A multifactorial analysis of factors associated with dental erosion

Anamnestic risk factors for erosive tooth wear: Systematic review, mapping, and meta-analysis

OBJECTIVES

Erosive tooth wear is a multifactorial condition. The aim of this systematic review and meta-analysis was to identify key risk factors for erosive tooth wear in permanent dentition.

STUDY SELECTION

Observational studies reporting anamnestic risk factors for erosive tooth wear. Methodological quality and risk of bias were assessed using the modified Newcastle-Ottawa scale for cross-sectional studies. Risk factors were visually presented in a heatmap, and where possible, random-effects meta-analyses were performed for the odds ratios (ORs) of risk factors.

SOURCES

Electronic databases (MEDLINE, Embase, Scopus, and Web of Science) and manual searches in February 2023. The protocol was registered in PROSPERO (CRD4202339776).

DATA

A total of 87 publications reporting on 71 studies were included in the systematic review. The studies examined a variety of anamnestic risk factors (n = 80) that were categorized into ten domains (socio-demographics, socio-economics, general health, oral diseases, medication, oral hygiene, food, beverages, dietary habits, and leisure-related risk factors). Meta-analyses revealed significant associations between erosive tooth wear and male gender (padj.<0.001; OR=1.30, 95 % CI: 1.16-1.44), regurgitation (padj.=0.033; OR=2.27, 95 % CI: 1.41-3.65), digestive disorders (padj.<0.001; OR=1.81, 95 % CI: 1.48-2.21), consumption of acidic foods (padj.=0.033; OR=2.40, 95 % CI: 1.44-4.00), seasoning sauces (padj.=0.003; OR=1.28, 95 % CI: 1.13-1.44), nutritional supplements (padj.=0.019; OR=1.73, 95 % CI: 1.28-2.35), and carbonated drinks (padj.=0.019; OR=1.43, 95 % CI: 1.17-1.75). Most included studies exhibited low bias risk.

CONCLUSIONS

Observational studies investigated a variety of anamnestic risk factors for erosive tooth wear. Future studies should employ validated questionnaires, particularly considering the most important risk factors.

CLINICAL SIGNIFICANCE

Erosive tooth wear is a prevalent condition. Clinicians should concentrate primarily on symptoms of gastroesophageal reflux disease and dietary factors when screening patients at risk for erosive tooth wear.

The Effect of Oral Care Foams and a Spray on Salivary pH Changes after Exposure to Acidic Beverages in Young Adults

Soft drinks may have a deleterious effect on dental health due to a high titratable acidity and a low pH that could be sufficient to induce tooth demineralization. The use of oral care products immediately after acidic challenge may diminish the erosive potential of soft drinks. We assessed the effect of oral care foams and a spray on salivary pH changes after exposure to Coca-Cola® in young adults. Thirty-three consenting eligible patients were recruited in this double-blind, randomized, crossover study performed in six visits. Baseline examination included unstimulated salivary flow rate, stimulated salivary buffer capacity, and the simplified oral hygiene index (OHI-S) assessment. Salivary pH and time for pH recovery were registered after exposure to Coca-Cola® alone or that followed by the application of each of the studied products (an oral foam containing hydroxyapatite and probiotics, an oral foam containing amino fluoride, an alkaline oral spray, and tap water). Thirty-two patients completed the entire study protocol and were included in the final analysis. The mean minimum salivary pH and the mean oral clearance rate after rinsing with Coca-Cola® were 6.3 and 27 min, respectively. Further rinsing with any one of the tested solutions, including tap water, resulted in a significant improvement in these parameters. When the pH curves were plotted, the oral care products demonstrated a lower area under the curve that differed significantly from the area under the curve for Coca-Cola®; tap water did not differ significantly from Coca-Cola® and oral care products. Minimum salivary pH correlated positively with salivary buffer capacity and salivation rate, while salivary clearance correlated with OHI-S plaque scores. In conclusion, the effect of oral care foams and a spray on minimum salivary pH and salivary clearance after exposure to Coca-Cola® did not differ significantly among the tested products and tap water. Trial registration NCT06148662. Funding: none.

In Vitro Risk Assessment of Dental Acid Erosion Caused by Long-Term Exposure to Oral Liquid Bandages

Oral mucosa inflammation can cause severe pain and interfere with eating, reducing quality of life. However, few options for self-care are available. An oral liquid bandage forms a protective film over the affected area. We aimed to assess the acid erosion risk when a newly developed oral liquid bandage (ORAPLA) is accidentally deposited on teeth and to examine the relative acid erosion risk at multiple time points of the maximum recommended duration of continuous use. ORAPLA was applied to both enamel and dentin blocks from 45 bovine anterior mandibular teeth, and an acid challenge was performed in a simulated oral cavity with artificial saliva, with one exposure cycle lasting 6 h. The enamel showed substantial defects and a decrease in Vickers hardness after nine cycles, with no change in surface roughness. Dentin showed an increase in parenchymal defects and surface roughness and a trend toward decreased Vickers hardness with increasing exposure time. We found no significant acid corrosion in enamel after up to nine times the upper limit of normal use time or in dentin after up to six times the upper limit. We conclude that the acid erosion risk due to accidental attachment to teeth is low, and in the human oral cavity with salivary buffering and remineralization, likely even lower.

Different Methods of Scan Alignment in Erosive Tooth Wear Measurements: An In Vitro Study

BACKGROUND

Model alignment in cases of erosive tooth wear can be challenging, and no method has been reported to outweigh the others.

METHODS

Extracted human teeth were mounted on two models and scanned at different times, from 1 h to 2 weeks, with an intraoral scanner (3Shape TRIOS 4) before and after immersion in Monster® energy drink and tap water. The scans were superimposed (3Shape TRIOS Patient Monitoring, Version 2.2.3.3, 3Shape A/S, Copengagen, Denmark). Best fit, best-fit tooth comparison, reference best fit using fillings, and palatal rugae as reference points were used for alignment. Surface profile differences were calculated in a cross-section view. The nonparametric Bland-Altman and Kruskal-Wallis tests were used.

RESULTS

First, statistically significant differences were marked after 4 days of immersion. The measurements obtained after 2 weeks of immersion were statistically significantly different from the measurements obtained at the different time points until 1 week. No statistically significant differences (p < 0.05) were observed among the alignment methods at any time.

