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The role of saliva in regurgitation erosion.

It has been suggested that salivary characteristics are important in the progression of erosion. The aim of this investigation was to measure salivary parameters in 22 patients with erosion, 10 with normal (non-pathological) levels of reflux (Group I) and 12 with previously diagnosed pathological levels of gastro-oesophageal reflux (Group II). A further 10 subjects without evidence of erosion and no history of reflux disease acted as controls (Group III). No statistically significant differences in salivary flow rate, buffering power or the concentrations of calcium, phosphorus and fluoride were detected. The results suggest that variation in the characteristics of unstimulated and stimulated saliva collected during waking hours do not have a major role in erosion.

Adult↗

Development of low erosive carbonated fruit drinks 2. Evaluation of an experimental carbonated blackcurrant drink compared to a conventional carbonated drink.

OBJECTIVE: Previous studies demonstrated that a non-carbonated blackcurrant juice drink with added calcium produced little erosion of enamel in vitro and in situ by comparison with other low pH fruit drinks. The aim of this study is to evaluate the erosive effects in situ of an experimental formulation carbonated drink with added calcium, compared to a conventional carbonated drink over a 20 day period using a similar design as in previous studies. METHOD: The study was a single centre, single blind, randomised placebo controlled three cell crossover design involving 15 volunteers. The test drinks were an experimental carbonated ready-to-drink (RTD) blackcurrant drink, a conventional carbonated RTD orange drink and water. Two enamel samples were retained in situ, in the midline of the hard palate on an upper removable acrylic appliance. Drinks were 250 ml volumes consumed four times per day during 20 working days. Measurements of enamel loss were made on enamel samples after days 2, 5, 10, 15 and 20 by profilometry. RESULTS: The experimental carbonated blackcurrant drink caused significantly less enamel loss than the conventional carbonated orange drink at all time points measured, but was not significantly different from water at days 2, 5 and 20. CONCLUSIONS: This study has shown that it is possible to modify carbonated soft drinks in a manner similarly shown with non-carbonated soft drinks, to minimise dental erosion.

Adult↗

Dental erosion--the problem and some practical solutions.

There has been a clinical impression among dental practitioners, particularly those working with children, that the problem of dental erosion is increasing. Is this really the case or are we more aware of the problem? What is causing this increase, if it really exists? Perhaps more importantly, what can we do about it? This article looks at the prevalence, and aetiology of dental erosion, particularly in children, and makes some practical suggestions for possible control.

Adolescent↗

Artificial saliva substitutes and mineral dissolution.

The erosive potentials of a number of commercially available artificial saliva substitutes have been investigated using an in vitro hydroxyapatite powder dissolution assay. Most of the saliva substitutes examined did not show any appreciable erosive potential, although one product resulted in greater mineral dissolution levels. There appeared to be little correlation between pH and mineral dissolution levels for the different saliva substitutes examined. Whilst saliva substitutes may be of assistance in maintaining some physiological function in patients with impaired salivary flow, it is important to choose a product with low erosive potential where the natural dentition is present.

Aerosols↗

The need for psychiatric-dental liaison in the treatment of bulimia.

During dental examinations 38% of 66 outpatients with bulimia were found to have evidence of significant enamel erosion, and chronicity of vomiting was significantly associated with erosion. Liaison with colleagues in dentistry is necessary when working with bulimic patients.

Adolescent↗

[Prevalence of non carious dental lesions in the department of Dakar].

Non carious dental lesions are destructions of dental external surfaces originating from non bacterial cause in opposition to dental caries. We distinguish 5 types of non carious dental lesions: attrition, abrasion, abfraction, erosion and demastication. These lesions may be pathological or physiological. Data dealing with them are not very numerous in the literature. Their study shows a real interest in conservative dentistry because of problems both aesthetic and functional they set We carried out an epidemiological trial in the department of Dakar with as aim providing data on the prevalence of these lesions. Our results have disclosed the following rates of prevalence: 60% of attrition, 25,55% of abrasion, 7,22% of abfraction, 5,55% of demastication and 1,68% of erosion. The results indicate once more the importance of the need for clinical evaluation of those dental lesions.

