The role of calcium in the prevention of erosive tooth wear: a systematic review and meta-analysis.

OBJECTIVES: The loss of hard dental tissue due to recurrent acid challenges and mechanical stresses without bacterial involvement is known as erosive tooth wear (ETW). Many studies in the literature have concentrated on variables that may affect the ETW process and prevent its occurrence or reduce its advancement. However, to date, no previous systematic review has evaluated the role of calcium in preventing ETW. Therefore, the purpose of the present systematic review was to review and critically appraise the scientific evidence regarding the role of calcium formulations in the prevention of ETW. METHODS: The review protocol was registered in the PROSPERO international prospective register of systematic reviews (Ref: CRD42021229819). A literature search was conducted in electronic databases to identify in situ randomized controlled trials evaluating the prevention of ETW following the application of calcium formulations. The outcomes studied included mean enamel loss, surface microhardness, surface roughness, mean erosion/softening depth, mineral loss/precipitation and remineralization. Study characteristics and outcomes of included studies were summarized. Cochrane's risk-of-bias tool 2.0 was used to assess the quality of eligible studies, and meta-analysis using a random effects model was performed. RESULTS: The search retrieved 869 studies of which 21 were considered eligible. Regarding the results of the quality assessment for potential risk of bias in all included studies, overall, 5 studies were considered as being at low risk, another 12 at unclear risk and 4 at high risk of bias. The findings of the studies showed that the addition of calcium in juice drinks led to reduced enamel loss, with blackcurrant juice presenting 2.6 times statistically significant less enamel loss compared to orange juice (p = 0.0001, I2 = 89%). No statistically significant difference in mean surface microhardness of eroded enamel was recorded between chewing gum with or without casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) (p = 0.31, I2 = 71%). Contradictory were the results regarding the effect of milk and CPP-ACP pastes on prevention of ETW. CONCLUSIONS: Calcium formulations play an important role in ETW prevention, mainly through their addition to acidic drinks.

Terminology of Erosive Tooth Wear: Consensus Report of a Workshop Organized by the ORCA and the Cariology Research Group of the IADR.

Our understanding of erosive tooth wear and its contributing factors has evolved considerably over the last decades. New terms have been continuously introduced, which frequently describe the same aspects of this condition, whereas other terms are being used inappropriately. This has led to unnecessary confusion and miscommunication between patients, professionals, and researchers. A group of 15 experts, selected by the European Organization for Caries Research (ORCA) and the Cariology Research Group of the International Association for Dental Research (IADR), participated in a 2-day workshop to define the most commonly used terms in erosive tooth wear. A modified Delphi method was utilized to reach consensus. At least 80% agreement was achieved for all terms discussed and their definitions related to clinical conditions and processes, basic concepts, diagnosis, risk, and prevention and management of erosive tooth wear. Use of the terms agreed on will provide a better understanding of erosive tooth wear and intends to enable improved communication on this topic.

Does delayed toothbrushing after the consumption of erosive foodstuffs or beverages decrease erosive tooth wear? A systematic review and meta-analysis.

