Zeta potentials of human enamel and hydroxyapatite as measured by the Coulter DELSA 440

Chitosan nanoparticle applications in dentistry: a sustainable biopolymer

The epoch of Nano-biomaterials and their application in the field of medicine and dentistry has been long-lived. The application of nanotechnology is extensively used in diagnosis and treatment aspects of oral diseases. The nanomaterials and its structures are being widely involved in the production of medicines and drugs used for the treatment of oral diseases like periodontitis, oral carcinoma, etc. and helps in maintaining the longevity of oral health. Chitosan is a naturally occurring biopolymer derived from chitin which is seen commonly in arthropods. Chitosan nanoparticles are the latest in the trend of nanoparticles used in dentistry and are becoming the most wanted biopolymer for use toward therapeutic interventions. Literature search has also shown that chitosan nanoparticles have anti-tumor effects. This review highlights the various aspects of chitosan nanoparticles and their implications in dentistry.

Characteristics of tin-containing fluoride toothpastes related to erosive tooth wear protection

OBJECTIVES

To assess the effect of different tin-containing toothpastes on the control of erosive tooth wear in enamel and dentin.

METHODS

Enamel and dentin slabs were randomly distributed into 7 experimental groups (n = 10/substrate): C-: negative control (Artificial saliva); AmF (regular fluoridated toothpaste without tin); Sn-1 (SnF2/NaF); Sn-2 (SnF2/NaF/SnCl2); Sn-3 (SnCl2/NaF); Sn-4 (SnF2/SnCl2); Sn-5 (SnCl2/AmF/NaF/chitosan). Specimens were submitted to 5-day erosion-abrasion cycling. Surface loss (SL) was determined with an optical profilometer. Tin deposition on the tooth surfaces and some characteristics of the toothpastes (pH, potentially available F-, %weight of solid particles, and RDA) were also assessed. Data were statistically analyzed (α = 0.05).

RESULTS

For enamel, the Sn-2 presented the lowest SL, not differing significantly from AmF, C+, and Sn-3. The SL of these groups was significantly lower than the C-, except for Sn-3. Sn-1 and Sn-4 were also not significantly different from C-. For dentin, C- significantly showed the highest SL values, whilst, Sn-1 presented the lowest SL, not differing significantly from AmF, Sn-2, C+, and Sn-3. There was a significant positive association between enamel SL and the pH and tin deposition. Dentin SL was significantly negatively associated with the %weight of solid particles and RDA.

CONCLUSIONS

Most of the tin-toothpastes were able to exhibit some protection against ETW. In this process, the toothpastes characteristics play a role, as lower enamel SL was significantly associated with lower pH values and tin deposition; and lower dentin SL was associated with higher %weight of solid particles and RDA of the toothpastes.

CLINICAL SIGNIFICANCE

Tin-containing toothpastes can be used for erosive tooth wear protection, but our study showed that their effect depends on the pH, amount of tin deposition, % weight of solid particles and RDA of the toohpastes.

The composition of the dental pellicle: an updated literature review

Background

The dental pellicle is a thin layer of up to several hundred nm in thickness, covering the tooth surface. It is known to protect the teeth from acid attacks through its selective permeability and it is involved in the remineralization process of the teeth. It functions also as binding site and source of nutrients for bacteria and conditioning biofilm (foundation) for dental plaque formation.

Methods

For this updated literature review, the PubMed database was searched for the dental pellicle and its composition.

Results

The dental pellicle has been analyzed in the past years with various state-of-the art analytic techniques such as high-resolution microscopic techniques (e.g., scanning electron microscopy, atomic force microscopy), spectrophotometry, mass spectrometry, affinity chromatography, enzyme-linked immunosorbent assays (ELISA), and blotting-techniques (e.g., western blot). It consists of several different amino acids, proteins, and proteolytic protein fragments. Some studies also investigated other compounds of the pellicle, mainly fatty acids, and carbohydrates.

Conclusions

The dental pellicle is composed mainly of different proteins, but also fatty acids, and carbohydrates. Analysis with state-of-the-art analytical techniques have uncovered mainly acidic proline-rich proteins, amylase, cystatin, immunoglobulins, lysozyme, and mucins as main proteins of the dental pellicle. The pellicle has protective properties for the teeth. Further research is necessary to gain more knowledge about the role of the pellicle in the tooth remineralization process.

pH-Responsive Biomaterials for the Treatment of Dental Caries-A Focussed and Critical Review

Dental caries is a common and costly multifactorial biofilm disease caused by cariogenic bacteria that ferment carbohydrates to lactic acid, demineralizing the inorganic component of teeth. Therefore, low pH (pH 4.5) is a characteristic signal of the localised carious environment, compared to a healthy oral pH range (6.8 to 7.4). The development of pH-responsive delivery systems that release antibacterial agents in response to low pH has gained attention as a targeted therapy for dental caries. Release is triggered by high levels of acidogenic species and their reduction may select for the establishment of health-associated biofilm communities. Moreover, drug efficacy can be amplified by the modification of the delivery system to target adhesion to the plaque biofilm to extend the retention time of antimicrobial agents in the oral cavity. In this review, recent developments of different pH-responsive nanocarriers and their biofilm targeting mechanisms are discussed. This review critically discusses the current state of the art and innovations in the development and use of smart delivery materials for dental caries treatment. The authors' views for the future of the field are also presented.