Female↗

Dental erosions in subjects living on a raw food diet.

The aim of the study was to investigate the frequency and severity of dental erosions and its association with nutritional and oral hygiene factors in subjects living on a raw food diet. As part of a larger dietary study 130 subjects whose ingestion of raw food was more than 95% of the total food intake were examined. The median duration of the diet was 39 (minimum 17, maximum 418) months. Before the clinical examination, the participants answered questionnaires and recorded their food intake during a 7-day period. Dental erosions were registered using study models. As a control 76 sex- and age-matched patients from our clinic were randomly selected. The raw food diet records showed the median daily frequency of ingesting citrus fruit to be 4.8 (minimum 0.5, maximum 16.1). The median intake of fruit was 62% (minimum 25%, maximum 96%) of the total, corresponding to an average consumption of 9.5 kg of fruit (minimum 1.5, maximum 23.7) per week. Compared to the control group subjects living on a raw food diet had significantly (p</=0.001) more dental erosions. Only 2.3% of the raw food group (13.2% of the controls) had no erosive defects, whereas 37.2% had at least one tooth with a moderate erosion (55.2% of the controls) and 60.5% had at least one tooth with a severe erosion (31.6% of the controls). Within the raw food group no significant correlation was found between nutrition or oral health data and the prevalence of erosions. Nevertheless, the results showed that a raw food diet bears an increased risk of dental erosion compared to conventional nutrition.

Adolescent↗

Erosion on abraded dental hard tissues by acid lozenges: an in situ study.

The aim of this study was to analyse the erosive effect of acidic lozenges and to compare it with that of orange juice, known to have the capacity to cause erosion. Two acidic, sugar-free lozenges and orange juice were tested in situ in nine patients. Changes in surface Knoop microhardness and change in the surface texture were assessed. The results revealed that orange juice and one acidic lozenge were--under the conditions of this experiment--capable of significantly softening abraded enamel (P < or = 0.017). It was concluded that excessive consumption of acidic lozenges could have the potential to enhance existing dental erosion.

Adult↗

Dietary effects on dental diseases.

Dental caries is a highly prevalent chronic disease and its consequences cause a lot of pain and suffering. Sugars, particularly sucrose, are the most important dietary aetiological cause of caries. Both the frequency of consumption and total amount of sugars is important in the aetiology of caries. The evidence establishing sugars as an aetiological factor in dental caries is overwhelming. The foundation of this lies in the multiplicity of studies rather than the power of any one. That statement by the British Nutrition Foundation's Task Force on Oral Health, Diet and Other Factors, sums up the relationship between sugars and caries in Europe. There is no evidence that sugars naturally incorporated in the cellular structure of foods (intrinsic sugars) or lactose in milk or milk products (milk sugars) have adverse effects on health. Foods rich in starch, without the addition of sugars, play a small role in coronal dental caries. The intake of extrinsic sugars beyond four times a day leads to an increase risk of dental caries. The current dose-response relationship between caries and extrinsic sugars suggests that the sugars levels above 60 g/person/day for teenagers and adults increases the rate of caries. For pre-school and young children the intakes should be proportional to those for teenagers; about 30 g/person/day for pre-school children. Fluoride, particularly in toothpastes, is a very important preventive agent against dental caries. Toothbrushing without fluorides has little effect on caries. As additional fluoride to that currently available in toothpaste does not appear to be benefiting the teeth of the majority of people, the main strategy to further reduce the levels of caries, is reducing the frequency of sugars intakes in the diet. Dental erosion rates are considered to be increasing. The aetiology is acids in foods and drinks and to a much lesser extent from regurgitation.

