Evaluation of salivary parameters and remineralizing effects of yogurt in counteracting the cariogenic impact of candy consumption: An in vivo study

Background

The consumption of sugary snacks like candies alters the oral environment, increasing the risk of dental caries. This study evaluates changes in salivary pH, calcium, phosphorus, alkaline phosphatase, and total antioxidant capacity (TAC) following the consumption of candies and yogurt.

Aim

To compare the impact of candies on the oral environment and assess the effectiveness of rinsing with water versus consuming yogurt in reversing cariogenic changes in saliva.

Materials and methods

Baseline saliva samples (5 mL) were collected from 60 children. Participants consumed candies, and saliva was collected 10 min post-consumption. They were divided into two groups: Group 1 rinsed with water, and Group 2 consumed yogurt. Saliva samples were collected at 10, 20 and 30 min post-intervention and analyzed for pH, calcium, phosphorus, alkaline phosphatase, and TAC. Data were analyzed using paired t-tests and post hoc Tukey tests.

Results

Candy consumption significantly decreased pH, calcium, phosphorus, and alkaline phosphatase levels (p < 0.001) and increased TAC levels (p < 0.001). Both water rinsing and yogurt consumption reversed these changes. Yogurt showed superior remineralization, with pH, calcium, phosphorus, and alkaline phosphatase levels returning to baseline more effectively than water rinsing (p < 0.001 for all comparisons). TAC levels were also restored more quickly with yogurt (p < 0.05).

Conclusion

Candy consumption induces a cariogenic environment. Both water rinsing and yogurt consumption effectively reversed these effects, with yogurt showing enhanced remineralization potential.

The Remineralization of Enamel from Saliva: A Chemical Perspective

The natural remineralization of enamel is of major importance for oral health. In principle, early erosions (demineralization) induced by acidic beverages and foods as well as initial caries lesions can be covered and remineralized by the deposition of calcium phosphate, i.e., tooth mineral. This remineralization effect is characterized by the presence of calcium and phosphate ions in saliva that form hydroxyapatite on the enamel surface. Although it is apparently a simple crystallization, it turns out that remineralization under in vivo conditions is actually a very complex process. Calcium phosphate can form a number of solid phases of which hydroxyapatite is only one. Precipitation involves the formation of metastable phases like amorphous calcium phosphate that convert into biological apatite in a number of steps. Nanoscopic clusters of calcium phosphate that can attach on the enamel surface are also present in saliva. Thus, remineralization under strictly controlled in vitro conditions (e.g., pH, ion concentrations, no additives) is already complex, but it becomes even more complicated under the actual conditions in the oral cavity. Here, biomolecules are present in saliva, which interact with the forming calcium phosphate mineral. For instance, there are salivary proteins which have the function of inhibiting crystallization to avoid overshooting remineralization. Finally, the presence of bacteria and an extracellular matrix in plaque and the presence of proteins in the pellicle have strong influences on the precipitation on the enamel surface. The current knowledge on the remineralization of the enamel is reviewed from a chemical perspective with a special focus on the underlying crystallization phenomena and the effects of biological compounds that are present in saliva, pellicle, and plaque. Basically, the remineralization of enamel follows the same principles as calculus formation. Notably, both processes are far too complex to be understood on a microscopic basis under in vivo conditions, given the complicated process of mineral formation in the presence of a plethora of foreign ions and biomolecules.

Case Report on Caries Assessment Using Intraoral Scanner Compared with Bitewing Radiographs

Dental caries remains one of the main reasons patients seeing their dentist. They either show up for preventive measures, diagnostics, or treatment of present caries lesions. To date, diagnostics are performed visually, supported by using bitewing radiographs. While radiographic diagnostics should only be performed on a biannual basis, and some caries process will not be seen with visual diagnostics, there remains a lack in regular checkups. Therefore, different technical applications can be used for regular diagnostics. One of those is the near-infrared imaging (NIRI) technology. In this case report, a patient presented with incipient caries lesions. These lesions were diagnosed visually, radiographically, and using NIRI. After diagnosis of incipient caries lesions, the patient was advised to use a hydroxyapatite toothpaste and a hydroxyapatite gel for the remineralization of the lesions and prevention of caries progression. The patient was followed up for 6 months with regular checkups in between. Visual diagnostics and NIRI were used to detecting the caries progress. After 6 months, bitewing radiographs were used in addition. In this clinical investigation we were able to show for the first time that NIRI and bitewing radiographs are able to detect and follow incipient caries lesions. Additionally, this study highlights that hydroxyapatite-containing oral care products are able to arrest and remineralize the caries process.

