The effect of pH on the erosion of dentine and enamel by dietary acids in vitro

Fluoride varnishes supplemented with nano-sized sodium trimetaphosphate reduce enamel erosive wear in vitro

OBJECTIVE

To evaluate the effect of fluoride (F) varnishes with sodium trimetaphosphate (TMP) on erosive tooth wear (ETW) in vitro.

METHODS

Enamel blocks (n = 100) were divided into 5 experimental groups (n = 20/group): Placebo (Pla - without F/TMP); 5 % NaF (NaF); 5 % NaF + 5 % micrometric TMP (NaF+5 %MICRO); 5 % NaF + 2.5 % nano-sized TMP (NaF+2.5 %NANO), and 5 % NaF + 5 % nano-sized TMP (NaF+5 %NANO). Blocks received a single varnish application (6 h contact), and were submitted to 4 daily erosive challenges (ERO, 0.05 M citric acid, pH 3.2, 90 s, under agitation), for 5 days. After ERO, half of the blocks (n = 10/group) were subjected to brushing abrasion (ERO+ABR). Profilometry, surface hardness (SH), and cross-sectional hardness (ΔKHN) were determined. The data were submitted to 2-way ANOVA and Fisher's LSD test (p < 0.05).

RESULTS

Enamel wear was significantly lower for ERO compared with ERO+ABR for all varnishes tested (p < 0.001), following the pattern NaF+5 %NANO < NaF+5 %MICRO < NaF < NaF+2.5 %NANO < Pla (both for ERO and ERO+ABR). The highest SH loss was observed for Pla and the lowest for NaF (ERO) and NaF+2.5 %NANO (ERO+ABR), without significant differences among NaF+2.5 %NANO, NaF, and NaF+5 %MICRO. The highest ΔKHN values were observed for NaF+5 %MICRO and NaF+5 %NANO at 5-30 µm, with less marked differences among the groups at 30-70 µm (ERO and ERO+ABR).

CONCLUSIONS

The addition of TMP to F varnishes significantly improves protection against ETW in vitro. The use of 5 % nano-sized TMP further enhances such effects.

CLINICAL SIGNIFICANCE

F varnishes containing TMP can reduce enamel loss caused by ERO or ERO+ABR.

A Comparative Evaluation of the Effect of Different Beverages on Colour Stability and Surface Micromorphology of Nanocomposite Restorative Material

AIM

This investigation was carried out to evaluate the color stability of a nanocomposite restorative material and the erosive potential of carbonated soft drinks (Coca-Cola; The Coca-Cola Company, Atlanta, Georgia, United States) and packaged orange juice (Real Fruit Power Orange; Dabur Ltd, Ghaziabad, Uttar Pradesh, India) on its surface micromorphology.

MATERIALS AND METHODS

Sixty discs (2mm thick and 10mm diameter) of nanocomposite material (Herculite Précis; KaVo Kerr, Brea, California, United States) were prepared using a silicon cylindrical mold. Initially, all the specimens were stored in artificial saliva in five Petri dishes; 12 specimens in each dish. In the Petri dishes, the specimens were immersed in the respective beverages once or twice a day. Before and after each immersion, the specimens were stored in artificial saliva at room temperature. Artificial saliva was changed each day, i.e., every 24 hours. The whole procedure was carried out for three months and then evaluated for color stability using a spectrophotometer and surface micromorphology using a scanning electron microscope. Now, the exposure of specimens to aerated drinks (Coca-Cola) and packaged orange juice (Real Orange) was put to a halt, and specimens were kept continuously in artificial saliva. This procedure was carried out for one month and then evaluated for color stability. The information was analyzed using PASW Statistics for Windows, Version 18.0 (Released 2009; SPSS Inc., Chicago, United States). A p-value of 0.05 was considered significant.

RESULTS

The p-value after three months, which is < 0.001 (p<0.05) indicates that the mean color difference values for groups I, II, III, IV, and V show a statistically significant change between the five groups, and similarly, the p-value after one month, which is < 0.001 (p<0.05) indicates that the mean color difference values for groups I, II, III, IV, and V show a statistically significant change between the five groups. Specimens immersed in the carbonated drink twice a day showed clinically more color change than packaged orange juice and artificial saliva on the composite restorative material. Coca-Cola, an aerated drink, was shown to have a higher erosive potential on the composite restorative material than Real Fruit Power Orange and fake saliva.

CONCLUSION

The findings are consistent with the hypothesis that repeated exposure to carbonated beverages (such as Coca-Cola and packaged juice) degrades the surface qualities of dental restorations.

Microenvironmental pH Modification in Buccal/Sublingual Dosage Forms for Systemic Drug Delivery

Many drug candidates are poorly water-soluble. Microenvironmental pH (pH_M) modification in buccal/sublingual dosage forms has attracted increasing interest as a promising pharmaceutical strategy to enhance the oral mucosal absorption of drugs with pH-dependent solubility. Optimizing drug absorption at the oral mucosa using pH_M modification is considered to be a compromise between drug solubility and drug lipophilicity (Log D)/permeation. To create a desired pH_M around formulations during the dissolution process, a suitable amount of pH modifiers should be added in the formulations, and the appropriate methods of pH_M measurement are required. Despite pH_M modification having been demonstrated to be effective in enhancing the oral mucosal absorption of drugs, some potential risks, such as oral mucosal irritation and teeth erosion caused by the pH modifiers, should not been neglected during the formulation design process. This review aims to provide a short introduction to the pH_M modification concept in buccal/sublingual dosage forms, the properties of saliva related to pH_M modification, as well as suitable drug candidates and pH modifiers for pH_M modifying buccal/sublingual formulations. Additionally, the methods of pH_M measurement, pH_M modification methods and the corresponding challenges are summarized in the present review.

The dynamic interplay of dietary acid pH and concentration during early-stage human enamel and dentine erosion

Dental erosion continues to be a significant global health concern affecting nearly 30% of adults world-wide. With increasing soft drink consumption predominantly driving its prevalence, strategies for prevention and control are often implemented when erosion is severe, or rates are high in the populace. While factors affecting dental erosion such as pH on enamel has received much attention, the effect of dietary acid concentration when factored out to a commercially available pH has yet to be determined. Furthermore, understanding these effects on dentine, which is known to be more susceptible to erosion than enamel can unravel structure property relationships between acid characteristics and hard tissue types. This study aimed to develop structure-property relationships between dietary acid concentration, and pH, on the nano-textural and nano-mechanical properties of human enamel and dentine during short-term simulated drinking. To achieve this, a novel sample preparation methodology and analysis approach was developed by applying atomic force microscopy (AFM) in quantitative imaging mode. This enabled simultaneous measurement of enamel and dentine morphology and mechanical properties. Flow-cells were used to simulate drinking, exposing polished and smear layer free human enamel and dentine to 30 s repeated cycles of unbuffered citric acid 6% (pH = 1.88) and 1% (w/v) (pH = 2.55) and commercially available buffered pH = 3.8 states, for up to 180 s. The same 50 µm × 50 µm area of specimen morphology was analysed using in-house developed nanotextural analysis using the bearing area curve (BAC) with a focus on roughness (Ra), normalised peak (PA) and valley areas (VA). Mechanical properties were simultaneously measured for stiffness (N/m) after each 30 s. While all studies agree pH is a major factor in the erosion of enamel, here its dominance over the treatment time varied, with concentration surpassing the importance of pH after initial acid contact. Conversely, dentine erosion showed concentration-dependent changes in morpho-mechanical properties only. These results not only highlight the dynamic process of erosion, but how the interplay between acid characteristics and dental tissue type impact the progression of very early-stage erosion.

