Methods for assessment of dental erosion.

Various assessment techniques have been applied to evaluate the loss of dental hard tissue and the surface-softened zone in enamel induced by erosive challenges. In this chapter, the most frequently adopted techniques for analyzing the erosively altered dental hard tissues are reviewed, such as profilometry, measuring microscope techniques, microradiography, scanning electron microscopy, atom force microscopy, nano- and microhardness tests and iodide permeability test. Moreover, methods for chemical analysis of minerals dissolved from dental hard tissue are discussed. It becomes evident that the complex nature of erosive mineral loss and dissolution might not be comprehended by a single technique, but needs application of different approaches for full understanding.

Modelo de conductancia hidráulica de la dentina humana ex vivo / Hydraulic conductance model of ex vivo human dentin

El objetivo principal de este trabajo fue montar y probar un modelo experimental para medir la conductancia hidráulica de la dentina ex vivo. Diecisiete terceros molares sanos, con indicación de exodoncia, de donantes sanos de edades entre 15 y 30 años fueron obtenidos mediante consentimiento informado. Luego de limpiarlos, desinfectarlos, incluirlos en resina epóxica y cortarlos se obtuvieron 17 muestras de dentina, correspondiente a un disco de resina con un corte coronal de diente que presenta dentina expuesta en ambas caras de éste. Tres equipos para medir la conductancia hidráulica de la dentina fueron armados siguiendo la descripción del modelo de Pashley. Las muestras fueron instaladas en una cámara de difusión, conectada mediante tubos de silicona a una pipeta graduada y una columna de agua de 20cm. Mediante el desplazamiento de una burbuja de agua al interior de la pipeta, se midió la conductancia hidráulica de cada muestra, 3 veces los días 14, 21, 28 y 35 postextracción. Los datos fueron tabulados y analizados estadísticamente. No existe diferencia en la tasa de flujo de una muestra medida en los tres equipos (p=0.5937). No existe diferencia en las mediciones de la conductancia hidráulica de 13 muestras de dentina humana medida en los días 14, 21, 28 y 35 postextracción (p=0.0704). Es posible montar un modelo experimental para estudiar la conductancia hidráulica de la dentina ex vivo, basado en el modelo de Pashley y col. El modelo pareciera ser confiable, pero es necesaria más investigación para poder validar su confiabilidad.

The main objective of this work was to mount and test an experimental model to measure the hydraulic conductance of ex vivo dentin. Seventeen healthy third molars, with indication of extraction of healthy donors aged between 15 and 30 years were obtained by informed consent. After cleaning them, disinfecting them, including them in resin epoxy and cutting them, there were 17 samples of dentin, corresponding to a disk of resin with a coronal section of tooth showing the dentin exposed on both sides of it. Three machines to measure the hydraulic conductance of the dentin were assembled according to the description of the model of Pashley. Samples were installed in a Chamber of diffusion, connected by using silicone tubes to a graduated transfer pipette and a 20cm water column. Through the displacement of a bubble of water in the inside of the pipette, the hydraulic conductance of each sample was measured 3 times on the 14th, 21st, 28th and 35th day post extraction. The data were tabulated and analyzed statistically. There is no SS difference in the rate of flow of a measured sample in the three machines (p=0.5937). There is no SS difference in measurements of the hydraulic conductance of 13 samples of human dentin measured in days 14, 21, 28 and 35 postextraction (p=0.0704). It is possible to mount an experimental model to study the hydraulic conductance of dentin ex vivo, based on the model of Pashley. The model seems to be reliable, but more research is needed in order to validate its reliability.

Análise química do precipitado formado na reação entre hipoclorito de sódio e digluconato de clorexidina / Chemical analysis of the precipitate formed by mixing sodium hypochlorite and chlorhexidine digluconate

