Effect of NaF, AmF, KF gels and NaF toothpaste combined with a saliva substitute on dentin lesions in vitro.

OBJECTIVE: The aim of the present in vitro study was to evaluate the remineralizing effects of NaF, AmF, KF gels and NaF toothpaste in combination with a potentially demineralizing saliva substitute (Glandosane; pH = 5.1) being widely used in Germany. METHODS: In each of 120 dentin specimens, three artificial lesions were created. One lesion was covered for analysis of pre-demineralization (ΔZB). Treatments during pH cycling (3 × 1 h demineralization/day [pH = 5.0] and 3 × 3 h Glandosane/day; 12 h 100%humidity) were as follows: no treatment (NT), application (5 min,2×/day) of 12.500 ppm F- [pH = 6.04] (NaF-gel1), 12.500 ppm F- [pH = 7.34] (NaF-gel2), 12.500 ppm F- [pH = 5.82] (AmF-gel), 1450 ppm F- [pH = 7.35] (KF-gel), and 5000 ppm F- [pH = 8.14]; (NaF-TP) for 7 days (E1). Subsequently, from each specimen, one lesion was covered, while the remaining lesion was cycled for another 7 days (E2). Differences in integrated mineral loss (ΔΔZE1/ΔΔZE2) were calculated between values before and after pH cycling. RESULTS: Mean (95%CI) ΔZB was 3851 (3762;3939) vol% × µm. Except for NaF-gel2 and NaF-TP, specimens of all other groups further demineralized. Only NaF-gel2 induced a significant gain in mineral content (p ≤ 0.004; paired t test). Significant differences in the change of mineral loss were found between NT and all fluoride groups for both ΔΔZE1 and for ΔΔZE2 (p < 0.05, Bonferroni post hoc test). However, only NaF-gel2 and NaF-TP induced remineralization. CONCLUSION: Under the in vitro conditions chosen, all fluoride agents could significantly hamper the adverse effects of a demineralizing saliva substitute. CLINICAL SIGNIFICANCE: In combination with a demineralizing saliva substitute, slight mineral gain was only observed for neutral NaF-gel2 and 5000 ppm F- toothpaste.

Saliva substitutes in combination with high-fluoride gel on dentin remineralization.

OBJECTIVE: This study aimed to determine whether the application of a high-fluoride gel could increase the remineralization of subsurface dentin lesions stored in saliva substitutes. MATERIALS AND METHODS: Demineralized bovine dentin specimens were stored in mineral water (W), Glandosane (G), or modified Saliva natura (SN). Different treatments were applied twice daily: no treatment, Elmex sensitive mouth rinse (E), ProSchmelz gel (P), Duraphat toothpaste (D), ED, PD, and EPD. Differences in mineral loss were evaluated by transversal microradiography after 2 and 5 weeks. RESULTS: The treatments with E, D, and ED inhibited the mineral loss induced by G and enabled some mineral gain. ProSchmelz was not able to inhibit the demineralizing effect of G. This high-fluoride gel induced an erosive mineral loss in combination with G. The use of ProSchmelz in combination or not with other fluoride products did not increase remineralization of specimens stored in SN or W (p > 0.05). ProSchmelz resulted in an erosion of the specimens stored in W and revealed a lower mineralized surface layer of specimens stored in SN. CONCLUSION: Topical application of high-fluoride gel reduced the mineral loss induced by G but resulted in an erosion of specimens' surface. In addition, ProSchmelz did not demonstrate beneficial effects in combination with SN on subsurface dentin lesion remineralization. CLINICAL RELEVANCE: Within the limitations of an in vitro study, it was concluded that the application of a high-fluoride gel did not promote additional effects on remineralization of subsurface dentin lesions in combination with saliva substitutes when compared to products with lower fluoride concentration.

Effect of saliva substitutes in combination with fluorides on remineralization of subsurface dentin lesions.

