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Objective The aim of this study was to investigate the relationship between tooth wear and dentine hypersensitivity on occlusal/incisal tooth surfaces and the time since dietary acid consumption. Method 350 subjects were recruited from hospital and general practice in SE England aged 19–34 years old. The severity of tooth wear and dentine hypersensitivity was calculated on occlusal/incisal tooth surfaces per subject using Basic Erosive Wear Examination (BEWE) and Cumulative Hypersensitivity Index (CHI) scores respectively at each appointment. The CHI score relied on evaporative stimuli applied to each occlusal/incisal tooth surface. The subjects were also asked about the time since their last acidic food or drink consumption. Result Tooth wear was recorded in 93% (n = 327) of subjects and dentine hypersensitivity was recorded in 56% (n = 196) of subjects. A positive statistically significant relationship existed between the severity of tooth wear and severity of dentine hypersensitivity recorded using BEWE and CHI on occlusal/incisal tooth surfaces (p < 0.01). Dentine hypersensitivity and tooth wear were correlated with consumption of acidic beverages (p < 0.01). The severity of dentine hypersensitivity on occlusal/incisal tooth surfaces was associated with the time since the subject's last acidic food consumption (p < 0.01). Among those subjects who consumed an acidic beverage within 60 min of their appointment, 87.2% (n = 130) had dentine hypersensitivity. Among subjects who had consumed the acidic beverage more than 1 h previously, the prevalence of dentine hypersensitivity was 12.8% (n = 19). Conclusion The severity of tooth wear on occlusal/incisal tooth surfaces is associated with the dentine hypersensitivity severity. Subjects who consume dietary acidic beverages more recently are more likely to have dentine hypersensitivity. Clinical significance Occlusal tooth surfaces suffer erosive, attritive and abrasive tooth wear. Tooth wear is important in the aetiology of dentine hypersensitivity on these surfaces. Dentine hypersensitivity is more likely initiated if subjects consume acidic beverages more recently. This supports clinically the episodic nature of dentine hypersensitivity caused predominately by active erosive tooth wear.

To compare single-application fluoride formulations on enamel erosion and erosion-abrasion in vitro.Enamel specimens were pretreated with either sodium, tin, titanium, or sodium/calcium fluoride and subjected to either an erosion model or an erosion-abrasion model, after which optical profilometry was used to measure enamel step height loss.For erosion, the titanium fluoride (P.001) reduced enamel loss, whereas the calcium, tin, and sodium treatments showed no significant effects (P.05). For erosion-abrasion, the titanium fluoride increased enamel loss in comparison to control (P.001).Titanium fluoride has differing effects on enamel loss from erosion and erosion-abrasion models.

Gastric juice entering the mouth causes dental erosion. Common causes for the migration of gastric juice through the lower and upper oesophageal sphincters are reflux disease, laryngopharyngeal reflux, eating disorders, chronic alcoholism and pregnancy. Gastroesophageal reflux is a common condition affecting up to 65% of the Western population at some point in their lifetime. A typical clinical sign of acidic gastric juice entering the mouth is palatal dental erosion. As the condition becomes more chronic it becomes more widespread. There have been relatively few randomised studies investigating the aetiology of acids causing erosion. Of the few that have reported their findings, it appears that gastric acids have the potential to induce moderate-to-severe erosion. This literature review reports the conditions associated with the movement of gastric juice and dental erosion using medical and dental sources.

Aim This study developed the Schiff Index into a Cumulative Hypersensitivity Index (CHI) to measure dentine hypersensitivity (DH) severity per subject. It validates this score by investigating if it compares to one comprising a percentage score from all tooth surfaces and as a highest score per subject. Materials and methods Overall, 350 subjects were recruited from hospital and general practice in south-east England. Buccal, occlusal and oral Schiff Index scores were collected and percentages calculated based on scores 1, 1 and above, 2 and above and 3. CHI scores and highest Schiff Index scores were also recorded per subject. Spearman correlation coefficients (p-values) assessed the relationship between CHI scores, Schiff Index percentages and Schiff Index highest per subject. Results In subjects with a Schiff Index score of 1 or more on at least one tooth surface (indicating DH was present), correlation of the CHI score to the Schiff Index percentage score was 0.982 (p

