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PubMed1985

Medical consequences of eating disorders.

While much has appeared in the recent literature about various psychotherapeutic techniques used to treat eating disorders, little attention has been paid to the medical complications. Prominent among these are heart damage, failure of the endocrine system, infarction and perforation of the stomach after acute dilatation, multiple suicide attempts, aspiration, injury or rupture of the esophagus, severe bleeding per rectum causing anemia due to laxative abuse, hypokalemic nephropathy, depressive disorders due to starvation, and severe erosion of the enamel of the teeth resulting in extensive loss of teeth. I decry the sudden trend of nonmedically trained personnel rushing into the treatment of eating disorders, particularly anorexia nervosa and bulimia, because they know little about the possibly fatal consequences of their failure to attend to some of these medical phenomena. I also note with grave concern the identification of the medical profession with the "thin is better" mentality of our culture, which blinds them to the serious medical consequences of eating disorders.

Amenorrhea↗

PubMed2003

Dental and periodontal lesions in patients with gastro-oesophageal reflux disease.

OBJECTIVE: Dental erosion has been considered an extraesophageal manifestation of gastro-oesophageal reflux disease, but few reports have studied the relationship between this disease and other periodontal or dental lesions. The aim of this study was to investigate the prevalence of dental and periodontal lesions in patients with gastro-oesophageal reflux disease. PATIENTS AND METHODS: A total of 253 subjects were prospectively studied between April 1998 and May 2000. Two study groups were established: 181 patients with gastro-oesophageal reflux disease and 72 healthy volunteers. Clinical assessment, including body mass index and consumption of tobacco and alcohol, was performed in all subjects, as well as a dental and periodontal examination performed by a dentist physician, blind as to the diagnosis of subjects. Parameters evaluated were: (a) presence and number of dental erosion, location and severity, according to the Eccles and Jenkins index [Prosthet Dent 1979;42:649-53], modified by Hattab [Int J Prosthes 2000;13:101-71; (b) assessment of dental condition by means of the CAO index; and (c) periodontal status analysed by the plaque index, the haemorrhage index, and gingival recessions. RESULTS: Clinical parameters were similar in both groups (p > 0.05). Age was statistically associated with the CAO index, presence of dental erosion, and gingival recession (p < 0.001, Student's t-test). Compared with the control group, the percentage of dental erosion was significantly higher in the gastro-oesophageal reflux disease group (12.5 vs. 47.5%, p < 0.001, chi2-test), as was the number and severity of dental erosions (p < 0.001, Student's t-test). Location of dental erosion was significantly different between groups. Age was not statistically related to either the amount or severity of dental erosion. CAO and periodontal indices were similarly distributed between groups. CONCLUSIONS: Dental erosion may even be considered as an extraesophageal manifestation of gastro-oesophageal reflux disease. The fact that the prevalence of caries and periodontal lesions is similar in patients with gastro-oesophageal reflux disease and in healthy volunteers suggests a lack of relationship with gastro-oesophageal reflux disease.

Adolescent↗

PubMed1995

The distribution of erosion in the dentitions of patients with eating disorders.

Anorexia and bulimia nervosa (the eating disorders) are potentially life threatening and are becoming more prevalent. This paper reviews the effects of these disorders on dental erosion and reports a study to assess the effects of the eating disorders on the erosion of teeth relating the severity of erosion to factors such as the frequency of self-induced vomiting (SIV). One hundred and twenty-two eating disorder patients and an equal number of age, sex, and social class matched controls were studied. The study population was divided into subgroups according to the eating disorder. All the subgroups had significantly more abnormal toothwear than the controls (P < 0.005), with the differences being most marked in the SIV groups. Further analysis did not find any consistent relationships to the frequency or duration of SIV.

Anorexia↗

PubMed1996

Restorative therapy for erosive lesions.

