Should We Wait to Brush Our Teeth? A Scoping Review Regarding Dental Caries and Erosive Tooth Wear.

BACKGROUND: Tooth brushing is a universal recommendation. However, the recommendations related to the time of its execution are conflicting, especially when dealing with patients at risk of erosive tooth wear (ETW) or dental caries. SUMMARY: Our objective was to summarize the evidence on the timing of brushing with fluoridated toothpaste in relation to ETW and cariogenic dietary challenges. We conducted a scoping review following the PRISMA-ScR checklist, using three databases searching for in vivo, in situ, or in vitro studies involving human teeth exposed to either a cariogenic or an erosive challenge. Only models including human saliva and fluoride were assessed. Data selection, extraction, and risk of bias analysis were done in duplicate and independently. From 1,545 identified studies, 17 (16 related to ETW and 1 to dental caries) were included. Most evidence (n = 10) supported that brushing with a fluoride-containing product does not increase ETW, independent of the moment of brushing. Delaying tooth brushing up to 1 h (n = 4) or individualized recommendations based on the patient's problem (n = 2) were less frequent. Only one study reported that brushing pre- or post-meal does not affect Streptococcus mutans counts. Most data were in situ (n = 13), and the overall study quality was judged as sufficient/low risk of bias. KEY MESSAGES: Although the available evidence lacked robust clinical studies, tooth brushing using fluoridated products immediately after an erosive challenge does not increase the risk of ETW and can be recommended, which is in line with recommendations for dental caries prevention. Furthermore, we suggest updating the international guidelines to promote individualized recommendations based on risk factors to prevent either ETW or dental caries.

Quality of Patient-Centered eHealth Information on Erosive Tooth Wear: Systematic Search and Evaluation of Websites and YouTube Videos.

BACKGROUND: Due to the declining prevalence of dental caries, noncarious tooth defects such as erosive tooth wear have gained increased attention over the past decades. While patients more frequently search the internet for health-related information, the quality of patient-centered, web-based health information on erosive tooth wear is currently unknown. OBJECTIVE: This study aimed to assess the quality of patient-centered, web-based health information (websites and YouTube videos) on erosive tooth wear. METHODS: German-language websites were systematically identified through 3 electronic search engines (google.de, bing.de or yahoo.de, and duckduckgo.com) in September 2021. Eligible websites were independently assessed for (1) technical and functional aspects via the LIDA instrument, (2) readability via the Flesch reading-ease score, (3) comprehensiveness of information via a structured checklist, and (4) generic quality and risk of bias via the DISCERN instrument by 2 different reviewers. An overall quality score (ie, higher scores being favored) generated from all 4 domains was used as the primary outcome. Quality scores from each domain were separately analyzed as secondary outcomes and compared by the Friedman test. The effect of practice-specific variables on quality scores of websites from private dental offices was assessed using generalized linear modeling. Eligible YouTube videos were judged based on (1) the comprehensiveness of information, (2) viewers' interaction, and (3) viewing rate. The comprehensiveness of information was compared between websites and YouTube videos using the Wilcoxon rank-sum test. RESULTS: Overall, 231 eligible websites and 7 YouTube videos were identified and assessed. The median overall quality of the websites was 33.6% (IQR 29.8%-39.2%). Secondary outcome scores amounted to 64.3% (IQR 59.8%-69.0%) for technical and functional aspects, 40.0% (IQR 34.0%-49.0%) for readability, 11.5% (IQR 3.9%-26.9%) for comprehensiveness of information, and 16.7% (IQR 8.3%-23.3%) for generic quality. While the comprehensiveness of information and generic quality received low scores, technical and functional aspects as well as readability resulted in higher scores (both Padjusted<.001). Regarding practice-specific variables, websites from private dental offices outside Germany (P=.04; B=-6.64, 95% CI -12.85 to -0.42) or from dentists who are a dental society member (P=.049; B=-3.55, 95% CI -7.09 to -0.01) resulted in lower readability scores (ie, were more difficult to read), while a shorter time since dentists' examination resulted in higher readability scores (P=.01; B=0.24 per year, 95% CI 0.05-0.43). The comprehensiveness of information from YouTube videos was 34.6% (IQR 13.5%-38.5%). However, the comprehensiveness of information did not vary between websites and YouTube videos (P=.09). Additionally, viewers' interaction (1.7%, IQR 0.7%-3.4%) and viewing rates (101%, IQR 54.6%-112.6%) were low. CONCLUSIONS: The quality of German-language, patient-centered, web-based information on erosive tooth wear was limited. Especially, the comprehensiveness and trustworthiness of the available information were insufficient. Web-based information on erosive tooth wear requires improvement to inform patients comprehensively and reliably.

