Demineralization of dentine grooves in vitro

Caries mainly occurs at retention sites for plaque such as pits, fissures, margins of restorations and interproximal sites. An in vitro model was developed to investigate dentine caries in narrow gaps. Forty bovine coronal dentine discs were covered with bonding agent. In 20 discs, two grooves, 200 and 340 mu m wide and 500 mu m deep, were sawn to mimic fissures. In the 20 other discs, a 1-mm-wide groove was made and, after polyester sheets were placed against both walls, filled with composite. After curing of the composite and removal of the sheets, grooves of 22 mu m remained at the borders of the restoration. All grooves were exposed to 8% methylcellulose gel 0.1 M lactic acid at pH 4.8 for 1 week. Demineralization was determined by microradiography of sections sawn out of the center of the discs. The walls of the grooves showed subsurface lesions, which decreased in size towards the base of the grooves. The average mineral losses (vol % x mu m) at the entrance of the 22-, 200- and 340-mu m-wide grooves were 1,112 (SD 370), 1,277 (293) and 1,277 (255), halfway down the groove 218 (150), 659 (244) and 797 (207) and at the base of the groove 140 (88), 285 (145) and 504 (205), respectively. Analysis of variance and Tukey's B test showed that the average mineral losses from grooves of different width and from sites at different depth were all significantly different at p<0.05 level, but not for the mineral losses from the entrance of the two wider grooves and from the two lower sites in the narrowest groove. The reduced mineral loss in the two narrower groove widths is assumed to be caused by the more limited inward diffusion of acids and outward diffusion of mineral ions through the methylcellulose gel.

Effect of sodium hypochlorite treatment on remineralization of human root dentine in vitro

Dentine consists simplified of mineral and of several organic components. Sodium hypochlorite (NaOCl) is a well-known nonspecific proteolytic agent capable to remove organic material. The aim of this study was to investigate the influence of organic material removal from artificial dentine lesions by means of NaOCl pretreatment on subsequent remineralization with and without fluoride. Human root dentine samples were demineralized in an acidic gel (pH = 5) at 37 degrees C for 2 weeks. After 2 min of pretreatment with a 0.4, 2 or 10% NaOCl solution, the samples were remineralized in a 20 mM HEPES buffer (pH = 7) containing 1.5 mM Ca(2) and 0.9 mM phosphate with or without addition of 10 ppm F(-) as NaF at 37 degrees C for 8 days. Mineral profiles were assessed by means of transversal microradiography after diol treatment to avoid shrinkage caused by drying. In a separate experiments the dentine contraction caused by 10% NaOCl was assessed. The contraction (negligible for sound dentine) was found to be about 12% for the lesions. The remineralization results showed that pretreatment with a 10% NaOCl solution for 2 min, increased lesion remineralization. After NaOCl treatment, the amount of accumulated mineral increased by about 27% without F in the remineralization solution, and by about 4% with 10 ppm in solution. The in vitro results suggest that removal of organic materials from dentine lesions is an interesting approach to enhance remineralization.

[Constant composition study on kinetics of enamel demineralization]

The aim of this work was to investigate the kinetic behaviour of whole enamel demineralization compared with that of powder enamel. Constant composition technique was used to maintain a constant undersaturation degree with respect to hydroxyapatite in the demineralizing solutions. The demineralizing processes were monitored by recording the volume of adding titrant solution. Finally, sections were measured for lesion depth by microradiography, and blocks were tested for microhardness. The results showed that demineralization of enamel powder nearly completed within 40 minutes, while demineralization of whole enamel was much slower and with a constant rate within the experimental time. It was also found there were significant increases of concentrations of calcium and phosphate in solutions during the first 40 hours of whole enamel demineralization. It suggests that the kinetic behaviour of whole enamel demineralization is different from that of powder enamel, which is not only due to the unique transport process in whole tissue, but also possible due to a different phase transformation before and after formation of a surface layer.

The influence of mineral loss on the auto-fluorescent behaviour of in vitro demineralised dentine

The aim of this study is to investigate the influence of demineralisation on the fluorescent properties of dentine. The fluorescence emission at 529 nm due to 515 nm excitation of in vitro demineralised lesions was determined with a micro-Raman spectroscope as a function of location. Results were compared with the mineral loss profiles of the same lesions measured by microradiography. The root surfaces of 6 in vitro demineralised human third molars (lactic acid CMC gel, pH 5; six groups: 0, 4, 7, 14, 18 and 21 days) were used in the experiment. Thin slices of +/- 130 microns were cut perpendicular to the tooth axis. The fluorescence scans corresponded to mineral loss profiles. Confocal microscope images showed increasing fluorescence with increasing mineral loss. From these results it is concluded that this mineral loss causes an increase in auto-fluorescence by a factor of at least 10, therefore the chromophore causing this green fluorescence must be organic in nature. De-quenching or modification of this fluorophore due to the demineralisation process is probably the cause for the increase of the green fluorescence.

Autofluorescence of bulk sound and in vitro demineralized human root dentin

The aim of this paper is to report on the demineralization-induced changes in dentin autofluorescence. Confocal laser scanning microscopy (CLSM) images and fluorescence excitation and emission spectra in vitro demineralized root surfaces and sound controls on the same tooth roots were compared. When observed in CLSM images, demineralized dentin, excited at 488 nm, gave an increased emission at 529 nm compared to sound dentin. The difference in fluorescence decreased deeper into the root, as the sound dentin underneath the lesion was reached. In contrast, when using fluorescence spectrophotometry, excitation around 460 and 488 nm yielded a lower emission around 520 nm for demineralized dentin than for sound dentin, but in a more pronounced peak. From excitation spectra for emission around 520 nm, it could be seen that in demineralized dentin the contribution of excitation between 480 and 520 nm was more important than in sound dentin. The recorded fluorescence in CLSM images was not affected by demineralization-caused changes in scattering and absorption properties, due to the small measurement volume. Thus, the increased fluorescence for demineralized dentin implies an increased quantum yield. In fluorescence spectrophotometry, where the measurement volume is large, changes in scattering and absorption do have an influence on the fluorescence signal. Then, increased absorption by non-fluorescing chromophores and increased re-absorption around the emission wavelength may compensate for the increase in quantum yield and absorption around the excitation wavelength by fluorophores.

pH-cycling of enamel and dentin lesions in the presence of low concentrations of fluoride

F-dentifrice usage causes slightly elevated fluoride levels in saliva. Therefore, the effects of permanent low fluoride concentrations versus daily dentifrice treatments were studied on enamel and dentin lesions in a pH-cycling model of alternating demineralization and remineralization. Groups received 1) no fluoride treatment, 2) 3 mu M (0.06 ppm) F continuously present during re- and demineralization or 3) daily 5-min F-dentifrice treatments. Solutions were analyzed for changes in calcium and fluoride. Cumulative results (10 d) showed that for the non-fluoride group the dentin lesions increased, while for enamel lesions mineral uptake and loss were balanced. Addition of 3 mu M F caused small, non-significant, enhancement of remineralization (1-7%), while demineralization was significantly inhibited for both tissues (9-23%). The daily dentifrice treatments resulted in a balance between mineral uptake and loss of dentin, due to inhibited demineralization (-33%) and enhanced remineralization (+79%). For enamel, the F-dentifrice treatments resulted in 43% reduction of demineralization, with no significant effect on remineralization. Fluoride loss from the 3 mu M F cycling solutions was significant (up to 50%) and constant during the experimental period. Microradiographic analysis showed remineralization at the lesion front in enamel. In dentin, the lesion depth was increased in all groups, with concomitant mineral deposition in the surface region of the dentifrice group. Results indicate that slightly elevated fluoride levels may be considerably less effective in inhibiting lesion progression in dentin than in enamel, and suggest mineral uptake and loss to occur at similar depths for enamel lesions, while demineralization and remineralization occur at different depths in dentin.

