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Neutralizing salivary pH by mouthwashes after an acidic challenge

November 2015
Journal of Investigative and Clinical Dentistry 8(2)

DOI:10.1111/jicd.12198

Authors:

Mojdeh Dehghan

The University of Tennessee Health Science Center

Colette Stewart

The University of Tennessee Health Science Center

Show all 7 authorsHide

Aim: The aim of the present study was to test the neutralizing effect of mouthwashes on salivary pH after an acidic challenge. Methods: Twelve participants were recruited for three visits, one morning per week. Resting saliva was collected at baseline and after 2-min swishing with 20 mL orange juice as an acidic challenge. Participants then rinsed their mouth for 30 s with 20 mL water (control), an over-the-counter mouthwash (Listerine), or a two-step mouthwash, randomly assigned for each visit. Saliva was collected immediately, 15, and 45 min after rinsing. The pH values of the collected saliva were measured and analyzed with anova, followed by Student-Newman-Keuls post-hoc test (significance level: 0.05). Results: Orange juice significantly lowered salivary pH. Immediately after rinsing, Listerine and water brought pH back to baseline values, with the pH significantly higher in the Listerine group. The two-step mouthwash raised pH significantly higher than Listerine and water, and higher than the baseline value. Salivary pH returned to baseline and was not significantly different among groups at 15 and 45 min post-rinsing. Conclusions: Mouth rinsing after an acidic challenge increased salivary pH. The tested mouthwashes raised pH higher than water. Mouthwashes with a neutralizing effect can potentially reduce tooth erosion from acid exposure.

Participant allocation.

…

. Demographic information of participants

…

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Content uploaded by Colette Stewart

Content may be subject to copyright.

ORIGINAL ARTICLE

Oral Biosciences

Neutralizing salivary pH by mouthwashes after an acidic

challenge

Mojdeh Dehghan

, Daranee Tantbirojn

, Emily Kymer-Davis

, Colette W. Stewart

Yanhui H Zhang

, Antheunis Versluis

& Franklin Garcia-Godoy

1 Department of Restorative Dentistry, College of Dentistry, University of Tennessee Health Science Center, Memphis, TN, USA

2 Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, TN, USA

3 Summer Research Program, College of Dentistry, University of Tennessee Health Science Center, Memphis, TN, USA

Keywords

acid, clinical study, mouthwash, saliva, tooth

erosion.

Correspondence

Dr Daranee Tantbirojn, Department of

Restorative Dentistry, College of Dentistry,

University of Tennessee Health Science

Center, 875 Union Avenue, Memphis, TN

38163, USA.

Tel: +1-901-448-6372

Email: dverslui@uthsc.edu

Received 24 June 2015; accepted 3 October

2015.

doi: 10.1111/jicd.12198

Abstract

Aim: The aim of the present study was to test the neutralizing effect of mouth-

washes on salivary pH after an acidic challenge.

Methods: Twelve participants were recruited for three visits, one morning per

week. Resting saliva was collected at baseline and after 2-min swishing with

20 mL orange juice as an acidic challenge. Participants then rinsed their mouth

for 30 s with 20 mL water (control), an over-the-counter mouthwash (Lister-

ine), or a two-step mouthwash, randomly assigned for each visit. Saliva was

collected immediately, 15, and 45 min after rinsing. The pH values of the col-

lected saliva were measured and analyzed with ANOVA, followed by Student–

Newman–Keuls post-hoc test (signiﬁcance level: 0.05).

Results: Orange juice signiﬁcantly lowered salivary pH. Immediately after rins-

ing, Listerine and water brought pH back to baseline values, with the pH sig-

niﬁcantly higher in the Listerine group. The two-step mouthwash raised pH

signiﬁcantly higher than Listerine and water, and higher than the baseline

value. Salivary pH returned to baseline and was not signiﬁcantly different

among groups at 15 and 45 min post-rinsing.

Conclusions: Mouth rinsing after an acidic challenge increased salivary pH.

The tested mouthwashes raised pH higher than water. Mouthwashes with a

neutralizing effect can potentially reduce tooth erosion from acid exposure.

