N X West

University of Bristol, Bristol, England, United Kingdom

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Publications (77)124.76 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To compare the enamel protection efficacy of a stabilized stannous fluoride (SnF2 ) dentifrice to a sodium fluoride (NaF)/triclosan dentifrice following acidic erosive challenge. In this in situ, randomized, controlled, double-blind, two-treatment, four-period crossover clinical trial, subjects wore an appliance fitted with human enamel samples 6 h day(-1) during each 15-day treatment period. Twice each treatment day they swished with their assigned dentifrice slurry: 0.454% SnF2 /0.077% NaF or 0.32% NaF/0.3% triclosan. After each treatment and two other times daily, subjects swished with 250 ml of orange juice over a 10-min period (acidic erosive challenge). Enamel samples were measured for tooth surface loss using contact profilometry at baseline and days 10 and 15. Thirty-six subjects (mean age 44.8 years, range 23-65 years) were randomized to treatment; 33 subjects completed the final study visit. There were no statistically significant baseline differences (P > 0.44) in the specimen surfaces of the two dentifrice treatment groups via profilometry. At day 10, the SnF2 dentifrice provided a statistically significant (P < 0.0001) reduction in enamel loss by 67% versus the NaF/triclosan dentifrice with estimated medians of 1.22 and 3.68 μm, respectively. At day 15, the SnF2 dentifrice again provided a significantly greater benefit (P < 0.0001) against tooth surface loss versus the NaF/triclosan dentifrice, with 68% less erosion, and estimated medians of 1.60 and 5.03 μm, respectively. Both dentifrices were well tolerated. A stabilized SnF2 dentifrice provided superior protection against the initiation and progression of tooth enamel surface loss in situ after erosive challenge compared to a NaF/triclosan dentifrice. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
    International Journal of Dental Hygiene 06/2015; DOI:10.1111/idh.12159 · 0.68 Impact Factor
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    ABSTRACT: Investigation of early enamel erosion using replica impressions to compare changes in enamel surface topography in vivo prior to and over a 24hour period following acid challenge. A single treatment, blinded, enamel replica clinical study was undertaken in 20 healthy subjects. Replica tooth impressions were taken at baseline, following acid challenge and 2, 4, 7 and 24hours post challenge. Subjects consumed 500ml of acidic soft drink over 30mins. Scanning electron microscopy of surface tomography was characterized with a descriptive 5 point scale by 4 judges. Duplicate impressions were taken to assess reproducibility. 18 subjects had scorable sequences. Descriptive analyses showed erosive changes following acid consumption and reparative changes in the subsequent 24hour period. Comparing baseline replica to the 24hours replica, there were no significant differences (p=0.26) in tooth surface characteristics. Comparing the replica taken immediately following acidic challenge with the subsequent replicas at 2, 4, 7 and 24hours, showed clear reduction of erosive effects on the enamel surface at 2hours (p=0.02) and a highly significant reduction at 4, 7 and 24hours (p<0.001). This methodology demonstrated the ability to follow the progression and recovery of early erosive enamel lesions over 24hours being accurate and reproducible. This study suggests enamel repair commences within 2hours following a substantial acidic challenge and is completed 4 to 24hours later. After 24hours, the tooth surface appeared visibly indistinguishable from the original tooth surface, suggestive of a recovery process occurring. Healthy erosive lifestyles often culminate in tooth wear. The time taken for enamel remineralisation following acidic challenge is unknown however, this study suggests the repair process is relatively slow following a substantial acidic challenge, and at least 4-24hours should elapse prior to further acidic consumption to allow for recovery. Copyright © 2015. Published by Elsevier Ltd.
