[Risk analysis Erosive Tooth Wear (ETW): checklist for a quick assessment of the risk factors for ETW in the dental practice]. / Risikoanalyse Erosive Tooth Wear (ETW): Checkliste zur schnellen Bewertung der Risikofaktoren für ETW in der Zahnarztpraxis.

Erosive Tooth Wear (ETW) is the loss of tooth structure without bacterial involvement. As the resulting loss of tooth structure is irreversible, an early evaluation of the multifactorial etiology, accurate diagnosis and regular follow-up are essential. The ETW is dynamic and its progression should be continuously monitored. A risk analysis table was developed to systematically record risk factors for ETW (Fig. 2). This allows ETW management to be integrated more efficiently into clinical practice and the progression to be documented over the years. If ETW is assumed, the risk analysis should be performed and updated at least every two years. In the assessment, risk-promoting and risk-inhibiting factors are marked, added together and compared. If the negative factors pre-dominate, measures should be taken to minimize the risk for ETW. The main purpose of the risk analysis is therefore to evaluate the individual etiology, coun-teract negative factors, promote positive factors and prevent progression.

[Total rehabilitation in case of amelogenesis imperfecta].

The aim of the treatment of this case was to restore the form, function and aesthetics of all teeth in a patient with amelogenesis imperfecta within the age limit of the disability insurance (IV). Single-tooth zirconia crowns were selected as the treatment of choice and cemented with a conventional glass ionomer cement. For the maintenance of the oral rehabilitation and the protection of the reconstructions a michigan splint was produced and instructed to be carried over night.

Posterior ceramic versus metal restorations: A systematic review and meta-analysis.

OBJECTIVES: The goal of this systemic review and meta-analysis was to evaluate the longevity of indirect adhesively-luted ceramic compared to conventionally cemented metal single tooth restorations. DATA: Randomized controlled trials (RCT) investigating indirect adhesively-luted ceramic restorations compared to metal or metal-based cemented restorations in permanent posterior teeth. SOURCES: Three electronic databases (PubMed, CENTRAL (Cochrane) and Embase) were screened. No language or time restrictions were applied. Study selection, data extraction and quality assessment were done in duplicate. Risk of Bias and level of evidence was graded using Risk of Bias 2.0 tool and Grade Profiler 3.6. RESULTS: A total of 3056 articles were found by electronic databases. Finally, four RCTs were selected. Overall, 443 restorations of which 212 were adhesively-luted ceramic restorations and 231 conventionally cemented metal restorations have been placed in 314 patients (age: 22-72 years). The highest annual failure rates were found for ceramic restorations ranging from 2.1% to 5.6%. Lower annual failure rates were found for metal (gold) restorations ranging from 0% to 2.1%. Meta-analysis could be performed for adhesively-luted ceramic vs. conventionally cemented metal restorations. Conventionally cemented metal restoration showed a significantly lower failure rate than adhesively-luted ceramic ones (visual-tactile assessment: Risk Ratio (RR)[95%CI]=0.31[0.16,0.57], low level of evidence). Furthermore, all studies showed a high risk of bias. CONCLUSION: Conventionally cemented metal restorations revealed significantly lower failure rates compared to adhesively-luted ceramic ones, although the selected sample was small and with medium follow-up periods with high risks of bias.

Erosive tooth wear and wedge-shaped defects in 1996 and 2006: cross- sectional surveys of Swiss army recruits.

The purpose of this study was to determine the prevalence and possible etiological factors of erosive tooth wear and wedge-shaped defects in Swiss Army recruits and compare the findings with those of an analogous study conducted in 1996. In 2006, 621 recruits between 18 and 25 years of age (1996: 417 recruits; ages 19 to 25) were examined for erosive tooth wear and wedge-shaped defects. Additional data was acquired using a questionnaire about personal details, education, dentition’s subjective condition, oral hygiene, eating and drinking habits, medications used, and general medical problems. In 2006, 60.1% of those examined exhibited occlusal erosive tooth wear not involving the dentin (1996: 82.0%) and 23.0% involving the dentin (1996: 30.7%). Vestibular erosive tooth wear without dentin involvement was seen in 7.7% in 2006 vs. 14.4% in 1996. Vestibular erosive tooth wear with dentin involvement was rare in both years (0.5%). Oral erosive tooth wear lacking exposed dentin was also rare in those years, although more teeth were affected in 2006 (2.1%) than in 1996 (0.7%). The examinations in 2006 found one or more initial wedge-shaped lesions in 8.5% of the recruits, while 20.4% of the study participants exhibited such in 1996. In 1996, 53% consumed acidic foods and beverages more than 5 times/day; in 2006, 83.9% did so. In neither study did multivariate regression analyses show any significant correlations between occurrence and location of erosive tooth wear and wedge-shaped defects and various other parameters, e.g., eating and hygiene habits, or dentin hyper-sensitivity. Despite a significant increase in consumption of acidic products between 1996 and 2006, the latter study found both fewer erosive tooth wear and fewer wedge-shaped defects (i.e., fewer non-carious lesions.).