Introduction

Dental erosion or erosive tooth wear associated with

chronic stomach acid exposure in patients with bulimia,

acid reﬂux, pregnancy morning sickness, and other sys-

temic conditions can pose a signiﬁcant oral health prob-

lem for this population.

1–3

Gastroesophageal reﬂux

disease (GERD) signiﬁcantly contributes to dental ero-

sion, with a 24% prevalence of dental erosion in GERD

patients.

1,4

Dental erosion due to chronic stomach acid

exposure is the most frequent oral manifestation of buli-

mia nervosa.

Although the frequency of associated dental

erosion is not known, the lifetime prevalence of bulimia

nervosa among women has been reported to be 2%.

According to the National Eating Disorders Association,

20 million women and 10 million men in the USA suffer

from eating disorders sometime in their lifetime.

Dental

erosion can lead to pain from tooth hypersensitivity and

loss of form and function of the dentition, which requires

extensive and costly restorative work. Therefore, a practi-

cal oral care regime to prevent or control dental erosion

will beneﬁt a large number of patients.

Incorporating agents to prevent or control dental ero-

sion in toothpaste is questionable, because toothbrushing

after an acid attack might further damage softened tooth

structures.

8,9

Baking soda and ﬂuoride rinse has been rec-

ommended to neutralize stomach acid and reharden

compromised enamel, respectively.

Recently, a two-step

ª2015 Wiley Publishing Asia Pty Ltd 1

Journal of Investigative and Clinical Dentistry (2015), 0, 1–5

mouthwash was developed for the prevention and control

of dental erosion from stomach acid exposure.

The ﬁrst

rinse of the two-step mouthwash aims to neutralize the

acid. The second rinse follows the ﬁrst rinse to enhance

rehardening of the affected tooth structure. A previous

in vitro study demonstrated that the two-step mouthwash

signiﬁcantly rehardened enamel softened by hydrochloric

acid when the rehardening was carried out in pooled

human saliva.

However, the neutralizing aspect has to

be proven under clinical conditions.

There is currently no concrete protocol for the preven-

tion and treatment of dental erosion immediately after an

acidic episode. The purpose of this clinical study was to

test the effectiveness and neutralizing capability of two

different mouthwashes on salivary pH after an acidic

challenge in comparison to rinsing with water. The

administered acidic challenge was orange juice instead of

hydrochloric acid to simulate stomach regurgitation. The

null hypothesis was that there was no difference in sali-

vary pH after rinsing with the tested mouthwashes or

water following an acidic challenge.

Methods

After receiving institutional review board approval to

conduct a clinical study (14-03123-XP), healthy adults

between the ages of 18 and 60 years were recruited to

participate. The exclusion criteria included allergy or

hypersensitivity to milk or other mouthwash ingredients,

pregnancy or lactating, diabetes, under antibiotics or

immune-suppressive treatment, using antigingivitis/an-

tibacterial oral care products within the past 2 weeks, par-

ticipating in any other oral/dental product studies, or

receiving elective dental treatment. Participants signed the

informed consent form prior to participation, and were

informed about conﬁdentiality in accordance with the

Health Insurance Portability and Accountability Act Stan-

dards for Privacy of Individually Identiﬁable Health Infor-

mation guidelines. Procedures performed were reviewed

by the institution review board, and thus were in accor-

dance with the ethical standards of the Declaration of

Helsinki. Participants received monetary compensation, a

toothbrush, and United States Food and Drug Adminis-

tration-approved toothpaste (Crest cavity protection;

Procter & Gamble, Cincinnati, OH, USA) to use at home

during the study. Participants were told not to use any

mouthwash at home during the study.

The study used a randomized, three-treatment design.

It involved one prescreening/enrolment clinic visit and

three treatment clinic visits of one morning per week. A

total of 23 participants were prescreened, 15 agreed to

participate, and 12 completed all treatment visits (Fig-

ure 1). The appointment time was between 7.30 and

10.30 hours. Participants were asked not to use oral

cleansing products nor eat after 21.00 hours the night

before and the morning of each visit. A small sample of

resting whole saliva (approximately 0.5 mL) was collected

at baseline. The acidic challenge was carried out by having

participants rinse with 20 mL orange juice (pH 3.9)

(Minute Maid Premium Pulp-Free, Sugar Land, TX,

Figure 1. Participant allocation.