The effects of a sodium hypochlorite treatment on demineralized root dentin

The effects of a 10% NaOCl treatment for 2 min on demineralized human root dentin were investigated by means of: microradiography (MR), scanning electron microscopy (SEM), confocal laser scanning microscopy (CLSM) and secondary ion mass spectroscopy (SIMS). MR measurements revealed that NaOCl caused a tissue contraction not related to water loss but to removal of organic substance(s), resulting in reductions of the lesion depth and mineral loss values by 15% and 42%, respectively. CLSM observations on wet dentin showed that the dentinal tubules underneath the surface are clearly observable and not deformed substantially by the NaOCl, except near the outermost surface. This indicates the importance of wet as well as of dried (high vacuum) observations. SEM micrographs (high vacuum) showed definite changes in the outer dentin surface structure; 85% of the originally open dentinal tubules were closed after NaOCl treatment. No marked changes were observed in the dentin ultrastructure inside lesions, as shown by SEM on fractured surfaces. SIMS data, pertaining to samples in high vacuum, showed a remarkable increase of chlorine (Cl) content in the entire lesion due to the NaOCl, indicating deep penetration of the original OC1 ions. The results suggest that the 2-min treatment of demineralized dentin by NaOCl solutions removes and/or changes part of the dentin matrix in nearly the whole lesion. As a consequence the mineral is somewhat redistributed, the outermost surface of a few mu m is changed, but the main dentin structure and element composition are still intact. These findings indicate that NaOCl treatments are of interest in remineralization and hyper-remineralization studies of dentin.

Role of models in assessing new agents for caries prevention--non-fluoride systems

While fluoride is an effective anti-caries agent, the search for more effective alternative therapies continues. A wide range of non-fluoride anti-caries agents has been postulated, and this paper reviews some of the pre-clinical models that have been utilized in their evaluation and some of the pitfalls that must be avoided. Using data on the potential anti-caries efficacy of phosphopeptides obtained from casein, the caution that must be applied in extrapolating laboratory data to predict clinical performance is discussed. Evaluation strategies that focus on only one potential mode of action (e.g., inhibition of demineralization) may overestimate the true clinical efficacy which may arise from a combination of two or more effects (e.g., inhibition of demineralization and stimulation of remineralization). Although laboratory and in situ data predict anti-caries efficacy for sodium trimetaphosphate in combination with fluoride, this was not found in three-year clinical trials. A possible reason for this, the lack of suitable calibration methods, is discussed. Finally, some comments on the appropriateness of laboratory evaluation strategies are made.

The application of in vitro models to research on demineralization and remineralization of the teeth

Progress in in vivo and in situ experimentation has led many researchers to speculate as to the relevance and importance of in vitro testing protocols in caries research. A Medline/Biosis search for the present review revealed well over 300 citations (since 1989) documenting in vitro tests associated with caries research on mineralization and fluoride reactivity. The present survey documents these recent applications of in vitro test methods in both mechanistic and 'profile' caries research. In mechanistic studies, in vitro protocols over the past five years have made possible detailed studies of dynamics occurring in mineral loss and gain from dental tissues and the reaction dynamics associated with fluoride anticaries activity. Similarly, in profile applications, in vitro protocols make possible the inexpensive and rapid--yet sensitive--assessment of F anticaries efficacy within fluoride-active systems, and these tests represent a key component of product activity confirmation. The ability to carry out single variable experiments under highly controlled conditions remains a key advantage in in vitro experimentation, and will likely drive even further utilization, as advances continue in physical-chemical and analytical techniques for substrate analysis in these protocols. Despite their advantages in vitro testing protocols have significant limitations, most particularly related to their inability to simulate the complex biological processes involved in caries.

In situ caries models

By using in situ models, we have the potential to study both fundamental aspects of the caries process as well as more applied research problems such as the effect of food on dental caries and the role of fluoride in caries prevention in human subjects without actually causing caries in the natural dentition. The key experimental parameters that need to be considered in the development of an in situ model are the characteristics of the subject panel, the physical design of the model, the type of hard tissue substrate and the method of assessing mineral status, and the study design and clinical protocol. Each parameter must be carefully considered in relation to the objectives of the research, study design requirements, ethical considerations, impact on clinical relevance, and impact on the control of variation. The major source of variation associated with in situ models should be of biological and not experimental origin. The design and conduct of proper in situ model studies require a clear understanding of the caries process, sound analytical support, and a knowledge of how to work with research subjects to achieve a high level of compliance. Given the complex nature of caries, a combination of hard tissue substrates--including sound, surface-softened lesions and subsurface lesions--may be necessary to model all aspects of caries progression and prevention successfully. Internal validation of in situ models using fluoride dose-response controls is considered to be necessary for studies evaluating the efficacy of new fluoride dentifrice formulations.

Role of saliva in caries models

The crucial role played by the actions of saliva in controlling the equilibrium between de- and remineralization in a cariogenic environment is demonstrated by the effects on caries incidence of salivary dysfunction and by the distribution of sites of caries predilection to those were salivary effects are restricted. However, of the several properties of saliva which may confer protective effects, it is not certain which are most important. A distinction can be made between static protective effects, which act continuously, and dynamic effects, which act during the time-course of the Stephan curve. Evidence implicates salivary buffering and sugar clearance as important dynamic effects of saliva to prevent demineralization; of these, the buffering of plaque acids may predominate. Enhanced remineralization of white spot lesions may also be regarded as dynamic protective effects of saliva. Fluoride in saliva (from dentifrices, ingesta, etc.) may promote remineralization and (especially fluoride in plaque) inhibit demineralization. The design of experiments using caries models must take into account the static and dynamic effects of saliva. Some models admit a full expression of these effects, while others may exclude them, restricting the range of investigations possible. The possibility is raised that protective effects of saliva and therapeutic agents may act cooperatively.

Effect of low levels of fluoride on calcium uptake by demineralized human enamel

The effect of fluoride (ca. 0.1 parts/10(6)) on calcium uptake by enamel was examined under alternating remineralizing and demineralizing conditions. The remineralizing solutions contained either 0, 0.058, 0.104, or 0.138 parts/10(6) fluoride (ex NaF), while the demineralizing solutions contained no added fluoride. During the demineralization periods, calcium loss was similar for all groups. However, during the remineralizing periods, all levels of added fluoride were found to promote calcium uptake. Calcium levels taken up by the artificial lesions were sound to increase with increasing fluoride concentration in solution, and were independent of surface area of exposed enamel. In the absence of fluoride, even under conditions that are considered to be remineralizing, further demineralization took place.

