牙齿酸蚀症

牙齿酸蚀症与频繁消费酸性饮料及食物、患某些疾病使胃酸频繁进入口腔内接触牙齿等有一定的关系。牙齿酸蚀症影响着牙齿健康但人们对其认识不多。本文对牙齿酸蚀症的流行状况、病因、临床表现及诊断和治疗的研究进展作一综述。     

牙齿酸蚀症

牙齿酸蚀症与频繁消费酸性饮料及食物、患某些疾病使胃酸频繁进入口腔内接触牙齿等有一定的关系。牙齿酸蚀症影响着人们的牙齿健康。本文就牙齿酸蚀症的流行状况、病因、临床表现及诊断和治疗的研究进展作一综述     

牙齿酸蚀症

牙齿酸蚀症与频繁消费酸性饮料及食物、患某些疾病使胃酸频繁进入口腔内接触牙齿等有一定的关系。牙齿酸蚀症影响着牙齿健康但人们对其认识不多。本文对牙齿酸蚀症的流行状况、病因、临床表现及诊断和治疗的研究进展作一综述。     

徐州市5岁和12岁儿童酸蚀症调查研究

目的了解徐州市儿童酸蚀症的流行情况。方法采用分层整群随机抽样方法,抽取徐州市1 219名5岁儿童和786名12岁儿童进行酸蚀症流行病学调查。通过调查表记录酸蚀症的临床检查结果,调查问卷调查酸蚀症的危险因素。采用Logistic多元回归分析酸蚀症的危险因素。结果徐州市5岁儿童牙齿酸蚀症的患病率为10.91%,12岁儿童牙齿酸蚀症的患病率为22.14%。酸蚀症的等级多为1级和2级,3级以上的酸蚀症极少。酸蚀症危险因素的比值比（OR）分别为：酸性水果,1.120;酸奶,1.062;运动饮料,1.159;碳酸饮料,1.151;果汁,1.187;睡前喝酸性饮料或酸奶,6.102;胃食道返流性疾病,2.311;维生素C,1.565;补铁剂,1.598。结论我国儿童牙齿酸蚀症已广泛存在,今后应加强口腔卫生教育和饮食指导,减少酸性食品和饮料的摄入量和摄入频率,促进口腔健康。     

影响牙齿酸蚀症风险性的唾液因素研究进展

唾液是牙齿的外环境。唾液的无机成分、有机成分、缓冲能力及流速流量对酸蚀症风险性都有着重要的影响。了解影响酸蚀症风险性的唾液因素,可对唾液针对性地检测,能够及早发现酸蚀症易感人群, 有助于酸蚀症的早期诊断、早期预防。该文就影响酸蚀症风险性的唾液因素研究进展作一综述。     

牙酸蚀症指数的研究现状

［摘要］ 近年来,随着国内外牙酸蚀症患病率的增长,此疾病受到研究者的关注,同时,不少针对酸蚀症的评估指数也被提出并应用到临床检查、流行病学调查和实验室研究中。本文就几种当前主要应用于流行病学调查和临床检查的酸蚀症指数作一综述。     

控制牙齿酸蚀症的研究进展

牙齿酸蚀症是指在没有细菌参与的情况下,由化学因素引起的牙体硬组织慢性、不可逆性破坏的疾病。此疾病在人群中普遍存在。控制酸蚀症的发生和发展是口腔临床工作的难点,正日益受到研究者的关注。本文就酸蚀症的早期诊断、风险评估及预防策略的研究进展作一综述。     

视神经炎患者激素治疗引起牙酸蚀症1例

牙酸蚀症是指牙齿受到不涉及细菌的化学物质侵蚀使得牙齿硬组织发生进行性破坏的一种疾病。病因包括内在因素和外在因素，内在因素如暴食、厌食、胃肠道疾病、药物等导致的胃食管反流而引起的牙齿酸蚀，外在因素则主要包括饮食、药物、职业因素等。本文介绍了1位患者，因诊断为视神经炎而接受糖皮质激素治疗，从而引起胃食管反流症状，出现全口牙齿尤其是上颌牙列的重度酸蚀破坏。本文主要就视神经炎激素治疗与牙酸蚀症发生的机制进行了探讨。     

