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The effectiveness of community water fluoridation in the United States.

Grand Rapids, the first city in the world to implement controlled water fluoridation, has served as a model for thousands of other communities. Fluoridation is one of the greatest public health and disease-preventive measures of all time. Its advantages include effectiveness for all, ease of delivery, safety, equity, and low cost. Today, nearly 56 percent of the US population lives in fluoridated communities (62% of those on central water supplies). Previously observed caries reductions of one-half to two-thirds are no longer attainable in the United States because other fluoride methods and products have reduced the caries prevalence in all areas, thus diluting the measurement of effectiveness, and because benefits of fluoridation are dispersed in many ways to persons in nonfluoridated areas. Water fluoridation itself, however, remains as effective as it ever was among groups at high risk to dental caries. Contrary to early beliefs that stressed the importance of preeruptive fluoride exposure, fluoridation also provides an important source of topical fluoride and facilitates remineralization. Although data on effectiveness and safety are compelling, future progress of water fluoridation will be affected by economic, political, and public perception factors.

Cariostatic Agents↗

Sulcal plaque pH and remineralization of sulcal caries in rats exposed to dietary and water fluoride.

After being inoculated with Streptococcus (mutans) sobrinus 6715 and fed a mildly caries-promoting diet for 14 days, sulcal plaque pH response to topical application of a 10% sucrose solution was measured in two groups of rats. The first group (experimental) was then fed diet and drinking water to which 1 mmol (20 ppm) fluoride had been added (0.5 mmol for 7 days and 1 mmol for 14 days) and pH measurements were repeated. The second group was held as a control and a third group was sacrificed to provide baseline caries scores. There was no difference in the fall in pH after topical application of 10% sucrose solution between the control and experimental group, nor between the pre- and postfluoride measurements for the experimental group. Sulcal caries incidence in the experimental group was significantly lower than in the control group. The results of this experiment emphasize the importance of a cariostatic mechanism of action for fluoride based on remineralization of enamel lesions and do not support the in vivo adaptation to fluoride by oral microorganisms.

Animals↗

Influence of fluoride and pH on in vitro remineralization of bovine enamel.

Subsurface lesions in bovine enamel slices were remineralized. The remineralization solutions contained either 0.03, 0.3, or 1.0 ppm fluoride at either pH 5.5 or 6.8. The amount of remineralization was determined after periods of up to 610 h, using quantitative microradiography. The results showed that after 126 h of remineralization in the presence of 0.03 ppm fluoride significantly (p less than 0.05) more remineralization occurred at pH 6.8 than at pH 5.5. At 0.3 and 1.0 ppm fluoride no significant differences between pH 5.5 and pH 6.8 were observed. An interaction between fluoride and pH was observed. The observed differences in the rates of remineralization are explained by the formation and subsequent transformation of the precursors octacalcium phosphate (pH 6.8) and brushite (pH 5.5) into (fluor)apatites.

Animals↗

[A study of the mechanism of effects of solution containing trace elements on remineralization layer formation of enamel carious lesions].

OBJECTIVE: To study the effects of several remineralization solutions with different composition on the artificial demineralization lesions of bovine enamel and the mechanism of remineralization layer formation. METHODS: 36 bovine teeth were selected and artificial carious lesions were formed with lactic acid gel. Then all specimens were divided into 4 groups which contained no fluoride, fluoride, fluoride-calcium-phosphate-tin, and de-ionic water separately, and the de-ionic group was taken as control. The structure and composition of the sediments on the enamel surface were evaluated and detected by X-ray photoelectron spectroscopy (XPS) and scanning electron microscopy (SEM). Histological change of enamel section was examined by polarized microscopy. RESULTS: Compared with the control group, all the solutions had remineralization effects, especially the solutions containing trace elements. XPS showed that there were sediments formed on the surface of carious lesion, the compositions of the sediments were CaF2, HAP and non-specifically absorbed fluoride (NSAF). Irregular, crystal deposits were also found under SEM on the enamel surface. The polarized microscopy results showed that the observed demineralization areas decreased after exposure to the solutions. CONCLUSION: Solutions containing fluoride and trace elements were effective on remineralization. The possible mechanism is that CaF2 and NSAF, instead of FA formed in the remineralization layer. Moreover, the remineralization effects of the fluoride solutions containing trace elements are more outstanding than that without trace elements. The potential mechanism is the synergistic action of fluoride and trace elements.

Animals↗

The continuum of dental caries--evidence for a dynamic disease process.

