Remineralization of enamel subsurface lesions in situ by the use of three commercially available sugar-free gums

Background.  Commercially available sugar-free chewing gums have been claimed to provide oral health benefits.
Aim.  The aim of this randomized, double-blind crossover in situ study was to compare the efficacy of three commercially available sugar-free chewing gums: Trident White, Orbit, and Orbit Professional, in remineralizing enamel subsurface lesions in situ .
Design.  Specimens containing enamel subsurface lesions were sectioned into test and control half-slabs with the test half-slabs inserted into removable palatal appliances. For each test chewing period, subjects were randomly allocated one of three test gums. Subjects ( n  = 10) chewed the randomly allocated gum for a 20-min period four times per day for 14 days. Each subject chewed all three test gums, with a 7-day washout period between crossovers. After each 14-day cycle, test and control half-slabs were paired, embedded in resin, sectioned, and subjected to microradiography to determine remineralization.
Results.  The gum TW produced significantly greater remineralization (18.4 ± 0.9%) than Orbit (8.9 ± 0.5%) and Orbit Professional (10.5 ± 0.9%).
Conclusion.  The superior remineralization activity of the TW gum in situ was attributed to the presence of casein phosphopeptide–amorphous calcium phosphate nanocomplexes.     

Effects of a chewing gum containing phosphoryl oligosaccharides of calcium (POs-Ca) and fluoride on remineralization and crystallization of enamel subsurface lesions in situ

Objectives

Manufacturers are adding fluoride (F) to calcium-containing chewing gums to further promote enamel remineralization. The aim of this study was to assess the effect of a chewing gum containing phosphoryl oligosaccharides of calcium (POs-Ca) and fluoride on remineralization of enamel subsurface lesions, in a double-blind, randomized controlled in situ trial.

Methods

Thirty-six volunteer subjects wore removable buccal appliances with three different insets of bovine enamel with subsurface demineralized lesions. For 14 days the subjects chewed one of the three chewing gums (placebo, POs-Ca, POs-Ca + F), three times a day. After each treatment period, the insets were removed from the appliance, embedded, sectioned, polished and then subjected to laboratory tests; mineral level was determined by transverse microradiography (TMR; n = 36), and hydroxyapatite (HAp) crystallites were assessed by synchrotron radiation wide-angle X-ray diffraction (WAXRD; n = 13). Data were analysed by t-test or Wilcoxon rank-sum test with Bonferroni corrections at 0.05 significance level.

Results

Chewing POs-Ca and POs-Ca + F gums resulted in 21.9 ± 10.6 and 26.3 ± 9.4 (mean ± SD) percentage mineral recovery, which was significantly higher than that of placebo gum (15.0 ± 11.4) (p < 0.05). Chewing POs-Ca + F gum resulted in 24.9 ± 5.4 (mean ± SD) percentage HAp crystallites recovery, which was significantly higher compared to POs-Ca (16.0 ± 4.1%) or placebo (11.1 ± 4.8%) gums (p < 0.05).

Conclusions

Addition of POs-Ca to the chewing gum resulted in significant remineralization of enamel subsurface lesions. Although POs-Ca + F gum was not superior in TMR recovery rate when compared with POs-Ca gum, WAXRD results highlighted the importance of fluoride ion bioavailability in the formation of HAp crystallites in enamel subsurface lesions in situ (NCT01377493).     

Effect of casein phosphopeptide - amorphous calcium phosphate containing chewing gum on salivary concentration of calcium and phosphorus: An in-vivo study

Aim: Caries clinical trials of sugar-free chewing gum have shown that the gum is noncariogenic and in fact has anticariogenic effect through the stimulation of saliva. Sugar-free gums, therefore, may be an excellent delivery vehicle for safe and effective additive, capable of promoting enamel remineralization. Casein phosphopeptide - amorphous calcium phosphate (CPP-ACP) nanocomplexes incorporated into sugar-free chewing gum have shown to remineralize enamel subsurface lesions in situ. So this study was conducted to evaluate the effect of CPP-ACP containing sugar-free chewing gum on salivary concentration of calcium and phosphorous. Materials and Methods : Unstimulated saliva from each 24 selected subjects was collected. Then each subject was given two pellets of chewing gum containing CPP-ACP and asked to chew for a period of 20 min, after which saliva samples were collected from each individual. Once all the samples were collected they were assessed for calcium and phosphorous concentration using affiliated reagent kits and photometer. Statistical Analysis Used: Data obtained were analyzed using student's paired t test. Results: Significant difference was found in the calcium and phosphorus concentration of saliva before and after chewing CPP-ACP containing chewing gum. Conclusions: Chewing of CPP-ACP containing chewing gum showed a significant increase in the salivary concentration of calcium for a prolonged period of time hence it may help in the remineralization of tooth surfaces.     