    Journal of dentistry 04/2015; DOI:10.1016/j.jdent.2015.04.002 · 2.84 Impact Factor
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    ABSTRACT: Research on dental erosion has largely been undertaken at room temperature despite fruit juice drinks often being consumed at elevated temperatures in the United Kingdom, notably during periods of convalesce. The aim of the study was to evaluate the erosive potential of two fruit juices containing acidic non-alcoholic drinks at elevated temperatures in situ on human enamel after 5, 10 and 15 days. A commercially available conventional apple and blackcurrant fruit juice drink was compared to a blackcurrant juice drink modified to have low erosive potential, and mineral water consumed at approximately 59 °C. Twenty-one healthy volunteers aged 18 or over participated in a single-centre, single-blind (blinded to the investigator), three-treatment crossover study. Subjects were randomised to a treatment sequence using a Latin square design. Subjects wore upper removable appliances containing one human enamel specimen from 9 am to 5 pm for 15 days for each beverage. Measurements of enamel loss were recorded after 5, 10 and 15 days by contact surface profilometry. The low erosive blackcurrant drink caused significantly less enamel loss (P < 0·05) than the commercially available conventional apple and blackcurrant fruit juice drink and was not statistically significantly different to mineral water at any of the time points in the study. Consuming the modified low erosive blackcurrant drink at an elevated temperature resulted in negligible enamel loss in situ, consistent with room temperature findings. © 2015 John Wiley & Sons Ltd.
    Journal of Oral Rehabilitation 03/2015; 42(7). DOI:10.1111/joor.12285 · 1.93 Impact Factor
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    ABSTRACT: To compare the enamel protection efficacy of stannous-containing sodium fluoride and sodium monofluorophosphate (MFP)/triclosan dentifrices marketed in India in an in situ erosion model with acidic challenge. This randomised and controlled, in situ, supervised, double-blind clinical trial employed a two-treatment, four-period crossover design, wherein subjects wore an appliance fitted with human enamel samples 6 h/day during each 10 day treatment period and swished twice daily with their assigned dentifrice slurry: Oral-B(®) Pro-Health (maximum 1,000 ppm F as sodium fluoride with stannous chloride) or Colgate(®) Strong Teeth with Cavity Protection (maximum 1,000 F as sodium MFP and triclosan). Subjects swished with 250 ml of orange juice over a 10 min period after each treatment and twice daily for the acidic erosive challenge. Enamel samples were measured for tooth surface loss using contact profilometry at baseline and day 10. A total of 34 subjects were randomised to treatment; 32 subjects completed the final visit. Baseline profilometry measurements of the specimen surfaces were near zero within ± 0.3 μm, and no statistically significant difference (P > 0.48) on average was observed between the two test dentifrices. At day 10, the stannous-containing dentifrice demonstrated 88% less erosion (P < 0.0001) relative to the MFP/triclosan dentifrice. Estimated medians (95% confidence intervals) were 0.21 μm (0.17, 0.25) for the stannous-containing dentifrice versus 1.66 μm (1.39, 1.99) for the MFP/triclosan dentifrice. Both dentifrices were well-tolerated. Compared with MFP/triclosan toothpaste, a stabilised stannous-containing sodium fluoride dentifrice gave statistically significantly greater protection against tooth enamel surface loss in situ following repeated acid erosive challenge.
    Journal of Indian Society of Periodontology 03/2015; 19(2):182. DOI:10.4103/0972-124X.145817
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    ABSTRACT: The role of periodontitis as a risk factor for multiple systemic diseases is widely accepted and there is growing evidence of an association between periodontitis and sporadic late onset Alzheimer's disease (SLOAD). Recent epidemiologic, microbiologic and inflammatory findings strengthen this association, indicating that periodontal pathogens are possible contributors to neural inflammation and SLOAD. The aim of this article is to present contemporary evidence of this association.
