Remineralisation of teeth

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Example: Demineralization and remineralization of dental enamel in the presence of acid and fluoride in saliva and plaque fluid. Remineralization is a natural process and does not have to involve fluoride. Enamel-fluoride-remineralization.svg
Example: Demineralization and remineralization of dental enamel in the presence of acid and fluoride in saliva and plaque fluid.

Remineralization is a natural process and does not have to involve fluoride.

Tooth remineralization is the natural repair process for non-cavitated tooth lesions, [1] [2] in which calcium, phosphate and sometimes fluoride ions are deposited into crystal voids in demineralised enamel. Remineralization can contribute towards restoring strength and function within tooth structure. [3]

Contents

Demineralization is the removal of minerals (mainly calcium) from any of the hard tissues: enamel, dentine, and cementum. [4] It begins at the surface, and may progress into either cavitation (tooth decay) or erosion (tooth wear). Tooth decay demineralization is caused by acids from bacteria in the dental plaque biofilm whilst tooth wear is caused by acids from non-bacterial sources. These can be extrinsic in source, such as carbonated drinks, or intrinsic acids, usually from stomach acid coming into the mouth. Both types of demineralization will progress if the acid attacks continue unless arrested or reversed by remineralization. [5] [6]

Tooth decay process

When food or drinks containing fermentable sugars enter the mouth, the bacteria in dental plaque rapidly feed on the sugars and produce organic acids as by-products. [1] The glucose produced from starch by salivary amylase is also digested by the bacteria. When enough acid is produced so that the pH goes below 5.5, the acid dissolves carbonated hydroxyapatite, the main component of tooth enamel. [7] The plaque can hold the acids in contact with the tooth for up to two hours, before it is neutralized by saliva. Once the plaque acid has been neutralized, the minerals can return from the plaque and saliva to the enamel surface.

However, the capacity for remineralization is limited, and if sugars enter the mouth too frequently then a net loss of minerals from enamel produces a cavity, through which bacteria can infect the inner tooth and destroy the latticework. This process requires many months or years. [8] [4]

Natural tooth remineralization

Role of saliva

Remineralization occurs on a daily basis after attack by acids from food, through the presence of calcium, phosphate and fluoride found in saliva. [9] [10] Saliva also acts as a natural buffer to neutralize acid, preventing demineralization in the first place. If there is reduced saliva flow or reduced saliva quality, this will increase the risk of demineralization and create the need for treatment in order to prevent demineralization progression. [4]

Saliva function can be organized into five major categories that serve to maintain oral health and create an appropriate ecologic balance:

As the demineralization process continues, the pH of the mouth becomes more acidic which promotes the development of cavities. Dissolved minerals then diffuse out of the tooth structure and into the saliva surrounding the tooth. The buffering capacity of saliva greatly impacts the pH of plaque surrounding the enamel, thereby inhibiting caries progression. Plaque thickness and the number of bacteria present determine the effectiveness of salivary buffers. [4] The high salivary concentrations of calcium and phosphate which are maintained by salivary proteins may account for the development and remineralization of enamel. The presence of fluoride in saliva speeds up crystal precipitation forming a fluorapatite-like coating which will be more resistant to caries. [4]

Treatment and prevention

Besides professional dental care, there are other ways for promoting tooth remineralization:

Fluoride

Fluoride therapy

Fluoride is a mineral found naturally in rock, air, soil, plants and water and may assist by:

  • Potentially repairing early white spot lesions found on the tooth surface that may develop into cavities. [ citation needed ]

And a reduction in cavities may result in the following downstream benefits:

  • Protecting children and adults against tooth decay [11] [12] [12] [12] :  4  
  • Helps prevent premature tooth loss of baby teeth due to decay and overall assists in guiding the adult teeth to correct tooth eruption. [ citation needed ]
  • Aids in the prevention of invasive dental treatment therefore reducing the amount of money spent on dental treatment [ citation needed ]
  • Provides an overall community advantage, especially individuals from low socioeconomic communities, who have less access to other forms of fluoride treatments [ citation needed ]
  • Evidence confirms that water fluoridation is a safe and effective way to help protect teeth against decay [12] [12] :  4-5  
  • The addition of fluoride to the water does not alter the taste or smell of the drinking water [ citation needed ]

Fluoride therapy is often used to promote remineralization. This produces the stronger and more acid-resistant fluorapatite, rather than the natural hydroxyapatite. Both materials are made of calcium. In fluorapatite, fluoride takes the place of a hydroxide. [13]

