Dental erosion. Definition, classification and links

Morphological characteristics of non-carious cervical lesions. A systematic review

OBJECTIVES

This systematic review assessed the morphological characteristics of non-carious cervical lesions (NCCL), among clinical and ex-vivo studies assessed by observational and imaging methods.

DESIGN

The search strategy was conducted on four online databases (MEDLINE, Embase, Scopus and Web of Science) and grey literature (Google Scholar and OpenGrey). The study selection was performed by three reviewers from March to September (2023). The eligibility criteria were established according to the PICO strategy and included NCCL, morphological characteristics and clinical and ex-vivo study designs. The data extraction considered general data that identifies the study, evaluation method, parameter to assess the outcome and the main results for each study. The risk of bias was evaluated using Joanna Briggs Institute critical appraisal tool, and a personalized tool.

RESULTS

The search resulted in 252 studies. A total of 14 studies were included. Prevalence of NCCLs ranged from 3.5 %to 77.78 % with a higher presence in premolars. Common characteristics were wear facets, occluded tubules or cracks, occlusal stress, scratch marks, dimples and craters, structure loss, and dentin sclerosis, which appear more often on buccal surface and were generally classified as wedge-shaped, saucer-shaped. Etiological hypothesis was mainly related to multifactorial factors. In most of the studies, the risk of bias was classified as high.

CONCLUSIONS

The morphological characteristics of NCCL showed a wide range of descriptions regarding appearance, prevalence, lesion-related measures, and macro and microscopic descriptions.

Oral Health Status of Workers in Acid Exposure Environments in Japan: A Cross-sectional Study

Although the working environment may play a role in dental acid erosion, few studies have been conducted on this in Japanese workers in recent years. The purpose of this study was to investigate oral health status, including dental erosion, in workers who may have been exposed to an acidic environment. The study participants were recruited by an online research company. Oral examinations and questionnaire surveys were conducted on this cohort in January 2023. A total of 144 participants were finally included. Workers exposed to an acidic environment showed more use of protective equipment and underwent more dental examinations at the workplace (p<0.001). Possible dental erosion was observed in only 3 out of the total of 144 participants (2.1%), however. No significant difference was observed in the number of teeth, caries experience, or dental erosion according to the number of years of acid exposure in the workplace. The results of this study suggest that acid exposure exerts a relatively small effect on the oral health status of workers in Japan.

Dental care staff's experience with risk assessment of dental erosion: a qualitative study

BACKGROUND

The risk assessment of dental erosion among children and adolescents is an important aspect of dental care, as dental erosion constitutes a rapidly growing, global problem. Dental professionals rely solely on their own perception, as the current risk assessment process is not completely automatized, which affects the risk assessment reliability.

AIM

To explore dental professionals' experiences with risk assessment of dental erosion among children and adolescents.

METHOD

In-depth interview was used as data collection method. A total of 11 dental professionals were interviewed. The interviews were analyzed using qualitative content analysis.

RESULTS

The findings were summarized in the categories Professionals' responsibility, Systematic approach , and Collaboration and communication. Dental staff perceived that their basic knowledge regarding erosion should be improved, and skills development was desired to reduce the knowledge gaps around the risk assessment of dental erosion. They alleged that the systematic approach could be improved by reducing workplace stress, implementing a universal dental erosion index, improving the existing risk assessment software, and automating the risk assessment of the condition. Dental professionals also experienced a need to calibrate and collaborate with each other and with other healthcare professionals to improve patient care.

CONCLUSION

Dental professionals experienced their basic knowledge of dental erosion and their risk assessment as good, but a more advanced skill development was required. Furthermore, they experienced the risk assessment software as a good tool that should be improved to compile more objective risk assessment. A universal erosion index was also requested.

Erosion protective properties of the enamel pellicle in-situ

OBJECTIVES

Previous studies on short- and long-term pellicles showed that the enamel pellicle provides partial protection against erosion. The aim of the present study was to investigate the protective properties of clinically relevant pellicles formed within 2 to 24 h. The hypothesis was that factors such as pellicle formation time, intraoral location, and acidic challenge severity would not influence the erosion-protective properties of the pellicle.

METHODS

Six subjects participated in the study. Bovine enamel specimens were prepared and intraorally exposed at buccal or palatal sites for 2, 6, 12, and 24 h to allow pellicle formation, followed by erosion using 0.1 % or 1 % citric acid. Calcium release and surface microhardness were measured, and specimens were analysed using scanning and transmission electron microscopy. Quantitative data were statistically analysed with three-way ANOVA and Tuckey's multiple comparison test (p = 0.05).

RESULTS

Pellicle formation time and intraoral location did not significantly influence the erosion-protective properties of the pellicle, while citric acid concentration significantly affected enamel erosion. The pellicle thickness increased with longer formation times and on buccal sites, but decreased or was entirely removed following treatment with 0.1 % or 1 % citric acid, respectively. The enamel surface exhibited a characteristic erosion pattern.

CONCLUSIONS

This study underscores the importance of investigating pellicle properties within the critical 2- to 24-h timeframe and highlights the significance of pellicle thickness in acid resistance.

CLINICAL SIGNIFICANCE

These findings provide valuable insights into the factors influencing the protective properties of enamel pellicles and could guide preventive measures in dental practice.

A Comprehensive Review on Manufacturing and Characterization of Polyetheretherketone Polymers for Dental Implant Applications

Aging, tooth trauma, and pathological infections cause partial or total tooth loss, leading to the usage of dental implants for restoration treatments. As such, mechanical and tribological properties play an important role in the osseointegration and durability of these implants. Metallic and ceramic implants are shown to have mechanical properties much higher than the natural teeth structure, leading to stress shielding-related failure of an implant. Stress shielding occurs due to the difference in the elastic modulus between the implant material and the surrounding teeth structure, leading to bone loss and implant failure. The implant's properties (i.e., mechanical) should be as close as human teeth components. To achieve this, various materials and coatings are being developed and investigated. This review is a comprehensive survey of materials, manufacturing, coating techniques, and mechanical and tribological characterizations of dental implants, with a particular focus on polyetheretherketone (PEEK) as a potential alternative dental implant material. PEEK has mechanical properties similar to natural teeth, which make it a promising material for dental implants. The findings of this review suggest that PEEK offers superior biocompatibility, osseointegration, and wear resistance for implant applications. With the help of bioactive coatings, bone growth on the implant surface can be promoted. In addition, PEEK dental implants made using three-dimensional (3D) printing technology can significantly reduce the cost of implants, making them more affordable and increasing access to dental care, which can improve oral health significantly. In summary, this review highlights the potential of PEEK as a promising alternative dental implant material, and provides an overview of various techniques, testing, and future directions for PEEK dental implants.

Erosive Effect of Canned Juices and Soft Drinks on Surface Roughness of Restorative Materials Used in Pediatric Dentistry: An Ex Vivo Study

Aim

To evaluate and compare the effect of fruit juice (orange) and cola drink (noncarbonated) on the surface texture of composite (3M ESPE Filtek Bulk Fill) and glass ionomer cement (GIC) (ChemFil Superior).

