Penetration of fluoride into natural plaque biofilms

Caries occurs at inaccessible stagnation sites where plaque removal is difficult. Here, the penetration through plaque of protective components, such as fluoride, is likely to be crucial in caries inhibition. We hypothesized that topically applied fluoride would readily penetrate such plaque deposits. In this study, plaque biofilms generated in vivo on natural enamel surfaces were exposed to NaF (1000 ppm F-) for 30 or 120 sec (equivalent to toothbrushing) or for 30 min. Biofilms were then sectioned throughout their depth, and the fluoride content of each section was determined with the use of a fluoride electrode. Exposure to NaF for 30 or 120 sec increased plaque fluoride concentrations near the saliva interface, while concentrations near the enamel surface remained low. Fluoride penetration increased with duration of NaF exposure. Removal of exogenous fluoride resulted in fluoride loss and redistribution. Penetration of fluoride into plaque biofilms during brief topical exposure is restricted, which may limit anti-caries efficacy.     

Fluoride concentrations in unerupted fluorotic human enamel.

Unerupted fluorotic human enamel was obtained from teeth surgically removed from patients with dental fluorosis. Fluoride was measured in samples produced by serial acid etching from the surface to the interior of blocks of buccal and lingual enamel. The severity of fluorosis, according to the TF index, was determined from the macroscopic and microradiographic appearance of the specimens. The shape of the fluoride profiles was not affected by the degree of severity of fluorosis, but the fluoride concentrations increased with increasing severity of lesions. Fluoride concentrations were similar to those previously recorded in erupted fluorotic enamel and were not related to the length of time the teeth had been present in the jaws. It was concluded that the fluoride content of erupted fluorotic enamel represents fluoride acquired during tooth formation and that further uptake prior to eruption may be negligible.     

Effect of pH on fluoride penetration into natural human plaque

Since recent studies have demonstrated that penetration profiles of fluoride into plaque falls from the saliva plaque interface towards the enamel, it was hypothesized that charged components may restrict the inward diffusion of fluoride i.e., protonated fluoride and may penetrate more effectively than fluoride ion. Therefore, in this study, we investigated the effects of pH on fluoride uptake and distribution in natural undisturbed human plaque formed in vivo by means of the Leeds in situ device. At pH 3 significantly less fluoride was present throughout the plaque layer compared with pH 7. Similar profiles were seen in the plaque produced over 1 week and 3 weeks. These results may be due to binding to components of the plaque matrix via hydrogen bonding. Protonation of bacterial cell surfaces may also lead to binding of the ionized portion of fluoride. In conclusion, low pH affected the short-term fluoride uptake from a 1,000 ppm fluoride solution.     

Relationship between demineralization events in dental enamel and the pH and mineral content of plaque.

Acid production in dental plaque from fermentation of dietary carbohydrate does not necessarily lead to demineralization of the underlying enamel. In the past it has been understood that pH buffering by plaque constituents must be overcome to allow the pH to fall, and then the fall must be of sufficient magnitude to exceed a critical pH value, i.e. the point where plaque fluid is just saturated with respect to enamel mineral. An evaluation of the literature suggests, however, that the critical pH is not a fixed value. It changes slowly as enamel mineral solubility changes with repeated pH cycling. Further, plaque mineral ion sinks, in which ions are removed from solution (first described by Luoma in 1964) and ion reservoirs from which ions are added to solution, modulate the critical pH value during plaque pH fall and rise so that its exact value is difficult to predetermine. A solid phase calcium phosphate ion reservoir in plaque may saturate plaque fluid with respect to enamel mineral continuously as the pH falls so that the critical pH is never exceeded. Common ion repression of enamel mineral dissolution is likely to be effective in the order pH greater than Ca greater than P. Plaque fluoride influences enamel dissolution in more than one way. Simultaneous dissolution of hydroxyapatite and reprecipitation of fluorapatite, a process which results in apparent dissolution repression, is probably the most important mechanism initially. This process may coat individual enamel crystals with a F-rich layer so that, while the total F content is rather low, its effective solubility is more like that of fluorapatite. Fluoride in plaque fluid may then repress enamel mineral dissolution by common ion repression. If fluoride action follows this sequence efforts to build F into enamel clinically would be just as important as attempts to maintain F levels in plaque and saliva.     

Enamel microhardness and fluoride uptake underneath fermenting and non-fermenting artificial plaque.