Effect of addition of citric acid and casein phosphopeptide-amorphous calcium phosphate to a sugar-free chewing gum on enamel remineralization in situ

Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) has been shown to remineralize enamel subsurface lesions in situ. The aim of this study was to investigate the effects of CPP-ACP in a fruit-flavoured sugar-free chewing gum containing citric acid on enamel remineralization, and acid resistance of the remineralized enamel, using an in situ remineralization model. The study utilized a double-blind, randomized, crossover design with three treatments: (i) sugar-free gum (2 pellets) containing 20 mg citric acid and 18.8 mg CPP-ACP, (ii) sugar-free gum containing 20 mg citric acid alone, (iii) sugar-free gum not containing CPP-ACP or citric acid. Ten subjects were instructed to wear removable palatal appliances, with 4 half-slab insets of human enamel containing demineralized subsurface lesions and to chew gum (2 pellets) for 20 min 4 times per day for 14 days. At the completion of each treatment the enamel half-slabs were removed and half of the remineralized lesion treated with demineralization buffer for 16 h in vitro. The enamel slabs (remineralized, acid-challenged and control) were then embedded, sectioned and subjected to microradiography to determine the level of remineralization. Chewing with gum containing citric acid and CPP-ACP resulted in significantly higher remineralization (13.0 +/- 2.2%) than chewing with either gum containing no CPP-ACP or citric acid (9.4 +/- 1.2%) or gum containing citric acid alone (2.6 +/- 1.3%). The acid challenge of the remineralized lesions showed that the level of mineral after acid challenge was significantly greater for the lesions exposed to the gum containing CPP-ACP.     

Retention in plaque and remineralization of enamel lesions by various forms of calcium in a mouthrinse or sugar-free chewing gum

Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) nanocomplexes incorporated into sugar-free chewing gum have been shown to remineralize enamel subsurface lesions in situ. The aim of this study was to compare the ability of CPP-ACP, with that of other forms of calcium, to be retained in supragingival plaque and remineralize enamel subsurface lesions in situ when delivered in a mouthrinse or sugar-free gum in randomized, double-blind trials. In the mouthrinse study, only the CPP-ACP-containing mouthrinse significantly increased plaque calcium and inorganic phosphate levels, and the CPP were immunolocalized to the surfaces of bacterial cells as well as the intercellular matrix. In the chewing gum studies, the gum containing the CPP-ACP, although not containing the most calcium per piece of gum, produced the highest level of enamel remineralization independent of gum-chewing frequency and duration. The CPP could be detected in plaque extracts 3 hrs after subjects chewed the CPP-ACP-containing gum. The results showed that CPP-ACP were superior to other forms of calcium in remineralizing enamel subsurface lesions.     

Acid resistance of enamel subsurface lesions remineralized by a sugar-free chewing gum containing casein phosphopeptide-amorphous calcium phosphate

The aim of this clinical study was to investigate the acid resistance of enamel lesions remineralized in situ by a sugar-free chewing gum containing casein phosphopeptide-amorphous calcium phosphate nanocomplexes (CPP-ACP: Recaldent). The study utilized a double-blind, randomized, crossover design with two treatments: (i) sugar-free gum containing 18.8 mg of CPP-ACP, and (ii) sugar-free gum not containing CPP-ACP as control. Subjects wore removable palatal appliances with insets of human enamel containing demineralized subsurface lesions and chewed the gum for 20 min 4 times per day for 14 days. After each treatment the enamel slabs were removed and half of each lesion challenged with acid in vitro for 8 or 16 h. The level of remineralization was determined using microradiography. The gum containing CPP-ACP produced approximately twice the level of remineralization as the control sugar-free gum. The 8- and 16-hour acid challenge of the lesions remineralized with the control gum resulted in 65.4 and 88.0% reductions, respectively, of deposited mineral, while for the CPP-ACP-remineralized lesions the corresponding reductions were 30.5 and 41.8%. The acid challenge after in situ remineralization for both control and CPP-ACP-treated lesions resulted in demineralization underneath the remineralized zone, indicating that the remineralized mineral was more resistant to subsequent acid challenge. The results show that sugar-free gum containing CPP-ACP is superior to an equivalent gum not containing CPP-ACP in remineralization of enamel subsurface lesions in situ with mineral that is more resistant to subsequent acid challenge.     

