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PubMed1989

Association between acid fumes in the work environment and dental erosion.

The effect of inorganic acid fumes from the work environment on the erosion of teeth was studied blindly. A sample of 186 workers was drawn from four factories. Among the 157 dentulous participants, 76 were working in departments containing acid fumes, and 81 had never worked under such conditions and were used as referents. Of the acid workers 18.4% had one or more teeth with erosion, and the corresponding figure for the referents was 8.6%. With a longer duration of exposure the proportion of subjects with erosion increased. The acid workers had more teeth with erosion than the referents, especially upper anterior teeth. The findings suggest that even today exposure to inorganic acid fumes from the work environment may increase the erosion of teeth, especially the upper anterior teeth, which are not continuously protected by saliva and the lips.

Adult↗

PubMedDate not supplied

The implication of phenylketonuria on oral health.

PURPOSE: This study was performed to evaluate the oral health of children with PKU and to assess, in vitro, the erosive potential of 5 amino acid supplements commonly prescribed in the management of these children. METHODS: Forty children with phenylketonuria underwent a full dental examination and were compared with an age and sex matched control group. The erosive potential of the supplements was assessed by comparing their pH and titratable acidity to those of Coca Cola and orange juice. RESULTS: There was no significant difference between the affected and control groups in the level of dental caries, with over 75% of the children examined being caries free. However significantly more (33%) children with phenylketonuria exhibited signs of tooth wear compared with 24% of the controls (P < 0.05). While Coca Cola had the lowest pH (2.46), the titratable acidity of the flavoured supplements (92.86-126.8 mEq/l) was significantly higher than both their unflavored counterparts (4.18-14.0 mEq/l) and Coca Cola (38.56 mEq/l). CONCLUSIONS: Despite the potentially damaging nature of their diet, significantly less children with PKU had ever seen a dentist. Health professionals involved in the care of these patients should be aware of the implications of management and provide appropriate dental advice and referral.

Adolescent↗

PubMed2006

[Erosion effect of a newly developed soft drink].

In this article, the erosion effect of a newly developed soft drink available in 3 different flavours is compared with the erosion effect of some common soft drinks. Several basic parameters of the soft drinks were determined: pH, titratable acidity, and the calcium as well as phosphate concentration. Three methods were used to assess in vitro the erosion depth of the soft drinks in enamel specimens. Erosion depth is defined as the mean height of lost enamel. The methods used were atomic absorption spectroscopy for calcium loss, a colorimetric ammonium molybdate method for phosphate loss and non-contact profilometry for enamel volume loss. The newly developed soft drink realized statistically significantly less erosion depth when compared with cola and apple juice and statistically non-significantly less erosion depth when compared with orange soda.

Beverages↗

PubMedDate not supplied

Incisor teeth status in patients with reflux oesophagitis.

A retrospective non-controlled inventory study was done in order to assess the dental status, with specific attention paid to the incisor teeth, in patients with reflux oesophagitis. A questionnaire was sent to 293 consecutive patients in whom reflux oesophagitis was diagnosed endoscopically. A complete dental prosthesis was present in 46.8% of the patients, the remainder had a complete set of teeth or a partial dental prosthesis. Damage in the upper incisors was present in 32.5% of the cases, in the lower incisors in 7.8%, and in both in 26.9%. In the remainder no damage was present. No complaints were significantly associated with the presence or absence of dental damage. There was, however, a significant association between duration of complaints and presence of damage in the upper incisors. Although it is not certain that all cases of damage actually are the result of gastro-oesophageal reflux, and the data presented possibly overestimate the true prevalence, dental erosions as a complication of gastro-oesophageal reflux are likely to occur in a large number of patients.

Adolescent↗

PubMed1993

Erosion by soft drinks of rat molar teeth assessed by digital image analysis.

A digital imaging analysis (DIA) procedure for recording and assessing erosive changes on teeth was developed and evaluated against an older subjective method. Results after exposure of rats' teeth to various soft drinks showed that the DIA system was superior to the conventional method, with improved precision. The system provided a direct and highly sensitive means of quantifying the erosion of dental hard tissues by three different soft drinks, showing that it could be used to evaluate erosiveness and other dental damage. After 6 weeks' exposure to soft drinks in the diet, the area of intact enamel on the lingual surface of the first mandibular molar averaged 47% on apple juice, 27% on still orange and 6% on carbonated orange. The greatest exposure of dentine (36%) was on the still orange drink. Eroded enamel accounted for 72.5% of the tooth surface on the carbonated drink.

