It is well established that the daily use of an over-the-counter fluoride dentifrice effectively reduces caries. It has also been demonstrated that adding calcium, phosphate, and fluoride to soft drinks decreased their cariogenic effects.39 Clearly, patients with hyposalivation, and those consuming acidic beverages, would benefit from dietary counseling and the routine use of products that prevent demineralization and promote remineralization.
Xylitol, a nonfermentable five-carbon sugar alcohol that interacts with Ca2+, facilitates the transport of calcium across biological membranes, and promotes the remineralization of enamel. Furthermore, as a nonfermentable five carbon sugar alcohol, xylitol cannot be used as an energy source by bacteria (e.g., S. mutans). Reduced bacterial counts and increased bioavailability of calcium ions promote remineralization and marginally reduce caries activity.32,40 Xylitol is available in breath mint, candy, and granulated formulations (Figure 3). For optimal effect, the recommended rate of application is 2 to 3 times a day after meals, i.e., 5 to 8 grams of xylitol per day.32
Figure 3. Xylitol Products.
Recaldent™ (a casein phosphopeptide -amorphous calcium phosphate or CPP-ACP) is a milk-derived product that promotes the remineralization of teeth. It is available in a sugar-free gum (Trident XtraCare with Recaldent), toothpaste, and cream formulations (Figure 4). The products have the ability to stabilize calcium, phosphate, and fluoride ions as water-based amorphous complexes; increase their bioavailability; and promote the remineralization of enamel.41 Remineralization appears to increase with usage, suggesting dose dependency.
Figure 4. Calcium Phosphate Products.
It must be emphasized that saliva substitutes, sialagogues, and the use of other products (including the regular use of over-the-counter fluoride dentifrices) mentioned do not constitute a total chemical solution to the problem of demineralization and remineralization.42 The daily use of a prescription-strength fluoride dentifrices or gels contain 1.1 percent neutral sodium fluoride or the weekly use of a 0.2 percent neutral sodium fluoride mouthrinse combined with the application of a 5 percent neutral sodium fluoride varnish applied every 6 months is recommended for at risk patients of all ages.32