Techniques to Evaluate Dental Erosion: A Systematic Review of Literature

Evaluating the pH of Various Commercially Available Beverages in Pakistan: Impact of Highly Acidic Beverages on the Surface Hardness and Weight Loss of Human Teeth

The objectives of this study were to investigate the pH of common beverages and to evaluate the effects of common acidic beverages on the surface hardness and weight loss of human tooth specimens. A total of 106 beverages were conveniently purchased from supermarkets in Karachi, Pakistan. Prior to evaluation, beverages were refrigerated or stored at room temperature in accordance with the manufacturers’ recommendations. Beverages were categorized into six groups: ‘Sports and Energy drinks’, ‘Water’, ‘Fruit Juices and Drinks’, ‘Sodas’, ‘Milk and Flavored Milk’ and ‘Teas and Coffee’. Using a pH meter, the pH of each beverage was measured in triplicate at room temperature. In addition, the influence of five highly acidic beverages on the weight loss and surface hardness of human tooth specimens was evaluated using gravimetric analysis and the Vickers hardness tester, respectively. ‘Sports and Energy drinks’, ‘Fruits Juices and Drinks’ and ‘Sodas’ were the most acidic beverage categories, with a pH range of 3.00−5.00. A total of 33% of beverages tested in this study were highly acidic (pH less than 4.00), 29% of beverages were moderately acidic (pH 4.00−4.99) and 31% were mildly acidic (pH 5.00−6.99). Significant weight loss was observed in all immersed specimens compared to control counterparts (p < 0.05). Similarly, for surface hardness, five highly acidic beverages (Red Bull, Pepsi, Apple Cidra, Tang Mosambi and Tang Orange) significantly decreased the surface hardness of specimens (p < 0.05). The pH levels of commonly available beverages in Pakistan are highly acidic, which may encourage loss of minerals from teeth; hence, affecting their surface hardness.

Impact of fluoride-releasing orthodontic adhesives on the shear bond strength of orthodontic brackets to eroded enamel following different surface treatment protocols

PURPOSE:

To assess the impact of enamel surface treatment protocols and the types of adhesive materials on the shear bond strength (SBS) of brackets to eroded enamel substrate.

MATERIALS AND METHODS:

Eighty extracted premolars were randomly assigned to four main groups in which group C (no treatment) was the control group. The remaining groups were exposed to an erosion challenge through short-term acidic exposure to HCl solution (0.01 M, pH 2.3) for 30 s, with an agitation speed of 50 rpm at an environmental temperature of 25°C. The eroded enamel surface within each group was treated as follows: group N received no treatment; in group P, the eroded enamel was treated with 35% phosphoric acid (Ultradent Products, South Jordan, UT, USA) for 15 s, followed by a rinse for 10 s; and in group F, the eroded enamel was treated with fluoride gel (Bifluorid 12; Voco-GmbH, Cuxhaven, Germany) for 4 min. The brackets were bonded with either a resin composite adhesive (Transbond XT; light-cure adhesive, 3M Unitek, CA, USA) or resin-modified glass ionomer cement (Fuji Ortho LC-GC Corporation, Japan). The specimens were tested for SBS, and the bond failure was assessed according to the adhesive remnant index (ARI). Analysis of variance (ANOVA) and Tukey's post-hoc tests (P < 0.05) were used to compare the SBS of the groups. The ARI values between the groups were recorded.

RESULTS:

Statistically significant differences were found among the tested variables (P < 0.05). Group P showed the highest mean SBS values regardless of the type of adhesive used, and the difference was statistically significant (P < 0.05). The application of the fluoride gel showed no statistically significant improvement in SBS values. The failure mode distribution among the test groups indicated that failures at the adhesive–bracket interface were predominant in group C compared with the other study groups.

CONCLUSIONS:

Fluoride pretreatment, which was used to remineralize the eroded enamel surfaces before bonding, resulted in a decrease in the SBS of the orthodontic brackets in vitro compared with the other treated groups. The use of fluoride-releasing adhesive also enhances bonding to the eroded enamel surfaces.

