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Severe and rapid erosion of dental enamel from swimming: A clinical report
Abstract
The diagnosis and treatment of a patient with excessive and rapid erosion of enamel is presented. Although the Center for Disease Control and the dental literature have reported on dental enamel erosion resulting from swimming pool chlorination, the awareness of such etiology among dental professionals may be limited. Common findings in these reports include cold sensitivity, a distinctive appearance resembling laminate veneer preparations of the facial surfaces of anterior teeth, occurrence of diastemas, and at times, a rough or gritty texture of the remaining tooth structure. Clinical presentations of erosive lesions can be diagnosed and the best course of treatment determined.
... While analysing the effect of nutritional variables on gingival and periodontal health,the imbalance of the host immune system is commonly identified among the obese Dr Deepak Thomas ,Dr Binitta Paul , Dr Syed Muhammed Jiffry individuals and could explain the observed association of obesity with certain diseases 12,13 including periodontitis . The recent studies have shown that periodontal diseases can exhibit an influence on systemic health such as altering blood chemistry with a rise in inflammatory mediators, affecting blood glucose level and increasing the risk for cardiovascular diseases, proposing that oral health might affect the health 14,15 of the entire body .Although, many studies on the association between obesity and periodontal disease have been reported. In Kerala, there have not been studies which have examined the association between abdominal obesity and periodontal disease based on Kerala populations. ...
... Assessments of oral health can reflect both the positive and negative aspects of self and well-being. "Health psychologists have recognized that psychological assets such as optimism and resilience correlate with an individual's quality of life, particularly how well she or he is able to cope with disease and poor 5,14 health" . Common dimensions in OHRQL instruments are depicted in the Figure 3. ...
... of quorum sensing inhibitors is the structural mimics of quorum-sensing signals, such as the halogenated furanones and the synthetic AIPs that are similar to the AHL and AIP signals, respectively. Evidence shows that these inhibitors act by interfering with the14corresponding signal binding to the receptor, or15by decreasing the receptor concentration. The other group of small chemicals is the enzyme inhibitors. ...
... A recent study found that acidic swimming pool water is one of the causes of dental enamel erosion (Lussi, 2006). Additionally, several clinical reports have shown that swimming in pools with improperly maintained chlorination can cause enamel erosion (Savad, 1982;Gabai et al., 1988;Geurtsen, 2000;Dawes & Boroditsky, 2008;Jahangiri et al., 2011). ...
... First, gas chlorination resulted in the formation of hydrochloric acid in water (Geurtsen, 2000). Second, excessive use of trichloroisocyanuric acid (TCCA) tablets caused cyanuric acid residue in water (Jahangiri et al., 2011). TCCA is widely used as a disinfectant in swimming pools. ...
... TCCA was chosen for this study because it is commonly used in smaller pools (Jahangiri et al., 2011), and in many countries (Tachikawa et al., 2002). After hydrolysis in water, TCCA is converted to HOCL, which has strong microbial activity. ...
The effect of chlorinated water on tooth erosion was studied. Tooth specimens were bathed in a pH cycling system
of chlorinated water and artificial saliva under one of the following conditions: I) a 4 hour continuous cycle, and II) a 1 hour/
day cycle for 4 weeks. Each group was divided into four subgroups for testing in chlorinated water with pH of 2, 3, 4 or 5.
Enamel loss and percentage of surface microhardness change (%SMC) were measured. After 4 hour, chlorinated water with
pH 2, 3, 4 and 5 produced enamel loss of 1.4, 0.4, 0.0 and 0.0 micrometers, and %SMC was reduced by 57.2, 13.7, 2.9 and
-0.2% respectively. After 4 weeks, erosion was recorded at 63.3, 1.0, 0.0 and 0.0 micrometers, and %SMC was reduced by
97.2, 52.1, 5.7 and 1.5%, respectively. The study revealed that the pH level of chlorinated water and the duration of exposure
are important factors in enamel erosion.
... Recent studies have demonstrated a cause-and-effect association between prolonged exposure to gas-chlorinated swimming pool water and dental erosion, and the competitive swimmers is considered to be the higher risk group [56][57][58][59]. Curiously, a few case reports showed severe and rapid loss of enamel by regular swimmers as a result of long time spent in inadequately maintained pools [56,57]. ...
... Recent studies have demonstrated a cause-and-effect association between prolonged exposure to gas-chlorinated swimming pool water and dental erosion, and the competitive swimmers is considered to be the higher risk group [56][57][58][59]. Curiously, a few case reports showed severe and rapid loss of enamel by regular swimmers as a result of long time spent in inadequately maintained pools [56,57]. Chlorine is the most common agent used to keep swimming pools free of bacterial and other microorganisms, and the cyanuric acid is usually added to stabilize this agent [52,57]. ...
... Curiously, a few case reports showed severe and rapid loss of enamel by regular swimmers as a result of long time spent in inadequately maintained pools [56,57]. Chlorine is the most common agent used to keep swimming pools free of bacterial and other microorganisms, and the cyanuric acid is usually added to stabilize this agent [52,57]. However, if the pH water conditions became inadequately buffered and the pH remains lower than expected (7.2 to 8.0), there is a potential risk of tooth demineralization and the facial surfaces of anterior teeth are mostly affected [56,[58][59][60]. ...
