Prevalence of erosive tooth wear and associated risk factors in Colombian adolescents

Accurate determination of the prevalence of erosive tooth wear (ETW) and associated risk factors in adolescents can inform clinical management guidelines. The aim of this analytical cross-sectional study was to estimate the prevalence, severity, and risk factors of ETW in adolescents aged 12-15 years in the municipality of Usaquén in Bogotá, Colombia. Two calibrated examiners clinically assessed ETW using Basic Erosive Wear Examination (BEWE) Index (range: 0-3). All tooth surfaces (excluding proximal) were scored to allow estimation of the Highest (0-3) and Total BEWE (sum of Highest BEWE score per sextant: 0-18) scores per patient. Sociodemographic characteristics, ETW risk factors, and caries severity (ICDAS-epi-merged) were evaluated, and their association with the presence of ETW (indicated by a Highest BEWE score of 2-3) was examined using preliminary analyses and logistic regression models. The study sample included 454 adolescents (mean age: 13.5±1.1 years; female: 61.7%), and the prevalence of ETW was 71.6%. The majority of participants exhibited a Highest BEWE score of 3 (58.0%) and a Total BEWE score ≤8 (84.3%). The preliminary analysis showed an association between the presence of ETW and age, caries, and brushing teeth before eating (p-value < 0.05). Risk factors for ETW included always brushing teeth before eating [adjusted Prevalence Ratio (PRa) 1.31, p-value=0.014], presence of extensive carious lesions (PRa 1.23, p-value = 0.024), male gender (PRa 1.14, p-value = 0.028), and age > 14 years (PRa 1.17, p-value = 0.009). Although ETW was highly prevalent, most Colombian adolescents exhibited low Total BEWE scores. ETW was associated with frequent fruit intake, age, toothbrushing habits, caries lesions, and sex.

The role of calcium in the prevention of erosive tooth wear: a systematic review and meta-analysis

OBJECTIVES

The loss of hard dental tissue due to recurrent acid challenges and mechanical stresses without bacterial involvement is known as erosive tooth wear (ETW). Many studies in the literature have concentrated on variables that may affect the ETW process and prevent its occurrence or reduce its advancement. However, to date, no previous systematic review has evaluated the role of calcium in preventing ETW. Therefore, the purpose of the present systematic review was to review and critically appraise the scientific evidence regarding the role of calcium formulations in the prevention of ETW.

METHODS

The review protocol was registered in the PROSPERO international prospective register of systematic reviews (Ref: CRD42021229819). A literature search was conducted in electronic databases to identify in situ randomized controlled trials evaluating the prevention of ETW following the application of calcium formulations. The outcomes studied included mean enamel loss, surface microhardness, surface roughness, mean erosion/softening depth, mineral loss/precipitation and remineralization. Study characteristics and outcomes of included studies were summarized. Cochrane's risk-of-bias tool 2.0 was used to assess the quality of eligible studies, and meta-analysis using a random effects model was performed.

RESULTS

The search retrieved 869 studies of which 21 were considered eligible. Regarding the results of the quality assessment for potential risk of bias in all included studies, overall, 5 studies were considered as being at low risk, another 12 at unclear risk and 4 at high risk of bias. The findings of the studies showed that the addition of calcium in juice drinks led to reduced enamel loss, with blackcurrant juice presenting 2.6 times statistically significant less enamel loss compared to orange juice (p = 0.0001, I2 = 89%). No statistically significant difference in mean surface microhardness of eroded enamel was recorded between chewing gum with or without casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) (p = 0.31, I2 = 71%). Contradictory were the results regarding the effect of milk and CPP-ACP pastes on prevention of ETW.

CONCLUSIONS

Calcium formulations play an important role in ETW prevention, mainly through their addition to acidic drinks.