Patients with gastroesophageal reflux disease (both reflux oesophagitis and non-erosive reflux disease): Prevalence and severity of erosive tooth wear and saliva properties.

BACKGROUND: The prevalence between erosive tooth wear (ETW) in association with reflux oesophagitis (RO) has been reported. However, the severity of both diseases and the relationship between ETW and non-erosive reflux disease (NERD) is unclear. OBJECTIVES: The prevalence and severity of ETW were investigated in RO, NERD and healthy controls. METHODS: 135 patients with RO, 65 with NERD and 40 healthy controls were recruited for this case-control study. A modified tooth wear index was used to evaluate the prevalence and severity of ETW. Salivary secretion and buffer capacity were assessed prior to endoscopy. The prevalence and severity of ETW, saliva properties among each group were analysed using Pearson's chi-squared test. RESULTS: A total of 135 cases (56.3%) were categorised as the patient with ETW (55 with mild RO, 49 with severe RO and 31 with NERD). There was a significant relationship between the prevalence of RO and ETW, while there was no significant correlation between the prevalence of NERD and ETW. There was a significant difference related to the severity between RO and ETW. For salivary secretion, there was a significant difference between with and without ETW in patients with mild RO, severe RO and NERD. There was a significant difference between with and without ETW for salivary buffer capacity in patients with mild and severe RO. CONCLUSION: There was a significant association of the prevalence and severity between RO and ETW. Clinical signs such as ETW and salivary buffer capacity depended on the severity of RO.

Factors associated with prevalence and severity of erosive tooth wear in patients with reflux oesophagitis.

BACKGROUND: Extrinsic factors for erosive tooth wear (ETW) have been widely reported, but the intrinsic factors for wear remain unclear. OBJECTIVES: The aim of this study was to evaluate the factors associated with the prevalence of ETW in patients with reflux oesophagitis (RO). To prevent severe ETW with RO, factors associated with severity of ETW were also evaluated. METHODS: A total of 270 patients with RO were recruited. A modified tooth wear index was used to evaluate the prevalence and severity of ETW. Salivary secretion and buffering capacity were assessed prior to endoscopy. Subjects were asked to complete a medical condition and oral self-care questionnaire. Univariate and multivariate analyses were employed to identify factors collectively associated with the prevalence and severity of ETW. RESULTS: A total of 212 cases were categorized as patients with ETW (148 with mild ETW and 64 with severe ETW). Multivariate analyses indicated that saliva secretion, severity of RO and proton pump inhibitor (PPI) resistance were associated with the prevalence of ETW, whereas age, BMI and severity of RO were associated with the severity of ETW. The odds ratio of saliva secretion and BMI were less than 1, meaning that higher saliva secretion resulted in a lower prevalence of ETW and lower BMI was associated with severe ETW. CONCLUSION: Saliva secretion, severity of RO and PPI resistance were associated with the prevalence of ETW, whereas age, BMI and severity of RO were associated with the severity of ETW. Lower saliva secretion and BMI were significant factors for ETW.

Systematic review and meta-analysis on prevalence and anamnestic risk factors for erosive tooth wear in the primary dentition.

