Avaliação do efeito protetor de fluoretos associados ao polímero bioadesivo Carbopol no desgaste erosivo / Evaluation of the protective effect of fluoride associated to bioadhesive polymer Carbopol in the erosive wear

O efeito protetor do flúor contra erosão tem sido relacionado principalmente à formação de depósitos de fluoreto de cálcio e à adsorção de íons flúor na superfície dental, assim hipotetizou-se que a incorporação ao polímero Carbopol 980 poderia potencializar o efeito protetor de soluções fluoretadas no controle do desgaste erosivo do esmalte com a formação de um filme superficial protetor. A proposta foi dividida em duas etapas. A primeira etapa consistiu em um estudo in vitro no qual foi testada a associação do polímero Carbopol ao Fluoreto de sódio (NaF) e Fluoreto de Sódio mais Cloreto de Estanho (NaF + Sn) quanto ao efeito remineralizante e protetor contra a erosão inicial, na presença da película adquirida. O teste de estabilidade de pH (pH stat) foi realizado, tratando cristais de hidroxiapatita com as soluções descritas, a fim de testar o potencial protetor dos componentes isolados ou associados, quanto à dissolução da hidroxiapatita, prevendo assim o potencial protetor das soluções testadas. Em seguida, espécimes cilíndricos em esmalte bovino polido (3 mm diâmetro) foram desmineralizados com ácido cítrico a 0,3% (pH 2,6) por 2 minutos (n=15). Os espécimes foram imersos em saliva humana por 2 horas para formação da película adquirida e foi então realizado o tratamento com as soluções experimentais por 2 minutos [NaF (500 ppm F), NaF + Carbopol (0,1%), NaF + Sn (500 ppm F + 800 ppm Sn), NaF + Sn + Carbopol], água deionizada (controle negativo) e solução comercial (Elmex ­ controle positivo). Uma nova imersão em saliva humana (2 h) foi realizada para remineralização, seguida por novo desafio ácido. A microdureza Knoop foi medida em diferentes tempos: inicial, após o primeiro desafio ácido, após a imersão nas soluções de tratamento (potencial de remineralização) e após o segundo desafio ácido (potencial protetor). Foi realizada uma nova imersão nas soluções-teste para mensuração do fluoreto solúvel em álcali da superfície do esmalte. Foram utilizados os testes ANOVA e Tukey (5%). Observou-se que a dissolução da hidroxiapatita foi menor nos grupos tratados com NaF + Sn + Carbopol se comparado aos demais grupos, resultado que corrobora com o maior potencial remineralizante e protetor, medidos por microdureza.A mensuração de flúor adsorvido na superfície também foi maior para o grupo com associação NaF + Sn + Carbopol comparado aos demais grupos. A segunda etapa foi um estudo in situ, realizado com as soluções experimentais que apresentaram o maior potencial protetor no estudo in vitro. Para tal, os espécimes em esmalte bovino polido foram divididos em três grupos (n=60): solução NaF + Sn (controle positivo), solução NaF + Sn + Carbopol, e água deionizada (controle negativo). Foi testado um modelo in situ em 3 fases. Quinze voluntários participaram do estudo. Em cada fase, os voluntários usaram um dispositivo palatal contendo 4 espécimes cada, sendo que dois foram submetidos a um ciclo de erosão e remineralização por 5 dias. Este ciclo consistiu na utilização dos dispositivos palatais por 2 horas para formação da película, seguido por imersão extra oral em ácido cítrico 1% (pH 2,3 - 5 minutos -4x/dia), com intervalos de 1 hora de exposição à saliva in situ entre os desafios, e tratamento com as soluções 2x/dia, por 1 minuto. Os outros dois espécimes foram submetidos à erosão/abrasão/remineralização, sendo a abrasão realizada 2x/dia, por 15 segundos com a escova elétrica ativa sobre os espécimes, antes dos tratamentos diários com as soluções e a erosão/remineralização conforme descrito. Ao final do experimento, a perda superficial (em µm) dos espécimes foi avaliada por perfilometria e os dados foram submetidos aos testes ANOVA dois fatores e Tukey (5%). Houve diferença entre os desafios (erosão e erosão+abrasão), assim como os tratamentos com soluções fluoretadas foram capazes de proteger o esmalte contra o desgaste erosivo, significantemente diferentes do controle negativo. Pode-se concluir que tanto para o estudo in vitro quanto para o estudo in situ a associação do NaF ao Sn e também estes ao Carbopol apresentaram resultados promissores diminuindo o desenvolvimento do desgaste erosivo(AU)