The effect of Phytosphingosine and bioactive glass-ceramics in preventing dental enamel erosion

This study evaluated the effect of phytosphingosine (PHS) and bioactive glass-ceramic (Biosilicate) on dental enamel in terms of color alteration (ΔE), microhardness, and surface roughness when submitted to erosive challenge (EC). Sixty specimens of bovine teeth (6×6×2mm) were obtained. Initial color (Easyshade, VITA), KHN (HMV-2, Shimadzu), and Ra (SJ-201P, Mitutoyo) measurements were performed. Specimens were separated into groups according to treatments: PHS, 10% Biosilicate, PHS+10% Biosilicate, and artificial saliva (control) and submitted to EC with Coca-Cola for 2 min. This cycle was repeated 4 times daily/15 days. Between cycles, specimens remained in artificial saliva (2 h/37°C). After daily cycles, they were also stored in artificial saliva at 37ºC. Final color, microhardness, and surface roughness measurements were done. Color and KHN data were analyzed by one-way ANOVA, Tukey's test; and Ra, by 2-way ANOVA, repeated measures, and Tukey's test (p<.05). The highest ΔE occurred in Saliva+EC (p<.05). Groups treated with PHS presented lower color change than Saliva+EC (p<.05). All the groups presented mean values above the 50:50% perceptibility (50:50%PT) and acceptability (50:50%AT) thresholds, except for control that showed mean value above 50:50%PT but below 50:50%AT. Biosilicate+EC showed higher relative microhardness than Saliva+EC (p<.05), but was similar to PHS+EC and PHS+Biosilicate+EC. Final enamel surface roughness increased for all the groups (p<.05), except for the control. The Biosilicate may prevent enamel mineral loss induced by erosion better than saliva. The PHS associated or not to Biosilicate demonstrated better color stability than saliva.

Topical Agents for Nonrestorative Management of Dental Erosion: A Narrative Review

A nonrestorative approach to the management of dental erosion is the foremost option: controlling dental erosion. The objectives of this study are to provide an overview and to summarise the effects and properties of topical anti-erosive agents as a nonrestorative treatment of dental erosion. A literature search was conducted on five databases of peer-reviewed literature—Cochrane Library, EMBASE, PubMed, Scopus and Web of Science—to recruit articles published between 1 January 2000 and 31 December 2021. The literature search identified 812 studies; 95 studies were included. Topical anti-erosive agents can be broadly categorised as fluorides, calcium phosphate-based agents, organic compounds and other anti-erosive agents. In the presence of saliva, fluorides promote the formation of fluorapatite on teeth through remineralisation. Calcium phosphate-based agents supply the necessary minerals that are lost due to the acid challenge of erosion. Some organic compounds and other anti-erosive agents prevent or control dental erosion by forming a protective layer on the tooth surface, by modifying salivary pellicle or by inhibiting the proteolytic activity of dentine collagenases. Topical anti-erosive agents are promising in managing dental erosion. However, current evidence shows inconsistent or limited results for supporting the use of these agents in clinical settings.

Dentin erosion preventive effects of various plant extracts: An in vitro atomic force microscopy, scanning electron microscopy, and nanoindentation study

The overall consumption of acidic beverages has become more common, making the prevention and treatment of dental erosion an important consideration. The aim of this in vitro study was to evaluate the effect of various plant extracts in preventing dentin erosion. Seven experimental groups (fluoride-free water, fluoride-containing mouthwash [Colgate Plax], green tea, rosehip, clove, pomegranate, and grape seed) were formed, each consisting of 20 bovine dentin samples. The specimens were exposed daily to demineralization and remineralization cycles three times per day over 5 days through a 5-min plant extract application before each erosive episode. Surface roughness, nanohardness values, and morphological changes on dentin surfaces were examined using atomic force microscopy (AFM), nanoindentation, and scanning electron microscopy (SEM). The data were subjected to Kruskal-Wallis and Friedman tests (p < .05). There were statistically significant differences between the groups in terms of nanohardness values (p < .05), except for the pomegranate and grape seed groups. The highest nanohardness value was observed in the clove group (1.24 ± 0.34 GPa), whereas the lowest nanohardness value was noted in the grape seed group (0.20 ± 0.04 GPa). The nanohardness values of positive and negative control groups after erosion cycles were statistically higher than the initial nanohardness values (p < .05).There was no statistically significant difference between the groups in surface roughness values (p > .05). Macromolecular deposits were observed both in the SEM and AFM images of the pomegranate, Colgate, and rosehip groups. It can be concluded that the clove extract group is more successful in preventing dentin erosion than the other groups. Green tea is also effective in preventing dentin erosion, similar to clove extract. The application of plant extracts may be a new treatment strategy in preventing dentin erosion. Plant extracts may also reduce the severity of existing dentin erosion. Clove and green tea extracts may present novel natural therapy potential by inhibiting dentin erosion.

