Influence of toothbrushing on enamel softening and abrasive wear of eroded bovine enamel: an in situ study

[Research Progress on the Correlation Between Oral Frailty and Dietary Intake in Older Adults]

With the increase in age, the oral function of older adults shows an age-related decline, which limits the types, quantity, and quality of their diet. Limited dietary intake can lead to a lack of basic nutrients needed for maintaining oral health, induce a series of oral diseases, and further aggravate the deterioration of oral functions. Oral frailty is the accumulation of mild oral function decline and is an emerging concept in the field of oral health. Currently, research on oral frailty and dietary intake mostly focuses on the impact of single-dimensional oral function decline on the dietary intake, dietary structure, and dietary satisfaction of older adults, as well as the impact of different dietary structures on the status of oral health among older adults. There is still a lack of large-sample, high-quality research on the relationship between comprehensive oral function decline and dietary intake. In addition, existing oral frailty intervention measures often place a narrow emphasis on the exercise and recovery of oral function without considering the impact of dietary intake and nutritional status on the development of oral frailty. Relevant research on taking dietary intake as an entry point or using it as a comprehensive intervention method also needs to be further explored by researchers. In the future, specialized assessment and screening of dietary status may be introduced in the routine health management practices for older adults. Furthermore, targeted intervention programs could also be proposed based on the characteristics of the oral status and the dietary intake habits of older adults, so as to prevent the functional decline related to dietary intake and nutritional supplementation. Herein, we reviewed the correlation between dietary intake and oral frailty to provide new ideas and directions for formulating comprehensive management strategies for oral frailty.

Practical training using BEWE aimed at improving the diagnosis ability of erosive tooth wear for dental students-A randomized trial

INTRODUCTION

Erosive tooth wear (ETW) has been gaining attention due to its high prevalence. However, ETW clinical diagnosis is difficult and may go unnoticed by many professionals. The present study aimed to develop, implement and evaluate a theoretical-practical training using active methodologies in the development of undergraduate students' skills for the diagnosis of ETW compared to the traditional teaching method.

MATERIALS AND METHODS

This randomized controlled study involved two parallel groups: control group (n = 22), with learning based only on theoretical content and test group (n = 24), learning by theoretical-practical activity mediated by monitors/tutors. The theoretical class covered the current concepts of ETW, aetiology, diagnosis, use of the BEWE index, prevention and treatment. The practical training included exercises and discussions based on the diagnosis using BEWE scores of a collection of images and extracted teeth. To evaluate the efficacy of the teaching-learning methods, a theoretical multiple-choice questionnaire and a practical test using images and extracted teeth were applied. The outcome was the number of correct answers. Groups were compared by Mann-Whitney (theoretical knowledge) and T tests (practical ability in diagnosis) (p < .05).

RESULTS

There was no significant difference between groups in the theoretical evaluation (p = .866). The test group showed higher ability to diagnose ETW lesions compared to the control group in the practical tests (p = .001). The performance of ETW diagnosis was similar when images were used in comparison to extracted teeth (p = .570).

CONCLUSION

The practical activity associated with theoretical classes can be a promising strategy to improve the development of undergraduate students' skills in the diagnosis of ETW.

Sports Diet and Oral Health in Athletes: A Comprehensive Review

Food and fluid supply is fundamental for optimal athletic performance but can also be a risk factor for caries, dental erosion, and periodontal diseases, which in turn can impair athletic performance. Many studies have reported a high prevalence of oral diseases in elite athletes, notably dental caries 20-84%, dental erosion 42-59%, gingivitis 58-77%, and periodontal disease 15-41%, caused by frequent consumption of sugars/carbohydrates, polyunsaturated fats, or deficient protein intake. There are three possible major reasons for poor oral health in athletes which are addressed in this review: oxidative stress, sports diet, and oral hygiene. This update particularly summarizes potential sports nutritional effects on athletes' dental health. Overall, sports diet appropriately applied to deliver benefits for performance associated with oral hygiene requirements is necessary to ensure athletes' health. The overall aim is to help athletes, dentists, and nutritionists understand the tangled connections between sports diet, oral health, and oral healthcare to develop mitigation strategies to reduce the risk of dental diseases due to nutrition.

