Effects of silver diamine fluoride on demineralization protection after a secondary acid challenge

Abstract Objective This investigation describes the effects of 5% sodium fluoride varnish and 38% silver diamine fluoride on demineralization protection of human enamel lesions of three different severities after a secondary acid challenge. Study design Specimens underwent color and enamel surface microhardness change measurements after demineralization and treatment events. Transverse microradiography was conducted following the secondary demineralization. Results After treatments, enamel surface microhardness change showed that 24-hour lesions treated with fluoride varnish had less rehardening than 24-hour lesions treated with silver diamine fluoride (p<0.05), whereas 144-hour lesions from both treatment groups showed a beneficial decrease in surface microhardness change that was markedly better in samples treated with silver diamine fluoride (p<0.05). After the secondary demineralization, 24- and 144-hour lesions treated with silver diamine fluoride showed a sustained beneficial decrease in enamel surface microhardness change when compared to fluoride varnish-treated samples of the corresponding lesion severity (p<0.05). Transverse microradiography showed no difference between fluoride varnish- and silver diamine fluoride-treated samples of any corresponding lesion severity, indicating that remineralization in both fluoride varnish- and silver diamine fluoride-treated samples was proportional to each other after a secondary acid challenge. Conclusions Using silver diamine fluoride may have comparable benefits to fluoride varnish in mineral loss prevention.

Study on the remineralization of demineralized enamel surfaces with glycine-guided carboxymethyl chitosan/amorphous calcium phosphate / 口腔疾病防治

Objective@#To explore effect on the remineralization of demineralized enamel surfaces with glycine-guided carboxymethyl chitosan (CMC)/amorphous calcium phosphate (ACP).@*Methods@# Remineralized solultion at different stages were prepared: ①reactive CMC/ACP (CMC/ACP nanoparticles treated with NaClO), ②reactive CMC/ACP+glycine; transmission electron microscopy was used to detect the morphology of the remineralized solution particles. Twenty teeth were randomly divided into two groups: group A and group B. Reactive CMC/ACP was applied to the enamel surface of group A and group B was treated with reactive CMC/ACP remineralization solution containing glycine. Scanning electron microscopy was used to detect the enamel surface morphology before and after remineralization, and nanoindentation was used to detect the mechanical strength (including nanoindentation depth, hardness and elastic modulus) of the enamel surface.@*Results@#Under a transmission electron microscope, the particles in the reactive CMC/ACP remineralization solution were smooth, and the increase in particle size was approximately 100-300 nm. After the addition of glycine, the particles in the reactive CMC/ACP remineralization solution particles showed a linear ordered arrangement, and microcrystals were formed in the solution 15 min later, with a crystal length of approximately 5-15 μm. Remineralization in group A was granular and heterogeneous. In group B, the crystal morphology of the demineralized enamel was homogeneous and ordered, similar to that of natural enamel. The nanoindentation depth of group B after remineralization was smaller than that of group A, and it was closest to that of natural enamel, there was no significant difference between group B and natural enamel in terms of the hardness and elastic modulus of the enamel surface after remineralization.@*Conclusion@# CMC/ACP nanoparticles treated with NaClO can rapidly and specifically form directional and ordered remineralization on the enamel surface of a model of glycine-guided rapid remineralization of enamel caries. The surface structure of remineralized enamel is similar to that of natural enamel in terms of nanoindentation depth, hardness and elastic modulus.

Remineralizing potential of CPP-ACP in white spot lesions – A systematic review

The aim of this systematic review was to assess the long term remineralizing potential of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) only in paste form compared with fluoride varnish, and or placebo in both naturally occurring and post-orthodontic white spot lesions in vivo. Data Sources: The literature search covered the electronic databases: PubMed and Google scholar from 2005-2016. Only articles published in English were included. Randomized control trials in which CPP-ACP delivered by paste form were included. All studies which met inclusion criteria underwent two independent reviews. Study Selection: Two ninety five articles were identified from the search after excluding duplications. Abstracts of forty one articles were reviewed independently. Twenty nine articles were excluded after reading abstract. Full text articles were retrieved for fifteen relevant studies. After reviewing articles independently, three articles were excluded after full text reading. Finally twelve studies were selected based on the eligibility criteria. The remineralizing effect of CPP-ACP were compared with placebo and fluoridated toothpaste and fluoride varnish in randomized control trial. Conclusion: A high level evidence of remineralizing potential of CPP-ACP on naturally occurring white spot lesion and WSL post orthodontic treatment was found in comparison with placebo/fluoridated toothpaste and fluoride varnish without any statistically significant difference. Well-designed RCTs are, therefore, required to improve the level of evidence in this area.