OBJECTIVE: Controversy exists regarding the effectiveness of delayed toothbrushing in decreasing erosive tooth wear (ETW). The purpose of this systematic review and meta-analysis was to assess the effects of delayed toothbrushing on ETW. MATERIALS AND METHODS: This systematic review and meta-analysis was conducted according to the PRISMA statement and registered in PROSPERO (CRD42020200463). PubMed, Embase, and Web of Science databases were systematically searched with no publication year limits. Screening and data extraction were performed independently by two reviewers. In situ and in vitro studies comparing ETW after delayed and immediate toothbrushing following an erosive attack were included. Review Manager software 5.3 (The Cochrane Collaboration, Oxford, UK) was used for statistical analyses. Heterogeneity was assessed with the Cochran Q test and I2 statistics. RESULTS: Of the 565 potentially relevant studies, 26 full-text articles were assessed for eligibility. Twelve articles were included in the systematic review, and 11 were included in the qualitative analyses. No significant difference in the ETW of human enamel was observed between delayed and immediate toothbrushing (P = 0.13), whereas significantly less ETW of bovine enamel was observed after delayed toothbrushing (P < 0.001). No significant difference in the ETW of bovine dentin was observed between delayed and immediate toothbrushing (P = 0.34). Studies on human dentin were not available. Subgroup analyses revealed a significant contribution of the use of fluoridated toothpaste to decreasing the ETW of human enamel after erosion and toothbrush abrasion (P = 0.02). CONCLUSIONS: Bovine and human teeth behaved differently in response to erosion and toothbrush abrasion. Delayed toothbrushing after an erosive attack was not effective at decreasing the ETW of human enamel compared to immediate toothbrushing, whereas it was effective at decreasing the ETW of bovine enamel. CLINICAL RELEVANCE: Delayed toothbrushing alone after the consumption of erosive foodstuffs or beverages is not capable of preventing erosive enamel wear.

Erosive tooth wear: Knowledge among young adults and their preferred information sources.

OBJECTIVES: The aim of this study was to learn more about levels of knowledge relating to erosive tooth wear and about the most desirable way of disseminating dental information among young adults. METHODS: The research was a cross-sectional study of 331 young adults (20-25 years old) attending 25 dental care practices. Participants were asked to fill out a questionnaire with questions about their background, knowledge relating to erosive tooth wear and the preferred way of acquiring information about erosive tooth wear. RESULTS: The results showed that there are gaps in the knowledge of young adults about erosive tooth wear. The knowledge score depended on educational level and dental information received in the past. The preferred way of acquiring information was chairside information from an oral health care professional complemented by tailored information in writing. CONCLUSION: There is a lack of knowledge among young adults about erosive tooth wear. They prefer to receive information from the oral health care professionals accompanied by tailored information in writing. Further research should focus on developing this tailored information in line with the advice given by the oral health care professional.

[Preventive dentistry 10. Erosive tooth wear]. / Preventieve tandheelkunde 10. Erosieve gebitsslijtage.

Erosive tooth wear has recently been at the centre of attention and its prevalence of erosive tooth wear among adolescents in the Netherlands appears to be rising. The multifactorial nature of the aetiology of the condition makes it difficult to identify the relevant causal factors, both in individual cases and within the general population. Preventive intervention is indicated in those cases where (active) erosive tooth wear is diagnosed. Early diagnosis is important, especially in younger patients. Preventive measures, such as dietary advice and the use of fluoride, are recommended but the scientific evidence for their effectiveness is still limited. In cases where acid reflux disease is the cause, treatment with medicines can have the effect of reducing the progression of tooth wear. Recognising a non-active condition, for example after successful preventive treatment, is difficult, but will be supported with digital methods in the near future.

Effectiveness of resin-based materials against erosive and abrasive enamel wear.

OBJECTIVE: The objective of this study was to test the effectiveness of resin-based materials against erosive enamel wear under erosive and abrasive challenges by orange juice and tooth brushing. METHODS: Fifty enamel specimens from third molars were assigned to five groups: ICON resin infiltration with no etching (ICON-NE), ICON resin infiltration with 15 % HCl etching (ICON-AE), Seal & Protect sealant (S&P), Tetric EvoFlow (TEF), and control. Erosive lesions were first created on enamel, then treated with resin-based materials. Erosive and abrasive challenges by orange juice and tooth brushing were repeated after treatments. Erosive wear of the treated areas was measured with 3D scanning microscopy, and data were analyzed using ANOVA and paired t tests. RESULTS: Treatments with ICON, S&P, and TEF created a protective material coating of 4.5 ± 1.9 µm, 44.3 ± 8.1 µm, and 84.6 ± 15.7 µm in thickness on the lesion surfaces, respectively. After 15 cycles of erosive and abrasive challenges, enamel or material losses were 21.9 ± 2.3 µm for control, 24.5 ± 4.0 µm for ICON-NE, 24.6 ± 7.4 µm for ICON-AE, 11.2 ± 4.1 µm for S&P, and 3.9 ± 1.9 µm for TEF, respectively. The protective coatings were completely lost in the ICON infiltration groups but remained intact in both the S&P and TEF groups after erosive and abrasive challenges. CONCLUSION: In contrast to a resin sealant and a flowable composite, ICON infiltration resin was not effective in protecting enamel surfaces from erosive and abrasive wear. CLINICAL RELEVANCE: Sealant and flowable composite resin may create protective coatings on eroded enamel surfaces and prevent further tissue loss.

