Comparative Effect of Calcium Mesoporous Silica Versus Calcium and/or Fluoride Products on the Reduction of Erosive Tooth Wear and Abrasive Enamel Lesion

Abstract Objective: To evaluate the effect of a calcium nanocompound on the reduction of erosive tooth wear and abrasion. Material and Methods: Bovine enamel specimens (BE), were randomly assigned to the following groups (n = 10): G1 = Calcium mesoporous silica nanoparticles (Ca2+MSNs); G2 = casein phosphopeptide-amorphous calcium phosphate (CPP-ACP, 2% CPP-ACP, GC®); G3 = casein phosphopeptide-amorphous calcium fluoride phosphate (CPP-ACFP, 2% CPP-ACP + 900 ppm F-, GC®); G4 = sodium fluoride NaF (900 ppm F-, positive control); and G5 = distilled and deionized water (negative control). Each product was applied to the exposed area for one minute, three times per day for three consecutive days, and followed by the immersion of the specimens in Sprite Zero™ - a low-pH solution (2.58) for five minutes (Coca-Cola™). After the first and last erosive challenges of the day, the specimens were submitted to abrasion in a toothbrush machine for 15 seconds (200 g/BE). The specimens were analysed using 3D non-contact optical profilometry, with tooth structure loss (TSL) measurements and scanning electron microscopy (SEM). TSL values were analysed by Kruskal-Wallis and Mann-Whitney tests (p<0.05). Results: There were no significant differences between G1 (10.95 µm) and G3 (10.80 µm) treatments for TSL values; however both resulted in significantly reduced TSL values compared with the G5 (16.00 µm) (p<0.05). The G4 (12.26 µm) showed no statistically significant difference when compared to the G5 (16.00 µm). The groups G1 and G3 presented higher surface preservation than the G5. Conclusion: Ca2+MSNs was effective for reducing tooth surface loss caused by erosive tooth wear and abrasion.

Protein Profiles of Individuals with Erosive Tooth Wear

Abstract Objective: To determine if protein profiles identified in saliva could be used to determine risk and severity of erosive tooth wear. Material and Methods: Three types of saliva sampling were performed to obtain saliva from 34 18-year old individuals that received regular dental check-ups, along with clinical status of the dentition and risk factor related to erosive tooth wear using the VEDE scale. Protein profiles in saliva were determined using electrophoresis and the calculation of the percentage of a specific band at a specific molecular weight in relationship to the total protein in that sample (% of total) using molecular weight standards. This quantification was repeated for each protein band across a range of molecular weights for each sample to test for association with erosive tooth wear status. Results: There were no differences in the number of detectable proteins sourced from the parotid gland, nor the unstimulated and stimulated whole saliva. Five out of the 34 individuals had no signs of erosive tooth wear despite an acidic diet and were more likely to have proteins with molecular weight smaller than 1 KDa (p=0.03). Conclusion: There is potential for the use of protein profiling to determine risks for erosive tooth wear.

Evaluation of Sugar Content and Erosive Potential of the Commonly Prescribed Liquid Oral Medications

Abstract Objective: To assess the total sugar content, endogenous pH, total soluble solids content (TSSC) and titratable acidity of the commonly prescribed long-term and short-term liquid oral medicines (LOM) for children and to compare the erosive potential with the total sugar content and total soluble solids of the LOM. Material and Methods: Twenty-three most commonly prescribed pediatric LOM were evaluated in-vitro for the cariogenic and erosive potential. Manufacturers' information on labels, endogenous pH, titratable acidity, TSSC, and the total sugar content was determined. Descriptive statistics and the Mann-Whitney U test were applied. Results: Overall, 22 LOM contained sugar. Only 3 LOM revealed the sugar content of the formulation but did not disclose the quantity (Cheston, Ventorlin and Eptoin). None of the samples revealed the sugar content as well as endogenous pH in their labels. The overall mean total sugar content was 6.92 ± 3.49 g/100ml, ranging from 3.40 ± 0.00 (corticosteroids) to 9.67 ± 0.61 (antitussive/expectorant). The mean endogenous pH for the total sample of medicines was 5.91 ± 1.51 (range of 3.5 to 10.3). Eptoin (0.013%) presented the lowest titratable acidity and Imol (1.171%) presented the highest titratable acidity with an overall mean of 0.40 ± 0.73. Omnacortil and Epilex presented the highest TSS content (19.3%), and Ventorlin presented the lowest TSS content (18.7%) with an overall mean of 18.97 ± 0.19. Over twelve medicines were identified to have the potential to cause dental erosion. No significant differences were seen in the total sugar content, total soluble solids, titratable acidity, and the endogenous pH between the short-term and long-term LOMs (p=0.145, p=0.263, p=0.067 and p=0.107), respectively. Conclusion: The pediatric LOMs showed the presence of the sugar, low endogenous pH, high titratable acidity and high total soluble solids.

Restorative Rehabilitation of a Patient with Generalized Non-Carious Cervical Lesions: Case Report / Rehabilitación restaurativa de un paciente con lesiones cervicales no-cariosas generalizadas: Reporte de un caso

ABSTRACT Non-Carious Cervical Lesions (NCCL) are a current problem of multifactorial origin that is associated with the loss of vertical occlusal dimension, hypersensitivity, loss of teeth, fractures, and many other pathologies that affect the masticatory function of the oral cavity. Identification of the etiological factors of NCCL comprises a key piece for the solution of the problem. Based on clinical scientific evidence related with the diagnosis, a restorative treatment must be planned according to the loss of dental structure in order to return function and aesthetics. The purpose of this case report was to describe a 54-year-old male patient who was diagnosed with generalized NCCL combined with occlusal vertical dimension loss. The protocol of the treatment process is described.

RESUMEN Las lesiones cervicales no cariosas (LCNC) son una problemática actual de origen multifactorial, la cual se ve asociada a la pérdida de dimensión vertical oclusal, hipersensibilidad, pérdida de dientes, fracturas y muchas otras patologías que afectan la función masticatoria de la cavidad bucal. La identificación de los factores etiológicos de las LCNC son piezas claves para la solución del problema. Basados en la evidencia científica clínica relacionado con el diagnóstico, se debe planificar un plan de tratamiento restaurativo que depende de la pérdida de la estructura dentaria para devolver la función y estética. El objetivo de este reporte de caso es describir a un paciente masculino de 54 años a quien se le diagnosticó LCNC generalizadas combinado con una pérdida de dimensión vertical oclusal. El protocolo de plan de tratamiento es descrito paso a paso.

