Prevention Of Erosive Tooth Wear Research Articles

Toothpaste containing TiF4 and chitosan against erosive tooth wear in situ.

ObjectiveThis study compared the protective effect of an experimental TiF4/Chitosan toothpaste with a commercial toothpaste on the prevention of erosive tooth wear (ETW) in situ. MethodsFifteen subjects took part in this crossover and double-blind study, in which they wore a palatal appliance containing 4 bovine enamel and 4 dentin in 3 phases (5 days each). Half of the samples were subjected to erosive challenges (90 s in 0.1 % citric acid, pH 2.5, 4 times/day), and the other half to erosive plus abrasive challenges (15 s plus 45 s of contact, 2 times/day). The phases corresponded to the application of the different toothpastes: 1) TiF4 (1400 ppm F−) plus Chitosan, 2) Elmex®, Erosion Protection (1400 ppm F−, Chitosan), and 3) Placebo (negative control). Tooth wear was measured using contact profilometry (μm) and submitted to two-way RM ANOVA/Tukey test (p < 0.05). ResultsNo significant differences were detected between the experimental and commercial toothpastes, regardless of the challenge on both tissues. Both significantly reduce ETW compared to negative control (p < 0.0006). Tooth wear was increased by brushing only on eroded enamel (p < 0.01), but not on dentin (p = 0.6085). TiF4/Chitosan [erosion 2.98 ± 1.12 μm vs. erosion and abrasion 3.12 ± 1.33 μm] and Elmex® toothpastes [erosion 2.35 ± 0.93 μm vs. erosion and abrasion 2.98 ± 1.0 μm] minimized the impact of brushing compared to placebo on enamel [erosion 4.62 ± 1.48 μm vs. erosion and abrasion 5.15 ± 1.50 μm]. ConclusionsTiF4 plus chitosan toothpastes showed to be effective in minimizing the ETW as the commercial toothpaste is in situ. Clinical RelevanceThe experimental toothpaste has similar effect against ETW compared to the commercial toothpaste. Considering the increased ETW prevalence worldwide, this result supports clinical trials and a possible application of this experimental anti-erosive toothpaste in the future.

EBD spotlight: The role of calcium in the prevention of erosive tooth wear: a systematic review and meta-analysis

EBD spotlight: The role of calcium in the prevention of erosive tooth wear: a systematic review and meta-analysis

The role of calcium in the prevention of erosive tooth wear: a systematic review and meta-analysis.

The loss of hard dental tissue due to recurrent acid challenges and mechanical stresses without bacterial involvement is known as erosive tooth wear (ETW). Many studies in the literature have concentrated on variables that may affect the ETW process and prevent its occurrence or reduce its advancement. However, to date, no previous systematic review has evaluated the role of calcium in preventing ETW. Therefore, the purpose of the present systematic review was to review and critically appraise the scientific evidence regarding the role of calcium formulations in the prevention of ETW. The review protocol was registered in the PROSPERO international prospective register of systematic reviews (Ref: CRD42021229819). A literature search was conducted in electronic databases to identify in situ randomized controlled trials evaluating the prevention of ETW following the application of calcium formulations. The outcomes studied included mean enamel loss, surface microhardness, surface roughness, mean erosion/softening depth, mineral loss/precipitation and remineralization. Study characteristics and outcomes of included studies were summarized. Cochrane's risk-of-bias tool 2.0 was used to assess the quality of eligible studies, and meta-analysis using a random effects model was performed. The search retrieved 869 studies of which 21 were considered eligible. Regarding the results of the quality assessment for potential risk of bias in all included studies, overall, 5 studies were considered as being at low risk, another 12 at unclear risk and 4 at high risk of bias. The findings of the studies showed that the addition of calcium in juice drinks led to reduced enamel loss, with blackcurrant juice presenting 2.6 times statistically significant less enamel loss compared to orange juice (p = 0.0001, I2 = 89%). No statistically significant difference in mean surface microhardness of eroded enamel was recorded between chewing gum with or without casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) (p = 0.31, I2 = 71%). Contradictory were the results regarding the effect of milk and CPP-ACP pastes on prevention of ETW. Calcium formulations play an important role in ETW prevention, mainly through their addition to acidic drinks.