The use of high-phosphorus supplements to inhibit dental enamel demineralisation by ice lollies

Five new formulations of water ice lollies with a high-phosphorus (low Ca) supplementation ratio were tested for their erosiveness of dental enamel or hydroxylapatite in vitro. Compared with the basic unsupplemented lolly, all five formulations that had been prepared with additional calcium and phosphorus, but in a low Ca/P ratio, as potential inhibitors of demineralisation, were associated with significantly less attack on dental mineral, as measured by the dissolution of calcium and phosphorus.

Influence of fluoride in saliva during the early cariogenic changes in the enamel of boys and girls

In boys and girls cariogenic changes in the dental enamel in relation to fluoride (F-) concentrations in stimulated and unstimulated saliva were studied in a six-month period. Also the use of various types of applications of F- was assessed. No difference in the use of F- between boys and girls before and after the interval was observed. Also no clear differences were found between boys and girls in the levels of F- in both types of saliva, determined at the end of the six-month period. The most important finding was that for all children, a significantly positive relationship was found between the disappearance of white spots turning into sound enamel (regression) and the F-concentration in unstimulated saliva. In addition, girls who developed new white spots had higher levels of F-, but those who developed new cavities had lower F- levels in both types of saliva. Apparently F- can prevent dental caries by acting very early on remineralization and demineralization processes in enamel surfaces.

Structure of artificial enamel lesions after topical applications of high-concentration sodium fluoride solution in vitro

A three-layer structure, including a columnar layer (CL), a buffer layer, and unaffected intact enamel, was successively formed from the outer to the inner part of artificial enamel lesions (AEL) by topical applications of a high-concentration acidic sodium fluoride solution (10,000 ppm, pH 5.6) in vitro. The AEL was produced in bovine enamel that was decalcified for 5 days in a lactic acid gel system. The morphological observations by using scanning electron microscopy showed that the CL was made of columnar deposits of small globules about 0.5 microns in diameter. It was observed for the first time that small globules filled the demineralized interprismatic regions in the buffer layer. The unaffected intact enamel was protected from further demineralization under the acidic condition. Structure and composition of the CL were investigated by using X-ray diffraction and X-ray photoelectron spectroscopy. In the CL the atomic ratio was Ca:P = 12.6 and Ca:F = 0.75, and the small globules were mainly a mixture of polycrystalline calcium fluoride and hydroxyapatite. For comparison, the sound enamel and the AEL attained by applications of 0 and 100 ppm acidic sodium fluoride solutions (pH 5.6) were also investigated. The formation mechanism of the three-layer structure and the related cariostatic effects are discussed.

Formation of phosphate-containing calcium fluoride at the expense of enamel, hydroxyapatite and fluorapatite

During the caries process complex reactions involving calcium, phosphate, hydrogen and fluoride ions as main species take place. In this study the precipitation and dissolution reactions occurring in suspensions of enamel, hydroxyapatite (HAP) and fluorapatite (FAP) on addition of fluoride were investigated under well-defined conditions. pH and pF were monitored; calcium and phosphate concentrations were measured at selected times; the solid phases were examined by infra-red, X-ray diffraction and transmission electron microscopy. Precipitation of phosphate-containing calcium fluoride crystals, CaF2(P), can cause severe reduction in the calcium ion concentration and release of hydrogen ions from the precipitated phosphate. These reactions result in considerable dissolution of enamel, HAP and even of FAP. More of the added mineral dissolves with 50 mmol/l fluoride than with 10 mmol/l fluoride, mainly due to the greater reduction in calcium ion concentration. This work shows that phosphate-containing calcium fluoride is most likely an important compound to be considered in the caries process.

The influence of the organic matrix on demineralization of bovine root dentin in vitro

The effect of matrix degradation on the rate of demineralization of dentin lesions was investigated. It was hypothesized that the demineralized matrix would inhibit the demineralization of the underlying mineralized dentin. Bovine root dentin specimens were alternately demineralized and incubated with either a bacterial collagenase or buffer (control). The demineralization was carried out under various conditions: Acetic acid solutions were used to form incipient and advanced erosive lesions, and lactic acid solutions containing a bisphosphonate were used to form incipient subsurface lesions. Under all conditions, the demineralization was found to be accelerated when the matrix was degraded by collagenase. This increase was more pronounced in advanced erosive lesions than in incipient lesions. Microscopic examination of collagenase-treated specimens revealed that the matrix of erosive lesions contained several layers of differently affected matrices, whereas the matrix of subsurface lesions appeared to be equally affected throughout the lesion. In conclusion, the matrix degradation was different in erosive and subsurface lesions but promoted the demineralization in both types of lesions.

Effects of aluminum (III) and fluoride on the demineralization of bovine enamel: a longitudinal microradiographic study

Longitudinal microradiography has been used to determine inhibiting effects of aluminum (III), Al, and fluoride on mineral loss from slices of bovine enamel exposed to a demineralizing solution 4 h daily for 35 days. Inhibitor treatment was 5 min four times daily. For the remaining time, the samples were immersed in a neutral calcium phosphate solution which allowed neither remineralization nor demineralization. This study indicates that a 1-mM (27 ppm) solution of Al in a 0.1-M lactate solution, pH 5, has an inhibitory effect on the in vitro demineralization of bovine enamel. Application of this solution alternating with 20 mM (380 ppm) fluoride gave the same total inhibition as treatment with 20 mM fluoride alone.

In situ models, physico-chemical aspects

In situ (intra-oral) caries models are used for two purposes. First, they provide information about oral physiological processes. Such information helps to detail our knowledge of the oral ecosystem and to verify conclusions from in vitro experiments. Second, in situ models are utilized to test preventive agents in the phase between laboratory testing and clinical trials. Most investigations involving enamel inserts have been aimed at testing new dentifrices. The experimental designs of such studies usually do not allow one to draw conclusions on physico-chemical processes, e.g., because of single point measurements. Studies of model parameters (lesion type, lesion severity, and de/remineralization in time) constitute only a minority of the research reports. The most striking observation obtained with in situ models has been the significant differences in de/remineralization observed among individuals and, more importantly, within one individual during different time periods and between different sites in the same mouth (for review, see ten Cate et al., 1992). Regardless of this, some general findings can be inferred: During in situ demineralization, up to 62 vol% microns/day may be removed from enamel. For dentin specimens, this value may be as high as 89 vol% microns/day. For remineralization, during fluoride dentifrice treatment, a median deposition rate of 0.7%/day (for lesions with integrated mineral loss values between 2000 and 4000 vol% microns) is found. The rate of deposition seems to be correlated with the extent of the pre-formed lesion. This suggests that the number of sites (crystallite surface) available for calcium phosphate precipitation is an important parameter.(ABSTRACT TRUNCATED AT 250 WORDS)

The video camera compared with the densitometer as a scanning device for microradiography

In the recent past image analysis systems, comprising a video (CCD) camera and dedicated software, have replaced densitometer-based systems to analyze mineral content profiles using transversal microradiography (TMR). The main reasons for the introduction of the CCD camera were the ease and speed at which it can be operated. The densitometer, as a scanning device for TMR, has in the recent years been validated and is in this study considered as 'gold standard'. Comparisons of the two scanning devices for measuring the optical density of microradiograms have never been reported in the literature. The focus of this study was on accuracy and reproducibility of the scanning devices with the emphasis put on possible limitations of the CCD camera relative to the densitometer. These include resolution, number of gray levels and homogeneity of illumination of the scan area. The microscope was arranged in such a way that the same area on the microradiogram could be assessed by both scanning devices. Three different types of lesions were analyzed: a subsurface lesion, a surface-softened lesion and a laminated lesion. Paired t tests showed no significant difference between the mineral content profiles produced by the two scanning devices. The integrated mineral loss values were calculated and compared with analysis of variance and showed no significant differences. It is therefore concluded that mineral content profiles and integrated mineral loss obtained by the CCD camera are as accurate and reproducible as those obtained by the densitometer.

