The relationship between gastro-oesophageal reflux disease and dental erosion

Effect of acidic environment on color and translucency of different indirect restorative materials

PURPOSE

The aim of the current study was to evaluate the effect of simulated gastric acid on the color and translucency of different indirect restorative materials.

MATERIALS AND METHODS

A total of 36 disc-shaped samples were cut by using an isomet saw and divided into four equal groups (n = 9) according to the material type: Group Z: translucent zirconia (Ceramill® Zolid ht.+ preshade, Amann Girrbach, Koblach, Austria); Group E: lithium disilicate (IPS e.max CAD, Ivoclar Vivadent AG, Schaan, Liechtenstein); Group C: resin nanoceramic (Cerasmart, GC, Tokyo, Japan); Group P: polyether ether ketone (PEEK) (Bettin Zirconia Dentale Italy) veneered with indirect high impact polymer composite (HIPC) (breCAM HIPC, Bredent GmbH & Co. KG, Germany). The samples were immersed in simulated gastric acid (HCl, pH 1.2) for 96 hours at 37 °C in an incubator. The color change (ΔE00) and translucency (RTP00) were measured every 9.6 hours (one-year clinical simulation) of immersion in simulated gastric acid.

RESULTS

For color change (∆E00) and translucency (RTP00) among the tested materials, there was a highly statistically significant difference (P < 0.001) after every year of follow-up. The color change in both Z and G groups was the lowest after 1 year of acid immersion, followed by that in group H, and the highest change in color was recorded in group P.

CONCLUSION

High translucent zirconia is recommended in patients who are concerned about esthetic, especially with acidic oral environment.

Effect of air-abrasion pretreatment with three bioactive materials on enamel susceptibility to erosion by artificial gastric juice

OBJECTIVE

The purpose of the study was to investigate the protective effect of three in-office preventive treatments with bioactive materials against enamel erosion induced by artificial gastric juice similar to that found in gastroesophageal reflux disease (GERD) patients. The treatments included air-abrasion of enamel with a fluoride-containing bioactive glass (BioMinF®), Bioglass 45S5 (ProSylc) and nano-hydroxyapatite (MI Pearls) to test enamel susceptibility following an erosive challenge.

METHODS

Enamel surface loss was evaluated using confocal microscopy, while changes in enamel surface roughness and morphology were also investigated after the treatments. SEM and EDS were used to observe formation of apatite crystals on enamel and to detect alterations in mineral composition. In Group 1 (negative control) the specimens did not receive any treatment; Group 2 specimens (positive control) treated with 0.4 % SnF₂, while in Groups 3-5 enamel was air-abraded with BioMinF®, ProSylc and MI Pearls, respectively.

RESULTS

All the experimental groups reduced significantly enamel surface loss compared to the negative control group (p < 0.05), except for the MI Pearls treatment (p > 0.05). The most protective behavior against erosion presented the treatment with SnF₂. BioMinF induced the larger amount of apatite crystals on the enamel surface, followed by ProSylc.

SIGNIFICANCE

BioMinF and ProSylc treatments may be beneficial against dental erosion induced by gastric juice in GERD patients, while MI Pearls treatment may not suitable for this indication. Both materials promote formation of apatite crystals on enamel in acidic conditions protecting the surface from the erosion. The tested treatments may be useful in GERD patients who cannot comply with at-home therapies with SnF₂.

Crown Reconstruction of Erosive Wear Using High-viscosity Glass Ionomer Cement: A Case Report

The aim of this clinical report is to present a possible alternative treatment, with 24-month follow-up, for restoring tooth loss due to extensive erosive tooth wear. A 21-year-old male patient, complaining of intense sensitivity in the maxillary posterior teeth, and presenting severe wear on maxillary premolar and molar teeth due to gastroesophageal reflux, sought care in the university clinics. The planned treatment was to refer for medical treatment and perform restorations with the high-viscosity glass ionomer cement Equia Forte (GC Corporation, Tokyo, Japan), aiming to restore the dental anatomy and to consequently decrease the pain symptomatology. A silicone guide, obtained from a diagnostic waxing, was used during the restorative approach considering the patient's occlusion. After all the clinical steps of the restorative technique, an occlusal adjustment of restorations was performed. During monthly recalls up to 24 months, the treatment was stable and in service. In addition, the patient reported no pain and improved chewing, leading to a better quality of life.

Atomic force microscopy analysis of the surface alterations of enamel, dentin, composite and ceramic materials exposed to low oral pH in GERD

Dental erosion is a significant topic in medical literature, both for gastroenterology and dental medicine. Dental structure loss has a psychosocial and functional significance. The pathogenesis of dental erosion in patients diagnosed with gastroesophageal reflux disease (GERD) characterized by the presence of an acidic oral environment after reflux episodes, is not well understood. The present study was designed to observe the effect of low oral pH in time on natural surfaces including enamel and dentine, but also on materials used in treating these dental destructions such as composites and ceramics. The acidic oral environment was estimated in relation to salivary pH. In the dental laboratory, 5-mm2 and 1-mm composite pieces of thick enamel, dentine, Emax Ceramic and Nexco Ivoclar were cut in order to be analyzed using atomic force microscopy (AFM) and to observe the surface alterations. Gastric acid was collected and mixed with saliva until a pH value of 6.0 was obtained, in which the pieces were immersed for 24, 120, 240 h. Roughness of each surface was calculated at a microstructure and nanostructure level. The results showed significant alterations in enamel and dentine exposed to a lower pH level beginning even at a short immersion time, in comparison with composites and ceramics which had no alterations. In conclusion, multidisciplinary attention should be given to detect and manage acidity of the oral cavity caused by GERD, in order to prevent dental erosion.

Potential of different fluoride gels to prevent erosive tooth wear caused by gastroesophageal reflux

Background

This in-vitro-study aimed to evaluate the potential of different fluoride gels to prevent gastroesophageal reflux induced erosive tooth wear.

Methods

Surface baseline profiles of a total of 50 bovine enamel specimens [randomly assigned to five groups (G1–5)] were recorded. All specimens were positioned in a custom made artificial oral cavity and perfused with artificial saliva (0.5 ml/min). Reflux was simulated 11 times a day during 12 h by adding HCl (pH 3.0) for 30 s (flow rate 2 ml/min). During the remaining 12 h (overnight), specimens were stored in artificial saliva and brushed twice a day (morning and evening) with a toothbrush and toothpaste slurry (15 brushing strokes). While specimens in the control group (G1) did not receive any further treatment, specimens in G2–5 were coated with different fluoride gels [Elmex Gelée (G2); Paro Amin Fluor Gelée (G3); Paro Fluor Gelée Natriumfluorid (G4); Sensodyne ProSchmelz Fluorid Gelée (G5)] in the evening for 30 s. After 20 days, surface profiles were recorded again and enamel loss was determined by comparing them with the baseline profiles. The results were statistically analysed using one-way analysis of variance (ANOVA) followed by Tukey`s HSD post-hoc test.

