Is there a relationship between asthma and dental erosion? A case control study

Prevalence of erosive tooth wear in risk group patients: systematic review

OBJECTIVE

This systematic review investigates the prevalence of erosive tooth wear (ETW) in individuals classified as risk groups (gastroesophageal reflux disease, eating disorders, special diets, acidic beverage, drugs and alcohol, legal drugs and medications, and occupational or sports).

MATERIALS AND METHODS

The research was conducted in nine databases (PubMed/MEDLINE, Embase, Cochrane Library, LILACS/BVS, SciELO, Scopus, Science Direct, Open Grey, and Web of Science) up to April 2024 (PROSPERO CRD42021270150), along with a manual search of grey literature. Observational studies involving children and adults from these previously mentioned risk groups, which provided data on ETW prevalence, were included without date or language restrictions. The methodological quality of studies was evaluated using the Joanna Briggs Institute's Prevalence Data Critical Appraisal Tool. General and subgroup data were meta-analyzed using a random-effects model.

RESULTS

Overall, 4403 studies were retrieved, out of which 148 met the inclusion criteria. Each risk group showed higher prevalences of ETW in these patients in general and subgroup analysis; although subgroup analysis was not possible for all risk groups due to the heterogeneity of the indices found.

CONCLUSIONS

The Legal drugs and Medications risk group showed lower overall prevalence values (30%), while the Drugs and Alcohol risk group obtained higher values (67%). Prevalence rates for other groups were: Gastroesophageal reflux disease (54.1%), Eating Disorders (65%), Special Diets (65.9%), Acidic Beverages (40%), Occupational and Sports (51%).

CLINICAL RELEVANCE

This systematic review highlights that risk groups are indeed at significant risk for the development of ETW and greater preventive care and dental monitoring are needed.

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.

The association between erosive toothwear and asthma - is it significant? A meta-analysis

BACKGROUND

The association of asthma with oral conditions such as dental caries, dental erosion, periodontal diseases and oral mucosal changes has been the subject of debate among dental practitioners. Existing evidence indicates that an inhaler is the most common and effective way of delivering the asthma medications directly into the lungs. Few studies in the past attributed this association to the changes in salivary flow caused due to these medications. Considering this unclear association, the aim of the present meta-analyses is to identify the association between erosive toothwear and asthma from individual studies conducted until date.

METHODOLOGY

Electronic databases were systematically searched until 30th September 2022. Articles identified using the search strategy were imported to RAYYAN systematic review software. Data was extracted relating to study design, geographic location, year of publication, sample size, the assessment method for erosive toothwear and asthma. The Newcastle Ottawa scale was utilized to assess the quality of evidence reported from the included studies. RevMan Version 5.3 was used to perform a random-effects meta-analysis to produce pooled estimates from OR and 95% CI of included studies. The I² statistic was used to determine the extent of heterogeneity. A funnel plot was generated to visually assess the potential for publication bias. Sensitivity analyses were performed by excluding individual studies one at a time. GRADE approach was used for grading the evidence for key comparisons.

RESULTS

Twelve articles were included in the final meta-analysis. A total of 1027 asthmatics and 5617 non-asthmatics were included. All studies demonstrated moderate to low risk of bias. The overall pooled estimate (OR: 2.03; 95% CI: 0.96, 4.29) and subgroup analyses in children (OR: 1.67; 95% CI: 0.63, 4.42) did not show statistically significant difference in the occurrence of dental erosion between the asthmatic and non-asthmatic group. However, asthmatic adults had significantly greater dental erosion in comparison to the control adults (OR: 2.76; 95% CI: 1.24, 6.16). Sensitivity analyses also provided inconclusive evidence. Funnel plot asymmetry indicated significant heterogeneity, changes in effect size and selective publication.

CONCLUSION

The association between inhalational asthmatic medication and tooth wear is inconclusive. There are a number of confounding factors that play a greater role in causing dental erosion in these patients. Dentist must pay particular attention to these factors while treating asthmatic patients. The authors produce a comprehensive checklist in order to ensure complete assessment before providing advice on their medications alone.

Sugar content and erosive potential of commonly prescribed Orodispersible tablets- An in vitro study

Background: Dental caries is a major non-communicable disease of public health concern caused due to freely available dietary sugars. We aimed to compare the sugar content and erosive potential with duration of use and drug classes of orodispersible tablets (ODTs).  Methods: We conducted an  in vitro evaluation of the total sugar content (TSC), Potential of Hydrogen (pH), solubility, and Titratable Acidity (TA) of commonly prescribed 62 ODTs. TA was measured by titrating the samples with known amount of. 0.1N sodium hydroxide (NaOH) with phenolphthalein indicator and pH was determined by digital pH meter. TSC was evaluated by phenol sulphuric acid. Solubility was assessed by filtration.  Results: Out of the 62 ODTs, majority were Antimicrobials (n=30). One-quarter of the ODTs (26%) had a mean pH below ≤5.5. No significant difference was seen in the mean pH with respect to different drug classes (p=0.082) and duration of use of ODTs. A significant difference was seen in the mean percentage solubility with respect to drug classes (p<0.001). Antimicrobials had the least percentage of solubility as compared to other drug classes. Antiemetics and proton pump inhibitors (24.33 ± 17.34) had significantly higher mean percentage sugar content than Antimicrobials (23.25 ± 17.16). No significant difference was seen in the mean TSC with respect to various drug classes (p=0.718) and between the duration of use of drugs (P=0.568) respectively. No significant difference was seen in the mean percentage TA with respect to drug class (p=0.123) and duration of use of drugs (p=0.424).   Conclusion: Overall, we can conclude that one in four ODT formulations had a pH below 5.5 (critical pH).  Only one ODT formulation did not have a sugar content. No difference was seen in the mean pH, sugar content, and TA with respect to duration of use of drugs and drug classes.

