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A new method for assessing the prevalence of dental fluorosis--the Tooth Surface Index of Fluorosis.

A new index for measuring the prevalence of dental fluorosis, the Tooth Surface Index of Fluorosis (TSIF), was used to assess the condition in the permanent teeth of 807 children, aged 8 to 16, who had resided all their lives in one of seven Illinois communities with an optimal concentration of fluoride in its water or with 2, 3, or 4 times the optimal concentration. Fluorosis was absent in 84.5% of all tooth surfaces examined in the community with optimal fluoride. In contract, only 31.9% of tooth surfaces had no fluorosis in the community with 4-times the optimal fluoride level. In the optimal fluoride area, 79% of facial surfaces of maxillary anterior teeth, which are esthetically conspicuous, had no fluorosis, whereas only 15.8% of these surfaces in the 4-times optimal area were unaffected. The percentages of all tooth surfaces affected by fluorosis characterized by staining, pitting, or both were 1%, 8%, 19%, and 38%, respectively, in communities with 1-, 2-, 3-, and 4- times optimal fluoride. Differences in fluorosis based on maximum score for all tooth surfaces in a child were statistically significant (an extended chi 2 statistic) among all communities. First molars and incisors in children 8 to 10 years old were affected by more fluorosis than were the same teeth in children 13 to 16 years old. These teeth had been erupted for about 5 years longer in the older age group. The difference might result from abrasion or remineralization of these teeth in the older children or from greater consumption of fluoride by the younger children during tooth development.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Mechanistic aspects of the interactions between fluoride and dental enamel.

For many years after the discovery of its caries preventive effect, fluoride was thought to be primarily active by lowering the solubility of the apatitic mineral phase of the dental hard tissues. Recent findings have shed new light on the mechanisms by which fluoride inhibits or delays dental caries. Fluoride present in the oral fluids alters the rate of the naturally occurring dissolution and reprecipitation processes at the tooth-oral fluid interface. Demineralization of enamel is inhibited by concentrations of fluoride in the sub-ppm range. Likewise, remineralization of incipient caries lesions (the earliest stage of enamel caries) is accelerated by trace amounts of fluoride. As these two processes comprise dental caries the physiological balance between hard tissue breakdown and repair is favorably shifted by fluoride. The driving force for both phenomena is thermodynamic, that is, fluorapatite or a fluoridated hydroxyapatite may form when fluoride is supplied at low concentrations. This article critically reviews the current information about tooth-fluoride interactions, both from laboratory and clinical studies.

Dental Caries↗

Novel topical fluoride delivery system I: remineralization of ground bovine teeth.

Laboratory studies were carried out on a newly conceived fluoride-containing remineralizing system with bovine teeth. The prototype fluoride delivery device involved micronized calcium fluoride maintained at the tooth surface with a cellulose film. Together with salivary calcium and phosphate (or simulated saliva), this system was able to generate and maintain the appropriate thermodynamic activity driving force for significant fluorapatite deposition in a reasonably short time (approximately 48 hr).

Animals↗

Minimal treatment of the carious lesion.

The development of reliable adhesive technology in the oral cavity has opened the way to an entirely new approach to the treatment of active carious lesions. The initial lesion, prior to complete penetration of the enamel, can often be controlled with remineralization techniques. However, once the dentine is breached, surgical intervention is required. With modern instrumentation, including fibre-optic lighting and magnification with binocular loupes, a more surgical approach has been developed, allowing removal of caries with very limited destruction of sound tooth structure. Experience over the last 5 years has led to the development of a classification of cavity designs as well as a reliable method of instrumentation and restoration based on the use of glass-ionomer cement and composite resin. The remineralization available through the glass-ionomer cements and the adhesion developed with both the cement and composite resin allows for maintenance of the original strength of the tooth along with a high resistance to further breakdown. The classification of cavity design is presented as well as a detailed description of the suggested instrumentation for the development of the cavities.

Dental Caries↗

Conventional glass ionomers as posterior restorations. A status report for the American Journal of Dentistry.

The search for a material to replace amalgam continues as a major quest in materials science. Resin composites may offer one solution but an alternative class of material, the glass ionomer cements (GICs) may have some potential for fulfilling this role. GICs were first introduced to the dental profession in 1976, and have now become an accepted part of the dental armamentarium, especially for use in low load bearing situations. They possess a low coefficient of thermal expansion similar to that of tooth structure, physicochemical bonding to both enamel and dentin, and the release of fluoride ions into the adjacent tooth tissue. These properties help to reduce marginal leakage and may contribute to a reduced incidence of recurrent decay in the restored tooth. Fluoride released into the ambient fluids has a caries-preventive effect in neighboring teeth by enhancing remineralization and inhibiting demineralization of the dental hard tissues. The main criticisms of the GICs are their brittleness, poor surface polish, porosity and surface wear. To overcome some of these deficiencies, considerable attention has been directed at improving their physical properties, especially with the addition of metal powders, the metal-modified GICs. Different metal powders have been tried, including alloys of silver and tin, pure silver, gold, titanium, palladium and stainless steel. There is conflicting data as to whether or not these materials are sufficiently strong for use in high stress restorations, especially their potential use as replacement materials for amalgam fillings.

Bicuspid↗

Phosphoprotein extraction from the dentine/cementum complex of human tooth roots.

Root shards were placed in dialysis tubing and demineralized to completion in either 10% disodium EDTA, pH 7.4, 0.6 M HCl, 0.1 M HCl, 0.5 M acetic or 75 mM-25 mM lactic-acetic acids. The demineralized shards were then re-extracted with 0.05 M tris-HCl, 1.0 M NaCl. DEAE chromatography revealed that the major peak of the 0.6 M CHl and EDTA extracts contained organic phosphorus, whereas much less organic phosphorus was found in the major peak of the 0.1 M HCl extract. Analysis of the re-extracts gave a pattern opposite to that obtained from the initial extractions. Measurements of protein and organic phosphorus released during extraction and re-extraction confirmed these results. Staining of SDS-PAGE gels for phosphoprotein with Stains-All resulted in a blue smear in fractions containing organic phosphorus. Thus the extraction of phosphoproteins from human tooth roots differed depending upon the demineralizing conditions. This ability to remove phosphoprotein differentially will allow further investigation of the role of phosphoprotein in mineralization and remineralization.

Acetates↗