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

Remineralizing Potential of Milk and GC Tooth Mousse on Demineralized Human Enamel: An In Vitro Comparative Evaluation

Introduction Caries initiation is associated with demineralization of the subsurface tooth enamel. Today, bioactive agents based on milk products have been developed to enhance remineralization under cariogenic conditions. However, there is limited information on the remineralization potential of milk.

Materials and Methods Fifty enamel specimens were prepared from sound human premolars. All enamel specimens were then placed in demineralizing solution for 4 days at 37°C to produce artificial carious lesion. Baseline surface microhardness (SMH) was evaluated using Vickers indenter. Enamel specimens were then randomly divided into three groups. Group 1 specimens were kept in artificial saliva, whereas group 2 and 3 enamel specimens were treated with milk and GC tooth mousse, respectively, for 5 minutes twice daily for 21 days. Post-treatment SMH measurements of all specimens were evaluated on the 7th, 14th, and 21st day. Data was statistically analyzed using one-way analysis of variance test and Tukey honest significant difference post-hoc test.

Results There were no significant differences in the SMH values in the control group at any time interval. There were statistically significant increases in the post-SMH values in milk and GC tooth mousse (p < 0.001) at the end of 21st day of remineralization.

Conclusion Milk showed remineralization potential comparable to that of GC tooth mousse.

Synthesis of plate-like β-tricalcium phosphate nanoparticles and their efficiency in remineralization of incipient enamel caries

The purpose of this study was to synthesize nano-sized β-tricalcium phosphate (nano-TCP) particles and determine its concentration-dependent properties on incipient enamel caries lesions. Nano-TCP was synthesized as a wet chemical through a method using low concentration of precursors and low addition rate of calcium nitrate tetrahydrate as a second phase. Morphology and phase composition of the particles were analyzed by SEM, XRD, and EDXA techniques. Incipient enamel lesions were created in human premolars with an acidic buffer. The teeth were then incubated in aqueous dispersions of nano-TCP as remineralization solutions. Sodium fluoride solution and deionized water were used as positive and negative control groups, respectively. The quality and thickness of the remineralized layer on enamel were investigated using SEM. The data were statistically analyzed by analysis of variance (ANOVA) and post hoc Tukey’s test. The synthesized nano-TCP mostly consisted of porous platelet-like crystals of 50–100 nm thickness and pore diameters of 100–300 nm. SEM observation showed that a homogenous layer was formed on the surface of the enamels remineralized in nano-TCP solutions. The thickness of the mineralized layer was dependent on the incubation time and nano-TCP concentration.

Toothpaste with Nanosized Trimetaphosphate Reduces Enamel Demineralization

This double-blind crossover study assessed the effects of a low-fluoride (low-F) dentifrice containing nanosized sodium trimetaphosphate (TMP) on enamel demineralization in situ. Nineteen subjects wore palatal appliances containing 4 blocks of bovine enamel and were randomly assigned to brush their teeth with placebo (without F/TMP), 250-ppm F (250F), 250F plus 0.05% nanosized TMP (250F-TMPnano), and 1,100-ppm F (1,100F) dentifrices during 7 d, under cariogenic challenge. Enamel surface hardness and cross-sectional hardness (ΔKHN [Knoop hardness number]), as well as F, calcium (Ca), and phosphorus (P) concentrations, were determined. Also, biofilm that formed on the blocks was analyzed for F, Ca, P, and insoluble extracellular polysaccharide concentrations. Data were submitted to analysis-of-variance models and Student-Newman-Keuls test ( P < 0.05). The 250F-TMPnano dentifrice promoted the lowest ΔKHN among all groups ( P < 0.001), while the percentage of surface hardness loss was similar to 1,100F. Also, similar F, Ca, and P concentrations in enamel were observed for 1,100F and 250F-TMPnano. In the biofilm, the highest F content was observed for 1,100F; Ca content was similar between 1,100F and 250F-TMPnano; and P content was similar among all groups. Similar extracellular polysaccharide values were observed for 250F-TMPnano and 1,100F ( P < 0.001), ionic activity of CaHPO40, CaF+, and HF0 ( P < 0.05) and degree of saturation of hydroxyapatite and CaF2 ( P < 0.05). It was concluded that the protective effect of 250F-TMPnano dentifrice was similar to a conventional dentifrice for most of the variables studied, having a more pronounced effect on the subsurface lesion when compared with the conventional toothpaste (1,100F).

