Chelating effect of citric acid is negligible for development of enamel erosions

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

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

Influence of periodic polyphenol treatment on the anti-erosive potential of the acquired enamel pellicle-A qualitative exploratory study

OBJECTIVE

The aim of the present study was to investigate the impact of periodic polyphenol treatment on the ultrastructure and anti-erosive potential of an in-situ formed pellicle.

METHODS

Subjects wore intraoral appliances with buccally and palatally fixed bovine enamel specimens. During 6 h of intraoral pellicle formation, 100 ml black tea or tannic acid was applied ex-vivo every 25 min for 5 min. Untreated pellicles served as control. After the trial, specimens were immersed in 0.1% or 1% citric acid for 60 s and analysed for calcium release with atomic adsorption spectrometry and ultrastructure with transmission electron microscopy.

RESULTS

Specimens covered by pellicles treated with black tea or tannic acid released less calcium than untreated pellicles. Ultrastructural analyses reveal an increase in pellicle's thickness and density after treatment with polyphenols.

CONCLUSIONS

Periodic polyphenol treatment of the pellicle modify its ultrastructure and increase its anti-erosive potential.

CLINICAL SIGNIFICANCE

Consumption of polyphenolic beverages can enhance the anti-erosive potential of the enamel pellicle.

Effect of different citrus sweets on the development of enamel erosion in vitro

The increased consumption of citrus sweets can contribute to the development of erosive tooth wear (ETW).

Fluoride dentifrice containing calcium silicate and sodium phosphate salts on dental erosion: In vitro study

OBJECTIVE

To investigate the effect of a commercial dentifrice containing fluoride, calcium silicate, and sodium phosphate and its dual phase gel serum to prevent erosive tooth wear in enamel.

METHODS

Forty-eight enamel specimens were selected by surface hardness and randomly allocated into 4 groups (n = 12) according to the commercial toothpastes: non-fluoridated (NF); 1100 ppm Stannous fluoride (SnF₂); 1450 ppm MFP + calcium silicate + sodium phosphate (CSSP); CSSP + dual-phase gel (CSSP + Serum). Cyclic experiments were repeated 3x / day for five days, including an erosive challenge with 0.05 M citric acid (pH 3.75 for 30 s), treatment with toothpaste slurries (1 min), and remineralization with artificial saliva (pH 7.0 for 60 min). Surface alterations were determined by stylus profilometry (μm) and scanning electron microscopy (SEM). Data were analyzed by ANOVA and Tukey tests (α = 0.05).

RESULTS

SnF₂, CSSP and CSSP + Serum significantly reduce surface wear compared to NF treated group. Besides, there were no significant differences among SnF₂, CSSP and CSSP + Serum. In micrographs of both groups treated with CSSP, the surface demonstrates the presence of a protective layer as a deposition of particles.

CONCLUSIONS

Dentifrice containing calcium silicate and sodium phosphate with or without the dual-phase gel was able to prevent the erosive tooth wear.

New animal model of extrinsic dental erosion-Erosive effect on the mouse molar teeth

OBJECTIVE

Consumption of acidic food and drinks is considered as important risk factor for development of dental erosion. There are several in vitro and in situ studies focusing on the risk indicators and preventive treatment, however, the need for a standardized animal model has been emphasised for many years. The aim was to establish an animal model of extrinsic dental erosion, which may serve as a standard for future studies to improve our understanding of the erosion.

DESIGN

Two acidic drinks, sports drink and cola drink, were given to young mice for six weeks. Experimental and control (water) molars and incisors were dissected out and observed by scanning electron microscopy (SEM). Mandibular first molars were subsequently ground transversely and observed again by SEM. The tooth height and enamel thickness were measured on the SEM images.

RESULTS

The lingual surface of the mandibular molars was most eroded after consumption of acidic drinks. The cola drink exhibited higher erosive effect on mandibular molars compared to sports drink. The lingual tooth height, compared to control, was about 34% and 18% lower in the cola drink and sports drink molars, respectively. Compared to the control molars, the lingual enamel was about 23% thinner in the sports drink molars and totally eroded on the certain lingual areas of the cola drink molars.

CONCLUSIONS

This new animal model of extrinsic dental erosion and the presented method with ground molars observed in SEM are suitable for further studies, which will gain deeper insights into the erosive disease.

Do Abrasives Play a Role in Toothpaste Efficacy against Erosion/Abrasion?

Abrasives may counteract the efficacy of anti-erosion toothpastes either due to physical effects or due to interaction with active agents. This study aimed to investigate whether the amount of abrasives is a determinant for the efficacy of Sn2+-containing toothpastes with or without chitosan additive. Enamel samples were eroded (0.50 wt% citric acid, pH 2.5; 6 × 2 min/day) on a shaking desk - 30/min in experiment 1 (E1) and 35/min in experiments 2 (E2) and 3 (E3) - and immersed in toothpaste slurries (2 × 2 min). Half of the samples were additionally brushed (15 s, load 200 g) within the immersion time. The toothpastes contained 0, 5, 10, 15, and 20% silica. In E1 and E2 the active ingredients were F- (700 ppm as amine fluoride, 700 ppm as NaF) and Sn2+ (3,500 ppm as SnCl2); in E3 chitosan (0.5%) was additionally added. The placebo contained 20% silica. Tissue loss was determined profilometrically. In E1, slurries completely inhibited tissue loss; distinct surface deposits occurred. With brushing, tissue loss significantly increased up to an abrasive content of 10%, but decreased significantly with higher amounts; 20% silica revealed similar values as the abrasive-free formulation. In E2, all slurries inhibited tissue loss distinctly irrespective of the amounts of abrasives. With brushing, a similar trend as in E1 was observed but with much less efficacy. The chitosan-containing formulations in E3 were much more effective; similar results as in E1 were found. In conclusion, the amount of abrasives had no effect when toothpastes were applied as slurries, but played an important role with brushing.