Objective: This review provides important insights into how the personal lifestyle behaviors may affect the oral health, especially with respect the Operative Dentistry field. Thus, the effect of lifestyle behavior on the dental hard tissues and restorative materials was explored, aiming to assess preventive and restorative strategies. Materials and Methods: Studies focusing on the potential effects of lifestyle behaviors on the restorative dentistry were used as a resource data. The collected literature was based on the original scientific full-papers from peer-reviewed journals in PubMed database. Results: Lifestyle behaviors may lead to changes in the appearance of dental tissue and dental restorations. The frequent consumption of coffee, tea, red wine and tobacco can lead to discoloration of tooth and resin-based materials. In addition, cigarette smoke may hinder the adhesive bonding mechanism and also may affect the physical properties of restorative materials. Occupational exposure to acid environment, addicted to acid drinks and regular/competitive swimmers should be aware of the potential risk for dental erosion. Moreover, since sports injuries can seriously lead to tooth and facial damage, the use of protective devices during sports activities should be emphasized, especially for athletes and regular practitioners of high-risk activities. Conclusion: Lifestyle behaviors may jeopardize the dental tissues and accelerate the aging process of aesthetic dental restorations. Thus, the widespread knowledge of this potential risks on the oral health and restorative dentistry is beneficial for targeting educational health care programs, preventive and reparative therapies.
... The characteristics of the typical lesion are severe loss of enamel creating diastema, definite margins of the lesion resembling anterior veneer preparation, wear of the incisal edges resulting in the reduction of clinical crown height, and tooth hypersensitivity. 1,5,6 Definitive treatment for this type of lesion aims to eliminate hypersensitivity, replace lost tooth structure, and establish proper esthetics. Several treatment modalities can be performed depending on the severity of the tooth surface loss such as direct composite resin restorations, laminate veneers, and complete coverage crowns. ...
... Several treatment modalities can be performed depending on the severity of the tooth surface loss such as direct composite resin restorations, laminate veneers, and complete coverage crowns. 6 To gain desirable esthetic outcomes, metal-free restorative materials are usually recommended to restore the extensively damaged anterior teeth. 7 The objective of this case report is to describe the clinical appearance and treatment approach in a case of severe dental erosion caused by swimming in a poorly maintained swimming pool with low pH pool water. ...
... Previous clinical case reports and in vitro studies demonstrated that low pH swimming pool water was a contributing factor of enamel erosion on the anterior teeth. 5,6 This patient had a significant habit of frequent swimming in an improperly chlorinated swimming pool. The clinical findings in this case fitted with the clinical characteristics of dental erosion caused by exposure to poor-chlorinated pool water. ...
This clinical report presents the clinical appearance and treatment approach in a case of excessive anterior teeth erosion resulted from swimming in a poorly-chlorinated swimming pool. Clinical findings revealed tooth sensitivity, severe enamel erosion resembling veneer preparations, and the presence of anterior open bite. A novel hybrid ceramic (Vita Enamic) was chosen for fabricating full-coverage crowns for this patient. After 6-months follow-up, the tooth sensitivity disappeared and the patient was satisfied with esthetic outcome. The hybrid ceramic restorations can be recommended with no complications.
... A similar pattern of tooth surface loss in swimmers was reported in other clinical reports. [14][15][16] Although the relationship between handedness and the side on which non-carious cervical lesions may develop is still controversial, yet it is worth mentioning that the patient is righthanded which could explain the incidence of the erosive tooth wear lesions more drastically on the left incisors, in relation to the right. 17,18 The maxillary right central incisor seems to have a labio-version position with slight rotation, making it more prone to contact the stiff toothbrush filaments, as the patient brushes his teeth regularly, in relation to anterior teeth in the same quadrant. ...
... At first sight, the patient was thought to have had preparations done to receive anterior aesthetic veneers, but meticulous patient history played the pivotal role to reach the definitive diagnosis in this case which dictated the most suitable management approach. Although similar erosive lesions' characteristics were reported in swimmers, [14][15][16] but to our knowledge, none have been managed through the injection molding technique. ...
Background:
Tooth wear can have a multifactorial aetiology which requires thorough patient assessment and aesthetic management.
Purpose:
This case report discusses the management of a young, Egyptian swimmer complaining of tooth sensitivity associated with erosive tooth wear. Anterior teeth were restored using the injection molding technique, also known as the injectable composite resin technique, to overcome the patient's complaint and enhance the aesthetics of compromised anterior teeth.
Patients and methods:
Thorough patient assessment was followed by impression taking, a diagnostic wax-up and intraoral mock-up fabrication for aesthetic, functional and biological verification. Upon the patient's agreement on the proposed treatment, an injection molding technique was carried out.
Conclusion:
The tooth loss pattern associated with erosive tooth wear in competitive swimmers showed a very characteristic presentation. Detailed patient history is imperative for successful assessment of the risk factors contributing to the condition and treatment planning in such cases. The use of injection molding technique for restoration of anterior teeth is a simple, straightforward and aesthetically pleasing alternative for patients with erosive tooth wear requiring direct composite veneers.
... Intrinsic factors include vomiting and gastroesophageal reflux, while the extrinsic ones include exposure to acidic foods and drinks, certain medication, occupational factors (wine tasters, manufacturing electrolytic/ galvanic batteries, etc.), and lifestyle [1]. Dental erosion might also affect performance swimmers due to the exposure to chlorinated water in swimming pools [2]. ...
... Chlorine is the most commonly used agent to maintain swimming pool water pH at a balanced level (7.2-7.8), and to prevent bacterial growth [2]. In our study we compared the demineralising effect of chlorinated water with a pH within the recommended limits (W3, pH 7.46), and 2 chlorinated waters with pH under these limits (W1 -pH 7.11, taken from a swimming pool, and W2 -pH 5.06, prepared in the laboratory). ...
This study reports on the in vitro erosive capacity of three different pH chlorinated waters on dental enamel,
and the anti-erosive protection conferred by three dental materials (toothpaste, remineralising cream, and
fluoride varnish), assessed by scanning electron microscopy. Fluoride varnish provided the best protection,
forming a resistant thin film on the enamel’s surface. The observed ultrastructural changes of the enamel
surface were low when the tooth paste was used, and more pronounced when the remineralising cream
was used.
... Intrinsic factors include vomiting and gastroesophageal reflux, while the extrinsic ones include exposure to acidic foods and drinks, certain medication, occupational factors (wine tasters, manufacturing electrolytic/ galvanic batteries, etc.), and lifestyle [1]. Dental erosion might also affect performance swimmers due to the exposure to chlorinated water in swimming pools [2]. ...
