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PubMed2005

In vitro efficacy of a whitening toothpaste containing calcium carbonate and perlite.

OBJECTIVES: The studies described in this paper aimed to assess the stain removal efficacy, fluoride efficacy and abrasivity to enamel and dentine of a new whitening toothpaste containing calcium carbonate and perlite, using appropriate in vitro models. METHODS: Stain removal efficacy was assessed using the pellicle cleaning ratio (PCR) method. Fluoride efficacy was assessed using remineralisation, demineralisation and fluoride-uptake methods. Abrasivity was assessed using an enamel and dentine wear method. RESULTS: The results showed that the new whitening toothpaste was able to remove extrinsic tooth stain more effectively than three commercially available toothpaste formulations. The fluoride efficacy was superior to a non-fluoridated control and was not significantly different to a clinically tested fluoride-containing toothpaste. The abrasivity data showed that the calcium carbonate/perlite toothpaste is no more abrasive to enamel or dentine than two other commercially available whitening toothpastes. CONCLUSIONS: The studies show that the new whitening toothpaste is effective in extrinsic stain removal, has an efficacious fluoride source and does not have an undue degree of abrasivity to enamel or dentine compared to other relevant commercially available products.

Aluminum Oxide↗
PubMed2005

Effects of sanguinaria in fluoride-containing dentifrices on the remineralisation of subsurface carious lesion in vitro.

OBJECTIVE: The purpose of this study was to investigate the potential cariostatic benefits of dentifrice containing both fluoride (F) and sanguinaria (SG) in a silica abrasive formula using the microbial de- and re-mineralisation cycle model. METHODS: Samples of bovine tooth enamel were embedded in resin, polished, exposed to a lactate carbopol buffer system for 44 hours, and divided into one control and five test groups of 12 specimens each by randomised blocks with VHN stratification. Surface microhardness was compared before and after the microbial cyclic sequences. RESULTS: VHNs for groups treated with dentifrices containing 1,000 ppm F from MFP with or without bamboo salt (BS) were significantly higher than the control. The groups treated with dentifrices containing F from NaF/silica with or without SG had significantly higher VHNs than that with F from MFP/DCPD. The VHNs treated with dentifrice containing both NaF-SG demonstrated the highest among test groups, indicating that there may be a synergistic effect in remineralising the incipient subsurface lesion. CONCLUSION: The dentifrice containing both NaF and SG showed a significantly greater effect (p < 0.05) on the remineralisation of the enamel lesion than the other test dentifrices.

Alkaloids↗
PubMed1998

A quantitative light microscopic study of the odontoblast and subodontoblastic reactions to active and arrested enamel caries without cavitation.

This study describes cellular and microradiographic findings in thin undemineralized enamel-dentine sections from 36 enamel caries lesions from freshly extracted third molars. Lesions activity was determined by clinical examination and the estimated age of the lesion at extraction time. The cellular reactions to the enamel/dentine lesion complex were measured using computerized histomorphometry under the following conditions: (a) the cytoplasm:nucleus ratio of the odontoblast cell; (b) the odontoblast cell:dentinal tubule ratio, and (c) the adjacent predentine area (microm2). The first cellular reactions were observed beneath superficial enamel lesions before visible alterations in dentine mineralization. The cytoplasm:nucleus ratio of the odontoblast cells was markedly reduced, and only active lesions showed evidence of cellular proliferation into the cell-free zone. In more advanced active lesions the affected odontoblast cells had a significantly lower cytoplasm:nucleus ratio compared with the controls. Similar changes were not seen in arrested or slow-progressing lesions. Before onset of tertiary dentine formation there was a positive correlation between odontoblast cell size and predentine formation. Primary odontoblast cells were involved in early tertiary or reactionary dentine formation without odontoblast cell replacement. Reactionary dentine was only seen in active lesions, suggesting that reactions in the dentine/pulp complex are closely associated with the external environment.

Adult↗
PubMed1998

A descriptive report of the effects of a 16-month xylitol chewing-gum programme subsequent to a 40-month sucrose gum programme.