    British dental journal 01/2015; 218(1):29-34. DOI:10.1038/sj.bdj.2014.1137 · 1.08 Impact Factor
  • Nicola X. West, Maria Davies
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    ABSTRACT: ContextThe gold standard treatment modality for dentine hypersensitivity has not yet been established. This review examines the effectiveness of self and professionally applied treatments for the reduction of pain from dentine hypersensitivity.Materials and Methods Electronic (3 databases) and hand searches were performed 14-21 July 2014 to identify randomised clinical trials for the treatment of dentine hypersensitivity.ResultsThis systematic review provided numerous treatment modalities for dentine hypersensitivity. Eleven agents and 105 Randomised Controlled Trials were robust enough to be included. The studies varied considerably in design, observation period, active agents, formulation of the whole agent, negative and positive controls and comparator products investigated. The stimuli used were always airblast and often airblast/tactile. Due to the heterogeneity between the studies and lack of direct comparison between agents there was insufficient data to undertake a meta-analysis to compare agents for meaningful conclusions. Best available evidence for each treatment agent has been documented as a narrative.Conclusions Treatments including stannous fluoride, arginine and calcium sodium phosphosilicate and strontium toothpaste appear to be clinically effective for the treatment of dentine hypersensitivity compared to comparators and controls. There is limited evidence to confirm the relative effectiveness of individual professionally applied agents.This article is protected by copyright. All rights reserved.
    Journal Of Clinical Periodontology 12/2014; 42. DOI:10.1111/jcpe.12336 · 3.61 Impact Factor
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    ABSTRACT: Objective; The ability of a dentifrice containing the bioactive material calcium sodium phosphosilicate (CSPS) to remineralise the surface of dentine and physically occlude patent tubules was investigated in a 20 day in situ randomised clinical study. Methods; Changes in surface microhardness and surface topography of dentine specimens treated for 5, 10, 15 and 20 days, twice daily with either a dentifrice containing 5% CSPS or a fluoride-only containing placebo dentifrice were compared. The substantivity of any mineral deposits formed on the surface of dentine were investigated by the application of an intra-oral dietary acid challenge twice daily during the final 10 days of treatment. Results After 5 and 10 days of treatment, the dentine samples in both treatment groups demonstrated an increase in surface microhardness. After 10 days of treatment the increase in surface hardness was directionally greater for the specimens treated with 5% CSPS dentifrice. Introducing an intra-oral acid exposure resulted in a reduction in surface microhardness which was significantly greater for the specimens treated with the placebo dentifrice compared to the dentifrice containing 5% CSPS, at day 20. Occlusion of the patent tubules was evident at each time-point and was significantly greater for the 5% CSPS containing dentifrice on days 5 and 10. On day 15 both dentifrices demonstrated the same degree of occlusion. Conclusion This in situ study demonstrated that dentifrice containing 5% CSPS may have potential to mineralise and occlude the dentine in the oral environment. Study Registered under NRES Committee South West–Exeter (11/SW/0163). Clinical Significance: This work provides evidence of potential agents that can be used to reduce the pain of dentine hypersensitivity when formulated into dentifrice and applied as part of a normal oral hygiene routine.
    Journal of Dentistry 10/2014; 43(6). DOI:10.1016/j.jdent.2014.10.005 · 2.84 Impact Factor
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    ABSTRACT: Removal of extrinsic staining using sodium chlorite containing mouthrinses Zoe Wintle, Shelley Goad, Emma Macdonald, Siân B Jones, Vaclav Velkoborsky, Sankha Ghosh and Nicola X West Objective: Extrinsic tooth staining is usually a result of dietary chromogens adhering to the pellicle surface. Sodium chlorite is included in oral mouthrinses in order to reduce build-up of plaque and to break down volatile sulphur compounds that cause malodour. The study aimed to determine how effective a sodium chlorite containing mouthrinse is at removing extrinsic stain from human enamel. Methods: Human enamel was sourced from our tissue bank. Extrinsic dietary stain was achieved by soaking human enamel in saliva sourced from our tissue bank followed by 0.2% chlorhexidine based mouthwash and either tea, red wine or coffee. This was repeated 10 times. Following staining the enamel was exposed to one of the following treatments 1) Swissdent Extreme Whitening Mouthwash (0.25% sodium chlorite), 2) Swissdent Extreme Whitening Mouthwash (2.0% sodium chlorite), 3) Ultradex Oral Rinse, 4) Listerine Whitening Mouthrinse or 5) water for a total of 14 x 4 minute cycles. The degree of staining was measured using a chromameter and the values presented as E*ab. Results: The amount of stain removal following treatment with both the sodium chlorite containing mouthrinses was significantly greater than that observed for the other test solutions (p<0.05) after each cycle up to 14 cycles irrespective of the dietary stain. Optimal stain removal was achieved for both the sodium chlorite mouthrinses following between 3 and 5 cycles, equivalent to 12 – 20 minutes of exposure. Following treatment with the sodium chlorite mouthrinses, the enamel appeared a natural colour compared to dark brown following the staining cycles. Conclusion: Sodium chlorite containing mouthrinses were successful in removing extrinsic stain caused by three different dietary components compared to other commercially available mouthrinses.