Sugar content and erosive potential of commonly prescribed Orodispersible tablets- An in vitro study

Background: Dental caries is a major non-communicable disease of public health concern caused due to freely available dietary sugars. We aimed to compare the sugar content and erosive potential with duration of use and drug classes of orodispersible tablets (ODTs).  Methods: We conducted an  in vitro evaluation of the total sugar content (TSC), Potential of Hydrogen (pH), solubility, and Titratable Acidity (TA) of commonly prescribed 62 ODTs. TA was measured by titrating the samples with known amount of. 0.1N sodium hydroxide (NaOH) with phenolphthalein indicator and pH was determined by digital pH meter. TSC was evaluated by phenol sulphuric acid. Solubility was assessed by filtration.  Results: Out of the 62 ODTs, majority were Antimicrobials (n=30). One-quarter of the ODTs (26%) had a mean pH below ≤5.5. No significant difference was seen in the mean pH with respect to different drug classes (p=0.082) and duration of use of ODTs. A significant difference was seen in the mean percentage solubility with respect to drug classes (p<0.001). Antimicrobials had the least percentage of solubility as compared to other drug classes. Antiemetics and proton pump inhibitors (24.33 ± 17.34) had significantly higher mean percentage sugar content than Antimicrobials (23.25 ± 17.16). No significant difference was seen in the mean TSC with respect to various drug classes (p=0.718) and between the duration of use of drugs (P=0.568) respectively. No significant difference was seen in the mean percentage TA with respect to drug class (p=0.123) and duration of use of drugs (p=0.424).   Conclusion: Overall, we can conclude that one in four ODT formulations had a pH below 5.5 (critical pH).  Only one ODT formulation did not have a sugar content. No difference was seen in the mean pH, sugar content, and TA with respect to duration of use of drugs and drug classes.

Assessment of Orthodontic Treatment Need and Oral Health-Related Quality of Life in Asthmatic Children Aged 11 to 14 Years Old: A Cross-Sectional Study

This study investigated the need for orthodontic treatment in asthmatic children aged 11 to 14 years and how the treatment affected their oral health-related quality of life (OHRQoL).

MATERIALS AND METHODS

This cross-sectional study was conducted at the dental clinic of the University of Salamanca in 2020-2022. The study selected a consecutive sample of 140 children with asthma (52.1% girls; 47.9% boys). This study used the Orthodontic Treatment Needs Index (OTN) to analyze the need for orthodontic treatment and the Children's Perception Questionnaire (CPQ11-14) to assess OHRQoL.

RESULTS

Sex and age did not significantly influence the need for orthodontic treatment, although age may be considered influential for OHRQoL concerning oral symptoms (p < 0.01), functional limitations (p < 0.05), and total score on the CPQ_11-14 questionnaire (p < 0.05): the younger the age, the greater the effect of the need for orthodontic treatment on OHRQoL. The social well-being of the patients was much more significantly impacted by the need for orthodontic treatment (15.7 ± 1.91) than by oral symptoms (7.64 ± 1.39), which were the least impacted. In all parts of the CPQ_11-14 questionnaire and in the patients' total scores, we observed significant agreement (p < 0.01) that treatment influenced OHRQoL.

CONCLUSION

An inverse relationship exists between the severity of the treatment needed and OHRQoL.

Relation between Childhood Asthma and Dental Erosion in Al-Kharj Region of Saudi Arabia: A Cross-Sectional Study

Background:

Asthma is a long-lasting disease that affects large number of the society and could impact on the oral health leading to increase in the needs of prevention and treatment. Currently, the prevalence of childhood asthma in Saudi Arabia is ranging from 9% to 33%.

Objective:

the objective was to evaluate dental erosion in control children and those with asthma.

Materials and Methods:

This was a cross-sectional study, with a sample of 100 children aged 3–12 years. Equally distribution of subjects was between the asthmatic and non-asthmatic group, at Prince Sattam Bin Abdulaziz University Dental Clinics, Alkharj, Saudi Arabia. The assessment consisted of an oral examination assessing erosive wear according to the American Academy of Pediatrics 2018 guidelines and a questionnaire to the parents/guardians addressing the background details and information about the child asthma.

Results:

Among 12 (24%) asthmatic children and 9 (18%) non-asthmatic children had dental erosion. In the adjusted analysis, no association was found between asthma and erosion. It has been shown that oral hygiene may have an effect occurrence or severity of erosion; brushing teeth once or more per day appeared to have less incidence of dental erosion compared with those not brushing their teeth regularly.

Conclusions:

This article provided no additional data than that given earlier, where no correlation was observed between asthma and dental erosion in children aged from 3 to 12 years.

Dental erosive wear in primary teeth among five-year-olds - Bergen, Norway

OBJECTIVE

To estimate the prevalence of dental erosive wear among five-year-olds in Bergen, Norway, and to investigate associations between background factors and the condition.

METHODS

A total of 387 children received a dental examination in five Public Dental Service clinics in Bergen, Norway. The parents responded to items about the children's dental hygiene and drinking habits, type of beverage container, diet, and other habits, and about their own age, educational level and country of origin. We explored background variables for possible associations with the outcome status as worst affected by erosive wear (19.4%, n = 75). Chi-squared statistics and logistic regression (Odds Ratios (OR): 95% Confidence Intervals (CI), served as statistical tools).

RESULTS

Approximately 80% showed erosive wear (by SEPRS and by adopted diagnostic instrument (78.5% vs 79.8%)). The condition affected maxillary anterior teeth in 13.9% (n = 54), and cuppings in molars in 79.3% (n = 307) of cases. Grinding teeth during the day and/or night (OR: 1.87, CI: 1.07-3.25) and male sex (OR: 1.76, CI: 1.05-2.96) significantly related to outcome status as worst affected by erosive wear, respectively.

CONCLUSION

Dental erosive wear was widespread. Grinding teeth and male sex associated with outcome status as worst affected by erosive wear.

The interrelationship between xerogenic medication use, subjective oral dryness and tooth wear

OBJECTIVE

To investigate the association between xerogenic medication use and tooth wear among American adults and whether this association can be explained by subjective oral dryness.

METHODS

We used data from 3578 adults who participated in the National Health and Nutritional Examination Survey (NHANES). Tooth wear was clinically determined using the modified Tooth Wear Index. Information on xerogenic medication use, subjective oral dryness (amount of saliva in mouth and feeling the mouth dry when eating) and potential confounders (sociodemographic factors, dental insurance coverage, gastroesophageal reflux disease medication use and soft drinks intake) were self-reported. The associations among xerogenic medication use, subjective oral dryness and tooth wear were assessed in regression models adjusting for confounders.

RESULTS

Adults taking xerogenic medication had greater odds of reporting too little amount of saliva and feeling the mouth dry when eating. In addition, participants taking one and multiple (two or more) xerogenic medications had, respectively, 1.53 (95 % CI: 1.01-2.32) and 1.44 (95 % CI: 0.62-3.33) greater odds of having tooth wear than those taking no xerogenic medications. In a regression model including all explanatory variables, the association of xerogenic medication use with tooth wear was fully attenuated whereas subjective oral dryness (amount of saliva in mouth but not feeling the mouth dry when eating) remained positively associated with prevalence of tooth wear. Similar findings were obtained with long-term use of xerogenic medication (in the past month and for three or more years).