Different vehicles containing CaneCPI-5 reduce erosive dentin wear in situ

OBJECTIVE

This study evaluated the protective capacity of a sugarcane-derived cystatin (CaneCPI-5) in different vehicles (1-solution and 2-chitosan gel) against erosive dentin wear in situ.

METHODS

In part-1, 15 volunteers participated in a crossover protocol (solutions): Water; Elmex™ and CaneCPI-5. The volunteers wore an appliance with 4 dentin samples for 5 days. These samples were treated with a drop of the solutions for 1 min (4X/d), then the acquired pellicle (AP) was formed and the samples were subjected to erosive challenges (EROSION: citric acid, for 90 s, 4X/day). 2X/day, half of the samples were also abraded for 15 s (ABRASION). In part-2, 16 volunteers participated in a crossover protocol (gel): No gel, Chitosan gel, Chitosan gel + NaF and Chitosan gel + CaneCPI-5. The volunteers also wore an appliance. The samples were treated once/day with the gel or not for 4 min, then the AP was formed and the samples were subjected to erosive and abrasive challenges, as reported in part-1. Dentin wear was measured by profilometry. Data were analyzed by two-way RM-ANOVA and Sidak's tests (p < 0.05).

RESULTS

Part-1: Elmex™ and CaneCPI-5 significantly reduced dentin loss in comparison with Water for the EROSION/ABRASION conditions (p < 0.05). Part-2, all the treated groups significantly reduced the dentin loss in comparison to the No gel. The greatest reduction was found for the gel + CaneCPI-5 group for the EROSION/ABRASION (p < 0.05).

CONCLUSION

The solution and chitosan gel containing CaneCPI-5 protected against erosive dentin wear in situ.

CLINICAL RELEVANCE

These different vehicles are probably sufficient for protecting people with high risk of developing erosive dentin wear.

The Effect of Toothpastes Containing Natural Ingredients Such As Theobromine and Caffeine on Enamel Microhardness: An In Vitro Study

The current study aimed to investigate the effect of biocompatible kinds of toothpastes containing natural ingredients such as theobromine and caffeine on the enamel microhardness after demineralization. 72 maxillary premolar teeth extracted for orthodontic purposes were used in this study. Primary enamel surface microhardness examinations were performed using a Digital Micro Vickers Hardness Tester following the Knoop technique (50 g load for 15 s with three indentations at various points). The specimens were immersed in lactic acid (pH = 5.4) for 7 days, washed with distilled water, dried, and then retested for microhardness. According to the type of toothpaste used for brushing, all specimens were categorized as follows: Group 1, Theodent classic® toothpaste (theobromine); Group 2, Power Energy toothpaste (caffeine); Group 3, Colgate toothpaste (fluoride); and Group 4, distilled water as the negative control. The specimens were retested for enamel microhardness after brushing 2 times a day for one month. After brushing with different types of toothpaste, for all experiment groups, the increase in microhardness values in the demineralized enamel surfaces was significant and there were significant differences between them (p value <0.05). The fluoride group had the highest microhardness and had a significant difference with the caffeine and distilled water groups, but there was no significant difference with the theobromine group (p value <0.05). In the theobromine group, the hardness was considerably higher than in the caffeine and distilled water groups. There was no significant difference between the caffeine and distilled water groups. Theobromine toothpaste had the same remineralization effect as that of fluoride toothpaste, while caffeine toothpaste had no positive effect on the remineralization process.

Prevention of erosive tooth wear: targeting nutritional and patient-related risks factors

This article provides an overview of the nutritional and patient-related risk factors involved in the aetiology of erosive tooth wear (ETW) and the preventive strategies to counteract them. The first step is to diagnose clinical signs of ETW and to recognise causal factors. Low pH and high buffer capacity of foods/drinks are the major risk factors, while the calcium concentration is the main protective factor. Reduction of frequency of consumption and contact time of erosive foods/drinks with the teeth, use of straws appropriately positioned and consumption of dairy products are advisable. Oral hygiene has a role in the development of ETW, however, postponing toothbrushing is not clinically advisable. In cases of drug abuse, chronic alcoholism, GERD or bulimia, the patient must be referred to a doctor. Immediately after vomiting, patients might be advised to rinse the mouth. Saliva has an important protective role and patients with reduced salivary flow can benefit from the use of chewing gum. Recent studies have focused on improving the protective capacity of the acquired pellicle as well as on the role of protease inhibitors on dentine erosion. However, the degree of evidence for these preventive measures is low. Clinical trials are necessary before these measures can be recommended.

