The Role of Remineralising Agents in Oral Care

Remineralisation refers to the natural repair mechanism that restores minerals in the teeth in the ionic form to the hydroxyapatite crystal lattice. 

This process usually occurs under near-neutral pH conditions and forms new hydroxyapatite crystals that are more resistant to dissolution by acids in the oral cavity.

Remineralising agents are substances/ molecules that assist in the remineralisation cycle.

Tooth remineralisation takes place when the oral cavity reaches a ‘critical pH’, typically around 5.5. This means above this pH the teeth begin to remineralise. This may occur due to one or more of the following :

• Low cariogenic bacterial concentration
• Fluoride availability 
• High salivary secretion rate
• Inorganic ions in saliva

To be a good remineralising agent, a substance should:

• Be able to deliver optimum calcium and phosphate to the sub-surface
• Be able to work at an acidic pH
• Not encourage the formation of calcium
• Enhance saliva’s remineralisation properties 
• Have benefits over fluoride

Arginine is a naturally occurring amino acid found in dietary proteins and has been considered safe for use in dentifrices. It is a major substrate for generating alkaline ions by oral biofilms colonising teeth. It has a multifaceted mechanism of action, and here’s how it helps remineralisation in the oral cavity:

•  It acts as an eco-modulator of biofilm and promotes pH homeostasis via metabolism.
• It helps reverse white spots and early demineralised lesions
• Arginine metabolism produces ammonia as one of the byproducts, which influences the host’s ability to prevent or stop caries progression by encouraging remineralisation.
• Since less acid is produced in an alkaline environment, demineralisation is reduced.
• The alkaline environment also prevents the proliferation of cariogenic bacteria.

Casein is a milk phosphor protein that interacts with calcium and phosphate. Here’s how it helps remineralise the tooth structure:

• Calcium phosphopeptide (CPP) stabilises calcium and phosphate ions in dental plaque and enamel. 
• It also keeps calcium and phosphate in the amorphous state, enabling them to enter enamel.
• CPP stabilises amorphous calcium phosphate (ACP) , maintaining a state of supersaturation of calcium and phosphate. This reduces demineralisation and increases the possibility of remineralisation.

Fluoride-based products remineralise enamel and help reduce demineralisation. They are popular due to their cariostatic abilities and affordability. The most common fluoride product used as remineralising agents is varnishes. 

Here’s how they work!

• The fluoride ions from the varnish bind to enamel and dentine, making them more acid resistant.
• Fluoride varnishes also adhere to the tooth surfaces for a long time, keeping them in close contact with fluoride longer.

This popular non-acidogenic sweetener is known to interfere with plaque formation. Here’s how it contributes as a remineralising agent:

• It interferes with the adherence of plaque to the tooth surface.
• Neutralises plaque pH by decreasing the formation of lactic acid.
• It increases the salivary flow rate and stimulates the production of bicarbonate and phosphates.
• It is known to reduce the levels of S. mutans and inhibit its metabolism.

Encourage remineralisation and improve clinical outcomes.

This is the most patented toothpaste globally and boasts of technology that combines natural chemistry and biology of the oral cavity to deliver complete oral health protection.

Colgate Total contains a Dual Zinc Arginine formula that works in the following ways:

• Arginine destabilises the bacterial biofilms and enhances zinc delivery.
• Zinc Citrate and oxide have immediate antimicrobial action but continue to fight germs for 12 hours—nonstop!

Benefits of Colgate Total

• Reduce plaque and gingivitis
• Reduce sensitivity
• Reduce bacterial growth on teeth, gums and cheeks
• Reduce bad breath
• Reduce stains

References:

1. Qaiser, S., Devadiga, D., & Hegde, M. N. (n.d.). Remineralising Agents: An Updated Review. Research Journal of Pharmaceutical Biological and Chemical Sciences, 11(1), 181-188. https://doi.org/10.33887/rjpbcs/2020.11.1.25

2. Arifa, M. K., Ephraim, R., & Rajamani, T. (2019). Recent advances in dental hard tissue remineralization: A review of literature. International Journal of Clinical Pediatric Dentistry, 12(2), 139-144. https://doi.org/10.5005/jp-journals-10005-1603

3. Marwah, N., Asokan, S., Puranik, M. P., Nuvvula, S., Suprabha, B. S., Wadgave, U., Goyal, V., Kakanur, M., Damle, S., Sreenivasan, P., Shyam, S., & Thakur, D. (2023). Arginine: A new paradigm in preventive oral care. International Journal of Clinical Pediatric Dentistry, 16(5), 698-706. https://doi.org/10.5005/jp-journals-10005-2693