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PubMed2003

Minimally invasive dentistry.

BACKGROUND: During the past few decades, scientific developments in cariology, dental materials and diagnostic systems have changed dentistry's approach to diagnosis and management of dental caries. The authors summarize these developments. OVERVIEW: Dental adhesives and restorative materials, new understanding of the caries process and remineralization, and changes in caries prevlance have catalyzed the evolution in caries management from G.V. Black's "extension for prevention" to "minimally invasive." The authors describe the scientific basis for early diagnosis; a modified classification of caries based on site and size of lesion remineralization; reduction of cariogenic bacteria; and minimally invasive cavity preparation design, techniques and material selection. CONCLUSIONS AND PRACTICE IMPLICATIONS: Minimally invasive dentistry is based on advances in science. Emerging technologies will facilitate evolution to primary prevention of caries, though technical, cultural and economic obstacles to full implementation in clinical practice now exist.

Air Abrasion, Dental↗

PubMed1998

Remineralizing efficacy of a mineral enriched mouth rinse and fluoridated dentifrice on artificial carious lesions: an in vivo scanning electron microscopic study.

This comparative investigation was carried out to evaluate the remineralization potential on early artificial carious lesions under Scanning Electron Microscope (SEM) of a Mineral enriched mouthrinse and a fluoridated dentifrice using an in-vivo intra-oral removable appliance model. This findings revealed that the remineralization was found to have occurred in almost all the samples (in children) using non-fluoridated, fluoridated dentifrices as well as those using mineral enriched mouthrinse. However the qualitative analysis of the remineralization revealed that in case of non-fluoridated dentifrice group, the prismatic holes showed deposition of granular, variable sized particles with uneven distribution, while in fluoridated dentifrice group, deposits were found to have partially but more densely filled up the prism cores. In case of mineral enriched mouthrinse group these deposits were found to be in the form of amorphous globular precipitate.

Adolescent↗

PubMed2001

Emerging methods used in the prevention and repair of carious tissues.

A systematic review was undertaken to investigate four emerging methodologies that might be used in the prevention of caries and/or repair of carious tissues. These included a partitioned dentifrice, laser technology, fluoride-releasing dental materials, and for deep carious lesions, bone morphogenic protein (BMP) therapy. The search strategy was to review articles written in English, indexed in MEDLINE and EMBASE databases and published since 1976. Over two hundred articles were read but because of the inclusion and exclusion criteria, only thirty-three were included in the evidence tables. The review of partitioned toothpaste showed either a greater remineralizing effect or a greater increase in the resistance to demineralization of both enamel and dentin, with the exception of its lack of effectiveness on coronal caries in the only clinical trial. Five of the six in vitro studies on enamel and the one study on dentin reported that lased tissue was less soluble than nonlased. Six clinical and four in situ studies were reviewed in answering the question as to whether fluoride-releasing restorative materials increase the remineralization or resistance to demineralization of human enamel and dentin. Eight of these reported positive findings. Six animal studies investigating BMP were reviewed, and all showed the ability of BMP to induce tubular dentin formation. Although the laboratory, animal, and limited clinical trials report encouraging results, independent, randomized, controlled clinical trials need to be carried out before these emerging technologies can be recommended for use in general practice.

Animals↗

PubMed1992

The in vitro effect of glass-ionomer cement restoration on enamel subjected to a demineralization and remineralization model.

The purpose of this in vitro study was to evaluate differences in initiation and progression of carieslike lesions around restorations in enamel. A demineralization/remineralization cycling model was used to induce experimental secondary caries around cavities restored with glass-ionomer cement or composite resin. The effects of these materials were compared by microhardness profiles. The results indicated that glass-ionomer cement showed potential value as a restorative material for the prevention or reversal of caries in enamel adjacent to restorations, even in situations of high cariogenic challenge.

Bicuspid↗

PubMed1998

A longitudinal laser fluorescence study of white spot lesions in orthodontic patients.

