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Bulimia nervosa, an increasingly common eating disorder, involves binge eating and subsequent purging behavior. Repeated self-induced vomiting may lead to dental erosion. This article describes the use of resin-bonded ceramic crowns to manage a severely eroded maxillary dentition in such a patient.
Gastroesophageal reflux disease (GERD) is a relatively common gastrointestinal disorder in the United States. The reflux of acid adversely affects the mucosal lining of the esophagus and is responsible for dental erosion. This article briefly reviews the etiology, risk factors, and medical management of GERD. The patient presentation describes the rehabilitation of a young adult with GERD who needed multidisciplinary care.
Over a period of some years, the components of a system for discerning erosion on children's teeth have been progressively developed, for use in an extensive project seeking correlations between erosion and various perceived risk factors. The aim was the detection of minute levels of erosion, based on mappings of the palatal surfaces of the maxillary central incisors in children. Significant challenges were encountered, the primary problem being the impracticality of placing control marks that would aid the realignment of successive measurements. The paper describes the erosion detection system and initial experiences based on the results of the first 100 subjects measured after 9 months. The procedures detected the occurrence of erosion of 50 microm magnitude on about one-quarter of the teeth over the 9 month period, at a precision estimated to be +/- 15 microm. The occurrence of some anomalous incidents prevented the procedure from being fully automatic, and it necessitated human examination of a graphical diagram derived from the surface matching program, but it was nevertheless superior to current practices of examining impressions or replicas entirely by eye.
In order to test the ability of an algorithm to quantify simulated palatal erosion, a total of 10 extracted permanent upper central incisors were mounted in brass blocks. Baseline impressions were recorded using an addition cured silicone impression material in a metal impression tray. Once set and removed from the teeth, the impressions were coated twice with a high silver content electroconductive paint, applied using a brush, before being backed up with die stone to form an electroconductive replica. Each tooth was then subject to three treatments: application of phosphoric acid etchant gel for 60 s, application of etchant gel for 120 s and immersion for 3 h in Diet Coca-Cola*. After each one the replication process was repeated. Thereafter all replicas were mapped using a computer controlled electrical probe and the resultant digital terrain models (DTMS) compared using a surface matching and difference detection algorithm (SMADDA). Surface matching was unsuccessful only in one instance. As the duration of the insult increased, so did the proportion of the surface that underwent change to a maximum of 33.3%. Anatomical site was significantly (P < 0.05) associated with the susceptibility to erosion. The cingulum periphery appeared most resistant to this. The algorithmic approach offers much scope for monitoring dental erosion as acid dissolution of the tooth's surface appears to occur gradually. The cingulum region appears relatively more resistant to this process than other tooth sites and thus facilitates the process of surface matching. Further testing is however, required to determine precisely the algorithm's upper tolerance level.
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Tooth enamel erosion occurs only in susceptible individuals regardless of food and beverage consumption patterns, that is, consumption of an acidic drink or food alone is highly unlikely to cause erosion. Susceptibility is highly variable from person to person and multifactorial in nature, as are the causes of erosion itself. Tooth enamel erosion is relatively rare and is easily misdiagnosed. A thorough differential diagnosis that eliminates the many other possible causes of enamel loss must be conducted. It is important to distinguish dental erosion from dental caries. Although the end result is similar, these two pathologies rarely occur simultaneously at the same site. In cases of true erosion, the tooth enamel is demineralised by direct contact with acids, while caries is a disease that occurs by the action of acids produced by plaque biofilm micro-organisms. It should also be stressed, clinically speaking, that erosion is primarily a surface phenomenon, while caries generally begins as a subsurface demineralisation of enamel structure that eventually leads to a pit in the tooth surface. As tooth enamel erosion is relatively rare, and the result of many factors, further research is needed to determine why susceptibility to erosion differs so widely from person to person.
Erosive tooth wear appears to be no less frequent in the United States than in the United Kingdom and Europe and is of increasing concern as a significant cause of tooth destruction in younger persons. Consumption of numerous dietary sources of acids is increasing in modern societies. In addition, involuntary regurgitation may be a significant cause of tooth erosion. These primary causes can be exacerbated by xerostomia, which is induced by many drugs. Initial preventive treatments are directed at neutralizing the effects of the acids, and initial restorative treatments should be conservative, using adhesive materials. Treatment of advanced tooth tissue loss is difficult and expensive, and preventive management is emphasized.
As modern societies increase their acidic food and beverage consumption, erosive tooth wear is an increasing cause of tooth destruction among young people. The primary causes can be exacerbated by xerostomia, which can be induced by dehydration, several systemic diseases, or any of a number of drugs. Initial preventive treatments are directed at eliminating extrinsic acids, reducing xerostomia and other co-factors, and increasing teeth's resistance to acid. Initial restorative treatments should be conservative, using adhesive materials. Treatment of advanced tooth tissue loss is difficult; preventive management is emphasized.
