Frontiers of Global Research Trend on Root Caries: A Bibliometric Analysis.

OBJECTIVE: This study aimed to examine the global research trend and frontiers in the field of root caries. METHODS: Two independent investigators searched the Web of Science Core Collection to include journal articles published on root caries from 1994 to 2023. They examined citation trends of the selected publications and performed bibliometric analysis using VOSviewer. Cooccurrence and cocitation analysis were used to calculate the burst strength of the most cited keywords and the most cited publications. RESULTS: This study included 1144 publications (1004 scientific research articles and 140 review articles) for bibliometric analysis. The number of publications from 2018 to 2023 was 404, accounting for 35% (404/1144) over the last 30 years. The annual citation count showed a gradual upward trend with a surge from 2018. The cooccurrence analysis classified the publications into four clusters which were in vitro studies, prevention, microbiology, and epidemiology. Cocitation analysis revealed silver diamine fluoride, systematic review, and randomized clinical trial were the three main keywords; and their citation burst strength (period) were 17.2 (2017-2023), 9.4 (2015-2023), and 6.9 (2018-2023), respectively. Noninvasive treatment of root caries (narrative review), aetiology of root caries (narrative review), and use of silver diamine fluoride in arresting root caries (clinical trial) were the topics (publication type) of the three most cited publications; and their burst strength (period) were 8.9 (2017-2020), 5.9 (2017-2021), and 4.7 (2015-2018), respectively. CONCLUSION: This study highlights the recent growing research interest in root caries, particularly on its microbiology, prevention, and the use of silver diamine fluoride.

Erosive effects of commercially available alcoholic beverages on enamel.

This study aimed to investigate the effects of four alcoholic beverages on enamel erosion. Fifty enamel specimens were randomly allocated into the following five groups (n=10): group 1, water as negative control; group 2, red wine; group 3, white wine; group 4, distilled spirit; and group 5, beer. The specimens were immersed in the respective solution for a 16 h demineralization, followed by an 8 h remineralization in artificial saliva. Cyclic de- and re-mineralization were performed for 8 days. Surface roughness, microhardness and morphology of the enamel specimens were studied after the cycling. The results were analyzed by One-way ANOVA and Dunnett's post-hoc test (p<0.05). All investigated beverages showed an erosive effect on enamel. White wine had the highest erosive potential whereas distilled spirit had the least.

Cleaved SPP1-rich extracellular vesicles from osteoclasts promote bone regeneration via TGFß1/SMAD3 signaling.

Bone remodeling is a tightly coupled process between bone forming osteoblasts (OBs) and bone resorbing osteoclasts (OCs) to maintain bone architecture and systemic mineral homeostasis throughout life. However, the mechanisms responsible for the coupling between OCs and OBs have not been fully elucidated. Herein, we first validate that secreted extracellular vesicles by osteoclasts (OC-EVs) promote osteogenic differentiation of mesenchymal stem cells (MSCs) and further demonstrate the efficacy of osteoclasts and their secreted EVs in treating tibial bone defects. Furthermore, we show that OC-EVs contain several osteogenesis-promoting proteins as cargo. By employing proteomic and functional analysis, we reveal that mature osteoclasts secrete thrombin cleaved phosphoprotein 1 (SPP1) through extracellular vesicles which triggers MSCs osteogenic differentiation into OBs by activating Transforming Growth Factor ß1 (TGFß1) and Smad family member 3 (SMAD3) signaling. In conclusion, our findings prove an important role of SPP1, present as cargo in OC-derived EVs, in signaling to MSCs and driving their differentiation into OBs. This biological mechanism implies a paradigm shift regarding the role of osteoclasts and their signaling toward the treatment of skeletal disorders which require bone formation.

Effects of a 445 nm diode laser and silver diamine fluoride in preventing enamel demineralisation and inhibiting cariogenic bacteria.