Orthodontic treatment with fixed appliances increases the caries risk in young persons. The aim of this study was to apply a new caries diagnostic method, quantitative laser fluorescence, for longitudinal in vivo quantification of changes in incipient enamel lesions related to fixed orthodontic appliances. Seven young patients with active caries lesions disclosed at removal of the orthodontic brackets and bands were enrolled in the study. Caries preventive measures were intensified, including dietary advice, oral hygiene instructions, and the regular use of a fluoride dentifrice. The caries lesions were monitored with the quantitative laser fluorescence method after removal of the brackets and once a month thereafter. For each lesion, three quantities were measured: lesion area (mm2), mean fluorescence loss (%) over the lesion, and maximum loss of fluorescence (%) in the lesion. During a 1-year follow-up period, the areas of the lesions decreased and the enamel fluorescence lost was partly regained indicating that a remineralization process had occurred. It was concluded that quantitative laser fluorescence seems suitable for in vivo monitoring of mineral changes in incipient enamel lesions, and useful for the evaluation of preventive measures in caries prone persons, such as orthodontic patients.

Adolescent↗

PubMed1985

Influence of repeated APF applications on long-term remineralization of initial lesions in bovine enamel.

Initial lesions in bovine enamel were remineralized in vitro for periods lasting from one hour to two weeks; in some cases, remineralization was interrupted daily for a ten-minute APF application. After two weeks, surface coatings appeared on APF-treated specimens; SEM and TEM observations, including selected area and micro-electron diffraction, indicated both a layered structure within these coatings, and the predominance of calcium fluoride single crystals, ranging from 0.1 to 1.0 micrometer in size. Using double (45 Ca and 32 P) labeled remineralizing solutions, we obtained depth profiles of deposited labeled calcium and phosphate; these indicated that repeated APF applications prevented inward penetration of calcium and phosphate and limited the deposition of these ions to an outer surface region corresponding to the surface coating. These phenomena are explained in terms of the composition and apparent reactivity of the coating.

Acidulated Phosphate Fluoride↗

PubMed1995

[The cariostatic mechanisms of action of fluorides. A review].

In the past the inhibition of caries by fluorides was ascribed to the reduced solubility of enamel due to the incorporation of F- into the enamel mineral. During the last years the understanding of the cariostatic mechanism has changed fundamentally. Based on these new findings the loosely bound fluorides, which are present in the surroundings of the teeth after application of topicals, are regarded as decisive for the caries preventing effect by causing an inhibition of demineralization, enhancing the remineralization process and supporting the precipitation of CaF2. The formation of CaF2 is induced after application of topicals, and the material stays relatively stable in the mouth, due to adsorbed HPO4(2-) ions at the surface of CaF2. During the cariogenic challenge, CaF2 releases F- ions due to the reduced concentration of HPO4(2-) ions at acidic pH values. The CaF2 therefore functions as a pH-controlled F(-)-reservoir and is the most important supplier of free F- ions during the cariogenic challenge.

Dental Enamel↗

PubMed1995

Lipoteichoic acid inhibits remineralization of artificial subsurface lesions and surface-softened enamel.

Dental plaque produces not only acids by which underlying enamel is demineralized but also compounds which may inhibit repair of the lesions. The aim of this study was to determine how lipoteichoic acid, a bacterial compound that is abundant in dental plaque and inhibits calcium phosphate precipitation in vitro, affects the remineralization of incipient enamel lesions. Subsurface and surface-softened lesions were made in thin sections of bovine enamel, incubated with various amounts of lipoteichoic acid (isolated from Lactobacillus casei), and remineralized in 1.5 mmol/L CaCl2, 0.9 mmol/L KH2PO4, 130 mmol/L KCl, and 20 mmol/L Hepes, pH 7.0. Remineralization was followed during several weeks by repeated microradiography of the sections, and characterized by the changes in the integrated mineral loss of the lesions and the differential mineral profiles. The results showed that: (1) the effects of lipoteichoic acid on lesion remineralization were dose-dependent; (2) in subsurface lesions only the highest dose of lipoteichoic acid affected remineralization, which was delayed throughout the lesions; and (3) in surface-softened enamel, lipoteichoic acid did not affect the remineralization of the deeper parts, but remineralization of a surface zone of from 25 to 30 microns was increasingly inhibited with increasing doses. These effects were explained by different permeabilities of the surfaces of both types of lesions for the inhibitor: In subsurface lesions, lipoteichoic acid may have mainly clogged the porosities in the surface layer, whereas it could penetrate substantially into surface-softened enamel.

