Effect of experimental fluorosis on the surface topography of developing enamel crystals

Crystal Initiation Structures in Developing Enamel: Possible Implications for Caries Dissolution of Enamel Crystals

Investigations of developing enamel crystals using Atomic and Chemical Force Microscopy (AFM, CFM) have revealed a subunit structure. Subunits were seen in height images as collinear swellings about 30 nM in diameter on crystal surfaces. In friction mode they were visible as positive regions. These were similar in size (30–50 nM) to collinear spherical structures, presumably mineral matrix complexes, seen in developing enamel using a freeze fracturing/freeze etching procedure. More detailed AFM studies on mature enamel suggested that the 30–50 nM structures were composed of smaller units, ~10–15 nM in diameter. These were clustered in hexagonal or perhaps a spiral arrangement. It was suggested that these could be the imprints of initiation sites for mineral precipitation. The investigation aimed at examining original freeze etched images at high resolution to see if the smaller subunits observed using AFM in mature enamel were also present in developing enamel i.e., before loss of the organic matrix. The method used was freeze etching. Briefly samples of developing rat enamel were rapidly frozen, fractured under vacuum, and ice sublimed from the fractured surface. The fractured surface was shadowed with platinum or gold and the metal replica subjected to high resolution TEM. For AFM studies high-resolution tapping mode imaging of human mature enamel sections was performed in air under ambient conditions at a point midway between the cusp and the cervical margin. Both AFM and freeze etch studies showed structures 30–50 nM in diameter. AFM indicated that these may be clusters of somewhat smaller structures ~10–15 nM maybe hexagonally or spirally arranged. High resolution freeze etching images of very early enamel showed ~30–50 nM spherical structures in a disordered arrangement. No smaller units at 10–15 nM were clearly seen. However, when linear arrangements of 30–50 nM units were visible the picture was more complex but also smaller units including ~10–15 nM units could be observed.

Conclusions: Structures ~10–15 nM in diameter were detected in developing enamel. While the appearance was complex, these were most evident when the 30–5 nM structures were in linear arrays. Formation of linear arrays of subunits may be associated with the development of mineral initiation sites and attendant processing of matrix proteins.

Enamel crystals of mice susceptible or resistant to dental fluorosis: an AFM study

Objective

This study aimed to assess the overall apatite crystals profile in the enamel matrix of mice susceptible (A/J strain) or resistant (129P3/J strain) to dental fluorosis through analyses by atomic force microscopy (AFM).

Material and Methods

Samples from the enamel matrix in the early stages of secretion and maturation were obtained from the incisors of mice from both strains. All detectable traces of matrix protein were removed from the samples by a sequential extraction procedure. The purified crystals (n=13 per strain) were analyzed qualitatively in the AFM. Surface roughness profile (Ra) was measured.

Results

The mean (±SD) Ra of the crystals of A/J strain (0.58±0.15 nm) was lower than the one found for the 129P3/J strain (0.66±0.21 nm) but the difference did not reach statistical significance (t=1.187, p=0.247). Crystals of the 129P3/J strain (70.42±6.79 nm) were found to be significantly narrower (t=4.013, p=0.0013) than the same parameter measured for the A/J strain (90.42±15.86 nm).

Conclusion

Enamel crystals of the 129P3/J strain are narrower, which is indicative of slower crystal growth and could interfere in the occurrence of dental fluorosis.

Nanostructure evaluation of healthy and fluorotic dentin by atomic force microscopy before and after phosphoric acid etching

The aim was to characterize by atomic force microscopy (AFM) the nanostructure of human dentin surfaces affected by dental fluorosis (DF) before and after phosphoric acid etching. This study included 240 human dentin samples classified according to the severity of DF, which were divided into four groups using the Thylstrup-Fejerskov Index (TFI). Samples were analyzed by AFM before and after acid etching for 15, 30, and 60 s. The roughness (R(a)) for healthy dentin, and dentin with mild, moderate, and severe fluorosis were 440 nm, 442 nm, 445 nm, and 449 nm, respectively. After 15, 30, and 60 s of acid etching, all healthy and fluorotic dentin samples increased in roughness (p<0.05). The diameter of dentinal tubule orifices (D(t)) in healthy human dentin increased after acid etching for 60 s. We conclude that effective etching times are 15 s for healthy and mild dentin fluorosis, 30-s for moderately fluorosed dentin, and 45-60 s for severe fluorotic dentin.

