Diagnostic accuracy of clinical signs to detect erosive tooth wear in its early phase.

BACKGROUND: Agreement exists about most of the clinical features of erosive tooth wear, though no evidence supports their validity in diagnosing the condition. OBJECTIVE: This study aimed to determine the accuracy of clinical signs for diagnosing erosive tooth wear in a young adult general population. METHODS: We conducted a cross-sectional study of dental students. In the first session, two examiners independently determined the presence of erosive tooth wear based on glazed enamel surfaces, morphological changes on non-occlusal surfaces, flattening of convex areas, or any type of concavity. In the second session, one examiner recorded the presence of clinical signs according to the Tooth Wear Evaluation System. The diagnostic accuracy of each clinical sign, both alone and combined, was assessed by calculating their sensitivity and specificity for detecting erosive tooth wear and performing multivariate logistic regression models. RESULTS: Of the 147 participants (78 women and 69 men; median age, 22 years) we included, 76.2% had erosive tooth wear. The single clinical signs with greatest balance between the sensitivity and specificity were 'convex areas flatten' (63% and 71%, respectively) and 'dull surface' (47% and 89%, respectively). Multivariate logistic regression revealed that 'preservation of the enamel cuff' (odds ratio, 22) and the combination of 'smooth silky shining, silky glazed appearance, and dull surface' (odds ratio, 68) had the best predictive values. CONCLUSIONS: The most accurate clinical signs for detecting early erosive tooth wear were dull surface, flattened convex areas and preservation of the enamel cuff.

Evaluation of Struthio camelus eggshell as an in vitro alternative to extracted human teeth in preliminary screening studies on dental erosion.

OBJECTIVES: This in vitro work investigates the potential of ostrich eggshell as a substitute for extracted human teeth in preliminary screening studies on dental erosion. Additionally, it aims to demonstrate the potential of ostrich eggshell compared to human enamel in evaluating the efficacy of a preventive agent in protecting against dental erosion, using an artificial mouth model. METHODS: The experiment utilized 96 erosion testing specimens from each substrate, human enamel, and ostrich eggshell. The specimens were subjected to six different experimental regimens of increasing erosive challenge, simulating the consumption of an acidic drink. The acidic drink was delivered at a consistent volume and duration range. Both artificially stimulated and unstimulated saliva flowed throughout the experimental regimens. Surface hardness was measured using a Through-Indenter Viewing hardness tester with a Vickers diamond, while surface profiling was done using a surface contacting profilometer with a diamond stylus. An automated chemistry analyzer system was used to detect calcium and phosphate ions. RESULTS: The study found that ostrich eggshell specimens demonstrated predictable surface loss, hardness drop, and ion loss due to the acidic challenge. Meanwhile, enamel appeared to fall short in terms of surface hardness predictability. The transient hardness loss phase, which manifests as an overlooked decrease in surface hardness despite significant ion and structural loss, may explain this phenomenon. CONCLUSIONS: The experiment showed that assessing surface loss is essential in addition to hardness testing, particularly as certain experimental conditions may produce a false perception of tissue recovery despite the actual surface loss. By analyzing the response of ostrich eggshell specimens to erosive challenges, researchers were able to identify an "overlooked" reduction in hardness in enamel specimens. The differences in the structure, chemical composition, and biological response to erosion in the presence of artificial saliva between enamel and ostrich eggshell could explain their distinct behaviors.

Monitoring of erosive tooth wear: what to use and when to use it.

Although we are increasingly recognising the need to assess patients for accelerated rates of tooth wear progression, it is often difficult to do so within a feasible diagnostic window. This paper aims to provide evidence-based timelines which a diagnosing clinician can expect to assess tooth wear progression in study models, clinical indices, clinical photographs and visually with intraoral scans. It also discusses new technologies emerging for the quantitative assessment of tooth wear, timelines for diagnosis, and caveats in the 3D scan registration and analysis process.

Case Report: Case report: Rapidly progressing tooth wear dominated by intrinsic and extrinsic erosion.

