The preventive impact of theobromine on enamel microhardness in comparison with sodium fluoride solution: A comparative in-vitro study
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Abstract
Background: In the realm of preventive dentistry, fluoride-based remineralization techniques have long been the prevailing approach. However, the field is currently experiencing a revolutionary shift as innovative technological advancements offer effective means to facilitate the remineralization of dental surfaces. This study aimed to investigate the effect of theobromine application compared to sodium fluoride and artificial saliva on the microhardness of human tooth enamel. Methods: A sample of 34 extracted sound maxillary first premolars were selected for the research; one of these teeth was used for scanning electron microscope investigation, while the remaining 33 teeth were assigned randomly to three groups: (1) the theobromine group (2) the sodium fluoride group and (3) the artificial saliva group (negative control). Treatment solutions were applied during a 28-day pH cycle followed by subjecting the samples to demineralizing solution to form artificial white spot lesions. The enamel structure of the study sample was evaluated quantitatively using Vickers's microhardness test (Jinan Kason Testing Equipment Co., China) conducted with a diamond indenter that applied a 300 g load for 15 seconds. Three indentations were made on the buccal surfaces with a distance of 500 μm and qualitatively by scanning electron microscope (representative samples not included in statistical analysis). Data analyses were performed by Levene test and General Linear Model Repeated Measure Factorial ANOVA with Tukey HSD, the accepted level of significance was 0.05. Results: The present study result showed that teeth treated with theobromine had a higher mean of surface microhardness in the treatment and the demineralization stages than that of the teeth treated with sodium fluoride, with a statistically significant difference (p<0.05). Conclusions: Theobromine could preserve enamel microhardness more than sodium fluoride after the acid challenge.
Received date: 21-12-2025
Accepted date: 20-02-2026
Published date: 15-09-2026
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References
Abonayla MF, Alwaheb AM. The Effect of Socioeconomic Level on dental caries among preschool children in Baghdad city. Ind J Pub-lic Health.2020; 11: 2333-42 . DOI: https://doi.org/10.37506/v11/i2/2020/ijphrd/195185
Al-Ward FS, Radhi NJ. The Impact of Chitosan and Ozonated Water on the Remineralization of White Spot Lesion in Vitro. Med J Bab-ylon.2023;20: 33-40. DOI: https://doi.org/10.4103/MJBL.MJBL_261_22
Kadhem DJ, Al Haidar AH. Remineralization of Dentine Caries Using Moringa Oleifera Based Nano-Silver Fluoride: A Single-Blinded, Randomized, Active-Controlled Clinical Trial. Dent Hypo.2022;13: 82-85. DOI: https://doi.org/10.4103/denthyp.denthyp_57_22
Almaas JK, Diab BS. The impact of caries experience on quality of life among dental students in Iraq. J Bagh Coll dent.2020;32(3):8-13. DOI: https://doi.org/10.26477/jbcd.v32i3.2894
Hasan DM, Abbas MJ, Al-Ghurabi BH. Improvement of human dental enamel using laser-prepared indium oxide nanoparticles sus-pension solution (in vitro study). Egyptian J Hospit Med.2023;90(2):2677-87.. DOI: https://doi.org/10.21608/ejhm.2023.286428
Amaechi BT, AbdulAzees PA, Alshareif DO, Shehata MA, Lima PP, Abdollahi A, Kalkhorani PS, Evans V. Comparative efficacy of a hydroxyapatite and a fluoride toothpaste for prevention and remineralization of dental caries in children. BDJ open.2019;;5:18. DOI: https://doi.org/10.1038/s41405-019-0026-8
Ullah R, Zafar MS, Shahani N. Potential fluoride toxicity from oral medicaments: A review Iranian J Basic Med Sci.2017;20:841-848.
Zohoori FV, Maguire A. Are there good reasons for fluoride labelling of food and drink. British J Dent2018 Feb 23;224(4):215-217. DOI: https://doi.org/10.1038/sj.bdj.2018.123
Celik ZC, Özbay Yavlal G, Yanıkoğlu F, Kargül B, Tağtekin D, Stookey GK, Peker S, Hayran O. Do ginger extract, natural honey and bitter chocolate remineralize enamel surface as fluoride toothpastes? An in-vitro study. Niger J Clin Pract.2021; 24: 1283-1288. DOI: https://doi.org/10.4103/njcp.njcp_683_20
Sharmin DD. Comparative evaluation on antimicrobial activity of theobromine and two commercial kids fluoride toothpaste-An in vitro study. Int J Dent Oral Heal.2016;2(5):61-5. DOI: https://doi.org/10.25141/2471-657X-2016-5.0103
Husni MA, Nugroho AK, Sulaiman TN, Fakhrudin N. Microencapsulation of Green Coffee Beans (Coffea canephora) Extract using Whey Protein Concentrate. Iraqi J Pharma Sci.2022;31(1):20-31. DOI: https://doi.org/10.31351/vol31iss1pp20-31