Materials and methods

A total of eighty pellets each were prepared with composite (3M ESPE Filtek Bulk Fill) and GIC (ChemFil Superior) material using a brass mold with an inner diameter of 3 mm and a thickness of 3 mm according to the manufacturer's instructions. Around 10 pellets of each material were placed in airtight plastic containers. The baseline surface texture value was obtained by profilometer. An 8-day immersion regime was carried out according to Maupome et al. After the 8-day test period, pellets were reevaluated for surface texture final value. The values were statistically analyzed.

Results

A statistically significant lower surface roughness of composite restorative material was observed when treated with high-concentration orange juice and medium-concentration. Conversely, a statistically significant lower surface roughness of GIC restorative material was observed when it was treated with the low-concentration group, high-concentration orange juice, and medium-concentration orange juice.

Conclusion

The surface roughness patterns of restorative materials increased as the number of immersion regimes increased.

How to cite this article

Vishwanathaiah S, Maganur PC, Khabrany HM, et al. Erosive Effect of Canned Juices and Soft Drinks on Surface Roughness of Restorative Materials Used in Pediatric Dentistry: An Ex Vivo Study. Int J Clin Pediatr Dent 2024;17(7):807-811.

Prevalence and Risk Factors of Bone and Dental Lesions in Neotropical Deer

Bone and dental lesions have been documented in various deer species globally, affecting the efficiency of ingestion and digestion, consequently influencing their general health and leading to a decline in survival and reproductive performance. The present study aimed to characterize bone and dental lesions in the dry skulls of individual deer, estimate the prevalence of these lesions, and assess potential risk factors associated with the development of bone and dental alterations. This study assessed bone and dental lesions in 180 dry skulls of eleven neotropical deer species, originating from both captivity and wildlife conditions, through direct visual inspection. A high prevalence of bone and dental lesions was observed in all analyzed species. Dental calculus was the most common alteration (96.7%), followed by dental wear (71.1%). Animal age positively correlated with most bone and dental alterations, indicating that older animals showed more lesions. Additionally, the prevalence of these alterations was similar between sexes. Moreover, all lesions were more common in captive-bred animals, likely attributed to their older age and a less diverse diet. Blastocerus dichotomus and Mazama americana were most affected by bone resorption and dental trauma and had the highest dental calculus prevalence, along with Subulo gouazoubira and Passalites nemorivagus. All eleven species evaluated in the present study were susceptible to the occurrence of bone and dental lesions. Therefore, monitoring oral health and diet in captivity are fundamental practices for the conservation of these species.

Should We Wait to Brush Our Teeth? A Scoping Review Regarding Dental Caries and Erosive Tooth Wear

BACKGROUND

Tooth brushing is a universal recommendation. However, the recommendations related to the time of its execution are conflicting, especially when dealing with patients at risk of erosive tooth wear (ETW) or dental caries.

SUMMARY

Our objective was to summarize the evidence on the timing of brushing with fluoridated toothpaste in relation to ETW and cariogenic dietary challenges. We conducted a scoping review following the PRISMA-ScR checklist, using three databases searching for in vivo, in situ, or in vitro studies involving human teeth exposed to either a cariogenic or an erosive challenge. Only models including human saliva and fluoride were assessed. Data selection, extraction, and risk of bias analysis were done in duplicate and independently. From 1,545 identified studies, 17 (16 related to ETW and 1 to dental caries) were included. Most evidence (n = 10) supported that brushing with a fluoride-containing product does not increase ETW, independent of the moment of brushing. Delaying tooth brushing up to 1 h (n = 4) or individualized recommendations based on the patient's problem (n = 2) were less frequent. Only one study reported that brushing pre- or post-meal does not affect Streptococcus mutans counts. Most data were in situ (n = 13), and the overall study quality was judged as sufficient/low risk of bias.

KEY MESSAGES

Although the available evidence lacked robust clinical studies, tooth brushing using fluoridated products immediately after an erosive challenge does not increase the risk of ETW and can be recommended, which is in line with recommendations for dental caries prevention. Furthermore, we suggest updating the international guidelines to promote individualized recommendations based on risk factors to prevent either ETW or dental caries.

The erosive effect of pomegranate juice on enamel: An in vitro study

AIM

Dental erosion is a chemical-mechanical process that leads to the loss of dental hard tissues. This study aimed to investigate the effect of pomegranate juice on the enamel.

METHODS

Enamel blocks were randomly divided into three groups: deionized water, cola, and pomegranate juice. The blocks were immersed in the solutions four times a day for 14 days, and stored in artificial saliva for the remaining period. The surface hardness was measured on days 7 and 14. The surface structures of the demineralized blocks were observed via scanning electron microscopy (SEM), and the depth of demineralization was observed via confocal laser scanning microscopy (CLSM). The pH, calcium, and phosphorus levels of the three solutions were analyzed.

RESULTS

The microhardness values of the blocks in the pomegranate juice and cola groups decreased with the increase in the demineralization time. The blocks in the pomegranate juice group exhibited large fractures in the enamel column, whereas those in the cola group had pitted enamels with destruction of the interstitial enamel column. Compared with cola group, fluorescent penetration increased in pomegranate juice (P < 0.01). The pH of cola (2.32 ± 0.09) was lower than that of pomegranate juice (3.16 ± 0.16). Furthermore, the calcium content in pomegranate juice was significantly higher than that in cola (P < 0.01). Alternatively, the concentration of phosphorous in cola was significantly higher than that in pomegranate juice (P < 0.01).

CONCLUSION

These findings indicate that pomegranate juice can cause enamel demineralization with an erosive potential comparable to that of cola.

Carbon dots combined with phytosphingosine inhibit acid-induced demineralization of hydroxyapatite in vitro

OBJECTIVES

To study the effects of carbon dots (CDs), in combination with phytosphingosine (PHS), against acid-induced demineralization of hydroxyapatite in vitro.

METHODS

CDs were generated from citric acid and urea by microwave heating. Transmission electron microscope (TEM), FT-IR, and fluorescence intensity were used to characterize the CDs. A hydroxyapatite (HAp) model was used to investigate the protective effects of CDs, PHS, and their combinations with and without a salivary pellicle against acid-induced demineralization in vitro. Ca2+ release as a parameter to evaluate the inhibition of demineralization was measured by capillary electrophoresis. The interactions between CDs, PHS, and HAp discs were investigated using a fluorescence detector.

RESULTS

Uniform-sized CDs were synthesized, showing typical optical characteristics. CDs exhibited no inhibition of acid-induced demineralization in vitro, in contrast to PHS. Notably, a pre-coating of CDs increased the protective effects of PHS against acid-induced demineralization, which was not disturbed by the presence of a salivary pellicle and Tween 20. Scanning electron microscope (SEM) confirmed the binding and layers formed of both CDs and PHS to the HAp surfaces. Based on fluorescence spectra CDs binding to HAp seemed to be dependent on Ca2+ and PO43- interactions.