The eventual outcome of dental caries is determined by the dynamic balance between pathological factors that lead to demineralization and protective factors that lead to remineralization. Pathological factors include acidogenic bacteria, inhibition of salivary function, and frequency of ingestion of fermentable carbohydrates. Protective factors include salivary flow, numerous salivary components, antibacterials (both natural and applied), fluoride from extrinsic sources, and selected dietary components. Intervention in the caries process can occur at any stage, either naturally or by the insertion of some procedure or treatment. Dental caries covers the continuum from the first atomic level of demineralization, through the initial enamel or root lesion, through dentinal involvement, to eventual cavitation. The dynamic balance between demineralization and remineralization determines the end result. The disease is reversible, if detected early enough. Since demineralization can be quantified at early stages, before frank cavitation, intervention methods can be tested by short-term clinical trials.

Cariostatic Agents↗

Laboratory enamel solubility reduction and fluoride uptake from enamelon dentifrice.

The presence of calcium-releasing ingredients in toothpastes containing sodium fluoride is usually avoided to prevent loss of active fluoride due to the formation of the insoluble calcium salt. The purpose of this study was to determine the bio-availability of fluoride from Enamelon Toothpaste (E), which simultaneously supplies fluoride, calcium and phosphate salts from a dual dispensing package. Fluoride uptake into artificially lesioned enamel cores due to the use of the test dentifrice (E) diluted 1:3 in whole human saliva was compared to that from a clinically proven effective sodium fluoride/silica USP reference toothpaste (C) and a non-fluoride control (E-w/o F). Enamel solubility reduction due to the use of E, C and E-w/o F was measured by determining the quantity of phosphate released to lactic acid buffer before and after treatment of the crowns of molars with 1:3 slurries of the dentifrices in water. Fluoride uptakes and enamel solubility reductions were 5031 +/- 158 ppm and 21.6 +/- 2.2% for E, 1915 +/- 39 ppm and 13.6 +/- 2.0% for C, and -3 +/- 2 ppm and 0.8 +/- 1.7% for E-w/o F. The fluoride uptake and enamel solubility reductions from E were significantly greater than from C (p < 0.001, Fisher LSD), and both fluoride-containing dentifrices significantly outperformed E-w/o F (p < 0.001). The laboratory results indicate that the calcium and phosphate salts delivered by the remineralizing Enamelon dentifrice increase the bioavailability of fluoride to substantially exceed that of the clinically proven standard dentifrice.

Analysis of Variance↗

An in vitro assessment and a pilot clinical study of electrical resistance of demineralized enamel.

Electrical resistance measurement was evaluated in vitro and in vivo as a method for comparing the remineralizing performance of toothpastes. In the in vitro study, areas of sound enamel on 12 unrestored, mature, extracted human molars and bicuspids, with electrical resistance readings greater than 99.99 M omega, were demineralized to an electrical resistance of 1 to 4 M omega. The teeth were divided into three groups. The change in electrical resistance was measured following a 15 cycle regimen of treatment, demineralization and salivary soaking. Treatments were five-minute exposures to either a 1:2 slurry in saliva of Enamelon (E), a remineralizing fluoride-toothpaste also containing soluble calcium and phosphate ions, a 1:2 slurry in saliva of Crest (C), a conventional fluoride toothpaste (P), or to saliva alone. Demineralization was performed with a 30-minute exposure to 0.1 M lactic acid 50% saturated with calcium hydroxyapatite. The salivary soaking was 1 hour in duration. The mean electrical resistance of the E, C and the saliva treated sites was 63.9 +/- 4.3, 37.6 +/- 9.5 and 2.1 +/- 0.7 M omega, respectively. The final resistance was statistically different for each group (p < 0.05). A pilot clinical study was then conducted to assess the electrical resistance technology in vivo. Eighteen adult subjects with at least one site of early enamel caries with an electrical resistance between 1.0 M omega and 20.00 M omega were randomly assigned to either Enamelon, Crest, or a non-fluoride placebo toothpaste and asked to brush twice daily. After three months, the mean resistance of the test sites was 23.57 M omega for E, 9.61 M omega for C and 13.24 M omega for P. However, the mean resistance changes did not proceed consistently over time. At the end of the study, the electrical resistance measurements on four sites out of twelve in Group E were suggestive of remineralization, whereas measurements on one site out of ten were suggestive of remineralization in Group C and two or three sites out of twelve were suggestive of remineralization in Group P. Progression of demineralization was possibly indicated in only one site, which was in Group C. There were insufficient subjects for statistical significance in the pilot clinical study. There were apparent problems with the variability of some measurements between visits in the in vivo study. Overall, however, the results of both studies indicate that with modifications to the equipment, electrical resistance measurements may be a means of comparing the remineralization performance of toothpastes.

Adult↗

Remineralization across the resin-dentin interface: in vivo evaluation with nanoindentation measurements, EDS, and SEM.