CONCLUSION

Current (last month) use of xerogenic medication was associated with the presence of tooth wear. This association was accounted for by subjective indicators of oral dryness.

CLINICAL SIGNIFICANCE

Dentists should be familiar with the possible connection between patient's medical prescription and tooth wear. Changing prescriptions to non-xerogenic alternatives, whenever possible, could improve patients' oral condition. The findings also suggest that patients may recognise, through the perception of dry mouth, when medication is placing them at risk.

Association between asthma and caries-related salivary factors: a meta-analysis

OBJECTIVES

This meta-analysis aimed to examine the comprehensive conclusive evidence of association between asthma and caries-related salivary factors including salivary pH (SpH), salivary flow rate (SFR), salivary buffer capacity (SBC), and other salivary components.

METHODS

Electronic databases (Web of Science, PubMed, Scopus, Cochrane Library, and Open Gray databases) were searched for relevant studies. After screening, studies were selected and data were collected from each study. The risk of bias in individual studies and across studies was evaluated. Mean differences (MD) were used to measure the effect estimates in the comparisons of SFR, SpH, SBC, and other salivary components. Additional analyses, namely sensitivity, subgroup, and Grades of Recommendation, Assessment, Development, and Evaluation analyses, were also conducted.

RESULTS

Eighteen and fourteen studies were included in the qualitative and quantitative synthesis, respectively. Significantly higher SFR (MD = -0.3, 95% CI [-0.39, -0.2], p < 0.001) and SpH (MD = -0.25, 95% CI [-0.45, -0.05], p = 0.01) were found in the reference group compared to the group with asthma. A significant difference in SBC was found only for unstimulated saliva (MD = -0.20, 95% CI [-0.24, -0.15], p < 0.001). No significant associations were found between asthma and other salivary components (p > 0.05).

CONCLUSIONS

Notwithstanding the limitations of this study, the evidence showed that SFR whether stimulated or unstimulated was significantly reduced in asthma patients. SBC and SpH were significantly reduced in asthma patients only when saliva was unstimulated. No evidence was found regarding the association between asthma and other salivary components.

Asthma, long-term asthma control medication and tooth wear in American adolescents and young adults

OBJECTIVE

This study explored the associations of asthma and long-term asthma control medication with tooth wear among American adolescents and young adults.

METHODS

Data from 2186 participants of the National Health and Nutrition Examination Survey (NHANES) were used. Asthma and prescribed long-term medication were collected through questionnaires. The number of surfaces with tooth wear was determined during clinical examinations. Associations were tested in Hurdle regression models adjusting for confounders.

RESULTS

The prevalence of tooth wear was 58%, with an average of 6.1 (SD: 4.0) surfaces affected among those with the condition. The prevalence of asthma was 10.3%, with 2.9% of participants using long-term medication for asthma control. In the adjusted regression model, asthma was not associated with tooth wear. However, long-term control medication was associated with greater odds of having tooth wear (odds ratio: 3.33; 95%CI: 1.24-8.97), but it was not associated with the number of surfaces with tooth wear among those with the condition (rate ratio: 1.01; 95% CI: 0.58-1.75).

CONCLUSION

This cross-sectional analysis of national data shows that taking long-term asthma medication was positively associated with having tooth wear.

Conservative Management of Dental Erosion in Adolescents with Medical Conditions

The prevalence of dental erosion among children and adolescents is trending higher in recent decades and is becoming a major concern. Dental erosion can be caused by either extrinsic or intrinsic acids or both. One of the established aetiological factors for dental erosion by intrinsic acid is the gastrooesophageal reflux disease. The degree of dental erosions may be influenced by any medical conditions that cause a reduction in salivary flow such as the salivary gland excision, autoimmune disease, radiation to the head and neck regions, and medications. If left untreated, the dental erosion can cause dentine hypersensitivity, loss of occlusal vertical height, and aesthetic problems. For effective management of dental erosion, the aetiology of each case must be determined, and its detection at an early stage is of prime importance. This case report illustrates the conservative management of dental erosion in two adolescent patients presented with their medical conditions and behaviour issues. The aim of the treatments was to preserve the vitality of the affected teeth. The treatments were successfully completed using a conservative approach, with the patients' medical conditions taken into consideration.

Prevention of erosive tooth wear: targeting nutritional and patient-related risks factors

This article provides an overview of the nutritional and patient-related risk factors involved in the aetiology of erosive tooth wear (ETW) and the preventive strategies to counteract them. The first step is to diagnose clinical signs of ETW and to recognise causal factors. Low pH and high buffer capacity of foods/drinks are the major risk factors, while the calcium concentration is the main protective factor. Reduction of frequency of consumption and contact time of erosive foods/drinks with the teeth, use of straws appropriately positioned and consumption of dairy products are advisable. Oral hygiene has a role in the development of ETW, however, postponing toothbrushing is not clinically advisable. In cases of drug abuse, chronic alcoholism, GERD or bulimia, the patient must be referred to a doctor. Immediately after vomiting, patients might be advised to rinse the mouth. Saliva has an important protective role and patients with reduced salivary flow can benefit from the use of chewing gum. Recent studies have focused on improving the protective capacity of the acquired pellicle as well as on the role of protease inhibitors on dentine erosion. However, the degree of evidence for these preventive measures is low. Clinical trials are necessary before these measures can be recommended.

Prevalence of erosive lesions with respect to risk factors in a young adult population in Poland-a cross-sectional study

OBJECTIVE

The study was conducted to investigate the prevalence of erosive lesions and related risk factors in the population of 18-year-old young adults in Poland.

MATERIALS AND METHODS

Calibrated examiners measured erosive tooth wear according to Basic Erosive Wear Examination (BEWE) scoring system in 1869 patients and assessed the impact of risk factors with a questionnaire.

RESULTS

Erosion was present in 42.3% of the patients. Early damage to the enamel was the most frequent finding (BEWE 1)-28.9%. More advanced lesions (BEWE 2) were observed in 12% of the patients. Advanced damage to the teeth (BEWE 3) was diagnosed rarely-1.4% of the examined population. Acidic diet, hygienic habits, and medical conditions such as asthma, eating disorders, and esophageal reflux showed statistical significance, as associated with erosion in the examined population.

CONCLUSIONS

The present study indicates that dental erosion is a common oral disease in the 18-year-old population with prevalence of frequency and intensity in males. However, on the basis of observations carried out in recent years, it may be assumed that the prevalence of this type of lesion is increasing.

CLINICAL RELEVANCE

Present findings support other longitudinal studies toward evaluation of the BEWE system as a valuable standard for assessing erosive and related risk factors among different populations.

