Effect of fluoride gels with nano-sized sodium trimetaphosphate on the in vitro remineralization of caries lesions.

OBJECTIVE: To evaluate the effects of fluoride (F) gels supplemented with micrometric or nano-sized sodium trimetaphosphate (TMPmicro and TMPnano, respectively) on the in vitro remineralization of caries-like lesions. METHODOLOGY: Bovine enamel subsurface lesions (n=168) were selected according to their surface hardness (SH) and randomly divided into seven groups (n=24/group): Placebo (without F/TMP), 4,500 ppm F (4500F), 4500F + 2.5% TMPnano (2.5% Nano), 4500F + 5% TMPnano (5% Nano), 4500F + 5% TMPmicro (5% Micro), 9,000 ppm F (9000F), and 12,300 ppm F (Acid gel). The gels were applied in a thin layer for one minute. Half of the blocks were subjected to pH cycling for six days, whereas the remaining specimens were used for loosely- (calcium fluoride; CaF2) and firmly-bound (fluorapatite; FA) fluoride analysis. The percentage of surface hardness recovery (%SHR), area of subsurface lesion (ΔKHN), CaF2, FA, calcium (Ca), and phosphorus (P) on/in enamel were determined. Data (log10-transformed) were subjected to ANOVA and the Student-Newman-Keuls' test (p<0.05). RESULTS: We observed a dose-response relation between F concentrations in the gels without TMP for %SHR and ΔKHN. The 2.5% Nano and 5% Micro reached similar %SHR when compared with 9000F and Acid gels. For ΔKHN, Placebo and 5% Nano gels had the highest values, and 5% Micro, 2.5% Nano, 9000F, and Acid gels, the lowest. All groups had similar retained CaF2 values, except for Placebo and Acid gel. We verified observed an increase in Ca concentrations in nano-sized TMP groups. Regarding P, TMP groups showed similar formation and retention to 9000F and Acid. CONCLUSION: Adding 2.5% nano-sized or 5% micrometric TMP to low-fluoride gels lead to enhanced in vitro remineralization of artificial caries lesions.

Effect of fluoride gels with nano-sized sodium trimetaphosphate on the in vitro remineralization of caries lesions

Abstract Objective To evaluate the effects of fluoride (F) gels supplemented with micrometric or nano-sized sodium trimetaphosphate (TMPmicro and TMPnano, respectively) on the in vitro remineralization of caries-like lesions. Methodology Bovine enamel subsurface lesions (n=168) were selected according to their surface hardness (SH) and randomly divided into seven groups (n=24/group): Placebo (without F/TMP), 4,500 ppm F (4500F), 4500F + 2.5% TMPnano (2.5% Nano), 4500F + 5% TMPnano (5% Nano), 4500F + 5% TMPmicro (5% Micro), 9,000 ppm F (9000F), and 12,300 ppm F (Acid gel). The gels were applied in a thin layer for one minute. Half of the blocks were subjected to pH cycling for six days, whereas the remaining specimens were used for loosely- (calcium fluoride; CaF2) and firmly-bound (fluorapatite; FA) fluoride analysis. The percentage of surface hardness recovery (%SHR), area of subsurface lesion (ΔKHN), CaF2, FA, calcium (Ca), and phosphorus (P) on/in enamel were determined. Data (log10-transformed) were subjected to ANOVA and the Student-Newman-Keuls' test (p<0.05). Results We observed a dose-response relation between F concentrations in the gels without TMP for %SHR and ΔKHN. The 2.5% Nano and 5% Micro reached similar %SHR when compared with 9000F and Acid gels. For ΔKHN, Placebo and 5% Nano gels had the highest values, and 5% Micro, 2.5% Nano, 9000F, and Acid gels, the lowest. All groups had similar retained CaF2 values, except for Placebo and Acid gel. We verified observed an increase in Ca concentrations in nano-sized TMP groups. Regarding P, TMP groups showed similar formation and retention to 9000F and Acid. Conclusion Adding 2.5% nano-sized or 5% micrometric TMP to low-fluoride gels lead to enhanced in vitro remineralization of artificial caries lesions.

