Polyphenols for Preventing Dental Erosion in Pre-clinical Studies with in situ Designs and Simulated Acid Attack.

Dental erosion is a chemical process characterized by acid dissolution of dental hard tissue, and its etiology is multifactorial. Dietary polyphenols can be a strategy for dental erosion management, collaborating to preserve dental tissues through resistance to biodegradation. This study describes a comprehensive review to interpret the effects of polyphenols on dental erosion of pre-clinical models with in situ designs and simulated acid attacks on enamel and dentin samples. We aim to evaluate evidence about Polyphenols' effects in the type of dental substrate, parameters of erosive cycling chosen in the in situ models, and the possible mechanisms involved. An evidence-based literature review was conducted using appropriate search strategies developed for main electronic databases (PubMed, Scopus, Web of Science, LILACS, EMBASE, LIVIVO, CINAHL, and DOSS) and gray literature (Google Scholar). The Joanna Briggs Institute checklist was used to evaluate the quality of the evidence. From a total of 1900 articles, 8 were selected for evidence synthesis, including 224 specimens treated with polyphenols and 224 control samples. Considering the studies included in this review, we could observe that polyphenols tend to promote a reduction in erosive and abrasive wear compared to control groups. However, as the few studies included have a high risk of bias with different methodologies and the estimated effect size is low, this conclusion should not be extrapolated to clinical reality.

Prevalence and association of gastroesophageal reflux disease and dental erosion: An overview of reviews.

OBJECTIVES: The aim of this overview of reviews was to retrieve and evaluate the available evidence concerning the prevalence and association between gastroesophageal reflux disease (GERD) and erosive tooth wear (ETW). DATA: A literature search was conducted in electronic databases and relative systematic reviews with or without meta-analyses were located. Updated supplemental search was also undertaken to identify additional primary studies. SOURCES: Medline (via Pubmed), Embase, Scopus, Cochrane Register of Systematic Reviews, PROSPERO and Epistemonikos.org database were searched. Additional search of the gray literature, abstracts of conferences and meetings as well as manual search of the reference lists of retrieved studies, was also performed. STUDY SELECTION: The search retrieved 116 systematic reviews of which 10 were considered eligible and eight additional primary studies. CONCLUSIONS: GERD constitutes a risk factor for ETW and there is a positive association between the two conditions. In the present overview, despite the heterogeneity between studies and the low level of evidence, it was clearly supported that individuals with GERD have an increased probability of also presenting with signs of ETW. In special groups of population, a high association was found between GERD and ETW. The geographic location may affect the association between GERD and ETW, while regarding the effect of flow rate, buffering capacity of saliva and oral microbial changes caused by GERD, the results were controversial. CLINICAL SIGNIFICANCE: Appropriate preventive dental care should be considered for individuals with GERD and a multidisciplinary medical and dental approach for the management of individuals with ETW is advised. The results of this study can be used by dentists dealing with typical and atypical GERD signs and symptoms in the oral environment, but also by the physicians and gastroenterologists who need to motivate their patients for oral examination.

A Brief History of Tooth Wear.

Historical publications that have significantly improved the understanding of tooth wear mechanisms are reviewed with a focus on descriptions of the lesions, the evolution of their classification systems, and considerations addressing the main risk factors. Surprisingly, most important advances are often the oldest. Likewise, they are currently only marginally known, which requires a major dissemination effort.

Influence of different ultra-soft toothbrushes on erosive tooth wear.

OBJECTIVE: To investigate the influence of different ultra-soft toothbrushes on the progression of erosive tooth wear (ETW). METHODS: Bovine enamel and dentin specimens (n = 10) were submitted to a 5-day erosive-abrasive cycling model (0.3% citric acid for 5 min, artificial saliva for 60 min, 4x/day). Toothbrushing was carried out 2x/day for 15 s, with the different toothbrushes tested (A- Edel White: flexible handle, tapered bristles; B- Oral-B Gengiva Detox: regular handle, criss-cross tapered bristles; C- Colgate Gengiva Therapy: flexible handle, tapered bristles, high tuft density; d- Oral-B Expert Gengiva Sensi: regular handle, round end bristles, high tuft density; E- Oral-B Indicator Plus: soft brush, round end bristles (control). Surface loss (SL, in µm) was assessed by optical profilometry. The toothbrush characteristics were evaluated by a surgical microscope. Data were statistically analyzed (α=0.05). RESULTS: For enamel, toothbrush C showed the highest SL (means±SD: 9.86 ± 1.28) and it did not differ significantly from A (8.60 ± 0.50), both with flexible handles. The lowest SL was observed for the toothbrush Control E (6.76 ± 0.63), which differed significantly from A and C, but not from the other toothbrushes. For dentin, the highest SL was found for toothbrush D (6.97 ± 1.05) and it did not differ significantly from E (6.23 ± 0.71). The lowest SL was observed for B (4.61 ± 0.71) and C (4.85 + 0.83), without significant differences from A (5.01 ± 1.24). CONCLUSIONS: The ultra-soft toothbrushes had different impacts on the progression of ETW on the dental substrates. On enamel, higher ETW values were observed for the flexible handle toothbrushes, while for dentin, round-end bristles (ultra-soft and soft) caused more ETW. CLINICAL SIGNIFICANCE: Knowledge about the effect of different ultra-soft toothbrushes on ETW can help clinicians to recommend the most suitable types for their patients, bearing in mind that toothbrushes can impact enamel and dentin differently.

