Factors associated with prevalence and severity of erosive tooth wear in patients with reflux oesophagitis

BACKGROUND

Extrinsic factors for erosive tooth wear (ETW) have been widely reported, but the intrinsic factors for wear remain unclear.

OBJECTIVES

The aim of this study was to evaluate the factors associated with the prevalence of ETW in patients with reflux oesophagitis (RO). To prevent severe ETW with RO, factors associated with severity of ETW were also evaluated.

METHODS

A total of 270 patients with RO were recruited. A modified tooth wear index was used to evaluate the prevalence and severity of ETW. Salivary secretion and buffering capacity were assessed prior to endoscopy. Subjects were asked to complete a medical condition and oral self-care questionnaire. Univariate and multivariate analyses were employed to identify factors collectively associated with the prevalence and severity of ETW.

RESULTS

A total of 212 cases were categorized as patients with ETW (148 with mild ETW and 64 with severe ETW). Multivariate analyses indicated that saliva secretion, severity of RO and proton pump inhibitor (PPI) resistance were associated with the prevalence of ETW, whereas age, BMI and severity of RO were associated with the severity of ETW. The odds ratio of saliva secretion and BMI were less than 1, meaning that higher saliva secretion resulted in a lower prevalence of ETW and lower BMI was associated with severe ETW.

CONCLUSION

Saliva secretion, severity of RO and PPI resistance were associated with the prevalence of ETW, whereas age, BMI and severity of RO were associated with the severity of ETW. Lower saliva secretion and BMI were significant factors for ETW.

Patients with gastroesophageal reflux disease (both reflux oesophagitis and non-erosive reflux disease): Prevalence and severity of erosive tooth wear and saliva properties

BACKGROUND

The prevalence between erosive tooth wear (ETW) in association with reflux oesophagitis (RO) has been reported. However, the severity of both diseases and the relationship between ETW and non-erosive reflux disease (NERD) is unclear.

OBJECTIVES

The prevalence and severity of ETW were investigated in RO, NERD and healthy controls.

METHODS

135 patients with RO, 65 with NERD and 40 healthy controls were recruited for this case-control study. A modified tooth wear index was used to evaluate the prevalence and severity of ETW. Salivary secretion and buffer capacity were assessed prior to endoscopy. The prevalence and severity of ETW, saliva properties among each group were analysed using Pearson's chi-squared test.

RESULTS

A total of 135 cases (56.3%) were categorised as the patient with ETW (55 with mild RO, 49 with severe RO and 31 with NERD). There was a significant relationship between the prevalence of RO and ETW, while there was no significant correlation between the prevalence of NERD and ETW. There was a significant difference related to the severity between RO and ETW. For salivary secretion, there was a significant difference between with and without ETW in patients with mild RO, severe RO and NERD. There was a significant difference between with and without ETW for salivary buffer capacity in patients with mild and severe RO.

CONCLUSION

There was a significant association of the prevalence and severity between RO and ETW. Clinical signs such as ETW and salivary buffer capacity depended on the severity of RO.

Quality of Patient-Centered eHealth Information on Erosive Tooth Wear: Systematic Search and Evaluation of Websites and YouTube Videos

BACKGROUND

Due to the declining prevalence of dental caries, noncarious tooth defects such as erosive tooth wear have gained increased attention over the past decades. While patients more frequently search the internet for health-related information, the quality of patient-centered, web-based health information on erosive tooth wear is currently unknown.

OBJECTIVE

This study aimed to assess the quality of patient-centered, web-based health information (websites and YouTube videos) on erosive tooth wear.

METHODS

German-language websites were systematically identified through 3 electronic search engines (google.de, bing.de or yahoo.de, and duckduckgo.com) in September 2021. Eligible websites were independently assessed for (1) technical and functional aspects via the LIDA instrument, (2) readability via the Flesch reading-ease score, (3) comprehensiveness of information via a structured checklist, and (4) generic quality and risk of bias via the DISCERN instrument by 2 different reviewers. An overall quality score (ie, higher scores being favored) generated from all 4 domains was used as the primary outcome. Quality scores from each domain were separately analyzed as secondary outcomes and compared by the Friedman test. The effect of practice-specific variables on quality scores of websites from private dental offices was assessed using generalized linear modeling. Eligible YouTube videos were judged based on (1) the comprehensiveness of information, (2) viewers' interaction, and (3) viewing rate. The comprehensiveness of information was compared between websites and YouTube videos using the Wilcoxon rank-sum test.

RESULTS

Overall, 231 eligible websites and 7 YouTube videos were identified and assessed. The median overall quality of the websites was 33.6% (IQR 29.8%-39.2%). Secondary outcome scores amounted to 64.3% (IQR 59.8%-69.0%) for technical and functional aspects, 40.0% (IQR 34.0%-49.0%) for readability, 11.5% (IQR 3.9%-26.9%) for comprehensiveness of information, and 16.7% (IQR 8.3%-23.3%) for generic quality. While the comprehensiveness of information and generic quality received low scores, technical and functional aspects as well as readability resulted in higher scores (both Padjusted<.001). Regarding practice-specific variables, websites from private dental offices outside Germany (P=.04; B=-6.64, 95% CI -12.85 to -0.42) or from dentists who are a dental society member (P=.049; B=-3.55, 95% CI -7.09 to -0.01) resulted in lower readability scores (ie, were more difficult to read), while a shorter time since dentists' examination resulted in higher readability scores (P=.01; B=0.24 per year, 95% CI 0.05-0.43). The comprehensiveness of information from YouTube videos was 34.6% (IQR 13.5%-38.5%). However, the comprehensiveness of information did not vary between websites and YouTube videos (P=.09). Additionally, viewers' interaction (1.7%, IQR 0.7%-3.4%) and viewing rates (101%, IQR 54.6%-112.6%) were low.

