Why Is There a Need for Enamel Remineralization to Prevent Active Carious Processes?
Enamel demineralization is one of the major causative factors that cause dental caries to spread or the bacterial invasion of pathogens into tooth enamel, causing dental cavitation and pulpal involvement, pain, and swelling. Global incidence rates demonstrate that almost four out of every five primary teeth in children and over half of the permanent teeth in adolescents and young adults continue to be affected by dental caries, burdening oral healthcare demands. While dental fillings, endodontic therapies, and capping are aimed at the conventional treatment of cavitations in the teeth, there are several noninvasive treatment strategies for remineralizing the tooth enamel. As we know, tooth enamel is made of calcium hydroxyapatite crystals that contribute to more than 95 percent of its hard tooth structure. The aim of remineralizing agents, such as fluorides in professionally advocated commercial fluoridated toothpaste, fluoride gels, and mouthwashes, is to remineralize the enamel to prevent enamel demineralization. However, there are several minimally invasive remineralizing therapies for dental enamel, as it is primarily an inorganic structure composed of calcium crystals.
One of the primary aims of a remineralizing agent for tooth enamel is to control the formation of dental biofilm or plaque caused by bacteria and food lodgement on the tooth enamel. Doing so stops the dental carious process, and the enamel's structural integrity is preserved, protecting the tooth.
Noninvasive New Age Therapies for Enamel Remineralisation:
These noninvasive to minimally invasive new age remineralizing therapies are being investigated for their future role in dentistry. They are listed below, briefly elaborated as follows according to the progress in current dental research:
Ozone Therapy:
This is one of the fundamentally important noninvasive remineralizing therapies for tooth enamel, with the most potential to replace the traditional dental treatment strategy of tooth filling. Ozone therapy aims to reduce the acidogenic environment in which the oral pathogens thrive, thereby arresting or preventing bacterial progression in the oral cavity. Ozone therapy yields potential as an alternative or replacement for restoring the tooth with dental fillings or artificial materials by allowing scope for remineralization of dentin tissue in the teeth.
Ozone cannot possibly eliminate the detrimental proteins from the cavitated or carious lesions caused by a bacterium. Still, it can also facilitate the diffusion of calcium and phosphate ions through the various lesions, resulting in an effective remineralization therapy. Ozone therapies for remineralizing enamel are further known to exhibit very low-grade cytotoxicity and, hence, are an orally biocompatible and friendly management strategy.
The promising future role of ozone is due to its use in restorative and preventive dentistry. This can be attributed to the potent oxidation capacity of ozone against the oxidized bacterial cell wall, which eventually leads to the death or lysis of oral pathogenic dental caries, causing bacteria like streptococcus and staphylococcus. Its remineralizing potency in the second layer of the tooth, for example, the dentin layer, needs to be researched further and extensively to prove its remineralizing benefits or in treating conditions like dentinal hypersensitivity shortly. This nature of ozone in counteracting the acidic proteins that are usually produced by oral cariogenic bacteria holds, hence, a promising futuristic role in treating dental hypersensitivity, which is usually caused by osmotic stimulation, leading to sudden fluid movement within the dentin tubules (past the enamel layer). By attempting to reduce the osmotic stimulation, dentinal hypersensitivity would be treated non invasively by using ozone therapy.
Low-Viscosity Resin Therapy :
This intermediate remineralization therapy of the dental enamel can halt the dental caries progression in the enamel. These are called intermediate remineralizing therapies because they combine the modes or principles of both preventive and restorative dental treatments.
The rationale of these therapies is that by infiltrating the dental carious lesions or cavities with resin, the enamel porosities are effectively penetrated, leading to an arrest in the demineralization process by the cariogenic or acidogenic bacterium. Low-viscosity resin therapies are currently used to treat white spot lesions that are common after orthodontic treatment.
As white spot lesions are indeed one of the side effects of conventional braces or orthodontic management, low-viscosity resin can be durable in the long-term restorative and remineralizing management of these lesions with positive success rates or good outcomes, as per a few documented case reports in dental research. In terms of esthetics and function, the enamel can be restored to its natural appearance with the application of the low-viscosity infiltrating resin.
Lasers:
The utilization of laser technology is not at all new in dental medicine and represents a major revolution in different dental applications over the last two decades. In dental caries management and periodontal disease or infection control, several types of laser therapies, such as neodymium-doped yttrium aluminum garnet (Nd: YAG) laser and erbium-doped yttrium aluminum garnet (Er: YAG) laser, are used to halt the progression of dental caries in both decisions / primary and permanent dentition.
The combination of argon laser irradiation alongside topical acidulated phosphate fluoride treatment has shown excellent esthetic and functional results in effectively promoting enamel remineralization. Not only has this combination treatment created a protective barrier against dental pathogenic or carious lesions, but clinical outcomes show reduced dental cavitation depth and prevention of demineralization by the cariogenic bacteria.
The laser enameloplasty procedure (a cosmetic dental procedure that reshapes teeth to improve their appearance), before the dental sealant placement, would be used in promoting caries resistance of the tooth enamel and holds promising future scope in restorative dentistry, as it can potentially eliminate the need for traditional etching methods that the dentist uses before dental fillings.
Conclusion:
Hence, the new age of minimally invasive or noninvasive remineralization therapies for dental enamel is aimed at preventive and primary management of arresting or halting dental caries progression in the initial stages. Hence, they hold promising future scope in dentistry. It is to be noted that these treatment strategies have ample scope over conventional or traditional dental treatments in addressing tooth decay, cavitation, or caries caused by acidogenic bacteria.
