Physical properties and enamel remineralization potential of arginine-fluoride varnishes.

OBJECTIVE: The study objectives were to examine the physical properties and enamel remineralization potential of fluoride (F) varnishes incorporated with arginine (Arg). METHODS: Four commercial F varnishes: 1) Duraphat®; 2) Flúor Protector®, 3) Fluor Protector S®, and 4) Fluorimax™ were supplemented with 2% w/v. Arg. The control/experimental varnishes underwent rheometric analysis to assess varnish density (δ), velocity (ν), and associated viscosity, both quantitatively (ν/δ) and qualitatively based on determined mass, volume, distance flow, and time under experimentation. The varnish wet/dry weights (at 2 h) were also analysed. Further, sound enamel specimens (T0) with artificial incipient caries-like lesions (T1) were treated with control/experimental varnishes and subjected to remineralization assay with artificial saliva for 6 h. Thereafter (T2), the specimens were characterized to estimate precipitated Ca and net enamel F uptake. Additionally, mineral density (MD) was assessed using micro-CT at T0, T1, and T2 to derive mineral gain (MG) and % remineralization for the treatment groups. RESULTS: When Arg is incorporated, the physical properties of the F-containing varnishes undergo a significant transformation, resulting in higher density, varnish weight, dry varnish weight, and viscosity compared to their respective control varnishes (p < 0.05). Incorporating Arg-in Duraphat®, Fluor Protector S®, and Fluorimax™ significantly improved both enamel Ca precipitation and F uptake compared to the respective controls (p < 0.05). Additionally, the enamel F uptake was significantly higher with all the tested varnishes when enriched with Arg (p < 0.05). The combined data for MD, MG, and % remineralization suggests that the remineralization potential of F-varnishes significantly increased when enriched with Arg (p < 0.05). CONCLUSION: Incorporating Arg in inorganic F varnishes improves their physical properties and enhances the enamel remineralization potential of the varnishes. CLINICAL SIGNIFICANCE: This study highlights the possibility of incorporating Arg in distinct F-source varnishes. The synergism between active components (Arg-F) aids in enhanced remineralization and superior varnish physical properties, demonstrating a promising approach for high caries-risk patients.

The use of mouthwash containing trimetaphosphate as an adjunct therapy to fluoridated toothpaste reduces enamel demineralization.

INTRODUCTION: The decline in dental caries has been attributed to the widespread use of fluoride (F). Two forms of presentation are fluoridated toothpaste (FT) and mouthwash (MW), widely used by the population. MATERIALS AND METHODS: This study aimed to evaluate in vitro the effects of combining FT and MW, whether supplemented with sodium trimetaphosphate (TMP) or not, on dental enamel demineralization. Bovine enamel blocks (n = 60) were selected based on initial surface hardness (SHi) and divided into 5 experimental groups (n = 12 each): I) Placebo Toothpaste (without F/TMP); II) 1100 ppm F Toothpaste (FT); III) 1100F associated with a MW at 100 ppm F (FT + MW 100F); IV) 1100F associated with a MW at 225 ppm F (FT + MW 250F); and V) 1100F associated with a MW at 100 ppm F supplemented with 0.4 % TMP (FT + MW 100F-TMP). The blocks were treated twice a day, undergoing 5 pH cycles over 7 days. Thus, the percentage change in surface hardness (%SH), integrated subsurface hardness loss (ΔKHN), and the concentration of F, phosphorus (P), and calcium (Ca) in the enamel were determined. The data were submitted to ANOVA and Student-Newman-Keuls test (p < 0.001). RESULTS: The 1100F group was statistically inferior to the groups associated with MW for %SH, ΔKHN, and the concentration of P and Ca in the enamel (p < 0.001). Blocks treated with FT + MW 225F and FT + MW 100F-TMP showed significantly lower %SH compared to the other groups (p < 0.001). The FT + MW 100F - TMP group exhibited the lowest depth mineral loss (ΔKHN), and higher concentration de P in enamel (p < 0.001). CONCLUSION: The adjunct use of MW with FT produces a greater protective effect in inhibiting enamel demineralization, and the supplementation of TMP to the MW with 100F provides a superior effect compared to MW with 225F. CLINICAL SIGNIFICANCE: This combination of treatments could be regarded as one of several alternative fluoride supplements for subjects at elevated risk of caries.

Amelogenin-inspired peptide, calcium phosphate solution, fluoride and their synergistic effect on enamel biomimetic remineralization: an in vitro pH-cycling model.