Nakamoto T, Falster AU, Simmons Jr WB. Theobromine: a safe and effective alternative for fluoride in dentifrices. J Caff Res.2016;6:1-9. DOI: https://doi.org/10.1089/jcr.2015.0023
Irawan MI, Noerdin A, Eriwati YK. The effect of time in the exposure of theobromine gel to enamel and surface hardness after de-min-eralization with 1% citric acid. In J Phys Conf Seri.2017;884(1);012005. DOI: https://doi.org/10.1088/1742-6596/884/1/012005
Golfeshan F, Mosaddad SA, Ghaderi F. The Effect of Toothpastes Containing Natural Ingredients Such as Theobromine and Caffeine on Enamel Microhardness: An in Vitro Study. Evid based Complement Altern Med 2021; 2021: DOI: https://doi.org/10.1155/2021/3304543
Mahardhika A, Noerdin A, Eriwati YK. The effects of brushing on human enamel surface roughness after NaF gel and theobromine gel exposure. In J Phys: Conf Ser.2017;884(1):012007. DOI: https://doi.org/10.1088/1742-6596/884/1/012007
Thorn AK, Lin WS, Levon JA, Morton D, Eckert GJ, Lippert F. The effect of theobromine on the in vitro de-and remineralization of enamel carious lesions. J Dent.2020:103: Article no. 100013. DOI: https://doi.org/10.1016/j.jjodo.2020.100013
Lippert F. The effects of fluoride, strontium, theobromine and their combinations on caries lesion rehardening and fluoridation. Arch Oral Biol.2017;80:217-21. DOI: https://doi.org/10.1016/j.archoralbio.2017.04.022
Al-Mamoori RM, Al Haidar AH. Effect of Resin Infiltration and Microabrasion on the Microhardness of the Artificial White Spot Le-sions (an in vitro study). J Bag Coll Dent.2022;34:44-50. DOI: https://doi.org/10.26477/jbcd.v34i1.3091
Ulusoy NB, Akbay Oba A, Cehreli ZC. Effect of Er, Cr: YSGG laser on the prevention of primary and permanent teeth enamel demin-er-alization: SEM and EDS evaluation. Photobiomod, Photomed Laser Surg.2020;38:308-15. DOI: https://doi.org/10.1089/photob.2019.4772
Abdulhussein DN, Al Haidar AH. Preventive effect of combined Er, Cr: YSGG and fluoride gel on acid resistance of the permanent tooth enamel: An in vitro study. J Clin Exper Dent.2023;15:e225. DOI: https://doi.org/10.4317/jced.60023
Amaechi BT, Porteous N, Ramalingam K, Mensinkai PK, Ccahuana Vasquez RA, Sadeghpour A, Nakamoto T. Remineralization of ar-tificial enamel lesions by theobromine. Caries Res.2013;47:399-405. DOI: https://doi.org/10.1159/000348589
Farhad F, Kazemi S, Bijani A, Pasdar N. Efficacy of theobromine and sodium fluoride solutions for remineralization of initial enamel caries lesions. Fron Den.2021;18:10. DOI: https://doi.org/10.18502/fid.v18i10.6134
Ten Cate JM, Duijsters PP. Alternating demineralization and remineralization of artificial enamel lesions. Caries Res.1982; 16:201-10. DOI: https://doi.org/10.1159/000260599
Tschoppe P, Zandim DL, Martus P, Kielbassa AM. Enamel and dentine remineralization by nano-hydroxyapatite toothpastes. J Dent.2011;39:430-7. DOI: https://doi.org/10.1016/j.jdent.2011.03.008
Elsherbini MS. Assessment of remineralization potential of Theobromine and Sodium Fluoride gels on Artificial Caries like lesions. Braz Den Sci.2020;;23 (3):11. DOI: https://doi.org/10.14295/bds.2020.v23i3.1975
Shalan LA, Thiab SA. The Effect of Different Light Cure Systems on Microhardness of Bulk Fill Composite Materials. J Bag coll Dent.2017;325:1-8.
Jawad MK, Ali AF. The Effect of Multi-Wall Carbon Nanotubes on the Microhardness of the Tooth Enamel. J Bag Coll Dent.2016;28:169-173. DOI: https://doi.org/10.12816/0024729
Belcheva A, El Feghali R, Nihtianova T, Parker S. Effect of the carbon dioxide 10,600-nm laser and topical fluoride gel application on enamel microstructure and microhardness after acid challenge: an in vitro study. Lasers Med Sci.2018;33:1009-17. DOI: https://doi.org/10.1007/s10103-018-2446-4
Li X, Wang J, Joiner A, Chang J. The remineralisation of enamel: a review of the literature. J Dent.2014;42:12-20. DOI: https://doi.org/10.1016/S0300-5712(14)50003-6
Durhan MA, Bilsel SO, Gokkaya B, Yildiz PK, Kargul B. Caries Preventive Effects of Theobromine Containing Toothpaste on Early Childhood Caries: Preliminary Results. Acta Stomatol Croat.2021;55:18-27 DOI: https://doi.org/10.15644/asc55/1/3
Nasution AI, Zawil C. The comparison of enamel hardness between fluoride and theobromine application. International JContemp Dent Med Rev.2014;2014:4 pages.
Shawky R, Khattab N. Evaluation of the remineralizing effect of theobromine and fluoride using scanning electron microscope. Egyp-tian Dent J.2021;67:119-126. DOI: https://doi.org/10.21608/edj.2020.52781.1402
El Moshy S, Abbass MM, El-Motayam AM. Biomimetic remineralization of acid etched enamel using agarose hydrogel model. F1000Rsearch.2018;7:1476-89. DOI: https://doi.org/10.12688/f1000research.16050.1
Taneja V, Nekkanti S, Gupta K, Hassija J. Remineralization potential of theobromine on artificial carious lesions. J Int Soc Prev Com-mun Dent.2019;9:576-583. DOI: https://doi.org/10.4103/jispcd.JISPCD_265_19