Protective Effect of Adhesive Systems associated with Neodymium-doped Yttrium Aluminum Garnet Laser on Enamel Erosive/Abrasive Wear.

AIM: This study evaluated the efficacy of self-etching adhesive systems associated or not associated with the neodymium-doped yttrium aluminum garnet (Nd:YAG) laser on the protection against enamel erosive/abrasive wear. MATERIALS AND METHODS: Bovine enamel specimens were demineralized with 0.3% citric acid (5 minutes). The samples were randomly assigned to eight groups (n = 20): SB - Single Bond Universal (3M/ESPE); SB+L - Single Bond Universal + laser (80 mJ/10 Hz); FB - Futurabond U (Voco); FB+L -Futurabond U + laser; GEN - G-aenial bond (GC); GEN+L -G-aenial bond + laser; L - laser irradiation; and C - no treatment. The laser was applied before light curing. The samples were subjected to erosive/abrasive challenges (0.3% citric acid - 2 minutes and tooth brushing four times daily for 5 days). Enamel surface loss was recovered profilometrically by comparison of baseline and final profiles. The adhesive layer thickness, retention percentage of the protective layer, and microhardness of cured adhesive were measured. Data were analyzed using one-way analysis of variance and Tukey's test (5%). RESULTS: There were significant differences for all parameters (p = 0.0001). Mean values ± SD and results of the Tukey's test were: Surface wear: GEN - 4.88 (±1.09)a, L - 5.04 ± 0.99)a, FB - 5.32 (±0.93)ab, GEN + L - 5.46 (±1.27)abc, SB + L - 5.78 (±1.12)abc, FB + L - 6.23 (±1.25)bc, SB - 6.35 (±1.11)c, and C - 6.46 (±0.61)c; layer thickness: GEN - 15.2 (±8.63)c, FB - 5.06 (±1.96)a, GEN + L - 13.96 (±7.07)bc, SB + L - 4.24 (±2.68)a, FB + L - 9.03 (±13.02)abc, and SB - 7.49 (±2.80)ab; retention: GEN - 68.89 (±20.62)c, FB - 54.53 (±24.80)abc, GEN + L - 59.90 (±19.79)abc, SB + L - 63.37 (±19.30)bc, FB + L - 42.23 (±17.68) a, and SB - 47.78 (±18.29)ab; microhardness: GEN - 9.27 (±1.75)c; FB - 6.99 (±0.89)b; GEN + L - 6.22 (±0.87)ab; SB + L - 15.48 (±2.51)d; FB + L - 10.67 (±1.58)c; SB - 5.00 (±1.60)a. CONCLUSION: The application of Futurabond U and G-aenial bond on enamel surface, as well as the Nd:YAG laser irradiation alone, was able to reduce the enamel wear. The use of laser after the adhesive systems did not improve their efficacy. CLINICAL SIGNIFICANCE: Erosive/abrasive wear is a prevalent condition in clinical practice affecting many patients. The association of adhesive systems and Nd:YAG laser is of considerable clinical interest because it assesses new treatments to reduce the erosive/abrasive wear that would help dentists in clinical treatment decisions to reduce enamel wear and achieve a successful treatment.

