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Cariology and Operative Dentistry, Department of Restorative Sciences, Graduate School, Tokyo Medical and Dental University,
5-45 Yushima 1-chome, Bunkyo-ku, Tokyo 113-8549, Japan
b
Cooperative Research Centre for Oral Health Sciences, Melbourne Dental School, Bio21 Institute of Molecular Science and Biotechnology,
University of Melbourne, Parkville, Victoria, Australia
c
Support Program for Improving Graduate School Education at Tokyo Medical and Dental University, Tokyo, Japan
d
Global Center of Excellence Program; International Research Center for Molecular Science in Tooth and Bone Diseases,
Tokyo Medical and Dental University, Tokyo, Japan
article info
abstract
Article history:
Objectives: Means of objectively assessing white spot enamel lesions (WSEL) are critical for
determining their potential activity and monitoring the success of preventive treatments.
The aim of this study was to determine whether surface pH measurements of WSEL changed
20 April 2010
Methods: Eight healthy subjects (1 male and 7 females) with at least one WSEL were recruited
(1964 years). Each subject was placed on a preventive treatment program including the
daily application of a CPP-ACP paste (MI paste, GC Corp., Japan) with custom fitted trays for
Keywords:
more than 6 months. The surface pH values of sound enamel and WSEL were monitored for
Casein phosphopeptide-stabilized
up to 2 years using a micro-pH sensor. The visual appearance of the WSEL was monitored via
digital photography, and images were analyzed qualitatively on a 5-point scale to assess the
White spot
success of the remineralization preventive program. The relationship between the qualita-
pH
tive assessment of WSEL appearance and the WSEL pH was investigated using a Spearmans
Enamel
Saliva
Results: The surface pH of the WSEL was different to that of the sound enamel surrounding it
in all patients at all times. All lesions showed visual improvement as the treatment period
progressed. The pH of the WSEL increased towards that of sound enamel over the course of
treatment significantly correlating with the visual improvement of the lesion (rho = 0.63,
p < 0.0001).
Conclusions: The clinical assessment of WSEL surface pH changes with time may have utility
as an additional objective measure for the assessment of WSEL activity.
# 2010 Elsevier Ltd. All rights reserved.
1.
Introduction
* Corresponding author. Tel.: +81 3 5803 5483; fax: +81 3 5803 0195.
E-mail address: kitasako.ope@tmd.ac.jp (Y. Kitasako).
0300-5712/$ see front matter # 2010 Elsevier Ltd. All rights reserved.
doi:10.1016/j.jdent.2010.04.010
2.
2.1.
2.2.
Preventive program
585
made trays for 30 min after evening tooth brushing. At the end
of the application time the patient removed the tray but did
not rinse or expectorate thereby leaving the residual paste
around the teeth. The intraoral tray was not worn during
consumption of food or drink or oral hygiene procedures, and
when the tray was removed, it was stored in a sealed moist
plastic bag at room temperature. Subjects were instructed to
rinse and clean their trays using tap water. Each subject
followed this treatment regime for at least 9 months up to 24
months and attended 3 monthly review appointments. No
alterations were made to the subjects diet and oral hygiene
procedures for the duration of the study. All subjects lived in a
city which did not have a fluoridated reticulated water supply
and used non-fluoride-containing toothpaste after breakfast
and before retiring at night. Patients were supplied with MI
Paste at each visit after returning their previously used tube
which was weighed to determine compliance.
2.3.
2.4.
586
Fig. 1 pH measurement system consisting of pH meter, signal converter and micro-pH sensor shown in (a). Dimensions of
the ISFET micro-pH sensor and the reference electrode shown in (b) and (c). Micro-pH sensor measuring the pH of a WSEL
shown in (d).
2.5.
2.6.
Statistical analysis
3.
Results
587
Table 1 Longitudinal pH values (mean W SD) of sound enamel and WSEL before and after the institution of the preventive
program.
Time (months)
Sound enamel
WSEL
Paired differenceb
12
18a
24a
6.80 0.07 a
5.94 0.17
0.86 0.15
6.80 0.07 a
6.22 0.18 b
0.58 0.17 d
6.84 0.05 a
6.38 0.18 bc
0.46 0.17 d
6.85 0.05 a
6.38 0.20 bc
0.47 0.19 d
6.85 0.05 a
6.44 0.20 bc
0.41 0.20 d
6.85 0.05 a
6.49 0.16 c
0.35 0.18 d
6.84 0.05
6.66 0.16
0.19 0.13
6.83 0.05
6.70 0.08
0.13 0.05
Similarly marked means in the same row are not significantly different ( p > 0.05).
18-month data based on 4 subjects (7 WSEL) and 24-month data based on 2 subjects (3 WSEL) this data was not used in the statistical
analysis due to missing data points.
b
All paired differences were significantly different from 0 ( p < 0.001).
a
Table 2 Longitudinal flow rate and pH values (mean W SD) of stimulated saliva and acidified saliva before and after the
institution of the preventive program.
Time (months)
Flow rate
Stimulated pH
Acidified pH
12
18a
0.66 0.35 a
6.93 0.38 c
5.12 0.76 ef
0.94 0.37 ab
7.25 0.46 cd
5.08 0.75 e
1.04 0.42 b
7.35 0.32 d
5.86 0.66 fg
1.13 0.42 b
7.35 0.23 d
6.01 0.6 g
1.11 0.47 b
7.29 0.25 d
5.71 1.00 efg
0.97 0.42 b
7.50 0.23 d
5.87 0.85 efg
1.28 0.77
7.45 0.24
6.18 0.75
24a,b
1.00
7.45
5.90
Similarly marked means in the same row are not significantly different ( p > 0.05).
18-month data based on 4 subjects and 24-month data based on 2 subjects this data was not used in the statistical analysis due to missing
data points.
b
Mean without standard deviation presented as only two data points.
a
Fig. 2 Clinical photograph of WSEL on the mesial of tooth 13 (arrow) and its response to treatment with time.
588
4.
Discussion
Acknowledgments
This project was supported by Grant #21592413 from the Japan
Society for the Promotion of Science, and for Global Center of
Excellence Program for International Research Center for
Molecular Science in Tooth and Bone Diseases at Tokyo
Medical and Dental University. Dr. Glenn Walker and Mr.
Masaomi Ikeda are acknowledged for assistance with statistical analysis.
references
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