from the dental surface. Data were analyzed using a two-way ANOVA followed by Tukey's test. Dentifrice with 1100 ppm F and the combination of F-varnish with the dentifrices significantly reduced enamel demineralization compared with the negative control (p < 0.05), but the isolated effects of F-varnish and dentifrice with low concentration were not significant (p > 0.05). The effect of combining F-varnish with the dentifrices was not greater than the effect of the dentifrices alone (p < 0.05). The data suggest that the combination of F-varnish with dentifrices containing 500 and 1100 ppm F is not more effective in reducing demineralization in primary teeth than the isolated effect of dentifrice containing 1100 ppm F.     

Effect of fluoridated milk on enamel and root dentin demineralization evaluated by a biofilm caries model

Although some studies suggest an anticaries effect of fluoridated bovine milk (F-milk) on enamel, evidence is still considered weak. Even more uncertain, the effect of F-milk on root caries remains largely unknown. This study evaluated the effect of F-milk on enamel and on root dentin demineralization using a validated Streptococcus mutans biofilm model, simulating a high cariogenic challenge. S. mutans (UA159) biofilms were formed on bovine enamel and root dentin saliva-coated slabs after measuring initial surface microhardness (SH). Biofilms were exposed to 10% sucrose 8×/day and treated 2×/day with either: (1) 0.9% NaCl (negative control), (2) bovine milk, (3) F-milk (5.0 ppm F as NaF) or (4) NaF 0.05% (anticaries-positive control). Medium pH was monitored twice/day, as a biofilm acidogenicity indicator. After 5 days for enamel and 4 days for dentin, biofilms were recovered to analyze: biomass, soluble proteins, viable microorganisms, and extra- and intracellular polysaccharides. Enamel and dentin demineralization were estimated by percentage of SH loss. Results were compared by ANOVA and Tukey's test. Neither acidogenicity nor biofilm composition differed among treatment groups in biofilms formed on enamel or dentin (p > 0.05). F-milk, however, significantly reduced enamel and dentin demineralization when compared with the negative control (p < 0.05). Also, F-milk was as efficient as 0.05% NaF to reduce enamel (p > 0.05), but not dentin demineralization (p < 0.05). These findings suggest that milk containing 5.0 ppm of fluoride is effective to control enamel caries and that it may be effective on root dentin caries prevention.     

In situ effect of frequent sucrose exposure on enamel demineralization and on plaque composition after APF application and F dentifrice use

Since the effect of the combination of methods of fluoride use on enamel demineralization and on plaque composition is not clearly established, this study examined the effect of the combination of acidulated phosphate fluoride (APF) application and F dentifrice on enamel demineralization and on plaque composition. In this crossover study, 16 volunteers, wearing a palatal appliance containing bovine enamel blocks, were subjected to 4 treatment groups: non-fluoridated dentifrice (PD), FD, APF+PD, and APF+FD. The APF was applied to the enamel before the 14-day experimental period. During the experimental period, test dentifrices were applied 3x/day, and a 20% sucrose solution was applied 4x and 8x/day by being dripped on the blocks. Although APF application was able either to increase F concentration in plaque or to reduce the % of mutans streptococci, its combination with F dentifrice use neither reduced enamel mineral loss nor changed any other measured plaque variable with respect to the FD group alone.     

Effects of low level fluoride on the resolutive behavior of dental enamel]

The purpose of this investigation was to study the low level fluoride on the resolutive behavior of dental enamel in vitro.Twelve enamel slabs were used to treat with acidulated phosphate fluoride solutions containing different F concentration and then with acidic artificial carious gel.Chemical analysis were carried out with atomic absorption spectrophotometer,fluoride ion-selective electrode and electron microprobe.Results indicate that different F concentration in environmental solutions make different physicochemical ways on effects to enamel demineralization,they are specific and non-specific absorption of fluoride ions or dissolution and reprecipitation of fluoridated apatite and CaF(2).     

