Envejecimiento dental prematuro en deportistas / Premature dental aging in athletes

El desgaste natural de los dientes ocurre dependiendo de factores como: calidad de la estructura dental, calidad de la saliva, biotipo facial que determina la fuerza de mordida; de acuerdo a estos factores locales bucales se va envejeciendo la dentadura. Pero los deportistas presentan un patrón de desgaste mayor y continuo debido al tipo de deporte que practican, las horas de entrenamiento, el consumo de bebidas con pH ácido, el cepillado dental vigoroso; todos estos factores pueden conducirlos a que desarrollen lesiones no cariosas (AU)

The natural wear of the teeth occurs depending on factors such as: quality of the dental structure, quality of the saliva, facial biotype that determines the bite force, according to these local oral factors, the teeth age. But in athletes they present a pattern of greater and continuous wear due to the type of sport they practice, the hours of training, the consumption of drinks with an acidic pH, vigorous tooth brushing; all these factors can lead them to develop non-carious lesions (AU)

Influence of cavity depth and restoration of non-carious cervical root lesions on strain distribution from various loading sites.

BACKGROUND: We aimed to investigate the load-induced strain variation in teeth with unrestored and resin-based composite restored non-carious cervical lesions (NCCLs). METHODS: Twelve extracted premolars were provided for measuring buccal-side root NCCLs. Strain gauges were fixed at four measuring sites of each tooth, two at the buccal surface and two at the lingual surface. NCCLs were prepared with occlusal margins at the cemento-enamel junction. A static 9-kg load was applied at seven occlusal loading points: buccal cusp tip (BC), inner inclination of the BC, lingual cusp tip (LC), inner inclination of the LC, center of the mesial marginal ridge or distal marginal ridge, and center of the central groove. The strain was detected at each site in teeth with NCCL depths of 0 (control), 0.5, 1.0, and 1.5 mm. Each NCCL was restored using an adhesive composite resin, and the strains were re-measured. RESULTS: The strains at the NCCL occlusal and gingival margins decreased with increasing defect depths, and the effect was significant when the depth of the defect was 1.5 mm. Loading on the buccal and lingual cusps induced prominent strain variation. The strains at all depth distribution recovered to nearly intact conditions when the NCCLs were restored. CONCLUSIONS: NCCLs at 1.5 mm depth are detrimental, but they can be restored using resin composites. CLINICAL SIGNIFICANCE: The existence of NCCLs should not be ignored. The depth of the NCCL may affect the progression of the lesion. Resin composite restoration is an appropriate method for preventing persistent NCCL deterioration.

Assessment of oxidative stress in saliva of children with dental erosion.

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.

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.

Measurement of surface roughness changes of unpolished and polished enamel following erosion.

OBJECTIVES: To determine if Sa roughness data from measuring one central location of unpolished and polished enamel were representative of the overall surfaces before and after erosion. METHODS: Twenty human enamel sections (4x4 mm) were embedded in bis-acryl composite and randomised to either a native or polishing enamel preparation protocol. Enamel samples were subjected to an acid challenge (15 minutes 100 mL orange juice, pH 3.2, titratable acidity 41.3mmol OH/L, 62.5 rpm agitation, repeated for three cycles). Median (IQR) surface roughness [Sa] was measured at baseline and after erosion from both a centralised cluster and four peripheral clusters. Within each cluster, five smaller areas (0.04 mm2) provided the Sa roughness data. RESULTS: For both unpolished and polished enamel samples there were no significant differences between measuring one central cluster or four peripheral clusters, before and after erosion. For unpolished enamel the single central cluster had a median (IQR) Sa roughness of 1.45 (2.58) µm and the four peripheral clusters had a median (IQR) of 1.32 (4.86) µm before erosion; after erosion there were statistically significant reductions to 0.38 (0.35) µm and 0.34 (0.49) µm respectively (p<0.0001). Polished enamel had a median (IQR) Sa roughness 0.04 (0.17) µm for the single central cluster and 0.05 (0.15) µm for the four peripheral clusters which statistically significantly increased after erosion to 0.27 (0.08) µm for both (p<0.0001). CONCLUSION: Measuring one central cluster of unpolished and polished enamel was representative of the overall enamel surface roughness, before and after erosion.

Stress and its role in the dentin hypersensitivity in rats.

