Remeineralizing Agents: A Comprehensive Review

Introduction:

  • The process of caries formation is a cycle of remineralization and demineralization with various stages being reversable and others being irreversible.
  • White spot lesions are manifestation of the earliest stage of caries progression, it is reversable.

Fluoride:

  • The most common used. 
  • When the acid attacks the enamel surface, the pH rises and fluoride in the microenvironment causes enamel dissolution to stop. As pH rises, new and large fluoride crystals containing fluorhydroxyapatite form, thereby reducing the enamel demineralization and enhances remineralization.
  • Fluoride prevents caries by the following mechanisms:
  1. Promotes remineralization 
  2. Increases resistance to acid demineralization 
  3. Interferes in the formation of plaque microorganisms 
  4. Increases the rate of post eruptive maturation
  5. Alters tooth morphology.
  • Fluoride dentifrices are considered the most effective agent in preventing enamel demineralization.
  • Tooth paste containing 1000 ppm has establish effectiveness, but recent studies showed improved results with 5000 ppm

Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP)

  • The anticariogenic properties of milk and milk products, such as cheese, have been studied previously in animal model. This activity has been attributed to the direct chemical effects of phosphoprotein casein and calcium phosphate components in cheese.
  • The CPP component has the ability to bind and stabilize calcium and phosphate in solution. CPP can also bind to dental plaque and tooth enamel. Each molecule of CPP can bind upto 25 calcium ions, 15 phosphate ions, and 5 fluoride ions. The calcium phosphate in these complexes is biologically available for remineralization of subsurface lesions in tooth enamel.
  • CPP have ability to stabilize calcium phosphate, preventing the dissolution of calcium and phosphate ions.
  • The ACP-CPP also acts as reservoir of bio-available calcium and phosphate

Casein Phosphopeptide-Amorphous Calcium Fluoride Phosphate (CPP-ACFP)

  • CPPs have been shown to keep fluoride ions in solution, thereby enhancing the efficacy of the fluoride as a remineralizing agent, with the end result being the formation of fluoroapatite

Bioactive Glass

  • bioactive glass(e.g. NovaMin) an inorganic amorphous calcium sodium phosphosilicate 
  • NovaMin is claimed to release calcium and phosphate ions intraorally to help the self-repair process of enamel.
  • A silica-rich surface layer forms through polycondensation of hydrated silica groups on which precipitation of ions happens which crystallizes over time to form a hydroxyl-carbonate apatite, this chemical reaction may enhance remineralization.
  • appeared to have a greater effect on remineralization of carious-like lesions in permanent teeth when compared to that of a fluoride-containing dentifrice.
  • Functional Tricalcium Phosphate
  • fTCP stabilizes fluoride in solution and maintains high concentration of calcium, phosphate and fluoride in white spot lesions.
  • Inclusion of NaF has been shown to produce stronger, more acid-resistant mineral relative to fluoride alone.

Xylitol

  • Non-fermentable sugar alcohol.
  • Forms less of plaque and reduces the number of Mutans streptococci in saliva.
  • It might be involved in the enamel demineralization and remineralizing process by acting as a ca2+ carrier required for remineralization.
  • Xylitol has been developed using a NaF varnish, the xylitol coating prevents early reaction and produces a sustained release of the remineralizing ions.

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