酸蚀对牙釉质裂的影响

目的：研究37％磷酸酸蚀牙面对牙釉质裂的影响。方法：收集因正畸需要拔除的上颌第一前磨牙60个,用钝物打击的方法制造与牙体长轴平行并延伸至颊面中央区域的釉质裂,随机分为3组,每组20个,分别以37％磷酸凝胶处理15s、30s、60s。对牙齿横断面进行扫描电镜观察。对每组正常釉质区及釉质裂区的酸蚀深度进行测量,所获数据进行统计学分析。结果：釉质裂区浸蚀深度较正常区域浸蚀深度有显著差异,在相同的处理时间,釉质裂区酸蚀深度均高于正常釉质区,酸蚀深度由高到低为：釉质裂区60s酸蚀,釉质裂区30s酸蚀,正常釉质区60s酸蚀,正常釉质区30s酸蚀,釉质裂区15s酸蚀,正常釉质区15s酸蚀。结论：正畸粘接前,应对牙面进行仔细检查,对存在釉质裂的牙齿,应严格控制酸蚀时间,并给予必要的防龋处理。     

自酸蚀粘结系统的研究进展

自酸蚀粘结系统是一种将酸性功能成分和偶联剂混合,牙齿表面脱矿与偶联作用同时发生,省略了独立的酸蚀步骤的牙科粘结材料,它的研究应用是牙科粘结技术研究发展的新趋势,本文对自酸蚀粘结系统的原理、主要分类、相关成分和作用以及该系统的特点进行综述。     

Patterns of tooth surface loss among winemakers.

There are a few documented case studies on the adverse effect of wine on both dental hard and soft tissues. Professional wine tasting could present some degree of increased risk to dental erosion. Alcoholic beverages with a low pH may cause erosion, particularly if the attack is of long duration, and repeated over time. The purpose of this study was to compare the prevalence and severity of tooth surface loss between winemakers (exposed) and their spouses (non-exposed). Utilising a cross-sectional, comparative study design, a clinical examination was conducted to assess caries status; the presence and severity of tooth surface loss; staining (presence or absence); fluorosis and prosthetic status. The salivary flow rate, buffering capacity and pH were also measured. Thirty-six persons, twenty-one winemakers and fifteen of their spouses participated in the study. It was possible to show that there was a difference in terms of the prevalence and severity of tooth surface loss between the teeth of winemakers and those who are not winemakers. The occurrence of tooth surface loss amongst winemakers was highly likely due to frequent exposure of their teeth to wine. Frequent exposure of the teeth to wine, as occurs among wine tasters, is deleterious to enamel, and constitutes an occupational hazard. Erosion is an occupational risk for wine tasters.     

Managing dental erosion

The clinical signs of dental erosion are initially subtle, yet often progress because the patient remains asymptomatic, unaware and uninformed. Erosion typically works synergistically with abrasion and attrition to cause loss of tooth structure, making diagnosis and management complex. The purpose of this article is to outline clinical examples of patients with dental erosion that highlight the strategy of early identification, patient education and conservative restorative management. Dental erosion is defined as the pathologic chronic loss of dental hard tissues as a result of the chemical influence of exogenous or endogenous acids without bacterial involvement. Like caries or periodontal disease, erosion has a multifactorial etiology and requires a thorough history and examination for diagnosis. It also requires patient understanding and compliance for improved outcomes. Erosion can affect the loss of tooth structure in isolation of other cofactors, but most often works in synergy with abrasion and attrition in the loss of tooth structure (Table 1). Although erosion is thought to be an underlying etiology of dentin sensitivity, erosion and loss of tooth structure often occurs with few symptoms. The purpose of this article is threefold: first, to outline existing barriers that may limit early management of dental erosion. Second, to review the clinical assessment required to establish a diagnosis of erosion. And third, to outline clinical examples that review options to restore lost tooth structure. The authors have included illustrations they hope will be used to improve patient understanding and motivation in the early management of dental erosion.     

