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.

Dental Erosion Prevalence and Its Association With Obesity Among Children With and Without Special Healthcare Needs

PURPOSE

Dental erosion and childhood obesity are associated with a common risk factor, soft drink consumption. The present study aims to assess the prevalence of dental erosion and its association with obesity among children with and without special healthcare needs.

MATERIALS AND METHODS

A cross-sectional study was conducted on 1,200 school children (400 children with special needs (CSHN) and 800 children without special needs) in the age group of 6 to 16 years. Dental erosion was diagnosed according to World Health Organization (WHO) criteria. Body mass index (BMI; weight/height in kg/m2) was recorded for each child. The association of dental erosion and obesity was analysed using multivariate logistic regression analysis.

RESULTS

A total of 331 (27.6%) children presented with dental erosion. Dental erosion prevalence among CSHN was 33.5% and among children without special needs was 24.6%. In the final fully adjusted model, children with obesity presented 2.32 times (95%CI 1.17-4.89, P = 0.001) higher odds ratio (OR) of having dental erosion than normal-weight children. Children who consumed soft drinks ≥ 1 time/day and 2-6 times a week presented with an OR of 2.65 (95%CI 1.23-5.21, P = 0.001) times of dental erosion. Children with chronic vomiting and bulimia presented with a 3.27 (95%CI 1.72-6.12, P = 0.001) times higher OR of dental erosion. Children with gastric reflux presented with a 3.21 (95%CI 1.52 - 5.86, P = 0.001) times higher OR of dental erosion.

CONCLUSION

The prevalence of dental erosion was slightly higher for special needs children compared to children without special needs. The study outcome suggests that obesity, chronic vomiting, consumption of soft drinks, and gastric reflux are statistically significantly associated with dental erosion.

The effect of red wine in modifying the salivary pellicle and modulating dental erosion kinetics

This study investigated the potential of red wine in modulating dental erosion kinetics in the presence or absence of salivary pellicle. Polished human enamel specimens were used in two conditions; presence or absence of acquired enamel pellicle; and subdivided according to exposure: red wine, orange juice, apple juice, or citric acid. The specimens were incubated in clarified whole human saliva (presence of acquired enamel pellicle) or in a humid chamber (absence of acquired enamel pellicle) for 2 h at 37°C, then in the test substances for 1 min, at 25°C, under shaking. This was repeated four times. Surface hardness was measured initially and after each cycle and surface reflection intensity was measured initially and after all cycles. In the presence of acquired enamel pellicle, red wine caused the least surface hardness loss, followed by orange juice, apple juice, and citric acid. Statistically significantly less surface reflection intensity loss was observed for red wine and orange juice than for apple juice and citric acid. In the absence of acquired enamel pellicle, red wine and orange juice caused less surface hardness loss than apple juice and citric acid. Orange juice showed the least surface reflection intensity loss, followed by red wine, citric acid, and apple juice. The polyphenol composition of these drinks can notably modulate the erosion kinetics.

Acid Resistance of Glass Ionomer Cement Restorative Materials

In view of the need for aesthetics, restorations of teeth will typically be completed using tooth colored restorative materials. With the advent of biomimetic restorative materials, such as glass ionomer cements (GIC), much greater emphasis is now being placed on how well such materials can resist the challenge of acids that are present in foods and drinks, or gastric contents that are regurgitated. This laboratory study compared the dissolution and behavior of five GIC materials (GC Fuji® VII, GC Fuji® Bulk, GC Fuji® IX Fast, Fuji® IX Extra and GC Equia® Forte Fil) when exposed to three acids (citric acid, phosphoric acid and lactic acid), versus ultrapure deionized water, which was used as a control. Discs of each material GIC were submerged in solutions and percentage weight changes over time determined. Subsequently, the GIC materials were also placed as a part of standardized Class II sandwich restorations in bovine teeth (n = 20), and submerged in the solutions, and the extent of GIC dissolution and protection of the adjacent tooth was scored. Weight loss increased with time and with acid concentration. Overall, the most soluble material was GC Fuji® IX Extra, while GC Fuji® IX Fast and GC Fuji® Bulk were less soluble, and the least soluble material was GC Equia® Forte Fil. The most destructive solution for both the discs and for GIC restorations in teeth was 10% citric acid, while the least destructive acid was 0.1% lactic acid. The more recent GIC materials GC Fuji® Bulk and GC Equia® Forte Fil showed increased acid resistance over the older GIC materials, and this further justifies their use in open sandwich Class II restorations in more hostile environments.