Prevalence, incidence and distribution of erosion.

There is evidence that the presence of erosion is growing steadily. Due to different scoring systems, samples and examiners, it is difficult to compare the different studies. Preschool children from 2 to 5 years showed erosion on deciduous teeth in 1 to 79% of the subjects. Schoolchildren (aged from 5 to 9 years) already had erosive lesions on permanent teeth in 14% of the cases. In the adolescent group (aged between 9 and 20 years), 7 to 100% of the persons examined showed signs of erosion. Incidence data (the increase in the number of subjects presenting signs of dental erosion) was evaluated in four of these studies and presented average annual values between 3.5 and 18%, depending on the initial age of the examined sample. In adults (aged from 18 to 88 years) prevalence data ranged between 4 and 100%. Incidence data are scarce in this age group, and only one study was found analysing the increase of affected surfaces, showing an incidence of 5% for the younger and 18% for older age groups. In general, males present more erosive tooth wear than females. The distribution showed a predominance of affected occlusal surfaces (mandibular first molars) followed by facial surfaces (anterior maxillary teeth). Oral erosion was frequently found on maxillary incisors and canines. Overall, prevalence data are not homogeneous. Nevertheless, there is a trend towards a more pronounced rate of erosion in younger age groups. Furthermore, a tendency was found for more erosive lesions with increasing age and these erosions progressed with age.

Restorative therapy of erosive lesions.

When substance loss caused by erosive tooth wear reaches a certain degree, oral rehabilitation becomes necessary. Until some 20 years ago, the severely eroded dentition could only be rehabilitated by the provision of extensive crown and bridge work or removable overdentures. As a result of the improvements in resin composite restorative materials, and in adhesive techniques, it has become possible to rehabilitate eroded dentitions in a less invasive manner. However, even today advanced erosive destruction requires the placement of more extensive restorations such as overlays and crowns. It has to be kept in mind that the etiology of the erosive lesions needs to be determined in order to halt the disease, otherwise the erosive process will continue to destroy tooth substance. This overview presents aspects concerning the restorative materials as well as the treatment options available to rehabilitate patients with erosive tooth wear, from minimally invasive direct composite reconstructions to adhesively retained all-ceramic restorations. Restorative treatment is dependent on individual circumstances and the perceived needs and concerns of the patient. Long-term success is only possible when the cause is eliminated. In all situations, the restorative preparations have to follow the principles of minimally invasive treatment.

Erosive tooth wear in children.

Erosive tooth wear in children is a common condition. Besides the anatomical differences between deciduous and permanent teeth, additional histological differences may influence their susceptibility to dissolution. Considering laboratory studies alone, it is not clear whether deciduous teeth are more liable to erosive wear than permanent teeth. However, results from epidemiological studies imply that the primary dentition is less wear resistant than permanent teeth, possibly due to the overlapping of erosion with mechanical forces (like attrition or abrasion). Although low severity of tooth wear in children does not cause a significant impact on their quality of life, early erosive damage to their permanent teeth may compromise their dentition for their entire lifetime and require extensive restorative procedures. Therefore, early diagnosis of erosive wear and adequate preventive measures are important. Knowledge on the aetiological factors of erosive wear is a prerequisite for preventive strategies. Like in adults, extrinsic and intrinsic factors, or a combination of them, are possible reasons for erosive tooth wear in children and adolescents. Several factors directly related to erosive tooth wear in children are presently discussed, such as socio-economic aspects, gastroesophageal reflux or vomiting, and intake of some medicaments, as well as behavioural factors such as unusual eating and drinking habits. Additionally, frequent and excessive consumption of erosive foodstuffs and drinks are of importance.

Buonocore Memorial Lecture. Dental erosion.

There is some evidence that dental erosion is steadily spreading. To diagnose erosion, dental professionals have to rely on clinical appearance, as there is no device available to detect it. Adequate preventive measures can only be initiated if the different risk factors and potential interactions between them are known. When substance loss, caused by erosive tooth wear, reaches a certain degree, oral rehabilitation becomes necessary. Prior to the most recent decade, the severely eroded dentition could only be rehabilitated by the provision of extensive crown and bridgework or removable dentures. As a result of the improvements in composite restorative materials and in adhesive techniques, it has become possible to rehabilitate eroded dentitions in a less invasive manner.

Treating open carious lesions in anxious children with ozone. A prospective controlled clinical study.