... Chlorine is the most commonly used agent to maintain swimming pool water pH at a balanced level (7.2-7.8), and to prevent bacterial growth [2]. In our study we compared the demineralising effect of chlorinated water with a pH within the recommended limits (W3, pH 7.46), and 2 chlorinated waters with pH under these limits (W1 -pH 7.11, taken from a swimming pool, and W2 -pH 5.06, prepared in the laboratory). ...
This study reports on the in vitro erosive capacity of three different pH chlorinated waters on dental enamel,
and the anti-erosive protection conferred by three dental materials (toothpaste, remineralising cream, and
fluoride varnish), assessed by scanning electron microscopy. Fluoride varnish provided the best protection,
forming a resistant thin film on the enamel’s surface. The observed ultrastructural changes of the enamel
surface were low when the tooth paste was used, and more pronounced when the remineralising cream
was used.
... Okul çağı çocukları arasında sıklıkla tercih edilen spor aktivitelerinden biri yüzmedir. Havuz suyunun dezenfeksiyonu amacı ile uygulanan klorlama sırasında ortaya çıkan hidroklorik asidin suyun pH değerini dü-Ģürdüğü ve bu havuzlarda yüzen çocuklarda erozyona neden olabileceği bildirilmiĢtir [20][21][22] . Yüzücüler arasında yapılan farklı epidemiyolojik çalıĢmalarda erozyon görülme sıklığı %26-%90 olarak rapor edilmiĢtir [23][24][25] . ...
Amaç: Okul dıĢı saatlerde amatör olarak spor yapan çocukların beslenme alıĢkanlıkları içerisinde erozyona neden olan yiyecek ve içeceklerin tüketim sıklığı ile havuz suyunun yüzme sporu yapan çocuklarda erozyona etkisinin olup olmadığını incelemektir.
Gereç ve Yöntem: ÇalıĢmaya yaĢları 6-15 arasında değiĢen ve amatör olarak yüzme veya yüzme dıĢı spor yapan 51 kız, 56 erkek toplam 107 çocuk katıldı. Çocukların sosyo-demografik bilgilerinin yanı sıra, yapılan spor türü ve süresi, erozyona neden olan içecekler ile yiyeceklerin tüketilmesi ile ilgili 22 soruluk bir anket uygulandı. Ağız içi muayeneleri yapılarak dental erozyon ve çürük durumu kaydedildi. ÇalıĢmaya ait etik kurul onayı alındı.
Bulgular: Erozyona neden olan etkenler arasında enerji içeceği tüketimi % 0.9 olarak bulunurken, spor içeceği tüketimi %32.7 olarak belirlendi. ÇalıĢmaya katılan tüm çocuklarda dental erozyon görülme sıklığı %17, DMFT ve dmft değerleri 6,81±6,34, 1,95±4,13 olarak bulundu. Yüzme sporu yapan çocuklarda eroz- yon görülme oranı (%28.3), yüzme dıĢı sporları yapan çocukların oranlarından (%5.7) istatistiksel olarak anlamlı düzeyde yüksek bulundu (p:0.004; p<0.05). Ancak yüzme sporu yapan çocukların spor yapma süresine göre erozyon görülme oranları açısından istatistiksel olarak anlamlı bir farklılık bulunmadı (p:0,800; p>0.05). Spor içeceğinin erozyona etkisi değerlendirildiğinde, gruplar arasında erozyon varlığı açısından istatistiksel olarak anlamlı bir farklılık bulunmadı (p>0.05).
Sonuç: Spor dalları arasında yüzme, erozyon oluĢumu için bir risk faktörüdür ve bu sporu yapan çocuklarda diĢ hekimliği koruyucu uygulamaları önem taĢımaktadır.
Anahtar Kelimeler: Spor, çocuk, yüzme, erozyon
... However, they can be conservatively treated with esthetic restorative procedures such as indirect composite resin restorations or ceramic laminate veneer to achieve the most predictable esthetic and functional outcome. 6,7 Rehabilitation of extensive erosion, however, remains a challenge because multiple teeth are often involved. 5 The sandwich approach, developed by Vailati et al, 5,8 is a technique that consists of reconstruction of the lingual aspect of eroded anterior teeth with resin palatal veneers, followed by restoration of the facial aspect with ceramic veneers. ...
The esthetic and functional rehabilitation of worn anterior teeth should follow the principles of minimally invasive dentistry. When dental wear occurs at both the facial and palatal surfaces, the sandwich approach of reconstructing eroded anterior teeth with palatal followed by facial veneers is a straightforward treatment that preserves sound dental structure.
... Although a low pH can cause irritation in the absence of appropriate glasses, excess chlorine in the water. It can not be detected by swimmers, allowing the acidic water in contact with the teeth, could cause irreversible tooth structure wear 20 . In published case, swimming athlete showed several loss of tooth enamel, in just two weeks, especially in their anterior teeth. is case emphasizes the need to ensure that the water is properly chlorinated and pH adjusted to 7.5 21 . ...
Sports Dentistry (SD) acts in the prevention, maintenance and treatment of oral and facial injuries, as well as the collection and dissemination of information on dental trauma, beyond stimulus to research. Establishes as a duty for the dentist detect problems related to the athlete’s stomatognathic system. This essay is based on the provided data from the literature related to SD, including definition, practice areas and research fields. To discuss the data, six areas were categorized: shares in sports dentistry; oral health of athlete; sports-related dental implications; dental-facial trauma; face shields; and mouthguards. The analyzed data show that the SD is still an underexplored field of action by dentists, but it is expanding, despite not being recognized specialty by the Federal Council of Dentistry, but the Brazilian Academy of Sports Dentistry has been created with a mission to show the real importance of Dentistry in sport. The dentist should be part of the group of professionals associated with the athlete to perform periodic checks in order to ensure oral health which may contribute to athletes ́performance. When impact occurs, however, it would be possible reduce the severity of the impact related to injuries, by using helmets, masks, goggles, face shields and mouthguard. Additionally, it is imperative that dentists, sports coaching, athletes, and professional who work with athletes be aware of the benefits of incorporating SD as an important academic and professional subject.
