Prevalence of erosive tooth wear in risk group patients: systematic review.

OBJECTIVE: This systematic review investigates the prevalence of erosive tooth wear (ETW) in individuals classified as risk groups (gastroesophageal reflux disease, eating disorders, special diets, acidic beverage, drugs and alcohol, legal drugs and medications, and occupational or sports). MATERIALS AND METHODS: The research was conducted in nine databases (PubMed/MEDLINE, Embase, Cochrane Library, LILACS/BVS, SciELO, Scopus, Science Direct, Open Grey, and Web of Science) up to April 2024 (PROSPERO CRD42021270150), along with a manual search of grey literature. Observational studies involving children and adults from these previously mentioned risk groups, which provided data on ETW prevalence, were included without date or language restrictions. The methodological quality of studies was evaluated using the Joanna Briggs Institute's Prevalence Data Critical Appraisal Tool. General and subgroup data were meta-analyzed using a random-effects model. RESULTS: Overall, 4403 studies were retrieved, out of which 148 met the inclusion criteria. Each risk group showed higher prevalences of ETW in these patients in general and subgroup analysis; although subgroup analysis was not possible for all risk groups due to the heterogeneity of the indices found. CONCLUSIONS: The Legal drugs and Medications risk group showed lower overall prevalence values (30%), while the Drugs and Alcohol risk group obtained higher values (67%). Prevalence rates for other groups were: Gastroesophageal reflux disease (54.1%), Eating Disorders (65%), Special Diets (65.9%), Acidic Beverages (40%), Occupational and Sports (51%). CLINICAL RELEVANCE: This systematic review highlights that risk groups are indeed at significant risk for the development of ETW and greater preventive care and dental monitoring are needed.

Effects of Dentifrices With Antierosive Potential on the Surface of Bovine Enamel Submitted to Acidic Beverage.

OBJECTIVES: To evaluate the effects of dentifrices containing sodium fluoride (NaF) combined with NovaMin (Sensodyne Repair & Protect-SRP), NaF combined with stannous fluoride (SnF2, Oral-B Pro-Gengiva-OBP), and amine fluoride (AmF, Colgate Elmex-ELM) on enamel subjected to simulated erosive cycling. MATERIALS AND METHODS: Bovine enamel-dentin discs (n = 10/group) were subjected to erosive cycling with orange juice (pH = 3.29, 5 min, 3x/day), artificial saliva (SA-2 h, 3x/day and overnight) and treated with dentifrice (2 min, 2x/day) or without treatment (CONT). Surface microhardness (SMH) was evaluated at baseline (T0), on the first (T1) and fifth (T5) days. SMH loss (%SHL) was calculated. Surface roughness (Ra, µm) was determined at T0 and T5. Morphology and mineral content were evaluated under scanning electron microscopy and energy-dispersive x-ray spectroscopy. Data were analyzed using ANOVA/Tukey or Bonferroni (α = 5%). RESULTS: No differences in %SHL were detected among groups at T1. At T5, OBP promoted %SHL, Ra, and ΔRa significantly lower than all the other groups (p < 0.05). All groups exhibited morphological changes in topography and similar Ca/P means before and after treatments. CONCLUSIONS: Dentifrice containing SnF2 minimized the negative effects on the SMH and Ra caused by exposure to orange juice after 5 days of simulated cycling. CLINICAL RELEVANCE: Patients who are more exposed to risk factors for dental erosion could benefit from the use of dentifrice containing SnF2.

EFFECT OF LASER IRRADIATION ASSOCIATED WITH FLUORIDE IN DECREASING EROSIVE TOOTH WEAR: A SYSTEMATIC REVIEW WITH A NETWORK META-ANALYSIS  .

OBJECTIVE: The present systematic review with a network meta-analysis (NMA) aimed to evaluate the effect of high-power lasers, associated or not with fluoride compounds, to control and prevent Erosive Tooth Wear (ETW). METHODS: The review was registered in the PROSPERO (CRD42021242547) and followed the PICO question: P (population): enamel and dentin substrate; I (Intervention): high-power laser irradiation, associated or not with fluoride compounds; C (Control): no-treatment; and O (Outcomes): prevention/control of ETW. The electronic databases PubMed, Scopus, and EMBASE were searched. Two independent reviewers evaluated in vitro and in situ studies. The risk of bias was assessed using the RoBDEMAT tool. The estimated treatment effect derived from direct and indirect comparisons were analyzed and the difference between these effects was calculated based on the data of enamel and dentin surface loss (in µm). RESULTS: A total of 179 studies were retrieved and after the exclusion of duplicates, 103 studies had their titles and abstracts evaluated. Thirty-nine studies had their full text analyzed for data extraction (Cohen Kappa = 0.88). For sound enamel, the laser irradiation (L), fluoride application (F) and, the association of treatments (L + F) promoted higher protection than No-Treatment (NT). For eroded enamel, L + F and F did not differ, but both treatments reduced surface loss compared to NT and L. For sound and eroded dentin, treatments with laser increased surface loss. CONCLUSIONS: Although a high-power laser has some potential to prevent erosive tooth wear, this effect is not better than that of standard fluoride. The use of laser in the management of dentin erosive wear can be harmful.

Experimental toothpastes containing ß-TCP nanoparticles functionalized with fluoride and tin to prevent Erosive Tooth Wear.