PURPOSE: Saliva substitutes are prescribed to patients suffering from radiation-induced hyposalivation to alleviate oral complaints; however, some available products have shown to demineralize dentin. The purpose of this in vitro study was to evaluate the effects of two saliva substitutes in combination or not with fluoridation on remineralization of bovine dentin subsurface lesions. MATERIALS AND METHODS: Dentin specimens were demineralized, and stored in either mineral water (control; volvic, danone), Glandosane (cell pharm), or modified Saliva natura (SN, Medac) for 5 weeks (37° C). The following treatments were applied twice daily (n = 12/group): (1) no treatment; (2) immersion in pure Elmex sensitive mouthrinse (250 ppm F-; 10 min; Gaba); (3) brushing with Duraphat toothpaste (5,000 ppm F-; Colgate)/storage solution slurry (5 s; ratio 1:3); (4) combination of treatments 2 and 3. Differences in mineral parameters before and after storage/treatment were microradiographically evaluated. RESULTS: After 5 weeks, Glandosane-induced a significant demineralization of dentin specimens. The mineral loss of specimens stored in Glandosane was significantly higher compared to all other solutions (p < 0.05), and this side effect was inhibited by the fluoride products (p < 0.05; ANOVA, Tukey). Modified Saliva natura enabled considerable remineralization, and this was significantly increased by daily application of both fluoride products (p < 0.05). CONCLUSIONS: Modified Saliva natura has remineralizing properties, while Glandosane is a demineralizing saliva substitute that should only be used with frequently applied fluorides in dentate patients.

The influence of daily application of fluoride products on subsurface bovine enamel lesions stored in saliva substitutes.

PURPOSE: To evaluate in the laboratory the effects of daily fluoride applications on remineralization of subsurface bovine enamel lesions stored in different saliva substitutes. METHODS: Enamel specimens were prepared (n = 144) and demineralized (subsurface lesions; 37 degrees C; pH 4.95; 10 days). Before and after demineralization, specimen surfaces were partly covered with nail varnish (control of sound/demineralized enamel). The specimens were either stored (5 weeks; 37 degrees C) in mineral water (W, control, S(OCP) 0.7, pH 7.0), Glandosane (G, S(OCP) 0.3, pH 5.2), or modified Saliva Natura (SN, S(OCP) 2.0, pH 5.98), and were submitted to the following treatments twice daily: (0) no treatment; (ES) immersion in pure Elmex Sensitive mouthrinse (10 minutes); (D) brushing with Duraphat toothpaste/storage solution slurry (5 seconds + contact time 115 seconds; ratio 1:3); (ES+D) combination of ES and D treatments. Mineral parameters before and after storage/treatment were evaluated from microradiographs. RESULTS: Specimens stored in G showed significantly higher demineralization compared to the other solutions (P < 0.05, ANOVA, Tukey's post hoc test); the combined treatment with fluoride products significantly reduced the demineralizing effect of G. After 2 and 5 weeks, specimens stored in SN revealed a higher remineralization compared to the control solution (P < 0.05). Daily application of fluoride products did not promote an additional effect on remineralization of specimens stored in SN (P > 0.05).

Design of a randomized controlled double-blind crossover clinical trial to assess the effects of saliva substitutes on bovine enamel and dentin in situ.

BACKGROUND: Hyposalivation is caused by various syndromes, diabetes, drugs, inflammation, infection, or radiotherapy of the salivary glands. Patients with hyposalivation often show an increased caries incidence. Moreover, hyposalivation is frequently accompanied by oral discomfort and impaired oral functions, and saliva substitutes are widely used to alleviate oral symptoms. However, preference of saliva substitutes due to taste, handling, and relief of oral symptoms has been discussed controversially. Some of the marketed products have shown demineralizing effects on dental hard tissues in vitro. This demineralizing potential is attributed to the undersaturation with respect to calcium phosphates. Therefore, it is important to modify the mineralizing potential of saliva substitutes to prevent carious lesions. Thus, the aim of the present study was to evaluate the effects of a possible remineralizing saliva substitute (SN; modified Saliva natura) compared to a demineralizing one (G; Glandosane) on mineral parameters of sound bovine dentin and enamel as well as on artificially demineralized enamel specimens in situ. Moreover, oral well-being after use of each saliva substitute was recorded. METHODS/DESIGN: Using a randomized, double-blind, crossover, phase II/III in situ trial, volunteers with hyposalivation utilize removable dentures containing bovine specimens during the experimental period. The volunteers are divided into two groups, and are required to apply both saliva substitutes for seven weeks each. After both test periods, differences in mineral loss and lesion depth between values before and after exposure are evaluated based on microradiographs. The oral well-being of the volunteers before and after therapy is determined using questionnaires. With respect to the microradiographic analysis, equal mineral losses and lesion depths of enamel and dentin specimens during treatment with SN and G, and no differences in patients' experienced oral comfort after SN compared to G usage are expected (H0). DISCUSSION: Up to now, 14 patients have been included in the study, and no reasons for early termination of the trial have been identified. The design seems suitable for determining the effects of saliva substitutes on dental hard tissues in situ, and should provide detailed information on the oral well-being after use of different saliva substitutes in patients with hyposalivation. TRIAL REGISTRATION: ClinicalTrials.gov ID. NCT01165970.