Protective effect of anti-erosive solutions enhanced by an aminomethacrylate copolymer

ObjectiveTo investigate if an aminomethacrylate copolymer (AMC) could potentiate the anti-erosive effect of solutions containing sodium fluoride -F (225 ppm F−) and sodium fluoride associated to stannous chloride -FS (800 ppm Sn2+). MethodsThe experimental solutions (F, FS, AMC, AMC + F, AMC + FS, and deionized water-DW as negative control) were tested in the presence of acquired pellicle. Polished bovine enamel specimens (n = 13/group) were submitted to an erosion-rehardening cycle (2 h immersion in human saliva, 5 min in 0.3 % citric acid, 1 h in human saliva, 4×/day, 5 days). Treatment with the solutions was performed for 2 min, 2×/day. The rehardening (%Re) and protective (%Prot) potential of the solutions were assessed in the beginning of the experiment, and the surface loss (SL) by contact profilometry after 5 days. Additional bovine specimens (n = 5/group) were prepared to evaluate the contact angle on the treated enamel surface. The zeta potential of the dispersed hydroxyapatite (HA) crystals after the treatment with the solutions was also measured (n = 3/group). Data were statistically analyzed (α = 0.05). ResultsThe association with AMC improved the %Re and the %Prot for W and F, but not for FS. The results of SL were: AMC + F = AMC + FS < AMC < FS < F < DW. The presence of AMC significantly reduced the contact angle on enamel surfaces. The HA presented a strong negative surface charge after the treatment with DW, F and FS, whereas after the treatment with the solutions containing AMC it became positive. ConclusionAMC has potential to enhance the anti-erosive effect of fluoride solutions. Clinical significanceThe aminomethacrylate copolymer (AMC) may be a promising agent to be added to oral care products for the prevention of erosive tooth wear.

Anti-erosive effect of rinsing before or after toothbrushing with a Fluoride/Stannous Ions solution: an in situ investigation: Application order of Fluoride/Tin products for erosive tooth wear

Objective: To evaluate the impact of the application of a F-/Sn2+-containing mouthrinse before or after toothbrushing with a F-/Sn2+/chitosan toothpaste on the progression of erosion/abrasion on enamel and dentin. Methods: This crossover in situ study had five arms: Control (toothbrushing without toothpaste), Brushing (toothbrushing with toothpaste), Brushing + Rinsing, Rinsing + Brushing, and Rinsing (without toothbrushing). Fifteen subjects used removable mandibular appliances containing 3 enamel and 3 dentin specimens, which were subjected to erosion-abrasion cycling of 60 min salivary pellicle formation followed by 5 min extra-oral erosion with 1% citric acid (4x/day for 5 days). Treatments were performed in situ after first and last erosive challenges with rinse (10 ml; 30 s) and/or toothbrushing with/without toothpaste (with electric toothbrush; 5 s per specimen; total 2 min contact with slurry). Surface loss (SL) was evaluated with an optical profilometer. Data were analyzed by two-way repeated measures ANOVA and Tukey tests (α = 0.05). Results: The Control showed the highest SL (mean ± SD for enamel: 24.58 ± 11.32; dentin: 32.32 ± 10.10; all μm). Rinsing alone resulted in significantly lower SL value (enamel: 8.30 ± 4.96; dentin: 16.15 ± 8.29) compared with arms that applied toothpaste, except Brushing + Rinsing. None of the arms that underwent toothbrushing with the toothpaste differed from each other (p > 0.05). Dentin specimens showed significantly higher SL values than enamel (p < 0.001). Conclusion: The order of treatment applications had no influence on their anti-erosive effect; however, toothbrushing with F-/Sn2+/chitosan toothpaste reduced enamel surface loss. Additional rinsing with F-/Sn2+ mouthrinse did not offer improved protection.Clinical significance: The use of fluoride- and stannous- containing toothpastes and mouthrinses is an important approach in the prevention of erosive tooth wear. Further evidence is needed to support the benefit of combining these products against this condition.