OBJECTIVE: To study the effects of a 445 nm diode laser (L) and silver diamine fluoride (F) on preventing enamel demineralisation and inhibiting cariogenic bacteria. METHODS: Thirty-three enamel slices were sectioned each into four blocks for four groups to receive L with F (LF), F, L and Water (W, control). Ten blocks from each group were used to evaluate demineralisation. Surface morphology, lesion depth and nanohardness of the blocks after pH-cycling were studied by scanning electron microscopy (SEM), nanohardness test, and micro-computed tomography, respectively. Twenty-three blocks per group were used for biofilm assessment. Morphology, viability, and growth kinetics of the Streptococcus mutans biofilm were assessed by SEM, confocal laser scanning microscopy, and the counting of colony-forming units (CFUs), respectively. RESULTS: SEM images of LF-treated enamel showed an intact surface compared with other groups. Nanohardness (GPa) for LF, F, L and W were 1.43±0.17, 1.01±0.11, 1.04±0.13 and 0.73±0.14, respectively (p < 0.001; LF>F, L>W). Their lesion depths (µm) were 46±8, 52±6, 88±13 and 111±9, respectively (p < 0.001; LF, F<L<W). SEM showed few bacteria for LF and F compared with other groups. Their dead-live ratio were 1.67±0.13, 1.60±0.15, 0.39±0.05 and 0.32±0.05, respectively (p < 0.001; LF, F>L>W). Log CFUs for LF, F, L and W were 4.2±0.3, 4.5±0.2, 7.9±0.3 and 9.4±0.2, respectively (p < 0.05; LF<F<L<W). Two-way ANOVA analysis revealed an interaction effect on nanohardness and Log CFUs between the laser irradiation and SDF treatment (p < 0.001). CONCLUSION: This study showed a superior caries preventive effect of a combined treatment of the diode laser and SDF. Because diode laser and SDF are affordable and readily available, clinicians can provide this treatment to their patients for caries prevention. CLINICAL SIGNIFICANCE STATEMENT: Diode lasers are handy, afforable and readily avaliable to clinicians. This study provides information of use of 445 nm diode laser for caries prevetion. The laser irradiation hopefully can be added before conventional topical SDF application.

Effect of Strontium-Doped Bioactive Glass on Preventing Formation of Demineralized Lesion.

This study investigated the effect of strontium-doped bioactive glass (SBAG) on the formation of dental demineralized lesions. MATERIALS AND METHODS: The study materials were 48 sound human tooth specimens with both dentine and enamel, divided equally into four groups: Group 1 (SBAG), Group 2 (SBAG+Fluoride), Group 3 (Fluoride), and Group 4 (Water as control). After 14 days of pH cycling, the surface morphology of the specimens was observed by scanning electron microscopy. Crystal characteristics of the precipitates were assessed by X-ray diffraction (XRD). Micro-CT was used to measure the mineral loss and the depths of the demineralized lesions formed. RESULTS: Exposure of collagen in inter-tubular areas in dentine was seen in the control group (Group 4) but not in Groups 1 to 3. In Group 2, there were obvious granular particles on the surface of the dentine. XRD revealed precipitation of apatites on the surface of the tooth specimens in Groups 1 to 3. The mean lesion depths in dentine were 81.80 µm, 30.68 µm, 39.04 µm, and 146.36 µm in Groups 1 to 4, respectively (p < 0.001). Lesions in enamel were only found in the control group. The mean mineral loss values in the dentine lesions were 1.25 g/cm3, 0.88 g/cm3, 0.87 g/cm3, and 1.65 g/cm3, in Groups 1 to 4, respectively (p < 0.001). CONCLUSION: Strontium-doped bioactive glass has a preventive effect on the formation of demineralized lesions in enamel and dentine.

Effects of 9,300 nm Carbon Dioxide Laser on Dental Hard Tissue: A Concise Review.

A carbon dioxide laser at 9,300 nm has a high absorption affinity for water and a shallow depth of penetration. It can be used for soft tissue surgery and hemostasis. Besides, it matches well with the absorption characteristic of hydroxyapatite in enamel and dentine. Therefore, the laser possesses a great ability for energy transfer to dental hard tissues. It has a low risk of thermo-damage to the dentine-pulp complex because it has a shallow depth of heat absorption. Hence, the laser is safe for dental hard tissue preparation. A carbon dioxide laser at 9,300 nm can effectively alter the chemical structure of teeth. It increases the ratio of calcium to phosphorus and converts the carbonated hydroxyapatite to the purer hydroxyapatite of enamel and dentine. It can alter the surface morphology of a tooth through surface melting, fusion, and ablation of dentine and enamel. At higher power, it removes caries lesions. It can enhance the success of restoration by increasing the bond strength of dental adhesives to the dentine and enamel. A carbon dioxide laser at 9,300 nm can also be used with fluoride for caries prevention. The advancement of technology allows the laser to be delivered in very short pulse durations and high repetition rates (frequency). Consequently, the laser can now be used with high peak power. The objective of this review is to discuss the effects and potential use of a 9,300 nm carbon dioxide laser on dental hard tissue.