The protective effect of fluoride against erosion has been related mainly to the formation of calcium fluoride deposits and the adsorption of fluoride ions on the dental surface, so it was hypothesized that the incorporation to the Carbopol 980 polymer could potentiate the protective effect of fluoride solutions in the control of the enamel erosive wear with the formation of a protective film. The proposal was divided in two stages. The first stage consisted of an in vitro study in which the association of Carbopol polymer to sodium fluoride (NaF) and sodium fluoride with tin chloride (NaF + Sn) was tested in the presence of acquired pellicle. The ph stat test was used to test the protective potential of these components isolated or associated, in relation to the dissolution of hydroxyapatite, thus predicting the protective potential of the solutions tested. The remineralizing and protective effect against initial erosion measured by microhardness was investigated. Cylindrical polished bovine enamel specimens (3 mm diameter) was prepared and demineralized with 0.3% citric acid (pH 2.6) for 2 minutes (n=15). The specimens were immersed in human saliva for 2 hours to allow acquired pellicle formation and then, treatment with experimental solutions for 2 minutes were performed [NaF (500 ppm F), NaF + Carbopol (0,1%), NaF + Sn (500 ppm F + 800 ppm Sn), NaF + Sn + Carbopol], deionized water (negative control) and comercial mouthrinse (Elmex ­ positive control). A new immersion in human saliva (2 h) for remineralization and then new acid challenge were performed. The Knoop microhardness was measured at different times: baseline, after the first acid challenge, after treatments (remineralization potential), and after second acid challenge (protective potential). Additionally, a new immersion in test solutions was conducted for the measurement of alkalisoluble fluoride on enamel surface. ANOVA and Tukey tests were applied (5%). It was observed that the dissolution of hydroxyapatite was lower in the groups treated with NaF + Sn + Carbopol compared to the other groups. This result was also observed with the remineralizing and protective potentials, measured by microhardness. The measurement of alkali-soluble fluoride on enamel surface was also higher to the NaF + Sn + Carbopol association group compared to the other groups.The second stage was an in situ study carried out with the experimental solutions that present the greatest protective potential in the previous in vitro study. For this, polished enamel specimens were divided into three groups (n = 60): NaF + Sn (positive control), NaF + Sn + Carbopol, and deionized water (negative control). An in situ model with three stages was tested. Fifteen volunteers participated in the study. In each phase, volunteers used a palatal appliance containing 4 specimens each, in which two were submitted to an erosion and remineralization cycle for 5 days. This cycle consisted of using the appliance for 2 hours for pellicle formation, followed by extra oral immersion in 1% citric acid (pH 2.3 - 5 minutes - 4x/day) with intervals of 1 hour of in situ saliva exposure between challenges and treatment with the solutions 2x/day for 1 minute. The other two specimens were subjected to erosion/abrasion/remineralization cycle, in which abrasion was performed 2x/day - 15 seconds, with active electric toothbrush, before the daily treatment with the solutions, and erosion/remineralization as previously described. At the end of the experiment, enamel surface loss (µm) was evaluated by profilometry and the data were analyzed by two-way ANOVA and Tukey tests (5%). There were differences between the challenges (erosion and erosion + abrasion), as well as treatments with fluoride solutions were able to protect the enamel against erosive wear, significantly different from the negative control. It can be concluded that for both the in vitro and the in situ study, the association of NaF to Sn, and these to Carbopol, presented promising results reducing the development of erosive wear(AU)

Is a Basic Erosive Wear Examination (BEWE) reliable for recording erosive tooth wear on 3D models?

OBJECTIVES: To assess the reliability of the BEWE index on 3D models and to compare 3D-assessed erosive tooth wear scores with clinically detected scores. METHODS: In total, 1964 members of the Northern Finland Birth Cohort 1966 participated in a standardized clinical dental examination including the Basic Erosive Wear Examination (BEWE) and dental 3D modelling at the age of 45-46 years. Of those examined, 586 were randomly selected for this study. 3D models were assessed using the same BEWE criteria as in the clinical examination. Calculated kappa values as well as the prevalence and severity of erosive wear according to the clinical examination and 3D models were compared. Re-examinations were performed to calculate intra- and inter-method and -examiner agreements. RESULTS: The BEWE index on 3D models was reproducible; the mean intra- and inter-examiner agreement were 0.89 and 0.87, respectively, for sextant level, and 0.64 and 1, respectively, for BEWE sum scores. Erosive tooth wear was recorded as more severe in 3D models than in the clinical examination, and inter-method agreement was 0.41 for severe erosive wear (BEWE sum>8). The biggest inter-method differences were found in upper posterior sextants. CONCLUSIONS: The BEWE index is reliable for recording erosive tooth wear on 3D models. 3D models seem to be especially sensitive in detecting initial erosive wear. Additionally, it seems that erosive wear may be underscored in the upper posterior sextants when assessed clinically. Due to the nature of 3D models, the assessment of erosive wear clinically and on 3D models may not be entirely comparable. CLINICAL SIGNIFICANCE: 3D models can serve as an additional tool to detect and document erosive wear, especially during the early stages of the condition and in assessing the progression of wear. When scoring erosive wear clinically, care must be taken especially when assessing upper posterior sextants.

Dental erosion: Prevalence and severity among 16-year-old adolescents in Troms, Norway.

AIM: To study the prevalence, distribution and severity of dental erosion among 16-year-old adolescents in the Troms region of Norway. MATERIALS AND METHODS: Study design: The participants were recruited through the Tromsø-study ("Fit Futures"), and 392 16-year-olds were examined for dental erosion using clinical intraoral photographs. Three calibrated clinicians used the Visual Erosion Dental Examination (VEDE) system to register and grade the dental erosive wear. RESULTS: More than one third (38%) of the participants showed dental erosion on at least one tooth surface, 18% were limited to the enamel, while 20% of the adolescents showed erosive wear extending into the dentine. The occlusal surfaces of the lower first molars, and the palatal surfaces of the maxillary incisors were the most often and most severely affected. Of the participants showing dental erosion, 93% exhibited "cuppings" on the molars, with 48% limited to the enamel and 52% extending into the dentine. The highest prevalence of "cuppings" (73%) was found on the first lower molars, especially the mesiobuccal cusp of the teeth. The prevalence and severity of dental erosion was found to be higher in male than in female participants (p < 0.0001). CONCLUSION: The results from this study indicate a high prevalence and severity of dental erosion among adolescents in Troms and stress the importance of information, early and effective diagnostics and implementation of prevention strategies.

Functional occlusal patterns during lateral excursions in young adults.