Effect of pH and titratable acidity on enamel and dentine erosion

OBJECTIVES

The relative effect of pH and titratable acidity on tooth erosion remains unclear. We determined the effect of both properties on in vivo salivary pH recovery and on enamel and dentine early erosion in situ.

METHODS

Solutions simulating acidic beverages with different pHs (2.5 or 3.5) and titratable acidities (0, 25, or 100 mM citric acid) were tested. In an in vivo study (n = 20 participants), the salivary pH was determined before, during, and up to 2 min after exposure to the tested solutions. In situ, 12 participants exposed enamel and root dentine slabs to the tested solutions simulating a beverage consumption; early erosion was assessed by percentage of surface hardness loss (%SHL). Groups were compared by ANOVA (p < 0.05).

RESULTS

Saliva pH was lower after exposure to solutions at pH 2.5, irrespective of titratable acidity; pH recovery took longer for solutions with higher titratable acidities, irrespective of their pHs. In situ, the highest %SHL was observed for the solution with lower pH and higher titratable acidities. The addition of citric acid increased the %SHL by 2.5-3 times in enamel, and at least 5 times in dentine.

CONCLUSIONS

Both pH and titratable acidity may play a role on the erosive potential of acidic beverages.

CLINICAL RELEVANCE

Acidic beverages with lower pHs promote erosion by an initial acid etching of the surface; those with a higher titratable acidity slow down the salivary pH recovery. Both properties contribute to the overall erosive potential.

Exploration of in vitro drug release testing methods for saquinavir microenvironmental pH modifying buccal films

Buccal films containing a pH modifying excipient may be able to increase bioavailability of drugs with pH-dependent solubility such as saquinavir. Access to suitable in vitro drug release testing methods may facilitate buccal formulation development. This study aimed to explore two release testing methods for characterising buccal films and to elucidate the relationship between microenvironmental pH (pH_M, i.e. the pH around the swelling films) and saquinavir release. The Franz diffusion cell method was applicable to investigate the effect of hydroxypropyl methylcellulose (HPMC) grade on saquinavir release. Films containing HPMC K3 LV had a faster saquinavir release than films containing HPMC K100 LV. A UV/Vis imaging method was developed to visualise saquinavir release and pH_M changes during the initial dissolution. Within 5 min, the pH_M decreased from 6.8 to around 5.4 for HPMC K100 LV-based films containing 11.1 % or 16.6 % (w/w) malic acid. Subsequently, the pH_M increased due to increasing concentrations of saquinavir. An increase in malic acid content led to a faster saquinavir release. The combination of methods may be broadly applicable for excipient screening in development of buccal formulations. The imaging approach holds promise for characterizing other pH modifying formulation principles.

Diagnosis of Occlusal Tooth Wear Using 3D Imaging of Optical Coherence Tomography Ex Vivo

The aim of this study was to assess the utility of 3D imaging of optical coherence tomography (OCT) for the diagnosis of occlusal tooth wear ex vivo. Sixty-three extracted human molars with or without visible tooth wear were collected to take digital intraoral radiography and 3D OCT images. The degree of tooth wear was evaluated by 12 examiners and scored using 4-rank scale: 1-slight enamel wear; 2-distinct enamel wear; 3-tooth wear with slight dentin exposure; 4-tooth wear with distinct involvement of dentin. The degree of tooth wear was validated by the histological view of confocal laser scanning microscopy (CLSM). The sensitivity, specificity, and area under the curve (AUC) of receiver operating characteristic analysis were calculated. Diagnostic accuracy was compared with the agreement with CLSM observation using weighted kappa. The results were statistically analyzed at a significance level of α = 0.05. Three-dimensional OCT showed significantly higher sensitivity (p < 0.05) for all the diagnostic thresholds of enamel wear and dentin exposure than digital radiography (0.82, 0.85, and 0.79 vs. 0.56, 0.52, and 0.57, respectively). Three-dimensional OCT showed higher AUC and kappa coefficients than digital radiography (p < 0.05), where mean AUC and Kappa values were 0.95 and 0.76 for OCT and 0.92 and 0.47 for radiography, respectively. No significant difference of specificity was observed (p > 0.05). Three-dimensional OCT could visualize and estimate the degree of tooth wear and detect the dentin exposure at the tooth wear surface accurately and reproducibly. Consequently, a new guideline for tooth wear assessment can be proposed using OCT.

Quality Assessment of Three Types of Drinking Water Sources in Guinea-Bissau

The lack of access to safe drinking water causes important health problems, mainly in developing countries. In the West African country Guinea-Bissau, waterborne diseases are recognised by WHO as major infectious diseases. This study analysed the microbiological and physicochemical parameters of drinking water in the capital Bissau and its surroundings. Twenty-two sites belonging to different water sources (piped water, tubewells and shallow wells) were surveyed twice a day for three weeks, in both dry and wet seasons. Most of the microbiological parameters were out of the acceptable ranges in all types of water and both seasons and tended to worsen in the wet season. Moreover, in Bissau, the levels of faecal contamination in piped water increased from the holes to the consumer (tap/fountain). Several physicochemical variables showed values out of the internationally accepted ranges. Both well sources showed low-pH water (4.87–5.59), with high nitrite and iron levels in the wet season and high hexavalent chromium concentration in the dry season. The residual chlorine never reached the minimum recommended level in any of the water sources or seasons, suggesting a high risk of contamination. Results reveal a lack of quality in the three water sources analysed, coherent with the high number of diarrheal cases in the country. There is an urgent need to improve sanitarian conditions to reduce the disease burden caused by these waterborne illnesses.

Pathogenesis, diagnosis and management of dentin hypersensitivity: an evidence-based overview for dental practitioners

Though dentin hypersensitivity (DHS) is one of the most common complaints from patients in dental clinics, there are no universally accepted guidelines for differential diagnosis as well as selection of reliable treatment modalities for this condition. The neurosensory mechanisms underlying DHS remain unclear, but fluid movements within exposed dentinal tubules, i.e., the hydrodynamic theory, has been a widely accepted explanation for DHS pain. As several dental conditions have symptoms that mimic DHS at different stages of their progression, diagnosis and treatment of DHS are often confusing, especially for inexperienced dental practitioners. In this paper we provide an up-to-date review on risk factors that play a role in the development and chronicity of DHS and summarize the current principles and strategies for differential diagnosis and management of DHS in dental practices. We will outline the etiology, predisposing factors and the underlying putative mechanisms of DHS, and provide principles and indications for its diagnosis and management. Though desensitization remains to be the first choice for DHS for many dental practitioners and most of desensitizing agents reduce the symptoms of DHS by occluding patent dentinal tubules, the long-term outcome of such treatment is uncertain. With improved understanding of the underlying nociceptive mechanisms of DHS, it is expected that promising novel therapies will emerge and provide more effective relief for patients with DHS.

