Search Results (45)

This article reviews the topic of stannous fluoride as an anti-caries additive in toothpastes. It is based on a literature survey carried out using Science Direct, supplemented by information from PubMed. The keywords used were stannous fluoride, toothpaste, clinical effects, caries, hypersensitivity, gingival health, structure and aqueous solutions. The initial searches covered the period 2015–2024 and identified 57 references. Older references cited in these papers, and also papers already known to the author, were also included. The information thus obtained shows that stannous fluoride has three main effects, namely, reduction in the viability of the oral biofilm, increase in remineralisation of the hydroxyapatite tooth mineral and occlusion of dentinal tubules leading to reduced hypersensitivity. Stannous fluoride was shown to be the most effective of all the fluoride additives used in toothpastes. In much of the dental literature, this is attributed to the effects of Sn²⁺ ions. However, as has been shown extensively in the wider scientific literature, free Sn²⁺ ions do not occur in aqueous systems. Rather, the initial products of the dissolution of SnF₂ is undissociated, hydrated SnF₂ and SnF⁺ ions. These gradually exchange fluoride to form Sn(OH)₂ and Sn(OH)⁺. Their likely mechanism of action based on their toxicity towards oral micro-organisms and their interaction with hydroxyapatite is discussed. Full article

The aim of this randomized clinical trial was to evaluate the efficacy of two different remineralising toothpastes in preventing dental caries and promoting oral health. Patients aged 6–18 years old with healthy and fully erupted first permanent molars (C1 and C2 DIAGNOdent scores) were enrolled and randomized into two groups according to the home-hydroxyapatite-based remineralising treatment used: the Trial group used zinc carbonate hydroxyapatite-based treatment (Biorepair Total Protective Repair), while the Control group used magnesium strontium carbonate hydroxyapatite conjugated with chitosan toothpaste (Curasept Biosmalto Caries Abrasion & Erosion). Dental and periodontal parameters were measured over a six-month period, including the DIAGNOdent Pen Index (primary outcome), BEWE Index, Plaque Index, Bleeding Score, Schiff Air Index, and ICDAS assessed with DIAGNOcam. A total of 40 patients were equally allocated in the two groups and finally analyzed. A significant reduction in the DIAGNOdent Pen score was reported in the Trial group after 1 month of treatment, while in the Control group, no significant change was found. The Trial group also showed a significant reduction in plaque levels after 3 months of treatment, while in the Control group, it occurred after 1 month. However, the Bleeding Score and Schiff Air Index showed no significant differences between the groups, suggesting that additional measures may be required to address gingival inflammation and hypersensitivity. The ICDAS index also showed no statistically significant changes, due to the limited duration of this study. Overall, zinc-hydroxyapatite-based toothpaste was more effective than magnesium strontium carbonate hydroxyapatite toothpaste in enhancing enamel remineralisation in the short-term period. The assigned treatments did not result in significant improvements in the oral indexes assessed in this study. Full article

Background and Objectives: Dental caries has seen an increase in untreated cases, leading to significant health and quality-of-life impacts, necessitating innovative approaches like the promising non-operative management with silver diamine fluoride. This study aimed to evaluate the mechanisms of action of silver diamine fluoride on arresting dental caries in primary teeth. Materials and Methods: A systematic search was conducted across MEDLINE (PubMed), Google Scholar, and Wiley Online Library, including both in vivo and in vitro studies published from 1 January 2017 to 16 October 2022. The Cochrane Risk of Bias Tool assessed bias in in vivo studies, while the Quality Assessment Tool for In Vitro Studies evaluated the methodological quality of in vitro studies. Results: Nineteen publications met the inclusion criteria. Two studies indicated that silver diamine fluoride application significantly alters oral microflora, contributing to caries arrest. Additionally, two studies reported increased mineral density and mineral content in demineralised primary teeth, emphasising silver diamine fluoride’s role in promoting remineralisation. Three studies demonstrated significant improvements in surface microhardness, enhancing tooth resistance. However, no significant qualitative changes in bacterial species composition were noted. Modified silver diamine fluoride application techniques, including light curing or laser irradiation, enhanced efficacy, with light curing notably increasing surface microhardness. Based on a limited number of studies, no statistically significant differences in clinical effectiveness were observed with higher silver diamine fluoride concentrations or extended application durations. Conclusions: Silver diamine fluoride effectively induces quantitative changes in oral microflora and enhances the microhardness and mineral density of enamel and dentine in primary teeth, with modified application methods showing potential for improved outcomes. Full article