Effects of fluoride treatment on phosphoric acid-etching in primary teeth: an AFM observation

The aim of this study was to examine the effect of fluoride application on 37% phosphoric acid-etching by atomic force microscopy (AFM) in primary tooth samples based on a clinical protocol used in a pediatric dental hospital. Enamel samples were prepared from 36 exfoliated and non-carious primary teeth. Primary tooth samples were randomly assigned to one of the four groups based on the timing of acid-etching with 37% phosphoric acid after an acidulated phosphate fluoride (APF) pre-treatment. Group 1 received no fluoride application, Group 2 was pre-treated with fluoride and then received acid-etching 2 weeks later. One week separated the fluoride treatment and the acid-etching in Group 3, while Group 4 received acid-etching immediately after the fluoride treatment. The vestibular enamel surfaces of each primary tooth sample were scanned in air at a resolution of 512 x 512 pixels and a scan speed of 0.8 line/s. On the enamel surfaces of the primary teeth after APF pre-treatment, debris were observed although the teeth were smoother than they were prior to APF. As a result, it was concluded that APF treatment is responsible for decreased primary tooth surface roughness. The enamel surfaces etched for 20s showed that acid-etching was effective not only in removing scratches and debris, but also for evaluating enamel rod characteristics. Primary tooth enamel surfaces after etching showed minute structures caused by the decreased hydroxyapatite nanoparticle space, compared to those before etching. Also, acid-etching showed significantly increased roughness effects (p<0.0001, n=9). Finally, as more time elapsed after APF pre-treatment, the roughness was decreased to a lesser degree (p=0.005, n=9). We suggest that primary teeth etching 2 weeks after APF pre-treatment used clinically in pediatric hospitals may be effective to obtain properly etched enamel surfaces.

The impact of fluoride on ameloblasts and the mechanisms of enamel fluorosis

Intake of excess amounts of fluoride during tooth development cause enamel fluorosis, a developmental disturbance that makes enamel more porous. In mild fluorosis, there are white opaque striations across the enamel surface, whereas in more severe cases, the porous regions increase in size, with enamel pitting, and secondary discoloration of the enamel surface. The effects of fluoride on enamel formation suggest that fluoride affects the enamel-forming cells, the ameloblasts. Studies investigating the effects of fluoride on ameloblasts and the mechanisms of fluorosis are based on in vitro cultures as well as animal models. The use of these model systems requires a biologically relevant fluoride dose, and must be carefully interpreted in relation to human tooth formation. Based on these studies, we propose that fluoride can directly affect the ameloblasts, particularly at high fluoride levels, while at lower fluoride levels, the ameloblasts may respond to local effects of fluoride on the mineralizing matrix. A new working model is presented, focused on the assumption that fluoride increases the rate of mineral formation, resulting in a greater release of protons into the forming enamel matrix.

Chemical and crystallographic study of remineralized surface on initial carious enamel treated with Galla chinensis

To investigate the morphologic, chemical and crystallographic characters of remineralized surface on initial carious enamel treated with Galla chinensis, scanning electron microscopy equipped with energy dispersive analysis spectroscopy were used, and X-ray microdiffraction (microzone XRD) was used for the first time to analyze in situ the microzone crystallite of remineralized surface on carious enamel. Bovine sound enamel slabs were demineralized to produce initial carious lesion in vitro. Then, the lesions were exposed to a pH-cycling regime for 12 days of remineralization. Each daily cycle included 4x1 min applications with one of the three treatments: distilled and deionized water (DDW); 1 g/L NaF; 4 g/L G. chinensis extract (GCE). After the treatments, some rod-like deposits and many irregular prominences were found on GCE-treated enamel surface, and the intensities of Ca and P signals showed a tendency to increase; Ca:P ratio was significantly higher than that of DDW-treated enamel. X-ray microdiffraction showed hydroxyapatite was still the main component of GCE-treated enamel, and the crystallinity was increased, the crystal lattice changed gently with decreased lattice parameter a. These results indicated the potential of GCE in promoting the remineralization of initial enamel carious lesions, and supported the previous hypothesis about GCE mechanism. Combined with the anti-bacteria and demineralization inhibition properties of GCE, the natural G. chinensis may become one more promising agent for caries prevention.

Effects of Galla chinensis on the surface topography of initial enamel carious lesion: an atomic force microscopy study

To investigate the effect of Galla chinensis on the surface topography of initial enamel carious lesion, atomic force microscope (AFM) was used, and it was a new AFM application in enamel de-/remineralization research. Bovine sound enamel slabs were demineralized to produce initial carious lesion in vitro. Then, the lesions were exposed to a pH-cycling regime for 12 days. Each daily cycle included 4x1 min applications with one of three treatments: negative control group: deionized water; positive control group: 1 g/L aqueous solutions of NaF; experimental group: 4 g/L aqueous solutions of G. chinensis extract (GCE). The surface topography and roughness were investigated on the enamel slabs before and after pH-cycling by AFM. 3D AFM images revealed the surface topographical changes of GCE-treated enamel. Significant difference existed before and after the pH-cycling among the groups. AFM offers a powerful tool for enamel de-/remineralization research. The surface roughness results provide the evidences to remineralization of carious lesion, and indicate the potential of G. chinensis in promoting the remineralization. G. chinensis may become one more promising agent for caries prevention.