Objectives: To develop an innovative computerised routine, in conjunction with a minimally destructive imaging technique, to quantify dentine tubule occlusion. Methods: Polished human dentine samples (n = 480) were brushed during a 4-day in situ study with two occlusion-based dentifrices, a sodium fluoride control dentifrice (1,450 ppm) or water. Samples were imaged with tandem scanning microscopy (TSM) and conventional scanning electron microscopy (SEM). The level of dentine patency was then assessed using a visual ordinal scale (‘standard') or quantitatively using a specially designed computational routine. Results: The occlusion-based dentifrice resulted in significantly less patent dentine than controls for the ‘standard' (p = 0.01) assessment, but not for computer analyses (p = 0.10). The correlation of the number of individual patent tubules counted visually and by the computational routine in calibrations and in the in situ study was ≥0.8. Conclusions: This study identified a new computer-based routine, capable of objectively quantifying the patency of dentine imaged by SEM and TSM.

The art and craft of recording intra-oral anatomy successfully with dental impressions relies on the interaction of three critical factors – the ‘golden triangle of impression-taking’: an appreciation of the anatomical features to be recorded, the material used to take the impression and the clinical handling/operative technique applied. This paper aims to discuss the three factors and their inter-relationships, detailing clinical tips for successful, reproducible and consistent outcomes. Clinical Relevance: Obtaining accurate dental impressions is the key to success in a wide range of clinical restorative procedures. This paper offers clinical advice to practitioners to plan and then take predictable, good quality impressions for their restorative cases.

It has been suggested that the use of alcohol-containing mouthrinses could lead to the presence of acetaldehyde in saliva. In this cross-over study, salivary acetaldehyde levels and microbial profiles were determined before and after rinsing with ethanol-containing mouthrinses with essential oils (EO) and cetyl pyridinium chloride (CPC) as the active ingredients, and with 21.6% ethanol and water controls. After rinsing with all ethanol-containing rinses, acetaldehyde was detected in saliva after 30 s but declined to low levels after 5 min. The highest peak levels were seen with the ethanol control (median = 82.9 μM at 2 min) and were significantly higher than those seen at the same time after rinsing with the EO rinse (43.1 μM). There was no correlation between microbial counts or plaque scores and acetaldehyde levels, although dividing the subjects on the basis of a peak acetaldehyde salivary concentration of90.8 μM after the ethanol rinse revealed that the high responders were highly significantly more likely to harbour salivary yeasts than were the low responders. Rinsing with ethanol-containing mouthrinses causes a rapid, but transient, increase in salivary acetaldehyde levels.

The aim of this study was to assess the prevalence of gastro-oesophageal reflux disease (GORD) symptoms and tooth wear in patients with Sjögren’s syndrome (SS) compared with matched controls. GORD symptoms were assessed for 33 SS patients and 20 age- and sex-matched controls. Tooth wear was assessed in all patients and controls. The results were further analysed in two subgroups of SS patients and controls with and without GORD symptoms (SS patients without GORD symptoms: n = 11, controls without GORD symptoms: n = 18). A higher proportion of SS patients reported suffering from heartburn and regurgitation than controls (p < 0.001 and p = 0.02, respectively). SS patients without GORD symptoms had a statistically significantly higher percentage of surfaces with tooth wear affecting dentine than controls (p < 0.001).

Objectives Previous work has shown protection to eroded teeth offered by a resin-based adhesive lasted up to three months. The hypothesis investigated in this study was whether application of a fissure sealant would offer longer protection. Methods Seventeen adult patients with palatal tooth wear were recruited and written consent obtained. Metal discs were cemented on the palatal surfaces of all upper anterior teeth following previously published techniques. Alternate teeth within each subject were randomly chosen and coated with a clear fissure sealant using previously published methods. The uncoated teeth were used as controls. Accurate impressions were taken in custom made trays and repeated at 3, 6, 9, 12 and 20 months and scanned using a non-contacting laser profilometer. Results The mean (standard deviation) thickness of the fissure sealant was 290 μm (500) at the start and after 3 months a mean thickness of 120 μm (260) remained. At this point the control surfaces showed a mean 70 μm (113) of tooth wear. At 6 and 9 months the mean wear for control teeth was higher at 120 μm (114) and 110 μm (114) than sealed teeth at 50 μm (260) and 60 μm (440), respectively. A comparison of paired sites within subjects at their final visit indicated a statistically significant difference in wear between the sealed and control teeth ( p = 0.016). Conclusions The use of fissure sealant to protect palatal dentine surfaces may have a role in prevention of tooth wear for up to a period of nine months.

