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A case of severe dental erosion.
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Restoring erosion associated with gastroesophageal reflux using direct resins: case report.
Gastroesophageal reflux disease (GERD) is a condition where stomach acids are chronically regurgitated into the esophagus and oral cavity, resulting in pathology, such as esophagitis, varices or ulcers. Continual exposure of the teeth to these acids can also cause severe dental erosion. This condition frequently is asymptomatic, and the only evident sign may be the irreversible erosion of tooth structure. The dentist often is the first health care professional to identify the affected dentition. Knowledge of this cause and effect relationship between GERD and dental erosion will better prepare the practitioner to refer patients for appropriate diagnosis and treatment of the underlying medical condition and provide treatment for the affected teeth. This article presents a case report where dental erosion was present due to GERD. After management of the disease with medication, dental treatment of the eroded dentition is described, including diagnosis, treatment planning and restorative reconstruction.
ADOLESCENT ENAMEL DECALCIFICATION. REPORT OF A CASE.
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INHIBITION OF THE EROSIVE PROPERTIES OF WATER ICES BY THE ADDITION OF CALCIUM AND PHOSPHATE.
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Cervical enamel: a danger zone.
The British Standards Institutions's document (1974) recommending toothpaste specifications states that 'There is no evidence that any toothpaste ever produces a level of abrasion causing harm to dental enamel'. This paper questions the assumption that the enamel crown, especially at the cervical margin, is able to cope with modern dietary insult and a 'good' oral hygiene regimen, regardless of the enamel abrasivity of the dentifrice used. Once the enamel crown is breached the underlying dentine is sensitive and vulnerable to physical damage. In this work the potential rates of erosive and abrasive loss are related to the thickness of the protective enamel and to the relevance of fluoride treatments for adults. It is suggested that improvements in dental care and an increased tooth life expectancy now make the loss of tooth tissues at the cervical margin more important than is apparent at first sight.
Esthetic conservative restoration of cervical erosion.
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Quantitative analysis of the impact of the organic matrix on the fluoride effect on erosion progression in human dentine using longitudinal microradiography.
After an initial demineralisation, an intensive fluoridation is capable of inhibiting the erosive mineral loss in dentine completely, which might be related to the presence of the exposed organic dentine matrix. Aim of the present study was, therefore, to evaluate whether fluoride is also effective when the organic material is removed. The study was a cyclic de- and remineralisation model over 5 days in vitro. Samples from human coronal dentine were demineralised with citric acid (pH 2.3; 6 x 10 min per day) and intermittently stored in a remineralisation solution. Groups (n = 25 each) were defined as follows: Group 1: erosion only, no fluoridation; Group 2: erosion, alternately fluoridation with toothpaste (NaF; 0.15% F-; 3 x 5 min per day), mouthrinse (Olaflur/SnF2; 0.025 F-; 3 x 5 min per day) and gel (Olaflur/NaF; 1.25% F-; at Days 1 and 3 instead of one toothpaste application); Group 3: erosion and fluoridation as Group 2, organic material was continuously removed with collagenase (from Clostridium Histolyticum type VII, 100 U/ml) added to the remineralisation solution. Mineral content was monitored daily using longitudinal microradiogaphy. After fluoridation in the presence of collagenase, a linear increase in mineral loss (73.3 +/- 17.6 microm at Day 5) was observed, which significantly (P < or = 0.001) exceeded that of the control group (45.9 +/- 14.3 microm at Day 5). After fluoridation in the absence of collagenase, mineral loss ceased after the 2nd day (12.2 +/- 10.2 microm at Day 5) and was significantly lower compared to Groups 1 and 3 (P < or = 0.001). The results indicate that the dentine matrix is essential for the effectiveness of fluoride in dental erosion.
Dental erosion associated with asymptomatic gastroesophageal reflux.
An eight-year-old girl presented with severe erosion of the primary dentition and early erosion of the erupted permanent teeth. Although the pattern of erosion was consistent with that seen with acid erosion, the diagnosis could not be elucidated from the patient's symptoms, or medical or dental history. A 24-hour pH probe study documented severe gastroesophageal acid reflux. Oral salivary pH tested during sleep nightly for one week revealed low oral pH. Treatment with metoclopramide and ranitidine was instituted to decrease acid availability for reflux. Custom-fitted, maxillary and mandibular trays were fashioned to deliver sodium fluoride gel twice daily, and fissure sealants were placed in the hopes of retarding erosion of existing permanent teeth, as well as preventing similar erosion of erupting permanent dentition.
The Class V lesion--aetiology and restoration.
The aetiology of non-carious cervical lesions is discussed. These have been variously described as 'abrasion', 'erosion', 'abrasion/erosion', and 'idiopathic cervical'. However, many lesions do not fit the classical appearance or location of an erosive and/or abrasive origin, and there is increasing interest in the possible role of occlusal stress in their aetiology. Non-carious cervical lesions often require restoration, and there are essentially three options using tooth-coloured materials: a restorative glass ionomer cement, a liner/base glass ionomer cement overlayed with a resin composite, or a resin composite bonded by an enamel/dentine-adhesive. The materials and techniques used in these options are discussed, indicating their advantages and disadvantages. Results of available clinical trials of these systems are given, and the link with the stress theory of cervical tooth loss is described. The preferred restorative approaches in order are: resin-modified restorative glass ionomer; resin-modified liner/base glass ionomer with a microfine resin composite overlay; enamel/dentine bonding agent with a microfine resin composite.
Brushing abrasion of softened and remineralised dentin: an in situ study.