A systematic review of dietary acids and habits on dental erosion in adolescents

BACKGROUND

Dental erosion is the dissolution of dental hard tissues caused by acids of a non-bacterial origin. Dietary acids are considered the predominant and most controllable factor.

AIM

To synthesise the literature on the effects of dietary acids and habits on dental erosion in the permanent dentition of 10- to 19-year-old adolescents.

MATERIALS AND METHODS

An electronic literature search was undertaken in Cochrane, MEDLINE, CINAHL, Dentistry & Oral Sciences Source via EBSCOhost, and Embase with no restriction on the date of publication.

RESULTS

The initial search identified 449 articles, and 338 remained after removal of duplicates. Seventy-seven articles remained after screening of titles and abstracts, and 52 were eligible for the full-text review. A considerable variety of beverages, food, and dietary habits were reported as risk factors for dental erosion. The most consistent findings implicated the erosive potential of carbonated beverages and the consumption of acidic drinks at bedtime.

CONCLUSIONS

Although results were not consistent between cohort and cross-sectional studies, this review suggests certain dietary risk factors may contribute to dental erosion in adolescents. There is a need for more high-quality cohort studies to establish more conclusive evidence on the role of dietary acids and habits on dental erosion.

Cross-Sectional Analysis of Prevalence and Aetiological Factors of Dental Erosion in Turkish Children Aged 7-14 Years

PURPOSE

This study aimed to estimate the prevalence, distribution, and the associated factors of tooth erosion in Turkish school children.

MATERIALS AND METHODS

A cross-sectional analysis was performed on a representative sample of 473 children (aged 7-14 years) from 11 public schools in Turkey. Parents were asked to fill out a questionnaire to collect sociodemographic data. A questionnaire was also given to the children, to collect data pertaining to personal demographic details and habits of consuming acidic foods and drinks. The O'Sullivan index was used to assess affected permanent teeth. The data were analysed using a chi-square test and multivariate logistic regression analysis.

RESULTS

Dental erosion was observed in 21.8% of the children. Lesions were most often observed in the enamel with less than half of the buccal surface affected. Erosion was found to be statistically significantly higher in older children and in those with an elevated body mass index (BMI) (p <0.05). The consumption of fruit juices, drinks with cola, orange soft drinks, gaseous, cocoa milk, iced tea, sodas, sports drinks, energy drinks, oranges, lemons, kiwis, grapefruits, apples, peaches, and fruit yogurts was statistically significantly higher in students with erosion (p <0.05). There was no statistically significant relationship between students' sex, systemic disease, premature birth and low birth weight, exercise activity level, socioeconomic status, parental education level, and oral hygiene habits with erosion (p >0.05).

CONCLUSION

Although erosive lesions were limited to the enamel, the prevalence of erosion was high. Erosion was statistically significantly associated with older age, elevated BMI, consumption of certain beverages, and fruit.

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.

Dental Erosion Risk Factors in 6 to 12 Year Old children in Mexico City

Objective: To assess the prevalence and dental erosion risk factors in Mexican schoolchildren. Study design: A transversal and analytical study was conducted on 411 children aged 6 to 12 years old in a public primary school of Mexico City. The children's parents answered a standardized questionnaire about their risk factors, and the Smith and Knight index was applied to assess their dental erosion degree. Results: The prevalence of dental erosion was 62%. The odds ratio and X² tests revealed that probiotic beverage consumption (OR 1.658; CI 95%: 1.106-2.485; p = 0.014), sports beverages (OR: 2.807; CI 95%: 1.129-6.983; p = 0.021), natural juices (OR: 3.344; CI 95%: 1.556-7.184; p = 0.003), fruits and snacks with hot peppers and lemon (OR: 1.594; CI 95%: 1.066-2.382; p = 0.023), and syrups (OR: 1.869; CI 95%: 1.060-3.296; p = 0.029) were all risk factors for dental erosion. Conclusions: This study indicated that a high existence of dental erosion, which mainly affects the primary molars, is related to the frequent consumption of beverages and foods with acidic pH levels.