Film-Forming Polymers for Tooth Erosion Prevention

Different agents have been proposed to prevent the progression of acid induced dental substance losses, which are called erosive tooth wear (ETW), such as fluorides, calcium, and phosphate-based products; however, there is a need for a further increase in efficacy. Recently, the ability of polymers to interact with the tooth surface, forming acid resistant films, has come into the focus of research; nevertheless, there is still the need for a better understanding of their mode of action. Thus, this article provides an overview of the chemical structure of polymers, their mode of action, as well as the effect of their incorporation into oral care products, acid beverages, and antacid formulations, targeting the prevention of ETW. Recent evidence indicates that this may be a promising approach, however, additional studies are needed to confirm their efficacy under more relevant clinical conditions that consider salivary parameters such as flow rate, composition, and clearance. The standardization of methodological procedures such as acid challenge, treatment duration, and combination with fluorides is necessary to allow further comparisons between studies. In conclusion, film-forming polymers may be a promising cost-effective approach to prevent and control erosive demineralization of the dental hard tissue.

Improved bond performances of self-etch adhesives to enamel through increased MDP-Ca salt formation via phosphoric acid pre-etching

OBJECTIVES

The chemical affinity between 10-methacryloyloxydecyl dihydrogen phosphate (MDP) and hydroxyapatite (HAp) is an important factor in the enamel bonding provided by MDP-based self-etch (SE) adhesives, besides microinterlocking mechanisms. This study aimed to investigate how phosphoric acid pre-etching affects MDP-Ca salt formation in the application of MDP-based SE adhesives.

METHODS

Single Bond Universal (SBU), All Bond Universal (ABU), Clearfil Universal Bond Quick (CBQ), and a MDP-based all-in-one adhesive (EXP) were used in both SE and etch-and-rinse (ER) modes, along with Clearfil SE Bond and untreated enamel (UE) as controls. The MDP-Ca salts produced with or without etching were examined by nuclear magnetic resonance, Raman spectroscopy, X-ray photoelectron spectroscopy, X-ray diffraction, and Fourier-transform infrared spectroscopy. Zeta potential, contact angle, and scanning electron microscopy measurements were employed to elucidate the mechanism behind the changes in MDP/HAp chemical affinity upon pre-etching.

RESULTS

The percentage of MDP-Ca salt in EXP_ER (73.13%) was higher than that in EXP_SE (43.27%). Characteristic CH₂ (1130, 1441, 2853, and 2909 cm^-1), CC (1641 cm^-1), and CO (1718 cm^-1) bands were observed in the Raman spectra of EXP_ER. Pre-etching increased the negative zeta potential of the enamel surface compared to that of UE (P < 0.001). The contact angles of MDP-based adhesives applied to pre-etched enamel were significantly lower than those of the self-etched surface (P < 0.05).

SIGNIFICANCE

The increased MDP-Ca salt formation is a significant advantage of phosphoric acid pre-etching, improving the MDP/HAp chemical affinity in addition to increasing surface wettability.

Effect of TiF4/NaF and chitosan solutions on biofilm formation and prevention of dentin demineralization

OBJECTIVE

This study evaluated the effect of experimental solutions containing TiF₄/NaF and chitosan on bacterial species of microcosm biofilm and on dentin demineralization.

DESIGN

Microcosm biofilm was produced from human saliva mixed with McBain medium (0.2% sucrose) on bovine dentin for 5 days, under 5% CO₂ and 37 °C. From the 2nd day to 5th day, the treatments were applied (1×60s/day) as following: (1) NaF (500 ppm F^-, positive control); (2) TiF₄ and NaF (TiF₄: 190 ppm Ti⁴⁺ and 300 ppm F^-; NaF: 190 ppm F^-); (3) similar to 2 plus 0.5% chitosan (Ch 500 mPa.s, 75% deacetylation); (4) phosphate buffer solution (negative control); and (5) 0.5% chitosan (Ch 500 mPa.s, 75% deacetylation). CFU counting was performed for total microorganism, total streptococci, total lactobacilli and mutans streptococci. Dentin demineralization was measured by transverse microradiography-TMR. The data were compared using ANOVA/Tukey or Kruskal-Wallis/Dunn tests (p < 0.05).