The effect of adding calcium lactate to xylitol chewing gum on remineralization of enamel lesions

The purpose of the study was to determine whether adding calcium lactate to chewing gum containing xylitol enhances remineralization of enamel surfaces using an early caries lesion model. Enamel slabs were cut from human extracted sound teeth and artificial subsurface lesions created within each. Half the enamel slabs were used as controls and stored in a humidifier while half were mounted into oral appliances worn by 10 volunteers (22-27 years old, 2 males and 8 females) in a three-leg trial, during which they wore the appliance without chewing gum, chewed gum containing xylitol + calcium lactate or chewed gum containing only xylitol 4 times a day for 2 weeks. Calcium concentrations in the enamel surfaces of control and test slabs were measured by X-ray spectrometry and degrees of remineralization were calculated. The mean degree of remineralization was greater after chewing xylitol-Ca gum (0.46 +/- 0.10) than after no gum (0.16 +/- 0.14) or after chewing xylitol gum (0.33 +/- 0.10) (p < 0.01). In conclusion, chewing gum containing xylitol + calcium lactate could enhance remineralization of enamel surface compared to chewing gum containing only xylitol or no gum chewing.     

Effects of various forms of calcium added to chewing gum on initial enamel carious lesions in situ

The purpose of this randomized, cross-over in situ study was to determine the effects of 4 chewing gums on artificial caries-like subsurface lesions. Two chewing gums (1 with zinc citrate and 1 without) contained dicalcium phosphate (3.9%), calcium gluconate (1.8%) and calcium lactate (0.45%), 1 chewing gum contained casein phosphopeptide-amorphous calcium phosphate nanocomplexes (0.7%), and another one contained no calcium. Fifteen subjects without current caries activity (7 male, 8 female; mean age: 27.5 +/- 2.5 years) wore removable buccal appliances in the lower jaw with 4 bovine enamel slabs with subsurface lesions. The appliances were inserted immediately before gum chewing for 20 min and then retained for an additional 20 min. This was performed 4 times per day. Every subject chewed 4 different chewing gums over 4 periods of 14 days each. During a fifth period (control) the subjects only wore the appliances without chewing gum. At completion of each period the enamel slabs were embedded, sectioned and subjected to transversal microradiography. With regard to change of mineral loss and of lesion depth no significant differences could be found between chewing gums containing calcium and calcium-free chewing gums. Moreover, the chewing gum groups and the control group did not differ significantly if adjustments were made for baseline values (p > 0.05; ANCOVA). Under the conditions of the present study it may be concluded that the use of chewing gum offers no additional remineralizing benefit to buccal tooth surfaces, even if the chewing gum contains calcium compounds.     

Swallowing threshold parameters of subjects with shortened dental arches

Objectives

To quantify swallowing threshold parameters of subjects with a moderate shortened dental arch dentition (SDA: missing molar teeth, but premolar teeth in occluding position and uninterrupted anterior regions) compared to subjects with a complete dental arch dentition (CDA).

Methods

Fourteen females with SDA (3–4 occlusal premolar units) and 14 females with CDA were instructed to chew silicone test ‘food’ (cubic particles with a total volume of 3 cm³). They spit it out the moment they felt the urge to swallow and the pulverized particles were collected. Swallowing threshold parameters were number of chewing cycles, time until ‘swallowing’, and median particle size of the pulverized particles as determined by sieving the food. Chewing tests were performed twice and outcomes were averaged.

