New Technology Gives Teeth a Chance
For four decades, consumers have relied on fluoride in toothpaste and water to help strengthen teeth and reduce cavities. Now manufacturers of dental products are using a novel approach to boost the mineral content of teeth that may help reduce and even reverse early decay.
The new technology, using a process called remineralization, delivers extra doses of calcium and phosphate to replace minerals lost when teeth face the daily assault of food and bacteria in the mouth. “It’s the next logical step after fluoride when it comes to prevention,” says Frederick Eichmiller, director of the American Dental Assn. Health Foundation’s Paffenbarger Research Center. The Gaithersburg, Md.-based center holds numerous patents in this field.
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The first product on the market to add remineralization ingredients is a fluoride toothpaste called Enamelon, manufactured by a small company of the same name that is based in Cranbury, N.J. Warner-Lambert Co., of Morris Plains, N.J., is also selling an updated version of its sugarless gum for adults, Trident Advantage, as well as Trident for Kids, both of which contain Recaldent, a patented remineralization ingredient developed by Australian researchers. The additive is likely to be applied in the future to mouthwashes, lozenges, professional dental products and even beverages, Eichmiller says.
Teeth, like bones, face an ongoing battle to maintain the mineral building blocks essential to their strength. Under ideal circumstances, a natural balance is maintained as saliva, which contains calcium and phosphate, replenishes minerals dissolved by acidic plaque or food. But when the equilibrium tips so that more minerals are lost than gained, the tooth surfaces can become more vulnerable to decay.
Fluoride, now ubiquitous in toothpastes, already acts to speed up the saliva’s natural remineralization. “What’s new is finding ways to deliver additional calcium and phosphate along with the fluoride to make the process much faster,” Eichmiller says. Research at his center and elsewhere found that delivering remineralization ingredients in a soluble form could actually stop an early cavity in its tracks. “If we catch it early on, we can heal the cavity so the teeth will repair themselves. That’s relatively new. We always thought it was irreversible once the process started,” he says.
Enamelon’s chairman, Steven Fox, says the remineralizing properties of the toothpaste could provide benefits for the population at large, but may be especially helpful to a growing number of adults who are more vulnerable to cavities because of reduced saliva flow. This includes diabetics, kidney dialysis patients and cancer patients undergoing radiation treatment, as well as people taking a variety of medications such as certain high blood pressure drugs, antidepressants or antihistamines. The growing elderly population also provides an expanding market of people eager to keep their teeth intact.
Fox, who is a dentist, cites extensive animal and human studies to support his claims, including a recently published study by Tufts University researchers involving cancer patients undergoing radiation treatment. In this high-risk group, he says, Enamelon was seven times more effective than a standard fluoride toothpaste in reversing dental caries.
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An alternative approach, developed by researchers at the University of Melbourne, uses Recaldent in the chewing gum Trident Advantage. Studies have previously shown that sugar-free gum alone can help stimulate saliva production and thereby bathe the teeth in extra minerals. Five recent clinical studies demonstrate that the new Trident Advantage gum further enhances the remineralization process, according to Doris Lennon-Thompson, the senior director of science and clinical evaluation at Adams Worldwide R&D;, a division of Warner-Lambert.
Most of the research on remineralization has been limited to short-term studies in animals and humans showing that combinations of calcium and phosphate can strengthen teeth, as well as studies in special populations, such as radiation patients. This research suggests that cavities will be reduced in the general population over the long run. But full-blown proof would require expensive studies in large human populations over several years.
“Clinically we don’t have the long-term cavity data to say how much total benefit there would be,” Eichmiller says. Clifford Whall, director of product evaluation for the dental association’s Council on Scientific Affairs, says that none of the new remineralization dental products have won the association’s “seal of acceptance,” a designation that requires the submission of extensive long-term human research data to prove safety and effectiveness.
