4. Discussion
caries lesions, caries, diet behaviors, tooth, NCL, orthodontic
SECONDARY, HYDROXYAPATITE, CARIES, DENTIN HYPERSENSITIVITY
In the present clinical trial, the effectiveness of hydroxyapatite toothpaste in preventing caries development was compared with that of fluoride (1,450 ppm) toothpaste, to determine the non-inferiority of the hydroxyapatite toothpaste to the fluoride toothpaste. Analysis of both the primary and the secondary outcome measures demonstrated non-inferiority of the two products to each other. This result is in agreement with two previously published clinical trials (The present study used a toothpaste with sodium fluoride (1,450 ppm fluoride) as control toothpaste. Sodium fluoride is one of the most frequently used fluoride compounds in fluoridated toothpastes worldwide (Approximately almost 90% of the subjects remained caries-free (no increase in DMFS) in the present study, representing the caries-preventing effect of both toothpastes within the study duration. This is higher than in data from Rao et al. (The primary parameter in the present study was the DMFS index. This index was established in clinical studies that investigated the caries-preventing effect of toothpastes (When comparing the mean DMFS increase on the tooth surface level during the 18-month study duration with the previously published studies (Comparison on the mean increase in DMFS between this study and the published studies on adults using fluoridated toothpastes.In addition to DMFS, the overall number of caries lesions was determined with DIAGNOcam. DIAGNOcam is a modern device for laser diode near-infrared light transillumination of dental tissues. The appliance combines fiber optic transillumination with near-infrared (NIR) light and a digital camera to non-ionizing imaging of dental tissues. DIAGNOcam enables the visualization of caries lesions on occlusal and approximal surfaces and measures their severity in real time. It may be used without any limitation to monitor the caries process. It is a non-invasive and non-destructive tool (The difference in DMFS (visual) and NCL based on DIAGNOcam (near-infrared light transillumination) can be explained by the sensitivity of this method. While decayed surfaces can only be detected on the outer area of the tooth visually by an experienced clinician, transillumination methods can also detect lesions underneath the surface (A notable trend was also observed in the PCR index of the hydroxyapatite group: Unlike the fluoride group, the PCR scores in the hydroxyapatite group showed a tendency to a lowering of scores during the course of the study (A strength of the present study is that the same toothpaste composition was used for the hydroxyapatite toothpaste and the fluoride toothpaste except that they differed in their main active ingredients (i.e., hydroxyapatite vs. fluoride). All other ingredients remained the same. While the non-inferiority of hydroxyapatite to fluoride toothpastes was shown in caries risk groups [children (Secondly, as we tested the influence of both toothpastes on caries progression, the patients were not monitored according to dietary habits, and they kept their sugar intake under real-life conditions. There were no specific inclusion or exclusion criteria concerning the diet. However, the subjects had comparable diet behaviors due to living in urban areas in both study centers (A limitation of this study is that the study population was relatively homogeneous, consisting of healthy, predominantly young adults without significant oral health problems. However, previously published RCTs on hydroxyapatite toothpastes were performed in caries risk groups, i.e., orthodontic patients (There are several reasons why hydroxyapatite toothpastes represent an alternative to fluoride toothpastes. Hydroxyapatite is a safe active ingredient (Hydroxyapatite has been shown to be not only efficient in caries prevention, but also in other fields of oral prevention, such as reduction of dentin hypersensitivity (In summary, the three clinical caries studies [Paszynska et al. (