RESULTS

No differences were found between the treatments with respect to CFU counting (p > 0.05). Dentin treated with TiF₄/NaF plus chitosan solution presented the lowest demineralization compared to the negative control and pure chitosan solution. On the other hand, this experimental solution did not significantly differ from TiF₄/NaF solution, being both able to significantly reduce mineral loss.

CONCLUSION

TiF₄/NaF plus chitosan solution, at suitable pH to be clinically applicable, had no antimicrobial effect, but it was able to reduce dentin caries development under this model.

Polysaccharide-Based Micro- and Nanosized Drug Delivery Systems for Potential Application in the Pediatric Dentistry

The intensive development of micro- and nanotechnologies in recent years has offered a wide horizon of new possibilities for drug delivery in dentistry. The use of polymeric drug carriers turned out to be a very successful technique for formulating micro- and nanoparticles with controlled or targeted drug release in the oral cavity. Such innovative strategies have the potential to provide an improved therapeutic approach to prevention and treatment of various oral diseases not only for adults, but also in the pediatric dental practice. Due to their biocompatibility, biotolerance and biodegradability, naturally occurring polysaccharides like chitosan, alginate, pectin, dextran, starch, etc., are among the most preferred materials for preparation of micro- and nano-devices for drug delivery, offering simple particle-forming characteristics and easily tunable properties of the formulated structures. Their low immunogenicity and low toxicity provide an advantage over most synthetic polymers for the development of pediatric formulations. This review is focused on micro- and nanoscale polysaccharide biomaterials as dental drug carriers, with an emphasis on their potential application in pediatric dentistry.

Effect of TiF4/NaF and chitosan solutions on the development of enamel caries under a microcosm biofilm model

OBJECTIVES

To evaluate the effect of experimental solutions containing TiF₄/NaF and chitosan on bacterial species and on enamel caries prevention.

METHODS

Microcosm biofilm was produced from human saliva mixed with McBain saliva (0.2% sucrose) on bovine enamel for five days, under 5% CO₂ and 37 °C. From the second day until the end, the treatments were applied (1 × 60 s/day): (1) NaF (500 ppm F^-, positive control); (2) TiF₄ and NaF (TiF₄: 190 ppm Ti⁴⁺ and 300 ppm F^-; NaF: 190 ppm F^-); (3) similar to 2 plus 0.5% chitosan (Ch 500 mPas, 75% deacetylation); (4) phosphate buffer solution (negative control); and (5) 0.5% chitosan (Ch 500 mPas, 75% deacetylation). CFU counting was performed for total microorganism, total streptococcus, total lactobacillus and Streptococcus mutans. Enamel demineralization was measured by transverse microradiography-TMR. The data were compared using ANOVA/Tukey or Kruskal-Wallis/Dunn tests (p < .050).

RESULTS

No differences were found between the treatments with respect to CFU counting (ANOVA, p > .050). Enamel treated with TiF₄/NaF plus chitosan solution presented the lowest demineralization compared to the negative control and pure chitosan solution. On the other hand, this experimental solution did not significantly differ from TiF₄/NaF and NaF solutions, being all of them able to significantly reduce mineral loss (50-74%), but only TiF₄/NaF plus chitosan reduced lesion depth (55%) compared to the negative control (p = .001).

CONCLUSION

TiF₄/NaF plus chitosan solution had no antimicrobial effect, but it was able to reduce enamel caries development in 79% compared to control under this model.

CLINICAL SIGNIFICANCE

This study showed that TiF₄/NaF plus chitosan solution had no antimicrobial effect, but it was able to reduce enamel caries development under a microcosm biofilm model.

Effects of Phosphoric Acid Pre-Etching on Chemisorption between Enamel and MDP-Containing Universal Adhesives: Chemical and Morphological Characterization, and Evaluation of Its Potential

This study aimed to provide evidence that phosphoric acid pre-etching is necessary for the chemisorption between enamel and 10-methacryloyloxydecyl dihydrogen phosphate (MDP)-containing universal adhesives. Three MDP-containing universal adhesives: Single Bond Universal (SBU), All Bond Universal (ABU), and Clearfil Universal Bond Quick (CBQ), as well as an experimental MDP-containing adhesive (EX) were investigated. Clearfil SE Bond (CSE) was a control and untreated enamel (UE) was another control. Self-etch (SE) and etch-and-rinse (ER) bonding modes were employed for universal adhesives. The enamel surfaces with different treatments were observed with a scanning electron microscope (SEM). The chemical bonds in the enamel reactants were determined using Fourier transform infrared spectroscopy (FTIR), X-ray photoelectron spectroscopy (XPS), and nuclear magnetic resonance (NMR). The charge changes with phosphoric acid pre-etching or without were characterized by ζ-potential. FTIR confirmed the chemisorption between enamel and MDP-containing adhesives. XPS and ³¹P NMR studies detected improved chemical affinity to the phosphoric acid etching + MDP-containing universal adhesives applied with enamel. The ζ-potential of MDP-containing universal adhesives absorbed with enamel, with or without etching became more negative compared with that of UE (P < 0.05). Furthermore, single etching created a negative ζ-potential with a higher absolute value (P = 0.009). Phosphoric acid pre-etching can increase the negative charge on the enamel surface and facilitate the chemical reactions of MDP and hydroxyapatite (HAp) to produce more calcium salts, thus improving the chemisorption between enamel and MDP-containing universal adhesives.

