Appraisal of the remineralizing potential of child formula dentifrices on primary teeth: An in vitro pH cycling model

Remineralizing Potential of Low-fluoridated, Nonfluoridated and Herbal Nonfluoridated Dentifrices on Demineralized Surface of Primary Teeth: An In Vitro Study

Aim

The aim of this in vitro study is to evaluate the remineralizing potential of commercially available low-fluoridated, nonfluoridated, and herbal nonfluoridated child formula dentifrices on primary teeth.

Materials and methods

Total of 36 primary teeth were placed in the demineralizing solution for 96 hours to produce artificial carious lesions of approximately 100 μm depth, and then cut longitudinally into 30 sections of 100–150 μm thickness and randomly assigned to three groups. Sections were treated with low-fluoridated, nonfluoridated, and herbal nonfluoridated dentifrice. Lesions were evaluated using polarized light microscopy.

Results

Intragroup comparison of mean lesion depth from pretreatment to posttreatment among the three study groups revealed that maximum reduction in lesion depth was found to be in group I (low-fluoridated) followed in descending order by group III (herbal nonfluoridated) and group II (nonfluoridated), respectively.

Conclusion

Group I (low-fluoridated) and group III (herbal nonfluoridated) demonstrated remineralization of carious lesions by virtue of a decrease in lesion depth, whereas group II (nonfluoridated) showed an increase in lesion depth.

Clinical significance

Fluoride dentifrices are the most widely used products that deliver topical fluoride to the oral environment. The major drawback is the risk of dental fluorosis, which occurs because of ingestion of dentifrices, in preschool children. This necessitates use of preventive measures which include (1) reducing the amount of toothpaste used, (2) supervised brushing in preschool children and (3) developing low-fluoride toothpastes for minimizing risk of dental fluorosis. Further dental professionals must investigate effectiveness of increasingly popular “Herbal” products.

How to cite this article

Tiwari S, Saha S, Dhinsa K, et al. Remineralizing Potential of Low-fluoridated, Nonfluoridated and Herbal Nonfluoridated Dentifrices on Demineralized Surface of Primary Teeth: An In Vitro Study. Int J Clin Pediatr Dent 2022;15(3):251-257.

The Efficacy of Non-fluoridated Toothpastes on Artificial Enamel Caries in Primary Teeth: An In Vitro Study

Aims

The aim of this study was to evaluate the remineralizing effect among various non-fluoridated toothpastes on artificial caries in primary teeth.

Materials and Methods

Fifty sound primary incisor teeth were embedded in self-curing acrylic resin and immersed in demineralizing solution for 4 days forming artificial caries. All teeth were divided into five groups (10 teeth/group): Group I deionized water (control); Group II 1000 ppm F (Kodomo^®); Group III non-fluoridated toothpaste containing calcium glycerophosphate and calcium lactate (Dokbuaku^®); Group IV casein phosphopeptides-amorphous calcium phosphate (CPP-ACP) paste (GC Tooth Mousse^®), and Group V non-fluoridated toothpaste containing nanohydroxyapatite (NHA) (Apagard^®). The specimens were subjected to pH-cycling and immersed in toothpaste slurry twice for 7 days. Baseline, before, and after pH-cycling surface microhardness (SMH) values were measured by Vickers hardness numbers, and the percentage recovery of SMH (%SMHR) was calculated. Data were analyzed by one-way analysis of variance and Tukey's multiple comparison at 95% confidence intervals.

Results

The SMH values of test groups were significantly higher than those of the control group (p = 0.00). The %SMHR was -5.72±7.03% in the control group, Group II was significantly higher than Group III but there were no significant differences among Groups II, IV, and V (p > 0.05).

Conclusion

Non-fluoridated toothpastes containing CPP-ACP or NHA for young children had efficacy in remineralizing effect on primary teeth comparable with 1000 ppm fluoridated toothpaste.

Comparative Evaluation of the Remineralizing Potential of Commercially Available Agents on Artificially Demineralized Human Enamel: An In vitro Study

Background

Caries is highly prevalent multifactorial disease, but its progression can be prevented in the initial stage of demineralization through remineralization (RML). Various materials have been proposed for the same, successful outcome can prove to be a boon in the prevention of caries.

Aim

The aim of the study is to assess the RML potential of four commercially available agents so as to restore the enamel closest to its previous microhardness levels.