STATEMENT OF PROBLEM: A valid system for assessing and classifying functional occlusion has not been established. The prevalence of anterior protected articulation is not known. PURPOSE: The purpose of this study was to quantify the prevalence of various functional occlusal contact patterns, including anterior protected articulation, among dental students. MATERIAL AND METHODS: Occlusal contacts were examined during lateral excursions from the maximal intercuspal position to the canine-to-canine position in 100 young adults. A combination of 3 common clinical methods was used: a visual examination, articulating paper, and feedback from the participants. RESULTS: Data from 3 classification systems were analyzed: (1) Occlusal contacts on the working side only ­ canine protected articulation was present in 25% of laterotrusions; anterior protected articulation was present in 18.5% of laterotrusions. Group function was present in 56% of laterotrusions. Other schemes were present in 0.5% of laterotrusions. (2) Contacts on both the working and the nonworking side. (3) Contacts on the working and nonworking side during both right and left laterotrusion. Nonworking side contacts were present in 33% of the participants. Nonworking side interference was present in 1 participant. CONCLUSIONS: The prevalence of anterior protected articulation found in this study was high enough to allow anterior protected articulation to be considered one of the fundamental working side occlusal contact patterns. More studies will be necessary to confirm this finding.

Avaliação do sistema antioxidante e estresse oxidativo de saliva em crianças de 4 a 6 anos de idade que apresentam erosão dentária / The antioxidant system and oxidative stress evaluation of saliva of children between 4-6 years who had dental erosion

A erosão dentária é um problema de saúde bucal e seu processo ocorre em uma condição multifatorial. Dentre seus principais fatores, a saliva desempenha importantes funções protetoras contra o desenvolvimento deste problema que afeta principalmente as crianças e jovens. O objetivo do presente estudo foi avaliar o sistema antioxidante e o estresse oxidativo da saliva de crianças de 4 a 6 anos de idade que possuíam erosão dentária comparando com crianças que não apresentavam esse problema de saúde bucal. Um único examinador treinado e calibrado para o diagnóstico de erosão dentária segundo o índice de BEWE (Basic Erosive Wear Examination), selecionou 40 crianças de 4 a 6 anos de idade que freqüentavam a Clinica de Prevenção de Odontopediatria da Universidade de São Paulo, formando 2 grupos, de crianças com erosão (n=22) e crianças sem erosão (n=18). A quantidade do biofilme dental foi obtida utilizando o índice de higiene oral simplificado (IHO-S) e foi feita a coleta de saliva não estimulada para as análises bioquímicas. O fluxo salivar, a capacidade tampão da saliva, o pH salivar e a proteína total da saliva foram avaliados. Também foram determinadas as atividades das enzimas superóxido dismutase (SOD) e catalase (CAT), o ácido úrico, o valor do malodialdeído (MDA) para determinação do estresse oxidativo e o total antioxidante (TAS). A proteína total foi menor no grupo de crianças com erosão dentária (p=0,03) e a quantidade de biofilme também foi menor nas crianças com erosão dentária média (desvio padrão) de 0,76 (0,25) comparadas com as crianças sem erosão dentária 1,18 (0,28). Não houve diferença estatística no sistema antioxidante e no estresse oxidativo da saliva de crianças com erosão dentária. A ação do sistema antioxidante e do estresse oxidativo na saliva, não influenciou na erosão dentária, quando ainda se encontrava em estágios mais iniciais deste problema de saúde bucal.

Dental erosion is a problem of oral health and its process occurs in multifactorial conditions. Among its principal factors, saliva plays an important protection role against the development of this problem, which affects children and youngsters mostly. The goal of this study was assessing the antioxidant system and oxidative stress in the saliva of children between the age of four and six who had dental erosion, comparing it to children who did not present this problem of oral health. One single examiner who was trained and prepared for diagnosing dental erosion according to the BEWE (Basic Erosive Wear Examination) index has selected forty children between the age of four and six who went to the Clinic of Prevention of Pediatric Dentistry of the University of São Paulo. Two groups were formed, one of children with dental erosion (n=22), and another with no dental erosion (n=18). The quantity of dental biofilm was verified using the simplified index of oral hygiene (OHI-S) and unstimulated saliva was collected for biochemical analyses. The salivary flow, the buffering capacity of saliva, salivary pH and the total amount protein in it were assessed. The activity of superoxide dismutase and catalase enzymes was also identified, and so were the uric acid and the amount of malodialdehyde (MDA)for determining oxidative stress and total antioxidant status(TAS). There was less total protein in the group of children with dental erosion (p=0,03) and the quantity of biofilm was also smaller in children with dental erosion (standard deviation) of an average of 0,76 (0,25), comparing with children with no dental erosion 1,18 (0,28). There was no statistic difference as far as the antioxidant system and oxidative stress are concerned in the saliva of children with dental erosion. The activity of the antioxidant system and oxidative stress in saliva have not influenced the dental erosion process while it was still in its early stages.

Avaliação in situ do potencial da solução de AmF/NaF/SnCl2, associada ou não ao laser de CO2, em prevenir a erosão em esmalte dental bovino / In situ assessment of the potential of AmF/NaF/SnCl2 solution, associated or not to CO2 laser irradiation, on preventing dental enamel erosion

