Prevalence of enamel white spots and risk factors in children up to 36 months old

The aim of this study was to determine the prevalence of enamel white spots and the quality of oral hygiene in children up to 36 months old, in municipalities with different fluoride levels in the water supply, analyzing the contribution of several variables. After approval of the Ethics Committee, the parents signed an informed consent form and were interviewed about their educational level, economic classification of the family, nursing habits, use of toothpaste, access to dental service and other information. The children were clinically examined using the same codes and criteria established by the WHO (World Health Organization) and ADA (American Dental Association). The data were processed and analyzed with the Epi-info software program, version 3.2, and Microsoft Excel. Fisher's exact test (p<0.05) was applied to assess the association among the variables. The enamel white spot prevalence was 30.8% and the age group, duration of the bedtime milk feeding habit, age of initial practice of oral hygiene and presence of caries lesions with cavitation were considered statistically significant with regard to enamel white spot prevalence (p < 0.05). No association was found between oral hygiene quality and the study variables. © 2009 Sociedade Brasileira de Pesquisa Odontológica.

Evaluation of some properties of fermented milk beverages that affect the demineralization of dental enamel

The aim of this in vitro study was to evaluate the erosive capacity of fermented milk beverages, as well as some of their properties that affect the demineralization of dental enamel (pH, buffering capacity, fluoride, calcium and phosphorus contents). Three different batches of 6 commercial brands of fermented milk beverages were analyzed. pH evaluation was accomplished using a potentiometer. The buffering capacity was measured by adding 1 mol L -1 NaOH. Fluoride concentration was assessed by an ion specific electrode after hexamethyldisiloxane-facilitated diffusion, and calcium and phosphorus concentrations were assessed by a colorimetric test using a spectrophotometer. Sixty specimens of bovine enamel were randomly assigned to 6 groups (n = 10). They were exposed to 4 cycles of demineralization in the fermented milk and remineralization in artificial saliva. Enamel mineral loss was determined by surface microhardness (%SMHC) and profilometric tests. The samples' pH ranged from 3.51 to 3.87; the buffering capacity ranged from 470.8 to 804.2 μl of 1 mol L -1 NaOH; the fluoride concentration ranged from 0.027 to 0.958 μgF/g; the calcium concentration ranged from 0.4788 to 0.8175 mgCa/g; and the phosphorus concentration ranged from 0.2662 to 0.5043 mgP/g. The %SMHC ranged from-41.0 to -29.4. The enamel wear ranged from 0.15 μm to 0.18 μm. In this in vitro study, the fermented milk beverages did not promote erosion of the dental enamel, but rather only a superficial mineral loss.

Enamel remineralization by fluoride-releasing materials: Proposal of a pH-cycling model

This study proposes a pH-cycling model for verifying the dose-response relationship in fluoride-releasing materials on remineralization in vitro. Sixty bovine enamel blocks were selected for the surface microhardness test (SMH 1). Artificial caries lesions were induced and surface microhardness test (SMH 2) was performed. Forty-eight specimens were prepared with Z 100, Fluroshield, Vitremer and Vitremer 1/4 diluted - powder/liquid, and subjected to a pH-cycling model to promote remineralization. After pH-cycling, final surface microhardness (SMH 3) was assessed to calculate percent recovery of surface microhardness (%SMH R). Fluoride present in enamel (μg F/mm 3) and in the pH-cycling solutions (μg F) was measured. Cross-sectional microhardness was used to calculate mineral content (ΔZ). There was no significant difference between Z 100 and control groups on analysis performed on - %SMH R, ΔZ, μ F and μ F/mm 3 (p>0.05). Results showed a positive correlation between %SMH R and μg F/mm 3 (r=0.9770; p=0.004), %SMH R and μg F (r=0.9939; p=0.0000001), DZ and μg F/mm 3 (r=0.9853; p=0.0002), ΔZ and μg F (r=0.9975; p=0.0000001) and between μg F/mm 3 and μg F (r=0.9819; p=0.001). The pH-cycling model proposed was able to verify in vitro dose-response relationship of fluoride-releasing materials on remineralization.

Evaluating the bonding of two adhesive systems to enamel submitted to whitening dentifrices.

