Non-Fluoridated Remineralising Agents - A Review of Literature

Dental caries is not merely a continuous and one-way process of demineralisation of the mineral phase, but repeated episodes of demineralisations and remineralisation. The remineralisation process is a natural repair mechanism to restore the minerals again, in ionic forms, to the hydroxyapatite (HAP) crystal lattice. It occurs under nearneutral physiological pH conditions whereby calcium and phosphate mineral ions are redeposited within the caries lesion from saliva and plaque fluid resulting in the formation of newer HAP crystals, which are larger and more resistant to acid dissolution. An insight into the caries process’s multifactorial aetiopathogenesis has resulted in a paradigm shift towards minimally invasive dentistry. This era of personalised care using the medical model for caries management assimilates the signs of examining, diagnosing, intercepting, and managing dental caries at a microscopic level. Fluoride mediated salivary remineralisation system is considered the cornerstone of non-invasive approach for managing non-cavitated carious lesions. However, the effect of fluoride was found to be limited to the outer surface of the tooth, and it was observed that fluoride does not influence the modifiable factors in dental caries such as the biofilm. Hence, fluoride does not reduce the cariogenic challenge especially for high-risk individuals. Due to this gap in the conventional fluoride therapies, non-fluoridated remineralising systems have emerged, which interact with the tooth by delivering calcium and phosphorous ions, modifying the biofilm and neutralising the organic acids. This review re-examines the philosophy behind non-fluoridated remineralisation, their mode of action, availability in the market and evidence-based studies of the most promising advancements in remineralisation approaches. KEY WORDS Caries, Minimally Invasive Dentistry, Remineralisation, Non-Fluoridated Remineralising Systems