Prevalence and Its Associated Risk Factors in Tooth Wear

Antioxidant Mechanisms of the Protective Action of Selenase in Experimental Chronic Generalized Periodontitis

Inflammatory periodontal diseases, despite all the efforts of modern dentistry, remain an important predictor of tooth loss worldwide. Oxidative stress plays a crucial role in the pathogenesis of periodontitis, making the use of antioxidants an attractive option for its treatment. Our attention was drawn to the selenium compound Selenase as an antioxidant therapeutic agent. In this study, we modeled a calcium-deficient prooxidant chronic generalized periodontitis (CGP) model in white non-linear rats. Then, after 14 days, Selenase (50 μg/kg) and Mexidol (250 mg/kg) were administered intragastrically. Blood samples from the animals were analyzed using ELISA and biochemical methods to determine Cu-Zn SOD, nitrotyrosine, GPX-4, iNOS, NOx, GSH, and GSSG levels. The CGP model led to the typical clinical signs of periodontitis, including hyperemia, edema, gingival pocket formation, bleeding, tooth mobility, as well as an increase in molecular-biochemical markers of nitrosative stress and a reduction of endogenous antioxidants in the blood. Selenase resulted in a decrease in the clinical manifestations of CGP, reduced iNOS, nitrotyrosine, and NOx levels, and an increase in Cu-Zn SOD and GPX-4 compared to the control group (p < 0.05). Mexidol had a less pronounced effect on these markers compared to Selenase (p < 0.05).

Tooth Wear Prevalence and Associated Risk Factors Among a Small Portuguese Community: A Retrospective Study

Background/Objectives: Early tooth wear (TW) assessment prevents challenging and costly dental treatments. Knowledge of data on the prevalence and risk factors is crucial for developing preventive guidelines. This retrospective cross-sectional study aims to study the prevalence of TW in a sample of patients seeking a Screening and Emergency appointment at Egas Moniz Dental Clinic (EMDC) and its associated risk factors. Methods: Descriptive and logistic regression analysis were applied to data from a sample of 2266 patients, collected between 2021 and 2023, to ascertain the presence of tooth wear, its different types and its correlation with potential risk factors. Results: The prevalence of dental wear was found to be 54.7%, with attrition (24.1%) being the most prevalent lesion and erosion (2.7%) the least prevalent. Concerning the risk predictors for tooth wear, age (OR = 1.01-1.05, p < 0.05), decreased DVO (OR = 2.16, p = 0.028), antacids (OR = 7.07, p = 0.003), mastication difficulties (OR = 1.87, p = 0.039), drugs (OR = 2.38, p = 0.032) and use of mouthwash (OR = 1.47, p = 0.008) were positively associated. Gender (OR = 0.7, p = 0.015) was negatively associated, with females showing a 30% less risk than males. Conclusions: It was concluded that TW is prevalent and increases with age, underscoring the necessity for timely and accurate diagnosis to minimize its progression. Additionally, it is crucial to conduct a thorough evaluation of the risk factors involved to implement effective preventive measures and treatment strategies.

Clinical performance of minimally invasive full-mouth rehabilitation using different materials and techniques for patients with moderate to severe tooth wear: a systematic review and meta-analysis

OBJECTIVE

To evaluate short, mid and long-term clinical outcomes and patients' satisfaction of minimally invasive full-mouth rehabilitation using different materials and techniques for patients with moderate to severe tooth wear. Furthermore, materials were analyzed to identify their influences on clinical results.

MATERIALS AND METHODS

Search was conducted in PubMed, Cochrane Central Register of Controlled Trial, Embase, Web of science and Scopus until December 19, 2024. Randomized clinical trials (RCT), cohort studies and case series with at least mean period of 3 years were included. The revised Cochrane risk of bias tool, Newcastle-Ottawa scale and Joanna Briggs Institute Critical Appraisal were used to evaluate the quality of RCT, cohort studies and case series. Meta-analysis and Poisson regression were conducted.