A previous caries trial (Belize studies) involved the usage of sucrose chewing-gum for a period of 40 months in one group of initially 10-year-old subjects in an environment of high sugar consumption, high caries activity, and limited access to restorative care. After the termination of the 40-month supervised sucrose gum usage, the 109 subjects of the original sucrose group retrieved at the endpoint of the original trial were invited to participate in a xylitol chewing-gum programme (involving the usage of the '100% pellet-shaped formular') for 16 months. The average daily consumption level of xylitol was up to 14 g per subject, normally used in seven daily chewing episodes. Although most subjects used chewing-gum at schools and received their gum portions from a school official, gum chewing during these 16 months was mostly unsupervised. After 16 months, 83 subjects (76%; mean age 14.9 years) were retrieved. The caries status of these subjects was examined by the same calibrated, blinded examiners as in the original trial. To mask the examiners, 141 similar non-participating subjects were recruited from the same school classes and were examined in a random order with the gum-using subjects, according to the same standard routine. The intensified xylitol gum usage for 16 months was associated with a reduction of the mean DMFS score from 10.9 (at 40 months) to 9.3 (at 56 months, p = 0.0013) and a reduction in caries rate from 20.1 caries onsets per 1,000 surface-years (40-month period average rate) to 10.2 caries onsets per 1,000 surface-years. The reduction in DMFS score resulted mostly from the change in the D component of the index and possibly reflected a stabilisation of the caries process and rehardening of some caries lesions to a non-progressive carious state.

Adolescent↗
PubMed1998

Identification of human serum albumin in human caries lesions of enamel: the role of putative inhibitors of remineralisation.

Carious attack on enamel is not a unidirectional process but involves both demineralisation and remineralisation. The chemistry of carious attack on enamel has, to a large extent, now been clarified as far as mineral components are concerned but little attention, however, has been paid to the identity of organic material in carious lesions and its possible role in the caries process. The only clear information available is that organic material accumulates with time within enamel lesions. The present study was aimed at identifying a specific protein component known to bind to hydroxyapatite (albumin) in carious lesions with a view to investigating its role in the disease process. The distribution of albumin within both white spot and fissure lesions and adjacent sound enamel of extracted human teeth was investigated using SEM immunohistochemistry on undermineralised sections of human enamel and employing a polyclonal antibody to human serum albumin. The nature of the protein, i.e. whether it was in the form of intact molecules or degraded fragments, was investigated by Western blotting, employing the same antibody. The immunohistochemistry revealed the presence of albumin within both interproximal white spot and fissure lesions with little if any present in sound enamel. The Western blotting indicated that the albumin was in the intact form with no evidence of degradation products. The ability of albumin to bind and to inhibit growth of calcium phosphate crystals raises the question as to the possible role of such a molecule in the development of carious lesions.

Antibodies↗
PubMedDate not supplied

Fluoride profiles in dental plaque in vivo formed on fluoride pre-treated human enamel.

Using a novel device capable of generating plaque in vivo on a natural enamel substrate, it has been possible to determine fluoride profiles from the saliva-plaque interface towards the enamel surface. Fluoride profiles in dental plaques tended to fall from the saliva-plaque interface towards the enamel. The device also offered the possibility of examining fluoride distributions after pre-treatment of the enamel with fluoride in vitro. Fluoride profiles were determined in plaque generated in vivo on enamel surfaces, which had been previously treated with a 900-ppm fluoride solution. The results showed the previously reported fall from the plaque surface, but in addition, a further rise towards the enamel surface was seen. The data imply that enamel loaded with fluoride can release some of this fluoride back into the plaque and may act as a fluoride reservoir.

Calcium↗
PubMedDate not supplied

In situ acid resistance of in vivo formed white spot lesions.

Thin sections of natural enamel lesions, so-called white spots (WS), and areas of sound enamel (SEn) adjacent to the WS were exposed to an intraoral environment for 2 weeks. Thin sections of WS samples, clamped in a PMMA holder, were microradiographed before and after exposure to intraoral conditions. Acid resistance was evaluated by lesion depth and mineral changes during the cariogenic challenge. The results show that there were statistically significant differences in lesion depth, mineral loss and mineral volume percent at the surface before and after the intraoral cariogenic challenge at least at p<0.05, except for a change in mineral volume percent at the surface of WS samples. This exception indicates that no mineral change occurred in the surface layer of WS. The fact of 2.8 and 1.8 times higher ratios of SEn over WS of mean changes in lesion depth and mineral loss data, respectively, seems to indicate a quantitative difference in acid resistance level of WS lesions compared with the areas of SEn. Regarding the site of mineral changes, a distinctive feature of WS samples is that mineral loss occurs at the bottom of lesions. In contrast, areas of SEn produce a typical subsurface type of lesions. From this in situ study, it can be concluded that the surface of WS samples was apparently much more acid-resistant (at least approximately 2 times) than the areas of SEn that received a similar intraoral acid challenge.

Acids↗
PubMedDate not supplied

Changes in the cultivable flora in deep carious lesions following a stepwise excavation procedure.