The aim of the present in situ study was to evaluate the effect of different periods of intra-oral remineralisation on the susceptibility of softened dentin to toothbrushing abrasion. Groups of 6 human dentin specimens (A-F) were recessed in the buccal aspects of intra-oral appliances which were worn for 21 days by 11 volunteers. The samples were demineralised twice a day extra-orally in the acidic beverage Sprite Light (pH 2.9) for 90 s. Subsequently, the dentin specimens were brushed at different times. Specimen A was brushed immediately after demineralisation. Specimens B-E were brushed after the intra-oral appliances had been worn for various periods in the mouth: specimen B for 10 min, C for 20 min, D for 30 min and E for 60 min. Specimen F was not brushed (control). After 21 days, dentin wear was measured with a profilometer. The following values (means +/- standard deviation) were recorded (microm): A, 23.6 +/- 16.7; B, 37.9 +/- 29.7; C, 31.8 +/- 26.5; D, 18.5 +/- 10.5; E, 15.3 +/- 11.6; F, 12.6 +/- 6.7. There was a statistically significantly increased dentin loss for groups A, B and C as compared to the controls (U test: p < 0.05). However, after intra-oral periods of 30 and 60 min, wear was not significantly higher than in unbrushed controls. It is concluded that for protection of dentin surfaces at least 30 min should elapse before toothbrushing after an erosive attack.
Dental erosion. I. Erosion-like patterns occurring in association with other dental conditions.
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Regurgitation erosion as a possible cause of tooth wear in ancient British populations.
Clinically, in modern populations, tooth wear can be differentiated into three main types--attrition, abrasion and erosion, acting either separately or together. Anthropologists generally have not recognized erosion as a factor affecting the teeth of past populations. This study compares the patterns of wear known to be associated with erosion in present-day dental patients with those found in some British, pre-Conquest, skeletons. It is concluded that erosion may have been a major factor causing the extensive tooth wear in some 20 of 151 individuals.
Dental erosions caused by gastroesophageal reflux disease in children.
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Tooth surface loss from abrasion, attrition and erosion.
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Saliva and salivary pellicle composition and proteomic profile in smokers vs. non-smokers and its effect on dental erosion.
OBJECTIVE: To analyse the salivary composition and proteomic profile of saliva and the salivary pellicle in smokers compared to non-smokers, and to examine potential differences in the erosion-protective capacity of the salivary pellicle. METHODS: Twenty-five smokers and 25 non-smokers were included. Unstimulated and stimulated saliva samples were analysed regarding flow rate, pH, buffer capacity, calcium, phosphate, fluoride, and protein content. Saliva and salivary pellicle samples were analysed by data-independent acquisition mass spectrometry (DIA-MS) for proteome profiling. In an in situ experiment, intraoral splints were loaded with bovine enamel and dentine specimens for 120 min. Pellicle-covered specimens were extraorally eroded (HCl, pH 2.3, 60 s). Calcium release was determined photometrically and compared to pellicle-free controls. RESULTS: Except for phosphate in stimulated saliva (padj.=0.003), salivary parameters were not significantly different between smokers and non-smokers. Proteome profiling detected 1759±154 proteins (cumulative 1963) in saliva, and 4262±362 proteins (cumulative 4625) in the salivary pellicle. The relative abundances of 282 (unstimulated saliva), 338 (stimulated saliva), and 4 (salivary pellicle) protein groups differed significantly between smokers and non-smokers. Functional enrichment analysis of differentially abundant human proteins revealed biological processes such as coagulation, immune response, and carcinogenic reactive oxygen species processes to be impacted by smoking. The salivary pellicle had a significant erosion-protective effect in enamel compared to the control (41.4 ± 6.3 nmol/mm2), but no differences between smokers (33.2 ± 10.6 nmol/mm2, padj.=0.001) and non-smokers (32.7 ± 8.6 nmol/mm2, padj.=0.001) were found. CONCLUSION: The proteomic profiles of both unstimulated and stimulated saliva and the salivary pellicle differ between smokers and non-smokers. CLINICAL SIGNIFICANCE: Despite the different proteomic profiles indicating a significant impact of smoking on the oral cavity, the erosion-protective capacity of the salivary pellicle of smokers and non-smokers does not differ.
In situ evaluation of different remineralization periods to decrease brushing abrasion of demineralized enamel.
The aim of the present in situ study was to evaluate the effect of different periods of intraoral remineralization to decrease the susceptibility of previously demineralized enamel against toothbrushing abrasion. Six human enamel specimens (A-F) were recessed in the buccal aspects of each of eight intraoral appliances which were worn for 21 days by 8 panelists. Demineralization of the samples was performed twice a day extraorally in the acidic beverage Sprite Light for 90 s. Subsequently, the enamel specimens were brushed at different times. Specimen A was brushed immediately after the demineralization. The remaining samples B-E were brushed after the intraoral appliances had been worn for various periods of remineralization: specimen B, 10 min; C, 20 min; D, 30 min and E, 60 min, respectively. Specimen F was only demineralized and remineralized, but not brushed. After 21 days, enamel wear was measured with a laser profilometer. The following values (mean +/- standard deviation) were obtained: specimen A, 6.78+/-2.71 microm; B, 5.47+/-3.39 microm; C, 6.06+/-3.18 microm; D, 5.43+/-2.58 microm; E 4.78+/-2.57 microm, and F 0.66+/-1.11 micro;m. Analysis of variance revealed a significant influence of remineralization period on abrasive wear. However, even after a remineralization period of 60 min the wear was significantly increased as compared to the demineralized, but not brushed control. It is concluded that (1) abrasion resistance of softened enamel increases with remineralization period and (2) at least 60 min should elapse before toothbrushing after an erosive attack.