Fluid Intake and the Occurrence of Erosive Tooth Wear in a Group of Healthy and Disabled Children from the Malopolska Region (Poland).

Background: The aim of this study was to analyse the relationship between the type and amount of fluid intake and the incidence of erosive tooth wear in a group of healthy children and children with disabilities. Methods: This study was conducted among children aged 6-17 years, patients of the Dental Clinic in Kraków. The research included 86 children: 44 healthy children and 42 children with disabilities. The prevalence of erosive tooth wear using the Basic Erosive Wear Examination (BEWE) index was assessed by the dentist, who also determined the prevalence of dry mouth using a mirror test. A qualitative-quantitative questionnaire on the frequency of consumption of specific liquids and foods related to the occurrence of erosive tooth wear, completed by the children's parents, was used to assess dietary habits. Results: The occurrence of erosive tooth wear was determined for 26% of the total number of children studied, and these were mostly lesions of minor severity. The mean value of the sum of the BEWE index was significantly higher (p = 0.0003) in the group of children with disabilities. In contrast, the risk of erosive tooth wear was non-significantly higher in children with disabilities (31.0%) than in healthy children (20.5%). Dry mouth was significantly more frequently identified among children with disabilities (57.1%). Erosive tooth wear was also significantly more common (p = 0.02) in children whose parents declared the presence of eating disorders. Children with disabilities consumed flavoured water or water with added syrup/juice and fruit teas with significantly higher frequency, while there were no differences in quantitative fluid intake between groups. The frequency and quantity of drinking flavoured waters or water with added syrup/juice, sweetened carbonated, and non-carbonated drinks were associated with the occurrence of erosive tooth wear for all children studied. Conclusions: The group of studied children presents inappropriate drinking behaviours regarding the frequency and amount of beverages consumed, which, especially in a group of children with disabilities, may contribute to the formation of erosive cavities.

Prevalence of dental attrition and its relationship with dental erosion and salivary function in young adults.

OBJECTIVES: The aim of this study was to estimate the prevalence of dental attrition in a young adult population and to explore associated factors. METHOD AND MATERIALS: Dental students aged 18 to 40 years old with a minimum of 24 natural teeth were invited to take part in this cross-sectional study. Their demographic information, medical history, perceived stress, frequency of dietary acid intake, and frequency of oral habits were obtained through several questionnaires. Assessment of each type of tooth wear (erosion, attrition, and abrasion) was performed according to the tooth wear evaluation system (TWES 1.0). All participants underwent salivary tests. Statistical analysis was performed by chi-squared or Mann-Whitney tests and logistic regression models. RESULTS: In total, 178 participants (88 women and 90 men) with a median age of 22 years were included and of those 74.7% (95% confidence interval [CI], 68% to 81%) had dental attrition. Univariate analysis revealed positive associations for male sex, age, body mass index, awake bruxism frequency, and erosive tooth wear with the presence of dental attrition. Multivariable logistic regression (Nagelkerke r2 = 0.31) indicated that dental attrition was associated with erosive tooth wear (adjusted odds ratio [aOR], 6.3; 95% CI, 2.8 to 14.2), body mass index (aOR, 1.3; 95% CI, 1.1-1.5), and age (aOR, 1.2; 95% CI 1.0 to 1.3). CONCLUSION: Dental attrition is present in most young adults of Catalonia. The associated factors were erosive tooth wear, body mass index, and age. Slight alterations of salivary parameters do not seem to predict dental attrition. (Quintessence Int 2023;54:168-175; doi: 10.3290/j.qi.b3622405).

Prevalence of tooth wear and associated factors: A birth cohort study.

OBJECTIVES: To investigate the prevalence of tooth wear and associated factors in adults from the 1982 Pelotas Birth Cohort. METHODS: A subsample of the 5,914 individuals from the 1982 Pelotas Birth Cohort was randomly selected to be interviewed and clinically examined at the age of 31. Tooth wear was evaluated using a simplified version of the Tooth Wear Index (TWI), considering the absence or presence of tooth wear in dentin of first molars and anterior teeth (incisors and canines). Independent variables were socioeconomic, demographic, unhealthy behavior, and mental health. Crude and adjusted Poisson regression models were employed. A significant level of P ≤ 0.05 was adopted. RESULTS: A total of 537 individuals were evaluated. A tooth wear prevalence of 61.6% was observed. Females presented a statistically significant lower tooth wear in dentin prevalence ratio (PR) compared to males in the adjusted analysis (PR 0.76; 95% CI: 0.67-0.86). Acid beverage consumption (PR 1.22; 95% CI: 1.01-1.49) and consumption of alcoholic beverages (PR 1.19; 95% CI: 1.04-1.35) were positively associated with tooth wear. CONCLUSION: Almost 2/3 of the surveyed individuals presented tooth wear in dentin. Being a male, higher consumption of alcohol and acidic beverages were factors associated with tooth wear. CLINICAL SIGNIFICANCE: There was a high prevalence of tooth wear in dentin in the adult population. Data has also shown the etiological complexity of tooth wear, reinforcing the importance of an early diagnosis and the establishment of preventive measures to decrease the potentially hazardous effect of tooth wear over time.

