The prevalence of tooth wear in a cluster sample of adolescent schoolchildren and its relationship with potential explanatory factors

Restorative Materials Exposed to Acid Challenge: Influence of Temperature on In Vitro Weight Loss

Consumption of acidic beverages and foods could provoke erosive damage, both for teeth and for restorative materials. Temperatures of consumption could influence the erosive effects of these products. The aim of this in vitro study is to assess the influence of an acidic challenge on the weight loss of different restorative materials. Resin composites and glass-ionomer cements (GIC) were tested. The medium of storage was Coca-Cola (Coca-Cola, Coca-Cola Company, Milano, Italy) at two different temperatures, 4 and 37 °C, respectively for Group A and Group B. For each group, nine specimens were prepared for each material tested. After 7 days, weight was assessed for each sample, and the percentage weight loss was calculated. For all the resin composites (Groups 1−13), no significant weight losses were noticed. (<1%). Conversely, GICs (Groups 14 and 15) showed significant weight loss during the acidic challenge, which was reduced in the case of these materials that included a protective layer applied above. Significant differences were registered with intra-group analysis; weight loss for specimens immersed in Coca Cola at 37 °C was significantly higher for almost all materials tested when compared to specimens exposed to a cooler medium. In conclusion, all the resin composites showed reliable behaviour when exposed to acidic erosion, whereas glass-ionomer cements generally tended to solubilize.

Influence of Enamel Exposure to Acidic Drink on Shear Bond Strength of Different Fissure Sealants

In the present study, we evaluated the influence of bovine enamel exposure to acidic drinks (Coca-Cola, Coca-Cola Company, Milano, Italy, pH = 2.37) on shear bond strength of three sealants (Fissurit; Grandio Seal and Admira Fusion—Voco Gmbh, Cuxhaven, Germany). For each sealant, two adhesive techniques were tested to investigate the impact of the adhesive application on shear bond strength of sealants after immersion in acidic drink and in the control: Group 1—Control: enamel surface was not in contact with acid drinks, acid etching application and self-adhesive technique for fissure sealant; Group 2—enamel surface was not in contact with acid drinks, acid etching, and adhesive applications, an etch-and-rinse technique for fissure sealant; Group 3—enamel surface was immersed in acid drink, acid etching application and self-adhesive technique for fissure sealant; Group 4—enamel surface was immersed in acid drink, acid etching, and adhesive applications, an etch-and-rinse technique for fissure sealant. For each specimen, the sealant composite resin was applied to the enamel surface and tested with a universal testing machine. Shear bond strength was measured in MPa and with an optical microscope to determine failure modes, quantified with adhesive remnant index (ARI). Enamel acidification variably influenced bond strength values of the different sealants. When no enamel pretreatment was applied, no significant differences were found among the sealants (p > 0.05). However, the mere application of acid etching without adhesive procedures resulted in lower bond strength (p < 0.001). The acid pretreatment affected significantly the bond strength of all sealants tested (p < 0.001), but no significant differences were recorded between the subgroups.

Epidemiology of Erosive Tooth Wear, Dental Fluorosis and Molar Incisor Hypomineralization in the American Continent

Non-carious dental lesions such as developmental defects of enamel (DDE) and erosive tooth wear (ETW) are the subject of intensive research. This paper aims to give perspectives on both DDE, including dental fluorosis and molar incisor hypomineralization (MIH), and ETW, presenting epidemiological data from the Americas and associated diagnostic aspects. Besides, it is important to present evidence to guide the clinical assessment process, supporting the clinicians' management decisions towards better oral health of their patients. The overall increase in the worldwide prevalence of non-carious lesions discussed in this this paper may reflect the need of perceptual changes. Although the number of publications related to these conditions has been increasing in the last years, there is still a need for clinical diagnostic and management awareness to include these conditions in routine dental practice. Besides, it is important to provide recommendations for standardized clinical assessment criteria, improving the process and helping clinicians' adherence. In this sense, this paper discusses the most commonly implemented indices for each condition. Thus, despite the wide range of diagnostic indices, BEWE is proposed to be the index recommended for ETW assessment, Dean or Thylstrup &amp; Fejerskov indices for fluorosis and preferably the EAPD criteria (or modified DDE index) for MIH. Overall, non-carious lesions are a growing concern, and it is important to implement preventive measures that control their severity and progression, and accurate diagnosis by the dental clinician.

A systematic review of dietary acids and habits on dental erosion in adolescents

BACKGROUND

Dental erosion is the dissolution of dental hard tissues caused by acids of a non-bacterial origin. Dietary acids are considered the predominant and most controllable factor.

AIM

To synthesise the literature on the effects of dietary acids and habits on dental erosion in the permanent dentition of 10- to 19-year-old adolescents.

MATERIALS AND METHODS

An electronic literature search was undertaken in Cochrane, MEDLINE, CINAHL, Dentistry & Oral Sciences Source via EBSCOhost, and Embase with no restriction on the date of publication.

RESULTS

The initial search identified 449 articles, and 338 remained after removal of duplicates. Seventy-seven articles remained after screening of titles and abstracts, and 52 were eligible for the full-text review. A considerable variety of beverages, food, and dietary habits were reported as risk factors for dental erosion. The most consistent findings implicated the erosive potential of carbonated beverages and the consumption of acidic drinks at bedtime.

CONCLUSIONS

Although results were not consistent between cohort and cross-sectional studies, this review suggests certain dietary risk factors may contribute to dental erosion in adolescents. There is a need for more high-quality cohort studies to establish more conclusive evidence on the role of dietary acids and habits on dental erosion.

Contemporary management of minimal invasive aesthetic treatment of dentition affected by erosion: case report

Background

The paradigm shift obtained with new dental materials permits minimally invasive dentistry, by following a biomimetic approach. Erosion increasingly affects the adult population through dental substance loss by acid attack. Oral rehabilitation is often extensive and requires careful mouth examination and treatments codified in the literature.

