Kinetics of enamel demineralization in vitro

An In Vitro Evaluation of the Effects of Air-Polishing Powders on Sound and Demineralised Enamel

AIM

To evaluate the effects of two air-polishing powders, during orthodontic treatment, on the surface roughness of sound and demineralised enamel.

MATERIALS AND METHODS

Forty-two caries-free human molars were collected, and the enamel surfaces were flattened and polished. Teeth were assigned to two groups (n = 21 each), a sound- and a demineralised-enamel group (subjected to pH-cycling over 2 weeks to create artificially induced white spot-like lesions). Within each group, teeth were further assigned to three groups (n = 7 each), air polished with either sodium bicarbonate, erythritol, or a negative control (water). Each sample was treated for 5 and 150 s. The average surface roughness (Ra) for each sample was measured using white-light-sensor profilometry.

RESULTS

On sound enamel, the Ra was roughly 0.17 ± 0.07 μm. After 150 s of air polishing, the Ra increased with erythritol (by 0.28 μm), and even more so with bicarbonate treatment (by 0.68 μm) (p < 0.01). On demineralised enamel, the Ra was roughly 0.79 ± 0.56 μm. The Ra increased after 5 s of air-polishing treatment similarly with erythritol and bicarbonate powders (by 1.03 μm and 1.04 μm, respectively) (p = 0.025), and even more after 150 s (by 2.48 μm and 2.49 μm, respectively) (p < 0.001).

CONCLUSIONS

On white spot lesions, one should be aware that enamel surface roughness will increase with both erythritol and bicarbonate air-polishing powders, especially with longer exposure times.

Effects of bovine milk osteopontin on in vitro enamel remineralization as a topical application prior to immersion in remineralizing solutions with/without fluoride

The aim of the present study was to investigate the effects of bovine milk osteopontin (OPN) on enamel remineralization as a topical application prior to immersion in remineralizing solutions with/without fluoride. Bovine enamel blocks were demineralized then were divided into the following 3 groups: OPN (2.7 and 5.4 µM) solutions and deionized water (control). Each group was divided into 2 groups (remineralizing solution with or without 1 ppm of fluoride (F)). The specimens were analyzed by micro-CT and scanning electron microscope (SEM). The percentage of remineralization was higher in remineralization solution with than without F (p<0.05). The present results suggest that bovine milk OPN inhibits remineralization in solution without F, but 5.4 µM bovine milk OPN does not inhibit remineralization of the demineralized body using solution containing F by interrupting mineral deposition on the enamel surface.

A comparative study of two chemical models for creating subsurface caries lesions on aprismatic and prismatic enamel

PURPOSE

To investigate the mineral density and lesion depth of artificial caries lesions on aprismatic enamel and prismatic enamel created by lactic acid and acetic acid buffers.

METHODS

Forty bovine enamel blocks were allocated to: aprismatic enamel (Group A) and prismatic enamel (Group C) in acetic acid buffer for 192 h and aprismatic enamel (Group B) and prismatic enamel (Group D) in lactic acid buffer for 96 h. The mineral loss and lesion depth were measured using micro-computed tomography.

RESULTS

A significant difference (P = 0.01) was observed in the mineral loss (%) in the lesions on aprismatic enamel and prismatic enamel treated with lactic acid buffer while no significant difference (P = 0.51) was observed in the mineral loss (%) in the lesions on aprismatic enamel and prismatic enamel treated with acetic acid buffer. No significant difference was noted in the mean lesion depth of lesions on aprismatic enamel and prismatic enamel treated with acetic acid and lactic acid buffers (P > 0.05).

CONCLUSION

Aprismatic enamel and prismatic enamel have similar mineral loss in acetic acid while prismatic enamel showed more mineral loss compared to aprismatic enamel in lactic acid.

pH-activated antibiofilm strategies for controlling dental caries

Dental biofilms are highly assembled microbial communities surrounded by an extracellular matrix, which protects the resident microbes. The microbes, including commensal bacteria and opportunistic pathogens, coexist with each other to maintain relative balance under healthy conditions. However, under hostile conditions such as sugar intake and poor oral care, biofilms can generate excessive acids. Prolonged low pH in biofilm increases proportions of acidogenic and aciduric microbes, which breaks the ecological equilibrium and finally causes dental caries. Given the complexity of oral microenvironment, controlling the acidic biofilms using antimicrobials that are activated at low pH could be a desirable approach to control dental caries. Therefore, recent researches have focused on designing novel kinds of pH-activated strategies, including pH-responsive antimicrobial agents and pH-sensitive drug delivery systems. These agents exert antibacterial properties only under low pH conditions, so they are able to disrupt acidic biofilms without breaking the neutral microenvironment and biodiversity in the mouth. The mechanisms of low pH activation are mainly based on protonation and deprotonation reactions, acids labile linkages, and H⁺-triggered reactive oxygen species production. This review summarized pH-activated antibiofilm strategies to control dental caries, concentrating on their effect, mechanisms of action, and biocompatibility, as well as the limitation of current research and the prospects for future study.

Effects of the Incorporation of Bioactive Particles on Physical Properties, Bioactivity and Penetration of Resin Enamel Infiltrant

Purpose

The resinous infiltrant lacks remineralizing activity. This research aimed to develop and evaluate bioactivity, physico-mechanical properties and penetration of resin infiltrants containing Biosilicate or nanohydroxyapatite.

Methods

Experimental resin infiltrant (ERI; 75/25 wt.% TEGDMA/BisEMA) was divided among the groups Pure Experimental (PE); ERI + Biosilicate 5 or 10% (Bio5; Bio10), ERI + 10% nanohydroxyapatite (Hap10), and Icon (DMG, Germany). Bioactivity was analyzed by SEM, EDS and FT-IR/ATR after soaking in SBF. Degree of conversion (DC), sorption and solubility (SO; SOL), flexural strength, modulus of elasticity (FS; E-modulus), contact angle (CA) and penetration were characterized. Extent of penetration was analyzed by treating white spot lesions (WSL) in human dental enamel samples with the infiltrants and subsequently analyzing specimens by confocal laser scanning microscopy. Data from each test were submitted to ANOVA and Tukey's tests (p < 0.01).

Results

SEM, EDS and FT-IR showed the formation of precipitates and increase in the rates of Ca and P in the groups with bioactive particles, after storage in SBF. Hap10 showed higher DC and CA values than all the other groups. Groups Bio5 and Bio10 showed CA values similar to those of Icon, higher SO and SOL values, and reduction in other properties. All infiltrants were capable of penetrating into the WSLs.

Conclusion

The incorporation of Biosilicate (5 or 10%) or nanohydroxyapatite (10%) into ERI induced mineral deposition on the surface and did not compromise infiltration and penetration into WSLs, however, compromising their physico-mechanical properties.