PURPOSE: To determine whether the treatment of dental caries with ozone was possible in apprehensive children and to ascertain whether ozone reverses caries in open single-surface lesions. Further, the influence of ozone on laser fluorescence was investigated. METHODS: 82 lesions in 28 children with at least two open single-surface lesions were assessed. The children were anxious and were judged by the referring dentist as non-treatable. For each test lesion, which was treated with ozone, a control lesion was left without ozone treatment. Hardness and laser fluorescence values were assessed and the changes for hardness and laser fluorescence values in the test lesion were compared with the values in the control lesion after 2, 4, 6, and 8 months. RESULTS: 94 percent of the children were treatable and 93% lost their dental anxiety. The hardness values improved significantly in the ozone-treated test lesions after 4, 6, and 8 months (P< 0.05) compared with baseline while the control lesions had no significant change in hardness at any recall interval. Comparing the differences between test and control teeth over time, the laser fluorescence values improved, however the improvement was not statistically significant (P> 0.05). The use of ozone resulted in an average reduction of 13% of the laser fluorescence values immediately after the ozone treatment.

Prevalence, incidence and distribution of erosion.

There is some evidence that the presence of erosion is growing steadily. Because of different scoring systems, samples and examiners, it is difficult to compare and judge the outcome of the studies. Preschool children aged between 2 and 5 years showed erosion on deciduous teeth in 6-50% of the subjects. Young schoolchildren (aged 5-9) already had erosive lesions on permanent teeth in 14% of the cases. In the adolescent group (aged between 9 and 17) 11-100% of the young people examined showed signs of erosion. Incidence data (= increase of subjects with erosion) evaluated in three of these studies were 12% over 2 years, 18% over 5 years and 27% over 1.5 years. In adults (aged between 18 and 88), prevalence data ranged between 4 and 82%. Incidence data are scarce; only one study was found and this showed an incidence of 5% for the younger and 18% for the older examined group (= increase of tooth surfaces with erosion). Prevalence data indicated that males had somewhat more erosive tooth wear than females. The distribution of erosion showed a predominance of occlusal surfaces (especially mandibular first molars), followed by facial surfaces (anterior maxillary teeth). Oral erosion was frequently found on maxillary incisors and canines. Overall, prevalence data are not homogeneous. Nevertheless, there is already a trend for more pronounced rate of erosion in younger age groups. Therefore, it is important to detect at-risk patients early to initiate adequate preventive measures.

Chemical factors.

pH value, calcium, and phosphate and to a lesser extent fluoride content of a drink or foodstuff are important factors explaining erosive attack. They determine the degree of saturation with respect to tooth minerals, which is the driving force for dissolution. Solutions oversaturated with respect to dental hard tissue will not dissolve it. Addition of calcium (and phosphate) salts to erosive drinks showed protection of surface softening. Today, several Ca-enriched soft drinks are on the market or products with naturally high content in Ca and P are available (such as yoghurt), which do not soften the dental hard tissue. The greater the buffering capacity of the drink or food, the longer it will take for the saliva to neutralize the acid. The buffer capacity of a solution has a distinct effect on the erosive attack when the solution remains adjacent to the tooth surface and is not replaced by saliva. A higher buffer capacity of a drink or foodstuff will enhance the processes of dissolution because more ions from the tooth mineral are needed to render the acid inactive for further demineralization. Further, the amount of drink in the mouth in relation to the amount of saliva present will modify the process of dissolution. There is no clear-cut critical pH for erosion as there is for caries. Even at a low pH, it is possible that other factors are strong enough to prevent erosion.

Occupation and sports.

In rare cases the occupation - be it at work or during professional and strenuous sports activities - may give a clue to a patient's risk factors for dental erosion. However, no detrimental effects were described on a population level. Frequent contact to inorganic or organic acids at work could increase the occurrence and progression of erosion. In some studies, acid workers had significantly more teeth with erosive tooth wear than the controls. Clinical findings showed erosion mainly on upper anterior teeth and dentine hypersensitivity. Occupation groups at risk would mostly be found in the chemical industry, but also others like wine tasters may have dental erosion. A few case reports and studies have reported an association between sports activities and erosive tooth wear. The cause could be direct acid exposure or strenuous exercise, which may increase gastroesophageal reflux. Risk groups are swimmers exercising in water with low pH and athletes consuming frequently erosive sport drinks. It has to be kept in mind that sports drinks and occupation can be for some patients a cofactor in the development or in the increase of dental erosion. However, it is unlikely that one or two isolated factors will be responsible for this multifactorial condition.

Restorative therapy of erosion.