CONCLUSIONS

CDs combined with PHS showed protective effects against acid-induced demineralization of HAp discs in vitro.

Erosive potential of vitamin waters, herbal drinks, carbonated soft drinks, and fruit juices on human teeth: An in vitro investigation

Background

Dental erosion is the loss of dental hard tissues through the acid dissolution of tooth minerals. One of the major factors that cause erosion is the consumption of acidic food and drinks. This study investigated and compared the effect of vitamin waters, herbal beverages, carbonated soft drinks, and fruit juices on the loss of human dental hard tissue.

Methods

Human tooth samples were immersed in various drinks: vitamin waters, herbal beverages, carbonated soft drinks, and fruit juices. The pH value of each drink was measured using a pH meter. The weight of each sample was determined before and after six days of immersion in the tested drink, and the weight loss percentage was calculated. The exposed tooth surfaces were also examined under a scanning electron microscope.

Results

Most of the tested drinks were acidic and displayed pH values lower than the critical pH for enamel erosion. Significant weight loss of the tooth samples was found in all tested drink groups. Additionally, the samples immersed in fruit juices and herbal beverages exhibited significantly greater weight loss than those immersed in carbonated soft drinks. Scanning electron micrographs showed samples immersed in the tested drinks to demonstrate structural disintegration with occasional void spaces, except for samples immersed in Doi Kham® Lemongrass drink.

Conclusion

Most of the tested drinks have the potential to cause dissolution and destruction of dental hard tissues. Consumers should be aware that prolonged exposure to these drinks could lead to permanent loss of tooth mineral and dental erosion.

Temporomandibular joint biomechanics and equine incisor occlusal plane maintenance

In equine dentistry, the physiological incisor occlusal surface is visually perceived as a plane with a distinct inclination to the head's coronal plane, extending rostro-ventrally to caudo-dorsally. To better understand the formation of this inclined plane and its connection to dental wear, we investigated the hypothesis that it arises from masticatory movements and the considerable distance between mandibular articular heads and the incisor occlusal surfaces, acting as the three points of support for the mandibles. Leveraging data from a large-scale clinical study involving static and dynamic orthodontic measurements in horses, we approximated the mandibular movement range where incisor occlusion and dental wear occur. By introducing and testing a segment coordinate system, we explored possible angular deviations from the occlusal plane caused by mandibular roll and pitch rotations during two lateral mandibular movement patterns, protrusion and retrusion. Theoretical biomechanical calculations and simulations confirmed the visual perception of the incisor occlusal surface as a plane. To further examine our assumptions, we employed a simple mechanical simulator to assess incisor normal occlusion and provoked malocclusions (diagonal, smile, and frown bite) by modifying temporomandibular joint (TMJ) movement patterns. The results from clinical investigations were corroborated by both the theoretical analysis and mechanical simulations, strengthening our understanding of the biomechanical basis behind the physiological incisor occlusal plane maintenance in horses. These findings have significant implications for equine dental health and contribute to a thorough understanding of TMJ dynamics.

Polyphenols for Preventing Dental Erosion in Pre-clinical Studies with in situ Designs and Simulated Acid Attack

Dental erosion is a chemical process characterized by acid dissolution of dental hard tissue, and its etiology is multifactorial. Dietary polyphenols can be a strategy for dental erosion management, collaborating to preserve dental tissues through resistance to biodegradation. This study describes a comprehensive review to interpret the effects of polyphenols on dental erosion of pre-clinical models with in situ designs and simulated acid attacks on enamel and dentin samples. We aim to evaluate evidence about Polyphenols' effects in the type of dental substrate, parameters of erosive cycling chosen in the in situ models, and the possible mechanisms involved. An evidence-based literature review was conducted using appropriate search strategies developed for main electronic databases (PubMed, Scopus, Web of Science, LILACS, EMBASE, LIVIVO, CINAHL, and DOSS) and gray literature (Google Scholar). The Joanna Briggs Institute checklist was used to evaluate the quality of the evidence. From a total of 1900 articles, 8 were selected for evidence synthesis, including 224 specimens treated with polyphenols and 224 control samples. Considering the studies included in this review, we could observe that polyphenols tend to promote a reduction in erosive and abrasive wear compared to control groups. However, as the few studies included have a high risk of bias with different methodologies and the estimated effect size is low, this conclusion should not be extrapolated to clinical reality.

Estimation of the Efficacy of Remineralizing Agents on the Microhardness of Deciduous Teeth Demineralized Using Pediatric Formulations

AIM

This study aimed to evaluate the demineralizing effect of commonly used pediatric syrup formulations on primary teeth and the efficacy of two readily available remineralizing agents in treating this effect.

MATERIALS AND METHODS

Ninety primary teeth were used for sample preparation and divided into three groups: antibiotic syrup (group A), cough syrup (group B), and control (group C) groups. These groups were further categorized into intragroups according to the treatment with remineralizing agents: groups A1, B1, and C1 received GC Tooth Mousse (casein phosphopeptide-amorphous calcium phosphate, CPP-ACP paste) and groups A2, B2, and C2 received Clinpro Tooth Crème. The samples were subjected to a series of demineralization cycles for 14 days, and remineralization cycles until 30 days were performed using two remineralizing agents, that is, GC Tooth Mousse (CPP-ACP paste) and Clinpro Tooth Crème and were evaluated using Vicker's microhardness test.

RESULTS

Antibiotic syrup (group A) and cough syrup (group B) showed a significant decrease in surface microhardness compared with control (group C). All intragroups showed an increase in surface microhardness after treatment with remineralizing agents, which was significantly higher in intragroups A1, B1, and C1 treated with GC Tooth Mousse (CPP-ACP paste).

CONCLUSIONS

Oral liquid medications showed definite demineralization potential. CPP-ACP paste was found to be better than Clinpro Tooth Crème for demineralized teeth.

CLINICAL SIGNIFICANCE

The use of over-the-counter drugs has increased among the average Indian population, especially for the treatment of fever, cold, and cough. Unwise use of medications by the present population without proper medical guidance will lead to irreparable changes in future generations.

Damage from Carbonated Soft Drinks on Enamel: A Systematic Review

The present study was conducted to analyze the erosive potential of the ever-increasing consumption of carbonated drinks on the dental surface. To identify relevant studies, a comprehensive search was conducted on PubMed, Scopus, and Web of Science covering the last 5 years (2018–2023) using the following Boolean keywords: “soft drinks AND tooth”. Finally, a total of 19 studies were included. The initial search provided a total of 407 items. Nineteen records were finally involved in the inclusion phase, seven of which were in vivo and twelve in vitro. An abuse of carbonated acid substances leads to an increase in the possibility of dental erosion with consequent structural disintegration and reduction of the physical and mechanical properties of the enamel. There is thus greater bacterial adhesion on rougher surfaces, determined by the erosive process, and therefore a greater risk of caries. The pH of most commercialized carbonated drinks is lower than the critical pH for the demineralization of the enamel. Carbonated drinks’ pH and duration of exposure have different deleterious effects on enamel.

