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

Predisposing Factors for Erosive Tooth Wear in Permanent Teeth Among Asthmatic Children and Adolescents

OBJECTIVES

Epidemiological studies indicate that erosive tooth wear (ETW) is a common threat of tooth surface loss. The etiology of ETW is multifactorial. The prevalence of asthma is increasing in developed countries, especially in children. Studies evaluating ETW in asthmatic children are conflicting. With our study, we aimed to investigate the association between general and asthmatic factors and the presence of ETW.

METHODS

Population of this cross-sectional observational study consisted of children aged 6-17 years under treatment for asthma at University Medical Centre. ETW was determined using the Basic Erosive Wear Examination index. Questionnaires completed by parents and data from patients' medical records provided information on demographics, medical history, medication use, dietary habits, oral hygiene, fluoride exposure and type, dose, frequency, duration, and mode of asthma medication use.

RESULTS

379 asthmatic children participated in the study. The prevalence of ETW was 17.2% (n = 379). The mean total BEWE score was 0.76 ± 2.12. A statistically significant higher presence of ETW and higher total BEWE index were found in the group consuming acidic sports drinks (OR = 3.318), in the group aged 12-17 years (OR = 6.233), in the group using asthma medication for more than 3 years (OR = 3.379) and in the group using medication in the dry powder inhaled form (OR = 2.447).

CONCLUSIONS

Asthmatic children should avoid drinking acidic drinks since longer duration of asthma medication use is already associating them with higher ETW presence. From the ETW point of view, metered-dose inhaled medications are more tooth-friendly than dry powder inhaled forms.

Wear behavior of 3D printed, minimally invasive restorations: Clinical data after 24 months in function

STATEMENT OF PROBLEM

The prevalence of pathological tooth wear and a reduced vertical dimension of occlusion has increased, but prosthetic rehabilitation concepts have been invasive, time-consuming, and expensive. How affordable, esthetic, and less invasive treatment concepts will perform remains unclear.

PURPOSE

The purpose of this proof-of-concept clinical study was to evaluate the wear behavior of 3-dimensionally (3D) printed, minimally invasive restorations fabricated from a ceramic- reinforced composite resin material after 24 months in clinical function.

MATERIAL AND METHODS

The study included 28 participants who received noninvasive 3D printed restorations made of a computer-aided design and computer aided-manufacturing (CAD-CAM) ceramic-reinforced composite resin material (n=352). Maximum occlusal height loss and mean profile loss were measured by using an intraoral scanner and a matching software program (Geomagic Control X; 3D systems) by 1 clinician. Scans were conducted at baseline and after 12 and 24 months. A descriptive statistical analysis, including mean values, medians, standard deviations (SDs) interquartile range and 95% confidence interval (95% CI) were conducted (α=.05).

RESULTS

Maximum occlusal height loss and mean profile loss were analyzed. The molar restorations showed the highest mean values of maximum occlusal height loss after 12 (0.76 mm) and 24 (1.25 mm) months. The anterior restorations showed the lowest wear rates. In general, 123 restorations (35%) had material wear >0.5 mm and were classified as fractured after 24 months of clinical application. Most of the nonfractured restorations experienced localized material wear between 0.11 mm and 0.35 mm, whereas mean profile loss values varied between 0.05 mm and 0.11 mm.

CONCLUSIONS

Three-dimensionally printed, noninvasive restorations manufactured from a ceramic-reinforced composite resin material showed considerable material wear after 2 years of clinical function, and the material appears suitable only for interim restorations.

Deproteinization with Papain enzyme improves the bonding performance of self-etch adhesives to eroded dentin

To evaluate the effect of papain enzyme pretreatment on the bonding performance of self-etch adhesives (SEAs) to eroded dentin, assess its proteinizing effect, and examine the ultrastructure of the pretreated eroded dentin surface and resin-dentin interface. Artificially eroded dentin surfaces were created and pretreated with papain enzyme, while untreated eroded dentin surface served as a control. The treated dentin surfaces were bonded with Clearfil SE Bond 2 (SEB) and Clearfil Universal Bond Quick (UBQ). Microtensile bond strength (µTBS) was measured after 24-hour storage and after 10,000 thermocycles, between 5 °C and 55 °C. Additionally, the deproteinizing effect was evaluated by comparing changes in the amide-to-phosphate ratio using Raman microscopy. Dentin morphology and resin-dentin interface were investigated using scanning electron microscopy. Statistical analysis was performed using three-way ANOVA with Tukey's post hoc tests, and t-tests (p < 0.05). Pretreatment with papain enzyme slightly increased the initial µTBS of SEB, while significantly increasing the initial µTBS of UBQ (p < 0.05). Furthermore, papain enzyme could stabilize the µTBS of both adhesives after thermocycles (p > 0.05). It also significantly reduced the amide-to-phosphate ratio (p < 0.05) altered the surface morphology and improved the structure of resin-eroded dentin interfaces. Deproteinization with papain enzyme dissolved the organic components on the eroded dentin surface, leading to the improvement of resin infiltration, increased thickness of the hybrid layer, and improved the bond durability of SEAs to eroded dentin. The application of the papain enzyme as a pretreatment has the potential to enhance and maintain the bonding performance of self-etch adhesives to eroded dentin. This leads to improved adhesion and restoration quality on compromised eroded dentin surfaces.

Systematic review and meta-analysis on prevalence and anamnestic risk factors for erosive tooth wear in the primary dentition

BACKGROUND

Erosive tooth wear is a multifactorial and common condition in children.

AIM

This systematic review and meta-analysis aimed to determine the prevalence and key risk factors for erosive tooth wear in the primary dentition of children up to 7 years of age.

DESIGN

Electronic databases (PubMed, Embase, Scopus, and Web of Science) were searched in February 2023 for observational studies reporting prevalence and anamnestic risk factors. Additionally, a manual hand search was performed. Meta-analyses were conducted for the prevalence and odds ratios of identified risk factors. Risk of bias was assessed using the Newcastle-Ottawa scale modified for cross-sectional studies.

RESULTS

A total of 26 sources, reporting on 23 studies, were included in the systematic review. The overall estimated prevalence of children with erosive tooth wear in the primary dentition amounted to 35.6% (95% CI: 24.8-48.1). Anamnestic factors were structured into domains. Meta-analyses revealed gastroesophageal reflux disease (GERD; padj. = .008; OR = 1.98, 95% CI: 1.37-2.87), consumption of acidic food (padj. < .001; OR = 5.14, 95% CI: 3.56-7.42) and acidic drinks (padj. < .001; OR = 6.90, 95% CI: 4.64-10.25), holding beverages in the mouth while drinking (padj. = .035; OR = 1.82, 95% CI: 1.26-2.63), and snacking regularly (padj. = .041; OR = 1.58, 95% CI: 1.18-2.10) to be significantly associated with erosive tooth wear.

CONCLUSION

Future research should use standardized questionnaires to assess erosive tooth wear and its underlying risk factors (PROSPERO: CRD4202339776).

Relationship between dental erosion and asthma medication in children: a systematic review

Introduction

Dental erosion is an alteration that affects the integrity of teeth, which has several aetiologies. It is mentioned that asthma medications may be an etiologic factor; however, studies fail to clarify the possible association between these variables in children with asthma. Therefore, the purpose of this study will be to determine the relationship between dental erosion and asthma medication consumption in paediatric patients.

Materials and methods

A systematic research was performed in databases such as MEDLINE (PubMed), Scopus, Web of Science, Scielo, Cochrane Library, Embase, LILACS and gray literature (Open Gray). Two researchers independently selected the articles according to the population, exposure, outcome, study design (PEOS) question using the Rayyan program. Newcastle-Ottawa scale was used to assess the risk of bias.

Results

Six articles were included from 120 selected articles. The studies by Bairappan, Domenzain and Arafa studies show a higher prevalence of dental erosion in children with asthma medication as opposed to healthy children, whereas the studies by Dugmore and Rock, Alazmah and Rezende report a higher prevalence of erosive lesions in healthy children.

Conclusions

Asthma medications are not a determining factor for the occurrence of erosive lesions in the teeth of paediatric patients with this systemic condition.

Prevalence of dentine hypersensitivity, erosive tooth wear, gingival recession and periodontal health in seven European countries

OBJECTIVES

To determine the prevalence and associated risk indicators for dentine hypersensitivity (DH), erosive tooth wear (ETW), gingival recession (GR), and gingival inflammation (bleeding on probing, BOP), with clinical and questionnaire data from seven European countries.

METHODS

A cross-sectional, observational, seven-European country, epidemiological study in systemically healthy adults. Participants completed a questionnaire regarding oral hygiene, diet and lifestyle factors. A clinical examination, by calibrated examiners, measured DH (Schiff; participant yes/no), ETW (basic erosive tooth wear examination, BEWE), GR (mm), and BOP (yes/no).

