Carboxymethyl Chitosan—Fluoride-doped Amorphous Calcium Phosphate: A Novel Remineralizing Gel

remineralization of teeth is considered the keystone of current caries control theories.Fluoride converts hydroxyapatite (HA) crystals to fluorapatite crystals that are highly resistant to acids that demineralize the enamel and dentin.Fluoride also inhibits bacterial growth by affecting the enzyme enolase in glycolysis.9 However, it is necessary to follow safety protocols and instructions while using fluoridated toothpaste and mouthwashes, as accidental consumption of high doses of fluoride can be fatal.According to recommended daily allowances, a 0.1 mg fluoride/kg body, weight/day in children up to the age of 8 is regarded safe, creating no evident form of fluorosis in permanent teeth.However, the quantity of fluoride in drinking water, dietary supplements, and topical treatments must be considered, as they are all recognized as potential sources of fluorosis.Furthermore, the likely hazardous IntroductIonDental caries is a cyclic phenomenon involving phases of loss and gain of the mineral component of enamel and dentine (referred to respectively as demineralization and remineralization) rather than a continuous and unidirectional process of demineralization. 1 The occurrence of dental caries progresses from the initial demineralization, that is the dissolution of enamel apatite crystals, to a visible white spot lesion, followed by dentin involvement, and finally by tooth decay or cavitation.The progression through these stages is due to a constant imbalance between pathogenic and protective factors, which leads to the breakdown of apatite crystals and the net loss of calcium, phosphate, and other ions from the tooth.This process is known as demineralization. 2 Remineralization refers to supplying calcium and phosphate ions from an external source to encourage ion deposition into crystal voids in demineralized enamel to create a net mineral gain.3 When net mineral loss and net mineral gain are in balance, a state of health prevails in the oral cavity.4 As the disease progresses from white spot lesions to frank caries, dentists need to take more dire measures, such as drilling and filling the tooth and surgical intervention to save the tooth, although these treatments treat the disease and not the cause.It has taken almost a century for dentistry to go from the pioneering notion of "extension for prevention" to the more recent concept of "Minimally Invasive Dentistry (MID)." 5 MID is a concept that combines prevention, remineralization, and minimum intervention for the repair and restoration of teeth.6,7 It strives to manage noncavitated white spot lesions noninvasively favoring remineralization to minimize disease progression and enhance aesthetics, strength, and function.8 The MID clearly states the necessity for clinically effective methods to remineralize early carious lesions.Fluoride-facilitated