Las erosiones serán inevitablemente nuestra principal preocupación en términos de salud bucal en el presente siglo.
La batalla contra la caries está siendo ganada en los países desarrollados, los que han vuelto ahora sus ojos hacia el daño que produce el ácido por cualquiera de las vías en que llega a la boca, endógena o exógena.
Esta recopilación sobre este tema es nueva y recién comienzo a hacerla en 2010. A pesar de todos los resguardos y contra todo pronóstico, he perdido la original que tenía más de 8 años. Trataré de recuperarla de a poco.
Rev Panam Salud Publica. 2010 Feb;27(2):132-7.
Sucrose concentration and pH in liquid oral pediatric medicines of long-term use for children.
Passos IA, Sampaio FC, Martínez CR, Freitas CH.
Departamento de Odontologia Restauradora, Centro de Ciências da Saúde, Universidade Federal da Paraíba, João Pessoa, Brazil.
Abstract
OBJECTIVES: To determine the pH and sucrose concentrations (SC) of pediatric liquid drugs of long-term use by children in order to evaluate the potential risk for dental caries and dental erosion. METHODS: After assessing the pH, we analyzed 71 aqueous medicine samples for sucrose by the Lane-Eynon general volumetric method. The pH and SC values (mean +/- standard deviation (SD) were calculated according to therapeutic action. RESULTS: The highest and the lowest SC values (mean +/- SD) were found in respiratory (37.75% +/- 17.23%) and endocrine drugs (11.97% +/- 15.16%) (p < 0.01). The values for medicines prescribed for daily ingestion were 47.15% +/- 9.57%, whereas for twice daily and three or four times a day, these numbers were 24.42% +/- 18.03% and 34.43% +/- 14.83%, respectively (p < 0.01). The SC (mean +/- SD)) values were higher in syrups (36.32% +/- 17.62%) than in other formulations (p > 0.05). The overall pH (mean +/- SD) was 5.89 +/- 2.02 (range 2.3 +/- 0.01 to 10.6 +/- 0.02). In products with acidic pH, the SC (mean +/- SD) was significantly lower (22.14% +/- 15.72%) than in nonacidic medicines (39.22% +/- 15.82%) (p < 0.001). CONCLUSIONS: It can be concluded that the pediatric medicines studied have a high SC and low pH, which vary according to therapeutic class, daily dose, and brand. Caution about dental caries, dental erosion, and systemic diseases such as diabetes mellitus is warranted when these medicines are ingested frequently.
Arch Oral Biol. 2010 Apr;55(4):294-9. Epub 2010 Mar 1.
Influence of the digestive enzymes trypsin and pepsin in vitro on the progression of erosion in dentine.
Schlueter N, Hardt M, Klimek J, Ganss C.
Department of Conservative and Preventive Dentistry, Dental Clinic of the Justus-Liebig-University Giessen, Schlangenzahl 14, D-35392 Giessen, Germany. nadine.schlueter@dentist.med.uni-giessen.de <nadine.schlueter@dentist.med.uni-giessen.de>
Abstract
OBJECTIVES: In patients with eating disorders, gastric and pancreatic enzymes could possibly reach the oral cavity during vomiting and could perhaps degrade the organic matrix of eroded dentine. This in vitro study sought to investigate whether pepsin, trypsin or the combination of both, have an influence on erosive mineral loss in dentine and whether they are able to degrade the organic matrix. METHODS: Sixty-four human dentine specimens were prepared and randomly divided into four groups. Specimens were cyclically de- and remineralised for six days. Demineralisation was performed with an HCl-solution (6x 5min daily, pH 1.6) in groups 1 and 3; in groups 2 and 4 the demineralisation solution additionally contained pepsin (750 microg/ml). After demineralisation, specimens of groups 3 and 4 were treated with a trypsin solution (6x 10min daily, 2000 BAEE/ml). After each day, mineral content (mum) was determined microradiographically, and the matrix degradation was determined by hydroxyproline analysis. RESULTS: After six days, treatment with pepsin (group 2) or trypsin (group 3) had no significant influence on mineral loss. The combined impact of pepsin and trypsin led to significantly higher mineral loss (group 4: 202.5+/-37.4) compared to all other groups (group 1: 139.1+/-29.5, p<or=0.001; group 2: 108.8+/-34.7, p<or=0.001; group 3: 157.8+/-37.2, p<or=0.05). Hydroxyproline was found in all pepsin-solutions but in no trypsin- or HCl-solutions. CONCLUSION: The combined impact of pepsin and trypsin intensified dentine erosion progression in vitro. This could be one reason for the fast proceeding of dental erosion in patients with chronic vomiting.
J Oral Rehabil. 2009 Jul;36(7):498-507.
Clinical in situ study investigating abrasive effects of two commercially available toothpastes.
Giles A, Claydon NC, Addy M, Hughes N, Sufi F, West NX.
Division of Restorative Dentistry, Department of Oral and Dental Science, University of Bristol, UK.
Abstract
The aim of this study was to determine if the abrasive effect on dentine of two commercially available toothpastes, known to vary in their in vitro abrasive levels, can be differentiated in an in situ model after 10 days, assessed by contact profilometry. This was a single centre, single blind, randomized, split mouth, two treatment, in situ study, in 34 healthy subjects, evaluating the abrasive effects of two marketed desensitizing toothpastes, (Colgate Sensitive Multi Protection toothpaste – C; Sensodyne Total Protection – S). Subjects wore bi-lateral, lower buccal appliances, each fitted with four dentine sections which were power brushed three times a day with the treatment regimen. Each subject received two toothpaste treatments for 10 days during the treatment period. Samples were measured at baseline and day 10 by contact and non-contact profilometry and day 5 by contact profilometry. Thirty-four subjects were included in the efficacy analysis. Results from contact profilometry showed statistically significant (P < 0.0001) dentine loss compared to baseline at day 5 and 10 for both pastes. At each time point, C showed statistically significantly greater dentine loss than S, P < 0.0001. After 10 days treatment, the difference in dentine loss between the pastes was 1.4 microm. The non-contact profilometry data showed similar trends. After 10 days of treatment, C showed statistically significantly greater dentine loss than S, with treatment difference of 0.9 microm, P = 0.0057. The methodology used has successfully differentiated between the abrasivity of the two pastes in respect of dentine surface loss over time in an in situ environment.
Br Dent J. 2010 Mar 13;208(5):217-8.
Evidence summary: how can dietary advice to prevent dental erosion be effectively delivered in UK general dental practice?
Peninsula Dental School.
Abstract
Since August 2009, members of the newly redeveloped Primary Care Dentistry Research Forum (http://www.dentistryresearch.org) have taken part in an online vote to identify questions in day-to-day practice that they felt most needed to be answered with conclusive research. The question which received the most votes formed the subject of a critical appraisal of the relevant literature. Each month a new round of voting takes place to decide which further questions will be reviewed. Dental practitioners and dental care professionals are encouraged to take part in the voting and submit their own questions to be included in the vote by joining the website. This paper details a summary of the findings of the third critical appraisal. In conclusion, the critical appraisal has identified that there is no conclusive answer to this question at present. No evidence was identified relating to the effectiveness of different strategies to apply dietary advice for the prevention of dental erosion. Given the apparently increasing prevalence of the disease in industrialised countries, this appears to be a priority area for future primary research.
Br Dent J. 2010 Mar 13;208(5):207-9.
A proposed system for screening tooth wear.
Department of Prosthodontics, Kings College London Dental Institute, Floor 25, Guy’s Tower, London Bridge, SE1 9RT. david.bartlett@kcl.ac.uk
Abstract
This paper presents a useful and convenient way to record the severity of tooth wear for patients seen in primary care. The index developed in collaboration with colleagues in Europe because there is widespread belief that tooth wear and in particular erosion is a growing issue for practitioners. The index is based on the BPE and uses similar protocols. It is designed to be simple to use, easily recorded in the notes, and gives practitioners the opportunity to record that the wear has been examined and considered. The four level index uses 0 (no wear), 1 (initial loss of surface texture), 2 (<50% loss of surface) and 3 (>50% loss of surface) to record the severity of wear.
Arch Oral Biol. 2010 Mar;55(3):223-8. Epub 2010 Jan 18.
Effect of TiF4, ZrF4, HfF4 and AmF on erosion and erosion/abrasion of enamel and dentin in situ.
Wiegand A, Hiestand B, Sener B, Magalhães AC, Roos M, Attin T.
Clinic for Preventive Dentistry, Periodontology and Cariology, University of Zurich, Plattenstrasse 11, 8032 Zurich, Switzerland. annette.wiegand@zzmk.uzh.ch
Abstract
OBJECTIVE: This in situ study aimed to analyse the impact of different tetrafluorides (TiF(4), ZrF(4) and HfF(4)) and AmF on erosion and erosion plus abrasion of enamel and dentin. DESIGN: Ten volunteers took part in this crossover and double-blind study performed in 8 phases of each 3 days. In each phase, 2 bovine enamel and 2 dentin specimens were fixed in intraoral appliances. One enamel and one dentin sample were pretreated once with TiF(4), ZrF(4), HfF(4) or AmF (all 0.5M F) for 60s, while the other samples remained unfluoridated and served as control. Then, all samples were subjected to either erosion only (4 times/day, 90 s) or to erosion and abrasion (2 times/day, 30 s/sample). Toothbrushing abrasion was performed 90 min after the first and last erosion with an electrical toothbrush and fluoridated toothpaste at 1.2N. After 3 days, enamel and dentin loss was assessed by profilometry (microm) and analysed by repeated measures ANOVA and paired t-test (p<0.05). RESULTS: All fluoride solutions reduced enamel and dentin loss significantly compared to the controls. Generally, eroded samples showed less wear than eroded and abraded samples. The protective potential of the fluorides was not significantly different and was only slightly, but mostly not significantly, decreased by abrasion. The protective effect of the fluoride solutions was similar in enamel and dentin. CONCLUSION: Tetrafluorides and AmF are able to reduce erosion and erosion plus abrasion in situ and are almost equally effective. Copyright 2009 Elsevier Ltd. All rights reserved.
Caries Res. 2010;44(1):20-3. Epub 2009 Dec 31.
Dental erosion protection by fermented shrimp paste in acidic food.
Faculty of Dentistry, Prince of Songkla University, Hat Yai, Songkhla, Thailand. chanya.ch @ psu.ac.th
Abstract
The aim of this study was to determine the extent to which fermented shrimp paste (which has a high calcium concentration) reduces dental erosion in vitro. In experiment 1, enamel specimens were exposed to various concentrations of shrimp paste in tamarind juice for 15 min, once a day, for a total of 29 days. In experiment 2, pre-softened enamel specimens were exposed to different concentrations of shrimp paste in water, using an exposure method similar to experiment 1. Profilometry and a microhardness test were used to assess changes in enamel loss and softening. The results showed that shrimp paste can reduce the erosive potential of tamarind juice and re-harden softened enamel. Copyright 2009 S. Karger AG, Basel.
J Dent. 2010 Apr;38(4):284-9. Epub 2009 Dec 3.
Comparison of in vitro erosion potentials between beverages available in the United Kingdom and the United States.
Murrell S, Marshall TA, Moynihan PJ, Qian F, Wefel JS.
College of Dentistry, University of Iowa, Dental Science Building, Iowa City, IA 52242-1010, United States.
