A spectroscopic and surface microhardness study on enamel exposed to beverages supplemented with lower iron concentrations.

OBJECTIVES: This study aimed to compare the in vitro mineral loss and surface microhardness (SMH) changes in human enamel specimens following supplementation of acidic carbonated beverages with low iron concentrations than when treated without. STUDY DESIGN: 180 enamel blocks each from primary and permanent teeth were prepared and equally subdivided (n=10) for their respective treatments in Group 1 (Coca Cola and Sprite without iron supplementation) and Group 2 (beverages supplemented with 2/5 mmol/L FeSO4.7H2O). Following initial SMH estimation, the blocks were subjected to 3 treatment cycles of 5/20 minute incubation periods, equally interspaced by a 5-min treatment in artificial saliva. The calcium and phosphate released after each cycle were analyzed spectrophotometrically and the final SMH was recorded. The results were tested using student's T test, One-way ANOVA and Kruskal Walli's test (p<0.05). RESULTS: Two and five mmol/L FeSO4.7H2O supplementation produced a highly significant SMH change and calcium and phosphate reduction than when treated without (p<.0005). Both the enamel specimens showed similar patterns of mineral loss and SMH reduction, with pronounced effects in the twenty minute incubation cycles. CONCLUSION: Our results suggest that 2 mmol/L FeSO4.7H2O supplementation to acidic beverages is beneficial in reducing mineral loss and preserving surface microhardness of human enamel.

In vitro assessment of the acid resistance of demineralized enamel irradiated with Er, Cr:YSGG and Nd:YAG lasers.

PURPOSE: This study's purpose was to evaluate the acid resistance of demineralized enamel irradiated with high-intensity lasers. METHODS: Enamel fragments were demineralized and treated as follows (N=10): Group 1-no treatment; Group 2-five percent sodium fluoride (NaF) varnish; Group 3-Er, Cr:YSGG laser (8.92 J/cm2, 0.5 W, 20 Hz, 30 seconds); Group 4-NaF and Er, Cr:YSGG laser; Group 5-Er, Cr:YSGG laser and NaF; Group 6-Nd:YAG laser (84.9 J/cm2, 0.5 W, 10 Hz, 30 seconds); Group 7-NaF and Nd:YAG laser; and Group 8-Nd:YAG laser and NaF. The samples were subjected to pH-cycling and assessed by microhardness (analysis of variance; α equals five percent) at different depths from the outer enamel surface. Samples were observed using polarized light microscopy (PLM) and scanning electron microscopy (SEM). RESULTS: There were no significant differences among the experimental groups in any of the subsurface layers evaluated. PLM observation revealed that the extent of demineralization of the irradiated samples was similar to the samples for Group 1 (control). SEM observation showed that irradiated surfaces were ablated and presented areas of melting. CONCLUSIONS: Laser irradiation, with or without applying five percent sodium fluoride, was not capable of increasing the enamel white spot lesions' acid resistance.

Souakine mouth rinse solution protects deciduous enamel from simulated erosion in vitro.

AIM: To determine whether a souakine mouth rinse solution can provide protection of deciduous teeth against simulated erosion in vitro. MATERIALS AND METHODS: Thirty deciduous anterior teeth were used. Half of each tooth was covered with a varnish and teeth were randomly divided into a treated (S) and a control group (C). Each group was immersed in cola drink for 5 minutes and treated with an aqueous solution of Souakine (S) or water (C) for 2 minutes. The treatment was renewed 5 times a day for 8 days. Teeth were then embedded, sectioned and observed under polarised light microscope. Observed data were quantitatively analysed by SPSS software. RESULTS: In group (C), the unvarnished part of the enamel showed a deep green layer of erosion, compared to the varnished part. The difference in depth of this layer was significant (p<0.05). In group (S), the green layer of erosion was highly located in the unvarnished part as compared to the unvarnished part of the control group (C) (p<0.05). This layer of erosion was comparable to that in the varnished part, either in control or treated groups. CONCLUSION: The beneficial results of Souakine against erosion are validated either by a protective or a remineralisation effect.

Comparison of Knoop and Vickers surface microhardness and transverse microradiography for the study of early caries lesion formation in human and bovine enamel.