Consensus Report of the European Federation of Conservative Dentistry: Erosive tooth wear – diagnosis and management.

OBJECTIVE: Due to an increased focus on erosive tooth wear (ETW), the European Federation of Conservative Dentistry (EFCD) considered ETW as a relevant topic for generating this consensus report. MATERIALS AND METHODS: This report is based on a compilation of the scientific literature, an expert conference, and the approval by the General Assembly of EFCD. RESULTS: ETW is a chemical-mechanical process resulting in a cumulative loss of hard dental tissue not caused by bacteria, and it is characterized by loss of the natural surface morphology and contour of the teeth. A suitable index for classification of ETW is the basic erosive wear examination (BEWE). Regarding the etiology, patient-related factors include the predisposition to erosion, reflux, vomiting, drinking and eating habits, as well as medications and dietary supplements. Nutritional factors relate to the composition of foods and beverages, e.g., with low pH and high buffer capacity (major risk factors), and calcium concentration (major protective factor). Occupational factors are exposition of workers to acidic liquids or vapors. Preventive management of ETWaims at reducing or stopping the progression of the lesions. Restorative management aims at reducing symptoms of pain and dentine hypersensitivity, or to restore esthetic and function, but it should only be used in conjunction with preventive strategies. CONCLUSIONS: Effective management of ETW includes screening for early signs of ETW and evaluating all etiological factors. CLINICAL RELEVANCE: ETW is a clinical condition, which calls for the increased attention of the dental community and is a challenge for the cooperation with other medical specialities.

Colour improvement and stability of white spot lesions following infiltration, micro-abrasion, or fluoride treatments in vitro.

SUMMARY BACKGROUND/OBJECTIVES: White spot lesions (WSLs) are unwelcome side effects of fixed appliances that compromise the treatment outcome. Recently, infiltration of WSLs has been introduced as a viable treatment alternative. The objective was to evaluate the colour improvement of WSLs and their stability against discolouration following infiltration, fluoride, or micro-abrasion treatments in vitro. MATERIALS/METHODS: Artificial WSLs were created in bovine enamel (N = 96) using acidic buffer solution (pH 5, 10 days) and were randomly allocated to four groups. Specimens were treated with infiltration (Icon, DMG), fluoride (Elmex Caries Protection, GABA), and micro-abrasion (Opalustre, Ultradent) or remained untreated (control). Groups were discoloured for 24 hours in tea or tea + citric acid. Colour components and visible colour change (L*, a*, b*, ΔE) were measured spectrophotometrically on following time points: baseline, after WSL formation, after treatment, and during discolouration (8, 16, and 24 hours). Data were analysed using Kruskal-Wallis and Mann-Whitney tests. RESULTS: WSL formation increased (L*) in all groups. Only infiltration reduced this effect to baseline. Highest ΔE improvement was obtained by infiltration and micro-abrasion followed by fluoride. This improvement was stable only for infiltration during discolouration. L*, a*, and b* changed significantly during discolouration in all groups except infiltration. Within the same treatment group, discolouration solutions did not differ significantly. LIMITATIONS: In vitro testing cannot replicate the actual mode of colour improvement or stability but can be used for ranking materials and techniques. CONCLUSIONS/IMPLICATIONS: Infiltration and micro-abrasion treatments were capable of diminishing the whitish appearance of WSLs. Only infiltrated WSLs were stable following discolouration challenge.

Screening of CO(2) laser (10.6 µm) parameters for prevention of enamel erosion.

