Remineralizing potential of various agents on dental erosion

Effect of three different remineralising agents on prevention against acidic erosion of primary teeth: an in vitro study

PURPOSE

This study aimed to evaluate and compare the protective effect of fluoride varnish (Enamelast™, Ultradent Inc., Cologne, Germany), casein phosphopeptide-amorphous calcium phosphate fluoride/CPP-ACPF (MI Paste Plus, GC Corp., Tokyo, Japan) and self-assembling P11-4 peptide (Curodont™ Protect, Credentis AG, Windisch, Switzerland), against acidic erosion of primary teeth.

METHODS

Forty primary anterior teeth were randomly assigned to four groups (n = 10): group 1: control, group 2: fluoride varnish, group 3: CPP-ACPF and group 4: self-assembling P11-4 peptide. After applying remineralising agents, except for the control group, all specimens underwent an erosive challenge of carbonated soft drink and artificial saliva for 15 cycles of 6 s each at 6-h intervals for a day. Groups were compared in terms of surface microhardness, roughness readings, and surface scanning with an extra-oral scanner (D800; 3Shape A/S) before and after the erosive process.

RESULTS

All experimental groups showed superior results than the control group regarding microhardness, surface roughness, and substance loss. The fluoride varnish group showed significantly favourable results in microhardness change. There was no significant difference between the experimental groups regarding surface roughness and enamel loss measurements.

CONCLUSION

5% NaF fluoride varnish, CPP-ACPF and self-assembling P11-4 peptide protect the enamel of primary teeth against erosion compared to artificial saliva alone.

Influence of Different Mouthwashes on the Efficacy of Fluoridated Dentifrices in Prevention of Enamel Erosion: An In Vitro Study

AIM

The purpose of the current study was to evaluate the impact of three various mouthwashes on the effectiveness of fluoride dentifrices in preventing enamel erosion.

MATERIALS AND METHODS

A total of 120 sound intact human premolar teeth which were extracted for orthodontic treatment were selected for the study. A 3 × 3 mm window section was positioned in the middle of the coronal surface of the tooth in order to define the study area. Each sample was placed in a solution of 1% citric acid (pH 3.5) for 10 minutes in order to produce an eroded surface. All samples were divided into two main groups (60 samples each) as follows: Group A for sodium fluoride dentifrices and group B for stannous fluoride dentifrices, again it is subdivided into: CHX: Chlohex ADS®, EO: Listerine®, CPC: Colgate® Plax (20 samples in each subgroup). After that, samples underwent the pH cycling model for 5 days. Samples were examined for surface loss using a scanning electron microscope.

RESULTS

In sodium fluoride dentifrices group, before intervention, the surface loss was 3.12 ± 1.03 in CHX group, 3.08 ± 1.20 in EO group, and 3.09 ± 0.96 in CPC group. After intervention, the less surface loss found with CHX group (2.18 ± 0.84), followed by CPC (2.34 ± 0.74) and EO group (2.46 ± 0.97). In stannous fluoride dentifrices group, before intervention, the surface loss in CHX group was 3.26 ± 1.19, in EO group, it was 3.18 ± 1.31, and in CPC group, it was 3.22 ± 1.06. After intervention, the less surface loss found with CHX: group (1.90 ± 0.54), followed by CPC (2.24 ± 0.28) and EO group (2.38 ± 0.20).

CONCLUSION

The present study concluded that the fluoride dentifrices' preventive effects against tooth surface loss were unaffected by a different mouthwashes with varying compositions and major constituents. In terms of erosion, fluoridated toothpaste containing stannous fluoride was found to provide better surface loss protection than sodium fluoride.

CLINICAL SIGNIFICANCE

Primary prevention and the eradication of contributing causes are the greatest strategies for preventing erosion. Simultaneously, antibacterial agent in the mouthwashes may help in enhancing the effect of fluoride in the enamel, owing to their high affinity for teeth structures. Therefore, in addition to cause-related treatment, further efforts to reduce tooth tissue loss are also necessary.

Morphological and Elemental Evaluation of Investigative Mouthwashes to Repair Acid-Eroded Tooth Surface

Purpose

Erosive tooth wear (ETW) is characterized by subsurface demineralization and tooth substance loss with crater formation. Remineralization of subsurface demineralization has previously been demonstrated; however, repair of the eroded surface is still under investigation. This study investigated the effectiveness of mouthwashes containing hydrolyzed wheat protein (HWP) in repairing ETW through promotion of organized crystal growth.