Tooth wear is multi-factorial presenting as a combination of abrasion, attrition, and erosion. This case report represents a case of combined tooth wear in a 46-year-old Indo-Trinidadian male, with a predominant erosive component with both the clinical signs and features of intrinsic and extrinsic erosion. This patient case is unique since the wear predominated by dental erosion has occurred rapidly evidenced by the physical clinical appearance of a lack of compensation and the upper left premolars and molars relatively unaffected by the overall effects of tooth wear. This lack of compensation, where opposing teeth have not supra-erupted to maintain inter-arch stability, and the maintenance of occlusal vertical dimension on the left due to the non-worn posterior maxillary teeth, provides the benefit of simplifying subsequent restorative management. The medical and diet history corroborates the diagnoses of intrinsic and extrinsic erosion respectively. Complications noted with rapid tooth wear, such as dentine sensitivity and pulpal necrosis are known sequelae of tooth wear however the patient presented in this case report shows a concomitant high caries experience and poor oral hygiene. Cases such as the one presented here require not only comprehensive dental management, utilizing a restorative approach but also medical referral for confirmation of a diagnosis and management of gastroesophageal reflux disease. Inherent to the management of this patient should be a multidisciplinary medical and dental approach, with confirmation and management of the cause of the intrinsic erosion as well as restorative dental management, together with dietary counseling to mitigate the effect of intrinsic and extrinsic sources of acid on dental hard tissue. A key lesson learned from this case is the importance of history and targeted questioning when trying to determine the cause of tooth wear dominated by intrinsic and extrinsic erosion.

Dental Erosion Evaluation with Intact-Tooth Smartphone Application: Preliminary Clinical Results from September 2019 to March 2022.

Dental erosion is a process of deterioration of the dental hard tissue; it is estimated that about 30% of permanent teeth are affected in adolescence. The Intact-Tooth application allows for the better estimation of the problem, inserting itself in the diagnosis process, and better care and prevention for the patient. It provides him with scientifically validated protocols, which the patient can consult at any time. The purpose of this report was to conduct an initial evaluation on the use of the application, which has been available since September 2019: the analysis of the collected data allowed the first investigation of the incidence of the problem and the degree of susceptibility in the registered patients. Photos of 3894 patients with dental erosion were uploaded, through which the degree of susceptibility and the BEWE (basic erosive wear examination index) index could be assessed; of these, 99.72% had a susceptibility grade of 0 to 8, while 0.28% had a medium-high susceptibility grade; this result is related to the age and sex of the patients. The management of patients through the help of the application could promote the diagnosis and treatment of enamel diseases and encourage the self-learning of the learning machine, thanks to the number of clinical cases uploaded.

Agreement between two common tooth wear indices: Guidance on indications for use.

AIM: To assess the level of agreement between the simplified Tooth Wear Index (S-TWI) and the Basic Erosive Tooth Wear Examination (BEWE). METHODS: Data from 477 adult participants in the Adult Dental Health Survey were analysed. They were examined at home using the S-TWI and the BEWE, in that order. Agreement in the highest score at person, segment and sextant levels was measured with Gwek's agreement coefficient. The impact of the threshold used to define tooth wear (any [mild/moderate/severe] vs no wear, moderate/severe vs no/mild wear and severe vs no/mild/moderate wear) on their agreement was also evaluated. RESULTS: The prevalence of any, moderate/severe and severe tooth wear was 93.1%, 36.1% and 4.6% according to the S-TWI and it was 98.9%, 70.9% and 21.4% according to the BEWE, respectively. The agreement in the highest score between both indices was 0.745 (95% CI: 0.715, 0.775) at person level, 0.771 (95% CI: 0.746, 0.796) at the anterior segment level, 0.795 (95% CI: 0.766-0.824) for the upper anterior sextant and 0.905 (95% CI: 0.895-0.915) for the lower anterior sextant. The agreement between indices was higher for any wear than for severe wear at person, segment and sextant level. However, it was the weakest for moderate/severe wear regardless of the assessment level. CONCLUSION: The agreement between indices was high, especially when focusing on specific parts of the mouth (lower anterior teeth) and when using specific thresholds of tooth wear severity (any wear and severe wear). Agreement was constantly low when using the moderate/severe wear threshold. CLINICAL SIGNIFICANCE: When used as an epidemiological tool, the BEWE may report higher levels of tooth wear than the S-TWI. The BEWE may be a better screening tool whereas the S-TWI may be a better tool to use when determining secondary or tertiary care referral.