Abstract
OBJECTIVE: Our objective was to compare the physiochemical properties and erosion potentials between beverages available in the UK and the US. METHODS: The physiochemical properties (pH, titratable acidity and fluoride concentration) and erosion potential on enamel surfaces of beverages available in the UK were compared to similar beverages from the US. Enamel windows were exposed to beverages for 25h. Teeth were sectioned through the windows, and lesion depths were defined as the average distance between the original tooth structure and the base of demineralization. RESULTS: The pH was lower in UK apple juice, orange juice, Diet Pepsi and Sprite Zero (p<0.05), and higher in UK orange soda and diet orange soda than in similar US beverages (p<0.05). Titratable acidities were higher in UK apple juice, orange juice, orange soda, diet orange soda and Sprite (p<0.01), and lower in UK Sunny D than in the US counterpart (p<0.001). Fluoride concentrations were lower in UK apple juice, orange juice, Coke, and Diet Coke, Sprite and Sprite Zero (p<0.001), and higher in UK orange soda, diet orange soda, Pepsi and Diet Pepsi than in their US counterparts (p<0.001). Lesion depths were higher in UK apple juice, orange juice, Diet Coke, Sprite and Sprite Zero than in their US counterparts (p<0.05). Lesion depths were associated with pH (p=0.010) and country of origin (p=0.002). CONCLUSIONS: Under similar laboratory conditions, the physiochemical properties and erosion potentials on enamel surfaces differed between some, but not all, beverages available in the UK and the US. Copyright 2009 Elsevier Ltd. All rights reserved.
Community Dent Health. 2010 Mar;27(1):46-51.
Are paediatric medicines risk factors for dental caries and dental erosion?
Neves BG, Farah A, Lucas E, de Sousa VP, Maia LC.
Departamento de Odontopediatria e Ortodontia, Universidade Federal do Rio de Janeiro, Brasil.
Abstract
THE OBJECTIVE: To assess in vitro the cariogenic and erosive potentials of Brazilian liquid oral paediatric medicines. SETTING: Twenty-three paediatric medicines available on the Brazilian market were evaluated. The sample consisted of antihistamines, antitussives, bronchodilators and mucolytics. MAIN OUTCOME MEASURES: Duplicates of each bottle were analyzed for sugar concentration using normal-phase- high-performance liquid chromatography (HPLC). Quantification of sugars and sorbitol was calculated using the peak heights of commercial standards as references. pH measurements were determined using a digital pH meter. Titratable acidity was assessed by diluting three aliquots of each medicine, and increments of 0.1N NaOH were titrated until neutrality was reached. Viscosity was determined using a viscosemeter. RESULTS: Sugars were detected in 56.5% of the medicines. Sucrose was identified in 10 medicines, with concentrations ranging from 11.36 g% to 85.99 g%. Glucose was detected in five medicines, with concentrations varying from 4.64 g% to 40.19 g%; fructose in six medicines, with concentrations ranging from 5.09 g% to 46.71 g%. Twelve medicines exhibited sorbitol, with values ranging from 5.39 g% to 46.09 g%. Most tested medicines were acidic, with pH values ranging between 2.6 and 5.7. Only two medicines (Fluimucil and Polaramine) presented pH 6.4 and 6.0, respectively. Titratable acidity mean values ranged between 0.28 and 16.33 mL. Viscosity values varied between 2.8 cP and 412.3 cP. CONCLUSIONS: Many paediatric medicines showed high sugar concentration, pH values below the critical value and high titratable acidity values, all of which increase the medicines’ cariogenic and erosive potentials.
Rev Med Suisse. 2010 Feb 24;6(237):384-6, 388-9.
[An interface between pediatrics and oral medicine: oral manifestations of gastroesophageal reflux in children]
[Article in French]
Madrid C, Abarca M, Pop S, Korsvold T, Bouferrache K.
Service de stomatologie et de médecine dentaire, PMU CHUV, 1011 Lausanne. Carlos.Madrid@hospvd.ch
Abstract
Gastro-oesophageal reflux (GOR) is a common disorder in the pediatric population. In association with esophagitis, GOR may impair children’s quality of life. Extra-oesophageal manifestations are of specific interest in oral medicine because the refluxate may reach impair both oral mucosa and hard dental tissues. Some oral symptoms are so specific that they should raise the attention for other GOR symptoms. Dental erosion is a potential risk in children with gastroesophageal reflux: the pediatrician should routinely refer children with gastroesophageal reflux to a pediatric dentist to diagnose erosions and if needed restore the teeth. Conversely, in the presence of unexplained dental erosions the dentist and/or the pediatrician should discuss the possibility of an occult GOR.
J Biomed Mater Res B Appl Biomater. 2010 May;93(2):304-8.
Effect of two restorative materials on root dentine erosion.
Domiciano SJ, Colucci V, Serra MC.
Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
Abstract
This study sought to evaluate the microhardness of root dentine adjacent to glass-ionomer and composite resin restorations after erosive challenge. A crossover study was performed in two phases of 4 consecutive days each. One hundred twelve bovine root dentine slabs were obtained, and standardized box-shaped cavities were prepared at center of each specimen. The prepared cavities were randomly restored with glass-ionomer cement or composite resin. The slabs were randomly assigned among 14 volunteers, which wore intraoral palatal device containing four restored root dentin slabs. Starting on the second day, half of the palatal acrylic devices were immersed extraorally in a lemonade-like carbonated soft drink for 90 s, four times daily for 3 days. After 3-day wash-out, dentine slabs restored with the alternative material were placed into palatal appliance and the volunteers started the second phase of this study. After erosive challenges, microhardness measurements were performed. Regardless of the restorative material employed, eroded specimens demonstrated lower microhardness value (p < 0.0001). At eroded condition examined in this study, dentine restored with glass-ionomer cement showed higher microhardness values (p < 0.0001). It may be concluded that the glass-ionomer cement decreases the progression of root dentine erosion at restoration margin. (c) 2010 Wiley Periodicals, Inc.
Dent Update. 2010 Jan-Feb;37(1):12-4, 16-8.
Strategies for the prevention of erosive tooth surface loss.
Morriston Hospital, Morriston, Swansea SA6 6NL, UK.
Republished in:
Abstract
This article explores the available strategies for protection against erosive toothwear. As part of a preventive regime, the importance of dietary counselling is discussed. Risk factors that render patients susceptible to erosive toothwear need to be identified in early life, if possible, as it may improve their treatment outcome through the instigation of preventive measures. Practical advice and the importance of education regarding timing of toothbrushing following an acid challenge should be given to patients. Availability of fewer erosive beverages may prove acceptable alternatives for some patients, especially where poor compliance is an issue. Some patients may benefit from intra-oral appliances to improve and maintain delivery of fluoride. The importance of fluoride use and of products such as Pronamel/Tooth Mousse aimed at preventing erosive tooth surface loss are discussed. CLINICAL RELEVANCE: Erosive toothwear is becoming an increasing problem for patients. Practical preventive measures that can be employed to reduce the amount of erosive toothwear are desirable.
J Dent Res. 2010 May;89(5):468-72. Epub 2010 Mar 3.
Gels containing MMP inhibitors prevent dental erosion in situ.
Kato MT, Leite AL, Hannas AR, Buzalaf MA.
Bauru Dental School, University of São Paulo, Department of Biological Sciences, Al. Octávio Pinheiro Brisolla, 9-75, Bauru-SP 17012-901, Brazil.
Abstract
Matrix metalloproteinase (MMP) inhibition has been shown to reduce dentin caries progression, but its role in dental erosion has not yet been assessed. This study tested the hypothesis that gels containing MMP inhibitors (epigallocatechin gallate-EGCG and chlorhexidine) can prevent dental erosion. Volunteers (n = 10) wore palatal devices containing bovine dentin blocks (n = 10/group) treated for 1 min with EGCG at 10 (EGCG10) or 400 microM (EGCG400), chlorhexidine at 0.012%, F at 1.23% (NaF), and no vehicle (placebo). Erosion was performed with Coca-Cola (5 min) 4X/day during 5 days. The wear, assessed by profilometry (mean +/- SD, microm), was significantly reduced by the gels containing MMP inhibitors (0.05 +/- 0.02(a), 0.04 +/- 0.02(a), and 0.05 +/- 0.02(a) for EGCG10, EGCG400, and chlorhexidine, respectively) when compared with NaF (0.79 +/- 0.35(b)) and placebo gels (1.77 +/- 0.35(b)) (Friedman and Dunn’s tests, p < 0.01). The use of gels delivering MMP inhibitors was shown to prevent erosion and opens a new perspective for protection against dental erosion.
J Dent. 2010 Mar;38(3):182-90. Epub 2010 Jan 15.
Quantifying and qualifying surface changes on dental hard tissues in vitro.
Field J, Waterhouse P, German M.
School of Dental Sciences, Newcastle University, Framlington Place, Newcastle-upon-Tyne, Tyne and Wear NE2 4BW, United Kingdom. james.field@ncl.ac.uk
Abstract
INTRODUCTION: Tooth surface loss (TSL) is an increasingly recognised problem. We are therefore seeing an increase in the number and complexity of in vitro studies investigating factors that modify effects at the tooth surface. AIM: The aim of this paper is to provide a narrative review that illustrates the more commonly used in vitro methods (both historical and contemporaneous) that are available for measuring surface loss and surface change. METHOD: An initial search (March 2009) was carried out using Scopus abstract and citation database with the keywords ‘dental’ AND ‘erosion OR abrasion’ AND ‘surface change OR surface loss’ AND ‘vitro’ (1975-2009). This resulted in 69 papers which were reviewed and the methods critically appraised. Bibliographic material from the papers was then used in order to find other appropriate sources. RESULTS: It is clear that tooth surface change is a complex process that can be measured in a variety of ways. No single technique provides a comprehensive assessment of the remaining tooth surface, and each technique suffers its own limitations. What is also clear is that way in which surface change is reported by each of the techniques gives little information relating to how the surface may change in the immediate future. CONCLUSION: Despite a variety of available in vitro tests for measuring surface changes, the roughness average (R(a)) is still the main reported measurement within dental studies. Using the same set of profilometric data, it is proposed that additionally reporting bearing area parameters will allow a further and more meaningful description of the surface quality. Copyright 2010 Elsevier Ltd. All rights reserved.
Dent Mater. 2010 Apr;26(4):326-36. Epub 2010 Jan 4.
Quantification of dental erosion–a comparison of stylus profilometry and confocal laser scanning microscopy (CLSM).
Heurich E, Beyer M, Jandt KD, Reichert J, Herold V, Schnabelrauch M, Sigusch BW.
Institute of Materials Science and Technology (IMT), Chair in Materials Science, Friedrich-Schiller-University Jena, Löbdergraben 32, Jena, Germany.
Abstract
OBJECTIVES: Since stylus profilometry applies a force on the sample surface, it is logical to hypothesize that the profilometer penetrates the surface of the enamel softened by acid solutions. The aims of the present study were, therefore, to test the hypothesis that surface profilometry measurements of eroded enamel alter the surface of the enamel, to quantify the potential effect of the surface alteration (scratches) on the measured values of enamel erosion by atomic force microscopy and to compare the values of enamel loss caused by erosion as measured by profilometry and non-contact confocal laser scanning microscopy (CLSM). METHODS: Enamel samples, cut from unerupted human third molars were treated with Volvic Mineral Water and citric acid solutions of different pH values. The enamel material loss was measured by two different contact profilometers and a reflection mode CLSM. The scratches depth was analyzed by atomic force microscopy. RESULTS: Our study demonstrated that the tip of the profilometer penetrated the surface of eroded enamel during the profilometry measurements, leading to clearly visible surface scratches on the enamel samples. The profilometers created surface scratches of a depth ranging from 57.6 (47.1)nm to 577.1 (157.6)nm on the surface of the eroded enamel and led, therefore, to a larger measured value of erosion. It was shown that the depth of the scratches depends on the pH value, the erosion time and the profilometer used. SIGNIFICANCE: With few exceptions profilometers deliver reliable values of erosive enamel material loss, although they create surface scratches on eroded enamel. Reflection mode CLSM is a non-tactile, fast and precise method for analyzing enamel erosion quantitatively in vitro. Copyright (c) 2009 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.
