Effects of Calcium and Phosphate on Dissolution of Enamel, Dentin and Hydroxyapatite in Citric Acid.

The aim was to evaluate the effect of dissolved calcium and phosphate on dissolution rate of enamel, dentin and compressed hydroxyapatite (HA) in citric acid solution as a function of pH. At pH 2.5, dissolution rate of enamel increased significantly by 6% in 20 mmol/L added calcium but, otherwise, dissolution rates of neither enamel, dentin nor HA were significantly affected by 10 or 20 mmol/L calcium. However, enamel dissolution rate was reduced by > 50 mmol/L calcium. At pH 3.25 and 4.0, 10-20 mmol/L calcium inhibited dissolution of enamel by 29-100% and HA by 65-75% but did not affect dentin dissolution. Phosphate (10 or 20 mmol/L) did not inhibit dissolution of enamel, dentin or HA at any pH, but there were increases in dissolution rate of all three substrates at pH 2.5 and, in one test with dentine (at 20 mmol/L phosphate), at pH 3.25. The results suggest that calcium addition to soft drinks and other acidic products such as medications may reduce erosivity against enamel, provided that pH is not too low; that phosphate would not reduce erosivity against enamel; and that neither calcium nor phosphate at these concentrations would reduce erosivity against dentin.

The erosive effect of various drinks, foods, stimulants, medications and mouthwashes on human tooth enamel.

Two forms of non-carious dental disorder - erosive tooth hard tissue loss and dental erosion - have been increasingly observed in recent years. Dental erosion is the chemical loss of dental hard substances caused by exposure to acids not derived from oral bacteria. Mechanical forces from, for example, the tongue, the cheeks or toothbrushing, increase loss of partly-demineralized tooth surfaces and the cumulative loss of dental hard tissue is defined as erosive tooth wear (ETW). Dental hard tissue losses which occur because of very frequent acid exposure, such as through increased vomiting, but without mechanical stress, are also assigned to tooth erosion. Without prior softening, practically no loss of enamel takes place due to abrasion with the modern Western diet. The present work is a continuation of earlier work. A total of 226 beverages, food, stimulants as well as medicines and mouthwashes were tested for their erosive potential on premolars and deciduous molars covered with a human pellicle. The influence of temperature, phosphate and calcium was also investigated in additional experiments. The change in hardness before and after immersion in the respective test substance was measured and the erosive potential was classified. For each test product, we determined pH and other properties which were possibly related to erosive potential. There were considerable and sometimes surprising differences between the tested products. The addition of phosphate did not influence the erosive potential of the liquids, but calcium did. A modified erosion scheme is presented, which incorporates these and other new findings.

[The erosive effect of various drinks, foods, stimulants, medications and mouthwashes on human tooth enamel] / Die erosive Wirkung verschiedener Getränke, Speisen, Genussmittel, Medikamente und Mundspülungen auf den menschlichen Zahnschmelz.

Two forms of non-carious dental disorder - ero- sive tooth hard tissue loss and dental erosion - have been increasingly observed in recent years. Dental erosion is the chemical loss of dental hard substances caused by exposure to acids not de- rived from oral bacteria. Mechanical forces from, for example, the tongue, the cheeks or tooth- brushing, increase loss of partly demineralized tooth surfaces and the cumulative loss of dental hard tissue is defined as erosive tooth wear (ETW). Dental hard tissue losses that occur be- cause of very frequent acid exposure, such as through increased vomiting, but without me- chanical stress, are also assigned to tooth erosion. Without prior softening, practically no loss of enamel takes place due to abrasion with the modern Western diet. The present work is a con- tinuation of earlier work. A total of 226 beverag-es, foods, stimulants as well as medicines and mouthwashes were tested for their erosive po- tential on premolars and deciduous molars covered with a human pellicle. The influence of temperature, phosphate and calcium was also investigated in additional experiments. The change in hardness before and after immersion in the respective test substance was measured, and the erosive potential was classified. For each test product, we determined pH and other properties which were possibly related to erosive potential. There were considerable and sometimes surpris- ing differences between the tested products. The addition of phosphate did not influence the ero- sive potential of the liquids, but calcium did. A modified erosion scheme that incorporates these and other new findings is presented.

The interactions between attrition, abrasion and erosion in tooth wear.

