Comparison of erosion of dental enamel by four drinks using an intra-oral applicance

Title: Chemotherapy-Induced Oral Complications and Prophylaxis Strategies

Cancer is currently a significant therapeutic challenge and is frequently connected with numerous adverse effects. Despite many improvements in chemotherapy, oral complications are common, leading to poor quality of life and chemotherapeutic dose reduction, which impair survival. This review summarizes the most common dental complications in patients receiving chemotherapy. We mainly focus on oral mucositis as it is a major cause of dose-limiting toxicity. Furthermore, oral candidiasis, viral infections, and xerostomia will be discussed. Conclusions: preventing complications is significantly more important than treating them. All patients beginning systemic anticancer treatment should undergo a thorough oral examination and get appropriate prophylaxis.

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

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

Spectroscopic and microscopic examination of teeth exposed to green tea at different temperatures

Tea is a popular beverage consumed at different temperatures. The effect of tea on teeth at different temperatures has not been studied previously. The present study used an in vitro green tea immersed tooth model at different tea temperatures (hot and cold) compared to an in vivo tea administration model allowing rats to drink tea over the course of a week. The elements present in tea leaves were identified by Inductively Coupled Plasma Mass Spectrometry (ICP-MS) and compared to the elements in teeth (enamel surface) using Laser-Induced Breakdown Spectroscopy (LIBS). Here, LIBS demonstrated in vivo and in vitro green tea treatments resulted in a significant increase in the mineral elements found in enamel. For the in vitro assessment, elements in enamel varied based on cold-tea and hot-tea treatment; however, hot water reduced the elements in enamel. Atomic force microscopy found the in vivo tea group had a higher roughness average (RA) compared with the in vivo water group. Cold tea and hot tea in vitro groups demonstrated lower RA than in vitro water controls. Scanning electron microscopy found hot water induced cracks more than 1.3μm in enamel while cold tea and hot tea promoted the adhering of extrinsic matter to teeth. Overall, teeth treated to high temperature lost the mineral phase leading to demineralization. Our results indicate that green tea protects enamel, but its protective action in dental structures is enhanced at cold temperature.

Comparison of Salivary pH Changes after Consumption of Two Sweetened Malaysian Local Drinks among Individuals with Low Caries Experience: A Pilot Study

Background

Regular consumption of sweetened beverages has been associated with dental caries, which is mediated through salivary pH. The salivary pH changes among individuals with low caries experience after consumption of two local sweetened drinks is compared.

Methods

In this block randomised controlled parallel group, an open-label pilot study of 49 participants aged 21–25 were selected. The participants were randomised into three groups: mineral water, chocolate drink and sirap bandung. One day prior to the test, scaling was done and the participants did not eat or drink anything on the test day till the saliva sample collection was done. Salivary pH was measured at baseline and after the consumption of the drinks with a glass electrode digital pH meter at five-minute interval for half an hour. The statistical significance was assessed at the level of 5%.

Results

After consumption of chocolate drink and sirap bandung, the salivary pH dropped from a baseline of 7.09 for chocolate drink and 7.13 for sirap bandung to 6.69 for chocolate and 6.86 for sirap bandung. This difference was statistically significant (P < 0.001).

Conclusion

Sweetened milk based local drinks can increase the caries susceptibility. In the community, information about limiting the intake of sweetened drinks should be reinforced.

Contribution of HIV Infection, AIDS, and Antiretroviral Therapy to Exocrine Pathogenesis in Salivary and Lacrimal Glands

The structure and function of exocrine glands are negatively affected by human immunodeficiency virus (HIV) infection and its co-morbidities, including innate and adaptive immune responses. At the same time, exocrine function may also be influenced by pharmacotherapies directed at the infectious agents. Here, we briefly review the role of the salivary glands and lacrimal glands in normal physiology and exocrine pathogenesis within the context of HIV infection and acquired immune deficiency syndrome (AIDS), including the contribution of antiretroviral therapies on both. Subsequently, we discuss the impact of HIV infection and the types of antiretroviral therapy on disease management and therapy development efforts.

