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Dental erosion in Cuban children associated with excessive consumption of oranges.

Marked erosion at the mesial edges of upper front teeth was observed during an examination of Cuban children. The preferential erosion of mesial edges produced characteristic V-shaped defects on upper central incisors, and the aim of the present study, carried out on 12-yr-old children (N = 1010) in 10 communities in the Province of Havana was to establish the frequency of dental erosion and explain its occurrence. The symmetrical erosion of teeth 11 and 21 (excluding crown injuries and attrition) were clinically classified into four grades: 0.5 = objectionable; 1 = abnormal mesial shortening of incisal edges; 2 = V-shaped defect of cutting edges; 3 = exposure of dentine and extension of the erosive defect to the lateral incisors. In four of the communities, children did not show or rarely showed incisal erosion. In the other six communities, the frequency was surprisingly high (16.6-40.9%). Overall, 17.4% of children exhibited erosion, and the occurrence was significantly higher in girls (20.7%) than in boys (15.0%). The typical V-shaped pattern of erosion seems to be a consequence of the manner in which citrus fruits are eaten. There was also a positive correlation between the frequency of dental erosion and the proximity of citrus plantations, which presumably related to the extent of (daily) orange consumption.

Adolescent↗

Erosion rebuttal.

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Dentifrices↗

Influence of acidified fluoride gel on abrasion resistance of eroded enamel.

The objective of the study was to evaluate the abrasion resistance of eroded enamel brushed with an acidified fluoride gel. Each enamel specimen was prepared from one of 64 bovine incisors. The specimens were embedded in acrylic resin, ground flat, polished and subsequently covered with a tape exposing an area of 1.8x10.0 mm in the center of the enamel specimens. The samples were alternatingly stored in a demineralizing solution (5 min) and a remineralizing solution (1min) four times. An acidic soft drink (Sprite Light(R)) served as a demineralizing solution and artificial saliva was used as a remineralizing solution. After each remineralization the specimens were brushed in an automatic brushing machine (2,000 strokes, 2.5 N load) and subsequently stored again in saliva (1 min). A mixture of artificial saliva (5 ml) with a gel (1 ml) based on the formulation of Elmex(R) gelée (Wybert, Lörrach, Germany) served as an abrasive slurry. Thirty seconds after brushing, the slurry was removed from the specimens by rinsing with destilled water. For each of 16 specimens the following gels (A-D) were used: gels A (pH 7.0) and B (pH 4.5) were unfluoridated; gels C (pH 7.0) and D (Elmex gelée; pH 4.5) contained 1.25% F-. After two cycles the specimens were kept in the saliva for 8 h. Finally the tape was removed and the abrasion was determined profilometrically. The following values (mean +/- SD) were obtained and statistically analyzed by analysis of variance and Wilcoxon two-sample tests (p</=0.01): gel A, 0.96+/-0.24 microm; B, 1.58+/-0.32 microm; C, 0. 71+/-0.23 microm; D, 0.25+/-0.08 microm. The differences between all experimental groups were statistically significant. It is assumed that treatment of enamel erosions with an acidified fluoride gel results in a higher abrasion resistance compared to gels which are either unfluoridated or neutral.

Amines↗

Morphology evaluation of primary enamel exposed to antihistamine and fluoride dentifrice--an in vitro study.

This in vitro study sought to evaluate the action of a pediatric medication with low pH and high acidity in primary enamel submitted (or not) to daily applications of fluoride dentifrice. For this study, 70 blocks of primary molars (n = 10 per subgroup) were analyzed using scanning electron microscopy. Six subgroups (two control and four experimental) were submitted to different treatments for 10 days. Microscopically, the enamel blocks of the subgroups that received medication and fluoride demonstrated the largest areas of partially or totally conditioned superficial enamel. The opposite was observed in the subgroups that were not exposed to fluoride; erosions in the internal enamel and in the transition zone between deep enamel and dentine showed superior percentiles. It was concluded that the medication modified the morphology of the primary enamel and that the use of fluoride was able to reduce the erosive effect of the formulation.

Cariostatic Agents↗

Effectiveness of two fluoridation measures on erosion progression in human enamel and dentine in vitro.