Nanocapsule pH Regulator: Sustained Continuous Alkali Release from Thermosensitive Liposomes Reduces Acid Erosion

Thermosensitive liposomes are major drug delivery carriers, which enable targeting of drugs and burst release of the drugs from the liposomes at the site of action by applying a local heat stimulation above body temperature. Although the burst release is significant for a one-shot high-rate release of drugs at the target site, this type of release has a limited sustained action of the drugs. In this study, we report the alkali-encapsulating thermosensitive liposomes enabling environment pH regulation by sustained continuous cargo release at human body temperature. The liposomes encapsulating alkalis successfully neutralized the environmental acids for hours by releasing the alkalis and prevented acid erosion of hydroxyapatite matrix. Taken together, the present liposomes are effective for the sustained release of cargo at body temperature, specifically the alkali-encapsulating liposomes can be a preventing agent for dental caries in the oral cavity. The sustained release under endogenous body heat characteristics of thermosensitive liposomes showcased in this study can also be extended for prolonged intravenous drug exposure from targeted liposomal drug nanotherapeutics in the near future.

Effect of Grit-blasting on the Color Stability of Zirconia Ceramics Following Exposure to Beverages

Aim

The aim of this study was to evaluate the effect of grit-blasting on the color stability of zirconia ceramics following exposure to beverages.

Method

A total of 80 planar zirconia specimens were prepared from dense sintered zirconium blocks and were randomly allocated into four groups (n=20). Ten specimens from each group were grit-blasted (GB) using aluminum trioxide powder from a distance of 10 mm. The remaining 10 specimens were used as such without grit-blasting (NGB). The grit-blasted and non-grit-blasted specimens were immersed in artificial saliva, Coffee, Red Bull, and Coca-Cola at room temperature over a 28-day test period. Color measurement (ΔE) of the zirconia specimens was performed at baseline (T0) and after seven (T1), 14 (T2), and 28 (T3) days of immersion in the beverages using the Color Eye 7000A Spectrophotometer (Gretag Macbeth, New Windsor, NY). The data were analyzed using analysis of variance (ANOVA) and the post-hoc Bonferroni test. A p-value of less than 0.05 was considered statistically significant.

Result

The GB specimens immersed in coffee showed the highest color changes as compared to other groups (4.47± 0.04) and the NGB specimens stored in saliva showed the lowest ΔE values (0.83± 0.03). Energy drinks and soft drinks showed similar ΔE values at the end of the 28-day study period in both the NGB and GB groups. All the specimens, irrespective of the beverages, in both groups showed increased ΔE values at different immersion periods except for NGB specimens immersed in saliva, which showed decreased ΔE values from T2 to T3.

Conclusion

GB specimens showed increased ΔEs compared to NGB Zirconia ceramics. Among the beverages, the coffee immersion of GB specimens showed marked color changes. The specimens immersed in the energy and acidic drinks from both groups showed perceivable color changes at the end of the 28-day study period.

Efficacy of remineralizing agents to occlude dentinal tubules in primary teeth subjected to dentin hypersensitivity in vitro: SEM study

Aim:

Comparison of casein phosphopeptides (CPPs) and amorphous calcium phosphate (ACP), tricalcium phosphate, and hydroxyapatite on assessment of dentine tubule occlusion on primary enamel using scanning electron microscope (SEM).

Materials and Methods:

A total of 20 freshly extracted noncarious primary molars were randomly divided into four groups (A to D) with five sections in each group; group A: negative control, group B: CPP-ACP, group C: tricalcium phosphate, and group D: Hydroxyapatite (HA). To assess tubule occlusion, 20 dentin sections of 2 mm thickness were obtained from cervical third of sound primary molars. Each section were processed to simulate the hypersensitive dentin and the test agents were brushed over the sections with an electric toothbrush and observed under SEM for calculation of the percentage of occluded tubules.

Results:

Group B and D showed greater percentage of tubule occlusion than group C. Intergroup comparison of tubule occlusion potential of Group B and D was not significant.

Conclusion:

HA showed significantly higher dentinal tubule occlusion when compared to CPP-ACP and tricalcium phosphate.

[Dental erosion in a sample of Valencian children. Prevalence and evaluation of eating habits]

Introduction

Introduction: dental erosion is the pathological, chronic, localized and painless loss of dental tissues, produced by the chemical action of acids, where the action of microorganisms is not involved. In recent years, a significant increase in the prevalence of this pathology has been observed, especially in children and adolescents. Objectives: to determine the prevalence of dental erosion in temporary dentition using the Basic Erosive Wear Examination Index (BEWE) in children between 5 and 12 years of age, and to determine the eating habits that may favor the development of these lesions. Methods: a cross-sectional study was carried out on a sample of 391 children. A survey was conducted where eating habits were analyzed and a clinical examination of the temporary teeth was performed using the BEWE index. Results: the prevalence of dental erosion in the studied sample was 19.7 %, with mild lesions being most common. Conclusions: in all, 30.62 % of the studied population had a low risk of dental erosion, and risk was seen to increase with consumption of acidic beverages (soft drinks, isotonic drinks and fruit juices) and acidic fruits such as oranges, grapes and apples.

Comparative Analysis of CPP&ndash;ACP, Tricalcium Phosphate, and Hydroxyapatite on Assessment of Dentinal Tubule Occlusion on Primary Enamel Using SEM: An In Vitro Study

Background

Over the last few decades, fluoride in various forms has been proved to reduce caries and dentinal hypersensitivity in both the primary and permanent dentitions. Recently, newer materials containing calcium and phosphate ions, tricalcium phosphate, and hydroxyapatite has received much attention.

Aim

The aim of the study was to compare CPP–ACP, tricalcium phosphate, and hydroxyapatite in relation to the assessment of dentine tubule occlusion on primary enamel using scanning electron microscope (SEM).

Materials and methods

Forty freshly extracted noncarious primary molars were randomly divided into 4 groups (I–IV) with 10 sections in each group—group I: negative control, group II: CPP–ACP, group III: tricalcium phosphate, group IV: hydroxyapatite. To assess tubule occlusion, twenty dentin sections of 2-mm thickness were obtained from the cervical third of sound primary molars. Each section was processed to simulate the hypersensitive dentin and the test agents were brushed over the sections with an electric toothbrush and observed under a SEM for calculation of the percentage of occluded tubules.

Results

Groups II and IV showed a greater percentage of tubule occlusion than group III. An intergroup comparison of tubule occlusion potential of groups II and IV was not significant.

Conclusion

Hydroxyapatite showed significantly higher dentinal tubule occlusion when compared to CPP–ACP and tricalcium phosphate.

How to cite this article

Shah R, Bajaj M. Comparative Analysis of CPP–ACP, Tricalcium Phosphate, and Hydroxyapatite on Assessment of Dentinal Tubule Occlusion on Primary Enamel Using SEM: An In Vitro Study. Int J Clin Pediatr Dent 2019;12(5):371–374.

