Development of a method in situ to study toothpaste abrasion of dentine. Comparison of 2 products

Cervical wear pathobiology by robot-simulated 3-year toothbrushing - New methodological approach

OBJECTIVES

An ex-vivo study was aimed at (i) programming clinically validated robot three-year random toothbrushing, (ii) evaluating cervical macro- and microwear patterns on all tooth groups of different functional age, (iii) documenting and codificating wear related morphological features at the cemento-enamel junction in young teeth and on roots in older teeth.

DESIGN

Following ethical approval random toothbrushing (44 strokes per tooth horizontally, rotating, vertically; 2x/d) with manual toothbrushes and low-abrasive dentifrice was performed in an artificial oral cavity with brushing-force 3.5 N on 14 extracted human teeth. Morphological features were examined by SEM at baseline and after simulated 3 years using the replication technique. 3D-SEM analyses were carried out with a four-quadrant back scattered electron detector. Wilcoxon-Mann-Whitney-test was used for statistical analyses.

RESULTS

3-year random toothbrushing with horizontal, rotating and vertical brushing movements revealed morphological features classified as four enamel patterns, one dentin pattern and three cervical patterns. Negative impacts were enamel, cementum and dentin loss. Positive impact on oral health was removing dental calculus and straightening cervical traumatic and iatrogenic damages. The volume loss varied from x̅=34.25nl to x̅=87.75nl. Wear extended apically from 100 to 1500 micrometres.

CONCLUSION

Robot simulated toothbrushing in an artificial oral cavity, with subsequent SEM and 3D-SEM assessment, elucidated both negative and oral health-contributing micromorphology patterns of cervical wear after simulated 3-year random toothbrushing. Cervical macro- and microwear of cementum revealed, for the first time, what we describe as overhanging enamel peninsulas and enamel islands on roots in young teeth, but no enamel islands on roots from older teeth after root cementum loss. In contrast, many older teeth exhibited enamel peninsulas.

Evaluation of the effects of whitening toothpaste containing nanohydroxyapatite on surface roughness and color change in restorative materials

Background

The effects of whitening toothpastes containing nanohydroxyapatite on the surfaces of restorative materials are not well known. This study evaluated the changes in surface roughness and color of coffee-stained restorative materials after brushing with nanohydroxyapatite and other whitening toothpastes.

Methods

Disc-shaped specimens were formed using microhybrid, nanohybrid, and supra-nano-filled composite (n = 30) and stained with a coffee solution. A brushing simulation was applied with toothpastes containing nanohydroxyapatite (Dentiste Plus White), perlite (Signal White System) and hydrogen peroxide (Colgate Optic White) for 7, 15, and 30 days. Color and surface roughness measurements were taken before and after brushing. Color change (∆E₀₀) was calculated using the CIEDE2000 system.

Results

Supra-nano-filled composite-Dentiste Plus White, supra-nano-filled composite-Colgate Optic White, and nanohybrid composite-Signal White System were the groups with the greatest color change observed on the 7th, 15th, and 30th days, respectively. The smallest color change was seen in the microhybrid composite-Signal White System, microhybrid composite-Dentiste Plus White, and nanohybrid composite-Dentiste Plus White groups on the 7th, 15th, and 30th days, respectively. No significant surface roughness changes were observed in the nanohybrid composite-Dentiste Plus White, supra-nano-filled composite-Colgate Optic White, supra-nano-filled composite-Dentiste Plus White, or supra-nano-filled composite-Signal White System groups.

Conclusions

Whitening toothpaste containing nanohydroxyapatite provided a high degree of color change in the short term and did not create significant surface roughness in nanohybrid or supra-nano-filled composites.

Abrasion Behavior of Different Charcoal Toothpastes on Human Dentin When Using Electric Toothbrushes

The aim of this study was to investigate abrasion on human dentin after brushing with activated charcoal toothpastes. A self-designed brushing machine was used to brush five groups (Group A: Water, Group B: Sensodyne Pro Schmelz, Group C: Splat Blackwood, Group D: Curaprox Black is White, and Group E: Prokudent Black Brilliant) with electrically powered toothbrushes for 4 h. The abrasive dentin wear was calculated using profilometry data. Furthermore, thermogravimetric analyses and scanning electron microscopy were used to analyze the composition of the toothpastes. Mean dentin loss by brushing were (71 ± 28) µm (Splat Blackwood), (44 ± 16) µm (Curaprox Black is White), (38 ± 13) µm (Prokudent Black Brilliant), (28 ± 14) µm (Sensodyne Pro Schmelz), and (28 ± 13) µm (Water). Groups A/B/D/E and group C each lie in one subset, which is statistically different from the other subset according to a post hoc Tukey test (p = 0.05). Within the limitations, it can be concluded that the content of activated charcoal in charcoal toothpastes had little influence on the observed abrasive behavior, although one of the charcoal toothpastes showed the highest abrasion on dentin.

Colour stability of stained composite resins after brushing with whitening toothpaste

OBJECTIVE

The aim of this study was to evaluate the effect of brushing with whitening toothpaste on the colour change of composite resins discoloured with coffee.

METHODS

Disc-shaped samples were prepared using one nano-hybrid (Clearfil Majesty Esthetic), one micro-hybrid (GC G-aenial Anterior) and one nano-ceramic composite (Zenit) (n = 6). After initial colour measurements, the samples were coloured in the coffee solution for 5 days. Colour measurements were made again after the colouring process, and brushing simulation was applied for 7, 15 and 30 days with two different whitening toothpastes containing calcium carbonate+perlite (Signal whitening system, SWN) and hydrated silica+hydrogen peroxide (Colgate optic White, COW) and a conventional non-whitening toothpaste containing hydrated silica (Sensodyne pronamel, SPN). Colour change (∆E₀₀ ) after brushing was calculated using the CIEDE2000 system. Repeated measures variance analysis was used for the analysis of data.

RESULTS

G-aenial anterior and Zenit showed significant coloration compared to Majesty esthetic after coloration with coffee (p < 0.05). The colour change in all composite resins was above the clinically acceptable limit (ΔE₀₀  > 1.8). Colour change over time after brushing with both whitening toothpastes differed significantly (p < 0.05). SWN and COW exhibited a significantly higher whitening effect than SPN (p < 0.05). While there was no significant difference in composite groups brushed with the SWS (p > 0.05), there was a significant difference between Majesty esthetic, G-aenial anterior and Zenit in groups brushed with COW (p < 0.05).

CONCLUSIONS

Colour change was high in micro-hybrid and nano-ceramic composites which were discoloured in coffee. The whitening toothpastes were effective in reducing the coloration caused by coffee.