More needs to be learned about the etiology of erosion lesions before they can be accurately diagnosed, confidently treated and, more importantly, prevented. The treatment is dependent on the location and the degree of erosion. The decision to treat an erosion lesion should be based on careful consideration of the etiology and progression of the condition. Reasons for restoring noncarious enamel/dentin lesions are discussed and various therapeutic measures are provided. Preventive and restorative therapeutic measures for noncarious abrasive/ erosive lesions are proposed such as: a change of dietary or behavior patterns; application of desensitization products; intensive fluoride therapy with or without iontophoresis; brushing with desensitizing dentifrices; adhesive penetration with dentin bonding agents; glass ionomers and compomers; resin composites; composite or porcelain veneers; crown and bridge work; occlusal adjustments and nightguard fabrication if the abfraction factor coincides. The clinical durability of restorative therapy and important clinical factors related to the restoration of multifactorial defects are discussed.

Composite Resins↗

PubMed2005

Effects of sucking acidic candies on saliva in unilaterally irradiated pharyngeal cancer patients.

Patients who have received radiation therapy on the head and neck area often use acidic candies to relieve symptoms of dry mouth. Therefore, the aim of this study was to determine the erosive potential in relation to teeth of an acidic candy in 10 such patients. The patients sucked the candy while their whole saliva was collected into a closed system at different times: baseline, candy-stimulated, and post-stimulated. The erosive potential of the candy was evaluated from candy-induced changes in saliva degree of saturation with respect to hydroxyapatite (HAp). Previously published normative values were used for comparison. The results showed that saliva became significantly more undersaturated with respect to HAp in irradiated patients, and failed to return to baseline values during the post-stimulatory period, which it normally does in healthy individuals. Thus, prevention of dental breakdown in these patients should involve counseling regarding choice of stimulant for dry mouth relief.

Acids↗

PubMedDate not supplied

[Acid mist occupational exposure and oral disease: a review].

This study is a review of published research findings on the oral effects of occupational exposure to acid mists. A literature search was conducted on MEDLINE, LILACS, SciELO, BBO, and DEDALUS, identifying eight articles and a doctoral dissertation focusing on this association. Findings were consistent with a positive association between occupational exposure to acid mists and dental erosion, according to the literature published since 1919. Studies on the association between acid mist exposure in the workplace and periodontal disease, or oral mucous lesions, were more recent and scarce, and their findings remain controversial. Several methodological drawbacks were observed, such as small sampling size and poorly developed analysis, as exemplified by little or no attention to confounding variables. These findings support the relevance of this research area and the need for improved research design. They also highlight the importance of considering oral health as a component of workers' health in effective preventive programs.

Air Pollutants, Occupational↗

PubMed1997

Application of transverse microradiography for measurement of mineral loss by acid erosion.

This paper describes a novel application of transverse microradiography for the detection and quantification of mineral loss due to acid erosion in thin tooth sections. Sixty-four specimens were randomly divided into eight equal-sized groups and exposed to an orthophosphoric-acid-based erosive fluid (pH = 3) for 0, 0.25, 0.5, 1, 2, 5, 12, or 24 hrs. We made microdensitometric scans separately across both enamel and dentin to derive data for the total mineral loss and the minimum mineral content within the eroded area. We then analyzed specimens using a profilometer to determine (1) the area above a plot of penetration depth against distance and (2) the maximum depth of penetration. Correlation coefficients for comparisons between microradiographic and profilometric data for both enamel and dentin specimens varied between 0.87 and 0.96. Two-sample t tests demonstrated that the microradiographic technique could detect early erosion, i.e., discriminate between erosion times of less than 1 hr. It was concluded that this application of transverse microradiography was a useful and acceptable method for the measurement of early mineral loss in vitro, occurring as a result of acid erosion.

Absorptiometry, Photon↗

PubMed1996

Methods of assessing erosion and erosive potential.

Methods for use in vitro are reviewed first, classified under the examination of extracted teeth, chemical and physical methods, digital image analysis, scanning electron microscopy and other potentially useful techniques. Methods for recording erosion in laboratory animals are dealt with next, including techniques that can also be used in vitro, Restarski's system and various modifications of it, and digital image analysis. Thirdly the main systems and indices that have been designed for clinical use are arranged under case histories and clinical examination, scales of severity and indices of diagnosis of varying complexity. Finally, some of the main advantages and limitations of the techniques are summarized.

Acids↗

PubMed2003

Permeability and morphology of dentin after erosion induced by acidic drinks.