The aim of this study was to evaluate by micro-shear bond strength test, the bond strength of composite resin restoration to enamel submitted to whitening dentifrices. Forty bovine teeth were embedded in polystyrene resin and polished. The specimens were randomly divided into eight groups (n=5), according to the dentifrice (carbamide peroxide, hydrogen peroxide and conventional dentifrice) and the adhesive system (Prime & Bond 2.1 and Adper Single Bond 2). Dentifrice was applied for 15 minutes a day, for 21 days. Thirty minutes after the last exposure to dentifrice, the samples were submitted to a bonding procedure with the respective adhesive system. After that, four buttons of resin were bonded in each sample using transparent cylindrical molds. After 24 hours, the teeth were submitted to the micro-shear bond strength test and subsequent analysis of the fracture mode. Data were submitted to analysis of variance and Fisher's PLSD test (alpha = 0.05). The micro-shear bond strength showed no difference between adhesives systems but a significant reduction was found between the control and carbamide groups (p = 0.0145) and the control and hydrogen groups (p = 0.0370). The evaluation of the failures modes showed that adhesive failures were predominant. Cohesive failures were predominant in group IV The use of dentifrice with peroxides can decrease bonding strength in enamel.

Association of enamel microabrasion and dentinal bleaching in recovering an adolescent patient's smile: a case report

This article presents the enamel microabrasion protocol for removing intrinsic white stains of hard texture on the enamel surface, using a 37% phosphoric acid/pumice mixture associated with a carbamide peroxide-based bleaching agent in custom-made mouth trays. We observed that these clinical procedures were safe and effective, and solved our patient's esthetic problem. © 2010 Nova Science Publishers, Inc.

Analysis of the effects of thermal cycling on the microtensile shear bond strength of a self-etching and a conventional pit and fissure sealants to dental enamel

Objective: To analyze the effects of thermal cycling on the microtensile shear bond strength of a self-etching and a conventional pit and fissure sealants to dental enamel. Material and Method: Twenty-four healthy human molars extracted for orthodontic reasons, were sectioned in the mesio-distal direction and divided into two groups (n=24) according to the sealant to be applied: GI - conventional sealant Climpro (3M/ESPE) and GII - self-etching sealant Enamel Loc (Premier Dental). The sealants were applied on flattened enamel in matrixes 1 mm in diameter, in accordance with the manufacturers' recommendations. The specimens were stored in distilled water at 37°C for 24 hours. After this, half the samples of both groups were submitted to 500 thermal cycles in 30s baths at temperatures between 5 and 55°C. Forty-eight hours after the samples were made, the microtensile shear test was performed in an Instron 4411 test machine, with a stainless steel wire with a cylindrical cross section of 0.2mm in diameter at a constant speed of 0.5mm/s. The bond strength values were submitted to ANOVA for 2 factors and the fracture patterns were examined under an optical microscope at 65X magnification. Results: Thermal cycling did not influence the bond strength of the two sealants. The conventional sealant Climpro presented a statistically higher microtensile shear bond strength (11.72MPa, 11.34MPa with and without cycling, respectively) than the self-etching sealant Enamel Loc (5.92MPa, 5.02MPa with and without cycling, respectively). Fracture pattern analysis showed the occurrence of 100% of adhesive failures for Enamel Loc, while the conventional sealant Climpro presented 95% of adhesive failures and 5% of mixed failures. Conclusion: The conventional sealant presented higher microtensile shear bond strength to dental enamel in comparison with the self-etching sealant. Thermal cycling did not affect the bond strength of the sealants used in this study. © 2011 Nova Science Publishers, Inc.

Effects evaluation of remaining resin removal (three modes) on enamel surface after bracket debonding

Introduction: An appropriate selection of instruments is essential to perform a correct debonding technique, by properly removing orthodontic brackets and the remaining resin. Objective: The aim of this study was to evaluate three methods of remaining resin removal on enamel surface after bracket debonding, by means of Scanning Electron Microscopy (SEM). Methods: Eighteen bovine incisors were selected and divided into three groups (A, B and C) of six teeth each. Before bracket bonding, epoxy resin casts were obtained by impression of the teeth with addition silicon, in order to register baseline enamel characteristics and representing the control group. The methods for remaining resin removal were: Group A - gross and medium granulation Soflex discs; Group B - carbide bur in low-speed; Group C - carbide bur in high-speed. Soflex polishing system fine and ultrafine granulation discs were used for Group A, rubber tips for Groups B and C, and polishing paste for all groups. After polishing, impression of teeth were taken and casts were analyzed by means of SEM. The baseline enamel characteristics (Control Group) were compared to the final aspect of enamel to determine the method that generated less enamel abrasion. Results and Conclusion: The remaining resin removal by carbide bur in low-rotation, and enamel polished with rubber tips followed by polishing paste produced the smaller damage to the enamel.