Acids↗

[Erosion caused by gastric reflux in children. Discussion of etiology, clinical appearance and therapy in two cases].

Dental erosion is a disease occurring not only in adults but also in children. Thereby, deciduous and permanent teeth are involved. The cause of these lesions is an extended acid exposure due to extrinsic or intrinsic factors. Unlike caries, the erosive process occurs without involving bacteria. Main reasons are extensive consumption of erosive (soft) drinks and foodstuffs or gastrooesophageal reflux with regurgitation of gastric acid into the oral cavity. Often, the first signs of this disease are erosive lesions of the teeth and therefore dentists have an important role in early diagnosis. Two clinical cases are presented and the clinical diagnosis, the course and possible systemic and local preventive and therapeutic measures are discussed. Patients suffering from erosion can be treated successfully if the correct diagnosis and adequate preventive and therapeutic measures are performed.

Adolescent↗

[Bacterial enzymatic activity in the oral cavity].

The research is intended to get knowledge of some enzymatic activity of Actinomyces Israeli bacteria isolated from the mouth of several subjects and it shows how such bacterium can give rise to erosive phenomena of the enamel of the teeth and also to infections of the periodontal through a process causing the formation of a cloudy halo in the cultures.

Actinomyces↗

Clinical investigations of gastro-oesophageal reflux: Part 1.

Most people have at some time experienced the symptoms of heartburn associated with gastro-oesophageal reflux. Fortunately, these symptoms are usually short-lived and require no treatment, but in some patients severe and prolonged reflux of gastric juice into the mouth can cause dental erosion. This paper, the first in a two-part series, describes the aetiology of gastro-oesophageal reflux and associated problems that may be encountered.

Esophagogastric Junction↗

Retention of KOH-soluble fluoride on enamel and dentine under erosive conditions--A comparison of in vitro and in situ results.

OBJECTIVES: Aim of the study was to investigate the stability of CaF(2)-like precipitates on enamel and dentine under neutral or acidic conditions and to compare in vitro and in situ results. METHODS: Human enamel and dentine specimens were fluoridated (Elmex fluid, 5 min) and subjected to erosive demineralisation (Sprite light: 3/day each; 30 s in vitro, 2 min in situ) or stored under neutral conditions for 4 (in vitro) or 7 (in situ) days. KOH-soluble fluoride was determined using an ion selective electrode. Between the acid attacks, specimens were stored in remineralisation solution (in vitro) or retained in the oral cavity (four volunteers for enamel and dentine each). RESULTS: Initially, high amounts of KOH-soluble fluoride were gained (between 77.9+/-12.3 and 96.0+/-46.4 microg/cm2). Under neutral conditions in vitro, a significant decrease on enamel (16.2+/-5.0 microg/cm2) and dentine (18.6+/-10.5 microg/cm2) was found, which was more severe under acidic conditions (6.3+/-3.0 and 5.1+/-2.1 microg/cm2, respectively). Under in situ conditions, KOH-soluble fluoride was strikingly stable on enamel under neutral (42.3+/-12.6 microg/cm2) as well as under acidic conditions (54.1+/-17.4 microg/cm2). On dentine, the dissolution kinetics of KOH-soluble fluoride was similar to the in vitro conditions, but the loss was less severe (45.3+/-12.9 microg/cm2 under neutral and 8.8+/-6.4 microg/cm2 under acidic conditions). CONCLUSIONS: In vitro, more KOH-soluble fluoride was lost under erosive compared to neutral conditions. The intra-oral environment was considerably protective for CaF2-like precipitates especially on enamel.

Amines↗

The voluntary reflux phenomenon.

Dental erosion can be caused by recurrent contact with regurgitated gastric acid and there are a number of recognised conditions in which this can occur. A previously undescribed condition, which we have termed the 'voluntary reflux phenomenon', is described, and an illustrative case history given, together with details of several other similar cases. The condition may well be first recognised by the dentist, may have serious psychiatric implications, and has features which can help distinguish it from other causes of gastric acid mediated dental erosion. These features are described and discussed, and some suggestions for initial management in general practice made, should the condition be suspected.