BACKGROUND: Several methods were introduced for enamel biomimetic remineralization that utilize a biomimetic analogue to interact and absorb bioavailable calcium and phosphate ions and induce crystal nucleation on demineralized enamel. Amelogenin is the most predominant enamel matrix protein that is involved in enamel biomineralization. It plays a major role in developing the enamel's hierarchical microstructure. Therefore, this study was conducted to evaluate the ability of an amelogenin-inspired peptide to promote the remineralization potential of fluoride and a supersaturated calcium phosphate solution in treating artificially induced enamel carious lesions under pH-cycling regimen. METHODS: Fifty enamel slices were prepared with a window (4*4 mm2 ) on the surface. Five samples were set as control healthy enamel and 45 samples were subjected to demineralization for 3 days. Another 5 samples were set as control demineralized enamel and 40 enamel samples were assigned into 8 experimental groups (n=5) (P/I, P/II, P/III, P/AS, NP/I, NP/II, NP/III and NP/AS) according to peptide treatment (peptide P or non-peptide NP) and remineralizing solution used (I; calcium phosphate solution, II; calcium phosphate fluoride solution, III; fluoride solution and AS; artificial saliva). Samples were then subjected to demineralization/remineralization cycles for 9 days. Samples in all experimental groups were evaluated using Raman spectroscopy for mineral content recovery percentage, microhardness and nanoindentation as healthy, demineralized enamel and after pH-cycling. Data were statistically analysed using two-way repeated measures Anova followed by Bonferroni-corrected post hoc test for pairwise multiple comparisons between groups. Statistical significance was set at p= 0.05. Additionally, XRD, FESEM and EDXS were used for crystal orientation, surface morphology and elemental analysis after pH-cycling. RESULTS: Nanocrystals clumped in a directional manner were detected in peptide-treated groups. P/II showed the highest significant mean values in mineral content recovery (63.31%), microhardness (268.81±6.52 VHN), elastic modulus (88.74±2.71 GPa), nanohardness (3.08±0.59 GPa) and the best crystal orientation with I002/I300 (1.87±0.08). CONCLUSION: Despite pH changes, the tested peptide was capable of remineralizing enamel with ordered crystals. Moreover, the supplementary use of calcium phosphate fluoride solution with peptide granted an enhancement in enamel mechanical properties after remineralization.

High-Resolution Characterization of Enamel Remineralization Using Time-of-Flight Secondary Ion Mass Spectrometry and Electron Microscopy.

INTRODUCTION: The aim of this in vitro study was to assess the suitability of high-resolution time-of-flight secondary ion mass spectrometry (ToF-SIMS) for visualizing cross-sectional changes in human enamel microstructure and chemical composition during treatment and remineralization cycling of artificially generated caries lesions underneath an artificial plaque. METHODS: Treatments consisted of exposure to twice daily toothpaste/water slurries prepared from 0, 1,100, and 5,000 µg/g fluoride (F) NaF/silica toothpastes. In addition, treatments with slurries prepared from 1,100 µg/g F SnF2/silica toothpastes were done using 44Ca in the remineralization solution to allow for differentiation of newly formed mineral and exploration of incorporated metal dopants using ToF-SIMS. Complementary microhardness, scanning electron microscopy, and high-resolution transmission electron microscopy (HR-TEM) investigations were performed on enamel cross sections. RESULTS: HR-TEM was used for the first time to determine the change in crystallinity during remineralization revealing distinct microstructural zones within one lesion. Chemical mapping using ToF-SIMS demonstrated that the distribution of F, while observed primarily in the new mineral phase, was widespread throughout the lesion with 44Ca substantially limited to the remineralizing mineral. Both penetrated the inter-rod spaces of the sound enamel illustrating how acid damage propagates into the native mineral as the caries lesion deepens. HR-TEM examination revealed different regions within the lesion characterized by distinct micro- and ultrastructures. Importantly, HR-TEM revealed a return of crystallinity following remineralization. F dose-response observations verified the ability of these high-resolution techniques to differentiate remineralization efficacy. CONCLUSION: The collective results provided new insights such as the visualization of F or calcium penetration pathways, as well as new tools to study the caries process.

The effect of different concentrations of fluoride in toothpastes with or without bioactive glass on artificial root caries.

