Gastroesophageal reflux disease and tooth erosion

Reliability of the Assessment of Tooth Wear Severity on Dental Hard Tissues and Dental Restorations, Using the TWES 2.0, by Nonexperts

BACKGROUND

Tooth wear is a multifactorial process resulting in the loss of dental hard tissues. For its assessment, the tooth wear evaluation system (TWES) 2.0 has been published. Previous studies on the TWES involved well-trained practitioners, rather than nonexperts.

OBJECTIVE

The first aim of this study was to investigate the reliability of the assessment of tooth wear severity on dental hard tissues, using the TWES 2.0, by nonexperts. The second aim was to investigate the reliability of assessment of wear severity on dental restorations, using a third scale.

METHODS

Forty-seven dental students evaluated at least 9 of 14 possible patient cases on dental casts and intraoral photographs. Cohen's kappa (agreement with sample solution) and Fleiss' kappa (Inter-rater reliability) were calculated.

RESULTS

The agreements of the operators' ratings compared to the sample-solution resulted in Cohen's kappa between 0.02 and 0.9. The agreements were 0.34 for occlusal; 0.43 for vestibular; 0.57 for oral surfaces. Inter-rater reliability (Fleiss' kappa) was 0.35 for occlusal, 0.17 for vestibular and 0.24 for oral assessment. The inter-rater reliability of the ratings on tooth surfaces with restorations was lower with 0.21 (occlusal), 0.14 (vestibular) and 0.39 (oral). The agreement on different restorations differed tremendously.

CONCLUSIONS

The ability to correctly assess the cases varied considerably between individual examiners. Within the limits of this study, assessment of restorations was slightly more challenging compared to natural teeth, particularly in occlusal regions or when the restorative material is gold. Subsequent studies should address whether enhanced training and improved definition of tooth wear grades result in higher reliability scores.

Effect of Acidic Media on Surface Topography and Color Stability of Two Different Glass Ceramics

OBJECTIVE

 The aim of this study was to determine the effect of two acidic beverages (orange juice and H3PO4-containing fizzy drink) on the surface topography and color stability of two commonly used computer-aided design/computer-aided manufacturing (CAD/CAM) ceramic materials.

MATERIALS AND METHODS

 Sixty samples of two CAD/CAM ceramic materials, lithium disilicate (IPS e-max CAD) and zirconia reinforced lithium silicate (Vita Suprinity), were prepared according to the manufacturer's instructions. The samples were immersed in one of three media (artificial saliva, orange juice and H3PO4-containing fizzy drink) and then stored in an incubator at 37 °C for 24 hours). Before and after immersion in different media, the surface roughness (Ra) of the samples was assessed using profilometer (JITAI8101 Surface Roughness Tester-Beijing Jitai Tech Detection Device Co. Ltd, China) and the color parameters were measured using VITA Easyshade Advance 4.01 (VITA shade, VITA made, VITA). Surface topography was observed using scanning electron microscope (SEM) and surface mineral content was compared before and after immersion. Paired sample t-test was used to determine the change in Ra before and after immersion. Two-way analysis of variance was used to determine the effect of different CAD/CAM materials and immersion media on the mean ∆Ra and mean ∆E of the studied groups. Tukey's honest significant difference posthoc test was used for multiple comparisons at a level of significance (α = 0.05).

RESULTS

 A significant increase in Ra and a decrease in the color stability of the two investigated ceramic materials were detected after immersion in the acidic media than in artificial saliva. SEM and energy-dispersive X-ray results revealed the dissolution of the glassy matrix and the exposure of silicate crystals.

CONCLUSION

 The surface topography and color stability of glass ceramics are affected by the pH of different acidic media.

Impact of simulated gastric acid on the physical and mechanical properties of vacuum-formed retainers: an in vitro study

BACKGROUND

A decrease in oral pH levels may have detrimental effects on vacuum-formed retainers since an acidic oral environment could impact the mechanical and physical properties of these retainers. The present In vitro study aimed to evaluate the effect of simulated gastric acid at pH 4 and 1.2 on the surface microhardness, flexural strength, and color change of three different types of orthodontic retainer materials.

METHODS

A total of 144 vacuum-formed commercially available retainer materials: copolyesters, polypropylene, and PET-G (n = 48/group) were evaluated. Each specimen was immersed in distilled water, and then the specimens were divided into two subgroups: those with a pH of 4 and those with a pH of 1.2. The microhardness test was performed using Innovatest, the flexural strength was evaluated by a universal testing machine, and the color change was analyzed using a spectrophotometer. The data were analyzed using One-Way ANOVA and independent sample t test at a significance value of P ≤ 0.05.

RESULTS

Our findings indicated a significant decrease in flexural strength in all the experimental groups after immersion in pH 1.2 and 4 solutions (P < 0.001), with PET-G being the most affected material, followed by copolyester and polypropylene. Only copolyester demonstrated a significant decrease in surface microhardness following immersion in a pH 4 solution (P = 0.025). All materials exhibited the greatest degree of color alteration CP (P = 0.006), PP (P = 0.001), and PET-G (P = 0.009) respectively.

CONCLUSION

The study concluded that copolyester adversely affects flexural strength, surface microhardness, and color when subjected to immersion in simulated gastric acid. Therefore, care is recommended for patients diagnosed with gastroesophageal reflux disease.

Overall satisfaction following laparoscopic fundoplication for patients with atypical extraesophageal symptoms: A comparative cohort study

BACKGROUND

Some patients with gastroesophageal reflux (GERD) experience extraesophageal symptoms, which are considered due to laryngopharyngeal reflux (LPR). Most studies evaluating fundoplication for LPR report outcomes from individuals who also have typical esophageal GERD symptoms. Information is limited for patients with LPR but no GERD symptoms. To determine whether LPR patients benefit from fundoplication outcomes were determined for individuals with LPR ± GERD and also those without LPR.

METHODS

Patients undergoing fundoplication from 1997 to 2015 were identified and divided into three symptom groups: LPR only, LPR and GERD, and GERD only. Heartburn, dysphagia, and satisfaction were assessed using 0-10 analog scores and compared at short (1-2 years) and later (5 years) follow-up.

RESULTS

2204 patients underwent fundoplication. 24 patients had LPR only, 130 patients had LPR and GERD, and matched to 1319 patients with GERD only. At 1-2 years follow-up, the LPR only group had lower satisfaction scores than those with GERD symptoms (± concurrent LPR) (7.00 ± 3.49 vs. 8.41 ± 2.42, p = 0.019, and mean ± s.d.). At 1-2 years, 68.1% of the LPR only group had a good outcome (satisfaction score: 7-10) versus 84.6% with LPR and GERD and 84.1% with GERD only.

CONCLUSION

At 1-2 years follow-up, patients with LPR only were less satisfied following fundoplication compared with patients with typical GERD (±LPR). However, some patients with LPR only did benefit and might be considered for surgery if appropriately counseled. Outcomes were similar for patients with LPR and typical GERD and those with only typical symptoms.

Association Between Gastroesophageal Reflux Disease and Periodontitis: A Longitudinal Follow-Up Study from the Korean National Health Screening Cohort

BACKGROUND

Gastroesophageal reflux disease (GERD) and periodontitis are common conditions in older adults that can lead to serious complications, gaining public health attention. Although GERD and periodontitis share common risk factors, such as age, lifestyle habits, and socioeconomic status, large-scale studies examining their specific relationship are limited.

METHODS

This study aimed to assess the association between GERD and the likelihood of developing periodontitis using a national validated cohort data from Korea. Data were drawn from the Korean National Health Insurance Service Health Screening Cohort (2004-2019) using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) diagnostic codes. The study included 16,744 GERD patients and 66,976 matched controls (matched 1:4 by age, sex, income, and residence). Cox proportional hazard models estimated hazard ratios (HRs) for periodontitis, adjusting for various factors, with subgroup analyses based on age, income, and other covariates.