Effect of dentifrice containing fluoride and/or baking soda on enamel demineralization/remineralization: an in situ study

The additive effect of baking soda on the anticariogenic effect of fluoride dentifrice is not well established. To evaluate it, a crossover in situ study was done in three phases of 28 days. Volunteers, using acrylic palatal appliances containing four human enamel blocks, two sound (to evaluate demineralization) and two with artificial caries lesions (to evaluate remineralization), took part in this study. During each phase, 10% sucrose solution was dripped (3 times a day) only onto the sound blocks. After 10 min, a slurry of placebo, fluoride (F) or fluoride and baking soda (F+NaHCO(3)) dentifrice was dripped onto all enamel blocks. The results showed a higher F concentration in dental plaque formed during treatment with F+NaHCO(3) than placebo (p<0.05), but the difference related to F dentifrice was not significant. The enamel demineralization was lower, and remineralization was greater, after treatment with F+NaHCO(3) than placebo (p<0.05), but the difference related to F dentifrice was not significant. The data suggest that baking soda neither improves nor impairs the effect of F dentifrice on reduction of demineralization and enhancement of remineralization of enamel.     

CaF(2) formation: cariostatic properties and factors of enhancing the effect

CaF(2) or a CaF(2)-like material/phosphate-contaminated CaF(2) is a major reaction product during topical treatment of dental hard tissues. Recently, evidence has suggested that CaF(2) is formed not only on surfaces but also to some extent in the enamel. The minimum concentration of fluoride required for CaF(2) formation is not well known and may depend on whether calcium is available from plaque fluid or only through dissolution of the dental hard tissue. Furthermore, surface adsorption of fluoride to crystals may cause local concentrations necessary for CaF(2) formation. It has been suggested that CaF(2) acts as a pH-controlled reservoir of fluoride. The rate-controlling factor appears to be phosphate, which controls the dissolution rate of CaF(2) at high pH. Increasing fluoride concentration, prolonging the exposure time or using a fluoride solution with low pH can increase CaF(2) formation. CaF(2) formed at low pH contains less internal phosphate which has been shown to be less soluble. This may be of clinical significance for fluoride applied topically a few times per year.     

Evaluation of the effects of a pyrophosphate-fluoride anticalculus dentifrice on remineralization and fluoride uptake in situ.

Enamel slabs and thin sections with artificially formed caries lesions were placed in the removable dentures of 15 subjects who brushed them three times daily for 2 weeks with a 1.3% pyrophosphate/1,100 ppm F/1.5% Gantrez dentifrice, a 1,100-ppm F dentifrice without pyrophosphate or Gantrez, or a placebo dentifrice in a double-blind, crossover study. Analysis of the thin sections by quantitative microradiography showed that the pyrophosphate/F dentifrice remineralized the lesions 15.9% (p less than 0.05) and the fluoride dentifrice 11.2%, whereas the placebo produced 4.4% demineralization. Fluoride uptake by the enamel slabs was similar for both fluoride dentifrices and significantly greater from the placebo dentifrice (p less than 0.05). The findings suggest that the anticaries mechanisms of fluoride include not only the prevention of demineralization, but also the promotion of remineralization.     

氟化物与镧、钼协同应用抑制牙釉质脱矿过程的研究

目的 :明确氟化物与镧、钼协同应用的防龋效果 ,为其应用研究提供实验依据。方法 :体外建立人工龋模型 ,氟离子、镧离子、钼离子分别应用及协同应用预处理后形成的人工龋 ,经扫描电镜和显微硬度测量研究表明 ,氟与钼、镧协同应用预处理形成的牙釉质人工龋 ,其脱矿深度较用同样浓度单独含镧、钼或氟预处理液处理者浅 ,釉质脱矿最轻 ,形成的人工龋深度最浅。釉质表面形成的覆盖物最厚、致密 ,呈块状和片状结晶 ,晶粒大、与下方釉质结合紧密。显微硬度高 ,它在抗酸实验中显示了较强的抗酸性。协同应用的防龋机理亦被探讨。结论 :氟、钼、镧协同应用防龋效果最好     

Effect of rinsing with water immediately after APF gel application on enamel demineralization in situ

This double-blind crossover in situ study evaluated the effect of rinsing with water immediately after the application of acidulated phosphate fluoride (APF) on enamel demineralization. APF application was followed by: no rinsing or consuming of liquids or solids for the next 30 min; immediately washing with water jet or drinking of a glass of water. All treatments showed a statistically significant decrease in enamel mineral loss compared to the control (p < 0.05), but the differences among treatments were not significant (p > 0.05). The data suggest that the recommendation of asking patients to refrain from drinking water following professional APF application does not seem to have an influence on the anticaries effect of fluoride.     

