Remineralisation of teeth
Encyclopedia
Remineralisation of teeth (UK spelling; US remineralization of teeth) is a process in which minerals are returned to the molecular structure of the tooth
itself. Teeth are (often) porous allowing fluids and demineralisation beneath the surface of the tooth. When demineralised, these pores become larger. This process cannot replace lost tooth material: it will not fill a cavity that has developed into a hole.
Tooth decay is an infectious disease
, the key feature of which is an increase within dental plaque
of bacteria such as Streptococcus mutans
and Lactobacillus
. These produce organic acids when carbohydrates, especially sugar, are eaten. When enough acid is produced so that the pH
goes below 5.5, the acid dissolves carbonated
hydroxyapatite, the main component of tooth enamel
, in a process known as demineralisation. After the sugar is gone, the mineral loss can be recovered—or remineralised—from ions dissolved in the saliva. Cavities result when the rate of demineralisation exceeds the rate of remineralisation and the latticework is destroyed, typically in a process that requires many months or years.
Fluoride therapy
is often used to promote remineralisation. This produces the stronger and more acid-resistant fluorapatite
, rather than the natural hydroxylapatite
. (Both are made of calcium. The fluoride takes the place of a hydroxide
.)
Fluoride exerts its major effect by creating low levels of fluoride ions in saliva and plaque fluid, thus exerting a topical
or surface effect. A person living in an area with fluoridated water may experience rises of fluoride concentration in saliva to about 0.04 mg/L several times during a day. Technically, this fluoride does not prevent cavities but rather controls the rate at which they develop. When fluoride ions are present in plaque fluid along with dissolved hydroxyapatite, and the pH is higher than 4.5, a fluorapatite
-like remineralised veneer
is formed over the remaining surface of the enamel; this veneer is much more acid-resistant than the original hydroxyapatite, and is formed more quickly than ordinary remineralised enamel would be. The cavity-prevention effect of fluoride is partly due to these surface effects, which occur during and after tooth eruption
.
The calcium used to rebuild teeth must be dissolved in the saliva.
Some remineralisation methods may work for "white spot lesions" but not necessarily "intact tooth surfaces".
Tooth
Teeth are small, calcified, whitish structures found in the jaws of many vertebrates that are used to break down food. Some animals, particularly carnivores, also use teeth for hunting or for defensive purposes. The roots of teeth are embedded in the Mandible bone or the Maxillary bone and are...
itself. Teeth are (often) porous allowing fluids and demineralisation beneath the surface of the tooth. When demineralised, these pores become larger. This process cannot replace lost tooth material: it will not fill a cavity that has developed into a hole.
Tooth decay is an infectious disease
Infectious disease
Infectious diseases, also known as communicable diseases, contagious diseases or transmissible diseases comprise clinically evident illness resulting from the infection, presence and growth of pathogenic biological agents in an individual host organism...
, the key feature of which is an increase within dental plaque
Dental plaque
Dental plaque is a biofilm, usually a pale yellow, that develops naturally on the teeth. Like any biofilm, dental plaque is formed by colonizing bacteria trying to attach themselves to a smooth surface...
of bacteria such as Streptococcus mutans
Streptococcus mutans
Streptococcus mutans is a facultatively aerobic, Gram-positive coccus-shaped bacterium commonly found in the human oral cavity and is a significant contributor to tooth decay.The microbe was first described by J Kilian Clarke in 1924.-Introduction:...
and Lactobacillus
Lactobacillus
Lactobacillus is a genus of Gram-positive facultative anaerobic or microaerophilic rod-shaped bacteria. They are a major part of the lactic acid bacteria group, named as such because most of its members convert lactose and other sugars to lactic acid. They are common and usually benign...
. These produce organic acids when carbohydrates, especially sugar, are eaten. When enough acid is produced so that the pH
PH
In chemistry, pH is a measure of the acidity or basicity of an aqueous solution. Pure water is said to be neutral, with a pH close to 7.0 at . Solutions with a pH less than 7 are said to be acidic and solutions with a pH greater than 7 are basic or alkaline...
goes below 5.5, the acid dissolves carbonated
Carbonate
In chemistry, a carbonate is a salt of carbonic acid, characterized by the presence of the carbonate ion, . The name may also mean an ester of carbonic acid, an organic compound containing the carbonate group C2....
hydroxyapatite, the main component of tooth enamel
Tooth enamel
Tooth enamel, along with dentin, cementum, and dental pulp is one of the four major tissues that make up the tooth in vertebrates. It is the hardest and most highly mineralized substance in the human body. Tooth enamel is also found in the dermal denticles of sharks...
, in a process known as demineralisation. After the sugar is gone, the mineral loss can be recovered—or remineralised—from ions dissolved in the saliva. Cavities result when the rate of demineralisation exceeds the rate of remineralisation and the latticework is destroyed, typically in a process that requires many months or years.