Cobalt–Chromium Dental Alloys: Metal Exposures, Toxicological Risks, CMR Classification, and EU Regulatory Framework

During the 20th century, metal alloys have assumed an important role as restorative materials. Among existing examples, cobalt–chromium (Co–Cr) alloys increasingly began to be used in medicine and especially in dentistry. Their success is mainly due to their mechanical properties such as stiffness, strength and corrosion resistance, thus allowing a high biocompatibility. There are quite meaningful data on the corrosion and toxicity of Co–Cr alloys for their use in restorative materials such as dental prostheses. Toxicological studies following Co and Cr exposures in the oral cavity are more difficult to conduct because there are many different situations leading to the release of metal ions and wear particles. Furthermore, the links between exposure and the appearance of local or systemic toxicity are not automatic. Since 2017, the European Union (EU) regulatory framework for Co–Cr alloys has been undergoing profound changes. A new EU Medical Devices Regulation (MDR) (2017/745) will be applied in May 2021 with the need to consider that Co metal is a new carcinogenic, mutagenic and toxic to reproduction (CMR) substance. On 18 February 2020, the 14th Adaptation to Technical Progress (ATP14) to the Classification, Labelling and Packaging (CLP) regulation was published, including the harmonised classification for Co metal as a CMR 1B substance. In this context, the use of Co might be forbidden if the medical devices are invasive and as soon as they include more than 0.1% (m/m) Co. This review provides a specific overview on Co–Cr dental alloys in terms of metal ions and wear particles release, toxicological risks, and the actual and new EU regulatory framework.

Buffer Solution Reduces Acidic Toothpaste Abrasivity Measured in Standardized Tests

It has been speculated that the diluent used to test toothpaste abrasivity in standard tests may have an impact on their results, especially in the context of acidic toothpastes. This study tested whether an acidic toothpaste is indeed more abrasive than a neutral counterpart of otherwise identical composition, and whether this increased abrasivity is prevented by a buffered solution simulating saliva. Two experimental toothpastes of identical composition yet different pH (7.0 vs. 5.0) were prepared using standard ingredients. Subsequently, they were tested in standard absolute dentin abrasion and relative dentin abrasivity (RDA) experiments. To prepare slurries for these tests, deionized water as recommended by the International Organization for Standardization (ISO 11609:2017) was used, or a buffer solution containing bicarbonate and phosphate. The pH in these slurries was assessed and compared to the pH obtained in oral slurries of healthy individuals. Results showed that a significant (one-way ANOVA, p &lt; 0.05) increase in mean absolute dentin abrasion and RDA values by 35 and 14%, respectively, was obtained when water was used as the diluent in conjunction with the acidic toothpaste as compared to the buffer solution. This was not the case with the neutral toothpaste. This result was explained by the finding that the buffer solution neutralized the pH in experimental slurries of the acidic toothpaste, while deionized water was unable to elevate the pH of the acidic toothpaste. That toothpaste was also neutralized in oral slurries. It was concluded that indeed the current ISO standard may result in a systematic overestimation of acidic toothpaste abrasivity.

Wear mechanism of human tooth enamel: The role of interfacial protein bonding between HA crystals

Human tooth enamel, the most mineralized tissue in body, contains less than 2 wt% protein. Consequently, the importance of the protein to enamel mechanical response has always been overlooked. In this study, the role of minor protein in providing enamel microstructure and mechanical performance, especially tribological properties, were studied using deproteinization treatment and nano-indentation/scratch technique. Via the change from the original to the deproteinated conditions, a nanostructure degeneration from the assembly of hydroxyapatite (HA) crystals into nano-fibers to crystal aggregation has been found between the high-wear-resistance and low-wear-resistance on the enamel surface. Correspondingly, an energy dissipation to cause a unit volume of wear on enamel surface decreases by 50%, and wear volume increases by 80%. With the presence of protein, the occurrence of enamel wear requires to break the interfacial protein bonding between the HA crystals in nano-fibers and the break dissipates considerable energy, which benefits the enamel to resist wear. Thus, the protein in enamel, although of a very low content, is essential to resisting wear by mediating the assembly of rigid HA crystals via interfacial protein bonding. Replicating functions of the protein component will be critical to the successful development of bio-inspired materials that are designed for wear-resistance.

Dentine hypersensitivity and dentine exposure in Arab patient populations

BACKGROUND

Dentine hypersensitivity is a frequent oral complaint that is usually associated with several factors including diet and oral hygiene practices.

OBJECTIVE

The aim of this study was to assess the prevalence, severity and correlates of dentine hypersensitivity and dentine exposure-related risk indicators in a sample from six Arab countries.

METHODS

A multinational cross-sectional study was conducted on a sample of 2924 participants, attending dental practices, aged 18-35 years from six Arab countries. Trained examiners assessed dentine hypersensitivity using the Schiff scale and scored the tooth with the highest value in each sextant. Participants were asked to complete a questionnaire that assessed the frequency of drinking and eating acidic foods and their oral health habits.

RESULTS

Overall, the Schiff score 1 was found in 938 (32.6%), score 2 in 613 (21%) and score 3 in 274 (9%) of the participants. There was variation between countries with Saudi Arabia (13.9%) and Oman (15%) having the highest prevalence of hypersensitivity and Kuwait (2.2) and Jordan the lowest (4.8%). Participants who experienced toothache and difficulty eating once a day were significantly more likely to have Schiff score 2 or 3 (OR: 2.51, 95% CI: 1.54-2.87; OR: 1.34, 95% CI: 1.04-1.73, respectively). Furthermore, drinking soft drinks once a day was also significantly associated with dentine exposure (OR: 1.4, 95% CI: 1.19, 1.65).

CONCLUSION

In this cross-sectional study, dentine sensitivity and exposure were common in Arab patient populations.

Dentin tubule obturation of a bioglass-based dentin desensitizer under repeated exposure to lactid acid and brushing

Background

Dentin hypersensitivity is a frequent finding especially in periodontitis patients. Conventional treatment aims for obstruction of dentin tubules by disabling liquid and osmotic fluctuation to and from the pulpal chamber. A novel bioglass-based desensitizer was shown to obstruct tubules and to resist periodic exposure to lactic acid. Whether this obstruction is resistant to brushing had not been tested so far. Accordingly, the present study aimed to assess dentin tubule obstruction after repeated acid exposure and brushing.

Methods

Sixty dentin discs were cleaned with 17% EDTA, mounted into a pulp fluid simulator and randomly divided into 3 groups: No surface treatment in Group A, Seal&Protect® in group B and DentinoCer in group C. Discs were exposed to 0.1 M non-saturated lactic acid thrice and standardized brushing twice a day for 12 days. At baseline and after 2, 4 and 12 d samples were removed from the setting and prepared for top-view SEM analysis to assess tubule obstruction using the Olley score. Discs were then vertically cut and the section surface morphologically assessed using backscatter imaging. For both vertical and sectional surfaces EDX analysis was used to characterize the surface composition in the tubular and inter-tubular area.

