Erosive assessment of dry mouth lozenges and tablets on enamel and dentin.

OBJECTIVES: To assess the erosive potential of dry mouth lozenges and tablets on enamel and dentin. MATERIALS AND METHODS: The following lozenges and tablets were tested: Salese, Oracoat Xylimelts, Cotton Mouth, TheraBreath, DenTek OraMoist, SmartMouth, ACT, CVS Health, Rite Aid, Med Active, and Hager Pharma. pH Analysis: Each lozenge or tablet was crushed with a pestle and mortar and 5 g of the resultant powder was dissolved in 10 ml of distilled water (pH 7.02) The pH of each lozenge solution was assessed by using a calibrated pH meter. Titratable Acidity (TA) was determined by adding 0.1 M of NaOH to each homogenous tablet solution until the pH reached 7.0. Gravimetric Analysis was measured with freshly extracted molars crown/roots were sectioned at the CEJ and enamel and dentin specimens were fabricated. The specimens were then submerged in 5 ml of solution containing 2.5 gm of crushed tablets for 24 h, 48 h, 96 h and 14 days with measurements performed at each interval after drying. The solutions were renewed at each interval. RESULTS: Significant correlation between pH and TA was observed for lozenges and tablets evaluated (p < 0.0001). Both variables were strongly correlated with enamel and dentin loss (p < 0.0001). For enamel, DenTek resulted in significantly more substance loss (p < 0.05) than with the other tested products, while Xylimelts presented the lowest percentage of substance loss. For dentin, Cotton Mouth resulted in the highest substance loss, and Xylimelts presented the lowest percentage of substance loss. CONCLUSIONS: There is a strong correlation between the pH, tritatable aciditiy, and erosive potential of these products. DenTek and Cotton Mouth reported erosive effect to the enamel and dentin, respectively. Xylimelts performed better than the rest of the products in relationship to enamel and dentin.

Short communication: In vitro assessment of erosive potential of energy drinks.

AIM: This in vitro study was to evaluate the endogenous pH, titratable acidity, total soluble solids content (TSSC) and nonreducing sugars of energy drinks. METHODS: Nine energy drinks (Bad Boy Power Drink, Red Bull, Red Bull Sugar Free, Flying Horse, Burn, Night Power, Flash Power, Flying Horse Light and 220V) were evaluated by a randomised experiment with 3 repetitions on each sample. pH analysis performed by potentiometry and buffering capacity was assessed by dilution of each drink. Increments of 0.1 N KOH were titrated until neutrality reached. TSSC readings were performed by Brix refractometry using an Abbé refractometer. RESULTS: pH values ranged from 1.52 (Flash Power) to 3.20 (Red Bull) and all drinks showed pH 5.5. Titratable acidity values ranged from 0.56 (220V) to 1.04 (Bad Boy Power Drink). Flying Horse Light presented the lowest TSSC content (1.66%) and Flying Horse presented the highest (12.58%). Non-reducing sugars values ranged from 0.00% (Red Bull Sugar Free and Flying Horse Light) to 54.33% (Flying Horse). CONCLUSION: The energy drinks evaluated have a high erosive potential, as they present low pH and a high non-reducing sugar content.

Strong effect on dentin after the use of high concentrations of citric acid: an assessment with co-site optical microscopy and ESEM.

OBJECTIVES: To perform a longitudinal analysis of the effect of four substances (citric acid at 1%, 5% and 10% concentrations and 17% EDTA) on dentin. METHODS: Sixteen human molars had their crowns removed exposing cervical root dentin. A grinding procedure was used to produce a standardized smear layer and to create a smooth surface for analysis. Environmental scanning electron microscopy (ESEM) was used for qualitative observations while co-site optical microscopy (CSOM) and image analysis (IA) provided a quantitative comparison of the effect of the substances for several experimental times from 15 to 300s. The methods allowed the observation of the same areas after each experimental time. The open tubule area fraction was measured for several CSOM image fields, at each experimental time, for the four substances. Thus, it was possible to follow the phenomenon and quantitatively analyze the effect of the substances. Kolmogorov-Smirnov, Kruskal-Wallis H and Wilcoxon signed-ranks (with Bonferroni correction) tests were used to analyze the data. The level of significance was set at p<0.05. RESULTS: The CA solutions showed the greatest chelating effect, which was proportional to concentration (EDTA: 9.4-32.8% (15-300s); 1% CA: 21.1-32.2% (15-300s); 5% CA: 32.4-43.1% (15-300s); 10% CA: 35.1-39.5% (15-30s). Erosive effects were observed on inter and peritubular dentin for 5% CA and 10% CA after 60s. SIGNIFICANCE: ESEM allowed a detailed qualitative comparison of the effect of the four substances. CSOM and IA provided a quantitative comparison method with good statistical significance. Future studies should focus on the consequences of dentin erosion caused by citric acid.

Topographic and radiographic profile assessment of dental erosion. Part II: effect of citrus fruit juices on human dentition.

