Toward esthetically and biomechanically reliable anterior resin composite restorations: Current clinical experiences among dental practitioners in Saudi Arabia.

Background: Esthetic anterior composite restorations are very challenging. They constitute a main part of the clinical practice of restoring teeth with resin composites. Distinctive variations in composite material selection and technique of application in anterior teeth exist when compared to the practice of restoring posterior teeth with resin composites. In a continuation of a previous assessment of class II resin composite practice,  a cross-sectional survey study was performed to determine the awareness of general dental practitioners in Saudi Arabia about resin composite restorations in anterior teeth and to provide evidence-based recommendations to improve their practice. Methods: A total of 500 dental practitioners from different provinces in Saudi Arabia were invited to participate in an online questionnaire which comprised four domains and included a total of sixteen questions addressing aspects regarding the selection of resin composites, cavity configuration, etching protocol, light-curing technique, liner application, application of poly-chromatic composite, as well as finishing and polishing procedures. Chi square testing and descriptive statistics were used to analyze the attained data. Results: From 250 respondents, the greatest participation was from the Eastern and Middle provinces of Saudi Arabia. Female dentists participated less than males. There was no general agreement between participants regarding the resin composite material or the employed technique of application in restoring anterior tooth defects. Respondents indicated that discoloration and hypersensitivity were the most common reasons for patient's dissatisfaction with resin composites in anterior teeth. Conclusions: Dental practitioners are highly encouraged to improve their clinical practice of restoring anterior teeth using resin composites with the focus upon continuous education programs, online webinars, and workshops.

Scientific trends on research on denture stomatitis based on Scopus database: A bibliometric analysis.

Background: Denture stomatitis is a clinical condition that affects people who wear removable maxillary dentures. It causes redness, soreness, and erythema and ultimately affects the general condition of the patient. The objective of this study was to analyze the leading countries, journals, organizations, and authors and the frequently used keywords associated with denture stomatitis. Material and Methods: A bibliometric analysis of publications indexed in the Scopus database was conducted, and the article titles, abstracts, and keywords were analyzed using the VOSviewer software. Denture stomatitis-related publications from 1960 to 2021 were collected. This study included only research papers published in English with "article" as the paper type and dentistry as the subject area. Results: Data from a total of 461 articles and 10 different journals were obtained. The papers were published in 64 different countries. Brazil and the United States of America were the top contributing countries, and the University of Sydney was the leading organization. Papers published in the Journal of Oral Rehabilitation received the highest number of citations, while author Gordon Ramage from the University of Glasgow received the highest number of citations. Conclusions: The bibliometric analysis revealed that the number of denture stomatitis-related publications indexed in the Scopus database is increasing globally. Since 2007, there has been an increase in research interest regarding denture stomatitis, with more publications from several countries expected to be published in different journals. Key words:Bibliometric analysis, denture, candida, VOSviewer, maxilla.

Potential Antigenic Candidates for the Development of Peptide-Based Vaccines to Induce Immunization against Helicobacter pylori Infection in BALB/c Mice.

Helicobacter pylori (H. pylori) has been identified as a group-1 definite carcinogen. As of yet, there is no available vaccine for this microorganism. Our study aimed to identify antigenic peptides in H. pylori using an in silico proteomic approach, and to evaluate their effectiveness as potential vaccine candidates. Four different peptide sequences were prioritized using the reverse vaccinology, namely, CagA1, CagA2, VacA, and SabA. Peptides emulsified with Freunde's adjuvant were used to immunize BALB/C mice. Subcutaneously immunized mice were challenged by oral administration of H. pylori. IgG, IgA, IL4, and IL17 were detected in mice sera. Histopathology of the dissected stomach of vaccinated and control mice were assessed using H&E stain. IgG was significantly higher in mice vaccinated with SabA. IL-4 was significantly increased in CagA1, CagA2, VacA, and SabA vaccinated mice compared to the adjuvant group. Additionally, histopathological examination of gastric tissue showed a protective effect in the vaccinated groups compared to adjuvant and PBS groups. Our findings indicate a promising effect of the tested epitopes, particularly the SabA antigen, to induce an immune response against H. pylori.

The Antifungal and Antibiofilm Activities of Caffeine against Candida albicans on Polymethyl Methacrylate Denture Base Material.