Results

Group A showed clean tubular lumina at all time points. From day 2 onwards dentin showed exposed collagen fibers. Group 2 initially showed a complete surface coverage that flattened out during treatment without ever exposing tubules. At baseline, samples of Group C displayed a complete homogeneous coverage. From day 2 on tubules entrances with obstructed lumen became visible. While on day 4 and 12 the dentin surface exposed collagen fibers the lumina remained closed. EDX analysis of the vertical and horizontal views showed that P and Ca were predominant elements in both the inter- and tubular dentin while Si peaks were found in the tubule plugs.

Conclusion

While group B displayed a packed layer on the surface during the whole investigation time group C samples lost their superficial layer within 48 h. Tubule plugs containing considerable Si proportions indicated previous presence of DentinoCer, while high Ca and P proportions suggest obturation by dentin-like material.

Effect of four different dentifrices applied by customized automated brushing device on enamel surface abrasion: An in vitro profilometric study

Aim:

The aim of this study is to evaluate the enamel surface abrasion using four different dentifrices and a customized automated brushing machine under a profilometer.

Materials and Methods:

A total of 30 enamel blocks (9 mm × 9 mm × 2 mm) were prepared from freshly extracted maxillary central incisors which were randomly divided into five equal groups (Group 1: specimens brushed with Colgate Total, Group 2: specimens brushed with Colgate Lemon and Salt, Group 3: specimens brushed with Colgate Visible White, Group 4: specimens brushed with Colgate Sensitive, and Group 5: intact enamel surface). Samples were brushed using a customized automated toothbrushing machine for 60 min. A profilometric read out (Ra value) was taken for each group subjected to brushing and also for the control group.

Statistical Analysis:

Statistical analysis used in this study was one-way analysis of variance followed by post hoc Tukey's test.

Results:

Statistically significant differences (P < 0.05) were observed in the values of enamel abrasion (Ra) among Group 1–Group 4 whereas Group 5 (control group) had no significant difference in enamel abrasion (P > 0.05).

Conclusion:

The highest enamel abrasion was observed in the group with Colgate Visible White toothpaste, and the least enamel abrasion was seen in the group with Colgate Sensitive Plus.

Etiological Aspects of Noncarious Dental Lesions

PURPOSE

The aim of the present study was to correlate etiological factors with noncarious cervical lesions in a group of patients from Craiova.

MATERIAL AND METHODS

The study was conducted between November 2015 and May 2016 on 50 patients, aged 18-56 years, who addressed to the Oral Rehabilitation Clinic, from the University of Medicine and Pharmacy of Craiova. Patients were divided into two groups: the study group consists of patients who had noncarious cervical dental lesions (NCCLs) and the control group with patients who did not have noncarious cervical lesions. Each patient underwent a clinical examination and completed a questionnaire, referring to eating habits, oral hygiene, vicious habits and personal impressions about the appearance and functionality of his teeth, highlighting the factors involved in the noncarious dental lesions etiology.

RESULTS

The study group consisted of 64% women and 36% men. Noncarious cervical lesions were higher in men (72.22%) compared to women (56.25%). Regarding on the tooth brushing method, it has been noted that 34% of patients used a vertical tooth brushing method, 52% were using a circular brushing method, while 14% were practicing a horizontal tooth brushing method. Cervical sensitivity has been detected in 48% of the patients, against 52% who showed no sensitivity. 62% of the participants did not have bruxism, while nighttime/daytime bruxism was found in 38% of the patients.

CONCLUSIONS

There are several etiological factors correlated with noncarious cervical lesions, among which are: tooth brushing method, bruxism, eating behaviors.

Treatment Protocol for Dentin Hypersensitivity

How to cite this article

Escalante-Otárola W, Castro-Núñez G, Jordão-Basso KCF, Lima SL, Kuga MC, Bandeca MC. Treatment Protocol for Dentin Hypersensitivity. World J Dent 2017;8(1):1-4.

Dentin abrasivity of various desensitizing toothpastes

Background

The aim of this study was to compare the abrasivity of various commercially available toothpastes that claim to reduce dentin hypersensitivity.

Methods

Dentin discs were prepared from 70 human extracted molars. The discs were etched with lemon juice for 5 min, and one half of the discs were covered with aluminum tape. Following this, they were brushed with 6 different toothpastes, simulating a total brushing time of 6 months. As a negative control, discs were brushed with tap water only. The toothpastes contained pro-arginine and calcium carbonate, strontium acetate, stannous fluoride, zinc carbonate and hydroxyapatite, new silica, or tetrapotassium pyrophosphate and hydroxyapatite. After brushing, the height differences between the control halves and the brushed halves were determined with a profilometer and statistically compared using a Mann–Whitney U test for independent variables.

Results

A significant difference (p < 0.001) in height difference between the controls and the toothpaste-treated samples was found in all cases, except for the stannous fluoride-containing toothpaste (p = 0.583). The highest abrasion was found in the toothpaste containing zinc carbonate and hydroxyapatite, and the lowest was found in the toothpaste containing pro-arginine and calcium carbonate.

Conclusions

Desensitizing toothpastes with different desensitizing ingredients have different levels of abrasivity, which may have a negative effect on their desensitizing abilities over a long period of time.

Dentine sensitivity: past, present and future

OBJECTIVE

This review defines dentine sensitivity (DS), its prevalence, its aetiology, the mechanism(s) responsible for DS, its diagnosis and its treatment. The review then examines the modes of action of various treatments for DS including potassium salts, strontium salts, bioglasses, arginine/calcium carbonate and professional treatments such as adhesives and oxalates. The methods used to evaluate the various treatment modalities are discussed, including laboratory studies and randomised controlled clinical trials.

DATA SOURCES AND STUDY SELECTION

A literature search was conducted using PubMed, Ovid Medline and Cochrane reviews for information on DS and its treatments, as well as laboratory and clinical studies used to evaluate the efficacy of various DS treatments. With regard to efficacy of treatments for DS only reports of clinical studies that were randomised, controlled and blinded were reviewed. The authors offer new insights into the shortcomings of the recent systematic review of the use of oxalates for DS.

CONCLUSION

The authors introduce the concept of a novel desensitising mouthrinse containing 1.4% potassium oxalate: Listerine® Advanced Defence Sensitive mouthrinse. Readers of this supplement issue of the Journal of Dentistry are invited to review the significance of managing the clinical problem of DS. They are also invited to assess data from laboratory and randomised controlled clinical studies in order to understand the advantages offered by regular use of 1.4% potassium oxalate-containing mouthrinse, Listerine Advanced Defence Sensitive, in particular its resistance to daily erosive and/or abrasive challenges.

Use of dentifrices to prevent erosive tooth wear: harmful or helpful?