Effect of Myracrodruon urundeuva and Qualea grandiflora extracts on viability and activity of microcosm biofilm and prevention of enamel demineralization in vitro / Efeito de extratos de Myracrodruon urundeuva All. e Qualea grandiflora Mart. sobre a viabilidade e atividade de biofilme microcosmo e na prevenção da desmineralização do esmalte in vitro

The objective of this study was to evaluate the antimicrobial and anti-caries effects of two plant extracts. The first chapter dealt with a review of the literature whose objective was to discuss the antimicrobial potential of Brazilian natural agents on the biofilm related to dental caries and gingivitis/periodontal disease. The research of the articles was carried out using PubMed. We found a total of 23 papers. Most of the studies were performed using planktonic microorganisms or under clinical trials. Nineteen articles were focused on cariogenic bacteria. From these nineteen articles, eleven were also about periodontopathogenic bacteria. Four studies addressed only periodontopathogenic bacteria. The most tested Brazilian natural agents were green propolis, essential oils of Lippia sidoides and Copaifera sp. Most of the tested agents showed similar results when compared to positive control (essential oils and extracts) or better effect than negative control (green propolis). More studies involving protocols closer to the clinical condition and the use of response variables that allows understanding the mechanism of action of natural agents are necessary before the incorporation of these natural agents into dental products. The second chapter aimed to test the effect of the hydroalcoholic extracts of Myracrodruon urundeuva All. and Qualea grandiflora Mart. leaves on the viability of the microcosm biofilm and on the prevention of enamel demineralization. The microcosm biofilm was produced on bovine enamel, using human saliva pool mixed with McBain saliva (0.2% sucrose) for 14 days. The biofilm was treated daily with the extracts for 1 min. M. urundeuva at 100, 10 and 0.1 µg/ml and Q. grandiflora at 100 and 0.1 µg/ml reduced cell viability similarly to the positive control and significantly more than negative control. M. urundeuva at 1000, 100 and 0.1 µg/ml were able to reduce the counting formation unit-CFU counting of lactobacilli sp. and Streptococcus mutans, while Q. grandiflora at 1000 and 1.0 µg/ml significantly reduced the S. mutans CFU counting. On the other hand, the natural extracts did not reduce the production of extracellular polyssacharides, lactic acid and the development of enamel caries lesions. The third chapter aimed to evaluate the effect of hydroalcoholic extracts of M. urundeuva and Q. grandiflora (alone or combined) on the viability of S. mutans biofilm and the prevention of enamel demineralization. S. mutans strain (ATCC 21175) was reactivated in BHI broth. Minimum inhibitory concentration, minimum bactericidal concentration, minimum biofilm inhibitory concentration and minimum biofilm eradication concentration were determined to choose the concentrations to be tested under the biofilm model. S. mutans biofilm (5x105 CFU/ml) was produced on bovine enamel using McBain saliva with 0.2% sucrose for 3 days. The biofilm was treated daily with the extracts for 1 min. M. urundeuva (isolated or combined) at concentrations equal or higher than 0.625 mg/ml was able to reduce the bacteria viability, whereas Q. grandiflora extract alone showed antimicrobial effect at 5 mg/ml only (p<0.05). On the other hand, none of the extracts was able to reduce the development of enamel caries lesions. Despite the tested natural extracts have antimicrobial effect; they are unable to prevent caries in enamel.(AU)