INTRODUCTION: The perception of pain varies individually. Chronic stress leads to analgesia. The use of animal chronic mild stress model to mimic human condition was previously developed and now applied in the evaluation of pain perception in rats with dentin hypersensitivity (DH). AIMS: Using DH model induced by dentin erosion (DE) mediated by acidic solution, the present study aimed the evaluation of the interaction of chronic stress and pain induced by DH in rats with DE. METHODS: DH was induced by ad libitum 30-day intake of acidic solution. Stress was induced by the New York subway model. Body weight was weekly taken, during treatment. Groups WO (water, no stress), WS (water and stress), EO (acidic solution, no stress) and ES (acidic solution, stress) were submitted to treatments. RESULTS: After 30 days, all groups were submitted to DH test assessed by cold water stimuli in the labial surface of molars, for 5s, and the rats responses were scored as grades 0, 0.5, 1, 2, or 3. After euthanasia, blood was taken to obtain the levels of corticosterone, stomachs were observed in fresh preparations, kidneys and livers were submitted to histological evaluation. Open field model supported stress evaluation, as did corticosterone analysis. Stressed animals showed significant increase in pain perception and a decrease in locomotion frequency, tending to be more frequent in the periphery of the arena, corroborating stressed behavior and the need of protection as a pain relief. Corticosterone levels were increased in the stressed rats with dentin erosion and also corroborate present findings. Finally, reduction in weight gain was impaired in stressed group with dentin erosion. CONCLUSION: The animal model enabled the evaluation of how chronic mild stress interfered in DH pain perception.

The effect of antacid on salivary pH in patients with and without dental erosion after multiple acid challenges.

PURPOSE: To evaluate the effect of antacid swish in the salivary pH values and to monitor the pH changes in subjects with and without dental erosion after multiple acid challenge tests. METHODS: 20 subjects with tooth erosion were matched in age and gender with 20 healthy controls according to specific inclusion/exclusion criteria. Baseline measures were taken of salivary pH, buffering capacity and salivary flow rate using the Saliva Check System. Subjects swished with Diet Pepsi three times at 10-minute intervals. Changes in pH were monitored using a digital pH meter at 0-, 5-, and 10- minute intervals and at every 5 minutes after the third swish until pH resumed baseline value or 45 minutes relapse. Swishing regimen was repeated on a second visit, followed by swishing with sugar-free liquid antacid (Mylanta Supreme). Recovery times were also recorded. Data was analyzed using independent t-tests, repeated measures ANOVA, and Fisher's exact test (α= 0.05). RESULTS: Baseline buffering capacity and flow rate were not significantly different between groups (P= 0.542; P= 0.2831, respectively). Baseline salivary pH values were similar between groups (P= 0.721). No significant differences in salivary pH values were found between erosion and non-erosion groups in response to multiple acid challenges (P= 0.695) or antacid neutralization (P= 0.861). Analysis of salivary pH recovery time revealed no significant differences between groups after acid challenges (P= 0.091) or after the use of antacid (P= 0.118). There was a highly significant difference in the survival curves of the two groups on Day 2, with the non-erosion group resolving significantly faster than the erosion group (P= 0.0086).

Oral health of elite athletes and association with performance: a systematic review.

BACKGROUND: We aimed to systematically review the epidemiology of oral disease and trauma in the elite athlete population and to investigate the impact of oral health on sporting performance. METHODS: Authors searched Ovid MEDLINE (1950 to October 2013), Ovid EMBASE (1980 to October 2013), EBSCO SPORTDiscus (up to October 2013) and OpenGrey (http://www.opengrey.eu). No date or language restrictions were applied. Papers were included if they evaluated the oral health of professional athletes. The methodological quality of papers was evaluated using a modification of the Newcastle-Ottawa scale. RESULTS: The literature search led to 9858 potentially relevant citations. Following a set of predefined exclusion criteria, 34 studies remained. Twenty-six studies reported on dental trauma, which ranged in prevalence from 14% to 47% varying by sport and country. Sixteen studies considered the oral health of athletes and reported high prevalence of oral diseases: dental caries 15-75%, dental erosion 36-85%, periodontal disease 15%. In four studies, a range between 5% and 18% of athletes reported negative impact of oral health or trauma on performance. The methodological quality of included studies was generally low. CONCLUSIONS: Within the limits of the review, oral health of athletes is poor. We hypothesise that poor oral health associates with self-reported performance; however, this needs to be tested. Further studies on representative samples of athletes are needed to assess the size of the problem of poor oral health as well as to investigate the possible impact on performance using objective measures of performance.

Effect of a novel bioactive glass-ceramic on dentinal tubule occlusion: an in vitro study.