Effects of frequency and duration of acid exposure on demineralization/remineralization behaviour of human enamel in vitro

An in vitro oscillating system, employing human enamel and realistic time intervals and temperature (approximately 35 degrees C) and measuring mineral loss/gain on a volume basis, was used to investigate the effects of both frequency and duration of exposure to low pH (< 5) on the demineralization and remineralization behaviour of human enamel. Sections of human teeth were cycled through one of three different regimens: (1) 3 x 20-min acid challenges; (2) 6 x 10-min acid challenges and (3) 6 x 20 min acid challenges, over single 24-hour periods. The acid challenge periods of 3 x 20, 6 x 10 and 6 x 20 min produced no significant differences in net mineral lost, i.e., the volume of mineral lost per volume of enamel exposed was similar irrespective of frequency or duration of acid exposure (approximately 0.5% vol/vol). Increased frequency of acid exposure did, however, tend to alter the total demineralization/total remineralization amounts, resulting in significantly greater amounts of mineral loss and gain. The data suggest that the remineralization capacity of enamel is considerable and that factors such as inhibition of remineralization may be important in determination of net mineral loss from the tooth.

In vitro bond strengths and SEM evaluation of dentin bonding systems to different dentin substrates

In comparison to enamel, bonding to normal dentin is a greater challenge because of its organic constituents, fluid-filed tubules, and variations in intrinsic composition. Bonding to sclerotic dentin is even more difficult. To evaluate the shear bond strengths of four adhesive systems to dentin substrates with different levels of mineralization, 120 extracted human teeth were randomly assigned to three groups (n = 40). After mid-coronal dentin was exposed, groups of specimens were artificially hypermineralized by immersion in a remineralizing solution, demineralized by means of an acetic acid demineralizing solution, or stored in distilled water to model sclerotic, carious, and normal dentin, respectively. Resin composite was bonded to dentin by use of commercial adhesive systems. After the specimens were thermocycled, shear bond strengths were determined in an Instron universal testing machine. Dentin substrates and resin/dentin interfaces were examined by SEM. For each adhesive system, the mean shear bond strength to normal dentin was significantly higher than that to either of the other substrates. Shear bond strengths to hypermineralized dentin were significantly higher than those to demineralized dentin with all adhesives except Prisma Universal Bond 3.

An in vitro model for studying the efficacy of fluoride dentifrices in preventing root caries

This investigation tested and validated an in vitro model for studying the effects of fluoride on human dentin mineral content and fluoride uptake. Four studies examined the effects of different concentrations of fluoride, established dose-response profiles with NaF and Na2PO3F, and tested commercial dentifrices. A 7- or 14-day cyclic treatment regimen involved four 1-min exposures of sound human dentin specimens to the treatment agents, a 4-hour acid challenge period, and 20 h in human saliva daily. Mineral content was analyzed by image analysis microradiography and fluoride assays were performed using a microdrill biopsy technique. Data from these studies established the ability of the in vitro model to provide reproducible results, to demonstrate significant dose-related differences in the effects of both NaF- and Na2PO3F-containing treatments on dentin fluoride uptake and demineralization, and to detect a fluoride-induced reduction in dentin caries, relative to a nonfluoride control, similar to results established in a clinical trial.

Effect of xylitol and sorbitol in chewing-gums on mutans streptococci, plaque pH and mineral loss of enamel

Seventeen subjects with more than 3 x 10(5) mutans streptococci per millilitre of saliva completed this randomised, cross-over study. Four different chewing-gums, containing: (1) 70% xylitol, (2) 35% xylitol + 35% sorbitol, (3) 17.5% xylitol + 52.5% sorbitol, and (4) 70% sorbitol, were tested. The participants used 12 pieces of each gum per day for 25 days. During the four experimental periods, they wore a removable palatinal plate containing two demineralised enamel samples, and brushed their teeth with a non-fluoridated toothpaste. The results showed that an increased concentration of xylitol in the gum resulted in a lower number of mutans streptococci in both saliva and dental plaque, although the decreases were only significant in the saliva samples (p < 0.01). The pH drop in plaque, measured in vivo after a 1-min mouthrinse with a 10% sorbitol solution, was least pronounced after the 70% xylitol gum and most pronounced after the 70% sorbitol gum period (p < 0.01). No significant differences were found after a mouthrinse with a 10% sucrose solution. All demineralised enamel samples lost mineral during the experimental periods. However, the lesion depth as well as the mineral loss values, assessed microradiographically, did not differ significantly between the four chewing-gums.

Delayed effect of wheat starch in foods on the intraoral demineralization of enamel

There is considerable evidence for an association between dental caries and food starches. However, the intraoral utilization of starch may be quite complex, giving rise to conflicting results. Demineralization induced by unsweetened cookies was examined in an intraoral model system that utilized palatal appliances containing blocks of bovine enamel. The enamel surfaces were covered with either a filter paper disc to trap sugars or a layer of Streptococcus mutans to metabolize the sugars and bring about enamel demineralization. Demineralization was determined as an increase in porosity with respect to iodide ions (delta Ip). Measurements revealed a rapid elevation and maintenance of high levels of maltose in the plaque space after ingestion of the unsweetened or sweet cookies. Entrapped food particles appeared to serve as a reservoir of maltose. Unsweetened cookies brought about enamel demineralization, but the pH of the streptococcal plaque fell slowly, and the initiation of demineralization was delayed. Thus, delta Ip and plaque pH were -0.3 +/- 1.3 U and 6.1 +/- 0.3, respectively, after 15 min. The delay was shown to be related to the need to induce the acidogenic streptococci to metabolize maltose. Once induced, delta Ip rose rapidly and reached a maximum at 45 min. Sweet cookies released sucrose and maltose and brought about a rapid onset of demineralization. In summary, the data demonstrated (1) that maltose was released rapidly from unsweetened cookie particles and diffused into the plaque space of the model system and (2) that maltose-dependent demineralization of enamel required time for the induction of the streptococcal cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Secondary caries in dentine around composites: a wavelength-independent microradiographical study

Composite restorations are prone to develop secondary caries if a gap exists between tissue and restoration. The aim of this article was to quantify the effects of a fluoridating and non-F composite on secondary dentine caries in vitro as a function of time. The mineral loss in dentine was assessed in an artificial gap of 200 microns width at the composite/dentine interface; the samples were demineralised in a carboxymethylcellulose gel (pH = 5, 37 degrees C) for 8 weeks. Once a week the mineral content of the samples was determined using non-destructive wavelength-independent microradiography (WIM). After 8 weeks transversal microradiography (TMR) was done on the samples to investigate the mineral distribution of the dentine lesions. The WIM results show that the fluoride-releasing composite decreased the dentine demineralisation statistically significantly with respect of the non-F control by approximately 45%. The mineral loss values are found to be strictly proportional to time; the demineralisation reduction is expected to continue over extended periods of clinical relevance. The TMR results show that the fluoridating composite reduced the mineral loss values significantly with respect to the non-F control by approximately 55%, but had a negligible effect on the lesion depth values. This study indicates that WIM is an accurate and reliable technique to measure in vitro secondary dentine caries next to a composite restoration as a function of time.