Wear properties of dental ceramics and porcelains compared with human enamel.

STATEMENT OF PROBLEM: Contemporary pressable and computer-aided design/manufacturing (CAD/CAM) ceramics exhibit good mechanical and esthetic properties. Their wear resistance compared with human enamel and traditional gold based alloys needs to be better investigated. PURPOSE: The purpose of this in vitro study was to compare the 2-body wear resistance of human enamel, gold alloy, and 5 different dental ceramics, including a recently introduced zirconia-reinforced lithium silicate ceramic (Celtra Duo). MATERIAL AND METHODS: Cylindrical specimens were fabricated from a Type III gold alloy (Aurocast8), 2 hot pressed ceramics (Imagine PressX, IPS e.max Press), 2 CAD/CAM ceramics (IPS e.max CAD, Celtra Duo), and a CAD/CAM feldspathic porcelain (Vitablocs Mark II) (n=10). Celtra Duo was tested both soon after grinding and after a subsequent glaze firing cycle. Ten flat human enamel specimens were used as the control group. All specimens were subjected to a 2-body wear test in a dual axis mastication simulator for 120000 loading cycles against yttria stabilized tetragonal zirconia polycrystal cusps. The wear resistance was analyzed by measuring the vertical substance loss (mm) and the volume loss (mm(3)). Antagonist wear (mm) was also recorded. Data were statistically analyzed with 1-way ANOVA tests (α=.05). RESULTS: The wear depth (0.223 mm) of gold alloy was the closest to that of human enamel (0.217 mm), with no significant difference (P>.05). The greatest wear was recorded on the milled Celtra Duo (wear depth=0.320 mm), which appeared significantly less wear resistant than gold alloy or human enamel (P<.05). CONCLUSIONS: The milled and not glazed Celtra Duo showed a small but significantly increased wear depth compared with Aurocast8 and human enamel. Wear depth and volumetric loss for the glaze-fired Celtra Duo and for the other tested ceramics did not statistically differ in comparison with the human enamel.

Primary and secondary prevention of periodontal and peri-implant diseases: Introduction to, and objectives of the 11th European Workshop on Periodontology consensus conference.

BACKGROUND: Periodontitis prevalence remains high. Peri-implantitis is an emerging public health issue. Such a high burden of disease and its social, oral and systemic consequences are compelling reasons for increased attention towards prevention for individuals, professionals and public health officials. METHODS: Sixteen systematic reviews and meta-reviews formed the basis for workshop discussions. Deliberations resulted in four consensus reports. RESULTS: This workshop calls for renewed emphasis on the prevention of periodontitis and peri-implantitis. A critical element is the recognition that prevention needs to be tailored to the individual's needs through diagnosis and risk profiling. Discussions identified critical aspects that may help in the large-scale implementation of preventive programs: (i) a need to communicate to the public the critical importance of gingival bleeding as an early sign of disease, (ii) the need for universal implementation of periodontal screening by the oral health care team, (iii) the role of the oral health team in health promotion and primary and secondary prevention, (iv) understanding the limitations of self-medication with oral health care products without a diagnosis of the underlying condition, and (v) access to appropriate and effective professional preventive care. CONCLUSIONS: The workshop provided specific recommendations for individuals, the oral health team and public health officials. Their implementation in different countries requires adaptation to respective specific national oral health care models.

A profilometry-based dentifrice abrasion Method for V8 brushing machines. Part I: Introduction to RDA-PE.