Dental erosion is the loss of dental hard tissues caused by non-bacterial acids. Due to acid contact, the tooth surface becomes softened and more prone to abrasion from toothbrushing. Dentifrices containing different active agents may be helpful in allowing rehardening or in increasing surface resistance to further acidic or mechanical impacts. However, dentifrices are applied together with brushing and, depending on how and when toothbrushing is performed, as well as the type of dentifrice and toothbrush used, may increase wear. This review focuses on the potential harmful and helpful effects associated with the use of dentifrices with regard to erosive wear. While active ingredients like fluorides or agents with special anti-erosive properties were shown to offer some degree of protection against erosion and combined erosion/abrasion, the abrasive effects of dentifrices may increase the surface loss of eroded teeth. However, most evidence to date comes from in vitro and in situ studies, so clinical trials are necessary for a better understanding of the complex interaction of active ingredients and abrasives and their effects on erosive tooth wear.

Influence of different toothpaste abrasives on the bristle end-rounding quality of toothbrushes

OBJECTIVES

To evaluate the influence of different toothpaste abrasives on the bristle wear and bristle tip morphology of toothbrushes with different degrees of hardness.

MATERIAL AND METHODS

Ninety samples of bovine incisor teeth were used in this study. The samples were randomly divided into three groups according to the bristle hardness of the toothbrush used: soft bristles (S); extra-soft bristles (ES); hard bristles (H). The toothbrushes of each group were randomly divided into six subgroups with five toothbrushes each, according to the abrasive of the toothpaste used in the simulation: Negative control (distilled water); toothpaste 1 (silica); toothpaste 2 (hydrated silica); toothpaste 3 (calcium carbonate, calcium bicarbonate and silica); toothpaste 4 (tetrapotassium pyrophosphate, silica and titanium dioxide); toothpaste 5 (calcium carbonate). The samples were placed in a toothbrushing simulating machine that simulating three months of brushing. The toothbrush bristles were evaluated by the bristle wear index, and the bristle tips morphology was evaluated by the bristle tip morphology index.

RESULTS

The ES brush presented the highest bristle wear among the toothbrushes. Additionally, the S brushes showed better morphology of the bristles followed by ES and H brushes. The type of abrasive only influenced the bristle tip morphology of the ES brushes. The toothpaste 3 induced the worse bristle tip morphology than all the other toothpastes.

CONCLUSIONS

Different abrasives have influence only on the bristle tip morphology of the ES brushes.

The importance of measuring toothpaste abrasivity in both a quantitative and qualitative way

OBJECTIVE

To evaluate the relative abrasivity of different toothpastes and polishing pastes both qualitatively and quantitatively.

MATERIALS AND METHODS

Acrylic plates were exposed to brushing in a brushing machine with a toothpaste/water slurry for 1 and 6 h. Twelve different toothpastes were used and also four different polishing pastes. The results were evaluated using a profilometer after 1 and 6 h of brushing (corresponding to 2000 and 12 000 double strokes, respectively). A surface roughness value (Ra-value) and also a volume loss value were calculated from the profilometer measurements. These values were then correlated to each other. An unpaired t-test for the difference in the abrasion values between the toothpastes and the abrasion values over time was used.

RESULTS

The polishing paste RDA® 170 yielded higher Ra-values than RDA 250®, both after 1 and 6 h of brushing (1.01 ± 0.22 and 8.99 ± 1.55 compared to 0.63 ± 0.26 and 7.83 ± 5.89, respectively) as well as volume loss values (3.71 ± 0.17 and 20.20 ± 2.41 compared to 2.15 ± 1.41 and 14.79 ± 11.76, respectively), thus poor correlations between the RDA and Ra and Volume loss values were shown. Among the toothpastes, Apotekets® showed the highest Ra value after 1 h of brushing and Pepsodent® whitening after 6 h of brushing. Pepsodent® whitening also showed the highest volume loss values, both after 1 and 6 h of brushing.

CONCLUSION

This study emphasizes the importance of not only considering the RDA value, but also a roughness value, when describing the abrasivity of a toothpaste. Furthermore, it can be concluded that so called 'whitening' toothpastes do not necessarily have a higher abrasive effect than other toothpastes.

Scaffold-free microtissues: differences from monolayer cultures and their potential in bone tissue engineering

OBJECTIVES

Cell-based therapies for bone augmentation after tooth loss and for the treatment of periodontal defects improve healing defects. Usually, osteogenic cells or stem cells are cultivated in 2D primary cultures, before they are combined with scaffold materials, even though this means a loss of the endogenous 3D microenvironment for the cells. Moreover, the use of single-cell suspensions for the inoculation of scaffolds or for the direct application into an area of interest has the disadvantages of low initial cell numbers and susceptibility to unwanted cellular distribution, respectively.

MATERIALS AND METHODS

We addressed the question whether an alternative to monolayer cultures, namely 3D microtissues, has the potential to improve osteogenic tissue engineering and its clinical outcome.

RESULTS

By contrast, to monolayer cultures, osteogenic differentiation of 3D microtissues is enhanced by mimicking in vivo conditions. It seems that the osteogenic differentiation in microtissues is enhanced by strong integrin-extracellular matrix interaction and by stronger autocrine BMP2 signaling. Moreover, microtissues are less prone to wash out by body fluids and allow the precise administration of large cell numbers.

CONCLUSION

Microtissue cultures have closer characteristics with cells in vivo and their enhanced osteogenic differentiation makes scaffold-free microtissues a promising concept in osteogenic tissue engineering.

CLINICAL RELEVANCE

Microtissues are particularly suitable for tissue engineering because they improve seeding efficiency of biomaterials by increasing the cell load of a scaffold. This results in accelerated osteogenic tissue formation and could contribute to earlier implant stability in mandibular bone augmentation.

Scaffold-free microtissues: differences from monolayer cultures and their potential in bone tissue engineering

Objectives

The paper’s aim is to review dentin hypersensitivity (DHS), discussing pain mechanisms and aetiology.

Materials and methods

Literature was reviewed using search engines with MESH terms, DH pain mechanisms and aetiology (including abrasion, erosion and periodontal disease).

Results

The many hypotheses proposed for DHS attest to our lack of knowledge in understanding neurophysiologic mechanisms, the most widely accepted being the hydrodynamic theory. Dentin tubules must be patent from the oral environment to the pulp. Dentin exposure, usually at the cervical margin, is due to a variety of processes involving gingival recession or loss of enamel, predisposing factors being periodontal disease and treatment, limited alveolar bone, thin biotype, erosion and abrasion.

Conclusions

The current pain mechanism of DHS is thought to be the hydrodynamic theory. The initiation and progression of DHS are influenced by characteristics of the teeth and periodontium as well as the oral environment and external influences. Risk factors are numerous often acting synergistically and always influenced by individual susceptibility.

