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Research Article Open Access

Agarwal et al., Oral Hyg Health 2014, 2:1

http://dx.doi.org/10.4172/2332-0702.1000122

Review Article Open Access

Oral Hygiene & Health

Volume 2 • Issue 1 • 1000122Oral Hyg Health

ISSN: 2332-0672 JOHH, an open access journal

Keywords: Dental Cares; Non fluorde agents; Preventon

Introducton

Dental cares s one o the most common preventable chldhooddsease; people are susceptble to ths alment throughout the letme[1]. Data rom the Natonal Health and Nutrton Examnaton Survey(NHANES) conducted between 1999 and 2004 revealed that 28 percento chldren rangng rom 2 to 5 years o age had one or more prmary

tooth affected by dental cares and 51 percent o chldren had one ormore prmary tooth affected by age 6 to 11. In the permanent dentton,10 percent o chldren aged 6 to 8 had dental cares and 51 percent o

chldren were affected by age 12 to 15 [2]. Te preventve care provdershave the ntenton or preventon beyond the scope o provdnghygene therapy and oral hygene nstructons. Dental decay s manlydue to demneralzaton whch s caused by acds produced by bactera,

partcularly mutans Streptococc and possbly lactobacll that ermentdetary carbohydrates. Ts occurs wthn a bactera-laden gelatnousmateral called dental plaque that adheres to tooth suraces and

becomes colonzed by bactera. Tus, cares results rom the nterplay othree man actors over tme: detary carbohydrates, carogenc bacterawthn dental plaque, and susceptble hard tooth suraces [3]. Te use

o fluordated toothpastes [4], other topcally appled fluordes [5],fluordated muncpal water [6] and pt and ssure sealants [7,8] alongwth detary mprovement reman manstays o cares management.

Tese modaltes, whch are based on hgh qualty evdence, are therst choce or preventon and control o dental cares. Fluorde’sant-cares effcacy s well-proven and may arse rom multple modes

o acton, .e., nhbton o tooth demneralzaton, promoton o

ncpent leson remneralzaton, and perhaps, antbacteral effects oncarogenc bactera [9]. Clncal evdence would suggest that ncreasng

the concentraton o fluorde above the conventonal level o 1000 or1500 ppm n dentrces wll gve an ncreased benet although therewould appear to be somethng o a law o dmnshng returns [10].

Although fluorde s hghly effectve on smooth-surace cares, tseffect would seem to be more lmted on pt and ssure cares, andthese lesons tend to domnate the cares experence o developed

countres currently enjoyng the benets o fluorde. Apart romfluorde, dental health educaton programme, det counsellng, oralhygene measures lke dentrces, dfferent brushng technque are also

used n preventon o dental cares. Varous ant plaque agents, and

other agents lke enzymes have been effectvely used as preventon o

dental cares. From the 1930‘s when the researches came to know the

ant-cares effect o the fluorde, many gargantuan water fluordatonprogram have been mplcated, but these programs has shown to be

successul only n attanng a 50% cares reducton but none o them

was able to contan the cares process [11]. Snce 1970‘s researchesstarted to search or non-fluorde agents or the preventon o dentalcares [12]. Non-fluorde agents may serve as adjunctve therapeutcs

or preventng, arrestng or even reversng dental cares. Te objectveo ths paper s to present a complete revew o recent advances o

varous non-fluordated cares preventng agents.

Recent Advances n Cares Preventon

Argnne

Argnne, a common amno acd ound n salva s broken down by

oral plaque bactera to acd neutralzng alkal. Te producton o acd

by dental plaque s the drect cause o dental cares; t s noteworthy

that ncreases n the proportons o acdurc organsms appear to occur

at the expense o speces that are less acdurc and generally assocated

wth dental health; ncludng Streptococcus sanguns and Streptococcus gordon [13-15]. Some o the less acdurc organsms assocated wth

dental health derve protecton rom plaque acdcaton by hydrolysng

urea or argnne to ammona, ether by expressng a urease enzyme

or by the argnne demnase system (ADS), respectvely. Producton

o ammona by oral bactera can postvely nfluence the balance

between remneralzaton and demneralzaton o the tooth and may

help to prevent the emergence o a carogenc mcroflora [16-18].

Tereore, the capacty o oral bolms to generate alkal appears to be

a major cares-nhbtng actor [19]. Urea and argnne can be rapdly

metabolzed by oral bactera to elct a rse n envronmental pH. A

strong correlaton between elevated levels o ree argnne n salva and

cares resstance has also been revealed [20]. In addton, dental plaque

o cares-resstant ndvduals has been shown to have hgher pH valuescompared to the plaque o cares-susceptble ndvduals, and n part

the ncreased pH has been correlated wth elevated ammona levels[21-33].

*Corresponding author: Ravi Agarwal, Department of Pedodontics and preventive

Dentistry, K D Dental College and Hospital, Mathura-281001, Uttar Pradesh, India,

Tel: +918755525993; Fax: 0565-2530764; E-mail: [email protected]

Received January 28, 2014; Accepted February 25, 2014; Published March 03,

2014

Citation: Agarwal R, Singh C, Yeluri R, Chaudhry K (2014) Prevention of Dental

Caries-Measures beyond Fluoride. Oral Hyg Health 2: 122. doi: 10.4172/2332-

0702.1000122

Copyright: © 2014 Agarwal R, et al. This is an open-access article distributedunder the terms of the Creative Commons Attribution License, which permits

unrestricted use, distribution, and reproduction in any medium, provided the

original author and source are credited.

Abstract

Dental caries is one of the most common infectious microbial diseases. It is rightly said that prevention is better

than cure. Various steps in prevention of dental caries have been taken, uoride being the most common among

them. Various non- uoride agents are also present which helps in prevention of dental caries. Various agents

like, arginine, plant extracts, sucrose free polyol gums, probiotics, novamin, Dentrifrices, antimicrobials, CPP- ACP

etc are commonly used in prevention of dental caries. This paper reviews about these non-uoride agents in the

prevention of dental caries.

Prevention of Dental Caries-Measures beyond FluorideRavi Agarwal*, Chanchal Singh, Ramakrishna Yeluri and Kalpna Chaudhry

Department of Pedodontics, K D Dental College and Hospital, Mathura, India

http://dx.doi.org/10.4172/2332-0702.1000122http://dx.doi.org/10.4172/2332-0702.1000122http://dx.doi.org/10.4172/2332-0702.1000122http://dx.doi.org/10.4172/2332-0702.1000122


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Citation: Agarwal R, Singh C, Yeluri R, Chaudhry K (2014) Prevention of Dental Caries-Measures beyond Fluoride. Oral Hyg Health 2: 122. doi:

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Plant extracts

Tere s a global need or alternatve preventon and treatment

optons and products or oral dseases that are sae, effectve andeconomcal. One such strategy would be to very the enormous use omedcnal plants. A number o phytochemcals, ncludng antbacteralagents have been derved rom edble plants and demonstrateantbacteral propertes aganst Streptococcus mutans.

Neem, Azadrachta ndca: Wolnsky et al. [24] nvestgated thenhbtory effects o acqueous extracts rom Neem upon bacteralaggregaton, growth and adheson to hydroxyapatte and producton onsoluble glucan, whch may effect n vtro plaque ormaton.

Tuls, Ocmum sanctum: uls, Ocmum sanctum s a plant oIndan orgn and a tme tested premer medcnal herb. Te extract otuls s used to treat a varety o llnesses that nclude dabetes melltus,arthrts, bronchts and skn dseases. Te antmcrobal property

o tuls has been tested aganst a varety o mcroorgansms lkeStaphylococus aureus, Klebsella, candda albcans, E. col and proteussp. Te antmcrobal actvty o tuls s attrbuted to ts consttuentsnamely ursolc acd and carvacrol. Agarwal et al. [25] n ther studydemonstrated an antmcrobal potental o tuls extract at varousconcentratons and acheved maxmum antmcrobal potental at 4%concentraton level.