Erosive effects of commercially available alcoholic beverages on enamel

This study aimed to investigate the effects of four alcoholic beverages on enamel erosion. Fifty enamel specimens were randomly allocated into the following five groups (n=10): group 1, water as negative control; group 2, red wine; group 3, white wine; group 4, distilled spirit; and group 5, beer. The specimens were immersed in the respective solution for a 16 h demineralization, followed by an 8 h remineralization in artificial saliva. Cyclic de- and re-mineralization were performed for 8 days. Surface roughness, microhardness and morphology of the enamel specimens were studied after the cycling. The results were analyzed by One-way ANOVA and Dunnett's post-hoc test (p<0.05). All investigated beverages showed an erosive effect on enamel. White wine had the highest erosive potential whereas distilled spirit had the least.

Morphological and Elemental Evaluation of Investigative Mouthwashes to Repair Acid-Eroded Tooth Surface

Purpose

Erosive tooth wear (ETW) is characterized by subsurface demineralization and tooth substance loss with crater formation. Remineralization of subsurface demineralization has previously been demonstrated; however, repair of the eroded surface is still under investigation. This study investigated the effectiveness of mouthwashes containing hydrolyzed wheat protein (HWP) in repairing ETW through promotion of organized crystal growth.

Methods

Enamel Erosion was created on 210 enamel blocks by 10-minute demineralization in 1% Citric Acid (pH 3.5). Then, blocks were randomly assigned to seven groups (30/group); (A) 0.2% HWP, B) 1% HWP, (C) 2% HWP, (D) 1% HWP + 0.05% NaF, (E) Listerine™ mouthwash, (F) 0.02% NaF Crest™ Pro-health mouthwash and (G) artificial saliva (AS) only. Groups were subjected to daily pH-cycling consisting of one 5-minute erosive challenge with citric acid, three 1-minute mouthwash treatment periods, and then storage in AS for the rest of the time for 28 days. Treatment effects were assessed using SEM-EDX. Statistical analysis was by ANOVA and Tukey's multiple comparison.

Results

In groups exposed to HWP-containing mouthwashes, there was growth of fiber-like crystals that increased in packing density in a dose-dependent manner (0.2%, 1%, 2%) on the eroded enamel surfaces, with increased calcium and phosphate contents on the treated surfaces. The non-HWP-containing groups had the eroded surfaces covered by structureless deposit layer firmly attached to the surface.

Conclusion

Treating eroded enamel surface with HWP-containing mouthwash resulted in repair of the damaged tissue by formation of a protective layer of crystal deposits within and on the eroded enamel tissue.

Effect of acidic media on flexural strength and fatigue of CAD-CAM dental materials

OBJECTIVE

To investigate the effect of acidic media, including beverages and gastric fluids on flexural strength and fatigue of CAD-CAM materials.

METHODS

Four CAD-CAM materials (high-translucency zirconia (Ceramill Zolid HT+), lithium disilicate (IPS e-max CAD), hybrid ceramic (Vita Enamic), and nanohybrid resin composite (Grandio Blocs) were prepared and immersed in one of five media (gastric HCl, white wine, Coca-Cola, orange juice, and artificial saliva) in an incubator (37 ℃, 24 h). Surface topography and roughness were obtained using a scanning electron microscope (SEM) and a stylus contact profilometer, respectively. Initial 3-point flexural strength was measured for half of the bars (n = 20/gp) using a universal testing machine (0.5 mm/min). The other bars underwent 10⁶ cyclic fatigue loadings before measurement of residual 3-point flexural strength. Data were statistically analyzed (two-way and three-way ANOVA, Tukey's post-hoc, p < 0.05). Weibull distributions were plotted for reliability analysis.

RESULTS

Zirconia bars has the highest initial flexural strengths followed by lithium disilicate, while resin composite and hybrid ceramic groups had the lowest strength regardless of the erosive medium. Cyclic fatigue significantly reduced initial flexural strengths for all materials except for hybrid ceramic and resin composite. Weibull moduli were the highest for zirconia, lithium disilicate and resin composite and lowest for hybrid ceramic.

SIGNIFICANCE

Erosive media significantly changed surface roughness of CAD-CAM materials except for zirconia and resin composite without jeopardizing the flexural strength of the CAD-CAM materials. Despite the higher flexural strengths for zirconia and lithium disilicate, resin composite and hybrid ceramic were more resistant to cyclic fatigue.

Evaluation of Surface Roughness of Different Esthetic Restorative Materials after Immersion in Different Acidic Media

Abstract: Background: Dental erosion that resulted from increasing the acidity of oral conditions not only affects tooth substrates but also the performance of some esthetic restorations. Objective: The aim of the current study was to measure and evaluate the surface roughness of different tooth colored restorative materials (resin composites) after immersion for certain time in different acidic food and drinks. Material and method: Three types of composite restoration have been used in this study. The three types were of three main groups. Each group of twenty specimens (n= 20) were divided according to type of acidic media they were immersed in into five sub-groups (n=4). Different acidic beverages and drinks were used in this study include Coke Cola soft drink, orange juice, Pepsi soft drink, sports drink, and lemon juice. Immersion of specimens’ in previously mentioned acidic drinks were for 5 minutes then they have been immersed in distilled water to simulate to great extent what happened in oral cavity. These procedures repeated daily for 14 days. Surface roughness for specimens have been measured by a profilo-meter (Talysurf CLI 1000, Leicester, England) device before and after immersion. Data were collected, tabulated and analyzed using one-way ANOVA. Results: The assessment of surface roughness by one-way ANOVA and Tukey's post hoc tests showed significant differences for composite material types as well as an interaction between these parameters for each composite after immersion in different acidic beverages (P<.05). Conclusion: Within the limitation of this study, results revealed that composition of both resin composite and different acidic beverages and drinks play an important role in initiation and conduction of surface roughness at the outer surface of resin composite restoration.

Prevalence and risk factors of erosive tooth wear among young adults in the Singapore military

OBJECTIVES

Erosive tooth wear (ETW) is defined as the irreversible chemo-mechanical loss of dental hard tissues without plaque or bacteria and has been a growing phenomenon in the general population worldwide. The aim of this study was to determine the prevalence of ETW and the associated risk factors among young military personnel in Singapore.

MATERIALS AND METHODS

This cross-sectional study consisted of a questionnaire and clinical examination of military personnel between 18 and 25 years. The questionnaire collected information on demographics, medical and dental history, lifestyle and dietary habits. Tooth wear was clinically evaluated using the Basic Erosive Wear Examination (BEWE) index. The participants were profiled into four risk categories (none, low, moderate, severe) based on the sum score. Multivariable logistic regression analysis was performed to determine the risk factors associated with the presence of ETW.

RESULTS

Out of 1296 participants evaluated, 21.8% of them had ETW. The anterior sextants were more affected by erosion than posterior sextants for both arches. The risk factors significantly associated with ETW were GERD (OR = 2.83, p = 0.041), presence of self-reported TMD symptoms (OR = 2.51, p < 0.001), acidic food (OR = 2.03, p < 0.001) and drinks (OR = 3.07, p < 0.001), high caries risk (OR = 4.59, p < 0.001) and toothbrush stiffness (OR = 4.67, p < 0.001).