Erosive characteristics and fluoride content of cola-type drinks

AIM

Excessive consumption of carbonated soft drinks is detrimental to general and oral health. This study determined endogenous pH, titratable acidity (TA) and fluoride (F) ion concentration of cola-type drinks available in the UK. Subsidiary aims were to compare: (i) endogenous pH and TA of drinks upon opening (T0) and after 20 minutes (T20); (ii) endogenous pH, TA and F ion concentration of diet vs regular and plastic bottle vs canned drinks.

METHODS

Endogenous pH, TA (mls 0.1M NaOH) and F ion (mg/L) of 71 products were measured using a pH meter and F-ISE. A Wilcoxon Signed Ranks Test compared pH and TAs at T0 and T20; a Mann-Whitney U test compared pH, TAs and F ion concentration for; a) regular vs diet drinks; and b) plastic bottle vs canned drinks.

RESULTS

Mean (±SD) pH for regular and diet drinks was 2.44 ± 0.12 and 2.83 ± 0.33 respectively (p = 0.001). Mean NaOH (ml) to raise pH to 5.5 and 5.7 was 5.49 ± 0.76 and 6.40 ± 0.78 (regular drinks); 5.17 ± 1.03 and 6.03 ± 1.07 (diet drinks). Diet (p = 0.040) and regular (p = 0.041) drinks had higher TA to pH 5.7 at T0 compared with T20; at T20 regular drinks had higher TA to pH 5.5 (p = 0.026) and pH 5.7 (p = 0.030) than diet drinks. There was no difference in F ion concentration between regular vs diet drinks (p = 0.754) and no significant container effect.

CONCLUSION

Erosive characteristics were similar between manufacturers, but higher erosive potentials were evident at T0 compared with 20 minutes later and for regular compared with diet drinks. F ion concentration of drinks was low.

Effect of Various Sugary Beverages on Salivary pH, Flow Rate, and Oral Clearance Rate amongst Adults

Introduction. Diet is a major aetiological factor for dental caries and enamel erosion. This study was undertaken with the aim of assessing the effect of selected locally available beverages on salivary pH, flow rate, and oral clearance rate amongst adults. Materials and Method. This clinical trial comprised 120 subjects. Test beverages undertaken were pepsi, fruit drink, coffee, and sweetened milk. Statistical analysis was carried out using SPSS version 17. Descriptive statistics, one-way ANOVA, and post hoc Tukey's test were applied in the statistical tests. Results. It was found that salivary pH decreased for all the beverages immediately after consumption and the salivary flow rate increased after their consumption. The oral clearance rate of sweetened milk was found to be the least at 6.5 minutes and that of pepsi was found to be 13 minutes. However, the oral clearance rates of fruit drink and coffee were found to be equal at 15 minutes. Conclusion. Although it was found out that liquids cleared rapidly from the oral cavity, they had a significant cariogenic and erosive potential. Hence, it is always advised to minimise the consumption of beverages, especially amongst children and young adults to maintain a good oral health.

Effect of Soft Drinks and Fresh Fruit Juice on Surface Roughness of Commonly used Restorative Materials

In this in vitro study, the effects of a Cola drink, and fresh fruit juice (citrus) on the surface roughness on flowable composite and resin-modified glass ionomer cement (RMGIC) each was evaluated and compared. Using a brass mold 70 pellets each of flowable composite (Filtek™ Flow) and RMGIC tricure restorative material were prepared according to the manufacturer's instructions. Two groups (groups I and II) were formed containing 30 pellets of each material. Remaining 10 pellets of each restorative material did form the control group [water (group III)]. Experimental group pellets were again divided into three subgroups (mild, moderate and severe) containing 10 pellets each and were kept in plastic containers with 30 ml Cola drink (group I) and fresh fruit juice (group II) respectively. Immersion regime was followed according to M aupome G et al. Baseline and final surface roughness (Ra) value for each pellet was evaluated using a profilometer. Statistical analysis was done with Wilcoxon's signed rank test and analysis of variance (ANOVA) followed by Mann-Whitney test. Results showed that the erosive effect of both Cola drink and fresh fruit juice caused significant surface roughness on both flowable composite and RMGIC restorative materials in the mild, moderate and severe immersion regimes. How to cite this article: Maganur P, Satish V, Prabhakar AR, Namineni S. Effect of Soft Drinks and Fresh Fruit Juice on Surface Roughness of Commonly used Restorative Materials. Int J Clin Pediatr Dent 2015;8(1):1-5.

Possible ways of reducing dental erosive potential of acidic beverages

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

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

OBJECTIVES

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

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.