Effect of fluoride

The presence of fluoride in saliva and plaque fluid interacts with remineralization process in many ways and thus exerts a topical or surface effect. A person living in an area with fluoridated water may experience rises of fluoride concentration in saliva to about 0.04 mg/L several times during a day. [14] Technically, this fluoride does not prevent cavities but rather controls the rate at which they develop making them take a lot longer and making them easier to prevent via normal brushing as it will take a higher amount of acid, usually built up over a number of days, to destroy the created fluorapatite. [15] When fluoride ions are present in plaque fluid along with dissolved hydroxyapatite, and the pH is higher than 4.5, [16] a fluorapatite-like remineralised veneer is formed over the remaining surface of the enamel; this veneer is much more acid-resistant than the original hydroxyapatite, and is formed more quickly than ordinary remineralised enamel would be. [1] The cavity-prevention effect of fluoride is partly due to these surface effects, which occur during and after tooth eruption. [17] Fluoride interferes with the process of tooth decay as fluoride intake during the period of enamel development for up to 7 years of age; the fluoride alters the structure of the developing enamel making it more resistant to acid attack. In children and adults when teeth are subjected to the alternating stages of demineralisation and remineralization, the presence of fluoride intake encourages remineralization and ensures that the enamel crystals that are laid down are of improved quality. [18] Fluoride is commonly found in toothpastes. Fluoride can be delivered to many parts of the oral cavity during brushing, including the tooth surface, saliva, soft tissues and remaining plaque biofilm. [19] Some remineralization methods may work for "white spot lesions" but not necessarily "intact tooth surfaces". [20]

Fluoridated toothpaste

Regular use of a fluoridated toothpaste has been shown to provide a significant source of fluoride to the mouth by the means of direct fluoride contact to tooth structure. [21] The types of fluoride added to toothpaste include: sodium fluoride, sodium monofluorophosphate (MFP), and stannous fluoride. [22]

As stated previously, fluoride has been proven to positively affect the remineralization process. Therefore, by using an adequately fluoridated toothpaste regularly, this assists the remineralization process of any hard tooth tissues.

Fluoride varnish

Fluoride varnishes were developed late 1960s and early 1970s and since then they have been used both as a preventative agent in public health programs and as a specific treatment for patients at risk of caries by the 1980s, mostly in European countries. [21] Fluoride varnishes were developed primarily to overcome their shortcoming which is to prolong the contact time between fluoride and tooth surfaces. [21] Furthermore, when compared to other existing topical fluoride the advantages of fluoride varnishes application are being a quick and easy procedure for the clinicians, reduced discomfort for the receiving patients, and greater acceptability by the patients. Fluoride varnishes are a concentrated topical fluoride containing 5% sodium fluoride (NaF) except the Fluor protector which contains difluorosilane. [21] There are many types of fluoride varnishes and among them the popular brands are Duraphat and Fluor Protector. Currently, the anti-caries effect fluoride varnishes are backed up by Cochrane systematic reviews, 2002 which was updated in 2013 included 22 trials with 12,455 children aged 1–15 years old. The conclusion made is similar to its previous review, a 46% reduction in D(M)FS and 33% reduction in d (e/m)fs in permanent teeth and deciduous teeth respectively [21]

Water fluoridation

Community water fluoridation is the addition of fluoride in the drinking water with the aim of reducing tooth decay by adjusting the natural fluoride concentration of water to that recommended for improving oral health. The NHMRC an Australian Government statutory body, released the public statement of efficacy and safety of fluoridation 2007 to set the recommended water fluoridation to the target range of 0.6 to 1.1 mg/L, depending on climate, to balance reduction of dental caries (tooth decay) and occurrence of dental fluorosis (mottling of teeth). Moreover the public statement states that the fluoridation of drinking water is an effective way to ensure the community is exposed to fluoride and can benefit from its preventative role in tooth decay. [23]

Plaque control

Oral hygiene practices involve the mechanical removal of plaque from hard tissue surfaces [24] Cariogenic bacteria levels in the plaque determine whether caries will occur or not, therefore, effective removal of plaque is paramount. [25] The removal of plaque inhibits demineralisation of teeth, and reversely increases opportunities for remineralization.