RESULTS

3551 participants completed the study, mean age 44 ± 17.4, 43.6 % male, 26.1 % rural dwellers. DH (Schiff ≥ 1) was seen in 75.9 % of participants, ETW (BEWE ≥ 1) in 97.6 %, GR (≥1 mm) in 87.9 %. 65.7 % participants had BOP ≥ 10 % sites, 34.3 % BOP<10 % with probing depths ≤3 mm. DH, ETW, GR and BOP increased markedly during young adult life. Thereafter, GR and ETW continued to increase, DH declined after around age 38-47, and BOP plateaued after age 48. DH was significantly associated with ETW (p < 0.001) and GR (p < 0.01); GR was significantly associated with BOP on lingual surfaces (p = 0.017). There were significant associations between increased full mouth BOP ≥ 10 % and reduced brushing duration and exercise frequency (p < 0.001); increased DH and heartburn (p < 0.001); decreased DH (p < 0.001), ETW (p < 0.001) and BOP ≥ 10 % (p = 0.002) with powered toothbrush use.

CONCLUSIONS

Prevalence of oral conditions assessed was high, greater than in the majority of the GR, DH and ETW literature. Periodontal health was seen in a third of sampled individuals. All these conditions varied markedly by country and age.

CLINICAL SIGNIFICANCE

Oral diseases and conditions were highly prevalent throughout the seven European countries investigated. For the majority, these conditions are eminently preventable and treatable by changing behaviours. Upstream policy changes are needed to address these health challenges, to raise awareness and to empower individuals with oral health education and support.

Bullying and oral health in Egyptian adolescents: the moderating role of sense of coherence and resistance to peer influence

BACKGROUND

Bullying is the intentional, repeated and prolonged aggressive behavior towards victim(s) who feel powerless to defend themselves. It could influence adolescents' mental health. Some adolescents possess coping skills which enable them to overcome such adversities. The present study assessed the association between bullying, sense of coherence (SOC), resistance to peer influence (RPI) and oral health in Egyptian adolescents.

MATERIALS AND METHODS

A cross-sectional survey that included 12-16 year old adolescents attending 6 schools in Damanhour, Egypt was conducted from March to December 2023. Data were collected through clinical examination and self-administered questionnaires. Clinical examination assessed dental caries (DMFT), oral hygiene (plaque index) and gingival condition (gingival index). Toothbrushing frequency and sugar consumption were assessed by (World Health Organization-child form), bullying (Revised Olweus Bully Victim Questionnaire), SOC (Sense of Coherence Scale-Short Form) and RPI (Resistance to Peer Influence Questionnaire). The independent variables were bullying, SOC and RPI. The dependent variables were untreated caries, gingival inflammation and toothbrushing frequency. Multivariable multilevel regression assessed the relationship between the independent and dependent variables after adjusting for potential confounders. Adjusted regression coefficients (B), adjusted odds ratios (AOR) and 95% confidence intervals (CI) were calculated. Effect modifications by SOC and RPI were evaluated.

RESULTS

The response rate was 95.25% (N = 602), mean (SD) age was 14.01 (1.15). Half of the students (49.83%) were girls. About 42% had untreated caries, only 15.78% brushed their teeth twice daily and the mean (SD) gingival index was 1.57 (0.40). About 25% were victims, (9.30%) bullies and (18.60%) bully-victims. Victims showed significantly lower odds of twice daily toothbrushing (AOR = 0.52, p = 0.04). Bullies and bully-victims showed non-significantly higher odds of untreated caries (AOR = 1.42, p = 0.25), (AOR = 1.21, p = 0.42), respectively. Bullying was not associated with gingival inflammation. Higher SOC and RPI mitigated the impact of bullying on untreated caries and toothbrushing frequency.

CONCLUSION

Bullying was associated with higher odds of untreated caries and lower odds of twice daily toothbrushing in Egyptian adolescents. Higher SOC and RPI alleviated this relationship, highlighting the importance of individual coping strategies to oral health.

Effectiveness and safety of biosilicate-enhanced bleaching gels on enamel with early erosion lesion

AIM

This study evaluated the efficacy and cytotoxicity of 35% hydrogen peroxide (HP) gel incorporated with 10% (w/w) biosilicate (BioS) on sound enamel and early-stage enamel erosion lesions.

METHODS

Discs of enamel/dentin were selected, subjected to erosive cycles (0.3% citric acid, pH 2.6), and treated with (n = 8): HP (35% HP, positive control); HP_BioS [carboxymethyl cellulose (CMC) + HP + BioS]; BioS (CMC + BioS); CMC (negative control). The discs were adapted to artificial pulp chambers with the enamel exposed for bleaching, and the dentin facing toward the culture medium (Dulbecco's modified Eagle's medium [DMEM]). Bleaching was performed in three 30-min sessions at 7-day intervals. After bleaching, the diffusion product (DMEM extract + diffused HP) was pipetted onto MDPC-23 odontoblastic cell line and inoculated. Color parameters (ΔL, Δa, Δb), color change (ΔE00), and changes in whiteness index (ΔWID) were determined before (T0) and after the last bleaching session (T3). Cell viability (MTT, %), H2O2 diffusion (μg/mL), oxidative cell stress (OxS), and cell fluorescence (live/dead assay, in confocal microscopy) were assessed (ANOVA/Tukey; α = 0.05).

RESULTS

No difference in ΔL, Δa, Δb, ΔE00, and ΔWID were found between HP and HP_BioS (p > 0.05). The incorporation of BioS decreased the HP diffusion into the substrates and mitigated oxidative stress in early-stage eroded enamel (p < 0.05). HP_BioS presented significantly higher cell viability compared with HP under erosion conditions. Live/dead assay indicated that BioS_HP maintained viability with larger clusters of viable cells.

CONCLUSION

Incorporating BioS into HP maintained bleaching effectiveness, favored cell viability, reduced the oxidative stress, and the cytotoxicity in teeth with early-stage erosion.

CLINICAL SIGNIFICANCE

BioS formulation showed promising results for reducing cytotoxicity in patients seeking tooth bleaching and presenting undetectable early-stage erosion.

Addition of substances to reduce the erosive potential of acidic beverages to tooth enamel: A scoping review

OBJECTIVE

This scoping review aimed (1) to map, analyse, interpret and synthesize data from in situ studies on which substances were added to acidic beverages to reduce the erosive potential on tooth enamel and (2) to establish the level of evidence of the effectiveness of adding substances to acidic beverages to reduce the erosive potential on tooth enamel.

DESIGN

This is a scoping review, according to the methods from the Joanna Briggs Institute and PRISMA-ScR, with high-sensitivity searches in the databases PubMed (MEDLINE), Virtual Health Library, Embase (Elsevier), Scopus (Elsevier), Web of Science and ScienceDirect (Elsevier). In situ studies published in English until December 2022 were included. Studies that did not report a control group were excluded. To map and summarize the results, tables and figures were used.

RESULTS

From 895 potentially eligible articles, nine were included. Blackcurrant juices (n = 5) with the addition of calcium (n = 3) or xanthan gum (n = 2) formulations were the most tested in terms of reducing the erosive potential of the beverages on tooth enamel. The profilometer was the equipment of choice (n = 8) for evaluating the loss of enamel structure after the experimental tests.

CONCLUSIONS

Calcium and xanthan gum are among the most tested by in situ studies, offering promising results in reducing the erosive potential of fruit juices and carbonated and energy drinks.

Influence of bottled salad dressings on the development of enamel erosion in the presence or absence of salivary pellicle - An in vitro study

Background

Acidic beverages are believed to elevate the risk of enamel surface erosion. In addition to the intake of soft drinks, the increased consumption of salad dressings has been linked to a higher prevalence of dental erosion. Therefore, the current study aimed to investigate the influence of bottled salad dressings on the development of enamel erosion in the presence or absence of pellicle through in vitro experiment.

Methods

Preliminary pH and calcium analyses of solutions were performed. Highest pH and calcium content was found for sandwich spread i.e., 4.69 and 55.4 mg/100 g grams, respectively. Eighty tooth specimens (measuring 4 × 4 × 3 mm) were prepared from extracted human premolars and randomly assigned to four groups (group 1: orange juice; group 2: eggless plain mayonnaise; group 3: sandwich spread; and group 4: thousand island dressing) with 20 samples in each group. Ten tooth specimens from each group were immersed in 20 ml of the respective solutions for 5 min (control group). The remaining ten tooth specimens from each group were submerged in 5 mL saliva vials for 3 min to facilitate salivary pellicle formation before being immersed in their respective solutions for 5 min (saliva-covered group). Pre and post-experimental assessments of enamel roughness and hardness were conducted using a surface roughness tester and Knoop Hardness indenter, respectively.