Contemporary fluid intake and dental caries in Australian children

In Australia, caries experience of 6-year-old and 12-year-old children has increased since the mid to late 1990s. Previously, caries rates had declined, attributable to community water fluoridation. The recent caries increase has been attributed speculatively to changes in fluid intake, including increased consumption of sweet drinks and bottled waters. Increasing urbanization and globalization have altered children's diets worldwide, promoting availability and access to processed foods and sweet drinks. Studies in Australia and internationally have demonstrated significant associations between sweet drink intake and caries experience. Despite widespread fluoride availability in contemporary Australian society, the relationship between sugar consumption and caries development continues and restricting sugar intake remains key to caries prevention. Caries risk assessment should be included in treatment planning for all children; parents should be advised of their child's risk level and given information on oral health promotion. Readily-implemented caries risk assessment tools applicable to parents and clinicians are now available. Public health information should increase awareness that consuming sweet drinks can have deleterious effects on the dentition as well as the potential for promoting systemic disease. Restricting sales of sweet drinks and sweet foods and providing healthy food and drinks for purchase in schools is paramount.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Evaluation of Microleakage of RMGIC and Flowable Composite Immersed in Soft Drink and Fresh Fruit Juice: An in vitro Study

Aim : The objective of the study was to evaluate and compare the effect of a soft drink and a fresh fruit juice on the microleakage of flowable composite and resin modified glass lonomer cement (RMGIC).

Methods and materials : 70 non-carious human premolars were collected and stored in saline until further use. Class-V cavities were prepared and restored with RMGIC on the buccal surface and flowable composite on the lingual surface for evaluating microleakage. The experimental groups (Group I and II ) comprised of 60 teeth, while the remaining 10 formed the control group (Group III―Water). The experimental groups were further divided into 2 groups (Group I―Cola drink and Group II―Fresh orange fruit juice) of 30 teeth each. Each group was then further divided into 3 subgroups (Short, Medium and Long-immersion) containing 10 teeth as shown in flow chart.

Immersion regime was followed according to Maupome G et al and microleakage was evaluated by using Rhodamine B dye and examined under stereomicroscope.

Results : Microleakage data obtained was statistically analyzed by Chi-square test. The teeth showed statistically significant microleakage as the immersion regime increased.

Interpretation and Conclusion : Low pH soft drink caused highly significant microleakage at the tooth and restorative material interface in medium and high immersion regimes signifying that the leakage pattern was directly proportional to the number of immersions. Thus, the study conclusively proves that the ‘sipping habit’ associated with commonly available low pH beverages is detrimental to the longevity of restorations.

Surface degradation of composite resins by acidic medicines and pH-cycling

This study evaluated the effects of acidic medicines (Dimetapp® and Claritin®), under pH-cycling conditions, on the surface degradation of four composite resins (microhybrid: TPH, Concept, Opallis and Nanofilled: Supreme). Thirty disc-shaped specimens (Ø = 5.0 mm / thickness = 2.0 mm) of each composite were randomly assigned to 3 groups (n = 10): a control and two experimental groups, according to the acidic medicines evaluated. The specimens were finished and polished with aluminum oxide discs, and the surface roughness was measured by using a profilometer. After the specimens were submitted to a pH-cycling regimen and immersion in acidic medicines for 12 days, the surface roughness was measured again. Two specimens for each material and group were analyzed by scanning electron microscopy (SEM) before and after pH-cycling. Data were analyzed by the Student's-t test, ANOVA, Duncan's multiple range test and paired t-test (α=0.05). Significant increase in roughness was found only for TPH in the control group and TPH and Supreme immersed in Claritin® (p<0.05). SEM analyses showed that the 4 composite resins underwent erosion and surface degradation after being subjected to the experimental conditions. In conclusion, although the roughness was slightly affected, the pH-cycling and acidic medicines caused surface degradation of the composite resins evaluated. Titratable acidity seemed to play a more crucial role on surface degradation of composite resins than pH.