Clinical relevance

Whilst the pain mechanism of DHS is not well understood, clinicians need to be mindful of the aetiology and risk factors in order to manage patients’ pain and expectations and prevent further dentin exposure with subsequent sensitivity.

In situ randomised trial investigating abrasive effects of two desensitising toothpastes on dentine with acidic challenge prior to brushing

OBJECTIVES

To determine if brushing dentine with 2 moderate RDA desensitising toothpastes, results in a significant dentine wear difference and whether this difference continues to be relevant when preceded with an erosive challenge.

METHODS

An in situ, single centre, single blind, randomised, split mouth study, evaluated the difference in abrasion of 2 toothpastes (SFM - Sensodyne Fresh Mint(®) RDA 70; CPHM - Crest Pro-Health Clean Mint(®) RDA 120) in 28 healthy volunteers. Two toothpaste treatments were administered 3×/day, for each of the two 15 day periods, subjects wearing bi-lateral, lower buccal appliances each with 4 dentine sections. A 2 min extra-oral acidic challenge preceded toothbrushing for 2 study arms. Contact profilometry measured samples at baseline, days 5, 10 and 15.

RESULTS

Brushing with SFM was significantly less abrasive than brushing with CPHM at all time points, with or without a preceding acidic challenge (p<0.0001). The additional dentine loss arising from the erosive challenge prior to brushing with each paste was linear with time and independent of abrasive effect.

CONCLUSIONS

The desensiting toothpastes' RDA, directly related to dentine loss with toothbrushing. An acidic challenge prior to brushing did not negate the benefits of reduced wear from the lower RDA paste compared to the higher RDA paste. When brushing eroded dentine, the additional wear appeared independent of abrasive effect. Dentine hypersensitivity sufferers should be recommended to use a low-moderate RDA toothpaste, not to brush more than 2×/day and not immediately following an acidic challenge.

The erosive effects of saliva following chewing gum on enamel and dentine: an ex vivo study

OBJECTIVES

The primary objective was to determine the erosive effect of expectorated saliva, following chewing acidic gum, on enamel and dentine samples, using a non-acidic gum as a negative control. Secondary objectives were to determine the effect of brushing enamel and dentine samples and the effect of individual saliva pH and buffering.

DESIGN

A single-centre, single-blind, placebo-controlled, two-way crossover study.

SETTING

A clinical trial, involving healthy participants, undertaken at Bristol Dental School and Hospital.

METHODS

Eight healthy participants expectorated saliva onto prepared enamel and dentine samples while chewing gum (strawberry flavoured acidic gum [active] or peppermint flavoured non-acidic gum [control]). Half of the enamel and dentine samples were brushed before measurement by contact profilometry.

MAIN OUTCOME MEASURES

Mean enamel and dentine erosion, with and without brushing and the relationship to salivary buffering.Results At 10 days, mean depth of surface loss from dentine samples (95% CI), following chewing of acid-containing gum and subsequent brushing, was -11.34 μm (2.22 μm) and from un-brushed dentine samples was -11.02 μm (1.71 μm). No significant erosion was noted for other groups.

CONCLUSIONS

Frequent chewers of acid-containing gums are susceptible to dentine erosion even in the presence of good salivary buffering. Enamel erosion was insignificant within the time constraints of the present study but warrants further investigation.

The use of a profilometer for both quantitative and qualitative measurements of toothpaste abrasivity

AIM

To evaluate the abrasivity of different toothpastes both quantitatively and qualitatively with a profilometer technique and to correlate these findings to the radioactive dentin abrasivity (RDA) value.

MATERIALS AND METHODS

Acrylic plates were exposed to brushing in a brushing machine with 11 different toothpastes. The results were evaluated using a profilometer. A surface roughness value (Ra-value), that is, a qualitative measurement, and also a volume value, that is, a quantitative measurement, were calculated from the profilometer results. These values were then correlated to each other and to the RDA-value. A comparison between RDA, Ra and volume measurements was performed using linear fitting procedure.

RESULTS

The results showed that the correlation between RDA and Ra measurements was low (R(2) = 0.04) and also that the correlation between RDA and volume measurements was low (R(2) = 0.00002). Correlation between Ra and abraded volume was high (R(2) = 0.87).

CONCLUSIONS

It is important to consider not only the RDA-value when evaluating toothpaste abrasivity. From the profilometer results both a quantitative (volume) and qualitative (roughness) measurement of the abrasivity of a toothpaste can be obtained.

Clinical in situ study investigating abrasive effects of two commercially available toothpastes

The aim of this study was to determine if the abrasive effect on dentine of two commercially available toothpastes, known to vary in their in vitro abrasive levels, can be differentiated in an in situ model after 10 days, assessed by contact profilometry. This was a single centre, single blind, randomized, split mouth, two treatment, in situ study, in 34 healthy subjects, evaluating the abrasive effects of two marketed desensitizing toothpastes, (Colgate Sensitive Multi Protection toothpaste - C; Sensodyne Total Protection - S). Subjects wore bi-lateral, lower buccal appliances, each fitted with four dentine sections which were power brushed three times a day with the treatment regimen. Each subject received two toothpaste treatments for 10 days during the treatment period. Samples were measured at baseline and day 10 by contact and non-contact profilometry and day 5 by contact profilometry. Thirty-four subjects were included in the efficacy analysis. Results from contact profilometry showed statistically significant (P < 0.0001) dentine loss compared to baseline at day 5 and 10 for both pastes. At each time point, C showed statistically significantly greater dentine loss than S, P < 0.0001. After 10 days treatment, the difference in dentine loss between the pastes was 1.4 microm. The non-contact profilometry data showed similar trends. After 10 days of treatment, C showed statistically significantly greater dentine loss than S, with treatment difference of 0.9 microm, P = 0.0057. The methodology used has successfully differentiated between the abrasivity of the two pastes in respect of dentine surface loss over time in an in situ environment.

Clinical study investigating abrasive effects of three toothpastes and water in an in situ model

OBJECTIVES

This in situ study compared the abrasive effect of repeated brushings (over 10 days) of a low relative abrasive dentine (RDA) toothpaste with moderate and high relative abrasive dentine (RDA) toothpastes, on human dentine in situ.

MATERIALS AND METHODS

The study design was single centre, single blind, randomized, split mouth, two period, four-treatment cross-over, in situ study in 20 healthy subjects. Subjects wore bi-lateral lower buccal appliances each fitted with four dentine sections with treatment applied with a power toothbrush, during each 10 day study period. Samples were measured at baseline, day 5 and day 10 by contact profilometry, and baseline and day 10 with non-contact profilometry.

RESULTS

Nineteen subjects were included in the efficacy analysis. Results as measured by contact and non-contact profilometry from brushing with the moderate RDA paste and high RDA paste showed significantly (p<0.0001) more abrasion to dentine than brushing with the low RDA paste or water after 10 days. Dentine loss following tooth brushing with the low RDA paste was not significantly different from brushing with water, after 10 days.