Transtornos alimentares e manifestações orais em adolescentes / Eating disorders and oral manifestations in adolescents / Trastornos alimenticios y manifestaciones orales en adolescentes

Introdução:Os transtornos alimentares são distúrbios psiquiátricos debilitantes, caracterizados por desordem persistente nos hábitos alimentares ou nos comportamentos docontrole de massa corporal.Objetivo:Avaliar, dentre adolescentes de três escolas públicas de ensino médio em Natal-RN, a prevalência dos transtornos alimentares e descrevermanifestações odontológicas relacionadas.Metodologia:Estudo realizado em duas fases, utilizando-seum questionário autoaplicável,Body Shape Questionnaire-BSQpara selecionara amostra. Os selecionados foram submetidos a uma avaliação partindoda história médica pregressa e exame clinico odontológico, paradiagnosticar as manifestações orais presentes. Resultados:Fase 1: Dos 231 alunos que responderam o questionário, 9 foram selecionados. No exame clínico observou-seque 22,2% dos avaliados apresentavam perda inicial da textura da superfície dentária na face palatina do segundo sextante, em 77,7% constatou-se hipertrofia da glândula parótida, 66,6% obtiveram escore 2 no Registro Periodontal Simplificado (PSR) e 11,1% dos examinadostinhaqueilite angular. Na fase 2: Dos 264 estudantes que responderam ao BSQ, 29estavamabaixo dopeso,164jovens apresentavam peso ideal, 24 peso muito abaixo do normal, enquanto a situação de sobrepeso foi observada em 47 estudantes. Quanto aoquestionário 25 (9%)apresentaram algum grau de distúrbio de distorção de imagem corporal, dentre os quais 80% do sexo feminino e 20% do sexo masculino. Conclusões:Foram encontradosepisódios de regurgitação associados a má nutrição e incorreta higienização da cavidade oral que favoreceuo aparecimento de alterações bucais.As principais manifestações encontradas foram: erosão dentária (22,2%), hipertrofia das glândulas salivares parótidas (77,7%), escore 2 no Registro Periodontal Simplificado-PSR (66,6%) e queilite angular (11,1%).É fundamental instrumentalizar ocirurgião-dentista a reconhecer tais manifestações,atrabalhar comabordagem multidisciplinar visando a melhoria da qualidade de vida do jovem, tratando assequelas e ajudando-o a superar suas necessidades.A maiorlimitação do estudo foi o encaminhamento desses jovens para tratamento (AU).

Introduction: Eating disorders are debilitating psychiatric disorders characterized by persistent disorder in eating habits or body mass control behaviors. Objective: To evaluate, among adolescents from three public high schools in Natal-RN, the prevalence of eating disorders and describe related dental manifestations.Methodology: Two-phasestudy using a self-administered Body Shape Questionnaire-BSQ to select the sample. Those selected were submitted to an evaluation based on previous medical history and dental examination to diagnose the oral manifestations present. Results: Phase 1: Of the 231 students who answered the questionnaire, 9 were selected. In the clinical examination it was observed that 22.2% of the subjects had initial loss of tooth surface texture on the palate of the second sextant, 77.7% had parotid gland hypertrophy, 66.6%had score 2 in the Registry. Periodontal Disease (PSR) and 11.1% of those examined had angular cheilitis. In phase 2: Of the 264 students who responded to the BSQ, 29 were underweight, 164 young people were underweight, 24 underweight, while overweight was observed in 47 students. Regarding the questionnaire 25 (9%) presented some degree of body image distortion disorder, among which 80% were female and 20% were male. Conclusions: Regurgitation episodes associated with poor nutrition and poor oral cavity hygiene were found, favoring the appearance of oral alterations. The main manifestations found were: dental erosion (22.2%), parotid salivary gland hypertrophy (77.7%), Simplified Periodontal Record (PSR) score 2 (66.6%) and angular cheilitis (11.1%). . It is essential to instruct the dentist to recognize such manifestations, to work with a multidisciplinary approach aimed at improving the quality of life of young people, treating the sequelae and helping them to overcome their needs. The major limitation of the study was the referral of these young people for treatment (AU).

Introducción:los trastornos alimentarios son trastornos psiquiátricos debilitantes caracterizados por un trastorno persistente en los hábitos alimentarios o en los comportamientos de control de la masa corporal. Objetivo:evaluar, entre los adolescentes de tres escuelas secundarias públicas de Natal-RN, la prevalencia de los trastornos alimentarios y describir las manifestaciones dentales relacionadas. Metodología:Estudio de dos fases utilizando un cuestionario de forma corporal autoadministrado-BSQ para seleccionar la muestra. Los seleccionados fueron sometidos a una evaluación basada en el historial médico previo y el examen dental para diagnosticar las manifestaciones orales presentes. Resultados: Fase 1: De los 231 estudiantes que respondieron el cuestionario, se seleccionaron 9. En el examen clínico se observó que el 22.2% de los sujetos tenían una pérdida inicial de la textura de la superficie dental en el paladar del segundo sextante, el 77.7% tenía hipertrofia de la glándula parótida, el 66.6% tenía una puntuación de 2 en el Registro. La enfermedad periodontal (PSR) y el 11,1% de los examinados tenían queilitis angular. En la fase 2: de los 264 estudiantes que respondieron al BSQ, 29 tenían bajo peso, 164 jóvenes tenían bajo peso, 24 tenían bajo peso, mientras que se observó sobrepeso en 47 estudiantes. En cuanto al cuestionario 25 (9%) presentó algún grado de trastorno de distorsión de la imagen corporal, entre los cuales el 80% eran mujeres y el 20% hombres. Conclusiones:se encontraron episodios de regurgitación asociados con una nutricióndeficiente y una mala higiene de la cavidad oral, lo que favorece la aparición de alteraciones orales. Las principales manifestaciones encontradas fueron: erosión dental (22.2%), hipertrofia de la glándula salival parótida (77.7%), puntaje 2 del registro periodontal simplificado (PSR) (66.6%) y queilitis angular (11.1%). . Es esencial instruir al dentista para que reconozca tales manifestaciones, para trabajar con un enfoque multidisciplinario dirigido a mejorar la calidad de vida de los jóvenes, tratar las secuelas y ayudarlos a superar sus necesidades. La principal limitación del estudio fue la derivación de estos jóvenes para recibir tratamiento (AU).