AmF/NaF/SnCl2 solution reduces in situ enamel erosion - profilometry and cross-sectional nanoindentation analysis

This in situ study aimed to investigate the effect of a tin-containing fluoride solution in preventing enamel erosion. Also, its effects on the partly demineralized zone were assessed for the first time. Thirteen volunteers participated in this 2-phase study, wearing removable intra-oral appliances containing four sterilized bovine enamel slabs, for 8 days, where 2 treatment protocols were tested using samples in replicas (n = 13): CO - no treatment (negative control) and FL - AmF/NaF/SnCl2 solution (500 ppm F-, 800 ppm Sn2+, pH = 4.5). Samples were daily exposed to an erosive challenge (0.65% citric acid, pH 3.6, 4 min, 2x/day). In the 2nd phase, volunteers switched to the other treatment protocol. Samples were evaluated for surface loss using a profilometer (n = 13) and a cross-sectional nanohardness (CSNH) test (n = 13) was carried out in order to determine how deep the partly demineralized zone reaches below the erosive lesion. The data were statistically analyzed by two-way ANOVA. Erosive challenges lead to smaller enamel surface loss (p < 0.001) in the FL group when compared to group CO. Data from CSNH showed that there was no significant difference in demineralized enamel zone underneath erosion lesions between the groups. An amorphous layer could be observed on the surface of enamel treated with tin-containing solution alone. Under the experimental conditions of this in situ study, it can be concluded that AmF/NaF/SnCl2 solution prevents enamel surface loss but does not change the hardness of the partly demineralized zone near-surface enamel.

Comparative evaluation of surface properties of enamel and different esthetic restorative materials under erosive and abrasive challenges: An in vitro study

Introduction:

Noncarious tooth surface loss is a normal physiological process occurring throughout the life, but it can often become a problem affecting function, esthetics or cause pain.

Aim:

The purpose of this study was to assess the effect of erosive and abrasive challenges on the surface microhardness and surface wear of enamel and three different restorative materials, that is, nanofilled composite, microfilled composite and resin-modified glass ionomer cement (RMGIC) by using Vickers microhardness tester and profilometer respectively.

Subjects and Methods:

Nanofilled composite (Filtek^™ Z350 × T), microfilled composite (Heliomolar^®) and RMGIC (Fuji II LC) were used in the study.

Results:

Nanofilled composite resin has the best resistance to erosion and/or abrasion among all the materials tested, followed by microfilled composite and RMGIC respectively.

Conclusion:

Toothbrush abrasion has a synergistic effect with erosion on substance loss of human enamel, composites, and RMGIC. The susceptibility to acid and/or toothbrush abrasion of human enamel was higher compared to restorative materials.

Prevalence and risk factors for dental erosion among 11- to 14-year-old school children in South India

This cross-sectional survey was conducted to assess the prevalence and severity of dental erosion and to determine the potential risk factors for dental erosion among 11- to 14-year-old school children in South India. The total sample size for the study was 605, of which 303 school children were from private schools and 302 from public schools. A questionnaire was designed to record information about socio-demographic characteristics, oral hygiene practices, dietary habits and risk factors for dental erosion. Chi square test, bivariate analysis and Logistic regression analysis were performed to analyse the data. The children who consumed lemon several times a day (OR = 13.41, P < 0.001), and those who preferred carbonated drinks (OR = 2.80, P = 0.007) had a higher tendency to develop dental erosion. The overall prevalence of dental erosion was found to be low (8.9%). Erosion was found to be greater in posterior teeth (65.6%) than anterior teeth (34.4%). Loss of enamel only with loss of surface contour was observed in most (94.8%) of the cases. The prevalence of dental erosion was found to be low in school children. Private school children were affected more by dental erosion. Frequency of lemon consumption and consumption of carbonated drinks were identified as risk factors.

Mechanisms of action of fluoridated acidic liquid dentifrices against dental caries

OBJECTIVE

This study attempted to clarify the mechanisms of action of fluoridated acidic liquid dentifrices against dental caries.