Background: Dental caries remains a significant global health problem. One of the fundamental mechanisms underlying the development and progression of dental caries is the dynamic process of demineralisation/remineralisation. In vitro models have played a critical role in advancing our understanding of this process and identifying potential interventions to prevent or arrest dental caries. This literature review aims to provide a structured oversight of in vitro mineralisation models which have been used to study the tooth demineralisation/remineralisation process. Methods: Publications from 2019 to 2023 were screened to identify articles reporting the use of in vitro models to study the demineralisation/remineralisation of tooth caries. The included studies were methodologically assessed for their information on (i) substrate, (ii) lesion formation, and (iii) mineralisation models. Results: The most reported substrates used in the studies were human teeth along with bovine incisors. Acetic/lactic buffers were the most common solutions to induce caries lesions. pH cycling was the most frequently used mineralisation model for simulating the daily change within the oral environment. This review discussed the advantages and limitations of various approaches. Conclusions: Standardisation of in vitro mineralisation models is crucial for enabling effective comparison between studies and advancing caries research. Full article

Silver nanoparticles have unique physical, chemical, and biological properties that make them attractive for medical applications. They have gained attention in dentistry for their potential use in caries management. This study reviews the different synthesis methods of silver nanoparticles and the application of them for caries management. Silver nanoparticles are tiny silver and are typically less than 100 nanometres in size. They have a high surface area-to-volume ratio, making them highly reactive and allowing them to interact with bacteria and other materials at the molecular level. Silver nanoparticles have low toxicity and biocompatibility. Researchers have employed various methods to synthesise silver nanoparticles, including chemical, physical, and biological methods. By controlling the process, silver nanoparticles have defined sizes, shapes, and surface properties for wide use. Silver nanoparticles exhibit strong antibacterial properties, capable of inhibiting a broad range of bacteria, including antibiotic-resistant strains. They inhibit the growth of cariogenic bacteria, such as Streptococcus mutans. They can disrupt bacterial cell membranes, interfere with enzyme activity, and inhibit bacterial replication. Silver nanoparticles can inhibit biofilm formation, reducing the risk of caries development. Additionally, nano silver fluoride prevents dental caries by promoting tooth remineralisation. They can interact with the tooth structure and enhance the deposition of hydroxyapatite, aiding in repairing early-stage carious lesions. Silver nanoparticles can also be incorporated into dental restorative materials such as composite resins and glass ionomer cements. The incorporation can enhance the material’s antibacterial properties, reducing the risk of secondary caries and improving the longevity of the restoration. Full article

This study aims to investigate whether toothbrushes with fluoride-infused bristles have any (re)mineralisation effects on bovine enamel. Bovine incisors (N = 160) were extracted, and the buccal side of the crown was cut into dimensions of ~5 mm × 5 mm with a low-speed saw. These specimens were randomly allocated into four groups: half (80 teeth) were stored in demineralising solution (DM), and the other half were stored in deionised water (DW) for 96 h. Then, they were brushed with a force of 2.0 ± 0.1 N for five min with a manual toothbrush with either fluoride-infused (TF) or regular (TR) bristles. Microhardness (Vickers), X-ray diffraction (XRD), energy-dispersive X-ray spectroscopy (EDS), and scanning electron microscopy (SEM) were used to investigate the surfaces of the bovine enamel specimens before and after brushing. Two-way ANOVA was used to analyse the hardness data, and the pairwise comparison method was used to analyse the Ca/P ratio, for each group at α = 0.05. The results show that brushing with either of these toothbrushes increased the Vickers microhardness on DM and DW enamel (p < 0.001), whereas hydroxyapatite was revealed in all groups by XRD. The DM samples showed a significant increase (p < 0.05) in the Ca/P ratios after brushing with TR and TF. Conversely, under DW conditions, these ratios decreased significantly after brushing. In terms of the F atomic%, TF increased significantly. SEM revealed mineral deposition in the DM groups after toothbrushing. To conclude, toothbrushing effectively induces the microhardness of sound and demineralised enamel, while fluoride-infused bristles might be able to retain fluoride on the enamel surface. Full article

Dental caries is an avoidable and complex condition impacting billions of individuals worldwide, posing a specific concern among younger generations, despite the progress of oral hygiene products. This deterioration occurs due to the acid demineralization of tooth enamel, leading to the loss of minerals from the enamel 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 and plays a key role in the bio mineralisation process. The aim of this study is to investigate the self-assembly microstructure and reticulation behaviour of a newly developed bioactive hydrogel with leucine-rich amelogenin peptide (LRAP) intended for enamel remineralisation. SEM, AFM, UV-VIS, and FTIR analyses emphasize the ability of peptides to promote cell adhesion and the treatment of early carious lesions. In conclusion, short-chain peptides can be used in hydrogels for individual or professional use. Full article