OBJECTIVE: The aim of this study was to screen CO(2) laser (10.6 µm) parameters to increase enamel resistance to a continuous-flow erosive challenge. BACKGROUND DATA: A new clinical CO(2) laser providing pulses of hundreds of microseconds, a range known to increase tooth acid-resistance, has been introduced in the market. METHODS: Different laser parameters were tested in 12 groups (n=20) with varying fluences from 0.1 to 0.9 J/cm(2), pulse durations from 80 to 400 µs and repetition rates from 180 to 700 Hz. Non-lased samples (n=30) served as controls. All samples were eroded by exposure to hydrochloric acid (pH 2.6) under continuous acid flow (60 µL/min). Calcium and phosphate release into acid was monitored colorimetrically at 30 sec intervals up to 5 min and at 1 min intervals up to a total erosion time of 15 min. Scanning electron microscopic (SEM) analysis was performed in lased samples (n=3). Data were statistically analysed by one-way ANOVA (p<0.05) and Dunnett's post-hoc tests. RESULTS: Calcium and phosphate release were significantly reduced by a maximum of 20% over time in samples irradiated with 0.4 J/cm(2) (200µs) at 450 Hz. Short-time reduction of calcium loss (≤1.5 min) could be also achieved by irradiation with 0.7 J/cm(2) (300µs) at 200 and 300 Hz. Both parameters revealed surface modification. CONCLUSIONS: A set of CO(2) laser parameters was found that could significantly reduce enamel mineral loss (20%) under in vitro erosive conditions. However, as all parameters also caused surface cracking, they are not recommended for clinical use.

Influence of chemical activation of a 35% hydrogen peroxide bleaching gel on its penetration and efficacy--in vitro study.

OBJECTIVES: The aim of this study was to evaluate the effects of chemical activation of hydrogen peroxide (HP) gel on colour changes and penetration through the tooth structure. METHODS: One hundred and four bovine incisors were used. One dentine (CD) disc and one enamel-dentine (ED) disc were prepared from each tooth. They were positioned over artificial pulpal chambers and the bleaching was performed with an experimental 35% HP gel. Two control and six experimental groups were prepared. In the positive control group (PC) no chemical activator was used. In the negative control group (NC) the specimens did not receive any bleaching. Each experimental group received a different chemical activator (manganese gluconate-MG; manganese chlorite-MC; ferrous sulphate-FS; ferrous chlorite-FC; and mulberries root extract-MRE). After the bleaching procedure a sample of solution was collected from the artificial pulpal chamber and the HP concentration was measured. The data were analysed using ANOVA, Tukey's, and Dunnett's tests. RESULTS: The groups MG and FS showed a significantly lower penetration of HP than the PC group. For the parameter Delta E, all the groups, with the exception of the group MRE, showed a significantly higher means in relation to the PC group in ED colour. For dentine colour, just the groups MG and FS had significant differences in relation to PC. CONCLUSIONS: The addition of MG and FS decreases the penetration of HP. The chemical activation using metal salts tested was effective in increasing the bleaching effect.

The erosive potential of 1% citric acid supplemented by different minerals: an in vitro study.

PURPOSE: The objective of the present in vitro study was to evaluate the effect of different minerals in combination with 1% citric acid on dental erosion. MATERIALS AND METHODS: Ninety enamel samples were randomly allocated to nine groups (G1: pure 1% citric acid solution [control]; G2: with 1 mM Ca; G3: with 0.047 mM F; G4: with 1 mM Fe; G5: with 1 mM P; G6: with 1 mM Ca and 0.047 mM F; G7: with 1 mM Ca and 1 mM P; G8: with 1 mM Fe and 0.047 mM F; G9: with 1 mM Ca, 1 mM P, 0.047 mM F and 1.0 mM Fe). The samples were subjected to six pH cycles, each consisting of immersion in pure or modified 1% citric acid (1 min) followed by storage in artificial saliva (59 min). Enamel wear was assessed using profilometry. RESULTS: Data were analysed using analysis of variance and Tukey test (P < 0.05). Enamel loss (mean + or - SD) amounted to between 0.87 + or - 0.30 and 1.74 + or - 0.74 microm but did not significantly differ among the groups. CONCLUSIONS: The modification of 1% citric acid with different minerals did not have a protective effect on enamel erosion.

Chlorhexidine and green tea extract reduce dentin erosion and abrasion in situ.