Prunus mume: Prunus mume s a common rut n Asa, whch

has been used n tradtonal Chnese medcne. It s consdered to be

the potental canddate or developng an oral antmcrobal agent

to control or prevent dental dseases assocated wth oral pathogenc

bactera lke Streptococcus mutans, S. sobrnus, S. mts, S. Sanguns,

Lactobacllus acdophlus, P. gngvals, Aggregatbacter actnomycetem

comtans [26].

Green and black tea (Camella snens): Varous component n

green and black tea (leaves o Camella snenss, [Teaceae]) notably

smple catechns, have antcarogenc actvty. Tese nclude: a drect

bactercdal effect aganst S mutans and S sobrnus; preventon o

bacteral adherence to teeth; nhbton o glucosyl transerase, thus

lmtng the bosynthess o stcky glucan; nhbton o human and

bacteral amylases. Ferrazzano et al. [27] concluded that the ant-

carogenc effect aganst ala hemolytc streptococc by polyphenols

rom cocoa, coffee and tea suggest urther possble applcaton o these

beverages n the preventon and pathogeness o dental cares.

Hop plant (Humulus lupulus): agashra et al. [28] reported

the nhbton o S. Mutants and other oral streptococc, by theantmcrobally actve ngredents o hop plant. Tey ound that all

tested hop consttutes nhbted the streptococc wth mnmum

nhbtory concentraton at pH 7.5 ranged rom 2 to 50 µg/ml.

Antmcrobal actcty o hop consttuents was greater than other plant

products such as thymol, nerol, cnnamon ol, ol o clove, menthol and

eucalyptol.

Olec acd, Lnolec acd, epcatechn polymer (Cacao bean

husk): Tese shows antmcrobal actvty aganst planktonc cells omutans Streptococc. It has an nhbtory effect on water-nsolublesubstances, polymer glucan synthess, adherence, acd producton bymutans streptococc. It also helps n reducton n plaque accumulatonand cares development n rats nected wth S. mutans or S. sobrnus

[29,30].Proanthocyandns, phenolc acds, flavonols (Cranberry):

Tese shows antmcrobal actvty aganst bolm cells o mutans

streptococc. It causes dsrupton o acdogenc/acdurc propertes oplanktonc and bolm cells o S. mutans. It has nhbtory effects on Gtactvty and adherence by mutans Streptococc and causes reducton o

ormaton o S. mutans bolms and EPS content. Reducton n caresdevelopment n rats nected wth S. mutans s also seen [31-33].

Apgenn and tt Farnesol: Apgenn and tt Farnesol are twonaturally occurrng agents that affect the development o carogencbolms. Apgenn nhbts the actvty o glucosyltranserases nsoluton and on the surace o salva-coated hydroxyapatte beadsand t was devod o antbacteral actvty. tt-Farnesol showedmodest antbacteral actvty aganst bolms and ts effects onglucosyltranserases were mnmal [34]. It also enhances the carostatceffectveness o fluorde. Te combnaton o these novel agents wthfluorde may represent a potentally useul and an alternatve approachto the current chemotherapeutc strateges to prevent ths ubqutousdsease by reducng the expresson o vrulence o S. mutans wthout

necessarly suppressng the resdent oral flora [35].

Meswak chewng stcks (Twgs of Salvadora persca): Tesestcks embedded n agar or suspended above the agar plate had strongantbacteral effects aganst all tested bactera. Te antbacteral effecto suspended meswak stcks suggested the presence o volatle actveantbacteral compound [36-39].

Propols: Propols s a natural beehve product, and cacao beanhusk extracts have also shown sgncant antbacteral actvty aganstS. mutans and/or S. sobrnus n vtro [29,38,39] Propols extract whenused as a mouthwash exhbts an n vvo antmcrobal actvty aganst S.

mutans and mght be used as an alternatve measure to prevent dentalcares [40]. opcal applcatons o chemcally characterzed Propolsextracts have also been shown to be hghly effectve n reducng the

ncdence and severty o smooth surace and sulcal cares n rats[39,41]. However, the carostatc effects o propols are hghly varabledependng on ts chemcal composton and geographcal orgn. Tere

are many other reports n the lterature concernng the antmcrobalactvtes that varous plant extracts may have aganst carogenc bactera,although the majorty o these studes provde lmted or ncomplete

normaton due to the lack o chemcal characterzaton o the extracts.However, there are a ew exceptons. For example, L et al. [42] havedented gallotannns rom Melaphs chnenss and trterpenes

(ceanothc acd and ceanothetrc acd) rom Ceanothus amercanus asantmcrobal agents that harbor actvty aganst mutans streptococc.Furthermore, a chemcally characterzed extract o Galla chnenss

(contanng gallc acd and methyl gallate) has been demonstrated to

mpede the growth o S. mutans and other cares- related organsms,ncludng Lactobacllus rhamnosus and Actnomyces naeslund, wthn

bolms [43]. Recently, establshed that naturally occurrng phenolccompounds generally dsplay antbacteral actvty by dsruptng themembrane lpd-proten nterace as nononc surace-actve agents

[44]. Ramakrshna et al. [38] studed varous natural alternatvesderved rom plants and plant products and concluded that t can serveas a preventon and treatment opton aganst carogenc bactera.

Chnese Lcorce Root: A new cavty ghtng herbal lollpop thatcontans a specal herbal ormula extracted rom the Chnese lcorceroot can help to mmoblze major organsms responsble or tooth

decay. Tese orange flavoured herbal lollpops was dscovered bymcrobologst at the UCLA school o dentstry should be consumed

twce a day- one n the mornng afer breakast and another aferproessonal teeth cleanng between two and our tmes a year.

Xyltol: A sweet alternatve dscovered n 1891 by German chemst

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Eml Fscher. Dental benets o xyltol were rst recognzed n Fnlandn 1970 usng anmal models. Te rst chewng gum developed wththe am o reducng cares and mprovng oral health was released

n Fnland n 1975 and n Unted States shortly afer. Xyltol s notermented by carogenc plaque bactera and thus does not lower thepH o the plaque. It reduces the accumulaton o plaque on the suraceo the tooth. It accumulates ntracellular n MS and nhbts the bacteralgrowth. Xyltol reduces MS by alterng ther metabolc pathways. Ithas long been known to have antbacteral propertes, n partcularto depress the proporton o Streptococcus mutans n plaque [45,46],and also to reduce ts acdogencty [47]. In addton, xyltol has beensuggested to have an ablty to nhbt enamel dssoluton n vtro [48].In clncal studes, xyltol chewng gums have, n general, been reportedto nhbt the development o cares [49]. In chldren reportng caresexperence, consumpton o xyltol contanng lozenges or hard candyreduces ncdence o coronal cares [50-52]. For chldren below agetwo, n addton to the study that evaluated xyltol tablets, the xyltol-contanng syrup among chldren n the Marshall Islands and reporteda statstcally sgncant dfference n avor o xyltol syrup [53]. Teres nsuffcent evdence that xyltol syrup prevents cares n chldrenunder 2 years o age. Tere s nsuffcent evdence regardng xyltoldentrrce as t contans other ngredents whch mght nhbt theproducton o dental cares [54,55].