Animals↗

PubMed2004

Relationship between dental erosion, soft drink consumption, and gastroesophageal reflux among Icelanders.

The aim of this study was to determine the prevalence of dental erosion in young Icelandic adults (19-22 years old) and patients with gastroesophageal reflux disease (GERD), in relation to their soft drink consumption and gastroesophageal reflux. Eighty subjects (40 males and 40 females), comprising 57 young adults (mean age 21 +/- 2 years) and 23 GERD patients (mean age 35 +/- 10 years), were enrolled in this study. All subjects answered a detailed frequency questionnaire of soft drink consumption and participated in a clinical examination. Erosion was scored for incisor and molar teeth separately. No significant difference was observed in the prevalence of dental erosion between young adults and GERD patients. However, by combining the two study groups a three-fold higher risk of having erosion in molars or incisors was found for subjects drinking Coca-Cola three times a week or more often ( p < 0.05). Additionally, significantly higher erosion scores were found in molars among subjects drinking more than 1 litre of carbonated drinks (all brands) per week ( p < 0.05). It is concluded that the frequency of soft drink consumption is a strong risk factor in the development of dental erosion.

Adult↗

PubMed2001

Dental erosion in a group of British 14-year-old school children. Part II: Influence of dietary intake.

OBJECTIVES: The aims of the present study were first to investigate the dietary intake pattern of UK teenagers and secondly to determine the relationship, if any, between dental erosion and dietary intake in these children. METHODS: The study group consisted of a cluster random sample of 14-year-old school children in Birmingham, UK: 418 children were examined from 12 different schools; 209 were male and 209 female. Data on the rate and frequency of consumption of drinks, foods, and fruits were obtained from a self-reported questionnaire supplemented by a structured interview. The data were analysed using SPSS with Chi-square, and Spearman correlation analysis. RESULTS: Over 80% of the teenagers regularly consumed soft drinks but approximately half of these children had a relatively low weekly consumption. However, 13% and 10% respectively had more than 22 intakes per week of cola and other carbonated drinks. Almost a quarter of these 14-year-olds had alcoholic drinks, with significantly more males than females involved (Chi-square P < 0.05) . Girls had a greater intake of fruits. Statistically significant correlations were found between the prevalence of erosion and the consumption of soft drinks, carbonated beverages, alcohol drinks, fresh fruits, Vitamin-C tablets and foodstuffs (Spearman correlation analysis P < 0.05). CONCLUSION: It was concluded that consumption particularly of soft drinks was high and common in teenage school children in Birmingham, UK. In addition there was a relationship between dental erosion and acidic dietary intake. Further investigation of the erosive potential of these drinks and foods is required.

Adolescent↗

PubMed2003

Dental health behavior, gastroesophageal disorders and dietary habits among Norwegian recruits in 1990 and 1999.

A questionnaire was given to representative samples of Norwegian recruits in 1990 and 1999 to explore dental health habits, history of gastroesophageal disorders and diet with possible relations to dental erosion. The samples were 792 (mean age 20.9 years) and 676 (mean age 21.6 years), respectively, and the corresponding responses were 62% and 100%. Minor differences in self-reported dental health habits and gastroesophageal disorders were found. The respondents' dentists had provided information about dental erosion for 8.2% of the respondents in 1990 versus 14.5% in 1999. There was an increase in the reported frequency of daily intake of juice from 17% to 24% (P = 0.006) and carbonated soft drink from 54% to 61% (P = 0.025) in the period 1990-99. The frequency of training activity showed minor changes, but in 1999 it was more common to drink during exercise (94% versus 74% in 1990, P < 0.001), and the majority drank water. Sixteen percent of recruits ate oranges daily in 1990; in 1999 this had dropped to 11% (P = 0.012). The corresponding proportion that ate apples daily had dropped from 17% to 8% in the period (P < 0.001). It is likely that lifestyle factors related to diet among young men have changed in the period 1990-99 in a direction that may increase the prevalence of dental erosions.

Adult↗

PubMed2005

Dentin erosion simulation by cantilever beam fatigue and pH change.

