Alternatives to fluoride in the prevention and treatment of dental erosion.

In recent years, different agents have been discussed as potential alternatives to fluoride in the prevention of dental erosion. These agents are intended to form acid-resistant layers on the surface, to induce repair of eroded lesions by mineral precipitation or to prevent the enzymatic degradation of demineralised collagen. The application of adhesives and/or fissure sealants is considered to be an effective alternative to fluoride, but requires professional application and, depending on the product used, a re-sealing of the surface every several months. Studies testing film-forming products, such as polymers, have suggested the potential effectiveness of some of these approaches, such as chitosan, although further studies are needed to confirm the effectiveness of this approach. Other studies have demonstrated that products designed to deliver calcium and/or phosphate have not been successful at providing a significant anti-erosive effect. In advanced erosive lesions, the demineralised collagenous dentine matrix can be degraded by host enzymes such as matrix metalloproteinases (MMPs). As well as fluorides, epigallocatechin gallate and chlorhexidine have been identified as effective MMP inhibitors, with the potential to reduce the progression of dentine erosion. While fluoride compounds have 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.