Calcium phosphate nanoparticles for potential application as enamel remineralising agent tested on hydroxyapatite discs

Calcium phosphate exhibits excellent biocompatibility, and with particle size in the nanoscale, calcium phosphate nanoparticles (CPNPs) were explored to replace the hydroxyapatite lost in the nanoporous teeth due to dental erosion. CPNPs (2% w/v) colloidally stabilised by sodium citrate were synthesised via co-precipitation. They were characterised in terms of particle size, morphology, crystallinity, Ca/P ratio and calcium ion release. To ensure uniformity of the substrate, hydroxyapatite (HA) discs were examined as an alternative substrate model to enamel. They were eroded in acetate buffer (0.5 M; pH 4.0) at various timepoints (1, 5, 10, 30 min, and 2, 4 h), and their physical differences compared to enamel were assessed in terms of surface microhardness, surface roughness and step height. The remineralisation properties of the synthesised CPNPs on eroded HA discs at different pH levels were investigated. It was established that CPNPs were heterogeneously deposited on the HA discs at pH 9.2, whereas newly precipitated minerals from CPNPs were potentially formed at pH 6.2.

Acid-induced demineralisation of human enamel as a function of time and pH observed using X-ray and polarised light imaging

Acid-induced enamel demineralisation affects many individuals either by exposure to acidic diets, acidic gas pollution (dental erosion) or to dental plaque acids (dental caries). This study aimed to develop in situ X-ray and light imaging methods to determine progression of enamel demineralisation and the dynamic relationship between acid pH and mineral density. Hourly digital microradiograph time-lapse sequences showed the depth of enamel demineralisation in 500 µm thick sections progressed with time from the surface towards the dentine following a power-law function, which was 21% faster than the lateral demineralisation progression after exposure for 85 h to lactic acid (10%, pH 2.2). The minimum greyscale remaining (mineral content) within the induced enamel lesion followed an exponential decay, while the accumulated total greyscale loss with time was linear, which showed a constant anisotropic mineral release within the enamel architecture. This 85 h demineralisation method studied by polarised light microscopy time-lapse sequences showed that once the demineralisation front reached the enamel Hunter-Schreger bands, there was preferential demineralisation along those bands. Mineral density loss was linear with increasing pH acidity between pH 5.2 and pH 4.0 (with 0.4 pH increments) when incubated over a 3-week period exposed to 0.5% lactic acid. At pH 4.0, there was complete mineral loss in the centre of the demineralised area after the 3-week period and the linear function intercepted the x-axis at ~ pH 5.5, near the critical pH for hydroxyapatite (HAp). These observations showed how intrinsic enamel structure and pH affected the progression of demineralisation. STATEMENT OF SIGNIFICANCE: Hydroxyapatite crystallites (HAp) in human enamel dissolve when exposed to an acidic environment but little is known about how the intrinsic structures in enamel and pH influence the demineralisation kinetics. We have developed a time-lapse in situ microradiography method to quantify microscopic anisotropic mineral loss dynamics in response to an acid-only caries model. Correlation with polarised light microscopy time-lapse sequences showed that larger structures in enamel also influence demineralisation progression as demineralisation occurred preferentially along the Hunter-Schreger bands (decussating prismatic enamel). The pH-controlled enamel mineral release in a linear manner quantifying the relationship between HAp orientation and acid solubility. These findings should direct the development of improved anti-demineralisation/ remineralisation treatments to retain/ restore the natural intrinsic enamel structure.

Remineralization of enamel subsurface lesions using toothpaste containing tricalcium phosphate and fluoride: an in vitro µCT analysis

Background

This study aimed to compare the efficacies of experimental toothpastes containing functionalized tricalcium phosphate (fTCP) with and without fluoride for in vitro enamel remineralization under pH-cycling conditions.

Methods

To create artificial white spot lesions, 36 bovine enamel specimens were immersed in a demineralization solution for 10 days. During pH-cycling for 12 days, the specimens were divided into four groups based on the experimental toothpaste type used: (a) fTCP-free, fluoride-free (fTCP − F −); (b) fTCP-containing, fluoride-free (fTCP + F −); (c) fTCP-free, fluoride-containing (fTCP − F +); and (d) fTCP-containing, fluoride-containing (fTCP + F +). Micro-focus X-ray computed tomography (μCT) scans of all specimens were obtained before demineralization, after demineralization, and after pH-cycling. The mineral density and mineral loss (ΔZ) in the enamel subsurface lesions were measured and the percentage of remineralization (%R) was calculated from ΔZ after demineralization and pH-cycling. One-way ANOVA with Tukey’s test was used for statistical analysis of the %R values. The treated enamel surface was investigated via scanning electron microscopy (SEM).

Results

The fTCP − F − group presented with the lowest amount of mineral gain after pH-cycling. In contrast, the fTCP + F + group showed the highest degree of remineralization within all lesion parts. The %R was highest in the fTCP + F + group (38.2 ± 7.8, all P < 0.01). SEM revealed the presence of small crystals on the enamel rods in the fTCP + F − and fTCP + F + groups.

Conclusions

The experimental toothpaste containing fTCP and fluoride increased remineralization of the artificial enamel subsurface lesions during pH-cycling. Furthermore, fTCP and fluoride appear to act independently on the remineralization of enamel subsurface lesions, although they coexisted in one toothpaste type.

Trial registration: This is not a human subject research.

Assessment of the antibacterial, antivirulence, and action mechanism of Copaifera pubiflora oleoresin and isolated compounds against oral bacteria

The microorganisms that constitute the oral microbiome can cause oral diseases, including dental caries and endodontic infections. The use of natural products could help to overcome bacterial resistance to the antimicrobials that are currently employed in clinical therapy. This study assessed the antimicrobial activity of the Copaifera pubiflora oleoresin and of the compounds isolated from this resin against oral bacteria. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) assays provided values ranging from 6.25 to > 400 μg/mL for the C. pubiflora oleoresin and its isolated compounds. The fractional inhibitory concentration index (FICI) assay showed that the oleoresin and chlorhexidine did not act synergistically. All the tested bacterial strains formed biofilms. MICB₅₀ determination revealed inhibitory action: values varied from 3.12-25 μg/mL for the oleoresin, and from 0.78 to 25 μg/mL for the ent-hardwickiic acid. Concerning biofilm eradication, the C. pubiflora oleoresin and hardwickiic acid eradicated 99.9 % of some bacterial biofilms. Acid resistance determination showed that S. mutans was resistant to acid in the presence of the oleoresin and ent-hardwickiic acid at pH 4.0, 4.5, and 5.0 at all the tested concentrations. Analysis of DNA/RNA and protein release by the cell membrane demonstrated that the oleoresin and hardwiickic acid damaged the bacterial membrane irreversibly, which affected membrane integrity. Therefore, the C. pubiflora oleoresin and ent-hardwickiic acid have potential antibacterial effect and can be used as new therapeutic alternatives to treat oral diseases such as dental caries and endodontic infections.