OBJECTIVE: The aims of the present laboratory study were twofold: a) to investigate the suitability of Knoop and Vickers surface microhardness (SMH) in comparison to transverse microradiography (TMR) to investigate early enamel caries lesion formation; b) to compare the kinetics of caries lesion initiation and progression between human and bovine enamel. DESIGN: Specimens (90×bovine and 90×human enamel) were divided into six groups (demineralization times of 8/16/24/32/40/48h) of 15 per enamel type and demineralized using a partially saturated lactic acid solution. SMH was measured before and after demineralization and changes in indentation length (ΔIL) calculated. Lesions were characterized using TMR. Data were analyzed (two-way ANOVA) and Pearson correlation coefficients calculated. RESULTS: ΔIL increased with increasing demineralization times but plateaued after 40h, whereas lesion depth (L) and integrated mineral loss (ΔZ) increased almost linearly throughout. No differences between Knoop and Vickers SMH in their ability to measure enamel demineralization were observed as both correlated strongly. Overall, ΔIL correlated strongly with ΔZ and L but only moderately with the degree of surface zone mineralization, whereas ΔZ and L correlated strongly. Bovine demineralized faster than human enamel (all techniques). CONCLUSIONS: Lesions in bovine formed faster than in human enamel, although the resulting lesions were almost indistinguishable in their mineral distribution characteristics. Early caries lesion demineralization can be sufficiently studied by SMH, but its limitations on the assessment of the mineral status of more demineralized lesions must be considered. Ideally, complementary techniques to assess changes in both physical and chemical lesion characteristics would be employed.

Resin bonding using etch-and-rinse and self-etch adhesives to decalcified deciduous enamel after bioactive glass air abrasion.

PURPOSE: Bioactive glass air abrasion is a conservative technique for removal of initial decalcified enamel superficial layer and caries vs alumina air abrasion. This study evaluated shear bond strength of composite resin to sound and decalcified deciduous enamel using etch-and-rinse and self-etch adhesives after alumina and bioactive glass air abrasion. MATERIALS AND METHODS: Ninety-six fat enamel surfaces, mounted in acrylic resin, were prepared from 48 deciduous molars. Half of the specimens were decalcified with a demineralizing solution. Both intact and decalcified specimens were assigned to two groups for alumina and bioactive glass air abrasion. In each group, the specimens were subdivided into two groups for application of Clearfil SE Bond or Optibond FL adhesives (n = 12). After composite resin bonding, the specimens underwent shear bond test. Data were analyzed using three-way analysis of variance (ANOVA), linear regression model and independent-sample t-test (α = 0.05). RESULTS: No significant differences were noted in bond strength of composite resin after alumina or bioactive glass air abrasion (p = 0.272). Optibond FL adhesive and enamel decalcification produced higher bond strength (p = 0.000, p = 0.001 respectively). CONCLUSION: In this study, bioactive glass air abrasion produced bond strength comparable to the conventional method. This technique might be an alternative method for preparation of normal and/or decalcified enamel of deciduous teeth for resin bonding.

Dentin decalcification during lithium treatment: case report.

Severe dental decay and changes in tooth structure have been reported in association with the use of lithium in Psychiatry, but lithium effects on tooth inorganic composition remain unknown. A 30-year-old woman with bipolar disorder, treated with lithium carbonate presented severe dental decay. Dentin samples from lithium and healthy volunteers were collected and submitted to ionic and ultrastructural analysis. Samples from the lithium patient exhibited irregular peritubular walls and the mineral crystals were irregularly arranged in the intertubular dentin. In addition, a decrease in Mg/P/Ca and an increase of Zn concentrations were detected. These data suggest that the severe dental decay and changes in the tooth structure observed for the lithium-treated patient are related to dentin mineral loss and that this pathological condition is different from caries lesions.

Effect of resin composites with sodium trimetaphosphate with or without fluoride on hardness, ion release and enamel demineralization.

PURPOSE: To evaluate the effect of the addition of sodium trimetaphosphate (TMP) with or without fluoride on enamel demineralization, and the hardness and release of fluoride and TMP of resin composites. METHODS: Bovine enamel slabs (4 x 3 x 3 mm) were prepared and selected based on initial surface hardness (n = 96). Eight experimental resin composites were formulated, according to the combination of TMP and sodium fluoride (NaF): TMP/NaF-free (control), 1.6% sodium fluoride (NaF), and 1.5%, 14.1% and 36.8% TMP with and without 1.6% NaF. Resin composite specimens (n = 24) were attached to the enamel slabs with wax and the sets were subjected to pH cycling. Next, surface and cross-sectional hardness and fluoride content of enamel as well as fluoride and TMP release and hardness of the materials were evaluated. Data were statistically analyzed using ANOVA (P < 0.05). RESULTS: The presence of fluoride in enamel was similar in fluoridated resin composites (P > 0.05), but higher than in the other materials (P < 0.05). The combination of 14.1% TMP and fluoride resulted in less demineralization, especially on lesion surface (P < 0.05). The presence of TMP increased fluoride release from the materials and reduced their hardness.