CONCLUSIONS

The methodology successfully showed clear differentiation between the amount of dentine lost following toothbrushing with the low RDA paste compared to the moderate or high RDA pastes. Dentine loss following brushing with the low RDA paste showed a comparable degree of abrasion to brushing with water.

Abrasion of eroded dentin caused by toothpaste slurries of different abrasivity and toothbrushes of different filament diameter

OBJECTIVE

This study aimed to evaluate the impact of toothpaste slurry abrasivity and toothbrush filament diameter on abrasion of eroded dentin in vitro.

METHODS

Eroded dentin samples (hydrochloric acid, pH 2.6, 15s) were brushed with 40 strokes in an automatic brushing machine using manual toothbrushes with different filament diameter (0.15, 0.20 or 0.25 mm). The toothbrushes were applied with a control slurry free of abrasive particles (RDA-value 10) or toothpastes slurries with different abrasivity (RDA-values 20, 50 or 100). Each erosive-abrasive cycle was followed by storage of the dentin samples in artificial saliva for 3h. After each 4 cycles, the samples were stored in artificial saliva for 15 h. After 60 cycles, dentin loss was measured by profilometry and statistically analysed by ANOVA and linear regression analysis.

RESULTS

Dentin loss increased along with the RDA-value of the toothpaste slurries. The impact of the filament diameter on dentin loss was less evident compared to the RDA-value. However, toothbrushes with smaller filament stiffness caused higher dentin wear in all toothpaste slurry groups (RDA 20, 50 and 100) except for the paste-free control group (RDA 10).

CONCLUSION

Abrasion of eroded dentin increased along with the RDA-value of the toothpaste slurry and with decreasing filament diameter of the toothbrush.

The measurement of enamel wear by four toothpastes

OBJECTIVES

To determine the enamel abrasivity of three whitening toothpastes and a silica toothpaste and to measure the brushing forces used.

METHODS

Polished human enamel blocks were indented with a Knoop diamond and attached to dentures of adult volunteers. The blocks were brushed ex vivo, twice per day with either a whitening toothpaste containing Perlite (White System), a commercial whitening toothpaste (A and B) or a silica toothpaste. After four and twelve-weeks, one block per subject was removed and the Knoop indent remeasured. From the changes in the indent length, the amount of enamel wear was calculated.

RESULTS

The mean enamel wear (sd) for White System, silica toothpaste, whitening toothpaste A and B after four-weeks was 0.14 (0.15), 0.09 (0.16), 0.14 (0.12) and 0.89 (0.93) and after twelve-weeks was 0.24 (0.21), 0.37 (0.73), 0.36 (0.52) and 1.04 (0.98) microm respectively. After four-weeks, the differences in enamel wear between whitening toothpaste B and all other toothpastes were of statistical significance (p < 0.003), but not after twelve-weeks. The mean ex vivo normal brushing force (sd) was 2.67 (1.33) N.

CONCLUSIONS

All three whitening toothpastes did not give significantly more enamel wear than a silica toothpaste after twelve-weeks in situ with ex vivo brushing.

The measurement in vitro of dentine abrasion by toothpastes

OBJECTIVES

To investigate the in vitro dentine wear after tooth brushing with a range of nine toothpastes.

METHODS

70 bovine dentine blocks (aproximately 1 cm long) were used. Specimens were brushed in vitro with toothpastes with a range of abrasive. All the specimens were submitted to 10,000 brushing cycles with a 200g load. Initial and final weight and profile data were obtained using an analytical scale and a profile projector respectively.

RESULTS

Significant differences between the test products were found (p < 0.05). The mean dentine wear ranged from 0.039 to 0.006g and 0.502 to 0.185mm, with the highest wear for the whitening toothpastes.

CONCLUSIONS

This study demonstrated that the type of toothpaste abrasive can contribute to dentine wear.

Influence of rotating-oscillating, sonic and ultrasonic action of power toothbrushes on abrasion of sound and eroded dentine

OBJECTIVE

This in vitro study aimed to evaluate the susceptibility of sound and eroded dentine to brushing abrasion performed by different rotating-oscillating, sonic and ultrasonic toothbrushes.

METHODS

Toothbrushing abrasion (20 cycles, each 30 s) was applied to bovine dentine samples (each subgroup n = 10) exhibiting both a demineralized (each cycle: 1% citric acid, pH: 2.3, 60 s; 30 min remineralization in artificial saliva) and a sound surface area. Toothbrushing was performed in an automatic brushing machine with the rotating-oscillating, sonic and ultrasonic toothbrushes either (a) activated, supplemented by 20 strokes/min of the brushing machine, (b) inactivated, supplemented by 20 strokes/min of the brushing machine or (c) inactivated, supplemented by 80 strokes/min of the brushing machine. A manual toothbrush was applied with 20, 80 or 100 linear strokes/min. Specimens of the control group were not brushed after erosion. After each cycle, the samples were stored in artificial saliva for 4 h. After 20 cycles, loss of sound and softened dentine was determined by profilometry. Mann-Whitney-Wilcoxon test and Bonferroni corrections were applied to the data (p < 0.05).

RESULTS

For all groups, demineralized dentin areas exhibited significantly higher abrasion values than the respective sound dentine surfaces. However, mean dentine loss of both softened and sound dentine was higher after use of the rotating-oscillating, sonic and ultrasonic brushes with the activated regime [(a) eroded dentine: 9.94-16.45 microm; sound dentine: 3.31-5.47 microm] than after brushing with the inactivated regimes [(b) eroded dentine: 5.10-5.62 microm; sound dentine: 1.16-1.81 microm; (c) eroded dentin: 7.64-8.89 microm; sound dentine: 1.38-1.69 microm].

CONCLUSION

The results indicate that rotating-oscillating, sonic or ultrasonic action of the power toothbrushes leads to an increased loss of demineralized and sound dentine.

Wear of dentine in vitro by toothpaste abrasives and detergents alone and combined

AIM

To measure in vitro the abrasion of dentine by toothpaste detergents and abrasives alone and combined.

MATERIALS AND METHODS

Detergents used were tego betain, sodium lauryl sulphate (SLS), adinol and pluronic diluted to 1% w/v. Abrasives were three artificial silicas, tixosil 73 and 123 and Zeodent 113, and calcium carbonate used at 2.5% w/v. Flat human dentine specimens were brushed with aqueous detergent solutions or abrasive slurries, detergent abrasive slurries and water for 20,000 brush strokes. Dentine loss was measured by non-contacting profilometry at 10,000 and 20,000 strokes. Silica particle size distribution was measured by laser deflection.

RESULTS

Loss of dentine occurred with all detergents, abrasives and detergent abrasion combinations, but was not linear with number of brush strokes. Water appeared to remove the smear layer only, but all detergents exceeded the predicted smear layer thickness. The silica abrasives differed in abrasion properties despite similar particle size distribution. Different detergents modulated the abrasives actions in mainly positive or mainly negative directions.

