Caries and fluoride processes

OBJECTIVES: The purpose of the work was to establish the level and source of salivary fluoride, whether it could interact with tooth mineral and whether it was able to effect calcium re-acquisition and remineralisation. METHODS: Fluoride in saliva and in solution was measured by electrode, calcium by complexometric titration and phosphate colourimetrically-to measure salivary fluoride, its uptake by mineral and the effects of such low levels on calcium and phosphate levels in solution in contact with suspensions of mineral hydroxyapatite. RESULTS: Fluoride levels in saliva were low but could interact with hydroxyapatite. Such levels caused apatite crystallite growth and preferential acquisition of calcium by calcium-deficient apatite. CONCLUSIONS: Salivary fluoride contents rose with increasing water fluoride levels. It was acquired by hydroxyapatite mineral. Topical fluoride was stored on oral tissues. Even these low fluoride contents could cause mineral crystallite growth with preferential calcium uptake. On a mineral area basis these effects were caused by quite low fluoride uptakes. These findings do not support reliance upon large fluoride uptakes by tooth enamel as evidence for commensurate caries reductions.     

Study of the fluoridated adhesive resin cement--fluoride release, fluoride uptake and acid resistance of tooth structures.

The objectives of this study, were to evaluate the fluoride release from fluoridate adhesive resin cement, fluoride uptake into surrounding tooth structures and the effect of their acid resistance. Several specimens were prepared using a plastic ring mould, from extracted human premolars, and prepared from enamel and dentin of the central area of the buccal surface of bovine teeth. The fluoride release rate of fluoridate adhesive resin cement (PN 200) per day was higher than other materials during the 7-day study period. Fluoride released and fluoride uptake by tooth structures was higher in the fluoridate adhesive resin cement. WDX analysis showed the fluoride concentration on dentin contact area was higher than that of enamel after 60 days of immersion in deionized water. The calcium release values were similar for enamel and dentin plates in the various test materials. The present findings indicated the important enhancement of tooth structure acid resistance by fluoridate material.     

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提要：牙齿防龋用氟化物涂膜是一种用于牙齿表面的含氟涂膜材料，一般由成膜材料、氟化物和挥发性溶剂组成， 分为稀糊剂型、悬浮液型和溶液型3种类型。涂于牙齿表面后，氟化物涂膜能在牙齿表面附着一段时间，期间能缓慢释放氟离子。释放的氟离子能进入釉质内，形成氟磷灰石，同时在釉质表面形成氟化钙沉积层，从而提高牙釉质抗酸蚀能力。     

Enamel fluoride in relation to severity of human dental fluorosis

The aim of this study was to test whether the concentrations of fluoride in fluorotic human enamel are related to the degree of severity of dental fluorosis classified according to the index described by Thylstrup and Fejerskov. Teeth representing the entire spectrum of human dental fluorosis were analyzed. Fluoride concentrations were determined by serial acid-etching from surface to interior of blocks of enamel cut from each tooth. Fluoride was measured by ion electrode and calcium by atomic absorption spectrophotometry. The results showed that the pattern of distribution of fluorotic enamel is similar to that described for normal enamel. Increasing severity of fluorotic lesions was associated with increasing concentrations of fluoride throughout the enamel. It is concluded that although further studies are required to establish the relative contribution of fluoride which may be taken up posteruptively by fluorotic enamel, the findings support the hypothesis that the TF index reflects increasing exposure to fluoride during tooth development.     

