Effect of low levels of fluoride in solution on enamel demineralization in vitro

Enhanced enamel remineralization under acidic conditions in vitro

We conducted this study to test the hypothesis that acidic solutions undersaturated with respect to enamel and supersaturated with respect to fluorapatite can enhance enamel remineralization by reducing preferential remineralization of the outer lesion and promoting mineral ion penetration. We used quantitative microradiography to assess mineral changes in artificial surface-softened and subsurface lesions in human enamel in vitro, induced by such an acidic solution and by a neutral remineralizing solution. For surface-softened lesions, the extent of remineralization was similar for both solutions, although preferential remineralization of the outer lesion was observed with the neutral solution. For subsurface lesions, preferential remineralization of the outer lesion was not observed with either solution. However, the extent of subsurface lesion remineralization by the acidic solution was significantly greater than that observed with the neutral solution. Results obtained are noted to reflect inherent differences in lesion type and the properties of the solutions studied.

Effect of fluoride in phosphate buffer solution on bonding to artificially carious enamel

The purpose of the present study was to evaluate the effect of fluoride on resin bonding to artificially carious enamel. Specimens from demineralized human enamel sections were prepared using two commercially available adhesives (Clearfil SE Bond, Kuraray; Single Bond, 3M) and a composite resin (Clearfil AP-X, Kuraray) according to manufacturers' instructions. They were then immersed in phosphate buffered saline solution with varied fluoride concentrations at 0, 0.1, 0.5, 1, and 10 ppm. After immersion in each solution for one, three, or seven days, microshear bond strength was measured. The bond strengths of both adhesive systems to artificially carious enamel significantly increased after immersion in fluoride-phosphate buffer solution. Based on the findings obtained, we thus proposed not to remove the white enamel lesions for bonding in the clinic. They might be preserved and treated using fluoride applications.

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.

The effect of stretching on the release of fluoride from fluoridated elastomeric ligatures

INTRODUCTION

The aim of this in-vitro investigation was to determine whether stretching increases the amount of fluoride released from fluoridated elastomeric ligatures.

METHODS

Ten groups of 4 fluoridated elastomeric ligatures stretched over edgewise premolar brackets were compared with 10 groups of 4 ligatures that were not stretched over brackets. Each group was placed in individual polyethylene bottles containing 1 mL of distilled water and maintained at 37 degrees C in an incubator. A polyethylene bottle containing only distilled water and 4 brackets was used as the control. The fluoride content of the samples was determined once a day for 7 days and regularly thereafter up to 196 days. A fluoride-ion selective electrode coupled to an analyzer was used to determine the fluoride content of the solutions. The sample solutions were changed 24 hours before readings to prevent the results from being cumulative.

RESULTS

The fluoride-ion release for each of the groups was calculated and expressed as total fluoride release in micrograms of fluoride per day per milliliter per elastomer. During the first month in solution, the stretched fluoridated elastomers released approximately 32 microgF.day/mL and the unstretched speciments released 30 microgF.day/mL. This represents a 7% increase in fluoride release, which was statistically significant (P = .007). Over the entire test period (196 days), the modules stretched over the brackets released about 13% more fluoride. This was also a statistically significant difference (P = .001).

CONCLUSIONS

Stretching increases the concentration and amount of fluoride released from fluoridated elastomeric ligatures.

Soft drinks and dental health: a review of the current literature

In recent years there has been increased interest in the role of commercial soft drinks in dental diseases namely as dental caries and erosion. The objective of this paper has been to review the past and current literature to determine the present knowledge on this subject. The literature related to dental caries, erosion, drinks, soft drinks and fruit juices was reviewed. The literature shows efforts have been taken to modify soft drinks by either adding or deleting certain components so as to reduce their harmful effects on teeth. A rational protocol to encourage the sensible use of drinks and the modification of drinks to render them less harmful would be advisable.

Effect of 0.4% stannous fluoride gel on Streptococci mutans in relation to elastomeric rings and steel ligatures in orthodontic patients

BACKGROUND

Patients with fixed orthodontic appliances often experience an absolute increase in the number of Streptococci mutans colony-forming units (cfu). The aim of this investigation was to study the development of biofilm and S. mutans cfu in connection with stainless steel ligatures and elastomeric rings in orthodontic patients treated with and without 0.4% stannous fluoride gel (SFG).

MATERIAL

Forty-seven patients were divided into 2 groups: those treated with 0.4% SFG for 4 minutes (experimental) and those without 0.4% SFG (control). In each patient, elastomeric rings were used for ligation on 1 side of the dental arch midline, and stainless steel ligatures were used on the opposite side. Saliva samples were collected before and after appliance placement. At 15 and 30 days after appliance placement, biofilm samples from the stainless steel ligatures and the elastomeric rings were collected and subjected to microbiologic procedures and scanning electron microscopy (SEM) analysis.

RESULTS

The numbers of S. mutans cfu in the saliva and biofilm were not statistically different between the teeth fitted with elastomeric rings and stainless steel ligatures, or between the experimental and control groups. SEM analysis showed biofilm formation on both ligature ties.

CONCLUSIONS

Topical application of 0.4% SFG in orthodontic patients with elastomeric rings or stainless steel ligatures does not cause a significant decrease in S. mutans cfu in the saliva and biofilm.

Impact of modified acidic soft drinks on enamel erosion

OBJECTIVE

To evaluate the enamel erosive potential of modified acidic soft drinks under controlled conditions in an artificial mouth.

MATERIALS AND METHODS

From each of 144 bovine incisors one enamel sample was prepared. Labial surfaces of the samples were ground flat, polished and covered with adhesive tape, leaving an exposed area. The samples were distributed among four (A-D) groups for treatment with A: Coca-Cola, B: Sprite; C: Sprite light, D: orange juice. Either 1.0 mmol l(-1) calcium (Ca) or a combination (comb.) of 0.5 mmol l(-1) calcium plus 0.5 mmol l(-1) phosphate plus 0.031 mmol l(-1) fluoride was added to the beverages. Samples of each group were subdivided into three subgroups (-original; -Ca and -comb.) for treatment with original and modified drinks. De- and remineralization cycles were based on a standard protocol described earlier. Surface loss of the specimens was determined using profilometry after test procedure.

RESULTS

In all subgroups, loss of enamel was observed. The enamel loss recorded for the samples rinsed with original Sprite and original orange juice was significantly higher compared with all other solutions (P = 0.001). Lowest enamel loss was recorded for the original Coca-Cola group (P = 0.001). With the exception of Coca-Cola, demineralization with the modified beverages led to significantly lower losses compared with the respective original solutions.

CONCLUSION

Modification of the test soft drinks with low concentrations of calcium or a combination of calcium, phosphate and fluoride may exert a significant protective potential with respect to dental erosion.