CONCLUSIONS

The quality of German-language, patient-centered, web-based information on erosive tooth wear was limited. Especially, the comprehensiveness and trustworthiness of the available information were insufficient. Web-based information on erosive tooth wear requires improvement to inform patients comprehensively and reliably.

Advances in Preventive and Therapeutic Approaches for Dental Erosion: A Systematic Review

This review discusses both preventive measures and clinically implemented therapy procedures that have been developed recently for the prevention and treatment of tooth erosion.

METHODS

The databases PubMed, Scopus, and Web of Science were used for a thorough search. Studies on the prevention and treatment of dental erosion that were conducted in English and used in vitro were among the inclusion criteria.

RESULTS

The search turned up 391 papers in total, with 34 of those publications matching the requirements for inclusion. Varnishes, toothpastes, and solutions containing fluoride and other substances were used as preventive measures.

CONCLUSIONS

Dental erosion is a significant issue, and taking preventative steps is crucial to lessening the disease's spread and its effects. Interventions based on fluoride seem to be successful at halting erosion and encouraging remineralization. To effectively address severe tooth erosion, therapeutic methods, including composite restorations, prosthetic crowns, and veneers, are available. Dental erosion causes aesthetic and functional issues that are best addressed with less invasive treatments like direct composite restorations. To improve and broaden the range of available treatments for this common dental issue, additional research and development are required.

Exploratory Analysis of Objective Outcome Measures for the Clinical Assessment of Erosive Tooth Wear

This study proposed using enamel surface texture and thickness for the objective detection and monitoring of erosive tooth wear (ETW), comparing them to the standard subjective Basic Erosive Wear Evaluation (BEWE). Thirty-two subjects (n = 597 teeth) were enrolled in this longitudinal observational clinical study. Enamel thickness (by cross-polarization optical coherence tomography, CP-OCT) and 3D dental microwear parameters, i.e., area-scale fractal complexity (Asfc), anisotropy (Str), and roughness (Sa) (by white-light scanning confocal profilometry), were obtained from buccal surfaces. Buccal, occlusal, and lingual surfaces were scored for BEWE and the maximum score per tooth (BEWEMax) was determined at baseline and 12 months (M12). Data outcome relationships were evaluated (alpha = 0.05). Enamel thickness decreased (p < 0.001), BEWE scores, Sa, and Str increased (p < 0.001), while Asfc did not change at M12. Baseline BEWEBuccal correlated strongly with BEWEMax (r = 0.86, p < 0.001) and moderately with BEWELingual (r = 0.42, p < 0.001), but not with enamel thickness (r = 0.03, p = 0.43). Change (Δ) in surface texture outcomes correlated poorly but significantly with ΔBEWEBuccal (r = -0.15-0.16, p < 0.001) and did not correlate with Δenamel thickness (r = 0.02-0.09, p > 0.06). Teeth with BEWE progression revealed a greater increase in ΔSa and ΔStr. These findings suggest that enamel surface roughness can potentially determine ETW severity, and CP-OCT may be relevant for clinically monitoring enamel thickness.

Prevalence and association of gastroesophageal reflux and dental erosion: An overview of reviews

OBJECTIVES

The aim of this overview of reviews was to retrieve and evaluate the available evidence concerning the prevalence and association between gastroesophageal reflux disease (GERD) and erosive tooth wear (ETW).

DATA

A literature search was conducted in electronic databases and relative systematic reviews with or without meta-analyses were located. Updated supplemental search was also undertaken to identify additional primary studies.

SOURCES

Medline (via Pubmed), Embase, Scopus, Cochrane Register of Systematic Reviews, PROSPERO and Epistemonikos.org database were searched. Additional search of the grey literature, abstracts of conferences and meetings as well as manual search of the reference lists of retrieved studies, was also performed.

STUDY SELECTION

The search retrieved 116 systematic reviews of which 10 were considered eligible and eight additional primary studies.

CONCLUSIONS

GERD constitutes a risk factor for ETW and there is a positive association between the two conditions. In the present overview, despite the heterogeneity between studies and the low level of evidence, it was clearly supported that individuals with GERD have an increased probability of also presenting with signs of ETW. In special groups of population, a high association was found between GERD and ETW. The geographic location may affect the association between GERD and ETW, while regarding the effect of flow rate, buffering capacity of saliva and oral microbial changes caused by GERD, the results were controversial.

CLINICAL SIGNIFICANCE

Appropriate preventive dental care should be considered for individuals with GERD and a multidisciplinary medical and dental approach for the management of individuals with ETW is advised. The results of this study can be used by dentists dealing with typical and atypical GERD signs and symptoms in the oral environment, but also by the physicians and gastroenterologists who need to motivate their patients for oral examination.

