Dental erosion and aspirin headache powders: a clinical report

The Prevalence of Tooth Wear and Their Associated Etiologies Among Adult Subjects Visiting Umm Al-Qura University Dental Clinic in Makkah City, Saudi Arabia

In the past two decades, changing trends in socioeconomic status, dietary habits, and individual lifestyles of individuals have led to the emergence of tooth wear as an oral health problem. The present study aimed to investigate the prevalence and the associated etiologies of tooth wear in a convenience sample of adult patients visiting outpatient clinics of the Faculty of Dentistry at Umm Al-Qura University. This cross-sectional study was conducted on adult patients (18-40 years old) visiting outpatient clinics of the Faculty of Dentistry, Umm Al-Qura University. Two trained examiners visually assessed patients' tooth wear using Smith and Knight's Tooth Wear Index (TWI). Following the clinical examination, patients completed a self-administered questionnaire detailing risk factors such as the frequency of intake of acidic food and medicines, general health, chewing habits, dietary factors, and oral health-associated preventive behaviors. The resulting collected data were tabulated and statistically analyzed using Statistical Product and Service Solutions (SPSS, version 21; IBM SPSS Statistics for Windows, Armonk, NY). The total prevalence of tooth wear was 74%, and the recorded mean wear score (TWI) was 0.380 ± 0.386; anterior teeth exhibited greater wear than posterior teeth. Numerous associations were recorded between tooth wear and the tested variables in demographics, habits, diet, and medications, but most of them were not statistically significant. When toothbrushing habits were explored, the only factors to played a significant role in abrading the tooth structure were the type of brush bristles used (P-value = 0.026) and the frequency of brush renewal (P = 0.043). Patients who frequently ate citrus fruits and other acidic foods recorded high wear scores (0.509 ± 0.311 and 0.508 ± 0.402, respectively), although the difference was not statistically significant. When chewing occurred on both sides of the mouth, less tooth wear was recorded than if chewing was on the right or left side only (0.371 ± 0.260, 0.422 ± 0.273, and 0.520 ± 0.419, respectively). The study data support an association between tooth wear and patient occupation, use of hard-bristled and new toothbrushes, eating of citrus and other acidic food, and chewing on one side, as all of these factors increased the risk of tooth wear.

Introspection of the Etiopathological Mechanisms Underlying Noncarious Cervical Lesions: Analysis of the Different Theories and Their Impact on the Mineralized Structures of the Tooth

The noncarious cervical lesions (NCCLs) recognize an etiological framework of onset very different from the carious processes with etiology whose bacteria aggregated in a biofilm play a predominant role, leading in this way to the loss of the mineralized structure of the tooth. The pathological picture of the NCCLs, which manifests itself with a clinical picture of dental wear, differs from caries because it mainly recognizes a series of pathological processes, such as erosion, through the action of generally acidic chemical agents and abrasion, which is basically expressed through repeated mechanical trauma characteristic of tooth brushing. However, in the literature, there is no unanimous agreement in identifying only these two mechanisms, but there are some who propose a more marked role of anomalous occlusal loads, which would be unloaded on some teeth which, in addition to both erosive and abrasive mechanisms, would give rise to abfraction. Therefore, the aim of this review was to collect literature etio-pathological information and discuss the mechanisms underlying NCCLs.

Are Down syndrome children more vulnerable to tooth wear?

BACKGROUND

An oral condition that has largely been ignored in the Down syndrome population is pathological tooth wear. This study is aimed to create more awareness of the reasons underlying the tooth wear observed in patients with Down syndrome and to suggest different methods to prevent this condition. This research also potentially serves as a platform for future researchers to perform an in-depth analysis of the factors we identified. The aim of this study was to determine if children with Down syndrome are more prone to tooth wear than children who do not have Down syndrome.

METHODS

Our sample consisted of 120 children with Down syndrome who were compared with 120 children with no disabilities. The parents or guardians were asked to complete a questionnaire and a 3-day diet chart, while the wear on each tooth was recorded using the standardised Simplified Smith and Knight Tooth Wear Index.

RESULTS

Children with Down syndrome experience tooth wear more frequently than non-Down syndrome children. A history of asthma, mouth breathing and gastro-oesophageal reflux disease as well as the intake of acidic diet and drinks has exerted significant effects on the prevalence of tooth wear.