Effect of a Single Application of CPP-ACPF Varnish on the Prevention of Erosive Tooth Wear: An AAS, AFM and SMH Study.

The aim of this study was to investigate the in vitro effect of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and fluoride-containing varnish on prevention enamel erosive tooth wear. A total of 28 enamel samples were prepared from human molars, divided into four groups: CPP-ACPF varnish, TCP-F varnish, NaF varnish, and deionised water. For the remineralisation process stimulated human pooled saliva was used. After treatment, all enamel samples were exposed to 10 ml of Coca Cola. Ca++ release was determined by atomic absorption spectroscopy (AAS). The surface topography was evaluated by atomic force microscopy (AFM). Surface microhardness of enamel was analysed and SMHR % (surface microhardness reduction ) was calculated. Data were analysed with repeated measures analysis of variance (ANOVA). Deionised water demonstrated a statistically significantly higher Ca+2 release compared to those of groups NaF > fTCP > CPP-ACPF, respectively (p <0.01). All groups measured for root-mean-square-roughness (Rrms) showed a statistically significantly difference of 6 × 6 μm2 and 12 × 12 μm2 enamel area (p <0.05) compared with a negative control group. CPP-ACPF varnish showed rougher surfaces than all remineralisation groups. SMHR % of enamels were as follows: CPP-ACPF < fTCP < NaF < deionised water (p <0.01). According to the findings of this study; CPP-ACP containing agents have a statistically statistically significant effect on preventing dental erosion. Among these, CPP-ACPF-containing remineralisation agents have the most effect on the remineralisation process.

Effect of silver diamine fluoride on the prevention of erosive tooth wear in vitro

ObjectivesTo investigate the ability of silver diamine fluoride (SDF) to prevent erosive tooth wear in enamel and dentin. MethodsSDF (38 %) was compared to deionized water (DIW, negative control), potassium fluoride (KF, fluoride control), silver nitrate (AgNO3, silver control), and fluoride varnish (FV, clinical reference) using erosion and erosion-abrasion cycling models. Bovine enamel and dentin slabs were embedded in resin blocks. Two resin blocks were glued to form study blocks (n=8, per treatment), one for erosion and the other for the erosion-abrasion model. The blocks were treated once and then subjected to a five-day cycling model, with five daily citric acid erosive challenges (0.3 % citric acid/pH 2.6). Abrasion was performed using a toothbrushing machine with a medium-abrasive silica as abrasive (erosion-abrasion model only). Artificial saliva was used to remineralize the specimens after erosion/abrasion and as storage media between cycles. Surface loss (SL) was determined by non-contact profilometry. Data were analyzed using ANOVA (α=0.05). ResultsBoth eroded-abraded enamel and dentin specimens exhibited significantly more SL in all treatment groups than the only eroded ones (p<0.001). For dentin, both AgNO3 and DIW groups had significantly more SL than SDF, KF, and FV groups (p<0.001), for both models. For enamel, specimens had more SL in both AgNO3 and DIW groups compared to SDF, KF, and FV groups, in the erosion model. When enamel specimens were subjected to erosion-abrasion, FV resulted in the least SL (p<0.001). ConclusionSDF was effective in reducing dental erosion on both substrates, but dental erosion-abrasion only on dentin. Clinical significanceSDF may become a viable intervention for ETW prevention in dentin (e.g. exposed roots) once its efficacy has been confirmed under clinical conditions.

Antierosive Effect of Topical Fluorides: A Systematic Review and Meta-Analysis of In Situ Studies.