Results

The overall highest mean wear of enamel (9.88 ± 1.73 µm) was observed in the control group (G1), where no fluoride gel was applied. It was significantly higher (p < 0.001) compared to all other groups. G2 (5.03 ± 1.43 µm), G3 (5.47 ± 0.63 µm, p = 0.918) and G4 (5.14 ± 0.82 µm, p > 0.999) showed the overall best protection from hydrochloric acid induced erosion. Enamel wear in G5 (6.64 ± 0.86 µm) was significantly higher compared to G2 (p = 0.028) and G4 (p = 0.047).

Conclusions

After 20 days of daily application, all investigated fluoride gels are able to significantly reduce gastroesophageal reflux induced loss of enamel.

Gastroesophageal reflux disease: prevalence and Extraesophageal manifestations among undergraduate students in South West Nigeria

BACKGROUND

The reflux of noxious contents of the stomach may cause oesophageal and extra-oesophageal complications either by direct contact of aspirated gastric refluxate with the upper airway or by a vago-vagal reflex. This study aimed to determine the prevalence of gastroesophageal disease (GERD) and extraesophageal manifestations among undergraduate students in a tertiary institution in Nigeria.

METHODS

This is a cross-sectional study involving undergraduate students in a private University in Nigeria. Study proforma had three parts. Part A consisted of self-administered questionnaire designed to obtain students biodata. Part B consisted of standard Carlsson-Dent questionnaire. A score of 4 and above on Carlsson- Dent questionnaire was considered diagnostic of gastroesophageal reflux symptoms (GERD). Thereafter those who had GERD were further questioned and examined for extra-oesophageal symptoms of GERD.

RESULTS

The total number of the study participants was 647, out of which 212 (32.8%) had GERD. One hundred and forty-four (67.9%) and 86 (32.1%) females and male had GERD respectively (p = 0.13). The extraesophageal symptoms found in those with GERD were, dysphagia, coated tongue, nocturnal cough, xerostomia, lump in the throat, asthma-like symptoms, recurrent sore throat, frequent throat clearing, halithosis and dental erosion among others.

CONCLUSION

GERD is common among this study population, with a prevalence rate of 32.8%. Only age showed significant predictor for GERD. Varying extra-oesophageal manifestations were found in those with GERD.

Prevention of Enamel Softening by Rinsing with a Calcium Solution before Dental Erosion

OBJECTIVES

This in situ study aimed to evaluate whether rinsing with a calcium-containing solution prior to an erosive attack reduces the softening of enamel.

MATERIALS AND METHODS

A total of 240 bovine enamel samples with determined baseline surface microhardness (KHN) were allocated to 5 runs in which each of the 12 volunteers performed the following experiment: 4 enamel samples were inserted in a custom-made intraoral appliance and carried in the mouth (upper jaw) for 30 min before each volunteer either rinsed his mouth for 60 s with a fluoride- and stannous ion-containing dental erosion protection mouth rinse as positive control (run 1), milk (run 2), a solution prepared from a 500-mg calcium effervescent tablet dissolved in 100 mL (run 3) or 200 mL (run 4) water, or did not perform any rinsing with a test solution before the erosive attack (run 5, negative control). To simulate the erosive attack, volunteers rinsed their mouth with a commercial soft drink (Sprite Zero) for 60 s and afterwards with water to stop the erosive process. Finally, surface microhardness was measured again and hardness loss (ΔKHN) calculated. A mixed effect model was fitted to the data set to investigate whether the different runs showed differences with respect to ΔKHN.

RESULTS

No significant difference in softening of enamel (mean of ΔKHN; lower confidence level/upper confidence level) was observed between the negative control run 5 (50.7; 60.8/40.6), run 2 (50.7; 60.8/40.6), run 3 (38.7; 48.8/28.6) and run 4 (40.7; 50.8/30.6) (p > 0.05, respectively). Enamel softening in the positive control run 1 (25.4; 35.6/15.3) was significantly lower compared to the softening in run 5 (p < 0.001). No significant difference was observed between run 1 and run 3 (p = 0.09).

CONCLUSION

Other than the fluoride- and stannous ion-containing dental erosion protection mouth rinse, none of the investigated calcium-containing solutions is able to significantly reduce erosion-induced softening of enamel.

How to select patients for antireflux surgery? The ICARUS guidelines (international consensus regarding preoperative examinations and clinical characteristics assessment to select adult patients for antireflux surgery)

OBJECTIVE

Antireflux surgery can be proposed in patients with GORD, especially when proton pump inhibitor (PPI) use leads to incomplete symptom improvement. However, to date, international consensus guidelines on the clinical criteria and additional technical examinations used in patient selection for antireflux surgery are lacking. We aimed at generating key recommendations in the selection of patients for antireflux surgery.

DESIGN

We included 35 international experts (gastroenterologists, surgeons and physiologists) in a Delphi process and developed 37 statements that were revised by the Consensus Group, to start the Delphi process. Three voting rounds followed where each statement was presented with the evidence summary. The panel indicated the degree of agreement for the statement. When 80% of the Consensus Group agreed (A+/A) with a statement, this was defined as consensus. All votes were mutually anonymous.

RESULTS

Patients with heartburn with a satisfactory response to PPIs, patients with a hiatal hernia (HH), patients with oesophagitis Los Angeles (LA) grade B or higher and patients with Barrett's oesophagus are good candidates for antireflux surgery. An endoscopy prior to antireflux surgery is mandatory and a barium swallow should be performed in patients with suspicion of a HH or short oesophagus. Oesophageal manometry is mandatory to rule out major motility disorders. Finally, oesophageal pH (±impedance) monitoring of PPI is mandatory to select patients for antireflux surgery, if endoscopy is negative for unequivocal reflux oesophagitis.

CONCLUSION

With the ICARUS guidelines, we generated key recommendations for selection of patients for antireflux surgery.