Prevalencia de erosión dental en estudiantes de 12 a 16 años utilizando Basic Erosive Wear Examination (BEWE) en una institución educativa pública peruana / Prevalência da erosão dental em estudantes de 12 a 16 anos de idade utilizando Basic Erosive Wear Examination (BEWE) numa escola pública peruana / Dental erosion in 12 to 16 years old school students using Basic Erosive Wear Examination (BEWE) index

Introducción: El objetivo de este estudio fue determinar la prevalencia y la distribución de erosión dental en estudiantes de 12 a 16 años de edad de la institución educativa pública María Auxiliadora del distrito de Chorrillos, Lima-Perú. Materiales y métodos: Se evaluaron 382 estudiantes de una institución educativa pública peruana con el índice de diagnóstico de erosión dental Basic Erosive Wear Examination (BEWE). Después de la evaluación clínica, se obtuvieron los puntajes por sextantes, y posteriormente fueron sumados para obtener en un puntaje acumulativo total. Los datos fueron analizados mediante estadística descriptiva y para relacionar la erosión con las variables género y edad Originalse aplicó la prueba de Chi cuadrado y Anova (una cola) (p<0,05). Resultados: La prevalencia de erosión dental fue de 12.04%. En cuanto a su distribución, la edad más representativa fue el grupo de 16 años (28.26%), el género femenino fue el más frecuente (54.3%), y en cuanto a la localización por maxilar, el inferior resultó predominante (54.35%) en los dientes posteriores, (56.52%) y caras oclusales (65%). Conclusión: Del total de estudiantes evaluados, el 12.04% presentó erosión dental. Asimismo, se encontró mayor distribución de erosión dental en el género femenino y en los estudiantes de 16 años de edad, sin embargo no hubo significancia estadística.

Introdução: O objetivo deste estudo foi determinar a prevalência e a distribuição da erosão dental em estudantes de 12 a 16 anos de idade de uma escola pública Maria Auxiliadora (Distrito Chorrillos), Lima-Perú. Materiais e métodos: 382 estudantes de uma escola pública peruana foram avaliados com o Basic Erosive Wear Examination (BEWE), índice de diagnóstico de erosão dental. Após da avaliação clínica, a pontuação foi obtido por sextantes, e posteriormente foram somados para obter a pontuação total. Os dados foram analisados mediante a análise estatística descritiva. Para erosão dentária, as variaveis gênero e idade aplicou-se o teste Chi quadrado Introdução: O objetivo deste estudo foi determinar a prevalência e a distribuição da erosão dental em estudantes de 12 a 16 anos de idade de uma escola pública Maria Auxiliadora (Distrito Chorrillos), Lima-Perú. Materiais e métodos: 382 estudantes de uma escola pública peruana foram avaliados com o Basic Erosive Wear Examination (BEWE), índice de diagnóstico de erosão dental. Após da avaliação clínica, a pontuação foi obtido por sextantes, e posteriormente foram somados para obter a pontuação total. Os dados foram analisados mediante a análise estatística descritiva. Para erosão dentária, as variaveis gênero e idade aplicou-se o teste Chi quadrado

Introduction: The aim of this study was to determine the prevalence and distribution of dental erosion in 12 to 16 year old students from "María Auxiliadora" public school at Chorrillos, Lima-Perú. Materials and methods: A total of 382 students were clinically exanimated for dental erosion using the Basic Erosive Wear Examination (BEWE). After the clinical examination, scores were obtained by sextants. They were then summed to produce in a accumulative score. The data was analyzed by descriptive statistics to relate the erosion with the sex and age. The Chi squared and Anova test (oneway) were used (p<0,05). Results: The prevalence of dental erosion was 12.04% and as to its distribution, the most representative age was the group of 16 years (28.26%), female were most frequent (54.3%), the predominant location was the lower maxilary (54.35%) posterior teeth (56.52%) oclusal surfaces (65%). Conclusions: Of the total number of students evaluated, 12.04% had dental erosion. A greater distribution of dental erosion in the female and in students of 16 years of age was found, but there was no statistical significance.

Esthetic rehabilitation with ultra-thin ceramic veneers and direct mock-up in the treatment of dental erosion ­ case report

Dental erosion is a high prevalence condition characterized by the loss of dental substance due to chemical agents. it can also be associated with physical wear, affecting function and aesthetics. ceramic veneers can provide effective solutions to patients affected by erosive disorders, by means of an indirect approach and minimal intervention. recent advances in cementation techniques and ceramic materials have allowed their use in reduced thicknesses, known as "dental contact lenses" or "ultra-thin veneers". they contribute significantly to the preservation of the dental structures, having excellent mechanical properties and providing satisfactory aesthetic solutions. their manufacture requires rigorous planning and the use of three-dimensional models or mock ups in order to preview the final outcome. case: the aim of this report is to communicate the use of this technique for the treatment and successful 12-months follow-up of a patient affected by dental erosion of the maxillary central incisors. special interest was placed on direct mock-up, which is a simple technique not requiring laboratory steps. luting of the lithium disilicate veneers was carried out with a light-curing resin cement and try-in pastes, yielding a very satisfactory result. conclusion: diagnosis and early treatment of this disorder allows the application of conservative techniques, such as ultra-thin veneers, which are seen as a promising alternative treatment to full coverage restorations and traditional ceramic veneers.