Site specific properties of carious dentin matrices biomodified with collagen cross-linkers.

PURPOSE: To assess in non-cavitated carious teeth the mechanical properties of dentin matrix by measuring its reduced modulus of elasticity and the effect of dentin biomodification strategies on three dentin matrix zones: caries-affected, apparently normal dentin below caries-affected zone and sound dentin far from carious site. METHODS: Nano-indentations were performed on dentin matrices of carious molars before and after surface modification using known cross-linking agents (glutaraldehyde, proanthocyanidins from grape seed extract and carbodiimide). RESULTS: Statistically significant differences were observed between dentin zones of demineralized dentin prior to surface biomodification (P < 0.05). Following surface modification, there were no statistically significant differences between dentin zones (P < 0.05). An average increase of 30-fold, 2-fold and 2.2-fold of the reduced modulus of elasticity was observed following treatments of the three dentin zones with proanthocyanidin, carbodiimide and glutaraldehyde, respectively.

The color change in artificial white spot lesions measured using a spectroradiometer.

OBJECTIVES: The purpose of this study was to determine the color of white spot lesions. MATERIALS AND METHODS: Human premolars were subjected to a pH cycling to produce artificial caries lesions and classified into groups (n = 10/group): group 1, immersion in deionized water; group 2, pH cycling without fluoride (F) application; group 3, pH cycling with immersion in 1,000 ppm NaF solution; and group 4, pH cycling with immersion in 5,000 ppm NaF solution. CIE L*a*b* color parameters of the tooth were determined using a spectroradiometer at baseline, after demineralization and after pH cycling. The extent of demineralization was evaluated by scanning electron microscopy (SEM) and electron microprobe analysis (EPMA). RESULTS: Significant degrees of color change (ΔE*) were observed after demineralization (p < 0.05). The changes were mainly due to an increase in lightness (L*) and a decrease in yellowness (b*). F application induced a significantly large ΔE* in group 4 (p < 0.05). The color reversal after remineralization was mostly due to the recovery of L*. SEM and EPMA verified that net mineral gains occurred in the subsurface lesions. CONCLUSIONS: The initially white appearance of enamel caries was a result of changes of L* and b*. F treatment partially restored the color of white spot lesions. CLINICAL RELEVANCE: F-driven remineralization induced both mineral gains and esthetic enhancement of artificially produced enamel white spot lesions. The increase of L* and the decrease of b* contributed to the color changes.

Comparative evaluation of the remineralising effects and surface microhardness of glass ionomer cement containing grape seed extract and casein phosphopeptide - amorphous calcium phosphate: an in vitro study.

AIM: To evaluate and compare in vitro the remineralising effects and surface microhardness of glass ionomer cement (GIC), GIC containing grape seed extract and GIC containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP). METHODS: An in vitro study with 45 mandibular premolars with standardised class V cavities prepared on the buccal and lingual surfaces. Artificial caries-like lesions were created and teeth were randomly divided into 3 groups of 15 teeth each. Each tooth was sectioned longitudinally into buccal and lingual halves; lingual half was used as control and the other as the test specimen. Axial longitudinal sections of the control specimens were analysed under polarised light microscopy. The experimental halves were restored with 3 materials. Group I: glass ionomer cement (GIC), Group II: 10% (w/w) grape seed extract and GIC (GSGIC), Group III: 10% (w/w) casein phosphopeptide-amorphous calcium phosphate (Recaldent) and GIC (CPPGIC). The restored tooth specimens were exposed to pH cycling for 28 days and analysed again for remineralisation under polarised microscopy. For the second part of the study, 60 cylindrical specimens (20 each) were made using standardised brass moulds and the three experimental materials. The specimens were immersed individually in de-ionised water. After 7 days of immersion, 10 specimens from each group were subjected to microhardness measurements and repeated on the remaining specimens at the end of 30 days. STATISTICS: One way ANOVA and post-hoc Tukey's test were used for statistical analysis. RESULTS: CPPGIC showed the greatest remineralisation followed by GSGIC and least for GIC. Comparisons of microhardness between the three groups were not statistically significant. CONCLUSION: Grape seed extract and CPPACP can be used for remineralisation of damaged dentine and their incorporation into GIC does not compromise the microhardness properties significantly.

