Effect of fluoride application during radiotherapy on enamel demineralization

Abstract Radiation-related caries are one the most undesired reactions manifested during or after head and neck radiotherapy. Fluoride application is an important strategy to reduce demineralization and enhance remineralizaton. Objective: To evaluate the effect of the topical application of fluoride during irradiation on dental enamel demineralization. Material and Methods: Thirty molars were randomly divided into three groups: Non-irradiated (NI), Irradiated (I), Irradiated with fluoride (IF). Each group was subdivided according to the presence or absence of pH-cycling (n=5). In the irradiated groups, the teeth received 70 Gy. The enamel's chemical composition was measured using Fourier Transform Infrared Spectrometry (organic matrix/mineral ratio - M/M and relative carbonate content - RCC). Vickers microhardness (VHN) and elastic modulus (E) were evaluated at three depths (surface, middle and deep enamel). Scanning electron microscopy (SEM) was used to assess the enamel's morphology. Results: The FTIR analysis (M/M and RCC) showed significant differences for irradiation, pH-cycling and the interaction between factors (p<0.001). Without pH-cycling, IF had the lowest organic matrix/mineral ratio and relative carbonate content. With pH-cycling, the organic matrix/mineral ratio increased and the relative carbonate content decreased, except for IF. VHN was influenced only by pH-cycling (p<0.001), which generated higher VHN values. ANOVA detected significant differences in E for irradiation (p<0.001), pH-cycling (p<0.001) and for the interaction between irradiation and pH-cycling (p<0.001). Increased E was found for group I without pH-cycling. With pH-cycling, groups I and IF were similar, and showed higher values than NI. The SEM images showed no morphological changes without pH-cycling. With pH-cycling, fluoride helped to maintain the outer enamel's morphology. Conclusions: Fluoride reduced mineral loss and maintained the outer morphology of irradiated and cycled enamel. However, it was not as effective in preserving the mechanical properties of enamel. Radiotherapy altered the enamel's elastic modulus and its chemical composition.

Effect of fluoride application during radiotherapy on enamel demineralization.

OBJECTIVE: Radiation-related caries are one the most undesired reactions manifested during or after head and neck radiotherapy. Fluoride application is an important strategy to reduce demineralization and enhance remineralizaton. To evaluate the effect of the topical application of fluoride during irradiation on dental enamel demineralization. MATERIAL AND METHODS: Thirty molars were randomly divided into three groups: Non-irradiated (NI), Irradiated (I), Irradiated with fluoride (IF). Each group was subdivided according to the presence or absence of pH-cycling (n=5). In the irradiated groups, the teeth received 70 Gy. The enamel's chemical composition was measured using Fourier Transform Infrared Spectrometry (organic matrix/mineral ratio - M/M and relative carbonate content - RCC). Vickers microhardness (VHN) and elastic modulus (E) were evaluated at three depths (surface, middle and deep enamel). Scanning electron microscopy (SEM) was used to assess the enamel's morphology. RESULTS: The FTIR analysis (M/M and RCC) showed significant differences for irradiation, pH-cycling and the interaction between factors (p<0.001). Without pH-cycling, IF had the lowest organic matrix/mineral ratio and relative carbonate content. With pH-cycling, the organic matrix/mineral ratio increased and the relative carbonate content decreased, except for IF. VHN was influenced only by pH-cycling (p<0.001), which generated higher VHN values. ANOVA detected significant differences in E for irradiation (p<0.001), pH-cycling (p<0.001) and for the interaction between irradiation and pH-cycling (p<0.001). Increased E was found for group I without pH-cycling. With pH-cycling, groups I and IF were similar, and showed higher values than NI. The SEM images showed no morphological changes without pH-cycling. With pH-cycling, fluoride helped to maintain the outer enamel's morphology. CONCLUSIONS: Fluoride reduced mineral loss and maintained the outer morphology of irradiated and cycled enamel. However, it was not as effective in preserving the mechanical properties of enamel. Radiotherapy altered the enamel's elastic modulus and its chemical composition.

Topical laser application enhances enamel fluoride uptake and tribological properties.