CONCLUSION

ETW is prevalent among the young military population, with over half of the population at a risk of ETW. Gastric reflux disease, TMD, acidic diet, dental caries susceptibility and the use of stiff toothbrushes were identified as significant risk factors.

CLINICAL RELEVANCE

A large proportion of young military personnel exhibited mild to moderate risk of ETW. Dental professionals can identify risk-susceptible individuals at a young age and educated them with preventive measures and dietary interventions to prevent the progression of the condition.

Regular Physical Activity and Dental Erosion: A Systematic Review

Dental erosion is the irreversible pathological loss of hard tissues, which are chemically dissolved by acids, especially through external means, such as diet (e.g., fruit juices, isotonic or energy drinks). This systematic review was designed to answer the question “Is there a relationship between dental erosion and regular physical activity with or without sports drink consumption?” Following the inclusion and exclusion criteria, sixteen studies were included in this systematic review (according to PRISMA statement guidelines). Based on the meta-analysis, physically active individuals who declared regular consumption of sports drinks had a more than 2.5-fold increase in the odds of erosive lesions. In general, nearly half of the people who practiced sports experienced tooth erosion, and more than half frequently consumed sports beverages. Despite the heterogeneity of the included studies (different age groups, various sports disciplines), regular physical activity was associated with an increased risk of dental erosion, especially under the influence of frequent consumption of sports drinks.

Oral affections in an ex situ population of marsh deer (Blastocerus dichotomus): a retrospective study (1990-2020)

ABSTRACT: Oral diseases are limiting to health, welfare, and conservation practices, especially in the case of endangered animals. In this retrospective study, a survey on oral health-related conditions noted in the clinical records for 261 deer comprised in an ex situ population of the Marsh Deer Conservation Center (CCCP) over 30 years (1990-2020) was carried out. Of these, 49 (18.77%) marsh deer (31 females - 63.27% and 18 males - 36.73%) had clinical oral affections; the affected deer’s mean age was 8.9 years. Logistic regression analysis was performed, and the variable age was significantly associated with the presence of dental affections. Thus, with a change in the age category, a deer had eight times the chance of manifesting oral affections; therefore, age can be considered a risk factor for the manifestation of oral affections in the species. Increased facial volume (65.3%), accumulation of food in the mouth (36.7%), tooth loss (22.4%), fistulas (22.4%), mucosal or palatal lesions (22.4%), tooth wear (20.4%), and tooth root exposure (18.3%) were the most frequently recorded lesions. The relatively high occurrence of oral affections in Blastocerus dichotomus reiterates the importance of oral health care when deer are kept in human care.

Characterization of dynamic process of carious and erosive demineralization - an overview

To review the analytical methods for carious and erosive demineralization an initial search of peer-reviewed scientific literature from the digital library database of PubMed/Medline indexed journals published up to early 2022 was carried out based on keywords relevant to the topic criteria including bibliographic citations from the papers to gather the most updated information. This current review aims to provide an updated overview of the advantages, limitations, and potential applications of direct and indirect research methods available for studying various dynamic stages of carious and erosive demineralization in enamel and dentin. This paper categorizes and describes the most suitable, frequently adopted and widely used quantitative and qualitative techniques in in vitro/in vivo research which are well-established, emerging, or comparatively novel techniques that are being explored for their potential validation.

Protective effect of green tea catechins on eroded human dentin: an in vitro/in situ study

The present study sought to evaluate the protective effect of Epigallocatechin-3-gallate (EGCG) and commercial green tea (GT) on eroded dentin using in vitro and in situ experimental models. For the in vitro experiment, matrix metalloproteinases (MMPs) were extracted from demineralized human coronary dentin powder (citric acid, pH 2.3) and assessed via a colorimetric assay and electrophoresis in gelatin. The gels were exposed to buffers with: control (no treatment), 0.05% sodium fluoride (NaF), 0.12% chlorhexidine digluconate (CHX), GT infusion, and 0.1% EGCG, and their respective activity was analyzed by zymography. For the in situ experiment, 20 healthy volunteers (aged 20-32 years) participated in this single-center, blind, crossover study. The subjects wore upper removable devices containing four human dentin blocks. Erosive challenge (coke-1 min) was performed four times/day/5 days. Blocks were treated for 1 min with: control (No treatment), 0.05% NaF, 0.1% EGCG, and GT. Thereafter, the specimens were subjected to stylus profilometry and SEM. ANOVA was used to evaluate dentin roughness and wear, with a significance level of 5%. In the zymography analysis, 0.12% CHX, GT, and 0.1% EGCG were found to inhibit the action of MMPs; however, in the colorimetric assay, only green tea inhibited the activity of MMPs. There were no significant differences observed in dentin roughness or wear (p > 0.05). Herein, EGCG and GT inhibited the activity of endogenous proteases, resulting in protection against erosion-induced dentin damage; however, they could not prevent tooth tissue loss in situ.

An insight into the world of sports dentistry

Dental trauma in the field of sports is the major linking channel between sports and dentistry. Sports dentistry is the branch of sports medicine that deals with the prevention of oral or facial athletic injuries, oral diseases and manifestations. Sports dentistry is also related to mild traumatic brain injuries during games and erosive lesions due to continuous intake of highly acidic sports and energy drinks. Stress among sportsperson has also been depicted to impact their athletic performance leading athletes to the intake of drugs. Smokeless tobacco consumption and sponsorship is also found among athletes. Therefore, it is emphasized the need for a "team dentist," initiating from high schools to professional teams. The sports or "team dentist" assists athletes in the effective prevention, treatment, and diagnosis of various types of oral injuries. Sport-related orofacial injuries can be prevented by wearing primary protective devices such as properly fitting helmets, face masks and/or mouth guards. They can also enlighten athletes about the benefits of practicing yoga, as it reduces stress and improves performance. Hence, the dentist can perform an imperative role in informing parents, athletes, coaches and patients about the importance of preventing orofacial injuries in sports.

Influence of periodic milk or cream treatment on the anti-erosive potential of the acquired enamel pellicle

OBJECTIVE

The purpose of the present study was to assess the anti-erosive potential of the acquired enamel pellicle formed in situ under the influence of periodic milk or cream treatment.

METHODS

The pellicle was formed on bovine enamel specimens in the oral cavity at buccal and palatal sites of upper molars in 6 subjects, using removable acrylic splints. During 6-h of intraoral exposure, splints were removed from the oral cavity every 25 min, treated with milk or cream for 5 min, and subsequently re-inserted into the oral cavity. After 6 h, pellicle covered specimens were immersed in citric acid (0.1 or 1.0 %) for 1 min, and processed for measurement of surface microhardness, determination of calcium release by atomic absorption spectroscopy, scanning and transmission electron microscopy. Statistical analysis was performed with SAS.

