|Year : 2019 | Volume
| Issue : 4 | Page : 92-96
Effect of tooth mousse on enamel erosion – An in vitro study
Babita Karda1, Neetika Singh1, Charan Kamal Kaur2, Isha Aggarwal3
1 Department of Pediatric and Preventive Dentistry, Bhojia Dental College and Hospital, Baddi, Himachal Pradesh, India
2 Department of Pediatric and Preventive Dentistry, RIMS, Imphal, Manipur, India
3 Department of Orthodontics, Bhojia Dental College and Hospital, Baddi, Himachal Pradesh, India
|Date of Submission||10-Jul-2019|
|Date of Acceptance||11-Dec-2019|
|Date of Web Publication||12-Feb-2020|
H. No 715, First Floor, Sector 69, Mohali, Punjab
Source of Support: None, Conflict of Interest: None
In industrialized countries, dental erosion has gained much more attention due to decrease in dental caries. Remineralization of carious lesion can be enhanced by using casein phosphopeptide amorphous calcium phosphate (ACP) which is an effective remineralizing agent. Aim: The study is performed to assess the after effect of Tooth Mousse (CPP-Casein Phosphopeptide-ACP) paste on dental erosion produced by drinks by applying contact profilometer. Materials and Methods: Twenty human teeth (molar and premolar) were collected from patients with either compromised periodontal conditions or extracted due to orthodontic purpose. Samples were categorized into four groups, i.e., Group-I-Coca Cola (10), Group-II-Frooti (10), Group-III-Coca-Cola + Tooth Mousse (10), and Group-IV-Frooti + Tooth Mousse (10). Ph is calibrated by using pH meter with digital electrode. At baseline and after erosive exposure, surface roughness of samples was calculated using profilometer. The values were then statistically interpreted using Bonferroni Post-hoc test. Results: In the present study, after remineralization by Tooth Mousse (Group III and Group IV) change in surface roughness (Ra values) after erosive challenge and remineralization by Tooth Mousse were significant for Group III (Coke + Tooth Mousse) when compared with Group-I (Coke), whereas it was nonsignificant for Group – IV (Frooti + Tooth Mousse) when compared to other Group-II. Conclusion: The present study shows protective effect of CCP-ACP paste on dental erosion that is caused by drinks.
Keywords: Amorphous calcium phosphate-casein phosphopeptide, demineralization, profilometer, remineralization
|How to cite this article:|
Karda B, Singh N, Kaur CK, Aggarwal I. Effect of tooth mousse on enamel erosion – An in vitro study. J Dent Res Rev 2019;6:92-6
|How to cite this URL:|
Karda B, Singh N, Kaur CK, Aggarwal I. Effect of tooth mousse on enamel erosion – An in vitro study. J Dent Res Rev [serial online] 2019 [cited 2020 Apr 2];6:92-6. Available from: http://www.jdrr.org/text.asp?2019/6/4/92/278219
| Introduction|| |
Dental Erosion had been an evaded in early dentistry. Nothing could be done to intervene dental erosion at early stages which is foremost requirement for this era due to evolution of Western life style and standard.
Dental erosion is a chemical process of acid demineralization result in mineral loss from the tooth surface without involving acidogenic bacterial plaque.
There are two sources of acids endogenous and exogenous. Endogenous causes are bulimia nervosa, regurgitation of gastric acids, eating disorders, etc. Exogenous causes includes acidic medication, food, and drinks., Consumption of acidic food and drink are more common cause of dental erosion.
In previous years, softdrinks were considered as habit of affluent but after 2003, 91% sales were made to middle-class population. According to market analyzers, volume of soft drinks consumed in India was 11,755 million liter in 2013, and it was estimated that consumption of these soft drinks will increased by 19% in the year 2018.
Children and adolescents are at greatest risk as consumption is largest in these groups.
There is decrease in occlusal and vertical dimensions which leads to tooth sensitivity in dental erosion. As the condition deteriorates the treatment become more expensive and difficult. Hence, steps should be taken to prevent dental erosion.
Preventive approaches against dental erosion includes the modification of tooth brushing habits, use of fluoridated products, and use of composite resins on eroded areas., These approaches provide some protection against dental erosion, but more improved programs should be undertaken to diminish the risk associated.
Literature had reviewed Bowine milk as anticariogenic in animal caries models and effective in remineralization of enamel lesion. Thus, milk and milk products were considered as remineralizing agents.
GC cooperation, Japan has manufactured Tooth Mousse. It contains casein phosphopeptide (CPP) and amorphous calcium phosphate (ACP) complexes. Tooth Mousse has remineralizing effect.
Acidic ph leads to removal of ACP from CPP which increases their level in saliva that stabilizes the concentration of phosphate and calcium in saliva.