Protective Effect of Solutions Containing Polymers Associated with Fluoride and Stannous Chloride on Hydroxyapatite Dissolution

This study investigated the protective effect of experimental solutions containing 4 polymers (polyoxirane, hydroxypropylmethylcellulose [HPMC], pectin, and an amino methacrylate copolymer [AMC]) in 2 concentrations (low and high) associated or not with sodium fluoride (F; 225 ppm F-) or sodium fluoride plus stannous chloride (FS; 800 ppm Sn2+) on the dissolution of hydroxyapatite crystals (HA). Deionized water was the control. The pretreated HA was added to a 0.3% citric acid solution (pH 3.8). An automatic titrant machine added aliquots of 0.1 N HCl at a rate of 28 μL/min, in a total reaction time of 5 min. Groups were compared with 2-way ANOVA and Tukey's test, and concentrations with Student t test (5%). The zeta potential of the HA treated with the solutions was measured. Significant differences were found for both factors and interaction (p < 0.0001). The treatments with F and FS solutions resulted in a lower amount of dissolved HA than the control. Among the polymers' solutions, only AMC was able to reduce the amount of dissolved HA, changing the surface charge of HA to positive. AMC improved the protective effect of F, but it did not affect FS. Polyoxirane and HPMC reduced the protective potential of the FS solution. No differences were found between the concentrations of the polymers. It was concluded that F and FS reduced the amount of dissolved HA. The protective effect of the experimental solutions against HA dissolution was polymer dependent. The F effect was enhanced by its combination with AMC, but the protection of FS was impaired by polyoxirane and HPMC.

Effect of chitosan solutions with or without fluoride on the protection against dentin erosion in vitro

The aim of this study was to assess the protective effect of experimental solutions containing chitosan at different viscosities with or without fluoride (TiF₄ /NaF) on dentin loss in vitro. Bovine dentin samples (n = 15) were prepared and allocated to one of the following treatments: (i) 0.5% chitosan (500 mPas); (ii) 0.5% chitosan (2,000 mPas); (iii) 0.042% NaF and 0.049% TiF₄ ; (iv) as (iii) with addition of 0.5% chitosan (500 mPas); (v) as (iii) with addition of 0.5% chitosan (2,000 mPas); (vi) commercial solution with SnCl₂ /AmF/NaF (positive control); or (vii) deionized water (negative control). The samples were submitted to pH cycling for 7 d (0.1% citric acid, 4 × 90 s d^-1 ). The treatment was applied once a day for 30 s. The dentin loss was quantified using a contact profilometer. Three samples per group were evaluated using scanning electron microscopy. The dentin loss (μm) was submitted to anova and Tukey's test for differences between treatments. Among the treatments tested, only chitosan 500 mPas was able to statistically significantly reduce the dentin loss compared to the negative control, being similar to the positive control. TiF₄ /NaF, whether with or without chitosan, had no protective effect. Chitosan 500 mPas and SnCl₂ /AmF/NaF solutions have comparable protective effect against dentin erosion in vitro.

Modes of Action and Clinical Efficacy of Particulate Hydroxyapatite in Preventive Oral Health Care − State of the Art

Background:

Particulate Hydroxyapatite (HAP; Ca5(PO4)3(OH)) is being increasingly used as multifunctional active ingredient in oral care. Due to its high similarity to human enamel crystallites, it is considered as a biomimetic agent.

Objective:

The aim of this narrative review is to identify the modes of action of HAP in preventive oral health care based on published studies. The outcomes are expected to improve the understanding of the effects of HAP in the oral cavity and to provide a knowledge base for future research in the field of biomimetic oral care.

Methods:

The data analyzed and discussed are primarily based on selected published scientific studies and reviews fromin vivo,in situ, andin vitrostudies on HAP in the field of preventive oral health care. The databases Cochrane Library, EBSCO, PubMed and SciFinder were used for literature search.

Results:

We identified different modes of action of HAP in the oral cavity. They are mainly based on (I) Physical principles (e.g. attachment of HAP-particles to the tooth surface and cleaning properties), (II) Bio-chemical principles (e.g. source of calcium and phosphate ions under acidic conditions and formation of an interface between HAP-particles and the enamel), and (III) Biological principles (e.g. HAP-particles interacting with microorganisms).

Conclusion:

Although more mechanistic studies are needed, published data show that HAP has multiple modes of action in the oral cavity. Since the effects address a wide range of oral health problems, HAP is a biomimetic agent with a broad range of applications in preventive oral health care.