OBJECTIVE: The purpose of this study was to evaluate the in vivo remineralization of the possible non-resin infiltrated hybridoid layer between the hybrid layer and the subjacent dentin substrate using nanoindentation, energy dispersive x-ray spectroscopy microanalyses (EDS), and scanning electron microscopy (SEM) technologies. METHOD AND MATERIALS: Twenty Class V cavities were placed in healthy adult monkey teeth. Each cavity was total etched with 37% phosphoric acid for 60 seconds, rinsed, and air dispersed, and SA-Primer was applied to the collagen layer. Cavities were divided into two groups: In group 1, Protect Liner (low-viscosity resin) and Clearfil AP-X (resin composite) were placed per manufacturer's directions, and no bonding agent was placed on the acid-etched interface. In group 2, Clearfil Photobond (bonding agent) was applied, and Protect Liner and Clearfil AP-X were placed as in group 1. Teeth were observed at 7 days (control) and 6 months by nanoindentation, EDS, and SEM. RESULTS: Six-month data showed an increased nanohardness in areas 5 pm adjacent to the demineralized or partially demineralized dentin interface. Following treatment with a conventional adhesive system on the acid-etched interface (group 2), there were increased nanohardness and calcium EDS measurements in the substrate just below the resin-dentin impregnated layer. CONCLUSION: Our 6-month in vivo nanoindentation and EDS data demonstrate that the non-resin infiltrated zone becomes remineralized following adhesive resin treatment.

Acid Etching, Dental↗

The effect of an experimental mouthrinse on enamel lesion remineralization in vitro.

This paper describes the effect of a 2 ppm fluoride containing, slightly acidic mouthrinse (pH = 6) on the remineralization of enamel lesions in vitro. The rinse was applied twice daily for 2 min, on about 85 microns in depth artificial lesions. Artificial enamel lesions were formed at pH = 5 in a 6% CMC gel. The lesions were subsequently remineralized in vitro in a neutral remineralizing solution (1.5 mM Ca and 0.9 mM phosphate) with or without the application of the rinse. After 3 weeks the samples were evaluated by means of quantitative microradiography. The results showed that a statistically significant reduction in lesion depth occurred of 48 and 29% with or without rinse application, with respect to the original lesion depth. The effect of the rinse compared with no rinse decreased the lesion depth by 40%. The data indicate that application of a slightly acidic rinse with 2 ppm fluoride applied twice a day, stimulates the remineralization at the lesion front and does not lead to blocking of enamel pores observed after acidic, high level F applications (APF).

Animals↗

Effect of acid-etching on fluoride-treated caries-like lesions of enamel: a SEM study.

Etching patterns by 20 percent phosphoric acid on caries-like lesions of enamel (white spot) untreated and treated with 0.4 APF were studied at 30, 60, 120 seconds of etch-times using the Scanning Electron Microscope (SEM). The surface topography of acid-etched teeth varied according to the etch time. Acid etching of caries-like lesions treated with fluoride showed etching patterns similar to sound enamel. Based on Silverstone's classification, thirty seconds etch-time produced type III pattern of surface morphology, while type I and type II were observed with 60 and 120 seconds of etch time. Fluoride treated lesions showed increased porosity and in addition to a surface coating of numerous small globules of calcium fluoride. Low level of topical fluoride before sealant application should be beneficial, since this allows a more rapid rate and increased degree of remineralization and possible arrest in the progress of caries lesions.

Acid Etching, Dental↗

Acid resistance of human enamel in vitro after bicarbonate application during remineralization.

OBJECTIVES: The aim of this study was to investigate the acid resistance of subsurface enamel lesions remineralized with bicarbonate solutions during remineralization. METHODS: Two experiments were carried out. In experiment 1, mineral uptake and acid resistance of remineralized enamel lesions were analyzed quantitatively by microradiography for mineral changes. Bicarbonate solutions of 0.5, 5.0 and 50.0 mM were used. In experiment 2, to clarify acid resistance mechanisms, the pH changes in demineralizing solutions on the remineralized enamel surfaces were measured continuously. Only a bicarbonate solution of 5.0 mM was used. RESULTS: In experiment 1, the bicarbonate-treated groups were more acid resistant than the non-treated groups (p<0.05). However, no statistically significant difference was observed among the different concentrations of bicarbonate. In experiment 2, the pH rise of the bicarbonate group was greater than the other groups. CONCLUSION: It was found that bicarbonate-treated enamel lesions were resistant to acid. It would suggest that bicarbonate ions applied during remineralization may have penetrated into the subsurface lesions. These ions may have worked as buffer agents against the acid challenge and inhibited the decrease in pH.

Acids↗

In situ remineralization of enamel lesions using continuous versus intermittent fluoride application.

Remineralization of early enamel lesions was studied in situ using a F chewing gum or a F-releasing device (FRD). Enamel specimens with subsurface lesions were mounted in removable lower appliances in 6 adults. A F-free dentifrice was used for all regimens. Test groups chewed five sticks/day (0.1 mg F/stick), or one FRD (0.5 mg F/day) was mounted in the midline of the appliance. The microhardness was measured after the 21-day intraoral exposure, and in vitro acid resistance testing was performed. Separate specimens were used to measure F content or changes in mineral density. Comparable values for both F gum and FRDs were higher (p > 0.05) than controls for acid resistance testing and percent remineralization. The F content for FRDs exceeded that of both F gum and controls.