CONCLUSION

In comparison to the best-fit model, both palatal rugae and fillings can be used. The best-fit tooth comparison method is a reliable option; however, it should be used with caution in cases of major surface loss.

Association of salivary parameters and erosive tooth wear in preschool children

The aims of this study were to 1) assess the association between erosive tooth wear (ETW) according to the BEWE (Basic Erosive Wear Examination) scoring system and salivary parameters and 2) compare salivary parameters according to ETW severity in the subgroup of children with ETW. This cross-sectional study included 52 preschool children aged 5 years paired by sex. A calibrated examiner assessed ETW using BEWE criteria, and stimulated saliva was collected to determine salivary flow, osmolality, pH, and buffering capacity. The children were divided into two groups: without ETW (n=26; BEWE score 0) and with ETW (n=26; BEWE scores 1 and 2). Logistic regression analysis was used to determine the magnitude of the association between ETW and salivary parameters and estimates of odds ratios (OR). In the unadjusted analysis, the ETW group was more likely to have lower salivary flow (OR = 0.079; 95%CI = 0.013-0.469; p = 0.005) and lower osmolality (OR = 0.993; 95%CI = 0.985-1.000; p = 0.049). In the adjusted analysis, salivary flow remained significantly associated with ETW (OR = 0.087; 95%CI = 0.014-0.533; p = 0.008). Lower salivary osmolality values were observed in ETW, especially in preschool children with more severe ETW (BEWE score 2). Receiver operating characteristic (ROC) determined a salivary osmolality cutoff point of < 201 for the presence of ETW. In conclusion, salivary flow rate was significantly associated with ETW prevalence. Lower values of salivary osmolality were observed in preschool children with distinct erosive lesions with significant loss of tooth structure (BEWE 2).

Risk factors of tooth wear in permanent dentition: A scoping review

BACKGROUND

Tooth wear (TW) prevalence is high and increasing and has important consequences on the patient's quality of life. Knowledge of risk factors is crucial to promote diagnosis, prevention strategies and timely interceptive treatment. Many studies have identified TW risk factors.

OBJECTIVE

This scoping review aims to map and describe suspected available factors associated with TW in permanent dentition based on quantitative measurement.

METHODS

The scoping review was conducted using the PRISMA extension of the Scoping Reviews checklist. The search was conducted in October 2022 from the Medline® (PubMed® interface) and Scopus® databases. Two independent reviewers selected and characterised the studies.

RESULTS

2702 articles were identified for assessment of titles and abstracts, and 273 articles were included in the review. The results show a need to standardise TW measurement indices and the study design. The included studies highlighted various factors, classified into nine domains: sociodemographic factors, medical history, drinking habits, eating habits, oral hygiene habits, dental factors, bruxism and temporomandibular disorders, behavioural factors, and stress. Results related to chemical TW (erosion) risk factors underline the importance of eating disorders, gastroesophageal reflux and lifestyle, particularly drinking and eating behaviours, which supports developing public health information campaigns and interventions. Besides chemical, this review identifies evidence of several mechanical TW risk factors, such as toothbrushing and bruxism; the influence of this last factor needs to be further explored.

CONCLUSIONS

TW management and prevention require a multidisciplinary approach. Dentists are in the first line to detect associated diseases such as reflux or eating disorders. Consequently, practitioners' information and guideline diffusion should be promoted, and a TW risk factors checklist (the ToWeR checklist) is proposed to help diagnostic approaches.

Drugs Prescribed for Asthma and Their Adverse Effects on Dental Health

Asthma is a chronic, heterogeneous respiratory pathology characterized by reversible airway inflammation. Therapeutics focus on symptom reduction and control, aimed at preserving normal pulmonary function and inducing bronchodilatation. The objective of this review is to describe the adverse effects produced by anti-asthmatic drugs on dental health, according to the reported scientific evidence. A bibliographic review was carried out on databases, such as Web of science, Scopus, and ScienceDirect. Most anti-asthmatic medications are administered using inhalers or nebulizers, making it impossible to avoid contact of the drug with hard dental tissues and oral mucosa, and thus promoting a greater risk of oral alterations, mainly due to decreases in the salivary flow and pH. Such changes can cause diseases, such as dental caries, dental erosion, tooth loss, periodontal disease, bone resorption, as well as fungal infections, such as oral candidiasis.

Development of a sodium fluoride and stannous chloride-containing gel for treatment of dental erosion

This study synthesized and tested experimental gels containing fluoride (F-) and stannous (Sn2+) ions for the control of dental erosion. Enamel and dentin polished specimens were eroded (1% citric acid solution, 10 min) and randomly allocated into 5 groups (n=10): Placebo - Hydroxypropyl Methylcellulose (HMC) gel; F+Sn+HMC - 7,500 ppm F- / 15,000 ppm Sn2+; F+HMC - 7,500 ppm F-; Commercial acidulated phosphate fluoride gel (12,300 ppm F-); and Control - no treatment. After treatment (applied for 60 s), specimens underwent an erosion-remineralization cycling (5 min in 0.3% citric acid solution, 60 min in artificial saliva, 4×/day, 20 days). Surface loss (SL, in µm) was determined after the 5th, 10th and 20th days of cycling (α=0.05). For enamel, after 5 and 10 days, F+Sn+HMC presented the lowest SL, which did not differ from the commercial gel. After 20 days, no differences were found between commercial, F+HMC, and F+Sn+HMC groups. Placebo did not differ from the control at any time points, and both groups presented the highest SL when compared to the other groups. For dentin, on the 5th day, F+Sn+HMC, F+HMC and commercial did not differ significantly, showing lower SL than the control and the placebo. On the 10th day, F+Sn+HMC and commercial presented the lowest SL compared to control and placebo. After 20 days, only the commercial gel showed lower SL than the control and placebo. Thus, the experimental F+Sn+HMC gel was able to control the progression of tooth erosion.