The enamel softening and loss during early erosion studied by AFM, SEM and nanoindentation

Enamel dissolution occurs when it contacts with acids produced by plaque bacteria, foods or drinks. There have been numerous and varied studies quantifying and characterizing the rate, extent and chemical aspects of enamel erosion; however, there is still hot debate about the amounts of enamel softening and loss. The objective of this study was to measure the enamel erosion process with high accuracy. Native third molars were partly eroded in citric acid (pH = 3.8) with some domains protected by a Ti coating layer. The surface morphology and structures before and after exposure to citric acid for different time periods were studied by AFM, SEM and nanoindentation, respectively. Based on this, the functions between the amounts of enamel softening, loss and erosion time were established for the first time. It was demonstrated that AFM, SEM and nanoindentation were suitable for measuring the early stages of enamel demineralization qualitatively and quantitatively.

The effect of dilution on the in vitro erosive potential of a range of dilutable fruit drinks

BACKGROUND

Only one previous study has investigated the effect which dilution has on the erosive potential of dilutable fruit drinks. Based solely on measurement of neutralizable acidity, the authors concluded that the erosive potential of diluting juices may be reduced substantially by the addition of water. This has not been verified in an in vitro enamel erosion model.

OBJECTIVE

The aim of this study was to examine the effect of dilution on the erosive potential of five dilutable fruit drinks.

METHODS

For each product, the erosive potential of three dilutions (1 : 3, 1 : 6 and 1 : 15) was assessed by measuring the initial pH and neutralizable acidity; in vitro enamel erosion was measured by profilometry following immersion for 1 h.

RESULTS

For the majority of products, increasing dilution from 1 : 3 to 1 : 15 produced a statistically significant rise in initial pH, though they remained markedly acidic. Increasing the dilution factor consistently produced a statistically significant decrease in neutralizable acidity. Increasing the dilution factor from 1 : 3 to 1 : 15 produced a statistically significant reduction in in vitro enamel erosion in only three of the five products tested.

CONCLUSIONS

Increasing the dilution factor of dilutable fruit drinks within a range likely to be acceptable to the consumer may not effectively reduce their erosive potential.

The health benefits of calcium citrate malate: a review of the supporting science

There has been considerable investigation into the health benefits of calcium citrate malate (CCM) since it was first patented in the late 1980s. This chapter is a comprehensive summary of the supporting science and available evidence on the bioavailability and health benefits of consuming CCM. It highlights the important roles that CCM can play during various life stages. CCM has been shown to facilitate calcium retention and bone accrual in children and adolescents. In adults, it effectively promotes the consolidation and maintenance of bone mass. In conjunction with vitamin D, CCM also decreases bone fracture risk in the elderly, slows the rate of bone loss in old age, and is of benefit to the health and well-being of postmenopausal women. CCM is exceptional in that it confers many unique benefits that go beyond bone health. Unlike other calcium sources that necessitate supplementation be in conjunction with a meal to ensure an appreciable benefit is derived, CCM can be consumed with or without food and delivers a significant nutritional benefit to individuals of all ages. The chemistry of CCM makes it a particularly beneficial calcium source for individuals with hypochlorydia or achlorydia, which generally includes the elderly and those on medications that decrease gastric acid secretion. CCM is also recognized as a calcium source that does not increase the risk of kidney stones, and in fact it protects against stone-forming potential. The versatile nature of CCM makes it a convenient and practical calcium salt for use in moist foods and beverages. The major factor that may preclude selection of CCM as a preferred calcium source is the higher cost compared to other sources of calcium commonly used for fortification (e.g., calcium carbonate and tricalcium phosphate). However, formation of CCM directly within beverages or other fluid foods and/or preparations, and the addition of a concentrated CCM solution or slurry, are relatively cost-effective methods by which CCM can be incorporated into finished food and beverage products.

Are sugars-free medicines more erosive than sugars-containing medicines? An in vitro study of paediatric medicines with prolonged oral clearance used regularly and long-term by children

OBJECTIVE

The reduced use of sugars-containing (SC) liquid medicines has increased the use of other dose forms, potentially resulting in more widespread dental effects, including tooth wear. The aim of this study was to assess the erosive potential of 97 paediatric medicines in vitro.

METHODS

The study took the form of in vitro measurement of endogenous pH and titratable acidity (mmol). Endogenous pH was measured using a pH meter, followed by titration to pH 7.0 with 0.1-M NaOH.

