Enamel Carious Lesions Research Articles

Efficacy of bisphosphonates in detection of early enamel caries using NIR fluorescence imaging and inhibition of caries progression.

NIR fluorescence imaging using bisphosphonate-Indocyanine green has been indicated for early interproximal caries detection. This study assessed diagnostic accuracy of caries detection by NIR fluorescence imaging with OsteoSense 750® (OS750) in vitro and ex vivo, and to analyze the therapeutic efficacy of a bisphosphonate (Etidronate) in inhibiting enamel caries progression in vitro.Methods: Four experiments were conducted using extracted human teeth; 1) to calculate the infiltration rate of OS750 into interproximal white spot lesions using fluorescence microscope, 2) to assess diagnostic accuracy of interproximal natural white spot lesions using desktop NIR fluorescence imaging device in vitro setting, 3) to assess diagnostic accuracy of artificially created deeper enamel carious lesion (0.5 mm~1.0 mm) using NIR fluorescence image through the head-mount display in ex vivo setting, 4) to compare the progression on the enamel caries lesions treated by Etidronate, NaF and distilled-water. Diagnostic accuracy was analyzed using sensitivity, specificity and receiver operating curves (ROC). The caries progression was calculated with micro-CT and was statistically analyzed using a two-way ANOVA and the Tukey HDS post-hoc test.Results: 1) The infiltration rate of OS750 was 101.83% ± 8.66 (Min: 90.10%, Max: 133.94%). 2) The average of sensitivity and specificity in vitro setting experiments were 86.7% ± 4.4% and 70% ± 11%, respectively. The average of area under the ROC curves (AUC) was 0.883 ± 0.059 indicating excellent performance. 3) The mean sensitivity and specificity in ex vivo setting was 82.97% ± 15% and 76.78% ± 13.27% respectively. 4) The carious lesion volume treated by Etidronate was significantly smaller at post treatment-1 (p<0.05) and treatment-2 (p<0.01) than the control. There was no significant difference in lesion volume in the Etidronate and NaF group at the time point of post treatment-1.Conclusion: This study suggests that bisphosphonates contribute to both early diagnosis of enamel caries and inhibition of caries progression.

Enamel remineralization efficacy of three widely used remineralizing tooth pastes: An in-vitro study

Background: With introduction of newer enamel remineralization products in the market, it becomes important to evaluate and compare their remineralization efficacy. Hence the objective of the study was to assess and compare the enamel remineralizing efficacy of Casein phosphopeptide amorphous calcium phosphate cream, Nano-hydroxyapatite containing paste and Xylitol containing paste on artificially induced enamel carious lesions using surface micro hardness analysis.Methods: In-vitro study was conducted using 50 enamel specimens, randomly allocated to 5 groups of 10 samples each after standardization of Surface micro hardness. Except Group 1, specimens were subjected to demineralization for 4 days at 370 C following remineralization with slurry of remineralizing agents; Tooth Mousse Plus, nano-HAP and Remin Pro.Specimens were subjected to pH cycling for 28 days followed by assessment of surface micro hardness (PISMH). Student’s paired t-test, One-way analysis of variance test (ANOVA) and post hoc Tukey test were used for statistical analysis.Results: The surface harness of Tooth Mousse plus (333.62±38.95VHN) and Remin Pro (342.24±27) groups were significantly higher than the sound enamel group, nanoHap group (275.97±67) and demineralized enamel group (p

Fluoride alternatives for remineralization of early enamel carious lesions, Fact or Fiction?- A Systematic Review

Aim: The purpose of this study was to systematically assess the quality of evidence supporting fluoride's alternatives for treating early enamel caries. Methods: A broad search strategy using PubMed and other sources was performed. For sensitive search strategy, we used MESH database and the following search queries: (‘‘Remineralization’’ [Mesh] OR ‘‘Remineralisation’’) AND (‘‘Caries’’ [Mesh] OR ‘‘Decay’’) AND (‘‘Fluoride’’). Predetermined criteria were: parallel, randomized, controlled trial studies with 6 to 18 years old children. Results: 1919 articles from PubMed advanced search were initially revealed then 79 papers were picked up, in addition to 536 from other sources. One paper only removed as a duplicate (by the author, title and reference). The remaining articles were indicated for closer assessment. Out of 614 papers were screened by title, only 29 met the inclusion criteria of this review. Additional screening by abstract was done independently by the three researchers to result in 7 articles. Conclusion: From this review, there is moderate clinical evidence to support preventive agents as fluoride substitutes. This review suggests the use of resin infiltration and fluoridated Miswak as remineralizing agents.