In vitro assessment of erosive effects of some common soft drinks on dental hard tissues

Background/Aim: The chemical nature of soft drinks is acidic, so they possess the capacity to cause hard tissue erosion. The aim of this study is to assess the potentially erosive effect linked to pH and titratable acidity of some common soft drinks on dental hard tissues in prolonged time exposure. Material and Methods: Seven types of soft drinks in Romanian market were selected for this study. The pH and Titratable acidity were determined. Twenty one human dental hard tissue specimens were immersed in 5 ml solution each for 336h. Every 48h weight loss was determined for each specimen and after 336h volume changes were calculated. Enamel microhardness was determined using a Microhardness Tester model HV-1000 and compared to normal enamel microhardness. Results: The pH values of beverages ranged from 2.37 to 3.1, showing no significant differences. All specimens presented color and surface texture modifications, weight loss and volume reduction. There were found significant differences between the mean values of weight loss and enamel microhardness of each type of specimens and type of beverages tested. The most representative findings were achieved by indentations done in specific zones on Sprite® immersed specimen. This result suggest that microhardness near the eroded surface was significant lower than in other zones. Conclusions: Data obtained have shown that all the soft drinks tested had an erosive effect, causing dental hard tissue dissolution. For prolonged time exposure titratable acidity may be a major predictor for erosive potential. Dental erosion may affect different levels of enamel causing decreased enamel microhardness.

Prevalence and Extrinsic Risk Factors for Dental Erosion in Adolescents

OBJECTIVE

This manuscript examined the prevalence and extrinsic risk factors for dental erosion (DE) in early and middle adolescents in Pasto, Colombia.

STUDY DESIGN

Dental erosion was evaluated in a random sample of 384 individuals aged 10-15 years attending three primary and high schools in this cross-sectional study. Clinical dental assessment for DE was done using O'Sullivan index. Data on general sociodemographic variables and extrinsic risks factors were obtained. Descriptive and univariate binary logistic regression analyses were performed.

RESULTS

Dental erosion was observed in 57.3% of individuals. The univariate binary logistic regression analysis showed that frequency of drinking natural fruit juices (OR 2.670, 95% CI 1.346 - 5.295, P=0.004) and their pH (OR 2.303, 95% CI 1.292 - 4.107, P=0.004) were more associated with the odd of DE in early adolescence. However, a high SES (OR 10.360, 95% CI 3.700 - 29.010, P<0.001) and frequency of snacks with artificial lemon taste (OR 3.659, 95% CI 1.506 - 8.891, P=0.003) were highly associated with the risk of DE in middle adolescence.

CONCLUSIONS

The results suggest that DE is a prevalent condition in adolescents living in a city in southern Colombia. The transition from early to middle adolescence implies new bio-psychosocial changes, which increase the risk for DE.

Evaluation of Remineralization Potential of Beverages modified with Casein Phosphopeptide-Amorphous Calcium Phosphate on Primary and Permanent Enamel: A Laser Profiler Study

Purpose

To assess the erosive potential of carbonated beverages and the remineralization potential of beverages with added casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) paste on primary and permanent enamel.

Materials and methods

A total of 32 primary and 32 permanent enamel specimens were immersed for 5, 10, and 30 minutes, respectively, in beverages, i.e., Coke, Sprite, Mirinda, and Mountain Dew, with and without added 0.2% CPP-ACP. Samples were profiled before immersion and after immersion under laser profiler.

Results

Coke was found to be highly erosive at it caused significant enamel erosion at both 10 and 30 minutes of immersion (p < 0.05) for both primary and permanent enamel. The 30-minute immersion caused significant amount of reminerali-zation over primary enamel in all groups, whereas permanent enamel remineralization was significant in Sprite and Mountain Dew at 30 minutes in all the groups (p < 0.05).

Conclusion

This study demonstrated that enamel erosion occurred after immersion in carbonated beverages. Remineralization of enamel was observed after immersion in beverages modified with CPP-ACP paste. Primary enamel was susceptible to remineralization compared with permanent enamel. Within the limitations of this in vitro study, the application of CPP-ACP paste may enhance the remineralization after an erosive challenge and thus offer some protection for patients who are at risk for erosion.

How to cite this article: Rai N, Sandhu M, Sachdev V, Sharma R. Evaluation of Remineralization Potential of Beverages modified with Casein Phosphopeptide-Amorphous Calcium Phosphate on Primary and Permanent Enamel: A Laser Profiler Study. Int J Clin Pediatr Dent 2018;11(1):7-12.

Bond strength and interfacial morphology of orthodontic brackets bonded to eroded enamel treated with calcium silicate-sodium phosphate salts or resin infiltration

OBJECTIVE

 To investigate the shear bond strength (SBS) of orthodontic brackets bonded to eroded enamel treated with preventive approaches and to examine the enamel/bracket interfaces.

MATERIALS AND METHODS

 Ninety-one brackets were bonded to seven groups of enamel samples: sound; eroded; eroded+treated with calcium silicate-sodium phosphate salts (CSP); eroded+infiltrated by ICON^®; eroded+infiltrated by ICON^® and brackets bonded with 1-month delay; eroded+infiltrated by an experimental resin; and eroded+infiltrated by an experimental resin and brackets bonded with 1-month delay. For each group, 12 samples were tested in SBS and bond failure was assessed with the adhesive remnant index (ARI); one sample was examined using scanning electron microscopy (SEM).

RESULTS

 Samples treated with CSP or infiltration showed no significant differences in SBS values with sound samples. Infiltrated samples followed by a delayed bonding showed lower SBS values. All of the values remained acceptable. The ARI scores were significantly higher for sound enamel, eroded, and treated with CSP groups than for all infiltrated samples. SEM examinations corroborated the findings.

CONCLUSIONS

 Using CSP or resin infiltration before orthodontic bonding does not jeopardize the bonding quality. The orthodontic bonding should be performed shortly after the resin infiltration.

Demineralization-remineralization dynamics in teeth and bone

Biomineralization is a dynamic, complex, lifelong process by which living organisms control precipitations of inorganic nanocrystals within organic matrices to form unique hybrid biological tissues, for example, enamel, dentin, cementum, and bone. Understanding the process of mineral deposition is important for the development of treatments for mineralization-related diseases and also for the innovation and development of scaffolds. This review provides a thorough overview of the up-to-date information on the theories describing the possible mechanisms and the factors implicated as agonists and antagonists of mineralization. Then, the role of calcium and phosphate ions in the maintenance of teeth and bone health is described. Throughout the life, teeth and bone are at risk of demineralization, with particular emphasis on teeth, due to their anatomical arrangement and location. Teeth are exposed to food, drink, and the microbiota of the mouth; therefore, they have developed a high resistance to localized demineralization that is unmatched by bone. The mechanisms by which demineralization-remineralization process occurs in both teeth and bone and the new therapies/technologies that reverse demineralization or boost remineralization are also scrupulously discussed. Technologies discussed include composites with nano- and micron-sized inorganic minerals that can mimic mechanical properties of the tooth and bone in addition to promoting more natural repair of surrounding tissues. Turning these new technologies to products and practices would improve health care worldwide.