BACKGROUND: Erosive tooth wear is a multifactorial and common condition in children. AIM: This systematic review and meta-analysis aimed to determine the prevalence and key risk factors for erosive tooth wear in the primary dentition of children up to 7 years of age. DESIGN: Electronic databases (PubMed, Embase, Scopus, and Web of Science) were searched in February 2023 for observational studies reporting prevalence and anamnestic risk factors. Additionally, a manual hand search was performed. Meta-analyses were conducted for the prevalence and odds ratios of identified risk factors. Risk of bias was assessed using the Newcastle-Ottawa scale modified for cross-sectional studies. RESULTS: A total of 26 sources, reporting on 23 studies, were included in the systematic review. The overall estimated prevalence of children with erosive tooth wear in the primary dentition amounted to 35.6% (95% CI: 24.8-48.1). Anamnestic factors were structured into domains. Meta-analyses revealed gastroesophageal reflux disease (GERD; padj. = .008; OR = 1.98, 95% CI: 1.37-2.87), consumption of acidic food (padj. < .001; OR = 5.14, 95% CI: 3.56-7.42) and acidic drinks (padj. < .001; OR = 6.90, 95% CI: 4.64-10.25), holding beverages in the mouth while drinking (padj. = .035; OR = 1.82, 95% CI: 1.26-2.63), and snacking regularly (padj. = .041; OR = 1.58, 95% CI: 1.18-2.10) to be significantly associated with erosive tooth wear. CONCLUSION: Future research should use standardized questionnaires to assess erosive tooth wear and its underlying risk factors (PROSPERO: CRD4202339776).

Erosive tooth wear among non-institutionalised older adults in Hong Kong: a cross-sectional study.

BACKGROUND: Non-institutionalised older adults is the majority of older adults in Hong Kong. The study aimed to examine erosive tooth wear (ETW) and its association with dental conditions and oral hygiene habits among non-institutionalised older adults in Hong Kong. METHODS: This cross-sectional study recruited dentate adults aged 60 or above from nine elderly daycare centres in the five main districts of Hong Kong. The study consists of a questionnaire survey and a clinical examination. A researcher used a questionnaire to collected the participants' demographic information, oral hygiene habits such as toothbrushing habits and dental visit behaviour. A calibrated examiner performed an oral examination in the daycare elderly centre to assess the ETW using basic erosive wear (BEWE) criteria. Oral hygiene was recorded using visible plaque index. Prosthetic status was recorded using the World Health Organization criteria. Logistic regression was used to examine the correlation between ETW and the dental conditions and oral hygiene habits. RESULTS: This study recruited 433 dentate adults and 333 adults were female (77%). Their age ranged from 60 to 99 years and their mean age was 74 years (SD = 7). They all had ETW (BEWE > 0). Over half of them (57%) had BEWE score of 3, indicating severe ETW. Analysis showed increasing age (OR = 1.030, p = 0.029) and older adults with untreated dental caries had higher odds (OR = 1.822, p = 0.002) of presenting severe ETW. No other associations were found between the ETW and the factors studied. CONCLUSION: Hong Kong non-institutionalised older adults aged 60 or above had ETW and more than half of them had severe ETW. Increasing age and having untreated dental caries were associated with severe ETW.

Association of Locus Xq26.1-27.3 with Erosive Tooth Wear Phenotypes in a Group of Adolescents.

Erosive tooth wear is a multifactorial condition of an increasing prevalence. There is a need for discovering individual genetic predisposition for the development of this condition. Considering that the chromosome X locus was previously shown to be associated with dental caries, the aim of the present study was to look for the association between this locus and erosive tooth wear when dietary habits are considered as a co-factor. Saliva samples, erosive wear experience data, and dietary information from 16- to 18-year-old dental patients (n = 705) were used. Genotyping analyses were performed, and thereafter, analyses considering diet and oral hygiene data, using logistic regression, with the assumption that erosive tooth wear is a complex gene-environment model. Genotypic analyses revealed an association between chromosome X marker rs1324156 and erosive tooth wear phenotype. Logistic regression analysis showed that, in the presence of less common allele of rs12687601 and rs1324156, erosive tooth wear more likely develops when associated with numerous dietary variables from the questionnaire. These results indicate that erosive tooth wear may be the result of gene-environment interactions.

Erosive tooth wear and salivary parameters among competitive swimmers and non-swimmers in Egypt: a cross-sectional study.