Identification of Key Functional Motifs of Native Amelogenin Protein for Dental Enamel Remineralisation.

Dental caries or tooth decay is a preventable and multifactorial disease that affects billions of people globally and is a particular concern in younger populations. This decay arises from acid demineralisation of tooth enamel resulting in mineral loss from the subsurface. The remineralisation of early enamel carious lesions could prevent the cavitation of teeth. The enamel protein amelogenin constitutes 90% of the total enamel matrix protein in teeth and plays a key role in the biomineralisation of tooth enamel. The physiological importance of amelogenin has led to the investigation of the possible development of amelogenin-derived biomimetics against dental caries. We herein review the literature on amelogenin, its primary and secondary structure, comparison to related species, and its’ in vivo processing to bioactive peptide fragments. The key structural motifs of amelogenin that enable enamel remineralisation are discussed. The presence of several motifs in the amelogenin structure (such as polyproline, N- and C-terminal domains and C-terminal orientation) were shown to play a critical role in the formation of particle shape during remineralization. Understanding the function/structure relationships of amelogenin can aid in the rational design of synthetic polypeptides for biomineralisation, halting enamel loss and leading to improved therapies for tooth decay.

Microtensile bond strength of TTEMA/TEGDMA remineralizing adhesive to early carious enamel lesions

Objectives: Resin adhesive could be used as a carrier of nano-hyrdoxy apatite particles added to treat early enamel caries. The aim of this study was to evaluate microtensile bond strength of a remineralizing enamel infiltrant to early carious enamel lesion. Methods: An artificial caries model was used to induce early partially-cavitated enamel caries-like lesion in maxillay centrals. Nano hydroxyapatite particles (nHA) were applied in two forms to a low shrinkage low viscosity resin adhesive: particles were directly added to resin adhesive or silanated before addition. Unmodified ad-hesive was used as control. Micro-tensile bond strength (MTBS) was performed to evaluate bond strength to demineralized enamel after application of the remineralizing resin adhesive (n=20, α=0.05). Scanning electron microscopy (SEM) was performed to assess mode of failure and to study infiltrant-enamel interface. Results: Direct addition of nano-particles resulted in significant reduction (F=32, P<0.001) in MTBS (19 MPa ± 3.8) compared to addition of silanated particles (24 MPa ± 3.2) which presented comparable values to the unmodified enamel infiltrant (26 MPa ± 4.1). SEM image analysis revealed adhesive failure observed for directly added particles while the other two groups demonstrated cohesive failure observed in the resin adhesive. On the other hand, direct addition of nHA resulted in partial remineralization of enamel (42% recovery in calcium content). Conclusions: TTEMA/TEGDMA enamel infiltrant could be used as a carrier for nano hydroxyapatite particles without compromising bond strength to early carious enamel lesions.

Non-invasive Treatment of Demineralized Enamel by Eggshell Powder, Bioactive Glass, and Casein: Comparative Study

Introduction: Non-invasive treatment protocol of demineralized enamel lesions as more conservative procedure by different remineralizing agents would bring a major approach in the clinical management of these enamel defects. Aim: The present study was aimed to investigates in-situ remineralization of the demineralized enamel surface, by treatment with different remineralizing agents and stored in an artificial saliva with neutral pH, at 37 °C for 21 days. Materials and Method: We investigated the morphology, and chemical composition of the demineralized and remineralized enamel surface, which treated with Chicken Eggshell powder solution (CESPS), Bioactive Glass (BAG), and Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) as remineralizing agent twice daily and stored in artificial saliva for 21 days. The surface morphology, as well as the chemical composition of the remineralized enamel samples were studied by scanning electron microscopy (SEM) coupled with energy dispersive X-ray (EDX) spectrometry. Results: CESPS resulted in the higher and significant remineralization results when comparing with BAG alone or in combination with it as well as it showed significant effect when compared with CPP-ACP. Conclusion: CESPS, BAG, and CPP-ACP can use as non-invasive treatment of early carious enamel lesions.

