Remineralization of artificial enamel lesions by theobromine

The antimicrobial activity of theobromine against cariogenic microbes: an in vitro pilot study

OBJECTIVE

This pilot study aimed to compare the antimicrobial effect of theobromine, sodium fluoride, and a theobromine-sodium fluoride combination against the following caries-associated bacteria: Streptococcus mutans and Actinomyces naeslundii.

METHODOLOGY

Antimicrobial susceptibility was tested via the broth microdilution method, with suspensions cultured on each microbe's respective selective media. Shapiro-Wilk's was completed and all the data showed normality (p > 0.05), and One-way ANOVA was applied to infer the significant differences in the viable counts between the groups.

RESULTS

All experimental conditions for both S. mutans and A. naeslundii groups resulted in a significantly lower bacterial abundance in comparison to the control medium, without any active antimicrobial agent (p < 0.001). There was no significant difference in viable count between the theobromine, fluoride, or combination groups against either microbe (p > 0.05).

CONCLUSION

Theobromine's antimicrobial activity against S. mutans and A. naeslundii was found similar to that of fluoride, whether used independently or in combination. Further testing of theobromine is necessary to assess its role as an alternative anticaries agent.

Comparative evaluation of fluoride-free remineralization agents with and without Er,Cr:YSGG laser on artificial enamel remineralization

This study aimed to evaluate the efficacy of fluoride-free remineralizing agents in initial enamel caries, with and without combined Er,Cr:YSGG laser application. The remineralization effect of various agents and their combinations on artificial initial caries was investigated using 10 experimental groups (n = 7): NC, negative control; PC, positive control; TM, calcium-phosphate compounds (CPP-ACP); TD, theobromine-containing toothpaste; RG, ROCS® remineralizing gel; L, Er,Cr:YSGG laser (2780 nm; 0.25 W; repetition rate, 20 Hz; pulse duration, 140 μs; tip diameter, 600 μm; without air/water cooling); L + fluoride toothpaste; L + TM; L + TD; and L + RG. The demineralized bovine enamel specimens were subjected to an 8-day pH cycle by daily application of the remineralizing agents and laser therapy once prior to the pH cycle and paste application. The enamel samples underwent the Vickers surface microhardness test, and one sample per group was analyzed with scanning electron microscopy. The Kruskal Wallis test was used to compare the microhardness recovery percentage (SMHR%) for each group, and multiple comparisons were made with the Dunn test. Groups L (p = 0.003), RG (p = 0.019), L + TM (p < 0.001), L + fluoride toothpaste (p = 0.001),and L + RG (p = 0.036) exhibited significant increase in SMHR%. The tested remineralizing agents exhibited no statistically significant difference in effect when used alone and in combination with Er,Cr:YSGG laser. Combined application of Er,Cr:YSGG laser and ROCS® remineralization gel effectively promoted enamel remineralization, while use of CPP-ACP and fluoride toothpaste alone was ineffective. Theobromine-containing toothpaste exhibited the least SMHR%. Long-term evaluation of these agents is recommended.

Theobromine versus casein phospho-peptides/Amorphous calcium phosphate with fluoride as remineralizing agents: effect on resin-dentine bond strength, microhardness, and morphology of dentine

BACKGROUND

This study aimed to assess the impact of theobromine and casein phospho-peptides/amorphous calcium phosphate with fluoride (CPP-ACPF) on the resin-dentine bond strength, microhardness, and dentine morphology.

METHODS

A total of 18 sound human molars for micro-tensile bond strength (µTBS), 20 sound human premolars for microhardness, and 30 premolars for Scanning electron microscopy/energy-dispersive X-ray spectroscopy (SEM/EDX) were used. Based on the pre-treatment used, teeth were split into six groups; sound dentine, demineralized dentine, and demineralized dentine treated with theobromine (Sigma Aldrich) and MI paste plus (GC International, USA) for two-time intervals; 5 min and 1 month. The bonded teeth were sectioned to produce 1 mm² resin-dentine sticks which were evaluated for µTBS using a universal testing device (Instron 3365, USA). The dentine microhardness was tested by using the Vickers microhardness tester (Nexus 4000 TM, Netherlands). The pre-treated dentine surface was examined using SEM/EDX (Neoscope JCM-6000 plus Joel benchtop SEM, Japan). µTBS results were analysed with two-way ANOVA. Microhardness and EDX results were analysed with two-way mixed model ANOVA. The significance level was set at (p ≤ 0.05).

