The effect of aspartame and pH changes on the erosive potential of cola drinks in bovine enamel : an in vitro study

The aim of this study was to clarify the mechanism behind the different erosive potential of regular and light cola drinks: pH difference and/or aspartame presence. Sixty bovine enamel blocks were randomly divided into 5 groups: RC - regular cola, RCpH - addition of base to increase regular cola pH, RCAS - addition of aspartame to regular cola, LC - light cola, and LCpH - addition of acid to decrease light cola pH. Two-thirds of the blocks surface was coated with nail varnish for reference. The samples were daily subjected to four erosive challenges for 2 minutes. Between the erosive challenges (2h) and overnight the samples were maintained in artificial saliva. The response variable was the percentage surface hardness change (%SHC) after 1st experimental day and enamel surface loss (µm) measured at the 5th day by profilometry. Data were analyzed by ANOVA and Tukey?s test (p<0.05). Independently of the cola modifications, all groups promoted similar hardness change of enamel surface. RC promoted higher enamel loss (6.69±0.71µm) than LC (4.80±0.77µm). The acid addition to light cola (LCpH: 6.60±1.78µm) significantly enhanced its erosive potential, which did not differ from RC. The base addition to regular cola (RCpH-4.00±0.64µm) resulted in similar wear to LC. The addition of aspartame to the regular cola (RCAS 5.44±0.65µm) resulted in similar wear to LC and RC. The data suggest that the pH alteration has a major impact on the erosive potential of cola drinks, however, the sweetener also has some influence

Effect of vegetable oils applied over acquired enamel pellicle on initial erosion

Objective The prevalence of dental erosion has been recently increasing, requiring new preventive and therapeutic approaches. Vegetable oils have been studied in preventive dentistry because they come from a natural, edible, low-cost, and worldwide accessible source. This study aimed to evaluate the protective effect of different vegetable oils, applied in two concentrations, on initial enamel erosion. Material and Methods Initially, the acquired pellicle was formed in situ for 2 hours. Subsequently, the enamel blocks were treated in vitro according to the study group (n=12/per group): GP5 and GP100 – 5% and pure palm oil, respectively; GC5 and GC100 – 5% and pure coconut oil; GSa5 and GSa100 – 5% and pure safflower oil; GSu5 and GSu100 – 5% and pure sunflower oil; GO5 and GO100 – 5% and pure olive oil; CON− – Deionized Water (negative control) and CON+ – Commercial Mouthwash (Elmex® Erosion Protection Dental Rinse, GABA/positive control). Then, the enamel blocks were immersed in artificial saliva for 2 minutes and subjected to short-term acid exposure in 0.5% citric acid, pH 2.4, for 30 seconds, to promote enamel surface softening. The response variable was the percentage of surface hardness loss [((SHi - SHf) / SHf )×100]. Data were analyzed by one-way ANOVA and Tukey’s test (p;0.05) and less than the other groups (

Influence of mandibular and palatal intraoral appliances on erosion in situ study outcome

The standardization of in situ protocols for dental erosion is important to enable comparison between studies. Objective: Thus, the objectives of this study were to evaluate the influence of the location of in situ intraoral appliance (mandibular X palatal) on the extent of enamel loss induced by erosive challenges and to evaluate the comfort of the appliances. Material and Methods: One hundred and sixty bovine enamel blocks were selected according to their initial surface hardness and randomly divided into two groups: GI - palatal appliance and GII - mandibular appliance. Twenty volunteers wore simultaneously one palatal appliance (containing 4 enamel blocks) and two mandibular appliances (each one containing 2 enamel blocks). Four times per day during 5 days, the volunteers immersed their appliances in 0.01 M hydrochloric acid for 2 minutes, washed and reinserted them into the oral cavity for 2 hours until the next erosive challenge. After the end of the in situ phase, the volunteers answered a questionnaire regarding the comfort of the appliances. The loss of tissue in the enamel blocks was determined profilometrically. Data were statistically analyzed by paired t-test, Chi-square and Fisher's Exact Test (p&lt;0.05). Results: The enamel blocks allocated in palatal appliances (GI) presented significantly higher erosive wear when compared to the blocks fixed in mandibular appliances (GII). The volunteers reported more comfort when using the palatal appliance. Conclusions: Therefore, the palatal appliance is more comfortable and resulted in higher enamel loss compared to the mandibular one