Objectives: To investigate the effect of an aqueous sodium fluoride solution of increasing concentration on erosion and attrition of enamel and dentine in vitro.Methods: Enamel and dentine sections from caries-free human third molars were polished flat and taped (exposing a 3 mm x 3 mm area) before being randomly allocated to 1 of 5 groups per substrate (n = 10/gp): G1 (distilled water control); G2 (225 ppm NaF); G3 (1450 ppm NaF); G4 (5000 ppm NaF); G5 (19,000 ppm NaF). All specimens were subjected to 5, 10 and 15 cycles of experimental wear [1 cycle = artificial saliva (2 h, pH 7.0) + erosion (0.3% citric acid, pH 3.2, 5 min) + fluoride/control (5 min) + attrition (60 linear strokes in artificial saliva from enamel antagonists loaded to 300 g)]. Following tape removal, step height (SH) in m was measured using optical profilometry.Results: When the number of cycles increased the amount of tooth surface loss increased significantly in enamel and dentine after attrition and erosion and for dentine after attrition. Attrition and erosion resulted in greater surface loss than attrition alone after 15 cycles of experimental wear of enamel. 5000 ppm and 19,000 ppm sodium fluoride solutions had a protective effect on erosive and attritional enamel tooth wear in vitro, however no other groups showed significant differences.Conclusions: The more intensive the fluoride regime the more protection was afforded to enamel from attrition and erosion. However, in this study no such protective effect was demonstrated for dentine. (C) 2010 Elsevier Ltd. All rights reserved.

To investigate the relationship between dental erosion, oral pH and drinking habit in a group of adolescents.Oral pH was measured simultaneously at the surface of four teeth in 11 patients, aged 10-16 years, with erosion and in 10 controls subjects without erosion using antimony electrodes. Measurements were made before, during and after drinking 330 ml of a carbonated drink. The method and timing of drinking the beverage, reported dietary intake of acidic foods and flow rate and buffering capacity of saliva were recorded.The erosion patients reported drinking more carbonated drinks (p0.01) and drinking directly from a can more frequently than the controls (p0.05). They also drank twice as quickly (p0.05). The pH at the buccal surface of a molar remained lower for longer in the erosion patients than in the patients without erosion (p0.01), whilst the labial surface of the upper central incisor had a longer exposure to low pH in the controls subjects (p0.05).The pattern of oral pH differed between subjects with and without erosion after drinking an acidic beverage. This may be related to observed differences in drinking habit, which could have influenced the pattern of erosion in these subjects.

Manifestations of atypical gastroesophageal reflux disease (GORD) are varied, and the presentation of atypical symptoms may occur in the absence of typical symptoms. The most sensitive and specific investigation for GORD is pH monitoring, and its application in atypical disease is utilized throughout this paper as a basis for correlating disease and pathogenesis. The less well-known areas of laryngeal manifestations, particularly chronic hoarseness and globus, are discussed in addition to recent work on orodental manifestations. Well-known areas of cardiac and respiratory manifestations, which include chronic cough and asthma, are also reviewed. Evidence from clinical trials indicates that aggressive anti-reflux therapy in patients with atypical symptoms can be effective. Where appropriate, medical therapy may involve long-term proton pump inhibitor, although further research outlining the roles of other therapies such as surgery is awaited.

Summary Aims. The purpose of this study was to assess the prevalence of tooth wear, symptoms of reflux and salivary parameters in a group of patients referred for investigation of gastro-oesophageal reflux disease (GORD) compared with a group of control subjects. Materials and methods. Tooth wear, stimulated salivary flow rate and buffering capacity and symptoms of GORD were assessed in patients attending an Oesophageal Laboratory. Patients had manometry and 24-h pH tests, which are the gold standard for the diagnosis of GORD. Tooth wear was assessed using a modification of the Smith and Knight tooth wear index. The results were compared to those obtained from a group of controls with no symptoms of GORD. Results. Patients with symptoms of GORD and those subsequently diagnosed with GORD had higher total and palatal tooth wear ðp , 0:05Þ: The buffering capacity of the stimulated saliva from the control subjects was greater than patients with symptoms of GORD ðp , 0:001Þ: Patients with hoarseness had a lower salivary flow rate compared with those with no hoarseness. Conclusions. Tooth wear involving dentine was more prevalent in patients complaining of symptoms of GORD and those diagnosed as having GORD following 24-h pH monitoring than controls. Patients had poorer salivary buffering capacity than control subjects. Patients complaining of hoarseness had lower salivary flow rate than controls.