Methods

Enamel Erosion was created on 210 enamel blocks by 10-minute demineralization in 1% Citric Acid (pH 3.5). Then, blocks were randomly assigned to seven groups (30/group); (A) 0.2% HWP, B) 1% HWP, (C) 2% HWP, (D) 1% HWP + 0.05% NaF, (E) Listerine™ mouthwash, (F) 0.02% NaF Crest™ Pro-health mouthwash and (G) artificial saliva (AS) only. Groups were subjected to daily pH-cycling consisting of one 5-minute erosive challenge with citric acid, three 1-minute mouthwash treatment periods, and then storage in AS for the rest of the time for 28 days. Treatment effects were assessed using SEM-EDX. Statistical analysis was by ANOVA and Tukey's multiple comparison.

Results

In groups exposed to HWP-containing mouthwashes, there was growth of fiber-like crystals that increased in packing density in a dose-dependent manner (0.2%, 1%, 2%) on the eroded enamel surfaces, with increased calcium and phosphate contents on the treated surfaces. The non-HWP-containing groups had the eroded surfaces covered by structureless deposit layer firmly attached to the surface.

Conclusion

Treating eroded enamel surface with HWP-containing mouthwash resulted in repair of the damaged tissue by formation of a protective layer of crystal deposits within and on the eroded enamel tissue.

Film-Forming Polymers for Tooth Erosion Prevention

Different agents have been proposed to prevent the progression of acid induced dental substance losses, which are called erosive tooth wear (ETW), such as fluorides, calcium, and phosphate-based products; however, there is a need for a further increase in efficacy. Recently, the ability of polymers to interact with the tooth surface, forming acid resistant films, has come into the focus of research; nevertheless, there is still the need for a better understanding of their mode of action. Thus, this article provides an overview of the chemical structure of polymers, their mode of action, as well as the effect of their incorporation into oral care products, acid beverages, and antacid formulations, targeting the prevention of ETW. Recent evidence indicates that this may be a promising approach, however, additional studies are needed to confirm their efficacy under more relevant clinical conditions that consider salivary parameters such as flow rate, composition, and clearance. The standardization of methodological procedures such as acid challenge, treatment duration, and combination with fluorides is necessary to allow further comparisons between studies. In conclusion, film-forming polymers may be a promising cost-effective approach to prevent and control erosive demineralization of the dental hard tissue.

Topical Agents for Nonrestorative Management of Dental Erosion: A Narrative Review

A nonrestorative approach to the management of dental erosion is the foremost option: controlling dental erosion. The objectives of this study are to provide an overview and to summarise the effects and properties of topical anti-erosive agents as a nonrestorative treatment of dental erosion. A literature search was conducted on five databases of peer-reviewed literature—Cochrane Library, EMBASE, PubMed, Scopus and Web of Science—to recruit articles published between 1 January 2000 and 31 December 2021. The literature search identified 812 studies; 95 studies were included. Topical anti-erosive agents can be broadly categorised as fluorides, calcium phosphate-based agents, organic compounds and other anti-erosive agents. In the presence of saliva, fluorides promote the formation of fluorapatite on teeth through remineralisation. Calcium phosphate-based agents supply the necessary minerals that are lost due to the acid challenge of erosion. Some organic compounds and other anti-erosive agents prevent or control dental erosion by forming a protective layer on the tooth surface, by modifying salivary pellicle or by inhibiting the proteolytic activity of dentine collagenases. Topical anti-erosive agents are promising in managing dental erosion. However, current evidence shows inconsistent or limited results for supporting the use of these agents in clinical settings.