Restorative Rehabilitation of a Patient With Tooth Wear: A One-Year Clinical Follow-Up Report

Tooth wear is a multifactorial process of complex aetiology. It may be considered a physiological or pathological process depending upon the rate and degree of occurrence. The patients may present with symptoms of sensitivity, pain, headaches or recurrent loss of restorations and prostheses, leading to loss of function. This case report describes the rehabilitation of a 65-year-old male patient with intrinsic dental erosion combined with generalised attrition. The restorative treatment aimed at restoring anterior guidance, establishing a stable occlusion for the patient with minimal intervention.

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.

Morphological and Elemental Evaluation of Investigative Mouthwashes to Repair Acid-Eroded Tooth Surface

Purpose

Erosive tooth wear (ETW) is characterized by subsurface demineralization and tooth substance loss with crater formation. Remineralization of subsurface demineralization has previously been demonstrated; however, repair of the eroded surface is still under investigation. This study investigated the effectiveness of mouthwashes containing hydrolyzed wheat protein (HWP) in repairing ETW through promotion of organized crystal growth.

Methods

Enamel Erosion was created on 210 enamel blocks by 10-minute demineralization in 1% Citric Acid (pH 3.5). Then, blocks were randomly assigned to seven groups (30/group); (A) 0.2% HWP, B) 1% HWP, (C) 2% HWP, (D) 1% HWP + 0.05% NaF, (E) Listerine™ mouthwash, (F) 0.02% NaF Crest™ Pro-health mouthwash and (G) artificial saliva (AS) only. Groups were subjected to daily pH-cycling consisting of one 5-minute erosive challenge with citric acid, three 1-minute mouthwash treatment periods, and then storage in AS for the rest of the time for 28 days. Treatment effects were assessed using SEM-EDX. Statistical analysis was by ANOVA and Tukey's multiple comparison.

Results

In groups exposed to HWP-containing mouthwashes, there was growth of fiber-like crystals that increased in packing density in a dose-dependent manner (0.2%, 1%, 2%) on the eroded enamel surfaces, with increased calcium and phosphate contents on the treated surfaces. The non-HWP-containing groups had the eroded surfaces covered by structureless deposit layer firmly attached to the surface.

Conclusion

Treating eroded enamel surface with HWP-containing mouthwash resulted in repair of the damaged tissue by formation of a protective layer of crystal deposits within and on the eroded enamel tissue.

[Aesthetic management of erosive tooth wear using injection molding technique]

In this article, on the example of a clinical case, the technique of restoring two central teeth in a patient with increased enamel erasability with highly filled fluid composite materials using injection techniques is described. The application of this technique has become possible because the new fluid composites have similar mechanical, physical and aesthetic properties to universal composite materials.

Tooth Wear and Oral-Health-Related Quality of Life in Dentate Adults

OBJECTIVES

This study estimated the extent to which tooth wear, adjusted for (oral) health risk indicators, impacts adversely on the Oral-Health-Related Quality of Life (OHRQoL) of dentate adults.

METHODS

A cross-sectional study was conducted and had a convenience sample of 570 adults ≥18 years old with at least one bilateral molar occlusal contact. Participants answered a self-applied questionnaire (ICC=0.71) consisting of four domains: socio-demographics, oral care attendance, (oral) health conditions and lifestyle, complaints and oral-health-related quality of life (OHIP-14). Tooth wear was clinically assessed using the Basic Erosive Wear Examination index by two examiners, whose inter-examiner reliability were k=0.76-0.80.

RESULTS

The outcome was a high score on the OHRQoL (median split ≥ 7). The prevalence of tooth wear was 75.0%. Only 30.2% of adults reported impacts on at least 1 performance parameter affected 'fairly often' or 'very often'. The hierarchical logistic regression showed that participants 35-54 years old (OR=2.1), who were ever prevented from regular oral health care due to costs of care (OR=3.6), who ingested acidic beverages ≥ daily (OR=1.7), who had tooth sensitivity (OR= 2.9) and those having the impression that their teeth have changed appearance (OR= 5.9) were significantly more likely to report lower OHRQoL than their counterparts. The severity of tooth wear was not significant when considering moderate and severe cases together.

CONCLUSIONS

Although the prevalence of tooth wear was high, its severity and impact on OHRQoL were limited. However, distal and proximal indicators for tooth wear were mediators for impaired OHRQoL and treatment needs.

CLINICAL SIGNIFICANCE

Prevalence and severity of tooth wear had limited impact on OHRQoL in adults. Distal and proximal indicators for tooth wear were mediators for impaired OHRQoL. The understanding of these relationships offers an opportunity to assess in depth the treatment needs and quality of life of patients affected by tooth wear.

Impact of desensitizing/whitening toothpastes on tooth color change after abrasion and erosion-abrasion

OBJECTIVE

To evaluate the impact of desensitizing toothpastes (D), their whitening versions (DW) and whitening toothpastes (W) on tooth color change.