Probotcs and replacement therapy: Probotcs are dened aslve mcro-organsms, prncpally bactera, that are sae or humanconsumpton and when ngested n suffcent quanttes, have benecaleffect on human health, beyond basc nutrton [56]. Frst probotcspeces to be ntroduced n research was Lactobacllus acdophlus byHull et al. n 1984; ollowed by Bdobacterum bdum by Caglar etal. [57]. Probotc have shown to nfluence mmune system through

several molecular mechansms: In oral cavty, probotcs can createa bolm, actng as a protectve lnng or oral tssues aganst oraldseases. Such a bolm keeps bacteral pathogens off oral tssues byllng a space pathogens would nvade n the absence o the bolm;and competng wth carogenc bactera and perodontal pathogensgrowth. Te admnstraton o probotc lactobacll (LGG) n mlk tokndergarden chldren n Helsnk, Fnland resulted n reducton ontal cares development. Comell et al. [58] studed 23 dary bacteralstrans or the preventon o dental cares and reported that onlytwo strans namely Streptococcus thermophlus and Lactcoccus lacts were able to adhere to salva-coated hydroxyapatte and were urthersuccessully ncorporated nto a bolm smlar to the dental plaque.Recently t was shown that probotc cheese reduced the prevelance ooral candda [59]. Cheese mght be the deal vehcle or admnsterngprobotcs to humans. Cheese enhances remneralzaton and preventsdemneralzaton o enamel. Yogurt products contanng L. reuter showed a sgncant growth nhbtory effect aganst S. mutans, whleyoghurts wth lactobaccll other than L. reuter dd not show such

nhbton. Resdence tme o probotcs n oral cavty afer treatmentwthdrawal was studed by Çaglar et al. [60]. A reduced S. mutans levelwas shown afer a two-week use o a L. reuter-enrched yogurt; effects

were observed durng use and or a ew days afer dscontnuaton.A loss o L. reuter colonzaton was observed by Wol et al. [61] twomonths afer havng dscontnued probotc use. Suckng a medcal

devce contanng the probotc lozenge wth L. reuter once daly or 10days reduced the levels o salvary mutans [62]. However t s unlkelythat a permanent colonzaton occurs. Tereore, regular consumpton

o probotc products s needed to mantan the preventve andtherapeutc levels.

In addton to probotcs, another measure that compettvely

reduces the pathogen composton n the oral flora has emerged wththe advances n gene engneerng and DNA recombnaton technology.Ts method s the so-called replacement therapy. Replacement therapy

nvolves the use o a harmless effector stran that s permanentlycolonzed n the host’s mcroflora. Ts effector stran s desgned toprevent the colonzaton or outgrowth o a partcular pathogen. oprevent an necton usng replacement therapy (recently reerred toas probotc therapy), a natural or genetcally moded effector strans used to ntentonally colonze the stes n susceptble host tssues thatare normally colonzed by a pathogen. I the effector stran s betteradapted than the pathogen, colonzaton or outgrowth o the pathogenwll be prevented by blockng the attachment stes, by competng oressental nutrents, or va other mechansms. As long as the effectorstran perssts as a resdent o the ndgenous flora, the host s protectedpotentally or an unlmted perod o tme. S. mutans stran BCS3-L1

s a genetcally moded effector stran desgned or use n replacementtherapy to prevent dental cares. o be an effectve effector stran, BCS3L1 must satsy our prerequstes: It must have a sgncantly reducedpathogenc potental to promote cares. It must persstently colonze

the S. mutans stes, thereby preventng colonzaton by dsease-causng strans whenever the host comes nto contact wth them. Itmust aggressvely dsplace ndgenous strans o S. mutans and allow

prevously nected subjects to be treated wth replacement therapy.It must be sae and not make the host susceptble to other dseasecondtons. From a standpont o replacement therapy or cares

preventon, mplantaton o an effector stran would best be achevedn chldren mmedately afer tooth erupton and beore the acqustono a cares-nducng stran. A nal aspect o replacement therapy saetys the requrement or controlled spread o the effector stran wthn thepopulaton. Mutacn 1140 up-producton clearly provdes a selectve

advantage to BCS3-L1 colonzaton. However, the mnmum nectousdose has not been determned or ths stran or any S. mutans stran nhumans.

Novamn: Novamn alls nto a newer category o boactveglass-ceramc materal that has been avalable snce the 1960’s asmaterals to help n bone repar. Te actve ngredent s a calcum

sodum phosphoslcate that reacts when exposed to aqueous meda,thus provdng calcum and phosphate ons to the appled surace.Examples o Novamn powered technology nclude Oravve, a

product rom Natural Health Organcs, whch s a non-fluordated,and non-prescrpton dentrce contanng 5% Novamn. Boactveglasses have been tested under dfferent clncal stuatons, such ashavng an antbacteral effect [63]. Novamn-contanng dentrce

s statstcally more effectve than a placebo dentrce [64]. One othese studes was done by and compared a dentrce contanng 5%Novamn and Fluorde (MFP) to a commercally avalable dentrce n

remneralzaton o subsurace carous lesons n human tooth enamel.It used conocal laser scannng mcroscopy (CLSM), whch s able todstngush between sound enamel and demneralzed enamel usng a

fluorescent dye [65].

Dentfrces: ooth-pastes are the valuable adjuncts to oral hygeneas they make brushng more pleasant and more effectve. Many

attempts have been made at varous tmes to add-therapeutcal agentswth the object o ntererng wth oral flora, lmtng plaque ormatonand makng teeth more resstant to cares.

Chlorophyll: Chlorophyll was one o the earlest agents added to

the paste and s stll present n some tooth-pastes. Although n vtro tests showed that chlorophyll- contanng tooth pastes lmts bacteralgrowth, but clncal trals have not shown any ant- cares effects [12,66].

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Ammonated tooth-paste: Ts usually contans urea, anddeveloped n an attempt to control the acd producton n plaque. Anumbers o clncal trals were carred out, but all gave very lttle postve

or nconclusve results. Ammonated pastes have been superseded bymore effectve agents, Ant-botc toothpastes contanng penclln,trclosan or topcal ant-botc such as tyrothrcn have also beentred. It was based on the assumpton that acdogenc bactera aredestroyed, cares wll be controlled.

Ant-enzyme paste: Tese toothpastes were ntroduced on thebass that they nterere wth enzyme systems o the bactera and thuswth ther growth and uncton. Stll ther effectveness has not beenevaluated by clncal trals [12,66]. Varous other dentrces contanngherbal products lke neem, tuls, clove ol, propols are avalable whchshow benecary effect n preventng dental cares.

Antmcrobals: ypcally antmcrobal agents target both supra-gngval plaque, and more mportantly sub-gngval plaque buldup.Clncal decsons to delver antmcrobal agents exst n a balancebetween delverng relevant and clncally measurable amounts, but atthe same tme not dsruptng the natural ecology o the mouth whchprovdes protecton rom opportunstc pathogens and the overgrowtho exogenous mcrobes.

Chlorhexdne: Currently mouthrnses that contan 0.12%chlorhexdne are marketed wthn the Unted States. Chlorhexdne s abroad spectrum antbotc that klls Gram-postve and Gram-negatvebactera as well as yeasts at hgh concentratons. At lethal concentratonschlorhexdne causes rreparable damage to the cell membrane otarget mcrobes, and at sub-lethal concentratons chlorhexdne cannterere wth the sugar transport and acd producton o the carogencstreptococc strans, provdng a bacterostatc effect. Chlorhexdne

s typcally utlzed because o ts great retenton wthn the plaquecoated enamel surace, and studes report that 30% o the delveredchlorhexdne s retaned n the mouth afer use [67,68]. Te effcacy othe chemcal has come under scrutny as some clncal trals have aledto produce sgncant level o cares reducton, and sde effects such asstanng and an altered taste sensaton have been reported [69].

rclosan s used to ncrease the ablty o mouthwashes to bnd tothe oral mucosa, and thus be avalable or long perod o tme. Jenknset al. compared the magntude and duraton o salvary bacteral countreducton produced by a sngle rnse o 0.2% trclosan, 1% sodumlauryl sulate and 0.2% chlorhexdne mouthwashes. Tey oundconsderable reducton n bacteral count whch remaned sgncantor three hours wth trclosan and or 7 hours wth sodum lauryl sulate

and chlorhexdne [70]. Te use o 0.3% trclosan mouth rnse showedsgncant reducton n salvary Streptococcus mutans count [71].

Essental ols: Essental ols have also been extensvely studedor antmcrobal actvty aganst cares-related bactera. Essental olsderved rom plants are typcally a complex mxture o approxmately20-60 compounds that are n soluton at varous concentratons.Overall, the man chemcal group s prmarly composed o terpenods,ollowed by aromatc and alphatc consttuents [72]. Tymol andeugenol nhbt the growth o a wde range o oral mcroorgansmsncludng mutans streptococc [36,37].