[Tooth Erosions Associated with Gastroesophageal Reflux: Cause, Prevention and Restorative Therapy]

Tooth Erosions Associated with Gastroesophageal Reflux: Cause, Prevention and Restorative Therapy Abstract. Dental erosions are caused by the recurring contact of solutions which are unsaturated in tooth minerals,ith hard tooth substances. This initially leads to softening and later to an irreversible loss of hard tooth substance. Erosion is observed particularly with excessive consumption of acidic foods (e.g. soft drinks or citrus fruits) but also in connection with gastrointestinal (gastroesophageal reflux disease) or psychosomatic diseases (anorexia nervosa or bulimia nervosa). The aim of this article is to define dental erosions, their causes, prevalence and consequences as well as possible preventive measures. Based on a clinical example of a patient with reflux-related erosions, a therapy option with direct composite tooth build-up is presented.

Managing Bariatric Patients in Dentistry

Obesity is a growing issue across the world, presenting a range of challenges to society. Management of obese or bariatric patients in the dental environment has become more commonplace. This article considers an overview of obesity, reviews its dental impact and offers some solutions to minimising those challenges in the dental setting.

Gastro-oesophageal reflux is common in oligosymptomatic patients with dental erosion: A pH-impedance and endoscopic study

BACKGROUND

Dental erosion is a complication of gastro-oesophageal reflux disease (GORD) according to the Montreal consensus statement. However, GORD has not been comprehensively characterized in patients with dental erosions and pH-impedance measures have not been reported.

OBJECTIVES

Characterize GORD in patients with dental erosions using 24-h multichannel intraluminal pH-impedance measurements (pH-MII) and endoscopy.

METHODS

This single-centre study investigated reflux in successive patients presenting to dentists with dental erosion using pH-MII and endoscopy.

RESULTS

Of the 374 patients, 298 (80%) reported GORD symptoms <2 per week, 72 (19%) had oesophagitis and 59 (16%) had a hiatal hernia. In the 349 with pH-MII the mean percentage time with a pH <4 (95% CI) was 11.0 (9.3-12.7), and 34.4% (31.9-36.9) for a pH <5.5, a critical threshold for dental tissue. The mean numbers of total, acidic and weakly acidic reflux episodes were 71 (63-79), 43 (38-49) and 31 (26-35), respectively. Of the reflux episodes, 19% (17-21) reached the proximal oesophagus. In 241 (69%) patients reflux was abnormal using published normal values for acid exposure time and reflux episodes. No significant associations between the severity of dental erosions and any reflux variables were found. The presence of GORD symptoms and of oesophagitis or a hiatal hernia was associated with greater reflux, but not with increased dental erosion scores.

CONCLUSIONS

Significant oligosymptomatic gastro-oesophageal reflux occurs in the majority of patients with dental erosion. The degree of dental erosion did not correlate with any of the accepted quantitative reflux indicators. Definition of clinically relevant reflux parameters by pH-MII for dental erosion and of treatment guidelines are outstanding. Gastroenterologists and dentists need to be aware of the widely prevalent association between dental erosion and atypical GORD.

The wear and tear of teeth

A review is presented of the mechanical damage suffered by tooth crowns. This has been the subject of much recent research, resulting in a need to revise some of the thinking about the mechanisms involved. Damage is classified here by scale into macro-, meso- and microfracture. The focus is on the outer enamel coat because this is the contact tissue and where most fractures start. Enamel properties appear to be tailored to maximize hardness, but also to prevent fracture. The latter is achieved by the deployment of developmental flaws called enamel tufts. Macrofractures usually appear to initiate as extensions of tufts on the undersurface of the enamel adjacent to the enamel-dentine junction and extend from there into the enamel. Cracks that pass from the tooth surface tend to be deflected by an enamel region of high toughness; if they find the surface again, a chip (mesofracture) is produced. The real protection of the enamel-dentine junction here is the layer of decussating inner enamel. Finally, a novel analysis of mechanical wear (microfracture) suggests that the local toughness of the enamel is very important to its ability to resist tissue loss. Enamel and dentine have contrasting behaviours. Seen on a large scale, dentine is isotropic (behaving similarly in all directions) while enamel is anisotropic, but vice versa on a very small scale. These patterns have implications for anyone studying the fracture behaviour of teeth.

Restorative management using hybrid ceramic of a patient with severe tooth erosion from swimming: a clinical report

This clinical report presents the clinical appearance and treatment approach in a case of excessive anterior teeth erosion resulted from swimming in a poorly-chlorinated swimming pool. Clinical findings revealed tooth sensitivity, severe enamel erosion resembling veneer preparations, and the presence of anterior open bite. A novel hybrid ceramic (Vita Enamic) was chosen for fabricating full-coverage crowns for this patient. After 6-months follow-up, the tooth sensitivity disappeared and the patient was satisfied with esthetic outcome. The hybrid ceramic restorations can be recommended with no complications.

Dental approach to erosive tooth wear in gastroesophageal reflux disease

BACKGROUND

The duration of gastro-esophageal reflux disease (GERD), the frequency of reflux, the pH and type of acid, and the quality and quantity of saliva affect the severity of dental erosion due to GERD.

OBJECTIVE

To summarize the diagnostic protocol and treatment of dental erosion due to GERD.

METHODS

A Medline literature search was performed to identify articles associated with a dental approach to GERD.

RESULTS

The dental professional must carry out a diagnostic protocol, which includes collecting data on the patient's medical and dietary history, occupational/recreational history, dental history, and oral hygiene methods. Intraoral, head and neck, and salivary function examinations should be performed to expose the dental implications of GERD symptoms.

CONCLUSION

Diagnosing the cause of erosive tooth wear can help prevent further damage. Patients must be informed about how to prevent GERD.

Bioinspired amphiphilic phosphate block copolymers as non-fluoride materials to prevent dental erosion

Inspired by the fact that certain natural proteins, e.g. casein phosphopeptide or amelogenin, are able to prevent tooth erosion (mineral loss) and to enhance tooth remineralization, a synthetic amphiphilic diblock copolymer, containing a hydrophilic methacryloyloxyethyl phosphate block (MOEP) and a hydrophobic methyl methacrylate block (MMA), was designed as a novel non-fluoride agent to prevent tooth erosion under acidic conditions. The structure of the polymer, synthesized by reversible addition-fragment transfer (RAFT) polymerization, was confirmed by gel permeation chromatography (GPC), Fourier transform infrared spectroscopy (FTIR), and nuclear magnetic resonance spectroscopy (NMR). While the hydrophilic PMOEP block within the amphiphilic block copolymer strongly binds to the enamel surface, the PMMA block forms a hydrophobic shell to prevent acid attack on tooth enamel, thus preventing/reducing acid erosion. The polymer treatment not only effectively decreased the mineral loss of hydroxyapatite (HAP) by 36-46% compared to the untreated control, but also protected the surface morphology of the enamel specimen following exposure to acid. Additionally, experimental results confirmed that low pH values and high polymer concentrations facilitate polymer binding. Thus, the preliminary data suggests that this new amphiphilic diblock copolymer has the potential to be used as a non-fluoride ingredient for mouth-rinse or toothpaste to prevent/reduce tooth erosion.