Use of a novel 9.3-µm carbon dioxide laser and silver diamine fluoride: Prevention of enamel demineralisation and inhibition of cariogenic bacteria.

OBJECTIVE: To investigate the effects of a 9.3-µm carbon dioxide (CO2) laser and silver diamine fluoride (SDF) on the prevention of enamel demineralisation and inhibition of cariogenic bacteria. METHODS: Enamel blocks were applied with Laser (Group-1), SDF (Group-2), Laser + SDF (Group-3) and no treatment (Group-4), and then subjected to an 8-day pH-cycling for cariogenic challenge. Lesion depth and cross-sectional micro-hardness were assessed. Surface morphological and chemical changes were studied using scanning electron microscope (SEM) with energy dispersive spectroscopy (EDS). For the antibacterial activity, treated enamel blocks were incubated with Streptococcus mutans. The biofilm morphology, kinetics and viability were assessed by SEM, colony-forming units (CFUs) and confocal laser scanning microscope (CLSM), respectively. RESULTS: Lesion depths (µm) for Group-1 to Group-4 were 88 ± 21, 26 ± 11, 13 ± 9 and 115 ± 25, respectively (p < 0.001; Group-2 and Group-3 < Group-1 < Group-4). Group-3 had a significantly higher cross-sectional micro-hardness than the other three groups. EDS determined that Group-4 had the lowest calcium-to-phosphorus molar ratio among the groups (p < 0.001). SEM images showed apparent bacteria accumulation on enamel surfaces in Group-4, but not in other groups. Log CFUs for Group-1 to Group-4 were 6.2 ± 0.6, 2.9 ± 0.8, 2.2 ± 1.1 and 7.3 ± 0.3, respectively (p < 0.001; Group-2 and Group-3 < Group-1 < Group-4). CLSM images revealed that live bacteria dominated in Group-4, but not in other groups. SIGNIFICANCE: The irradiation with a 9.3-µm CO2 laser alone can prevent the demineralisation of enamel and reduce the adhesion of cariogenic bacteria. Moreover, adding SDF can significantly increase the preventive effect and antibacterial ability.

Preventing Enamel Caries Using Carbon Dioxide Laser and Silver Diamine Fluoride.

Objective: This study was intended to investigate the caries prevention potential of carbon dioxide (CO2) laser (λ = 10,600 nm) irradiation followed by application of silver diamine fluoride (SDF) to enamel. Materials and methods: Human enamel specimens were randomly allocated to four groups (n = 10 per group). Group 1 specimens were treated with SDF; Group 2 specimens were treated with a CO2 laser; Group 3 specimens were irradiated with a CO2 laser then treated with SDF, and Group 4 specimens received no treatment. All specimens were subjected to pH cycling for cariogenic challenge. Lesion depth, microhardness, surface morphology, and elemental analysis were assessed. Results: The lesion depths for Groups 1-4 were 33 ± 16, 80 ± 9, 18 ± 15, and 102 ± 9 µm, respectively (p < 0.001; Group 3 < Group 1 < Group 2 < Group 4). Knoop hardness values for Groups 1-4 were 61 ± 19, 68 ± 20, 78 ± 27, and 36 ± 8, respectively (p = 0.002; Group 4 < Groups 1, 2, and 3). The enamel in Group 4 but not in the other groups showed a roughened surface resembling an acid-etched pattern. Calcium-to-phosphorus molar ratios of Groups 1-4 were 1.68 ± 60.09, 1.61 ± 0.06, 1.69 ± 0.10, and 1.49 ± 0.10, respectively (p < 0.001; Group 4 < Groups 1, 2, and 3). Conclusions: Using the CO2 laser or SDF separately enhanced the resistance of enamel to cariogenic challenge. Moreover, there was an additional effect of the combined use of the CO2 laser and SDF for preventing enamel demineralization.

Layer-by-layer self-assembly polyelectrolytes loaded with cyclic adenosine monophosphate enhances the osteo/odontogenic differentiation of stem cells from apical papilla.