The aim of the present study was to evaluate the effect of fluoride on the progression of erosive demineralisation in human enamel and dentine using a cyclic de- and remineralisation model in vitro. The mineral content expressed in micrometres was determined daily by longitudinal microradiography (LMR) and presented as cumulative mineral loss over 5 days. For erosive demineralisation, all samples were immersed in 0.05 M citric acid (pH 2.3) for 6x10 min/day and stored in a remineralisation solution. Fluoridation measures were performed as follows: group 1: control, no fluoridation; group 2: toothpaste fluoridation 3x5 min/daily (NaF, 0.15% F-); group 3: toothpaste fluoridation as group 2 and additionally application of a fluoride mouthrinse (Olaflur/SnF2, 0.025%F-) 3x5 min/daily and on days 1 and 3 gel fluoridation (Olaflur/NaF; 1.25% F-) for 1x5 min. After the first experimental day, no significant differences were found between the groups. However, after 5 days the erosive mineral loss values for enamel were 147.5+/-18.7 microm in the control group, 128.1+/-15.0 microm in group 2 (p< or =0.05) and 116.1+/-12.4 microm in group 3 (p< or =0.001). In dentine, the respective values were 136.7+/-16.4, 111.8+/-26.9 (p< or =0.001) and 60.3+/-17.8 (p< or =0.001). The intensive fluoridation significantly reduced erosion progression in enamel but had a more pronounced effect on dentine. The results suggest that subjects with erosive lesions should use an intensive fluoridation measure.

Analysis of Variance↗

The prevalence of dental erosion in preschool children in China.

OBJECTIVE: To describe the prevalence of dental erosion and associated factors in preschool children in Guangxi and Hubei provinces of China. METHODS: Dental examinations were carried out on 1949 children aged 3-5 years. Measurement of erosion was confined to primary maxillary incisors. The erosion index used was based upon the 1993 UK National Survey of Children's Dental Health. The children's general information as well as social background and dietary habits were collected based on a structured questionnaire. RESULTS: A total of 112 children (5.7%) showed erosion on their maxillary incisors. Ninety-five (4.9%) was scored as being confined to enamel and 17 (0.9%) as erosion extending into dentine or pulp. There was a positive association between erosion and social class in terms of parental education. A significantly higher prevalence of erosion was observed in children whose parents had post-secondary education than those whose parents had secondary or lower level of education. There was also a correlation between the presence of dental erosion and intake of fruit drink from a feeding bottle or consumption of fruit drinks at bedtime. CONCLUSION: Erosion is not a serious problem for dental heath in Chinese preschool children. The prevalence of erosion is associated with social and dietary factors in this sample of children.

Beverages↗

Erosion of deciduous and permanent dental hard tissue in the oral environment.

OBJECTIVES: The objectives of this study were two-fold: (1) to determine (by surfometry) loss of deciduous and permanent enamel and dentine following consumption of a single low pH orange drink for 15days; and (2) to determine (by surfometry) loss of deciduous and permanent enamel and dentine following consumption of the product 2 versus 4 times per day for 15days. METHODS: Sixteen healthy volunteers participated in a single centre, single blind, 2-phase crossover study, conducted according to Good Clinical Practice, and employing the validated model described by West and co-workers (Journal of Dentistry 1998; 26:329-335). RESULTS: In all tissues, erosion was progressive over time, the pattern being more linear in enamel than in dentine. In general, erosion of deciduous enamel was greater than that of permanent enamel, though this difference was significant only for those specimens exposed to 4 drinks per day. Conversely, erosion of dentine was generally greater in the permanent tissue, though differences rarely reached conventional levels of statistical significance. Increasing frequency of consumption resulted in increased loss of tissue, but this difference was neither proportional nor consistently statistically significant. CONCLUSIONS: It is concluded that statistically significant differences in susceptibility of deciduous and permanent enamel to erosion appear to emerge over time and with increasing frequency of consumption. This is of importance clinically given the reduced dimensions of the deciduous dentition and the element of 'abuse' of soft drinks by the child population. Further development of soft drinks with low erosive potential is recommended.

Adult↗

Dental erosion associated with soft-drink consumption in young Saudi men.

This study reports on the causative factors of dental erosion in selected high- (n = 19) and low-erosion (n = 19) subgroups of a larger random sample (n = 95) of young male Saudi military inductees. By means of a questionnaire, the role of various possible factors related to oral health in general, and to dental erosion in particular, was assessed for each participant. Clinical examination included recordings of severity of dental erosion and fluorosis, presence of buccal cervical defects and first permanent molar 'cuppings', DMFT and DMFS, visible plaque index, and gingival bleeding index. In addition, bitewing radiographs, study casts, and intraoral color transparencies were obtained for each individual. Logistic regression analysis showed a strong correlation between the presence of dental erosion and a high level of consumption of cola-type soft drinks. Other statistically significant associated factors, although of less predictive strength, were type of cleaning aid and gingival bleeding index. In subgroup comparisons, dental problems (primarily pain), number of buccal cervical defects, and number of missing teeth were significantly greater in the high- than in the low-erosion subgroup.