The effect of ammonium fluoride solution at various concentrations on enamel

The fluoride concentrations of ammonium fluoride solution (NH4F,pH 4.4), which has the same effect on enamel powder as conventional APF solution, were studied. Human enamel powder (200 mesh passed) was treated with solutions of NH4F (1,000 ppmF-, 3,000 ppmF-, 5,000 ppmF-, 7,000 ppmF-, 9,000 ppmF-, pH 4.4) and APF (9,000 ppmF-, pH 3.4) for 5 min. at 37 degrees C. Some of the specimen was washed with 1MKOH solution for 48 hours. Fluoride uptake by enamel powder was analyzed by means of chemical analysis and reaction products identified using X-ray diffractometry. The fluoride uptake of 5,000 ppmF- of NH4F-treated enamel was the same as that of APF-treated enamel. X-ray diffractometry showed that CaF2 was formed in the experimental groups. CaF2 with high crystallinity was formed in the NH4F-treated enamel, and the peak height of X-ray diffraction pattern of CaF2 in 3,000 ppmF- of NH4F-treated enamel was the same as that of APF-treated enamel. In conclusion, the ammonium fluoride solution of 3,000-5,000 ppmF- had a similar effect on enamel powder as conventional APF solution.     

Effect of low-fluoride toothpastes combined with hexametaphosphate on in vitro enamel demineralization

Objectives

The aim of this study was to evaluate the anticaries effect of low-fluoride toothpastes combined with hexametaphosphate (HMP) on enamel demineralization.

Methods

Bovine enamel blocks were subjected to pH cycling and treatment with toothpaste's slurries (15 groups; 2×/day). Toothpaste mixtures contained the following: no fluoride (F) plus HMP (from 0 to 3.0%); 250 ppm F plus HMP (from 0 to 3.0%); 500 ppm F; 1100 ppm F; and a commercial toothpaste (1100 ppm F). After pH cycling, surface and cross-sectional hardness, as well as F present in the enamel were determined. The demineralization depth was analyzed using polarized light microscopy. The variables were subjected to 1-way ANOVA, followed by Student–Newman–Keuls’ test (p < 0.05).

Results

In the absence of fluoride, 0.5% HMP promoted the lowest mineral loss and its effect was similar to that of a 250 ppm F toothpaste (p > 0.05). The combination of 0.5% HMP and 250 ppm F resulted in lower mineral loss (p < 0.05) and similar lesion depth when compared to the 1100 ppm F toothpaste (p > 0.05).

Conclusion

To conclude, the combination of 0.5% HMP and 250 ppm fluoride in a toothpaste has a similar inhibitory effect on enamel demineralization in vitro when compared to a toothpaste containing 1100 ppm F.

Clinical significance

The anticaries effect of toothpaste containing 250 ppm F combined with 0.5% HMP was similar to that of a 1100 ppm F toothpaste, despite the 4-fold difference in F concentration. Although such effects still need to be demonstrated in clinical studies, it may be a viable alternative for preschool children.     

A study of the ability of an in situ remineralization model to differentiate between the effects of two fluoride dentifrices that produced significantly different clinical caries results.