Cyclic adenosine monophosphate (cAMP) is a second messenger involved in the dental regeneration. However, efficient long-lasting delivery of cAMP that is sufficient to mimic the in vivo microenvironment remains a major challenge. Here, cAMP was loaded in stem cells from apical papilla (SCAPs) using layer-by-layer self-assembly with gelatin and alginate polyelectrolytes (LBL-cAMP-SCAPs). LBL-cAMP-SCAPs expressed cAMP and increased the phosphorylation level of cAMP-response element-binding protein (CREB) which were evaluated by immunofluorescence and western blotting (WB). Enzyme-linked immunosorbent assay (ELISA) demonstrated that a sustained release of cAMP and vascular endothelial growth factor (VEGF) were present up to 14 days. Scanning electron microscopy (SEM) found LBL-coated SCAPs exhibited a spheroid-like morphology. CCK8 and live/dead staining showed that LBL treatment had no significant effect on cell proliferation and viability. LBL-cAMP-SCAPs enhanced mineralized nodule formation and up-regulated the mRNA levels of the osteogenesis-related genes, as well as related transcription factor-2 protein level which were revealed by Alizarin red staining, RT-PCR and WB, respectively. In conclusion, LBL self-assembly loaded with cAMP promoted the osteo/odontogenic differentiation of SCAPs, thereby providing a potential strategy for bioactive molecular delivery in dental regeneration.

Inhibition of dentine caries using fluoride solution with silver nanoparticles: An in vitro study.

OBJECTIVES: To investigate the remineralising and staining effects of sodium fluoride (NaF) with silver nanoparticles (AgNPs) on artificial dentine caries. METHODS: Human dentine blocks with artificial caries were divided into four groups. Group 1 received 5 % NaF (22,600 ppm fluoride) with 4000 ppm AgNPs; group 2 received 4000 ppm AgNPs; group 3 received 5 % NaF, group 4 received deionised water (negative control). All groups underwent three biochemical cycles. Each cycle included Streptococcus mutans biofilm challenge and remineralisation process. The lesion depth, mineral-organic content, surface morphology and crystal characteristics of dentine blocks were evaluated using micro-computed tomography, Fourier transform infrared spectroscopy, scanning electron microscopy (SEM) and X-ray diffraction. Colour change of dentine blocks was assessed using spectrophotometry. RESULTS: The mean lesion depths of groups 1-4 were 151.13 ± 29.13 µm, 172.38 ± 23.44 µm, 190.41 ± 32.81 µm and 221.24 ± 27.91 µm, respectively. The hydrogen phosphate-to-amide I ratios of groups 1-4 were 5.98 ± 0.36, 3.86 ± 0.56, 4.00 ± 0.67 and 2.53 ± 0.40, respectively. There was no significant interaction effect between AgNPs and NaF. SEM showed less exposure of dentine collagen fibres in group 1 when compared to other groups. X-ray diffraction revealed presence of silver chloride and metallic silver in group 1 and 2. There was no significant difference in colour change among the four groups (p = 0.74). CONCLUSIONS: NaF solution with AgNPs can remineralise dentine caries without staining. CLINICAL SIGNIFICANCE: Sodium fluoride solutions that include silver nanoparticles have potential uses in the management of caries.

Use of Silver Nanomaterials for Caries Prevention: A Concise Review.

OBJECTIVE: The aim of this concise review is to summarize the use of silver nanomaterials for caries prevention. METHODS: Two researchers independently performed a literature search of publications in English using Embase, Medline, PubMed, and Scopus databases. The keywords used were (silver nanoparticles OR AgNPs OR nano silver OR nano-silver) AND (caries OR tooth decay OR remineralisation OR remineralization). They screened the title and abstract to identify potentially eligible publications. They then retrieved the full texts of the identified publications to select original research reporting silver nanomaterials for caries prevention. RESULTS: The search identified 376 publications, and 66 articles were included in this study. The silver nanomaterials studied were categorized as resin with silver nanoparticles (n=31), silver nanoparticles (n=21), glass ionomer cement with silver nanoparticles (n=7), and nano silver fluoride (n=7). Most (59/66, 89%) studies investigated the antibacterial properties, and they all found that silver nanomaterials inhibited the adhesion and growth of cariogenic bacteria, mainly Streptococcus mutans. Although silver nanomaterials were used as anti-caries agents, only 11 (11/66, 17%) studies reported the effects of nanomaterials on the mineral content of teeth. Eight of them are laboratory studies, and they found that silver nanomaterials prevented the demineralization of enamel and dentin under an acid or cariogenic biofilm challenge. The remaining three are clinical trials that reported that silver nanomaterials prevented and arrested caries in children. CONCLUSION: Silver nanoparticles have been used alone or with resin, glass ionomer, or fluoride for caries prevention. Silver nanomaterials inhibit the adhesion and growth of cariogenic bacteria. They also impede the demineralization of enamel and dentin.