Prevalence of dental erosion and the implications for oral health

The literature on dental erosion is made up of a number of areas, some of which are reviewed here: there are anecdotal case reports, linking a small number of clinical cases with a possible etiogical factor. The second area of evidence concentrates on case control studies in which there is a strong association with dental erosion, for example, patients with bulimia. The final piece of epidemiological evidence is beginning to emerge as prevalence studies, but the information from prevalence data worldwide is scanty. It is difficult to compare prevalence studies because of the different indices used in the various studies and also because of the different teeth assessed in the sample. Standardization of indices used would overcome some of these differences as would the reporting of results in a comparable way. However, identifying the true prevalence of erosion per se is fraught with difficulty because there may be more than one etiological factor operating and attrition and or abrasion may complicate the picture, especially in older populations. Case reports frequently associate evidence of erosion with excessive use of particular drinks or foodstuffs so they must be viewed with caution. There is an increasing awareness, amongst the dental profession, of the potential for this particular form of tooth wear to occur. It is important that the dental team is vigilant and instigates preventive measures before tooth tissue loss becomes clinically significant. The importance of erosion in dental health promotion should not be overlooked.     

Clinical studies of dental erosion and erosive wear

We define erosion as a partial demineralisation of enamel or dentine by intrinsic or extrinsic acids and erosive tooth wear as the accelerated loss of dental hard tissue through the combined effect of erosion and mechanical wear (abrasion and attrition) on the tooth surface. Most experts believe that during the last decade there has been a significant increase in the prevalence and severity of erosive tooth wear, particularly in adolescents. Even when erosive wear occurs in its milder forms, this is a matter of concern, as it may compromise the integrity of an otherwise healthy dentition in later life. The erosive wear process is complicated and modified by many chemical, behavioural and associated processes in the mouth. If interventions are to be developed it is therefore important that in vivo methods are developed to assess the outcomes of the erosion and erosive wear processes and the effects of interventions upon them. This paper discusses potential methods of investigating erosion and erosive wear in vivo and the difficulties associated with clinical studies.     

Prevalence of tooth erosion and associated factors in 11‐14‐year‐old Brazilian schoolchildren

Objective: Prevalence data about tooth erosion has attracted increasing attention in the dental community; however, population‐based studies that assessed the impact of demographic, socioeconomic, and dietetic predictors on tooth erosion are scarce. This investigation assessed the prevalence of this condition of a sample of 11‐14‐year‐old schoolchildren and the etiological factors. Method: A cross‐sectional study in a multistage random sample of 944, 11‐14‐year‐old Brazilian schoolchildren was conducted in Santa Maria, Brazil. We recorded the prevalence and severity of tooth erosion, dental caries, and dental enamel hypoplasia. Socioeconomic and habits/dietetic data were collected by a structured questionnaire. Data were analyzed using Poisson regression model taking into account the cluster sample. Results: Prevalence of tooth erosion was low (7.2%). The most affected teeth were the maxillary incisors. Labial surfaces were more often affected than palatal ones. All the erosive lesions observed were confined to the enamel. Older children [prevalence ratio (PR) = 1.71; 95% confidence interval (CI): 1.06‐2.76] with dental enamel hypoplasia (PR = 1.98; 95% CI: 1.21‐3.22) were more likely to have tooth erosion. No significant association was observed between tooth erosion, dental caries, habits and dietary patterns, and socioeconomic factors. Conclusion: The data suggest that tooth erosion was associated with age and presence of hypoplasia. It may indicate the need of strategies to diagnose in early stages and to minimize consequences.     

The prevalence and distribution of dental caries in a Romano-British population

Dental disease, incidence of tooth loss and prevalence and distribution of caries were studied in 517 Romano-British skulls from a single burial site. The overall prevalence of caries was higher than previously recorded in Romano-British studies which were influenced by inclusion of soil erosion cavities. Numbers of missing teeth and whether such teeth were lost ante or post mortem also influenced prevalence. Caries prevalence was lower than in modern populations, but the pattern was similar, except that approximal caries occurred more commonly at the cervical margin of the Romano-British teeth than at the contact areas as seen in modern material. Tooth loss was also less marked, but modern dentistry does not appear to have altered the patterns of tooth loss and caries attack.     