Assessment of the oral health status of asthmatic children

OBJECTIVES

To assess the oral health status and salivary composition in a group of children suffering from bronchial asthma.

MATERIALS AND METHODS

The sample consisted of sixty asthmatic children, sixty healthy negative controls, and sixty healthy positive controls of both sexes with age ranging from 4 to 12 years old. The asthmatics were grouped according to disease severity into mild, moderate, or severe asthmatic. All the children were clinically examined to assess their dental caries experience (decayed, indicated for extraction, and filled primary tooth [def] and decayed-missing-filled permanent tooth [DMF]), dental erosion condition (tooth wear index), and gingival health condition (gingival index [GI]). Salivary samples were collected and assessed for salivary flow rate, salivary pH, and the level of calcium, sodium, and potassium.

RESULTS

The results of this study revealed that asthmatic children presented significantly higher def, DMF score, and GI mean values compared to the control groups. Severe asthmatics significantly presented the highest def and GI score. Salivary analysis revealed reduced stimulated salivary flow rate and altered salivary pH. In addition, significantly elevated mean salivary calcium level found to be associated with higher GI mean score.

CONCLUSIONS

Children suffering from bronchial asthma should receive special dental preventive attention as presented with greater risk for oral and dental diseases as compared to the healthy controls.

Prevalence and Extrinsic Risk Factors for Dental Erosion in Adolescents

OBJECTIVE

This manuscript examined the prevalence and extrinsic risk factors for dental erosion (DE) in early and middle adolescents in Pasto, Colombia.

STUDY DESIGN

Dental erosion was evaluated in a random sample of 384 individuals aged 10-15 years attending three primary and high schools in this cross-sectional study. Clinical dental assessment for DE was done using O'Sullivan index. Data on general sociodemographic variables and extrinsic risks factors were obtained. Descriptive and univariate binary logistic regression analyses were performed.

RESULTS

Dental erosion was observed in 57.3% of individuals. The univariate binary logistic regression analysis showed that frequency of drinking natural fruit juices (OR 2.670, 95% CI 1.346 - 5.295, P=0.004) and their pH (OR 2.303, 95% CI 1.292 - 4.107, P=0.004) were more associated with the odd of DE in early adolescence. However, a high SES (OR 10.360, 95% CI 3.700 - 29.010, P<0.001) and frequency of snacks with artificial lemon taste (OR 3.659, 95% CI 1.506 - 8.891, P=0.003) were highly associated with the risk of DE in middle adolescence.

CONCLUSIONS

The results suggest that DE is a prevalent condition in adolescents living in a city in southern Colombia. The transition from early to middle adolescence implies new bio-psychosocial changes, which increase the risk for DE.

Dental treatment in children with asthma - a review

This article aims to explain the effects of long-term use of asthma medications. It will discuss the effects of asthma on the oral cavity, as well considerations for the dentist when treating asthmatic patients. It will also explain how to manage asthma in the dental setting and provide advice on maintaining oral health for asthmatic patients.

Dental Erosion and Dentin Hypersensitivity among Adult Asthmatics and Non-asthmatics Hospital-based: A Preliminary Study

Background:

Asthma is a chronic inflammatory condition affecting the airways leading to spasm and swelling of the airways. The medications taken for the treatment of asthma can result in dental erosion and dentin hypersensitivity.

Objectives:

The aims of this study were to investigate the severity of dental erosion amongst adult asthmatics according to: gender, type and duration of medication taken and to compare dental erosion and dentin hypersensitivity between asthmatics and non-asthmatics.

Subjects and Methods:

Comparative, cross-sectional hospital based study among 40 asthmatics (M=15 & F=25) and 40 non-asthmatics (M=18 & F=22) in the age range of 18-60 year selected purposefully from Al-Shaab Teaching Hospital in Khartoum city. The Basic Erosive Wear Index was used for dental erosion assessment. Dentine hypersensitivity was determined by giving ice cold water and rated using the Visual Analogue Scale. Chi-square and Student’s t-test were used for statistical analysis with P value ≤.05.

Results:

There was an association between severity of dental erosion and presence of asthma (P=0.03), where asthmatics had a higher degree of erosion (moderate and severe) and non-asthmatics a lower degree. No significant association was found between dental erosion and gender, type and duration of medication among asthmatics group. A statistically significant difference was revealed in the degree of dentin hypersensitivity (P=0.00) among asthmatics (35.13%) and non-asthmatics (14.13%).

Conclusion:

Asthmatic patients had a higher degree of dental erosion and dentin hypersensitivity compared to non-asthmatics. Among asthmatic patients there was no association between severity of dental erosion and gender, type and duration medication was taken for.

Dental erosion among 12-year-old schoolchildren: a population-based cross-sectional study in South Brazil

OBJECTIVE

To assess the epidemiology and risk indicators for dental erosion among 12-year-old schoolchildren in South Brazil.

METHODS

A population-based cross-sectional survey was conducted in Porto Alegre, Brazil, using a representative sample of 12-year-old schoolchildren (n = 1,528). Dental erosion was recorded according to the Basic Erosive Wear Examination (BEWE) index. Parents answered questions on socio-economic status, brushing frequency and general health. Schoolchildren answered questions on dietary habits. Anthropometric data were collected. Statistical analysis included logistic and Poisson regression models.

RESULTS

The prevalence of dental erosion was 15% [95% confidence interval (95% CI): 13.6-16.5], being mainly mild erosion. Boys [odds ratio (OR) = 1.57, 95% CI: 1.17-2.10], private school attendees (OR = 1.45, 95% CI: 1.01-2.06) and schoolchildren reporting the daily consumption of soft drinks (OR = 5.04, 95% CI: 1.17-21.71) were more likely to have at least one tooth with dental erosion. Gender [boys, rate ratio (RR) = 1.66, 95% CI: 1.28-2.17], type of school (private, RR = 1.89, 95% CI: 1.53-2.35), the consumption of soft drinks (sometimes: RR = 5.27, 95% CI: 1.46-19.05; daily: RR = 6.82, 95% CI: 1.39-33.50) and the daily consumption of lemon (RR = 1.49, 95% CI: 1.11-2.00) were significantly associated with the number of affected surfaces.

CONCLUSIONS

The present study found a moderate prevalence of dental erosion among young schoolchildren, with mild erosion being the most prevalent condition. Socio demographic variables and dietary habits were associated with dental erosion in this population.

Assessment of sleep bruxism, orthodontic treatment need, orofacial dysfunctions and salivary biomarkers in asthmatic children

OBJECTIVE

To evaluate the sleep bruxism, malocclusions, orofacial dysfunctions and salivary levels of cortisol and alpha-amylase in asthmatic children.

