Hard drugs use and tooth wear: a scoping review.

OBJECTIVES: This study aims to map evidence on the relationship between hard drug use and dental wear. The scoping review is guided by the question: What is the relationship between hard drug consumption and dental wear? MATERIALS AND METHODS: Adhering to PRISMA-ScR guidelines, searches were conducted across PubMed, Embase, and four databases in March 2024. Inclusion criteria included studies investigating the association between hard drug use and dental wear, regardless of publication date or language. Data were presented through narrative exposition, tables, and a conceptual framework. RESULTS: Twenty-eight studies (four case-control, three cross-sectional, five case reports, and sixteen literature reviews) were included. Among case-control studies, 75% observed an association between drug use and dental erosion; however, no cross-sectional studies demonstrated this association. Despite questionable quality, reviews established connections between drug use and dental erosion. Studies aimed to elucidate potential causes for dental erosion. CONCLUSIONS: Analysis suggests a potential link between hard drug use and dental wear, though indirect. Factors like bruxism and reduced salivary pH may contribute to dental wear among drug users. Further investigation through primary studies exploring this relationship is necessary. CLINICAL RELEVANCE: Dentists should focus not only on clinical characteristics of dental wear but also on mediating factors such as bruxism and decreased salivary pH associated with drug use. This holistic approach allows for a deeper understanding of dental wear mechanisms, enabling targeted preventive and therapeutic interventions.

Millennial drinks: acidity, fluoride content, and enamel softening.

This in vitro study aimed to evaluate the acidity and fluoride content of beverages commonly consumed by millennials and the enamel-softening effect of these drinks on tooth enamel. The study included 13 beverages in 4 categories: energy (sports) drink, flavored sparkling water, kombucha, and other (an unsweetened iced tea, a vegetable-fruit juice blend, and a soft drink). The acidity was measured with a pH/ion meter, and the fluoride concentration was measured with a combined fluoride electrode coupled to the meter (n = 10 measurements per beverage). The Vickers hardness number of extracted molars was measured before and after a 30-minute immersion in 4 representative beverages via 2 immersion protocols (n = 10 per beverage per protocol): (1) immersion in the beverage only and (2) immersion alternating between the beverage and artificial saliva every other minute. The pH and fluoride concentrations of the beverages ranged from 2.652 to 4.242 and from 0.0033 to 0.6045 ppm, respectively. One-way analysis of variance (ANOVA) revealed that all differences between beverages in pH values were statistically significant, as were the majority of differences in fluoride concentrations (P < 0.001). The beverages and the 2 immersion methods significantly affected enamel softening (2-way ANOVA, P = 0.0001 to 0.033). The representative energy drink (pH 2.990; 0.0102 ppm fluoride) caused the greatest enamel softening followed by the representative kombucha (pH 2.820; 0.2036 ppm fluoride). The representative flavored sparkling water (pH 4.066; 0.0098 ppm fluoride) caused significantly less enamel softening than the energy drink and kombucha. A root beer (pH 4.185; 0.6045 ppm fluoride) had the least enamel softening effect. All tested beverages were acidic and had a pH below 4.5; only some contained fluoride. Flavored sparkling water, likely due to its higher pH, caused less enamel softening than the tested energy drink and kombucha. The fluoride content of kombucha and root beer lower their enamel-softening effects. It is imperative that consumers be aware of the erosive potential of beverages they consume.

Effect of pH and titratable acidity on enamel and dentine erosion.