Anti-Erosive Effect of Solutions Containing Sodium Fluoride, Stannous Chloride, and Selected Film-Forming Polymers

The aim of this study was to evaluate the anti-erosive effect of solutions containing sodium fluoride (F: 225 ppm F–), stannous chloride (Sn: 800 ppm Sn2+), and some film-forming polymers (Gantrez: Poly [methylvinylether-alt-maleic anhydride]; PGA: propylene glycol alginate; Plasdone: poly[vinylpyrrolidone]; and CMC: carboxymethylcellulose). Solutions were tested in an erosion-remineralization cycling model, using enamel and dentin specimens (n = 10, for each substrate). Distilled water was the negative control. Cycling consisted of 120 min immersion in human saliva, 5 min in 0.3% citric acid solution, and 120 min of exposure to human saliva, 4×/day, for 5 days. Treatment with solutions (pH = 4.5) was carried out 2×/day, for 2 min. Surface loss (SL) was evaluated with optical profilometry. Zeta potential of hydroxyapatite crystals was determined after treatment with the solutions. Data were statistically analyzed (α = 0.05). For enamel, all polymers showed significantly lower SL (in µm) than the control (11.09 ± 0.94), except PGA (10.15 ± 1.25). PGA significantly improved the protective effect of F (4.24 ± 0.97 vs. 5.64 ± 1.60, respectively). None of the polymers increased the protection of F+Sn (5.13 ± 0.78). For dentin, only Gantrez (11.40 ± 0.97) significantly reduced SL when compared with the negative control (12.76 ± 0.75). No polymer was able to enhance the effect of F (6.28 ± 1.90) or F+Sn (7.21 ± 1.13). All fluoridated solutions demonstrated significantly lower SL values than the control for both substrates. Treatment of hydroxyapatite nanoparticles with all solutions resulted in more negative zeta potentials than those of the control, except Plasdone, PGA, and F+Sn+PGA, the latter two presenting the opposite effect. In conclusion, Gantrez, Plasdone, and CMC exhibited an anti-erosive effect on enamel. PGA increased the protection of F. For dentin, only Gantrez reduced erosion.

Polymeric materials and films in dentistry: An overview

The use of polymeric materials (PMs) and polymeric films (PMFs) has increased in medicine and dentistry. This increasing interest is attributed to not only the excellent surfaces of PMs and PMFs but also their desired mechanical and biological properties, low production cost, and ease in processing, allowing them to be tailored for a wide range of applications. Specifically, PMs and PMFs are used in dentistry for their antimicrobial, drug delivery properties; in preventive, restorative and regenerative therapies; and for corrosion and friction reduction. PMFs such as acrylic acid copolymers are used as a dental adhesive; polylactic acids are used for dental pulp and dentin regeneration, and bioactive polymers are used as advanced drug delivery systems. The objective of this article was to review the literatures on the latest advancements in the use of PMs and PMFs in medicine and dentistry. Published literature (1990–2017) on PMs and PMFs for use in medicine and dentistry was reviewed using MEDLINE/PubMed and ScienceDirect resources. Furthermore, this review also explores the diversity of latest PMs and PMFs that have been utilized in dental applications, and analyzes the benefits and limitations of PMs and PMFs. Most of the PMs and PMFs have shown to improve the biomechanical properties of dental materials, but in future, more clinical studies are needed to create better treatment guidelines for patients.

Chitosan Biomaterials for Current and Potential Dental Applications

Chitosan (CHS) is a very versatile natural biomaterial that has been explored for a range of bio-dental applications. CHS has numerous favourable properties such as biocompatibility, hydrophilicity, biodegradability, and a broad antibacterial spectrum (covering gram-negative and gram-positive bacteria as well as fungi). In addition, the molecular structure boasts reactive functional groups that provide numerous reaction sites and opportunities for forging electrochemical relationships at the cellular and molecular levels. The unique properties of CHS have attracted materials scientists around the globe to explore it for bio-dental applications. This review aims to highlight and discuss the hype around the development of novel chitosan biomaterials. Utilizing chitosan as a critical additive for the modification and improvement of existing dental materials has also been discussed.