Risk factors for and prevention of caries and dental erosion in children and adolescents with asthma

There are many studies and reviews of the relationship between the asthma disease in young individuals on the one hand and caries and dental erosion on the other. The causes of caries and dental erosion might be related to the asthmatic drugs, low pH and the sweeteners that the inhaled drug contains and perhaps even the lifestyle of children and adolescents with asthma. The main focus of this review is therefore to describe various preventive strategies, based on long experience of preventive dental care in Sweden. Two fact boxes are presented, one on fluoride toothpaste as a population-based intervention for different ages and one on diet counselling in children and adolescents with asthma. The most important thing is to introduce fluoride toothpaste early in the child's life and that the parents brush the child's teeth twice a day, in the morning after breakfast and at night before bedtime, up to the age of 10. Moreover, a high-risk approach with an additional fluoride supply at home is presented, together with the application of fluoride varnish at the clinic. Regarding diet counselling, it is important to make sure that the child has regular meals during the day, maximum five to six times a day, to allow the teeth to rest between meals and restrict sweets and soft drinks to once a week. It is important to identify children and adolescents with asthma as early as possible and to refer them to a dental team for preventive treatment.

Oral health assessment in children aging 8–15 years with bronchial asthma using inhalation medication

Objectives:

Materials and Methods:

Results:

Conclusion:

A systematic review of dietary acids and habits on dental erosion in adolescents

BACKGROUND

Dental erosion is the dissolution of dental hard tissues caused by acids of a non-bacterial origin. Dietary acids are considered the predominant and most controllable factor.

AIM

To synthesise the literature on the effects of dietary acids and habits on dental erosion in the permanent dentition of 10- to 19-year-old adolescents.

MATERIALS AND METHODS

An electronic literature search was undertaken in Cochrane, MEDLINE, CINAHL, Dentistry & Oral Sciences Source via EBSCOhost, and Embase with no restriction on the date of publication.

RESULTS

The initial search identified 449 articles, and 338 remained after removal of duplicates. Seventy-seven articles remained after screening of titles and abstracts, and 52 were eligible for the full-text review. A considerable variety of beverages, food, and dietary habits were reported as risk factors for dental erosion. The most consistent findings implicated the erosive potential of carbonated beverages and the consumption of acidic drinks at bedtime.

CONCLUSIONS

Although results were not consistent between cohort and cross-sectional studies, this review suggests certain dietary risk factors may contribute to dental erosion in adolescents. There is a need for more high-quality cohort studies to establish more conclusive evidence on the role of dietary acids and habits on dental erosion.

Prevalence of sensitive teeth and associated factors: a multicentre, cross-sectional questionnaire survey in France

BACKGROUND

As far as we know, little data, whether obtained from self-administered questionnaires or upon dental clinical examination, has been published on the prevalence of sensitive teeth (ST) in the French adult population. The objectives of the present work were to estimate ST prevalence and characteristics in the general population of France and to explore the associated factors.

METHOD

A multicentre cross-sectional study was conducted between November 2011 and March 2013 in six French cities. Adult passers-by in public places were invited to answer an electronic questionnaire on a tablet computer. Only people who declared having at least one natural tooth were included in the study. A logistic regression model was used for the multivariate analysis.

RESULTS

The prevalence of ST during the previous 12 months reported by the sample of 2413 participants was 42.2% [95% CI: 40.2-44.1%]. The final logistic regression model showed significant statistical associations between ST and female gender, use of tobacco, consumption of soft drinks, limited access to oral care and poor oral hygiene habits (p < 0.05).

CONCLUSIONS

This study provides prevalence data on ST in a general population in France, which seems to remain high despite the existence of many therapies. It should alert professionals to a clinical manifestation that is becoming increasingly prevalent and that they will have to take into consideration to help reduce the discomfort arising from it.

[Dental erosion in a sample of Valencian children. Prevalence and evaluation of eating habits]

Introduction

Introduction: dental erosion is the pathological, chronic, localized and painless loss of dental tissues, produced by the chemical action of acids, where the action of microorganisms is not involved. In recent years, a significant increase in the prevalence of this pathology has been observed, especially in children and adolescents. Objectives: to determine the prevalence of dental erosion in temporary dentition using the Basic Erosive Wear Examination Index (BEWE) in children between 5 and 12 years of age, and to determine the eating habits that may favor the development of these lesions. Methods: a cross-sectional study was carried out on a sample of 391 children. A survey was conducted where eating habits were analyzed and a clinical examination of the temporary teeth was performed using the BEWE index. Results: the prevalence of dental erosion in the studied sample was 19.7 %, with mild lesions being most common. Conclusions: in all, 30.62 % of the studied population had a low risk of dental erosion, and risk was seen to increase with consumption of acidic beverages (soft drinks, isotonic drinks and fruit juices) and acidic fruits such as oranges, grapes and apples.

100% Fruit Juice and Dental Health: A Systematic Review of the Literature

Background: The objective of this systematic review was to assess the scope and breadth of publicly available prospective cohort and randomized controlled trial (RCT) literature on 100% fruit juice and dental caries or tooth erosion in humans.

Methods: We performed a systematic search in MEDLINE/PubMed, EMBASE, and Web of Science for studies published from inception through May 2018, and the Cochrane Library databases for reports published through January 2018. Prospective cohort studies or RCTs conducted on dental health and 100% fruit juice, and published in English were selected. No restrictions were set for age, sex, geographic location, or socioeconomic status.

Results: Eight publications representing five independent prospective cohort studies and nine publications on nine RCTs were included. All prospective cohort studies were in children or adolescents, and all RCTs were in adults. Prospective cohort studies on tooth erosion found no association between juice intake and tooth erosion, while those on dental caries incidence reported either no association or an inverse association between 100% fruit juice intakes and dental caries incidence. RCTs on tooth erosion showed decreased microhardness, increased surface enamel loss, increased erosion depth, greater enamel softening, and/or increased pellicle layer with 100% fruit juice, and those on dental caries showed increased demineralization of enamel slabs with 100% fruit juice.

Conclusions: The existing evidence on 100% fruit juice intake and caries and tooth erosion are not conclusive. Overall, prospective cohort studies in children and adolescents found no association between 100% fruit juice intake and tooth erosion or dental caries, but, RCT data in adults suggests that 100% fruit juice could contribute to tooth erosion and dental caries. The RCT data, however, were from small, short-term studies that utilized intra-oral devices generally devoid of normal plaque or saliva action, and generally employed conditions that are not reflective of normal juice consumption.

Erosive wear of the primary dentition: who is aware of it?

AIM

To determine the influence of erosive tooth wear in the primary dentition on parental perceptions of oral health.

METHODS

This cross-sectional study involved a standardised clinical examination of 775 preschool aged children and a parent-administered questionnaire. Erosive tooth wear was measured using the Basic Erosive Wear Examination Index.