RESULTS

Overall, 55 (57%) formulations had an endogenous pH of < 5.5. The mean (+/- SD) endogenous pH and titratable acidity for 41 SC formulations were 5.26 +/- 1.30 and 0.139 +/- 0.133 mmol, respectively; for 56 sugars-free (SF) formulations, these figures were 5.73 +/- 1.53 and 0.413 +/- 1.50 mmol (P > 0.05). Compared with their SC bioequivalents, eight SF medicines showed no significant differences for pH or titratable acidity, while 15 higher-strength medicines showed lower pH (P = 0.035) and greater titratable acidity (P = 0.016) than their lower-strength equivalents. Chewable and dispersible tablets (P < 0.001), gastrointestinal medicines (P = 0.002) and antibiotics (P = 0.007) were significant predictors of higher pH. In contrast, effervescent tablets (P < 0.001), and nutrition and blood preparations (P = 0.021) were significant predictors of higher titratable acidity.

CONCLUSIONS

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

The relationship between enamel softening and erosion caused by soft drinks at a range of temperatures

OBJECTIVES

Investigations of the erosive potential of soft drinks are usually performed at room or body temperature, but drinks are more frequently served chilled, with ice, or hot. Since the rate of chemical reactions usually increases with temperature, it is predicted that erosion is more severe at high temperatures and reduced at low temperatures. The aim of this study was to investigate the correlation between enamel softening, enamel erosion, and temperature.

METHODS

Atomic force microscopy nanoindentation and non-contact optical profilometry were used to assess changes in enamel nanomechanical properties after 5 min and erosive material loss after 30 min exposure to two different non-carbonated soft drinks at 4, 25, 50 and 75 degrees C.

RESULTS

For one drink (Robinson's Original Juice Drink), there was a statistically significant difference between nanomechanical properties and erosion depth at all temperatures, with softening and erosion increasing with temperature. For another drink (Ribena ToothKind Juice Drink), there was a slight softening and virtually no material loss, and temperature had no statistically significant impact on erosion. There was a good linear correlation (R2 = 0.94) between nanomechanical properties and material loss.

CONCLUSIONS

The difference between the drinks can be explained by their composition. For the erosive drink, material loss increased, and nanohardness decreased, approximately linearly with temperature. The correlation between softening and erosion demonstrated that nanomechanical properties after very short erosion times can be considered a good predictor of bulk material loss after considerably longer erosion times.

Comparison of Calcium/Phosphorus Analysis, Longitudinal Microradiography and Profilometry for the Quantitative Assessment of Erosive Demineralisation

The study is a comparison of methods for the quantitative measurement of erosive mineral loss including longitudinal microradiography (LMR), profilometry (PM), and analysis of calcium (CA) and phosphorus (PA) in the erosion solution. Polished human enamel samples were taped, covered with nail varnish and the edges of the resulting enamel window marked with drilled holes as a reference. All samples were subjected to baseline LMR. Sixty samples each were eroded with citric acid (0.05 M; pH 2.3; 10 ml per sample) for 30, 60, 90, or 120 min. Erosive loss of each sample was estimated by the four methods. All methods revealed a linear erosive loss over time and showed good linear correlation. Values calculated from PM and LMR were both approximately 20% lower than those from CA and PA. After 30 min erosion, LMR showed no significant correlation with the other three methods. With LMR, erosive loss below 20 microm should be interpreted with care.

Influence of the Organic Matrix on Root Dentine Erosion by Citric Acid

This investigation was conducted in an attempt to clarify the role of the organic matrix in bovine dentine demineralisation by 1% citric acid. Dentine slabs (n = 15) were treated for 2 min with 10% sodium hypochlorite (NaOCl, a strong protein solvent), 2% glutaraldehyde (GDA, a protein fixative) or deionised water (DIW, as negative control) prior to each of 5 demineralisation periods of 30 min. The mineral loss (DeltaZ), lesion depth (LD) and surface loss (SL) were determined after each period of demineralisation, by transverse microradiography. The NaOCl-treated group showed higher DeltaZ and LD than the GDA- and DIW-treated groups. No differences between GDA and DIW groups were found. The DeltaZ and LD profiles were explained by quadratic fits (r(2) >0.80; p = 0.001) in all groups. SL was detected only in the NaOCl-treated group. The data suggested that the maintenance of the organic matrix in the lesion might be important to reduce the erosion progression rate.