J Dent. 2010 Feb;38(2):131-7. Epub 2009 Sep 30.
Dynamics of tooth erosion in adolescents: a 3-year longitudinal study.
El Aidi H, Bronkhorst EM, Huysmans MC, Truin GJ.
Department of Preventive and Restorative Dentistry, Radboud University Nijmegen Medical Centre, NL-6500 HB Nijmegen, Netherlands. H.ElAidi@dent.umcn.nl
Abstract
OBJECTIVES: The aim of the present study was to estimate the prevalence, incidence and progression of tooth erosion on both mouth and tooth level over a 3-year period in a sample of adolescents. The study also aimed to investigate age, gender and socio-economic influences. METHODS: Tooth erosion was recorded three times with 1.5 years intervals in a sample of 622 children, aged 10-12 years at baseline. RESULTS: Tooth erosion was present in 30.4% of the 11-year-olds, and 44.2% in 15-year-olds. Deep enamel or dentin was eroded in 1.8% of the 11-year-olds and in 23.8% of the 15-year-olds. Significantly more boys than girls showed tooth erosion as did children from a low socio-economic background compared with other children. The incidence of new tooth surfaces exhibiting erosion, in erosion-free children, decreased significantly with age, while the progression in children with erosion did not change. The incidence of tooth erosion in upper incisors and lower first molars decreased significantly with age. In upper incisors, a statistical significant relationship between SES and incidence was found, with lower incidences for higher SES. For first molars, only a relationship between gender and incidence was found, with a lower incidence for girls. CONCLUSIONS: The incidence of new tooth surfaces exhibiting erosion, in erosion-free children, decreased significantly with age. In children with tooth erosion the condition progressed steadily. On tooth level the incidence decreased significantly with age for upper incisors and lower first molars. There was a difference in influence of background variables on the incidence of tooth erosion between molars and upper incisors. Copyright 2009 Elsevier Ltd. All rights reserved.
Ann Acad Med Stetin. 2009;55(1):70-8.
[Frequency and etiology of noncarious cervical lesions with pulp exposure]
[Article in Polish]
Zakład Stomatologii Ogólnej Pomorskiej Akademii Medycznej w Szczecinie al. Powstańców Wlkp. 72, 70-111 Szczecin.
Abstract
PURPOSE: Noncarious cervical lesions have a multifactorial etiology encompassing occlusal trauma, toothbrush abrasion, and exposure of enamel to erosive factors. The purpose of this study was to determine the frequency of cervical lesions with exposure of pulp and to analyze their etiology. MATERIAL AND METHODS: The study was done in 124 patients (59 women and 65 men) with a mean age of 44 years (15-72 years). Clinical assessment of cervical lesions was based on criteria of the universal tooth wear index for the cervical surface. Additionally, the following findings were recorded: frequency of cervical lesions depending on tooth type, pulp exposure, oral hygiene status, and type of occlusal guidance. The questionnaire consisted of detailed questions concerning toothbrushing, frequency of consumption of some foods, and parafunctional habits. The risk of cervical lesion was estimated with the logistic regression model. RESULTS: The frequency, localization, and depth of noncarious cervical lesions were related to age of the patient. Very deep defects with pulp exposure were found in 44 teeth. The effect of consumption of acid foods and drinks and of oral hygiene habits on the depth of wedge-shaped defects was corroborated. Correlations between lateral excursive tooth contact, bruxism, and formation of cervical lesions were disclosed, confirming the relationship between occlusal pathology and cervical lesions. CONCLUSIONS: Elucidation of the multifactorial etiology of cervical lesions is important for proper treatment and prevention of pulp exposure.
Br Dent J. 2010 Mar 13;208(5):207-9.
A proposed system for screening tooth wear.
Department of Prosthodontics, Kings College London Dental Institute, Floor 25, Guy’s Tower, London Bridge, SE1 9RT. david.bartlett@kcl.ac.uk
Abstract
This paper presents a useful and convenient way to record the severity of tooth wear for patients seen in primary care. The index developed in collaboration with colleagues in Europe because there is widespread belief that tooth wear and in particular erosion is a growing issue for practitioners. The index is based on the BPE and uses similar protocols. It is designed to be simple to use, easily recorded in the notes, and gives practitioners the opportunity to record that the wear has been examined and considered. The four level index uses 0 (no wear), 1 (initial loss of surface texture), 2 (<50% loss of surface) and 3 (>50% loss of surface) to record the severity of wear.
Systematic Review of the Prevalence of Tooth Wear in Children and Adolescents.
Kreulen CM, Van ‘t Spijker A, Rodriguez JM, Bronkhorst EM, Creugers NH, Bartlett DW.
Department of Oral Function and Prosthetic Dentistry, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Abstract
Data on the prevalence of tooth wear among children and adolescents are inconsistent. Given the impact of extensive tooth wear for over a lifetime, evidence on the extent is required. The aim was to systematically review the literature on the prevalence of tooth wear in children and adolescents. A PubMed literature search (1980-2008) used the keywords ‘tooth’ AND ‘wear’; ‘dental’ AND ‘attrition’ AND ‘prevalence’; ‘dental’ AND ‘wear’ AND ‘prevalence’; ‘erosion AND prevalence’ AND ‘abrasion AND prevalence’. Following exclusion criteria, 29 papers were reviewed using established review methods. There was a total of 45,186 subjects (smallest study 80 and largest study 17,047 subjects) examined from thirteen multiple random clusters, eight multiple convenience clusters and eight convenience clusters. Nine different tooth wear indices were used, but the common denominator among studies was dentin exposure as an indicator of severe wear. Forest plots indicated substantial heterogeneity of the included studies. Prevalence of wear involving dentin ranged from 0 to 82% for deciduous teeth in children up to 7 years; regression analysis showed age and wear to be significantly related. Most of the studies in the permanent dentition showed low dentin exposure, a few reported high prevalence (range 0-54%); age and wear were not related (regression analysis). The results of this systematic review indicate that the prevalence of tooth wear leading to dentin exposure in deciduous teeth increases with age. Increase in wear of permanent teeth with age in adolescents up to 18 years old was not substantiated. Copyright © 2010 S. Karger AG, Basel.
Curr Opin Support Palliat Care. 2010 Mar;4(1):31-5.
Links between oral and gastrointestinal health.
School of Dentistry, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia. richard.logan@adelaide.edu.au
Abstract
PURPOSE OF REVIEW: To review the links between oral and gastrointestinal health and discuss their implications in clinical management. RECENT FINDINGS: There are many instances in which changes that occur within the oral cavity reflect systemic disease elsewhere in the body. Oral manifestations may be the first sign of gastrointestinal disease. This is definitely the case in the inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis. However, although the oral manifestations are relatively well recognized, the links between pathobiology at different sites do not appear to be fully investigated in the literature. This is not the case with alimentary tract mucositis, a side effect of cancer treatment. Increasing interest in the pathobiology of mucositis and the links between changes that occur at different sites of the alimentary has changed the way that this common side effect of cancer treatment has been managed. SUMMARY: Changes occurring in the oral cavity associated with systemic diseases, including gastrointestinal disease, have been long recognized. Further study into the pathobiology of oral links with inflammatory bowel disease is also recommended so that these diseases are better understood. Importantly, however, the oral manifestations of systemic disease must be highlighted so that, if they are the first manifestations that can be clinically recognized, patients can have appropriate investigations and be managed in a timely fashion. A multidisciplinary management of patients is crucial so that they receive appropriate and comprehensive healthcare.
Arch Oral Biol. 2009 Nov;54(11):997-1001. Epub 2009 Sep 1.
Effect of fluoride varnish and gel on dental erosion in primary and permanent teeth.
Murakami C, Bönecker M, Corrêa MS, Mendes FM, Rodrigues CR.
Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of São Paulo, Av. Lineu Prestes, 2227, 05508-000 São Paulo, SP, Brazil. chrismurakami@gmail.com
Abstract
OBJECTIVE: To assess the effect of a fluoride varnish and gel on the erosive wear of primary and permanent teeth. DESIGN: Sixty human primary (n=30) and permanent (n=30) enamel specimens were randomly assigned to one of the following groups: APF gel (1.23% F), NaF varnish (2.26% F), and control (no treatment). Fluoride gel was applied for 4 min and fluoride varnish for 24 h. Six daily demineralisation-remineralization cycles of 5 min of immersion in a cola drink (pH 2.3) and 30 min in artificial saliva were conducted during 7 days. All specimens were stored in artificial saliva between and after cycles. Surface Knoop microhardness (%SMHC) readings were performed at baseline, 48 h and 7 days. Data were tested using ANOVA and Tukey’s tests (p<0.05). RESULTS: For primary enamel, the mean %SMHC (+/-SD) after 48 h and 7 days was, respectively: gel (31.0+/-14.4 and 36.9+/-7.5), varnish (26.7+/-9.5 and 38.3+/-8.7), and control (35.8+/-8.6 and 45.0+/-8.6). For permanent enamel, such values were: gel (37.5+/-7.7 and 27.8+/-7.5), varnish (31.7+/-9.6 and 27.4+/-11.1) and control (48.6+/-6.4 and 43.1+/-6.4). In primary enamel, erosion inhibition by fluoride was not significant at 48 h (p=0.203) and 7 days (p=0.082). In permanent specimens, both products showed a significant effect (p<0.001). CONCLUSIONS: Both fluoride varnish and gel were able to inhibit erosive enamel loss but mainly in the permanent experimental groups. Primary and permanent enamel substrates reacted differently to both demineralization by a cola drink and remineralization by fluoridated compounds.
Compend Contin Educ Dent. 2009 Nov-Dec;30(9):616-20.
Etiology and prevention of acid erosion.
Department of Prosthodontics, Kings College London Dental Institute, London Bridge, London, England.
Abstract
Acid erosion is the chemical effect of dietary or gastric acids on enamel and dentine. Unlike dental caries, which is a bacterially mediated condition, acid erosion normally is combined with physical forms of attrition and abrasion. The clinical appearance of acid erosion in the early stages is seen characteristically as hollowed-out lesions on occlusal surfaces and on smooth surfaces as a subtle change in the tooth contour. As the condition progresses, the lesions coalesce and form widespread dentin exposure and coronal destruction. Dietary acids that are present in beverages and fruits potentially can cause acid erosion. However, dietary habits involving frequent consumption of acids are believed to be important determinants in the risk of developing clinical signs of acid erosion. Prevention using fluoride toothpastes, dietary modifications, and calcium-based products probably have a significant clinical effect in reducing the risk of developing acid erosion.
The effect of CPP-ACP on enamel wear under severe erosive conditions.
Ranjitkar S, Kaidonis JA, Richards LC, Townsend GC.