BACKGROUND: This in vitro study aimed to assess the ability and efficacy of HX-BGC, a novel bioactive glass-ceramic (SiO2-P2 O5-CaO-Na2 O-SrO), to reduce dentine tubule permeability. METHODS: Dentine discs from human third molars were etched and randomly allocated into five groups: Group 1--distilled water; Group 2--Sensodyne Repair toothpaste (containing NovaMin®); Group 3--HX-BGC toothpaste (containing 7.5% HX-BGC); Group 4--control toothpaste (without HX-BGC); and Group 5--HX-BGC powder. Specimens were treated daily by brushing with an electric toothbrush for 20 seconds. Between daily treatments (7 days total), specimens were immersed in artificial saliva for 24 hours. Dentine permeability was measured at baseline, after the first treatment, after the first 24-hour immersion in artificial saliva and at the end of day 7. Dentine morphology and surface deposits were observed by scanning electron microscopy after one day and 7 days of treatment, respectively. RESULTS: Sensodyne Repair and bioactive glass-ceramic toothpaste significantly and immediately lowered dentine permeability. The HX-BGC powder group showed the highest reduction in dentine permeability after 7 days of treatment. CONCLUSIONS: The novel bioactive glass-ceramic material HX-BGC is effective in reducing dentine permeability by occluding open dentine tubules, indicating that HX-BGC may be a potential treatment for dentine hypersensitivity.

Dental wear: a scanning electron microscope study.

Dental wear can be differentiated into different types on the basis of morphological and etiological factors. The present research was carried out on twelve extracted human teeth with dental wear (three teeth showing each type of wear: erosion, attrition, abrasion, and abfraction) studied by scanning electron microscopy (SEM). The study aimed, through analysis of the macro- and micromorphological features of the lesions (considering the enamel, dentin, enamel prisms, dentinal tubules, and pulp), to clarify the different clinical and diagnostic presentations of dental wear and their possible significance. Our results, which confirm current knowledge, provide a complete overview of the distinctive morphology of each lesion type. It is important to identify the type of dental wear lesion in order to recognize the contributing etiological factors and, consequently, identify other more complex, nondental disorders (such as gastroesophageal reflux, eating disorders). It is clear that each type of lesion has a specific morphology and mechanism, and further clinical studies are needed to clarify the etiological processes, particularly those underlying the onset of abfraction.

The effect of mouthwashes containing biguanides on the progression of erosion in dentin.

BACKGROUND: Dental erosion is caused by frequent exposure to acids without the involvement of microorganism. This study analyzed the effect of biguanides (polyhexamethylene biguanide - PHMB and chlorhexidine - CHX) on dentin erosion due to their possible influence on the enzymatic degradation of the demineralized organic matrix. METHOD: Sixty bovine dentin specimens were prepared. On both sides of their surface, nail varnish was applied to maintain the reference surfaces for the determination of dentin loss. Samples were cyclically de- and remineralized for 6 days. Demineralization was performed with a 0.87 M citric acid solution (6×5 min daily). Thereafter, samples were treated with distilled water (negative control), 0.12% CHX (positive control), 0.07% PHMB, Sanifill Perio Premium™ (0.07% PHMB plus 0.05% NaF), or F solution (0.05% NaF) for 1 min and then subjected to enzymatic challenge for 10 min using a bacterial collagenase (Clostridium hystoliticum, 100 µg/ml). Dentin loss was assessed using profilometry (µm) daily. Data were analyzed using 2-way repeated measures-ANOVA and Bonferroni's test (p < 0.05). RESULTS: Dentin loss progressed significantly for all groups during the 6 days. After the 3rd day, Sanifill Premium™, CHX, and PHMB significantly reduced dentin erosion compared to control. On the 6th day, the lowest mean (±SD) dentin loss was observed for Sanifill Perio Premium™ (94.4 ± 3.9 µm). PHMB and CHX led to intermediate dentin loss (129.9 ± 41.2 and 135.3 ± 33.5 µm, respectively) that was significantly lower than those found for negative control (168.2 ± 6.2 µm). F (157.4 ± 6.1 µm) did not significantly differ from negative control. CONCLUSIONS: Sanifill Perio Premium™ mouthwash has a good potential to reduce dentin loss, which might be associated with the presence of PHMB.

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

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

Is erosive tooth wear an oral disease?