Effect of in situ aspartame mouthwash to prevent intrinsic and extrinsic erosive tooth wear

The aim was to evaluate whether aspartame regular mouthwash prior to erosive challenges with citric or hydrochloric acids would be able to prevent erosive enamel wear. This randomized, single blind in situ study was conducted with 3 crossover phases of 5 days. Polished bovine enamel blocks (n=252) were randomly divided among 6 groups/ 3 phases/ 21 volunteers. The groups under study were: aspartame solution (0.024% of aspartame in deionized water - experimental group), deionized water (negative-control) and stannous-containing solution (Elmex® Erosion Protection Dental Rinse; positive-control); subjected to erosion on citric acid or hydrochloric acid. Four times per day the volunteers rinsed the intraoral appliance with the respective solutions (in situ) prior to immersion of half of the appliance in 0.05M citric acid and the other half in 0.01M hydrochloric acid for 120 seconds (extraoral). The response variable was enamel loss by profilometry. Data were analyzed by ANOVA and Tukey?s test (p<0.05). No difference on enamel loss was found between aspartame solution and deionized water. Stannous-solution resulted in less enamel loss compared to deionized water. Hydrochloric acid resulted in higher enamel loss than citric acid. In this model, aspartame was not able to prevent erosive tooth wear against citric or hydrochloric acids

Resin based materials penetration in eroded lesions, with and without enamel conditioning: an in vitro study

Uma alternativa de tratamento para as lesões iniciais de erosão é a aplicação de materiais resinosos. Porém, não há estudos que avaliem a penetração desses materiais no interior da lesão de erosão, o que poderia interferir em sua adesão e efeito. Portanto, o objetivo do presente estudo foi avaliar a penetração do infiltrante, adesivos e selante de fossas e fissuras, sobre lesões iniciais de erosão, com e sem condicionamento da superfície de esmalte. Utilizando um protocolo in vitro, foram estudados os tipos de tratamento em 5 níveis (Adhese®- sistema adesivo autocondicionante de 2 passos, Tetric N-Bond®- sistema adesivo convencional de 2 passos, Single Bond®- sistema adesivo convencional de 2 passos, Helioseal Clear®- selante resinoso e Icon®- infiltrante) e o tipo de condicionamento do esmalte em 2 níveis (com e sem). Os materiais foram corados com 0,02 mg/ml de solução etanólica de isotiocianato de tetrametilrodamina. Para o desenvolvimento da lesão inicial de erosão, 75 blocos de esmalte bovino (4 x 4 mm) foram imersos em HCl 0,01 M, pH 2,3, durante 30 segundos. Posteriormente, em metade da superfície dos blocos foram aplicados os materiais (marcados com rodamina), seguindo as instruções dos fabricantes. Na outra metade, os materiais foram aplicados da mesma forma, mas sem o condicionamento prévio do esmalte. Os blocos foram avaliados por Microscopia Confocal de Varredura a Laser nos modos de reflexão e fluorescência. Nas imagens geradas foram mensuradas a profundidade de desmineralização, a penetração e a espessura dos materiais, por meio do software ImageJ. Os dados foram analisados pelo teste ANOVA a dois critérios e teste de Tukey (p0,05), com exceção do Icon® (maior desmineralização) em relação ao Adhese® (p0,05). A aplicação do HeliosealClear® resultou em maior espessura de material seguido pelo Icon®, com diferença estatística significativa entre eles (p0,05). Concluiu-se que para todos os materiais resinosos estudados, o condicionamento prévio da superfície de esmalte aumentou a penetração do material no interior da lesão, sendo que o material com maior penetração foi o infiltrante (Icon®).The application of resin based materials is an alternative of treatment for eroded lesions. Nevertheless, there are no studies about the penetration of these materials into eroded lesion, which might affect its adhesion and effect. Therefore, the purpose of this study was to evaluate the penetration of infiltrant, adhesives and pit and fissure sealant on initial eroded lesion, with and without prior enamel surface conditioning. By using an in vitro protocol, types of treatment were studied at 5 levels (AdheSE®- two-steps self-etching adhesive system, Tetric N-Bond®- two-steps conventional adhesive system, Single Bond® - two-steps conventional adhesive system, Helioseal Clear®- resin sealant and Icon®-infiltrant) and type of enamel conditioning in two levels (with and without). The materials were stained with 0.02 mg/ml ethanolic solution of tetramethylrhodamine isothiocyanate. Bovine enamel samples (4 x 4 mm) were immersed in 0.01 M HCl, pH 2.0, for 30 seconds in order to produce initial eroded lesions. Afterwards, the materials (previously marked with rhodamine) were applied on half of sample enamel surface following the manufacturers instructions. On the other half of sample enamel surface, the materials were applied following the same instructions but without prior enamel surface conditioning. The enamel samples were evaluated by Confocal Laser Scanning Microscope using reflection and fluorescence modes. Depth of demineralization, depth of penetration and thickness of the materials were measured using ImageJ software. Data were analyzed by two-way ANOVA and Tukey test (p0.05), except Icon® (higher demineralization) compared to AdheSE® (p0.05). The application of Helioseal Clear® resulted in increased thickness of material followed by Icon®, with statistically significant difference (p0.05). It was concluded that for the studied resin based materials, the prior enamel surface conditioning increased penetration of the material into the eroded lesion and the infiltrant (Icon®) presented the highest penetration

