Comparison of exposed dentinal surfaces resulting from abrasion and erosion

Dental macrowear, diet, and anterior tooth use in Colobus polykomos and Piliocolobus badius

Two similarly-sized colobine species living sympatrically in the Ivory Coast's Taï Forest that differ in both diet and oral processing behavior provide an opportunity to explore the strength of associations between feeding behavior and dental wear patterns. Here we test the hypothesis that vigorous processing of tough, hard Pentaclethra macrophylla pods by Colobus polykomos manifests in greater anterior tooth wear relative to that observed in Piliocolobus badius, which does not exploit this resource. We assessed levels of anterior tooth wear in a sample of 160 upper incisors and 131 lower incisors from 18 adult Colobus polykomos and 62 adult Piliocolobus badius naturally deceased individuals from Taï National Park. We operationalized tooth wear by dividing the area of exposed dentin by total occlusal crown area. To assess relative degrees of incisor wear, we regressed incisor wear against molar wear (sample = 105 upper molars, 135 lower molars) for the pooled Colobus polykomos and Piliocolobus badius wear data and compared the number of individuals from each species that fell above and below the pooled regression curve for each model using Chi-square tests of independence and odds ratios. Under our hypothesis, we would expect more Colobus polykomos points above the pooled regression curve than Piliocolobus badius, indicating higher incisor wear relative to molar wear in Colobus polykomos. Nine of sixteen interspecific comparisons demonstrated this predicted pattern; however, none of the Chi-square tests or odds ratios were significant, indicating no difference between Colobus polykomos and Piliocolobusbadius incisor wear relative to molar wear. The absence of significant differences in incisor wear relative to molar wear highlights the challenge of identifying idiosyncratic feeding behavior in fossil taxa and the necessity for continued exploration of the relationship between diet and macrowear.

Surface-Sensitive Microwear Texture Analysis of Attrition and Erosion

Scale-sensitive fractal analysis of high-resolution 3-dimensional surface reconstructions of wear patterns has advanced our knowledge in evolutionary biology, and has opened up opportunities for translatory applications in clinical practice. To elucidate the microwear characteristics of attrition and erosion in worn natural teeth, we scanned 50 extracted human teeth using a confocal profiler at a high optical resolution (X-Y, 0.17 µm; Z < 3 nm). Our hypothesis was that microwear complexity would be greater in erosion and that anisotropy would be greater in attrition. The teeth were divided into 4 groups, including 2 wear types (attrition and erosion) and 2 locations (anterior and posterior teeth; n = 12 for each anterior group, n = 13 for each posterior group) for 2 tissue types (enamel and dentine). The raw 3-dimensional data cloud was subjected to a newly developed rigorous standardization technique to reduce interscanner variability as well as to filter anomalous scanning data. Linear mixed effects (regression) analyses conducted separately for the dependent variables, complexity and anisotropy, showed the following effects of the independent variables: significant interactions between wear type and tissue type ( P = 0.0157 and P = 0.0003, respectively) and significant effects of location ( P < 0.0001 and P = 0.0035, respectively). There were significant associations between complexity and anisotropy when the dependent variable was either complexity ( P = 0.0003) or anisotropy ( P = 0.0014). Our findings of greater complexity in erosion and greater anisotropy in attrition confirm our hypothesis. The greatest geometric means were noted in dentine erosion for complexity and dentine attrition for anisotropy. Dentine also exhibited microwear characteristics that were more consistent with wear types than enamel. Overall, our findings could complement macrowear assessment in dental clinical practice and research and could assist in the early detection and management of pathologic tooth wear.