Topical fluoride treatment prevents dental caries. However, the resulting calcium-fluoride-like deposits are soft and have poor wear resistance; therefore, frequent treatment is required. Lasers quickly heat surfaces and can be made portable and suitable for oral remedies. We examined the morphology, nanohardness, elastic modulus, nanowear, and fluoride uptake of fluoride-treated enamel followed by CO2 laser irradiation for 5 and 10 sec, respectively. We found that laser treatments significantly increased the mechanical properties of the calcium-fluoride-like deposits. The wear resistance of the calcium-fluoride-like deposits improved about 34% after laser irradiation for 5 sec and about 40% following irradiation for 10 sec. We also found that laser treatments increased fluoride uptake by at least 23%. Overall, laser treatment significantly improved fluoride incorporation into dental tissue and the wear resistance of the protective calcium-fluoride layer.

Diode laser irradiation and fluoride uptake in human teeth.

AIM: To evaluate chemically the effects of diode laser on fluoride uptake before and after laser irradiation of enamel surfaces. METHODS: Crowns of 20 sound human teeth were halved and a 3 x 3 mm acid-resistant varnish uncovered window left for: A) no treatment; B) fluoride (Elmex gel); C) diode (fluoride + diode laser); D) diode (diode laser + fluoride). The dental surfaces were analysed using a fluoride ion-selective electrode, in order to evaluate the fluoride treatment in combination with a diode laser. Also, to investigate laser-induced compositional changes (contents in F(-)) in enamel before/after laser irradiation and topical fluoride application. RESULTS: The mean ± SD of fluoride uptake of teeth of group A was 1.55 ± 0.89 mg/l. Mean fluoride uptake increased sevenfold after fluoride gel treatment: 10.51 ± 3.38 mg/l for group B, up to 15 times after gel and laser treatment: 23.62 ± 3.58 mg/l for group C and was 22.7 ± 4.60 mg/l for group D (diode laser before fluoride application). The Kruskal Wallis test indicated a statistically significant effect of fluoride uptake for all three treatments (p<0.001). The Student-Newman-Keuls multiple comparison test indicated a statistically significant increase of fluoride uptake before and after all treatments, and also a statistically significant difference for laser treatment versus fluoride gel. However, there was no statistically significance difference between laser groups. CONCLUSIONS: There is an enhanced capability of lasers to increase fluoride uptake of enamel and providing protection to enamel surface from acid attack.

The effect of laser-activated Acidulated Phosphate Fluoride on enamel submitted to erosive solution only: an in vitro preliminary evaluation.

AIM: The purpose of this in vitro study was to evaluate the potential effect of laser therapy on the prevention of erosive demineralisation either alone or combined with acidulated phosphate fluoride gel on human enamel. It was hypothesized that such a treatment would decrease enamel solubility. STUDY DESIGN: Efficacy of 2940 nm Er:YAG laser with preset parameters--alone or combined with APF (Acidulated Phosphate Fluoride) gel--was tested on freshly extracted human permanent molars. MATERIALS AND METHODS: Ten sound human third molars were sectioned into 5 surfaces (2 x 3 mm) with hard tissue microtome and were randomly allocated into different treatment groups as follows. The Vicker's hardness of each surface was obtained at the baseline. Group 1, negative control group: no treatment. Group 2, positive control group: only 1.23% APF gel (Denti-Care gel, Medicom) 1 minute application. Group 3: irradiated with surface modification mode (2940 nm, 1.2j/cm², 10 Hz, 300 µm) Er:YAG laser. Group 4: Er:YAG laser application following 1.23% APF gel. Group 5: 1.23% APF gel following Er:YAG laser application. The demineralisation process was obtained by immersion of specimens in a soft drink for 10 minutes and then the Vickers hardness was reevaluated. STATISTICS: For statistical analyses within groups the Kruskal Wallis test was used, while for comparing groups the paired sample t test (significance p<0.05) was used. RESULTS: The difference in microhardness values of each group obtained following the treatments was not statistically significant (p>0.05). Beside, no statistical difference was found in Vickers value related to the application of fluoride prior or after laser therapy. Conclusion Er:YAG laser irradiation alone or combined with APF decreased the enamel solubility but combined treatment did not show any significant additional effect.

A comparative study to evaluate the effect of fluoride releasing sealant cured by visible light, argon lasers, and light emitting diode curing units: an in vitro study.