Erosive tissue loss is part of the physiological wear of teeth. Clinical features are an initial loss of tooth shine or luster followed by flattening of convex structures; with continuing acid exposure, concavities form on smooth surfaces, or grooving and cupping occur on incisal/occlusal surfaces. Dental erosion must be distinguished from other forms of wear, but can also contribute to general tissue loss by surface softening, thus modifying physical wear processes. The determination of dental erosion as a condition or pathology is relatively easy in the case of pain or endodontic complications, but is ambiguous in initial stages and in terms of function or esthetics. The impact of dental erosion on oral health is discussed. However, it can be concluded that in most cases dental erosion is best described as a condition, with the acid being of nonpathological origin.

The interactions between attrition, abrasion and erosion in tooth wear.

Tooth wear is the result of three processes: abrasion (wear produced by interaction between teeth and other materials), attrition (wear through tooth-tooth contact) and erosion (dissolution of hard tissue by acidic substances). A further process (abfraction) might potentiate wear by abrasion and/or erosion. Knowledge of these tooth wear processes and their interactions is reviewed. Both clinical and experimental observations show that individual wear mechanisms rarely act alone but interact with each other. The most important interaction is the potentiation of abrasion by erosive damage to the dental hard tissues. This interaction seems to be the major factor in occlusal and cervical wear. The available evidence is insufficient to establish whether abfraction is an important contributor to tooth wear in vivo. Saliva can modulate erosive/abrasive tooth wear, especially through formation of pellicle, but cannot prevent it.

Erosion in relation to nutrition and the environment.

When considering the erosive potential of a food or drink, a number of factors must be taken into account. pH is arguably the single most important parameter in determining the rate of erosive tissue dissolution. There is no clear-cut critical pH for erosion as there is for caries. At low pH, it is possible that other factors are sufficiently protective to prevent erosion, but equally erosion can progress in acid of a relatively high pH in the absence of mitigating factors. Calcium and phosphate concentration, in combination with pH, determine the degree of saturation with respect to tooth minerals. Solutions supersaturated with respect to enamel or dentine will not cause them to dissolve, meaning that given sufficient common ion concentrations erosion will not proceed, even if the pH is low. Interestingly, the addition of calcium is more effective than phosphate at reducing erosion in acid solutions. Today, several calcium-enriched soft drinks are on the market, and acidic products with high concentrations of calcium and phosphorus are available (such as yoghurt), which do not soften the dental hard tissues. The greater the buffering capacity of the drink or food, the longer it will take for the saliva to neutralize the acid. A higher buffer capacity of a drink or foodstuff will enhance the processes of dissolution because more release of ions from the tooth mineral is required to render the acid inactive for further demineralization. Temperature is also a significant physical factor; for a given acidic solution, erosion proceeds more rapidly the higher the temperature of that solution. In recent years, a number of interesting potentially erosion-reducing drink and food additives have been investigated.

In vitro study of the effect of a dentifrice containing 8% arginine, calcium carbonate, and sodium monofluorophosphate on acid-softened enamel.

OBJECTIVE: To investigate the possible mode of action of a dentifrice containing 8% arginine and calcium carbonate (Pro-Argin Technology), and sodium monofluorophosphate in delivering the benefits of preventing acid erosion and rehardening acid-softened enamel. METHODS: The surfaces of acid-softened bovine enamel specimens were evaluated after application of a dentifrice containing 8% arginine, calcium carbonate, and sodium monofluorophosphate in vitro. Scanning Electron Microscopy (SEM), Electronic Spectrometry for Chemical Analysis (ESCA), and Secondary Ion Mass Spectrometry (SIMS) were used to characterize the enamel surfaces. RESULTS: Exposure of pristine enamel surfaces to citric acid resulted in clear roughening of the surface. Multiple applications of a dentifrice containing 8% arginine, calcium carbonate, and sodium monofluorophosphate to the surface of the enamel resulted in the disappearance of the microscopic voids observed by SEM as a function of treatment applications. The ESCA analysis demonstrated that both the nitrogen and carbonate levels increased as the number of treatments increased, which provides evidence that arginine and calcium carbonate were bound to the surface. Observance of arginine's signature mass fragmentation pattern by SIMS analysis confirmed the identity of arginine on the enamel surface. CONCLUSION: A series of in vitro experiments has demonstrated a possible mode of action by which a dentifrice containing 8% arginine, calcium carbonate, and sodium monofluorophosphate delivers the benefits of preventing acid erosion and rehardening acid-softened enamel. The combination of arginine and calcium carbonate adheres to the enamel surface and helps to fill the microscopic gaps created by acid, which in turn helps repair the enamel and provides a protective coating against future acid attacks.

The effect of saliva substitutes on enamel erosion in vitro.