2ª2015 Wiley Publishing Asia Pty Ltd

Neutralizing salivary pH by mouthwashes M. Dehghan et al.

USA) for 2 min, followed by saliva collection. Participants

then rinsed their mouth for 30 s with 20 mL water

(Ozarka 100%, Natural Spring Water; Stamford, CT,

USA) as a control, Listerine (Johnson & Johnson, Skill-

man, NJ, USA), or a two-step mouthwash, randomly

assigned for each visit. The two-step mouthwash is based

on bicarbonate, calcium, phosphate, ﬂuoride, and natural

ingredients.

The ﬁrst-step rinse aims to neutralize the

acid. The second-step rinse follows the ﬁrst rinse in order

to reharden the affected tooth structures. Listerine, an

over-the-counter mouthwash, was selected due to its pop-

ularity. The pH values of the ﬁrst- and second-step rinses

were 8.9 and 6.1, and the pH values of Listerine and

water were 4.3 and 5.2, respectively. Neither the partici-

pant nor the investigators knew which treatment was

given at each visit. Immediately, 15, and 45 min after

rinsing, saliva was collected. During the visit, the

participants were told not to eat, drink, or chew gum or

candy.

Salivary pH was measured immediately with a 1.3 mm-

diameter glass combination electrode (Orion 9810BN

Micro pH Electrode; Thermo Scientiﬁc, Chelmsford, MA,

USA) connected to a pH/ISE meter (Orion 710A; Thermo

Scientiﬁc). The electrode was calibrated with pH 7.00 and

pH 4.00 buffer solutions (Fisher Scientiﬁc, Fair Lawn, NJ,

USA). Differences in salivary pH among the three rinses

and among the time intervals were statistically analyzed

with one-way ANOVA, followed by Student–Newman–Keuls

post-hoc tests (signiﬁcance level: 0.05).

Results

The demographic data of the participants are shown in

Table 1. All participants attended all three clinical treat-

ment visits. No adverse event was reported. Salivary pH

at different time intervals is shown in Figure 2 and listed

with statistical results in Table 2. There was no signiﬁcant

difference in salivary pH among the three groups at base-

line. After rinsing with orange juice, the pH signiﬁcantly

dropped in all groups. Salivary pH was raised back to the

baseline values immediately after rinsing with water or

Listerine, with the pH signiﬁcantly higher in the Listerine

group. The two-step mouthwash raised salivary pH signiﬁ-

cantly higher than the baseline value, and signiﬁcantly

higher than Listerine and water. Fifteen and 45 min after

rinsing, pH values in all groups went back to baseline level.

Discussion

Various oral care products containing ﬂuoride and/or

calcium phosphate are readily available for caries preven-

tion or tooth erosion, but none has directly addressed

Table 1. Demographic information of participants

No. participants Total 12

Sex Male 4

Female 8

Age (years) Mean standard deviation 36 12

Range 23–55

Race Caucasian 4

African American 8

Figure 2. Salivary pH at baseline, after acidic challenge with orange

juice, and after rinsing with the two-step mouthwash, Listerine, or

water. ( ) Two-step; ( ), Listerine, ( ) Water.

Table 2. Mean standard deviation of sali-

vary pH at baseline, after acid challenge with

orange juice, and after rinsing with one of

the three rinses (immediately, 15 min, and

45 min)

Rinse Baseline Orange juice Immediately 15 min 45 min

Listerine 6.74 0.45

4.98 0.83

7.00 0.60

B,b

6.64 0.67

6.66 0.52

Two-step 6.83 0.46

5.06 0.95

8.16 0.57

C,c

6.77 0.46

6.78 0.42

Water 6.75 0.37

5.20 1.05

6.33 0.80

A,b

6.55 0.69

6.78 0.56

P-value 0.8493 0.8536 0.0001 0.6770 0.7945

Different uppercase letters in the same column indicate statistically signiﬁcant differences

among rinses at the same time interval (signiﬁcant only at ‘immediately’); different lowercase

letters in the same row indicate signiﬁcant differences among time intervals within the same

rinse (ANOVA followed by Student–Newman–Keuls post-hoc test, a=0.05).

