Dental erosion has emerged as a significant modern oral health problem, characterized by the chemical dissolution of tooth structure resulting from frequent exposure to intrinsic or extrinsic acids. With a high global prevalence ranging from 30% to 50% in children and 20% to 40% in adults, its management is a clinical priority to prevent long-term complications like dentine hypersensitivity and functional impairment. This review outlines the multifactorial etiology of erosion, encompassing dietary acids, gastroesophageal reflux, and reduced salivary flow. The historical context of oral care is explored, leading to a discussion on contemporary management strategies centered on remineralization. Fluoride ions play a crucial role by inhibiting demineralization, facilitating the formation of acid-resistant fluorapatite, and exerting antibacterial effects. A major focus is placed on advanced biomimetic, calcium phosphate-based topical agents such as Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP), functionalized Tricalcium Phosphate (fTCP), and Hydroxyapatite (HAP), which effectively replenish lost minerals. The review further explores innovative methods, such as laser-assisted and electrically enhanced remineralization. Finally, it outlines next-generation regenerative strategies, including self-assembling peptides (P11-4), stem cell therapies, 3D bioprinting, and gene-editing (CRISPR) technologies, which aim to biologically regenerate lost enamel and dentine. The field is rapidly evolving from a preventive to a restorative paradigm, with future directions focusing on biologically based, minimally invasive therapies to fully restore tooth structure and function. Several in vitro studies have been carried out to evaluate the effects of fluoride-containing varnish and dentifrice on eroded enamel surfaces [ Several studies have been reported to understand the mechanism of tooth demineralization prevention by the application of topical fluoride-containing products. 2.2. Mechanisms of Fluoride in Demineralization Inhibition In general, four mechanisms are involved in minimizing tooth demineralization. Surface Protection via Plaque Fluid Fluoride : Fluoride ions in plaque fluid penetrate into the tooth subsurface and protect apatite crystals from acidic dissolution at low pH. Systematically incorporated fluoride ions are not sufficient to inhibit the effects of these acidic ions [ 76 ]. Most available data are derived from in vitro studies, with substantially stronger support currently existing for their efficacy in caries prevention. Sodium fluoride (NaF) : Sodium fluoride is the most widely used inorganic fluoride source in toothpastes, mouthrinses, and varnishes [ 83 ]. NaF primarily promotes the formation of a calcium fluoride-like surface reservoir and enhances fluorapatite formation during remineralization, reducing mineral loss under repeated acid challenges. However, at typical toothpaste concentrations and neutral pH, NaF forms only a thin surface reservoir, that may be insufficient to protect the tooth surface against conditions that result in repeated or prolonged acid exposure [ 83 , 84 , 85 ]. Titanium tetrafluoride (TiF 4 ): The preventive role of topically applied fluorides is well established. However, titanium tetrafluoride (TiF 4 ) has demonstrated superior protective effects against both dental caries and erosive tooth wear compared with conventional fluorides such as sodium fluoride (NaF), stannous fluoride (SnF 2 ), and acidulated phosphate fluoride (APF) [ 86 , 87 ]. Collectively, these materials increase the availability of calcium and phosphate at the tooth surface, reduce enamel softening and slow the progression of erosion, particularly when combined with appropriate fluoride exposure and dietary acid control. 3.1. Casein Phosphopeptide Amorphous Calcium Phosphate (CPP-ACP) CPP-ACP complex, patented by the University of Melbourne, Australia, received recognition in 1999 when the U.S. Food and Drug Administration (FDA) approved the use of Recaldent in chewing gum formulations at concentrations of up to 5% w / w [ 105 ]. When applied topically, nano-hydroxyapatite particles can penetrate demineralised enamel and bind to exposed hydroxyapatite crystals, promoting the regeneration of lost mineral content [ 19 ]. Unlike fluoride, which primarily strengthens enamel by forming fluorapatite, HAP physically fills micropores and surface defects, acting as a scaffold for remineralisation [ 20 ]. Recent in vitro and in situ studies have demonstrated that HAP-containing toothpaste and mouthrinses significantly reduce the progression of enamel erosion by forming a protective layer on the tooth surface [ 21 ]. (2023) In vivo study (12 weeks duration) CPP-ACP varnish Significantly reduced dentin surface loss [ 9 ] Schlagenhauf et al. (2019) Randomised trial HAP toothpaste (fluoride-free) Prevention of caries and erosion in young adults [ 10 ] Paszynska et al. (2021) Children aged 6–10 HAP toothpaste (12-week use) Significant enamel remineralisation without fluoride [ 11 ] Hao et al. (2021) Artificial saliva model fTCP + fluoride mouthrinse Increased surface hardness, better acid resistance [ 12 ] Inchingolo et al. (2023) Clinical trial, 120 patients TCP-fluoride toothpaste vs. fluoride-only Superior enamel protection in TCP group [ 13 ] Souza et al. (2020) Eroded enamel slabs CCSP treatment (2×/day) Reduced mineral loss, formed mineral-rich layer [ 26 ] Pinto et al. (2021) Randomised trial, 90 participants CCSP toothpaste for 8 weeks Improved enamel smoothness and sensitivity reduction [ 27 ] Borges et al. (2023) In vitro acidic challenge model CCSP + fluoride paste Reduced enamel surface roughness, improved acid resistance [ 28 ] 4. Innovative Methods/Tools for Effective Application of Remineralizing Agents Innovative advanced methods, when combined with biomimetic approaches for tooth surface remineralization, could pave the way for improved oral health outcomes.

