J.S. Wefel

MORPHOLOGY, HISTOLOGY AND CRYSTALLOGRAPHY OF HUMAN DENTAL ENAMEL TREATED WITH PULSED LOW-ENERGY INFRARED-LASER RADIATION

The surface morphology of human enamel treated with pulsed, infrared laser radiation was examined using reflected light and scanning electron microscopy. Thin (

Effects of Low-energy CO2 Laser Irradiation and the Organic Matrix on Inhibition of Enamel Demineralization

In the past two decades, accumulated evidence has clearly demonstrated the inhibitory effects of laser irradiation on enamel demineralization, but the exact mechanisms of these effects remain unclear. The purpose of this study was to investigate the effects of low-energy CO2 laser irradiation on demineralization of both normal human enamel and human enamel with its organic matrix removed. Twenty-four human molars were collected, cleaned, and cut into two halves. One half of each tooth was randomly selected and its lipid and protein content extracted. The other half of each tooth was used as the matched control. Each tooth half had two window areas. All the left windows were treated with a low-energy laser irradiation, whereas the right windows served as the non-laser controls. After caries-like lesion formation in a pH-cycling environment, microradiographs of tooth sections were taken for quantification of demineralization. The mean mineral losses (with standard deviation) of the enamel control, the lased enamel, the non-organic enamel control, and the lased non-organic enamel subgroups were 3955 (1191), 52(49), 4565(1311), and 1191 (940), respectively. A factorial ANOVA showed significant effects of laser irradiation (p = 0.0001), organic matrix (p - 0.0125), and the laser-organic matrix interaction (p = 0.0377). The laser irradiation resulted in a greater than 98% reduction in mineral loss, but the laser effect dropped to about 70% when the organic matrix in the enamel was removed. The results suggest that clinically applicable CO2 laser irradiation may cause an almost complete inhibition of enamel demineralization.

Acidic beverages increase the risk of in vitro tooth erosion

Acidic beverages are thought to increase the potential for dental erosion. We report pH and titratable acidities (ie, quantity of base required to bring a solution to neutral pH) of beverages popular in the United States and lesion depths in enamel and root surfaces after beverage exposure, and we describe associations among pH, titratable acidity, and both enamel and root erosive lesion depths. The pH of 100% juices, regular sodas, diet sodas, and sports drinks upon opening and the titratable acidity both upon opening and after 60 minutes of stirring were measured. Enamel and root surfaces of healthy permanent molars and premolars were exposed to individual beverages (4 enamel and 4 root surfaces per beverage) for 25 hours, and erosion was measured. Statistical analyses included 2-sample t tests, analyses of variance with post hoc Tukey studentized range test; and Spearman rank correlation coefficients. All beverages were acidic; the titratable acidity of energy drinks was greater than that of regular and diet sodas that were greater than that of 100% juices and sports drinks (P < .05). Enamel lesion depths after beverage exposures were greatest for Gatorade, followed by those for Red Bull and Coke that were greater than those for Diet Coke and 100% apple juice (P < .05). Root lesion depths were greatest for Gatorade, followed by Red Bull, Coke, 100% apple juice, and Diet Coke (P < .05). Lesion depths were not associated with pH or titratable acidity. Beverages popular in the United States can produce dental erosion.

Effect of a fluoride varnish on demineralization adjacent to orthodontic brackets

Home fluoride regimens have long been used to reduce the amount of demineralization adjacent to orthodontic appliances. In the absence of patient compliance, another method of applying the fluoride must be used. The purpose of this study was to evaluate, in vitro, the ability of a fluoride varnish, Duraflor, to directly inhibit demineralization of enamel surrounding orthodontic brackets. Brackets were bonded to 36 extracted human canines and premolars with a traditional composite resin and randomly assigned to three equal groups of twelve. Group 1 served as the control with no topical application after bonding. Group 2 was treated with a single application of a nonfluoridated placebo varnish. Group 3 was treated with a single application of Duraflor. All groups were cycled in an artificial caries challenge for 1 hour two times daily for 37 days and were brushed with a medium bristled toothbrush to simulate mechanical wear of the varnish. Demineralization of enamel was evaluated in longitudinal buccolingual tooth sections using polarized light microscopy. Both average depth and area of demineralization were measured with a sonic digitizer. ANOVA (P </=. 0001) and Duncans test (P </=.05) indicated significant differences in depth and area of demineralized enamel. Those teeth treated with Duraflor exhibited 50% less demineralization than the control teeth and an even greater difference when compared to the placebo group. Fluoride varnishes should be considered for use as a preventive adjunct to reduce enamel demineralization adjacent to orthodontic brackets, particularly in patients who exhibit poor compliance with oral hygiene and home fluoride use.

