Is there a relationship between asthma and dental erosion? A case control study

Summary. Objectives. The aims of this study were firstly to assess and compare the prevalence of dental erosion and dietary intake between three groups of children; children with asthma, those with significant tooth erosion but with no history of asthma, and children with no history of asthma or other medical problems. Secondly, to discover whether there was a relationship between medical history and dietary practises of these children and the levels of dental erosion. Thirdly, to measure and compare their salivary flow rates, pH and buffering capacity. Methods. The study consisted of 3 groups of children aged 11–18 years attending Birmingham Dental Hospital: 20 children with asthma requiring long‐term medication, 20 children referred with dental erosion, and 20 children in the age and sex matched control group. Tooth wear was recorded using a modification of the tooth wear index (TWI) of Smith and Knight. Data on the medical and dietary history were obtained from a self‐reported questionnaire supplemented by a structured interview. The salivary samples were collected under standard methods for measurements. Results. Fifty percent of the children in the control group had low erosion and 50% moderate erosion. However, high levels were recorded in 35% of children in the asthma group and 65% in the erosion group. There appeared to be no overall differences in diet between the groups. There was an association between dental erosion and the consumption of soft drinks, carbonated beverages and fresh fruits in all the three groups. More variables related to erosion were found in the erosion and asthma groups. A comparison between the three groups showed no significant differences in unstimulated and stimulated salivary flow rates, or pH and buffering capacity. Conclusion. There were significant differences in the prevalence of erosion between the three groups, children with asthma having a higher prevalence than the control group. Although there was a relationship between the levels of erosion and some medical history and acidic dietary components, these did not explain the higher levels in asthmatic children. Further investigation is required into the factors affecting the increased prevalence of erosion in children with asthma.     

Fluorosis: is it really a problem?

BACKGROUND: Scientists have noted an association between mottled enamel and fluoride exposure since the early 1900s. By the mid-1900s, they also recognized that fluoride intake was related to lower caries incidence. To harness the protective effect of fluoride while limiting the occurrence of fluorosis, dental researchers have recommended that the fluoride level in chinking water be 1 part per million or less. OVERVIEW: Despite the recognition that fluoride levels in water can be controlled to offer caries protection with minimal risk of fluorosis, the cosmetic defect continues to appear. However, although the word "fluorosis" conjures up images of brown stained and pitted enamel, such severe cases rarely are seen in the United States. Children in this country are exposed to fluoride from numerous sources and the appearance of mild fluorosis is not unusual. CONCLUSIONS AND PRACTICE IMPLICATIONS: In most cases, fluorosis is a minor cosmetic defect that should not be cause for alarm. Dentists should educate their patients about the optimal range of fluoride intake for caries protection, sources of fluoride and the possibility of fluorosis.     

Is a symmetrical face really attractive?

Facial symmetry plays an important role in facial attractiveness and is one of the major criteria used to determine attractiveness in humans. In craniomaxillofacial surgery, facial symmetry is one of the main considerations. The aim of this study was to determine anthropometric measurements quantitatively and investigate the relationship between facial symmetry and attractiveness in a local Malay population. The study included 30 photographed Malay individuals and 100 photograph assessors, all aged between 18 and 26 years. The assessors indicated their preferences regarding the more attractive face on original and manipulated (symmetrical face) photographs. None of the photographed subjects had a perfectly symmetrical face (asymmetry index (AI) of 0%); 33.3% of the photographed subjects had an AI in the range of 1.6–2.0%. The majority of assessors chose the manipulated symmetrical face as the most attractive (manipulated photograph selected in 91.2% of cases). As facial symmetry is considered a critical factor in attractiveness, it is beneficial to consider balance and symmetry prior to facial reconstruction. The AI values found in this study may be useful as guidance to determine the normal minimum balance of facial symmetry. No AI values indicating perfect symmetry were observed for the unedited facial anthropometric measurements. However, the projection of a perfectly symmetrical face does influence the perception of facial attractiveness.     

Is atypical odontalgia a psychological problem?

