Root caries lesions inhibition and repair using commercial high-fluoride toothpastes with or without tri-calcium phosphate and conventional toothpastes containing or not 1.5% arginine CaCO3: an in situ investigation

Could the Arginine-Fluoride Association Have a Real Impact on Caries Prevention?

In the context of preventive therapy, fluoride has allowed the reduction of the incidence and prevalence of caries. The establishment of the protective role of arginine in the neutralization of plaque acids has led to the development of new arginine-fluorine associations to potentiate this preventive aspect. Studies have reported that this association could provide superior efficacy compared to fluoride alone. A synergistic effect that could be potential and thus represent a promising ecological approach for caries prevention. However, confirmation of the effective efficacy of the arginine-fluoride association requires additional clinical studies to be carried out before establishing recommendations.

The combination of arginine and fluoride-containing bioactive glass acted synergistically in inhibiting enamel demineralization in permanent teeth

OBJECTIVES

To evaluate the in-vitro efficacy of inhibiting enamel demineralization using arginine in combination with fluoride-containing bioactive glass (FBG).

METHODS

In this study, the healthy enamel blocks were first demineralized in acetic acid for 24 h, then soaked in anti-demineralization treatment solutions containing either arginine or FBG or both for 96 h.The specimens treated in acetic acid were applied as the control group. The pH, calcium and phosphorus ion concentrations of the solutions were measured before and after treatment. Changes in enamel mineral weight, microhardness, and composition were also analyzed.

RESULTS

The present of arginine facilitated fluorine release from treatment solutions with the presence of FBG. Both arginine and FBG significantly increased the pH of treatment solutions and prevented the further mineral weight loss compared to the control group. All anti-demineralization treatment groups showed significant increases in microhardness, but there was no statistical difference among the treatment groups. The SEM analysis showed enamel restoration in the arginine and FBG groups upon treatment, while the combined groups showing a superior anti-demineralization efficacy. 19F NMR showed the formation of fluorapatite in samples treated with solutions containing FBG.

CONCLUSIONS

Both arginine and FBG could inhibit enamel demineralization to some extent, and their combination demonstrated an enhanced anti-demineralization efficacy. The low-concentration combination group exhibited anti-demineralization effects comparable to those of high-concentration ones.

CLINICAL SIGNIFICANCE

This study introduces a new approach for caries prevention by combining the application of arginine and FBG. The release of fluorine promoted by the presented arginine along with calcium and phosphorus ions from FBG facilitated FAP formation. Additionally, the increment of pH resulting from arginine and FBG degradation further prevents enamel demineralization.

Salivary fluoride bioavailability after use of high-fluoride dentifrices with different compositions: A short-term randomized clinical trial

OBJECTIVE

The objective of the study was to evaluate the kinetics of salivary F bioavailability after the use of high-fluoride dentifrices with different compositions and their amount of total soluble fluoride (TSF).

METHODS

A short-term clinical randomized trial was performed in which 15 adult participants were randomly allocated into three groups: 5000 ppm F-dentifrice, 5000 ppm F-dentifrice + TCP (tri-calcium phosphate) and 1450 ppm F-dentifrice. Unstimulated saliva was collected at different times: baseline (before toothbrushing), immediately after brushing/water rinsing and at 5, 15 and 30 min and 1, 2, 4, 8 and 12 h after brushing. The TSF in dentifrices and saliva samples was analysed using an ion-specific electrode. For statistical analysis, the paired t-test and Kruskal-Wallis were used with Dunn's post-test with a 95% confidence interval.

RESULTS

There was no significant difference between the declared TSF and that found in 5000 ppm F-dentifrice and 1450 ppm F-dentifrice (p ≥ 0.13); however, in the 5000 ppm F-dentifrice + TCP, approximately 500 ppm less TSF was observed (p = 0.0024). The area under the curve (AUC, μg F/ml min-1) of both high-fluoride dentifrices (321.7 ± 84.0 and 223.6 ± 55.1 for the one without and with TCP, respectively) was higher than the conventional one (89.97 ± 15.6) attesting a higher F-bioavailability (p = 0.04). Furthermore, they were able to provide F-salivary levels higher than the baseline for up to 2 h, while this time was 1 h for the 1450 ppm F-dentifrice (p ≤ 0.003).