Differences in susceptibility of deciduous and permanent teeth to erosion exist, albeit depending on protocol design and method of assessment.

Controversial results showing that deciduous teeth are more susceptible to erosion than permanent teeth might be related to study designs. We investigated how different conditions (pH: 3.0, 4.0, 5.0; acid agitation: gentle or vigorous; acid exposure times: 1-5 min) affect the susceptibility of both teeth to erosion. Enamel specimens (90 deciduous, 90 permanent) were distributed into groups (n = 15 permanent, n = 15 deciduous) according to acid pH (pH 5, 4 or 3) and agitation (gentle or vigorous) during erosive challenge. Both milder (less incubation time, gentle agitation, and higher pH) and more severe (longer incubation times, vigorous shaking, and lower pH) conditions were used. Demineralization was measured by relative surface microhardness (rSMH) and calcium released to the acid. Demineralization increased gradually for both teeth with increasing incubation time, agitation (gentle or vigorous), and with decreasing acid pH. The differences between deciduous and permanent teeth depended on the protocol design and assessment method. Under milder conditions, demineralization was better detectable with rSMH. Under more severe conditions, differences were more perceptible with calcium analyses. Differences exist in the susceptibility to erosion between deciduous and permanent teeth, but they are only distinguishable when the appropriate assessment method is used for the specific erosive condition.

Tooth Wear Evaluation System (TWES) 2.0-Reliability of diagnosis with and without computer-assisted evaluation.

BACKGROUND: Tooth wear is a multifactorial process, leading to the loss of dental hard tissues. Therefore, it is important to detect the level of tooth wear at an early stage, so monitoring can be initiated. The Tooth Wear Evaluation System (TWES) enables such a multistage diagnosis of tooth wear. The further developed TWES 2.0 contains a complete taxonomy of tooth wear, but its reliability has not yet been validated. OBJECTIVES: The aim of the study was to examine in a randomised controlled trial (RCT) whether diagnoses made based on the TWES 2.0 are reproducible and whether this reproducibility is also achieved with computer-assisted diagnostics. METHODS: 44 dental students received extensive training in TWES 2.0 assessment and taxonomy. The students each evaluated at least 10 (of the present 14) anonymised patient cases using gypsum models and high-resolution intra-oral photographs according to TWES 2.0. One half initially evaluated on paper; the other half used dedicated software (CMDfact / CMDbrux). After half of the patient cases (5), the evaluation methods were switched (AB/BA crossover design). The diagnoses were then evaluated for agreement with the predefined sample solution. RESULTS: Evaluation of agreement with the sample solution according to Cohen's kappa indicated a value of 0.46 for manual (traditional) evaluation; and 0.44 for computer-assisted evaluation. Evaluation of agreement between examiners was 0.38 for manual and 0.48 for computer-assisted evaluation (Fleiss' kappa). CONCLUSION: The results of this study proved that the taxonomy of the TWES 2.0 has acceptable reliability and can thus be used by dentists. Accordingly, the system can be learned quickly even by untrained practitioners. Comparable results are achieved with computer-assisted evaluation.

Knowledge on and treatment practices of erosive tooth wear among Finnish dentists.

OBJECTIVES: To investigate Finnish dentists' knowledge on and means of recording, detecting and diagnosing erosive tooth wear (ETW). Treatment options and possible differences in treatment decisions between general and specialized dentists were also evaluated. MATERIALS AND METHODS: An electronic questionnaire was sent by e-mail to 3664 Finnish dentists. Respondents' gender, age, work experience, field of specialty, and practice location were requested. The questionnaire also included a patient case where the dentists were asked about their choice of treatment. Statistical analyses were performed using means, proportions, and cross tabulations. RESULTS: Response rate was 24% (n = 866). Almost all respondents (98.0%) recorded ETW in patient files, but only 4.1% used a detailed scoring system. Of the respondents, 64.4% usually found the cause of ETW. Use of carbonated beverages (84.3%), energy drinks (57.0%), and reflux disease (53.1%) were reported to be probable causes. The majority of the respondents (80.9%) usually assessed patient's dietary history while 1.9% evaluated saliva secretion rate. When asked about treatment decisions of ETW patients, the differences between general dentists and specialized dentists were not as obvious as hypothesized. CONCLUSIONS: This study suggests that the Finnish dentists who participated in this survey are able to detect and/or diagnose erosive tooth wear, but there is variation in recording it. The differences in treatment decisions between general dentists and specialized dentists seem to be moderate. The treatment practices for ETW are not established and further research to create clinical guidelines seems to be needed.