Apesar de vários estudos terem demonstrado resultados promissores do uso da solução de AmF/NaF/SnCl2 no controle da erosão do esmalte dental, não existem relatos da sua associação com a irradiação do substrato com o laser de CO2, de comprimento de onda de 9,6 ?m. Desta forma, o presente estudo teve como objetivo avaliar o potencial da solução de AmF/NaF/SnCl2, associada ou não ao laser de CO2 (4,5 J/cm2, 20 Hz, 20 ?s), em controlar a erosão em esmalte dental bovino. Treze voluntários participaram desse estudo in situ, de delineamento cruzado, em 02 fases (04 dias cada), onde 04 tratamentos foram testados utilizando réplicas (n = 13): GC - nenhum tratamento (controle negativo); GF - solução de AmF/NaF/SnCl2 (controle positivo); GL - irradiação com laser de CO2 (9,6 ?m); GLF - laser de CO2 associado à solução de AmF/NaF/SnCl2. Os voluntários usaram dispositivos intra-bucais removíveis contendo 08 amostras de esmalte bovino. Na primeira fase, 07 voluntários utilizaram dispositivos intra-bucais contendo amostras dos grupos GC e GL, e outros 06 voluntários utilizaram dispositivos contendo amostras dos grupos GF e GLF. Na segunda fase, os voluntários foram cruzados, permitindo que todos os grupos experimentais fossem avaliados no meio bucal dos 13 voluntários da pesquisa. Os dispositivos intra-bucais foram removidos da boca para ciclagem erosiva ex-situ em ácido cítrico 0,65%, pH 3,6, durante 4 minutos, 2x/dia, em horários pré-determinados. As amostras foram avaliadas em perfilômetro óptico de não-contato (n = 13) para análise da perda de tecido mineral após o desafio erosivo, e um ensaio de ultramicrodureza transversal (n = 13) foi realizado com o objetivo de determinar a profundidade da área de desmineralização abaixo da superfície do esmalte erodido. A análise morfológica foi realizada utilizando microscopia eletrônica de varredura (MEV) (n = 3).

Os dados foram analisados estatisticamente por meio do modelo ANOVA 2 fatores para medidas repetidas, com subsequente comparação entre os diferentes tratamentos (? = 0,05). A ciclagem ácida realizada no presente estudo provocou perda de esmalte significativamente maior (p < 0,001) nos grupos GC (4,8 ± 1,4A ?m) e GL (4,4 ± 2,0A ?m). Não houve diferença estatística entre a perda de superfície nos grupos GF (1,9 ± 0,9B ?m) e GLF (1,7 ± 0,9B ?m). Os resultados de ultramicrodureza transversal mostraram que as amostras tratadas com a solução fluoretada (grupo GF) apresentaram uma zona parcialmente desmineralizada com média de dureza semelhante às amostras do grupo que não recebeu qualquer tipo de tratamento (grupo GC), com ambos os grupos apresentando média de dureza significativamente maior que os grupos que foram irradiados com o laser de CO2 (GL e GLF) (p < 0,001). As micrografias mostraram que as características morfológicas superficiais do esmalte nos grupos irradiados com laser de CO2 apresentaram-se semelhantes nos grupos GL e GLF, verificando-se a presença de áreas sugestivas de derretimento, resolidificação, microporos e microtrincas, sem evidências de precipitados fluoretados no grupo GFL. Uma camada amorfa pôde ser observada nas superfícies de esmalte tratadas apenas com a solução fluoretada contendo estanho. Pode-se concluir que o uso do enxaguatório bucal fluoretado contendo estanho (500 ppm F-, 800 ppm Sn2+, pH = 4,5) mostrou potencial de prevenção da erosão de esmalte dental. A irradiação do esmalte dental com o laser associado à solução fluoretada mostrou-se eficaz, mas seu efeito não foi sinérgico. O laser de CO2 (9,6 ?m), nos parâmetros utilizados, não foi capaz de prevenir a erosão em esmalte causada por ácido cítrico.

Although several studies have shown promising results using the AmF/NaF/SnCl2 solution in preventing the erosion of dental enamel, there are no reports of their association with the irradiation of the substrate with the CO2 laser, working at 9.6 ?m. Thus, this study aimed to evaluate the potential of AmF/NaF/SnCl2 solution, associated or not to CO2 laser irradiation (4.5 J/cm2, 20 Hz, 20 ?s), to prevent erosion on dental enamel. Thirteen volunteers participated in this 2-phase (4 days each), crossover study, where 04 treatments were tested using replicas (n = 13): GC - no treatment (negative control); GF - AmF/NaF/SnCl2 solution (positive control); GL - CO2 laser irradiation (9.6 ?m); GLF - CO2 laser irradiation associated with AmF/NaF/SnCl2 solution. The volunteers wore removable intra-buccal appliances containing eight bovine enamel samples. In the first phase, seven volunteers used intra-oral appliances containing samples of groups GC and GL and 6 volunteers, appliances containing samples of groups GF and GLF. In the second phase volunteers were crossed over, allowing all experimental groups were evaluated in the buccal environment of the 13 volunteers. Intra-buccal appliances were removed from the mouth and were exposed to a daily ex-situ erosive cycling (0.65% citric acid, pH 3.6, for 4 minutes, 2x/day) at pre-determined times. Samples were evaluated for surface loss using an optical non-contact profilometer (n = 13) for analysis of loss of mineral after the erosive challenge and a cross-sectional nanohardness test (n = 13) was carried out in order to determine the depth of demineralized area below the erosive lesion. Morphological analysis was carried out using scanning electron microscopy (SEM) (n = 3).

