Journal of Conservative Dentistry
Home About us Editorial Board Instructions Submission Subscribe Advertise Contact e-Alerts Login 
Users Online: 13229
Print this page  Email this page Bookmark this page Small font sizeDefault font sizeIncrease font size

Table of Contents   
Year : 2022  |  Volume : 25  |  Issue : 5  |  Page : 454-462
Characterization of dynamic process of carious and erosive demineralization – an overview

1 Department of Conservative Dentistry and Endodontics, A.B Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to be University), Mangalore, Karnataka, India
2 Department of Oral and Maxillofacial Pathology, A.B Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to be University), Mangalore, Karnataka, India

Click here for correspondence address and email

Date of Submission19-Mar-2022
Date of Decision25-Apr-2022
Date of Acceptance17-May-2022
Date of Web Publication05-Jul-2022


To review the analytical methods for carious and erosive demineralization an initial search of peer-reviewed scientific literature from the digital library database of PubMed/Medline indexed journals published up to early 2022 was carried out based on keywords relevant to the topic criteria including bibliographic citations from the papers to gather the most updated information. This current review aims to provide an updated overview of the advantages, limitations, and potential applications of direct and indirect research methods available for studying various dynamic stages of carious and erosive demineralization in enamel and dentin. This paper categorizes and describes the most suitable, frequently adopted and widely used quantitative and qualitative techniques in in vitro/in vivo research which are well-established, emerging, or comparatively novel techniques that are being explored for their potential validation.

Keywords: Analysis; caries; characterization; demineralization; dentin; enamel; erosion; research

How to cite this article:
Devadiga D, Shetty P, Hegde MN. Characterization of dynamic process of carious and erosive demineralization – an overview. J Conserv Dent 2022;25:454-62

How to cite this URL:
Devadiga D, Shetty P, Hegde MN. Characterization of dynamic process of carious and erosive demineralization – an overview. J Conserv Dent [serial online] 2022 [cited 2023 Jun 10];25:454-62. Available from:

   Background Top

After dental caries, the non-carious erosion of mineralized hard tissues has shown an increasing prevalence in modern societies.[1],[2],[3] While both alter the composition, crystallography, microstructure, and mechanical properties, dental erosion [Table 1][4],[5],[6],[7],[8],[9],[10] is chiefly considered as a surface phenomenon resulting from direct acid contact on the tooth surface, while dental caries [Table 2][12],[13],[14],[15],[16],[17],[18],[19],[20] in contrast initially forms subsurface lesions by bacterial acids until cavitation occurs.[21],[22]
Table 1: Erosive Demineralization

Click here to view
Table 2: Carious Demineralization

Click here to view

To understand the complex nature and the dynamic progress of carious and erosive demineralization, several methods and techniques have been used to develop clinically relevant solutions for its prevention and management.[23] In addition, as methods to assess enamel are unsuitable for dentine due to histological variations, the application of a single technique may be inadequate, requiring a combination of qualitative, quantitative, and semi-quantitative (approximate) measurements. The surface-softening effect in the early stages and the subsequent loss of tooth substance has been studied by various direct and indirect methods including: Chemical Analysis, Surface Hardness/Profilometry, Microscopy, and Spectroscopy techniques.[24],[25],[26][Table 3]. The advanced research tools with capabilities to measure subsurface effects[27],[28] include Transverse Microradiography (TMR), Scanning Electron Microscopy (SEM), Optical Coherence Tomography (OCT), Raman Spectroscopy, Fourier Transform Infrared Spectroscopy (FT-IR), Atomic Force Microscopy (AFM) and Confocal Laser Scanning Microscopy (CLSM).[29]
Table 3: Analytical methods for characterization of dynamic process of carious and erosive demineralization

Click here to view

   Chemical Analysis Top

It includes spectrophotometric and colorimetric methods for measuring the concentrations of calcium and phosphate released into the dissolving solution by an erosive challenge or its dissolution protection following therapeutic modification, estimation of pH, and other mineral constituents such as fluoride or magnesium. Limitations: Only indirect measurement of net ions concentration under in vitro conditions.[3],[27]

  1. Atomic Absorption Spectrophotometry (AAS) is a chemical analytical technique that measures the adsorption of optical light by calcium atoms released in solutions when both enamel and dentin[30] are subjected to acidic challenge. Advantages: Reliable estimation[31] with negligible interference from phosphate solutes[32] measured by spectrophotometry of a colored phosphate complex[33],[34]
  2. Inductively Coupled Plasma- Atomic Emission Spectroscopy (ICP-AES) operates based on stoichiometry and density of hydroxyapatite[27],[35] by the characteristic wavelength of electromagnetic radiation emitted. Limitation: Inability to determine origins of Ca/P (surface/subsurface)[36]
  3. Iodide Permeability Test [IPT] low-cost in vitro evaluation of iodide recovery from samples immersed in potassium iodide as a measure of porous volume, suitable for swift screening of erosive potential on enamel only.[27]

   Surface Analysis Top

Surface Hardness

This analysis is used frequently for evaluating mineral loss (ML)/gain by measuring the surface resistance of a material when penetrated with different sizes of indenters, dwell time, and forces at micro or nanoscale. Although a relatively low-cost nondestructive method,[30] it is an empirical method that only provides an indirect assessment of mineral content, requiring further validation[36] and compromised results from elimination of the outer mineralized layer during flattening and polishing of test surface.[37]

Microhardness calculates the Knoop hardness number or Vickers hardness numbers using a diamond indenter (rhomboidal or tetra-pyramidal, respectively)[27] distinguished as Surface Microhardness (SMH) indenter load is placed perpendicular to the polished surface; Cross-section Microhardness (CSMH) indenter load is placed parallel to the anatomical surface of the tissue.[38] Limitation: Subjective to inaccuracies if (i) indentations are ill-defined, (ii) substrate is resilient (like dentin), and (iii) flat surface not level oriented and presence of deposits like fluoride.[27]

Nano-indentation (nanoscale upto1μm, under loads of 0.25mN -50mN) uses a trigonal-pyramidal Berkovich diamond indenter with shallow penetration depths (upto500 nm) for higher sensitivity in the assessment of even small variations and Young's modulus (elastic deformation).[38] For dentin, Atomic Force Microscopy (AFM) used with nano-indentation provides superior visual control in the placement of small nano-indenters.[27],[28]