Bacterial colonization and degradation of demineralized dentin matrix in situ

Lesion formation in dentin involves demineralization followed by degradation of the exposed organic matrix. Proteinases from microorganisms present in the dentin are believed to play an important role in the breakdown of the dentinal collagen. In this study, the microflora colonizing decalcified dentin matrix, placed in situ, was identified. The gelatinolytic activity of the isolated strains was assessed and related to the degradation of the dentin matrix. The predominant species found were Streptococcus mitis. Peptostreptococcus productus, Lactobacillus casei, Propionibacterium species and Veillonella parvula. Marked interindividual variation in the composition of the microflora was observed. The microflora possessed gelatinolytic activity, although no correlation was found with the severity of dentin matrix degradation. The chemically determined loss of collagen varied between 0 and 67 wt% per participant and corresponded with the extent of collagen degradation observed by transmission electron microscopy.

A single-section model for enamel de- and remineralization studies. 1. The effects of different Ca/P ratios in remineralization solutions

A prerequisite for the accurate measurement of differences between pre- and post-experimental mineral profiles in single sections by quantitative microradiography is a high degree of reproducibility of the analytical procedures. We have determined the reproducibility of both the production and analyses of microradiographs. Lesions were made in seven single bovine enamel sections and radiographed three times. Each microradiograph was then analyzed on three different occasions by use of an image analysis system. This resulted in only small standard deviations in the lesion parameters. The method was used to determine the sites of mineral deposition in lesions in single sections during remineralization in three different solutions, one of which contained 1.5 mmol/L Ca and 0.9 mmol/L PO4 (standard solution); the other two solutions were low in either Ca or PO4, but all three had the same degree of supersaturation. The mineral profiles and lesion parameters were determined after lesion formation and after remineralization for 4 days, 1, 2, and 3 weeks. The decrease in IML (integrated mineral loss) in the lesions remineralized in the standard solution was greatest during the first week. Lesion profiles revealed that, under non-standard conditions, mineral deposition was retarded in the deeper part of the lesion, in contrast to the even distribution of mineral deposition from the standard solution. Differences in IML changes and lesion profiles between these bovine enamel experimental groups diminished when remineralization continued for 2 and 3 weeks. Possibly, the reactivity of mineral surfaces in newly made lesions affected the diffusion of remineralizing ions from low concentration solutions to the lesion front.

Effect of intermittent delivery of fluoride to solution on root hard-tissue de- and remineralization measured by 125I absorptiometry

The effect of intermittent fluoride levels on root hard-tissue de- and remineralization was studied once daily for 21 days in a pH-cycling caries model with simulated fluoride clearance curves. Four root hard-tissue blocks, from each of 12 human teeth, were cut out parallel to the cementum surface. During a daily 15-hour period, the blocks were subjected 12 times to pH changes similar to those which occur in plaque after a carbohydrate intake. The fluoride was delivered immediately before a daily nine-hour remineralization period. Four experiments were independently carried out: One block from each tooth was subjected to pH-cycling without and with fluoride delivery, simulating a rinse with 0.025, 0.2, and 1.0% sodium fluoride (NaF), respectively. The mineral change in the blocks was monitored by 125I absorptiometry and expressed as the change in transmission (delta T). The surface between the data points (delta T values) and the x axis (time points) was used as a summary measure, i.e., the area under the curve (AUC). When no fluoride was delivered, the delta T increased over 21 days, indicating loss of mineral. The AUC was, on average, 5.85 +/- 0.68 (mean +/- S.E.) %.day. In the 0.025% NaF-rinse experiment, there was a marked reduction in mineral loss, indicated by an average AUC of 1.66 +/- 0.59%.day. In both the 0.2 and 1.0% NaF-rinse experiments, a decrease in delta T, indicating gain of mineral, was observed from day 2. Negative delta T values occurred after 7 and 3 days, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of fluoride incorporation into human dental enamel on its demineralization in vitro

Coronal surfaces of extracted human teeth were ground to a depth of about 1 mm and then cut in half labiolingually. One half was used as a control; the other half was exposed, for 3 days, to a fluoride-enriching buffer (0.1 mol/l lactic acid, 19.7 mmol/l CaCl2, 10.8 mmol/l KH2PO4, 3 mmol/l NaN3; pH adjusted to 4.68 with KOH) having fluoride concentrations from 0.0002 to 2.2 parts/10(6). This exposure resulted in an uptake of fluoride by the enamel to a depth of 2 microns without any apparent demineralization. The fluoride uptake was proportional to the F concentration of the enriching solution, reaching concentrations of about 8000 parts/10(6) within the first micrometre of enamel exposed to the highest F concentration; the controls had uniform F concentrations not exceeding 50 parts/10(6) along the 2.5 microns of enamel depth sampled. Thin sections (140-160 microns) were cut perpendicularly to the lingual surface, coated with protective resin except for a window about 1 mm long on the ground lingual surface, and exposed to a demineralizing buffer. The mineral losses of the sections were followed over 5 days by microradiography and image analysis. Fluoride enrichment resulted in reduced demineralization and the reduction was inversely related to the enamel fluoride content. The controls displayed a uniform erosion of the surface enamel whereas all the treatments below 1.5 parts/10(6) in the enriching solutions developed typical subsurface 'lesions'. The mineral content of the surface layer increased with increasing time of exposure to the demineralizing buffer.(ABSTRACT TRUNCATED AT 250 WORDS)

Scanning microradiographic study of the kinetics of subsurface demineralization in tooth sections under constant-composition and small constant-volume conditions

The kinetics of subsurface demineralization of tooth sections has been studied in real-time by scanning microradiography (SMR). Demineralization was carried out: (1) with a large volume of solution buffered to pH = 4 to maintain a constant composition; and (2) in a small constant volume (approximately 3 mL), buffered initially at pH = 4, so that the degree of saturation at the tooth surface increased as the tooth dissolved. At constant composition, the change in lesion depth, Y, with time, T, followed a linear relation, Y = a + bT, for T > 44 +/- 5 h. Before this time, the relation could be approximated by a linear one with different a and b constants. At constant volume, Y = q(1-e-r(T + s)) for all T, where q, r and s are constants. Similar relations, with different constants, were found for the mineral loss per unit area of lesion exposed to acid. These results showed that the process of demineralization under the rather severe conditions used was essentially a surface-controlled process. The change of slope at approximately 44 h and the presence of the constant s in the exponential function were attributed to a change in kinetics after formation of the surface layer.

