Description of a new laboratory evaluation method of interdental brush abrasion as a clinical hazard

OBJECTIVES

To simulate the abrasive potential of an interdental brush when applied with toothpastes and prophylactic gels/solutions in a novel laboratory brushing simulation set-up.

METHODS

A brushing device was customized to treat dentin samples mimicking a simplified interdental space with an interdental brush (ISO 2). The brushing, that is, 7200 strokes for 1 h, was performed with artificial saliva (control), a povidone-iodine solution, and slurries of chlorhexidine and fluoride gels as well as three toothpastes with different RDA values ranging from 29 to 100, respectively. The loss of dentin was profilometrically assessed and compared with ANOVA and Fishers LSD.

RESULTS

While artificial saliva as control, the solution and the gel slurries showed no measurable dentin loss, toothpastes resulted in a measurable linear surface damage with respect to the actual intrinsic RDA values and ranged from 12.6 to 26.5 μm (p < 0.001).

CONCLUSIONS

Any interdental cleaning product should be tailored and carefully instructed. Any over- and misuse should be avoided, which applies especially to the use of interdental brushes in combination with abrasive toothpastes.

Effect of different brushing parameters on erosive tooth wear in primary bovine enamel and dentin

This in-vitro study aimed to analyse the effect of brushing and different brushing parameters (kind of toothpaste, kind of toothbrush, brushing force) on erosive tooth wear of primary bovine enamel and dentin. Specimens were prepared from primary bovine enamel or dentin (each group n = 12) and cyclically eroded (6 × 60 s/d, citric acid, pH 2.4) and brushed with children's toothbrushes (2 × 15 s/d) over 5 days. The brushing parameters under investigation were: toothpaste (fluoridated, fluoride-free), toothbrush (manual; rotating-oscillating and sonic, each at two different activation modes) and brushing force (1 N, 2 N). Specimens that were only eroded and not brushed served as controls. Enamel and dentin wear was quantified using widefield confocal microscopy. Statistical analysis was performed using three- and one-way ANOVAs followed by Scheffe's (enamel) or Tamhane's (dentin) post-hoc tests (p < 0.05). Brushing with the fluoridated toothpaste was able to significantly reduce erosive wear in enamel (by 15 to 37%, 6 of 10 groups) and in dentin (by 58 to 72%, all groups), while brushing with the fluoride-free toothpaste was not different from the controls. Considering the kind of toothpaste and brushing force, slight differences between the toothbrushes were observed in enamel, but not in dentin. Within the same toothbrush and activation mode, almost no differences between 1 and 2 N brushing force were detected. In conclusion, erosive tooth wear on primary bovine dental hard tissue mainly depends on the kind of toothpaste, rather than on the kind of toothbrush and the brushing force.

In vitro assessment of dental erosion caused by clear aligners

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

Sports Diet and Oral Health in Athletes: A Comprehensive Review

Food and fluid supply is fundamental for optimal athletic performance but can also be a risk factor for caries, dental erosion, and periodontal diseases, which in turn can impair athletic performance. Many studies have reported a high prevalence of oral diseases in elite athletes, notably dental caries 20-84%, dental erosion 42-59%, gingivitis 58-77%, and periodontal disease 15-41%, caused by frequent consumption of sugars/carbohydrates, polyunsaturated fats, or deficient protein intake. There are three possible major reasons for poor oral health in athletes which are addressed in this review: oxidative stress, sports diet, and oral hygiene. This update particularly summarizes potential sports nutritional effects on athletes' dental health. Overall, sports diet appropriately applied to deliver benefits for performance associated with oral hygiene requirements is necessary to ensure athletes' health. The overall aim is to help athletes, dentists, and nutritionists understand the tangled connections between sports diet, oral health, and oral healthcare to develop mitigation strategies to reduce the risk of dental diseases due to nutrition.

Longterm abrasive and erosive effect of whitening toothpaste on dentin surface

PURPOSE

To evaluate the amount of dentin loss following immersion in or toothbrushing with whitening toothpaste (WT) containing hydrogen peroxide (HP) and citric acid (CA). Additionally, the amount of dentin loss after brushing with a WT alone or in combination with a conventional toothpaste was assessed, and the effects of HP and CA solutions on the dentin surface were investigated.

METHODS

Bovine dentin specimens (n= 350) were randomly assigned to seven solutions of various compositions as toothpaste: The specimens assigned to each solution were then further divided into five treatment groups (n=10 each) : Group A = 1-hour immersion in each solution (ES); Group B = 10,000 brushing in ES; Group C = 1-hour immersion in ES + 10,000 brushing in ES; Group D = 1-hour immersion in ES + 10,000 brushing in reference slurry (RS); Group E = 10,000 brushing in ES + 10,000 brushing in RS. The amount and pattern of dentin loss were determined, and the surfaces were observed using noncontact profilometry.

RESULTS

The WT (pH 5.0) caused lower dentin loss than RS after a single brushing cycle; however, the extent of dentin loss after 1 hour of immersion in the WT was significantly greater than that in the RS. Among the specimens treated with WT, a significant difference in dentin loss was observed between Group C and Groups D and E (P< 0.05) but not between Groups D and E. The surfaces exposed to CAS1, CAPB, and WT exhibited U-shaped patterns of dentin loss after brushing or immersion, whereas a wedge-shaped pattern was observed in those that underwent brushing with the RS.

CLINICAL SIGNIFICANCE

The effects (dentin abrasion) of a whitening toothpaste containing hydrogen peroxide and citric acid when used in combination with a conventional toothpaste were similar to those seen with the continuous use of a conventional toothpaste alone.

Proteomic analysis of stimulated saliva in gastroesophageal reflux disease patients with and without erosive tooth wear: Observational study

OBJECTIVE

To evaluate the difference in the proteomic profile of stimulated saliva in patients with gastroesophageal reflux disease (GERD) with (GE) and without (GNE) erosive tooth wear (ETW), regarding both human and bacterial proteins.

METHODS

Stimulated saliva (SS) was collected from 16 patients (8/group). Samples were centrifuged at 4.500 g for 15 min under refrigeration to remove all debris. The supernatant from each saliva sample was taken and frozen at -80 °C. After extracting the proteins, they were submitted to reverse phase liquid chromatography and mass spectrometry (nLC-ESI-MS/MS). Label-free proteomic quantification was performed using Protein Lynx Global Service (PLGS) software (p < 0.05) for human and bacterial proteins.

RESULTS

In total, 67 human proteins were common for GNE and GE groups. GNE group presented, compared to GE group, increase in proteins that confer antimicrobial and acid resistant properties, such as cystatins, histatin and immunoglobulins. However, GNE group had a marked decrease in subunits of hemoglobin (α, β and delta). Regarding bacterial proteins, for SS, 7 and 10 unique proteins were identified in the GE and GNE groups, respectively. They are related to protein synthesis and energy metabolism and interact with human proteins typically found in saliva and supramolecular complexes of the acquired pellicle.

CONCLUSIONS

Our data indicate that the stimulation of the salivary flow increases acid resistant and antimicrobial proteins in saliva, which might protect against ETW.

CLINICAL SIGNIFICANCE

This pioneer study showed important differences in the human and bacterial proteome of SS in patients with GERD with or without ETW.

Erosion behaviour of human, bovine and equine dental hard tissues

Dental hard tissues from different species are used in dental research, but little is known about their comparability. The aim of this study was to compare the erosive behaviour of dental hard tissues (enamel, dentin) obtained from human, bovine and equine teeth. In addition, the protective effect of the pellicle on each hard tissue under erosive conditions was determined. In situ pellicle formation was performed for 30 min on enamel and dentin samples from all species in four subjects. Calcium and phosphate release was assessed during 120 s of HCl incubation on both native and pellicle-covered enamel and dentin samples. SEM and TEM were used to examine surface changes in native enamel and dentin samples after acid incubation and the ultrastructure of the pellicle before and after erosive exposure. In general, bovine enamel and dentin showed the highest degree of erosion after acid exposure compared to human and equine samples. Erosion of human primary enamel tended to be higher than that of permanent teeth, whereas dentin showed the opposite behaviour. SEM showed that eroded equine dentin appeared more irregular than human or bovine dentin. TEM studies showed that primary enamel appeared to be most susceptible to erosion.

