Surface hardness evaluation of different composite resin materials: influence of sports and energy drinks immersion after a short-term period

Objectives:

This study evaluated the effect of sports and energy drinks on the surface hardness of different composite resin restorative materials over a 1-month period.

Material and Methods:

A total of 168 specimens: Compoglass F, Filtek Z250, Filtek Supreme, and Premise were prepared using a customized cylindrical metal mould and they were divided into six groups (N=42; n=7 per group). For the control groups, the specimens were stored in distilled water for 24 hours at 37º C and the water was renewed daily. For the experimental groups, the specimens were immersed in 5 mL of one of the following test solutions: Powerade, Gatorade, X-IR, Burn, and Red Bull, for two minutes daily for up to a 1-month test period and all the solutions were refreshed daily. Surface hardness was measured using a Vickers hardness measuring instrument at baseline, after 1-week and 1-month. Data were statistically analyzed using Multivariate repeated measure ANOVA and Bonferroni''s multiple comparison tests (α=0.05).

Results:

Multivariate repeated measures ANOVA revealed that there were statistically significant differences in the hardness of the restorative materials in different immersion times (p<0.001) in different solutions (p<0.001). The effect of different solutions on the surface hardness values of the restorative materials was tested using Bonferroni''s multiple comparison tests, and it was observed that specimens stored in distilled water demonstrated statistically significant lower mean surface hardness reductions when compared to the specimens immersed in sports and energy drinks after a 1-month evaluation period (p<0.001). The compomer was the most affected by an acidic environment, whereas the composite resin materials were the least affected materials.

Conclusions:

The effect of sports and energy drinks on the surface hardness of a restorative material depends on the duration of exposure time, and the composition of the material.     

The pH and titratable acidity of a range of diluting drinks and their potential effect on dental erosion

Objectives. To investigate, in vitro, the potential dental effects of diluting juices by measuring their acidity levels and to examine the effect dilution has on the potential erosive properties of the drinks.

Methods. Four commonly available diluting drinks were assessed for both pH and titratable acidity at a variety of dilutions, reflecting the range of concentrations over which such drinks may be consumed. Predetermined dilutions of citric acid and hydrochloric acid, with similar pH values to those of the drinks, were used as positive control acidic solutions. The pH measurements throughout the study were made using a pH electrode connected to an Orion EA940 IonAnalyser.

Results. All four drinks demonstrated a high degree of resistance to a rise in pH, indicating high intrinsic buffering capacity. The measured pH changed very little with increasing dilution ratio when compared to the citric and hydrochloric acid controls, even when considered extremely dilute. In contrast, the titratable acidity of each of the drinks reduced proportionally with increasing dilution, thereby reducing considerably its erosive potential.

Conclusions. While dilution had very little effect on the measured pH values, the titratable acidity reduced as the drink became more dilute. Since there appears to be a direct relationship between dilution and titratable acidity, the erosive potential of diluting juices may be reduced substantially by the addition of water. It remains unlikely, however, that the drinks would ever be consumed at a ‘safe’ level of dilution due to diminished taste and colour.     

The acidic and erosive potential of five sports drinks

Sports drinks are becoming increasingly popular as we are all being encouraged to adopt a healthier lifestyle with regular exercise. However, many of these products are based on acidic fruits and may contribute to erosion. The aim of this study was to screen a number of these products for their potential to cause enamel erosion in vitro. The erosive potential of a number of readily available sports drinks was assessed in the laboratory by measuring their pH, neutralisable acidity and their ability to erode enamel. These were compared to a positive control, orange juice and a negative control, water. The pH of the sports drinks ranged from 3.16-3.70 with their neutralisable acidity ranging from 9.74-13.44 mls of 0.1M NaOH. The amount of enamel removed following 1-hour immersion in the sports drinks ranged from 1.18-5.36 microns. In comparison, the orange juice control had a pH of 3.68, a neutralisable acidity of 19.68 mls of 0.1 M NaOH and removed 3.24 microns of enamel. Many of the sports drinks tested were found to be erosive. This information will be of use to clinicians when counselling patients with tooth surface loss who use fruit based sports drinks regularly.     