Programmed antibacterial and mineralization therapy for dental caries based on zinc-substituted hydroxyapatite/ alendronate-grafted polyacrylic acid hybrid material

The domination of cariogenic bacteria in dental plaque biofilms is the primary cause of dental caries. In view of this, for the purpose of an effective treatment of dental caries, it is of great importance to inhibit the activity of acidogenic bacteria and promote the remineralization of damaged teeth simultaneously. However, the expensive antibacterial agents and poor mineralization ability of materials limit the practical applications. Biomineralization regulated by non-collagenous proteins (NCPs) gives hints to combine the remineralization ability of NCPs with accessible antibacterial property effectively. In this work, we propose a programmed antibacterial and remineralization strategy for the therapy of dental caries based on zinc-substituted hydroxyapatite/ alendronate-grafted polyacrylic acid hybrid nanoneedles (ZHA@ALN-PAA). This hybrid material dissolves in the acidic caries environment and regulate the pH to nearly neutral (6.5). Abundant calcium/ phosphate ions are supplemented and the ALN-PAA embedded in it has also been released, which assists the biomineralization on tooth defect. It has been revealed that the inhibition ratio of ZHA@ALN-PAA against Streptococcus mutans is the highest (11.25 folds that of HA), which originates from the highest zinc ions released (132.9 mg/L). Besides, the interspace of etched enamel is fully filled with regenerated nanorods and the surface microhardness (SMH) is significantly improved (3.68 folds that of etched enamel) after only 3 days of mineralization in vitro. This strategy developed here is simple and cost-effective, which can be referred to design the effective anti-caries materials applied for clinic treatment and daily oral care.

Targeted metabolomics of pellicle and saliva in children with different caries activity

Pellicle is the initial proteinaceous layer that is formed almost instantaneously on all solid surfaces in the oral cavity. It is of essential relevance for any interactions and metabolism on the tooth surface. Up to now, there is no information on the metabolome of this structure. Accordingly, the present study aims to characterise the metabolomic profile of in-situ pellicle in children with different caries activity for the first time in comparison to saliva. Small molecules such as carbohydrates, amino acids, organic acids, and fatty acids, putatively involved in the formation of caries were quantified using mass spectrometry (MS)-based techniques, such as (stable isotope dilution analysis)-ultra-performance liquid chromatography-tandem MS and gas chromatography/electron ionisation-MS. Pellicle and corresponding saliva samples were collected from caries-active, caries-free and caries-rehabilitated 4- to 6-year-old children. The most abundant analytes in pellicle were acetic acid (1.2-10.5 nmol/cm2), propionic acid (0.1-8.5 nmol/cm2), glycine (0.7-3.5 nmol/cm2), serine (0.08-2.3 nmol/cm2), galactose (galactose + mannose; 0.035-0.078 nmol/cm2), lactose (0.002-0.086 nmol/cm2), glucose (0.018-0.953 nmol/cm2), palmitic acid (0.26-2.03 nmol/cm2), and stearic acid (0.34-1.81 nmol/cm2). Significant differences depending on caries activity were detected neither in saliva nor in the corresponding pellicle samples.

Spectral characteristics of caries autofluorescence obtained from different locations and caries severities

Dental caries usually occurs at interproximal and occlusal surfaces. The purpose of the present study was to determine if characteristic spectral factors extracted from autofluorescence (AF) spectra are informative regarding caries detection and the determination of caries stage as compared with DIAGNOdent results. AF spectra were obtained from caries lesions of different severities at two locations using a 405 nm laser. Three spectral factors, that is, spectral slope at 550 to 600 nm, spectral area under the curve at 500 to 590 nm and two-peak ratio between 625 and 667 nm, were extracted. The values of three spectral factors linearly decreased as caries progressed. According to micro-CT images, conventional visual and tactile inspections of lesions under or overestimated (25%-65%) caries states, and brown or thickly stained layer on interproximal or occlusal surfaces, respectively, caused misclassifications of caries stage. Of the spectral factors examined, spectral slope and area under curve for interproximal and occlusal surfaces, respectively, were found to be significantly related to caries stage and showed least data overlap. For interproximal and occlusal surfaces, DIAGNOdent readings of different stages overlapped considerably though their mean values were significantly different regardless of stage.

Decomposition Rate, pH, and Enamel Color Alteration of At-Home and In-Office Bleaching Agents

Abstract This study evaluated the decomposition rate (DR), pH, enamel color alteration (DE) and whiteness index (DWI) promoted by at-home and in-office bleaching. Enamel surface was submitted to (n=10): at-home (10%, 15%, 20% carbamide peroxide - CP, 6% hydrogen peroxide -HP) and three 35% HP agents with light irradiation (LED, laser, and halogen) or no treatment (control). The DR and pH of agents were measured after 0, 2, 4, 6 and 8 h (at-home) or after 5, 15, 20, 30 and 40 min (in-office). Color parameters (L*, a*, b*, DE, DWI) were determined at baseline and after bleaching. DR, pH, L*, a*, b* data were analyzed by one-way (at-home) or two-way (in-office) repeated measures ANOVA and Tukey test. DE and DWI, by one-way (at-home) or two-way (in-office) ANOVA and Tukey test. DR of at-home agents was similar after 6 and 8 h (p>0.05), with pH close to neutral (6.5 to 6.9, CP) or acid 5.9 (6% HP). From 4 to 8 h, DE was higher for 15% and 20% CP compared with 10% CP (p<0.05). After 40 min, DR of 35% HP agents was similar and all exhibited significant DE in one application (p<0.05), regardless light irradiation. DWI indicated whitening effect with no differences among groups (p>0.05). One 35% HP showed alkaline pH, and the others, pH < 5.5. At-home agents could be applied for 2 h (15%, 20% CP, 6% HP) and 4 h (10% CP) and the in-office agents, up to 40 min in one application, without light.

A Novel Kinetic Method to Measure Apparent Solubility Product of Bulk Human Enamel

Introduction: Tooth enamel mineral loss is influenced by its solubility product value, which is fundamental to the understanding of de- and remineralization resulting from a carious or erosive challenge. Published pKsp values for human enamel and hydroxyapatite range from 110 to 126 suggesting a heterogeneous nature of enamel solubility. However, this range of values may also result from the variety of methods used, e.g., some authors reporting values for suspensions of enamel powder and others for bulk enamel. The aim of this study was to develop a method to measure the solubility of bulk human enamel under controlled in vitro conditions simulating demineralization behavior of enamel within the oral environment using scanning microradiography (SMR). SMR was used to monitor real-time changes in enamel demineralization rates at increasing calcium concentrations in a caries simulating demineralization solution until the concentration at which thermodynamic equilibrium between enamel and solution was achieved. Method: 2 mm thick caries free erupted human enamel slabs with the natural buccal surfaces exposed were placed in SMR cells exposed to circulating caries-simulating 2.0 L 0.1 M pH = 4.0 acetic acid, at 25°C. SMR was used to continuously measure in real-time the decrease in mineral mass during the demineralization at 5 different points from on each slab. Demineralization rates were calculated from a linear regression curve of projected mineral mass against demineralization time. Changes in the demineralization rates were monitored following a series of successive increases in calcium (and phosphate at hydroxyapatite stoichiometric ratios of Ca:P 1.67) were added to the demineralizing solution, until demineralization ceased. The pH was maintained constant throughout. Results: Demineralization halted when the calcium concentration was ~30 mM. At higher calcium concentrations, mineral deposition (remineralization) occurred. By comparison with results from speciation software calculations for the calcium phosphate ternary system, this result suggests that the bulk solubility product of enamel (pKsp_BEnamel) under the conditions used is 121. Discussion: The apparent pKsp_BEnamel under these conditions was higher than many previous reported values, and much closer to those previously reported for HAp. However, this is a bulk value, and does not reflect that enamel is a heterogeneous material, nor the influence of ionic inclusions.