Effect of fluoridated bleaching gels on the remineralization of predemineralized bovine enamel in vitro.

OBJECTIVES: This study evaluated possible differences regarding the remineralization of predemineralized enamel after exposure to fluoridated or non-fluoridated bleaching gels. METHODS: 120 enamel specimens were prepared from sixty bovine incisors; before and after demineralization (37 degrees C; pH 4.95; 10d), one-quarter of each specimen's surface was covered with nail varnish (control sound/demineralized). Subsequently, the specimens were stored for 16h daily in a remineralizing solution (pH 7.0; 14d), while for the remaining time (8h) various bleaching gels were applied: (1) no treatment (control), (2) Opalescence regular (O, Ultradent), (3) Opalescence PF (O-PF), (4) Nite White ACP (NW-ACP, Discus Dental) and (5) Nite White ACPF (NW-ACPF). Following, half of the bleached parts were nail-varnished and stored for another 3-weeks period in a remineralizing solution. Differences in mineral losses (DeltaDeltaZ) and lesion depths (DeltaLD) before and after treatment/remineralization period were evaluated from microradiographs. DeltaDeltaZ(surface) values (mineral loss of the outer 18microm of the lesion) were calculated. RESULTS: After 2 and 5 weeks DeltaDeltaZ/DeltaLD values of the bleaching groups did not differ significantly from the controls. Treatment with NW-ACPF for 2 weeks resulted in significantly lower DeltaDeltaZ values compared to NW-ACP (p=0.032) and NW-ACPF in higher values than Opalescence regular (p=0.006). Two weeks treatment with O and O-PF resulted in decreased DeltaDeltaZ(surface) values compared to control (p<0.0005), whereas with NW-ACPF no significant differences could be observed (p=0.062). Application of NW-ACP induced significantly increased DeltaDeltaZ(surface) values compared to control (p=0.001). CONCLUSIONS: No supporting influence of fluoride-containing bleaching gels on remineralization could be observed.

Linseed based saliva substitutes and their effect on mineral dissolution of predemineralized bovine dentin in vitro.

OBJECTIVES: Polymers used in saliva substitutes might inhibit remineralization. The present study evaluated the effects of various calcium, phosphate, and fluoride concentrations of linseed based solutions on the mineral loss of predemineralized bovine dentin in vitro. METHODS: Dentin specimens were prepared, embedded and polished. The specimens were demineralized (pH 5.6; 6 d; 37 degrees C) and half of each sample was covered with nail varnish. Subsequently, the specimens (n=10) were exposed to 14 linseed based solutions (calcium 0-1.1 mM; phosphate 0-7.7 mM, fluoride 0-0.03 mM) at pH 5.5 and 6.5 as well as to Salinum for 14 days (37 degrees C). The differences in mineral loss (DeltaDeltaZ) between the values prior to and after storage in the solutions were evaluated from microradiographs of thin sections. RESULTS: After the exposure to the various solutions decreased mineral contents compared to those after demineralization could be observed (p<0.05; paired t-test) whereas for the specimens stored in solution with the highest calcium and phosphate concentration no significant change in mineral loss could be evaluated (p>0.05). Salinum induced a significantly greater mineral loss compared to the equivalent saturated solution (p<0.05; ANOVA, Bonferroni). The general linear model revealed a significant dependency for DeltaDeltaZ on 'phosphate' (p=0.000) and 'fluoride' (p=0.001), but not on 'calcium' (p=0.397) and 'pH' (p=0.368). CONCLUSIONS: The addition of calcium, phosphates, and fluorides seems to have a positive effect on the remineralizing qualities of linseed based saliva substitutes.

Effect of polymers used in saliva substitutes on demineralized bovine enamel and dentin.