Several authors have asserted that psychological factors are the underlying cause of atypical odontalgia. However, objective evidence is lacking to support this claim. In this study, the Minnesota Multiphasic Personality Inventory was used to assess psychological functioning of an atypical odontalgia population. Means of the standard scores for each Minnesota Multiphasic Personality Inventory scale were within normal ranges. Standard scores for atypical odontalgia profiles compared with standard scores for a chronic headache group (matched for age, sex, and chronicity) were similar and scales for both groups were within normal ranges. These findings fail to support psychological dysfunction as a primary condition associated with patients suffering from atypical odontalgia.     

Is trust a predictor of having a dental home?

BACKGROUND: Developing a better understanding of sociodemographic variables that predict having a dental home may aid in reducing the disparities in oral health among minorities in the United States. METHODS: The authors used data from a telephone survey of 1,005 randomly selected low-income residents (403 men, 602 women) aged 18 or older in two Florida counties--Miami-Dade and Duval--to examine the sociodemographic characteristics of people who reported having a regular dentist. RESULTS: Bivariate analyses showed that respondents' levels of trust in physicians and dentists were strongly associated with having a dental home. After adjusting for other variables in a multiple logistic regression model, the authors found that respondents with a moderate level of trust in physicians and dentists were 52 percent less likely (odds ratio, or OR, = 0.48; 95 percent confidence interval, or CI, 0.26 to 0.89) and those with low trust were 54 percent less likely (OR = 0.46; 95 percent CI, 0.28 to 0.75) than those with high trust to have a regular dentist. Race/ethnicity, sex, age, education level and employment status remained significant correlates of having a regular dentist in the multivariate model. CONCLUSIONS: The results of this study suggest that efforts to reduce disparities in access to dental care and establish dental homes should include programs to increase patients' trust in dental professionals. CLINICAL IMPLICATIONS: While policy-makers consider ways to improve access to dental care, dental professionals should work at the community level to increase the level of trust of the community in the dental health provider.     

Ultrasonic measurement of enamel thickness: a tool for monitoring dental erosion?

OBJECTIVES: Wear of dental hard tissues, e.g. dental erosion, is reported to be a growing problem. A non-destructive measurement of enamel layer thickness would provide the opportunity for both early diagnosis, and longitudinal measurement of progressive enamel loss. It was the aim of this study to investigate the potential of ultrasonic pulse-echo measurements for the enamel thickness measurement. METHODS: Nine extracted human incisor teeth were selected and stored in physiological saline. Mesial and distal tooth parts were removed, resulting in a central tooth slice of about 2 mm thickness. Where possible three buccal, and one palatal measuring sites were selected and indicated by pencil marks on one of the section planes. Ultrasonic pulse-echo measurements were made at each site using a Panametrics 25DL thickness gauge (Panametrics, Waltham, MA, USA), using a perspex delay line transducer (15 MHz) and glycerine coupling medium. Ultrasonic measurements were validated by measuring the thickness of the enamel layer at the marked side of the tooth slices with a light stereomicroscope at 120 x magnification. Two observers performed independent measurements. RESULTS: Limits of agreement for measurements by two observers (n = 42) were -0.09 and 0.09 mm. Measurements performed at 21 degrees C and 34 degrees C were not significantly different, as analysed by paired Student's t-test (p = 0.19). Pearson's correlation coefficient between ultrasonic and microscopic measurements was 0.90. Analysis of all measurements from both observers at both temperatures yielded a sound velocity in enamel of 6.5 x 10(3) m/s (standard error 0.1 x 10(3) m/s). CONCLUSIONS: It was concluded that the ultrasonic measurement of the enamel thickness is feasible without enamel preparation.     

Silicone sealers, acetic acid vapours and dental erosion: a work-related risk?

The aim of the present study was to investigate whether the acetic acid released by some silicone sealers during the curing process poses an increased risk for dental erosion, thus constituting an occupational hazard to exposed individuals.The material comprised 13 individuals (x=30 years, 10 men and 3 women) who had been exposed to an average of 4.2 years' (range 0.6-10 years) of working with silicone. Each had comprehensive medical and dental examinations carried out. A sex- and aged-matched group of 20 healthy, unexposed workers from the same company served as controls for the medical examination, while study models from randomly selected sex- and age-matched individuals were used as controls for assessing the severity of erosion. Using a questionnaire, an assessment of the role of various possible factors related to oral and general health, and to dental erosion in particular, was made for each participant in the exposed group. Clinical examination included recordings of severity of dental erosion, presence of "cuppings", DMFT, salivary secretion rate and buffer capacity, visible plaque index and gingival bleeding index. In addition, bitewing radiographs, study casts and intraoral colour transparencies were obtained for each individual.The severity of dental erosion was significantly higher in those exposed to silicone compared to controls.There was also a significant correlation between the period of exposure to silicone in the workplace and severity of erosion. Medical problems, especially with regard to upper respiratory tract symptoms, were significantly more common among exposed individuals than controls. In conclusion, a relationship between occupational exposure to acetic acid vapours from silicone sealers and development of dental erosion would appear to exist.     

