饮食和牙齿侵蚀症

张丁教授点评：口腔医师在进行卫生宣教时重点放在牙面清洁，常常忽略日常饮食对于牙面脱矿的影响。随着经济的发展，人们的饮食习惯发生变化，尤其是儿童服用含酸或产酸的饮食、饮料的机率大大增加，关注饮食习惯对于牙齿脱矿的影响应该成为我们在新的经济情况下口腔保健应考虑的问题。本文提出的与牙齿侵蚀症相关的饮食建议有助于我们在日常生活中预防牙齿脱矿。     

Untreated dental trauma among homeless people in Midwest Brazil

Homeless people are usually more exposed to traumatic events that may cause dental injuries than those with more stable housing. Previous studies on the oral health condition of this population group have shown high levels of dental caries, periodontal diseases, and tooth loss, but evidence on dental trauma is scarce. Furthermore, there is no report from Latin American countries. The aim of this study was to describe the prevalence of untreated traumatic dental injuries (TDI) among adult homeless people in a Brazilian capital city. A sample of 102 adults attending a public homeless shelter was clinically examined using the criteria of the 2010 Brazilian National Oral Health Survey. TDI was found in 10.8% of the participants, and the most common types of injury were enamel-dentin fractures and avulsion. The overall prevalence was relatively low, but the proportion of anterior tooth loss due to trauma and other reasons shows the need for more appropriate health care for this vulnerable population group.     

Prevalence of dental erosion among people with gastroesophageal reflux disease in China

Statement of problem

Gastroesophageal reflux disease (GERD) is typically diagnosed based on symptoms of regurgitation and heartburn, although it may also manifest as asthma-like symptoms, laryngitis, or dental erosion.

Cupped lesions of early onset dental erosion in young southeast Queensland adults

BACKGROUND: Dental erosion manifests as cupped lesions on cusp apices and in fissures of teeth in patients from southeast Queensland referred with excessive tooth wear. When found in young adults, these lesions may indicate early onset of active dental erosion. If the numbers and extent of cupped lesions increase with age, erosion may be a slow cumulative process. METHODS: This cross-sectional study recorded the presence or absence and the relative sizes of cupped lesions from all cusps and occlusal fissures on premolar and permanent molar teeth from study models by image analysis. Type-specimens of cupped lesions were examined. RESULTS: The incidence by tooth reflected time in the mouth, post-tooth emergence. A linear increase in lesion number and size, with age, was found. However, cupped lesions occurred on mandibular first molar cusp apices as often, and attained greater extent, in adults under 27 years compared with older subjects. CONCLUSION: Marked differences were found between lesion number and size, between maxillary and mandibular molar sites that reflect differences in salivary protection against dental erosion. The significance of this study is that the mandibular first permanent molar indicates the age of onset and severity of dental erosion.     

Saliva and dental erosion

Dental erosion is a multifactorial condition. The consideration of chemical, biological and behavioral factors is fundamental for its prevention and therapy. Among the biological factors, saliva is one of the most important parameters in the protection against erosive wear.

Objective

This review discusses the role of salivary factors on the development of dental erosion.

Material and Methods

A search was undertaken on MEDLINE website for papers from 1969 to 2010. The keywords used in the research were "saliva", "acquired pellicle", "salivary flow", "salivary buffering capacity" and "dental erosion". Inclusion of studies, data extraction and quality assessment were undertaken independently and in duplicate by two members of the review team. Disagreements were solved by discussion and consensus or by a third party.

Results

Several characteristics and properties of saliva play an important role in dental erosion. Salivary clearance gradually eliminates the acids through swallowing and saliva presents buffering capacity causing neutralization and buffering of dietary acids. Salivary flow allows dilution of the acids. In addition, saliva is supersaturated with respect to tooth mineral, providing calcium, phosphate and fluoride necessary for remineralization after an erosive challenge. Furthermore, many proteins present in saliva and acquired pellicle play an important role in dental erosion.

Conclusions

Saliva is the most important biological factor affecting the progression of dental erosion. Knowledge of its components and properties involved in this protective role can drive the development of preventive measures targeting to enhance its known beneficial effects.     