Diagnosis and staging of caries using spectral factors derived from the blue laser-induced autofluorescence spectrum

OBJECTIVE

The aim of this study was to identify the factors derived from the 405nm laser-induced autofluorescence (AF) spectra that could be used to diagnose and stage caries.

MATERIALS AND METHODS

Teeth (20 teeth per stage) were classified as sound, stage II, III, and IV based on a visual and tactile inspection. The specimens were re-examined and reclassified based on micro-CT analysis. From the teeth, the AF was obtained using a 405nm laser. Three spectral factors (spectral slope at 550-600nm, area under the curve at 500-590nm, and two-peak ratio between 625 and 667nm) were derived from the AF spectra. Using these factors, the diagnosis and staging of caries were tested, and the results were compared with those of DIAGNOdent.

RESULTS

After micro-CT analysis, only 13, 11, and 13 teeth were reclassified as stages II, III, and IV, respectively. The reclassified groups showed less data overlap between the stages, and the spectral slope was 40.1-74.6, 27.5-39.6, 11.1-27.4, and 1.0-9.7 for sound, stage II, III, and IV, respectively. The differentiation of stages III and IV using DIAGNOdent appeared to be difficult due to the considerable data overlap.

CONCLUSION

Among the factors tested, the spectral slope at 550-600nm showed the best match with the caries specimens, in which their stage had been identified precisely.

CLINICAL SIGNIFICANCE

The 405nm laser-induced AF spectra can be applied to the diagnosis and staging of caries alone or in conjunction with conventional methods, such as visual, tactile, and X-ray inspection.

Characterization of enamel caries lesions in rat molars using synchrotron X-ray microtomography

Dental caries is a ubiquitous infectious disease with a nearly 100% lifetime prevalence. Rodent caries models are widely used to investigate the etiology, progression and potential prevention or treatment of the disease. To explore the suitability of these models for deeper investigations of intact surface zones during enamel caries, the structures of early-stage carious lesions in rats were characterized and compared with previous reports on white spot enamel lesions in humans. Synchrotron X-ray microcomputed tomography non-destructively mapped demineralization in carious rat molar specimens across a range of caries severity, identifying 52 lesions across the 30 teeth imaged. Of these lesions, 13 were shown to have intact surface zones. Depth profiles of fractional mineral density were qualitatively similar to lesions in human teeth. However, the thickness of the surface zone in the rat model ranges from 10 to 58 µm, and is therefore significantly thinner than in human enamel. These results indicate that a fraction of lesions in rat caries possess an intact surface zone and are qualitatively similar to human lesions at the micrometer scale. This suggests that rat caries models may be a suitable analog through which to investigate the structure of surface zone enamel and its role during dental caries.

Interfacial degradation of adhesive composite restorations mediated by oral biofilms and mechanical challenge in an extracted tooth model of secondary caries

OBJECTIVE

To study the combined effect of simulated occlusal loading and plaque-derived biofilm on the interfacial integrity of dental composite restorations, and to explore whether the effects are modulated by the incorporation of sucrose.

METHODS

MOD-class-II restorations were prepared in third molars. Half of the specimens (n=27) were subjected to 200,000 cycles of mechanical loading using an artificial oral environment (ART). Then, both groups of specimens (fatigued and non-fatigued) were divided into three subgroups for testing in CDC-reactors under the following conditions: no biofilm (Control), biofilm with no sucrose (BNS) and biofilm pulsed with sucrose (BWS). BNS and BWS reactors were incubated with a multispecies inoculum from a single plaque donor whereas the control reactor was not. The BWS reactor was pulsed with sucrose five times a day. The biofilm challenges were repeated sequentially for 12 weeks. pH was recorded for each run. Specimens were examined for demineralization with micro-CT and load capacity by fast fracture test.

RESULTS

Demineralization next to the restorations was only detectable in BWS teeth. Fracture loads were significantly reduced by the concomitant presence of biofilm and sucrose, regardless of whether cyclic mechanical loading was applied. Cyclic loading reduced fracture loads under all reactor conditions, but the reduction was not statistically significant.

CONCLUSIONS

Sucrose pulsing was required to induce biofilm-mediated degradation of the adhesive interface. We have presented a comprehensive and clinically relevant model to study the effects of mechanical loading and microbial challenge on the interfacial integrity of dental restorations.

Micro-CT and FE-SEM enamel analyses of calcium-based agent application after bleaching

OBJECTIVES

The objective of the present study is to evaluate the effects of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on bleached enamel.

MATERIALS AND METHODS

A bleaching agent (35% hydrogen peroxide) was applied, 4 × 8 min on premolar teeth (n = 8). A CPP-ACP paste was applied for 7 days. Prior and post-treatment, microtomography images were obtained and 3D regions of interest (ROIs) were selected, from outer enamel, extending to 110.2-μm depth. CT parameters of structure: thickness (St.Th), separation (St.Sp), and fragmentation index (Fr.I.) were calculated for each (ROI). Data was submitted to paired t tests at a 95% confidence level. The samples were evaluated at 3000 to 100,000 magnification. Quantitative analysis of enamel mineral content was also determined by SEM EDX.

RESULTS

There was a significant increase in structure thickness and calcium content. The phosphorus content increased after bleaching. There was also a decreased separation and fragmentation index on the outer enamel to a depth of 56.2 μm (p < 0.05). There were no changes at 110.2-μm depth for the bleaching CPP-ACP association. A covering layer and decreased spaces between the hydroxyapatite crystals appeared around the enamel prisms, 7 days after the CPP-ACP application.

CONCLUSIONS

The application of a CPP-ACP provides a compact structure on the enamel's outer surface, for 7 days, due to calcium deposition. CT parameters seem to be a useful tool for mineralizing and remineralizing future studies.

CLINICAL RELEVANCE

CPP-ACP neutralizes any adverse effects on enamel surface when applied during a week after bleaching and minimizes any side effects of the bleaching treatment due to a more compact structure.