Contemporary diagnosis and management of dental erosion.

OBJECTIVE: This article is aimed at providing an overview of the topic of erosive tooth wear (ETW), highlighting the clinical signs, diagnosis, and management of dental erosion. OVERVIEW: With the increased prevalence of ETW, it is important that oral health professionals are able to recognize the early signs. Early clinical signs of dental erosion are characterized by loss of enamel texture, a silky glossy appearance, and sometimes a dulling of the surface gloss, referred to as the "whipped clay effect, cupping, and restorations 'standing proud'." The progression of ETW should be monitored by means of diagnostic models or clinical photographs. ETW can be as a result of acid attack of extrinsic or intrinsic origin. CONCLUSION: There is an increase of ETW that is being recognized by the profession. The first step in diagnosing and management is to recognize as early as possible that the process is occurring. At that point a determination of whether the primary etiology is either intrinsic or extrinsic should be made. If these findings are confirmed, appropriate prevention, and management strategies can be adopted followed by appropriate restorative therapy. CLINICAL SIGNIFICANCE: The prevalence of ETW continues to increase. It is therefore important that oral health care providers have a better understanding of the etiology, pathophysiology, and management of this condition. This review aims to provide the guidelines for diagnosis and management of dental erosion.

[Novel insights on the etiology, diagnosis and prevention of dental erosion].

Dental erosion is a progressive loss and damage of tooth hard tissues caused by contacting acidic substances. It is an occupational disease for workers who make acidic products such as acids, vinegar, etc. In the past decades, a rising of prevalence rate of dental erosion, especially in the youth groups, along with the change of dietary habits and the increased consumption of sweet and acidic diets, has attracted public's attention. This article reviews and analyzes the literature on the prevalence, etiology, prevention and treatment of dental erosion, so as to provide guidance for early diagnosis and treatment of dental erosion and support for making occupational disease prevention strategies.

Evaluation of Sugar Content and Erosive Potential of the Commonly Prescribed Liquid Oral Medications

Abstract Objective: To assess the total sugar content, endogenous pH, total soluble solids content (TSSC) and titratable acidity of the commonly prescribed long-term and short-term liquid oral medicines (LOM) for children and to compare the erosive potential with the total sugar content and total soluble solids of the LOM. Material and Methods: Twenty-three most commonly prescribed pediatric LOM were evaluated in-vitro for the cariogenic and erosive potential. Manufacturers' information on labels, endogenous pH, titratable acidity, TSSC, and the total sugar content was determined. Descriptive statistics and the Mann-Whitney U test were applied. Results: Overall, 22 LOM contained sugar. Only 3 LOM revealed the sugar content of the formulation but did not disclose the quantity (Cheston, Ventorlin and Eptoin). None of the samples revealed the sugar content as well as endogenous pH in their labels. The overall mean total sugar content was 6.92 ± 3.49 g/100ml, ranging from 3.40 ± 0.00 (corticosteroids) to 9.67 ± 0.61 (antitussive/expectorant). The mean endogenous pH for the total sample of medicines was 5.91 ± 1.51 (range of 3.5 to 10.3). Eptoin (0.013%) presented the lowest titratable acidity and Imol (1.171%) presented the highest titratable acidity with an overall mean of 0.40 ± 0.73. Omnacortil and Epilex presented the highest TSS content (19.3%), and Ventorlin presented the lowest TSS content (18.7%) with an overall mean of 18.97 ± 0.19. Over twelve medicines were identified to have the potential to cause dental erosion. No significant differences were seen in the total sugar content, total soluble solids, titratable acidity, and the endogenous pH between the short-term and long-term LOMs (p=0.145, p=0.263, p=0.067 and p=0.107), respectively. Conclusion: The pediatric LOMs showed the presence of the sugar, low endogenous pH, high titratable acidity and high total soluble solids.