Surface Profilometry

Surface Profilometry (Surfometry) is a well-established technique for the assessment of surface roughness in early erosion of both dentine and enamel[27],[39],[40] and recording step height that quantifies tissue loss regarding a nontreated area.[27]

Types: a) Contact Profilometry: conduct two-dimensional (2D) mechanical scanning with a diamond or steel-tipped stylus. Limitations: (i) The stylus may penetrate the soft demineralized surface,[41],[42] leading to an overestimation of depth, (ii) only provides changes in surface roughness much like SMH.[36] (b) Non - contact LASER (Optical) Profilometry based on the optical triangulation principle uses a LASER probe with a vertical range (300 μm–10 mm) for three-dimensional (3D) measurements of surface topography between the reference points. Advantages: Gold standard method suitable for (1) analyzing very deep erosion pits, curved natural surfaces, and (2) may quantify tooth loss if flattened specimens can be obtained.[40],[43],[44],[45] Limitation: Affected by angulation of positioning, color, and transparency.[45]

   Optical Analysis Top

Quantitative Light-induced Fluorescence (QLF)

It works on the optical principle that the natural fluorescence emanating from dentine is modified by the porosity of demineralized enamel. This causes scattering of incident blue-green infrared light to appear darker and quantified as the percentage of change of fluorescence radiance by the QLF software.[46],[47] eg., DIAGNOdent (KAVO, Biberach, Germany). Advantage: Non-invasive monitoring in both in-vivo[29] as well as in-vitro

Optical Coherence Tomography (OCT)

It utilizes an interferometer for cross-sectional imaging of enamel thickness/porosity and measures backscattered light[29] from internal microstructures[50],[51] using near-infrared light. Advantage: Non-destructive clinical method for quantitative assessment of high-resolution 3D images of micro-morphological changes in initial caries by optical scattering[52],[53] and detection of eroded lesions as a function of depth, based on the intensity of backscattered light.[54] Limitations: (1) Reduced spatial resolution for probing in vivo,[55] (2) usage restricted to initial lesions,[56] and (3) high cost and lack of commercial availability for clinical use.[57] Variant: Swept Source OCT (SS-OCT) has a tunable LASER that sweeps at high speeds to generate 3D volumetric datasets.[51]

   Microscopic Analysis Top

It mainly includes qualitative techniques based on optical, X-ray, electron, and scanning principles for microstructural characterization of the surface/subsurface layer used either alone or combined with quantitative elemental analysis.[29],[58],[59]

Light Microscopy

It is an optical microscope that uses visible light and a system of lenses that was limited in its depth (up to 0.2μm) and magnification(1000-1500X); later widened the applications using ultraviolet (UV) light, infrared, fluorescence, phase contrast, and digital microscopes.[59]

Visible Light Microscopy was used to measure height differences between eroded and non-eroded areas.

Types: i) Transmitted Light Microscopy (TLM) measures erosion depth in both enamel and dentine using thin ground sections and thickness of the demineralized matrix overlying eroded dentine.[27] ii] Polarized Light Microscopy (PLM) is a qualitative method for measuring erosion depth by observing changes in the crystal birefringence in thin cross-sectional slices for mineral density in the form of pore volume and can discriminate between partly and fully demineralized tissues.[60],[61]

Fluorescence Microscopy uses optical microscopes with high-intensity UV light from a mercury arch lamp and fluorescent stains to increase the contrast/resolution of the image. Later, Confocal microscopes were developed to overcome the drawbacks of visible light microscopy using laser light and digital imaging with a focused pinhole camera.[29]

Confocal LASER Scanning Microscopy (CLSM)

Optically sectioned sequential high-resolution collected by a monochromatic LASER scan from several focal planes is combined to generate 2D optical sections including depth measurement while alteration in mineral content and morphology can be studied based on variation in reflection and scattering of light.[44] Being nondestructive it quantifies both erosive losses of minerals as a function of depth by fluorescent volume and alteration in microstructural quality during early erosion.[36] Variant: 3D- Focus Varying Microscope [FVM][62] scanning a sequence of 2D data sets for creating a 3D image (vertical resolution of up to 10 nm); in subsurface lesions of solid samples.[34],[36] Advantages: (1) High-resolution images of a submicron level similar to SEM. (2) High speed (3) quantifies bulk tissue loss through height mapping of the eroded area with sound reference[63] and depth of softening. (4) Unlike TMR, SEM and OCT it uses freely accessible equipment and image processing software.[36] Limitations: (1) Elaborate specimen preparation of thin sections with surface clearing by chemo-mechanical pretreatment with 5.25% sodium hypochlorite solution combined with ultrasonication and vacuum followed by labeling with a fluorescent dye (rhodamine with a compatible absorption peak of 511 nm) and fixing with cyanoacrylate glue onto a glass slide for observation.[29] (2) Relatively lower resolution for surface imaging, unsuitable for thick specimens; hence, must be combined with other higher resolution tools like SEM, transmission electron microscopy (TEM), and AFM for superior evaluation.[29]

Electron Microscopy

These methods are based on the interaction of high-energy electron beams that either interact with the specimen surface or get transmitted through the specimen to generate a variety of signals.[29]

Scanning Electron Microscopy [SEM] is a widely employed qualitative tool for magnified visualization of ultramicroscopic complexity (micro/nanoscale) of surface/cross-sectional topography using high-energy focused beam of electrons.[29],[64],[65],[66] Limitations: (i) Permits only subjective, qualitative assessment.[30] (ii) destructive technique, and (iii) requires the availability of bespoke equipment/expertise.[36] The limitation of elemental analysis may be overcome by combining it with Energy Dispersive Spectrometry (EDS).[29] Types: (i) Conventional SEM (C-SEM) requires pre -coating of the sample surface with a conductive material such as gold-sputtering in a high-vacuum chamber (to ensure the secondary electrons emitted stay focused to interact with the detector), that can cause artifacts/cracked surface.[29] (ii) ii) Environmental SEM (E-SEM) uses elevated gas pressures to allow discharge of surface charge due to gas molecular ionization to strengthen electron signal without need for vacuum dehydration or conductive surface coating[30] of moist substrates like dentin and in situ evaluation.[67] Limitation: Low resolution is limited to main structures[67] due to defocusing or scattering of the electron beam. (iii) Low Vacuum SEM (LV-SEM) is similar to a C-SEM, but operates at elevated pressures to avoid surface cracking and need for surface charging/coating.