Avaliação do sistema antioxidante e estresse oxidativo de saliva em crianças de 4 a 6 anos de idade que apresentam erosão dentária / The antioxidant system and oxidative stress evaluation of saliva of children between 4-6 years who had dental erosion

A erosão dentária é um problema de saúde bucal e seu processo ocorre em uma condição multifatorial. Dentre seus principais fatores, a saliva desempenha importantes funções protetoras contra o desenvolvimento deste problema que afeta principalmente as crianças e jovens. O objetivo do presente estudo foi avaliar o sistema antioxidante e o estresse oxidativo da saliva de crianças de 4 a 6 anos de idade que possuíam erosão dentária comparando com crianças que não apresentavam esse problema de saúde bucal. Um único examinador treinado e calibrado para o diagnóstico de erosão dentária segundo o índice de BEWE (Basic Erosive Wear Examination), selecionou 40 crianças de 4 a 6 anos de idade que freqüentavam a Clinica de Prevenção de Odontopediatria da Universidade de São Paulo, formando 2 grupos, de crianças com erosão (n=22) e crianças sem erosão (n=18). A quantidade do biofilme dental foi obtida utilizando o índice de higiene oral simplificado (IHO-S) e foi feita a coleta de saliva não estimulada para as análises bioquímicas. O fluxo salivar, a capacidade tampão da saliva, o pH salivar e a proteína total da saliva foram avaliados. Também foram determinadas as atividades das enzimas superóxido dismutase (SOD) e catalase (CAT), o ácido úrico, o valor do malodialdeído (MDA) para determinação do estresse oxidativo e o total antioxidante (TAS). A proteína total foi menor no grupo de crianças com erosão dentária (p=0,03) e a quantidade de biofilme também foi menor nas crianças com erosão dentária média (desvio padrão) de 0,76 (0,25) comparadas com as crianças sem erosão dentária 1,18 (0,28). Não houve diferença estatística no sistema antioxidante e no estresse oxidativo da saliva de crianças com erosão dentária. A ação do sistema antioxidante e do estresse oxidativo na saliva, não influenciou na erosão dentária, quando ainda se encontrava em estágios mais iniciais deste problema de saúde bucal.

Dental erosion is a problem of oral health and its process occurs in multifactorial conditions. Among its principal factors, saliva plays an important protection role against the development of this problem, which affects children and youngsters mostly. The goal of this study was assessing the antioxidant system and oxidative stress in the saliva of children between the age of four and six who had dental erosion, comparing it to children who did not present this problem of oral health. One single examiner who was trained and prepared for diagnosing dental erosion according to the BEWE (Basic Erosive Wear Examination) index has selected forty children between the age of four and six who went to the Clinic of Prevention of Pediatric Dentistry of the University of São Paulo. Two groups were formed, one of children with dental erosion (n=22), and another with no dental erosion (n=18). The quantity of dental biofilm was verified using the simplified index of oral hygiene (OHI-S) and unstimulated saliva was collected for biochemical analyses. The salivary flow, the buffering capacity of saliva, salivary pH and the total amount protein in it were assessed. The activity of superoxide dismutase and catalase enzymes was also identified, and so were the uric acid and the amount of malodialdehyde (MDA)for determining oxidative stress and total antioxidant status(TAS). There was less total protein in the group of children with dental erosion (p=0,03) and the quantity of biofilm was also smaller in children with dental erosion (standard deviation) of an average of 0,76 (0,25), comparing with children with no dental erosion 1,18 (0,28). There was no statistic difference as far as the antioxidant system and oxidative stress are concerned in the saliva of children with dental erosion. The activity of the antioxidant system and oxidative stress in saliva have not influenced the dental erosion process while it was still in its early stages.

Avaliação in situ do potencial da solução de AmF/NaF/SnCl2, associada ou não ao laser de CO2, em prevenir a erosão em esmalte dental bovino / In situ assessment of the potential of AmF/NaF/SnCl2 solution, associated or not to CO2 laser irradiation, on preventing dental enamel erosion

Apesar de vários estudos terem demonstrado resultados promissores do uso da solução de AmF/NaF/SnCl2 no controle da erosão do esmalte dental, não existem relatos da sua associação com a irradiação do substrato com o laser de CO2, de comprimento de onda de 9,6 ?m. Desta forma, o presente estudo teve como objetivo avaliar o potencial da solução de AmF/NaF/SnCl2, associada ou não ao laser de CO2 (4,5 J/cm2, 20 Hz, 20 ?s), em controlar a erosão em esmalte dental bovino. Treze voluntários participaram desse estudo in situ, de delineamento cruzado, em 02 fases (04 dias cada), onde 04 tratamentos foram testados utilizando réplicas (n = 13): GC - nenhum tratamento (controle negativo); GF - solução de AmF/NaF/SnCl2 (controle positivo); GL - irradiação com laser de CO2 (9,6 ?m); GLF - laser de CO2 associado à solução de AmF/NaF/SnCl2. Os voluntários usaram dispositivos intra-bucais removíveis contendo 08 amostras de esmalte bovino. Na primeira fase, 07 voluntários utilizaram dispositivos intra-bucais contendo amostras dos grupos GC e GL, e outros 06 voluntários utilizaram dispositivos contendo amostras dos grupos GF e GLF. Na segunda fase, os voluntários foram cruzados, permitindo que todos os grupos experimentais fossem avaliados no meio bucal dos 13 voluntários da pesquisa. Os dispositivos intra-bucais foram removidos da boca para ciclagem erosiva ex-situ em ácido cítrico 0,65%, pH 3,6, durante 4 minutos, 2x/dia, em horários pré-determinados. As amostras foram avaliadas em perfilômetro óptico de não-contato (n = 13) para análise da perda de tecido mineral após o desafio erosivo, e um ensaio de ultramicrodureza transversal (n = 13) foi realizado com o objetivo de determinar a profundidade da área de desmineralização abaixo da superfície do esmalte erodido. A análise morfológica foi realizada utilizando microscopia eletrônica de varredura (MEV) (n = 3). Os dados foram analisados estatisticamente por meio do modelo ANOVA 2 fatores para medidas repetidas, com subsequente comparação entre os diferentes tratamentos (? = 0,05). A ciclagem ácida realizada no presente estudo provocou perda de esmalte significativamente maior (p < 0,001) nos grupos GC (4,8 ± 1,4A ?m) e GL (4,4 ± 2,0A ?m). Não houve diferença estatística entre a perda de superfície nos grupos GF (1,9 ± 0,9B ?m) e GLF (1,7 ± 0,9B ?m). Os resultados de ultramicrodureza transversal mostraram que as amostras tratadas com a solução fluoretada (grupo GF) apresentaram uma zona parcialmente desmineralizada com média de dureza semelhante às amostras do grupo que não recebeu qualquer tipo de tratamento (grupo GC), com ambos os grupos apresentando média de dureza significativamente maior que os grupos que foram irradiados com o laser de CO2 (GL e GLF) (p < 0,001). As micrografias mostraram que as características morfológicas superficiais do esmalte nos grupos irradiados com laser de CO2 apresentaram-se semelhantes nos grupos GL e GLF, verificando-se a presença de áreas sugestivas de derretimento, resolidificação, microporos e microtrincas, sem evidências de precipitados fluoretados no grupo GFL. Uma camada amorfa pôde ser observada nas superfícies de esmalte tratadas apenas com a solução fluoretada contendo estanho. Pode-se concluir que o uso do enxaguatório bucal fluoretado contendo estanho (500 ppm F-, 800 ppm Sn2+, pH = 4,5) mostrou potencial de prevenção da erosão de esmalte dental. A irradiação do esmalte dental com o laser associado à solução fluoretada mostrou-se eficaz, mas seu efeito não foi sinérgico. O laser de CO2 (9,6 ?m), nos parâmetros utilizados, não foi capaz de prevenir a erosão em esmalte causada por ácido cítrico.