Trace elements: Dfferent trace elements has been nvestgatedwere znc, tn, alumnum, copper, ron, strontum, barum, manganeseand molybdenum, gold, lead etc. Alumnum, copper, and ron have

the most commonly used as carostatc agent, although each wouldprobably have organo-leptc problems used n oral care productsas smple salts. Moreover, the toxcty o many metals lke alumnum,

copper, barum molybdenum, would restrct the concentraton atwhch they could be saely used [66,73].

CPP-ACP: Recent developments n the area o remneralzatonnclude casen phosphopeptde-amorphous calcum phosphate (CPP-ACP) Dary products such as mlk, mlk concentrates and cheese arerecognzed as non-carogenc or carostatc n several laboratory studesdue to the presence o mlk phosphoproten, casen [74]. Te casenphosphopeptdes (CPP) are derved rom casen by tryptc dgeston. In1987, Reynolds ound that CPPs were ncorporated nto the ntra-oralapplance plaque and were assocated wth a substantal ncrease n theplaque’s content o calcum and phosphate [75]. All CPPs contan thesequence mot -Pse-Pse-Pse-Glu-Glu-, where Pse s a phosphoserylresdue. Trough these multple phosphoseryl resdues, CPPs have amarked ablty to stablze calcum phosphate ons n soluton and toorm an amorphous calcum phosphate (ACP) complex, reerred to asCPP-ACP [74,76]. Te mlk proten, CPP, stablzes hgh concentratons

o calcum phosphate ons n ACP solutons. Te CPP-ACP s taken upby dental bolms and localzes to the enamel surace as nanopartcles.

Calcum, phosphate and fluorde rom CPP-ACP, whch are released

durng Acdogenc challenge, help to mantan the supersaturated

state o these ons n the bolm and so promote remneralzaton

over demneralzaton [77]. Several randomzed clncal trals (RC)

have shown that CPP-ACP added to sugar-ree chewng gums, [78]

tooth paste [79] or dental cream [80,81] ncreased enamel subsurace

remneralzaton. Tese RC results suggested both a short-term

remneralzaton effect o CPP-ACP and a cares-preventng effect or

long-term clncal CPP-ACP use [82]. A recent study has demonstrated

that CPP could be detected on the tooth surace 3hours afer chewng

sugar ree gum contanng CPP ACP. Recaldent s an actve ngredent

derved rom caesn, part o proten ound n cow’s mlk. It workssaely; strengthen teeth by delverng calcum and phosphate n a

unque soluble orm to remneralze enamel. Recaldent wll not affect

people wth lactose ntolerance. Te acd resstance o enamel lesons

remneralzaton n stu by a sugar ree chewng gum contanng CPP

ACP s smlar to gum not contanng CPP ACP [83]. Ca et al. [84]

demonstrated the effect o CPP ACP ncorporated nto a sugar ree

lozenges on enamel remneralzaton n a human n stu model.

Concluson

We have a varety o new agents whch can be used to preventdental cares but applcaton o these agents n clncal trals s stlllmted n the developng countres. Moreover dental cares s a mult-actoral and all non-fluorde measures should be evaluated properly nhuman trals so that they can be ntroduced at the communty level orthe preventon o dental cares.

References

1. Selwitz RH, Ismail AI, Pitts NB (2007) Dental caries. Lancet 369: 51-59.

2. Singh ML, Papas AS (2009) Long-term clinical observation of dental caries

in salivary hypofunction patients using a supersaturated calcium-phosphate

remineralizing rinse. J Clin Dent 20: 87-92.

3. Dawes C (1989) Fluorides: mechanisms of action and recommendations for

use. J Can Dent Assoc 55: 721-723.

4. Walsh T, Worthington HV, Glenny AM, Appelbe P, Marinho VC, et al. (2010)

Fluoride toothpastes of different concentrations for preventing dental caries in

children and adolescents. Cochrane Database Syst Rev: CD007868.

5. American Dental Association Council on Scientic Affairs (2006) Professionally

applied topical uoride: evidence-based clinical recommendations. J Am Dent

Assoc 137: 1151-1159.

6. (2001) Recommendations for using uoride to prevent and control dental caries

http://dx.doi.org/10.4172/2332-0702.1000122http://www.ncbi.nlm.nih.gov/pubmed/17208642http://www.ncbi.nlm.nih.gov/pubmed/19711609http://www.ncbi.nlm.nih.gov/pubmed/19711609http://www.ncbi.nlm.nih.gov/pubmed/19711609http://www.ncbi.nlm.nih.gov/pubmed/2676116http://www.ncbi.nlm.nih.gov/pubmed/2676116http://www.ncbi.nlm.nih.gov/pubmed/20091655http://www.ncbi.nlm.nih.gov/pubmed/20091655http://www.ncbi.nlm.nih.gov/pubmed/20091655http://www.ncbi.nlm.nih.gov/pubmed/16873333http://www.ncbi.nlm.nih.gov/pubmed/16873333http://www.ncbi.nlm.nih.gov/pubmed/16873333http://www.ncbi.nlm.nih.gov/pubmed/11521913http://www.ncbi.nlm.nih.gov/pubmed/11521913http://www.ncbi.nlm.nih.gov/pubmed/16873333http://www.ncbi.nlm.nih.gov/pubmed/16873333http://www.ncbi.nlm.nih.gov/pubmed/16873333http://www.ncbi.nlm.nih.gov/pubmed/20091655http://www.ncbi.nlm.nih.gov/pubmed/20091655http://www.ncbi.nlm.nih.gov/pubmed/20091655http://www.ncbi.nlm.nih.gov/pubmed/2676116http://www.ncbi.nlm.nih.gov/pubmed/2676116http://www.ncbi.nlm.nih.gov/pubmed/19711609http://www.ncbi.nlm.nih.gov/pubmed/19711609http://www.ncbi.nlm.nih.gov/pubmed/19711609http://www.ncbi.nlm.nih.gov/pubmed/17208642http://dx.doi.org/10.4172/2332-0702.1000122


5/6


10.4172/2332-0702.1000122

Page 5 of 6



in the United States. Centers for Disease Control and Prevention. MMWR

Recomm Rep 50: 1-42.

7. Ahovuo-Saloranta A, Hiiri A, Nordblad A, Mäkelä M, Worthington HV (2008)

Pit and ssure sealants for preventing dental decay in the permanent teeth of children and adolescents. Cochrane Database Syst Rev: CD001830.

8. Beauchamp J, Caueld PW, Crall JJ, Donly K, Feigal R, Gooch B (2008)

Evidence-based clinical recommendations for the use of pit-and-ssure

sealants: a report of the American Dental Association Council on Scientic

Affairs. J Am Dent Assoc 139: 257-268.

9. Roberts AJ (1995) Role of models in assessing new agents for caries

prevention--non-uoride systems. Adv Dent Res 9: 304-311.

10. Ripa LW (1989) Clinical studies of high-potency uoride dentifrices: a review. J

Am Dent Assoc 118: 85-91.

11. Mullen J; European Association for Paediatric Dentistry (2005) History of water

uoridation. Br Dent J 199: 1-4.

12. Dental public health, Introduction to Community Dental Health: Slack.

13. Aas JA, Griffen AL, Dardis SR, Lee AM, Olsen I, et al. (2008) Bacteria of dental

caries in primary and permanent teeth in children and young adults. J Clin Microbiol 46: 1407-1417.

14. Becker MR, Paster BJ, Leys EJ, Moeschberger ML, Kenyon SG, et al. (2002)

Molecular analysis of bacterial species associated with childhood caries. J Clin

Microbiol 40: 1001-1009.

15. Bowden GH (1984) Possibilities for modifying the caries attack by altering the

oral microora. J Can Dent Assoc 50: 169-172.

16. Dawes C, Dibdin GH (2001) Salivary concentrations of urea released from a

chewing gum containing urea and how these affect the urea content of gel-

stabilized plaques and their pH after exposure to sucrose. Caries Res 35: 344-353.