BACKGROUND: The aims of this study were to evaluate 1) the alterations of dentin permeability after single exposure of dentin to several acidic soft drinks with different acid composition; 2) the effectiveness of smear layer on dentin surface to prevent erosion of sound dentin; and 3) the role of brushing procedures. METHODS: Dentin discs from human third molars were prepared. Each disc was treated with 0.5 M neutral EDTA for 5 minutes to remove the smear layer and to calculate the maximum fluid flow rate for each disc (to which an arbitrary value of 100% was assigned) using a pressure apparatus working at 1.0 psi. An homogeneous thin smear layer was then recreated with an abrasive paper under water. The following acidic drinks were applied for 5 minutes onto dentin surface: cola drink (phosphoric acid), orange fruit juice (ascorbic + citric acid), white wine (tartaric acid), vinegar (acetic acid), and mucolytic syrup (benzoic and tartaric acid). Each sample was then brushed for 3 minutes. Finally, each sample was brushed with a toothpaste and, as the final step, etched with phosphoric acid for 1 minute. Permeability was measured after each step. RESULTS: All acidic drinks were able to statistically increase dentin permeability and to open dentinal tubules by removing the smear layer. CONCLUSIONS: The study demonstrated that acidic drinks increased dentin permeability by removing and dissolving the smear layer and smear plugs. The erosion of peritubular dentin and smear plug removal is the main agent responsible for the increase in dentin permeability and probably for clinical dentin hypersensitivity. Brushing procedures reduced dentin permeability, creating a new fine and thin smear layer. Toothpaste may play a protective role in preventing complete smear layer removal and reducing dentin hypersensitivity by producing a new artificial smear layer and deposit inside tubules. The use and the abuse of acidic drinks may damage dentin and increase the risk for dentin hypersensitivity.

Acids↗

PubMedDate not supplied

Wear: mechanisms, manifestations and measurement. Report of a workshop.

OBJECTIVE: The purpose of this workshop was to bring together a tribologist (T.A.S.), a clinician (L.H.M) and a dental materials scientist (R.W.V) to discuss the fundamental mechanisms of wear and how these relate to the manifestations and measurement of wear in dentistry. Eighty delegates contributed to a valuable discussion led by the workshop chairman (C.H.L.). KEY POINTS: Wear is the net result of a number of fundamental processes: abrasion, adhesive effects, fatigue and corrosive effects which act in different combinations on the various classes of materials. In ceramics, sliding compression and surface corrosion greatly increase wear, whereas the ability to deform either plastically or elastically influences the wear of polymers. The filler particle distribution is a major variable influencing the wear of composites. In the mouth, wear can be considered in terms of its site, timing and mechanism. The latter may involve direct contact between surfaces or result from the action of slurries; both of which are affected by surface corrosion (erosion). Although wear can be categorized at the chairside, its precise measurement involves the use of replica models and surface contouring. Laboratory simulation is useful to study fundamental wear mechanisms; but it is not able to predict clinical wear. CONCLUSIONS: The management of clinical wear requires a proper understanding of the underlying mechanisms. This can only be achieved through close co-operation between all the disciplines which seek to understand and manage wear. The attendance of so many delegates at this workshop indicates the willingness to participate in this process.

Adhesiveness↗

PubMed2006

[Dental erosion in children and adolescents: gastroenterologic background].

Reflux of acidic gastric secretions into the oral cavity may cause significant dental erosion. This gastro-oesophageal reflux has been shown to occur in children as well as in adults, and is often not accompanied by typical reflux symptoms. When symptoms are present the children may complain of heartburn, food regurgitation and epigastric pain. Current investigation involves ambulatory 24-hour oesophageal pH-measurements. In the case of exaggerated reflux, the main therapeutic option is medical acid suppression for several years. The pathogenesis, the diagnostic and therapeutic procedures as well as the importance of the cooperation between dentists and gastroenterologists are described and therapeutic advices are given.

Adolescent↗

PubMed2004

Comparison of deep bite and open bite cases: normative data for condylar positions, paths and radiographic appearances.