ª2015 Wiley Publishing Asia Pty Ltd 3

M. Dehghan et al. Neutralizing salivary pH by mouthwashes

neutralizing saliva acidity. Patients suffering from condi-

tions, such as GERD or eating disorders, are in need of

agents that can prevent or control tooth erosion by

increasing salivary pH. The present study was designed as

a proof of concept, mainly to obtain initial information

about the effect of mouthwashes on salivary pH. The

results conﬁrm a common perception that rinsing washes

away the acid. Rinsing with water or Listerine raised the

acidic pH to the neutral level of baseline resting saliva.

The null hypothesis was rejected; the two mouthwashes

used in this study both signiﬁcantly increased salivary pH

after acidic challenge more than rinsing with water alone.

Interestingly, Listerine is mildly acidic with a pH of 4.3.

However, after rinsing with Listerine, salivary pH increased

approximately two units, whereas the pH only increased

one unit after water rinsing. It was postulated that the taste

of Listerine stimulated salivary ﬂow, and thus was more

effective than water in raising the pH. The two-step mouth-

wash was the most effective, as it increased salivary pH by

approximately three units. The mouthwash has been devel-

oped to provide neutralizing and remineralizing effects.

The pH values of the ﬁrst- and second-step rinses were 8.9

and 6.1, respectively. The pH increase from rinsing with

either Listerine or the two-step mouthwash was transient.

Salivary pH returned to neutral baseline values after

15 min in all groups, and no further change in pH was

observed after 45 min. Therefore, rinsing after every acidic

episode would be necessary to prevent tooth erosion. Nei-

ther mouthwash showed prolonged retention periods.

Lindquist et al.

reported that antacid chewing tablets

raised the intra-oral pH to 7.5 after hydrochloric acid expo-

sure and maintained pH above the baseline level for

30 min. Although the antacid tablet was effective in

increasing the intra-oral pH, mastication could abrade the

softened enamel, and thus chewing gum or antacid tablets

is not recommended.

Participants recruited in the present study were gener-

ally healthy. Although hydrochloric acid would have been

a better representation of stomach acid, orange juice was

chosen for this study due to the concerns of possible ero-

sive effects of hydrochloric acid on tooth structures. From

a clinical perspective, it would be unethical to have

patients rinse with hydrochloric acid. Orange juice is less

acidic than stomach reﬂuxate, which was reported to have

an average pH of 2.9.

Orange juice lowered salivary pH

1.55–1.76 units, compared to pH drop of approximately

two and 3.5 units after rinsing with hydrochloric acid at

pH 2 and pH 1, respectively.

Participants were asked

not to use oral cleansing products nor eat the night and

the morning before each visit in order to reduce variables

on salivary pH. The baseline pH value for each partici-

pant was consistent between visits, as well as at the end

of the measurements. We chose to measure salivary pH

to reﬂect the overall oral environment that affects tooth

erosion. Patients suffering from bulimia, acid reﬂux, preg-

nancy morning sickness, and other systemic conditions

resulting in an acidic episode are exposing their teeth to

higher rates of erosion due to the drastic decrease in oral

pH. Utilizing a mouthwash to neutralize the salivary pH

can reduce the acidic exposure time of enamel, and allow

saliva to modulate the severity of erosion and facilitate a

faster recovery time to reach the baseline pH. Future

studies using similar methodology in populations with

acid regurgitation will determine direct beneﬁts from the

neutralizing effect of mouthwashes. Patients suffering

from stomach acid exposure, such as in acid reﬂux, eating

disorders, and other systemic conditions involving

chronic regurgitation, might beneﬁt from the acid-neutra-

lizing ability of the tested mouthwashes when used regu-

larly.

Acknowledgments

The present study supported by the University of Ten-

nessee Health Science Center College of Dentistry Alumni

Endowment Fund and the Tennessee Dental Association

Foundation. We would like to thank Ms Laura Rush and

Ms Marisa Arriaga (both from the University of Ten-

nessee Health Science Center) for their help, and Arla

Foods for donation of a mouthwash ingredient.