Fluoride and calcium release from peppermint-flavored fluoride varnish containing dicalcium-phosphate-dihydrate coated with xylitol

Bakground: Fluoride varnish with high initial fluoride and calcium release can help patients with high-risk caries. Ample quantities of free fluoride and calcium ions in the oral cavity can enhance enamel remineralization. This study aimed to investigate the effect of dicalcium phosphate dihydrate coated with xylitol (DCPD-xylitol), in fluoride varnish, on the release of fluoride and calcium ions in the oral cavity.Materials and methodsDCPD powder with xylitol was synthesized by preparing a 60% xylitol solution and mixed it with DCPD solution. The mixture was stirred for 1 h at room temperature and dried at 80 °C for 18 h to reduce the water content. Then, the powder was used in the formulation of peppermint-flavored fluoride varnish as an active agent. The amounts of fluoride and calcium ion released in deionized water at 37 °C for 6 h were assessed with an ion-selective electrode. The cumulative fluoride and calcium ion release data were analyzed using one-way analysis of variance (ANOVA) and the post hoc Tukey test with α = 0.05.ResultsThe results showed that the addition of DCPD coated with xylitol provided better bioavailability of the ions than DCPD without coating. Peppermint-flavored fluoride varnish (PFFV) with DCPD-xylitol 1% gave the highest fluoride ion release (296.90 mg/L) compared to the varnishes with other xylitol concentrations and the positive control. In contrast, PFFV DCPD-xylitol 5% afforded the highest calcium ion release at 111.20 mg/L.ConclusionsThis study concluded that xylitol affects the bioavailability of free fluoride and calcium ions in varnishes. However, the efficacy of fluoride and calcium uptake in enamel and under different in vitro media conditions requires further investigation.     

Fluoride enhancement of chlorhexidine uptake by hydroxyapatite and enamel powders

The purpose of the present study was to examine the in vitro adsorption of chlorhexidine and fluoride to hydroxyapatite and tooth enamel powders. Samples of hydroxyapatite or enamel powder were suspended in aqueous solutions of chlorhexidine gluconate 2.0; chlorhexidine acetate 1.5%; sodium fluoride of various concentrations (0.2%, 1%, 2%) and mixtures of sodium fluoride and chlorhexidine. The data obtained in the study show that chlorhexidine and fluoride adsorb to hydroxyapatite and tooth enamel in vitro. Furthermore, the amount of fluoride adsorbed to hydroxyapatite is reduced in the presence of chlorhexidine in the solution. A probable explanation for this effect may be that there is a competitive adsorption of fluoride and chlorhexidine on to the same binding sites on the hydroxyapatite. Additionally, the presence of fluoride dramatically increases the affinity of chlorhexidine for hydroxyapatite. The fact that fluoride strongly enhanced the adsorption of chlorhexidine to hydroxyapatite and enamel, indicates that fluoride may be of clinical interest beyond the prevention of caries.     

Effect of fluoride on artificial caries lesion progression and repair in human enamel: regulation of mineral deposition and dissolution under in vivo-like conditions

OBJECTIVE: This study was carried out to determine in vitro the effect of fluoride on (1) the demineralization of sound human enamel and (2) the progression of artificial caries-like lesions, under relevant oral conditions. METHODS: Thin sections of sound human enamel were exposed to solutions undersaturated with respect to tooth enamel to a degree similar to that found in dental plaque fluid following sucrose exposure in vivo, containing fluoride concentrations (0-0.38ppm) found in plaque fluid. Mineral changes were monitored for 98 days, using quantitative microradiography. The effect of fluoride (1.0-25.0ppm) on the progression of artificial caries-like lesions was similarly studied. RESULTS: Fluoride concentrations of 0.19ppm and greater were found to prevent the demineralization of sound enamel in vitro. However, significantly higher concentrations of fluoride (25.0ppm) were required to prevent further demineralization of artificial caries-like lesions. Demineralizing solutions with intermediate fluoride concentrations (2.1-10.1ppm) induced simultaneously remineralization in the outer portion of the lesion and demineralization in the inner portion. Simultaneous remineralization and demineralization were also observed in hydroxyapatite pellets. CONCLUSIONS: Our results show that the observed effect of fluoride on enamel demineralization is not solely a function of bulk solution properties, but also depends on the caries-status of the enamel surface. A mechanistic model presented indicates that, in comparison to sound enamel surfaces, higher concentrations of fluoride are required to prevent the progression of artificial caries-like lesions under in vivo-like conditions since the diffusion of mineral ions that promote remineralization is rate-limiting.     