Diet

Demineralization is caused by bacteria excreting acids as a product of their metabolism of carbohydrates. By reducing the intake frequency of carbohydrates in an individual's diet, remineralization is increased and demineralization is decreased. Diet control is an important aspect in promoting remineralization to occur naturally. A loss of the tooth enamel structure and cavitation may occur if the demineralization phase continues for a long period of time. This disturbance of demineralisation caused by the presence of fermentable carbohydrates continues until the saliva has returned to a normal pH and had sufficient time to penetrate and neutralize the acids within any cariogenic biofilm present. [26]

Increased sugar consumption in the means of foods and drinks containing high levels of sugar are known to be associated with high rates of dental decay. As a result, members of the dental team routinely assess patients' diets and highlight areas where this could be improved to reduce the risk of dental decay. A balanced diet is an important contributing factor towards oral health and general health. It is common knowledge that certain dietary habits contribute to disease, whether patients take note of advice which is given to them and change their diet as a result, is less certain. [27]

Recent studies on diet and caries have been confounded by the widespread use of fluoride toothpastes. Studies have argued that with greater exposure to fluoride, the sugar consumption/caries relationship may be weaker in the modern age than previously thought, with fluoride raising the threshold of sugar intake at which caries progresses to cavitation. It has been concluded in modern societies that a significant relationship between sugars and caries persists despite the regular widespread use of fluoride toothpaste. [28] Several reviews conclude that high sugar consumption continues to be the main threat for dental health of whole populations in some developed and many developing countries. Therefore, a key strategy to further reducing levels of caries in individuals as well as for populations, is by means of reducing the frequency of sugar intakes in the diet.

Foods high in refined carbohydrates, such as concentrated fruit snack bars, sweets, muesli bars, sweet biscuits, some breakfast cereals and sugary drinks including juices can contribute to dental decay, especially if eaten often and over long periods as the sugar nourishes the cariogenic bacteria in mouth. The bacteria produce acid, which destroys teeth. Highly refined packaged foods such as savory crackers and chips can also have high levels of carbohydrates. It is important to check the nutritional information panel on packaged foods to determine which foods and drinks have high carbohydrate concentrations. [29]

To prevent demineralisation in the mouth, it is important for an individual to ensure they have a well-balanced diet, including foods containing calcium and foods that are low in acids and sugars. The individual should have a diet high in fresh fruits and vegetables, wholegrain cereals, legumes, seeds and nuts. Sugary snacks including lollies, fruit bars, muesli bars, biscuits, dried fruit, cordials, juices and soft drinks should be limited as they contribute to dental decay and dental erosion. Additionally, excessive starchy foods (such as bread, pasta, and crackers), fruits and milk products consumed frequently can cause the growth of dental plaque and bacteria. [29] Therefore healthy eating[ vague ], healthy drinking[ vague ] and proper maintenance of oral hygiene is the best way to promote and maintain sound tooth structure for an individual.

Xylitol, Sorbitol, and Erythritol

Xylitol is a naturally-occurring sweetener that can be synthetically produced in bulk. It is classified as a sugar alcohol. [10] Xylitol inhibits acid production by oral bacteria and promotes remineralization of the teeth. [10] It can be found in various products which include chewing gums and lozenges. Xylitol has been found to reduce mutans streptococci in plaque and saliva and reduce the binding of these to the acquired enamel pellicle. [10] This in turn leads to less adherent plaque and a decrease in acid production. [10] In addition, chewing xylitol gum will stimulate increased salivary flow which in turn increases the amount of calcium in the saliva and enhances the oral clearance.

Additional saliva flow which includes chewing products such as gums that contain no fermentable carbohydrates can aid in the modulation of plaque pH. Xylitol is a sugar alcohol which provides the sensation of tasting sweetness in foods, particularly chewing gum, without providing sucrose which is the only sugar that S.mutans are capable of using to produce the polyacrylamide adhesive which allows them bind to the teeth. Xylitol does not actively reduce or harm the presence or capacities of oral bacteria, but rather does not offer them the sustenance to propagate or function. There are often claims of significant dental benefits of Xylitol. These generally derive from the perspectives of; saliva production is increased during chewing and oral stimulation which can help to maintain a more adequate supply of saliva to support normal oral functioning. Also, the idea of Xylitol being a sweetener option which does not serve as fuel for oral bacteria is considered to be the healthier alternative than sucrose (table sugar), fructose, lactose, galactose products. While these considerations may not reverse any conditions in health, they are more so preventative, and do not further the consequential events such as dental caries, malodorous breath, excessive plaque and gingivitis conditions.