RESULTS

Ten studies in this review included three case series, six cohort studies and one RCT with three low, six moderate risks and one some concerns. Annual failure rates (AFRs) and annual complication rates (ACRs) of direct composite restorations were 0-6.2% and 1.0%-4.2%, respectively. AFRs of indirect restorations were 0%-0.5%. Overall ACRs of indirect restorations fabricated by traditional indirect resin composites, polymer-infiltrated ceramic-network, resin nanoceramics and ceramics were at 1.6%-15.1%, 0.7%-4.8%, 0.5%-5.0% and 0.2%-1.1%, respectively. The estimated AFRs of direct composites, resin nanoceramics and ceramics were 0.64%, 0.13% and 0.04% respectively. Significantly lowest AFRs of ceramic was found after mid-term follow-up with incidence rate ratios of direct composites, resin nanoceramics and ceramics being 1: 0.68 (P = 0.60): 0.001 (P < 0.05). The estimated ACRs of the three materials were 2.16%, 2.14% and 0.62%. Overall AFRs of restorations using different techniques were 0%-0.5%. Overall ACRs of direct and indirect techniques were 1.1%-2.2% and 0.2%-4.8%, respectively. Overall ACRs of hybrid technique were 0.5% to 15.1%. Restoration fracture was the most predominant complication regardless of materials. High appreciation was expressed by patient reported outcomes measures.

CONCLUSIONS

Minimally invasive full-mouth rehabilitation for patients with moderate to severe tooth wear presented good clinical performance apart from traditional indirect resin composite used in posterior teeth.

CLINICAL RELEVANCE

Minimally invasive full-mouth rehabilitation should be strongly advocated for the patients with moderately and severely worn dentition.

Exploring the relationship of salivary pH and flow rate with tooth wear severity: A cross-sectional study

BACKGROUND

Tooth wear is the loss of dental hard tissue due to chemical and mechanical processes, and its prevalence ranges from 13 to 80 % in the general population. Management depends on understanding potential risk factors; however, the role of saliva as one of them is not completely understood. The aim of this study was to explore the relationship between salivary pH and flow, and tooth wear in patients referred to a specialized dental clinic for tooth wear management.

METHODOLOGY

Data used in this study included stimulated (SWS) and unstimulated whole salivary (UWS) pH and flow rate. Dependent variables were the average occlusal Tooth Wear Index (TWI) and the average of the surfaces with the maximum Tooth Wear Evaluation System 2.0 score (TWES). Univariate and multivariate linear regression models were utilized, including a multivariate analysis without outliers. Sex and age were added as confounders.

RESULTS

A total of 159 patients were included in this study. The average age of the individuals was 37.1 (± 9.1) years and 34 (21 %) were female. Univariate models showed a statistically significant association between both TWI and SWS pH. Multivariate models showed that the negative associations between SWS (β = -0.20, C.I. = -0.36 - -0.03 [TWI]; β = -0.12, C.I. = -0.22 - -0.02 [TWES]) and UWS pH (β = -0.12, C.I. = -0.26 - 0.02 [TWI]; β = -0.09, C.I. = -0.18 - 0.00 [TWES]) and tooth wear were largely unaffected by confounders. These associations were also robust against outliers. A relevant association with flow rate was not detected.

CONCLUSION

This study shows that salivary pH was inversely associated with tooth wear severity even after correction for confounders, such as flow rate, age, and sex. This association was especially significant for SWS. Although no causal relationship can be established, the results suggest a role of salivary pH in tooth wear in patients with moderate to severe tooth wear. No association was found between tooth wear and flow rate.

Childhood early oral ageing syndrome: prevalence and association with possible aetiological factors and consequences for the vertical dimension of occlusion: protocol for a cross-sectional study

INTRODUCTION

Childhood early oral ageing syndrome (CEOAS) is a condition involving oral abnormalities resulting from systemic diseases of different origins that are related to the current lifestyle of the paediatric population. Enamel defects associated with intrinsic and extrinsic factors promote the early loss of tooth structure at an accelerated pace, with negative impacts on function, aesthetics and quality of life. The aim of the study is to identify the prevalence of early tooth wear in childhood and its severity using the CEOAS index, which is a tool for the diagnosis of the condition and for epidemiological surveys, involving the investigation of abnormalities of the oral cavity in the paediatric population and possible factors associated with the severity of the condition.