INTRODUCTION: Competitive swimmers spend considerable time practicing their sport. Prolonged exposure to chlorinated water can alter salivary parameters and might compromise oral health. This study aimed to determine erosive tooth wear status and its related risk factors among competitive swimmers as compared to non-swimmers. MATERIALS AND METHODS: A cross-sectional study consisting of 180 athletes (90 competitive swimmers versus 90 competitive rowers "non-swimmers") was conducted. Participants were interviewed on the common erosion risk factors. The Basic Erosive Wear Examination system was used to assess the status of erosive tooth wear. Stimulated saliva sample was collected before and after a training session and pool pH was evaluated using pH strips for 7 days. Data were analyzed using descriptive statistics and multivariable analysis. RESULTS: The prevalence of dental erosion was significantly higher among competitive swimmers (60%) with higher BEWE scores compared to non-swimmers (25.6%). The salivary flow rate was reduced significantly after training sessions in both groups while salivary pH increased among swimmers. Evaluation of pool water revealed a continuous reduction in the pH level, reaching a very acidic pH level of 3.24. CONCLUSION: Erosive tooth wear is more prevalent among competitive swimmers. Years of practice and regular consumption of acidic drinks increase the odds of developing erosive lesions. A high incidence of erosive lesions may be attributed to a reduction in swimming pool pH level. Salivary parameters showed variations between groups after training sessions.

Association between asthma and oral conditions in children and adolescents: a systematic review with meta-analysis.

OBJECTIVE: To investigate the association between asthma and oral conditions in children and adolescents. MATERIAL AND METHODS: Observational studies that evaluated the association between asthma and oral conditions in children and/or adolescents were retrieved from five databases, grey literature and reference lists up to April 7th, 2022. Meta-analyses were performed, and I2 statistics were calculated. The mean difference was used as a measure of effect for continuous variables. Event frequencies were evaluated to determine odds ratios for dichotomous variables. Publication bias was investigated using Egger's test. The methodological quality (JBI) and certainty of the evidence (GRADE) were assessed. RESULTS: Forty-two studies were eligible, and sixteen were included in the meta-analysis. Mean dmft (MD: 1.11, 95%CI: 0.48-1.73), DMFT (MD: 1.01, 95% CI: 0.45-1.56), dmfs (MD: 3.62, 95%CI: 2.60-4.63) and DMFS (MD: 4.47, 95%CI: 0.98-7.96) indices were significantly higher in asthmatic children and adolescents compared to those without asthma. In the analysis of biofilm, asthmatic children and adolescents had a higher Plaque Index compared to those without asthma (MD: 0.18, 95%CI: 0.03-0.33). CONCLUSION: Asthmatic children and adolescents may be more likely to develop tooth decay and build up biofilm compared to those without asthma. It is suggested that there are no differences between asthmatic and non-asthmatic children and adolescents regarding gingivitis, developmental defects of enamel or erosive tooth wear. The certainty of the evidence was classified as 'very low'. CLINICAL RELEVANCE: Knowledge of the risks that asthma and asthma medications for oral health can assist in counselling families of children and adolescents with this condition in terms of control and prevention measures for oral problems.

[Aesthetic management of erosive tooth wear using injection molding technique]. / Esteticheskoe lechenie vertikal'noi stiraemosti zubov s ispol'zovaniem in"ektsionnoi tekhniki.

In this article, on the example of a clinical case, the technique of restoring two central teeth in a patient with increased enamel erasability with highly filled fluid composite materials using injection techniques is described. The application of this technique has become possible because the new fluid composites have similar mechanical, physical and aesthetic properties to universal composite materials.

Prevalence of Erosive Tooth Wear and Associated Dietary Factors among a Group of Finnish Adolescents.