This study aimed to assess the ability of modern resin-based “bioactive” materials (RBMs) to induce dentine remineralisation via mineral deposition and compare the results to those obtained with calcium silicate cements (CSMs). The following materials were employed for restoration of dentine cavities: CSMs: ProRoot MTA (Dentsply Sirona), MTA Angelus (Angelus), Biodentine (Septodont), and TheraCal LC (Bisco); RBMs: ACTIVA BioACTIVE Base/Liner (Pulpdent), ACTIVA Presto (Pulpdent), and Predicta Bioactive Bulk (Parkell). The evaluation of the mineral deposition was performed through scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX) on the material and dentine surfaces, as well as at the dentine–material interface after immersion in simulated body fluid. Additionally, the Ca/P ratios were also calculated in all the tested groups. The specimens were analysed after setting (baseline) and at 24 h, 7, 14, and 28 days. ProRoot MTA, MTA Angelus, Biodentine, and TheraCal LC showed significant surface precipitation, which filled the gap between the material and the dentine. Conversely, the three RBMs showed only a slight ability to induce mineral precipitation, although none of them was able to remineralise the dentine–material interface. In conclusion, in terms of mineral precipitation, modern “bioactive” RBMs are not as effective as CSMs in inducing dentine remineralisation; these latter represent the only option to induce a possible reparative process at the dentin–material interface. Full article

The management of root caries remains a challenge for clinicians due to its unique anatomical location and structure. There is increasing interest in utilising artificial root caries lesions to develop new strategies for remineralisation. An ideal protocol has not yet been agreed upon. The aim of this review is to provide a structured overview of previously reported in vitro root caries models. The literature was screened and mined for information mainly on substrate selection, model systems utilised, and variables used in the models. Human roots (60%) were the most frequently used substrates, followed by bovine roots (40%). Chemical models (69%) were the most frequently utilised model systems, followed by microbiological models (27%), to form root caries lesions. Acetate buffer solution (80%), pH 5.0 or above (40%), and a demineralisation time of five days (25%) were the common variables used in the chemical systems, while mono-species biofilm was most frequently used (73%) in microbiological models and Streptococcus mutans was the most common bacterial strain utilised in these models (80%). This review highlights the variability amongst the experimental approaches, discusses the advantages and limitations of these approaches, and emphasises that standardisation of experimental conditions along with sustained research will benefit root caries research. Full article

Over the last decade, there has been an increasing interest in the use of bioceramics for biomedical purposes. Bioceramics, specifically those made of calcium phosphate, are commonly used in dental and orthopaedic applications. In this context, hydroxyapatite (HA) is considered a viable option for hard tissue engineering applications given its compositional similarity to bioapatite. However, owing to their poor mechanobiology and biodegradability, traditional HA-based composites have limited utilisation possibilities in bone, cartilage and dental applications. Therefore, the efficiency of nano HA (nHA) has been explored to address these limitations. nHA has shown excellent remineralising effects on initial enamel lesions and is widely used as an additive for improving existing dental materials. Furthermore, three-dimensional printing (3DP) or fused deposition modelling that can be used for creating dental and hard tissue scaffolds tailored to each patient’s specific anatomy has attracted considerable interest. However, the materials used for producing hard tissue with 3DP are still limited. Therefore, the current study aimed to develop a hybrid polymer nanocomposite composed of nHA, nanoclay (NC) and polylactic acid (PLA) that was suitable for 3DP. The nHA polymer nanocomposites were extruded into filaments and their physiochemical properties were evaluated. The results showed that the addition of nHA and NC to the PLA matrix significantly increased the water absorption and contact angle. In addition, the hardness increased from 1.04 to 1.25 times with the incorporation of nHA. In sum, the nHA-NC-reinforced PLA could be used as 3DP filaments to generate bone and dental scaffolds, and further studies are needed on the biocompatibility of this material. Full article

This study aimed to investigate the antibiofilm and remineralising effects of peptide GAPI on artificial dentin caries. After creating artificial carious lesions, eighty dentine blocks were randomly assigned for treatment twice daily with GAPI (GAPI group) or deionised water (control group). Both groups underwent a 7-day biochemical cycle. Scanning electron microscopy (SEM) showed S. mutans with damaged structures that partially covered the dentine in the GAPI group. The dead–live ratios for the GAPI and control groups were 0.77 ± 0.13 and 0.37 ± 0.09 (p < 0.001). The log colony-forming units for the GAPI and control groups were 7.45 ± 0.32 and 8.74 ± 0.50 (p < 0.001), respectively. The lesion depths for the GAPI and control groups were 151 ± 18 µm and 214 ± 15 µm (p < 0.001), respectively. The mineral losses for the GAPI and control groups were 0.91 ± 0.07 gHAcm⁻³ and 1.01 ± 0.07 gHAcm⁻³ (p = 0.01), respectively. The hydrogen-to-amide I ratios for the GAPI and control groups were 2.92 ± 0.82 and 1.83 ± 0.73 (p = 0.014), respectively. SEM micrographs revealed fewer exposed dentine collagen fibres in the GAPI group compared to those in the control group. Furthermore, X-ray diffraction (XRD) patterns indicated that the hydroxyapatite in the GAPI group was more crystallised than that in the control group. This study demonstrated GAPI’s antibiofilm and remineralising effects on artificial dentin caries. Full article

