Effectiveness of caries prevention in patients with high mineralization level of permanent teeth

BACKGROUND: Dental caries is one of the most common diseases, present in about 95%–98% of the world’s population, which represents a serious public health problem. Since the 1980s of the 20th century, many studies have shown that caries resistance depends on the mineralization of tooth enamel during tooth eruption. An important stage in the formation of a child’s dental status is the process of enamel maturation, the period when dental caries is most likely to occur. Some studies suggest that tooth development is independent of external factors and is controlled mainly by genetics, while others suggest that development is also influenced by external factors. Interventions for the prevention of tooth decay have been studied many times, but the data on remedies for the prevention of tooth decay in teeth with high mineralization are inconsistent.

AIM: To identify the clinical and morphological criteria of highly mineralized teeth and to evaluate the efficacy of caries prevention measures in patients with highly mineralized permanent teeth.

METHODS: The first stage consisted of determining the clinical and morphological parameters of teeth extracted for orthodontic indications in children aged 9 to 15 years. Next, patients were followed for one year, divided into groups based on their use of calcium- and phosphorus-containing preparations, hydroxyapatite, or no supplementation. The following examinations were performed: assessment of the DMFT (decay, missing, filled teeth) index, enamel resistance testing, and quantitative light-induced fluorescence (QLF) measurements.

RESULTS: 86 people took part in the study. As a result of the study, the clinical and morphological criteria of highly mineralised teeth were clarified.

Clinical criteria: fissure enamel is dense, smooth, and shiny; fissures are of open type, grooved; the enamel surface is dense and smooth in the maxillary, lingual, and approximal areas; absence of enamel defects in the form of stains or pigmentation; teeth erupted on time and symmetrically, have a correct anatomical shape; and a high level of acid resistance is determined. Thus, ΔF was in the range from −2.3 ± 0.05 to 0%, the Simple Hygiene Score ranged from 0 to 1.12 ± 0.03, and the TER-test had values up to 26.31 ± 2.03% in patients with high mineralisation of teeth.

Morphological criteria: Enamel openings are not more than 2 μm. The depth of penetration of enamel bridges into dentin is up to 5–10 μm. In each enamel bridge, there are up to 5–6 enamel tunnels with increased density and smaller diameter. On the slice, there are no changes along the entire length of the enamel surface, and the whole pattern is homogeneous.

The study found that in patients aged 9–15 years old, daily home prophylaxis with preparations containing calcium and phosphorus, as well as preparations containing hydroxyapatite for a year, allows for the preservation of the structure of enamel, as well as helps to prevent enamel caries during the period of the replacement bite.

CONCLUSION: In patients with a high level of tooth mineralization, the degree of resistance does not significantly change with the use of drugs for home prophylaxis, but maintains the structure of enamel during overbite period.