Materials and Methods

Sixty permanent intact premolars were randomly divided into six groups: Four test groups - (1) bioactive glass (BAG) Novamin (SHY-NM), (2) nano-hydroxyapatite (nHAp) (Acclaim), (3) functionalized tricalcium phosphate (f-TCP) (Clinpro Tooth Crème), and (4) grape seed extract (GSE); one positive control - (5) fluoride (1000 ppm) containing dentifrice (Colgate Calci-Lock); and one negative control - (6) distilled water. The samples were initially evaluated for baseline surface microhardness (SMH); later on, these samples were placed in the demineralizing solution for 48 h in an incubator at 37°C, and postdemineralization again SMH was measured. Thereafter, the samples were subjected to the pH cycling for consecutive 21 days, and SMH was recorded. The SMH was evaluated using a Vickers microhardness tester. Statistical analysis was done using a post hoc Tukey test for each group based on the stage of treatment and one-way ANOVA for comparison among different groups.

Results

BAG Novamin showed SMH recovery at 96.75% followed by f-TCP at 95.83%, nHAp at 90.88%, and GSE at 48.71%. Statistically significant differences were observed between the first three groups and the rest of the groups after RML stage.

Conclusion

BAG Novamin, f-TCP, and nHAp showed considerable RML followed to a lesser extent by GSE.

Effects of Fluoride on Two Chemical Models of Enamel Demineralization

This study evaluated the effects of fluoride on subsurface enamel demineralization induced by two commonly used chemical models. Forty-eight enamel blocks were demineralized at pH = 5.0 by an acetate buffer (Group 1), a lactate buffer (Group 2), an acetate buffer with 0.02 ppm fluoride (Group 3) and a lactate buffer with 0.02 ppm fluoride (Group 4) at 25 °C for 3 weeks. The surface destruction percentage (SDP), mineral loss and lesion depth of the blocks were studied using micro-computed tomography. An elemental analysis of the enamel surface was evaluated using an energy-dispersive X-ray spectroscopy. Surface micro-hardness was determined by the Knoop Hardness Test. The mean lesion depth of Groups 1 through 4 were 134.1 ± 27.2 μm, 96.1 ± 16.5 μm, 97.5 ± 22.4 μm and 91.1 ± 16.2 μm, respectively (p < 0.001; group 1 > 2, 3 > 4). The SDPs of groups 1 through 4 were 7.8 ± 8.93%, 0.71 ± 1.6%, 0.36 ± 1.70% and 1.36 ± 2.94% (p < 0.001; group 1 > 2, 3, 4). The fluoride in mean weight percentages of groups 1 through 4 were 1.12 ± 0.24%, 1.10 ± 0.20%, 1.45 ± 0.40% and 1.51 ± 0.51%, respectively (p < 0.001; group 3, 4 > 1, 2). The mean Knoop hardness values of groups 1 through 4 were 27.5 ± 13.3, 39.7 ± 19.3, 73.6 ± 44.2 and 91.0 ± 57.2, respectively (p < 0.001; group 4 > 3 > 2 > 1). The chemical model using an acetate buffer solution created significantly deeper zones of subsurface demineralization on enamel than the lactate buffer solution. An acetate buffer may damage the enamel surface, but the surface damage can be prevented by adding fluoride.

Effect of dentifrices on their remineralizing potential in artificial carious lesions: An in situ study

Background:

The eventual sequel of dental caries is determined by the dynamic equilibrium between pathological factors which lead to demineralization and protective elements, which in turn leads to remineralization. Remineralization is the natural process for noncavitated demineralized lesions and relies on calcium and phosphate ions assisted by fluoride to rebuild a new surface on existing crystal remnants in subsurface lesions remaining after demineralization. Hence, the present study was designed to evaluate the efficacy of fluoride dentifrices in remineralizing artificial caries-like lesions in situ.

Materials and Methods:

A double-blind, randomized study with an initial washout period of 7 days was carried out for 3 weeks. Twenty volunteers were enrolled, who wore the intraoral cariogenicity test appliance having enamel slabs incorporated into them, for 3 weeks. 10 participants were instructed to use Group A dentifrice (fluoride) and the other 10 Group B dentifrice (nonfluoride) for brushing their teeth. The enamel slabs were analyzed by surface microhardness testing and scanning electron microscopy (SEM) at 3 intervals.

Results:

No significant differences was seen in the microhardness values recorded for Group A and Group B at baseline and after demineralization (P > 0.05); however Group B exhibited lesser microhardness compared to Group A, after intra-oral exposure (P < 0.05). In the SEM analysis, the Group A enamel surfaces had more regular and longer crystallites to those of the Group B.

Conclusion:

Fluoride dentifrices avert the decrease in enamel hardness and loss of minerals from the enamel surface to a large extent as compared to the nonfluoride dentifrices.