Recaldent--evidence for clinical activity

The Associations between Snack Intake and Cariogenic Oral Microorganism Colonization in Young Children of a Low Socioeconomic Status

Cariogenic microorganisms are crucial pathogens contributing to the development of early childhood caries. Snacks provide fermentable carbohydrates, altering oral pH levels and potentially affecting microorganism colonization. However, the relationship between snack intake and cariogenic microorganisms like Candida and Streptococcus mutans in young children is still unclear. This study aimed to assess this association in a prospective underserved birth cohort. Data from children aged 12 to 24 months, including oral microbial assays and snack intake information, were analyzed. Sweet and non-sweet indices based on the cariogenic potential of 15 snacks/drinks were created. Mixed-effects models were used to assess the associations between sweet and non-sweet indices and S. mutans and Candida carriage. Random forest identified predictive factors of microorganism carriage. Higher non-sweet index scores were linked to increased S. mutans carriage in plaques (OR = 1.67, p = 0.01), potentially strengthening with age. Higher sweet index scores at 12 months were associated with increased Candida carriage, reversing at 24 months. Both indices were top predictors of S. mutans and Candida carriage. These findings underscore the associations between snack intake and cariogenic microorganism carriage and highlight the importance of dietary factors in oral health management for underserved young children with limited access to dental care and healthy foods.

Bioactive Inorganic Materials for Dental Applications: A Narrative Review

Over time, much attention has been given to the use of bioceramics for biomedical applications; however, the recent trend has been gaining traction to apply these materials for dental restorations. The bioceramics (mainly bioactive) are exceptionally biocompatible and possess excellent bioactive and biological properties due to their similar chemical composition to human hard tissues. However, concern has been noticed related to their mechanical properties. All dental materials based on bioactive materials must be biocompatible, long-lasting, mechanically strong enough to bear the masticatory and functional load, wear-resistant, easily manipulated, and implanted. This review article presents the basic structure, properties, and dental applications of different bioactive materials i.e., amorphous calcium phosphate, hydroxyapatite, tri-calcium phosphate, mono-calcium phosphate, calcium silicate, and bioactive glass. The advantageous properties and limitations of these materials are also discussed. In the end, future directions and proposals are given to improve the physical and mechanical properties of bioactive materials-based dental materials.

In vitro mineral apposition analysis of two Colombian plant extracts on Amelogenesis imperfecta teeth

OBJECTIVE

To determine if native Colombian Piper marginatum Jacq. and Ilex guayusa Loes plant extracts have a remineralizing effect on teeth with Amelogenesis imperfecta in comparison with the commercial products Clinpro-3M and Recaldent™.

MATERIAL AND METHODS

An in vitro study was carried out with 128 human teeth slices (64 healthy and 64 with Amelogenesis imperfecta) on which an initial Raman spectroscopy was performed followed by Raman spectroscopies at 0, 24, 48, and 72 h to determine possible remineralization by observing mineral increase or decrease as a result of P. marginatum Jacq. and I. guayusa Loes extract application in comparison to control substance (Clinpro and Recaldent™) application. Obtained data were analyzed using a bivariate method with a t unidirectional test. Significant differences among groups were determined by an ANOVA with Dunnett post hoc tests.

RESULTS

Native I. guayusa Loes and P. marginatum Jacq. Colombian plants extracts exhibited phosphate and orthophosphate mineral apposition, where P. marginatum Jacq. presented better results.

CONCLUSIONS

Native Colombian I. guayusa Loes and P. marginatum Jacq plant extract might in the future be useful for dental tissue remineralization, as they induced phosphate and orthophosphate mineral apposition, main components of tooth enamel. These types of natural compounds can become an alternative to fluorine, whose ingestion is harmful to the human body.

Effect of Bioactive Glass-Containing Light-Curing Varnish on Enamel Remineralization

This study aimed to evaluate the effect of novel experimental light-curing bioactive glass (BAG)-containing varnish on enamel remineralization. An experimental light-curing, BAG-containing varnish and two commercial varnishes (Nupro White Varnish; Dentsply International, York, PA, USA and Tooth Mousse; GC Corporation, Tokyo, Japan) were used. Microhardness tests (n = 3), field emission scanning electron microscopy (FE-SEM) coupled with energy dispersive X-ray spectroscopy (EDS) (n = 5), and X-ray diffraction (XRD) analysis (n = 5) were performed to compare the remineralization effect of three varnishes with and without ultrasonication. The data of microhardness test were analyzed using one-way ANOVA and Tukey's post hoc comparison (P < 0.05). Microhardness of demineralized enamel increased after the application of three varnishes (P < 0.05). The experimental BAG-containing varnish showed the highest microhardness among the three varnishes (P < 0.05). Ultrasonication decreased microhardness of Tooth Mousse and BAG-containing varnish groups (P < 0.05). FE-SEM and XRD revealed precipitates of hydroxyapatite (HAP) or fluorapatite (FAP) crystals of three varnishes. The novel experimental BAG-containing varnish may be a promising clinical strategy for the remineralization of early carious lesions or demineralized enamel surfaces.