In vitro Efficacy of Experimental Chitosan-Containing Solutions as Anti-Erosive Agents in Enamel

The present study evaluated the effect of chitosans with different viscosities, dissolved in an AmF/SnCl2 solution, against erosion or erosion/abrasion. A total of 192 specimens were assigned to 2 × 6 groups (n = 16 specimens each): negative control, 4 chitosan solutions (groups Ch50, Ch500, Ch1000, and Ch2000, with viscosity of 50, 500, 1,000, or 2,000 mPas, respectively, 0.5% chitosan, 500 ppm F-, 800 ppm Sn2+, pH 4.4), and positive control (500 ppm F-, 800 ppm Sn2+, pH 4.3). One half of the groups was demineralized (experiment 1, E1; 10 days, 6 × 2 min/day, 0.5% citric acid, pH 2.8) and exposed to solutions (2 × 2 min/day); the other half was additionally brushed (15 s, 200 g) with non-fluoridated toothpaste before solution immersion (experiment 2, E2). Treatment effects were investigated by profilometry, energy-dispersive X-ray spectroscopy and scanning electron microscopy (SEM). In E1, all the chitosan-containing solutions reduced enamel loss by 77-80%, to the same extent as the positive control, except for Ch2000 (p ≤ 0.05), which completely inhibited tissue loss by the formation of precipitates. In E2, Ch50 and Ch500 showed best performance, with approximately 60% reduction of tissue loss compared to the negative control group (p ≤ 0.05 compared to other groups). SEM analysis showed differences between negative control and the other groups but only minor differences amongst the groups treated with active agents. In both E1 and E2, treatment with active agents resulted in surface enrichment of carbon and tin compared to negative control (p ≤ 0.001); brushing removed parts of carbon and tin (p ≤ 0.001). Chitosan shows different properties under erosive and erosive/abrasive conditions. Under erosive conditions high viscosity might be helpful, whereas lower viscosity seems to be more effective in cases of chemo-mechanical challenges.

Characterization and optimization of pH-responsive polymer nanoparticles for drug delivery to oral biofilms

We previously reported on cationic, pH-responsive p(DMAEMA)-b-p(DMAEMA-co-BMA-co-PAA) block copolymer micelles with high affinity for dental and biofilm surfaces and efficient anti-bacterial drug release in response to acidic pH, characteristic of cariogenic (tooth-decay causing) biofilm microenvironments. Here, we show that micelle pH-responsive behaviors can be enhanced through alterations in corona:core molecular weight ratios (CCR). Although similarly stable at physiological pH, upon exposure to acidic pH, micelles with CCR of 4.1 were less stable than other CCR examined. Specifically, a ~1.5-fold increase in critical micelle concentration (CMC) and ~50% decrease in micelle diameters were observed for micelles with CCR of 4.1, compared to no changes in micelles with CCR of 0.8. While high CCR was shown to enhance pH-responsive drug release, it did not alter drug loading and dental surface binding of micelles. Diblocks were shown to encapsulate the antibacterial drug, farnesol, at maximal loading capacities of up to ~27 wt% and at >94% efficiencies, independent of CCR or core size, resulting in micelle diameter increases due to contributions of drug volume. Additionally, micelles with small diameters (~17 nm) show high binding capacity to hydroxyapatite and dental pellicle emulating surfaces based on Langmuir fit analyses of binding data. Finally, micelles with high CCR that have enhanced pH-responsive drug release and binding were shown to exhibit greater antibiofilm efficacy in situ. Overall, these data demonstrate how factors essential for nanoparticle carrier (NPC)-mediated drug deliverycan be enhanced via modification of diblock characteristics, resulting in greater antibiofilm efficacy in situ.

The Future of Fluorides and Other Protective Agents in Erosion Prevention

The effectiveness of fluoride in caries prevention has been convincingly proven. In recent years, researchers have investigated the preventive effects of different fluoride formulations on erosive tooth wear with positive results, but their action on caries and erosion prevention must be based on different requirements, because there is no sheltered area in the erosive process as there is in the subsurface carious lesions. Thus, any protective mechanism from fluoride concerning erosion is limited to the surface or the near surface layer of enamel. However, reports on other protective agents show superior preventive results. The mechanism of action of tin-containing products is related to tin deposition onto the tooth surface, as well as the incorporation of tin into the near-surface layer of enamel. These tin-rich deposits are less susceptible to dissolution and may result in enhanced protection of the underlying tooth. Titanium tetrafluoride forms a protective layer on the tooth surface. It is believed that this layer is made up of hydrated hydrogen titanium phosphate. Products containing phosphates and/or proteins may adsorb either to the pellicle, rendering it more protective against demineralization, or directly to the dental hard tissue, probably competing with H+ at specific sites on the tooth surface. Other substances may further enhance precipitation of calcium phosphates on the enamel surface, protecting it from additional acid impacts. Hence, the future of fluoride alone in erosion prevention looks grim, but the combination of fluoride with protective agents, such as polyvalent metal ions and some polymers, has much brighter prospects.

pH-activated nanoparticles for controlled topical delivery of farnesol to disrupt oral biofilm virulence