RESULTS

While both remineralizing materials at the two-time intervals demonstrated µTBS comparable to sound dentine (46.38 ± 12.18), the demineralized group demonstrated statistically the lowest µTBS (p < 0.001). Whether used for 5 min or 1 month, theobromine significantly increased the microhardness (50.18 ± 3.43) and (54.12 ± 2.66) respectively (p < 0.001), whereas MI paste only increased the hardness (51.12 ± 1.45) after 1 month (p < 0.001).

CONCLUSIONS

The pre-treatment of demineralized dentine with theobromine for 5 min or 1 month could enhance its bond strength and microhardness while for MI paste plus, only 1-month application was efficient to ensure remineralization.

Theobromine versus Casein phospho-peptide/Amorphous Calcium Phosphate with Fluoride as remineralizing agents: Effect on resin-dentine bond strength, microhardness, and morphology of dentine.. [DOI: 10.21203/rs.3.rs-2722167/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Background: This study aimed to assess the impact of theobromine and casein phospho-peptides/amorphous calcium phosphate with Fluoride (CPP/ACPF) on the resin-dentine bond strength, microhardness, and dentine morphology. Methods: Based on the pre-treatment used, 18 sound human third molars were split into six groups.; sound dentine, demineralized dentine, and demineralized dentine treated with theobromine and MI paste plus for two-time intervals; 5 minutes and 1 month. The bonded teeth were sectioned to produce 1 mm2 resin-dentine sticks which were evaluated for micro-tensile bond strength (µTBS) using a universal testing device. The dentine microhardness was tested by using the Vickers microhardness tester. The pre-treated dentine surface was examined using Scanning electron microscopy/energy-dispersive X-ray spectroscopy (SEM/EDX). µTBS results were analysed with two-way ANOVA. Microhardness and EDX results were analysed with two-way mixed model ANOVA. Results: While both remineralizing materials at the two-time intervals demonstrated µTBS comparable to sound dentine, the demineralized group demonstrated statistically the lowest µTBS. Whether used for 5 minutes or 1 month, theobromine significantly increased the microhardness, whereas MI paste only increased the hardness after 1 month. Conclusions: The pre-treatment of demineralized dentine with theobromine and MI paste plus could enhance its bond strength and microhardness.

Bacterial adhesion and antibacterial property of coating materials containing theobromine and S-PRG filler

Theobromine (TB) has been reported to promote tooth remineralization, strengthen tooth substance, and relieve dentin hypersensitivity. This study aimed to evaluate experimental tooth coating materials containing TB and surface pre-reacted glass-ionomer (S-PRG) fillers by examining the effects on bacterial adhesion and antibacterial properties. In addition, the amount of TB eluted from the coating material was measured. There was no significant difference in bacterial adhesion depending on the presence or absence of TB in the coating material, however, a significant decrease in the amount of bacterial adhesion was observed when S-PRG fillers were added to the coating material. The amount of eluted TB did not differ depending on the type of the filler in the coating material. It was suggested that TB could be used to develop a new dental material with the potential ability to inhibit the initiation and progression of dental caries.

Thebromine Targets Adenosine Receptors to Control Hippocampal Neuronal Function and Damage

Theobromine is a caffeine metabolite most abundant in dark chocolate, of which consumption is linked with a lower risk of cognitive decline. However, the mechanisms through which theobromine affects neuronal function remain ill-defined. Using electrophysiological recordings in mouse hippocampal synapses, we now characterized the impact of a realistic concentration of theobromine on synaptic transmission and plasticity. Theobromine (30 μM) facilitated synaptic transmission while decreasing the magnitude of long-term potentiation (LTP), with both effects being blunted by adenosine deaminase (2 U/mL). The pharmacological blockade of A₁R with DPCPX (100 nM) eliminated the theobromine-dependent facilitation of synaptic transmission, whereas the A_2AR antagonist SCH58261 (50 nM), as well as the genetic deletion of A_2AR, abrogated the theobromine-induced impairment of LTP. Furthermore, theobromine prevented LTP deficits and neuronal loss, respectively, in mouse hippocampal slices and neuronal cultures exposed to Aβ_1-42 peptides, considered a culprit of Alzheimer's disease. Overall, these results indicate that theobromine affects information flow via the antagonism of adenosine receptors, normalizing synaptic plasticity and affording neuroprotection in dementia-related conditions in a manner similar to caffeine.