OBJECTIVES: To investigate the effect of saliva substitutes on enamel erosion in vitro. METHODS: A total of 204 bovine enamel samples were embedded in acrylic resin and allocated to 17 groups (n=12). The specimens were eroded in an artificial mouth (3 days; 6×30 s/days, flow rate: 2 ml/min) using citric acid (pH: 2.5). Immediately after the erosive attacks, saliva substitutes (12 sprays, 3 gels) were applied. Between the erosive cycles the specimens were rinsed with artificial saliva (flowrate: 0.5 ml/min). A SnCl2/AmF/NaF-containing mouthrinse was used as positive control, water spray served as negative control. Enamel loss was measured profilometrically and the data were analyzed using one-way ANOVA followed by Scheffé's post hoc tests (p<0.05). RESULTS: Four saliva substitutes increased enamel erosion, probably due to the low pH or the content of citric acid. Several saliva substitutes were able to reduce enamel erosion significantly by 60-90% (in the range of the positive control). The protective potential of these products was in the range of the positive control (reduction of enamel loss to 30% of negative control). The erosion-protective potential of these high-viscous products is probably related to their film-forming properties, leading to a mechanical protection of the surface. CONCLUSION: Saliva substitutes containing a very low pH exhibit a distinct erosive potential, while most high-viscous products present an erosion-protective effect. It can be recommended that patients suffering from xerostomia and at high risk for dental erosion should use high-viscous saliva substitutes, but should avoid saliva substitutes with low pH or containing citric acid. CLINICAL SIGNIFICANCE: It can be recommended that patients suffering from xerostomia and at high risk for dental erosion should use high-viscous saliva substitutes, but should avoid saliva substitutes with low pH or containing citric acid.

Dental erosive wear assessment among adolescents and adults utilizing the basic erosive wear examination (BEWE) scoring system.

OBJECTIVES: To investigate erosive tooth wear and related variables among adolescents and adults in Israel, utilizing the new basic erosive wear examination (BEWE) scoring system, in an attempt to contribute to the ongoing review, evaluation, and further development of an international standardized index. MATERIAL AND METHODS: A cross-sectional, descriptive, and analytic survey was conducted among 500 subjects of five age groups. Dental erosion was measured according to the new BEWE scoring system. Independent variables included gender, age, origin, education, employment status, and diet. A backward stepwise linear regression model was applied to identify significantly associated variables. RESULTS: Fifty percent of the survey subjects demonstrated erosive tooth wear; among them, 10 % had distinct erosion of over 50 % of the dental surface. Total BEWE score differences by age groups were statistically significant; as the age increased, the mean total BEWE scores increased (p < 0.001). The association between acidic foods and erosion was evident among the younger population (p = 0.038). In a multiple regression model, age (p < 0.001) and diet (p = 0.044) achieved statistical significance as variables associated with dental erosive wear. CONCLUSIONS: Our study is one of the first to use the BEWE scoring system in an epidemiological survey among adolescents and adults. It was found that the BEWE index is straightforward, easy to conduct, and comfortably accepted by the examinees. CLINICAL RELEVANCE: The present findings, together with further international research, should contribute toward continued evaluation of the BEWE system as an international standard and thereby, toward more optimal understanding, evidence-based treatment, and prevention of dental erosive wear.

Saliva composition in three selected groups with normal stimulated salivary flow rates, but yet major differences in caries experience and dental erosion.

OBJECTIVE: It was hypothesized that, by comparing matched subjects with major differences in these dental diseases, but yet normal saliva flow rates, it would be possible to obtain data on the effect of saliva composition on dental disease isolated from the effect of the flow rate. Thus, the aim of the study was to compare the major physicochemical characteristics of stimulated whole saliva in three groups of 85 subjects, each with normal saliva flow rates and at least 24 remaining teeth. MATERIALS AND METHODS: A group with very little dental disease (healthy), a group with dental erosion (erosion) and a group with very high caries experience (caries) were chosen. Furthermore, the aim was to determine whether differences among groups could also be found on an individual level. RESULTS: Although it was not possible to retrieve three groups whose members were completely identical, the present study points in the direction that, on a group level, subjects with very little dental disease seemed to have a more favorable physicochemical saliva composition with respect to higher calcium, phosphate, bicarbonate, pH, degree of saturation with respect to hydroxyapatite and a lower critical pH (p < 0.05 or less). However, on an individual level the explanatory power for the saliva composition was only 10% for caries experience and only 11% for dental erosion (p < 0.001). CONCLUSION: The compositional analyses performed in this study on stimulated whole saliva, including major physicochemical characteristics of saliva, will most likely have little predictive value for future dental caries and erosion in single individuals.