Tooth wear--dental erosion

Use of new scratch test and tensile test for evaluation of bond strength of selfadhesive flowable resin composite for repair of artificial tooth erosion

The purpose of this study was to use a new scratch test and tensile test to evaluate the bond strength between artificial erosive enamel or dentin and self-adhesive resin composites as a coating material. Coronal enamel or dentin surface was exposed to an erosive cycle (artificial saliva [AS], pH:7.0 for 6.5 h and acidic carbonated beverages for 5 min, alternated 3 times per day) for the eroded-surface or stored in AS for the remineralized-surface. Two self-adhesive flowable resin composites, Fusio and LLB-CR6 (prototype), and a conventional flowable resin composite, BEAUTIFIL FLOW with self-etching primer system, Clearfil Mega Bond, were applied to enamel or dentin surfaces; and then the bond strengths were measured. For the eroded-surface, there were no significant differences in bonding strength among all materials, as assessed by the new scratch test. Thus, these self-adhesive flowable resin composites might be useful for coating materials on acid-eroded tooth surfaces.

The prevalence of dental erosion in 5-year-old preschoolers in Sharjah, United Arab Emirates

Objective:

The aim of this study was to determine the percentage of 5-year-old preschoolers in Sharjah, affected by dental erosion and to assess the predictors.

Materials and Methods:

A total of 403 5-year-old children were examined of which 48.14% (n = 194) were boys and 51.86% (n = 209) were girls; 31.27% (n = 126) were Emirati and 68.73% (n = 277) were non-Emirati Arabs. Examination of dental erosion was confined to palatal surfaces of maxillary incisors using the erosion index described in the UK National Survey of Children's Dental Health, 1993. Dental caries was charted using the World Health Organization 1997 criteria.

Results:

In the sample of 403 5-year-old preschoolers examined, dental erosion was apparent in 237 (58.80%) children, with 55.09% showing the dissolution of enamel and 3.72% exhibiting exposed dentin. Predictors of dental erosion as determined by logistic regression concluded that compared to Emirati citizens other Arab nationalities have 0.27 times the odds (95% confidence interval [CI] =0.18–0.42) of having tooth erosion (P < 0.05). Children with caries experience have 0.28 times the odds (95% CI = 0.16–0.51) of having tooth erosion compared to children with no caries experience (P < 0.05). Children who drink sugary or carbonated beverages have 0.30 times the odds (95% CI = 0.19–0.41) of having dental erosion compared to children who drink water (P < 0.05).

Conclusions:

The findings of this study indicate that 58.80% of 5-year-old preschoolers in Sharjah, United Arab Emirates, were affected by dental erosion. Caries experience and consumption of acidic drinks were associated with dental erosion.

Nutritional status, tooth wear and quality of life in Brazilian schoolchildren

OBJECTIVE

To evaluate the correlation among nutritional status, tooth wear and quality of life in Brazilian schoolchildren.

DESIGN

The study followed a cross-sectional design. Nutritional status was measured via anthropometry using BMI and tooth wear was measured using the Dental Wear Index; both these assessments were carried out by a trained recorder according to standard criteria. A modified version of the Child Oral Impacts on Daily Performances was used to assess quality of life.

SETTING

City of Bauru, in Brazil.

SUBJECTS

A cluster sample of 396 schoolchildren (194 boys and 202 girls) aged 7-10 years.

RESULTS

The anthropometric assessment showed similar situations for both sexes regarding underweight (31·40 % in boys and 30·20 % in girls) and overweight/obesity (33·96 % in boys and 33·17 % in girls). The underweight children showed a greater severity of tooth wear in the primary teeth (OR=0·72; CI 0·36, 1·42), although in the permanent dentition the obese children had a greater severity of tooth wear (OR=1·42; 95 % CI 0·31, 6·55). The tooth wear was correlated with age for both dentitions.

CONCLUSIONS

Tooth wear in the primary and permanent dentition may be related to nutritional status. Tooth wear and obesity did not have a significant impact on the schoolchildren's perception of quality of life.

Implementation and experience of a new method for posterior vertical bite reconstruction using direct resin composite restorations in the private practice--a survey

OBJECTIVE

The purpose of the present survey was to evaluate the implementation and experience of a new method for posterior vertical bite reconstruction using direct resin composite restorations by private practitioners who attended a hands-on continuing education course on this technique.

MATERIALS AND METHODS

In the years 2007 and 2008, 17 1-day continuing education courses on vertical bite reconstruction in the worn dentition by using direct resin composite restorations were attended by 310 participants. A 13-item questionnaire was posted to all course participants in April 2009 seeking information on the acceptance, implementation and experience of the presented technique in the private practice.