BACKGROUND: In this study, the effect of pure caffeine was established against Candida albicans (C. albicans) using different microbiological techniques. METHODS: Broth microdilution and colony forming units (CFUs) assays were used to detect the minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC). The Live/Dead fluorescent dyes were implemented to determine the yeast viability. Polymethyl methacrylate acrylic resin (PMMA) discs were prepared to evaluate caffeine's effects against adherent C. albicans using microplate reader, CFUs, and scanning electron microscope (SEM). RESULTS: caffeine's MIC was detected around 30 mg/mL, while the MFC was considered at 60 mg/mL. In an agar-well diffusion test, the inhibition zones were wider in caffeine groups. The Live/Dead viability test verified caffeine's antifungal effects. The optical density of the adherent C. albicans on PMMA discs were lower at 620 nm or 410 nm in caffeine groups. CFU count was also reduced by caffeine treatments. SEM revealed the lower adherent C. albicans count in caffeine groups. The effect of caffeine was dose-dependent at which the 60 mg/mL dose demonstrated the most prominent effect. CONCLUSION: The study reinforced caffeine's antifungal and antibiofilm properties and suggested it as an additive, or even an alternative, disinfectant solution for fungal biofilms on denture surfaces.

Toward a Clinically Reliable Class II Resin Composite Restoration: A Cross-Sectional Study into the Current Clinical Practice among Dentists in Saudi Arabia.

Objective: The aim of this study was to evaluate the current clinical practice of general dentists in Saudi Arabia in restoring class II cavities using direct resin composites and to set evidence-based practice recommendations of concern. Methods: An online survey formed of 20 questions and classified into four domains was developed. 500 dentists in 5 Saudi provinces were invited to join the survey anonymously and voluntarily using poster announcements and e-mail invitations. Descriptive statistics were used to analyze participants' responses. Results: 343 responses were received. Dentists in Saudi Arabia vary in their clinical practices and techniques of insertion of resin composite in class II cavities. 67% of participants use cotton rolls for isolating the field while 32% use rubber dam isolation. 33% and 28% of respondents use circumferential matrix (Tofflemire) and AutoMatrix, respectively. Fracture, followed by recurrent caries and open proximal contacts, was the received main reason of failure of class II direct resin composite restorations. Conclusion: Diversity of class II resin composite practices exists among dentists in Saudi Arabia. For ensuring optimum quality outcomes and high standards of restorative dentistry healthcare, several dentists in Saudi Arabia need to reconsider their clinical practice and modify their clinical procedures of direct class II resin composites. Several evidence-based practice guidelines are recommended to dentists in this article to improve their practice and enhance the clinical reliability and longevity of class II direct resin composite restorations.

Oral manifestations associated with Novel Coronavirus Disease - 2019 (COVID-19): A questionnaire based hypothetical study.

Background: Since the Coronavirus disease 2019 (COVID-19) outbreak in 2019, the virus has evolved drastically, presenting with sets of mutations that influence its properties, including transmissibility and antigenicity. The oral mucosa is postulated as probable portal entry and several oral manifestations have been identified, which places dental professionals in a position to recognize probable COVID-19 patients depending on oral signs and symptoms in the initial phases of the disease itself. As co-existing with COVID-19 seems to be a new reality, greater understanding is required regarding early oral signs and symptoms which can be predictors for timely intervention and prevention of complications in COVID-19 patients. The objective of the study is to identify the distinguishing oral signs and symptoms among COVID-19 patients and to establish possible correlation between severity of COVID-19 infection and oral symptoms. Methods: This study recruited 179 ambulatory, non-hospitalized COVID-19 patients from the Kingdom of Saudi Arabia's Eastern Province's designated hotels for COVID-19 and home isolated patients from the same region using a convenience sample method. Data was collected by qualified and experienced investigators, including two physicians and three dentists, using a validated comprehensive questionnaire through telephonic interviews with the participants. The X 2 was used to assess the categorical variables, and odd's ratio was calculated to determine the strength of the association between general symptoms and oral manifestations. Results: Oral and nasopharyngeal lesions or conditions like loss of smell and taste, xerostomia, sore throat, and burning sensation were predictors of COVID-19-related systemic symptoms such as cough, fatigue, fever, and nasal congestion were identified to be statistically significant (p<0.05). Conclusions: The study reveals the occurrence of olfactory or taste dysfunction, dry mouth, sore throat, and burning sensation along with COVID-19 generic symptoms, should be considered as suggestive yet not conclusive indicators of COVID-19.