The Effects of Three Remineralizing Agents on the Microhardness and Chemical Composition of Demineralized Enamel

This study aimed to determine the effects of three different varnish materials (containing casein phosphopeptide-amorphous calcium phosphate, nano-hydroxyapatite, and fluoride) on enamel. Thirty-three extracted human third molars were used for specimen preparation. These were demineralized using phosphoric acid. Three experimental groups (n = 11) were treated with 3M™ Clinpro™ White Varnish, MI Varnish^®, and Megasonex^® toothpaste, respectively, every twenty-four hours for fourteen days. Analysis of the microhardness of the specimens’ enamel surfaces was carried out via the Vickers method, and by scanning electron microscopy/energy dispersive X-ray spectroscopy (SEM/EDS). Analysis was performed at three stages: at baseline value, after demineralization, and after the period of remineralization. Data were subjected to Scheffe’s post hoc test. The mean microhardness values (HV0.1) obtained for the group of samples treated with MI Varnish^® were higher compared with the other two groups (p = 0.001 for both comparisons), while the first and third groups did not differ significantly from each other (p = 0.97). SEM analysis showed uneven patterns and porosities on all samples tested. EDS results showed an increase in the mineral content of the examined samples, with the highest mineral content observed in the MI Varnish^® group. It can be concluded that MI Varnish^® use has a better remineralization effect on enamel than the other two materials.

Nanoencapsulated fluoride as a remineralization option for dental erosion: an in vitro study

OBJECTIVE

To compare the in vitro performance of different dentifrices indicated for dental erosion and a new dentifrice with controlled fluoride release system (NanoF) in terms of surface microhardness remineralization in enamel erosion lesions.

MATERIALS AND METHODS

72 human enamel specimens were divided into 6 groups (n = 12): PC (100% NaF - positive control); NC (Placebo - negative control); 50%nF (50% NanoF + 50% free NaF), 100%nF (100% NanoF); PN (Sensodyne^® ProNamel™) and AG (Colgate^® Sensitive Pro-Relief™). A surface microhardness analysis was performed before (SH₀) and after (SH₁) the erosion lesion formation. The blocks were submitted to a 5-day de-remineralization cycling model, consisting of 90 s immersion on 0.1% citric acid (4x/day) and 1 min treatment with dentifrice slurries along with 1 mL/block of human saliva (2x/day). Lastly, the final surface microhardness analysis (SH₂) was measured and the percentage of surface microhardness remineralization (%SMH_R) was calculated. Data were analysed with 2-way ANOVA and Tukey's test (p < .05).

RESULTS

Statistically significant differences were observed for SH₂ and %SMH_R between NC and AG with the other groups (p < .05). The best %SMH_R from the experimental groups was found in 100%nF and PN.

CONCLUSION

Dentifrices with NanoF exhibited a surface microhardness remineralization similar to sodium fluoride (PC). Therefore, NanoF dentifrice can be an alternative to prevent and treat patients with dental erosion.

The use of a new calcium mesoporous silica nanoparticle versus calcium and/or fluoride products in reducing the progression of dental erosion

Objective

There is increasingly common the consumption more times a day of foods and acidic drinks in the diet of the population. The present study aimed to evaluate and compare the effects of a calcium mesoporous silica nanoparticle single application of other calcium and/or fluoride products in reducing the progression of dental erosion.

Methodology

Half of the eroded area was covered of 60 blocks of enamel, after which the block was submitted to the following treatments: (Ca²⁺-MSN), casein phosphopeptide–amorphous calcium phosphate (CPP-ACP); CPP-ACP/F-(900 ppm F−); titanium tetrafluoride (TiF₄ 1%) (positive control); sodium fluoride (NaF 1.36%) (positive control); and Milli-Q^® water (negative control) before being submitted to a second erosive challenge. A surface analysis was performed via a three-dimensional (3D) noncontact optical profilometry to assess the volumetric roughness (Sa) and tooth structure loss (TSL) and and through scanning electron microscopy (MEV). An analysis of variance (ANOVA) and Tukey’s test were performed.

Results

Regarding Sa, all experimental groups exhibited less roughness than the control (p<0.05). The TSL analysis revealed that the Ca²⁺-MSN and NaF groups were similar (p>0.05) and more effective in minimizing tooth loss compared with the other groups (p<0.05).

Conclusions

The Ca²⁺-MSN and NaF treatments were superior compared with the others and the negative control.

