What Are Dental Caries and Dental Plaque?
It is surprising to note that despite the daily use (on a large community basis, even across different countries in the world) of fluoride dentifrices globally, dental caries still, in fact, continues to be one of the underestimated and most prevalent oral conditions that remain a public health threat and issue. This is because untreated carious lesions can cause a sequence of localized infections of the tooth, necessitating the need for endodontic treatment like root canal treatment or intervention to save the tooth.
Dental caries are known to be a multifactorial as well as a dynamic tooth disease that is fundamentally characterized by the mineral loss (calcium hydroxyapatite crystals in the enamel) of the dental hard tissue. Bacteria that form the dental plaque deposits further have the potency to metabolize carbohydrates that can produce lactate or other enamel-dissolving acids, which eventually result in demineralization of the enamel. The enamel, being the first layer of the tooth that undergoes demineralization, would hence initiate the sequel in an acidic or cariogenic environment for the bacterium to destroy the hard tissue layer of the tooth-producing caries. Dental plaque similarly is the primary initiator behind gingival and periodontal diseases (inflammatory diseases of the soft tissues) around the tooth. Plaque is not only responsible for harboring oral pathogens, but the biofilm can promote a reservoir of these pathogens that lower the oral immune defense of the host and lead to CAL (clinical attachment loss) of the gingiva or the soft tissue surrounding the tooth. Apart from regular dental follow-up and dental cleaning or oral prophylaxis, it is important to implement mechanical and chemical plaque control measures to promote oral health.
What Are the Benefits of Fluoride-Arginine Dentifrice?
Dentifrices that contain at least 1.5 percent arginine and around 1450 ppm (parts per million) of fluoride and sodium monofluorophosphate in the insoluble form of calcium have been focused upon extensively through dental research and have been recently introduced in the last decade to the public markets after much investigation and testing. Medical research studies performed on these fluoridated dentifrices, which comprise arginine indicate that arginine is an element that is capable of positively affecting plaque metabolism and eventually decreasing the caries risk of an individual when used in combination with fluorides. Arginine is known to be primarily the semi-essential amino acid that can be obtained from different dietary sources or foods, dairy, and beverages, for example, milk, milk-derived by-products, beef, poultry, shellfish, cereals, some dried fruits, and others. Current medical and dental research that investigated and has focused on several meta-analyses and research studies showed that dentifrices containing either only fluoride or ideally the combination of fluoride and arginine have a potent remineralization impact upon sound as well as demineralized bovine enamel.
What Is the Rationale Behind the Use of Arginine in Modern-Day Dentifrices?
The rationale behind the use of arginine in this formulation is that the insoluble calcium, when combined with 1.5 percent arginine, would be either presented in the form of calcium carbonate or dehydrated form of calcium. As there are specifically oral pathogens or certain oral microorganisms, for instance, Streptococcus sanguinis (that are implicated in the dental caries pathway), the metabolization by arginine of these organisms would tend to produce ammonia as a by-product. The ammonia produced would then neutralize the plaque acids and favor plaque pH (potential of hydrogen) homeostasis, as per current dental research. Specifically, this ammonia production via the arginine metabolism, simply put, can rather prompt a neutral environment or pH that would be much less favorable to the bacterial or pathogenic outgrowth that is responsible for dental caries and dental plaque. As the most popular hypothesis that exists according to dental caries pathogenesis in the tooth enamel or dental plaque formation as well, it is the presence of the acidic environment initiated by these bacterial pathogens that can be the causative factor mainly. Hence, research indicates that the use of arginine and fluoride as a combination to fight acid-producing cariogenic bacteria significantly reduced caries risk for individuals who need a mechanical form of caries and plaque control measure.
How to Promote Dental Remineralisation?
The standard treatment that is adopted by dentists for dental caries comprises not only dental restoration or management through the excavation of caries followed by sealants or fillings but also a need to promote home care regimens for the patient to promote oral hygiene. This can be done by re-balancing the remineralization processes, which involve controlling all the risk factors responsible for dental plaque and caries.
Can the Demineralized Enamel Undergo Any Process of Remineralization?
Well, the answer, according to dental surgeons, is that while the calcium and phosphate layers are dissolved away from the enamel calcium hydroxyapatite crystals within, the development of initial carious lesions can be certainly stopped or reversed when this dental caries favoring medium that is the acidic environment is removed. Instead, when the saturated saliva in the mouth or oral cavity tends to retain calcium, phosphate, or fluoride minerals and they are carried effectively to the enamel surface through the use of remineralizing solutions or chemical plaque control agents (denitrifiers or fluoridated mouthwashes, toothpaste, and others), there would be a possibility in the repair or the restoration of the original hydroxyapatite structure of the enamel.
Conclusion
Dentists should promote awareness regarding the risk factors responsible for caries and plaque, such as patients avoiding the ingestion of dietary or saturated carbohydrates, the importance of correct tooth brushing techniques to control dental plaque formation, exposing the dental hard tissues or the enamel and dentin to regular fluoride use through dentifrices or other oral products comprising fluoride, etc. Current dental research indicates that arginine use is considered quite safe and can be used in the preparation of dentifrices to have the dual impact of fighting both dental caries and dental plaque. Dental surgeons advise deep oral prophylaxis or restorative management through recommended regular dental follow-ups or at regular, timely intervals to keep a check on oral health. Hence, the use of dentifrices as an adjunct recommended by dentists for home care regimens would indeed be deemed suitable for preventing dental diseases globally.