Washed cells of Streptococcus sanguis were used to form artificial plaque on the surface of bovine enamel and incubated underneath buffer solutions, initial pH 6, for 36 h at 37 degrees C. The decrease in the microhardness of the enamel surface under fermenting "plaque" could be prevented with fluoride. Enamel under a fermenting "plaque" took up significantly more (P less than 0.0u) fluoride than enamel under a non-fermenting "plaque" (initial F- in buffer: 10 parts/10(6)). The artificial plaque did not accumulate fluoride. Within fermenting "plaques/, the pH decreased significantly more without flouride (P less than 0.01) than with fluoride. Fluoride combined with sucrose more than negated the softening of the enamel caused by sucrose fermentation, i.e. it increased the hardness above the original values. The diffusion of fluoride through the fermenting artificial plaque was more rapid than through a non-fermenting plaque. These findings suggest that caries-conducive circumstances may promote fluoride uptake by enamel compared with non-caries-conducive circumstances.     

Enamel microhardness and fluoride uptake underneath fermenting and non-fermenting artificial plaque

abstract – Washed cells of Streptococcus sanguis were used to form artificial plaque on the surface of bovine enamel and incubated underneath buffer solutions, initial pH 6, for 36 h at 37°C. The decrease in the microhardness of the enamel surface under fermenting "plaque" could be prevented with fluoride. Enamel under a fermenting "plaque" took up significantly more (P < 0.01) fluoride than enamel under a non-fermenting "plaque" (initial F⁻ in buffer: 10 parts/10⁶). The) artificial plaque did not accumulate fluoride. Within fermenting "plaques", the pH decreased significantly more without fluoride ( P <0.01) than with fluoride. Fluoride combined with sucrose more than negated the softening of the enamel caused by sucrose fermentation, i.e. it increased the hardness above the original values. The diffusion of fluoride through the fermenting artificial plaque was more rapid than through a non-fermenting plaque. These findings suggest that caries-conducive circumstances may promote fluoride uptake by enamel compared with non-caries-conducive circumstances.     

Enamel fluoride and caries in Icelandic children and a comparison of enamel fluoride in Swedish and Icelandic children

The fluoride content in surface enamel and its relationship to caries experience was studied in a group of Icelandic schoolchildren living in a low-fluoride area. Fluoride content was assessed by means of in vivo enamel biopsies sampled from 248 subjects aged 11 and 12 years. Dental examinations were performed in conjunction with the biopsy sampling and by the same examiner 1 year later. The prevalence and incidence of initial (DSI) and manifest (DFS) caries lesions were recorded separately. A median fluoride concentration of 610 ppm at a median biopsy depth of 4.2 microns was observed. A significant positive correlation was found between DSI and enamel fluoride content in girls and all older children. Additionally, surface enamel fluoride was measured in 72 Swedish children from a low-fluoride area but exposed to regular topical fluoride treatments. The difference in mean fluoride concentrations between the Icelandic and Swedish study populations was highly significant. From the measured fluoride concentrations the enamel fluoride profiles for both study populations were constructed. The differences in fluoride content were most pronounced in the outermost layer, apparently reflecting the higher exposure to and acquisition of topical fluoride in the Swedish children.     

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.     

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.     

Role of fluoride in oral health promotion

Fluoride has played a pivotal role in oral health promotion over the past 50 years. This paper reviews key issues currently impacting on the role of fluoride in preventing dental caries. The understanding of the process of dental caries and the mode of action of fluoride has changed in recent years. Dental caries is a continuous process of demineralisation and remineralization of the enamel and fluoride plays a key role in this process through its action at the plaque enamel interface. It is now accepted that the primary mode of action of fluoride is post-eruptive. The post-eruptive action of fluoride has resulted in new methods of delivering fluoride. The paper discusses the impact of these new methods of delivering fluoride on total fluoride intake in children and on the prevalence of dental fluorosis. The role of different methods of delivering fluoride both on a community and individual basis is presented and recommendations are outlined.     