How can we restrict the sale of sports and energy drinks to children? A proposal for a World Health Organization‐sponsored framework convention to restrict the sale of sports and energy drinks

High‐sugar drinks, including fruit drinks, soft drinks, sports drinks and energy drinks, are of no nutritional value and contribute to the burden of dental disease in all age groups. The manufacturers of sports and energy drinks have elected to target children in their marketing campaigns and promote a misleading association between their products, healthy lifestyles and sporting prowess. The World Health Organization (WHO) has acknowledged that strategies aimed at prevention of dental disease are the only economically viable options for managing the oral health of children in low‐ and middle‐income countries. Developed nations will also be advantaged by preventive programmes given that the cost of providing dental care to those who cannot pay draws valuable resources away from more pressing health issues. The Convention on the Rights of the Child (CRC) obligates governments to develop legislation to protect the health of children. A framework convention modelled on the existing Framework Convention for Tobacco Control, supported by the WHO, would assist governments to proactively legislate to restrict the sale of sports and energy drinks to children. This article will consider how a framework convention would be an advantage with reference to the strategies used by sports and energy drink manufacturers in Australia.     

New animal model of extrinsic dental erosion-Erosive effect on the mouse molar teeth

ObjectiveConsumption of acidic food and drinks is considered as important risk factor for development of dental erosion. There are several in vitro and in situ studies focusing on the risk indicators and preventive treatment, however, the need for a standardized animal model has been emphasised for many years. The aim was to establish an animal model of extrinsic dental erosion, which may serve as a standard for future studies to improve our understanding of the erosion.DesignTwo acidic drinks, sports drink and cola drink, were given to young mice for six weeks. Experimental and control (water) molars and incisors were dissected out and observed by scanning electron microscopy (SEM). Mandibular first molars were subsequently ground transversely and observed again by SEM. The tooth height and enamel thickness were measured on the SEM images.ResultsThe lingual surface of the mandibular molars was most eroded after consumption of acidic drinks. The cola drink exhibited higher erosive effect on mandibular molars compared to sports drink. The lingual tooth height, compared to control, was about 34% and 18% lower in the cola drink and sports drink molars, respectively. Compared to the control molars, the lingual enamel was about 23% thinner in the sports drink molars and totally eroded on the certain lingual areas of the cola drink molars.ConclusionsThis new animal model of extrinsic dental erosion and the presented method with ground molars observed in SEM are suitable for further studies, which will gain deeper insights into the erosive disease.     

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.     

A comparison of sports and energy drinks--Physiochemical properties and enamel dissolution

The consumption of sports and energy drinks by children and adolescents has increased at an alarming rate in recent years. It is essential for dental professionals to be informed about the physiochemical properties of these drinks and their effects on enamel. The present study measured the fluoride levels, pH, and titratable acidity of multiple popular, commercially available brands of sports and energy drinks. Enamel dissolution was measured as weight loss using an in vitro multiple exposure model consisting of repeated short exposures to these drinks, alternating with exposure to artificial saliva. The relationship between enamel dissolution and fluoride levels, pH, and titratable acidity was also examined. There was a statistically significant difference between the fluoride levels (p = 0.034) and pH (p = 0.04) of the sports and energy drinks studied. The titratable acidity of energy drinks (11.78) was found to be significantly higher than that of sports drinks (3.58) (p < 0.001). Five of the energy drinks (Red Bull Sugar Free, Monster Assault, Von Dutch, Rockstar, and 5-Hour Energy) were found to have the highest titratable acidity values among the brands studied. Enamel weight loss after exposure to energy drinks was significantly higher than it was after exposure to sports drinks. The effect of titratable acidity on enamel weight loss was found to vary inversely with the pH of the drinks. The findings indicated that energy drinks have significantly higher titratable acidity and enamel dissolution associated with them than sports drinks. Enamel weight loss after exposure to energy drinks was more than two times higher than it was after exposure to sports drinks. Titratable acidity is a significant predictor of enamel dissolution, and its effect on enamel weight loss varies inversely with the pH of the drink. The data from the current study can be used to educate patients about the differences between sports and energy drinks and the effects of these drinks on tooth enamel.     

Patterns in consumption of potentially erosive beverages among adolescent school children in the Netherlands

Aim: To determine the frequency of intake and patterns in consumption of potentially erosive beverages in school children in the Netherlands. Methods: A cross‐sectional, single centre study was performed among 502 school children in Rotterdam, in age varying between 12 and 19 years. Data on consumption of soft drinks, energy drinks, sports drinks and alcopops were obtained through a self‐reported questionnaire. Gender‐ and age‐related differences in consumption were analysed with Chi‐square, Kruskal–Wallis and Mann–Whitney tests. Associations between variables were investigated with Chi‐square tests and Spearman’s rank order correlation analysis. Results: Boys consumed soft drinks, energy drinks and sports drinks more frequently than girls, and on average also consumed higher amounts of these drinks. No gender‐related differences were observed in alcopop consumption. Consumption of all drinks was most frequent at 14‐ or 15‐year of age, with the exception of alcopops which was most frequent by 16‐year‐old school children. Significant positive associations were observed between the consumption of soft drinks, energy drinks and/or sports drinks. Alcopop consumption was only associated with consumption of energy drinks. Conclusion: Consumption of soft drinks, energy drinks, sports drinks and alcopops by school children is related to age and gender. The significant positive associations between the consumption of these drinks suggest that a subgroup of school children exists with a high cumulative intake of these potentially erosive drinks.     

