Remineralisation of teeth

However, the capacity for remineralization is limited, and if sugars enter the mouth too frequently then a net loss of minerals from enamel produces a cavity, through which bacteria can infect the inner tooth and destroy the latticework.

[8][4] Remineralization occurs on a daily basis after attack by acids from food, through the presence of calcium, phosphate and fluoride found in saliva.

[4] Saliva function can be organized into five major categories that serve to maintain oral health and create an appropriate ecologic balance: As the demineralization process continues, the pH of the mouth becomes more acidic which promotes the development of cavities.

The buffering capacity of saliva greatly impacts the pH of plaque surrounding the enamel, thereby inhibiting caries progression.

[13] The presence of fluoride in saliva and plaque fluid interacts with remineralization process in many ways and thus exerts a topical or surface effect.

Fluoride can be delivered to many parts of the oral cavity during brushing, including the tooth surface, saliva, soft tissues and remaining plaque biofilm.

Fluoride varnishes were developed late 1960s and early 1970s and since then they have been used both as a preventative agent in public health programs and as a specific treatment for patients at risk of caries by the 1980s, mostly in European countries.

Currently, the anti-caries effect fluoride varnishes are backed up by Cochrane systematic reviews, 2002 which was updated in 2013 included 22 trials with 12,455 children aged 1–15 years old.

The NHMRC an Australian Government statutory body, released the public statement of efficacy and safety of fluoridation 2007 to set the recommended water fluoridation to the target range of 0.6 to 1.1 mg/L, depending on climate, to balance reduction of dental caries (tooth decay) and occurrence of dental fluorosis (mottling of teeth).

A loss of the tooth enamel structure and cavitation may occur if the demineralization phase continues for a long period of time.

This disturbance of demineralisation caused by the presence of fermentable carbohydrates continues until the saliva has returned to a normal pH and had sufficient time to penetrate and neutralize the acids within any cariogenic biofilm present.

It is common knowledge that certain dietary habits contribute to disease, whether patients take note of advice which is given to them and change their diet as a result, is less certain.

It has been concluded in modern societies that a significant relationship between sugars and caries persists despite the regular widespread use of fluoride toothpaste.

Foods high in refined carbohydrates, such as concentrated fruit snack bars, sweets, muesli bars, sweet biscuits, some breakfast cereals and sugary drinks including juices can contribute to dental decay, especially if eaten often and over long periods as the sugar nourishes the cariogenic bacteria in mouth.

Additionally, excessive starchy foods (such as bread, pasta, and crackers), fruits and milk products consumed frequently can cause the growth of dental plaque and bacteria.

[29] Therefore, a diet low in sugar and proper maintenance of oral hygiene is the best way to promote and maintain sound tooth structure for an individual.

Additional saliva flow which includes chewing products such as gums that contain no fermentable carbohydrates can aid in the modulation of plaque pH.

Xylitol does not actively reduce or harm the presence or capacities of oral bacteria, but rather does not offer them the sustenance to propagate or function.

Also, because Xylitol is a sweetener option which does not serve as fuel for oral bacteria it is considered to be the healthier alternative than sucrose (table sugar), fructose, lactose, galactose products.

[33] P11-4 (Ace-QQRFEWEFEQQ-NH2, Curolox) is a synthetic, pH controlled self-assembling peptide used for biomimetic mineralization e.g. for enamel regeneration or as an oral care agent.

It builds a 3-D bio-matrix with binding sites for Calcium-ions serving as nucleation point for hydroxyapatite (tooth mineral) formation.

The high affinity to tooth mineral is based on matching distances of Ca-ion binding sites on P11-4 and Ca spacing in the crystal lattice of hydroxyapatite.