RESULTS

71% and 81% of 3 (n = 256) and 5 year-old children (n = 337) respectively exhibited signs of erosive tooth wear. Prevalence was influenced by region (p = 0.049) (p = 0.007) in both age cohorts (χ², p < 0.05) respectively and by parental level of education (p = 0.012) in the 5-year-old cohort. Parental perception of oral health was significantly associated (χ², p < 0.05) with parental level of education in the 5-year-old cohort and with the presence of dental caries, reports of pain and dental appearance of the child in both age cohorts. Parental perceptions were unaffected by the degree of erosive tooth wear their child exhibited (p = 0.0564), (p = 0.739) in both age cohorts respectively.

CONCLUSIONS

Erosive dental tooth wear is increasingly observed in the primary dentition however is not perceived as an oral health issue by parents. Its diagnosis and management therefore, fall heavily within the remit of the dental practitioner.

Erosive tooth wear: Knowledge among young adults and their preferred information sources

OBJECTIVES

The aim of this study was to learn more about levels of knowledge relating to erosive tooth wear and about the most desirable way of disseminating dental information among young adults.

METHODS

The research was a cross-sectional study of 331 young adults (20-25 years old) attending 25 dental care practices. Participants were asked to fill out a questionnaire with questions about their background, knowledge relating to erosive tooth wear and the preferred way of acquiring information about erosive tooth wear.

RESULTS

The results showed that there are gaps in the knowledge of young adults about erosive tooth wear. The knowledge score depended on educational level and dental information received in the past. The preferred way of acquiring information was chairside information from an oral health care professional complemented by tailored information in writing.

CONCLUSION

There is a lack of knowledge among young adults about erosive tooth wear. They prefer to receive information from the oral health care professionals accompanied by tailored information in writing. Further research should focus on developing this tailored information in line with the advice given by the oral health care professional.

Assessing Preschoolers' Beverage Consumption Using the Theory of Planned Behavior

Childhood obesity and caries are linked to sugar-sweetened beverage (SSB) and excessive juice consumption. We assessed psychosocial factors influencing children's beverage consumption and strategies to promote healthier choices. Using a quantitative and qualitative approach guided by the theory of planned behavior, we surveyed and interviewed 37 parents of preschool-aged children on barriers and facilitators of children's beverage consumption. Most children (83.8%) consumed SSBs, 67.6% drank >4 to 6 oz of juice per day. Parent's self-efficacy was the strongest correlate of parent's behavioral intention to limit SSB (0.72, standard error 0.08, P = .03). Parents' motivations to limit their child's SSB intake extended beyond simply preventing caries and obesity; they also considered the implications of these conditions on children's self-image, future health, and quality of life. Yet, the influence of multidimensional barriers made it difficult to reduce children's SSB consumption. Interventions that address parental attitudes, values, and self-efficacy to address external factors could help reduce children's SSB consumption.

Gastro-oesophageal reflux - an important causative factor of severe tooth wear in Prader-Willi syndrome?

BACKGROUND

Prader-Willi syndrome (PWS) is the most common genetic human obesity syndrome and is characterized by hypotonia, endocrine disturbances, hyperphagia, obesity and mild mental retardation. Oral abnormalities, such as decreased salivary flow rates and extreme tooth wear, have also been described. Studies have shown a significant increase in reflux symptoms in individuals with obstuctive sleep apnoea syndrome and increased BMI, both of which are typical findings in PWS. Gastro-oesophageal reflux disease (GORD) has been identified in some individuals with PWS and is a significant intrinsic factor in dental tooth wear. The aim of this study was therefore to estimate the prevalence of GORD in adults and children and to evaluate a possible correlation between GORD and tooth wear in adults with PWS. They were all registered at the TAKO-centre.

RESULTS

Twenty-nine individuals, 17 adults with a mean age of 32.6 years (range 18-48) and 12 children with a mean age of 8.8 years (range 3-17), agreed to undergo 24-hour oesophageal pH monitoring, and 90% of those enrolled managed to complete the examination. Four children and eleven adults were diagnosed with pathological gastro-oesophageal reflux, which is defined as acid exposure (pH less than 4) more than 3.6 or 4.3 percent of the time, respectively. Manometry performed in the adult group showed a pathologically high lower oesophageal sphincter pressure in four of the five individuals who had normal oesophageal pH values (pH under 4 less than 4.3% of the time). The two groups (reflux and non-reflux) were well balanced according to BMI, genotype, tooth grinding and hyposalivation. However, twice as many individuals in the reflux group as in the non-reflux group reported high consumption of acidic foods and drinks. Increased tooth wear was significantly correlated with GORD in the two groups (reflux n=6 and non-reflux n=6).

CONCLUSIONS

The prevalence of gastro-oesophageal reflux is high in individuals with PWS. Tooth wear was strongly associated with GORD and acidic drinks, and both may be important aetiological factors underlying the extreme tooth wear in this group. Our data suggest a need for routine screening for GORD and dental wear in young individuals with Prader-Willi syndrome.

Dental erosion, prevalence and risk factors among a group of adolescents in Stockholm County

Aims

To investigate the prevalence and risk factors of dental erosion (DE) among a group of adolescents in Stockholm County.

Materials and methods

This cross sectional cohort study was conducted at three clinics of the Public Dental Service in Stockholm County. Fifteen and 17 year old adolescents (1335) who scheduled their regular dental health examination were asked to participate. After drop-outs a sample of 1071 individuals, 547 males and 524 females were enrolled in the study. Presence of erosive wear was diagnosed (yes/no) on marker teeth by trained dentists/dental hygienists and photographs were taken. The adolescents answered a questionnaire regarding oral symptoms, dietary and behavioural factors. Two calibrated specialist dentists performed evaluation of the photographs for severity of DE using a modified version of the Simplified Erosion Partial Recording System (SEPRS).

Results

DE was clinically diagnosed in 28.3% of 15 years old and 34.3% of 17 years old. Severe erosive wear (grade 3 and 4 according to SEPRS) was found in 18.3% of the adolescents based upon the intra-oral photographs. DE was more prevalent and severe among males than females. Clinically diagnosed erosive lesions correlated significantly with soft drink consumption (p < 0.001), the use of juice or sport drinks as a thirst quencher after exercise (p = 0.006) and tooth hypersensitivity when eating and drinking (p = 0.012). Furthermore, self-assessed gastric reflux was a factor strongly associated with DE (p < 0.001).