DESIGN

In the in vitro leg, enamel specimens were submitted to a pH-cycling model, treated with distinct dentifrices (0, 550 μgF/g pH 4.5 and pH 7.0, 1100 or 5000 μgF/g pH 7.0) and analyzed using hardness. Alkali-soluble fluoride (F) deposition was quantified on pre-demineralized specimens treated with the dentifrices. In the clinical leg, 2-to-4-year-old children who had been using liquid dentifrices for 6 months (550 μgF/g pH 4.5 or pH 7.0 or 1100 μgF/g pH 7.0) had their plaque samples collected 5 and 60 min after the last brushing. Fluoride uptake in whole plaque was evaluated.

RESULTS

The reduction of the pH had a partial preventive effect on subsurface hardness loss only. [F] had a significant influence on the deposition of fluoride, surface and subsurface hardness loss. In vivo, the reduction of the pH was able to significantly increase plaque F uptake, leading to similar levels as those found for the neutral dentifrice containing twice [F].

CONCLUSION

The results obtained from in vitro studies whose design does not include the presence of dental plaque should be interpreted with caution.

Erosive cola-based drinks affect the bonding to enamel surface: an in vitro study

Objective

This study aimed to assess the impact of in vitro erosion provoked by different cola-based drinks (Coke types), associated or not with toothbrushing, to bonding to enamel.

Material and Methods

Fifty-six bovine enamel specimens were prepared and randomly assigned into seven groups (N=8): C- Control (neither eroded nor abraded), ERO-RC: 3x/1-minute immersion in Regular Coke (RC), ERO-LC: 3x/1-minute immersion in Light Coke (LC), ERO-ZC: 3x/1-minute immersion in Zero Coke (ZC) and three other eroded groups, subsequently abraded for 1-minute toothbrushing (EROAB-RC, EROAB-LC and EROAB-ZC, respectively). After challenges, they were stored overnight in artificial saliva for a total of 24 hours and restored with Adper Single Bond 2/Filtek Z350. Buildup coronal surfaces were cut in 1 mm² -specimens and subjected to a microtensile test. Data were statistically analyzed by two-way ANOVA/Bonferroni tests (α=0.05). Failure modes were assessed by optical microscopy (X40). The interface of the restorations were observed using Confocal Laser Scanning Microscopy (CLSM).

Results

All tested cola-based drinks significantly reduced the bond strength, which was also observed in the analyses of interfaces. Toothbrushing did not have any impact on the bond strength. CLSM showed that except for Zero Coke, all eroded specimens resulted in irregular hybrid layer formation.

Conclusions

All cola-based drinks reduced the bond strength. Different patterns of hybrid layers were obtained revealing their impact, except for ZC.

Risk indicators associated with dental erosion among Jordanian school children aged 12-14 years of age

AIM

To identify potential risk indicators of dental erosion (DE) among 12- to 14-year-old Jordanian school children.

DESIGN

A random cross-sectional sample was selected from Amman, Irbid, and Al-Karak governorates. A weighted multistage random sampling system was used to yield 3812, 12- to 14-year-old school children from 81 schools. The study utilized a self-reported questionnaire of factors reported in the literature and thought to be associated with DE. Full mouth recording using the tooth wear index modified by Millward et al. (1994) was performed by a single calibrated examiner.

RESULTS

Logistic regression analysis defined the risk indicators that were simultaneously associated with DE with geographical location, medical condition including frequent mouth dryness, and having frequent bouts of vomiting or using a cortisol inhaler, dietary habits including consumption of carbonated beverages, lemon, sour candies, and sports drinks, keeping soft drinks in the mouth for a long time, brushing teeth following soft beverages or drinking lemon juice at bed time.

CONCLUSIONS

Dental erosion is a multifactorial condition in which mouth dryness, vomiting, cortisol inhaler use, keeping soft drinks in the mouth, drinking beverages at bed time, consumption of lemon, sour candies, and having confectionary as snacks are risk indicators, and area of residence are all potential factors.