OBJECTIVES: This in situ/ex vivo study aimed to analyse the impact of possible MMP-inhibitors (chlorhexidine and green tea extract) on dentin wear induced by erosion or erosion plus abrasion. METHODS: Twelve volunteers took part in this cross-over and double-blind study performed in 4 phases of each 5 days. Bovine dentin samples were worn in palatal appliances and subjected to extraoral erosion (4 times/day, Coca-Cola, 5 min) or erosion plus abrasion (2 times/day, fluoride-free toothpaste and electrical toothbrush, 15s/sample). Immediately after each erosion, the appliances were reinserted in the mouth and the oral cavity was rinsed for 60s with: 250 ppm F solution (SnF(2)/AmF, pH 4.5, Meridol-Gaba, Switzerland), 0.12% chlorhexidine digluconate (0.06% chlorhexidine, pH 6.0, Periogard-Colgate, Brazil), 0.61% green tea extract solution (OM24, 100% Camellia Sinensis leaf extract, catechin concentration: 30+/-3%, pH 7.0, Omnimedica, Switzerland) or deionized water (pH 6.0, control). Dentin loss was assessed by profilometry (microm). The data were analysed by two-way repeated measures ANOVA and Bonferroni post hoc test. RESULTS: There was a significant difference between the conditions (EroxEro+Abr, p<0.001) and among the solutions (p<0.001). All solutions (F: 1.42+/-0.34; 1.73+/-0.50, chlorhexidine: 1.15+/-0.26; 1.59+/-0.32, green tea: 1.06+/-0.30; 1.54+/-0.55) significantly reduced the dentin wear when compared to control (2.00+/-0.55; 2.41+/-0.83) for both conditions. There were not significant differences among green tea extract, chlorhexidine and F solutions. CONCLUSIONS: Thus, the possible MMP-inhibitors tested in this study seem to be a promising preventive measure to reduce dentin erosion-abrasion, but their mechanism of action needs to be investigated in further studies.

TiF(4) and NaF at pH 1.2 but not at pH 3.5 are able to reduce dentin erosion.

OBJECTIVE: This study aimed to analyse and compare the protective effect of buffered (pH 3.5) and native (pH 1.2) TiF(4) in comparison to NaF solutions of same pH on dentin erosion. DESIGN: Bovine samples were pretreated with 1.50% TiF(4) or 2.02% NaF (both 0.48M F) solutions, each with a pH of 1.2 and 3.5. The control group received no fluoride pretreatment. Ten samples in each group were eroded with HCl (pH 2.6) for 10x60s. Erosion was analysed by determination of calcium release into the acid. Additionally, the surface and the elemental surface composition were examined by scanning electron microscopy (two samples in each group) and X-ray energy-dispersive spectroscopy in fluoridated but not eroded samples (six samples in each group). Cumulative calcium release (nmol/mm(2)) was statistically analysed by repeated measures ANOVA and one-way ANOVA at t=10min. RESULTS: TiF(4) and NaF at pH 1.2 decreased calcium release significantly, while TiF(4) and NaF at pH 3.5 were not effective. Samples treated with TiF(4) at pH 1.2 showed a significant increase of Ti, while NaF pretreatment increased F concentration significantly. TiF(4) at pH 1.2 led to the formation of globular precipitates occluding dentinal tubules, which could not be observed on samples treated with TiF(4) at pH 3.5. NaF at pH 1.2 but not at pH 3.5 induced the formation of surface precipitates covering dentinal tubules. CONCLUSION: Dentin erosion can be significantly reduced by TiF(4) and NaF at pH 1.2, but not at pH 3.5.

Light cola drink is less erosive than the regular one: an in situ/ex vivo study.

OBJECTIVE: This in situ/ex vivo study assessed the erosive potential of a light cola drink when compared to a regular one. METHODS: During 2 experimental 14-days crossover phases, eight volunteers wore palatal devices with 2 human enamel blocks. The groups under study were: group light, erosive challenge with light cola drink and group regular, erosive challenge with regular cola drink. During 14 days, erosive challenges were performed extraorally 3X/day. In each challenge, the device was immersed in 150ml of light cola (group light) or regular cola (group regular) for 5min. Erosion was analysed by surface profilometry (microm) and surface microhardness change (%SMH). The data were statistically analyzed using paired t test (p<0.05). RESULTS: Group light (0.6+/-0.2microm) showed significantly lesser wear than group regular (3.1+/-1.0microm). There was no significant difference between the groups for the %SMH (group light -63.9+/-13.9 and group regular -78.5+/-12.7). CONCLUSIONS: The data suggest that the light cola drink is less erosive than the regular one.

