Dental erosion secondary to ethanol-induced emesis

The psychology of tooth wear

AIM

To review the main psychological and mental conditions that are manifested dentally in the form of tooth wear. These conditions include depression, eating disorders, and alcohol and drug use disorders. The paper will also review the comorbidity of these conditions and the relevance of other medical conditions and lifestyle factors, such as gastroesophageal reflux disorder, smoking and diet, in the expression of tooth wear.

CONCLUSION

A holistic, multidisciplinary, healthcare approach is required in management of tooth wear patients with underlying mental health disorders. Dentists and Dental Care Professionals can have an important role in identifying these mental disorders through the observed tooth wear. They can also play a key role in monitoring patients' response and compliance to medical treatment through the monitoring of tooth wear progression and expression.

Erosive lesions in patients with alcoholism

BACKGROUND

The authors conducted a study to determine the occurrence of erosive tooth lesions in patients with alcoholism and to establish the influence of salivary flow rates and pH levels on their appearance.

METHODS

The authors conducted a cross-sectional study in 140 participants (70 with clinically diagnosed alcoholism who were undergoing therapy for their addiction were in the test group and 70 who did not consume alcohol were in the control group). The authors determined the participants' salivary statuses by measuring the flow rates and pH levels of both unstimulated and stimulated saliva.

RESULTS

The authors found more erosive lesions in the test group (P < .01). They detected a higher number of erosive lesions in participants in the test group who had a pH range of 5 to 6 compared with a pH range of 6 to 7 (P = .01). They found a significant correlation between alcoholism and unstimulated salivary flow rate (P < .05).

CONCLUSIONS

The salivary flow rate was similar in control and test groups. The prevalence of erosion in the test group was higher than that in the control group, which may be related to the decrease in salivary pH of both stimulated and unstimulated saliva in this group. The results of the study showed no connection between erosion prevalence and pH levels and stimulated salivary flow rates.

CLINICAL IMPLICATIONS

Patients with alcoholism may be at risk of developing erosive lesions on their teeth owing to the low pH level of their oral environment and decreased saliva levels.

Perioesthetic approach to the diagnosis and treatment of carious and noncarious cervical lesions: Part I

Several factors can contribute to the development of noncarious cervical lesions. Therefore, these lesions can be described and classified according to their primary etiology. Traditionally, most dentists have treated noncarious cervical lesions only with restorative methods, for example, composite resin restorations. However, in many cases, a periodontal or a combined restorative/periodontal approach provides a better esthetic and functional result. In part I of this two-part report, we provide a review of noncarious cervical lesions and a series of clinical case reports showing surgical techniques used and the importance of the periodontal aspect of lesion management.

Erosion caused by gastroesophageal reflux: diagnostic considerations

Dental erosion occurs with a high prevalence in the general population, but its impact on prosthodontic care is often unrecognized. The etiology of dental erosion is difficult to establish because it may result from a variety of causes and may have different presentations. Our purpose was to review the literature relevant to dental erosion and to report a patient presentation in which an unusual pattern of severe erosion was the dental manifestation of asymptomatic gastroesophageal reflux disease.

The prevalence, etiology and management of tooth wear in the United Kingdom

STATEMENT OF PROBLEM

Recent epidemiologic evidence suggests that tooth wear is now a significant problem in both children and adults. There is growing evidence that a major cause of severe wear in patients is regurgitation erosion due to a variety of factors including gastroesophageal reflux disease.

PURPOSE

The purpose of this article is to discuss the prevalence of tooth wear in the United Kingdom. Emphasis in management should be on accurate diagnosis, and in some patients, long-term monitoring before embarking on any irreversible, interventive treatment. Even when treatment is necessary, a period of monitoring is helpful to assess the rate of progress of the wear, the effectiveness of preventive measures, and therefore the extent of the treatment necessary.

Determinants of oral health in a group of Danish alcoholics

The purposes of this survey were to describe dental health in a group of alcoholics and to analyze the influence of social background, dental health behavior and alcohol-related variables on dental health among alcoholics. The dental health in a group of consecutively admitted alcoholics (n = 195) was described with respect to number of teeth present, DMFS, DS and the prevalence of dental erosion, removable dentures, edentulousness, and untreated dental decay. No major differences were found with respect to number of teeth and dental caries (DMFS), when compared to reference figures of the general population. As to untreated decay, however, 3-5 x more actual decayed surfaces were found among the alcoholics. In the multivariate analyses, neither DMFS, nor untreated decay were found to be associated with alcohol-related indicators. These variables were, however, related to variables of social background and dental health behavior. As to number of teeth present, an association was found with duration of alcoholism, but this relationship was eliminated, when the analysis was controlled with respect to social situation. In contrast, dental erosion was related to duration of alcoholism irrespective of confounding control of dental health behavior and social situation. Hence, the study indicates that oral health in alcoholics can be explained mainly by social situation and dental health behavior and not by variables associated directly with alcohol consumption. An exception was the presence of dental erosion, which was associated with the exposure to alcohol.

