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      Enamel remineralization: controlling the caries disease or treating early caries lesions?

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          Abstract

          The emphasis currently given to new technologies for enamel remineralization suggests that the changes in the understanding of the dental caries disease, which occurred in the last century, were either not yet adopted or were forgotten. Just like in the past, when the disease was "treated" by restoring cavities, there is presently a misunderstanding on the concept of incipient lesion remineralization. The aim of this paper was to review some concepts about caries, the natural phenomenon of enamel remineralization and the effect of fluoride (F) on it, and also to discuss the clinical relevance of remineralizing products recently launched in the marketplace aiming to "treat early caries lesions".

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          Changing paradigms in concepts on dental caries: consequences for oral health care.

          O Fejerskov (2015)
          Kuhn proposed in his Structure of Scientific Revolutions (1962) that the theoretical framework of a science (paradigm) determines how each generation of researchers construes a causal sequence. Paradigm change is infrequent and revolutionary; thereafter previous knowledge and ideas become partially redundant. This paper discusses two paradigms central to cariology. The first concerns the most successful caries-preventive agent: fluoride. When it was thought that fluoride had to be present during tooth mineralisation to 'improve' the biological apatite and the 'caries resistance' of the teeth, systemic fluoride administration was necessary for maximum benefit. Caries reduction therefore had to be balanced against increasing dental fluorosis. The 'caries resistance' concept was shown to be erroneous 25 years ago, but the new paradigm is not yet fully adopted in public health dentistry, so we still await real breakthroughs in more effective use of fluorides for caries prevention. The second paradigm is that caries is a transmittable, infectious disease: even one caused by specific microorganisms. This paradigm would require caries prevention by vaccination, but there is evidence that caries is not a classical infectious disease. Rather it results from an ecological shift in the tooth-surface biofilm, leading to a mineral imbalance between plaque fluid and tooth and hence net loss of tooth mineral. Therefore, caries belongs to common 'complex' or 'multifactorial' diseases, such as cancer, cardiovascular diseases, diabetes, in which many genetic, environmental and behavioural risk factors interact. The paper emphasises how these paradigm changes raise new research questions which need to be addressed to make caries prevention and treatment more cost-effective. Copyright 2004 S. Karger AG, Basel
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            Dental caries: a dynamic disease process.

            John D B Featherstone (2008)
            Abstract Dental caries is a transmissible bacterial disease process caused by acids from bacterial metabolism diffusing into enamel and dentine and dissolving the mineral. The bacteria responsible produce organic acids as a by-product of their metabolism of fermentable carbohydrates. The caries process is a continuum resulting from many cycles of demineralization and remineralization. Demineralization begins at the atomic level at the crystal surface inside the enamel or dentine and can continue unless halted with the end-point being cavitation. There are many possibilities to intervene in this continuing process to arrest or reverse the progress of the lesion. Remineralization is the natural repair process for non-cavitated lesions, and relies on calcium and phosphate ions assisted by fluoride to rebuild a new surface on existing crystal remnants in subsurface lesions remaining after demineralization. These remineralized crystals are acid resistant, being much less soluble than the original mineral.
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              What is the critical pH and why does a tooth dissolve in acid?

              Colin Dawes (2003)
              This paper discusses the concept of critical pH for dissolution of enamel in oral fluids. The critical pH does not have a fixed value but rather is inversely proportional to the calcium and phosphate concentrations in the solution. The paper also discusses why teeth dissolve in acid, why remineralization of white-spot caries lesions is possible and why remineralization of teeth eroded by acid is not possible.
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                Author and article information

                Contributors
                Jaime Aparecido Cury: Role: ND
                Livia Maria Andaló Tenuta: Role: ND
                Journal
                Journal ID (publisher): bor
                Title: Brazilian Oral Research
                Abbreviated Title: Braz. oral res.
                Publisher: Sociedade Brasileira de Pesquisa Odontológica - SBPqO (São Paulo )
                ISSN: 1807-3107
                Publication date (Print): June 2009
                Volume: 23
                Issue: suppl 1
                Pages: 23-30
                Affiliations
                [1 ] Universidade Estadual de Campinas Brazil
                Article
                Publisher ID: S1806-83242009000500005
                DOI: 10.1590/S1806-83242009000500005
                PubMed ID: 19838555
                SO-VID: 0a61a58f-a19d-4a1f-b095-94d22d9cfc65
                License:

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=1806-8324&lng=en
                Categories
                Subject: DENTISTRY, ORAL SURGERY & MEDICINE

                ScienceOpen disciplines: Dentistry
                Keywords: Dental caries,Dental enamel,Tooth remineralization,Fluorides
                Data availability:
                ScienceOpen disciplines: Dentistry
                Keywords: Dental caries, Dental enamel, Tooth remineralization, Fluorides

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