Comparative Effect of Calcium Mesoporous Silica Versus Calcium and/or Fluoride Products Against Dental Erosion

The aim of this study was to compare the effects of a single application of a new calcium mesoporous silica nanoparticle (Ca2+-MSN) versus other calcium and/or fluoride products against dental erosion. Enamel blocks were half-covered and assigned to six groups (n = 10): Ca2+-MSNs; casein phosphopeptide-amorphous calcium phosphate mousse (CPP-ACP); CPP-ACP/F- (900 ppm F-); titanium tetrafluoride (TiF4 1%); sodium fluoride (NaF 1.36%); and Milli-Q® water (negative control). A single application for each product was completed on the exposed areas of the blocks and were submitted to an erosive challenge. Differences in volumetric roughness (Sa), and tooth structure loss (TSL) by use of three-dimensional noncontact optical profilometry were evaluate. Scanning electron microscopy (SEM) was performed. Analysis of variance and Tukey's test for Sa and the Kruskal-Wallis and Mann-Whitney U tests (p< 0.05) for TSL, respectively. Results: When evaluating Sa, all products presented differences in roughness when compared with the control group (p< 0.05) but not with each other (p > 0.05). However, when analyzing the TSL, it was observed that Ca2+-MSNs, TiF4, and NaF were more effective in preventing dental erosion versus CPP-ACP, CPP-ACP/F-, and Milli-Q® water (p< 0.05). In the SEM images, the negative control presented the worst loss of dental structure, with more porous enamel. Ca2+-MSNs were as effective as TiF4 and NaF to reduce the tooth structure loss.

Complementary remineralizing effect of self-assembling peptide (P11-4) with CPP-ACPF or fluoride: An in vitro study

Background

Self-assembling peptide has been recently introduced to promote hard tissue regeneration for treating early non-cavitated carious lesions. This study investigates the efficacy of biomimetic self-assembling peptide (P11-4) on enamel remineralization combined with CPP-ACPF or fluoride.

Material and Methods

Artificial enamel lesions were created on buccal surface of 60 specimens and were randomly assigned to six groups according to the remineralizing agent: G1-(Control, artificial saliva), G2-(Fluoride varnish), G3-(CPP-ACPF varnish), G4-(Self-assembling peptide), G5-(Self-assembling peptide+fluoride varnish), G6-(Self-assembling peptide+CPP-ACPF varnish). All products were applied according to manufacturer’s instructions and specimens were stored in a daily renewed artificial saliva. Surface microhardness (SMH) and scanning electron microscope (SEM) were assessed at baseline, after demineralization, 1 week and 4 weeks storage. SMH values were analyzed using ANOVA and Tukey’s post-hoc test.

Results

The highest statistically significant SMH values were found in G6 followed by G5, G4, G2 and G3 while the lowest values were found in G1. No statistically significant difference was found between G5 and G6. Also, no statistically significant difference was found between G2 and G3. SEM showed that G4, G5, G6 resulted in more pronounced remineralization, reversing the demineralized enamel fish scale pattern compared to G2 and G3 after 1 week and 4 week remineralization.

Conclusions

Complementary effect was obtained after combining self-assembling peptide with CPP-ACPF or fluoride showing the highest remineralizing potential early after 1 week and even after 4 weeks compared to when each agent used alone. Added benefits can be obtained through combining self-assembling peptide with other remineralzing agents allowing faster and enhanced regeneration of non-cavitated caries lesions.

Key words:Enamel regeneration, biomimetic remineralization, self-assembling peptide, CPP-ACPF, fluoride.

Effect of Cpp-aCp and Cpp-aCpf pastes on the Surface Hardness of Initial Dental Erosion Lesions: an In Situ Study

To analyze the effect of intra-oral application of CPP-ACP and CPP-ACPF pastes on the surface hardness of initial dental erosion lesions.Bovine enamel specimens were randomly assigned into 6 volunteers in 3 treatment groups: GI: CPP-ACP paste, GII: CPP-ACPF paste and GIII (Control): Placebo paste without CPP-ACP and without fluoride. Enamel specimens were selected by surface hardness (SHi), in vitro eroded by immersion in hydrochloric acid for 30 seconds (SHdes) and randomized between treatment groups and volunteers, who used the palatal intraoral device for 2 hours, applied the treatment on the specimens and used the palatal intraoral device for an additional 3 hours in 3 crossed phases, interspersed with a 7-day washout period. Subsequently, the surface hardness (SHre) was measured to estimate the re-hardening potential of the softened enamel promoted by treatments. Data were analyzed using the t-test and one-way ANOVA, adopting 5% significance level. Mean final and post-erosion hardness values were statistically significant for pastes tested (p<0.05), which presented re-hardening effect of the softened enamel, but with no difference between them and placebo (p>0.05). CPP-ACP and CPP-ACPF pastes did not demonstrate higher efficacy in re-hardening the eroded enamel compared to placebo paste.

