Early childhood caries(ECC) is a biofilm-mediated, multifactorial, dynamic disease induced by the imbalance between demineralization and remineralization of dental hard tissues.¹ Caries progress when the equilibrium of demineralization and remineralization is tilted, leading to net mineral loss and white spot lesion(WSLs) formation.² Since a lower level of mineralization and the thin enamel make primary teeth more susceptible to caries formation, effective control of initial lesions before cavitation is of utmost importance.³

Remineralization of the initial lesion is always a viable option that arrests or reverses the caries process at a lesion level which reduces the loss of sound tooth structure.⁴ Sodium fluoride varnish(NaF) is a professionally used topical fluoride preparation that is simple, relatively inexpensive and effective in controlling the progression of WSLs.⁵ However, it has been claimed that the effect of fluoride is limited to the outer 30um and does not enter a deeper subsurface demineralized zone, where remineralization is much needed for the affected enamel.⁶

Owing to this limitation seeking an alternative that diffuses deeply into the subsurface caries in a biomimetic way similar to the natural remineralization could be valuable. One such is the Self-assembling peptide(SAP11-4) which mimics the action of natural enamel proteins that aid in guided enamel regenerartion.⁷ Several methods exist for the detection and assessment of WSLs, visual and tactile method is commonly used for detection and photography is simple and effective for assessment. There are limited clinical studies evaluating the efficacy of SAP11-4 and NaF on primary teeth, henceforth this study is undertaken.