Prevalence and microscopic features of enamel pearls from permanent human molars

Enamel pearls are ectopic structures observed mainly on the roots of permanent teeth and could be related to periodontal diseases. Aim: To evaluate the prevalence of enamel pearls in extracted human molars and characterize their structures using light and scanning electron microscopy. Methods: The study comprised 2,201 extracted human permanent molars. The teeth were analyzed and classified according to morphological features. The presence, location and shape of enamel pearls were investigated. Fifteen human molars with enamel pearls were embedded in acrylic resin and observed by light microscopy. Results: Seventy-one enamel pearls were identified on third molar root. Microscopically, most pearls were composed of prismatic irregular enamel and normal dentin. The dentinoenamel junction presented an irregular course. The number of dentinal tubules was normal and they presented curvature to continue within the root dentin of the carrier tooth. Dentinal tubules below the enamel pearls were closer to each other. Conclusions: Scanning electron microscopic analysis revealed that the enamel pearls were similar to coronal enamel.

Effect of bleaching on sound enamel and with early artificial caries lesions using confocal laser microscopy

The aim of this study was to evaluate effect of bleaching agents on sound enamel (SE) and enamel with early artificial caries lesions (CL) using confocal laser scanning microscopy (CLSM). Eighty blocks (4 × 5 × 5 mm) of bovine enamel were used and half of them were submitted to a pH cycling model to induce CL. Eight experimental groups were obtained from the treatments and mineralization level of the enamel (SE or CL) (n=10). SE groups: G1 - unbleached (control); G2 - 4% hydrogen peroxide (4 HP); G3 - 4 HP containing 0.05% Ca (Ca); G4 - 7.5% hydrogen peroxide (7.5 HP) containing amorphous calcium phosphate (ACP). CL groups: G5 - unbleached; G6 - 4 HP; G7 - 4 HP containing Ca; G8 - 7.5 HP ACP. G2, G3, G6, G7 were treated with the bleaching agents for 8 h/day during 14 days, while G4 and G8 were exposed to the bleaching agents for 30 min twice a day during 14 days. The enamel blocks were stained with 0.1 mM rhodamine B solution and the demineralization was quantified using fluorescence intensity detected by CLSM. Data were analyzed using ANOVA and Fisher's tests (α=0.05). For the SE groups, the bleaching treatments increased significantly the demineralization area when compared with the unbleached group. In the CL groups, no statistically significant difference was observed (p>0.05). The addition of ACP or Ca in the composition of the whitening products did not overcome the effects caused by bleaching treatments on SE and neither was able to promote remineralization of CL.

Optical characterization of one dental composite resin using bovine enamel as reinforcing filler

The use of composite resins for restorative procedure in anterior and posterior cavities is highly common in Dentistry due to its mechanical and aesthetic properties that are compatible with the remaining dental structure. Thus, the aim of this study was to evaluate the optical characterization of one dental composite resin using bovine enamel as reinforcing filler. The same organic matrix of the commercially available resins was used for this experimental resin. The reinforcing filler was obtained after the gridding of bovine enamel fragments and a superficial treatment was performed to allow the adhesion of the filler particles with the organic matrix. Different optical images as fluorescence and reflectance were performed to compare the experimental composite with the human teeth. The present experimental resin shows similar optical properties compared with human teeth. © 2012 SPIE.

Bleaching gels containing calcium and fluoride: Effect on enamel erosion susceptibility

This in vitro study evaluated the effect of 35 hydrogen peroxide (HP) bleaching gel modified or not by the addition of calcium and fluoride on enamel susceptibility to erosion. Bovine enamel samples (3 mm in diameter) were divided into four groups (n = 15) according to the bleaching agent: control-without bleaching (C); 35 hydrogen peroxide (HP); 35 HP with the addition of 2 calcium gluconate (HP + Ca); 35 HP with the addition of 0.6 sodium fluoride (HP + F). The bleaching gels were applied on the enamel surface for 40 min, and the specimens were subjected to erosive challenge with Sprite Zero and remineralization with artificial saliva for 5 days. Enamel wear was assessed using profilometry. The data were analyzed by ANOVA/ Tukey's test (P 0.05). There were significant differences among the groups (P = 0.009). The most enamel wear was seen for C (3.37 ± 0.80 μm), followed by HP (2.89 ± 0.98 μm) and HP + F (2.72 ± 0.64 μm). HP + Ca (2.31 ± 0.92 μm) was the only group able to significantly reduce enamel erosion compared to C. The application of HP bleaching agent did not increase the enamel susceptibility to erosion. However, the addition of calcium gluconate to the HP gel resulted in reduced susceptibility of the enamel to erosion. © 2012 Alessandra B. Borges et al.

