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ABSTRACT: The application of fluoride varnishes is an effective method of enamel remineralization and the prevention of dental caries. Fluoride varnishes were enhanced with additional substances in order to achieve better therapeutic effects. In this review, we searched the following databases: PubMed®/MEDLINE®, Cochrane Library, EBSCO, and Embase® for original English language research papers published in 2000-2015, on fluoride varnishes enhanced with amorphous calcium phosphate (ACP), tricalcium phosphate (TCP), the functionalized form of tricalcium phosphate (fTCP), sodium calcium phosphosilicate (CSPS), sodium trimetaphosphate (TMP), and calcium glycerylphosphate (CaGP). Twelve papers fulfilled the inclusion criteria. The presence of ACP increases the fluoride ion (F) uptake in damaged enamel 2.5-fold and in healthy enamel 4-fold, compared to varnish enhanced with TCP. The effectiveness of TCP enhanced F varnishes has not been proven. Studies on TMP show its synergy with F in the remineralization of white spot lesions. CaGP and NaF varnishes with ACP protect enamel against demineralization equally well. F varnishes with ACP, TCP, and TMP effectively block demineralization and increase remineralization of dental enamel. NaF varnish enhanced with ACP is recommended by many authors for the remineralization of caries enamel lesions while varnish enhancement with TCP is recommended for the remineralization of white spot lesions caused by orthodontic treatment.
Key words: Amorphous calcium phosphate; Calcium glycerylphosphate; Fluoride varnishes; Functionalized form of tricalcium phosphate; Sodium calcium phosphosilicate; Sodium trimetaphosphate; Tricalcium phosphate.
INTRODUCTION
According to the WHO, dental caries is a common disease with a prevalence rate of 100% in adults and 60%-90% in children.1 The first symptom is a white spot lesion (WSL), i.e., a macroscopically visible demineralization of dental tissue.2 Demineralization and remineralization are dynamic processes that occur constantly inside the oral cavity affecting the development of dental caries.3 WSLs are often observed in patients with poor oral hygiene, in patients wearing orthodontic braces, and in those who are frequent consumers of large amounts of sugar-sweetened beverages, sweets, and snacks.4,5 Remineralization is aided by an early decision to start a cariostatic diet and the use of fluoride ion (F)based products.6 In an attempt to further improve the efficacy of remineralization, fluoride varnishes have been modified to include calcium and inorganic phosphate ions, e.g., amorphous calcium phosphate (ACP), tricalcium phosphate (TCP), the functionalized form of tricalcium phosphate (fTCP),...