Results

Overall, enamel roughness was notably elevated in the control group, with the eggless plain mayonnaise (0.52 ± 0.38) and thousand island dressing groups (0.57 ± 0.29) showing a significant increase in surface roughness post-test (p = 0.05). Nevertheless, there was no significant difference in the enamel roughness between the groups. On the other hand, regardless of the presence/absence of the salivary pellicle, a marked decrease in enamel hardness was observed among all groups except for group 3 (sandwich spread) with a mean score of 311.5 ± 82.6 (p < 0.05).

Conclusion

A significant increase in surface roughness and reduction in enamel hardness was observed with salad dressings. However, in vitro formed salivary pellicle showed a protective effect against tooth erosion.

Erosive Effect of Canned Juices and Soft Drinks on Surface Roughness of Restorative Materials Used in Pediatric Dentistry: An Ex Vivo Study

Aim

To evaluate and compare the effect of fruit juice (orange) and cola drink (noncarbonated) on the surface texture of composite (3M ESPE Filtek Bulk Fill) and glass ionomer cement (GIC) (ChemFil Superior).

Materials and methods

A total of eighty pellets each were prepared with composite (3M ESPE Filtek Bulk Fill) and GIC (ChemFil Superior) material using a brass mold with an inner diameter of 3 mm and a thickness of 3 mm according to the manufacturer's instructions. Around 10 pellets of each material were placed in airtight plastic containers. The baseline surface texture value was obtained by profilometer. An 8-day immersion regime was carried out according to Maupome et al. After the 8-day test period, pellets were reevaluated for surface texture final value. The values were statistically analyzed.

Results

A statistically significant lower surface roughness of composite restorative material was observed when treated with high-concentration orange juice and medium-concentration. Conversely, a statistically significant lower surface roughness of GIC restorative material was observed when it was treated with the low-concentration group, high-concentration orange juice, and medium-concentration orange juice.

Conclusion

The surface roughness patterns of restorative materials increased as the number of immersion regimes increased.

How to cite this article

Vishwanathaiah S, Maganur PC, Khabrany HM, et al. Erosive Effect of Canned Juices and Soft Drinks on Surface Roughness of Restorative Materials Used in Pediatric Dentistry: An Ex Vivo Study. Int J Clin Pediatr Dent 2024;17(7):807-811.

Effect of erosive conditions on different sealant materials used in paediatric dentistry

To evaluate the effect of acidic challenge on erosion depth and topographic characteristics of different materials used as occlusal sealants. Two hundred specimens of five sealant materials (Fuji IX, Ketac Molar, Fuji II, Equia and Clinpro) and forty bovine teeth enamel samples (control) were prepared and exposed to acidic challenge. The specimens were immersed in four different solutions (orange juice, coke drink, citric acid or distilled water) under mildly shaken conditions for 3 days. The erosion depth profiles were measured using a profilometer and Scanning Electron Microscope (SEM). Two-way ANOVA with Tukey post-hoc test was performed to evaluate the interactions. Sealant material and acidic challenge had significant effects on erosion depth. Among the materials, Fuji II presented the highest mean of erosion depth after immersion in orange juice, coke drink, and citric acid. All materials groups presented higher erosion depth values after immersion in the citric acid solution, except Clinpro. Bovine enamel presented higher erosion depth values compared to all materials when submitted to erosive challenge. Sealant materials submitted to the acidic challenge presented different degrees of erosion and topographic modification; however, they are less susceptible to erosion than bovine teeth enamel.

In vitro effect of fluoride gels supplemented with nano-sized sodium trimetaphosphate on enamel erosive wear

OBJECTIVE

To assess the protective effect of fluoride (F) gels supplemented with micrometric or nano-sized sodium trimetaphosphate (TMPmicro and TMPnano, respectively) against enamel erosion in vitro.

METHODS

Bovine enamel blocks (n = 140) were selected according to their surface hardness, and randomly divided into seven groups (n = 20/group), according to the gels tested: Placebo (without F/TMP), 4,500 μg F/g (4500F), 9,000 μg F/g (9000F), 4500F plus 2.5 % TMPnano (2.5 % Nano), 4500F plus 5 % TMPnano (5 % Nano), 4500F plus 5 % TMPnano (Micro 5 %) and 12,300 μg F/g (Acid gel). Blocks were treated once during one minute with the gels, and submitted to erosive (ERO, n = 10/group) or erosive plus abrasive (ERO+ABR, n = 10/group) challenges 4 times/day, for 90 s for each challenge (under reciprocating agitation), during consecutive 5 days. Blocks were analyzed by profilometry, and by surface (SH) and cross-sectional hardness (∆KHN). Data were submitted to two-way ANOVA, and Fisher's LSD test (p < 0.05).

RESULTS

For ERO, both TMPnano-containing gels promoted enamel wear significantly lower than Placebo and 4500F, reaching levels similar to both positive controls (9000F and acid gel); significantly lower softening was observed for enamel treated with 4500F+5 % Micro and 4500F+2.5 % Nano. Also, the lowest ∆KHN values were observed for 4500F+2.5 % TMPnano among the TMP-containing gels. For ERO+ABR, the lowest enamel wear was achieved by the use of 4500F+5 % Nano among all gels, including both positive controls; lower softening was observed for Placebo and 9000F groups.

CONCLUSION

The addition of 5 % nano-sized TMP to a low-fluoride gel produced superior protective effects for enamel under both challenges conditions, when compared with micrometric TMP, reaching values similar to or superior than both positive controls, respectively for ERO and ERO+ABR.

CLINICAL SIGNIFICANCE

The supplementation of low-F gels with TMP was shown to significantly improve their effects on enamel erosive wear, and the use of nano-sized TMP further enhances this protective action.

Time-and cost-effective 3-dimensional-printing workflow to rehabilitate worn dentitions: A clinical report

Current restorative methods of restoring worn or eroded dentition present drawbacks that may deter dentists or patients from pursuing complete mouth rehabilitation. A novel additive manufacturing approach using 3D printed definitive composite resin restorations is described as a less technique-sensitive and more cost-effective alternative. These restorations are straightforward to repair, modify, or replace.

Preventive dental erosion with silver diamine fluoride: An in vitro study

OBJECTIVES

To evaluate the erosion preventive effect of 38 % silver diamine fluoride (SDF) solution in enamel and dentin of human permanent teeth.

METHODS

Ninety enamel and ninety dentin blocks were prepared from permanent molars and allocated into three groups. Gp-SDF received a one-off application of 38 % SDF solution. Gp-SNF received a one-off application of a solution containing 800 ppm stannous chloride and 500 ppm fluoride. Gp-DW received a one-off application of deionized water. The blocks were submitted to acid challenge at pH 3.2, 2 min, 5 times/day for 7 days. All blocks were immersed in human saliva between cycles for one hour. The crystal characteristics, percentage of surface microhardness loss (%SMHL), surface loss, and elemental analysis and surface morphology were examined by X-ray diffraction (XRD), microhardness test, non-contact profilometry, and energy-dispersive X-ray spectroscopy (EDS) and scanning electron microscopy (SEM), respectively. Data of%SMHL and surface loss were analyzed by one-way ANOVA.

RESULTS

XRD spectra revealed that fluorapatite and silver compounds formed in Gp-SDF, while fluorapatite and stannous compounds formed in Gp-SNF. Gp-DW presented only hydroxyapatite. The median (interquartile range) of%SMHL in Gp-SDF, Gp-SNF and Gp-DW were 27.86(3.66), 43.41(2.45), and 46.40(3.54) in enamel (p< 0.001), and 14.21(1.57), 27.99(1.95), and 33.18(1.73) in dentin, respectively (p < 0.001). The mean (standard deviation, μm) of surface loss of Gp-SDF, Gp-SNF, and Gp-DW were 2.81(0.59), 4.28(0.67), and 4.63(0.64) in enamel (p < 0.001) and 4.13(0.69), 6.04(0.61), and 7.72(0.66) in dentin, respectively (p < 0.001). SEM images exhibited less enamel corruption and more dentinal tubular occlusion in Gp-SDF compared to Gp-SNF and Gp-DW. EDS analysis showed silver was detected in Gp-SDF while stannous was detected in the dentin block of Gp-SNF.

CONCLUSION

38 % SDF yielded superior results in protecting enamel and dentin blocks from dental erosion compared to SNF and DW.

CLINICAL SIGNIFICANCE

Topical application of 38 % SDF is effective in preventing dental erosion in human enamel and dentin.

Anamnestic risk factors for erosive tooth wear: Systematic review, mapping, and meta-analysis

OBJECTIVES

Erosive tooth wear is a multifactorial condition. The aim of this systematic review and meta-analysis was to identify key risk factors for erosive tooth wear in permanent dentition.

