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PubMed2006

The role of erosion, abrasion and attrition in tooth wear.

There is increasing clinical awareness of erosion of enamel and dentine by dietary acids and the consequent increased susceptibility to physical wear. Enamel erosion is characterized by acid-mediated surface softening that, if unchecked, will progress to irreversible loss of surface tissue, potentially exposing the underlying dentine. In comparison, dentine erosion is less well understood as the composition and microstructure are more heterogeneous. Factors which affect the erosive potential of a solution include pH, titratable acidity, common ion concentrations, and frequency and method of exposure. Abrasion and attrition are sources of physical wear and are commonly associated with tooth brushing and tooth-to-tooth contact, respectively. A combination of erosion and abrasion or attrition exacerbates wear; however, further research is required to understand the role of fluoride in protecting mineralized tissues from such processes. Abrasive wear may be seen in a wide range of patients, whereas attritive loss is usually seen in individuals with bruxism. Wear processes are implicated in the development of dentine hypersensitivity. Saliva confers the major protective function against wear due to its role in pellicle formation, buffering, acid clearance, and hard tissue remineralization. This review focuses on the physiochemical factors impacting tooth wear.

Dental Enamel↗
PubMed1998

[Velocity of erosion and factors that modify human tooth demineralization in vitro].

Velocity of erosion on human teeth exposed to a carbonated beverage as a function of time and temperature has been studied in vitro, as well as the effect of the experimental formation of a acquired pellicle and the influence of the inclusion of either F or saliva on the dissolving capacity of beverage. During the first stage of exposition, erosion as a function of time showed a biphasic curve, being the rate low during the first 10 minutes time; thereafter, velocity increased and remained stable until the 60 minute incubation period finished. At the second stage, demineralization followed a monophasic curve, displaying a stable rate until the end of it. At the initial stage, molar ratio Ca/P was much less than that corresponding to hydroxyapatite (approximately 1.67); however, as exposition to erosive beverage was prolonged, the former ratio reached values compatible with this mineral species. F or saliva incorporation together with the experimental formation of the acquired pellicle significatively reduced beverage demineralizing capacity (p < 0.0001). This finding introduces the possibility of attenuating such erosive capacity of carbonated beverages by including not excessively toxic fluoride quantities.

Adult↗
PubMed2005

Structure, attachment, replacement and growth of teeth in bluefish, Pomatomus saltatrix (Linnaeus, 1776), a teleost with deeply socketed teeth.

Tooth replacement poses many questions about development, pattern formation, tooth attachment mechanisms, functional morphology and the evolution of vertebrate dentitions. Although most vertebrate species have polyphyodont dentitions, detailed knowledge of tooth structure and replacement is poor for most groups, particularly actinopterygians. We examined the oral dentition of the bluefish, Pomatomus saltatrix, a pelagic and coastal marine predator, using a sample of 50 individuals. The oral teeth are located on the dentary and premaxillary bones, and we scored each tooth locus in the dentary and premaxillary bones using a four-part functional classification: absent (A), incoming (I), functional (F=fully ankylosed) or eroding (E). The homodont oral teeth of Pomatomus are sharp, deeply socketed and firmly ankylosed to the bone of attachment. Replacement is intraosseus and occurs in alternate tooth loci with long waves of replacement passing from rear to front. The much higher percentage of functional as opposed to eroding teeth suggests that replacement rates are low but that individual teeth are quickly lost once erosion begins. Tooth number increases ontogenetically, ranging from 15-31 dentary teeth and 15-39 premaxillary teeth in the sample studied. Teeth increase in size with every replacement cycle. Remodeling of the attachment bone occurs continuously to accommodate growth. New tooth germs originate from a discontinuous dental lamina and migrate from the lingual (dentary) or labial (premaxillary) epithelium through pores in the bone of attachment into the resorption spaces beneath the existing teeth. Pomatomus shares unique aspects of tooth replacement with barracudas and other scombroids and this supports the interpretation that Pomatomus is more closely related to scombroids than to carangoids.

Animals↗
PubMed2004

Why is there and should there be more attention paid to dental erosion?

Fluoride delivered by fluoridation, toothpaste, and mouth rinses, combined with regular preventive professional and personal care, has given us a much better opportunity to keep our teeth for a lifetime. But in contrast to better preventive care, lifestyle changes leading to stress or dietary changes in what and how we drink and eat may adversely affect the esthetics and/or healthy look of our teeth. Surface-enamel wear can be described as the result as well as a chronicle of an individual's life. Components of wear--including abfraction, attrition, abrasion, and erosion--combine to characterize the lifetime of wear. The chemical-erosive-wear component appears to be changing because of modern cultural life choices. A number of literature reports conclude that excessive exposure to various acid sources can contribute to the chemical erosion of tooth surfaces. For example, the hydrochloric acid regurgitated from the stomach, the acid added to swimming pools to combat microbes, the citric and chelating carboxylic acids of fruit and fruit-based beverages, the phosphoric acid of cola beverages, and the acetic acid of vinegars used for salads all can contribute to the chemical erosion of tooth surfaces. While these acid sources have the potential to erode, our saliva and the manner in which we consume these substances can largely modify the erosive action of the acids they contain. With a better understanding of our personal lifestyle choices coupled with the educated guidance of our profession, we can help to reduce the opportunities for erosive wear to occur.

Acetic Acid↗
PubMed1989

Depth and area of dental erosions, and dental caries, in bulimic women.

