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PubMed2005

The effect of bleaching on enamel susceptibility to acid erosion and demineralisation.

INTRODUCTION: The purpose of this in vitro study was to determine if enamel that had been bleached by carbamide (urea) peroxide gel (CPG) was at increased risk of either acid erosion or demineralisation (early caries) than un-bleached enamel. METHODS: Human incisors were employed. The samples were randomly assigned to one of 4 groups; a) 10% CPG, b) 16% CPG, c) 22% CPG and d) 10% CPG with xylitol, fluoride and potassium. Each specimen was moistened with saliva and the appropriate formulation placed for 2 hours for a total of 40 hours of exposure. In order to ensure that bleaching had taken place, tooth shades were monitored using the Shade-Eye device. Following the bleaching process, one half of the specimen was subjected to an erosive challenge, the other to a demineralisation system with one half of each sub-sample retained as a non-bleached control. Samples were assessed longitudinally with quantitative light-induced fluorescence (QLF) and at the conclusion of the study with transverse micro-radiography (TMR). RESULTS: Erosion was detected in all samples (DeltaQ 126+/-23.4), in both bleached and non-bleached areas. There was no statistical difference between the bleached and non-bleached areas either within the treatment groups or between them. Caries-like lesions were detected on all samples; TMR revealed sub-surface lesions on all teeth and QLF data supported this (DeltaQ 89+/-18.9). Following statistical analysis there were no differences detected between the bleached and non-bleached areas, nor between the different concentrations of the bleaching solution. CONCLUSION: These results suggest that tooth bleaching with carbamide (urea) peroxide (using commercially available concentrations) does not increase the susceptibility of enamel to acid erosion or caries.

Analysis of Variance↗

PubMed1999

Morphology of dental enamel and dentine-enamel junction in osteogenesis imperfecta.

OBJECTIVES: The aim of this study was to examine the morphology of primary and permanent human enamel, and the dentine-enamel junction, in individuals with osteogenesis imperfecta (OI) type I, III and IV in undecalcified sections using polarized light microscopy, microradiography and scanning electron microscopy (SEM), and to relate the findings to the type of OI. SAMPLE AND METHODS: Extracted or exfoliated teeth from 15 patients representing the OI types I, III and IV (12 primary teeth from seven patients, and 11 permanent teeth from eight patients). Ten primary and nine permanent teeth from normal healthy patients served as controls. The teeth were serially cut longitudinally in a bucco-lingual direction and contact microradiographs were made. The sections were examined in polarized light. Sections of primary and permanent teeth were examined by means of SEM. RESULTS: This study shows that the permanent enamel from patients with OI exhibits few structural changes. No relationships were found between enamel morphology and the types of OI (I, III, IV). Primary enamel appeared to be slightly more irregularly mineralized, especially in cases with the additional diagnosis dentinogenesis imperfecta. The major findings were deviations in association with the dentine-enamel junction, and locally a lower degree of mineralization. CONCLUSIONS: The mesodermal disease OI might also be manifested in ectodermal enamel, probably because of suboptimal mesenchymal-ectodermal interactions during amelogenesis.

Dental Enamel↗

PubMed1997

Effect of fluoride treatment on remineralization of bleached enamel.

The objective of the study was to evaluate the remineralizing capacity of different fluoride treatments on dental enamel bleached with carbamide peroxide (Opalescence). Sixty bovine enamel slabs were subjected to four cycles comprising bleaching (12 h) and remineralization in artificial saliva (8 h). The samples were evenly distributed among four groups (A-D). During the first hour of the remineralization period the specimens in Group A were covered with a fluoride varnish (Duraphat; 2.23% F-). In group B the enamel slabs were stored in a fluoride solution (0.2% F- as NaF) for 1 min prior to remineralization. Group C did not receive a fluoride treatment, and group D (control) was stored in distilled water instead of bleaching. Microhardness (VHN) was evaluated before the experiments and after the second and fourth cycle, respectively. Final hardness was calculated as percentage of the initial hardness. Analysis of variance was applied to the data followed by pairwise comparisons with corrected level of significance (P < 0.01). Hardness decreased significantly in groups A-C compared to the control group (D). The bleached and unfluoridated specimens (group C) showed a significantly higher hardness loss compared to the fluoridated specimens, whereas no significant difference was observed between the two fluoridated groups. It is concluded that remineralization of bleached enamel is improved by application of highly concentrated fluorides.

Analysis of Variance↗

PubMed1999

Factors influencing the development of dental erosion in vitro: enamel type, temperature and exposure time.