RESULTS

Statistical analysis did not indicate major differences between erosive surface alterations on enamel specimens covered by pellicles treated with cream or milk, and those covered by control pellicles. In addition, TEM analysis did not reveal any differences concerning the ultrastructure of the different pellicle treatments during acid exposure. All pellicles were dissolved in part after exposure to 0.1 % citric acid and were nearly completely removed after treatment with 1.0% citric acid.

CONCLUSIONS

It is concluded that periodic treatment with milk or cream during pellicle formation in situ does not improve the protective potential of the acquired enamel pellicle against erosion.

CLINICAL SIGNIFICANCE

Modification of the pellicle by consumption of milk or cream prior to an acidic challenge cannot sufficiently protect enamel from erosion.

Genetic Aspects of Dental Erosive Wear and Dental Caries

Objectives

The present review aims to give an overview of the literature focusing on novel genetic aspects of dental erosion and dental caries. Once the tooth erupts into the oral cavity, the regenerative capability of enamel is fundamentally limited due to the loss of dental epithelium during eruption. The susceptibility or resistance to dental erosion and caries is presumably a result of environmental, phenotypic, and/or genetic influence. Even though it is evident that individuals frequently exposing their teeth to acid and sugar are at high risk of developing dental erosion and caries, the findings exclusively based on these factors are elusive. Data resources and study selection. The present review was based on data collected from the National Library of Medicine database with different combinations of the following terms: "tooth," "dental," "dentin," "enamel," "erosion," "erosive wear," "caries," "decay," "gene," and "genetic." A total of forty-six studies met the inclusion criteria. Data were extracted by one reviewer and verified by another.

Conclusion

The high prevalence of erosion and caries among certain groups, and observations that not all individuals appearing to be at risk develop these lesions, has sparked research on identifying genetic effects to these conditions. A connection of genome-wide and candidate gene studies has increased considerably in the literature. This review reveals largely varying success among studies, demonstrating the difficulties of developing the study with adequate sample sizes and durable phenotype definitions that permit enough statistical power to identify genetic contributors.

Comparative Study of Technologies for Tubule Occlusion and Treatment of Dentin Hypersensitivity

This study aimed to evaluate the occluding/remineralization performance and resistance to acid attacks of the mineralization layer formed by a tooth-desensitizing gel containing amorphous calcium magnesium phosphate (ACMP) particles and compare it to six other desensitizing products available on the market. Similar comprehensive studies are few and there is especially a lack of studies that are up to date. A dentin-disc model was used for in vitro evaluation of the desensitizing toothpastes/gels. Application of the products was performed twice daily for seven days. One set of specimens were evaluated using scanning electron microscopy (SEM) directly after the final treatment and another set was evaluated after an acid challenge, exposing specimens to 2 wt% citric acid. The ACMP desensitizing gel was the only product resulting in complete occlusion by the formation of mineralized material on the dentin surface and inside the tubules. Particle deposition was dominant after treatment with the other desensitizing products, with little or no mineralization, resulting in partial occlusion only. Sensodyne Repair & Protect and Oral-B Pro-Expert showed the highest resistance toward acid attacks. Material inside the tubules remained relatively unaffected by acid attacks in all specimens. The results in this study indicated a great variability among the occluding agents in terms of occlusion and acid resistance of the mineralization layer. The high degree of occlusion and intra-tubular mineralization that could mitigate the effect of acid solubilization indicate that the ACMP desensitizing gel may be a superior option for the treatment of dentin hypersensitivity.

Reliability of qualitative occlusal tooth wear evaluation using an intraoral scanner: A pilot study

Dental wear analysis through the use of an intraoral scanner is a reality of modern dentistry. This study aimed to investigate the reliability of qualitative tooth wear evaluation through three-dimensional images captured with an intraoral scanner and compared to clinical and photographic examinations. Eighteen adult volunteers of both genders (18 to 55 years old) were submitted to clinical exams, intraoral photographs and intraoral scanning protocol using an optical scanner (TRIOS® Pod, 3Shape, Copenhagen, Denmark). Occlusal tooth wear, from second to second premolars, was measured by two evaluators and reevaluated after 30 days, according to a slight modification of the method described by Mockers et al. Weighted Kappa was used to measure intra and inter-examiner agreement. The Friedman test was used to verify the differences among methods. Random and systematic errors were assessed using Bland-Altman plots. All statistical analysis was performed with p<0.05. There was a substantive agreement for clinical (K = 0.75) and photographic exams (K = 0.79) and a moderate agreement for intraoral scanner analysis (K = 0.60) for inter-examiner evaluation. A substantial intra-examiner agreement was obtained for both evaluators. No significant difference between the methods was observed (p = 0.7343 for examiner 1 and 0.8007 for examiner 2). The Bland-Altman plot confirmed no systematic errors between the methods and a random error of 0.25 with the scanner method when compared to clinical assessment. All three methods showed reliability in qualitative occlusal tooth wear evaluation. Intraoral scanning seems to be a sound and reliable tool to evaluate tooth wear when compared to traditional methods, considering the lower inter-examiner agreement and the inherent limitations of this pilot study. Further research will be necessary in order to achieve more robust evidence.

Full-mouth adhesive rehabilitation of a severe case of erosion treated with v-shaped veneers

OBJECTIVE

To demonstrate a minimally invasive approach of a full-mouth rehabilitation of a severe case of erosion treated with v-shaped veneers, tabletops, overlays, veneerlays, laminate veneers, and a full contour veneer.

CLINICAL CONSIDERATIONS

The present case report successfully rehabilitated a full-mouth case of severely eroded teeth with minimal healthy structure removal, maintaining viability of all teeth that were vital before the treatment started, and promoting long-lasting esthetic and functional results after 3 years of use.

CONCLUSIONS

A deep knowledge of etiology, etiopathogenesis, and classifications of dental erosion will guide the clinician in the right direction for solving this issue correctly, according to modern prosthetic and conservative principles.

CLINICAL SIGNIFICANCE

Dental erosion represents today a relatively widespread phenomenon among the global population and a significant challenge in each of its clinical stages for the clinicians who must treat it. In advanced stages, a careful evaluation phase of the case, a great patient motivation and a wise use of materials and clinical protocols are the success key of the case. Moreover, an advanced knowledge of adhesive dentistry is strictly required to successfully manage a severe erosion case with a modern and minimally invasive approach.

Contemporary diagnosis and management of dental erosion

OBJECTIVE

This article is aimed at providing an overview of the topic of erosive tooth wear (ETW), highlighting the clinical signs, diagnosis, and management of dental erosion.

OVERVIEW

With the increased prevalence of ETW, it is important that oral health professionals are able to recognize the early signs. Early clinical signs of dental erosion are characterized by loss of enamel texture, a silky glossy appearance, and sometimes a dulling of the surface gloss, referred to as the "whipped clay effect, cupping, and restorations 'standing proud'." The progression of ETW should be monitored by means of diagnostic models or clinical photographs. ETW can be as a result of acid attack of extrinsic or intrinsic origin.