Tooth wear is the result of three processes: abrasion (wear produced by interaction between teeth and other materials), attrition (wear through tooth-tooth contact) and erosion (dissolution of hard tissue by acidic substances). A further process (abfraction) might potentiate wear by abrasion and/or erosion. Knowledge of these tooth wear processes and their interactions is reviewed. Both clinical and experimental observations show that individual wear mechanisms rarely act alone but interact with each other. The most important interaction is the potentiation of abrasion by erosive damage to the dental hard tissues. This interaction seems to be the major factor in occlusal and cervical wear. The available evidence is insufficient to establish whether abfraction is an important contributor to tooth wear in vivo. Saliva can modulate erosive/abrasive tooth wear, especially through formation of pellicle, but cannot prevent it.

Understanding the chemistry of dental erosion.

Dental erosion is caused by repeated short episodes of exposure to acids. Dental minerals are calcium-deficient, carbonated hydroxyapatites containing impurity ions such as Na(+), Mg(2+) and Cl(-). The rate of dissolution, which is crucial to the progression of erosion, is influenced by solubility and also by other factors. After outlining principles of solubility and acid dissolution, this chapter describes the factors related to the dental tissues on the one hand and to the erosive solution on the other. The impurities in the dental mineral introduce crystal strain and increase solubility, so dentine mineral is more soluble than enamel mineral and both are more soluble than hydroxyapatite. The considerable differences in structure and porosity between dentine and enamel influence interactions of the tissues with acid solutions, so the relative rates of dissolution do not necessarily reflect the respective solubilities. The rate of dissolution is further influenced strongly by physical factors (temperature, flow rate) and chemical factors (degree of saturation, presence of inhibitors, buffering, pH, fluoride). Temperature and flow rate, as determined by the method of consumption of a product, strongly influence erosion in vivo. The net effect of the solution factors determines the overall erosive potential of different products. Prospects for remineralization of erosive lesions are evaluated.

Interactions between dodecyl phosphates and hydroxyapatite or tooth enamel: relevance to inhibition of dental erosion.

Tooth surface modification is a potential method of preventing dental erosion, a form of excessive tooth wear facilitated by softening of tooth surfaces through the direct action of acids, mainly of dietary origin. We have previously shown that dodecyl phosphates (DPs) effectively inhibit dissolution of native surfaces of hydroxyapatite (the type mineral for dental enamel) and show good substantivity. However, adsorbed saliva also inhibits dissolution and DPs did not augment this effect, which suggests that DPs and saliva interact at the hydroxyapatite surface. In the present study the adsorption and desorption of potassium and sodium dodecyl phosphates or sodium dodecyl sulphate (SDS) to hydroxyapatite and human tooth enamel powder, both native and pre-treated with saliva, were studied by high performance liquid chromatography-mass Spectrometry. Thermo gravimetric analysis was used to analyse residual saliva and surfactant on the substrates. Both DPs showed a higher affinity than SDS for both hydroxyapatite and enamel, and little DP was desorbed by washing with water. SDS was readily desorbed from hydroxyapatite, suggesting that the phosphate head group is essential for strong binding to this substrate. However, SDS was not desorbed from enamel, so that this substrate has surface properties different from those of hydroxyapatite. The presence of a salivary coating had little or no effect on adsorption of the DPs, but treatment with DPs partly desorbed saliva; this could account for the failure of DPs to increase the dissolution inhibition due to adsorbed saliva.

Inhibition of hydroxyapatite dissolution by whole casein: the effects of pH, protein concentration, calcium, and ionic strength.

Formulating drinks with reduced erosive potential is one approach for reducing dental erosion. In this study, whole casein was added to citric acid solutions representative of soft drinks, and the hydroxyapatite dissolution rate was assessed. Adding 0.02% (w/v) casein to acid solutions significantly reduced the hydroxyapatite dissolution rate by 51 +/- 4% at pH values of 2.80, 3.00, 3.20, 3.40, and 3.60, although the baseline dissolution rates of course varied as a function of pH. The protein concentration [0.002, 0.02, and 0.2% (w/v) casein] had no significant effect on dissolution inhibition. Adding both casein and calcium to citric acid resulted in a further reduction in the dissolution rate at low and intermediate calcium concentrations (5 and 10 mM) but not at higher calcium concentrations (20 and 50 mM). Ionic strength had no significant impact on the efficacy of casein. Casein also significantly reduced the hydroxyapatite dissolution rate when the hydroxyapatite was coated with a salivary pellicle. The reduction in dissolution rate is ascribed to firmly adsorbed casein on the hydroxyapatite surface, which stabilizes the crystal surface and inhibits ion detachment.

An investigation using atomic force microscopy nanoindentation of dental enamel demineralization as a function of undissociated acid concentration and differential buffer capacity.