Conclusion

The study indicated that DE was common among adolescents in Stockholm County and associated with both internal and external risk factors.

The Influence of Behavioural and Sociodemographic Risk Indicators on Erosive Tooth Wear in Flemish Adolescents, Belgium

Although Belgium has recently been ranked as the second highest consumer of soft drinks in Europe, no data on erosive tooth wear (ETW) are currently available. Therefore, the aim of this cross-sectional study was to determine the prevalence and associated risk indicators of ETW in adolescents residing in the region of Flanders, Belgium. Convenience sampling was used to recruit participants from different types of Belgian schools: general and vocational/technical education. Three calibrated dentists performed the dental examinations and a self-reported questionnaire was applied to evaluate risk indicators related with ETW. ETW was classified using the Basic Erosive Wear Examination (BEWE) index, and the overall prevalence was calculated using BEWE sum >0. The Kruskal-Wallis test, the Mann-Whitney U test, and logistic regression analysis were performed to evaluate frequencies and risk associations. From a total of 613 recruited adolescents (mean age: 15.1 years, SD: 0.8), 48.6% presented at least one affected tooth surface by ETW (BEWE sum >0), 14.4% (n = 88) scored BEWE sum >2, and the highest score obtained was BEWE sum = 8. Two predictive variables were found to have an association with ETW: vocational/technical type of education (OR: 1.49; 95% CI: 1.03-2.13) and frequent consumption of soft drinks (OR: 2.08; 95% CI: 1.38-3.14). In conclusion, ETW is a common condition presented with low severity among Flemish adolescents. Additionally, the frequent consumption of soft drinks and being part of a vocational/technical education appear to be risk indicators for ETW in this population. The latter indicates the need for specific orientated oral health promotion programmes for the prevention of ETW in Flemish adolescents.

Dentinal tubules occluded by bioactive glass-containing toothpaste exhibit high resistance toward acidic soft drink challenge

BACKGROUND

Dentine hypersensitivity is a common problem attributed by patent dentinal tubules. Ingredients incorporated in toothpastes aim to occlude patent dentinal tubules to minimize the dentine hypersensitivity. However, frequent consumption of acidic soft drinks may reverse the dentinal tubules' occlusion. In this in vitro study, the efficacy of dentinal tubules occluded by commercially available toothpastes to withstand different durations of an acidic soft drink challenge was investigated.

METHODS

One hundred and twenty dentine discs were divided into three groups. The discs from each group were brushed with toothpaste containing bioactive glass, arginine and control toothpaste. Each group was then divided into four subgroups and exposed to acidic soft drink over four different time durations.

RESULTS

The scoring and the percentage of occluded dentinal tubules by Novamin-containing toothpaste was significantly better compared with arginine or the control toothpaste. Acidic soft drink challenge reduced the extent of dentinal tubules occlusion along with time. Dentinal tubules occluded by Novamin-containing toothpaste withstand the acidic challenge comparatively for a longer period.

CONCLUSIONS

The findings demonstrated that occlusion of dentinal tubules is more efficient by the bioactive glass-containing toothpaste and thus may contribute to its better resistance to acidic soft drink challenge.

Content analysis of nutritional information in paediatric oral health education leaflets

BACKGROUND

The aim of this study was to determine if paediatric oral health education leaflets with a food and nutritional focus provide messages that are clear and consistent with the current Australian Dietary Guidelines and the Infant Feeding Guidelines.

METHODS

Forty-three leaflets aimed at parents were sourced from Australian state and territory Health Departments, oral health industry partners and commercial organisations, and a content analysis was performed. Recommendations on food and drink type, consumption frequency and general diet and nutrition advice were considered and cross-referenced with the Australian Dietary Guidelines and the Infant Feeding Guidelines to identify areas of consistency and discrepancy.

RESULTS

Twenty leaflets recommended reducing the consumption of sugary and/or acidic food, while 23 leaflets recommended reducing the consumption of sugary and/or acidic drinks. The majority of the leaflets advised water (n = 35) and milk (n = 23) to drink. Although 33 leaflets encouraged a healthy diet, seven of these did not specify what a healthy diet was. Twenty-eight leaflets provided early childhood-related (0-2 years) feeding advice. Confusing messages were found in nine leaflets, with ambiguous recommendations that were open to individual interpretation.

CONCLUSIONS

There were some inconsistencies between the leaflets and the dietary and infant feeding guidelines in Australia; and across the leaflets, as not all important messages were included in any one leaflet. Government Health Departments and other relevant agencies should ensure that advisory messages regarding diet, particularly those with dental implications, are clear, complete and consistent across all dental educational leaflets.

The availability of novelty sweets within high school localities

Highlights the growth in the novelty sweets market.

These sweets are acidic and sweet and therefore can lead to both dental caries and dental erosion.

The high sugar content may also contribute to overnutrition and overweight or obesity.

The design of these sweets, in resealable containers, encourages repeated consumption which is detrimental to oral health.

Background Reducing sugar consumption is a primary focus of current global public health policy. Achieving 5% of total energy from free sugars will be difficult acknowledging the concentration of free sugars in sugar sweetened beverages, confectionery and as hidden sugars in many savoury items. The expansion of the novelty sweet market in the UK has significant implications for children and young adults as they contribute to dental caries, dental erosion and obesity.

Objective To identify the most available types of novelty sweets within the high school fringe in Cardiff, UK and to assess their price range and where and how they were displayed in shops.

Subjects and methods Shops within a ten minute walking distance around five purposively selected high schools in the Cardiff aea representing different levels of deprivation were visited. Shops in Cardiff city centre and three supermarkets were also visited to identify the most commonly available novelty sweets.

Results The ten most popular novelty sweets identified in these scoping visits were (in descending order): Brain Licker, Push Pop, Juicy Drop, Lickedy Lips, Big Baby Pop, Vimto candy spray, Toxic Waste, Tango candy spray, Brain Blasterz Bitz and Mega Mouth candy spray. Novelty sweets were located on low shelves which were accessible to all age-groups in 73% (14 out of 19) of the shops. Novelty sweets were displayed in the checkout area in 37% (seven out of 19) shops. The price of the top ten novelty sweets ranged from 39p to £1.

Conclusion A wide range of acidic and sugary novelty sweets were easily accessible and priced within pocket money range. Those personnel involved in delivering dental and wider health education or health promotion need to be aware of recent developments in children's confectionery. The potential effects of these novelty sweets on both general and dental health require further investigation.

