The oral medicine of tooth wear

Overview of Interim and Temporary Restorations of Teeth During Endodontic Treatment

Root canal treatment of vital, non-infected teeth can often be completed in a single visit, negating the necessity for dressing and provisionalization. Conversely, cases involving infected canals typically demand multiple visits, during which antibacterial medicaments are applied, making effective provisionalization crucial for varying durations. The key components of a successful root canal treatment include adequate canal shape to promote efficient obturation, thorough chemical and mechanical debridement, and complete removal of pulp tissue remnants and bacteria. The primary cause of pain following the initiation of endodontic treatments is often attributed to inadequate debridement or incomplete removal of the pulp tissue, closely followed by insufficient temporary restorations. This review aims to comprehensively overview provisionalization materials used during and immediately after endodontic procedures.

Oral Health and Behavior Patterns of Women with Eating Disorders-A Clinical Pilot Study

BACKGROUND

Chronic stomach regurgitation associated with eating disorders (EDs) poses a high risk for tooth erosion. This study investigated oral health conditions, behavioral patterns, and tooth erosion in women with EDs.

METHODS

16 ED and 13 healthy women were enrolled; 14 ED and 10 healthy control subjects completed the study. Subjects completed demographic, medical, oral, and behavioral health history questionnaires. Dental caries status was recorded as Decayed, Missing and Filled Teeth (DMFT)index and the severity of tooth erosion as Basic Erosive Wear Examination (BEWE) scores. Saliva was collected for flow rate, pH, and buffering capacity analysis.

RESULTS

The ED group had a lower stimulated saliva flow rate and higher DMFT index but no significant difference in BEWE scores compared to the controls (t-test, significance level 0.05). Five of the fourteen ED subjects exhibited extensive tooth erosion, which may have been exacerbated by their tooth-brushing behavior.

CONCLUSIONS

Although some ED subjects showed extensive tooth erosion in this pilot study, the average BEWE score of the ED group was not significantly different from the controls. Extensive tooth erosion in ED may relate to the low stimulated salivary flow. A larger-scale clinical study is necessary to validate these results.

Noncarious cervical lesions: Response from a 25-year clinical follow-up study

STATEMENT OF PROBLEM

The etiology and diagnosis of noncarious cervical lesions (NCCLs) remain poorly understood.

PURPOSE

The purpose of this clinical study was to examine NCCL progression in an existing group of participants, establish the incidence of new NCCLs in a 25-year follow-up study, and relate them to possible risk factors, including occlusal factors.

MATERIAL AND METHODS

Thirty-three participants who had completed a questionnaire about their habits, diet, and personal information were evaluated in this observational retrospective study. Impressions were made, and casts from 3 time periods (Phase I in 1996, Phase II in 1999, and Phase III in 2021) were scanned to obtain digital casts. The casts were then evaluated in a 3-dimensional analysis software program (Geomagic Control; 3D Systems) to establish digital comparisons between NCCLs and occlusal wear. Furthermore, data from an occlusal analysis device (T-Scan; Tekscan) collected in Phase I was used to analyze occlusal interferences relating to the progression of NCCLs. The statistical analysis applied nonparametric tests, followed by the assessment of the association between NCCLs and risk factors, including occlusal wear, through binary logistic regression (α=.05).

RESULTS

At the end of Phase III, 7 new individuals with NCCLs were detected compared with Phase II. The median percentage progression of NCCLs per participant was 0.0% in Phase I, 7.1% in Phase II, and 35.7% in Phase III (P<.005). Occlusal wear in Phase I was associated with 5.02 times the occurrence of NCCLs in Phase III; occlusal wear in Phase II was associated with 4.73 times the occurrence of NCCLs in Phase III; and occlusal wear in Phase III was associated with 1.94 times the occurrence of NCCLs in Phase III (P<.001). Occlusal interference in border movements of the mandible was associated with a 3.55 times greater chance of presenting NCCLs in Phase III (P<.001). Additionally, statistically significant risk factors for the presence of NCCLs in Phase III were an acidic diet (P=.043) and alcohol consumption (P=.021).

CONCLUSIONS

The 25-year data showed an association between NCCLs and specific risk factors, including occlusal wear and occlusal interferences.

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.

Effect of Green Tea Extract Mouthrinse and Probiotic Mouthrinse on Salivary pH in a Group of Schoolchildren: An In Vivo Study

Aim and Objective:

The aim of the study was to assess the efficacy of probiotic and green tea mouthrinse on salivary pH.