RESULTS

The overall incidence of periodontitis was similar between the GERD and control groups, with no significant difference in the adjusted hazard ratios (aHR = 1.00, 95% CI 0.99-1.02, p = 0.625). However, subgroup analyses in the GERD group showed a slightly increased likelihood of periodontitis in individuals over 60 years old (aHR = 1.03, 95% CI 1.00-1.06, p = 0.050) and those in lower-income brackets (aHR = 1.03, 95% CI 1.01-1.06, p = 0.023).

CONCLUSIONS

In summary, while GERD was not associated with an increased overall probability of periodontitis, age and socioeconomic factors may influence the likelihood of periodontitis development in certain GERD patients. These findings may highlight the need for targeted preventive strategies and closer oral health monitoring in older and lower-income populations with GERD.

The Ways of Forming and the Erosion/Decay/Aging of Bioapatites in the Context of the Reversibility of Apatites

This study primarily focused on the acid erosion of enamel and dentin. A detailed examination of the X-ray diffraction data proves that the products of the acid-caused decay of enamel belong to the family of isomorphic bioapatites, especially calcium-deficient hydroxyapatites. They are on a trajectory towards less and less crystallized substances. The increase in Bragg's parameter d and the decrease in the energy necessary for the changes were coupled with variability in the pH. This was valid for the corrosive action of acid solutions with a pH greater than 3.5. When the processes of natural tooth aging were studied by X-ray diffraction, a clear similarity to the processes of the erosion of teeth was revealed. Scarce data on osteoporotic bones seemed to confirm the conclusions derived for teeth. The data concerning the bioapatite decays were confronted with the cycles of apatite synthesis/decay. The chemical studies, mainly concerning the Ca/P ratio in relation to the pH range of durability of popular compounds engaged in the synthesis/decay of apatites, suggested that the process of the formation of erosion under the influence of acids was much inverted in relation to the process of the formation of apatites, starting from brushite up to apatite, in an alkaline environment. Our simulations showed the shift between the family of bioapatites versus the family of apatites concerning the pH of the reaction environment. The detailed model stoichiometric equations associated with the particular stages of relevant processes were derived. The synthesis processes were alkalization reactions coupled with dehydration. The erosion processes were acid hydrolysis reactions. Formally, the alkalization of the environment during apatite synthesis is presented by introducing Ca(OH)2 to stoichiometric equations.

Evaluation of incipient enamel-carious-like lesion treated with hydroxyapatite-chitosan nanocomposite hydrogel

BACKGROUND

Non-invasive restoration of tooth enamel is a topic of high relevance in dental material science. Multiple approaches have been proposed to reach optimum reconstruction results. The current study was performed to evaluate the cross-sectional microhardness besides mineral quality and content in artificially induced carious enamel after treatment with hydroxyapatite-chitosan (HAp-CS) nanocomposite gel.

METHODS

Artificially carious lesions were induced by immersion of teeth in acidic carboxymethyl cellulose gel (pH 4.95-5) for 24- and 72-hours periods. Two different compositions of HAp-CS nanocomposite hydrogel were prepared with two different ratios 50/50 (%) and 70/30 (%), respectively. Additionally, sodium fluoride gel (1000 ppm concentration) was prepared and used as reference. Gels were applied to carious lesions twice/day for 3 min/each. After 45 days of application, surface morphology, energy dispersive x-ray spectroscopy, micro-Raman analysis in addition to cross-sectional microhardness were evaluated. Statistical analysis was performed using two-way ANOVA and Tukey's post hoc statistical tests.

RESULTS

Surface morphological evaluation of treated surfaces showed obliteration of surface irregularities. Groups demineralized for 24 hours and treated with 70/30 (HAp-CS) showed highest significant cross-sectional-microhardness (P ≤ 0.05). Evaluated subsurface cross-sectional microhardness showed better mineral quality for groups demineralized for 24 hours and treated with HAp-CS nanocomposite gels.

CONCLUSIONS

Nanocomposite gel with 70/30 (HAp-CS) could efficiently improve cross-sectional microhardness and both minerals composition and quality for lesions demineralized for 24 hours. More severely induced lesions, as demineralized for 72 hours, need more powerful agent compositions and/or prolonged application protocols for improvement.

Association between Oral Microbiome and Gastroesophageal Reflux Severity

Background/Objectives: Gastroesophageal reflux disease (GORD) is caused by gastric contents refluxing back into the oesophagus and oral cavity. It can lead to injuries to the mucosa in the form of erosion and ulcers. Our past research have shown acid reflux severity and disease progression is associated with alternations in the microbiota of the distal oesophagus. The aim of this study was to explore whether changes in the oral microbiota occurred in GORD patients and establish any associations with reflux severity. Methods: Fresh mouthwash samples were collected from 58 patients experiencing reflux symptoms referred for 24 h pH monitoring. The participants were categorised into three groups based on their DeMeester scores: Normal (<14.72), Mild (14.2-50), and Moderate/severe (>51). Microorganism identity and diversity were generated using hypervariable tag sequencing and analysing the V1-V3 region of the 16S rRNA gene. Results: No differences in microbiota diversity were found in oral microbiota between groups using the Chiao1 diversity index and Shannon diversity index. Microbiota in the Mild group showed reductions in Rothia dentocariosa and Lautropia, while Moryella and Clostridiales_1 were increased compared with the Normal group. In the Moderate/severe group, the abundance of Rothia aeria was reduced compared with the Normal group, while Schwartzia, Rs_045, Paludibacter, S. satelles, Treponema, and T. socranskii all had increased abundance. The abundance of Prevotella pallens was higher in the Mild group compared with Moderate/severe, while S. satelles and Paludibacter abundances were lower. Conclusions: Our study shows the oral microbiome show significant differences between acid reflux severity groups, as categorised by DeMeester score.

Effect of gastric acids on the mechanical properties of conventional and CAD/CAM resin composites - An in-vitro study

OBJECTIVES

Dental erosion in patients with gastroesophageal reflux disease (GERD) is a current and frequent condition that may compromise the mechanical properties and clinical durability of resin-based composites (RBCs). This study assessed the mechanical properties of conventional and computer-aided design/computer-aided manufacturing (CAD/CAM) RBCs subsequent to simulated gastric acid aging.

MATERIALS AND METHOD

Three conventional and three CAD/CAM composites were assessed. They were divided into an experimental group (exposed to simulated gastric acid aging) and a control group (no aging). Both groups were analyzed for Vickers microhardness (VHN), wear and flexural strength over a period of six months. The failure rate probability for each RBC was calculated through the Weibull cumulative distribution function (m). Statistical analysis was conducted using repeated measures ANOVA, 3-way ANOVA, a non-parametric Kruskal-Wallis and U Mann-Whitney tests (α = 0.05).

RESULTS

The mechanical properties of all the RBCs dropped significantly after aging (p < 0.05). Lower VHN and flexural strength values, along with greater wear values were evident in the experimental groups, though the effects of the treatment varied between RBCs. The Weibull m of all the RBCs decreased over time.

CONCLUSION

Conventional RBCs might show greater reduction in mechanical properties compared to CAD/CAM RBCs when exposed to gastric acid attack. Thus, CAD/CAM composites may represent a suitable choice for the treatment of patients presenting erosive issues.

Gastroesophageal reflux disease as a risk factor of dental hard tissues erosions

Gastroesophageal reflux disease (GERD) is a common chronic disease leading to a spontaneous and regular retrograde flow of gastric and/or duodenal contents into the esophagus. Reflux of the gastric contents into the oral cavity refers to the extraesophageal presentation of the disease, which, in the absence of timely treatment, can result in erosion of dental hard tissue (EDHT) through repeated exposure of the dental tissue to acidic contents. EDHT are non-carious lesions of the dental hard tissues (mainly enamel, and in some cases dentin), induced by a chemical reaction involving acids, which results in demineralization processes. The incidence rates of EDHT in adult patients with GERD are 32.5–51.5%. The EDHT in GERD develops in stages. Initially, the gradual degradation of tooth pelicula happens when it gradually becomes decayed by repeated acidic attacks. The loss of the pelicula results in direct contact of hydrochloric acid refluxate with the enamel surface and initiation of its demineralization at pH < 5.5 with dissolution of hydroxyapatite crystals. Given the high prevalence of GERD in the population, it seems important to update an integrated approach to the treatment of such patients, which involves pharmacotherapy provided by the gastroenterologist, as well as prevention and minimally invasive treatment of presentations in the oral cavity by the dentist. Patients with EDHT due to GERD need to maintain individual oral hygiene (use mouth washes with a neutral pH level, avoid abrasive toothpastes), use remineralization therapy at home applying remogels (Tooth Mousse), and also be observed by a dentist as part of the follow-up care. Minimally invasive treatment by the dentist involves restorations using composite tooth filling materials and ceramic veneers. It is reasonable to empirically use proton pump inhibitors twice a day for 3 months for the direct treatment of GERD in patients with EDHT.