Case Report: Case report: Rapidly progressing tooth wear dominated by intrinsic and extrinsic erosion.

Tooth wear is multi-factorial presenting as a combination of abrasion, attrition, and erosion. This case report represents a case of combined tooth wear in a 46-year-old Indo-Trinidadian male, with a predominant erosive component with both the clinical signs and features of intrinsic and extrinsic erosion. This patient case is unique since the wear predominated by dental erosion has occurred rapidly evidenced by the physical clinical appearance of a lack of compensation and the upper left premolars and molars relatively unaffected by the overall effects of tooth wear. This lack of compensation, where opposing teeth have not supra-erupted to maintain inter-arch stability, and the maintenance of occlusal vertical dimension on the left due to the non-worn posterior maxillary teeth, provides the benefit of simplifying subsequent restorative management. The medical and diet history corroborates the diagnoses of intrinsic and extrinsic erosion respectively. Complications noted with rapid tooth wear, such as dentine sensitivity and pulpal necrosis are known sequelae of tooth wear however the patient presented in this case report shows a concomitant high caries experience and poor oral hygiene. Cases such as the one presented here require not only comprehensive dental management, utilizing a restorative approach but also medical referral for confirmation of a diagnosis and management of gastroesophageal reflux disease. Inherent to the management of this patient should be a multidisciplinary medical and dental approach, with confirmation and management of the cause of the intrinsic erosion as well as restorative dental management, together with dietary counseling to mitigate the effect of intrinsic and extrinsic sources of acid on dental hard tissue. A key lesson learned from this case is the importance of history and targeted questioning when trying to determine the cause of tooth wear dominated by intrinsic and extrinsic erosion.

Association between gastric reflux, obesity and erosive tooth wear among psychiatric patients.

ABSTRACT: The prevalence of erosive tooth wear and obesity are high in psychiatric patients and soft drink consumption is a common risk factor associated with both diseases. This study aimed to assess the association between soft drink consumption, gastric reflux, erosive tooth wear, and obesity among resident patients at the Psychiatric Hospital, Taif, Saudi Arabia.This descriptive, cross-sectional study included 223 adult psychiatric inpatients (126 male, 97 female) with a mean age of 42.3 years (± 2.2). Dental erosion detection was performed according to World Health Organization criteria. The medical evaluation included assessment of the body mass index (BMI). With appropriate sample weighting, relationships between erosive tooth wear, gastric reflux, and obesity were assessed using multivariable logistic regression.Ninety eight patients (43.9%) presented with erosive tooth wear. The mean BMI for the entire study population was 27.7 ±â€Š6.3 kg/m2. Regression analysis showed a strong association between erosive tooth wear and chronic vomiting or bulimia (adjusted odds ratio = 2.11; 95% confidence interval [CI] = 1.98-5.07, P < .001), gastric reflux (adjusted odds ratio = 2.13; 95% CI = 1.34-6.23, P < .001), consumption of soft drinks (adjusted odds ratio = 2.14; 95% CI = 1.03-6.08, P < .001), and schizophrenia and delusional disorders (adjusted odds ratio = 2.07; 95% CI = 1.98-5.08, P < .001).This study demonstrates a significant association between erosive tooth wear prevalence and chronic vomiting or bulimia, consumption of soft drinks, and gastric reflux among resident patients at psychiatric hospital.

Current Concepts and Best Evidence on Strategies to Prevent Dental Erosion.

Dental erosion is a multifactorial condition associated with chemical, biological, and behavioral factors whereby a non-bacterial chemical process leads to an irreversible loss of dental structure. Consequences of this erosive process include painful sensitivity, susceptibility to further erosion, mechanical wear, changes in occlusion, exposure of dental pulp, and poor esthetics. Substantial evidence has revealed new insights to diagnosing early stages of dental erosion and enabling novel preventive approaches to control its progression. In the context of outpatient medical/dental practice, clinicians often encounter patients with progressive dental erosion. This article summarizes published research in this area of dentistry to suggest guidelines that are clinically oriented but scientifically fundamental. It is aimed at helping clinicians effectively integrate this information into their professional evaluations of dental erosion with regard to diagnosis, risk factors, clinical signs, assessment, and clinical preventive strategies and treatment. Clinicians should address patient diet habits, educate patients on prevalence data, and inform them regarding potential acidic interactions, such as medically induced acidic conditions, that may ultimately lead to tooth destruction. Prevention of dental erosion, including the recognition of initial erosive lesions and the implementation of the early intervention, involves the clinical expertise of both the dentist and physician.