Adult↗

Regional bond strengths of resins to human root dentine.

OBJECTIVES: The demand for restoration of root dentine defects such as cervical erosion and root caries has significantly increased recently, but there is limited information on the performance of the adhesive resins to radicular dentine. The purpose of this study was to measure the regional tensile bond strength (TBS) of composite bonded to human root and coronal dentine, and to observe the interface between resin and root dentine by SEM. METHODS: Human extracted cuspid teeth were used to measure TBS with a new microtensile bond test. Enamel and cementum were removed from the labial tooth surfaces to form a long cavity preparation into dentine from the mid-crown to the apex of the root within the same tooth. All Bond 2 (all etch technique) or Imperva Bond (no etch) was bonded to dentine surfaces and covered with Protect Liner resin composite. The resin-bonded teeth were serially sliced into 16 sections at right angles to the long axis of the tooth, and the bonded surfaces were trimmed to give a bonded surface area of 1 mm2 for TBS testing. RESULTS: All Bond 2 bond strengths to coronal and apical dentine showed high values (23.5 MPa) but the bond strength was significantly lower on cervical root dentine. Imperva Bond produced a relatively high tensile bond strength to all regional areas. SEM showed that the thickness of the resin-infiltrated layer formed by All Bond 2 in root dentine was less than coronal areas. Resin infiltration with Imperva Bond was always less than 0.5 micron. The results suggest that high TBS values can be obtained with minimal resin infiltration in root dentine.

Acid Etching, Dental↗

Factors influencing the development of dental erosion in vitro: enamel type, temperature and exposure time.

The influence of temperature, duration of exposure, and enamel type on the development and progression of dental erosion has been determined. Three experiments were devised as follows. Eroded lesions were produced on enamel samples with orange juice: (1) at different temperatures; (2) for different lengths of time; and (3) on bovine permanent, human deciduous and human permanent enamel. Lesion parameters (mineral loss and lesion depth) were quantified using transverse microradiography. Both lesion parameters were significantly lower at 4 degrees C when compared with 20 degrees C and 37 degrees C, and at 20 degrees C when compared with 37 degrees C. Lesion parameters increased significantly as the length of exposure increased, and were positively correlated (r=0.98, P<0.05) to the exposure time. Both parameters were significantly greater in bovine enamel than human permanent and deciduous enamel, and in human deciduous than permanent enamel. Lesion progression, as measured by mineral loss, was in the ratio 2.0:1.5:1.0 for bovine:human deciduous:human permanent, and by lesion depth, 1.7:1. 3:1.0. In conclusion, the erosiveness of orange juice was less pronounced at a lower temperature, and increased with an increased exposure time. Erosion progressed twice as fast in bovine permanent than in human permanent enamel, and 1.5 times more rapidly in human deciduous than in permanent enamel.

Animals↗

Development of low erosive carbonated fruit drinks. 1. Evaluation of two experimental orange drinks in vitro and in situ.

OBJECTIVES: To determine the in vitro erosive potential and in situ erosive effect of two new formulation low calorie carbonated orange drinks with that of two conventional diet products and water. METHODS: In the in vitro study, six specimens of deciduous and permanent enamel were randomly allocated to each of the five products and a '4h' protocol employed. In the in situ study, 15 healthy volunteers participated in a single centre, single blind, 5-phase crossover study, conducted according to Good Clinical Practice, and employing a validated model. RESULTS: The in vitro erosive potential of the experimental formulations was less than that of the comparators at all time points. Conversely, the observed erosive potential of both experimental formulations was greater than that of the control. Consistent statistically significant differences were found in relation to permanent enamel only. Unfortunately, the in situ study did not produce results entirely consistent with those of the in vitro study. Notably, a generally progressive loss of enamel was observed in specimens exposed to the control. CONCLUSIONS: The data from the in vitro study show the experimental formulations to have low comparative erosivity. However, the methodologies in vitro and in situ somewhat unusually do not correlate in ranking the erosivity of drinks. The results of this study should therefore be viewed with caution, further research being clearly warranted.

Adolescent↗

Susceptibility of the collagenous matrix from bovine incisor roots to proteolysis after in vitro lesion formation.