Fluoride acquisition on and in human enamel during topical application in vitro

Abstract – Fluoride acquisition during topical fluoride treatment was studied after different time intervals, at different concentrations and at different pH. The effects of pretreating the enamel with Ca⁺⁺, and of pre-etching were also tested. Four experimental groups of repeated measures design were established. Chemical assessments were made of the amounts of fluoride formed on (as alkali soluble fluoride, i.e., calcium fluoride) and in enamel (as firmly bound fluoride). The depositions on enamel were also demonstrated by SEM. The amounts of alkali soluble fluoride on enamel increased with time, concentration, pH-decrease and calcium availability. The time of exposure seemed to be the major factor. The amounts of fluoride deposited on enamel outranged by far (>70%) the amounts of fluoride acquired in the enamel. The formation of alkali soluble fluoride on enamel is probably limited by the availability of calcium ions. It is suggested that the fluoride on enamel may protect the enamel surface and serve as a reservoir of fluoride.     

Surface adsorption of fluoride and ionic exchange reactions on hydroxyapatite.

The experiments showed that a part of the fluoride which was taken up by hydroxyapatite or teeth at low concentrations of fluoride at neutral pH was soluble in alkali (IN KOH, 24 h) and was thus not fluoroapatite. Calcium fluoride could not form under the present conditions because the solubility of this compound was not exceeded. It is suggested that the alkali soluble fluoride is adsorbed to calcium ions bound as counterions in the hydration layer of the hydroxyapatite or the enamel. This is consistent with previous findings in this laboratory, showing that fluoride displaced acidic proteins adsorbed to calcium receptors on the hydroxyapatite surface in the same way as other anions displace proteins. It could also be shown that polyanions and polycations adsorbed to hydroxyapatite surfaces by ionic exchange, displacing phosphate or phosphate and calcium respectively in the process. A model is suggested which differs slightly from that proposed by Bernardi.     

Fluoride acquisition on and in human enamel during topical application in vitro

Fluoride acquisition during topical fluoride treatment was studied after different time intervals, at different concentrations and at different pH. The effects of pretreating the enamel with Ca++, and of pre-etching were also tested. Four experimental groups of repeated measures design were established. Chemical assessments were made of the amounts of fluoride formed on (as alkali soluble fluoride, i.e., calcium fluoride) and in enamel (as firmly bound fluoride). The depositions on enamel were also demonstrated by SEM. The amounts of alkali soluble fluoride on enamel increased with time, concentration, pH-decrease and calcium availability. The time of exposure seemed to be the major factor. The amounts of fluoride deposited on enamel outranged by far (greater than 70%) the amounts of fluoride acquired in the enamel. The formation of alkali soluble fluoride on enamel is probably limited by the availability of calcium ions. It is suggested that the fluoride on enamel may protect the enamel surface and serve as a reservoir of fluoride.     

In vitro efficacy of a whitening toothpastecontaining calcium carbonate and perlite

Objectives : The studies described in this paper aimed to assess the stain removal efficacy, fluoride efficacy and abrasivity to enamel and dentine of a new whitening toothpaste containing calcium carbonate and perlite, using appropriate in vitro models. Methods : Stain removal efficacy was assessed using the pellicle cleaning ratio (PCR) method. Fluoride efficacy was assessed using remineralisation, demineralisation and fluoride‐uptake methods. Abrasivity was assessed using an enamel and dentine wear method. Results : The results showed that the new whitening toothpaste was able to remove extrinsic tooth stain more effectively than three commercially available toothpaste formulations. The fluoride efficacy was superior to a non‐fluoridated control and was not significantly different to a clinically tested fluoride‐containing toothpaste. The abrasivity data showed that the calcium carbonate/perlite toothpaste is no more abrasive to enamel or dentine than two other commercially available whitening toothpastes. Conclusions : The studies show that the new whitening toothpaste is effective in extrinsic stain removal, has an efficacious fluoride source and does not have an undue degree of abrasivity to enamel or dentine compared to other relevant commercially available products.     