Case presentation

This clinical report proposes a reasoned approach to erosion treatment for a 39-year-old male patient presenting several old fixed prostheses. These old restorations are all of correct quality and are retained. The temporomandibular joint was free from disorder. Only defective reconstructions are remade together with eroded teeth, according to a three-step technical protocol. In the first step, mock-up manufacturing is performed which occlusal vertical dimension increased to 1 mm provoking passive dental overeruption to the second and third molars. In all, one ceramic crown was remade, and two ceramic onlays and a resin composite were integrated on the posterior teeth. The last step consisted of palatal veneers on the maxillary incisor and canine, and an aesthetic resin composite on the incisor edge. After these treatments, regular assessments were carried out at 4 months then at 6 months with visual, photographic and radiographic examinations.

Conclusion

The present dental care philosophy is to preserve dental tissue as much as possible, even in large erosion cases, and to respond to the aesthetic and functional expectations of the patient. This methodology requires a thorough evaluation phase, compliance with the protocol and regular patient follow-up.

Pediatric Esophageal Disorders: Diagnosis and Treatment of Reflux and Eosinophilic Esophagitis

Gastroesophageal reflux (GER) occurs frequently in infants, generally at its worst at 4 months of age, with approximately two-thirds of infants spitting up daily. GER typically improves after 7 months of age, with only ∼5% of infants continuing to have reflux at 1 year of age. The diagnosis can often be made based on clinical symptoms. Upper GI (UGI) study has low sensitivity and specificity and should not be ordered as a diagnostic test for reflux. UGI study is best for evaluating other anatomic causes of vomiting. GER becomes problematic gastroesophageal reflux disease (GERD) when complications are present, including feeding difficulties and poor weight gain. Conservative treatment and thickened formula can be helpful for treating GERD. Proton pump inhibitors (PPIs) are frequently prescribed for treating reflux. However, studies do not show a definite benefit in infants, and there are potential side effects. Older children with GERD may present with regurgitation, heartburn, chest discomfort, dysphagia, abdominal pain, vomiting, poor appetite, or poor weight gain. Upper endoscopy is considered for children with concerning symptoms, persistent symptoms despite treatment, and relapse of symptoms after treatment. Other esophageal disorders can have a similar clinical presentation as GERD, notably eosinophilic esophagitis (EoE). EoE is a chronic immune-mediated disorder of the esophagus, which may present as dysphagia, food impaction, heartburn, vomiting, abdominal pain, feeding difficulties, or failure to thrive. Diagnosis is made histologically by the presence of esophageal eosinophilia on endoscopic biopsies in the correct clinical setting.

Oral findings in children and adolescents with Prader-Willi syndrome

OBJECTIVE

To assess the significance of changes in the saliva in the etiology of gingivitis and tooth wear in children and adolescents with Prader-Willi syndrome (PWS).

MATERIALS AND METHODS

The study included 80 (2.8-18 years old; 39 girls and 41 boys): 40 in PWS group (mean age 8.0 ± 4.24 years) and 40 in control group (mean age 7.9 ± 4.12 years). General condition, oral para-functional habits, tooth wear (modified TWI), oral hygiene and gingival status (Plaque Index (PLI) and Gingival Index (GI)), localization of gingivitis, and salivary characteristics were assessed. The chi-square test, the Mann-Whitney U test, Spearman's rank correlation, and odds ratio based on logistic regression in a statistical analysis were applied.

RESULTS

Chances of gingivitis were increased by low PLI (odds ratio (OR) = 32.53), low resting salivary flow (OR = 3.96), increased viscosity of saliva (OR = 3.54), and mouth breathing (OR = 8.17). For gingivitis in anterior regions, low PLI (OR = 107.67), low resting (OR = 5.73) and stimulated (OR = 1.86) salivary flow, increased viscosity of saliva (OR = 5.87), mouth breathing (OR = 10.00), and low stimulated salivary flow (OR = 3.18) were observed. Tooth wear rates were increased by teeth grinding (OR = 16.20), mouth breathing (OR = 4.33), increased viscosity of saliva (OR = 11.67) and low resting (OR = 6.07), and stimulated (OR = 4.22) salivary flow.

CONCLUSIONS

In PWS, reduced salivary secretion, increased viscosity, of saliva and mouth breathing increase the risk of plaque-induced gingivitis and tooth wear.

CLINICAL RELEVANCE

The prevention and treatment of tooth wear and gingivitis in PWS patients is necessary not only to treat bruxism and mouth breathing but also to limit the influence of negative changes of saliva.

The proteomic profile of the acquired enamel pellicle according to its location in the dental arches

OBJECTIVE

This study evaluated the variation in the protein profile of the acquired enamel pellicle (AEP) formed in vivo according to its location in the dental arches.

DESIGN

The AEP was formed for 120min in 9 volunteers. Pellicle formed at upper+lower anterior facial (ULAFa; teeth 13-23 and 33-43), upper anterior palatal (UAPa; teeth 13-23), lower anterior lingual (LALi; teeth 33-43), upper+lower posterior facial (ULPFa; teeth 14-17 24-27, 34-37 and 44-47), upper posterior palatal (UPPa; teeth 14-17 and 24-27) and lower posterior lingual (LPLi; teeth 34-37 and 44-47) regions were collected separately and processed for analysis by label-free LC-ESI-MS/MS.

RESULTS

Three-hundred sixty three proteins were identified in total, twenty-five being common to all the locations, such as Protein S100-A8, Lysozyme C, Lactoferrin, Statherin, Ig alpha-2, ALB protein, Myeloperoxidase and SMR3B. Many proteins were found exclusively in the AEP collected from one of the regions (46-UAPa, 33-LALi, 59-ULAFa, 31-ULPFa, 44-LPLi and 39-UPPa).

CONCLUSIONS

The protein composition of the AEP varied according to its location in the dental arches. These results provide important insights for understanding the differential protective roles of the AEP as a function of its location in the dental arches.

Tooth wear: a cross-sectional investigation of the prevalence and risk factors in Beijing, China

Objectives:

The aim of this study was to evaluate the epidemiology of tooth wear in Beijing and to establish appropriate preventive measures.