The susceptibility of the organic matrix from permanent bovine incisor roots to proteolytic breakdown after in vitro lesion formation was investigated. Root surfaces were exposed to 0.1 M acetic acid, pH 4.0, to produce erosive lesions or to 0.1 M lactic acid, 0.2 mM methane hydroxy diphosphonate, pH 5.0, to produce subsurface lesions. After demineralization, the roots were treated with a bacterial collagenase. The quantity of enzyme-degradable collagen in the root tissue was found to be proportional to the calcium released during demineralization, until a plateau value was reached at calcium concentrations in solution of 3.3 mM at pH 4.0 and 2.7 mM at pH 5.0. The degradability of collagen was found to be substantially less in subsurface lesions than in erosive lesions. The presence of cementum-free areas did not affect the results. These findings suggest that the mineral component of the roots is composed of several fractions which differ in their solubility properties in weak acids.

Animals↗

The dental health of 3-year-old children in east Cumbria 1993.

A study of the dental health of 135 3-year-old children, with reference to social class group, was undertaken in East Cumbria District between September and December 1993. Caries free subjects numbered 110 (81.5 per cent), the mean number of decayed, missing, and filled teeth was 0.59; the value of the decayed component of the dmft index was 0.49. Caries experience was confined to 25 (18.5 per cent) individuals whose mean dmft was 3.20, seven of these subjects experienced rampant decay to the maxillary incisor teeth and three had received a dental general anaesthetic. An inverse relationship was demonstrated between dental caries and social class. Trauma to the maxillary incisors had occurred in 17 (12.6 per cent) children, with discolouration and fracture of the enamel and dentine the most prevalent types of injuries sustained. A relatively high proportion of the subjects, 39 (28.9 per cent), had experienced erosion to palatal surfaces of the maxillary incisors. The most prevalent type of erosion was that involving both enamel and dentine. Only 14 (10.4 per cent) children examined used fluoride supplements in this low-fluoride area; 98 (72.6 per cent) subjects reported registration with a dentist.

Cariostatic Agents↗

Surface microhardness changes, enamel fluoride uptake, and fluoride availability from commercial toothpastes.

OBJECTIVE: The aim of the present study was to evaluate the ability of a new fluoride-containing dentifrice to protect surface-softened enamel against further erosive challenges in an in vitro cycling model, and to relate any effects to enamel fluoride uptake (EFU) and free fluoride. METHODOLOGY: Human enamel specimens were subjected to a daily cycling regimen comprising: three two-minute treatments; five two-minute challenges using 1% citric acid pH 3.8; and remineralization in a mixture of human saliva and mucin-containing artificial saliva. Surface microhardness (SMH) was measured at baseline, 10, and 20 days, and the fluoride content of biopsied specimens determined at 20 days. EFU studies were based on method #40 described in the United States Food and Drug Administration (FDA) testing procedures. Free-fluoride availability was determined from slurries of one part toothpaste plus three parts deionized water. RESULTS: SMH showed that a 1150 ppm NaF test dentifrice protected enamel specimens greater than Crest Cavity Protection (1100 ppm NaF) and a fluoride-free placebo at both 10 days and 20 days (p < 0.05). The fluoride content of specimens treated with this prototype was higher than either Crest or the placebo. SMH for a 1450 ppm NaF test dentifrice was greater than for Elmex Sensitive (1450 ppm amine F) and placebo at 10 days, while both products were greater than the placebo at 20 days. The fluoride content of specimens treated with this test dentifrice was higher than Elmex Sensitive, which was higher than placebo. The fluoride uptake seen in the cycling model correlated for the NaF dentifrices with a standard EFU procedure. Different EFU results for a series of commercial dentifrices demonstrated that EFU is not necessarily a function of free-fluoride availability. CONCLUSION: This study demonstrated that fluoride dentifrices can increase the protection of enamel against an erosive challenge in vitro, and that the increased protection correlated with fluoride uptake. The fluoride uptake seen in the cycling model correlated with a standard FDA EFU procedure for the NaF dentifrices. The present studies demonstrate the importance of formulation effects on driving performance in in vitro models.

Cariostatic Agents↗

Wine tasting and dental erosion. Case report.

A case of widespread dental erosion is reported in an individual who had worked in the wine industry for ten years. This occupation involved daily tasting of at least 20 wines, but often more. The erosion manifested as dental sensitivity with there being cervical erosion, occlusal pitting, and loss of enamel around restorations. The effect of immersing unerupted human teeth in white wine (pH 3.3) was examined with the scanning electron microscope, where marked surface changes had occurred after 24 hours of exposure.

Adult↗