Dynamic measurement of the optical properties of bovine enamel demineralization models using four-dimensional optical coherence tomography

Dental enamel mineral loss is multifactorial and is consequently explored using a variety of in vitro models. Important factors include the presence of acidic pH and its specific ionic composition, which can both influence lesion characteristics. Optical coherence tomography (OCT) has been demonstrated as a promising tool for studying dental enamel demineralization. However, OCT-based characterization and comparison of demineralization model dynamics are challenging without a consistent experimental environment. Therefore, an automated four-dimensional OCT system was integrated with a multispecimen flow cell to measure and compare the optical properties of subsurface enamel demineralization in different models. This configuration was entirely automated, thus mitigating any need to disturb the specimens and ensuring spatial registration of OCT image volumes at multiple time points. Twelve bovine enamel disks were divided equally among three model groups. The model demineralization solutions were citric acid (pH 3.8), acetic acid (pH 4.0), and acetic acid with added calcium and phosphate (pH 4.4). Bovine specimens were exposed to the solution continuously for 48 h. Three-dimensional OCT data were obtained automatically from each specimen at a minimum of 1-h intervals from the same location within each specimen. Lesion dynamics were measured in terms of the depth below the surface to which the lesion extended and the attenuation coefficient. The net loss of surface enamel was also measured for comparison. Similarities between the dynamics of each model were observed, although there were also distinct characteristic differences. Notably, the attenuation coefficients showed a systematic offset and temporal shift with respect to the different models. Furthermore, the lesion depth curves displayed a discontinuous increase several hours after the initial acid challenge. This work demonstrated the capability of OCT to distinguish between different enamel demineralization models by making dynamic quantitative measurements of lesion properties. This has important implications for future applications in clinical dentistry.

pH Response and Tooth Surface Solubility at the Tooth/Bacteria Interface

Evaluating the physiochemical processes at the tooth surface/bacteria interface is important for elucidating the etiology of dental caries. This study aimed to compare the mineral solubility and protein degradation of coronal enamel (CE) and root dentin (RD), and investigate the involvement of dissolved components in bacteria-induced pH changes using a model of tooth/bacteria interface. An experimental apparatus forming a well was made of polymethyl methacrylate, and a bovine tooth (CE or RD) specimen was fixed at the bottom of the well. A miniature pH electrode was placed on the tooth, and Streptococcus mutans NCTC 10449 cells, grown in 0.5% glucose-containing complex medium, were packed into the well. The pH at the tooth/S. mutans interface was monitored continuously for 120 min after the addition of 0.5% glucose at 37°C. S. mutans cells were recovered from the wells, and the amounts of lactate and calcium were measured using a portable lactate meter and a fluorescent dye, respectively. Proteolytic activity was also evaluated fluorometrically. The pH of the RD/S. mutans interface was significantly higher than that of the CE/S. mutans interface (30 min: 6.37 ± 0.12 vs. 6.18 ± 0.11, 60 min: 6.08 ± 0.14 vs. 5.66 ± 0.27, 90 min: 5.49 ± 0.24 vs. 5.14 ± 0.22, p < 0.05). Greater amounts of calcium were dissolved from RD (3.19 ± 0.74 µg/mL) than from CE (1.84 ± 0.68 µg/mL; p < 0.05), while similar amounts of lactate were produced. Proteolytic activity was not detected at any of the interfaces. These results indicate that RD is more soluble to bacteria-induced acidification than CE. This method can contribute to the evaluation and development of caries-preventive materials.

Effects of a Novel Mouthwash on Dental Remineralization

Objective

The goal of this study was to evaluate the in vivo effects of a novel mouthwash on enamel remineralization.

Materials and Methods

Ten healthy volunteers wore removable intra-oral appliances for three study arms with duration of 5 days each. In 1 study arm, subjects used Oral Essentials Sensitivity Formula^R mouthwash; in another arm they used Sensodyne^R mouthwash, and in the third arm they used no mouthwash at all. Sequence of mouthwash use was randomized, and study participants and researchers were blinded throughout the study. Subjects used Crest Total Care^R toothpaste throughout the study. During a one week washout period before study begin and between each study arm, subjects also used Crest Total Care^R toothpaste. A total of 300 enamel samples were included in this study, 150 served as baseline controls, and 150 as test samples subjected to demineralization prior to intra-oral wear. At the end of each study arm, enamel chips were removed from the appliance and underwent standard Microhardness (Knoop) measurements, as did the control samples. Enamel microhardness in the test vs the 2 control groups was compared using the Kruskal-Wallis one-way analysis of variance with post-hoc Tukey’s test to test for differences in remineralization between the 3 treatments.

Results

Both mouthwashes demonstrated similar levels of recovery from demineralization as the “no mouthwash” arm of the study, with no significant differences for all groupings and comparisons (p>0.05).

Conclusion

A novel mouthwash for sensitive teeth supports enamel recovery from demineralization.

Effects of a Novel Dental Gel on Enamel Surface Recovery from Acid Challenge

BACKGROUND

Objective was to evaluate the in vivo effects of a novel dental gel (Livionex gelR) vs. a comparison dental gel on the surfaces of pre-eroded enamel chips.

METHODS

On days 1-5, after toothbrushing with dentifrice, nine subjects each wore 8 enamel chips mounted on a palatal appliance for 4 h. Enamel blocks were pre-demineralized daily. After 2 day washout, subjects repeated the protocol using fresh chips and the second toothpaste on days 8-12. Samples were evaluated using electron microscopy.

RESULTS

Ten standardized enamel surface photomicrographs/sample (total 1440 images) were evaluated for signs of erosion visually and on a scale of 0-3 by 1 evaluator. No significant differences were found between the 2 groups (p>0.32, 95% C.I.). Minimal surface erosion on approx. 15% of sample area was visible in both groups.

CONCLUSION

The enamel surface appeared similar after usage of a test or control dentifrice. Based on this study, the test formulation did not affect enamel surface recovery from an erosive challenge.

PRACTICAL IMPLICATIONS

Dentifrices can contribute to maintaining a healthy enamel surface. An all-natural dental gel formulation with novel anti-plaque mechanism achieved similar recovery from acid challenge to enamel as a control gel.

Salivary Anionic Changes after Radiotherapy for Nasopharyngeal Carcinoma: A 1-Year Prospective Study

Objectives

To investigate the salivary anionic changes of patients with nasopharyngeal carcinoma (NPC) treated by radiotherapy.

Material and Methods

Thirty-eight patients with T1-4, N0-2, M0 NPC received conventional radiotherapy. Stimulated whole saliva was collected at baseline and 2, 6 and 12 months after radiotherapy. Salivary anions levels were measured using ion chromatography.

Results

A reduction in stimulated saliva flow and salivary pH was accompanied by sustained changes in anionic composition. At 2 months following radiotherapy, there was a significant increase in chloride, sulphate, lactate and formate levels while significant reductions in nitrate and thiocyanate levels were found. No further changes in these anion levels were observed at 6 and 12 months. No significant changes were found in phosphate, acetate, or propionate levels throughout the study period.

Conclusions

Conventional radiotherapy has a significant and prolonged impact on certain anionic species, likely contributing to increased cariogenic properties and reduced antimicrobial capacities of saliva in NPC patients post-radiotherapy.

Distinct decalcification process of dentin by different cariogenic organic acids: Kinetics, ultrastructure and mechanical properties

OBJECTIVES

We studied artificial dentin lesions in human teeth generated by lactate and acetate buffers (pH 5.0), the two most abundant acids in caries. The objective of this study was to determine differences in mechanical properties, mineral density profiles and ultrastructural variations of two different artificial lesions with the same approximate depth.

METHODS

0.05M (pH 5.0) acetate or lactate buffer was used to create 1) 180μm-deep lesions in non-carious human dentin blocks (acetate 130h; lactate 14days); (2) demineralized, ∼180μm-thick non-carious dentin discs (3 weeks). We performed nanoindentation to determine mechanical properties across the hydrated lesions, and micro X-ray computed tomography (MicroXCT) to determine mineral profiles. Ultrastructure in lesions was analyzed by TEM/selected area electron diffraction (SAED). Demineralized dentin discs were analyzed by small angle X-ray scattering (SAXS).