Estado de salud de los primeros molares definitivos en pacientes pediátricos escolares

Se realizó una investigación observacional, descriptiva y de corte transversal; con la participación de 492 alumnos con edades comprendidas entre 6 y 12 años, matriculados en centros escolares primarios de la parroquia Alangasí, provincia de Pichincha y de la parroquia Puerto Baquerizo Moreno en la ciudad de San Cristóbal, Islas Galápagos, Ecuador; cuyos tutores legales dieron el respectivo consentimiento. El Sistema Internacional para la Detección y Evaluación de Caries (ICDAS) se utilizó para evaluar el estado de los primeros molares (16, 26, 36 y 46). Entre la población de estudio predominó la presencia del género femenino, además de la categoría que implican lesiones de caries en esmalte dental o en la de sano. Atendiendo a las medias, se apreció mayor afectación en los primeros molares de los participantes de Quito (1,51-2,37) en comparación con los de San Cristóbal (1,18-1,46); no observándose diferencias importantes atendiendo al género. Sin embargo, durante el análisis de los datos entre tipos de colegio se halló que la población de la escuela fiscal tenía más afectación (1,91-2,37). Además, hubo asociaciones entre categorías de las variables involucradas.

Tuftelin-derived peptide facilitates remineralization of initial enamel caries in vitro.

With the gradual discovery of functional domains in natural proteins, several biologically inspired peptides have been designed for use as biomaterials for hard tissue regeneration and repair. In this study, we designed a tuftelin-derived peptide (TDP) and tested its effects on hydroxyapatite crystallization and remineralization of initial enamel carious lesions in vitro. Using circular dichroism spectroscopy, we found that TDP contained 36.1% β-sheets and β-turns, which could be influenced by calcium ions. We verified the ability of TDP to crystallize hydroxyapatite using transmission electron microscopy and its ability to bind to the enamel surface and hydroxyapatite using confocal laser scanning microscopy and Langmuir adsorption isotherms (K = 881.56, N = 1.41 × 10-5 ). Artificial enamel lesions were generated on human enamel blocks and subjected to a 12-day pH cycling model and were treated with 25 μM TDP, 1 g/L sodium fluoride (NaF), or deionized water. We analyzed the results of remineralization by surface microhardness testing, polarized light microscopy, and transverse microradiography. The TDP group showed significantly higher surface microhardness recovery (49.21 ± 1.66%), shallower lesions (34.89 ± 4.05 μm), and less mineral loss (871.33 ± 81.49 vol%·μm) after pH cycling than the deionized water group (p < .05). There were no significant differences between the TDP and NaF groups. Our experiment indicated that TDP could regulate hydroxyapatite crystallization and promote remineralization of enamel caries in vitro.

Monitoring enamel caries on resin-treated occlusal surfaces using quantitative light-induced fluorescence: an in vitro study.

The aim of this study is to evaluate the ability of quantitative light-induced fluorescence (QLF) to monitor enamel caries lesions of different severity stages located on the occlusal surfaces of permanent teeth before and after treatment with resin infiltrant. Sixty extracted permanent teeth had one occlusal site selected and were categorized according to the International Caries Detection and Assessment System (ICDAS) criteria. The teeth were divided into three groups (n = 20): ICDAS 1, ICDAS 2, and ICDAS 3. The teeth were assessed by a trained examiner using QLF in two phases: (A) before and (B) after treatment with resin infiltrant. The caries lesions were evaluated using the following QLF parameters: area (mm2); ΔF, fluorescence loss (%); and ΔQ, fluorescence loss integrated over the lesion area (%*mm2). The resin infiltrant (Icon™) was applied on the occlusal surface following the manufacturer's recommendations. The teeth were then sectioned and prepared for polarized light microscopy analysis. The penetration of resin infiltrant was measured with ImageJ. The groups showed a statistically significant difference in all QLF parameters before and after caries infiltration, with the reduction of fluorescence values posttreatment (p < 0.05). Infiltrant penetration was observed in all groups, with a statistical difference between all groups (p < 0.05). The reduction in QLF parameters after resin infiltration suggests that QLF is able to monitor enamel caries lesions of different severity stages located on the occlusal surfaces of permanent teeth before and after treatment with resin infiltrant.