PURPOSE: To evaluate the effects of porcine mucin- and carboxymethylcellulose-based (CMC) solutions on the inhibition of demineralization of pre-demineralized bovine enamel and dentin in vitro. Additionally the sugar substitutes sorbit or xylit were added to the various solutions. METHODS: 54 enamel and dentin samples were prepared from 14 freshly extracted permanent bovine central incisors. The samples were demineralized (pH 5.0 for enamel and pH 5.5 for dentin; 14 days) and subsequently exposed to either mucin- or CMC-based solutions combined with xylit and sorbit at pH 5.5. After in vitro exposure, the specimens were cut perpendicular to the enamel/dentin surface and the sections were ground (4000 grit) to a uniform thickness (100 microm). Mineral loss and lesion depths were evaluated from microradiographs with a dedicated software package (TMR 2.0.27.2). RESULTS: For both dental hard tissues, storage in the mucin-containing solutions resulted in significantly higher lesion depths (deltaLD), but lower mineral loss values (deltadeltaZ) compared to the CMC-containing solutions (P< 0.05; 2-way ANOVA). For the dentin specimens, significant differences in deltadeltaZ were observed between sorbit and xylit (P< 0.05; 2-way ANOVA). The mineral loss and lesion depths of the enamel specimens did not differ significantly after storage in the various solutions (P> 0.05; Bonferroni post hoc test). For the dentin specimens stored in the solution containing mucin/xylit the mineral loss was significantly decreased compared to the other mucin groups as well as to the CMC/xylit solution (P< 0.05; Bonferroni post hoc test).

[The role of COX-2 in dentistry. Past or future?]. / Der Einsatz von COX-2 in der Zahnmedizin. Vergangenheit oder Zukunft?

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used to inhibit cyclooxygenase (COX) activity within the scope of pain and inflammation therapy. Although these pharmaceuticals are effective in the treatment of pain and inflammation, their routine and long-term administration is limited due to their side effects (e.g., gastrointestinal and renal complications, inhibition of platelet aggregation). COX isoenzymes are of great scientific interest, since these drugs are the main targets of NSAIDs. While the inhibition of COX-2 is related to anti-inflammatory effects, the use of COX-1 might be associated with adverse reactions. Therefore, new generation selective COX-2 inhibitors have been developed to reduce possible side effects. Recently, these new anti-inflammatory drugs have been used for the treatment of various inflammatory diseases. At the same time, COX-2 inhibitors appear promising for control of dental pain and for supportive treatment of inflammatory periodontal diseases. The superior analgesic and sustained efficacy, along with the reduced side effects of COX-2 inhibitors (compared to NSAIDs) have been revealed in numerous clinical studies, in particular after oral surgery. Moreover, NSAIDs have been used for periodontal therapy, and evidence from animal experiments and clinical trials has documented that NSAIDs seem to stabilize periodontal conditions by reducing the rate of alveolar bone resorption. This article reviews the use of NSAIDs and COX-2 inhibitors in dental medicine for pain control and periodontal therapy.

Conservative, Surgical, and Prosthetic Treatment of a Patient with a Periapical Lesion Associated with an Atypical Intraoral Sinus Tract.

This report describes a clinical case with an atypical intraoral sinus tract formation from diagnosis and treatment to short-term outcome and definitive prosthetic rehabilitation. In detail, the patient underwent conservative nonsurgical root canal treatment followed by guided bone augmentation of the regions involved in periapical inflammation and sinus tract formation. The removal of the inflammatory source of the lesion as well as the affected tissue clearly led to a healing of the surrounding bone tissues. Subsequently, the tooth was reconstructed using a fibreglass post and a metal-ceramic crown; an implant was successfully placed in the previously inflamed bone region.

Effects of regular and highly fluoridated toothpastes in combination with saliva substitutes on artificial enamel caries lesions differing in mineral content.