RESULTS

Diffusion-dominated demineralization was shown based on the linearity between lesion depths versus the square root of exposure time in either solution, with faster kinetics in acetate buffer. Nanoindentation revealed lactate induced a significantly sharper transition in reduced elastic modulus across the lesions. MicroXCT showed lactate demineralized lesions had swelling and more disorganized matrix structure, whereas acetate lesions had abrupt X-ray absorption near the margin. At the ultrastructural level, TEM showed lactate was more effective in removing minerals from the collagenous matrix, which was confirmed by SAXS analysis.

CONCLUSIONS

These findings indicated the different acids yielded lesions with different characteristics that could influence lesion formation resulting in their distinct predominance in different caries activities, and these differences may impact strategies for dentin caries remineralization.

Phase transformations in a human tooth tissue at the initial stage of caries

The aim of the paper is to study phase transformations in solid tissues of the human teeth during the development of fissure caries by Raman and fluorescence microspectroscopy. The study of the areas with fissure caries confirmed the assumption of the formation of a weak interaction between phosphate apatite enamel and organic acids (products of microorganisms). The experimental results obtained with by Raman microspectroscopy showed the formation of dicalcium phosphate dihydrate - CaHPO₄-2H₂O in the area of mural demineralization of carious fissure. A comparative analysis of structural and spectroscopic data for the intact and carious enamel shows that emergence of a more soluble phase - carbonate-substituted hydroxyapatite - is typical for the initial stage of caries. It is shown that microareas of dental hard tissues in the carious fissure due to an emerging misorientation of apatite crystals have a higher fluorescence yield than the area of the intact enamel. These areas can be easily detected even prior to a deep demineralization (white spot stage) for the case of irreversibly changed organomineral complex and intensive removal of the mineral component.

Remineralization effects of two pediatric dentifrices and one regular dentifrice on artificial carious lesion in primary teeth: An in vitro study

Aim:

The aim of the following study is to know the efficacy of remineralization of two pediatric dentifrices and one regular dentifrice on artificial carious lesions in primary teeth.

Materials and Methods:

A total of 21 teeth coated with nail varnish leaving a window of 1 mm were subjected to demineralization for 72 h. These 21 teeth were then sectioned into two equal parts with a diamond disc. The 42 sections obtained were then evaluated under the stereomicroscope and the demineralization values were noted. The 42 sections were divided into three groups: Group 1: Kidodent, Group 2: Cheeriogel, Group 3: Colgate Total and subjected to remineralization respectively for 7 days. The specimens were again evaluated under the stereomicroscope for the remineralisation values.

Results:

All the three dentifrices showed remineralization with artificial carious lesions. Colgate Total showed higher remineralization rates compared with the other two pediatric dentifrices. Kidodent showed a slightly higher remineralisation rate compared with Cheeriogel which was not significant.

Conclusion/Hypothesis:

The pediatric dentifrices also showed remineralization with artificial carious lesions. Hence, we conclude that, this amount of remineralization was more or less, when compared to the regular dentifrice which showed higher remineralization rates, which could lead to adverse effects, like fluorosis if not used judiciously. On basis of which we hypothetize: Pediatric dentifrices have an appropriate fluoride content, as required by the children, and also does not minimize the cariostatic effects.

Near-infrared hyperspectral imaging of water evaporation dynamics for early detection of incipient caries

OBJECTIVES

Incipient caries is characterized as demineralization of the tooth enamel reflecting in increased porosity of enamel structure. As a result, the demineralized enamel may contain increased amount of water, and exhibit different water evaporation dynamics than the sound enamel. The objective of this paper is to assess the applicability of water evaporation dynamics of sound and demineralized enamel for detection and quantification of incipient caries using near-infrared hyperspectral imaging.

METHODS

The time lapse of water evaporation from enamel samples with artificial and natural caries lesions of different stages was imaged by a near-infrared hyperspectral imaging system. Partial least squares regression was used to predict the water content from the acquired spectra. The water evaporation dynamics was characterized by a first order logarithmic drying model. The calculated time constants of the logarithmic drying model were used as the discriminative feature.

RESULTS

The conducted measurements showed that demineralized enamel contains more water and exhibits significantly faster water evaporation than the sound enamel. By appropriate modelling of the water evaporation process from the enamel surface, the contrast between the sound and demineralized enamel observed in the individual near infrared spectral images can be substantially enhanced.

CONCLUSIONS

The presented results indicate that near-infrared based prediction of water content combined with an appropriate drying model presents a strong foundation for development of novel diagnostic tools for incipient caries detection.

CLINICAL SIGNIFICANCE

The results of the study enhance the understanding of the water evaporation process from the sound and demineralized enamel and have significant implications for the detection of incipient caries by near-infrared hyperspectral imaging.

Beyond Streptococcus mutans: dental caries onset linked to multiple species by 16S rRNA community analysis

Dental caries in very young children may be severe, result in serious infection, and require general anesthesia for treatment. Dental caries results from a shift within the biofilm community specific to the tooth surface, and acidogenic species are responsible for caries. Streptococcus mutans, the most common acid producer in caries, is not always present and occurs as part of a complex microbial community. Understanding the degree to which multiple acidogenic species provide functional redundancy and resilience to caries-associated communities will be important for developing biologic interventions. In addition, microbial community interactions in health and caries pathogenesis are not well understood. The purpose of this study was to investigate bacterial community profiles associated with the onset of caries in the primary dentition. In a combination cross-sectional and longitudinal design, bacterial community profiles at progressive stages of caries and over time were examined and compared to those of health. 16S rRNA gene sequencing was used for bacterial community analysis. Streptococcus mutans was the dominant species in many, but not all, subjects with caries. Elevated levels of S. salivarius, S. sobrinus, and S. parasanguinis were also associated with caries, especially in subjects with no or low levels of S. mutans, suggesting these species are alternative pathogens, and that multiple species may need to be targeted for interventions. Veillonella, which metabolizes lactate, was associated with caries and was highly correlated with total acid producing species. Among children without previous history of caries, Veillonella, but not S. mutans or other acid-producing species, predicted future caries. Bacterial community diversity was reduced in caries as compared to health, as many species appeared to occur at lower levels or be lost as caries advanced, including the Streptococcus mitis group, Neisseria, and Streptococcus sanguinis. This may have implications for bacterial community resilience and the restoration of oral health.

Ion release from a novel orthodontic resin bonding agent for the reduction and/or prevention of white spot lesions. An in vitro study

OBJECTIVE

To measure ion release from four sol-gel bioactive glass-containing orthodontic resin bonding agents (BAG-Bonds) following immersion into simulated body fluid (SBF) at pH values of 4 and 7.

MATERIALS AND METHODS

Four BAG-Bonds, two containing fluoride, were developed. Prepared in our laboratory, the BAG-Bonds were composed of a mixture of resin monomers and bioactive glasses (BAGs). Workability of the final BAG-Bonds determined the amount of filler added to each, and this varied according to BAG composition. Commercially available Transbond-XT was used as the control. Three disks (10 mm × 2 mm) of each material were individually suspended in 3.5 mL of SBF at pH 4 and pH 7. SBF was analyzed to measure pH and ions released at 1 hour, 10 hours, and 100 hours. Calcium was measured by atomic absorption analysis, phosphate by ultraviolet visible spectrometry, and fluoride by an ion-specific electrode. The data were compared using a three-way analysis of variance, with P ≤ .05.