METHODS AND ANALYSIS

Children aged 3-6 years will be recruited from the paediatric clinic of Universidade Nove de Julho. Children with amelogenesis imperfecta, dentinogenesis imperfecta and genetic syndromes, as well as those undergoing orthodontic treatment will be excluded. A questionnaire will be administered addressing general health, sleep quality, dietary habits, oral hygiene habits and parafunctional habits. Clinical examinations will then be performed using the novel CEOAS index to assess tooth wear (scores 0-3) and determine the occurrence of enamel defects (scores I-III). The vertical dimension of occlusion (VDO) will also be measured. The CEOAS scores will be computed for the deciduous dentition and analysed statistically, with the significance level set at 5% (p<0.05).

ETHICS AND DISSEMINATION

This protocol has been approved by the institutional review board of Universidade Nove de Julho (process number: 6.713.724. Approved on 20 March 2024). The results will be submitted to international peer-reviewed journals and presented at international conferences.

TRIAL REGISTRATION NUMBER

www.

CLINICALTRIALS

gov, NCT06381414. Registered 23 April 2024.

Anamnestic risk factors for erosive tooth wear: Systematic review, mapping, and meta-analysis

OBJECTIVES

Erosive tooth wear is a multifactorial condition. The aim of this systematic review and meta-analysis was to identify key risk factors for erosive tooth wear in permanent dentition.

STUDY SELECTION

Observational studies reporting anamnestic risk factors for erosive tooth wear. Methodological quality and risk of bias were assessed using the modified Newcastle-Ottawa scale for cross-sectional studies. Risk factors were visually presented in a heatmap, and where possible, random-effects meta-analyses were performed for the odds ratios (ORs) of risk factors.

SOURCES

Electronic databases (MEDLINE, Embase, Scopus, and Web of Science) and manual searches in February 2023. The protocol was registered in PROSPERO (CRD4202339776).

DATA

A total of 87 publications reporting on 71 studies were included in the systematic review. The studies examined a variety of anamnestic risk factors (n = 80) that were categorized into ten domains (socio-demographics, socio-economics, general health, oral diseases, medication, oral hygiene, food, beverages, dietary habits, and leisure-related risk factors). Meta-analyses revealed significant associations between erosive tooth wear and male gender (padj.<0.001; OR=1.30, 95 % CI: 1.16-1.44), regurgitation (padj.=0.033; OR=2.27, 95 % CI: 1.41-3.65), digestive disorders (padj.<0.001; OR=1.81, 95 % CI: 1.48-2.21), consumption of acidic foods (padj.=0.033; OR=2.40, 95 % CI: 1.44-4.00), seasoning sauces (padj.=0.003; OR=1.28, 95 % CI: 1.13-1.44), nutritional supplements (padj.=0.019; OR=1.73, 95 % CI: 1.28-2.35), and carbonated drinks (padj.=0.019; OR=1.43, 95 % CI: 1.17-1.75). Most included studies exhibited low bias risk.

CONCLUSIONS

Observational studies investigated a variety of anamnestic risk factors for erosive tooth wear. Future studies should employ validated questionnaires, particularly considering the most important risk factors.

CLINICAL SIGNIFICANCE

Erosive tooth wear is a prevalent condition. Clinicians should concentrate primarily on symptoms of gastroesophageal reflux disease and dietary factors when screening patients at risk for erosive tooth wear.

Complete androgen insensitivity syndrome diagnosed after inguinal surgery in era of modern technology: a case report

Introduction

Androgen Insensitivity Syndrome (AIS) is a rare X-linked recessive disorder of sexual development. It results from mutations in the Androgen Receptor (AR) gene located on chromosome Xq11-12. Affected individuals have a male genotype but a female phenotype.