Synthesis and Characterization of Fluoridated Silver Nanoparticles and Their Potential as a Non-Staining Anti-Caries Agent.

OBJECTIVES: The first objective of this study was to prepare sodium fluoride (NaF) solution with various concentrations of polyethylene glycol-coated silver nanoparticles (PEG-AgNPs). The second objective was to study the antibacterial activity against Streptococcus mutans and the tooth-staining effect of the solution. METHODS: PEG-AgNPs were prepared via the one-step chemical reduction of silver acetate with thiolated polyethylene glycol. The PEG-AgNPs were characterized with ultraviolet-visible spectrometry and transmission electron microscopy. The half maximal inhibitory concentration (IC50) for the PEG-AgNPs against Streptococcus mutans and human gingival fibroblasts (HGF-1) were determined. The staining effect on dentin and enamel for the 2.5% NaF solutions with PEG-AgNPs at 12,800, 6400, 1600, and 400 ppm was investigated using digital spectrophotometry. The IC50 of the fluoridated silver nanoparticles against Streptococcus mutans were measured. RESULTS: The PEG-AgNPs have an average diameter of 2.56±0.43 nm and showed excellent stability at high ionic strength (2.5% NaF) for 18 months. The IC50 of PEG-AgNPs against Streptococcus mutans was found to be 21.16±1.08 ppm silver, which was half of IC50 against HGF-1 cells (42.36±1.12 ppm), providing a working range to kill bacteria with no harm to human cells. The formulations with different concentrations of PEG-AgNPs showed no significant staining of teeth. Combining PEG-AgNPs with NaF significantly expanded the therapeutic window against Streptococcus mutans by reducing its IC50. CONCLUSION: A biocompatible solution of NaF with PEG-AgNPs was developed. Because it has antibacterial activity against Streptococcus mutans and no tooth-staining effect, it can be used as an anti-caries agent.

The Antibacterial Mechanism of Silver Nanoparticles and Its Application in Dentistry.

Nanotechnology has recently emerged as a rapidly growing field with numerous biomedical science applications. At the same time, silver has been adopted as an antimicrobial material and disinfectant that is relatively free of adverse effects. Silver nanoparticles possess a broad spectrum of antibacterial, antifungal and antiviral properties. Silver nanoparticles have the ability to penetrate bacterial cell walls, changing the structure of cell membranes and even resulting in cell death. Their efficacy is due not only to their nanoscale size but also to their large ratio of surface area to volume. They can increase the permeability of cell membranes, produce reactive oxygen species, and interrupt replication of deoxyribonucleic acid by releasing silver ions. Researchers have studied silver nanoparticles as antimicrobial agents in dentistry. For instance, silver nanoparticles can be incorporated into acrylic resins for fabrication of removable dentures in prosthetic treatment, composite resin in restorative treatment, irrigating solution and obturation material in endodontic treatment, adhesive materials in orthodontic treatment, membrane for guided tissue regeneration in periodontal treatment, and titanium coating in dental implant treatment. Although not all authorities have acknowledged the safety of silver nanoparticles, no systemic toxicity of ingested silver nanoparticles has been reported. A broad concern is their potential hazard if they are released into the environment. However, the interaction of nanoparticles with toxic materials and organic compounds can either increase or reduce their toxicity. This paper provides an overview of the antibacterial use of silver nanoparticles in dentistry, highlighting their antibacterial mechanism, potential applications and safety in clinical treatment.

Remineralising Dentine Caries Using Sodium Fluoride with Silver Nanoparticles: An In Vitro Study.