In vitro evaluation of the effects of a fluoride-releasing composite on enamel demineralization around brackets.

OBJECTIVES: The aim of this in vitro study was to evaluate the effectiveness of a fluoride-releasing bonding agent in inhibiting enamel demineralization around orthodontic brackets after the exposure to a demineralizing solution. MATERIALS AND METHODS: Twenty-six extracted upper molars were bonded with two different composites: Transbond XT (TXT) and Transbond Plus (TPlus), fluoride-releasing (both 3M Unitek, Monrovia, CA, USA). The samples were exposed to an acid lactic solution for three days and then subjected to Metallographic Optical Microscope (MOM) and Scanning Electron Microscope/Energy Dispersive X-Ray (SEM/EDX) analyses. Enamel surface was examined in different areas: un-treated, etched and primer-painted, un-treated area with no acid exposure, central area with bracket bonded. The maximum demineralization depths and the fluoride content at 100, 200 and 300 µm depth were evaluated. RESULTS: MOM analysis showed statistically significant (p<0.001) differences in demineralization depth for TPlus group compared to TXT group with lower values for the first one. EDX analysis confirmed the presence of fluoride in TPlus group. CONCLUSIONS: The fluoride content of TPlus appeared able to weakly reduce the enamel demineralization.

Mechanical and micromorphological evaluation of chlorhexidine-mediated dentin remineralization.

Chlorhexidine (CHX) has been reported to reduce self-degradation of collagen fibrils by inhibiting host-derived protease activity in demineralized dentin. Theoretically, if the collagen fibril scaffold of demineralized dentin maintains its original crosslinkage pattern on treatment with CHX and appropriate supplementation with necessary mineral sources, dentin remineralization may occur in demineralized lesions. In this study, we provide direct mechanical and micromorphological evidence for the ability of CHX to promote remineralization of demineralized dentin. Specifically, with respect to demineralized dentin blocks treated with different concentrations of CHX (0.02-2%) and stored in simulated body fluid, we have observed a significant increase in the elastic modulus of dentin treated with relatively high concentrations of CHX (0.2 and 2%) as storage time increased, whereas the elastic modulus of the non-CHX treated control group decreased. We have also observed a dense mineral deposition along collagen fibrils in the dentin group treated with 0.2 and 2% CHX via field emission scanning electron microscopy.

Biomimetic approach for root caries prevention using a proanthocyanidin-rich agent.

The aim of this study was to evaluate the effects of a proanthocyanidin-rich grape seed extract (GSE) on the in vitro demineralization of root dentine. Root fragments were obtained from sound human teeth. The fragments were randomly assigned to different treatments solutions: GSE, fluoride (F), GSE+F and distilled water (control). Samples were treated daily for 30 min and subjected to a pH cycling artificial caries protocol using demineralization cycles (2.2 mM CaCl(2)×H(2)O, 2.2 mM KH(2)PO(4), 50 mM acetic acid, pH 4.3) for 6 h and remineralization cycles (20 mM HEPES, 2.25 mM CaCl(2)×H(2)O, 1.35 mM KH(2)PO(4), 130 mM KCl, pH 7.0) for 17.5 h. Mineral loss (ΔZ) and lesion depth (LD) were determined after 18 days of treatment/pH cycling, by transverse microradiography. GSE was able to minimize ΔZ and LD compared with the control group (p < 0.0001). The GSE+F and F groups showed the lowest values of ΔZ and LD (p < 0.05), with no statistically significant differences between them (p = 0.554 and p = 0.726, respectively). A biomimetic approach to strengthen root dentine using GSE results in decreased rates of root demineralization and may be used in conjunction with F to prevent root caries.

Exposure to lead exacerbates dental fluorosis.

AIM: Our aim was to test the hypothesis that co-exposure to lead and fluoride alter the severity of enamel fluorosis. MATERIALS AND METHODS: Wistar rats were allocated in four groups: control, and 3 groups that received water containing 100 ppm of fluoride (F), 30 ppm of lead (Pb), or 100 ppm of F and 30 ppm of Pb (F+Pb) from the beginning of gestation. Enamel analysis and F and Pb determinations in enamel, dentine, and bone were performed in 81-day-old animals. Fluorosis was quantified using a new fluorosis index based on the identification of incisor enamel defects (white bands and white islets, representing hypomineralization, and cavities) weighted according to their severity and quantity. Hypomineralization was validated histopathologically by polarizing microscopy and microradiography. Scores were given by two blinded calibrated examiners (intra and interexaminer kappa values were 0.8 and 0.86, respectively). RESULTS: The control and the Pb groups presented normal enamel. The F+Pb group presented more severe enamel defects compared with the F group (P<0.0001). CONCLUSIONS: This study shows that lead exacerbates dental fluorosis in rodents, suggesting that co-exposure to lead may affect the degree of fluorosis.