The relationship between gastro-oesophageal reflux disease and dental erosion

It is well known that acid regurgitated from the stomach into the mouth will erode teeth. Conditions such as anorexia and bulimia nervosa, chronic alcoholism and gastric disturbances cause palatal dental erosion. The common factor in these conditions is the role played by the stomach and oesophagus in the acid movement. Acid moving through the lower oesophageal sphincter into the oesophagus is described as gastro-oesophageal reflux (GOR). In some patients the acid movement becomes chronic, painful and requires treatment and is termed gastro-oesophageal reflux disease (GORD). It is felt by many gastroenterologists that GORD is a failure of the anti-reflux mechanism, which is predominantly controlled by the lower oesophageal sphincter (LOS). Regurgitation is the reflux of gastric juice through the upper oesophageal sphincter and into the oral cavity. Once the acid has reached the mouth the potential exists for damage to the teeth. This paper reviews the role of GOR, GORD and regurgitation in the aetiology of dental erosion.

Etiology of dental erosion--intrinsic factors

Dental erosion due to intrinsic factors is caused by gastric acid reaching the oral cavity and the teeth as a result of vomiting or gastroesophageal reflux. Since clinical manifestation of dental erosion does not occur until gastric acid has acted on the dental hard tissues regularly over a period of several years, dental erosion caused by intrinsic factors has been observed only in those diseases which are associated with chronic vomiting or persistent gastroesophageal reflux over a long period. Examples of such conditions include disorders of the upper alimentary tract, specific metabolic and endocrine disorders, cases of medication side-effects and drug abuse, and certain psychosomatic disorders, e.g. stress-induced psychosomatic vomiting, anorexia and bulimia nervosa or rumination. Based on a review of the medical and dental literature, the main symptoms of all disorders which must be taken into account as possible intrinsic etiological factors of dental erosion are thoroughly discussed with respect to the clinical picture, prevalence and risk of erosion.

Chronic alcoholism: an important condition in the dentist-patient relationship

OBJECTIVES

This paper aims to give the dental practitioner an insight into the impact of chronic alcoholism on sufferers.

METHODS

A review of the psychiatric and dental literature covering the aetiology, prevalence and complications is presented.

CONCLUSIONS

Chronic alcoholism has a number of serious medical and social problems which may affect the provision of dental treatment. It is important for the dental practitioner to be aware of the impact of this condition on patients as he or she may be in an ideal position to stop the alcoholic before a medical consultation has been sought.

Occlusal wear of teeth and restorative materials. A review of classification, etiology, mechanisms of wear, and some aspects of restorative procedures

This paper is a literature review of various aspects of the wear of occluding tooth surfaces. It presents classification and terminology of occlusal tooth wear, and discusses etiology and differential diagnosis. It may be difficult to differentiate among abrasion, attrition, and erosion because there is nearly always a combination of the various processes. These processes of wear are described, and the in vitro and in vivo wear of some restorative materials is discussed. Treatment of severe tooth wear is considered difficult; prophylactic measures are therefore important. Some guidelines for restorative treatment of patients with extensive occlusal tooth wear are given, with special emphasis on the type of treatment, the vertical dimension of occlusion, the space available, and choice of material for the restorations.

Depth and area of dental erosions, and dental caries, in bulimic women

Dental caries and the severity (depth) and area of erosions of tooth substance were studied in 11 bulimic subjects and 22 matched controls. Erosions were seen in 69% of the bulimics' teeth and in only 7% of the controls' (p less than 0.001). Depth of penetration was greater in the bulimics, extending even into the pulp, and the area of erosion was also larger. Scores for dental caries were higher in bulimics (mean DMFS 27.9, median 36) than in controls (mean DMFS 19.1, median 13.5), although the difference was not statistically significant. This study suggests that when erosions are present on the lingual surfaces of maxillary anterior teeth, as well as on the buccal surfaces of maxillary canines, premolars, and maxillary incisors, a diagnosis of bulimia is likely. Patients with these signs should be referred for medical help.