OBJECTIVE: To investigate the effect of different toothpastes either containing 5,000ppm-F, 1,450ppm-F or bioactive glass (BG) with 540ppm-F on artificial root carious lesions (ARCLs). METHOD: The crowns of 23 extracted sound teeth were removed leaving their roots only. Subsequently, each root was divided into four parts. A total of 15 sound root dentine (SRD) was left untreated as baseline. The ARCLs were developed for the remaining roots using demineralisation solution (pH-4.8). 15-ARCLs samples were then left untreated. The rest of samples were divided into four groups (n = 15 each) and treated with Group-1(BG with 540ppm-F); Group-2(5000ppm-F); Group-3(1450ppm-F) and Group-4(deionised water). 13-day pH-cycling included using demineralisation solution for 6 h, then placing samples into remineralisation solution (pH-7) for 16 h. Each sample was brushed with the assigned toothpaste twice a day during pH-cycling. Fluoride concentrations at each time point were measured using F-ISE, whilst calcium (Ca2+) and phosphorus (P) ion release was determined using ICP-OES, KHN, XRD, 19F-MAS-NMR analyses. RESULTS: KHN showed significant surface changes for each group (p<0.001). The uptake of Ca2+ occurred at days 1-2, phosphorus ion loss was high when compared to the uptake in all groups. XRD showed presence of sharp diffraction lines evidencing apatite formation for Groups 1-3. 19F-MAS-NMR confirmed fluorapatite presence in Groups 1-3. CONCLUSION: All toothpastes were promising in fluorapatite formation. BG with 540ppm-F toothpaste released more ions (Ca2+and P) and reharden the artificial root carious lesions when compared to other groups. However, 1450ppm-F toothpaste showed more fluoride-substituted apatite formation whilst 5000ppm-F toothpaste had more fluorapatite formation. CLINICAL SIGNIFICANCE: Toothpaste containing BG with 540ppm-F, 5000ppm-F and 1450ppm-F toothpastes are likely to have a significant impact in reversing and arresting root caries. However, randomised controlled double-blinded clinical trials are required to translate these results into clinical practice.

DOES TITANIUM TETRAFLUORIDE PROMOTE A PROTECTIVE EFFECT ON ERODED TOOTH? A SYSTEMATIC REVIEW AND META-ANALYSIS.

OBJECTIVE: This systematic review and meta-analyses aimed to evaluate the potential protective effect of titanium tetrafluoride (TiF4) compound compared to sodium fluoride (NaF) on eroded enamel or dentin. METHODS: Two independent reviewers searched PubMed, Scopus, Web of Science, LILACS, Cochrane, EMBASE, and Open gray Literature up to June 2020. MeSH terms, supplementary concepts, synonyms, and free terms were applied based on PICOS strategy (P- population: eroded enamel or dentin; I- intervention: eroded teeth treated with solution or varnish of TiF4; C- comparison: eroded teeth treated with a solution or varnish of NaF; O- outcome: mineral loss measurement; S- study design: in vitro studies). Seven distinct parameters evaluated the risk of bias, and all studies were submitted to 4 meta-analyses (first and second meta-analyses related to enamel loss treated with fluoride solution or varnish, respectively; third and fourth meta-analyses related to dentin loss treated with fluoride solution or varnish, respectively). A sensitivity test was performed by the RevMan software, based on standard mean difference calculation (P < .05). RESULTS: A total of 10,260 studies were retrieved, from which 22 studies were included in systematic review through eligibility criteria, of which 1 study was classified as low risk of bias, 19 as medium, and 3 as high. Seventeen studies were included in 4 different meta-analyses, presenting considerable overall heterogeneity (I2 = 95; 92; 95; and 93%, respectively) with statistical significance for TiF4 on the first meta-analysis, and no statistical significance for second, third, and fourth meta-analyses. CONCLUSIONS: Titanium tetrafluoride compound delivered as solution provided significant effective protection for erosion lesions on the enamel surface compared to sodium fluoride. However, when TiF4 or NaF were applied on enamel or dentin surfaces as varnish, both provided the same effective protection, based on in vitro studies with considerable heterogeneity.

Propolis and Diet Rich in Polyphenols as Cariostatic Agents Reducing Accumulation of Dental Plaque.

Conducted studies indicate the relationship between oral health and systemic diseases. Moreover, the latest research indicated that cariogenic bacteria may severely influence the course of SARS-CoV-2 infection and increase risk of COVID-19 complications. This article aims to review various applications of propolis and pay attention to a healthy diet rich in polyphenols, which may allow the reduction of dental plaque accumulation. A literature review has been conducted from June until November 2021. It showed that propolis could be a useful agent in decreasing the accumulation of dental plaque. Moreover, a diet rich in polyphenols prevents cariogenic bacteria and reduces the accumulation of dental plaque. A reduction of a dental plaque may influence the risk of a severe course of COVID-19. Therefore, propolis and a diet rich in polyphenols may play an important role in prophylaxis of systemic diseases. Recently, it has been proven that oral infection may affect cardiovascular system, musculoskeletal system, respiratory system, nervous system, as well as may be a risk factor for diabetes mellitus. These aspects should stimulate clinicians to further research about polyphenols.