Characterization of dynamic process of carious and erosive demineralization - an overview

To review the analytical methods for carious and erosive demineralization an initial search of peer-reviewed scientific literature from the digital library database of PubMed/Medline indexed journals published up to early 2022 was carried out based on keywords relevant to the topic criteria including bibliographic citations from the papers to gather the most updated information. This current review aims to provide an updated overview of the advantages, limitations, and potential applications of direct and indirect research methods available for studying various dynamic stages of carious and erosive demineralization in enamel and dentin. This paper categorizes and describes the most suitable, frequently adopted and widely used quantitative and qualitative techniques in in vitro/in vivo research which are well-established, emerging, or comparatively novel techniques that are being explored for their potential validation.

Influence of energy drinks on enamel erosion: In vitro study using different assessment techniques

Background

Dental erosion has become a relevant public health problem in recent years and is related to the increase in the consumption of acidic beverages. Objective: The aim of the present study was to evaluate the erosive potential of energy drinks on dental enamel using an in vitro erosion model.

Material and Methods

Thirty-eight blocks of human enamel were divided into four groups: G1- TNT Energy Drink®(n=8), G2- Red Bull® (n=10), G3- Monster Energy® (n=10), and G4- Coca-Cola® (n=10) (positive control). For the chemical analysis, the pH values, titratable acidity, and buffering capacity of the beverages were measured in triplicate. For the erosive test, the specimens were immersed in the beverages (5ml/block) for 30 minutes at room temperature with gentle shaking. Initial and final surface microhardness values were measured and the percentage of the loss of surface microhardness was calculated. Profilometry (surface loss and lesion depth) and mineral loss analysis (quantitative light-induced fluorescence) were performed. The data were analysed statistically using ANOVA followed by the Bonferroni correction, Pearson’s correlation test, and multiple linear regression (p<0.05).

Results

The energy drinks had pH values ranging from 2.36 to 3.41. The lowest titratable acidity value was recorded for Monster Energy® and the highest was recorded for TNT Energy Drink®. All energy drinks had buffering capacity values higher than Coca-Cola®. Analysing the eroded enamel surface, the specimens submitted to TNT Energy Drink® had the greatest percentage loss of surface microhardness, surface loss, depth, and mineral loss, followed by those submitted to Red Bull® and Monster Energy®. Surface loss was the only predictor of mineral loss (p<0.001).

Conclusions

Based on the study model employed, all the energy drinks examined were erosive to tooth enamel and TNT Energy Drink® had the worst behaviour.

Key words:Energy drinks, tooth erosion, tooth demineralisation, hardness tests, quantitative light-induced fluorescence.

SEM Evaluation of Tooth Surface after a Composite Filling Removal Using Er:YAG Laser, Drills with and without Curettes, and Optional EDTA or NaOCl Conditioning

(1) Background: This study aimed to evaluate the microporosity of the tooth surface structure adjacent to the cemento-enamel junction (CEJ) after the removal of composite fillings with a drill in comparison with removal by an Er:YAG laser and after cleaning with a periodontal curette, chemical EDTA and NaOCl (sodium hypochlorite) conditioning. (2) Methods: The research material consisted of 30 extracted premolars with cervical composite fillings. The teeth were divided into six groups according to the method of tooth preparation: group G1 (n = 5)-a diamond drill; group G2 (n = 5)-a diamond drill + curette; group G3 (n = 5)-a diamond drill + 24% EDTA (PrefGel, Straumann, Switzerland); group G4 (n = 5)-an Er:YAG laser (LightWalker, Fotona, Ljubljana, Slovenia) set with the following parameters: power: 1.65 W (composite removal, CR), 1.2 (tooth conditioning, TC), energy: 110 mJ (CR), 80 mJ (TC), frequency: 15 Hz, pulse duration: 50 μs, tip diameter: 1 mm, air/fluid cooling: 4, distance 1.5 mm, energy density: 14.01 J/cm2 (CR), 10.19 J/cm2 (TC); group G5 (n = 5)-an Er:YAG laser + 2% sodium hypochlorite (NaOCl); group G6 (n = 5)-an Er:YAG laser + 5.25% NaOCl. In each tooth, three cavities were made and subjected to analysis. The dentin surface was evaluated using a scanning electron microscope (SEM). (3) Results: Groups G1 and G2 exhibited mechanical damage to the tooth surface structure caused by the rotary motion of a diamond drill. The SEM image showed a smear layer that could only be removed chemically using 24% EDTA gel (group G3). The tooth surfaces prepared with the Er:YAG laser (groups G4-G6) revealed a homogeneous structure without damage along with open dentinal tubules (without smear layer) and visible denaturation of collagen fibers. The sodium hypochlorite (NaOCl) conditioning did not increase the visibility of dentinal tubules. (4) Conclusions: Dentin surfaces have open dentinal tubules after removal of the composite filling using the Er:YAG laser and therefore do not require additional NaOCl conditioning.