OBJECTIVE: To investigate the remineralizing and staining effects of sodium fluoride (NaF) solution with polyethylene glycol-coated silver nanoparticles (PEG-AgNPs) on artificial dentine caries. MATERIALS AND METHODS: Demineralized human dentine blocks were allocated to three groups. The blocks in group 1 underwent a topical application of a 12% silver diamine fluoride (SDF, 14,150 ppm fluoride) solution. The blocks in group 2 received a topical application of a 2.5% NaF (11,310 ppm fluoride) with PEG-AgNPs (400 ppm silver). The blocks in group 3 received deionized water. All blocks were subjected to pH cycling for 8 days. The surface morphology and cross-sectional features were investigated using scanning electron microscopy (SEM). The color parameters, crystal characteristics, lesion depth, and collagen degradation of the blocks were assessed using digital spectrophotometry, X-ray diffraction (XRD), micro-computed tomography, and spectrophotometry with a hydroxyproline assay, respectively. RESULTS: The SEM showed that dentine collagen was exposed in group 3 but not in groups 1 and 2. The mean lesion depths in groups 1 to 3 were 118±7 µm, 121±14 µm, and 339±20 µm, respectively (groups1,2<3; p<0.001). The data indicated that fluoridated PEG-AgNPs introduced no significant color effect on dentine, but SDF caused distinct discoloration. The XRD indicated that silver chloride was formed in group 1, and fluorapatite was detected in groups 1 and 2. The concentration of hydroxyproline liberated from collagen was significantly less in groups 1 and 2 than in group 3. CONCLUSION: The use of NaF solution with PEG-AgNPs can remineralize artificial dentine caries and inhibit collagen degradation without causing significant tooth staining.

Caries Prevention Effects of Silver Diamine Fluoride with 10,600 nm Carbon Dioxide Laser Irradiation on Dentin.

Objective: To investigate the caries prevention effect of silver diamine fluoride (SDF) with a carbon dioxide (CO2) laser (λ = 10,600 nm) on dentin. Method: Human dentin slices (n = 10) were prepared and allocated to the following treatments: Group 1 (SDF)-slices received an SDF application. Group 2 (laser)-slices were irradiated with a CO2 laser. Group 3 (laser + SDF)-slices were irradiated with a CO2 laser, followed by an SDF application. Group 4 (negative control)-slices had no treatment. All of the slices were subjected to pH cycling for cariogenic challenge. Lesion depth, nanohardness, and chemical and morphological changes were assessed by microcomputed tomography (micro-CT), nanoindentation, and scanning electron microscopy (SEM) with energy dispersive X-ray spectroscopy (EDS), respectively. Results: micro-CT determined lesion depths for groups 1-4 were 27 ± 6, 138 ± 32, 17 ± 5, and 182 ± 49 µm, respectively (p < 0.001; group 3 < group 1 < groups 2 and 4). The nanohardness values for groups 1-4 were 456 ± 109, 288 ± 5, 444 ± 142, and 258 ± 76 MPa, respectively (p = 0.003; groups 2 and 4 < groups 1 and 3). EDS determined that the calcium-to-phosphorus molar ratio for groups 1-4 were 1.26 ± 0.12, 1.07 ± 0.19, 1.37 ± 0.08, and 0.80 ± 0.17, respectively (p < 0.001; group 4 < group 2 < groups 1 and 3). SEM evidenced no ablation or cracking on the lased dentin surfaces. The treated dentin showed a relatively more intact and smoother surface morphology compared with the untreated dentin. Conclusions: SDF can reduce dentin demineralization against cariogenic challenge, and the caries preventive effect of SDF is further enhanced through CO2 laser irradiation.

Effects of 10,600 nm Carbon Dioxide Laser on Remineralizing Caries: A Literature Review.

