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Development and evaluation of a low erosive blackcurrant juice drink. 2. Comparison with a conventional blackcurrant juice drink and orange juice.

OBJECTIVE: A previous study demonstrated that an experimental low pH blackcurrant juice drink with calcium was markedly less erosive to enamel both in situ and in vitro than orange juice. Further development of the experimental blackcurrant juice drink formula has occurred and the aims of the present studies were two fold. Firstly, to confirm the low erosivity of the modified formulation and secondly, to provide more comparative data with other acidic fruit drink products. METHOD: The study was a single centre, single blind, randomised placebo controlled 4 cell crossover design involving 12 healthy volunteers. The test drinks were orange juice, water, experimental blackcurrant juice drink with calcium and a proprietary blackcurrant juice drink. Enamel samples were retained in situ at the mid palatal regions using intraoral appliances and exposed to 250 ml volumes of the drinks 4 times per day during 15 working days. Measurements of enamel loss were made by profilometry. The same method was modelled in vitro. RESULTS: By day 15 the mean losses of enamel in situ for orange juice, water, experimental blackcurrant juice drink with calcium and blackcurrant juice drink were 1.70, 0.05, 0.44 and 2.75 microns respectively. At all bar one measurement, the loss of enamel was significantly greater for all fruit drinks compared to water. Losses caused by the blackcurrant juice drink with calcium were significantly less than the other two fruit drinks at all time points. Losses of enamel by day 15 in the study in vitro were 13.02, 0.00, 1.78 and 39.02 microns respectively. The blackcurrant juice drink with calcium was not significantly different from water at days 3 and 6, otherwise all pairwise comparisons for differences between the 4 drinks at each time period were significant. CONCLUSIONS: The methodologies in situ and in vitro again appear to correlate in ranking the order of erosivity of drinks. The data particularly from the study in situ allude to the very low comparative erosivity of the further modified experimental blackcurrant juice drink with calcium and support the further development of such drinks for public consumption.

Adult↗

Gingivally submerged cervical erosion lesion--a clinical problem.

The technique used to treat cervical erosion lesions that are buried beneath the crest of the gingival tissue is described. With proper isolation of the field and careful gingival retraction as prerequisites, the surface topography of the completed restoration is almost indistinguishable from the adjacent enamel, and the gingival tissue response is good.

Adhesives↗

A comparison of acidic dietary factors in children with and without dental erosion.

The results of the UK Child Dental Health Survey of 1993 indicated that dental erosion was a problem in children, with acidic dietary components thought to be the main etiological factor. The aim of this study was to compare, in the form of a case control study, the diets of children with dental erosion with those who were caries-active or caries-free. Structured dietary histories were taken from 309 age and gender matched children to determine the type and frequency of intake of acidic foods and drinks, together with any drinking habits that prolonged exposure of the teeth to dietary acids. Results showed that the children with erosion drank acidic beverages significantly more frequently than children who either had caries or were caries-free. Children with erosion also drank milk or water significantly less often than the control groups, and were more likely to have a swishing or holding habit associated with drinking. Fruit and vinegar consumption was higher in the erosion group, as was the taking of vitamin C supplements. The results of this study suggest that the increased consumption of acidic foods and drinks, particularly when associated with a swishing or holding habit, may contribute to the development of erosion in some children. Dietary advice should emphasize the dangers of a highly acidic as well as that of a cariogenic diet.

Acetic Acid↗

Considerations for treating adolescent patients.

Adolescence is a time of accelerated growth with increasing caloric needs. A strong attraction for the taste of sugar and its availability have had detrimental consequences for the adolescent's dentition and general health. Numerous factors combine to contribute to the demineralization and erosion that predispose the enamel to smooth surface caries. Obesity and its associated maladies, eating disorders, and pregnancy are additional issues for consideration. Determining the need for and appropriate timing of extraction of third molars should be included in the treatment plan.

Adolescent↗

Eating disorder-induced dental complications: a case report.

Eating disorders are potentially life threatening and have not lost their relatively poor prognosis in the last decades. Whereas the increase in incidence and prevalence rates of anorexia nervosa over time are questionable, an increasing trend in incidence and prevalence of bulimia nervosa has been reported. Dentists are often involved in treating teeth of patients with both anorexia nervosa and bulimia nervosa because the teeth of these patients are regularly affected by erosion and caries. Without identification of the underlying evidence of psychological problems and consequent treatment, a patient's medical and dental health will deteriorate as the eating disorder progresses. The dentition of the patient with an eating disorder may offer specific signs and characteristics to alert the dentist.

