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.

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.

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.

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.

Dental erosion in gastro-esophageal reflux disease. A systematic review

The growing interest reflected in the studies on dental erosion is justified by the severe health problems it entails, i.e. esthetic, phonetic, masticatory disturbances and pulp complications. Most studies investigate the prevalence of dental erosion in adults and children, the severity of lesions and etiopathogenetic factors.

Erosive and cariogenic potential of various pediatric liquid medicaments on primary tooth enamel: A SEM study

BACKGROUND

Oral pediatric liquid medications (PLMs) are commonly used in children who suffer from chronic diseases. The physicochemical parameters of PLMs can have a deleterious effect on tooth structure.

OBJECTIVES

The purpose of the present study was to investigate the erosive and cariogenic effect of widespread PLMs on the surface roughness and structure of primary tooth enamel.

MATERIAL AND METHODS

The erosive potential of 8 common PLMs used in Egypt was assessed by measuring their inherent pH, using a digital pH electrode meter. The total sugar content was measured according to the Fehling method. The erosive effect of each liquid medicine on the enamel surface of primary teeth was assessed using scanning electron microscopy (SEM) and energy dispersive X-ray (EDX) microanalysis for calcium (Ca) and phosphorus (P) content.

RESULTS

Most PLMs revealed an acidic nature, with pH values ranging between 3.47 and 6.92. About 93.8% of analgesics had pH values ≤5.5, critical for enamel demineralization, whereas most antitussives and 1 antibiotic (Augmentin®) had pH values ≥6.2. Sucrose was present in all the samples studied. The SEM analysis revealed observable differences in the tooth enamel in the experimental groups, with different degrees of surface roughness and erosion.

CONCLUSIONS

The current results suggest that the pH, sugar content and Ca dissolution ability of PLMs can significantly influence erosion in primary tooth enamel.

Prevalence of risk factors for oral diseases in obese patients referred for bariatric surgery

BACKGROUND

Obesity is a risk factor for several chronic diseases, and scientific evidence suggests an association between obesity and oral diseases. In this study, the authors estimated the prevalence of risk factors for caries, dental erosion, and periodontal disease in a group of obese patients referred for bariatric surgery.

METHODS

The authors invited obese patients who were referred for bariatric surgery at a private center for treatment of obesity to participate in this study. The patients answered a questionnaire about their sociodemographic data, general and oral health histories, dietary habits, and oral health care behavior.

RESULTS

The authors evaluated a total of 255 participants; 200 (78.4%) were women, the median (interquartile range) age was 36.0 (30.0-43.0) years, and the median (interquartile range) body mass index was 39.7 (37.6-43.5) kilograms per square meter. The authors observed a high prevalence of risk factors for dental erosion; 78.4% of the participants consumed acidic foods daily, and 92.2% consumed acidic beverages daily. With respect to risk factors for caries, 38.5% of the participants reported high sucrose intake, and 59.6% preferred sweet beverages and foods with sucrose. Almost 13% of the participants reported having or having had dental mobility, and 59.6% reported having or having had gingival bleeding, suggesting a history of periodontal disease.

CONCLUSIONS

Obese patients referred for bariatric surgery are exposed to risks of experiencing oral diseases and should be evaluated by a dentist.

PRACTICAL IMPLICATIONS

Knowing the risk factors for oral diseases in obese patients is important in raising awareness about these risk factors, as well as to prevent complications in the oral cavity.

The erosive potential of additive artificial flavoring in bottled water

Acidic beverage consumption is a well-recognized contributor to extrinsic dental erosion. Although the pH values of some commercially available bottled waters are below neutral pH, water is still considered to be a safe and healthy choice. Artificial flavoring liquids or powders, known as water enhancers (WEs), have been introduced to the market to modify the taste of water. The purposes of the present study were to measure the pH and titratable acidity of WEs and to perform gravimetric analysis of teeth immersed in solutions of WEs mixed with different brands of bottled water in order to determine the erosive potential in vitro. The pH and titratable acidity using 0.1M sodium hydroxide were calculated for 7 brands of WEs added to 3 brands of bottled water, which had different initial pH values. Extracted human molar teeth were submerged in each combination of solutions for gravimetric analysis. Distilled water was used as the positive control and citric acid as the negative control. Data were analyzed with 2-way analysis of variance and post hoc Tukey-Kramer testing (P = 0.05). The pH value (2.9-3.0) and titratable acidity (32.2-35.3 mmol/L hydroxide) of all of the experimental solutions were considered acidic, regardless of the WE brand. Average tooth structure loss after 1 month of immersion in the solutions was 4%, and surface changes were consistent with erosive dissolution. The results showed that adding a WE to water significantly increases the potential for dental erosion. The high content of citric acid in WEs is believed to be the cause. Patients should be advised to use WEs with caution.