Development and evaluation of extended release bioadhesive sodium fluoride tablets

Localized fluoride delivery to the oral cavity is important in caries prevention. However, no current marketed dosage forms deliver fluoride for an extended period. This work describes the effect of poly (methyl vinyl ether-co-maleic anhydride) mixed calcium/sodium salt (Gantrez MS), sodium carboxymethylcellulose (NaCMC), polyethylene glycol 8000 (PEG8000) and Carbopol 934 (C934) on the in vitro dissolution and ex vivo bioadhesion of sodium fluoride matrix tablets. Dissolution was studied using USP Apparatus 2 and a low volume (3.1 ml), low flow (0.5 ml/min) dissolution apparatus. In both apparatus, the percent drug dissolved at 2, 4 and 8 h was found to be statistically dependent on the fractions of Gantrez MS and NaCMC. The interaction term was significant at 2 and 4 h (probability > (t) of less than 0.05). Ex vivo bioadhesion was studied using excised bovine gingiva and a TA.XT2i Texture Analyzer. Peak bioadhesive force and work of bioadhesion were found to be statistically dependent on the fractions of Gantrez MS and NaCMC with no interaction (probability > (t) of less than 0.01). Results indicate that bioadhesive matrix fluoride tablets of these mixtures can be designed to exhibit both bioadhesive and extended release properties.

Low-levels of fluoride in plaque and saliva and their effects on the demineralisation and remineralisation of enamel; role of fluoride toothpastes

AIM

To summarise support for current consensus on the likely means by which fluoride toothpastes reduce caries and review some relevant studies of the effect of low levels of fluoride on the demineralisation and remineralisation of enamel. The major anti-caries effect of fluoride toothpastes is thought to result from small but protracted elevations in levels of fluoride in plaque and saliva. Fluoride incorporated into enamel systemically does not reduce enamel solubility sufficiently to exert an anti-caries effect. Fluoride has the potential to exert an anti-caries benefit largely through three mechanisms; inhibition of demineralisation, promotion of remineralisation and interference with bacterial growth and metabolism. However, the low levels of fluoride thought to influence caries are insufficient to have a significant effect via the latter mechanism. Thus reductions in caries resulting from the use of fluoride toothpastes can be linked to modification of the demineralisation/remineralisation balance by direct effects on dental mineral exerted topically by low levels of fluoride. Numerous in vitro studies have shown that low levels of fluoride, typical of those found after many hours in resting plaque and saliva, and resulting from the regular use of fluoride toothpastes, can have a profound effect on enamel demineralisation and remineralisation.

Fluoridated elastomers: effect on disclosed plaque

OBJECTIVE

To investigate the effect of fluoridated elastomers on the quantity of disclosed dental plaque surrounding an orthodontic bracket in vivo.

DESIGN

A randomized, prospective, longitudinal clinical trial, employing a split mouth, crossover design.

SETTING

The Orthodontic Departments of Liverpool and Sheffield Dental Hospitals.

SUBJECTS AND METHODS

The subjects were 30 individuals about to start fixed orthodontic treatment. The study consisted of two experimental periods of 6 weeks with a washout period between. Fluoridated elastomers were randomly assigned at the first visit to be placed around brackets on 12, 11, 33 or 22, 21, 43. Non-fluoridated elastomers were placed on the contra-lateral teeth. After 6 weeks (visit 2) the elastomers were removed, the teeth disclosed and a photograph taken. Non-fluoridated elastomers were placed on all brackets for one visit to allow for a washout period. At visit 3, fluoridated elastomers were placed on the contra-lateral teeth to visit 1. At visit 4, the procedures at visit 2 were repeated. The photographs were scanned, then the area and proportion of the buccal surface covered with disclosed plaque was measured using computerized image analysis. A mixed-effects ANOVA was carried out with the dependent variable being the area or percentage area of disclosed plaque.

RESULTS

There was no evidence of a systematic error and substantial agreement for the repeat readings of the same images. The only significant independent variable for the area of disclosed plaque was the subject (p < 0.001). The significant independent variables for the proportion of disclosed plaque were the subject (p < 0.001) and the tooth type (p = 0.002). The independent variable describing the use of fluoridated or non-fluoridated elastomers was not significant for either the area or the proportion of disclosed plaque.

CONCLUSION

Fluoridated elastomers do not affect the quantity of disclosed plaque around an orthodontic bracket.

Effect of mineral supplements to citric acid on enamel erosion

The aim of this study was to evaluate the effect of mineral supplements to citric acid (1%; pH 2.21) on enamel erosion under controlled conditions in an artificial mouth. From each of 156 bovine incisors one polished enamel sample was prepared. The samples were divided among 13 experimental groups (n=12). In group 1 citric acid only was used (control). In groups 2-10 either calcium, phosphate or fluoride in various low concentrations was admixed to the citric acid. In groups 11-13 the citric acid was supplemented with a mixture of calcium, phosphate and fluoride. For demineralisation the specimens were rinsed with the respective solution for 1 min, immediately followed by a remineralisation period with artificial saliva (1 min). The specimens were cycled through this alternating procedure five times followed by rinsing for 8 h with artificial saliva. The de- and remineralisation cycle was repeated three times for each specimen interrupted by the 8 h-remineralisation periods. Before and after the experiments, the specimens were examined using microhardness testing (Knoop hardness) and laser profilometry. Hardness loss and enamel dissolution was significantly higher for the controls as compared to the remaining groups. Significantly lowest hardness loss for all groups was recorded for group 12 with admixture of calcium, phosphate and fluoride to citric acid. The significantly highest enamel loss was recorded for the controls compared to all other samples. Groups 3 and 4 revealed significantly lower and higher tissue loss compared to the remaining groups (2-13), respectively. The other groups did not differ significantly from each other. Modification of citric acid with calcium, phosphate and fluoride exerts a significant protective potential with respect to dental erosion. However, with the low concentrations applied enamel dissolution could not be completely prevented.

Volumetric assessment and quantitative element analysis of the effect of fluoridated milk on enamel demineralization

OBJECTIVES

It was the purpose of this study to investigate the effect of milk and fluoridated milk on experimentally induced caries-like-lesions.

MATERIALS AND METHODS

Twelve extracted impacted human molars were covered with wax leaving two 3 mm x 3 mm windows on the buccal and lingual surfaces and incubated alternating in demineralizing solution at pH 4.85 and in milk, F-milk, saline, and remineralizing solution, respectively. Afterwards serial ground sections were cut and investigated by polarization-light-microscopy (PLM) and SEM using EDX element analysis.

RESULTS

The results showed increased thickness of the superficial layer in the F-milk samples. Quantitative element analysis revealed a significant increase in the fluoride content of the superficial layer and of the body of the lesion of the F-milk group. The body of the lesion of the F-milk group was less demineralized than in the other groups.

CONCLUSION

From the results we conclude, that the parallel investigation by PLM, SEM combined with EDX quantitative element analysis is a powerful method to assess caries-like-lesion formation and that fluoridated milk has protective properties in inhibiting demineralization.