Transmission Electron Microscopy (TEM) generates higher resolution images than SEM by transmission of electrons through the specimen, but requires ultrathin samples (<100 nm) or a suspension on a grid for the study of the ultrastructure of carious dentin lesions.[68] Advantage: Generates both topographical characteristics as well as visualization of inner architecture.[29]

X-Ray Microscopy

It provides resolution between light microscopy and electron microscopy by using X-rays of shorter wavelength (10–0.01 nm) with higher penetrative energy to magnify internal features with image contrast provided by variable absorption by different components in the material.[69]

Microradiography (MR) is a full-field high-resolution imaging tool to quantify mineral content by recording the intensity of attenuated X-rays transmitted through sections as a MR image on photographic plates/film digitized by a video camera or photomultiplier.[70]

Types: (i) Transversal Micro-Radiography (TMR) considered as a gold standard, uses an X-ray beam directed perpendicular to that of lesion progression[27] for mineral quantification of lesion depth in caries, but only after 30 min of exposure for erosive lesions.[71],[72] Use of thin highly polished plano-parallel sections (50–200 μm) makes it very destructive, but highly sensitive to early changes, distribution of mineral, lesion depth, integrated ML, and position of the sub-surface layer.[70],[71],[73],[74] Limitations: (i) Extensive sample preparation and requirement of bespoke equipment operated by highly skilled experienced operators limits accessibility for most research studies (ii) Provides only quantification without morphological data.[36]

(ii) Longitudinal Microradiography (LMR) uses an x-ray beam directed parallel to the lesion direction; hence, cannot measure lesion depth profile.[27],[42],[75] As it is optimized for thicker sections (up to 400 μm)[70] it has reduced sensitivity to minute changes in mineral content; yet, it permits reuse of specimens for longitudinal observations.[30]

Scanning Probe Microscopes (SPM)

This is used to study the surface topographical and elemental structures with subatomic microscopic tools[76] such as Scanning Tunneling Microscopy (STM), Near-field Scanning Optical Microscopy (NSOM), and most importantly Atomic Force Microscopy (AFM).[23],[77]

Atomic Force Microscopy [AFM] imaging technique invented in 1986 is one of the most widely used tool in dental biological and material sciences. It uses a nondestructive probe for mapping an atomic-force field to provide 3D characterization of surface topographical details with both vertical and lateral resolution.[23],[76],[77] The AFM scanner probe tip attached to a cantilever scans the surface topography in the nanometric scale[23] measured by the deflection of a nondestructive LASER probe.[76],[77] The data acquired is analyzed using dedicated software to quantify dimensional changes in mineral density distribution as a function of depth[78] and measure viscoelasticity of demineralized dentin with nanoindentation.[28],[79]

The AFM Operates in 2 modes: (i) Contact mode (CM-AFM) where the tip is moved laterally in constant contact with the surface; (ii) Tapping mode (TM-AFM) where the tip is gently tapped to the position of the laser beam on the photodiode[24] and quantifies early surface changes by measuring height differences at the atomic level.

Advantages: (1) Minimal or no sample preparation that minimize artifacts and allow serial measurements. (2) adaptable to use under ambient or liquid conditions, conducting/insulating surfaces and (3) high-resolution visualization up to collagen network in the nano-hardness analysis of dentin.[23],[80],[81] Limitation: Being very time-consuming, it requires samples with a smooth surface and of limited size[23],[77] (0.25 sqmm~ 60 min). Applications: Surface/structure nano-characterization and mechanical properties of intact/altered enamel and dentin substrate in particular such as: (1) Demineralization and various interventional remineralization strategies[23],[82](2) observation of collagen network, micro-morphology of noncarious cervical lesions, changes like roughness and chemo-mechanical properties like elasticity caused by therapeutic/restorative agents at intertubular and peritubular level.[23],[76],[81]

Acoustic Microscopy

Scanning Acoustic Microscopy (SAM) or Acoustic Micro Imaging (AMI)[83] is a high-frequency ultrasonic non-destructive imaging technique based on acoustic principles to inspect subsurface layers of a specimen in an aqueous environment such as dentin demineralization process, but not specific enough to differentiate between erosion and abrasion.[84],[85]

   Spectroscopic Analysis Top

It refers to non-destructive techniques to evaluate the elemental structure of dental tissues based on the generation of spectra when electromagnetic radiation interacts with matter. The most widely employed spectroscopic tools used in combination with microscopy for visualization include Vibrational Spectroscopy [Infrared spectroscopy (IR)] like Fourier Transform Infrared Spectroscopy (FT-IR), Raman Spectroscopy, Ultraviolet & Visible spectroscopy (UV-Vis), Energy- Dispersive X-ray Spectroscopy [EDXS] and Secondary Ion Mass Spectrometry [SIMS].[36],[58]

X-ray Spectroscopy

Energy Dispersive X-ray Spectroscopy [EDS or EDX] is a quantitative elemental surface microanalysis tool that measures the characteristic x-rays emitted following electron bombardment and can identify deposits of therapeutic agents on the surface/subsurface using cross-sectional concentration profiles of the element.[27],[47]

EDX coupled with SEM imaging (SEM- EDX) adds 3D information to quantitative data. When electrons near the nucleus get excited by a high electron beam [SEM], the electrons in the distant site- drop energy levels to fill the holes causing the emission of energy dispersive x-rays [EDX] different frequencies.[27]

X-Ray Diffraction Analysis [XRD] is a non-destructive spectroscopic analysis of the crystallographic microstructure of a solid sample by recording the X-ray diffraction pattern (peaks/position) of structural characteristics and the composition when irradiated[28],[49] and changes affecting crystallites with ionic substitution after an erosive challenge.[86] The interference of the scattered X-ray beam passing through the atoms in the sample is observed and measured in Angstroms (1 Angstrom = 0.1 nm) using Bragg's Law for both single crystal or polycrystalline materials.[87] XRD pattern provides information on various phases, the composition of crystal structure/size, stress, and texture. Advantages: i) Non-destructive, ii) powder or solid surface (single crystal) samples,[87] iii) simultaneous detection of small-angle X-ray scattering (SAXS) as well as wide-angle X-ray diffraction (WA- XRD) for the degree of crystallinity in polymers and fibers.[86] Eg: Powder X-ray Diffractometry [P-XRD]- most widely used with powder samples. Limitation: Only a tiny fraction of crystallites may contribute to the diffraction pattern.