Er,Cr:YSGG Laser Energy Delivery: Pulse and Power Effects on Enamel Surface and Erosive Resistance

BACKGROUND

High power lasers have been suggested as a useful tool for dental caries and erosion prevention due to the increase of enamel acid resistance.

OBJECTIVE

to evaluate the effect of Er,Cr:YSGG (erbium,chromium:yttrium, scandium, gallium, garnet) laser irradiation pulse frequency and power on enamel surface and acid erosion resistance.

METHODS

By combining pulse frequency (5-75 Hz) and power settings (0.10-1.00 W), 20 irradiated groups and one nonirradiated control group were tested. A total of 63 bovine enamel blocks (n = 3/group) were prepared for surface hardness and roughness evaluation, performed in three phases: baseline, after irradiation, and after erosive challenge. Enamel blocks were irradiated with Er,Cr:YSGG laser with MZ8 tip (iPlus; Waterlase, Biolase, CA) for 30 sec according to experimental group and submitted. Erosive challenge consisted of four cycles alternating immersion in 0.01 M HCl (5 mL/mm²; 2 min; at 37°C) and immersion in artificial saliva for 3 h. Analysis of variance (three-way ANOVA), Tukey's test, and Pearson correlation were performed for the statistical analysis (p < 0.05).

RESULTS

After irradiation, groups irradiated with pulse frequency of 10 and 15 Hz showed a decrease in surface hardness. After erosive challenge, 5 and 75 W groups showed increase in surface hardness; 0.25, 0.5, 0.75, and 1 W groups showed minor alterations in surface roughness.

CONCLUSIONS

the irradiation of Er,Cr:YSGG laser with different parameters of power and pulse frequency settings may alter enamel surface and erosive resistance differently. Pulse frequency of 30 Hz and power of 0.50 W was considered the best parameter to prevent enamel acid erosion.

Oral manifestations of gastroesophageal reflux disease in children: A preliminary observational study

AIMS

This study aimed to document the prevalence of oral manifestations seen among pediatric gastroesophageal reflux disease (GERD) patients in Chennai, Tamil Nadu, India.

METHODOLOGY

This study was performed at various children's hospitals in Chennai. Fifty-one GERD patients who were assessed by endoscopy and 24 h pH-metry, 31 (60.78%) males and 20 (39.21%) females, aged 2-12 years (mean age, 7.43 years), comprised the study group. All patients answered a detailed frequency questionnaire related to regurgitation and acidic foods and participated in a clinical dental examination.

STATISTICAL ANALYSIS USED

Data were analyzed using the SPSS statistical software package version 19.

RESULTS

Among the GERD patients, 42 (82.35%) had dental erosion. A total of 668 (57.98%) deciduous teeth and 484 (42.02%) permanent teeth were examined, of which dental erosion was detected in 248 (21.52%) and 171 (14.84%) teeth, respectively. The most commonly affected primary tooth was the occlusal surface of the maxillary posteriors and commonly affected permanent tooth was occlusal surface of the mandibular molars.

CONCLUSIONS

There may be a positive correlation between GERD and dental erosion. According to this study, presence of erosion, especially in posterior teeth, could be a key to diagnose GERD and refer the child to the gastroenterologist.

Dental erosion in schoolchildren and associated factors: A cross-sectional study

CONTEXT

Throughout life, the teeth are exposed to different types of wear, including dental erosion, which is characterized by the loss of surface-mineralized tissue due to a chemical process without bacterial involvement and strongly influenced by eating habits.

AIM

The aim of this study to evaluate the prevalence of dental erosion in schoolchildren and associated factors.

SETTING AND DESIGN

This is a cross-sectional study.

MATERIAL AND METHODS

The study was conducted at a public and private school in the city of São Luís (MA), Brazil, involving a sample of 239 children aged 6-10 years. Data were collected through a questionnaire and clinical examination. Dental erosion was evaluated using the Basic Erosive Wear Examination.

STATISTICAL ANALYSIS

Data analysis involved descriptive statistics, Pearson's Chi-square test, the linear trend Chi-square test, and Fisher's exact test, with the level of significance set to 5%.

RESULTS

The male sex accounted for 50.2% of the sample and the female sex accounted for 49.8%; 62.8% attended the public school and 37.2% attended the private school. The prevalence of dental erosion was 11.7%, with the highest prevalence among 9-year-olds (46.4%). Dental erosion was significantly associated with age (P = 0.009) and type of school (P < 0.001).

