Evaluation of Quantum in Tooth Remineralisation Using a Mollusc, Avian and Plant-Source of Calcium against Different Tooth Remineralising Agents


  • Yadav Chakravarthy, Allen Anil Kurien, Vanitha Dattatraya Revankar, D. Y. Mallikarjunan, Kaarunya Ravikumar, Gautam Ranjit


Background: The loss of enamel is a dynamic process occasioned with periods of demineralisation and remineralisation. Hence, preventive measures against enamel dissolution and permanent damage should be a priority for oral health-care providers. It has been suggested that the beneficial health effects can be improved with calcium or calcium containing materials. There are many commercially available effective remineralising agents, however they are not economically feasible for the low economic population. Thus, there is a need for alternative sources of calcium that aid in tooth-enamel reminerasalisation.

Aims: (i) Investigated and compared invitro the potential of oyster (Crassostrea madrasensis) shells, domestic hen (Gallus gallus) eggshells and moringa oliefera leaves on tooth-enamel remineralisation. (ii) Comparatively evaluated invitro, the quantum of tooth remineralisation when oyster (Crassostrea madrasensis) shell, domestic hen (Gallus gallus) eggshells and moringa oliefera leaves on tooth enamel remineralisation were used.            (iii) Compared the quantum of tooth-enamel remineralisation between oyster(Crassostrea madrasensis)  shell, domestic hen(Gallus gallus) eggshells and Moringa oliefera leaves  with CPP-ACPF (GC Tooth Mousse Plus), Bioactive glass(BioEnamel) and Fluoride enhanced Hydroxyapatite(Remin Pro)

Objectives: (i) To provide an alternative natural tooth-enamel remineralising agent that is socioeconomically viable compared to the currently available commercial counterparts. These agents been tried in the liquid state can be used in the form of paste and powder that can be, very much part of a school oral health programme especially in rural India.

(ii) Since most of the commercially available tooth remineralising agents has casein as one of the primary ingredients, it has been observed that there are numerous people allergic to casein. Hence, the alternative remineralising agents to be tried in this study can be immensely beneficial to children and adolescent individuals who have casein intolerance.

(iii) Since one of the samples to be tried out is Moringa oliefera (Indian drumstick tree) leaves, this calcium containing plant extract may also serve as an alternative remineralising agents especially in vegen community.

Materials and Methods: Seventy human unerupted maxillary and mandibular 3rd molars were selected for the study. Carious lesions representing preliminary stage of subsurface enamel lesion were created by placing the tooth samples in 20ml of demineralisation bath for 72 hours. The samples were divided into 7 groups having 10 samples each. The seven groups were: Group 1: (Negative Control)Demineralised  enamel , Group 2 : (Positive Control)   CPP-ACPF, Group 3: Bioactive glass, Group 4: Flouride enhanced hydroxyapatite, Group 5: Domestic hen eggshell solution, Group 6: Oyster shell solution, Group 7: Moringa oliefera extract. The samples were then kept in a vibrating waterbath for 21 days. After 21 days, the samples were then tested by Vickers microhardness test and X-ray flouresence spectroscopy.

Results: All groups were evaluated for tooth-enamel remineralisation potential. This study demonstrated that all the alternative sources of calcium are promising. However, among the various alternatives tested, domestic hen (Gallus gallus) egg shell (group 5), proved to be better in remineralisation potential (222.43) than the oyster shell (201.65) (group 6) and moringa oliefera leaves (199.42) (group 7), (Table 1). However, group 3 (Bioactive glass) exhibited maximum efficacy in remineralising tooth enamel (250.93). The p value was determined as 0.001, that implies its highy significant.

Conclusion: The alternative calcium sources (domestic hen (Gallus gallus) egg shell, oyster shell  and Moringa oliefera leaves) exhibited remineralisation of tooth-enamel. Among the alternative sources, domestic hen (Gallus gallus) egg shell had maximum tooth-enamel remineralisation (222.43) but was not to the extent of the commercially available Bioactive glass (250.93). Nevertheless, the natural alternatives can definitely be a boon to people in developing countries of low socioeconomic groups, oral health programmes, people allergic to casein, etc.