Dental erosion and the role of saliva: a systematic review

OBJECTIVE

This review evaluates the relationship between saliva and dental erosion. The acidic environment that can be established in the mouth leads to dental erosion. Acid pH, low salivary flow, systemic pathologies of patients, intake of acidic foods, and poor oral hygiene contribute to an oral environment that favors the development of dental erosion.

MATERIALS AND METHODS

A literature search was performed on PubMed, Scopus, and Web of Science databases to assess the role of saliva and dental erosion. The inclusion criteria for the search were: year of publication from January 1st, 2013, to March 1st, 2023, and English language.

RESULTS

A total of 3,597 articles covering our topic were found, of which 15 were selected for qualitative analysis.

CONCLUSIONS

Saliva protects against erosion by neutralizing and removing intrinsic and extrinsic acids, promoting the formation of an acquired protective film, and providing mineral substrates for remineralization by maintaining homeostasis in the digestive tract and oral cavity.

The Impact of Prenatal Vitamin D on Enamel Defects and Tooth Erosion: A Systematic Review

Prenatal Vitamin D has been suggested to be critical for dental health in children, affecting outcomes including the prevalence of enamel defects and tooth erosion. This systematic review aimed to evaluate the potential impact of prenatal Vitamin D levels on these dental health outcomes. A total of seven studies, involving 6978 participants, were included after a comprehensive search of PubMed, Web of Science, and Scopus from 2013 to June 2023. The average age of mothers varied across studies, with Vitamin D levels or supplementation practices displaying significant variation among the study populations. The age of children at examination ranged from 3.6 to 6.6 years. The analysis demonstrated a diverse association between Vitamin D levels and dental outcomes, with enamel defects reported in 21.1% to 64% of the children and opacities ranging from 36% to 79.5% across studies. Maternal Vitamin D insufficiency was identified as a significant risk factor for enamel defects in one study (OR: 3.55), whereas high prenatal Vitamin D levels indicated a protective effect against Hypomineralized Second Primary Molars (OR: 0.84) and Molar Incisor Hypomineralization (OR: 0.95) in another. Conversely, low Vitamin D levels increased the risk of enamel hypoplasia (OR: 1.29) and dental decay. The maternal and child demographics varied greatly across the studies, and the assessment and prevalence of Vitamin D deficiency or insufficiency were heterogenous. This review illuminates the potential influence of prenatal Vitamin D on dental health in children, underscoring the importance of adequate Vitamin D levels during pregnancy. However, more robust research is required to establish the optimal Vitamin D intake during pregnancy to ensure healthy dental outcomes in children.

Impact of different brushing/abrasion protocols on erosive tooth wear for in vitro studies

OBJECTIVE

To investigate the influence of different toothbrushing (with dentifrice) protocols on the progression of erosive tooth wear for in vitro studies.

DESIGN

Bovine enamel specimens were randomly distributed into 12 experimental groups (n = 10), according to the study factors: (1) brushing movement (horizontal or circular); (2) slurry diluent (artificial saliva or distilled water); (3) toothpaste dilution ratio (1:2, 1:3 or 1:4). A 5-day erosion-abrasion cycling model was performed, each consisting of 4 erosive challenges (0.3 % citric acid, pH=2.6) followed by 60 min exposure to artificial saliva. Brushing with fluoride toothpaste (15 s, 1400 ppm F^-, AmF) was carried out 2x/day. Enamel surface loss (SL) was determined by optical profilometry. Data were statistically analyzed with three-way ANOVA and Tukey tests (α = 0.05).

RESULTS

SL was lower for the horizontal movement than for the circular (p = 0.044). There were no significant differences among the dilution ratios for artificial saliva. For distilled water, the more concentrated slurry (1:2) presented greater surface loss than the less concentrated slurries (1:3 and 1:4, p = 0.049 and p = 0.014, respectively). Dilutions with artificial saliva at ratios 1:3 and 1:4 presented higher surface loss than with distilled water (p = 0.008 and p < 0.001, respectively); however, for 1:2 ratio, there were no significant differences between the diluents.

CONCLUSIONS

The in vitro progression of enamel SL was influenced by the brushing movement, as well as the combination of the dilution ratio and the diluent of the toothpaste slurry, and therefore, all these factors must be considered when comparing results from different studies.

Effects of the application timing of anti-erosive agents on dentin erosion

This in vitro study aimed to evaluate the effects of the application timing of anti-erosive agents on dentin erosion. Eighty dentin specimens with dimensions of 2 × 2 × 2 mm were prepared and randomly divided into 4 groups based on the treatment solutions: 1.23 × 104 μg/ml sodium fluoride (NaF), 120 μg/ml chlorhexidine (CHX), 300 μg/ml quercetin (QUE), and deionized water (DW, negative control). The specimens in each group were further divided into 2 subgroups according to the application timing of the treatment solutions (n = 10): before the erosive challenges (PRE) and after the erosive challenges (POST). All specimens were submitted to 4 daily erosive challenges for 5 d. For each erosive challenge, the specimens in the subgroup PRE were treated with the respective solutions for 2 min and then immersed in cola drinks for 5 min, while the specimens in the subgroup POST were immersed in cola drinks for 5 min followed by treatment with the respective solutions for 2 min. The erosive dentin loss (EDL) was measured using a contact profilometer, and the surface morphology of the dentin specimens was evaluated by scanning electron microscopy at the end of the experiment. The data were statistically analyzed using two-way analysis of variance (ANOVA) and Bonferroni's test (α = 0.05). Significantly less EDL was observed in the groups NaF, CHX, and QUE than in the group DW (all P < 0.001). Significantly lower EDL was observed in the groups CHX and QUE than in the group NaF (P = 0.001 and P < 0.001, respectively). For CHX, subgroup POST exhibited significantly less EDL than subgroup PRE (P < 0.001). Regarding QUE, subgroup PRE showed significantly less EDL than subgroup POST (P < 0.001). Furthermore, a relatively greater number of obliterated dentinal tubules was visible in the subgroup POST rather than in the subgroup PRE of the group CHX, while in the group QUE, narrower dentinal tubules were observed in the subgroup PRE than those in subgroup POST. In conclusion, CHX and QUE showed the best performance in controlling dentin erosion. CHX was more effective in reducing EDL when applied after erosive challenges, whereas QUE worked more effectively when used before erosive attacks. The application timing should be considered when evaluating the effects of anti-erosive agents because it may determine their effectiveness.

Species-specific enamel differences in hardness and abrasion resistance between the permanent incisors of cattle (Bos primigenius taurus) and the ever-growing incisors of nutria (Myocastor coypus)

Hypselodont (ever-growing) teeth of lagomorphs or rodents have higher wear rates (of a magnitude of mm/week), with compensating growth rates, compared to the non-ever-growing teeth of ungulates (with a magnitude of mm/year). Whether this is due to a fundamental difference in enamel hardness has not been investigated so far. We prepared enamel samples (n = 120 per species) from incisors of cattle (Bos primigenius taurus) and nutria (Myocastor coypus, hypselodont incisors) taken at slaughterhouses, and submitted them to indentation hardness testing. Subsequently, samples were split into 4 groups per species (n = 24 per species and group) that were assessed for abrasion susceptibility by a standardized brush test with a control (no added abrasives) and three treatment groups (using fine silt at 4 ±1 μm particle size, volcanic ash at 96 ±9 μm, or fine sand at 166 ±15 μm as abrasives), in which enamel abrasion was quantified as height loss by before-and-after profilometry. The difference in enamel hardness between the species was highly significant, with nutria enamel achieving 78% of the hardness of cattle enamel. In the control and the fine sand group, no enamel height loss was evident, which was attributed to the in vitro system in the latter group, where the sand particles were brushed out of the test slurry by the brushes’ bristles. For fine silt and volcanic ash, nutria enamel significantly lost 3.65 and 3.52 times more height than cattle. These results suggest a relationship between enamel hardness and susceptibility to abrasion. However, neither the pattern within the species nor across the species indicated a monotonous relationship between hardness and height loss; rather, the difference was due to qualitative step related to species. Hence, additional factors not measured in this study must be responsible for the differences in the enamel’s susceptibility to abrasion. While the in vitro brush system cannot be used to rank abrasive test substances in terms of their abrasiveness, it can differentiate abrasion susceptibility in dental tissue of different animal species. The results caution against considering enamel wear as a similar process across mammals.