Estratégias preventivas para a erosão dentária

In recent years, due to the high prevalence of dental erosion, therapies to prevent the occurrence or inhibit the progression of this condition have been searched. The purpose of this thesis was to present four articles that evaluated possible preventive measures for enamel erosion. Specifically, it was evaluated: article I - the effect of five types of vegetable oils against initial enamel erosion; article II - protective effect of palm oil alone or associated with a fluoride solution against erosive enamel wear (chemicalmechanical/ toothbrushing); article III - the protective potential against erosive tooth wear of an aspartame solution, used as mouthwash prior to acid exposure; article IV - the effectiveness of a dentifrice with calcium silicate, phosphate and fluoride on the prevention of erosive wear (chemical-mechanical/toothbrushing). In all articles, deionized water (DW) was used as negative control and a solution (SS) or dentifrice (SD) containing fluoride and stannous as positive control. The response variable adopted was loss of surface hardness for article I and enamel loss in height for articles II, III and IV. In article I, two volunteers used the intraoral appliance for 2 hours to form the acquired pellicle and then the enamel blocks of each study group were treated in vitro by 5 different vegetable oils at 2 different concentrations (5 or 100%). Then, the blocks were immersed in artificial saliva for 2 minutes and subjected to 0.5% citric acid for 2 minutes. Data were analyzed by one-way ANOVA and Tukey\'s test (p <0.05). Among the evaluated vegetable oils, palm oil was the only one that presented protective potential against initial enamel erosion, resulting in less hardness loss than DW and SS. In Article II, volunteers used intraoral appliances in situ for 5 days, in which 4 ex vivo erosive cycling with 0.5% citric acid for 2 minutes was carried out. Prior to the first and third erosive challenge, DW, SS and palm oil associated or not to SS were applied on enamel blocks by administration of one drop of the respective solution, followed by acid immersion. Then, the abrasive challenge was performed (brushing for 15 seconds). Data were submitted to 2-way ANOVA and Tukey\'s test (p <0.05). For both, erosion and erosion + abrasion, palm oil alone or associated to SS resulted in less enamel loss than DW, but did not differ from SS. In article III, 4x/day volunteers performed in situ mouthwashes with DW, SS or 0.024% aspartame solution. Then half enamel blocks were immersed ex vivo in intrinsic (0.01M hydrochloric acid pH 2.3) and the other half in extrinsic (0.03 citric acid pH 2.4 for 2 minutes) acid challenge for 5 days. After statistical analysis (2-way ANOVA and Tukey\'s test, p <0.05), it was observed that aspartame was similar to DW and resulted in greater loss of enamel than SS. Hydrochloric acid promoted higher enamel loss than citric acid. In article IV, volunteers used intraoral appliances in situ for 5 days and 4 erosive cycling with 0.5% citric acid for 2 minutes was carried out. Right after the first and third cycling of the day the dentifrices, including the one with addition of calcium silicate, phosphate and fluoride, were applied for 1 minute and then, half of the enamel specimens were brushed for 15 seconds (abrasion). Statistical analysis was performed by 2-way ANOVA and Fischer\'s exact test (p <0.05). The dentifrice containing calcium silicate, sodium phosphate and fluoride protected the enamel against erosion similar to SD; but when subjected to abrasion by brushing, it showed similar enamel loss than DW, demonstrating no protective effect. Among the tested preventive measures, palm oil presented promising results in the prevention of erosive tooth wear, similarly to a stannous-solution. Aspartame, however, did not present a preventive effect against erosive tooth wear caused by intrinsic or extrinsic acid. The dentifrice containing calcium silicate, sodium phosphate and fluoride only presented a preventive effect against erosion but it did not show a protective effect against erosive tooth wear.Devido à alta prevalência de erosão dentária encontrada nos últimos anos, tem