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Dental erosion, oral hygiene, and nutrition in eating disorders.

OBJECTIVE: To determine the influence of oral hygiene practices and additional fluoride on erosive tooth wear in eating disorders. The proportional dietary intake of carbohydrates, fats, and proteins was also investigated. METHOD: Tooth wear was measured with the use of the tooth wear index (TWI). All subjects completed a questionnaire on past dental history as well as a 1-week diet sheet. A total of 33 subjects participated in the study, 20 of whom were follow-ups, allowing the progress of dental erosion to be made. All subjects were referred from the Department of Clinical Psychology. RESULTS: Oral hygiene practices between subjects with and without severe erosion were not significantly different. Only 8 bulimics spent more time brushing after vomiting than at other times. The pH of vomitus from 6 subjects ranged between 2.9 and 5.0, with a mean of 3.8, well below the critical pH for enamel demineralization to occur. Of the 20 follow-up subjects, 12 (60%) exhibited worsening tooth wear. The mean values for daily carbohydrate, protein, and fat intake were not significantly different at baseline and at recall, and the proportional dietary intake was similar to recommended energy provision at 47%, 40%, and 13%, respectively. DISCUSSION: The contribution by toothbrush abrasion to the overall wear in the eroded dentition of bulimics is not significant. Therefore, immediate post-vomiting oral hygiene practices can be recommended. The proportional nutritional intake values of carbohydrates, fats, and proteins in this group of bulimics are acceptable.

Adult↗

Predisposition to caries in hamsters following the Erosire effect of a commercial citrus beverage administered with and without supplemental fluoride.

A study was undertaken to investigate the effect of a citrus beverage on tooth erosion and predisposition to caries in hamster molars, and to determine if a supplement of 1.9 ppm fluoride to the beverage influences these systems. Results suggest that enamel erosion is a predisposing factor. The addition of physiological fluoride protects the enamel from erosion and caries.

Animals↗

Is there a relationship between asthma and dental erosion? A case control study.

OBJECTIVES: The aims of this study were firstly to assess and compare the prevalence of dental erosion and dietary intake between three groups of children; children with asthma, those with significant tooth erosion but with no history of asthma, and children with no history of asthma or other medical problems. Secondly, to discover whether there was a relationship between medical history and dietary practises of these children and the levels of dental erosion. Thirdly, to measure and compare their salivary flow rates, pH and buffering capacity. METHODS: The study consisted of 3 groups of children aged 11-18 years attending Birmingham Dental Hospital: 20 children with asthma requiring long-term medication, 20 children referred with dental erosion, and 20 children in the age and sex matched control group. Tooth wear was recorded using a modification of the tooth wear index (TWI) of Smith and Knight. Data on the medical and dietary history were obtained from a self-reported questionnaire supplemented by a structured interview. The salivary samples were collected under standard methods for measurements. RESULTS: Fifty percent of the children in the control group had low erosion and 50% moderate erosion. However, high levels were recorded in 35% of children in the asthma group and 65% in the erosion group. There appeared to be no overall differences in diet between the groups. There was an association between dental erosion and the consumption of soft drinks, carbonated beverages and fresh fruits in all the three groups. More variables related to erosion were found in the erosion and asthma groups. A comparison between the three groups showed no significant differences in unstimulated and stimulated salivary flow rates, or pH and buffering capacity. CONCLUSION: There were significant differences in the prevalence of erosion between the three groups, children with asthma having a higher prevalence than the control group. Although there was a relationship between the levels of erosion and some medical history and acidic dietary components, these did not explain the higher levels in asthmatic children. Further investigation is required into the factors affecting the increased prevalence of erosion in children with asthma.

Adolescent↗

Dental erosion in Icelandic teenagers in relation to dietary and lifestyle factors.

