Efficacy of Theobromine and Sodium Fluoride Solutions for Remineralization of Initial Enamel Caries Lesions
Abstract
Objectives: This study investigated the efficacy of theobromine in comparison with 0.05% sodium fluoride solution for remineralization of initial enamel caries lesions (IECLs).
Materials and Methods: Ninety non-carious extracted premolars were sectioned longitudinally into buccal and lingual segments. Caries-like lesions were induced in each segment using acidified gel. Forty-five buccal segments were used for surface microhardness (SMH) test, and 45 buccal segments were used for energy-dispersive X-ray spectroscopy (EDS). The lingual segments were used as the control group for EDS and SMH test. The baseline SMH was measured with a Vickers hardness tester, and the baseline calcium content was analyzed by EDS. Each test group was divided into three subgroups for treatment with (1) artificial saliva, (2) 1.1 mol/L theobromine, and (3) 0.05% sodium fluoride. Remineralization and demineralization were done by daily pH cycling to simulate the oral environment. Samples in each group were immersed in treatment solutions for 1 min before and after the remineralizing cycle. After a 7-day cycle, the SMH test and EDS analysis were performed again. Data were analyzed using one-way ANOVA, Tukey’s post-hoc test, and paired sample t-test (P<0.05).
Results: All treatments effectively remineralized the IECLs (P<0.05), and theobromine caused the maximum increase in SMH, which was significantly higher than the value in sodium fluoride group (mean value of 36.56±4.95 versus 23.25±3.92; P=0.000). EDS showed the highest calcium deposition in theobromine group (3.82±1.83wt%).
Conclusion: Theobromine is an effective cariostatic agent, and can be considered as a safe alternative to fluoride in preventive dental care.
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2. Vargas CM, Crall JJ, Schneider DA. Sociodemographic distribution of pediatric dental caries: NHANES III, 1988–1994. J Am Dent Assoc. 1998 Sep;129(9):1229-38.
3. Mohammadi M, Vaisi Raiegani, Jalali R. The prevalence of dental caries in decidiouse and permanent teeth in iranian children:A systematic review and meta-analisis. J Res Dent Sci. 2018 Sep;15(3):180-9.
4. White JM, Eakle WS. Rationale and treatment approach in minimally invasive dentistry. J Am Dent Assoc. 2000 Jun;131(1):13-9.
5. Arifa MK, Ephraim R, Rajamani T. Recent advances in dental hard tissue remineralization: A review of literature. Int J Clin Pediatr Dent. 2019 Mar-Apr;12(2):139-4.
6. Amaechi BT. Remineralization therapies for initial caries lesions. Curr Oral Health Rep. 2015 Apr;2(2):95-101.
7. Gocmen GB, Yanikoglu F, Tagtekin D, Stookey GK, Schemehorn BR, Hayran O. Effectiveness of some herbals on initial enamel caries lesion. Asian Pac J Trop Biomed. 2016 Oct;6(10):846-50.
8. Barbier O, Arreola-Mendoza L, Del Razo LM. Molecular mechanisms of fluoride toxicity. Chem Biol Interact. 2010 Nov;188(2):319-33.
9. Aravind A, Dhanya R, Narayan A, Sam G, Adarsh V, Kiran M. Effect of fluoridated water on intelligence in 10-12-year-old school children. J Int Soc Prev Community Dent. 2016 Dec;6(3):237-42.
10. Nakamoto T, Falster AU, Simmons Jr WB. Theobromine: a safe and effective alternative for fluoride in dentifrices. J Caff Res. 2016 Feb;6(1):1-9.
11. Nakamoto T, Simmons Jr WB, Falster AU, inventors; Biomedical Development Corp, assignee. Products of apatite-forming-systems. United States patent US 5,919,426. 1999 Jul 6.
12. Sadeghpour A. Chocolate and dental health. Chocolate and Health: Chemistry, Nutrition and Therapy PK Wilson and WJ Hurst (Eds) London: Royal Society of Chemistry. 2015 May:196-210.
13. Sadeghpour A, Nakamoto T, inventors; THEOCORP HOLDING CO LLC, assignee. Methods and compositions to improve mechanical resistance of teeth. United States patent US 9,610,235. 2017 Apr 4.
14. Syafira G, Permatasari R, Wardani N. Theobromine effects on enamel surface microhardness: In Vitro. J Dent Indonesia. 2012 Aug;19(2):32-6.
15. Suryana M, Irawan B, Soufyan A, editors. The effects of toothpastes containing theobromine and hydroxyapatite on enamel microhardness after immersion in carbonated drink. J Phys: Conf. Ser 2018 Aug;1073(3):32-7.