CONCLUSION

The present findings underscore the need for strategies to prevent or arrest the erosive process through local actions involving schoolchildren, parents/caregivers, and teachers.

Prevalence of dental erosion among 18-year-old adolescents in the borderland districts of Lviv (Ukraine) and Lublin (Poland)

INTRODUCTION AND OBJECTIVE

Recent epidemiological studies have shown an association between dental erosion occurrence and changes in lifestyle and dietary habits in both developed and developing countries, and now affects different regions of the world. Furthermore, in current literature, studies have shown that the prevalence of erosive tooth wear has increased particularly among the younger population. The aim of the study was to assess the prevalence and severity of erosive tooth wear among 18-year-old adolescents in the districts of Lviv (Ukraine) and Lublin (Poland).

MATERIAL AND METHODS

College students (254 subjects) aged 18, living in the Lviv and Lublin districts were examined. Erosive lesions presented in the teeth were assessed on the basis of the BEWE (Basic Erosive Wear Examination) index.

RESULTS

Among the 137 patients living in the Lublin district, 70 were females and 67 were males, while in the Lviv district, 60 women and 57 men were examined. In both districts, the following numbers of rural patients were examined: 66 in Lublin district and 56 in Lviv district; for urban inhabitants, the numbers were 71 in Lublin and 61 in Lviv. Analysing the BEWE values, it was noted that higher BEWE values, and resulting from them significant differences were observed in both male and female groups living in Lublin, compared with Lviv inhabitants. Based on clinical examination and statistical analysis, the occurrence of lesions of an erosive character in at least one sextant were observed in 59.85% of patients from Lublin district, and in 42.74% of patients from Lviv district.

CONCLUSIONS

On the basis of the conducted study in the Polish and Ukrainian groups of 18-year-old adolescents living on the borderland, it can be stated that dental erosion is a problem noticeable in both groups of cohorts, but with higher prevalence in the Lublin district.

Effect of dental erosion on oral health among employees of battery-manufacturing units in Baddi, Himachal Pradesh, India

OBJECTIVE

The objective of the study was to obtain data on prevalence and severity of dental erosion among acid industry workers in Baddi (Himachal Pradesh).

MATERIALS AND METHODS

A cross-sectional study was conducted among 800 battery industry workers. The demographic details were recorded on a prestructured pro forma. Type III examination was done. Dental erosion was recorded based on the index given by Bardsley (simplified scoring criteria for tooth wear index). Appropriate statistical tests were used to interpret the data.

RESULTS

The prevalence of dental erosion was found to be 48.6%. Prevalence increased with the duration of employment. Dental erosion was most commonly found in the labial surfaces of maxillary anterior teeth.

CONCLUSION

Erosion is a condition which is multifactorial and becomes more aggravating in the presence of acidic environment. Therefore, the workers working in such conditions should be more careful, and mandatory policies should also be followed by such industries to maintain the overall health of the workers.

Sports drink consumption and dental erosion among amateur runners

This cross-sectional study assessed the prevalence and potential risk factors for dental erosion in amateur athletes at running events. After a sample calculation, 108 runners from the state of Rio de Janeiro, Brazil, were selected and examined for dental wear by a single trained and calibrated evaluator (kappa = 1.00). To identify risk factors, the runners were interviewed by using a standardized, semi-structured questionnaire. The average (SD) age of the runners was 34.2 (11.45), and the prevalence of dental erosion was 19.4%. Gastroesophageal reflux, running frequency per week, and time expended during competition were associated with dental erosion (P < 0.05). The association between use of isotonic drinks and dental erosion was not significant (P > 0.05). In conclusion, dental erosion was not associated with use of isotonic drinks. However, frequency of exercise per week and gastroesophageal reflux were risk factors for dental erosion.

Prevalence and factors associated with dental erosion in individuals aged 12-30 years in a northeastern Brazilian city

Background/Purpose

Dental erosion in young individuals has increased significantly in recent years, due to changes in lifestyle. Thus, the present study investigated the prevalence and factors associated with dental erosion in individuals aged 12–30 years in the city of Imperatriz of Maranhão, Brazil.

Materials and methods

A cross-sectional study was conducted on 335 individuals who answered a questionnaire consisting of variables related to dental erosion. Afterwards, the individuals were subjected to clinical examinations and the basic erosive wear examination index was used to classify their teeth according to the presence and severity of dental erosion.