The aim of the current study is to assess effect of Tooth Mousse in hampering erosion caused by drinks by employing contact Profilometer.
| Materials and Methods|| |
This in vitro study was carried in Department of Paediatric Dentistry, National Dental College, DeraBassi, Mohali for 1 year with Metallurgy Department of PEC, Chandigarh.
Human molar, premolar teeth (20) collected from compromised periodontal conditions and those whose teeth were removed for orthodontic purpose were used. Crown portion were sectioned from root portion of each tooth using diamond disc through center of the tooth. Crown portion was then sectioned into two equal halves from center of tooth [Figure 1]. Enamel sections were then fixed firmly in acrylic blocks with enamel surface exposed [Figure 2]. Acrylic blocks were fabricated to grip the sample at time of surfometry. Abrasive papers of (Kemet International UK) fineness 600 grits to 1200 grits were used to smoothen enamel specimens. Polishing of samples were done using shofu diamond paste and super-snap buffs.
|Figure 1: (a) Crown portion is sectioned from root. (b) Crown portion is sectioned in two halves|
Click here to view
Whole specimen was covered with nail paint except a window of 3 mm × 5 mm dimension which was exposed on each enamel sample. Ph meter with electrode was used to measure pH of drink [Table 1]. Three readings were taken for each drink then their arithmetic mean is calculated as pH of drinks.
Readings of samples were taken at baseline and after the erosive\remineralizing challenge of each sample by Surfcom-130A manufactured in Tokyo (Japan) by Carls Zeiss.[Figure 3]
To measure the reading, tip of stylus of Profilometer runs transversally on each enamel surface of specimen. Three readings of each sample were taken, and the mean was noted as Baseline Ra values.
Enamel samples was divided into four groups
- Group I – 10 (COCA-COLA)
- Group II – 10 (FROOTI)
- Group III - 10 (COCO-COLA + CPP-ACP)
- Group IV - 10 (FROOTI + CPP-ACP)
Each drink were poured in separate air tight container (600 ml) labeled with each drink. Specimens were placed in the container and stored in 37°C for test period of 14 days. Of these four groups, all the specimen of Group III and Group IV were remineralized during the erosive challenge with GC-Tooth Mouse at 0, 8, 24, and 36 h. Fourteen days of erosive/remineralizing challenge were continued, and the beverages were replaced daily with new one. At the end of 14 days of erosive/remineralizing challenge, reading of each sample was taken using contact Profilometer and termed as postimmersion value.
| Results|| |
After erosive and remineralizing challenge, result obtained was tabulated from baseline to postimmersion as change in mean average surface roughness (μm) [Table 2].
The change in av surface roughness of all samples was statistically analyzed using One-way Anova, Bonferroni post-hoc test with 0.05% level of statistical significance, and Tukey honestly significant difference at alpha level of 0.05.
[Table 3] shows that when we compare the mean average surface roughness from baseline to after 14 days of erosive and remineralization challenge there is statistically significant change in mean average surface roughness.
|Table 3: Paired samples test - Comparing the (Ra) mean average surface roughness from baseline to postimmersion (μm)|
Click here to view
[Table 4] depicts comparison of all groups with each other. When Group I (COKE) was compared with Group III (COKE + CPP-ACP), there was statistically significant decrease surface roughness. Whereas, it was nonsignificant when Group II and Group IV were compared.
|Table 4: Intergroup comparison of change in average surface roughness (μm)|
Click here to view
[Table 5] shows three homogenous subsets obtained by applying Tukey HSD at alpha level of 0.05. [Table 5] shows homogenous subsets 1, Frooti + CPP + ACP (Group-IV) and FROOTI (Group-II) were least erosive whereas Homogenous subsets-3COKE (Group-I) was most erosive. In between these two subsets, homogenous subsets 2 were found. The subsets were not statistically significant among each other.
|Table 5: Homogeneous subset-Tukey honestly significant difference - Ranking of groups|
Click here to view
| Discussion|| |
As the life style evolved to western diet, there is considerate increase in the frequency of consumption of acidogenic food and drinks. Due to acidogenic diet, there is increase in risk of dental erosion, hence manufacturers nowadays are making products that decrease their effect on teeth. Tooth Mousse is a similar product that has been recently introduced in dental profession. The study suggests tooth mouse can prevent erosion of tooth enamel.
Profilometer uses direct profile of high resolution and high reproducibility, so they are widely used for the measurement of contours of enamel surface. Surfcom-130A uses a diamond stylus with a diameter of 5 μm, on which a force of 0.87 milli Newton is loaded. It is used to measure the irreversible loss of dental hard tissue. Measurements given by stylus are Ra, i.e., av. Surface roughness. Ra value measures av. Height of roughness component irregularities from a mean line within sampling length and is denoted in micron (μm). Smoother the value smoother the surface of sample.,
In our study we used the immersion protocol of 14 days (350 h) which is comparable with test period of 14 years of normal beverage consumption. This is a reasonable time span for assessing the effect of drinks in adolescents and young adults.
