Remineralization of caries lesions is naturally achieved by salivary ions, and it can be enhanced by external factors or elements such as fluoride. Numerous studies have demonstrated the ...remineralizing efficacy of fluoride therapies as well as the limitations with some groups of the population. Consequently, developing new remineralization therapies to close this gap in efficacy has been a priority for the last 2 decades. In this review, we summarize and briefly discuss some of the latest advances in remineralization therapies. Most new therapies try to enhance the effect of fluoride by adding other potentially active ingredients to the formulation, such as calcium, phosphate, stannous, xylitol, and arginine. Other remineralization strategies have focused on creating remineralizing scaffolds within the lesions (e.g., self-assembling peptides). While several of the new remineralization strategies have progressed significantly in recent years, for most of them, the evidence is still insufficient to assess their true clinical potential.
Aims
Saliva has been previously used as an inoculum for in vitro oral biofilm studies. However, the microbial community profile of saliva is markedly different from hard‐ and soft‐tissue‐associated ...oral biofilms. Here, we investigated the changes in the biofilm architecture and microbial diversity of in vitro oral biofilms developed from saliva, tongue or plaque‐derived inocula under different salivary shear forces.
Methods and Results
Four inoculum types (saliva, bacteria harvested from the tongue, toothbrush and curette‐harvested plaque) were collected and pooled. Biofilms (n ≥ 15) were grown for 20 h in cell‐free human saliva flowing at three different shear forces. Stained biofilms were imaged using a confocal laser scanning microscope. Biomass, thickness and roughness were determined by image analysis and bacterial community composition analysed using Ion Torrent. All developed biofilms showed a significant reduction in observed diversity compared with their respective original inoculum. Shear force altered biofilm architecture of saliva and curette‐collected plaque and community composition of saliva, tongue and curette‐harvested plaque.
Conclusions
Different intraoral inocula served as precursors of in vitro oral polymicrobial biofilms which can be influenced by shear.
Significance and Impact of the Study
Inoculum selection and shear force are key factors to consider when developing multispecies biofilms within in vitro models.
Although there is strong evidence for the effectiveness of sealants, one major barrier in sealant utilization is the concern of sealing over active caries lesions. This study evaluated detection and ...monitoring of caries lesions through a clear sealant over 44 mo. Sixty-four 7- to 10-year-old children with at least 2 permanent molars with International Caries Detection and Assessment System (ICDAS) scores 0-4 (and caries less than halfway through the dentin, radiographically) were examined with ICDAS, DIAGNOdent, and quantitative light-induced fluorescence (QLF) before sealant placement and 1, 12, 24, and 44 mo (except QLF) after. Bitewing radiographs were taken yearly. DIAGNOdent and QLF were able to distinguish between baseline ICDAS before and after sealant placement. There was no significant evidence of ICDAS progression at 12 mo, but there was small evidence of minor increases at 24 and 44 mo (14% and 14%, respectively) with only 2% ICDAS ≥ 5. Additionally, there was little evidence of radiographic progression (at 12 mo = 1%, 24 mo = 3%, and 44 mo = 9%). Sealant retention rates were excellent at 12 mo = 89%, 24 mo = 78%, and 44 mo = 70%. The small risk of sealant repair increased significantly as baseline ICDAS, DIAGNOdent, and QLF values increased. However, regardless of lesion severity, sealants were 100% effective at 12 mo and 98% effective over 44 mo in managing occlusal surfaces at ICDAS 0-4 (i.e., only 4 of 228 teeth progressed to ICDAS ≥ 5 associated with sealants in need of repair and none to halfway or more through the dentin, radiographically). This study suggests that occlusal surfaces without frank cavitation (ICDAS 0-4) that are sealed with a clear sealant can be monitored with ICDAS, QLF, or DIAGNOdent, which may aid in predicting the need for sealant repair.