OBJECTIVES: The relative effect of pH and titratable acidity on tooth erosion remains unclear. We determined the effect of both properties on in vivo salivary pH recovery and on enamel and dentine early erosion in situ. METHODS: Solutions simulating acidic beverages with different pHs (2.5 or 3.5) and titratable acidities (0, 25, or 100 mM citric acid) were tested. In an in vivo study (n = 20 participants), the salivary pH was determined before, during, and up to 2 min after exposure to the tested solutions. In situ, 12 participants exposed enamel and root dentine slabs to the tested solutions simulating a beverage consumption; early erosion was assessed by percentage of surface hardness loss (%SHL). Groups were compared by ANOVA (p < 0.05). RESULTS: Saliva pH was lower after exposure to solutions at pH 2.5, irrespective of titratable acidity; pH recovery took longer for solutions with higher titratable acidities, irrespective of their pHs. In situ, the highest %SHL was observed for the solution with lower pH and higher titratable acidities. The addition of citric acid increased the %SHL by 2.5-3 times in enamel, and at least 5 times in dentine. CONCLUSIONS: Both pH and titratable acidity may play a role on the erosive potential of acidic beverages. CLINICAL RELEVANCE: Acidic beverages with lower pHs promote erosion by an initial acid etching of the surface; those with a higher titratable acidity slow down the salivary pH recovery. Both properties contribute to the overall erosive potential.

The effect of 1,450 and 5,000 ppm sodium fluoride on polished dentin after citric acid erosion using change in step height.

PURPOSE: To measure step height change, using profilometry on dentin, after pre-treatment with sodium fluoride at 1,450 and 5,000 ppm and then erosion with citric acid. . METHODS: Dentin specimens (n= 150), sectioned from the coronal aspect of extracted human molars were randomly divided into three groups of 60 samples each and fully immersed in deionized water (control), or solutions of NaF with 1,450 ppm (F1450) or 5,000 ppm (F5000) for 3 minutes and then artificial saliva (not containing proteins) for 30 minutes. The samples were eroded for 10, 15, 20 or 25 minutes in 0.3% citric acid at pH 2.7. The mean step height change was calculated using confocal non-contact white light laser profilometry. . RESULTS: The mean (SD) step height for the control group at 25 minutes of acid exposure was 9.08 µm (± 0.74), for the F1450 fluoride group 8.74 µm (± 0.58) and for F5000 group 7.01 µm (± 0.56) µm, respectively. There were no statistically significant differences between the control group to the F1450 at any immersion times, whereas at F5000 there were statistically significant differences at all times (P< 0.0001). Within the limitations of this in vitro study, step height in dentin increased with time of exposure to citric acid and 5,000 ppm of sodium fluoride significantly reduced step height with artificial saliva. CLINICAL SIGNIFICANCE: 5,000 ppm NaF better protected dentin in an erosion model than concentrations commonly found in toothpastes.

Erosive potential of powdered juice drinks on dental enamel.

This study aimed to evaluate the erosive potential of powdered juice drinks on dental enamel in 2 stages: physiochemical characterization and erosive challenge testing. In stage 1, the pH and titratable acidity of 5 commercially available powdered juices in 10 different flavors were analyzed. Five treatment groups were then established based on the pH values, titratable acidity, and presence of citric acid in the juices, and their energy-dispersive X-ray (EDX) spectroscopy profiles were studied. In stage 2, the erosive effect of the juices was tested using a pH cycling model; polished bovine dental enamel blocks (n = 8) were treated 4 times daily on 5 consecutive days with 1% citric acid (positive control) or lemon, orange, pineapple, or cashew juice. The specimens were immersed in the erosive solutions, under agitation (100 rpm), for 1 minute at 25°C. Overnight and between treatments, the blocks were stored in artificial saliva without agitation. At the end of cycling, the enamel surfaces were evaluated by profilometry and scanning electron microscopy. The stage 2 results were submitted to 1-way analysis of variance followed by Tukey test (α = 0.05). The pH values of the juices ranged between 2.86 (lemon) and 3.84 (cashew), while the titratable acidity ranged from 14.5 (cashew) to 90.00 (lemon) mmol/L. Lemon juice showed the least calcium content (2.76%) and no (0.00%) phosphorus concentration. Orange, pineapple, and cashew juices showed the greatest concentrations of calcium and phosphorus and were therefore less erosive than lemon juice. The mean [SD] surface loss was higher in the lemon juice group (0.52 [0.16] µm), with no significant differences (P > 0.05) from the control (0.39 [0.09] µm) and orange juice (0.41 [0.12] µm). In groups exposed to pineapple juice (0.36 [0.04] µm) and cashew juice (0.16 [0.08] µm), the surface loss was significantly lower (P < 0.05) than that found in lemon juice. The results demonstrate that powdered juice drinks (especially lemon juice) present erosive potential and lead to surface loss of dental enamel.