Comparison of the microhardness of primary and permanent teeth after immersion in two types of carbonated beverages

OBJECTIVES

The consumption of carbonated beverages is one of the etiological factors that cause dental erosion. The purpose of this research was to compare changes in the microhardness of permanent and primary teeth after immersion in two types of carbonated beverages.

MATERIALS AND METHODS

This investigation was done on 30 healthy permanent molars and 30 healthy primary canines. Each group of primary and permanent teeth was subdivided into three groups of 10 teeth. The teeth was immersed in 40 ml of each of the three beverages for 5 min. One subgroup was immersed in water (as a control). The next was immersed in Lemon Delster and the last subgroup was immersed in Coca-Cola. The microhardness of enamel was measured using the Vickers method before and after immersion. Finally, the data was analyzed by paired t-test, one-way analysis of variance, and t-test.

RESULTS

Microhardness reduction in the primary teeth was significant in both the Lemon Delster and Coca-Cola groups (P < 0.05). This reduction was also statistically significant in the permanent teeth (P < 0.05). A comparison of the enamel changes in the primary teeth with permanent teeth after immersion in both beverages showed a greater microhardness reduction in the primary teeth in both the experimental groups.

CONCLUSIONS

Coca-Cola and Lemon Delster caused a significant reduction of microhardness in tooth enamel. This reduction was greater in primary teeth than in permanent teeth, and was also greater after immersion in Coca-Cola than after immersion in Lemon Delster.

Dentine sensitivity risk factors: A case-control study

Objective:

To identify the clinical and psychological risk factors associated with dentine hypersensitivity (DH) in order to provide an early diagnosis and preventive therapy.

Materials and Methods:

A nested case–control study was design between 2011 and 2012. A total of 61 DH cases and 122 controls participated in this investigation. Cases and controls were matched for sex, group of age and socioeconomic status in a ratio of 1:2. DH to different stimuli such as cold, heat, acid, and sweet was asked in patient interviews, and dental examinations were used to detect DH. Clinical and psychological risk factors such as dental hygiene, periodontal disease, acid diet, alcohol consumption, psychological stress, and psychopathological symptoms were inquired. Psychological stress was measured through the PSS-10 and psychopathological symptoms were evaluated by SCL-90-R in Spanish. Descriptive and univariate binary logistic regression analysis were performed to estimate the association between clinical and psychological risk factors and the presence of DH.

Results:

Toothpaste abrasivity (odds ratio [OR] 1.881, 95% confidence interval [CI] 1.010–3.502, P = 0.045), gingival recession (OR 2.196, 95% CI 1.020–4.728, P = 0.041), and periodontal therapy (OR 5.357, 95% CI 2.051–13.993, P < 0.001) were associated with DH. Subjects with perceived stress (OR 1.211, 95%, CI 0.518–2.833, P = 0.658), obsessive-compulsive (OR 1.266, 95%, CI 0.494–3.240, P = 0.623) and hostility (OR 1.235, 95%, CI 0.507–3.007, P = 0.642) symptoms had a clinical greater odd of DH.

Conclusion:

Oral hygiene products and periodontal conditions are important risk factors for DH. Individuals with perceived stress, obsessive-compulsive, and hostility symptoms may increase a clinical risk for this entity. Targeting to dental counseling focused on oral hygiene products, periodontal therapy and a psychological evaluation may be promising in DH prevention.

Novel developments in mobile sensing based on the integration of microfluidic devices and smartphones

Portable electronic devices and wireless communication systems enable a broad range of applications such as environmental and food safety monitoring, personalized medicine and healthcare management. Particularly, hybrid smartphone and microfluidic devices provide an integrated solution for the new generation of mobile sensing applications. Such mobile sensing based on microfluidic devices (broadly defined) and smartphones (MS(2)) offers a mobile laboratory for performing a wide range of bio-chemical detection and analysis functions such as water and food quality analysis, routine health tests and disease diagnosis. MS(2) offers significant advantages over traditional platforms in terms of test speed and control, low cost, mobility, ease-of-operation and data management. These improvements put MS(2) in a promising position in the fields of interdisciplinary basic and applied research. In particular, MS(2) enables applications to remote in-field testing, homecare, and healthcare in low-resource areas. The marriage of smartphones and microfluidic devices offers a powerful on-chip operating platform to enable various bio-chemical tests, remote sensing, data analysis and management in a mobile fashion. The implications of such integration are beyond telecommunication and microfluidic-related research and technology development. In this review, we will first provide the general background of microfluidic-based sensing, smartphone-based sensing, and their integration. Then, we will focus on several key application areas of MS(2) by systematically reviewing the important literature in each area. We will conclude by discussing our perspectives on the opportunities, issues and future directions of this emerging novel field.

Protective effects of resin sealant and flowable composite coatings against erosive and abrasive wear of dental hard tissues

OBJECTIVES

To test the effectiveness of sealant and flowable composite coating on eroded enamel, dentin and cementum under erosive/abrasive challenges in vitro.

METHODS

A total of 108 tissue sections (36 each for enamel, dentin and cementum) from third molars were assigned to three groups: Seal & Protect sealant (S&P), Tetric EvoFlow composite (TEF) and control. Erosive/abrasive lesions were created on each specimen by citric acid and brushing with toothpaste. S&P and TEF were applied to the lesions and subjected to erosive/abrasive cycling included 24 cycles of immersion in citric acid (pH 3.6) for 60min, followed by remineralization for 120min and brushing with toothpastes for 600 strokes at 150g. Erosive wear of materials or dental tissues were measured with 3D scanning microscopy and data were analyzed using ANOVA.

RESULTS

Treatments with S&P and TEF created a protective material coating of 42.7±17.8μm and 150.8±9.9μm in thickness, respectively. After 24 cycles of erosive/abrasive challenges, tissue losses were -346.9±37.3μm for enamel, -166.5±26.3μm for dentin and -164.7±18.2μm for cementum in untreated controls, as compared to material losses of -24.4±3.3μm for S&P, and -10.8±4.4μm for TEF, respectively. Both S&P and TEF were effective in protecting enamel, dentin and cementum against erosive tooth wear (p<0.01). S&P exhibited faster wear than TEF (p<0.01) and showed spotted peeling in a third of the specimens. TEF remained intact on all three types of dental tissues at the end of the 24 cycles of erosive/abrasive challenges.

CONCLUSIONS

A thin coating of flowable composite resin 150μm in thickness may provide long-term protection against erosive/abrasive tooth wear. Resin sealant may provide adequate protection for dental hard tissues in short-term and may require repeated applications if long-term protection is desired.

Chelating effect of citric acid is negligible for development of enamel erosions

AIM

Citric acid (CA) is a component in beverages responsible for dental erosion. The aim of this study was to examine the influence of CA with different pH, titratable acid and buffer capacity (ß), and the impact of the chelating effect of CA on development of enamel erosions.

MATERIAL AND METHODS

In a superfusion model, hydroxy apatite (HAp) dissolution of bovine enamel was measured in four experiments (EXP 1-4) with 27 experimental groups (n = 8 per group). The samples were superfused with different CA variations and respective controls. EXP-1: Dilution series of HCl (pH 2.15-3.02). EXP-2: Dilution series of natural CA (56-1.75 mmol l(-1); pH 2.15-3.02). EXP-3: CA solutions (56 and 14 mmol l(-1), ß: 39.7 and 10.2 mmol l(-1) pH(-1), respectively) with different titratable acidity at equal pH values. EXP-4: CA concentrations (56-1.75 mmol l(-1)) neutralized to pH 7.