Comparison of the Erosive Potential of Commercially Available Beverages on Human Enamel: An in vitro Study

Objective: To assess and compare the erosive potential of commercially available beverages and to evaluate the relationship between mineral loss and physiochemical properties (pH and titratable acidity) of different beverages. Material and Methods: Seven commercially available beverages [4 soft drinks, 1 chlorhexidine mouthwash and 2 controls (Amul milk and human saliva)] were tested. The pH and tritratable acidity of the beverages was determined. Fifty-six human premolars were sectioned into enamel and root surface (total 112 specimens) by using diamond-cutting machine. The specimens were immersed in each beverage for 24-hour intervals at 370C. The weight loss of the specimens and mineral loss (calcium, phosphorus and fluoride) was determined at pre and post immersion and was subjected to statistical analysis at p<0.05 level of significance. Results: All beverages included in this were acidic. Nimbooz exhibited significant (p<0.05) weight loss compared to all other beverages. Fanta shows significantly (p<0.05) high loss of phosphorus and calcium for enamel and root surface respectively. There was a week correlation with pH and tritratable acidity and loss of minerals. Conclusion: The erosive potential of Fanta and Nimbooz was significant compared to other beverages. However, it must be considered that there are numerous factors, which may influence the erosion rate in the intra oral environment; hence the result of this in vitro study should be applied with caution.

Effect of Fruit Juices and Other Beverages on Loss of Tooth Structure

Objective: To determine the effect of seven different beverages on tooth enamel. Material and Methods: Human teeth samples were immersed in each beverage (Pepsi, Red Bull, Orange juice, Apple juice, Lemon juice, Coffee and Green tea). Specimens were divided into seven groups by beverage type (n = 5 per group). Weight of the enamel was measured before and after immersion in different beverages daily for at periodic intervals of 24hrs, 7 days, 15 days and 30 days. The data were recorded after weighing the teeth at each time. The beverages were replaced daily. Anova and Tukey post hoc test was performed to compare the differences in percent weight loss. The significance level was set at 5%. Results: There was change in the mean percent weight loss amongst the different beverages with orange juice showing a high reduction in comparison to green tea and coffee. The mean weight reduction of orange juice was by 21% followed by Red Bull (13%), Pepsi (11%), Lemon juice (16%), Apple juice (16%), coffee (3%) and green tea (3%). Conclusion: This study shows that different beverages have erosive potential on teeth depending on the duration of the exposure.

Assessment of oxidative stress in saliva of children with dental erosion / Avaliação do estresse oxidativo da saliva de crianças com erosão dentária

ABSTRACT Objective To evaluate oxidative stress in saliva of children with dental erosion as compared to children with no erosion. Methods One single examiner, trained and prepared to make diagnosis of dental erosion according to the Basic Erosive Wear Examination index, selected 40 children aged 4 to 6 years, who attended a pediatric dentistry prevention clinic. Two groups were formed - one comprising children with dental erosion (n=22), and another with no dental erosion (n=18). The quantity of dental biofilm was verified using the Simplified Index of Oral Hygiene, and unstimulated saliva was collected for biochemical analyses. The following were assessed in saliva: flow rate, buffering capacity, pH, and total protein concentration. Malondialdehyde levels were also verified to determine oxidative stress and total antioxidant status. Results The quantity of biofilm was smaller in children with mean dental erosion±standard deviation (0.76±0.25), as compared to those with no dental erosion (1.18±0.28). There was no statistical difference in saliva parameters of oxidative stress in children with dental erosion. Conclusion The activity of oxidative stress in saliva did not influence dental erosion process when in its early stages.

RESUMO Objetivo Avaliar o estresse oxidativo da saliva de crianças que possuíam erosão dentária, comparadas àquelas que não apresentavam esta situação. Métodos Um único examinador, treinado e calibrado para o diagnóstico de erosão dentária, segundo o índice de Basic Erosive Wear Examination, selecionou 40 crianças de 4 a 6 anos de idade que frequentavam uma clínica de prevenção de odontopediatria. Dois grupos foram formados - um com aquelas que apresentavam erosão (n=22) e outro sem erosão (n=18). A quantidade do biofilme dental foi obtida utilizando o Índice de Higiene Oral Simplificado, tendo sido feita a coleta de saliva não estimulada para as análises bioquímicas. O fluxo salivar, a capacidade tampão da saliva, o pH salivar e a proteína total da saliva foram avaliados. Também foi verificado o valor do malondialdeído para determinação do estresse oxidativo e o total antioxidante. Resultados A quantidade de biofilme foi menor nas crianças, com erosão dentária média±desvio padrão (0,76±0,25) comparadas àquelas sem erosão dentária (1,18±0,28). Não houve diferença estatística nos parâmetros salivares de estresse oxidativo em crianças com erosão dentária. Conclusão A ação do estresse oxidativo na saliva não influenciou na erosão dentária, quando ainda nos estágios iniciais.

Dental Erosion in Pediatric Dentistry: What is the Clinical Relevance?

The Dental erosion is not a new phenomenon and should be used to refer to the chemical process ­­ tooth demineralization without the involvement of bacteria. Dental erosion has for many years been a condition of little interest to clinical dental practice or dental public health. The relevance of dental erosion has increased substantially over recent years since dental caries has been decreasing in many societies, although it is still much more spread compared to erosive tooth wear. This fact is supported not only by daily observation in dental practice, but also by the large number of academic publications on the subject. In the 1970s, fewer than five publications per year addressed dental erosion, whereas this had doubled to approximately 10 a year in the 1980s. In the late 2000s, there were more than 100 publications on the topic every year.

Surface Degradation of Resin-based Materials by Pediatric Syrup Containing Amoxicillin under Erosive Challenge

Objective: To investigate the effect of a pediatric syrup containing Amoxicillin on resin-based on the surfaces of resin-based materials under pH cycling. Material and Methods: Cylindrical samples (n=60) of a compomer (Freedom) and a microhybrid composite (TPH Spectrum) were prepared following the manufacturer's instructions. The specimens were divided into two groups and treated for 30min, twice a day, for 14 days with a pediatric syrup containing Amoxicillin, Amoxil™ 500mg/5ml (experimental group) or Distilled water (control group). During the 14 days, the samples were submitted to pH cycling (3h in demineralizing, 20h in remineralizing saliva, and 1h for treatment). The surface roughness was evaluated at baseline, on the 7th and 14th days of erosive challenge using a profilometer and illustrated by SEM. The data were statistically analyzed by one-way ANOVA, Tukey HSD and paired T- tests (p < 0.05). At baseline, the mean Ra TPH = mean Ra F (p > 0.05). Results: After 7 days, it was observed no erosion (p = 0.674) for THP Spectrum (0.19 Ra) and an increasing of Ra (p = 0.02) for Freedom (19.95 Ra). After 14 days, it was observed an increasing of Ra for both THP Spectrum (0.56 Ra) and for Freedom (3.44 Ra), demonstrating that the degradation was treatment and time-dependent (p < 0.001). The pediatric syrup containing Amoxicillin increased the surface roughness of the TPH Spectrum surface one and a half times (p = 0.003) and the surface roughness of Freedom was increased by more than two times (p < 0.001). SEM images showed different aspects of the surfaces of the two materials with a loss of integrity to both. Conclusion: The pediatric syrup containing Amoxicillin under pH cycling increased the roughness of the both tested resin-based restorative materials.