Materials and Methods:

This study was conducted over a period of 1 month among 40 healthy schoolchildren aged between 6 and 8 years. The subjects who fulfilled inclusion criteria were selected and randomly divided into two groups, namely probiotic and green tea groups. Salivary pH was recorded at baseline (0 day) and at the end of the specified time using GC pH strips. Statistical analysis was done using paired t test. P < 0.05 was considered statistically significant.

Result:

The comparison of mean pH scores for green tea showed that the pH of saliva was increased in the children after rinsing with green tea (6.00–7.60) and was statistically significant (P < 0.001). Similarly, when pre- and post-mean pH was compared in the probiotic group, the pH was found to be higher in the probiotic rinse group (5.60–7.20). The results were statistically significant.

Conclusion:

The study conducted shows the beneficial effects of green tea in providing a alkaline environment, which is conducive to the oral health of children.

Are Down syndrome children more vulnerable to tooth wear?

BACKGROUND

An oral condition that has largely been ignored in the Down syndrome population is pathological tooth wear. This study is aimed to create more awareness of the reasons underlying the tooth wear observed in patients with Down syndrome and to suggest different methods to prevent this condition. This research also potentially serves as a platform for future researchers to perform an in-depth analysis of the factors we identified. The aim of this study was to determine if children with Down syndrome are more prone to tooth wear than children who do not have Down syndrome.

METHODS

Our sample consisted of 120 children with Down syndrome who were compared with 120 children with no disabilities. The parents or guardians were asked to complete a questionnaire and a 3-day diet chart, while the wear on each tooth was recorded using the standardised Simplified Smith and Knight Tooth Wear Index.

RESULTS

Children with Down syndrome experience tooth wear more frequently than non-Down syndrome children. A history of asthma, mouth breathing and gastro-oesophageal reflux disease as well as the intake of acidic diet and drinks has exerted significant effects on the prevalence of tooth wear.

CONCLUSIONS

The early diagnosis and analysis of the underlying aetiology are important for the management of tooth wear in children with Down syndrome who have shown a greater tendency to develop erosive lesions.

Associations between tooth wear and dental sleep disorders: A narrative overview

Objectives

Tooth wear is a common finding in adult patients with dental sleep disorders. The aim of this paper was to review the literature on the possible associations between tooth wear and the following dental sleep disorders: sleep‐related oro‐facial pain, oral moistening disorders, gastroesophageal reflux disease (GERD), obstructive sleep apnoea syndrome (OSAS) and sleep bruxism.

Methods

A PubMed search was performed on 1 June 2018 using MeSH terms in the following query: Tooth Wear AND (Facial Pain OR Temporomandibular Joint Disorders OR Xerostomia OR Sialorrhea OR Gastroesophageal Reflux OR Sleep Apnea Syndrome OR Sleep Bruxism).

Results

The query yielded 706 reports on tooth wear and the mentioned dental sleep disorders. Several associations between tooth wear and the dental sleep disorders were suggested in the literature. It could be concluded that: (a) tooth wear is associated with dental pain and/or hypersensitivity; (b) oral dryness is associated with tooth wear, oro‐facial pain and sleep bruxism; (c) GERD is associated with tooth wear, oro‐facial pain, oral dryness, OSAS and sleep bruxism; (d) OSAS is associated with oral dryness, GERD and sleep bruxism; and (e) sleep bruxism is associated with tooth wear.

Conclusions

Tooth wear is associated with the dental sleep disorders oro‐facial pain, oral dryness, GERD and sleep bruxism. The dental sleep disorders are interlinked with each other, which leads to indirect associations as well, and makes the consequences of each single condition difficult to disentangle. Knowledge of these associations is clinically relevant, but more research is needed to confirm their validity.

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.

Impact of periodontal treatment on hospitalization for adverse respiratory events in asthmatic adults: A propensity-matched cohort study

BACKGROUND

Periodontal disease is prevalent in asthmatics, but it is unclear whether periodontal treatment plays a role in adverse respiratory events in these patients. We evaluated risk of hospitalization for adverse respiratory events (acute exacerbation, pneumonia, and acute respiratory failure) and mortality in asthmatic adults with and without periodontal treatment.

METHODS

We used National Health Insurance (NHI) claims data of Taiwan to identify 4771 asthmatic adults with periodontal disease who underwent periodontal treatment during 2000-2006. The control group consisted of asthmatic adults without periodontal disease at a 1:1 ratio matched by the propensity score. Both groups were followed up for 5years to estimate the risk of hospitalization for adverse respiratory events and mortality.