The Effect of Toothpastes Containing Natural Ingredients Such As Theobromine and Caffeine on Enamel Microhardness: An In Vitro Study

The current study aimed to investigate the effect of biocompatible kinds of toothpastes containing natural ingredients such as theobromine and caffeine on the enamel microhardness after demineralization. 72 maxillary premolar teeth extracted for orthodontic purposes were used in this study. Primary enamel surface microhardness examinations were performed using a Digital Micro Vickers Hardness Tester following the Knoop technique (50 g load for 15 s with three indentations at various points). The specimens were immersed in lactic acid (pH = 5.4) for 7 days, washed with distilled water, dried, and then retested for microhardness. According to the type of toothpaste used for brushing, all specimens were categorized as follows: Group 1, Theodent classic® toothpaste (theobromine); Group 2, Power Energy toothpaste (caffeine); Group 3, Colgate toothpaste (fluoride); and Group 4, distilled water as the negative control. The specimens were retested for enamel microhardness after brushing 2 times a day for one month. After brushing with different types of toothpaste, for all experiment groups, the increase in microhardness values in the demineralized enamel surfaces was significant and there were significant differences between them (p value <0.05). The fluoride group had the highest microhardness and had a significant difference with the caffeine and distilled water groups, but there was no significant difference with the theobromine group (p value <0.05). In the theobromine group, the hardness was considerably higher than in the caffeine and distilled water groups. There was no significant difference between the caffeine and distilled water groups. Theobromine toothpaste had the same remineralization effect as that of fluoride toothpaste, while caffeine toothpaste had no positive effect on the remineralization process.

Caries Preventive Effects of Theobromine Containing Toothpaste on Early Childhood Caries: Preliminary Results

Objective

Enamel remineralizing effects of theobromine have received much attention from the clinicians. The aim of this study was to investigate the caries preventive effect of theobromine containing toothpaste on children with early childhood caries (ECC).

Material and Methods

Salivary pH, buffering capacity and frequency of Streptococcus mutans (SM) levels were measured. Each child was assigned either fluoridated or theobromine containing toothpaste. The changes were analyzed using Laser Fluorescence system. Statistical analyses were performed.

Results

We included 13 children (mean age 4.25) with 145 teeth in the fluoridated toothpaste (Colgate Kids toothpaste) group; 13 children (mean age 4.46) with 115 teeth in theobromine containing toothpaste (Theodent^TMKids toothpaste) group. Both toothpastes demonstrated enamel remineralization and were effective in increasing the buffering capacity and pH (p < 0.05). A statistically significant decrease in S. mutans levels was found in both toothpaste groups (p<0.05).

Conclusion

Both toothpaste group showed a statistically significant amount of enamel remineralization. Since theobromine had the added benefits of increasing the salivary pH and decreasing the S.mutans levels, theobromine containing toothpastes can be considered effective agents in remineralizing white spot lesions and can be used in prevention of early enamel lesions.

Artificial Caries Lesion Characteristics after Secondary Demineralization with Theobromine-Containing Protocol

Developing artificial caries lesions with varying characteristics is needed to adequately study caries process in vitro. The objective of this study was to investigate artificial caries lesion characteristics after secondary demineralization protocol containing theobromine and fluoride. Sixty bovine enamel slabs (4 × 3 mm) were demineralized using a Carbopol-containing protocol for 6 days. A baseline area (2 × 3 mm) was protected with acid-resistant nail varnish, after which specimens were exposed for 24 h to a secondary demineralization protocol containing acetic acid plus one of four fluoride/theobromine combinations (n = 15): theobromine (50 or 200 ppm) and fluoride (0 or 1 ppm). Specimens were sectioned and analyzed using transverse microradiography for changes in mineral content, lesion depth, and surface layer mineralization. Data was analyzed using paired t-test and analysis of variance followed by Bonferroni test at 0.05 significance level. After secondary demineralization, fluoride-containing groups had significantly deeper lesions (p = 0.002 and 0.014) compared to the group with 0 ppm fluoride and 50 ppm theobromine. Mineral content and lesion depth were significantly different compared to baseline for all groups. Theobromine did not show an added effect on mineral uptake. Theobromine-containing groups exhibited particularly deep lesions with a more uniform mineral profile in the presence of fluoride.