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Full-text available

Dec 2022

Introducción: Los enjuagues bucales contribuyen a la inhibición de la formación de la placa bacteriana y, por tanto, pueden ayudar a mantener el pH salival cercano a neutro. Objetivo: Identificar cambios en el pH salival de pacientes portadores de aparatología ortodóncica fija, después del enjuague con una solución de Stevia rebaudiana Bertoni y un enjuague comercial de aceites esenciales. Métodos: Se realizó un experimento clínico con un diseño factorial mixto en pacientes portadores de aparatología ortodóncica fija. Una vez firmado el consentimiento informado, treinta y dos pacientes fueron asignados aleatoriamente a uno de 2 grupos: la solución de S. rebaudiana B. al 2 % o un enjuague comercial de aceites esenciales. Se utilizaron 15 ml de enjuague durante 60 s en todos los pacientes. El pH salival fue medido por dos observadores independientes calibrados, utilizando papel medidor de pH antes del enjuague (medición basal) y después del enjuague, a los 5 y 20 min. Los datos fueron analizados mediante el ANOVA mixto. Resultados: Se encontró una interacción estadísticamente significativa entre el tipo de tratamiento y el momento de medición del pH. Los pH medio de los grupos S. rebaudiana y aceites esenciales fueron respectivamente en la medición basal: 6,61 y 6,52 (p = 0,72); a los 5 min: 7,61 y 7,77 (p = 0,40); y a los 20 min: 7,72 y 6,82 (p < 0,001). Conclusiones: Ambos enjuagues tenían el efecto de aumentar el pH salival a niveles alcalinos a los 5 min, pero solo el enjuague de S. rebaudiana B. al 2 % mantuvo el pH básico a los 20 min.

ANALYSIS OF pH AND ANTIOXIDANT ACTIVITY OF COMMERCIALLY AVAILABLE MOUTHWASHES IN SRILANKA

Thesis

Sep 2022

Introduction: The use of mouthwashes has been reported first in history around 2700 BC in Chinese medicine. Since then, clinicians and general population use mouthwashes as an adjunct to mechanical plaque removal. Antimicrobial, anti-inflammatory and anti-cariogenic are some of the important biological properties which were expressed by mouthwashes and the main reason for their wide usage. Apart from that, chemical properties such as pH and antioxidant capacity are least concerned when choosing the appropriate mouthwash, but plays a crucial role inside the oral cavity. Objectives: The objective of this study was to assess the pH and antioxidant activity of commercially available mouthwashes in Sri Lanka. Material and method: The study was an experimental laboratory study conducted using ten commonly used commercially available mouthwashes in Sri Lanka. pH of mouthwashes was evaluated using a digital pH meter and antioxidant capacity was tested using two spectrophotometric methods, DPPH assay and ABTS assay. Three different batches of the same mouthwash brand were used in triplicates during data collection. Results: pH of mouthwashes ranged from 2.69(B) to 6.09(F) with majority of them below the critical pH value of 5.5. Four mouthwashes(A,B,C,D) among ten showed antioxidant activities with DPPH assay. Mean AEAC was ranged from 119.87µl AA/ml to 5.04µg AA/ml and IC50 values were ranged from 74.97µl/ml to 3.37µl/ml which were measured using DPPH assay. Additionally mouthwash H showed antioxidant activities with ABTS assay that was measured using TEAC and it was ranged from 0.14mg/ml to 2.16mg/ml. Some mouthwashes showed differences in pH and antioxidant capacities in between different batches of the same mouthwash brand. Conclusions: From the commonly used commercially available mouthwashes in Sri Lanka, all the mouthwashes had low pH but two of them were not potentially erosive. Five out of the ten types of mouthwashes had antioxidant properties beneficial for oral health. However only a single mouthwash (A) had both these beneficial properties

