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PubMed2001

Clinical decision-making for caries management in root surfaces.

This report presents the results of an evidence-based approach to obtaining the best available information on the natural history, prevalence, incidence, diagnosis, and treatment of root caries. Searches of electronic databases produced 807 references; from these and from citations in the selected articles, a final 161 references were used. We found that the information on the natural history of the disease does not provide practitioners with probabilities of, or time estimates for, progression of the disease through stages. For patients aged thirty and older, the prevalence of root caries is roughly 20 to 22 percent less than a person's age. Severity reaches over one lesion by age fifty, two lesions by age seventy, and just over three lesions for those seventy-five and older. About 8 percent (odds of 1:11) of the population would be expected to acquire one or more new root caries lesions in one year. The accuracy of current systems of diagnosis is unknown, although color has been shown to have little validity. Using the criteria of "softness" to define active lesions has been validated by the presence of microbes in the lesion. One strong study and other studies with weaker design or shorter duration add consistent support for the use of fluorides in the remineralization of root caries. Every three-month application of chlorhexidine varnish was shown to be efficacious in one arm of one study. Evidence for restoration of root caries is tentative since the studies were of limited design and duration.

Adult↗

PubMed1999

An in situ caries model to study demineralisation during fixed orthodontics.

OBJECTIVES: To investigate de/remineralization of enamel during the early stages of orthodontic treatment using the in situ caries model. DESIGN: A prospective, longitudinal study, using the in situ caries model. SETTING AND SAMPLE POPULATION: The Department of Orthodontics at the University of Liverpool School of Dentistry. Fifteen orthodontic patients undergoing fixed appliance treatment with extraction of premolar teeth. EXPERIMENTAL VARIABLE: Two enamel samples with pre-formed caries-like lesions were placed bilaterally, in specially constructed holders, on an orthodontic fixed appliance. One sample was bonded with a small bracket base. OUTCOME MEASURE: The parameters of the pre-formed carious lesion, expressed as mineral loss (delta Z), lesion depth (ld), lesion width (lw) and ratio (delta Z/ld) were compared between the bracketed, the non-bracketed and a control sample that had not been placed in the mouth. The difference between brackets place on the dominant (toothbrush hand) side and non-dominant side were also investigated. The correlation between mineral loss and length of time the sample was in the mouth was also analysed. RESULTS: There was considerable individual variation; however, a one-factor repeated analysis of variance showed a significant difference in ratio values between the three groups (p = 0.006). A pairwise comparison showed a significant reduction in ratio value for the non-bracketed sample compared with the control, but not the bracketed sample. There was no significant difference in mineral loss between the dominant and non-dominant sides. There was no linear correlation between the length of time the sample was in the mouth. CONCLUSION: An enamel sample with a pre-formed carious lesion, when placed in the mouth of an orthodontic patient, showed reduced remineralization in the presence of a simulated orthodontic bracket. Consistently effective preventive regimes to prevent demineralization in patients with fixed orthodontic appliances need to be developed. The technique described will be a valuable tool in this process.

Analysis of Variance↗

PubMed1989

Evaluation of the anticaries benefit of fluoride toothpastes using an enamel insert model.

The remineralization potential of fluoride toothpastes was studied using an in situ enamel insert model. Matched blocks of artificially demineralized human enamel were attached to partial dentures of 16 adult volunteers who brushed their teeth with either a toothpaste containing 1,500 ppm F or one containing 2,500 ppm F for a period of 6 weeks in a balanced, randomized crossover experiment. Computerized image analysis of microradiographs was used to measure the mineral density distribution in the enamel before and after in situ treatment. Both toothpastes demonstrated remineralization of artificial carious lesions. Significantly more remineralization was observed in enamel samples treated with the toothpaste containing 2,500 ppm F compared to that containing 1500 ppm F. This result is consistent with the outcome of a recent caries clinical trial testing the same toothpastes and finding enhanced anticaries efficacy from the higher fluoride level.

Adult↗

PubMed1986

A theoretical study of in vivo lesion repair using a controlled-release device.

A theoretical model of lesion remineralization predicts that in vivo caries repair can be effected in a five-day period by means of a controlled- and sustained-release device containing calcium, phosphate, and fluoride. The calculations detail an 80% repair before the remineralization process stops. However, the fluoridated hydroxyapatite formed is calculated to be about 20% more resistant to future attack than is hydroxyapatite, making effective repair complete. Optimal flux (W) conditions for repair of 100 microns lesions are WCa = 1.0 X 10(-6) kg/m2s, stoichiometric phosphate, and WF = 2.0 X 10(-9) kg/m2s.

