Prevention and Treatment of Dental Erosion: Beyond Fluorides.

Different agents have been discussed as potential alternatives to fluoride in the prevention and treatment of erosive tooth wear (ETW). These agents may act by (1) forming an acid-protective layer on the tooth surface, such as through the use of sealants, polymers or the modification of the acquired pellicle; (2) enhancing mechanisms of (mineral) precipitation; and/or (3) preserving the organic matrix of dentine. The application of adhesives, sealants or flowables is considered to be an effective alternative to fluoride, but requires a re-sealing of the surface every several months depending on the products used. Studies testing film-forming products, such as artificial polymers as well as engineering of acquired pellicle, have suggested the potential effectiveness of some of these approaches, such as chitosan and some salivary or saliva-derived proteins. Products designed to deliver calcium and/or phosphate have not been successful at providing a significant anti-erosive effect. In advanced ETW, the demineralised collagenous dentine matrix can be degraded by host enzymes, such as matrix metalloproteinases (MMPs). Epigallocatechin gallate and chlorhexidine as well as fluorides have been identified as effective MMP inhibitors, with the potential to reduce the progression of dentine erosion. While fluoride compounds have clearly been shown to have an anti-erosive potential, particularly those containing tin, alternative approaches that provide even greater protective capacity still need to be developed and proven to be effective clinically.