CONCLUSION

Both high-fluoride dentifrices similarly increased the salivary-F bioavailability in comparison with 1450 ppm F-dentifrice, despite the lower TSF presented by the dentifrice containing TCP.

Immediate and Sustained Root Caries Prevention of Fluoride Varnish Combined with Toothpastes

The aim of this study was to determine the immediate and sustained effect of a fluoride varnish and its combinations with toothpastes in preventing root caries development using a salivary microcosm in vitro model. Human root dentin specimens (n = 150) were randomly divided into 5 experimental protocols (n = 30): (1) Fluoride Varnish (V); (2) V followed by Paste One (V + PO); (3) V followed by Paste Plus (V + PP); (4) V followed by PO and PP (V + PO + PP); and (5) No treatment (control). One varnish layer was applied on the specimens (except for the control group) and kept for 18 h. Then, the varnish was removed and toothpaste treatments were initiated according to experimental groups. For the short-term incubation model (n = 15), the specimens were also immediately subjected to 7-day cariogenic challenge. For that, human saliva was used as bacterial inoculum and McBain artificial saliva containing 2% sucrose as growth medium. The other half of the specimens (n = 15) were used to study the varnish's sustained effect by long-term incubation (8 weeks) before cariogenic challenge. The protocols' anti-caries properties were evaluated by dentin porosity (rhodamine intensity; RI) and mineral density, while their anti-biofilm effects were evaluated using biofilm's biomass and viability assays. For short- and long-term incubation models, all experimental regimens resulted in statistically significant decreases (p < 0.05) in the RI (up to 180 μm and 120 μm, respectively) as well as higher mineral density compared to No treatment (p < 0.001). V + PO + PP and/or V + PO resulted in statistically lower RI compared to V for some depths (p < 0.05) in both models. There were changes in RI and mineral density within groups over time. All experimental treatments exhibited anti-biofilm effects. All prevention protocols exhibited immediate and sustained anti-caries effect against root caries development. The combination of a fluoride varnish with PO resulted in superior additional anti-caries effects.

The burden of root caries: Updated perspectives and advances on management strategies

BACKGROUND

Root caries has gained much attention in the last few years. As the world's population is ageing and people currently tend to retain more teeth compared with older generations, there is an increased prevalence of periodontal disease and gingival recession, which may accelerate the onset of root caries.

OBJECTIVE

This review aims to summarise recent findings related to the diagnosis, prevention and treatment of root caries.

MATERIALS AND METHODS

MEDLINE (OVID) and Scopus (Elsevier) searches were performed to identify and discuss articles that address the pathogenicity and clinical management of root caries.

RESULTS

Root caries is a multifactorial disease. Cariogenic species involved in root caries are less dependent on carbohydrates since collagen degradation inside the dentinal tubules can provide nutrients and microcavities for the invading microorganisms. Furthermore, the root surface has fewer minerals in comparison with enamel, which may accelerate the onset of demineralisation. Root caries could be prevented by patient education, modification of risk factors, and the use of in-office and home remineralisation tools. The use of non-invasive approaches to control root caries is recommended, as the survival rate of root caries restorations is poor. When plaque control is impossible and a deep/large cavity is present, glass ionomer or resin-based restorations can be placed.

CONCLUSION

The assessment of root carious lesions is critical to determine the lesion activity and the required intervention. Dental practitioners should also be aware of different prevention and treatment approaches to design optimum oral health care for root caries-affected patients.

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

This comprehensive review of the 2019 restorative dental literature is offered to inform busy dentists regarding remarkable publications and noteworthy progress made in the profession. Developed by the Scientific Investigation Committee of the American Academy of Restorative Dentistry, each author brings discipline-specific expertise to 1 of 8 sections of the report: (1) prosthodontics; (2) periodontics, alveolar bone, and peri-implant tissues; (3) implant dentistry; (4) dental materials and therapeutics; (5) occlusion and temporomandibular disorders; (6) sleep-related breathing disorders; (7) oral medicine and oral and maxillofacial surgery; and (8) dental caries and cariology. The report targets important information likely to influence day-to-day dental treatment decisions. Each review is not intended to stand alone but to update interested readers so that they may visit source material when greater detail is desired. As the profession moves toward evidence-based clinical decision-making, an incredible volume of potentially valuable dental literature continues to increase. It is the intention of this review and its authors to provide assistance in negotiating the extensive dental literature published in 2019. It is our hope that readers find this work useful in the clinical management of dental patients.