Fluoride release and remineralizing potential of varnishes in early caries lesions in primary teeth

This study evaluated the fluoride (F) release and remineralizing potential of varnishes containing sodium fluoride (5% NaF), 5% NaF with CPP-ACP and 5% NaF with TCP in early caries lesions in primary teeth. To determine the F release at 1, 4, 6, 24, 72, and 168 hr, strips were covered with the varnishes and immersed in purified water (n = 7). The varnishes and purified water (negative control) were applied on enamel blocks with early caries lesions (n = 16). Enamel blocks were stored in artificial saliva and submitted to a pH-cycling. The area of enamel hardness loss (ΔS) was analyzed by microhardness, lesion depth by polarized light microscopy (PLM) and the chemical analysis by Energy-dispersive X-ray spectroscopy. Data were submitted to Shapiro-Wilk, two-way and one-way ANOVA, Tukey and paired t-tests (α = 5%). All varnishes released F, but 5% NaF with CPP-ACP had the highest release at 4, 6, 24, and 72 hr (p < .05) followed by 5% NaF with TCP and 5% NaF. No significant difference in ΔS was observed among varnishes (5% NaF = 4,098.4 ± 1,407.9; 5% NaF with CPP-ACP = 4,164.0 ± 1,019.3; 5% NaF with TCP = 4,183.2 ± 1,527.2; p = .999), but all of them differed from the negative control group (6,757.8 ± 2,274.7; p < .001). Lesion depth was lower in varnishes groups compared to negative control (% reduction: 5% NaF = 41.8%, 5% NaF with CPP-ACP = 38.8%, and 5% NaF with TCP = 36.3%; p < .001). Similar Ca, P, and Ca/P ratio percentages among groups and F was not detected after the treatments. All fluoride varnishes showed potential to enhance remineralization of early caries lesions in primary teeth.

Preparation of a toothpaste containing theobromine and fluoridated bioactive glass and its effect on surface micro-hardness and roughness of enamel

The aim was to synthesize a toothpaste and analyze its effect on surface micro-hardness and roughness of enamel. Basic paste was prepared by using basic ingredients. Theobromine (0.2 wt%) and laboratory synthesized fluoridated-bioactive glass (F-BG, 4 wt%) were added to it. Post-demineralization, 36 enamel blocks were divided into six groups that were brushed with their respective toothpaste+artificial saliva (AS): group 1 (control): basic paste; group 2: basic paste+theobromine; group 3: commercial theobromine toothpaste; group 4: commercial BG toothpaste; group 5: basic paste+F-BG; and group 6: basic paste+theobromine+F-BG. On micro-hardness analysis, group 6 performed best, followed by group 4. Surface roughness results showed the maximum decrease in roughness values for group 6, followed by group 5. Treatment with toothpaste composition containing theobromine+F-BG resulted in the enamel's increased micro-hardness and decreased surface roughness.

Tuftelin-derived peptide facilitates remineralization of initial enamel caries in vitro

With the gradual discovery of functional domains in natural proteins, several biologically inspired peptides have been designed for use as biomaterials for hard tissue regeneration and repair. In this study, we designed a tuftelin-derived peptide (TDP) and tested its effects on hydroxyapatite crystallization and remineralization of initial enamel carious lesions in vitro. Using circular dichroism spectroscopy, we found that TDP contained 36.1% β-sheets and β-turns, which could be influenced by calcium ions. We verified the ability of TDP to crystallize hydroxyapatite using transmission electron microscopy and its ability to bind to the enamel surface and hydroxyapatite using confocal laser scanning microscopy and Langmuir adsorption isotherms (K = 881.56, N = 1.41 × 10^-5 ). Artificial enamel lesions were generated on human enamel blocks and subjected to a 12-day pH cycling model and were treated with 25 μM TDP, 1 g/L sodium fluoride (NaF), or deionized water. We analyzed the results of remineralization by surface microhardness testing, polarized light microscopy, and transverse microradiography. The TDP group showed significantly higher surface microhardness recovery (49.21 ± 1.66%), shallower lesions (34.89 ± 4.05 μm), and less mineral loss (871.33 ± 81.49 vol%·μm) after pH cycling than the deionized water group (p < .05). There were no significant differences between the TDP and NaF groups. Our experiment indicated that TDP could regulate hydroxyapatite crystallization and promote remineralization of enamel caries in vitro.