Minimally invasive caries removal using bio-active glass air-abrasion.

OBJECTIVES: Alumina air-abrasion has been used to clean teeth and shown to over-prepare access cavity preparation to caries. This study investigated the working hypothesis that bio-active glass air-abrasion is more self-limiting than alumina for minimally invasive caries removal. METHODS: Human extracted molars were scored visually using ICDAS II criteria, divided into sound and carious groups and air-abraded with alumina (n=10) and bio-active glass (n=10) in each group, using identical operating parameters. The amount of enamel removed was semi-quantitatively assessed using scanning electron microscopy. Operating time was recorded. RESULTS: Bio-active glass abrasion removed extrinsic stain and substantial quantities of enamel from all carious fissures but not from sound, where only minimal microscopic surface modifications were observed. Alumina air-abrasion resulted in faster extrinsic stain and clinically substantial enamel removal in both sound and carious groups equally. CONCLUSIONS: Bio-active glass air-abrasion appeared to show a significant self-limiting tendency towards demineralised enamel and extrinsic stain removal but was slower in comparison to alumina air-abrasion. Self-limiting bio-active glass air-abrasion could be used clinically to clean teeth, detect caries and minimally prepare carious enamel as part of MI caries access or placing a sealant restoration.

An in vitro evaluation of selective demineralised enamel removal using bio-active glass air abrasion.

Unnecessary over-preparation of carious enamel often occurs clinically during operative caries management. The working hypothesis to be investigated in this study is the potential for bio-active glass air abrasion to remove selectively only demineralised enamel in artificial enamel lesions when compared to equivalent alumina air abrasion, so potentially minimising cavity over-preparation. Bisected artificial, paired smooth surface enamel lesions on ethics-approved, extracted sound human molars were created and subsequently air abraded with 27 µm alumina (n = 19) and bio-active glass (n = 19). The difference between pre-operative lesion boundary and post-operative cavity margin was calculated following optical confocal fluorescent assessment of the lesion boundary. Data indicated mean% over-preparation (sound enamel removal) of 176% with alumina and 15.2% for bio-active glass (p = 0.005). Bio-active glass abrasion removed completely the demineralised enamel from artificial lesions with clinically insignificant over-preparation of sound tissue, indicating technique selectivity towards grossly demineralised enamel. Alumina air abrasion resulted in substantial enamel removal in both sound and demineralised tissues indicating the operator selectivity required to use the techniques effectively in clinical practice.

Combined effects of nano-hydroxyapatite and Galla chinensis on remineralisation of initial enamel lesion in vitro.

OBJECTIVES: The aim of the present study was to investigate the combined effects of nano-hydroxyapatite and Galla chinensis on remineralisation of initial enamel lesion. METHODS: Bovine enamel blocks with in vitro produced initial lesion were used. The lesions were subjected to a pH-cycling regime for 12 days. Each daily cycle includes 4 x 3 min application with one of five treatments: NaF (positive control), deionised water (negative control), crude aqueous extract of G. chinensis (GCE), nano-hydroxyapatite (nano-HA) and GCE with nano-HA. The samples were subsequently evaluated using a microhardness tester, polarised light microscopy (PLM), X-ray diffraction (XRD) and scanning electron microscopy (SEM). RESULTS: Surface hardness measurements and integrated mineral recovery value obtained from cross-sectional microhardness test (CSMH) revealed that all the treatment groups had significantly greater effect on enhancing remineralisation than that of the negative control group. Detailed investigation of both CSMH and PLM indicated that nano-HA would only help mineral deposition predominate in the outer layer of lesion and had limited capacity to reduce the lesion depth significantly. In GCE-nano-HA combined treatment group, more mineral deposition occurred in the lesion body and lesion depth was reduced significantly. Meanwhile, significantly greater mineral deposition in the outer portion of the lesion was also observed in comparison with GCE group. The results of XRD and SEM also showed that GCE could influence the deposition and adsorption of nano-HA. CONCLUSION: There was a significant synergistic effect of combined GCE and nano-HA treatment on promoting the remineralisation of initial enamel lesion.

