Stannous vs. Sodium Fluoride: When Dental Professionals Should Customize Treatment

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Over the years, the most common reason to use an active ingredient such as fluoride in toothpaste or oral rinses was to reduce dental decay. Dental professionals frequently hear patients ask, “What can I do to avoid developing cavities?” The most common active ingredient for this problem has been sodium fluoride, which is effective in the reduction of dental decay. Sodium fluoride is found in many over-the-counter toothpastes, prescription toothpastes, oral rinses, and is even found in most community water supplies.

Is providing our patients with one option for decay reduction enough? Is decay reduction the only interest to consider?

Options for Sodium Fluoride

For some patients, sodium fluoride is the best option for the prevention of dental decay. Sodium fluoride, or the similar sodium monofluorophosphate, works to destroy bacteria such as Streptococcus mutans and lactobacilli to achieve the reduction of dental decay.5

Sodium fluoride is a great option for supervised children and those who properly know how to spit excess paste and mouthwash out. It is also one of the best options for teenagers and adults who have a high decay rate, and it has been considered the standard for most dental patients for an extended period of time.

But for those who want or need more out of their paste and rinses, such as those with the prevalence of other oral problems or who might have underlying health concerns, what might be an alternative option?

The Alternative of Stannous Fluoride

Patients with an increased risk of (or current onset of) periodontal disease, those with xerostomia, or those who have had cancer treatments may increasingly benefit from a stannous fluoride paste. This is due to stannous fluoride’s ability to work not only in the prevention of decay but also in an antimicrobial action, resulting in the reduction of plaque biofilm and calculus buildup. Additionally, stannous fluoride can occlude exposed dentinal tubules, resulting in a reduction of dentinal hypersensitivity.6

In the past, stannous fluoride has been considered controversial for use in toothpaste and rinses, most commonly due to the risk of stain and metallic taste from the product containing tin and being unstable.1,3 Because of these negative side effects, oral health professionals selected stannous fluoride products only as a last resort option.

Thankfully, the product is much more consumer-friendly due to advancements in technology. Many attempts were made to improve the product, but the most successful was the addition of zinc phosphate and preservatives, resulting in stabilization of the stannous ions that greatly reduced staining as well as improved the flavor.2 Rather than using stannous fluoride only as a last resort, this product may be the future of oral disease reduction.

In one study, it was found that using this stabilized formula, in comparison to a sodium fluoride dentifrice, individuals had a statistically significant reduction of gingival inflammation and biofilm as measured clinically by the authors through plaque and gingival indices.2 Stannous fluoride users could also see an improvement of enamel recalcification as well as a reduction in extrinsic staining and symptoms associated with halitosis.1

In addition, the pH of the mouth after eating or drinking does not drop as low and comes back up to a neutral level more rapidly with stannous fluoride, making this type of product especially vital for those with xerostomia. Since these patients lack the proper amount of self-neutralizing saliva, a stannous fluoride product helps with neutralization, which can make a great difference in these patients’ enamel erosion and decay rates.3

As patients continue to take more medications associated with xerostomia, the importance of this benefit of stannous fluoride may continue to grow.

As oral health professionals make product suggestions to patients every day, it is important to look closely at the products we are recommending to our patients. Does patient A require a higher dose of sodium fluoride to slow down their progressive and high decay rate? How does this compare to patient B, who has a very low decay rate? Or patient C, who just completed head or neck radiation and is suffering from severe xerostomia? Besides the products we are recommending, demonstrating proper oral hygiene instructions for each product is just as important as recommending the product. Discussing with the patient on proper use, frequency, and technique should all be a part of our product recommendations.

Sodium and stannous fluorides are also not the only ingredients in pastes and rinses on the market, as there are other options for sensitivity ‒ most popularly potassium nitrate as well as other options such as xylitol and hydroxyapatite-based pastes for decay prevention. Let us challenge ourselves to truly know the benefits of the products we are suggesting and work to make specific and unique recommendations for every dental patient at every visit.

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References

  1. Fiorillo, L., Cervino, G., Herford, A.S., et al. Stannous Fluoride Effects on Enamel: A Systematic Review. Biomimetics (Basel, Switzerland). 2020; 5(3), 41. https://doi.org/10.3390/biomimetics5030041
  2. Hu, D., Li, X., Liu, H., et al. Evaluation of a Stabilized Stannous Fluoride Dentifrice on Dental Plaque and Gingivitis in a Randomized Control Trial with 6-month Follow-up. J Am Dent Assoc., 2019; 150(4): 245. PMID: 30797257.
  3. Mitchell, J. (2013, March 20). The Other Fluoride: The Benefits of Stannous Fluoride. Tufts Now. Retrieved from https://now.tufts.edu/articles/other-fluoride
  4. Myers, C.P., Pappas, I., Makwana, E., Begum-Gafur, R., Utgikar, N., Alsina, M.A., Fitzgerald, M., Trivedi, H.M., Gaillard, J.F., Masters, J.G., & Sullivan, R.J. Solving the problem with stannous fluoride: Formulation, stabilization, and antimicrobial action. J Am Dent Assoc., 2019 Apr; 150(4S):S5-S13. doi:10.1016/j.adaj.2019.01.004. PMID: 30797260.
  5. Sodium Fluoride. (2021, October 31). Drug Bank. Retrieved from https://go.drugbank.com/drugs/DB09325
  6. Schiff, T., Saletta, L., Baker, R.A., et al. Desensitizing Effect of a Stabilized Stannous Fluoride/sodium Hexametaphosphate Dentifrice. Compend Contin Educ Dent. 2005Íľ 26(9, suppl 1): 3540.