OBJECTIVES: The present study aimed to synthesize toothpastes containing Beta- TriCalcium Phosphate (ß-TCP) nanoparticles, functionalized with fluoride and tin, and test their ability to reduce erosive tooth wear (ETW). METHODS: Toothpastes were synthesized with the following active ingredients: 1100 ppm of fluoride (as sodium fluoride, F-), 3500 ppm of tin (as stannous chloride, Sn2+), and 800 ppm of ß-TCP (Sizes a - 20 nm; and b - 100 nm). Enamel specimens were randomly assigned into the following groups (n = 10): 1. Commercial toothpaste; 2. Placebo; 3 F-; 4. F- + ß-TCPa; 5. F- + ß-TCPb; 6. F- + Sn2+; 7. F- + Sn2+ + ß-TCPa and 8. F- + Sn2+ + ß-TCPb. Specimens were subjected to erosion-abrasion cycling. Surface loss (in µm) was measured by optical profilometry. Toothpastes pH and available F- were also assessed. RESULTS: Brushing with placebo toothpaste resulted in higher surface loss than brushing with F- (p = 0.005) and F- + ß-TCPb (p = 0.007); however, there was no difference between F- and F- + ß-TCPb (p = 1.00). Commercial toothpaste showed no difference from Placebo (p = 0.279). The groups F-, F- + ß-TCPa, F- + ß-TCPb, F- + Sn2+, F- + Sn2+ + ß-TCPa and F- + Sn2+ + ß-TCPb were not different from the commercial toothpaste (p > 0.05). Overall, the addition of ß-TCP reduced the amount of available fluoride in the experimental toothpastes. The pH of toothpastes ranged from 4.97 to 6.49. CONCLUSIONS: Although toothpaste containing ß-TCP nanoparticles protected enamel against dental erosion-abrasion, this effect was not superior to the standard fluoride toothpaste (commercial). In addition, the functionalization of ß-TCP nanoparticles with fluoride and tin did not enhance their protective effect. CLINICAL SIGNIFICANCE: Although ß-TCP nanoparticles have some potential to control Erosive Tooth Wear, their incorporation into an experimental toothpaste appears to have a protective effect that is similar to a commercial fluoride toothpaste.

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.

Effect of adding fluoride to camellia sinensis against dentin erosion generated by non-bacterial acids / Efecto de la adición de flúor a la camellia sinensis frente a la erosión de dentina generada por ácidos no bacterianos

Introduction: Natural products are an option to be used in different conditions in the oral cavity, such as Camellia sinensis, which due to its different properties would be beneficial in the erosion of the dental surface. Objetive: Determinar el efecto del extracto de Camellia sinensis (C. sinensis) adicionado con flúor frente a la acción erosiva de ácidos no bacterianos en la superficie de la dentina humana. Materials and Methods: Quasi-experimental, prospective, longitudinal, and in vitro study, consisting of 50 samples of human dentin, which were classified into 5 study groups: distilled water, hydrochloric acid, 2% C. sinensis extract, sodium fluoride. 2% and 2% C. sinensis extract added with 2% sodium fluoride. The surface roughness of each sample was evaluated with the SRT6200 digital roughness meter, obtaining a total average roughness and the measurements were carried out in two moments. Results: It was observed that the 2% C. sinensis extract, the 2% sodium fluoride, and the C. sinensis extract added with 2% sodium fluoride, showed a variation in surface roughness between before and after, which was not significant (p<0.05) in all cases. It should be noted that the C. sinensis plus sodium fluoride group is the one that obtained the best variation in the mean surface roughness than the other groups studied. Conclusions: The 2% C. sinensis extract, 2% sodium fluoride, and the combination of both compounds demonstrated an inhibitory effect against the erosive action of hydrochloric acid (0.01 M) on the dentin surface, not presenting a statistically significant difference in the results.

Introducción: Los productos naturales son una opción para ser usados en diferentes afecciones en la cavidad bucal, como lo podría ser la Camellia sinensis, que por sus diferentes propiedades sería de beneficio en la erosión de la superficie dental. Objetivo: Determinar el efecto del extracto de Camellia sinensis (C. sinensis) adicionado con flúor frente a la acción erosiva de ácidos no bacterianos en la superficie de la dentina humana. Materiales y Métodos: Estudio cuasi experimental, prospectivo, longitudinal ein vitro, constituido por 50 muestras de dentina de dientes permanentes, que se clasificaron en 5 grupos de estudio: Agua destilada, ácido clorhídrico, extracto de C. sinensis a 2%, fluoruro de sodio al 2% y extracto de C. sinensisa 2% adicionado con fluoruro de sodio al 2%. Se evaluó la rugosidad superficial de cada muestra con el rugosímetro digital SRT6200, obteniéndose una rugosidad media total y se realizaron las mediciones en dos momentos. Resultado: Se observó que el extracto de C. sinensisal 2%, el fluoruro de sodio al 2% y el extracto de C. sinensis adicionado con fluoruro de sodio al 2%, presentaron una variación de la rugosidad superficial entre el antes y el después, no siendo esta significativa (p<0.05) en todos los casos. Cabe resaltar que el grupo C. sinensis más fluoruro de sodio, es el que obtuvo una mejor variación de la media de rugosidad superficial, que los otros grupos estudiados. Conclusión: El extracto de C. sinensisal 2%, el fluoruro de sodio al 2% y la combinación de ambos compuestos demostraron un efecto inhibitorio frente a la acción erosiva del ácido clorhídrico (0,01 M) en la superficie de dentina, no presentando una diferencia estadísticamente significativa en los resultados.

Low-fluoride gels supplemented with nano-sized sodium trimetaphosphate reduce dentin erosive wear in vitro.