Atomic force microscopy observation of the enamel roughness and depth profile after phosphoric acid etching

The aim was to compare the enamel surface roughness (ESR) and absolute depth profile (ADP) (mean peak-to-valley height) by atomic force microscopy (AFM) before and after using four different phosphoric acids. A total of 160 enamel samples from 40 upper premolars were prepared. The inclusion criterion was that the teeth have healthy enamel. Exclusion criteria included any of the following conditions: facial restorations, caries lesions, enamel hypoplasia and dental fluorosis. Evaluations of the ESR and ADP were carried out by AFM. The Mann-Whitney U-test was used to compare continuous variables and the Wilcoxon test was used to analyze the differences between before and after etching. There were statistically significant differences (P <or= 0.05) among mean surface roughness and absolute depth before and after using four different phosphoric acids in healthy enamel; Etch-37 and Scotchbond Etching Gel showed higher profiles after etching (P <or= 0.05). There were statistically significant differences (P <or= 0.05) among roughness and ADP before and after using four different phosphoric acids in healthy enamel. However, consistently Etch-37 and Scotchbond Etching Gel showed the highest increase regarding the ESR and ADP after etching healthy enamel. AFM was a useful tool to study site-specific structural topography changes in enamel after phosphoric acid etching.

Effects of systemic fluoride and in vitro fluoride treatment on enamel crystals

Systemically administered fluoride at a concentration of 75 ppm increases the surface roughness of developing enamel crystals in rats, which may be significant in advancing our understanding of the biological mechanism of fluorosis. Thus, the aim of this study was to investigate whether the increased surface roughness may be a result of surface restructuring by the direct action of fluoride at the crystal surface. We examined the fluoride dose-dependent roughening of enamel crystal surfaces in vivo, in the rat, and whether this roughening could be mimicked by the in vitro treatment of rat enamel crystals with neutral pH fluoride solutions. Our results showed that enamel crystal surface roughness increased after treatment with increasing fluoride ion concentrations, whether applied in vitro or administered systemically. This suggests a mechanism, alongside others, for the increased surface roughness of crystals in fluorotic enamel.

The effects of fluoride on the nanostructure and surface pK of enamel crystals: an atomic force microscopy study of human and rat enamel

Atomic force microscopy (AFM) studies have revealed 30-40 nm-wide regular positively charged bands across maturation-stage rat enamel crystals. Low pH resolved these into positively charged spherical domains of approximately 30 nm diameter. Crystal surface pK values from adhesion force titrations were approximately 6.5. The effect of fluoride on this pK value and on the nanostructure of fluorosed human enamel crystals has not been reported. The nanostructure and surface chemistry (pK) of normal and fluorotic human and of fluoride-treated rat maturing enamel crystals was examined. Enamel was sectioned and polished, prior to examination, using AFM in height and friction modes. High-resolution height images revealed 30 nm-diameter spherical domains within crystals, arranged as layers of hexagons or as a shallow spiral. Fluorotic enamel showed similar, but less well ordered, nanodomains. These could represent an arrangement of original initiation sites or binding sites for modulating matrix proteins. Surface pK was derived from adhesion-force measurements between functionalized tips (OH or COOH) and crystal surfaces between pH 2 and pH 10. pK values of approximately 6.5 for normal crystals were reduced to approximately 5.5 after fluoride treatment. Reduction in surface pK by fluoride might indicate lowered protonation with possible effects on matrix protein binding.

Adsorption and interactions of dentine phosphoprotein with hydroxyapatite and collagen

Dentine phosphoprotein (DPP) has been proposed to both promote and inhibit mineral deposition during dentinogenesis. The present study aimed to investigate the molecular interactions of DPP and dephosphorylated DPP (DPP-p) with hydroxyapatite (HAP). Bovine DPP was purified and dephosphorylated by alkaline phosphatase to obtain DPP-p. DPP and DPP-p adsorption to HAP was determined along with their ability, when free in solution or bound to collagen, to influence HAP-induced crystal growth. Absorption isotherms suggested that lower DPP concentrations (1.5-6.25 microg ml(-1)) demonstrated a reduced affinity for HAP compared with higher protein concentrations (12.5-50.0 microg ml(-1)). Dephosphorylated DPP had a much reduced affinity for HAP compared with DPP. Dentine phosphoprotein inhibited seeded HAP crystal growth, in a dose-dependent manner, whilst removal of the phosphate groups reduced this inhibition. When bound to collagen fibrils, DPP significantly promoted the rate of HAP crystal growth over 0-8 min. Conversely, DPP-p and collagen significantly decreased the rate of crystal growth over 0-18 min. These results indicate a major role for the phosphate groups present on DPP in HAP crystal growth. In addition, concentration-dependent conformational changes to DPP, and the interaction with other matrix components, such as collagen, are important in predicting its dual role in the mineralization of dentine.