RESULTS

A total of 97 (31%) questionnaires were returned, whereas 67% of the respondents had used the presented technique. Analysis of the overall experience and satisfaction with the placed resin composite restorations using visual analog scale (VAS) revealed a mean VAS score of 7.2 ± 1.7 (0 = maximal unsatisfied, 10 = maximal satisfied). The direct resin composite restorations were predominantly rated 'good' within the assessed criteria surface texture, anatomical form, marginal integrity, marginal discoloration and color match. Ninety-eight percent of the private practitioners stated that they would continue to carry out vertical bite reconstructions according to this technique. The three most frequently observed clinical problems were related to marginal discolorations, bulk fractures and adhesive failures.

CONCLUSION

The presented restoration method was well accepted by private practitioners who used this treatment approach at least once after course participation, even though some clinical problems were observed.

Dental caries and its association with diet and dental erosion in Libyan schoolchildren

BACKGROUND. The change towards a more Westernised diet in Libya may increase the risk of caries and erosion in children. AIMS. To investigate any association between dental caries, dental erosion, and potential dietary risk factors in Libyan schoolchildren. METHODS. A random sample of 791 schoolchildren aged 12 years underwent dental examination for caries and erosion and completed a questionnaire to provide dietary data. Dental caries was assessed using the WHO (Oral Health Surveys: Basic Methods, 1997) criteria. Erosion was assessed using UK National Diet and Nutrition Survey (NDNS, Young People Aged 4-18 years. Volume 2: Report of the Oral Health Survey, 2000) criteria. Associations between caries and dietary variables were investigated through bivariate and multivariate analyses. RESULTS. Of the 791 12-year olds, 57.8% (457) had caries experience and 40.8% (323) had experience of erosion. One hundred and ninety-two subjects (42%) of the subjects with caries experience also had erosion, whilst 131 subjects (39.2%) of the 334 without caries had clinical signs of erosion (P = 0.464; OR, 1.123; 95% CI, 0.842, 1.497). There was no statistically significantly relationship between dental caries and dental erosion. Frequency of consumption of fruit-based sugared drinks was statistically significantly positively associated with experience of caries (P = 0.002). CONCLUSIONS. Dental caries experience was associated with frequency of consumption of sugared dietary items but not with dental erosion.

Assessment and management of dental erosion

Studies have shown a growing trend toward increasing prevalence of dental erosion, associated with the declining prevalence of caries disease in industrialized countries. Erosion is an irreversible chemical process that results in tooth substance loss and leaves teeth susceptible to damage as a result of wear over the course of an individual's lifetime. Therefore, early diagnosis and adequate prevention are essential to minimize the risk of tooth erosion. Clinical appearance is the most important sign to be used to diagnose erosion. The Basic Erosive Wear Examination (BEWE) is a simple method to fulfill this task. The determination of a variety of risk and protective factors (patient-dependent and nutrition-dependent factors) as well as their interplay are necessary to initiate preventive measures tailored to the individual. When tooth loss caused by erosive wear reaches a certain level, oral rehabilitation becomes necessary.

Oral manifestations in patients with gastro-oesophageal reflux disease: a single-center case-control study

OBJECTIVE

To assess the occurrence of oral pathological changes and symptoms in patients affected by gastro-oesophageal reflux disease (GERD).

PATIENTS AND METHODS

200 patients with GERD and 100 matched healthy controls were studied. Thorough visual examination of the dental and oral mucosal tissues was performed and medical history relevant to oral symptoms was collected. The primary outcome was defined as a statistically significant difference, between the study group and controls, in the presence of the following indicators: soft/hard palate and uvula erythema, tooth wear, xerostomia, oral acid/burning sensation, subjective halitosis and dental sensitivity. Statistical analysis included chi-squared test, and crude odds ratio with 95% CI.

RESULTS

Univariate analysis showed that xerostomia, oral acid/burning sensation, subjective halitosis, and soft and hard palate mucosa and uvula erythema were more common in patients with GERD than matched controls (P < 0.05).

CONCLUSIONS

This study failed to find any significant association between GERD and dental erosions, whereas some symptoms and other objective oral mucosal changes were found to be significantly associated with GERD.