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).

The Role of Vitamins in Oral Health. A Systematic Review and Meta-Analysis

The association between vitamins and oral health have recently been discussed, yielding increased attention from medical and dental perspectives. The present review aimed to systematically evaluate and appraise the most recently scientific papers investigating the role of vitamins in the prevention and treatment of the main oral diseases as hard dental pathological processes and gum/periodontal disease. Randomized controlled trials, cross-sectional studies, cohort studies, comparative studies, validation studies and evaluation studies, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, reporting associations between vitamins and oral diseases or the use of vitamins to prevent or treat oral diseases in patients of any age were included. PubMed, Embase and Scopus were searched to November 2019 using an ad hoc prepared search string. All the papers meeting the inclusion criteria were subjected to a quality assessment. The search identified 1597 papers; 741 were selected after removing duplicates. A total of 334 articles were excluded after title and abstract evaluation; 407 were assessed and 73 papers were full-text assessed; other 14 papers were discharged after full text evaluation, leaving finally 58 papers included. In general, there is weak evidence supporting the association between vitamins and both gingival/periodontal disease and hard dental pathological processes.

The effect of simulated erosive conditions on the frictional behavior of different orthodontic bracket-wire combinations

BACKGROUND

Frictional resistance is an important parameter in orthodontics that influences the effectiveness of archwire-guided tooth movement. Since the consumption of dietary acids has increased considerably over the last 2 decades, there is a rationale for investigating the process of degradation of orthodontic materials in an acidic environment and its effect on clinical efficiency.

OBJECTIVES

The aim of this study was to evaluate the effect of simulated erosive conditions on the frictional behavior between the brackets of 3 different materials and 3 different wire alloys.

MATERIAL AND METHODS

Three types of twin orthodontic brackets (stainless steel (SS), monocrystalline ceramic and titanium) and 3 types of archwires of the same dimension (SS, nickel-titanium (Ni-Ti) and beta-titanium (titanium-molybdenum alloy - TMA) were tested in 9 different combinations under simulated erosive and non-erosive conditions (18 groups, n = 10). Bracket-wire specimens in the erosivecondition groups were subjected to a pH cycling regimen with 1% citric acid and artificial saliva for 5 consecutive days. Bracket-wire specimens from the non-erosive-condition groups were incubated only in artificial saliva for 5 days. Static and kinetic friction were determined by measuring the force needed to move the wire through the bracket. A three-way analysis of variance and pairwise comparisons with the Student-Newman-Keuls test were performed.

RESULTS

Irrespective of the conditions, SS brackets with SS wire demonstrated significantly lower mean static and kinetic frictional resistance than other bracket-wire combinations (p < 0.01). Ceramic and titanium brackets generated high frictional forces with all 3 types of wire tested. Erosive conditions did not significantly influence static and kinetic frictional resistance in all bracket-wire groups.

CONCLUSIONS

Erosive conditions do not affect the frictional behavior of SS, Ni-Ti and TMA orthodontic archwires at a clinically significant level.

Association between soft drink consumption, gastric reflux, dental erosion, and obesity among special care children

OBJECTIVES

This study assessed the association between soft drink consumption, gastric reflux, dental erosion, and obesity among special care children.

MATERIALS AND METHODS

A total of 350 special care children (male-131, female-219) mean age of 12.6 (± 2.6) years were included. Detection of dental erosion was performed according to the World Health Organization criteria. The medical evaluation assessed body mass index (BMI). With appropriate sample weighting, relationships between dental erosion prevalence and obesity were assessed using multivariable logistic regression.

RESULTS

Overall prevalence of dental erosion was 36%. Mean BMI for entire study population was 24.7 (± 7.8). Regression analysis showed strong association between dental erosion prevalence and consumption of soft drinks (adjusted odds ratio = 1.8; 95% CI = 0.71-2.92, P < .05), bulimia (adjusted odds ratio = 2.27; 95% CI = 0.99-4.28, P < .001), and gastric reflux (adjusted odds ratio = 2.24; 95% CI = 0.82-4.1, P < .001). Bivariate analysis showed high prevalence of dental erosion among obese children compared to children with normal weight (P = .04).

CONCLUSION

The present study demonstrated a significant association between dental erosion prevalence and consumption of soft drinks and gastric reflux among special care children.