This study examined the cultivable microflora before and after stepwise excavation procedures in deep carious lesions in 9 permanent teeth, categorized according to degrees of proximal surface destruction. The final excavation was performed 4-6 months after the initial treatment, which included peripheral dentine excavation and removal of the central cariogenic biomass and the superficial necrotic dentine. Dentine colour and consistency were assessed by means of standardized scales before the application of a Ca(OH)(2) compound and temporary sealing. Reassessments were performed before and after the final excavation. Microbiological samples of the central demineralized dentine were obtained with a sterile bur before and after the first excavation, as well as before and after the final excavation. After anaerobic cultivation on enriched non-selective tryptic soy agar, 30 colonies from a representative area were identified by standardized biochemical and physiological tests. Before temporary restoration, a yellowish and light brown demineralized soft dentine was typically observed, and gram-positive rods accounted for 70% and lactobacilli for 50% of the total colony-forming units. Lactobacillus casei subsp. rhamnosus and Actinomyces naeslundii dominated the lactobacilli and the other gram-positive rods, respectively. Gram-negative rods were the next most frequent isolates, followed by streptococci, each group accounting for about 20% of the colony-forming units in positive samples. Before the final excavation, which did not cause exposure of the pulp in any of the cases, the retained demineralized dentine had changed into a darker and harder tissue, and the total colony-forming units, as well as the frequency and proportions of lactobacilli were substantially reduced. Gram-negative rods also declined, and the flora was dominated by A. naeslundii and various streptococci. In conclusion, the cultivable flora detected following the treatment interval had declined substantially, and the distribution of bacterial species did not represent a typical cariogenic microbiota of deep lesions, confirming the clinical findings of arrested caries progression.

Actinomyces↗
PubMedDate not supplied

Reversal of primary root caries using dentifrices containing 5,000 and 1,100 ppm fluoride.

This study compared the ability of two sodium fluoride dentifrices, one containing 5,000 ppm fluoride (Prevident 5000 Plus) and the other 1,100 ppm fluoride (Winterfresh Gel), to reverse primary root caries lesions (PRCLs). A total of 201 subjects with at least one PRCL each entered the study and were randomly allocated to use one of the dentifrices. After 6 months, 186 subjects were included in statistical analyses. At baseline and after 3 and 6 months, the lesions were clinically assessed and their electrical resistance measured using an electrical caries monitor. After 3 months, 39 (38.2%) of the 102 subjects in the 5,000 ppm F- group and 9 (10.7%) of 84 subjects using the 1,100 ppm F- dentifrice, had one or more PRCLs which had hardened (p = 0.005). Between baseline and 3 months, the log10 mean +/- SD resistance values of lesions for subjects in the 1,100 ppm F- group had decreased by 0.06+/-0.55, whereas those in the 5,000 ppm F- group had increased by 0.40+/-0.64 (p<0.001). After 6 months, 58 (56.9%) of the subjects in the 5,000 ppm F- group and 24 (28.6%) in the 1,100 ppm F- group had one or more PRCLs that had become hard (p = 0.002). Between baseline and 6 months, the log10 mean +/- SD resistance values of lesions for subjects in the 1,100 ppm F- group decreased by 0.004+/-0.70, whereas in the 5,000 ppm F- group, they increased by 0.56+/-0.76 (p<0.001). After 3 and 6 months, the distance from the apical border of the root caries lesions to the gingival margin increased significantly in the 5,000 ppm F- group when compared with the 1,100 ppm F- group. The plaque index in the 5,000 ppm F- group was also significantly reduced when compared with the 1,100 ppm F- group. The colour of the lesions remained unchanged. It was concluded that the dentifrice containing 5,000 ppm F- was significantly better at remineralising PRCLs than the one containing 1,100 ppm F-.

Adult↗
PubMedDate not supplied

The use of ultrasonication to study remineralisation of eroded enamel.

The aim of this study was to use ultrasonication and profilometry as methods to study de- and remineralisation of citric acid-eroded enamel at different pH values. Seventy-eight polished human enamel samples were divided into three test and three control groups of 13 specimens each. Three specimens of each group were chosen for SEM examination. The samples were exposed to 0.3% citric acid at pH 2.54, 3.2 or 4.5 for 2 h. The depths of the resulting lesions were measured by profilometry. The test groups were placed in artificial saliva and the control groups were stored in saline (0.9% NaCl) for 24 h and new profiles recorded. Finally all specimens were ultrasonicated in water for 5, 30, 120, 240 and 480 s with profilometric measurements at each time point. Ultrasonication of the test groups after remineralisation showed little effect on the lesion depth, whereas the control groups had an enamel loss of 2.1 microm at pH 2.54, 2.9 microm at pH 3.2 and 0.4 microm at pH 4.5 after 30-second ultrasonication. These differences from respective test groups were statistically significant at pH 2.54 and 3.2 but not at pH 4.5. Ultrasonication of control pH 2.54 and 3.2 specimens removed an amorphous covering layer to reveal a flattened surface with prisms outlined by prism boundaries. It can be concluded that remineralisation in artificial saliva stabilises the surface softened enamel against ultrasonication.