Case presentation

A 20-year-old female presented to the emergency room with a history of pain in the bilateral inguinal region. In ultrasonography (USG), bilateral inguinal hernia was suspected. While performing an emergency operation for hernia repair, hernia was revealed as bilateral abdominal testis. Then, after a gynecology consultation, a bilateral orchidectomy was done. Postoperative karyotyping showed a male genotype. Then the patient was discharged on hormone replacement therapy to maintain normal bone mineral density and secondary sexual characteristics.

Discussion

AIS presents with primary amenorrhea in pubertal females. The growth spurt and secondary sexual characteristics are normal except for absent axillary and pubic hair. There is a short-blind vagina, but the uterus is absent, and the abdominal testis presents as an inguinal hernia. Serum gonadotropin level, karyotyping, and imaging studies are done to reach a diagnosis. Management includes gonadectomy, genitoplasty, and hormone replacement therapy.

Conclusion

The objective of this report was to make clinicians aware that AIS can present as a bilateral inguinal hernia. In acute presentations, it can be misdiagnosed as a strangulated femoral hernia only later to be identified as an undescended abdominal testis during surgery. An absence of proper clinical judgment and reliance on USG for imaging can often lead to misdiagnosis in acute settings.

Elevated risk of dyspnea in adults with obesity

We investigated whether older adults (OA) with obesity are more likely to have dyspnea compared with OA without obesity, and whether OA with obesity are at a greater risk of having dyspnea compared with middle-aged (MA) and younger adults (YA) with obesity. We obtained de-identified data from the TriNetX UT Southwestern Medical Center database. We identified obesity and dyspnea using ICD-10-CM codes E66 and R06.0, respectively. Patients were separated into three age groups: OA, (65-75 y.o.), MA (45-55 y.o.), and YA (25-35 y.o). Within these groups, those with and without obesity or dyspnea were identified for analysis. The risk of dyspnea was greater in OA (risk ratio: 3.64), MA (risk ratio: 3.52), and YA (risk ratio: 2.76) with obesity compared with age-matched patients without obesity (all p < 0.01). The risk of dyspnea was greater in OA and MA with obesity compared with YA with obesity (both p < 0.001 vs. YA). These findings suggest that clinicians should consider obesity as an independent risk factor for dyspnea.

Risk factors of tooth wear in permanent dentition: A scoping review

BACKGROUND

Tooth wear (TW) prevalence is high and increasing and has important consequences on the patient's quality of life. Knowledge of risk factors is crucial to promote diagnosis, prevention strategies and timely interceptive treatment. Many studies have identified TW risk factors.

OBJECTIVE

This scoping review aims to map and describe suspected available factors associated with TW in permanent dentition based on quantitative measurement.

METHODS

The scoping review was conducted using the PRISMA extension of the Scoping Reviews checklist. The search was conducted in October 2022 from the Medline® (PubMed® interface) and Scopus® databases. Two independent reviewers selected and characterised the studies.

RESULTS

2702 articles were identified for assessment of titles and abstracts, and 273 articles were included in the review. The results show a need to standardise TW measurement indices and the study design. The included studies highlighted various factors, classified into nine domains: sociodemographic factors, medical history, drinking habits, eating habits, oral hygiene habits, dental factors, bruxism and temporomandibular disorders, behavioural factors, and stress. Results related to chemical TW (erosion) risk factors underline the importance of eating disorders, gastroesophageal reflux and lifestyle, particularly drinking and eating behaviours, which supports developing public health information campaigns and interventions. Besides chemical, this review identifies evidence of several mechanical TW risk factors, such as toothbrushing and bruxism; the influence of this last factor needs to be further explored.

CONCLUSIONS

TW management and prevention require a multidisciplinary approach. Dentists are in the first line to detect associated diseases such as reflux or eating disorders. Consequently, practitioners' information and guideline diffusion should be promoted, and a TW risk factors checklist (the ToWeR checklist) is proposed to help diagnostic approaches.