The relationship between overweight/obesity and dental erosion among a group of Saudi children and adolescents

Background

As childhood obesity is emerging in Saudi children and adolescents with high prevalence, it is considered as one of the major public health concerns. Therefore, it has been studied in relation to other diseases as a cause factor.

Aim

The aim of this study is to investigate whether childhood obesity is a risk indicator for dental erosion and to obtain information on dietary habits that are related to dental erosion in overweight/obesity in a group of Saudi children and adolescents.

Study Design

The study involved 370 children of both genders aged 4-18 years. The convenient sample included 190 overweight/obese children attending obesity clinic and 180 controls.

Materials and Methods

Body mass index (BMI) (kg/m²) was calculated and BMI percentile obtained based on the age- and sex-specific according to the Centers for Disease Control chart (normal 5^th to <85^th percentile, overweight 85^th to <95^th percentile, and obese ≥95^th percentile). Dental examination and questionnaire were carried out by one calibrated and trained examiner on these children using the UK Children's Dental Health Survey Classification for dental erosion.

Results

The prevalence of dental erosion was more significant in the study group (8.42%) than the normal group (2.78%). Its severity was higher in the form of loss of enamel surface characterization in the study group (86.36%) compared to controls (13.64%). Carbonated drinks that were taken at night and drinks that were taken at night and drunk without a straw showed higher prevalence of dental erosion (33.3% and 10.3%) in overweight/obese participants.

Conclusions

Dental erosion can be regarded as a risk indicator of childhood obesity in the form of loss of enamel surface characterization. Efforts should be taken to reduce carbonated drinks intake and to change the method of drinking erosive potential drinks among overweight/obese children.

Ultrastructural changes in the cemento-enamel junction caused by acidic beverages: An in vitro study

The present in vitro study was aimed at evaluating the morphological changes in the cemento-enamel junction (CEJ) after exposure to acidic beverages using the scanning electron microscopy (SEM). The initial pH and titratable acidity (TA) was analyzed from follow groups: (I) Coca cola, (II) orange juice, (III) Cedevita, (IV) Red Bull, (V) Somersby cider, and (VI) white wine. The CEJ samples (n = 64), obtained from unerupted third molars, were allocated to one control (artificial saliva, n = 16) and six experimental groups (n = 8). The experimental samples were immersed in beverages (50 ml) for 15 min, three times daily, 10 days, and in artificial saliva between immersions. SEM analysis was performed in a blind manner, according to scoring scale. One-way ANOVA and Tukey's post hoc tests, as well as Kruskal-Wallis and Mann-Whitney U test used for statistical analysis. The pH values of the acidic beverages ranged from 2.65 (Coca cola) to 3.73 (orange juice), and TA ranged from 1.90 ml (Coca cola) to 5.70 ml (orange juice) of NaOH to reach pH 7.0. The SEM analysis indicated statistically significant differences between the control samples and those immersed in acidic beverages. The Groups IV, I, and II, showed the highest CEJ damage grade while those of the Group VI were the lowest. All the tested acidic beverages caused morphological changes in the CEJ with a smaller or larger exposure of dentine surface, and were not always related to the pH or TA of acidic beverages.

Vegetarian diet and its possible influence on dental health: A systematic literature review

Objectives

People following a vegetarian diet could be more prone to oral health problems than people following a nonvegetarian diet. The aim of this systematic review was to examine the possible impacts of following a vegetarian diet on dental hard tissues, focusing on caries development, dental erosion and number of natural teeth.

Methods

PubMed, EMBASE, Web of Science and CINAHL were searched systematically up until 17 April 2019. Original studies comparing dental health (exclusively focusing on dental hard tissues) in vegetarians and nonvegetarians were selected. Study characteristics and outcome data were extracted, and the quality of the studies was assessed using the Newcastle‐Ottawa Scale. When a dental health characteristic was reported in three or more papers in a comparable way, a meta‐analysis was performed.