The purpose of this study was to determine whether an in situ remineralization model was able to show a difference in the effects of two dentifrices of different fluoride concentrations and significantly different clinical efficacies. Three dentifrices were tested in a double-blind, cross-over study design. The products contained 0 ppm F, 250 ppm F, or 1000 ppm F from sodium fluoride and were formulated with a silica base according to the formulations used in a human caries trial (Koch et al., 1990). Nineteen subjects each carried three or four thin sections of enamel in their partial dentures. The thin sections, containing artificial caries lesions, were covered with a steel mesh to provide space for plaque formation and then brushed in situ three times daily with the dentifrices. Following the two-week treatment periods, the specimens were removed from the dentures and analyzed for changes in mineral content. The findings showed that the placebo dentifrice (0 ppm F) resulted in 56.8 +/- 74.3% demineralization, the 250-ppm-F dentifrice produced 12.9 +/- 41.3% demineralization, thereby showing partial caries protection, and the 1000-ppm-F dentifrice produced 17.3 +/- 32.1% remineralization. Linear regression analysis showed that the percent remineralization was significantly related to the fluoride concentration in the dentifrice (p less than 0.001). The 250-ppm-F dentifrice was also significantly less effective than the 100-ppm-F dentifrice (p = 0.04, one-tailed Fisher Protected LSD test). These findings are in accord with the human caries trial and support the use of the present in situ remineralization model for prediction of the anticaries efficacy of fluoride dentifrice products.     

Development of multi-species consortia biofilms of oral bacteria as an enamel and root caries model system

The aim was to establish defined-species consortium plaque biofilms to investigate enamel and root caries in an artificial mouth. Strains of the putative enamel and root caries pathogens, Streptococcus mutans, Strep. sobrinus, Actinomyces naeslundii and Lactobacillus rhamnosus, were screened in batch culture for potential cariogenic properties: a low terminal pH, ability to aggregate, and catabolic diversity. The strains selected were grown as monoculture biofilms and as consortium plaque biofilms in a multiplaque artificial mouth. The biofilms were supplied with a constant flow of a simulated oral fluid and were given periodic sucrose (and in some instances glucose) to simulate meals. All the bacteria except L. rhamnosus formed large, monospecies biofilms with resting pH in the range 5.3-5.8. The consortia biofilms were larger and had a resting pH of 4.9-5.3. The consortia biofilms supplied with 8-hourly carbohydrate comprised mainly 'mutans' streptococci (58, SD 5.5%) and L. rhamnosus (42, SD 5.7%). A. naeslundii characteristically was absent or present in a low percentage (up to 4% colony-forming units). All biofilms demineralized polished bovine enamel and dentine blocks, as assessed by microradiography and enamel-surface microhardness measurement. The consortia also demineralized intact enamel and tooth roots; they were more cariogenic to enamel than any of the monoculture biofilms, as measured by enamel-surface softening, but variation in lesion depth was proportional to biofilm wet weight irrespective of acidogen composition (r = 0.93, p < 0.05). Enamel lesions had a well-mineralized intact surface and a zone of subsurface demineralization, typical of early natural lesions. Dentine and root lesions showed extensive demineralization but lacked a pronounced surface mineralized zone. Substitution of glucose for sucrose had no effect on the cariogenicity of the consortium to bovine enamel or human roots and had no major effect on the plaque composition. Continuously supplied fluoride (19 parts/10(6)) resulted in a substantially reduced enamel surface softening and subsurface demineralization of intact roots. It was concluded that consortia biofilms of selected caries pathogens generate realistic caries lesions in all tooth hard tissues under controlled growth conditions in the artificial mouth. This in vitro caries experimental model may prove useful for the study of interrelations between the plaque biofilm, tooth tissues and the oral environment, and for the development of procedures to modify the course of caries development.     

猕猴舌下——舌神经移位移植的病理学研究

目的 通过猴桃舌下－舌神经移位移植后的病理改变,证实舌神经移位移植后运动神经可以再生,舌肌可以重建其动力功能的临床应用价值。方法 采用ＨＥ常规染色,嗜银,髓鞘特殊染色及免疫酶标记、透射电镜,观察不同时期神经移位移植后舌肌的组织反应及神经重建状况,测定肌纤维中羟脯氨酸的含量。结果 神经移植３月、６月、１２占膜未见萎缩,舌肌间肌纤维萎缩以舌前份较为明显,Ｓ－１００蛋白染色显示肌束及肌纤维间可见神经纤维     

Effect of fluoride gels supplemented with sodium trimetaphosphate in reducing demineralization

Objectives

The objective of this study was to evaluate the in vitro effect of low-fluoride (F) gels supplemented with sodium trimetaphosphate (TMP) on enamel demineralization.