STUDY SELECTION

Observational studies reporting anamnestic risk factors for erosive tooth wear. Methodological quality and risk of bias were assessed using the modified Newcastle-Ottawa scale for cross-sectional studies. Risk factors were visually presented in a heatmap, and where possible, random-effects meta-analyses were performed for the odds ratios (ORs) of risk factors.

SOURCES

Electronic databases (MEDLINE, Embase, Scopus, and Web of Science) and manual searches in February 2023. The protocol was registered in PROSPERO (CRD4202339776).

DATA

A total of 87 publications reporting on 71 studies were included in the systematic review. The studies examined a variety of anamnestic risk factors (n = 80) that were categorized into ten domains (socio-demographics, socio-economics, general health, oral diseases, medication, oral hygiene, food, beverages, dietary habits, and leisure-related risk factors). Meta-analyses revealed significant associations between erosive tooth wear and male gender (padj.<0.001; OR=1.30, 95 % CI: 1.16-1.44), regurgitation (padj.=0.033; OR=2.27, 95 % CI: 1.41-3.65), digestive disorders (padj.<0.001; OR=1.81, 95 % CI: 1.48-2.21), consumption of acidic foods (padj.=0.033; OR=2.40, 95 % CI: 1.44-4.00), seasoning sauces (padj.=0.003; OR=1.28, 95 % CI: 1.13-1.44), nutritional supplements (padj.=0.019; OR=1.73, 95 % CI: 1.28-2.35), and carbonated drinks (padj.=0.019; OR=1.43, 95 % CI: 1.17-1.75). Most included studies exhibited low bias risk.

CONCLUSIONS

Observational studies investigated a variety of anamnestic risk factors for erosive tooth wear. Future studies should employ validated questionnaires, particularly considering the most important risk factors.

CLINICAL SIGNIFICANCE

Erosive tooth wear is a prevalent condition. Clinicians should concentrate primarily on symptoms of gastroesophageal reflux disease and dietary factors when screening patients at risk for erosive tooth wear.

In vitro assessment of dental erosion caused by clear aligners

The primary objective of this in vitro study was to investigate the erosive potential of enamel under the use of clear aligners (CA), by simulating in vivo conditions experienced by patients who do not remove their CA during the consumption of acidic beverages. In addition, the difference in erosion protection conferred by artificial and human saliva was also evaluated. Sound-extracted human premolars (n = 20) had half of their surfaces protected with acid-resistant nail polish and were randomly distributed into two experimental groups (n = 10): teeth immersed in human saliva or artificial saliva. All teeth had half of their lingual surfaces enclosed by a CA device. The erosive challenges consisted of individual immersion of each sample in citrus acid three times a day, intermediated by immersion in human saliva or artificial saliva for 2 h, during ten days of the erosive protocol. The enamel mineral content was analyzed by high-resolution microtomography. The differential mineral concentration profiles were obtained by subtracting the profile of the mineral concentration of the exposed area and enamel under the CA area from the respective sound area (control). In addition, enamel wear and enamel volume loss were measured. Scanning electron microscopy (SEM) was also performed to analyze the enamel surface. Data were analyzed by two-way ANOVA, followed by the Student-Newman-Keuls test. The enamel wear was higher in teeth immersed in artificial saliva, when compared to human saliva (p < 0.001). The volume loss of the exposed enamel area was lower for tooth immersed in human saliva than in artificial saliva (p < 0.001), during the acid challenge protocol. The use of CA during acid challenges promoted wear and mineral loss of dental enamel, being these changes more pronounced on the enamel surface under the CA. These results open a new path for the development of further studies adopting clinical protocols that promote more accurate responses in the clinical practice during orthodontic treatment.

Case Report: Case report: Rapidly progressing tooth wear dominated by intrinsic and extrinsic erosion

Tooth wear is multi-factorial presenting as a combination of abrasion, attrition, and erosion. This case report represents a case of combined tooth wear in a 46-year-old Indo-Trinidadian male, with a predominant erosive component with both the clinical signs and features of intrinsic and extrinsic erosion. This patient case is unique since the wear predominated by dental erosion has occurred rapidly evidenced by the physical clinical appearance of a lack of compensation and the upper left premolars and molars relatively unaffected by the overall effects of tooth wear. This lack of compensation, where opposing teeth have not supra-erupted to maintain inter-arch stability, and the maintenance of occlusal vertical dimension on the left due to the non-worn posterior maxillary teeth, provides the benefit of simplifying subsequent restorative management. The medical and diet history corroborates the diagnoses of intrinsic and extrinsic erosion respectively. Complications noted with rapid tooth wear, such as dentine sensitivity and pulpal necrosis are known sequelae of tooth wear however the patient presented in this case report shows a concomitant high caries experience and poor oral hygiene. Cases such as the one presented here require not only comprehensive dental management, utilizing a restorative approach but also medical referral for confirmation of a diagnosis and management of gastroesophageal reflux disease. Inherent to the management of this patient should be a multidisciplinary medical and dental approach, with confirmation and management of the cause of the intrinsic erosion as well as restorative dental management, together with dietary counseling to mitigate the effect of intrinsic and extrinsic sources of acid on dental hard tissue. A key lesson learned from this case is the importance of history and targeted questioning when trying to determine the cause of tooth wear dominated by intrinsic and extrinsic erosion.

Pomegranate extract on eroded dentin: antioxidant action, bond strength and morphology of the adhesive interface after aging

Objectives

This study aimed to evaluate the effect of pomegranate solution (Punica granatum) on eroded dentin through antioxidant action, shear bond strength (SBS) and interface morphology.

Materials and Methods

The 10% pomegranate peel extract was prepared by the lyophilization method. Punicalagin polyphenol was confirmed by high-performance liquid chromatography. Antioxidant activity was evaluated by capturing the 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical. For the SBS, 48 dentin fragments were divided into sound or eroded, and subdivided according to the pretreatment (n = 12): water or P. granatum. The surfaces were restored with self-etch adhesive and a bulk-fill resin (Ecosite; DMG). The SBS was done immediately (24 hours) and after thermal cycling + water storage (12 months). For scanning electron microscopy, 48 dentin fragments (24 sound and 24 eroded) received the same treatments as for SBS (n = 6), and they were analyzed after 24 hours and 12 months.

Results

The P. granatum had antioxidant action similar (p = 0.246) to the phenolic standard antioxidants. After 24 hours, eroded dentin had lower SBS than sound dentin (p < 0.001), regardless of the pretreatment. After 12 months, P. granatum maintained the SBS of sound dentin (13.46 ± 3.42 MPa) and eroded dentin (10.96 ± 1.90 MPa) statistically similar. The lowest values were found on eroded dentin treated with water (5.75 ± 1.65 MPa) (p < 0.001). P. granatum on eroded dentin caused peritubular demineralization and hybrid layer with resin tags.

Conclusions

The pomegranate extract had antioxidant action and preserved the adhesive interface of the eroded dentin.

The potential of galactomannan from Caesalpinia ferrea on erosive dentin wear reduction in vitro

Gels containing juca seed galactomannan (JSG) were evaluated for their potential to prevent the progression of dentin erosive wear in an in vitro study with four experimental groups (n = 9). The treatments included distilled water (DW), 0.05% stannous fluoride (121 ppm F), and 0.5% or 1% JSG. The specimens underwent a cycle (3 times/day) consisting of immersion in 1% citric acid (5 minutes), treatment (5 minutes), and artificial saliva exposure (2 hours/overnight) for 5 days. Surface changes were assessed using mechanical profilometry (wear), scanning electron microscopy (SEM), and energy-dispersive X-ray spectroscopy (EDS). The data were analyzed using ANOVA followed by Tukey's post-test (p < 0.05). The negative control group exhibited the highest wear (6.0 µm ± 3.5), significantly differing from the group treated with 0.05% stannous fluoride gel (p = 0.007), which showed less dentin loss. The groups treated with 0.5% and 1% JSG showed results similar to the negative control (p = 0.661; p = 0.212, respectively) and the stannous fluoride group (p = 0.103; p = 0.379, respectively). In the SEM images, the specimen treated with stannous fluoride showed obliterated tubules, while the JSG gels formed crystals on the dentin surface, as confirmed by the presence of oxygen and calcium in the EDS analysis. Although the JSG gels showed similar results to the stannous fluoride, did not exhibit superior efficacy at the tested concentrations.

The activity, distribution, and colocalization of cathepsin K and matrix metalloproteases in intact and eroded dentin

OBJECTIVES

This study aimed to assess the activity, distribution, and colocalization of cathepsin K (catK) and matrix metalloproteases (MMPs) in both intact and eroded dentin in vitro.