OBJECTIVE: The study assessed the effect of low-fluoride gels supplemented with micrometric or nano-sized sodium trimetaphosphate (TMP) on dentin erosive wear in vitro. DESIGN: Bovine dentin blocks (n = 154) were selected by surface microhardness and randomly allocated into seven groups (n = 22/group), according to the gels: Placebo; 4500 ppm F (4500F); 9000 ppm F (9000F); 5% TMP microparticulate plus 4500F (5TMPm+4500F); 2.5% TMP nanoparticulate plus 4500 F (2.5TMPn+4500F); 5% TMP nanoparticulate plus 4500F (5TMPn+4500F); and 12,300 ppm F acid gel (APF). All blocks were treated only once for 60 s and cyclically eroded (ERO, citric acid, 4 × 90 s/day) or eroded and brushed (4 × 15 s/day, five strokes/s, ERO+ABR) over five days (each subgroup n = 11). Dentin wear and integrated hardness loss in depth (ΔKHN) were determined, and the data were submitted to two-way ANOVA, followed by Tukey's test, and Spearman's correlation (p < 0.05). RESULTS: For ERO, all gels containing 4500F supplemented with TMP significantly reduced dentin wear compared with their counterpart without TMP, reaching values similar to 9000F. For ERO+ABR, 5TMPn+ 4500F gel led to significantly lower wear than all its counterparts, reaching values similar to 9000F and APF. As for ΔKHN, all gels containing TMP promoted superior protective effects compared with 4500F, reaching values similar to 9000F and APF under both challenges. A positive correlation between dentin wear and mineral content in depth was verified. CONCLUSIONS: Gels containing 4500F supplemented with TMP significantly reduced dentin erosive wear compared with pure 4500F, with additional benefit from the use of nanoparticles.

Addition of substances to reduce the erosive potential of acidic beverages to tooth enamel: A scoping review.

OBJECTIVE: This scoping review aimed (1) to map, analyse, interpret and synthesize data from in situ studies on which substances were added to acidic beverages to reduce the erosive potential on tooth enamel and (2) to establish the level of evidence of the effectiveness of adding substances to acidic beverages to reduce the erosive potential on tooth enamel. DESIGN: This is a scoping review, according to the methods from the Joanna Briggs Institute and PRISMA-ScR, with high-sensitivity searches in the databases PubMed (MEDLINE), Virtual Health Library, Embase (Elsevier), Scopus (Elsevier), Web of Science and ScienceDirect (Elsevier). In situ studies published in English until December 2022 were included. Studies that did not report a control group were excluded. To map and summarize the results, tables and figures were used. RESULTS: From 895 potentially eligible articles, nine were included. Blackcurrant juices (n = 5) with the addition of calcium (n = 3) or xanthan gum (n = 2) formulations were the most tested in terms of reducing the erosive potential of the beverages on tooth enamel. The profilometer was the equipment of choice (n = 8) for evaluating the loss of enamel structure after the experimental tests. CONCLUSIONS: Calcium and xanthan gum are among the most tested by in situ studies, offering promising results in reducing the erosive potential of fruit juices and carbonated and energy drinks.

Are S-PRG composites able to resist against erosive and abrasive challenges and protect surrounding enamel in situ?

OBJECTIVES: This study evaluated the resistance of S-PRG (Surface Pre-Reacted Glass-ionomer) composites and other restorative materials against erosive and abrasive challenges and their protective effect on enamel adjacent to the restorations. MATERIALS AND METHODS: Bovine enamel blocks were prepared and randomized into 12 groups, including 6 types of material, each of them subjected to erosion_e or erosion+abrasion_ea: Beautifil II (S-PRG); Beautifil Bulk Restorative (S-PRG); Filtek Z250 XT; Filtek Bulk Fill; EQUIA Forte; Riva Light Cure. Cavities were prepared in the middle of enamel blocks and restored with the materials. Initial profiling measurement was performed on the material and on adjacent enamel (100, 200, 300, 600 and 700 µm from the restoration margin). Palatal intraoral appliances with the restored enamel blocks were used by the volunteers (n = 10). During 5 days appliances were immersed in 2.5 % citric acid for 2 min; 6 × /day (erosion_e). For ea condition, blocks were brushed for 1 min after each acid immersion. Final profile assessment was performed. Data were analysed by two and three way ANOVA followed by Tukey's test (p < 0.05). RESULTS: Material wear: Riva Light Cure showed the highest wear followed by EQUIA Forte and then all resin composites, including the ones with S-PRG (p = 0.000). Enamel wear: there was significant interaction among type of restorative material, wear condition and distance (p = 0.014), enamel around materials showed similar wear (p = 0.983) and the enamel subjected to ea exhibited highest wear (p = 0.000). CONCLUSION: SPRG based composites showed resistance against erosive and abrasive challenges but were not able to protect enamel adjacent to the restorations. CLINICAL SIGNIFICANCE: S-PRG composites exhibit resistance to material wear comparable to resin composites. However, they have shown an inability to effectively protect the adjacent enamel under in situ erosive-abrasive conditions, despite the presence of mineral-loss-preventing ions surrounding materials.

Increase in plasma resveratrol levels and in acid-resistant proteins in the acquired enamel pellicle after use of resveratrol-containing orodispersible tablets.