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.     

The effect of Coca-Cola and fruit juices on the surface hardness of glass-ionomers and 'compomers'

The interaction of tooth-coloured dental restorative materials (a conventional glass-ionomer, two resin-modified glass-ionomers and two compomers) with acidic beverages has been studied with the aim of investigating how long-term contact affects solution pH and specimen surface hardness. For each material (ChemFil Superior, ChemFlex, Vitremer Core Build-Up/Restorative, Fuji II LC, Dyract AP and F2000) disc-shaped specimens were prepared and stored in sets of six in the following storage media: 0.9% NaCl (control), Coca-Cola, apple juice and orange juice. After time intervals of 1 day, 1 week, 1 month, 3 months, 4 months, 6 months and 1 year, solution pH and Vickers Hardness Number were determined for each individual specimen. Differences were analysed by anova followed by Student-Newman-Keuls post hoc analysis. All materials were found to reduce the pH of the 0.9% NaCl, but to increase the pH of the acidic beverages. The conventional glass-ionomers dissolved completely in apple juice and orange juice, but survived in Coca-Cola, albeit with a significantly reduced hardness after 1 year. The other materials survived in apple juice and orange juice, but showed greater reductions in surface hardness in these beverages than in Coca-Cola. Fruit juices were thus shown to pose a greater erosive threat to tooth coloured materials than Coca-Cola, a finding which is similar to those concerning dentine and enamel towards these drinks.     

Soft drinks and dental health: a review of the current literature

In recent years there has been increased interest in the role of commercial soft drinks in dental diseases namely as dental caries and erosion. The objective of this paper has been to review the past and current literature to determine the present knowledge on this subject. The literature related to dental caries, erosion, drinks, soft drinks and fruit juices was reviewed. The literature shows efforts have been taken to modify soft drinks by either adding or deleting certain components so as to reduce their harmful effects on teeth. A rational protocol to encourage the sensible use of drinks and the modification of drinks to render them less harmful would be advisable.     

Erosive effects of common beverages on extracted premolar teeth

BACKGROUND: Dental erosion is highly prevalent today, and acidic drinks are thought to be an important cause. The aim of the present investigation was to determine the erosive potential of a range of common beverages on extracted human teeth. METHODS: The beverages were tested for their individual pHs using a pH meter. The clinical effects of the most erosive beverages were determined by the degree of etching and Vickers microhardness of enamel. RESULTS: The results showed that many common beverages have pHs sufficiently low to cause enamel erosion. Lime juice concentrate (pH 2.1) had the lowest pH, followed by Coca-cola and Pepsi (both with pH 2.3) and Lucozade (pH 2.5). The erosive potential of these beverages was demonstrated by the deep etching of the enamel after five minutes. The Vickers Hardness of enamel was reduced by about 50 per cent in the case of lime juice (p < 0.001) and 24 per cent in the case of Coca-cola (p < 0.004). Addition of saliva to 50 per cent (v/v) of Coca-cola completely reversed the erosive effects on the enamel. CONCLUSIONS: Although only a few of the beverages with the lowest pHs were tested, the present study showed that the most acidic drinks had the greatest erosive effects on enamel. While saliva was protective against erosion, relatively large volumes were required to neutralize the acidity.     

Contemporary fluid intake and dental caries in Australian children

In Australia, caries experience of 6-year-old and 12-year-old children has increased since the mid to late 1990s. Previously, caries rates had declined, attributable to community water fluoridation. The recent caries increase has been attributed speculatively to changes in fluid intake, including increased consumption of sweet drinks and bottled waters. Increasing urbanization and globalization have altered children's diets worldwide, promoting availability and access to processed foods and sweet drinks. Studies in Australia and internationally have demonstrated significant associations between sweet drink intake and caries experience. Despite widespread fluoride availability in contemporary Australian society, the relationship between sugar consumption and caries development continues and restricting sugar intake remains key to caries prevention. Caries risk assessment should be included in treatment planning for all children; parents should be advised of their child's risk level and given information on oral health promotion. Readily-implemented caries risk assessment tools applicable to parents and clinicians are now available. Public health information should increase awareness that consuming sweet drinks can have deleterious effects on the dentition as well as the potential for promoting systemic disease. Restricting sales of sweet drinks and sweet foods and providing healthy food and drinks for purchase in schools is paramount.     