MATERIALS AND METHODS

Eroded dentin was obtained by consecutive treatment with 5% citric acid (pH = 2.3) for 7 days, while intact dentin remained untreated. Pulverized dentin powder (1.0 g) was extracted from both intact and eroded dentin using 5 mL of 50 mM Tris-HCl buffer (0.2 g/1 mL, pH = 7.4) for 60 h to measure the activity of catK and MMPs spectrofluorometrically. In addition, three 200-μm-thick dentin slices were prepared from intact and eroded dentin for double-labeling immunofluorescence to evaluate the distribution and colocalization of catK and MMPs (MMP-2 and MMP-9). The distribution and colocalization of enzymes were analyzed using inverted confocal laser scanning microscopy (CLSM), with colocalization rates quantified using Leica Application Suite Advanced Fluorescent (LAS AF) software. One-way analysis of variance (ANOVA) was used to analyze the fluorescence data related to enzyme activity (α = 0.05).

RESULTS

The activity of catK and MMPs was significantly increased in eroded dentin compared with intact dentin. After erosive attacks, catK, MMP-2, and MMP-9 were prominently localized in the eroded regions. The colocalization rates of catK with MMP-2 and MMP-9 were 13- and 26-fold higher in eroded dentin, respectively, than in intact dentin.

CONCLUSIONS

Erosive attacks amplified the activity of catK and MMPs in dentin while also altering their distribution patterns. Colocalization between catK and MMPs increased following erosive attacks.

CLINICAL RELEVANCE

CatK, MMP-2, and MMP-9 likely play synergistic roles in the pathophysiology of dentin erosion.

Risk factors of tooth wear in permanent dentition: A scoping review

BACKGROUND

Tooth wear (TW) prevalence is high and increasing and has important consequences on the patient's quality of life. Knowledge of risk factors is crucial to promote diagnosis, prevention strategies and timely interceptive treatment. Many studies have identified TW risk factors.

OBJECTIVE

This scoping review aims to map and describe suspected available factors associated with TW in permanent dentition based on quantitative measurement.

METHODS

The scoping review was conducted using the PRISMA extension of the Scoping Reviews checklist. The search was conducted in October 2022 from the Medline® (PubMed® interface) and Scopus® databases. Two independent reviewers selected and characterised the studies.

RESULTS

2702 articles were identified for assessment of titles and abstracts, and 273 articles were included in the review. The results show a need to standardise TW measurement indices and the study design. The included studies highlighted various factors, classified into nine domains: sociodemographic factors, medical history, drinking habits, eating habits, oral hygiene habits, dental factors, bruxism and temporomandibular disorders, behavioural factors, and stress. Results related to chemical TW (erosion) risk factors underline the importance of eating disorders, gastroesophageal reflux and lifestyle, particularly drinking and eating behaviours, which supports developing public health information campaigns and interventions. Besides chemical, this review identifies evidence of several mechanical TW risk factors, such as toothbrushing and bruxism; the influence of this last factor needs to be further explored.

CONCLUSIONS

TW management and prevention require a multidisciplinary approach. Dentists are in the first line to detect associated diseases such as reflux or eating disorders. Consequently, practitioners' information and guideline diffusion should be promoted, and a TW risk factors checklist (the ToWeR checklist) is proposed to help diagnostic approaches.

Eating Disorders and Dental Erosion: A Systematic Review

Both eating disorders and dental erosion are increasingly affecting adolescents and young adults. Thus, our systematic review was designed to answer the question: "Is there a relationship between dental erosion and eating disorders?" Following the inclusion and exclusion criteria, 31 studies were included in this systematic review (according to the PRISMA statement guidelines). Based on the meta-analysis, 54.4% of patients with bulimia nervosa and 26.7% with anorexia nervosa experienced tooth erosion. For the whole group of 1699 patients with eating disorders, erosive lesions were observed in 42.1% of patients. Bulimics were more than 10 times more likely to experience dental erosion compared to healthy individuals (OR = 10.383 [95%CI: 4.882-22.086]). Similarly, more than 16 times increased odds of tooth erosion were found in patients with self-induced vomiting (OR = 16.176 [95%CI: 1.438-181.918]). In conclusion, eating disorders are associated with an increased risk of developing erosive lesions, especially in patients with bulimia nervosa.

Combined use of stannous fluoride-containing mouth rinse and toothpaste prevents enamel erosion in vitro

OBJECTIVE

To compare the protective effect of commercial stannous-containing mouth rinses on enamel erosion in a simulated 5-day in vitro cycling model.

MATERIALS AND METHODS

81 human enamel specimens were embedded in resin blocks and divided into nine groups as follows; group 1: stannous fluoride (1000SnF2) toothpaste; groups 2,3, and 4 were the same as group 1 plus Elmex®, PerioMed™, and Meridol®, respectively, group 5: stannous fluoride (1450SnF2) toothpaste, groups 6, 7, and 8 were the same as group 5 plus Elmex®, PerioMed™, and Meridol®, respectively, group 9: negative control. An erosive challenge was induced with a 1 min hydrochloric acid (0.01 M, pH 2.2) treatment 3 times per day. Each cycle included immersing in the toothpaste slurry twice for two minutes and a one-minute rinse. The enamel slabs were immersed in artificial saliva between each erosive cycle and incubated overnight at 37 °C. Surface hardness loss and enamel loss were determined by Knoop surface hardness and non-contact profilometry, respectively. Finally, enamel surfaces were analyzed by scanning electron microscopy and X-ray energy dispersive spectroscopy (SEM/EDS).

RESULTS

All three mouth rinses had similar protective effects against erosion when using adjunct with 1000 SnF2 toothpaste (p > 0.05). With 1450 SnF2 toothpaste, Elmex® presented significantly lower surface hardness loss than Meridol® (p < 0.05). The combined use of Elmex® or PerioMed™ with toothpaste provided significantly better erosion protection than toothpaste alone, either 1000 or 1450 SnF2. In addition, 1000SnF2 toothpaste adjunct with mouth rinse is comparable to 1450 SnF2 toothpaste alone in preventing enamel erosion.

CONCLUSION

All three mouth rinses reduced enamel erosion. The additional use of a high concentration stannous containing mouth rinse with 1450 SnF2 toothpaste increases the protective effect against enamel erosion in vitro.

CLINICAL SIGNIFICANCE

To date, no standard protocol for preventing dental erosion is available. There are three stannous-containing mouth rinses on the market; however, no study compared their efficacy or indicated whether using adjuncts with anti-erosion toothpaste provides additional benefits. This study found that adding stannous mouth rinse to twice-daily toothpaste increases erosion protection.

The challenge of dietary management in soft drink consumption and its oral and systemic repercussions

Background:Soft drinks are drinks high in sugar and acidity, but low in nutritional benefits. Despite its great popularity, its consumption is alerted due to the numerous systemic harm caused. Aim:This work aims to provide information and critically review the literature on the risk of soft drink consumption in an integrative view with nutritional, dental, and medical aspects. Methods:A search was carried out based on the identification of the theme, determination of inclusion and exclusion criteria, selection of databases for research and, finally, the reading, interpretation, and discussion of the selected sources. A search was conducted using the keywords: "soft drinks" AND "obesity" OR "dental erosion" OR "diabetes" OR "hypertension" OR "mental health" OR "multimorbidities" in databases PubMed, SciELO, and LILACS between 2017 and 2022. Results:Seventy-six studies were included in the article after the qualitative synthesis. Conclusion:We conclude that the high consumption of soft drinks is associated with oral and general diseases. Therefore, a multi-professional approach to guide patients to moderate the consumption of these beverages is extremely important.

In vitro study on the preventive effect of children's toothpastes on erosive tooth wear of primary bovine enamel and dentin

This in vitro study aimed to analyse the effect of various children's toothpastes on erosive tooth wear of primary bovine enamel and dentin. Enamel and dentin specimens (n = 12) were cyclically eroded (6 × 60 s/d, citric acid, pH 2.4) and brushed (2 × 15 s/d, 2 N) over 5 days. Nine fluoride toothpastes (500 to 1450 ppm) and eight toothpastes containing no fluoride or other active ingredients (hydroxyapatite and/or xylitol) were tested. Unbrushed specimens served as control. Tissue loss was quantified using widefield confocal microscopy and statistically analysed using two-way and one-way ANOVAs followed by Scheffe's (enamel) or Tamhane's (dentin) post-hoc tests (p < 0.05). Only one fluoride toothpaste (1400 ppm) was able to reduce erosive wear of enamel significantly by 15% compared to the control (p_adj. = 0.002). All fluoridated toothpastes reduced dentin surface loss significantly by 32 to 69% compared to the control (p_adj. ≤ 0.001), while fluoride-free toothpastes were unable to reduce dentin loss significantly (p_adj. ≥ 0.971). Most fluoridated toothpastes caused less erosive wear compared to fluoride-free toothpastes. Children toothpastes containing fluoride were more effective in reducing erosive wear compared to toothpastes containing no fluoride or other active ingredients.

