Remineralisation of teeth

Tooth remineralisation is a naturally occurring process in the oral cavity. It is defined as a process in which calcium and phosphate ions are sourced to promote ion deposition into crystal voids in demineralised enamel. Remineralisation remains imperative towards the management of non-cavitated carious lesions and prevention of disease progression within the oral cavity. The process also has the ability to contribute towards restoring strength and function within tooth structure.

Tooth demineralization is a chemical process by which minerals (mainly calcium) are removed from any of the hard tissues—enamel, dentine, and cementum. The process of demineralization begins at the crystal surface found inside the hard tooth tissue and may progress into cavitation unless arrested or overridden by remineralisation. The effect of demineralisation can be reversed if there is sufficient time to allow remineralisation to occur to counteract the acids in the oral cavity. Together, demineralisation and remineralisation contribute towards a dynamic process.

The initiation of the caries process is triggered by an increase in the acidity of bacterial plaque. The process of dental caries occurs when the acid-producing bacteria found in dental plaque on teeth feed on fermentable carbohydrates and produce organic acids as by-products. The acids diffuse into the tooth surface and dissolve the carbonated hydroxyapatite mineral that consecutively forms a carious lesion. When food or drinks containing sugars enter the mouth, the bacteria within the plaque rapidly convert the sugars into acid. The plaque can hold the acid in contact with the tooth surface for up to 2 hours before it is neutralised by saliva. During the time that the plaque is acidic, some of the calcium and phosphate minerals are dissolved out of the enamel into the plaque and once the plaque acid has been neutralised the minerals can return to the enamel surface. However the capacity for remineralisation is limited and if sugars enter the mouth too frequently a net loss of mineral from the enamel surface results in a cavity through which bacteria can penetrate and infect the inner structure of the tooth. Although a key feature of tooth decay is the increase of bacteria such as and Lactobacillus in dental plaque, it is not considered as an infectious disease.

Tooth decay can be managed by modifying behaviour and controlling its causative factors, i.e. reducing the intake frequency of fermentable carbohydrates from food. This will reduce the chance of the dental biofilm developing into cariogenic biofilm. The bacteria in cariogenic biofilm produce organic acids when carbohydrates, especially sugar, are eaten. When enough acid is produced so that the pH goes below 5.5, the acid dissolves carbonated hydroxyapatite, the main component of tooth enamel, in a process known as demineralisation. After the sugar is gone, the mineral loss can be recovered—or remineralised—from ions dissolved in the saliva. Cavities result when the rate of demineralisation exceeds the rate of remineralisation and the latticework is destroyed, typically in a process that requires many months or years.

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