    2014 IADR/PER Congress; 09/2014
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    ABSTRACT: Objective: To investigate the separate and combined effects of erosion and abrasion challenges to enamel samples using an in situ model. Method: This was a single centre, single blind (blinded to the person responsible for performing the sample analysis), randomised, split mouth, four treatment regimen, single period in situ study in healthy adult volunteers. 26 healthy adults were enrolled, 24 subjects completed the study. Subjects were randomised to 4 different groups according to a predetermined randomised schedule. During the treatment period, subjects wore lower right and left buccal intra oral appliances each fitted with 4 polished human enamel samples (8 in total). One buccal appliance with 4 enamel samples underwent erosive challenge by soaking the samples in 50ml of orange juice for 5 minutes. The other appliance with 4 enamel samples were exposed similarly to water. Subsequently two samples in each appliance underwent tongue licking by the participant, the other two were not licked and all the samples were returned to the mouth. The study comprised 15 treatment days with 4 treatment sessions per day. Enamel samples were measured using contact profilometry at baseline and day 15 for surface changes. Two measurements for each sample were recorded at each timepoint. Result: Mean loss of material at 15 days was 0.08µm for specimens exposed to water without licking, 0.10µm with water and licking, 1.55µm with orange juice alone and 3.65µm with orange juice and licking. In the absence of erosive challenge, licking had no detectable effect (p=0.28). Without licking, orange juice had a highly significantly greater effect than water (p<0.001). Licking more than doubled the loss of material following erosive challenge (p<0.001). Conclusion: Erosive challenge to the enamel surface results in tissue loss and this is greatly increased when the abrasive effect of the tongue is combined with prior erosive challenge.
    IADR General Session and Exhibition 2014; 06/2014
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    ABSTRACT: Objective: To retrospectively compare the radiographic analysis of a 2 dimensional panoramic view with the 3 remaining sectional views (cross-sectional, axial and tangential) obtained from CBCT scans from patients considering implant treatment. Method: 10 patients were randomly selected and all identification/planning data removed. A single operator then examined the 2 dimensional panoramic view and a diagnostic observation was determined for each tooth or site. The same operator then reviewed each tooth or site on the sectional views and logged using a binary system any differences in the diagnostic observation. Result: The results show that 47% of sites examined in 3D have a different diagnostic observation to those examined in 2D. Conclusion: The quality of the images often provides additional radiographic information that is not readily apparent from conventional 2D imaging. This suggests that the use of CBCT offers additional value as a special investigation for other specialities in dentistry, not solely for implantology.