Investigation of the protective suitability of a dental fluorinated varnish by means of X Ray fluorescence and Raman spectroscopy

BACKGROUND AND AIM

Evaluating the protective effect in human enamel of a fluorinated varnish after enduring a citric acid erosive challenge.

METHODS

An in vitro model was developed considering the intraoral environment, human saliva and acid erosive procedures. The evaluation of the enamel specimens was undertaken through the direct analysis of enamel by means of Raman spectroscopy and Energy Dispersive X Ray Fluorescence (EDXRF). Ten tooth specimens per group were analysed during three stages: 1- before treatment; 2- After varnish (treatment group) or toothpaste (control) application; 3- After citric acid cycle. Additionally, Particle Induced Gamma Ray emission (PIGE) was used to gauge the fluorine uptake by enamel after the application of the varnish (stage 2). Results were presented as mean and standard deviation with ANOVA and Tukey post hoc performed considering a significance level of 0.05.

RESULTS

A significant (p < 0.05) higher Ca levels were detected in treatment group at stage 2 (37.4 ± 0.4 w/w%) and 3 (37.1 ± 0.1) when compared to the control group. After varnish application in treatment group, depolarization ratios were significant lower (p < 0.05) and anisotropy were significant higher (p < 0.05), however no differences were detected in FWHM.

CONCLUSIONS

The use of a fluorinated dental varnish suggests a protective effect for human enamel against dental erosion demineralization process which was detectable in an in vitro model.

Genes Involved in Immune Response and Their Impact on Caries Susceptibility and Erosive Tooth Wear

Dental caries is a bacteria-mediated disease that inherently triggers a response from the host. The impact of this response is discussed in this chapter with a focus on genes involved in either the innate or the adaptive immune system. Since erosive tooth wear involves losses of structure not mediated by bacteria, the impact of the immune system is likely neglectable.

Genomic Predictors of Caries Experience and Erosive Tooth Wear Affection

The field of genomics was launched when the mapping of DNA in humans and other species was accomplished. A new area began for the integrated study of all the genes in an organism, and in the case of humans, the understanding of the results of related biomedical interventions that can be tailored to benefit a particular individual. The market for direct-to-consumer genetic testing is growing, and the opportunity exists to add genetic variation relevant to oral health in general, and to dental caries and erosive tooth wear in particular, to these panels of variants that aim to inform the public regarding their own health risks.

The dentin pellicle - A neglected topic in dental research

OBJECTIVE

All soft and solid surfaces exposed to the oral cavity are covered by an acquired pellicle. While the pellicle adsorbed on enamel is well researched, only limited data are available on the dentin pellicle. The purpose of the present review is to summarize studies considering the composition, structure and properties of the dentin pellicle and compare them with the current state of research on enamel pellicle.

METHODS

The literature search was conducted using Medline database and Google Scholar, including checking reference lists of journal articles by handsearching. Thereby, 19 studies were included in the present review.

RESULTS AND CONCLUSION

The dentin pellicle has a similar ultrastructure to the enamel pellicle, which is up to 1 μm thick depending on pellicle formation time and localization in the oral cavity. In contrast, due to the lack of studies on the dentin pellicle regarding its composition and properties, a comparison to the enamel pellicle is difficult. So far, only one study showed anti-abrasive properties and data on anti-erosive properties were controversial. Despite becoming more and more clinically relevant due to the increasing frequency of dentin exposure, the dentin pellicle is largely unexplored. For further investigations it is not only necessary to standardize dentin specimens, but also to assess fundamental research on dentin itself, as its complex morphology and composition may have a crucial influence on pellicle formation. Furthermore, a more detailed knowledge of the dentin pellicle may also reveal target sites for modification in favor of its protective properties.

Impact of Brushing Protocols on Dentin Abrasion Caused by Different Abrasive Slurries

PURPOSE

To determine the impact of the brushing protocol on dentin wear by comparing continuous to intermittent brushing, with the same total time of brushing.

MATERIALS AND METHODS

Dentin specimens (n = 120) were evently distributed into six groups (A-F). The samples were brushed with slurries of different relative dentin abrasivity (RDA): Groups A+B (Sident 2480-1; RDA 85), groups C+D (Zeodent 113; RDA 67), and groups E+F (Zeodent 103; RDA 174). Groups A+C+E were brushed continuously (25 min) with one slurry preparation, while groups B+D+F were brushed intermittently (25 x 1 min) with a renewal of the slurry after each sequence. Dentin wear was determined using surface profilometry and statistically analysed with ANOVA and post-hoc tests.

RESULTS

Neither the mode of brushing (p = 0.72) nor the interaction (p = 0.18) of the brushing mode with the type of abrasive particles had a significant influence on the abrasive dentin wear. Only the type of abrasive particles had a statistically significant influence on abrasive dentin wear (p < 0.001).

CONCLUSION

The mode of brushing (continuously or intermittently) has no influence on abrasive dentin wear.

Prevalence and Associated Factors of Tooth Wear in Shanghai

OBJECTIVE

To estimate the prevalence and distribution of tooth wear among groups of adolescents and adults in Shanghai, China through an epidemiological survey, and explore the associated factors.

METHODS

Multistage, stratified, constant volume and cluster sampling methods were used in an epidemiological survey conducted in Shanghai in 2014. The basic erosive wear examination (BEWE) index was used to screen for tooth wear in different age groups: 12 years, 15 years, 18 to 35 years, 36 to 49 years and 50 to 74 years. A previously published questionnaire collected information including dietary habits, oral hygiene habits and general conditions.

RESULTS

This survey reports the results for 1806 participants in Shanghai. The prevalence of tooth wear was 59.7% in adolescents (BEWE ≥ 1) and 93.1% in adults (BEWE ≥ 2). The prevalence and severity of disease increased with age (P < 0.01). The teeth most susceptible to wear were the central incisors and first molars. Multivariate analysis of covariance (ANCOVA) results showed that soft drinks, alcoholic drinks, pickled vegetables and hard food, gastroesophageal reflux disease (GERD), xerostomia and poor tooth brushing habits were statistically correlated with tooth wear in different age groups.

CONCLUSION

The prevalence of tooth wear appears to be high in adolescents and adults in Shanghai. Frequent consumption of soft or alcoholic drinks, GERD, xerostomia and poor tooth brushing habits were positively associated with tooth wear in different age groups.

Tooth Wear and Associated Factors in School Children with Primary Dentition in Kathmandu Valley

BACKGROUND

Tooth wear is the loss of tooth structure from physical or chemical attack of nonbacterial origin. Predominant causative factor for tooth wear in primary dentition is erosion. This study was conducted to assess the prevalence of tooth wear and its associated factors in primary dentition.

METHODS

Analytical cross-sectional study was conducted after obtaining ethical approval among 425 children aged two to 12 years, enrolled in different preschools/schools located in Kathmandu valley. Informed consent from parents as well as assent from children were obtained. Oral examination for assessing tooth wear was done using Smith and Knight Tooth Wear Index. Self-administered questionnaires were sent to parents for considering the factors associated with tooth wear. Data were entered in Microsoft Excel Sheet and analysed in Statistical Package of Social Sciences. The chi-square/fisher's exact test was done to establish the association between tooth wear and various factors.