X-ray Photoelectron Spectroscopy [XPS] or Electron Spectroscopy for Chemical Analysis [ESCA] is a highly sensitive, non-destructive, semi-quantitative method for elemental identification derived from the ratio of elements (e.g., Ca/P) and chemical states of the constituent elements limited to an outer surface depth of few nanometers (~10 nm). Limitations: (1) Use of ultrahigh vacuum (<10−9 Torr), (2) appropriate only for surface evaluation (few nm).[88],[89]

Vibrational Spectroscopy

It refers to non-invasive molecular Infrared [IR] spectroscopy methods that analyze molecular structure for material and structural characterization of mineralized tissues in dentistry. They are based on the interactions occurring between electromagnetic radiation (10−7 m) and the nuclear vibrations in the molecules following absorption of mid-infrared light in Fourier Transform Infrared spectroscopy (FTIR) or inelastic scattering of near-infrared light by a molecule in Raman microspectroscopy.[90],[91]

Fourier Transform Infrared Spectroscopy (FTIR) is a non-destructive spectroscopic method for analysis of surface elemental and mineral crystallinity (size and order of arrangement) by measuring molecular bands at different vibration modes.[92] When infrared radiation is passed through a sample the transmitted signal is detected by a mathematical process termed Fourier transform and converted into an interpretable spectrum with patterns of linear response representing a molecular 'fingerprint' specific to its chemical structures. The sampling techniques may be Attenuated Total Reflection (ATR), Transmission, Specular or Diffuse Reflectance. Advantages: (1) Unknown materials and surface components[58] can be identified against a database of reference spectra. (2) Simple, sensitive cost-effective technique for analysis of small samples (upto10 microns).[93]

Raman Microspectroscopy technique based on Raman scattering phenomenon of inelastic scattering of light of different frequency by molecules irradiated with electromagnetic radiation of a single frequency.[89] It uses vibrational modes[37] of scattering molecules under monochromatic LASER irradiation to identify additional peaks as a 'fingerprint' for a specific compound[37] on the light spectrum characteristic of Raman emission type of spectra[47],[58] Uses: High spatial resolution (1–1.5 μm) for elemental analysis of demineralized dentin rather than its topography.[67] Advantages: 1) Direct, non-destructive method. (2) no sample preparation.[89]

Mass Spectrometry (MS)

It provides the mass : charge ratio of ions as a mass spectrum. Secondary Ion Mass Spectrophotometry [SIMS] measures semi-quantitative elemental and isotopic/molecular composition[30],[80] and the uptake of fluoride by initial erosive lesions[79] e.g, Dynamic SIMS (D-SIMS).[94] Although provides rapid depth profiling with high sensitivity;[27] some surface damage was seen.[30],[79],[95]

   Tomographic Analysis Top

micro-Computed Tomography (micro-CT) or X-ray Micro Tomography [XMT]

It is a high-resolution non-destructive in-vitro tool for quantification of mineral density, 3D visualization of internal microstructure, and monitoring of real-time demineralization.[96],[97] The scanning is performed under 100% humidity on specimens (placed in moist cotton to avoid dehydration) mounted on a rotating platform, before (baseline) and after acidic challenge using proprietary parameters/software to calculate the Mineral Density (MD), lesion depth, and Mineral Loss (ML) (vol% μm) values.[98] Limitations: (1) High radiation dose, long scan time unsuitable for in-vivo studies[99] (2) High-cost equipment and technical expertise for data computing.[100] (3) Provides no information on the crystallographic phase.[88]

   Other Analysis Techniques (Novel And Emerging) Top

  1. Microdensitometric Scan measures optical density by light transmission through images on positive film transparencies (radiographs) as computerized data graphically or digitally[91],[101]
  2. White Light Interferometry [WLI] performs topographic assessment using an optical interference microscope[34],[102] for assessing surface roughness, bulk loss of enamel surfaces following repeated acid exposures[94],[103]
  3. LASER Speckle Imaging[104] produces speckle images from the scattered coherent light pattern that are highly sensitive to detect minimal changes, such as early noncarious lesion of enamel. Advantage: Non-destructive, cost-effective method developed for clinical application
  4. Specular and Diffuse Reflection Analysis[105] is a proposed clinical diagnostic method that uses an optical reflectometer for measuring the Surface Reflection Intensity (SRI) by change of the specular reflection signal sensitive to the detection of early erosion assessment in vivo, which was validated with SMH and AAS analysis of calcium release[106]
  5. Bioluminescence Imaging is a novel technique proposed for the precise assessment of early stages of caries/erosive activity during the chemical reaction between a bioluminescent marker Calcium Sensitive Photoprotein-aequorin and calcium ions released by demineralization for mean light-output (grayscale value) using an imaging software.[107]