The influence of temperature, duration of exposure, and enamel type on the development and progression of dental erosion has been determined. Three experiments were devised as follows. Eroded lesions were produced on enamel samples with orange juice: (1) at different temperatures; (2) for different lengths of time; and (3) on bovine permanent, human deciduous and human permanent enamel. Lesion parameters (mineral loss and lesion depth) were quantified using transverse microradiography. Both lesion parameters were significantly lower at 4 degrees C when compared with 20 degrees C and 37 degrees C, and at 20 degrees C when compared with 37 degrees C. Lesion parameters increased significantly as the length of exposure increased, and were positively correlated (r=0.98, P<0.05) to the exposure time. Both parameters were significantly greater in bovine enamel than human permanent and deciduous enamel, and in human deciduous than permanent enamel. Lesion progression, as measured by mineral loss, was in the ratio 2.0:1.5:1.0 for bovine:human deciduous:human permanent, and by lesion depth, 1.7:1. 3:1.0. In conclusion, the erosiveness of orange juice was less pronounced at a lower temperature, and increased with an increased exposure time. Erosion progressed twice as fast in bovine permanent than in human permanent enamel, and 1.5 times more rapidly in human deciduous than in permanent enamel.

Animals↗

PubMed2003

Influence of liquid temperature and flow rate on enamel erosion and surface softening.

Enamel erosion and softening are based on chemical processes which could be influenced by many factors including temperature and acid flow rate. Knowledge of the influence of these variables could have relevance to research experiments and clinical outcomes. Both parameters were investigated using an ultrasonication and profilometry method to assess erosion depth and surface softening of enamel. The influence of temperature was studied by eroding polished human enamel samples at 4, 20, 35 or 50 degrees C for 2 h. Secondly, different liquid flow conditions were established by varying acid agitation. Additionally, a slow laminar flow and a jet of citric acid, to simulate drinking through a straw, were applied to specimens. Erosion depth increased significantly with acid temperature from 11.0 microm at 4 degrees C to 35.8 microm at 50 degrees C. Surface softening increased much more slowly and plateaued at 2.9 microm to 3.5 microm after 35 degrees C. A strong dependence of erosion on liquid flow was revealed. In unstirred conditions only 8.6 microm erosion occurred, which increased to 22.2 microm with slow stirring and 40.9 microm with fast stirring. Surface softening did not increase correspondingly with its largest extent at slow stirring at 3.4 microm.The implication of these data are: first, the conditions for erosion experiments in vitro or in situ need to be specified for reliable comparisons between studies. Secondly, erosion of teeth by soft drinks are likely to be influenced both by the temperature of the drink and individual drinking habits.

Citric Acid↗

PubMed2001

Restorative treatment decisions on occlusal caries in Scandinavia.

In order to map variations in the operative treatment threshold for occlusal caries, a pre-coded questionnaire was sent to a random sample of 759 dentists in Norway, 923 in Sweden, and 173 in the Danish Public Dental Health Service inquiring about caries and treatment strategies. A further intention was to explore the type of operative treatment and filling material dentists in Scandinavia would use given an occlusal lesion in the lower 2nd molar in a 20-year-old. It is found that close to 70% of dentists in the 3 countries would put off carrying out operative treatment of occlusal caries until they registered a moderately sized cavity and/or any radiolucency in dentin. In Sweden, 26.7% of dentists and in Denmark 24.3% would postpone operative treatment until the lesion had a large cavity and/or until radiolucency could be observed in the middle third of the dentin; in Norway, only 11.5% of dentists indicated this. The majority of dentists in all 3 countries preferred to drill only the carious part of the fissure, though in Norway more dentists (30.9%) would tend to drill the whole fissure compared to their Swedish (23.4%) and Danish (9.5%) colleagues. The majority of Danish dentists (52.4%) suggested amalgam for restoring the occlusal surface, while 19.9% of Norwegian and 2.9% of Swedish dentists would use amalgam. Composite was the first material of choice for 71.5% of the Swedish dentists, the remaining 25.6% suggesting conventional glass ionomer cement, light-cured 'glass ionomer cement', or a combination of glass ionomer cement and composite. The corresponding values for the Norwegian dentists were 39.1% and 41.0%, respectively, and for the Danish dentists 29.2% and 18.4%. In Scandinavia, the leading strategy for occlusal caries seems to be to postpone operative treatment until a definite cavity or radiolucency in the outer third of dentin can be observed, and to carry out operative treatment only of the part of the fissure that is carious. Composite resin is the predominant material of choice in Sweden, while in Denmark the majority of dentists preferred amalgam. Composite, or composite in combination with glass ionomer cement material, was the choice of almost 80% of Norwegian dentists.