OBJECTIVE: For patients with hyposalivation fluorides are supportive to prevent caries lesions. Remineralization of subsurface lesions might be improved by toothpastes containing 5000 µgF(-)/g compared with those having 1400 µgF(-)/g. This could be influenced by the degree of baseline mineralization. Therefore, this in vitro study evaluated the effects of fluoride toothpastes differing in fluoride concentration in combination with de- and remineralizing saliva substitutes using two lesion types. DESIGN: Specimens with shallow (SL; ΔZ (SD): 1915 (543) vol% × µm) or deep lesions (DL; 5804 (427) vol% × µm) were either stored in mineral water [saturation with respect to octacalcium phosphate (S(OCP)): 0.5], demineralizing experimental (Exp, S(OCP): 0.3), demineralizing commercial (Glandosane, S(OCP): 0.3), or remineralizing saliva substitute (modified Saliva natura; S(OCP): 1.9) for five weeks (37 °C). Either one of three brushing procedures was performed additionally three times daily: no brushing, Elmex anticaries toothpaste (E; 1400 µgF(-)/g), Duraphat toothpaste (D; 5000 µgF(-)/g). Mineral parameters before and after storage were evaluated using microradiographs. RESULTS: Storage in Exp as well as Glandosane induced a significant demineralization (p < 0.05; relatively more pronounced in SL than DL). Additional brushing in particular with D reduced these effects. Storage alone in modified Saliva natura remineralized specimens (p < 0.05). CONCLUSIONS: Under the in vitro conditions chosen shallow lesions seem to be more susceptible for demineralization compared with deeper ones when stored in an undersaturated (with respect to OCP) saliva substitute. The highly fluoridated toothpaste seemed to be more beneficial than a regular one.

Mineral distribution of artificial dentinal caries lesions after treatment with fluoride agents in combination with saliva substitutes.

OBJECTIVE: Some saliva substitutes have been shown to demineralize dentine in vitro. This effect is counteracted by the application of various fluorides. In contrast, remineralizing saliva substitutes might be supported by these treatments, depending on the dynamics during remineralization. The aim of this in vitro study was to evaluate the effects of fluoride mouthrinses or gels in combination with de-/remineralizing saliva substitutes on dentinal subsurface lesions. DESIGN: Demineralized bovine dentine specimens were stored either in mineral water [saturation with respect to octacalcium phosphate (S(OCP)): 0.7], Glandosane (G, S(OCP): 0.3) or in a modified saliva substitute Saliva natura (SN, S(OCP): 1.9) for five weeks (37°C). Fluoride agents were applied twice daily for 10 min (n = 15/group): no treatment, Meridol mouthrinse, Elmex sensitive solution, ProSchmelz fluoride gel, Elmex gelée. After storage thin sections were prepared and mineral losses before and after storage were evaluated from microradiographs. RESULTS: Specimens stored in G alone showed significantly higher mineral loss compared to those stored in water, SN or G in combination with any additional treatment (p < 0.05). Storage in SN and treatment with ProSchmelz fluoride gel led to significantly higher remineralization compared to all other groups (p < 0.05) and resulted in distinct mineral gain within the lesion body. CONCLUSIONS: Under the in vitro conditions chosen, use of fluoride agents in combination with a demineralizing saliva substitute resulted in reduced mineral loss. Storage in modified Saliva natura in combination with the application of ProSchmelz fluoride gel induced the most pronounced remineralization also of deeper lesion areas.

Remineralization of bovine enamel subsurface lesions: effects of different calcium-phosphate saturations in buffered aqueous solutions.

OBJECTIVE: To evaluate the remineralizing effects of aqueous phosphate-buffered solutions using various saturations with respect to octacalcium phosphate or brushite (OCP/DCPD) on bovine enamel subsurface lesions. METHOD AND MATERIALS: Demineralized specimens (n=18 per group) were exposed to one of six phosphate-buffered solutions with theoretical OCP saturations of S0.83, S1.17, S1.43, S1.64, S1.83, or S1.99 (pH, 6.3; calcium concentration, 0.53 to 3.18 mM). One aqueous solution without calcium was used as a negative control (S0; pH, 6.3); one without calcium and phosphate was a reference (S; pH, 4.3). HEPES-buffered Buskes solution served as a reference (B2.46; pH, 7.0); a pH-adjusted one was a positive control (B1.21; pH, 6.3). Mineral losses (whole lesion and surface area/inner part of the lesion) before and after storage (2 and 5 weeks, 37 °C) were evaluated from microradiographs. RESULTS: The pH values of all solutions remained stable. Compared to baseline, S0.83 to S1.99 and B2.46 to B1.21 showed significantly increased mineral gains after both storage periods (P<.05, paired t test). S0 showed neutral effects (P=.190), whereas S demineralized the specimens (P<.001). Storage in S1.64, S1.83, and S1.99 revealed no differences compared to B2.46 (P>.997, ANOVA and Tukey), but a mineral gain of S1.64 to S1.99 was significantly increased compared to B1.21 (P<.012). Similar results could be observed for surface areas and inner lesion parts. CONCLUSION: The in vitro conditions chosen revealed that the used phosphate buffer system was suitable to maintain stable pH values. The higher saturated (OCP) solutions S1.64, S1.83, and S1.99 revealed mineral gains comparable to B2.46; thus, saturations of 1.64 (OCP) or 1 (DCPD) might be preferable for remineralization studies.

