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PubMed2004

Dental erosion: possible approaches to prevention and control.

OBJECTIVES: To discuss the key elements for establishment of a preventive programme for dental erosion. DATA AND SOURCES: The data discussed are primarily based on published scientific studies and reviews from case reports, clinical trials, epidemiological, cohort, animal, in vitro and in vivo studies. References have been traced manually or by MEDLINE. STUDY SELECTION: The aetiology, pathogenesis and modifying factors of dental erosion were reviewed. Strategies to either prevent the occurrence or limit the damage of dental erosion or protect the remaining tooth tissues from further erosive destruction were reviewed and discussed. These includes: (A) measures to (1) enhance remineralisation and acid resistance of enamel surface softened by erosive challenge, (2) reduce the erosive potential of acidic products, (3) enhance salivary flow, (4) protect and restore erosively damaged tooth, and (5) provide mechanical protection against erosive challenge. (B) Health education geared towards (1) diminution of frequency of intake of dietary acids, and (2) change of habits and lifestyles that predispose teeth to erosion development. CONCLUSIONS: It may be easier to gain patients' compliance with the advice that immediately following an acidic challenge, a remineralising agent, such as fluoride mouthrinses, fluoride tablets, fluoride lozenges or dairy milk, should be administered to enhance rapid remineralisation of the softened tooth surface as well as serve as a mouth refresher, or an alternative, a neutralising solution should be used. Effective counselling on erosion preventive regimes should involve all healthcare personnel, dentists, doctors, pharmacist, nurses/hygienists and clinical psychologists.

Acids↗

PubMed2004

The use of in situ models and QLF for the study of coronal caries.

OBJECTIVES: The purpose of the paper is to review aspects of the systems available to model the caries process in enamel. METHODS: The in situ model developed in Liverpool, and the new method of quantifying mineral loss, Quantitative Light-induced Fluorescence (QLF), are described. QLF is a powerful new diagnostic tool which can be used to measure demineralisation and remineralisation in tooth surfaces in vivo; studies to optimise, validate and use QLF in different clinical situations are described. RESULTS: Examples of the use of in situ models show that they are particularly valuable for monitoring de and remineralisation of artificial lesions in relation to product testing as alternatives to clinical trials, and present significant advances over in vitro methods. Quantification of mineral loss by Transverse Microradiography (TMR) as in the traditional Liverpool model has produced much valuable information, but the destructive nature of the method limits experimental design, and removes the system from the clinical situation. As a possible alternative, QLF has been validated and optimised. Longitudinal measures can be made on the same surface, and examples of its use are for monitoring recurrent caries and demineralisation around orthodontic brackets. CONCLUSIONS: While current in situ models provide a major advance over earlier caries models, measurement of de and remineralisation by destructive methods such as transverse microradiography limits the design of experimental investigations. QLF offers significant time saving, reduces the cost of clinical studies, and because the measurements can be carried out longitudinally in vivo, can remove the need for intra-oral appliances carrying experimental tissues.

Dental Caries↗

PubMed2005

Development of an in situ root caries model B. In situ investigations.

OBJECTIVES: The aims of this pilot study were to assess the suitability of an in situ model for root caries studies, and to investigate the effect of sub-surface lesion mineral content and ultrastructural organisation on remineralisation. METHODS: Subjects were selected by criteria generally used for coronal caries models. Plaque pH responses and salivary flow rates were determined by standard methods. The chosen substrate was human dentine with artificially induced caries-like demineralisation and sterilised by gamma-irradiation (4100 Gy). Two levels of baseline demineralisation were induced by exposure to an acid buffer for 2 or 5 days. Mineral content was measured by computer-controlled quantitative microradiography. RESULTS: Remineralisation in situ was greater in smaller lesions with lower surface mineral content than in larger lesions in which the surface mineral content was high. CONCLUSIONS: The model is suitable for further development for investigating dentinal caries. More work is needed to validate the model by means of a fluoride dose-response study.

Adult↗

PubMed2005

Development of an in situ root caries model. A. In vitro investigations.