Adult↗

PubMed2004

Mineralization of dentin induced by treatment with bioactive glass S53P4 in vitro.

Dentin hypersensitivity can be managed to occlude dentin tubules, but none of the agents used are components of natural dentin. Using a calcium phosphate precipitation (CPP) method, dentin tubules can be occluded with a calcium phosphate (CaP) layer similar to the major inorganic component of dentin. The CPP method utilizes acidic pH conditions, such as etching of dentin, over the course of several dental treatments. A gentler method can be used to produce a CaP layer on the surface of dentin. By treating with bioactive glass S53P4 (BAG), or regular commercial glass (CG), mineralization occurs in physiologically neutral solutions such as simulated body fluid (SBF) and remineralization solution (RMS). After a short period of immersion, silica is dissolved from both types of glass, but the amount of silica released is much greater from BAG than from CG. The dissolved silica is adsorbed on the surface of dentin during the pretreatment procedure and enhances the mineralization of dentin in SBF. After 14 days' mineralization the dentin is fully covered by the CaP layer, but after 14 days' immersion in RMS decalcification of the dentin occurs. Pretreatment with BAG decreases the degree of decalcification of dentin during the mineralization process. These findings suggest that bioactive glass S53P4 can be used as a therapeutic material for mineralization of dentin and its tubules in a physiological environment.

Adsorption↗

PubMed2006

Clinical monitoring of the effect of fluorides on long-existing white spot lesions.

The aim of this examiner-blind, clinical monitoring was to observe long-existing white spot lesions over a period of 6 months and to evaluate the effectiveness of fluoridated toothpastes on these lesions. Thirty-nine subjects with at least one lesion participated in the study. They were randomly divided into two groups (n=20 and n=19) and instructed to brush their teeth either with toothpaste containing sodium fluoride (1500 ppm) (group 1) or with toothpaste containing amine fluoride (1250 ppm) (group 2). Lesions were measured with quantitative light-induced fluorescence (QLF) and alterations were quantified by DeltaQ as fluorescence loss integrated over the lesion area (% x mm(2)). All QLF images were taken by one examiner at baseline (DeltaQ1) and follow-up visits after 2, 4, 6, 8, 10, and 12 weeks, and after 4, 5, and 6 months (DeltaQ10). The results showed a slight but not significant progression of DeltaQ (% x mm(2)) in group 1 ((p>0.05; t-test), DeltaQ1 -20.31 (+/-41.06); DeltaQ10 -26.2 (+/-47.69)) and in group 2 ((p>0.05), DeltaQ1 -22.28 (+/-43.86); DeltaQ10 -26.39 (+/-46.4)). The results indicated no significant differences regarding the influence of the fluoridated toothpastes (p>0.05). It can be concluded that within 6?months the long-existing white spot lesions are stable concerning fluorescence loss over the lesion area. Moreover, fluoride does not seem to have any effect on long-existing white spot lesions.

Adolescent↗

PubMedDate not supplied

Developmental dental defects in children who reside by a river polluted by dioxins and furans.

The authors determined that demarcated hypomineralizations of developing teeth are a biological indicator of an early dioxin exposure in a healthy population of children. In the current study, the authors examined the prevalences of the demarcated hypomineralization lesions of teeth in 2 Finnish towns by the Kymijoki River--a river that is severely contaminated by dioxins and furans. The 4,120 permanent first molars of 1,030 children were studied. The prevailing levels of dioxins and furans in human milk were measured. The prevalences of the defects in children in Kotka and Anjalankoski were 14.2% and 5.6%, respectively, and the corresponding dioxins and furans in human milk were 13.4 pg/gm fat and 10.9 pg/gm fat (International Toxic Equivalents). In Anjalankoski, the duration of total breast-feeding was associated with the prevalence of the defects. Compared with the figures reported earlier in Finland, neither the prevalence of dental lesions nor the levels of dioxins and furans in human milk were increased in riverside residents.

Adolescent↗

PubMed2003

Sugars and dental caries.