The effect of theobromine on the in vitro de- and remineralization of enamel carious lesions

OBJECTIVES

This in vitro study investigated the effect of theobromine on the de- and remineralization of enamel carious lesions under plaque fluid-like conditions.

METHODS

Early carious lesions were created in 272 bovine enamel specimens and assigned to sixteen groups (n=17) based on Knoop surface microhardness (SMH). Lesions were demineralized again under plaque fluid-like conditions in the presence of fluoride (0.2 or 1ppm) and theobromine (0; 10; 100 or 200ppm) at different pH values (5.5 or 7.0) in a factorial design. SMH was determined again and percent SMH recovery (%SMHr) calculated. Three-way ANOVA was used for the fixed effects of fluoride, theobromine and pH levels to compare the differences between each level.

RESULTS

The three-way interaction was not significant (p=0.712). The two-way interaction between fluoride and pH was significant (p=0.030), whereas those between fluoride and theobromine as well as that for pH and theobromine were not (p=0.478 and p=0.998, respectively). Theobromine did not affect %SMHr at any of the tested concentrations. There were trends for the higher fluoride concentration and the higher pH resulting in more rehardening with the lesions exposed to 0.2ppm fluoride at pH 5.5 displaying significantly less rehardening than those exposed to 0.2ppm fluoride at pH of 7.0 and lesions exposed to 1ppm fluoride at pH of 5.5.

CONCLUSION

Theobromine, when continuously present in a plaque fluid-like medium at various concentrations and at different pH values, does not affect de- or remineralization of enamel carious lesions under the presently studied conditions.

CLINICAL SIGNIFICANCE

Based on the presently available evidence, theobromine cannot be recommended as an anticaries agent.

Remineralization Potential of Theobromine on Artificial Carious Lesions

Background and Aims:

This study aimed to investigate the remineralization potential of two concentrations of theobromine (100 mg/L and 200 mmg/L) with fluoridated dentifrice, NovaMin, and nanohydroxyapatite using DIAGNOdent, scanning electron microscopy (SEM), and energy dispersive X-ray (EDX) analysis.

Materials and Methods:

Two sections were taken from 50 teeth each. Artificial carious lesions were induced using demineralizing solution. Evaluation using DIAGNOdent, SEM, and EDX analysis for elemental evaluation of Ca/P ratio and fluoride ion was carried out. Teeth sections were then randomly assigned to five different groups: (1) fluoridated dentifrice (Colgate™, Colgate –Palmolive, India), Novamine- Shy NM™, Group pharamaceuticals, India), 3. Nano-hydroxyapatite- Remin Pro™, Voco, Germany) 4. 100mg and 5. 200mg of Theobromine toothpaste (Theodent classic™, Rennou, UK-853069003006). Remineralization was carried out for 14 days with two applications per day. Samples were reanalyzed using DIAGNOdent, SEM, and EDX.

Results:

A Tukey post-hoc test revealed statistically significant difference between NovaMin and all the other toothpastes (P < 0.001) for DIAGNOdent readings. On performing SEM-EDX analysis, it was seen that all agents had remineralization potential; however, no significant difference was found.

Conclusion:

Theobromine can be used as an effective novel remineralizing agent alternative to the already-available agents.

Effectiveness of Theobromine on Enamel Remineralization: A Comparative In-vitro Study

Background

Remineralizing agents demonstrate potential to reverse early carious lesions. Theobromine containing dentifrices claim to remineralize enamel lesions effectively. The aim of this in-vitro study was to evaluate and compare the remineralization potential of dentifrices containing theobromine, 0.21% sodium fluoride (NaF) with functionalized tricalcium phosphate (f-TCP) and amine fluoride on artificial enamel caries.