Age and gender-related differences in premolar and molar functional areas

The aim of the present study was to underline the difference in premolar-molar functional areas according to both age and gender in a human adult population. Premolar and molar series were marked manually on opposed casts with articulating paper and functional areas were evaluated by quantification of these markings. It was noticed that on average larger functional areas were displayed by the older group (19 individuals, mean age 71.2 years, minimum 68 years, maximum 73 years) in comparison with the younger one (24 individuals, mean age 27.4 years, minimum 22 years; maximum 33 years). It was also observed that the average total functional area (4 hemiarches) was larger in the male subgroup (n: 23; mean age 45; young adults, 14; old adults, 9) compared with the female one (n: 20; mean age 49; young adults, 10; old adults, 10). Nevertheless, this gender difference in premolar-molar functional areas was related to the individual occlusal areas. As a matter of fact, when the individual occlusal area was taken into account for each series in the form of a ratio (functional area/occlusal area), the values obtained were not different between both gender subgroups studied. When comparing premolar and molar functional ratios (functional area/occlusal area) between age groups, it appears that the values obtained were slightly higher for the premolar series (ratios for young and older adults, respectively: Premolar series: 23.6+/-7.5%, 30+/-6.5%; Molar series: 23.1+/-6.8%, 27.3+/-6.7%). This difference was interpreted in relation to the reference (occlusal area) chosen.

Effect of acidic food and drinks on surface hardness of enamel, dentine, and tooth-coloured filling materials

OBJECTIVES

The purpose of this study was to determine the effect of acidic food and drinks (Cola soft drink, drinking yogurt, orange juice, sports drink, Tom-yum soup) on surface hardness of various substrates (enamel, dentine, universal composite, microfilled composite, conventional glass ionomer, resin-modified glass ionomer, polyacid-modified resin composite).

METHODS

Specimens (n = 10) were alternately immersed, 5 s each, in food or drinks and in artificial saliva for 10 cycles. Baseline and post-immersion Vickers hardness were compared using paired t-test. The difference in hardness between the groups was analysed with one-way ANOVA followed by a least significant different (LSD) test.

RESULTS

Cola soft drink significantly reduced surface hardness of enamel, dentine, microfilled composite, and resin modified glass ionomer (p < 0.05). Orange juice and sports drink significantly reduced surface hardness of enamel (p < 0.05). Drinking yogurt and Tom-yum soup did not reduce surface hardness of any substrate.

CONCLUSION

This in vitro study confirms the erosive potential of certain acidic food and drinks that public should be aware of.

Dental erosion in 12-year-old schoolchildren: a cross-sectional study in Southern Brazil

OBJECTIVE

The aim of this study was to assess the prevalence and severity of dental erosion among 12-year-old schoolchildren in Joaçaba, southern Brazil, and to compare prevalence between boys and girls, and between public and private school students.

METHODS

A cross-sectional study was carried out involving all of the municipality's 499, 12-year-old schoolchildren. The dental erosion index proposed by O'Sullivan was used for the four maxillary incisors. Data analysis included descriptive statistics, location, distribution, and extension of affected area and severity of dental erosion.

RESULTS

The prevalence of dental erosion was 13.0% (95% confidence interval = 9.0-17.0). There was no statistically significant difference in prevalence between boys and girls, but prevalence was higher in private schools (21.1%) than in public schools (9.7%) (P < 0.001). Labial surfaces were less often affected than palatal surfaces. Enamel loss was the most prevalent type of dental erosion (4.86 of 100 incisors). Sixty-three per cent of affected teeth showed more than a half of their surface affected.

CONCLUSION

The prevalence of dental erosion in 12-year-old schoolchildren living in a small city in southern Brazil appears to be lower than that seen in most of epidemiological studies carried out in different parts of the world. Further longitudinal studies should be conducted in Brazil in order to measure the incidence of dental erosion and its impact on children's quality of life.

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.

Erosion, caries and rampant caries in preschool children in Jeddah, Saudi Arabia

OBJECTIVES

The objective of this study was to determine the prevalence of dental erosion in preschool children in Jeddah, Saudi Arabia, and to relate this to caries and rampant caries in the same children.

METHODS

A sample of 987 children (2-5 years) was drawn from 17 kindergartens. Clinical examinations were carried out under standardised conditions by a trained and calibrated examiner (M.Al-M.). Measurement of erosion was confined to primary maxillary incisors and used a scoring system and criteria based on those used in the UK National Survey of Child Dental Health. Caries was diagnosed using BASCD criteria. Rampant caries was defined as caries affecting the smooth surfaces of two or more maxillary incisors.

RESULTS

Of the 987 children, 309 (31%) had evidence of erosion. For 186 children this was confined to enamel but for 123 it involved dentine and/or pulp. Caries were diagnosed in 720 (73%) of the children and rampant caries in 336 (34%). The mean dmft for the 987 children was 4.80 (+/-4.87). Of the 384 children who had caries but not rampant caries, 141 (37%) had erosion, a significantly higher proportion than the 72 (27%) out of 267 who were clinically caries free (SND=2.61, P<0.01). Of the 336 with rampant caries, 96 (29%) also had evidence of erosion.