Efficacy and cytotoxicity of a bleaching gel after short application times on dental enamel

Objectives: This study aimed to evaluate and correlate the efficacy and cytotoxicity of a 35 % hydrogen peroxide (HP) bleaching gel after different application times on dental enamel. Materials and methods: Enamel/dentin disks in artificial pulp chambers were placed in wells containing culture medium. The following groups were formed: G1, control (no bleaching); G2 and G3, three or one 15-min bleaching applications, respectively; and G4 and G5, three or one 5-min bleaching applications, respectively. Extracts (culture medium with bleaching gel components) were applied for 60 min on cultured odontoblast-like MDPC-23 cells. Cell metabolism (methyl tetrazolium assay) (Kruskal-Wallis/Mann-Whitney; α = 5 %) and cell morphology (scanning electron microscopy) were analyzed immediately after the bleaching procedures and the trans-enamel and trans-dentinal HP diffusion quantified (one-way analysis of variance/Tukey's test; α = 5 %). The alkaline phosphatase (ALP) activity was evaluated 24 h after the contact time of the extracts with the cells (Kruskal-Wallis/Mann-Whitney; α = 5 %). Tooth color was analyzed before and 24 h after bleaching using a spectrophotometer according to the Commission Internationale de l'Eclairage L*a*b* system (Kruskal-Wallis/Mann-Whitney; α = 0.05). Results: Significant difference (p < 0.05) in cell metabolism occurred only between G1 (control, 100 %) and G2 (60.6 %). A significant decrease (p < 0.05) in ALP activity was observed between G2, G3, and G4 in comparison with G1. Alterations on cell morphology were observed in all bleached groups. The highest values of HP diffusion and color alterations were observed for G2, with significant difference among all experimental groups (p < 0.05). G3 and G4 presented intermediate color change and HP diffusion values with no statistically significant differences between them (p > 0.05). The lowest amount of HP diffusion was observed in G5 (p < 0.05), which also exhibited no significant color alteration compared to the control group (p > 0.05). Conclusions: HP diffusion through dental tissues and its cytotoxic effects were proportional to the contact time of the bleaching gel with enamel. However, shorter bleaching times reduced bleaching efficacy. Clinical relevance: Shortening the in-office tooth bleaching time could be an alternative to minimize the cytotoxic effects of this clinical procedure to pulp tissue. However, the reduced time of bleaching agent application on enamel may not provide adequate esthetic outcome. © 2012 Springer-Verlag Berlin Heidelberg.

In situ evaluation of a low fluoride concentration gel with sodium trimetaphosphate in enamel remineralization

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Effect of fluoride-treated enamel on indirect cytotoxicity of a16% carbamide peroxide bleaching gel to pulp cells

The aim of this study was to evaluate the possibility of fluoride solutions applied to enamel to protect pulp cells against the trans-enamel and transdentinal cytotoxicity of a 16% carbamide peroxide (CP) bleaching gel. The CP gel was applied to enamel/ dentin discs adapted to artificial pulp chambers (8 h/day) during 1, 7 or 14 days, followed by fluoride (0.05% or 0.2%) application for 1 min. The extracts (culture medium in contact with dentin) were applied to MDPC-23 cells for 1 h, and cell metabolism (MTT assay), alkaline phosphatase (ALP) activity and cell membrane damage (flow cytometry) were analyzed. Knoop microhardness of enamel was also evaluated. Data were analyzed statistically by ANOVA and Kruskal-Wallis tests (a=0.05). For the MTT assay and ALP activity, significant reductions between the control and the bleached groups were observed (p<0.05). No statistically significant difference occurred among bleached groups (p>0.05), regardless of fluoride application or treatment days. Flow cytometry analysis demonstrated 30% of cell membrane damage in all bleached groups. After 14 days of treatment, the fluoride-treated enamel presented significantly higher microhardness values than the bleached-only group (p<0.05). It was concluded that, regardless of the increase in enamel hardness due to the application of fluoride solutions, the treated enamel surface did not prevent the toxic effects caused by the 16% CP gel to odontoblast-like cells.