To compare normal overbite, deep bite and open bite cases with clinically healthy temporomandibular joints (TMJ) regarding the difference between condylar positions in centric relation (CR) and habitual or centric occlusion (CO), condylar paths and radiographic findings of condylar appearance in order to establish normative data. Three study groups of normal overbite, deep bite and open bite cases consisted each of 30 subjects with no detectable clinical signs of temporomandibular disorder. The CR-CO differences and axiographic tracings were recorded using the School Artikulator of Mack (SAM) diagnostic system. Condylar shape was evaluated on panoramic radiographs. The CR-CO differences were greater in the vertical plane in open bite cases, and direction of movements from CR to CO showed great variability. Open bite cases had significantly shorter condylar paths. Radiographic findings exhibited that 23% of the total sample showed evidence of erosion and 83% evidence of flattening of condyles. The erosion rates were higher in the open bite group, but flattening was seen more often in the deep bite group. Results of this study showed that open bite cases show larger vertical CR-CO slides and, shorter protrusion paths than normal and deep overbite cases. The radiographic appearance of condyles in non-patients may also differ significantly according to vertical incisor guidance type. Deep bite cases demonstrated a higher incidence of condylar flattening. This study indicates that the clinician should be paying special attention to the TMJ status of open bite patients.

Adolescent↗

PubMed2002

Effect of bleaching agents on the hardness and morphology of enamel.

PURPOSE: The goal of the present laboratory study was to analyze the effect of two home bleaching agents (Opalescence 10%, Ultradent, and Hi-Lite II, Shofu) as well as the separate solutions of 10% carbamide peroxide primary components (3% hydrogen peroxide and 7% urea) on enamel microhardness and surface morphology. MATERIALS AND METHODS: Thirty human molars stored in water for no longer than 3 months were selected. Their facial and lingual surfaces were embedded in acrylic resin, and the specimens were polished with up to 600-grit sandpaper. The 30 molar sections were divided into five groups as per treatment modality (n = 6); group 1, 10% carbamide peroxide bleach with carbopol (Opalescence, Ultradent); group 2, oxygen-free gel bleach (Hydroxylite, Hi-Lite II, Shofu); group 3, 3% hydrogen peroxide with carbopol (Dermus Pharmacy, Florianópolis, SC, Brazil); group 4, 7% urea treatment (Dermus Pharmacy); and control, group 5, artificial saliva (Dermus Pharmacy). Prior to treatment, six indentations (Vickers) were made on each of the six surfaces in each group under a load of 100 g for 30 seconds. Bleaching procedure was conducted for 3 hours per day for 2 weeks, the control group excepted. Following each bleaching session, the specimens were washed with deionized water and kept in artificial saliva at 37 degrees C, this solution being changed daily. Pre- and post-treatment microhardness data were analyzed using a two-way analysis of variance. In a similar way, 30 other specimens underwent the same procedures. After the bleaching period, the samples were observed under the scanning electron microscope. RESULTS: Specimens submitted to bleaching treatment with 3% hydrogen peroxide gel as described in this study showed a significant reduction of surface microhardness (p < .0001). The other treatment modalities had no effect on surface microhardness. No morphologic alterations were observed on enamel submitted to bleaching gel of 10% carbamide peroxide (Opalescence), oxygen-free gel (Hi-Lite II, Shofu), or 7% urea solution compared with the control (artificial saliva). However, the specimens bleached for 3 hours per day for 2 weeks with 3% hydrogen peroxide gel presented areas of mild erosion. The effect, nevertheless, was not uniform, occurring with varying intensity on all samples of enamel bleached with 3% hydrogen peroxide. CLINICAL SIGNIFICANCE: Bleaching treatment conducted with two home bleaching agents (Opalescence 10%, Ultradent, and Hi-Lite II, Shofu) had no adverse effects on enamel microhardness or on surface morphology. Bleaching with 3% hydrogen peroxide can have a negative effect on enamel hardness and surface morphology when performed as described in this study.

Acrylic Resins↗

PubMed1992

Five-year study of cervical erosions restored with resin and dentin-bonding agent.

The cumulative retention rate of a microfilled resin in non-undercut cervical abrasion/erosion lesions was studied over a 5-yr period. The enamel was etched and the dentin was pretreated with either Gluma (n = 75) or the first marketed version of Scotchbond (n = 30). The cumulative 5-yr retention rate of the Gluma fillings was 90% and that of the Scotchbond fillings 47% (the 95% confidence limits were 83-98% for Gluma fillings and 27-67% for Scotchbond fillings). The retention rate with both bonding agents was significantly higher in the maxillary arch than in the mandibular arch.