16. Lakshmi A, Vishnurekha C, Baghkomeh PN. Effect of theobromine in antimicrobial activity: An in vitro study. Dent Res J. 2019Mar-Apr;16(2):76-80.
17. Irawan M, Noerdin A, Eriwati YK, editors. The effect of time in the exposure of theobromine gel to enamel and surface hardness after demineralization with 1% citric acid. J Phys: Conf. Ser 2017 Aug;884(1):20-5.
18. Thorn AK, Lin WS, Levon JA, Morton D, Eckert GJ, Lippert F. The effect of theobromine on the in vitro de-and remineralization of enamel carious lesions. J Dent: X. 2020 May;3(1):100013.
19. Lippert F. The effects of fluoride, strontium, theobromine and their combinations on caries lesion rehardening and fluoridation. Arch Oral Biol. 2017Aug;80(1):217-21.
20. Amaechi B, Porteous N, Ramalingam K, Mensinkai P, Vasquez RC, Sadeghpour A, et al. Remineralization of artificial enamel lesions by theobromine. Caries Res. 2013 Apr;47(5):399-405.
21. Amaechi B, Higham S. In vitro remineralisation of eroded enamel lesions by saliva. J Dent. 2001 Jul;29(5):371-6.
22. Amaechi B, Higham S, Edgar W. Factors affecting the development of carious lesions in bovine teeth in vitro. Arch Oral Biol. 1998 Aug;43(8):619-28.
23. Verma A, Khurshid S, Parveen F, Khanna S, Pandey P. Remineralization: an approach towards conservation of tooth. J Evol Med and Dent Sci. 2015 Jul;4(61):10713-9.
24. Marinho VC, Chong LY, Worthington HV, Walsh T. Fluoride mouthrinses for preventing dental caries in children and adolescents. Cochrane Database Syst. Rev. 2016 Jul; 7(1):CD002284.
25. Santos A, Oliveira B, Nadanovsky P. Effects of low and standard fluoride toothpastes on caries and fluorosis: systematic review and meta-analysis. Caries Res. 2013 Feb;47(5):382-90.
26. Nasution AI, Zawil C. The comparison of enamel hardness between fluoride and theobromine application. Int J Contemp Dent Med Rev. 2014 Dec;1(1):1-4.
27. Qasthari A, Irawan B, Herda E, editors. The influence of brushing with theobromine and sodium monofluorophosphate toothpaste on enamel surface resistance to roughness after demineralization. J Phys: Conf. Ser 2018 Aug;1073(3):37-42.
28. Sulistianingsih I, Hidayat O. The remineralization potential of cocoa bean extract (Theobroma cacao) to increase the enamel microhardness. Padjajaran J Dent. 2017 Jul;29(2):107-12.
29. Kargul B, Özcan M, Peker S, Nakamoto T, Simmons WB, Falster AU. Evaluation of human enamel surfaces treated with theobromine: a pilot study. Oral Health and Prev Dent. 2012 Oct;10(3):275-82.
30. Pushpalatha C, Hegde S, Deveswaran R, Anandakrishna L. Assessment of remineralization potential of novel varnish on early enamel lesions using different optical methods. Emerging Trends in Photonics, Signal Processing and Communication Engineering: Springer; 2020: 195-202.
31. Eanes E. Enamel apatite: chemistry, structure and properties. J Dent Res. 1979 Mar;58(2_suppl):829-36.
32. Yuanita T, Zubaidah N, AR MI. Enamel hardness differences after topical application of theobromine gel and Casein Phosphopeptide-amorphous Calcium Phosphate. Cons Dent J. 2020 Jun;10(1):5-8.
33. Marickar YF, Lekshmi P, Varma L, Koshy P. EDAX versus FTIR in mixed stones. Urological res. 2009 Jul;37(5):271-6.
34. Akkus A, Karasik D, Roperto R. Correlation between micro-hardness and mineral content in healthy human enamel. J Clin Exp Dent. 2017 Apr;9(4):e569-73.
35. Taneja V, Nekkanti S, Gupta K, Hassija J. Remineralization potential of theobromine on artificial carious lesions. Journal of International Soc Prev and Community Dent. 2019 Nov;9(6):576-83.
36. Gündoğar ZU, Keskin G, Çinar Ç. Comparison of fluoride and the novel anti-caries agent theobromine on initial enamel caries: an in vitro study. Fluoride. 2019 May;52(3):456-66.