Saturation of human saliva with respect to calcium salts

It may be assumed that free ionic concentrations of calcium and phosphate in resting saliva tend to equilibrate with those in plaque fluid, and that salivary data can therefore be used to illustrate chemical conditions in both saliva and plaque. In the present study, salivary data collected from the literature or obtained in our laboratory were used to calculate degrees of super- and undersaturation with respect to apatites, brushite, beta-tricalcium phosphate, octacalcium phosphate, calcium carbonate and calcium fluoride in the pH range from 3 to 9. Concentrations of calcium, phosphate, fluoride, carbonate, and background ion strength of resting parotid saliva, resting submandibular saliva, and resting and stimulated whole saliva were entered into a computer program, and curves illustrating saturation in the pH range 3-9 constructed. It was found that oral fluids are supersaturated with respect to apatites above pH 5.3 and with respect to octacalcium phosphate and beta-tricalcium phosphate above pH 6. Parotid saliva was undersaturated with respect to brushite whilst submandibular saliva was supersaturated with respect to that salt in the pH range 6-8. Stimulated whole saliva with 25 mmol/l carbonate became supersaturated with respect to calcium carbonate only above pH 7.3, which may explain the absence of this salt in the human oral cavity. To maintain the saturation of oral fluids with respect to calcium fluoride, i.e. to ensure its survival in the mouth required 6 ppm fluoride in the aqueous phase. Therefore, this salt, the outcome of topical fluoride therapy, will inevitably dissolve in the oral fluids.

Metastable Equilibrium Solubility Behavior of Carbonated Apatites in the Presence of Solution Fluoride

The aims of the present investigation were to assess the applicability of the metastable equilibrium solubility (MES) concept for the carbonated apatites (CAPs) over a range of pH and a wide range of solution fluoride concentrations and to examine the hypothesis that, in the presence of solution fluoride, a surface complex with the stoichiometry of fluorapatite (FAP) governs the MES behavior. Two CAP samples were prepared by precipitation from reaction media containing calcium nitrate (Ca(NO(3))(2).4H(2)O) and sodium phosphate (NaH(2)PO(4).H(2)O) at two different levels of sodium bicarbonate. The MES distributions of the two CAP preparations were determined by equilibrating approximately 10 mg of CAP powder in 2 L of 0.1 M acetate buffers (ionic strength=0.50 M) at pH 4.5 and 5.5 and at various levels of calcium, phosphate, and fluoride. The fluoride concentrations ranged from 0.03 to 12 ppm. From the compositions of the equilibrating buffer solutions, ion activity products based upon the stoichiometries of hydroxyapatite (HAP) and FAP were calculated in an attempt to determine the correct function governing the dissolution of the CAP preparations. The results of this study demonstrated that both CAP preparations exhibit the MES distribution phenomenon in solution media of varying pH and fluoride concentrations. Furthermore, the experimental MES data obtained with both CAP preparations at the lower pH (4.5) and at higher solution fluoride levels (>/=0.1 ppm) were essentially superimposable when plotted against the ion activity product based upon the stoichiometry of FAP, suggesting that in the presence of solution fluoride the MES governing surface complex may be an entity possessing a stoichiometry approximated by that of FAP. When the HAP stoichiometry was assumed to represent the surface complex, good superposition of the data was not possible. Copyright 2000 Academic Press.

Salivary fluoride concentrations following applications of bioadhesive tablets and mouthrinses

Presence of elevated fluoride concentration in saliva is important for the prevention of caries. In the present study, we developed an intra-oral bioadhesive tablet aimed at delivering F(-) in the mouth over a prolonged period of time. Various tablet formulations were tested in vivo for their tolerance and adhesiveness. Two formulations were selected for further studies on salivary fluoride clearance. For comparison, mouthrinses with increasing F(-) concentrations were also examined. Results indicate that a bioadhesive tablet located on the upper gingiva is able to sustain salivary F(-) concentrations for about 10h without major side effects. Mouthrinses with high F(-) concentration were able to prolong salivary fluoride retention for more than 6h.

In vitro and in vivo fluoride release from orthodontic elastomeric ligature ties

Clinically, demineralization of enamel around orthodontic attachments can occur after only 1 month. Fluoride incorporation into elastomeric ligature ties may provide additional protection against decalcification through fluoride release. This study compared the fluoride release of fluoride-impregnated and nonfluoride elastomeric ligature ties (Ortho Arch Company) both in vitro and in vivo. A total of 260 fluoride-impregnated and 260 nonfluoride elastomerics were evaluated in this study, 400 in vitro and 120 in vivo. For the in vivo part of the study, six patients had fluoride and nonfluoride elastomerics placed in cross-quadrant fashion in their mouths; these were removed and tested for residual fluoride release after 1 month. With the use of the potentiometric analytical method, the fluoride release of the elastomerics was determined in distilled water as the 24-hour residual release, to compare the in vitro and in vivo fluoride leached into solution. The data was analyzed with the Wilcoxon matched-pairs signed ranks test. The distilled water control yielded an F- reading of 0.03 +/- 0.01 microgram/F/mL. In the in vitro part of the study, an average of 0. 38 microgram/F/mL/elastomeric was released over the 1 month period by the fluoride-impregnated elastomerics; this decreased significantly (P <. 05) to a 24-hour residual value at 1 month of 0.02 microgram/F/mL/elastomeric ligature, which is in the same order of magnitude as the distilled water control solution. The nonfluoride ties produced a calculated 24 hour residual fluoride release of 0. 003 microgram/F/mL/elastomeric after 1 month; this is much less than the distilled water control and would not be possible to measure accurately. After 1 month in vivo, significantly greater (P >.05) amounts of 24-hour residual fluoride were apparent: F- elastomerics = 1.43 microgram/F/mL/elastomeric and nonfluoride elastomerics = 0.44 microgram/F/mL/elastomeric. Fluoride ties gained weight intra-orally. Residual, leachable fluoride was present in fluoride-impregnated and nonfluoride elastomeric ligature ties after 1 month of intraoral use, due to imbibition. The clinical efficacy of fluoride-impregnated elastomeric ligature ties to prevent decalcification in the presence of plaque needs to be investigated.

Release of mineral ions in dental plaque following acid production

The release of appreciable amounts of calcium, phosphate and fluoride found in whole plaque into the plaque-fluid phase, following bacterial acid production, can potentially reduce the driving force for tooth demineralization. However, limited information is available on this topic, particularly on the release of fluoride. This study sought to determine the change in calcium, phosphate and fluoride concentrations in plaque fluid after sucrose exposure. 48 h overnight-fasted supragingival plaque samples were collected from all tooth surfaces (with the exception of the lower lingual anterior teeth) of one half of an individual mouth, following a 1 min water rinse. Plaque samples were then collected from the other half of the same mouth, following a 292 mM sucrose rinse. Plaque fluid was isolated by centrifugation and analysed for total calcium and phosphate (ion chromatography) and for free fluoride (ion-specific electrode). Samples were collected from seven individuals. Following sucrose exposure, plaque-fluid pH decreased significantly from 6.5+/- 0.3 to 5.4+/-0.2; calcium concentrations (mmol/l) also increased significantly (p < 0.01) from 1.9+/-0.5 to 5.0+/-2.1. Fluoride and phosphate concentrations in plaque fluid, however, did not increase significantly after sucrose exposure: mean concentrations (mmol/l) of fluoride after the water and sucrose rinses were 0.006+/-0.003 and 0.005+/-0.002, respectively, and mean phosphate concentrations (mmol/l) were 11.0+/-2.0 and 12.0+/-3.0, respectively. When results were expressed per wet plaque weight, phosphate concentrations were also found to increase significantly. The same trends were observed when additional plaque samples were treated in vitro with sucrose: fluoride-ion activity did not increase in plaque under in vivo-like conditions.