Erosive Potential of Industrialized Teas: An in vitro study

Objective: To evaluate the erosive potential of manufactured teas according to pH, titratable acidity and buffering capacity. Material and Methods: Eight types of manufactured teas of different brands and flavors acquired in supermarkets of João Pessoa, Brazil, were investigated. Indaiá® mineral water and Coca-Cola® were controls. The pH measurement and titratable acidity for pH 5.5 and 7.0 were performed in triplicate in 50 ml of each beverage. The buffering capacity was calculated based on pH and titratable acidity for pH 7.0. ANOVA, Tukey, and Pearson correlation, with p <0.05, were used for data analysis. Results: Data showed normal distribution by Kolmogorov-Smirnov test for all variables. There was a statistically significant relationship between groups analyzed in all variables (ANOVA, p <0.001). The pH of teas ranged from 2.70 (Black Tea with lemon-Leão Fuze®) to 4.03 (Natural Mate Tea - Matte Leão®). The following significant correlations (p <0.01) were observed: pH and titratable acidity; buffering capacity and pH; buffering capacity and titratable acidity. Conclusion: All teas analyzed were potentially erosive; however, Black Tea with lemon (Leão Fuze®) had the lowest pH, the highest titratable acidity and buffering capacity, demonstrating that the saliva will have greater difficulty in buffering this tea in the oral environment.

A Artrite Idiopática Juvenil como fator de risco para a erosão dentária: estudo preliminar / The Juvenile Idiopathic Arthritis as a risk factor for dental erosion: a preliminary study

O objetivo deste estudo foi avaliar se a presença da artrite idiopática juvenil (AIJ) em crianças e adolescentes pode ser considerada como indicador de risco para a erosão dentária. Para tal, foram utilizadas oitenta crianças e adolescentes com diferentes tipos de AIJ e 23 pacientes saudáveis como controle. Os critérios de inclusão foram diagnóstico de AIJ e classificação do subtipo de acordo com os critérios da Liga Internacional das Associações de Reumatologia(ILAR). Os dados sobre variáveis nutricionais, fatores socioeconômicos, vômitos, ingestão de medicamentos, hábitos alimentares e orais foram coletados por meio de questionário estruturado.Todos os pacientes foram submetidos a medição do fluxo salivar e exame clínico usando o índice Exame Básico de Desgaste Erosivo (BEWE). Dezesseis pacientes, todos afetados pelo subtipo oligo articular de AIJ mostraram redução da quantidade de saliva estimulada; dois deles apresentaram erosão e relataram consumo diário de refrigerantes. Foi relatado vômitos (uma vez por dia) por nove pacientes devido à ingestão de metotrexato sem correlação com o subtipo de AIJ. Nenhum deles exibiu erosão. O indicador de risco para a erosão dentária foi o subtipo de AIJ (artrite oligo articular), não havendo correlação significativa da presença de erosão dentária com as variáveis nutricionais, ingestão de medicamentos, hábitos alimentares e orais.

The purpose of this study was evaluate the existence of prevalence and risk indicators of dental erosion in patients affected by juvenile idiopathic arthritis (JIA). Eighty patients (61 females and 19males) with different kinds of JIA and 23 healthy control ones aging from 3 to 19 years were included in the study. The inclusion criteria were diagnosis of JIA and subtype classification according to the International League of Associations for Rheumatology (ILAR) criteria. Data on nutrition al variables, socioeconomic factors, vomiting, drug intake and dietary and oral habits were collected using a questionnaire. All patients underwent saliva measurement and clinical examination using Basic Erosive Wear Examination (BEWE) Index. Sixteen patients, all affected by the oligo articular subtype of JIA showed a reduced quantity of stimulated saliva; two of them showed erosion andre ported a daily soft drink intake. Vomiting (once a day) was reported by nine patients and was dueto methotrexate intake with no correlation with JIR subtype. None of them exhibited erosion. Risk indicator for wear was JIA subtype (oligo articular arthritis). There was no significant correlation of the presence of dental erosion with nutritional variables, drug intake or dietary and oral habits.

Influence of Soft Drink Intake on the Salivary pH of Schoolchildren

Objective: To evaluate the influence of Coca-Cola® consumption on the salivary pH of 12-year old children. Material and Methods: The convenience sample was composed of forty-five 12-year old students of both genders from public schools of Itatiba, state of São Paulo, Brazil. Salivary pH was measured with pH colorimetric tape indicator (Merck). The reading of the colorimetric method was made by an experienced evaluator under uniform lighting conditions. The colorimetric tape was positioned in the back of the student's tongue, which remained with the mouth shut for 30 Seconds. For control, the first measurement (T0) was performed before the intake of the soft drink (baseline pH). Subsequently, students were instructed to slowly drink 100 ml of Coca-Cola® using a plastic disposable cup. Immediately after ingestion, the pH was measured again with the colorimetric tape (t1). The oral pH values were also measured 5 minutes (t2), 10 minutes (t3) and 15 minutes (t4) after the soft drink intake, keeping the tape positioning always the same in all measurements. The statistical SAS software was used for data analysis. Comparisons of oral pH values at different times were performed by the Tukey-Kramer test adopting 5% significance level. Results: Immediately after soft drink intake, the salivary pH significantly decreased (pH = 6.26) (p <0.05) compared to baseline (pH = 7.23) (p <0.05). Fifteen minutes after ingestion, although an increase in the pH was observed (pH = 6.64), it had not yet returned to baseline (T0) (p <0.05). Conclusion: Coca-Cola® intake caused a significant reduction in salivary pH, without, however, reaching critical pH for enamel demineralization.