37. Parvathy Premnath JJ, Manchery N, Subbiah GK, Nagappan N, Subramani P. Effectiveness of theobromine on enamel remineralization: A comparative in-vitro study. Cureus. 2019 Sep;11(9):56-66.
38. Sharmin DD. Comparative evaluation on antimicrobial activity of theobromine and two commercial kids fluoride toothpaste–An invitro study. Int J Dent & Oral Heal. 2016 Nov;2(5):61-5.
39. Starvic B. Methylxanthines: Toxicity to humans. 3: theobromine, paraxanthine and the combined effects of methylxanthines. Food Chem Toxicol. 1988 Aug;26(8):725-33.
2. Vargas CM, Crall JJ, Schneider DA. Sociodemographic distribution of pediatric dental caries: NHANES III, 1988–1994. J Am Dent Assoc. 1998 Sep;129(9):1229-38.
3. Mohammadi M, Vaisi Raiegani, Jalali R. The prevalence of dental caries in decidiouse and permanent teeth in iranian children:A systematic review and meta-analisis. J Res Dent Sci. 2018 Sep;15(3):180-9.
4. White JM, Eakle WS. Rationale and treatment approach in minimally invasive dentistry. J Am Dent Assoc. 2000 Jun;131(1):13-9.
5. Arifa MK, Ephraim R, Rajamani T. Recent advances in dental hard tissue remineralization: A review of literature. Int J Clin Pediatr Dent. 2019 Mar-Apr;12(2):139-4.
6. Amaechi BT. Remineralization therapies for initial caries lesions. Curr Oral Health Rep. 2015 Apr;2(2):95-101.
7. Gocmen GB, Yanikoglu F, Tagtekin D, Stookey GK, Schemehorn BR, Hayran O. Effectiveness of some herbals on initial enamel caries lesion. Asian Pac J Trop Biomed. 2016 Oct;6(10):846-50.
8. Barbier O, Arreola-Mendoza L, Del Razo LM. Molecular mechanisms of fluoride toxicity. Chem Biol Interact. 2010 Nov;188(2):319-33.
9. Aravind A, Dhanya R, Narayan A, Sam G, Adarsh V, Kiran M. Effect of fluoridated water on intelligence in 10-12-year-old school children. J Int Soc Prev Community Dent. 2016 Dec;6(3):237-42.
10. Nakamoto T, Falster AU, Simmons Jr WB. Theobromine: a safe and effective alternative for fluoride in dentifrices. J Caff Res. 2016 Feb;6(1):1-9.
11. Nakamoto T, Simmons Jr WB, Falster AU, inventors; Biomedical Development Corp, assignee. Products of apatite-forming-systems. United States patent US 5,919,426. 1999 Jul 6.
12. Sadeghpour A. Chocolate and dental health. Chocolate and Health: Chemistry, Nutrition and Therapy PK Wilson and WJ Hurst (Eds) London: Royal Society of Chemistry. 2015 May:196-210.
13. Sadeghpour A, Nakamoto T, inventors; THEOCORP HOLDING CO LLC, assignee. Methods and compositions to improve mechanical resistance of teeth. United States patent US 9,610,235. 2017 Apr 4.
14. Syafira G, Permatasari R, Wardani N. Theobromine effects on enamel surface microhardness: In Vitro. J Dent Indonesia. 2012 Aug;19(2):32-6.
15. Suryana M, Irawan B, Soufyan A, editors. The effects of toothpastes containing theobromine and hydroxyapatite on enamel microhardness after immersion in carbonated drink. J Phys: Conf. Ser 2018 Aug;1073(3):32-7.
16. Lakshmi A, Vishnurekha C, Baghkomeh PN. Effect of theobromine in antimicrobial activity: An in vitro study. Dent Res J. 2019Mar-Apr;16(2):76-80.
17. Irawan M, Noerdin A, Eriwati YK, editors. The effect of time in the exposure of theobromine gel to enamel and surface hardness after demineralization with 1% citric acid. J Phys: Conf. Ser 2017 Aug;884(1):20-5.
18. Thorn AK, Lin WS, Levon JA, Morton D, Eckert GJ, Lippert F. The effect of theobromine on the in vitro de-and remineralization of enamel carious lesions. J Dent: X. 2020 May;3(1):100013.
19. Lippert F. The effects of fluoride, strontium, theobromine and their combinations on caries lesion rehardening and fluoridation. Arch Oral Biol. 2017Aug;80(1):217-21.
20. Amaechi B, Porteous N, Ramalingam K, Mensinkai P, Vasquez RC, Sadeghpour A, et al. Remineralization of artificial enamel lesions by theobromine. Caries Res. 2013 Apr;47(5):399-405.
