Fluorides and Non-Fluoride Remineralization Systems

Abstract

Caries develops when the equilibrium between de- and remineralization is unbalanced favoring demineralization. De- and remineralization occur depending on the degree of saturation of the interstitial fluids with respect to the tooth mineral. This equilibrium is positively influenced when fluoride, calcium and phosphate ions are added favoring remineralization. In addition, when fluoride is present, it will be incorporated into the newly formed mineral which is then less soluble. Toothpastes may contain fluoride and calcium ions separately or together in various compounds (remineralization systems) and may therefore reduce demineralization and promote remineralization. Formulating all these compounds in one paste may be challenging due to possible premature calcium-fluoride interactions and the low solubility of CaF2. There is a large amount of clinical evidence supporting the potent caries preventive effect of fluoride toothpastes indisputably. The amount of clinical evidence of the effectiveness of the other remineralization systems is far less convincing. Evidence is lacking for head to head comparisons of the various remineralization systems.

Enhancing Fluoride: Clinical Human Studies of Alternatives or Boosters for Caries Management

“…The current study did not identify evidence for any strategy to effectively be used as a substitute or alternative to fluoride for caries control, but identified some evidence derived from the use of microbial-related strategies (primarily from use of arginine combined with calcium) to support their potential use to boost the mechanism of action of fluoride. Thus, fluoride-based strategies remain the standard for caries prevention and management [Zero, 2009;Amaechi and van Loveren, 2013], with some limited evidence that boosting the effects of fluoride by the use of microbial-related strategies is a promising possibility. More long-term longitudinal studies, focusing in high-risk populations and confirmed by different research groups, will help confirm these findings over time.…”

“…These strategies include CPP-ACP, ACP, bioactive glass containing calcium sodium phosphosilicate (Novamin), tricalcium phosphate, nanohydroxyapatite, dicalcium phosphate dehydrate, etc. [Amaechi and van Loveren, 2013]. Since plaque fluid is already supersaturated at a neutral pH with respect to calcium phosphate in the tooth, the benefit of adding extra calcium to enhance remineralization has been questioned.…”

“…Remineralization agents should deliver calcium and phosphate, or boost the remineralization potential of saliva, without any side effects [Amaechi and van Loveren, 2013]. Fluoride is a very effective strategy to control dental caries and aid in tooth remineralization [Marinho et al, 2002[Marinho et al, , 2003a[Marinho et al, , b, 2004aWalsh et al, 2010;Benson et al, 2013], and is considered the gold standard for studying remineralization.…”

Management of Salivary Hypofunction in Sjögren’s Syndrome

“…This is complicated by the fact that the various toothpaste recipes are periodically tweaked and re-formulated, so it can be difficult to track which toothpaste/rinse contains which product and how much of the product. In general, there is currently a lack of strong clinical data to support the use of these products [1,28]. There is the sense that these products are not harmful and may have the potential to help [29] and may be considered as adjunct therapy in SS patients with dry mouth [1].…”

Effect of a calcium phosphate and fluoride paste on prevention of enamel demineralization

“…in saliva and plaque and around the tooth surface. An ideal topical remineralization agent should diffuse and deliver calcium and phosphate into the enamel and increase the remineralization capability of saliva 6) . From a chemical point of view, the theory behind prevention of demineralization and promotion of remineralization by these agents relies on local buffering of pH and supersaturation with respect to tooth minerals.…”