Assessment of the Remineralizing Efficacy of Grape Seed Extract vs Sodium Fluoride on Surface and Subsurface Enamel Lesions: An In Vitro Study.

AIM: The aim of this study was to evaluate the efficacy of grape seed extract (GSE) on remineralization of surface and subsurface enamel lesions compared to that of sodium fluoride (NaF). MATERIALS AND METHODS: A total of 20 intact bovine incisor crowns were separated from their roots and immersed in a demineralizing solution for 96 hours at 37°C to create artificial enamel lesions. The specimens were randomly divided into two groups (n = 10): 6.5% GSE solution and 1000 ppm NaF solution. The specimens were subjected to six daily pH cycles for 8 days. The microhardness test was carried out at three different stages: baseline, after artificial caries formation, and after pH cycling. Raman spectroscopy was used to evaluate the depth of enamel remineralization. Surface morphology and elemental analysis were assessed using a scanning electron microscope (SEM) and an energy dispersive X-ray (EDX) spectroscope, respectively. Statistical analysis was performed using SPSS 22.0 at a significance level of p ≤ 0.05. RESULTS: There was a significant increase in the mean values of enamel surface microhardness after pH cycles in the two groups compared to after artificial caries formation, but there was no significant difference between both groups. The B-type carbonate/phosphate (Ca/P) ratio at 10 and 40 µm depth revealed no significant difference between the two groups. Scanning electron microscope micrograph revealed occlusion of porosities and particle precipitation on the enamel surface of the two groups, while EDX results for the Ca/P ratio of the GSE and NaF groups were 1.59 and 1.60, respectively. CONCLUSION: Grape seed extract and NaF are equally effective in remineralizing surface and subsurface artificial enamel lesions. CLINICAL SIGNIFICANCE: Grape seed extract can be considered a promising herbal material and a safe alternative to traditional NaF for the noninvasive treatment of enamel lesions.

Application of green tea extracts epigallocatechin-3-gallate in dental materials: Recent progress and perspectives.

Because of excellent biocompatibility, antioxidant activity, and anti-caries ability, epigallocatechin-3-gallate (EGCG) has been widely studied in the treatment of oral diseases, such as periodontal disease, oral cancer, and dental caries. To reach the site of the lesion or achieve sustained release, play the role of anti-caries, anti-inflammatory, or to maintain or improve the physical properties of the modified material，EGCG need to be cross-linked or embedded with dental adhesives, barrier membranes, bone replacement materials, tissue regeneration materials, and antimicrobial anti-caries materials to better prevent or treat oral diseases. This article reviews the applications of EGCG in oral materials, involving various areas of the oral cavity, reveals their excellent potential, and sees shortcomings in these research to promote the better development of EGCG applications in oral materials such as oral repair materials, bone tissue engineering materials and antibacterial and anti-caries materials.

Synthesis and Characterization of Fluoridated Silver Nanoparticles and Their Potential as a Non-Staining Anti-Caries Agent.

OBJECTIVES: The first objective of this study was to prepare sodium fluoride (NaF) solution with various concentrations of polyethylene glycol-coated silver nanoparticles (PEG-AgNPs). The second objective was to study the antibacterial activity against Streptococcus mutans and the tooth-staining effect of the solution. METHODS: PEG-AgNPs were prepared via the one-step chemical reduction of silver acetate with thiolated polyethylene glycol. The PEG-AgNPs were characterized with ultraviolet-visible spectrometry and transmission electron microscopy. The half maximal inhibitory concentration (IC50) for the PEG-AgNPs against Streptococcus mutans and human gingival fibroblasts (HGF-1) were determined. The staining effect on dentin and enamel for the 2.5% NaF solutions with PEG-AgNPs at 12,800, 6400, 1600, and 400 ppm was investigated using digital spectrophotometry. The IC50 of the fluoridated silver nanoparticles against Streptococcus mutans were measured. RESULTS: The PEG-AgNPs have an average diameter of 2.56±0.43 nm and showed excellent stability at high ionic strength (2.5% NaF) for 18 months. The IC50 of PEG-AgNPs against Streptococcus mutans was found to be 21.16±1.08 ppm silver, which was half of IC50 against HGF-1 cells (42.36±1.12 ppm), providing a working range to kill bacteria with no harm to human cells. The formulations with different concentrations of PEG-AgNPs showed no significant staining of teeth. Combining PEG-AgNPs with NaF significantly expanded the therapeutic window against Streptococcus mutans by reducing its IC50. CONCLUSION: A biocompatible solution of NaF with PEG-AgNPs was developed. Because it has antibacterial activity against Streptococcus mutans and no tooth-staining effect, it can be used as an anti-caries agent.

