Effectiveness of Visual-Tactile Examination and DIAGNOdent Pen in Detecting Early Enamel Caries and Its Remineralisation: An In Vitro Study

Background. The caries preventive effect of Colgate Duraphat® and GC Tooth Mousse Plus® has been widely studied, but the remineralisation potential of initial occlusal caries using these two remineralisation materials remains unclear. Aim. This study is aimed at evaluating and comparing the remineralisation of early enamel caries on the occlusal surface of permanent posterior teeth using ICDAS II caries scoring system and DIAGNOdent Pen (DDPen) after remineralisation with Colgate Duraphat® and GC Tooth Mousse Plus®. Materials and Methods. Extracted posterior teeth ( N = 120 ) with incipient occlusal caries were included in this study. The occlusal surface of each tooth was scored using DDPen and ICDAS II scoring before remineralisation. Then, remineralisation of the teeth of the experimental group was carried out using either CPP-ACP-F or fluoride varnish. After the remineralisation procedures, the occlusal surface of each tooth was again scored using DDPen and ICDAS II scoring. The teeth were then fixed in dental stone blocks and sectioned longitudinally for histological examination using a stereomicroscope. Statistical analysis was performed to calculate the sensitivity and specificity of DDPen and ICDAS II to detect remineralisation and compare with the gold standard histological examination. Results. According to ICDAS-II scores, a significant difference was noted in GC Tooth Mousse Plus® and Duraphat® study samples, whereas the difference between the pre-and post-remineralisation of the control group was not significant. According to the DDPen score criteria, a statistically significant difference was noted among all study groups; however, a greater significance level was noted in the GC Tooth Mousse Plus® and Duraphat® study samples compared with the control group. The Spearman’s rank correlation of ICDAS-II and DDPen with Downer’s histological score (gold standard) revealed a higher association of DDPen score (.738) as compared to ICDAS-II scores (.430). Conclusion. The study concluded that both ICDAS II and DDPen could detect remineralisation of early enamel occlusal caries. DDPen was more sensitive than ICDAS-II to detect remineralisation compared with the Downers histological scores.

Effectiveness of Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP) Compared to Fluoride Products in an In-Vitro Demineralization Model

The goal of this study was to evaluate the effectiveness of the toothpaste Tooth Mousse compared to conventional fluoride-based versions in the prevention of enamel and dentin demineralization. Human enamel and dentin samples (n = 120 each) were exposed to artificial demineralization at pH 4.92. During the demineralization process, the samples in the test groups were periodically treated with Tooth Mousse (TM) containing casein-phosphopeptide -amorphous-calcium-phosphate (CPP-ACP) and Tooth Mousse Plus (TMP) containing amorphous-calcium-fluoride-phosphate (CPP-ACPF) to evaluate their protective properties. Fluoride toothpastes containing 1400 ppm amine fluoride (AmF) and 1450 ppm sodium fluoride (NaF) were applied in the positive control groups. Treatment with distilled water (group C-W) or demineralization without treatment (group C-D) served as negative controls. After the demineralization and treatment process, all samples were cut longitudinally and lesion depths were determined at six locations using polarized light microscopy. In TM/TMP groups (enamel: 80/86 µm, dentin: 153/156 µm) lesion depths were significantly smaller compared to the negative control groups C-W/C-D (enamel: 99/111 µm, dentin: 163/166 µm). However, TM and TMP compared to the positive controls AmF/NaF (enamel: 58/63 µm, dentin: 87/109 µm) showed higher lesion depths. The application of TM/TMP (89%/78%) during demineralization led to a reduced number of severe lesions compared to the negative controls C-W/C-D (100%/95%). In this study we demonstrate that Tooth Mousse is less effective regarding prevention of enamel and dentin demineralization compared to fluoride containing toothpastes.