Objective: To study the effects of carbon dioxide (CO2) lasers (λ = 10,600 nm) on remineralizing dental caries. Methods: This study involved performing a systematic search of English articles archived in the PubMed, Scopus, and Web of Science databases. The keywords used to identify the relevant articles were ((CO2 laser) OR (carbon dioxide laser)) AND ((dental caries) OR (tooth remineralization)). Publications before 2019 were selected. The titles and abstracts of the initially identified articles were screened. Duplicate records, reviews, and irrelevant studies were removed. Full texts were retrieved for publications that studied the effects of CO2 lasers on remineralizing dental caries. Results: The search identified 543 potentially relevant publications. A total of 285 duplicate records were removed. Sixteen articles were included in this review. Four studies reported that CO2 lasers inhibited bacterial growth. The growth of cariogenic bacteria, mainly Streptococcus mutans, on an irradiated tooth surface was slower compared with nonirradiated ones. Four studies investigated the reduction of the demineralization of enamel with cariogenic challenge. They found that CO2 lasers reduced the carbonate content of mineralized tissues and increased the microhardness of enamel. Nine studies used CO2 lasers associated with topical fluorides in remineralizing dental caries. The results of the synergistic effect of laser irradiation and fluoride application with regard to the inhibition of caries progression varied among these studies, whereas laser irradiation could enhance fluoride uptake to demineralized mineral tissues. Conclusions: CO2 laser irradiation increased acid resistance and facilitated the fluoride uptake of caries-like lesions. In addition, it reduced the growth of cariogenic bacteria.

Developing biocompatible silver nanoparticles using epigallocatechin gallate for dental use.

OBJECTIVE: To develop silver nanoparticles (AgNPs) using epigallocatechin gallate (EGCG) and evaluate its biocompatibility and inhibition effect on Streptococcus mutans biofilm growth. DESIGN: AgNPs were synthesized using EGCG as a reducing agent. Cytotoxicity was assessed using half-maximal inhibitory concentration (IC50) against human gingival fibroblast (HGF-1) and stem cells from human exfoliated deciduous teeth (SHED). Antibacterial properties were evaluated with minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) against S. mutans. Dentine blocks were treated with AgNPs, silver nitrate (AgNO3), or water before being incubated with S. mutans. The kinetics, morphology and viability of the biofilm at different time points were assessed by colony-forming units (CFUs), scanning electron microscopy (SEM), and confocal laser scanning microscopy (CLSM), respectively. Lactic acid and polysaccharide production of the biofilm were also investigated. RESULTS: Spherical AgNPs with diameter 17 ± 7 nm were developed. The IC50 of AgNPs and AgNO3 against HGF-1 were 44.88 ± 11.39 µg/mL and 11.53 ± 6.96 µg/mL, respectively (p < 0.001), whereas those against SHED were 68.02 ± 24.48 µg/mL and 9.54 ± 6.63 µg/mL, respectively (p = 0.02). The MIC of AgNPs and AgNO3 were 32.22 ± 7.34 µg/mL and 48.89 ± 15.11 µg/mL, respectively (p = 0.01), whereas their MBC was 63.33 ± 11.73 µg/mL and 85.00 ± 20.77 µg/mL, respectively (p = 0.02). Log CFUs of the AgNPs group were the lowest among the groups (p < 0.001). SEM and CLSM found a confluent biofilm in AgNO3 and water groups but not in AgNPs group. Biofilms in AgNPs group was revealed with lowest level of acidic acid and polysaccharides production (p < 0.001). CONCLUSION: This study developed biocompatible AgNPs which inhibited the growth of a cariogenic biofilm.

Effect of silver diamine fluoride and potassium iodide on shear bond strength of glass ionomer cements to caries-affected dentine.

OBJECTIVE: To investigate the effect of silver diamine fluoride (SDF) and potassium iodide (KI) treatment on dentine discolouration and the shear bond strength (SBS) of glass ionomer cements (GICs) to artificial caries-affected dentine. MATERIALS AND METHODS: Dentine slices from human molars were demineralised to mimic caries-affected dentine. They were randomly allocated for treatment (n = 20 per treatment) with SDF + KI, SDF (positive control) or water (negative control). All slices were immersed in the artificial saliva for 24 hours after treatments. The colour of the treated surfaces was assessed using the CIELAB system. Lightness values were measured. Total colour change (∆E) was calculated using water as the reference group, and was visible to the naked eyes if ∆E > 3.7. All dentine slices were bonded with GICs. The SBS was assessed using a universal testing machine. Colour parameters and the SBS were analysed using a one-way ANOVA test. RESULTS: The slices treated with SDF + KI had a higher lightness value those slices treated with water, whereas those treated with SDF presented a lower lightness value compared with those treated with water. The treatment with SDF + KI did not introduce any adverse colour effect to demineralised dentine (∆E = 14.4), whereas the application of SDF alone caused significant staining (∆E = 24.6). The SBS values (mean ±â€…SD) after treatment with SDF + KI, SDF and water were 3.0 ±â€…1.4 MPa, 2.3 ±â€…0.9 MPa and 2.6 ±â€…1.1 MPa, respectively (P = 0.217). CONCLUSION: The immediate application of KI solution after SDF treatment does not negatively affect adhesion of GICs to artificial caries-affected dentine. Moreover, KI treatment can reduce discolouration of demineralised dentine caused by SDF.