Carious lesion remineralizing potential of fluoride- and calcium-containing toothpastes: A laboratory study

BACKGROUND

The authors conducted a laboratory study to determine the carious lesion remineralization and fluoridation potential of fluoride (F)- and calcium-containing toothpastes.

METHODS

The authors created early carious lesions in bovine enamel specimens and assigned them to 7 treatment groups on the basis of their surface Vickers microhardness: Clinpro Tooth Crème (Clinpro) (3M ESPE), CTx4 Gel 1100 (CTx4) (Oral Biotech), Enamelon Fluoride Toothpaste (Enamelon) (Premier Dental), MI Paste ONE (MI-One) (GC America), Crest Cavity Protection Toothpaste (Crest) (Procter & Gamble), and 2 F-dose controls (low F, high F). The authors pH cycled the specimens for 10 days by using an established model, determined changes in surface microhardness, calculated percentage of surface microhardness recovery (%SMHr; primary outcome variable), and measured enamel F uptake (EFU). The authors used a 1-way analysis of variance for data analysis.

RESULTS

Study results showed an F-dose response for both %SMHr (low-F control: mean, 9.8; 95% confidence interval [CI], 5.7 to 13.8); Crest: mean, 26.2; CI, 21.8 to 30.6; high-F control: mean, 33.5; CI, 29.4 to 37.5) and EFU (low-F control: mean, 47; CI, 12 to 83; Crest: mean, 225; CI, 189 to 260; high-F control: mean, 307; CI, 271 to 342; all micrograms of F per cubic centimeter). For %SMHr, Clinpro (mean, 26.5; CI, 22.5 to 30.6) and CTx4 (mean, 27.3; CI, 23.1 to 31.5) were similar to Crest, all being superior to Enamelon (mean, 15.6; CI, 11.6 to 19.7), which was superior to MI-One (mean, 4.3; CI, 0.3 to 8.3). For EFU, there were no differences between Clinpro (mean, 189; CI, 153 to 224), CTx4 (mean, 177; CI, 142 to 213), Enamelon (mean, 196; CI, 161 to 232), and Crest, all being superior to MI-One (mean, 66; CI, 30 to 102).

CONCLUSIONS

This study's results failed to show superior remineralizing efficacy of any of the toothpastes compared with those of a calcium-free F toothpaste, with 2 of the 4 toothpastes being inferior. Clinical testing will be required to establish conclusive evidence.

PRACTICAL IMPLICATIONS

Clinicians should be aware of the remineralizing potential of new anticaries products.

Recent Advances in Remineralization Therapies for Caries Lesions

Remineralization of caries lesions is naturally achieved by salivary ions, and it can be enhanced by external factors or elements such as fluoride. Numerous studies have demonstrated the remineralizing efficacy of fluoride therapies as well as the limitations with some groups of the population. Consequently, developing new remineralization therapies to close this gap in efficacy has been a priority for the last 2 decades. In this review, we summarize and briefly discuss some of the latest advances in remineralization therapies. Most new therapies try to enhance the effect of fluoride by adding other potentially active ingredients to the formulation, such as calcium, phosphate, stannous, xylitol, and arginine. Other remineralization strategies have focused on creating remineralizing scaffolds within the lesions (e.g., self-assembling peptides). While several of the new remineralization strategies have progressed significantly in recent years, for most of them, the evidence is still insufficient to assess their true clinical potential.

A review of bioceramics-based dental restorative materials

Currently, much has been published related to conventional resin-based composites and adhesives; however, little information is available about bioceramics-based restorative materials. The aim was to structure this topic into its component parts and to highlight the translational research that has been conducted up to the present time. A literature search was done from indexed journals up to September 2017. The main search terms used were based on dental resin-based composites, dental adhesives along with bioactive glass and the calcium phosphate family. The results showed that in 123 articles, amorphous calcium phosphate (39.83%), hydroxyapatite (23.5%), bioactive glass (16.2%), dicalcium phosphate (5.69%), monocalcium phosphate monohydrate (3.25%), and tricalcium phosphate (2.43%) have been used in restorative materials. Moreover, seven studies were found related to a newly developed commercial bioactive composite. The utilization of bioactive materials for tooth restorations can promote remineralization and a durable seal of the tooth-material interface.