Edgard C. Moreno, PhD: a tribute to his major contributions to oral biology research

The seminal contributions of Dr. Edgard C. Moreno to physical chemical aspects of oral biology research are reviewed, with personal insights provided by the author. Dr. Moreno has made major contributions to our understanding of fundamental processes which occur within the oral cavity and which control the formation of mineralized tissues. These contributions include extensive research in the areas of: the chemistry of synthetic calcium phosphates and biominerals, the interaction of salivary proteins and other molecules of biological interest with calcium phosphate surfaces, the mechanism of dental caries formation and the effects of fluoride on this process, the mechanism of dental calculus formation and prevention, and the mechanism of dental enamel formation.

Prevention of early childhood caries

This paper reviews the methods used for the prevention of early childhood caries (ECC). The education of mothers or caregivers to promote healthy dietary habits in infants has been the main strategy used for the prevention of ECC. This review found that education has a modest impact on the development of ECC. While education should be promoted especially in high risk communities and population groups (low-income families and native populations), it should not be the only preventive strategy of ECC. Early screening for signs of caries development, starting from the first year of life, could identify infants and toddlers who are at risk of developing ECC and assist in providing information to parents about how to promote oral health and prevent the development of tooth decay. High risk children include those with early signs of ECC, poor oral hygiene, limited exposure to fluorides, and frequent exposure to sugary snacks and drinks. These children should be targeted with a professional preventive program that includes fluoride varnish application, fluoridated dentifrices, fluoride supplements, sealants, diet counseling, and chlorhexidine. Prevention of ECC also requires addressing the social and economic factors that face many families where ECC is endemic.

Fluoride release and re-uptake in direct tooth colored restorative materials

OBJECTIVES

Glass ionomers may be "recharged" through topical fluoride (F-) treatments; however, this reported "recharging," may be attributed to surface changes after F- treatment. This study examined differences in F- release and re-uptake among dual-cured and chemically-cured glass ionomers, and a photo-cured F- releasing composite. A secondary goal was to determine if tensile strength or surface roughness changed due to F- release, or F- re-uptake and re-release.

METHODS

In Phase 1, initial surface roughness and diametral tensile strength were measured. F- release was measured for 30 days. Strength and roughness were then remeasured. In Phase 2, surface roughness was measured, then materials were treated with a 5000 ppm neutral F- gel, the same gel without F-, or phosphoric acid. F- release was measured for 30 days, then final surface roughness and strength were determined.

RESULTS

Significant differences were found in amount and rate of F- release, and F- re-uptake and re-release among study materials and enamel controls (p < 0.001). The amount and rate of F- re-release after NaF treatment differed significantly from F- release after acid treatment in glass ionomers, although both groups showed increased F- release after surface treatment (p < 0.001). There were no significant changes in tensile strength or surface roughness after F- release or F- re-uptake and re-release as determined by ANOVA.

SIGNIFICANCE

The results of this in vitro study indicate that applications of neutral 5000 ppm F- gel to aged glass ionomer restorations results in a significant fluoride uptake and subsequent release. The data suggest that the application of neutral fluoride gel to glass ionomer restorations in situ may result in increases in oral fluoride concentrations, without affecting the restoration's surface roughness or tensile strength.

Distribution of fluoride in the oral cavity after application of a bioadhesive fluoride-releasing tablet

Bioadhesive fluoride tablets are fluoride-releasing devices that can be applied to the oral mucosa by the patient and release fluoride for several hours. From earlier research, it is known that a single fluoride source in the mouth can lead to an uneven distribution of fluoride in the oral cavity. In this study, fluoride concentrations were determined at different sites of the oral cavities of 13 healthy human volunteers after the application of a bioadhesive fluoride tablet containing 0.5 mg fluoride. The sites were: (1) labial surfaces of the upper central incisors, (2) lingual surfaces of the lower central incisors, (3) labial surface of the first upper left molar, and (4) labial surface of the lower right first molar. The tablet was fixed either centrally on the palate or in the lower labial sulcus in two consecutive experiments. Saliva was sampled with polyethylene sponges 5, 10, 20, 30, 60, 120, 180, and 240 minutes after tablet insertion. Fluoride was determined electrochemically. It could be shown that the area under the curve (AUC) values were significantly (p < 0.05) higher after tablet insertion in the lower labial sulcus at sampling site 1, a trend (p = 0.06) could be calculated for sampling sites 2 and 3, and no difference was found at sampling site 4. Fluoride could be detected in concentrations above 0.01 mmol.L-1 at all sampling sites after tablet insertion in the lower labial sulcus. This location seems to be a more appropriate tablet location than the palate.

Resin composites in dentistry: the monomer systems

The present review outlines the history of monomers used in resin composites, motivates further development, and highlights recent and ongoing research reported in the field of dental monomer systems. The monomer systems of most present-day resin composites are based on BisGMA, developed some 40 years ago, or derivatives of BisGMA. In the remaining resin composites, urethane monomers or oligomers are used as the basis of the monomer system. The main deficiencies of current resin composites are polymerization shrinkage and insufficient wear resistance under high masticatory forces. Both factors are highly influenced by the monomer system, and considerable efforts are being made around the world to reduce or eliminate these undesirable properties. The use of fluoride-releasing monomer systems, some of which are under investigation, has been suggested to mitigate the negative effects of marginal gaps formed in consequence of polymerization shrinkage. The very crux of the problem has also been approached with the synthesis of potentially low-shrinking/non-shrinking resin composites involving ring opening or cyclopolymerizable monomers. By the use of additives with a supposed chain transfer agent function, monomer systems have been formulated that improve the degree of conversion of methacrylate double bonds and mechanical properties. Many promising monomer systems have been devised, the implementation of which may be expected to improve the longevity of resin composite fillings and expand the indications for resin composites.

Increased overnight fluoride concentrations in saliva, plaque, and plaque fluid after a novel two-solution rinse

Recent studies showed that salivary, plaque-fluid, and whole-plaque fluoride were significantly higher 120 min after subjects rinsed with a novel two-solution rinse than after they rinsed with a NaF rinse of the same fluoride concentration. In this study, the persistence of these increases was investigated overnight, a period of time that is more clinically relevant. Improved analytical techniques for the ultramicro determination of whole-plaque and plaque-fluid fluoride from the same sample are also described. Thirteen subjects abstained from toothbrushing for 48 hrs and rinsed for 1 min with a 12 mmol/L (228 ppm) NaF or the two-solution rinse before bedtime. Samples were then collected the following morning before breakfast: (1) Saliva samples were either clarified by centrifugation or acid-extracted with 1 mol/L HClO4; and (2) single-site molar plaque samples were centrifuged to obtain plaque fluid and/or extracted with 1 mol/L HClO4. Results showed that, compared with NaF, the two-solution rinse produced significantly higher fluoride concentrations in all samples: The concentration of fluoride in whole plaque and whole saliva following the new rinse exceeded concentrations found after the NaF rinse by factors of three and four, respectively, while in plaque fluid, the two-solution rinse produced about a two-fold increase over NaF values, which were near baseline levels. This increase, however, was only about 20% in centrifuged saliva. The increases in saliva and especially in plaque-fluid fluoride after the two-solution rinse indicate a greater remineralization potential, while the enhanced fluoride reservoirs found in plaque overnight after this rinse constitute a reserve that may release fluoride into the plaque fluid over an extended period of time.