17. Dibdin GH, Dawes C (1998) A mathematical model of the inuence of salivary

urea on the pH of fasted dental plaque and on the changes occurring during a

cariogenic challenge. Caries Res 32: 70-74.

18. Kleinberg I (1967) Effect of urea concentration on human plaque pH levels in

situ. Arch Oral Biol 12: 1475-1484.

19. Burne RA, Marquis RE (2000) Alkali production by oral bacteria and protection

against dental caries. FEMS Microbiol Lett 193: 1-6.

20. Van Wuyckhuyse BC, Perinpanayagam HE, Bevacqua D, Raubertas RF,

Billings RJ, et al. (1995) Association of free arginine and lysine concentrations

in human parotid saliva with caries experience. J Dent Res 74: 686-690.

21. Margolis HC, Duckworth JH, Moreno EC (1988) Composition of pooled resting

plaque uid from caries-free and caries-susceptible individuals. J Dent Res 67:

1468-1475.

22. Stephan RM (1944) Intra-oral hydrogen-ion concentration associated with

dental caries activity. J Dent Res 23: 257-266.

23. Turtola LO, Luoma H (1972) Plaque pH in caries-active and inactive subjects

modied by sucrose and uoride, with and without bicarbonate-phosphate.

Scand J Dent Res 80: 334-343.

24. Wolinsky LE, Mania S, Nachnani S, Ling S (1966) The inhibiting effect of aqueous Azadirachta indica (Neem) extract upon bacterial properties

inuencing in vitro plaque formation. J Dent Res. 75(2):816-822.

25. Agarwal P, Nagesh L, Murlikrishnan (2010) Evaluation of the antimicrobial

activity of various concentrations of Tulsi (Ocimum sanctum) extract against

Streptococcus mutans: an in vitro study. Indian J Dent Res. 21(3):357-359.

26. Seneviratne CJ, Wong RW, Hägg U, Chen Y, Herath TD, et al. (2011) Prunus

mume extract exhibits antimicrobial activity against pathogenic oral bacteria. Int

J Paediatr Dent 21: 299-305.

27. Ferrazzano A, Taylor PW, Hamilton-Miller JM, Stapleton PD (2005)

Antimicrobial properties of green tea catechins. Food Sci Technol Bull 2: 71-81.

28. Tagashira M, Bhattacharya, Uchiyama K, Yoshimura T, Shirota M (1997)

Inhibition by hop bract polyphenols of cellular adherence and water-insoluble

glucan synthesis of mutans streptococci. Biosci Biotechnol Biochem 61: 332-

335.

29. Ooshima T, Osaka Y, Sasaki H, Osawa K, Yasuda H, et al. (2000) Caries

inhibitory activity of cacao bean husk extract in in-vitro and animal experiments.

Arch Oral Biol 45: 639-645.

30. Osawa K, Miyazaki K, Shimura S, Okuda J, Matsumoto M, et al. (2001)

Identication of cariostatic substances in the cacao bean husk: their anti-

glucosyltransferase and antibacterial activities. J Dent Res 80: 2000-2004.

31. Steinberg D, Feldman M, Ofek I, Weiss EI (2004) Effect of a high-molecular-weight component of cranberry on constituents of dental biolm. J Antimicrob

Chemother 54: 86-89.

32. Koo H, Xiao J, Klein MI, Jeon JG (2010) Exopolysaccharides produced by

Streptococcus mutans glucosyltransferases modulate the establishment of

microcolonies within multispecies biolms. J Bacteriol 192: 3024-3032.

33. Yamanaka A, Kimizuka R, Kato T, Okuda K (2004) Inhibitory effects of

cranberry juice on attachment of oral streptococci and biolm formation. Oral

Microbiol Immunol 19: 150-154.

34. Koo H, Pearson SK, Scott-Anne K, Abranches J, Cury JA, et al. (2002) Effects

of apigenin and tt-farnesol on glucosyltransferase activity, biolm viability and

caries development in rats. Oral Microbiol Immunol 17: 337-343.

35. Koo H, Schobel B, Scott-Anne K, Watson G, Bowen WH, et al. (2005) Apigenin

and tt-farnesol with uoride effects on S. mutans biolms and dental caries. J

Dent Res 84: 1016-1020.

36. Darout IA, Albandar JM, Skaug N, Ali RW (2002) Salivary microbiota levels in

relation to periodontal status, experience of caries and miswak use in Sudanese

adults. J Clin Periodontol 29: 411-420.

37. Almas K, Al-Zeid Z (2004) The immediate antimicrobial effect of a toothbrush

and miswak on cariogenic bacteria: a clinical study. J Contemp Dent Pract 5:

105-114.

38. Ramakrishna Y, Goda H, Baliga MS, Munshi AK (2011) Decreasing cariogenic

bacteria with a natural, alternative prevention therapy utilizing phytochemistry

(plant extracts). J Clin Pediatr Dent 36: 55-63.

39. Ikeno K, Ikeno T, Miyazawa C (1991) Effects of propolis on dental caries in rats.

Caries Res 25: 347-351.

40. Duailibe SA1, Gonçalves AG, Ahid FJ (2007) Effect of a propolis extract on

Streptococcus mutans counts in vivo. J Appl Oral Sci 15: 420-423.

41. Koo H, Rosalen PL, Cury JA, Park YK, Ikegaki M, et al. (1999) Effect of

Apis mellifera propolis from two Brazilian regions on caries development in

desalivated rats. Caries Res 33: 393-400.

42. Li XC, Cai L, Wu CD (1997) Antimicrobial compounds from Ceanothus

americanus against oral pathogens. Phytochemistry 46: 97-102.

43. Xie Q, Li J, Zhou X (2008) Anticaries effect of compounds extracted from Galla

chinensis in a multispecies biolm model. Oral Microbiol Immunol 23: 459-465.

44. Greenberg M, Dodds M, Tian M (2008) Naturally occurring phenolic antibacterial

compounds show effectiveness against oral bacteria by a quantitative structure-

activity relationship study. J Agric Food Chem 56: 11151-11156.

45. Loesche WJ, Grossman NS, Earnest R, Corpron R (1984) The effect of

chewing xylitol gum on the plaque and saliva levels of Streptococcus mutans. J

Am Dent Assoc 108: 587-592.

46. Svanberg M, Birkhed D (1991) E ffect of dentifrices containing either xylitol and

glycerol or sorbitol on mutans streptococci in saliva. Caries Res 25: 449-453.

47. Vadeboncoeur C, Trahan L, Mouton C, Mayrand D (1983) Effect of xylitol on

the growth and glycolysis of acidogenic oral bacteria. J Dent Res 62: 882-884.

48. Arends J, Smits M, Ruben JL, Christoffersen J (1990) Combined effect of xylitol

and uoride on enamel demineralization in vitro. Caries Res 24: 256-257.

49. Isokangas P (1987) Xylitol chewing gum in caries prevention. A longitudinal

study on Finnish school children. Proc Finn Dent Soc 83: 1-117.

50. Alanen P, Isokangas P, Gutmann K (2000) Xylitol candies in caries prevention:

results of a eld study in Estonian children. Community Dent Oral Epidemiol

28: 218-224.

51. Honkala E, Honkala S, Shyama M, Al-Mutawa SA (2006) Field trial on caries

prevention with xylitol candies among disabled school students. Caries Res

40: 508-513.

