# Comparative Evaluation of the Remineralizing Potential of Fluoridated and Non-fluoridated Agents on Demineralized Primary Tooth Enamel: An In Vitro Study

## TL;DR

This study compares how well different dental products can repair early tooth decay in children's primary teeth, finding that fluoridated and CPP-ACP treatments work best.

## Contribution

A direct in vitro comparison of fluoridated and non-fluoridated remineralizing agents on primary tooth enamel microhardness.

## Key findings

- CPP-ACP and NaF showed the most significant microhardness improvement in demineralized enamel.
- Nano-HA had moderate efficacy, while grape seed extract and saline were ineffective.
- Fluoridated agents and CPP-ACP are recommended for pediatric dental remineralization.

## Abstract

Introduction: Dental caries remains a highly prevalent condition in children, with primary teeth being particularly susceptible due to their lower mineral content and structural characteristics. Early intervention using remineralizing agents can reverse enamel demineralization and prevent disease progression. The aim of this study was to evaluate and compare the remineralizing efficacy of various fluoridated and non-fluoridated agents on the surface microhardness (SMH) of demineralized primary tooth enamel.

Materials and methods: This in vitro experimental study was conducted on 50 extracted, caries-free primary molars, randomly divided into five groups as Group 1, who received casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) paste (GC Tooth Mousse®, GC Corporation, Tokyo, Japan) (n = 10); Group 2, who was treated with nano-hydroxyapatite (nano-HA) toothpaste (Perfora™, Perfora Oral Care Pvt. Ltd., India) (n = 10); Group 3, who received grape seed extract solution (Vitis vinifera, Biomed Sensitive Toothpaste, Splat Global LLC, Moscow, Russia) (n = 10); Group 4, who was treated with sodium fluoride (NaF) (Mamaearth Natural Toothpaste, Honasa Consumer Pvt. Ltd., Haryana, India) (n = 10) serving as the positive control with 0.165% w/w NaF, which is equivalent to approximately 750 parts per million (ppm) fluoride; and Group 5, who was treated with normal saline (Baxter Healthcare Corporation, Deerfield, IL) (n = 10) serving as the negative control. Artificial enamel lesions were created using demineralizing solution (pH 4.5) for 72 hours. The agents were applied for four minutes daily for seven days. The samples were stored in artificial saliva for various applications. The SMH was measured using a Vickers microhardness tester at three time points: baseline (T0), after demineralization (T1), and after remineralization (T2). Statistical analysis was performed using one-way analysis of variance (ANOVA), paired t-tests, and Tukey’s post-hoc tests (p < 0.05).

Results: Post-remineralization analysis revealed statistically significant differences between groups (p = 0.002). The paired t-test showed that Groups 1 and 4 exhibited the most significant microhardness improvement. Group 2 showed moderate efficacy, whereas Groups 3 and 5 showed no significant remineralization effects. Post-hoc analysis confirmed the superior performance of Groups 1 and 4 compared to Group 5.

Conclusion: CPP-ACP and NaF demonstrated superior remineralization potential in demineralized primary enamel. Nano-HA showed moderate efficacy, whereas grape seed extract and saline were ineffective. These findings support the use of fluoridated and non-fluoridated agents in pediatric preventive dentistry.