Materials and methods

Bovine enamel blocks (n?=?160) were selected based on surface hardness (SH) and divided into eight treatment groups (n?=?20 per group): no F or TMP (placebo), 3 % TMP (3 %TMP), 5 % TMP (5 %TMP), 4,500 μg F/g (4,500), 4,500 μg F/g?+?3 % TMP (4,500 3 %TMP), 4,500 μg F/g?+?5 % TMP (4,500 5 %TMP), 9,000 μg F/g (9,000), and 12,300 μg F/g (acid gel). Blocks were subjected to demineralization/remineralization cycling for 5 days. Subsequently, surface hardness (SH₁) and integrated loss of subsurface hardness (ΔKHN) were assessed, and the concentrations of loosely bound (CaF₂-like) and firmly bound (FA-like) formed and retained F were determined.

Results

The 4,500 5 %TMP and acid gel groups showed similar results and had the lowest mineral loss (SH₁ and ?KHN). The acid gel group had the highest concentration of CaF₂-like F, but the formation and retention of FA-like F was greater in the 4,500 5 %TMP group than in the acid gel group (p?<?0.05).

Conclusion

It is possible to inhibit enamel demineralization with low-F gels supplementing these gels with 5 % TMP.

Clinical relevance

The low-F gel containing TMP can be regarded as a safer alternative for clinical use from a toxicological point of view since it contains half of the amount of a conventional formulation while promoting similar anticaries effect.     

Effect of fluoride on artificial caries lesion progression and repair in human enamel: regulation of mineral deposition and dissolution under in vivo-like conditions

OBJECTIVE: This study was carried out to determine in vitro the effect of fluoride on (1) the demineralization of sound human enamel and (2) the progression of artificial caries-like lesions, under relevant oral conditions. METHODS: Thin sections of sound human enamel were exposed to solutions undersaturated with respect to tooth enamel to a degree similar to that found in dental plaque fluid following sucrose exposure in vivo, containing fluoride concentrations (0-0.38ppm) found in plaque fluid. Mineral changes were monitored for 98 days, using quantitative microradiography. The effect of fluoride (1.0-25.0ppm) on the progression of artificial caries-like lesions was similarly studied. RESULTS: Fluoride concentrations of 0.19ppm and greater were found to prevent the demineralization of sound enamel in vitro. However, significantly higher concentrations of fluoride (25.0ppm) were required to prevent further demineralization of artificial caries-like lesions. Demineralizing solutions with intermediate fluoride concentrations (2.1-10.1ppm) induced simultaneously remineralization in the outer portion of the lesion and demineralization in the inner portion. Simultaneous remineralization and demineralization were also observed in hydroxyapatite pellets. CONCLUSIONS: Our results show that the observed effect of fluoride on enamel demineralization is not solely a function of bulk solution properties, but also depends on the caries-status of the enamel surface. A mechanistic model presented indicates that, in comparison to sound enamel surfaces, higher concentrations of fluoride are required to prevent the progression of artificial caries-like lesions under in vivo-like conditions since the diffusion of mineral ions that promote remineralization is rate-limiting.     

Relationship between total and ionized calcium concentrations in human whole saliva and dental plaque fluid.

Ionized and total calcium were determined with an ion-selective electrode in unstimulated whole saliva and in simultaneously collected plaque fluid. The mean ionic and total concentrations in saliva from 20 subjects were 0.53 and 1.03 mmol/l respectively, and in plaque fluid 0.64 and 1.20 mmol/l. The total calcium concentration in saliva was closely related to the total calcium concentration in plaque fluid (r = 0.95, p less than 0.001) as was the ionized calcium concentration in saliva to that of plaque fluid (r = 0.84, p less than 0.001).