Increase in Ra values of Group-I and Group-II was due to the erosive effect of soft drinks as they contain phosphoric acid, citric acid and maleic acid that decreases the ph of oral cavity thus increases the decalcification, erosion of dental enamel. Ph of drinks range from 1.87 to 3.18, which is below the critical pH, at which enamel dissolution takes place.
Similar ph values were obtained for coke, lemonades, fermented milk by Seow et al. Margaret L Hunter.
Ra values were more for Group I (coke) when compared to Group II (Frooti) after erosive challenge. This reveals that Coca–Cola contains carbonic acid and phosphoric acid that leads to increase in decalcification, even when carbon-di-oxide has been blown off from the drinks. Other additional factors like saliva, buffer capacity also contribute to the same.
For the prevention of enamel dissolution topical fluorides like oral rinses, foams, varnishes, gel have been considered so far as it increases the resistance of enamel against acid attack., Calcium and phosphate are the recent materials which are used for these erosive challenges to enhance protective effect of fluorides.
In our study after remineralization by Tooth Mousse (Group III and Group IV) the changes in Ra values were significant for Group III (Coke + Tooth Mousse) when compared with Group I (coke) whereas the change in Ra values were nonsignificant for Group IV (Frooti + Tooth Mousse) when compared to other Group IV.
Acidic condition leads to separation of ACP from CPP leading to increase in phosphate and calcium ion activity, CPP-ACP stabilise their level in saliva and vice versa thus preventing precipitation of phosphate and calcium thus stabilize these compound in saliva.
Sule Bayarak et al. concluded in their study that fluoride varnish with CPP-ACP is most effective agent.
CPP-ACP help in preventing demineralization and facilitate remineralization of dental caries or Erosion by forming buffers free calcium and phosphate ion leading to stage of super saturation with respect to tooth enamel.
CPP-ACP acts as rich source of calcium and phosphate. It facilitates formation of crystal layer partially covering the prism and filling the intra prism space. Thus preventing acidic effect.,
Ceci et al. (2015) noted a significant difference when compared eroded enamel specimen with demineralized/remineralized specimen. They concluded there is significant reduction in surface roughness after application of CPP-ACP paste.
Zawaideh et al. concluded that application of remineralizing agents Pronamel and Tooth Mousse significantly reduce the softening of enamel by acid in permanent and primary teeth in an in situ study.
de Oliveira et al. concluded in an situ study carried out on 10 volunteers that there significant remineralization of eroded lesion after in-cooperation of CCP-ACP on sugar free gums.
Medem et al. compared CPP-ACP, 1.23% APF gel, artificial saliva in primary dentition. The treatment with these agents lead to reduction in erosion of enamel that is caused due to carbonated drinks on. APF gel was shown to most significant in reducing erosive loss.
CPPs prevent crystals from changing to a particular size and precipitating out of the solution by binding to calcium and phosphates in nanoparticles. The Amorphous calcium phosphate maintain super saturated state by releasing calcium and phosphate ion, thus enhancing remineralization process. Therefore, CPP-ACP can decrease demineralization and increase remineralization of tooth surfaces.
In the presence of biofilm the effect of CPP-ACP will be increased. Usually, under oral conditions, CPP act as calcium phosphate reservoirs. In the present study, we analyze the acidity of drinks with pH; however, few additional factors can also contribute to enamel erosion.
The study showed benefits of CPP-ACP for decreasing the harmful effects of cold drinks and beverages on tooth surfaces.
| Conclusion|| |
Regardless of drawbacks of in vitro study, the change in average surface roughness was the lowest in Group IV (FROOTI + CPP-ACP) followed by Group–II (FROOTI), Group – III (COKE + CPP-ACP) and the highest for Group-I (COKE). Thus, Coca Cola showed the highest erosive potential; however, application of CPP-ACP has great degree of protection against erosive drinks.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Lussi A. Dental erosion. Monogr Oral Sci 2006;20:1-8.
Imfeld T. Dental erosion. Definition, classification and links. Eur J Oral Sci 1996;104:151-5.
Järvinen VK, Rytömaa II, Heinonen OP. Risk factors in dental erosion. J Dent Res 1991;70:942-7.
Eccles JD, Jenkins WG. Dental erosion and diet. J Dent 1974;2:153-9.
Asher C, Read MJ. Early enamel erosion in children associated with the excessive consumption of citric acid. Br Dent J 1987;162:384-7.