BACKGROUND:The effectiveness of the application of topical fluorides in prevention of erosive tooth wear has been an issue of controversy in the literature. The objective of this systematic review was to assess in situ studies investigating the effects of using topical fluorides on prevention of erosive tooth wearMATERIAL AND METHODS:Two electronic databases PubMed/MEDLINE and Cochrane Central Register of Controlled Trials were searched. Eligibility criteria included in situ-controlled studies that assessed the effect of the erosive process without additional tooth brushing. The search involved English-written articles only. A total of 684 potentially relevant titles and abstracts were found after removal of duplicates, of which 22 full-text articles were selected. Seventeen studies were included in the qualitative synthesis of which 6 studies included in the meta-analysis. The following data were obtained for each study: authors, year of publication, country, study design, periods of study, duration, blinding, interventions (type/concentration/form), tooth substrate, location of the intraoral appliance, number of samples attached to each appliance, type of acidic media used for erosive challenge, duration of erosive challenge, subjects (number/age/sex), reported side effects -if any-, measuring device, amounts of tissue loss.RESULTS:The risk of bias of the included studies was assessed using the Cochrane Collaboration tool for assessing the risk of bias. A meta-analysis of the present study was performed using Comprehensive Meta-Analysis version 2.2.048 software.CONCLUSION:The use of oral hygiene products containing AmF/NaF/SnCl2 or NaF may be effective in the prevention of erosive tooth wear.

Erosive tooth Wear in special Olympic athletes with intellectual disabilities

BackgroundSpecial Olympics (SO) events represent an opportunity to obtain considerable information regarding intellectual disable (ID) patients. Studies done with SO data have shown an overview of the oral health status of these athletes; however, no information exists regarding the erosive tooth wear (ETW). Therefore, the aim of this study is to determine the presence and severity of ETW in athletes with ID who participated in the SO Belgium 2016.MethodsThe study population consisted in 232 athletes with ID who participated in the SO special smiles program, Belgium 2016. For analysis, the sample was divided in three groups: a) athletes with ID under the age of 25 not diagnosed with Down Syndrome (DS) (n = 174), b) athletes with DS under the age of 25 (n = 39) and c) athletes with DS from 25 and older ages (n = 58). Two calibrated dentists performed dental examinations using the Basic Erosive Wear Examination Index (BEWE). The BEWE sum > 0 was used to determine prevalence of ETW. Severity was determined by two- indicators: 1) By risk levels (low, medium and high risk) proposed by the BEWE index, and 2) by the highest score reached per subject in at least one tooth (BEWE1, 2 or 3). Chi-square test and Mann-Whitney U test were used to detect significant differences among different groups (p < 0.05).ResultsThe prevalence of ETW for young athletes with ID was 51.14%. Within these athletes, the DS group presented a significant higher mean BEWE sum (4.67, SD 5.64) and prevalence of ETW (69.2%BEWE> 0) when compared to athletes without DS (mean BEWE sum: 1.96, SD 3.47 and 46.3% BEWE> 0; p < 0.05). Furthermore, a significantly higher percentage of athletes with DS were considered at high risk of ETW (p < 0.05).ConclusionsAs a conclusion, half of the young athletes with ID presented at least one affected surface with ETW. The recorded prevalence and severity of ETW for the younger group of athletes with DS was distinctly higher than the athletes with ID not having DS. This shows the need to generate knowledge in order to provide correct management and prevention of erosive tooth wear in populations with ID.

Evaluation of the effectiveness of olive oil on the prevention of dental erosion: An In vitro study