OBJECTIVE: This paper describes the development and standardization of a profilometry-based method for assessment of dentifrice abrasivity called Radioactive Dentin Abrasivity - Profilometry Equivalent (RDA-PE). METHODS: Human dentine substrates are mounted in acrylic blocks of precise standardized dimensions, permitting mounting and brushing in V8 brushing machines. Dentin blocks are masked to create an area of "contact brushing." Brushing is carried out in V8 brushing machines and dentifrices are tested as slurries. An abrasive standard is prepared by diluting the ISO 11609 abrasivity reference calcium pyrophosphate abrasive into carboxymethyl cellulose/glycerin, just as in the RDA method. Following brushing, masked areas are removed and profilometric analysis is carried out on treated specimens. Assessments of average abrasion depth (contact or optical profilometry) are made. RESULTS: Inclusion of standard calcium pyrophosphate abrasive permits a direct RDA equivalent assessment of abrasion, which is characterized with profilometry as Depth test/Depth control x 100. Within the test, the maximum abrasivity standard of 250 can be created in situ simply by including a treatment group of standard abrasive with 2.5x number of brushing strokes. RDA-PE is enabled in large part by the availability of easy-to-use and well-standardized modern profilometers, but its use in V8 brushing machines is enabled by the unique specific conditions described herein. CONCLUSION: RDA-PE permits the evaluation of dentifrice abrasivity to dentin without the requirement of irradiated teeth and infrastructure for handling them. In direct comparisons, the RDA-PE method provides dentifrice abrasivity assessments comparable to the gold industry standard RDA technique.

[Sleep bruxism in children and adolescents]. / Bruxismo de sueño en niños y adolescentes.

Bruxism is a rhythmic masticatory muscle activity, characterized by teeth grinding and clenching. This is a phenomenon mainly regulated by the central nervous system and peripherally influenced. It has two circadian manifestations, during sleep (sleep bruxism) and awake states (awake bruxism). Bruxism is much more than just tooth wearing. It is currently linked to orofacial pain; headaches; sleep disorders; sleep breathing disorders, such as apnea and hypopnea sleep syndrome; behavior disorders, or those associated with the use of medications. It is also influenced by psycho-social and behavior factors, which means that oromandibular parafunctional activities, temporomandibular disorders, malocclusion, high levels of anxiety and stress, among others, may precipitate the occurrence of bruxism. Nowadays, its etiology is multifactorial. The dentist and the pediatrician are responsible for its early detection, diagnosis, management, and prevention of its possible consequences on the patients. The aim of this review is to update the concepts of this disease and to make health professionals aware of its early detection and its timely management.

Tooth surface loss: causes, management, and prevention.

OBJECTIVES: Tooth wear, also referred to as tooth surface loss, occurs due to causes other than caries. This involves the loss of hard tissues, namely enamel, dentin, and/or cementum. Types of tooth wear/tooth surface loss are abrasion, abfraction, attrition, and erosion. These multifactorial conditions can be caused by factors such as lifestyle, diet, or even habits, and may not be symptomatic. The focus of this article is to provide clinicians with detailed examples and explanations of the causes of tooth loss to aid in early diagnosis. Through early identification, the preventive measures outlined can be implemented to avoid excessive tooth wear. The provision of a treatment flowchart and general treatment recommendations aims to help clinicians determine when to restore these lesions and the most appropriate treatment measures for the four types of wear. METHOD AND MATERIALS: The PubMed (MEDLINE) search engine was used to gather information on teeth restricted to a 5-year period (26 August 2018 to 25 July 2022). Only English-language studies and reviews with the best balance of sensitivity and specificity were considered. A Boolean search of the PubMed dataset was implemented to combine a range of keywords: ("tooth wear" OR tooth attrition OR tooth erosion OR tooth abrasion OR tooth abfraction). Additional articles were selected through Google Scholar. RESULTS: By this process, many articles and studies were obtained, and the 48 most relevant published studies were chosen and used in the current review. CONCLUSION: Tooth wear affects an increasing number of individuals and can have detrimental effects physically, mentally, and emotionally. It is important to stress early diagnosis and management of tooth wear through monitoring, prevention, and treatment where indicated.

Customized anterior guidance for occlusal devices: classification and rationale.