CONCLUSIONS

The early diagnosis and analysis of the underlying aetiology are important for the management of tooth wear in children with Down syndrome who have shown a greater tendency to develop erosive lesions.

Prevalence and Indicators of Tooth Wear among Chinese Adults

Numerous epidemiological studies have focused on the prevalence and related indicators of tooth wear. However, no sufficient studies have been conducted with Chinese adults. The purpose of this study was to assess the prevalence of tooth wear and identify related indicators among adults aged 36 to 74 years in Wuhan City, P.R. China. A cross-sectional and analytic study was conducted with 720 participants, aged 35–49 yrs and 50–74 yrs, in 2014. Each age group included 360 participants, of which 50% were males and 50% were females. All participants completed a questionnaire before examination. Tooth wear was assessed using the modified Basic Erosive Wear Examination (BEWE) index. The data were analyzed using the chi-square test and binary logistic regression analysis. The prevalence of tooth wear was 67.5% and 100% in the 35–49 and 50–74 age groups, respectively. The prevalence of dentin exposure was 64.7% and 98.3%, respectively. A significantly higher prevalence of tooth wear and dentin exposure was found in the 50–74 yr group than in the 35–49 yr group (p < 0.05). Critical indicators of tooth wear and dentin exposure included high frequency of acidic drinks and foods consumption, low socio-economic status, and unilateral chewing. The frequency of changing toothbrushes and the habit of drinking water during meals were associated with tooth wear. In addition, the usage of hard-bristle toothbrushes and consuming vitamin C and aspirin were found to be linked with dentin exposure. In conclusion, the prevalence of tooth wear and dentin exposure observed in Chinese adults was high, and the results revealed an association between tooth wear and socio-behavioral risk indicators.

The prevalence and risk indicators of tooth wear in 12- and 15-year-old adolescents in Central China

BACKGROUND

Tooth wear has been investigated in numerous countries, and the prevalence has varied. However, the data on tooth wear in China are scarce. The aim of this study was to describe the prevalence of tooth wear and to investigate the relative indicators associated with tooth wear in 12- and 15-year-old adolescents in Wuhan City, Hubei Province, Central China.

METHODS

A cross-sectional descriptive study was undertaken among 720 adolescents in Hubei Province, Central China. The age groups in this study were 12- and 15-year-old, and each group consisted of 360 participants in which females and males represented 50 % each. A modified version of the Basic Erosive Wear Examination (BEWE) tooth wear index was used for the buccal, cervical, occlusal/incisal and lingual surfaces of all of the teeth in the 720 adolescents. All of the participants were asked to answer a questionnaire consisting of questions about their current and historical dietary habits and oral hygiene.

RESULTS

The prevalence of tooth wear was 18.6 and 89.4 % in 12- and 15-year-old adolescents, respectively. The prevalence rates of dentin exposure were 1.9 and 5.6 %, respectively. A significantly higher prevalence of tooth wear and dentin exposure in 15-year-old adolescents was found than in 12-year-old adolescents (p < 0.001 and p = 0.011). Several factors such as drinking soft drinks and fruit juices immediately after sports, taking aspirin, reflux, unilateral chewing, tooth brushing once daily or less often, duration of brushing less than 2 min and swimming in the summer were found to be associated with tooth wear.

CONCLUSIONS

Tooth wear in 12- and 15-year-old adolescents in Central China is a significant problem and should receive greater attention. The prevalence of tooth wear increases with age and associated with socio-behavioral risk factors.

Prevalence of tooth erosion and associated factors in 13-16-year old adolescents in Greece

OBJECTIVES

The aim of this study was to estimate the prevalence of dental erosion and to investigate possible associations among dental erosion and medical history, dietary and lifestyle habits in a sample of adolescents in Greece.

STUDY DESIGN

The study sample consisted of 770 adolescents, 374 boys and 396 girls aged 13 to 16 years. All individuals were clinically examined and answered questions regarding their medical history, rate and frequency of drinks and food consumption and lifestyle habits. Statistical analysis of the questionnaire items was performed by using the multiple logistic regression analysis model.