METHODS

Tooth specimens were allocated into 11 groups (n = 10): 1. Artificial saliva (control); 2. Sensodyne Repair & Protect (SRP-D); 3. Sensodyne Repair & Protect Whitening (SRP-DW); 4. Colgate Sensitive Pro-Relief (CSPR-D); 5. Colgate Sensitive Pro-Relief Real White (CSPR-DW); 6. Colgate Total 12 (CT12); 7. Colgate Total 12 Whitening (CT12-W); 8. Sensodyne True White (ST-W); 9. Curaprox Black Is White (CB-W); 10.Oral-B 3D White Perfection (OB3D-W) and 11. Erosion-only. They were submitted to two models: A. abrasion; B. erosion/abrasion. Color change (ΔE₀₀ ), ΔL, Δa, and Δb were determined with a spectrophotometer. Data were statistically evaluated (α = 0.05).

RESULTS

For both models, ∆E₀₀ of D did not differ significantly from DW. An overall decrease in luminosity (-∆L) and increase (+∆b) in yellowness of the tooth occurred. In abrasion, all groups reduced redness (-∆a) and only SRP-DW differed from control (p = 0.016), but for ∆E₀₀ , ∆L and ∆b, all toothpastes did not differ from the control. In erosion/abrasion, CB-W showed significantly lower ∆E₀₀ and ∆b than the control (∆E₀₀ : p = 0.026; ∆b: p = 0.005) and SRP-D (∆E₀₀ : p = 0.028; ∆b: p = 0.025). Only SRP-DW, CSPR-DW, ST-W, CB-W, and erosion-only had increased redness (+∆a), but none differed from control.

CONCLUSIONS

The toothpastes did neither promote whitening nor avoid the yellowish aspect of the tooth after abrasion and erosion-abrasion, regardless of their claim.

CLINICAL SIGNIFICANCE

Desensitizing and/or whitening toothpastes induced similar changes on tooth color, without promoting whitening effect or reduction in its yellowish aspect.

Association between gastric reflux, obesity and erosive tooth wear among psychiatric patients

The prevalence of erosive tooth wear and obesity are high in psychiatric patients and soft drink consumption is a common risk factor associated with both diseases. This study aimed to assess the association between soft drink consumption, gastric reflux, erosive tooth wear, and obesity among resident patients at the Psychiatric Hospital, Taif, Saudi Arabia.This descriptive, cross-sectional study included 223 adult psychiatric inpatients (126 male, 97 female) with a mean age of 42.3 years (± 2.2). Dental erosion detection was performed according to World Health Organization criteria. The medical evaluation included assessment of the body mass index (BMI). With appropriate sample weighting, relationships between erosive tooth wear, gastric reflux, and obesity were assessed using multivariable logistic regression.Ninety eight patients (43.9%) presented with erosive tooth wear. The mean BMI for the entire study population was 27.7 ± 6.3 kg/m2. Regression analysis showed a strong association between erosive tooth wear and chronic vomiting or bulimia (adjusted odds ratio = 2.11; 95% confidence interval [CI] = 1.98-5.07, P < .001), gastric reflux (adjusted odds ratio = 2.13; 95% CI = 1.34-6.23, P < .001), consumption of soft drinks (adjusted odds ratio = 2.14; 95% CI = 1.03-6.08, P < .001), and schizophrenia and delusional disorders (adjusted odds ratio = 2.07; 95% CI = 1.98-5.08, P < .001).This study demonstrates a significant association between erosive tooth wear prevalence and chronic vomiting or bulimia, consumption of soft drinks, and gastric reflux among resident patients at psychiatric hospital.

Erosive tooth wear among athletes

The following article deals with various considerations concerning the frequently observed occurrence of dental erosion in athletes. It summarizes the basics of erosive tooth wear development as well as special etiologic factors for groups of athletes with increased prevalence of dental erosion and concludes with preventive advice. (Originally published (in German) in Quintessenz Zahnmed 2021;72:1008-1017).

Cross-polarization optical coherence tomographic assessment of in situ simulated erosive tooth wear

This clinical study tested cross-polarization optical coherence tomography (CP-OCT) monitoring of erosive tooth wear (ETW). Twenty participants completed a 14-day/arm, 3-arm crossover study simulating different ETW severities. Participants received two enamel specimens (per arm) and were randomized to: severe (s-ETW, lemon juice/pH:2.5/4.25%wt/vol citric acid), moderate (m-ETW, grapefruit juice/pH:3.5/1.03%wt/vol citric acid), and non-ETW (water). Enamel thickness was measured with CP-OCT (day[D] 0, 7, 14) and micro-computed tomography (μ-CT; D14). Enamel surface loss was determined with CP-OCT and optical profilometry (OP; D7, D14). CP-OCT showed higher enamel surface loss for D14 than D7 for m-ETW (P = .009) and s-ETW (P = .040) and differentiated severity at D14 (s-ETW > non-ETW, P = .027). OP was able to differentiate surface loss between days (D7 < D14, P < .001) for m-ETW and s-ETW, and ETW severity effect after 7 and 14 days (non-ETW < m-ETW < s-ETW, P < .001). At D14, CP-OCT and μ-CT were positively correlated (r = .87, ICC = .62). CP-OCT showed potential as a tool for clinical ETW monitoring.