Assessment of Mineral Gain in White Spot Lesions Using CPP-ACP and CPP-ACFP in Different Clinical Protocols: A Proof of Concept Study

Subsurface remineralization can be promoted by the topical application of nanoparticles of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP). To assess changes in enamel white spot lesions, an in situ proof-of-concept investigation was performed using 5 subjects (all of whom were healthy young adults) with a cross-over study design. Custom orthodontic brackets were attached to the buccal surfaces of the maxillary second premolar and first molar teeth. Each bracket had a recess that held a slab of enamel with a standardized 100 μm deep white spot lesion (WSL). Changes in mineral were evaluated in lesion cross sections using backscatter electron imaging (BSE) and electron probe microanalysis (EPMA). The following products were applied twice daily for 2 weeks: GC Tooth Mousse™ (CPP-ACP), Tooth Mousse Plus™ (CPP-ACFP), CPP-ACFP Mineral Enhanced (CPP-ACFP Enh), or the vehicle paste of CPP-ACFP containing 900 ppm fluoride. To ensure blinding, all products had identical flavours and packaging. For each subject, the products were used in a random sequence, with washout periods between products. Compared to the baseline situation, favourable changes in white spot lesions occurred with all products. Analysis of enamel samples in cross section showed improvements in mineral levels, as seen in BSE grey scale levels from the enamel surface through the lesion. These were accompanied by enhanced calcium and phosphorus levels as seen using EPMA. The ranking of products for subsurface mineral gain, from best to worst, was: CPP-ACFP = CPP-ACFP Enh > CPP-ACP > vehicle with fluoride. Rapid remineralization occurred in this clinical model, which is due to a combination of factors: the enamel slabs were located on tooth surfaces exposed to parotid saliva, the surfaces were brushed regularly to remove dental plaque biofilm, and compliance with twice daily topical use of products was high. Such model systems may be useful for screening new product formulations for their effect on enamel WSL.

Effect of Bioactive Glass-Containing Light-Curing Varnish on Enamel Remineralization

This study aimed to evaluate the effect of novel experimental light-curing bioactive glass (BAG)-containing varnish on enamel remineralization. An experimental light-curing, BAG-containing varnish and two commercial varnishes (Nupro White Varnish; Dentsply International, York, PA, USA and Tooth Mousse; GC Corporation, Tokyo, Japan) were used. Microhardness tests (n = 3), field emission scanning electron microscopy (FE-SEM) coupled with energy dispersive X-ray spectroscopy (EDS) (n = 5), and X-ray diffraction (XRD) analysis (n = 5) were performed to compare the remineralization effect of three varnishes with and without ultrasonication. The data of microhardness test were analyzed using one-way ANOVA and Tukey’s post hoc comparison (P < 0.05). Microhardness of demineralized enamel increased after the application of three varnishes (P < 0.05). The experimental BAG-containing varnish showed the highest microhardness among the three varnishes (P < 0.05). Ultrasonication decreased microhardness of Tooth Mousse and BAG-containing varnish groups (P < 0.05). FE-SEM and XRD revealed precipitates of hydroxyapatite (HAP) or fluorapatite (FAP) crystals of three varnishes. The novel experimental BAG-containing varnish may be a promising clinical strategy for the remineralization of early carious lesions or demineralized enamel surfaces.

Comparison of the effect of GC tooth mousse and fluoride varnish on dentin hypersensitivity reduction.

Objective: To compare the mean dentin hypersensitivity after using GC tooth mousse versus fluoride varnish in patients with dentinal hypersensitivity due to non-carious cervical lesions. Study Design: Randomized Control Trial. Setting: Watim Dental College, Rawalpindi. Period: February to August 2019. Material & Methods: A total number of 166 patients were enrolled in the study. Informed consent and demographic information were taken. The subjects were randomized by using random number table to minimize bias. Patients were divided into 2 groups. Fluoride varnish (group 1) which is the control group and GC Tooth Mousse which is group 2, both were used 3 times in the first day during the first week. On follow up the tooth sensitivity was noted. The follow up appointment to measure the level of dentinal hypersensitivity was done after the given treatment on the 7th day of the first week. For measuring the dentin hypersensitivity, the Visual Analogue Scale was used. The data that was collected was entered and 1 then it was analyzed on SPSS version 21. Results: In this study mean age of the fluoride varnish group patients was 44.14±8.95 years, in GC tooth mousse group patients was 44.24±9.04 years. The mean pain score of fluoride varnish group patients was 1.98±1.43 while in GC Tooth Mousse paste group patients was 2.39±1.21 (p-value=0.048). Conclusion: Fluoride varnish group showed significantly lower mean dentin hypersensitivity than to GC tooth mousse group in patients with dentinal hypersensitivity with caries free cervical lesions.