RESULTS

Two hundreds and sixty adolescents were diagnosed as having dental erosion, giving a prevalence rate 33.8%. The habit of holding drinks in the mouth before swallowing [OR=2.85, 95% CI=1.45-5.58] (p=0.002), the ingestion of acidic drinks at bedtime [OR=0.24, 95% CI=0.11-0.53] (p=0.000), the consumption of car- bonated drinks [OR=3.99, 95% CI=1.37-11.59] (p=0.011) and fruit juices [OR=0.12, 95% CI=0.04-0.38] (p=0.000) were the most important associated factors of dental erosion.

CONCLUSIONS

The prevalence of dental erosion in the study sample was 33.8% while dental erosion experience was associated with frequency and habits of consumption of some dietary components. Key words:Prevalence, tooth erosion, risk factors, adolescents.

Erosive potential of sugar free and sugar containing pediatric medicines given regularly and long term to children

OBJECTIVE

To assess the erosive potential of 94 pediatric medicines of various therapeutic groups in vitro.

METHODS

In vitro measurement of endogenous pH and titratable acidity (mmol) of 94 formulations was done. Endogenous pH was measured using a pH meter, followed by titration with 0.1-M NaOH using phenolphthalein as indicator.

RESULTS

Overall, 55 (59%) formulations had an endogenous pH of <5.5. The mean (±SD) endogenous pH and titratable acidity for 45 SC formulations were 5.52 ± 1.18 and 0.165 ± 0.131 mmol, respectively; for 49 sugars-free (SF) formulations, these figures were 5.81 ± 1.43 and 0.393 ± 1.225 mmol (P > 0.05).Compared with their SC bioequivalents, eight SF medicines showed no significant differences for pH or titratable acidity, while 10 higher-strength medicines showed lower pH (P 0.035) and greater titratable acidity (P 0.026) than their lower-strength equivalents. Chewable and dispersible tablets, gastrointestinal medicines and antibiotics were significant predictors of higher pH. In contrast, effervescent tablets, and nutrition and blood preparations were significant predictors of higher titratable acidity.

CONCLUSIONS

Pediatric SF medicines were not more erosive than SC medicines in vitro; a more significant predictor of their erosive potential was dose form. Higher the dose form more was the erosive potential of the medicine.

Dental erosion and its growing importance in clinical practice: from past to present

Since the mid-1990s, the focus of studies on tooth wear has steadily shifted from the general condition towards the more specific area of dental erosion; equally, a shift has occurred from studies in adults to those in children and adolescents. During this time, understanding of the condition has increased greatly. This paper attempts to provide a critical overview of the development of this body of knowledge, from earlier perceptions to the present. It is accepted that dental erosion has a multifactorial background, in which individual and lifestyle factors have great significance. Notwithstanding methodological differences across studies, data from many countries confirm that dental erosion is common in children and young people, and that, when present, it progresses rapidly. That the condition, and its ramifications, warrants serious consideration in clinical dentistry, is clear. It is important for the oral healthcare team to be able to recognize its early signs and symptoms and to understand its pathogenesis. Preventive strategies are essential ingredients in the management of patients with dental erosion. When necessary, treatment aimed at correcting or improving its effects might best be of a minimally invasive nature. Still, there remains a need for further research to forge better understanding of the subject.

Erosive lesions in patients with alcoholism

BACKGROUND

The authors conducted a study to determine the occurrence of erosive tooth lesions in patients with alcoholism and to establish the influence of salivary flow rates and pH levels on their appearance.

METHODS

The authors conducted a cross-sectional study in 140 participants (70 with clinically diagnosed alcoholism who were undergoing therapy for their addiction were in the test group and 70 who did not consume alcohol were in the control group). The authors determined the participants' salivary statuses by measuring the flow rates and pH levels of both unstimulated and stimulated saliva.

RESULTS

The authors found more erosive lesions in the test group (P < .01). They detected a higher number of erosive lesions in participants in the test group who had a pH range of 5 to 6 compared with a pH range of 6 to 7 (P = .01). They found a significant correlation between alcoholism and unstimulated salivary flow rate (P < .05).

CONCLUSIONS

The salivary flow rate was similar in control and test groups. The prevalence of erosion in the test group was higher than that in the control group, which may be related to the decrease in salivary pH of both stimulated and unstimulated saliva in this group. The results of the study showed no connection between erosion prevalence and pH levels and stimulated salivary flow rates.