A dynamic relation exists between sugars and oral health. Diet affects the integrity of the teeth; quantity, pH, and composition of the saliva; and plaque pH. Sugars and other fermentable carbohydrates, after being hydrolyzed by salivary amylase, provide substrate for the actions of oral bacteria, which in turn lower plaque and salivary pH. The resultant action is the beginning of tooth demineralization. Consumed sugars are naturally occurring or are added. Many factors in addition to sugars affect the caries process, including the form of food or fluid, the duration of exposure, nutrient composition, sequence of eating, salivary flow, presence of buffers, and oral hygiene. Studies have confirmed the direct relation between intake of dietary sugars and dental caries across the life span. Since the introduction of fluoride, the incidence of caries worldwide has decreased, despite increases in sugars consumption. Other dietary factors (eg, the presence of buffers in dairy products; the use of sugarless chewing gum, particularly gum containing xylitol; and the consumption of sugars as part of meals rather than between meals) may reduce the risk of caries. The primary public health measures for reducing caries risk, from a nutrition perspective, are the consumption of a balanced diet and adherence to dietary guidelines and the dietary reference intakes; from a dental perspective, the primary public health measures are the use of topical fluorides and consumption of fluoridated water.

Adolescent↗

PubMed2003

Effect of fluoride exposure on cariostatic potential of orthodontic bonding agents: an in vitro evaluation.

AIMS: The aims of this in vitro study were to compare the cariostatic potential of a resin modified glass ionomer cement (Fuji Ortho LC) to that of a resin control (Transbond) for bracket bonding and to compare the effect of extrinsic fluoride application on the cariostatic potential of each material. SETTING: Ex vivo study. MATERIALS AND METHODS: Orthodontic brackets were bonded to 40 extracted premolars, 20 with Fuji Ortho LC and 20 with Transbond. The teeth were subjected to pH cycling, pH 4.55, and pH 6.8, over a 30-day period. Ten teeth bonded with each material were immersed in a 1000 ppm fluoride solution for 2 minutes each day. Fluoride release was measured throughout the study from all teeth. After 30 days, the teeth were assessed visually for signs of enamel decalcification. RESULTS: Significant differences in decalcification existed macroscopically between all four groups of teeth, with the exception of those bonded with Fuji Ortho LC alone compared with Transbond alone (P = 0.22), and Fuji Ortho LC alone compared with Transbond with added fluoride (P = 0.3). Fluoride release from Fuji Ortho LC alone fell to minimal values, but with the addition of extrinsic fluoride the levels fell initially and then followed an upward trend. There was minimal fluoride release, from Transbond alone, but with daily addition of extrinsic fluoride, subsequent fluoride release was increased. Significant differences existed in the amount of fluoride released between all groups, except comparing Fuji Ortho LC alone and Transbond with added fluoride. CONCLUSIONS: The results of this study have indicated that with an in vitro tooth-bracket model, the creation of white spot inhibition could best be achieved by the use of a resin-modified glass ionomer cement, supplemented with fluoride exposure. The least protection was afforded by the composite control. The resin-modified glass ionomer cement alone and the composite with added fluoride demonstrated equivalent protection.

Acrylic Resins↗

PubMed2001

Effects of chelating agents and sodium hypochlorite on mineral content of root dentin.

Effects of combined and single use of EDTA, RC-Prep, and NaOCl on mineral content of root dentin were evaluated in vitro using energy dispersion spectrometric microanalysis. Thirty-six standardized midroot dentin specimens obtained from human anterior teeth were used. Specimens were polished and divided into six experimental groups. The first two groups were treated with EDTA or RC-Prep followed by NaOCl irrigation. Groups 3 to 5 were treated with EDTA, RC-Prep, and NaOCl, respectively. The last group was irrigated with saline solution as a control. Levels of calcium, phosphorus, and magnesium were measured in the root dentin after treatments. The results showed that (i) EDTA combined with NaOCl irrigation as final flush and NaOCl alone changed the calcium/phosphorus ratio of root dentin significantly (p < 0.05); and (ii) there was a significant increase in the magnesium level after the use of chelating agent combined with NaOCl (p < 0.05). It was concluded that using NaOCl irrigation as final flush altered the effectiveness of chelating agents on root dentin.

Calcium↗

PubMed1991

Tooth enamel softening with a cola type drink and rehardening with hard cheese or stimulated saliva in situ.

The in-situ remineralization effect of hard cheese was compared with that of saliva on tooth enamel in man. The intra-oral test of softening enamel surfaces by a cola type drink followed by rehardening by chewing hard cheese and/or parafilm was assessed by microhardness and SEM measurements. Cheese consumption significantly increased the enamel hardness, whereas stimulated saliva did not have this effect. The remineralizing effects are presumably due to uptake of calcium and phosphate salts by the surface enamel. Morphologically, the enamel surfaces did not return to their original state.

Carbonated Beverages↗

PubMed1991

A random effects model for some epidemiological features of dental caries.