Enamel demineralization adjacent to orthodontic brackets bonded with hybrid glass ionomer cements: An in vitro study☆☆☆★

Enamel demineralization is recognized as a possible side effect of bonding orthodontic brackets with composite resins. Fluoride-releasing restorative materials have been shown to inhibit tooth demineralization. The purpose of this study was to evaluate two fluoride-releasing hybrid glass ionomer bonding agents for inhibition of enamel demineralization surrounding orthodontic brackets under two experimental conditions. This in vitro study used 72 extracted human premolars. Twenty-four teeth were bonded with Advance resionomer, 24 were bonded with Fuji Ortho LC hybrid glass ionomer and 24 were bonded with Transbond XT composite resin as the control. The teeth were cycled in an artificial caries challenge three times daily for 30 days. Half of the teeth in each group were brushed twice daily with a fluoridated dentifrice, and the other half were not brushed. Demineralization of enamel surrounding orthodontic brackets was evaluated with polarized light microscopy. Enamel lesions were photographed under maximum illumination. Images were projected, and demineralized areas were traced. Both average depth and area were measured with a sonic digitizer. Analysis of variance (P <.0001) and Duncans test (P <.05) indicated significant differences in depth and area of demineralized enamel such that lesion size was: Transbond XT no brush > Transbond XT brush > Advance no brush = Advance brush = Fuji Ortho LC no brush = Fuji Ortho brush. The promising results of this in vitro study warrant further clinical investigation of hybrid glass ionomer adhesives as orthodontic bonding agents to minimize enamel demineralization.

Effects of Fluoride on Caries Development and Progression Using Intra-Oral Models

This paper reviews the use of Intraoral model systems to help elucidate the role of fluoride and. its mechanism of action in caries prevention. The Intraoral models currently in use were found to be of three general types. The most widely used system has consisted of a removable appliance that relies on the use of dacron gauze or a recessed sample to enhance plaque formation. Similarly, the banding model of Ogaard requires the presence of orthodontic band material to produce a plaque accumulation niche for demineralization, while the crown single-section technique relies mainly on placement of the sections in plaque-retentive areas (below contact points). In general, the models may be used for the assessment of food cariogenicity, an evaluation of de- and re-mineralization, and measurement of fluoride incorporation into enamel or root substrates.On evaluation of lesion initiation and progression in vivo, it is apparent that few non-destructive in vivo techniques are available that offer the sensitivity of...This paper reviews the use of intra-oral model systems to help elucidate the role of fluoride and its mechanism of action in caries prevention. The intra-oral models currently in use were found to be of three general types. The most widely used system has consisted of a removable appliance that relies on the use of dacron gauze or a recessed sample to enhance plaque formation. Similarly, the banding model of Ogaard requires the presence of orthodontic band material to produce a plaque accumulation niche for demineralization, while the crown single-section technique relies mainly on placement of the sections in plaque-retentive areas (below contact points). In general, the models may be used for the assessment of food cariogenicity, an evaluation of de- and re-mineralization, and measurement of fluoride incorporation into enamel or root substrates. On evaluation of lesion initiation and progression in vivo, it is apparent that few non-destructive in vivo techniques are available that offer the sensitivity of laboratory-based analysis. Thus, the use of intra-oral models that allow lesion formation and progression to occur in the oral environment, but can be measured with the sensitivity of in vitro techniques, has been extremely important. Although the magnitude of the fluoride dose, the longevity of fluoride in the oral environment, and the time required for remineralization are different from those found in vitro, it is apparent that the presence of fluoride in the aqueous phase is now thought to be of primary importance. Mechanistically, the presence of fluoride will both inhibit demineralization by acid and promote remineralization under more neutral conditions. Thus, one of fluorides major contributions is to affect the rates of lesion formation and progression. It was concluded that low-concentration fluoride agents with a high frequency of application would best fulfill the above needs.