RESULTS

Significant differences in calcium and phosphate ion release were found between the four BAG-Bonds and the control at multiple time points. Significant changes in pH were also found. There was no measureable release of fluoride from any of the materials.

CONCLUSIONS

The BAG-Bonds showed the capacity for buffering acidic oral environments and significant release of calcium ions into their surrounding environment, and they hold the potential to be biomimetic bonding agents that may reduce white spot lesion formation.

Application of the specular and diffuse reflection analysis for in vitro diagnostics of dental erosion: correlation with enamel softening, roughness, and calcium release

We present assembly and application of an optical reflectometer for the analysis of dental erosion. The erosive procedure involved acid-induced softening and initial substance loss phases, which are considered to be difficult for visual diagnosis in a clinic. Change of the specular reflection signal showed the highest sensitivity for the detection of the early softening phase of erosion among tested methods. The exponential decrease of the specular reflection intensity with erosive duration was compared to the increase of enamel roughness. Surface roughness was measured by optical analysis, and the observed tendency was correlated with scanning electron microscopy images of eroded enamel. A high correlation between specular reflection intensity and measurement of enamel softening (r(2) ≥ -0.86) as well as calcium release (r(2) ≥ -0.86) was found during erosion progression. Measurement of diffuse reflection revealed higher tooth-to-tooth deviation in contrast to the analysis of specular reflection intensity and lower correlation with other applied methods (r(2) = 0.42-0.48). The proposed optical method allows simple and fast surface analysis and could be used for further optimization and construction of the first noncontact and cost-effective diagnostic tool for early erosion assessment in vivo.

Analysis of the erosive effect of different dietary substances and medications

Excessive consumption of acidic drinks and foods contributes to tooth erosion. The aims of the present in vitro study were twofold: (1) to assess the erosive potential of different dietary substances and medications; (2) to determine the chemical properties with an impact on the erosive potential. We selected sixty agents: soft drinks, an energy drink, sports drinks, alcoholic drinks, juice, fruit, mineral water, yogurt, tea, coffee, salad dressing and medications. The erosive potential of the tested agents was quantified as the changes in surface hardness (ΔSH) of enamel specimens within the first 2 min (ΔSH2-0 = SH2 min - SHbaseline) and the second 2 min exposure (ΔSH4-2 = SH4 min - SH2 min). To characterise these agents, various chemical properties, e.g. pH, concentrations of Ca, Pi and F, titratable acidity to pH 7·0 and buffering capacity at the original pH value (β), as well as degree of saturation (pK - pI) with respect to hydroxyapatite (HAP) and fluorapatite (FAP), were determined. Erosive challenge caused a statistically significant reduction in SH for all agents except for coffee, some medications and alcoholic drinks, and non-flavoured mineral waters, teas and yogurts (P < 0·01). By multiple linear regression analysis, 52 % of the variation in ΔSH after 2 min and 61 % after 4 min immersion were explained by pH, β and concentrations of F and Ca (P < 0·05). pH was the variable with the highest impact in multiple regression and bivariate correlation analyses. Furthermore, a high bivariate correlation was also obtained between (pK - pI)HAP, (pK - pI)FAP and ΔSH.

Affinity of hydroxyapatite (001) and (010) surfaces to formic and alendronic acids: a quantum-mechanical and infrared study

The affinity of the (001) and of the water reacted (010)WR hydroxyapatite surfaces towards formic and alendronic acids is studied with density functional theory (PBE functional) using periodic boundary conditions based on Gaussian basis set. Structures, energetic of the adsorption and vibrational features of the adsorbates are computed in order to understand at the atomic level both the cariogenic processes (for the formic acid) and the features of anti-osteoporosis drugs (for the alendronic acid). For both molecules the interaction energy is very high on an absolute scale, and for all examined cases, it is higher on the (010)WR HA surface than on the (001) one. For the latter, a number of cases by which the acidic proton of the adsorbate is transferred to the HA surface are also characterized. For the formic acid case, experimental infrared spectra are also measured and the position and nature of the C=O stretching bands have been found to be in excellent agreement with the quantum mechanical simulations. For alendronic acid IR experiments are still not available and the present predicted infrared spectra will be useful as a guide to interpret future experimental studies.

Evidence of intact histatins in the in vivo acquired enamel pellicle

Understanding the composition and function of the acquired enamel pellicle (AEP) has been a major goal in oral biology. The aim of this study was to test the hypothesis that intact histatins are part of the in vivo AEP and that histatins after adsorption to HA have effects on in vitro enamel demineralization. This is the first study demonstrating the presence of intact histatins in vivo in the AEP. The in vitro experiments show that all naturally occurring histatins in the AEP have the potential to provide some level of protection against acid injury.

A simplified quantitative test--adapted Checkbuf test--for resting saliva buffering capacity compared with a standard test

OBJECTIVE

The aim of this study was to adapt a quantitative test for stimulated saliva, known as the Checkbuf test, to measure the buffering capacity of resting saliva and to evaluate its correlation with the Ericsson test for resting saliva.

STUDY DESIGN

Resting saliva was collected from 112 patients. Buffering capacity was assessed with the adapted Checkbuf test and 4 other methods: Ericsson test for resting saliva, Checkbuf test, and commercially available paper and liquid colorimetric tests for stimulated saliva. Data were analyzed by Cohen kappa coefficient to evaluate the agreement between the Ericsson test and the other tests.

RESULTS

There was a significant positive agreement between the Ericsson test for resting saliva and adapted Checkbuf test (kappa = 0.708). However, there were no agreements between the Ericsson test and the 3 other tests.

CONCLUSIONS

This study demonstrated that the adapted Checkbuf test is useful for measuring resting saliva buffering capacity, even for subjects with low salivary flow rates.

Microbiological or chemical models of enamel secondary caries compared by polarized-light microscopy and energy dispersive X-ray spectroscopy

Different secondary caries models may present different results. The purpose of this study was to compare different in vitro secondary caries models, evaluating the obtained results by polarized-light microscopy (PLM), scanning electron microscopy (SEM), and energy dispersive X-ray spectroscopy (EDS). Standardized human enamel specimens (n = 12) restored with different materials (Z250 conventional composite resin-CRZ, Freedom polyacid-modified composite resin-CRF, Vitremer resin-modified glass-ionomer-GIV, and Fuji IX conventional glass-ionomer cement-GIF) were submitted to microbiological (MM) or chemical caries models (CM). The control group was not submitted to any caries model. For MM, specimens were immersed firstly in sucrose broth inoculated with Streptococcus mutans ATCC 35688, incubated at 37 degrees C/5% CO(2) for 14 days and then in remineralizing solution for 14 days. For CM, specimens were submitted to chemical pH-cycling. Specimens were ground, submitted to PLM and then were dehydrated, gold-sputtered and submitted to SEM and EDS. Results were statistically analyzed by Kruskall-Wallis and Student-Newman-Keuls tests (alpha = 0.05). No differences between in vitro caries models were found. Morphological differences in enamel demineralization were found between composite resin and polyacid-modified composite resin (CRZ and CRF) and between the resin-modified glass-ionomer and the glass-ionomer cement (GIF and GIV). GIF showed higher calcium concentration and less demineralization, differing from the other materials. In conclusion, the glass-ionomer cement showed less caries formation under both in vitro caries models evaluated.