Exposed root surfaces frequently exhibit non-carious notches representing material loss by abrasion, erosion, and/or abfraction. Although a contribution from mechanical stress is often mentioned, no definitive proof exists of a cause-effect relationship. To address this, we examined dimensional changes in dentin subjected to cyclic fatigue in two different pH environments. Human dentin cantilever-beams were fatigued under load control in pH = 6 (n = 13) or pH = 7 (n = 13) buffer, with a load ratio (R = minimum load/maximum load) of 0.1 and frequency of 2 Hz, and stresses between 5.5 and 55 MPa. Material loss was measured at high- and low-stress locations before and after cycling. Of the 23 beams, 7 withstood 1,000,000 cycles; others cracked earlier. Mean material loss in high-stress areas was greater than in low-stress areas, and losses were greater at pH = 6 than at pH = 7, suggesting that mechanical stress and lower pH both accelerate erosion of dentin surfaces.

Dental Stress Analysis↗

PubMed2005

Silicone sealers, acetic acid vapours and dental erosion: a work-related risk?

The aim of the present study was to investigate whether the acetic acid released by some silicone sealers during the curing process poses an increased risk for dental erosion, thus constituting an occupational hazard to exposed individuals. The material comprised 13 individuals (x=30 years, 10 men and 3 women) who had been exposed to an average of 4.2 years' (range 0.6-10 years) of working with silicone. Each had comprehensive medical and dental examinations carried out. A sex- and aged-matched group of 20 healthy, unexposed workers from the same company served as controls for the medical examination, while study models from randomly selected sex- and age-matched individuals were used as controls for assessing the severity of erosion. Using a questionnaire, an assessment of the role of various possible factors related to oral and general health, and to dental erosion in particular, was made for each participant in the exposed group. Clinical examination included recordings of severity of dental erosion, presence of "cuppings", DMFT, salivary secretion rate and buffer capacity, visible plaque index and gingival bleeding index. In addition, bitewing radiographs, study casts and intraoral colour transparencies were obtained for each individual. The severity of dental erosion was significantly higher in those exposed to silicone compared to controls. There was also a significant correlation between the period of exposure to silicone in the workplace and severity of erosion. Medical problems, especially with regard to upper respiratory tract symptoms, were significantly more common among exposed individuals than controls. In conclusion, a relationship between occupational exposure to acetic acid vapours from silicone sealers and development of dental erosion would appear to exist.

Acetic Acid↗

PubMed2001

Evaluation of pH and erosion time on demineralisation.

In the current study the effect of various pH values of citric acid and erosion time on erosion depth and subsurface demineralisation of human enamel was studied. In a laboratory investigation, six groups of 10 samples were eroded in 0.3% citric acid for 2 h at pH 2.54, for 2 h or 4 h at pH 3.2 and for 2 h, 4 h or 8 h at pH 4.5. The erosion depth was measured using a profilometer. The demineralised layer was then removed by ultrasonicating the samples with profilometric measurements taken at 5, 30, 120, 240 and 480 s ultrasonication time. The six test groups were classified by analysis of variance into four homogeneous groups according to their erosion depth and into three homogeneous groups according to their subsurface demineralisation. Erosion depth clearly depended on the pH value of the acid and the contact time. Depth of subsurface demineralisation and surface morphology did not depend on erosion depth. Similar subsurface demineralisation depths can be produced by appropriate combinations of pH and contact time.

Analysis of Variance↗

PubMed2004

Protective effect of the in situ formed short-term salivary pellicle.