DESIGN

108 7-9-yr-old children were selected from Policlinic Santa Teresinha Doutor Antonio Haddad Dib (asthmatics, n=53) and from public schools (controls, n=55), Piracicaba, SP, Brazil. Sleep bruxism diagnosis was confirmed by parental report of grinding sounds and the presence of shiny and polish facets on incisors and/or first permanent molars. The index of orthodontic treatment need was used for occlusion evaluation. Orofacial dysfunctions were evaluated using the nordic orofacial test-screening (NOT-S). Salivary cortisol and alpha-amylase were expressed as "awakening response" (AR), calculated as the difference between levels immediately after awakening and 30 min after waking, and "diurnal decline" (DD), calculated as the difference between levels at 30 min after waking and at bedtime. Data were analyzed using Shapiro-Wilk/Kolmogorov-Smirnov, Chi-square, unpaired t test/Mann-Whitney and paired t/Wilcoxon tests.

RESULTS

Sleep bruxism was more prevalent in children with asthma than controls (47.2% vs. 27.3%, p<0.05). Asthmatics had higher scores of NOT-S total and interview (p<0.05). Dysfunctions on sensory function and chewing and swallowing were more frequent in asthmatics (p<0.05). Salivary cortisol AR on weekend was significantly higher for asthmatics (p<0.05). Salivary cortisol DD was significantly higher on weekday than weekend for controls (p<0.05). There were no significant differences in alpha-amylase values in and between groups.

CONCLUSIONS

The presence of asthma in children was associated with sleep bruxism, negative perception of sensory, chewing and swallowing functions, and higher concentrations of salivary cortisol on weekend.

Avaliação de hábitos de higiene bucal, hábitos alimentares e pH salivar em pacientes com ausência e presença de lesões cervicais não cariosas

OBJETIVO: Avaliar hábitos de higiene bucal, hábitos alimentares e pH salivar em pacientes com ausência e presença de lesões cervicais não cariosas. MÉTODO: Por meio de um estudo transversal, foram avaliados 88 pacientes, de ambos os sexos, feminino (63,6%) e masculino (36,4%), entre 18 e 71 anos, nos Serviços de Oclusão das cidades de João Pessoa e Campina Grande. Realizaram-se avaliações clínicas, por um único examinador calibrado, para diagnosticar a presença das lesões, a face, os grupos dentários, os hábitos de abrasão e erosão, e o pH Salivar. Utilizaram-se análises descritivas e não paramétricas (Qui-Quadrado, coeficiente ρ de Spearman e teste U de Mann-Whitney), com 5% de nível de significância e 95% de intervalo de confiança. RESULTADO: Verificou-se a prevalência de 65,90% dos pacientes com lesões e o grupo dos pré-molares foi o mais atingido pelas lesões, que estiveram frequentes na face vestibular e na maxila. O gênero não apresentou associação com a presença das lesões, enquanto que a idade foi estatisticamente significante (p<0,001) para a presença destas. O número e a direção de escovação (Fator Abrasivo) e pH Salivar não demonstraram associação com a presença das lesões, enquanto que a frequência do consumo de refrigerantes, de 1 a 7× semanais, apresentou associação positiva. CONCLUSÃO: Os pacientes com alterações oclusais apresentam um elevado número de lesões cervicais não cariosas e a frequência do consumo de refrigerantes representou associação estatística com a presença de lesões.

Tooth wear and associated risk factors in a sample of Australian primary school children

BACKGROUND

Anecdotally, tooth wear is increasing, perhaps attributable to diet. The irreversible surface loss may result in sensitivity and loss of form and function. Little data exist on the prevalence of tooth wear in Australian children. This study investigated consumption of potentially erosive foods and drinks, examining the prevalence, distribution of tooth wear and associations in a sample of children.

METHODS

Parents of 350, 6-12-year-olds reported their child's oral hygiene, dietary intake, medical and dental histories; 154 children (subsample) were examined. Associations were studied with single and multivariable analyses.

RESULTS

Tooth wear was parentally reported for 17% (59 children of the study population) and observed in 66% (102 of the subsample), particularly affecting primary teeth. Significant risk factors for parentally reported tooth wear were: consuming 2-4 cups soft drink/day (OR = 9.52), citrus flavoured sweets/gums ≥1/day (5.10), citrus fruits 1-2/wk (4.28); tooth grinding (5.32); medical condition present (2.48); male gender (2.80). Drinking 2-4 cups fruit juice/day was a significant risk factor for both parentally reported (3.23) and observed tooth wear (3.97).

CONCLUSIONS

Tooth wear appeared under-reported as some parents were unaware their child's teeth were affected. Significant risk factors for tooth wear were identifiable from children's histories. Risk factors should be addressed early so that tooth wear in the primary dentition does not affect permanent teeth.

Effect of inhaled medication and inhalation technique on dental caries in asthmatic patients

Background

The purpose of this study was to examine the relationship between the type of inhaled medication, length of use, dosing, the inhaler use technique and the severity and duration of disease on the dental caries of asthmatic patients.

Objectives

In the present study, the frequency of dental caries in the asthmatic patients and control group was examined. In addition the possible association of dental caries with disease duration, disease severity, asthma symptoms, chest wheeze, PFT values, and dose of medication and inhalation use technique was evaluated.

Materials and Methods

40 asthmatic patients of both sex (20-30 years old) and 40 age and sex matched controls were studied. In asthmatic patients, the type, dose, duration of medications, the technique of inhaler use and severity and duration of the disease were recorded. The dental health status including DT, MT, FT and DMFT (decay, missing, filling teeth) were examined. In addition, pulmonary function tests (PFTs) were performed for both groups.

Results

All PFT variables in asthmatic patients were significantly lower than those of control group except for FVC (P < 0.001 for all cases). All indices of dental caries in asthmatic group were higher than those of controls which was statistically significant for MT and DMFT (P < 0.005 for both cases). Only FT and DMFT in patients with 11-15 years asthma duration were significantly more than those of 6-10 years (P < 0.05 for both cases). There was no significant correlation between indices of dental caries and disease duration, PFT values; doses of medication or the technique of inhaler use; although the technique of inhaler use was relatively acceptable in all asthmatic patients.

Conclusions

These results showed that dental caries among asthmatic patients was more common than control group which can be due to using inhaler drugs or the technique of inhaler use.