   Conclusion Top

Currently, available research methods to study the dynamic process of demineralization are based on the stage of the lesion under examination by combining microstructural and crystallographic characterization.[108] Most research methods have limited capability in detecting early mineral changes or periodic assessments occurring overtime before or after therapeutic intervention including the current gold standard of TMR. Although a wide spectrum two-dimensional imaging modalities exists, 3-dimensional tools like AFM provide a superior assessment of surface topography and mechanical properties at higher resolution. While microscopic tools enable observation of microstructural changes at high magnification most spectroscopy techniques can provide elemental analysis non-destructively when used in combination.[29],[71] Observation of the dynamics of demineralization and remineralization by longitudinal monitoring with a sensitive, rapid, cost-effective, non-destructive method for quantitative and qualitative assessment can enable the early diagnosis, selection and development of therapeutic strategies tailored to treat and inhibit carious-erosive demineralization and promote remineralization.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Jaeggi T, Lussi A. Prevalence, incidence and distribution of erosion. Monogr Oral Sci 2014;25:55-73.  Back to cited text no. 1
Imfeld T. Dental erosion. Definition, classification and links. Eur J Oral Sci 1996;104:151-5.  Back to cited text no. 2
Huysmans MC, Chew HP, Ellwood RP. Clinical studies of dental erosion and erosive wear. Caries Res 2011;45 Suppl 1:60-8.  Back to cited text no. 3
Lussi A, Carvalho TS. Erosive tooth wear: A multifactorial condition of growing concern and increasing knowledge. Monogr Oral Sci 2014;25:1-15.  Back to cited text no. 4
Lussi A, Schlueter N, Rakhmatullina E, Ganss C. Dental erosion – An overview with emphasis on chemical and histopathological aspects. Caries Res 2011;45 Suppl 1:2-12.  Back to cited text no. 5
Shellis RP, Barbour ME, Jesani A, Lussi A. Effects of buffering properties and undissociated acid concentration on dissolution of dental enamel in relation to pH and acid type. Caries Res 2013;47:601-11.  Back to cited text no. 6
Featherstone JD, Lussi A. Understanding the Chemistry of Dental Erosion. In Dental Erosion, Monogr Oral Sci. First edition Basel, Karger. 2006; Vol. 20: 66-76.  Back to cited text no. 7
Meurman JH, ten Cate JM. Pathogenesis and modifying factors of dental erosion. Eur J Oral Sci 1996;104:199-206.  Back to cited text no. 8
Ganss C, Lussi A, Schlueter N. The histological features and physical properties of eroded dental hard tissues. Monogr Oral Sci 2014;25:99-107.  Back to cited text no. 9
Shellis RP, Addy M. The interactions between attrition, abrasion and erosion in tooth wear. Monogr Oral Sci 2014;25:32-45.  Back to cited text no. 10
Schlueter N, Amaechi BT, Bartlett D, Buzalaf MA, Carvalho TS, Ganss C, et al. Terminology of erosive tooth wear: Consensus report of a workshop organized by the ORCA and the Cariology Research Group of the IADR. Caries Res 2020;54:2-6.  Back to cited text no. 11
Abou Neel EA, Aljabo A, Strange A, Ibrahim S, Coathup M, Young AM, et al. Demineralization-remineralization dynamics in teeth and bone. Int J Nanomed 2016;11:4743-63.  Back to cited text no. 12
Goldberg M. Enamel and dentin carious lesions. JSM Dent 2020;8:1120.  Back to cited text no. 13
Gill J. Dental caries: The Disease and its Clinical Management, Third edition. Br Dent J 2016;221:443.  Back to cited text no. 14
Pitts NB, Zero DT, Marsh PD, Ekstrand K, Weintraub JA, Ramos-Gomez F, et al. Dental caries. Nat Rev Dis Primers 2017;3:1-6.  Back to cited text no. 15
Sivapathasundharam B, Raghu AR. Dental Caries. In Shafer's Textbook of Oral Pathology, Ninth Edition, [An adaptation of A Textbook of Oral Pathology, 1983, 4e, Elsevier Inc], RELX India Pvt Ltd, India. 2020 Jun 23: 369-403.  Back to cited text no. 16
Kidd E, Fejerskov O. How does a Caries lesion develop? In Essentials of Dental Caries: Fourth Edition, Oxford University Press, Oxford, OX2 6DP, UK 2016:14-47.  Back to cited text no. 17
Chaussain-Miller C, Fioretti F, Goldberg M, Menashi S. The role of matrix metalloproteinases (MMPs) in human caries. J Dent Res 2006;85:22-32.  Back to cited text no. 18
Zandoná AG, Ritter AV, Eidson RS. Dental Caries: Etiology, Clinical characteristics, two-dimensional imaging modalities exists, 3-dimensional tools like AFM provide a superior assessment of surface topography and mechanical properties at higher resolution Risk Assessment, and Management. In Sturdevant's Art and Science of Operative Dentistry, Seventh Edition, St. Louis, Missouri, USA. Elsevier 2019:40-94.  Back to cited text no. 19
Conrads G, About I. Pathophysiology of Dental Caries. In Caries Excavation: Evolution of Treating Cavitated Carious Lesions, Monogr Oral Sci. Basel, Karger 2018; Vol. 27:1-10.  Back to cited text no. 20
Tulek A, Mulic A, Runningen M, Lillemo J, Utheim TP, Khan Q, et al. Genetic aspects of dental erosive wear and dental caries. Int J Dent 2021;2021:5566733.  Back to cited text no. 21
Robinson C, Shore RC, Brookes SJ, Strafford S, Wood SR, Kirkham J. The chemistry of enamel caries. Crit Rev Oral Biol Med 2000;11:481-95.  Back to cited text no. 22
Tsenova-Ilieva I, Karova E. Application of atomic force microscopy in dental investigations. Int J Sci Res 2020;9:1319-26.  Back to cited text no. 23
Barbour ME, Rees JS. The laboratory assessment of enamel erosion: A review. J Dent 2004;32:591-602.  Back to cited text no. 24
Attin T, Wegehaupt FJ. Methods for assessment of dental erosion. Monogr Oral Sci 2014;25:123-42.  Back to cited text no. 25
