Dental caries is a highly prevalent diet-related disease and is a major public health problem. A goal of modern dentistry is to manage non-cavitated caries lesions non-invasively through ...remineralization in an attempt to prevent disease progression and improve aesthetics, strength, and function. Remineralization is defined as the process whereby calcium and phosphate ions are supplied from a source external to the tooth to promote ion deposition into crystal voids in demineralized enamel, to produce net mineral gain. Recently, a range of novel calcium-phosphate-based remineralization delivery systems has been developed for clinical application. These delivery systems include crystalline, unstabilized amorphous, or stabilized amorphous formulations of calcium phosphate. These systems are reviewed, and the technology with the most scientific evidence to support its clinical use is the remineralizing system utilizing casein phosphopeptides to stabilize and deliver bioavailable calcium, phosphate, and fluoride ions. The recent clinical evidence for this technology is presented and the mechanism of action discussed. Biomimetic approaches to stabilization of bioavailable calcium, phosphate, and fluoride ions and the localization of these ions to non-cavitated caries lesions for controlled remineralization show promise for the non-invasive management of dental caries. PUBLICATION ABSTRACT
Background: To investigate, in vitro, the effect on enamel erosion of the addition of 0.2% w/v casein phosphopeptide‐amorphous calcium phosphate (CPP‐ACP) to four commercially‐available soft drinks, ...two of which were carbonated.
Methods: Enamel specimens (n = 27) were sectioned from sound extracted human third molar teeth and polished to a mirror finish. Exposed enamel windows of 1 mm2 were created by painting the surface with acid‐resistant nail varnish. Four citric flavoured soft drinks (pH range 2.2 to 2.4) and distilled deionized water (DDW) were tested. Each drink was tested with and without 0.2% CPP‐ACP w/v. The specimens were placed into 50 mL of solution at 37 °C for 30 minutes, rinsed and varnish removed. The samples were profiled with a white light profilometer and erosive depths recorded.
Results: All soft drinks tested caused enamel erosion but adding 0.2% w/v CPP‐ACP significantly reduced (p <0.05) erosive depth in all test solutions in comparison with the solutions without CPP‐ACP. The erosive depths for all solutions with 0.2% CPP‐ACP did not differ significantly from those of DDW.
Conclusions: Adding CPP‐ACP at 0.2% w/v significantly decreased the erosivity of all four soft drinks. The erosivity of the soft drinks with 0.2% CPP‐ACP added did not differ significantly from that of distilled water.
Background
A range of dental varnishes have been commercialized recently that contain calcium and inorganic phosphate in addition to fluoride. The aim of this study was to analyse the fluoride, ...calcium and inorganic phosphate ion release from: (1) MI Varnish containing casein phosphopeptide‐amorphous calcium phosphate (CPP‐ACP); (2) Clinpro White containing functionalized tricalcium phosphate (fTCP); (3) Enamel Pro containing amorphous calcium phosphate; (4) Bifluorid 5 containing calcium fluoride; and (5) Duraphat (no added calcium control).
Methods
The varnishes were applied to a standardized surface area of polyvinyl chloride (n = 7 per group) and immersed in 25 g of distilled deionized water which was changed at 1, 4, 24, 72 and 168 hours. The ion release was determined by ion chromatography and expressed as μmol (cumulative) per gram of varnish.
Results
All varnishes released measurable fluoride and calcium, however only MI Varnish and Enamel Pro released significant levels of inorganic phosphate. At 24 hours the order of cumulative fluoride release was: 1>3>4>2=5 with 1 significantly higher (p < 0.05) than the rest. At 72 and 168 hours, the cumulative calcium release was: 1>4>3>2=5 with 1 significantly higher (p < 0.05) than the rest.
Conclusions
MI Varnish containing CPP‐ACP had the highest release of calcium and fluoride ions.