High consumption of fruit juices and carbonated drinks has been related to dental erosion. Teenage male Icelanders consume about 800 ml of carbonated drinks per day on average and this corresponds with the main age group and gender of patients seen with erosion. This study examined the prevalence of dental erosion in 15-year-old children in Reykjavík and looked at the association between erosion and some lifestyle factors in a case-control study drawn from the same sample. A 20% sample of the 15-year-cohort population (n = 278) was selected. Dental erosion was classified by location and severity (1 = enamel erosion; 2 = dentine erosion; 3 = severe dentine erosion) and was seen in 21.6% of subjects (68.3% male; 72% scored as grade 1; 23% grade 2; 5% grade 3). Control subjects were the first healthy subjects examined after a case subject had beens diagnosed. In the case-control study, information was gathered by multiple-choice questionnaire on symptoms of gastric reflux, tooth sensitivity, some lifestyle and dietar-factors. Several lifestyle and dietary factors, previously shown to be significantly related to dental caries in Icelandic teenagers, showed no significant relationship to tooth erosion. Although dietary factors are probably important in causing erosion, dietary recall questionnaires did not help in discovering individuals likely to develop erosion.

Adolescent↗

A new type of sliding hiatus hernia.

A series of patients showing a previously unrecognized type of sliding hiatus hernia is presented and analyzed. This type of hernia is characterized by reflux of the mucous membrane of the Hiss angle into the lumen of the esophagus. The occurrence of mucosal prolapse is a secondary phase of gastroesophageal reflux. The mucous plug prevents further reflux of the acid contents of the stomach into the esophagus and mouth. After the appearance of mucosal prolapse, the symptoms and signs of esophagitis disappear. The most characteristic complaint of the patients is retrosternal pain on lying and bending down. Endoscopy with provocative tests reveals the mucosal prolapse. Tooth erosions due to previous acid reflux into the mouth are diagnostic. The symptoms of this new subtype of sliding hiatus hernia were cured by the Nissen fundoplication.

Adult↗

Prevention and minimally invasive treatment of erosions.

Erosive tooth wear is a multifactorial cumulative lifetime process, which may lead to tooth surface loss. Acids of intrinsic and extrinsic origin are the main etiological factors. This paper focuses on preventive measures and minimally invasive restorations. The application of high fluoride, time of toothbrushing as well as the intake of erosive foodstuffs or beverages should be optimized. Sealing of the tooth surfaces and small composite fillings are minimally invasive treatments for erosive lesions.

Beverages↗

Diagnosis and dental treatment of a young adult patient with gastroesophageal reflux: a case report with 2-year follow-up.

A young adult who complained of extreme dentin sensitivity to tactile and thermal stimuli exhibited severe, generalized tooth erosion and an associated parafunctional habit. The diagnosis of the underlying general disease and treatment of its dental sequelae are presented, together with a 2-year follow up. Patients who are suspected of having gastroesophageal reflux should be referred to a gastroenterologist or other health professionals to ensure early diagnosis and treatment of the underlying disorder, thus minimizing the destruction of the patient's dentition and improving the patient's general health. Dental treatment should be adjusted to fit the characteristics of each case.

Adult↗

In vitro action of Bordeaux red wine on the microhardness of human dental enamel.

Several studies have demonstrated that the regular and large consumption of wine is associated with increased risk of tooth erosion. Here, the effect of Bordeaux red wine on enamel was estimated by measuring changes in its Vickers microhardness. Thirty premolars were used; microhardness tests were performed on buccal areas before and after 10, 30, 90 and 120 s immersion in the wine (pH=3.9). Enamel surfaces were also observed by scanning electron microscopy. No statistically significant difference was found between the mean Vickers microhardness obtained at t=0 and 90 s, but slight signs of enamel demineralisation were observed with the scanning electron microscope. It appears that wine has no disastrous effect on the microhardness of dental enamel when the two are in contact for less than 90 s. When the exposure is for at least 120 s, it may become harmful, as the decrease in the microhardness of enamel was then significant (P<0.05).

Adolescent↗

Restorative therapy of erosion.