    IADR General Session and Exhibition 2014; 06/2014
  • Nicola X. West, Andrew Joiner
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    ABSTRACT: Objectives To summarise the chemical, biological and host factors that impact enamel mineral loss, to highlight approaches to contemporary management of clinical conditions involving mineral loss and summarise emerging trends and challenges in this area. Data sources “Medline” and “Scopus” databases were searched electronically with the principal key words tooth, enamel, *mineral*, caries and erosion. Language was restricted to English and original studies and reviews were included. Conference papers and abstracts were excluded. Conclusions Enamel mineral loss leads to the degradation of the surface and subsurface structures of teeth. This can impact their shape, function, sensitivity and aesthetic qualities. Dental caries is a multifactorial disease caused by the simultaneous interplay of dietary sugars, dental plaque, the host and time. There is a steady decline in dental caries in developed countries and the clinical management of caries is moving towards a less invasive intervention, with risk assessment, prevention, control, restoration and recall. Tooth wear can be caused by erosion, abrasion and attrition. Dental erosion can be the result of acid from intrinsic sources, such as gastric acids, or extrinsic sources, in particular from the diet and consumption of acidic foods and drinks. Its prevalence is increasing and it increases with age. Clinical management requires diagnosis and risk assessment to understand the underlying aetiology, so that optimal preventative measures can be implemented. Overall, prevention of enamel mineral loss from caries and tooth wear should form the basis of lifelong dental management. Evidence based oral hygiene and dietary advice is imperative, alongside preventive therapy, to have a healthy lifestyle, whilst retaining hard tooth tissue.
    Journal of Dentistry 06/2014; 42:S2–S11. DOI:10.1016/S0300-5712(14)50002-4 · 2.84 Impact Factor
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    ABSTRACT: To introduce a new interproximal mineralisation model and to investigate the effectiveness of novel toothpaste and dual phase gel formulations to remineralise acid softened enamel in a simulated interproximal environment.
    Journal of Dentistry 06/2014; 42S1:S46-S52. DOI:10.1016/S0300-5712(14)50007-3 · 2.84 Impact Factor
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    ABSTRACT: Objective: To compare the anti-erosion benefits of two marketed dentifrices in a 15 day in situ model. Method: The present study utilized a single centre, double blind, randomised, two-treatment, and four period crossover design. Thirty-seven subjects were enrolled and 33 completed the study. Each study period took place over a span of 15 days. Subjects were randomized to treatment sequences and received one of two marketed dentifrice products each period. Treatments included a 0.454% Stannous Fluoride dentifrice (Oral-B PRO EXPERT®) and a 0.3% Triclosan/sodium fluoride dentifrice (Colgate Total Advanced®). Subjects wore an intra-oral appliance retaining 2 polished human enamel samples for 6 hours/day, swishing with the assigned dentifrice slurry twice a day and swishing with 250ml of orange juice for 10 minutes four times/ day. Contact profilometry was used to measure surface changes of enamel samples at Baseline, days 10 and 15. Two measurements for each sample were recorded at each visit. Result: No statistically significant treatment differences were observed at Baseline for the two dentifrice groups (p>0.44) with means of -0.015 and -0.024 for the Stannous Fluoride and the Triclosan dentifrices, respectively. At day 10 the Stannous Fluoride dentifrice demonstrated 66.8% lower enamel loss than the Triclosan dentifrice (p<0.0001) with means of 1.222µm and 3.676 µm, respectively, and at day 15, a 68.3% lower enamel loss (p<0.0001) with means of 1.595 µm and 5.027 µm, respectively. Both test products were well tolerated. Conclusion: The in situ clinical study demonstrated the superior anti-erosion efficacy of the 0.454% Stannous Fluoride dentifrice relative to the 0.3% Triclosan/sodium fluoride dentifrice against an erosive challenge to human enamel.