Efeito anti-erosivo de soluções contendo diferentes polímeros / Anti-erosive effect of solutions containing different polymers

O desgaste erosivo tem sido reconhecido como uma condição frequente nos últimos anos, principalmente devido a mudanças nos hábitos alimentares e comportamentais das populações em geral. Considerando a natureza irreversível desta condição, o diagnóstico precoce e a adoção de medidas preventivas são muito importantes. Dentre elas, a adição de polímeros a produtos de higiene bucal associados ou não a fluoretos apresenta-se como uma alternativa promissora, já que alguns polímeros apresentam compatibilidade com as estruturas dentais e capacidade de formação de um filme protetor. Este estudo foi subdivido em três artigos que visaram, através de diferentes abordagens, investigar o efeito anti- erosivo de polímeros formadores de filme, bem como o efeito da associação destes com fluoretos. O primeiro artigo consistiu em uma revisão da literatura sobre aspectos relacionados ao potencial de utilização dos polímeros para a prevenção da erosão dental. O segundo artigo consistiu em um estudo de varredura para verificar a capacidade de redução da dissolução da hidroxiapatita promovida por soluções contendo quatro polímeros (polioxirano, hidroxipropilmetilcelulose, pectina e um copolímero do polimetacrilato) associadas ou não com fluoreto de sódio -F (225 ppm F- ) e fluoreto de sódio + cloreto de estanho (800 ppm Sn2+) - FS. A mensuração do potencial zeta da hidroxiapatita dispersa tratada com as soluções experimentais foi realizada a fim de complementar a análise. O terceiro artigo consistiu em um estudo de ciclagem erosiva/reendurecedora na presença de película adquirida que se propôs a investigar o potencial de remineralização, potencial de proteção, a perda superficial e a tensão superficial do esmalte após o tratamento com as soluções contendo o copolímero do polimetacrilato. Concluiu- se que a utilização de polímeros formadores de filme, associados ou não a fluoretos, constitui uma abordagem promissora para prevenção da erosão dental. Dentre os polímeros investigados, o copolímero do polimetacrilato é um promissor agente para ser adicionado à produtos de higiene bucal visando a prevenção dos desgastes erosivos(AU)

Erosive wear has been recognized as a frequent condition in recent years, mainly due to changes in the dietary and behavioral habits of the general population. Considering the irreversible nature of this condition, early diagnosis and the adoption of preventive measures are very important. Among them, the addition of polymers to oral care products associated or not with fluorides is a promising alternative, as some polymers have compatibility with dental structures and ability to form a protective film. This study was subdivided into three articles that aimed, through different approaches, to investigate the anti-erosive effect of film- forming polymers, as well as the effect of their association with fluorides. The first article consisted of a literature review about aspects related to the potential use of polymers to prevent dental erosion. The second article consisted of a scanning study to verify the ability to decrease the hydroxyapatite dissolution promoted by solutions containing four polymers (polyoxyrane, hydroxypropyl methylcellulose, pectin and a polymethacrylate copolymer) associated or not with sodium fluoride -F (225 ppm F- ) and sodium fluoride + tin chloride (800 ppm Sn2+ ) -FS. Measurement of the zeta potential of dispersed hydroxyapatite treated with experimental solutions was performed to complement the analysis. The third article consisted of an erosive/rehardening cycling study in the presence of acquired pellicle that aimed to investigate remineralization potential, protection potential, surface loss and surface tension of the enamel after treatment with solutions containing the polymethacrylate. It was concluded that the use of film- forming polymers, associated or not with fluorides, is a promising approach for the prevention of dental erosion. Among the polymers investigated, the polymethacrylate copolymer is a promising agent to be added to oral hygiene products to prevent erosive wear(AU)

General and erosive tooth wear of 16-year-old adolescents in Kuantan, Malaysia: prevalence and association with dental caries.

BACKGROUND: The objective of this study was to determine the prevalence and severity of general tooth wear (GTW), i.e. tooth wear irrespective of etiology and erosive tooth wear (ETW), i.e. tooth wear predominantly due to erosion; and also to investigate the relationship between ETW and dental caries experience in 16-year-old adolescents in Kuantan, Malaysia. METHODS: A multi-staged cluster sampling method was employed. A total of 598 16-year-old adolescents participated in this study. Participants' demographic profile was assessed through a self-administered questionnaire. Clinical examinations were carried out under standardized conditions by a single examiner. The level of GTW was recorded using the modified Smith and Knight's Tooth Wear Index (TWI) whilst ETW were recorded using the Basic Erosive Wear Examination (BEWE) index. This index was developed to record clinical findings and assist in the decision-making process for the management of erosive tooth wear. Dental caries was recorded using the D3MFT index whereby D3 denotes obvious dental decay into dentine detected visually. RESULTS: The prevalence of GTW, ETW and dental caries, i.e. percentage of individuals found to have at least one lesion, was 99.8%, 45.0% and 27.8% respectively. Two thirds of affected teeth with GTW were observed to have a TWI score of 1 whereas almost all of the affected teeth with ETW had a BEWE score of 2. The mean D3MFT was 0.62 (95% CI 0.50, 0.73) with Decayed (D) teeth being the largest component, mean D3T was 0.36 (95% CI 0.30, 0.43). There was no significant association between socio-demographic factors and prevalence of ETW. Logistic regression analysis also showed no significant relationship between the prevalence of ETW and D3MFT (p > 0.05). CONCLUSIONS: Almost all adolescents examined had GTW but they were mainly early lesions. However, nearly half were found to have ETW of moderate severity (BEWE score 2). No significant relationship between the occurrence of erosive tooth wear and caries was observed in this population.