CONCLUSION

There is an increase of ETW that is being recognized by the profession. The first step in diagnosing and management is to recognize as early as possible that the process is occurring. At that point a determination of whether the primary etiology is either intrinsic or extrinsic should be made. If these findings are confirmed, appropriate prevention, and management strategies can be adopted followed by appropriate restorative therapy.

CLINICAL SIGNIFICANCE

The prevalence of ETW continues to increase. It is therefore important that oral health care providers have a better understanding of the etiology, pathophysiology, and management of this condition. This review aims to provide the guidelines for diagnosis and management of dental erosion.

Characterisation of mechanical and surface properties of novel biomimetic interpenetrating alumina-polycarbonate composite materials

OBJECTIVE

To determine the mechanical and surface characteristics of two novel biomimetic interpenetrating phase alumina-polycarbonate (Al₂O₃-PC) composite materials, comprising aligned honeycomb-like porous ceramic preforms infiltrated with polycarbonate polymer.

METHOD

Two composite materials were produced and characterised. Each comprised a porous structure with a ceramic-rich (polymer-poor) top layer, graduated through to a more porous ceramic-poor (polymer-rich) bottom layer. In addition, pure polycarbonate and dense alumina specimens were subjected to the same characterisation namely: density, compression, three-point bend, hardness, surface loss and surface roughness testing. Scanning electron microscopy and micro computerised tomography were employed for structural examination.

RESULTS

Three-dimensional aligned honeycomb-like ceramic structures were produced and full interpenetration of the polymer phase was observed using MicroCT. Depending on the ceramic volume in the initial aqueous ceramic suspension, the density of the final interpenetrating composites ranged from 2.64 to 3.01g/cm³, compressive strength ranged from 192.43 to 274.91MPa, flexural strength from 105.54 to 148.47MPa, fracture toughness from 2.17 to 3.11MPa.m^½, hardness from 0.82 to 1.52GPa, surface loss from 0.71 to 1.40μm and surface roughness, following tooth brushing, from 0.70 to 0.99μm. Composite specimens showed characteristic properties part way between enamel and polycarbonate.

SIGNIFICANCE

There was a correlation between the initial solid ceramic loading in the aqueous suspension, used to produce the porous ceramic scaffolds, and the subsequent characteristic properties of the composite materials. These novel composites show potential as aesthetic orthodontic bracket materials, as their properties fit part way between those of ceramic, enamel and polycarbonate.

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

BACKGROUND

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

AIM

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Nanoscale effects of beverages on enamel surface of human teeth: An atomic force microscopy study

Dental erosion has become a prevalence disease and attracted increasing attention worldwide. In this research, we quantitatively evaluate the mechanical and morphological changes in the very early stages of softening and weakening of human enamel surfaces induced by soft drinks using atomic force microscopy (AFM). With an increase of the immersion time in soft drinks, we found a significant increase of surface roughness (R_q) of the enamel surface. The prismatic structure of enamel was clearly observed after a 1-h immersion in Coca-Cola®, which shows its strong erosion effect. According to the elastic modulus mapping images obtained by AFM, a considerable decrease of elastic modulus (E) of enamel surface has been found as the enamel surface structures are etched away by soft drinks. A high surface roughness of enamel will result in a high chance of cavities due to easier bacterial adhesion on rougher surface, while a drastic deterioration of the mechanical properties of the enamel will weaken its protection property. Our findings show the serious influence of acidic drinks on enamel surface at the very beginning stage of etching process, which is quite meaningful for people to prevent dental erosion and keep dental health.

Acid Effects on the Physical Properties of Different CAD/CAM Ceramic Materials: An in Vitro Analysis

PURPOSE

To evaluate the flexural strength, elastic modulus, microhardness, and surface roughness of monolithic zirconia, lithium disilicate ceramics, and feldspathic ceramics after being exposed to different acidic solutions.

MATERIALS AND METHODS

Rectangular specimens (n = 180) were prepared from three different ceramic materials: lithium disilicate, monolithic zirconia, and feldspathic porcelain. Initial Surface roughness of ninety specimens (n = 30/material) was evaluated using an optical noncontact profilometer. Thirty specimens of each material were immersed in one of the following solutions (n = 10/group): citric acid; acidic beverage; and artificial saliva, which served as the control. Post immersion surface roughness, flexural strength, and elastic modulus were determined using an optical noncontact profilometer and three-point bending test. Another thirty specimens of each material were immersed in the aqueous solutions (n = 10/group) following the same protocol and subjected to microhardness test using a Vickers diamond microhardness tester. A scanning electron microscope (SEM) was used to examine the surface characteristics changes. ANOVA and Post-hoc Tukey's Kramer tests were used for data analysis (α = 0.05).

RESULTS

Immersion in different solutions did not affect the flexural strength and elastic modulus of lithium disilicate or zirconia. Microhardness and surface roughness were significantly affected in all groups (p < 0.05). For feldspathic porcelain groups, the flexural strength and elastic modulus were significantly decreased in the citric acid group (p = 0.045 and p = 0.019). Also, there were significant differences among all feldspathic porcelain groups (p = 0.001) in terms of microhardness and surface roughness values.

CONCLUSIONS

The tested acidic agents significantly affected the flexural strength, elastic modulus, surface roughness, and microhardness of feldspathic porcelain. However, the flexural strength and elastic modulus of evaluated lithium disilicate and zirconia did not change significantly.

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.

Dental Erosion Risk Factors in 6 to 12 Year Old children in Mexico City

Objective: To assess the prevalence and dental erosion risk factors in Mexican schoolchildren. Study design: A transversal and analytical study was conducted on 411 children aged 6 to 12 years old in a public primary school of Mexico City. The children's parents answered a standardized questionnaire about their risk factors, and the Smith and Knight index was applied to assess their dental erosion degree. Results: The prevalence of dental erosion was 62%. The odds ratio and X² tests revealed that probiotic beverage consumption (OR 1.658; CI 95%: 1.106-2.485; p = 0.014), sports beverages (OR: 2.807; CI 95%: 1.129-6.983; p = 0.021), natural juices (OR: 3.344; CI 95%: 1.556-7.184; p = 0.003), fruits and snacks with hot peppers and lemon (OR: 1.594; CI 95%: 1.066-2.382; p = 0.023), and syrups (OR: 1.869; CI 95%: 1.060-3.296; p = 0.029) were all risk factors for dental erosion. Conclusions: This study indicated that a high existence of dental erosion, which mainly affects the primary molars, is related to the frequent consumption of beverages and foods with acidic pH levels.