Examining relationship between occupational acid exposure and oral health in workplace.

BACKGROUND: Acid mist can suspend in the air and enter the body via skin contact, the respiratory tract, or even oral intake, which pose various health hazards. Previous studies have shown that occupational exposure to acid mist or acidic solutions is a major risk factor for oral diseases. However, the findings are inconsistent and do not consider individual factors and lifestyles that may cause the same oral diseases. Therefore, we conducted a comprehensive oral health survey and collected detail information to confirm the effect of acidic solution exposure on worker's oral health. METHODS: From 4 acidic solution factories, a total of 309 subjects (157 in control and 152 in exposed group) was enrolled. All participants competed oral examinations and self-report questionnaire, including the decayed, missing, and filled teeth (DMFT) index, community periodontal index (CPI), loss of attachment (LA) index, and tooth erosion. Multivariate logistic regression analysis was used to determine the association between the acidic solution exposure and oral health. RESULTS: The results showed that acid exposure was correlated with soft oral tissue injury rather than hard oral tissue in our survey. In the multivariate model (adjusted for sex, age, worked years, education level, mouthwash use, dental floss use, tooth brushing, mask use, smoking, drinking, chewing areca and dietary habits with acidic foods), significant relationships of acid exposure with LA score were observed (OR = 2.32, 95% CI 1.03-5.26). However, the presence of acid exposure was not significantly associated with tooth erosion, DMFT, and CPITN. CONCLUSION: Our study highlighted that occupational acid exposure was an independent risk factor for periodontal health, especially LA. It is important to strengthen occupational hazard control, educate workers on oral disease and related factors, and raise the awareness of oral hygiene.

Differences in the Natural Enamel Surface and Acquired Enamel Pellicle following Exposure to Citric or Hydrochloric Acid.

OBJECTIVES: The aim of this study was to investigate variations in the interaction between enamel, that is, the acquired enamel pellicle (AEP) and citric or hydrochloric acid. MATERIALS AND METHODS: A 24-h AEP was formed on natural enamel specimens (n = 40) from pooled whole mouth human saliva. Samples were randomly allocated to citric (0.3%, pH 3.2) or hydrochloric (HCl) acid (0.01 M, pH 2.38) exposure for 30 or 300 s. The total protein concentration (TPC), and phosphorous and calcium concentrations of the pellicle were determined before and after acid exposure, and again after re-immersion in saliva. Surface roughness and tandem scanning confocal microscopy imaging were used to assess enamel changes. RESULTS: After 300 s of citric acid exposure, the mean ± SD TPC reduced from 5.1 ± 1.1 to 3.5 ± 1.1 mg/mL (p < 0.05). In contrast, after 300 s of HCl exposure, the mean TPC did not reduce significantly from baseline (6.6 ± 1.1 to 5.7 ± 0.7 mg/mL) but was significantly reduced in the reformed pellicle to 4.9 ± 1.2 mg/mL (p < 0.001). This reduction occurred after significant release of calcium and phosphorous from the enamel surface (p < 0.001). Thirty seconds of exposure to either acid had no obvious effect on the AEP. The surface roughness of the enamel decreased after acid exposure but no differences between groups was observed. CONCLUSIONS: These findings indicate that citric acid interacted with proteins in the AEP upon contact, offering enamel protection. In contrast, HCl appeared to bypass the pellicle, and reduced protein was observed only after changes in the enamel chemical composition.

Consumption of acidic drinks, knowledge and concern about dental erosive wear in Norwegian high school students.