The aim of this study was to investigate the prevalence and severity of erosive tooth wear (ETW) among Finnish adolescents and to evaluate how frequency as well as amount of the use of erosive products is associated with ETW. The study population consisted of 328 voluntary, >15-year-old secondary school students (males 49.1%, females 50.9%) in three municipalities in Finland. Clinical examination to measure ETW (BEWE index) was carried out by trained and calibrated dentists. Piloted questionnaires included questions on consumption of drinks, fruits and berries, as well as tooth brushing frequency. Means and medians of frequencies and amounts of consumed erosive products were calculated and associations with ETW severity were analysed by logistic regression models. One-third (36.9%) of the participants were in need of at least preventive measures for ETW (BEWE sum score ≥3), but severe ETW (BEWE sum score >9) was rare (2.1%). Boys had severe ETW significantly more frequently than girls (p < 0.001). Habitual consumption of erosive drinks was common especially among boys compared to girls (p = 0.001). ETW was significantly associated with the amount of consumed erosive drinks, fruits, or berries. The prevalence of ETW among adolescences in Finland seems to be at the same level as in other Nordic and European countries. Consumption of erosive products is common and thus, the risk for tooth erosion is high, especially in boys. In addition to erosive drinks, also berries and fruits are associated with ETW and should be included in individual dietary counselling when early signs of ETW are clinically detected.

Relationship between erosive tooth wear and possible etiological factors among dental students.

OBJECTIVES: The aim of this study was to assess the relationship between erosive tooth wear (ETW) and possible etiological factors in a group of dental students. MATERIALS AND METHODS: A total of 126 dental students from a public dental school were included in this study. A questionnaire was used to investigate the possible etiological factors related to ETW. The Basic Erosive Wear Examination (BEWE) criteria were used to examine the status of ETW. A univariable and multivariable logistic regression models were used to assess the relationship between the presence of ETW and explanatory variables. RESULTS: Univariable analysis revealed that taking acidic foods and alcohol more than 4-5 times per week increases the odds of ETW by 6.043 and 2.532 times, respectively, and taking dairy products, fruit juice, and milk more than 4-5 times per week decreases the likelihood of ETW by 61%, 66%, and 80%, respectively. The results of multivariable regression analysis showed that the frequency of consumption of especially acidic foods significantly increased the risk of ETW (OR = 9.981, 95% CI 3.577-27.849, p < 0.001). CONCLUSIONS: Although the ETW status of dental students, who are the future dentists, varies depending on different possible etiological factors, especially the consumption of acidic foods has increased the risk of ETW approximately 10 times. CLINICAL RELEVANCE: The findings highlight the high relevance of ETW, especially with acidic food consumption, and the importance of controlling potential etiological factors in dental students.

Prevalence and risk factors of erosive tooth wear among young adults in the Singapore military.

OBJECTIVES: Erosive tooth wear (ETW) is defined as the irreversible chemo-mechanical loss of dental hard tissues without plaque or bacteria and has been a growing phenomenon in the general population worldwide. The aim of this study was to determine the prevalence of ETW and the associated risk factors among young military personnel in Singapore. MATERIALS AND METHODS: This cross-sectional study consisted of a questionnaire and clinical examination of military personnel between 18 and 25 years. The questionnaire collected information on demographics, medical and dental history, lifestyle and dietary habits. Tooth wear was clinically evaluated using the Basic Erosive Wear Examination (BEWE) index. The participants were profiled into four risk categories (none, low, moderate, severe) based on the sum score. Multivariable logistic regression analysis was performed to determine the risk factors associated with the presence of ETW. RESULTS: Out of 1296 participants evaluated, 21.8% of them had ETW. The anterior sextants were more affected by erosion than posterior sextants for both arches. The risk factors significantly associated with ETW were GERD (OR = 2.83, p = 0.041), presence of self-reported TMD symptoms (OR = 2.51, p < 0.001), acidic food (OR = 2.03, p < 0.001) and drinks (OR = 3.07, p < 0.001), high caries risk (OR = 4.59, p < 0.001) and toothbrush stiffness (OR = 4.67, p < 0.001). CONCLUSION: ETW is prevalent among the young military population, with over half of the population at a risk of ETW. Gastric reflux disease, TMD, acidic diet, dental caries susceptibility and the use of stiff toothbrushes were identified as significant risk factors. CLINICAL RELEVANCE: A large proportion of young military personnel exhibited mild to moderate risk of ETW. Dental professionals can identify risk-susceptible individuals at a young age and educated them with preventive measures and dietary interventions to prevent the progression of the condition.

Knowledge about caries and erosive tooth wear is confused among Norwegian high school students.