Diagnostic value associated with the combination of saliva pepsin and microorganisms in functional heartburn and gastroesophageal reflux disease

Heartburn is a common symptom shared by both gastroesophageal reflux disease (GERD) and functional heartburn (FHB), which can make it challenging to differentiate between the two conditions. However, examining oral manifestations of GERD can be a cost-effective and readily available method to aid in this differentiation process. It may serve as a valuable tool in distinguishing GERD from FHB.

Tooth Wear Evaluation System 2.0-Evaluation of diagnostic reliability in the assessment of signs and symptoms for tooth wear by non-experts

BACKGROUND

Tooth wear is a multifactorial condition that manifests through various signs and symptoms. These individual signs and symptoms were described in multiple studies, leading to the inclusion in TWES 2.0 (Tooth Wear Evaluation System 2.0) and the forthcoming DC-TW (Diagnostic Criteria for Tooth Wear). However, a study evaluating their reliability has yet to be conducted.

OBJECTIVE

The aim of the study was to examine the reliability in the assessment of 6 signs of pathological tooth wear and 18 clinical signs and symptoms determining aetiology, all of which are included in the TWES 2.0/DC-TW.

METHODS

48 dental students (operators) evaluated patient cases from a patient pool of 14 patients on dental casts and high-resolution intraoral photographs. The agreement between all operators for each sign and symptom was calculated based on ICC (Intraclass Correlation Coefficients). Additionally, the agreement of each operator's evaluation with a predefined sample solution was calculated based on Cohen's kappa.

RESULTS

Inter-user agreement ranged from near perfect (0.91) to poor (0.02) for the various pathology signs or aetiology symptoms of tooth wear (mean 0.32). The agreements of the operator's ratings compared to the sample solution resulted in Cohen's kappa from 0.18 to 1 (mean 0.59) for the pathology signs and ranged from 0.02 to 0.51 for the aetiology signs (mean 0.38).

CONCLUSIONS

The reliability of the signs and symptoms examined and the ability of individual investigators to correctly identify and assign signs and symptoms varied widely. The current assessment tools for the qualification of tooth wear need further refinement, and examiners need intensive training in tooth wear assessment.

Adjacent Implant Influence on Tooth Restoration in a Gastro-Esophageal Reflux Disease (GERD) Patient Using Monoblock Post-Fused Crown: A Case Report

This case report explores how the presence of an adjacent implant influenced the restoration of a tooth with pulpitis in a gastro-esophageal reflux disease (GERD) patient. A patient with GERD requires a tooth-colored crown not only for aesthetics but also to address potential galvanic concerns arising from an adjacent implant. GERD, a condition causing non-cavity erosion, weakens tooth structure over time, presenting significant challenges in treatment. It resulted in bite relapse and insufficient occlusal clarity over time. A comprehensive treatment approach was needed to restore both function and appearance. This involved managing galvanism using non-metallic materials to ensure optimal occlusal clarity, as well as meticulously reinforcing and restoring tooth structure. Monoblock post-fused crowns were chosen for their superior durability, stability, and comfort. The ceramic layering not only effectively prevented galvanic issues by insulating the tooth structure but also significantly improved the natural appearance of teeth, thereby promoting long-term oral health and successfully managing complex dental concerns. The dental team successfully restored the damaged tooth by considering specific factors that influenced the treatment plan, including achieving optimal aesthetic outcomes.

Dental evaluation is helpful in the differentiation of functional heartburn and gastroesophageal reflux disease

BACKGROUND

Heartburn is identically the key symptom of both, gastroesophageal reflux disease (GERD) and functional heartburn (FHB), making the differential diagnosis resource-intensive. Oral manifestations of GERD can be easily examined; therefore, their exploration might be a cheap, widely available, and useful tool in the differentiation of GERD and FHB.

AIM

To evaluate the prevalence of dental erosions (DE) and periodontal diseases (PD) in patients with heartburn and their association with GERD and FHB.

METHODS

A total of 116 [M/F: 51/65, mean age: 54 (17-80) years] consecutive patients with heartburn were enrolled for detailed esophageal function and orodental examinations.

RESULTS

Dental disorders were detected in 89% (103/116). Patients with PD + DE had significantly more often pathologic reflux (90.0% vs 27.8%; P < 0.05), higher esophagitis scores (1.8 vs 0.9; P < 0.05), and a significantly different mean impedance curve (P = 0.04) than those without any dental diseases. The opposite approach established that patients with GERD had significantly higher prevalence of DE and PD, especially if both were present (28.9% vs 2.0%; P < 0.01), more severe PD (1.5 vs 1.0; P < 0.01), and longer history of heartburn (15 years vs 9 years; P < 0.01) than those with FHB.

CONCLUSION

The dental evaluation of patients with heartburn seems to be useful in the differential diagnosis of GERD and FHB. Among the studied parameters, the co-appearance of DE and PD seems to be the best predictor of GERD, whereas the absence of dental disorders was mostly observed in FHB.

Updated consensus guidelines on the management of Phelan-McDermid syndrome

Phelan-McDermid syndrome (PMS) is a genetic condition caused by SHANK3 haploinsufficiency and characterized by a wide range of neurodevelopmental and systemic manifestations. The first practice parameters for assessment and monitoring in individuals with PMS were published in 2014; recently, knowledge about PMS has grown significantly based on data from longitudinal phenotyping studies and large-scale genotype-phenotype investigations. The objective of these updated clinical management guidelines was to: (1) reflect the latest in knowledge in PMS and (2) provide guidance for clinicians, researchers, and the general community. A taskforce was established with clinical experts in PMS and representatives from the parent community. Experts joined subgroups based on their areas of specialty, including genetics, neurology, neurodevelopment, gastroenterology, primary care, physiatry, nephrology, endocrinology, cardiology, gynecology, and dentistry. Taskforce members convened regularly between 2021 and 2022 and produced specialty-specific guidelines based on iterative feedback and discussion. Taskforce leaders then established consensus within their respective specialty group and harmonized the guidelines. The knowledge gained over the past decade allows for improved guidelines to assess and monitor individuals with PMS. Since there is limited evidence specific to PMS, intervention mostly follows general guidelines for treating individuals with developmental disorders. Significant evidence has been amassed to guide the management of comorbid neuropsychiatric conditions in PMS, albeit mainly from caregiver report and the experience of clinical experts. These updated consensus guidelines on the management of PMS represent an advance for the field and will improve care in the community. Several areas for future research are also highlighted and will contribute to subsequent updates with more refined and specific recommendations as new knowledge accumulates.

Influence of Storing Composite Filling Materials in a Low-pH Artificial Saliva on Their Mechanical Properties-An In Vitro Study

Restorative composites are subjected to various influences in the oral cavity environment, such as high or low temperatures, the mechanical force generated during mastication, colonization of various microorganisms, and low pH, which may result from ingested food and the influence of microbial flora. This study aimed to investigate the effect of a recently developed commercial artificial saliva (pH = 4, highly acidic) on 17 commercially available restorative materials. After polymerization, the samples were stored in an artificial solution for 3 and 60 days and subjected to crushing resistance and flexural strength tests. The surface additions of the materials were examined in terms of the shapes and sizes of the fillers and elemental composition. When stored in an acidic environment, the resistance of the composite materials was reduced by 2-12%. Larger compressive and flexural strength resistance values were observed for composites that could be bonded to microfilled materials (invented before 2000). This may result from the filler structure taking an irregular form, which results in a faster hydrolysis of silane bonds. All composite materials meet the standard requirements when stored for a long period in an acidic environment. However, storage of the materials in an acid environment has a destructive impact on the materials' properties.