RESULTS

CA led to higher HAp-dissolution than HCl. With higher pH, the difference in HAp-dissolution rate between the two acids became increasingly smaller. At equal pH, HAp-dissolution was higher for the CA with the higher amount of titratable acid. However, no clear correlation between erosion and titratable acid or ß could be found. Only minimal amounts of HAp were dissolved by neutralized CA compared to CA with natural pH.

CONCLUSION

Under the chosen conditions chelating effects of CA do not have a relevant influence of HAp-dissolution of enamel. Moreover, amount of HAp-dissolution by CA is not attributed to a single factor alone. The interplay between the different parameters of CA seems to be responsible for its erosive potential.

CLINICAL RELEVANCE

The erosive potential of solutions containing citric acid with unknown concentrations could not be predicted using a single parameter alone, and should at best determined in experimental set-ups.

Effect of foods and drinks on primary tooth enamel after erosive challenge with hydrochloric acid

The aim of this study was to evaluate the effect of industrialised foods and drinks on primary tooth enamel previously eroded with hydrochloric acid (HCl). The crowns of one hundred two specimens were subjected to an erosive challenge with HCl and randomly divided into six groups (n = 17): Chocolate Milk (Toddynho® - Pepsico) - negative control; Petit Suisse Yogurt (Danoninho® - Danone); Strawberry Yogurt (Vigor); Apple puree (Nestlé); Fermented Milk (Yakult® - Yakult); and Home Squeezed Style Orange Juice (del Valle) - positive control. The 28-day immersion cycles for the test products were performed twice daily and were interspersed with exposure of the test substrate to artificial saliva. Measurements of enamel surface microhardness (SMH) were performed initially, after immersion in HCl and at 7, 14, 21 and 28 days of experimentation. A two-way ANOVA, according to a split-plot design, followed by the sum of squares decomposition and Tukey's test, revealed a significant effect for the interaction between Foods and Drinks and Length of Exposure (p < 0.00001). Orange juice resulted in greater mineral loss of enamel after 28 days. None of the test products was associated with recovery of tooth enamel microhardness.

Laser speckle imaging: a novel method for detecting dental erosion

Erosion is a highly prevalent condition known as a non-carious lesion that causes progressive tooth wear due to chemical processes that do not involve the action of bacteria. Speckle images proved sensitive to even minimal mineral loss from the enamel. The aim of the present study was to investigate the use of laser speckle imaging analysis in the spatial domain to quantify shifts in the microstructure of the tooth surface in an erosion model. 32 fragments of the vestibular surface of bovine incisors were divided in for groups (10 min, 20 min. 30 min and 40 min of acid etching) immersed in a cola-based beverage (pH approximately 2.5) twice a day during 7 days to create an artificial erosion. By analyzing the laser speckle contrast map (LASCA) in the eroded region compared to the sound it was observed that the LASCA map shifts, proportionally to the acid each duration, by: 18%; 23%; 39% and 44% for the 10 min; 20 min; 30 min and 40 min groups, respectively. To the best of our knowledge, this is the first study to demonstrate the correlation between speckle patterns and erosion progression.

Erosive Effect of Different Soft Drinks on Enamel Surface in vitro: Application of Stylus Profilometry

OBJECTIVE

To assess the erosive potential of various soft drinks by measuring initial pH and titratable acidity (TA) and to evaluate enamel surface roughness using different exposure times.

MATERIALS AND METHODS

The initial pH of the soft drinks (group 1: Coca-Cola; group 2: orange juice; group 3: Cedevita; group 4: Guarana, and group 5: strawberry yoghurt) was measured using a pH meter, and TA was measured by titration with NaOH. Enamel samples (n = 96), cut from unerupted human third molars, were randomly assigned to 6 groups: experimental (groups 1-5) and control (filtered saliva). The samples were exposed to 50 ml of soft drinks for 15, 30 and 60 min, 3 times daily, during 10 days. Between immersions, the samples were kept in filtered saliva. Enamel surface roughness was measured by diamond stylus profilometer using the following roughness parameters: Ra, Rq, Rz, and Ry. Data were analyzed by one-way ANOVA, Tukey's post hoc and Student-Newman-Keuls post hoc tests.

RESULTS

The pH values of the soft drinks ranged from 2.52 (Guarana) to 4.21 (strawberry yoghurt). Orange juice had the highest TA, requiring 5.70 ml of NaOH to reach pH 7.0, whereas Coca-Cola required only 1.87 ml. Roughness parameters indicated that Coca-Cola had the strongest erosion potential during the 15 min of exposure, while Coca-Cola and orange juice were similar during 30- and 60-min exposures. There were no significant differences related to all exposure times between Guarana and Cedevita. Strawberry yoghurt did not erode the enamel surface regardless of the exposure time.

CONCLUSION

All of the tested soft drinks except yoghurt were erosive. Erosion of the enamel surfaces exposed to Coca-Cola, orange juice, Cedevita, and Guarana was directly proportional to the exposure time.

Possible ways of reducing dental erosive potential of acidic beverages

Frequent consumption of acidic beverages is related to excessive tooth wear, namely dental erosion. Preventive measures may involve reduction or elimination of acidic drink consumption. However, the success of this approach is difficult to achieve as it is highly dependent on patient compliance. Therefore, a practical way of minimizing the erosive potential of popular acidic drinks may be their chemical modification. The aim of this article was to review the different methods of modification and their shortcomings. The available literature demonstrates that the erosive potential of most acidic beverages could be reduced. To date, the effectiveness of soluble calcium salts supplementation is the best established. However, modification can reduce the sensorial quality of the drink and shorten its shelf-life. There is also a need to evaluate the lowest effective and safe dose of the additive.

Erosive potential of soft drinks on human enamel: an in vitro study

BACKGROUND/PURPOSE

Most soft drinks are acidic in nature. Regular consumption of these drinks may result in dental erosion. The aim of this in vitro study was to evaluate the erosive potential of different soft drinks in Taiwan by a novel multiple erosive method.

METHODS

Four commercially available soft drinks in Taiwan were selected for this study. The properties of each product were analyzed to measure their pH, titratable acidity, and ion contents. The erosive potential of the soft drinks was measured based on the amount of loss of human enamel surface following its exposure to the soft drinks tested for different periods (20 minutes, 60 minutes, and 180 minutes). The enamel loss was measured using a confocal laser scanning microscope.

RESULTS

The pH values of the soft drinks were below the critical pH value (5.5) for enamel demineralization, and ranged from 2.42 to 3.46. The drink with ingredients of citric acid and ascorbic acid had the highest titratable acidity (33.96 mmol OH(-)/L to pH 5.5 and 71.9 mmol OH(-)/L to pH 7). Exposure to all the soft drinks resulted in loss of human enamel surface (7.28-34.07 μm for 180-minute exposure). The beverage with the highest calcium content had the lowest erosive potential.