Ready-to-drink non-alcoholic beverages

Purpose

The appearance of a rapidly expanding range of ready-to-drink packaged beverages in the marketplace has been met with widespread consumer acceptance. The aim of this study is to profile the nutritional composition and dental erosive potential of a sample of beverages sold for consumption in Brisbane supermarkets.

Design/methodology/approach

In all, 44 beverages were assessed to determine their pH and titratable acidity. Information relating to nutritional composition was also collected.

Findings

Milk-based beverages had the highest energy concentration, while soft drinks, energy drinks, flavoured milk, and fruit and vegetable juice categories contained products with very high sugar concentrations (>10g/100ml). All beverages, except milk-based products and still water, had a pH of less than 4.8. Titratable acidity was highest for energy drinks and fruit and vegetable juices.

Research limitations/implications

Energy drinks and fruit and vegetable juices had the highest sugar content and titratable acidity of all the beverage categories and so would be expected to have the greatest potential to cause oral health problems. Milk drinks had the highest energy concentration, but the lowest erosive potential. Regular consumption of many ready-to-drink pre-packaged beverages is therefore inconsistent with recommendations in current dietary and oral health guidelines.

Originality/value

Rather than considering nutritional composition alone, this study examined both nutritional and physicochemical properties of ready-to-drink packaged beverages to reach a more holistic assessment of their health impact.

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.

Analyses of the Erosive Effect of Dietary Substances and Medications on Deciduous Teeth

This study aimed at analysing the erosive potential of 30 substances (drinks, candies, and medicaments) on deciduous enamel, and analyse the associated chemical factors with enamel dissolution. We analysed the initial pH, titratable acidity (TA) to pH 5.5, calcium (Ca), inorganic phosphate (P_i), and fluoride (F) concentration, and degree of saturation ((pK -pI)_HAP, (pK -pI)_FAP, and (pK−pI)_CaF2) of all substances. Then, we randomly distributed 300 specimens of human deciduous enamel into 30 groups (n = 10 for each of the substances tested. We also prepared 20 specimens of permanent enamel for the sake of comparison between the two types of teeth, and we tested them in mineral water and Coca-Cola^®. In all specimens, we measured surface hardness (VHN: Vickers hardness numbers) and surface reflection intensity (SRI) at baseline (SH_baseline and SRI_baseline), after a total of 2 min (SH_2min) and after 4 min (SH_4min and SRI_4min) erosive challenges (60 ml of substance for 6 enamel samples; 30°C, under constant agitation at 95 rpm). There was no significant difference in SH_baseline between deciduous and permanent enamel. Comparing both teeth, we observed that after the first erosive challenge with Coca-Cola^®, a significantly greater hardness loss was seen in deciduous (−90.2±11.3 VHN) than in permanent enamel (−44.3±12.2 VHN; p = 0.007), but no differences between the two types of teeth were observed after two challenges (SH_4min). After both erosive challenges, all substances except for mineral water caused a significant loss in relative surface reflectivity intensity, and most substances caused a significant loss in surface hardness. Multiple regression analyses showed that pH, TA and Ca concentration play a significant role in initial erosion of deciduous enamel. We conclude that drinks, foodstuffs and medications commonly consumed by children can cause erosion of deciduous teeth and erosion is mainly associated with pH, titratable acidity and calcium concentration in the solution.

Supplementation of an orange juice with dietary proteins to prevent enamel and dentin erosion

Protein supplementation may be an alternative to reduce the erosive potential of acidic drinks. The aim of this in vitro study was to evaluate the erosive potential of an orange juice modified by dietary proteins. A commercially available orange juice was added 0.2 g/L casein, 2.0 g/L ovalbumin and their combination. The juice with no additives and a commercially available calcium-modified juice were used as negative and positive controls, respectively. Human enamel and dentin specimens (n=11) were tested in an erosion-remineralization cycling model. Enamel was analyzed by surface microhardness and profilometry, whilst dentin by profilometry only. Statistical analyses were performed using one-way ANOVA followed by Tukey's test (p<0.05). Calcium-modified juice showed the lowest erosive potential for both analyses (p<0.05). For enamel, the protein-added groups did not differ from each other (p>0.05) and showed significantly lower enamel loss compared to negative control (p<0.05). Regarding surface microhardness, casein showed the highest values compared to negative control (p<0.05). For dentin, none of the protein-added groups showed lower values of surface loss compared to negative control (p>0.05). In conclusion, for enamel the protein-modified orange juices presented reduced erosion of enamel, with casein showing a trend for better protection. For dentin, no reduction in the erosive potential was observed for the tested protein-modified orange juices.

Association of erosion with timing of detection and selected risk factors in primary dentition: a longitudinal study

OBJECTIVE

The aims of this study were to determine the prevalence of erosion in a birth cohort at 24, 36, and 48 months and to investigate risk factors for erosion.

METHODS

One hundred and fifty-four children from a birth cohort were followed at 24, 36, and 48 months of age.

RESULTS

Of the 154 children examined, 0% (0/154), 7% (11/154), and 28% (40/154) had erosion detected for the first time at 24, 36, and 48 months, respectively (P < 0.001). A cumulative total of 51 (33%) children and 256 (8%) teeth had erosion by the age of 48 months. There were no significant associations between erosive lesions first detected at 36 months and oral hygiene behaviour, medical conditions, or dietary habits reported at the 24- or 36-month examinations (all P > 0.05). In contrast, erosive lesion first detected at 48 months was positively associated with the use of a feeding bottle reported at the 36-month examination (P = 0.026).

CONCLUSIONS

The prevalence of dental erosion in young children increased with age, with clinically detectable lesions forming between 24 and 36 months of age. Erosive lesions first detected at 48 months were positively associated with the use of a feeding bottle reported at 36 months.

The relationship between consumption of beverages and tooth wear among adults in the United States

OBJECTIVES

To investigate the prevalence and severity of tooth wear (TW) and its relationship with consumption of beverages among adults in the United States.

METHODS

The National Health and Nutrition Examinations Survey data for 2003-2004 was analyzed. TW was defined as "wear on at least one surface of at least one examined tooth." Drink/juice consumption was ascertained via a Food Frequency Questionnaire processed with Diet*Calc software to obtain the average daily consumption frequency for all queried drinks and juice categories including milk. Survey-weighted descriptive and multivariable analyses with interaction terms were performed.