Polymeric materials and films in dentistry: An overview

The use of polymeric materials (PMs) and polymeric films (PMFs) has increased in medicine and dentistry. This increasing interest is attributed to not only the excellent surfaces of PMs and PMFs but also their desired mechanical and biological properties, low production cost, and ease in processing, allowing them to be tailored for a wide range of applications. Specifically, PMs and PMFs are used in dentistry for their antimicrobial, drug delivery properties; in preventive, restorative and regenerative therapies; and for corrosion and friction reduction. PMFs such as acrylic acid copolymers are used as a dental adhesive; polylactic acids are used for dental pulp and dentin regeneration, and bioactive polymers are used as advanced drug delivery systems. The objective of this article was to review the literatures on the latest advancements in the use of PMs and PMFs in medicine and dentistry. Published literature (1990–2017) on PMs and PMFs for use in medicine and dentistry was reviewed using MEDLINE/PubMed and ScienceDirect resources. Furthermore, this review also explores the diversity of latest PMs and PMFs that have been utilized in dental applications, and analyzes the benefits and limitations of PMs and PMFs. Most of the PMs and PMFs have shown to improve the biomechanical properties of dental materials, but in future, more clinical studies are needed to create better treatment guidelines for patients.

Efficacy of different strategies to treat root dentin eroded by liquid or gaseous hydrochloric acid associated with brushing abrasion

OBJECTIVE

This study aims to evaluate how casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) associated with Nd:YAG or Diode laser affects dentin exposed to hydrochloric acid (HCl) with or without tooth brushing.

DESIGN

One hundred and sixty human root dentin blocks were selected after they were initially eroded with liquid HCl (pH 1.2) 3x for one day. The blocks were divided into the following groups: G1- liquid HCl (HCl-l), G2- HCl-l + brushing, G3- gaseous HCl (HCl-g), and G4- HCl-g + brushing. Each group was randomly assigned to the following treatments (n = 10): A) Control (no treatment), B) CPP-ACP, C) CPP-ACP associated with Nd:YAG laser (λ = 1064 nm) (40 mJ, 10 Hz, 0.4 W, 15 s), and D) CPP-ACP associated with Diode laser (λ = 980 nm) (0.5 W, 200 μs, 15 s). The treatment with CPP-ACP (G2, G3 and G4) was applied on the dentine surface for 5 min. Erosion (6x/day/20 s) and erosion (6x/day/20 s) with abrasion (2x/10 s) were performed for five days. Dentin volume loss was determined by 3D confocal laser microscopy. Data were analyzed with two-way ANOVA and Tukey's tests.

RESULTS

G1 - CPP-ACP (10.77 ± 1.66) and CPP-ACP associated with Diode laser (9.98 ± 0.89) showed lower volume loss in relation Control group (12.86 ± 0.63) (p < 0.05). G2 - CPP-ACP associated with Diode laser (12.41 ± 1.08) elicited lower volume loss as compared to the Control (14.42 ± 1.24) (p < 0.05). As for G3 and G4, all treatments showed similar volume loss.

CONCLUSION

CPP-ACP and CPP-ACP associated with Diode laser could control dental tissue loss in dentin eroded by liquid HCl. Moreover, CPP-ACP associated with Diode laser could effectively decrease dental tissue loss in dentin exposed to liquid HCl and brushing.

Comparative evaluation of remineralizing efficacy of biomimetic self-assembling peptide on artificially induced enamel lesions: An in vitro study

Background

The biomimetic self-assembling peptide technology is a paradigm for dental hard tissue regeneration.

Aim

To investigate the efficacy of biomimetic self-assembling peptide (P₁₁-4) on enamel remineralization compared to casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF) and fluoride-based delivery systems.

Materials and Methods

Artificial enamel lesions were created on buccal surfaces of 40 extracted human molars. Specimens were randomly assigned to four groups (n = 10) according to the remineralizing agent used: G1 - control: artificial saliva, G2 - fluoride varnish, G3 - CPP-ACPF varnish, G4 - self-assembling peptide agent. All products were applied according to the manufacturer's instructions and the specimens were stored in daily renewed artificial saliva. Surface microhardness (SMH) was assessed at baseline, after demineralization, after 1 week and after 4 weeks storage. SMH values were analyzed using ANOVA and Tukey's post hoc test.