Enamel and dentine remineralization by nano-hydroxyapatite toothpastes.

OBJECTIVES: This in vitro study evaluated the effects of nano-hydroxyapatite (n-HAp) toothpastes on remineralization of bovine enamel and dentine subsurface lesions. METHODS: Specimens were demineralized, randomly divided into five groups, and exposed to an aqueous remineralizing solution for two and five weeks (37 °C). Brushing procedures were performed with the respective toothpaste/storage solution slurry twice daily (2 × 5 s; total contact time of the slurries 2 × 120s/d): storage in remineralizing solution only (0); additional brushing with B (20 wt% zinc carbonate nano-hydroxyapatite, ZnCO(3)/n-HAp); BS (24 wt% ZnCO(3)/n-HAp); E (0.14 wt% amine fluoride); or A (7 wt% pure n-HAp). Differences in mineral loss (ΔΔZ) before and after storage/treatment were microradiographically evaluated. RESULTS: Dentine groups 0, B, BS, and A showed significantly higher ΔΔZ values compared to E (p < 0.05; ANOVA). Enamel ΔΔZ values of group A were significantly higher compared to group E (p < 0.05), whilst no significant differences of these groups could be observed compared to 0, B, and BS (p > 0.05). CONCLUSIONS: With the in vitro conditions chosen, toothpastes containing n-HAp revealed higher remineralizing effects compared to amine fluoride toothpastes with bovine dentine, and comparable trends were obtained for enamel.

Effect of fluoride gels and mouthrinses in combination with saliva substitutes on demineralised bovine enamel in vitro.

OBJECTIVE: Besides the use of saliva substitutes, patients suffering from hyposalivation are instructed to apply fluoride products to prevent caries. Some saliva substitutes have been shown to demineralise enamel; an effect that might be counteracted by the application of fluoride gels or mouthrinses. Combined use of these products with remineralising or neutral saliva substitutes might result in more pronounced remineralisation. METHODS: Demineralised bovine enamel specimens were either stored in mineral water [W, control; saturation with respect to octacalcium phosphate (S(OCP)): 0.7], an experimental demineralising carboxymethylcellulose (CMC)-based solution (C, S(OCP): 0.3), or in a modified (S(OCP)) saliva substitute [Saliva natura (SN), S(OCP): 1.6] for five weeks (37 degrees C). After two weeks half of the exposed surfaces were nail varnished. The following treatments were applied twice daily for 10min each time (n=14-18/group): 1: no treatment, 2: Meridol mouthrinse, 3: Elmex sensitive mouthrinse, 4: ProSchmelz fluoride gel, and 5: Elmex gelée. Mineral parameters before and after storage were evaluated from microradiographs. RESULTS: Specimens stored in C showed significantly higher mineral loss compared to W and SN (p<0.05; ANOVA). For C additional use of fluorides resulted in less demineralisation (p<0.05) compared to C alone. SN in combination with ProSchmelz led to significantly higher remineralisation compared to all other groups (p<0.05). CONCLUSIONS: Use of fluorides reduces the detrimental effects of the demineralising solution. Treatment with ProSchmelz in combination with storage in a saliva substitute supersaturated with respect to OCP yielded to most pronounced remineralisation under the conditions chosen.

Etiologic factors of hyposalivation and consequences for oral health.