Adult↗

The erosive potential of commercially available mouthrinses on enamel as measured by Quantitative Light-induced Fluorescence (QLF).

DESIGN: Longitudinal in vitro. METHODS: Previously extracted, caries free, human premolars were selected and prepared by gentle pumicing and coating in an acid-resistant nail-varnish save for an exposed enamel window on the buccal surface. Each was assigned to one of eight groups (six per group, 10 in positive control); positive control (citric acid, pH 2.7, F(-) 0 ppm), negative control (pH 7.0, F(-) 0 ppm) Listerine (pH 3.87, F(-) 0.021 ppm), Tesco Value (pH 6.05, F(-) 289.00 ppm), Tesco Total Care (pH 6.20, F(-) 313.84 ppm), Sainsbury's (pH 6.15, F(-) 365.75 ppm), Sensodyne (pH 6.12, F(-) 285.30 ppm) and Corsodyl (pH 5.65, F(-) 0 ppm). The titratable acid values (TAV) for each rinse were established using volume (ml) of 0.1 M NaOH to achieve pH 7. Fluoride values were obtained by ion selective electrode. The solutions were kept at 37 degrees C and gently agitated. Teeth were removed at hourly intervals for 15 h, air-dried and subjected to Quantitative Light-induced Fluorescence (QLF) examination by a blinded examiner and DeltaQ values recorded. At the conclusion of the study each of the positive control teeth and one from each other group were sectioned through the eroded lesion, ground and polished to 100 micrometers and subjected to transverse microradiography and DeltaZ recorded for validation. RESULTS: TAVs were: Listerine 2.45 L > Sainsbury's 0.35 ml >Tesco Total Care 0.14 ml > Tesco Value 0.08 ml > Corsodyl 0.10 ml >Sensodyne 0.9 ml. DeltaQ increased over time for the positive control, (0 h 0.2, 10 h 95.2, 15 h 152.3). Negative controls remained stable. The increase in DeltaQ for each rinse after 15 h was Listerine (9.3(+/-7.2)), Corsodyl (1.5(+/-1.2)), Tesco Value (1.8(+/-1.2)), Tesco Total Care (1.4(+/-1.1)), Sainsbury's (3.4(+/-2.2)), Sensodyne (0.9(+/-1.6)). TMR confirmed the presence/absence of erosive lesions. CONCLUSIONS: QLF effectively monitored erosion in the positive controls and lack of erosion in the NC. Only one mouthrinse (Listerine) caused any erosion compared to the negative control, but this was only significant after 14 h of continuous use.

Analysis of Variance↗

[Histopathological and therapeutical aspects of cervical lesions].

The term "cervical lesions" definies all the alterations consisting in a loss of hard dental tissues located along the cement-enamel junction, and may be more specifically defined as carious lesions (LCC) and non-carious lesions (NCCL). The non-carious cervical lesions are characterized by the loss of mineralised dental tissue in the absence of a carious process. This definition includes three different lesion categories: abrasion, erosion and the cervical lesions caused by stress (abfractions). In this paper the authors explain the histological, clinical, preventive findings of NCCL and try to give some guidelines to choose the appropriate material to restore different types of non carious cervical lesions.

Dental Caries↗

The influence of different factors on in vitro enamel erosion.

The aim of this study was to use two demineralization test methods to analyze the erosive potential of beverages and foodstuffs. In addition, the surface microhardness test and the iodide permeability test were compared. Surface microhardness and iodide permeability were measured before and after exposure. To characterize the beverages and foodstuffs the content of phosphate, calcium and fluoride, pH, the titrable amount of base to pH 5.5 and 7.0 as well as the buffer capacity at pH 5.5 were determined. Sprite light showed the highest significant decrease in surface microhardness (p < or = 0.05) followed by grapefruit juice, apple juice and salad dressing. The highest significant increase in iodide permeability (p < or = 0.05) was caused by exposure to grapefruit juice followed by apple juice (Sprite light was not tested). Multiple linear regression analyses revealed that the erosive capacity of different drinks, juices and foodstuffs are statistically significantly associated with their acidity, pH values, phosphate and fluoride contents as well as the baseline surface microhardness or iodide permeability values of the exposed enamel.

