NON-FLUORIDATED REMINERALISING AGENTS: A REVIEW

Dental caries is a biofilm-mediated, sugar-driven, multifactorial disease characterized by a dynamic imbalance between demineralization and remineralization of the dental hard tissues. Although fluoride remains the cornerstone of modern caries prevention and remineralization, concerns regarding excessive fluoride exposure, fluorosis, limited effectiveness in pits and fissures, nutritional deficiencies and other practical limitations have stimulated the development of non-fluoridated remineralising agents. These agents act through various mechanisms, including the delivery of calcium and phosphate ions, enhancement of salivary remineralization, modification of the dental biofilm, biomimetic regeneration of enamel, and suppression of cariogenic microorganisms. Calcium phosphate-based systems such as amorphous calcium phosphate, casein phosphopeptide-amorphous calcium phosphate, functionalized tricalcium phosphate and bioactive glass have demonstrated considerable potential in promoting remineralization. Recent advances in nanotechnology, self-assembling peptides and enamel biomimetic systems have further expanded the possibilities for non-fluoride-based caries management. Biofilm modifiers, natural products and antimicrobial approaches also offer promising adjunctive strategies. This review discusses the rationale, classification, mechanisms of action and clinical applications of currently available and emerging non-fluoridated remineralising agents.