REMINERALIZATION EFFECT OF EGG SHELL POWDER AND NOVAMINE ON INITIAL CARIES-LIKE LESIONS IN YOUNG PERMANENT TEETH (IN-VITRO STUDY)

Introduction: Despite the cariostatic effect of fluoride, the continuous use of fluoridated toothpastes increases the risk of dental fluorosis. Therefore, new safe alternative technologies of teeth remineralization must be introduced to arrest dental caries and remineralize the early enamel carious lesions. Objectives: The aim of the study was to evaluate the remineralizing effect of eggshell powder and novamine on initial caries-like lesions in young permanent teeth compared to fluoride. Material and Methods: A total of 96 permanent teeth were selected. Each Tooth was coated with nail varnish, leaving squares of 4x4 mm. Each tooth was sectioned into 2 halves longitudinally in a buccolingual direction through the center of the window to obtain a mesial and a distal half (192 specimens). One half was treated and the other half was remained untreated to serve as its negative control. Teeth were assigned into three groups according to treatment agent; group I (eggshell powder solution), group II (novamine toothpaste) and group III (fluoride toothpaste) .Specimens were immersed in the demineralizing solution for 72 hours to produce artificial carious lesions on the exposed enamel surface. Results: There was a statistically significant mean microhardness and lesion depth values between test subgroups IA (eggshell powder), IIA (novamine) and their controls (P 0.001). There was statistically significant difference in mean percent difference values of enamel microhardness among three groups (P 0.001). Conclusions: Both eggshell powder and novamine were effective for remineralization of initial caries-like lesions of young permanent teeth.

PH-responsive calcium and phosphate-ion releasing antibacterial sealants on carious enamel lesions in vitro

ObjectiveNanoparticles of amorphous calcium phosphate (NACP) have shown beneficial effects of a robust release of calcium and phosphate ions at low pH. Here we examined the effect of NACP combined into antibacterial/rechargeable sealant formulations on the mineral content of artificial carious enamel during pH-cycling mimicking intraoral conditions. Materials and MethodsNACP and a quaternary ammonium methacrylate (DMAHDM) were synthesized. Three resin sealants were formulated: "base formulation" (without NACP and DMAHDM, used as control); "NACP on the base formulation" (with 20 wt.% NACP); "NACP on the antibacterial formulation" (with 20 wt.% NACP and 5 wt.% DMAHDM). Standardized enamel windows on sealed non-carious human molars were demineralized and randomly divided into four groups: three groups of teeth sealed with the experimental materials and one group of teeth without sealant application used as negative control. The teeth were exposed to pH cycling regime. The changes in the mineral content of enamel were assessed by quantitative surface hardness loss in percentage (%SHL) and qualitative analyses via scanning electron microscopy/energy-dispersive X-ray spectroscopy (SEM-EDX) and polarized light microscopy (PLM). ResultsThe contact with NACP-containing formulations provoked significant lower %SHL on sealed enamel (p < 0.05) in comparison to control groups. This outcome was supported by the results of SEM-EDX, in which the enamel presented higher percentages of calcium and phosphate than control groups. PLM showed less enamel superficial demineralization around the sealants containing NACP. ConclusionNACP incorporated into an antibacterial sealant protected the enamel against demineralization. pH-responsive calcium and phosphate-ion releasing sealants with antimicrobial and rechargeable properties may be a reliable complementary approach for caries management. Clinical significanceDental caries is the most common childhood disease. Enamel demineralization represents the initial stage of carious lesion formation and may lead to invasive dental procedures. We explored the role of amorphous calcium phosphate (NACP) in a newly-developed antibacterial and rechargeable dental sealant formulation as a preventive approach.

Minimally invasive proximal cavities restored with a hybrid, flowable and low-shrinking composite: effect of marginal ridge preservation on failure pattern

Objectives: The present study assessed the restorative potential of silorane, flowable or hybrid-based composite resin for the ultraconservative occlusal fossa technique. Materials and methods: Thirty-two intact human molars received in the proximal ridge a 1x2x4 mm size occlusal cavity leaving the enamel ridge intact. The bur was then tilted at 30° alongside enamel ridge to simulate a typical carious cavity. After enamel etching and application of adhesive system, cavities were filled with three composites and then, a 0.8 mm diameter hole was prepared beneath the proximal contact area to simulate an incipient enamel carious lesion. Restored molars were submitted to mechanical loading. The adhesive interfaces before and after loading were evaluated with SEM. The fracture test was performed on fatigued molars and maximum breaking loads were recorded. Results: The hybrid and silorane composites showed, after the fatigue test, higher percentages of continuous margins (81±12 and 75±17, respectively) in comparison to flowable material (53±24). Similar fracture resistance was recorded by the three composite types, but significantly lower than the fracture resistance of the non-restored group. Nevertheless, a trend to a ductile behaviour, i.e. better capacity for elastic deformation, was observed in the group restored with the hybrid composite. Conclusions: Minimally invasive occlusal restorations with marginal ridge preservation and simulated proximal decay can be efficiently restored with hybrid and low shrinking composites. The flowable composite might not be indicated in this cavity type, in view of the marginal degradation observed after the fatigue test.