Labour G. Winemakers, looks after those teeth! ANZ. Wine Ind J 2003;18:78-9.
Lussi A, Hellwig E. Risk assessment and preventive measures. Monogr Oral Sci 2006;20:190-9.
Piekarz C, Ranjitkar S, Hunt D, McIntyre J. An in vitro
assessment of the role of Tooth Mousse in preventing wine erosion. Aust Dent J 2008;53:22-5.
Reynolds EC. Remineralization of enamel subsurface lesions by casein phosphopeptide-stabilized calcium phosphate solutions. J Dent Res 1997;76:1587-95.
Rees J, Loyn T, Chadwick B. Pronamel and tooth mousse: An initial assessment of erosion prevention in vitro
. J Dent 2007;35:355-7.
Attin T, Koidl U, Buchalla W, Schaller HG, Kielbassa AM, Hellwig E. Correlation of microhardness and wear in differently eroded bovine dental enamel. Arch Oral Biol 1997;42:243-50.
Hooper S, West NX, Sharif N, Smith S, North M, De'Ath J, et al
. A comparison of enamel erosion by a new sports drink compared to two proprietary products: A controlled, crossover study in situ
. J Dent 2004;32:541-5.
West NX, Hughes JA, Parker DM, Newcombe RG, Addy M. Development and evaluation of a low erosive blackcurrant juice drink. 2. Comparison with a conventional blackcurrant juice drink and orange juice. J Dent 1999;27:341-4.
Von Fraunhofer J, Barnes A, Barnes D. Enamel dissolution in citric acid containing beverages. J Dent Res (Abstract); 2006.
Seow WK, Thong KM. Erosive effects of common beverages on extracted premolar teeth. Aust Dent J 2005;50:173-8.
Hunter ML, Patel R, Loyn T, Morgan MZ, Fairchild R, Rees JS. The effect of dilution on the in vitro
erosive potential of a range of dilutable fruit drinks. Int J Paediatr Dent 2008;18:251-5.
Tahmassebi JF, Duggal MS, Malik-Kotru G, Curzon ME. Soft drinks and dental health: A review of the current literature. J Dent 2006;34:2-11.
Meurman JH, Härkönen M, Näveri H, Koskinen J, Torkko H, Rytömaa I, et al
. Experimental sports drinks with minimal dental erosion effect. Scand J Dent Res 1990;98:120-8.
Vieira A, Ruben JL, Huysmans MC. Effect of titanium tetrafluoride, amine fluoride and fluoride varnish on enamel erosion in vitro
. Caries Res 2005;39:371-9.
Jensdottir T, Nauntofte B, Buchwald C, Bardow A. Effects of calcium on the erosive potential of acidic candies in saliva. Caries Res 2007;41:68-73.
Murantham P, Suchit P. The effect of casein phosphopeptide amorphous calcium phosphate and a cola soft drink on in vitro
enamel hardness. J Am Dent Assoc 2009;140:455-60.
Bayrak S, Tuloglu N, Bicer H, Sen Tunc E. Effect of fluoride varnish containing CPPACP on preventing enamel erosion. Scanning Volume 2017;Article ID 1897825:7.
Cochrane NJ, Shen P, Yuan Y, Reynolds EC. Ion release from calcium and fluoride containing dental varnishes. Aust Dent J 2014;59:100-5.
Poggio C, Lombardini M, Dagna A, Chiesa M, Bianchi S, “Protective effect on enamel demineralization of a CPP-ACP paste: An AFM in vitro
study,” Journal of Dentistry 2009;37:949-54.
Reynolds EC. Anticariogenic complexes of amorphous calcium phosphate stabilized by casein phosphopeptides: A review. Spec Care Dentist 1998;18:8-16.
Ceci M, Mirando M, Beltrami R, Chiesa M, Poggio C. Protective effect of casein phosphopeptideamorphous calcium phosphate on enamel erosion: Atomic force microscopy studies. Scanning 2015;37:327-34.
Zawaideh FI, Owais AI, Mushtaha S. Effect of CPP-ACP or a potassium nitrate sodium fluoride dentifrice on enamel erosion prevention. J Clin Pediatr Dent 2017;41:135-40.
de Oliveira AF, de Oliveira Diniz LV, Forte FD, Sampaio FC, Ccahuana-Vásquez RA, Tochukwu Amaechi B. In situ
effect of a CPP-ACP chewing gum on enamel erosion associated or not with abrasion. Clin Oral Investig 2017;21:339-46.
Maden EA, Acar O, Altun C, Polat GG. The Effect of Casein Phosphopeptide-Amorf Calcium Phosphate and Acidulated Phosphate Fluoride Gel on Dental Erosion in Primary Teeth: An in Vitro
Study. J Clin Pediatr Dent 2017;41:275-9.
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]