Role of oxidative stress in the relationship between periodontitis and systemic diseases

Periodontitis is a common inflammatory disease. It is characterized by destruction of the supporting structures of the teeth and could lead to tooth loss and systemic inflammation. Bacteria in inflamed gingival tissue and virulence factors are capable of entering the bloodstream to induce systemic inflammatory response, thus influencing the pathological process of many diseases, such as cardiovascular diseases, diabetes, chronic kidney disease, as well as liver injury. An increasing body of evidence show the complex interplay between oxidative stress and inflammation in disease pathogenesis. When periodontitis occurs, increased reactive oxygen species accumulation leads to oxidative stress. Oxidative stress contributes to major cellular components damage, including DNA, proteins, and lipids. In this article, the focus will be on oxidative stress in periodontal disease, the relationship between periodontitis and systemic inflammation, and the impact of periodontal therapy on oxidative stress parameters.

Sleep quality among undergraduate medical students in Rwanda: a comparative study

Despite the abundance of literature highlighting poor sleep quality among medical students and its detrimental impact on their mental well-being and academic performance, no study has been conducted to investigate the sleep quality of undergraduate medical students in Rwanda to date. Therefore, this study sought to determine the magnitude of sleep quality of undergraduate medical students in Rwanda and to compare the scores of seven components of sleep quality across classes. This cross-sectional study was conducted among 290 undergraduate medical students aged 18-35 years (mean = 24, SD = 2.9) randomly recruited countrywide from 1st November 2021 to 1st March 2022. The questionnaire was self-administered with 2 sections: characteristics of medical students, and Pittsburgh Sleep Quality Index (PSQI). The Pearson Chi-square test was used to test whether the categories of seven components of sleep quality differ between classes, then ANOVA followed by the post hoc test was used to test if the seven components and global score of Pittsburgh Sleep Quality Index differ between classes. The results revealed that the global PSQI mean score was 7.73 (SD = 2.83), with fifth-year medical students reporting the highest PSQI mean score (M = 8.44, SD = 2.77), followed by first-year (M = 8.15, SD = 3.31). One-way ANOVA showed that the global PSQI score (F = 2.76, p = 0.028), subjective sleep quality (F = 3.35, p = 0.011), habitual sleep efficiency (F = 10.20, p < 0.001), and daytime dysfunction (F = 3.60, p = 0.007) were significantly different across classes. Notably, the post hoc test revealed significant scores differences in the global PSQI score between class II and V (p = 0.026), in subjective sleep quality between class I and II (p = 0.043), and between class I and IV (p = 0.016); habitual sleep efficiency between class V and all other classes (p < 0.001); and daytime dysfunction between class III and IV (p = 0.023). This paper concludes by arguing that poor sleep quality is highly prevalent among medical students in Rwanda, with final and first-year students reporting the poorest sleep quality. There were significant differences across classes in the global PSQI, subjective sleep quality, habitual sleep efficiency, and daytime dysfunction. Intervention approaches such as sleep education, behavioral changes, and relaxing techniques are recommended to address contributing factors and ultimately maximize the academic goals of Rwandan medical students.