OBJECTIVES: The objectives of the present study were to assess the consumption of acidic beverages, knowledge and concern about preventing dental erosive wear, and to examine potential associations between these variables, in a sample of high school students. MATERIALS AND METHODS: A survey measuring acidic beverage consumption, knowledge and concern about erosive tooth wear was conducted at 13 high schools in Rogaland county, Norway. RESULTS: Of the 850 students who completed the questionnaire, 26% reported that they drink acidic beverages every day. There were significant gender differences for the consumption of acidic drinks. The survey also demonstrated that a high proportion of students lacks basic knowledge of what erosive tooth wear is, and that this lack of knowledge is associated with a more frequent intake of acidic beverages. However, students who responded that they are concerned about preventing dental erosive wear reported that they drink soft drinks and energy drinks less frequently than students who are not concerned about this. CONCLUSIONS: Results from this study support assumptions about a lack of knowledge about dental erosive wear in youth, and that this lack of knowledge is associated with a more frequent intake of acidic drinks.

Dental erosion in mice with impaired salivary gland function.

Objective: Salivary flow rate exerts an essential impact on the development and progression of dental erosion. In this work, the experimental dental erosion in non-obese diabetic (NOD) mice with reduced salivary flow rate was induced, and the erosive effect of acidic drinks on their dentition was studied.Material and methods: Three acidic drinks (sports drink, cola light drink and sugar containing cola drink) were given to adult NOD mice (groups: N = 11) as the only drink for 6 weeks. Two control groups were included; wild type and NOD control (groups: N = 9). Experimental and control (water) teeth were dissected out and observed by scanning electron microscopy (SEM). Mandibular first molars were subsequently embedded in Epon, ground transversely, observed again by SEM, and the enamel thickness and tooth height were measured.Results: Mandibular molars were considerably more eroded than maxillary molars. The erosive process started at the top of the cusps and subsequently extended in the cervical, mesio-distal, and pulpal direction. Erosive lesions were evident in increased succession from sports drink, cola light to cola drink exposed mandibular molars, with the lingual tooth height being approximately 23%, 26%, and 37% lower, respectively, compared to the control. The lingual enamel was approximately 48% thinner in sports drink molars and 62% thinner in cola light molars. In cola drink molars, the lingual enamel was totally eroded, and significant erosion of dentine was evident.Conclusion: Reduced salivary flow, together with a high consumption of acidic drinks, results in severe erosion of NOD mice molars.

Comparison of Profilometric and Microindentation Analyses for Determining the Impact of Saliva on the Abrasion of Initially Eroded Enamel.

The aim of this in vitro study was to investigate the impact of saliva on the abrasion of eroded enamel using two measuring methods. A total of 80 bovine enamel specimens from 20 bovine incisors were allocated to four experimental groups (n = 20 specimens per group). After baseline surface microhardness (SMH) measurements and profilometry all specimens were subjected to erosion (2 min, 1% citric acid, pH: 3.6, 37°C). SMH was determined again, and the depths of the Knoop indentations were calculated. Thereafter, specimens were incubated in human saliva (group 1 - no incubation/control, group 2 - 0.5 h, group 3 - 1 h, group 4 - 2 h) before toothbrush abrasion was performed. After final SMH measurements and profilometry, indentations were remeasured, and surface loss was calculated. SMH did not return to baseline values regardless of the length of saliva incubation. Further, an irreversible substance loss was observed for all specimens. With the indentation method, significantly (p < 0.05) more substance loss was found for controls (least square means ± standard error of 198 ± 19 nm) than for groups 2-4 (110 ± 10, 114 ± 11, and 105 ± 14 nm). Profilometric assessment showed significantly more substance loss for controls (122 ± 8 nm) than for group 4 (106 ± 5 nm). Intraclass correlation for interrater reliability between measurement methods was low (0.21, CI: 0.1-0.3), indicating poor agreement. Exposure of eroded enamel to saliva for up to 2 h could not re-establish the original SMH. The amount of measured substance loss depended on the measurement method applied.

Influence of Surfactants and Fluoride against Enamel Erosion.