Effect of Zamzam Water on Microhardness of Primary Tooth Enamel After Erosion Induced by Claritin Syrup: An In-vitro Study

Background:

Dental erosion is an irreversible damage to hard tissues in the mouth due to acid dissolution not induced by microorganisms. Oral medications contributed to the etiology of dental erosion. Among these medications, antihistamine-containing syrups were reported to have a considerable erosive effect on hard dental tissues.

Objective:

The objective was to evaluate the effect of Zamzam water on the microhardness of primary tooth enamel after erosion induced by Claritin™ syrup.

Materials and Methods:

The present in-vitro study was conducted on 25 primary central incisor teeth. The labial surfaces of the specimens were prepared for microhardness testing. Baseline microhardness was measured first, then the samples were submerged in the erosive agent Claritin™ syrup, for 30 min every 12 h for 12 days. Thereafter, all the teeth were placed in Zamzam water for 30 min every 12 h for 12 days. The microhardness was measured by the Vickers hardness tester and expressed as Vickers microhardness value (VH). The measurements were completed three times for the same sample: baseline, after erosion, and after Zamzam treatment. Data were analyzed statistically using one-way repeated analysis of variance (ANOVA) followed by Tukey’s post hoc test.

Results:

The primary teeth included in this study showed a significant increase in their surface microhardness after Zamzam water treatment; the mean value of VH was increased from 33.12 ± 1.62 to 89.32 ± 8.52 (P-value <0.0001).

Conclusion:

Zamzam water could be introduced as a part of the management of dental erosion in the primary dentition.

Seeing is believing? When scanning electron microscopy (SEM) meets clinical dentistry: The replica technique

In restorative dentistry, the in situ replication of intra-oral situations, is based on a non-invasive and non-destructive scanning electron microscopy (SEM) evaluation method. The technique is suitable for investigation restorative materials and dental hard- and soft-tissues, and its interfaces. Surface characteristics, integrity of interfaces (margins), or fracture analysis (chipping, cracks, etc.) with reliable resolution and under high magnification (from ×50 to ×5,000). Overall the current study aims to share detailed and reproducible information about the replica technique. Specific goals are: (a) to describe detailed each step involved in producing a replica of an intra-oral situation, (b) to validate an integrated workflow based on a rational sequence from visual examination, to macrophotography and SEM analysis using the replica technique; (c) to present three clinical cases documented using the technique. A compilation of three clinical situations/cases were analyzed here by means the replica technique showing a wide range of possibilities that can be reached and explored with the described technique. This guidance document will contribute to a more accurate use of the replica technique and help researchers and clinicians to understand and identify issues related to restorative procedures under high magnification.

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.

Prevalence of Dentinal Hypersensitivity and Dental Erosion among Competitive Swimmers, Kerala, India

Background

Professional swimmers face a hidden occupational hazard due to improper maintenance of pool. Ill maintained pools can lead to erosive effects on dental health and thus needs to be evaluated.

Methodology

Fifty-six competitive swimmers from two training centers were contacted and surveyed for swimming exposure and oral health. A visual analog scale was used to rate the tooth sensitivity. Dental erosion and dental caries were recorded according to WHO oral health assessment criteria (2013). The dentinal hypersensitivity experience was assessed using the dentine hypersensitivity experience questionnaire - 15 (DHEQ-15). Data were analyzed using Chi-square test and multivariate analysis.

Results

The prevalence of dentinal hypersensitivity and dental erosion was found to be 69.6% and 48.2%, respectively. The common surfaces affected by dental erosion were palatal surfaces of maxillary anterior, followed by lingual surfaces of mandibular anterior. There was a direct association between duration of the stay in pool and dental erosion. The DHEQ-15 questionnaire revealed that more than 80% of the participants never felt these sensations had any serious long-term effects on oral health.

Conclusions

Oral health professional must understand dental erosion among competitive swimmers as an occupational oral health hazard and provide early counseling and necessary invasive and noninvasive care.