Infants' Fluoride Intake from Drinking Water Alone, and from Water Added to Formula, Beverages, and Food

In infants, the majority of total ingested fluoride is obtained from water, formula and beverages prepared with water, baby foods, and dietary fluoride supplements. Few studies have investigated the distribution of fluoride intake from these sources among young children at risk for dental fluorosis. The purpose of this study was to assess estimated water fluoride intake from different sources of water among a birth cohort studied longitudinally from birth until age 9 months. Parental reports were collected at 6 weeks, 3 months, 6 months, and 9 months of age for water, formula, beverage, and other dietary intake during the preceding week. Fluoride levels of home and child-care tap and bottled water sources were determined. This report estimates daily quantities of fluoride ingested only from water-both by itself and used to reconstitute formula, beverages, and food. Daily fluoride intake from water by itself ranged to 0.43 mg, with mean intakes < 0.05 mg. Water fluoride intake from reconstitution of concentrated infant formula ranged to 1.57 mg, with mean intakes by age from 0.18 to 0.31 mg. Fluoride intake from water added to juices and other beverages ranged to 0.67 mg, with means < 0.05 mg. Estimated total daily water fluoride intake ranged to 1.73 mg fluoride, with means from 0.29 to 0.38 mg.

Remineralization of natural and artificial lesions in human dental enamel in vitro. Effect of calcium concentration of the calcifying fluid

Exposure of both small carious lesions and artificial caries-like lesions to a synthetic calcifying fluid in vitro produced a significant degree of ‘healing’ or remineralization of the lesion. Changing the calcium concentration of the calcifying fluid had a marked effect on the degree of remineralization produced. When a low calcium concentration of 1 mM was employed, remineralization occurred throughout the entire depth of a lesion. Under these conditions, there was a mean reduction of 69% in area of the body of the lesion and a mean increase of 40% in orientated mineral. The dark zone at the advancing front of the lesion showed a dramatic increase in area of 526% and was much closer to the enamel surface relative to the control. When higher calcium ion concentrations of 3 mM were used, remineralization occurred but was limited to the surface of the lesion. Under these conditions, the mean reduction in area of the body of the lesion was 20%, brought about by a mean increase in orientated mineral of 17%. Although changes were found in relation to the dark zone, these were much smaller than those found for the 1-mM fluid, the increase in area being 38%. With respect to exposure times, results obtained using ten consecutive 24-hour exposures to the synthetic calcifying fluid were similar to those obtained after ten consecutive 1-hour exposures. Remineralization, therefore, occurred within each 1-hour exposure increment. Scanning electron microscopy showed that crystal diameters for sound enamel were in the range 35–40 nm. In the body of the lesion crystal diameters were reduced and found to be in the range 10–30 nm. In lesions remineralized with the high calcium-calcifying fluid containing 3 mM calcium, crystal diameters were larger than those found in either control lesions or in sound enamel, being in the range 50–75 nm. When the low calcium-calcifying fluid was used, remineralized lesions showed crystal diameters in the range 50–150 nm with a small number of crystals having diameters of 200 nm. Calculation of the supersaturation of the calcifying fluids revealed that the low calcium-calcifying fluid having 1 mM calcium favors crystal growth as opposed to nucleation.

The Effect of Topical Fluoride Agents on Fluoride Uptake and Surface Morphology

Four topical fluoride agents were evaluated in vitro for their ability to form permanently bound fluoride. APF, NH4F, and Na2SnF6 formed soluble reaction products, while TiF4 did not. Surface coatings were present on those samples that showed higher levels of fluoride after washing.

Effects of Titanium Tetrafluoride on Human Enamel

Extracted human third molars were treated with a solution of titanium tetrafluoride. Calcium, phosphorus and fluoride microanalysis showed a high fluoride uptake and reduced enamel solubility for the treated surfaces. Scanning electron microscope examination showed the presence of a coating that was only partially removed by treatment with perchloric acid.