RESULTS

Compared with controls, the periodontal treatment group had lower overall incidence of hospitalization for adverse respiratory events [5.41 vs. 6.07 per 100 person-years, 95% confidence interval (CI)=0.78-0.92] and intensive care unit admissions (1.14 vs. 1.25 per 100 person-years, 95% CI=0.79-0.99). In addition, the all-cause mortality rate was significantly lower in the periodontal treatment group than in the control group during the follow-up period (1.86 vs. 2.79 per 100 person-years, 95% CI=0.59-0.71).

CONCLUSION

Asthmatic adults who underwent periodontal treatment were at lower risk of hospitalization for adverse respiratory events and mortality than those without periodontal disease. Asthmatic adults should adopt more precautionary oral hygiene and ensure that they undergo regular periodontal health checkups.

The impact of bulimia nervosa on oral health: A review of the literature

Eating disorders are a potentially life-threatening group of mental disorders, which affect a patient's relationship with food and their body. This manifests itself through chaotic and disordered eating habits. One such eating disorder is bulimia nervosa, which has a lifetime prevalence of 1%. While there is consensus that bulimic behaviour directly causes dental erosion due to vomiting and acidic food choices, there is less clear evidence for a direct link between bulimia nervosa and dental caries, although there does still appear to be an association. Reduced salivary flow rate is a common feature among bulimics, but this is often due to anti-depressant medication rather than dietary habits or vomiting, and the effects are largely limited to unstimulated whole salivary flow rate and don't affect stimulated whole salivary flow rate. Parotid enlargement is present in a number of cases but this tends to be a minority. Further research is required given the limitations of current studies, especially gender imbalances among the populations studied and a lack of clear focus on bulimia nervosa.

Worn is born: The role of the maxillo-mandibular relation in management of worn dentition

Worn dentition, often accompanied by occlusion changes such as reduced vertical dimension, poses a big challenge to both diagnosis and treatment. Current established causes fail to explain the observed tooth wearing patterns, and the treatments based on the documented pathogeneses are often unpredictable and require frequent maintenance. From the perspective of stomatognathic system, we postulate that the role of maxillo-mandibular relation is a crucial part in the tooth wear progression patterns, and should be well addressed in treatment planning. Incompatible occlusion with the inherent tendency of maxillo-mandibular relation has a profound effect on either wearing of natural teeth or failures of restorations. With the aid of cephalometrics and analysis of occlusion it is now possible to reduce this fallacy and achieve a harmony by re-designing the occlusion. According to our treated worn dentition cases, the restoring treatment guided by the tendency of maxillo-mandibular relation showed very promising results.

The tooth wear evaluation system: a modular clinical guideline for the diagnosis and management planning of worn dentitions

Tooth wear is a multifactorial condition, leading to the loss of dental hard tissues, viz. enamel and dentine. Tooth wear can be divided into the subtypes mechanical wear (attrition and abrasion) and chemical wear (erosion). Because of its multifactorial aetiology, tooth wear can manifest itself in many different representations, and therefore, it can be difficult to diagnose and manage the condition. A systematic approach is a sine qua non. In the below-described tooth wear evaluation system (TWES), all necessary tools for a clinical guideline are present in different modules. This allows the dental clinician, in a general practitioner setting as well as in a referral practice setting, to perform a state-of-the-art diagnostic process. To avoid the risk of a too cumbersome usage, the dental clinician can select only those modules that are appropriate for a given setting. The modules match with each other, which is indispensable and essential when different modules of the TWES are compared. With the TWES, it is possible to recognise the problem (qualifying), to grade its severity (quantifying), to diagnose the likely causes and to monitor (the progress of) the condition. In addition, a proposal for the classification of tooth wear is made. Further, it is possible to determine when to start a treatment, to make the decision which kind of treatment to apply and to estimate the level of difficulty of a restorative treatment.

Dental erosion and its growing importance in clinical practice: from past to present

Since the mid-1990s, the focus of studies on tooth wear has steadily shifted from the general condition towards the more specific area of dental erosion; equally, a shift has occurred from studies in adults to those in children and adolescents. During this time, understanding of the condition has increased greatly. This paper attempts to provide a critical overview of the development of this body of knowledge, from earlier perceptions to the present. It is accepted that dental erosion has a multifactorial background, in which individual and lifestyle factors have great significance. Notwithstanding methodological differences across studies, data from many countries confirm that dental erosion is common in children and young people, and that, when present, it progresses rapidly. That the condition, and its ramifications, warrants serious consideration in clinical dentistry, is clear. It is important for the oral healthcare team to be able to recognize its early signs and symptoms and to understand its pathogenesis. Preventive strategies are essential ingredients in the management of patients with dental erosion. When necessary, treatment aimed at correcting or improving its effects might best be of a minimally invasive nature. Still, there remains a need for further research to forge better understanding of the subject.