... There are some anecdotic case reports on the harmful effect of regular swimming in chlori- (6% enamel/ 5% dentine) yes prevalence of erosion increased with exposure time nated swimming pool water, showing a rapid loss of dental hard tissue in a very short time [105,106] . It is assumed that non-buffered swimming pool water can lead to dental erosion, in particular in competitive swimmers, since it might have a low pH and might be under-saturated with respect to hydroxyapatite. ...
Individuals have different risks for developing erosive lesions depending on background, behavioural, dietary and medical variables. It is anticipated that people with regular impact of gastric juice, i.e. patients with eating disorders and gastroesophageal reflux disease (GERD) have a specially high risk of developing dental erosions; the same could be true for those with special diets, regular consumption of acidic beverages, medicine and drug intake and occupational exposure to acids. Eating disorders are associated with an increased occurrence, severity and risk for dental erosion, even though not all bulimic patients show a pathological level of tooth wear. There seems also to be a tendency that in the case of GERD, erosion is more common and more severe than in healthy controls. Regarding exogenous causes, many studies, though not all, document a positive association between the consumption of acidic beverages and dental erosions and there seems to be a dose-response relationship; however, further studies are necessary for a final statement. The same applies for the association between drug or medication intake or special diet and erosion prevalence. Though only few studies exist, there seems to be a tendency for an increase of erosion prevalence amongst persons abusively consuming alcohol. Some studies show an increased risk for dental erosion for employees testing wine or working in acid processing factories. Even though some associations between acid impact and erosion prevalence appear clear, the number of studies is small. There is a lack of controlled prevalence studies, making it difficult to give final statements for all risk groups. © 2014 S. Karger AG, Basel.
Dental trauma in the field of sports is the major linking channel between sports and dentistry. Sports dentistry is the branch of sports medicine that deals with the prevention of oral or facial athletic injuries, oral diseases and manifestations. Sports dentistry is also related to mild traumatic brain injuries during games and erosive lesions due to continuous intake of highly acidic sports and energy drinks. Stress among sportsperson has also been depicted to impact their athletic performance leading athletes to the intake of drugs. Smokeless tobacco consumption and sponsorship is also found among athletes. Therefore, it is emphasized the need for a "team dentist," initiating from high schools to professional teams. The sports or "team dentist" assists athletes in the effective prevention, treatment, and diagnosis of various types of oral injuries. Sport-related orofacial injuries can be prevented by wearing primary protective devices such as properly fitting helmets, face masks and/or mouth guards. They can also enlighten athletes about the benefits of practicing yoga, as it reduces stress and improves performance. Hence, the dentist can perform an imperative role in informing parents, athletes, coaches and patients about the importance of preventing orofacial injuries in sports.
It is nearly impossible to attend a sporting event from youth leagues to professional and not see multiple bottles or 5 gallon jugs of sports drinks. Athletes of all ages and skill levels are led to believe that they need sports drinks and, even more outrageous, energy drinks to compete at the highest levels. Child athletes are under constant attack by slick marketing campaigns that tell them they need sports drinks to properly hydrate themselves as they play sports. Sports drinks and energy drinks are big business all over the world. There are negative consequences to the use of these products. Sports and energy drinks can and do cause dental erosion. Energy drinks can be downright dangerous to use. The Center for Behavioral Health Statistics and Quality (CBHSQ) in a 2013 report said that ER visits linked to energy drink consumption had doubled from 2007 to 2011. The sports team dentist must be aware of this trend and the dangers of use and abuse of sports and energy drinks and counsel athletes on their use and work with team physicians and trainers to educate players on the truth of hydration science.
De chemische erosiviteit van voedingsmiddelen hangt af van verschillende factoren, waaronder pH, buffercapaciteit, de aanwezigheid van calcium-, fosfaat- en fluoride-ionen, en van calciumbindende ingrediënten. Gezamenlijk bepalen deze de verzadigingsgraad van een drank ten opzichte van hydroxyapatiet en fluoroapatiet.
In het algemeen is de erosiviteit van een drank hoger naarmate de pH lager is. Dranken met een lage pH hoeven echter niet erosief te zijn, zolang de concentratie van remineraliserende ionen zoals calcium en fluoride maar hoog genoeg is.
Naast de erosiviteit van het voedingsmiddel spelen bij het ontstaan van erosie andere factoren een rol, zoals (verlaagde) speekselsecretie, de adhesiviteit van een drank, de manier van drinken en lifestyle factoren.
Een andere belangrijke oorzaak van erosie is reflux van maagzuur en veelvuldig braken onder meer als gevolg van eetstoornissen.
In the light of multiple research on dental erosion, by using the spectrophotometry absorption method, we have conducted a in vitro study with the aim to highlight the erosive effect of chlorinated pool water, as well as the protective role of a lacquer and of two different toothpastes with remineralizant effect. Followed targets: the erosive capacity evaluation of three chlorinated waters used for swimming pools, the quantitative determination of the calcium and phosphates concentration absorbed by these waters, the quantitative determination of the remineralization and protection capacity of some dental materials on the enamel exposed to the action of chlorinated waters. After exposing the enamel to the action of these waters, we determined that the swimming pool waters improperly chlorinated represent a risk factor for the performant and casual swimmers. These waters have the capacity to demineralize the dental enamel in vitro, the severity of the demineralization being influenced by the pH and the capacity of extracting different of calcium and phosphates. The three materials used for protection are able to remineralize the dental enamel, the best effect being given by the application of fluorinated lacquers. Optimal maintenance of the swimming pools and specific prophylactic methods for the performant swimmers are necessa eg y.