The 'sialo-microbial-dental complex' in oral health and disease

Biofilms are naturally found in all wet environments including the oral structures of nearly all species. Human oral biofilms have existed since our earliest ancestors and have evolved symbiotically with the dentition over many millennia within a Palaeolithic, hunter-gatherer setting. Irrespective of the plant-animal ratio, it can be argued that the Palaeolithic diet was essentially acidic, and acted as a selective force for much of the evolution of the stomatognathic system. The relationship between saliva, biofilm and teeth, the 'sialo-microbial-dental complex', provides oral health benefits and offers a different perspective to the old dental paradigm that only associated oral biofilms (plaque) with disease (caries). This new paradigm emphasises that oral biofilms are essential for the 'mineral maintenance' of teeth. Oral biofilms provide physical protection from dietary acid and together with bacterial metabolic acids cause the resting pH of the biofilm to fall below neutral. This is then followed by the re-establishment of a neutral environment by chemical interactions mediated by the saliva within the biofilm. Such pH fluctuations are often responsible for the cyclic demineralisation, then remineralisation of teeth, a process necessary for tooth maturation. However, since the advent of farming and especially since the industrial revolution, the increase in consumption of carbohydrates, refined sugars and acidic drinks has changed the ecology of biofilms. Biofilm biodiversity is significantly reduced together with a proliferation of acidogenic and aciduric organisms, tipping the balance of the 'demin-remin' cycle towards net mineral loss and hence caries. In addition, the consumption of acidic drinks in today's societies has removed the protective nature of the biofilm, leading to erosion. Erosion and caries are 'modern-day' diseases and reflect an imbalance within the oral biofilm resulting in the demineralisation of teeth.

Functional dental occlusion: an anthropological perspective and implications for practice

Physiologic changes occur in dental occlusion throughout life, resulting from the interplay between functional demands and reciprocating adaptive responses. These changes have been reported in the anthropological literature and they reflect evolutionary changes in the human stomatognathic system during the Paleolithic, hunter-gatherer period. Specific occlusal changes occur in response to different environments, leading to extensive variation within and between extinct and extant human populations. For example, functional demands can cause occlusal and interproximal tooth wear, resulting in shortening of the dental arch, continual tooth eruption and changes in masticatory patterns. Since the advent of farming through to our current industrialized culture, functional demands on the human masticatory system, and its adaptive responses to these demands, have been reduced considerably. Indeed, it is only occasionally that functional demands are severe enough to lead to obvious pathology in the modern human dentition. In contrast to normal masticatory activity, 'modern-day conditions' such as dental caries, periodontal disease and erosion, can lead to significant changes in dental occlusion that are pathological and need to be treated. The masticatory system is a dynamic, functional unit that displays considerable change over a lifetime. In this concept paper, it is proposed that modern human populations living in industrialized environments display dental occlusions that can be considered to be 'neotenous'; that is, our dentitions tend to reflect an unworn stage of our ancestors that was only seen in infants, juveniles and young adults. Clinicians can draw on both phylogenetic and ontogenetic perspectives of 'functional dental occlusion' to differentiate continual physiological changes occurring over time that require ongoing review, from pathological responses that require intervention.

An anthropological perspective: another dimension to modern dental wear concepts

For many years, research on tooth wear by dental academics has been diametrically opposite to that of anthropological research, with each discipline having a different understanding as to the nature of the wear processes. Dental focus revolved around preventive and restorative considerations while the anthropological focus was a biological understanding related to human evolution, diet, environment, form, and function and included all the craniofacial structures. Introducing the anthropological perspective into modern dentistry gives an insight into the “bigger picture” of the nature and extent of tooth wear. By combining anthropological evidence with clinical knowledge and experience, it is most likely to provide the best-informed and biologically based approach to the management of tooth wear in modern societies.

Dental pathology in dolphins (Cetacea: Delphinidae) from the southern coast of Brazil

Pathological processes observed in the stomatognathic systems of mammalian species are a useful source of information about the habits, evolution and general health of such animals. Studies of pathological conditions on teeth are common in humans and other primates, but rare in wild animals in general and marine mammals in particular. For cetaceans, previous studies provided scanty records of dental anomalies in a few species. This is the first broad and systematic inventory of dental pathology in dolphins. Specimens stored at scientific collections from the southern coast of Brazil were visually inspected under a stereoscopic microscope using a dental explorer. Diagnosis of lesions and anomalies followed literature descriptions. Abnormalities such as caries-like lesions, mineralized calculus deposits, dental erosion, enamel anomalies (hypoplasia and exogenous pigmentation), root resorption, germination and other shape anomalies, were diagnosed in the delphinids Sotalia guianensis, Delphinus capensis, Stenella frontalis, Stenella coeruleoalba, Lagenodelphis hosei, Pseudorca crassidens, Orcinus orca, Steno bredanensis and Tursiops truncatus. Endogenous causes may be related to the occurrence of certain conditions, but the aetiology of caries-like lesions and calculus accumulation is still unknown for cetaceans. The diagnosis of alveolar anomalies and other bone lesions in specimens with dental pathology lead us to believe these lesions modify the integrity of the periodontal ligament and bony tissues, adding to the burden of morbidity of affected animals.