Effects of sodium fluoride on the actin cytoskeleton of murine ameloblasts

Fluoride is associated with a decrease in the incidence of dental caries, but excess fluoride can lead to enamel fluorosis, a defect that occurs during tooth enamel formation. In fibroblasts, the Arhgap gene encodes a RhoGAP, which regulates the small G protein designated RhoA. Fluoride treatment of fibroblasts inactivates RhoGAP, thereby activating RhoA, which leads to elevation of filamentous actin (F-actin). Since RhoA is a molecular switch, our hypothesis is that in ameloblasts, fluoride may alter the cytoskeleton through interference with the Rho signaling pathway. Our objective was to measure the effects of sodium fluoride on F-actin using tooth organ culture and confocal microscopy. The results indicated that cellular responses to fluoride include elevation of F-actin in ameloblasts. It was concluded from immunohistochemistry, RT-PCR and confocal approaches that the components of the Rho pathway are present in ameloblasts, and that the response to fluoride involves the Rho/ROCK pathway.

The effect of fluoride on the developing tooth

This review aims to outline the effects of fluoride on the biological processes involved in the formation of tooth tissues, particularly dental enamel. Attention has been focused on mechanisms which, if compromised, could give rise to dental fluorosis. The literature is extensive and often confusing but a much clearer picture is emerging based on recent more detailed knowledge of odontogenesis. Opacity, characteristic of fluorotic enamel, results from incomplete apatite crystal growth. How this occurs is suggested by other changes brought about by fluoride. Matrix proteins, associated with the mineral phase, normally degraded and removed to permit final crystal growth, are to some extent retained in fluorotic tissue. Fluoride and magnesium concentrations increase while carbonate is reduced. Crystal surface morphology at the nano-scale is altered and functional ameloblast morphology at the maturation stage also changes. Fluoride incorporation into enamel apatite produces more stable crystals. Local supersaturation levels with regard to the fluoridated mineral will also be elevated facilitating crystal growth. Such changes in crystal chemistry and morphology, involving stronger ionic and hydrogen bonds, also lead to greater binding of modulating matrix proteins and proteolytic enzymes. This results in reduced degradation and enhanced retention of protein components in mature tissue. This is most likely responsible for porous fluorotic tissue, since matrix protein removal is necessary for unimpaired crystal growth. To resolve the outstanding problems of the role of cell changes and the precise reasons for protein retention more detailed studies will be required of alterations to cell function, effect on specific protein species and the nano-chemistry of the apatite crystal surfaces.

Serum fluoride levels in a group of Egyptian infants and children from Cairo city

In this study, the authors investigated fluoride levels in the serum of infants and children (n = 296) and in the breast milk from nursing mothers (n = 60) in Cairo city. Their goal was to evaluate the necessity and safety of implementing a fluoride supplementation program. The authors used an ion-selective electrode to assay fluoride by direct potentiometry. Also, 2- to 12-yr-old participants underwent clinical dental examinations to detect caries and/or fluorosis. The serum fluoride levels of infants were significantly lower than levels found in preschoolers and school-age children. Serum fluoride correlated positively with age; it was significantly lower during the 1st than 2nd yr of infancy (p = 0.005). Breast or formula feeding did not influence serum fluoride status; the fluoride levels in mothers' milk reflected the serum levels of their own infants. Dental examinations revealed that 81% of the children had caries, whereas there was no evidence of fluorosis. Serum fluoride levels did not vary with the presence or absence of dental caries and did not correlate with the number of decayed, missing, or filled teeth. Gender did not influence serum fluoride expression, and the percentile values were unrelated to height, weight, or head circumference. These findings suggest the necessity and safety of improving the fluoride consumption levels of infants and children in Cairo city. Wider-scale studies are needed to obtain better insight into the problem.

Evidence for charge domains on developing enamel crystal surfaces

The control of hydroxyapatite crystal initiation and growth during enamel development is thought to be mediated via the proteins of the extracellular matrix. However, the precise nature of these matrix-mineral interactions remains obscure. The aim of the present study was to use a combination of atomic and chemical force microscopy to characterize developing enamel crystal surfaces and to determine their relationship with endogenous enamel matrix protein (amelogenin). The results show regular and discrete domains of various charges or charge densities on the surfaces of hydroxyapatite crystals derived from the maturation stage of enamel development. Binding of amelogenin to individual crystals at physiological pH was seen to be coincident with positively charged surface domains. These domains may therefore provide an instructional template for matrix-mineral interactions. Alternatively, the alternating array of charge on the crystal surfaces may reflect the original relationship with, and influence of, matrix interaction with the crystal surfaces during crystal growth.