Risk indicators for dental erosive wear among 18-yr-old subjects in Oslo, Norway

The aim was to investigate risk indicators associated with dental erosive wear among 18-yr-old subjects in Oslo, Norway. Of 3,206 adolescents invited to participate in a screening examination for erosive wear, 1,456 were examined (giving a response rate of 45%). As part of the examination all participants completed a self-administered questionnaire. Associations between the presence of erosive lesions and the possible risk indicators were assessed by logistic regression analyses, taking into account the hierarchical relationships between the independent variables. Of all 18-yr-old subjects examined, 38% had at least one tooth with erosive lesions. Multivariate analyses showed significant associations between the presence of erosive wear and being male, brushing teeth once per day or less, episodes of vomiting, daily/weekly episodes of gastro-oesophageal reflux, consumption of fruit juice and sugary soft drinks several times per day, as well as consumption of sugary soft drinks daily to once per week. In conclusion, in addition to gender, dietary habits such as frequent consumption of fruit juice and sugary soft drinks, and the occurrence of reflux and vomiting, appear to be risk indicators for erosive wear. When counselling adolescents at risk, the gender-specific risk indicators should be taken into account.

Dental care utilization among dentate adults with asthma: findings from the 2008 Behavioral Risk Factor Surveillance System

OBJECTIVES

This study investigated dental care service utilization among dentate adults with asthma and identified factors affecting dental care use among this population.

METHODS

Data from 414,509 adults in the United States who participated in the 2008 Behavioral and Risk Factor Surveillance System were used to estimate the percentage of dentate adults with asthma who had at least one dental visit within the past year.

RESULTS

The proportion of respondents with asthma who had at least one dental visit within the past year compared with the general population was significantly lower (67.4 percent versus 71.2 percent, P < 0.001 for dental visit for any reason; 64.3 percent versus 69.6 percent, P < 0.001 for dental cleaning). The adjusted odds of a dental visit for any reason within the past year for those with asthma were 0.86 [95% confidence interval (CI), 0.81-0.91], and for dental cleaning 0.82 (95% CI, 0.78-0.87) times that of those without asthma, respectively. Multivariable modeling showed dentate adults with asthma who are male, high school or less educated, unemployed, lower income, current smokers, and have lost more than six teeth were less likely to have a dental visit within the past year.

CONCLUSIONS

Compared with nonasthmatic individuals, dentate adults with asthma had a lower frequency of dental visits in the past year. Given a higher risk of oral disease among this population, healthcare providers should focus more effort on educating certain subgroups of patients with asthma on the importance of regular dental care.

Oral manifestations of gastroesophageal reflux disease

Numerous case-control and other studies involving confirmation of gastroesophageal reflux disease (GERD) by esophageal pH-metry and the assessment of dental erosions have shown significant associations between the two conditions in both adults and children. By contrast, when asked to vote on whether GERD may cause dental erosions, only 42% of physicians strongly agreed that such an association existed in adults, and just 12.5% strongly agreed for children, respectively in two global consensus reports. Part of this divergence between the perceptions of physicians and the findings of research publications may reflect a general lack of oral health education during medical training, and cursory oral examinations being made under less-than-ideal conditions. Adequate salivary secretions are essential for the protection of the teeth and the oropharyngeal and esophageal mucosa. The quantity and quality of the saliva require monitoring as many drugs, including several of the proton pump inhibitors (PPIs), can cause hyposalivation. In addition, PPIs do not always result in adequate acid suppression. Therefore, collaboration between physicians and dentists is strongly advocated to prevent or ameliorate possible adverse oral effects from both endogenous and exogenous acids, and to promote adequate saliva production in patients with GERD.

Impact of inhalation therapy on oral health

Inhalation therapy has been employed as the mainstay of the treatment in chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD). Beta-2 agonists, anticholinergic bronchodilators, inhaled corticosteroids, and sodium cromoglycate are often used alone or in combination in an inhaled form. Studies have shown that inhaled drugs used in the treatment have some adverse effects on the oral health based on their dosage, frequency, and duration of use. Several oral conditions such as xerostomia, dental caries, candidiasis, ulceration, gingivitis, periodontitis, and taste changes have been associated with inhalation therapy. Since the prevalence of chronic respiratory diseases is rising, it is important to provide optimal oral care to the individuals receiving inhalation therapy. This article will review the influence of inhaled drugs on the oral health of individuals and adequate management and prevention of the same.

Dental caries status and salivary properties of asthmatic children and adolescents

AIMS

This study aimed to investigate the dental caries status and salivary properties in 3- to 15-year-old children/adolescents.

METHODS

The sample was split in two groups: asthma group (AG), composed of 65 patients who attended Public Health Service; asthma-free group (AFG), composed of 65 nonasthmatic children/adolescents recruited in two public schools. Stimulated salivary samples were collected for 3 min. Buffering capacity and pH were ascertained in each salivary sample. A single trained and calibrated examiner (kappa = 0.98) performed the dental caries examination according to WHO criteria.

RESULTS

The AFG showed salivary flow rate (1.10 ± 0.63 mL/min) higher (P = 0.002) than AG (0.80 ± 0.50 mL/min). An inverse relationship was observed between asthma severity and salivary flow rate (Phi coefficient, rφ: 0.79, P = 0.0001). Children with moderate or severe asthma showed an increased risk for reduced salivary flow rate (OR: 17.15, P < 0.001). No association was observed between drug use frequency (P > 0.05) and drug type (P > 0.05) with salivary flow rate. Buffering capacity was similar in both groups. No significant differences were encountered in dental caries experience between AFG and AG groups.

CONCLUSIONS

Although asthma can cause reduction in flow rate, the illness did not seem to influence dental caries experience in children with access to proper dental care.

Asthma and oral health: a review

Asthma is a chronic inflammatory condition that causes the airways to constrict and produce excess mucus, making breathing difficult. It is characterized by the obstruction of airflow which is variable over a short period of time. This condition is reversible, either spontaneously or can be controlled with the help of drugs. Asthma medication comprises bronchodilators, corticosteroids and anticholinergic drugs. Most of these drugs are inhaled using various forms of inhalers or nebulizers. The effect of these drugs on oral health is the subject of debate among dental practitioners. Patients taking asthma medication may be at risk of dental caries, dental erosion, periodontal diseases and oral candidiasis. Hence, patients with bronchial asthma on medication should receive special prophylactic attention. This article reviews the correlation between asthma and oral health, and suggests various measures to counter possible oral health problems related to asthma.

Relationship between dental erosion and respiratory symptoms in patients with gastro-oesophageal reflux disease

OBJECTIVES

Both dental erosion and respiratory symptoms are extra-oesophageal manifestations of gastro-oesophageal reflux disease (GERD). The aim of this study was to determine whether dental erosion was correlated with respiratory symptoms in GERD patients.