Results

Twenty‐one papers reporting on 18 studies were included in this review. In meta‐analyses, the vegetarian diet was associated with a higher risk for dental erosion (odds ratio: 2.40 [95% confidence interval: 1.24, 4.66]; P = .009) and a lower decayed, missing and filled teeth (DMFT) score (mean difference: −0.15 [95% confidence interval: −0.29, −0.02]; P = .023), although the quality of most included studies was poor and the findings for DMFT score became insignificant when only studies on adults were included in the meta‐analysis. A meta‐analysis for the other dental characteristics was not possible due to the limited number of eligible studies. There was inconsistent evidence for a link between following a vegetarian diet and dental caries or the number of natural teeth.

Conclusions

Within the limitations of the present study, the findings suggest that following a vegetarian diet may be associated with a greater risk of dental erosion.

Updates in the field of non-esophageal gastroesophageal reflux disorder

Introduction: Gastroesophageal reflux disease (GERD) is one of the most prevalent conditions in Western Countries, normally presenting with heartburn and regurgitation. Extra-esophageal (EE) GERD manifestations, such as asthma, laryngitis, chronic cough and dental erosion, represent the most challenging aspects from diagnostic and therapeutic points of view because of their multifactorial pathogenesis and low response to proton pump inhibitors (PPIs). In fact, in the case of EE, other causes must by preventively excluded, but instrumental methods, such as upper gastrointestinal endoscopy and laryngoscopy, have low specificity and sensitivity as diagnostic tools. In the absence of alarm signs and symptoms, empirical therapy with a double-dose of PPIs is recommended as a first diagnostic approach. Subsequently, impedance-pH monitoring could help to define whether the symptoms are GERD-related. Areas covered: This article reviews the current literature regarding established and proposed EE-GERD, reporting on all available options for its correct diagnosis and therapeutic management. Expert opinion: MII-pH could help to identify a hidden GERD that causes EE. Unfortunately, standard MII-pH analysis results are often unable to define this association. New parameters such as the mean nocturnal baseline impedance and post-reflux swallow-induced peristaltic wave index may have an improved diagnostic yield, but prospective studies using impedance-pH are needed.

Randomized in situ clinical trial evaluating erosion protection efficacy of a 0.454% stannous fluoride dentifrice

OBJECTIVES

To assess the protective effects of a 0.454% stabilized stannous fluoride dentifrice and a marketed triclosan dentifrice against enamel erosion in a 10-day in situ model.

METHODS

This was a double-blind, randomized, 2-treatment, 4-period, crossover in situ trial involving healthy adult participants. Participants were randomized to a treatment sequence involving the following products: a highly bioavailable 0.454% stannous fluoride dentifrice (Procter & Gamble) and a marketed dentifrice control containing 0.24% sodium fluoride and 0.3% triclosan (Colgate-Palmolive). Each study period took place over 10 days. Participants wore an intra-oral appliance retaining two polished human enamel samples for 6 hours per day. Two times per day they swished with the assigned dentifrice slurry and four times per day they swished with 250 mL of orange juice (25 mL per minute) over a 10-minute period. Contact profilometry measurements were made for each sample at baseline and day 10 to determine surface change.

RESULTS

Thirty-six participants were enrolled and 33 completed the study (mean age = 40.5 years). The stannous fluoride dentifrice demonstrated 93.5% less enamel loss than the NaF/triclosan dentifrice (P < 0.001) at Day 10, with median enamel loss of 0.097 µm and 1.495 µm, respectively. Both products were well tolerated.

CONCLUSION

The stannous fluoride dentifrice demonstrated significantly greater erosion protection efficacy relative to the NaF/triclosan dentifrice in this randomized in situ clinical trial.

Analysis of food frequency and acquired dietary allowance (ADA) in relation to dental caries and dental erosion affecting dental postgraduate students of Sawangi: A cross-sectional survey

Background:

The development and integrity of the oral cavity and the progression of oral diseases may be affected by the nutritional status and diet of the person. The most ubiquitous oral diseases are found to be dental caries and periodontal diseases in the world. Therefore, the aim of the present study was to assess the correlation between food frequency with nutrient adequacy ratio (NAR), NAR with dental caries, and dental erosion.

Materials and Methods:

This study was conducted among dental postgraduate (PG) students. A self-administered questionnaire was developed with consisted food frequency, acquired dietary allowance, Decayed, Missing Filled teeth (DMFT) index, and tooth wear index. Correlation was assessed between food frequency and NAR, NAR with dental caries and dental erosion.