Materials and methods

Sound extracted human premolars were demineralized to produce deep artificial carious lesions. The teeth were sectioned longitudinally and allocated to three treatment groups with nine specimens in each group: Group A (NaF + f-TCP), Group B (amine fluoride), and Group C (theobromine). The specimens were then subjected to pH cycling for seven days. Confocal laser scanning microscopy (CLSM) was utilized to record the patterns of demineralization and remineralization. One-way ANOVA and paired t-test were used to analyze changes in lesion depth. The level of significance was set at p<0.05.

Results

All three dentifrices effectively remineralized artificial carious lesions (paired t-test, p<0.001). Of the groups, Group A (54.97%) reported the highest percentage change in lesion depth values followed closely by Group B (51.51%) and Group C (31.71%), respectively.

Conclusion

Within this in-vitro study, theobromine containing dentifrice was effective in remineralizing lesions of enamel. However, theobromine demonstrated less remineralization potential in comparison to dentifrices containing NaF + f-(TCP) and amine fluoride.

Effects of theobromine addition on chemical and mechanical properties of a conventional glass ionomer cement

In vitro effect of 1% theobromine addition on the physical and chemical properties of conventional glass ionomer (GIC) cement was investigated. Conventional GIC (GIC-C) and 1% theobromine added to GIC (GIC-THEO) specimens were compared regarding the microhardness (n = 10), sorption (n = 5), solubility (n = 5), color change (n = 10), fluoride release in saliva (n = 10) and the amount of biofilm deposition (n = 20). Compared against conventional GIC, adding 1% theobromine increased microhardness (p < 0.05), while its sorption, solubility, color and fluoride release to saliva (p > 0.05) remained unchanged. On the other hand, Streptococcus mutans biofilm amount deposited on its surface decreased statistically when theobromine was added to GIC (p < 0.05). Based on the results, it could be concluded that 1% theobromine addition to GIC can be a good strategy as it keeps some of its properties and improves microhardness and biofilm deposits strengthening its role in the preventive approach of dentistry.

Recent Advances in Dental Hard Tissue Remineralization: A Review of Literature

The dental caries is not simply a continuous and unidirectional process of the demineralization of the mineral phase, but a cyclic event with periods of demineralizations and remineralisation. The remineralization process is a natural repair mechanism to restore the minerals again, in ionic forms, to the hydroxyapatite (HAP) crystal lattice. It occurs under near-neutral physiological pH conditions whereby calcium and phosphate mineral ions are redeposited within the caries lesion from saliva and plaque fluid resulting in the formation of newer HAP crystals, which are larger and more resistant to acid dissolution. Numerous types of remineralizing agents and remineralizing techniques have been researched and many of them are being used clinically, with significantly predictable positive results. The recent researches on remineralization are based on biomimetic remineralization materials, having the capability to create apatite crystals within the completely demineralized collagen fibers.

How to cite this article

Arifa MK, Ephraim R, et al. Recent Advances in Dental Hard Tissue Remineralization: A Review of Literature. Int J Clin Pediatr Dent 2019;12(2):139-144.

Effects of toothpastes on white spot lesions around orthodontic brackets using quantitative light-induced fluorescence (QLF) : An in vitro study

AIM

The aim of this study was to investigate the effects of toothpastes with different contents on the remineralization of white spot lesions around orthodontic brackets by quantitative light-induced fluorescence (QLF).

MATERIALS AND METHODS

A total of 45 freshly extracted human mandibular first molars were selected. Artificial caries lesions were created on enamel surfaces using an acidified gel system for 7 days. Initial relative fluorescence loss was calculated as the pretreatment (baseline) fluorescence value by QLF device. Molar tubes were bonded using light-cured resin composite cement. The specimens were randomly divided into three experimental groups (n = 15). Different toothpastes were applied to demineralized enamel: (1) fluoride-containing toothpaste (Colgate Total^®), (2) Novamin-containing toothpaste (Sensodyne^® Repair and Protect), (3) probiotic-containing toothpaste (GD Probiotic Toothpaste^®). After 2 weeks of treatment, fluorescence loss and lesion area were measured with QLF. To determine fluorescence changes, intergroup comparisons were performed with a multivariate analysis of variance, followed by Tukey's test at a probability value of p < 0.05.

RESULTS

Significant differences were observed between initial and posttreatment QLF measurements of the demineralized enamel specimens treated with the various agents (p < 0.05). In all experimental groups, significant fluorescence radiance increase and decrease of the lesion area (p = 0.000) was found.