OBJECTIVES: The paper describes preliminary in vitro investigations, the objectives of which were to examine the influence of certain experimental parameters on artificial carious lesion formation in root hard tissues, and their remineralisation. These experiments formed part of a wider study that aimed to develop an in situ model of root caries, based on the existing coronal caries model used in Liverpool. The present studies examined the effects (a) of the anatomical origin of the dentine, the presence or absence of cementum, the exposure time and the type of demineralising system, on lesion development, and (b) of baseline lesion size on the extent and location of mineral re-precipitation. METHODS: Mineral content parameters in plano-parallel sections taken from dentine lesions were determined by computer-controlled transverse microradiography. RESULTS: The importance of the anatomical origin of the dentine on lesion formation was investigated by comparing in vitro lesion formation in premolar and molar dentine, and in dentine from apical, middle and coronal thirds of the root: no difference was observed between these sites. Lesions formed more rapidly in acid buffer solutions than in acid gel systems, and were more reliably produced when cementum was removed. The effect of baseline lesion size on subsequent in vitro remineralisation demonstrated that a small baseline mineral content was associated with a larger percentage mineral gain. The location of mineral deposition throughout the lesion was also influenced by baseline mineral content parameters. CONCLUSIONS: The results form a basis for the further development of an in situ dentinal caries model, providing data to suggest that manipulation of parameters involved in the preparation of artificial carious lesions has a significant effect on the behaviour of the lesion, particularly the phenomenon of remineralisation. Further work is needed to investigate the behaviour of the model in situ.

Bicuspid↗

PubMed2006

Pronamel and tooth mousse: an initial assessment of erosion prevention in vitro.

OBJECTIVES: The aim of this study was to examine whether a single topical application of proenamel or tooth mousse would prevent enamel erosion METHODS: Enamel samples were treated with either proenamel or tooth mousse applied for 15 min. The control group was placed in distilled water for 15 min. All specimens were then exposed to an erosive challenge of 0.2% citric acid for 1h. Enamel loss was determined using surfometry. RESULTS: The mean amount of enamel removed in the control group was 5.02 microm (S.D. 1.16). The mean enamel loss in the proenamel group was 2.60 microm (S.D. 0.90) and the mean enamel loss in the tooth mousse group was 3.28 microm (S.D. 1.22). The results for the proenamel group were statistically significantly different from the control group at the p<0.01 level and the results for the tooth mousse group were statistically significantly different from the control group at the p<0.05 level. CONCLUSIONS: Tooth mousse and proenamel may offer a degree of protection from erosion of permanent enamel.

Analysis of Variance↗

PubMed2006

Effect of compounds of Galla chinensis on remineralisation of initial enamel carious lesions in vitro.

OBJECTIVE: To evaluate the effect of compounds of Galla chinensis on the remineralisation of initial enamel carious lesions in vitro. METHODS: Sixty bovine enamel blocks with early lesions were prepared and randomly divided into six treatment groups. The lesions were subjected to a pH-cycling regime for 12 days. Each daily cycle included 4x1min applications with one of six treatments; 1000ppm F aq. (as NaF, positive control); deionized water (negative control); or 4000ppm aqueous solutions of four G. chinensis extracts (GCEs); GCE, GCE-B, GCE-B1, or GCE-B2. Surface enamel microhardness was measured on the enamel blocks before and after demineralisation, and after pH-cycling, and percentage surface microhardness recovery (%SMHR) was calculated. The enamel specimens were then sectioned (thickness ca. 80microm) and examined by polarized light microscopy. RESULTS: All samples rehardened significantly compared to baseline. Fluoride had a significantly greater effect than all other treatments. In the GCEs groups, %SMHR was significantly greater than DDW for the GCE, GCE-B and GCE-B1 groups. There was no significant difference between the GCE-B2 group and DDW. Polarized light microscopy showed that the thickness of the surface layer increased obviously in all specimens including NaF group, GCE group, GCE-B group and GCE-B1 group. Negative birefringent band appeared in the lesions body and the depth of the lesions was obviously reduced. CONCLUSION: The present study has demonstrated the potential of three GCEs (GCE, GCE-B and GCE-B1) to effect net rehardening of artificial carious lesions under dynamic pH-cyclic conditions.