Impact of modified acidic soft drinks on enamel erosion

OBJECTIVE

To evaluate the enamel erosive potential of modified acidic soft drinks under controlled conditions in an artificial mouth.

MATERIALS AND METHODS

From each of 144 bovine incisors one enamel sample was prepared. Labial surfaces of the samples were ground flat, polished and covered with adhesive tape, leaving an exposed area. The samples were distributed among four (A-D) groups for treatment with A: Coca-Cola, B: Sprite; C: Sprite light, D: orange juice. Either 1.0 mmol l(-1) calcium (Ca) or a combination (comb.) of 0.5 mmol l(-1) calcium plus 0.5 mmol l(-1) phosphate plus 0.031 mmol l(-1) fluoride was added to the beverages. Samples of each group were subdivided into three subgroups (-original; -Ca and -comb.) for treatment with original and modified drinks. De- and remineralization cycles were based on a standard protocol described earlier. Surface loss of the specimens was determined using profilometry after test procedure.

RESULTS

In all subgroups, loss of enamel was observed. The enamel loss recorded for the samples rinsed with original Sprite and original orange juice was significantly higher compared with all other solutions (P = 0.001). Lowest enamel loss was recorded for the original Coca-Cola group (P = 0.001). With the exception of Coca-Cola, demineralization with the modified beverages led to significantly lower losses compared with the respective original solutions.

CONCLUSION

Modification of the test soft drinks with low concentrations of calcium or a combination of calcium, phosphate and fluoride may exert a significant protective potential with respect to dental erosion.

The laboratory assessment of enamel erosion: a review

OBJECTIVES

To review the various methods and techniques available to assess enamel erosion in vitro.

DATA

Peer reviewed scientific articles.

SOURCES

Medline and Web of Science searches and manual searching.

STUDY SELECTION

Laboratory based assessments only included.

CONCLUSIONS

A number of macroscopic and microscopic techniques have been used to assess enamel erosion in vitro and in situ. This review examines techniques which are either well established or comparatively novel techniques that are being explored for their potential.

An in situ Investigation into the Abrasion of Eroded Dental Hard Tissues by a Whitening Dentifrice

This crossover study aimed to investigate abrasion of previously eroded hard dental tissues by a whitening dentifrice compared to a regular dentifrice. After a 3-day lead-in period, 14 volunteers were randomly assigned to use one of the toothpastes while wearing a removable appliance, containing 3 enamel and 3 root dentine slabs on each side. On the first day salivary pellicle was allowed to form. Twice daily for the following 3 days, one side of each appliance was immersed in an acidic carbonated drink ex vivo while the other side remained unexposed. Specimens were then brushed with the allocated dentifrice. After a 3-day washout period, new sets of enamel and dentine slabs were mounted in the appliances and the participants commenced period 2 using the alternative toothpaste. Acid-treated specimens always showed more wear than untreated specimens. The whitening dentifrice did not significantly increase the wear of softened enamel compared with the regular dentifrice. Brushing with the whitening toothpaste led to significantly greater wear of sound enamel and of both eroded and sound dentine than the regular dentifrice. The results suggest that whitening dentifrices may not increase the wear of acid-softened enamel but may have a more deleterious effect on dentine than regular toothpastes.

Prevention. Part 3: prevention of tooth wear

Non-carious destruction of teeth has been observed in archaeological material from various parts of the world and clearly pre-dates the first appearance of dental caries. Attrition, abrasion and erosion are also described in the classic text of Pindborg on the pathology of the dental hard tissues. Whilst the dental profession, at least in affluent parts of the world, was engaged in diagnosing, treating and later preventing dental caries these other causes of tooth destruction were largely ignored.

Salivary pH changes during soft drinks consumption in children

Dental erosion seems to have increased, perhaps partly as a result of an increase in the consumption of soft drinks.

AIM

The aim of this study was to measure salivary pH, flow rate and buffering capacity before and after soft drinks intake in children with erosive lesions and to compare these to equivalent values for healthy caries-free individuals.

DESIGN

The study was conducted as a case-control study using standard salivary tests. Thirty children with erosion and 30 age and sex-matched children free from erosion and active caries were included in this study.

METHODS

Salivary flow rate was measured through expectoration into a graduated tube, salivary buffering capacity through colourimetric procedures and salivary pH using a digital pH meter.