OBJECTIVE: This study evaluated the effect of administration of trans-resveratrol-containing orodispersible tablets on the protein composition of the AEP and on blood plasma trans-resveratrol concentrations. METHODS: Ten volunteers participated in two crossover double-blind phases. In each phase, after dental prophylaxis, they received a trans-resveratrol (15 mg) orodispersible tablet, or a placebo tablet (without actives). The AEP formed after 120 min was collected with electrode filter papers soaked in 3 % citric acid. Blood samples were collected 30, 45, 60 and 120 min after the use of the tablet. After protein extraction, AEP samples were analyzed by shotgun labelfree quantitative proteomics and plasma samples were analyzed by high-performance liquid chromatography (HPLC). RESULTS: Eight hundred and two proteins were identified in the AEP. Among them, 336 and 213 were unique to the trans-resveratrol and control groups, respectively, while 253 were common to both groups. Proteins with important functions in the AEP had increased expression in the trans-resveratroltreated group, such as neutrophil defensins, S100 protein isoforms, lysozyme C, cystatin-D, mucin-7, alphaamylase, albumin, haptoglobin and statherin. Trans-resveratrol was detected in the plasma at all the times evaluated, with the peak at 30 min. CONCLUSIONS: The administration of trans-resveratrol in sublingual orodispersible tablets was effective both to increase the bioavailability of the polyphenol and the expression of antibacterial and acid-resistant proteins in the AEP, which might benefit oral and general health.

Novel resin-based material containing ß-tricalcium phosphate nanoparticles for the reduction of dentin permeability.

OBJECTIVES: To synthesize and characterize a novel dentin adhesive containing Beta-Tricalcium Phosphate (ß-TCP) nanoparticles and test its ability to reduce dentin permeability (dP). METHODS: Experimental adhesives were prepared by mixing Bis-GMA, TEGDMA, HEMA (50/25/25 wt.%), photo-initiators, and inhibitors. The following groups were tested: Experimental adhesives without ß-TCP (Exp.); with 10 wt.% ß-TCP (Exp.10 wt.% ß-TCP); with 15 wt.% ß-TCP (Exp.15 wt.% ß-TCP), Scotchbond Multi-Purpose (SBMP) and Clearfil SE Protect Bond (CFPB). Degree of conversion (DC%, 10 and 20 s); Flexural Strength (FS), Knoop Hardness (KHN), and Cell Viability (OD%) tests were performed. dP was evaluated by hydraulic conductance, using human dentin disks (n=12), at three-time intervals: post-EDTA (T0); post-treatment (T1); and post-erosion/abrasion cycling (T2). Data were statistically analyzed (α=0.05). RESULTS: For all groups, exposure time for 20 s presented a higher DC% than for 10 s. For FS, filled adhesives did not differ from unfilled and from CFPB. Experimental adhesives did not differ among them and showed lower KHN than the commercial products. Cell viability did not differ among adhesives, except Exp. 15 wt.%, which showed lower OD% than Exp., Exp. 10% and, CFPB. For dP, only Exp.10 and 15 wt.% ß-TCP did not present difference between the times T1 and T2. After cycling, Exp.10 wt.% ß-TCP presented lower permeability than Exp. and CFPB. CONCLUSIONS: The incorporation of 10 wt.% ß-TCP nanoparticles into the resin-based dental material did not affect its mechanical properties and biocompatibility, and promoted the greatest reduction in dentin permeability, sustaining this effect under erosive/abrasive challenges. CLINICAL SIGNIFICANCE: A novel resin-based dental material containing ß-TCP nanoparticles was able to reduce dentin permeability, maintaining its efficacy after erosive/abrasive challenges. The synthesized material did not affect dental pulp cell viability and might be promising for other conditions that require dental remineralization, such as tooth wear and dental caries.

Efeito protetor de dentifrícios fluoretados associados ao polímero aminometacrilato no desgaste erosivo do esmalte / Protective effect of fluoride dentifrices in association with aminomethacrylate polymer against the enamel erosive wear

O desgaste dental erosivo tem se tornado uma condição cada vez mais preocupante, com taxas globais de prevalência crescentes, principalmente em indivíduos jovens. Os polímeros formadores de filme têm sido investigados como uma alternativa para o controle da progressão do desgaste dental erosivo, especialmente quando associados a compostos fluoretados, protegendo o tecido dental contra a ação dos ácidos. Dentre eles está o aminometacrilato, que mostrou resultados promissores em estudos prévios sob a forma de solução, porém seu efeito quando adicionado a formulações de dentifrícios ainda não havia sido pesquisado. Dessa forma, o presente estudo visou avaliar o potencial protetor da associação do aminometacrilato com dentifrícios fluoretados frente à erosão inicial e ao desgaste erosivo do esmalte. Para isso, 72 espécimes em esmalte bovino polido foram alocados aleatoriamente em seis níveis de tratamento: erosão (controle negativo sem desafio abrasivo- CNE), abrasão sem dentifrício (controle negativo da abrasão- CNA), dentifrício sem agente ativo (placeboPL), dentifrício com fluoreto de sódio (NaF ­ 1450 ppm F-), dentifrício experimental com aminometacrilato (AMC ­ 4%) e dentifrício fluoretado com aminometacrilato (AMC+F). O grupo CNE foi submetido apenas à ciclagem erosiva, e os demais passaram por desafios erosivos e abrasivos. A ciclagem erosiva/abrasiva consistiu em imersão dos espécimes em saliva humana (1h) para a formação da película adquirida, exposição ao ácido cítrico 0,3% por 5 minutos (4x/dia) e aplicação dos tratamentos (2x/dia), intercalados por imersão em saliva humana (1h), todos sob agitação (30 rpm). A ciclagem foi repetida por 5 dias. A microdureza superficial Knoop (KN) dos espécimes foi analisada no primeiro dia da ciclagem para avaliação da erosão inicial do esmalte. A análise foi realizada em quatro momentos: KNinicial (esmalte sadio), KNE1(após a primeira exposição ao ácido), KNT (após o tratamento), KNE2 (após a segunda exposição ao ácido). Com base nestes valores, foram calculados o potencial de reendurecimento (%Re = [(KNT-KNE1) / (KNE1)] x 100) e de proteção do esmalte (%Prot = [(KNE2-KNE1) / (KNE1)] × 100). A análise perfilométrica foi realizada antes e depois do término da ciclagem (após 5 dias) para determinação da perda de estrutura (em µm). O potencial de adsorção de flúor solúvel em KOH no esmalte foi analisado ao final do ciclo erosivo (µg/cm2). Espécimes representativos de cada grupo foram observados em microscopia eletrônica de varredura após o término da ciclagem. Foram aplicados os testes ANOVA um fator e Tukey (5%). Os valores para %Re foram: CNE (3,11±4,09)a; CNA (1,62±11,38)a; PL (1,78±3,51)a; AMC (5,59±3,08)a; F (7,53±9,17)a; AMC+F (20,23±7,10)b. Para %Prot foram: CNE (-50,68±5,27)a; CNA (-49,71±6,43)a; PL (-51,65±3,74)a AMC (-41,21±8,47)b; F (-34,10±5,99)b; AMC+F (-19,80±7,95)c. Para perda estrutural: CNE (7,46±2,26)a, CNA (10,14±2,08)ab, PL(13,11±2,69)c, AMC (7,74±2,10)a, F (11,38±2,07)bc, AMC+F (7,52±2,59)a. Para flúor adsorvido na superfície foram observados os valores de: CNE (0,160 ±0,069)a; CNA (0,179 ±0,034)a; PL (0,275 ±0,142)a; AMC (0,422 ±0,161)a; F (1,29 ±0,311)b; AMC+F (1,46 ±0,217)b. Concluiu-se que a adição do copolímero aminometacrilato em dentifrícios potencializou o efeito do fluoreto de sódio contra a erosão inicial do esmalte e o desgaste erosivo do esmalte (AU)