Intra-oral retention of fluoride by bovine enamel from amine fluoride toothpaste and 0.4% amine fluoride liquid application

The purpose of this study was to compare in vivo fluoride accumulation in enamel and in enamel lesions from a single topical fluoride application and daily toothbrushing with a fluoride dentifrice. Amine fluoride preparations were used for both products. Intra-oral appliances with bovine enamel specimens were worn by volunteers during a period of seven weeks. After this period, the specimens were analyzed for fluoride uptake and change in demineralization susceptibility. The results demonstrated that lesions had a high fluoride uptake capacity. Fluoride content values increased by 25-30 micrograms/cm2 during a single topical application, as compared with 10-15 micrograms/cm2 during seven weeks of toothbrushing. About half the fluoride acquired as a result of topical treatment was lost during subsequent exposure to the oral fluids when no further fluoride supplementation was given. The uptake of fluoride by sound enamel was comparatively small, regardless of the use of fluoride dentifrice or application. The presence of mature plaque at the time of fluoride application did not affect the amounts of fluoride delivered. Acid susceptibility tests showed that the enamel solubility exhibited a negative correlation with fluoride content of the specimens.     

Fluoride retention in clean and plaque-covered demineralized enamel in vivo after application of monofluorophosphate

The retention of fluoride in clean and plaque-covered demineralized enamel in vivo was measured 1 wk after a single application of a MFP solution with low or high content of free fluoride. Demineralization of the enamel was induced in vivo during a 4-wk period prior to application of fluoride by applying orthodontic bands on a pair of premolars scheduled for extraction of orthodontic reasons. The band from one tooth of each pair was then removed and the tooth cleaned (clean enamel lesion). The band on the contralateral tooth (plaque-covered enamel lesion) was left in place. The MFP solutions were applied and the teeth extracted after one more week. The chemical form of fluorine in the lesions was analyzed by conventional acid etching of the enamel combined with KOH dissolution and by a nondestructive surface analysis using ESCA to detect intact monofluorophosphate ions. The ESCA measurements showed that MFP was only present in the clean enamel lesions, indicating complete hydrolysis by dental plaque. Alkali soluble fluoride could be extracted from both plaque-covered and clean enamel lesions. Conflicting results regarding the amount of fluoride uptake in the lesions were obtained with the acid etching and the ESCA technique. It was thus not clearly established whether plaque enhanced fluoride uptake in carious lesions after MFP application.     

Fluoride retention in clean and plaque-covered demineralized enamel in vivo after application of monofluorophosphate

The retention of fluoride in clean and plaquc-covcred demineralized enamel in vivo was measured 1 wk after a single application of a MFP solution with low or high content of free fluoride. Demineralization of the enamel was induced in vivo during a 4-wk period prior to application of fluoride by applying orthodontic bands on a pair of premolars scheduled for extraction of orthodontic reasons. The band from one tooth of each pair was then removed and the tooth cleaned (clean enamel lesion). The band on the contralateral tooth (plaque-covered enamel lesion) was left in place. The MFP solutions were applied and the teeth extracted after one more week. The chemical form of fluorine in the lesions was analyzed by conventional acid etching of the enamel combined with KOH dissolution and by a nondestructive surface analysis using ESCA to detect intact monofluorophosphate ions. The ESCA measurements showed that MFP was only present in the clean enamel lesions, indicating complete hydrolysis by dental plaque. Alkali soluble fluoride could be extracted from both plaque-covered and clean enamel lesions. Conflicting results regarding the amount of fluoride uptake in the lesions were obtained with the acid etching and the ESCA technique. It was thus not clearly established whether plaque enhanced fluoride uptake in carious lesions after MFP application.     

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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。     

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.     

Metabolomic effects of xylitol and fluoride on plaque biofilm in vivo

Dental caries is initiated by demineralization of the tooth surface through acid production from sugar by plaque biofilm. Fluoride and xylitol have been used worldwide as caries-preventive reagents, based on in vitro-proven inhibitory mechanisms on bacterial acid production. We attempted to confirm the inhibitory mechanisms of fluoride and xylitol in vivo by performing metabolome analysis on the central carbon metabolism in supragingival plaque using the combination of capillary electrophoresis and a time-of-flight mass spectrometer. Fluoride (225 and 900 ppm F(-)) inhibited lactate production from 10% glucose by 34% and 46%, respectively, along with the increase in 3-phosphoglycerate and the decrease in phosphoenolpyruvate in the EMP pathway in supragingival plaque. These results confirmed that fluoride inhibited bacterial enolase in the EMP pathway and subsequently repressed acid production in vivo. In contrast, 10% xylitol had no effect on acid production and the metabolome profile in supragingival plaque, although xylitol 5-phosphate was produced. These results suggest that xylitol is not an inhibitor of plaque acid production but rather a non-fermentative sugar alcohol. Metabolome analyses of plaque biofilm can be applied for monitoring the efficacy of dietary components and medicines for plaque biofilm, leading to the development of effective plaque control.     