RESULTS

Among total participants, 295 (69.4%) had tooth wear in at least one or more teeth. Tooth wear was seen significantly higher in children with increasing age (p<0.001). It was significantly associated with brushing technique (p=0.022), type of toothbrush (p=0.005), increasing duration of bottle feeding (p=0.003), in children frequently taking sour food stuffs (p=0.019) and soft drinks/juices (p<0.001).

CONCLUSIONS

Prevalence of tooth wear was high in primary dentition that increased with age. The condition was significantly associated with type of brushing technique, brushing frequency, materials used and type of diet. Tooth wear is a major problem in young age group having multifactorial etiology. It may lead to dental hypersensitivity and pulpal involvement if not followed up in early stages.

Nanoscale effects of beverages on enamel surface of human teeth: An atomic force microscopy study

Dental erosion has become a prevalence disease and attracted increasing attention worldwide. In this research, we quantitatively evaluate the mechanical and morphological changes in the very early stages of softening and weakening of human enamel surfaces induced by soft drinks using atomic force microscopy (AFM). With an increase of the immersion time in soft drinks, we found a significant increase of surface roughness (R_q) of the enamel surface. The prismatic structure of enamel was clearly observed after a 1-h immersion in Coca-Cola®, which shows its strong erosion effect. According to the elastic modulus mapping images obtained by AFM, a considerable decrease of elastic modulus (E) of enamel surface has been found as the enamel surface structures are etched away by soft drinks. A high surface roughness of enamel will result in a high chance of cavities due to easier bacterial adhesion on rougher surface, while a drastic deterioration of the mechanical properties of the enamel will weaken its protection property. Our findings show the serious influence of acidic drinks on enamel surface at the very beginning stage of etching process, which is quite meaningful for people to prevent dental erosion and keep dental health.

Multicenter study to develop and validate a risk assessment tool as part of composite scoring system for erosive tooth wear

OBJECTIVES

(i) To develop, validate, and apply in practice a new risk assessment tool for erosive tooth wear (ETW) including a risk factors questionnaire and a saliva secretion evaluation, which combined with a clinical index, can be part of an ETW composite scoring system; (ii) to assess ETW lesions and current and past erosive challenges in younger age groups.

METHODS

The Tooth Surface Loss/Erosion Working Group of the European Association of Dental Public Health consisted of an international panel of experts designed the survey component of the new tool (Erosive Wear Assessment of Risk-EWAR) and confirmed its construct and content validity. After receiving ethical approvals and informed consents, the EWAR tool (questionnaire + saliva secretion evaluation) was applied in a multicenter cross-sectional study with 207 participants aged 15-21 years old from four countries (Finland, Greece, Romania, the USA). BEWE score was used for the clinical assessment of ETW.

RESULTS

A total of 58.5% of participants had ETW. 10.9% and 20.3% of participants had low secretion of stimulated (< 1 ml/min) and unstimulated saliva (< 0.25 ml/min), respectively. The following factors were bivariately significantly associated with ETW: energy drink consumption, low secretion of stimulated saliva, juices consumption, erosive drink consumption for quenching thirst between meals, erosive drink kept in the mouth, feeling pain/icing after consuming something acidic or cold, and co-existence of other type of tooth wear. In regression analysis, only energy drink consumption (OR = 3.5, 95% CI: 1.39, 8.9), low secretion of stimulated saliva (OR = 36.3, 95% CI: 4.71, 78.94), and feeling pain/icing (OR = 8.8, 95% CI: 1.92, 40.04) remained significant.

CONCLUSIONS

The examiners of the study reported that the EWAR tool appeared to be an affordable and easy-to-use instrument. Some challenges occurred during the saliva collection process. Inferential analysis revealed that the risk factors/indicators of low stimulated salivary flow, energy drink consumption, and pain/icing with ETW were considered the most important in ETW occurrence.

CLINICAL RELEVANCE

EWAR tool combined with the BEWE clinical index can be used for ETW risk assessment for epidemiological studies and chairside use.

Quercetin reduces erosive dentin wear: Evidence from laboratory and clinical studies

OBJECTIVE

The aim of the present study was to evaluate the effect of quercetin on the acid resistance of human dentin through both laboratory and clinical studies.

METHODS

Two hundred and twelve dentin blocks (2 mm × 2 mm × 2 mm) were prepared and used. For the laboratory study, dentin specimens were randomly divided into 8 groups (n = 12): deionized water, ethanol, 1.23 × 10⁴ μg/ml sodium fluoride (NaF), 120 μg/ml chlorhexidine, 183.2 μg/ml epigallocatechin gallate (EGCG), and 75 μg/ml, 150 μg/ml, and 300 μg/ml quercetin (Q75, Q150, and Q300). The specimens were treated with the respective solutions for 2 min and then subjected to in vitro erosion (4 cycles/d for 7 d). The surface microhardness loss (%SMH_l), erosive dentin wear, and surface morphology were evaluated and compared. For the impact on MMP inhibition, the release of crosslinked carboxyterminal telopeptide of type I collagen (ICTP) and the thickness of the demineralized organic matrix (DOM) were measured using additional dentin specimens. For the clinical study, the specimens were treated with NaF or Q300 for 2 min and then subjected to in vivo erosion (4 cycles/d for 7 d). The %SMH_l and erosive dentin wear of the specimens were measured to determine whether quercetin similarly inhibits erosion in situ.

RESULTS

The quercetin-treated group had a significantly lower %SMH_l and erosive dentin wear than any other group, and the effect was concentration-dependent in vitro (P < 0.05). Dentin treated with quercetin produced significantly less ICTP and had a thicker DOM than the control dentin (P < 0.05). After in vivo erosion, the %SMH_l and erosive dentin wear of the Q300 group were significantly lower than those of the control group (P < 0.05).

SIGNIFICANCE

The application of quercetin was shown, for the first time, to increase the acid resistance of human dentin, possibly through MMP inhibition and DOM preservation.

Effect of Duodenogastric Reflux on Dental Enamel

PURPOSE

To evaluate the effects of stomach and duodenal fluid on enamel surfaces, simulating the action of refluxed liquid in patients with duodenogastric reflux.

METHODS AND MATERIALS

Forty bovine incisors were used to obtain enamel fragments. Only half of the enamel surface was exposed to erosive challenges; the samples were then randomly divided into the following four groups (n = 10): G1: HCl; G2: HCl + pepsin; G3: HCl + ox bile + NaHCO3; and G4: HCl + pancreatin + NaHCO3. The specimens were placed in 37°C solutions, six times per day, for 20 s, over a period of 5 days and then analysed for morphology, surface roughness and the step formed on the dental enamel using confocal laser microscopy. The data were analysed using the Kruskal-Wallis and Dunn's test (p <0.05).

RESULTS

Both analyses revealed a higher step and surface roughness for the G3 group (5.6 μm ± 1.69, 2.2 μm ± 1.61), which were statistically significant compared with the G1 and G2 groups (3.9 μm ± 1.5 μm; 1.0 μm ± 0.18; 3.7 μm ± 1.45; and 0.9 μm ± 0.12) (p <0.05); only the step in the G4 group (4.9 μm ± 1.8 μm) was similar to that of the G3 group (p >0.05). Morphological analysis showed greater structural loss in the G3 and G4 groups.

CONCLUSIONS

Bile and pancreatin, in combination with hydrochloric acid, may promote a greater loss of structure, increased surface roughness and loss of enamel prismatic anatomy.