O digluconato de clorexidina reage com o hipoclorito de sódio formando um precipitado, que segundo a literatura, é composto por para-cloroanilina (PCA), ou por para-clorofenil uréia (PCU) e para-clorofenilguanidil-1,6-diguanidil-hexano (PCGH). Este estudo visou analisar quimicamente os produtos formados e a presença de PCA no precipitado. Para isso, foi realizada a reação de 50 mL de solução de hipoclorito de sódio a 5% (NaOCl) e de 50 mL de solução de digluconato de clorexidina a 2% (CLX) em proporções iguais (1:1). O precipitado foi separado do sobrenadante e desidratado. A CLX pura, uma amostra do precipitado puro e outra amostra de precipitado com adição de PCA foram diluídas em dimetilsulfóxido deuterado e analisados em ressonância magnética nuclear 1D 1H (RMN) para verificar, por comparação, a presença da PCA no precipitado e para obtenção dos deslocamentos químicos dos produtos presentes no precipitado. Outra amostra do precipitado, de solução de CLX e de PCA foram separadas em cromatografia líquida de alta eficiência e analisadas em espectrômetro de massa (HPLC-ESI-MS) para identificação dos pesos moleculares dos compostos. A comparação do espectro do precipitado puro e do espectro do precipitado com adição de PCA permitiu analisar que o dubleto presente na região dos compostos aromáticos, referente à PCA, não está presente no espectro do precipitado puro demonstrando que não há PCA no precipitado. A análise do espectro de RMN do precipitado puro sugere que há formação de compostos com um e dois anéis aromáticos. Os espectros de massa permitem sugerir que há quebra da molécula de CLX, pelo hipoclorito de sódio, em sítios específicos (grupo biguanidil) que resultam na formação de fragmentos da molécula de clorexidina que se reorganizam formando oligômeros, ou seja, moléculas em que algumas unidades se repetem e, uma vez formadas, são estáveis e insolúveis em água. É possível concluir que no precipitado não há presença de PCA, sugerindo-se que haja PCGH e outros compostos com pesos moleculares maiores que o da clorexidina, denominados, neste estudo, C3, C4, C5, C6 e C7.

The reaction between chlorhexidine digluconate and sodium hypochlorite result in a precipitate, which according to the literature, is composed of para-chloroaniline (PCA), or para-chlorophenylurea (PCU) and para-chlorophenylguanidyl-1,6- diguanidyl-hexane (PCGH). The purpose of this study was to determine the chemical composition, the relative molecular weight of the compounds and whether PCA is formed in the precipitate. A 2% chlorhexidine digluconate solution was mixed in a 1:1 ratio with 5% NaOCl solution producing the precipitate. It was centrifuged, separed from the supernatant and dried. Pure CHX, the precipitate, as well as a mixture of precipitate and pure PCA were dissolved in deuterated dimetilsulfoxide and then analyzed using one-dimensional 1H nuclear magnetic resonance (MNR) to determine whether PCA was formed and to obtain precipitates chemical shifts. Other precipitate, CHX digluconate solution and PCA samples were analized using high performance liquid chromatography - electrospray ionization - mass spectrometry (HPLC-ESI-MS). Comparing the spectrum of the precipitate alone and precipitate with PCA allow to identify that PCA doublet peaks are not present in the spectrum of the precipitate alone, demonstrating that there are no PCA in the precipitate. NMR spectrum of the precipitate alone suggests that there is compounds with one and two aromatic rings. Mass spectra suggests that breaks in chlorhexidine molecule on specific sites (biguanidil groups), by sodium hypochlorite, results in fragments that forms oligomers molecules in wich some units are repeated and, once formed, are stable and insoluble in water. On the basis of this study, there is no PCA in the precipitate and suggesting that there may be other compounds like PCGH and others compounds, all of which are bigger in size than CHX, called, in this study, C3, C4, C5, C6 and C7.

Understanding and managing dentin hypersensitivity.

Dental hygienists frequently encounter clients who present with one or several sensitive teeth. These clients often rely on the dental hygienist to help determine the cause and to provide supportive treatment to relieve their discomfort. Therefore, it is essential for dental hygienists to fully understand the complexity of dentin sensitivity, be well informed about treatment approaches, and have an appreciation of the difficulties inherent in designing and conducting clinical hypersensitivity trials. Difficulties in designing hypersensitivity research have precluded a definitive answer concerning a best treatment approach. The purpose of this course is to present dental hygienists with current information about the pain of sensitive teeth and the associated differential diagnosis. The theory of pain transmission, etiology of dentin sensitivity, professional and self-care treatment modalities, and natural remission of tooth sensitivity will be discussed. Tooth and pulp biology will be reviewed as a means of explaining treatment and management approaches. At completion of this course, as measured by a post-test, participants with be prepared to apply the knowledge gained to their evidence-based practice to positively impact the oral health of their clients.

Shear bond strength of 4th & 5th generation dentin bonding agents in the presence and absence of moisture. An in vitro study.