52. Oscarson P, Lif Holgerson P, Sjostrom I, Twetman S, Stecksen-Blicks C (2006)

Inuence of a low xylitol-dose on mutans streptococci colonisation and caries

development in preschool children. Eur Arch Paediatr Dent 7: 142-147.

http://dx.doi.org/10.4172/2332-0702.1000122http://www.ncbi.nlm.nih.gov/pubmed/11521913http://www.ncbi.nlm.nih.gov/pubmed/11521913http://www.ncbi.nlm.nih.gov/pubmed/18843625http://www.ncbi.nlm.nih.gov/pubmed/18843625http://www.ncbi.nlm.nih.gov/pubmed/18843625http://www.ncbi.nlm.nih.gov/pubmed/18310730http://www.ncbi.nlm.nih.gov/pubmed/18310730http://www.ncbi.nlm.nih.gov/pubmed/18310730http://www.ncbi.nlm.nih.gov/pubmed/18310730http://www.ncbi.nlm.nih.gov/pubmed/8615950http://www.ncbi.nlm.nih.gov/pubmed/8615950http://www.ncbi.nlm.nih.gov/pubmed/2643652http://www.ncbi.nlm.nih.gov/pubmed/2643652http://www.ncbi.nlm.nih.gov/pubmed/2643652http://www.ncbi.nlm.nih.gov/pubmed/16215546http://www.ncbi.nlm.nih.gov/pubmed/16215546http://www.ncbi.nlm.nih.gov/pubmed/18216213http://www.ncbi.nlm.nih.gov/pubmed/18216213http://www.ncbi.nlm.nih.gov/pubmed/18216213http://www.ncbi.nlm.nih.gov/pubmed/11880430http://www.ncbi.nlm.nih.gov/pubmed/11880430http://www.ncbi.nlm.nih.gov/pubmed/11880430http://www.ncbi.nlm.nih.gov/pubmed/6367908http://www.ncbi.nlm.nih.gov/pubmed/6367908http://www.ncbi.nlm.nih.gov/pubmed/11641570http://www.ncbi.nlm.nih.gov/pubmed/11641570http://www.ncbi.nlm.nih.gov/pubmed/11641570http://www.ncbi.nlm.nih.gov/pubmed/9438574http://www.ncbi.nlm.nih.gov/pubmed/9438574http://www.ncbi.nlm.nih.gov/pubmed/9438574http://www.ncbi.nlm.nih.gov/pubmed/9438574http://www.ncbi.nlm.nih.gov/pubmed/5237332http://www.ncbi.nlm.nih.gov/pubmed/5237332http://www.ncbi.nlm.nih.gov/pubmed/11094270http://www.ncbi.nlm.nih.gov/pubmed/11094270http://www.ncbi.nlm.nih.gov/pubmed/7722066http://www.ncbi.nlm.nih.gov/pubmed/7722066http://www.ncbi.nlm.nih.gov/pubmed/7722066http://www.ncbi.nlm.nih.gov/pubmed/3198844http://www.ncbi.nlm.nih.gov/pubmed/3198844http://www.ncbi.nlm.nih.gov/pubmed/3198844http://jdr.sagepub.com/content/23/4/257.refshttp://jdr.sagepub.com/content/23/4/257.refshttp://www.ncbi.nlm.nih.gov/pubmed/4506735http://www.ncbi.nlm.nih.gov/pubmed/4506735http://www.ncbi.nlm.nih.gov/pubmed/4506735http://www.ncbi.nlm.nih.gov/pubmed/8655780http://www.ncbi.nlm.nih.gov/pubmed/8655780http://www.ncbi.nlm.nih.gov/pubmed/8655780http://www.ncbi.nlm.nih.gov/pubmed/8655780http://www.ncbi.nlm.nih.gov/pubmed/8655780http://www.ncbi.nlm.nih.gov/pubmed/20930344http://www.ncbi.nlm.nih.gov/pubmed/20930344http://www.ncbi.nlm.nih.gov/pubmed/20930344http://www.ncbi.nlm.nih.gov/pubmed/20930344http://www.ncbi.nlm.nih.gov/pubmed/20930344http://www.ncbi.nlm.nih.gov/pubmed/21401748http://www.ncbi.nlm.nih.gov/pubmed/21401748http://www.ncbi.nlm.nih.gov/pubmed/21401748http://www.ncbi.nlm.nih.gov/pubmed/19844590http://www.ncbi.nlm.nih.gov/pubmed/19844590http://www.ncbi.nlm.nih.gov/pubmed/9058972http://www.ncbi.nlm.nih.gov/pubmed/9058972http://www.ncbi.nlm.nih.gov/pubmed/9058972http://www.ncbi.nlm.nih.gov/pubmed/9058972http://www.ncbi.nlm.nih.gov/pubmed/10869475http://www.ncbi.nlm.nih.gov/pubmed/10869475http://www.ncbi.nlm.nih.gov/pubmed/10869475http://www.ncbi.nlm.nih.gov/pubmed/11759010http://www.ncbi.nlm.nih.gov/pubmed/11759010http://www.ncbi.nlm.nih.gov/pubmed/11759010http://www.ncbi.nlm.nih.gov/pubmed/15163648http://www.ncbi.nlm.nih.gov/pubmed/15163648http://www.ncbi.nlm.nih.gov/pubmed/15163648http://www.ncbi.nlm.nih.gov/pubmed/15163648http://www.ncbi.nlm.nih.gov/pubmed/20233920http://www.ncbi.nlm.nih.gov/pubmed/20233920http://www.ncbi.nlm.nih.gov/pubmed/20233920http://www.ncbi.nlm.nih.gov/pubmed/15107065http://www.ncbi.nlm.nih.gov/pubmed/15107065http://www.ncbi.nlm.nih.gov/pubmed/15107065http://www.ncbi.nlm.nih.gov/pubmed/12485324http://www.ncbi.nlm.nih.gov/pubmed/12485324http://www.ncbi.nlm.nih.gov/pubmed/12485324http://www.ncbi.nlm.nih.gov/pubmed/16246933http://www.ncbi.nlm.nih.gov/pubmed/16246933http://www.ncbi.nlm.nih.gov/pubmed/16246933http://www.ncbi.nlm.nih.gov/pubmed/12060423http://www.ncbi.nlm.nih.gov/pubmed/12060423http://www.ncbi.nlm.nih.gov/pubmed/12060423http://www.ncbi.nlm.nih.gov/pubmed/14973564http://www.ncbi.nlm.nih.gov/pubmed/14973564http://www.ncbi.nlm.nih.gov/pubmed/14973564http://www.ncbi.nlm.nih.gov/pubmed/22900445http://www.ncbi.nlm.nih.gov/pubmed/22900445http://www.ncbi.nlm.nih.gov/pubmed/22900445http://www.ncbi.nlm.nih.gov/pubmed/1836157http://www.ncbi.nlm.nih.gov/pubmed/1836157http://www.ncbi.nlm.nih.gov/pubmed/19089172http://www.ncbi.nlm.nih.gov/pubmed/19089172http://www.ncbi.nlm.nih.gov/pubmed/19089172http://www.ncbi.nlm.nih.gov/pubmed/19089172http://www.ncbi.nlm.nih.gov/pubmed/10460964http://www.ncbi.nlm.nih.gov/pubmed/10460964http://www.ncbi.nlm.nih.gov/pubmed/10460964http://www.ncbi.nlm.nih.gov/pubmed/9276981http://www.ncbi.nlm.nih.gov/pubmed/9276981http://www.ncbi.nlm.nih.gov/pubmed/18954351http://www.ncbi.nlm.nih.gov/pubmed/18954351http://www.ncbi.nlm.nih.gov/pubmed/19007234http://www.ncbi.nlm.nih.gov/pubmed/19007234http://www.ncbi.nlm.nih.gov/pubmed/19007234http://www.ncbi.nlm.nih.gov/pubmed/6427315http://www.ncbi.nlm.nih.gov/pubmed/6427315http://www.ncbi.nlm.nih.gov/pubmed/6427315http://www.ncbi.nlm.nih.gov/pubmed/1810657http://www.ncbi.nlm.nih.gov/pubmed/1810657http://www.ncbi.nlm.nih.gov/pubmed/6575035http://www.ncbi.nlm.nih.gov/pubmed/6575035http://www.ncbi.nlm.nih.gov/pubmed/2276161http://www.ncbi.nlm.nih.gov/pubmed/2276161http://www.ncbi.nlm.nih.gov/pubmed/2276161http://www.ncbi.nlm.nih.gov/pubmed/2276161http://www.ncbi.nlm.nih.gov/pubmed/3685009http://www.ncbi.nlm.nih.gov/pubmed/3685009http://www.ncbi.nlm.nih.gov/pubmed/10830