State of the Art Enamel Remineralization Systems: The Next Frontier in Caries Management

The principles of minimally invasive dentistry clearly dictate the need for clinically effective measures to remineralize early enamel caries lesions. While fluoride-mediated remineralization is the cornerstone of current caries management philosophies, a number of new remineralization strategies have been commercialized or are under development that claim to promote deeper remineralization of lesions, reduce the potential risks associated with high-fluoride oral care products, and facilitate caries control over a lifetime. These non-fluoride remineralizing systems can be broadly categorized into biomimetic enamel regenerative technologies and the approaches that repair caries lesions by enhancing fluoride efficacy. This paper discusses the rationale for non-fluoride remineralization and the mechanism of action, challenges, and evidence behind some of the most promising advances in enamel remineralization therapies.

Calcium phosphates as ion-releasing fillers in restorative resin-based materials

Calcium phosphates (CaP) are the main constituents of the mineral phase in bones and teeth and, along with calcium silicates and bioactive glasses, have been extensively investigated in remineralization of enamel and dentin. When used as ion-releasing fillers in resin-based materials, they could contribute to extend the service life of adhesive restorations, remineralize caries-affected dentin or prevent caries lesions under sealants and orthodontic brackets. However, the development of resin-based bioactive materials is not straightforward because of the several compositional variables involved in ion release. Also, CaP particles do not reinforce the material; therefore, if high mechanical properties are required, the ratio between CaP particles and reinforcing fillers must be observed. Several research groups have investigated how CaP phase, particle size and content, as well as resin matrix formulation affect remineralization, ion release kinetics and mechanical properties of these materials. This review presents an overview of the main findings reported in the literature.

Impact of an anticaries mouthrinse on in vitro remineralization and microbial control

Objective. The objective of this research was to evaluate the caries control potential of a new fluoride mouthrinse that also contained antimicrobial agents and a biofilm disrupting agent using different in vitro models. Methods. Four in vitro studies were conducted to assess the performance of this three pronged approach to caries control: (1) traditional enamel fluoride uptake, (2) surface microhardness study using pH cycling model and subsequent fluoride uptake, (3) a salivary biofilm flow-through study to determine the anti-microbial activity, and (4) a single species biofilm model measuring effect on biofilm matrix disruption. Results. The data showed that a LISTERINE rinse with fluoride, essential oils and xylitol was superior in promoting enamel fluoride uptake and in enhancing antimicrobial activity over traditional commercially available fluoridated products. An increase of the surface microhardness was observed when the LISTERINE rinse was used in combination with fluoridated toothpaste versus the fluoridated toothpaste alone. Finally, it was demonstrated that xylitol solutions disrupted and reduced the biovolume of biofilm matrix of mature Streptococcus mutans. Conclusion. These in vitro studies demonstrated that a fluoride mouthrinse with antimicrobial agent and biofilm matrix disrupting agent provided multifaceted and enhanced anti-caries efficacy by promoting remineralization, reducing acidogenic bacteria and disrupting biofilm matrix.

Treatment of white spot lesions with ACP paste and microabrasion

OBJECTIVE

To examine the effects of application of casein phosphopeptide amorphous calcium phosphate (CPP-ACP) paste and microabrasion treatment on the regression of white spot lesions (WSLs).

MATERIALS AND METHODS

Artificially-induced WSLs in bovine enamel were randomly assigned to one of four treatment groups: CPP-ACP paste only, microabrasion only, microabrasion and CPP-ACP, and a control. Samples were treated with each regimen twice daily for 2 weeks and stored in remineralizing solution between the treatments. Quantitative light-induced fluorescence was used to measure changes in fluorescence, which indicate changes in mineral content of WSLs immediately before (T1) and 2 weeks after treatment (T2). A two-within-subject factor analysis of variance was used to analyze the significance of any changes in mineral content of the lesions from T1 to T2.

RESULTS

There was a statistically significant (P < .05) gain in fluorescence associated with the microabrasion only, as well as the microabrasion and CPP-ACP treatments. The changes in fluorescence for the CPP-ACP treatment alone were not statistically significant (P  =  .40).

CONCLUSIONS

CPP-ACP paste alone does not significantly improve the fluorescence value (ie, the mineral content) of WSLs. Within the limitations of this in vitro study, microabrasion treatment with or without CPP-ACP improved the fluorescence and thus reduced WSLs.