Fluoride (F) ions actively participate in the dental enamel remineralisation process and inhibit the activity of cariogenic bacteria of the oral biofilm. However, increased systemic intake of F during critical periods of amelogenesis can lead to dental fluorosis (DF). The necessity of our study stemmed from the growing consumption of bottled water, as water is one of the primary sources of F in humans, and labelling F concentration is optional. Our aim was to evaluate the F concentration in bottled natural mineral or spring still waters available on the market in Iasi, Romania. We purchased forty different brands of still bottled water from the major grocery stores and tested them using an ion-selective electrode method. The reliability of the data was assessed by the intraclass correlation coefficient (ICC), while the differences between the obtained and labelled F values were examined using a paired samples t-test. The tested F levels ranged between 0.0338 and 4.6262 milligrams per litter (mg/L). The majority of the samples, around 85% recorded F values ranging from 0.232 to 0.0338 mg/L, offering slight or no benefit in caries prevention. Another 10% of the samples had F values ranging between 0.3 and 0.4 mg/L and could provide a dental health benefit. A percentage of 5% of the tested samples recorded F levels above the optimal level of 0.7 mg/L, as set by the American Dental Association (ADA) and the United States Department of Health and Human Services (U.S. HHS). This elevated F concentration poses a potential risk for DF in infants and toddlers, indicating that regular consumption of these samples may be unsafe. Full article

Caries is a chronic disease that causes the alteration of the structure of dental tissues by acid dissolution (in enamel, dentine and cementum) and proteolytic degradation (dentine and cementum) and generates an important cost of care. There is a need to visualise and characterise the acid dissolution process on enamel due to its hierarchical structure leading to complex structural modifications. The process starts at the enamel surface and progresses into depth, which necessitates the study of the internal enamel structure. Artificial demineralisation is usually employed to simulate the process experimentally. In the present study, the demineralisation of human enamel was studied using surface analysis carried out with atomic force microscopy as well as 3D internal analysis using synchrotron X-ray tomography during acid exposure with repeated scans to generate a time-lapse visualisation sequence. Two-dimensional analysis from projections and virtual slices and 3D analysis of the enamel mass provided details of tissue changes at the level of the rods and inter-rod substance. In addition to the visualisation of structural modifications, the rate of dissolution was determined, which demonstrated the feasibility and usefulness of these techniques. The temporal analysis of enamel demineralisation is not limited to dissolution and can be applied to other experimental conditions for the analysis of treated enamel or remineralisation. Full article

The prospect of repair, regeneration, and remineralisation of the tooth tissue is currently transitioning from the exploratory stages to successful clinical applications with materials such as dentine substitutes that offer bioactive stimulation. Glass-ionomer or polyalkenoate cements are widely used in oral healthcare, especially due to their ability to adhere to the tooth structure and fluoride-releasing capacity. Since glass-ionomer cements exhibit an inherent ability to adhere to tooth tissue, they have been the subject of modifications to enhance bioactivity, biomineralisation, and their physical properties. The scope of this review is to assess systematically the modifications of glass-ionomer cements towards bioactive stimulation such as remineralisation, integration with tissues, and enhancement of antibacterial properties. Full article

Researchers have developed novel bioactive materials for caries management. Many clinicians also favour these materials, which fit their contemporary practice philosophy of using the medical model of caries management and minimally invasive dentistry. Although there is no consensus on the definition of bioactive materials, bioactive materials in cariology are generally considered to be those that can form hydroxyapatite crystals on the tooth surface. Common bioactive materials include fluoride-based materials, calcium- and phosphate-based materials, graphene-based materials, metal and metal-oxide nanomaterials and peptide-based materials. Silver diamine fluoride (SDF) is a fluoride-based material containing silver; silver is antibacterial and fluoride promotes remineralisation. Casein phosphopeptide-amorphous calcium phosphate is a calcium- and phosphate-based material that can be added to toothpaste and chewing gum for caries prevention. Researchers use graphene-based materials and metal or metal-oxide nanomaterials as anticaries agents. Graphene-based materials, such as graphene oxide-silver, have antibacterial and mineralising properties. Metal and metal-oxide nanomaterials, such as silver and copper oxide, are antimicrobial. Incorporating mineralising materials could introduce remineralising properties to metallic nanoparticles. Researchers have also developed antimicrobial peptides with mineralising properties for caries prevention. The purpose of this literature review is to provide an overview of current bioactive materials for caries management. Full article