Background: Quantitative light‐induced fluorescence (QLF) and digital photography (DP) have been proposed as clinical methods for measuring changes in enamel mineral content. The aim of this study ...was to compare the ability of QLF and DP with the in vitro gold standard transverse microradiography (TMR) to measure the remineralization of enamel subsurface lesions.
Methods: Subsurface lesions were formed in enamel (n = 40) and exposed to remineralization solutions for 10 days. Changes were analysed by DP, QLF and TMR to determine percentage changes in luminescence (%L), fluorescence (%F) and mineral content (%R), respectively and correlation between these parameters determined.
Results: The correlations between TMR and QLF (r = 0.63), TMR and DP (r = 0.59), and DP and QLF (r = 0.64) were all moderate but statistically significant (p < 0.001). The variability in %L and, to a lesser extent, %F values significantly impacted on the potential role of DP and QLF as methods by which mineral content changes produced by remineralization treatments could be accurately measured.
Conclusions: Both QLF and DP provided data that correlated moderately with TMR data. QLF images were easier to analyse, free of glare and had less variability compared with those produced using DP.
Background: Dental erosion is an increasingly prevalent problem in Australia. The aim of this study was to analyse the composition and erosive potential of beverages sold for consumption in ...Victorian schools.
Methods: Fifteen drinks were selected and analysed to determine their pH, titratable acidity and ionic composition (calcium, fluoride and inorganic phosphate). The erosive potential of the beverages was measured by analysing weight loss, surface loss and the release of calcium ions from human enamel following a 30‐minute or 24‐hour exposure. The association of the chemical parameters with the measures of erosion was determined using Spearman’s rank correlation.
Results: All beverages tested except the milks and the bottled water produced significant dental erosion in vitro. The only chemical parameter that correlated significantly with all measures of erosion was the initial pH of the beverage (p < 0.01). Levels of fluoride similar to those of Australian reticulated water were found in the carbonated beverages.
Conclusions: The majority of the tested beverages sold from school canteens exhibited erosive potential.
Abstract A new glass-ionomer cement (GIC) (Fuji VII™ EP) includes 3% (w/w) casein phosphopeptide–amorphous calcium phosphate (CPP–ACP) to enhance ion release. Objectives To assess this new GIC ...compared with a GIC without CPP–ACP (Fuji VII™) with respect to ion release, changes in surface hardness and in mass under a variety of acidic and neutral conditions. Methods Eighty blocks of Fuji VII™ (F7) and Fuji VII™ EP (F7EP) were subjected to three acidic solutions (lactic and citric acids pH 5.0, hydrochloric acid pH 2.0) and water (pH 6.9) over a three-day period. Ion release, surface hardness and weight measurements were carried out every 24 h. Results Higher calcium ion release from F7EP was observed under all acidic conditions. Increased inorganic phosphate ion release was observed for F7EP in hydrochloric and citric acids. Fluoride ion release was similar between F7 and F7EP under all conditions but was significantly higher in acids compared with water. After three days there was no significant difference in surface hardness ( p > 0.05) between the two materials under all conditions except hydrochloric acid. Minimal change in mass was observed for F7 and F7EP in water, lactic and hydrochloric acids, however citric acid caused significantly more mass loss compared with water ( p < 0.001). Conclusion Incorporation of 3% (w/w) CPP–ACP into F7 enhanced calcium and phosphate ion release, with no significant change in fluoride ion release and no adverse effects on surface hardness or change in mass. Clinical significance statement GICs have the potential to release fluoride ions particularly under acidic conditions associated with dental caries and erosion. A new GIC containing CPP–ACP and fluoride releases not only fluoride ions but also calcium and phosphate ions under acidic conditions which should help to inhibit demineralisation associated with caries and erosion.
Background: Dental erosion is an increasingly prevalent problem in Australia, with the consumption of sports beverages suggested as a risk factor. The aim of this study was to compare the erosive ...potential of Australian sports beverages.
Methods: Ten beverages were selected and analysed to determine their pH, titratable acidity and apparent degree of saturation with respect to apatite. The erosive potential of the beverages was measured by human enamel surface loss and surface softening following a 30‐minute exposure. A taste testing panel was established to determine the palatability of the sports beverages.