This study investigated the effect of surfactants associated with sodium fluoride (NaF) on enamel erosion prevention, using an erosion-remineralization in vitro model. Sodium lauryl sulfate (SLS), polysorbate 20 (P20), and cocoamidopropyl betaine (CAPB) were tested, at concentrations of 1.0 and 1.5%, and associated or not with NaF (275 ppm). The control groups were distilled water and the NaF solution. Bovine enamel samples (n = 12) were prepared and submitted to a 5-day cycling model: acid challenge (0.3% citric acid, pH 2.6, 4×/day), human saliva (2 h, 4×/day), and the treatment solutions (2 min, 2×/day). The protective potential of the agents against initial erosion was assessed by microhardness and the surface loss by profilometry. Enamel surface wettability was determined by goniometry, protein adsorption was measured by spectroscopy (FTIR), and the KOH-soluble fluoride was quantified. Goniometry showed that SLS and CAPB increased enamel wettability. No differences were found among the surfactants regarding protein adsorption. Microhardness showed that SLS reduced NaF protection. P20 (1 and 1.5%) and CAPB 1.5% presented a protective effect, but lower than the NaF solution. Profilometry showed that CAPB protected enamel, but no agent associated with NaF promoted a higher protection than the NaF solution alone. KOH-soluble fluoride analysis showed that all surfactants reduced the fluoride adsorption on the enamel surface. Therefore, the surfactants tested (except for P20) changed the enamel surface energy. The SLS decreased the protective potential of NaF on initial erosion, but no tested agent interfered with the protective effect of NaF on enamel erosive wear.

Relationship between erosive tooth wear and beverage consumption among a group of schoolchildren in Mexico City.

OBJECTIVE: To assess the association between erosive tooth wear (ETW) and consumption of different kinds of beverages in a group of schoolchildren 11-14 years old in Mexico City. METHODS: Cross-sectional study in a sample of students (n = 512) in Mexico City. The Basic Erosive Wear Examination (BEWE) was used to quantify ETW. Beverage consumption (BC) was determined using a frequency questionnaire; beverages included pure water, natural fruit juices, milk, hot beverages, and soft drinks. Ordinal logistic regression model was used to evaluate the association between the presence of ETW and BC. RESULTS: In total, 45.7% of the schoolchildren showed an initial loss of surface texture (BEWE = 1) and 18.2% a distinct defect involving loss of dental tissue (BEWE ≥ 2) in at least one tooth. For each glass (350 ml) of milk/week, the odds of not having erosive wear (BEWE = 0) versus having an initial loss of surface texture (BEWE = 1) or of having an initial loss of surface texture versus the presence of a defect involving the loss of dental tissue (BEWE ≥ 2) decreased 4% (OR = 0.96, 95% CI 0.93-0.99, p = 0.008); for each portion of sweet carbonated beverage consumed (350 ml), the odds increased 3% (OR = 1.03, 95% CI 1.001-1.07, p = 0.046). CONCLUSION: The intake of milk and milk-based products could be a dietary means of helping prevent ETW, especially if their consumption could replace sweet carbonated drink consumption. CLINICAL RELEVANCE: Knowing the impact of beverage consumption on ETW helps to provide suitable recommendations for the prevention and control of ETW in order to promote tooth longevity.

Effect of sucralfate against hydrochloric acid-induced dental erosion.

