The role of Tooth Mousse in preventing enamel wear
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Abstract
In addition to its role as a remineralising agent in preventing dental
caries, recent evidence has shown that Tooth Mousse (TM),
manufactured by GC Corporation, Japan, may reduce enamel wear
under conditions simulating attrition and acid regurgitation. Objective:
Our aims were to determine whether TM could reduce enamel wear
under different in vitro conditions and to clarify its likely mode of
action. Methods: Buccal and lingual enamel halves of human third
molar teeth were worn against each other in a purpose-built
electromechanical tooth wear machine under a load of 10.0 kg. In
experimental sample 1, enamel specimens (n = 12) were worn for
around 10,000 cycles in the presence of hydrochloric acid (pH = 1.2).
The machine was stopped every two minutes (160 cycles of wear) and
specimens were washed and dried before TM was applied for four
minutes. Specimens were washed again and dried before the cycle was
continued. This protocol was also followed for experimental sample 2
(n = 12) using Tooth Mousse containing the same formulation but
without the remineralising agent, CPP-ACP (TM-). In the control
sample (n = 12), the specimens were worn at pH = 1.2, but no TM or
TM- was applied. Wear rates were compared between the samples
using one-way ANOVA. Results: There were no significant differences
in rates of enamel wear between samples 1 and 2 (0.44 ± 0.05 vs 0.63 ±
0.06 mm3 per 1,000 cycles), but both these rates were significantly less
than that in the control sample (0.92 ± 0.11 mm3 per 1,000 cycles)
(p<0.05). Conclusions: Tooth Mousse with and without the
remineralising agent reduced enamel wear under conditions simulating
attrition and acid regurgitation. We suggest that this is related to the
lubricating agents in the TM formulation (for example, glycerol).
Introduction
There is an increasing awareness in clinical dentistry of the need to
better understand the aetiology and management of tooth wear as
increasing numbers of elderly patients are retaining their natural teeth
to a stage where they present with extensive wear (Nunn, 2000). In
addition, a significant number of younger patients are presenting with
wear of both primary and permanent teeth (Khan et al., 1997; Jaeggi
and Lussi, 2006).
Previous in vitro studies conducted under conditions simulating
attrition and corrosion (commonly termed dental erosion) have
provided insights into the complex nature of wear in enamel, dentine
and restorative materials. In an in vitro study conducted by Kaidonis et
al. (1998) at loads of 3.2, 6.2 and 10.0 kg, rates of enamel wear were
noted to be very rapid at a highly acidic pH of 1.2 (simulating acid
regurgitation) compared with a less acidic pH of 3.0 (simulating
presence of soft drinks) or a neutral pH of 7.0.
Our pilot study investigating lubricating properties of a commercially
available, water-based cream containing casein phosphopeptide and
amorphous calcium phosphate (CPP-ACP) (Tooth Mousse, GC
Corporation, Japan) has shown that enamel specimens, worn under a
load of 8.2 kg, showed reduction in wear rate by around 70% with
continuous application of Tooth Mousse compared with continuous
application of hydrochloric acid lubricant (pH = 3.0) (unpublished
data). These findings are supported by other data on dentine wear under
conditions simulating corrosion and abrasion (Narayana et al., 2005).
These results warrant a more detailed investigation of enamel wear
prevention using Tooth Mousse under various conditions, including
acid regurgitation.
Our aims were to determine whether TM could reduce enamel wear
under different in vitro conditions and to clarify its likely mode of
action (pH = 1.2). We hypothesized that enamel wear could be reduced
by frequent application of Tooth Mousse.
S. Ranjitkar*, J.A. Kaidonis, G.C. Townsend, And L.C. Richards
School of Dentistry, The University of Adelaide, Australia
Materials and methods
Enamel from buccal and palatal halves of third molar teeth were mounted
separately on scanning electron microscopy studs using autopolymerising
resin, with three spherical titanium steel balls (2 mm in diameter) being
equally spaced around them. These specimens were then worn against each
other in electro-mechanical tooth wear machines under a load of 10.0 kg and
at a pH of 1.2 for around 10,000 cycles. In experimental sample 1 (n = 12),
the machine was stopped every two minutes (160 cycles of wear) and
specimens were washed for 15 seconds and dried for 10 seconds. TM was
then applied for four minutes. The specimens were further subjected to two
cycles of washing and drying, with each cycle comprising washing for 30
seconds and drying for 15 seconds, before the wear cycle was continued. The
same protocol was followed for experimental sample 2 (n = 12) using Tooth
Mousse containing the same formulation but without the remineralising
agent, CPP-ACP (TM-). In the control sample (n = 12), the specimens were
worn at pH = 1.2, but no TM or TM- was applied.
Enamel wear was quantified by measuring the reduction in volume of enamel
specimens using a 3D profilometer (PIXA-4, Roland DG, Tokyo, Japan)
provided with ‘Dr. PICZA' software and a purpose-written MATLAB
software (Liu et al., 2004). For qualitative assessment of tooth wear, negative
impressions of enamel specimens were obtained using a light-body polyvinyl
siloxane impression material (Imprint II, 3M-ESPE Corporation). Clear
epoxy resin replicas were then prepared for examination under a scanning
electron microscope.