se buscado terapias para prevenir a ocorrência ou inibir o avanço desta condição. O propósito deste estudo foi apresentar quatro artigos que avaliaram possíveis medidas preventivas para erosão dentária do esmalte. Especificamente, foram avaliados: artigo I - o efeito de cinco tipos de óleos vegetais contra a erosão inicial; artigo II - capacidade protetora do óleo de dendê sozinho ou associado uma solução fluoretada contra desgaste dentário erosivo (químido-mecânico/escovação); artigo III - o potencial protetor contra o desgaste dentário erosivo de uma solução com aspartame, utilizada como bochecho previamente a exposição ácida; artigo IV - a eficácia da aplicação do dentifrício com adição de silicato de cálcio, fosfato e flúor na prevenção do desgaste erosivo (químido-mecânico/escovação). Em todos os artigos adotou-se água deionizada (AD) como controle negativo e solução (SE) ou dentifrício (DE) contendo fluoreto e estanho como controle positivo. A variável de resposta adotada foi perda de dureza de superfície para o artigo I e perda de tecido dental duro em altura para os artigos II, III e IV. No artigo I, dois voluntários utilizaram o dispositivo intrabucal durante 2 horas para formação da película adquirida e em seguida, os blocos de esmalte de cada grupo em estudo foram tratados in vitro por 5 diferentes óleos vegetais em 2 concentrações distintas (5 ou 100%). A seguir, os blocos foram imersos em saliva artificial por 2 minutos e então, em ácido cítrico 0,5% por 2 minutos. Os dados foram analisados por ANOVA 1 critério e teste de Tukey (p<0,05). Dentre os óleos vegetais avaliados, o óleo de dendê foi o único que apresentou potencial protetor contra erosão inicial do esmalte pois resultou em menor perda de dureza quando comparado a AD e SE. No artigo II, voluntários utilizaram aparelhos palatinos in situ por 5 dias, sendo realizadas 4 ciclagens erosivas ex vivo em ácido cítrico 0,5% por 2 minutos, anteriormente a primeira e a terceira ciclagem a AD, o SE e o óleo de dendê associado ou não à SE foram aplicados nos blocos de esmalte por meio da administração de uma gota da respectiva solução, seguida da imersão ácida e então, o desafio abrasivo foi realizado (escovação por 15 segundos). Os dados foram submetidos a ANOVA 2 critérios e teste de Tukey (p<0,05). Tanto para erosão como para erosão+abrasão, o óleo de dendê sozinho ou associado à SE resultou em menor perda de esmalte do que AD, porém não diferiu da SE. No artigo III, os voluntários realizaram bochechos in situ 4x/dia com 0,024% de aspartame e então, metade dos blocos de esmalte foram submetidos ex vivo ao desafio com ácido intrínseco (ácido clorídrico a 0.01M pH 2.3) e a outra metade ao extrínseco (ácido cítrico 0.03M pH 2.4) durante 5 dias. Após análise estatística (ANOVA 2 critérios e teste de Tukey, p<0,05), constatou-se que o aspartame foi similar à AD e resultou em maior perda de esmalte do que SE; sendo que o ácido clorídrico promoveu maior perda de esmalte do que o ácido cítrico. No artigo IV, voluntários utilizaram aparelhos palatinos in situ por 5 dias e foram realizadas 4 ciclagens erosivas em ácido cítrico 0,5% por 2 minutos, sendo que logo após a primeira e terceira ciclagem do dia, os dentifrícios, incluindo o com adição de silicato de cálcio, fosfato e flúor foram aplicados por 1 minuto e metade dos espécimes foram escovados por 15 segundos (abrasão). A análise estatística foi realizada por ANOVA 2 critérios e teste exato de Fischer (p<0.05). O dentifrício contendo silicato de cálcio, fosfato de sódio e flúor protegeu o esmalte contra a erosão semelhantemente ao DE. Porém quando a abrasão por escovação foi associada, o mesmo resultou em perda de esmalte semelhante a AD e portanto, não houve efeito protetor. Dentre as medidas preventivas testadas o óleo de dendê apresentou resultados promissores na prevenção do desgaste dentário erosivo, se assemelhando ao estanho. Já o aspartame, não apresentou efeito preventivo contra o desgaste dentário erosivo causado por ácido intrínseco ou extrínseco. O dentifrício contendo silicato de cálcio, fosfato de sódio e flúor, só apresentou efeito preventivo contra a erosão, mas não foi capaz de proteger o esmalte contra o desgaste dentário erosivo