OBJECTIVES: This study investigated differences in high school students' subjective and objective knowledge- and concerns about preventing caries and/or erosive tooth wear and the associations between these variables. MATERIALS AND METHODS: A survey was conducted among students at 16 high schools in Norway. The survey included a range of fact-based questions to measure objective knowledge about caries and erosive tooth wear, as well as questions about students' perceptions of his/her own knowledge (subjective knowledge) and concerns about preventing the two conditions. RESULTS: There were small differences in subjective knowledge about caries and erosive tooth wear among the 784 students who completed the survey (p < .01). However, students scored significantly higher on objective knowledge about caries (mean 2.99) than about erosive tooth wear (mean 1.45), p < .01, and seemed to confuse the two conditions. By contrast, students scored significantly worse on questions about beverages' potential to cause caries (mean 5.18) than to cause erosive tooth wear (mean 6.30), p < .001. Finally, objective knowledge about caries was positively associated with subjective knowledge about caries, but corresponding associations could not be found for erosive tooth wear. CONCLUSIONS: Knowledge about caries and erosive tooth wear seemed to be confused among Norwegian high school students.

Impact of desensitizing/whitening toothpastes on tooth color change after abrasion and erosion-abrasion.

OBJECTIVE: To evaluate the impact of desensitizing toothpastes (D), their whitening versions (DW) and whitening toothpastes (W) on tooth color change. METHODS: Tooth specimens were allocated into 11 groups (n = 10): 1. Artificial saliva (control); 2. Sensodyne Repair & Protect (SRP-D); 3. Sensodyne Repair & Protect Whitening (SRP-DW); 4. Colgate Sensitive Pro-Relief (CSPR-D); 5. Colgate Sensitive Pro-Relief Real White (CSPR-DW); 6. Colgate Total 12 (CT12); 7. Colgate Total 12 Whitening (CT12-W); 8. Sensodyne True White (ST-W); 9. Curaprox Black Is White (CB-W); 10.Oral-B 3D White Perfection (OB3D-W) and 11. Erosion-only. They were submitted to two models: A. abrasion; B. erosion/abrasion. Color change (ΔE00 ), ΔL, Δa, and Δb were determined with a spectrophotometer. Data were statistically evaluated (α = 0.05). RESULTS: For both models, ∆E00 of D did not differ significantly from DW. An overall decrease in luminosity (-∆L) and increase (+∆b) in yellowness of the tooth occurred. In abrasion, all groups reduced redness (-∆a) and only SRP-DW differed from control (p = 0.016), but for ∆E00 , ∆L and ∆b, all toothpastes did not differ from the control. In erosion/abrasion, CB-W showed significantly lower ∆E00 and ∆b than the control (∆E00 : p = 0.026; ∆b: p = 0.005) and SRP-D (∆E00 : p = 0.028; ∆b: p = 0.025). Only SRP-DW, CSPR-DW, ST-W, CB-W, and erosion-only had increased redness (+∆a), but none differed from control. CONCLUSIONS: The toothpastes did neither promote whitening nor avoid the yellowish aspect of the tooth after abrasion and erosion-abrasion, regardless of their claim. CLINICAL SIGNIFICANCE: Desensitizing and/or whitening toothpastes induced similar changes on tooth color, without promoting whitening effect or reduction in its yellowish aspect.

Risk prediction models for erosive wear in preschool-aged children: a prospective study.