Grenby TH. Methods of assessing erosion and erosive potential. Eur J Oral Sci 1996;104:207-14.  Back to cited text no. 26
Schlueter N, Hara A, Shellis RP, Ganss C. Methods for the measurement and characterization of erosion in enamel and dentine. Caries Res 2011;45 Suppl 1:13-23.  Back to cited text no. 27
Shellis RP, Ganss C, Ren Y, Zero DT, Lussi A. Methodology and models in erosion research: Discussion and conclusions. Caries Res 2011;45 Suppl 1:69-77.  Back to cited text no. 28
Nawrocka A, Piwonski I, Sauro S, Porcelli A, Hardan L, Lukomska-Szymanska M. Traditional microscopic techniques employed in dental adhesion research-applications and protocols of specimen preparation. Biosensors (Basel) 2021;11:408.  Back to cited text no. 29
Attin T. Methods for assessment of dental erosion. Monogr Oral Sci 2006;20:152-72.  Back to cited text no. 30
Grenby TH, Mistry M, Desai T. Potential dental effects of infants' fruit drinks studied in vitro. Br J Nutr 1990;64:273-83.  Back to cited text no. 31
Caglar E, Lussi A, Kargul B, Ugur K. Fruit yogurt: Any erosive potential regarding teeth? Quintessence Int 2006;37:647-51.  Back to cited text no. 32
Chen PS, Toribara TY, Warner H. Microdetermination of phosphorus. Anal Chem 1956;28:1756-8.  Back to cited text no. 33
Ganss C, Lussi A. Diagnosis of erosive tooth wear. Monogr Oral Sci 2014;25:22-31.  Back to cited text no. 34
Ganss C, Lussi A, Klimek J. Comparison of calcium/phosphorus analysis, longitudinal microradiography and profilometry for the quantitative assessment of erosive demineralisation. Caries Res 2005;39:178-84.  Back to cited text no. 35
Hookham MJ, Lynch RJ, Naughton DP. Characterisation of mineral loss as a function of depth using confocal laser scanning microscopy to study erosive lesions in enamel: A novel non-destructive image processing model. J Dent 2020;99:103402.  Back to cited text no. 36
Gilchrist F, Santini A, Harley K, Deery C. The use of micro-Raman spectroscopy to differentiate between sound and eroded primary enamel. Int J Paediatr Dent 2007;17:274-80.  Back to cited text no. 37
Arends J, ten Bosch JJ. Demineralization and remineralization evaluation techniques. J Dent Res 1992;71:924-8.  Back to cited text no. 38
Hughes JA, Jandt KD, Baker N, Parker D, Newcombe RG, Eisenburger M. Further modification to soft drinks to minimize erosion: A study in-situ. Caries Res 2002;36:70-4.  Back to cited text no. 39
Azzopardi A, Bartlett DW, Watson TF, Sherriff M. The measurement and prevention of erosion and abrasion. J Dent 2001;29:395-400.  Back to cited text no. 40
Ren YF, Zhao Q, Malmstrom H, Barnes V, Xu T. Assessing fluoride treatment and resistance of dental enamel to soft drink erosion in vitro: Applications of focus variation 3D scanning microscopy and stylus profilometry. J Dent 2009;37:167-76.  Back to cited text no. 41
Ganss C, Lussi A, Scharmann I, Weigelt T, Hardt M, Klimek J, et al. Comparison of calcium analysis, longitudinal microradiography and profilometry for the quantitative assessment of erosion in dentine. Caries Res 2009;43:422-9.  Back to cited text no. 42
Sundaram G, Wilson R, Watson TF, Bartlett DW. Effect of resin coating on dentine compared to repeated topical applications of fluoride mouthwash after an abrasion and erosion wear regime. J Dent 2007;35:814-8.  Back to cited text no. 43
Diaci J. Laser profilometry for the characterization of craters produced in hard dental tissues by Er: YAG and Er, Cr: YSGG Lasers. J Laser Health Acad 2008;2:1-10.  Back to cited text no. 44
Rodriguez JM, Curtis RV, Bartlett DW. Surface roughness of impression material and dental stones scanned by non-contact laser profilometry. Dent Mater 2008;25:500-5.  Back to cited text no. 45
Ganss C, Schlueter N, Hardt M, Schattenberg P, Klimek J. Effect of fluoride compounds on enamel erosion in vitro: A comparison of amine, sodium and stannous fluoride. Caries Res 2008;42:2-7.  Back to cited text no. 46
Ganss C, Hardt M, Lussi A, Cocks AK, Klimek J, Schlueter N. Mechanism of action of tin-containing fluoride solutions as anti-erosive agents in dentine – An in vitro tin-uptake, tissue loss, and scanning electron microscopy study. Eur J Oral Sci 2010;118:376-84.  Back to cited text no. 47
Jayarajan J, Janardhanam P, Jayakumar P, Deepika. Efficacy of CPP-ACP and CPP-ACPF on enamel remineralization – An in vitro study using scanning electron microscope and DIAGNOdent. Indian J Dent Res 2011;22:77-82.  Back to cited text no. 48
[PUBMED]  [Full text]  
Amaechi BT, Higham SM. Quantitative light-induced fluorescence: A potential tool for general dental assessment. J Biomed Opt 2002;7:7-13.  Back to cited text no. 49
Wilder-Smith CH, Wilder-Smith P, Kawakami-Wong H, Voronets J, Osann K, Lussi A. Quantification of dental erosions in patients with GERD using optical coherence tomography before and after double-blind, randomized treatment with esomeprazole or placebo. Am J Gastroenterol 2009;104:2788-95.  Back to cited text no. 50
Kashiwa M, Shimada Y, Sadr A, Yoshiyama M, Sumi Y, Tagami J. Diagnosis of occlusal tooth wear using 3D imaging of optical coherence tomography ex vivo. Sensors (Basel) 2020;20:E6016.  Back to cited text no. 51
Louie T, Lee C, Hsu D, Hirasuna K, Manesh S, Staninec M, et al. Clinical assessment of early tooth demineralization using polarization sensitive optical coherence tomography. Lasers Surg Med 2010;42:738-45.  Back to cited text no. 52
Machoy M, Seeliger J, Szyszka-Sommerfeld L, Koprowski R, Gedrange T, Woźniak K. The use of optical coherence tomography in dental diagnostics: A state-of-the-art review. J Healthc Eng 2017;2017:7560645.  Back to cited text no. 53
Chew HP, Zakian CM, Pretty IA, Ellwood RP. Measuring initial enamel erosion with quantitative light-induced fluorescence and optical coherence tomography: An in vitro validation study. Caries Res 2014;48:254-62.  Back to cited text no. 54