Effect of black tea and matrix metalloproteinase inhibitors on eroded dentin in situ

Purpose of this in situ study was to evaluate the surface properties of eroded dentin specimens activated with three different matrix metalloproteinase (MMP) inhibitors (chlorhexidine [CHX], fluoride, green tea), black tea, and water. One hundred eighty dentin samples were prepared from extracted third molars and then samples divided into six groups. Ten volunteers were carried three specimens of each group, on acrylic palatal appliances, which were fabricated exactly for them (n = 3). Erosive cycles were done by immersing appliances in cup containing Cola and was followed by rinsing with test solutions. Microhardness values were measured. Surface properties were investigated by atomic force microscopy (AFM). Lowest change in microhardness was shown in fluoride group whereas negative control group (water) had the highest change. There were no statistically significant differences among surface roughness changes (p > .05). The least change in microhardness was seen in the fluoride group (13.05 ± 8.07), while the control group showed the highest change (33.80 ± 12.42) and was statistically significant when compared to other groups (p < .05). Besides lowest depth, values were shown in fluoride group as well. AFM evaluations showed macromolecular deposits on surfaces of fluoride, CHX, and black tea groups. No superior results were detected in CHX + fluoride group and black tea showed similar surface characteristics as green tea. Mouthrinses containing not only green tea but also black tea could be beneficial for patients with exposed dentin surfaces. Catechines and theaflavins in teas could be useful for improving surface quality.

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

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

Functionalized Graphene Oxide Shields Tooth Dentin from Decalcification

This in vitro study assessed the efficacy of functionalized graphene oxide (f-GO) nanocomposites on the decalcification of dentin, because dental caries of the root surface is becoming one of the new problems in aged society. Hydroxyapatite plates (HAP) and dentin slices were coated with f-GO nanocomposites by comparing them to silver diamine fluoride as a positive control, then treated with decalcification solutions such as ethylenediaminetetraacetic acid and citrate at 37°C for 24 h. Scanning electron microscopy (SEM) revealed significant protection of the surface morphology of HAP and dentin. On the other hand, a cariogenic Streptococcus mutans growth was inhibited by f-GO nanocomposites. In addition, cytotoxicity of them to epithelial cells was much less than that of povidone-iodine, which is commonly used for oral disinfectant. We synthesized 5 different f-GO nanocomposites such as GO–silver (Ag), GO-Ag–calcium fluoride (CaF2), GO-CaF2, GO-zinc, and GO–tricalcium phosphate (Ca3(PO4)2). They were standardized by evaluating under SEM, transmission electron microscopy (TEM), X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), thermogravimetry analysis (TGA), and Raman spectra after being synthesized in an aseptic technique. The abilities of GO-Ag, GO-Ag-CaF2, and GO-CaF2 nanocomposites were most preventive for decalcification. In addition, GO-Ag and GO-Ag-CaF2 almost completely inhibited S. mutans growth. However, they did not exhibit cytotoxicity to epithelial cells except at the highest concentration (0.1 w/v%) of GO-Ag and GO-Ag-CaF2. Furthermore, these f-GO nanocomposites exhibited less or no discoloration of dentin, although commonly used silver diamine fluoride causes discoloration of dentin to black. Thus, these f-GO nanocomposites are useful to protect dental caries on the tooth root that becomes a social problem in aged society.

Effect of erosive challenges on deciduous teeth undergoing restorative procedures with different adhesive protocols - an in vitro study