Although several studies have shown promising results using the AmF/NaF/SnCl2 solution in preventing the erosion of dental enamel, there are no reports of their association with the irradiation of the substrate with the CO2 laser, working at 9.6 ?m. Thus, this study aimed to evaluate the potential of AmF/NaF/SnCl2 solution, associated or not to CO2 laser irradiation (4.5 J/cm2, 20 Hz, 20 ?s), to prevent erosion on dental enamel. Thirteen volunteers participated in this 2-phase (4 days each), crossover study, where 04 treatments were tested using replicas (n = 13): GC - no treatment (negative control); GF - AmF/NaF/SnCl2 solution (positive control); GL - CO2 laser irradiation (9.6 ?m); GLF - CO2 laser irradiation associated with AmF/NaF/SnCl2 solution. The volunteers wore removable intra-buccal appliances containing eight bovine enamel samples. In the first phase, seven volunteers used intra-oral appliances containing samples of groups GC and GL and 6 volunteers, appliances containing samples of groups GF and GLF. In the second phase volunteers were crossed over, allowing all experimental groups were evaluated in the buccal environment of the 13 volunteers. Intra-buccal appliances were removed from the mouth and were exposed to a daily ex-situ erosive cycling (0.65% citric acid, pH 3.6, for 4 minutes, 2x/day) at pre-determined times. Samples were evaluated for surface loss using an optical non-contact profilometer (n = 13) for analysis of loss of mineral after the erosive challenge and a cross-sectional nanohardness test (n = 13) was carried out in order to determine the depth of demineralized area below the erosive lesion. Morphological analysis was carried out using scanning electron microscopy (SEM) (n = 3).

Association between soft drink consumption, oral health and some lifestyle factors in Swedish adolescents.

OBJECTIVE: The aim was to investigate the relationship between soft drink consumption, oral health and some lifestyle factors in Swedish adolescents. MATERIALS AND METHODS: A clinical dental examination and a questionnaire concerning lifestyle factors, including drinking habits, oral hygiene, dietary consumption, physical activity and screen-viewing habits were completed. Three hundred and ninety-two individuals completed the study (13-14 years, n = 195; 18-19 years, n = 197). The material was divided into high and low carbonated soft drink consumption groups, corresponding to approximately the highest and the lowest one-third of subjects in each age group. Differences between the groups were tested by the Mann-Whitney U-test and logistic regression. RESULTS: Intake of certain dietary items, tooth brushing, sports activities, meal patterns, screen-viewing behaviors, BMI and parents born outside Sweden differed significantly between high and low consumers in one or both of the two age groups. Dental erosion (both age groups) and DMFT/DMFS (18-19 years group) were significantly higher in the high consumption groups. Logistic regression showed predictive variables for high consumption of carbonated soft drinks to be mainly gender (male), unhealthy dietary habits, lesser physical activity, higher BMI and longer time spent in front of TV/computer. CONCLUSION: High soft drink consumption was related to poorer oral health and an unhealthier lifestyle.

Is erosive tooth wear an oral disease?

Erosive tissue loss is part of the physiological wear of teeth. Clinical features are an initial loss of tooth shine or luster followed by flattening of convex structures; with continuing acid exposure, concavities form on smooth surfaces, or grooving and cupping occur on incisal/occlusal surfaces. Dental erosion must be distinguished from other forms of wear, but can also contribute to general tissue loss by surface softening, thus modifying physical wear processes. The determination of dental erosion as a condition or pathology is relatively easy in the case of pain or endodontic complications, but is ambiguous in initial stages and in terms of function or esthetics. The impact of dental erosion on oral health is discussed. However, it can be concluded that in most cases dental erosion is best described as a condition, with the acid being of nonpathological origin.

Diagnosis of erosive tooth wear.

The clinical diagnosis 'erosion' is made from characteristic deviations from the original anatomical tooth morphology, thus distinguishing acid-induced tissue loss from other forms of wear. Primary pathognomonic features are shallow concavities on smooth surfaces occurring coronal from the enamel-cementum junction. Problems from diagnosing occlusal surfaces and exposed dentine are discussed. Indices for recording erosive wear include morphological as well as quantitative criteria. Currently, various indices are used, each having their virtues and flaws, making the comparison of prevalence studies difficult. The Basic Erosive Wear Examination (BEWE) is described, which is intended to provide an easy tool for research as well as for use in general dental practice. The cumulative score of this index is the sum of the most severe scores obtained from all sextants and is linked to suggestions for clinical management. In addition to recording erosive lesions, the assessment of progression is important as the indication of treatment measures depends on erosion activity. A number of evaluated and sensitive methods for in vitro and in situ approaches are available, but the fundamental problem for their clinical use is the lack of reidentifiable reference areas. Tools for clinical monitoring are described.