Remineralization Effect of Calcium Glycerophosphate in Fluoride Mouth Rinse on Eroded Human Enamel: An In Vitro Study

Aims and Objectives

The aim of this in vitro study was to evaluate the remineralization effect of calcium glycerophosphate (CaGP) in fluoride mouth rinse on permanent enamel eroded by a soft drink.

Materials and Methods

Forty sound permanent premolars were embedded in self-curing acrylic resin and immersed in Coca-Cola to create erosive lesions. The teeth were divided into four groups (n = 10): Group I artificial saliva; Group II sodium fluoride; Group III sodium fluoride + sodium monofluorophosphate; and Group IV sodium monofluorophosphate + CaGP. The specimens in the assigned groups underwent pH cycling for ten days. The baseline, after erosion, and after remineralization surface microhardness (SMH) values were determined. The data were analyzed by one-way analysis of variance (ANOVA). The mean SMH value between groups and one-way repeated measures ANOVA for the mean SMH value within each group and Bonferroni's for multiple comparisons at a 95% confidence level were determined. The average SMH was used and calculated as the percentage recovery of SMH.

Results

After being eroded by the cola soft drink, the mean SMH values in all groups were significantly decreased. After remineralization, Group I had the lowest %SMHR. The %SMHR of Groups II, III, and IV were significantly higher than Group I (P < 0.001). However, there were no significant differences among Groups II, III, and IV (P > 0.05).

Conclusions

Fluoride mouth rinse with and without CaGP showed similar efficacies in remineralizing eroded permanent enamel.

Intraoral scanner-based monitoring of tooth wear in young adults: 24-month results

OBJECTIVES

Tooth wear causes irreversible cumulated surface loss and already occurs at a young age. Therefore, the objective of this clinical prospective observational study was to monitor the occlusal surface of a mandibular first molar in young adults for a period of 24 months. Furthermore, potential aetiological factors obtained by a questionnaire were considered.

MATERIALS AND METHODS

The study teeth (FDI #36 or #46) of 81 participants (mean age 22.8 ± 2.2 years) were scanned with the intraoral scanner (IOS, Trios 3, 3Shape) at the second follow-up (T2) after an observation period of 24 months. Standard-tessellation-language datasets were superimposed with baseline (T0) and T2 scans in 3D analysis software (GOM Inspect). The maximum vertical substance loss was measured between T0 and T2 at 6/7 areas (4/5 cusps and 2 ridges) of each study tooth and data compared to the already published data of the first follow-up (T1) after 12-month observation period. The morphology of tooth wear was classified into three groups: cupping (C), facet (F) and combined cupping-facet (CF). The analysis of aetiological factors, such as acid impacts, was based on a questionnaire filled out by participants at time points T0, T1 and T2. Non-parametric tests were used for statistical analysis (p < 0.05).

RESULTS

The buccal load-bearing cusps (mesiobuccal: median 15 μm, 95%CI 11/18 μm; mesiolingual 8 μm, 0/11 μm) were most affected by tooth wear. Loss values increased significantly at T2 compared to T1 for all areas, although significantly less than in the first 12 months (T0-T1). Areas that already exhibited F at T0 mostly displayed them also at T2 and only rarely developed further into C or CF. The only association between aetiological factors and loss values could be detected for sex as males had significantly higher loss values than females.

CONCLUSIONS

Progression of tooth wear could be clearly shown with high interindividual variations in loss values among participants. This indicates the need for individual monitoring with IOS.

CLINICAL RELEVANCE

IOSs show the potential for patient-specific monitoring to detect the progression of tooth wear. Thus, data of 24 months fills the gap of tooth wear data for young adults in literature. Further studies over a longer observation period are highly recommended to gain more information about the dynamic of tooth wear and aetiological factors.

Fluid Intake and the Occurrence of Erosive Tooth Wear in a Group of Healthy and Disabled Children from the Małopolska Region (Poland)

Background: The aim of this study was to analyse the relationship between the type and amount of fluid intake and the incidence of erosive tooth wear in a group of healthy children and children with disabilities. Methods: This study was conducted among children aged 6-17 years, patients of the Dental Clinic in Kraków. The research included 86 children: 44 healthy children and 42 children with disabilities. The prevalence of erosive tooth wear using the Basic Erosive Wear Examination (BEWE) index was assessed by the dentist, who also determined the prevalence of dry mouth using a mirror test. A qualitative-quantitative questionnaire on the frequency of consumption of specific liquids and foods related to the occurrence of erosive tooth wear, completed by the children's parents, was used to assess dietary habits. Results: The occurrence of erosive tooth wear was determined for 26% of the total number of children studied, and these were mostly lesions of minor severity. The mean value of the sum of the BEWE index was significantly higher (p = 0.0003) in the group of children with disabilities. In contrast, the risk of erosive tooth wear was non-significantly higher in children with disabilities (31.0%) than in healthy children (20.5%). Dry mouth was significantly more frequently identified among children with disabilities (57.1%). Erosive tooth wear was also significantly more common (p = 0.02) in children whose parents declared the presence of eating disorders. Children with disabilities consumed flavoured water or water with added syrup/juice and fruit teas with significantly higher frequency, while there were no differences in quantitative fluid intake between groups. The frequency and quantity of drinking flavoured waters or water with added syrup/juice, sweetened carbonated, and non-carbonated drinks were associated with the occurrence of erosive tooth wear for all children studied. Conclusions: The group of studied children presents inappropriate drinking behaviours regarding the frequency and amount of beverages consumed, which, especially in a group of children with disabilities, may contribute to the formation of erosive cavities.

Do matrix metalloproteinase and cathepsin K inhibitors work synergistically to reduce dentin erosion?

OBJECTIVES

To evaluate the effects of matrix metalloproteinase (MMP) and cathepsin K (catK) inhibitors on resistance to dentin erosion.

METHODOLOGY

A total of 96 dentin specimens (3×3×2 mm) were prepared and randomly assigned into four groups (n=24): deionized water (DW); 1 µM odanacatib (ODN, catK inhibitor); 1 mM 1,10-phenanthroline (PHEN, MMP inhibitor); and 1 µM odanacatib + 1 mM 1,10-phenanthroline (COM). Each group was further divided into two subgroups for the application of treatment solutions before (PRE) and after erosive challenges (POST). All specimens were subjected to four daily erosive challenges for 5 d. For each erosive challenge, the specimens in subgroup PRE were immersed in the respective solutions before cola drinks, while the specimens in subgroup POST were immersed in the respective solutions after cola drinks (the immersion duration was 5 min in both cases). All specimens were stored in artificial saliva at 37°C between erosive challenges. The erosive dentin loss (EDL) was measured by profilometry. The residual demineralized organic matrix (DOM) of specimens was removed using type VII collagenase and evaluated by profilometry. Both the EDL and thickness of the residual DOM were statistically analyzed by two-way analysis of variance (ANOVA) and Bonferroni's test (α=0.05). The surface topography and transverse sections of the specimens were observed using SEM. MMPs and catK were immunolabeled in the eroded dentin and in situ zymography was performed to evaluate the enzyme activity.

RESULTS

Significantly lower EDL was found in the groups ODN, PHEN, and COM than in the control group (all p<0.05), while no significant difference in EDL was found among the groups ODN, PHEN, and COM (all p>0.05). The application sequence showed no significant effect on the EDL of the tested groups (p=0.310). A significantly thicker DOM was observed in the group ODN than in the control group regardless of the application sequence (both p<0.05). The treatment with ODN, PHEN, and COM inhibited the gelatinolytic activity by approximately 46.32%, 58.6%, and 74.56%, respectively.

CONCLUSIONS

The inhibition of endogenous dentinal MMPs and catK increases the acid resistance of human dentin but without an apparent synergistic effect. The inhibition of MMPs and catK is equally effective either before or after the acid challenge.

Prevalence of tooth wear and associated factors: A birth cohort study

OBJECTIVES

To investigate the prevalence of tooth wear and associated factors in adults from the 1982 Pelotas Birth Cohort.

METHODS

A subsample of the 5,914 individuals from the 1982 Pelotas Birth Cohort was randomly selected to be interviewed and clinically examined at the age of 31. Tooth wear was evaluated using a simplified version of the Tooth Wear Index (TWI), considering the absence or presence of tooth wear in dentin of first molars and anterior teeth (incisors and canines). Independent variables were socioeconomic, demographic, unhealthy behavior, and mental health. Crude and adjusted Poisson regression models were employed. A significant level of P ≤ 0.05 was adopted.