This study sought to monitor changes in the topography, morphology, and radiographic profiles of human permanent teeth that had been exposed to citrus fruit juices. The effect of long-term exposure was monitored for a prolonged duration of 20 weeks according to set criteria. Topographic and morphologic changes were observed at weekly intervals following challenge by test fluids (orange, lemon, and grapefruit juices) and compared with control fluids (acetic acid and water). The qualitative changes in the specimens' topography and the morphology of citrus fruit juices and control fluids are described as a function of time, in specific details. The digitized radiographic images obtained at four-week intervals were analyzed and the changes were assessed. The results indicated that orange juice specimens demonstrated the mildest changes, while lemon juice specimens displayed the most severe damage to the coronal segments of the teeth. This damage manifested as loss of cusp height, cervical enamel, and coronal radius, as well as reduction of enamel cap height. Of the tested and control fluids, lemon juice displayed the most eros ion, followed by acetic acid, grapefruit juice, orange juice, and water, which had no effect. Continued immersion in the four acidic fluids led to varying degrees of enamel loss progression.

Assessment of enamel erosion and protective effect of salivary pellicle by surface roughness analysis and scanning electron microscopy.

PURPOSE: To assess dental erosion caused by 0.1% and 1.0% citric acid in vitro and to estimate the protective influence of experimentally formed salivary pellicle. MATERIALS AND METHODS: Bovine enamel slabs (n = 80) were polished and embedded in epoxy resin. For the formation of pellicle layer 40 specimens were immersed for 24 h in pooled human saliva. Erosion was caused by immersion in citric acid solution for 1, 5, 10 and 30 min. Erosive alterations on the pellicle-covered and non-covered enamel specimens were scored as a change (delta) of surface roughness parameters Ra, Rt and RzDIN using contact profilometer and observed in scanning electron microscope. RESULTS: Profilometric analysis of eroded enamel specimens emphasized the aggressiveness of even low concentrated citric acid with a short period of challenge. The change of roughness parameters after 1-min immersion in 0.1% citric acid were 16.4, 182.6 and 132.2 nm for deltaRa, deltaRt and deltaRzDIN, respectively, and 54.8, 516.6 and 258.2 nm after 1-min immersion in 1.0% citric acid. Changes of the surface roughness were dependent on the exposure time and concentration of acidic solution. Pellicle layer significantly reduced the extent of erosive destruction, which was additionally documented on SEM-micrographs. Residual pellicle-like structures were detected after 5 min of immersion in 0.1% citric acid. However, there were no significant differences in pellicle-covered and non-covered enamel slabs measured profilometrically for 1.0% citric acid with 10 min and 30 min exposure time. CONCLUSION: The findings confirm the property of pellicle layer to resist against erosive influence of organic acids, which is, however, limited by duration of acidic treatment and concentration of erosive agent.

Preliminary in vitro assessment of erosive potential using the ultra-micro-indentation system.

The aim of this study was to measure the change in hardness and modulus of elasticity of enamel and dentine in primary teeth using the ultra-micro-indentation system (UMIS) after exposure to potentially erosive beverages and to relate the changes to the chemical composition of the test beverages. Primary molar teeth were sectioned and polished. Indentations were made in enamel and dentine prior to and then after exposure to one of four beverages: distilled water (control), orange juice, Orange Cordial, Fanta((R)) and a 'toothfriendly' Tropical Orange Cordial (Ribena((R))). Each beverage was then analysed. Fanta and Orange Cordial were the only test beverages to show a statistically significant reduction in the enamel hardness in comparison to the control and only Fanta showed a significant reduction in dentine hardness. None of the test beverages significantly reduced the modulus of elasticity of either enamel or dentine. Statistically the pH, phosphate and fluoride concentrations of the beverages were correlated with softening of enamel. Calcium concentration and titratable acidity were correlated with softening of dentine. The UMIS offers another method of measuring the basic mechanical properties of enamel and dentine. This is useful in predicting the erosive potential of substrates. It is likely that the pH, titratable acidity, fluoride, phosphate and calcium content of beverages are all important in determining the potential erosiveness of beverages.

Dental erosion and soft drinks: a qualitative assessment of knowledge, attitude and behaviour using focus groups of schoolchildren. A preliminary study.

OBJECTIVES: This qualitative study was designed to record the perception by Newcastle children of the influences on their choice of drinks and their knowledge of the dental health problems caused by acidic drinks. METHODS: Four focus groups, each involving 8 Newcastle schoolchildren (4 boys and 4 girls) formed the basis of the study. Two age groups, 13-14-year-olds and 8-9-year-olds, and two socio-economic groups were investigated, using state schools in Newcastle upon Tyne. A moderator guided the children to discuss their choice of drink and its dental effects amongst themselves. RESULTS: In total, 32 children participated in the focus groups and the results suggested that 8-9-year-olds preferred still, fruit-flavoured drinks whilst 13-14-year-olds preferred carbonated drinks. Taste was the most important influence on drink choice in all age groups. Parents and friends were more influential in younger children, whilst cost, availability and thirst were more important to older children. Younger children did not believe advertisements whilst older children thought they might work if seen enough times. Dental knowledge was confused in all age groups and only the 13-14-year-old-high socio-economic groups knew that acidic drinks were bad for the teeth. Different methods for addressing the problem of erosion were suggested by different age groups. There was very little difference between the socio-economic groups in the areas discussed. CONCLUSIONS: The children's knowledge of dental diseases and the effect of drinks on the teeth were confused. The factors that influence drink choice appear to change with age, rather than socio-economic status.