Noncarious cervical lesions: Morphology and progression, prevalence, etiology, pathophysiology, and clinical guidelines for restoration

PURPOSE

To synthesize the literature regarding noncarious cervical lesions (NCCLs) and propose clinical guidelines when lesion restoration is indicated.

MATERIAL AND METHODS

A PubMed search was performed related to NCCL morphology, progression, prevalence, etiology, pathophysiology, and restoration.

RESULTS

NCCLs form as either rounded (saucerlike) depressions with smooth, featureless surfaces that progress mainly in height or as V-shaped indentations that increase in both height and depth. Prevalence ranges from less than 10% to over 90% and increases with age. Common locations are the facial surfaces of maxillary premolars. They have a multifactorial etiology due to personal habits such as excessive horizontal toothbrushing and consumption of acidic foods and drinks. Occlusal factors have been identified as contributing to the prevalence of NCCLs in some studies, whereas other studies indicate there is no relationship. The concept of abfraction has been proposed whereby mechanical stress from occlusal loading plays a role in the development and progression of NCCLs with publications supporting the concept and others indicating it lacks the required clinical documentation. Regardless of the development mechanism, demineralization occurs and they are one of the most common demineralization diseases in the body. Treatment should be managed conservatively through preventive intervention with restorative treatment delayed until it becomes necessary due to factors such as lesion progression, impact on patient's quality of life, sensitivity, poor esthetics, and food collection may necessitate restoration. Composite resins are commonly used to restore NCCLs although other materials such as glass ionomer and resin-modified glass ionomer are also used. Sclerotic dentin does not etch like normal dentin and therefore it has been recommended to texture the dentin surface with a fine rotary diamond instrument to improve restoration retention. Some clinicians use mechanical retention to increase retention. Beveling of enamel is used to increase the bonding area and retention as well as enhance the esthetic result by gradually creating a color change between the restoration and tooth. Both multistep and single-step adhesives have been used. Dentin etching should be increased to 30 seconds due to the sclerotic dentin with the adhesive agent applied using a light scrubbing motion for 20 seconds but without excessive force that induces substantial bending of a disposable applicator. Both flowable and sculptable composite resins have been successfully used with some clinicians applying and polymerizing a layer of flowable composite resin and then adding an external layer of sculptable composite resin to provide enhanced resistance to wear. When caries is present, silver diamine fluoride has been used to arrest the caries rather than restore the lesion.

CONCLUSIONS

Noncarious cervical lesions (NCCLs) form as smooth saucerlike depressions or as V-shaped notches. Prevalence values as high as 90% and as low as 10% have been reported due to habits such as excessive toothbrushing and an acidic diet. Occlusal factors have been proposed as contributing to their presence but it remains controversial. Publications have both supported and challenged the concept of abfraction. They are one of the most common demineralization diseases in the body. Conservative treatment through prevention is recommended with restorative treatment delayed as long as possible. When treatment is needed, composite resins are commonly used with proposed restorative guidelines including texturing the sclerotic dentin, beveling the enamel, potential use of mechanical retention, 30 seconds of acid etching, and use of either multistep or single-step adhesives in conjunction with a light scrubbing motion for 20 seconds without excessive force placed on disposable applicators.

Assessment of the Erosive Potential of Mineral Waters in Bovine Dental Enamel

Background:

High intake of acidic foods and beverages has been often associated with the onset of dental erosive wear.

Objetive:

This study in vitro assessed the pH of different mineral waters marketed in Brazil and their effects on the properties and surface of dental enamel.

Methods:

Forty-eight bovine incisor specimens were divided into four groups (n=12): CG-control group, PeG-Perrier, PrG-Prata, and SLG-São Lourenço. The immersion cycles were performed after analysis of the pH of the waters, for 5 days (5 minutes in mineral water and 60 minutes in artificial saliva). Knoop micro-hardness was assessed by means of three indentations with a load of 50kgf for 15 seconds, and surface roughness with a cut off of 0.25mm. The data were analysed using Student's t-test, ANOVA, and Tukey test, with a significance level of 5%.

Results:

The groups of waters with lower pH (Perrier® and São Lourenço®) exhibited a reduction in Knoop micro-hardness (p<0.0001) and an increase in surface roughness (p=0.04 and p=0.004, respectively). The Prata water group did not exhibit significant changes in Knoop micro-hardness (p=0.07) and surface roughness (p=0.26).

Conclusion:

Mineral waters with a pH below the critical value can lead to a reduction in surface hardness and roughness in the bovine enamel.

Association of Gastroesophageal Reflux Disease With Dental Erosion

Gastroesophageal reflux disorder (GERD) or chronic acid reflux disorder is a condition in which acid-containing contents continuously leak from the stomach and return to the esophagus. Acid reflux disease occurs in nearly every person at some unspecified time. In reality, it is considered as a reoccurrence of acid reflux disease disorder and heartburn, every day. However, when you have acid reflux disorder/heartburn greater than two times every week over numerous weeks, constantly take heartburn medicinal tablets and antacids. However, if your signs and symptoms and symptoms keep returning, you can have superior GERD. Your GERD needs to be handled with the aid of your healthcare employer. Now not simply to alleviate your symptoms, but because of the reality, GERD can result in extra intense issues. Dental erosion (DE) is the shortage of the ground of your tooth because of acids you eat or drink or acids arising from your stomach. Those acids can wash away the tough substance that makes up your enamel, number one to tooth floor loss. Acid also can melt the teeth floor, making it much less complicated to wear away with the beneficial aid of erosion. This is called acid put on or erosive enamel wear. The belly contains many sturdy acids that are used to digest food. Vomiting and reflux can reason those belly acids to enter your mouth. Gastric acids are very sturdy and might purpose considerable harm to the tooth. DE is the lack of the enamel's hard tissues due to the interplay of gastric juice, pepsin, and acid.

Prevalence and Risk of Dental Erosion in Patients with Gastroesophageal Reflux Disease: A Meta-Analysis

Aim: The present paper aims to systematize data concerning the prevalence and risk of dental erosion (DE) in adult patients with gastroesophageal reflux disease (GERD) compared to controls. Materials and methods: Core electronic databases, i.e., MEDLINE/PubMed, EMBASE, Cochrane, Google Scholar, and the Russian Science Citation Index (RSCI), were searched for studies assessing the prevalence and risk of DE in adult GERD patients with publication dates ranging from 1 January 1985 to 20 January 2022. Publications with detailed descriptive statistics (the total sample size of patients with GERD, the total sample size of controls (if available), the number of patients with DE in the sample of GERD patients, the number of patients with DE in the controls (if available)) were selected for the final analysis. Results: The final analysis included 28 studies involving 4379 people (2309 GERD patients and 2070 control subjects). The pooled prevalence of DE was 51.524% (95 CI: 39.742–63.221) in GERD patients and 21.351% (95 CI: 9.234–36.807) in controls. An association was found between the presence of DE and GERD using the random-effects model (OR 5.000, 95% CI: 2.995–8.345; I² = 79.78%) compared with controls. When analyzing studies that only used validated instrumental methods for diagnosing GERD, alongside validated DE criteria (studies that did not specify the methodologies used were excluded), a significant association between the presence of DE and GERD was revealed (OR 5.586, 95% CI: 2.311–13.503; I² = 85.14%). Conclusion: The meta-analysis demonstrated that DE is quite often associated with GERD and is observed in about half of patients with this extremely common disease of the upper gastrointestinal tract.