Results

The number of chewing cycles until ‘swallowing’ of subjects with SDA was approximately 1.7 times (p < 0.005) that of the controls and this took approximately 1.6 times more time (p < 0.01). The median particle size until ‘swallowing’ did not differ significantly between the groups, but demonstrated large individual differences. Regression analyses indicated that the ratio of median particle size until ‘swallowing’ of SDA and CDA becomes progressively unfavourable for SDA with increasing numbers of chewing cycles.

Conclusions

Subjects with SDA pulverized test ‘food’ particles to sizes comparable to subjects with CDA, but chewed longer with more chewing cycles until ‘swallowing’. Higher numbers of chewing cycles were associated with increasing difference between SDA and CDA regarding the median particle size until ‘swallowing’.

Clinical significance

Compared to subjects with CDA, subjects with moderate SDA pulverize test food particles to comparable size by chewing longer before “swallowing”. Therefore, overloading the digestive system by swallowing courser food particles is unlikely in SDA. Consequently, replacement of absent molars just to optimize chewing function is not advised.     

Effects of different amine fluoride concentrations on enamel remineralization

Objectives

The aim of this study was to investigate the effects of decreasing fluoride concentrations on repeated demineralizing challenges on human enamel.

Materials and methods

In 24 teeth, 3 mm × 3 mm windows were prepared on the buccal and lingual sides and treated in a cycling demineralization–remineralization model. Remineralization was achieved with 100, 10 and 0.1 ppm fluoride from anime fluoride. Coronal sections were cut through the artificial lesions, and three sections per tooth were investigated using polarized light microscopy and scanning electron microscopy with quantitative element analysis.

Results

The morphology of the lesions was studied, and the extensions of the superficial layer and the body of the lesion were measured. Using element analysis, the Ca, P and F content were determined. The body of the lesion appeared remineralized after application of 100 ppm fluoride, while remineralization of the lesion was less successful after application of 10 and 0.1 ppm fluoride. The thickness of the superficial layer increased with decreasing fluoride concentrations, and also the extension of the body of the lesion increased. Ca and P content increased with increasing fluoride concentrations.

Conclusions

The effectiveness of fluoride in enamel remineralization increased with increasing fluoride concentration.

Clinical relevance

A consistently higher level of fluoride in saliva should be a goal in caries prevention.     

Synchrotron radiation microbeam X-ray fluorescence analysis of zinc concentration in remineralized enamel in situ

Objective

Remineralization is an indispensable phenomenon during the natural healing process of enamel decay. The incorporation of zinc (Zn) into enamel crystal could accelerate this remineralization. The present study was designed to investigate the concentration and distribution of Zn in remineralized enamel after gum chewing.

Methods

The experiment was performed at the Photon Factory. Synchrotron radiation was monochromatized and X-rays were focused into a small beam spot. The X-ray fluorescence (XRF) from the sample was detected with a silicon (Si) (lithium (Li)) detector. X-ray beam energy was tuned to detect Zn. The examined samples were small enamel fragments remineralized after chewing calcium phosphate-containing gum in situ. The incorporation of Zn atom into hydroxyapatite (OHAP), the main component of enamel, was measured using Zn K-edge extended X-ray absorption fine structure (EXAFS) with fluorescence mode at the SPring-8.

Results

A high concentration of Zn was detected in a superficial area 10-μm deep of the sectioned enamel after gum chewing. This concentration increased over that in the intact enamel. The atomic distance between Zn and O in the enamel was calculated using the EXAFS data. The analyzed atomic distances between Zn and O in two sections were 0.237 and 0.240 nm.

Conclusion

The present experiments suggest that Zn is effectively incorporated into remineralized enamel through the physiological processes of mineral deposition in the oral cavity through gum-chewing and that Zn substitution probably occurred at the calcium position in enamel hydroxyapatite.     

Effect of fluoride varnish and gel on dental erosion in primary and permanent teeth

Objective

To assess the effect of a fluoride varnish and gel on the erosive wear of primary and permanent teeth.