RESULTS

Our study sample consisted of 3,773 adults (aged 20 and above). Eighty percent of the subjects had evidence of TW, and soft drinks were the most consumed beverage. Significant interactions between the effects of age, gender, and race/ethnicity on TW were found (P < 0.001). After adjustment for demographic factors, consumption of fruit drinks was found to be significantly associated with the severity [odds ratio (OR) = 1.32 and 1.42], but not prevalence of TW. However, this trend was reversed for grape juice consumption (OR = 0.34, 0.41).

CONCLUSIONS

This study demonstrates that a substantial proportion of adults had evidence of TW, which was affected by demographic factors in a complex way. Fruit drinks consumption in adults was associated with the severity of TW, but not with the prevalence of TW after adjusting for demographics. These findings are important for the development of appropriate treatment guidelines, public policy, and programs aimed at reducing TW in adults.

Sour sweets and acidic beverage consumption are risk indicators for dental erosion

This study aimed to investigate the association between dental erosive wear and potential background, behavioural and dietary risk indicators and to assess whether there is a dose-response relationship between the level of acidic beverage consumption and dental erosive wear among adolescents. Of 846 adolescents (aged 16-18 years) scheduled for dental recall examinations, 795 (94%) accepted to participate. All participants completed a self-administered questionnaire regarding their background (gender and age), tooth-brushing frequency and dietary habits (the amount and frequency of acidic food and beverage consumption as well as the chosen method and manner of consuming acidic drinks). The association between the presence of erosive lesions and the possible risk indicators was assessed by logistic regression analyses. Of all participants examined, 37% had ≥3 surfaces with dental erosions and were considered to be affected individuals. In the present study, multivariate logistic analyses revealed a significant association between the dental erosive wear and high consumption of sour sweets and sports drinks. The tooth-brushing frequency was not significantly associated with dental erosive wear. Additionally, to the best of our knowledge, the results are the first to indicate a dose-response relationship between the daily consumption of acidic drinks and dental erosive wear.

Erosive Tooth Wear among 12-Year-Old Schoolchildren: A Population-Based Cross-Sectional Study in Montevideo, Uruguay

The aim of this study was to assess the prevalence, extent, severity, intraoral distribution and risk indicators for erosive tooth wear (ETW) among 12-year-old schoolchildren from Montevideo, Uruguay. A population-based, cross-sectional survey was conducted using a representative sample of 1,136 12-year-old schoolchildren attending public and private schools. Parents answered questions on socioeconomic status and general health. Schoolchildren answered questions on dietary and oral hygiene habits. Two calibrated examiners recorded ETW on permanent teeth according to the Basic Erosive Wear Examination (BEWE) score system. Logistic regression models were performed to assess the association between the predictor variables and the prevalence of ETW (overall and severe ETW). Odds ratios (OR) and the respective 95% confidence intervals (CI) were estimated. The prevalence of ETW was 52.9%, being mild erosion (BEWE = 1) in the vast majority of cases (48.5%). Severe erosion (BEWE ≥2) was detected in 4.4% of schoolchildren. The overall prevalence of ETW differed significantly between categories of gender and socioeconomic status, but only between gender in the severe ETW analysis. The overall extent of ETW was significantly different between categories of gender, socioeconomic status, and swish before swallow. The extent of severe ETW differed between categories of swish before swallow and brushing frequency. In the logistic regression analysis, no association was found between the studied variables and the overall prevalence of ETW. Males were more likely to have severe ETW than females (OR = 3.22, 95% CI = 1.50-6.89). ETW may be considered a public health problem among 12-year-old-Uruguayan schoolchildren.

Association between soft drink consumption, oral health and some lifestyle factors in Swedish adolescents

OBJECTIVE

The aim was to investigate the relationship between soft drink consumption, oral health and some lifestyle factors in Swedish adolescents.

MATERIALS AND METHODS

A clinical dental examination and a questionnaire concerning lifestyle factors, including drinking habits, oral hygiene, dietary consumption, physical activity and screen-viewing habits were completed. Three hundred and ninety-two individuals completed the study (13-14 years, n = 195; 18-19 years, n = 197). The material was divided into high and low carbonated soft drink consumption groups, corresponding to approximately the highest and the lowest one-third of subjects in each age group. Differences between the groups were tested by the Mann-Whitney U-test and logistic regression.

RESULTS

Intake of certain dietary items, tooth brushing, sports activities, meal patterns, screen-viewing behaviors, BMI and parents born outside Sweden differed significantly between high and low consumers in one or both of the two age groups. Dental erosion (both age groups) and DMFT/DMFS (18-19 years group) were significantly higher in the high consumption groups. Logistic regression showed predictive variables for high consumption of carbonated soft drinks to be mainly gender (male), unhealthy dietary habits, lesser physical activity, higher BMI and longer time spent in front of TV/computer.

CONCLUSION

High soft drink consumption was related to poorer oral health and an unhealthier lifestyle.

Degradation of orthodontic wires under simulated cariogenic and erosive conditions

This study examined the effect of cariogenic and erosive challenges (CCs and ECs, respectively) on the degradation of copper-nickel-titanium (CuNiTi) orthodontic wires. Sixty wire segments were divided into four treatment groups and exposed to CCs, ECs, artificial saliva, or dry storage (no-treatment control). CC and EC were simulated using a demineralizing solution (pH 4.3) and a citric acid solution (pH 2.3), respectively. Following treatment, the average surface roughness (Ra) of the wires was assessed, and friction between the wires and a passive self-ligating bracket was measured. CuNiTi wires subjected to ECs exhibited significantly higher Ra values than did those that were stored in artificial saliva. In contrast, surface roughness was not affected by CCs. Finally, friction between the treated wires and brackets was not affected by ECs or CCs. Our results indicate that CuNiTi orthodontic wires may suffer degradation within the oral cavity, as ECs increased the surface roughness of these wires. However, rougher surfaces did not increase friction between the wire and the passive self-ligating bracket.

The effects of smoothies on enamel erosion: an in situ study

OBJECTIVES

To measure, in vitro, the pH and titratable acidity (TA) of various soft drinks and to assess the erosive effect of smoothies using an in situ model.