An assessment of three contemporary dental caries epidemiological instruments: a critical review.

Aim Dental caries epidemiological surveys produce information that may be used to assist health policy makers in the planning of preventive and curative strategies. The detection instruments used in these surveys should be able to identify the correct, true stage of the disease or medical condition. This makes it essential that valid instruments are used. This study aimed to critically review commonly used visual/tactile caries assessment instruments in epidemiological surveys with respect to their manageability, reproducibility and validity, and how results are reported.Method A Pubmed search identified the following international visual/tactile instruments for caries detection more than once between 2013 and 2018: World Health Organisation (WHO), International Caries Detection and Assessment System (ICDAS) and Caries Assessment Spectrum and Treatment (CAST).Results The review revealed that the WHO instrument can be considered a screening instrument, that the ICDAS instrument lacks sufficient validity and takes time to apply and that the CAST instrument is promising, but requires further field testing before it can be considered a fully proven caries-assessment instrument in epidemiology. It is recommended that calculating caries prevalence should be based on the presence of cavitated dentine carious lesions, that the prevalence of enamel carious lesions be reported separately and that the dmf/DMF index not be used in its current form.Conclusion Researchers/dentists should be knowledgeable of the limitations and advantages of common caries assessment instruments. Caries prevalence should not be based on the dmf/DMF index but on cavitated dentine carious lesions (d/D-component) as the M- and F-component do not refer to a disease stage.

The interference of digital radiographic image acquisition and processing protocols in the diagnosis of incipient enamel carious lesions.

This study aims to evaluate the diagnosis of proximal carious lesions through different parameters of execution and visualization of the images. Proximal carious lesions were artificially induced in human teeth three different times (10, 20, and 30 hours) by in vitro demineralization. The teeth were radiographed with the Dürr digital system using three exposure times (0.10, 0.16, and 0.20s) and three different resolutions in the scanning of the phosphor plates (20-, 25- and 40-line pairs). After acquiring the images, they were submitted to VistaScan Fine, Caries 1, and Caries 2 software filters. Three radiologists analyzed the images in JPEG format. The Pearson's chi-square test showed an association between longer demineralization time and the presence of injury according to the professional's classification. There was no statistically significant association among the other parameters, exposure time, resolution, and use of filters and the presence of a lesion. All parameters showed a greater sensitivity than specificity. The exposure time of 0.2s showed better accuracy, the resolutions 25 and 40lp showed equal results and better than 20lp and the Fine filter obtained better values than the Caries 1 and 2 filters. Despite the variation of parameters, exposure time, resolution, and use of filters, there were no statistically significant differences. For better diagnostic accuracy, it is recommended to use 0.2s of exposure time and a Fine filter, and scan the phosphor plates with 25lp. Key words:Orbital fracture, Etiology, Orbital trauma, Road traffic accidents, Trauma.

Comparative evaluation of three different toothpastes on remineralization potential of initial enamel lesions: A scanning electron microscopic study.

The early enamel lesions are reversible as it is a process involving mineral transactions between the teeth and saliva. To evaluate the efficiency of three different tooth pastes on remineralization potential of initial enamel lesions using Vickers Micro hardness Test and Scanning electron microscopy. Artificial carious lesions were prepared in human enamel with demineralizing solution. The treatment agents included were Colgate sensitive plus® toothpaste, Regenerate enamel science™ toothpaste, BioRepair® toothpaste and control as Deionized water. All the samples were subjected to treatment solutions as per the pH cycling model for 12 days to simulate the daily oral environment's acid challenge. The remineralization parameters-surface hardness and surface roughness of enamel blocks were evaluated with Vickers indenter and Scanning electron microscope respectively. Statistical Analysis: ANOVA test was used to check mean differences between the groups. Post hoc analysis was done using Tukey's post hoc test. SEM images were graded according to Bonetti et al grading criteria. As per statistical analysis, maximum remineralization of enamel blocks occurred after applying Colgate Sensitive Plus® tooth paste followed by BioRepair® tooth paste and Regenerate enamel Science™ toothpaste. Least remineralization potential was shown by control group. Colgate sensitive plus tooth paste with Pro Argin™ formula can be regarded as a potential remineralising agent. It can be concluded as a noninvasive means of managing early enamel carious lesions.