Tooth whitening is increasingly sought in both clinical and home settings, raising concerns about the efficacy and safety of various whitening agents and their delivery systems. This narrative review compares the whitening performance and biocompatibility of active ingredients, including hydrogen peroxide, carbamide peroxide, activated charcoal, sodium bicarbonate, fluoride compounds, and blue covarine, with particular emphasis on the role of polymer-based carriers in formulation strategies. Hydrogen peroxide and carbamide peroxide remain the most effective agents for intrinsic whitening, but are associated with risks of enamel surface alterations, microhardness reduction, and potential cytotoxicity, particularly at higher concentrations. Sodium bicarbonate provides moderate whitening effects through extrinsic stain removal, while fluoride compounds play a supportive role by reducing demineralization and tooth sensitivity, thereby preserving enamel integrity. These properties make them valuable adjuncts or alternatives for patients with high sensitivity risks. Blue covarine offers immediate optical effects without inducing intrinsic color changes, whereas activated charcoal poses risks of enamel abrasion and surface roughness with limited long-term efficacy. Polymer-based carriers such as Carbopol gels, polyvinylpyrrolidone, and hydroxypropyl methylcellulose are incorporated into whitening formulations to improve viscosity, adhesion, and modulate the release of active ingredients. These polymers might help minimize diffusion of bleaching agents into deeper dental tissues, potentially reducing cytotoxic effects, and may improve handling characteristics. However, dedicated studies evaluating the unique advantages of polymers in different whitening systems remain limited. A comprehensive understanding of both the active ingredients and delivery technologies is critical to balancing esthetic outcomes with long-term oral health. From a clinical perspective, polymer-based Such surface alterations may reduce enamel gloss and increase the risk of extrinsic stain accumulation and plaque retention, potentially diminishing whitening effects and impacting periodontal health [ 37 ]. Joiner and Luo reported that excessive abrasiveness in certain whitening toothpastes, including those containing charcoal, may contribute to progressive enamel wear, dentin exposure, increased sensitivity, and compromised tooth structure over time [ 34 ]. Huaman-Sarmiento et al. reported that brushing with charcoal-containing products reduces enamel microhardness and increases surface roughness, although it does not alter tooth color [ 38 ]. These findings suggest that frequent use of highly abrasive formulations could increase the risk of enamel surface damage and long-term structural compromise [ 34 ]. Although not the primary focus of most studies, some charcoal toothpastes include polymer-based thickening agents such as carbomer or cellulose derivatives, which help increase viscosity and stabilize particles within the formulation [ 34 ]. While Huaman-Sarmiento et al. Formulation ■ Some charcoal toothpastes contain polymers (e.g., carbomer, cellulose derivatives) to increase viscosity and stabilize particles [ 34 , 35 ]. ■ No strong evidence that polymers provide protective effects against abrasion in charcoal-based formulations [ 35 ]. ■ Marketing claims such as “natural,” “chemical-free,” or inherently safer are not substantiated by robust evidence [ 35 ]. 2.4. Fluoride Compounds 2.4.1. Color Evaluation Fluoride compounds have been extensively used in dentistry for caries prevention and enamel remineralization, and their inclusion in tooth whitening protocols has attracted considerable interest in recent years. Unlike hydrogen peroxide or carbamide peroxide, sodium bicarbonate does not chemically bleach tooth structures but functions primarily through mechanical action that disrupts and removes extrinsic stains from enamel surfaces [ 1 , 33 ]. AlShehri et al. [ 43 ] conducted an in vitro study in which enamel specimens were subjected to repeated brushing cycles with various over-the-counter whitening products, including a baking soda-based toothpaste. Their results demonstrated that the baking soda group achieved an average color change of ΔE = 4.2. Instead of chemically bleaching tooth structures, blue covarine deposits fine blue pigments on the enamel surface. This pigment layer modifies how light reflects off the teeth, helping to visually neutralize yellowish tones and create the immediate perception of whiter teeth [ 36 ]. However, clinical evidence suggests that the whitening effect of blue covarine remains limited. In a randomized controlled clinical trial conducted by Meireles et al. [ 50 ], seventy-five participants were assigned to use either a conventional toothpaste, a blue covarine-containing whitening toothpaste, or a 10% carbamide peroxide bleaching agent over two weeks. The results indicated no significant differences between the blue covarine and conventional toothpaste groups regarding objective tooth color improvement. Parameters such as tooth shade, CIELab values, ΔEab, and ΔE00 showed p -values ranging from 0.3 to 0.7. In contrast, the carbamide peroxide group demonstrated significantly greater color changes, with p equal to 0.001, and participants in this group also reported higher satisfaction scores. Although blue covarine toothpastes are generally regarded as safe, clinicians should advise patients about their limitations. Unlike peroxide-based bleaching agents that penetrate enamel and chemically modify chromophores within tooth structures, blue covarine achieves its effect through surface pigment deposition. This optical effect is temporary and diminishes over time due to factors such as chewing, drinking, and regular oral hygiene practices. Therefore, repeated and consistent use is necessary to maintain the perceived whitening benefit [ 51 ].

