Dentistry

I began this paper with certain ideas regarding the carries process. It is a known fact that fluoride helps to prevent carious lesions. Not a whole lot of studies or information is out there on what I sought out to find. That would be the relationship between calcium phosphate and carious lesions. I am familiar with the remineralization process of enamel, and so I decided my topic would appropriately be that calcium phosphate can prevent carious lesions by helping to remineralize the enamel. It was difficult to find material to support this topic. While researching, I came across numerous products that contain calcium phosphate and claim to what I would like it to do.
Carious lesions don’t just develop over night. It is a process and it takes a long time, any where from six months to two years. Dental caries is a dynamic process characterized by alternating periods of demineralization and remineralization (Harris and Garcia-Godoy 45). Enamel is composed of densely packed hydroxyapatite crystals. The hydroxyapatite crystals are made up of tricalcium phosphate. During demineralization this is what is lost. Once enough of this mineral is lost, part of the tooth structure will collapse forming a cavity. Remineralization is when those ions lost are redeposited in a demineralized area. It all starts small. We have that wonderful acquired pellicle which is like fly paper for bacteria. When the bacteria accumulates a plaque is now present. The bacterial plaque will produce acids, which can eventually cause the enamel structure to collapse (Winston 1580).
Since calcium and phosphate are what is lost during demineralization, for the remineralization to occur we must replace these minerals. Saliva naturally contains calcium and phosphate (Winston 1580). Each person can have a different salivary concentration of these minerals. It was found that men have a higher concentration of salivary calcium than women (Sewon 917). There are any number of factors that play hand in hand with a high level of salivary calcium. High calcium content of the saliva gives us a high rate of remineralization after initial demineralization. It was noted that the number of decayed, missing, or filled teeth was lower in patients with high salivary calcium (males). Some drawbacks to having this much mineral content in the saliva are more bleeding on probing. This is due to an increase in plaque. It was also found that this calcium rich plaque hardens very rapidly. Now we have calculus, which has plaque retentive features. This brings us to the fact that epidemiological studies have shown that periodontitis is more prevalent in me in than in women. The calculus build up is a definite factor for periodontal disease. The study ended with the knowledge that a high concentration of salivary calcium is definitely associated with gingivitis, which can progress to periodontitis. But at the same time a high concentration of salivary calcium was associated with better dental health i.e. less carious lesions (Sewon 918).

Certain people can lack salivary and its mineral contents. Someone who is suffering from hypo salivation (xerostomia), Some receiving head and neck radiation, people who use certain drugs, and even certain diseases can put them at risk for lack of proper salivary function. This puts them at risk for increased caries development due to a lack of saliva’s buffering properties and its ability to help remineralize enamel (Winston 1581).
A study was performed where a sugar free gum containing Casein Phosphopeptide- Amorphous Calcium Phosphate (CPP-ACP) was tested on its remineralization abilities (Shen 2069). Amorphous calcium phosphate is used instead of calcium phosphate because it is a more soluble solution form of the mineral (Winston 1583). The CPP-ACP was shown the enhance remineralization. Just chewing the gum increases salivary flow in the oral cavity. We can’t forget about our added ingredient, CPP-ACP. Saliva and CPP-ACP mixed together, bathing the teeth for 20 minutes at a time. The results were fantastic. The amount of remineralization as compared to a person who did not chew this gum was significantly higher. If someone even chewed a different piece of gum the effects would be helpful. We know that saliva has buffering properties and the chewing does increase salivary flow. The only draw back could be that the gum with sugar can serve as a cariogenic substance. Dental plaque loves sugars. That is how the bacterial plaque is able to produce its acids, which are so harmful to the enamel (Shen 2069).
Now what if we put calcium and phosphate into our dentifrice? Most dentifrices only include a sodium fluoride content. The rest is usually geared toward whitening, the aesthetic part for the user. Only if your teeth are full of fillings who will care how white your teeth are. The whitening agents in dentifrices are abrasive. Now give that to someone who recently had orthodontic treatment and you can further demineralize the enamel. Colgate total has sodium fluoride and triclosan, a broad-spectrum antibacterial agent. Another dentifrice, Enamelon, has amorphous calcium phosphate and sodium fluoride. A study was performed for a duration of 14 days on “caries-free molars”. The teeth were subject to acid treatments to create carious lesions and then period of treatment with the two dentifrices mentioned above. The amounts of remineralization were measured. Both treatment with the fluoride dentifrice and the calcium phosphate containing fluoride dentifrice showed a reduction in the lesion depth of 30 to 42 percent (Hicks 22). Although both dentifrices were actively helping to remineralize the lesion, the calcium phosphate and fluoride dentifrice showed a greater reduction in lesion depth than the fluoride dentifrice (Hicks 25).
Caries prevention is so important. Parents need to be educated on how to prevent is and what substance can be used to supplement the regular home care. Many pediatricians do not tell mothers why it is so important not to put the baby to bed with the bottle. They only ask if the mother does it. Now I am sure many mothers will not tell it is so knowing they shouldn’t be doing it. But I bet you that if they knew why they wouldn’t even try doing it again. Teenagers in orthodontic treatment need some kind of fluoride rinse and perhaps even a prescribed dentifrice with a larger dose of the fluoride. I recommend highly a dentifrice with calcium phosphate as well as fluoride due to its remineralization properties. Unfortunately the dentifrice Enamelon that has these minerals went out of business. How can they compete with Crest and Colgate who make products that satisfy only the aesthetic needs of its consumers? The problem really goes back to the fact that the consumer needs to be educated.

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