Durability of the anti-erosive effect of surfaces sealants under erosive abrasive conditions

OBJECTIVE

To test the durability of sealants applied for prevention of erosive dentine mineral loss under erosive/abrasive conditions.

METHODS

Forty-eight bovine dentine samples doped with (32)P were randomly allocated to four groups (1-4). All samples performed a de- and remineralizations pre-cycling (6 × 1 min erosion in HCl: pH 3.0, mean time and overnight immersion in artificial saliva) for 1 day. Sealing was done as follows; (1) unsealed, (2) Seal & Protect, (3) K-0184 (experimental sealer) and (4) OptiBond FL. After sealing, samples were immersed in HCl for 3 h (baseline measurement). Then, the following erosive/abrasive and remineralisations cycling was performed for 8 days: 3 h/day erosion with HCl, 600 brushing strokes/day and storage in artificial saliva for the rest of the day. Sealer permeability was evaluated by assignation of (32)P in the acid used for the erosive attacks.

RESULTS

At baseline, the significantly highest dentine loss was observed for the unsealed control group, while the mineral loss was not statistically significantly different between the sealed groups 2 and 3. At all days of the erosive/abrasive and remineralizations cycling and cumulatively the significantly highest mineral loss was observed for group 1, while the significantly lowest mineral loss was observed for the samples sealed with Seal & Protect (group 2) and K-0184 (group 3). In all groups, no significant increase in the (32)P release was observed.

CONCLUSION

Surface sealants are able to reduce the erosive dentine mineral loss and maintain this erosion-preventing efficacy over the whole duration (simulating 8 month in-vivo) of the erosive/abrasive cycling.

Role of forensic odontologist in post mortem person identification

The natural teeth are the most durable organs in the bodies of vertebrates, and humankind's understanding of their own past and evolution relies heavily upon remnant dental evidence found as fossils. The use of features unique to the human dentition as an aid to personal identification is widely accepted within the forensic field. Comparative dental identifications play a major role in identifying the victims of violence, disaster or other mass tragedies. The comparison of ante-mortem and postmortem dental records to determine human identity has long been established. Indeed, it is still a major identification method in criminal investigations, mass disasters, grossly decomposed or traumatized bodies, and in other situations where visual identification is neither possible nor desirable. This article has comprehensively described some of the methods, and additional factors aiding in postmortem person identification.

Gastroesophageal reflux, dental erosion, and halitosis in epidemiological surveys: a systematic review

In published studies, it has been suggested that dental wear is associated with gastroesophageal reflux disease (GERD). This systematic review was carried out to evaluate the association of GERD, dental erosion, and halitosis and to compare the indices adopted in epidemiological surveys. The Medline database (until October, 2011) was searched systematically to identify studies evaluating the prevalence of oral alterations, such as dental erosion and halitosis, in patients with GERD symptoms. Two reviewers analyzed all reports and the selected studies were evaluated according to the quality of evidence, using the validated Newcastle-Ottawa Quality Assessment Scale. Full-text copies of a total of 32 publications were obtained in duplicate. Sixteen publications were identified among the citations in the Bibliographic lists of studies that fulfilled the exclusion/inclusion criteria and quality of evidence. The relationship between dental erosion and GERD patients was significant in only seven studies. According to three studies, halitosis could be one of several extraesophageal symptoms or manifestations in GERD patients. In one study, it was found that the mucosa of GERD patients was significantly more acidic in comparison with that of the control group. This systematic review showed that there is a relationship between GERD and oral diseases (dental erosion and halitosis). The epidemiological surveys used different indices to analyze GERD and dental erosion. Further research could investigate the best method for assessing the two diseases.

In vitro evaluation of the microhardness of bovine enamel exposed to acid solutions after bleaching

Acid erosion is a superficial loss of enamel caused by chemical processes that do not involve bacteria. Intrinsic and extrinsic factors, such as the presence of acid substances in the oral cavity, may cause a pH reduction, thus potentially increasing acid erosion. The aim of this study was to evaluate the microhardness of bleached and unbleached bovine enamel after immersion in a soda beverage, artificial powder juice and hydrochloric acid. The results obtained for the variables of exposure time, acid solution and substrate condition (bleached or unbleached enamel) were statistically analyzed by the ANOVA and Tukey tests. It was concluded that a decrease in microhardness renders dental structures more susceptible to erosion and mineral loss, and that teeth left unbleached show higher values of microhardness compared to bleached teeth.

Oral symptoms including dental erosion in gastroesophageal reflux disease are associated with decreased salivary flow volume and swallowing function

BACKGROUND

This preliminary clinical study aimed to evaluate the effects of salivary flow volume and swallowing function on oral symptoms including dental erosion in gastroesophageal reflux disease (GERD).

METHODS

The subjects were 40 GERD patients and 30 (15 younger, 15 older) healthy controls. Detailed medical, dietary, and dental histories were obtained to identify individual behavioral habits potentially associated with dental erosion. Oral examination evaluated dental erosion and determined scores for the decayed, missing, filled (DMF) index, the papillary, marginal, attached (PMA) index for gingivitis, and the Simplified Oral Hygiene Index (OHI-S). Salivary flow volume and swallowing function were evaluated by the Saxon test and repetitive saliva swallowing test, respectively.

RESULTS

The DMF index and OHI-S scores differed significantly between all 3 groups. The PMA index was significantly different between the GERD group and the two control groups. The prevalence of dental erosion was 24.3% in the GERD group (0% in the control groups). No specific relationship was found between the incidence of dental erosion and dietary history or behavioral habits. The Saxon test results were significantly lower in the GERD group than in both the control groups. Frequency of swallowing was significantly lower and time to first swallow was significantly longer in the GERD group than in the two control groups.

CONCLUSIONS

Oral symptoms in GERD are likely to be associated with impaired salivary flow volume or swallowing function. Treatment for the oral dryness induced by reduced salivary flow volume and rehabilitation for swallowing function could be indicated in patients with GERD.

Long-term protective effect of surface sealants against erosive wear by intrinsic and extrinsic acids

OBJECTIVE

To test sealants to prevent erosive tooth wear caused by extrinsic and intrinsic acids under long-term exposition.