Animals↗

PubMed2002

Analysis of pulpal reactions to restorative procedures, materials, pulp capping, and future therapies.

Every year, despite the effectiveness of preventive dentistry and dental health care, 290 million fillings are placed each year in the United States; two-thirds of these involve the replacement of failed restorations. Improvements in the success of restorative treatments may be possible if caries management strategies, selection of restorative materials, and their proper use to avoid post-operative complications were investigated from a biological perspective. Consequently, this review will examine pulp injury and healing reactions to different restorative variables. The application of tissue engineering approaches to restorative dentistry will require the transplantation, replacement, or regeneration of cells, and/or stimulation of mineralized tissue formation. This might solve major dental problems, by remineralizing caries lesions, vaccinating against caries and oral diseases, and restoring injured or replacing lost teeth. However, until these therapies can be introduced clinically, the avoidance of post-operative complications with conventional therapies requires attention to numerous aspects of treatment highlighted in this review.

Bacterial Vaccines↗

PubMed1997

The role of diet, fluoride and saliva in caries prevention.

Saliva is rich in calcium and phosphates, facilitating remineralization of early carious lesions. There is evidence that remineralization is associated with an increase in the size of enamel crystals and a consequent increase in resistance to caries. The contribution of sucrose to the implantation, colonization and metabolic activities of cariogenic bacteria has been clearly established, and has led to the search for sucrose substitutes. Recent report from Australia and the United States of America have reconfirmed the safety and efficacy of fluoride in preventing dental caries. The use of fluoride in various forms thus remains the cornerstone of most caries prevention programme.

Cariostatic Agents↗

PubMed1994

Mode of action of fluoride: application of new techniques and test methods to the examination of the mechanism of action of topical fluoride.

Modern techniques in dental research continue to assist in the study of the mode of (anticaries) action of topical fluorides. The Plaque Glycolysis and Regrowth Model (PGRM) facilitates the standardized assessments of antimicrobial effects on plaque following use of test formulations in vivo without complications arising from coincident mineral reactivity. In vivo plaque glycolysis testing demonstrates that topically applied fluoride, at conventional levels found in dentifrices, has only modest effects on the metabolic (acid-producing) activity of dental plaque. Any 'plaque' contribution to fluoride efficacy must come from more subtle effects on plaque acidogenicity than those measured in PGRM. The 19-FMAS NMR (Magic Angle Spinning Nuclear Magnetic Resonance) technique provides unambiguous measures of the reaction products of F-enamel interactions. Studies have revealed a new 'reaction product' of fluoride-enamel interactions--designated as Non-Specifically-Adsorbed Fluoride, NSAF. This species, along with FAP (fluoroapatite), FHAP (fluorohydroxyapatite), and CaF2 (calcium fluoride), contributes to the remineralization/demineralization benefits of fluoride. pH cycling and in situ denture chip studies permit quantitative assessments to be made of the relative benefits of fluoride in promoting remineralization and in inhibiting demineralization. Results from pH cycling/in situ experiments are strongly supportive of Koulourides' 'Acquired Acid Resistance' concept, describing fluoride's decay-preventive effects. The continued application of new analytical/physical techniques and testing regimens to the study of fluoride anticaries mechanisms may lead to the development of improved fluoride agents/treatment modalities for the prevention of dental caries.