Adult↗

The protective effect of fluoride treatments against enamel erosion in vitro.

Fluoride is known to reduce enamel solubility during the caries process. The aim of this investigation was to determine whether fluoride preparations affect erosion attributed to citric acid and citric acid-based soft drinks. Flat enamel specimens embedded in epoxy resin were prepared from caries free, human third molar teeth extracted from patients aged 18-35 years. Specimens were polished to have a profile within a tolerance of +/-0.3 microm measured on a profilometer. Specimens were taped to leave a 2 mm window of exposed enamel. Groups of specimens were exposed to citric acid and soft drinks with and without the addition of sodium fluoride or exposed to the same solutions after pre-treatment with fluoride products. Enamel loss was measured by profilometer after 10, 20 and 30 min of acid exposure. The different acidic solutions varied significantly in the amount of erosion produced both with and without the addition of fluoride. In addition, the different fluoride products differed significantly in the protective effect afforded. Both fluoride application methods reduced in mean terms, enamel erosion at all time points and by all acidic solutions. The majority of differences were <25% and as the study was powered to show differences as significant at or above this level few reached statistical significance. Fluoride applied to enamel either in acidic solutions or as a pre-treatment, reduces enamel erosion; however, the actual clinical benefit appears low. More studies are required, including investigations in situ.

Adolescent↗

Dental erosions in relation to lactovegetarian diet.

The subjects of this study were 26 lactovegetarians and their age- and sex-matched controls. Clinical and radiologic examinations were made and samples of wax-stimulated whole saliva were collected. Dental erosions were recorded and documented with photographs and plaster models. Incipient, moderate and grave erosive defects were observed in 26.9%, 19.2% and 30.8% of the lactovegetarians, respectively. In controls, however, no erosions were observed. When tested by multiple linear regression analysis, the main factors affecting dental erosions were the rate of flow of saliva, and consumption of vinegar and vinegar conserves, citrus fruits and acidic berries.

Adult↗

Methods for assessment of dental erosion.

Various assessment techniques have been applied to evaluate the loss of dental hard tissue and the surface-softened zone in enamel induced by erosive challenges. In this chapter, the most frequently adopted techniques for analyzing the erosively altered dental hard tissues are reviewed, such as profilometry, microradiography, scanning electron microscopy, atom force microscopy, nano- and microhardness tests and iodide permeability test. Moreover, methods for chemical analysis of minerals dissolved from dental hard tissue are discussed. It becomes evident that the complex nature of erosive mineral loss and dissolution might not be comprehended by a single technique, but needs application of different approaches for full understanding.

Fluorescence↗

Effect of fluoride varnish and solution on enamel erosion in vitro.

The effect of fluoride varnish and solution on initial enamel erosion was studied. Enamel specimens prepared from human third molars were treated for 24 h with Duraphat varnish (2.26% F) or for 48 h with NaF solution (1.2% F), washed, and immersed in cola beverage (pH 2.6) for up to 15 min. The surface microhardness was measured using a Vickers diamond in a Leitz indentation apparatus at base-line, after fluoride treatment, and after 1, 5, and 15 min exposure to acidic drink. The specimens were then prepared and studied using a JEOL JSM-35 scanning electron microscope. The results showed that both fluoride treatment caused an increase in enamel hardness values and subsequent inhibition of softening which was statistically highly significant. Scanning electron micrographs revealed the difficulty of removing Duraphat varnish from the enamel surface, and remnants of varnish were seen irrespective of vigorous sonication in acetone. However, in areas devoid of varnish, erosion was observed as mainly irregular lesions similar to those seen in the NaF solution treated and control specimens. The present study showed that treatment of enamel with topical fluoride prior to acidic challenge can inhibit initial erosion.

Adult↗