To evaluate the effect of erosive challenges on the tooth- restoration interface of deciduous teeth treated with different adhesive protocols. Deciduous molars were cut mesiodistally, then embedded, abraded and polished (n=80). Samples were randomly divided according to the adhesive system used into: G1 (Adper Single Bond2®, etch-and-rinse), G2 (Universal Single Bond®, self-etching), G3 (OptibondFL®, etch-and-rinse with Fluoride) and G4 (BondForce®, self-etching with Fluoride). After standardized cavity preparation (2 mm diameter x 2 mm depth), adhesive systems were applied and samples were restored (composite resin Z350®). Half of the samples were exposed to erosive/abrasive cycles (n = 10, each adhesive group), and the other half (control group; n = 10) remained immersed in artificial saliva. For microleakage analysis, samples were submersed in methylene blue and analyzed at 40x magnifications. Cross-sectional microhardness (CSMH) was carried out (50 g/5 s) at 25 μm, 50 μm, and 100 μm from the eroded surface and at 25 μm, 75 μm, and 125 μm from the enamel bond interface. Regarding microleakage, 7.5% of the samples showed no dye infiltration, 30% showed dye infiltration only at the enamel interface, and 62.5% showed dye infiltration through the dentin-enamel junction, with no difference between groups (p≥0.05). No significant difference was observed in CSMH at different depths (two-way ANOVA, p≥0.05). We did not observe significant changes in microleakage or CSMH after erosive/abrasive challenges in deciduous teeth treated with different adhesive protocols (etch-and-rinse and self-etching adhesives, with and without fluoride).

Effect of a Bioactive Glass Ceramic on the Control of Enamel and Dentin Erosion Lesions

Abstract This study evaluated the effect of a bioactive glass ceramic for the control of erosion and caries lesions. Fragments (n=10) of bovine enamel and root dentin received daily application of different treatments (Biosilicate; Acidulated Phosphate Fluoride- APF; Untreated - control) during the performance of erosive cycles. Surfaces were analyzed with 3D optical profilometry to quantify the superficial loss in four periods (1, 7, 14 and 21 days), as well as the lesion depth with confocal laser scanning microscopy. For caries progression assessment, initial Knoop microhardness was measured on enamel bovine fragments. Initial carious lesions were developed and specimens were divided into three groups (n=10), according to the daily topical application (Biosilicate; APF; no application - control), during the de-remineralization cycles for 14 days. Final microhardness was obtained to calculate the change of surface microhardness. Subsurface demineralization was analyzed using cross-sectional microhardness (depths 10, 30, 50, 70, 90, 110 and 220 µm). Data were tested using ANOVA and Tukey’s test (a=5%). Results of erosive evaluation showed that Biosilicate promoted the lowest (p<0.05) values of surface loss, regardless of time, for both enamel and dentin; APF promoted lower (p<0.05) surface loss than control; analyzing different periods of time, APF did not show difference (p>0.05) between 14 and 21 days of demineralization. Results of enamel caries assessment showed that Biosilicate resulted in higher (p<0.05) surface and subsurface microhardness than both APF and control-applications. It may be concluded that Biosilicate application showed a higher potential to reduce surface loss and development of erosion and caries lesions.

Progression of erosive lesions after Nd:YAG laser and fluoride using optical coherence tomography

This study aimed to use optical coherence tomography (OCT) to assess the progression of erosive lesions after irradiation with Nd:YAG laser and application of topical fluoride. One-hundred and twenty dentin samples (4 × 4 × 2 mm) obtained from bovine incisors were used. Samples were protected with acid-resistant nail varnish, with exception of a central circular area 2 mm in diameter. All samples were submitted to erosive cycles with citric acid solution 0.05 M (citric acid monohydrate-C6H8O7·H2O); M = 210.14 g/mol) pH 2.3, at room temperature, for 20 min, 2×/day, throughout 20 days. After 10 days of acid challenges, lesions became visible, and each group received a different treatment (n = 15): control (without treatment), topical application of sodium fluoride 2 % for 4 min; Nd:YAG laser with different irradiation parameters (1, 0.7, and 0.5 W); and the association of fluoride with the laser parameters. OCT readouts were performed on day 01 (before the first acid challenge-OCT1), on day 05 (OCT2), day 10 (OCT3-after treatment), day 15 (OCT4), day 17 (OCT5), and day 20 (OCT6). The OCT images generated made it possible to measure the amount of tooth tissue loss over the 20 days of erosive cycle, before and after treatments, and to monitor early dentin demineralization progression. After statistical analysis, the fluoride group was observed to be the one that showed smaller loss of tissue over time. The OCT technique is promising for diagnosing and monitoring erosive lesion damage; however, further in vitro and in vivo research is needed to improve its use.