In situ remineralization of enamel lesions using continuous versus intermittent fluoride application

Remineralization of early enamel lesions was studied in situ using a F chewing gum or a F-releasing device (FRD). Enamel specimens with subsurface lesions were mounted in removable lower appliances in 6 adults. A F-free dentifrice was used for all regimens. Test groups chewed five sticks/day (0.1 mg F/stick), or one FRD (0.5 mg F/day) was mounted in the midline of the appliance. The microhardness was measured after the 21-day intraoral exposure, and in vitro acid resistance testing was performed. Separate specimens were used to measure F content or changes in mineral density. Comparable values for both F gum and FRDs were higher (p > 0.05) than controls for acid resistance testing and percent remineralization. The F content for FRDs exceeded that of both F gum and controls.

In situ anticariogenic potential of glass ionomer cement

The purpose of this study was to compare the amount of fluoride in plaque formed on glass ionomer cement or composite and to evaluate the effects of fluoride released on growth of cariogenic microflora, fluoride uptake, and secondary caries formation under in situ conditions of a high cariogenic challenge. Ten adult volunteers took part in this crossover study performed in two phases of 28 days. Eighty enamel blocks were randomly restored with glass ionomer cement (Chelon-Fil-Espe) or composite (Silux). During each phase of the study, an acrylic resin appliance, containing four enamel blocks restored with the same material, was constructed for each of the volunteers. During the experimental period, all subjects used fluoride-free dentifrice, refrained from brushing the restored enamel blocks, and immersed the appliances into 20% sucrose solution eight times a day. Fluoride levels, mutans streptococci, and lactobacilli were assessed in dental plaque. Fluoride uptake and microhardness profiles were determined in enamel around the restorations. Statistical analyses indicated a significantly higher level of fluoride (p < 0.05) and a lower level of mutans streptococci plaque formed on glass ionomer cement. Analysis of variance in a split-plot model indicated that in the enamel around the glass ionomer restoration the fluoride uptake was significantly greater (p < 0.025) and the mineral loss significantly lower (p < 0.01). The results show that glass ionomer cement presents a broad anticariogenic effect and may be of value in preventing secondary caries, even under conditions of a high caries risk.

Effect of sucrose concentration on the cariogenic potential of pooled plaque fluid from caries-free and caries-positive individuals

Pooled plaque samples were obtained from (1) coronal surfaces of two groups of caries-free (CF) subjects, (2) coronal 'white-spot' surface areas of a group of caries-positive (CP) subjects, and (3) exposed, sound root surfaces of root caries-free (RCF) and root caries-positive (RCP) subjects. The plaque samples were obtained before and 3 min after a 1 min rinse with a 0.5, 1, 2, 5 and 10% sucrose solution. Plaque fluid was then isolated from each plaque sample by centrifugation and analyzed for inorganic ions, organic acids, and pH values. With increasing sucrose concentration: (1) plaque fluid pH and the degree of saturation (DS) with respect to tooth mineral decreased; (2) the pH and DS values of CP and RCP samples were consistently lower than those of CF and RCF samples, respectively; (3) plaque fluid lactic acid concentrations increased and were consistently higher in the CP and RCP samples than in the CF and RCF samples, respectively, and (4) plaque fluid lactic acid concentrations leveled off between 1 and 5% sucrose; this occurred at lower sucrose concentrations with CP and RCP samples than with CF and RCF samples, respectively. RCP samples contained consistently higher levels of mutants streptococci than RCF samples. The chemical composition of plaque fluids, following sucrose exposure, were found to correlate well with caries history. The observed differences in lactic acid concentrations in samples from CF and CP subjects are discussed with regard to differences in microbiological composition and possible differences in plaque permeability to sucrose.

Influence of constant fluoride levels in solution on root hard tissue de- and remineralization measured by 125I absorptiometry

To study the effect of fluoride on de- and remineralization of root hard tissue, an automatic pH-cycling caries model, simulating Stephan curves, was used for 21 days. From each of 13 unexposed human roots, four cementum/dentin blocks were prepared. Four experiments were carried out: one block from each tooth as subjected to pH cycling without and with fluoride at the concentrations of 0.02 ppm (1.0 mumol/l), 0.20 ppm (10.5 mumol/l) and 2.00 ppm (105.3 mumol/l) in the de- and remineralizing solutions, respectively. Mineral change in the specimens was monitored by 125I absorptiometry. When no fluoride was added to the solutions the change in transmission (delta T) increased continuously over 21 days, indicating loss of mineral. In the 0.02-ppm F experiment, there was a marked decrease in delta T, but almost no change in the 0.20-ppm F experiment. pH cycling with 2.00 ppm F in the solutions resulted in a gain of mineral in or most likely on the surface of the cementum/dentin blocks, indicated by a continuously decreasing delta T. The fluoride level in the solution significantly influenced the change in the mineral content of the specimens. Microradiographs of the sectioned blocks showed radiodense surface zones, varying degrees of subsurface demineralization and signs of remineralization or mineral deposition.

Microbiological validation of assessments of caries activity during cavity preparation

The operative management of primary and secondary caries assumes that all discoloured tissue at the enamel-dentine junction (EDJ) represents active disease and this is removed to arrest the carious process. This study aims to establish clinical criteria to differentiate between active and arrested caries at the EDJ using microbiological assessment of dentine samples to verify its clinical status. Radiographs were available for posterior teeth. Cavities (n = 205) were prepared under rubber dam. After gaining access, areas of the EDJ were chosen and assessments made of consistency (soft, medium, hard), colour (dark brown, mid-brown, pale) and moisture content (wet, dry). Dentine was removed by using a No. 3 round burr and placed in 1 ml of bacteriological culture broth. This sampling procedure was repeated at the same site once during cavity preparation and again when the cavity was judged as fully prepared. Samples were vortexed, diluted and cultured to give viable counts of the total anaerobic microflora, mutans streptococci and lactobacilli; viable counts were expressed as log10 (CFU per sample +1). Results showed no significant differences between the microflora of primary and secondary caries. The number of bacteria recovered diminished significantly as cavities were completed. Initial samples from soft and wet lesions harboured significantly more bacteria, lactobacilli and mutans streptococci than samples from medium, hard or dry lesions. Lesions visible on radiographs harboured more bacteria, including lactobacilli and mutans streptococci, while dentine colour was not discriminatory.(ABSTRACT TRUNCATED AT 250 WORDS)

Fluoride and mineral content in hyper-remineralized coronal bovine dentine in vitro after an acid challenge

In this paper the acid resistance of hyper-remineralized dentine was quantified by means of fluoride and mineral measurements. Hyper-remineralization was achieved by demineralization of dentine in an acidic gel system (pH 5) for 3 weeks, followed by remineralization in a solution containing 1.5 mM Ca, 0.9 mM phosphate and 10 ppm F at pH 7 and 37 degrees C for 8 days. The samples were subsequently again demineralized in the gel system mentioned for 1, 2 and 3 weeks. Analysis for fluoride was done by means of the microdrill biopsy technique and to obtain information on the fluoride distribution by secondary ion mass spectrometry (SIMS); mineral was assessed by microradiography. The results showed that in hyper-remineralized dentine the original fluoride content was approximately 30,000 ppm F. This value was still in the same order after the acid challenge of 3 weeks at pH 5. These values were substantially higher than the baseline values in sound or in demineralized dentine being about 900 ppm F. The main microradiographic result was that there was no significant mineral change in the hyper-remineralized dentine due to the acid challenges. There was, however, a tendency for mineral redistribution deeper into the dentine lesion leading to lamination phenomena. The SIMS experiments on some of the samples showed a fluoride distribution in agreement with the microdrill fluoride data. Furthermore a fluoride redistribution took place in deeper parts of the lesion due to the acid challenges. The combined fluoride concentration and microradiographical data indicate that fluoride-enriched and highly mineralized hyper-remineralized dentine is more acid resistant than sound or demineralized dentine.