    AADR Annual Meeting & Exhibition 2014; 03/2014
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    ABSTRACT: To compare the erosion protection efficacy of a stabilised, stannous fluoride (SnF2 ) dentifrice versus a sodium fluoride (NaF) dentifrice using a modified in situ clinical model. This study, a randomised parallel group in situ design with in vivo product use and ex vivo acid challenge, compared: A, a dentifrice containing 1,450 ppm F as NaF; B, a dentifrice containing 1,450 ppm F (1,100 ppm F as SnF2 + 350 ppm F as NaF); and T, tap water. Sample size was n = 4 per group (total of 12 subjects) and within each subject appliances were placed on each side of the mouth (left and right). Enamel specimens were placed in different positions of the mouth (front, mid-front, mid-rear, rear) in each appliance (total = 8 specimens per subject). Product treatment was twice per day (lingual brushing for 30 seconds followed by swishing for 90 seconds with the resultant product/saliva slurry) in vivo for 15 days, and ex vivo acid treatment (0.02 m citric acid 5 minutes four times per day; total exposure time = 300 minutes). Data were analysed using a general linear repeated measures model with treatment, side and position as fixed effects. Within subjects, correlations were modelled assuming a different correlation and variance for treatment B relative to the other groups. Pairwise treatment differences were performed using a 5% two-sided significance level. Enamel loss (in μm) was significantly lower (P < 0.005) for treatment B versus treatments A and T. Treatment B reduced enamel surface loss by 86.9% relative to treatment A. There was no statistical difference in mean enamel loss (P = 0.51) between treatments A and T. Enamel loss was not statistically different for side (left vs. right; P = 0.44) or position (front, mid-front, mid-rear, rear; P = 0.36). This modified in situ erosion model confirmed the enhanced erosion protection benefits of a stabilised SnF2 dentifrice versus a conventional NaF dentifrice, validating the ability of the model to safely and effectively demonstrate differences in the erosion protection potential of oral care products.
    International Dental Journal 03/2014; 64 Suppl 1:43-50. DOI:10.1111/idj.12102 · 1.20 Impact Factor
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    ABSTRACT: To determine if a stabilised, stannous-containing sodium fluoride dentifrice provides greater enamel protection in situ against intraoral dietary erosive challenges compared with a sodium fluoride/potassium nitrate dentifrice. A single-centre, investigator blind, randomised, supervised, two-treatment, non-brushing, four-period crossover in situ study was undertaken, with each test period being 15 days. Thirty-five healthy adult subjects were recruited to participate in the study, which included four erosive acid challenges per day. Subjects were randomised to product treatment, which included either: (1) a stannous-containing sodium fluoride dentifrice (Oral-B(®) Pro-Expert Sensitive) or (2) a sodium fluoride/potassium nitrate dentifrice (Sensodyne(®) Pronamel(®) ). Each study subject wore an intraoral appliance retaining two sterilised, polished human enamel samples for 6 hours/day. Subjects swished with an allocated dentifrice slurry twice a day and with 250 ml of orange juice for 10 minutes (25 ml/minute over a 10-minute period) four times per day. The primary and secondary outcomes for this study were enamel loss measured using contact profilometry at days 15 and 5, respectively, using parametric analysis methods. At day 15, a 38% lower enamel loss (P < 0.0001) was observed, with estimated medians of 2.03 μm (SE 0.247) and 3.30 μm (SE 0.379), in favour of the stannous-containing dentifrice. At day 5, specimens treated with the stannous-containing sodium fluoride dentifrice demonstrated 25% less enamel loss than those treated with the sodium fluoride/potassium nitrate dentifrice. Treatment differences at day 5 were also statistically significant (P < 0.05), with estimated medians of 1.37 μm (SE 0.177) and 1.83 μm (SE 0.223), respectively. Results of this in situ study suggest the stabilised, stannous-containing sodium fluoride dentifrice could be used to provide significantly greater protection to enamel from erosive acid challenge compared with that provided by conventional fluoride-containing products.