Estudo das características clínicas, comportamentais e dos parâmetros salivares de pacientes portadores de lesões cervicais não cariosas e um grupo controle / Study of clinical, behavioral and salivary parameters in patients with non-carious cervical lesions and a control group

A saliva é um fluido biológico com importante papel nos fenômenos que ocorrem na cavidade bucal. O efeito da sua composição sobre as perdas de estruturas dentais de origem não cariosa, como o desgaste dental, tem sido estudado. No entanto, há conflitos nos resultados apresentados por esses estudos, mostrando uma dificuldade em identificar os fatores salivares que possam proteger ou intensificar a evolução do processo. Assim, o presente estudo se propôs a analisar as características clínicas, comportamentais e de alguns parâmetros salivares em dois grupos experimentais: pacientes que apresentam lesões cervicais não cariosas (LCNCs) (n=20) e um grupo controle (n=20). Foram coletados dados clínicos e comportamentais através de um exame clínico e de uma entrevista, a seguir amostras de saliva estimulada e não-estimulada foram coletadas e analisados: pH, capacidade tampão, fluxo salivar, concentração de proteínas totais, atividade da amilase salivar, concentração de ureia salivar e a concentração dos íons sódio, fósforo, potássio, magnésio e cálcio. A capacidade tampão foi medida pela titulação da saliva com uma solução de HCL 0,01N; o fluxo salivar se deu pela relação entre o volume de saliva e o tempo de coleta (ml/min); as concentrações de proteínas totais, ureia e a atividade da amilase foram determinadas por método colorimétrico; as concentrações dos íons cálcio, fósforo, magnésio, potássio e sódio foram determinadas por espectrometria de emissão óptica com plasma acoplado indutivamente (ICP-OES).

Os resultados foram submetidos aos testes Qui-quadrado, teste t e Mann-Whitney (p<0,05). As características relacionadas aos hábitos de higiene dental, dieta ácida, hábitos parafuncionais, presença de distúrbios gástricos, secura bucal e prévio tratamento periodontal, não mostraram relação com a presença de lesões cervicais não cariosas. Os pacientes portadores de LCNCs se queixaram mais de sensibilidade dental (p=0,0014). Foi observado um maior número de lesões cervicais de pequena profundidade (79%), em formato de cunha (72%), apresentando hipersensibilidade dentinária (HD) (86%), localizados nos dentes posteriores (88,18%) e na maxila (66,14%), sendo os pré-molares os dentes mais afetados (56,69%). Os níveis de cálcio na saliva não-estimulada do grupo de pacientes com LCNCs foi significativamente maior em relação ao controle (p=0,041). A concentração de potássio na saliva estimulada foi significativamente maior no grupo controle (p=0,028). As variáveis fluxo salivar, pH, capacidade tampão, concentração de proteínas totais, ureia, amilase, sódio, magnésio e fósforo não mostraram diferenças estatisticamente significativas entre os dois grupos. Conclui-se que os fatores comportamentais não interferiram no aparecimento das lesões cervicais não cariosas. As LCNCs são pouco profundas, em formato de cunha, acometem mais dentes superiores e pré-molares e são acompanhadas de HD. As concentrações de cálcio e potássio podem interferir na formação das LCNCs.

Saliva is a biological fluid with an important role in the phenomena that occur in the oral cavity. The effect of salivary composition in loss of tooth structure with no carious origin, such as tooth wear, has been studied. However, there are conflicts in the results presented by studies showing a difficulty in identifying the salivary factors which may protect or intensify the development of tooth wear process. The aim of this study was to analyze the clinical, behavioral and some salivary parameters into two groups: patients with non-carious cervical lesions (NCCLs) (n=20) and a control group (n=20). Clinical and behavioral data were collected through a clinical examination and an interview. Saliva samples stimulated and unstimulated were collected and analyzed: pH, buffer capacity, flow rate, total protein, amylase activity, urea, sodium, phosphorus, potassium, magnesium and calcium. The buffer capacity was measured by titration of saliva samples using 0.01N HCl solution; flow rate was the relationship between the volume of saliva and the collection time (ml/min); the concentrations of total protein, urea and amylase activity were determined by colorimetric method; concentrations of calcium, phosphorus, magnesium, potassium and sodium were determined by inductively coupled plasma optical emission spectrometry (ICP-OES). The results were tested to the chi-square test, t-test and Mann-Whitney U test (p<0.05).

The characteristics related to dental hygiene, acidic diet, parafunctional habits, presence of gastric disorders, dry mouth, and previous periodontal treatment did not show relationship to the presence of non-carious cervical lesions. Patients with non-carious cervical lesions complained over tooth sensitivity (p=0.0014). It observed an increased number of cervical lesions small depth (79%), wedge-shaped (72%), with dentin hypersensitivity (86%), located the posterior teeth (88,18%) and maxilla (66,14%), the premolars being the most affected teeth (56,69%). The concentration of calcium in unstimulated saliva of patients with NCCLs was significantly higher compared to control (p=0.041). The concentration of potassium was significantly higher in stimulated saliva in the control group (p=0.028). The results flow rate, pH, buffer capacity, total protein, urea, amylase, sodium, magnesium and phosphorus showed no significant differences between the two groups. It is concluded that behavioral factors do not interfere in the presence of non-carious cervical lesions. The NCCLs are shallow, wedge-shaped, affecting more maxilla and premolars and are accompanied by DH. The calcium and potassium concentrations may interfere with the formation of NCCLs.