Occlusal devices can protect the dentition from attrition and are commonly prescribed for the treatment of myogenous orofacial pain. The occlusal scheme of the device controls the forces on teeth during mandibular closure and excursions. Smooth anterior guidance from anterior teeth contact and posterior teeth disclusion has been described as a component of a therapeutic occlusion. Clinical research on the effects of occlusal devices is extensive, but documentation about the actual occlusion studied is lacking. A classification of anterior guidance design for occlusal devices and the rationale for optimum force distribution is presented. This classification can guide clinicians as to the criteria for proper occlusal device fabrication and improve dental research.

Sleep bruxism: review and update for the restorative dentist.

Sleep bruxism (SB) is a parafunctional oromotor activity that can sometimes pose a threat to the integrity of the structures of the masticatory system if the magnitude and direction of the forces exerted exceed the system's adaptive capacity. Over the years science has tried to provide a consistent explanation of the etiopathogenesis and physiopathology of SB, although the pathophysiological mechanisms are, even now, not fully understood yet. There is at present no specific, effective treatment to permanently eliminate the habit of SB. There are only palliative therapeutic alternatives steered at preventing the pathological effects of SB on the stomatognathic system and alleviating the negative clinical consequences of the habit. The aim of this paper is to review and update the fundamental scientific concepts of SB based on the scientific literature and to furnish an approach to the main types of therapy available, in an attempt to assist the general and restorative dentist to manage those clinical situations in which SB is a significant risk factor for the oral health and/or dental treatment of the patient.

Epidemiology, aetiology and prevention of tooth wear.

Tooth wear is a commonly reported finding globally; however, many patients are unaware of having tooth wear. Identifying early signs of erosion, abrasion or attrition and determining the risk factors contributing to a patient's tooth wear may help to prevent further loss of enamel and dentine in the future. Appropriate prevention should be instigated, or appropriate referral made to other health professionals, when conditions such as gastroesophageal reflux or eating disorders are suspected. This paper presents the epidemiology and aetiological factors for tooth wear, as well as identifying the common clinical presentations of tooth wear. Patient perspectives on tooth wear and preventive techniques that can be utilised are also discussed.

Tooth surface loss: tools and tips for management.

UNLABELLED: Tooth surface loss is becoming increasingly prevalent. Many cases can be managed with preventive measures, although there remain a number of patients for whom restorative intervention is indicated. Traditional treatment modalities have entailed extensive 'full-mouth' indirect restoration, although this approach has a number of disadvantages. Contemporary restorative techniques allow for a broader range of treatment options: this paper presents an overview of common issues and clinical techniques to overcome these. CLINICAL RELEVANCE: Treatment options and guidance for managing patients who present with tooth surface loss.

Effect of fluoride group on dental erosion associated or not with abrasion in human enamel: A systematic review with network metanalysis.

OBJECTIVES: This systematic review evaluated the efficacy of monovalent and polyvalent fluoride group compared to the non-fluoride group on the prevention of enamel erosion associated or not with abrasion in in situ studies. DESIGN: This review was registered in the PROSPERO (CRD42017071118) and followed PRISMA 2020 guidelines. A systematic and comprehensive search was performed using PUBMED, WEB OF SCIENCE, SCOPUS, EMBASE, BBO, LILACS, SCIELO, and grey literature IBICT-BDTD. All in situ and ex vivo studies of erosion and erosion/abrasion tooth wear were included, with no language or date restrictions. RESULTS: 730 studies were obtained and after exclusion of duplicates, 311 were included for title and abstract reading. Two independent authors (kappa= 0.98) systematically conducted the selection phase. Considering the eligibility criteria and after full-text reading, 19 studies were included in qualitative and quantitative analysis. CONCLUSION: Network metanalysis showed that polyvalent fluoride group, especially Sn-compounded, prevented enamel wear by erosion and erosion/abrasion compared to the non-fluoride group and monovalent fluoride group. Both low and high concentration monovalent fluoride group were not able to prevent erosion wear associated or not with abrasion. Sensitivity analysis of the network metanalysis was performed with the low risk of bias studies and the results were confirmed. There is robust evidence that stannous-compounded fluoridated and titanium tetrafluoride agents are effective in preventing erosion and erosion/abrasion compared to the non-fluoride group and other interventions.