Materials and Methods:

This cross-sectional analysis involved a questionnaire survey conducted for 1,812 individuals aged 12–74 years in Beijing. Subjects were local residents living in the region for >6 months before the survey. Subjects were evaluated using clinical examinations with the basic erosive wear examination index and a self-administered questionnaire. Statistical analyses were performed using SPSS software.

Results:

The prevalence of maxillary tooth wear was 84.9% for the molars, 68.9% for the premolars, 74.1% for the canines and 97% for the incisors. In the mandible, the corresponding prevalence rates were 85.2%, 59.3%, 78.6% and 97.4%, respectively. The occlusal, incisal and cervical surfaces showed more frequent wear compared with the other surfaces. Age, acidic beverages, xerostomia and brushing habits were identified as risk factors for tooth wear (P<0.05).

Conclusions:

Tooth wear is common in Beijing. Specific preventive measures should be recommended for individuals reporting excessive consumption of fruits and/or acidic beverages, and those with xerostomia. In particular, incisor wear should be carefully monitored in individuals of all age groups.

A 4 year prospective longitudinal study of progression of dental erosion associated to lifestyle in 13-14 year-old Swedish adolescents

OBJECTIVES

To evaluate the progression of dental erosion in 13-14 year-olds after 4 years, and its association with lifestyle and oral health.

METHODS

227 randomly selected 13-14 year-olds from a Public Dental Clinic, Örebro, Sweden, were investigated. A clinical examination was performed which included dental caries/gingival/plaque status, as well as grading of dental erosion at the tooth surface and participant levels in "marker teeth", including buccal/palatal surfaces of 6 maxillary anterior teeth (13-23), and occlusal surfaces of first molars. An interview and a questionnaire regarding drinking habits and other lifestyle factors were completed. All investigations were repeated at follow-up. The participants were divided into high and low progression erosion groups and logistic regression statistics were applied.

RESULTS

175 individuals participated at follow-up. Progression occurred in 35% of the 2566 tooth surfaces. 32% of the surfaces had deteriorated by one severity grade (n=51 individuals) and 3% by two grades (n=2 individuals). Boys showed more severe erosion than girls at the follow-up. Among the variables predicting greater progression, a lower severity of erosive wear at baseline had the highest OR (13.3), followed in descending order by a "retaining" drinking technique, more frequent intake of drinks between meals, low GBI and lesser sour milk intake, with reference to the baseline recording. Using these five variables, sensitivity and specificity were 87% and 67% respectively, for predicting progression of erosion.

CONCLUSIONS

Progression of erosive lesions in Swedish adolescents aged 13-14 years followed up to age 17-18 years was common and related to certain lifestyle factors.

CLINICAL SIGNIFICANCE

In permanent teeth, dental erosion may develop early in life and its progression is common. Dental health workers should be made aware of this fact and regular screenings for erosion and recording of associated lifestyle factors should be performed.

A study of the periodontal state of a late Medieval United Kingdom population

OBJECTIVE

To study the severity of bone loss in a Medieval UK population, and compare this with other ancient UK populations from different time periods.

DESIGN

Skulls from a burial site in York (XI-XV century) were investigated. Skulls with a minimum of 17 teeth were included and were divided from childhood into five age groups. Direct measurements from the cement enamel junction (CEJ) to the alveolar crest (AC) were undertaken at six points around each tooth with a UNC 15 probe. The mean bone loss was calculated for each tooth type.

RESULTS

Seventy five skulls were included in the study (12-60 years of age). Bone loss was found to increase with age, but stabilized in older individuals (>45 years). The mean CEJ-AC distance varied from 2.1mm in the youngest group to a maximum of 4.1mm in 36-45 year olds. Results were compared with a Roman-British population (Whittaker et al., 1982) where comparable values for mean bone loss were 2.2mm and 5.4mm respectively, and a population of XVIII century Londoners (Whittaker et al., 1998) where bone loss of 1.1mm and 4.0mm was reported for the youngest and oldest age groups respectively.

CONCLUSION

Measuring the CEJ-AC distance in dried skulls from ancient populations may be used as a proxy for the levels of periodontal disease irrespective of tooth wear. The findings from the current study suggest that the severity of periodontitis as determined by measurements of alveolar bone loss on dried skulls from this ancient population, seems to have declined in the United Kingdom from the III-V century to XVIII century. This may be due to changes in environmental factors including living conditions and diet, together with individual characteristics including systemic illness and genetic make up.

Erosive Tooth Wear among 12-Year-Old Schoolchildren: A Population-Based Cross-Sectional Study in Montevideo, Uruguay

The aim of this study was to assess the prevalence, extent, severity, intraoral distribution and risk indicators for erosive tooth wear (ETW) among 12-year-old schoolchildren from Montevideo, Uruguay. A population-based, cross-sectional survey was conducted using a representative sample of 1,136 12-year-old schoolchildren attending public and private schools. Parents answered questions on socioeconomic status and general health. Schoolchildren answered questions on dietary and oral hygiene habits. Two calibrated examiners recorded ETW on permanent teeth according to the Basic Erosive Wear Examination (BEWE) score system. Logistic regression models were performed to assess the association between the predictor variables and the prevalence of ETW (overall and severe ETW). Odds ratios (OR) and the respective 95% confidence intervals (CI) were estimated. The prevalence of ETW was 52.9%, being mild erosion (BEWE = 1) in the vast majority of cases (48.5%). Severe erosion (BEWE ≥2) was detected in 4.4% of schoolchildren. The overall prevalence of ETW differed significantly between categories of gender and socioeconomic status, but only between gender in the severe ETW analysis. The overall extent of ETW was significantly different between categories of gender, socioeconomic status, and swish before swallow. The extent of severe ETW differed between categories of swish before swallow and brushing frequency. In the logistic regression analysis, no association was found between the studied variables and the overall prevalence of ETW. Males were more likely to have severe ETW than females (OR = 3.22, 95% CI = 1.50-6.89). ETW may be considered a public health problem among 12-year-old-Uruguayan schoolchildren.