Analysis of Variance↗
PubMedDate not supplied

Effect of time on the remineralisation of enamel by synthetic saliva after citric acid erosion.

The aim of this in vitro study was to determine the influence of remineralisation time on rehardening of surface-softened enamel after citric acid erosion. Seven groups of 13 samples of human enamel were eroded in 0.3% citric acid at pH 3.2 for 2 h followed by profilometric measurements. Individual groups of specimens were placed in artificial saliva for 1, 2, 4, 6, 9 or 24 h. A control group was placed in isotonic saline for 24 h. After new profilometric measurements samples were ultrasonicated stepwise up to 480 s with profilometric measurements performed at 5, 30, 120, 240 and 480 s to measure the depth of surface softening. The control group had a softened surface layer of mean thickness 2.9 microm. Mineral deposition was seen at all remineralisation times by scanning electron microscopy. Exposure to artificial saliva for 1, 2 or 4 h produced a partial rehardening of the softened enamel; the additional surface losses produced by ultrasonication were lower and time delayed compared to the control group. Specimens remineralised for 6, 9 and 24 h showed little evidence of surface loss after ultrasonication. The data suggest that a complete rehardening of the softened enamel in vitro is reached after a remineralisation time of 6 h. These data are of clinical relevance to tooth wear. However, there is a need for studies in situ of enamel demineralisation and remineralisation.

Analysis of Variance↗
PubMedDate not supplied

Effectiveness of two fluoridation measures on erosion progression in human enamel and dentine in vitro.

The aim of the present study was to evaluate the effect of fluoride on the progression of erosive demineralisation in human enamel and dentine using a cyclic de- and remineralisation model in vitro. The mineral content expressed in micrometres was determined daily by longitudinal microradiography (LMR) and presented as cumulative mineral loss over 5 days. For erosive demineralisation, all samples were immersed in 0.05 M citric acid (pH 2.3) for 6x10 min/day and stored in a remineralisation solution. Fluoridation measures were performed as follows: group 1: control, no fluoridation; group 2: toothpaste fluoridation 3x5 min/daily (NaF, 0.15% F-); group 3: toothpaste fluoridation as group 2 and additionally application of a fluoride mouthrinse (Olaflur/SnF2, 0.025%F-) 3x5 min/daily and on days 1 and 3 gel fluoridation (Olaflur/NaF; 1.25% F-) for 1x5 min. After the first experimental day, no significant differences were found between the groups. However, after 5 days the erosive mineral loss values for enamel were 147.5+/-18.7 microm in the control group, 128.1+/-15.0 microm in group 2 (p< or =0.05) and 116.1+/-12.4 microm in group 3 (p< or =0.001). In dentine, the respective values were 136.7+/-16.4, 111.8+/-26.9 (p< or =0.001) and 60.3+/-17.8 (p< or =0.001). The intensive fluoridation significantly reduced erosion progression in enamel but had a more pronounced effect on dentine. The results suggest that subjects with erosive lesions should use an intensive fluoridation measure.

Analysis of Variance↗
PubMed2001

How to measure the effects of fluoride treatments in clinical trials? Assessment: modern versus traditional methods.

In recent years there has been a pronounced change in the epidemiology and disease pattern of dental caries. In the current context, traditional methods of caries assessment, discriminating lesions at cavitation, are clinically inappropriate, and obsolete for research requiring detection of a very early phase of mineral loss. Modern prospective caries studies require sensitive methods permitting the measurement of small changes in tooth mineral content, and objective, quantitative measurements of such changes are now possible in a single caries lesion. For longitudinal studies there are noninvasive methods for assessment of new lesions as well as quantitative changes (progression or regression) in existing lesions. Among as yet unresolved issues are improved methods to assess the current activity of a lesion, methods for detection and quantification of secondary caries and root caries, calibration of methodologies between different research institutes, and methods capable of assessment of the whole continuum in the development of a caries lesion, from initial loss of mineral to cavitation.

Calibration↗
PubMedDate not supplied

Validity and reproducibility of a laser fluorescence system for detecting the activity of white-spot lesions on free smooth surfaces in vivo.