Nanotechnology in toothpaste: Fundamentals, trends, and safety

Several studies have revealed that healthcare nanomaterials are widely used in numerous areas of dentistry, including prevention, diagnosis, treatment, and repair. Nanomaterials in dental cosmetics are utilized to enhance the efficacy of toothpaste and other mouthwashes. Nanoparticles are added to toothpastes for a variety of reasons, including dental decay prevention, remineralization, hypersensitivity reduction, brightening, and antibacterial qualities. In this review, the benefits and uses of many common nanomaterials found in toothpaste are outlined. Additionally, the capacity and clinical applications of nanoparticles as anti-bacterial, whitening, hypersensitivity, and remineralizing agents in the treatment of dental problems and periodontitis are discussed.

Doses of fluoride toothpaste for children up to 24 months

AIM

The aim of this study was to test the dose of fluoride toothpaste by parents for their children aged up to 24 months.

METHODS

Parents who use fluoride toothpastes for their children were asked to dose two commercially available toothpastes (A and B) with 1000 ppm fluoride each for their children as they would normally do at home. The toothpaste amounts were weighed, and as reference, the weight of an 'optimal' grain of rice-size amount of each toothpaste was used.

RESULTS

61 parents dosed a mean of 0.263 ± 0.172 g toothpaste A and 0.281 ± 0.145 g toothpaste B. The parents' mean doses were 5.9 times higher for toothpaste A and 7.2 times higher for toothpaste B than an 'optimal' grain of rice-size amount (the reference dose as recommended). The difference between parent's and reference dose was statistically significant (p < 0.001). Moreover, 39.3% of parents were not aware about conditions of use and warnings that have to be printed on the package of fluoride toothpastes.

CONCLUSION

In this study, parents significantly overdosed the toothpaste for their children. To avoid fluoride intake from toothpaste, parents can choose fluoride-free alternatives for the oral care of their infants and toddlers.

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.

Caries-preventing effect of a hydroxyapatite-toothpaste in adults: a 18-month double-blinded randomized clinical trial

Background

Dental caries is a worldwide challenge for public health. The aim of this 18-month double-blinded, randomized, clinical trial was to compare the caries-preventing effect of a fluoride-free, hydroxyapatite toothpaste (test) and a toothpaste with sodium fluoride (1450 ppm fluoride; positive control) in adults.

Methods

The primary endpoint was the percentage of subjects showing no increase in overall Decayed Missing Filled Surfaces (DMFS) index. The study was designed as non-inferiority trial. Non-inferiority was claimed if the upper limit of the exact one-sided 95% confidence interval for the difference of the primary endpoint DMFS between test and control toothpaste was less than the predefined margin of non-inferiority (Δ ≤ 20%).

Results

In total, 189 adults were included in the intention-to-treat (ITT) analysis; 171 subjects finished the study per protocol (PP). According to the PP analysis, no increase in DMFS index was observed in 89.3% of subjects of the hydroxyapatite group and 87.4% of the subjects of the fluoride group. The hydroxyapatite toothpaste was not statistically inferior to a fluoride toothpaste with regard to the primary endpoint.

Conclusion

Hydroxyapatite was proven to be a safe and efficient anticaries agent in oral care.

Clinical trial registration

NCT04756557.

Remineralization Strategies for Teeth with Molar Incisor Hypomineralization (MIH): A Literature Review

Molar incisor hypomineralization (MIH) is a highly prevalent dental developmental disorder with a significant health burden for patients and high treatment needs, yet no comprehensive review article on all remineralization systems as a non-invasive treatment approach for MIH has been published. Typical characteristics of MIH-affected teeth are a lower mineral density and lower hardness compared to healthy teeth leading to sensitivity and loss of function. Thus, the use of formulations with calcium phosphates to remineralize MIH-affected teeth is reasonable. This review presents an up-to-date overview of remineralization studies focusing on active ingredients investigated for remineralization of MIH, i.e., casein phosphopeptide amorphous calcium phosphate (CPP-ACP), casein phosphopeptide amorphous calcium fluoride phosphate (CPP-ACFP), hydroxyapatite, calcium glycerophosphate, self-assembling peptide, and fluoride. Overall, 19 studies (in vitro, in situ, and in vivo) were found. Furthermore, an additional search for studies focusing on using toothpaste/dentifrices for MIH management resulted in six studies, where three studies were on remineralization and three on reduction of sensitivity. Overall, the studies analyzed in this review showed that MIH-affected teeth could be remineralized using calcium phosphate-based approaches. In conclusion, calcium phosphates like CPP-ACP, calcium glycerophosphate, and hydroxyapatite can be used to remineralize MIH-affected teeth. In addition to MIH-remineralization, CPP-ACP and hydroxyapatite also offer relief from MIH-associated tooth sensitivity.