Objective: To investigate how the size of the space between restoration and dentinal wall of the tooth affects the development of secondary caries lesions, especially wall lesions. Methods: ...Tooth-resin composite specimens were mounted on custom-made gap model stages and divided into 4 groups (n = 10): group 1 with a 30-µm gap throughout both enamel and dentin, group 2 with a 30-µm enamel gap and 530-µm dentinal gap, group 3 with 525-µm gaps in both enamel and dentin, and group 4 with 525-µm and 1,025-µm gaps in enamel and dentin, respectively. Specimens were gas sterilized and incubated in a cycling microbial caries model for 8 days and analyzed with confocal microscopy for lesion size at the enamel outer lesion (EOL), enamel wall lesion (EWL), dentin wall lesion A (DWL-A) next to the dentin-enamel junction (DEJ) and dentin wall lesion B (DWL-B) at 750 µm from the DEJ. Results: No difference in EOL or EWL size was found between the groups. DWL-A and DWL-B were larger in group 3 than groups 1 and 2. A larger DWL-B was found in group 3 than group 4. Conclusions: The presence of additional space at the dentinal wall area did not affect secondary caries development as long as the enamel gap was small. However, with enamel gaps of approximately 500 µm, the presence of the additional gap space at the dentinal wall led to the development of smaller dentinal wall lesions at the deeper parts of the simulated cavity. In uniform gaps, the size of the interface was positively correlated with the size of the dentinal wall lesions.
Objectives: To investigate the relationship of gap size and secondary caries in a newly developed secondary caries microbial model that permits adjustment of the gap between the tooth and a ...restoration. Methods: Tooth-resin-matrix composite specimens were mounted on gap-model stages with a gap size of 50 or 500 µm in experiment 1, and 0, 25, 250, or 1,000 µm in experiment 2. They were attached to plastic Petri plates, gas-sterilized and then incubated in a microbial caries model (with Streptococcus mutans TH16 in 1% sucrose tryptic soy broth for 1 h, 4 times/day, and with a buffer solution for the rest of the day). After 8 days of incubation, tooth specimens were sectioned and stained overnight with a rhodamine B solution. Digital images taken under a confocal microscope were analyzed for lesion size at the outer surface lesion and wall lesion (WL). Results: Gap size was found to affect the development of dentin WL area in experiment 1 and enamel and dentin WL areas in experiment 2, with bigger lesions being observed in the wider gap group (p < 0.05). Conclusion: The findings of this study suggest that the size of the gap between tooth and restoration affects the development of secondary caries along the cavity wall.
Abstract Objectives The influence of toothbrushing duration and dentifrice quantity on fluoride efficacy against dental caries is poorly understood. This study investigated effects of these two oral ...hygiene factors on enamel remineralisation (measured as surface microhardness recovery SMHR), enamel fluoride uptake (EFU), and net acid resistance (NAR) post-remineralisation in a randomized clinical study using an in situ caries model. Methods Subjects (n = 63) wore their partial dentures holding partially demineralised human enamel specimens and brushed twice-daily for two weeks, following each of five regimens: brushing for 120 or 45 s with 1.5 g of 1150 ppm F (as NaF) dentifrice; for 120 or 45 s with 0.5 g of this dentifrice; and for 120 s with 1.5 g of 250 ppm F (NaF) dentifrice. Results Comparing brushing for 120 s against brushing for 45 s, SMHR and EFU increased by 20.0% and 26.9% respectively when 1.5 g dentifrice was used; and by 22.8% and 19.9% respectively when 0.5 g dentifrice was used. Comparing brushing with 1.5 g against brushing with 0.5 g dentifrice, SMHR and EFU increased by 35.3% and 51.3% respectively when brushing for 120 s, and by 38.4% and 43.0% respectively when brushing for 45 s. Increasing brushing duration and dentifrice quantity also increased the NAR value. The effects of these two oral hygiene factors on SMHR, EFU, and NAR were statistically significant (p < 0.05 in all cases). Conclusion Brushing duration and dentifrice quantity have the potential to influence the anti-caries effectiveness of fluoride dentifrices. Study NCT01563172 on ClinicalTrials.gov. Clinical significance The effect of two key oral hygiene regimen factors – toothbrushing duration and dentifrice quantity – on fluoride’s anticaries effectiveness is unclear. This 2-week home-use in situ remineralisation clinical study showed both these factors can influence fluoride bioactivity, and so can potentially affect fluoride’s ability to protect against caries.