Analysis of Variance↗

PubMed1994

Combined orthodontic-endodontic therapy: case report of orthodontic movement of a recalcified lateral incisor.

Unlike most cases of combined orthodontic and endodontic therapy that have been reported, in this case endodontic treatment with calcium hydroxide-induced calcification was utilized prior to orthodontic treatment. A 14-yr-old female required orthodontic therapy due to anterior crowding. Preoperative periapical radiographs indicated that the maxillary right lateral incisor demonstrated advanced lateral root resorption of the distal surface. It was decided to use calcium hydroxide therapy to halt any further resorption prior to orthodontic movement. Approximately 1 yr was required to gain calcification, fill the canal with gutta-percha, and place the maxillary closing arch. Subsequent orthodontic treatment did align the teeth in a desirable manner without jeopardy to the recalcified root.

Adolescent↗

PubMed1999

Hydroxyapatite applied as direct pulp capping medicine substitutes for osteodentin.

Tissue changes in rat incisors after direct pulp capping with hydroxyapatite (OH-AP) have been investigated using light and electron microscopy. Immediately after direct pulp capping, necrotic cells and cell debris were scattered only in the superficial zone of an exposed site. At day 1, both neutrophils having many vacuoles and macrophages phagocytizing numerous OH-AP granules appeared in the lower part of the OH-AP layer. At day 3, the cells surrounding the basal part of the OH-AP layer had large nuclei and well-developed rough-surfaced endoplasmic reticulum. At day 5, the newly formed mineralized tissue consisting of needle-like crystals was observed directly adjacent to the deepest zone of the OH-AP layer. However, fibroblast-like cells phagocytosing applied OH-AP granules were seen even at this period. These findings suggest that the applied OH-AP could directly substitute for osteodentin.

Animals↗

PubMed2001

In vitro remineralisation of eroded enamel lesions by saliva.

OBJECTIVES: It is speculated that saliva, with its mineral content, may possess a reparative effect on an early erosion which is characterised by softened surface and slight subsurface demineralisation in addition to a crater. This study aimed to determine the possible remineralisation of early enamel erosion by saliva. METHODS: Eroded lesions were produced in bovine incisors by 1-h immersion in orange juice. Control sections and three experimental slabs were produced from each tooth. The three slabs were assigned randomly to one of three remineralising agents: clarified natural saliva (NS), artificial saliva (AS) and remineralising solution (RS). All solutions had a pH of 7.2, a fluoride concentration of 0.022 ppm, and were changed daily. NS was collected daily from the same individual at the same time of day. The specimens were exposed to their respective remineralising agents for 28 days. Using microradiography and image analysis, the mineral loss (Delta z) and lesion depth (ld) were quantified in sections cut from the control and experimental slabs. RESULTS: A significant (p<0.001) amount of mineral was gained following exposure to each remineralising agent. Significantly less Delta z and ld were observed for the experimental groups compared with the control group (p<0.001; paired t-test). This effect was greatest with RS and least with AS. Inter-group comparison (Duncan multiple tests) showed no significant difference in Delta z among the experimental groups, however ld was significantly higher for AS (p<0.001) compared with RS and NS, and no difference was observed between RS and NS. CONCLUSION: Saliva as well as remineralising solutions can remineralise early enamel erosion.

Animals↗

PubMed2001

Investigation to evaluate and validate the Leeds in situ device for the study of enamel remineralisation in vivo.