Comparative Evaluation of Bond Strength and Microleakage of Three Ion-Releasing Restorative Materials at Various pH Levels

The aim of this study was a comparison of the micro-tensile bond strength (μTBS) to dentin and microleakage of in vitro class V restorations of three different ion-releasing restorative materials under various pH conditions: giomer, a resin-modified glass ionomer (RMGI), and a new alkasite material. A μTBS test was performed using a universal testing machine, immediately and after storage at different pH (4, 7, and 10) buffer solutions (n = 15) over 24 h, and the failure mode was analyzed. For microleakage analysis, class V restorations were performed on extracted premolars, which were sectioned and stored in pH 4-, 7-, and 10-buffered fluorescent 0.02% rhodamine B dye. The specimens were observed under a confocal laser scanning microscope (CLSM) and scored using the acquired images. There were no significant differences in the μTBS according to the type of material (p = 0.518). The giomer showed a decreased bond strength under the pH 4 condition compared with the immediately tested or pH 7-stored specimens (p ≤ 0.043). In the microleakage analysis, the class V restoration with giomer showed a higher microleakage than RMGI or alkasite (p = 0.001). For RMGI and alkasite, the specimens stored at pH 4 showed a significantly lower microleakage than those stored at pH 7 (p = 0.028). RMGI and alkasite can be adopted as restorative materials in generalized or localized low-pH conditions.

Erosive Effect of Acidic Beverages and Dietary Preservatives on Extracted Human Teeth—An In Vitro Analysis

Objectives Frequent consumption of acidic beverages and dietary preservatives in younger generation, diet-conscious (celebrities), and obese individuals have a rapid impact on demineralization of the teeth. An attempt was made to analyze the erosive potential of various acidic beverages.

Materials and Methods One hundred and ninety extracted human permanent teeth were sectioned longitudinally, pre-weighed, randomly grouped, and placed in nine acidic beverages (200 mL) with predetermined pH, i.e., three commercially available fruit juices, three carbonated drinks, and three dietary preservatives.

Statistical Analysis The sectioned specimens (n = 10) were analyzed at time intervals of 12, 24, 48, and 96 days. Mean weight loss was calculated, and surface changes were assessed under a stereomicroscope. The demineralization pattern and microscopic changes were observed under a compound and polarizing microscope. One-way analysis of variance test followed by Tukey's post-hoc analysis was employed.

Results Overall the maximum demineralizing effect was caused by vinegar and apple cider. In the fruit juices category, lemon juice induced significant changes, while in the carbonated drinks category Coca-Cola induced the maximum changes and in the category of food preservatives vinegar induced the maximum changes. Severe discoloration was seen with respect to Coca-Cola followed by Mountain Dew (carbonated drink).

Conclusion The present study is unique as three different types of microscopes have been employed and both dentin and enamel of permanent teeth have been analyzed. In addition, the effect of dietary preservatives on hard tissues was evaluated. Oral health educators can reinforce important practices such as decreasing the frequency of consumption and time duration of beverage contact with the teeth. Also, the use of mouth rinses and buffering agents after the consumption of dietary beverages can be advocated along with regular fluoride application for those who are regular consumers.

Updates in association of gastroesophageal reflux disease and dental erosion: systematic review

Introduction: Dental erosion occurs by dissolving dental apatite when exposed to non-bacterial acids. One of the factors that predispose to dental erosion is gastroesophageal reflux disease (GERD) due to chronic regurgitation of gastric contents to the oropharynx. Thus, in addition to other extraesophageal symptoms, individuals with GERD may have erosive dental lesions.Areas covered: The objective of this systematic review was to evaluate the association and prevalence of erosive wear in patients with GERD. The bibliographic search was performed in the Pubmed and Web of Science databases, using the descriptors 'gastroesophageal reflux disease' AND 'dental erosion', considering clinical studies recently published from 2012 to 2020.Expert opinion: GERD can be considered a risk factor for the development of erosive dental lesions, whose prevalence was significantly higher in this group. However, several other factors can be commonly associated with the prevalence and severity of dental erosion among the world population, such as dietary habits, lifestyle, abrasion and bruxism. Thus, the prevalence and distribution of erosive lesions among healthy and GERD subjects varied widely among studies, which denotes the etiological complexity of dental erosion and reinforces the importance of careful and detailed anamnesis in order to establish an accurate diagnosis.

Upper Gastrointestinal Disorders in Adult Patients with Intellectual and Developmental Disabilities

The purpose of this literature review is to address the diagnosis and treatment of upper gastrointestinal (GI) disorders in patients with intellectual and developmental disabilities (IDD). Manifestations of upper GI dysmotility and disorders include dysphagia, pulmonary aspiration, malnutrition, gastroesophageal reflux, and gastritis, all of which can impact a person’s quality of life and lead to chronic, life-threatening conditions. This article will explore the existing diagnostic methods and treatments for gastrointestinal disorders as they relate to patients with IDD.

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.

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.

Predictors of dental erosions in patients evaluated with upper digestive endoscopy: a cross-sectional study

The most studied medical condition related with dental erosions is gastroesophageal reflux disease (GERD). The aim of this study was to assess other predictors of dental erosions besides GERD in outpatients referred for upper digestive endoscopy. In a cross-sectional study, we prospectively evaluated 235 patients who underwent upper digestive endoscopy. Patients were interviewed and examined by a trained dentist before the endoscopies, addressing dental health as well as clinical information and food intake. Dental erosion was classified using Basic Erosive Wear Examination score. Potential predictors for dental erosions were: gender, age, chronic use of antidepressants and proton pump inhibitors (PPI), diabetes mellitus, body mass index, heartburn and acid regurgitation scores, chocolate intake, reflux esophagitis and hiatal hernia. Overall prevalence of dental erosions was 23.4%. The most parsimonious Poisson regression model for dental erosions considered age, chocolate intake and acid regurgitation as predictors. Dental erosions were associated with acid regurgitation in patients younger than 50 years [adjusted prevalence ratio (PR) = 1.8 (95% CI 1.1-2.9)] and with chocolate intake in patients older than 50 years [PR = 2.1 (95% CI 1.2-3.9]. The surfaces most eroded were palatine/lingual (n = 25) and occlusal (n = 25), followed by vestibular (n = 5). In outpatients evaluated with upper digestive endoscopy, the variables associated with dental erosions were age younger than 50 years, acid regurgitation and chocolate intake. Referral for dental evaluation should be considered for young patients with GERD and frequent acid regurgitation.

Effect of Dental Erosion and Methods for its Control on the Marginal and Internal Adaptation of Restorations with Different Adhesive Systems

AbstractThe dentin exposed to erosive challenges is often superficially protected to prevent progression of the lesion. This study investigated the marginal and internal adaptation of composite resin restorations made on surfaces that had first been treated with different methods for controlling erosion. Cavities with margins in dentin were prepared in bovine incisors (n=360) and were divided into three groups according to the method for controlling the erosive challenge: negative control, topical application of fluoride and resin-modified glass ionomer varnish. The specimens were then randomly divided into three sub-groups according to the exposure to simulated gastric acid solution (DES) (5% HCl, pH=2.2) and subsequent remineralization (RE): negative control, 9 and 18 cycles of DES-RE. Finally, teeth were divided into four groups, depending on the bonding agent used for composite resin restoration (n=10): conventional etch-and-rinse adhesive system (2 and 3 steps) and self-etching (1 and 2 steps). Front and internal images of the interface tooth/restoration were recorded in stereoscopic microscope (15x) to quantify the percentage of adhesive failures. Despite the promising results of the resin-modified glass ionomer varnish after 9 cycles; no protective material prevented increased internal defects after 18 erosive cycles. More continuous internal margins were noted with etch-and-rinse acid systems after more intense erosion. The maintenance of internal margins in eroded substrates was positively influenced by the resin-modified glass ionomer varnish and, under the most aggressive challenge, by the use of etch-and-rinse adhesives systems. Keywords: Tooth Erosion. Dentin. Acid Gastric. ResumoA dentina exposta a desafios erosivos é muitas vezes superficialmente protegida para prevenir a progressão da lesão. Este estudo investigou a adaptação marginal e interna de restaurações de resina composta realizadas em superfícies que foram previamente tratadas com diferentes métodos para controlar a erosão. Cavidades com margens em dentina foram preparadas em dentes incisivos bovinos (n=360) e divididas em três grupos de acordo com o método de controle do desafio erosivo: controle negativo, aplicação tópica de flúor e verniz de ionômero de vidro modificado por resina. Os espécimes foram então divididos aleatoriamente em três subgrupos de acordo com a exposição à solução de ácido gástrico simulada (DES) (HCl a 5%, pH = 2,2) e posterior remineralização (RE): controle negativo, 9 e 18 ciclos de DES-RE. Por fim, os dentes foram divididos em quatro grupos, de acordo com o agente de união utilizado para a restauração da resina composta (n=10): sistema adesivo convencional (2 e 3 passos) e autocondicionante (1 e 2 passos). Imagens frontais e internas da interface dente/restauração foram registradas em microscópio estereoscópico (15x) para quantificar a porcentagem de falhas adesivas. Apesar dos resultados promissores do verniz de ionômero de vidro modificado por resina após 9 ciclos; nenhum material de proteção impediu o aumento de defeitos internos após 18 ciclos erosivos. Margens internas mais contínuas foram observadas com sistemas adesivos convencionais após erosão mais intensa. A manutenção das margens internas em substratos erodidos foi influenciada positivamente pelo verniz de ionômero de vidro modificado por resina e, sob o desafio mais agressivo, pelo uso de sistemas de adesivos convencionais. Palavras-chave: Erosão Dentária. Dentina. Ácido Gástrico.