Influence of cigarette smoke combined with different toothpastes on enamel erosion.

This in vitro study aimed to evaluate the effect of different toothpastes on dental enamel subjected to an erosive cycle with and without exposure to cigarette smoke. Bovine enamel specimens were randomly allocated into 12 groups (n = 12). For the in vitro simulation of smoking, half the groups underwent an exposure cycle of 20 cigarettes per day for 5 days. Subsequently, all groups were subjected to a 5-day erosion cycle intercalating demineralization (1 min; 1% citric acid; pH = 3.5) and treatment with toothpaste slurries (2 min) of NaF, SnF2, F/Sn/Chitosan, F/CaSiO3/Na3PO4, and F/bioactive glass. The control group was immersed in distilled water. Surface microhardness (SMH) was measured initially, after exposure to smoke, and after the erosive cycle, and %SMH was calculated. At the end of the experimental cycle, surface roughness, profilometry, and atomic force microscopy (AFM) were performed. SMH increased after exposure to cigarette smoke (p < 0.05). After the erosive cycle, there were no differences between the presence and absence of cigarette smoke exposure in SMH and roughness (p > 0.05). Besides increasing enamel SMH, cigarette smoke did not prevent enamel loss after the erosion cycle (p < 0.05). In profilometry, roughness and surface loss had the lowest values in the groups treated with SnF2 and F/Sn/Chitosan (p < 0.05). AFM showed lower mineral loss with F/CaSiO3/Na3PO4 and F/Sn/Chitosan. For all groups, except F/CaSiO3/Na3PO4, cigarette smoke resulted in higher enamel wear. F/Sn/Chitosan showed the best results against erosion.

Inhibition Effects of Different Toothpastes on Demineralisation of Incipient Enamel Lesions.

PURPOSE: To evaluate the inhibitory effects of different toothpastes on demineralisation of incipient enamel lesions using a toothbrush simulator. MATERIALS AND METHODS: Fifty enamel specimens were prepared from extracted human molars. The specimens were randomly assigned to the following groups (n = 10/group): 1. no treatment (control); 2. toothpaste containing arginine (ProRelief, Colgate;); 3. fluoride toothpaste (Pronamel, Sensodyne GlaxoSmithKlein); 4. tooth mousse containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) (Recaldent, GC); 5. toothpaste (Restore, Dr. Collins) containing bioactive glass (NovaMin, GlaxoSmithKlein). All specimens were exposed to pH cycling. The remineralising agents were applied to the samples with a toothbrush simulator for 2 min twice a day for five days. The weight percentage of mineral changes for the elements calcium (Ca), phosphorus (P), sodium (Na) and silica (Si) were measured by SEM energy-dispersive x-ray spectroscopy (SEM-EDX). SEM revealed properties of treated enamel surfaces. The data were analysed using one-way ANOVA. RESULTS: Statistically significantly higher levels of Ca and P were found in all groups compared to the control (p < 0.05). CONCLUSIONS: The toothpastes' efficacy of inhibiting demineralisation depended on the active ingredients in the respective toothpaste. The demineralisation inhibition efficacy of the tested toothpastes depended on the active ingredients in the toothpaste.

WITHDRAWN: Ozone therapy for the treatment of dental caries.