The effect of chewing gum use on in situ enamel lesion remineralization

Two independent cross-over studies investigated the possibility of enhanced early enamel lesion remineralization with the use of chewing gum. The first study involved a sorbitol-containing chewing gum, and the second, which had an identical protocol, tested a sucrose-containing chewing gum. In each study, 12 volunteers wore in situ appliances on which were mounted enamel sections containing artificial caries lesions. Subjects brushed twice daily for two min with a 1100-ppm-F (NaF) dentifrice (control and test) and in the test phase chewed five sticks of gum per day for 20 min after meals and snacks. Microradiographs of the enamel lesions were made at baseline and at the end of the seven-week experimental period. In the sugar-free gum study, the weighted mean total mineral loss (delta z) difference [(wk7-wk0) x (-1)] was 788 vol.% min. x micron for the gum, corresponding to remineralization of 18.2%, vs. the control value of 526 vol.% min. x micron, 12.1% remineralization (p = 0.07). There were no significant differences for the surface-zone (p = 0.20) and lesion-body (p = 0.28) values. In the sucrose-containing gum study, the delta z difference was 743 vol.% min. x micron for the gum, corresponding to a remineralization of 18.3%, vs. the control value of 438 vol.% min. x micron, 10.8% remineralization (p = 0.08). The surface-zone values were not significantly different (p = 0.55). For the lesion body, however, the sucrose-containing gum value of 6.11 vol.% min. was significantly different (p = 0.01) from that of the control (2.81 vol.% min.).

Composition of pooled plaque fluid from caries-free and caries-positive individuals following sucrose exposure

The composition of pooled plaque fluid from five population samples was determined before and at selected times (7, 15, 30, and 60 min) after a 10% sucrose rinse. Subjects were grouped according to caries status (caries-free, CF, DMFS = 0; caries-positive, CP, DMFS > 10). Samples were also studied from white-spot surfaces and from sound surfaces of the same mouths of two additional CP groups. Plaque fluid was isolated by centrifugation and analyzed for organic acids, inorganic ions (ion chromatography), and pH (microelectrodes). Prior to sucrose exposure, plaque fluids from the CF subgroups and from sound surfaces of the CP subjects had higher pH values than samples from CP subgroups and from white-spot surfaces, respectively; the ionic compositions were otherwise similar. Starved plaque fluids were also found to be supersaturated with respect to enamel and to a significantly greater degree in the CF samples, suggesting that CF plaque fluid may have a greater remineralization potential than CP samples. Following sucrose exposure, a rapid decrease in plaque fluid pH was observed, which corresponded primarily to lactic acid production. For all times examined, mean pH and DS(En) values were lower and lactic acid concentrations were higher in the CP samples than in the CF samples; noted differences were statistically significant at 7 min for pH and DS(En), and at 7, 15, and 30 min for lactic acid. Lower values of DS(En) suggest that plaque fluid from CP subjects had a measurably greater cariogenic potential.(ABSTRACT TRUNCATED AT 250 WORDS)

Solubilization of dentin matrix collagen in situ

The effects of the oral environment on dentin matrix collagen were studied. In the partial prostheses of 12 participants, two completely demineralized dentin specimens were mounted covered by a Dacron gauze. After an experimental period of seven weeks, the specimens were transferred to a trypsin-containing buffer for determination of the amount of denatured collagen. Subsequently, the specimens were incubated with a bacterial collagenase for assessment of the amount of collagen. After the intra-oral exposure, there was a collagen loss varying between 1 and 47 wt%. This variation might be due to differences in proteolytic activity of the colonizing microflora. After exposure to the oral environment, only about 0.5 wt% of the available collagen was trypsin-degradable. This indicates a rapid solubilization of the denatured collagen from the specimens into the oral cavity. A separate group of specimens was examined by light microscopy and transmission electron microscopy. Various degrees of breakdown could be discerned. Some experimental specimens showed loss of surface integrity and tubules heavily infected with different types of micro-organisms. The lumens of the tubules were enlarged, sometimes creating caverns as a result of the loss of the intertubular collagenous matrix.

Subsurface demineralization in dental enamel and other permeable solids during acid dissolution

Subsurface demineralization of dental enamel during acid dissolution has been reported many times, but its cause remains obscure. At first, the phenomenon was thought to result from the physical structure of enamel. More recent studies have shown that subsurface demineralization occurs in other permeable solids, indicating that there must be more fundamental factors involved in this curious effect. In order for this phenomenon to be investigated, dissolution experiments were carried out by means of real-time scanning microradiography in various systems, including enamel, or aggregates of hydroxyapatite (calcium, strontium, or barium), or hydroxides (calcium or magnesium). These were chosen to discriminate between effects of structure and composition. It was found that it was not possible for the demineralization observed in these systems to be attributed to a common feature. From this, it is concluded that subsurface demineralization in enamel and other mineralized tissues should not be ascribed to a single cause.

An in situ enamel section model for assessment of enamel re/demineralization potential

An enamel-section-carrying intra-oral appliance to predict the results of double-blind anti-caries studies has been developed. Initial validation was against the F concentration effect attained in a clinical trial where three sodium monofluorophosphate (SMFP) dentifrices were used. Original appliance-based work showed significant differences in remineralization between non-F and F dentifrices, but not between different F dentifrices. However, it was shown later that acidified gel-prepared lesions were not as responsive as solution-prepared lesions to de- and remineralizing processes, and lesion remineralization rates were found to be dependent on initial lesion size. An in situ cross-over study was then repeated with use of acid-solution-created lesions, and seven volunteers completed the project. Each brushed twice daily x 2 min with either 0, 1000, or 2500 ppm F, as SMFP dentifrice. After a two-week wash-out, subjects wore the appliances for four weeks. Enamel mineral content was assessed at 0, two, and four weeks via microradiography/microdensitometry, and a statistically significant dose-response was obtained between non-F and F as well as between 1000 and 2500 ppm F pastes, i.e., as per the three-year clinical trial data. Hence, the model's suitability for pre-clinical screening was confirmed. It has also been used in caries microbiological studies, in root caries investigations, and currently in chewing gum cariogenicity experiments.

Sample size considerations in designing studies with intra-oral models

Especially during recent years, the use of pre-clinical models for predicting the efficacy of fluoride systems has assumed greater importance within the scientific community. Originally utilized primarily to screen experimental fluoride delivery systems, preclinical models are now being considered as predictors of clinical efficacy in lieu of controlled clinical caries trials. Of the various preclinical models presently available, human intra-oral models have the greatest potential for reflecting intended usage conditions and therefore may be the most meaningful models for predicting clinical efficacy. However, only with the proper consideration of numerous critical variables can studies using intra-oral models be appropriately designed to achieve the desired objectives. Clearly, these models must provide relevant information in a manner which reflects clinically established cariostatic activity and be capable of detecting established differences in the amount of cariostatic activity, i.e., dose-response effects. Three sources of variation must be considered before an appropriate study design and sample size can be chosen. Based on fluoride uptake data from an intra-oral model with proximally-located enamel specimens, estimates of variation among subjects, within subjects, and among specimens within subjects were obtained. Multiple specimens per panelist do not affect the first two sources of variation. Thus, the number of panelists, and not the number of specimens, is of primary importance when pre-test data are used to choose the appropriate study design and calculate the required sample size.