Erythritol may have greater protective action than xylitol and sorbitol. [30] However, this research is industry funded and not as comprehensive as the research on xylitol.

Biomimetic glass and ceramics

Biomimetic glass and ceramic particles, including amorphous calcium sodium phosphosilicate (CSPS, NovaMin) and amorphous calcium phosphate (ACP, Recaldent), are used in some toothpastes and topical preparations to promote remineralization of teeth. [31] These particles have a structure mimicking hydroxyapatite, providing new sites for mineralisation to occur. [32] Their binding to the teeth also occludes open dentin tubules, helping to reduce dentin hypersensitivity. Evidence is insufficient to recommend either for any indications, but the evidence for CSPS [31] is stronger than that for ACP. [33]

Oligopeptide P11-4

P11-4 (Ace-QQRFEWEFEQQ-NH2, Curolox) is a synthetic, pH controlled self-assembling peptide used for biomimetic mineralization e.g. for enamel regeneration or as an oral care agent. [34] It has a high affinity to tooth mineral. [35]

P11-4 is a self-assembling β-peptide. It builds a 3-D bio-matrix with binding sites for Calcium-ions serving as nucleation point for hydroxyapatite (tooth mineral) formation. The high affinity to tooth mineral is based on matching distances of Ca-ion binding sites on P11-4 and Ca spacing in the crystal lattice of hydroxyapatite. The matrix formation is pH controlled and thus allows control matrix activity and place of formation. [36]

Self assembling properties of P11-4 are used to regenerate early caries lesions. By application of P11-4 on the tooth surface, the peptide diffuse through the intact hypomineralized plate into the early caries lesion body and start, due to the low pH in such a lesion, to self-assemble generating a peptide scaffold mimicking the enamel matrix. Around the newly formed matrix de-novo enamel-crystals are formed from calcium phosphate present in saliva. Through the remineralization caries activity is significantly reduced in comparison with a fluoride treatment alone. [37] In aqueous oral care gels the peptide is present as matrix. It binds directly as matrix to the tooth mineral and forms a stable layer on the teeth. [38] This layer does protect the teeth from acid attacks. It also occludes open dentin tubule and thus reduces the dental sensitivity.

See also

Related Research Articles

<span class="mw-page-title-main">Human tooth</span> Calcified whitish structure in humans mouths used to break down food

Human teeth function to mechanically break down items of food by cutting and crushing them in preparation for swallowing and digesting. As such, they are considered part of the human digestive system. Humans have four types of teeth: incisors, canines, premolars, and molars, which each have a specific function. The incisors cut the food, the canines tear the food and the molars and premolars crush the food. The roots of teeth are embedded in the maxilla or the mandible and are covered by gums. Teeth are made of multiple tissues of varying density and hardness.

<span class="mw-page-title-main">Toothpaste</span> Substance to clean and maintain teeth

Toothpaste is a paste or gel dentifrice used with a toothbrush to clean and maintain the aesthetics and health of teeth. Toothpaste is used to promote oral hygiene: it is an abrasive that aids in removing dental plaque and food from the teeth, assists in suppressing halitosis, and delivers active ingredients to help prevent tooth decay and gum disease (gingivitis). Owing to differences in composition and fluoride content, not all toothpastes are equally effective in maintaining oral health. The decline of tooth decay during the 20th century has been attributed to the introduction and regular use of fluoride-containing toothpastes worldwide. Large amounts of swallowed toothpaste can be poisonous. Common colors for toothpaste include white and blue.

<span class="mw-page-title-main">Tooth enamel</span> Major tissue that makes up part of the tooth in humans and many animals

Tooth enamel is one of the four major tissues that make up the tooth in humans and many animals, including some species of fish. It makes up the normally visible part of the tooth, covering the crown. The other major tissues are dentin, cementum, and dental pulp. It is a very hard, white to off-white, highly mineralised substance that acts as a barrier to protect the tooth but can become susceptible to degradation, especially by acids from food and drink. In rare circumstances enamel fails to form, leaving the underlying dentin exposed on the surface.

<span class="mw-page-title-main">Tooth decay</span> Deformation of teeth due to acids produced by bacteria

Tooth decay, also known as cavities or caries, is the breakdown of teeth due to acids produced by bacteria. The cavities may be a number of different colors from yellow to black. Symptoms may include pain and difficulty with eating. Complications may include inflammation of the tissue around the tooth, tooth loss and infection or abscess formation.