Tooth surface loss is a process that results in non-carious lesions.
Several categories of tooth surface loss exist, including erosion,
attrition, abrasion, and abfraction. There can be many causes of
this condition, including bruxism, clenching, disease, dietary
factors, habits and lifestyle, incorrect tooth brushing, abrasive
dentifrices, the craniofacial complex, iatrogenic dentistry, and
aging. Determining the etiology of tooth surface loss can be
difficult but is possible through observation of the pattern of
tooth surface loss on the teeth and is necessary for treatment
planning to prevent failure. Management of this process includes
prevention, tooth remineralization, and active treatment by
restoring the involved teeth. Treatment can range from minimally
invasive and adhesive dentistry, to full mouth rehabilitation, to
restoring the lost vertical height.
The "art of the smile" lies in the clinician's ability to recognize the positive elements of beauty in each patient and then create a strategy to enhance the attributes that fall outside the parameters of the prevailing esthetic concept. New technologies have enhanced our ability to see our patients more dynamically and facilitated the quantification and communication of newer concepts of function and appearance. In a 2-part article, we present a comprehensive methodology for recording, assessing, and planning treatment of the smile in 4 dimensions. In part 1, we discussed the evolution of smile analysis and reviewed the dynamic records needed. In part 2, we review smile analysis and treatment strategies and present a brief case report.
The "art of the smile" lies in the clinician's ability to recognize the positive elements of beauty in each patient and to create a strategy to enhance the attributes that fall outside the parameters of the prevailing esthetic concept. New technologies have enhanced our ability to see our patients more dynamically and facilitated the quantification and communication of newer concepts of function and appearance. In a 2-part article, we present a comprehensive methodology for recording, assessing, and planning treatment of the smile in 4 dimensions. In part 1, we discuss the evolution of smile analysis and review the dynamic records needed. In part 2, we will review smile analysis and treatment strategies and present a brief case report.
Non-carious destruction of teeth has been observed in archaeological material from various parts of the world and clearly pre-dates the first appearance of dental caries. Attrition, abrasion and erosion are also described in the classic text of Pindborg1 on the pathology of the dental hard tissues. Whilst the dental profession, at least in affluent parts of the world, was engaged in diagnosing, treating and later preventing dental caries these other causes of tooth destruction were largely ignored.
Dental caries is a highly prevalent diet-related disease and is a major public health problem. A goal of modern dentistry is to manage non-cavitated caries lesions non-invasively through remineralization in an attempt to prevent disease progression and improve aesthetics, strength, and function. Remineralization is defined as the process whereby calcium and phosphate ions are supplied from a source external to the tooth to promote ion deposition into crystal voids in demineralized enamel, to produce net mineral gain. Recently, a range of novel calcium-phosphate-based remineralization delivery systems has been developed for clinical application. These delivery systems include crystalline, unstabilized amorphous, or stabilized amorphous formulations of calcium phosphate. These systems are reviewed, and the technology with the most scientific evidence to support its clinical use is the remineralizing system utilizing casein phosphopeptides to stabilize and deliver bioavailable calcium, phosphate, and fluoride ions. The recent clinical evidence for this technology is presented and the mechanism of action discussed. Biomimetic approaches to stabilization of bioavailable calcium, phosphate, and fluoride ions and the localization of these ions to non-cavitated caries lesions for controlled remineralization show promise for the non-invasive management of dental caries.
To study the dietary behavior and knowledge about dental erosion and self-reported symptoms that can be related to dental erosion among Chinese adults in Hong Kong.
Chinese adults aged 25-45 years were randomly selected from a list of registered telephone numbers generated by computer. A telephone survey was administered to obtain information on demographic characteristics, dietary habits, dental visits, and knowledge of and presence of self-reported symptoms that can be related to dental erosion.
A total of 520 participants were interviewed (response rate, 75%; sampling error, +/- 4.4%) and their mean age was 37. Most respondents (79%) had ever had caries, and about two thirds (64%) attended dental check-ups at least once a year. Respondents had a mean of 5.4 meals per day and 36% had at least 6 meals per day. Fruit (89%) and lemon tea/water (41%) were the most commonly consumed acidic food and beverage. When asked if they ever noticed changes in their teeth, most respondents (92%) said they had experienced change that can be related to erosion. However, many (71%) had never heard about dental erosion and 53% mixed up dental erosion with dental caries.
Hong Kong Chinese adults have frequent intake of food and many have experienced symptoms that can be related to dental erosion. Their level of awareness of and knowledge about dental erosion is generally low, despite most of them have regular dental check-ups. Dental health education is essential to help the public understand dental erosion and its damaging effects.
Eating disorders (ED) are a group of psychopathological disorders affecting patient relationship with food and her/his own body, which manifests through distorted or chaotic eating behavior; they include anorexia nervosa, bulimia nervosa and ED not otherwise specified and may be burdened with life-threatening complications. As oral manifestations of ED can occur in many phases of disease progression, they play a significant role in assessment, characterization and prognosis of ED.
Mucosal, dental, and salivary abnormalities associated with ED have been reviewed. Relations between oral menifestations and pathogenesis, management and prognosis of ED have been critically analysed.
Oral manifestations of ED include a number of signs and symptoms involving oral mucosa, teeth, periodontium, salivary glands and perioral tissues; differences exist between patients with anorexia and bulimia. Oral manifestations of ED are caused by a number of factors including nutritional deficiencies and consequent metabolic impairment, poor personal hygiene, drugs, modified nutritional habits and underlying psychological disturbances.
Oral manifestations of ED can cause impairment of oral function, oral discomfort and pain, and an overall deterioration of aesthetics and quality of life. Their treatment can contribute to overall patient management and prognosis.
To assess dental status and sports supplement uptake in swimmers and cyclists. To determine chemico-physical properties of the most popular sports drinks.