Root caries: a periodontal perspective

BACKGROUND AND OBJECTIVE

A prevailing dental problem in the periodontal patient is root caries. Specifically, periodontal involvement often results in root surfaces becoming exposed and at risk for this condition. Periodontal therapy often leads to increased gingival recession as well, and the associated increased root caries risk may compromise the long-term success and survival of periodontally treated teeth.This narrative review will address the topic of root caries in the periodontal patient, focusing on unmet research needs.

MATERIAL AND METHODS

The Medline database was searched to identify items dealing with root caries, in terms of clinical features, diagnosis, pathogenic mechanisms and histopathology, as well as epidemiology, focusing then on the relationship between root caries and periodontal disorders.

RESULTS

Although there is extensive literature on root caries, consensus is lacking regarding certain aspects, such as diagnostic criteria, prevalence within populations and indisputable risk factors. Advancing age could be an aggravating factor in susceptibility to root caries for the periodontal patient; however, definitive evidence in this regard is still missing. Similarly, full awareness of the increased risk of root caries in patients with periodontal disease or long-term periodontal treatment appears to be still lacking.

CONCLUSION

Research regarding root caries in age-specific (elderly) periodontal patients is needed. Improved oral hygiene practices, locally applied preventive measures, good dietary habits and regular dental check-ups are crucial approaches to prevent both periodontal disease progression and root caries. Periodontal patients with root exposure should follow a strict root caries prevention protocol, as an integral component of their periodontal maintenance therapy.

Effect of fluoride on tooth erosion around orthodontic brackets

The aim of the present study was to evaluate the effect of fluoride in prevention of tooth erosion around orthodontic brackets under erosive challenge. Edgewise brackets were bonded with Transbond™ XT composite on vestibular surface of 40 bovine incisors. The teeth were assigned to 4 groups (n=10): G1: Remineralizing saliva; G2: Erosive challenge; G3: Experimental group submitted to topical application of neutral fluoride gel (2% NaF) before erosive challenge; G4: Experimental group submitted to three daily applications of fluoride dentifrice (PFM 1500 ppmF) during erosive challenge. After 14 days of erosive challenge, direct visual and tactile examination were performed by two calibrated and trained examiners (Kappa = 0.867). The following scores were used: 0 = Intact enamel, 1 = Demineralized enamel without cavity, 2 = Demineralized enamel with cavity, 3 = Remineralized enamel without cavity, 4 = Remineralized enamel with cavity. Kruskal-Wallis and Mann-Whitney tests were applied to determine erosion levels, establishing a confidence interval of 95% (p<0.05). G2 and G3 presented 100% of score 2, with large cavities, presenting rough and opaque surface. G4 showed 50% of score 3 and 50% of score 4. Considering the studied conditions, it was found a significant difference between G2 and G4 and between G3 and G4 (p<0.01). By contrast to single application of neutral fluoride gel, the high frequency of use of fluoride at low concentration had a great influence during the dynamics of erosion.

Dental manifestations in bariatric patients: review of literature

The rate of bariatric surgery has significantly risen in the past decade as an increasing prevalence of extreme obesity can be observed. Although bariatric surgery is an effective therapeutic modality for extreme obesity, it is associated with risk factors affecting also oral health. Based on an overview of the current literature, this paper presents a summary of dental manifestations in bariatric patients. Bariatric surgeries are associated with an increased risk for gastro-esophageal reflux which in turn might account for the higher amount of carious and erosive lesions observed in bariatric patients. As a result, also dentin hypersensitivity might be observed more frequently. The current data indicate that recommended postsurgical meal patterns and gastric reflux might increase the risk for dental lesions, particularly in the presence of other risk factors, such as consumption of sweet-tasting foods and acidic beverages. Further research is needed to evaluate the correlation of bariatric surgery and the development of dental diseases.

In vitro alterations in dental enamel exposed to acidic medicines

OBJECTIVE

To evaluate the effect of acidic medicines (Klaricid(®), Claritin(®), and Dimetapp(®)) on surface enamel in vitro.

METHODS

Enamel blocks (n=104) were randomly distributed into two groups: G1 (pH-cycling simulating physiological oral conditions) and G2 (erosive conditions). Each group was divided into four subgroups, three to be immersed in the medicines and the control in deionized water. Specimen surfaces were evaluated for roughness and hardness at baseline and again after the in vitro experimental phase, which included 30 min immersions in the medicines twice daily for 12 days. Scanning electron microscopy (SEM) was also performed after the in vitro experimental phase.