Gargling Effect of Zamzam Water on Salivary pH

Article

Full-text available

May 2021

Caries is a multifactorial infection disease that happened during the decrease of salivary pH caused by acids from bacterial metabolism. Bicarbonate is an important buffer component in saliva that can help neutralize salivary pH. Zamzam water has high bicarbonate content. This study aimed to evaluate the effect of gargled with Zamzam water on salivary pH. This experimental research was done with pre-test and post-test control group design involving 40 dentistry students at the University of Sriwijaya aged 18-23 years old, with DMF-T score ≤3. Samples were divided into 2 groups, the Zamzam water group, and thedistilled water group. Samples gargled their mouth with 10 ml of a 25% sucrose solution for one minute, then saliva was collected with spitting method and salivary pH was measured with digital pH meter and recorded as initial pH. Samples then gargledwith 20 ml of Zamzam water or distilled water according to each group for one minute, then saliva was collected in the same way as before, and pH was measured and recorded as final pH. Data were analyzed with paired t-test and Mann-Whitney. The result showed that salivary pH increased significantly after gargled with Zamzam water (p0,05). The mean difference of salivary pH aftergargled with Zamzam water was statistically higher than distilled water (p0,05). In conclusion, Gargled with Zamzam water can increase salivary pH.

Effectiveness of a neutralizing mouthwash in rehardening softened enamel. Journal Cosmetic Dent 2014:30(3)Fall:72-79, 2014.

Article

Dec 2014

Toothbrushing after an erosive attack: Will waiting avoid tooth wear?

Article

Aug 2014
EUR J ORAL SCI

The purpose of this study was to determine if storage for up to 4 h in human saliva results in a decrease of erosive tooth wear (ETW) and in an increase of surface microhardness (SMH) of enamel samples after an erosive attack with subsequent abrasion. Furthermore, we determined the impact of individual salivary parameters on ETW and SMH. Enamel samples were distributed into five groups: group 1 had neither erosion nor saliva treatment; groups 2–5 were treated with erosion, then group 2 was placed in a humid chamber and groups 3–5 were incubated in saliva for 30 min, 2 h, and 4 h, respectively. After erosion and saliva treatments, all groups were treated with abrasion. Surface microhardness and ETW were measured before and after erosion, incubation in saliva, and abrasion. Surface microhardness and ETW showed significant changes throughout the experiment: SMH decreased and ETW increased in groups 2–5, regardless of the length of incubation in saliva. The results of groups 3–5 (exposed to saliva) were not significantly different from those of group 2 (not exposed to saliva). Exposure of eroded enamel to saliva for up to 4 h was not able to increase SMH or reduce ETW. However, additional experiments with artificial saliva without proteins showed protection from erosive tooth wear. The recommendation to postpone toothbrushing of enamel after an erosive attack should be reconsidered.

Epidemiology, course, and outcome of eating disorders

Article

Sep 2013
CURR OPIN PSYCHIATR

To review the recent literature about the epidemiology, course, and outcome of eating disorders in accordance with the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The residual category 'eating disorder not otherwise specified' (EDNOS) was the most common DSM-IV eating disorder diagnosis in both clinical and community samples. Several studies have confirmed that the DSM-5 criteria for eating disorders effectively reduce the proportion of EDNOS diagnoses. The lifetime prevalence of DSM-5 anorexia nervosa among women might be up to 4%, and of bulimia nervosa 2%. In a cross-national survey, the average lifetime prevalence of binge eating disorder (BED) was 2%. Both anorexia nervosa and bulimia nervosa are associated with increased mortality. Data on long-term outcome, including mortality, are limited for BED. Follow-up studies of BED are scarce; remission rates in randomized controlled trials ranged from 19 to 65% across studies. On a community level, 5-year recovery rates for DSM-5 anorexia nervosa and bulimia nervosa are 69 and 55%, respectively; little is known about the course and outcome of BED in the community. Applying the DSM-5 criteria effectively reduces the frequency of the residual diagnosis EDNOS, by lowering the threshold for anorexia nervosa and bulimia nervosa, and adding BED as a specified eating disorder. Course and outcome studies of both anorexia nervosa and bulimia nervosa show that no significant differences exist between DSM-5 and DSM-IV definitions.