Abrasion of eroded and sound enamel by a dentifrice containing diamond abrasive particles

Eroded enamel is more susceptible to abrasive wear than sound enamel. New toothpastes utilizing diamond particles as abrasives have been developed. The present study investigated the abrasive wear of eroded enamel by three commercially available toothpastes (one containing diamond particles) and compared it to the respective wear of sound enamel caused by these toothpastes. Seventy-two bovine enamel samples were randomly allocated to six groups (S1­S3 and E1­E3; n=12). Samples were submitted to an abrasive (S1­S3) or erosion plus abrasion (E1­E3) cycling. Per cycle, all samples were brushed (abrasion; 20 brushing stokes) with the following toothpastes: S1/E1: Signal WHITE SYSTEM, S2/E2: elmex KARIESSCHUTZ and S3-E3: Candida WHITE DIAMOND (diamond particles). Groups E1­E3 were additionally eroded with HCl (pH 3.0) for 2 min before each brushing procedure. After 30, 60 and 90 cycles enamel wear was measured by surface profilometry. Within the same toothpaste and same number of cycles, enamel wear due to erosion plus abrasion was significantly higher than due to mere abrasion. After 30, 60 and 90 cycles, no significant difference in the wear in groups S1 and S2 was observed while the wear in group E1 was significantly (p<0.05, ANOVA, Scheffecyc) lower than that in group E2. After 90 cycles, wear in group S3 was about 5 times higher than that in group S2, while wear in group E3 was about 1.3 times higher than that in group E2. As compared to the other two investigated toothpastes, the dentifrice containing diamond particles caused slightly higher abrasive wear of eroded enamel and distinctly higher wear of sound enamel compared to the conventional toothpastes under investigation.

A novel approach to study in situ enamel erosion and abrasion lesions.

OBJECTIVES: This study investigated previous hypotheses that the tongue can abrade acid softened/eroded enamel surfaces. METHODS: Twelve upper removable appliances each retaining 2 anterior and 2 posterior human enamel specimens were constructed. Each specimen was exposed to acid on both surfaces, but only one surface was allowed contact with the tongue. Therefore, 96 surfaces were assessed. Appliances were worn from 9.30 to 17.00 Monday to Friday for 22days. Acid eroded lesions were created by immersing the specimens for 5min in 50ml orange juice three times daily. Enamel loss was measured using Quantitative light- induced fluorescence (QLF) and Non- contact profilometry (NCLP) and the differences (D) between tongue (Dt) and palate facing (DP) surfaces determined. RESULTS: %ΔFD(t-p) from the two anterior specimens were greater than from those placed posteriorly with mean values of 15.9% (±9.1) and 14.4% (±8.4), 5.6% (±8.7) and 4.5% (±6.6) respectively. Similarly, NCLP data showed anterior specimens had greater differences for mean step height (MSH) between tongue- facing and the palate- facing (control) surfaces than posterior specimens. MSHD(t-p) values were 59.4µm (±30.3) for anterior tongue facing surfaces and 55.5µm (±29.4) for posterior palate facing surfaces. For the posterior specimens MSH was 48.1µm (±26.1) and 51.7µm (±30.4) respectively (p<0.05). CONCLUSION: The greater enamel surface loss of the anterior specimens demonstrates that abrasion by the tongue on acid softened/eroded enamel in situ is likely.

A randomised clinical trial to determine the abrasive effect of the tongue on human enamel loss with and without a prior erosive challenge.

OBJECTIVES: To investigate the abrasive effect of the tongue on human enamel loss with and without a prior dietary acid challenge in an in situ model. METHODS: A single centre, single blind, randomly allocated, split mouth, four treatment regimen, in situ study in healthy adult volunteers was undertaken. Twenty four subjects wore two lower intra-oral appliances each fitted with 4 human enamel samples 6h/day for 15 days. The samples were treated with either 50ml orange juice or water for 5min ex vivo 4x/day; prior to being licked or not licked with the subject's tongue for 60s. There were 2 samples per group per subject. Surface loss was measured by contact profilometry. RESULTS: 23 subjects completed the study with no adverse events. The mean loss of enamel at 15days was: 0.08µm for water without licking, 0.10µm with water and licking; 1.55µm with orange juice alone, 3.65µm with orange juice and licking. In the absence of erosive challenge, licking had no detectable effect on enamel loss p=0.28. Without licking, orange juice had a highly significant effect on loss compared to water, p<0.001. Erosive challenge followed by licking more than doubled the loss of enamel p<0.001. CONCLUSIONS: When enamel was exposed to orange juice prior to licking, tissue loss as a result of tongue abrasion of the eroded surface was increased, and double that of the erosive challenge alone. Licking enamel with the tongue had no perceptible effect on enamel loss in the absence of the erosive challenge. CLINICAL SIGNIFICANCE: Enamel wear resulting from tongue abrasion on tooth surfaces softened by acid challenge, can be an unavoidable consequence of oral function. This may account for the pattern of erosive toothwear on palatal and occlusal tooth surfaces, reinforcing the importance of restricting the frequency of dietary acid challenge in susceptible individuals.

