Assessment of Remineralization Potential of Pediatric Toothpastes Containing Fluoride and Biomimetic Agents on Primary Tooth Enamel

Background: Early childhood caries (ECCs) remains a significant public health concern, affecting 60%–90% of children globally. Fluoridated toothpastes are the primary preventive measure, but emerging remineralizing agents offer additional therapeutic potential for reversing early enamel demineralization in primary teeth. Materials and Methods: Sixty extracted sound primary incisors were sectioned to obtain 120 enamel specimens. Primary teeth were collected from the Department of Pedodontics and Preventive Dentistry, Dasmesh Institute of Research and Dental Sciences, Faridkot, India. After baseline microhardness measurement, specimens underwent artificial demineralization using acidic buffer (pH 4.5) for 96 h. Specimens were randomly allocated to six groups ( n = 20): Group 1 – 1000 ppm fluoride toothpaste; Group 2 – 500 ppm fluoride toothpaste; Group 3 – fluoride-free calcium phosphate toothpaste; Group 4 – fluoride with xylitol toothpaste; Group 5 – nano-hydroxyapatite toothpaste; and Group 6 – artificial saliva (control). pH cycling was performed for 14 days with twice-daily toothpaste application. Surface microhardness and mineral content were assessed using Vickers hardness testing and energy-dispersive X-ray spectroscopy. Results: All treatment groups showed significant remineralization compared to control ( P < 0.001). The 1000 ppm fluoride group demonstrated the highest microhardness recovery (78.4% ±6.2%), followed by nano-hydroxyapatite (72.6% ±5.8%) and fluoride with xylitol (68.3% ±5.4%). Calcium-phosphate ratio improved significantly in all treatment groups, with nano-hydroxyapatite showing the highest mineral gain (2.14 ± 0.18) compared to baseline (1.52 ± 0.12). Conclusion: Pediatric toothpastes containing 1000 ppm fluoride and nano-hydroxyapatite demonstrated superior remineralizing potential on primary tooth enamel. These findings support their use in preventing and reversing ECCs.