Comparison of the erosive potential of gastric juice and a carbonated drink in vitro

Article

Nov 2008

The aim of this study was to compare the erosive effect of gastric juice and a carbonated drink on enamel and dentine by measuring release of calcium from 30 hemisectioned teeth in vitro. In addition, the titrable acidity (mL of 0·05 M sodium hydroxide required to neutralize) and pH of the fluids was estimated. The mean pH of the seven gastric acid samples was 2·92 (range 1·2–6·78) and mean titratable acidity 0·68 mL (range 0·03–1·64). Both the pH and the titratable acidity of the gastric juice varied between patients all of whom suffered from symptoms of reflux disease. The carbonated drink had a pH of 2·45 and a titratable acidity of 0·29 mL. The median amount of calcium released by the gastric acids from enamel was 69·6 μg L–1 (interquartile range 5·4–144) and 62·4 μg L–1 (2·2–125·3) from dentine. The carbonated drink released 18·7 μg L–1 (13·4–23·4) and 18·6 μg L–1 (11·9–35·3), respectively. The differences in calcium release by gastric juice and the carbonated drink were statistically significant for both enamel (P < 0·005) and dentine (P < 0·01). It is concluded that gastric juice has a greater potential, per unit time, for erosion than a carbonated drink.

Gastroesophageal reflux, dental erosion, and halitosis in epidemiological surveys: A systematic review

Article

Oct 2012

In published studies, it has been suggested that dental wear is associated with gastroesophageal reflux disease (GERD). This systematic review was carried out to evaluate the association of GERD, dental erosion, and halitosis and to compare the indices adopted in epidemiological surveys. The Medline database (until October, 2011) was searched systematically to identify studies evaluating the prevalence of oral alterations, such as dental erosion and halitosis, in patients with GERD symptoms. Two reviewers analyzed all reports and the selected studies were evaluated according to the quality of evidence, using the validated Newcastle-Ottawa Quality Assessment Scale. Full-text copies of a total of 32 publications were obtained in duplicate. Sixteen publications were identified among the citations in the Bibliographic lists of studies that fulfilled the exclusion/inclusion criteria and quality of evidence. The relationship between dental erosion and GERD patients was significant in only seven studies. According to three studies, halitosis could be one of several extraesophageal symptoms or manifestations in GERD patients. In one study, it was found that the mucosa of GERD patients was significantly more acidic in comparison with that of the control group. This systematic review showed that there is a relationship between GERD and oral diseases (dental erosion and halitosis). The epidemiological surveys used different indices to analyze GERD and dental erosion. Further research could investigate the best method for assessing the two diseases.

Eating Disorders and their Implications on Oral Health — Role of Dentists

Article

Dec 2011

Eating disorders (EDs) are primary psychological conditions, often associated with severing medical complications. EDs are characterized by perturbed eating behavior patterns. Their increasing incidence and prevalence is causing concerns to healthcare professionals. Because eating disorders are a complex issue, a multidisciplinary approach to treatment is required and this team includes Psychiatrists, Psychologists and Nutritionists. The purpose of this paper is to review the role of the dentists especially the pediatric dentist and orthodontist in identifying oral manifestations of EDs, which may be utilized for oral diagnosis, referral and management of underlying psychiatric condition and also secondary oral conditions.

Oral profiles of bulimic women: Diagnosis and management. What is the evidence?

Article

Dec 2002

Walter Bretz

This article is a critical appraisal of the literature on the oral complications of bulimia. The MEDLINE database yielded a total of 82 English-language reports published between 1966 and 2002 that were pertinent to the topic of oral manifestations and treatment of bulimia. The literature is composed primarily of reviews, letters, case reports with or without restorative management, and descriptive studies of small sample sizes. At present, retrospective case-control studies are the only studies available with levels of evidence in the vicinity of 3 to 4. From these studies it is apparent that bulimic women present with a variety of oral and pharyngeal signs and symptoms, including dental caries and tooth erosion, dental pain, increased levels of cariogenic bacteria, orthodontic abnormalities, xerostomia (the subjective complaint of a dry-mouth) and decreased saliva secretion (the objective measure), decreased salivary pH, decreased periodontal disease, parotid enlargement, and swallowing impairments. Dental erosion is the major finding associated with bulimia. Case reports describe restoration of damaged surfaces with porcelain-laminated veneers, dentin-bonded crowns with minimal tooth preparation, composites, and complete-coverage restorations. However, what is really needed is identification of oral markers of bulimic behavior for early detection of bulimic patients by dentists and by physicians that can prevent the deleterious effects of frequent vomiting on the oral/dental tissues.