RESULTS

A total of 537 individuals were evaluated. A tooth wear prevalence of 61.6% was observed. Females presented a statistically significant lower tooth wear in dentin prevalence ratio (PR) compared to males in the adjusted analysis (PR 0.76; 95% CI: 0.67-0.86). Acid beverage consumption (PR 1.22; 95% CI: 1.01-1.49) and consumption of alcoholic beverages (PR 1.19; 95% CI: 1.04-1.35) were positively associated with tooth wear.

CONCLUSION

Almost 2/3 of the surveyed individuals presented tooth wear in dentin. Being a male, higher consumption of alcohol and acidic beverages were factors associated with tooth wear.

CLINICAL SIGNIFICANCE

There was a high prevalence of tooth wear in dentin in the adult population. Data has also shown the etiological complexity of tooth wear, reinforcing the importance of an early diagnosis and the establishment of preventive measures to decrease the potentially hazardous effect of tooth wear over time.

Assessment of the Erosive Potential of Mineral Waters in Bovine Dental Enamel

Background:

High intake of acidic foods and beverages has been often associated with the onset of dental erosive wear.

Objetive:

This study in vitro assessed the pH of different mineral waters marketed in Brazil and their effects on the properties and surface of dental enamel.

Methods:

Forty-eight bovine incisor specimens were divided into four groups (n=12): CG-control group, PeG-Perrier, PrG-Prata, and SLG-São Lourenço. The immersion cycles were performed after analysis of the pH of the waters, for 5 days (5 minutes in mineral water and 60 minutes in artificial saliva). Knoop micro-hardness was assessed by means of three indentations with a load of 50kgf for 15 seconds, and surface roughness with a cut off of 0.25mm. The data were analysed using Student's t-test, ANOVA, and Tukey test, with a significance level of 5%.

Results:

The groups of waters with lower pH (Perrier® and São Lourenço®) exhibited a reduction in Knoop micro-hardness (p<0.0001) and an increase in surface roughness (p=0.04 and p=0.004, respectively). The Prata water group did not exhibit significant changes in Knoop micro-hardness (p=0.07) and surface roughness (p=0.26).

Conclusion:

Mineral waters with a pH below the critical value can lead to a reduction in surface hardness and roughness in the bovine enamel.

Soft drinks and dental erosion during pediatric age: a clinical investigation

BACKGROUND

Dental erosion is an irreversible condition of loss of teeth hard tissues caused by intrinsic or extrinsic acids attack, without bacterial involvement. Common soft drinks have an acid pH and they release hydrogen ions and act as chelating agents, dissolving teeth mineral component. The aim of the study was to investigate the correlation between the consumption of soft drinks in children and the degree of dental erosion.

METHODS

A questionnaire of 15 multiple choice questions was addressed to the parents of the 231 children needing different dental treatments. Responses were compared with the level of dental erosion of their child, that was clinically investigated using the Basic Erosive Wear Examination (BEWE) index.

RESULTS

About 26.8% of subjects fall into a high-risk category of dental erosion while 24.2% in a low risk level. Socioeconomic status and oral hygiene habits are able to affect the degree of dental erosion. Toothpastes containing fluoride have not proved effective in preventing this phenomenon and no significant correlations were found between the type of toothbrush used and its frequency of use.

CONCLUSIONS

It is necessary to apply preventive measures such as information on the processes and causes of erosion, instruction about right home oral hygiene maneuvers and the possible use of specific products, to avoid the development of problems related to severe dental wear.

Tooth Wear and Tribological Investigations in Dentistry

Dental or tooth wear is a physiological process in the life cycle of teeth. Loss of the occlusal surface may cause excessive tooth wear. Several factors may contribute to tooth wear with different intensities and duration in the oral cavity. The oral cavity is generally compared to a tribological system to determine the various types of wear between teeth and restorative materials and assess the amount of dental wear. However, it is challenging to investigate in vitro and in vivo wear owing to the complexity of tooth wear; thus, a clear correlation between in vitro and in vivo data could not be established. This review is aimed at providing an insight into the etiology of tooth wear and tribological investigations in dentistry.

Knowledge about caries and erosive tooth wear is confused among Norwegian high school students

OBJECTIVES

This study investigated differences in high school students' subjective and objective knowledge- and concerns about preventing caries and/or erosive tooth wear and the associations between these variables.

MATERIALS AND METHODS

A survey was conducted among students at 16 high schools in Norway. The survey included a range of fact-based questions to measure objective knowledge about caries and erosive tooth wear, as well as questions about students' perceptions of his/her own knowledge (subjective knowledge) and concerns about preventing the two conditions.

RESULTS

There were small differences in subjective knowledge about caries and erosive tooth wear among the 784 students who completed the survey (p < .01). However, students scored significantly higher on objective knowledge about caries (mean 2.99) than about erosive tooth wear (mean 1.45), p < .01, and seemed to confuse the two conditions. By contrast, students scored significantly worse on questions about beverages' potential to cause caries (mean 5.18) than to cause erosive tooth wear (mean 6.30), p < .001. Finally, objective knowledge about caries was positively associated with subjective knowledge about caries, but corresponding associations could not be found for erosive tooth wear.

CONCLUSIONS

Knowledge about caries and erosive tooth wear seemed to be confused among Norwegian high school students.

The Suitability of Questionnaires for Exploring Relations of Dietary Behavior and Tooth Wear

Tooth wear is a relevant oral health problem, especially at a young age. Although ongoing acid exposures may contribute to tooth wear, the role of acidic dietary components in this context remains unclear. To date, in tooth wear studies, dietary behavior has been assessed using traditional questionnaires, but the suitability of this approach has not been investigated so far. In our longitudinal study, we followed 91 participants (21.0 ± 2.2 years) over a period of 1 year (373 ± 19 days) and monitored tooth wear with an intraoral scanner. At baseline (T0) and at the end (T1), we assessed dietary behavior with questionnaires asking about the consumption frequencies of acidic dietary components and the acid taste preferences. Complete data were available from 80 subjects. The consumption frequencies of T0 and T1 correlated weakly to moderately. Taste preferences seem to be a more consistent measure, but there was predominantly no significant correlation with the corresponding consumption frequencies. None of the dietary parameters showed a significant relation with tooth wear. The suitability of dietary questionnaires to assess tooth-relevant dietary behavior seems to be limited.

Prevalence and Associated Factors of Erosive Tooth Wear among Preschool Children-A Systematic Review and Meta-Analysis

The prevalence of dental erosion among preschool children and its associated factors range widely between studies. The aims of this review are to evaluate the literature and to determine the prevalence and associated factors of dental erosion among children below 7 years old. An electronic search was undertaken to identify observational studies evaluating the prevalence of dental erosion and its associated factors in children below 7 years old. Dual independent screening, data extraction, risk of bias assessment, meta-analysis, meta-regression, and evaluation of quality of evidence were performed. Twenty-two papers were included. The overall estimated prevalence of dental erosion in children was 39.64% (95% CI: 27.62, 51.65; I2 = 99.9%), with very low certainty of evidence. There was also low-quality evidence suggesting that the likelihood of (1) boys having dental erosion was significantly higher than girls (p < 0.001) and (2) children with digestive disorders having dental erosion was significantly higher than those without such digestive disorders (p = 0.002). Qualitative synthesis identified that more frequent intake of fruit juices and soft drinks correlated with erosive tooth wear. Dental erosion is prevalent among over one-third of preschool children. Digestive disorders and dietary factors are the main potential contributing factors.

Pathophysiology of Demineralization, Part I: Attrition, Erosion, Abfraction, and Noncarious Cervical Lesions

PURPOSE OF THE REVIEW

Compare pathophysiology for infectious and noninfectious demineralization disease relative to mineral maintenance, physiologic fluoride levels, and mechanical degradation.

RECENT FINDINGS

Environmental acidity, biomechanics, and intercrystalline percolation of endemic fluoride regulate resistance to demineralization relative to osteopenia, noncarious cervical lesions, and dental caries. Demineralization is the most prevalent chronic disease in the world: osteoporosis (OP) >10%, dental caries ~100%. OP is severely debilitating while caries is potentially fatal. Mineralized tissues have a common physiology: cell-mediated apposition, protein matrix, fluid logistics (blood, saliva), intercrystalline ion percolation, cyclic demineralization/remineralization, and acid-based degradation (microbes, clastic cells). Etiology of demineralization involves fluid percolation, metabolism, homeostasis, biomechanics, mechanical wear (attrition or abrasion), and biofilm-related infections. Bone mineral density measurement assesses skeletal mass. Attrition, abrasion, erosion, and abfraction are diagnosed visually, but invisible subsurface caries <400μm cannot be detected. Controlling demineralization at all levels is an important horizon for cost-effective wellness worldwide.

