Evaluation of the effects of fluoride varnish and casein phosphopeptide amorphous calcium phosphate on prevention of dental erosion caused by pediatric medicines on primary teeth

Dental erosion is defined as a progressive loss of dental hard tissues by chemical dissolution without bacterial involvement. Currently the prevalence of dental erosion has increased especially among children and adolescents. The aetiology has been related to the regular use of products with low endogenous pH, high acidity, and absence or low concentrations of ions including those of calcium, fluoride, and phosphate in their composition. The liquid medicatitons are among these products because they possess these characteristics. Therefore, in view of the increased use of oral medicines by children for prolonged periods in recent years, especially those with chronic diseases, the aim of this in vitro research was to evaluate, the effect of application of fluoride varnish and casein phosphopeptide amorph calcium phosphate against dental erosion caused by medications on primary teeth. In the study, non-cariogenic, healthy 60 primary molar teeth that freshly extracted and 4 pediatric liquid medicine that have different content were used. %5 NaF (Enamelast®, Ultradent Product Inc., USA) varnish and Tooth Mousse (Tooth Mousse®, GC America Inc., Alsip, USA) used as a protective agents againts dental erosion caused by pediatric syrups and erosive challange. The samples were arranged to be 5 tooth enamel samples in each acrylic block and and total acrylic blocks' number were 24. The samples divided into 12 groups (n=10) as; G1= Augmentin, G2= Lordes, G3= Polivit , G4= Ventolin, G5= Fluoride varnish + Augmentin, G6= Fluoride varnish + Lordes, G7= Fluoride varnish + Polivit, G8= Fluoride varnish + Ventolin, G9= GC Tooth Mousse + Augmentin, G10= GC Tooth Mousse + Lordes, G11= GC Tooth Mousse + Polivit, G12= GC Tooth Mousse + Ventolin. Before immersion cycles, the drug's pH, titratable acidity and buffering capacities were measured. As a control groups, medicines applied for G1, G2, G3, G4 twice a day for 5 min, then immersed artificial saliva. Fluoride varnishes applied for G5, G6, G7, G8 before the pH cycle and the specimens were stored for 24 hour in a moist environment. CPP-ACP applied 3 min twice a day for G9, G10, G11, G12, before and after the demineralization. Except contol groups, the specimens were subjected to erosive cycles for five days. After erosive cycle the speicmens immersed in a remineralization sdolution for two days. The surface microhardness was checked at baseline and at the end of 7th day by Vickers hardness testing machine (HMV-2 series Shimadzu Corporation, Kyoto, Japan). Data were analyzed with paired t-test, Wilcoxon t-test, Mann Whitney U test and Kruskall Wallis test. P < 0.05 was considered to be significant for all analyzes. The microhardness values of all groups ( except G5, G7, G8 ) showed that there was a significant difference between baseline and final measurments. Except G5, G7 and G8, all groups showed significant decrease of microhardness values after immersion cycle. According to the findings of this study, fluoride varnish have a significant effect on erosion, protecting the enamel positive remineralization activity on preventing dental erosion. CPP-ACP failed to protect tooth samples during the erosive challange.