OBJECTIVE: Devising effective measures for the prevention of hydrochloric acid (HCl)-induced erosion is of great significance. This is even more important in dentine, in which products have limited diffusion. Therefore, agents that can bind to proteins forming an acid-resistant gel-like coat, such as sucralfate, may stand out as a promising alternative. This study investigated the protective effect of sucralfate suspensions against HCl-induced dental erosion. MATERIALS AND METHODS: In the first experiment, hydroxyapatite (HAp) crystals were pre-treated with a commercial sucralfate suspension (CoSS, pH 5.9), a stannous-containing sodium fluoride solution (NaF/SnCl2 pH 4.5), two prepared sucralfate suspensions (PrSS, pH 5.9 and 4.5), or deionized water (DI, control). HAp dissolution was measured using a pH-stat system. In a subsequent experiment, embedded/polished enamel and root dentine slabs were allocated into five groups to be treated with one of the tested substances prior to and during erosion-remineralization cycles (HCl-2 min + artificial saliva 60 min, two times per day, 5 days). Surface loss was assessed profilometrically. Data were analyzed by ANOVA and Tukey's tests. RESULTS: HAp dissolution was as follows: NaF/SnCl2 < CoSS < PrSS/pH 4.5, while PrSS/pH 5.9 = DI and both did not differ from CoSS and PrSS/pH 4.5. In enamel, surface loss did not differ between CoSS and PrSS/pH 4.5, with both having lower surface loss than PrSS/pH 5.9 and DI and NaF/SnCl2 differing only from DI. In root dentine, surface loss was as follows: CoSS < PrSS/pH 5.9 < (NaF/SnCl2 = DI), while PrSS/pH 4.5 = CoSS = PrSS/pH 5.9. CONCLUSION: Sucralfate suspension provided anti-erosive protection to HCl-induced erosion. CLINICAL RELEVANCE: Sucralfate may protect teeth against erosion caused by gastric acid.

Erosive potential of soy-based beverages on dental enamel.

BACKGROUND: This study aimed to investigate the erosive potential of soy-based beverages in comparison to fruit juices of the same flavor. METHODS: Human enamel blocks were randomly divided into 9 groups (n = 8), according to the beverage category (soy or non-soy juices). The initial pH, TA and ß at the original pH value were measured in triplicate. The composition of calcium, phosphate and total protein was analyzed using the specific colorimetric method. The fluoride analysis was performed using a selective electrode. The degree of saturation (DS) and the critical pH (CpH) of each beverage with respect to hydroxyapatite (HAp) and fluorapatite (FAp) were calculated using the computational software. Enamel samples were immersed into 67.5 mL of each drink for 120 minutes. Enamel surface loss (ESL) and differences in surface roughness (ΔRaE-S) were analyzed by a 3D non-contact profilometer. RESULTS: Non-soy beverages exhibited the lowest pH values (2.93 to 3.40). The highest values of calcium concentration were founded in soy-based formulations. Juices with soy in their composition tend to have high DS when compared with non-soy based beverages (p = .0571). Soy beverages produced less ESL than non-soy beverages (p < .05). ΔRaE-S was not significantly different between the categories. The ESL and ΔRaE-S were positively correlated with initial pH and buffering capacity in soy-based beverages. On the other hand, in non-soy beverages, the ESL was negatively correlated with the TA to 7.0 and the fluoride composition whereas the ΔRaE-S was negatively correlated with the TA to 5.5. CONCLUSIONS: The erosive potential of soy beverages was lower than non-soy based beverages.

Tooth wear in patients treated with HIV anti-retroviral therapy.

BACKGROUND: The objective of this study was to elucidate the relationship between HIV anti-retroviral therapy and tooth wear. METHODS: Assessment of tooth wear was conducted both with a survey questionnaire and clinical assessment at Russell Street Dental Clinic in Portland, Oregon. The survey questionnaire comprised of questions on study participant's gender, age, HIV status, current medications, awareness of tooth grinding or clenching, jaw soreness, tooth or gum soreness, and frequency of headaches. For the clinical evaluation, a dental provider recorded the degree of wear on each tooth using a scale of 0-3. An individual tooth-wear index was used to rank patients with regard to incisal and occlusal wear. Data analysis included descriptive analysis, tests of association and regression analysis using SPSS V.24. RESULTS: The study sample involved 93 patients (HIV + ve = 60, HIV-ve = 33) with age range of 20-90 yrs. (mean = 49 yrs., s.d = 13.3). 92 and 67% participants of the HIV + ve and HIV-ve groups, respectively, presented with tooth wear. The mean tooth wear index was higher in HIV + ve patients than HIV-ve patients (8.2 vs. 7.8), however, this difference was not statistically significant (p > 0.05). A significant, positive correlation was found between HIV presence and tooth wear index, after accounting for age (B = 0.71, p < 0.05). The number of years on anti-retroviral therapy alone was positively correlated with tooth wear index (R2 = 0.116, p < 0.05). After controlling for age, years of anti-retroviral therapy use was positively correlated with tooth wear index (B = 0.047, p > 0.05). CONCLUSIONS: The findings from this study suggest that HIV + ve patients, who are on anti-retroviral therapy have significant tooth wear, although more studies with larger sample size are needed to confirm this. There is a critical need to initiate a dialogue with medical providers about tooth wear as a possible side effect of antiretroviral therapy and to introduce appropriate preventive measures.