One-way ANOVA was used to determine whether there were significant
differences in the mean rates of enamel wear between various samples.
Statistical significance was set at the 0.05 probability level.
Figure 1. A 3D scanner that records the heights (z) of surface mesh points (x and y) of a specimen with
an active piezo sensor (left), and settings for scanning resolution in Dr PICZA software (right).
Figure 2. Reference planes passing through the tip of the three external reference points (titanium balls)
of an enamel specimen before (left) and after (right) wear.
Figure 3. Illustration of the calculation of enamel loss before (left) and after (right) wear using a
purpose-written MATLAB software. A reference plane is constructed using three reference points
before and after wear, and enamel loss is calculated as the difference in volumes between these stages.
Results Discussion
There were no significant differences in rates of enamel wear between samples Our findings indicate that Tooth Mousse with and without the
1 and 2 (0.44 ± 0.05 vs 0.63 ± 0.06 mm3 per 1,000 cycles), but both these rates remineralising agent is effective in reducing rates of enamel wear
were significantly less than that in the control sample (0.92 ± 0.11 mm3 per under conditions simulating attrition and acid regurgitation, although
1,000 cycles) (p<0.05). Tooth Mousse resulted in a further 31.1% reduction in tooth wear.
Unlike in previous in vitro and in situ studies confirming
Wear facets of enamel specimens treated with Tooth Mousse and Tooth anticariogenic properties of CPP-ACP delivered in a solution phase
Mousse Minus were shinier than those of control specimens. However, wear (Reynolds, 1997), Tooth Mousse was applied as a paste in our study.
facets treated with Tooth Mousse Minus were less shiny than those treated with Our findings imply that Tooth Mousse may have some remineralising
Tooth Mousse. potential when applied as a paste. However, it seems that traces of
glycerol and other residues still adhere to the enamel surface even after
it has been thoroughly washed. It is hypothesised that these “third
bodies” provide lubrication between opposing wear facets resulting in
Volume worn (cubic mm per 1,000 cycles)
1.20
wear facets that are highly polished.
1.00
0.80
Future studies are needed to elucidate the role of remineralisation on
0.60 reduction of tooth wear at various loads and pH values both in vitro
and in situ. The effectiveness of frequent application of Tooth Mousse
0.40 on tooth wear prevention should also be compared with other
remineralising agents (for example, involving fluoride) currently used
0.20
in clinical practice.
0.00
Experimental s ample 1 Experimental s ample 2 Control s ample Conclusion
Figure 4. Comparison of the rates of enamel wear in the experimental sample 1 (TM), experimental sample Frequent application of Tooth Mousse is effective in reducing enamel
2 (TM-) and control (no TM). The wear rates of both the experimental samples were smaller than that of wear under conditions simulating attrition and acid regurgitation. These
the control sample at p<0.05.
findings open up new possibilities for the prevention of tooth wear.
Acknowledgements
This product was conducted during the tenure of the first author as a
recipient of a Dental Postgraduate Research Award from the National
Health and Medical Research centre of Australia. We would also like to
acknowledge the Australian Dental Research Foundation Inc (Grant no:
40/2005) for funding this project. We thank the G. C. corporation for
providing us with Tooth Mousse and Tooth Mousse Minus samples, and
the 3M ESPE Corporation for donating impression materials used in this
Figure 5. Photographs of wear facets of the experimental sample 1 (left) and the control sample (right) study.
taken at angles that best showed the most shiny areas.
References
1. Jaeggi T, Lussi A (2006). Prevalence, incidence and distribution of
erosion. Monogr Oral Sci 20: 44-65.
2. Kaidonis J, Richards LC, Townsend GC, Tansley GD (1998). Wear
of human enamel: a quantitative in vitro assessment. J Dent Res
77:1983-1990.
3. Khan F, Young WG, Daley TJ (1997). Dental erosion and bruxism.
Aust Dent J 43:117-128.
4. Narayana T, Ranjitkar S, Kaidonis J, Townsend GC, Richards LC
Figure 6. Scanning electron micrographs of wear facets of the experimental sample 1 (left) and the control (2005). An in vitro study of wear prevention in dentine. Aust Dent J
sample (right) corresponding to those shown in Figure 5.
50 (Suppl 1):S43.
5. Nunn JH. Prevalene and distribution of tooth wear. In Addy M,
Embery G, Edgar WM, Orchardson R, eds. Tooth wear and
sensitivity: clinical advances in restorative dentistry. London:
Martin Dunitz Ltd, 2000: pp 93-103.
6. Reynolds (1997). Remineralization of enamel subsurface lesions by
casein phosphopeptide-stabilized calcium phosphate solutions. J
Dent Res 76: 1587-1595.
Contact
Dr Sarbin Ranjitkar
Figure 7. Photographs of wear facets of gold-coated epoxy replicas of enamel specimens subjected to
treatment with Tooth Mousse (left), Tooth Mousse Minus (middle) and no tooth Mousse (right).
E-mail: sarbin.ranjitkar@adelaide.edu.au