METHODS

88 GERD patients were recruited and assigned to three groups mainly according to the frequency of respiratory symptoms: Group I: never; Group II: occasional (1-2 days a week or less); Group III: frequent (3-5 days a week or more). All patients underwent medical evaluations, including medical history, questionnaire answering and alimentary tract examinations. Dental examinations were carried out on these patients and 36 healthy controls. Dental erosions were measured by modified method of Smith and Knight Tooth Wear Index (TWI). Location and severity of dental erosion were recorded.

RESULTS

The prevalence of dental erosion in Group III (64.52%) was higher (p<0.05) than that in Groups I (36.67%) and II (44.44%). GERD patients were presented with dental erosion with TWI scores ranging from 1 to 4. Though proportion of dental erosion with Score 2 (7/20) in Group III was higher than that in Group I (2/11) and Group II (3/12), there was no statistical significance in the proportions of erosion scores among three patient groups. Correlation coefficient between airway symptoms and scores of dental erosion was 0.231 (p<0.05). Palatal erosion of upper incisor was seen in 8 persons (72.7%) in Group I, 9 persons (75%) in Group II and 16 persons (80%) in Group III (p>0.05). Labial erosion of upper incisors was found in 1 person in Groups I and II respectively and 4 persons in Group III. All patients with labial erosion on upper incisors had palatal erosion, except 1 patient in Group III.

CONCLUSIONS

In GERD patients, dental erosions are more prevalent in patients with frequent respiratory symptoms than those in patients with occasional and without respiratory symptoms. Palatal erosion of upper incisor is the main manifestation in patients. Acid reflux is the main causative factor of dental erosion in GERD patients with airway symptoms.

Dental Erosion in Children

Dental erosion or chemical wearing away of the tooth structure is a dental health problem of the modern world and if not detected early, may result in serious irreversible damage to the dentition. An awareness of its clinical appearance, etiology, and risk factor is important to plan the preventive and curative management of such problems.

This paper discusses the diagnostic protocol along with preventive and various restorative options available to treat this multifactorial nature of tooth wear.

Methodological considerations concerning the development of oral dental erosion indexes: literature survey, validity and reliability

Within the context of preventing non-communicable diseases, the World Health Report (2002) and the WHO Global Oral Health Program (2003) put forward a new strategy of disease prevention and health promotion. Greater emphasis is placed on developing global policies in oral health promotion and oral disease prevention. The Decayed, Missing, Filled Teeth (DMFT) index does not meet new challenges in the field of oral health. Dental erosion seems to be a growing problem, and in some countries, an increase in erosion of teeth is associated with an increase in the consumption of beverages containing acids. Therefore, within a revision of the WHO Oral Health Surveys Basic Methods, new oral disease patterns, e.g. dental erosion, have to be taken into account. Within the last 20 years, many studies on dental erosion have been carried out and published. There has been a rapid growth in the number of indexes quantifying dental erosion process in different age groups. However, these indexes are not comparable. This article discusses quality criteria which an index intended for assessing tooth erosion should possess.

Factors associated with asthma symptoms in schoolchildren from Greece: the Physical Activity, Nutrition and Allergies in Children Examined in Athens (PANACEA) study

To evaluate whether dietary habits and anthropometric and lifestyle characteristics are associated with the prevalence of asthma symptoms, a sample of 700 Greek schoolchildren were evaluated through a standardized questionnaire. Body height and weight were measured, and body mass index was calculated. Multiple logistic regression and multivariate techniques (principal components analysis) were performed. Overall lifetime prevalence for asthma symptoms was found to be 23.7%. Increased body weight, sedentary lifestyle, and consumption of sulphur-dioxide-enriched foods and beverages seem to promote asthma symptoms, while avoidance of this chemical preservative and physical activity was associated with reduced odds of reporting asthma symptoms.

Effect of inhaled budesonide on oropharyngeal, Gram-negative bacilli colonization in asthma patients

BACKGROUND AND OBJECTIVE

The effect of inhaled budesonide on oropharyngeal Gram-negative bacilli colonization (OGNBC) in asthmatic patients was investigated.

METHODS

Oropharyngeal cultures were obtained from asthmatic patients attending the hospital respiratory outpatient clinic, at baseline and 1 month after treatment with 800 microg/day of inhaled budesonide. Cultures were evaluated for OGNBC and compared with those of healthy controls.

RESULTS

A total of 148 cultures (74 from asthma patients, 74 from healthy controls) were evaluated. Six cultures (8.1%) from healthy controls, eight cultures (10.8%) from asthma patients obtained before treatment and 20 cultures (27.0%) obtained after treatment were positive for OGNBC (P < 0.05). Gender, age, presence of atopy and the degree of illness were not found to be related to the presence of OGNBC in and healthy control cultures. In the cultures obtained from the patients after treatment, OGNBC was higher in patients >50 years and in those with FEV1 < 70% (P < 0.05). Nine (18.8%) of 48 patients <50 years compare with 11 (42.3%) of the 26 patients >50 revealed OGNBC (P < 0.05). OGNBC were observed in 18.9% of the patients with FEV1 = 70% and in 47.6% of those with FEV1 < 70% (P < 0.05).

CONCLUSIONS

The increased rate of OGNBC in asthma patients treated with inhaled budesonide was found to be related to increased age and lower level of FEV1. Further studies with larger numbers of patients are required for the interpretation of this colonization in the course of lower respiratory infections in these patients.

The effects of xerogenic medications on oral mucosa among the Veterans Dental Study participants

OBJECTIVES

To examine the association of xerogenic medications with the oral mucosa inflammation score (OMS) in US male veterans.

METHODS

The relationship of having the worst 25th percentile in OMS and intake of xerogenic medications with different pharmacologic indications was analyzed by logistic regression, controlling for age in 3 categories (< or =44, 45-64, > or =65), smoking, disease burden index, alcohol abuse, and the duration of medication, in 290 subjects participating in the Veterans Dental Study.

RESULTS

When polypharmacy and denture-wearing status in addition to the aforementioned covariates were controlled, the odds ratios for cardiovascular disease medications and sympathetic agonists were 2.82 (95% confidence interval [CI] 1.35-5.91, P < .006), and 2.96 (CI 1.21-7.26, P < .02), respectively, and those for psychotropics and antihistamines were 2.12 (CI 0.94-4.80, P < .06) and 2.09 (CI 0.80-5.48, P < 0.14), respectively.

CONCLUSION

Xerogenic medication may be associated with oral mucosal pathology.