Acid Etching, Dental↗

PubMed1989

[The role of mechanical factors in the development of cervical wedge-shaped erosions].

The surface of single or multiple cervical wedge-shaped defects was studied with a scanning electron microscope. After an initial stage during which the root surface became smooth and polished, the developed lesions had an angular shape with the presence of one or several grooves of 0.2 to 0.3 mm in width at the angle vertex. The presence of these grooves forming horizontal gutters strongly suggested the existence of a horizontal brushing movement. Beside these large grooves, a more or less parallel network of fine striae was observed. The lesion surfaces consisted of dentin with obliquely oriented tubules which were not completely sclerosed. Relatively thin bacterial layers were present on these surfaces. The presence of horizontal wear gutters seemed to confirm the traumatic origin of the wedge-shaped defects connected with toothbrushing.

Adult↗

PubMed1996

The weaning diet and dental health.

Weaning practice can have a major influence on both immediate and future dental health and good dietary practices from birth have the potential to secure a healthy dentition for life. In a recently published report it is recommended that infants (an infant may be defined as a child who has not yet reached the age of one year) be weaned on foods and drinks free as far as possible of non-milk extrinsic (NME) sugars. At the same time, there has also been an increasing development of low-sugar and sugar-free products for infants. There has also been growing concern that infant drinks with low pH may cause enamel erosion in primary teeth, a phenomenon that is perhaps more widespread than has been recognised in the past. The aim of the weaning diet is to achieve a diet which fulfills nutritional requirements for the growing child and which contains a wide variety of foods and drinks. It is suggested that items high in NME sugars are not a necessary part of the diet, should be regarded as 'occasional', and not given every day. Drinks other than milk or water should constitute a minority of total drinks and be given only at main mealtimes; they should not be given in bottles or at bedtime.

Beverages↗

PubMed2002

Effects of 10% carbamide peroxide on the enamel surface morphology: a scanning electron microscopy study.

BACKGROUND: Several studies have been published about the effect of carbamide peroxide on enamel surface morphology. However, only a few studies have been carried out under intraoral conditions. The purpose of this study was to investigate the effect of two commercially available 10% carbamide peroxide bleaching products (Colgate Platinum and Starbrite) on the enamel surface morphology under intraoral conditions. MATERIALS AND METHODS: Twenty-four subjects were divided into two groups and assigned a product to use for 2 weeks. Epoxy resin replicas obtained from the maxillary right central incisors of the subjects before, immediately after, and 3 months after the bleaching procedure were examined under a scanning electron microscope. RESULTS: Immediately after the bleaching procedure, the surface porosity of enamel had increased in the Colgate Platinum group, whereas erosive surface alterations were observed in the Starbrite group. At 3 months, the surface morphology of enamel in the Colgate Platinum group was similar to the untreated enamel surface. In the Starbrite group, erosive defects on the enamel surface had decreased within 3 months, and the appearance of the enamel surface was almost the same as the untreated enamel. CONCLUSION: Even though both bleaching agents caused alterations in the surface morphology of enamel, these alterations were reversed within 3 months following treatment. CLINICAL SIGNIFICANCE: The results of this study suggest that 10% carbamide peroxide bleaching products cause alterations in enamel surface morphology immediately after bleaching, and the degree of these alterations depends on the brand of bleaching agent and duration of application time. However, these alterations revert to almost normal within 3 months.

Adult↗

PubMed1996

Clinical performance of two dentine adhesives: 2-year results.

Scotchbond MP and ART Bond were used without intentional enamel etching to bond a total of 43 resin composite restorations in Class V 'abrasion/ erosion' lesions. The cumulative loss rates after 6 months, 1 year, and 2 years, respectively, were Scotchbond MP: 9, 14, 27 per cent; and ART Bond: 0, 5, 5 per cent. These data were not compared because each material was used on different patients. The results support the higher bond strength to dentine in the laboratory of Scotchbond MP compared with its predecessor Scotchbond 2. There was a slight but clinically insignificant amount of enamel marginal staining for both products after 2 years, confirming the necessity to etch the enamel for effective marginal sealing.

Acid Etching, Dental↗