Changes in surface morphology and mineralization level of human enamel following in-office bleaching with 35% hydrogen peroxide and light irradiation.

The objective of this study was to evaluate the alterations on surface morphology and mineral loss of human enamel following in-office bleaching with 35% hydrogen peroxide and light irradiation. Dental enamel samples were obtained from human third molars and randomly divided into 10 groups (n = 10). The control group remained untreated. Bleached groups were treated with one of three whitening products. Bleaching was performed in a single session, during which bleaching gel was applied to the enamel surface three times for 10 minutes each time. During treatment, the bleaching agents were either irradiated by a halogen light or an LED/diode laser or were not irradiated at all. Microhardness testing was performed with a Knoop indentor and the surface morphologic observations were carried out by scanning electron microscopy (SEM). Cross-sectional microhardness (CSMH) and polarized light microscopy (PLM) were used to measure the depth of demineralization. The results revealed a significant decrease in surface microhardness values and changes to the enamel morphology after bleaching. CSMH and PLM showed that bleached enamel presented lower volume percentage of mineral up to 40 micrometers from the enamel surface and demineralization areas located in the subsuperficial region of enamel, respectively. It was concluded that 35% hydrogen peroxide can alter the surface morphology and the mineralization level of the dental enamel surface and sub-surface regardless of what type of bleaching light is used.

Influence of the irradiation distance and the use of cooling to increase enamel-acid resistance with Er:YAG laser.

OBJECTIVES: The aim of this study was to assess the influence of irradiation distance and the use of cooling in the Er:YAG laser efficacy in preventing enamel demineralization. METHODS: 84 enamel blocks were randomly assigned to seven groups (n=12): G1: control group - no treatment, G2-G7: experimental groups treated with Er:YAG laser (80mJ/2Hz) at different irradiation distances with or without cooling: G2: 4mm/2mL; G3: 4mm/no cooling; G4: 8mm/2mL; G5: 8mm/no cooling; G6: 16mm/2mL; G7: 16mm/no cooling. The samples were submitted to an in vitro pH cycles for 14 days. Next, the specimens were sectioned in sections of 80-100microm in thickness and the demineralization patterns of prepared slices were assessed using a polarized light microscope. Three samples from each group were analyzed with scanning electronic microscopy. Analysis of variance and the Fisher test were performed for the statistical analysis of the data obtained from the caries-lesion-depth measurements (CLDM) (alpha=5%). RESULTS: The control group (CLDM=0.67mm) was statistically different from group 2 (CLDM=0.42mm), which presented a smaller lesion depth, and group 6 (0.91mm), which presented a greater lesion depth. The results of groups 3 (CLDM=0.74mm), 4 (CLDM=0.70mm), 5 (CLDM=0.67mm) and 7 (CLDM=0.89mm) presented statistical similarity. The scanning electronic microscopy analysis showed ablation areas in the samples from groups 4, 5, 6 and 7, and a slightly demineralized area in group 2. CONCLUSIONS: It was possible to conclude that Er:YAG laser was efficient in preventing enamel demineralization at a 4-mm irradiation distance using cooling.

Morphological and chemical characterization of tooth enamel exposed to alkaline agents.

OBJECTIVES: In this study, morphological and chemical changes in teeth enamel exposed to alkaline agents, with or without surfactants, have been investigated. In addition, chemical effects of the organic surface layer, i.e. plaque and pellicle, were also investigated. METHODS: The present study was conducted using several techniques: Fourier transform infrared spectroscopy (FTIR), X-ray photoelectron spectroscopy (XPS), X-ray diffraction (XRD) and scanning electron microscopy (SEM). RESULTS: From XPS-measurements, it was found that exposure to alkaline solutions resulted in a massive removal of carbon from the tooth surface, and that the addition of surfactants increased the rate under present conditions. Based on the results from the FTIR-analysis, no substitution reactions between phosphate, carbonate and hydroxide ions in the enamel apatite could be detected. From a minor SEM-analysis, degradation and loss of substance of the enamel surface was found for the exposed samples. From XRD-analysis, no changes in crystallinity of the enamel apatite could be found between the samples. CONCLUSIONS: The findings in this study show that exposure to alkaline solutions results in a degradation of enamel surfaces very dissimilar from acidic erosion. No significant erosion or chemical substitution of the apatite crystals themselves could be discerned. However, significant loss of organic carbon at the enamel surface was found in all exposed samples. The degradation of the protective organic layer at the enamel surface may profoundly increase the risk for caries and dental erosion from acidic foods and beverages.