Tooth wear and the role of salivary measures in general practice patients

OBJECTIVES

The goal of this study was to investigate the association between tooth wear and salivary measures in a random sample of patients from practices of dentist members of a practice-based research network.

MATERIALS AND METHODS

Patients completed a questionnaire on oral self-care, health, dietary habits, medications, and socio-demographic variables. Six salivary characteristics (consistency, resting salivary flow, resting salivary pH, stimulated salivary flow, stimulated salivary pH, and buffering capacity) were measured, and a dental examination included categorizing patients according to the dentist's judgment of the degree of tooth wear (i.e., none/minimal, some, or severe/extreme). Bivariate and multinomial logistic regression models were used to relate salivary characteristics and other factors to the outcome of tooth wear.

RESULTS

Data are reported from 1,323 patients (age range 16-97 years) from 61 practices. Patient age, gender, number of teeth, and perception of dry mouth were associated with tooth wear, but salivary and dietary factors were either weakly or not related.

CONCLUSIONS

The findings of this cross-sectional assessment suggest that using these salivary tests and dietary assessments in real-life clinical settings is unlikely to be useful in assessing tooth wear risk. Suggestions are offered about risk assessment for tooth wear.

CLINICAL RELEVANCE

Assessing a dental patient's risk of tooth wear using salivary measures and dietary assessments as described is not recommended for general dental practice until stronger evidence exists indicating its utility.

Comparison of the possible protective effect of the salivary pellicle of individuals with and without erosion

The acquired pellicle adheres to tooth surfaces and has been suggested to provide differing degrees of protection against acidic erosion. This study investigated whether pellicle formed on enamel blocks in patients suffering dietary dental erosion modified the effect of an in vitro simulated dietary challenge, in comparison with pellicle formed on enamel blocks in healthy subjects and to no-pellicle enamel samples. Sixty subjects recruited from dental erosion clinics were compared to healthy age-matched controls. Subjects wore a custom-made maxillary splint holding human enamel blocks for 1 h during which the acquired enamel pellicle was formed. Enamel blocks were removed from the splints and a simulated dietary erosive challenge of 10 min was performed. In addition the challenge was performed on 30 enamel samples without pellicle. Profilometry showed no statistical difference between samples from the erosion subjects with a mean step height of 1.74 µm (SD 0.88) and median roughness (Sa) of 0.39 µm (interquartile range, IQR 0.3-0.56) and the controls with 1.34 µm (SD 0.66) and 0.33 µm (IQR 0.27-0.38), respectively. The control samples without pellicle had Sa of 0.44 µm (IQR 0.36-0.69) and these differences were statistically significant compared to those from the healthy subjects (p = 0.002). Mean (SD) microhardness reduction with a 100-gram load for the erosion group was 113.5 (10) KHN, for healthy subjects was 93 (15.4) KHN and for the enamel samples without pellicle 139.6 (21.8) KHN and all groups were statistically different. The microhardness and roughness data suggested the pellicle influenced erosion under these study conditions.

Carbohydrate supplementation and prolonged intermittent high-intensity exercise in adolescents: research findings, ethical issues and suggestions for the future

In the last decade, research has begun to investigate the efficacy of carbohydrate supplementation for improving aspects of physical capacity and skill performance during sport-specific exercise in adolescent team games players. This research remains in its infancy, and further study would be beneficial considering the large youth population actively involved in team games. Literature on the influence of carbohydrate supplementation on skill performance is scarce, limited to shooting accuracy in adolescent basketball players and conflicting in its findings. Between-study differences in the exercise protocol, volume of fluid and carbohydrate consumed, use of prior fatiguing exercise and timing of skill tests may contribute to the different findings. Conversely, initial data supports carbohydrate supplementation in solution and gel form for improving intermittent endurance running capacity following soccer-specific shuttle running. These studies produced reliable data, but were subject to limitations including lack of quantification of the metabolic response of participants, limited generalization of data due to narrow participant age and maturation ranges, use of males and females within the same sample and non-standardized pre-exercise nutritional status between participants. There is a lack of consensus regarding the influence of frequently consuming carbohydrate-containing products on tooth enamel erosion and the development of obesity or being overweight in adolescent athletes and non-athletes. These discrepancies mean that the initiation or exacerbation of health issues due to frequent consumption of carbohydrate-containing products by adolescents cannot be conclusively refuted. Coupled with the knowledge that consuming a natural, high-carbohydrate diet -3-8 hours before exercise can significantly alter substrate use and improve exercise performance in adults, a moral and ethical concern is raised regarding the direction of future research in order to further knowledge while safeguarding the health and well-being of young participants. It could be deemed unethical to continue study into carbohydrate supplementation while ignoring the potential health concerns and the possibility of generating similar performance enhancements using natural dietary interventions. Therefore, future work should investigate the influence of pre-exercise dietary intake on the prolonged intermittent, high-intensity exercise performance of adolescents. This would enable quantification of whether pre-exercise nutrition can modulate exercise performance and, if so, the optimum dietary composition to achieve this. Research could then combine this knowledge with ingestion of carbohydrate-containing products during exercise to facilitate ethical and healthy nutritional guidelines for enhancing the exercise performance of adolescents. This article addresses the available evidence regarding carbohydrate supplementation and prolonged intermittent, high-intensity exercise in adolescent team games players. It discusses the potential health concerns associated with the frequent use of carbohydrate-containing products by adolescents and how this affects the research ethics of the field, and considers directions for future work.

Dietary factors associated with dental erosion: a meta-analysis

Background

Some diet factors are risk factors for dental erosion.

Methods

We performed computer searches of PubMed, Cochrane Library, EBSCO, CALIS, et al., to search for studies investigating risk factors for dental erosion. For risk factors investigated in a comparative way, we computed pooled odds ratios (ORs) using the Mantel and Haenszel method.

Results

A total of 9 studies met the inclusion criteria, and 6 risk factors were considered, including soft drinks, sports drinks, juice, vitamin C, milk, and yoghourt. The following associations were found for soft drinks (OR = 2.41, 95%CI = 2.03–2.85) and vitamin C (OR = 1.16, 95%CI = 1.10–1.22). While juice (OR = 0.90, 95%CI = 0.25–3.24), sports drinks (OR = 1.58, 95%CI = 0.88–2.85), milk (OR = 0.67, 95%CI = 0.11–4.01), and yoghourt products (OR = 1.05, 95%CI = 0.28–3.96) were not associated with dental erosion.