Occupational exposure to airborne proteolytic enzymes and lifestyle risk factors for dental erosion--a cross-sectional study.

This study examined the hypothesis that occupational exposure to airborne proteolytic enzymes is associated with dental erosions on the facial surfaces of exposed teeth. Individuals (n = 425) working at a pharmaceutical and biotechnological enterprise (Novozymes A/S) were examined; their mean age was 35 years (range = 18-67 years) and 143 (34%) were women. Two hundred and two of these individuals were newly employed by the company. Occupational exposure was assessed from questionnaire and workplace information. For practical analytical purposes, individuals were categorized as either previously exposed to proteolytic enzymes or not. Information on relevant lifestyle factors and medical history was obtained from a questionnaire. The main effect measure was facial erosion, but lingual erosion indices and the presence of Class V restorations were also considered. The validity of these measures was shown to be very high. Adjusted for potential confounders, there was no association between history of occupational exposure to proteolytic enzymes and prevalent facial or lingual erosion. With respect to prevalence of Class V restorations, the association was significant. The present study did not support directly our primary hypothesis that occupational exposure to airborne proteolytic enzymes is associated with dental erosions on the facial surfaces of exposed teeth. However, the results indicate that exposure to proteolytic enzymes may lead to pronounced tooth substance loss, demanding treatment.

An in vitro assessment of the erosive potential of some designer drinks.

The aim of this study was to establish the amount of surface enamel lost following immersion in a number of designer drinks using surface profilometry. Orange juice was used as a positive control. Twenty four designer drinks were tested and it was found that 18 out of 24 of these drinks produced surface enamel loss that was significantly greater by between two and six times than the orange juice control. It was concluded that many of the commercially available designer drinks had considerable erosive potential.

A rapid epidemiological assessment of dental erosion to assist in settling an industrial dispute.

A rapid epidemiological assessment (REA) of industrial dental erosion was undertaken with the aim of formulating a range of treatment strategies which could be used to settle an industrial dispute. This dispute concerned compensation for a group of adult male metalworkers who had complained of dental sensitivity and that their teeth had been "eaten by acid" at their workplace, an electroplating factory in Springs near Johannesburg, South Africa. The REA methods employed included a clinical examination, a structured socio-demographic questionnaire and colour photographs of each subject. Sixty per cent of the subjects reported pain and/or sensitivity to eating and/or drinking, 76 per cent showed varying degrees of loss of tooth structure, and 25 per cent reported teeth had been lost as a result of the industrial erosion. The project involved negotiating with mine management and trade union representatives, each with conflicting interests, and with people's oral health and large sums of money at stake. In this context, the aim of the research was to design an instrument to resolve conflict and to promote oral health at an industrial site, while retaining scientific objectivity and rigour. As a result of the REA, the workers who were examined are in the process of being compensated, while the National Union of Mineworkers and mine management are engaged in reaching a settlement. Preventive measures have been initiated at the factory. The area has been declared a "respiratory zone", which makes the wearing of respiratory masks obligatory.

In vitro quantitative assessment of enamel microhardness after exposure to eroding immersion in a cola drink.

Studies assessing the erosive potential of soft drinks have employed long time intervals of immersion that may not accurately depict the impact of frequent soft drink consumption on enamel. This in vitro study assessed the effect of a cola drink on enamel, replicating an actual drinking pattern. Six groups of 4 human enamel slabs were immersed (5 min each bath) in fresh cola drink, with immersions taking place with or without agitation, and under 3 regimes of frequency intake (low intake, 1 immersion/day; medium, 5/day; high, 10/day). Quantitative assessments of surface erosion were done over an 8-day interval using surface microhardness testing (Vickers). Results showed a sharp decrease from baseline (mean value 352.1 Vickers Hardness Number, SD 32.5) to day 1 (269.3, SD 41.0) and then continued decreasing throughout the assay, although less markedly, to reach 204.5, SD 45.4 on day 8. Microhardness decreased regardless of frequency regime, except on day 8, on which slabs from the low intake group were harder (233.2, SD 25.0) than slabs from the high intake group (169.8, SD 49.5; p < 0.05). Results from the ANOVA on the factorial experiment indicated that the role of agitation was statistically significant (d.f. = 1, F = 7.2, p = 0.020) while the level of intake was of borderline significance (d.f. = 2, F = 3.2, p = 0.075). The main effect resulting from the joint roles of agitation and intake indicated that there was an important interaction between the two variables (d.f. = 3, F = 4.5, p = 0.023).