Effect of erosive challenge before and after the restoration of primary teeth

The aim of this in vitro study was to investigate the erosive effect of a soft drink on primary teeth before and after restoration. Enamel blocks were obtained from 64 primary canines (N = 144) and divided into 3 groups (n = 48): 1, erosive challenge before and after restoration; 2, erosive challenge after restoration; and 3, no erosive challenge (control). The blocks received standardized preparations and were restored with 1 of 4 materials (n = 12): composite resin, bulk-fill composite resin, conventional glass ionomer cement, or resin-modified glass ionomer cement. The erosive challenge consisted of immersing the blocks in a cola soft drink for 1 minute at 25°C, 4 times a day for 5 days. The microhardness, roughness, marginal infiltration, and marginal adaptation of the specimens in all 3 groups were evaluated. Data were analyzed with the Kruskal-Wallis and Bonferroni tests. The results showed that the erosive challenge significantly altered all of the evaluated properties of all of the restorative materials (P < 0.05). The erosive challenge decreased the microhardness and marginal adaptation and increased the roughness and marginal infiltration of the tested materials. Composite resin had the highest values for microhardness and marginal adaptation as well as the lowest roughness value and dye infiltration score both with and without the erosive challenge. Subjecting teeth to erosive challenge before and after restoration altered the enamel microhardness and roughness significantly more than did erosive challenge only after restoration. Composite resin was the material least affected by the erosive challenge.

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.

Prevalence, Incidence, and Progression of Erosive Tooth Wear and Their Respective Risk Factors Among Schoolchildren in Mexico City

Purpose: To evaluate the cumulative incidence and progression of erosive tooth wear (ETW) and identify risk factors over 18 months in a cohort of 11- to 14-year-old schoolchildren in Mexico. Methods: The study was conducted in public schools located in northern Mexico City. Permanent teeth of 424 schoolchildren were examined using the basic erosive wear examination. The possible risk factors were included in the logistic models: the consumption of acidic food and beverages; habits related to the consumption of beverages; medication; gastroesophageal reflux; frequent vomiting; and characteristics of the saliva. Results: The prevalence of ETW was 62.5 percent (265 out of 424). The cumulative incidence was 35.2 percent (56 out of 159) and the progression was 72.8 percent (193 out of 265). The consumption of acidic beverages increased the relative risk (RR) of both the cumulative incidence (RR equals 1.09; 95 percent confidence interval [95% CI] 1.02 to 1.18; P=0.005) and the progression (RR equals 1.16; 95% CI 1.01 to 1.34; P=0.003). Conclusions: This population has a high risk of the development and progression of ETW, found in approximately one-third and approximately two-thirds of the schoolchildren, respectively. The most important risk factor was the consumption of acidic beverages.

Quantitative and Qualitative Evaluation of Enamel Erosion Following Air Abrasion with Bioactive Glass 45S5

PURPOSE

To evaluate the effect of pre-treatment air abrasion of surfaces using bioactive glass 45S5 on the progression of erosion in bovine enamel induced by a common soft drink.

MATERIALS AND METHODS

Twelve intact bovine incisors were selected and 24 enamel samples were prepared and randomly assigned to two groups (n = 12): 1. control group, no anti-erosive treatment; 2. experimental group: samples were air abraded with bioglass 45S5 before the erosive challenge. The enamel samples were submitted to erosive cycling using a common soft drink. Enamel surface loss was evaluated using optical profilometry; surface microhardness and roughness changes were determined using Vickers method and Vertical Scanning Interferometry, respectively. In addition, SEM observations and EDS analysis were performed to detect any alterations in surface morphology and mineral content. The data were statistically analysed using one-way ANOVA and Tukey's post-hoc test at a significance level of α = 0.05.

RESULTS

The experimental group exhibited less (18.7%) surface loss than did the control group (p < 0.05), while also presenting a statistically significantly smaller decrease in surface microhardness compared to the control group after erosive cycling (p < 0.05). However, neither group showed a statistically significant change in surface roughness (p > 0.05). After the treatments, changes in surface morphology and mineral content of enamel were observed.

CONCLUSIONS

Surface pre-treatment using air abrasion bioglass 45S5 may help prevent enamel erosion induced by excessive consumption of soft drinks. Further clinical trials are needed to confirm the effectiveness of this method and its clinical significance.

[Controversy on the terminology of cervical lesions on tooth]

Hard tissue defects at cervical site of tooth has been called the wedge-shaped defect in China for a long time. Other terms, abfraction and non-carious cervical lesions have been proposed in early 1990s. These three different terms are reviewed and analyzed in the present article. The author suggests to use the term non-carious cervical lesions to replace the term wedge-shaped defect in China.

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

Tooth erosion is becoming an increasingly common dental problem among teenagers. The study aimed to determine risk factors for erosive lesions in young sports professionals. Participants were 155 students—102 physically active and 53 controls. The method included dental examination (including Basic Erosive Wear Examination) and a questionnaire concerning sports activity, dietary and hygienic habits. The sporting activity significantly correlated with erosive lesions (R_Spearman = 0.344). The regression model incorporating the kind of sports activity, special diet and (non-)drinking water was statistically significant (p = 0.922 for the Hosmer–Lemeshow test) and strong enough to predict erosive lesions in young athletes (AUC = 0.758). Water sports professionals were almost 14 times more likely to suffer from erosive lesions than control students. Drinking water as the main beverage decreased the odds by about 70%. The graphical interpretation of multidimensional correspondence analysis confirms the predictive value of these factors. The kind of sports activity adjusted by the main beverage and a special diet was the best variable to predict erosive lesions among teenagers. Early proper diagnosis with defined risk factors leads to better prevention and successful treatment.

Erosive/Abrasive Enamel Wear While Using a Combination of Anti-Erosive Toothbrush/-Paste

PURPOSE

To investigate dental enamel wear caused by erosion and abrasion while using a combination of anti-erosive toothbrush/-paste.

MATERIALS AND METHODS

A total of 60 enamel specimens from bovine incisors were randomly assigned into five groups of 12 specimens each (G1-5, n = 12): (G1) control group (no treatment), (G2) standard medium toothbrush Paro M43 and standard toothpaste Elmex Caries Protection, (G3) standard medium toothbrush Paro M43 and anti-erosive toothpaste Elmex Protection Erosion, (G4) anti-erosive toothbrush Elmex Erosion Soft and standard toothpaste Elmex Caries Protection, (G5) anti-erosive toothbrush Elmex Erosion Soft and anti-erosive toothpaste Elmex Protection Erosion. Initially, surface baseline profiles were recorded using profilometry. In a total of 60 cycles, all specimens were exposed to hydrochloric acid (pH = 3) for 1 min, rinsed with tap water to stop the erosive attack and brushed according to the specific protocol of each group (15 brushing strokes per run). Enamel loss was determined by comparing the surface profiles before and after 60 cycles and the results were statistically analysed using analysis of variance (ANOVA).

RESULTS

The significantly highest loss of enamel was observed in the control group G1(1.4 ± 0.20 µm) (p < 0.001). G2 turned out to be the most abrasive toothbrush/-paste combination (1.12 ± 0.15 µm), G3 the least invasive (0.40 ± 0.04 µm) (p < 0.001, respectively).

CONCLUSION

All combinations of the investigated toothbrushes/-pastes reduce erosive/abrasive enamel wear. However, the highest reduction was observed for the combination of anti-erosive toothpaste and standard toothbrush (G3).

Prevalence of Erosive Tooth Wear and Related Risk Factors in Adolescents: An Integrative Review

Purpose: Dental erosion has become increasingly frequent in adolescents and is considered an oral health problem in this phase of life. Several factors have been associated with the development of dental erosion in adolescents, including lifestyle, socioeconomic status, and risk behaviors. We performed an integrative review of the prevalence of dental erosion and associated factors in adolescents.<br/> Methods: We analyzed studies, published between 2008 and 2018, available in Portuguese, English and Spanish, about the prevalence of and factors associated with dental erosion in adolescents between 10 and 19 years of age. Methodological quality was assessed using the Critical Appraisal Skill Program. The eligibility criteria defined the selection of articles available through searches of the LILACS, PubMed^®, and MEDLINE databases conducted between July and September 2018.<br/> Results: Among the 503 articles retrieved during the initial search, 471 did not meet the inclusion criteria. Among the 32 selected studies, five found no factors significantly associated with dental erosion and 27 found significantly associated factors, such as sociodemographic characteristics, diet, age, and others.<br/> Conclusions: The prevalence of dental erosion in adolescents was considered high and associated with lifestyle, diet, and sociodemographic and economic characteristics.