Evaluation of the Antimicrobial Effect of Thymoquinone against Different Dental Pathogens: An In Vitro Study.

This study aimed to evaluate the antimicrobial effect of Thymoquinone (TQ) on four different oral microorganisms. Minimum Bactericidal Concentration (MBC), Minimum Inhibition Concentration (MIC), Broth microdilution, and Well diffusion tests were used to determine the optimum antimicrobial concentrations of TQ against Streptococcus salivarius, Streptococcus oralis, Streptococcus mutans, and Staphylococcus aureus over 1, 3, 6, 12 and 24 h. Chlorhexidine 0.12% was selected as a positive control. The inhibitory effect of TQ on bacterial growth was most noticeable with S. salivarius, while the least affected was S. aureus. TQ's MBC and MIC for S. oralis and S. aureus were comparable 2 mg/mL and 3 mg/mL, respectively. S. salivarius was most resistant to TQ and displayed a value of 5 mg/mL and 4 mg/mL for MIC and MBC, respectively. The viable count of different strains after exposure to TQ's MBC values was most noticeable with S. aureus followed by S. oralis and S. mutans, while S. salivarius was least affected. This study emphasized the promising antimicrobial effect of TQ against the four main oral microorganisms. It has a potential preventive effect against dental caries as well as other oral diseases.

Psychological Perceptions and Preparedness during Novel Coronavirus Disease - 2019 (COVID-19) Pandemic - A Multinational Cross-sectional Study among Healthcare Professionals.

Novel Coronavirus Disease 2019 (COVID-19) has caused serious repercussions both physically and mentally. The crisis has laid an enormous workload on the global healthcare fraternity. This article has attempted to study the emotional and psychological status of the medical and dental fraternity across seven Asian countries (India, Malaysia, the Gulf Cooperation countries (GCC) and, others) and also deduce the degree of mental preparedness as they spearhead the war against COVID-19. A cross-sectional, descriptive online survey was carried out among potential participants from online forums and other health-related social communities. Bivariate analysis with descriptive statistics was applied to decipher the results. A total of 788 complete responses were analyzed. The response rate was 77.1%. Results revealed the perception of the Healthcare Professionals about COVID-19 and its implications in their personal and professional lives. Many categories from psychological and emotional standpoints were analyzed. Older HCPs (above 35 years) reported high levels of stress at the workplace (p = 0.002). About 43.5% of the HCPs from India reported that they have not received any specialized training on containing COVID-19 or any contagious disease. Intense emotional stress was reported by the HCPs when colleagues get infected. The medical professionals (61.7%) exhibited more work stress compared to their dental counterparts. Analyzing the psychological and emotional status of HCPs is imperative especially in this COVID-19 situation. Similar analyses are crucial to gauge the quality of our healthcare system and take necessary actions like training the workforce, revamping the infrastructure, and regulating the workflow.

Psychological perceptions and preparedness during novel coronavirus disease - 2019 (covid-19) pandemic - a multinational cross-sectional study among healthcare professionals

Abstract Novel Coronavirus Disease 2019 (COVID-19) has caused serious repercussions both physically and mentally. The crisis has laid an enormous workload on the global healthcare fraternity. This article has attempted to study the emotional and psychological status of the medical and dental fraternity across seven Asian countries (India, Malaysia, the Gulf Cooperation countries (GCC) and, others) and also deduce the degree of mental preparedness as they spearhead the war against COVID-19. A cross-sectional, descriptive online survey was carried out among potential participants from online forums and other health-related social communities. Bivariate analysis with descriptive statistics was applied to decipher the results. A total of 788 complete responses were analyzed. The response rate was 77.1%. Results revealed the perception of the Healthcare Professionals about COVID-19 and its implications in their personal and professional lives. Many categories from psychological and emotional standpoints were analyzed. Older HCPs (above 35 years) reported high levels of stress at the workplace (p = 0.002). About 43.5% of the HCPs from India reported that they have not received any specialized training on containing COVID-19 or any contagious disease. Intense emotional stress was reported by the HCPs when colleagues get infected. The medical professionals (61.7%) exhibited more work stress compared to their dental counterparts. Analyzing the psychological and emotional status of HCPs is imperative especially in this COVID-19 situation. Similar analyses are crucial to gauge the quality of our healthcare system and take necessary actions like training the workforce, revamping the infrastructure, and regulating the workflow.