Efficacy of Two Toothpaste in Preventing Tooth Erosive Lesions Associated with Gastroesophageal Reflux Disease

Patients suffering from acid reflux due to endogenous causes are often affected by gastroesophageal reflux disease which, in the oral environment, causes lingual and palatal enamel erosion. As enamel does not have the intrinsic ability to repair itself, the application of alloplastic materials, such as toothpastes is suggestable. The aim of this “in vitro” study was to compare the effectiveness of two different toothpastes in preventing erosion due to gastroesophageal reflux disease. Six tooth elements from bovine jaws were prepared using a high-speed diamond bur and water irrigation. Acid attack simulation was carried out using a 15% HCl hydrochloric acid solution. After that, two different toothpastes with or without fluoride, were brushed at the sample surface using an electric toothbrush at standard position and force. SEM and profilometer analysis were performed. Statistically significant difference was found in average tooth surface roughness after using toothpaste with or without fluoride after the acid attack, as the former offered a greater remineralization. No difference was found in long-term prevention. Fluoridated toothpastes offer a greater degree of remineralization at a first acid attack, however, there is no difference in long-term prevention independently from the toothpaste type.

In vitro comparison of the erosive potential of four different wines on human dental enamel

Background/Aim: This study aimed to investigate the erosive potential of wines derived from Anatolia on human teeth in vitro. Material and Methods: In this study two red (Öküzgözü, Boğazkere) and two white (Sultaniye, Narince) wines, citric acid and distilled water were used to investigate erosive effects. The pH, titratable acidity, iron and calcium ion levels of the groups were measured. Each group included 10 specimen and they were exposed to 25 ml of wine sample for 5 seconds, artificial saliva for 10 seconds for 10 times. The initial and the final phosphate concentrations were measured by the UV spectrophotometer and the difference between the measurements was calculated. One sample was examined under a scanning electron microscope and the data were analyzed statistically using One-way ANOVA and Pearson correlation test. Results: Mineral loss and erosive lesion depth values were ranged from highest to the lowest Sultaniye, Boğazkere, Öküzgözü and Narince, respectively. Correlation between mineral loss and pH was statistically significant (p<0.01). However, there was no correlation between the iron and calcium ion level and mineral loss. Conclusions: All the investigated wines have pH values below the critical value for enamel dissolution while Sultaniye was significantly more erosive than the others. There is a negative correlation between pH and erosive potential of the wine. Within the limits of this in vitro study, it can be expected that a regular consumption of wines might cause dental erosion.

Current Systems-Level Evidence on Nutrition Interventions to Prevent and Treat Cardiometabolic Risk in the Pediatric Population: An Evidence Analysis Center Scoping Review

Improving and maintaining cardiometabolic health remains a major focus of health efforts for the pediatric population. Recent research contributes understanding of the systems-level nutrition factors influencing cardiometabolic health in pediatric individuals. This scoping review examines current evidence on interventions and exposures influencing pediatric cardiometabolic health to inform registered dietitian nutritionists working at each systems level, ranging from individual counseling to public policy. A literature search of MEDLINE, CINAHL, Cochrane Databases of Systematic Reviews, and other databases was conducted to identify evidence-based practice guidelines, systematic reviews, and position statements published in English from January 2017 until April 2020. Included studies addressed nutrition interventions or longitudinal exposures for participants 2 to 17 years of age who were healthy or had cardiometabolic risk factors. Studies were categorized according level of the social-ecological framework addressed. The databases and hand searches identified 2614 individual articles, and 169 articles were included in this scoping review, including 6 evidence-based practice guidelines, 141 systematic reviews, and 22 organization position statements. The highest density of systematic reviews focused on the effects of dietary intake (n = 58) and interventions with an individual child or family through counseling or education (n = 54). The least frequently examined levels of interventions or exposures were at the policy level (n = 12). Registered dietitian nutritionists can leverage this considerable body of recent systematic reviews to inform a systems-level, collaborative approach to prevention and treatment of pediatric cardiometabolic risk factors.

A digital workflow with the virtual enamel evaluation and stereolithographic template for accurate tooth preparation to conservatively manage a case of complex exogenous dental erosion

OBJECTIVE

This article describes a digital workflow using virtual enamel evaluation and a stereolithographic template for accurate tooth preparation for a complex exogenous dental erosion.

CLINICAL CONSIDERATIONS

A 22-year-old man with different degrees of defects on the labial surface in esthetic area was diagnosed as exogenous dental erosion. The residual undamaged enamel area and depth of defect were measured and analyzed accurately by creating a digital virtual patient based on the pretreatment data. According to the different conditions of residual enamel and tooth defect, the treatment plans of porcelain veneer, crown and composite resin were chosen for corresponding involved teeth. Based on the virtual wax-up and the suggested material thickness, a template for tooth preparation was designed and three-dimensional printed. This template together with a special bur indicating the reduction depth accurately guided the teeth preparation and achieved a long-term effect.

CONCLUSIONS

The virtual enamel evaluation contributes to obtaining the appropriate corresponding treatment plan objectively. The stereolithographic template effectively meets the accuracy of tooth preparation, preserving the tooth hard tissue to the greatest extent.

CLINICAL SIGNIFICANCE

The digital workflow described here may provide a quantifiable evaluation method and an accurate tooth preparation method for exogenous dental erosion.

Intraoral scanner-based monitoring of tooth wear in young adults: 12-month results

OBJECTIVES

To investigate tooth wear in young adults, intraoral scanning was used for digital monitoring of the mandibular first molar over 12 months. A possible influence of aetiological factors obtained by a questionnaire on tooth wear was investigated.

MATERIALS AND METHODS

A total of 109 participants (mean age at the start of the study: 21.0 ± 2.2 years) were included in this clinical study. At baseline (T0), an intraoral scan (Trios 3, 3Shape) of the study tooth (FDI # 36 or #46) was conducted. After a mean observation period of 373 ± 19 days, a second intraoral scan (T1, n = 94) of the same tooth as at T0 was performed and standard tessellation language datasets were superimposed with 3D analysis software (GOM Inspect). The occlusal surface of the study tooth was divided into 7 areas (5 cusps, 2 ridges) and maximum vertical substance loss was measured between T0 and T1 (n = 91). Three types of tooth wear were defined: cupping (C), facet (F) and combined cupping-facet (CF). Furthermore, a questionnaire on aetiological factors, such as dietary behaviour, was filled out at T0. Data were analysed with non-parametric tests (p < 0.05).

RESULTS

Only one study tooth exhibited no tooth wear at T0, whereas 3 teeth showed C, 47 teeth F and 40 teeth CF. A progression of vertical substance loss for all three types was shown. Most affected were the mesiobuccal cusps (43, 38/47 µm; median, 95%CI) followed by distobuccal (36, 33/39 µm), mesiolingual (35, 26/40 µm), distolingual (34, 27/36 µm) and distal (31, 25/34 µm). On mesial and distal ridges, only F was detected with the lowest vertical substance loss of all areas (mesial ridge: 0, 0/0 µm; distal ridge: 0, 0/0 µm). An association between aetiological factors and loss values could not be shown.

CONCLUSIONS

All study teeth showed clear signs of wear, and after only 1 year, further substance loss was detectable. This result is of significance for young adults.

CLINICAL RELEVANCE

Since data of young adults regarding tooth wear are scarce, the results give a first idea of the amount of vertical loss per year and its relation to aetiological factors such as dietary behaviour. Therefore, further studies over a longer observation period are highly recommended.

Influence of Low-pH Beverages on the Two-Body Wear of CAD/CAM Monolithic Materials

The aim of this in vitro study is to evaluate the effect of different acidic media on volumetric wear and surface roughness of CAD/CAM monolithic materials. Forty-eight rectangular specimens were prepared using different CAD/CAM monolithic materials: nanohybrid composite (Grandio Blocks, Voco), resin-based composite (Cerasmart, GC), lithium disilicate (E-Max, Ivoclar), and high-translucency zirconia (Katana STML, Kuraray Noritake). After storage in distilled water at 37 °C for two days, the specimens were tested using a chewing machine with a stainless-steel ball as an antagonist (49N loads, 250,000 cycles). Testing was performed using distilled water, Coca-Cola, and Red Bull as abrasive media. Wear and surface roughness analyses of the CAD/CAM materials were performed using a 3D profilometer and analyzed with two-way analysis of variance and post hoc pairwise comparison procedures. Worn surfaces were examined using scanning electron microscopy. Resin-based materials suffered higher volumetric wear than ceramics (p = 0.00001). Water induced significantly less volumetric wear than the other tested solutions (p = 0.0014), independent of the material tested. High-translucency zirconia showed less surface roughness than all the other materials tested. The selection of monolithic CAD/CAM materials to restore worn dentition due to erosive processes could impact restorative therapy stability over time. Resin-based materials seem to be more influenced by the acidic environment when subjected to a two-body wear test.