Dental Erosion in Children with Gastroesophageal Reflux Disease.

PURPOSE: The purpose of this study was to investigate the impact of gastroesophageal reflux disease (GERD) on dental erosion (DE) in children and analyze the association between dental erosion and diet, oral hygiene, and sociodemographic characteristics. METHODS: This case-control study encompassed 43 two- to 14-year-olds diagnosed positive for GERD by the 24-hour pH monitoring, paired by age group with 136 healthy controls, in Belo Horizonte, Minas Gerais, Brazil. DE was assessed by one calibrated examiner using the O'Sullivan index. A questionnaire was self-administered by parents collecting information regarding sociodemographics, oral hygiene, and dietary habits. Dental erosion experience was compared between the groups, and a stratified analysis was performed (P<0.05). RESULTS: Dental erosion was diagnosed in 10.6 percent (N equals 19) of all the children; 25.6 percent (N equals 11) of GERD children and 5.9 percent (N equals eight) of children without GERD, P=0.001). Dental erosion was not associated with dietary consumption or sociodemographic characteristics in both groups (P≥0.05). Children who used adult toothpaste had a 5.79 higher chance of having dental erosion in the group with GERD. CONCLUSION: Children diagnosed with gastroesophageal reflux disease were at an increased risk of having dental erosion when compared to healthy subjects; among the GERD children, dental erosion was associated with the use of adult toothpaste.

A Artrite Idiopática Juvenil como fator de risco para a erosão dentária: estudo preliminar / The Juvenile Idiopathic Arthritis as a risk factor for dental erosion: a preliminary study

O objetivo deste estudo foi avaliar se a presença da artrite idiopática juvenil (AIJ) em crianças e adolescentes pode ser considerada como indicador de risco para a erosão dentária. Para tal, foram utilizadas oitenta crianças e adolescentes com diferentes tipos de AIJ e 23 pacientes saudáveis como controle. Os critérios de inclusão foram diagnóstico de AIJ e classificação do subtipo de acordo com os critérios da Liga Internacional das Associações de Reumatologia(ILAR). Os dados sobre variáveis nutricionais, fatores socioeconômicos, vômitos, ingestão de medicamentos, hábitos alimentares e orais foram coletados por meio de questionário estruturado.Todos os pacientes foram submetidos a medição do fluxo salivar e exame clínico usando o índice Exame Básico de Desgaste Erosivo (BEWE). Dezesseis pacientes, todos afetados pelo subtipo oligo articular de AIJ mostraram redução da quantidade de saliva estimulada; dois deles apresentaram erosão e relataram consumo diário de refrigerantes. Foi relatado vômitos (uma vez por dia) por nove pacientes devido à ingestão de metotrexato sem correlação com o subtipo de AIJ. Nenhum deles exibiu erosão. O indicador de risco para a erosão dentária foi o subtipo de AIJ (artrite oligo articular), não havendo correlação significativa da presença de erosão dentária com as variáveis nutricionais, ingestão de medicamentos, hábitos alimentares e orais.

The purpose of this study was evaluate the existence of prevalence and risk indicators of dental erosion in patients affected by juvenile idiopathic arthritis (JIA). Eighty patients (61 females and 19males) with different kinds of JIA and 23 healthy control ones aging from 3 to 19 years were included in the study. The inclusion criteria were diagnosis of JIA and subtype classification according to the International League of Associations for Rheumatology (ILAR) criteria. Data on nutrition al variables, socioeconomic factors, vomiting, drug intake and dietary and oral habits were collected using a questionnaire. All patients underwent saliva measurement and clinical examination using Basic Erosive Wear Examination (BEWE) Index. Sixteen patients, all affected by the oligo articular subtype of JIA showed a reduced quantity of stimulated saliva; two of them showed erosion andre ported a daily soft drink intake. Vomiting (once a day) was reported by nine patients and was dueto methotrexate intake with no correlation with JIR subtype. None of them exhibited erosion. Risk indicator for wear was JIA subtype (oligo articular arthritis). There was no significant correlation of the presence of dental erosion with nutritional variables, drug intake or dietary and oral habits.

Dental treatment in children with asthma - a review.

This article aims to explain the effects of long-term use of asthma medications. It will discuss the effects of asthma on the oral cavity, as well considerations for the dentist when treating asthmatic patients. It will also explain how to manage asthma in the dental setting and provide advice on maintaining oral health for asthmatic patients.