Fluoride therapy
Fluoride therapy
Fluoride therapy is the delivery of fluoride to the teeth topically or systemically in order to prevent tooth decay which results in cavities. Most commonly, fluoride is applied topically to the teeth using gels, varnishes, toothpaste/dentifrices or mouth rinse. Systemic delivery involves...
is often used to promote remineralisation. This produces the stronger and more acid-resistant fluorapatite
Fluorapatite
Fluorapatite, often with the alternate spelling of fluoroapatite, is a mineral with the formula Ca53F . Fluorapatite is a hard crystalline solid. Although samples can have various color , the pure mineral is colorless as expected for a material lacking transition metals...
, rather than the natural hydroxylapatite
Hydroxylapatite
Hydroxylapatite, also called hydroxyapatite , is a naturally occurring mineral form of calcium apatite with the formula Ca53, but is usually written Ca1062 to denote that the crystal unit cell comprises two entities. Hydroxylapatite is the hydroxyl endmember of the complex apatite group...
. (Both are made of calcium. The fluoride takes the place of a hydroxide
Hydroxide
Hydroxide is a diatomic anion with chemical formula OH−. It consists of an oxygen and a hydrogen atom held together by a covalent bond, and carrying a negative electric charge. It is an important but usually minor constituent of water. It functions as a base, as a ligand, a nucleophile, and a...
.)
Fluoride exerts its major effect by creating low levels of fluoride ions in saliva and plaque fluid, thus exerting a topical
Topical
In medicine, a topical medication is applied to body surfaces such as the skin or mucous membranes such as the vagina, anus, throat, eyes and ears.Many topical medications are epicutaneous, meaning that they are applied directly to the skin...
or surface effect. A person living in an area with fluoridated water may experience rises of fluoride concentration in saliva to about 0.04 mg/L several times during a day. Technically, this fluoride does not prevent cavities but rather controls the rate at which they develop. When fluoride ions are present in plaque fluid along with dissolved hydroxyapatite, and the pH is higher than 4.5, a fluorapatite
Fluorapatite
Fluorapatite, often with the alternate spelling of fluoroapatite, is a mineral with the formula Ca53F . Fluorapatite is a hard crystalline solid. Although samples can have various color , the pure mineral is colorless as expected for a material lacking transition metals...
-like remineralised veneer
Veneer (dentistry)
In dentistry, a veneer is a thin layer of restorative material placed over a tooth surface, either to improve the aesthetics of a tooth, or to protect a damaged tooth surface. There are two main types of material used to fabricate a veneer, composite and dental porcelain...
is formed over the remaining surface of the enamel; this veneer is much more acid-resistant than the original hydroxyapatite, and is formed more quickly than ordinary remineralised enamel would be. The cavity-prevention effect of fluoride is partly due to these surface effects, which occur during and after tooth eruption
Tooth eruption
Tooth eruption is a process in tooth development in which the teeth enter the mouth and become visible. It is currently believed that the periodontal ligaments play an important role in tooth eruption...
.
The calcium used to rebuild teeth must be dissolved in the saliva.
Some remineralisation methods may work for "white spot lesions" but not necessarily "intact tooth surfaces".
See also
- Amorphous calcium phosphate
- Calcium lactateCalcium lactateCalcium lactate is a white crystalline salt made by the action of lactic acid on calcium carbonate. It is used in foods and given medicinally. Its E number is E327.Calcium lactate is often found in aged cheeses...
- Calcium phosphateCalcium phosphateCalcium phosphate is the name given to a family of minerals containing calcium ions together with orthophosphates , metaphosphates or pyrophosphates and occasionally hydrogen or hydroxide ions ....
- NovaMinNovaMinNovaMin is the brand name of a particulate bioactive glass that is used in dental care products for Remineralisation of teeth. It was developed and patented by...
- RecaldentRecaldentRecaldent, with the technical name casein phosphopeptide – amorphous calcium phosphate, or CPP-ACP, is a milk derived product that strengthens and remineralizes teeth and helps prevent dental caries...
- Tooth developmentTooth developmentTooth development or odontogenesis is the complex process by which teeth form from embryonic cells, grow, and erupt into the mouth. Although many diverse species have teeth, non-human tooth development is largely the same as in humans...
- ToothpasteToothpasteToothpaste is a paste or gel dentifrice used with a toothbrush as an accessory to clean and maintain the aesthetics and health of teeth. Toothpaste is used to promote oral hygiene: it serves as an abrasive that aids in removing the dental plaque and food from the teeth, assists in suppressing...
- Tooth enamelTooth enamelTooth enamel, along with dentin, cementum, and dental pulp is one of the four major tissues that make up the tooth in vertebrates. It is the hardest and most highly mineralized substance in the human body. Tooth enamel is also found in the dermal denticles of sharks...