OBJECTIVES: Recently, a novel device to generate dental plaque in situ on a removable human enamel surface was described. The device permitted the recovery of plaque intact and undisturbed on its enamel substrate. The aim of this investigation was to determine the utility and robustness of this model for analysis of the effects of therapeutics on both enamel remineralisation and on the overlying biofilm composition. METHODS: Enamel slices were taken from extracted sound human teeth, sterilised and a 'flat' area ground on each slice. An artificial lesion was formed within this area using acidified gel and the hardness of the enamel within the area of the lesion was determined at five sites using a 'Vickers' indenter. A nylon ring was then attached over the area of the lesion with cyanoacrylate and the excess enamel removed to form the completed device. Two devices were attached to the upper molars of 22 volunteers. Each volunteer was randomly assigned to receive either a fluoride containing (1500 ppm) or a fluoride free dentifrice. The devices were retained for a 4 week period whilst undertaking normal oral hygiene. All procedures were conducted according to GCP. After a 2 week break, the volunteers were fitted with two further devices, given dentifrice of the alternate type and the procedure repeated. Plaque from each device was harvested for microbiological analyses and the enamel subject to microhardness measurement. Then for each device the change in microhardness of the enamel within the lesion over the 4 week period was calculated. RESULTS: There were no significant differences in viable counts of total aerobic bacteria, mutans streptococci or lactobacilli, nor in acidic, aciduric or arginolytic populations in plaque from patients using the two different dentifrices. However, devices subjected to the fluoride containing dentifrice demonstrated a significantly greater increase in microhardness of the enamel (P<0.025). CONCLUSIONS: These results suggest that the novel in situ device is capable of measuring the effect of 1500 ppm fluoride on remineralisation of carious enamel over a 4 week period and is also well suited to determining concomitant effects on plaque ecology.

Adult↗

PubMed1998

In situ de- and remineralisation of enamel in response to sucrose chewing gum with fluoride or non-fluoride dentifrices.

OBJECTIVES: Enhancement of the remineralisation of artificial enamel lesions has been observed in an intraoral model whether subjects chewed gum sweetened with a non-cariogenic sweetener such as sorbitol [1-3] or sucrose [4] after meals or snacks, and with use of a conventional (1500 ppm F) fluoride dentifrice. Since most of the clinical surveys which have shown the potential cariogenicity of sucrose chewing gum [5] were conducted before use of fluoridated dentifrices became widespread, the effect of fluoride dentifrice on de- and remineralisation of artificial lesions in enamel in response to chewing sucrose-sweetened gum has been examined with the aim of attempting to resolve this apparent discrepancy. METHODS: Subjects wore an intraoral device bearing an enamel lesion and chewed one piece of sucrose gum for 20 min after each of three meals and two snacks daily for two 3-week periods, during which they used a dentifrice containing either 0 or 1500 ppm F in a double-blind, cross-over design. Measurement of the mineral content of the lesions was determined by microradiography or polarised light microscopy. RESULTS: It was found that remineralisation tended to occur with 1500 ppm F dentifrice, but demineralisation with non-F dentifrice; the difference in enamel mineral content between the two periods was significant (P < 0.05). CONCLUSIONS: The results indicate that the potential cariogenicity of sucrose-containing chewing gum may indeed be negated by the use of a conventional fluoride dentifrice.

Adolescent↗

PubMedDate not supplied

The effect of a resin-modified glass ionomer restorative material on artificially demineralised dentine caries in vitro.

OBJECTIVES: Recurrent caries is one of the most common reasons for the replacement of restorations. One method of reducing the frequency of this problem may be by using fluoride-releasing restorative materials. The aim of this in vitro study was to evaluate the progression of artificial lesions around resin-modified glass ionomer (Vitremer) restorations placed in root surfaces. Class V cavities were prepared on the mesial and distal surfaces of 28 human premolar teeth. Artificial carious wall lesions were created in all cavities. The root of each tooth was then hemisected through the middle of the two cavities, before being restored with either the glass ionomer or amalgam, while the opposing cavities on the same root portion were varnished as negative controls. Forty-eight specimens were pH-cycled in remineralising and demineralising solutions for 20 h and 4 h, respectively, each day for 4 weeks, whilst in a smaller control group of eight specimens, the demineralising solution was replaced with deionised water. Mineral changes in the carious lesions were evaluated using contact microradiography. RESULTS: Results showed that varying degrees of subsurface demineralisation and remineralisation were evident, with a laminated appearance in lesions adjacent to the glass ionomer. There was higher remineralisation in the glass ionomer-filled cavities compared with the amalgam-filled cavities. In the water-cycled group, glass ionomer showed an increase in mineral content (p < 0.05), while no changes were observed in the amalgam-filled cavities. CONCLUSIONS: This model has shown that glass ionomer has a greater potential than amalgam for remineralisation of artificially created wall lesions within an acidic environment.