Salivary pellicle, as previously investigated, protects the enamel surface after certain processes of maturation against the influence of acidic agents. The aim of the present study was to investigate the protective effect of the short-term salivary pellicle formed in situ over periods of 3, 60 and 120 min. Six human volunteers used intraoral acrylic splints with bovine enamel samples fixed at the buccal and palatal sites of the maxillary first molars and second premolars. Enamel specimens (n = 252) with and without pellicle were immersed for 60 s in 1.0% citric acid solution under agitation. Knoop surface hardness (KHN) of uneroded polished enamel was measured as a baseline and estimated immediately after erosive treatment reflecting the microhardness loss (DeltaKHN). The amounts of calcium dissolved from the eroded enamel surface were analysed by atomic absorption spectroscopy and scored in mg/l per 10 mm2 of enamel surface area. In addition, the scanning electron microscope was used for the micromorphological examination of the erosive alterations of the enamel surface. The average microhardness loss values after erosion of the enamel samples with buccally/palatally formed pellicle layers were measured as 139.1/144.9 DeltaKHN for 3 min pellicle, 145.9/146.9 DeltaKHN for 60 min pellicle and 141.7/138.6 DeltaKHN for 120 min pellicle. Calcium release values from the specimens with buccal/palatal pellicles were amounted to 15.0/14.9, 16.5/15.9 and 15.3/17.4 mg/l per 10 mm2 for 3, 60 and 120 min-old pellicles, respectively. No significant differences were related to the pellicle formation time and intraoral site (buccal or palatal) in all tested series (ANOVA, P < 0.05). However, significant protection of the enamel surface provided by the pellicle layer was observed on all pellicle-covered surfaces if compared to the non-covered enamel samples (calcium release: 25.6 mg/l per 10 mm2; microhardness loss 187.0 DeltaKHN). These data were in accordance with the morphologic alterations caused by citric acid on the pellicle-covered and pellicle non-covered specimens. It could be concluded that salivary pellicle formed in situ within a period of 3 min offers protection of enamel against citric acid. However, pellicle does not completely inhibit the erosive action of citric acid under the conditions of the present study.

Adult↗

PubMed2000

Oral pH and drinking habit during ingestion of a carbonated drink in a group of adolescents with dental erosion.

OBJECTIVES: To investigate the relationship between dental erosion, oral pH and drinking habit in a group of adolescents. METHODS: Oral pH was measured simultaneously at the surface of four teeth in 11 patients, aged 10-16 years, with erosion and in 10 controls subjects without erosion using antimony electrodes. Measurements were made before, during and after drinking 330 ml of a carbonated drink. The method and timing of drinking the beverage, reported dietary intake of acidic foods and flow rate and buffering capacity of saliva were recorded. RESULTS: The erosion patients reported drinking more carbonated drinks (p<0.01) and drinking directly from a can more frequently than the controls (p<0.05). They also drank twice as quickly (p<0.05). The pH at the buccal surface of a molar remained lower for longer in the erosion patients than in the patients without erosion (p<0.01), whilst the labial surface of the upper central incisor had a longer exposure to low pH in the controls subjects (p<0.05). CONCLUSION: The pattern of oral pH differed between subjects with and without erosion after drinking an acidic beverage. This may be related to observed differences in drinking habit, which could have influenced the pattern of erosion in these subjects.

Adolescent↗

PubMed2000

Effects of pH and concentration of citric, malic and lactic acids on enamel, in vitro.

OBJECTIVE: Dental erosion associated with soft drink consumption probably results from the contained dietary acids in the formulations. The pH value of any formulation is an important variable in acid erosion but not necessarily the only important factor. The aim of this study was to measure enamel erosion by citric, malic and lactic acids at pH values and acid concentrations representative of a range found in soft drink formulations and to determine the effect of adding calcium to citric acid. METHODS: Flat ground enamel samples were prepared from unerupted human third molar teeth. Groups of five specimens were placed in citric, malic and lactic acid solutions of different pH and acid concentration for three by 10 min exposures at 35 degrees C. Enamel loss was measured by profilometry. Enamel specimens were also exposed to citric acid solutions containing calcium at different pH values and at the same pH with different concentrations of calcium. RESULTS: Numerical data and contour plots for each acid showed a similar pattern for increasing erosion with decreasing pH and increasing acid concentration and vice versa for decreasing erosion. Increasing the concentration of calcium in a fixed pH citric acid solution resulted in decreased erosion. This effect was most marked at higher pH. CONCLUSIONS: This study has shown that under highly controlled conditions the erosion of enamel by solutions of dietary acids is influenced by the interplay of pH, acid concentration and presence of calcium. These variables and in particular the concentration of calcium could be manipulated to produce soft drinks with reduced erosivity to enamel.

Beverages↗

PubMed2003

Influence of liquid temperature and flow rate on enamel erosion and surface softening.

