In vitro enamel erosion and abrasion-inhibiting effect of different fluoride varnishes
Introduction
Dental erosion is defined as an irreversible loss of tooth tissue by exogenous or endogenous acids without bacterial involvement (Huysmans, Chew, & Ellwood, 2011), accompanied by a progressive softening of the superficial and near-surface layer of enamel. (Huysmans et al., 2011, Lussi and Carvalho, 2014, Lussi and Carvalho, 2015; Shellis, Barbour, Jesani, & Lussi, 2013). This softening surface turns less resistant, increasing the susceptibility to physical wear such as toothbrush abrasion (Ganss, Lussi, & Schlueter, 2014; Rios et al., 2006). Thus, the application of high concentrations of fluoride, especially varnish formulations, has been described to decrease the development of tooth enamel erosion and increase abrasion resistance (Lippert, 2014; Sar Sancakli, Austin, Al-Saqabi, Moazzez, & Bartlett, 2015).
The potential of sodium fluoride (NaF) and stannous fluoride to prevent dental erosion with efficacy has been described in the literature (Algarni et al., 2015; Sorvari, Meurman, Alakuijala, & Frank, 1994; Vieira, Jager, Ruben, & Huysmans, 2007). Recently, other products than fluoride, as casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and Xylitol, have been studied to observe their protective effect against erosion or abrasion.
CPP-ACP is the Recaldent™ technology based on amorphous calcium phosphate (ACP) stabilized by casein phosphopeptides (CPP). The benefits of CPP-ACP nanocomplexes are the high concentration of calcium and phosphate ions that promote enamel remineralisation. In the presence of fluoride ions, there is the production of an ACFP phase (CPP-ACP addicted with fluoride ion), which may contribute to remineralisation when the fluoride ions are disassociated (Cross, Huq, & Reynolds, 2007; Reynolds et al., 2008). Whereas the xylitol is a non-acidogenic sweetener (Makinen, 2010) able to form complexes with calcium ions (Makinen, 2010; Miake, Saeki, Takahashi, & Yanagisawa, 2003). Due this property, some authors believe that xylitol might enhance remineralisation and inhibit the dissolution of calcium and/or phosphate ions from enamel structure (Chunmuang, Jitpukdeebodintra, Chuenarrom, & Benjakul, 2007; Miake et al., 2003; Vongsavan, Surarit, & Rirattanapong, 2014). However, the role of xylitol has not been enough demonstrated as a preventive or remineralising agent (Tuncer, Onen, & Yazici, 2014)
Taking into account that in the researched literature no studies evaluating, at the same time, the effect of CPP-ACP/NaF and Xylitol/NaF varnishes with regard to erosion and abrasion, the purpose of the present study was to investigate the enamel erosion and abrasion-inhibiting effect of NaF fluoride varnishes with or without CPP-ACP and Xylitol.
Section snippets
Null hypothesis
The null hypothesis of this study was that the single application of CPP-ACP/NaF and Xylitol/NaF varnishes does not reduce alterations in roughness and tooth structure loss after an erosion and abrasion challenge.
Specimen preparation
Bovine teeth were prepared to obtain 40 enamel samples (4 × 4 × 2 mm). The teeth were stored in 4% formaldehyde (pH 7.0) solution until cut phase. The specimens were cut using an Isomet low-speed saw cutting machine (Buehler Ltd., Lake Bluff, Illinois, United States) with two diamond discs
Results
Regarding the surface roughness alterations, all varnish groups promote significantly lower changes in the enamel compared to the negative control (p = 0.0001). However, no difference among them, considering the Ra and Sa values (p > 0.05) was observed.
The greatest inhibition of TSL occurred when specimens were treated with CPP-ACP/NaF (7.09 ± 0.70 μm), which showed statistically lower values for mineral loss than NaF varnish (10.33 ± 1.36 μm, p = 0.002), Xylitol/NaF (9.96 ± 0.41 μm, p = 0.007), and negative
Discussion
Considering the results of the present study, the null hypothesis was rejected, since the CPP-ACP/NaF and Xylitol/NaF varnishes were able to reduce alterations in roughness and tooth structure loss after an erosion and abrasion challenge. Considering the surface roughness alterations (Ra and Sa values), all of the tested varnishes were better than the negative control, showing the same capacity for protection against surface roughness alterations. Thus, these varnishes could be seen as
Clinical significance statement
The potential of sodium fluoride (NaF) to prevent dental erosion and abrasion has been described in literature, but other products as CPP-ACP/NaF and xylitol/NaF could promote better protective effect against erosion or abrasion.
Acknowledgements
The authors acknowledge the financial support from CAPES, FAPERJ (E-26/201.316/2014) and CNPQ (302800/2012-3, and 152231/2016-1). This study is part of the PhD thesis of the first author.
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