The erosive tooth wear (ETW) has been a cause of concern, because its prevalence rates have increased in the recent years, mainly in young individuals. Film-forming polymers have been investigated as an alternative to control erosive tooth wear (ETW) progression, notably when associated to fluoride compounds, protecting the dental tissues against acids. Among them, the aminomethacrylate polymer has shown promissing results in previous studies. Nevertheless, its performance when added to toothpaste formulations remains unknown. Therefore, this study aims to evaluate the protective potential of fluoride toothpastes associated with aminomethacrylate against the initial erosion and erosive wear in enamel. For this, 72 polished bovine enamel specimens were divided in six treatments: ultra-pure water (erosion negative control without abrasive challenge- ENC), ultra-pure water (abrasion negative control abrasion without toothpaste- ANC), toothpaste without active agent (placebo- PL), experimental toothpaste with aminomethacrylate (AMC- 4% - AMC), toothpaste with sodium fluoride (NaF- 1450 ppm F- - F), and experimental toothpaste with sodium fluoride + aminomethacrylate (NaF+AMC ­ AMC+F). The NC group was subjected to erosion only. The other groups were subjected to erosion + abrasion. Three response variables were analyzed: initial erosion with Knoop surface microhardness (KN) in the first day of the cycle; enamel loss with profilometric analysis (µm), and surface adsorbed fluoride concentration at the end of the cycle. The erosive/abrasive cycling consisted in immersion of the specimens in human saliva (1 h) to form the acquired pellicle, exposure to citric acid (0.3%) for 5 minutes (4x/day) and treatments application under abrasion (2x/day), with immersion in saliva in the intermediate periods (1 h), all the immersions were realized under constant agitation (30 rpm). This cycling was repeated for 5 days. The microhardness was assessed in four moments: KNinitial (sound enamel), KNE1 (after the first acid exposure), KNT (after the treatment), KNE2 (after the second acid exposure). With these values it was calculated rehardening potential (%Re =[(KNT-KNE1) / (KNE1)] x 100), and protective potential (%Prot = [(KNE2-KNE1) / (KNE1)]100). The profilometric analysis was performed before the first cycle and after the last cycle. Then, the difference between the initial and final profiles were calculated to the enamel loss. Representative specimens from each group were analyzed by scanning electron microscopy (SEM). The data was analyzed by One-Way ANOVA and Tukey Test (5%). The values regarding %Re were: ENC (3,11±4,09)a; ANC(1,62±11,38)a; PL (1,78±3,51)a; AMC (5,59±3,08)a; F (7,53±9,17)a; AMC+F(20,23±7,10)b. For %Prot were observed the values: ENC (-50,68±5,27)a; ANC (-49,71±6,43)a; PL (-51,65±3,74)a; AMC (-41,21±8,47)b; F (-34,10±5,99)b; AMC+F (-19,80±7,95)c. Enamel loss were reported by the following values: ENC (7,46±2,26)a,ANC (10,14±2,08)ab, PL (13,11±2,69)c, AMC (7,74±2,10)a, F (11,38±2,07)bc, AMC+F(7,52±2,59)a. Surface adsorbed fluoride concentration was assessed, and thefollowing values were found: ENC (0,160 ±0,069)a; ANC (0,179 ±0,034)a; PL (0,275±0,142)a; AMC (0,422 ±0,161)a; F (1,29 ±0,311)b; AMC+F (1,46 ±0,217)b. It wasconcluded that the addition of aminomethacrylate copolymer to toothpaste enhancesthe effect of sodium fluoride against initial enamel erosion and erosive wear(AU)

Prevalence and Associated Factors to Non-Carious Cervical Lesions in Brazilian University Students: A Cross-Sectional Survey

Abstract Objective: To identify the prevalence, severity, hypersensitivity, and distribution of Non-carious cervical lesions (NCCL) among university students in Brazil. Material and Methods: 179 participants answered an anamnesis with twenty questions about the presence or absence of habits associated with NCCL. The participants' teeth were evaluated to identify the presence or absence of the lesion, its classification, involved surfaces, severity, hypersensitivity, and tooth wear index. A hypersensitivity test was performed with ice water. Data were analyzed using the chi-square test and simple logistic regression (p<0.01). Results: 179 participants answered an anamnesis with twenty questions about the presence or absence of habits associated with NCCL. The participants' teeth were evaluated to identify the presence or absence of the lesion, its classification, involved surfaces, severity, hypersensitivity, and tooth wear index. A hypersensitivity test was performed with ice water. Data were analyzed using the chi-square test and simple logistic regression (p<0.01). Conclusion: The prevalence of NCCL was 15.1% and abfraction was the most frequent lesion. Premolars were the teeth most affected by non-carious cervical lesions.