Adsorption↗

PubMed2004

The remineralizing effect of an essential oil fluoride mouthrinse in an intraoral caries test.

BACKGROUND: The authors conducted a two-week clinical study to determine the remineralizing effect of an experimental mouthrinse containing both fluoride and essential oils in an intraoral caries test model. METHODS: The study used an observer-blinded, randomized, controlled, 3 x 3 crossover design. The authors enrolled in the study 153 subjects, each of whom had a mandibular removable partial denture. Two partially demineralized human enamel specimens were mounted on each subject's removable partial denture. Subjects used either a fluoride mouthrinse with essential oils (the test mouthrinse), a fluoride nonessential oils mouthrinse (the positive control) or an essential oil nonfluoride mouthrinse (the negative control) twice daily for 14 days. The researchers assessed specimens for mineral content change and fluoride uptake using surface microhardness, or SMH, testing and enamel fluoride analysis, respectively. RESULTS: Of the 153 subjects enrolled in the study, 125 subjects were evaluable at the study endpoint. The results after two weeks showed that percentage of SMH recovery was 42 percent in the test group, 36 percent in the positive control group and 16 percent in the negative control group. The fluoride uptake was 19 micrograms per square centimeter, 16 microg/cm2 and 3 microg/cm2 for the test mouthrinse, positive control and negative control groups, respectively. In terms of both percentage of SMH and fluoride uptake, the test mouthrinse and positive control mouthrinse were statistically higher than the negative control mouthrinse, and the test mouthrinse was "at least as good as" the positive control mouthrinse. CONCLUSIONS: This study provides evidence that an essential oil mouthrinse with 100 parts per million fluoride is effective in promoting enamel remineralization and fluoride uptake. CLINICAL IMPLICATIONS: The combination of fluoride and essential oils in a mouthrinse may provide anticaries efficacy, in addition to essential oils' previously established antigingivitis efficacy.

Cariostatic Agents↗

PubMed1997

In vitro evaluation of topical fluorides for overdenture abutments.

STATEMENT OF PROBLEM: Topical fluorides are effective, yet none have been developed specifically for root or dentin surfaces. PURPOSE: This study evaluated the ability of several commercial topical fluorides to protect overdenture abutments from in vitro acid demineralization. MATERIAL AND METHODS: Twenty extracted teeth from persons aged 50 to 70 years were prepared for overdenture abutments. The teeth were sectioned to provide 40 buccal and lingual halves, covered with nail varnish except for windows on the occlusal and root surfaces, and randomly divided into 4 groups of 10 specimens, which were cycled for 6 hours in acid demineralization, washed, and then held 17 hours in a remineralizing solution for 18 days. Before each cycle, the specimens were treated with either Karigel, Karigel-N, or a NaF solution. The control group was treated with fluoride-free solution. RESULTS: The depth of the artificial lesions on the root surfaces showed a statistically significant dose response. On the occlusal, there were no differences in lesion depth between the various topical fluorides and the control group. But there was a dose response when the remineralized band was subtracted from the lesion depth. Remineralization bands in the occlusal lesions were not evident in the control group, but were present in the fluoride groups. CONCLUSION: This study suggests that higher concentrations of NaF are more protective for overdenture abutments.

Aged↗

PubMed1992

The effect of chewing gum use on in situ enamel lesion remineralization.

Two independent cross-over studies investigated the possibility of enhanced early enamel lesion remineralization with the use of chewing gum. The first study involved a sorbitol-containing chewing gum, and the second, which had an identical protocol, tested a sucrose-containing chewing gum. In each study, 12 volunteers wore in situ appliances on which were mounted enamel sections containing artificial caries lesions. Subjects brushed twice daily for two min with a 1100-ppm-F (NaF) dentifrice (control and test) and in the test phase chewed five sticks of gum per day for 20 min after meals and snacks. Microradiographs of the enamel lesions were made at baseline and at the end of the seven-week experimental period. In the sugar-free gum study, the weighted mean total mineral loss (delta z) difference [(wk7-wk0) x (-1)] was 788 vol.% min. x micron for the gum, corresponding to remineralization of 18.2%, vs. the control value of 526 vol.% min. x micron, 12.1% remineralization (p = 0.07). There were no significant differences for the surface-zone (p = 0.20) and lesion-body (p = 0.28) values. In the sucrose-containing gum study, the delta z difference was 743 vol.% min. x micron for the gum, corresponding to a remineralization of 18.3%, vs. the control value of 438 vol.% min. x micron, 10.8% remineralization (p = 0.08). The surface-zone values were not significantly different (p = 0.55). For the lesion body, however, the sucrose-containing gum value of 6.11 vol.% min. was significantly different (p = 0.01) from that of the control (2.81 vol.% min.).