Tooth mousse containing casein phosphopeptide-amorphous calcium phosphate prevents biofilm formation of Streptococcus mutans

Background Streptococcus mutans is a common cariogenic bacterium in the oral cavity involved in plaque formation. Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) has been introduced into tooth mousse to encourage remineralization of dental enamel. The aim of this research was to study the effect of tooth mousse containing CPP-ACP (GC Tooth Mousse®) or CPP-ACP with 0.2% fluoride (CPP-ACPF; GC Tooth Mousse Plus®; GCP) on S. mutans planktonic growth and biofilm formation. Methods S. mutans was cultivated in the presence of different dilutions of the tooth mousse containing CPP-ACP or CPP-ACPF, and the planktonic growth was determined by ATP viability assay and counting colony-forming units (CFUs). The resulting biofilms were examined by crystal violet staining, MTT metabolic assay, confocal laser scanning microscopy (CLSM), and scanning electron microscope (SEM). Results The CPP-ACP tooth mousse (GC) at a dilution of 5–50 mg/ml (0.5–5%) did not inhibit planktonic growth, and even increased the ATP content and the number of viable bacteria after a 24 h incubation. The same was observed for the CPP-ACPF tooth mousse (GCP), except for the higher concentrations (25 and 50 mg/ml) that led to a drop in the bacterial count. Importantly, both compounds significantly decreased S. mutans biofilm formation at dilutions as low as 1.5–3 mg/ml. 12.5 mg/ml GC and 6.25 mg/ml GCP inhibited biofilm formation by 90% after 4 h. After 24 h, the MBIC90 was 6.25 mg/ml for both. CLSM images confirmed the strong inhibitory effect GC and GCP had on biofilm formation when using 5 mg/ml tooth mousse. SEM images of those bacteria that managed to form biofilm in the presence of 5 mg/ml tooth mousse, showed alterations in the bacterial morphology, where the streptococci appear 25–30% shorter on the average than the control bacteria. Conclusion Our data show that the tooth mousse containing CPP-ACP reduces biofilm formation of the cariogenic bacterium S. mutans without killing the bacteria. The use of natural substances which inhibit biofilm development without killing the bacteria, has therapeutic benefits, especially in orthodontic pediatric patients.

Results of Application of Clinpro White Varnish® and Tooth Mousse® during the Enamel Mineral Maturation and its Focal Demineralization

According to some authors, the final maturation of tooth enamel occurs in 1- 2 years after eruption, and then for 2-3 years this process continues in just the fissure area. Full-fledged mineralization during this period is carried out due to the absorption of minerals from saliva, especially in respect to fluorine, calcium and phosphorus ions. As a result of the course of prophylactic treatment with Clin Pro White Varnish® and Tooth Mooth®, an activation of remineralization process was observed ended with the stabilization of the process or complete remineralization in the junior (6-7 years old) and the middle school group children (12-13 years old), which was confirmed by the obtained indices of the "DiagnodentKaVo" laser fluorometry test and the colorimetric test. The use of these preparations is a convenient and effective method in these age groups of children during the preventive treatment provision.

Comparative Evaluation of the Efficacy of Silver Diamine Fluoride, Sodium Fluoride and GC Tooth Mousse Plus and Fluoride Varnish as an Antibacterial Agent in Childhood Caries: As a Literature Review

Background: In preventive dentistry, it is important for the need to prevent rather than to treat early childhood caries and to improve the types of fluoride and application to see if the comparative efficacy is sufficient or insufficient because every type can relieve and give comfort to patients. Aims: To compare the effect of Silver Diamine Fluoride (SDF), fluoride varnish, fluoride gel and GC tooth mousse plus on Streptococcus mutants bacterial load. To evaluate the effect on the types of fluoride on caries. To compare the effect of prevention’s of early childhood caries by using different types of fluoride. Searching the databases using the keywords: sodium diamine fluoride; GC tooth mousse; fluoride varnish; fluoride gel; early childhood caries; caries; varnish; prevention. Materials and methods: 2010-December 2018, databases which were searched: MEDLINE via Ovid, Web of science, Embase, Cochrane Library, LILACS, and Dental specialties: pediatrics, oral preventive. Foreigner languages, editorials, letter to the editor, experimental studies with animals and Short communications were excluded from this review. Results: 2 studies assessed un-clear and need further research of SDF. 5 studies assessed that 12% of SDF has no effect but 38% has an effect with dentin and enamel with black staining as a disadvantage. 1 study showed that SDF is safe and effective compared to fluoride varnish, 2 studies showed that tooth mousse is recommended for early child caries without mentioning SDF and 3 studies found that it decreases the growth of mutants and aids in the remineralization of both enamel and dentin structure. Conclusion: To sum up this study silver diamine fluoride is effective and safe to use for preventing childhood caries than silver fluoride, GC tooth mousse and fluoride varnish, which saves time with increase accuracy and patient satisfaction.