Diet and dental caries

The most commonly discussed methods of caries control are use of fluoride, fissure sealing and toothbrushing. In fact, dietary control can be more effective than any of these. Studies have shown that if there is no sugar in the diet, then caries can be virtually eliminated. This article reviews the evidence, and offers guidance for the GDP giving dietary advice.     

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.     

Risk factors in dental erosion

Dental erosion and factors affecting the risk of its occurrence were investigated with a case-control approach. One hundred and six cases with erosion and 100 randomly selected controls from the same source population were involved in the study. All cases and controls were evaluated by the recording of structured medical and dietary histories and by examination of the teeth and saliva. Erosion was classified according to pre-determined criteria. The relative importance of associations between factors and erosion was analyzed by a logistic multivariable model. Adjusted odds ratios (AOR) were estimated. There was considerable risk of erosion when citrus fruits were eaten more than twice a day (AOR 37), soft drinks were drunk daily (AOR 4), apple vinegar was ingested weekly (AOR 10), or sport drinks were drunk weekly (AOR 4). The risk of erosion was also high in individuals who vomited (AOR 31) or exhibited gastric symptoms (AOR 10), and in those with a low unstimulated salivary flow rate (AOR 5).     

Vegetarian children and dental erosion

Background . There have been recent changes in teenage lifestyle and diet. The increasing consumption of soft drinks and foods containing significant acidic components may play a role in the development of dental erosion.
Objective . The aims of this investigation were firstly, to assess the prevalence of vegetarian children in a cluster random sample of 14-year-old children in Birmingham, United Kingdom. Secondly, to determine the prevalence of dental erosion in these children, and thirdly, to see if there were any differences between vegetarian and non-vegetarian children in the prevalence of dental erosion and dietary intake.
Design . A cluster random sample of 418 14-year-old children (209 males and 209 females) were examined from 12 different schools in Birmingham, United Kingdom; a dietary questionnaire was completed and the levels of tooth wear were recorded using a modification of the (TWI) index. All data were analysed using SPSS with t -test and Chi-square analysis. Significance was accepted at the P < 0·05 level.
Results . The results showed that 10% of the children were vegetarian; 52% of them had low dental erosion and 48% moderate dental erosion. Statistically there were no significant differences between vegetarian and non-vegetarian children in the prevalence of erosion; however, there were significant differences in some food and drink consumption.
Conclusions . It was concluded that dental erosion is common in teenage children, but there were no significant differences in prevalence between vegetarian and non-vegetarian children.     

Childhood asthma and dental erosion

The aim of this investigation was first to assess the prevalence of asthma in a random sample of fourteen-year-old children in Birmingham UK. Secondly to assess the levels of dental erosion in these children, and thirdly to see whether there was any correlation between children with asthma and the levels of dental erosion. A random sample of 418 children from twelve secondary schools was examined, 209 were male and 209 female. The level of tooth wear was recorded using a modification of the Tooth Wear Index of Smith and Knight. The prevalence of asthma in this group was 15.8 percent (66 children out of 418); the levels of dental erosion in children with asthma were higher.     

Sports drinks and dental erosion

Sports drinks were originally developed to improve hydration and performance in athletes taking part in intense or endurance sporting events. These drinks contain relatively high amounts of carbohydrates (sugars), salt, and citric acid. These ingredients create the potential for dental ramifications and overall public health consequences such as obesity and diabetes. High intake of sports drinks during exercise, coupled with xerostomia from dehydration, may lead to the possibility of erosive damage to teeth.     

Sports drinks and dental erosion

PURPOSE: To discuss the composition and rationale for the use of sports drinks along with recent studies investigating the relationship between sports drinks and dental erosion. METHODS: A review of the literature of sports drinks and dental erosion was done. RESULTS: For most athletes and individuals engaged in physical activity, the use of sports drinks does not provide a benefit over water. Furthermore, although there is much in vitro evidence that acidic drinks such as wine, fruit juices and carbonated soft drinks have erosive potential and there are relationships between consumption of these drinks and erosion, only one study has reported an association between sports drinks and dental erosion. Other factors such as drinking habit and salivary production may be more important determinants of dental erosion.