Estudo das características clínicas, comportamentais e dos parâmetros salivares de pacientes portadores de lesões cervicais não cariosas e um grupo controle / Study of clinical, behavioral and salivary parameters in patients with non-carious cervical lesions and a control group

A saliva é um fluido biológico com importante papel nos fenômenos que ocorrem na cavidade bucal. O efeito da sua composição sobre as perdas de estruturas dentais de origem não cariosa, como o desgaste dental, tem sido estudado. No entanto, há conflitos nos resultados apresentados por esses estudos, mostrando uma dificuldade em identificar os fatores salivares que possam proteger ou intensificar a evolução do processo. Assim, o presente estudo se propôs a analisar as características clínicas, comportamentais e de alguns parâmetros salivares em dois grupos experimentais: pacientes que apresentam lesões cervicais não cariosas (LCNCs) (n=20) e um grupo controle (n=20). Foram coletados dados clínicos e comportamentais através de um exame clínico e de uma entrevista, a seguir amostras de saliva estimulada e não-estimulada foram coletadas e analisados: pH, capacidade tampão, fluxo salivar, concentração de proteínas totais, atividade da amilase salivar, concentração de ureia salivar e a concentração dos íons sódio, fósforo, potássio, magnésio e cálcio. A capacidade tampão foi medida pela titulação da saliva com uma solução de HCL 0,01N; o fluxo salivar se deu pela relação entre o volume de saliva e o tempo de coleta (ml/min); as concentrações de proteínas totais, ureia e a atividade da amilase foram determinadas por método colorimétrico; as concentrações dos íons cálcio, fósforo, magnésio, potássio e sódio foram determinadas por espectrometria de emissão óptica com plasma acoplado indutivamente (ICP-OES).

Os resultados foram submetidos aos testes Qui-quadrado, teste t e Mann-Whitney (p<0,05). As características relacionadas aos hábitos de higiene dental, dieta ácida, hábitos parafuncionais, presença de distúrbios gástricos, secura bucal e prévio tratamento periodontal, não mostraram relação com a presença de lesões cervicais não cariosas. Os pacientes portadores de LCNCs se queixaram mais de sensibilidade dental (p=0,0014). Foi observado um maior número de lesões cervicais de pequena profundidade (79%), em formato de cunha (72%), apresentando hipersensibilidade dentinária (HD) (86%), localizados nos dentes posteriores (88,18%) e na maxila (66,14%), sendo os pré-molares os dentes mais afetados (56,69%). Os níveis de cálcio na saliva não-estimulada do grupo de pacientes com LCNCs foi significativamente maior em relação ao controle (p=0,041). A concentração de potássio na saliva estimulada foi significativamente maior no grupo controle (p=0,028). As variáveis fluxo salivar, pH, capacidade tampão, concentração de proteínas totais, ureia, amilase, sódio, magnésio e fósforo não mostraram diferenças estatisticamente significativas entre os dois grupos. Conclui-se que os fatores comportamentais não interferiram no aparecimento das lesões cervicais não cariosas. As LCNCs são pouco profundas, em formato de cunha, acometem mais dentes superiores e pré-molares e são acompanhadas de HD. As concentrações de cálcio e potássio podem interferir na formação das LCNCs.

Saliva is a biological fluid with an important role in the phenomena that occur in the oral cavity. The effect of salivary composition in loss of tooth structure with no carious origin, such as tooth wear, has been studied. However, there are conflicts in the results presented by studies showing a difficulty in identifying the salivary factors which may protect or intensify the development of tooth wear process. The aim of this study was to analyze the clinical, behavioral and some salivary parameters into two groups: patients with non-carious cervical lesions (NCCLs) (n=20) and a control group (n=20). Clinical and behavioral data were collected through a clinical examination and an interview. Saliva samples stimulated and unstimulated were collected and analyzed: pH, buffer capacity, flow rate, total protein, amylase activity, urea, sodium, phosphorus, potassium, magnesium and calcium. The buffer capacity was measured by titration of saliva samples using 0.01N HCl solution; flow rate was the relationship between the volume of saliva and the collection time (ml/min); the concentrations of total protein, urea and amylase activity were determined by colorimetric method; concentrations of calcium, phosphorus, magnesium, potassium and sodium were determined by inductively coupled plasma optical emission spectrometry (ICP-OES). The results were tested to the chi-square test, t-test and Mann-Whitney U test (p<0.05).

The characteristics related to dental hygiene, acidic diet, parafunctional habits, presence of gastric disorders, dry mouth, and previous periodontal treatment did not show relationship to the presence of non-carious cervical lesions. Patients with non-carious cervical lesions complained over tooth sensitivity (p=0.0014). It observed an increased number of cervical lesions small depth (79%), wedge-shaped (72%), with dentin hypersensitivity (86%), located the posterior teeth (88,18%) and maxilla (66,14%), the premolars being the most affected teeth (56,69%). The concentration of calcium in unstimulated saliva of patients with NCCLs was significantly higher compared to control (p=0.041). The concentration of potassium was significantly higher in stimulated saliva in the control group (p=0.028). The results flow rate, pH, buffer capacity, total protein, urea, amylase, sodium, magnesium and phosphorus showed no significant differences between the two groups. It is concluded that behavioral factors do not interfere in the presence of non-carious cervical lesions. The NCCLs are shallow, wedge-shaped, affecting more maxilla and premolars and are accompanied by DH. The calcium and potassium concentrations may interfere with the formation of NCCLs.