METHODS

144 bovine enamel samples were randomly allocated to twelve groups (1-12). Samples of groups 1, 5 and 9 remained unsealed (positive controls), 2, 6 and 10 were sealed with Silicon Seal Nano Mix and 3, 7 and 11 with Seal&Protect. Groups 4, 8 and 12 were sealed with flowable composite (negative controls). Groups 1-4 were immersed in artificial saliva, 5-8 in hydrochloric acid and groups 9-12 in citric acid for 28 days, respectively. After 1, 2, 4, 7, 11, 14, 21 and 28 days, solutions were renewed and enamel wear was quantified by assignation of (32)P in the solutions.

RESULTS

In all immersion solutions, lowest mineral loss was observed for the negative controls whilst highest loss was observed for unsealed positive controls. In artificial saliva and citric acid, the loss from samples sealed with Seal&Protect was not significantly different compared with negative controls whilst loss in groups sealed with Silicon Seal Nano Mix was significantly higher. In hydrochloric acid, loss from samples sealed with Seal&Protect was not different compared with that of negative controls up to 4 days. Except day 1, the mineral loss in the Seal&Protect group was significantly lower compared with that of the Silicon Seal Nano Mix group.

CONCLUSION

The tested resin based surface sealant is able to significantly reduce the erosive demineralisation of enamel caused by hydrochloric and citric acid even under long-term exposition.

Oral health status, salivary factors and microbial analysis in patients with active gastro-oesophageal reflux disease

AIM

To present a complex oral health status including salivary factors, microbial analysis and periodontal and hygiene indices in patients with active gastro-oesophageal reflux disease (GORD). Return of stomach contents is quite common in cases of gastro-oesophageal reflux. Pathological acid movement from the stomach into the oesophagus and oral cavity may lead to a development of dental erosion. Long-lasting untreated GORD may damage hard dental and periodontal tissues and alter the oral microbial environment. The quality and amount of the saliva play an important role in hard and soft oral tissues changes.

METHOD

Fifty patients with diagnosed GORD using 24-hour pH manometry underwent dental examination; 24 patients had active GORD and had been waiting for surgical therapy. In this patient group oral health status and salivary analysis were evaluated.

RESULTS

Indicated low salivary flow rates and buffering capacity with a low caries risk but a high risk for dental erosion progression.

Erosive lesions in patients with alcoholism

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

CLINICAL IMPLICATIONS

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

A review of the structure of human and bovine dental hard tissues and their physicochemical behaviour in relation to erosive challenge and remineralisation

OBJECTIVES

This review sets out to examine the suitability of bovine hard dental material in lieu of human material when investigating dental erosion, to review the evidence for the major factors popularly attributed to dental erosion: pH, pKa, acid type, erosion duration, temperature and stirring rate as well as examine the case for the use of fluoride in an anti-erosion capacity.

DATA SOURCES

Published works were selected using online search software ICI Web of Knowledge and Pubmed, with key terms such as "enamel", "erosion" and "bovine AND human" and cross referenced with relevant papers cited in the indices.

RESULTS

The growing trend of dental erosion, coupled to legislative changes has precipitated a recent shortage of human enamel and dentine for experimental work. This in turn has resulted in the increasing use of cheap and readily available alternate supplies being sourced. This alternate supply principally originates from beef cattle under 20 months of age, under the assumption that bovine enamel and dentine will behave in a manner similar to human material. Recent experiments attempting to compare the physicochemical properties of these two species have shown that erosion is not simply a matter of bulk tissue loss resulting from acid exposure, but a multi-factorial event encompassing ever increasing and varied complexity of the inter-relationship between solvent and substrate.

CONCLUSIONS

Accurate data from the published literature regarding the comparative properties of human and bovine hard dental tissue remains scarce but consensus appears to accept the continuing use of bovine enamel as a substitute for human enamel. This lack of comparative data is further hampered by the lack of an established, standardised protocol with which to evaluate the two species. In addition, much debate remains regarding the significant principal factors responsible for dental erosion and ways to minimise the pathological manifestation.

Quantification of dental erosions in patients with GERD using optical coherence tomography before and after double-blind, randomized treatment with esomeprazole or placebo

OBJECTIVES

Dental erosion, the chemical dissolution of enamel without bacterial involvement, is a rarely reported manifestation of gastroesophageal reflux disease (GERD), as well as of recurrent vomiting and dietary habits. It leads to loss of tooth substance, hypersensitivity, functional impairment, and even tooth fracture. To date, dental erosions have been assessed using only very basic visual methods, and no evidence-based guidelines or studies exist regarding the prevention or treatment of GERD-related dental erosions.

METHODS

In this randomized, double-blind study, we used optical coherence tomography (OCT) to quantify dental tissue demineralization and enamel loss before and after 3 weeks of acid-suppressive treatment with esomeprazole 20 mg b.i.d. or placebo in 30 patients presenting to the Berne University Dental Clinic with advanced dental erosions and abnormal acid exposure by 24-h esophageal pH manometry (defined as >4% of the 24-h period with pH<4). Enamel thickness, reflectivity, and absorbance as measures of demineralization were quantified by OCT before and after therapy at identical localizations on teeth with most severe visible erosions as well as several other predefined changes in teeth.

RESULTS

The mean+/-s.e.m. decrease of enamel thickness of all teeth before and after treatment at the site of maximum exposure was 7.2+/-0.16 black trianglem with esomeprazole and 15.25+/-0.17black trianglem with placebo (P=0.013), representing a loss of 0.3% and 0.8% of the total enamel thickness, respectively. The change in optical reflectivity to a depth of 25 black trianglem after treatment was-1.122 +/-0.769 dB with esomeprazole and +2.059+/-0.534 dB with placebo (P 0.012), with increased reflectivity signifying demineralization.

CONCLUSIONS

OCT non-invasively detected and quantified significantly diminished progression of dental tissue demineralization and enamel loss after only 3 weeks of treatment with esomeprazole 20 mg b.i.d. vs. placebo. This suggests that esomeprazole may be useful in counteracting progression of GERD-related dental erosions. Further validation of preventative treatment regimens using this sensitive detection method is required, including longer follow-up and correlation with quantitative reflux measures.

Dental erosion caused by gastroesophageal reflux disease: a case report

Introduction

Chronic regurgitation of gastric acids in patients with gastroesophageal reflux disease may cause dental erosion, which can lead in combination with attrition or bruxism to extensive loss of coronal tooth tissue.