649http://www.ncbi.nlm.nih.gov/pubmed/10830649http://www.ncbi.nlm.nih.gov/pubmed/10830649http://www.ncbi.nlm.nih.gov/pubmed/17063022http://www.ncbi.nlm.nih.gov/pubmed/17063022http://www.ncbi.nlm.nih.gov/pubmed/17063022http://www.ncbi.nlm.nih.gov/pubmed/17140543http://www.ncbi.nlm.nih.gov/pubmed/17140543http://www.ncbi.nlm.nih.gov/pubmed/17140543http://www.ncbi.nlm.nih.gov/pubmed/17140543http://www.ncbi.nlm.nih.gov/pubmed/17140543http://www.ncbi.nlm.nih.gov/pubmed/17140543http://www.ncbi.nlm.nih.gov/pubmed/17063022http://www.ncbi.nlm.nih.gov/pubmed/17063022http://www.ncbi.nlm.nih.gov/pubmed/17063022http://www.ncbi.nlm.nih.gov/pubmed/10830649http://www.ncbi.nlm.nih.gov/pubmed/10830649http://www.ncbi.nlm.nih.gov/pubmed/10830649http://www.ncbi.nlm.nih.gov/pubmed/3685009http://www.ncbi.nlm.nih.gov/pubmed/3685009http://www.ncbi.nlm.nih.gov/pubmed/2276161http://www.ncbi.nlm.nih.gov/pubmed/2276161http://www.ncbi.nlm.nih.gov/pubmed/6575035http://www.ncbi.nlm.nih.gov/pubmed/6575035http://www.ncbi.nlm.nih.gov/pubmed/1810657http://www.ncbi.nlm.nih.gov/pubmed/1810657http://www.ncbi.nlm.nih.gov/pubmed/6427315http://www.ncbi.nlm.nih.gov/pubmed/6427315http://www.ncbi.nlm.nih.gov/pubmed/6427315http://www.ncbi.nlm.nih.gov/pubmed/19007234http://www.ncbi.nlm.nih.gov/pubmed/19007234http://www.ncbi.nlm.nih.gov/pubmed/19007234http://www.ncbi.nlm.nih.gov/pubmed/18954351http://www.ncbi.nlm.nih.gov/pubmed/18954351http://www.ncbi.nlm.nih.gov/pubmed/9276981http://www.ncbi.nlm.nih.gov/pubmed/9276981http://www.ncbi.nlm.nih.gov/pubmed/10460964http://www.ncbi.nlm.nih.gov/pubmed/10460964http://www.ncbi.nlm.nih.gov/pubmed/10460964http://www.ncbi.nlm.nih.gov/pubmed/19089172http://www.ncbi.nlm.nih.gov/pubmed/19089172http://www.ncbi.nlm.nih.gov/pubmed/1836157http://www.ncbi.nlm.nih.gov/pubmed/1836157http://www.ncbi.nlm.nih.gov/pubmed/22900445http://www.ncbi.nlm.nih.gov/pubmed/22900445http://www.ncbi.nlm.nih.gov/pubmed/22900445http://www.ncbi.nlm.nih.gov/pubmed/14973564http://www.ncbi.nlm.nih.gov/pubmed/14973564http://www.ncbi.nlm.nih.gov/pubmed/14973564http://www.ncbi.nlm.nih.gov/pubmed/12060423http://www.ncbi.nlm.nih.gov/pubmed/12060423http://www.ncbi.nlm.nih.gov/pubmed/12060423http://www.ncbi.nlm.nih.gov/pubmed/16246933http://www.ncbi.nlm.nih.gov/pubmed/16246933http://www.ncbi.nlm.nih.gov/pubmed/16246933http://www.ncbi.nlm.nih.gov/pubmed/12485324http://www.ncbi.nlm.nih.gov/pubmed/12485324http://www.ncbi.nlm.nih.gov/pubmed/12485324http://www.ncbi.nlm.nih.gov/pubmed/15107065http://www.ncbi.nlm.nih.gov/pubmed/15107065http://www.ncbi.nlm.nih.gov/pubmed/15107065http://www.ncbi.nlm.nih.gov/pubmed/20233920http://www.ncbi.nlm.nih.gov/pubmed/20233920http://www.ncbi.nlm.nih.gov/pubmed/20233920http://www.ncbi.nlm.nih.gov/pubmed/15163648http://www.ncbi.nlm.nih.gov/pubmed/15163648http://www.ncbi.nlm.nih.gov/pubmed/15163648http://www.ncbi.nlm.nih.gov/pubmed/11759010http://www.ncbi.nlm.nih.gov/pubmed/11759010http://www.ncbi.nlm.nih.gov/pubmed/11759010http://www.ncbi.nlm.nih.gov/pubmed/10869475http://www.ncbi.nlm.nih.gov/pubmed/10869475http://www.ncbi.nlm.nih.gov/pubmed/10869475http://www.ncbi.nlm.nih.gov/pubmed/9058972http://www.ncbi.nlm.nih.gov/pubmed/9058972http://www.ncbi.nlm.nih.gov/pubmed/9058972http://www.ncbi.nlm.nih.gov/pubmed/9058972http://www.ncbi.nlm.nih.gov/pubmed/19844590http://www.ncbi.nlm.nih.gov/pubmed/19844590http://www.ncbi.nlm.nih.gov/pubmed/21401748http://www.ncbi.nlm.nih.gov/pubmed/21401748http://www.ncbi.nlm.nih.gov/pubmed/21401748http://www.ncbi.nlm.nih.gov/pubmed/20930344http://www.ncbi.nlm.nih.gov/pubmed/20930344http://www.ncbi.nlm.nih.gov/pubmed/20930344http://www.ncbi.nlm.nih.gov/pubmed/8655780http://www.ncbi.nlm.nih.gov/pubmed/8655780http://www.ncbi.nlm.nih.gov/pubmed/8655780http://www.ncbi.nlm.nih.gov/pubmed/4506735http://www.ncbi.nlm.nih.gov/pubmed/4506735http://www.ncbi.nlm.nih.gov/pubmed/4506735http://jdr.sagepub.com/content/23/4/257.refshttp://jdr.sagepub.com/content/23/4/257.refshttp://www.ncbi.nlm.nih.gov/pubmed/3198844http://www.ncbi.nlm.nih.gov/pubmed/3198844http://www.ncbi.nlm.nih.gov/pubmed/3198844http://www.ncbi.nlm.nih.gov/pubmed/7722066http://www.ncbi.nlm.nih.gov/pubmed/7722066http://www.ncbi.nlm.nih.gov/pubmed/7722066http://www.ncbi.nlm.nih.gov/pubmed/11094270http://www.ncbi.nlm.nih.gov/pubmed/11094270http://www.ncbi.nlm.nih.gov/pubmed/5237332http://www.ncbi.nlm.nih.gov/pubmed/5237332http://www.ncbi.nlm.nih.gov/pubmed/9438574http://www.ncbi.nlm.nih.gov/pubmed/9438574http://www.ncbi.nlm.nih.gov/pubmed/9438574http://www.ncbi.nlm.nih.gov/pubmed/11641570http://www.ncbi.nlm.nih.gov/pubmed/11641570http://www.ncbi.nlm.nih.gov/pubmed/11641570http://www.ncbi.nlm.nih.gov/pubmed/6367908http://www.ncbi.nlm.nih.gov/pubmed/6367908http://www.ncbi.nlm.nih.gov/pubmed/11880430http://www.ncbi.nlm.nih.gov/pubmed/11880430http://www.ncbi.nlm.nih.gov/pubmed/11880430http://www.ncbi.nlm.nih.gov/pubmed/18216213http://www.ncbi.nlm.nih.gov/pubmed/18216213http://www.ncbi.nlm.nih.gov/pubmed/18216213http://www.ncbi.nlm.nih.gov/pubmed/16215546http://www.ncbi.nlm.nih.gov/pubmed/16215546http://www.ncbi.nlm.nih.gov/pubmed/2643652http://www.ncbi.nlm.nih.gov/pubmed/2643652http://www.ncbi.nlm.nih.gov/pubmed/8615950http://www.ncbi.nlm.nih.gov/pubmed/8615950http://www.ncbi.nlm.nih.gov/pubmed/18310730http://www.ncbi.nlm.nih.gov/pubmed/18310730http://www.ncbi.nlm.nih.gov/pubmed/18310730http://www.ncbi.nlm.nih.gov/pubmed/18310730http://www.ncbi.nlm.nih.gov/pubmed/18843625http://www.ncbi.nlm.nih.gov/pubmed/18843625http://www.ncbi.nlm.nih.gov/pubmed/18843625http://www.ncbi.nlm.nih.gov/pubmed/11521913http://www.ncbi.nlm.nih.gov/pubmed/11521913http://dx.doi.org/10.4172/2332-0702.1000122