Results

Descriptive statistics, the chi-square test, Poisson univariate and multivariate regression were performed at 5% level of significance. The sample was characterized by 204 females (60.9%), the majority of whom were from 12 to 19 years of age (78.5%), among whom 28.7% presented dental erosion. Their monthly family income was from 1 to 3 minimum wages (56.4%). The variables that were significantly associated with the outcome were family income, chewing gum, and consumption of soft-drinks/juices before going to sleep (p=0.03, p=0.001, and p=0.04, respectively). Individuals who chewed chewing gum were 2.27 times (95% CI =1.43–3.60) more likely to present dental erosion than those who did not chew gum. Individuals who ingested soft drinks or juices were 2.30 times (95% CI =1.30–4.10) more likely to present dental erosion.

Conclusion

The prevalence of erosion reflected the need for programs of prevention and guidance for patients about the etiological factors of the disease.

The Effect of Casein Phosphopeptide-Amorf Calcium Phosphate and Acidulated Phosphate Fluoride Gel on Dental Erosion in Primary Teeth: An in Vitro Study

OBJECTIVE

This study aimed to investigate the effect of acidulated phosphate fluoride (APF) gel and casein phosphopeptide/amorphous calciumphosphate (CPP-ACP) on the dental erosion produced by carbonated soft drink in primary teeth.

STUDY DESIGN

This study evaluated by an in vitro model the effect of APF gel and CPP-ACP on the dental enamel previously subjected to erosive challenge with carbonated soft drink. Sixty sound human primary molars were prepared by embedding the crown sections in acrylic resin blocks leaving the enamel surfaces exposed. The surface roughness of the enamel was measured with prophilometry at baseline. Specimens were randomly divided into three treatment groups (n:20): artificial saliva, CPP-ACP, 1.23% APF gel. All specimens were then exposed to an erosive challenge of carbonated soft drink and artificial saliva for 20 cycles of 20 seconds each. Demineralization-remineralization cycles was repeated twice at eight-hour intervals and roughness values were measured. Enamel samples were treated with artificial saliva, CPP-ACP, 1.23% APF gel applied for 10 min after erosive challenge. The arithmetic average roughness (Ra) readings were recorded after remineralization agents were applied.

RESULTS

The mean surface roughness in all groups increased significantly after erosion process and decreased after remineralization treatment. After treatment, the mean surface roughness of the 1.23% APF gel group was significantly less than the other groups and the mean surface roughness of the artificial saliva group was significantly more than the other groups. 1.23% APF gel showed the highest protective effect against erosive enamel loss.

CONCLUSIONS

Under the conditions of this study, artificial saliva, CPP-ACP and 1.23% APF treatments were able to reduce erosive enamel loss produced by carbonated soft drink in primary teeth. However, 1.23% APF gel showed the highest protective effect against erosive enamel loss.

Oral health considerations in anorexia and bulimia nervosa. 2. Multidisciplinary management and personalized dental care

This article outlines a comprehensive, multidisciplinary strategy for treatment of patients with anorexia and bulimia nervosa. In this approach, primary medical intervention and emergency dental care are followed by the staging of treatment phases that integrate medical care, psychotherapy, nutritional counseling, and dental management, which may encompass various treatment options for repair of damaged dentition. Emphasis is placed on prevention of further tissue damage during all phases of management and following completion of the treatment course.

Susceptibility of partially desalivated rats to erosive tooth wear by calcium-supplemented beverages

OBJECTIVES

To investigate the susceptibility of partially desalivated rats to erosive tooth wear (ETW); the anti-erosive effect of a calcium-supplemented beverage; and the quantification of ETW by microcomputed tomography (micro-CT).

METHODS

The study population consisted of thirty-eight rats, divided into partially desalivated (n = 19) and normal salivary flow (n = 19). They were randomly allocated into three subgroups (n = 6-7): A-diet soda, B-diet soda + calcium, C-water (control). Solutions were provided ad libitum for 28 days, and the rats were euthanized afterwards. Each left hemi-mandible was scanned using micro-CT for enamel volume (three molars) calculation. Visual analysis of photographs of the lingual surface of first molars was performed independently by three blinded examiners. Data were statistically analysed (α = .05).

RESULTS

Micro-CT revealed no significant differences between partially desalivated or normal groups. Rats consuming A had more enamel loss than those consuming B or C, which did not differ from each other. For visual analysis, desalivation did not affect ETW. Rats consuming C showed the lowest ETW, followed by B and then A, for both partially desalivated and normal rats. Spearman correlation between the two ETW quantification methods was -.65.