Challenges in assessing erosive tooth wear.

Indices for assessing erosive wear are expected to deliver more than is expected of an ideal index: simple with defined scoring criteria so that it is reproducible, reflective of the aetiology of the condition and accurately categorizing shape, area and depth of affect, both at a point in time (prevalence) and longitudinally (incidence/increment). In addition, the differential diagnosis of erosive wear is complex, as it usually co-exists with other types of tooth wear. Therefore, a valid recording of erosive wear at an individual as well as at a population level without a thorough history with respect to general health, diet and habits is a challenge. The aims of this chapter are to describe the potential methodological challenges in assessing erosive wear, to critique the strengths and limitations of the existing erosion indices and to propose the adoption of a validated erosion index for the purpose for which it is intended.

Prevalence, incidence and distribution of erosion.

There is evidence that the presence of erosion is growing steadily. Due to different scoring systems, samples and examiners, it is difficult to compare the different studies. Preschool children from 2 to 5 years showed erosion on deciduous teeth in 1 to 79% of the subjects. Schoolchildren (aged from 5 to 9 years) already had erosive lesions on permanent teeth in 14% of the cases. In the adolescent group (aged between 9 and 20 years), 7 to 100% of the persons examined showed signs of erosion. Incidence data (the increase in the number of subjects presenting signs of dental erosion) was evaluated in four of these studies and presented average annual values between 3.5 and 18%, depending on the initial age of the examined sample. In adults (aged from 18 to 88 years) prevalence data ranged between 4 and 100%. Incidence data are scarce in this age group, and only one study was found analysing the increase of affected surfaces, showing an incidence of 5% for the younger and 18% for older age groups. In general, males present more erosive tooth wear than females. The distribution showed a predominance of affected occlusal surfaces (mandibular first molars) followed by facial surfaces (anterior maxillary teeth). Oral erosion was frequently found on maxillary incisors and canines. Overall, prevalence data are not homogeneous. Nevertheless, there is a trend towards a more pronounced rate of erosion in younger age groups. Furthermore, a tendency was found for more erosive lesions with increasing age and these erosions progressed with age.

Self-induced vomiting and dental erosion--a clinical study.

BACKGROUND: In individuals suffering from eating disorders (ED) characterized by vomiting (e.g. bulimia nervosa), the gastric juice regularly reaches the oral cavity, causing a possible risk of dental erosion. This study aimed to assess the occurrence, distribution and severity of dental erosions in a group of Norwegian patients experiencing self-induced vomiting (SIV). METHODS: The individuals included in the study were all undergoing treatment at clinics for eating disorders and were referred to a university dental clinic for examinations. One calibrated clinician registered erosions using the Visual Erosion Dental Examination (VEDE) system. RESULTS: Of 72 referred patients, 66 (63 females and three males, mean age 27.7 years) were or had been experiencing SIV (mean duration 10.6 years; range: 3 - 32 years), and were therefore included in the study. Dental erosions were found in 46 individuals (69.7%), 19 had enamel lesions only, while 27 had both enamel and dentine lesions. Ten or more teeth were affected in 26.1% of those with erosions, and 9% had ≥10 teeth with dentine lesions. Of the erosions, 41.6% were found on palatal/lingual surfaces, 36.6% on occlusal surfaces and 21.8% on buccal surfaces. Dentine lesions were most often found on lower first molars, while upper central incisors showed enamel lesions most frequently. The majority of the erosive lesions (48.6%) were found in those with the longest illness period, and 71.7% of the lesions extending into dentine were also found in this group. However, despite suffering from SIV for up to 32 years, 30.3% of the individuals showed no lesions. CONCLUSIONS: Dental erosion commonly affects individuals with ED experiencing SIV, and is more often found on the palatal/lingual surfaces than on the buccal in these individuals, confirming a common clinical assumption.

A survey of management strategies for noncarious cervical lesions.

Both causation and management of noncarious cervical lesions (NCCLs) (abfractions, wedge-shaped defects, stress-induced cervical lesions, and cervical erosion) remain debatable. A survey of clinicians' perceptions was therefore conducted at a recent professional meeting to determine optimal approaches to NCCL management. Examples of lesions differing in depth (1, 2, and 3 mm) were presented as being either sensitive or nonsensitive, and participants recorded their responses to the presented individual scenarios. This report provides information regarding correlations between increases in lesion depth, lesion sensitivity, and professionals' willingness to restore them. It was also noted that decisions to ensure mechanical retention positively influenced estimates for restoration longevity.

An investigation into the dental health of children with obesity: an analysis of dental erosion and caries status.

AIM: To investigate whether children with obesity experienced more erosion and caries than children with normal weight. METHODS: This study involved children aged 7-15 years. The study and control group comprised 32 children with BMI > 98th centile and 32 healthy children with normal BMI-for-age, respectively. O'Sullivan Erosion Index and WHO Caries Index were used in the examination of erosion and caries, respectively. Stimulated salivary flow rate, buffering capacity, Streptococcus mutans and lactobacilli counts (CFU/ml) were evaluated. A cross-sectional questionnaire survey was employed to collect information on participant's demographic background, oral health history and habits, and utilisation of dental care services. RESULTS: Children with obesity were more likely to have erosion than healthy children (p < 0.001), and had more erosion in terms of severity (p < 0.0001) and area affected (p < 0.0001), but not in the number of surfaces affected (p = 0.167). Posterior teeth were less likely than anterior teeth to be affected by erosion (OR 0.32, 95 % CI 0.012-0.082). Gender had no effect on erosion. There were no statistically significant differences in the DMFT, saliva profiles or questionnaire responses between the groups. CONCLUSIONS: Children with obesity may have high risk of dental erosion, but do not necessarily have higher risk of dental caries than children with normal weight.

