While watching a recent showing of the Wizard of Oz, I couldn’t help identifying with Dorothy’s plight. Just like Dorothy, a young teenager from a United States Kansas farm who daydreams about going over the rainbow only to realise she wants to go home, I, as a dental professional, constantly search for solutions to provide for my patients the best treatment possible only to recognise that the real value starts with me.
But how do we as dental healthcare providers effectively negotiate the myriad of messages to select products that are best for our patients? It can seem overwhelming at times with so many marketing campaigns and “glitz”.
We, as professionals, occasionally take the path of least resistance and stay in a normal routine rather than investigating new technologies that can benefit our patients. If we open ourselves to new resources, we gain more than knowledge during our quest; we gain colleagues and refine our critical thinking. Enlisting my dealer representative was valuable to me; she is reputable and provides me with an assortment of choices and shares my
concern for qualifying a product. For instance, remineralisation is the new buzz word and there is a tornado of new products available to the market.
Of all the technologies aimed at enhancing tooth remineralisation, fluoride remains the most widely used and thoroughly studied drug for the treatment of tooth decay. Some examples of calcium containing technologies aimed at providing remineralisation benefits include amorphous calcium phosphate and tricalcium phosphate.
Research has shown that the rate of remineralisation of enamel increases with the quantity of calcium and phosphate ions in a solution. The role of loosely-bound fluoride (calcium fluoride) found concentrated in plaque and saliva can supplement the demineralised tooth structure by providing an improved enamel crystal structure through the formation of acidresistant, fluoride-rich hydroxyapatite (fluorapatite). This form of incorporated fluoride ion is known as firmly-bound fluoride.
Amorphous calcium phosphate (ACP) was discovered by ADA Foundation Paffenbarger Research Center chemist and researcher, Ming S Tung in 1991. Amorphous calcium phosphate is a non-fluoride therapy that remineralises enamel and dentin. The most reactive and soluble calcium phosphate compound, ACP forms on the tooth enamel within the
dentin and dentinal tubules and also provides a reservoir of remineralising ions in the saliva. The ACP-forming ingredients also strengthen teeth by acting synergistically to promote more fluoride uptake into the tooth structure
as compared to similar fluoride products without ACP.
Tri-calcium phosphate (TCP) formula is developed through a manufacturing process of mechanochemical ball milling of tri-calcium phosphate with fumaric acid. This barrier inhibits the calcium from attaching to the fluoride ions. The barrier eventually will break down on the tooth surface and allow the calcium to be readily available.
Upon being applied to the tooth surfaces, both five per cent NaF varnish with ACP and five per cent NaF varnish with TCP dissolve and release fluoride, calcium and phosphorus ions into the saliva and on the tooth surface. As with any fluoride-containing product, these ions will migrate, transfer and move around to lesioned enamel. This
wrap-around benefit is not isolated to one technology or manufacturer but is available to all varnishes containing
22,600ppm of sodium fluoride. The level of availability and fluoride uptake is worth noting and considering.
Research is ongoing regarding multi-remineralisation technologies. Remineralisation therapy is an important factor in the reduction and reversal of caries’ damage or dentinal sensitivity. Teeth can heal if they have the correct balance of healing components. Fluoride products containing calcium technology may be superior to those which only contain fluoride. In addition, certain calcium technologies may be more appropriate than others for specific needs.
Just as Dorothy had always possessed the power to take herself home and could not rely on the wizard, we should not rely on pure market-speak to make our decisions. Educate yourself on all of the available technologies, determine why you are really using the product and how it best fits into your patients’ needs; perhaps a combination of therapies may best suit your patients.
References available on request.