Abstract
Dental caries is a dynamic noncommunicable disease which is multifactorial and dependent on the biological oral environment, human behaviour, and the social determinants of health. The World Health Organisation (WHO) identifies dental caries as the most prevalent and consequential oral disease affecting all age groups on a global scale, leading to large economic costs and lost productivity.
The clinical management of dental caries can be challenging for paediatric dental patients and dental practitioners. Dental caries remains the most common chronic disease in children resulting in six hundred million children with untreated dental caries worldwide in the year 2010 alone. According to the 2009 New Zealand Oral Health Survey, Māori and Pacific children and adolescents residing in higher socio-economic deprivation areas had the worse oral health outcomes.
The dental biofilm is a bacterial pellicle harbouring cariogenic mutans streptococci and lactobacilli which contribute to the microbial fermentation of residual foods leading to acid production and consequently leading to mineral loss from the tooth structure. Demineralisation is the loss of minerals from the tooth structure while remineralisation is the net mineral gain in demineralised tissue. When the caries activity is high and the oral environment favours the demineralisation cascade, an early enamel caries lesion initiates which is usually non-cavitated and white in appearance (white spot lesion).
Early enamel caries lesions (EECLs) describe the stage of the caries severity and not caries lesion activity. Minimal intervention dentistry (MID) is the minimal operative procedure that is rendered for the holistic management of the EECLs with the aim to preserve dental tissue. There is ongoing advocacy for early treatment of dental caries before cavity formation. Home care and professionally applied fluoride gels and varnishes have been the mainstay topical agents in promoting EECL remineralisation while newer strategies are being developed. Self-assembling peptides (SAPs) have shown potential in remineralisation of EECLs.
SAPs act as biological molecules and based on the self-assembling property of amelogenin and leucine rich amelogenin peptide (LRAP). SAPs claim stabilisation of the mineral due to the presence of the peptides and greater depth of remineralisation in EECLs. However, there is little evidence from standardized in-vitro and in-vivo research to support such claims. The aim of this laboratory-based research was to compare the remineralisation efficacy of a short (Curodont Repair ® (P11-4)), medium (P26), and long (LRAP) chain SAP with the standard 5% NaF varnish (Duraphat®) on EECLs.
Relevant research ethics approval obtained for collection of 25 sound premolar teeth. Enamel specimens were prepared according to the research protocols. Demineralising solution (DS) was used to create artificial EECLs in polished human dental enamel specimens, which were randomly allocated to the following treatment groups (n=10): Group 1: P11-4; Group 2: P26 solution; Group 3: LRAP solution; Group 4: 5% NaF varnish and Group 5: Deionised water (DIW). Following the treatment as per prescribed protocols, each specimen was subjected to eight days of pH cycling. Specimens from each test group were subjected to Micro-CT scans and nanomechanical testing to assess the mineral density (MD), hardness (H) and the elastic modulus (EM) properties of the sound, demineralised and treated enamel.
The mean MD percentage gain was highest in the P26 and P11-4 groups, followed by the LRAP, 5% NaF varnish and DIW groups. There was statistically significant difference between the four treatment and the negative control groups. In the outer layer of the artificial EECLs, the EM and H were highest amongst the P26, P11-4, followed by the LRAP and Duraphat. In the inner layer, the EM and H were highest amongst P11-4 and P26 groups, indicative of enhanced penetration and remineralisation of the deeper parts of the EECLs.
Self-assembling peptides P26 and P11-4 are more effective than 5% NaF varnish in remineralising the surface and deeper parts of the EECLs. The synergistic effect of SAPs and other homecare and professionally applied topical agents should be investigated. Although further research is warranted, it is expected that the integration of SAPs into the clinical management of EECLs will lead to favourable clinical outcomes. This supports the new paradigm of minimally invasive procedures for atraumatic experiences and improved quality of life for paediatric dental patents and their families.