Different Risk Factors for Erosive Tooth Wear in Rural and Urban Nepal: A National Study

BACKGROUND

Erosive tooth wear (ETW) is of growing concern, but data on ETW among Nepalese children are scarce. The main aim of the study was to investigate the prevalence and severity of ETW among Nepalese schoolchildren. We also aimed to analyse the risk indicators for ETW according to location (rural/urban) and the role of obesity in the risk for ETW.

METHODS

This national study was conducted among 5-15-year-old Nepalese schoolchildren from different regions. Altogether, 1137 out of 1151 schoolchildren participated in both a clinical examination and a survey. ETW was recorded using the Basic Erosive Wear Examination.

RESULTS

The prevalence of ETW was 65%. One-fifth of the examined subjects were in need of preventive or restorative treatment. Living in an urban area and studying in a private school were protective factors for ETW, whereas consuming fruits frequently and using charcoal for tooth cleaning increased the odds for ETW. Central obesity was the strongest risk indicator for ETW among urban residents.

CONCLUSIONS

ETW of low severity is common among Nepalese children and adolescents. Socio-demographic factors influence the prevalence of ETW in Nepal and there seems to be different factors that play a role in the ETW process according to location of residence.

Aesthetic Management of Erosive Tooth Wear in a Young Egyptian Swimmer: A Case Report

Background

Tooth wear can have a multifactorial aetiology which requires thorough patient assessment and aesthetic management.

Purpose

This case report discusses the management of a young, Egyptian swimmer complaining of tooth sensitivity associated with erosive tooth wear. Anterior teeth were restored using the injection molding technique, also known as the injectable composite resin technique, to overcome the patient’s complaint and enhance the aesthetics of compromised anterior teeth.

Patients and Methods

Thorough patient assessment was followed by impression taking, a diagnostic wax-up and intraoral mock-up fabrication for aesthetic, functional and biological verification. Upon the patient’s agreement on the proposed treatment, an injection molding technique was carried out.

Conclusion

The tooth loss pattern associated with erosive tooth wear in competitive swimmers showed a very characteristic presentation. Detailed patient history is imperative for successful assessment of the risk factors contributing to the condition and treatment planning in such cases. The use of injection molding technique for restoration of anterior teeth is a simple, straightforward and aesthetically pleasing alternative for patients with erosive tooth wear requiring direct composite veneers.

Dental erosive wear in primary teeth among five-year-olds - Bergen, Norway

OBJECTIVE

To estimate the prevalence of dental erosive wear among five-year-olds in Bergen, Norway, and to investigate associations between background factors and the condition.

METHODS

A total of 387 children received a dental examination in five Public Dental Service clinics in Bergen, Norway. The parents responded to items about the children's dental hygiene and drinking habits, type of beverage container, diet, and other habits, and about their own age, educational level and country of origin. We explored background variables for possible associations with the outcome status as worst affected by erosive wear (19.4%, n = 75). Chi-squared statistics and logistic regression (Odds Ratios (OR): 95% Confidence Intervals (CI), served as statistical tools).

RESULTS

Approximately 80% showed erosive wear (by SEPRS and by adopted diagnostic instrument (78.5% vs 79.8%)). The condition affected maxillary anterior teeth in 13.9% (n = 54), and cuppings in molars in 79.3% (n = 307) of cases. Grinding teeth during the day and/or night (OR: 1.87, CI: 1.07-3.25) and male sex (OR: 1.76, CI: 1.05-2.96) significantly related to outcome status as worst affected by erosive wear, respectively.

CONCLUSION

Dental erosive wear was widespread. Grinding teeth and male sex associated with outcome status as worst affected by erosive wear.

Contemporary diagnosis and management of dental erosion

OBJECTIVE

This article is aimed at providing an overview of the topic of erosive tooth wear (ETW), highlighting the clinical signs, diagnosis, and management of dental erosion.

OVERVIEW

With the increased prevalence of ETW, it is important that oral health professionals are able to recognize the early signs. Early clinical signs of dental erosion are characterized by loss of enamel texture, a silky glossy appearance, and sometimes a dulling of the surface gloss, referred to as the "whipped clay effect, cupping, and restorations 'standing proud'." The progression of ETW should be monitored by means of diagnostic models or clinical photographs. ETW can be as a result of acid attack of extrinsic or intrinsic origin.

CONCLUSION

There is an increase of ETW that is being recognized by the profession. The first step in diagnosing and management is to recognize as early as possible that the process is occurring. At that point a determination of whether the primary etiology is either intrinsic or extrinsic should be made. If these findings are confirmed, appropriate prevention, and management strategies can be adopted followed by appropriate restorative therapy.

CLINICAL SIGNIFICANCE

The prevalence of ETW continues to increase. It is therefore important that oral health care providers have a better understanding of the etiology, pathophysiology, and management of this condition. This review aims to provide the guidelines for diagnosis and management of dental erosion.

Enamel Softening Can Be Reduced by Rinsing with a Fluoride Mouthwash Before Dental Erosion but Not with a Calcium Solution

PURPOSE

This in-situ-study investigated if rinsing the oral cavity with a calcium containing solution or a fluoride containing mouthwash immediately before an erosive attack leads to reduced enamel softening.