Análise in vitro da morfologia e da resistência de união da resina composta à dentina erodida e irradiada com laser de Er: YAG com largura de pulso super curta / In vitro analysis of morphology and bond strength of composite resin to dentin eroded and irradiated with a super short pulse Er: YAG laser

Lesões dentais por erosão têm sido cada vez mais presentes na prática clínica. A restauração direta com resina composta é uma das opções de tratamento para lesões severas, em que há comprometimento estético/funcional. Com o aprimoramento da tecnologia, a utilização do laser para pré-tratamento da superfície dentinária, antes do condicionamento ácido, tem sido considerada como método alternativo para melhorar a adesão das resinas compostas às superfícies erodidas. Assim, o objetivo deste estudo in vitro foi avaliar a influência da irradiação com laser de Er:YAG (2,94 ?m), de pulso super-curto, na adesão da resina composta à superfície dentinária erodida. Quarenta e seis discos de dentina foram obtidos a partir de 46 dentes terceiros molares humanos. A dentina oclusal planificada de 40 molares humanos teve metade de sua face protegida com fita UPVC (dentina hígida), enquanto na outra metade foi produzida uma lesão de erosão através da ciclagem em ácido cítrico (0,05 M, pH 2,3, 10 minutos, 6x/dia) e solução supersaturada (pH 7,0, 60 minutos entre os ataques ácidos). Metade das amostras foi irradiada com o laser de Er:YAG (50 ?s, 2 Hz, 80 mJ, 12,6 J/cm2) e a outra não (grupo controle). Em cada grupo de tratamento (laser ou controle) (n=10), um sistema adesivo autocondicionante foi utilizado e, então, confeccionados 2 cilindros de resina composta, tanto do lado erodido como no hígido (total de 4 cilindros), os quais foram submetidos à avaliação da Resistência de União através do ensaio de microcisalhamento (1 mm/min), após armazenamento em saliva artificial por 24 h. A análise do padrão de fratura foi realizada em microscópio óptico (40x). Por meio da Microscopia Eletrônica

de Varredura (MEV), a morfologia das superfícies dentinárias hígida e submetida ao desafio erosivo, antes e após o tratamento com laser de Er:YAG (n=3), foi avaliada. Os valores obtidos de resistência de união (MPa) foram submetidos ao teste ANOVA e de comparações múltiplas de Tukey (p<0,05) e as análises das eletromicrografias foram feitas de forma descritiva. A análise morfológica da superfície mostrou alterações significativas na dentina hígida irradiada e na submetida à ciclagem erosiva, irradiada ou não. Quanto à resistência de união, houve diferença entre os 4 substratos analisados, sendo: dentina hígida irradiada (12,77±5,09 A), dentina hígida não irradiada (9,76±3,39 B), dentina erodida irradiada (7,62±3,39 C) e dentina erodida não irradiada (5,12±1,72 D). Houve predominância de padrão de fratura do tipo adesiva. Com base nos resultados e nos parâmetros de irradiação utilizados neste estudo, pode-se concluir que a erosão reduz a adesão em dentina e que o tratamento da superfície dentinária com laser de Er:YAG de largura de pulso super curta aumenta a adesão no substrato erodido ou hígido.

Dental erosion injuries have been increasingly present in clinical practice. Direct restoration with composite resin is one of the treatment options for severe injuries, where there is aesthetic/functional impairment. With the improvement of technology, laser-irradiation for pre-treatment of dentin before surface etching has been considered as an alternative method to improve the adhesion of composite resins to eroded surfaces. The objective of this in vitro study was to evaluate the influence of the irradiation with a super-short pulse Er:YAG (2.94 ?m) laser to the adhesion of composite resin to eroded dentin surface. Forty six dentin discs were obtained from 46 third molars. Forty samples of planned occlusal dentine, obtained from human molars, had half of their surface protected with plastic tape (sound dentin), while the other half was submitted to erosive cycles, consisted on immersion on citric acid (0.05 M, pH 2.3, 10 minutes, 6x/day) and supersaturated solution (pH 7.0, 60 minutes of acid attacks). Half of the samples was irradiated with the Er:YAG laser (50 ?s, 2 Hz, 80 mJ, 12.6 J/cm2) and the other was kept as control. In each treatment group (n = 10), a self-etching adhesive system was used and then two cylinders of composite resin were prepared, on both eroded and sound dentin (total of 4 cylinders). Microshear bond strength test was performed (1 mm/min), after 24 hours storage in artificial saliva.

The analysis of the fracture pattern was determined by optical microscopy (40x). The morphology of sound and eroded dentin, before and after treatment with the Er:YAG laser (n = 3) was evaluated under Scanning Electron Microscopy (SEM). Bond strength values (MPa) were subjected to ANOVA and Tukey multiple comparisons test (p<0.05). The analyses of electron micrographs were made descriptively. Morphological analysis of the surface showed significant changes in irradiated and sound dentin subjected to erosive cycling. As for the bond strength, there were differences among the groups, as follows: sound dentin submitted to irradiation (12.77 ± 5.09 A), non-irradiated sound dentin (9.76 ± 3.39 B), eroded dentin submitted to irradiation (7 62 ± 3.39 C) and non-irradiated eroded dentin (5.12 ± 1.72 D). There was a predominance for the adhesive mode of failure. It was concluded that the erosion reduces the adhesion to dentin and that treating the dentin surface with a super-short-pulse Er:YAG laser increases adhesion to both eroded or sound dentin.

Capacidade remineralizadora de princípios bioativos no esmalte dental submetido a desafio erosivo / Remineralizing ability of different bioactive materials on artificially eroded enamel

Este estudo analisou o potencial remineralizador de compostos com diferentes princípios bioativos no esmalte dental submetido a desafio erosivo. 40 espécimes de dentes bovinos com dimensões padronizadas (4x4mm2) foram submetidos ao desafio erosivo com ácido cítrico (pH=2,3 durante 1 hora) e submetidos a diferentes tratamentos remineralizadores com compostos bioativos, compondo os grupos experimentais: G1-sem tratamento; G2-fosfato de cálcio amorfo e fosfopeptídeo de caseína (RecaldentTM); G3- fosfato de cálcio nanoestruturado (NANO P); G4-flúor 1,23%. Os fragmentos foram analisados quantitativamente pelo método de fluorescência do tecido dental (QLF) em 4 momentos: baseline, desafio erosivo, 1°dia e 7ºdia. Os dados obtidos pelo método QLF foram submetidos à análise estatística por meio dos testes ANOVA 2 fatores para medidas repetidas e de comparações múltiplas de Bonferroni (α=5%). Não foram encontradas diferenças significantes entre os grupos experimentais tanto para o momento de análise baseline quanto para o momento desafio erosivo. No momento de análise 1°dia o grupo sem tratamento apresentou os maiores valores de Q (valor final da perda mineral do substrato), enquanto os menores foram encontrados para os grupos G2 e G3 que não apresentaram diferença estatística entre si. No momento de análise 7°dia os menores valores foram apresentados pelo grupo G2 e os maiores pelo grupo G1. Os tratamentos realizados acarretaram diferentes graus de remineralização no esmalte dental submetido a desafio erosivo. O composto bioativo RecaldentTM mostrou melhor desempenho nos índices de remineralização após sete dias de tratamento.