Effects of sports drinks and other beverages on dental enamel

A high percentage of people consume soft drinks that contain sugar or artificial sweeteners, flavorings, and various additives. The popularity of sports (energy) drinks is growing and this pilot study compares enamel dissolution in these and a variety of other beverages. Enamel blocks (approximately 7.0 x 5.0 x 2.5 mm) were sectioned from sound extracted human premolars and molars and measured, weighed, and immersed in the selected beverages for a total of 14 days. The pH of all beverages was measured. The enamel sections were weighed at regular intervals throughout the immersion period with the solutions being changed daily; all studies were performed in duplicate. The data were subjected to one-way ANOVA with post hoc Scheffe testing. Enamel dissolution occurred in all of the tested beverages, with far greater attack occurring in flavored and energy (sports) drinks than previously noted for water and cola drinks. No correlation was found between enamel dissolution and beverage pH. Non-cola drinks, commercial lemonades, and energy/sports drinks showed the most aggressive dissolution effect on dental enamel. Reduced residence times of beverages in the mouth by salivary clearance or rinsing would appear to be beneficial.     

Commercial soft drinks: pH and in vitro dissolution of enamel

Most soft drinks are acidic in nature and exposure to these drinks may result in enamel erosion. This study sought to measure the pH of 20 commercial brands of soft drinks, the dissolution of enamel resulting from immersion in these drinks, and the influence of pH on enamel loss. Comparison of the erosive potential of cola versus non-cola drinks as well as regular sugared and diet versions of the same brands was undertaken. The pH was measured immediately after opening the soft drink can. Enamel slices obtained from freshly extracted teeth were immersed in the soft drinks and weighed at baseline and after 6, 24, and 48 hours of immersion. Non-cola drinks had significantly higher pH values than cola drinks but showed higher mean percent weight loss. By contrast, sugared versions of the cola and non-cola drinks showed significantly lower pH values and higher mean percent weight loss than their diet counterparts. The pH value of the soft drink did not have a significant influence on the mean percent weight loss (r = -0.28). Prolonged exposure to soft drinks can lead to significant enamel loss. Non-cola drinks are more erosive than cola drinks. Sugared versions of cola and non-cola drinks proved to be more erosive than their diet counterparts. The erosive potential of the soft drinks was not related to their pH value.     

五类市售饮料的酸蚀性研究

目的:通过对碳酸类、果汁类、普通牛奶类、高钙奶类和瓶装矿泉水类等五类市售饮料的pH值、缓冲能力、钙、磷、氟离子等相关因素的测定,预测它们对牙齿的酸蚀能力。方法:选取15种市售饮料,采用精密酸度计测定饮料的pH值,用滴定法测定缓冲能力,用比色法测定钙、磷离子浓度,用电极法测定氟离子浓度。结果:果汁类、普通牛奶类、高钙奶类和瓶装矿泉水类的pH值分别是2.51～2.29、3.24～3.37、6.38～6.64、6.55～6.68和6.49～7.12;缓冲能力分别是1.15～3.15mmol/L(pH5.5)和3.85～5.15mmol/L(pH7.0)、2.10～2.45mmol/L(pH5.5)和2.95～3.15mmol/L(pH7.0)、0.45～0.65mmol/L(pH7.0)、0.35～0.60mmol/L(pH7.0)及<0.10mmol/L(pH10);钙离子浓度分别是0.44～1.61mmol/L、0.17～0.37mmol/L、2.49～3.14mmol/L、2.96～3.31mmol/L和0.01～0.35mmol/L;磷离子浓度分别是0.02～0.61mmol/L、0.53～0.84mmol/L、0.90～1.30mmol/L、0.86～1.34mmol/L和0.01～0.38mmol/L;氟离子浓度分别是0.03～0.05mg/L、0.08～0.12mg/L、0.03～0.05mg/L、0.04～0.05mg/L和0.02～0.06mg/L。碳酸类及果汁类饮料的pH值远低于釉质脱矿临界值5.5,缓冲能力较弱,钙、磷、氟离子的浓度较低。牛奶pH值趋近于中性,缓冲能力强,而且其中含有大量的钙、磷、氟离子。矿泉水pH值为中性,含有一定量的矿物质。结论:酸性饮料的酸蚀性最强,矿泉水次之,牛奶的酸蚀性最弱。     

Evaluation of the surface roughness of compomer by laser scanning microscopy

The purpose of this study was to evaluate the effect of alcoholic and low pH soft drinks on the surface roughness of compomer restorative materials. There were five tested materials and four immersion media. Specimens were immersed in test solutions for a 10-day period at a temperature of 37 degrees C. Measurement of the surface texture was carried out using a laser scanning microscope (a non-contact laser stylus tracing method). This was also used to produce the Laser Scanning Microscope Image (LSM Image). Specimens immersed in orange juice and whisky displayed higher values for Ra & Rz than specimens immersed in soft drinks and deionized water. LSM Image showed a difference between the control and the examined side, especially for specimens immersed in low pH soft drinks this could be due to the erosive effect of the media. Alcoholic and low pH soft drinks caused deterioration of the materials surface, which may lead to a clinically detectable rough and dull surface.     