Development of effective therapies to control oral biofilms is challenging, as topically introduced agents must avoid rapid clearance from biofilm-tooth interfaces while targeting biofilm microenvironments. Additionally, exopolysaccharides-matrix and acidification of biofilm microenvironments are associated with cariogenic (caries-producing) biofilm virulence. Thus, nanoparticle carriers capable of binding to hydroxyapatite (HA), saliva-coated HA (sHA), and exopolysaccharides with enhanced drug release at acidic pH were developed. Nanoparticles are formed from diblock copolymers composed of 2-(dimethylamino)ethyl methacrylate (DMAEMA), butyl methacrylate (BMA), and 2-propylacrylic acid (PAA) (p(DMAEMA)-b-p(DMAEMA-co-BMA-co-PAA)) that self-assemble into ∼21 nm cationic nanoparticles. Nanoparticles exhibit outstanding adsorption affinities (∼244 L-mmol(-1)) to negatively charged HA, sHA, and exopolysaccharide-coated sHA due to strong electrostatic interactions via multivalent tertiary amines of p(DMAEMA). Owing to hydrophobic cores, nanoparticles load farnesol, a hydrophobic antibacterial drug, at ∼22 wt %. Farnesol release is pH-dependent with t1/2 = 7 and 15 h for release at pH 4.5 and 7.2, as nanoparticles undergo core destabilization at acidic pH, characteristic of cariogenic biofilm microenvironments. Importantly, topical applications of farnesol-loaded nanoparticles disrupted Streptococcus mutans biofilms 4-fold more effectively than free farnesol. Mechanical stability of biofilms treated with drug-loaded nanoparticles was compromised, resulting in >2-fold enhancement in biofilm removal under shear stress compared to free farnesol and controls. Farnesol-loaded nanoparticles effectively attenuated biofilm virulence in vivo using a clinically relevant topical treatment regimen (2×/day) in a rodent dental caries disease model. Strikingly, treatment with farnesol-loaded nanoparticles reduced both the number and severity of carious lesions, while free farnesol had no effect. Nanoparticle carriers have great potential to enhance the efficacy of antibiofilm agents through multitargeted binding and pH-responsive drug release due to microenvironmental triggers.

Use of dentifrices to prevent erosive tooth wear: harmful or helpful?

Dental erosion is the loss of dental hard tissues caused by non-bacterial acids. Due to acid contact, the tooth surface becomes softened and more prone to abrasion from toothbrushing. Dentifrices containing different active agents may be helpful in allowing rehardening or in increasing surface resistance to further acidic or mechanical impacts. However, dentifrices are applied together with brushing and, depending on how and when toothbrushing is performed, as well as the type of dentifrice and toothbrush used, may increase wear. This review focuses on the potential harmful and helpful effects associated with the use of dentifrices with regard to erosive wear. While active ingredients like fluorides or agents with special anti-erosive properties were shown to offer some degree of protection against erosion and combined erosion/abrasion, the abrasive effects of dentifrices may increase the surface loss of eroded teeth. However, most evidence to date comes from in vitro and in situ studies, so clinical trials are necessary for a better understanding of the complex interaction of active ingredients and abrasives and their effects on erosive tooth wear.

Surface microanalysis and chemical imaging of early dentin remineralization

This study reports physical and chemical changes that occur at early dentin remineralization stages. Extracted human third molars were sectioned to obtain dentin discs. After polishing the dentin surfaces, three groups were established: (1) untreated dentin (UD), (2) 37% phosphoric acid application for 15 s (partially demineralized dentin-PDD), and (3) 10% phosphoric acid for 12 h at 25° C (totally demineralized dentin-TDD). Five different remineralizing solutions were used: chlorhexidine (CHX), artificial saliva (AS), phosphate solution (PS), ZnCl2, and ZnO. Wettability (contact angle), ζ potential and Raman spectroscopy analysis were determined on dentin surfaces. Demineralization of dentin resulted in a higher contact angle. Wettability decreased after immersion in all solutions. ζ potential analysis showed dissimilar performance ranging from -6.21 mV (TDD + AS) up to 3.02 mV (PDD + PS). Raman analysis showed an increase in mineral components after immersing the dentin specimens, in terms of crystallinity, mineral content, and concentration. This confirmed the optimal incorporation and deposition of mineral on dentin collagen. Organic content reflected scarce changes, except in TDD that appeared partially denatured. Pyridinium, as an expression of cross-linking, appeared in all spectra except in specimens immersed in PS.

Effect of a chitosan additive to a Sn2+-containing toothpaste on its anti-erosive/anti-abrasive efficacy--a controlled randomised in situ trial

OBJECTIVES

It is well known that Sn(2+) is a notable anti-erosive agent. There are indications that biopolymers such as chitosan can enhance the effect of Sn(2+), at least in vitro. However, little information exists about their anti-erosive/anti-abrasive in situ effects. In the present in situ study, the efficacy of Sn(2+)-containing toothpastes in the presence or absence of chitosan was tested.