The aim of the study was to determine the reproducibility and validity of DIAGNOdent in detecting active and arrested caries lesions on free smooth surfaces. Volunteers were selected from state schools of Piracicaba, São Paulo, Brazil. Overall, 220 lesions were clinically examined. Two specially trained ('calibrated') examiners performed both clinical and laser evaluations independently, and after a 1-week interval, the examinations were repeated. The intra-examiner agreement for the laser evaluation was substantial (kappa(ex1) = 0.79, kappa(ex2) = 0.71). There was almost perfect agreement between the two examiners for the clinical examination (kappa(ex1) = 0.95, kappa(ex2) = 0.85). The inter-examiner agreement showed substantial reproducibility (kappa = 0.77) for the laser examination and almost perfect agreement (kappa = 0.85) for the clinical evaluation. The validation criterion was the clinical examination of white spots, recorded as active or arrested. The sensitivity was 0.72 and the specificity was 0.73, which indicates that the DIAGNOdent was a good auxiliary method for detecting incipient caries lesions on free smooth surfaces. The utilization of both methods can improve the efficacy of caries diagnosis.

Adolescent↗
PubMedDate not supplied

Remineralisation of enamel lesions with daily applications of a high-concentration fluoride gel and a fluoridated toothpaste: an in situ study.

The inhibition of enamel demineralisation and the enhancement of remineralisation are positively but not linearly related to the concentration of fluoride, especially when high fluoride concentrations are used. The aim of this in situ experiment was to determine the maximum amount of enamel remineralisation that can be achieved with daily applications of very high concentrations of fluoride. For this purpose we compared the efficacy of a daily application of fluoridated topical gel (12500 ppm F, partly as NaF, Olafluor and Dectafluor, pH 4.5) in combination with a fluoridated toothpaste (1450 ppm F as NaF), with fluoridated toothpaste alone. Participants (n = 26, with partial dentures) were fitted with a demineralised enamel specimen (mean mineral loss of 1674 vol%.micro m) and were instructed to use one of the two fluoride treatments. After 4 weeks of treatment, the specimens were retrieved, a section was cut and analysed with microradiography. The remainder of each of the specimens was used for analysis of the 'loosely bound' and 'bound' fluoride. Fluoride was measured with gas-liquid chromatography. After 4 weeks in the mouth, the original lesion was reduced in size by 54% in the toothpaste + gel group (n = 14) and by 44% in the toothpaste-only group (n = 12), but the difference between the groups was not statistically significant. The mineral content profiles showed remineralisation of the lesions throughout the depth of the lesion. The enhancement of remineralisation by the high amounts of fluoride was most pronounced in the surface layer. For both the 'loosely bound' and 'bound' fluoride, a statistically significant increase in fluoride concentration could be found in the toothpaste + gel group. In the 4-week in situ period the use of high amounts of fluoride resulted in a maximum remineralisation rate. This is illustrated by an increase in remineralisation and higher fluoride concentrations in the toothpaste + gel group compared to the toothpaste-only group.

Dental Enamel↗
PubMedDate not supplied

Brushing abrasion of softened and remineralised dentin: an in situ study.

The aim of the present in situ study was to evaluate the effect of different periods of intra-oral remineralisation on the susceptibility of softened dentin to toothbrushing abrasion. Groups of 6 human dentin specimens (A-F) were recessed in the buccal aspects of intra-oral appliances which were worn for 21 days by 11 volunteers. The samples were demineralised twice a day extra-orally in the acidic beverage Sprite Light (pH 2.9) for 90 s. Subsequently, the dentin specimens were brushed at different times. Specimen A was brushed immediately after demineralisation. Specimens B-E were brushed after the intra-oral appliances had been worn for various periods in the mouth: specimen B for 10 min, C for 20 min, D for 30 min and E for 60 min. Specimen F was not brushed (control). After 21 days, dentin wear was measured with a profilometer. The following values (means +/- standard deviation) were recorded (microm): A, 23.6 +/- 16.7; B, 37.9 +/- 29.7; C, 31.8 +/- 26.5; D, 18.5 +/- 10.5; E, 15.3 +/- 11.6; F, 12.6 +/- 6.7. There was a statistically significantly increased dentin loss for groups A, B and C as compared to the controls (U test: p < 0.05). However, after intra-oral periods of 30 and 60 min, wear was not significantly higher than in unbrushed controls. It is concluded that for protection of dentin surfaces at least 30 min should elapse before toothbrushing after an erosive attack.

Carbonated Beverages↗