MATERIALS AND METHODS

Bovine enamel samples (n = 240) with measured baseline surface microhardness (KHN) were assigned to five series (S1-5). Twelve participants carried out each series as follows: Four enamel samples of the associated test series were placed in an intraoral appliance and carried in each participants' mouth. After 30 min, the participants either rinsed the oral cavity for 60 s with 30 ml of a solution prepared from a 1,000 mg calcium effervescent tablet dissolved in 100 ml water (S2), an 800 mg calcium containing mineral supplement powder (5 g) dissolved in 200 ml water (S3), a fluoride (500 ppm) mouthwash (S4), a fluoride (500 ppm) and stannous chloride (800 ppm) containing mouthwash (S5), or did not rinse with any test solution before the erosive attack (S1, negative control). The participants subsequently rinsed the oral cavity with 100 ml of a soft drink (Sprite Zero) for 60 s to simulate the erosive attack and immediately afterwards with water to stop the erosive process. As final step, surface microhardness was measured a second time and hardness loss (∆KHN) calculated. Differences of ∆KHN between the series were investigated by fitting a mixed effect model to the data set.

RESULTS

The highest loss of microhardness and thus softening of enamel (mean of ∆KHN; lower/upper confidence level) was observed in the negative control (S1: 60.2; 67.6/52.8). While no statistically significant difference (P > 0.05) compared to S1 could be found in S2 (50.0; 57.4/42.5) and S3 (54.6; 62.1/47.2), statistically significantly less softening of enamel (P < 0.001) was discovered in S5 (33.8; 41.2/26.4) and S4 (41.8.2; 49.3/34.4). S5 showed the overall lowest values for ∆KHN and thus best protection from enamel softening.

CONCLUSION

Rinsing with a fluoride mouthwash or a fluoride and stannous chloride containing mouthwash immediately before an erosive attack reduces the softening of enamel. None of the investigated calcium-containing solutions was able to reduce erosion induced softening of enamel.

The Prevalence of Erosive Tooth Wear and Related Risk Factors in 6- to 12-Year-Old Students

PURPOSE

To evaluate the epidemiological characteristics of erosive tooth wear in primary school students aged 6-12 in Jinzhou, including: prevalence, severity, extent, intraoral distribution and associated risk factors.

MATERIALS AND METHODS

The data collection consists of two parts: the first part is the clinical examination of the participants. All erupted teeth were clinically assessed by three calibrated examiners, and classified according to the basic erosive wear examination (BEWE); The second part is a questionnaire about demographic information, parafunctional movement and lifestyle, completed by the parents or their guardians.

RESULTS

A total of 1,469 children were included in this experiment; erosive tooth wear (ETW) prevalence (BEWE ≥ 1) was 54.9%. According to cumulative BEWE index, the proportion of different ETW severity (high, medium, low, none) was 6.8%, 16.3%, 27.0% and 49.9%, respectively. In an analysis of risk factors, family factor, age, gender, extracurricular study time, oral hygiene habit, bruxism, unilateral mastication and acid diet was associated with the prevalence of ETW.

CONCLUSIONS

This study shows that ETW has a high prevalence in students aged 6-12, and more common in deciduous molars and deciduous canine. Abrasion, attrition and erosion play an important role in ETW.

Erosive Tooth Wear, Presence of Parafunctional Habits and Tooth Injuries-Occurrence in a Group of Children and Adolescents Exposed to Domestic Violence

OBJECTIVES

To compare the prevalence of parafunctional habits, erosive tooth wear and occurrence of tooth injuries among children being under the care of Social Welfare Centre and children treated in the Department of Children's Dentistry of the Medical University of Warsaw.

STUDY DESIGN

The study contains environmental and medical interviews, record-based analysis and clinical examination. Parafunctional habits were rated on the base of dental interviews and clinical examinations. The occlusal surfaces were evaluated by visual examination using modified tooth wear index (TWI). Tooth injuries were reported from a medical interview labeled using Andreasen classification. The consent of the bioethics committee and guardians of children participated in the study was obtained.

RESULTS

The study involved 782 patients, including 404 children from dysfunctional families (average age 11,4 ± 3,7) and 378 from ordinary families-control group (8,53 ± 3,92). In the study group we observed higher prevalence of erosive tooth wear (44,66% vs 18,02% p=0,000), dental trauma (9,4% vs 3,44% p=0,001) and a presence of parafunctional habits (67,8% vs 20,4 % p=0,000).

CONCLUSION

The occurrence of parafunctional habits, erosive tooth wear and tooth injuries may be an indicator of domestic violence and a component of maltreated child syndrome.

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

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

Efficacy of a Stannous-containing Dentifrice for Protecting Against Combined Erosive and Abrasive Tooth Wear In Situ

PURPOSE

The in-situ efficacy of an experimental stannous (Sn)-containing sodium fluoride (NaF) dentifrice against erosion and erosive tooth wear was compared with a conventional NaF dentifrice.

MATERIALS AND METHODS

This was a randomised, controlled, double-blind, parallel-group clinical trial. Mandibular appliances containing four enamel specimens (2 per side [L/R] of the appliance) were worn by 60 generally healthy adult subjects. Subjects were randomised to treatment based on age and gender. Treatments included a Sn-containing NaF or conventional NaF dentifrice. Conditions of erosion (dentifrice slurry treatment) and erosion/tooth wear (dentifrice slurry plus brushing) were compared. Dentifrices were used twice per day for 30 s of lingual brushing, followed by 90 s of slurry exposure. In addition, the two specimens on the left side of the mouth were brushed for 5 s each, using a power toothbrush. All specimens were exposed to four daily erosive challenges with commercial orange juice (pH 3.6). Tooth wear was measured as enamel loss using non-contact profilometry on day 10.