Case presentation

This clinical report describes treatment of severe tooth wear of a gastroesophageal reflux disease patient who is 54-year-old Turkish male patient. After his medical treatment, severe tooth wear, bruxism and decreased vertical dimensions were determined. The vertical dimension was re-established and maxillary and mandibular anterior and posterior teeth were prepared for metal-ceramic restorations. Metal-ceramic fixed partial dentures were fabricated as full mouth restorations for both maxillary and mandibular arches because of splinting all teeth. And then maxillary stabilization splint was fabricated for his bruxism history.

Conclusion

Significant loss of coronal tooth structure must taken into consideration. Gastroesophageal reflux disease by itself or in combination with attrition, abrasion or bruxism may be responsible for the loss. An extensive diagnostic evaluation is essential for the medical and dental effects of the problem.

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

OBJECTIVE

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

PATIENTS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Effect of pepsin on erosive tissue loss and the efficacy of fluoridation measures in dentine in vitro

OBJECTIVES

In dentine, erosive lesion progression and efficacy of fluoridation measures for symptomatic therapy of dental erosion are both dependent on the presence of the organic matrix. In patients with eating disorders in combination with chronic vomiting, the demineralized organic matrix can be degraded by gastric enzymes. The aim of this study was to investigate the effect of pepsin on erosion progression and the efficacy of fluoride in dentine.

MATERIAL AND METHODS

Human dentine specimens were prepared and randomly divided into 4 groups of 20 specimens each. They were subjected to a cyclic de- and remineralization procedure for 9 days. For demineralization (6 x 2 min per day), an HCl solution (pH 1.6) was used in all groups. In two groups, pepsin (1.5 mg mL(-1)) was added to the demineralization solution. Fluoridation was performed in two groups 6 x 1 min per day with a mouth rinse (Olaflur/SnF(2); 250 ppm F(-)) after demineralization with both the HCl solution and the pepsin containing solution. Degradation of collagen was quantified by analyzing hydroxyproline and tissue loss was determined microradiographically. SEM images were taken in addition.

RESULTS

In the pepsin group, 1.72 (0.26) microg mL(-1) (mean (SD)) hydroxyproline per day was detected, and in the pepsin-fluoride group 1.95 (0.50) microg mL(-1). Tissue loss after 9 days in the control group was similar to that in the pepsin group (122.2 (53.4) microm and 122.2 (38.0) microm, n.s., respectively). Fluoridation reduced tissue loss after demineralization (98.8 (30.2) microm) but not after pepsin treatment (125.2 (34.2) microm; p< or =0.05).

CONCLUSION

Under the conditions used, pepsin had no influence on tissue loss, but altered the efficacy of fluoridation measures.

Restoration of erosion associated with gastroesophageal reflux caused by anorexia nervosa using ceramic laminate veneers: a case report

Ceramic laminate veneers are useful to restore incisors suffering from severe erosion.

Dental demineralization associated with gastroesophageal reflux in an orthodontic patient

Gastroesophageal reflux is a common gastrointestinal disorder that can cause irreversible damage to the hard tissues of the teeth. We report an adolescent patient with severe dental demineralization associated with gastroesophageal reflux during orthodontic treatment. Diagnosis and prevention aspects are presented and discussed.

Protective effect of the in situ pellicle on dentin erosion–an ex vivo pilot study

AIM

The acquired pellicle is well known as an anti-erosive proteinaceous layer on enamel, but its protective properties on dentin have not been investigated in detail until now. The aim of the present ex vivo study was to evaluate the erosive effects on pellicle coated dentin.

METHODS

Bovine dentin slabs were exposed to the oral cavity of one subject for 120 min for in situ pellicle formation. Subsequently, the slabs were incubated with HCl (pH 2.3) in vitro for 5 min and erosive calcium-release was measured photometrically. In addition, the acid treated specimens were evaluated by transmission electron microscopy (TEM). Pellicle free samples served as controls.

RESULTS

Calcium erosion from the pellicle coated dentin slabs amounted to 23.5+/-2.9 microg Ca/min (pellicle free samples: 32.2+/-4.2 microg Ca/min). The difference was statistically significant (p < or = 0.05). In pellicle coated as well as in uncoated dentin samples, TEM-evaluation showed a demineralised dentinal surface layer which thickness ranged between 3 and 6 microm. The pellicle itself was partially dissolved but not removed by hydrochloric acid treatment.

CONCLUSION

The protective properties of the acquired pellicle against an erosive challenge of the dentinal surface are limited. The dentinal pellicle functions like an ion permeable network rather than a barrier.

Erosive effects of different acids on bovine enamel: release of calcium and phosphate in vitro

The present study intended to investigate minimal erosive effects of different acids on enamel during short time incubation via determination of calcium and phosphate dissolution. Bovine enamel specimens were eroded for 1-5 min with eight different acids of pH 2, 2.3 and 3 (citric (CA), maleic (MA), lactic (LA), tartaric (TA), phosphoric (PA), oxalic (OA), acetic (AA) and hydrochloric acid (HCl)). Calcium (Ca) and phosphate (P) release were determined photometrically using arsenazo III (calcium) and malachite green (phosphate) as substrates. Each subgroup contained eight enamel specimens. Amount of titratable acid was determined for all acidic solutions. MA, LA, TA, AA and HCl caused linear release of Ca and P, PA of Ca, CA of P. For CA, MA, LA, TA, AA, PA and HCl mineral loss was shown to be pH-dependent. Ca dissolution varied between 28.6+/-4.4 (LA, pH 2) and 2.4+/-0.7 nmol mm(-2)min(-1) (HCl, pH 3), P dissolution ranged between 17.2+/-2.6 (LA, pH 2) and 1.4+/-0.4 nmol mm(-2)min(-1) (HCl, pH 3). LA was one of the most erosive acids. AA was very erosive at pH 3. HCl and MA were shown to have the lowest erosive effects. There was only a weak correlation (r=0.28) between P and Ca release and the amount of titratable acid. The method of the present study allows investigation of minimal erosive effects via direct determination of P and Ca dissolution. During short time exposition at constant pH level, erosive effects mainly depend on pH and type of acid but not on amount of titratable acid.

The prevalence of dental erosion in Nigerian patients with gastro-oesophageal reflux disease

Background

In various people of the Western world, gastro-oesophageal reflux (GOR) has been reported to be a common problem. Various studies have also assessed the relationship between GOR and dental erosion. The authors are not aware of such studies in Nigerians. It is therefore the aims of the present study to estimate the prevalence of GOR; to estimate the prevalence of dental erosion in patients with GORD; to document the oral findings in patients diagnosed with GORD and to compare these findings with previous studies elsewhere.

Methods

A total of 225 subjects comprising of 100 volunteers and 125 patients diagnosed with GORD were involved in this study. History of gastric juice regurgitation and heartburn were recorded. Oral examination to quantify loss of tooth structure was done using the tooth wear index (TWI) designed by Smith and Knight (1984).