Dental caries and the severity (depth) and area of erosions of tooth substance were studied in 11 bulimic subjects and 22 matched controls. Erosions were seen in 69% of the bulimics' teeth and in only 7% of the controls' (p less than 0.001). Depth of penetration was greater in the bulimics, extending even into the pulp, and the area of erosion was also larger. Scores for dental caries were higher in bulimics (mean DMFS 27.9, median 36) than in controls (mean DMFS 19.1, median 13.5), although the difference was not statistically significant. This study suggests that when erosions are present on the lingual surfaces of maxillary anterior teeth, as well as on the buccal surfaces of maxillary canines, premolars, and maxillary incisors, a diagnosis of bulimia is likely. Patients with these signs should be referred for medical help.

Adult↗
PubMed1966

Dental erosion.

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Humans↗
PubMed1969

Cervical erosion.

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Tooth Erosion↗
PubMed1991

Progression and surface ultrastructure of in vitro caused erosive lesions in human and bovine enamel.

Surface prismatic and aprismatic human enamel and unpolished or diamond-polished specimens of bovine enamel, with test and control surfaces on each studied block, were immersed in phosphoric acid containing cola beverage (pH 2.6) and citric or malic acid containing sports drinks (pH 2.8 and 3.4, respectively) for 15-180 min. The specimens were then prepared and studied in a JEOL 35C scanning electron microscope. In human aprismatic surface enamel an irregular type of dissolution was observed, with severely affected areas adjacent to less affected ones. Prismatic human and bovine specimens showed a characteristic dissolution where initial erosion after 15 min immersion was seen to affect specifically the prism sheath areas. Longer immersion caused dissolution of enamel prism cores followed by interprismatic areas. In bovine enamel malic acid affected least the surface ultrastructure when compared with citric and phosphoric acids after 15-30 min of immersion, but thereafter no difference was observed between the acids in causing erosion. Diamond-polished enamel was found more liable to erosion than non-polished enamel. Thus, the structure of enamel greatly modified the progression of in vitro caused erosion, in particular in human tooth specimens.

Animals↗
PubMed2006

Prevalence, incidence and distribution of erosion.

There is some evidence that the presence of erosion is growing steadily. Because of different scoring systems, samples and examiners, it is difficult to compare and judge the outcome of the studies. Preschool children aged between 2 and 5 years showed erosion on deciduous teeth in 6-50% of the subjects. Young schoolchildren (aged 5-9) already had erosive lesions on permanent teeth in 14% of the cases. In the adolescent group (aged between 9 and 17) 11-100% of the young people examined showed signs of erosion. Incidence data (= increase of subjects with erosion) evaluated in three of these studies were 12% over 2 years, 18% over 5 years and 27% over 1.5 years. In adults (aged between 18 and 88), prevalence data ranged between 4 and 82%. Incidence data are scarce; only one study was found and this showed an incidence of 5% for the younger and 18% for the older examined group (= increase of tooth surfaces with erosion). Prevalence data indicated that males had somewhat more erosive tooth wear than females. The distribution of erosion showed a predominance of occlusal surfaces (especially mandibular first molars), followed by facial surfaces (anterior maxillary teeth). Oral erosion was frequently found on maxillary incisors and canines. Overall, prevalence data are not homogeneous. Nevertheless, there is already a trend for more pronounced rate of erosion in younger age groups. Therefore, it is important to detect at-risk patients early to initiate adequate preventive measures.

Adolescent↗
PubMed1991

Scanning electron microscopic study of the effect of salivary pellicle on enamel erosion.

A bovine tooth model system was used to study the effect of experimental salivary pellicle on enamel erosion. Test blocks with varnish-covered control surfaces in each specimen were immersed into an acidic cola beverage (pH 2.6) for 120 min, either with or without the pellicle which was grown for 7 days by using clarified human saliva. After immersion, the pellicle was removed from some specimens with 10% sodium hypochlorite (20 h at 20 degrees C) and ultrasonic bath (60 s) to study its effect on erosion. All specimens were then studied in the scanning electron microscope. The specimens without pellicle (positive controls) showed gross erosion with prism core dissolution in all study blocks. The specimens with pellicle showed occasionally a film-like integument covering the apparently intact test surfaces with adjacent enamel surfaces slightly eroded. The erosion, however, was not of the same magnitude as in the positive controls. After removing the pellicle, the enamel surfaces showed pitted appearance of the prism heads; the demineralization seemed to attack more the prism sheath areas. Thus, salivary pellicle was found to protect the underlining enamel from erosion in vitro.

Animals↗
PubMed2004

Dental erosion: possible approaches to prevention and control.

OBJECTIVES: To discuss the key elements for establishment of a preventive programme for dental erosion. DATA AND SOURCES: The data discussed are primarily based on published scientific studies and reviews from case reports, clinical trials, epidemiological, cohort, animal, in vitro and in vivo studies. References have been traced manually or by MEDLINE. STUDY SELECTION: The aetiology, pathogenesis and modifying factors of dental erosion were reviewed. Strategies to either prevent the occurrence or limit the damage of dental erosion or protect the remaining tooth tissues from further erosive destruction were reviewed and discussed. These includes: (A) measures to (1) enhance remineralisation and acid resistance of enamel surface softened by erosive challenge, (2) reduce the erosive potential of acidic products, (3) enhance salivary flow, (4) protect and restore erosively damaged tooth, and (5) provide mechanical protection against erosive challenge. (B) Health education geared towards (1) diminution of frequency of intake of dietary acids, and (2) change of habits and lifestyles that predispose teeth to erosion development. CONCLUSIONS: It may be easier to gain patients' compliance with the advice that immediately following an acidic challenge, a remineralising agent, such as fluoride mouthrinses, fluoride tablets, fluoride lozenges or dairy milk, should be administered to enhance rapid remineralisation of the softened tooth surface as well as serve as a mouth refresher, or an alternative, a neutralising solution should be used. Effective counselling on erosion preventive regimes should involve all healthcare personnel, dentists, doctors, pharmacist, nurses/hygienists and clinical psychologists.

Acids↗