Analysis of Variance↗

PubMed2004

Remineralization potential of a new toothpaste formulation: an in vitro study.

The aim of the present study was to determine the ability of a dentifrice containing a mixture of ion-exchange resins (named NMTD), which supplies calcium, fluoride, phosphate, and zinc ions, to promote remineralization and/or inhibit demineralization of dental human enamel in a pH cycling model in vitro. A fluoride toothpaste was used as the control. The enamel specimens were tested for microhardness before and after 10 days and 16 days of the demineralizing and remineralizing treatments. The results of this study showed both dentifrices were effective in limiting in vitro enamel demineralization although the effects were not significantly different from each other. Inclusion of calcium and phosphate ion-exchange resins in the dentifrice containing a fluoride ion-exchange resin maintained a similar net outcome of the conventional dentifrice in the demineralization/remineralization process under the experimental conditions employed.

Analysis of Variance↗

PubMed2006

Minimal intervention dentistry: part 1. Strategies for addressing the new caries challenge in older patients.

The aging of the population combined with increased retention of natural teeth into old age means that clinicians now face a new caries challenge in older dentate patients. An increase in the onset of dental caries is evident among patients who may not have had high levels of caries in the past and who may have undergone extensive restorative procedures during their lifetimes. Minimal intervention dentistry (MID), a modern evidence-based approach to caries management in dentate patients, uses the medical model, whereby disease is controlled by the "oral physician" and an affiliated dental team. The main components of a geriatric approach to MID are assessment of the risk of disease, with a focus on early detection and prevention; external and internal remineralization; use of a range of restorations, dental materials and equipment; and surgical intervention only when required and only after disease has been controlled. This first in a series of 2 articles describes and illustrates oral disease management in geriatric MID, which involves the assessment and management of a diverse range of primary and modifying factors, integrated with an evaluation of the plaque-biofilm interface and the resultant dynamic oral disease process.

Aged↗

PubMedDate not supplied

The role of fluoride mouthrinses in the control of dental caries: a brief review.

Fluoride mouthrinses have generally proved to be effective in controlling caries in clinical studies. Caries reductions in North American studies have averaged about 30%. Large-scale school-based mouthrinse programs conducted during the 1970s, however, used historical controls at a time when caries rates were now known to be declining. Post-hoc analysis of the absolute (not relative) caries reductions in these studies showed that school-based fluoride mouthrinse programs were of questionable benefit from a cost standpoint. Fluoride mouthrinses have been shown to reduce demineralization and enhance remineralization of enamel adjacent to orthodontic bands and brackets. Benefits in adults have been less well documented. Use of fluoride mouthrinses by young children is discouraged until they have mastery of their swallowing reflexes. This paper recommends the use of fluoride mouthrinses for patients at increased or high risk for dental caries, but cautions that school-based programs be undertaken only in communities with a high population caries rate.

Adult↗

PubMed1990

[Studies on the remineralization of enamel using radioisotopes].

Enamel of human and bovine teeth was found to show sorption of free calcium ions after damage caused by short-term exposure to diluted hydrochloric acid or mechanical damage. The experiment was carried out using radioisotopes 32P and 45Ca and it was shown that majority of incorporated ions remained in the enamel after prolonged washing out with water as well as after brushing with toothpaste. A considerable stability of binding of the incorporated phosphate ions was noted in the damaged enamel after exposure to calcium salt solution, and marked stability of binding of the incorporated calcium ions after exposure to phosphate solution.

Animals↗

PubMed2004

[Effect of tea polyphenol on the demineralization and remineralization of enamel in vitro].

