Erosion caused by gastroesophageal reflux: diagnostic considerations

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.

Acidogenic Potential of Packaged Fruit Juices and its Effect on Plaque and Salivary pH

AIM

The aim of this study was to analyze the acidogenic potential of the various commercially available fruit juices and to evaluate the salivary and plaque pH changes before and after consumption of the fruit juices that were kept at various temperatures.

MATERIALS AND METHODS

Baseline plaque and salivary pH were measured for 30 volunteers, and the test was conducted for 4 consecutive days on which juices with a known pH was consumed, which were kept at varying temperatures. The resulting changes in the plaque and salivary pH were measured after 1, 5, 15, and 30 minutes of the consumption of the fruit juices using a portable standard digital pH meter.

RESULTS

Among the three juices compared, grape juice was found to be more acidic compared to the orange juice and pineapple juice. The pH fall was maximum after consumption of grape juice followed by orange and pineapple juice, respectively. The consumption of ice candy caused a greater fall in pH followed by the refrigerated juice and the juices that were kept at room temperature, respectively.

CONCLUSION

Parents are unaware of the harmful effects of endogenous acids in the fruit juices and their effect on the teeth. We, as primary dental care providers, should take initiatives to provide adequate knowledge and information regarding this new trend of consuming frozen fruit juices and must strongly discourage this form of consumption as a frequent habit.

CLINICAL SIGNIFICANCE

Though many presume that the readily available fruit juices are healthy, frequent consumption of these fruit juices causes acid dissolution of enamel as most of these juices have a pH below the critical level. Hence the present study was conducted to evaluate the erosive potential of the various commercial fruit juices. As with increased awareness by both the dentists and the parents, the problem of fruit-juice-induced tooth loss may be reduced.

HOW TO CITE THIS ARTICLE

Mehta LK, Hegde A, et al. Acidogenic Potential of Packaged Fruit Juices and its Effect on Plaque and Salivary pH. Int J Clin Pediatr Dent 2019;12(4):312-317.

In Vivo Electron Paramagnetic Resonance Tooth Dosimetry: Dependence of Radiation-Induced Signal Amplitude on the Enamel Thickness and Surface Area of Ex Vivo Human Teeth

In vivo L-band electron paramagnetic resonance tooth dosimetry is a newly developed and very promising method for retrospective biodosimetry in individuals who may have been exposed to significant levels of ionizing radiation. The present study aimed to determine the relationships among enamel thickness, enamel area, and measured electron paramagnetic resonance signal amplitude with a view to improve the quantitative accuracy of the dosimetry technique. Ten isolated incisors were irradiated using well-characterized doses, and their radiation-induced electron paramagnetic resonance signals were measured. Following the measurements, the enamel thickness and area of each tooth were measured using micro-focus computed tomography. Linear regression showed that the enamel area at each measurement position significantly affected the radiation-induced electron paramagnetic resonance signal amplitude (p < 0.001). Simulation data agreed well with this result. These results indicate that it is essential to properly consider enamel thickness and area when interpreting electron paramagnetic resonance tooth dosimetry measurements to optimize the accuracy of dose estimation.

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.

Influence of surface treatment on the wear of solid zirconia

OBJECTIVE

Recently there has been talk of the use of full-contour solid zirconia crowns or bridge restorations with no porcelain overlay. This could be a useful solution for patients with bruxism or limited interocclusal space. However, the hardness of zirconia could affect the opposite natural dentition. The aim of this in-vitro study was to investigate the role of surface treatments on the wear of a zirconia material and its antagonist.

MATERIALS AND METHODS

Fifty plates (10 × 10 × 1 mm) made of zirconia (LavaMulti(™) ZrO2, 3M ESPE), divided into five equal groups, were sandblasted and ground under standardized conditions with a fine-grit diamond bur (Komet Brasseler, Germany) to simulate clinical conditions. Group (a) was only fired, (b) was fired and sandblasted, (c) only ground, (d) was ground and additionally polished (EVE Ceramic Polishing-Set, Pforzheim) and (e) was ground and glazed. Wear behavior was measured with a pin-on-disk apparatus ABREX against 6 mm steatite balls as antagonists (45°, 5 N load, 5000 cycles, water). The amount of wear was determined topographically using a 3-D profilometer (Concept 3D, Mahr, Germany) by measuring the height loss of the antagonist and the depth of wear Pt of the zirconia.

RESULTS

In groups (a), (b), (c) and (d) the wear value Pt could not be determined (<1 μm). Wear values of the antagonists (steatite balls) revealed a similar outcome in contact with (b), (c) and (e) in the range of 81-85 μm, whereas (e) was more abrasive but not significantly. A noticeable difference in the wear of the antagonist showed group (d) to have the smallest value.

CONCLUSION

Polished zirconia seems to have the lowest wear on the antagonists, in contrast with the other kinds of surface treatment.

Restoration of Occlusal Vertical Dimension in Dental Erosion Caused by Gastroesophageal Reflux: Case Report

The authors describe a minimally invasive procedure for occlusal rehabilitation in a young patient presenting with mild mandibular prognathism and loss of occlusal vertical dimension caused by dental erosion from chronic gastroesophageal reflux.

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.

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.

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.

Factors affecting enamel and ceramic wear: a literature review

Enamel wear by ceramics may adversely affect maintenance of the vertical dimension of occlusion and can increase the potential for thermal sensitivity. In this article, factors related to the abrasion of enamel by dental ceramics are critically reviewed. Concepts of physical, microstructural, chemical, and surface characteristics of dental ceramics on wear are presented based on research published since 1950. A PubMed search for key words (wear of enamel and ceramic) was supplemented with a hand search to identify relevant peer-reviewed articles published in English. Based on the literature, it can be concluded that material factors, their proper handling, and control of the patient's intrinsic risk factors related to wear are critically important to the reduction of enamel wear by dental ceramics.

Analyzing the etiology of an extremely worn dentition

Patients requiring extensive restorative care frequently exhibit significant loss of tooth structure. Specific clinical findings in an extremely worn dentition may vary widely and are often confusing. Severe wear can result from a mechanical cause, a chemical cause, or a combination of causes. The location of the wear, the accompanying symptoms and signs, and information gained from the patient interview are essential components in determining the etiology. A diagnostic decision tree facilitates a systematic analysis and diagnosis of dental wear.