INTRODUCTION:

The human tooth consists of the highly mineralised tissues of the body containing hydroxyapatite as the primary constituents. Worldwide, the contribution of dental caries to the burden of oral diseases is about 10 times higher than that of the peridontal disease^[1].

Miller's "Chemoparasitic theory "states that caries is brought about by acid dissolution of mineral phase of teeth. This theory emphasizes that there is an association between mineral content of teeth and dental caries^[2][3].

A surgical approach to the elimination if carious lesions was developed a century ago; but there was no valid alternative. The focus has just shifted to the detection of early stages of the caries lesions and the non invasive treatment of these lesions. Dental caries is said to be a slow process and during early stages non- invasive intervention can convert the lesion to inactive state from an active state^[4].

This principle is the key to preventive dentistry. The best mode for easier management is the use of remineralising products.

Fluoride, calcium-phosphate based systems, calcium sodium phosphosilicate etc. are some of the remineralising agents.

This review article focuses on the remineralising agents and their mode of actions to treat dental caries and clinical applications.

MATERIALS AND METHODS:

Fluoride is the most important remineralising agent in the prevention of dental caries. Fluorides can exchange with hydroxyl group in the apatite crystal forming fluorapatite. The fluoride can enter void spaces on the apatite crystals. Fluorides can even contribute to remineralisation of early lesions and act as an antimicrobial agent against bacteria and inhibits enzyme which are essential for the growth and bacterial metabolism^[5].

Many attempts have been made to produce clinical remineralisation of white spot lesions. Either a calcium phosphate solutions, fluoride solutions or a combination of the two has been used. The composition of remineralised enamel is different from normal enamel and may vary according to the conditions employed to produce the remineralisation. Fluoride increases the rate of remineralisation from calcium phosphate. They are introduced into the oral environment via personal (eg. Denitrifices, rinses) or professional appliances (eg. varnishes, foams, gels, flouride releasing restoration material^[6].

PERSONALLY USED FLUORIDES :

Fluoride Denitrifices and Mouthrinses :

Dentifrices contain 0.1% Fluoride and uptake of this fluoride in etched enamel or in incipient lesions enhances remineralisation. Fluoride mouthrinses are advised for school children over 2 years of age, person with high caries susceptibility and patients with orthodontic and prosthetic appliances.

Fluoride Solutions:^[7]

The topical fluoride solutions which are used commonly are 2% of sodium chloride,8% of stannous fluoride and 1.23% of acidulated phosphate fluoride solutions. Initially a prophylaxis is done followed by drying and isolation of each quadrant and 2% of Nacl is applied for 3-4 minutes. This procedure is called Knuston's technique which is done at 3,7,10 and 13 years.

Fluoride Sels:^[7]

Gels adhere to teeth and eliminate continuous wetting of enamel and it is possible to treat two- four quadrants.

Fluoride Varnish:^[7]

Topical fluoride reagents have the disadvantage of rapid loss of soluble fluoride formed on teeth. To solve this problem, flouride varnish was introduced.

Calcium phosphate based remineralisation:

Enamelon :

Enamelon consists of unstabilized calcium and phosphate salts with sodium fluoride. The calcium salts are separated from the phosphate salts and sodium fluoride by a plastic divider in the centre of the toothpaste tube. This works on the principle that since calcium and phosphate ions are not stabilised thus allowing the two ions to combine into insoluble precipitates. These precipitates dissolve in saliva releasing amorphous calcium fluoride phosphate precipitates. Thus the calcium and phosphate ions inhibits demineralisation and promotes remineralisation^[8]

Dicalcium Phosphate Dihydrate:

DCPD abrasive is unique for fluoride stability. To clarify the role of DCPD in improving the effects of fluoride in the mouth, a number of studies was conducted. The influence of slurries of DCPD or silicon dioxide on the intraoral plaque pH was measured by the help of sucrose challenge in humans. The data indicates that DCPD slurries were most efficient in preventing plaque pH drop when compared to silica. Toothpastes containing MPF and DCPD was more efficient than MFD/ silica toothpaste^[9].

Recaldent:

It is derived from casein which is a protein derived from cow's milk. It is available as casein phosphopeptide stabilised amorphous calcium phosphate. These ions can freely diffuse to enamel subsurface lesions to promote remineralisation ^[8].

Novamin:

Novamin is one of these bioactive glass - ceramic materials, which falls into a class of newer agents that provide calcium and phosphate. When microscopic particles of Novamin are exposed to saliva, they release mineral ions forming hydroxycarbonate apatite, the chief mineral constituent of teeth^[10]. Novamin can kill up to 99.99% of pathogens associated with caries ^[11][12].

Sugar Substitutes:

Xylitol is a commonly used sugar substitutes, especially in chewing gums^[13]. Xylitol acts by ^[14] reducing plaque formation, making plaque less adhesive and increasing the salivary flow ^[15].

Ozone:

Ozone is a chemical compound which is a powerful oxidising agent^[16]. Ozone can shift microbial flora from acidogenic and aciduric micro organisms to normal commensal for the remineralisation to occur^[17].Ozone therapy has been accepted in various dental applications including prosthodontics, orthodontics and preventive dentistry. Presently Healzone remineralising solution is approved for the treatment of caries^[18].

CONCLUSION:

The primary objective of this review was to discuss the clinical relevance of remineralising products aiming to treat early caries lesions. Prevention of dental caries with the help of remineralising agents is the whole concept of this review and the philosophy focusing on the intervention at the earliest possible stage with the long term protection of the patient as a whole entity.

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18. Brazzelli M, Mckenzie L. Fieldings, Fraser C, Clarkson J , Kilonzo M, Waugh N., Systematic review of effectiveness and cost effectiveness of Heal Ozone for the treatment of occlusal pit/fissure caries and root caries, Health Technol Assess. iii-iv, ix-80.

Received on 08.03.2016 Modified on 01.04.2016

Research J. Pharm. and Tech 2016; 9(10):1734-1736.

DOI: 10.5958/0974-360X.2016.00349.8