Influence of pure fluorides and stannous ions on the initial bacterial colonization in situ

The present clinical-experimental study aims to examine the effect of pure experimental fluoride solutions and stannous chloride on the initial oral bioadhesion under in situ conditions. After 1 min of pellicle formation on bovine enamel slabs, 12 subjects rinsed with 8 ml of the fluoride test solutions (NaF, Na2PO3F, AmF, SnF2,) with 500 ppm fluoride concentration each for 1 min. Additionally, rinsing without a solution (control) and rinsing with 1563 ppm SnCl2 solution took place for 1 min. Afterwards, fluorescence microscopy took place to visualize bacterial adhesion and glucan formation (8 h oral exposition) with DAPI and ConA and the BacLight method. TEM was performed to visualize the pellicle ultrastructure together with EDX to detect stannous ions. The rinsing solutions with pure SnF2 and SnCl2 reduced significantly the initial bacterial colonization (DAPI). While, NaF and Na2PO3F showed no significant effect compared to the control. There was no significant difference between AmF, SnF2 and SnCl2. All tested experimental solutions showed no reducing effect on the glucan formation. Considerable alterations of the pellicle ultrastructure resulted from rinsing with the Sn-containing solutions. SnF2 appears to be the most effective type of fluoride to reduce initial bacterial colonization in situ. The observed effects primarily have to be attributed to the stannous ions' content.

Effect of CPP-ACPF and Nano-hydroxyapatite Preventive Treatments on the Susceptibility of Enamel to Erosive Challenge

PURPOSE

The purpose of this in vitro study was to evaluate the effect of two preventive clinical treatments on bovine enamel susceptibility after erosive challenge induced by a soft drink.

MATERIALS AND METHODS

Eighteen sound bovine incisors were used for this study. Three experimental groups were assigned as follows: Group 1 was the control group; Group 2 specimens received a CPP-ACPF paste treatment; and Group 3 specimens received a treatment with a product containing 1% nano-hydroxyapatite and 455 ppmF-. The specimens were submitted to erosive challenge using a common soft drink (Coca Cola). The erosive activity on the enamel was evaluated by measuring surface microhardness change (Vickers method), surface roughness alterations and surface loss (vertical scanning interferometry (VSI) method). The data were statistically analysed using one-way analysis of variance (ANOVA) and Tukey's post-hoc test at a level of statistical significance a = 0.05.

RESULTS

The tested treatments exhibited significantly lower decreases in surface microhardness compared to the control group after the erosive challenge (p < 0.05). The tested treatment groups did not show statistically significant lower increases in surface roughness compared to the control group (p > 0.05). In addition, the treatment groups exhibited statistically significant lower surface loss than the control group (p < 0.05).

CONCLUSION

Although the tested treatments reduced erosive activity, none of them provided complete protection against the development of enamel erosion, which means that they should be only used as a part of an individually tailored preventive programme.

Remineralizing Effect of Casein Phosphopeptide-Amorphous Calcium Phosphate and Sodium Fluoride on Artificial Tooth Enamel Erosion: An In Vitro Study

AIM

To compare in vitro the remineralizing effect of toothpastes with casein phosphopeptide-amorphous calcium phosphate (FPC-FCA) and sodium fluoride on the artificial erosion of tooth enamel.

MATERIALS AND METHODS

For the first phase of artificial erosion, group I was considered as the control group without treatment or erosion. For groups II and IV, the drink was used (Coca-Cola®), for groups III and V, the drink (Inca-Kola®), and the four groups were demineralized four times a day (every 3 hours for 2 minutes) for 5 days. In the treatment phase in groups II and III, brushing was performed with sodium fluoride paste (Colgate®), groups IV and V received brushing with FPC-FCA complex (MiPaste®), and for all groups, the same procedure was performed four times a day (every 3 hours for 5 minutes) for 90 days. At the end, the microroughness of the surfaces of all the groups was evaluated by means of a Rugosimeter (Mitutoyo).

RESULTS

It was evidenced that the group of sodium fluoride presented a microroughness of 2.79 μm being the group of least remineralization, but the FPC-FCA complex showed a microroughness of 1.96 μm; however, the control group presented a microroughness of 3.20 μm, and the groups sodium fluoride, FPC-FCA compared to the control group proved to be statistically significant with a p < 0.05.

CONCLUSION

The remineralizing effect of FPC-FCA (MiPaste®) complex proved to be greater than sodium fluoride paste (Colgate®) under artificial enamel erosive conditions.

CLINICAL IMPORTANCE

The results of this research serve as a basis for industries to generate products that have the potential for remineralization against various erosive beverages that are consumed daily. How to cite this article: Pirca K, Balbín-Sedano G, Romero-Tapia P, et al. Remineralizing Effect of Casein Phosphopeptide-Amorphous Calcium Phosphate and Sodium Fluoride on Artificial Tooth Enamel Erosion: An In Vitro Study. J Contemp Dent Pract 2019;20(11):1254-1259.

Direct composite resin restorations for teeth with dental erosion: a case report

Acid erosion should be treated according to its multifactorial etiology. This case report describes a patient with tooth wear caused by daily intake of acidic carbonated beverages. After meticulous clinical and radiographic analysis, the clinician restored the teeth temporarily with chemically cured glass ionomer cement. Afterward, the patient underwent basic periodontal therapy with scaling and coronal polishing. The patient received guidance regarding daily oral hygiene and eating habits to control the ingestion of acidic drinks. After reestablishing adequate oral conditions, the clinician placed direct composite resin restorations on the maxillary anterior teeth that displayed dental erosion. The clinical procedures improved the patient's oral health as well as the form, esthetics, and function of the worn teeth.

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.

Diagnostic Value of the Basic Erosive Wear Examination for the Assessment of Dental Erosion on Patients, Dental Photographs, and Dental Casts

OBJECTIVES

The aim of this trial was to investigate the diagnostic value of the basic erosive wear examination (BEWE) in clinical use, on dental photographs, and on dental casts over a two-year follow-up period (2013-2015). According to the main hypothesis for longitudinal monitoring of dental erosion, the BEWE is equally reproducible by the three assessment methods.

METHODS AND MATERIALS

The clinical assessment included intraoral photographic documentation, dental impressions, oral examination, and assessment of BEWE. Clinical assessment of BEWE was done by one blinded examiner, whereas assessment on photographs and dental casts was performed by three calibrated examiners and repeated after 14 days. The three assessment methods were analyzed separately by longitudinal agreement and inter- and intrarater reliability (intraclass correlation coefficient) alongside 95% confidence intervals (CIs).

RESULTS

Comparing the longitudinal data of the years 2013-2015, clinical use and photographs showed no significant difference (p=0.0681-0.9963), whereas the statistical analysis showed a significant difference for dental casts by comparing data from 2013 vs 2014 (p=0.0266) as well as data from 2013 vs 2015 (p=0.0001). Statistical evaluation of overall BEWE showed an intrarater reliability of 0.79-0.91 for photographs and 0.60-0.87 for dental casts. The interrater reliability was 0.77 (95% CI=[0.69; 0.84]) for photographs and 0.63 (95% CI=[0.52; 0.72]) for dental casts.

CONCLUSION

This investigation showed that in longitudinal clinical monitoring, the assessment of the BEWE on patients and dental photographs yielded comparable results. In addition, based on these findings, the assessment of the BEWE on dental casts showed moderate reproducibility. Therefore, dental casts may be better used for laboratory assessment techniques.

