New Preventive Approaches Part I: Functional Peptides and Other Therapies to Prevent Tooth Demineralization

The limited effect of fluoride on root caries has prompted the study of new preventive therapies, which involve recently developed functional peptides, lasers, phosphate-based technologies, among several other approaches. Most of the specific peptides currently investigated have been developed based on the available information related to the protective action of salivary proteins, including statherin-derived peptides. Other peptides include 8DSS, self-assembling peptide P11-4, antimicrobial peptides, and casein phosphopeptides combined with amorphous calcium phosphate. These were shown to increase remineralization and/or to protect against demineralization through different mechanisms, including the attraction of calcium ions to the demineralized tissue, delivery of available calcium, and antimicrobial action. Regarding phosphate-based technologies, the addition of polyphosphate salts to fluoridated vehicles has been shown to promote a synergistic effect in promoting enamel remineralization and in preventing demineralization, in studies with in vitro, in situ, and clinical protocols. Sodium trimetaphosphate has also been shown to promote intrafibrillar collagen remineralization, phosphate uptake by previously demineralized dentin, and deposition of needle-like crystallites at intrafibrillar level. As for the use of lasers, their effects on the mineral content and crystallinity of dentin were shown to be related to the removal of water and protein, besides surface melting by thermal degradation. Lasers have also been shown to have synergistic/additive effects with fluoride on the prevention of root dentin demineralization, due to the enhanced fluoride uptake and the decreased calcium and phosphate loss. Although the above-mentioned therapies seem to be promising alternatives to prevent root caries, clinical evidence is still required.