Current concepts on the theories of the mechanism of action of fluoride

The caries-preventive effect of fluoride is mainly attributed to the effects on demineralization/remineralization at the tooth oral fluids interface. Sub ppm levels of fluoride in saliva are effective in shifting the balance from demineralization, leading to caries, to remineralization. This is attributed to the fluoride-enhanced precipitation of calcium phosphates, and the formation of fluorhydroxyapatite in the dental tissues. Low fluoride levels are found in saliva after toothbrushing with fluoride containing dentifrices. Similar concentrations are ineffective in interfering with processes of growth and metabolism of bacteria, and also do not result in a significantly reduced dissolution of tooth mineral as a result of (firmly bound) fluoride incorporation. Comparative studies of fluoride efficacy have shown that higher concentrations in solution are needed in pH-cycling studies of dentine than in enamel to maintain the mineral balance or to induce remineralization. This is attributed to the greater solubility of the dentine and the smaller size of the dentine crystallites compared to enamel. Fluoride slow-release devices, in the form of fluoride-releasing restorative materials, may serve to increase the fluoride levels in saliva and plaque to levels at which caries can be prevented, also in high-risk patients. Research questions for the next millennium and future perspectives for fluoride applications should be found in the retention and slow release of fluoride after various combinations of fluoride treatment, the combination of fluoride and anti-microbial treatment, the individualization of caries prevention, and the combination of preventive schemes with new developments in caries diagnosis.     

Fluoride profiles in dental plaque in vivo formed on fluoride pre-treated human enamel

Using a novel device capable of generating plaque in vivo on a natural enamel substrate, it has been possible to determine fluoride profiles from the saliva-plaque interface towards the enamel surface. Fluoride profiles in dental plaques tended to fall from the saliva-plaque interface towards the enamel. The device also offered the possibility of examining fluoride distributions after pre-treatment of the enamel with fluoride in vitro. Fluoride profiles were determined in plaque generated in vivo on enamel surfaces, which had been previously treated with a 900-ppm fluoride solution. The results showed the previously reported fall from the plaque surface, but in addition, a further rise towards the enamel surface was seen. The data imply that enamel loaded with fluoride can release some of this fluoride back into the plaque and may act as a fluoride reservoir.     

4种防龋方法在固定矫治中预防牙釉质脱矿的研究

目的:比较4种防龋方法在正畸固定矫治中预防牙釉质脱矿的效果.方法:采用固定矫治器矫治的200名患者随机分为4组(n=50),分别用普通牙膏、含氟牙膏、氟保护漆和护牙素对牙釉质进行处理,定期随访,比较矫治完成后4组患者的牙釉质脱矿情况.结果:按牙齿数计算含氟牙膏、普通牙膏、氟保护漆和护牙素4组牙釉质的脱矿率分别为16.3％、21.9％、9.3％和8.5％ (x2=99.7,P=0.000001)氟保护漆和护牙素组脱矿率低于其他2组,该2组脱矿率之间的差异无统计学意义(x2=0.39,P=0.529851).结论:应用含氟制剂可以有效预防固定矫治中牙釉质脱矿的发生,护牙素和氟保护漆的效果更明显.     

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氟是人体可能必需的微量元素,适量摄入可对机体代谢产生积极影响。氟亦可通过降低釉质溶解度和促进再矿化、对微生物产生作用达到预防龋病的目的。氟化物应用可分为全身应用和局部应用。目前在我国,局部用氟已成为广泛使用、安全有效的防龋方法之一。     

Distribution of fluoride in the enamel of rat incisors examined by an abrasive microsampling technique

This study was undertaken to reveal detailed changes in fluoride distribution at different developmental stages of upper incisor enamel under various fluoride administration regimes. Four groups of Wistar rats received water containing 0, 25, 50 and 100 parts/10(6) fluoride respectively for 10 weeks. Five different enamel specimens were removed from the developing enamel, excluding the matrix-formation stage. Fluoride distribution in each specimen was analysed from the surface to the enamel-dentine junction using an abrasive microsampling technique. Fluoride concentration was invariably highest at the surface and decreased sharply towards the interior at every site in both control and experimental groups. The concentration throughout the tissue increased with fluoride intake at each stage of development. The fluoride-gradient curves were similar at each of the different sites of tooth development. However, the fluoride concentration of the enamel interior was significantly higher at early maturation than at the other four sites.     