RESULTS

At the day 10 visit, the adjusted mean (SE) enamel loss for specimens receiving slurry (erosion) treatment was 4.7 µm (0.61) [Sn-containing NaF] and 8.73 µm (1.12) [NaF control], with results demonstrating a statistically significant benefit for the Sn-containing dentifrice (46.2% benefit; p = 0.009). For specimens exposed to erosion/tooth wear conditions, enamel loss = 6.68 µm (1.29) (Sn-containing NaF) and 10.99 µm (1.29) (NaF group), with results statistically significant (p = 0.048; 39.2% better, favouring the Sn-containing dentifrice). When data were combined, enamel loss (SE) for all specimens subjected to erosion + erosion/tooth wear was 5.61 µm (0.77) (Sn-containing NaF]) and 9.9 µm (1.3) (NaF group). The difference again was statistically significant, favouring the Sn-containing group (p = 0.022; 43.4% better).

CONCLUSIONS

The Sn-containing dentifrice demonstrated significantly better protection than did NaF under erosive and erosive/tooth wear conditions.

Dental Caries and the Erosive Tooth Wear Status of 12-Year-Old Children in Jakarta, Indonesia

Background: Indonesia has the largest population of all countries in southeast Asia. However, little information is available on the oral health status of Indonesian children. The aims of this study were to assess dental caries and erosive tooth wear in 12-year-old children in Jakarta, Indonesia and to investigate the associated risk factors. Methods: Samples were selected using cluster sampling. Parents were asked to complete a self-administered questionnaire regarding their oral health knowledge, demographic information, their child’s dietary habits, and oral health-related behaviors. Experience of caries and erosive tooth wear were recorded using the Decayed, Missing (due to caries), and Filled Teeth (DMFT) index and the Basic Erosive Wear Examination (BEWE) index, respectively. Results: Of 779 children invited, 696 participated in the survey. Of these, 61% had experienced caries, and the mean DMFT score was 1.58. Almost all decay was untreated. Children who were female, who had a high frequency of soft drink intake, and whose father’s educational level was low were more likely to have dental caries. Most children had at least one lesion of erosive tooth wear. Children whose mother’s educational level was low were more likely to have erosive tooth wear. Conclusions: The prevalence of dental caries and erosive tooth wear was high in 12-year-old children in Jakarta. Their dietary habits and parental level of education were associated with the presence of these dental conditions.

[The erosive potential of different drinks, foodstuffs and medicines – a vade mecum]

There is increasing evidence that the excessive consumption of acidic drinks and foods contributes to dental erosion and may be an important contributing factor for erosive tooth wear. The aims of the present contribution were twofold: (1) to assess the erosive potential of 116 dietary substances and medications; (2) to determine the chemical properties with an impact on the erosive potential. Using 300 deciduous and 1,020 permanent human teeth, enamel specimens were prepared and a pellicle was formed with human saliva. The erosive potential of the tested agents was quantified as the change in surface hardness of the specimens after 2 min of erosion. To characterise these agents, the following chemical properties were determined: pH, titratable acidity to pH 7, concentrations of Ca, Pi and F, as well as the degree of saturation with respect to hydroxyapatite. We conclude that some drinks, foodstuffs and medications may cause erosion. However, pH is not the only decisive factor, since some acidic substances did not cause dental erosion.

A survey on the prevalence and risk indicators of erosive tooth wear among adolescents in Guangzhou, South China

BACKGROUND

Erosive tooth wear (ETW) has become a crucial oral health problem over the decades in China.

OBJECTIVES

To explore the prevalence and risk indicators of ETW among adolescents in Guangzhou, south China.

METHODS

A cross-sectional survey of 720 participants was conducted in Guangzhou, using an equal-sized, stratified, multistage random sampling approach. The participants were from two different age groups (12- and 15-year-olds), 360 per group. The ratio of males to females was 1:1 in each group. ETW was recorded utilising the basic erosive wear examination (BEWE) index as the dependent variable. Independent variables included age, gender, region, socioeconomic status, dietary factors, oral health measures and others.

RESULTS

The prevalence rates (weighted) of ETW and dentin exposure (DE) were 56.1% and 26.2% among adolescents in Guangzhou, with mean teeth (weighted) of 1.8 ± 2.5 and 0.6 ± 1.5, respectively. No matter the prevalence or the mean teeth, the 15-year-olds were higher than the 12-year-olds; the mean teeth of ETW of males was higher than that of females; the mean teeth of ETW and DE of the adolescents of low socioeconomic status were higher than those of high socioeconomic status. Medium to high risk levels were found for 10.1%. In the multiple regression model, age, gender and taking acidic foods/drinks before sleep were associated with ETW.

CONCLUSIONS

Moderate ETW in the permanent dentition was common among adolescents in Guangzhou. However, the teeth involved were low. Dietary factors and demographics were the main risk indicators.