Enamel erosion and softening are based on chemical processes which could be influenced by many factors including temperature and acid flow rate. Knowledge of the influence of these variables could have relevance to research experiments and clinical outcomes. Both parameters were investigated using an ultrasonication and profilometry method to assess erosion depth and surface softening of enamel. The influence of temperature was studied by eroding polished human enamel samples at 4, 20, 35 or 50 degrees C for 2 h. Secondly, different liquid flow conditions were established by varying acid agitation. Additionally, a slow laminar flow and a jet of citric acid, to simulate drinking through a straw, were applied to specimens. Erosion depth increased significantly with acid temperature from 11.0 microm at 4 degrees C to 35.8 microm at 50 degrees C. Surface softening increased much more slowly and plateaued at 2.9 microm to 3.5 microm after 35 degrees C. A strong dependence of erosion on liquid flow was revealed. In unstirred conditions only 8.6 microm erosion occurred, which increased to 22.2 microm with slow stirring and 40.9 microm with fast stirring. Surface softening did not increase correspondingly with its largest extent at slow stirring at 3.4 microm.The implication of these data are: first, the conditions for erosion experiments in vitro or in situ need to be specified for reliable comparisons between studies. Secondly, erosion of teeth by soft drinks are likely to be influenced both by the temperature of the drink and individual drinking habits.

Citric Acid↗

PubMed1996

Determinants of oral health in a group of Danish alcoholics.

The purposes of this survey were to describe dental health in a group of alcoholics and to analyze the influence of social background, dental health behavior and alcohol-related variables on dental health among alcoholics. The dental health in a group of consecutively admitted alcoholics (n = 195) was described with respect to number of teeth present, DMFS, DS and the prevalence of dental erosion, removable dentures, edentulousness, and untreated dental decay. No major differences were found with respect to number of teeth and dental caries (DMFS), when compared to reference figures of the general population. As to untreated decay, however, 3-5 x more actual decayed surfaces were found among the alcoholics. In the multivariate analyses, neither DMFS, nor untreated decay were found to be associated with alcohol-related indicators. These variables were, however, related to variables of social background and dental health behavior. As to number of teeth present, an association was found with duration of alcoholism, but this relationship was eliminated, when the analysis was controlled with respect to social situation. In contrast, dental erosion was related to duration of alcoholism irrespective of confounding control of dental health behavior and social situation. Hence, the study indicates that oral health in alcoholics can be explained mainly by social situation and dental health behavior and not by variables associated directly with alcohol consumption. An exception was the presence of dental erosion, which was associated with the exposure to alcohol.

Adult↗

PubMed1997

The resistance of titanium tetrafluoride-treated human enamel to strong hydrochloric acid.

The acid resistance of TiF4-treated enamel was investigated to establish a possible treatment modality for endogenous dental erosion. Enamel slabs were prepared from human molars and treated with solutions of TiF4. Scanning electron microscopy (SEM) and microhardness testing were used to examine the effects of the exposure of the treated enamel to strong acid. SEM micrographs showed the presence of heavy deposits on enamel surfaces. The surface coating, formed following TiF4 application, appeared to be resistant to severe acid attacks. Microhardness measurements showed that TiF4 treatment inhibited enamel softening. It is concluded that topical TiF4 application may be effective in prevention of dental erosion caused by hydrochloric acid from the stomach in patients with frequent vomiting or gastroesophageal reflux.

Cariostatic Agents↗

PubMed2005

An investigation of some food-approved polymers as agents to inhibit hydroxyapatite dissolution.

Dental erosion involves dissolution of the hydroxyapatite fraction of enamel and dentine, so agents that reduce the dissolution rate of hydroxyapatite could find application in food products aimed at reducing erosion. This study was performed to test some common food ingredients and additives for their effect on the dissolution rate of hydroxyapatite in a citric acid solution representative of soft drinks. Pyrophosphate, tripolyphosphate and a linear chain polyphosphate (average 25 phosphate units) significantly reduced the hydroxyapatite dissolution rate by 35, 46 and 64%, respectively. Xanthan gum and carboxymethylcellulose significantly reduced the hydroxyapatite dissolution rate by 29 and 16%, respectively. The protective effect may be ascribed to the binding of condensed phosphate or to the formation of an adsorbed layer of gum at the hydroxyapatite surface. Several other common food additives had no statistically significant effect on the hydroxyapatite dissolution rate. Polyphosphate exhibited a considerable persistence of action, causing a reduction in the dissolution rate for 3 h after treatment. Tripolyphosphate was slightly persistent, and pyrophosphate and xanthan gum did not exhibit a substantial persistence of action. A solution containing polyphosphate and xanthan gum reduced the hydroxyapatite dissolution rate by 70% and exhibited a similar persistence of action to the solution containing only polyphosphate. These compounds are suggested to have potential as erosion-reducing agents in soft drinks.

Buffers↗