Beruflich Dokumente
Kultur Dokumente
REMINERALIZATION
AGENTS IN DENTISTRY
Dr. J. Aurlene
II year Post Graduate
Dept. Of Public Health Dentistry
SRM Dental College, Ramapuram
Dental caries process is a
continuous process
resulting from many
cycles of demineralization
and remineralization.
Fermentable carbohydrates provide plaque bacteria with substrate for acid production.
This causes a rapid drop in plaque pH and when pH becomes less than 5.5, hydroxyapatite in
enamel breaks down and calcium and phosphate ions diffuse out from the enamel.
5.5 is the “critical pH”, the point where equilibrium exists. There is no mineral dissolution and no
mineral precipitation.
The plaque remains acidic for about 30-60 minutes after which normal pH is restored gradually.
The calcium and phosphate ions re-enter enamel when normal pH is restored and thus
remineralization occurs.
REMINERALIZATION
Remineralization is defined as the process whereby calcium and phosphate ions are supplied
from an external source to the tooth thereby, causing ion deposition into crystal voids in
demineralized enamel, thus producing net mineral gain.
Fluoride reduces the decay of tooth enamel by the formation of fluorapatite and its
incorporation into the dental enamel. The fluoride ions reduce the rate of tooth enamel
demineralization and increase the rate of remineralization of teeth at the early stages of cavities.
Mechanism of Action of Fluorides
MOUTHRINSES
VARNISHES
TOPICAL FLUORIDES
GELS VARNISHES FOAMS MOUTHRINSES
Finn Brudevold Schmidt (1964) Bibby
(1960)
APF gel Duraphat - NaF APF foam Sodium fluoride
Fluorprotector-
difluorosilane
Carex
1.23% Duraphat- 2.26% 1.23% 0.2% weekly use
Fluorprotector- 0.05% daily use
0.7%
Carex- 1.8%
12,300ppm 22,600ppm 12,300ppm 900ppm
7000ppm 225ppm
18,000ppm
Gels are dispensed Application is done Foams are also Used by forcefully
into trays that fit the using an applicator dispensed into trays swishing 10 ml of
patients upper and brush, first on the that fit the patients the liquid around
lower dental arches. lower arch and then upper and lower the mouth.
on the upper arch. dental arches.
4 minutes 4 minutes 4 minutes 60 seconds
Fluoride Dentifrices
A dentifrice is a substance used with a tooth brush for the purpose of cleaning the accessible
surfaces of the teeth.
The first clinical trial with fluoride toothpaste was done by Bibby et al in 1942.
Fluoride compounds present in fluoride dentifrices are sodium fluoride, amine fluoride,
monofluorophosphate and stannous fluoride.
Most toothpastes contains between 0.22% (1,000 ppm) and 0.312% (1,450 ppm) fluoride.
High-fluoride content toothpaste generally contains 1.1% (5,000 ppm) sodium fluoride.
A 200g tube of Colgate contains 1000ppm of fluoride with the fluoride compound as
Monofluorophosphate.
A single brushing with a full ribbon of paste on a brush head provides about one gram of
toothpaste and will expose the individual to approximately 1mgF.
For young children non fluoridated and non abrasive toothpaste is recommended till the child is 4
years of age, after 6 years of age fluoridated toothpaste should be used.
Calcium Phosphate Based
Remineralization of early carious lesions can be done by using CPP–ACP. It has the ability to
counteract the action of acids in cases of erosion.
Used for both deciduous and permanent teeth. Fluoride-free tooth Mousse is a safe product to
use in babies’ teeth especially children below 2 years with early childhood caries.
Used for patients with special care needs such as patients with intellectual impairment,
developmental and physical disabilities, cerebral palsy, Down’s syndrome and those with any
medical problems such as patients who is undergoing radiation therapy.
Used for high caries-risk patients in order to remineralize early enamel lesions.
Used in cases of molar incisor hypomineralization (MIH), so as to remineralize hypoplastic molars
and white spot lesions.
Reynolds and Black (1999) the incorporation of CPP-ACP into sugar-free chewing gum in clinical
studies demonstrated that the addition of 1.0% CPP-ACP to either sorbitol or xylitol-based gum
can increase in enamel remineralization by 100% relative to the control gum.
Walsh LJ 2000 In a human enamel demineralization study, 1.0% CPP-ACP solution was used twice
daily which produced 51±19% reduction in enamel mineral loss caused by frequent sugar
exposure. The twice daily use of the 1.0% CPP-ACP solution resulted in a 144% increase in
calcium level and 160% increase in inorganic phosphate level in the pediatric population.