Prevalence of erosive tooth wear and associated risk factors in Colombian adolescents

Abstract Accurate determination of the prevalence of erosive tooth wear (ETW) and associated risk factors in adolescents can inform clinical management guidelines. The aim of this analytical cross-sectional study was to estimate the prevalence, severity, and risk factors of ETW in adolescents aged 12-15 years in the municipality of Usaquén in Bogotá, Colombia. Two calibrated examiners clinically assessed ETW using Basic Erosive Wear Examination (BEWE) Index (range: 0-3). All tooth surfaces (excluding proximal) were scored to allow estimation of the Highest (0-3) and Total BEWE (sum of Highest BEWE score per sextant: 0-18) scores per patient. Sociodemographic characteristics, ETW risk factors, and caries severity (ICDAS-epi-merged) were evaluated, and their association with the presence of ETW (indicated by a Highest BEWE score of 2-3) was examined using preliminary analyses and logistic regression models. The study sample included 454 adolescents (mean age: 13.5±1.1 years; female: 61.7%), and the prevalence of ETW was 71.6%. The majority of participants exhibited a Highest BEWE score of 3 (58.0%) and a Total BEWE score ≤8 (84.3%). The preliminary analysis showed an association between the presence of ETW and age, caries, and brushing teeth before eating (p-value < 0.05). Risk factors for ETW included always brushing teeth before eating [adjusted Prevalence Ratio (PRa) 1.31, p-value=0.014], presence of extensive carious lesions (PRa 1.23, p-value = 0.024), male gender (PRa 1.14, p-value = 0.028), and age > 14 years (PRa 1.17, p-value = 0.009). Although ETW was highly prevalent, most Colombian adolescents exhibited low Total BEWE scores. ETW was associated with frequent fruit intake, age, toothbrushing habits, caries lesions, and sex.

Dentin erosive wear is reduced by fluoride varnishes containing nanosized sodium trimetaphosphate in vitro

Abstract This study evaluated the effect of fluoride varnishes containing micrometric or nanosized sodium trimetaphosphate (TMP) on dentin erosive wear in vitro. Bovine root dentin blocks were selected by surface hardness and randomly divided into five experimental groups/varnishes (n = 20/group): placebo, 5% sodium fluoride (NaF); 5% NaF+5% micrometric TMP; 5% NaF+2.5% nanosized TMP; and 5% NaF+5% nanosized TMP. Half of the surface of all blocks received a single application of the assigned varnish, with subsequent immersion in artificial saliva for 6 h. Varnishes were then removed and the blocks were immersed in citric acid (90 s, 4×/day, 5 days). After each erosive cycle, ten blocks of each group were immersed in a placebo dentifrice for 15 s (ERO), while the other ten blocks were subjected to abrasion by brushing (ERO+ABR). Dentin erosive wear was assessed by profilometry. Data were submitted to 2-way ANOVA and to the Holm-Sidak test (p<0.05). Dentin erosive wear was significantly higher for ERO+ABR than for ERO for all varnishes. TMP-containing varnishes promoted superior effects against dentin erosive wear compared with 5% NaF alone; and 5% nanosized TMP led to the lowest wear among all varnishes. In conclusion, the addition of TMP to conventional fluoride varnish (i.e., varnish containing only NaF) enhanced its protective effects against bovine root dentin erosion and erosion+abrasion. Additionally, the use of 5% nanosized TMP led to superior effects in comparison to 5% micrometric TMP, both for erosion and erosion+abrasion in vitro.

Can the combination of proanthocyanidin and vitamin E or palm oil effectively protect enamel against in vitro erosive and abrasive challenges?

Abstract Objectives This study aimed to assess the effect of proanthocyanidin, palm oil and vitamin E against erosive and erosive+abrasive challenges in vitro after enamel pellicle formation in situ. Methodology Bovine enamel blocks (n=84) were obtained and divided into the following treatment groups: negative control (NC) - deionized water; positive control (PC) - SnCl2/NaF/AmF-containing solution; palm oil (PO); 2% proanthocyanidin (P2); vitamin E (VitE); 2% proanthocyanidin+palm oil (P2PO); and 2% proanthocyanidin+vitamin E (P2VitE). For 5 days, one half of the sample from each group was subjected to erosion and the other half was subjected to erosion+abrasion. The acquired enamel pellicle (AEP) was pre-formed in situ for 30 minutes. The specimens were then treated in vitro with solutions (500 µl, 30s for each group). Subsequently, the blocks were left in the oral cavity for another hour to obtain the modified AEP. The blocks were immersed in 0.5% citric acid (pH=2.5) for 90s, 4×/day. AEP formation and treatment were carried out before the first and third erosive challenges, and after these challenges, abrasive cycles (15s) were performed on half of the samples. Enamel wear was quantified by profilometry and data were analyzed by two-way ANOVA and Tukey's test (p<0.05). Results All groups showed higher wear when exposed to erosion+abrasion than when exposed to erosion alone (p=0.0001). PO, P2VitE, P2, and P2PO showed enamel wear similar to the PC group, but only PC, PO and P2VitE differed from the NC group. The other groups behaved similarly to NC. Conclusion It was concluded that the combination of proanthocyanidin and vitamin E was effective in reducing wear in the face of in vitro erosive and erosive+abrasive challenges.