Results

Self-assembling peptide showed the highest statistically significant mean SMH followed by fluoride and CPP-ACPF while the lowest mean SMH was found in artificial saliva. However, no statistically significant difference was found between fluoride and CPP-ACPF. Higher statistically significant mean SMH was found after 4 weeks compared to 1 week remineralization in all groups.

Conclusions

Self-assembling peptide confers the highest remineralizing efficacy compared to fluoride and CPP-ACPF, showing a promising, noninvasive regeneration potential. Furthermore, extended period of time helped attain more benefits from the remineralizing regimens applied.

Assessment of Enamel Remineralisation After Treatment with Four Different Remineralising Agents: A Scanning Electron Microscopy (SEM) Study

INTRODUCTION

Decades of research has helped to increase our knowledge of dental caries and reduce its prevalence. However, according to World Oral Health report, dental caries still remains a major dental disease. Fluoride therapy has been utilised in a big way to halt caries progression, but has been met with limitations. This has paved the way for the development of newer preventive agents that can function as an adjunct to fluoride or independent of it.

AIM

The purpose of the present study was to evaluate the ability of Casein Phosphopeptide-Amorphous Calcium Phosphate Fluoride (CPP ACPF), Bioactive Glass (BAG), fluoride enhanced Hydroxyapatite (HA) gel and self-assembling peptide P₁₁-4 to remineralise artificial carious lesions in enamel in vitro using a 30 day pH cycling model through surface microhardness analysis and SEM.

MATERIALS AND METHODS

Sixty enamel samples were divided into five groups of 12 samples each. The control Group A consisted of intact enamel samples, Group B: CPP-ACPF (Tooth Mousse Plus), Group C: BAG (SHY- NM), Group D: fluoride enhanced HA gel (ReminPro) and Group E: Self-assembling peptide P₁₁-4 (Curodont Protect). All groups excluding the control group were subjected to demineralisation following which four of these groups were remineralised using the four remineralising agents. The treated groups were subjected to pH cycling over a period of 30 days. This was followed by assessment of surface microhardness and SEM for qualitative evaluation of surface changes. The results were analysed by One-Way Analysis Of Variance (ANOVA). Multiple comparisons between groups were performed by paired t-test and post-hoc Tukey test.

RESULTS

The results of the study revealed that remineralisation of enamel was the highest in samples of Group E (Self assembling peptide P₁₁-4) followed by Group B (CPP-ACPF), Group C (BAG) and Group D (fluoride enhanced HA gel). There was a significant difference (p<0.05) in the remineralising ability between the self assembling peptide P₁₁-4 group and BAG and fluoride enhanced HA gel group. Although no significant difference was observed between the self assembling peptide P₁₁-4 and CPP-ACPF group, the self assembling peptide P₁₁-4 remineralised the enamel lesions more effectively. SEM photomicrographs of the test groups demonstrated either amorphous crystals or particles scattered on the surface or lines of remineralisation along the prismatic borders.

CONCLUSION

Self assembling peptide P₁₁-4 demonstrated promising results by effectively and significantly remineralising the enamel lesions as compared to other test agents.

Changes in the Concentration of Ions in Saliva and Dental Plaque after Application of CPP-ACP with and without Fluoride among 6-9 Year Old Children

STATEMENT OF PROBLEM

The casein phospho peptide-amorphous calcium phosphate with or without fluoride (CPP-ACPF and CPP-ACP respectively) are of considerably new materials which are highly recommended for prevention of dental caries. However, there is a shortage in literature on how they affect the ion concentration of saliva or dental plaque.

OBJECTIVES

The aim of this study was to evaluate the concentration of calcium, phosphate and fluoride in the plaque and saliva of children with Early Childhood Caries (ECC) after applying the CPP-ACP paste in comparison with the use of CPP-ACPF paste.

MATERIALS AND METHODS

One ml of un-stimulated saliva of 25 preschool children was collected and then 1 mg of the plaque sample was collected from the buccal surfaces of the two first primary molars on the upper jaw. CPP-ACP as well as CPP-ACPF pastes were applied on the tooth surfaces in two separate steps. In steps, plaque and saliva sampling was performed after 60 minutes. The amount of calcium ions was measured by Atomic Absorption Device and the amount of phosphate and fluoride ions was measured by Ion Chromatography instrument. Data were analyzed using Repeated Measurements ANOVA at a p < 0.05 level of significance.