Questionnaire Survey on the Management of Erosive Tooth Wear

PURPOSE

This questionnaire survey aimed to analyse management strategies for erosive tooth wear and to identify factors influencing dentists' decision-making.

MATERIALS AND METHODS

A questionnaire presenting clinical cases with erosive tooth wear on anterior and posterior teeth (BEWE scores 1 to 3) was sent electronically to German dentists (n = 13.683). Statistical analysis was performed by Wilcoxon signed-rank tests, Kruskal-Wallis-tests and Fisher's exact tests (p <0.05).

RESULTS

Only 455 dentists (3.3%, mean age: 52.3 ± 9.6) participated. Suggested therapeutic measures were statistically significantly different between BEWE 1, 2 and 3 (p <0.001) and between anterior and posterior teeth with BEWE scores 1 or 2 (p ≤0.025). Initial erosive lesions (BEWE 1) were mainly treated by information about the main causes and/or preventive measures (posterior teeth: 75.6%, anterior teeth: 64.4%), only 20.0% and 31.3% considered restorative treatment for posterior and anterior teeth, respectively. For teeth presenting score 2, a very high proportion of dentists considered restorative treatment (posterior teeth: 60.6%) additionally to prevention, especially when anterior teeth (91.0%) were affected. In case of severe erosive lesions (BEWE 3), the vast majority of dentists considered restorative treatment (posterior teeth: 98.3%, anterior teeth: 99.8%). The decision-making was mainly dependent on the lesion depth, size of affected surfaces and the presence of pain. Fluoride agents and agents containing tin chloride or tin fluoride were most frequently recommended as preventive measures. If distinct defects (BEWE 2) were treated restoratively, mainly composite restorations were performed (posterior teeth: 72.0%, anterior teeth: 90.5%). Severe defects (BEWE 3) were mostly restored with ceramic restorations (posterior teeth: 66.1%, anterior teeth: 66.6%).

CONCLUSION

Stepwise management of erosive tooth wear was observed. Dentists' decision-making was related to severity and localisation of erosive tooth wear and to various patient-related factors (e.g. depth of lesion and size of affected surface per tooth).

Do fluoride toothpastes have similar preventive effect in permanent and primary teeth against erosive tooth wear?

BACKGROUND

Little is known about fluoride toothpastes effect on primary teeth submitted to erosive tooth wear.

OBJECTIVES

To evaluate the preventive effect of different toothpastes on surface loss (SL) after severe erosion/abrasion model and to compare this effect between permanent (PT) and primary teeth (pt).

DESIGN

Enamel samples were randomly divided according toothpastes groups (n = 17). G1: placebo; G2: NaF; G3: AmF-NaF-SnCl2 anti-erosion; G4: SnF2 ; and G5: NaF anti-erosion for children. Samples were incubated in artificial saliva (1 hour), submitted to erosive challenge (3 minutes; 1% citric acid; pH3.6; at 25°C) and to toothbrush abrasion (2 minutes slurry immersion; 50 strokes; 200 g) during 30 cycles. Surface loss (μm; mean ± SD) was quantified by contactless profilometry. The effects of the two covariables "tooth" and "toothpaste" were analysed by non-parametric ANOVA, variables with significant effects were tested by Wilcoxon tests.

RESULTS

pt showed significantly higher surface loss than PT in all groups (P < 0.001). The mean values of SL of each group were: G1 PT 18.18(±3.98), pt 25.65(±9.21); G2 PT 14.76(±2.82), pt 18.11(±3.92); G3 PT 12.62(±5.29), pt 15.61(±6.70); G4 PT 17.12(±2.24), pt 23.41(±7.9); G5 PT 13.24(±1.29), pt 18.28(±8.96).

CONCLUSIONS

In permanent teeth, G3 showed the best preventive effect. In primary teeth, G1, G3, and G5 showed similar effect.

Etiological Aspects of Noncarious Dental Lesions

PURPOSE

The aim of the present study was to correlate etiological factors with noncarious cervical lesions in a group of patients from Craiova.

MATERIAL AND METHODS

The study was conducted between November 2015 and May 2016 on 50 patients, aged 18-56 years, who addressed to the Oral Rehabilitation Clinic, from the University of Medicine and Pharmacy of Craiova. Patients were divided into two groups: the study group consists of patients who had noncarious cervical dental lesions (NCCLs) and the control group with patients who did not have noncarious cervical lesions. Each patient underwent a clinical examination and completed a questionnaire, referring to eating habits, oral hygiene, vicious habits and personal impressions about the appearance and functionality of his teeth, highlighting the factors involved in the noncarious dental lesions etiology.

RESULTS

The study group consisted of 64% women and 36% men. Noncarious cervical lesions were higher in men (72.22%) compared to women (56.25%). Regarding on the tooth brushing method, it has been noted that 34% of patients used a vertical tooth brushing method, 52% were using a circular brushing method, while 14% were practicing a horizontal tooth brushing method. Cervical sensitivity has been detected in 48% of the patients, against 52% who showed no sensitivity. 62% of the participants did not have bruxism, while nighttime/daytime bruxism was found in 38% of the patients.

CONCLUSIONS

There are several etiological factors correlated with noncarious cervical lesions, among which are: tooth brushing method, bruxism, eating behaviors.