Efeito protetor de enxaguatórios com diferentes fluoretos utilizados previamente aos desafios erosivos/abrasivos em esmalte e dentina / Protective effect of solutions with different fluorides used previously to erosive/abrasive challenges in enamel and dentin

Aim: To evaluate the protection offered by commercial mouthwashes containing sodium fluoride or stannous chloride associated with sodium fluoride to enamel and dentin, prior to erosive and abrasive cycling. Materials and Methods: Enamel and dentin samples were obtained from bovine incisors and subdivided into 3 groups (n=10), according to the fluoridated ingredient tested: FS (sodium fluoride - NaF (225 ppm)); FE (tin fluoride - NaF + SnCl2 (800 ppm Sn2+)); control (distilled water). The samples were submitted to an erosive/abrasive cycle with immersion in citric acid (lemon soda for 5 min, 4×/day, 5 days, with remineralization intervals in artificial saliva for 60 min). Abrasion was carried out with an electric brush (200 g/force) after the first and last cycles, 2x/day, and immediately afterward immersed in the tested solutions. Structure loss was obtained by optical profilometry. The data were subjected to analysis of variance and multiple comparison for each substrate separately. Results: For enamel there was a difference between the groups (p = 0.027), with the FS showing less loss of structure compared to the control 2.02 (±0.48). The FE group showed similar loss to the control and FS 2.32 (±0.58)ab. For dentin there was a difference between the groups (p = 0.011), with FE showing less loss of structure compared to the other groups, 0.82 (25% - 0.34; 75% - 0.95). Discussion: The protection of fluorides in erosive/abrasive challenges depends on the type and dental substrate. Conclusion: Mouthwash with sodium fluoride prior to erosive/abrasive challenges caused less loss of enamel surface, while for dentin, sodium fluoride associated with stannous chloride caused less loss of structure.

Objetivo: Avaliar a proteção oferecida por soluções para bochecho de fluoreto de sódio ou cloreto de estanho associado ao fluoreto de sódio ao esmalte e à dentina, previamente à ciclagem erosiva e abrasiva. Materiais e Métodos: Amostras de esmalte e dentina foram obtidas a partir de incisivos bovinos e subdivididas em 3 grupos (n=10), de acordo com o princípio ativo fluoretado testado: FS (fluoreto de sódio - NaF (225 ppm)); FE (fluoreto de estanho - NaF + SnCl2 (800 ppm Sn2+)); controle (água destilada). As amostras foram submetidas a um ciclo erosivo/abrasivo com imersão em ácido cítrico (refrigerante de limão por 5 min, 4×/dia, 5 dias, com intervalos de remineralização em saliva artificial por 60 min). A abrasão foi realizada com escova elétrica (200 g/força) após o primeiro e o último ciclos, 2×/dia, e logo em seguida imersos nas soluções testadas. A perda de estrutura foi obtida por perfilometria óptica. Os dados foram submetidos à análise de variância e comparação múltipla para cada substrato separadamente. Resultados: Para esmalte houve diferença entre os grupos (p = 0,027), tendo o FS apresentados menor perda de estrutura comparado ao controle 2,02 (±0,48). O grupo FE apresentou perda similar ao controle e ao FS 2,32 (±0,58)ab. Para dentina houve diferença entre os grupos (p = 0,011), sendo que o FE apresentou menor perda de estrutura comparado aos demais grupos 0,82 (25% - 0,34; 75% - 0,95). Discussão: A proteção dos fluoretos em desafios erosivos/abrasivos depende do tipo e do substrato dental. Conclusão: O bochecho com fluoreto de sódio previamente aos desafios erosivos/abrasivos apresentou menor perda de superfície em esmalte, enquanto para dentina o fluoreto de sódio associado ao cloreto de estanho apresentou menor perda de estrutura.

Does the application of dimethyl sulfoxide improve resin bonding to eroded dentine? Four-year in vitro evaluation.

OBJECTIVE: To evaluate the effect of dimethyl sulfoxide (DMSO) on the microtensile bond strength (µTBS) and nanoleakage (NL) of universal adhesives on eroded dentine, immediately and after four years of water storage. METHODS: Sixty-four sound human molars were distributed into 16 groups according to (1) Dentine surface (sound and eroded dentine); (2) dimethyl sulfoxide application (with or without); (3) Application mode (etch-and-rinse or self-etch) and (4) Storage time (immediate and four years). One mild universal adhesive was used (Scotchbond Universal). The restoration was then performed with a composite resin and the specimens were sectioned into resin-dentine bonded sticks. Resin-dentine bonded sticks were tested (immediately and after four years of water storage) for µTBS (0.5 mm/min) or used to assess NL. Data on µTBS and NL were analyzed using four-way ANOVA and Tukey's test (α = 0.05). RESULTS: Only the 3-way cross-product interaction 'substrate vs DMSO vs time' was statistically significant (p = 0.007). Eroded dentine showed a lower mean of µTBS and a higher mean of NL values than sound dentine. However, when DMSO was applied, no significant decrease of µTBS or NL values was observed after four years of water storage, regardless of adhesive strategies, or dentine evaluated, when compared to immediate results. SIGNIFICANCE: Water-based DMSO pre-treatments not only prevent degradation of MDP-containing simplified adhesives but also serve as a potential alternative to improve long-term bonding properties to eroded dentine. The versatility of using a single pre-treatment for both self-etch or etch-and-rinse bonding to eroded dentin may facilitate future clinical applications.