Evaluation of The Effects of Different Remineralization agents on Initial Enamel Lesions by Scanning Electron Microscope and Energy-Distributed X-ray Analysis

Aim: The present study compares the effectiveness of four different remineralization agents on the demineralized enamel of permanent human incisors. The purpose of this study is to evaluate the effectiveness of remineralization agents on the initial enamel lesion. Material- Methods: Crowns affected by demineralization were divided into two equal parts. The right halves of the teeth were subjected to no other processes after demineralization for control purposes and were kept in artificial saliva for the duration of the experiment. The left halves of the crowns were remineralized using a 5% NaF-containing fluoride varnish (GC MI Varnish GC Corp, Tokyo, Japan), a casein phosphopeptide and amorphous calcium toothpaste (GC Tooth Mousse, GC Corp, Tokyo, Japan), fluoride, hydroxyapatite, and xylitol, containing a water-soluble remineralization paste (Remin Pro™, Voco, Germany) and calcium, magnesium and phosphate-containing gel (Medical Remineralizing gel (R.O.C.S. Trading GmbH, Munich, Germany). After a 21-day remineralization process, and SEM/EDX analysis was performed, and a One Way Anova was used for statistical analysis. Results: According to EDX analysis, the R.O.C.S. medical remineralizing gel was found to have a lower Ca/P ratio than the other material groups (p =0.04). Remin Pro™, Voco, and the R.O.C.S. were higher than the control group in evaluating the Ca / P ratio (p=0.014), (p=0.025). Conclusions: The R.O.C.S group, treated with fluoride-free xylitol-containing, a remineralization agent, showed the lowest Ca/P ratio. Compared to demineralized halves of the teeth (control groups), Remin Pro™, Voco, and R.O.C.S. medical remineralizing gel may be considered as affecting on initial enamel lesions. Key Words: Remineralizing Agents, EDX, SEM, Enamel,

Experiences of oral health: before, during and after becoming a regular user of GC Tooth Mousse Plus®

Background Clinical trials and laboratory studies from around the world have shown that GC Tooth Mousse Plus® (TMP) is effective in protecting teeth from tooth decay and erosion, buffering dental plaque pH, remineralising white spot lesions and reducing dentine hypersensitivity. However, no other study has assessed the experiences of oral health, before, during and after individuals becoming regular users of TMP. The aim of this study was to identify how participants’ oral health status changed after introducing TMP into their oral hygiene routine. Methods A qualitative study using Charmaz’s grounded theory methodology was conducted. Fifteen purposively sampled regular users of TMP were interviewed. Transcripts were analysed after each interview. Data analysis consisted of transcript coding, detailed memo writing, and data interpretation. Results Participants described their experiences of oral health and disease, before, during and after introducing TMP into their daily oral hygiene routine, together with the historical, biological, financial, psychosocial, and habitual dimensions of their experiences. Before becoming a regular user of TMP, participants described themselves as having a damaged mouth with vulnerable teeth, dry mouth, and sensitivity. Various aspects of participants’ histories were relevant, such as, family history and history of oral disease. Having a damaged mouth with vulnerable teeth, dry mouth and sensitivity was explained by those elements. Despite some initial barriers, once being prescribed TMP by a dental professional, a three-fold process of change was initiated: starting a new oral hygiene routine, persevering daily, and experiencing reinforcing outcomes. This process led to a fundamental lifestyle change. Participants transitioned from having a damaged mouth with vulnerable teeth to having a comfortable mouth with strong teeth; at the same time participants felt empowered by this newly found status of being able to keep their teeth for life. Barriers and facilitators for incorporating TMP on daily oral hygiene routine were also identified. Conclusions Participants valued having a comfortable mouth with strong teeth, which did not require repeated restorations. Seeing concrete results in their mouths and experiencing a more comfortable mouth boosted adherence to daily applications of TMP, which was maintained over time.