Influence of mandibular and palatal intraoral appliances on erosion in situ study outcome

Abstract The standardization of in situ protocols for dental erosion is important to enable comparison between studies. Objective: Thus, the objectives of this study were to evaluate the influence of the location of in situ intraoral appliance (mandibular X palatal) on the extent of enamel loss induced by erosive challenges and to evaluate the comfort of the appliances. Material and Methods: One hundred and sixty bovine enamel blocks were selected according to their initial surface hardness and randomly divided into two groups: GI - palatal appliance and GII - mandibular appliance. Twenty volunteers wore simultaneously one palatal appliance (containing 4 enamel blocks) and two mandibular appliances (each one containing 2 enamel blocks). Four times per day during 5 days, the volunteers immersed their appliances in 0.01 M hydrochloric acid for 2 minutes, washed and reinserted them into the oral cavity for 2 hours until the next erosive challenge. After the end of the in situ phase, the volunteers answered a questionnaire regarding the comfort of the appliances. The loss of tissue in the enamel blocks was determined profilometrically. Data were statistically analyzed by paired t-test, Chi-square and Fisher's Exact Test (p<0.05). Results: The enamel blocks allocated in palatal appliances (GI) presented significantly higher erosive wear when compared to the blocks fixed in mandibular appliances (GII). The volunteers reported more comfort when using the palatal appliance. Conclusions: Therefore, the palatal appliance is more comfortable and resulted in higher enamel loss compared to the mandibular one

Vitamin E: A potential preventive approach against dental erosion-an in vitro short-term erosive study.