Toothpaste Abrasion and Abrasive Particle Content: Correlating High-Resolution Profilometric Analysis with Relative Dentin Abrasivity (RDA)

In this in vitro study, the influence of the concentration of abrasive particles on the abrasivity of toothpastes was investigated using laser scan profilometry on polymethyl methacrylate (PMMA) surfaces with the aim of providing an alternative method to developers for screening of new toothpaste formulations. PMMA plates were tested in a toothbrush simulator with distilled water and four model toothpastes with increasing content of hydrated silica (2.5, 5.0, 7.5, 10.0 wt%). The viscosity of the model toothpaste formulations was kept constant by means of varying the content of sodium carboxymethyl cellulose and water. The brushed surfaces were evaluated using laser scan profilometry at micrometer-scale resolutions, and the total volume of the introduced scratches was calculated along with the roughness parameters Ra, Rz and Rv. RDA measurements commissioned for the same toothpaste formulations were used to analyze the correlation between results obtained with the different methods. The same experimental procedure was applied to five commercially available toothpastes, and the results were evaluated against our model system. In addition, we characterize abrasive hydrated silica and discuss their effects on PMMA-sample surfaces. The results show that the abrasiveness of a model toothpaste increases with the weight percentage of hydrated silica. Increasing roughness parameter and volume loss values show good correlation with the likewise increasing corresponding RDA values for all model toothpastes, as well as commercial toothpastes without ingredients that can damage the used substrate PMMA. From our results, we deduce an abrasion classification that corresponds to the RDA classification established for marketed toothpastes.

Overview on Adjunct Ingredients Used in Hydroxyapatite-Based Oral Care Products

Hydroxyapatite, Ca₅(PO₄)₃(OH), is a biomimetic active ingredient, which is used in commercial oral care products such as toothpastes and mouthwashes worldwide. Clinical studies (in vivo) as well as in situ and in vitro studies have shown the preventive effects of hydroxyapatite in various field of oral care. In some products, hydroxyapatite is combined with other active ingredients, to achieve an additional antibacterial effect or to promote gum health. This review analyzes the efficacy of six selected natural and nature-inspired ingredients that are commonly used together with hydroxyapatite. These additional actives are either antibacterial (lactoferrin, xylitol, and zinc) or promote gum health (allantoin, bisabolol, and hyaluronic acid). A systematic literature search was performed, and all studies found on each ingredient were analyzed. In summary, all analyzed ingredients mentioned in this review are well described in scientific studies on their beneficial effect for oral health and can be used to expand the preventive effect of hydroxyapatite in oral care products.

Remineralization of molar incisor hypomineralization (MIH) with a hydroxyapatite toothpaste: an in-situ study

AIM

This randomized, double-blind, crossover, in-situ study, compared the efficacy of toothpastes based on microcrystalline hydroxyapatite (HAP; fluoride-free) or fluoride, in remineralizing molar incisor hypomineralization (MIH).

METHODS

Two lesion-bearing enamel blocks were produced from each of thirty extracted permanent molars diagnosed with MIH. Sixty produced blocks were randomly assigned to two groups (30/group): 20% HAP or 1450 ppm fluoride toothpaste. Each group was subdivided into, etched (n = 20), with lesion surface treated with 32% phosphoric acid-etchant for 5 s, and unetched (n = 10). Blocks were cemented into intra-oral appliances (2 blocks/appliance) worn full-time by 15 subjects. Subjects used the toothpastes in a two-phase crossover manner, lasting 14 days per phase, after one-week washout period. Baseline and post-treatment mineral density (MD) was quantified using microcomputed tomography.

RESULTS

Overall, both groups showed statistically significant (paired t-test; p < 0.001) net-gain when MD was compared pre-treatment and post-treatment. HAP: pre-treatment (1.716 ± 0.315) and post-treatment (1.901 ± 0.354), Fluoride: pre-treatment (1.962 ± 0.363) and post-treatment (2.072 ± 0.353). Independent t-test demonstrated a practically significantly (≥10%) higher percentage remineralization with HAP toothpaste (26.02 ± 20.68) compared with fluoride toothpaste (14.64 ± 9.60). Higher percentage remineralization was observed in etched than unetched samples.