METHOD

The in vitro phase of this study included measuring the inherent pH of six different commercially available smoothies, diet coke, and citric acid 0.3% (positive control) using a pH meter. The TA was determined by titration with NaOH. In the second part of the study, an in situ model was used. An upper removable appliance capable of retaining two enamel slabs was constructed and worn by 14 volunteers. The drinks under test were Innocent(®) strawberries and banana smoothie and citric acid. Volunteers were instructed to dip the appliance in the test solutions extra-orally five times daily for 2 min each time for 21 days. Measurements of enamel loss were made by surface profilometry and microhardness.

RESULTS

Diet Coke was found to be the most acidic drink (pH 2.61), whereas Innocent(®) mangoes and passion fruit smoothie showed to be the least (pH 3.9). With regard to TA, Innocent(®) blackberries, strawberries, and blackcurrant smoothie had the highest TA requiring 10.8 mol of NaOH to reach pH 7.0, whereas citric acid required only 3.1 mol of NaOH to reach the same pH value. Surface profilometry and microhardness testing revealed that citric acid caused a statistically significantly greater tooth surface loss compared with smoothie after 21-day pH cycling protocol.

CONCLUSION

Smoothies are acidic and have high TA levels. Innocent(®) strawberries and banana smoothie had an erosive potential to the teeth. However, its erosive effect was significantly less compared with citric acid after 21-day pH cycling protocol using an in situ model.

A randomised in situ trial, measuring the anti-erosive properties of a stannous-containing sodium fluoride dentifrice compared with a sodium fluoride/potassium nitrate dentifrice

OBJECTIVES

To determine if a stabilised, stannous-containing sodium fluoride dentifrice provides greater enamel protection in situ against intraoral dietary erosive challenges compared with a sodium fluoride/potassium nitrate dentifrice.

METHODS

A single-centre, investigator blind, randomised, supervised, two-treatment, non-brushing, four-period crossover in situ study was undertaken, with each test period being 15 days. Thirty-five healthy adult subjects were recruited to participate in the study, which included four erosive acid challenges per day. Subjects were randomised to product treatment, which included either: (1) a stannous-containing sodium fluoride dentifrice (Oral-B(®) Pro-Expert Sensitive) or (2) a sodium fluoride/potassium nitrate dentifrice (Sensodyne(®) Pronamel(®) ). Each study subject wore an intraoral appliance retaining two sterilised, polished human enamel samples for 6 hours/day. Subjects swished with an allocated dentifrice slurry twice a day and with 250 ml of orange juice for 10 minutes (25 ml/minute over a 10-minute period) four times per day. The primary and secondary outcomes for this study were enamel loss measured using contact profilometry at days 15 and 5, respectively, using parametric analysis methods.

RESULTS

At day 15, a 38% lower enamel loss (P < 0.0001) was observed, with estimated medians of 2.03 μm (SE 0.247) and 3.30 μm (SE 0.379), in favour of the stannous-containing dentifrice. At day 5, specimens treated with the stannous-containing sodium fluoride dentifrice demonstrated 25% less enamel loss than those treated with the sodium fluoride/potassium nitrate dentifrice. Treatment differences at day 5 were also statistically significant (P < 0.05), with estimated medians of 1.37 μm (SE 0.177) and 1.83 μm (SE 0.223), respectively.

CONCLUSIONS

Results of this in situ study suggest the stabilised, stannous-containing sodium fluoride dentifrice could be used to provide significantly greater protection to enamel from erosive acid challenge compared with that provided by conventional fluoride-containing products.

Protective effects of SnF2 - Part II. Deposition and retention on pellicle-coated enamel

Deposition of an acid-resistant barrier onto enamel represents a potentially superior means for delivering protection against dietary, erosive acid challenges.

PURPOSE

The purpose of this study was to demonstrate the ability of a stabilised stannous fluoride (SnF2 ) dentifrice to: (1) deposit a SnF2 barrier layer onto pellicle-coated enamel surfaces; (2) increase the intensity of the barrier layer over time; and (3) be retained on the enamel surface for hours after product use.

METHODS

Squares of human enamel were exposed to pooled saliva for 1 hour (pellicle formation) and separated into six sets. Set 1 was treated with the supernatant of a 1:3 slurry of the test dentifrice (Crest(®) Pro-Health(®) : water for 2 minutes), then rinsed. Set 2 was treated in the same manner and then placed into saliva (6 hours). Set 3 was cycled through seven repeated treatments. Set 4 was treated for seven cycles and then placed into saliva (6 hours). Set 5 was a water control, and set 6 was a water control that remained in saliva for 6 hours. Surface analysis of specimens was done using laser ablation Inductively Coupled Plasma Mass Spectroscopy (ICP-MS).

RESULTS

Deposition of a barrier layer was demonstrated, beginning with the initial treatment, with Sn (using isotopes (117) Sn + (120) Sn) measured on the enamel surface as the reference marker. Deposition of the barrier layer was greater after seven cycles, and the retention of this layer was highly significant (P = 0.05, anova: 6 hours).

CONCLUSIONS

This study confirms that: (1) the stabilised SnF2 dentifrice deposits a barrier layer onto the enamel surface, beginning with the first use of the product; (2) this barrier is enhanced following multiple treatments; and (3) the barrier layer is retained on the enamel surface for hours after product use.

Association between dental erosion and diet in Brazilian adolescents aged from 15 to 19: a population-based study

Dental erosion is a pathological condition resulting from the irreversible dissolution of the mineralized portion of the teeth, being recognized in modern society as an important cause of loss of tooth structure. The aim of this study was to assess the prevalence and its association with diet in Brazilian adolescents of Campina Grande, PB, Brazil. A population-based study was conducted on a stratified sample of 675 adolescents aged from 15 to 19 of both sexes using the index proposed by O'Sullivan. Dental examinations were performed by two calibrated dentists (kappa = 0.82). The significance level adopted was 5%. The prevalence of dental erosion was 21%, and the upper central incisors and lateral incisors were the most affected elements, with 50.5% and 40.2%, respectively. The buccal surface showed greater impairment (51.4%) and 67.8% of teeth with dental erosion had more than half of the surface of affected area. Most damage was on the enamel (93.5%). There were no statistically significant differences between the occurrence of dental erosion and gender, age, socioeconomic status, self-reported ethnicity, and diet. There was high prevalence of dental erosion in its early stages among adolescents and there were no significant differences in the frequency of the consumption of foods and beverages and the presence of dental erosion.