Evaluating the effects of remineralizing agents on early carious lesions

Abstract Background Initial carious lesions are reversible, and fluoride-containing reagents effectively promote tooth enamel remineralization in the initial carious lesions. Numerous remineralizing agents are promoted, some containing fluoride and others containing alternatives, due to fluoride toxicity concerns. The objective of this study is to investigate the effects of three remineralizing agents; fluoride varnish (5% NaF, Duraphat®), casein phosphopeptide-amorphous calcium phosphate paste (CPP-ACP, Tooth Mousse®), and casein phosphopeptide-amorphous calcium phosphate fluoride paste (CPP-ACPF, Tooth Mousse Plus®), on the initial carious lesions. Methods Forty sound human maxillary premolar teeth were randomized into four experimental groups (n = 10): distilled water, fluoride varnish, CPP-ACP, and CPP-ACPF. All forty teeth were cut in half mesiodistally. Vicker’s microhardness test was performed on the buccal half of each tooth, and the lingual half was examined with both a spectrophotometer for color dimension and an Atomic Force Microscope to evaluate roughness. The four experimental groups of teeth were first systematically demineralized, and then remineralized using one of the four remineralizing agents. During the experiments, each tooth’s microhardness, color, and roughness were examined a total of three times: 1) Before treatment, 2) After demineralization, and 3) After remineralization. At each stage, a scanning electron microscope was used to examine surface features and enable EDX chemical composition analysis. Results Demineralization carried out in preparation for testing of the agents caused enamel hardness to decrease significantly. Enamel roughness increased, although not significantly. After remineralization, each of the three remineralizing agents had significantly increased both hardness and lightness (L*), compared to the demineralized enamel. Each agent decreased enamel roughness, but again the roughness change was not significant. Comparing the three remineralizing agents, there were no significant differences between the agents in effectiveness. Conclusion Each of the three remineralizing agents significantly increased hardness and lightness (L*) in decalcified enamel, and the three agents were equally effective in doing so.