Results

Twenty patients with GORD presented with dental erosion in the maxillary anterior teeth with TWI scores ranging from 1–3. The prevalence of erosion was found to be statistically significant between GORD patients (16%) and control (5%) (p < 0.05), but not significant between endoscopic diagnostic groups (p > 0.05).

Conclusion

The present study supports the consideration of dental erosion as the extra-oesophageal manifestation of GORD. However the association between GORD and burning mouth sensation needs more investigation.

Gastroesophageal reflux disease, tooth erosion, and prosthodontic rehabilitation: A clinical report

Gastroesophageal reflux disease (GERD) is a relatively common gastrointestinal disorder in the United States. The reflux of acid adversely affects the mucosal lining of the esophagus and is responsible for dental erosion. This article briefly reviews the etiology, risk factors, and medical management of GERD. The patient presentation describes the rehabilitation of a young adult with GERD who needed multidisciplinary care.

The validation of Quantitative light-induced fluorescence to quantify acid erosion of human enamel

OBJECTIVE

The purpose of this study was to validate the Quantitative light-induced fluorescence (QLF) device against transverse microradiography (TMR) with regard to the quantification of enamel erosion in vitro.

DESIGN

Longitudinal in vitro.

METHODS

Thirty previously extracted, caries free, human premolars were selected and prepared by gentle pumicing and coating in an acid-resistant nail-varnish save for an exposed window on the buccal surface. QLF baseline images were taken and the teeth then exposed to an erosive solution, 0.1% citric acid (pH 2.74). Teeth were removed at 30min intervals, air-dried and QLF images taken. At this time one tooth was randomly selected, removed from solution and sectioned through the lesion at three sites. The polished sample (100microm) was subjected to TMR and analysed for erosive mineral loss using proprietary software, with the DeltaZ values noted. QLF images were analysed by a blinded examiner with DeltaF and DeltaQ values recorded. Data were entered into SPSS and the correlation between the DeltaZ and DeltaF, and DeltaZ and DeltaQ values calculated.

RESULTS

A wide range of erosive lesions was produced, with a steady increase in both DeltaZ and DeltaF over time; DeltaZ (24.0 (S.D. 1.2)-6114.3 (S.D. 1177.57)); DeltaF (1.8-11.2), DeltaQ (2.5-202.6). The results were scatter plotted and a regression line calculated. A positive correlation between DeltaZ and DeltaF of 0.91 was found, and for DeltaZ and DeltaQ; 0.87.

CONCLUSIONS

The ability for QLF to detect and longitudinally monitor in vitro erosion has been shown. The strong positive correlation of DeltaF with DeltaZ suggests that percentage fluorescence loss as measured by QLF could be of great value in the development of a non-destructive, longitudinal tool for use in vitro, in situ and possibly in vivo.

Oral manifestations in a group of young patients with anorexia nervosa

Anorexia nervosa (AN) is an eating disorder (ED) identified using DSM-IV criteria. Eating disorders are occurring increasingly earlier in childhood and can lead to a series of oral manifestations. The aim of this study was to evaluate the correlation between stomatognathic lesions and eating disorders in 80 young patients (76 females and 4 males aged 9-18 years) with restricting or binge-eating/purging AN. The results confirm the close correlation between ED and oral lesions, the most common of which were dental erosion, dentinal hypersensitivity, the extrusion of amalgam restorations and xerostomia. The authors conclude by emphasising the importance of involving dentists in the diagnosis and treatment of ED.

Oral health of children with gastro-esophageal reflux disease: a controlled study

BACKGROUND

The aim of this study was to compare the dental health of children with gastro-esophageal reflux disease (GERD) with a healthy control group.

METHODS

Dental examinations were conducted for 52 children (31 boys and 21 girls) with a definitive history of GERD. For every subject enrolled in the study, a healthy control sibling without the condition was recruited. Medical histories were obtained from medical records, and dental and dietary histories were obtained from parents. The teeth were examined for erosion, dental caries, and enamel hypoplasia, and sampled for Streptococcus mutans.

RESULTS

The prevalence of erosion by teeth was found to be statistically significant between GERD patients (14 per cent) and controls (10 per cent) (p<0.05). GERD patients had erosion in more permanent teeth compared to controls (4 per cent vs 0.8 per cent, p<0.05), and more severe erosion (p<0.05). Caries experience was also higher in GERD patients compared to controls (p<0.05). Although there were more subjects with Streptococcus mutans in the GERD group compared to the control group (42 per cent vs 25 per cent), the difference was not statistically significant.

CONCLUSIONS

Children with GERD have more erosion and dental caries compared to healthy controls and should be targeted for increased preventive and restorative care.

Dental erosion caused by silent gastroesophageal reflux disease

BACKGROUND

Gastroesophageal reflux disease, or GERD, is a relatively common condition, in which stomach acid may be refluxed up through the esophagus and into the oral cavity, resulting in enamel erosion. Symptoms such as belching, unexplained sour taste and heartburn usually alert the patient to the condition. In silent GERD, however, these symptoms do not occur, and enamel erosion of the posterior dentition may be the first indication of GERD.

CASE DESCRIPTION

A 30-year-old man came to a dental clinic with enamel erosion on the occlusal surfaces of his posterior teeth and the palatal surfaces of his maxillary anterior teeth. He reported no history of gastrointestinal disease or heartburn.

CLINICAL IMPLICATIONS

Enamel erosion may be a clinical sign of silent GERD that allows the dentist to make the initial diagnosis. Referral to a physician or gastroenterologist is necessary to define the diagnosis; however, dental expertise may be essential in distinguishing between differential diagnoses such as bulimia, attrition and abrasion. Successful treatment of this medical condition is necessary before dental rehabilitation can be initiated successfully.

Dental erosion patterns from intrinsic acid regurgitation and vomiting

BACKGROUND

The distribution of lesions from dental erosion due to intrinsic acid regurgitation and vomiting may be different from patterns of dental erosion due to extrinsic acids. To date studies have failed to validate this assumption. This study described the sites and nature of lesions from dental erosion in cases of intrinsic acid regurgitation, and compared them with the distribution of lesions occurring in age and sex matched controls, whose lesions are due to extrinsic acids.

METHODS

The University of Queensland tooth wear clinic patients were screened to select 30 cases, 21 self-identified bulimics and nine medically diagnosed chronic gastric acid regurgitators, and 30 controls. Epoxy resin models of the subjects' dentition were examined under stereoscopic light microscope at magnification 16 to 40. The patterns and sites of tooth wear were recorded for teeth representative of 20 tooth sites in every subject.