Fluoride varnishes supplemented with nano-sized sodium trimetaphosphate reduce enamel erosive wear in vitro.

OBJECTIVE: To evaluate the effect of fluoride (F) varnishes with sodium trimetaphosphate (TMP) on erosive tooth wear (ETW) in vitro. METHODS: Enamel blocks (n = 100) were divided into 5 experimental groups (n = 20/group): Placebo (Pla - without F/TMP); 5 % NaF (NaF); 5 % NaF + 5 % micrometric TMP (NaF+5 %MICRO); 5 % NaF + 2.5 % nano-sized TMP (NaF+2.5 %NANO), and 5 % NaF + 5 % nano-sized TMP (NaF+5 %NANO). Blocks received a single varnish application (6 h contact), and were submitted to 4 daily erosive challenges (ERO, 0.05 M citric acid, pH 3.2, 90 s, under agitation), for 5 days. After ERO, half of the blocks (n = 10/group) were subjected to brushing abrasion (ERO+ABR). Profilometry, surface hardness (SH), and cross-sectional hardness (ΔKHN) were determined. The data were submitted to 2-way ANOVA and Fisher's LSD test (p < 0.05). RESULTS: Enamel wear was significantly lower for ERO compared with ERO+ABR for all varnishes tested (p < 0.001), following the pattern NaF+5 %NANO < NaF+5 %MICRO < NaF < NaF+2.5 %NANO < Pla (both for ERO and ERO+ABR). The highest SH loss was observed for Pla and the lowest for NaF (ERO) and NaF+2.5 %NANO (ERO+ABR), without significant differences among NaF+2.5 %NANO, NaF, and NaF+5 %MICRO. The highest ΔKHN values were observed for NaF+5 %MICRO and NaF+5 %NANO at 5-30 µm, with less marked differences among the groups at 30-70 µm (ERO and ERO+ABR). CONCLUSIONS: The addition of TMP to F varnishes significantly improves protection against ETW in vitro. The use of 5 % nano-sized TMP further enhances such effects. CLINICAL SIGNIFICANCE: F varnishes containing TMP can reduce enamel loss caused by ERO or ERO+ABR.

Avaliação do potencial erosivo de bebidas ácidas / Evaluation of the erosive potential of acid drinks

Objetivo: o presente estudo teve como objetivo avaliar, in vitro, o potencial erosivo para o esmalte dentário de bebidas ácidas, comumente ingeridas pela população e encontradas com frequência no comércio da grande Florianópolis, SC, Brasil. Método: a mensuração do potencial erosivo das bebidas foi realizada através da detecção do potencial hidrogeniônico (pH) e acidez titulável (AT). A amostra foi composta por refrigerantes à base de cola, Coca-Cola® e Pepsi®; isotônicos Gatorade®-morango e maracujá e Powerade®-mix de frutas; Chás industrializados Natural Tea®-limão e Chá Matte Leão®-natural; energéticos Red Bull® e Monster Energy®; sucos naturais de Laranja Pera e de Limão Taiti; água saborizada H2OH!®-sabor limão; e água mineral, para o grupo controle. O pH foi aferido com pHmetro digital (Sensoglass SP1800) e para a AT foi utilizado o método padronizado pelo Instituto Adolfo Lutz, todos os ensaios foram realizados em triplicata. Para a análise estatística descritiva, foram empregados teste t e a ANOVA. Resultados: os menores valores de pH foram encontrados para a bebida Coca-Cola® e suco de limão com 2,3. Para AT, as amostras que apresentaram os maiores valores foram os sucos naturais, com 35,1 para o suco de limão e 13,5 para o suco de laranja. Todas as bebidas analisadas possuem potencial erosivo ao esmalte dental, por apresentarem valores de pH menores que 5,5. Quanto as mensurações de AT, os sucos naturais apresentaram os maiores valores. Conclusão: todas as bebidas do estudo foram consideradas iminentemente erosivas à estrutura dental.(AU)

Objetivo: o presente estudo teve como objetivo avaliar, in vitro, o potencial erosivo para o esmalte dentário de bebidas ácidas, comumente ingeridas pela população e encontradas com frequência no comércio da grande Florianópolis, SC, Brasil. Método: a mensuração do potencial erosivo das bebidas foi realizada através da detecção do potencial hidrogeniônico (pH) e acidez titulável (AT). A amostra foi composta por refrigerantes à base de cola, Coca-Cola® e Pepsi®; isotônicos Gatorade®-morango e maracujá e Powerade®-mix de frutas; Chás industrializados Natural Tea®-limão e Chá Matte Leão®-natural; energéticos Red Bull® e Monster Energy®; sucos naturais de Laranja Pera e de Limão Taiti; água saborizada H2OH!®-sabor limão; e água mineral, para o grupo controle. O pH foi aferido com pHmetro digital (Sensoglass SP1800) e para a AT foi utilizado o método padronizado pelo Instituto Adolfo Lutz, todos os ensaios foram realizados em triplicata. Para a análise estatística descritiva, foram empregados teste t e a ANOVA. Resultados: os menores valores de pH foram encontrados para a bebida Coca-Cola® e suco de limão com 2,3. Para AT, as amostras que apresentaram os maiores valores foram os sucos naturais, com 35,1 para o suco de limão e 13,5 para o suco de laranja. Todas as bebidas analisadas possuem potencial erosivo ao esmalte dental, por apresentarem valores de pH menores que 5,5. Quanto as mensurações de AT, os sucos naturais apresentaram os maiores valores. Conclusão: todas as bebidas do estudo foram consideradas iminentemente erosivas à estrutura dental.(AU)