A comparative life cycle assessment of dental restorative materials

ObjectivesDifferent types of direct-placement dental materials are used for the restoration of structure, function and aesthetics of teeth. The aim of this research investigation is to determine, through a comparative cradle-to-gate life cycle assessment, the environmental impacts of three direct-placement dental restorative materials (DRMs) and their associated packaging.MethodsThree direct-placement dental materials; dental amalgam, resin-based composite (RBC) and glass polyalkenoate cements (GIC) are assessed using primary data from a manufacturer (SDI Limited, Australia). The functional unit consisted of ‘one dental restoration’ of each restorative system under investigation: 1.14 g of dental amalgam; 0.25 g of RBC (plus the adhesive = 0.10 g); and 0.54 g of GIC. The system boundary per restoration included the raw materials and their associated packaging materials for each DRM together with the processing steps for both the materials and packaging. The environmental impacts were assessed using an Egalitarian approach under the ReCiPe method using Umberto software and the Ecoinvent database. Nine different impact categories were used to compare the environmental performance of these materials.ResultsDental amalgam had the highest impact across most of the categories, but RBC had the highest Global Warming Potential. The highest sources of the environmental impacts for each restorative material were: Amalgam, derived from material use; RBC, derived from energy use in processing material and packaging material; GIC, derived from material and energy use for packaging.SignificanceLess intensive energy sources or more sustainable packaging materials can potentially reduce the impacts associated with RBC and GIC thus making them suitable alternatives to dental amalgam.     

A comparison of enamel erosion by a new sports drink compared to two proprietary products: a controlled, crossover study in situ

OBJECTIVE: The aim of the study was to measure the erosive potential of a prototype sports drink on enamel in a model in situ. METHODS: The study was a single centre, single blind, randomised crossover design balanced for residual effects involving 18 subjects. The drinks were the prototype formulation containing calcium and maltodextrin (test), two sports drink products containing sugars (drink with calcium and positive control) and water (negative control). During each 15-day study period, subjects wore a palatal removable appliance carrying two flat human enamel specimens. Drinks were imbibed as 250 ml volumes over 10 min 4 times per day. Loss of enamel was measured on days 5, 10 and 15 using a contacting profilometer. RESULTS: Very little erosion occurred with the test, drink with calcium and negative control drinks and differences between the test and negative control only reached significance at day 15. The positive control produced progressive erosion over time and significantly more than the test or negative control at all time points. CONCLUSION: The technology of adding calcium with appropriate pH adjustment, which has been applied previously to soft and carbonated drinks to markedly reduce erosive potential, can be applied to sports drinks to the same end. Significant variation in the carbohydrate composition does not influence this outcome.     

Relationship between sports drinks and dental erosion in 304 university athletes in Columbus,Ohio, USA

Acidic soft drinks, including sports drinks, have been implicated in dental erosion with limited supporting data in scarce erosion studies worldwide. The purpose of this study was to determine the prevalence of dental erosion in a sample of athletes at a large Midwestern state university in the USA, and to evaluate whether regular consumption of sports drinks was associated with dental erosion. A cross-sectional, observational study was done using a convenience sample of 304 athletes, selected irrespective of sports drinks usage. The Lussi Index was used in a blinded clinical examination to grade the frequency and severity of erosion of all tooth surfaces excluding third molars and incisal surfaces of anterior teeth. A self-administered questionnaire was used to gather details on sports drink usage, lifestyle, health problems, dietary and oral health habits. Intraoral color slides were taken of all teeth with erosion. Sports drinks usage was found in 91.8% athletes and the total prevalence of erosion was 36.5%. Nonparametric tests and stepwise regression analysis using history variables showed no association between dental erosion and the use of sports drinks, quantity and frequency of consumption, years of usage and nonsport usage of sports drinks. The most significant predictor of erosion was found to be not belonging to the African race (p < 0.0001). The results of this study reveal no relationship between consumption of sports drinks and dental erosion.