The effect of theobromine on the in vitro de- and remineralization of enamel carious lesions

ObjectivesThis in vitro study investigated the effect of theobromine on the de- and remineralization of enamel carious lesions under plaque fluid-like conditions. MethodsEarly carious lesions were created in 272 bovine enamel specimens and assigned to sixteen groups (n=17) based on Knoop surface microhardness (SMH). Lesions were demineralized again under plaque fluid-like conditions in the presence of fluoride (0.2 or 1ppm) and theobromine (0; 10; 100 or 200ppm) at different pH values (5.5 or 7.0) in a factorial design. SMH was determined again and percent SMH recovery (%SMHr) calculated. Three-way ANOVA was used for the fixed effects of fluoride, theobromine and pH levels to compare the differences between each level. ResultsThe three-way interaction was not significant (p=0.712). The two-way interaction between fluoride and pH was significant (p=0.030), whereas those between fluoride and theobromine as well as that for pH and theobromine were not (p=0.478 and p=0.998, respectively). Theobromine did not affect %SMHr at any of the tested concentrations. There were trends for the higher fluoride concentration and the higher pH resulting in more rehardening with the lesions exposed to 0.2ppm fluoride at pH 5.5 displaying significantly less rehardening than those exposed to 0.2ppm fluoride at pH of 7.0 and lesions exposed to 1ppm fluoride at pH of 5.5. ConclusionTheobromine, when continuously present in a plaque fluid-like medium at various concentrations and at different pH values, does not affect de- or remineralization of enamel carious lesions under the presently studied conditions. Clinical significanceBased on the presently available evidence, theobromine cannot be recommended as an anticaries agent.

PERBEDAAN KEKERASAN PERMUKAAN ENAMEL SETELAH APLIKASI FLUORIDE VARNISH DAN CASEIN PHOSPO PEPTIDE-AMORPHOUS CALSIUM PHOSPHATE FLUORIDE (CPP-ACPF) (PENELITIAN IN VITRO)

Background: Caries is a chronic, slowly progressing disease, with symptoms not detected at the onset of the disease but generally much later. Its initiation is associated with demineralization (calcium and phosphate loss) of subsurface tooth enamel, resulting in the formation of a subsurface lesion. To restore the natural equilibrium, either remineralization must be enhanced or demineralization must be retarded. There are some topical agents that can enhance remineralization such as topical fluor and casein phosphopeptide – amorphous calcium phosphate (CPP-ACP). Purpose: The aim of this study is to analyze the differences of the enamel surface microhardness after application of fluoride varnish and CPP-ACPF. Methode: 27 blocks bovine enamel were devided into 3 groups. Group 1 – control (No surface treatment), group 2 – fluoride varnish and group 3 – CPP-ACPF. Initial surface hardness enamel was measured for all enamel specimens. Artificial enamel carious lesions were created by immersing enamel samples to demineralization solution (pH 4,5) for 72 hours at temperature 370 C. The surface microhardness of demineralized enamel specimens was measured. A caries progression test (pH cycling) was carried out, which consisted of alternative demineralization (3 hours), remineralization with artificial saliva (21 hours) and application topical agent twice a day for 14 days. Then, the last surface enamel microhardness is measured. Result: Group 3 showed significantly highest Vickers hardness number (P&lt;0,05) followed by group 2 and the lowest is group 1. Conclusions: This study proved that enamel surface microhardness after application of CPP-ACPF was higher than fluoride varnish.