BACKGROUND: Despite increasing prevalence, age-specific risk predictive models for erosive tooth wear in preschool-age children have not been developed. Identification of at-risk groups and the timely introduction of behavioural change or treatment will stop the progression of erosive wear in the permanent dentition. This study aimed to identify age-specific risk factors for erosive wear. Distinct risk prediction models for 3-year-old and 5-year-old children were developed. METHODS: A prospective cohort study included school-based clinical examinations and parent administered questionnaires for consented 3 and 5-year-old healthy children. Calibrated examiners measured the following health parameters under standardised conditions: erosion, using the Basic Erosive Wear Examination Index (BEWE), caries using the International Caries Detection and Assessment System (ICDAS), plaque and calculus according to the British Association for the Study of Community Dentistry (BASCD) scores, dental traumatic injuries and soft tissue lesions, salivary testing and BMI. Other health conditions were collected via a parent-administered questionnaire that explored oral- and general-health. Non parametric tests were utilised to explore the temporal relation of erosion with, demographic factors, oral hygiene habits, general health and dietary habits. Variables showing significance with a difference in BEWE cumulative score over time were utilised to develop two risk prediction models. The models were evaluated by Receiver Operating Characteristics analysis. RESULTS: Risk factors for the 3-year-old cohort (N = 336) included erosive wear (χ2(1, 92) = 12.829, p < 0.001), district (χ2(5, 92) = 17.032, p = 0.004) and family size (χ2(1, 92) = 4.547, p = 0.033). Risk factors for the 5-year-old cohort (N = 441) also included erosive wear (χ2(1, 144) = 4.768, p = 0.029), gender (χ2(1, 144) = 19.399, p < 0.001), consumption of iced tea (χ2(1, 144) = 8.872, p = 0.003) and dry mouth (χ2(1, 144) = 9.598, p = 0.002). CONCLUSIONS: Predictive risk factors for 3-year-old children are based on demographic factors and are distinct from those for 5-year-old children based on biological and behavioural factors. Erosive wear is a risk factor for further wear in both age cohorts.

Caries experience in adolescents 13-14 years with and without erosive tooth wear: a case-control study.

BACKGROUND: Erosive tooth wear (ETW) and dental caries have common etiological factors, such as unhealthy eating habits, and reduced salivary flow rate. AIM: To analyze the association between caries experience (CE) and ETW in adolescents 13-14 years. STUDY DESIGNS: Ninety-seven cases with distinctive ETW were identified and then sex-matched with a group of 97 controls and a group of 97 cases with initial ETW. The variables included were CE, presence of debris/dental calculus, salivary parameters, food and beverage consumption, chewable vitamin C tablet consumption, gastroesophageal reflux, frequent vomiting, and tooth brushing. Multinomial logistic regression models were adjusted. RESULTS: An association was found between cases with a distinctive ETW defect and CE (OR = 1.09 (95% CI: 1.01-1.17); p = 0.020), sweet carbonated drinks consumption (OR = 1.16 (95% CI: 1.03-1.31); p = 0.012), and frequent vomiting (OR = 3.19 (95% CI: 1.02-10.01); p = 0.047). CONCLUSIONS: The preventive management of both ETW and dental caries should aim to reduce exposure to foods and beverages with high acid and sugar content. Given the association between ETW and acid attack by gastric juice, this would be an indicator of the need for referral to a specialist for treatment.

Monitoring of Erosive Tooth Wear with Intraoral Scanners In vitro.

Intraoral scanners (IOS) have been used to quantify tooth wear, but so far they have not been systematically validated for monitoring of tissue loss. The aim of this in vitro study was to investigate whether progression of tissue loss can be detected with an IOS and whether IOS values agree with those obtained with noncontacting profilometry (PRO) serving as a standard method. Model jaws were mounted in a phantom head positioned in a dental chair. Flattened areas were prepared on the non-load-bearing cusps of the first molars (model teeth; n = 16) in order to fix flat enamel samples with an experimental area and a reference area. After baseline PRO and IOS, the experimental enamel area was stepwise etched with 35% H3PO4 gel (4 × 30 s and 4 × 15 s). After each etching, PRO and IOS was performed and the vertical tissue loss between the reference and experimental areas was measured, each at the same 3 measurement points. Furthermore, cupped cusps were simulated by stepwise preparation of the load-bearing cusps of the model teeth with a spherical diamond bur, and the maximum vertical depth after each preparation step was measured only by IOS. Trios3 (3Shape, Denmark), Carestream CS3600 (Carestream, USA) and an optical profilometer (MicroProf, Fries, Germany) were used to measure the flat areas of the enamel samples, whereas only IOS were used to measure curved surfaces on the load-bearing cupped cusps of the model teeth. The IOS data were analyzed with an external software (GOM Inspect, Germany) and with the respective internal IOS software. PRO revealed a mean (±SD) tissue loss of 17.1 ± 4.7 µm after 30-s etching steps and 10.1 ± 5.1 µm after the 15-s etching steps. IOS and software types were able to detect the progression of tissue loss after each etching step (p ≤ 0.001 each); Bland-Altmann plots revealed good agreement with PRO regardless of the order of tissue loss, and no systematic difference was found. Increasing cupped lesion depths were detected by all IOS, with no significant differences between IOS and analysis methods. IOS were able to detect small amounts of tissue loss under simulated clinical conditions and seem to be a promising tool for monitoring even initial erosive tooth wear.