When substance loss caused by erosive tooth wear reaches a certain degree, oral rehabilitation becomes necessary. Prior to the most recent decade, the severely eroded dentition could only be rehabilitated by the provision of extensive crown and bridge work or removable overdentures. As a result of the improvements in composite restorative materials, and in adhesive techniques, it has become possible to rehabilitate eroded dentitions in a less invasive manner. However, even today advanced erosive destruction requires the placement of more extensive restorations such as ceramic veneers or overlays and crowns. It has to be kept in mind that the etiology of the erosive lesions needs to be determined in order to halt the disease, otherwise the erosive process will continue to destroy tooth substance. This overview presents aspects concerning the restorative materials as well as the treatment options available to rehabilitate patients with erosion, from minimally invasive direct composite reconstructions to adhesively retained all-ceramic restorations. Restorative treatment is dependent on individual circumstances and the perceived needs and concerns of the patient. Long-term success is only possible when the cause is eliminated. In all situations, the restorative preparations have to follow the principles of minimally invasive treatment.

Ceramics↗

Risk assessment and preventive measures.

A prerequisite for preventive measures is to diagnose erosive tooth wear and to evaluate the different etiological factors in order to identify persons at risk. No diagnostic device is available for the assessment of erosive defects. Thus, they can only be detected clinically. Consequently, erosion not diagnosed in the early stage may render timely preventive measures difficult. In order to assess the risk factors, patient should record their dietary intake for a distinct period of time. Then a dentist can determine the erosive potential of the diet. Particularly, patients with more than four dietary acid intakes have a higher risk for erosion when other risk factors (such as holding the drink in the mouth) are present. Regurgitation of gastric acids (reflux, vomiting, alcohol abuse, etc.) is a further important risk factor for the development of erosion which has to be taken into account. Based on these analyses, an individually tailored preventive program may be suggested to the patients. It may comprise dietary advice, optimization of fluoride regimes, stimulation of salivary flow rate, use of buffering medicaments and particular motivation for nondestructive toothbrushing habits with a low abrasive toothpaste. The frequent use of fluoride gel and fluoride solution in addition to fluoride toothpaste offers the opportunity to reduce somewhat abrasion of tooth substance. It is also advisable to avoid abrasive tooth cleaning and whitening products, since they may remove the pellicle and may render teeth more susceptible to erosion. Since erosion, attrition and abrasion often occur simultaneously all causative components must be taken into consideration when planning preventive strategies.

Acids↗

Sports supplement drinks and dental health in competitive swimmers and cyclists.

AIM: To assess dental status and sports supplement uptake in swimmers and cyclists. To determine chemico-physical properties of the most popular sports drinks. DESIGN: Descriptive, prevalence study of tooth wear and caries experience. Questionnaire analysis of sports drinks usage. SETTING: Two public swimming pools in Liverpool and three cycle clubs in North West England. SUBJECTS AND METHOD: A convenience sample of swimmers and cyclists was examined for caries and tooth wear. A questionnaire ascertained which sports drinks were consumed and their pattern of consumption. pH and titratable acidity, concentrations of calcium, phosphate and fluoride, and viscosity were analysed. Salivary flow rate in response to these drinks and water was also determined. RESULTS: 25 swimmers and 20 cyclists participated. Caries experience and tooth wear into dentine (excluding incisally exposed dentine) was significantly more frequent among cyclists (P < 0.05). Cyclists had significantly more upper palatal wear (P < 0.001). Pattern of sport drink consumption between the two groups was significantly different (P < 0.001). pH range of the most popular sport drinks was 2.4-4.5. Salivary flow rate after a 1-minute rinse was significantly lower (P < 0.05) with one drink (0.47 ml/min) and water (0.41 ml/min) compared with the other drinks. CONCLUSIONS: An association between caries or erosive tooth wear and sport drink consumption was not found. However, the erosive potential of sport drinks is real and must be borne in mind as an aetiological factor for erosion in young people.

Adolescent↗

Tooth wear: attrition, erosion, and abrasion.