Introduction: Previous studies have shown that a calcium prerinse can increase intraoral fluoride retention from a fluoride rinse. To explore the potential of this approach to control root caries, we ...assessed intraoral fluoride bioavailability after a calcium prerinse in older adults with normal to low salivary flow rates. Methods: In a 2-period crossover trial (NCT04239872), 20 participants (65–80 y old), with low or normal salivary flow rate, rinsed for 1 min with a 0.05% NaF mouth rinse (226 ppm F, F only) or with this rinse immediately after a 1-min rinse with 150 mM calcium lactate (Ca→F). Dental biofilm and saliva samples were collected before and up to 2 h after the rinse(s). Fluoride concentrations in saliva (whole and clarified) and dental biofilm (fluid and solid phases) were blindly determined. Data were statistically analyzed by a mixed-effects model for the effect of treatment, time, and their interaction ( α = 5%). Results: The Ca→F group resulted in significantly higher fluoride concentrations in all variables analyzed, for almost all of the collection time points. The effect was greater in the biofilm solids and whole saliva (compatible with the formation of calcium fluoride deposits) and still significant ( P < 0.001) after 2 h in the biofilm fluid and clarified saliva, suggesting that fluoride stored in insoluble particles was released, increasing free fluoride. Conclusion: The use of a calcium prerinse before a fluoride rinse was able to prolong intraoral fluoride bioavailability in older adults. Knowledge Transfer Statement: A calcium prerinse increased intraoral fluoride bioavailability in older individuals. This approach could be used to improve root caries control without the need to increase the fluoride concentration in dental products.
The acquired dental pellicle helps prevent erosion, but the protection level is unknown. This in situ study tested whether a two-hour pellicle protects against different erosive challenges by orange ...juice. Subjects wore palatal appliances loaded with either enamel or dentin specimens. Pellicle was allowed to form, or not (control), on the surfaces of the specimens intra-orally for 2 hrs before the erosive challenges of 0 (control), 10, 20, and 30 minutes’ duration. Specimens were randomly removed from the appliances after each challenge. Percentage of surface microhardness change (%SMC) was determined for the enamel specimens, and that of mineral loss and lesion depth for the dentin specimens. Enamel specimens with the pellicle showed a significantly lower %SMC, only after the 10-minute challenge. No protection was found for dentin. It was concluded that the acquired pellicle reduced dental erosion, but that this effect was limited to the less severe erosive challenge on enamel surfaces.
Oncology patients often experience swallowing difficulties, which can compromise adherence to treatment and consequently reduce its effectiveness. Improper handling of these hazardous drugs can lead ...to the risk of inhalation of particles or other exposures endangering the health of the persons involved such as nurses and pharmacists. The aim of this review is to analyse and update the recommendations for the manipulation of oral antineoplastic drugs in patients with swallowing difficulties. A literature review of articles, websites, guidelines and other documents published up to about the conditions of handling and administration of oral antineoplastic agents in oncology and oncohaematology was carried out. A table of 110 active principles was compiled. The information was grouped according to the name of the drug, instructions for oral and nasogastric tube administration and suggested recommendations. Among the drugs reviewed, 66.4% were suitable for dissolution. Although there is a lot of information in the literature, the nonstop development of new oncological drugs requires continuous updating. Therefore, we have collected the most recent data to provide a consultation tool for healthcare professionals and patients with swallowing difficulties.
Abstract Objective Professionally applied acidulated phosphate fluoride has been shown to reduce caries incidence. However, it has been suggested that its efficacy might be reduced in advanced ...non-cavitated lesions. This study aimed to compare the surface rehardening and fluoride uptake effect of 2%-NaF solutions at different pH on non-cavitated caries-like lesions with two different levels of demineralization. Methods Human enamel specimens were demineralized to create early and advanced non-cavitated lesions. Specimens for each type of lesion were divided into 3 groups, treated for four minutes with either 2%-NaF pH 3.5, 2%-NaF at pH 7.0, or neutral deionized water, and exposed to a pH cycling remineralization/demineralization model for five days. An additional treatment was then done as described above followed by five more days of cycling (total of 2 treatments, ten-day pH cycling). Specimens were analyzed for surface microhardness change and fluoride uptake. Results It was found that for both types of lesions, acidic pH fluoride treatment was significantly ( p < 0.05) more effective than neutral pH treatment in rehardening the lesion surface and promoting fluoride uptake. Furthermore, the low pH vs neutral pH difference in rehardening was significantly larger in the less demineralized lesions ( p = 0.0001). Water treatment resulted in no rehardening or fluoride uptake. Conclusions Results from this study suggest that high concentration fluoride treatments at acidic pH are more effective in rehardening the surface of non-cavitated caries lesions and promoting fluoride uptake than those at neutral pH. This effect appears to be greater in less demineralized lesions when compared to more advanced ones. Clinical significance The results of this investigation suggest that when no other attenuating circumstances are present (e.g., the possibility of damaging tooth-coloured restorations), high concentration fluoride treatments for high risk individuals might be more efficacious using products at low pH.
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