Adult↗

[Use of biopolymer membrane diplen-F in treatment of initial enamel carious lesion on smooth surfaces].

The aim of the study was to evaluate the possibility of using a fluoride product included in a biodegradable membrane in remineralization of initial enamel carious lesions. The membrane has anti-bacterial, anti-inflammatory and remineralization properties, with a long-term effect. The efficiency of this treatment was assessed by measuring the surface of the demineralization area and its depth. The results proved that the use of this membrane in association with remineralization therapy of the initial enamel carious lesions increase the chances of success and represents a simple solution easily accepted by the patients.

Administration, Topical↗

In vivo remineralization by a monofluorophosphate dentifrice as determined with a thin-section sandwich method.

Artificial caries lesions were formed in thin sections of subsurface enamel sandwiched between protective sheets of plastic. Six lesions were placed into the buccal surfaces of lower partial dentures of seven subjects, covered with a stainless steel mesh to provide a plaque cover, and brushed with either a sodium monofluorophosphate or placebo dentifrice for four weeks, by means of a double-blind random cross-over design. Analysis of the lesions by quantitative microradiography revealed that significant remineralization (21%) occurred in the monofluorophosphate group and significant further demineralization (27%) in the placebo group. The difference between the active and placebo treatments was significant (p = 0.02), showing that the monofluorophosphate was effective not only in preventing lesion progression but also in promoting mineral deposition. The simultaneous presence of remineralized lesions and lesions with increased demineralization showed the non-uniformity of conditions within a mouth.

Absorptiometry, Photon↗

Intra-oral models for studying de- and remineralization in man: methodology and measurement.

A wide range of different methodologies and measurement techniques has been employed in laboratories around the world for the study of de- and remineralization of enamel and dentin in intra-oral systems. These different approaches are summarized and discussed in relation to the nature of the different research questions to be studied by means of the intra-oral model.

Animals↗

Interactions of fluoride and non-fluoride agents with the caries process.

Fundamental to the caries process and its inhibition is an understanding of the composition and structural relationships of dental mineral. These have received greater study in recent years, leading to a better understanding of the processes involved. Fluoride has been the most successful of the anti-caries agents to date, and many studies have concentrated on this ion. The anti-caries action of fluoride has been only partially explained by the early finding that fluoride-treated mineral was less soluble, and this criterion is now less widely accepted. The dissolutive process of caries is inhibited by fluoride, monofluorophosphate, trimetaphosphate, and zinc. However, only the first three of these show anti-caries activity. The presence of fluoride during in vivo and in vitro caries is conducive to the formation of an apparently intact surface zone. Current evidence is that this zone reforms during the caries process, thus acquiring fluoride and having larger crystallites compared with sound enamel. Trimetaphosphate also favors the formation of a surface zone. There is a clear beneficial involvement of fluoride, even at low levels, in the process of lesion remineralization. It is highly probable that this process results from re-growth of residual enamel crystallites rather than de novo precipitation of calcium phosphates. Levels of fluoride found in saliva can interact with dental mineral. Although zinc has been shown to adsorb upon apatite mineral and to restrict subsequent crystal growth, it does not appear to affect the action of fluoride, including remineralization, adversely. This may be due to the fact that the uptake of zinc is reversible.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

[Progression and stagnation of caries].

When carious lesions are forming, it is possible that they progress rapidly, but slow progress up to complete stagnation also may occur. Which mode of development prevails depends on the demineralization potential in the oral cavity, but also on remineralizing factors. Infrequent sugar pulses and careful plaque removal diminish the cariogenic forces; stagnation of lesion formation and preservation of integrity are favoured by ample salivary secretions, high mineral content of the diet and lifelong frequent availability of small amounts of fluoride.

Dental Caries↗

Root caries histopathology and chemistry.

This paper reviews the histopathology of root surface caries, and the effect of fluoride on the root caries process. The root caries process may be defined as a dynamic equilibrium similar to enamel caries. The caries process produced acid demineralization in exposed root surfaces and resulted in a lesion body when viewed in the light microscope. A relatively intact surface layer was not always present unless root caries was observed. In the absence of fluoride, a significant surface layer was left devoid of mineral but with intact collagen. Fluoride helped to prevent lesion formation and produced radiodense banding within the lesions in in vitro models. Remineralization occurred on the remaining mineral and not on the collagen matrix devoid of mineral. The conversion of active to inactive root caries requires the formation of a mineralized layer and implies the loss of surface tissues and contour in the clinical situation.

Animals↗