Mylonas P, Austin RS, Moazzez R, Joiner A, Bartlett DW. In vitro evaluation of the early erosive lesion in polished and natural human enamel. Dent Mater 2018;34:1391-400.  Back to cited text no. 55
Tsai MT, Wang YL, Yeh TW, Lee HC, Chen WJ, Ke JL, et al. Early detection of enamel demineralization by optical coherence tomography. Sci Rep 2019;9:17154.  Back to cited text no. 56
Katkar RA, Tadinada SA, Amaechi BT, Fried D. Optical coherence tomography. Dent Clin North Am 2018;62:421-34.  Back to cited text no. 57
Kaczmarek K, Leniart A, Lapinska B, Skrzypek S, Lukomska-Szymanska M. Selected spectroscopic techniques for surface analysis of dental materials: A narrative review. Materials (Basel) 2021;14:2624.  Back to cited text no. 58
Leng Y. Light Microscopy Materials Characterization: Introduction to Microscopic and Spectroscopic Methods. Ch. 1. Singapore: Wiley; 2009. p. 1-45.  Back to cited text no. 59
Al-Malik MI, Holt RD, Bedi R, Speight PM. Investigation of an index to measure tooth wear in primary teeth. J Dent 2001;29:103-7.  Back to cited text no. 60
White I, McIntyre J, Logan R. Studies on dental erosion: An in vitro model of root surface erosion. Aust Dent J 2001;46:203-7.  Back to cited text no. 61
Maia AM, Longbottom C, Gomes AS, Girkin JM. Enamel erosion and prevention efficacy characterized by confocal laser scanning microscope. Microsc Res Tech 2014;77:439-45.  Back to cited text no. 62
Heurich E, Beyer M, Jandt KD, Reichert J, Herold V, Schnabelrauch M, et al. Quantification of dental erosion – A comparison of stylus profilometry and confocal laser scanning microscopy (CLSM). Dent Mater 2010;26:326-36.  Back to cited text no. 63
Azzopardi A, Bartlett DW, Watson TF, Sherriff M. The surface effects of erosion and abrasion on dentine with and without a protective layer. Br Dent J 2004;196:351-4.  Back to cited text no. 64
Cheng ZJ, Wang XM, Cui FZ, Ge J, Yan JX. The enamel softening and loss during early erosion studied by AFM, SEM and nanoindentation. Biomed Mater 2009;4:015020.  Back to cited text no. 65
Field J, Waterhouse P, German M. Quantifying and qualifying surface changes on dental hard tissues in vitro. J Dent 2010;38:182-90.  Back to cited text no. 66
Wang Y, Yao X. Morphological/chemical imaging of demineralized dentin layer in its natural, wet state. Dent Mater 2010;26:433-42.  Back to cited text no. 67
Zavgorodniy AV, Rohanizadeh R, Swain MV. Ultrastructure of dentine carious lesions. Arch Oral Biol 2008;53:124-32.  Back to cited text no. 68
Fearne J, Anderson P, Davis GR. 3D X-ray microscopic study of the extent of variations in enamel density in first permanent molars with idiopathic enamel hypomineralisation. Br Dent J 2004;196:634-8.  Back to cited text no. 69
Anderson P, Elliott JC. Rates of mineral loss in human enamel during in vitro demineralization perpendicular and parallel to the natural surface. Caries Res 2000;34:33-40.  Back to cited text no. 70
Hall AF, Sadler JP, Strang R, de Josselin de Jong E, Foye RH, Creanor SL. Application of transverse microradiography for measurement of mineral loss by acid erosion. Adv Dent Res 1997;11:420-5.  Back to cited text no. 71
Amaechi BT, Higham SM, Edgar WM. Use of transverse microradiography to quantify mineral loss by erosion in bovine enamel. Caries Res 1998;32:351-6.  Back to cited text no. 72
Hara AT, Ando M, Cury JA, Serra MC, González-Cabezas C, Zero DT. Influence of the organic matrix on root dentine erosion by citric acid. Caries Res 2005;39:134-8.  Back to cited text no. 73
Schmuck BD, Carey CM. Improved contact X-ray microradiographic method to measure mineral density of hard dental tissues. J Res Natl Inst Stand Technol 2010;115:75-83.  Back to cited text no. 74
Ganss C, Hardt M, Blazek D, Klimek J, Schlueter N. Effects of toothbrushing force on the mineral content and demineralized organic matrix of eroded dentine. Eur J Oral Sci 2009;117:255-60.  Back to cited text no. 75
Kubinek R, Zapletalova Z, Vujtek M, Novotoný R, Kolarova H, Chmelickova H. Examination of dentin surface using AFM and SEM. Mod Res Educ Top Microsc 2007;11:593-8.  Back to cited text no. 76
Silikas N, Lennie AR, England K, Watts DC. AFM as a tool in dental research. Microsc Anal 2001;82:19-21.  Back to cited text no. 77
Kinney JH, Balooch M, Haupt DL Jr., Marshall SJ, Marshall GW Jr. Mineral distribution and dimensional changes in human dentin during demineralization. J Dent Res 1995;74:1179-84.  Back to cited text no. 78
Balooch M, Wu-Magidi IC, Balazs A, Lundkvist AS, Marshall SJ, Marshall GW, et al. Viscoelastic properties of demineralized human dentin measured in water with atomic force microscope (AFM)-based indentation. J Biomed Mater Res 1998;40:539-44.  Back to cited text no. 79
Reddy NV, Vengala D, Snehika G, Achanta A, Mareddy AR. Evaluation of external surface structure, roughness, and absolute depth profile of fluorotic enamel compared to healthy enamel using atomic force microscope: An in vitro study. Int J Clin Pediatr Dent 2020;13:246-50.  Back to cited text no. 80
Zapletalová Z, Kubínek R, Vůjtek M, Novotný R. Examination of dentin surface using AFM (our experience). Acta Med (Hradec Kralove) 2004;47:343-6.  Back to cited text no. 81
Poggio C, Lombardini M, Vigorelli P, Ceci M. Analysis of dentin/enamel remineralization by a CPP-ACP paste: AFM and SEM study. Scanning 2013;35:366-74.  Back to cited text no. 82
Yu H. Scanning acoustic microscopy for material evaluation. Appl Microsc 2020;50:25.  Back to cited text no. 83
Ślak B, Ambroziak A, Strumban E, Maev RG. Enamel thickness measurement with a high frequency ultrasonic transducer-based hand-held probe for potential application in the dental veneer placing procedure. Acta Bioeng Biomech 2011;13:65-70.  Back to cited text no. 84