Contemporary fluid intake and dental caries in Australian children

In Australia, caries experience of 6-year-old and 12-year-old children has increased since the mid to late 1990s. Previously, caries rates had declined, attributable to community water fluoridation. The recent caries increase has been attributed speculatively to changes in fluid intake, including increased consumption of sweet drinks and bottled waters. Increasing urbanization and globalization have altered children's diets worldwide, promoting availability and access to processed foods and sweet drinks. Studies in Australia and internationally have demonstrated significant associations between sweet drink intake and caries experience. Despite widespread fluoride availability in contemporary Australian society, the relationship between sugar consumption and caries development continues and restricting sugar intake remains key to caries prevention. Caries risk assessment should be included in treatment planning for all children; parents should be advised of their child's risk level and given information on oral health promotion. Readily-implemented caries risk assessment tools applicable to parents and clinicians are now available. Public health information should increase awareness that consuming sweet drinks can have deleterious effects on the dentition as well as the potential for promoting systemic disease. Restricting sales of sweet drinks and sweet foods and providing healthy food and drinks for purchase in schools is paramount.

Oral health of children with respiratory diseases

Children with respiratory disorders are at risk of compromised oral health. It has been shown that both dental hard tissue damage (dental caries, dental erosion, mild enamel developmental defects) and soft tissue damage (gingivitis, periodontal disease and calculus formation) are more likely for such children. The aetiology of this increased risk of oral health problems is associated both with the illness itself and/or the drug therapies used. Oral health management strategies for the home and surgery are outlined.

A model for the prediction of tooth wear in individuals

BACKGROUND

Easily applied, age-specific standards are useful in assisting clinicians to decide whether the extent of tooth wear observed in a given patient at a specific age is acceptable or whether intervention is indicated.

METHOD

A simple method of scoring tooth wear and previously established mathematical relationships between tooth wear scores and age, provide the basis of a method for predicting tooth wear scores. In its most specific form, the method can be used to predict tooth wear scores for individual patients at subsequent ages. Alternatively, tables or graphs can be consulted to provide a less precise prediction of tooth wear that can assist clinicians to decide whether the amount of wear reflects high, moderate or low rates of wear at the specified age.

CONCLUSION

In cases where there is no reason to believe that aetiological factors have changed significantly over time, data obtained from the methods described can assist clinicians to plan appropriate management for patients presenting with unacceptable levels of tooth wear.

Interim and temporary restoration of teeth during endodontic treatment

One of the main aims of endodontic treatment is to eliminate micro-organisms from within the root canal system. A further aim is to prevent the ingress of any further bacteria during and after treatment. These aims are usually achieved by various means and stages throughout the treatment process. Endodontic treatment is usually performed on teeth that have lost the integrity of the external coronal tooth structure which has allowed bacteria to enter the tooth and ultimately reach the pulp space. Further opening of the tooth occurs when an endodontic access cavity is made to allow treatment to be performed. Hence, there will always be a need for interim and temporary restoration of teeth undergoing endodontic treatment. Many different materials and techniques have been proposed, and these proposals have been based on many research reports. The purposes of this article are to review the literature regarding the use of interim and temporary restorations, and to provide recommendations regarding such restorations for clinicians to follow when providing endodontic treatment.

The potential for dental plaque to protect against erosion using an in vivo-in vitro model--a pilot study

BACKGROUND

Tooth erosion is a problem for professional wine tasters (exogenous erosion from frequent exposure to wine acids) and for people with gastro oesophageal reflux disease (GORD) and bulimia who experience frequent reflux of gastric contents into the mouth (endogenous erosion from mainly HCl). The objective in this study was to determine whether plaque/pellicle could provide teeth with any protection from two common erosive acids, using an in vivo-in vitro technique.

METHODS

Tiles of human tooth enamel and root surfaces were prepared from six extracted, unerupted third molar teeth and sterilized. Mandibular stents were prepared for six volunteer subjects and the tiles bonded to the buccal flanges of these stents. They were worn initially for three days to permit a layer of pellicle and plaque to form over the tile surfaces, and for a further 10 days of experimentation. Following cleaning of the plaque/ pellicle layer from the tiles on the right side flange, all the tiles were submerged in either 0.06M HCl or white wine for an accumulated time of 600 and 1500 minutes, respectively. Depths of erosion were determined using light microscopy of sections of the enamel and root tiles. SEM of the lesion surfaces was carried out to investigate the nature of erosive damage and of plaque/pellicle remnants.