O objetivo foi avaliar os efeitos antimicrobiano e anti-cárie de dois extratos de plantas. O primeiro capítulo se referiu a uma revisão da literatura cujo objetivo foi discutir o potencial antimicrobiano dos agentes naturais brasileiros sobre o biofilme relacionado à cárie dentária e à gengivite/doença periodontal. A pesquisa dos artigos foi realizada usando o PubMed. Foram encontrados 23 trabalhos. A maioria dos estudos foi realizada utilizando microorganismos na fase planctônica ou ensaios clínicos. Dezenove artigos foram focados em bactérias cariogênicas. Dos dezenove artigos, onze também eram sobre bactérias periodontopatogênicas. Quatro estudos abordaram apenas bactérias periodontopatogênicas. Os agentes naturais brasileiros mais testados foram própolis verde, óleos essenciais de Lippia sidoides e Copaifera sp. Os agentes testados apresentaram resultados similares quando comparados ao controle positivo (óleos essenciais e extratos) ou melhor efeito que o controle negativo (própolis verde). Mais estudos próximos da condição clínica e o uso de variáveis de resposta que permitam entender o mecanismo de ação são necessários, para permitir a incorporação desses agentes naturais em produtos odontológicos. O segundo capítulo teve como objetivo testar o efeito dos extratos hidroalcoólicos de Myracrodruon urundeuva All. e Qualea grandiflora Mart. sobre a viabilidade do biofilme microcosmo e na prevenção da desmineralização do esmalte. O biofilme microcosmo foi produzido em esmalte bovino, utilizando pool de saliva humana misturada à saliva de McBain (0,2% de sacarose) durante 14 dias. O biofilme foi tratado diariamente com os extratos durante 1 min. M. urundeuva a 100, 10 e 0,1 µg/ml e Q. grandiflora a 100 e 0,1 µg/ml reduziram a viabilidade dos microrganismos de forma semelhante ao controle positivo e significativamente maior do que o controle negativo. M. urundeuva a 1000, 100 e 0,1 µg/ml foi capaz de reduzir a contagem de Unidade formadora de colônia-UFC para Lactobacilos totais e Streptococcus mutans, enquanto a Q. grandiflora a 1000 e 1,0 µg/ml reduziu significativamente a contagem de UFC para S. mutans. Os extratos naturais não conseguiram reduzir a produção de polissacarídeos extracelulares-PEC, ácido lático e o desenvolvimento da lesão cariosa em esmalte. O terceiro capítulo teve como objetivo avaliar o efeito dos extratos hidroalcoólicos de M. urundeuva. e Q. grandiflora (sozinhos ou combinados) sobre a viabilidade do biofilme de S. mutans e na prevenção da desmineralização do esmalte. Cepa de S. mutans (ATCC 21175) foi reativada em caldo BHI. Concentração inibitória mínima, concentração bactericida mínima, concentração inibitória mínima de biofilme e concentração de erradicação mínima de biofilme foram determinadas para escolher as concentrações a serem testadas sob o modelo de biofilme. O biofilme de S. mutans (5x105 CFU/ml) foi produzido em esmalte bovino, utilizando saliva de McBain com 0,2% de sacarose durante 3 dias. O biofilme foi tratado diariamente com os extratos durante 1 min. M. urundeuva (isolada ou combinada) nas concentrações iguais ou superiores a 0,625 mg/ml foi capaz de reduzir a viabilidade das bactérias, enquanto que o extrato da Q. grandflora apresentou efeito antimicrobiano somente a 5 mg/ml (p<0,05). Nenhum dos extratos reduziu o desenvolvimento da lesão da cárie. Apesar dos extratos naturais terem efeito antimicrobiano, são incapazes de prevenir o desenvolvimento da lesão cariosa em esmalte.(AU)

Analysis of the antimicrobial and anti-caries effects of TiF4 varnish under microcosm biofilm formed on enamel

Abstract Titanium tetrafluoride (TiF4) is known for interacting with enamel reducing demineralization. However, no information is available about its potential antimicrobial effect. Objectives This study evaluated the antimicrobial and anti-caries potential of TiF4 varnish compared to NaF varnish, chlorhexidine gel (positive control), placebo varnish and untreated (negative controls) using a dental microcosm biofilm model. Material and Methods A microcosm biofilm was produced on bovine enamel previously treated with the varnishes, using inoculum from human saliva mixed with McBain saliva, under 0.2% sucrose exposure, for 14 days. All experiments were performed in biological triplicate (n=4/group in each experiment). Factors evaluated were: bacterial viability (% dead and live bacteria); CFU counting (log10 CFU/mL); and enamel demineralization (transverse microradiography - TMR). Data were analysed using ANOVA/Tukey's test or Kruskal-Wallis/Dunn's test (p<0.05). Results Only chlorhexidine significantly increased the number of dead bacteria (68.8±13.1% dead bacteria) compared to untreated control (48.9±16.1% dead bacteria). No treatment reduced the CFU counting (total microorganism and total streptococci) compared to the negative controls. Only TiF4 was able to reduce enamel demineralization (ΔZ 1110.7±803.2 vol% μm) compared to both negative controls (untreated: ΔZ 4455.3±1176.4 vol% μm). Conclusions TiF4 varnish has no relevant antimicrobial effect. Nevertheless, TiF4 varnish was effective in reducing enamel demineralization under this model.

