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Tooth remineralisation is a naturally occurring process in the oral cavity. It is defined as a process in which calcium and phosphate ions are sourced to promote ion deposition into crystal voids in demineralised enamel. Remineralisation remains imperative towards the management of non-cavitated carious lesions and prevention of disease progression within the oral cavity. The process also has the ability to contribute towards restoring strength and function within tooth structure.
Tooth demineralization is a chemical process by which minerals (mainly calcium) are removed from any of the hard tissues—enamel, dentine, and cementum. The process of demineralization begins at the crystal surface found inside the hard tooth tissue and may progress into cavitation unless arrested or overridden by remineralisation. The effect of demineralisation can be reversed if there is sufficient time to allow remineralisation to occur to counteract the acids in the oral cavity. Together, demineralisation and remineralisation contribute towards a dynamic process.
Role of saliva
Saliva, being the watery substance that constantly circulates the oral cavity, is capable of impacting both the remineralisation and demineralisation processes. It is secreted through the major salivary glands including the parotid, submandibular, sublingual and Von Ebner’s glands as well as the hundreds of minor salivary glands that are located throughout the oral cavity.
Remineralization occurs on a daily basis after an acidogenic challenge through the presence of saliva. Calcium, phosphate and fluoride found in saliva, are required for effective remineralization and maintenance of the enamel surface integrity. Therefore, as saliva is rich in calcium and phosphate ions, It can act as a natural buffer to neutralise acid and allow demineralised tooth tissues to be remineralised. If there is reduced saliva flow or reduced saliva quality, this will increase the risk of demineralization and create the need for treatment in order to prevent demineralisation progression.
Saliva function can be organised into five major categories that serve to maintain oral health and create an appropriate ecologic balance:
Lubrication and protection
Buffering action and clearance
Maintenance of tooth integrity
Taste and digestion.
As the demineralisation process continues, the pH of the mouth becomes more acidic which promotes the development of cavities. Dissolved minerals then diffuse out of the tooth structure and into the saliva surrounding the tooth. The buffering capacity of saliva greatly impacts the pH of plaque surrounding the enamel, thereby inhibiting caries progression. Plaque thickness and the number of bacteria present determine the effectiveness of salivary buffers. The high salivary concentrations of calcium and phosphate which are maintained by salivary proteins may account for the development and remineralisation of enamel. The presence of fluoride in saliva speeds up crystal precipitation forming a fluorapatite- like coating which will be more resistant to caries.
Besides professional dental care, there are other ways for promoting tooth remineralisation:
Fluoride therapy, Fluoridated toothpaste, Fluoride varnish, Water fluoridation, Plaque control, a low carbohydrate diet and the use of Sixtol, is a natural sweetener, also known as a sugar alcohol. Xylitol inhibits acid production by oral bacteria and promotes remineralisation of the teeth.
Fluoride is a mineral found naturally in rock, air, soil, plants and water and it assists by:
Protecting children and adults against tooth decay
Repairing early white spot lesions found on the tooth surface that may develop into cavities (holes in teeth).
Helps prevent premature tooth loss of baby teeth due to decay and overall assists in guiding the adult teeth to correct tooth eruption.
Aids in the prevention of invasive dental treatment therefore reducing the amount of money spent on dental treatment
Provides an overall community advantage, especially individuals from low socioeconomic communities, who have less access to other forms of fluoride treatments
Evidence confirms that water fluoridation is a safe and effective way to help protect teeth against decay
The addition of fluoride to the water does not alter the taste or smell of the drinking water
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.