Descriptive, prevalence study of tooth wear and caries experience. Questionnaire analysis of sports drinks usage.
Two public swimming pools in Liverpool and three cycle clubs in North West England.
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.
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.
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.
The "art of the smile" lies in the clinician's ability to recognize the positive elements of beauty in each patient and to create a strategy to enhance the attributes that fall outside the parameters of the prevailing esthetic concept. New technologies have enhanced our ability to see our patients more dynamically and facilitated the quantification and communication of newer concepts of function and appearance. In a 2-part article, we present a comprehensive methodology for recording, assessing, and planning treatment of the smile in 4 dimensions. In part 1, we discuss the evolution of smile analysis and review the dynamic records needed. In part 2, we will review smile analysis and treatment strategies and present a brief case report.
The "art of the smile" lies in the clinician's ability to recognize the positive elements of beauty in each patient and then create a strategy to enhance the attributes that fall outside the parameters of the prevailing esthetic concept. New technologies have enhanced our ability to see our patients more dynamically and facilitated the quantification and communication of newer concepts of function and appearance. In a 2-part article, we present a comprehensive methodology for recording, assessing, and planning treatment of the smile in 4 dimensions. In part 1, we discussed the evolution of smile analysis and reviewed the dynamic records needed. In part 2, we review smile analysis and treatment strategies and present a brief case report.
The aim of this study was to evaluate the prevalence, clinical manifestations, and etiology of dental erosion among children. A total of 153 healthy, 11-year-old children were sampled from a downtown public school in Istanbul, Turkey comprised of middle-class children. Data were obtained via: (1) dinical examination; (2) questionnaire; and (3) standardized data records. A new dental erosion index for children designed by O'Sullivan (2000) was used. Twenty-eight percent (N=43) of the children exhibited dental erosion. Of children who consumed orange juice, 32% showed erosion, while 40% who consumed carbonated beverages showed erosion. Of children who consumed fruit yogurt, 36% showed erosion. Of children who swam professionally in swimming pools, 60% showed erosion. Multiple regression analysis revealed no relationship between dental erosion and related erosive sources (P > .05).
Dental erosion is characterized as a disorder with a multifactorial aetiology including environmental acid exposure. The purpose of this article was to summarize and discuss the available information concerning occupational dental erosion.
Information from original scientific papers, case reports and reviews with additional case reports listed in PubMed, Medline or EMBASE [search term: (dental OR enamel OR dentin) AND (erosion OR tooth wear) AND (occupational OR worker)] were included in the review. References from the identified publications were manually searched to identify additional relevant articles.
The systematic search resulted in 59 papers, of which 42 were suitable for the present review. Seventeen papers demonstrated evidence that battery, galvanizing and associated workers exposed to sulphuric or hydrochloric acid were at higher risk of dental erosion. For other industrial workers, wine tasters and competitive swimmers, only a few clinical studies exist and these do not allow the drawing of definitive conclusions.
Occupational acid exposure might increase the risk of dental erosion. Evidence for occupational dental erosion is limited to battery and galvanizing workers, while data for other occupational groups need to be confirmed by further studies.
Dental erosion is a multifactorial condition: The interplay of chemical, biological and behavioural factors is crucial and helps explain why some individuals exhibit more erosion than others. The erosive potential of erosive agents like acidic drinks or foodstuffs depends on chemical factors, e.g. pH, titratable acidity, mineral content, clearance on tooth surface and on its calcium-chelation properties. Biological factors such as saliva, acquired pellicle, tooth structure and positioning in relation to soft tissues and tongue are related to the pathogenesis of dental erosion. Furthermore, behavioural factors like eating and drinking habits, regular exercise with dehydration and decrease of salivary flow, excessive oral hygiene and, on the other side, an unhealthy lifestyle, e.g. chronic alcoholism, are predisposing factors for dental erosion. There is some evidence that dental erosion is growing steadily. To prevent further progression, it is important to detect this condition as early as possible. Dentists have to know the clinical appearance and possible signs of progression of erosive lesions and their causes such that adequate preventive and, if necessary, therapeutic measures can be initiated. The clinical examination has to be done systematically, and a comprehensive case history should be undertaken such that all risk factors will be revealed.
This case report describes the almost complete loss of enamel by acid erosion, particularly from the anterior teeth, in a woman who swam daily for 2 weeks in an improperly chlorinated swimming pool in Cuba. It emphasizes the need for both swimmers and swimming pool staff to ensure that the water has been properly chlorinated and that the pH has been adjusted to 7.5.
Dental erosion is defined as irreversible loss of dental hard tissue by a chemical process (acid acid and/or chelation exposure) that does not involve bacteria. The acidic attack leads to an irreversible loss of dental hard tissue, which is accompanied by a progressive softening of the surface. This softened zone is more susceptible to mechanical forces, such as abrasion , which in turn have little or no effect on sound dental hard tissues. The chemical and mechanical processes can occur individually or together, although the effect of erosion is often dominant. The etiology of erosion is multifactorial and not fully understood. The studies should clearly delineate erosion, attrition, and abrasion with identification of etiologic factors. There are different predisposing factors and aetiologies of the erosive condition. As erosive tooth wear is a multifactorial condition, preventive strategies have to be applied which account for chemical, biological and behavioral factors involved in the etiology and pathogenesis of erosion There is an increasing awareness in clinical dentistry of the need to better understand the aetiology and management of tooth wear as increasing numbers of elderly patients are retaining their natural teeth to a stage when they present with extensive wear. The clinical management of erosion should focus on early detection and prevention before a restorative approach is considered. Early recognition of erosion is important to successfully manage and prevent disease progression.
This chapter discusses the scientific evidence for the anticariogenic activity of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) nanocomplexes. The chapter starts by introducing dental caries (tooth decay) and then presents the ultrastructure of the CPP-ACP nanocomplex. It then presents a detailed review of the scientific literature describing the anticariogenic activity of CPP-ACP and mechanisms of action. The chapter concludes with recommendations for clinical use of the CPP-ACP.