Adult↗

PubMedDate not supplied

Effect of a calcium carbonate-based dentifrice on in situ enamel remineralization.

This crossover study evaluated the effect of calcium carbonate (CaCO(3))-based monofluorophosphate dentifrice on enamel remineralization. Ten volunteers wore palatal appliances containing four enamel blocks with caries-like lesions, two of them covered by a test plaque of mutans streptococci. The following treatments were evaluated: a negative control, a silica-based or a CaCO(3)-based dentifrice, and the percentage of enamel surface microhardness recovery was determined. The CaCO(3)-based dentifrice was more effective than the negative control on the enhancement of enamel remineralization, either in the presence or absence of test plaque. This efficacy was also shown by the silica-based dentifrice but only in the presence of test plaque.

Analysis of Variance↗

PubMedDate not supplied

[The effect of mineralizing solutions on the enamel status and on dental caries lesions].

The purpose of the study was to develop the optimal variant of using remineralizing solutions to improve dental enamel resistance; for this the efficacies of 10% Ca gluconate solution, 1% Na fluoride solution, and 3% remodent solution were examined. These solutions were found to promote a sooner 'maturation' of the enamel than is natural and to improve caries resistance of the enamel.

Calcium Gluconate↗

PubMed2001

What is the optimum fluoride concentration needed for the remineralization process?

In vitro experiments could demonstrate that only negligible amounts of fluoride are necessary to promote remineralization of incipient caries lesions. From the clinical point of view, there is evidence that only under certain circumstances is a stabilization of the surface zone of an incipient caries lesion the true mechanism of action of topically applied fluorides. However, an optimum universally valid fluoride concentration needed for this process cannot be defined.

Cariostatic Agents↗

PubMed1995

The effect of sucrose-containing chewing-gum use on in situ enamel lesion remineralization.

Two independent cross-over studies have now been carried out to evaluate the effect of a regime of chewing sucrose-containing gum on enamel lesion remineralization. The first study has been reported in detail elsewhere. This further study aimed to increase the data set with an additional 13 volunteers. Similar protocols were followed in both studies. Weighted averages from the two studies showed delta z values corresponding to 16.8% remineralization for the gum versus 11.6% remineralization for the control (p = 0.046, two-sided). A significant difference between test and control was evident for lesion body (p = 0.0004, two-sided) but not for surface zone (p = 0.32, two-sided).

Adult↗

PubMed1999

Fluoride mechanisms.

This article discusses fluoride mechanisms in relation to dental caries. The authors specifically address firmly bound versus loosely bound fluoride; different fluoride active ingredients; fluoride and demineralization and remineralization; fluoride slow-release devices and F-releasing dental materials; antimicrobial effects of fluoride; the uptake of fluoride by oral bacteria; inhibition of enolase, protein-intruding ATPase and sugar transport; the various aspects of plaque as it relates to fluoride; and the rational use of fluoride.

Anti-Bacterial Agents↗

PubMed1994

In situ models, physico-chemical aspects.

In situ (intra-oral) caries models are used for two purposes. First, they provide information about oral physiological processes. Such information helps to detail our knowledge of the oral ecosystem and to verify conclusions from in vitro experiments. Second, in situ models are utilized to test preventive agents in the phase between laboratory testing and clinical trials. Most investigations involving enamel inserts have been aimed at testing new dentifrices. The experimental designs of such studies usually do not allow one to draw conclusions on physico-chemical processes, e.g., because of single point measurements. Studies of model parameters (lesion type, lesion severity, and de/remineralization in time) constitute only a minority of the research reports. The most striking observation obtained with in situ models has been the significant differences in de/remineralization observed among individuals and, more importantly, within one individual during different time periods and between different sites in the same mouth (for review, see ten Cate et al., 1992). Regardless of this, some general findings can be inferred: During in situ demineralization, up to 62 vol% microns/day may be removed from enamel. For dentin specimens, this value may be as high as 89 vol% microns/day. For remineralization, during fluoride dentifrice treatment, a median deposition rate of 0.7%/day (for lesions with integrated mineral loss values between 2000 and 4000 vol% microns) is found. The rate of deposition seems to be correlated with the extent of the pre-formed lesion. This suggests that the number of sites (crystallite surface) available for calcium phosphate precipitation is an important parameter.(ABSTRACT TRUNCATED AT 250 WORDS)

Dental Caries↗

PubMed1990

Effect of two sodium fluoride dentifrices on fluoride uptake and remineralization in situ.