Shen and Reynolds in 2001, in their study showed that CPP-ACP in a sugar-free chewing gum
enhanced remineralization of enamel subsurface lesions in situ by 100%, when compared with
the control sugar-free gum not containing CPP-ACP.
Unstabilised Calcium Phosphate System
Calcium and phosphate are not stabilized, allowing the two ions to combine into insoluble
precipitates.
CALCIUM SUCROSE PHOSPHATE
Nova Min is a bioactive glass containing calcium sodium phosphosilicate, and comprises 45%
SiO2, 24.5% Na2O, 24.5% CaO and 6% P2O5.
NovaMin as well as other CSPS materials were originally developed as bone regenerative
materials in the early 1970s.
In the presence of water or saliva NovaMin rapidly releases sodium ions. This increases the local
pH and initiates the release of calcium and phosphate.
The calcium-phosphate complexes crystallize into hydroxycarbonate apatite, which is chemically
and structurally similar to biological apatite.
NovaMin has been incorporated into toothpastes, gels and prophy pastes.
XYLITOL
Xylitol is one of a number of non-sugar sweeteners permitted for use in foods throughout the
world.
Habitual use of xylitol is associated with a significant reduction in caries incidence and increased
tooth remineralization.
Cariogenic bacteria process xylitol very poorly, producing little acid. This decreases caries
incidence and promotes colonization of less virulent strains of bacteria that can ferment xylitol.
A minimum of 5-6 grams and three exposures per day (from chewing gum and/or candies) is
required for clinical effect.
A novel method of delivering remineralizing ions (calcium and phosphate) in combination with
xylitol has been developed using a NaF varnish (Embrace Varnish, Pulpdent).
This varnish contains calcium and phosphate salts that have been nano-coated with xylitol.
The xylitol coating prevents early reaction and produces a sustained release of the remineralizing
ions. Saliva exposure dissolves the xylitol and frees the calcium and phosphate ions.
NANOHYDROXYAPATITE
The main constituents of dental hard tissue is is hydroxyapatite which is 95wt% and 75wt% for
enamel and dentin, respectively.
The nanohydroxyapatite powder has a crystal dimension of 50-100 nm in length and 20-40 nm in
width.
HA nanocrystals adhere to the pores created by demineralization. These adherent nanocrystals
aggregate and grow into microclusters and form a uniform apatite layer on the demineralized
surface.
Enamel surface remineralization: Using
synthetic nanohydroxyapatite
Thirty sound human premolars were divided into nanohydroxyapatite group (n = 15) and the
sodium fluoride group (n = 15). The specimens were subjected to demineralization before
being coated with 10% aqueous slurry of 20 nm nanohydroxyapatite or 2% sodium fluoride.
The remineralizing efficacy of the materials was evaluated using surface microhardness (SMH)
measurements, scanning microscopic analysis.
Gupta K, Taneja V, Kumar S, Bhat S. Remineralizing Agents– An Insight into the Current and Future
Trends. Int J Oral Health Med Res 2016;3(2):55-58
Naveena P, Nagarathana C, Sakunthala BK (2014) Remineralizing Agent -Then and Now -An Update.
Dentistry 4:256.
Kandelman D, Gagnon G, Clinical results after 12 months from a study of the incidence and
progression of dental caries in relation to consumption of chewing gum containing xylitol in school
preventive programs, J Dent Res, 1987:66:1407-1411.
Reynolds EC, Remineralization of enamel subsurface lesions by casein phosphopeptide-stabilization
calcium phosphate solutions, J Dent Res, 1997;79(9):1587-95.
Cross KJ, Huq NL, Reynolds EC, Casein Phosphopeptides in oral health-chemistry and clinical
applications, Curr Pharm Des, 2007, 13 (8):793-800.
Zero DT, Dentifrices, mouthwashes and remineralization/caries arrestment strategies, BMC Oral Health,
2006:6 (Suppl 1):S9-S22.
Featherstone JD, Dental Caries: a dynamic disease process, Aust Dent J, 2008;53(3):286-91.
Van Louveren C, the antimicrobial action of fluoride and its role in caries inhibition, J Dent
Res1990:69:676-81.
Suni S, Panchmal GS, Shenoy RP, Jodalli P, Sonde L. Caries Prevention through Casein Phosphopeptide–
Amorphous Calcium Phosphate (CPP–ACP). Int J Oral Health Med Res 2015;2(4):70-73.
Laurence J. Walsh. Contemporary technologies for remineralization therapies: A review. international
dentistry SA VOL. 11, NO. 6.
Damen JJ, ten Cate JM, Silica-induced precipitation of calcium phosphate in the presence of inhibitors
of of hydroxyapatite formation, J Dent Res, 1992: 71:453-457.
http://www.oralhealthgroup.com/features/dental-remineralization-simplified/
THANK YOU