The effect of fluoride on apatite structure and growth

Fluoride participates in many aspects of calcium phosphate formation in vivo and has enormous effects on the process and on the nature and properties of formed mineral. The most well-documented effect of fluoride is that this ion substitutes for a column hydroxyl in the apatite structure, giving rise to a reduction of crystal volume and a concomitant increase in structural stability. In the process of enamel mineralization during amelogenesis (a unique model for the cell-mediated formation of well-crystallized carbonatoapatite), free fluoride ions in the fluid phase are supposed to accelerate the hydrolysis of acidic precursor(s) and increase the driving force for the growth of apatitic mineral. Once fluoride is incorporated into the enamel mineral, the ion likely affects the subsequent mineralization process by reducing the solubility of the mineral and thereby modulating the ionic composition in the fluid surrounding the mineral, and enhancing the matrix protein-mineral interaction. But excess fluoride leads to anomalous enamel formation by retarding tissue maturation. It is worth noting that enameloid/enamel minerals found in vertebrate teeth have a wide range of CO3 and fluoride substitutions. In the evolutionary process from elasmobranch through enameloid to mammalian enamel, the biosystems appear to develop regulatory functions for limiting the fluoridation of the formed mineral, but this development is accompanied by an increase of carbonate substitution or defects in the mineral. In research on the cariostatic effect of fluoride, considerable emphasis is placed on the roles of free fluoride ions (i.e., preventing the dissolution and accelerating the kinetics of remineralization) in the oral fluid bathing tooth mineral. Fluoride also has been used for the treatment of osteoporosis, but much still remains to be learned about maximizing the benefit and minimizing the risk of fluoride when used as a public health measure.

Determination of fluoride from fluoride-releasing elastomeric ligature ties

Unaesthetic white spot lesions or larger unsightly areas of decalcification around orthodontic brackets remain a significant problem during fixed appliance treatment. This study determined the in vitro fluoride release from 200 fluoride-containing elastomeric ligature ties. With the potentiometric analytic method, the fluoride release was determined in distilled water, for 10 groups of 20 elastomerics, representing the clinical usage in a patient. Readings were taken every 24 hours for 5 days and then every second week for 6 months. The data were analyzed with the Wilcoxon matched pairs signed ranks test. Fluor-I-Ties (Ortho Arch Company Inc., Hoffman Estates, III.) released significant amounts of fluoride compared with the control readings. The fluoride release was characterized by an initial burst of fluoride during the first day and second day, followed by a logarithmic decrease. By the end of the second week 88% of the total fluoride had been leached from the elastomerics, but adequate magnitudes of fluoride were released over the remainder of the test period to aid theoretically in the prevention of demineralization and enhance remineralization of enamel through calcium fluoride and fluorapatite formation. For optimum clinical benefit, Fluor-I-Ties should be replaced monthly. Future prospective longitudinal clinical studies are indicated.

The distribution of fluoride in carious human enamel

The proton probe has been used to map F concentration changes in the enamel of 15 teeth showing clinical evidence of caries. Thin sections through the lesions were microradiographed and measurements made of the surface zone (radiodense) and body (radiolucent) areas. Each section was then scanned with a focused beam of 2.5 MeV protons, 2000 spot analyses being performed over areas up to 2 x 3 mm. F was determined by detecting gamma rays from a nuclear reaction and the data used to construct 3-D surface plots. The maximum F concentration in the lesion surface zone was extremely variable, ranging from 1750 to 21,700 ppm, and rarely occurred over the deepest part of the lesion. F levels were elevated in the lesion body but usually to a small extent only. A large increase in F throughout the lesion body was found in 3 lesions only, and was associated with a surface zone that was thin or of low x-ray density. Relatively small F increases in the lesion body were associated with either a thick, x-ray dense surface layer having a greatly increased F level (> 10,000 ppm) or, conversely, with a surface layer having a relatively small F increase. Since F uptake can be regarded as a "marker" of past remineralization events, this study shows that remineralization can and does occur in the body of natural enamel caries lesions, especially when the surface layer is thin or lost. Fluoride availability that encourages the formation of an extremely dense surface layer may result in under-achievement of this natural repair process in the lesion body.

Physical model for lesion formation in the presence of low levels of solution fluoride

A quantitative physical model is presented for the formation of subsurface carious lesions in the presence of low levels of solution fluoride. Calculations using independently determined model parameters are in agreement with mineral density profiles measured in bovine enamel lesions. The proposed mechanism is controlled by fluoride in the following way: as fluoride diffuses into enamel, it is rapidly adsorbed to enamel crystallites, resulting in very low microenvironmental fluoride concentrations, so long as the crystals are not saturated with respect to fluoride adsorption. The result of this saturable adsorption is a widening band of fluoride-saturated crystals near the surface, beneath which the microenvironmental fluoride concentrations are negligible. In the saturated band, the microenvironmental fluoride concentration in the pore solution is high enough to suppress dissolution, while in the deeper, relatively fluoride free region, dissolution can occur. In addition to predicting observed mineral density profiles, the model also predicts the demarcation in solution conditions between the regime where subsurface lesion formation occurs and that where the dissolution pattern is that of surface erosion; and the lack of insensitivity of dissolution rate to hydrodynamics in the presence of low levels of fluoride, as contrasted to the square root of stirring rate dependency observed in the absence of fluoride.

Enamel dissolution in relation to fluoride concentrations in the fluid of dental plaque-like layers of precultured Streptococcus sobrinus

Two experiments were conducted to find out what concentration of fluoride (F), when added as NaF to the fluid of an in vitro caries model, would be sufficient for full protection of the underlying enamel during a long (20 or 40 h) fall in 'plaque' pH. An existing caries model with bovine enamel and Streptococcus sobrinus 'plaque' was employed, while the fluid phase was initially either fully or partially saturated with tricalcium phosphate. In the model with fully saturated and more strongly buffered fluid, a 10 parts/10(6) addition of F to the fluid phase caused no inhibition of the pH fall. In the model with partially saturated and weakly buffered fluid, prevention of the pH fall increased along with increase of added F from 2 to 20 parts/10(6). In each model, the 10 parts/10(6) addition of F was associated with complete prevention of the increase of calcium (Ca) in the fluid phase. In the partially saturated, weakly buffered model, findings on the inorganic P of the fluid phase agreed with findings on Ca. The findings for microhardness of the enamel surface indicated a complete prevention of the enamel softening through the 10 parts/10(6) F additive. Enamel F content was elevated by the fermentation, and even more so when F was added with sugar to the fluid phase. The Ca content of Strep. sobrinus cells was reduced when incubated with sucrose for 40 h and, especially, with sucrose and F.(ABSTRACT TRUNCATED AT 250 WORDS)