Results: All sports beverages except Sukkie and Endura produced substantial surface loss and surface softening. Compared with the other sports beverages, Sukkie and Endura had a higher pH, lower titratable acidity and higher calcium content. However, Sukkie and Endura were deemed to be less palatable than the other more acidic sports beverages.
Conclusions: The majority of the sports beverages tested produced dental erosion in this in vitro model. However, two new products Sukkie and Endura have lower erosive potential but also lower palatability.
Background: The aim of this in vitro study was to determine the effect of four different orthodontic adhesive removal techniques on sound, demineralized and remineralized enamel.
Methods: Composite ...resin adhesive was bonded to 100 teeth which were divided into four groups with each comprising five sound teeth and 20 teeth with demineralized and remineralized lesions adjacent to the adhesive. Adhesive was removed with either: (1) slow speed bur (SS); (2) high speed bur (HS); (3) aluminium oxide disc (DC); or (4) ultrasonic scaler (US). Damage to the enamel was assessed using white light profilometry, digital photography and scanning electron microscopy.
Results: The least to greatest mean depth of damage with the four different adhesive removal techniques to sound enamel was DC = SS < US = HS and to demineralized and remineralized enamel were DC < HS < US = SS. Sound enamel experienced the least amount of damage. Remineralization prior to adhesive removal significantly reduced the amount of damage produced by all techniques compared with demineralized enamel. Discs were the least damaging to demineralized and remineralized enamel compared with the other removal techniques.
Conclusions: When demineralization was present discs were found to be the least damaging adhesive removal technique and remineralization further reduced the amount of enamel damage.
Background: Casein phosphopeptide‐amorphous calcium phosphate (CPP‐ACP) is an anticariogenic agent that is suitable to be added to foods. The aim of this double‐blind, three‐way crossover randomized ...study was to investigate the capacity of CPP‐ACP, when added to bovine milk, to remineralize enamel subsurface lesions in situ.
Methods: Ten subjects drank 100 mL of bovine milk containing no added CPP‐ACP (control milk), 0.2% (w/v) CPP‐ACP or 0.3% (w/v) CPP‐ACP, for 30 seconds once daily for 15 days, whilst wearing removable appliances with attached slabs of enamel containing subsurface enamel lesions. After each treatment and a one‐week washout period, subjects crossed over to another treatment and this was repeated until they had consumed each of the three milk products. At the completion of each treatment the enamel slabs were removed and remineralization was determined using microradiography.
Results: The results demonstrated that all three milk samples remineralized enamel subsurface lesions in situ. However, the two milk samples containing added CPP‐ACP each produced significantly greater remineralization than the control milk.
Conclusions: The remineralizing effect of CPP‐ACP in milk was dose‐dependent with milk containing 0.2% CPP‐ACP and 0.3% CPP‐ACP producing an increase in mineral content of 81% and 164%, respectively, relative to the control milk.
Background
The aims of this study were to: (1) analyse the fluoride content of tank water; (2) determine whether the method of water collection or storage influenced fluoride content; and (3) survey ...participant attitudes towards water fluoridation.
Methods
Plastic tubes and a questionnaire were distributed through dentists to households with water tanks in Victoria. A midstream tank water sample was collected and fluoride analysed in triplicate using ion chromatography
Results
All samples (n = 123) contained negligible amounts of fluoride, with a mean fluoride concentration of <0.01 ppm (range: <0.01–0.18 ppm). No statistically significant association was found between fluoride content and variables investigated such as tank material, tank age, roof material and gutter material. Most people did not know whether their tank water contained fluoride and 40.8% preferred to have access to fluoridated water. The majority thought fluoride was safe and more than half of the respondents supported fluoridation. Fluoride content of tank water was well below the optimal levels for caries prevention.
Conclusions
People who rely solely on tank water for drinking may require additional exposure to fluoride for optimal caries prevention.
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