Study on application of natural medicine epigallocatechin gallate for primary enamel caries remineralization / 口腔疾病防治

Objective@#This in vitro study aimed to investigate the remineralization effect of the natural medicine epigallocatechin gallate on artificial enamel caries in primary human teeth. @*Methods @#We divided 30 sound primary upper anterior teeth into 3 groups according to a random number table, including experimental group (epigallocatechin gallate group), positive control group (NaF group) and blank control group (artificial saliva group), with 10 teeth in each group. After test in vitro, Micro Hardness Tester was applied to measure hardness of samples before and after demineralization. Scanning electron microscopy (SEM) was used to observe the result of primary enamel surface remineralization. @*Results@# A significant increase in enamel surface microhardness between the three groups after remineralization (F=1 199.975, P < 0.05). The difference between 2 groups was compared with each other among 3 groups. Statistical significance was found (vs experimental group q=41.986, P < 0.05; vs positive control group q=68.174, P < 0.05), suggesting that both positive control group and experimental group could promote the remineralization of primary enamel, and the effect of epigallocatechin gallate was weaker than NaF (q=26.188, P < 0.05 ). The results from SEM indicated that there was large amount of sediment on the surface of primary enamel surface of incisors in the experimental group and positive control group, while primary enamel surface of incisors in the blank control group was honeycomb and uneven, with less sediment. @*Conclusion@#Based on this in vitro study, epigallocatechin gallate can promote the remineralization of demineralized enamel of primary teeth, indicating its potential use as a natural remineralization medicine.

Remineralisation effect of 1,500 ppm fluoride-containing toothpaste in enamel early caries lesion / 대한구강보건학회지

OBJECTIVES: We compared the effects of a 1,500 ppm fluoride-containing toothpaste and a 1,000 ppm fluoride-containing toothpaste, which were revised up to the recent revision, and evaluated their effects on the tooth surface after adding bamboo salt to the preparations. METHODS: Experimental early artificial caries specimens were subjected to one of four treatments (n=12 per treatment group): 1,500 ppm NaF, 2% bamboo salt+1,000 ppm NaF, 1,000 ppm NaF, and control treatment. The specimens were exposed to the experimental toothpaste, artificial saliva, and demineralized solution. The treated specimens were analyzed using Vickers surface hardness testing, scanning electron microscopy, and atomic force microscopy. RESULTS: The toothpaste with a high fluoride concentration (1,500 ppm NaF) showed more remineralization than did the toothpaste with a low fluoride concentration (1,000 ppm NaF). The 2% bamboo salt+1,000 ppm NaF group showed remineralization similar to the 1,500 ppm NaF group and higher surface microhardness than the 1,000 ppm NaF group. CONCLUSIONS: Toothpastes containing 1,500 ppm NaF have a higher preventive effect against dental caries than do toothpastes containing 1,000 ppm NaF. The addition of bamboo salt to fluoride-containing dentifrices improves their effectiveness in preventing dental caries.

Optimizing concentration of bioactive glass that promotes early enamel caries remineralization / 天津医药

Objective To explore the optimum concentration of bioactive glass that promotes early enamel caries remineralization. Methods Fresh bovine incisors were selected and used for enamel specimen preparation. All specimens were randomly divided into two groups:micro hardness group and fluorescence group. Both groups were further divided into 3%, 6%and 9%groups. These specimens were placed in containers with demineralization liquid at 37℃for 72 hours. Then they were treat with 3%, 6%and 9%bioactive glass solution respectively twice a day for 5 minutes each. Samples in all three groups were dipped circularly into an artificial demineralization solution and an artificial saliva solution for 15 days. The mi?crohardness of enamel surface was measured before and after demineralization and remineralization. The different value of microhardness before and after remineralization was calculated. The thickness of fluorescence beneath the surface of early enamel caries was observed to evaluate the extend of remineralization effect. Results The difference in value of micro hard?ness in 6%group was the highest while that in 3%group was the lowest. The differences were significant. The difference in value of demineralization depth in 6%group was greater than those in 3%and 9%groups (P<0.05). There was no statistical?ly significance between those in 3%group and 9%group. Conclution The optimum concentration of bioactive glass solu?tion that promotes the remineralization of early enamel caries is 6%, which is ideal for remineralization of early enamel caries.