RESULTS

Results showed significant differences between cases and controls for salivary pH, flow rate, buffering capacity, maximum pH drop and minimum pH reached after soft drinks intake.

CONCLUSIONS

It is concluded that all the factors studied are involved in dental erosion and that preventive care is mandatory for children who frequently drink these kinds of beverages.

The pH and titratable acidity of a range of diluting drinks and their potential effect on dental erosion

OBJECTIVES

To investigate, in vitro, the potential dental effects of diluting juices by measuring their acidity levels and to examine the effect dilution has on the potential erosive properties of the drinks.

METHODS

Four commonly available diluting drinks were assessed for both pH and titratable acidity at a variety of dilutions, reflecting the range of concentrations over which such drinks may be consumed. Predetermined dilutions of citric acid and hydrochloric acid, with similar pH values to those of the drinks, were used as positive control acidic solutions. The pH measurements throughout the study were made using a pH electrode connected to an Orion EA940 IonAnalyser.

RESULTS

All four drinks demonstrated a high degree of resistance to a rise in pH, indicating high intrinsic buffering capacity. The measured pH changed very little with increasing dilution ratio when compared to the citric and hydrochloric acid controls, even when considered extremely dilute. In contrast, the titratable acidity of each of the drinks reduced proportionally with increasing dilution, thereby reducing considerably its erosive potential.

CONCLUSIONS

While dilution had very little effect on the measured pH values, the titratable acidity reduced as the drink became more dilute. Since there appears to be a direct relationship between dilution and titratable acidity, the erosive potential of diluting juices may be reduced substantially by the addition of water. It remains unlikely, however, that the drinks would ever be consumed at a 'safe' level of dilution due to diminished taste and colour.

The erosive effect of herbal tea on dental enamel

OBJECTIVES

The aim of this study was to determine whether conventional black tea and a herbal tea were capable of eroding dental enamel. A further aim was to investigate whether herbal tea of the type tested eroded dental hard tissues to a greater or lesser extent than conventional black tea.

METHODS

Three groups of 21 teeth were exposed to a conventional black tea Typhoo (Group A), a herbal tea Twinings Blackcurrant, Ginsing and Vanilla (Group B) and water, which acted as a control (Group C). Sequential profilometric tracings of the specimens were taken, superimposed and the degree of enamel loss calculated as the area of disparity between the tracings before and after exposure.

RESULTS

Conventional black tea and herbal tea, of the type tested, both resulted in tooth surface loss. Tooth surface loss, which resulted from exposure to herbal tea (mean 0.05mm(2), s.d. 0.02), however, was significantly greater (P=0.00) than that which resulted from exposure to conventional black tea (mean 0.01mm(2), s.d. 0.00) and water (mean 0.00mm(2), s.d. 0.00).

CONCLUSIONS

It was concluded that herbal tea and conventional black tea of the type tested result in erosion of dental enamel. The erosive effect of the herbal tea of the type tested was five times more severe than that of the conventional black tea tested. The cumulative effects of regular consumption of herbal tea of the type tested are likely, therefore, to be of clinical significance.

Rampant early childhood dental decay: an example from Italy

OBJECTIVES

This study sought to estimate the prevalence and related prediction factors for dental caries in 3- to 5-year-old children in Rome, Italy.

METHODS

From a sample of 2,025 children, 1,494 (73.8%) were included in the analysis. Children with at least two primary maxillary incisors showing evidence of caries experience were considered affected by rampant early childhood dental decay (RECDD). Behavioral and socioeconomic variables, mutans streptococci counts, diet, and nutritional status were investigated for their association with RECDD using regression analysis.

RESULTS

The prevalence of any caries was 27.3 percent, and was 7.6 percent for RECDD. Among all children, mean dft and dt scores per person were 1.1 (SD = 2.4) and 0.9 (SD = 2.3), respectively; among those classified as having RECDD, scores were 6.9 (SD = 4.2) and 6.7 (SD = 4.3), respectively. Children with RECDD had 56 percent of all the decayed teeth in the sample. Low and medium social classes, use of a baby bottle filled with sweetened beverages, high salivary mutans streptococcal levels, and malnutrition were directly associated with RECDD; milk and yogurt consumption and low Plaque Index scores were inversely associated with the condition.