Impact of the halitosis on QoL in overweight and obese patients: Based on six years of experience in two centers in sulaimani governorate, Kurdistan Region/Iraq, and case series study

BACKGROUND/OBJECTIVES

The patients who are overweight and obese, are under stress of excess body weight, embarrassed, one may imagine the impact of halitosis on this group of patients, this is an attempt to evaluate this extra impact, and which aspect of quality of life will be affect in the overweight and obese.

SUBJECTS/METHODS

A prospective case series study including 885 overweight or obese patients, they were consulting for advice, diet and or drugs and various bariatric operations. A group of normal weight patients with halitosis, matched in age group and gender were enrolled as a control group for comparison. Patients who have either oral causes of the condition or pseudo halitosis or halite-phobia or were using drugs like phenytoin, cyclosporine or calcium channel blockers, isosorbide di-nitrate, Chloral hydrate, Nitrites and Nitrates, Dimethyl sulphoxide, Disulphiram, cytotoxic agents, Phenothiazine were excluded.

INTERVENTIONS/METHODS

The work conducted over a period of 6 years from February 1st, 2012 to March 1st, 2018. Prospective evaluation of the type and etiology of halitosis was done by using organoleptic measurement, which is not a slandered but evaluated by a group of academic colleagues. The patients were advised to avoid eating odiferous foods for 48 hours before the assessment and both the patient and the examiner should refrain from drinking coffee, tea or juice, smoking and using scented cosmetics before the assessment.

RESULTS

Halitosis in the overweight and obese patients magnifies the negative aspects of quality of life: avoidance, narrow social circle (P Value = 0.3415, 95% confidence interval = 11.43924-29.67085), avoidance of sex by partner (P Value = 0.0143, 95% confidence interval = 04.11537-17.08480), low self-esteem (P Value = 0.0100, 95% confidence interval = 10.66794-28.44776), teasing by others and negative thoughts (P Value = 0.4013, 95% confidence interval = 11.43924-29.67085). While obesity was not a cause of avoidance of to be kissed by partner in obese patients, but was a direct cause for this avoidance in obese patients with halitosis (P Value = 0.0143, 95% confidence interval = 04.11537-17.08480). Halitosis in normal weight patients affects the quality of life remarkably but not to the extent of halitosis in overweight and obese patients, especially social life and self-esteem which will suffer most.

CONCLUSIONS

The quality of life of overweight and obese, especially emotional and social aspects was significantly disturbed by halitosis more than normal weight subjects with halitosis.

Risk factors associated with oral manifestations and oral health impact of gastro-oesophageal reflux disease: a multicentre, cross-sectional study in Pakistan

OBJECTIVE

Gastro-oesophageal reflux disease (GORD) is a relatively common disorder and manifests with extraoesophageal symptoms, such as dental erosions (DE), cough, laryngitis, asthma, and oral soft- and hard-tissue pathologies. This study aimed (1) to identify oral soft and hard-tissue changes in patients with GORD and (2) to evaluate these oral changes as indices for assessing GORD and its severity.

SETTING

This cross-sectional study was conducted at four major tertiary care government hospitals, in two metropolitan cities of Pakistan.

PARTICIPANTS

In total, 187 of 700 patients who underwent oesophago-gastro-duodenoscopy and having GORD were included in the study. Patients with GORD were divided according to the presence of DE into group A (with DE, chronic/severe GORD) and group B (without DE, mild GORD). Patients who were unconscious and had extremely limited mouth opening were excluded.

PRIMARY AND SECONDARY OUTCOME MEASURES

Abnormal conditions and lesions of the oral mucosa were recorded. The impact of oral hard and soft-tissue changes on the oral health-related quality of life was assessed using the Pakistani (Urdu) version of the validated Oral Health Impact Profile-14 (OHIP-14) instrument.

RESULTS

Oral submucous fibrosis (66.3%), ulceration (59.4%) and xerostomia (47.6%) were significantly more common in group A (p<0.05). The prevalence of GORD was 26.7%, within which the prevalence of DE was 35.3%. Unhealthy dietary pattern, nausea/vomiting, oesophagitis, xerostomia, ulceration, gingivitis and angular cheilitis showed a statistically significant association with chronic GORD and DE. All subscales of OHIP-14 were positively correlated (p<0.05) in patients with GORD and DE, with notable impact on psychological discomfort (rs=0.30), physical disability (rs=0.29), psychological disability (rs=0.27) and functional limitation (rs=0.20).

CONCLUSION

Patients with GORD and DE presented with more severe oral manifestations than did those with GORD and no DE. We recommend timely dental check-ups to assess the severity of both systemic and oral disease.

Oral health-related quality of life in patients with upper gastrointestinal and hepatic disorders in Pakistan: validation of the Oral Health Impact Profile-14 in the Urdu language

Introduction

The Oral Health Impact Profile (OHIP-14) has been used extensively to measure the impact of oral disease on oral health-related quality of life (HRQoL) but has not been validated in the Urdu language or tested in gastroenterology.

Aims

To validate the OHIP-14 for use in Pakistan and its ability to assess oral health in patients with upper gastrointestinal (GI) and hepatic disorders.

Design

Multicentre, cross-sectional.

Setting

Four major tertiary care hospitals.

Methods

The OHIP-14 was tested for reliability and validity in 700 patients referred for oesophago-gastro-duodenoscopic (OGD) investigation of the symptoms of upper GI or hepatic disease. Socio-demographic details and oral examination findings (for oral lesions and DMFT) were recorded.

Results

The mean (±standard deviation) total OHIP-14 score (range 0–56) was estimated to be 23.38 ± 10.47, indicating a significant impact of upper gastrointestinal and hepatic disorders on oral health. The reliability coefficient of the OHIP-14 was above 0.7 threshold, and the tool had good internal consistency (α = 0.83). When associated with worsening DMFT (decayed, missed, and filled teeth) index value, the highest correlations (p < 0.01) were detected with functional limitation (rs = 0.234), physical disability (rs = 0.230), and psychological discomfort (rs = 0.221).

Conclusion

The OHIP-14 is a precise and valid instrument for assessing oral-HRQoL in a gastroenterological setting amongst Pakistani population.

Dental erosion, prevalence and risk factors among a group of adolescents in Stockholm County

Aims

To investigate the prevalence and risk factors of dental erosion (DE) among a group of adolescents in Stockholm County.