CONCLUSION

Novamin-containing toothpaste provided more increase of fluorescence compared to fluoride- and probiotic-containing toothpastes.

The effects of fluoride, strontium, theobromine and their combinations on caries lesion rehardening and fluoridation

OBJECTIVE

The aim was to investigate the effects of fluoride, strontium, theobromine and their combinations on caries lesion rehardening and fluoridation (EFU) under pH cycling conditions.

DESIGN

Human enamel specimens were demineralized at 37°C for 24h using a pH 5.0 solution containing 50mM lactic acid and 0.2% Carbopol 907 which was 50% saturated with respect to hydroxyapatite. Lesions were assigned to nine treatment groups (n=16) based on Knoop surface microhardness indentation length.

TREATMENT

aqueous solutions were: placebo, 11.9mM sodium fluoride (F), 23.8mM sodium fluoride (2×F), 1.1mM strontium chloride hexahydrate (Sr), 1.1mM F theobromine, Sr+theobromine, F+Sr, F+theobromine, F+Sr+theobromine. Lesions were pH cycled for 5d (daily protocol: 3×1min-treatment; 2×60min-demineralization; 4×60min & overnight-artificial saliva). Knoop indentation length was measured again and%surface microhardness recovery (%SMHr) calculated. EFU was determined using the acid-etch technique. Data were analysed using ANOVA.

RESULTS

Model showed fluoride dose-response for both variables (2×F>F>placebo). For%SMHr, F+Sr+/-theobromine resulted in more rehardening than F, however less than 2×F. F+theobromine was similar to F. For EFU, F+Sr was inferior to F, F+theobromine and F+Sr+theobromine which were similar and inferior to 2×F. In absence of fluoride, Sr, theobromine or Sr+theobromine were virtually indistinguishable from placebo and inferior to F.

CONCLUSIONS

It can be concluded that a) strontium aids rehardening but not EFU and only in presence of fluoride; b) theobromine does not appear to offer any anti-caries benefits in this model; c) there are no synergistic effects between strontium and theobromine in the presence or absence of fluoride.

Theobromine Upregulates Osteogenesis by Human Mesenchymal Stem Cells In Vitro and Accelerates Bone Development in Rats

Theobromine (THB) is one of the major xanthine-like alkaloids found in cacao plant and a variety of other foodstuffs such as tea leaves, guarana and cola nuts. Historically, THB and its derivatives have been utilized to treat cardiac and circulatory disorders, drug-induced nephrotoxicity, proteinuria and as an immune-modulator. Our previous work demonstrated that THB has the capacity to improve the formation of hydroxyl-apatite during tooth development, suggesting that it may also enhance skeletal development. With its excellent safety profile and resistance to pharmacokinetic elimination, we reasoned that it might be an excellent natural osteoanabolic supplement during pregnancy, lactation and early postnatal growth. To determine whether THB had an effect on human osteoprogenitors, we subjected primary human bone marrow mesenchymal stem cells (hMSCs) to osteogenic assays after exposure to THB in vitro and observed that THB exposure increased the rate of osteogenesis and mineralization by hMSCs. Moreover, THB exposure resulted in a list of upregulated mRNA transcripts that best matched an osteogenic tissue expression signature as compared to other tissue expression signatures archived in several databases. To determine whether oral administration of THB resulted in improved skeletal growth, we provided pregnant rats with chow supplemented with THB during pregnancy and lactation. After weaning, offspring received THB continuously until postnatal day 50 (approximately 10 mg kg^-1 day^-1). Administration of THB resulted in neonates with larger bones, and 50-day-old offspring accumulated greater body mass, longer and thicker femora and superior tibial trabecular parameters. The accelerated growth did not adversely affect the strength and resilience of the bones. These results indicate that THB increases the osteogenic potential of bone marrow osteoprogenitors, and dietary supplementation of a safe dose of THB to expectant mothers and during the postnatal period could accelerate skeletal development in their offspring.

Evaluation of the remineralization capacity of CPP-ACP containing fluoride varnish by different quantitative methods

Objective

The aim of this study was to evaluate the efficacy of CPP-ACP containing fluoride varnish for remineralizing white spot lesions (WSLs) with four different quantitative methods.