School of Dentistry, The University of Adelaide, Adelaide, SA 5005, Australia. sarbin.ranjitkar@adelaide.edu.au
Abstract
OBJECTIVE: In addition to its role as a remineralizing agent in preventing dental caries, recent evidence has shown that casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) can protect teeth against erosion. The aim of this study was to determine whether CPP-ACP could reduce enamel wear rates under severe erosive conditions simulating heavy attrition and gastric regurgitation. DESIGN: Enamel specimens were subjected to 10,000 wear cycles at a load of 100 N and pH 1.2 in a tooth wear machine. The machine was stopped every 2 min (160 cycles), and CPP-ACP in the form of a paste was applied for 5 min in experimental group 1. A paste with the same formulation but without CPP-ACP was applied in experimental group 2. No paste was applied in the control group. RESULTS: A linear mixed model analysis indicated that the mean wear rates in experimental group 1 (0.44+/-0.05 mm(3) per 1000 cycles) and in experimental group 2 (0.63+/-0.06 mm(3) per 1000 cycles) were significantly lower than that in the control group (0.92+/-0.11 mm(3) per 1000 cycles) (p<0.05). The mean wear rate in experimental group 1 was also lower than that in experimental group 2 (p<0.05). Wear facets in experimental groups 1 and 2 were noted to be smoother and more polished than those in the control group. CONCLUSIONS: Both remineralizing and lubricating properties of the paste containing CPP-ACP appear to contribute to wear reduction in enamel. These findings may lead to new strategies for the clinical management of tooth wear.
Arch Oral Biol. 2009 Jun;54(6):518-26. Epub 2009 Mar 26.
The effect of acidic beverages on the ultrastructure of the acquired pellicle–an in situ study.
Hannig C, Berndt D, Hoth-Hannig W, Hannig M.
Department of Operative Dentistry and Periodontology, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany.
Abstract
AIM: The aim of the present in situ study was to investigate ultrastructural alterations as well as protective properties of the pellicle layer during consumption of acidic beverages. METHODS: Bovine enamel slabs were fixed on buccal and palatal aspects of individual splints and exposed in the oral cavities of three subjects for 120 min. In the following, the subjects drank orange juice, coke light or sprite light. Half of the specimens were removed afterwards, the others were exposed to the oral fluids for another 120 min. Erosive alterations of the bovine enamel slabs were measured by determination of the Knoop-micro-hardness. In addition, the ultrastructure of the pellicle was evaluated by transmission electron microscopy (TEM). RESULTS: Determination of Knoop-micro-hardness yielded only little reduction of the relative Knoop-hardness in situ during consumption of sprite light (-0.053+/-0.019) and coke light (-0.075+/-0.04). With orange juice nearly no change of the hardness was recorded. TEM-pictures showed that the globular outer layers of the pellicle were removed to a different extent according to the localisation of the specimens in the oral cavity, whereas the basal pellicle was not affected by the acidic beverages. On the specimens carried for another 120 min after the erosive attack, lacunae filled with organic structures were observed underneath the basal side of the pellicle. CONCLUSION: During fast consumption of acidic beverages in situ, the erosive effects on pellicle coated bovine enamel are moderate and juices seem to be less harmful as compared with low pH soft drinks. Pellicle proteins in eroded lacunae may impact the remineralization process.
Arch Oral Biol. 2009 May;54(5):432-6. Epub 2009 Mar 10.
Effect of stannous and fluoride concentration in a mouth rinse on erosive tissue loss in enamel in vitro.
Schlueter N, Klimek J, Ganss C.
Department of Conservative and Preventive Dentistry, Dental Clinic of the Justus Liebig University, Schlangenzahl 14, D-35392 Giessen, Germany. nadine.schlueter@dentist.med.uni-giessen.de
Abstract
The aim of this in vitro study was to investigate the influence of stannous and fluoride ion concentrations in various experimental solutions on erosion progression in enamel. Human enamel specimens were subjected to a cyclic de- and remineralisation procedure for 10 days, with six demineralisation periods per day, of 5 min each. Erosive demineralisation was performed with 0.05 M citric acid (pH 2.3). Except in the control group, specimens were treated for 2 min with test solutions after the first and the sixth demineralisation. Test solutions were: 1500 mg/L F(-) groups: group 1: 2800 mg/L Sn(2+); group 2: 2100 mg/L Sn(2+); group 3: 1400 mg/L Sn(2+); group 4: 700 mg/L Sn(2+); 1000 mg/L F(-) groups: group 5: 2100 mg/L Sn(2+); group 6: 1400 mg/L Sn(2+). All preparations were adjusted to pH 4.5. Tissue loss was determined profilometrically after the last experimental day. As expected, the greatest tissue loss (microm, mean+/-S.D.) was found in the control group (72.6+/-11.5). All test solutions were able to reduce tissue loss significantly (p <or= 0.001). The reduction of tissue loss by test solutions depended on the ratio of the tin concentration to the fluoride concentration. Lowest values were obtained by the application of the solutions of group 1 (7.8+/-2.5) and group 5 (7.6+/-5.2). Solutions with high concentrations of tin and fluoride are very effective in reducing erosive tissue loss, and their efficacy increased with increasing ratios of tin to fluoride concentrations.
Oper Dent. 2010 Jan-Feb;35(1):125-9.
Restoration of occlusal vertical dimension in dental erosion caused by gastroesophageal reflux: case report.
Reston EG, Closs LQ, Busato AL, Broliato GA, Tessarollo FR.
Department of Restorative Dentistry, School of Dentistry, Lutheran University of Brazil, Canoas, RS, Brazil. ereston@dental-core.com.br
Abstract
The authors describe a minimally invasive procedure for occlusal rehabilitation in a young patient presenting with mild mandibular prognathism and loss of occlusal vertical dimension caused by dental erosion from chronic gastroesophageal reflux.
Int Dent J. 2009 Dec;59(6):358-62.
The erosive potential of lollipops.
Brand HS, Gambon DL, Paap A, Bulthuis MS, Veerman EC, Amerongen AV.
Department of Dental Basic Sciences, Section of Oral Biochemistry, Academic Centre for Dentistry Amsterdam, Vrije Universiteit, The Netherlands. hs.brand@vumc.nl
Abstract
AIM: To determine the erosive potential of several commercially available lollipops and the protective effect of saliva. METHODS: The erosive potential of lollipops was determined in vitro by measuring the pH and neutralisable acidity. Subsequently, 10 healthy volunteers tested different types of lollipops. Whole saliva was collected 5 minutes before, 15 minutes during and 10 minutes after consumption. Salivary flow rate and pH were determined. RESULTS: Fruit flavoured and cola flavoured lollipops have a very low pH (2.3 – 2.4). Yogurt-containing and salmiak (salty liquorice) flavoured lollipops have much higher pH values (3.8-4.7). The neutralisable acidity of 1g of lollipop showed a large variation from < 200 microl to > 1700 microl 0.1 M NaOH. In vivo, lollipops induced 2.5 to 4.7-fold increase in salivary flow rate with a concomitant drop in salivary pH. For fruit flavoured and cola flavoured lollipops the salivary pH dropped below pH 5.5. For strawberry yogurt and salmiak lollipops, the salivary pH remained above this critical value. The volunteers did not report significant differences in preferences for the lollipops. CONCLUSIONS: Lollipops differ considerable in erosive potential, with fruit flavoured and cola flavoured lollipops having the highest risk for inducing dental erosion. This information is of use for clinicians counselling juvenile patients with dental erosion.
J Clin Dent. 2009;20(6):192-8.
Evaluation of different fluoridated dentifrice formulations using an in situ erosion remineralization model.
GlaxoSmithKline Consumer Healthcare Weybridge, Surrey, UK. Ashley.P.Barlow@gsk.com
Abstract
OBJECTIVE: The objective of these three clinical in situ studies was to investigate the relative performance of commercially available and experimental dentifrice formulations, having different fluoride sources and excipient ingredients, at remineralizing a bovine enamel surface previously softened by a dietary acid challenge. METHODS: Each study utilized the same randomized, placebo-controlled, single-blind, crossover design. Subjects undertook single brushings of their natural teeth, with an in situ appliance in place, using different dentifrices in a randomly assigned order. Study A involved 58 subjects with the following dentifrices: Sensodyne Pronamel (1450 ppm F as NaF/5% KNO3); Blend-a-Med Classic (1450 ppm F as NaF); and a matched (Pronamel) placebo control (0 ppm F). Study B involved 56 subjects with the following dentifrices: Sensodyne Pronamel (1150 ppm F as NaF/5% KNO3); Crest Cavity Protection (1100 ppm F as NaF); Crest Pro-Health (0.454% SnF2 [1100 ppm F]/sodium hexametaphosphate); and a matched (Pronamel) placebo control (0 ppm F). Study C involved 56 subjects with the following dentifrices: Sensodyne Pronamel (1150 ppm F as NaF/5% KNO3); Sensodyne Pronamel Gentle Whitening (1150 ppm F as NaF/5% KNO3); Colgate Sensitive Multi Protection (1000 ppm F as NaMFP/5.53% potassium citrate/2% zinc citrate); and a matched (Pronamel) placebo control (0 ppm F). Subjects wore their palatal appliances holding eight bovine enamel blocks, previously exposed for 25 minutes to an in vitro erosive challenge with grapefruit juice, for the duration of the experiment. Five minutes after appliance insertion, subjects undertook a supervised, 90-second brush/rinse regimen with their assigned dentifrice. Surface microhardness (SMH) of the specimens was determined prior to the erosive challenge (baseline), after the in vitro erosive challenge, and were remeasured after four hours in situ remineralization following the tooth brushing event. Finally, SMH values were determined after a second in vitro erosive challenge at the end of the in situ remineralization period. Statistical analyses included ANOVA and pair-wise comparisons between treatments, testing at a 5% significance level. RESULTS: All three studies demonstrated significantly greater percent surface microhardness recovery (% SMHr) and percent relative erosion resistance (% RER) for dentifrices containing sodium fluoride compared to placebo controls. Overall, significantly greater % SMHr (p < 0.0001) was observed for Sensodyne Pronamel compared to Blend-a-Med Classic, Crest Pro-Health, and Colgate Sensitive Multi Protection dentifrices. Similarly, Sensodyne Pronamel delivered directionally better % RER vs. Blend-a-Med Classic (p = 0.0731), and significantly higher % RER vs. Crest Pro-Health (p = 0.0074) and Colgate Sensitive Multi Protection (p <0.0001). Crest Cavity Protection demonstrated significantly better % RER (p = 0.031) than Crest Pro-Health, which in turn demonstrated significantly better % RER than the placebo control (p < 0.0001). No other statistically significant between-product comparisons were observed. CONCLUSION: The results of these in situ studies support the effectiveness of dentifrices containing sodium fluoride to reharden enamel previously softened with an erosive challenge. Furthermore, these studies demonstrate the protective effects conferred to enamel, from erosion following the remineralization process in the presence of “ionic” fluoride. Under clinically relevant conditions, Sensodyne Pronamel and Sensodyne Pronamel Gentle Whitening offered superior anti-erosion performance compared to currently marketed dentifrice controls. These studies reinforce previous research indicating the importance of formulation effects on the relative remineralization performance of dentifrices under erosive conditions.
J Clin Dent. 2009;20(6):186-91.
Fluoride penetration from toothpastes into incipient enamel erosive lesions investigated using dynamic secondary ion mass spectrometry.
Fowler CE, Gracia L, Edwards MI, Brown A, Rees GD.