    International Dental Journal 03/2014; 64 Suppl 1:35-42. DOI:10.1111/idj.12101 · 1.20 Impact Factor
  • Nicola West, Joon Seong, Maria Davies
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    ABSTRACT: Dentine hypersensitivity is a common oral pain condition affecting many individuals. The aetiology is multifactorial; however, over recent years the importance of erosion has become more evident. For dentine hypersensitivity to occur, the lesion must first be localised on the tooth surface and then initiated to exposed dentine tubules which are patent to the pulp. The short, sharp pain symptom is thought to be derived from the hydrodynamic pain theory and, although transient, is arresting, affecting quality of life. This episodic pain condition is likely to become a more frequent dental complaint in the future due to the increase in longevity of the dentition and the rise in tooth wear, particularly amongst young adults. Many efficacious treatment regimens are now available, in particular a number of over-the-counter home use products. The basic principles of treatment are altering fluid flow in the dentinal tubules with tubule occlusion or modifying or chemically blocking the pulpal nerve. © 2014 S. Karger AG, Basel.
    Monographs in oral science 01/2014; 25:108-122. DOI:10.1159/000360749
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    ABSTRACT: To compare three instruments for their ability to quantify enamel loss after acid erosion. 6 randomized parallel groups of bovine enamel samples were subjected to citric acid (higher acidity) or orange juice (lower acidity) erosion and remineralisation in a cycling model. Two protected shoulders were created on each of the samples using tape, to serve as reference for analysis. The time of exposure to each acid was varied, along with presence or absence of agitation. After treatment, samples were measured on 3 instruments capable of measuring step height: a contact profilometer (CP); a non-contact profilometer (NCP); and a confocal laser scanning microscope (CLSM) by three different examiners. Additionally, 3D (volume) step height was also measured using the CLSM. Increasing acid concentration and exposure time resulted in greater erosion, as did agitation of samples while in acid solution. All instruments/methods identified the same statistically significant (p<0.05) pair-wise differences between the treatments groups. Further, all four methods exhibited strong agreement (Intra-class correlation≥0.96) in erosion level and were highly correlated, with correlations of 0.99 or higher in all cases. All instruments/methods used in this study produced very similar conclusions with regard to ranking of enamel loss, with data showing very high agreement between instruments. All instruments were found to be equally suited to the measurement of enamel erosion.
    Dental materials: official publication of the Academy of Dental Materials 10/2013; 29(12). DOI:10.1016/j.dental.2013.09.015 · 4.16 Impact Factor
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    ABSTRACT: Prevalence of oral pain from dentine hypersensitivity and significant risk factors: a European population-based cross-sectional study OBJECTIVES: Dentine hypersensitivity (DH) manifests as a transient but arresting oral pain. The incidence is thought to be rising, particularly in young adults, due to increases in consumption of healthy, yet erosive, diets. This study aimed to assess the prevalence of DH and relative importance of risk factors, in 18-35 year old Europeans. In 2011, 3187 adults were enrolled from general dental practices in France, Spain, Italy, United Kingdom, Finland, Latvia and Estonia. DH was clinically evaluated by cold air tooth stimulation, patient pain rating (yes/no), accompanied by investigator pain rating (Schiff 0-3). Erosive toothwear (BEWE index 0-3) and gingival recession (mm) were recorded. Patients completed a questionnaire regarding the nature of their DH, erosive dietary intake and toothbrushing habits. Results: 41.9% of patients reported pain on tooth stimulation and 56.8% scored ≥1 on Schiff scale for at least one tooth. Clinical elicited sensitivity was closely related to Schiff score and to a lesser degree, questionnaire reported sensitivity (26.8%), possibly reflecting the transient nature of the pain, alongside good coping mechanisms. Significant associations were found between clinically elicited DH and erosive toothwear and gingival recession. The questionnaire showed marked associations between DH and risk factors including heartburn/acid reflux, vomiting, sleeping medications, energy drinks, smoking and acid dietary intake. Overall, the prevalence of DH was high compared to many published findings, with a strong, progressive relationship between DH and erosive toothwear, which is important to recognise for patient preventive therapies and clinical management of DH pain.