Saliva with reduced calcium and phosphorous concentrations: Effect on erosion dental lesions.

OBJECTIVES: To investigate whether saliva formulations with reduced calcium (Ca) and inorganic phosphorous (Pi) concentration would affect dental erosion caused by hydrochloric acid (HCl). METHODS: Enamel and root dentine bovine slabs were embedded, polished, and measured for surface Knoop microhardness (SMH). After reference areas were created, specimens were exposed to HCl solution (0.01 M; pH 2; 120 s) and immersed in artificial salivas (6 hr) containing three different Ca/Pi concentrations (n = 15), which simulate serum conditions of normo-, mild, or severe hypocalcemia. The control group was immersed in Ca/Pi-free saliva. The study protocol was carried out 2×/day for 5 days. Surface loss of enamel and root dentine was assessed using an optical profilometer, and SMH was remeasured for enamel. RESULTS: One-way analysis of variance (p < .001) and Tukey's test showed that enamel loss in groups subjected to artificial salivas that simulated mild or severe hypocalcemia did not differ from that resembling normocalcemia. %SMH was lower when saliva was mildly and normally concentrated in Ca/Pi (p < .001). Root dentine loss was higher in saliva simulating severe hypocalcemia than in those referring to mild, hypo-, and normocalcemia. CONCLUSIONS: Depending on the dental substrate, salivary formulations resembling serum hypocalcemia affected surface loss due to erosion and rehardening thereof.

Effectiveness of Clinpro XT in Reducing Dentin Permeability and its Resistance to Acid Challenges.

PURPOSE: To evaluate the efficacy of Clinpro XT in reducing dentin permeability and the stability of this effect after different acid challenges. MATERIALS AND METHODS: Sixty-five roots of extracted human third molars were used. From each tooth, one dentin specimen was prepared and connected to a fluid filtration system to measure the dentin permeability after each of the following steps: sample preparation; treatment with 37% phosphoric acid; application of Clinpro XT; three acid challenges. Specimens were randomly assigned to 5 groups (n = 13) according to the acidic solution applied: Coca-Cola, natural lemon juice, wine vinegar, white wine and Red Bull energy drink. An additional 10 third molars were used to evaluate the degree of occlusion of the dentinal tubules and the surface roughness. RESULTS: Clinpro XT statistically significantly reduced dentin permeability after just a single application. No statistically significant increase in dentin permeability could be detected after three consecutive challenges. The application of Clinpro XT promotes the occlusion of dentinal tubules and reduces the surface roughness. CONCLUSION: The Clinpro XT is effective in reducing dentin permeability. This effect persists even after acid challenges.

The erosive potential of additive artificial flavoring in bottled water.

Acidic beverage consumption is a well-recognized contributor to extrinsic dental erosion. Although the pH values of some commercially available bottled waters are below neutral pH, water is still considered to be a safe and healthy choice. Artificial flavoring liquids or powders, known as water enhancers (WEs), have been introduced to the market to modify the taste of water. The purposes of the present study were to measure the pH and titratable acidity of WEs and to perform gravimetric analysis of teeth immersed in solutions of WEs mixed with different brands of bottled water in order to determine the erosive potential in vitro. The pH and titratable acidity using 0.1M sodium hydroxide were calculated for 7 brands of WEs added to 3 brands of bottled water, which had different initial pH values. Extracted human molar teeth were submerged in each combination of solutions for gravimetric analysis. Distilled water was used as the positive control and citric acid as the negative control. Data were analyzed with 2-way analysis of variance and post hoc Tukey-Kramer testing (P = 0.05). The pH value (2.9-3.0) and titratable acidity (32.2-35.3 mmol/L hydroxide) of all of the experimental solutions were considered acidic, regardless of the WE brand. Average tooth structure loss after 1 month of immersion in the solutions was 4%, and surface changes were consistent with erosive dissolution. The results showed that adding a WE to water significantly increases the potential for dental erosion. The high content of citric acid in WEs is believed to be the cause. Patients should be advised to use WEs with caution.