Resumo O novo Coronavírus 2019 (COVID-19) tem causado sérias repercussões tanto físicas como mentais. A crise colocou uma enorme carga de trabalho sobre a comunidade global de saúde. O objetivo foi estudar o estado emocional e psicológico da comunidade médica e dentária em sete países asiáticos (Índia, Malásia, os países da Cooperação do Golfo (GCC) e, outros) e também deduzir o grau de preparo mental à medida que conduzem a guerra contra a COVID-19. Foi realizado um estudo transversal e descritivo online entre potenciais participantes de fóruns online e outras comunidades sociais relacionadas com a saúde. Foi aplicada uma análise bivariada com estatística descritiva para decifrar os resultados. Foram analisadas um total de 788 respostas completas. A taxa de resposta foi de 77,1%. Os resultados revelaram a percepção dos Profissionais de Saúde sobre a COVID-19 e as suas implicações na sua vida pessoal e profissional. Foram analisadas muitas categorias do ponto de vista psicológico e emocional. Os HCP mais velhos (acima de 35 anos) relataram níveis elevados de stress no local de trabalho (p = 0,002). Cerca de 43,5% dos HCP da Índia relataram não ter recebido qualquer formação especializada sobre a contenção de COVID-19 ou qualquer doença contagiosa. O estresse emocional intenso foi relatado pelos HCPs quando os colegas foram infectados. Os profissionais médicos (61,7%) exibiram mais stress de trabalho em comparação com os seus homólogos dentários. A análise do estado psicológico e emocional dos HCP é imperativa, especialmente nesta situação de COVID-19. Análises semelhantes são cruciais para avaliar a qualidade do nosso sistema de saúde e tomar as ações necessárias como a formação da força de trabalho, a renovação das infra-estruturas, e a regulação do fluxo de trabalho.

Optical coherence tomography's current clinical medical and dental applications: a review.

Optical coherence tomography (OCT) is a non-invasive investigative technique that is used to obtain high-resolution three-dimensional (3D) images of biological structures. This method is useful in diagnosing diseases of specific organs like the eye, where a direct biopsy cannot be conducted. Since its inception, significant advancements have been made in its technology. Apart from its initial application in ophthalmology for retinal imaging, substantial technological innovations in OCT brought by the research community have enabled its utilization beyond its original scope and allowed its application in many new clinical areas. This review presents a summary of the clinical applications of OCT in the field of medicine (ophthalmology, cardiology, otology, and dermatology) and dentistry (tissue imaging, detection of caries, analysis of dental polymer composite restorations, imaging of root canals, and diagnosis of oral cancer). In addition, potential advantages and disadvantages of OCT are also discussed.

Efficacy of propolis in remineralising artificially induced demineralisation of human enamel - An in-vitro study.

OBJECTIVE: In this in vitro study, we aimed to analyse the enamel-remineralisation potential of propolis. MATERIALS AND METHODS: Twenty enamel blocks (N = 20) were randomly divided into two groups (n = 10). In group 1 (control), enamel blocks were brushed with artificial saliva (AS). In group 2, they were brushed with propolis oil. All the blocks were demineralised by exposing them to 6 wt% citric acid (pH: 2.2) for 5 min. Brushing was performed inside a tooth brushing simulation machine with manual toothbrushes. Each sample received 5,000 linear strokes. Surface microhardness analysis was performed for each sample at three time intervals (pre-demineralisation or baseline, post-demineralisation, and post-remineralisation) to obtain the Vickers hardness numbers (VHNs). RESULTS: An enhancement in the microhardness of the enamel samples was observed after brushing with propolis oil when compared with brushing using AS alone. In group 1 (control group), the mean baseline VHN was 583.66. It decreased to 116.23 after demineralisation and increased to 184.02 after remineralisation. The mean baseline VHN of group 2 was 506.91. It decreased to 317.60 after demineralisation and increased to 435.19 after remineralisation. The VHN values of both the groups revealed statistically significant differences (p < 0.05) in inter-group and intra-group comparisons. CONCLUSION: Brushing of enamel blocks with propolis led to a greater enhancement in their microhardness levels when compared with the control group. Future studies are essential to validate the exact mechanism of the beneficial effects of propolis on enamel.