BACKGROUND: Dental caries is a bacterially mediated disease characterised by demineralisation of the tooth surface, which may lead to cavitation, discomfort, pain and eventual tooth loss. Ozone is toxic to certain bacteria in vitro and it has been suggested that delivering ozone into a carious lesion might reduce the number of cariogenic bacteria. This possibly could arrest the progress of the lesion and may, in the presence of fluoride, perhaps allow remineralisation to occur. This may in turn delay or prevent the need for traditional dental conservation by 'drilling and filling'. OBJECTIVES: To assess whether ozone is effective in arresting or reversing the progression of dental caries. SEARCH METHODS: We searched the Cochrane Oral Health Group's Trials Register (to 7 November 2003); Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2003, Issue 3); MEDLINE and PREMEDLINE (OVID) (1966 to November 2003); EMBASE (OVID) (1980 to November 2003); CINAHL (OVID) (1982 to November 2003); AMED (OVID) (1985 to November 2003). Quintessence was handsearched through 2002 and KaVo were contacted as manufacturers of the HealOzone apparatus for any additional published or unpublished trials. SELECTION CRITERIA: Inclusion was assessed independently by at least two reviewers. Trials were only included if they met the following criteria: randomisation in a controlled trial; single surface in vivo carious lesion accessible to ozone application; clear allocation concealment; ozone application to the lesions in the intervention group; no such application of ozone in the control group; outcomes measured after at least 6 months. DATA COLLECTION AND ANALYSIS: Reviewers independently extracted information in duplicate. A paucity of comparable data did not allow meta-analytic pooling of the included studies. MAIN RESULTS: Three trials were included, with a combined total of 432 randomised lesions (137 participants). Forty-two conference papers, abstracts and posters were excluded (from an unknown number of studies). The risk of bias in all studies appeared high. The analyses of all three studies were conducted at the level of the lesion, which is not independent of the person, for this reason pooling of data was not appropriate or attempted. Individual studies showed inconsistent effects of ozone on caries, across different measures of caries progression or regression. Few secondary outcomes were reported, but one trial reported an absence of adverse events. AUTHORS' CONCLUSIONS: Given the high risk of bias in the available studies and lack of consistency between different outcome measures, there is no reliable evidence that application of ozone gas to the surface of decayed teeth stops or reverses the decay process. There is a fundamental need for more evidence of appropriate rigour and quality before the use of ozone can be accepted into mainstream primary dental care or can be considered a viable alternative to current methods for the management and treatment of dental caries.

White Spot Lesion Remineralisation Agents in Primary Teeth: A Systematic Review.

PURPOSE: To perform a systematic review of articles related to the clinical efficacy of topical fluoride varnishes/gels, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and other remineralisation agents of white spot lesions (WSL) in primary teeth. MATERIALS AND METHODS: Electronic and manual searches were conducted through diverse electronic databases. The search was limited to randomised, clinical, controlled trials, and quasi-experimental papers in full-text version. Suitable individual studies were evaluated through a previously reported quality system, their data extracted and carefully analysed. RESULTS: The search identified 298 citations, and 95 were chosen and reviewed in full text. Nine relevant citations met the eligibility criteria for inclusion in the systematic review. Pair comparisons were made between fluoride varnishes, CPP-ACP, dental lasers, and control interventions. CONCLUSIONS: Clinicians are encouraged to discuss more high-quality studies in order to provide sufficient evidence and to confirm the clinical utility of remineralisation agents of WSL in primary teeth.

Remineralisation of enamel white spot lesions pre-treated with chitosan in the presence of salivary pellicle.

OBJECTIVE: To investigate the remineralisation of chitosan pre-treated enamel white spot lesions (WSLs) by bioglass in the presence of the pellicle layer. METHODS: 50 artificial enamel white spot lesions were created by acidic gel. Two lesions were used to investigate the formation of the pellicle layer by treating with human whole saliva for 3 min. 48 lesions were assigned to 6 experimental groups (n = 8): (1) bioactive glass slurry, (2) bioactive glass containing polyacrylic acid (BG + PAA) slurry, (3) chitosan pre-treated WSLs with BG slurry (CS-BG), (4) chitosan pre-treated WSLs with BG + PAA slurry (CS-BG + PAA), (5) "standard" remineralisation solution (RS) and (6) de-ionised water (negative control, NC). Remineralisation was carried out using a pH-cycling model for 7 days. Before each treatment using remineralising agents, 3-min pellicle was formed on lesions' surfaces. Mineral content changes, surface and subsurface microhardness and ultrastructure were evaluated by Raman intensity mapping, Knoop microhardness and scanning electron microscopy, respectively. Data were statistically analysed using one-way ANOVA with Tukey's test (p < 0.05 is considered as significant). RESULTS: Despite the heterogeneously formed pellicle layer, all groups showed an increase in surface mineral content after pH-cycling. Chitosan pre-treatment enhanced the subsurface remineralisation of WSLs using bioglass as both pre-treated groups showed greater surface and subsurface microhardness compared to NC. CS-BG exhibited denser subsurface structure than BG, while in CS-BG + PAA the crystals were bigger in size but resemble more enamel-like compared to BG + PAA as shown in SEM observations. Remineralisation of RS was limited to the surface as no significant subsurface changes of mechanical properties and structure were found. CONCLUSIONS: Chitosan pre-treatment can enhance WSL remineralisation with bioglass biomaterials when a short-term salivary pellicle is present. A further investigation using a long-term pH-cycling model with mature pellicle is suggested with regards to clinical application. CLINICAL SIGNIFICANCE: Chitosan pre-treatment has the potential in clinical application to remineralise subsurface lesions to achieve lesion consolidation.