CONCLUSION

The tested toothpaste based on hydroxyapatite can remineralize MIH lesions. Pre-treating the tooth surface with acid-etchant enhanced remineralization.

Incorporation of Fluoride into Human Teeth after Immersion in Fluoride-Containing Solutions

Toothpastes and mouth rinses contain fluoride as a protective agent against caries. The aim of this study was to determine the degree of fluoride-uptake by human tooth mineral during immersion into fluoride-containing aqueous solutions as different pH. Human teeth were immersed in fluoride-containing solutions to assess the extent of fluoride incorporation into tooth enamel. A total of 16 extracted teeth from 11 patients were immersed at 37 °C for one minute into aqueous fluoride solutions (potassium fluoride; KF) containing either 250 ppm or 18,998 ppm fluoride (1-molar). Fluoride was dissolved either in pure water (neutral pH) or in a citrate buffer (pH 4.6 to 4.7). The elemental surface composition of each tooth was studied by energy-dispersive X-ray spectroscopy in combination with scanning electron microscopy and X-ray powder diffraction. The as-received teeth contained 0.17 ± 0.16 wt% fluoride on average. There was no significant increase in the fluoride content after immersion in 250 ppm fluoride solution at neutral or acidic pH values. In contrast, a treatment with a 1-molar fluoride solution led to significantly increased fluoride concentrations by 0.68 wt% in water and 9.06 wt% at pH 4.7. Although such fluoride concentrations are far above those used in mouth rinses or toothpastes, this indicates that fluoride can indeed enter the tooth surface, especially at a low pH where a dynamic dissolution-reprecipitation process may occur. However, precipitations of calcium fluoride (globuli) were detected in no cases.

Management for Caries Prevention in ADHD Children

Emotional Dysregulations (ED) represent a major health risk present in about 5% of children and are associated with diverse forms of childhood psychiatric disorders and symptoms such as Attention-Deficit/Hyperactivity Disorder (ADHD) [...].

Risk of Dental Caries and Erosive Tooth Wear in 117 Children and Adolescents' Anorexia Nervosa Population-A Case-Control Study

Introduction

Restrictive type of anorexia nervosa (AN) is still one of the most severe eating disorders worldwide with an uncertain prognosis. Patients affected by AN should be encouraged to undertake psychiatric care and psychotherapy, but whether they should necessarily be included in careful dental care or not may still be questionable. Even though there is a constantly increasing number of AN studies, there are just a few data about the youngest group of AN children and adolescents aged < 18.

Methodology

This case-control study aimed to compare the dental health and gingival inflammation level in female adolescent inpatients affected by severe AN restrictive subtype vs. controls. Based on clinically confirmed 117 AN cases (hospitalized in years 2016-2020 in public Psychiatric Unit, BMI < 15 kg/m2, mean age 14.9 ± 1.8), the dental status has been examined regarding the occurrence of caries lesions using Decay Missing Filling Teeth (DMFT), erosive wear as Basic Erosive Wear Examination (BEWE), gingival condition as Bleeding on Probing (BOP) and plaque deposition as Plaque Control Record (PCR). The results were compared with age-matched 103 female dental patients (BMI 19.8 ± 2.3 kg/m2, age 15.0 ± 1.8, p = 0.746) treated in a public University dental clinic.

Results

AN patients were found to present a higher incidence of oral-related complications according to dental status (DMFT 3.8 ± 4.5 vs. 1.9 ± 2.1, p = 0.005), erosive tooth wear (BEWE 18.9 vs. 2.9%, p < 0.001), less efficient in controlling plaque (PCR 43.8 vs. 13.7%, p < 0.001) and gingival inflammation (BOP 20.0 vs. 3.9%, p < 0.001) compared with female adolescents. In the AN group, a significant correlation between BOP, BEWE, and duration of AN disease (p < 0.05), similarly to the number of decayed teeth D, filled teeth F and PCR were detected (p < 0.05).

Conclusions

Although the obtained results did not reveal any severe oral status, our findings indicated impaired dental and gingival conditions in young anorexics. Considering AN's potential role in oral health, it is essential to monitor dental treatment needs and oral hygiene levels in their present status to prevent forward complications in the future.