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53. Milgrom P, Ly KA, Tut OK, Mancl L, Roberts MC, et al. (2009) Xylitol pediatric

topical oral syrup to prevent dental caries: a double-blind randomized clinical

trial of efcacy. Arch Pediatr Adolesc Med 163: 601-607.

54. Sintes JL, Elias-Boneta A, Stewart B, Volpe AR, Lovett J (2002) Anticaries efcacy of a sodium monouorophosphate dentifrice containing xylitol in a

dicalcium phosphate dihydrate base. A 30-month caries clinical study in Costa

Rica. Am J Dent 15: 215-219.

55. Sintes JL, Escalante C, Stewart B, McCool JJ, Garcia L, et al. (1995) Enhanced

anticaries efcacy of a 0.243% sodium uoride/10% xylitol/silica dentifrice:

3-year clinical results. Am J Dent 8: 231-235.

56. Tanboga I, Çaglar E, Kargul B (2003) Campaign of probiotic food consumption

in Turkish children, oral perspectives ‘Probiotics for your child’. Int J Pediatr

Dent. 13: 59-64.

57. Caglar E, Holcombh, Kargul B, Tanboga I (2005) Bacteriotherapy and

probiotics’ role on oral health. Oral Dis 11: 131-137.

58. Comelli EM, Guggenheim B, Stingele F, Neeser JR (2002) Selection of dairy

bacterial strains as probiotics for oral health. Eur J Oral Sci 110: 218-224.

59. Ahola AJ, Yli-Knuuttila H, Suomalainen T, Poussa T, Ahlström A, et al. (2002) Short-term consumption of probiotic-containing cheese and its effect on dental

caries risk factors. Arch Oral Biol 47: 799-804.

60. Caglar E, Cildir SK, Ergeneli S, Sandalli N, Twetman S (2006) Salivary mutans

streptococci and lactobacilli levels after ingestion of the probiotic bacterium

Lactobacillus reuteri ATCC 55730 by straws or tablets. Acta Odontol Scand

64: 314-318.

61. Wolf BW, Garleb KA, Ataya DG, Casas IA (1995) Safety and tolerance of

Lactobacillus reuteri in healthy adult male subjects. Microb Ecol Health Dis.

8: 41-50.

62. Caglar E, Kuscu OO, Cildir SK, Kuvvetli SS, Sandalli N (2008) A probiotic

lozenge administered medical device and its effect on salivary mutans

streptococci and lactobacilli. Int J Paediatr Dent 18: 35-39.

63. Allan I, Newman H, Wilson M (2001) Antibacterial activity of particulate bioglass

against supra- and subgingival bacteria. Biomaterials 22: 1683-1687.

64. Marinho VC, Higgins JP, Sheiham A, Logan S (2003) Fluoride toothpastes for preventing dental caries in children and adolescents. Cochrane Database Syst

Rev. 1: CD002278.

65. Allaudin SS, Fontana M (2006) Evaluation of Novamin as an adjunct to uoride

for caries lesion remineralization. Novamin Research Report.

66. KG Chhabra, Preetha J Shetty, Prasad KVV, Chaya S Mendon, Ramya

Kalyanpur. (2011) The beyond measures: Non ouride preventive measures

for dental caries. JIOH 3: 1-7.

67. Marsh PD (2010) Controlling the oral biolm with antimicrobials. J Dent 38

Suppl 1: S11-15.

68. Oatmen RT. Preventive Dentistry Techniques in the Treatment of Dental Caries

and Biolm Control: A Review. Honors Projects. Undergraduate Research and

Creative Practice.

69. Autio-Gold J (2008) The role of chlorhexidine in caries prevention. Oper Dent

33: 710-716.

70. Jenkins S, Addy M, Newcombe R (1991) Triclosan and sodium lauryl sulphate

mouthwashes (I). Effects on salivary bacterial counts. J Clin Periodontol 18:

140-144.

71. Kulkarni VV, Damle SG (2003) Comparative evaluation of efcacy of sodium uoride, chlorhexidine and triclosan mouth rinses in reducing the mutans

streptococci count in saliva: an in vivo study. J Indian Soc Pedod Prev Dent

21: 98-104.

72. Shapiro S, Guggenheim B (1995) The action of thymol on oral bacteria. Oral

Microbiol Immunol 10: 241-246.

73. Glass RL, Rothman KJ, Espinal F, Vélez H, Smith NJ (1973) The prevalence of

human dental caries and water-borne trace metals. Arch Oral Biol 18: 1099-1104.

74. Reynolds EC (1998) Anticariogenic complexes of amorphous calcium

phosphate stabilized by casein phosphopeptides: a review. Spec Care Dentist

18: 8-16.

75. Reynolds EC (1987) The prevention of sub-surface demineralization of bovine

enamel and change in plaque composition by casein in an intra-oral model. J

Dent Res 66: 1120-1127.

76. Reynolds E (2007) Calcium phosphopeptide complexes.77. Azarpazhooh A, Limeback H (2008) Clinical efcacy of casein derivatives: a

systematic review of the literature. J Am Dent Assoc 139: 915-924.

78. Morgan MV, Adams GG, Bailey DL, Tsao CE, Fischman SL, et al. (2008) The

anticariogenic effect of sugar-free gum containing CPP-ACP nanocomplexes

on approximal caries determined using digital bitewing radiography. Caries Res

42: 171-184.

79. Rao SK, Bhat GS, Aradhya S, Devi A, Bhat M (2009) Study of the efcacy of

toothpaste containing casein phosphopeptide in the prevention of dental caries:

a randomized controlled trial in 12- to 15-year-old high caries risk children in

Bangalore, India. Caries Res 43: 430-435.

80. Andersson A, Skold-Larsson K, Hallgren A (2007) Effect of a dental cream

containing amorphous cream phosphate complexes on white spot lesion

regression assessed by laser uorescence. Oral Health Prev Dent. 5: 229-233.

81. Bailey DL, Adams GG, Tsao CE, Hyslop A, Escobar K, et al. (2009) Regression

of post-orthodontic lesions by a remineralizing cream. J Dent Res 88: 1148-1153.

82. Yengopal V, Mickenautsch S (2009) Caries preventive effect of casein

phosphopeptide-amorphous calcium phosphate (CPP-ACP): a meta-analysis.

Acta Odontol Scand 67: 321-332.

83. Iijima Y, Cai F, Shen P (2004) Acid resistance of enamel subsurface lesions

remineralized by a sugar free chewing gum containing casein phosphopeptide-

amorphous calcium phosphate. Caries Res 38: 551-56.

84. Cai F, Shen P, Morgan MV, Reynolds EC (2003) Remineralization of

enamel subsurface lesions in situ by sugar-free lozenges containing casein

phosphopeptide-amorphous calcium phosphate. Aust Dent J 48: 240-243.

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Citation: Agarwal R, Singh C, Yeluri R, Chaudhry K (2014) Prevention of DentalCaries-Measures beyond Fluoride. Oral Hyg Health 2: 122. doi: 10.4172/2332-

0702.1000122
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