We describe a random effects model for caries lesion development and progression based on considering the effects of the pH fluctuations over time in microbial dental plaque as a Wiener process with a single absorptive barrier. The model predicts that the period of greatest risk to developing caries occurs shortly after eruption, but thereafter the longer a surface survives without developing a lesion, the less likely will it be that a lesion will subsequently develop. The model is able to anticipate why the effect of water fluoridation on caries prevalence is most pronounced when caries is diagnosed at cavity level. This model offers one way in which the variability which characterizes the complex ecosystem associated with dental caries may be considered a subject of interest for enhancing our understanding of its pathogenesis and epidemiology.

Absorption↗

PubMed1997

Salivary parameters of relevance for assessing caries activity in individuals and populations.

A review of the non-microbial salivary parameters with respect to their possible association with caries activity is presented. The parameters are limited to those which already are or at least in the near future will obviously be simple enough, also for clinical purposes. Salivary flow rate is undoubtedly the most important single parameter since the cariostatic activity or efficacy of practically all other salivary parameters depends on the flow rate. Flow rate as such has no linear association with dental caries but there seems to exist an individual "threshold" limit which is decisive for enhanced caries activity. This threshold limit varies among different individuals and therefore the so-called normal values for unstimulated or stimulated flow rate are more reliable on a population level than among individuals for screening purposes. In any individual a regular and longitudinal follow-up of the flow rate is of higher clinical value than only a single cross-sectional measurement. Salivary buffer effect has only a weak negative association with caries activity and again, this effect is of greater clinical significance on a population level. Since the decisive processes in caries attack occur within or under the dental plaque, the buffering effect of saliva is limited and obviously more important to screen for erosion-than caries-prone individuals. Although important for dental health, none of the salivary antimicrobial agents as such has shown any strong association with caries activity. The only ones with some evidence of a regulatory role are secretory IgA antibodies, hypothiocyanite ions, and agglutinins. However, the data are controversial and it seems that instead of measuring individual parameters, the assessment of saliva's functional properties (such as the ability to aggregate bacteria, prevent their adhesion to hydroxyapatite or sugar metabolism etc.) is more important for clinical purposes. Of the parameters involved in de- and remineralization process, only salivary fluoride content has some association with caries susceptibility but its diagnostic or predictive value is questionable.

Agglutinins↗

PubMed2006

Seckel syndrome associated with oligodontia, microdontia, enamel hypoplasia, delayed eruption, and dentin dysmineralization: a new variant?

Seckel syndrome (SCKL) [OMIM Entry 210600] is a rare, autosomal recessive syndrome, characterized by severe intrauterine and postnatal growth retardation, microcephaly, mental retardation, and typical facial appearance with beaklike protrusion of the midface (bird-headed). Associated findings may include limb anomalies, dislocation of femoral heads, scoliosis, and gastrointestinal malformation. A 14-year-old boy is presented with brain hypoplasia, pachygyria, hydrocephaly, enamel hypoplasia and root dysplasia in the temporary dentition, and oligodontia, severe microdontia, and delayed eruption of the permanent dentition. The association of SCKL with the above unusual dental findings may represent a new phenotype.

Abnormalities, Multiple↗

PubMed1996

Methods of assessing erosion and erosive potential.

Methods for use in vitro are reviewed first, classified under the examination of extracted teeth, chemical and physical methods, digital image analysis, scanning electron microscopy and other potentially useful techniques. Methods for recording erosion in laboratory animals are dealt with next, including techniques that can also be used in vitro, Restarski's system and various modifications of it, and digital image analysis. Thirdly the main systems and indices that have been designed for clinical use are arranged under case histories and clinical examination, scales of severity and indices of diagnosis of varying complexity. Finally, some of the main advantages and limitations of the techniques are summarized.

Acids↗

PubMed1996

Lessening dental erosive potential by product modification.

Current interest in dental erosion has led to increasing attention to ways in which potentially erosive products might be modified. Information on how this could be achieved has been hard to gather, and has focused chiefly on possibilities in reformulating soft drinks. The bulk of the work published on this relates to calcium and phosphate supplementation, ranging from early experimentation on saturation of a demineralising medium with tricalcium phosphate, through tests of more soluble phosphates and other calcium salts providing various levels of Ca2+ and PO4(3-), to a calcium citrate malate additive specially formulated to curb erosion by soft drinks. Opinions on the effectiveness of citrate, the practicability of reducing the acidity levels of soft drinks, and the possible applications of fluoride, bicarbonates and certain constituents of milk products are also included. Finally, an attempt has been made to summarize some of the advantages and shortcomings of the different methods, but it is clear that much further work will be needed before firm guidelines on the best routes to product improvement can be laid down.

Acids↗