CONCLUSIONS

Detergents appear able to attack the dentine surface to produce wear. Abrasives vary considerably in wear produced under similar conditions. Detergents modulate the effect of abrasives in a way that may reflect the rheological properties of the mixture.

Tooth brushing, tooth wear and dentine hypersensitivity — are they associated?

Evidence suggests that patients suffer the painful symptoms of dentine hypersensitivity when dentine is exposed and the dentinal tubule system is opened to the oral cavity to allow stimuli to trigger a neural response in the pulp via a hydrodynamic mechanism. The processes needed to localise lesions of dentine hypersensitivity include loss of enamel and/or gingival recession. Whilst tooth brushing with or without toothpaste appears to cause minimal wear to enamel (in the absence of acids), circumstantial evidence implicates tooth brushing with gingival recession and exposure of dentine. Other tooth wear processes notably attrition and acid erosion cause loss of enamel and can expose dentine. Therefore sensitivity may result. How lesions of dentine hypersensitivity are initiated is a matter of conjecture and based on extrapolating data from studies, mainly in vitro, to affect in vivo. Again this circumstantial type of evidence suggests that abrasion by some toothpastes and erosion by dietary acid could open the tubule system. Little is known about the actual effect of desensitising toothpastes on lesions of dentine hypersensitivity even though they are formulated to either occlude dentinal tubules or block the neural response in the pulp. Clinical studies have produced contradictory findings for the efficacy of products and there have been extremely few evidence based reviews. In conclusion, available evidence supports a probable link of tooth brushing, with or without toothpaste and an acidic diet to both tooth wear and dentine hypersensitivity, and suggests also that dentine hypersensitivity is a tooth wear phenomenon. Although there is a need for more direct clinical and scientific evidence for these associations, it is recommended that they be taken into consideration when planning management strategies for the dentine hypersensitivity sufferer.

Abrasion of human enamel and dentine caused by toothpastes of differing abrasivity determined using an in situ wear model

OBJECTIVES

To determine the rates of enamel and dentine wear in situ during tooth brushing with a range of five toothpastes of differing RDA and REA values.

METHODS

Enamel/dentine inserts were placed in the buccal aspects of full upper dentures of human volunteers. Enamel wear was determined by change in Knoop indent length and dentine wear was determined from the enamel-dentine step height, measured using optical profilometry.

RESULTS

Significant differences between the test products were found for both enamel and dentine (p < 0.05). However for the conventional toothpastes the rate of wear was similar and differences between the products were not generally statistically significant for either enamel or dentine, despite the fact that their RDA values differed by more than a factor of two. The rate of wear was found to decrease throughout the duration of the study.

CONCLUSIONS

The study demonstrated that the methodology used is capable of assessing enamel and dentine wear in situ within a relatively short period of time. The data suggest that whilst in vitro tests have value in understanding differences in abrasivity between products, they cannot be used to predict in vivo effects.

The measurement of enamel and dentine abrasion by tooth whitening products using an in situ model

OBJECTIVES

To determine the enamel and dentine wear of two whitening toothpastes using an in situ model with ex vivo brushing.

METHODS

Human enamel/dentine (approximately 50:50) blocks (approximately 4 x 4mm) were placed in the upper buccal aspects of full or partial dentures of a group of 25 subjects. Subjects brushed the specimens ex vivo with either a calcium carbonate/perlite or silica containing whitening toothpaste under exaggerated conditions as compared to normal for 30 s, twice per day. Specimens were removed after 4, 8 and 12 weeks and the wear to the enamel and dentine was determined. Enamel wear was determined by change in Knoop indent length and dentine wear was determined from the enamel-dentine step height, measured using optical profilometry.

RESULTS

The mean wear after 12 weeks was for enamel 0.27 and 0.19 microns, and for dentine 34.3 and 61.1 microns, for the calcium carbonate/perlite and silica toothpastes respectively. There were no significant differences between products after 12 weeks. The rate of wear was found to decrease throughout the duration of the study.

CONCLUSION

There were no significant differences between the two whitening toothpastes in terms of enamel and dentine wear after 12 weeks brushing.

A comparison of enamel erosion by a new sports drink compared to two proprietary products: a controlled, crossover study in situ

OBJECTIVE

The aim of the study was to measure the erosive potential of a prototype sports drink on enamel in a model in situ.

METHODS

The study was a single centre, single blind, randomised crossover design balanced for residual effects involving 18 subjects. The drinks were the prototype formulation containing calcium and maltodextrin (test), two sports drink products containing sugars (drink with calcium and positive control) and water (negative control). During each 15-day study period, subjects wore a palatal removable appliance carrying two flat human enamel specimens. Drinks were imbibed as 250 ml volumes over 10 min 4 times per day. Loss of enamel was measured on days 5, 10 and 15 using a contacting profilometer.

RESULTS

Very little erosion occurred with the test, drink with calcium and negative control drinks and differences between the test and negative control only reached significance at day 15. The positive control produced progressive erosion over time and significantly more than the test or negative control at all time points.

CONCLUSION

The technology of adding calcium with appropriate pH adjustment, which has been applied previously to soft and carbonated drinks to markedly reduce erosive potential, can be applied to sports drinks to the same end. Significant variation in the carbohydrate composition does not influence this outcome.

An in situ Investigation into the Abrasion of Eroded Dental Hard Tissues by a Whitening Dentifrice

This crossover study aimed to investigate abrasion of previously eroded hard dental tissues by a whitening dentifrice compared to a regular dentifrice. After a 3-day lead-in period, 14 volunteers were randomly assigned to use one of the toothpastes while wearing a removable appliance, containing 3 enamel and 3 root dentine slabs on each side. On the first day salivary pellicle was allowed to form. Twice daily for the following 3 days, one side of each appliance was immersed in an acidic carbonated drink ex vivo while the other side remained unexposed. Specimens were then brushed with the allocated dentifrice. After a 3-day washout period, new sets of enamel and dentine slabs were mounted in the appliances and the participants commenced period 2 using the alternative toothpaste. Acid-treated specimens always showed more wear than untreated specimens. The whitening dentifrice did not significantly increase the wear of softened enamel compared with the regular dentifrice. Brushing with the whitening toothpaste led to significantly greater wear of sound enamel and of both eroded and sound dentine than the regular dentifrice. The results suggest that whitening dentifrices may not increase the wear of acid-softened enamel but may have a more deleterious effect on dentine than regular toothpastes.