Long-term remineralizing effect of MI Paste Plus on regression of early caries after orthodontic fixed appliance treatment: a 12-month follow-up randomized controlled trial.

Background: Casein-phosphopeptide-amorphous-calcium-fluoride-phosphate (CPP-ACFP) can remineralize subsurface lesions. It is the active ingredient of MI-Paste-Plus® (MPP). The long-term remineralization efficacy is unknown. Objective: To evaluate the long-term effect of MPP versus a placebo paste on remineralization of enamel after fixed orthodontic treatment over a 12-month period. Design: This trial was designed as a prospective, double-blinded, placebo-controlled RCT. Methods: Patients with subsurface lesions scheduled for removal of the appliance were included. They applied either MPP or control paste once a day at bedtime for 12 months, complementary to normal oral hygiene. Main outcome measures: Changes in enamel lesions (primary outcome) were fluorescence loss and lesion area determined by quantitative light-induced fluorescence (QLF). Secondary outcomes were Microbial composition, by conventional plating, and acidogenicity of plaque, by capillary ion analysis (CIA), and lesion changes scored visually on clinical photographs. Randomization: Participants [age = 15.5 years (SD = 1.6)] were randomly assigned to either the MPP or the control group, as determined by a computer-randomization scheme, created and locked before the start of the study. Participants received neutral-coloured concealed toothpaste tubes marked A or B. Blinding: The patients and the observers were blinded with respect to the content of tube A or B. Results: A total of 51 patients were analysed; MPP (n = 25) versus control group (n = 26); data loss (n = 14). There was no significant difference between the groups over time for all the used outcome measures. There was a significant improvement in enamel lesions (fluorescence loss) over time in both groups (P < 0.001 and P < 0.001), with no differences between groups. Limitations: Being an in vivo study, non-compliance of the subjects could have influenced the result. Conclusion: The additional use of MPP in patients with subsurface enamel lesions after orthodontic fixed appliance treatment did not improve these lesions during the 1 year following debonding. Registration: This trial is registered at the medical ethical committee of the VU Medical Centre in Amsterdam (NL.199226.029.07).

CPP-ACP: Effect on Dental Plaque Acidity after Water Rinsing Following Topical Fluoride Therapy.

OBJECTIVES: There is some evidence that water rinsing immediately after topical fluoride therapy has the potential to reduce the effectiveness of fluoride. The aim was to determine if covering fluoridated teeth with a layer of mousse containing CPP-ACP could prevent the adverse effect of rinsing on fluoride and consequently its buffering effect on dental plaque pH during cariogenic challenge. STUDY DESIGN: This randomized, controlled, crossover, in situ study was conducted on 25 participants. The participants were subjected to acidulated phosphate fluoride (APF) application followed by five treatment protocols: (1) water rinsing after 30 minutes (APF-30) or (2) immediate water rinsing (APF-0); (3) using CPP-ACP immediately before water rinsing (F-CPP-ACP); and two control groups: (4) no fluoride therapy (No-F) and (5) using CPP-ACP and immediate water rinsing (CPP-ACP-0). After 48 hours, teeth were rinsed with 10% sucrose solution and plaque pH was measured before and after 5, 10, 15, 20 and 30 minutes. RESULTS: The least pH changes, the lowest pH drop, and the quickest pH recovery were found in the APF-30 and F-CPP-ACP groups. APF-0 ranked in the middle and the highest values were in the control groups. CONCLUSIONS: The results show that in the case using CPP-ACP on fluoridated teeth, water rinsing immediately after topical fluoride therapy did not seem to influence the inhibitory effect of fluoride on plaque acidity.

Fluoride Supplementation Adherence and Barriers in a Community Without Water Fluoridation.