Conclusions

This meta-analysis provides comprehensive evidence-based assessment of diet-related factors for dental erosion. Preventive strategies should be taken to reduce dental erosion.

Tooth surface loss and associated risk factors in northern saudi arabia

Aim. To evaluate tooth surface loss (TSL) severity and associated risk factors in a representative sample of Saudi adults. Materials and Methods. Four hundred TSL patients (200 females and 200 males) participated in this study. Each patient completed a comprehensive questionnaire interview (using a modified Tooth wear Assessment Questionnaire) and then examined for the severity of TSL (using ordinal scale). Results. Seventy-five percent of participants demonstrated attrition, 90% had erosion, 15% had abrasion, and 95% had more than one type of TSL. The most common risk factors were consumption of acidic food/drinks (78%), parafunctional habits (70%), and unilateral chewing (50%). 77% of participants demonstrated grade 2 TSL. Males demonstrated greater TSL severity (P ≤ 0.05). Age, systemic disease, number of remaining teeth, acidic food/drinks, bruxism/parafunction, biting objects, facial pain/tenderness, sour taste, exposure to dust, unilateral chewing, using dental abrasives, and brushing frequency/technique had significant relationship with TSL severity (P ≤ 0.05). Conclusions. TSL has a multifactorial aetiology. Parafunction, gastrointestinal problems, and diet were the most common aetiological factors reflecting changes to stressful modern life-styles, eating/drinking habits, and behaviours. Gender didn't influence the aetiology of TSL; however males demonstrated more TSL severity. Patients' age had significant correlation to TSL severity.

Dental erosion in the 21st century: what is happening to nutritional habits and lifestyle in our society?

Several developments in Western Europe may have contributed to the increased prevalence of dental erosion during the last decades. Exposing children to sour taste at an early age increases the preference for acidic food and drinks later in life. Acidic fruits and beverages became widely available due to economic prosperity. New types of acidic candies were developed, some of which are kept in the mouth for very long times. Children are exposed to intense marketing of these acidic products, which are widely available in supermarkets and school canteens. In the meantime, much less attention has been paid to the development and marketing of less erosive food products.

Long-term protective effect of surface sealants against erosive wear by intrinsic and extrinsic acids

OBJECTIVE

To test sealants to prevent erosive tooth wear caused by extrinsic and intrinsic acids under long-term exposition.

METHODS

144 bovine enamel samples were randomly allocated to twelve groups (1-12). Samples of groups 1, 5 and 9 remained unsealed (positive controls), 2, 6 and 10 were sealed with Silicon Seal Nano Mix and 3, 7 and 11 with Seal&Protect. Groups 4, 8 and 12 were sealed with flowable composite (negative controls). Groups 1-4 were immersed in artificial saliva, 5-8 in hydrochloric acid and groups 9-12 in citric acid for 28 days, respectively. After 1, 2, 4, 7, 11, 14, 21 and 28 days, solutions were renewed and enamel wear was quantified by assignation of (32)P in the solutions.

RESULTS

In all immersion solutions, lowest mineral loss was observed for the negative controls whilst highest loss was observed for unsealed positive controls. In artificial saliva and citric acid, the loss from samples sealed with Seal&Protect was not significantly different compared with negative controls whilst loss in groups sealed with Silicon Seal Nano Mix was significantly higher. In hydrochloric acid, loss from samples sealed with Seal&Protect was not different compared with that of negative controls up to 4 days. Except day 1, the mineral loss in the Seal&Protect group was significantly lower compared with that of the Silicon Seal Nano Mix group.

CONCLUSION

The tested resin based surface sealant is able to significantly reduce the erosive demineralisation of enamel caused by hydrochloric and citric acid even under long-term exposition.

Alliance of oral hygiene practices and abrasion among urban and rural residents of Central India

OBJECTIVES

To attain alliance between the oral hygiene practices with prevalence of tooth abrasion among urban and rural adult population of Central India. To plan dental care services in inaccessible areas and to suggest appropriate remedial measures to prevent this avertable and self-inflicted injury of teeth in this cross-sectional study.

MATERIALS AND METHODS

A sum of 1045 adult residents both from Urban (529) and rural (516) parts of Bhopal district (Central India) was selected on a random basis. The multistage sampling technique was adopted to ascertain the sample size. In urban area the study population consisted of 240 males, 289 females and 201 males and 315 females in rural area respectively. All residents above 18 years of age from the Bhopal district were included in cross-sectional study. Assessment form comprises of questionnaire and general information on oral hygiene practices, dietary habits and medical history. Abrasion was assessed using diagnostic criteria recommended by Smith and Knight (modified). Chi- square test was used to test associations between categorical variables at 5% level of significance. Regression analysis attempted to define for risk factors causing abrasion. Literature on the prevalence of abrasion is very sparse, so attempt is made to correlate the etiological factors and recommend to prevent tooth wear.

RESULTS

Investigation of this cross-sectional study was aggregate of 1045 residences. Result shows high prevalence of abrasion 70.2%. Higher prevalence concomitant with diffident habits related to oral hygiene maintenance was recorded more among rural (76.9%) when compared to urban dwellers (63.7%). Presence of abrasion verifies statistical significance in relation to age, rural urban difference and variations in habit of oral hygiene care. Stated in the present study, avertable and self-inflicted is tooth abrasion, recurrently resulted by the reprehensible brushing method and common use of indigenous material for the maintenance of oral hygiene.

CONCLUSION

Shows significant liaisons with the presence of abrasions in relation to Urban and rural dwelling, age, material used and mode of brushing and duration of brushing. Indigenous and course material causes high amount of enamel wear and with the advancement in age abrasion tend to increase. Prevalence of abrasion does not show any gender predilection. Cultural believes, lifestyle and transition reflects in deviating presence of abrasion in populations.