Protein Profiles of Individuals with Erosive Tooth Wear

Abstract Objective: To determine if protein profiles identified in saliva could be used to determine risk and severity of erosive tooth wear. Material and Methods: Three types of saliva sampling were performed to obtain saliva from 34 18-year old individuals that received regular dental check-ups, along with clinical status of the dentition and risk factor related to erosive tooth wear using the VEDE scale. Protein profiles in saliva were determined using electrophoresis and the calculation of the percentage of a specific band at a specific molecular weight in relationship to the total protein in that sample (% of total) using molecular weight standards. This quantification was repeated for each protein band across a range of molecular weights for each sample to test for association with erosive tooth wear status. Results: There were no differences in the number of detectable proteins sourced from the parotid gland, nor the unstimulated and stimulated whole saliva. Five out of the 34 individuals had no signs of erosive tooth wear despite an acidic diet and were more likely to have proteins with molecular weight smaller than 1 KDa (p=0.03). Conclusion: There is potential for the use of protein profiling to determine risks for erosive tooth wear.

Comparative Effect of Calcium Mesoporous Silica Versus Calcium and/or Fluoride Products on the Reduction of Erosive Tooth Wear and Abrasive Enamel Lesion

Abstract Objective: To evaluate the effect of a calcium nanocompound on the reduction of erosive tooth wear and abrasion. Material and Methods: Bovine enamel specimens (BE), were randomly assigned to the following groups (n = 10): G1 = Calcium mesoporous silica nanoparticles (Ca2+MSNs); G2 = casein phosphopeptide-amorphous calcium phosphate (CPP-ACP, 2% CPP-ACP, GC®); G3 = casein phosphopeptide-amorphous calcium fluoride phosphate (CPP-ACFP, 2% CPP-ACP + 900 ppm F-, GC®); G4 = sodium fluoride NaF (900 ppm F-, positive control); and G5 = distilled and deionized water (negative control). Each product was applied to the exposed area for one minute, three times per day for three consecutive days, and followed by the immersion of the specimens in Sprite Zero™ - a low-pH solution (2.58) for five minutes (Coca-Cola™). After the first and last erosive challenges of the day, the specimens were submitted to abrasion in a toothbrush machine for 15 seconds (200 g/BE). The specimens were analysed using 3D non-contact optical profilometry, with tooth structure loss (TSL) measurements and scanning electron microscopy (SEM). TSL values were analysed by Kruskal-Wallis and Mann-Whitney tests (p<0.05). Results: There were no significant differences between G1 (10.95 µm) and G3 (10.80 µm) treatments for TSL values; however both resulted in significantly reduced TSL values compared with the G5 (16.00 µm) (p<0.05). The G4 (12.26 µm) showed no statistically significant difference when compared to the G5 (16.00 µm). The groups G1 and G3 presented higher surface preservation than the G5. Conclusion: Ca2+MSNs was effective for reducing tooth surface loss caused by erosive tooth wear and abrasion.

Early detection of enamel demineralization by optical coherence tomography.

Enamel is the outermost layer of the tooth that protects it from invasion. In general, an acidic environment accelerates tooth demineralization, leading to the formation of cavities. Scanning electron microscopy (SEM) is conventionally used as an in vitro tool for the observation of tooth morphology changes with acid attacks. Yet, SEM has intrinsic limitations for the potential application of in vivo detection in the early demineralization process. In this study, a high-resolution optical coherence tomography (OCT) system with the axial and transverse resolutions of 2.0 and 2.7 µm in teeth has been utilized for characterizing the effect of the acidic environment (simulated by phosphoric acid) on the enamel topology. The scattering coefficient and the surface roughness of enamel can be directly derived from the OCT results, enabling a quantitative evaluation of the topology changes with demineralization. The dynamic process induced by the acid application is also recorded and analyzed with OCT, depicting the evolution of the demineralization process on enamel. Notably, the estimated enamel scattering coefficient and surface roughness significantly increase with the application time of acid and the results illustrate that the values of both parameters after demineralization are significantly larger than those obtained before the demineralization, illustrating both parameters could be effective to differentiate the healthy and demineralized teeth and determine the severity. The obtained results unambiguously illustrate that demineralization of the tooth surface can be successfully detected by OCT and further used as an indicator of early-stage cavity formation.