When substance loss caused by erosive tooth wear reaches a certain degree, oral rehabilitation becomes necessary. Prior to the most recent decade, the severely eroded dentition could only be rehabilitated by the provision of extensive crown and bridge work or removable overdentures. As a result of the improvements in composite restorative materials, and in adhesive techniques, it has become possible to rehabilitate eroded dentitions in a less invasive manner. However, even today advanced erosive destruction requires the placement of more extensive restorations such as ceramic veneers or overlays and crowns. It has to be kept in mind that the etiology of the erosive lesions needs to be determined in order to halt the disease, otherwise the erosive process will continue to destroy tooth substance. This overview presents aspects concerning the restorative materials as well as the treatment options available to rehabilitate patients with erosion, from minimally invasive direct composite reconstructions to adhesively retained all-ceramic restorations. Restorative treatment is dependent on individual circumstances and the perceived needs and concerns of the patient. Long-term success is only possible when the cause is eliminated. In all situations, the restorative preparations have to follow the principles of minimally invasive treatment.

Erosive tooth wear: diagnosis, risk factors and prevention.

PURPOSE: To provide an overview on diagnosis, risk factors and prevention of erosive tooth wear, which is becoming an increasingly important factor when considering the long- term health of the dentition. RESULTS: Awareness of dental erosion by the public is still not widespread due to the cryptic nature of this slowly progressing condition. Smooth silky-glazed appearance with the absence of perikymata and intact enamel along the gingival margin, with cupping and grooving on occlusal surfaces are some typical signs of enamel erosion. In later stages, it is sometimes difficult to distinguish between the influences of erosion, attrition or abrasion during a clinical examination. Biological, behavioral and chemical factors all come into play, which over time, may either wear away the tooth surface, or potentially protect it. In order to assess the risk factors, patient should record their dietary intake for a distinct period of time. Based on these analyses, an individually tailored preventive program may be suggested to patients. It may comprise dietary advice, optimization of fluoride regimes, stimulation of salivary flow rate, use of buffering medicaments and particular motivation for non-destructive tooth brushing habits. The frequent use of fluoride gel and fluoride mouthrinse in addition to fluoride toothpaste offers the opportunity to minimize abrasion of tooth substance.

[Erosion caused by gastric reflux in children. Discussion of etiology, clinical appearance and therapy in two cases]. / Refluxbedingte Erosionen bei Kindern. Anhand von zwei Fallbeispielen wird die Atiologie, das klinische Erscheinungsbild und Therapiemodalitäten von Erosionen bei Kindern diskutiert.

Dental erosion is a disease occurring not only in adults but also in children. Thereby, deciduous and permanent teeth are involved. The cause of these lesions is an extended acid exposure due to extrinsic or intrinsic factors. Unlike caries, the erosive process occurs without involving bacteria. Main reasons are extensive consumption of erosive (soft) drinks and foodstuffs or gastrooesophageal reflux with regurgitation of gastric acid into the oral cavity. Often, the first signs of this disease are erosive lesions of the teeth and therefore dentists have an important role in early diagnosis. Two clinical cases are presented and the clinical diagnosis, the course and possible systemic and local preventive and therapeutic measures are discussed. Patients suffering from erosion can be treated successfully if the correct diagnosis and adequate preventive and therapeutic measures are performed.

[Erosion in early school-age children]. / Erosionen bei Kindern im frühen Schulalter.

The aim of the present study was to determine the prevalence, the severity and the distribution of erosive lesions in children, living in a rural region in Switzerland. A total of 42 children, aged between five and nine years, were examined. The following parameters were assessed: erosion on the facial, occlusal and oral tooth sites; flow rate and buffering capacity of resting saliva; oral hygiene and nutrition. The occurrence of erosive lesions was as follows: All children had one or more erosive lesions degree 1 (erosion within enamel) on occlusal surfaces and 20 (47.6%) of them showed at least one lesion of degree 2 (dentinal erosion). Already six (14.3%) of the examined children had one or more erosive lesions on occlusal surfaces of permanent teeth. Facial and oral erosions were scarce and only deciduous teeth were involved: Facial erosive lesions were examined in four (9.5%) (degree 1) and two (4.8%) (degree 2) of the children and oral lesions in three (7.1%) (degree 1) and one (2.4%) of them (degree 2). No statistically significantly impact of the following parameters on the occurence, distribution and degree of erosive lesions was found: age, gender, flow rate of resting saliva, buffering capacity, orale hygiene and nutrition. The results show clearly that erosive lesions can be detected already on deciduous teeth and the young permanent dentition is also involved. Early detection of the lesions is important. Preventive measures have to be initiated to stop or at least to diminish the erosive process.

Prevention and minimally invasive treatment of erosions.

Erosive tooth wear is a multifactorial cumulative lifetime process, which may lead to tooth surface loss. Acids of intrinsic and extrinsic origin are the main etiological factors. This paper focuses on preventive measures and minimally invasive restorations. The application of high fluoride, time of toothbrushing as well as the intake of erosive foodstuffs or beverages should be optimized. Sealing of the tooth surfaces and small composite fillings are minimally invasive treatments for erosive lesions.