Conservative Management of Chronic Suppurative Parotitis in Patients with Sjögren Syndrome: A Case Series.

BACKGROUND Parotitis is an inflammation of the parotid gland, which can be caused by factors including infection, radiation, and hyposalivation secondary to systemic conditions, such as Sjögren syndrome, rheumatoid arthritis, or medication. Bacterial parotitis is a rare complication that can be observed in patients with hyposalivation. However, it is also observed in elderly and immunocompromised patients. Lack of continuous flushing of salivary glands and their ducts due to decreased salivary flow renders the glands prone to retrograde colonization with oral microflora. Several microorganisms have been associated with bacterial infections of the parotid glands; Staphylococcus aureus is the most common, accounting for 80% of cases, followed by mixed bacterial communities, including streptococci, anaerobes, and gram-negative bacilli. Bacterial parotitis presents as tenderness, swelling, and purulent sialorrhea from the salivary gland's duct. Immediate administration of broad-spectrum antibiotics, based on the results of the patient's culture and sensitivity test, has shown success in treating these cases. CASE REPORT We report 3 cases of chronic suppurative parotitis secondary to dry mouth and due to Sjögren syndrome that did not respond to oral or intravenous antibiotics and was successfully managed using conservative methods, such as the local application of superficial moist heat and periodic pus drainage by manipulating the parotid glands at dental clinics. CONCLUSIONS We concluded that conservative approaches, such as massaging the glands, local application of superficial moist heat, and periodic pus drainage without using antibiotics, should be considered as the first-line management of bacterial infection of the parotid glands.

Knowledge of dentists, dental auxiliaries, and students regarding the COVID-19 pandemic in Saudi Arabia: a cross-sectional survey.

BACKGROUND: This study aimed to assess the knowledge of dental professionals in Saudi Arabia regarding severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 2019 (COVID-19). METHODS: A questionnaire was developed to assess various dental professionals from both governmental and private sectors through online and social media outlets. RESULTS: A total of 1,033 questionnaires were collected (273 dental students, 193 dental auxiliary personnel, 544 dentists). In all, 63.4% of the respondents worked in hospitals. Of all the respondents, 44.9%, 33.4%, and 21.7% worked in governmental clinics, academia, and the private sector, respectively. Overall knowledge of the incubation period and route of transmission of SARS-CoV-2 was consistent across all dental professions. Knowledge of hand-soap cleaning time was significantly different among dental professionals (p < 0.001). Dental professionals displayed significant disagreement on the survival of SARS-CoV-2 outside the host (p < 0.001). Furthermore, 75.1% of the respondents were reluctant to treat a suspected COVID-19 patient, and 92% of the participants believed that the mode of transmission was droplet inhalation. Fever, coughing, and shortness of breath were identified as the most common symptoms of COVID-19. Most standard methods of prevention in the dental office were selected by at least 50% of the participants. CONCLUSIONS: Dental professionals seem to be consistent regarding their knowledge of the incubation period of SARS-CoV-2. However, knowledge of viral survivability and recommended hand-soap washing time was significantly variable among the professionals. A high degree of apprehension toward suspected COVID-19 patients existed among all dental professionals. Pandemic-awareness campaigns are essential among healthcare providers.

Incidental Diagnosis on Orthopantomography of Langerhans Cell Histiocytosis with Multifocal Jaw Involvement: A Case Report of Single-System Disease.

BACKGROUND Langerhans cell histiocytosis (LCH) is a relatively rare neoplasm with a strong inflammatory component. It has diverse clinical manifestations, which range from a single lesion or multiple bony lesions to severe multisystem involvement. Approximately 10% to 20% of cases of LCH occur in the jaw, with the posterior mandible being the site most frequently involved. CASE REPORT We report on the case of a 42-year-old man who presented with bilateral osteolytic lesions in the posterior mandible that were incidentally discovered during routine radiographic screening. Histological examination of the specimen confirmed the diagnosis of LCH. CONCLUSIONS This case illustrates the importance of orthopantomography (OPG) as a screening tool in new patients to perform an overall evaluation of the teeth and surrounding structures, such as the bone, temporomandibular joint, and sinuses. Moreover, OPG can be used to screen for the presence of asymptomatic lesions that are often diagnosed incidentally on radiographs.

