By the time caries has reached dentin the resistance has dropped by a factor of 30.
What is the efficacy of Fl?
only drug proven to prevent
dental caries lesions
higher conc (5000 vs 1500) enhanced remineralization and inhibited demineralization
What is the ACP mechanism?
Amorphous Calcium Phosphate Free & available for incorporation into tooth structure
Best for pts. w/mild remin probs and high motivation
Two-phase delivery system
Prevents the calcium and phosphate from reacting
What is the drawback of ACP?
acid challenge (pH<5.5) breaks down ACP and not available after
What is CPP?
Casein Phosphopeptides (CPP)
bind calcium and phosphate and keep them in a soluble, amorphous state
provides SUBSTANTIVITY to ACP
penetrate into the tooth enamel, work synergistically with fluoride and repair demineralized areas
What is enamelon?
insoluble calcium phosphate crystals
How is MI paste applied?
pea-sized on finger
smear on teeth
What are the indications for MI paste?
High caries risk
Infants & Children
What is the composition/chemical features of MI Paste?
•NaF: 900 ppm* (OTC toothpaste: 1000 ppm*)
Why is Fl added to CPP-ACP?
superior anti-caries effect than Fluoride alone
high risk for dental caries and dental erosion
Remineralized(thickened) through the body vs surface only of Fl alone
What is the forumulation of MI Paste Plus?
5 :3 :1
5 / Calcium
3 / Phosphate
1 / Fluoride
What do studies say about CPP-ACP?
CT evidence insufficient to make conclusions regarding the longterm effectiveness of casein derivatives, specifically CPP-ACP, in preventing caries in vivo and treating dentin hypersensitivity or dry mouth
not yet been substantiated
Topically applied fluoride remains the standard for anti-caries effectiveness
What is Tri-calcium phosphate?
anticavity toothpaste 1.1 (5000ppm F-) blended/milled with organic materials
• Calcium – phosphate bonds are broken
• Calcium oxides become ‘protected’ by the organic materials
• TCP ingredient can coexist with fluoride ions in an aqueous dentifrice base High fluoride availability
• Organic carry the calcium to the tooth surface, protected from fluoride ion High fluoride bioavailability during application
• Saliva activates the calcium compound degrading the protective coating, releasing calcium at the tooth surface Calcium bioavailability during application
What activates tri-calcium phosphate?
saliva at tooth surface increase bioavailability
What is Novamin?
Particulate “bioactive glass” material
attach to tooth surface,
→ react with water
→ release Ca2+ and PO43- ions
→ new HA forms on tooth surface
Found in NUPRO Sensodyne Prophylaxis Paste with NovaMin (5000ppm F- too)
How do HA nanocrystals(pHluorigel) work?
• Resting saliva pH = 6.75
• Stimulated saliva pH = 7.8
• HA dissociates into Ca2+ and PO4 3- ions at pH < 5.5
• Fluorapatite (FA) dissociates at pH < 4.5
∴ Saliva environment favors presence of HA and FA nanocrystals over ions
How properties of O3 make it good for the mouth?
Powerful oxidant, disinfectant (CONFLICTING)
unstable releases nascent oxygen
Disinfection of endodontic systems (CONFLICTING)
Promote soft tissue healing (e.g. apthous ulcers)
Tooth whitening (oxidation)
HALT/REVERSAL OF CARIES LESIONS (NO EVIDENCE)
what are Ozone medical uses?
• Wound healing – long history
• Gangrene, infection, burns
• Ocular diseases
• Kills microorganisms, safe for human tissue cells (GOOD EVIDENCE)
What were the original uses of O3 in dentistry?
• enhance local oxygen supply,
• inhibit bacterial proliferation
What is the intraoral mechanism of O3?
• Oxidizing action drives O2 beneath surface of lesion to
• Neutralization of acids creates hostile environment for
• Lesion is populated with non-cariogenic bacteria
• Remineralization from salivary or topically-applied
sources of F, Ca, and PO is facilitated
What was really the only good evidence for O3 dentistry?
prophy for restorative prior to etching
What is Icon (DMG)?
Diffusion barrier for proximal lesion infiltration of NON-CAVITATED, smooth surface lesions
White spot lesions
Infiltrate the porous body of lesion with low-viscosity resin
Block diffusion pathways INSIDE vs surface sealant for cariogenic acids