In Pediatric Dentistry, the use of pit and fissure sealant is one of the essential forms of prevention. Pit and fissure caries may be substantially decreased by obliteration of these developmental defects in occlusal, buccal and lingual surfaces with resin based dental sealants. Visible light-curing units, or LCUs, are an integral part of modern adhesive dentistry" They are used to cure resin based composite restoration materials, resin modified glass-ionomer and pit and fissure sealants, as well as to bond orthodontic teeth. Most recently, the argon laser has been approved for initiating the setting reaction with visible light cured-resins. Argon curing of resin materials has been show to enhance the physical properties and degree of polymerization of the resin, while reducing the polymerization time by 75 percent. The study is undertaken considering the inadequate research reports of regarding the comparison of curing ability using argon laser. LEDs and visible light as well as the resistant towards caries activity of the preventive fluoride releasing pit and fissure sealant cured by above mentioned curing units.

Increased fluoride uptake and acid resistance by CO2 laser-irradiation through topically applied fluoride on human enamel in vitro.

OBJECTIVES: The aim of the current in vitro study was to evaluate the effect of CO(2)-laser treatment immediately after applying amine fluoride solution on enamel. It was hypothesized that such a treatment would increase enamel fluoride uptake, and reduce dissolution rate and thermal surface alterations. METHODS: Fluoride uptake was determined in 40 human enamel sections randomly assigned to four groups (n=10), which were either left untreated (1), exposed to a 1% amine fluoride solution for 15s without irradiation (2), irradiated for 15s with a continuous-wave carbon dioxide laser (3), or laser-treated for 15s through the amine fluoride solution applied immediately beforehand (4). Fluoride uptake was determined with an ion selective electrode after acid dissolution of the specimens (surface and subsurface layers). For the determination of acid resistance, another 40 enamel sections were treated according to the above protocol. Acid resistance was determined in surface and subsurface layers by measuring eluted calcium upon 3% lactic acid exposure with atomic absorption spectrometry. Enamel surface alterations after laser irradiation were monitored using scanning electron microscopy. RESULTS: Laser irradiation through the fluoride solution led to significantly higher fluoride contents in the surface enamel layer compared to fluoride treatment alone or laser treatment alone (p=0.002). Laser treatment with or without fluoride resulted in an increased acid resistance of enamel specimens. Fewer surface alterations were observed upon SEM examination of specimens irradiated through the amine fluoride solution compared to counterparts treated with laser only. CONCLUSIONS: CO(2) laser light application through an amine fluoride solution may be useful and effective in the prevention of caries.

Argon laser curing of fluoride-releasing pit and fissure sealant: in vitro caries development.

The purpose of this study was to compare the effect of argon laser polymerization of a visible-light-cured, fluoride-releasing pit and fissure sealant on caries development in vitro. A total of twelve caries-free premolar and molar teeth was selected, and underwent a fluoride-free prophylaxis and soft tissue debridement. Cavity preparations were placed in buccal and lingual surfaces. Lingual cavity preparations were filled with the fluoride-releasing sealant (UltraSealXTplus, Ultradent) and visible light cured per the manufacturer's recommendation. Buccal preparations were filled with the fluoride-releasing sealant and argon laser cured (231 mW, 12 J/cm2 for 10 seconds). Following sealant placement, the teeth were sectioned into buccal and lingual halves. An acid-resistant varnish was placed leaving a 1 mm rim of exposed surface enamel adjacent to the sealant. The specimens were then thermocycled in synthetic saliva (500 cycles, 5 to 50 degrees C). In vitro caries lesions were formed (2.2 mM Ca, 2.2 mM PO4, 50 mM acetic acid, 5 ppm fluoride, pH 3.95). Longitudinal sections (five sections per tooth half) were obtained and evaluated by polarized light microscopy for mean outer surface lesion depths and frequency of wall lesions. Mean primary surface (outer) lesion depth was significantly decreased (ANOVA, DMR, P < .05) for the fluoride-releasing sealant with argon laser polymerization (152 +/- 16 um) when compared with visible light curing (211 +/- 23 um). Likewise, wall lesion frequency was substantially reduced for the argon laser polymerized sealants (17 percent) when compared with that for the visible light polymerized sealants (24 percent, ANOVA, DMR, P < .05). Argon laser polymerization of a fluoride-releasing pit and fissure sealant improved caries resistance markedly in the surface enamel adjacent to the sealant material. Argon laser curing enhanced the caries protective ability of the sealant along the enamel-resin cavosurface, as noted by a decrease in wall lesion frequency. Argon laser polymerization provides further caries protection against a cariogenic challenge over that afforded by fluoride-releasing sealants. Caries development around a sealant material may be hampered by the combination of fluoride release from the sealant and argon laser polymerization.