Results:

Out of 123 PGs 100 PGs participated in the study making response rate 81%. Consumption of chapatti, pulses vegetables white rice, sugar, milk and milk products, and acidic food is on the daily basis mostly and it was statistically significant (P < 0.05). A statistically significant difference (P < 0.05) was also seen between frequency of consuming food items in decreasing order is fats, legumes, roots and tubers, fruits, meat and meat products, fried foods, vitamin and mineral supplements those who eat daily and never.

Conclusion:

The significant association between food frequency and nutrient adequacy ratio might be helpful assessing nutritional values. The high use of acidic beverages is a serious threat to the health of the oral cavity.

In vitro evaluation of the effects of frequently prescribed pediatric drugs on the microhardness of permanent tooth enamel

BACKGROUND

Dental erosion is considered one of the oral cavity diseases. Frequent intake of liquid oral medications can be an effective factor in tooth erosion.

OBJECTIVES

This study aimed to evaluate the effects of frequently prescribed pediatric drugs on the permanent dental enamel microhardness over a period of 14 days in vitro.

MATERIAL AND METHODS

In this study, 11 pediatric drugs with different active ingredients were used; the control group consisted of teeth immersed in distilled water. The immersion cycles were applied 3 times a day for 1 min. The measurements of the samples prepared were taken at 0 (baseline), 7 and 14 days after the immersion cycles using a Vickers hardness testing machine. The pH, titratable acidity (TA) and buffering capacity of the syrups were assessed.

RESULTS

The measurements of the tooth samples that were immersed in drug solutions except Deltacortril® showed that there was a significant difference between days 0, 7 and 14. The microhardness values for the tooth samples that were immersed in the Deltacortril drug solution decreased, but no significant difference was found. There were no statistically significant differences between the day 0, 7 and 14 measurements in the control group.

CONCLUSIONS

Commonly used and prescribed pediatric drugs pose a risk for tooth erosion. Pediatricians should be aware of the effects of prescription drugs on erosion, and stress the need for compliancy with oral hygiene procedures.

Does Acid Challenge Affect the Properties and Bond Stability of Restorative Materials on Primary Teeth?

PURPOSE

To evaluate the effect of acidic challenge (AC) on the properties and bond stability of restorative materials to primary enamel and dentin.

MATERIALS AND METHODS

One hundred twenty primary molars were assigned to 12 groups according to substrate (enamel or dentin), restorative material (composite, high-viscosity glass ionomer cement [HV-GIC] or resin-modified glass-ionomer cement [RM-GIC]), and immersion after restoration (control [saline solution/7 days] or AC [cola-based drink/5 min/3x per day/7 days]). Twenty-four hours after the restorative procedure, specimens were submitted to one of the proposed challenges. Half of the specimens were immediately subjected to the microshear bond strength test, and the other half after 12 months. To determine flexural strength flexural strength and superficial roughness (SR), 30 specimens were built up. After 24 h, the first measurement of SR from 10 specimens was performed. Specimens were then immersed in one of proposed challenges and SR was measured again. Subsequently, flexural strength testing was performed. Bond strength, surface roughness, and flexural strength data were subjected to ANOVA and Tukey's test.

RESULTS

Composite showed the highest bond strengths compared to the others materials on both substrates. The storage period negatively influenced the bond strength only for composite groups in dentin. AC after restoration negatively influenced bond strength when the materials were evaluated in eroded dentin. AC affected the second SR measurement, showing increased SR for all restorative materials. AC did not affect flexural strength.

CONCLUSION

The acidic challenge jeopardizes the surface roughness and bond strength of restorations to eroded dentin.

Impact of occupational dental erosion on oral health-related quality of life among battery factory workers in Bengaluru, India

BACKGROUND

A greater understanding of impact of occupational dental erosion on oral health-related quality of life (OHRQoL) will sensitize both employee and employers to adopt strict protective measures for oral health. The research aimed to determine the relationship between occupational dental erosion and OHRQoL among battery and other factory workers in Bengaluru, India.

MATERIALS AND METHODS

This cross-sectional comparative study enrolled a total of 400 workers. Structured proforma assessed information on sociodemographic details, oral hygiene practices, adverse oral habits, and work-related practices. OHRQoL was determined using oral health impact profile-14 (OHIP-14). Dental erosion was measured using Smith and Knight's tooth wear index modified by Millward et al. 1994 scoring system independent t-test, Mann-Whitney U-test and Spearman's correlation was performed. P < 0.05 was considered statistically significant.