Attrition, erosion, and abrasion result in alterations to the tooth and manifest as tooth wear. Each classification acts through a distinct process that is associated with unique clinical characteristics. Accurate prevalence data for each classification are not available since indices do not necessarily measure one specific etiology, or the study populations may be too diverse in age and characteristics. The treatment of teeth in each classification will depend on identifying the factors associated with each etiology. Some cases may require specific restorative procedures, while others will not require treatment. A review of the literature points to the interaction of the three entities in the initiation and progression of lesions that may act synchronously or sequentially, synergistically or additively, or in conjunction with other entities to mask the true nature of tooth wear, which appears to be multifactorial.

Acids↗

[Erosions of hard tooth substance].

Lemon juice was applied to intact and eroded tooth surfaces in vivo to demonstrate the development of erosions based on morphological changes. Under the influence of the fruit acid the protecting pellicles are removed and the enamel demonstrates the typical etch lesion with a honeycomb surface structure. In the dentin the acid works mainly on the peritubular area. Abrasive brushing techniques wear down the already damaged tooth surfaces.

Acid Etching, Dental↗

The influence of air polishers on tooth enamel. An in-vitro study.

This study compares the effect of 4 different air-powder abrasive devices (PWS) (Air-Flow-S1, Clean-Jet, Prophy-Jet 30, Prophy-Unit) on tooth enamel. Freshly extracted bovine teeth were partially embedded in polyurethane, the labial surface ground flat and highly polished. Subsequently the teeth were subjected to the spray from the air-powder abrasive device for 60 s or polished with a prophylactic paste (CCS 170, CCS 250 or Cleanic) for the same length of time. The effects of the different air-powder abrasive systems were tested under multiple adjustments of powder/air and water. In addition the effects of air-powder abrasive systems and prophylactic pastes on several dentin surfaces were measured. The resulting surface textures of the teeth were examined using laser optic profilometry. In this process multiple measurements of roughness as well as tooth erosion were determined. The Clean-Jet led to significantly rougher surfaces than the 3 prophylactic pastes at every setting. The Air-Flow-S1, Prophy-Jet 30 and Prophy-Unit resulted in enamel abrasion that was either less than that caused by the prophylactic pastes or not significantly different at every examined setting. The 3 polishing pastes removed 3.6 microns to 7.2 microns of enamel in 60 s. The Clean-Jet removed significantly more enamel at every setting per unit of time than the prophylactic pastes (up to 0.1 mm/min); therefore routine application of this device is not advised. Enamel abrasion by the Air-Flow-S1, Prophy-Jet 30 and Prophy-Unit was either less than that measured with the prophylactic pastes or not significantly different. However, the Air-Flow-S1 was more abrasive than Cleanic paste at maximum water adjustment. The Air-Flow-S1 removed 641.2 microns/min of dentin compared to 339.6 microns/min by the Prophy-Jet 30.

Air↗

Dental complications following gastric restrictive bariatric surgery.

BACKGROUND: Morbid obesity is a scourge of the 21st century. The effective therapeutic measure is bariatric surgery. The medical literature has inadequately reported the potential deleterious effects of such surgery on dental health. Acidic levels in the oral cavity, which are known to be one of the postoperative side-effects of bariatric surgery, directly result in dental caries and tooth erosion. We investigated the self-assessment of postoperative bariatric patients with regard to their dental health and associated variables. METHODS: 113 patients (25% compliance), who had been operated on in three Jerusalem hospitals, responded to a mailed questionnaire. RESULTS: Patients' average age was 40+/-10 years; bariatric surgery had been performed 5+/-4 years previously. Of the patients, 37% reported eating more sweet foods after surgery, only 20% reported improved oral hygiene, only 34% reported increased frequency of visits to the dentist, and 37% reported greater dental hypersensitivity after surgery. Significant associations were found between reported dental hypersensitivity and vomiting (P=0.013), and also dental hypersensitivity and indigestion (P=0.021). Patients from the three hospitals reported different patterns of visits to the dentist. The most common variable (80% of the subjects) associated with visits to the dentist after surgery was dental hypersensitivity. CONCLUSION: Medical teams need to consider potential dental problems after bariatric surgery, and to supply their patients with the appropriate information and instructions regarding oral hygiene maintenance, healthy dietary patterns and regular dental health monitoring by a dentist or dental hygienist.

Adult↗