Análise in vitro da morfologia e da resistência de união da resina composta à dentina erodida e irradiada com laser de Er: YAG com largura de pulso super curta / In vitro analysis of morphology and bond strength of composite resin to dentin eroded and irradiated with a super short pulse Er: YAG laser

Lesões dentais por erosão têm sido cada vez mais presentes na prática clínica. A restauração direta com resina composta é uma das opções de tratamento para lesões severas, em que há comprometimento estético/funcional. Com o aprimoramento da tecnologia, a utilização do laser para pré-tratamento da superfície dentinária, antes do condicionamento ácido, tem sido considerada como método alternativo para melhorar a adesão das resinas compostas às superfícies erodidas. Assim, o objetivo deste estudo in vitro foi avaliar a influência da irradiação com laser de Er:YAG (2,94 ?m), de pulso super-curto, na adesão da resina composta à superfície dentinária erodida. Quarenta e seis discos de dentina foram obtidos a partir de 46 dentes terceiros molares humanos. A dentina oclusal planificada de 40 molares humanos teve metade de sua face protegida com fita UPVC (dentina hígida), enquanto na outra metade foi produzida uma lesão de erosão através da ciclagem em ácido cítrico (0,05 M, pH 2,3, 10 minutos, 6x/dia) e solução supersaturada (pH 7,0, 60 minutos entre os ataques ácidos). Metade das amostras foi irradiada com o laser de Er:YAG (50 ?s, 2 Hz, 80 mJ, 12,6 J/cm2) e a outra não (grupo controle). Em cada grupo de tratamento (laser ou controle) (n=10), um sistema adesivo autocondicionante foi utilizado e, então, confeccionados 2 cilindros de resina composta, tanto do lado erodido como no hígido (total de 4 cilindros), os quais foram submetidos à avaliação da Resistência de União através do ensaio de microcisalhamento (1 mm/min), após armazenamento em saliva artificial por 24 h. A análise do padrão de fratura foi realizada em microscópio óptico (40x). Por meio da Microscopia Eletrônica

de Varredura (MEV), a morfologia das superfícies dentinárias hígida e submetida ao desafio erosivo, antes e após o tratamento com laser de Er:YAG (n=3), foi avaliada. Os valores obtidos de resistência de união (MPa) foram submetidos ao teste ANOVA e de comparações múltiplas de Tukey (p<0,05) e as análises das eletromicrografias foram feitas de forma descritiva. A análise morfológica da superfície mostrou alterações significativas na dentina hígida irradiada e na submetida à ciclagem erosiva, irradiada ou não. Quanto à resistência de união, houve diferença entre os 4 substratos analisados, sendo: dentina hígida irradiada (12,77±5,09 A), dentina hígida não irradiada (9,76±3,39 B), dentina erodida irradiada (7,62±3,39 C) e dentina erodida não irradiada (5,12±1,72 D). Houve predominância de padrão de fratura do tipo adesiva. Com base nos resultados e nos parâmetros de irradiação utilizados neste estudo, pode-se concluir que a erosão reduz a adesão em dentina e que o tratamento da superfície dentinária com laser de Er:YAG de largura de pulso super curta aumenta a adesão no substrato erodido ou hígido.

Dental erosion injuries have been increasingly present in clinical practice. Direct restoration with composite resin is one of the treatment options for severe injuries, where there is aesthetic/functional impairment. With the improvement of technology, laser-irradiation for pre-treatment of dentin before surface etching has been considered as an alternative method to improve the adhesion of composite resins to eroded surfaces. The objective of this in vitro study was to evaluate the influence of the irradiation with a super-short pulse Er:YAG (2.94 ?m) laser to the adhesion of composite resin to eroded dentin surface. Forty six dentin discs were obtained from 46 third molars. Forty samples of planned occlusal dentine, obtained from human molars, had half of their surface protected with plastic tape (sound dentin), while the other half was submitted to erosive cycles, consisted on immersion on citric acid (0.05 M, pH 2.3, 10 minutes, 6x/day) and supersaturated solution (pH 7.0, 60 minutes of acid attacks). Half of the samples was irradiated with the Er:YAG laser (50 ?s, 2 Hz, 80 mJ, 12.6 J/cm2) and the other was kept as control. In each treatment group (n = 10), a self-etching adhesive system was used and then two cylinders of composite resin were prepared, on both eroded and sound dentin (total of 4 cylinders). Microshear bond strength test was performed (1 mm/min), after 24 hours storage in artificial saliva.

The analysis of the fracture pattern was determined by optical microscopy (40x). The morphology of sound and eroded dentin, before and after treatment with the Er:YAG laser (n = 3) was evaluated under Scanning Electron Microscopy (SEM). Bond strength values (MPa) were subjected to ANOVA and Tukey multiple comparisons test (p<0.05). The analyses of electron micrographs were made descriptively. Morphological analysis of the surface showed significant changes in irradiated and sound dentin subjected to erosive cycling. As for the bond strength, there were differences among the groups, as follows: sound dentin submitted to irradiation (12.77 ± 5.09 A), non-irradiated sound dentin (9.76 ± 3.39 B), eroded dentin submitted to irradiation (7 62 ± 3.39 C) and non-irradiated eroded dentin (5.12 ± 1.72 D). There was a predominance for the adhesive mode of failure. It was concluded that the erosion reduces the adhesion to dentin and that treating the dentin surface with a super-short-pulse Er:YAG laser increases adhesion to both eroded or sound dentin.