An overview of tooth wear, i.e. of non-carious destructive processes affecting the teeth including abrasion, demastication, attrition, abfraction, resorption and erosion is presented. The nomenclature and classification of dental erosion commonly used in the dental literature are summarized. They are based on etiology (extrinsic, intrinsic, idiopathic), on clinical severity (Classes I to III), on pathogenetic activity (manifest, latent) or on localization (perimolysis). Interactions between erosion and abrasion, demastication, attrition, and abfraction as well as caries and low salivary flow rate are highlighted.
Background: Wine makers and assessors frequently experience severe dental erosion. The objectives of this study were to develop an in vitro model of dental erosion caused by frequent wine contact with teeth, and to use this model to assess the effectiveness of a variety of methods which might protect against this form of erosion.
Methods: An initial pilot study found that riesling style wine was more erosive than champagne style, and both more than claret. Wine tasting was simulated by subjecting exposed windows of enamel and root surfaces on 50 intact, extracted human teeth to 1400 one minute exposures to white wine (pH 3.2). A variety of dental materials were applied to the exposed windows on groups of teeth prior to erosive challenge, to assess their protective ability.
Results: Protective resin coatings and fluoride varnishes protected both enamel and roots against wine induced erosion. A high degree of protection was provided by APF gel, with less by NaF gel.
Conclusions: It was concluded that dentists may be able to help minimise erosion resulting from frequent wine-tasting in their patients by the clinical application of one or a combination of these agents at times prior to prolonged assessment periods.
The purpose of the study was to evaluate and compare three scoring systems for dental erosion representing different approaches: the recently proposed Basic Erosive Wear Examination (B.E.W.E.), the Simplified Tooth Wear Index (S-T.W.I.), and the Evaluating Index of Dental Erosion (EV.I.D.E.), which are introduced and calibrated in the present study, in order to contribute to the development of a standardised and validated erosion index.
A cross-sectional study was conducted, in which a random and stratified sample of 502 adolescents aged 14-16 years was examined using the aforementioned scoring systems.
A significant number of Greek adolescents had experienced dental erosion: 58%, 51.6% and 45.2%, according to the B.E.W.E., S-T.W.I. and EV.I.D.E. scores, respectively. Additionally, 22.7-24.3% of the subjects had lesions into dentine (according to the EV.I.D.E. and S-T.W.I. scores respectively), whereas the B.E.W.E. classified all subjects with erosion in the "none" and "low" risk level categories. However, the use of the B.E.W.E. cumulative scores was important for avoiding the overestimation of the prevalence of erosion. The aetiological criteria of the EV.I.D.E. seemed to reduce the false positive cases.
The S-T.W.I. appeared to have the lowest content validity, while the B.E.W.E. was a convenient to use index, with sufficient sensitivity and specificity. Nevertheless, the B.E.W.E. cut-off values have to be reconsidered in order to reflect the severity of the erosive lesions. The B.E.W.E. could also be supplemented with a group of sufficient validated aetiological criteria, which are necessary to establish a more accurate differential diagnosis of dental erosion.
Both dental erosion and respiratory symptoms are extra-oesophageal manifestations of gastro-oesophageal reflux disease (GERD). The aim of this study was to determine whether dental erosion was correlated with respiratory symptoms in GERD patients.
88 GERD patients were recruited and assigned to three groups mainly according to the frequency of respiratory symptoms: Group I: never; Group II: occasional (1-2 days a week or less); Group III: frequent (3-5 days a week or more). All patients underwent medical evaluations, including medical history, questionnaire answering and alimentary tract examinations. Dental examinations were carried out on these patients and 36 healthy controls. Dental erosions were measured by modified method of Smith and Knight Tooth Wear Index (TWI). Location and severity of dental erosion were recorded.
The prevalence of dental erosion in Group III (64.52%) was higher (p<0.05) than that in Groups I (36.67%) and II (44.44%). GERD patients were presented with dental erosion with TWI scores ranging from 1 to 4. Though proportion of dental erosion with Score 2 (7/20) in Group III was higher than that in Group I (2/11) and Group II (3/12), there was no statistical significance in the proportions of erosion scores among three patient groups. Correlation coefficient between airway symptoms and scores of dental erosion was 0.231 (p<0.05). Palatal erosion of upper incisor was seen in 8 persons (72.7%) in Group I, 9 persons (75%) in Group II and 16 persons (80%) in Group III (p>0.05). Labial erosion of upper incisors was found in 1 person in Groups I and II respectively and 4 persons in Group III. All patients with labial erosion on upper incisors had palatal erosion, except 1 patient in Group III.
In GERD patients, dental erosions are more prevalent in patients with frequent respiratory symptoms than those in patients with occasional and without respiratory symptoms. Palatal erosion of upper incisor is the main manifestation in patients. Acid reflux is the main causative factor of dental erosion in GERD patients with airway symptoms.
Studies have shown a growing trend toward increasing prevalence of dental erosion, associated with the declining prevalence of caries disease in industrialized countries. Erosion is an irreversible chemical process that results in tooth substance loss and leaves teeth susceptible to damage as a result of wear over the course of an individual's lifetime. Therefore, early diagnosis and adequate prevention are essential to minimize the risk of tooth erosion. Clinical appearance is the most important sign to be used to diagnose erosion. The Basic Erosive Wear Examination (BEWE) is a simple method to fulfill this task. The determination of a variety of risk and protective factors (patient-dependent and nutrition-dependent factors) as well as their interplay are necessary to initiate preventive measures tailored to the individual. When tooth loss caused by erosive wear reaches a certain level, oral rehabilitation becomes necessary.
PURPOSE
The authors describe a minimally invasive procedure for occlusal rehabilitation in a young patient presenting with mild mandibular prognathism and loss of occlusal vertical dimension caused by dental erosion from chronic gastroesophageal reflux.