Impact of fluoride, milk and water rinsing on surface rehardening of acid softened enamel. An in situ study.

PURPOSE: To evaluate the impact of fluoride, milk and water rinsing on surface rehardening of acid softened enamel in situ. METHODS: Ten subjects performed six tests of4 hours each. In each test, three softened enamel samples were attached to intraoral appliances. For softening, samples were immersed extraorally in an acidic beverage for 120 seconds. Subsequently, specimens were worn intraorally for 5 minutes (Tests 1-3) or 30 minutes (Tests 4-6). Thereafter, the volunteers rinsed with a 250 ppm SnF2/Olaflur solution (Tests 1 and 4), milk (Tests 2 and 5) or non-carbonated mineral water (Tests 3 and 6) for 60 seconds. At each test, one sample was covered with tape during intraoral rinsing and thus, served as control. After rinsing, both test and the control samples were exposed to the oral cavity for up to 4 hours after demineralization. Surface microhardness (SMH) of the specimens was assessed at baseline, immediately after softening and 4 hours after softening. For each subject, the secretion rate of resting and stimulated saliva, buffering capacity and pH-value as well as calcium and phosphate concentration of saliva were measured. Statistical analysis was performed by ANCOVA followed by stratified analyses with Bonferroni correction. RESULTS: Baseline Knoop Hardness (mean +/- S.D.) amounted to 403.1 +/- 39.4. Immediately after softening, mean SMH was reduced to 214.4 +/- 24.1 KHN. Rinsing with 250 ppm fluoride, milk or water after 5 minutes or 30 minutes intraoral exposure of softened samples had a significant effect on rehardening. The increase of SMH (DeltaKHN) was highest after rinsing with fluoride (5 minutes: 95.0 +/- 18.3; 30 minutes: 94.2 +/- 24.3) followed by milk (5 minutes: 77.1 +/- 14.1; 30 minutes: 80.3 +/- 18.7) and water (5 minutes: 49.0 +/- 9.9; 30 minutes: 47.0 +/- 14.1), but did not achieve baseline values. It is concluded that a single rinse with a 250 ppm SnF2/Olaflur solution, milk or water increases rehardening of previously acid softened enamel.

Effect of olive oil and an olive-oil-containing fluoridated mouthrinse on enamel and dentin erosion in vitro.

OBJECTIVE: The study aimed to analyse the impact of olive oil and an olive-oil-containing fluoridated mouthrinse on enamel and dentin erosion. MATERIAL AND METHODS: Bovine enamel and dentin specimens were submitted to 10 alternating demineralization and remineralization cycles each consisting of 5 min pretreatment with the test solutions, i.e. distilled water as negative control, 100% olive oil, 2% olive oil emulsion, 2% olive-oil-containing mouthrinse (Xerostom), acidic 13.2 mmol x l(-1) (250 ppm) fluoride solution as positive control, storage in artificial saliva (30 min), demineralization in citric acid (3 min, pH 2.3) and again storage in artificial saliva (60 min). Each group contained 10 enamel and dentin samples. Enamel and dentin loss was analyzed by profilometry after 10 cycles. RESULTS: Treatment with 100% olive oil was not effective in reducing enamel and dentin loss. Application of 2% olive oil or the olive-oil-containing mouthrinse also showed protection against erosion, but to a lesser degree compared to the positive control. CONCLUSION: Olive oil offered protection against enamel and dentin erosion when applied as 2% emulsion or 2% olive-oil-containing mouthrinse, but is not effective when applied as pure oil (100%). However, 2% olive oil emulsion is less effective in reducing erosion compared to the acidic 13.2 mol x l(-1) fluoride solution.