INTODUCTION:

Tooth enamel is the highest mineralized tissue of the body. It is

mainly composed of 96% inorganic material, 4% being organic
material and water.
Dental caries prevention and arresting carious lesions are among
the main objectives of dental health care. Tooth structure is
subject to constant demineralization and remineralization
processes in the oral cavity. Therefore, any disturbance in the
balance of the oral cavity will destruct tooth structure. the
reaction between hydrogen ions, produced by bacterial
metabolism, and the phosphate group of enamel crystals leads to
enamel dissolution/demineralization. This process can be reversed
at normal pH and in presence of calcium and phosphorus ions.
Incipient enamel lesions can be remineralized, especially using
treatments to promote remineralization.

REMINERLIZATION: is defined as the process where calcium

anf phosphate ions are supplied from a source external to tooth to
promote ions deposition into cystal voids in demineralized
enamel.

REMINERLIZING AGENTS:
1. -Fluoride has long been known to be effective in protecting
the dental enamel from caries by reducing enamel dissolution and
enhancing enamel reminralization process.
-Fluoride can be reached to be people by many methods.It can be
added to water or toothpaste.

- studies have been conducted on different types of fluoride and

their application methods in order to assess the effects of fluoride.
When fluoride products are applied to enamel surface of the
teeth, the fluoride ions replace the hydroxide ions in the
hydroxyapatite crystal structure of the teeth.The lower solubility
of fluorapatite compared to that of hydroxyapatite results in
higher acid resistance of the enamel. Larger binding forces
between the fluoride and apatite crystals increase the hardness of
the teeth.
When fluoride concentration in enamel is increased by topical
fluoride application, this leads to the formation of a fluoride film
on the enamel surface, thus reducing the penetration of acid by
bacteria and enhancing remineralization. Therefore, topical
fluoride application is used for individuals with high caries risk,
orthodontic patients, and patients with decreased salivary flow.
Topical fluoride application can be classified into personal and
professional applications. Sodium fluoride (NaF) solution can be
applied to the teeth with a cotton applicator or by using
iontophoresis. The preventive effects of 2% NaF solution against
initial dental caries have been reported. In addition, fluoride gels
and varnishes enhance remineralization of initial carious lesions
and resist enamel demineralization. It was reported that the
incidence of dental caries decreased when Fluor Protector was
applied to enamel surface of bovine teeth and the teeth were
exposed to cariogenic beverages.

Topical fluoride application

Water fluoridation:
-water fluoridation is the most inexpensive way to distribute the
benefits of fluoride to the communities.Several laboratory
investigations have clearly demonstrated that the presence of low
levels of fluoride[0.03ppm or higher] in saliva or plaque fluid
reduces the rate of enamel deminralization during caries process
and promotes reminralization early caries lesions.

2.Casein phosphopeptide - amorphous calcium phosphate

(CPP-ACP),which obtain from milk, averts caries by simultaneous
inhibition of adherence of oral bacteria to saliva , coated hydroxyl
apatite crystals by selective inhibition to steptocooccal adhesion
to teeth. It can modulate the microbal composition odf dental
plaque and favor establishment of less cariogenic species as oral
actiomyces .

3. Calcium sodium phosphatesilicate bioactive glass (BAG)

has been introduced as a reminerlizing agent .Calcium sodium
phosphosilicate disintegrates and gives off sodium that gets

exchanged with hydrogen cations (H+ or H3O+). when it comes in

contact with saliva results in the release of calcium (Ca2+) and
phosphate (PO42) ions from the particle structure.There is a
transient increase in pH that brings about the precipitation of
calcium and phosphate ions from saliva and the particles to form
a calcium phosphate layer on the tooth surfaces. Ca-P complexes
crystallizes to form hydroxycarbonate apatite that is chemically
and structurally similar to biological apatite.
N.B: Within the limits of this study BAG and ACP-CPP both act as
novel agents to repair and prevent demineralization, while BAG
being more effective for early remineralization; but eventually,
both have similar remineralizing potential.

4.XYLITOL CARRIER: The use of chewing gum carring xylitol

increase salivary flow and enhances the protective properties of
saliva .This is the concentration of carbonate and phosphate is
higher in stimulated saliva and the resultant increase in plaque PH
and salivary buffering capacity prevent demineralization of tooth
stacture .Moreover , the higher concentration of Ca , P & hydroxyl
ions in such saliva enhances the reminerlization .

5.Toothpaste contain nano-hydroxyappatite crystals. The

nano-hydroxyapatite crystals had dimension of 50-100 nm in
length and 20-40 nm in width. It was ensured that these
nanohydroxyapatite crystals are similar to apatite crystals in
human enamel.
the nanohydroxyapatite group produced a surface morphology
close to the biologic enamel, the increase in mineral content (Ca/P
ratio) was more significant in the nanohydroxyapatite group.

However,
there
are
reminerlization such as:

many

challenges

that

face

1) Bad oral hygiene of patients.

2) Bad habits as smoking , alcoholics,etc .

3) Late caries lesions (as reminerlization agents can be applied
only to early caries lesions that appear in the form of white spots
of hypominerlized enamel on tooth surface).

So the dentist should change attitude and life style of the

patients to improve oral hygiene and avoid caries attack
that cause demineralization.

References :
-published online 2016 May ,
The effect of different fluoride application methods on the
remineralization of initial carious lesions.
Seon Mi Byeon, Min Ho Lee, and Tae Sung Bae

-2016 Jul-Aug; A comparative evaluation of remineralizing ability

of bioactive glass and amorphous calcium phosphate casein
phosphopeptide on early enamel lesion

Udaya Kumar Palaniswamy,1 Neha Prashar,2 Mamta Kaushik,2

Surender Ram Lakkam,1 Shikha Arya,1 and Swetha Pebbeti1

-Non-fluoridated reminerlizing technolpgy.

Challenges
In enamel
Reminerlization

Made by :
-Mariam El masry
Mariam Kotb

-Mariam Mamdouh
Mhrous

- Mariam

-Mariam Abdelmaged
mahmoud

- Mariam