Knowledge Transfer Statement: Although toothpastes containing ≥1,000-ppm fluoride are more effective than low-fluoride formulations against dental caries, their early use can lead to side effects. This has prompted intensive research on alternatives to increase the anticaries effect of low-fluoride toothpastes. The present in situ study demonstrated that the addition of sodium trimetaphosphate nanoparticles to toothpastes containing 250-ppm fluoride significantly enhances the protective effect of this formulation against enamel demineralization to levels comparable to a 1,100-ppm fluoride toothpaste in terms of most of the variables studied. Most important, this formulation promoted the lowest loss of subsurface hardness among all groups, suggesting that caries lesions would take longer to develop under clinical conditions when compared with a conventional (1,100-fluoride) toothpaste.

Effect of toothpaste with nano-sized trimetaphosphate on dental caries: In situ study

OBJECTIVES

This in situ study was to evaluate the remineralizing effect of a fluoride toothpaste supplemented with nano-sized sodium trimetaphosphate (TMP).

METHODS

This blind and cross-over study was performed in 4 phases of 3 days each. Twelve subjects used palatal appliances containing four bovine enamel blocks with artificial caries lesions. Volunteers were randomly assigned into the following treatment groups: Placebo (without F and TMP); 1100 ppm F (1100), 1100 supplemented with 3% micrometric TMP (1100 TMP) and with nano-sized TMP (1100 TMPnano). Volunteers were instructed to brush their natural teeth with the palatal appliances in the mouth during 1min (3 times/day), so that blocks were treated with natural slurries of toothpastes. After each phase, the percentage of surface hardness recovery (%SHR), integrated mineral recovery (IMR) and integrated differential mineral area profile (ΔIMR) in enamel lesions were calculated. F in enamel was also determined. Data were analyzed by ANOVA and Student-Newman-Keuls test.

RESULTS

Enamel surface became 20% harder when treated with 1100 TMPnano in comparison with 1100 (p<0.001). 1100 TMPnano showed remineralizing capacity (IMR; ΔIMR) 66% higher when compared with 1100 TMP (p<0.001). Enamel F uptake in the 1100 TMPnano group was 2-fold higher when compared to its counterpart without TMP (p<0.001).

CONCLUSION

The addition of 3% TMPnano to a conventional toothpaste was able to promote an additional remineralizing effect of artificial caries lesions.

CLINICAL SIGNIFICANCE

Toothpaste containing 1100 ppm F associated with TMPnano showed a potential of higher remineralization to 1100 ppm F and 1100 ppm F micrometric TMP.

In vitro enamel remineralization capacity of composite resins containing sodium trimetaphosphate and fluoride

OBJECTIVES

This study evaluated the in vitro enamel remineralization capacity of experimental composite resins containing sodium trimetaphosphate (TMP) combined or not with fluoride (F).

MATERIALS AND METHODS

Bovine enamel slabs were selected upon analysis of initial surface hardness (SH1) and after induction of artificial carious lesions (SH2). Experimental resins were as follows: resin C (control—no sodium fluoride (NaF) or TMP), resin F (with 1.6% NaF), resin TMP (with 14.1% TMP), and resin TMP/F (with NaF and TMP). Resin samples were made and attached to enamel slabs (n = 12 slabs per material). Those specimens (resin/enamel slab) were subjected to pH cycling to promote remineralization, and then final surface hardness (SH3) was measured to calculate the percentage of surface hardness recovery (%SH). The integrated recovery of subsurface hardness (ΔKHN) and F concentration in enamel were also determined. Data was analyzed by ANOVA and Student-Newman-Keuls test (p < 0.05).