Composition and cariogenic potential of dental plaque fluid

Our understanding of the chemical events that take place at the tooth-plaque interface has improved greatly through studies of the chemical composition and properties of dental plaque fluid. In the absence of fermentable carbohydrate, plaque fluid has been found to be supersaturated with respect to tooth mineral and other calcium phosphate phases, thus exhibiting the potential to support calculus formation and the remineralization of incipient carious lesions. Following the exposure to fermentable carbohydrate, the degree of saturation of plaque fluid decreases rapidly, primarily due to lactic acid production and the lowering of plaque fluid pH. The extent of these chemical changes has been shown to be associated with differences in caries history. Such studies have been facilitated by the recent development of microanalytical techniques. Unfortunately, little is known about the relationship between the observed chemical changes in plaque fluid and the microbial composition of plaque. Limited information is also available on the association of immune factors in plaque fluid with dental disease.

Effects of low fluoride concentrations on formation of caries-like lesions in human enamel in a sequential-transfer bacterial system

Human enamel surfaces were exposed to sequential batch cultures of Streptococcus mutans NCTC 10832 in a sucrose-rich medium containing 0-5 mg/l added fluoride (F). In 10-day experiments, subsurface lesion formation was partly inhibited by 1 mg/l F and completely by 2 and 5 mg/l F, but small lesions formed in 2 mg/l F in 21-day experiments. Analysis of the spent media, together with analogous, bacteria-free experiments, suggested that lesion inhibition involved two main effects. First, inhibition of bacterial acid production reduced the pH fall, resulting in reduced undersaturation with respect to hydroxyapatite and consequently reduced rate of demineralization. Secondly, interaction of F with enamel mineral resulted in a small increase in reprecipitation during periods of supersaturation and a much larger reduction in demineralization during periods of undersaturation. It is concluded that, at low F concentrations, inhibition of bacterial acid production is a major factor in lesion inhibition, which may contribute significantly to caries prevention in vivo where plaque fluid F levels are raised by frequent topical applications.

The clinical evaluation of a fluoride-containing orthodontic bonding material

A clinical trial comparing a conventional adhesive, Concise, with a new fluoride-containing composite cement is described. The bond failure rate, plaque score, gingival health, and enamel decalcification were assessed for each material after a minimum period of 1 year. The preliminary results show no significant difference between the two materials for each of the variables examined, although there was a reduction in the number of white spot lesions using the fluoride-containing composite. The level of fluoride ion concentration required to inhibit the growth of oral micro-organisms is discussed.

Salivary fluoride clearance after a single intake of fluoride tablets and chewing gums in children, adults, and dry mouth patients

The aim of the present investigation was to compare the clearance pattern in saliva and the salivary stimulating effect of a new fluoride (F) chewing gum (Fluorette) with three other F products used in Scandinavia for many years for caries prevention. Concentration of F was determined in whole saliva in three groups of subjects: 1) children, 10-12 yr of age (n = 20), 2) adults (n = 20), and 3) dry mouth patients (n = 15), after a single intake of the two tablets, Dentan and Fludent, and the two chewing gums, Fluomin and Fluorette, all containing 0.25 mg F as NaF. Sucking was allowed until the tablets had been completely dissolved in the mouth. The chewing gums were used for 15 min. Saliva samples were collected from subjects expectorating 0.3-0.5 ml at nine different time intervals up to 45 min after the intake. There were some significant differences in the maximum F concentration, the area under the salivary fluoride concentration curve (AUC) when plotted against time, and the salivary stimulating effect among the four products, but as a whole they were small and probably of minor clinical importance. Among the various groups, the dry mouth patients showed the highest salivary F concentration. Thus, the main conclusion from this study is that the F tablets and chewing gums studied, including the new product Fluorette, had approximately the same clearance pattern in saliva and the same salivary stimulating effect. However, there were great variations among the different subjects.

Effect of fluoride incorporation into human dental enamel on its demineralization in vitro

Coronal surfaces of extracted human teeth were ground to a depth of about 1 mm and then cut in half labiolingually. One half was used as a control; the other half was exposed, for 3 days, to a fluoride-enriching buffer (0.1 mol/l lactic acid, 19.7 mmol/l CaCl2, 10.8 mmol/l KH2PO4, 3 mmol/l NaN3; pH adjusted to 4.68 with KOH) having fluoride concentrations from 0.0002 to 2.2 parts/10(6). This exposure resulted in an uptake of fluoride by the enamel to a depth of 2 microns without any apparent demineralization. The fluoride uptake was proportional to the F concentration of the enriching solution, reaching concentrations of about 8000 parts/10(6) within the first micrometre of enamel exposed to the highest F concentration; the controls had uniform F concentrations not exceeding 50 parts/10(6) along the 2.5 microns of enamel depth sampled. Thin sections (140-160 microns) were cut perpendicularly to the lingual surface, coated with protective resin except for a window about 1 mm long on the ground lingual surface, and exposed to a demineralizing buffer. The mineral losses of the sections were followed over 5 days by microradiography and image analysis. Fluoride enrichment resulted in reduced demineralization and the reduction was inversely related to the enamel fluoride content. The controls displayed a uniform erosion of the surface enamel whereas all the treatments below 1.5 parts/10(6) in the enriching solutions developed typical subsurface 'lesions'. The mineral content of the surface layer increased with increasing time of exposure to the demineralizing buffer.(ABSTRACT TRUNCATED AT 250 WORDS)

Distribution of fluoride in saliva and plaque fluid after a 0.048 mol/L NaF rinse

An ultramicro method has recently been described for measurement of plaque-fluid fluoride concentration (Vogel et al., 1990a). This method was used: (1) for exploration of the variation in fluoride concentration of plaque fluid collected from the same buccal tooth sites following a 0.048 mol/L NaF (0.2%) rinse, and (2) for examination of the distribution of fluoride in plaque fluid and saliva within one hour after this rinse. Results indicated an average coefficient of variation (CV) of 31% for plaque-fluid fluoride in triplicate samples recovered simultaneously from the buccal-proximal region of two teeth after the rinse. This was similar to the CV found for plaque-fluid fluoride from the same sites after separate administrations of the rinse. A strong linear correlation was found between salivary and plaque-fluid fluoride at 30 and 60 min after rinse administration, showing that plaque-fluid fluoride is influenced by the concentration of salivary fluoride after administration of this rinse. Plaque-fluid fluoride concentrations were higher than that in saliva at baseline, 30, and 60 min. Very large inter-site and intersubject variations in plaque-fluid distribution were observed, with the central incisors showing the slowest clearance. These variations suggest that an examination of plaque-fluid fluoride from specific tooth regions may be essential for understanding the effects of fluoride on the site-specificity of caries.