Patterns in consumption of potentially erosive beverages among adolescent school children in the Netherlands

AIM

To determine the frequency of intake and patterns in consumption of potentially erosive beverages in school children in the Netherlands.

METHODS

A cross-sectional, single centre study was performed among 502 school children in Rotterdam, in age varying between 12 and 19 years. Data on consumption of soft drinks, energy drinks, sports drinks and alcopops were obtained through a self-reported questionnaire. Gender- and age-related differences in consumption were analysed with Chi-square, Kruskal-Wallis and Mann-Whitney tests. Associations between variables were investigated with Chi-square tests and Spearman's rank order correlation analysis.

RESULTS

Boys consumed soft drinks, energy drinks and sports drinks more frequently than girls, and on average also consumed higher amounts of these drinks. No gender-related differences were observed in alcopop consumption. Consumption of all drinks was most frequent at 14- or 15-year of age, with the exception of alcopops which was most frequent by 16-year-old school children. Significant positive associations were observed between the consumption of soft drinks, energy drinks and/or sports drinks. Alcopop consumption was only associated with consumption of energy drinks.

CONCLUSION

Consumption of soft drinks, energy drinks, sports drinks and alcopops by school children is related to age and gender. The significant positive associations between the consumption of these drinks suggest that a subgroup of school children exists with a high cumulative intake of these potentially erosive drinks.

Prevalence and associated factors of dental erosion in children and adolescents of a private dental practice

BaCKGROUND. The prevalence of dental erosion seems to be rising in young populations, particularly among individuals of higher socioeconomic status. AIM. To assess the prevalence and associated factors of dental erosion in children and adolescents of a private dental practice. DESIGN. A total of 232 participants, aged 2-20 years, were examined. Dietary habits, oral hygiene, and medical data were collected from dental records. Logistic regression analyses were conducted. RESULTS. Dental erosion prevalence was of 25.43% and was highest on the occlusal surfaces (76%). Associated factors were: frequent consumption of soft drinks (OR = 2.33; 95% CI = 1.01-5.38) and candies (OR = 3.23; 95% CI = 1.25-8.32); and interaction between these two factors (OR = 3.95; 95% CI = 1.60-9.75). On anterior teeth, associated factors were: frequent consumption of fruits (OR = 2.53; 95% CI = 1.09-5.91); and age (OR = 1.07 95% CI = 1.01-1.14). Milk consumption was associated with a lower prevalence of dental erosion (OR = 0.40; 95% CI = 0.17-0.94). CONCLUSIONS.  A relatively high prevalence of erosion was found in association with frequent intake of soft drinks, candies, and fruits. The consumption of milk seemed to protect against dental erosion on anterior teeth.

Tooth wear and wear investigations in dentistry

Tooth wear has been recognised as a major problem in dentistry. Epidemiological studies have reported an increasing prevalence of tooth wear and general dental practitioners see a greater number of patients seeking treatment with worn dentition. Although the dental literature contains numerous publications related to management and rehabilitation of tooth wear of varying aetiologies, our understanding of the aetiology and pathogenesis of tooth wear is still limited. The wear behaviour of dental biomaterials has also been extensively researched to improve our understanding of the underlying mechanisms and for the development of restorative materials with good wear resistance. The complex nature of tooth wear indicates challenges for conducting in vitro and in vivo wear investigations and a clear correlation between in vitro and in vivo data has not been established. The objective was to critically review the peer reviewed English-language literature pertaining to prevalence and aetiology of tooth wear and wear investigations in dentistry identified through a Medline search engine combined with hand-searching of the relevant literature, covering the period between 1960 and 2011.

Dental erosion: understanding this pervasive condition

Dental erosion is a contemporary disease, mostly because of the change of the eating patterns that currently exist in society. It is a "silent" and multifactorial disease, and is highly influenced by habits and lifestyles. The prevalence of dental erosion has considerably increased, with this condition currently standing as a great challenge for the clinician, regarding the diagnosis, identification of the etiological factors, prevention, and execution of an adequate treatment. This article presents a dental erosion review and a case report of a restorative treatment of dental erosion lesions using a combination of bonded ceramic overlays to reestablish vertical dimension and composite resin to restore the worn palatal and incisal surfaces of the anterior upper teeth. Adequate function and esthetics can be achieved with this approach.

Factors associated with the incidence of erosive wear in upper incisors and lower first molars: a multifactorial approach

OBJECTIVES

The aim was to investigate associations between factors and the incidence of erosive wear in lower first molars and upper incisors, and to investigate whether these associations differ between these locations.

METHODS

The study sample of this 3-year longitudinal study consisted of 572 children (mean age 11.9 years, SD=0.9). The permanent dentition was examined for erosive wear according to a modified Lussi-index (1996). Information on biological and behavioural factors was gathered by clinical examinations (at baseline, after 1.5 and 3 years) and by questionnaires (every six months).

RESULTS

The incidence of erosive wear in upper incisors over 3 years was 22.2%, for lower first molars the incidence was 14.8%. Multivariate logistic regression analysis showed that carbonated soft drink (OR=1.04) and tooth grinding (OR=2.93) were positively associated with the incidence of erosive wear in upper incisors and milk (OR=0.95) and yoghurt products (OR=0.88) were negatively associated. The incidence of erosive tooth wear in lower first molars was positively associated with alcoholic mixed drink (OR=1.45) and tooth grinding (OR=4.00) and was negatively associated with milk (OR=0.96) and yoghurt products (OR=0.84). The incidence of erosive wear in lower first molar was lower in girls than in boys (OR=0.51). t-Tests on the odds ratios of the factors showed that between the two incidence models only the odds ratios of anterior contact significantly differed.

CONCLUSIONS

In the present study, except for anterior contact, no substantial differences in risk factors between the incidence of erosive wear in lower first molars and upper incisors were found. This indicates that the aetiology of erosive wear for the two locations is similar.

Sports drinks and energy drinks for children and adolescents: are they appropriate?