CONCLUSIONS

The level of erosion was similar to that seen in children of an equivalent age in the UK. Caries was a risk factor for erosion in this group of children.

Advances in dental public health

Dental public health has been defined as 'the science and art of preventing oral diseases, promoting oral health and improving the quality of life through the organised efforts of society'. Dental practitioners most often have the oral health of individual patients as their primary focus but the aim of public health is to benefit populations. Early developments in dental public health were concerned largely with demonstrating levels of disease and with treatment services. With greater appreciation of the nature of oral health and disease, and of their determinants has come recognition of the need for wider public health action if the effects of prevention and oral health promotion are to be maximized.

A look at forensic dentistry--Part 1: The role of teeth in the determination of human identity

Forensic dentistry can be defined in many ways. One of the more elegant definitions is simply that forensic dentistry represents the overlap between the dental and the legal professions. This two-part series presents the field of forensic dentistry by outlining two of the major aspects of the profession: human identification and bite marks. This first paper examines the use of the human dentition and surrounding structures to enable the identification of found human remains. Conventional and novel techniques are presented.

Investigation of an index to measure tooth wear in primary teeth

Tooth wear, in particular erosion, has been reported to be widespread in children in the UK. Wear may affect either dentition, but epidemiological measurement has proved difficult.

OBJECTIVES

The objectives of this study were: (a) to investigate use of a simple index of wear in primary teeth; and (b) to compare findings from visual examination and from photographs with those at histological examination of the same teeth.

SAMPLE AND METHODS

Forty-one exfoliated or extracted primary anterior teeth were assessed visually and using photographs. Ground sections of the teeth were prepared and examined using polarised light microscopy.

RESULTS

On visual examination, 31 of the 41 teeth had evidence of wear. In 14 teeth, tissue loss was confined to enamel and in 17 it extended into dentine. Findings on photographs were very similar to those on visual examination. Of the 10 teeth without erosion visually, two had evidence of loss on histological examination. Of the 14 with visual evidence of erosion confined to enamel, dentine was exposed in 11 cases. Diffuse demineralisation was evident histologically in 11 of the 31 teeth with evidence of erosion.

CONCLUSIONS

It was concluded that clinical assessment of erosion may underestimate the extent of the condition. Under the conditions of the study, photographs gave results similar to those on visual examination.

Relative susceptibility of deciduous and permanent dental hard tissues to erosion by a low pH fruit drink in vitro

OBJECTIVES

The objectives of this study were two-fold: (1) to determine (by surfometry) loss of deciduous and permanent enamel and dentine following 15days' exposure to a single low pH orange drink; and (2) to determine (by surfometry) loss of deciduous and permanent enamel and dentine following exposure to the product 2 versus 4 times per day for 15days.

METHODS

This in vitro study employed the validated methodology described by West and co-workers [Journal of Dentistry, 1998;26:329-335.]

RESULTS

In all four tissues, erosion was progressive over time, though this pattern was more linear in enamel than in dentine. In general, erosion of enamel was greater in the deciduous tissue, while erosion of dentine was greater in the permanent tissue. However, these differences were rarely of statistical significance. Increasing frequency of exposure resulted in a non-proportional increase in tissue loss.

CONCLUSIONS

Differences in susceptibility of deciduous and permanent tissues to erosion by a low pH drink in vitro appear to exist, though these may not be of statistical significance. Care may be indicated in the delivery of dietary advice, since reduced frequency of exposure to a low pH drink does not appear to result in a proportional reduction in tissue loss.

Do we really want a quick fix?

Dental practitioners have been encouraged recently to take a more structured long term view of their continuing professional development, in particular being wary of any 'weekend' courses apparently offering 'quick fix' solutions to their clinical problems.

Dentine hypersensitivity — an enigma? a review of terminology, mechanisms, aetiology and management

Dentine hypersensitivity is a relatively common problem experienced in clinical dental practice. This condition may disturb the patient during eating, drinking, brushing and sometimes even breathing. Therapeutic intervention by desensitising agents may provide only partial pain relief and recurrence is common. Much remains unknown about dentine hypersensitivity, even the terminology can be questioned. Most of the literature over decades has been concerned with reporting clinical trials proving the efficacy of numerous treatments for dentine hypersensitivity. Indeed, besides haemorrhoids, there can be few other diseases or conditions known to man that can apparently be successfully treated by so many and extremely varied agents and formulations applied topically. This paper will discuss the epidemiology, mechanisms of pain production and aetiological factors for the condition in the hope of developing ideas for more realistic prevention and management strategies.