Materials and methods

This cross sectional cohort study was conducted at three clinics of the Public Dental Service in Stockholm County. Fifteen and 17 year old adolescents (1335) who scheduled their regular dental health examination were asked to participate. After drop-outs a sample of 1071 individuals, 547 males and 524 females were enrolled in the study. Presence of erosive wear was diagnosed (yes/no) on marker teeth by trained dentists/dental hygienists and photographs were taken. The adolescents answered a questionnaire regarding oral symptoms, dietary and behavioural factors. Two calibrated specialist dentists performed evaluation of the photographs for severity of DE using a modified version of the Simplified Erosion Partial Recording System (SEPRS).

Results

DE was clinically diagnosed in 28.3% of 15 years old and 34.3% of 17 years old. Severe erosive wear (grade 3 and 4 according to SEPRS) was found in 18.3% of the adolescents based upon the intra-oral photographs. DE was more prevalent and severe among males than females. Clinically diagnosed erosive lesions correlated significantly with soft drink consumption (p < 0.001), the use of juice or sport drinks as a thirst quencher after exercise (p = 0.006) and tooth hypersensitivity when eating and drinking (p = 0.012). Furthermore, self-assessed gastric reflux was a factor strongly associated with DE (p < 0.001).

Conclusion

The study indicated that DE was common among adolescents in Stockholm County and associated with both internal and external risk factors.

Effect of surface protection on the permeability of eroded dentin

CONTEXT

Eroded dentin might present the opening of dentinal tubules, increasing permeability, and consequently dentinal hypersensitivity.

AIMS

This study evaluated the permeability of dentin surfaces exposed to different levels of erosion and methods of surface protection.

MATERIALS AND METHODS

Dentine samples (3 mm × 3 mm × 1 mm) were prepared from bovine incisors (n = 90) and divided into three groups according to the method of controlling erosive challenge: Negative control, topical fluoride application, and glass ionomer sealant. Subsequently, they were randomly divided into three subgroups according to the exposure of simulated gastric acid solution (Demineralization - DES) (5% HCl, pH = 2.2), and remineralization (RE); negative control, 9 and 18 cycles DES-RE. The dentin permeability was measured by assessing the hydraulic conductance (μl/min.cmH₂O.cm²). Statistical analysis was performed by two-way ANOVA and Tukey's test.

RESULTS AND CONCLUSIONS

Greater permeability was observed after 18 erosive cycles, followed by exposure to 9 cycles and negative control (P < 0.0001). The application of glass ionomer sealant resulted in a major reduction of the hydraulic conductivity, regardless of the erosive challenge. Control groups and topical fluoride application showed similar results. In conclusion, the severity of erosive challenge contributed to the increase of dentin permeability. Besides, the glass ionomer sealant was the only protection agent that promoted significant effects in dentin permeability.

Oral manifestations of gastrointestinal disorders

Background

A considerable number of gastrointestinal disorders (GIDs) of varied nature (inflammatory, infectious, genetic and other etiology) may produce alterations in the hard and soft oral tissues. Among these are Crohn’s disease, ulcerative colitis, celiac and gastroesophageal reflux disease.

Material and Methods

Article search was done using the National library of medicine (PubMed) database using different search terms and analyzed according to their importance.

Results

A large variety of GIDs can give rise to oral lesions, including: RAS like ulceration, mucosal tags, cobblestoning, mucogingivitis, labial and facial swelling, pyostomatitis vegetans, disgeusia and dental abnormalities, among others. Although in most cases the gastrointestinal signs and symptoms highlight in the clinical picture, a considerable percentage of these patients are affected by oral manifestations before the onset of gastrointestinal symptoms. This lesions can cause significant functional and aesthetics damages as well deteriorate the patient quality of life.

Conclusions

Although the frequency of oral manifestations is variable across GIDs and in most cases is non-specific, these alterations may precede the underlying disease and therefore can facilitate an opportune diagnosis.

Key words:Gastrointestinal disorders, oral lesions, oral mucosal disorders.

Assessment of the oral health status of asthmatic children

OBJECTIVES

To assess the oral health status and salivary composition in a group of children suffering from bronchial asthma.

MATERIALS AND METHODS

The sample consisted of sixty asthmatic children, sixty healthy negative controls, and sixty healthy positive controls of both sexes with age ranging from 4 to 12 years old. The asthmatics were grouped according to disease severity into mild, moderate, or severe asthmatic. All the children were clinically examined to assess their dental caries experience (decayed, indicated for extraction, and filled primary tooth [def] and decayed-missing-filled permanent tooth [DMF]), dental erosion condition (tooth wear index), and gingival health condition (gingival index [GI]). Salivary samples were collected and assessed for salivary flow rate, salivary pH, and the level of calcium, sodium, and potassium.

RESULTS

The results of this study revealed that asthmatic children presented significantly higher def, DMF score, and GI mean values compared to the control groups. Severe asthmatics significantly presented the highest def and GI score. Salivary analysis revealed reduced stimulated salivary flow rate and altered salivary pH. In addition, significantly elevated mean salivary calcium level found to be associated with higher GI mean score.

CONCLUSIONS

Children suffering from bronchial asthma should receive special dental preventive attention as presented with greater risk for oral and dental diseases as compared to the healthy controls.

Original Research. Evaluation of Dental Erosion in a Group of Romanian Children Diagnosed with Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is a very common digestive disorder, which occurs when the acidic contents of the stomach returns into the esophagus to some extent, reaching the mouth, thereby increasing the frequency of dental erosion and caries. Since saliva plays a huge role in oral homeostasis, it is important to examine the role of this parameter in the appearance of the above mentioned oral lesions. The aim of our study was evaluate the oral condition of children suffering from reflux disease and to assess the relationship between salivary pH and the incidence of dental erosion and caries. In this prospective study we examined 25 children diagnosed with GERD, referred for hospitalization. Bedside intra-oral examination (DMFT index, gingival index) and strip method pH value determination was performed. We observed that patients with low pH values had increased caries frequency, and dental erosion was also noticeable. Statistical significance was determined comparing the DMFT index in groups with different pH values. We concluded that the high number of erosions is closely related to gastroesophageal reflux disease, as a consequence of the low pH value, which represents the main cause of oral manifestations in GERD.

Incidence and Pattern of Dental Erosion in Gastroesophageal Reflux Disease Patients

Aim:

Gastroesophageal reflux disease (GERD) is a very common condition whose consequences of are localized not only in the esophagus; extra-esophageal involvement has frequently been reported. The aim of the study is to examine the incidence and pattern of dental erosion in GERD patients.

Methodology:

A total of 50 patients were recruited in this study (control -25 and GERD -25). All participants diagnosed having GERD by the endoscopic examination by their gastroenterologist are included. The patients were examined for dental erosion and will be quantified using Basic erosive wear examination index.

Results:

The results showed that the incidence of dental erosion was 88% as compared to 32% in the control group which was found to be statistically significant.

Nanoscratch testing for the assessment of enamel demineralization under conditions simulating wine erosion

BACKGROUND

Erosive tooth wear and dentinal hypersensitivity are common problems affecting professional wine tasters. By using nanoscratch testing, the aim of this in vitro study was to assess enamel softening under conditions simulating 10 one-minute episodes of wine erosion.

METHODS

Ten enamel specimens were bathed in artificial saliva for 2 hours before being eroded for 10 episodes, with each episode comprising one minute of wine erosion followed by one minute of remineralization in artificial saliva. Nanoscratches were placed with a spherical tip (20 μm radius) in a nanoindenter under a load of 100 mN at baseline (stage 1), after a one-erosion episode (stage 2) and after 10-erosion episodes (stage 3).

RESULTS

There were significant effects of erosion stages on both scratch depth (p<0.001) and surface roughness (p<0.001). Post hoc tests showed significant differences in both scratch depths and surface roughness between stages 1 and 3 (p<0.001), and between stages 2 and 3 (p<0.01).

CONCLUSIONS

Enamel softening occurs at an early stage of wine tasting, emphasizing the need to implement early preventive strategies in professional wine tasters. Further research elucidating the fundamental mechanisms involved in early stages of erosion has the potential to lead to development of more effective preventive strategies.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Supraesophageal Reflux: Correlation of Position and Occurrence of Acid Reflux-Effect of Head-of-Bed Elevation on Supine Reflux

BACKGROUND

Supraesophageal reflux of gastric contents can contribute to perennial nasopharyngitis, cough, and asthma. However, effective treatment strategies for supraesophageal reflux disease (SERD) remain inadequately defined.