Correlation of PTC Taste Status with Fungiform Papillae Count and Body Mass Index in Smokers and Non-Smokers of Eastern Province, Saudi Arabia.

Phenylthiocarbamide (PTC) is a bitter compound that is similar in taste to the polyphenols present in most vegetables and fruits. The human taste response towards this compound influences dietary preference, which has a bearing on an individual's body mass index (BMI). Another factor that influences taste perception is fungiform papillae count. This, in turn, is governed by genetic factors or deleterious habits such as smoking. Establishing a link between all the above factors could lead to a wider understanding of obesity, which is a global health issue. PTC taste response, BMI, and fungiform papillae were recorded and statistically analyzed between two groups-smokers and nonsmokers. There was no statistically significant difference between smokers and nonsmokers with regard to PTC tasting ability. However, there was a significant inverse relationship between BMI and PTC tasting ability and fungiform papillae count both in smokers and nonsmokers. Thus, it can be inferred that as BMI increases, there is a lower likelihood of experiencing the bitter taste of PTC. Additionally, the ability to taste PTC decreases with diminishing numbers of fungiform papillae. Smoking does not affect bitter PTC tasting ability despite negatively affecting fungiform papillae count.

Risk Assessment of Healthcare Workers at the Frontline against COVID-19.

The novel coronavirus disease 2019 (COVID-19) is a global pandemic. Healthcare workers (HCWs) are on the frontline of treating patients infected with COVID-19. However, data related to its infection rate among HCWs are limited. The aim was to present evidence associated with the number of HCWs being infected with COVID-19 from most viral affected countries (Italy, China, United States, Spain, and France). Furthermore, we looked into the reasons for HCWs COVID 19 infections and strategies to overcome this problem. Early available evidence suggested that HCWs are being increasingly infected with the novel infection ranging from 15% to 18% and in some cases up to 20% of the infected population. Major factors for infection among HCWs include lack of understanding of the disease, inadequate use and availability of Personal Protective Equipment (PPE), uncertain diagnostic criteria, unavailability of diagnostic tests and psychological stress. Therefore the protection of HCWs by authorities should be prioritized through education and training, the readiness of staff, incentives, availability of PPEs, and psychological support.

Oral squamous cell carcinoma: metastasis, potentially associated malignant disorders, etiology and recent advancements in diagnosis.

Oral squamous cell carcinoma (OSCC) is a commonly occurring head and neck cancer. It has a high prevalence in certain parts of the world, and is associated with a high mortality rate. In this review, we describe metastasis related to OSCC, and disorders that could lead to OSCC with common etiological factors. In addition, a brief account of the diagnosis of OSCC and role of salivary biomarkers in its early detection has also been highlighted. Google Scholar and PubMed search engines were searched with keywords including "oral squamous cell carcinoma", "OSCC", "oral cancer", "potentially malignant disorders in oral cavity", "etiological factors of OSCC",  "diagnosis of OSCC", and "salivary biomarkers and OSCC" to gather the literature for this review. The review concludes that OSCC has the potential for regional as well as distant metastasis, and many potentially malignant diseases can transform into OSCC with the help of various etiological factors. Diagnosis of OSCC involves traditional biopsy, but salivary biomarkers could also be utilized for early recognition.

The role of salivary contents and modern technologies in the remineralization of dental enamel: a narrative review.

Human enamel once formed cannot be biologically repaired or replaced. Saliva has a significant role in remineralization of dental enamel. It not only has a buffering capacity to neutralize the oral cavity's low pH generated after acidic encounters, but also acts as a carrier of essential ions, such as fluoride, calcium and phosphate, which have a positive role in enamel's remineralization. This review discusses how salivary contents, like proteins and enzymes, have a natural role in enamel's mineralization. In addition, the presence of ions, such as fluoride, calcium and phosphate, in saliva further enhances its capability to remineralize the demineralized enamel surface. The review further examines modern innovative technologies, based on biomimetic regeneration systems, including dentin phosphoproteins, aspartate-serine-serine, recombinant porcine amelogenin, leucine-rich amelogenin peptide and nano-hydroxyapatite, that promote enamel remineralization. Fluoride boosters like calcium phosphates, polyphosphates, and certain natural products can also play an important role in enamel remineralization.