In situ Effect of Chewing Gum with and without CPP-ACP on Enamel Surface Hardness Subsequent to ex vivo Acid Challenge

The erosion-protective effect of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) is controversial. This study aimed to investigate the ability of CPP-ACP chewing gum to prevent a single event of erosive demineralization in situ. Bovine enamel blocks (n = 120) were randomly assigned to 3 phases according to the baseline surface hardness: phase I (PI) - chewing gum with CPP-ACP, phase II (PII) - chewing gum without CPP-ACP, and control phase (PIII) - salivary effect without stimulation (no gum). Nineteen volunteers participated in this study during 3 crossover phases of 2 h. In PI and PII, the volunteers wore intraoral palatal appliances for 120 min and chewed a unit of the corresponding chewing gum for the final 30 min. In the control phase the volunteers wore the appliance for 2 h, without chewing gum. Immediately after intraoral use, the appliances were extraorally immersed in a cola drink for 5 min to promote erosive demineralization. The percentage of surface hardness loss was calculated. The data were analyzed by ANOVA models and Tukey's test. Lower enamel hardness loss was found after the use of chewing gum with CPP-ACP (PI: 32.7%) and without CPP-ACP (PII: 33.5%) compared to the salivary effect without stimulation (PIII: 39.8%) (p < 0.05). There was no difference between PI and PII (p > 0.05). The results suggest that the use of chewing gum immediately before an erosive demineralization can diminish enamel hardness loss. However, the presence of CPP-ACP in the chewing gum cannot enhance this protective effect.

Sphingoid Bases Inhibit Acid-Induced Demineralization of Hydroxyapatite

Calcium hydroxyapatite (HAp), the main constituent of dental enamel, is inherently susceptible to the etching and dissolving action of acids, resulting in tooth decay such as dental caries and dental erosion. Since the prevalence of erosive wear is gradually increasing, there is urgent need for agents that protect the enamel against erosive attacks. In the present study we studied in vitro the anti-erosive effects of a number of sphingolipids and sphingoid bases, which form the backbone of sphingolipids. Pretreatment of HAp discs with sphingosine, phytosphingosine (PHS), PHS phosphate and sphinganine significantly protected these against acid-induced demineralization by 80 ± 17%, 78 ± 17%, 78 ± 7% and 81 ± 8%, respectively (p < 0.001). On the other hand, sphingomyelin, acetyl PHS, octanoyl PHS and stearoyl PHS had no anti-erosive effects. Atomic force measurement revealed that HAp discs treated with PHS were almost completely and homogeneously covered by patches of PHS. This suggests that PHS and other sphingoid bases form layers on the surface of HAp, which act as diffusion barriers against H+ ions. In principle, these anti-erosive properties make PHS and related sphingosines promising and attractive candidates as ingredients in oral care products. © 2014 S. Karger AG, Basel

Remineralizing potential of various agents on dental erosion

AIM

The purpose of this study is to compare the effect of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP, Tooth Mousse) containing and casein phosphopeptide-amorphous calcium phosphate with fluoride (CPP-ACPF, Tooth Mousse Plus) containing pastes on dental erosion.

MATERIALS AND METHODS

Thirty permanent non-carious premolars indicated for orthodontic extraction were included in this study and were sectioned in mesiodistal direction vertically. After immersion in the carbonated drink for 14 min, samples were treated with various remineralizing pastes which were CPP-ACP containing paste (Tooth Mousse) and CPP-ACPF containing paste (Tooth Mousse Plus) according to the manufacturer's instructions. Vickers Microhardness was recorded at baseline, after exposure to erosive drink and after treatment with remineralizing pastes. Data obtained was statistically analysed using Student t-test with a level of significance set at p < 0.05.

RESULTS

CPP-ACP (Tooth Mousse) and CPP-ACP with fluoride (Tooth Mousse Plus) resulted in 30.52% and 38.98% increase in post-erosion microhardness values respectively. The remineralizing potential of CPP-ACP with fluoride containing paste (Tooth Mousse Plus) was significantly better than that of CPP-ACP containing paste (Tooth Mousse) (p < 0.05).

CONCLUSION

Casein phosphopeptide-amorphous calcium phosphate with fluoride (CPP-ACPF, Tooth Mousse Plus) can be recommended to be used in preventing erosive tooth wear from acidic beverages.

