Journal of Clinical and Diagnostic Research. 2022 Jun, Vol-16(6): ZC08-ZC15 8 8 DOI: 10.7860/JCDR/2022/53105.16471 Original Article Dentistry Section Comparison of the Remineralisation Potential between Flaxseed Paste, Aloe Vera Gel and Fluoride Toothpaste on Artificially Created White Spot Lesions around Orthodontic Brackets: An In-vitro Study INTRODUCTION White Spot Lesions (WSL) are considered as undesirable outcomes after orthodontic treatment. It has a chalky white appearance which is an optical phenomenon due to mineral loss in the subsurface and surface of enamel [1]. The brackets, wires, bands, excess composite, serve as a housing for plaque and colonisation of aciduric bacteria like Streptococcus mutans over a period of time and results in active WSL. They are difficult for the patient to cleanse and are also a limitation to the self-cleansing properties of the oral musculature and saliva [2]. Approximately one-third of orthodontic patients are found to have atleast one WSL [3]. The extent of the risk posed by decalcification during orthodontic treatment is a wide range of 2% to 96% of tooth surfaces [4]. Traditionally fluoride toothpaste has been used for control of WSL. They maintain the plaque fluid supersaturated with fluorapatite, hence moving the balance of caries process towards remineralisation [5]. High concentration fluoride application can create hypermineralised areas on the enamel surface and prevent passage of ions into the deeper affected layers, which is unaesthetic [6]. There is lack of reliable evidence to support the effectiveness of remineralising agents for the treatment of post orthodontic white spot lesions. Swallowing of fluoride could be detrimental to health because of its toxicity especially in children, it could accumulate in the tissues overtime and cause adverse health effects and dental fluorosis [7]. Recently, various organic vegetables and food supplements have shown to promote oral health. Antimicrobial compounds derived from plants can be considered an alternative to chemical agents for plaque control and prevention of demineralisation [8]. Newer findings show that polyphenol component in plants have potential activity in preventing oral diseases and anticariogenic properties [9]. ‘Linum usitatissimum’- Flaxseed has minerals like calcium, magnesium, phosphorous and potassium which can help in surface remineralisation of enamel [10]. The polyphenol compound called lignans in flaxseed possess antibacterial activity against cariogenic bacteria Streptococcus mutans [11]. ‘Aloe barbadensis’ -Aloe Vera mouth rinse was found to reduce plaque and gingivitis in orthodontic patients [12]. AV tooth gel was found to be effective in controlling cariogenic bacteria similar to other commercially available toothpastes [13]. AV gel was also reported to have remineralising potential, abundance in essential amino acids and deposition of arginine associated to the calcium on the enamel surface was suggested as the mechanism of remineralisation [14]. RASIGA GANDHI 1 , DILIP SRINIVASAN 2 , SANGEETHA DURAISAMY 3 , RAVI KANNAN 4 Keywords: Anticariogenic, Dental plaque, Microhardness, Plant polyphenols ABSTRACT Introduction: White Spot Lesion (WSL) is one of the major iatrogenic effect at the end of treatment that might reduce both patient’s and orthodontist’s satisfaction in otherwise promising treatment results. Flaxseed and Aloe Vera (AV) have been used as phytotherapeutic agents because of inherent antimicrobial, anti-inflammatory, antioxidants and healing properties. They were considered in this study for their effectiveness in remineralisation of WSL. Aim: To evaluate and compare the remineralisation potential of organic flaxseed paste, Aloe Vera gel and fluoride toothpaste on artificially created white spot lesions around orthodontic brackets using Vicker’s microhardness assessment, spectrophotometry and Scanning Electron Microscope (SEM). Materials and Methods: This experimental in-vitro study was undertaken in Department of Orthodontics, SRM Dental College, Ramapuram, Chennai, Tamil Nadu, India, in October 2020. Forty eight extracted premolar teeth were exposed to demineralising solution for 48 hours in-vitro and randomly assigned to four groups: Group 1- untreated control, group 2- treated with flaxseed paste, group 3- treated with Aloe Vera gel and group 4-treated with fluoride toothpaste. All groups except control were treated with their respective remineralising paste for 28 days. Vicker’s Microhardness Number (VHN) and spectrophotometric values (∆L, ∆a, ∆b, ∆E) were evaluated for normal enamel, WSL, remineralisation after 14 and 28 days. The surface characteristics were analysed using SEM. Statistical analysis was performed using repeated measures Analysis of Variance (ANOVA) and post hoc Bonferroni test was for pairwise comparison between groups with significance level p≤0.05. Results: Total of 48 extracted teeth were treated and analysed in their respective groups after 28 days. Aloe Vera gel showed highest surface microhardness (SMH) (144.09±6.05 VHN) and has statistically significant difference (p<0.001) compared to flaxseed paste (125.28±3.75 VHN) and then the fluoride toothpaste (121.20±5.12 VHN). There was no significant difference (p-value=0.31) between flaxseed paste and fluoride toothpaste. Significant (p-value=0.05) ∆E changes were observed in groups treated with flaxseed paste (16.39) and fluoride toothpaste (15.08) after 28 days. SEM verified mineral gain in all three treatment groups. Conclusion: All the three groups increased mineral gain. Aloe Vera gel showed promising results by significantly remineralising WSLs. Flaxseed paste and fluoride toothpaste had SMH recovery which was lesser than Aloe Vera gel but, these two groups significantly improved the colour of WSL.