Osteoporosis Assessment among Adults with Liver Cirrhosis

Osteopenic bone disease occurs frequently in patients with chronic liver cirrhosis, which most frequently presents with hepatic osteodystrophy. Thus, the relationship between nutritional status and bone mineral density has been poorly measured in liver cirrhosis. This single-center study consisted of a group of 70 patients diagnosed with liver cirrhosis. The nutritional status was evaluated with the Controlling Nutritional Status index, and volumetric vertebral bone mineral density was measured with quantitative computed tomography. Among the 70 patients included, osteopenia and osteoporosis were found in 71% and 24.3%, respectively. Malnutrition assessed with the Controlling Nutritional Status index was observed in 56 (80%) patients and was more frequent in alcoholic cirrhosis patients than viral cirrhosis patients (87.24% vs. 65.22%). Significant positive correlation with Controlling Nutritional Status score was found with Model for End-Stage Liver Disease (rho = 0.576, p-value < 0.0001), Child−Pugh score (rho = 0.670, p-value < 0.0001), International Normalized Ratio (rho = 0.517, p-value = 0.001), aspartate aminotransferase (rho = 0.293, p-value = 0.045), and bilirubin (rho =0.395, p-value = 0.02). Among the liver cirrhosis patients, 15 had osteoporosis and 49 had osteopenia at the lumbar spine (L1-L4 vertebrae), as determined by bone mass density via quantitative computed tomography. A non-significant relationship between Controlling Nutritional Status index-assessed nutritional status and bone mass density was documented. Regarding osteoporosis, no differences were found between the viral and alcohol types of liver cirrhosis patients (p-value = 0.870). Age, obesity, grade of varices, Child−Pugh score, and Model for End-Stage Liver Disease score were associated with osteoporosis in patients with liver cirrhosis.

Different Risk Factors for Erosive Tooth Wear in Rural and Urban Nepal: A National Study

BACKGROUND

Erosive tooth wear (ETW) is of growing concern, but data on ETW among Nepalese children are scarce. The main aim of the study was to investigate the prevalence and severity of ETW among Nepalese schoolchildren. We also aimed to analyse the risk indicators for ETW according to location (rural/urban) and the role of obesity in the risk for ETW.

METHODS

This national study was conducted among 5-15-year-old Nepalese schoolchildren from different regions. Altogether, 1137 out of 1151 schoolchildren participated in both a clinical examination and a survey. ETW was recorded using the Basic Erosive Wear Examination.

RESULTS

The prevalence of ETW was 65%. One-fifth of the examined subjects were in need of preventive or restorative treatment. Living in an urban area and studying in a private school were protective factors for ETW, whereas consuming fruits frequently and using charcoal for tooth cleaning increased the odds for ETW. Central obesity was the strongest risk indicator for ETW among urban residents.

CONCLUSIONS

ETW of low severity is common among Nepalese children and adolescents. Socio-demographic factors influence the prevalence of ETW in Nepal and there seems to be different factors that play a role in the ETW process according to location of residence.

Acidic food choice among adolescents with bulimic symptomatology: a major risk factor for erosive tooth wear?

PURPOSE

Evaluate dietary habits and the presence of erosive tooth wear (ETW) among female adolescents with varying severity of bulimic symptomatology.

METHODS

An explanatory study was conducted with 72 female school adolescents with bulimic symptomatology, aged 15-18 years in Southeastern Brazil. Dietary habits were evaluated through a food frequency questionnaire. Bulimic symptomatology was evaluated and classified (mild, moderate and severe) according to the Bulimic Investigatory Test of Edinburgh. ETW examinations were performed. Data analysis involved descriptive statistics, bivariate analysis, Kruskal-Wallis/Mann-Whitney tests and Poisson regression. Ethical approval and informed consents were obtained.

RESULTS

The final population consisted of 62 participants. The prevalence of ETW differed among adolescents with mild, moderate and severe bulimic symptomatology (p = 0.001), corresponding to 5.9%, 8.0% and 45.0%, respectively. Adolescents with severe bulimic symptomatology presented higher daily consumption of acidic food: citric fruits (p < 0.005), diet soda (p < 0.009) and ketchup (p = 0.004). No difference related to vomiting practices was observed between groups (p = 0.060). The adjusted regression model showed that a higher prevalence of ETW was associated with self-induced vomit at least once a week (PR = 2.42, 95% CI = 1.00-5.86, p = 0.05) and higher frequencies of consumption of citric fruits (PR = 7.96, 95% CI = 1.50-42.11, p = 0.015) and diet soda (PR = 2.32, 95% CI = 1.09-4.91, p = 0.029).

CONCLUSION

It was the food choices (acidic food) and not purging practices that differed among adolescents with varying severity of bulimic symptomology. Likewise, higher consumption of citric fruits was the main factor associated with higher prevalence of ETW.

LEVEL OF EVIDENCE

III case-control analytic study.