Validation of the Basic Erosive Wear Examination.

The Basic Erosive Wear Examination (BEWE) is a practical index for screening tooth wear, using a 4-point ordinal scale (0-3). The highest score is recorded in each sextant and a total score (or BEWE sextant cumulative) is calculated per subject. This study aims to investigate if the BEWE sextant cumulative score compares to one comprising a percentage score from all tooth surfaces and as a highest BEWE per subject. The aim is to assess the validity of this score. A total of 350 subjects were recruited from hospital and general practice in south-east England. Buccal, occlusal and lingual/palatal BEWE scores were collected and percentages calculated based on scores 1, 1 and above, 2 and above and 3. BEWE sextant cumulative scores and highest BEWE scores were also recorded per subject. Spearman's correlation coefficients (p values) assessed the relationship between BEWE sextant cumulative scores, BEWE percentages and BEWE highest score per subject. The BEWE sextant cumulative score correlates significantly to a BEWE score taken as a percentage score from all tooth surfaces (Spearman's r > 0.5, p < 0.001) and especially to BEWE surface scores of 1 and above and 2 and above (r > 0.8, p < 0.001) and as a highest surface score per subject (r > 0.8, p < 0.001). BEWE sextant score provides a representation of tooth wear on all tooth surfaces. This study validates a tooth wear index, which provides clinicians with risk indicators of a patient's level of tooth wear and may help to guide clinical management.

Prevalence of dental erosion in young adults aged 18 years in Poland.

AIM: The aim of this study was to assess the prevalence of tooth wear in young adults in Poland. METHODS: A total of 1,886 persons aged 18 years, selected on a basis of multistage sampling, were examined within the Nationwide Dental Health Monitoring Programme. Previously calibrated dentists measured tooth wear using the BEWE-scoring system (Basic Erosive Wear Examination). RESULTS: Out of 1,886 young adults, 42.2% presented the signs of dental erosion. Considered the severity of erosion, it was graded as 1, 2 and 3 in 28.9%, 11.9% and 1.5% of 18-year-olds, respectively. CONCLUSIONS: Results of clinical assessment of dental erosion in 18-year-old young adults revealed that erosive tooth wear is an important problem in this age group. Of them, 13.4% had signs of advanced tooth wear which may lead to serious clinical problems in the future.

Adhesively restored anterior maxillary dentitions affected by severe erosion: up to 6-year results of a prospective clinical study.

UNLABELLED: In case of severe dental erosion, the maxillary anterior teeth are often particularly affected. Restoring such teeth conventionally (ie, crowns) would frequently involve elective endodontic therapy and major additional loss of tooth structure. A novel, minimally invasive approach to restore eroded teeth has been developed and is currently being tested in the form of a prospective clinical trial, termed The Geneva Erosion Study. To avoid crowns, two separate veneers with different paths of insertion have been used to restore the affected anterior maxillary teeth, regardless of clinical crown length and amount of remaining enamel. This treatment is called The Sandwich Approach. OBJECTIVES: The purpose of this case series study was to analyze the mid-term clinical outcome of maxillary anterior teeth affected by severe dental erosion that were restored following the Sandwich Approach. MATERIALS AND METHODS: Twelve consecutively consulting patients (mean age: 39.4 years) suffering from advanced dental erosion have been enrolled in the study and were subsequently treated. Due to the late interception of the disease, all patients needed a full-mouth rehabilitation, which was performed without any conventional crowns. At the level of the maxillary anterior teeth, a total of 70 palatal indirect composite restorations and 64 facial feldspathic ceramic veneers were delivered. Both types of veneers were adhesively luted with a hybrid composite. Clinical reevaluations were performed 6 months after insertion of the veneers, and then annually, using modified United States Public Health Service (USPHS) criteria. Marginal adaptation, marginal integrity (seal, absence of infiltration), status of pulp vitality, postoperative sensitivity, esthetics, and restoration success/failure, were the principal clinical parameters analyzed. RESULTS: After an up to 6-year observation time (mean observation time 50.3 months for the palatal veneers and 49.6 months for the facial veneers), no complete or major failure of the restorations was encountered. On the basis of the criteria used, most of the veneers rated Alpha for marginal adaptation and marginal seal. Secondary caries or endodontic complications were not detected. Using visual analogue scale analysis, the patient-centered satisfaction revealed a high esthetic and functional acceptance of 94.6%. CONCLUSIONS: Compared to conventional crown preparation, restoring compromised maxillary anterior teeth by means of 2 veneers prevents excessive tooth structure removal and loss of tooth vitality. Questions on the longevity of this new treatment arise, due to the nonfavorable initial status of the teeth to be restored (eg, lack of enamel, sclerotic dentin substrate and short clinical crowns). The clinical performance of the teeth treated following the Sandwich Approach seems promising, since none of the treated teeth lost their vitality, no failure of any of the restorations was detected, and the patients' overall satisfaction was high. Even though further investigation is needed to determine the clinical long-term performance of the described treatment modality, the encouraging mid-term results (biological, esthetic, and mechanical success) clearly question if conventional crowns in the anterior maxillary segments can still continue to be considered the best and only option to treat this particular population of patients.