Hyposalivation is represented by a reduced salivary flow rate and can be caused by etiologic factors such as systemic diseases and intake of various medications or by radiotherapy following head and neck cancer. The aim of this review was to compile data about the qualitative and quantitative changes of salivary components during hyposalivation, and to summarize their consequences for oral health. A Medline/PubMed/Scopus search was conducted to identify and summarize articles published in English and German that reported on etiology of hyposalivation and changes in the salivary composition due to hyposalivation of different origins. The search revealed 94 articles, 71 of which were original articles. Apart from the reduction of the salivary flow rate, the quality of saliva is strongly altered because of systemic diseases, medications, and radiotherapy, including increased viscosity and pH shift to more acidic values and changes in salivary protein compositions. Furthermore, hyposalivation may be accompanied by pronounced shifts in specific microbial components, in particular toward a highly acidogenic microflora. Moreover, therapy of hyposalivation is often restricted to palliative treatment (ie, saliva substitutes or gels). To prevent tooth tissue demineralization, clinicians should consider saliva substitutes that are supersaturated with calcium and phosphates and contain fluoride.

Saliva substitute in combination with high-concentrated fluoride toothpaste: effects on demineralised dentin in vitro.

OBJECTIVES: The aim of this in vitro study was to assess the effects of saliva substitutes (modified with respect to calcium, phosphates, and fluorides) in combination with a high-concentrated fluoride toothpaste on demineralised dentin. METHODS: Before and after demineralisation of bovine dentin specimens (subsurface lesions; 37 degrees C, pH 5.0, 5 d), one-quarter of each specimen's surface was covered with nail varnish (control of sound/demineralised tissue). Subsequently, specimens were exposed to original Saliva natura (saturation with respect to octacalciumphosphate [S(OCP)]: 0.03; SN 0), or to three lab-produced Saliva natura modifications (S(OCP): 1, 2, and 3; SN 1-3) for 2 and 5 weeks (37 degrees C). An aqueous solution (S(OCP): 2.5) served as positive control (PC). Two times daily (2min each), Duraphat toothpaste (5000ppmF(-); Colgate)/saliva substitute slurry (ratio 1:3) was applied gently. Differences in mineral losses (DeltaDeltaZ) and lesion depths (DeltaLD) between values before and after exposure were microradiographically evaluated. RESULTS: After both treatment periods specimens immersed in SN 0 revealed significantly higher mineral losses (lower DeltaDeltaZ values) and lesion depths (lower DeltaLD) compared to PC (p<0.05; ANOVA). After 5 weeks, specimens stored in SN 1 and 2 showed significantly higher mineral losses compared to PC (p<0.05), while those stored in SN 3 showed similar results (p>0.05). No differences in mineral loss could be observed between SN 2 and 3 (p>0.05). CONCLUSIONS: Under the conditions of this limited protocol, the combination of Saliva natura solutions slightly saturated with respect to OCP in combination with a high-concentrated fluoride toothpaste enabled remineralisation of dentin in vitro.

Effects of regular and whitening dentifrices on remineralization of bovine enamel in vitro.

OBJECTIVE: To compare in vitro the remineralizing effects of different regular dentifrices and whitening dentifrices (containing pyrophosphates) on predemineralized enamel. METHOD AND MATERIALS: Specimens from 84 bovine incisors were embedded in epoxy resin, partly covered with nail varnish, and demineralized in a lactic acid solution (37 degrees C, pH 5.0, 8 days). Parts of the demineralized areas were covered with nail varnish, and specimens were randomly assigned to 6 groups. Subsequently, specimens were exposed to a remineralizing solution (37 degrees C, pH 7.0, 60 days) and brushed 3 times a day (1:3 slurry with remineralizing solution) with 1 of 3 regular dentifrices designed for anticaries (group 1, amine; group 2, sodium fluoride) or periodontal (group 3, amine/stannous fluoride) purposes or whitening dentifrice containing pyrophosphates (group 4, sodium fluoride). An experimental dentifrice (group 5, without pyrophosphates/fluorides) and a whitening dentifrice (group 6, monofluorophosphate) served as controls. Mineral loss and lesion depths were evaluated from contact microradiographs, and intergroup comparisons were performed using the closed-test procedure (alpha =.05). RESULTS: Compared to baseline, specimens brushed with the dentifrices containing stannous/amine fluorides revealed significant mineral gains and lesion depth reductions (P < .05). Concerning the reacquired mineral, the whitening dentifrice performed worse than the regular dentifrices (P > .05), while mineral gain, as well as lesion depth, reduction was negligible with the control groups. CONCLUSION: Dentifrices containing pyrophosphates perform worse than regular dentifrices but do not necessarily affect remineralization. Unless remineralizing efficacy is proven, whitening dentifrices should be recommended only after deliberate consideration in caries-prone patients.