EFFECT OF TWO REMINERALIZING AGENTS ON MICROHARDNESS OF INITIAL ENAMEL CARIESLIKE LESIONS IN YOUNG PERMANENT TEETH

INTRODUCTION: Dental caries in enamel is unique amongst diseases as enamel is both acellular and avascular. Thus, in contrast to other tissues, enamel cannot heal itself by a cellular repair mechanism. Nonetheless, it is now well established that the formation of incipient enamel caries is a reversible process where periods of progression alternates with periods of remineralization. OBJECTIVES: The purpose of this study was to compare the effect of Nano-hydroxyapatite paste and casein phosphopeptide-amorphous calcium phosphate fluoride paste remineralizing capacity on initial enamel carious lesions of young permanent teeth. MATERIALS AND METHODS: Sixty extracted young permanent teeth with a standardized window on enamel were immersed in a demineralizing solution for 48 hours to produce subsurface enamel lesions. They were divided into three groups according to remineralizing agents (N=20): group I: Nano-hydroxyapatite paste; group II: casein phosphopeptide-amorphous calcium phosphate fluoride paste; and group III: control (untreated). The enamel surface microhardness (SMH) was measured at baseline, after incipient enamel lesion formation and after treatment. RESULTS: The mean surface microhardness (201.46) was found to be higher in teeth treated with Nano-hydroxyapatite paste than mean surface microhardness (195.61) in those treated with casein phosphopeptide-amorphous calcium phosphate fluoride paste. However, this difference was not statistically significant P=0.26. CONCLUSIONS: Both Nano-hydroxyapatite paste and casein phosphopeptide-amorphous calcium phosphate fluoride paste were effective for remineralization of early caries-like lesions of young permanent teeth.

Remineralization effectiveness of the PAMAM dendrimer with different terminal groups on artificial initial enamel caries in vitro

ObjectiveDisruption of the demineralization–remineralization balance could trigger the development of dental caries, making it challenging for enamel to “self-heal”. Thus, extrinsic assistance is needed to restore enamel lesions and stop undermining progression. The aim of this study was to investigate enamel remineralization in a simulated oral environment via poly (amino amine) (PAMAM) dendrimers quantitatively. MethodsBovine enamel specimens were shaken in demineralization solution (pH 4.5, 37°C, 50rpm/min) for 72h to create initial enamel carious lesions. The subsurface-demineralized specimens were then divided into four groups: enamel treated with PAMAM-NH2, enamel treated with PAMAM−COOH, enamel treated with PAMAM−OH, and enamel treated with deionized water. The treated specimens underwent subsequent 12-day pH cycling. Enamel blocks were analyzed by transverse microradiography (TMR), surface microhardness testing and scanning electron microscopy (SEM) before and after demineralization and pH cycling. ResultsGroups treated with PAMAM dendrimers showed lower lesion depth and less mineral loss, attained more vertical-section surface microhardness recovery, and adsorbed more mineral deposits (p<0.05). The enamel lesion remineralization values of PAMAM-NH2, PAMAM-COOH, and PAMAM-OH groups were 76.42±3.32%, 60.07±5.92% and 54.52±7.81%, respectively. SignificanceIn conclusion, PAMAM with different terminal groups could induce enamel remineralization, among which PAMAM-NH2 showed the most prominent competence, followed by PAMAM-COOH and PAMAM-OH, in that order.

Dental caries and oral health-related quality of life of 3-year-olds living in Lima, Peru.

Untreated dental caries negatively impacts children and their families; the implication of which is best measured through assessing quality of life. Information related to Oral Health-Related Quality of Life (OHRQoL) in Peruvian pre-school children is scarce. To investigate the relationship between dental caries and the OHRQoL of 3-year-old children. Randomly selected government pre-schools (n=17), situated in three low socio-economic status districts in Lima, participated. The OHRQoL data were obtained using the Peruvian (P) ECOHIS questionnaire. Clinical examinations using the Caries Assessment Spectrum and Treatment (CAST) instrument were performed on 308 children. From which, 213 parents returned the P-ECOHIS form. ANOVA, Tamhane, and Tukey methods were used to analyse the data. The mean age of the children was 3.04years. The two highest mean P-ECOHIS scores in the child section were 'child symptoms' and 'child psychology' while 'parent distress' scored highest in the parent section. The prevalence of dental caries was 64.3% (CAST scores 4-7). Including CASTcode 3 (enamel carious lesion), the dental caries prevalence was 93.4%. The mean P-ECOHIS scores for 'child symptoms', 'child functions', 'child impact', 'parent distress', and 'the sample' were statistically significantly higher for children with MaxCASTcodes 5 and 6 (dentine and pulpally involved cavities, respectively) than for those with MaxCASTcode 3. The presence of cavitated teeth with and without pulpal involvement impacts negatively on the OHRQoL of 3-year-old children.