Aim: The aim of this study was to explore the anti-erosive effect of olive oil against citric acid on bovine teeth and to compare the effectiveness with that of fluoride varnish. Materials and Methods: An observational analytical cross-sectional study among forty recently extracted bovine incisor teeth. From each tooth, a cubic of 4 mm × 4 mm was cut. Five surfaces of the cubic were coated by nail varnish leaving only the enamel window uncovered. The specimen was divided into four groups randomly: Group 1: five teeth (control group) nothing used, Group 2: five teeth immersed in olive oil for 6 h, Group 3: five teeth immersed in olive oil for 48 h, and Group 4: 10 teeth immersed in fluoride varnish 48 h. Then, each specimen was immersed in citric acid (pH: 2.3) for 15 and 30 min. The amount of calcium dissolved was measured by atomic absorption spectrophotometer. Different variables were statistically compared by t-test and ANOVA test with the level of significant set at P≤ 0.05. Results: The mean of calcium dissolution among the control group at 15 min was 2.8 mg/dl, while dissolution in 30 min was 6.1 mg/dl. When comparing the effect of exposure time duration of all specimens in citric acid, it was found that calcium dissolution increased in 30 min exposure than in 15 min exposure. Emersion of teeth in olive oil for 6 h was effective in reducing enamel erosion when exposed to citric acid 1% at 15 min, while in 30-min exposure to citric acid was less effective and to a lesser degree than fluoride varnish (sodium fluoride). Conclusion: Bovine teeth immersed in olive oil for 6 h resist the erosive effect of citric acid exposure for 15 min. Olive oil has less effect on the prevention of erosive tooth wear when compared to fluoride varnish.

Efficacy of toothpastes in the prevention of erosive tooth wear in permanent and deciduous teeth

To evaluate the erosive preventive effect of toothpastes in permanent (PT) and deciduous teeth (dt). Enamel samples were divided into five groups (n= 20): G1: placebo toothpaste; G2: NaF toothpaste; G3: AmF-NaF-SnCl2 anti-erosion toothpaste; G4: SnF2-toothpaste; and G5: NaF anti-erosion toothpaste for children. The samples were exposed to five erosion-abrasion cycles (artificial saliva incubation; 3min in 1% citric acid; 2min in slurry, toothbrush abrasion, 50 strokes, 200g). Surface microhardness (SMH), surface specular reflection intensity (SRI), and cumulative surface loss (CSL) were measured. Comparisons among toothpastes were evaluated using Kruskal-Wallis tests and comparisons between PT and dt were evaluated using Wilcoxon's rank sum test. G1 exhibited significantly lower SMH values in PT than the other toothpastes (p< 0.05), with no significant differences among the others groups. In dt, G1 and G4 exhibited significantly different values than the other groups (p< 0.05). G4 exhibited lower values of SRI in both types of teeth. Deciduous teeth presented significantly higher SRI than PT (p< 0.05), except for G3. Deciduous teeth generally presented higher CSL than PT, except for G3. Deciduous teeth were more prone to mineral loss than permanent teeth. G5 exhibited better efficacy for both teeth, while G3 exhibited a better preventive effect only for deciduous teeth. Erosive tooth wear prevalence in children is growing and deciduous teeth are more susceptible than permanent teeth. Considering this, it is important to know the preventive effect of different toothpastes in an initial erosion-abrasion model.

Prevention of erosive tooth wear: targeting nutritional and patient-related risks factors.

This article provides an overview of the nutritional and patient-related risk factors involved in the aetiology of erosive tooth wear (ETW) and the preventive strategies to counteract them. The first step is to diagnose clinical signs of ETW and to recognise causal factors. Low pH and high buffer capacity of foods/drinks are the major risk factors, while the calcium concentration is the main protective factor. Reduction of frequency of consumption and contact time of erosive foods/drinks with the teeth, use of straws appropriately positioned and consumption of dairy products are advisable. Oral hygiene has a role in the development of ETW, however, postponing toothbrushing is not clinically advisable. In cases of drug abuse, chronic alcoholism, GERD or bulimia, the patient must be referred to a doctor. Immediately after vomiting, patients might be advised to rinse the mouth. Saliva has an important protective role and patients with reduced salivary flow can benefit from the use of chewing gum. Recent studies have focused on improving the protective capacity of the acquired pellicle as well as on the role of protease inhibitors on dentine erosion. However, the degree of evidence for these preventive measures is low. Clinical trials are necessary before these measures can be recommended.