Methods of assessment of early dentine erosion: a review.

Dentine erosion is an increasingly recognised problem, especially in aging population, and various methods have been utilised for its assessment. This narrative review was planned to summarise the methods for the assessment of the early stages of dentine erosion. Relevant original articles published in the English language from 2013 to 2017 were reviewed. Laboratory techniques and methods with in vivo potential were separately studied. It is evident that the assessment of early dentine erosion is complex and requires a combination of methods. For clinical evaluation, chemical analysis and optical methods show great potential but are in need of more validation.

Restorative Rehabilitation of a Patient with Generalized Non-Carious Cervical Lesions: Case Report / Rehabilitación restaurativa de un paciente con lesiones cervicales no-cariosas generalizadas: Reporte de un caso

ABSTRACT Non-Carious Cervical Lesions (NCCL) are a current problem of multifactorial origin that is associated with the loss of vertical occlusal dimension, hypersensitivity, loss of teeth, fractures, and many other pathologies that affect the masticatory function of the oral cavity. Identification of the etiological factors of NCCL comprises a key piece for the solution of the problem. Based on clinical scientific evidence related with the diagnosis, a restorative treatment must be planned according to the loss of dental structure in order to return function and aesthetics. The purpose of this case report was to describe a 54-year-old male patient who was diagnosed with generalized NCCL combined with occlusal vertical dimension loss. The protocol of the treatment process is described.

RESUMEN Las lesiones cervicales no cariosas (LCNC) son una problemática actual de origen multifactorial, la cual se ve asociada a la pérdida de dimensión vertical oclusal, hipersensibilidad, pérdida de dientes, fracturas y muchas otras patologías que afectan la función masticatoria de la cavidad bucal. La identificación de los factores etiológicos de las LCNC son piezas claves para la solución del problema. Basados en la evidencia científica clínica relacionado con el diagnóstico, se debe planificar un plan de tratamiento restaurativo que depende de la pérdida de la estructura dentaria para devolver la función y estética. El objetivo de este reporte de caso es describir a un paciente masculino de 54 años a quien se le diagnosticó LCNC generalizadas combinado con una pérdida de dimensión vertical oclusal. El protocolo de plan de tratamiento es descrito paso a paso.

Risk factors associated with oral manifestations and oral health impact of gastro-oesophageal reflux disease: a multicentre, cross-sectional study in Pakistan.

OBJECTIVE: Gastro-oesophageal reflux disease (GORD) is a relatively common disorder and manifests with extraoesophageal symptoms, such as dental erosions (DE), cough, laryngitis, asthma, and oral soft- and hard-tissue pathologies. This study aimed (1) to identify oral soft and hard-tissue changes in patients with GORD and (2) to evaluate these oral changes as indices for assessing GORD and its severity. SETTING: This cross-sectional study was conducted at four major tertiary care government hospitals, in two metropolitan cities of Pakistan. PARTICIPANTS: In total, 187 of 700 patients who underwent oesophago-gastro-duodenoscopy and having GORD were included in the study. Patients with GORD were divided according to the presence of DE into group A (with DE, chronic/severe GORD) and group B (without DE, mild GORD). Patients who were unconscious and had extremely limited mouth opening were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES: Abnormal conditions and lesions of the oral mucosa were recorded. The impact of oral hard and soft-tissue changes on the oral health-related quality of life was assessed using the Pakistani (Urdu) version of the validated Oral Health Impact Profile-14 (OHIP-14) instrument. RESULTS: Oral submucous fibrosis (66.3%), ulceration (59.4%) and xerostomia (47.6%) were significantly more common in group A (p<0.05). The prevalence of GORD was 26.7%, within which the prevalence of DE was 35.3%. Unhealthy dietary pattern, nausea/vomiting, oesophagitis, xerostomia, ulceration, gingivitis and angular cheilitis showed a statistically significant association with chronic GORD and DE. All subscales of OHIP-14 were positively correlated (p<0.05) in patients with GORD and DE, with notable impact on psychological discomfort (rs=0.30), physical disability (rs=0.29), psychological disability (rs=0.27) and functional limitation (rs=0.20). CONCLUSION: Patients with GORD and DE presented with more severe oral manifestations than did those with GORD and no DE. We recommend timely dental check-ups to assess the severity of both systemic and oral disease.