The authors conducted an in vitro study to compare the hardness of normal enamel with enamel eroded by a cola soft drink and enamel remineralized by casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) or artificial saliva. Materials and
The authors immersed 40 extracted sound central and lateral incisors alternately in a cola soft drink or artificial saliva for 10 cycles of five seconds each. They repeated this procedure two times at six-hour intervals. They divided the samples randomly into four groups and applied CPP-ACP to the samples, immersed them in artificial saliva, deionized water or both. They measured the hardness on the labial surface at baseline, after erosion and after remineralization and analyzed the data with one-way repeated-measures analysis of variance and two-way analysis of variance.
The cola soft drink significantly decreased enamel hardness. CPP-ACP and CPP-ACP and artificial saliva significantly increased the hardness of eroded enamel. CPP-ACP and CPP-ACP and artificial saliva increased the hardness of eroded enamel significantly more than artificial saliva did.
CPP-ACP increased the hardness of eroded enamel. CPP-ACP had a greater effect on enamel hardness than did artificial saliva.
Consumption of a cola soft drink can cause tooth erosion. CPP-ACP may significantly remineralize eroded enamel compared with artificial saliva.
Our aim was to study if bulimia nervosa (BN) has an impact on salivary gland function and if such changes are related to dental erosion.
Twenty women with BN and twenty age- and gender-matched controls participated. Flow rate and composition of whole and glandular saliva, as well as feeling of oral dryness were measured. Dental erosion was measured on casts.
Compared with control subjects, unstimulated whole saliva (UWS) flow rate was reduced in persons with BN, primarily owing to intake of medication (P = .007). No major compositional salivary changes were found. In the BN group, the dental erosion score was highest and complaints of oral dryness were more frequent.
The BN persons had impaired UWS, mainly owing to medication; increased feeling of oral dryness; and more dental erosion. Dental erosion was related to the duration of eating disorder, whereas no effect of vomiting frequency or intake of acidic drinks on reduced UWS was observed.
New guidelines for establishing the vertical dimension of occlusion have been reviewed. They are based upon the fact that the body of the mandible assumes an easily recordable, repetitive horizontal and vertical position when the patient is at the /S/ position during speech. This controlled method of developing vertical dimension correlates the posterior speaking space with the placement of the upper and lower anterior teeth when set to a phonetic standard. This permits the development of a dependable vertical dimension of occlusion for most patients and also serves as a guide for the more difficult to treat Class II and tongue-thrusting patients. A method of obtaining a protrusive registration is also presented; it coordinates the angle of the eminences with the actual incisal guide angle of the patient. In all techniques there should be a final try-in after the setup of the teeth is complete. The guidelines presented in this article for controlling speech and "verticentric" can also be used to verify and/or alter that which has been established by any technique.
A systematic, orderly approach to the problem of establishing harmonious phonetics, esthetics, and function in fixed restorations has been described. The system requires an initial investment of time in performing an adequate diagnostic waxing, but recoups that time in many clinical and laboratory procedures. The method has proved a valuable asset in fixed prosthodontic care. The technique can be expanded and combined with other techniques with a little imagination and artistic bent.
In September 1982, two Charlottesville, Virginia, residents were found by their dentists to have general erosion of dental enamel consistent with exposure to acid. Both patients were competitive swimmers at the same private club pool. No other common exposure could be determined. An epidemiologic survey was made of 747 club members. Symptoms compatible with dental enamel erosion were reported by 3% of nonswimmers (9/295), 12% of swimmers who were not members of the swim team (46/393), and 39% of swim team members (23/59). All four swimmers with clinically verified dental enamel erosion had trained regularly in the pool for competitive swimming meets, compared with one of eight matched swimmers without enamel erosion. Examination of the implicated swimming pool revealed a gas-chlorinated pool with corrosion of metal fixtures and etching of cement exposed to the pool water. A pool water sample had a pH of 2.7, i.e., an acid concentration approximately 100,000 times that recommended for swimming pools (pH 7.2-8.0). A review of pool management practices revealed inadequate monitoring of pool water pH. Acid erosion of dental enamel--"swimmer's erosion"--is a painful, costly, irreversible condition which can be caused by inadequately maintained gas-chlorinated swimming pools.
The technique describes the use of lateral interocclusal records in a semiadjustable articulator. The lateral records are used to mount the dentures in different positions on the articulator; the instrument is not adjusted to the lateral records. Occlusal adjustments are made by opening and closing the instrument, and grinding away interfering tooth contacts. Excursions from centric occlusion to the lateral occlusal relationships are not made during this type of occlusal grinding.
Several reports indicate an increased prevalence of dental erosion among intensive swimmers due to low pH gas-chlorinated pool water. Contrary to other extrinsic factors which induce erosion located on the facial aspect, low pH pool water results in general dental erosion. Additionally, a case report is presented which describes the very rapid occurrence of excessive general dental erosion of a competitive swimmer due to gas-chlorinated pool water within 27 days. The observation of several authors as well as this case underscore the significance of a regular pH monitoring of chlorinated swimming pool water. The high incidence indicates that dental erosion due to frequent swimming is of considerable diagnostic and therapeutic significance. Furthermore, it is recommended to fluoridate the teeth of intensive swimmers regularly to prevent dental erosion.
Controversy persists regarding the treatment planning criteria for esthetic restorations. This article reviews the literature regarding the biocompatibility, marginal adaptation, color matching, patient selection, technique sensitivity, and mode and rate of failure of tooth-colored restorations. A Medline search was completed for the period from 1986 to 2006, along with a manual search, to identify pertinent English peer-reviewed articles and textbooks. The key words used were amalgam, posterior composite resin, ceramic inlays/onlays, CEREC, porcelain laminate veneers, all-ceramic crowns, and all-ceramic fixed partial dentures.