Remineralisation of enamel with silver diamine fluoride and sodium fluoride.

OBJECTIVE: To evaluate the remineralising effect of the adjunctive application of 38% silver diamine fluoride (SDF) solution and 5% sodium fluoride (NaF) varnish on artificial enamel caries lesions. METHODS: Forty-eight demineralised enamel specimens were allocated into four groups. Group 1 received 38% SDF and 5% NaF; Group 2 received 38% SDF; Group 3 received 5% NaF; and Group 4 received deionized water. After pH cycling, the surface morphology and fluoride content of the specimens were studied via scanning electron microscopy (SEM)/energy dispersive spectroscopy (EDS). The lesion depth and crystal characteristics were assessed using micro-computed tomography and X-ray diffraction (XRD) respectively. The crystallization reaction was performed by incubating hydroxyapatite powder with NaF or SDF for 48h. The precipitates were studied via transmission electron microscopy (TEM) and X-ray photoelectron spectroscopy (XPS). RESULTS: SEM demonstrated the destruction of the enamel surface in Group 4. EDS revealed that the mean fluoride weight percentage of Groups 1-4 were 1.28±0.15, 1.33±0.19, 1.03±0.09 and 0.87±0.04 respectively. The mean lesion depths of Groups 1-4 were 129±14µm, 131±16µm, 153±10µm and 181±21µm respectively. The addition of NaF to SDF did not reduce the lesion depths (p=0.779). XRD revealed that silver chloride formed as a main product in Groups 1 and 2. Meanwhile, TEM analysis indicated that silver nanoparticles were incorporated into hydroxyapatite crystal in SDF-treated hydroxyapatite. XPS spectra suggested that the chemical state of the silver was metallic. SIGNIFICANCE: The adjunctive application of SDF and NaF varnish had a similar remineralising effect to that of SDF on enamel caries.

Effect of Silver Nitrate and Sodium Fluoride with Tri-Calcium Phosphate on Streptococcus mutans and Demineralised Dentine.

This study investigated the effect of 25% silver nitrate (AgNO3) and 5% sodium fluoride (NaF) varnish with functionalized tri-calcium phosphate (fTCP) on a Streptococcus mutans (S. mutans) biofilm and dentine caries lesion. Demineralised dentine specimens were treated with 25% AgNO3 and 5% NaF + fTCP (Group 1), 25% AgNO3 and 5% NaF (Group 2), 25% AgNO3 (Group 3), or water (Group 4). The specimens were subjected to a S. mutans biofilm challenge after treatment. The biofilm was then studied via scanning electron microscopy (SEM), confocal laser scanning microscopy (CLSM), and colony forming units (CFU). The specimens were assessed by micro-computed tomography, X-ray diffraction (XRD), and Fourier transform infrared spectroscopy (FTIR). SEM and CLSM revealed less biofilm in Groups 1 to 3. The log10 CFU of Groups 1 to 4 were 4.5 ± 0.7, 4.4 ± 0.9, 4.4 ± 0.9, and 6.7 ± 1.0, respectively (Groups 1, 2, 3 < 4, p < 0.001). The lesion depths of Groups 1 to 4 were 212.6 ± 20.1 µm, 280.8 ± 51.6 µm, 402.5 ± 61.7 µm, and 497.4 ± 67.2 µm, respectively (Groups 1 < 2 < 3 < 4, p < 0.001). XRD demonstrated silver chloride formation in Groups 1, 2, and 3. FTIR found the amide I: HPO42− values of the four groups were 0.22 ± 0.05, 0.25 ± 0.05, 0.41 ± 0.12, and 0.64 ± 0.14, respectively (Groups 1, 2 < 3 < 4; p < 0.001). In conclusion, this study revealed that AgNO3 and NaF + fTCP reduced the damage of dentine caries by cariogenic biofilm.