Current Concepts and Best Evidence on Strategies to Prevent Dental Erosion.

Dental erosion is a multifactorial condition associated with chemical, biological, and behavioral factors whereby a non-bacterial chemical process leads to an irreversible loss of dental structure. Consequences of this erosive process include painful sensitivity, susceptibility to further erosion, mechanical wear, changes in occlusion, exposure of dental pulp, and poor esthetics. Substantial evidence has revealed new insights to diagnosing early stages of dental erosion and enabling novel preventive approaches to control its progression. In the context of outpatient medical/dental practice, clinicians often encounter patients with progressive dental erosion. This article summarizes published research in this area of dentistry to suggest guidelines that are clinically oriented but scientifically fundamental. It is aimed at helping clinicians effectively integrate this information into their professional evaluations of dental erosion with regard to diagnosis, risk factors, clinical signs, assessment, and clinical preventive strategies and treatment. Clinicians should address patient diet habits, educate patients on prevalence data, and inform them regarding potential acidic interactions, such as medically induced acidic conditions, that may ultimately lead to tooth destruction. Prevention of dental erosion, including the recognition of initial erosive lesions and the implementation of the early intervention, involves the clinical expertise of both the dentist and physician.

Transtornos alimentares e manifestações orais em adolescentes / Eating disorders and oral manifestations in adolescents / Trastornos alimenticios y manifestaciones orales en adolescentes

Introdução:Os transtornos alimentares são distúrbios psiquiátricos debilitantes, caracterizados por desordem persistente nos hábitos alimentares ou nos comportamentos docontrole de massa corporal.Objetivo:Avaliar, dentre adolescentes de três escolas públicas de ensino médio em Natal-RN, a prevalência dos transtornos alimentares e descrevermanifestações odontológicas relacionadas.Metodologia:Estudo realizado em duas fases, utilizando-seum questionário autoaplicável,Body Shape Questionnaire-BSQpara selecionara amostra. Os selecionados foram submetidos a uma avaliação partindoda história médica pregressa e exame clinico odontológico, paradiagnosticar as manifestações orais presentes. Resultados:Fase 1: Dos 231 alunos que responderam o questionário, 9 foram selecionados. No exame clínico observou-seque 22,2% dos avaliados apresentavam perda inicial da textura da superfície dentária na face palatina do segundo sextante, em 77,7% constatou-se hipertrofia da glândula parótida, 66,6% obtiveram escore 2 no Registro Periodontal Simplificado (PSR) e 11,1% dos examinadostinhaqueilite angular. Na fase 2: Dos 264 estudantes que responderam ao BSQ, 29estavamabaixo dopeso,164jovens apresentavam peso ideal, 24 peso muito abaixo do normal, enquanto a situação de sobrepeso foi observada em 47 estudantes. Quanto aoquestionário 25 (9%)apresentaram algum grau de distúrbio de distorção de imagem corporal, dentre os quais 80% do sexo feminino e 20% do sexo masculino. Conclusões:Foram encontradosepisódios de regurgitação associados a má nutrição e incorreta higienização da cavidade oral que favoreceuo aparecimento de alterações bucais.As principais manifestações encontradas foram: erosão dentária (22,2%), hipertrofia das glândulas salivares parótidas (77,7%), escore 2 no Registro Periodontal Simplificado-PSR (66,6%) e queilite angular (11,1%).É fundamental instrumentalizar ocirurgião-dentista a reconhecer tais manifestações,atrabalhar comabordagem multidisciplinar visando a melhoria da qualidade de vida do jovem, tratando assequelas e ajudando-o a superar suas necessidades.A maiorlimitação do estudo foi o encaminhamento desses jovens para tratamento (AU).