OBJECTIVE: To investigate the effect of tea polyphenol (TP) on the mineralization behaviour of enamel in two sterile, in vitro systems. METHODS: In the demineralization study, sound enamel sections were pH-cycled. Treatments were 2000 mg/L TP, 200 mg/L TP, 2000 mg/L TP + 100 mg/L fluoride, 100 mg/L fluoride, and deionized water. In the remineralization study, surface-softened enamel was used and pH-cycled as above. Test treatments were 2000 mg/L TP, 2000 mg/L TP + 250 mg/L fluoride, 250 mg/L fluoride, and deionized water. The acidic buffers were retained for calcium analysis. The enamel was analysed before and after pH-cycling by microhardness. RESULTS: In the demineralization study, the calcium depletion rates(CDR) were (0.43 +/- 0.05), (0.49 +/- 0.006), (0.21 +/- 0.02), (0.21 +/- 0.03) and (0.50 +/- 0.11) microgram/(mm2.h) respectively. The Knoop hardness values(KHV) percent reduction were 94.19 +/- 3.50, 96.62 +/- 0.63, 74.74 +/- 4.09, 77.79 +/- 3.11 and 97.32 +/- 4.03 respectively. There were no significant differences within either the TP-only groups or the fluoride groups, but the fluoride groups were significantly more efficacious than the TP-only groups (P < 0.05). In the remineralization study, the KHV percent increase were -11.96 +/- 10.1, -21.32 +/- 11.3, -49.52 +/- 24.6 and -4.24 +/- 8.51 respectively. Notably more remineralization was observed in the fluoride group. There were no significant differences between the other groups (P > 0.05). CONCLUSION: The data of this in vitro study suggest that TP has no effect on de/remineralization of enamel blocks and there is no synergetic action of TP and fluoride in a sterile system. This finding supports the proposition that tea polyphenols exert an anti-caries effect via an anti-microbial mode-of-action.

Animals↗

PubMed2006

Minimal intervention dentistry: part 2. Strategies for addressing restorative challenges in older patients.

Minimal intervention dentistry (MID), a modern, evidence-based approach to caries management in dentate patients, uses a medical model whereby disease is controlled by the "oral physician" and an affiliated dental team. Geriatric MID helps clinicians to address the ever-increasing restorative challenges presented by older patients, including erosion, abrasion, demineralization, rampant coronal and root caries, retained roots, recurrent caries (necessitating crowns and other repairs), subgingival caries, "wet" oral environments, salivary dysfunction, disruptive behaviours, poor compliance with preventive care, high plaque levels, and financial and other restrictions on care options. The main components of a geriatric approach to MID are assessment of the risk of disease, with a focus on early detection and prevention; external and internal remineralization; use of a range of restorations, dental materials, and equipment; and surgical intervention only when required and only after disease has been controlled. This second in a series of 2 articles describes direct restorative strategies to address the challenges of geriatric caries management, including choice of material, placement of glass ionomers, sandwich technique, techniques for the management of erosion and abrasion, tunnel and slot preparations, techniques for "wet" subgingival environments, vital pulp therapy and geriatric atraumatic restorative technique.

Aged↗

PubMed1994

The use of milk as a saliva substitute.

Xerostomia, a clinical manifestation of salivary gland dysfunction, affects many people. These individuals frequently sip liquids to alleviate the discomforts associated with hyposalivation. Milk appears to have many of the chemical and physical properties of a good saliva substitute. Besides the obvious benefit of providing moisture and lubrication for the dehydrated mucosa, milk buffers oral acids, reduces enamel solubility, and contributes to enamel remineralization. These anticariogenic factors are generally attributed to the high calcium and phosphate content along with the milk phosphoproteins that strongly adsorb to enamel. Patients with xerostomia frequently have difficulty in obtaining proper nutrition due to problems associated with lubricating, masticating, tasting, and swallowing food. Milk is a food with high nutritional quality that would certainly benefit most patients with xerostomia. Because of the nutritional, anticariogenic, and moisturizing properties of milk, patients with xerostomia may find milk of value as a saliva substitute to help reduce the oral health problems associated with hyposalivation.

Animals↗