Relationship between quantitative assessments of salivary buffering capacity and ion activity product for hydroxyapatite in relation to cariogenic potential

BACKGROUND

The ion activity product for hydroxyapatite (Ip(HA)) is a comprehensive parameter reflecting pH, calcium and phosphate ion concentration in saliva which govern the degree of saturation with respect to the dissolving tooth mineral. The aim of this study was to evaluate the relationship between quantitative assessments of salivary buffering capacity and Ip(HA) in relation to cariogenic potential.

METHODS

Stimulated whole saliva was collected from 33 patients, and the initial pH of samples was measured using a hand-held pH meter. Then samples were titrated with 0.1 N HCl to evaluate buffering capacities and divided into three groups (high, medium and low). After measuring concentrations of calcium and phosphate ions in the samples, Ip(HA) was calculated using the values of the ion concentrations and pH. Differences in the mean pH values, the concentrations of calcium, phosphate ions and log[Ip(HA)] among three groups were analysed using the Kruskal Wallis and the Mann-Whitney non-parametric test, p < 0.05.

RESULTS

After HCl 50 microL titration, there were statistical differences of the mean pH and Ip(HA) among each buffering capacity group. Moreover, after 50 microL HCl titration, there was an excellent correlation between the buffer capacity and log[Ip(HA)].

CONCLUSIONS

The pH change for saliva after HCl titration has a significant influence on the rate of Ip(HA).

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.

Influence of beverage composition on the results of erosive potential measurement by different measurement techniques

The influence of beverage composition on the measurement of erosive potential is unclear. The aim of this study was to evaluate whether beverage composition influences the measurement of erosive potential and to evaluate the influence of exposure in small and large volumes. Eleven beverages were included: water (control), 3 alcopops, 2 beers and 5 soft drinks. For each beverage 15 bovine enamel samples were used: 5 for chemical and 10 for profilometric analysis. After exposure to the beverages (63 min) the resulting solutions were analyzed for Ca and inorganic phosphorus (P(i)) content. The samples for optical profilometry were submersed sequentially in 500 ml or in 1 ml of the drinks for 3, 6, 9, 15 and 30 min (total 63 min). For some of the beverages high baseline concentrations of Ca (energy drink) or P(i) (cola drink, cola lemon drink, beer, beer lemon) were found. Some of the beverages showed a good correlation between the chemical methods. Profilometry (both for 1 and 500 ml) showed generally lower enamel losses than the chemical methods. Lower enamel losses were found for the profilometry 1 ml compared to the profilometry 500 ml only for the cola drinks. It can be concluded that the composition of the beverages had a significant effect on the determination of the erosive potential with chemical analyses. Drink composition also influenced the effect of small versus large exposure volumes, indicating the need for standardization of exposure parameters.

Effect of pH of amine fluoride containing toothpastes on enamel remineralization in vitro

BACKGROUND

One of the important factors of the demineralization and remineralization equilibrium of enamel is the pH of the surrounding solutions. Effort has been laid in the formulation of different fluoride compounds and the fluoride content in toothpastes but much less is known about the influence of the pH of the toothpastes on their effectiveness. It was therefore the aim of this study to investigate the influence of different pH levels on enamel remineralization in an in vitro experiment using polarization light microscopy and EDX quantitative element analysis.

METHODS

A 5 x 5 mm window on the enamel surface of 40 caries free extracted human premolars was demineralized in a hydroxyethylcellulose solution at pH 4.8. The teeth were divided into 8 groups and the lower half of the window was covered with varnish serving as control. Each group was then immersed in toothpaste slurry containing amine fluoride (1400 ppm) at pH 4.1, 4.5, 5.1 and 6.9 or control toothpaste slurry without fluoride at pH 4.3, 4.7, 5.3 and 7.0. Serial sections were cut through the lesions and investigated with polarization light microscopy and quantitative EDX element analysis.

RESULTS

The PLM results showed a decreased porous volume of the body of the lesion after incubation with fluoridated toothpaste at pH 4.53 and 5.16. No differences between the experimental window and the control window were found in the other groups. The quantitative element analysis showed no differences in the element content of any of the groups.

CONCLUSION

From the results it can be concluded that slightly acidified fluoridated dentifrices may have a certain positive effect on enamel remineralization.

A new model for nanoscale enamel dissolution

The dissolution kinetics of human tooth enamel surfaces was investigated using nanomolar-sensitive constant composition (CC) and in situ atomic force microscopy (AFM) under simulated caries formation conditions (relative undersaturation with respect to hydroxyapatite = 0.902, pH = 4.5). Scanning electron microscopic (SEM) examination of the resulting etched enamel surfaces showed that deminerzalization, initiated at core/wall interfaces of rods, developed anisotropically along the c-axes. After an initial rapid removal of surface polishing artifacts, the dissolution rate decreased as the reaction proceeded in accordance with our recently proposed crystal dissolution model, resulting in hollow enamel cores and nanosized remaining crystallites, resistant to further dissolution. Generally, dissolution of minerals is regarded as a spontaneous reaction in which all the solid phase can be dissolved in undersaturated solutions. However, the dissolution of some biominerals may be suppressed when the crystallites approach nanometer size. This study shows that CC demineralization of enamel in acidic medium follows this new model that can be used to mimic carious lesion formation. In dissolution studies, nanosized enamel crystallites exhibit a remarkable degree of self-preservation in the fluctuating physiological milieu.

Effects of calcium phosphate nanoparticles on Ca-PO4 composite

Nano-particles of dicalcium phosphate anhydrous (DCPA) were synthesized for the first time. The objectives of this study were to incorporate DCPA nano-particles into resin for Ca-PO(4) release to combat dental caries, and to investigate the filler level effects. Nano-DCPA and nano-silica-fused silicon nitride whiskers at a 1:1 ratio were used at filler mass fractions of 0-75%. The flexural strengths in MPa (mean +/- SD; n = 6) of DCPA-whisker composites ranged from (106 +/- 39) at 0% fillers to (114 +/- 23) at 75% fillers, similar to (112 +/- 22) of a non-releasing composite (TPH) (p > 0.1). The composite with 75% fillers in a NaCl solution (133 mmol/L, pH = 7.4, 37 degrees C) yielded a Ca concentration of (0.65 +/- 0.02) mmol/L and PO(4) of (2.29 +/- 0.07) mmol/L. Relationships were established between ion-release and DCPA volume fraction V(DCPA): Ca = 4.46 V(DCPA)(1.6,) and = 66.9 V(DCPA)(2.6). Nano-DCPA-whisker PO(4) composites had high strength and released high levels of Ca-PO(4) requisite for remineralization. These new nano-composites could provide the needed combination of stress-bearing and caries-inhibiting capabilities.