CONCLUSION

All tested soft drinks were found to be erosive. Soft drinks with high calcium contents have significantly lower erosive potential. Low pH value and high citrate content may cause more surface enamel loss. As the erosive time increased, the titratable acidity to pH 7 may be a predictor of the erosive potential for acidic soft drinks. The erosive potential of the soft drinks may be predicted based on the types of acid content, pH value, titratable acidity, and ion concentration.

Three-dimensional profilometric assessment of early enamel erosion simulating gastric regurgitation

OBJECTIVES

A priority research area in minimal intervention dentistry is the characterization of the early stages of dental erosion. The aim of this in vitro study was to assess the effect of short, repetitive erosive challenges to human enamel over 2 min at pH 1.5 and 3.0 under conditions simulating gastric regurgitation.

METHODS

Enamel surfaces were subjected to erosive challenges at pH 1.5 (Group 1, n=10) and pH 3.0 (Group 2, n=9) for periods of 30s (stage 1), 60s (stage 2) and 120 s (stage 3). Quantitative changes were assessed longitudinally by measuring the 3D average surface roughness (Sa) values using 3D confocal microscopy. Qualitative micrographic assessment of surface changes was also conducted by using environmental scanning electron microscopy.

RESULTS

Linear mixed model analysis showed significant effects of the pH values (p<0.001) and the stages (p<0.001) on the observed Sa values. Post hoc tests showed significant increases in the Sa values between baseline and other stages in both groups (p<0.01). The mean Sa values also increased significantly from stage 1 to stage 2 in Group 1 (p<0.05). Micrographic analysis displayed severely etched enamel rods in Group 1, but only subtle changes in Group 2.

CONCLUSIONS

The complexity of the enamel surface is influenced by both acid concentration (pH value) and duration of acid exposure during early stages of erosion. Erosion occurring under conditions simulating GORD can be detected in its initial stages, opening up the possibilities of early diagnosis and management of this condition.

CLINICAL SIGNIFICANCE

Erosive tooth wear occurs progressively and insidiously, often creating complex treatment challenges. This emphasizes the need for early diagnosis and management in accordance with minimal intervention philosophy. Our findings provide a foundation for further research that could lead to the development of highly-sensitive clinical diagnostic tools and preventive strategies.

Effect of various tooth whitening modalities on microhardness, surface roughness and surface morphology of the enamel

The purpose of this study was to evaluate the effect of four whitening modalities on surface enamel as assessed with microhardness tester, profilometer, and scanning electron microscopy (SEM). Whitening was performed according to manufacturer's directions for over-the-counter (OTC), dentist dispensed for home use (HW) and in-office (OW) whitening. Do-it-yourself (DIY) whitening consisted of a strawberry and baking soda mix. Additionally, negative and positive controls were used. A total of 120 enamel specimens were used for microhardness testing at baseline and post-whitening. Following microhardness testing specimens were prepared for SEM observations. A total of 120 enamel specimens were used for surface roughness testing at baseline and post-whitening (n = 20 per group). Rank-based Analysis of Covariance was performed to compare microhardness and surface roughness changes. Tests of hypotheses were two-sided with α = 0.05. There was a significant difference in Knoop hardness changes (ΔKHN) among the groups (Kruskal-Wallis test, p < 0.0001). Significant hardness reduction was observed in the positive control and DIY group (p < 0.0001). Mean surface roughness changes (ΔRa) were significantly different among the groups (Kruskal-Wallis test, p < 0.0001). Surface roughness increased in the OTC group (p = 0.03) and in the positive control (p < 0.0001). The four whitening modalities-DIY, OTC, HW and OW induced minimal surface morphology changes when observed with SEM. It can be concluded that none of the four whitening modalities adversely affected enamel surface morphology. However, caution should be advised when using a DIY regimen as it may affect enamel microhardness and an OTC product as it has the potential to increase surface roughness.

The effects of smoothies on enamel erosion: an in situ study

OBJECTIVES

To measure, in vitro, the pH and titratable acidity (TA) of various soft drinks and to assess the erosive effect of smoothies using an in situ model.

METHOD

The in vitro phase of this study included measuring the inherent pH of six different commercially available smoothies, diet coke, and citric acid 0.3% (positive control) using a pH meter. The TA was determined by titration with NaOH. In the second part of the study, an in situ model was used. An upper removable appliance capable of retaining two enamel slabs was constructed and worn by 14 volunteers. The drinks under test were Innocent(®) strawberries and banana smoothie and citric acid. Volunteers were instructed to dip the appliance in the test solutions extra-orally five times daily for 2 min each time for 21 days. Measurements of enamel loss were made by surface profilometry and microhardness.

RESULTS

Diet Coke was found to be the most acidic drink (pH 2.61), whereas Innocent(®) mangoes and passion fruit smoothie showed to be the least (pH 3.9). With regard to TA, Innocent(®) blackberries, strawberries, and blackcurrant smoothie had the highest TA requiring 10.8 mol of NaOH to reach pH 7.0, whereas citric acid required only 3.1 mol of NaOH to reach the same pH value. Surface profilometry and microhardness testing revealed that citric acid caused a statistically significantly greater tooth surface loss compared with smoothie after 21-day pH cycling protocol.

CONCLUSION

Smoothies are acidic and have high TA levels. Innocent(®) strawberries and banana smoothie had an erosive potential to the teeth. However, its erosive effect was significantly less compared with citric acid after 21-day pH cycling protocol using an in situ model.

High fluoride and low pH level have been detected in popular flavoured beverages in Malaysia

OBJECTIVE

In children, excessive ingestion of fluoride from different sources including bottled drinking water and flavoured beverages or soft drinks can lead to the development of dental fluorosis. In addition, the pH level of beverages is important. Low pH can cause dental erosion. In this study we explore the fluoride content and pH level of certain popular beverages available in Malaysian supermarkets and hawkers' stalls.

METHODS

Bottled drinking water and selected popular flavoured packet drinks were purchased from a supermarket and the corresponding flavoured hawkers' drinks, from a hawker's stall in Kuala Lumpur. Fluoride and pH of the beverages were determined using digital fluoride meter and digital pH meter respectively.

RESULTS

It was found that fluoride content and pH level vary among the beverages. The mean fluoride content in both packet and hawkers' drinks (7.64±1.88 mg/L, 7.51±1.60 mg/L, respectively) was approximately 7 times higher than the bottled drinking water (1.05±0.35 mg/L). Among the beverages, the tea packet drink was found to contain the highest amount of fluoride (13.02±0.23 mg/L). The mean pH of bottled-drinking water was near neutral (6.96±0.17), but acidic for both supermarket (4.78.00±0.49) and hawkers' drinks (5.73±0.24). The lychee packet drink had the lowest pH level (2.97±0.03).

CONCLUSIONS

Due to the wide variation of the fluoride content and pH level of the drinks tested in this study, it is recommended that steps should be taken to control the fluoride concentration and pH level in beverages if dental fluorosis and erosion are to be prevented.