Sports and energy drinks are being marketed to children and adolescents for a wide variety of inappropriate uses. Sports drinks and energy drinks are significantly different products, and the terms should not be used interchangeably. The primary objectives of this clinical report are to define the ingredients of sports and energy drinks, categorize the similarities and differences between the products, and discuss misuses and abuses. Secondary objectives are to encourage screening during annual physical examinations for sports and energy drink use, to understand the reasons why youth consumption is widespread, and to improve education aimed at decreasing or eliminating the inappropriate use of these beverages by children and adolescents. Rigorous review and analysis of the literature reveal that caffeine and other stimulant substances contained in energy drinks have no place in the diet of children and adolescents. Furthermore, frequent or excessive intake of caloric sports drinks can substantially increase the risk for overweight or obesity in children and adolescents. Discussion regarding the appropriate use of sports drinks in the youth athlete who participates regularly in endurance or high-intensity sports and vigorous physical activity is beyond the scope of this report.

Effect of casein phosphopeptide-amorphous calcium phosphate added to acidic beverages on enamel erosion in vitro

BACKGROUND

To investigate, in vitro, the effect on enamel erosion of the addition of 0.2% w/v casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) to four commercially-available soft drinks, two of which were carbonated.

METHODS

Enamel specimens (n=27) were sectioned from sound extracted human third molar teeth and polished to a mirror finish. Exposed enamel windows of 1 mm2 were created by painting the surface with acid-resistant nail varnish. Four citric flavoured soft drinks (pH range 2.2 to 2.4) and distilled deionized water (DDW) were tested. Each drink was tested with and without 0.2% CPP-ACP w/v. The specimens were placed into 50 mL of solution at 37 °C for 30 minutes, rinsed and varnish removed. The samples were profiled with a white light profilometer and erosive depths recorded.

RESULTS

All soft drinks tested caused enamel erosion but adding 0.2% w/v CPP-ACP significantly reduced (p<.05) erosive depth in all test solutions in comparison with the solutions without CPP-ACP. The erosive depths for all solutions with 0.2% CPP-ACP did not differ significantly from those of DDW.

CONCLUSIONS

Adding CPP-ACP at 0.2% w/v significantly decreased the erosivity of all four soft drinks. The erosivity of the soft drinks with 0.2% CPP-ACP added did not differ significantly from that of distilled water.

Risk factors for dental erosion in a group of 12- and 16-year-old Brazilian schoolchildren

BACKGROUND

Dental erosion is a multifactorial disease and is associated with dietary habits in infancy and adolescence.

AIM

To investigate possible associations among dental erosion and diet, medical history and lifestyle habits in Brazilian schoolchildren.

DESIGN

The sample consisted of a random single centre cluster of 414 adolescents (12- and 16-years old) of both genders from private and public schools in Bauru (Brazil). The O'Brien [Children's Dental Health in the United Kingdom, 1993 (1994) HMSO, London] index was used for dental erosion assessment. Data on medical history, rate and frequency of food and drinks consumption, and lifestyle habits were collected by a self-reported questionnaire. Odds ratios with 95% confidence intervals were used to assess the univariate relationships between variables. Analysis of questionnaire items was performed by multiple logistic regression analysis. The statistical significance level was set at 5%.

RESULTS

The erosion present group comprised 83 subjects and the erosion absent group 331. There were no statistically significant correlations among dental erosion and the consumption of food and drinks, medical history, or lifestyle habits.

CONCLUSION

The results indicate that there was no correlation between dental erosion and the risk factors analysed among adolescents in Bauru/Brazil and further investigations are necessary to clarify the multifactorial etiology of this condition.

Patients' knowledge of risk factors for dental disease. A pilot service evaluation in a general dental practice

The major dental diseases, including erosion, caries and periodontal disease, are preventable, and the Department of Health has produced guidelines in a 'Prevention Toolkit' to aid prevention of these diseases in primary care.

AIM

To investigate patients' knowledge of the key themes in the Prevention Toolkit and to compare their knowledge of the different dental diseases.

METHODS

Patients attending a general dental practice in North West England were asked to complete a questionnaire while they waited to see their dentist. The questionnaire had been piloted for readability, relevance of questions, and ease of use. It included nine true/false questions on key prevention messages. Data from the respondents were used to assess whether there were differences in knowledge by age or gender and between the types of dental diseases. Results were analysed using chi-square tests.

RESULTS

105 patients completed the questionnaire. Of the 420 questions relating to periodontal diseases, 322 (77%) were answered correctly and 196 (47%) of the 420 questions on caries were answered correctly; however, only 32 (31%) of the 105 questions relating to erosion were answered correctly. There were significantly lower levels of knowledge of caries (P<0.01) compared with periodontal diseases. Worryingly, 47 (45%) of 105 respondents stated incorrectly that brushing teeth immediately after consuming a 'fizzy' drink would protect the teeth.

CONCLUSION

The results of this pilot service evaluation indicate that in the practice concerned, more needs to be done to promote disease prevention at the primary care level. The current questionnaire could form a valuable tool to audit and reinforce patients' knowledge, although it needs further development and validation. Longitudinal evaluation of the questionnaire, linking it with disease outcome measures, has the potential to indicate whether change in knowledge translates into behavioural change.

A controlled study of dental erosion in 2- to 4-year-old twins

BACKGROUND

Dental erosion (DE) in children is a significant oral health issue and has become a focus for research in clinical paediatric dentistry.

AIM

This study investigated DE in the primary dentition of 2- to 4-year-old twin and singleton children with regard to the genetic, medical and dietary factors associated with the condition.

DESIGN

The 128 subjects consisted of 88 twin children (31 monozygous, 50 dizygous, 7 unknown zygosity) and singletons (n = 40) aged 2-4 years. Medical, dental, and dietary histories were obtained. The children were examined for DE using a modified index.

RESULTS

The prevalence of DE by subject affected was 77% in monozygotic twins (MZ), 74% in dizygotic twins (DZ), and 75% in singleton controls (P > 0.1). Of the teeth scored, 12% had mild, 10% moderate, and 1% severe lesions, and DE was more severe in the older age group (P < 0.05). Concordance rates for erosion lesions in MZ and DZ co-twins were not statistically significant.