Dental erosion is a chemical loss of the mineralized dental tissue caused by exposure to nonbacterial acids. Different treatment protocols have been adopted with the use of fluoride compounds to promote the formation of a layer of mineral precipitation in eroded lesions. This systematic review aimed to evaluate the main treatments for dental erosion. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and recorded in the Open Science Framework database (OSF) under DOI 10.17605/OSF.IO/XMFNZ. The searches were conducted in six electronic databases (Pubmed, Embase, Web of Science, Cochrane, Scopus, Lilacs) and two grey literature sources (Google Scholar and OpenGrey). The eligibility criteria included in vitro studies that evaluated eroded teeth under treatment with some topical agent. Risk of bias assessment and qualitative synthesis were performed using the Cochrane collaboration's tool for assessing risk of bias modified for in vitro studies. A total of 522 studies were identified, and only four studies that fulfilled our eligibility criteria were included in this review. Among these studies, three were considered to have a low risk of bias, and one to have a high risk of bias. Two studies evaluated the anti-erosion effect of fluoride toothpaste, and the other two assessed the action of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on the surface of human teeth. Among the products analyzed, CPP-ACP was the only one that promoted a significant increase in enamel microhardness and reduced tooth wear. Based on the in vitro studies included in this review, there was no anti-erosion effect after using different fluoride toothpaste. However, it should be considered that one of these studies presented a high risk of bias. On the other hand, studies with CPP-ACP showed anti-erosion efficacy when applied before or after erosive wear. Among the products analyzed, CPP-ACP was the only one that promoted a significant increase in enamel microhardness and reduced tooth wear. Conclusion Based on the in vitro studies included in this review, there was no anti-erosion effect after using different fluoride toothpaste. However, it should be considered that one of these studies presented a high risk of bias. On the other hand, studies with CPP-ACP showed anti-erosion efficacy when applied before or after erosive wear. The use of fluoride in the form of mouthwash or brushing with toothpaste promotes structural remineralization, forming a mineral layer on the tooth surface and reducing subsequent demineralization, thus helping in the treatment and prevention of dental erosion ( Creeth et al., 2015 ). Although fluoride products are often used, most fluoridated formulations alone have limited preventive effects against tooth erosion as their action on the mineralization process is limited to the surface and the near-surface layers of enamel and is restricted to the demineralized enamel layer ( Lussi & Carvalho, 2015 ). Numerous vehicles, such as toothpaste, rinse solutions, gels, and varnishes, are currently available as strategies for using fluorides. These products contain different types of active ingredients with distinct anti-erosive properties, and some of them have been demonstrated to be effective preventive therapies against tooth erosion ( Buzalaf, Magalhães & Wiegand, 2014 ; Lussi et al., 2019 ). The most appropriate way to access the protective effects of these products would be in vivo studies, with randomized clinical trials considered the gold standard. These studies evaluated the surface of eroded tooth enamel and analyzed the effect of different remineralizing treatments. Individual results of studies The substances used to induce erosive wear were citric acid solution ( Bradna et al., 2015 ; João Souza et al., 2017 ; Ranjitkar et al., 2009 ) and Coca-Cola (Coke®) drink ( Panich & Poolthong, 2009 ). The studies by Bradna et al. (2015) and João Souza et al. (2017) evaluated the effect of various commercial toothpaste compared to the control group that immersed the teeth only in artificial saliva. APF gel Acidulated phosphate fluoride gel CPP-ACP Casein phosphopeptide-amorphous Among the topical agents, acidulated phosphate fluoride (APF) gel, Elmex® erosion, and Sensodyne® Pronamel showed the best results related to enamel protection ( Bradna et al., 2015 ; João Souza et al., 2017 ; Ranjitkar et al., 2009 ). Nevertheless, Elmex® erosion toothpaste showed high adhesion to enamel due to the high concentration of abrasive agents such as tin, it made the enamel surface a little scratched, compared to Sensodyne® Pronamel, which showed a smoother surface indicating less abrasiveness ( Bradna et al., 2015 ; João Souza et al., 2017 ). Figure 2 Risk of bias of the included studies, according to the Cochrane collaboration’s tool for assessing risk of bias. Discussion Our systematic review aimed to investigate effective treatments for dental erosion. Although fluoride products showed no significant reduction in enamel surface loss in the studies, there was a remineralizing effect on dental enamel after using CPP-ACP. However, the number and limitations of the included studies must be considered. Based on the present findings, it was possible to verify that all test products (toothpaste and tooth mousses) had different effects on enamel surface loss. In these cases, the efficacy of fluoride products is attributed to the formation of precipitates on the tooth surface, which acts as a protective barrier against acid impacts ( Schlueter et al., 2020 ). Although the studies in this review did not show a significant remineralizing effect of fluoride on tooth enamel, other recent studies in the literature have shown that the application of fluoride products after acid challenge to enamel reduced enamel loss ( Zanatta et al., 2020 ; Ionta, dos Santos & Mesquita, 2019 ). The studies by Bradna et al. (2015) and João Souza et al.