Evaluation of the pH and titratable acidity of teas commercially available in Brazilian market

OBJECTIVE: Tea has been considered a healthy alternative to other industrialized beverages. The objective of this study was to assess the erosive potential of teas commercially available in Brazil by pH and titratable acidity measures. METHODS: Eighteen teas available in Brazilian market were selected for this study (read to drink and brewed tea), and a brand of yerba mate (Ilex paraguariensis). Each product was analyzed for pH and titratable acidity. For comparison between different kinds of teas, the Student t test was used. RESULTS: The mean pH values for ready to drink teas ranged between 2.89 and 4.03, while for the brewed teas and yerba mate the values ranged between 6.75 and 7.89. The difference between the two groups was significant (p < 0.05). Regarding titratable acidity, the ready to drink teas showed mean values ranging between 3.77 ml and 12.68 ml. Brewed teas (including yerba mate) were not tested for titratable acidity because their pH values were greater than 7.0. CONCLUSION: Among the teas commercially available, ready to drink teas have lower pH values and higher titratable acidity compared to other teas. It suggests that they have an erosive potential.

Effect of beverages on bovine dental enamel subjected to erosive challenge with hydrochloric acid

This study evaluated by an in vitro model the effect of beverages on dental enamel previously subjected to erosive challenge with hydrochloric acid. The factor under study was the type of beverage, in five levels: Sprite® Zero Low-calorie Soda Lime (positive control), Parmalat® ultra high temperature (UHT) milk, Ades® Original soymilk, Leão® Ice Tea Zero ready-to-drink low-calorie peach-flavored black teaand Prata® natural mineral water (negative control). Seventy-five bovine enamel specimens were distributed among the five types of beverages (n=15), according to a randomized complete block design. For the formation of erosive wear lesions, the specimens were immersed in 10 mL aqueous solution of hydrochloric acid 0.01 M for 2 min. Subsequently, the specimens were immersed in 20 mL of the beverages for 1 min, twice daily for 2 days at room temperature. In between, the specimens were kept in 20 mL of artificial saliva at 37ºC. The response variable was the quantitative enamel microhardness. ANOVA and Tukey's test showed highly significant differences (p<0.00001) in the enamel exposed to hydrochloric acid and beverages. The soft drink caused a significantly higher decrease in microhardness compared with the other beverages. The black tea caused a significantly higher reduction in microhardness than the mineral water, UHT milk and soymilk, but lower than the soft drink. Among the analyzed beverages, the soft drink and the black tea caused the most deleterious effects on dental enamel microhardness.

Erosive and cariogenicity potential of pediatric drugs: study of physicochemical parameters

Background

Pediatric medications may possess a high erosive potential to dental tissues due to the existence of acid components in their formulations. The purpose was to determine the erosive and cariogenic potential of pediatric oral liquid medications through the analysis of their physicochemical properties in vitro.

Methods

A total of 59 substances were selected from the drug reference list of the National Health Surveillance Agency (ANVISA), which belong to 11 therapeutic classes, as follows: analgesics, non-steroidal anti-inflammatory, corticosteroids, antihistamines, antitussives, bronchodilators, antibacterials, antiparasitics, antiemetics, anticonvulsants and antipsychotics. Measurement of pH was performed by potentiometry, using a digital pH meter. For the Total Titratable Acidity (TTA) chemical assay, a 0.1 N NaOH standard solution was used, which was titrated until drug pH was neutralized. The Total Soluble Solids Contents (TSSC) quantification was carried out by refractometry using Brix scale and the analysis of Total Sugar Content was performed according to Fehling’s method. In addition, it was analyzed the information contained in the drug inserts with regard to the presence of sucrose and type of acid and sweetener added to the formulations.

Results

All drug classes showed acidic pH, and the lowest mean was found for antipsychotics (2.61 ± 0.08). There was a large variation in the TTA (0.1% - 1.18%) and SST (10.44% - 57.08%) values. High total sugar contents were identified in the antitussives (53.25%) and anticonvulsants (51.75%). As described in the drug inserts, sucrose was added in 47.5% of the formulations, as well as citric acid (39.0%), sodium saccharin (36.4%) and sorbitol (34.8%).

Conclusion

The drugs analyzed herein showed physicochemical characteristics indicative of a cariogenic and erosive potential on dental tissues. Competent bodies’ strategies should be implemented in order to broaden the knowledge of health professionals, drug manufacturers and general consuming public about the risks from the consumption of medicines potentially harmful to dental tissues.

Supplementation of soft drinks with metallic ions reduces dissolution of bovine enamel

OBJECTIVE

The aim of this study was to evaluate the effect of the addition of metallic ions to carbonated drinks on their erosive potential.

MATERIAL AND METHODS

Powdered enamel was added to carbonated beverages (Coca-ColaTM or Sprite ZeroTM and shaken for 30 s. The samples were then immediately centrifuged and the supernatant removed. This procedure was repeated 5 times with the beverages containing Cu2+, Mg2+, Mn2+ or Zn2+ (1.25-60 mmol/L). For Coca-ColaTM, the concentration of each ion that exhibited the highest protection was also evaluated in combination with Fe2+. The phosphate or calcium released were analyzed spectrophotometrically. Data were analyzed using ANOVA and Tukey's test (p<0.05).

RESULTS

For Coca-ColaTM, the best protective effect was observed for Zn2+ alone (10 mmol/L) or in combination (1 mmol/L) with other ions (12% and 27%, respectively, when compared with the control). Regarding Sprite ZeroTM, the best protective effect was observed for Cu2+ at 15 and 30 mmol/L, which decreased the dissolution by 22-23%. Zn2+ at 2.5 mmol/L also reduced the dissolution of powdered enamel by 8%.

CONCLUSIONS

The results suggest that the combination of metallic ions can be an alternative to reduce the erosive potential of Coca-ColaTM. Regarding Sprite ZeroTM, the addition of Cu2+ seems to be the best alternative.

In vivo effects of two acidic soft drinks on shear bond strength of metal orthodontic brackets with and without resin infiltration treatment

OBJECTIVES

To evaluate the in vivo effects of two acidic soft drinks (Coca-Cola and Sprite) on the shear bond strength of metal orthodontic brackets with and without resin infiltration treatment. In addition, the enamel surface was evaluated, after debonding, using a scanning electron microscope.

MATERIALS AND METHODS

Sixty noncarious maxillary premolars, scheduled for extraction in 30 orthodontic patients, were used. Patients were randomly divided into two groups according to the soft drink tested (Coca-Cola or Sprite). In each group, application of resin infiltration (Icon. DMG, Hamburg, Germany) was done on one side only before bonding of brackets. Patients were told to rinse their mouth with their respective soft drink at room temperature for 5 minutes, three times a day for 3 months. Shear bond strength was tested with a universal testing machine. After shearing test, a scanning electron microscope was used to evaluate enamel erosion. Statistical analysis was performed by twoway analysis of variance followed by the least significant difference test.

RESULTS

The Coca-Cola group without resin infiltration showed the lowest resistance to shearing forces. Scanning electron micrographs of both groups after resin application showed a significant improvement compared with results without resin use, as the enamel appeared smoother and less erosive.

CONCLUSION

Pretreatment with the infiltrating resin has proved to result in a significant improvement in shear bond strength, regardless of the type of soft drink consumed.