Fluoride uptake around cavity walls; two-dimensional mapping by electron probe microanalysis

This study reports fluoride uptake around the cavity wall of teeth by two-dimensional mapping. Fluoride concentration was measured using the wavelength dispersive x-ray analysis (WDX) method. The buccal cavity wall of a human tooth was coated five times with 2% sodium fluoride solution at three-day intervals for 12 days, and then immersed in a normal saline solution at 37 degrees C. After one month, the tooth was bisected longitudinally through the center of the cavity surface perpendicular to the axial wall. On the polished surface of the cut tooth, the fluoride concentration was measured. Fluoride distribution maps around the cavity wall were drawn using a bundle of the observed analytical lines. Fluoride uptake from fluoride-releasing materials (conventional glass-ionomer cement, light-cured glass-ionomer cement, light-cured composite resin, light-cured bonding agent) around the cavity wall was investigated using the same method. The maps showed higher fluoride uptake in dentin than in enamel and a strong location dependence of fluoride uptake in a tooth, especially in the dentin. Fluoride uptake from the resin was greater than that from the cement. It was summarized from these results that a two-dimensional map of fluoride uptake can provide valuable information on the cariostatic properties of fluoride-releasing materials.     

Fluoride effect on the activity of enamel matrix proteinases in vitro

Dental fluorosis is common in individuals exposed to different sources of fluoride during tooth development. The mechanism causing this enamel defect is still unknown. Enamel matrix proteinases play a central role in the maturation of dental enamel, and inhibition of these enzymes by fluoride has been one explanation for dental fluorosis. We have investigated the effect of fluoride on the activity of enamel matrix proteinases using a colorimetric assay, casein zymography, and an enamel protein degradation assay. Fluoride (625 microM to 10 mM) inhibited neither the enzymatic activity of the crude matrix extract nor the activity of individual enamel enzymes separated by SDS-PAGE. The proposition that fluoride could directly inhibit enzymes was not confirmed in this study.     

Reversal of primary root caries using a dentifrice with a high fluoride content

Root caries is a widespread problem and can be quite serious in older populations. The restoration of root carious lesions is often difficult. Compared to enamel caries, there has been limited research into the pharmaceutical management of primary root caries lesions (PRCLs), and many of these studies have been carried out in vitro, with limited numbers of clinical trials. Fluoride is presently a cornerstone in dentifrice formulations for cost-effective and anticaries therapy. It is generally accepted that fluoride ions promote remineralization of tooth substances and reduce the rate of demineralization. The use of a dentifrice with a high fluoride content may be considered to reverse PRCLs, since more fluoride is required for the remineralization of roots than for enamel. This paper reviews the effects of dentifrices with high fluoride contents on the management of root caries.     

Mineral flux of surface enamel and root surfaces in acidified gelatin gels

Gels of crude gelatin were dialyzed to eliminate fluoride, and then acidified with 75 mM lactic and 25 mM acetic acid at pH 4.2 and interfaced with enamel and root surfaces in gel-surface ratio of 0.2 ml/0.15 cm2. Enamel and root surface to gel mineral flux was reduced by initial inclusion of 0.5 and 1.0 mM fluoride with 2.5 mM calcium and 1.5 mM phosphate in gels at pH 4.2. Inclusion of 0.25 mM fluoride in the gels without added mineral ions had no effect in the first 22-day interface. The 0.25, 0.5 and 1.0 mM fluoride remarkably increased remineralization in a second 12-day interface. This indicated that the first fluoride exposure initiated formation of fluorapatites in the enamel which required a lower degree of gel saturation for enhanced remineralization in the second acid exposure. Fluoride had the same effect, but greater effectiveness on enamel than root-surface remineralization. Gels of crude gelatin may contain sufficient mineral ions to alter remineralization-demineralization of enamel and root surface.