OBJECTIVE

The purpose of this study is to assess the prevalence and timing of SERD and to investigate the efficacy of head-of-bed elevation in its treatment.

METHODS

A retrospective chart review of patients seen at Scripps Clinic Division of Allergy, Asthma and Immunology was performed who had undergone overnight nasopharyngeal pH monitoring with a commercially available nasopharyngeal pH-monitoring device, Dx-pH Measurement System from Restech, San Diego, Calif. Subjects with reflux were classified based on the position of reflux as either supine only, upright only, or both supine and upright. In a subset of subjects with supine-only reflux, pH monitoring was compared before and after elevating the head of bed 6 inches.

RESULTS

Adequate nasopharyngeal pH-monitoring data were obtained for 235 patients. Reflux was detected in 113 (48%) patients. The pattern of reflux observed was 62 (55%) supine only, 4 (4%) upright only, and 47 (42%) upright and supine. Sequential overnight nasopharyngeal pH monitoring before and after head-of-bed elevation was obtained in 13 individuals with supine-only reflux. Ten subjects demonstrated significant improvement, 8 of whom demonstrated complete resolution of supine reflux with 6 inches of head-of-bed elevation.

CONCLUSION

This study provides new evidence that SERD frequently occurs in the supine position and that 6 inches of head-of-bed elevation is effective in reducing supine SERD.

Salivary gland disorders

Patients with salivary gland disease present with certain objective and/or subjective signs. An accurate diagnosis for these patients requires a range of techniques that includes the organized integration of information derived from their history, clinical examination, imaging, serology, and histopathology. This article highlights the signs and symptoms of the salivary gland disorders seen in the Salivary Gland Center, and emphasizes the methodology used to achieve a definitive diagnosis and therapy.

Three-dimensional profilometric assessment of early enamel erosion simulating gastric regurgitation

OBJECTIVES

A priority research area in minimal intervention dentistry is the characterization of the early stages of dental erosion. The aim of this in vitro study was to assess the effect of short, repetitive erosive challenges to human enamel over 2 min at pH 1.5 and 3.0 under conditions simulating gastric regurgitation.

METHODS

Enamel surfaces were subjected to erosive challenges at pH 1.5 (Group 1, n=10) and pH 3.0 (Group 2, n=9) for periods of 30s (stage 1), 60s (stage 2) and 120 s (stage 3). Quantitative changes were assessed longitudinally by measuring the 3D average surface roughness (Sa) values using 3D confocal microscopy. Qualitative micrographic assessment of surface changes was also conducted by using environmental scanning electron microscopy.

RESULTS

Linear mixed model analysis showed significant effects of the pH values (p<0.001) and the stages (p<0.001) on the observed Sa values. Post hoc tests showed significant increases in the Sa values between baseline and other stages in both groups (p<0.01). The mean Sa values also increased significantly from stage 1 to stage 2 in Group 1 (p<0.05). Micrographic analysis displayed severely etched enamel rods in Group 1, but only subtle changes in Group 2.

CONCLUSIONS

The complexity of the enamel surface is influenced by both acid concentration (pH value) and duration of acid exposure during early stages of erosion. Erosion occurring under conditions simulating GORD can be detected in its initial stages, opening up the possibilities of early diagnosis and management of this condition.

CLINICAL SIGNIFICANCE

Erosive tooth wear occurs progressively and insidiously, often creating complex treatment challenges. This emphasizes the need for early diagnosis and management in accordance with minimal intervention philosophy. Our findings provide a foundation for further research that could lead to the development of highly-sensitive clinical diagnostic tools and preventive strategies.

Dental Erosion in Patients with Gastroesophageal Reflux Disease (GERD) in a Sample of Patients Referred to the Motahari Clinic, Shiraz, Iran

STATEMENT OF PROBLEM

Systematic reviews of the literature show that the dental erosion is associated with the gastroesophageal reflux disease (GERD).The prevalence of the problem may not be exclusively similar in different countries.

PURPOSE

The purpose of this study was to investigate the association of gastro-esophageal reflux disease (GERD) with dental erosion in a sample of Iranian population regarding the standing difference in the Iranian oral hygiene and diet. Material s and Method: 140 patients with the average age of 30 to 50 years old comprised the study group. The participants were already eligible for the endoscopic examination, diagnosed by their gastroenterologist. All patients completed a detailed questionnaire regarding the medical and dental situations. After completing the questionnaire and before endoscopy, dental examination was performed by two blinded dentists.The endoscopy was then performed by a gastroenterologist and the patients were divided into three groups of healthy, suspected to GERD, and positive GERD. Data were collected and analyzed by Chi- Square test. The cross tabulation test was performed to compare the qualitative variants and discover the correlations. The statistical significance was adopted as: p < 0.05.

RESULTS

The prevalence of dental erosion in GERD patients (22.6%) was found to be higher than the suspected (5.3%) and the healthy (7%) individuals.

CONCLUSION

This study declared the GERD patients are at higher risk of developing dental erosion compared to the healthy individuals in a sample of Iranian population.

Evaluation and Comparison of Changes in Microhardness of Primary and Permanent Enamel on Exposure to Acidic Center-filled Chewing Gum: An in vitro Study

OBJECTIVES

The study is to evaluate changes in microhardness of enamel after exposure to acidic center filled chewing gum on primary and permanent teeth.

METHODS

Thirty primary and 30 permanent molar extracted teeth were painted with acid resistant varnish except a small window over buccal surface. Teeth were divided into four groups according to type of teeth and type of chewing gum (Center fresh and Bubbaloo) (D1, P1, D2 and P2); each tooth was exposed to whole chewing gum mashed with 5 ml of artificial saliva for five minutes at room temperature twice a day for 5 days. After the exposure, teeth were stored in deionized water and submitted for microhardness tests.

RESULTS

Paired t-test and independent sample t-test were used for statistical analysis. A significant reduction in microhardness was found between exposed and unexposed areas in all groups. There was no statistically significant difference in reduction of microhardness to chewing gums, and between primary and permanent enamel.

CONCLUSION

There is a definite reduction in microhardness in all groups exposed to chewing gums. Both the chewing gums are equally erosive; both permanent and primary teeth were affected. How to cite this article: Mudumba VL, Muppa R, Srinivas NCH, Kumar DM. Evaluation and Comparison of Changes in Microhardness of Primary and Permanent Enamel on Exposure to Acidic Center-filled Chewing Gum: An in vitro Study. Int J Clin Pediatr Dent 2014;7(1):24-29.

Counteractive effect of antacid suspensions on intrinsic dental erosion

This in vitro study aimed to investigate the anti-erosive effect of antacid suspensions applied to enamel after exposure to hydrochloric acid (HCl). Ninety bovine enamel slabs were embedded, flattened, and polished. Reference areas were created and specimens were divided into six groups. They were exposed to 0.01 M HCl (pH 2) for 2 min, followed by immersion for 1 min in one of the following test suspensions: magnesium hydroxide, aluminum hydroxide, magnesium hydroxide/aluminum hydroxide, sodium alginate/sodium bicarbonate/calcium carbonate, or hydrated magnesium aluminate. Artificial saliva was used as a negative control. Specimens were subjected to a total of five cycles of erosion/antacid treatment. Enamel surface loss was measured (in micrometers) by optical profilometry. In addition, baseline and final surface microhardness (SMH) values of enamel were obtained. It was found that antacid suspensions significantly reduced enamel loss, and that similar protection was afforded by all formulations. No differences were observed between the final enamel SMH values among groups. Antacid suspensions counteracted HCl-induced enamel loss, although they were not effective in reducing enamel softening. Mouth rinsing with antacid suspensions after vomiting can potentially represent a promising strategy to counteract enamel loss caused by erosion.

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.