Dentists Be Damned

Alternative Medicine for Tooth Pain

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Caries prevention is critical in children, especially in developing countries where younger generations are acquiring more westernized dietary habits, which is expected to contribute to an increase in dental caries. Despite there is a reduction in prevalence of dental caries it is still a problem of great importance. The reduction of caries prevalence has not occurred uniformly for all dental surfaces.

Several studies have been undertaken with the objective of determining the most accurate and precise method for detection of carious lesions among conventional and new methods, in order to identify caries lesion at an early stage when medical treatment is still possible.

Therefore new procedures have been standardized (Sridhar et al., 2009). The clinical diagnosis of WSLs has been made primarily by using traditional methods, such as visual inspection after air drying and tactile examination by dental probing. However, the subjectivity, lack of reproducibility, and prerequisite of the presence of a significantly advanced lesion have led to the introduction of several optical devices in recent decades. One such technique is laser fluorescence - DIAGNOdent- (Lusi et al., 1999). The results of studies suggest that this technique might be appropriate for the early detection and assessment of WSLs (Aljehani et al., 2006; Andersson et al., 2007). In this clinical study we can indicate that, over a period of 3 months, DIAGNOdent was useful as a method for quantitative evaluation of the remineralization of early carious lesions.

A new clinical index, the International Caries Detection and Assessment System (ICDAS), was developed as an internationally accepted caries detection system that would also enable the assessment of early enamel demineralization (Ismail et al., 2007). In the ICDAS I (2003) the visual examination was carried out on clean, plaque-free teeth after careful drying. The criteria were subsequently modified and the ICDAS II was created (Topping &Pitts, 2009). The improvement consisted of an exchange of codes to ensure that the system would reflect increased severity.

CPP-ACP has been shown to localize and stabilize calcium and phosphate ions at the tooth surface in a bioavailable form that can promote remineralization of enamel subsurface lesions in situ, restoring the white opaque appearance of the lesions to translucency, even in the presence of fluoride (Reynolds et al., 2003, 2008). CPP-ACP remineralized initial enamel lesions and showed a higher remineralizing potential when applied as a topical coating after the use of fluoridated toothpaste (Kumar et al, 2008). CPP-ACFP has been proven to restore mineral throughout the subsurface enamel with a mineral that is consistent with fluorapatite (Reynolds et al., 2008).

In the present study white spot lesions, in permanent teeth on children between 7 to 14 years, were followed longitudinally through a clinical evaluation using the ICDAS II criteria and by DIAGNOdent measurement over a period of 3 months. During this time, DIAGNOdent readings of carious lesions had a tendency to decrease, indicating remineralization of the lesions in both CPP-ACP and CPP-ACFP groups but not in the control group. These data are similar to those from other authors' studies made during similar periods of time (Andersson et al., 2009; Altemburger et al., 2010, Ferrezano et al., 2011, Uysal et al., 2010). Both products showed more efficacy than the control paste, despite all of the groups received the same oral hygienic instructions. The CCP-ACFP group presented significant lower fluorescence values after the 4th week. In the CPP-ACP group significant differences could be seen after the 8th week (table 3). This major remineralization speed could be caused by the presence of fluoride in the formulation. Some experimental studies have assessed that CPP-ACFP solutions at a pH lower than 5.5 have higher remineralization capacity than CPP-ACP (Cochrane NJ et.al, 2008).

There was a clear trend that the rate of visual score obtained was reasonably comparable with the DIAGNOdent values. Lesions clinically identified as active, showed higher fluorescence values in comparison to those coded as inactive, but only lesions clinically coded as 3 (ICDAS II criteria) showed significant higher LF value in comparison to all others in every phase of the study, as you can see in table 4. The results agree with those from Aljehani et al. (2006) in their study on white spots appeared after taking away brackets followed along a year.

Another topics we were interested in was to assess if carious lesions had clinical signs of activity (white, opaque, rough surface) or arrested (smooth yellow-brownish appearance) (Ekstrand et al., 2009) and if it was possible to detect changes along the study. As can be seen in table 2, clinical appearance of lesions was not modified during the study period in any group. The group of patients treated with CPP-ACP was the only showing a small number of lesions that clinically disappeared after the treatment. This results are in agreement with those given by Altenburger et al., (2010) and Aljehani et al., (2006), as well as Baley et al., (2009) that, in a 3-months study, after the evaluation of progression, regression or stabilization in a post-orthodontic population, did not find clinically detectable differences between a group treated with CPP-ACP and a control one, although considering only lesions coded as 2 or 3 (ICDAS II) he found a 31% more regressed lesions in the CPP-ACP group in comparison to the control group. Likely, a period longer than 3 months may be necessary in order to observe visually detectable changes of white spot lesions.

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