GlaxoSmithKline Consumer Healthcare, Weybridge, UK. christabel.x.fowler@gsk.com
Abstract
OBJECTIVE: The primary aim of this study was to assess the utility of dynamic secondary ion mass spectrometry (DSIMS) as a convenient and sensitive technique for determining fluoride uptake and distribution into incipient human enamel erosive lesions in vitro. A secondary aim was to correlate the extent of lesion rehardening following treatment with a toothpaste slurry, with relative fluoride uptake determined by DSIMS. The final aim was to compare fluoride uptake by incipient lesions treated with toothpastes containing different sources of fluoride using DSIMS. METHODS: Relative fluoride uptake into the surface and body of enamel erosive lesions was monitored by DSIMS as a function of fluoride concentration in a series of formulation-matched experimental pastes. Fluoride uptake into lesions that had been subjected to treatment with different toothpaste slurries in a single-treatment enamel lesion rehardening model was also determined, and its relationship with regard to the extent of rehardening and also the fluoride source investigated. RESULTS: Fluoride uptake by incipient erosive lesions treated with toothpastes containing NaF was quantitatively compared by DSIMS and found to be directly proportional to the fluoride concentration over the studied range (0-1400 ppm). Lesion repair observed in a single-treatment lesion rehardening model was positively correlated with the extent of fluoride uptake by the treated lesions. DSIMS was also able to show differences between commercial toothpastes containing different sources of fluoride and their ability to deliver the fluoride into the body of the lesion. The detrimental effect of sodium hexametaphosphate (NaHMP) present in Crest Pro-Health formulations previously reported in the single-treatment lesion rehardening model was also evident from the DSIMS elemental line scans obtained from the lesion cross-sections. CONCLUSION: DSIMS has been shown to be a powerful selective technique for quantifying relative fluoride uptake into enamel erosive lesions, and determining the extent and depth of lesion penetration. The relative efficacy of toothpastes containing fluoride from a variety of sources in the single-treatment lesion rehardening study is positively correlated with fluoride uptake and penetration determined by DSIMS.
J Clin Dent. 2009;20(6):178-85.
Inhibition of enamel erosion and promotion of lesion rehardening by fluoride: a white light interferometry and microindentation study.
Fowler CE, Gracia L, Edwards MI, Willson R, Brown A, Rees GD.
GlaxoSmithKline Consumer Healthcare Weybridge, UK. christabel.x.fowler@gsk.com
Abstract
OBJECTIVE: The primary aim of the present in vitro studies was to investigate fluoride as an inhibitor of citric acid-mediated demineralization of human enamel and promoter of lesion repair using a combination of white light interferometry, scanning electron microscopy, and microindentation. Secondary aims included investigation of the importance of brushing on bulk tissue loss, and comparison of the relative efficacy of commercially available toothpastes on inhibiting enamel surface softening and rehardening of incipient erosive lesions. METHODS: Resin-mounted polished enamel specimens were prepared from extracted human molars and pre-molars. Mean surface roughness (Sa) and bulk tissue loss following exposure to an erosive challenge, or an erosive challenge plus brushing were investigated using a MicroXAM ADE PhaseShift white light interferometer. Surface morphology was determined using a Zeiss Evo 50 scanning electron microscope (SEM). The utility of fluoride-based treatments to protect against subsequent acid demineralization and to promote remineralization of pre-formed incipient lesions was determined using microindentation-based enamel surface softening and enamel lesion rehardening models. RESULTS: Treating human enamel specimens with Sensodyne Pronamel conferred a clear protective benefit against a subsequent 300-second citric acid challenge as evidenced by the interferometry and SEM data. The increase in Sa and bulk tissue loss caused by an erosive challenge followed by brushing was markedly reduced by pre-treatment with sodium fluoride (NaF) in a concentration-dependent manner. Sensodyne Pronamel statistically outperformed Colgate Sensitive Enamel Protect both in the enamel surface softening model and lesion rehardening model, and conferred statistically superior enamel fluoride uptake. Treatment of erosive lesions with Sensodyne Pronamel resulted in statistically superior rehardening versus two Crest Pro-Health formulations containing stannous fluoride (SnF2) and sodium hexametaphosphate (NaHMP); the latter did not differ significantly from the fluoride-free negative control paste. Sensodyne Pronamel exhibited statistically significant superiority in a human saliva-based lesion rehardening model compared to Zendium Sensitive containing nominally comparable concentrations of NaF, as well as Colgate Sensitive and Colgate Sensitive Multi Protection containing sodium monofluorophosphate (NaMFP). CONCLUSION: The utility of NaF, whether delivered from simple solution or toothpaste, to reduce citric acid-mediated surface roughening and bulk tissue loss has been clearly demonstrated. The effectiveness of Sensodyne Pronamel as an anti-erosion toothpaste has also been demonstrated in various microhardness models. Crest Pro-Health toothpastes containing SnF2 and NaHMP were not statistically differentiable from a fluoride-free control paste in the lesion rehardening model. The latter result indicates that the benefit of fluoride to promote mineral formation is outweighed by the effect of NaHMP as a mineralization inhibitor in this model.
J Appl Oral Sci. 2009 Nov-Dec;17(6):560-4.
Protective effect of green tea on dentin erosion and abrasion.
Kato MT, Magalhães AC, Rios D, Hannas AR, Attin T, Buzalaf MA.
University of São Paulo, Bauru, SP, Brazil.
Abstract
OBJECTIVE: This in situ study evaluated the protective effect of green tea on dentin erosion (ERO) and erosion-abrasion (ABR). MATERIAL AND METHODS: Ten volunteers wore intraoral palatal appliances with bovine dentin specimens subjected to ERO or ERO + toothbrushing abrasion performed immediately (ERO+I-ABR) or 30 min after erosion (ERO+30-min-ABR). During 2 experimental 5-day crossover phases, the volunteers rinsed with green tea or water (control, 1 min) between each erosive (5 min, cola drink) and abrasive challenge (30 s, toothbrushing), 4x/day. Dentin wear was measured by profilometry. RESULTS: The green tea reduced the dentin wear significantly for all conditions compared to control. ERO+I-ABR led to significantly higher wear than ERO, but it was not significantly different from ERO+30-min-ABR. ERO+30-min-ABR provoked significant higher wear than ERO, only for the placebo treatment. CONCLUSIONS: From the results of the present study, it may be concluded that green tea reduces the dentin wear under erosive/abrasive conditions.
East Afr J Public Health. 2009 Aug;6(2):141-3.
Dental erosion due to lime consumption; review of literature and case report.
Bamise CT, Dinyain VE, Kolawole KA.
Department of Restoractive Dentistry, Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife, Nigeria. bamisect@yahoo.com
Abstract
BACKGROUND: Dental health is increasingly threatened by dental erosion introduced by today’s lifestyle. Extrinsic factor is the most implicated. Few literatures mentioned lime-incited dental erosion. CASE DESCRIPTION: A 49 year old woman was referred to our clinic with tooth wear and sensitivity. She was in good health but on daily dose of anti-hypertensive drugs for three years. Intraorally, classical erosive lesions were observed on the occlusal surfaces of the molars but of note are the lesions on the bucco-gingival surfaces of the maxillary incisors and the mandibular premolars. Dietary history eventually yielded inappropriate use of lime juice in order to slim down her weight. CLINICAL IMPLICATIONS: The use lime must be considered when assessing dietary causes of erosion. Extensive dental damage and dentine hypersensitivity are classical clinical features. Dentists must be able to make a diagnosis of lime-incited dental destruction and to institute the necessary therapeutic and preventive measures.
Conf Proc IEEE Eng Med Biol Soc. 2009;2009:440-3.
Refining enamel thickness measurements from B-mode ultrasound images.
Department of Bioengineering, University of Washington, Seattle, WA 98195 USA. jhua27@ u.washington.edu
Abstract
Dental erosion has been growing increasingly prevalent with the rise in consumption of heavy starches, sugars, coffee, and acidic beverages. In addition, various disorders, such as Gastroenterological Reflux Disease (GERD), have symptoms of rapid rates of tooth erosion. The measurement of enamel thickness would be important for dentists to assess the progression of enamel loss from all forms of erosion, attrition, and abrasion. Characterizing enamel loss is currently done with various subjective indexes that can be interpreted in different ways by different dentists. Ultrasound has been utilized since the 1960s to determine internal tooth structure, but with mixed results. Via image processing and enhancement, we were able to refine B-mode dental ultrasound images for more accurate enamel thickness measurements. The mean difference between the measured thickness of the occlusal enamel from ultrasound images and corresponding gold standard CT images improved from 0.55 mm to 0.32 mm with image processing (p = 0.033). The difference also improved from 0.62 to 0.53 mm at the buccal/lingual enamel surfaces, but not significantly (p = 0.38).
J Dent. 2010 Jan;38(1):72-81.
Morphological and chemical characterization of tooth enamel exposed to alkaline agents.
Taube F, Ylmén R, Shchukarev A, Nietzsche S, Norén JG.
Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, SE-405 30 Gothenburg, Sweden. abian.taube@amm.gu.se
Abstract
OBJECTIVES: In this study, morphological and chemical changes in teeth enamel exposed to alkaline agents, with or without surfactants, have been investigated. In addition, chemical effects of the organic surface layer, i.e. plaque and pellicle, were also investigated. METHODS: The present study was conducted using several techniques: Fourier transform infrared spectroscopy (FTIR), X-ray photoelectron spectroscopy (XPS), X-ray diffraction (XRD) and scanning electron microscopy (SEM). RESULTS: From XPS-measurements, it was found that exposure to alkaline solutions resulted in a massive removal of carbon from the tooth surface, and that the addition of surfactants increased the rate under present conditions. Based on the results from the FTIR-analysis, no substitution reactions between phosphate, carbonate and hydroxide ions in the enamel apatite could be detected. From a minor SEM-analysis, degradation and loss of substance of the enamel surface was found for the exposed samples. From XRD-analysis, no changes in crystallinity of the enamel apatite could be found between the samples. CONCLUSIONS: The findings in this study show that exposure to alkaline solutions results in a degradation of enamel surfaces very dissimilar from acidic erosion. No significant erosion or chemical substitution of the apatite crystals themselves could be discerned. However, significant loss of organic carbon at the enamel surface was found in all exposed samples. The degradation of the protective organic layer at the enamel surface may profoundly increase the risk for caries and dental erosion from acidic foods and beverages.
J Dent Child (Chic). 2009 Sep-Dec;76(3):181-7.
Influence of diet and salivary characteristics on the prevalence of dental erosion among 12-year-old schoolchildren.
Correr GM, Alonso RC, Correa MA, Campos EA, Baratto-Filho F, Puppin-Rontani RM.
Masters Program in Clinical Dentistry, Positivo University, Curitiba, PR, Brazil. giselenolasco@up.edu.br
PURPOSE: The aims of this study were to assess the prevalence of dental erosion among 12-year-old schoolchildren in Piracicaba, São Paulo, Brazil; and determine if gender, dietary habit, and salivary characteristics (salivary flow rate, buffer capacity, and pH) influence the erosion. METHODS: A cross-sectional study was carried out involving 389 children. Data on dietary habits, oral hygiene practices, and medical backgrounds were obtained by a survey. The erosion index proposed by O’Sullivan was used. Whole-fresh-saliva was collected and data was submitted to statistical analysis. RESULTS: The prevalence of dental erosion was 26 percent. There was no significant difference in prevalence between boys and girls (P=.19). Labial surfaces were the most affected (58 percent) and enamel loss was the most prevalent type of dental erosion (65 percent). Overall, no significant difference was found among salivary characteristics and prevalence of erosion (salivary flow rate: P=.98; buffer capacity: P=.75; pH: P=.80). Most children presented good salivary characteristics. Results indicate that the main risk factors for erosion were usage of acidic drugs, consumption of soft drinks, and temperature of acid fruits. CONCLUSIONS: The prevalence of erosion in 12-year-old schoolchildren living in Piracicaba, SF, Brazil could be considered high. Extrinsic factors were related to erosion, while salivary characteristics seemed to have no influence on erosion.
Caries Res. 2009;43(6):449-54. Epub 2009 Nov 25.
Effect of stannous fluoride and dilute hydrofluoric acid on early enamel erosion over time in vivo.