CONCLUSIONS

Partial desalivation did not increase ETW. Ca-containing beverage prevented ETW. Micro-CT quantified ETW, although it was not as sensitive as visual analysis.

TiF4 gel effects on tubular occlusion of eroded/abraded human dentin

This in situ study evaluated the tubular occlusion caused by 4% TiF₄ gel on the surface of eroded/abraded dentin. Sixty human dentin samples were eroded in vitro and assigned into six groups (n = 10) according to the in situ surface treatment and number of cycling days: 4% TiF₄ gel applied once (TiF₄ 1), twice (TiF₄ 2), or three times (TiF₄ 3) followed by 2, 4, and 6 days of erosive/abrasive in situ cycling, respectively. Control groups (no treatment) were subjected to 2 (C1), 4 (C2), and 6 (C3) days of erosive/abrasive in situ cycling only. A seventh group (n = 10) was comprised by in vitro uneroded samples (UN), subjected to 6 days of in situ erosive/abrasive cycling. Each cycling day consisted on six erosive (0.5% citric acid, pH 2.6) and one abrasive events. Environmental scanning electron microscopy micrographs were taken. For all groups, blinded examiners assessed dentin tubules occlusion using visual scores (0-unoccluded, 1-partially occluded by granular deposits, 2-partially occluded by reduction in tubular lumen into diamond shape, 3-completely occluded) on images captured prior and after the in situ phase. Scheirer-Ray-Hare test demonstrated that treatments significantly affected tubule occlusion (p < .001). Dunn's test showed that tubule occlusion in TiF₄ 3 was significantly higher than in C1. Tubule occlusion in remaining groups did not differ from that observed in groups TiF₄ 3 and C1. Tubule occlusion was significantly higher after in situ phase. It may be suggested that TiF₄ , when applied three times, was able to positively change tubule occlusion of dentin samples.

Effect of CPP-ACP or a Potassium Nitrate Sodium Fluoride Dentifrice on Enamel Erosion Prevention

AIM

To investigate in situ/ex vivo the effect of remineralizing agents in the prevention of dental erosion in permanent and primary teeth.

STUDY DESIGN

A randomized, controlled, double-blind study with crossover design with three treatment phases: Control, ProNamel^® and Tooth Mousse^™. Twenty adults and children wore removable palatal appliances containing two insets of permanent and primary human enamel and used the corresponding assigned toothpaste twice daily for 10 days. The enamel samples were then removed, mounted on acrylic bases and acid-challenged in demineralizing solution. Enamel surface microhardness (SμH) was measured pre and post acid challenge. Data were analyzed using two-way ANOVA and Tukey's post hoc test (P < 0.05).

RESULTS

The mean SμH values (Vicker's unit) prior to acid challenge were: Permanent teeth (Control 366.16 ± 12.28, ProNamel^® 372.18 ± 14.75, Tooth Mousse^™ 370.19 ± 11.88) and Primary teeth (Control 325.31± 11.90, ProNamel^® 327.34 ± 9.90, Tooth Mousse^™ 331.63 ± 10.55). Following the acid challenge, the mean %ΔSμH (±SD) were: Permanent (79.72 ± 1.59, 66.52 ± 2.45, 60.13 ± 4.98) and Primary (81.09 ± 2.90, 76.50 ± 3.13, 69.02 ± 4.23).

CONCLUSION

The application of remineralizing agents reduced the significantly softening by acidic attack of enamel especially in the permanent dentition.

Food acid content and erosive potential of sugar-free confections

BACKGROUND

Dental erosion is an increasingly prevalent problem associated with frequent consumption of acidic foods and beverages. The aim of this study was to measure the food acid content and the erosive potential of a variety of sugar-free confections.

METHODS

Thirty sugar-free confections were selected and extracts analysed to determine pH, titratable acidity, chemical composition and apparent degree of saturation with respect to apatite. The effect of the sugar-free confections in artificial saliva on human enamel was determined in an in vitro dental erosion assay using change in surface microhardness.

RESULTS

The change in surface microhardness was used to categorize the confections as high, moderate or low erosive potential. Seventeen of the 30 sugar-free confections were found to contain high concentrations of food acids, exhibit low pH and high titratable acidity and have high erosive potential. Significant correlations were found between the dental erosive potential (change in enamel surface microhardness) and pH and titratable acidity of the confections. Ten of these high erosive potential confections displayed dental messages on the packaging suggesting they were safe for teeth.

CONCLUSIONS

Many sugar-free confections, even some with 'Toothfriendly' messages on the product label, contain high contents of food acids and have erosive potential.