Effect of beverages on bovine dental enamel subjected to erosive challenge with hydrochloric acid

This study evaluated by an in vitro model the effect of beverages on dental enamel previously subjected to erosive challenge with hydrochloric acid. The factor under study was the type of beverage, in five levels: Sprite® Zero Low-calorie Soda Lime (positive control), Parmalat® ultra high temperature (UHT) milk, Ades® Original soymilk, Leão® Ice Tea Zero ready-to-drink low-calorie peach-flavored black teaand Prata® natural mineral water (negative control). Seventy-five bovine enamel specimens were distributed among the five types of beverages (n=15), according to a randomized complete block design. For the formation of erosive wear lesions, the specimens were immersed in 10 mL aqueous solution of hydrochloric acid 0.01 M for 2 min. Subsequently, the specimens were immersed in 20 mL of the beverages for 1 min, twice daily for 2 days at room temperature. In between, the specimens were kept in 20 mL of artificial saliva at 37ºC. The response variable was the quantitative enamel microhardness. ANOVA and Tukey's test showed highly significant differences (p<0.00001) in the enamel exposed to hydrochloric acid and beverages. The soft drink caused a significantly higher decrease in microhardness compared with the other beverages. The black tea caused a significantly higher reduction in microhardness than the mineral water, UHT milk and soymilk, but lower than the soft drink. Among the analyzed beverages, the soft drink and the black tea caused the most deleterious effects on dental enamel microhardness.

Novel amelogenin-releasing hydrogel for remineralization of enamel artificial caries

Recently, the use of recombinant full-length amelogenin protein in combination with fluoride has shown promising results in the formation of densely packed enamel-like structures. In this study, amelogenin (rP172)-releasing hydrogels containing calcium, phosphate, and fluoride were investigated for remineralization efficacy using in vitro early enamel caries models. The hydrogels were applied to artificial caries lesions on extracted human third molars, and the remineralization efficacy was tested in different models: static gel remineralization in the presence of artificial saliva, pH cyclic treatment at pH 5.4 acetic buffer and pH 7.3 gel remineralization, and treatment with multispecies oral biofilms grown in a continuous flowing constant-depth film fermenter. The surface microhardness of remineralized enamel increased significantly when amelogenin was released from hydrogel. No cytotoxicity was observed when periodontal ligament cells were cultured with the mineralized hydrogels.

Biofunctional properties of caseinophosphopeptides in the oral cavity

Caseinophosphopeptides (CPPs), bioactive peptides released from caseins, have the ability to enhance bivalent mineral solubility. This is relevant to numerous biological functions in the oral cavity (promotion of tooth enamel remineralisation, prevention of demineralisation and buffering of plaque pH). Therefore, CPPs may play a positive role as prophylactic agents for caries, enamel erosion and regression of white spot lesions. Most in vitro and in situ studies demonstrate strong evidence for the bioactivity of CPPs in the oral cavity. Nevertheless, relatively little is known concerning their use as adjuvants for oral health and more particularly regarding their long-term effects on oral health.

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.

Impact of acquired enamel pellicle modification on initial dental erosion

The acquired enamel pellicle that forms on the tooth surface serves as a natural protective barrier against dental erosion. Numerous proteins composing the pellicle serve different functions within this thin layer. Our study examined the effect of incorporated mucin and casein on the erosion-inhibiting potential of the acquired enamel pellicle. Cyclic acidic conditions were applied to mimic the erosive environment present at the human enamel interface during the consumption of soft drinks. One hundred enamel specimens were prepared for microhardness tests and distributed randomly into 5 groups (n = 20) that received the following treatment: deionized water, humidity chamber, mucin, casein, or a combination of mucin and casein. Each group was exposed to 3 cycles of a 2-hour incubation in human saliva, followed by a 2-hour treatment in the testing solution and a 1-min exposure to citric acid. The microhardness analysis demonstrated that the mixture of casein and mucin significantly improved the erosion-inhibiting properties of the human pellicle layer. The addition of individual proteins did not statistically impact the function of the pellicle. These data suggest that protein-protein interactions may play an important role in the effectiveness of the pellicle to prevent erosion.