Hjortsjö C, Jonski G, Thrane PS, Saxegaard E, Young A.
Department of Prosthodontics, Faculty of Dentistry, University of Oslo, Oslo, Norway. carl.hjortsjo@odont.uio.no
Recent experimental in vivo studies have shown that aqueous solutions of stannous fluoride (SnF(2)) and hydrofluoric acid (HF) can reduce enamel solubility after 5 min. The aim of this study was to evaluate the longer-term protective effect of SnF(2) (0.78%, pH 2.9) and HF (0.2%, pH 2.0) (both approximately 0.1 mol/l F) using the same experimental model. Labial surfaces of healthy anterior teeth (all four surfaces when possible, otherwise a pair of surfaces) in 103 subjects (n = 399 teeth) were exposed to citric acid (0.01 mol/l, pH 2.7). The acid was applied using a peristaltic pump (5 ml, 6 ml/min) and was collected in coded test tubes (etch I). The test solutions were then applied to the same surfaces of the teeth (1 min, 6 ml/min). After either 1, 7, 14 or 28 days, citric acid was again applied to the same surfaces and subsequently collected (etch II). Enamel solubility was examined by assessment of calcium concentration in etch I and etch II solutions using atom absorption spectroscopy. Median values were calculated for all time periods and statistical analysis was carried out using the Wilcoxon signed-ranks test. Results showed that HF reduced enamel solubility by 54 and 36% after 1 and 7 days, respectively. After 14 and 28 days, there was no longer any effect. SnF(2) showed no protective effect after the first day. Given these results, repeated application of HF and especially SnF(2) may be necessary to improve the protective effect of these fluorides, and this requires further testing.
Caries Res. 2009;43(6):422-9. Epub 2009 Oct 28.
Comparison of calcium analysis, longitudinal microradiography and profilometry for the quantitative assessment of erosion in dentine.
Ganss C, Lussi A, Scharmann I, Weigelt T, Hardt M, Klimek J, Schlueter N.
Department of Conservative and Preventive Dentistry, Dental Clinic, Justus Liebig University Giessen, Giessen, Germany. carolina.ganss@dentist.med.uni-giessen.de
Erosion of dentine causes mineral dissolution, while the organic compounds remain at the surface. Therefore, a determination of tissue loss is complicated. Established quantitative methods for the evaluation of enamel have also been used for dentine, but the suitability of these techniques in this field has not been systematically determined. Therefore, this study aimed to compare longitudinal microradiography (LMR), contacting (cPM) and non-contacting profilometry (ncPM), and analysis of dissolved calcium (Ca analysis) in the erosion solution. Results are discussed in the light of the histology of dentine erosion. Erosion was performed with 0.05 M citric acid (pH 2.5) for 30, 60, 90 or 120 min, and erosive loss was determined by each method. LMR, cPM and ncPM were performed before and after collagenase digestion of the demineralised organic surface layer, with an emphasis on moisture control. Scanning electron microscopy was performed on randomly selected specimens. All measurements were converted into micrometres. Profilometry was not suitable to adequately quantify mineral loss prior to collagenase digestion. After 120 min of erosion, values of 5.4 +/- 1.9 microm (ncPM) and 27.8 +/- 4.6 microm (cPM) were determined. Ca analysis revealed a mineral loss of 55.4 +/- 11.5 microm. The values for profilometry after matrix digestion were 43.0 +/- 5.5 microm (ncPM) and 46.9 +/- 6.2 (cPM). Relative and proportional biases were detected for all method comparisons. The mineral loss values were below the detection limit for LMR. The study revealed gross differences between methods, particularly when demineralised organic surface tissue was present. These results indicate that the choice of method is critical and depends on the parameter under study. Copyright 2009 S. Karger AG, Basel.
Caries Res. 2009;43(6):415-21. Epub 2009 Oct 28.
Efficacy of an experimental tin-F-containing solution in erosive tissue loss in enamel and dentine in situ.
Schlueter N, Klimek J, Ganss C.
Department of Conservative and Preventive Dentistry, Dental Clinic, Justus Liebig University, Giessen, Germany. nadine.schlueter@dentist.med.uni-giessen.de
The aim of this study was to evaluate the effects of an experimental tin-containing fluoride solution on erosive tissue loss in human enamel and dentine using a cyclic de- and remineralization model in situ. The study was a three-cell (7 days each) crossover design involving 20 healthy volunteers. Samples were mounted on buccal shields of mandibular mouth appliances and worn for 24 h, except during meals and oral hygiene. Samples were demineralized extraorally with 0.05 M citric acid (pH 2.3) for 6 x 5 min per day. Fluoride treatment was performed intraorally once per day for 30 s after the first demineralization. Three solutions were used: placebo (negative control); NaF solution (positive control, 1,000 mg/kg F, pH 4.5), and an experimental solution (1,900 mg/kg Sn as SnCl(2), 500 mg/kg F as NaF, 500 mg/kg F as amine fluoride, pH 4.5). Tissue loss was determined profilometrically. In enamel, tissue loss was 33.6 +/- 15.4 microm in the negative control group, 24.2 +/- 9.2 microm (p < or = 0.05) in the positive control group and 9.2 +/- 3.4 microm (p < or = 0.001) in the experimental solution group. The respective values for dentine were 47.8 +/- 15.5 microm in the negative control group, 34.1 +/- 9.3 microm (p < or = 0.001) in the positive control group and 23.9 +/- 6.4 microm (p < or = 0.001) in the experimental solution group. The tin-containing solution was very effective in inhibiting erosive mineral in enamel in situ, even under severe conditions and with short application times, but was less effective in dentine. Copyright 2009 S. Karger AG, Basel.
Front Oral Biol. 2009;13:190-6. Epub 2009 Sep 21.
Nothing in nature is as consistent as change.
Institute of Anthropology, Mainz University, Mainz, Germany. altkw@uni-mainz.de
Dentition, as a mechanically stressed part of the orofacial system, is subject to physiological wear processes that affect the occlusal surface, the cutting-edge and the approximate contact points of teeth. The reasons are abrasive food particles, tooth contacts during chewing as well as erosion. Up until the Middle ages and even further on, both the deciduous and the permanent dentition were, depending on age, subject to distinct hard tissue defects. These regularly led from normal over-bite, which develops during dentition, to a pronounced edge-to-edge bite. In dentistry this known phenomenon is widely interpreted as a pathological adaptation. Due to specific subsistence conditions and dietary habits in food intake and preparation abrasive changes can be found in the dentition of our ancestors, beginning with the history of humanity up until historic times. However, hardly in today’s population. Abrasive food particles and erosion are the main factors that cause wear in dental enamel. We analyzed occlusal hard tissue changes that led to edge-to-edge-bite in chronologically scattered skeletal series from different regions in Germany. The sample consists of both males and females from varying age groups. The skulls were photographed in standardized positions and radiographically examined. The results show that dental wear is a natural, age-dependent process which does not lead to pathological changes. Crowding and contact surface caries can even widely be impeded through abrasion. Therefore dental wear is a natural process that has only been prevented by ‘civilization’ in the past two centuries. Edge-to-edge-bite is still the preferable occlusion in man. Copyright (c) 2009 S. Karger AG, Basel.
Nutr Metab Cardiovasc Dis. 2009 Dec;19(10):683-9. Epub 2009 Jun 6.
Carbonated beverages and gastrointestinal system: between myth and reality.
Cuomo R, Sarnelli G, Savarese MF, Buyckx M.
Gastroenterology Unit, Department of Clinical and Experimental Medicine, University of Naples Federico II, Via Sergio Pansini 5, 80131 Napoli, Italy. rcuomo@unina.it
A wealth of information has appeared on non-scientific publications, some suggesting a positive effect of carbonated beverages on gastrointestinal diseases or health, and others a negative one. The evaluation of the properties of carbonated beverages mainly involves the carbon dioxide with which they are charged. Scientific evidence suggests that the main interactions between carbon dioxide and the gastrointestinal system occur in the oral cavity, the esophagus and the stomach. The impact of carbonation determines modification in terms of the mouthfeel of beverages and has a minor role in tooth erosion. Some surveys showed a weak association between carbonated beverages and gastroesophageal reflux disease; however, the methodology employed was often inadequate and, on the overall, the evidence available on this topic is contradictory. Influence on stomach function appears related to both mechanical and chemical effects. Symptoms related to a gastric mechanical distress appear only when drinking more than 300 ml of a carbonated fluid. In conclusion there is now sufficient scientific evidence to understand the physiological impact of carbonated beverages on the gastrointestinal system, while providing a basis for further investigation on the related pathophysiological aspects. However, more studies are needed, particularly intervention trials, to support any claim on the possible beneficial effects of carbonated beverages on the gastrointestinal system, and clarify how they affect digestion. More epidemiological and mechanistic studies are also needed to evaluate the possible drawbacks of their consumption in terms of risk of tooth erosion and gastric distress.
J Dent. 2009 Dec;37(12):944-8. Epub 2009 Aug 4.
In vitro efficacy of experimental tin- and fluoride-containing mouth rinses as anti-erosive agents in enamel.
Schlueter N, Klimek J, Ganss C.
Department of Conservative and Preventive Dentistry, Dental Clinic of the Justus Liebig University, Schlangenzahl 14, Giessen, Germany. nadine.schlueter@dentist.med.uni-giessen.de
OBJECTIVES: The aim of this in vitro study was to investigate the efficacy of various experimental tin- and fluoride-containing mouth rinses with stepwise reduced concentrations of the active agents on erosion progression in enamel. METHODS: Human enamel specimens were subjected to a cyclic demineralisation and remineralisation procedure for 10 days with 6 demineralisation periods per day, 5 min each. Erosive demineralisation was performed with 0.05 M citric acid (pH 2.3). Except in the control groups, the specimens were treated for 2 min with experimental mouth rinses after the first and sixth demineralisations. The tin concentrations ranged between 800 and 2800 ppm, and fluoride concentrations of 500 and 250 ppm were used. All preparations were adjusted to pH 4.5. As positive control, a commercially available, tin-containing mouth rinse was used (pH 4.2, 409 ppm Sn(2+), 250 ppm F(-)). Tissue loss was determined profilometrically. RESULTS AND CONCLUSION: As expected, the highest tissue loss was found in the negative control group. All experimental mouth rinses were able to reduce tissue loss significantly (p< or =0.001). The best reduction was achieved by the 2800 ppm Sn(2+), 500 ppm F(-) solution (80%). The lowest reduction was achieved by the 800 ppm Sn(2+), 250 ppm F(-) solution (54%). Amongst the 500 ppm F(-) solutions, in the Sn(2+) concentration range of 2800-800 ppm, only small differences in efficacy were observed, meaning that the tin concentration can probably be reduced without losing efficacy. This factor is particularly important if one regards the possible clinical applicability of such mouth rinses.
J Dent. 2009 Dec;37(12):949-54. Epub 2009 Aug 4.
Protective effect on enamel demineralization of a CPP-ACP paste: an AFM in vitro study.
Poggio C, Lombardini M, Dagna A, Chiesa M, Bianchi S.