Potential erosive effect of mouthrinses on enamel and dentin.

This in vitro study measured the pH values, titratable acidity (TA), and erosive potential of commercially available mouthrinses. A pH analysis of 6 mouthrinses (Listerine Total Care, Listerine Ultraclean, Listerine Original, Crest Pro-Health, Scope Classic, and ACT Total Care) was performed using a calibrated pH meter, and the neutralizable acidity was measured by titrating the mouthwashes against 0.1 M of sodium hydroxide. A gravimetric analysis was performed by submerging human enamel and dentin specimens in 5 mL of each mouthrinse for a total of 2 weeks. Specimens were weighed on a calibrated analytical balance at baseline, 24 hours, 48 hours, 96 hours, 1 week, and 2 weeks, and finally the loss of mass was calculated. The differences in erosive potential among the 6 mouthrinses were verified using nonparametric tests (Kruskal-Wallis and Mann- Whitney). The level of significance was set at 0.05. The mouthrinses were found to have the following mean pH/ TA values: Crest Pro-Health, 7.05/0.00; ACT Total Care, 6.31/5.44; Scope Classic, 5.18/0.42; Listerine Original, 3.98/9.26; Listerine Total Care, 3.43/5.88; and Listerine Ultraclean, 3.87/10.36. A significant correlation between pH and TA was observed for this dataset (P > 0.0001). No statistically significant difference in enamel loss among the groups was observed (P = 0.0631). However, a significant difference in dentin loss was observed among the 6 mouthrinses (P = 0.0011). Within the limitations of this in vitro study, it can be concluded that some mouthrinses have a pH lower than the critical pH of enamel and dentin. There is a significant association between acidic pH values and higher TA. Some of the tested mouthrinses presented an erosive potential on dentin.

Fast monitoring of tooth erosion caused by medicaments used in the treatment of respiratory diseases by ATR-FTIR and µ-EDXRF analysis.

The present study aimed to evaluate the erosive potential of four most commonly prescribed syrup medicaments for respiratory diseases. Attenuated total reflectance-Fourier transform infrared (ATR-FTIR) spectroscopy combined with multivariate statistical analysis and micro-energy-dispersive X-ray fluorescence spectrometry (µ-EDXRF) mapping was performed. Fifty-five root dentin fragments obtained from the buccal surface of 30 bovine teeth were prepared and divided into five experimental groups (n = 10): control-artificial saliva (S), acebrofilin hydrochloride (AC), ambroxol hydrochloride (AM), bromhexine hydrochloride (BR), and salbutamol sulfate (SS). The S group was stored only in artificial saliva and the other groups were treated with the medicaments (immersed for 1 min in 3 mL of the medication, three times daily, with 1-h intervals between the immersion cycles, during 5 days, 15 immersion cycles). There were a significant decrease in the Ca and P weight percentages (wt%) for dentin after medication treatments, except for AC (p > 0.05). Mineral content of dentin showed a clear gradation with increasing Ca and P wt% reduction in the order S < AC < AM < BR < SS. SS resulted in a significant increase in Ca/P ratio when compared to the control (p < 0.001). ATR-FTIR combined with multivariate, statistical analysis can quickly and reliably indicate extent of dentin erosion. Considering syrups with high-erosive potential should always follow with proper oral hygiene practices or search for an alternative medications void of such detrimental effects. Regular and prolonged use of these medicaments might bear the risk of causing erosion.