Design

Sixty human primary (n = 30) and permanent (n = 30) enamel specimens were randomly assigned to one of the following groups: APF gel (1.23% F), NaF varnish (2.26% F), and control (no treatment). Fluoride gel was applied for 4 min and fluoride varnish for 24 h. Six daily demineralisation-remineralization cycles of 5 min of immersion in a cola drink (pH 2.3) and 30 min in artificial saliva were conducted during 7 days. All specimens were stored in artificial saliva between and after cycles. Surface Knoop microhardness (%SMHC) readings were performed at baseline, 48 h and 7 days. Data were tested using ANOVA and Tukey's tests (p < 0.05).

Results

For primary enamel, the mean %SMHC (±SD) after 48 h and 7 days was, respectively: gel (31.0 ± 14.4 and 36.9 ± 7.5), varnish (26.7 ± 9.5 and 38.3 ± 8.7), and control (35.8 ± 8.6 and 45.0 ± 8.6). For permanent enamel, such values were: gel (37.5 ± 7.7 and 27.8 ± 7.5), varnish (31.7 ± 9.6 and 27.4 ± 11.1) and control (48.6 ± 6.4 and 43.1 ± 6.4). In primary enamel, erosion inhibition by fluoride was not significant at 48 h (p = 0.203) and 7 days (p = 0.082). In permanent specimens, both products showed a significant effect (p < 0.001).

Conclusions

Both fluoride varnish and gel were able to inhibit erosive enamel loss but mainly in the permanent experimental groups. Primary and permanent enamel substrates reacted differently to both demineralization by a cola drink and remineralization by fluoridated compounds.     

Interplay between fluoride and abrasivity of dentifrices on dental erosion–abrasion

Objectives

Eroded teeth are more susceptible to toothbrushing wear than sound teeth. We tested the hypothesis that fluoride and abrasivity of dentifrices can interact, modulating the development of erosive–abrasive lesions.

Methods

Human enamel and root dentin specimens were submitted to cycles of demineralization, remineralization and toothbrushing using six dentifrices formulated with three different abrasivity levels: low (L), medium (M) and high (H); with (+F) and without (−F) fluoride. Surface loss was quantified by optical profilometry and compared among groups (α = 0.05).

Results

In dentin, it was ranked: L < M < H, for both +F and −F dentifrices. In enamel, +F dentifrices had similar results; however for −F formulations, M and H did not differ. Fluoride reduced surface loss in enamel, at all abrasive levels. In dentin, the same fluoride effect was observed but only for the low abrasive formulation.

Conclusions

Both fluoride and abrasivity were important modulators of enamel surface loss, while abrasivity had a higher impact than fluoride on dentin.     

The effect of 24h non-stop hydrogen peroxide concentration on bovine enamel and dentine mineral content and microhardness

Objectives

Tooth bleaching agents may adversely affect tooth structure. The aim of this study was to investigate the effect of hydrogen peroxide concentration on mineral loss and microhardness of bovine teeth.

Methods

Twenty-six freshly extracted intact bovine incisor teeth were stored in distilled water. Five teeth were sectioned and four samples (2 mm × 2 mm × 1.5 mm) each of enamel and dentine were obtained from each tooth. The samples of enamel and dentine were divided into four groups and immersed in either 0%, 3%, 10% or 30% (w/v) hydrogen peroxide solutions for 24 h at 37 °C. Samples from the solutions were taken for ion release analysis using inductively coupled plasma mass spectrometry. The remaining 21 teeth were mounted in epoxy resin and the upper surface of the specimens were ground and polished to expose the enamel and dentine for microhardness measurements. These specimens were randomly divided into three equal groups and Vickers microhardness values were recorded on the enamel and dentine surfaces of each group before and after bleaching.

Results

The differences in ion release concentration after treatment with 0% (control) and each of 3%, 10% and 30% hydrogen peroxide (w/v) were statistically significant (p < 0.025). The release of calcium and phosphorous ions increased with increasing hydrogen peroxide concentrations. A significant reduction (p < 0.05) in Vickers microhardness values for enamel was recorded after bleaching.

Conclusions

Ion release from both enamel and dentine increased with increasing hydrogen peroxide concentration. Microhardness of enamel decreased significantly with bleaching.     

Chew on this: No support for facilitating effects of gum on spatial task performance

Objective

To determine whether chewing of gum facilitates spatial task performance in healthy participants, two behavioral experiments were performed.

