Stannous Fluoride Stabilized With Nitrate and Phosphates

Introduction

Sadly, oral diseases continue to pose a major health challenge worldwide. Continued advancement in both professional and at-home approaches to improving oral health is integral to achieving positive patient outcomes. Innovations in toothpaste formulations offer new opportunities to improve dental health, particularly with innovative ingredients that address multiple concerns simultaneously.

A recent breakthrough in oral care technology has led to the introduction of a stabilized stannous fluoride toothpaste that combines stannous fluoride with nitrate and phosphates (SNaP) to enhance stability and bioavailability. Clinical studies have demonstrated that this SNaP toothpaste effectively reduces plaque and gingivitis, alleviates hypersensitivity, and controls oral malodor more efficiently than traditional fluoride-based products.

Colgate is committed to fostering progress in preventive oral healthcare with the ultimate goal of improving patients’ dental health throughout the globe. By incorporating SNaP toothpaste into daily routines, dental professionals can offer patients a powerful tool to support patients’ long-term oral health.

— Phyllis A. Martina, RDH, MBA
Senior Professional Education Manager 
Colgate Oral Pharmaceuticals

Enhance Oral Health With Antibacterial Protection

As reported by the World Economic Forum and the World Health Organization, oral diseases impact 45% to 50% of the world’s population.^1,2 Along with dental caries, periodontal diseases are among the most prevalent oral diseases, with more than 40% of adults in the United States older than 30 experiencing some form of periodontitis.³

The prevalence of dentinal hypersensitivity is estimated at 11.5%,⁴ while oral malodor may impact up to 60% of the population, with many of the bacteria responsible for oral malodor also liable for periodontal diseases.⁵ Oral hygiene, particularly brushing twice daily with a multibenefit dentifrice, is key to preventing oral diseases.

Stannous fluoride (SnF₂) has been used as an anti-caries ingredient in toothpaste for more than 70 years.⁶ More recently, it has been acknowledged for its antibacterial, antisensitivity, and antigingivitis properties.⁷ However, maintaining SnF₂ in its active oxidation state has been challenging in past formulations, because of formula instability or incompatibility with other toothpaste ingredients.^7,8 This can lead to issues, such as tooth staining and poor taste.⁹ The development of a new stabilized SnF₂ toothpaste formula containing stannous fluoride stabilized with nitrate and phosphates (SNaP) represents a significant breakthrough in at-home oral care.

According to Manus et al,¹⁰ stannous ions that are chelated with phosphates help maintain a water-soluble, bioactive form of stannous. Simultaneously, nitrate helps prevent the chemical oxidation reactions that would lead to the degradation of the stannous ions.

The antibacterial efficacy of the SNaP toothpaste is one of the keys to its ability to deliver as a multibenefit toothpaste.⁷ A clinical test demonstrated the antibacterial efficacy of the SNaP toothpaste to statistically significantly reduce bacteria on the tongue, cheek, gingiva, and saliva as well as in dental plaque as compared to a nonantibacterial control toothpaste in as little as 2 weeks (p < 0.01).¹¹ These clinical results were supported by in vitro findings as well.

The antibacterial efficacy of this formula helps enhance SnF₂’s stability and bioavailability, as well as support its effectiveness against common oral health problems, while offering the flexibility to meet consumer preferences for flavors, foam, and esthetics. Several clinical studies have documented the efficiency of SNaP toothpaste against several of these common oral health problems.

Reduction in Plaque and Gingivitis

Plaque bacteria present at or below the gingival margin can induce gingivitis.¹² As dentists are well aware, control of gingivitis through plaque reduction is an important component to overall oral health. A 6-month randomized clinical trial was performed to test the effectiveness of SNaP toothpaste in reducing the presence of plaque and gingivitis compared to a negative control toothpaste that contained sodium monofluorophosphate.¹³

The 6-month randomized controlled trial, with an intermediate 3-month analysis, used the Turesky modification of the Quigley-Hein plaque index and the Löe-Silness gingival index to assess plaque and gingival health, respectively and also included evaluating the severity and interproximal indices for both plaque and gingivitis. After 6 months of twice daily use, the results showed that the SNaP toothpaste (test group) statistically significantly (p < 0.001 in all cases) outperformed the negative control toothpaste (negative control group) in all plaque and gingivitis parameters.¹³

As shown in the top of Figure 1, after 6 months, the SNaP toothpaste reduced the gingivitis index by 33.8% more than the negative control toothpaste and reduced the plaque index by 21.2% more than the negative control toothpaste as seen in the lower part of Figure 1. After 6 months, the SNaP toothpaste reduced gingival severity (bleeding) by 90% in comparison to the negative control toothpaste (Figure 2, top) and reduced plaque severity by 37.3% in comparison to the negative control toothpaste (Figure 2, bottom).

