Regular Physical Activity as a Potential Risk Factor for Erosive Lesions in Adolescents

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.

The Impact of Anorexia Nervosa and the Basis for Non-Pharmacological Interventions

Anorexia nervosa is a psychiatric disorder with an unknown etiology that is characterized by an individual's preoccupation with their weight and body structure while denying the severity of their low body weight. Due to the fact that anorexia nervosa is multifaceted and may indicate the coexistence of genetic, social, hormonal, and psychiatric disorders, a description of non-pharmacological interventions can be used to ameliorate or reduce the symptoms of this condition. Consequently, the purpose of the present narrative review is to describe the profile's context in the anorexic person as well as the support they would require from their family and environment. In addition, it is aimed at examining preventative and non-pharmacological interventions, such as nutritional interventions, physical activity interventions, psychological interventions, psychosocial interventions, and physical therapy interventions. To reach the narrative review aims, a critical review was conducted utilizing both primary sources, such as scientific publications, and secondary sources, such as bibliographic indexes, web pages, and databases. Nutritional interventions include nutritional education and an individualized treatment for each patient, physical activity interventions include allowing patients to perform controlled physical activity, psychological interventions include family therapy and evaluation of the existence of other psychological disorders, psychosocial interventions include management of the relationship between the patient and social media and physical therapy interventions include relaxation massages and exercises to relieve pain. All these non-pharmacological interventions need to be individualized based on each patient's needs.

Damage from Carbonated Soft Drinks on Enamel: A Systematic Review

The present study was conducted to analyze the erosive potential of the ever-increasing consumption of carbonated drinks on the dental surface. To identify relevant studies, a comprehensive search was conducted on PubMed, Scopus, and Web of Science covering the last 5 years (2018–2023) using the following Boolean keywords: “soft drinks AND tooth”. Finally, a total of 19 studies were included. The initial search provided a total of 407 items. Nineteen records were finally involved in the inclusion phase, seven of which were in vivo and twelve in vitro. An abuse of carbonated acid substances leads to an increase in the possibility of dental erosion with consequent structural disintegration and reduction of the physical and mechanical properties of the enamel. There is thus greater bacterial adhesion on rougher surfaces, determined by the erosive process, and therefore a greater risk of caries. The pH of most commercialized carbonated drinks is lower than the critical pH for the demineralization of the enamel. Carbonated drinks’ pH and duration of exposure have different deleterious effects on enamel.

Oral Cavity Clinical Evaluation in Psychiatric Patients with Eating Disorders: A Case-Control Study

Bulimia nervosa and anorexia nervosa are not the only disorders the symptoms of which may be present in the oral cavity. The assessment of the clinical condition of patients with eating disorder symptoms was aimed at in this study. The study group consisted of 60 patients with diagnoses from categories F4.xx, F5x.x, and F6x.x ICD-10 (International Classification of Diseases, Tenth Revision). Patients were qualified for the study based on the answers provided in the symptom checklists "O". An adequate control group was selected. All patients underwent a dental examination, including the assessment of API (aproximal plaque index) and DMF (decayed missing filled index). Studies have shown that patients with eating disorder symptoms were more likely to have dental erosions (in total, 28.81% of cases). The correlation of erosion with the symptoms of eating disorders was demonstrated for several assessed symptoms present in the symptom checklists "O". Such correlations have not been demonstrated in terms of gingival recession presence. The level of oral hygiene in patients with eating disorders was assessed as sufficient or bad and indicates the need to initiate dental treatment in this group. It is important to correlate the treatment of the underlying mental disease with dental treatment and regular dental checkups.

Oral Health in Patients with Inflammatory Bowel Diseases Qualified for Biologic Treatment

Oral health is closely linked to general health status in the form of a bidirectional relationship [...].

Effects of Contact Sports on Temporomandibular Disorders: An Observational Study

The study investigated the prevalence of temporomandibular disorders in 100 competitive athletes in contact sports, equally grouped by the practiced game: Soccer (SoG), Rugby (RG), American Football (AFG), Boxing (BoG), Basketball (BaG), compared to a randomly control group of 20 non-athletes (CG). Symptoms and signs were examined according to the standardized Diagnostic Criteria for Temporomandibular Disorders through a questionnaire and clinical evaluation. Arthralgia showed significant differences between RG and CG and between AFG and CG (p < 0.05). Study groups reported masticatory muscle pain during function, neck and shoulder pain more frequently than CG, except for BoG. Closing click was significantly more present in study groups than CG, while crepitation was significantly higher only in RG and AFG. The deviation was wider in SoG, RG and AFG compared to CG (p < 0.05). Tukey’s multiple comparisons test showed a statistically significant reduction in right laterotrusion in RG vs. CG (p < 0.05); the comparison showed a decrease in right laterotrusion in RG vs. SoG and BoG (p < 0.05), a decrease in endfeel in RG vs. CG, BaG and AFG (p < 0.05). The data seem to support a relationship between the prevalence of TMD symptoms and signs in competitive athletes in contact sports, especially in RG and AFG compared to CG.