CLINICAL IMPLICATIONS

Patients with alcoholism may be at risk of developing erosive lesions on their teeth owing to the low pH level of their oral environment and decreased saliva levels.

How valid are current diagnostic criteria for dental erosion?

In principle, there is agreement about the clinical diagnostic criteria for dental erosion, basically defined as cupping and grooving of the occlusal/incisal surfaces, shallow defects on smooth surfaces located coronal from the enamel–cementum junction with an intact cervical enamel rim and restorations rising above the adjacent tooth surface. This lesion characteristic was established from clinical experience and from observations in a small group of subjects with known exposure to acids rather than from systematic research. Their prevalence is higher in risk groups for dental erosion compared to subjects not particularly exposed to acids, but analytical epidemiological studies on random or cluster samples often fail to find a relation between occurrence or severity of lesions and any aetiological factor. Besides other aspects, this finding might be due to lack of validity with respect to diagnostic criteria. In particular, cupping and grooving might be an effect of abrasion as well as of erosion and their value for the specific diagnosis of erosion must be doubted. Knowledge about the validity of current diagnostic criteria of different forms of tooth wear is incomplete, therefore further research is needed.

Drug-induced disorders of teeth

It is essential that every health care professional who is involved with the prescription or recommendation of drugs be fully aware of any resultant disorders that may arise as a side-effect. A range of drugs can affect the teeth. In this review article, drugs that have the potential to induce changes in teeth have been classified as those leading to tooth discoloration (intrinsic and extrinsic), physical damage to tooth structure (enamel, dentin, and cementum), and alteration in tooth sensitivity.

Dental erosion due to wine consumption

BACKGROUND

Dental erosions can result from numerous causes, but extrinsic dietary factors are the most common. Because of wine's acidity, it may have a deleterious effect on teeth. Its use must be considered during an evaluation of erosive dental changes.

CASE DESCRIPTION

The author examined a 56-year-old woman because her referring dentist had noted extensive erosive loss of tooth structure, mainly enamel. The author eliminated the usual causes of dental erosion. It was only after a detailed history was obtained and dietary investigation was undertaken that the author determined that the amount, manner and timing of the patient's wine drinking was the cause of the problem.

CLINICAL IMPLICATIONS

Dentists should be aware that wine could be a cause of dental erosion. Early recognition negates progressive dental damage with its need for extensive dental restoration. Furthermore, because patients with wine-incited dental erosions consume large volumes of wine with its significant alcohol content, medical referral by the dentist for a liver assessment is indicated.

Tooth erosion caused by chewing aspirin

BACKGROUND

Although the effects of aspirin on the oral mucosa are well-documented, there is little documentation of the effects of aspirin-chewing on the enamel and dentin.

CASE DESCRIPTION

The authors present two cases of patients with damage to their tooth enamel and dentin. Both patients had similiar symptoms, but had not been told that chewing aspirin could harm tooth structure. The authors identify clinical signs and symptoms and discuss ways to prevent erosion.

CLINICAL IMPLICATIONS

The common factor in these cases is that aspirin was the only possible cause of the tooth erosion. Dentists should be aware of the effects of aspirin-chewing on tooth structure and advise their patients accordingly.

Eating disorders: dental implications

This article presents updated information on the 2 major eating disorders, anorexia nervosa and bulimia nervosa. Both conditions are found primarily in women. The eating disorders have significant morbidity and mortality associated with them. Patients are vulnerable to sudden death from cardiac arrhythmias. Suicide is a concern in some patients. The etiology of the eating disorders is unknown, but genetic, cultural, and psychiatric factors appear to play a role. Medical management may involve hospitalization to stabilize the patient, behavior modification, drugs, and psychotherapy. The long-term outcome of treatment is unclear at this time. The role of the dentist as a "case finder" is discussed. Also, the role of the dentist in restoring the dental and oral tissues to a healthy state in patients with eating disorders is presented.

Analyzing the etiology of an extremely worn dentition

Patients requiring extensive restorative care frequently exhibit significant loss of tooth structure. Specific clinical findings in an extremely worn dentition may vary widely and are often confusing. Severe wear can result from a mechanical cause, a chemical cause, or a combination of causes. The location of the wear, the accompanying symptoms and signs, and information gained from the patient interview are essential components in determining the etiology. A diagnostic decision tree facilitates a systematic analysis and diagnosis of dental wear.