Department of Operative Dentistry, University of Pavia, Piazzale Golgi 3, Pavia, Italy. nadine.schlueter@dentist.med.uni-giessen.de
OBJECTIVES: The aim of the present in vitro study was the evaluation of a CPP-ACP paste (Tooth Mousse) on preventing dental erosion produced by a soft drink (Coca Cola), using Atomic Force Microscopy (AFM). METHODS: Thirty extracted human central incisors free of caries were selected and divided in a treatment and a control half. The treatment halves were divided in three groups-group 1: demineralization with soft drink (4 intervals of 2 min); group 2: demineralization with soft drink (4 intervals of 2 min) plus Tooth Mousse; group 3: intact enamel plus Tooth Mousse. In groups 2 and 3 Tooth Mousse was applied for 3 min at 0, 8, 24 and 36 h. The surface of each specimen was imaged by AFM and R(rms) values were registered. RESULTS: Among treatment specimens of groups 1 and 2, a statistically significant difference (P<0.01) in R(rms) values was registered: treatment of the specimens with CPP-ACP paste had a protective effect on enamel demineralization. In group 3 no statistically significant difference was registered between exposed and not exposed halves of the specimens. CONCLUSIONS: The use of a CPP-ACP paste had a protective effect on enamel demineralization in an in vitro model.
J Dent. 2009 Dec;37(12):913-22. Epub 2009 Jul 24.
Erosion and abrasion of tooth-colored restorative materials and human enamel.
Yu H, Wegehaupt FJ, Wiegand A, Roos M, Attin T, Buchalla W.
Clinic for Preventive Dentistry, Periodontology and Cariology, University of Zurich, Plattenstrasse 11, Zurich, Switzerland. hao.yu@zzmk.uzh.ch
OBJECTIVES: The aim of this study was to investigate the effects of erosion and toothbrush abrasion on different restorative materials and human enamel. METHODS: Human enamel and 5 kinds of tooth-colored restorative materials were used. The restorative materials included three composite resins (Filtek Silorane, Tetric EvoCeram, and Tetric EvoFlow), a polyacid-modified composite (Dyract Extra), and a conventional glass-ionomer cement (Ketac Fil Plus). For each type of the material, 40 specimens were prepared and embedded in ceramic moulds and divided into four groups (n=10): control group (C), erosion group (E), abrasion group (A), and erosion-abrasion group (EA). The specimens were subjected to six daily erosive attacks (groups E and EA; citric acid, pH 2.3, 1 min) and/or six abrasive attacks (groups A and EA; toothbrush abrasion, 100 strokes, 1 min), while the control specimens (group C) were maintained in artificial saliva. After 10-day treatment, the substance loss and surface changes were determined by surface profilometry and scanning electron microscopy. RESULTS: Human enamel presented higher substance loss when compared to restorative materials. Generally, combined erosion-abrasion (EA) caused the highest substance loss, followed by erosion, abrasion, and storage in artificial saliva. Composite resin presented highest durability under erosive and/or abrasive attacks. Enamel and restorative materials showed degradation in groups E and EA through SEM observation. CONCLUSIONS: Toothbrush abrasion has a synergistic effect with erosion on substance loss of human enamel, polyacid-modified composite and glass-ionomer cement. The acid- and abrasive-resistance of human enamel was lower compared to restorative materials.
J Dent. 2009 Dec;37(12):994-8. Epub 2009 Sep 3.
Chlorhexidine and green tea extract reduce dentin erosion and abrasion in situ.
Magalhães AC, Wiegand A, Rios D, Hannas A, Attin T, Buzalaf MA.
Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil.
OBJECTIVES: This in situ/ex vivo study aimed to analyse the impact of possible MMP-inhibitors (chlorhexidine and green tea extract) on dentin wear induced by erosion or erosion plus abrasion. METHODS: Twelve volunteers took part in this cross-over and double-blind study performed in 4 phases of each 5 days. Bovine dentin samples were worn in palatal appliances and subjected to extraoral erosion (4 times/day, Coca-Cola, 5 min) or erosion plus abrasion (2 times/day, fluoride-free toothpaste and electrical toothbrush, 15s/sample). Immediately after each erosion, the appliances were reinserted in the mouth and the oral cavity was rinsed for 60s with: 250 ppm F solution (SnF(2)/AmF, pH 4.5, Meridol-Gaba, Switzerland), 0.12% chlorhexidine digluconate (0.06% chlorhexidine, pH 6.0, Periogard-Colgate, Brazil), 0.61% green tea extract solution (OM24, 100% Camellia Sinensis leaf extract, catechin concentration: 30+/-3%, pH 7.0, Omnimedica, Switzerland) or deionized water (pH 6.0, control). Dentin loss was assessed by profilometry (microm). The data were analysed by two-way repeated measures ANOVA and Bonferroni post hoc test. RESULTS: There was a significant difference between the conditions (EroxEro+Abr, p<0.001) and among the solutions (p<0.001). All solutions (F: 1.42+/-0.34; 1.73+/-0.50, chlorhexidine: 1.15+/-0.26; 1.59+/-0.32, green tea: 1.06+/-0.30; 1.54+/-0.55) significantly reduced the dentin wear when compared to control (2.00+/-0.55; 2.41+/-0.83) for both conditions. There were not significant differences among green tea extract, chlorhexidine and F solutions. CONCLUSIONS: Thus, the possible MMP-inhibitors tested in this study seem to be a promising preventive measure to reduce dentin erosion-abrasion, but their mechanism of action needs to be investigated in further studies.
Gen Dent. 2009 Sep-Oct;57(5):519-23.
Dental erosion due to excessive wine consumption.
Chehal HK, Pate DH, Cohen DM, Bhattacharyya I.
Department of Oral Maxillofacial Surgery and Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA.
Dental erosion can result in serious and irreversible damage to dentition, although it often is not recognized in the early stages. It is important to be aware of the numerous factors that can lead to tooth erosion, as this knowledge forms an important basis for intervention and treatment planning. This article presents a case of dental erosion involving an alcoholic woman who habitually consumed large quantities of white wine and discusses the dental erosion induced by excessive wine consumption. The authors also present the clinical aspects (including different etiologies of erosion) that distinguish extrinsic erosion from intrinsic erosion.
Compend Contin Educ Dent. 2009 Nov-Dec;30(9):616-20.
Etiology and prevention of acid erosion.
Department of Prosthodontics, Kings College London Dental Institute, London Bridge, London, England.
Acid erosion is the chemical effect of dietary or gastric acids on enamel and dentine. Unlike dental caries, which is a bacterially mediated condition, acid erosion normally is combined with physical forms of attrition and abrasion. The clinical appearance of acid erosion in the early stages is seen characteristically as hollowed-out lesions on occlusal surfaces and on smooth surfaces as a subtle change in the tooth contour. As the condition progresses, the lesions coalesce and form widespread dentin exposure and coronal destruction. Dietary acids that are present in beverages and fruits potentially can cause acid erosion. However, dietary habits involving frequent consumption of acids are believed to be important determinants in the risk of developing clinical signs of acid erosion. Prevention using fluoride toothpastes, dietary modifications, and calcium-based products probably have a significant clinical effect in reducing the risk of developing acid erosion.
Am J Gastroenterol. 2009 Nov;104(11):2788-95. Epub 2009 Aug 4.
Quantification of dental erosions in patients with GERD using optical coherence tomography before and after double-blind, randomized treatment with esomeprazole or placebo.
Wilder-Smith CH, Wilder-Smith P, Kawakami-Wong H, Voronets J, Osann K, Lussi A.
Brain-Gut Research Group and Gastroenterology Group Practice, Bern, Switzerland. cws@braingut.com
OBJECTIVES: Dental erosion, the chemical dissolution of enamel without bacterial involvement, is a rarely reported manifestation of gastroesophageal reflux disease (GERD), as well as of recurrent vomiting and dietary habits. It leads to loss of tooth substance, hypersensitivity, functional impairment, and even tooth fracture. To date, dental erosions have been assessed using only very basic visual methods, and no evidence-based guidelines or studies exist regarding the prevention or treatment of GERD-related dental erosions. METHODS: In this randomized, double-blind study, we used optical coherence tomography (OCT) to quantify dental tissue demineralization and enamel loss before and after 3 weeks of acid-suppressive treatment with esomeprazole 20 mg b.i.d. or placebo in 30 patients presenting to the Berne University Dental Clinic with advanced dental erosions and abnormal acid exposure by 24-h esophageal pH manometry (defined as >4% of the 24-h period with pH<4). Enamel thickness, reflectivity, and absorbance as measures of demineralization were quantified by OCT before and after therapy at identical localizations on teeth with most severe visible erosions as well as several other predefined changes in teeth. RESULTS: The mean+/-s.e.m. decrease of enamel thickness of all teeth before and after treatment at the site of maximum exposure was 7.2+/-0.16 black trianglem with esomeprazole and 15.25+/-0.17black trianglem with placebo (P=0.013), representing a loss of 0.3% and 0.8% of the total enamel thickness, respectively. The change in optical reflectivity to a depth of 25 black trianglem after treatment was-1.122 +/-0.769 dB with esomeprazole and +2.059+/-0.534 dB with placebo (P 0.012), with increased reflectivity signifying demineralization. CONCLUSIONS: OCT non-invasively detected and quantified significantly diminished progression of dental tissue demineralization and enamel loss after only 3 weeks of treatment with esomeprazole 20 mg b.i.d. vs. placebo. This suggests that esomeprazole may be useful in counteracting progression of GERD-related dental erosions. Further validation of preventative treatment regimens using this sensitive detection method is required, including longer follow-up and correlation with quantitative reflux measures.
Nutr Res. 2009 Aug;29(8):558-67.
Prolonged in vitro exposure to white wines enhances the erosive damage on human permanent teeth compared with red wines.
Willershausen B, Callaway A, Azrak B, Kloss C, Schulz-Dobrick B.
Department of Operative Dentistry, University Medical Center of the Johannes Gutenberg University Mainz, Augustusplatz 2, D-55131 Mainz, Germany. willersh@uni-mainz.de
The aim of this in vitro study was to determine and compare the erosive potentials of red and white wines, exerted on enamel surfaces prepared from extracted human permanent teeth. European wines (50 red, 50 white wines) from different regions were purchased, and the pH values were measured. Eight wines with different pH values were selected. Enamel samples with an average surface area of 25 mm(2) were prepared from 25 extracted permanent teeth from male and female patients aged 40 to 65 years and incubated with wines for up to 24 hours; the amounts of released calcium were determined colorimetrically, and mean surface roughness was measured with a profilometer. A quantitative elemental analysis for Ca was carried out in various depths (5-50 microm), using an electron probe microanalyzer. Incubation of the enamel surfaces with different wines caused a time-dependent release of calcium. After 24 hours, white wines caused a significantly higher (P = .003) Ca release (range: 8.74-28.56 mg dL(-1) 25 mm(-2)) than red wines (range: 4.85-19.43 mg dL(-1) 25 mm(-2)), whereas the values for surface roughness were similar (white wines: 2.67 +/- 0.92 microm; red wines: 2.64 +/- 0.66 mum). Incubation with white wines resulted in a higher loss of Ca down to a depth of 60 microm. In this study, it was demonstrated that white wines have higher erosive potentials than red wines. Within the limits of this in vitro study, it can be predicted that a frequent consumption of white wines might lead to severe dental erosion.
J Am Dent Assoc. 2009 Sep;140(9):1137-43.
The effect of salivary factors on dental erosion in various age groups and tooth surfaces.
Piangprach T, Hengtrakool C, Kukiattrakoon B, Kedjarune-Leggat U.
Section of Dental Public Health, Nonthai Hospital, Nakorn Ratchasima, Thailand.