Marangos O, Misra A, Spencer P, Katz JL. Scanning acoustic microscopy investigation of frequency-dependent reflectance of acid- etched human dentin using homotopic measurements. IEEE Trans Ultrason Ferroelectr Freq Control 2011;58:585-95.  Back to cited text no. 85
Siddiqui S, Anderson P, Al-Jawad M. Recovery of crystallographic texture in remineralized dental enamel. PLoS One 2014;9:e108879.  Back to cited text no. 86
Rajesh Kumar S, Bharath LV, Geetha R. Broad spectrum antibacterial silver nanoparticle green synthesis: Characterization, and mechanism of action. In Green Synthesis, Characterization and Applications of Nanoparticles, Micro and Nano Technologies, Elsevier Inc, Amsterdam, Netherlands 2019; Ch 17: 429 - 444  Back to cited text no. 87
Gerth HU, Dammaschke T, Schäfer E, Züchner H. A three layer structure model of fluoridated enamel containing CaF2, Ca (OH) 2 and FAp. Dent Mater 2007;23:1521-8.  Back to cited text no. 88
Epple M, Enax J, Meyer F. Prevention of caries and dental erosion by fluorides – A critical discussion based on physico-chemical data and principles. Dent J (Basel) 2022;10:6.  Back to cited text no. 89
Leng Y. Vibrational Spectroscopy for Molecular Analysis: In Materials Characterization: Introduction to Microscopic and Spectroscopic Methods, Wiley-VCH, Verlag GmbH & Co. KGaA, Weinheim, Germany. 2013; Ch9: 283-300.  Back to cited text no. 90
Orsini G, Orilisi G, Notarstefano V, Monterubbianesi R, Vitiello F, Tosco V, et al. Vibrational imaging techniques for the characterization of hard dental tissues: From bench-top to chair-side. Appl Sci 2021;11:11953.  Back to cited text no. 91
Jabin Z, Nasim I, Vishnu Priya V, Agarwal N. Quantitative analysis and effect of SDF, APF, NaF on demineralized human primary enamel using SEM, XRD, and FTIR. Int J Clin Pediatr Dent 2021;14:537-41.  Back to cited text no. 92
Kim IH, Son JS, Min BK, Kim YK, Kim KH, Kwon TY. A simple, sensitive and non-destructive technique for characterizing bovine dental enamel erosion: Attenuated total reflection Fourier transform infrared spectroscopy. Int J Oral Sci 2016;8:54-60.  Back to cited text no. 93
Joshi M, Joshi N, Kathariya R, Angadi P, Raikar S. Techniques to evaluate dental erosion: A systematic review of literature. J Clin Diagn Res 2016;10:E01-7.  Back to cited text no. 94
Zan KW, Nakamura K, Hamba H, Sadr A, Nikaido T, Tagami J. Micro-computed tomography assessment of root dentin around fluoride-releasing restorations after demineralization/remineralization. Eur J Oral Sci 2018;126:390-9.  Back to cited text no. 95
Davis GR, Mills D, Anderson P. Real-time observations of tooth demineralization in 3 dimensions using X-ray microtomography. J Dent 2018;69:88-92.  Back to cited text no. 96
Shimizu M, Matsui N, Sayed M, Hamba H, Obayashi S, Takahashi M, Tsuda Y, et al. Micro-CT assessment of the effect of silver diamine fluoride on inhibition of root dentin demineralization. Dent Mater J 2021;40:1041-8.  Back to cited text no. 97
Davis GR, Evershed AN, Mills D. Quantitative high contrast X-ray microtomography for dental research. J Dent 2013;41:475-82.  Back to cited text no. 98
Ghavami-Lahiji M, Davalloo RT, Tajziehchi G, Shams P. Micro-computed tomography in preventive and restorative dental research: A review. Imaging Sci Dent 2021;51:341-50.  Back to cited text no. 99
Mallon DE, Mellberg JR. Analysis of dental hard tissue by computerized microdensitometry. J Dent Res 1985;64:112-6.  Back to cited text no. 100
Holme B, Hove LH, Tveit AB. Using white light interferometry to measure etching of dental enamel. Measurement 2005;38:137-47.  Back to cited text no. 101
Stenhagen KR, Hove LH, Holme B, Taxt-Lamolle S, Tveit AB. Comparing different methods to assess erosive lesion depths and progression in vitro. Caries Res 2010;44:555-61.  Back to cited text no. 102
Koshoji NH, Bussadori SK, Bortoletto CC, Prates RA, Oliveira MT, Deana AM. Laser speckle imaging: A novel method for detecting dental erosion. PLoS One 2015;10:e0118429.  Back to cited text no. 103
Rakhmatullina E, Bossen A, Höschele C, Wang X, Beyeler B, Meier C, et al. Application of the specular and diffuse reflection analysis for in vitro diagnostics of dental erosion: Correlation with enamel softening, roughness, and calcium release. J Biomed Opt 2011;16:107002.  Back to cited text no. 104
Carvalho TS, Baumann T, Lussi A. A new hand-held optical reflectometer to measure enamel erosion: Correlation with surface hardness and calcium release. Sci Rep 2016;6:25259.  Back to cited text no. 105
Longbottom C, Vernon B, Perfect E, Haughey AM, Christie A, Pitts N. Initial investigations of a novel bioluminescence method for imaging dental demineralization. Clin Exp Dent Res 2021;7:786-94.  Back to cited text no. 106
Fowler CE, Creeth JE, Paul AJ, Carson C, Tadesse G, Brown A. The effect of dentifrice ingredients on enamel erosion prevention and repair. Surf Interface Anal 2021;53:528-39.  Back to cited text no. 107
Al-Shamrani SS. In vitro methods of surface characterization of dental erosion: A review. Int J Prev Clin Dent Res 2021;8:20-3.  Back to cited text no. 108
  [Full text]  

Correspondence Address:
Prof. Darshana Devadiga
Departments of Conservative Dentistry and Endodontics, A.B Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to be University), Mangalore, Karnataka
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jcd.jcd_161_22

Rights and Permissions


  [Table 1], [Table 2], [Table 3]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  

     Chemical Analysis
     Surface Analysis
     Optical Analysis
     Microscopic Analysis
   Spectroscopic An...
     Tomographic Analysis
   Other Analysis T...
    Article Tables

 Article Access Statistics
    PDF Downloaded84    
    Comments [Add]    

Recommend this journal