Two dentifrices containing 1100 ppm F from sodium fluoride in silica bases were compared to a placebo dentifrice in an in situ remineralization and fluoride uptake study. Fifteen subjects brushed artificially-formed caries lesions in 60 thin enamel sections and 30 enamel blocks with each dentifrice in a double-blind, randomized, cross-over study design. Analysis of the thin sections by quantitative microradiography before and after exposure to toothbrushing showed that the fluoride dentifrices produced 18.3% and 7.1% remineralization whereas use of the placebo resulted in 10.3% demineralization. The differences between all three dentifrices were statistically significant. Fluoride concentrations at the surface of the lesion increased from approximately 700 ppm F in untreated specimens to approximately 1800 ppm F in specimens treated with either of the two fluoride dentifrices. These data suggest that formulation differences may affect the anticaries activity of a dentifrice without being reflected by fluoride deposition.

Humans↗

PubMed1995

Role of models in assessing new agents for caries prevention--non-fluoride systems.

While fluoride is an effective anti-caries agent, the search for more effective alternative therapies continues. A wide range of non-fluoride anti-caries agents has been postulated, and this paper reviews some of the pre-clinical models that have been utilized in their evaluation and some of the pitfalls that must be avoided. Using data on the potential anti-caries efficacy of phosphopeptides obtained from casein, the caution that must be applied in extrapolating laboratory data to predict clinical performance is discussed. Evaluation strategies that focus on only one potential mode of action (e.g., inhibition of demineralization) may overestimate the true clinical efficacy which may arise from a combination of two or more effects (e.g., inhibition of demineralization and stimulation of remineralization). Although laboratory and in situ data predict anti-caries efficacy for sodium trimetaphosphate in combination with fluoride, this was not found in three-year clinical trials. A possible reason for this, the lack of suitable calibration methods, is discussed. Finally, some comments on the appropriateness of laboratory evaluation strategies are made.

Animals↗

PubMed2004

[The comparative study of the effect of silica and calcium carbonate based dentifrice on dentine abrasives in vitro].

PURPOSE: To evaluate the effect of Silica (SiO(2)) and Calcium Carbonate (CaCO(3)) based dentifrice on their dentine abrasives. METHODS: Microscope, environmental electron scanning electron microscope (SEM) and radioactive Dentine Abrasion (RDA) assay were used to quantitatively measure the wear of dentine. RESULTS: The mechanical brushing assay showed severe dentine abrasion with CaCO(3) based dentifrices. There were only minor scratches on the specimens brushed with SiO(2) dentifrices. Analysis of the thin section by SEM after exposure to dentifrices showed that NaF/SiO(2) produced significant remineralization whereas MFP/CaCO(3) system resulted in little remineralization. RDA values were 86.17 and 98.61 for SiO(2) based dentifrices and 222.85 and 253.84 for CaCO(3) based dentifrices, respectively. The morphology of the irregular shaped CaCO(3) with sharp points/edges further explained the brushing and RDA results. CONCLUSION: These results indicate that abrasive in dentifrice, e.g. CaCO(3), can cause severe abrasion of dentine in vitro.

Calcium Carbonate↗

PubMed2004

DIAGNOdent: an optical method for caries detection.

The onset of caries is characterized by demineralization of dental hard tissues. Optimal fluoridation with respective oral hygiene habits and diet may stop the progression of a lesion and even allow for its remineralization. The aim of modern dentistry must be a preventive approach rather than invasive repair of the disease. This is possible only with early detection and respective preventive measures. Some of today's diagnostic tools are not sensitive enough to detect this early onset of destruction. Tools based on fluorescence could have the possibility to overcome this problem. This overview will focus on today's knowledge of one possible tool, the DIAGNOdent.

Dental Caries↗

PubMed1995

Role of saliva in caries models.

The crucial role played by the actions of saliva in controlling the equilibrium between de- and remineralization in a cariogenic environment is demonstrated by the effects on caries incidence of salivary dysfunction and by the distribution of sites of caries predilection to those were salivary effects are restricted. However, of the several properties of saliva which may confer protective effects, it is not certain which are most important. A distinction can be made between static protective effects, which act continuously, and dynamic effects, which act during the time-course of the Stephan curve. Evidence implicates salivary buffering and sugar clearance as important dynamic effects of saliva to prevent demineralization; of these, the buffering of plaque acids may predominate. Enhanced remineralization of white spot lesions may also be regarded as dynamic protective effects of saliva. Fluoride in saliva (from dentifrices, ingesta, etc.) may promote remineralization and (especially fluoride in plaque) inhibit demineralization. The design of experiments using caries models must take into account the static and dynamic effects of saliva. Some models admit a full expression of these effects, while others may exclude them, restricting the range of investigations possible. The possibility is raised that protective effects of saliva and therapeutic agents may act cooperatively.

Animals↗