Design

In the first experiment, spatial task performance of 349 men and women preceding and after treatment administration (saccharated chewing gum, sugar-free chewing gum, no chewing gum) was assessed using effect modeling by means of Item Response Theory. In the second experiment, another 100 participants were either administered sugar-free chewing gum or no chewing gum during spatial task performance. Effects of gum in the second study were assessed by standard means of data analysis.

Results

Results indicated no significant effects of either chewing gum or sugar on spatial task performance in either experiment.

Conclusions

Our findings are consistent with recent studies investigating the influences of chewing gum on various memory functions, extending them by another measure of cognitive ability. Thus, further doubt is cast on enhancing effects of chewing gum on cognitive task performance.     

The effect of chewing gum use on in situ enamel lesion remineralization.

Two independent cross-over studies investigated the possibility of enhanced early enamel lesion remineralization with the use of chewing gum. The first study involved a sorbitol-containing chewing gum, and the second, which had an identical protocol, tested a sucrose-containing chewing gum. In each study, 12 volunteers wore in situ appliances on which were mounted enamel sections containing artificial caries lesions. Subjects brushed twice daily for two min with a 1100-ppm-F (NaF) dentifrice (control and test) and in the test phase chewed five sticks of gum per day for 20 min after meals and snacks. Microradiographs of the enamel lesions were made at baseline and at the end of the seven-week experimental period. In the sugar-free gum study, the weighted mean total mineral loss (delta z) difference [(wk7-wk0) x (-1)] was 788 vol.% min. x micron for the gum, corresponding to remineralization of 18.2%, vs. the control value of 526 vol.% min. x micron, 12.1% remineralization (p = 0.07). There were no significant differences for the surface-zone (p = 0.20) and lesion-body (p = 0.28) values. In the sucrose-containing gum study, the delta z difference was 743 vol.% min. x micron for the gum, corresponding to a remineralization of 18.3%, vs. the control value of 438 vol.% min. x micron, 10.8% remineralization (p = 0.08). The surface-zone values were not significantly different (p = 0.55). For the lesion body, however, the sucrose-containing gum value of 6.11 vol.% min. was significantly different (p = 0.01) from that of the control (2.81 vol.% min.).     

Growth of plaque while chewing sucrose and sorbitol flavoured gum

The aim of the study was to assess the claimed toothcleansing effect of sorbitol and sucrose flavoured chewing gums. A total of 24 dental students participated in a double-blind, four times crossed over clinical trial during which each student chewed both types of gum for 4 days each. No other means to clean the teeth were allowed during the test periods. Two 4-day periods of no oral hygiene and no chewing were used as controls indicating the normal growth rate of plaque. The results confirmed earlier observations that sorbitol flavoured gum does neither increase or decrease plaque formation. Chewing of sucrose gum, however, was found to promote the growth rate of plaque. The cleansing effect of the gums was also tested on the plaque formed during the 4-day no-oral-hygiene periods. In this part of the study the chewing of 10 pieces of sorbitol flavoured gum during a time period of 3 h did not significantly reduce the plaque scores, while the sucrose flavoured gum, correspondingly used, again resulted in a statistically significant increase in the amount of bacterial deposits. Because of the rapid reaction of the plaque to sucrose flavoured gum, so-called sugarless substitutes were recommended for those who insist on chewing.     

In situ effect of a CPP-ACP chewing gum on enamel erosion associated or not with abrasion

Objectives

The purpose of this study is to analyze the in situ effect of a casein phosphopeptide-stabilized amorphous calcium phosphate (CPP-ACP) chewing gum on human enamel erosion lesion associated or not with abrasion.

Material and methods

A three-way crossover study of 7 days was conducted involving 10 volunteers subjected to the same protocol: (G1) CPP-ACP sugar-free chewing gum, (G2) regular sugar-free chewing gum without CPP-ACP, and (G3) saliva—no chewing gum. An abrasion test was included in each phase. A 3D non-contact profilometry measurement of lesion depth and surface roughness was obtained of sound and eroded surfaces. A salivary calcium concentration was determined for all volunteers. ANOVA followed by Tukey’s test were used with a p < 0.05.