BACKGROUND: To prevent early childhood caries, the American Dental Association recommends oral fluoride supplementation for children in communities lacking water fluoridation who are at high caries risk. However, patient adherence to oral fluoride supplementation has not been studied in this population. This study assessed adherence to oral fluoride and barriers to adherence in a community lacking water fluoridation. METHODS: A self-administered survey was completed in a systematic sample of 209 parents of children aged 6 months to 4 years, during a primary care visit in an urban academic medical center. Participants reported frequency of administering oral fluoride to their children, as well as agreement or disagreement with proposed barriers to supplementation. Bivariate and multivariate analyses were used to assess adherence with oral supplementation and the association of barriers to supplementation and child receipt of fluoride on the day before. RESULTS: More than half of parents either had not or did not know if their child had received fluoride on the day before. Approximately 1 in 4 of parents had given fluoride in 0 of the previous 7 days. Difficulty remembering to give fluoride and agreeing that the child does not need extra fluoride were associated with not receiving fluoride on the day before. CONCLUSIONS: Adherence to oral fluoride supplementation in the primary care setting is low. Difficulty remembering to give fluoride daily is the greatest barrier to adherence. Further research on interventions to reduce common barriers is needed to increase fluoride administration and reduce early childhood caries in communities lacking water fluoridation.

Interventions for orthodontically induced white spot lesions: a systematic review and meta-analysis.

Background: Although orthodontic white spot lesions (WSLs) are one of the most often and most evident adverse effects of comprehensive fixed appliance treatment, the efficacy of interventions for WSLs has not yet been adequately assessed in an evidence-based manner. Objective: Aim of this systematic review was to assess the therapeutic and adverse effects of interventions to treat post-orthodontic WSLs from randomized trials in human patients. Search methods: An unrestricted electronic search of eight databases from inception to May 2016. Selection criteria: Randomized controlled trials assessing any interventions for post-orthodontic WSLs on human patients. Data collection and analysis: After duplicate study selection, data extraction, and risk of bias assessment according to the Cochrane guidelines, random-effects meta-analyses of mean differences (MDs), standardized mean differences (SMDs), and odds ratios (ORs), including their 95% confidence intervals (CIs) were performed, followed by subgroup and sensitivity analyses. Results: A total of 20 unique studies and a total of 942 (42 per cent male and 58% per cent female) patients were included, with an average age of 16.2 years and a mean number of 8.2 WSLs (range 2.2 to 45.4) per patient. These were allocated to adjunct treatment with casein phosphopeptide-stabilized amorphous calcium phosphate creams, external tooth bleaching, low- or high-concentration fluoride films, gels, mouthrinses or varnishes, resin infiltration, miswak chewing sticks, bioactive glass toothpastse, or to no adjunct treatment (i.e. conventional oral hygiene). The monthly use of fluoride varnish was the best supplement to improve WSLs in terms of lesion area (1 trial; MD = -0.80 mm2; 95% CI = -1.10, -0.50 mm2; P < 0.05; high quality) and enamel fluorescence (3 trials; SMD = -0.92; 95% CI = -1.32, -0.52; P < 0.05; high quality), followed by the use of fluoride film. WSL treatment did not provide a considerable improvement in their clinical evaluation (3 trials; OR = 0.97; 95% CI = 0.60, 1.56; P > 0.05; moderate quality), with imprecision due to small sample size being the main limitation of existing evidence. Conclusions: Based on the existing trials, interventions for post-orthodontic WSLs, mainly fluoride varnish, seem to be effective, but further research is needed to elucidate their clinical relevance. Registration: PROSPERO (CRD42016037538).

Prevention of occlusal caries using a ozone, sealant and fluoride varnish in children.

OBJECTIVES: To compare ozone with fissure sealants and fluoride varnish in the prevention of occlusal caries in permanent premolars of children in 12 months period. METHODS: A clinical trial was conducted on four groups of 10 years old schoolchildren: a group 1 - control group (n=50); a group 2 (n=21) in which fluoride varnish was applied and re-applied up to 12 months; a group 3 (n=17) in which sealant was applied and reapplied up to 12 months; and a group 4 (n=19) in which ozone was applied and re-applied up to 12 months. Percent caries reduction was studied in these initially healthy molars with complete occlusal eruption: 173 (control), 103 (varnish), 78 (sealants) and 103 (ozone) premolars met inclusion criteria. All patients were examined using DMFT index and Greene - Vermillion index at a baseline and in 6 months with a follow up period of 12 months. Each tooth was considered as the unit of the analysis. Data were analyzed using t-test and the chi-square tests. RESULTS: The prevalence of caries was: in group 1 - 3.5% (n=6), in group 2 and group 3 - 0% (n=0), in group 4 - 2.9%, (n=3). The changes in occlusal caries incidence between all groups were not statistically significant. CONCLUSIONS: The placement of fissure sealant, application of fluoride varnish, and application of ozone - are recommended to use in prevention of occlusal pit and fissure caries in permanent premolars in children. Furthermore, they are not significantly different from one another in their effectiveness.