Demineralization and remineralization evaluation techniques--added considerations

Methods used for the analysis of tooth de- and remineralization include techniques with various degrees of sophistication and quantitative capabilities, ranging from direct measures of mineral gain/loss (e.g., microradiography) to indirect measures (e.g., iodide permeability) of changes in tooth mineral properties. In all instances, the capabilities of methods for accurate determination of changes in tooth mineral properties are affected by procedures used in the preparation of specimens for analysis, the magnitude of change taking place in the test (vs. the detection limits of the techniques), and protocols for specimen analysis. In specific instances, such as in the case of dentin, unique specimen-handling and analysis procedures must be used to prevent artifacts. The choice of techniques for the assessment of de- and remineralization depends strongly upon study protocols and laboratory capabilities; however, 'quantitative' measures of mineral gain and loss are possible only if direct chemical or radiographic techniques are used. Either radiographic, cross-sectioned microhardness or polarized light can be used for the determination of lesion depth. Porosity, light-scattering, and surface microhardness are indirect techniques which complement direct measures of mineral gain and loss. Whatever methods are used in the analysis of de- and remineralization, researchers must take care to differentiate accurately among the quantitative capabilities of techniques used in analysis.

Demineralization and remineralization evaluation techniques

This paper compares the experimental techniques utilized to assess the de- or remineralization of enamel or dentin in intra-oral studies. In in situ studies, it is important for one to know how much mineral has been lost or gained, and where the loss or gain occurred. The main emphasis in this paper is on techniques suitable for direct or indirect mineral quantification. The measuring techniques considered are microradiography, iodine absorptiometry, various microhardness tests, polarized light, light-scattering, iodide permeability, and wet chemical analysis. The various techniques are compared concerning suitability for the determination of mineral content in vol% (or wt%), mineral changes in vol% micron (or kg.m-2), and mineral distributions. Furthermore, sample preparation, the importance of protein penetration, nominal mineral loss range, the estimated mineral loss threshold, and the applicability to dentin are compared and considered. It is concluded that, although more than ten techniques are available for the measurement of changes after de- or remineralization in situ, transverse microradiography is the most practical technique for the direct and quantitative measurement of mineral content, mineral changes, and mineral distributions. Cross-sectional microhardness testing and light-scattering are also practical indirect techniques for quantitative mineral loss (or gain) determination in intra-oral studies.

The effect of study design on in situ treatment of carious enamel lesions

The aim of this exploratory study was to investigate the influence of several factors on changes in the mineral content of carious enamel lesions treated in situ. The study involved 36 adult volunteers who used either a non-fluoride toothpaste or one of two fluoride toothpastes (1000 or 1500 ppm F). Human enamel specimens were prepared and attached to partial dentures as described previously (Schäfer, 1989) and treated in situ for between three and six weeks. The mineral content of lesions was determined by microradiography and computerized densitometry. The factors investigated in this study included study length, frequency of treatment, trial design, patient compliance, patient diet, and previous caries experience of the patient. The effects observed were small, relative to that of the treatment, and not statistically significant (p greater than 0.05). However, the trends in the data were all as would be intuitively predicted. Study duration correlated positively with observed lesion mineral content. Lesions worn by panelists using a fluoride toothpaste for six weeks contained greater levels of mineral with respect to placebo than did those in panelists on a three-week study. The residual variations in the three phases of the study were found to be similar, suggesting that there is no advantage in these studies having a cross-over design. Brushing frequency also correlated positively with observed lesion mineral content, with panelists brushing three times per day with a fluoridated dentifrice having lesions with greater levels of mineral, with respect to placebo, than those brushing twice per day. Overall, no clear relationship between reported diet and changes in lesion mineral levels was apparent.(ABSTRACT TRUNCATED AT 250 WORDS)

A flexible and rapid pH cycling procedure for investigations into the remineralisation and demineralisation behaviour of human enamel

A rapid and flexible model system has been developed to study human enamel behaviour under conditions of oscillating pH similar to those experienced in the mouth. The model uses realistic time intervals and operates at in vivo temperatures (35-37 degrees C). Mineral loss or gain is measured quantitatively on a volume basis. Results indicate that for single 1-day periods with three 20-min exposures to acid, 1% v/v of enamel mineral was lost. These results, together with the histological appearance of the tissue, are in close agreement with previous studies of enamel caries.

Secondary caries in situ around fluoride-releasing light-curing composites: a quantitative model investigation on four materials with a fluoride content between 0 and 26 vol%

In the literature, secondary caries around composite restorations is reported often. Fluoridated composites are therefore interesting materials because they might reduce or inhibit secondary caries. In this article an in situ model investigation is presented in which the effect of F-releasing composites on enamel demineralisation around an artificial gap of 200 microns width was quantified after 1 month. The fluoride content of the composites varied between 0 and 26 vol%. The beneficial effect of the fluoride released was larger in the gap than at the outer enamel surface. In the gap, all fluoridated composites reduced the enamel demineralisation statistically significantly with respect to the non-fluoridated control. Microradiography showed a reduction of lesion depth values of 27-45%, and a reduction of mineral loss values of 25-56%. At the outer enamel surface next to the artificial gap, a beneficial fluoridation effect was measurable only near the most fluoridated composite. The results indicate that fluoridated composites may play a role in the future prevention of secondary caries.

Limitations in the intraoral demineralization of bovine enamel

A model system was used to examine the relation between the duration of plaque pH fall and enamel demineralization following the intake of dietary carbohydrate in humans. Subjects wore palatal appliances containing blocks of bovine enamel covered with Streptococcus mutans IB 1600, and rinsed with 5 or 10% sucrose. Changes in iodide penetrability (delta Ip) of the enamel, and the pH and extracellular calcium and inorganic phosphate (Pi) concentrations of the streptococcal plaque were determined. Following rinses with 5% sucrose, delta Ip increased with time and reached a maximum (11.2 +/- 2.2 units) at 45-60 min although the S. mutans plaque remained acidic (pH = 4.8 +/- 0.6). After 10% sucrose, the maximum (14.7 +/- 3.1 units) was reached while the plaque pH was 4.0 +/- 0.3. Second rinses with sucrose increased delta Ip at most by 30%. Thus, demineralization did not persist throughout the period of low plaque pH, but occurred primarily during the early phase of plaque acidogenesis. Enamel demineralization appeared to be limited by factors other than the pH of the streptococcal plaque. Calcium concentrations in the S. mutans plaque rose to a maximum of 10.9 +/- 2.8 mEq/l at 30 min after the 5% sucrose rinses, then fell; Pi reached a stable level of 12.2 +/- 2.3 mEq/l by 60 min. Calculations showed that conditions approached saturation with respect to enamel and dicalcium phosphate dihydrate as demineralization reached a maximum. Demineralization appeared to be limited at low plaque pH, therefore, by the accumulation of high levels of mineral ions in the streptococcal plaque.(ABSTRACT TRUNCATED AT 250 WORDS)