The Effect of Er:YAG Laser Irradiation Combined With Fluoride Application on the Resistance of Primary and Permanent Dental Enamel to Erosion

Introduction: Erosion is an important cause of tooth mineral loss. The combined use of lasers and fluoride has been introduced as a novel modality for the prevention of enamel demineralization. This study aimed to assess the effect of Er:YAG laser combined with fluoride application on primary and permanent enamel resistance to erosion. Methods: Eighty enamel specimens of permanent (n=40) and primary (n=40) molars were prepared and randomly assigned to 4 groups: C-control (no pretreatment), F-acidulated phosphate fluoride (APF) gel, FL-APF gel application followed by Er:YAG laser irradiation, and LF-Er:YAG laser irradiation followed by the application of APF gel . The specimens were then submitted to pH cycling using Coca-Cola (pH=2.4). Enamel micro-hardness was measured using the Vickers microhardness tester before pretreatment and after the erosive process. The collected data were analyzed using the Kolmogorov-Smirnov test, two-way ANOVA and repeated measures ANOVA. Results: The micro-hardness of both permanent and primary enamel specimens significantly decreased after the erosive process (P < 0.05). In the permanent enamel specimens, the greatest reduction in micro-hardness was noted in groups C and F, while the least reduction was noted in group FL. However, these differences were not statistically significant (P > 0.05). In the primary enamel specimens, the greatest reduction in micro-hardness was noted in groups C and LF, while the least reduction was noted in group F. These differences were not statistically significant (P > 0.05). Conclusion: Within the limitations of this study, Er:YAG laser irradiation combined with fluoride application could not prevent erosion in permanent and primary enamel during the erosive process.

BARIATRIC SURGERY IMPACT ON GASTROESOPHAGEAL REFLUX AND DENTAL WEAR: A SYSTEMATIC REVIEW

Introduction:

Several oral problems may be perceived in individuals who were submitted to bariatric surgery, due to metabolic and behavioral changes relative to diet and oral hygiene. Tooth wear appears to suffer impact after bariatric surgery, because there may be an increase in gastroesophageal reflux.

Objective:

To systematically review the literature regarding the impact of bariatric surgery on gastroesophageal reflux and tooth wear.

Method:

The following databases were accessed by two independent, calibrated examiners: PubMed, Medline, Lilacs, Scielo and Cochrane using the following descriptors: “bariatric surgery” AND “dental erosion” OR “bariatric surgery” AND “dental erosion” AND “gastroesophageal reflux disease”. After excluding duplicate studies, 12 studies were initially evaluated by the title and abstract. The excluded studies were those without relevance to the present research, literature review studies and case reports. Thus, four articles were included in this study. All the articles evaluated indicated high association between gastroesophageal reflux and tooth wear in patients submitted to bariatric surgery. Association of these outcomes was more evident six months after the surgical procedure.

Conclusion:

Patients submitted to bariatric surgery showed higher prevalence of gastroesophageal reflux and tooth wear.

Are dental patients able to perceive erosive tooth wear on anterior teeth?: An internet-based survey assessing awareness and related action

BACKGROUND

Erosive tooth wear (ETW) is irreversible loss of dental hard tissue. The authors examined patients' ability to recognize ETW relative to sound teeth and teeth with caries.

METHODS

Using Amazon's crowdsourcing service, the authors recruited participants (N = 623) to view standardized images of buccal surfaces of teeth (sound, ETW, or caries). Participants reported whether a dental condition existed (yes or no), likelihood to seek care, and esthetic attractiveness for teeth with no, initial, moderate, or severe signs of ETW or caries.

RESULTS

Dental patients showed poor recognition of cases of ETW, especially compared with sound and caries-affected teeth at each level of severity. Patients were less likely to schedule a dental appointment for care or treatment of teeth with ETW than for teeth with caries at each level of severity. Patients also found ETW more esthetically attractive than caries at each level of severity and found initial ETW more attractive than sound teeth.

CONCLUSIONS

Dental patients struggle to recognize ETW, in general and compared with caries, at each level of severity and particularly for early stages of ETW. These recognition difficulties likely arise, in part, from tooth esthetic attractiveness standards (smooth and shiny teeth look more esthetic), possibly leading to lack of appropriate care-seeking behavior.

PRACTICAL IMPLICATIONS

This internet-based tool may be used to assess dental patients' awareness and ability to recognize cases of ETW. Improved patient awareness might lead to seeking professional care to prevent or delay ETW progression.

Experimental Comparison on Dental BioTribological Pairs Zirconia/Zirconia and Zirconia/Natural Tooth by Using a Reciprocating Tribometer

The application of tribology in dentistry is growing rapidly, intense research has been conducted to develop an understanding of dental tribology for better selection of artificial materials and dental implant design. Dental biotribology, has been one of the most important branches in biotribology in recent years. The aim of this research is to investigate the tribological performances in the tooth-to-tooth contact and material-to-natural tooth contact (zirconia vs. zirconia and natural tooth vs. zirconia). The presented research was carried out by testing the above mentioned tribological pairs with the use of a reciprocating tribometer under lubricated conditions (artificial saliva). The normal force used in the tests was 20 N the time for each test was of 60 min. The stroke length was 2 mm, according to the range of displacement used in scientific literature. The wear mass loss evaluation was evaluated by using a gravimetric method. In order to characterize the wear mechanisms, present in the worn surfaces after each of tribo-tests, a topographic analysis was carried with a 3D non-contact optical profiler. The results show that the minimum value of the COF is obtained in the case of Zirconia vs. Zirconia tribo-couple. The results on the wear mass loss show a very low wear rate when coupling in tribological condition natural tooth with a ceramic restoration (a mean value of 0.5 mg was found). This rate is even lower when the contact is between two artificial zirconia teeth.

Prevalence of non-carious cervical lesions among the general population of the Republic of Srpska, Bosnia and Herzegovina

INTRODUCTION

As non-carious cervical lesions (NCCLs) may compromise aesthetics and function, knowledge of their aetiological covariables enhances management of clinical complaints and success of restorative treatments.

AIMS

The primary aim of this study was to assess the presence of NCCLs among the general population of the Republic of Srpska, Bosnia and Herzegovina and the potential association with patient-related risk factors.

METHODS

A prevalence study of NCCLs included 738 respondents from eight towns/municipalities. Two dental practitioners examined all respondents. NCCLs were diagnosed according to the Smith and Knight tooth wear index, measured using a Williams periodontal probe. Data regarding risk factors were obtained through a structured questionnaire. Multivariate logistic regression was used to analyse the association of risk factors and the occurrence of NCCLs.

RESULTS

Non-carious cervical lesions were diagnosed in 384 (52%) respondents. Multivariate regression analysis showed that several variables were independently associated with the risk of developing NCCLs, including frequent consumption of acid food (P = 0.001), frequent consumption of acid drinks (P = 0.001), retaining drink in the mouth (P = 0.001), alcohol consumption (P = 0.030), bruxism (P = 0.018) and gastro-oesophageal reflux (P = 0.023). First mandibular premolars were the most affected teeth (left: 46.0%; right: 44.0%), followed by the second right maxillary premolars (37.3%), second left maxillary premolars (33.6%) and finally by the first right maxillary premolars (34.0%).

CONCLUSION

The results of the current study suggest that NCCLs occur frequently and have a multifactorial aetiology. The lowest prevalence was recorded among individuals younger than 20 years of age. As the majority of risk factors are modifiable, regular dental care could lead to the early detection of NCCLs.