The protective effect of fluoride treatments against enamel erosion in vitro

Fluoride is known to reduce enamel solubility during the caries process. The aim of this investigation was to determine whether fluoride preparations affect erosion attributed to citric acid and citric acid-based soft drinks. Flat enamel specimens embedded in epoxy resin were prepared from caries free, human third molar teeth extracted from patients aged 18-35 years. Specimens were polished to have a profile within a tolerance of +/-0.3 microm measured on a profilometer. Specimens were taped to leave a 2 mm window of exposed enamel. Groups of specimens were exposed to citric acid and soft drinks with and without the addition of sodium fluoride or exposed to the same solutions after pre-treatment with fluoride products. Enamel loss was measured by profilometer after 10, 20 and 30 min of acid exposure. The different acidic solutions varied significantly in the amount of erosion produced both with and without the addition of fluoride. In addition, the different fluoride products differed significantly in the protective effect afforded. Both fluoride application methods reduced in mean terms, enamel erosion at all time points and by all acidic solutions. The majority of differences were <25% and as the study was powered to show differences as significant at or above this level few reached statistical significance. Fluoride applied to enamel either in acidic solutions or as a pre-treatment, reduces enamel erosion; however, the actual clinical benefit appears low. More studies are required, including investigations in situ.

Influence of buffering effects of dentifrices and fluoride gels on abrasion on eroded dentine

OBJECTIVE

Evaluation of abrasion resistance of eroded and non-eroded dentine brushed with experimental dentifrices and gels of varying buffering capacities.

DESIGN

One hundred and twenty human dentine specimens were distributed among six groups (A-F) according to the different buffering capacities of experimental toothpastes and gels. The dentifrices (pH: 4.5) and gels (pH: 4.5) differed in fluoride content, RDA-value and buffer capacity (given as mg KOH needed for neutralisation): (A) 0.125%F, RDA: 77, 6mg KOH; (B) 0.125%F, RDA: 125, 24mg KOH; (C) 0.125%F, RDA: 129, 12mg KOH; (D) 0%F, RDA: 81, 1.55mg KOH; (E) 1.25%F, RDA: 21, 8.5mg KOH; (F) 0.125%F, RDA: 7, 3.11mg KOH. Ten specimens were cycled through three alternating demineralisations (1% citric acid, 5min) and remineralisations (artificial saliva, 1min) including brushing abrasion in an automatic brushing machine (2 x 2000 strokes). Ten samples of each group were not eroded, but only brushed.

RESULTS

After three cycles, loss of dentine was determined by profilometry (mean +/- S.D. [microm]). Eroded samples: (A) 37.12+/-4.95; (B) 48.67+/-4.77; (C) 39.88+/-3.76; (D) 32.92+/-2.67; (E) 3.65+/-1.35; (F) 6.47+/-1.31. Uneroded samples: (A) 30.78+/-6.47; (B) 37.84+/-7.75; (C) 30.07+/-3.05; (D) 26.93+/-2.30; (E) 1.76+/-0.94; (F) 0.51+/-0.18. Analysis of variance revealed significantly higher abrasion values for the eroded compared to the non-eroded samples (P<or=0.05). Dentifrices with same pH-value, fluoride content and similar RDA-values but a higher buffering capacity exhibited significantly more abrasion than toothpastes with lower buffering capacity. Highly-concentrated fluoride gel with higher buffering capacity lead to less abrasion values compared to the gel with low fluoride concentration and low buffering capacity.

CONCLUSION

Toothbrushing abrasion behaviour of eroded dentine may be influenced by the fluoride content, RDA-value and buffering capacity of the applied dentifrice or gel.

Can tooth brushing damage your health? Effects on oral and dental tissues

Circumstantial evidence based on anecdote, case reports, epidemiological data and studies in vitro and in situ implicate tooth brushing with toothpaste with tooth wear, gingival recession and dentine hypersensitivity. This review attempts to assess the clinical significance of the potential harm produced by this most common oral hygiene habit. The toothbrush alone appears to have no effect on enamel and very little on dentine. Most toothpaste also has very little effect on enamel and in normal use would not cause significant wear of dentine in a lifetime of use. Wear of enamel and dentine can be dramatically increased if tooth brushing follows an erosive challenge. Gingival recession has a multi-factorial aetiology and certain individuals and specific teeth may be predisposed to trauma from tooth brushing. Tooth brushing is known to cause gingival abrasions but how these relate to gingival recession is not known. The role of toothpaste in gingival abrasion and recession surprisingly has received little if any attention. Gingival recession most commonly exposes dentine and localises sites for dentine hypersensitivity. Some toothpaste products can expose dentinal tubules but erosion is probably the more dominant factor in dentine hypersensitivity. There is no evidence to indicate that electric and manual toothbrushes differ in effects on soft and hard tissues. It is only under, over or abusive use or when combined with erosion that significant harm may be thus caused. In normal use it must be concluded that the benefits of tooth brushing far out-way the potential harm.

Investigation of erosion and abrasion on enamel and dentine: a model in situ using toothpastes of different abrasivity

BACKGROUND

Studies in vitro suggest that abrasion and erosion may act synergistically to produce wear of enamel and dentine. Methods in situ are recently available to study separately erosion and abrasion of dental tissues. The aim of this study was to combine two in situ protocols to study the interplay between erosion and abrasion of enamel and dentine.

METHOD

The study was a single-blind, randomised, five-treatment cross-over design involving 15 healthy volunteers. During each 10-day study period, subjects wore from 0900 to 1700 h an upper removable acrylic appliance holding one polished enamel and one polished dentine specimen. The specimen treatment regimens were: 1. Drinking water and brushing with toothpaste A. 2. Drinking water and brushing with toothpaste B. 3. Drinking orange juice. 4. Drinking orange juice and brushing with toothpaste A. 5. Drinking orange juice and brushing with toothpaste B. Drinking and brushing times were around 0900, 1100, 1300 and 1500 h. Drinks were consumed as 250 ml over 10 min and brushing ex vivo for 1 min to each specimen. Measurement of tissue loss was made on days 5 and 10 of each period using a profilometer.

RESULTS

All treatments produced increasing tissue loss over time, which was considerably greater for dentine than enamel. For enamel, the data at days 5 and 10 showed a significant effect for erosion (i.e. orange juice was significantly more erosive than water), but no significant effect for abrasion (i.e. no significant difference between the two toothpaste treatments). The combined orange juice and toothpaste effects were directional for synergy but did not reach significance. For dentine at day 10, many specimens exceeded the 50 microm set limit of the profilometer and only day 5 data were considered. There were significant effects for erosion (orange juice produced significantly more erosion than water) and for abrasion (paste A was significantly more abrasive to dentine than paste B). The synergy effect could not be examined for dentine due to the truncation effect as the set limit of the profilometer was exceeded.

CONCLUSIONS

Erosion increases the susceptibility of enamel to toothpaste abrasion. Dentine is considerably more susceptible than enamel to erosion and abrasion alone or combined. Dentine loss appears to correlate with toothpaste abrasivity (RDA value).