Cariostatic effect and fluoride release from a visible light-curing adhesive for bonding of orthodontic brackets

This study was designed to investigate the cariostatic potential in vivo of a visible light-curing adhesive for the bonding of orthodontic brackets. The fluoride release of the adhesive in water and saliva was also measured. Ten orthodontic patients with premolars to be extracted participated. One bracket with Heliosit-Orthodontic (no fluoride) was positioned on the buccal surface of one premolar (control), and another bracket with Orthodontic cement VP 862 (containing fluoride) was positioned on the experimental contralateral premolar. The adhesives were cured with a Heliolux II lamp, and the teeth were extracted after 4 weeks. The patients used a fluoride toothpaste during the experiment. The mineral content of the enamel adjacent to the brackets was determined by quantitative microradiography. The fluoride release from disk-shaped plates of the fluoride adhesive was measured in water for a 6-month period and in human saliva for 24 hours. The fluoride adhesive reduced lesion depths by about 48% than the nonfluoride adhesive (P less than 0.05, t test). The largest release of fluoride from the plates in water was observable within the first week. However, a significant amount of fluoride was still released after 6 months. The fluoride release in saliva was significantly lower in human saliva at pH 7 than in water (P less than 0.01, t test). When salivary pH was lowered to 4, to mimic a cariogenic challenge, the amount of fluoride released increased up to the value measured in water. It was concluded that the regular use of fluoride toothpastes is insufficient to inhibit lesion development around orthodontic brackets.(ABSTRACT TRUNCATED AT 250 WORDS)

Fluoride availability in human saliva after dentifrice use: correlation with anticaries effects in rats

Studies were conducted to determine fluoride availability in saliva after dentifrice use and to relate this parameter to cariostatic efficacy in rat caries experiments. Three dentifrices--two commercial formulations (Colgate Winterfresh Gel and Crest Dentifrice with Na-Sr-polyacrylate) and an Experimental dentifrice--were compared with respect to salivary fluoride availability. All of the dentifrices tested contained 1100 ppm F as sodium fluoride. It was observed that the Experimental dentifrice and Crest dentifrice with Sr-polyacrylate exhibited low salivary fluoride availability relative to the Colgate Winterfresh Gel. Salivary fluoride availability was assessed by means of two parameters: (a) the fluoride concentration in the dentifrice saliva slurry expectorated after brushing, and (b) the area under the curve of salivary F concentration vs. time for up to two hours after dentifrice use. In two rat caries experiments, it was observed that both the Experimental dentifrice and the Sr-polyacrylate dentifrice provided less cariostatic efficacy than the clinically validated Positive Control (Colgate Winterfesh Gel). Analysis of these data provides further evidence in support of the concept that fluoride availability in saliva following dentifrice use is an important parameter related to anticaries efficacy.

In vivo fluoride concentrations measured for two hours after a NaF or a novel two-solution rinse

The concentrations of fluoride in various samples from the oral environment were measured at timed intervals after a novel rinse or a NaF rinse, both containing a total of 12 mmol/L (228 ppm) fluoride. The novel rinse consisted of two solutions mixed just before application: Part A contained calcium chloride and sodium acetate; part B contained a hydrolyzable source of fluoride (sodium hexafluorosilicate) and sodium phosphate. Samples were obtained as follows: Single-site plaque-fluid samples were obtained by centrifugation of first-molar plaque; pooled whole-plaque samples were collected from second molars; centrifuged, pooled whole-saliva was collected by vacuum. All samples were analyzed by micro-analytical methods. Results showed that, compared with NaF, the two-solution rinse produced significantly higher salivary fluoride concentrations, plaque-fluid fluoride concentrations, and acid-extractable fluoride in the whole plaque by factors of about 4, 2, and 6, respectively, at 120 min. The results of this study suggest that the new rinse may provide a greater cariostatic effect at the same fluoride dosage than does a NaF rinse.

Comparative solubility study of human dental enamel, dentin, and hydroxyapatite

The solubility properties of hydroxyapatite (HA) are compared with those of human dental enamel and dentin. The apatites used in this study were equilibrated with dilute phosphoric acid solutions in CO2-containing atmospheres. The experimental results are interpreted in terms of solubility models which consider the biological materials as either HA or carbonatoapatites. Both in the HA and the dental mineral systems, the results are consistent with the precipitation of another carbonate-containing apatitic phase during equilibration. However, although the chemical behavior of the HA systems is in very good agreement with predictions based on the solubility models, the results with the bioapatites are not; this inconsistency is more marked for dentin than for enamel but in both cases the results clearly indicate the inadequacy of assuming for these dental apatites the stoichiometry of HA. The models and the experimental results show that, in principle, it is possible to define the two dental minerals in terms of respective solubility product constants, if independent information is attained on the stoichiometry of these bioapatites.

Mechanistic aspects of the interactions between fluoride and dental enamel

For many years after the discovery of its caries preventive effect, fluoride was thought to be primarily active by lowering the solubility of the apatitic mineral phase of the dental hard tissues. Recent findings have shed new light on the mechanisms by which fluoride inhibits or delays dental caries. Fluoride present in the oral fluids alters the rate of the naturally occurring dissolution and reprecipitation processes at the tooth-oral fluid interface. Demineralization of enamel is inhibited by concentrations of fluoride in the sub-ppm range. Likewise, remineralization of incipient caries lesions (the earliest stage of enamel caries) is accelerated by trace amounts of fluoride. As these two processes comprise dental caries the physiological balance between hard tissue breakdown and repair is favorably shifted by fluoride. The driving force for both phenomena is thermodynamic, that is, fluorapatite or a fluoridated hydroxyapatite may form when fluoride is supplied at low concentrations. This article critically reviews the current information about tooth-fluoride interactions, both from laboratory and clinical studies.

Development and testing of bioadhesive, fluoride-containing slow-release tablets for oral use

The bioadhesive characteristics of tablets for oral use made from modified starch, polyacrylic acid (PAA), polyethylene glycol (PEG) and sodium carboxymethylcellulose (CMC) were investigated. Adhesion force and energy were determined in-vitro and maximal adhesion time was evaluated in-vivo in human subjects. In-vitro, PAA showed the best bioadhesive properties, followed by modified maize starch and PEG with a mol. wt of 300,000-400,000 daltons. The presence of 0.1 mg of fluoride as NaF did not lead to significant differences in adhesion force and energy for the same formulation. The in-vivo bioadhesion was not strongly correlated to the in-vitro data. PAA, despite its excellent adhesion, proved to be irritating to the mucosa. PEG with a mol, wt of 200,000 daltons was subject to erosion. CMC showed good bioadhesive properties but the mechanical strength of the tablets was low. Modified maize starch tablets containing 5% (w/w) PAA and PEG with a mol. wt of 300,000 daltons proved to be the most suitable formulations for a fluoride-slow-release tablet with bioadhesive properties. In-vitro, the tablets released all of the fluoride within the 8 h period, with a high initial release. The release rate was related to the water absorption rate of the tablets. The PAA-containing formulations and the CMC formulations had the fastest release. In-vivo, fluoride levels with a minimum of 150 and a maximum of 1000 micrograms mL-1 were maintained for 8 h in the oral cavity. These fluoride levels were sustained significantly longer than those obtained with the administration of fourfold the amount of fluoride in the form of a fluoride-containing toothpaste. The release characteristics in-vivo exhibited a high variation. The use of bioadhesive polymers in oral pharmacotherapy seems promising.