RESULTS

Resins F and TMP/F showed similar SH3 values (p = 0.478) and %SH (p = 0.336) and differed significantly from the other resins (p < 0.001). Considering ΔKHN values, resin TMP/F presented the lowest area of lesion (p < 0.001). The presence of F on enamel was different among the fluoridated resins (p = 0.042), but higher than in the other resins (p < 0.001).

CONCLUSIONS

The addition of TMP to a fluoridated composite resin enhanced its capacity for remineralization of enamel in vitro.

CLINICAL RELEVANCE

The combination of two agents with action on enamel favored remineralization, suggesting that composite resins containing sodium trimetaphosphate and fluoride could be indicated for clinical procedures in situations with higher cariogenic challenges.

Protective potential of casein phosphopeptide amorphous calcium phosphate containing paste on enamel surfaces

Background:

Dental caries remains the most common dental disease facing mankind. Prevention of initiation and interruption in progression of early lesions are the desirable modes of caries management. There is a scope for agents, which may be used to enhance anti - caries activity. This need has redirected research to develop novel preventive agents that can act as an adjunct to fluoride or independent of it. Casein Phosphopeptide – Amorphous Calcium Phosphate (CPP-ACP) is one such agent that has been proposed to have anti cariogenic properties.

Aim:

The purpose of this in vitro study was to evaluate the effect of paste containing CPP-ACP, MI Paste, on enamel remineralization.

Materials and Methods:

This study consisted of 30 samples embedded in orthodontic resin with either the buccal or lingual surface exposed. The samples were assigned to either a CPP-ACP containing paste; Fluoridated toothpaste; or a control group. The groups were then subjected to cycling in a demineralizing solution and a remineralizing solution. Groups II and III received prior application of MI paste and Fluoridated toothpaste respectively followed by cycling in a demineralizing solution and a remineralizing solution. Following 14 days of cycling, the samples were sectioned and examined using confocal microscopy. The lesion depth, were evaluated.

Statistical Analysis:

Image Proplus software was used to analyze the images. The values were statistically evaluated using one – way ANOVA and Scheffe's Test.

Results and Conclusion:

Within the limitations of the study it was concluded that enamel surfaces treated with the CPP-ACP paste exhibited the least lesion depths followed by the enamel surfaces treated with the fluoridated tooth paste and control group respectively.

Anticariogenic complexes of amorphous calcium phosphate stabilized by casein phosphopeptides: a review

Using laboratory, animal, and human in situ caries models, investigators have shown that casein phosphopeptide amorphous calcium phosphate complexes (CPP-ACP) exhibit an anticariogenic activity. The casein phosphopeptides (CPP) are produced from a tryptic digest of the milk protein casein by aggregation with calcium phosphate and purification by ultrafiltration. The CPP have a remarkable ability to stabilize calcium phosphate in solution and substantially increase the level of calcium phosphate in dental plaque. Through their multiple phosphoseryl residues, the CPP bind to forming clusters of amorphous calcium phosphate (ACP) in metastable solution, preventing their growth to the critical size required for nucleation and precipitation. The proposed mechanism of anticariogenicity for the CPP-ACP is that they localize ACP in dental plaque, which buffers the free calcium and phosphate lon activities, thereby helping to maintain a state of supersaturation with respect to tooth enamel depressing demineralization and enhancing remineralization. The CPP-ACP, unlike fluoride, can be added to sugar-containing foods and therefore have commercial potential as an additive to foods as well as to toothpastes and mouthwashes for the control of dental caries.

Role of Models in Assessing New Agents for Caries Prevention-Non-Fluoride Systems: Reaction Paper

Several important issues have been raised concerning the need for consideration of alternatives to fluoride. The principle reason to do so has been the lack of comprehensive effectiveness of fluoride, which in turn reveals incomplete understanding of the caries process. Included among the topics required for clarification of caries initiation would be quantitative methods for relating plaque pH values to the formation of caries. Thus, methods for assessing the activity of anticaries agents over time would be of considerable assistance in monitoring the effects of these test compounds on bacteria. The use of recombinant oral micro-organisms containing genetic fusions, to provide information on the effects of agents on bacteria growing in model systems, is discussed as a possible means of obtaining relevant data in situ.