21. Amaechi B, Higham S. In vitro remineralisation of eroded enamel lesions by saliva. J Dent. 2001 Jul;29(5):371-6.
22. Amaechi B, Higham S, Edgar W. Factors affecting the development of carious lesions in bovine teeth in vitro. Arch Oral Biol. 1998 Aug;43(8):619-28.
23. Verma A, Khurshid S, Parveen F, Khanna S, Pandey P. Remineralization: an approach towards conservation of tooth. J Evol Med and Dent Sci. 2015 Jul;4(61):10713-9.
24. Marinho VC, Chong LY, Worthington HV, Walsh T. Fluoride mouthrinses for preventing dental caries in children and adolescents. Cochrane Database Syst. Rev. 2016 Jul; 7(1):CD002284.
25. Santos A, Oliveira B, Nadanovsky P. Effects of low and standard fluoride toothpastes on caries and fluorosis: systematic review and meta-analysis. Caries Res. 2013 Feb;47(5):382-90.
26. Nasution AI, Zawil C. The comparison of enamel hardness between fluoride and theobromine application. Int J Contemp Dent Med Rev. 2014 Dec;1(1):1-4.
27. Qasthari A, Irawan B, Herda E, editors. The influence of brushing with theobromine and sodium monofluorophosphate toothpaste on enamel surface resistance to roughness after demineralization. J Phys: Conf. Ser 2018 Aug;1073(3):37-42.
28. Sulistianingsih I, Hidayat O. The remineralization potential of cocoa bean extract (Theobroma cacao) to increase the enamel microhardness. Padjajaran J Dent. 2017 Jul;29(2):107-12.
29. Kargul B, Özcan M, Peker S, Nakamoto T, Simmons WB, Falster AU. Evaluation of human enamel surfaces treated with theobromine: a pilot study. Oral Health and Prev Dent. 2012 Oct;10(3):275-82.
30. Pushpalatha C, Hegde S, Deveswaran R, Anandakrishna L. Assessment of remineralization potential of novel varnish on early enamel lesions using different optical methods. Emerging Trends in Photonics, Signal Processing and Communication Engineering: Springer; 2020: 195-202.
31. Eanes E. Enamel apatite: chemistry, structure and properties. J Dent Res. 1979 Mar;58(2_suppl):829-36.
32. Yuanita T, Zubaidah N, AR MI. Enamel hardness differences after topical application of theobromine gel and Casein Phosphopeptide-amorphous Calcium Phosphate. Cons Dent J. 2020 Jun;10(1):5-8.
33. Marickar YF, Lekshmi P, Varma L, Koshy P. EDAX versus FTIR in mixed stones. Urological res. 2009 Jul;37(5):271-6.
34. Akkus A, Karasik D, Roperto R. Correlation between micro-hardness and mineral content in healthy human enamel. J Clin Exp Dent. 2017 Apr;9(4):e569-73.
35. Taneja V, Nekkanti S, Gupta K, Hassija J. Remineralization potential of theobromine on artificial carious lesions. Journal of International Soc Prev and Community Dent. 2019 Nov;9(6):576-83.
36. Gündoğar ZU, Keskin G, Çinar Ç. Comparison of fluoride and the novel anti-caries agent theobromine on initial enamel caries: an in vitro study. Fluoride. 2019 May;52(3):456-66.
37. Parvathy Premnath JJ, Manchery N, Subbiah GK, Nagappan N, Subramani P. Effectiveness of theobromine on enamel remineralization: A comparative in-vitro study. Cureus. 2019 Sep;11(9):56-66.
38. Sharmin DD. Comparative evaluation on antimicrobial activity of theobromine and two commercial kids fluoride toothpaste–An invitro study. Int J Dent & Oral Heal. 2016 Nov;2(5):61-5.
39. Starvic B. Methylxanthines: Toxicity to humans. 3: theobromine, paraxanthine and the combined effects of methylxanthines. Food Chem Toxicol. 1988 Aug;26(8):725-33.
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| Issue | Vol 18 (Continuously Published Article-Based) | |
| Section | Original Article | |
| DOI | https://doi.org/10.18502/fid.v18i10.6134 | |
| Keywords | ||
| Theobromine Dental caries Tooth remineralization Sodium fluoride Mouthwash | ||
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How to Cite
1.
Farhad F, Kazemi S, Bijani A, Pasdar N. Efficacy of Theobromine and Sodium Fluoride Solutions for Remineralization of Initial Enamel Caries Lesions. Front Dent. 2021;18.