Home Oral Care Domiciliary Protocol for the Management of Dental Erosion in Rugby Players: A Randomized Clinical Trial

People performing regular physical activity are at high risk of dental erosion especially in cases of high sport drinks intake. Biomimetic hydroxyapatite-based oral hygiene products, like toothpastes and mouthwashes, have been investigated in recent years for their remineralizing activity on the teeth. The aim of the present study was to evaluate the efficacy of two different oral hygiene protocols, respectively consisting of the combination of a hydroxyapatite-based toothpaste plus mouthwash (Trial group) or toothpaste alone (Control Group). At baseline (T0), as well as at 15 days (T1), 30 days (T2) and 90 days (T3), the following clinical indexes were assessed: Basic Erosive Wear Examination (BEWE), Schiff Air Index (SAI), Visual Analogue Scale (VAS), Plaque Index (PI) and Bleeding Index (BI). In general, for all the indexes assessed, a progressive intragroup reduction was noticed from the baseline to the subsequent timepoints, with no intergroup differences. Accordingly, the use of the hydroxyapatite-based toothpaste, alone or in combination with the mouthwash containing hydroxyapatite as well, is an effective method for the domiciliary management of dental erosion in physically active individuals like rugby players.

Regular Physical Activity and Dental Erosion: A Systematic Review

Dental erosion is the irreversible pathological loss of hard tissues, which are chemically dissolved by acids, especially through external means, such as diet (e.g., fruit juices, isotonic or energy drinks). This systematic review was designed to answer the question “Is there a relationship between dental erosion and regular physical activity with or without sports drink consumption?” Following the inclusion and exclusion criteria, sixteen studies were included in this systematic review (according to PRISMA statement guidelines). Based on the meta-analysis, physically active individuals who declared regular consumption of sports drinks had a more than 2.5-fold increase in the odds of erosive lesions. In general, nearly half of the people who practiced sports experienced tooth erosion, and more than half frequently consumed sports beverages. Despite the heterogeneity of the included studies (different age groups, various sports disciplines), regular physical activity was associated with an increased risk of dental erosion, especially under the influence of frequent consumption of sports drinks.

Risk of Dental Caries and Erosive Tooth Wear in 117 Children and Adolescents' Anorexia Nervosa Population-A Case-Control Study

INTRODUCTION

Restrictive type of anorexia nervosa (AN) is still one of the most severe eating disorders worldwide with an uncertain prognosis. Patients affected by AN should be encouraged to undertake psychiatric care and psychotherapy, but whether they should necessarily be included in careful dental care or not may still be questionable. Even though there is a constantly increasing number of AN studies, there are just a few data about the youngest group of AN children and adolescents aged < 18.

METHODOLOGY

This case-control study aimed to compare the dental health and gingival inflammation level in female adolescent inpatients affected by severe AN restrictive subtype vs. controls. Based on clinically confirmed 117 AN cases (hospitalized in years 2016-2020 in public Psychiatric Unit, BMI < 15 kg/m², mean age 14.9 ± 1.8), the dental status has been examined regarding the occurrence of caries lesions using Decay Missing Filling Teeth (DMFT), erosive wear as Basic Erosive Wear Examination (BEWE), gingival condition as Bleeding on Probing (BOP) and plaque deposition as Plaque Control Record (PCR). The results were compared with age-matched 103 female dental patients (BMI 19.8 ± 2.3 kg/m², age 15.0 ± 1.8, p = 0.746) treated in a public University dental clinic.

RESULTS

AN patients were found to present a higher incidence of oral-related complications according to dental status (DMFT 3.8 ± 4.5 vs. 1.9 ± 2.1, p = 0.005), erosive tooth wear (BEWE 18.9 vs. 2.9%, p < 0.001), less efficient in controlling plaque (PCR 43.8 vs. 13.7%, p < 0.001) and gingival inflammation (BOP 20.0 vs. 3.9%, p < 0.001) compared with female adolescents. In the AN group, a significant correlation between BOP, BEWE, and duration of AN disease (p < 0.05), similarly to the number of decayed teeth D, filled teeth F and PCR were detected (p < 0.05).

CONCLUSIONS

Although the obtained results did not reveal any severe oral status, our findings indicated impaired dental and gingival conditions in young anorexics. Considering AN's potential role in oral health, it is essential to monitor dental treatment needs and oral hygiene levels in their present status to prevent forward complications in the future.