Effect of Dentifrice Usage Regime on Delivery and Efficacy of Fluoride This study will evaluate and compare the effect of the amount of toothpaste used and brushing time on enamel strengthening (percent of surface microhardness recovery, % SMHR) and enamel fluoride uptake (EFU).

pea-sized amount of fluoride toothpaste Spitting out after brushing rather than rinsing, to maintain fluoride concentration on tooth surfaces Continued Teeth cleaning is part of oral hygiene and involves the removal of dental plaque, calculus(tartar), and extrinsic stains from tooth surfaces to maintain oral hygiene and prevent oral disease People routinely clean their own teeth by brushing and interdental cleaning, and dental hygienists can remove hardened deposits (tartar) not removed by routine cleaning. Those with dentures and natural teeth m Use of…

to enamel (and dentin too, although not as well) via a micromechanical bond. As conservation of tooth structure is a key ingredient in tooth preservation Dental products are specially fabricated materials, designed for use in dentistry. There are many different types of dental products, and their characteristics vary according to their intended purpose. The concept of using "smart" materials in dentistry has attracted a lot of attention in recent years. Conventional glass ionomer cements (GICs) have many applications in dentistry. They are biocompatible with the dental pulp to some extent. Clinically, this material was initially used as a biomaterial to replace the lost osseous tissues in the human body. GIC fillings are a mixture of glass and an organic acid. The cavity preparation of a GIC filling is the same as a composite resin. GICs are chemically set via an acid-base reaction. Upon mixing of the material components, no light cure is needed to harden the material once placed in the cavity preparation. After the initial set, GICs still need time to fully set and harden. An advantage of GICs compared to other restorative materials is that they can be placed in cavities without any need for bonding agents. Another advantage is that they are not subject to shrinkage and microleakage, as the bonding mechanism is an acid-base reaction and not a polymerization reaction. Additionally, GICs contain and release fluoride, which is important to prevent carious lesions. As GICs release their fluoride, they can be "recharged" by the use of fluoride-containing toothpaste; this means they can be used to treat patients at high risk of caries. Although they are tooth-colored, GICs vary in translucency, and their aesthetic potential is not as great as that of composite resins. Newer formulations that contain light-cured resins can achieve a greater aesthetic result, but do not release fluoride as well as conventional GICs. The most important disadvantage of GICs is lack of adequate strength and toughness. To improve the mechanical properties of the conventional GIC, resin-modified ionomers have been marketed. GICs are usually weak after setting and are not stable in water; however, they become stronger with the progression of reactions and become more resistant to moisture. New generations of GICs aim to regenerate tissues; they use bioactive materials in the form of a powder or solution to induce local tissue repair. These materials release chemical agents in the form of dissolved ions or growth factors such as bone…

affected area penetrates the enamel into the dentin. Because dentin is not as hard as enamel, decay progresses … supplies, using fluoridated toothpaste or mouth rinse, or using sodium fluoride tablets, drops, or lozenges … and mobility of the involved tooth. The gum opposite the apex of the tooth is usually swollen on the cheek

which produces acids that dissolve tooth enamel. Although tooth enamel is the hardest substance in the … Left unchecked, the decay extends into the dentin. Because dentin is not as hard as enamel, decay progresses … to the teeth; adding fluoride to home water supplies; using fluoridated toothpaste or mouth rinse; or using