Is there such a thing as a 'healthy occlusion'?: lessons from history

Opinions on occlusion and its link to oral health could not be more diverse. These opinions are used as justification for an equally diverse range of treatments for so-called occlusally related problems, from heavy wear to chronic orofacial pain. Many claim to have evidence to back up their opinions, although much of it appears to be from a very weak source or based on clinical experience. The strongest case appears to be made by those who believe there is no link, by virtue of a lack of evidence to support its existence. Yet for many clinicians, it is a self-evident truth that occlusion must be related in some way to the function and dysfunction of the stomatognathic system. This article uses historical research to highlight where the pro-occlusionists may be going wrong. It also offers a new concept, based on anthropological studies, that indicates occlusion's link to oral health, and explains why most patients appear to have no occlusal problems for most of the time. This theory needs to be tested by researchers to establish its validity. In the meantime, dentists who feel the need to treat occlusal problems will find it supports a very conservative approach to care.

How valid are current diagnostic criteria for dental erosion?

In principle, there is agreement about the clinical diagnostic criteria for dental erosion, basically defined as cupping and grooving of the occlusal/incisal surfaces, shallow defects on smooth surfaces located coronal from the enamel–cementum junction with an intact cervical enamel rim and restorations rising above the adjacent tooth surface. This lesion characteristic was established from clinical experience and from observations in a small group of subjects with known exposure to acids rather than from systematic research. Their prevalence is higher in risk groups for dental erosion compared to subjects not particularly exposed to acids, but analytical epidemiological studies on random or cluster samples often fail to find a relation between occurrence or severity of lesions and any aetiological factor. Besides other aspects, this finding might be due to lack of validity with respect to diagnostic criteria. In particular, cupping and grooving might be an effect of abrasion as well as of erosion and their value for the specific diagnosis of erosion must be doubted. Knowledge about the validity of current diagnostic criteria of different forms of tooth wear is incomplete, therefore further research is needed.

Tooth wear: the view of the anthropologist

Anthropologists have for many years considered human tooth wear a normal physiological phenomenon where teeth, although worn, remain functional throughout life. Wear was considered pathological only if pulpal exposure or premature tooth loss occurred. In addition, adaptive changes to the stomatognathic system in response to wear have been reported including continual eruption, the widening of the masticatory cycle, remodelling of the temporomandibular joint and the shortening of the dental arches from tooth migration. Comparative studies of many different species have also documented these physiological processes supporting the idea of perpetual change over time. In particular, differential wear between enamel and dentine was considered a physiological process relating to the evolution of the form and function of teeth. Although evidence of attrition and abrasion has been known to exist among hunter-gatherer populations for many thousands of years, the prevalence of erosion in such early populations seems insignificant. In particular, non-carious cervical lesions to date have not been observed within these populations and therefore should be viewed as ‘modern-day’ pathology. Extrapolating this anthropological perspective to the clinical setting has merits, particularly in the prevention of pre-mature unnecessary treatment.

Role of wild plant foods among late Holocene hunter-gatherers from Central and North Patagonia (South America): An approach from dental evidence

This study evaluates the role of plant foods in the subsistence of hunter-gatherers that inhabited the Central East, Northwest, and Northeast Patagonia (Argentina) during the late Holocene (ca. 3,000-500 years BP). The goal of the present study is to assess the temporal variation of dental caries ratio and wear rate in skeletal samples to ascertain if the biological information supports the dietary shift toward greater consumption of wild plant foods around 1,500 years BP, suggested by other types of evidence. The authors registered caries, antemortem and postmortem tooth loss, and tooth wear from eight samples belonging to hunter-gatherers from Patagonia for which chronological sequences from early late Holocene (ca. 3,000-1,500 years BP) up to final late Holocene (ca. 1,500-500 years BP) are available. The results indicate that caries percentages in Patagonian samples fall within the range established for hunter-gatherers but there are significant geographical differences. In addition, caries ratio does not change significantly through time, so the amount of carbohydrates consumed seems to have remained fairly constant since 3,000 years BP. In contrast, there is a marked temporal trend toward the reduction of wear rates in the three areas, suggesting a faster rate in early late Holocene than in final late Holocene. These results would reflect a change to less hard and/or abrasive diets in the final late Holocene, probably owing to differences in food processing methods employed.

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.