Prevalence of erosive tooth wear and associated risk factors in 2-7-year-old German kindergarten children

OBJECTIVES

The aims of this study were to (1) investigate prevalence and severity of erosive tooth wear among kindergarten children and (2) determine the relationship between dental erosion and dietary intake, oral hygiene behaviour, systemic diseases and salivary concentration of calcium and phosphate.

MATERIALS AND METHODS

A sample of 463 children (2-7 years old) from 21 kindergartens were examined under standardized conditions by a calibrated examiner. Dental erosion of primary and permanent teeth was recorded using a scoring system based on O'Sullivan Index [Eur J Paediatr Dent 2 (2000) 69]. Data on the rate and frequency of dietary intake, systemic diseases and oral hygiene behaviour were obtained from a questionnaire completed by the parents. Unstimulated saliva samples of 355 children were analysed for calcium and phosphate concentration by colorimetric assessment. Descriptive statistics and multiple regression analysis were applied to the data.

RESULTS

Prevalence of erosion amounted to 32% and increased with increasing age of the children. Dentine erosion affecting at least one tooth could be observed in 13.2% of the children. The most affected teeth were the primary maxillary first and second incisors (15.5-25%) followed by the canines (10.5-12%) and molars (1-5%). Erosions on primary mandibular teeth were as follows: incisors: 1.5-3%, canines: 5.5-6% and molars: 3.5-5%. Erosions of the primary first and second molars were mostly seen on the occlusal surfaces (75.9%) involving enamel or enamel-dentine but not the pulp. In primary first and second incisors and canines, erosive lesions were often located incisally (51.2%) or affected multiple surfaces (28.9%). None of the permanent incisors (n = 93) or first molars (n=139) showed signs of erosion. Dietary factors, oral hygiene behaviour, systemic diseases and salivary calcium and phosphate concentration were not associated with the presence of erosion.

CONCLUSIONS

Erosive tooth wear of primary teeth was frequently seen in primary dentition. As several children showed progressive erosion into dentine or exhibited severe erosion affecting many teeth, preventive and therapeutic measures are recommended.

Mild dehydration: a risk factor for dental disease?

A review of the published international literature was undertaken to investigate whether dehydration is a risk factor for dental disease. Published evidence of associations between saliva and dental disease and between saliva and dehydration was observed, but the precise nature of these associations is unclear and no evidence of a direct link between dehydration and dental disease was found. It is concluded that no direct link between dehydration and dental disease has been proven, although there is considerable circumstantial evidence to indicate that such a link exists.

Safety of the newer inhaled corticosteroids in childhood asthma

Inhaled corticosteroids (ICS) remain a vital part of the management of persistent asthma, but concerns have been raised about their potential adverse effects in children. This review examines the safety data on three new ICS - fluticasone propionate, mometasone, and extrafine beclomethasone in hydrofluoroalkane (HFA-134a) propellant (QVAR The use of tradenames is for product identification purposes only and does not imply endorsement. formulation) in relation to the older corticosteroids. Topical adverse effects such as thrush and dysphonia are rare, but dental erosion is a possibility with powder forms of ICS because of their low pH. Thus, it is important to stress mouth rinsing after administration and maintaining good dental hygiene to minimize this risk. Biochemical adrenal suppression can be readily demonstrated, particularly with high doses of all ICS. The clinical relevance of this was uncertain in the past, but there have now been >50 reported cases of acute adrenal crises in children receiving ICS, most of whom were on fluticasone propionate. In order to minimize the risk of symptomatic adrenal suppression, it is important to back-titrate the ICS dose and alert families of children receiving high-dose ICS of this potential adverse effect. A pediatric endocrine opinion should be sought if adrenal suppression is suspected. The older ICS cause temporary slowing of growth velocity, but the limited data available do not show any significant compromise of final adult height. The effect on growth of fluticasone propionate may not be as great as with the older ICS, but the studies have been short term and only used low doses of fluticasone propionate. There have been case reports of growth suppression in children receiving high doses of fluticasone propionate. The limited studies performed on the effect of ICS on bone mineral density in children did not show any adverse effects, but there may be an increased risk of fractures. Hydrofluoroalkane beclomethasone (QVAR) is essentially the same drug as chlorofluorocarbon beclomethasone, but with double the lung deposition owing to the smaller particle size. Thus, it could be expected that any adverse effects seen with chlorofluorocarbon beclomethasone would be the same with hydrofluoroalkane beclomethasone. However, some of the published data, particularly in adults, suggest that hydrofluoroalkane beclomethasone may be less systemically active than chlorofluorocarbon beclomethasone, even at equipotent doses. As yet, there are no long-term data on mometasone, but initial studies in adults suggest there may be less suppression of the hypothalamic-pituitary-adrenal axis, although further studies are required, particularly in children.ICS will remain a cornerstone in the management of persistent pediatric asthma, provided that the diagnosis of asthma is secure. It is very important to use ICS appropriately and to ensure the lowest possible doses are used to achieve symptom control, thus minimizing the risk of serious adverse effects.

Asthma and tooth erosion. Is there an association?

OBJECTIVES

To investigate whether there is an association between asthma and tooth erosion in a representative random sample of adolescents in the East Midlands.

METHODS

A random sample of 1753 12-year-old children was examined in all schools in Leicestershire and Rutland. 1308 children were re-examined 2 years later. Tooth erosion was assessed using the index employed in the Children's Dental Health in the UK Survey 1993. Asthma presence was recorded on a self-completed questionnaire at the time of the 12 years examination. Data on asthma prescribing over a one year period was obtained from the Prescription Pricing Authority.

RESULTS

Asthma was present in 16.8% of 12-year-olds. Tooth erosion was recorded in 59% of children with asthma and in 59.7% who were asthma free. There was no significant difference in erosion prevalence between asthmatics and asthma free in a cohort of children at age 12 or 14 years, and the incidence of erosion was 12.8% and 12.3%, respectively. 88% of drugs prescribed for treatment of asthma had a pH above the critical pH of 5.5.

CONCLUSION

There was no association between asthma and tooth erosion. The majority of drugs prescribed for the treatment of asthma are not potentially erosive.

Prevention. Part 3: prevention of tooth wear

Non-carious destruction of teeth has been observed in archaeological material from various parts of the world and clearly pre-dates the first appearance of dental caries. Attrition, abrasion and erosion are also described in the classic text of Pindborg on the pathology of the dental hard tissues. Whilst the dental profession, at least in affluent parts of the world, was engaged in diagnosing, treating and later preventing dental caries these other causes of tooth destruction were largely ignored.