Resin-Based Materials Protect Against Erosion/Abrasion-a Prolonged In Situ Study

While patient compliance is key to preventive measures related to dental erosion, the application of resin-based materials could serve as an additional treatment to inhibit erosion progression. This in situ study evaluated the effect of applying resin-based materials, including resin infiltrant, on previously eroded enamel subjected to prolonged erosive and abrasive challenges. The factors under study were types of treatment (infiltrant [Icon], sealant [Helioseal Clear], adhesive [Adper Scotchbond Multi-Purpose Plus], and control [no treatment]); wear conditions (erosion [ERO] and erosion + abrasion [ERO + ABR]) and challenge time (5 and 20 days) in a single-phase study. The blocks were prepared from bovine enamel, eroded (0.01 M HCl, pH 2.3 for 30 seconds) and randomized among treatments, wear conditions, and volunteers. The application of resin-based materials followed the manufacturers' recommendations. Twenty-one volunteers wore the palatal intraoral device, in which one row corresponded to ERO and the other to ERO + ABR. In each row, all treatments were represented (2 blocks per treatment). For 20 days, the erosive challenge was performed 4 times/day (immersion in 0.01 M HCl, pH 2.3, for 2 minutes) for the ERO condition. For the ERO + ABR condition, two of the erosive challenges were followed by abrasion for 15 seconds with fluoride dentifrice slurry. Enamel and/or material loss was measured using profilometry (initial, after treatment, and after the end of the fifth and 20th days of in situ erosive challenge) and analyzed by ANOVA models and Tukey's test (α=0.05). The results showed that the application of resin-based materials did not cause superficial enamel loss. The infiltrant group showed a thicker layer of material above the enamel compared with the other materials (p=0.001). After the erosive challenge, there was no difference between the conditions ERO and ERO + ABR (p=0.869). All materials protected the enamel against erosion progression compared with the control group (p=0.001). Based on these results, we conclude that the application of resin-based materials results in protection of previously eroded enamel subjected to in situ erosive and abrasive challenge for 20 days.

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).

[Tooth Erosions Associated with Gastroesophageal Reflux: Cause, Prevention and Restorative Therapy]

Tooth Erosions Associated with Gastroesophageal Reflux: Cause, Prevention and Restorative Therapy Abstract. Dental erosions are caused by the recurring contact of solutions which are unsaturated in tooth minerals,ith hard tooth substances. This initially leads to softening and later to an irreversible loss of hard tooth substance. Erosion is observed particularly with excessive consumption of acidic foods (e.g. soft drinks or citrus fruits) but also in connection with gastrointestinal (gastroesophageal reflux disease) or psychosomatic diseases (anorexia nervosa or bulimia nervosa). The aim of this article is to define dental erosions, their causes, prevalence and consequences as well as possible preventive measures. Based on a clinical example of a patient with reflux-related erosions, a therapy option with direct composite tooth build-up is presented.

Performance of a newly developed mineral gel system on erosive and erosive/abrasive enamel loss. An in vitro study

We compared the prevention of erosive and erosive/abrasive enamel loss by a medical minerals gel system (R.O.C.S.) to that by an anti-erosive toothpaste. Seventy-two bovine enamel samples were randomly allocated to six groups (E1–E3 and EA1–EA3; n=12). Per day, samples were eroded (2 min) 9 times using HCl (pH 2.6). Between erosive challenges and over night samples were stored in artificial saliva. Per day, samples were stored (100 s; groups E1–E3) or additionally brushed (20 brushing strokes; groups EA1–EA3) in/with slurries prepared from artificial saliva plus: no additional toothpaste (control groups E1 and EA1), elmex erosion protection toothpaste (groups E2 and EA2), or R.O.C.S. toothpaste (groups E3 and EA3). Once per day, samples of groups E3 and EA3 were additionally treated (40 min) with a slurry prepared from artificial saliva and R.O.C.S. medical minerals gel. After 7, 14 and 21 days enamel loss was measured by surface profilometry and analyzed by Kruskal-Wallis tests and Conover post-hoc tests. Under erosive conditions only (groups E1–E3), at each time point of measurement the significantly lowest enamel loss was observed in group E2. Substance loss in group E3 was significantly higher, but significantly lower compared to that of group E1. Under erosive/abrasive conditions (groups EA1–EA3), at each time point of measurement the significantly lowest enamel wear was observed in group EA2. Wear in group EA3 was significantly higher even compared to that of group EA1. The tested R.O.C.S. medical minerals gel system was able to reduce erosive enamel loss but not erosive/abrasive enamel wear, and it was less effective than the elmex erosion protection toothpaste.

Prevalence, severity and explanatory factors of tooth wear in Arab populations

OBJECTIVES

The aim of this study was to assess the prevalence and severity of tooth wear and related risk indicators in six Arab countries.

METHODS

This multicenter, multinational cross-sectional study was conducted among 2924 participants between the ages of 18-35 years old from six Arab countries. Calibrated dentists assessed tooth wear using the Basic Erosive Wear Examination Index (BEWE). Participants were also asked to complete a questionnaire that assessed their dietary and oral health habits. Each participant was identified by the sextant with the highest BEWE score in the upper and lower jaws.

RESULTS

Odds ratios were estimated for correlates of tooth wear anterior and posterior regions. Oman had the highest prevalence of BEWE score 3 (N = 255 (60.2%)). Overall, the highest BEWE score 3 was observed on the incisal edge of the upper anterior teeth (N = 602 (20.6%)) and in the lower left posterior region (sextant 6) on the occlusal surface (N = 466 (15.9%)). Correlates of severe tooth wear in both regions were eating or drinking more than six times per day, age and education. Drinking soft drinks "once a day" was significantly associated with severe tooth wear in the posterior region (OR: 1.3, 95% CI:1.05, 1.6). Brushing teeth more than twice a day was inversely associated with tooth wear in the anterior region (OR:0.75, 95% CI: 0.57,0.97).

CONCLUSION

The prevalence of tooth wear in Arab populations is relatively high, specific preventive and therapeutic measures should be developed to target people at higher risk of this condition.

CLINICAL SIGNIFICANCE

Tooth wear is now regarded as a significant oral health problems, dentists should advise their patients about dietary and oral health habits that can lead to severe tooth wear.

Effect of Calcium-phosphate Desensitizers on Staining Susceptibility of Acid-eroded Enamel

OBJECTIVE

To investigate the effect of calcium-phosphate-based desensitizers, Teethmate AP paste (TMAP) and Teethmate Desensitizer (TMD) (Kuraray Noritake Dental, Tokyo, Japan), on the prevention of staining on acid-eroded enamel.

METHODS AND MATERIALS

Forty polished enamel samples (4×4×1 mm) from bovine incisors were randomly divided into five groups (n=8). After immersion in 50 mL of 0.5% citric acid (pH 2.5) for 15 minutes to form acid-eroded surfaces, the surfaces were subjected to different treatments with TMAP, TMD, and NaF (0.21% means 950 ppm) for five minutes. Another eroded group was not treated with desensitizer. For the control group, the samples were not eroded or treated. All the samples were stored in artificial saliva (AS) at pH 7.2 for 24 hours at 37°C. The TMAP, TMD, or NaF was reapplied at eight and 16 hours during the 24 hours of storage time. The surface roughness (Sa) was evaluated following ISO 25178 for surface texture using confocal laser scanning microscopy (VK-X 150 series, Keyence, Osaka, Japan) before acid erosion, after acid erosion, and after 24 hours of incubation in AS. Afterward, the color difference was measured with a dental colorimeter (Shade Eye NCC, Shofu, Kyoto, Japan) before and after staining with tea solution.

RESULTS

One-way repeated measures analysis of variance showed that acid erosion significantly increased Sa (p<0.001). TMAP- and TMD-treated groups exhibited lower Sa values than the NaF group and the no-desensitizer treatment group. The greatest staining was observed in the NaF group and the no-desensitizer group, while the TMAP and TMD groups significantly decreased the formation of stains.

CONCLUSIONS

Acid-eroded enamel increased surface roughness and tended to absorb more stains. However, the application of TMAP and TMD moderated the roughness and thus prevented the formation of extrinsic stains.

Effect of desensitizing toothpastes on dentin erosive wear and tubule occlusion. An in situ study

PURPOSE

To evaluate the effect of desensitizing dentifrices on dentin wear and tubule occlusion using a three-phase, single blind, crossover in situ trial.