Biofunctional properties of caseinophosphopeptides in the oral cavity

Caseinophosphopeptides (CPPs), bioactive peptides released from caseins, have the ability to enhance bivalent mineral solubility. This is relevant to numerous biological functions in the oral cavity (promotion of tooth enamel remineralisation, prevention of demineralisation and buffering of plaque pH). Therefore, CPPs may play a positive role as prophylactic agents for caries, enamel erosion and regression of white spot lesions. Most in vitro and in situ studies demonstrate strong evidence for the bioactivity of CPPs in the oral cavity. Nevertheless, relatively little is known concerning their use as adjuvants for oral health and more particularly regarding their long-term effects on oral health.

In vitro study of the effects of fluoride-releasing dental materials on remineralization in an enamel erosion model

OBJECTIVES

This study was conducted to compare the remineralization effects of five regimens on the loss of fluorescence intensity, surface microhardness, roughness and microstructure of bovine enamel after remineralization. We hope that these results can provide some basis for the clinical application of these materials.

METHODS

One hundred bovine incisors were prepared and divided into the following five groups, which were treated with distinct dental materials: (1) Clinpro™ XT varnish (CV), (2) F-varnish (FV), (3) Tooth Mousse (TM), (4) Fuji III LC(®) light-cured glass ionomer pit and fissure sealant (FJ) and (5) Base Cement(®) glass polyalkenoate cement (BC). Subsequently, they were detected using four different methods: quantitative light-induced fluorescence, microhardness, surface 3D topography and scanning electron microscopy (SEM).

RESULTS

The loss of fluorescence intensity of CV, BC and FJ groups showed significant decreases after remineralization (p<0.05). The microhardness values of the BC group were significantly higher than those of the other groups (p<0.05) after 6 weeks of remineralization. The CV group's surface roughness was significantly lower than those of the other groups after 6 weeks of remineralization (p<0.05). Regarding microstructure values, the FV group showed many round particles deposited in the bovine enamel after remineralization. However, the other four groups mainly showed needle-like crystals.

CONCLUSIONS

Glass ionomer cement (GIC)-based dental materials can promote more remineralization of the artificial enamel lesions than can NaF-based dental materials. Resin-modified GIC materials (e.g., CV and FJ) have the potential for more controlled and sustained release of remineralized agents. The effect of TM requires further study.

Strategies for noninvasive demineralized tissue repair

This article provides a state-of-the-art overview of clinically relevant evidence regarding effective, noninvasive management strategies to prevent, arrest, and remineralize caries lesions. With the rapidly increasing knowledge about oral biofilms and the process of caries in itself, the profession is embarking on new strategies. This is an exciting time, with several promising new agents and novel treatment modalities at the horizon to prevent and manage caries lesions. Some are already available in clinical practice. Studies, however, have yet to show conclusive evidence of clinical efficacy. None have shown to be more effective than fluoride and protection by sealant.

Analysis of the effect of CPP-ACP tooth mousse on enamel remineralization by circularly polarized images

OBJECTIVE

To evaluate the effect of casein phosphopeptide-amorphous calcium phosphate tooth mousse on the remineralization of bovine incisor by circularly polarized images.

METHODS

Eighty bovine incisors, each with a 4 x 4 mm artificially demineralized area, were used. The samples were divided into four groups: Group A, casein phosphopeptide-amorphous calcium phosphate tooth mousse; Group B, fluoride toothpaste; Group C, casein phosphopeptide-amorphous calcium phosphate tooth mousse and fluoride toothpaste; and Group D, no treatment. Circularly polarized images were taken after the specimens were treated for 3, 6, 9, or 12 weeks, and the size of the demineralized area and the mean grey level were measured. Data analysis was done using repeated measures variance analysis. Pearson correlation coefficients were computed to evaluate the correlation between the size of the demineralized area and the mean grey level.

RESULTS

In all four groups, the size of the demineralized area and the mean grey level declined with time. The size of the demineralized area of Group C was significantly smaller than that of Group A at the end of the third and sixth weeks (P = .039, P = .000, respectively), and the mean grey level of Group C was lower than that of Group A at the end of the 6th and 12th weeks (P = .037, P = .004, respectively). At the end of the 6th, 9th, and 12th weeks, the size of the demineralized area of Group C was smaller (P = .000, P = .005, P = .005, respectively) and the mean grey level was lower (P = .000) than those of Group B. No statistically significant correlations were detected between the size of the demineralized area and the mean grey level.

CONCLUSION

Casein phosphopeptide-amorphous calcium phosphate tooth mousse can reduce the size and mean grey level of demineralized areas and promote the remineralization of bovine enamel. Combined application with fluoride toothpaste strengthens the effect.