The SNaP toothpaste also outperformed the negative control toothpaste, improving the gingival interproximal index by 35.3% (Figure 3, top, page 30) and the plaque interproximal index by 22.3% after 6 months (Figure 3, bottom, page 30). Similar statistically significant results were also observed after 3 months of twice daily brushing. All participants using the SNaP toothpaste demonstrated improvements in gingival health after 6 months, including a reduction in bleeding (gingival severity) and an improvement in the gingival health of interproximal places in comparison to the negative control toothpaste.¹³

Improvements in Dentinal Hypersensitivity

Fluoride that contains stabilized SnF₂ has been shown to both prevent dental erosion and treat hypersensitivity.¹⁴ The potential of the SNaP toothpaste to relieve dentinal hypersensitivity was tested in vitro and in vivo. Confocal microscopy showed that the SNaP toothpaste occluded 86% of dentin tubules in vitro compared to 35% from a regular fluoride toothpaste.¹⁵

In a randomized, controlled, 7-day clinical trial, the SNaP toothpaste (test group) was compared to a positive control toothpaste, containing 5% potassium nitrate (positive control group), and a negative control toothpaste (negative control group) that did not contain any desensitizing ingredients.¹⁵ Subjects brushed with their assigned toothpaste twice daily for 7 days and were evaluated for dentinal hypersensitivity. Data were collected before brushing (baseline) and then after 1 day, 3 days, and 7 days of brushing. The mean values are shown in Figures 4 and 5.

An increase in tactile scores and a decrease in air blast scores were considered reductions in hypersensitivity. As compared to both the positive control and negative control toothpastes, the SNaP toothpaste provided statistically significant reductions (p < 0.001) in tactile and air blast dental hypersensitivity after 1 day of brushing and continued for 7 days.

By day 7, the SNaP toothpaste provided statistically significant reductions in tactile sensitivity of 79.8% and 90.2% compared to the positive and negative control toothpastes, respectively (Figure 4). Reductions in air blast sensitivity of 47.1% and 47.9% were also observed as compared to the positive and negative control toothpastes, respectively (Figure 5).

These findings suggest that the SNaP toothpaste is effective in reducing dentinal hypersensitivity as soon as the initial brush and continuing for at least 7 days. In contrast toothpastes that use numbing agents, such as potassium nitrate, can take up to 6 to 8 weeks to have an effect.¹⁶

Reduction in Oral Malodor

The SNaP toothpaste was evaluated for its capability in managing oral malodor.¹⁷ Oral malodor is often caused by dysbiotic biofilms in the mouth.¹⁸ The antimicrobial properties of the SNaP toothpaste help reduce bacterial load on oral surfaces, which may reduce oral malodor.¹¹

In a 3-week randomized controlled clinical trial, the SNaP toothpaste (test group) was compared to a negative control toothpaste (negative control group), known not to have any malodor benefits.¹⁹ Malodor was rated by trained judges on a 9-point organoleptic scale, with 1 = most pleasant and 9 = most unpleasant. After 3 weeks of use, the SNaP toothpaste provided a statistically significant (p < 0.001) reduction of 25.7% in overnight malodor (12 hours post-brushing) compared to the negative control toothpaste (Figure 6). Additionally, 85.7% of participants using the SNaP toothpaste achieved “pleasant breath” status (organoleptic score ≤ 5), while none in the negative control group did.

Conclusions

SNaP’s multifaceted approach addresses not only clinical efficacy but also consumer interests, making this multi-benefit toothpaste an appealing choice for patients. The delivered benefits of the SNaP toothpaste align with global health trends, focus on preventive care, and decrease the incidence of oral disease. The regular use of the SNaP toothpaste to deliver benefits against plaque and gingivitis, including bleeding as well as improvements among interproximal areas in the oral cavity, along with reductions in dentinal hypersensitivity and oral malodor, could reduce the need for more costly, invasive dental treatments if these conditions were not addressed.

Implications for Dental Professionals

The inclusion of SNaP technology into a toothpaste offers a promising new tool for improving oral health outcomes, especially in patients concerned about plaque bacteria, gingivitis, dentinal hypersensitivity, and oral malodor. The antibacterial properties of the SNaP toothpaste when combined with enhanced stability and patient-friendly features, make it a valuable addition to preventive dental care. By incorporating this formulation into daily oral care, dental professionals can help patients maintain better oral hygiene and support disease prevention.

Acknowledgment

All figures were originally published in: Rosing CK, Manus LM, Myers CP, et al. Active Prevention: Unlocking the Power of Stannous Fluoride: A New Dimension in Oral Care. Compendium. 2024;45 Supplement 3. Copyright © 2025 to Conexiant LLC. All rights reserved. Used with permission of the publisher.

References

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From Decisions in Dentistry. March/April 2025;11(2):27-31.