OBJECTIVES This study evaluated the in vitro effect of different components of palm oil on enamel in a short-term erosive challenge. METHODS The acquired enamel pellicle (AEP) was previously formed in situ for 2 h. Subsequently, the bovine enamel blocks were treated in vitro according to following solutions: G1-palm oil; G2-85% tocotrienol solution; G3-oily vitamin E; G4-oily vitamin A; G5-deionized water (negative control); G6-stannous-containing solution (Elmex® Erosion Protection Dental Rinse) (positive control). After application of the treatment solutions (500 µl, 30 s), the blocks were immersed in 0.5% citric acid (pH 2.4) during 30 s (initial erosion). The response variable was the percentage of surface hardness loss. Data were analyzed by one-way ANOVA and Fisher's Test (p < 0.05). RESULTS The positive control (G6), palm oil (G1) and oily vitamin E (G3) groups presented the lowest percentage of surface hardness loss, and were statistically different from the negative group (G5) (p < 0.05), and no differences were found between these three groups. The 85% tocotrienol solution (G2) and oily vitamin A groups (G4) were not different to the negative control group. CONCLUSIONS Stannous-containing positive control (Elmex® Erosion Protection), palm oil and oily Vitamin E were able to protect enamel against the erosive challenge performed in this in vitro study. In addition, vitamin E is probably the key ingredient of palm oil responsible for preventing enamel erosion. CLINICAL SIGNIFICANCE Vitamin E presented similar preventive effect to a commercial mouthwash stannous-containing solution (Elmex® Erosion Protection) against initial erosion and, it can be considered as a promising natural alternative for the formulations of solutions aiming to prevent erosive tooth wear

Effect of vegetable oils applied over acquired enamel pellicle on initial erosion

Abstract Objective The prevalence of dental erosion has been recently increasing, requiring new preventive and therapeutic approaches. Vegetable oils have been studied in preventive dentistry because they come from a natural, edible, low-cost, and worldwide accessible source. This study aimed to evaluate the protective effect of different vegetable oils, applied in two concentrations, on initial enamel erosion. Material and Methods Initially, the acquired pellicle was formed in situ for 2 hours. Subsequently, the enamel blocks were treated in vitro according to the study group (n=12/per group): GP5 and GP100 – 5% and pure palm oil, respectively; GC5 and GC100 – 5% and pure coconut oil; GSa5 and GSa100 – 5% and pure safflower oil; GSu5 and GSu100 – 5% and pure sunflower oil; GO5 and GO100 – 5% and pure olive oil; CON− – Deionized Water (negative control) and CON+ – Commercial Mouthwash (Elmex® Erosion Protection Dental Rinse, GABA/positive control). Then, the enamel blocks were immersed in artificial saliva for 2 minutes and subjected to short-term acid exposure in 0.5% citric acid, pH 2.4, for 30 seconds, to promote enamel surface softening. The response variable was the percentage of surface hardness loss [((SHi - SHf) / SHf )×100]. Data were analyzed by one-way ANOVA and Tukey’s test (p0.05) and less than the other groups (p<0.05). There was no difference between GP5, GC5, GC100, GSa5, GSu100, GSa100, GSu5, GO5, GO100, CON− and CON+. Conclusion Palm oil seems to be a promising alternative for preventing enamel erosion. However, further studies are necessary to evaluate a long-term erosive cycling

Delayed Treatment of Traumatized Primary Teeth with Distinct Pulp Response: Follow-Up until Permanent Successors Eruption

Complicated crown fracture and crown-root fracture with pulp involvement expose dental pulp to the oral environment. The pulp outcome is often unpredictable because the patient and injury which are related to variables can influence the treatment of choice and the prognosis of the case. This report presents the case of a 4-year-old boy with complicated crown fracture with pulp polyp in the primary right maxillary central incisor (51) and crown-root fracture with pulp involvement in the primary left maxillary central incisor (61), which was treated only 3 months after the tooth injuries. The treatment of choice was extraction of tooth (61) due to a periapical lesion with disruption of the dental follicle of the permanent successor and pulpotomy (MTA) of the tooth (51), because the pulp presented signs of vitality. At the follow-up visits, no clinical, symptomalogical, and radiographic changes were observed until the primary tooth’s exfoliation. However, at 3-year follow-up, the permanent successors showed hypocalcification and the position of the permanent right maxillary central incisors (11) was altered. Besides the conservative and adequate delayed treatment, the sequelae on the permanent successors could not be avoided