Material and Methods

Four windows (3x3 mm) were created on the enamel surfaces of bovine incisor teeth. A control window was covered with nail varnish, and WSLs were created on the other windows (after demineralization, first week and fourth week) in acidified gel system. The test material (MI Varnish) was applied on the demineralized areas, and the treated enamel samples were stored in artificial saliva. At the fourth week, the enamel surfaces were tested by surface microhardness (SMH), quantitative light-induced fluorescence-digital (QLF-D), energy-dispersive spectroscopy (EDS) and laser fluorescence (LF pen). The data were statistically analyzed (α=0.05).

Results

While the LF pen measurements showed significant differences at baseline, after demineralization, and after the one-week remineralization period (p<0.05), the difference between the 1- and 4-week was not significant (p>0.05). With regards to the SMH and QLF-D analyses, statistically significant differences were found among all the phases (p<0.05). After the 1- and 4-week treatment periods, the calcium (Ca) and phosphate (P) concentrations and Ca/P ratio were higher compared to those of the demineralization surfaces (p<0.05).

Conclusion

CPP-ACP containing fluoride varnish provides remineralization of WSLs after a single application and seems suitable for clinical use.

Inhibition of hydroxyapatite growth by casein, a potential salivary phosphoprotein homologue

Salivary phosphoproteins are essential in tooth mineral regulation but are often overlooked in vitro. This study aimed to evaluate the effect of casein, as a salivary phosphoprotein homologue, on the deposition and growth of hydroxyapatite (HA) on tooth surfaces. Hydroxyapatite growth was quantified using seeded crystal systems. Artificial saliva (AS) containing HA powder and 0, 10, 20, 50, or 100 μg ml(-1) of casein, or 100 μg ml(-1) of dephosphorylated casein (Dcasein), was incubated for 0-8 h at 37°C, pH 7.2. Calcium concentrations were measured using atomic absorption spectroscopy (AAS). Surface precipitation of HA on bovine enamel and dentine blocks, incubated in similar conditions for 7 d, was examined using field emission scanning electron microscopy (FE-SEM) and transmission electron microscopy (TEM) with selected area electron diffraction (SAED). Casein adsorption was assessed using modified Lowry assays and zeta-potential measurements. The AAS results revealed a concentration-dependent inhibition of calcium consumption. Hydroxyapatite precipitation occurred when no casein was present, whereas precipitation of HA was apparently completely inhibited in casein-containing groups. Adsorption data demonstrated increasingly negative zeta-potential with increased casein concentration and an affinity constant similar to proline-rich proteins with Langmuir modelling. Casein inhibited the deposition and growth of HA primarily through the binding of esterized phosphate to HA active sites, indicating its potential as a mineral-regulating salivary phosphoprotein homologue in vitro.

Identification and functional analysis of genome mutations in a fluoride-resistant Streptococcus mutans strain

It is known that fluoride-resistant microorganisms are different from fluoride-sensitive ones in growth, adherence and metabolic activity. It was hypothesized that these phenotypic differences were due to stable genotypic changes in the fluoride-resistant strains. However, until now, no studies have reported these genotypic changes. The aim of this study is to identify such changes in a fluoride-resistant Streptococcus mutans strain (C180-2FR) using whole-genome shotgun (WGS) sequencing and to examine the potential function of the identified mutations by comparing gene expression between the fluoride-sensitive (C180-2) and C180-2FR strains. We performed 50 bp paired-end Illumina shotgun sequencing for both strains. Through extensive bioinformatic analysis, we were able to identify 8 single nucleotide polymorphisms (SNPs) in the genome of C180-2FR, which were further confirmed by Sanger sequencing. Expression of the genes containing or in proximity to the SNPs in C180-2 and C180-2FR was then quantified by real-time PCR. A gene cluster containing genes coding for fluoride antiporters was up-regulated 10-fold in C180-2FR when compared to that in C180-2, independent of growth phase. Two SNPs are located in this gene cluster, one in its promoter region and the other in its protein-coding region. In addition, one gene, which codes for a putative glycerol uptake facilitator protein, was found to be down-regulated by 60% in C180-2FR at an early growth phase. The promoter region of this gene contained a SNP. No difference in expression was found for the other SNP-containing genes. In summary, using WGS sequencing, we were able to uncover genetic changes in the genome of a fluoride-resistant strain. These findings can provide new insights into the mechanism of microbial fluoride resistance.