Effect of the toothbrush tuft arrangement and bristle stiffness on the abrasive dentin wear.

The geometrical properties of toothbrushes play a role in developing abrasive tooth wear and non-carious cervical lesions. This study investigated the interplay between the toothbrush tuft arrangement (crossed vs. parallel) and bristle stiffness (soft vs. medium) on the abrasive dentin wear using three slurries with different levels of abrasivity (RDA: 67, 121 and 174). Twelve groups of bovine dentin samples (n = 20) were brushed with a combination of the aforementioned variables. Abrasive dentin wear was recorded with a profilometer and the resulting abrasive wear of each group was calculated and compared with each other using two-way ANOVA and pairwise tests. Toothbrushes with parallel tuft arrangement caused statistically significantly higher dentin wear compared to crossed tuft arrangement, regardless of the abrasivity level of the used slurry and the bristle stiffness. Soft crossed tuft toothbrushes caused statistically significantly higher abrasive dentin wear than medium crossed tuft toothbrushes, while soft and medium parallel tuft toothbrushes caused the same amounts of dentin wear, regardless of the RDA value of the used slurry. These results could be helpful for dentists and dental hygienists when advising patients. Crossed tuft toothbrushes could be a less-abrasive choice in comparison to parallel tuft toothbrushes.

European core curriculum in cariology for undergraduate dental students.

As dental caries prevalence is still high in many populations and groups of both children and adults worldwide, and as caries continues to be responsible for significant health, social and economic impacts, there is an urgent need for dental students to receive a systematic education in cariology based upon current best evidence. Although European curriculum guidelines for undergraduate students have been prepared in other dental fields over the last decade, none exist for cariology. Thus the European Organisation for Caries Research (ORCA) formed a task force to work with the Association of Dental Education in Europe (ADEE) on a European Core Curriculum in Cariology. In 2010, a workshop to develop such a curriculum was organised in Berlin, Germany, with 75 participants from 24 European and 3 North-South American countries. The Curriculum was debated by five pre-identified working groups: I The Knowledge Base; II Risk Assessment, Diagnosis and Synthesis; III Decision-making and Preventive Non-surgical Therapy; IV Decision-making and Surgical Therapy; and V Evidence-based Cariology in Clinical and Public Health Practice and then finalised jointly by the group chairs. According to this Curriculum, on graduation, a dentist must be competent at applying knowledge and understanding of the biological, medical, basic and applied clinical sciences in order to recognise caries and make decisions about its prevention and management in individuals and populations. This document, which presents several major and numerous supporting competences, does not confine itself to dental caries alone, but refers also to dental erosion/non-erosive wear and other dental hard tissue disorders.

Noncarious cervical lesions--a clinical concept based on the literature review. Part 1: prevention.

PURPOSE: Due to an increased prevalence of non-carious cervical lesions (NCCL), a clinical strategy for this lesion type should be considered. Previous reviews focused mainly on etiology and prevalence. In Part 1 of this paper, an evidence-based support for a preventive strategy of NCCL was elaborated. METHODS: Literature over the last 10 years available in the MEDLINE database was reviewed in order to find clinical evidence for a preventive approach to NCCL. Recommendations were based primarily on systematic reviews, clinical evaluations and a monograph. RESULTS: The etiology of NCCL is currently considered to be rather multifactorial, as clinical investigations found multiple factors associated with this type of lesions and due to the lack of evidence to support exclusively one or another factor. Based on the hypothesis of multifactorial origin, a preventive protocol has been established. No clinical research exists with respect to the prevention of NCCL and long-term clinical evaluations of the proposed preventive measures are needed.