Introduction: Eating disorders are debilitating psychiatric disorders characterized by persistent disorder in eating habits or body mass control behaviors. Objective: To evaluate, among adolescents from three public high schools in Natal-RN, the prevalence of eating disorders and describe related dental manifestations.Methodology: Two-phasestudy using a self-administered Body Shape Questionnaire-BSQ to select the sample. Those selected were submitted to an evaluation based on previous medical history and dental examination to diagnose the oral manifestations present. Results: Phase 1: Of the 231 students who answered the questionnaire, 9 were selected. In the clinical examination it was observed that 22.2% of the subjects had initial loss of tooth surface texture on the palate of the second sextant, 77.7% had parotid gland hypertrophy, 66.6%had score 2 in the Registry. Periodontal Disease (PSR) and 11.1% of those examined had angular cheilitis. In phase 2: Of the 264 students who responded to the BSQ, 29 were underweight, 164 young people were underweight, 24 underweight, while overweight was observed in 47 students. Regarding the questionnaire 25 (9%) presented some degree of body image distortion disorder, among which 80% were female and 20% were male. Conclusions: Regurgitation episodes associated with poor nutrition and poor oral cavity hygiene were found, favoring the appearance of oral alterations. The main manifestations found were: dental erosion (22.2%), parotid salivary gland hypertrophy (77.7%), Simplified Periodontal Record (PSR) score 2 (66.6%) and angular cheilitis (11.1%). . It is essential to instruct the dentist to recognize such manifestations, to work with a multidisciplinary approach aimed at improving the quality of life of young people, treating the sequelae and helping them to overcome their needs. The major limitation of the study was the referral of these young people for treatment (AU).

Introducción:los trastornos alimentarios son trastornos psiquiátricos debilitantes caracterizados por un trastorno persistente en los hábitos alimentarios o en los comportamientos de control de la masa corporal. Objetivo:evaluar, entre los adolescentes de tres escuelas secundarias públicas de Natal-RN, la prevalencia de los trastornos alimentarios y describir las manifestaciones dentales relacionadas. Metodología:Estudio de dos fases utilizando un cuestionario de forma corporal autoadministrado-BSQ para seleccionar la muestra. Los seleccionados fueron sometidos a una evaluación basada en el historial médico previo y el examen dental para diagnosticar las manifestaciones orales presentes. Resultados: Fase 1: De los 231 estudiantes que respondieron el cuestionario, se seleccionaron 9. En el examen clínico se observó que el 22.2% de los sujetos tenían una pérdida inicial de la textura de la superficie dental en el paladar del segundo sextante, el 77.7% tenía hipertrofia de la glándula parótida, el 66.6% tenía una puntuación de 2 en el Registro. La enfermedad periodontal (PSR) y el 11,1% de los examinados tenían queilitis angular. En la fase 2: de los 264 estudiantes que respondieron al BSQ, 29 tenían bajo peso, 164 jóvenes tenían bajo peso, 24 tenían bajo peso, mientras que se observó sobrepeso en 47 estudiantes. En cuanto al cuestionario 25 (9%) presentó algún grado de trastorno de distorsión de la imagen corporal, entre los cuales el 80% eran mujeres y el 20% hombres. Conclusiones:se encontraron episodios de regurgitación asociados con una nutricióndeficiente y una mala higiene de la cavidad oral, lo que favorece la aparición de alteraciones orales. Las principales manifestaciones encontradas fueron: erosión dental (22.2%), hipertrofia de la glándula salival parótida (77.7%), puntaje 2 del registro periodontal simplificado (PSR) (66.6%) y queilitis angular (11.1%). . Es esencial instruir al dentista para que reconozca tales manifestaciones, para trabajar con un enfoque multidisciplinario dirigido a mejorar la calidad de vida de los jóvenes, tratar las secuelas y ayudarlos a superar sus necesidades. La principal limitación del estudio fue la derivación de estos jóvenes para recibir tratamiento (AU).