Bicuspid↗

PubMed1994

Regression of white spot enamel lesions. A new optical method for quantitative longitudinal evaluation in vivo.

This article describes a new nondestructive optical method for evaluation of lesion regression in vivo. White spot caries lesions were induced with orthodontic bands in two vital premolars of seven patients. The teeth were banded for 4 weeks with special orthodontic bands that allowed plaque accumulation on the buccal surface. The teeth were left in the dentition for 2 or 4 weeks after debanding. Regular oral hygiene with a nonfluoridated toothpaste was applied during the entire experimental period. The optical scattering coefficient of the banded area was measured before banding and in 1-week intervals thereafter. The scattering coefficient returned to the sound value in an exponential manner, the half-value-time for left teeth being 1.1 week, for right teeth 1.8 weeks, these values being significantly inequal (p = 0.035). At the start of the regression period, the scattering coefficient of left teeth lesions was 2.5 as high as of right teeth lesions, values being inequal with p = 0.09. It is concluded that regression of initial lesions in the presence of saliva is a relatively rapid process. The new optical method may be of clinical importance for quantitative evaluation of enamel lesion regression developed during fixed appliance therapy.

Dental Caries↗

PubMed2001

A systematic review of selected caries prevention and management methods.

A systematic review of the periodic scientific literature was undertaken to determine the strength of the evidence for the efficacy of professional caries preventive methods applied to high risk individuals, and the efficacy of professionally applied methods to arrest or reverse non-cavitated carious lesions. An initial search identified 1435 articles, of which 27 were eventually included in the review. Among the 22 studies addressing the prevention of carious lesions in caries-active or high risk individuals, the strength of the evidence was judged to be fair for fluoride varnishes and insufficient for all other methods. Among the seven studies addressing the management of non-cavitated carious lesions, the strength of the evidence for efficacy was judged to be insufficient for all methods. The results do not indicate that the preventive and management methods reviewed are not efficacious; rather, they demonstrate that not enough is known to determine the efficacy of the methods. Suggestions for strengthening the limited evidence base involve the following: i) increasing the number of studies that examine prevention among high risk individuals and non-surgical management of non-cavitated lesions, ii) including a wider variety of subject ages, iii) targeting aspects of the efficacy questions not yet addressed, iv) strengthening research methods employed in the studies, and v) reporting methods and outcomes more completely.

Adolescent↗

PubMed2003

Application of survival analysis to carious lesion transitions in intervention trials.

OBJECTIVE: To demonstrate the usefulness of a survival-time regression model for the analysis of data from two 3-year trials of the caries-preventive effect of sugar-substituted chewing gums and fluoride toothpaste, carried out among 892 Lithuanian children. METHODS: A caries onset was defined as a transition from sound to carious and a caries recovery was defined as a transition from carious to sound. The time at risk for each type of transition was calculated. Using an exponential survival-time regression model, the hazard ratios for the covariates experimental group (control, sugar substitute, fluoride), age, gender, surface type and posteruptive surface age was estimated. This analysis was repeated using two alternative definitions of the caries transitions. RESULTS: The analyses confirmed that caries rates are higher in occlusal surfaces, and that posteruptive surface age influences caries rates. Moreover, it also confirmed that fluoride affects the outcome of ongoing caries activity more than the initiation of caries. CONCLUSIONS: Survival-time analysis of caries transitions allows for the extraction of much more information from caries trials than does the traditional DMF-based analysis, and traditional DMF incremental values may easily be derived from the models.