Aims Before embarking upon changes to teaching in prosthodontics it is important to identify what techniques are being used in general practice. The aim of this study was to assess the current range and quantity of fixed and removable prosthodontics reported in general dental practice in the South East of England. Method Structured questionnaires were sent to 191 randomly selected dentists from the GDC list in the South East of England, with 71% of the dentists completing the questionnaire. The questionnaire included demographic data, NHS/private and the range and quantity of fixed and removable prosthodontics. Results The reported number of removable prostheses undertaken was low; most metal dentures were made in private specialist practices, whereas most acrylic partial and complete dentures were made in NHS general practices. The number of bridges, in particular minimal preparation bridges, was low as opposed to the number of crowns, which was high in all types of practices. Implants were provided mainly by the specialists. Conclusions Dentists reported prescribing low numbers of removable and fixed prostheses with the exception of crowns. Metal dentures and implants were mainly provided by specialists. The implications of this study emphasise the importance in teaching crowns to undergraduates.

Dental erosion is the dissolution of enamel and dentine caused by organic or inorganic acids.1 The source of acid is normally either dietary acids2 or regurgitation of stomach juice3 into the mouth. Enamel and dentine begin dissolution at a pH of approximately 5.5.4 In achalasia, bacterial fermentation of food produces lactic acid, with a minimum pH of approximately 3.5,5 which has the potential to demineralise teeth if it reaches the mouth. This study investigated whether regurgitated lactic acid fermented from food lying within an achalasic oesophagus causes dental erosion. The aim of the study was to measure the prevalence of dental erosion in patients referred for management of untreated achalasia and to compare the results with a control group. Patients referred to the oesophageal laboratory from a variety of medical sources for …

Aims Before embarking upon changes to teaching in prosthodontics it is important to identify what techniques are being used in general practice. The aim of this study was to assess the current range and quantity of fixed and removable prosthodontics reported in general dental practice in the South East of England. Method Structured questionnaires were sent to 191 randomly selected dentists from the GDC list in the South East of England, with 71% of the dentists completing the questionnaire. The questionnaire included demographic data, NHS/private and the range and quantity of fixed and removable prosthodontics. Results The reported number of removable prostheses undertaken was low; most metal dentures were made in private specialist practices, whereas most acrylic partial and complete dentures were made in NHS general practices. The number of bridges, in particular minimal preparation bridges, was low as opposed to the number of crowns, which was high in all types of practices. Implants were provided mainly by the specialists. Conclusions Dentists reported prescribing low numbers of removable and fixed prostheses with the exception of crowns. Metal dentures and implants were mainly provided by specialists. The implications of this study emphasise the importance in teaching crowns to undergraduates.

To measure step height change, using profilometry on dentin, after pre-treatment with sodium fluoride at 1,450 and 5,000 ppm and then erosion with citric acid. .Dentin specimens (n= 150), sectioned from the coronal aspect of extracted human molars were randomly divided into three groups of 60 samples each and fully immersed in deionized water (control), or solutions of NaF with 1,450 ppm (F1450) or 5,000 ppm (F5000) for 3 minutes and then artificial saliva (not containing proteins) for 30 minutes. The samples were eroded for 10, 15, 20 or 25 minutes in 0.3% citric acid at pH 2.7. The mean step height change was calculated using confocal non-contact white light laser profilometry. .The mean (SD) step height for the control group at 25 minutes of acid exposure was 9.08 µm (± 0.74), for the F1450 fluoride group 8.74 μm (± 0.58) and for F5000 group 7.01 µm (± 0.56) µm, respectively. There were no statistically significant differences between the control group to the F1450 at any immersion times, whereas at F5000 there were statistically significant differences at all times (P0.0001). Within the limitations of this in vitro study, step height in dentin increased with time of exposure to citric acid and 5,000 ppm of sodium fluoride significantly reduced step height with artificial saliva.5,000 ppm NaF better protected dentin in an erosion model than concentrations commonly found in toothpastes.