Assessment of loosely-bound and firmly-bound fluoride uptake by tooth enamel from topically applied fluoride treatments

The amounts of loosely-bound fluoride (F) deposited on human enamel by two topical F treatments were measured with use of a constant-composition F washing method. Enamel biopsies conducted before treatment and after the washing were used for determination of the firmly-bound F uptake. The results showed that (1) the washing system did not remove F from untreated enamel surface, (2) a four-minute application of an acidulated phosphate fluoride (APF) gel deposited 27.2 (2.4) (mean, S.E.) micrograms of loosely-bound F per cm2 of enamel surface and 186 (111) ppm of firmly-bound F in the outer 10 microns of enamel, and (3) a four-minute application of a pH-2.1 dicalcium phosphate dihydrate (DCPD)-forming solution followed by APF produced 44.9 (3.1) micrograms/cm2 of loosely-bound F and 1280 (354) ppm of firmly-bound F in the outer 10 microns of enamel. The results showed that the DCPD pre-treatment effectively enhanced the enamel reactivity with F, so that the DCPD-APF treated enamel acquired greater amounts of both loosely-bound F and firmly-bound F than did samples treated with APF alone.

Tooth-bound fluoride and dental caries

The cariostatic effects of tooth-bound fluoride reported in the recent literature are reviewed. Several treatment procedures which can increase the tooth-bound fluoride content are described. Based on this information, it is suggested that effectiveness of currently used topical fluoride treatments may be significantly increased by (1) including in the regimen a dicalcium-phosphate-dihydrate-forming treatment so that a portion of the labile fluoride is re-incorporated as tooth-bound fluoride, and (2) employing application methods which ensure the effective delivery of treatment agents to the fissures, and to approximal and cervical surfaces, where most caries occurs.

Clinical evidence of the role of pre-eruptive fluoride in caries prevention

Recent clinical and laboratory evidence has suggested that systemic fluoride plays a more minor role in caries inhibition than was previously believed. This paper reviews clinical data on water fluoridation, the topical administration of fluorides, and fluoride supplements in the light of more recent understanding of the disease dental caries. Due to reduced functional usage, erupting teeth tend to accumulate plaque which has cariogenic potential. For this reason, the period from tooth emergence to the establishment of interproximal contact and full occlusion is the most critical for caries initiation. Analyses of clinical data indicate that maximum protection against caries is obtained when teeth erupt into an environment with low concentrations of ionic fluoride. The similarity in caries reductions obtained in water fluoridation studies and long-term studies with topically administered fluoride regimens, including fluoride-containing dentifrices, indicates that the pre-eruptive effect of fluoride is of borderline significance relative to the more significant post-eruptive effect. Water fluoridation and topical fluoride programs are thus important measures for the control of caries at the community level. For the individual, topical application of fluoride is seen as an integral part of caries treatment aimed at arresting progressive caries. Fluoride application is thus considered a supportive therapy, in conjunction with cariogenic plaque control. Daily use of fluoridated dentifrices from tooth eruption is more efficacious than daily use of fluoride supplements from birth.

Physicochemical perspectives on the cariostatic mechanisms of systemic and topical fluorides

The cariostatic mechanisms of systemic and topical fluoride agents are considered in light of a previously proposed model for the caries process. It is noted that fluoride, in principle, can induce a cariostatic effect: by (1) reducing enamel solubility when incorporated into the mineral structure; (2) by fostering the remineralization of incipient enamel lesions and the deposition of fluoridated phases (within dental plaque) which provide a source of mineral ions (Ca, P, F) under acidic conditions; and (3) by reducing the net rate of transport of matter out of the enamel surface, under acidic conditions, by inducing the reprecipitation of fluoridated hydroxyapatite phases within enamel. It is also noted that relatively high (approximately 12,000 ppm) concentrations of professionally applied topical fluorides significantly reduce the rate of acid production of cariogenic organisms (e.g., S. mutans). Based on an analysis of available clinical and laboratory data, it is concluded that the benefits provided by water fluoridation result, to a large degree, from a topical effect. It is suggested that clinical procedures be developed to establish and maintain low levels of free fluoride in plaque fluid. It appears that this will require frequent exposure to topical fluorides.

The antimicrobial action of fluoride and its role in caries inhibition

Despite a considerable amount of literature on the effects of fluoride in dental plaque, several urgent questions remain unanswered, such as: Does the inhibiting effect of fluoride on dental plaque metabolism contribute to caries prevention? Does adaptation of plaque to fluoride affect its cariogenicity? Single applications of fluoride directly to dental plaque reduced acid production. Also, fluoride dissolving from topically treated enamel reduced the acid production in covering layers of oral bacteria in vitro. The effects of both treatments were only of short duration and may not be relevant to caries prevention in vivo. In contrast, daily applications of fluoride resulted in a reduction of the acidogenicity of dental plaque even 8-12 h after the treatment. Such a reduction is likely to contribute to caries prevention. But it has to be realized that when plaque reaches saturation with respect to fluoridated calcium (phosphate) precipitates, enamel becomes insoluble and any antimicrobial effect becomes irrelevant. Still lacking are data on the antimicrobial effects of fluoride regimens normally used in home care, in weekly rinsing programs in schools, or treatments applied professionally every six months. Adaptation of Streptococcus mutans to fluoride has been suggested to reduce the cariogenic potential of the cells. In vitro-induced fluoride-resistant strains were less cariogenic in rats, and the velocity of acid production in vitro was reduced at constant pH greater than 5.5. Despite the ability of oral bacteria to adapt to fluoride, evidence of adaptation in dental plaque of normal subjects resulting in a reduced cariogenic potential has not yet been demonstrated.

Chemical events during tooth dissolution

The aims of the present survey were to describe some aspects of (a) enamel solubility in relation to pH and to the fluoride concentration, (b) chemical changes which occur during enamel dissolution, and (c) enamel resistance with an attempt to relate chemical events to clinical observations. The solubility of enamel powder increases dramatically with a decrease of pH. As long as the fluoride concentration in solution is high, the amount of enamel dissolved is low. When fluoride occurs only in the solid phase, the solubility is only slightly affected. Two clinically distinct lesions have been described in dental enamel: the erosion lesion, characterized by a dissolution of enamel from the surface; and the caries lesion, in which the enamel surface layer, accumulating fluoride, remains relatively intact, while the subsurface enamel dissolves. It was concluded that any dissolution of enamel is caused by an undersaturation with respect to enamel apatite. When whole enamel dissolves, the saturation with respect to fluorapatite determines whether a well-mineralized surface layer remains, i.e., whether the dissolution results in an erosion or a caries lesion. The degree of supersaturation with respect to fluorapatite determines the uptake of fluoride in the surface layer and its mineral content. It was observed that different areas of the enamel surface possess different degrees of resistance. A satisfactory explanation for the resistance has not been given.