Prevalence and etiologic factors of non-carious cervical lesions. A study in a Senegalese population]

The non carious cervical lesion (NCCL) is a loss of tooth tissue at the neck of affected teeth that is unrelated to tooth decay. They are commonly encountered in clinical practice and present in a variety of forms. The purpose of this paper is to determine the prevalence of the NCCL in a Senegalese population. From 655 patients, 112 with cervical lesions were identified i.e. a global prevalence of 17.10%. The prevalence rate for abrasion was reported to be 77.70%, 12.50% for abfraction and 9.80% for erosion. Etiological factors were studied for abrasion and erosion. 54% of the patients with abrasion used their toothbrush horizontally. For erosion, only external factors were identified: consumption of acidic drinks (9 patients) or alcohol (1 patient) and professional environment (1 patient). Dentists should consider these lesions in their daily practice.     

Dental erosion: part 2. The management of dental erosion

Dental erosion is an important cause of tooth tissue loss in both children and adults. An earlier article (Mahoney and Kilpatrick, 2003) discussed the prevalence and causes of dental erosion. This second article will discuss the management of this condition which is often complicated by the multifactorial nature of tooth wear. Management of dental erosion can be considered in three phases: immediate, interim and long-term. Immediate management includes the early diagnosis of dental erosion, recording the status of the disorder at baseline and implementing appropriate preventive strategies including those aimed at reducing the acidic exposure as well as those that attempt to increase an individual's resistance to erosive tooth tissue loss. Interim and long-term treatment includes the provision of temporary diagnostic restorations, ongoing monitoring of disease progression, definitive restorative work where appropriate, and modification and reinforcement of preventive advice. Each phase will be discussed in light of current evidence.     

Dental erosion: part 1. Aetiology and prevalence of dental erosion

Non-carious tooth tissue loss due to abrasion, attrition, abfraction and erosion has become a significant problem, occurring in up to 80 percent of children and in up to 43 percent of adults. Dental erosion is now recognised as an important cause of tooth tissue loss in both children and adults. It is caused by the presence of intrinsic or extrinsic acid of non-bacterial origin in the mouth. Intrinsic sources of acid include vomiting, regurgitation, gastro-oesophageal reflux or rumination. Extrinsic sources of acid are most commonly dietary acids. Medications, a patient's lifestyle choices and environment can also increase the risk of dental erosion. In this article we identify the prevalence of dental erosion and its main causative factors, and in Part II we will discuss the management of dental erosion.     

The prevalence of tooth erosion in 12-year-old children

OBJECTIVES: To establish the prevalence of tooth erosion in a representative sample of 12-year-old children in Leicestershire and Rutland. To determine if gender, ethnic group, deprivation or caries experience influences the prevalence of erosion. METHODS: A random sample of 1,753 12-year-olds resident in Leicestershire and Rutland were examined in 62 schools; 906 were boys and 847 girls; 1,379 were Caucasian and 316 Asian. Tooth erosion was assessed using the index employed in the survey of Children's Dental Health in England and Wales (1993). The Townsend index was used to record deprivation. RESULTS: Tooth erosion was found in 59.7% of the children, with 2.7% exhibiting exposed dentine. Significantly more boys than girls; Caucasian than Asian children; and those with caries experience, had erosion present (chi-square for all P<0.01). Overall no significant difference was found between deprivation categories, however socio-economically advantaged Caucasian children had significantly less tooth erosion than other groups. CONCLUSIONS: There was a high prevalence of tooth erosion in 12-year-old children. Significantly more erosion occurred in boys than girls, and culture appeared to influence prevalence. Children with caries experience had a higher prevalence of erosion than those without caries, which may reflect a lower level of dietary care. Deprivation seemed to affect the prevalence of tooth erosion in Caucasian children.