<span class="mw-page-title-main">Water fluoridation</span> Addition of fluoride to a water supply to reduce tooth decay

Water fluoridation is the controlled adjustment of fluoride to a public water supply solely to reduce tooth decay. Fluoridated water contains fluoride at a level that is effective for preventing cavities; this can occur naturally or by adding fluoride. Fluoridated water operates on tooth surfaces: in the mouth, it creates low levels of fluoride in saliva, which reduces the rate at which tooth enamel demineralizes and increases the rate at which it remineralizes in the early stages of cavities. Typically a fluoridated compound is added to drinking water, a process that in the U.S. costs an average of about $1.26 per person-year. Defluoridation is needed when the naturally occurring fluoride level exceeds recommended limits. In 2011, the World Health Organization suggested a level of fluoride from 0.5 to 1.5 mg/L, depending on climate, local environment, and other sources of fluoride. Bottled water typically has unknown fluoride levels.

<span class="mw-page-title-main">Fluorine deficiency</span> Medical condition

Fluoride or fluorine deficiency is a disorder which may cause increased dental caries and possibly osteoporosis, due to a lack of fluoride in diet. Common dietary sources of fluoride include tea, grape juice, wine, raisins, some seafood, coffee, and tap water that has been fluoridated. The extent to which the condition truly exists, and its relationship to fluoride poisoning has given rise to some controversy. Fluorine is not considered to be an essential nutrient, but the importance of fluorides for preventing tooth decay is well-recognized, despite the effect is predominantly topical. Prior to 1981, the effect of fluorides was thought to be largely systemic and preeruptive, requiring ingestion. Fluoride is considered essential in the development and maintenance of teeth by the American Dental Hygienists' Association. Fluoride incorporates into the teeth to form and harden teeth enamels. This makes the teeth more acid resistant, as well as more resistant to cavity forming bacteria. Caries-inhibiting effects of fluoride were first noticed 1902, when fluoride in high concentrations was found to stain teeth and prevent tooth decay.

<i>Streptococcus mutans</i> Species of bacterium

Streptococcus mutans is a facultatively anaerobic, gram-positive coccus commonly found in the human oral cavity and is a significant contributor to tooth decay. It is part of the "streptococci", an informal general name for all species in the genus Streptococcus. The microbe was first described by James Kilian Clarke in 1924.

<span class="mw-page-title-main">Hydroxyapatite</span> Naturally occurring mineral form of calcium apatite

Hydroxyapatite is a naturally occurring mineral form of calcium apatite with the formula Ca5(PO4)3(OH), often written Ca10(PO4)6(OH)2 to denote that the crystal unit cell comprises two entities. It is the hydroxyl endmember of the complex apatite group. The OH− ion can be replaced by fluoride or chloride, producing fluorapatite or chlorapatite. It crystallizes in the hexagonal crystal system. Pure hydroxyapatite powder is white. Naturally occurring apatites can, however, also have brown, yellow, or green colorations, comparable to the discolorations of dental fluorosis.

<span class="mw-page-title-main">Fluoride therapy</span> Medical use of fluoride

Fluoride therapy is the use of fluoride for medical purposes. Fluoride supplements are recommended to prevent tooth decay in children older than six months in areas where the drinking water is low in fluoride. It is typically used as a liquid, pill, or paste by mouth. Fluoride has also been used to treat a number of bone diseases.

<span class="mw-page-title-main">Dental fluorosis</span> Medical condition

Dental fluorosis is a common disorder, characterized by hypomineralization of tooth enamel caused by ingestion of excessive fluoride during enamel formation.

Dental plaque is a biofilm of microorganisms that grows on surfaces within the mouth. It is a sticky colorless deposit at first, but when it forms tartar, it is often brown or pale yellow. It is commonly found between the teeth, on the front of teeth, behind teeth, on chewing surfaces, along the gumline (supragingival), or below the gumline cervical margins (subgingival). Dental plaque is also known as microbial plaque, oral biofilm, dental biofilm, dental plaque biofilm or bacterial plaque biofilm. Bacterial plaque is one of the major causes for dental decay and gum disease.