Rinsing with Statherin-Derived Peptide Alters the Proteome of the Acquired Enamel Pellicle.

Changes in the proteomic profile of the acquired enamel pellicle (AEP) formed for 3 min or 2 h after rinsing with a peptide containing the 15 N-terminal residues of statherin, with serines 2 and 3 phosphorylated (StatpSpS), were evaluated. Nine volunteers participated in 2 consecutive days. Each day, after professional tooth cleaning, they rinsed for 1 min with 10 mL of phosphate buffer containing 1.88 × 10-5 M StatpSpS or phosphate buffer only (control). The acquired pellicle formed on enamel after 3 min or 2 h was collected with electrode filter papers soaked in 3% citric acid. After protein extraction, samples were analyzed by quantitative shotgun label-free proteomics. In the 3-min AEP, 19 and 131 proteins were uniquely identified in the StatpSpS and control groups, respectively. Proteins typically found in the AEP were only found in the latter. Only 2 proteins (neutrophil defensins) were increased upon treatment with StatpSpS, while 65 proteins (among which are several typical AEP proteins) were decreased. In the 2-h AEP, 50 and 108 proteins were uniquely found in StatpSpS and control groups, respectively. Hemoglobin subunits and isoforms of keratin were only found in the StatpSpS group, while cystatin-C, cathepsin D, and cathepsin G, isoforms of heat shock 70 and protocadherin were exclusively found in the control group. In addition, 23 proteins were increased upon treatment with StatpSpS, among which are histatin-1, serum albumin, and isoforms of neutrophil defensin and keratin, while 77 were decreased, most of them were typical AEP proteins. In both evaluated periods, rinsing with StatpSpS profoundly changed the proteomic profile of the AEP, which might impact the protective role of this integument against carious or erosive demineralization. This study provides important insights on the dynamics of the protein composition of the AEP along time, after rinsing with a solution containing StatpSpS.

Solutions and Gels Containing a Sugarcane-Derived Cystatin (CaneCPI-5) Reduce Enamel and Dentin Erosion in vitro.

The effect of solutions and gels containing a sugarcane-derived cystatin (CaneCPI-5) on the protection against enamel and dentin erosion in vitro was evaluated. Bovine enamel and dentin specimens were divided into 2 groups (n = 135 and 153/group for enamel and dentin, respectively) that were treated with solutions or chitosan gels containing 0.1 or 0.25 mg/mL CaneCPI-5. The positive controls for solutions and gels were Elmex Erosion Protection™ solution and NaF gel (12,300 ppm F), respectively. Deionized water and chitosan gel served as controls, respectively. The solutions were first applied on the specimens for 1 min and the gels for 4 min. Stimulated saliva was collected from 3 donors and used to form a 2-h acquired pellicle on the specimens. Then, the specimens were submitted to an erosive pH cycling protocol 4 times/day for 7 days (0.1% citric acid pH 2.5/90 s, artificial saliva/2 h, and artificial saliva overnight). The solutions and gels were applied again during pH cycling, 2 times/day for 1 min and 4 min, respectively, after the first and last erosive challenges. Enamel and dentin losses (µm) were assessed by contact profilometry. Data were analyzed by 2-way ANOVA and Tukey's test (p < 0.05). All the treatments significantly reduced enamel and dentin loss in comparison with controls. Both CaneCPI-5 concentrations had a similar protective effect against enamel erosion, but only the higher concentration was as effective against dentin erosion as the positive control. Regarding the vehicles, only the 0.1 mg/mL gel performed worse than the positive control for dentin. CaneCPI-5 reduced enamel and dentin erosion to a similar extent as the fluoride-containing vehicles. However, dentin requires higher CaneCPI-5 concentrations, in the case of gels. Solutions or gels containing CaneCPI-5 might be a new approach to protect against dental erosion.