RESULTS

Retained plaque was found to significantly inhibit dental erosion on enamel, from contact with both HCl and wine, compared with that resulting following its removal. However, it was found to provide no significant protection on root surfaces. SEM analysis of the tile surfaces revealed marked etching of enamel on the cleaned surfaces, and considerable alteration to the appearance of remaining plaque and pellicle on most surfaces.

CONCLUSION

Within the limitations of numbers of specimens, dental plaque/pellicle provided a significant level of protection to tooth enamel against dental erosion from simulated gastric acids and from white wine, using an in vivo-in vitro model. It was unable to provide any significant protection to root surfaces from these erosive agents. Possible reasons for this difference are explored.

Tooth wear: diet analysis and advice

Diet analysis and advice for patients with tooth wear is potentially the most logical intervention to arrest attrition, erosion and abrasion. It is saliva that protects the teeth against corrosion by the acids which soften enamel and make it susceptible to wear. Thus the lifestyles and diet of patients at risk need to be analysed for sources of acid and reasons for lost salivary protection. Medical conditions which put patients at risk of tooth wear are principally: asthma, bulimia nervosa, caffeine addiction, diabetes mellitus, exercise dehydration, functional depression, gastroesophageal reflux in alcoholism, hypertension and syndromes with salivary hypofunction. The sources of acid are various, but loss of salivary protection is the common theme. In healthy young Australians, soft drinks are the main source of acid, and exercise dehydration the main reason for loss of salivary protection. In the medically compromised, diet acids and gastroesophageal reflux are the sources, but medications are the main reasons for lost salivary protection. Diet advice for patients with tooth wear must: promote a healthy lifestyle and diet strategy that conserves the teeth by natural means of salivary stimulation; and address the specific needs of the patients' oral and medical conditions. Individualised, patient-empowering erosion WATCH strategies; on Water, Acid, Taste, Calcium and Health, are urgently required to combat the emerging epidemic of tooth wear currently being experienced in westernised societies.

Eating disorders and oral health: A review of the literature

This article is a review of the recent literature pertaining to the oral sequelae of eating disorders (EDs). Dentists are recognized as being some of the first health care professionals to whom a previously undiagnosed eating disorder patient (EDP) may present. However, despite the prevalence (up to 4 per cent) of such conditions in teenage girls and young adult females, there is relatively little published in the recent literature regarding the oral sequelae of EDs. This compares unfavourably with the attention given recently in the dental literature to conditions such as diabetes mellitus, which have a similar prevalence in the adult population. The incidence of EDs is increasing and it would be expected that dentists who treat patients in the affected age groups would encounter more individuals exhibiting EDs. Most of the reports in the literature concentrate on the obvious clinical features of dental destruction (perimolysis), parotid swelling and biochemical abnormalities particularly related to salivary and pancreatic amylase. However, there is no consistency in explanation of the oral phenomena and epiphenomena seen in EDs. Many EDPs are nutritionally challenged; there is a relative lack of information pertaining to non-dental, oral lesions associated with nutritional deficiencies.

Dental erosion in asthma: a case-control study from south east Queensland

BACKGROUND

Asthma medication places patients at risk of dental erosion by reducing salivary protection against extrinsic or intrinsic acids. But patterns of lesions in asthmatics may differ from patterns in non-asthmatics, because gastro-oesophageal reflux (GOR) is found in 60 per cent of asthmatics.

METHODS

The lesions in 44 asthma cases were compared to those of age and sex match controls with no history of asthma or medications drawn from the dental records of 423 patients referred concerning excessive tooth wear. The subjects were 70 males age range 15 to 55 years and 18 females age range 18 to 45. Anamnestic clinical data were compared between the two groups. Models of all 88 subjects were examined by light microscopy, and wear patterns were recorded on permanent central incisor, canine, premolar and first molar teeth.

RESULTS

Clinical differences were a higher incidence of tooth hypersensitivity, xerostomia, salivary gland abnormalities, gastric complaints, and self induced vomiting in the cases. No differences were found between the cases and controls on citrus fruit and acid soft drink consumption. More occlusal erosion sites were found in cases, whereas more attrition sites were found in the controls. There were no significant differences in palatal erosion on maxillary anterior teeth found between cases and controls. Lingual erosion of the mandibular incisors, found only in GOR patients, was not observed.

CONCLUSIONS

A higher incidence of erosion was found in asthmatics. Gastro-oesophageal reflux symptoms were not associated with the sign of lingual mandibular incisor erosion. The clinical significance is that asthmatics are at risk of dental erosion from extrinsic acid, but GOR does not appear to contribute in a site-specific manner.