Influence of five neutralizing products on intra-oral pH after rinsing with simulated gastric acid

Article

Aug 2011
EUR J ORAL SCI

Lindquist B, Lingström P, Fändriks L, Birkhed D. Influence of five neutralizing products on intra-oral pH after rinsing with simulated gastric acid. Eur J Oral Sci 2011; 119: 301–304. © 2011 Eur J Oral Sci The aetiology of dental erosion may be of both extrinsic and intrinsic origin. The aim of the present study was to test the ability of various neutralizing products to raise the low intra-oral pH after an erosive exposure, in this case to gastric acid, which was simulated using hydrochloric acid (HCl). Eleven adults participated. They rinsed with 10 ml of 10 mM HCl (pH 2) or 10 ml of 100 mM HCl (pH 1) for 1 min, after which the pH was measured intra-orally for up to 30 min at four sites (two approximal, one buccal, and the dorsum of the tongue). After rinsing with the two acid solutions (pH 1 and pH 2), the following products were used: (i) antacid tablet; (ii) gum arabic lozenge; (iii) mineral water; (iv) milk; and (v) tap water (positive control). The negative control was no product use. The five test products were used for 2 min after the erosive challenge. All the products produced an initially higher pH compared with the negative control. The antacid tablet resulted in the greatest and most rapid increase in pH, followed by the lozenge. In dental practice, the use of any of the neutralizing products tested, especially the antacid tablet, could be recommended in order to increase the intra-oral pH after an erosive challenge.

In situ Evaluation of Different Remineralization Periods to Decrease Brushing Abrasion of Demineralized Enamel

Article

May 2001

The aim of the present in situ study was to evaluate the effect of different periods of intraoral remineralization to decrease the susceptibility of previously demineralized enamel against toothbrushing abrasion. Six human enamel specimens (A-F) were recessed in the buccal aspects of each of eight intraoral appliances which were worn for 21 days by 8 panelists. Demineralization of the samples was performed twice a day extraorally in the acidic beverage Sprite Light for 90 s. Subsequently, the enamel specimens were brushed at different times. Specimen A was brushed immediately after the demineralization. The remaining samples B-E were brushed after the intraoral appliances had been worn for various periods of remineralization: specimen B, 10 min; C, 20 min; D, 30 min and E, 60 min, respectively. Specimen F was only demineralized and remineralized, but not brushed. After 21 days, enamel wear was measured with a laser profilometer. The following values (mean +/- standard deviation) were obtained: specimen A, 6.78+/-2.71 microm; B, 5.47+/-3.39 microm; C, 6.06+/-3.18 microm; D, 5.43+/-2.58 microm; E 4.78+/-2.57 microm, and F 0.66+/-1.11 micro;m. Analysis of variance revealed a significant influence of remineralization period on abrasive wear. However, even after a remineralization period of 60 min the wear was significantly increased as compared to the demineralized, but not brushed control. It is concluded that (1) abrasion resistance of softened enamel increases with remineralization period and (2) at least 60 min should elapse before toothbrushing after an erosive attack.

Comparison of the erosive potential of gastric juice and a carbonated drink in vitro

Article

Nov 2001

The aim of this study was to compare the erosive effect of gastric juice and a carbonated drink on enamel and dentine by measuring release of calcium from 30 hemisectioned teeth in vitro. In addition, the titrable acidity (mL of 0.05 M sodium hydroxide required to neutralize) and pH of the fluids was estimated. The mean pH of the seven gastric acid samples was 2.92 (range 1.2-6.78) and mean titratable acidity 0.68 mL (range 0.03-1.64). Both the pH and the titratable acidity of the gastric juice varied between patients all of whom suffered from symptoms of reflux disease. The carbonated drink had a pH of 2.45 and a titratable acidity of 0.29 mL. The median amount of calcium released by the gastric acids from enamel was 69.6 microg L-1 (interquartile range 5.4-144) and 62.4 microg L-1 (2.2-125.3) from dentine. The carbonated drink released 18.7 microg L-1 (13.4-23.4) and 18.6 microg L-1 (11.9-35.3), respectively. The differences in calcium release by gastric juice and the carbonated drink were statistically significant for both enamel (P < 0.005) and dentine (P < 0.01). It is concluded that gastric juice has a greater potential, per unit time, for erosion than a carbonated drink.