Beverages↗

Dental erosion related to alcoholism and an eating disorder: a case report.

Dental erosion has been reported in the literature with particular attention to etiology and diagnosis of the disorder. Unfortunately, little information exists to guide dental professionals in treatment planning predictable restorative outcomes for this patient population. This case report describes a unique presentation of severe dental erosion related to alcoholism and an eating disorder. Diagnosis and etiology of the condition are discussed and a comprehensive list of treatment options is evaluated. The interim occlusal overlay prosthesis is presented as a diagnostic and therapeutic appliance for use in this unique patient population.

Alcoholism↗

Dental erosions and gastro-oesophageal reflux disease in institutionalized intellectually disabled individuals.

OBJECTIVE: Both exogenous acids, from the diet, and endogenous acids, from stomach juice, can dissolve the enamel mineral, resulting in dental erosions. Gastric acid may reach the mouth by gastro-oesophageal reflux disease (GERD), recurrent vomiting, rumination and regurgitation. These conditions are frequently found in the intellectually disabled population. Therefore, we investigated the presence of dental erosions in combination with GERD among intellectually disabled inhabitants, with an IQ < 50, taken from three Dutch institutes. MATERIALS AND METHODS: At random 63 individuals underwent an oesophageal pH test and dental screening and possible predisposing and attributable factors were determined. An abnormal pH level was defined as a pH < 4, > 4.5% of the measured time. Subjects with dental erosions were compared to those without dental erosions. RESULTS: In 29 out of 63 (46.0%) cases evidence of dental erosions was found. In 19 of these 29 subjects with erosions (65.5%) GERD was diagnosed, compared to nine (26.5%) out of 34 subjects without erosions (P = 0.04). In the subjects with erosions mean duration of pH < 4 was 15.6% (range: 0.5-90.5) compared to 6.3% (range 0-40.4) in subjects without erosions (P = 0.02). An IQ < 35 was found to be predisposing (P < 0.001). CONCLUSION: In this population of 63 institutionalised intellectually disabled persons dental erosions were diagnosed in 46%. Sixty-five per cent of them had GERD. Individuals with longer duration of pH < 4 than 6.3% of the measured time and with an IQ < 35 were at higher risk to develop dental erosions. This study shows that dental erosions in the intellectually disabled population might be an oral manifestation of GERD.

Adolescent↗

[Effects of cocaine use on oral health and implications for dental treatment].

In The Netherlands, an increasing number of people use cocaine frequently, which may induce orofacial complications such as perforation of the nasal septum and palate, gingival lesions and dental erosion. In addition, recent use of cocaine increases the risk of cardiovascular complications during dental treatment, especially when local anaesthetics or adrenaline-impregnated retraction cords are used. Therefore, dental treatment should be postponed at least 6 to 24 hours after the use of cocaine.

Cardiovascular Diseases↗

Epidemiological-environmental study of lead acid battery workers. III. Chronic effects of sulfuric acid on the respiratory system and teeth.

The effects of long-term exposure to sulfuric acid mist on the teeth and respiratory system were studied in 248 workers in five plants manufacturing lead acid batteries. The prevalence of cough, phlegm, dyspnea, and wheezing as determined by questionnaire were not associated with estimates of cumulative acid exposure. There was only one case of irregular opacities seen on the chest radiographs. There was no statistically significant association of reduced FEV1, peak flow, FEF50, and FEF75 with acid exposure although the higher exposed group had lower mean values. FVC in the high exposure group showed a statistically significant reduction compared to the low exposure group, but there was no significant association when exposure was analyzed as a continuous variable. The ratio of observed to expected prevalence of teeth etching and erosion was about four times greater in the high acid-exposure group. The earliest case of etching occurred after 4 months exposure to an estimated average exposure of 0.23 mg/m3 sulfuric acid.

Adult↗

Histological studies of an adhesive paint-on restorative for cervical erosions.

A histological study of the response in the pulps of human teeth to cervical restorations made with a composite resin following etching of the enamel for 2 minutes with 50 per cent phosphoric acid showed moderate inflammation after 14 days. Three specimens showed normal structure after 98 days. Teeth restored without etching showed only slight inflammation.

Composite Resins↗

[Eating disorders (II)--dental aspects].

