Aim This randomized, double-blind, crossover, in-situ study, compared the efficacy of toothpastes based on microcrystalline hydroxyapatite (HAP; fluoride-free) or fluoride, in remineralizing molar incisor hypomineralization (MIH). Methods Two lesion-bearing enamel blocks were produced from each of thirty extracted permanent molars diagnosed with MIH. Sixty produced blocks were randomly assigned to two groups (30/group): 20% HAP or 1450 ppm fluoride toothpaste. Each group was subdivided into, etched (n = 20), with lesion surface treated with 32% phosphoric acid-etchant for 5 s, and unetched (n = 10). Blocks were cemented into intra-oral appliances (2 blocks/appliance) worn full-time by 15 subjects. Subjects used the toothpastes in a two-phase crossover manner, lasting 14 days per phase, after one-week washout period. Baseline and post-treatment mineral density (MD) was quantified using microcomputed tomography. Results Overall, both groups showed statistically significant (paired t-test; p < 0.001) net-gain when MD was compared pre-treatment and post-treatment. HAP: pre-treatment (1.716 ± 0.315) and post-treatment (1.901 ± 0.354), Fluoride: pre-treatment (1.962 ± 0.363) and post-treatment (2.072 ± 0.353). Independent t-test demonstrated a practically significantly (≥10%) higher percentage remineralization with HAP toothpaste (26.02 ± 20.68) compared with fluoride toothpaste (14.64 ± 9.60). Higher percentage remineralization was observed in etched than unetched samples. Conclusion The tested toothpaste based on hydroxyapatite can remineralize MIH lesions. Pre-treating the tooth surface with acid-etchant enhanced remineralization.

Molar incisor hypomineralization (MIH) is a highly prevalent dental developmental disorder with a significant health burden for patients and high treatment needs, yet no comprehensive review article on all remineralization systems as a non-invasive treatment approach for MIH has been published. Typical characteristics of MIH-affected teeth are a lower mineral density and lower hardness compared to healthy teeth leading to sensitivity and loss of function. Thus, the use of formulations with calcium phosphates to remineralize MIH-affected teeth is reasonable. This review presents an up-to-date overview of remineralization studies focusing on active ingredients investigated for remineralization of MIH, i.e., casein phosphopeptide amorphous calcium phosphate (CPP-ACP), casein phosphopeptide amorphous calcium fluoride phosphate (CPP-ACFP), hydroxyapatite, calcium glycerophosphate, self-assembling peptide, and fluoride. Overall, 19 studies (in vitro, in situ, and in vivo) were found. Furthermore, an additional search for studies focusing on using toothpaste/dentifrices for MIH management resulted in six studies, where three studies were on remineralization and three on reduction of sensitivity. Overall, the studies analyzed in this review showed that MIH-affected teeth could be remineralized using calcium phosphate-based approaches. In conclusion, calcium phosphates like CPP-ACP, calcium glycerophosphate, and hydroxyapatite can be used to remineralize MIH-affected teeth. In addition to MIH-remineralization, CPP-ACP and hydroxyapatite also offer relief from MIH-associated tooth sensitivity.

Aim LumiCare™ Caries Detection Rinse (LC Rinse), a starch-based rinse, illuminates active initial caries (positive response) using dental curing light, thus augmenting the dentist’s visual examination. This clinical study investigated if active caries as assessed by the International Caries Detection and Assessment System (ICDAS) were more likely to have positive LC Rinse response than sound surfaces and inactive caries. Methods 25 subjects participated in the study. Caries was assessed on selected teeth and the entire dentition, firstly using ICDAS and then by fluorescence evaluation after LC Rinse application. Data were statistically analyzed using Diagnostic Odds Ratio (OR) and Chi-square test X2 (α = 0.05). Sensitivity (Se), specificity (Sp), and Diagnostic accuracy (DA) were calculated. Results With selected teeth, active caries were 638.6 times (60.05 with full dentition) more likely to have positive LC Rinse response than sound surfaces and inactive caries combined (X2, p < 0.01) and 191.67 times (18.35 with full dentition) than inactive lesions only (X2, p < 0.01). With combined sound surfaces and inactive caries, Se, Sp, and DA of LC Rinse assessment were 0.94, 0.98, and 0.96 respectively. Conclusions LC Rinse can distinguish between active caries, inactive caries and hypomineralization, and can augment caries detection with high sensitivity, specificity, and diagnostic accuracy.

This study validated a microbial caries model (artificial mouth) for dental caries development to determine the optimal time to create early caries suitable for evaluation of the efficacy of caries therapeutic agents. In all, 40 human enamel blocks were placed in an artificial mouth at 37 °C and 5% CO2 and were exposed to brain heart infusion broth inoculated with S. mutans in continuous circulation (0.3 mL/min). The culture medium was replaced three times daily. Samples were exposed to 10% sucrose for 3 min, 3 times daily to promote biofilm growth. Five samples were harvested from the chamber after 3, 4, 5, 6, 7, 14, 21, and 28 days. At the end of experiment, samples were assessed visually by ICDAS criteria, while lesion depth (LD) and mineral loss (ML) were measured using polarizing light microscopy and transverse microradiography. Data were analyzed by Pearson correlation, ANOVA, and Tukey comparison test (p < 0.05). Results showed significant and strong positive correlation (p < 0.01) between all variables and biofilm growth time. LD and ML profiles of 7-day lesions seem to be the most suitable for remineralization studies. In conclusion, using the evaluated artificial mouth, early-stage caries suitable for products’ evaluation studies was produced within 7 days of exposure to microbial biofilm.

Aim: This randomized, double-blind, crossover, in-situstudy, compared the efficacy of toothpastes based on hydroxyapatite (HAP; fluoride-free) or fluoride, in remineralizing molar incisor hypomineralization (MIH). Methods: Two lesion-bearing enamel blocks were produced from each of thirty extracted permanent molars diagnosed with MIH. Sixty produced blocks were randomly assigned to two groups (30/group): 20% HAP or 1450 ppm fluoride toothpaste. Each group was subdivided into, etched (n=20), with lesion surface treated with 32% phosphoric acid-etchant for 5 seconds, and unetched (n=10). Blocks were cemented into intra-oral appliances (2 blocks/appliance) worn full-time by 15 subjects. Subjects used the toothpastes in a two-phase crossover manner, lasting 14 days per phase, after one-week washout period. Baseline and post-treatment mineral density (MD) was quantified using microcomputed tomography. Results: Overall, both groups showed statistically significant (paired t-test; p<.001) net-gain when MD was compared pre-treatment and post-treatment. HAP: pre-treatment (1.716±0.315) and post-treatment (1.901±0.354), Fluoride: pre-treatment (1.962±0.363) and post-treatment (2.072±0.353). Independent t-test demonstrated a practically significantly (≥10%) higher percentage remineralization with HAP toothpaste (26.02±20.68) compared with fluoride toothpaste (14.64±9.60). Higher percentage remineralization was observed in etched than unetched samples. Conclusion: The tested toothpaste based on hydroxyapatite can remineralize MIH lesions. Pre-treating the tooth surface with acid-etchant enhanced remineralization.