Remineralisation of teeth
Remineralisation of teeth is a process in which minerals are returned to the molecular structure of the tooth itself. Teeth usually have a semi-soft layer of enamel, the part which we see as the outside of the tooth, that is easily destroyed by the acid-producing bacteria feeding from consumed sugars.
Tooth decay process
Although a key feature of tooth decay is an increase within dental plaque of bacteria such as Streptococcus mutans and Lactobacillus, it is not considered as an infectious disease. Tooth decay can be managed by modifying behaviour to controlling its causative factors, i.e. reducing the frequency of fermentable carbohydrates from food. This will reduce the chance of the dental biofilm developing to a cariogenic biofilm. The bacteria in a cariogenic biofilm 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 hydroxyapatite. Both materials are made of calcium. In fluorapatite, fluoride takes the place of a hydroxide.
Effect of fluoride
Fluoride creates low levels of fluoride ions in saliva and plaque fluid and thus exerts 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 making them take a lot longer and making them easier to prevent via normal brushing as it will take a higher amount of acid, usually built up over a number of days, to destroy the created fluorapatite. 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.
Some remineralisation methods may work for "white spot lesions" but not necessarily "intact tooth surfaces".
- Amorphous calcium phosphate
- Calcium lactate
- Calcium phosphate
- Tooth development
- Tooth enamel
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