Patients suffering from eating disorders exhibit oral symptoms indicative to the otherwise concealed illness. The most striking features are the intrinsic erosions due to the regular surreptitious vomiting. They occur in very typical locations within the dental arches and have been termed "perimolysis". Dental professionals are often the first to discover and diagnose eating disorders by detecting perimolysis and consequently face the difficult task to motivate the patients--who often deny their illness--to seek psychiatric help and dental care. Such motivation must be done while respecting the patients' integrity and sense of self-worth. The primary goal of dental care is to preserve the remaining teeth and to prevent further erosive loss of dental hard tissue. The key elements of a dental preventive programme based on pathophysiologic grounds are to enhance local defence mechanisms, to offer chemical and mechanical protection and to diminish abrasive and erosive challenges. Dental restorative therapy must be part of a combined medical and dental treatment plan and should not be started before the eating disorder has been treated and the patients are considered to have stable prognosis. In view of the young age of the patients, the large extension of the erosive lesions and in order to avoid endodontological treatment of mostly sound pulps, non-invasive restorative concepts using adhesive technology should be preferably used. Prophylactic measures and restorative treatment are covered by health insurance (KGV; KLV 18c, 7) if the patients undergo psychiatric or similar adequate treatment.

Adolescent↗

Risk factors in dental erosion.

Dental erosion and factors affecting the risk of its occurrence were investigated with a case-control approach. One hundred and six cases with erosion and 100 randomly selected controls from the same source population were involved in the study. All cases and controls were evaluated by the recording of structured medical and dietary histories and by examination of the teeth and saliva. Erosion was classified according to pre-determined criteria. The relative importance of associations between factors and erosion was analyzed by a logistic multivariable model. Adjusted odds ratios (AOR) were estimated. There was considerable risk of erosion when citrus fruits were eaten more than twice a day (AOR 37), soft drinks were drunk daily (AOR 4), apple vinegar was ingested weekly (AOR 10), or sport drinks were drunk weekly (AOR 4). The risk of erosion was also high in individuals who vomited (AOR 31) or exhibited gastric symptoms (AOR 10), and in those with a low unstimulated salivary flow rate (AOR 5).

Adolescent↗

Communicating effectively with patients suspected of having bulimia nervosa.

BACKGROUND: The dental team often is confronted with the clinical appearance of erosion affecting the hard and soft oral tissues. An investigative process often is needed to determine the cause of such erosion, because factors other than eating disorders may be involved. The authors present a protocol that should be considered in the assessment of dental erosion. Guidelines provide direction for the clinician toward opening a dialogue with a patient when the suspected cause of erosion is an eating disorder. TYPES OF STUDIES REVIEWED: The authors review publications related to the causes of dental erosion and the patterns that are involved with both chemical and mechanical destruction of oral tissues. They also discuss the oral-tissue effects related to eating disorders. The authors stress the importance of assisting parents in obtaining adequate treatment for pediatric patients. RESULTS: Cases of eating disorders among female college students, athletes, preadolescent children and men are well-documented. However, dental staff members often do not feel comfortable beginning a dialogue with patients who are suspected of having an eating disorder. This article focuses on the proper protocol for approaching such patients and beginning a dialogue. In addition, the authors provide suggestions for limiting further erosive damage to the tissues. They also discuss other causes of erosion that should be considered when assessing any type of oral erosion. CLINICAL IMPLICATIONS: The dental team is in a prime position to assist patients who have eating disorders. Timely treatment by mental health and other medical professionals is crucial. The authors suggest a dialogue for approaching these patients and offer educational material to reduce further tissue destruction.

Adolescent↗

[Salivary tests for caries and erosion risk factors].

Apart from a health questionnaire and oral health examination with a clinical history, it is also important to inquire after oral and salivary complaints. Supplementary it is useful to assess dietary habits in patients at risk and to perform a number of simple salivary tests. Interpretation of all data obtained through these investigations, will enable the identification of a number of caries and erosion risk factors. On the basis of these risk factors a preventive treatment plan can be made for the patient. These data provide the possibility to evaluate the success of the preventive treatment plan after a few years and to make adjustments, if necessary.

Dental Caries↗

Complications of medical management of dental erosion.

This article reports the case of a patient presenting with dental erosion as a result of asymptomatic gastro-oesophageal reflux disease (GORD). The management of this patient is discussed, in particular the use of proton pump inhibitors. The advantages and disadvantages of the use of medication are discussed, especially in the light of the symptoms of GORD, which developed after taking omeprazole.

Adult↗