RESULTS

All medicines produced a significant reduction in hardness in G1 after 12 days (P<0.05). The three medicines promoted greater roughness after both pH-regimens - G1 and G2 (P<0.01), except for Claritin in G1. Scanning electron microscopy analysis showed erosive patterns in all subgroups. Dimetapp(®) showed the most erosion and Klaricid(®) the least, in both groups.

CONCLUSION

Dimetapp(®) (lowest pH and viscosity) and deionized water (control) showed the most pronounced erosive patterns. Klaricid(®) (highest pH and viscosity) presented an in vitro protective effect against acid attacks perhaps due to its mineral content and viscosity.

Insights into preventive measures for dental erosion

Dental erosion is defined as the loss of tooth substance by acid exposure not involving bacteria. The etiology of erosion is related to different behavioral, biological and chemical factors. Based on an overview of the current literature, this paper presents a summary of the preventive strategies relevant for patients suffering from dental erosion. Behavioral factors, such as special drinking habits, unhealthy lifestyle factors or occupational acid exposure, might modify the extent of dental erosion. Thus, preventive strategies have to include measures to reduce the frequency and duration of acid exposure as well as adequate oral hygiene measures, as it is known that eroded surfaces are more susceptible to abrasion. Biological factors, such as saliva or acquired pellicle, act protectively against erosive demineralization. Therefore, the production of saliva should be enhanced, especially in patients with hyposalivation or xerostomia. With regard to chemical factors, the modification of acidic solutions with ions, especially calcium, was shown to reduce the demineralization, but the efficacy depends on the other chemical factors, such as the type of acid. To enhance the remineralization of eroded surfaces and to prevent further progression of dental wear, high-concentrated fluoride applications are recommended. Currently, little information is available about the efficacy of other preventive strategies, such as calcium and laser application, as well as the use of matrix metalloproteinase inhibitors. Further studies considering these factors are required. In conclusion, preventive strategies for patients suffering from erosion are mainly obtained from in vitro and in situ studies and include dietary counseling, stimulation of salivary flow, optimization of fluoride regimens, modification of erosive beverages and adequate oral hygiene measures.

Dental erosion and severe tooth decay related to soft drinks: a case report and literature review

Soft drinks have many potential health problems. The inherent acids and sugars have both acidogenic and cariogenic potential, resulting in dental caries and potential enamel erosion. In this report we present a 25-year-old man complaining with the severe worn-out of the front teeth during the past 3 years. He had a history of drinking cola for more than 7 years and had a poor oral hygiene. Severe decays were present in the incisors and the canines, while less severe lesions were noted on the premolars and the molars. The review is to show the relationship between dental erosion and caries and soft drinks. Some efforts have been taken to reduce the harmful effect of soft drinks.

Acidic beverages increase the risk of in vitro tooth erosion

Acidic beverages are thought to increase the potential for dental erosion. We report pH and titratable acidities (ie, quantity of base required to bring a solution to neutral pH) of beverages popular in the United States and lesion depths in enamel and root surfaces after beverage exposure, and we describe associations among pH, titratable acidity, and both enamel and root erosive lesion depths. The pH of 100% juices, regular sodas, diet sodas, and sports drinks upon opening and the titratable acidity both upon opening and after 60 minutes of stirring were measured. Enamel and root surfaces of healthy permanent molars and premolars were exposed to individual beverages (4 enamel and 4 root surfaces per beverage) for 25 hours, and erosion was measured. Statistical analyses included 2-sample t tests, analyses of variance with post hoc Tukey studentized range test; and Spearman rank correlation coefficients. All beverages were acidic; the titratable acidity of energy drinks was greater than that of regular and diet sodas that were greater than that of 100% juices and sports drinks (P < .05). Enamel lesion depths after beverage exposures were greatest for Gatorade, followed by those for Red Bull and Coke that were greater than those for Diet Coke and 100% apple juice (P < .05). Root lesion depths were greatest for Gatorade, followed by Red Bull, Coke, 100% apple juice, and Diet Coke (P < .05). Lesion depths were not associated with pH or titratable acidity. Beverages popular in the United States can produce dental erosion.