Incorporation into human enamel of fluoride slowly released from a sealant in vivo

Fluoride incorporation into human enamel from an experimental sealant resin in vivo was investigated. The sealant consisted of a newly synthesized methacryloyl fluoride-methyl methacrylate (MF-MMA) copolymer resin, which contains acidic fluoride covalently bonded to carbonyl groups and releases fluoride ions slowly by hydrolysis in an aqueous environment. This experimental sealant was applied to the enamel of permanent pre-molars and the control sealant without MF-MMA copolymer to that of the contralateral teeth. Fluoride concentration was determined by an enamel biopsy procedure with acid-etching four weeks after the sealant application. As much as 3500 ppm fluoride was found to be deposited at 10 microns depth in the enamel under the MF-MMA copolymer sealant. The increase in fluoride concentration was significant even at 60 microns. Of the fluoride incorporated into the enamel, from 70 to 80% was present as a tightly bound form. This resin sealant is expected to protect the enamel from caries attack even after detachment of the sealant.     

粘贴含氟正畸托槽后菌斑和唾液中氟离子的变化

目的 测定粘贴含氟正畸托槽后,口腔内菌斑及唾液氟离子浓度的变化,探讨采用含氟正畸托槽预防牙釉质脱矿的意义.方法 选择10名志愿者,口腔内粘贴含氟正畸托槽.用离子选择性氟电极测定口腔内菌斑及唾液氟离子浓度,并与粘贴托槽前的基线水平相比较.结果 粘贴含氟正畸托槽后,菌斑及唾液中氟浓度均升高,唾液氟浓度持续3天高于基线水平,...     

Enamel and plaque fluoride following glass ionomer application in vivo.

Glass ionomer fillings have been suggested to act as a fluoride-releasing system in the mouth. The aim of the present study was to evaluate whether a glass ionomer slab applied on the enamel can increase the fluoride content of the enamel and plaque of adjacent teeth in real-life conditions with frequent exposure to fluoride from other sources. Twenty-five adults living in a town with fluoridated drinking water participated in the study. The initial enamel fluoride content on the buccal surface of the contralateral premolars was determined using the acid etch biopsy technique. A round glass ionomer slab was placed buccally on the first molar on a randomly chosen side of the mouth (test side). After 2 weeks, the enamel fluoride content of premolars on the test and control sides was again determined whilst avoiding the site of the first biopsy. In addition, one biopsy was made on a previously etched area. After 2 and 4 weeks, plaque was collected from three approximal surfaces both on the test and control side, and the total fluoride content of the plaque was analysed. There were no significant differences in the fluoride content of sound or etched enamel before and after placement of glass ionomer. The fluoride content of approximal plaque of teeth close to glass ionomer was not higher than that of the control teeth, either after 2 or 4 weeks. Using the present method, no increase in the fluoride level of teeth adjacent to glass ionomer could be demonstrated. This may be due to the masking effect of fluoride from other sources.     

Mass transfer of therapeutics through natural human plaque biofilms: a model for therapeutic delivery to pathological bacterial biofilms

Bacterial biofilms in the mouth are prime mediators of the destruction of the dental and oral tissues. This brief review summarises recent work using a device for generating intact plaque in the mouth on natural enamel surfaces such that quantitative studies of mass transfer through natural plaque biofilms could be carried out in relation to plaque architecture. This data is discussed against the background of existing information. The device revealed complex plaque architecture with high a surface area to mass ratio decreasing from the exterior of the biofilm towards the tissue surface. Fluoride, a potent inhibitor of caries was concentrated in the outer regions of the biofilm. This implies some restriction of diffusion and possibly binding to the high surface area of the outer biofilm. Whilst all components examined conformed to this distribution pattern, some relatively uncharged materials penetrated the bacterial biomass whilst other, more highly charged materials tended to be restricted to the channels or biomass surface. Plaque architecture was robust but could be altered using detergent indicating that biomass architecture and chemistry could be manipulated as a possible means of facilitating mass transport of therapeutics.