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Guest Foreword
j o u r n a l o f d e n t i s t ry 4 2 s 1 ( 2 0 1 4 ) s 1
Available online at www.sciencedirect.com
journal homepage: www.intl.elsevierhealth.com/journals/jden
Guest Foreword
Recent decades have shown a substantial improvement in oral health. Much of this change is attributed to the introduction and growing, widespread use of fluoridated toothpastes. In this period important paradigm shifts occurred as a result of the comprehensive new information about the aetiology, pathogenesis, prevention and restoration of tooth decay. Among these a consensus was reached that non-invasive clinical interventions should be the preferred treatment as long as possible. This was driven by observations that an initial invasive treatment is typically the start of a restoration cycle with increased loss of the dental tissues with every subsequent retreatment. In many societies, modern lifestyle changes have resulted in enhanced challenges to oral health. Apart from a higher frequency of cariogenic snacking, the frequent consumption of acidic beverages is a risk factor as it may lead to erosion. While fluoride toothpastes have shown their general efficacy in caries prevention there still is the need for more efficacious products, in particular for fluoride containing oral care products that are effective to prevent or repair acid induced erosion of the enamel. This Supplement encompasses the results of extensive studies to develop a fluoride toothpaste more efficacious than traditional fluoride toothpastes. The corner stone of this new product line is the addition of calcium silicate and phosphate. These components have a history in bone research, being used in several modifications in orthopaedics and oral surgery. The mechanistic studies reported demonstrate that during brushing with this product calcium silicate is deposited onto enamel surfaces. This deposition serves several purposes including dissolution under acid challenges resulting in increased calcium levels which can slow down demineralisation and the calcium silicate serves to nucleate hydroxyapatite crystals, hence enamel remineralisation. The physico-chemical processes involved, including at the enamel surface, were investigated with a range of techniques such as scanning and transmission electron microscopy (SEM and TEM), Fourier transform infrared analysis (FTIR), atomic force microscopy (AFM), Raman spectroscopy and with the new method of scanning electrochemical cell microscopy (SECCM).
With the latter technique it is possible to perform dissolution studies in small droplets of acid on a treated surface and describe in detail the effect treatments have on the kinetics of enamel dissolution. The combination of these techniques resulted in convincing evidence of the working mechanism of the calcium silicate additive. Also more established methods for preclinical screening of a new oral care product, such as pH-cycling and in situ experiments, were employed to quantify the effects of brushing with the new toothpaste on enamel de- and remineralisation. A valuable new application was an interproximal mineralisation model. Considering that dental caries mainly forms in secluded sites of the dentition with limited access of saliva and of oral care products, this method is a valuable tool to estimate potential in vivo efficacy. The clinical study design with enamel specimens placed intraorally (in situ model) is a valuable intermediate between laboratory testing and a full randomised clinical trial. The specimens are subject to in vivo conditions together with the regular use of a test product and then can be analysed with various sensitive laboratory measurement methods. In this case, a calcium silicate-phosphate toothpaste was included in combination with a gel of similar composition. Treatments with the novel dual product were found to reharden eroded enamel significantly more than regular fluoride toothpastes. The addition of calcium to oral care products has been the subject of study for considerable time, with the rationale that enamel remineralisation requires sufficient levels of free calcium and phosphate, of which the latter is abundantly available in the oral fluids. Merely adding soluble calcium has limited effect on the enhancement of remineralisation. The current approach involving calcium silicate deposition onto enamel, and its conversion into crystalline calcium phosphate, as hydroxyapatite, seems a more effective way for enamel remineralisation and therefore a promising approach in the prevention and repair of dental erosion.
0300-5712/$ – see front matter © 2014 Elsevier Ltd. All rights reserved.
JM ten Cate ACTA Amsterdam
Available online at www.sciencedirect.com
journal homepage: www.intl.elsevierhealth.com/journals/jden
Guest Foreword
Recent decades have shown a substantial improvement in oral health. Much of this change is attributed to the introduction and growing, widespread use of fluoridated toothpastes. In this period important paradigm shifts occurred as a result of the comprehensive new information about the aetiology, pathogenesis, prevention and restoration of tooth decay. Among these a consensus was reached that non-invasive clinical interventions should be the preferred treatment as long as possible. This was driven by observations that an initial invasive treatment is typically the start of a restoration cycle with increased loss of the dental tissues with every subsequent retreatment. In many societies, modern lifestyle changes have resulted in enhanced challenges to oral health. Apart from a higher frequency of cariogenic snacking, the frequent consumption of acidic beverages is a risk factor as it may lead to erosion. While fluoride toothpastes have shown their general efficacy in caries prevention there still is the need for more efficacious products, in particular for fluoride containing oral care products that are effective to prevent or repair acid induced erosion of the enamel. This Supplement encompasses the results of extensive studies to develop a fluoride toothpaste more efficacious than traditional fluoride toothpastes. The corner stone of this new product line is the addition of calcium silicate and phosphate. These components have a history in bone research, being used in several modifications in orthopaedics and oral surgery. The mechanistic studies reported demonstrate that during brushing with this product calcium silicate is deposited onto enamel surfaces. This deposition serves several purposes including dissolution under acid challenges resulting in increased calcium levels which can slow down demineralisation and the calcium silicate serves to nucleate hydroxyapatite crystals, hence enamel remineralisation. The physico-chemical processes involved, including at the enamel surface, were investigated with a range of techniques such as scanning and transmission electron microscopy (SEM and TEM), Fourier transform infrared analysis (FTIR), atomic force microscopy (AFM), Raman spectroscopy and with the new method of scanning electrochemical cell microscopy (SECCM).
With the latter technique it is possible to perform dissolution studies in small droplets of acid on a treated surface and describe in detail the effect treatments have on the kinetics of enamel dissolution. The combination of these techniques resulted in convincing evidence of the working mechanism of the calcium silicate additive. Also more established methods for preclinical screening of a new oral care product, such as pH-cycling and in situ experiments, were employed to quantify the effects of brushing with the new toothpaste on enamel de- and remineralisation. A valuable new application was an interproximal mineralisation model. Considering that dental caries mainly forms in secluded sites of the dentition with limited access of saliva and of oral care products, this method is a valuable tool to estimate potential in vivo efficacy. The clinical study design with enamel specimens placed intraorally (in situ model) is a valuable intermediate between laboratory testing and a full randomised clinical trial. The specimens are subject to in vivo conditions together with the regular use of a test product and then can be analysed with various sensitive laboratory measurement methods. In this case, a calcium silicate-phosphate toothpaste was included in combination with a gel of similar composition. Treatments with the novel dual product were found to reharden eroded enamel significantly more than regular fluoride toothpastes. The addition of calcium to oral care products has been the subject of study for considerable time, with the rationale that enamel remineralisation requires sufficient levels of free calcium and phosphate, of which the latter is abundantly available in the oral fluids. Merely adding soluble calcium has limited effect on the enhancement of remineralisation. The current approach involving calcium silicate deposition onto enamel, and its conversion into crystalline calcium phosphate, as hydroxyapatite, seems a more effective way for enamel remineralisation and therefore a promising approach in the prevention and repair of dental erosion.
0300-5712/$ – see front matter © 2014 Elsevier Ltd. All rights reserved.
JM ten Cate ACTA Amsterdam