<span class="mw-page-title-main">Sodium monofluorophosphate</span> Chemical compound

Sodium monofluorophosphate, commonly abbreviated SMFP, is an inorganic compound with the chemical formula Na2PO3F. Typical for a salt, MFP is odourless, colourless, and water-soluble. This salt is an ingredient in some toothpastes.

<span class="mw-page-title-main">Early childhood caries</span> Dental disease of young children

Early childhood caries (ECC), formerly known as nursing bottle caries, baby bottle tooth decay, night bottle mouth and night bottle caries, is a disease that affects teeth in children aged between birth and 71 months. ECC is characterized by the presence of 1 or more decayed, missing, or filled tooth surfaces in any primary tooth. ECC has been shown to be a very common, transmissible bacterial infection, usually passed from the primary caregiver to the child.The main bacteria responsible for dental cavities are Streptococcus mutans (S.mutans) and Lactobacillus. There is also evidence that supports that those who are in lower socioeconomic populations are at greater risk of developing ECC.

<span class="mw-page-title-main">Tin(II) fluoride</span> Chemical compound

Tin(II) fluoride, commonly referred to commercially as stannous fluoride (from Latin stannum, 'tin'), is a chemical compound with the formula SnF2. It is a colourless solid used as an ingredient in toothpastes.

Olaflur is a fluoride-containing substance that is an ingredient of toothpastes and solutions for the prevention of dental caries. It has been in use since 1966. Especially in combination with dectaflur, it is also used in the form of gels for the treatment of early stages of caries, sensitive teeth, and by dentists for the refluoridation of damaged tooth enamel.

<span class="mw-page-title-main">Oral hygiene</span> Cleaning the mouth by brushing the teeth and cleaning in between the teeth

Oral hygiene is the practice of keeping one's oral cavity clean and free of disease and other problems by regular brushing of the teeth and adopting good hygiene habits. It is important that oral hygiene be carried out on a regular basis to enable prevention of dental disease and bad breath. The most common types of dental disease are tooth decay and gum diseases, including gingivitis, and periodontitis.

<span class="mw-page-title-main">Fluoride varnish</span> Highly concentrated form of fluoride

Fluoride varnish is a highly concentrated form of fluoride which is applied to the tooth's surface, by a dentist, dental hygienist or other health care professional, as a type of topical fluoride therapy. It is not a permanent varnish but due to its adherent nature it is able to stay in contact with the tooth surface for several hours. It may be applied to the enamel, dentine or cementum of the tooth and can be used to help prevent decay, remineralise the tooth surface and to treat dentine hypersensitivity. There are more than 30 fluoride-containing varnish products on the market today, and they have varying compositions and delivery systems. These compositional differences lead to widely variable pharmacokinetics, the effects of which remain largely untested clinically.

<span class="mw-page-title-main">Tooth pathology</span> Medical condition

Tooth pathology is any condition of the teeth that can be congenital or acquired. Sometimes a congenital tooth disease is called a tooth abnormality. These are among the most common diseases in humans The prevention, diagnosis, treatment and rehabilitation of these diseases are the base to the dentistry profession, in which are dentists and dental hygienists, and its sub-specialties, such as oral medicine, oral and maxillofacial surgery, and endodontics. Tooth pathology is usually separated from other types of dental issues, including enamel hypoplasia and tooth wear.

<span class="mw-page-title-main">Oligopeptide P11-4</span> Chemical compound

Oligopeptide P11-4 is a synthetic, pH controlled self-assembling peptide used for biomimetic mineralization e.g. for enamel regeneration or as an oral care agent. P11-4 consists of the natural occurring amino acids Glutamine, Glutamic acid, Phenylalanine, Tryptophan and Arginine. The resulting higher molecular structure has a high affinity to tooth mineral. P11-4 has been developed and patented by The University of Leeds (UK). The Swiss company Credentis has licensed the peptide technology and markets it under the trade names including CUROLOX, REGENAMEL, and EMOFLUOR. They offer three products with this technology. As of June 2016 in Switzerland products are available with new Brand names from Dr. Wild & Co AG.