Age Factors↗

PubMed2001

Application of quantitative light-induced fluorescence to monitor incipient lesions in caries-active children. A comparative study of remineralisation by fluoride varnish and professional cleaning.

The aim of this study was to apply the quantitative light-induced fluorescence (QLF) method in a randomised controlled study, comparing treatment with fluoride varnish and professional tooth cleaning for remineralisation of white spot lesions in caries-active adolescents. In the fluoride varnish group (n = 13; 32 lesions), professional tooth-cleaning was followed by application of fluoride varnish at the beginning of the study, after 1 wk, and then once every 6 wk for 6 months. The other group (n = 18; 30 lesions) underwent professional tooth-cleaning once every 6 wk for 6 months. Enamel fluorescence was measured at baseline and at each visit. In the fluoride varnish group there was a significant change over time (baseline: 6 months) for both lesion area: and average change in fluorescence (decreased lesion area and increased fluorescence radiance). The corresponding changes in the professional tooth-cleaning group were not significant. There was a significant difference in average change in fluorescence between the two test groups. For lesion area, there was no significant difference, but a tendency towards a difference between the test groups. It was concluded that (a) the QLF method is a sensitive method, suitable for longitudinal quantification of incipient caries lesions on smooth surfaces; and (b) that repeated fluoride applications had a favourable effect on the remineralisation of white spot lesions as measured after 6 months.

Adolescent↗

PubMed2003

Effect of a combination of fluoride dentifrice and varnish on enamel surface rehardening and fluoride uptake in vitro.

The purpose of this study was to evaluate the effect of combining fluoride dentifrice (FD) and varnish (FV) on in vitro enamel surface rehardening and on fluoride uptake under a pH-cycling regimen. Seventy-eight bovine enamel blocks with early lesions were used and 52 were divided into four treatment groups: (a) placebo non-fluoridated dentifrice (PD); (b); FD (1100 p.p.m. F as NaF); (c); FV (Duraphat) + PD; and (d) FV + FD. The FV was applied to enamel blocks of groups FV + PD and FV + FD before the pH-cycling regimen, and all of them were submitted to dentifrice during cycling. Surface enamel microhardness was determined on the dental blocks before and after demineralization, and after the pH-cycling regimen. The percentage of surface microhardness recovery (%SMHR) was calculated. Fluoride in the blocks was also determined, after removing three layers of enamel. The highest values of percentage SMHR were observed for the FD group. The greatest fluoride uptake was found in the FD and FV + FD groups, but the difference between them was not statistically significant. It was found that the frequent use of fluoride dentifrice resulted in greater benefit in enamel surface rehardening, with a similar effect on fluoride uptake, when compared with its combination with a single fluoride varnish application.

Analysis of Variance↗

PubMed2002

The effect of commercially available saliva substitutes on predemineralized bovine dentin in vitro.

OBJECTIVE: The objective of this study was to evaluate the effects of various saliva substitutes (Artisial; Glandosane; Oralube; Saliva medac; Oralbalance) on the lesion depth and the mineral content of predemineralized bovine dentin in vitro. MATERIALS AND METHODS: Ninety-six dentin samples were prepared from 24 freshly extracted bovine incisors. The samples were predemineralized (pH 5.5; 10 days), and subsequently exposed to the various artificial salivas. A carbonate-reduced mineral water (Hirschquelle) as well as the mouthwash solutions Meridol and biotène served as controls. Lesion depth and mineral loss were evaluated from microradiographs of thin sections (110 microm) by a dedicated software package (TMR 1.24). RESULTS: After storage in Glandosane and biotène, the results indicated a significant mineral loss and an increase in lesion depth (P < 0.01; Wilcoxon). In contrast, specimens stored in Oralube showed a decrease in lesion depth and an increase in mineral content (P < 0.05; Wilcoxon). CONCLUSIONS: Thus, the use of neither Glandosane nor biotène can be recommended in dentate patients with severe xerostomia.

Amines↗