The remineralization effect of topical fluoride agents on artificial enamel caries / 대한구강보건학회지

OBJECTIVES: The aim of this study was to compare the remineralization effect of the topical fluoride agents on artificial enamel caries, under the chemical pH cycling model, using surface microhardness. METHODS: Bovine enamel specimens, embedded in acrylic resin with the labial surfaces exposed, were developed artificial enamel caries. Thereafter, this study used 56 samples on VHN 25-45. The experimental groups were divided into 4 groups: control, 2% NaF solution, 1.23% APF gel, 5% NaF varnish. Samples, except in the control group, were applied to each topical fluoride agent for 4 minutes. All groups were exposed to a pH cycling model, which consisted of demineralization (4 hours) and remineralization (20 hours) for 17 days. The Vickers surface microhardness number (VHN) was measured, using the microhardness tester. The results were analyzed, using a repeated measures analysis of variance of a general linear model, and compared the baseline, each day, using a contrast analysis (simple) about within a subject factor at a significance level of 0.05. RESULTS: Result of a repeated measures analysis regarding the surface microhardness of topical fluoride agents, there were significant differences at P-values of within and between the subject factor (P0.05). CONCLUSIONS: In this study, although there were significant differences at P-values of within and between the subject factor, there were no significant differences between the experiment groups on chemical pH cycling model in vitro, and it was limited to utilize this result in a clinical situation of the fluoride application.

Quantitative analysis of optical coherence tomography images for early natural enamel caries / 国际生物医学工程杂志

Objective Quantitative analysis of optical coherence tomography (OCT) images of naturally occurred early enamel caries was performed to find quantitative parameter indicator for detecting early caries by OCT.Methods Three human premolars with enamel natural caries in D0,D1,and D2 stages were selected respectively and scanned by OCT.The ratios of the average gray value of the caries region (object region) and sound region (background region),namely,the object-background contrast (OBC) were calculated in OCT images and selected as the quantitative parameters to analyze the OBC trend of different degree of enamel caries.Results Within the fixed depth,the OBC value showed a trend of first increase and then decrease with the severity of dental caries,indicating that OBC value increased with the severity of dental caries from normal to D1 stage,and then decreased from D1 to D2 stage.Conclusion The OBC value can be used as a new quantitative indicator for OCT to estimate the severity of naturally occurred early caries.

Effects of Rhubarb Extract on Calcium Dissolved Quantity in Demineralized Enamel / 国际中医中药杂志

Objective To observe effects of rhubarb extract on Ca dissolved quantity in demineralized enmnel. Methods Demineralization was performed after treating tooth facing with rhubarb extract of different concentrations and deionized water. The concentration of Ca was detected by ASCA biochemical analyzer after demineralization. Results Dissolved quantity of demineralized Ca in the rhubarb extract group (2 mg/ml, 4mg/ml) was significantly lower than that of the deionized water group (P<0.01) and the rhubarb extract group (1 mg/ml) (P<0.05), but higher than that of 2% sodium fluoride group (P>0.05). Dissolved quantity of demineralized Ca in the rhubarb extract (1 mg/ml) group was significantly higher thanthat of 2% sodium fluoride group (P<0.01), but lower than that of the deionized water group(P>0.05).Conclusion The rhubarb exwact (2mg/ml, 4mg/ml) can inhibit Ca dissolution in demineralized enamel.The inidal effective concentration of rhubarb extract is 2 mg/ml.

In vivo quantitative analysis of remineralization effect of remineralization solution "R" of incipient enamel dental caries / 대한치과보존학회지

Dental caries is a chronic disease that causes the destruction of tooth structure by the interaction of plaque bacteria, food debris, and saliva. There has been attempts to induce remineralization by supersaturating the intra-oral environment around the surface enamel, where there is incipient caries. In this study, supersaturated remineralized solution "R" was applied to specimens with incipient enamel caries, and the quantitative ananlysis of remineralization was evaluated using microradiography. Thirty subjects volunteered to participate in this study. Removable appliances were constructed for the subjects, and the enamel specimen with incipient caries were embedded in the appliances. The subjects wore the intra-oral appliance for 15 days except while eating and sleeping. The removable appliance were soaked in supersaturated solution "R", saline, or Senstime(R) to expose the specimen to those solutions three times a day, 5 minutes each time. After 15 days, microradiography was retaken to compare and evaluate remineralization. The results were as the following: 1. The ratio of remineralized area to demineralized area was significantly higher in the supersaturated solution "R" and Senstime(R) than in the saline. (p<0.05) 2. Remineralization in the supersaturated buffer solution "R" occurred in the significantly deeper parts of the tooth, compared to the Senstime(R) group containing high concentration of fluoride.(p<0.05) As in the above results, the remineralization effect of remineralized buffer solution "R" on incipient enamel caries has been proven. For clinical utilization, further studies on soft tissue reaction and the effect on dentin and cementum are necessary. In conclusion compared to commercially available fluoride solution, remineralization solution "R" showed better remineralization effect on early enamel caries lesion, so it is considered as effecient solution for clinical application.