Impact of Nanohydroxyapatite Tele-Micro-Remineralization on Early Caries in Children

Thesis Abstract

Early childhood caries remains a prevalent public health challenge, with conventional remineralization approaches often limited by accessibility, adherence, and the need for frequent clinical visits. This study investigates the impact of Nanohydroxyapatite (n-HA) tele-micro-remineralization, a remote monitoring and guidance intervention designed to enhance daily remineralization practices in children aged 6–12 years presenting initial enamel lesions. The aim is to evaluate whether tele-guided n-HA micro-remineralization improves lesion arrest and remineralization rates compared with standard in-clinic fluoride remineralization. Specific objectives include (1) to quantify changes in lesion depth and mineral content over a 12-month period using clinically graded Caries Assessment Spectrum and Treatment (CAST) indices and quantitative light-induced fluorescence (QLF) metrics; (2) to assess patient adherence to at-home remineralization protocols via a tele-monitoring platform that records daily product use, brushing frequency, and feedback responses; (3) to examine the mediating roles of caregiver engagement and health literacy on treatment outcomes; (4) to identify potential moderators such as socioeconomic status and baseline caries risk on efficacy; and (5) to compare cost-effectiveness of tele-micro-remineralization versus conventional fluoride varnish therapy. The methodological framework adopts a parallel-group randomized controlled trial (RCT) with 240 participating children recruited from urban and peri-urban dental clinics, stratified by age and baseline caries risk, and followed for 12 months. The intervention group receives daily nano-hydroxyapatite toothpaste combined with weekly tele-supervised micro-remineralization sessions delivered through a secure mobile platform, while the control group receives standard fluoride varnish applications at 0, 6, and 12 months. Data collection instruments include calibrated visual-tactile caries scoring, QLF imaging for quantitative mineral loss, a validated caregiver health literacy questionnaire, a bespoke tele-monitoring app capturing adherence metrics, and cost data from clinic records. Validity and reliability will be ensured through examiner calibration (kappa >0.80 for caries assessments), pilot testing of the tele-platform, and triangulation of QLF with histological estimations in a subset of cases. Data analysis will employ mixed-effects linear models to assess longitudinal changes in lesion metrics, controlling for clustering by site; multiple imputation willAddress missing data. Mediation analyses will test caregiver engagement and health literacy as pathways between intervention and outcomes, while moderation analyses will explore socioeconomic and baseline risk influences. The analysis plan also includes cost-effectiveness analysis using incremental cost-effectiveness ratios (ICERs) per lesion arrested and per quality-adjusted life year (QALY) gained, adopting the societal perspective. The study anticipates that tele-micro-remineralization will yield statistically significant greater lesion arrest rates, reduced lesion depth progression, and higher mineral density gains compared with conventional fluoride therapy, particularly among children with high caregiver engagement and adequate health literacy. Expected findings include improved adherence metrics, enhanced parental activation, and greater patient-reported satisfaction with remote guidance. The contribution to knowledge lies in providing robust empirical evidence on the efficacy and cost-effectiveness of integrating nanohydroxyapatite-based remineralization with telehealth-enabled monitoring for early caries management in pediatric populations, thereby informing policy and clinical guidelines for scalable non-invasive interventions. The study will draw on theoretical frameworks including the Health Belief Model to interpret adherence determinants and the Technology Acceptance Model to assess tele-platform uptake, positioning the research within a broader discourse on digital health-enabled preventive dentistry. Concluding, the research is anticipated to support a shift toward accessible, patient-centered remineralization strategies that leverage nanomaterials and telecommunication to arrest early caries while reducing the burden on traditional dental services. Recommendations will address optimization of tele-delivery protocols, caregiver education, integration with school dental programs, and future investigations into long-term outcomes and diverse populations.