RESULTS

Application of both CPP-ACPF and CPP-ACP significantly increased the concentration of calcium, phosphate, and fluoride in both saliva and dental plaque. Moreover, significantly higher salivary fluoride concentration was seen after application of CPP-ACPF compared to CPP-ACP. No other significant difference was observed between these two materials.

CONCLUSIONS

CPP-ACPF can be more useful than CPP-ACP in protecting the primary teeth against caries process, especially when there is poor hygiene.

A Dental Hygienist's and Therapist's Guide to the Management of Tooth Erosion

Dental care professionals can support patients to prevent and manage tooth erosion. The role of the dentist is to restore the structure and function of teeth damaged by acid erosion, while the role of the dental hygienist therapist is to work alongside the dentist to help manage and reduce the risk of tooth erosion. This article will highlight how the dental hygienist or therapist can identify tooth erosion. It will describe the features of tooth erosion and outline the causes. This article will discuss preventative care options for patients who are at risk of tooth erosion, including specific oral hygiene instructions, fluoride advice and use of other dental products.

Effect of dentifrice of varying fluoride concentration on surface microhardness of fluorosed enamel: an in vitro study

AIM

To evaluate the effect of dentifrice with varying concentrations of fluoride on surface microhardness of fluorosed enamel as compared to a non-fluoridated dentifrice.

STUDY DESIGN

In vitro, comparative type.

METHOD

60 enamel blocks with score-3 enamel fluorosis were randomly divided into three groups: Group I non-fluoridated dentifrice, Group II 1000-ppm fluoridated dentifrice and Group III 1400-ppm fluoridated dentifrice. After evaluating the baseline surface microhardness, samples from each group were brushed for 2 min, twice daily for a period of 21 days with 0.02 g of respective interventional agents as per protocol. Microhardness of the samples was re-evaluated at the end of 21 days. Statistical analysis was performed using paired t test, ANOVA and Kruskal-Wallis test.

RESULTS

The surface microhardness within the group from the baseline to 21st day post intervention, showed a statistically significant increase in all three groups, hence indicating that all the three interventional agents used were effective against the fluorosed enamel surface. Intergroup comparison of the surface microhardness of fluorosed enamel from baseline to 21st day post intervention showed a statistically significant difference (p < 0.001) amongst the groups with Group III proving most effective followed by Group I and Group II.

CONCLUSION

1400-ppm fluoridated dentifrice is more effective as compared to 1000-ppm fluoridated dentifrice and non-fluoridated dentifrice in increasing the surface microhardness of fluorosed enamel.

Accounting for measurement reliability to improve the quality of inference in dental microhardness research: a worked example

OBJECTIVES

Dental microhardness experiments are influenced by unobserved factors related to the varying tooth characteristics that affect measurement reproducibility. This paper explores the appropriate analytical tools for modeling different sources of unobserved variability to reduce the biases encountered and increase the validity of microhardness studies.

MATERIALS AND METHODS

The enamel microhardness of human third molars was measured by Vickers diamond. The effects of five bleaching agents-10, 16, and 30 % carbamide peroxide, and 25 and 38 % hydrogen peroxide-were examined, as well as the effect of artificial saliva and amorphous calcium phosphate. To account for both between- and within-tooth heterogeneity in evaluating treatment effects, the statistical analysis was performed in the mixed-effects framework, which also included the appropriate weighting procedure to adjust for confounding. The results were compared to those of the standard ANOVA model usually applied.

RESULTS

The weighted mixed-effects model produced the parameter estimates of different magnitude and significance than the standard ANOVA model. The results of the former model were more intuitive, with more precise estimates and better fit.

CONCLUSIONS

Confounding could seriously bias the study outcomes, highlighting the need for more robust statistical procedures in dental research that account for the measurement reliability. The presented framework is more flexible and informative than existing analytical techniques and may improve the quality of inference in dental research.

CLINICAL RELEVANCE

Reported results could be misleading if underlying heterogeneity of microhardness measurements is not taken into account. The confidence in treatment outcomes could be increased by applying the framework presented.