    Journal of dentistry 08/2013; 41(10). DOI:10.1016/j.jdent.2013.07.017 · 2.84 Impact Factor
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    ABSTRACT: Objective: To explore the extent of dentine mineralization, occlusion and wear conferred by an occluding toothpaste (5% calcium sodium phosphosilicate (CSPS)) compared to a control (0% CSPS) toothpaste on human dentine after up to 20 days of twice daily treatment using an in-situ model. Method: This was a single centre, two-treatment, two-period crossover, in-situ RCT in healthy subjects. Subjects wore lower right and left buccal intraoral appliances fitted with 8 dentine samples. Study toothpaste was applied to each appliance ex-vivo using an electric toothbrush for 20 days. In addition, subjects brushed their teeth twice daily with the assigned toothpaste. On days 11 to 20, an in-vivo orange juice acid challenge was applied. On days 5, 10, 15 and 20, one dentine sample was removed from each appliance and tested for hardness (SMH), microscopy (SEM) and wear (profilometry). Results: The CSPS and control toothpastes demonstrated statistically significant increases from baseline in hardness on Days 5 and 10. At Day 10, a non-statistically significant treatment difference was observed in favour of the CSPS toothpaste. On introduction of the acid challenge, both treatment groups demonstrated a reduction in hardness. The control toothpaste demonstrated a progressive reduction in hardness which was not observed in the CSPS group. A statistically significant treatment difference, in favour of CSPS, was detected at Day 20. Statistically significant between-treatment differences in tubule occlusion were detected at Days 5 and 10. At Day 10 the CSPS toothpaste demonstrated an occlusion score approaching “mostly occluded”. No statistically significant treatment differences were observed for dentine wear. Conclusion: This study demonstrates that the CSPS toothpaste occludes dentine tubules and confers a degree of protection against acid challenge induced dentine surface softening, in agreement with previous in-vitro observations and the known chemistry of CSPS.
    IADR/AADR/CADR General Session and Exhibition 2013; 03/2013
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    N X West, A Lussi, J Seong, E Hellwig
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    ABSTRACT: OBJECTIVES: The paper's aim is to review dentin hypersensitivity (DHS), discussing pain mechanisms and aetiology. MATERIALS AND METHODS: Literature was reviewed using search engines with MESH terms, DH pain mechanisms and aetiology (including abrasion, erosion and periodontal disease). RESULTS: The many hypotheses proposed for DHS attest to our lack of knowledge in understanding neurophysiologic mechanisms, the most widely accepted being the hydrodynamic theory. Dentin tubules must be patent from the oral environment to the pulp. Dentin exposure, usually at the cervical margin, is due to a variety of processes involving gingival recession or loss of enamel, predisposing factors being periodontal disease and treatment, limited alveolar bone, thin biotype, erosion and abrasion. CONCLUSIONS: The current pain mechanism of DHS is thought to be the hydrodynamic theory. The initiation and progression of DHS are influenced by characteristics of the teeth and periodontium as well as the oral environment and external influences. Risk factors are numerous often acting synergistically and always influenced by individual susceptibility. CLINICAL RELEVANCE: Whilst the pain mechanism of DHS is not well understood, clinicians need to be mindful of the aetiology and risk factors in order to manage patients' pain and expectations and prevent further dentin exposure with subsequent sensitivity.
    Clinical Oral Investigations 12/2012; 17(Suppl 1). DOI:10.1007/s00784-012-0887-x · 2.29 Impact Factor

Publication Stats

2k Citations
124.76 Total Impact Points

Institutions

  • 1999–2015
    • University of Bristol
      • School of Oral and Dental Sciences
      Bristol, England, United Kingdom
  • 2014
    • Worldwide Clinical Trials
      Nottigham, England, United Kingdom
  • 2004
    • Naval Postgraduate Dental School
      Maryland, United States
  • 1998–2004
    • British Society for Restorative Dentistry
      Bristol, England, United Kingdom