METHODS

Ten subjects participated in the randomised crossover study, wearing mandibular appliances with human enamel specimens. Specimens were extraorally demineralised (7 days, 0.5% citric acid, pH 2.6; 6 × 2 min/day) and intraorally exposed to toothpaste suspensions (2 × 2 min/day). Within the suspension immersion time, one half of the specimens were additionally brushed intraorally with a powered toothbrush (5 s, 2.5 N). Tested preparations were a placebo toothpaste (negative control), two experimental toothpastes (F/Sn = 1,400 ppm F(-), 3,500 ppm Sn(2+); F/Sn/chitosan = 1,400 ppm F(-), 3,500 ppm Sn(2+), 0.5 % chitosan) and an SnF2-containing gel (positive control, GelKam = 3,000 ppm Sn(2+), 1,000 ppm F(-)). Substance loss was quantified profilometrically (μm).

RESULTS

In the placebo group, tissue loss was 11.2 ± 4.6 (immersion in suspension) and 17.7 ± 4.7 (immersion in suspension + brushing). Immersion in each Sn(2+)-containing suspension significantly reduced tissue loss (p ≤ 0.01); after immersion in suspension + brushing, only the treatments with GelKam (5.4 ± 5.5) and with F/Sn/chitosan (9.6 ± 5.6) significantly reduced loss [both p ≤ 0.05 compared to placebo; F/Sn 12.8 ± 6.4 (not significant)]

CONCLUSION

Chitosan enhanced the efficacy of the Sn(2+)-containing toothpaste as an anti-erosive/anti-abrasive agent.

CLINICAL RELEVANCE

The use of Sn(2+)- and chitosan-containing toothpaste is a good option for symptomatic therapy in patients with regular acid impacts.

Chitosan adsorption on hydroxyapatite and its role in preventing acid erosion

Polymer adsorption onto an artificial saliva (AS) layer is investigated using quartz-crystal microbalance with dissipation (QCM-D) and chitosan as the model polymer. QCM-D is utilized in an innovative manner to monitor in situ adsorption of chitosan (CH) onto a hydroxyapatite (HA) coated crystal and to examine the ability of the adsorbed layer to "protect" the HA upon sequential exposure to acidic solutions. After deposition of a thin AS layer (16 nm), the total thickness on the HA substrate increases to 37 nm upon exposure to CH at pH 5.5 for 10 min. Correspondingly, the surface charge changes from negative (i.e., AS) to positive, consistent with the adsorption the polycationic CH onto or into the AS layer. Upon exposure to an oxidizing agent, the chitosan cross-links and collapses as noted by a decrease in thickness to 10 nm and an increase in the shear modulus by an order of magnitude. Atomic force microscopy (AFM) is used to determine the surface morphology and RMS roughness of the coated and HA surfaces after citric acid challenges. Both physisorbed and cross-linked chitosan are demonstrated to limit and prevent the erosion of HA, respectively.

Remineralization of partially demineralized dentine substrate based on a biomimetic strategy

Dentine remineralization is clinically significant for prevention and treatment of dentine caries, root caries, and dentine hypersensitivity. However, dentine remineralization is more difficult than enamel remineralization due to the abundant presence of organic matrix in dentine. The objective of this study was to develop a biomimetic method to facilitate remineralization of demineralized dentine through phosphorylation of type I collagen in demineralized dentine using sodium trimetaphosphate. The experimental results indicated that the effect of fluoride on remineralizing dentine was limited when residual mineral crystals were lacking on the surface of demineralized dentine, whereas the phosphorylation and Ca(OH)(2) pretreatment enhanced surface remineralization of the partially demineralized dentine. This biomimetic methodology resulted in favorable surface properties (i.e. highly negative charge and low interfacial free energy between substrate and aqueous medium) for crystal nucleation, and thus could be a promising method to remineralize superficially demineralized dentine lesions.

Salivary micelles: identification of complexes containing MG2, sIgA, lactoferrin, amylase, glycosylated proline-rich protein and lysozyme

Micelles represent macromolecular structures in saliva and the aim of this study was to identify salivary proteins that occur in these globular particles. Micelles were isolated from whole saliva (WS) collected from three individuals and analysed in different experiments. Samples were subjected to polyacrylamide gel electrophoreses, hydrolysed to determine their amino acid composition and total protein concentration, examined by scanning electron microscopy and examined on Western blots probed with a panel of antibodies directed against salivary proteins. On Coomassie Brilliant Blue stained gels, the banding pattern of whole saliva and micelles was similar but the intensity of bands was quite different. Amino acid analysis confirmed that the amino acid composition of micelles was distinct from that of whole saliva. Scanning electron microscopy showed that micelles exhibit a complex pattern consisting of individual particles or clusters of particles with different sizes and shapes. Micelles contain proteins with high (MG2 and secretory IgA), intermediate (lactoferrin, amylase and glycosylated proline-rich protein (PRP)) and low (lysozyme) molecular weight that were immuno-detected on blots probed with specific antibodies. Micelles represent particulate multicomponent structures in whole saliva that contain a subset of salivary proteins known to be important components of the innate immune system and are likely to play an important role in the maintenance of homeostasis in the oral environment.