Results

The enamel depth and the enamel surface roughness of the CPP-ACP gum group were significantly lower than the others (ANOVA, p < 0.05). No significant differences were observed between the treatments when associated with abrasion (p > 0.05). A positive and significant correlation was seen between the lesion depth and enamel surface roughness for GI (r = 0.87, p = 0.00) and GIII (r = 0.79, p = 0.00) groups. The estimated total calcium presented in the saliva after the chewed CPP-ACP gum showed no statistical significance between the mean absorbance values at the different time collections (p > 0.05).

Conclusions

It is demonstrated that the incorporation of the CPP-ACP into a sugar-free gum significantly increased the remineralization/protection of eroded enamel surface.

Clinical relevance

The CPP-ACP added to gum may be a suitable alternative vehicle, to deliver calcium ions to saliva and therefore protecting enamel.

     

Effect of fluoride sustained slow-releasing device on fluoride, phosphate and calcium levels in plaque biofilms over time measured using ion chromatography

Objectives

To determine whether there are any differences in fluoride (F), calcium (Ca) or phosphate (PO₄) concentrations in natural plaque biofilms between the upper right and left quadrants using a fluoride sustained slow-releasing device (FSSRD) placed in the upper right quadrant after 7 and 21 days. To report and validate a new methodology in measuring very low concentrations of F in dental plaque and saliva using ion chromatography.

Methods

Twenty-one participants were divided into two groups with 11 participants in group one and 10 in group two. Each participant had a FSSRD attached to the upper right second permanent molar and two plaque generating devices (PGDs) attached to the upper right and left first permanent molars. The PGDs were recovered after 7 days in group one and 21 days in group two.

Results

At both 7 and 21 days (right, left), F (1.081 ± 1.517 ppm, 0.736 ± 0.840 ppm) and (0.459 ± 0.888 ppm, 0.203 ± 0.139 ppm), PO₄ (1053 ± 533 ppm, 654 ± 246 ppm) and (865 ± 1099 ppm, 474 ± 304 ppm) and Ca (136 ± 132 ppm, 74 ± 36 ppm) and (130 ± 109 ppm, 77 ± 24 ppm), were higher in the quadrant containing the FSSRD but not significantly so (p > 0.05). Fluoride and PO₄ fell in both quadrants between 7 and 21 days, though not significantly.

Conclusions

Intriguingly while not statistically significant, 21 day plaque contained less fluoride than those investigated after 7 days. While the data was not statistically significant, it seems possible that F, Ca and PO₄ accumulated around the device to a limited extent but were washed away fairly quickly and distributed around the oral cavity.

Clinical importance

The FSSRD was found to reduce dmfs/DMFS by 76% and raise salivary F levels by ∼10 folds. This device is very helpful in reducing dental decay where compliance is impaired such as in patients with special needs. This study further investigates the anti-cariogenic effect of this device.     

Effects of fluoride concentration and temperature of milk on caries lesion rehardening

Objectives

The aim of the present in vitro study was to investigate the effects of fluoride concentration and temperature of milk on caries lesion rehardening under pH cycling conditions.

Methods

Incipient caries-like lesions were formed in human enamel specimens, characterized using Vickers surface microhardness (VHN) and assigned to seven treatment groups (n = 18 per group): fluoride was tested at five levels (0, 2.5, 5, 10, 20 mg/l, all 22 °C) and milk temperature at three levels (4, 22, 60 °C), but only for 10 mg/l F. Lesions were pH cycled for 15d (4×/daily 10 min milk treatments, 1×/daily 4 h acid challenge, remineralization in human/artificial saliva mixture). VHN of specimens were measured again and changes from lesion baseline were calculated. Subsequently, enamel fluoride uptake (EFU) was determined using the micro drill technique.

Results

Lesions responded to fluoride in a dose–response manner with higher fluoride concentrations resulting in more lesion rehardening (20 > 10 ≥ 5 ≥ 2.5 > 0 mg/l F). Furthermore, fluoridated milk at 60 °C was found to be more efficacious than at 4 °C (60 ≥ 22 > 4 °C). EFU results were similar (20 > 10 > 5 > 2.5 ≥ 0 mg/l F; 60 > 22 ≥ 4 °C).

Conclusions

Both fluoride concentration and milk temperature are likely to contribute to the anti-caries potential of fluoridated milk.