Braz Dent J 23(2) 2012
Braz Dent J (2012) 23(2): 160-166
M.S.C. Alves et al.
Bariatric surgery is currently the only effective
treatment for morbidly obese patients as it achieves
significant and sustained weight loss for millions
of individuals who suffer from morbid obesity. The
present popular operative procedures are all relatively
safe and efficient. However, all these procedures alter
anatomy and physiology of the gastrointestinal tract to
variable degrees (1). Therefore, surgery is not the final
step of obesity treatment, but it is rather the beginning
of a 1-2-year period of changes in behavior, diet and
physical activity followed by regular follow-up of a
multidisciplinary team of health professionals (2). The
Tooth Wear in Patients Submitted to
Maria do Socorro Coêlho ALVES1
Fernando Alberto Costa Cardoso da SILVA2
Stephanie Gomes ARAÚJO1
Antônio Cláudio Almeida de CARVALHO3
Alcione Miranda SANTOS4
Andrea Lúcia Almeida de CARVALHO5
1Dental School, UFMA - Federal University of Maranhão, São Luiz, MA, Brazil
2University Hospital, UFMA - Federal University of Maranhão, São Luís, MA, Brazil
3Brazilian Agricultural Research Agency, Macapá, AP, Brazil
4Department of Public Health, UFMA - Federal University of Maranhão, São Luiz, MA, Brazil
5Department of Dentistry, Dental School, UFMA - Federal University of Maranhão, São Luiz, MA, Brazil
Bariatric surgery may cause frequent vomiting episodes and gastroesophageal reflux, which promote the contact of gastric acids with
the teeth leading to irreversible loss of tooth structure. The aim of this study was to assess prevalence of tooth wear in bariatric patients.
One hundred and twenty-five patients were examined at a Public Hospital in São Luis, MA, Brazil, between July and October 2010,
being patients who had already been submitted to the bariatric surgery at least 6 months previously (Bariatric group), morbidly obese
patients who were on the waiting list for this surgery (Obese group) and patients who were waiting for ambulatory medical care in other
sectors (Control group). The patients answered an investigative questionnaire and were clinically examined using the Basic Erosive
Wear Examination (BEWE) scoring system, which allows the classification of the severity of noncarious dental lesions (NCDL) and
evaluation of risk. All patients presented some degree of tooth wear at different levels. However, the presence of NCDL was associated
with the group to which the patient belonged. The bariatric patients showed higher prevalence and a statistically significant level of
risk with regard to NCDLs when compared with the other patients, followed by the obese and control groups. Reflux and vomiting
did not seem to influence NCDL positively.
Key Words: Bariatric surgery, tooth wear, oral health.
alterations in the gastrointestinal shape and function
associated with the postoperative dietary changes
make these patients vulnerable to a series of potential
complications, such as abdominal pain, gallbladder
disease (biliary calculi), intestinal obstruction, peptic
ulcer, gastroesophageal reflux, nausea and vomiting
The gastroesophageal reflux disease (GERD), a
condition of high and rising incidence, may manifest
itself by typical (pyrosis and regurgitation) and
atypical (pulmonary, otorhinolaryngological and oral
problems) symptoms. Patients with GERD present a
higher incidence of dental erosion, aphthas, burning
mouth sensation, tooth sensitivity and a sour taste in
Correspondence: Profa. Dra. Maria do Socorro Coêlho Alves, Avenida Avicênia, Condomínio Green Village, casa 24, Calhau, 65071-370 São Luís,
MA, Brasil. Tel.: +55-98-3235-9981/9116-1144. Fax: +55-98-3235-9981. e-mail:email@example.com
Braz Dent J 23(2) 2012
166 M.S.C. Alves et al.
being higher than in the Control group. This is equally
important since obesity is a major public health problem
affecting millions of people worldwide. As this was
preliminary investigation, further studies are needed,
especially prospective studies.
In conclusion, the bariatric patients showed the
highest prevalence and level of risk with regard to NCDL
when compared with the morbidly obese and control
patients. However, reflux and vomiting did not seem to
influence the appearance of NCDL positively.
Cirurgia bariátrica pode provocar freqüentes episódios de vômito
e refluxo gastroesofágico o que promove o contato dos ácidos
gástricos com os dentes fazendo que haja perda irreversível
de estrutura dental. Este estudo teve como objetivo avaliar a
prevalência de desgaste dentário em pacientes bariátricos. Foram
examinados 125 pacientes em um Hospital Público de São Luís,
MA no período de julho a outubro de 2010, distribuídos em
pacientes que já tinham sidos submetidos à cirurgia bariátrica
há pelo menos 6 meses (Grupo bariátrico), obesos mórbidos
que estavam na lista de espera para esta cirurgia (Grupo obeso)
e por pacientes que esperavam por consulta médica ambulatorial
em outros setores (Grupo controle). Os pacientes responderam a
um questionário investigativo e foram examinados clinicamente
utilizando o “Basic Erosive Wear Examination” - BEWE (Índice
Básico do Desgaste Erosivo) que permite a classificação da
severidade das lesões não-cariosas e avaliação de risco. Todos
os pacientes apresentaram algum grau de desgaste dentário em
diferentes níveis. No entanto, a presença de LDNC (lesão dental
não-cariosa) estava associada ao grupo que o paciente pertencia.
O grupo bariátrico apresentou maior prevalência e nível de risco
em relação às LDNC’s estatisticamente significante quando
comparado aos outros grupos, seguido pelo grupo de obeso e
controle. Refluxo e vômito parecem não influenciar positivamente
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Received June 16, 2011
Accepted November 17, 2011