CONCLUSIONS

The prevalence of DE and the concordance of erosion lesions were similar between MZ and DZ twins and singleton children, suggesting that the contribution of genetic factors to DE is negligible.

A proposed system for screening tooth wear

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.

Dietary behavior and knowledge of dental erosion among Chinese adults

Objectives

To study the dietary behavior and knowledge about dental erosion and self-reported symptoms that can be related to dental erosion among Chinese adults in Hong Kong.

Methods

Chinese adults aged 25-45 years were randomly selected from a list of registered telephone numbers generated by computer. A telephone survey was administered to obtain information on demographic characteristics, dietary habits, dental visits, and knowledge of and presence of self-reported symptoms that can be related to dental erosion.

Results

A total of 520 participants were interviewed (response rate, 75%; sampling error, ± 4.4%) and their mean age was 37. Most respondents (79%) had ever had caries, and about two thirds (64%) attended dental check-ups at least once a year. Respondents had a mean of 5.4 meals per day and 36% had at least 6 meals per day. Fruit (89%) and lemon tea/water (41%) were the most commonly consumed acidic food and beverage. When asked if they ever noticed changes in their teeth, most respondents (92%) said they had experienced change that can be related to erosion. However, many (71%) had never heard about dental erosion and 53% mixed up dental erosion with dental caries.

Conclusion

Hong Kong Chinese adults have frequent intake of food and many have experienced symptoms that can be related to dental erosion. Their level of awareness of and knowledge about dental erosion is generally low, despite most of them have regular dental check-ups. Dental health education is essential to help the public understand dental erosion and its damaging effects.

Tooth-wear patterns in subjects with Class II Division 1 malocclusion and normal occlusion

INTRODUCTION

The aim of this study was to investigate the prevalence of tooth wear in adolescents with Class II malocclusion, compared with those with normal occlusion.

METHODS

The sample consisted of dental casts obtained from 310 subjects, divided into 3 groups: group 1, 110 subjects with normal occlusion (mean age, 13.51 years); group 2, 100 complete Class II Division 1 patients (mean age, 13.44 years); and group 3, 100 half-cusp Class II Division 1 patients (mean age, 13.17 years). Dental wear was assessed by using a modified version of the tooth-wear index. The 3 groups were compared by means of the Kruskal-Wallis and Dunn tests, considering the frequency and the severity of wear on each surface of each group of teeth. The level of statistical significance was set at 5%.

RESULTS

The normal occlusion group had statistically greater tooth wear on the palatal surfaces of the maxillary central incisors and the incisal surfaces of the maxillary canines than the corresponding surfaces in both Class II malocclusion groups. The complete and half-cusp Class II Division 1 malocclusion groups had statistically greater tooth wear on the occlusal surfaces of the maxillary second premolar and first molar, the occlusal surfaces of the mandibular premolars, and the buccal surfaces of the mandibular posterior teeth compared with the normal occlusion group. The half-cusp Class II Division 1 malocclusion group had significantly greater tooth wear on the incisal surfaces of the mandibular incisors compared with the complete Class II Division 1 malocclusion group.

CONCLUSIONS

Subjects with normal occlusion and complete or half-cusp Class II Division 1 malocclusions have different tooth-wear patterns. Tooth wear on the malocclusion subjects should not be considered pathologic but rather consequent to the different interocclusal tooth arrangement.

The effect of salivary factors on dental erosion in various age groups and tooth surfaces

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.

Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN)

OBJECTIVE

To develop a North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) international consensus on the diagnosis and management of gastroesophageal reflux and gastroesophageal reflux disease in the pediatric population.

METHODS

An international panel of 9 pediatric gastroenterologists and 2 epidemiologists were selected by both societies, which developed these guidelines based on the Delphi principle. Statements were based on systematic literature searches using the best-available evidence from PubMed, Cumulative Index to Nursing and Allied Health Literature, and bibliographies. The committee convened in face-to-face meetings 3 times. Consensus was achieved for all recommendations through nominal group technique, a structured, quantitative method. Articles were evaluated using the Oxford Centre for Evidence-based Medicine Levels of Evidence. Using the Oxford Grades of Recommendation, the quality of evidence of each of the recommendations made by the committee was determined and is summarized in appendices.

RESULTS

More than 600 articles were reviewed for this work. The document provides evidence-based guidelines for the diagnosis and management of gastroesophageal reflux and gastroesophageal reflux disease in the pediatric population.

CONCLUSIONS

This document is intended to be used in daily practice for the development of future clinical practice guidelines and as a basis for clinical trials.

Influence of fluoride concentration and ethanol pre-treatment on the reduction of the acid susceptibility of enamel

OBJECTIVE

To determine the association between KOH-soluble and structurally bound fluoride uptake and the erosion resistance of enamel, respectively. Additionally, the effect of enamel pre-treatment with ethanol before fluoridation was assessed.

METHODS

Sixty bovine incisors (4 specimens/tooth) were randomly allocated to six groups (A-F). Samples 1 and 2 remained untreated, serving as control at baseline. Pre-treatment of the samples was performed for 5 min with 99% ethanol (groups A, B and C) or physiologic saline (groups D, E and F). Samples 3 and 4 were treated either with 0.5% (groups A and D), 1.0% (groups B and E) or 1.5% (groups C and F) fluoride solution. In samples 1 and 3, uptake of KOH-soluble and structurally bound fluoride was determined. Samples 2 and 4 were used for the determination of acid susceptibility by immersion in 1 ml HCl for 30s. Calcium release into HCl was assessed by atomic absorption spectroscopy. Differences between the groups were calculated by unpaired t-tests (p<0.05).

RESULTS

Mode of pre-treatment showed no influence on fluoride acquisition. KOH-soluble and structurally fluoride uptake increased with increasing fluoride concentrations. Highest acid resistance was observed after treatment with 1% fluoride solution for both kinds of pre-treatment followed by 1.5% and 0.5% fluoride solution.

CONCLUSION

Dose-dependency was observed for enamel fluoride acquisition but not for acid resistance.