RESULTS

While the incisal edges of maxillary and mandibular anterior teeth of acid regurgitators were more frequently affected by erosion, incisal attrition was more common on controls' teeth. Cervical lesions were more commonly found in association with incisal attrition in the controls, and in association with incisal erosion in the cases. In 10 per cent of sites in case subjects, cervical lesions associated with incisal erosion were found on the lingual aspects of their mandibular incisors, canines and premolars. These lesions were almost exclusive to the case subjects.

CONCLUSIONS

These results validate that lingual cervical lesions associated with incisal erosion on the mandibular anterior teeth are strong discriminators between tooth wear in patients with bulimia nervosa or chronic gastro-oesophageal reflux and those whose dental erosion is due to extrinsic acids.

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

OBJECTIVES

The aims of this study were firstly to assess and compare the prevalence of dental erosion and dietary intake between three groups of children; children with asthma, those with significant tooth erosion but with no history of asthma, and children with no history of asthma or other medical problems. Secondly, to discover whether there was a relationship between medical history and dietary practises of these children and the levels of dental erosion. Thirdly, to measure and compare their salivary flow rates, pH and buffering capacity.

METHODS

The study consisted of 3 groups of children aged 11-18 years attending Birmingham Dental Hospital: 20 children with asthma requiring long-term medication, 20 children referred with dental erosion, and 20 children in the age and sex matched control group. Tooth wear was recorded using a modification of the tooth wear index (TWI) of Smith and Knight. Data on the medical and dietary history were obtained from a self-reported questionnaire supplemented by a structured interview. The salivary samples were collected under standard methods for measurements.

RESULTS

Fifty percent of the children in the control group had low erosion and 50% moderate erosion. However, high levels were recorded in 35% of children in the asthma group and 65% in the erosion group. There appeared to be no overall differences in diet between the groups. There was an association between dental erosion and the consumption of soft drinks, carbonated beverages and fresh fruits in all the three groups. More variables related to erosion were found in the erosion and asthma groups. A comparison between the three groups showed no significant differences in unstimulated and stimulated salivary flow rates, or pH and buffering capacity.

CONCLUSION

There were significant differences in the prevalence of erosion between the three groups, children with asthma having a higher prevalence than the control group. Although there was a relationship between the levels of erosion and some medical history and acidic dietary components, these did not explain the higher levels in asthmatic children. Further investigation is required into the factors affecting the increased prevalence of erosion in children with asthma.

Associated postmortem dental findings as an aid to personal identification

The use of the unique features of the human dentition to aid in personal identification is well accepted within the forensic field. Indeed, despite advances in DNA and other identification methodologies, comparative dental identifications still play a major role in identifying the victims of violence, disaster or other misfortune. The classic comparative dental identification employs the use of postmortem and antemortem dental records (principally written notes and radiographs) to determine similarities and exclude discrepancies. In many cases the tentative identification of the individual is unknown and therefore antemortem records cannot be located. In such a situation a dental profile of the individual is developed to aid the search for the individual's identity. With such a profile a forensic odontologist can identify and report indicators for age at time of death, race (within the four major ethnic groups) and sex. In addition to these parameters the forensic dentist may be able to give more insight into the individual. This paper outlines, for the non-expert, some of the additional personal information that can be derived from the teeth of the deceased, and which may assist in their ultimate identification.

Eating disorders: dental implications

This article presents updated information on the 2 major eating disorders, anorexia nervosa and bulimia nervosa. Both conditions are found primarily in women. The eating disorders have significant morbidity and mortality associated with them. Patients are vulnerable to sudden death from cardiac arrhythmias. Suicide is a concern in some patients. The etiology of the eating disorders is unknown, but genetic, cultural, and psychiatric factors appear to play a role. Medical management may involve hospitalization to stabilize the patient, behavior modification, drugs, and psychotherapy. The long-term outcome of treatment is unclear at this time. The role of the dentist as a "case finder" is discussed. Also, the role of the dentist in restoring the dental and oral tissues to a healthy state in patients with eating disorders is presented.

Risk indicators for tooth wear in New Zealand school children

AIM

To investigate the prevalence and severity of tooth wear in the primary dentition of a representative sample of New Zealand school children and relate these to possible risk factors.

DESIGN

A cross-sectional study.

SETTING

Primary schools in Dunedin, New Zealand.

PARTICIPANTS

104 children of both sexes, aged between 5 and 8 years, randomly selected.

METHODS

Clinical examinations of the buccal, occlusal/incisal and lingual surfaces of deciduous canines and molars.

MAIN OUTCOME MEASURE

Degree of wear and the presence of dentinal cupping of teeth. Information on weaning and consumption of fruit-based drinks at bed time, frequency of consumption of fruits, yoghurt, pickled foods, fizzy and fruit-based drinks.

RESULTS

The prevalence of tooth wear was similar in boys and girls and there were no significant differences between sides of the arches. A high percentage (82%) of children had at least one primary tooth with dentine exposed. While maxillary canines showed the greatest prevalence of dentine exposed, maxillary molars displayed the greatest prevalence of cupping. Severe tooth wear was less prevalent among children weaned after 12 months (14.3%) than those weaned earlier (27.9% P < 0.01). There were no statistically significant associations between wear and the consumption of fruit, yoghurt, pickled foods, fizzy drinks or fruit-based drinks.

CONCLUSIONS

Tooth wear associated with dentine exposure is common in 5-8 year old children. This is not significantly associated with dietary factors, but appears to be related to early weaning from the breast.

The oral medicine of tooth wear

This review illustrates, through a series of case histories, how oral medicine insights aid the diagnosis and management of patients with excessive tooth wear. The cases reviewed are drawn from the records of 500 southeast Queensland patients referred to the author over a 12 year period. Patients most at risk of dental erosion have work and sports dehydration, caffeine addiction, gastro-oesophageal reflux, asthma, diabetes mellitus, hypertension or other systemic diseases or syndromes that predispose to xerostomia. Saliva protects the teeth from the extrinsic and intrinsic acids which cause dental erosion. Erosion, exacerbated by attrition and abrasion, is the main cause of tooth wear. These cases illustrate that teeth, oral mucosa, salivary glands, skin and eyes should be examined for evidence of salivary hypofunction and attendant medical conditions. Based on comprehensive oral medicine, dietary analyses and advice, it would seem patients need self-management plans to deal with incipient chronic tooth wear. The alternative is the expensive treatment of pain, occlusal damage and pulp death required to repair the effects of acute severe tooth wear.