The aim of this study was analyze the remineralizing potential of different bioactive compounds on dental enamel submitted to erosive challenge. Forty bovine enamel specimens’ teeth with standardized dimensions (4x4mm2) were subjected to erosive challenge with citric acid (pH = 2.3 for one hour) and to different remineralizing treatments with bioactive compounds, composing the experimental groups: G1-without treatment; G2-amorphous calcium phosphate and casein phosphopeptide (RecaldentTM Plus); G3-calcium phosphate nanocluster (NANO P); G4- fluoride 1.23%. The fragments were quantitatively analyzed by the method of dental tissue fluorescence (QFL) in four different moments: baseline, erosive challenge, first day and seventh day. The data obtained through the QLF method were subjected to statistical analysis using two way ANOVA for repeated measurements and Bonferroni multiple comparison (α= 5%). No statistical differences were identified among the experimental groups in regards to the baseline analysis moment and to the erosive challenge moment. In the first day period analysis without treatment showed the highest values of Q (final value of substrate´s mineral loss) while the lowest values were obtained in the G2 and G3 groups, which did not presented statistical difference among them. During the seventh day analysis moment, the lowest value was presented by the G2 group while the highest value was presented by the G1 group. The tests performed led to different degrees of remineralization in dental enamel subjected to erosive challenge. The bioactive compound RecaldentT presented the highest levels of remineralization after the seventh day of treatment.

Instrument of self-perception and knowledge of dental erosion: cross-cultural adaptation to the Brazilian population

There are few instruments available in Brazil for obtaining data on dental erosion among adults. For this reason, the interview entitled “A Survey on Hong Kong People’s Dietary Behavior in Relations to Acid Erosion”, published in English, was considered for translation. The aim of this study was to perform a cross-cultural adaptation and content validation for the Brazilian population. After obtaining the author’s permission, the interview underwent several stages: translation, back translation, review by a bilingual person and a committee of experts, administration of the English instrument and of the Portuguese version to a bilingual group, and pretesting in a convenience sample of 50 adults. The interview was translated and adapted to the Portuguese language and the Brazilian culture. The analysis of the data revealed that the interview was easy to apply, conduct and understand; therefore, it was considered viable and capable of being used in different studies.

Avaliação do sistema antioxidante e estresse oxidativo de saliva em crianças de 4 a 6 anos de idade que apresentam erosão dentária / The antioxidant system and oxidative stress evaluation of saliva of children between 4-6 years who had dental erosion

A erosão dentária é um problema de saúde bucal e seu processo ocorre em uma condição multifatorial. Dentre seus principais fatores, a saliva desempenha importantes funções protetoras contra o desenvolvimento deste problema que afeta principalmente as crianças e jovens. O objetivo do presente estudo foi avaliar o sistema antioxidante e o estresse oxidativo da saliva de crianças de 4 a 6 anos de idade que possuíam erosão dentária comparando com crianças que não apresentavam esse problema de saúde bucal. Um único examinador treinado e calibrado para o diagnóstico de erosão dentária segundo o índice de BEWE (Basic Erosive Wear Examination), selecionou 40 crianças de 4 a 6 anos de idade que freqüentavam a Clinica de Prevenção de Odontopediatria da Universidade de São Paulo, formando 2 grupos, de crianças com erosão (n=22) e crianças sem erosão (n=18). A quantidade do biofilme dental foi obtida utilizando o índice de higiene oral simplificado (IHO-S) e foi feita a coleta de saliva não estimulada para as análises bioquímicas. O fluxo salivar, a capacidade tampão da saliva, o pH salivar e a proteína total da saliva foram avaliados. Também foram determinadas as atividades das enzimas superóxido dismutase (SOD) e catalase (CAT), o ácido úrico, o valor do malodialdeído (MDA) para determinação do estresse oxidativo e o total antioxidante (TAS). A proteína total foi menor no grupo de crianças com erosão dentária (p=0,03) e a quantidade de biofilme também foi menor nas crianças com erosão dentária média (desvio padrão) de 0,76 (0,25) comparadas com as crianças sem erosão dentária 1,18 (0,28). Não houve diferença estatística no sistema antioxidante e no estresse oxidativo da saliva de crianças com erosão dentária. A ação do sistema antioxidante e do estresse oxidativo na saliva, não influenciou na erosão dentária, quando ainda se encontrava em estágios mais iniciais deste problema de saúde bucal.

Dental erosion is a problem of oral health and its process occurs in multifactorial conditions. Among its principal factors, saliva plays an important protection role against the development of this problem, which affects children and youngsters mostly. The goal of this study was assessing the antioxidant system and oxidative stress in the saliva of children between the age of four and six who had dental erosion, comparing it to children who did not present this problem of oral health. One single examiner who was trained and prepared for diagnosing dental erosion according to the BEWE (Basic Erosive Wear Examination) index has selected forty children between the age of four and six who went to the Clinic of Prevention of Pediatric Dentistry of the University of São Paulo. Two groups were formed, one of children with dental erosion (n=22), and another with no dental erosion (n=18). The quantity of dental biofilm was verified using the simplified index of oral hygiene (OHI-S) and unstimulated saliva was collected for biochemical analyses. The salivary flow, the buffering capacity of saliva, salivary pH and the total amount protein in it were assessed. The activity of superoxide dismutase and catalase enzymes was also identified, and so were the uric acid and the amount of malodialdehyde (MDA)for determining oxidative stress and total antioxidant status(TAS). There was less total protein in the group of children with dental erosion (p=0,03) and the quantity of biofilm was also smaller in children with dental erosion (standard deviation) of an average of 0,76 (0,25), comparing with children with no dental erosion 1,18 (0,28). There was no statistic difference as far as the antioxidant system and oxidative stress are concerned in the saliva of children with dental erosion. The activity of the antioxidant system and oxidative stress in saliva have not influenced the dental erosion process while it was still in its early stages.