METHODS

The dentifrices containing Arginine and calcium carbonate (1,450 ppmF) and Novamin, (~1,426 ppmF) were tested in two conditions: A: abrasion and B: erosion/abrasion. A dentifrice without desensitizing agents was used as control (1,450 ppmF). In each study phase, 10 volunteers used intra-oral appliances containing dentin specimens (pre-treated with EDTA, to simulate hypersensitive dentin), which were either submitted to erosion with a cola-like drink (pH 2.6), 4×/day (2 minutes), followed by toothbrushing, using electric toothbrushes, with standard pressure (2×/ day, 5 seconds), or toothbrushing only. Dentin surface loss (SL, in µm) was determined with optical profilometry at the 3rd and 5th days of cycling. Dentin surface was analyzed with environmental scanning electron microscopy (ESEM), post EDTA and post cycling, and the dentin tubules were counted using Image J software. Data were statistically analyzed (α= 0.05).

RESULTS

For condition A and B, there were no significant differences in SL among toothpastes in both experimental times. There were also no significant differences between times within groups. For ESEM, in A, Toothpaste with Novamin was the only dentifrice that showed significantly less opened tubules post cycling than post EDTA. In B, Toothpaste with Novamin and control toothpaste presented less opened tubules post cycling. In conclusion, toothbrushing with the tested dentifrices promoted similar levels of dentin loss; however, for tubule occlusion, the toothpaste with Novamin was the only toothpaste effective for both conditions, abrasion and erosion/abrasion.

CLINICAL SIGNIFICANCE

Ideally, desensitizing dentifrices should promote obliteration of the dentin tubules or nerve desensitization, without further contributing to the progression of dentin wear.

Erosion-protecting effect of oral-care products available on the Swiss market. A pilot study

The present study sought to test oral-care products available on the Swiss market, such as toothpastes and gels, with respect to the protection of enamel against erosive tooth wear. A total of 56 enamel specimens were divided into 7 groups (n = 8): F-TP = Migros Budget Anti-Caries Toothpaste (Negative Control); F+Sn3500-TP = Elmex Erosion Protection Toothpaste (Positive Control); F-TP + F+Oligopep-Gel = Migros Budget Anti-Caries Toothpaste + Emofluor Protect Gel Professional; F+Sn3120-Gel = Emofluor Gel Intensive Care; F+Oligopep-TP = Candida Protect Professional Toothpaste; F+Sn1260-TP = Emoform-F Protect Toothpaste; and F+Sn3440-TP = Sensodyne Repair & Protect Toothpaste. The specimens were incubated in artificial saliva for 30 min and then brushed in a toothbrushing machine (10 s brushing; total 2 min exposure to the product). After the toothbrush abrasion, the specimens were rinsed, dried and submitted to an erosive challenge (2 min; 1% citric acid; pH 3.6). This sequence was repeated 4 times, and the total enamel surface loss was calculated using indentation measurements before and after the brushing period. All groups presented progressive surface loss throughout the experiment; after 4 cycles, total surface loss values ranged from 0.11 µm (F+Sn3120-Gel) to 0.89 µm (F+Sn1260-TP). Regarding the total surface loss values (median; interquartile range), F-TP (0.54; 0.42–0.59) presented no significant differences compared to any of the other groups. F+Sn3500-TP (0.33; 0.30–0.40), F-TP + F+Oligopep-Gel (0.34; 0.29–0.42) and F+Sn3120-Gel (0.11; 0.09–0.15) presented lower surface loss than F+Oligopep-TP (0.75; 0.59–0.98), F+Sn1260-TP (0.89; 0.68–1.13) and F+Sn3440-TP (0.69; 0.66–0.78). Conclusion: Although some of the oral-care products containing stannous ions or oligopeptide-104 presented numerically lower SL values, they did not present significantly better protection than a regular fluoride toothpaste. The gels showed a general trend of better enamel protection against ETW.

Effect of ultrasonic, sonic and rotating-oscillating powered toothbrushing systems on surface roughness and wear of white spot lesions and sound enamel: An in vitro study

PURPOSE

To evaluate the effect of ultrasonic, sonic and rotating-oscillating powered toothbrushing systems on surface roughness and wear of white spot lesions and sound enamel.

METHODS

40 tooth segments obtained from third molar crowns had the enamel surface divided into thirds, one of which was not subjected to toothbrushing. In the other two thirds, sound enamel and enamel with artificially induced white spot lesions were randomly assigned to four groups (n=10) : UT: ultrasonic toothbrush (Emmi-dental); ST1: sonic toothbrush (Colgate ProClinical Omron); ST2: sonic toothbrush (Sonicare Philips); and ROT: rotating-oscillating toothbrush (control) (Oral-B Professional Care Triumph 5000 with SmartGuide). The specimens were analyzed by confocal laser microscopy for surface roughness and wear. Data were analyzed statistically by paired t-tests, Kruskal-Wallis, two-way ANOVA and Tukey's post-test (α= 0.05).

RESULTS

The different powered toothbrushing systems did not cause a significant increase in the surface roughness of sound enamel (P> 0.05). In the ROT group, the roughness of white spot lesion surface increased significantly after toothbrushing and differed from the UT group (P< 0.05). In the ROT group, brushing promoted a significantly greater wear of white spot lesion compared with sound enamel, and this group differed significantly from the ST1 group (P< 0.05). None of the powered toothbrushing systems (ultrasonic, sonic and rotating-oscillating) caused significant alterations on sound dental enamel. However, conventional rotating-oscillating toothbrushing on enamel with white spot lesion increased surface roughness and wear.

CLINICAL SIGNIFICANCE

None of the powered toothbrushing systems (ultrasonic, sonic and rotating-oscillating) tested caused significant alterations on sound dental enamel. However, conventional rotating-oscillating toothbrushing on enamel with white spot lesion increased surface roughness and wear.

Impact of dentifrice abrasivity and remineralization time on erosive tooth wear in vitro

PURPOSE

To investigate the in vitro effects of simulated dentifrice slurry abrasivity (L-low, M-medium and H-high) and remineralization time (0, 30, 60 and 120 minutes) on erosive tooth wear.

METHODS

Enamel and root dentin specimens were prepared from bovine incisors (n= 8) and submitted to a cycling protocol including erosion, remineralization at the test times, and brushing with each of the tested slurries, for 5 days. Dental surface loss (SL) was determined by optical profilometry. Data was analyzed using mixed-model ANOVA and Fisher's PLSD tests (alpha= 0.05).

RESULTS

SL generally increased along with the increase in slurry abrasive level, with significance dependent upon the specific substrate and remineralization times. H showed the highest SL on both enamel and dentin; remineralization for 30 minutes reduced SL significantly (P< 0.05), but only for enamel. M showed intermediate SL values, with remineralization benefit clearly seen only after 120 minutes of remineralization (P< 0.05). L caused the least SL for both enamel and dentin, which was further reduced after remineralization for 120 and 30 minutes, respectively (both P< 0.05). Overall, root dentin had significantly higher SL than enamel. Less abrasive dentifrice slurries were able to reduce toothbrushing abrasion on both enamel and root dentin. This protection was enhanced by remineralization for all abrasive levels on enamel, but only for L on root dentin.

CLINICAL SIGNIFICANCE

High-risk erosion patients should avoid highly abrasive toothpastes, as remineralization can only partially compensate for their deleterious effects on eroded dental surfaces. Lower abrasive toothpastes are recommended.

Clinical Performance of Root Surface Restorations

This chapter describes the clinical performance of restorations placed in root caries lesions. The prevalence of root caries and other types of cervical lesions, caused by abfraction, erosion, and abrasion (non-carious cervical lesions) are high, mainly in the elderly; and therefore, restorative procedures are indicated. We will revise the restorative materials used to restore these types of lesions and present evidence-based findings to provide clinicians with better evidence for choosing them. Additionally, some steps of the restorative procedure for the placement of resin-based composites will be revised and common clinical questions related to these steps will be answered based on high evidence level, produced by randomized clinical trials and systematic reviews of the literature.