Acidic drinks and foodstuffs can demineralize dental hard tissues, leading to a pathological condition known as dental erosion, which is of increasing clinical concern. The first step in enamel dissolution is a demineralization of the outer few micrometres of tissue, which results in a softening of the structure. The primary determinant of dissolution rate is pH, but the concentration of undissociated acid, which is related to buffer capacity, also appears to be important. In this study, atomic force microscopy nanoindentation was used to measure the first initial demineralization (softening) induced within 1 min by exposure to solutions with a range of undissociated acid concentration and natural pH of 3.3 or with an undissociated acid concentration of 10 mmol l-1 and pH adjusted to 3.3. The results indicate that differential buffering capacity is a better determinant of softening than undissociated acid concentration. Under the conditions of these experiments, a buffer capacity of >3 mmol l-1 pH-1 does not have any further effect on dissolution rate. These results imply that differential buffering capacity should be used for preference over undissociated acid concentration or titratable acidity, which are more commonly employed in the literature.

An investigation of some food-approved polymers as agents to inhibit hydroxyapatite dissolution.

Dental erosion involves dissolution of the hydroxyapatite fraction of enamel and dentine, so agents that reduce the dissolution rate of hydroxyapatite could find application in food products aimed at reducing erosion. This study was performed to test some common food ingredients and additives for their effect on the dissolution rate of hydroxyapatite in a citric acid solution representative of soft drinks. Pyrophosphate, tripolyphosphate and a linear chain polyphosphate (average 25 phosphate units) significantly reduced the hydroxyapatite dissolution rate by 35, 46 and 64%, respectively. Xanthan gum and carboxymethylcellulose significantly reduced the hydroxyapatite dissolution rate by 29 and 16%, respectively. The protective effect may be ascribed to the binding of condensed phosphate or to the formation of an adsorbed layer of gum at the hydroxyapatite surface. Several other common food additives had no statistically significant effect on the hydroxyapatite dissolution rate. Polyphosphate exhibited a considerable persistence of action, causing a reduction in the dissolution rate for 3 h after treatment. Tripolyphosphate was slightly persistent, and pyrophosphate and xanthan gum did not exhibit a substantial persistence of action. A solution containing polyphosphate and xanthan gum reduced the hydroxyapatite dissolution rate by 70% and exhibited a similar persistence of action to the solution containing only polyphosphate. These compounds are suggested to have potential as erosion-reducing agents in soft drinks.

Effect of serum albumin on glycosaminoglycan inhibition of hydroxyapatite formation.

The interaction of proteins with hydroxyapatite (HAP), specifically proteoglycans and their spatial arms, glycosaminoglycans (GAGs) in addition to serum proteins, play an important role in regulating biological mineralisation. In this study, seeded HAP growth experiments revealed that inhibition of HAP formation by bovine serum albumin (BSA) was significantly elevated in combination with chondroitin 4-sulphate (C4S) versus BSA with heparin. Data suggest that C4S and BSA adsorb to different calcium sites on the HAP surface. In contrast, complexes of heparin and BSA may adsorb to HAP, thus reducing the rate of inhibition due to steric effects. In addition, the amount of protein bound to HAP growth seed was significantly higher in the presence of heparin versus C4S, confirming this suggestion. Furthermore, the data indicate that a GAG-induced conformational change in BSA occurs, which affects inhibition. This work provides novel information concerning binary molecule modulation of HAP growth.

Inhibition of hydroxyapatite crystal growth by bone proteoglycans and proteoglycan components.

The small leucine-rich proteoglycans (SLRPs) interact with hydroxyapatite (HAP) and have been demonstrated to be important modulators of mineralisation. In the present study we have examined the effect of bone SLRPs, purified bone glycosaminoglycan (GAG) chains and core proteins as well as commercial chondroitin 4-sulphate, chondroitin 6-sulphate and desulphated chondroitin on HAP crystal growth. Seeded HAP growth experiments revealed that addition of bone GAG chains resulted in almost complete inhibition of crystal growth (93%), with addition of core proteins and intact PGs resulting in 55 and 37% inhibition, respectively. In contrast, commercial chondroitin 4-sulphate was significantly less inhibitory compared with the bone SLRPs and components, yielding only a 6% reduction in HAP-induced crystal growth at the same concentration. Significantly, chondroitin 6-sulphate was found to be noninhibitory, whilst desulphated chondroitin was inhibitory to seeded HAP growth. The data indicate that direct adsorption of SLRPs to growth sites and their ability to bind calcium are significant determinants in the inhibitory process. In addition, PG/GAG chemistry and the conformation of the macromolecules in solution have also been shown to be important. This work provides new information regarding the role of bone SLRPs and their components in the regulation of the mineralisation process.