How valid are current diagnostic criteria for dental erosion?

In principle, there is agreement about the clinical diagnostic criteria for dental erosion, basically defined as cupping and grooving of the occlusal/incisal surfaces, shallow defects on smooth surfaces located coronal from the enamel-cementum junction with an intact cervical enamel rim and restorations rising above the adjacent tooth surface. This lesion characteristic was established from clinical experience and from observations in a small group of subjects with known exposure to acids rather than from systematic research. Their prevalence is higher in risk groups for dental erosion compared to subjects not particularly exposed to acids, but analytical epidemiological studies on random or cluster samples often fail to find a relation between occurrence or severity of lesions and any aetiological factor. Besides other aspects, this finding might be due to lack of validity with respect to diagnostic criteria. In particular, cupping and grooving might be an effect of abrasion as well as of erosion and their value for the specific diagnosis of erosion must be doubted. Knowledge about the validity of current diagnostic criteria of different forms of tooth wear is incomplete, therefore further research is needed.     

Is ART really atraumatic?

Atraumatic restorative treatment (ART) is an approach to the management of carious lesions that uses only hand instruments to remove carious tissue and to restore the tooth involved. The name ART implies that the approach is atraumatic to both the patient and the tooth. This study set out to evaluate whether ART is atraumatic in terms of both patient discomfort and tooth tissue conservation. Three hundred and fifty-nine patients were divided in two groups: one group was treated with hand instruments and the other with rotary equipment. Each patient received two restorations: one using amalgam and one using glass ionomer as the restorative material, placed without the use of anaesthesia. Less discomfort was reported with the ART approach compared to conventional restorations made using rotary instruments and amalgam. Moreover, preparations with hand instruments were smaller than those produced with rotary instruments. Reported discomfort was associated with the size of the preparation, although the influence of the operator on both criteria was considerable. A patient effect was also observed since patients who reported discomfort during the first treatment were more likely to report discomfort after the second treatment. In conclusion, the choice of the term "ART" as an atraumatic procedure is defensible.     

Is medication a risk factor for dental caries among older people?

OBJECTIVES: This study examined the association between chronic medication exposure and 5-year dental caries increment among older people, using a theoretical model whereby xerogenic medication is thought to lead to increased caries by either (i) chronically lowering salivary flow, thus reducing salivary buffering of plaque acids, or (ii) producing the symptoms of dry mouth, leading to symptomatic relief through the use of cariogenic drinks and foodstuffs. METHODS: Data were obtained from participants remaining at the 5-year follow-up phase of a cohort study of community-dwelling South Australians aged 60 +. Medication information was available at baseline and at 5 years, enabling only those medications taken on both occasions to be included in the analyses. Dental examinations were conducted at baseline and 5 years, and a reversal-adjusted 5-year caries increment was computed. Multivariate modelling was used to control the effects of potential confounders. RESULTS: Of the original sample, 528 (62.3%) remained after 5 years, with those remaining tending to be younger, healthier and less medicated than those lost to follow-up. Five-year coronal caries incidence was 66.9%. The adjusted coronal caries increment (AdjCI) was higher among males and among those taking a beta-blocker or an antiasthma drug for the previous 5 years. The 5-year incidence of root surface caries was 59.3%. A lower root surface AdjCI was associated with taking daily aspirin. Of the medications shown in earlier analyses to predict dry mouth, only the antiasthma drugs were associated with higher caries experience, and they had predicted more severe xerostomia symptoms. CONCLUSIONS: This study offers no strong evidence for a medication-caries relationship, as only one of the observed medication-caries associations was explicable in terms of the theoretical model. However, it should be acknowledged that older people taking antiasthma drugs may be at higher risk of coronal caries, possibly through measures taken for the symptomatic relief of dry mouth.