CONCLUSIONS

The high prevalence of RECDD suggests that the implementation of preventive programs should be a priority for dental public health. Because of its high prevalence among children as young as 3 years of age, preventive measures targeted toward pregnant women and toddlers should be developed and tested, while kindergarten students could be used for monitoring RECDD prevalence and for detection of communities at risk.

Ultrasonication as a method to study enamel demineralisation during acid erosion

The aim of this study was to use ultrasonication as a method to measure subsurface demineralisation of enamel. Polished human enamel samples with surface profiles within +/-0.3 microm were divided into 6 groups of 10 specimens. The groups of specimens were exposed to 0. 3% citric acid (pH 3.2) for 30 min, 1, 2, 3 or 4 h. The depths of the resulting lesions were measured using a profilometer. A control group was stored in water for 4 h. Ultrasonication in water was performed on the specimen groups for 5, 30, 120, 240 and 480 s with profilometric measurements at each time point. The depth of the erosion increased linearly with the exposure time. Most of the additional loss of enamel occurred with the 5-second ultrasonication. The 30-min and 1-hour erosion lesions were further deepened by approximately 1 microm with 5 s of ultrasonication. The 2-, 3- and 4-hour lesions were deepened by 2-4 microm with 5 s of ultrasonication. There were no changes in the control group. It is concluded that ultrasonication removed softened enamel from the surface of the eroded enamel. Ultrasonication together with accurate measurement of lesion depth by profilometry offers a useful method for studying the depth of enamel softening associated with erosion.

In vitro fluoride dose-response study of sterilized enamel lesions

Currently our intra-oral model uses enamel specimens that have been disinfected by soaking in buffered formalin (pH 6.8). However, because of increasing emphasis on infection control, it is important to identify a way to sterilize these specimens. The aim of this study was to determine if autoclaved, or gas sterilized, lesioned enamel responds to fluoride (F) in the same way alcohol-disinfected enamel lesions do. Seventy-two formalin-disinfected, human enamel specimens (3 mm) were lesioned in demineralizing solution for 96 h and were then divided into three groups. One group was autoclaved; one group was gas sterilized (ethylene oxide), and the remaining 24 specimens were further disinfected in 70% ethanol for 10 min. Specimens in each group were then treated 4 times/day for 4 weeks with 0, 250 or 1,100 ppm F dentifrice slurries in an in vitro cycling, remin/demin model. Following treatment, fluoride uptake was analyzed by microdrill biopsy, and lesion depth and mineral content changes (DeltaM) were determined by transverse microradiography. Data were analyzed by one-way ANOVA analysis. In all three groups of specimens there were significant (p<0.05) differences in fluoride uptake in response to different fluoride treatments. Autoclaved lesions failed to provide dose- response data with regard to changes in lesion mineral content. Because formalin and 70% alcohol are only disinfectants, and autoclaving altered the responsiveness of enamel lesions, results from this study suggest that, of the methods tested, gas sterilization is the preferred method for sterilizing enamel specimens that will be used in intra-oral studies.

Effects of pH and concentration of citric, malic and lactic acids on enamel, in vitro

OBJECTIVE

Dental erosion associated with soft drink consumption probably results from the contained dietary acids in the formulations. The pH value of any formulation is an important variable in acid erosion but not necessarily the only important factor. The aim of this study was to measure enamel erosion by citric, malic and lactic acids at pH values and acid concentrations representative of a range found in soft drink formulations and to determine the effect of adding calcium to citric acid.

METHODS

Flat ground enamel samples were prepared from unerupted human third molar teeth. Groups of five specimens were placed in citric, malic and lactic acid solutions of different pH and acid concentration for three by 10 min exposures at 35 degrees C. Enamel loss was measured by profilometry. Enamel specimens were also exposed to citric acid solutions containing calcium at different pH values and at the same pH with different concentrations of calcium.

RESULTS

Numerical data and contour plots for each acid showed a similar pattern for increasing erosion with decreasing pH and increasing acid concentration and vice versa for decreasing erosion. Increasing the concentration of calcium in a fixed pH citric acid solution resulted in decreased erosion. This effect was most marked at higher pH.

CONCLUSIONS

This study has shown that under highly controlled conditions the erosion of enamel by solutions of dietary acids is influenced by the interplay of pH, acid concentration and presence of calcium. These variables and in particular the concentration of calcium could be manipulated to produce soft drinks with reduced erosivity to enamel.