BACKGROUND: Saliva, tooth experiences and tooth position may be associated with dental erosion. To identify factors that may provide a potential protective effect against erosion, the authors compared salivary factors and behavioral aspects in participants in three age groups. Materials and METHODS: The authors evaluated 79 volunteer participants in three age groups: 16 through 20 years, 26 through 30 years and 46 through 50 years. They classified all teeth as having no erosion, having erosion involving only enamel or having erosion involving dentin on at least one surface. They collected saliva from each participant and determined pH, flow rate, buffering capacity, urea, total protein and volume required to neutralize orange juice. RESULTS: Unstimulated salivary buffering capacity and urea concentration in salivary samples of participants aged 16 through 20 years with no erosion (facial/buccal surface) were significantly greater than those in the group with enamel erosion (P < .05). In participants aged 26 through 30 years (occlusal surface), the stimulated salivary flow rate was higher in the group with enamel erosion than in the group with dentin erosion (P < .05). In the group aged 46 through 50 years (lingual and palatal surfaces), only stimulated salivary total protein was significantly higher in the group with enamel erosion (P < .05). In groups aged 16 through 20 years and 46 through 50 years, erosion appeared to be related to a preference for sour (acidic) tastes (P < .05). CONCLUSIONS: Saliva protects enamel and dentin from erosion. Its effectiveness in this role depends partly on salivary factors and may differ according to a person’s age and to the severity and site of erosion. CLINICAL IMPLICATIONS: Salivary factors including flow rate, urea, buffering capacity and neutralization capability help prevent dental erosion. The protective level of saliva varies by age and tooth experiences.
Aust Dent J. 2009 Sep;54(3):238-44; quiz 277.
Erosive potential of beverages sold in Australian schools.
Cochrane NJ, Cai F, Yuan Y, Reynolds EC.
Centre for Oral Health Science, Melbourne Dental School, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Victoria.
BACKGROUND: Dental erosion is an increasingly prevalent problem in Australia. The aim of this study was to analyse the composition and erosive potential of beverages sold for consumption in Victorian schools. METHODS: Fifteen drinks were selected and analysed to determine their pH, titratable acidity and ionic composition (calcium, fluoride and inorganic phosphate). The erosive potential of the beverages was measured by analysing weight loss, surface loss and the release of calcium ions from human enamel following a 30-minute or 24-hour exposure. The association of the chemical parameters with the measures of erosion was determined using Spearman’s rank correlation. RESULTS: All beverages tested except the milks and the bottled water produced significant dental erosion in vitro. The only chemical parameter that correlated significantly with all measures of erosion was the initial pH of the beverage (p < 0.01). Levels of fluoride similar to those of Australian reticulated water were found in the carbonated beverages. CONCLUSIONS: The majority of the tested beverages sold from school canteens exhibited erosive potential.
ust Dent J. 2009 Sep;54(3):228-32.
The effects of saliva on the erosive potential of three different wines.
Brand HS, Tjoe Fat GM, Veerman EC.
Department of Basic Dental Sciences, Section of Oral Biochemistry, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands. hs.brand@vumc.nl
BACKGROUND: The erosive potential of wine on teeth may be modified by the buffering capacity of saliva. This potential effect was studied for three different wines in vitro and in vivo. METHODS: The buffering capacity was studied in vitro by stepwise addition of small volumes of a dry white wine, a medium sweet white wine and a red wine to collected stimulated saliva. In vivo, this was studied by six volunteers vigorously rinsing 5 mL of each wine in their mouth for 15 to 45 seconds. Changes in salivary flow rate and pH were measured during a period of 10 minutes after rinsing with 5 mL wine. RESULTS: pH values < 5.5 were observed in vitro after addition of 0.2 mL dry white wine and medium sweet wine and after 0.3 mL red wine to 1 mL saliva. During rinsing with all wines, the intra-oral pH decreased to below 4 within 15 seconds and remained below this value for at least 45 seconds. After expectoration, the salivary pH remained significantly low for two to six minutes, despite a doubling of the flow rate observed during the first two minutes. CONCLUSIONS: Vigorously rinsing wine induced a decrease in intra-oral pH of significant degree and duration, which increases the risk of developing dental erosion.
Aust Dent J. 2009 Sep;54(3):212-9.
The cervical wedge-shaped lesion in teeth: a light and electron microscopic study.
Daley TJ, Harbrow DJ, Kahler B, Young WG.
School of Dentistry, The University of Queensland, Brisbane, Australia.
BACKGROUND: The cervical non-carious wedged-shaped lesion is controversial in that its aetiology may involve attrition, erosion, abrasion and stress-corrosion (abfraction). This study examined the histopathology of anterior teeth with cervical wedge-shaped lesions by light and electron microscopy to elucidate their pathogenesis. METHODS: Ten undecalcified human teeth with cervical lesions were available for investigation. Patency of the dentine tubules was tested using red dye penetration from the pulp chamber. The morphology of normal and sclerotic dentine adjacent to the cervical wedge-shaped lesions was investigated by scanning electron microscopy. The numbers and diameters of dentinal tubules were measured at different levels beneath the surfaces of the lesions. RESULTS: The gross and microscopic features of the worn teeth were described. Red dye penetration tests showed white tracts of sclerotic tubules contrasted with red tracts of patent tubules. Numbers of tubules per square area and diameters of patent and sclerotic tubules varied at different levels within the dentine due to deposits of intratubular dentine. CONCLUSIONS: The cervical wedge is shaped by interactions between acid wear, abrasion and dentinal sclerosis. No histopathological evidence of abfraction was found. Clinical diagnosis, conservation and restoration of non-carious cervical lesions need to take into account the extent of sclerotic dentine beneath wedge-shaped lesions.
Am J Gastroenterol. 2009 Nov;104(11):2788-95. Epub 2009 Aug 4.
Quantification of dental erosions in patients with GERD using optical coherence tomography before and after double-blind, randomized treatment with esomeprazole or placebo.
Wilder-Smith CH, Wilder-Smith P, Kawakami-Wong H, Voronets J, Osann K, Lussi A.
Brain-Gut Research Group and Gastroenterology Group Practice, Bern, Switzerland. cws@braingut.com
OBJECTIVES: Dental erosion, the chemical dissolution of enamel without bacterial involvement, is a rarely reported manifestation of gastroesophageal reflux disease (GERD), as well as of recurrent vomiting and dietary habits. It leads to loss of tooth substance, hypersensitivity, functional impairment, and even tooth fracture. To date, dental erosions have been assessed using only very basic visual methods, and no evidence-based guidelines or studies exist regarding the prevention or treatment of GERD-related dental erosions. METHODS: In this randomized, double-blind study, we used optical coherence tomography (OCT) to quantify dental tissue demineralization and enamel loss before and after 3 weeks of acid-suppressive treatment with esomeprazole 20 mg b.i.d. or placebo in 30 patients presenting to the Berne University Dental Clinic with advanced dental erosions and abnormal acid exposure by 24-h esophageal pH manometry (defined as >4% of the 24-h period with pH<4). Enamel thickness, reflectivity, and absorbance as measures of demineralization were quantified by OCT before and after therapy at identical localizations on teeth with most severe visible erosions as well as several other predefined changes in teeth. RESULTS: The mean+/-s.e.m. decrease of enamel thickness of all teeth before and after treatment at the site of maximum exposure was 7.2+/-0.16 black trianglem with esomeprazole and 15.25+/-0.17black trianglem with placebo (P=0.013), representing a loss of 0.3% and 0.8% of the total enamel thickness, respectively. The change in optical reflectivity to a depth of 25 black trianglem after treatment was-1.122 +/-0.769 dB with esomeprazole and +2.059+/-0.534 dB with placebo (P 0.012), with increased reflectivity signifying demineralization. CONCLUSIONS: OCT non-invasively detected and quantified significantly diminished progression of dental tissue demineralization and enamel loss after only 3 weeks of treatment with esomeprazole 20 mg b.i.d. vs. placebo. This suggests that esomeprazole may be useful in counteracting progression of GERD-related dental erosions. Further validation of preventative treatment regimens using this sensitive detection method is required, including longer follow-up and correlation with quantitative reflux measures.
J Dent. 2009 Oct;37(10):781-5. Epub 2009 Jun 18.
Interplay between fluoride and abrasivity of dentifrices on dental erosion-abrasion.
Hara AT, González-Cabezas C, Creeth J, Parmar M, Eckert GJ, Zero DT.
Oral Health Research Institute, Department of Preventive and Community Dentistry, Indiana University School of Dentistry, 415 N. Lansing Street, Indianapolis, 46202-2876 IN, USA. ahara@iupui.edu
OBJECTIVES: Eroded teeth are more susceptible to toothbrushing wear than sound teeth. We tested the hypothesis that fluoride and abrasivity of dentifrices can interact, modulating the development of erosive-abrasive lesions. METHODS: Human enamel and root dentin specimens were submitted to cycles of demineralization, remineralization and toothbrushing using six dentifrices formulated with three different abrasivity levels: low (L), medium (M) and high (H); with (+F) and without (-F) fluoride. Surface loss was quantified by optical profilometry and compared among groups (alpha=0.05). RESULTS: In dentin, it was ranked: L<M<H, for both +F and -F dentifrices. In enamel, +F dentifrices had similar results; however for -F formulations, M and H did not differ. Fluoride reduced surface loss in enamel, at all abrasive levels. In dentin, the same fluoride effect was observed but only for the low abrasive formulation. CONCLUSIONS: Both fluoride and abrasivity were important modulators of enamel surface loss, while abrasivity had a higher impact than fluoride on dentin.
Med Oral Patol Oral Cir Bucal. 2009 Aug 1;14(8):e376-83.
Dental erosion in alcoholic patients under addiction rehabilitation therapy.
Manarte P, Manso MC, Souza D, Frias-Bulhosa J, Gago S.
Department of Medical Sciences, Faculty of Health Sciences, University Fernando Pessoa, Porto, Portugal. patmon@ufp.edu.pt
OBJECTIVE: To determine the occurrence and severity of dental erosion in alcoholic patients undergoing detoxification at the North Alcoholic Regional Centre (CRAN), Porto, Portugal, and to assess socioeconomic and behavioural covariates of dental erosion occurrence. DESIGN: A cross-sectional descriptive study was carried out in one centre (CRAN) for addiction rehabilitation therapy in the north of Portugal. A sample of 1064 teeth was examined. The condition of the dental erosion was classified by means of severity and anatomic location, according to the Eccles and Jenkins dental erosion index, and a dichotomous outcome assessing the occurrence of dental erosion (severity dental erosion levels > 0 ). Dental erosion results were linked to data supplied by a questionnaire assessing socio-demographic characteristics, behaviour related to alcohol and drug use, including a history of drug and alcohol abuse, and oral health promotion using logistic multivariate regression analysis. RESULTS: Enamel and/or dentine erosion lesions were present on 49.4% of the teeth. Among these, 36.9% of occlusal surfaces presented dental erosion with a severity level of 1, 11.4% with a severity level 2 and 1.1% with a severity level 3. The highest occurrence of severity level 3 was found to exist in palatal dental surfaces (1.9%). Dental erosion on teeth surfaces was found to be independently associated with intra oral location (by arch, tooth type), patients’ socio-demographic characteristics, behaviour associated with a history of alcohol and drug abuse, and oral health promotion. Maxillary teeth, more so than mandibular teeth, presented moderate to higher severity erosion injuries (Wilcoxon test; p< 0.001); and significant differences in the severity of dental erosion were found between anterior and posterior teeth, in both the maxillary and the mandibular arches (Friedman test, p< 0.001). CONCLUSIONS: Alcohol-dependent patients undergoing a detoxification programme presented a high occurrence and a low severity of dental erosion lesions.The palatal surfaces of the anterior teeth, followed by incisive/occlusal surfaces in both anterior and posterior teeth, respectively, were most affected by erosion injuries.
[...] un buen augurio el aumento significativo que han tenido las publicaciones sobre erosiones. Ya era [...]