Extracated human molars were used for the study, flat dentinal surfaces were prepared on the occlusal surfaces, and then 4th and 5th generation dentin bonding agents were used in dry and moist conditions to bond composite resin onto the flat dentin surfaces. Shear Bond Strength was measured using Instron Universal Testing machine. Failures were recorded as adhesive, cohesive and mixed. Bond strength was highest in moist condition, because the moist surface permits more porous collagen network and hence greater infiltration of adhesive monomers, than do surfaces that are air dried. Moreover, those dentin bonding agents whose primers are based on acetone show improved bond strength, because acetone aggressively pursues and displaces water in the substrate, resulting in the primer resin being carried into tissue channels and porosities. When the dentin is air dried, the water that is supporting the collagen network evaporates causing the collagen network to collapse network is greatly reduced, which in turn decreases the premeability of intertubular dentin to adhesive resin and as a result causes decrease in bond strength. 5th generation dentin bonding agent showed significant improvement in the moist dentin bond strength.

The permeability of the dentine and other tissues that are exposed at the tip of a rat incisor.

The tissues that form the incisal surface of a rat incisor include dentine, an atubular calcified tissue which lines the last-formed dentine, and calcified pulp remnants. The permeability of these tissues was investigated in vitro and in vivo using Evans blue dye. The incisal surface was prepared by etching it with acid or removing 1 mm by fracturing or with a diamond disc followed by etching. In some cases, 1.5-3.0 mm was removed to expose the soft tissue of the pulp. The dye was applied for 30 min, then longitudinal sections of the crown were cut and examined microscopically to determine the extent to which the dye had diffused into the underlying tissues. In only those teeth in which the dye had been applied direct to the pulpal soft tissue could any be detected below the exposed tooth surface. In previous experiments, it was found that both cat and human dentines were freely permeable to Evans blue when they were tested in vitro. It is concluded that the dentine and other tissues that form the incisal surface of a rat incisor are less permeable than cat or human dentine.

A permeability barrier to lanthanum and the presence of collagen between odontoblasts in pig molars.

Previous experiments in rat incisors indicate that the odontoblasts form an impermeable barrier which prevents fluid movement between pulp and dentine. The permeability of the odontoblast layer has now been investigated in pig molars which are more analogous to human teeth. The heads and necks of anesthetised piglets were perfused intra-arterially with lanthanum nitrate in Ringer's solution or with Ringer's solution alone. Molar tooth germs were removed, sliced, fixed by immersion and embedded in resin. Ultrathin sections including pulp and dentine were examined by transmission electron microscopy. Fenestrated capillaries were permeable to the electron dense lanthanum which thus entered the extracellular space between the odontoblast cell bodies. The lanthanum was excluded from predentine indicating that a barrier to permeability is present. In the above specimens and in others from 2 animals which were fixed by perfusion fixation, longitudinally oriented bundles of collagen fibrils were found passing from dentine through predentine into the odontoblast layer. Longitudinal collagen was also present between odontoblast cell bodies and entering the pulp at their basal ends. This suggests that classical von Korff fibres are present during primary circumpulpal dentinogenesis. In some sections longitudinally oriented collagen was absent. The junctions showed features of classical tight junctions but open tight junctions containing longitudinal collagen were also observed, suggesting that the junctions may modulate. Despite a trace of evidence that lanthanum can leak through adjacent to longitudinally penetrating collagen we concluded that the biological permeability barrier is maintained. The presence of the barrier indicates that other than the longitudinal collagen fibrils of which the source is unknown, all molecules incorporated into dentine are deposited there by the odontoblasts. An advantage of the barrier may be that it provides a closed environment for the orderly process of matrix deposition and mineralisation of dentine.

Albumin interaction with caries-like lesions in bovine enamel.

The exposure of bovine enamel to an albumin-containing demineralizing solution results in penetration of protein into the porous enamel. Washing of this albumin-containing enamel results in a complete (low pretreatment albumin concentrations) or partial removal of the albumin (pretreatment concentrations greater than or equal to 200 micrograms/ml-1). Subsequent exposure to increasing salt concentrations of fluoride, phosphate, calcium or chloride shows a partial removal of albumin at fluoride or phosphate concentrations of 75 mM while complete removal occurred at 150-200 mM fluoride or phosphate. Exposure to either calcium or chloride, even at 3 M concentrations, showed a negligible albumin release. It is proposed that protein removed at high fluoride or phosphate concentrations is bound by a strong interaction between protein-carboxyl groups and calcium on the surface of the enamel mineral. The partial removal of albumin released at low fluoride or phosphate concentrations indicates an enamel-albumin interaction by means of Ca-bridging between protein-carboxyl groups and mineral phosphates. Finally, it is suggested that salt-free washing removes albumin that has lost its native form upon binding to the partially dissolved crystallites of the enamel. It is concluded that enamel is mainly protected from demineralization by the inhibitory effects of protein penetrated into the pores, in addition to possible protection by the pellicle on the surface.