An in sita Model for Simultaneous Assessment of Inhibition of Demineralization and Enhancement of Remineralization

Abstract

In situ models to assess the ability of oral care products or food components to enhance remineralization and/or inhibit demineralization of tooth enamel or roots must be very carefully designed to minimize the confounding effects of the many variables involved. Controlling these variables as closely as possible is essential if meaningful answers are to be obtained from the models. We have developed an in situ model which combines the experience of several groups. Detailed screening of subjects is essential. Selection criteria should include good general health, good dental health, mandibular partial denture, at least eight natural teeth, no active caries lesions, known fluoride history, normal salivary function, and no medications that affect salivary function. Each subject carries a sound enamel slab and an enamel slab with a pre-formed caries-like lesion (demineralized in vitro) in his/her denture on each side of the mouth for test periods of two or four weeks. The demineralization challenge is controlled by extra-oral immersion of the appliances in sucrose daily. Daily product exposure or daily food component exposure is used as desired. Compliance indicators and a diet diary are included. Whole saliva flow rate (unstimulated), plaque acidogenicity, and salivary fluoride are monitored during the test periods. At the end of the test period, the test slabs are assessed for mineral change, after being sectioned, by means of cross-sectional microhardness or microradiography. The mineral loss or gain (ΔM, μm × vol%), compared with adjacent control sections retained in the lab, is calculated as change in ΔZ (μm × vol%), namely, ΔM = ΔZTEST - ΔZ.CONTROL. In this model, demineralization occurs in sound enamel and in the pre-formed lesions in the absence of fluoride or other protective agents. The model has the potential to be able to differentiate among fluoride delivery systems and to assess the caries-protective effects of agents other than fluoride by use of small groups of subjects.