Topical fluorides are fluoride-containing drugs indicated in prevention and treatment of dental caries, particularly in children's primary dentitions. The dental-protecting property of topical fluoride can be attributed to multiple mechanisms of action, including the promotion of remineralization of decalcified enamel, the inhibition of the cariogenic microbial metabolism in dental plaque and the increase of tooth resistance to acid dissolution. Topical fluoride is available in a variety of dose forms, for example, toothpaste, mouth rinses, varnish and silver diamine solution. These dosage forms possess different absorption mechanisms and consist of different active ingredients. Common active ingredients include sodium fluoride, stannous fluoride, silver diamine fluoride. These ingredients account for different pharmacokinetic profiles, thereby having varied dosing regimes and therapeutic effects. A minority of individuals may experience certain adverse effects, including dermatological irritation, hypersensitivity reactions, neurotoxicity and dental fluorosis. In severe cases, fluoride overdose may lead to acute toxicity. While topical fluoride is effective in preventing dental caries, it should be used with caution in specific situations to avoid undesired side effects.

References

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  12. 1 2 3 4 Information Paper – Water fluoridation: dental and other human health outcomes. Canberra, Australia: Australian Government National Health and Medical Research Council. July 2017. ISBN   978-1-925129-83-0 . Retrieved 4 December 2021.‌
    ^ p4:Over sixty years of research shows that water fluoridation helps to prevent tooth decay by protecting against damage and helping with the repair of teeth. All of the studies in previous reviews and in the 2016 NHMRC Evidence Evaluation found that water fluoridation reduces tooth decay by 26-44% in children, teenagers and adults.    ‌
    ^ p7:target range of 0.6 to 1.1 mg/L    ‌
    ^ pp4-5:There is evidence that water fluoridation at current Australian levels [12] [12] :  7   is not associated with cognitive dysfunction, lowered IQ, cancer, hip fracture and Down syndrome. There is no reliable evidence of an association between water fluoridation at current Australian levels and other human health outcomes.
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  21. 1 2 3 4 5 Beltrán-Aguilar; Goldstein; Lockwood (2000). "Fluoride Varnishes: A Review of Their Clinical Use, Cariostatic Mechanism, Efficacy and Safety: A Review of Their Clinical Use, Cariostatic Mechanism, Efficacy and Safety". The Journal of the American Dental Association. 131 (5): 589–596. doi:10.14219/jada.archive.2000.0232. PMID   10832252.
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  25. ↑ Hicks, John; Garcia-Godoy, Franklin; Flaitz, Catherine (2003-01-01). "Biological factors in dental caries: role of saliva and dental plaque in the dynamic process of demineralization and remineralization (part 1)". The Journal of Clinical Pediatric Dentistry. 28 (1): 47–52. doi:10.17796/jcpd.28.1.yg6m443046k50u20. ISSN   1053-4628. PMID   14604142.
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  27. ↑ Moynihan, Paula; Erik Petersen, Poul (2004). "Diet, nutrition and the prevention of dental diseases" (PDF). Public Health Nutrition. 7 (1a): 201–226. doi: 10.1079/PHN2003589 . PMID   14972061 . Retrieved 22 May 2016.
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  29. 1 2 "Eating habits for a healthy smile and body" (PDF). The Journal of the American Dental Association. 141 (12): 1544. Jan–Feb 2011. doi:10.14219/jada.archive.2010.0115. PMID   21119136 . Retrieved 22 May 2016.
  30. ↑ de Cock, Peter (21 August 2016). "Erythritol Is More Effective Than Xylitol and Sorbitol in Managing Oral Health Endpoints". International Journal of Dentistry. 2016: 9868421. doi: 10.1155/2016/9868421 . PMC   5011233 . PMID   27635141.
  31. 1 2 Zhu, M; Li, J; Chen, B; Mei, L; Yao, L; Tian, J; Li, H (2015). "The Effect of Calcium Sodium Phosphosilicate on Dentin Hypersensitivity: A Systematic Review and Meta-Analysis". PLOS ONE. 10 (11): e0140176. Bibcode:2015PLoSO..1040176Z. doi: 10.1371/journal.pone.0140176 . PMC   4636152 . PMID   26544035.
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  37. ↑ Alkilzy, M; et al. (May 15, 2015). "Efficacy, Clinical Applicability and Safety, of CurodontTM Repair in Children with Early Occlusal Caries". Caries Res. 49: 311. doi:10.1159/000381323. S2CID   79016534.
  38. ↑ Chen, X; et al. (Sep 2014). "Dentine Tubule Occlusion of a Novel Self-n Vitro Evaluation of Dentine Remineralization by a Self-Assembling Peptide Using Scanning Electron Microscopy". Caries Res. 48: 402. doi: 10.1159/000360836 . Retrieved 1 July 2015.

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