Tooth wear is the result of three processes: abrasion (wear produced by interaction between teeth and other materials), attrition (wear through tooth-tooth contact) and erosion (dissolution of hard tissue by acidic substances). A further process (abfraction) might potentiate wear by abrasion and/or erosion. Both clinical and experimental observations show that individual wear mechanisms rarely act alone but interact with each other. The most important interaction is the potentiation of abrasion by erosive damage to the dental hard tissues. This interaction seems to be the major factor in occlusal and cervical wear. The available evidence seems insufficient to establish whether abfraction is an important contributor to tooth wear in vivo. Saliva can modulate erosive/abrasive tooth wear through formation of pellicle and by remineralisation but cannot prevent it.
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BACKGROUND: Endogenous dental erosion is that produced by contact of gastric acids with tooth structure. It may affect exposed root cementum/dentine as well as coronal enamel, causing marked loss of mineral. The aim of this study was to determine whether 1.23 per cent acidulated phosphate fluoride gel, if applied to the surface cementum at certain intervals during an erosive acid challenge, could provide any protection against demineralization. MATERIALS AND METHODS: Roots of preserved extracted human teeth were painted with a water and acid resistant varnish, leaving two windows (3x1mm) of exposed dentine. These were placed in a solution containing 0.06MHCl and 2.2mMCaHPO4, which has been shown to simulate gastric acid when it meets the tooth surface. The roots were placed in the erosive solution unprotected (controls), or subject to APF application for four minutes prior to and every 10, 30 or 120 minutes during the erosive challenge. Roots were removed at either 6 or 12 hours, washed thoroughly and cut into 120microm thick sections. Depths of demineralization were measured using an optical graticule under polarized light microscopy. RESULTS: A high level of protection was provided when the roots were coated with APF gel every 10 or 30 minutes. CONCLUSIONS: APF gel will partially inhibit endogenous erosion of roots for up to 30 minutes if applied, for example, the night before a morning reflux episode. This should be considered along with other erosion control or reduction procedures for patients suffering from the effects of endogenous erosion.
Tooth surface loss by erosion presents a challenge to the general practioner in terms of identification of patients at risk, diagnostic investigation and early therapy. The guidelines contain advice for changing the food habits and behaviour in oral hygiene. Patients, who prefer erosive products (fruits, juice, cola) or who vomit should use a bicarbonate mouthrinse to neutralize the acid. The spectrum of therapy reachs of simple fillings with glassionomer cements and composites to comprehensive crown therapy. Several particularities in the psychological care of patients with eating disorders are described.
Through investigation into 1671 workers who do six acid related jobs in fourteen factories,and 501 workers who work in non-acid condition in contrast.The paper has worked out the criteria of diagnosing occupational acid erosion disease,including the classified criteria of diagnosing single tooth acid erosion disease and the criteria of diagnosing different degrees of the tooth acid erosion disease in the oral cavity.It has also been found out that these are close relationships between the rate of suffering the occupational tooth acid erosion disease and the degree of the erosion,on the one hand and density of acid fog in the air and the types of acid workers are exposed ton and the length of the years working in such environment.
Dentine bonding resins may play a role in protecting dentine against acids for patients with erosion. Therefore, it is important to try and understand what potential difficulties may ensue when bonding to worn dentine. This paper reviews the literature on the changes between normal and worn dentine and the effect of this on the bonding to composite resins. A medline search was undertaken using the terms erosion, tooth wear and dentine bonding up until the spring of 2003. Although there are changes on the surface of worn dentine, there is little evidence that this may affect the bond.
Patients, healthcare professionals, and health product manufacturers focus on the benefits that the use of a medicine or health product will bring rather than the potential side effects. A case of erosive tooth surface loss caused by the repeated and prolonged use of an acidic mouthrinse is reported. The adverse effects of health care products on the dentition and methods to minimise potential damage are discussed.
Acid erosive tooth wear is increasingly being reported in many western countries, and is also being recognised as a significant cause of tooth destruction in persons with xerostomia. The primary aetiology is related to a high consumption of dietary sources of acids and also to an increasing awareness of gastric acid as a significant factor in both children and adults. Recommended preventive dental treatments aim to neutralise the effects of acids, reduce the severity of xerostomia, stimulate salivary flow and buffering capacity, and increase the acid resistance of tooth substance. Initial restorative treatments should be conservative, using adhesive dentistry techniques. This treatment approach is illustrated by the oral rehabilitation of a severe erosion case using adhesive onlays, veneers and all ceramic crowns.