RESULTS

The mean age of the participants in the study and control groups was 43.11 ± 8.02 and 45.93 ± 6.16 years, respectively. Less than half of the participants in the study group had positive behavioral work practice. The prevalence and severity of dental erosion was significantly higher in study group (39.5%) than control group (11.5%). Mean OHIP-14 score was significantly lower in study group (23.88 ± 0.88) than control group (26.06 ± 9.67). Dental erosion significantly correlated with work experience and OHIP-14.

CONCLUSION

The findings highlight the impact of occupational dental erosion on OHRQoL. Measures to enhance occupational safety thereby reducing exposure to occupational hazards are needed.

The effects of psychostimulants on oral health and saliva in children with attention deficit hyperactivity disorder: A case-control study

Introduction

This study investigated the dental health problems and saliva characteristics of children under psychostimulant therapy for attention-deficit hyperactivity disorder (ADHD).

Materials and Methods

One hundred and twenty children aged 7-12 years were divided into three groups. Groups 1-2 comprised children diagnosed with ADHD: those who had not yet started psychostimulant therapy (Group 1) and those already receiving long-term psychostimulant therapy (Group 2). Group 3 comprised healthy, nonmedicated children. Possible side effects of psychostimulants were investigated at the beginning of study in Group 2 and after 3 months drug use in Group 1. Bruxism and dental erosion prevalence, salivary Streptococcus mutans count, buffering capacity, and stimulated salivary flow rate (SSFR) were measured, and salivary α-amylase, calcium, total protein, and proline-rich acidic protein (PRAP) levels were quantified in the beginning of the study. Data were analyzed using the Kruskal-Wallis test.

Results

The most frequently reported side effects of psychostimulants were decreased appetite, dry mouth, and increased fluid consumption. The prevalence of bruxism and dental erosion was higher in Groups 1 and 2 than in Group 3, but the differences were not significant (P > 0.05). In Group 2, subjective dry mouth feel was reported by 32.5% of patients and 17.5% had a very low SSFR. Salivary α-amylase, calcium, total protein, and PRAP levels were lower in Group 2 than the others, but the differences were not significant (P > 0.05).

Conclusions

ADHD and psychostimulant therapy do not appear to be significantly related to decreasing SSFR or protective saliva components against dental caries. However, a systematic investigation of the long-term safety of psychostimulants is needed. The most effective method of maintaining dental health of children with ADHD is frequent appointments focusing on oral hygiene practices accompanied by dietary analyses.

Mechanical and surface properties analysis of restorative materials submitted to erosive challenges in situ

Objective:

This study aims to evaluate the effect of acidic solutions (AS) on surface roughness (Ra) and microhardness of restorative materials (RM).

Materials and Methods:

Eight volunteers wore intraoral palatal devices (IPD) containing samples of RM: Ketac Nano (KN); Ketac Nano + Biscover LV (KN-B); Esthet-X (EX); Esthet-X + Biscover LV (EX-B); Supreme XT (SXT); Supreme XT + Biscover LV (SXT-B); and bovine enamel. The samples were submitted to three phases: (1) immersion in 0.01M hydrochloric acid (HCl) – 10 min, three times/day (14 days); (2) immersion in soft drink (Sprite®) – 10 min, three times/day (14 days); and (3) keeping in saliva (14 days). Changes in Ra/microhardness were measured before/after the three phases.

Statistical Analysis:

ANOVA (α = 0.05) and Fisher's test.

Results:

Materials sealed with Biscover LV (B) presented lowest values in all periods. KN glass ionomer cement showed highest Ra values after exposure in AS. Application of B did not reduce the Ra for the composites studied, except for EX after immersion in HCl. AS promoted changes in Ra/microhardness of RM, except for sealed materials.

Conclusions:

The acids used were able to change the Ra and microhardness of RM, except of the sealed materials. The resin-modified GIC showed the most significant changes after immersion in AS; and the composites sealed with B, even after immersion in acidic solutions (AS), showed the lowest Ra values and the least degradation in microhardness, especially when subjected to low pH solutions.