Search Results (44)

Background/Objectives: The aim of this study was to show a standardized four-step technique that can offer individually personalized full-mouth therapy for each complex dental patient with erosive tooth wear resulting from bulimia nervosa, focusing on the individualized vertical dimension of occlusion (VDO), functional and aesthetic stability, and patient-reported outcomes, including dental symptoms, nutrition, self-perception, and quality of life. Methods: The following steps are proposed for structured full-mouth rehabilitation. Step 1: Intraoral diagnosis via a single computer-aided impression. Step 2: Determination of a new adequate vertical dimension of occlusion and soft tissue prediction. Step 3: Removable sample dentures—prototypes. Step 4: Non-prep/minimal-prep crowns as the long-term provisional/definitive treatment. Results: Nine adults (11% male) with dental erosion caused by bulimia nervosa (78%), gastro-esophageal reflux (11%), and soft drinks (11%) were part of this cohort. The novel digital workflow enabled restoration of an individualized vertical dimension of occlusion, stable occlusion, appropriate centric and eccentric contacts, biomimetic dental anatomy, harmonious tooth proportions, and optimized red–white aesthetics. Dental problems (hypersensitivity, dental pain), nutritional behavior, body perception, and quality of life improved after the full-mouth rehabilitation. Conclusions: The presented digital workflow offers a promising approach for full-mouth rehabilitation in patients with severe dental erosion, particularly associated with bulimia nervosa, enabling structured restoration planning and stepwise evaluation of the vertical dimension of occlusion and functional adaptation. Prospective studies with larger cohorts are needed to confirm long-term clinical outcomes and patient-reported benefits. Full article

The demineralization of tooth enamel is the primary consequence of dental caries, leading to cavities and finally tooth loss. Erosive tooth wear from acidic beverages and food is another factor that degrades enamel. In both cases, an acidic environment leads to etching and the final dissolution of tooth mineral, i.e., hydroxyapatite. Here, this process is discussed from a chemical perspective, taking into account the solubility of calcium phosphate and the presence of the pellicle (protein layer) and plaque (bacterial biofilms), which both affect the dissolution rate. While low pH is definitely decisive, calcium-binding ligands (e.g., acid anions, proteins) contribute to dissolution by removing calcium ions from the equilibrium. This is an important effect in the oral cavity where the concentration of biomolecules is high. The situation is complicated by the fact that the composition of saliva and the oral microbiome vary considerably between individuals. The state of current knowledge on the demineralization of enamel is summarized and discussed, also in the context of approaches to prevent dental caries and erosive tooth wear. Full article

Objective: To evaluate the ability of an experimental propolis/chitosan varnish to inhibit the erosive process in primary tooth enamel. Materials and Methods: Forty-two primary incisors were selected and divided into three groups (n = 14): control/no treatment, Duraphat^® varnish, and propolis/chitosan varnish. The varnishes were applied to the experimental area and left in place for 4 h. After varnish removal, the specimens were subjected to erosive challenges with Coca-Cola^®. The quantitative outcome variables were mineral loss assessed by longitudinal microhardness, surface roughness, and wear profile. The data were analyzed using ANOVA and Tukey’s test (p < 0.05). Results: Wear profile and surface roughness analyses showed no significant differences among the groups (p > 0.05). In the microhardness analysis, the control and experimental groups showed significant differences between the control and demineralized areas and between the control and experimental areas (p < 0.05). In the Duraphat group, a significant difference was observed between the control and experimental areas (p < 0.05). Conclusions: The experimental propolis/chitosan varnish was unable to prevent the progression of mineral loss in the enamel of primary teeth subjected to erosive challenge. Duraphat^® fluoride varnish was also unable to protect the enamel. Clinical relevance: Several studies have investigated the use of propolis and chitosan in dentistry, and promising results have been reported when these agents are used individually; however, the propolis/chitosan combination remains poorly explored. To the best of our knowledge, this is the first study to investigate this combination for dental erosion in primary teeth. Full article

Objectives: This study aimed to evaluate and compare the performance of three tooth wear indices—BEWE, simplified TWI (sTWI), and TWES 2.0—based on the visual assessment of digital intraoral scans. A secondary exploratory objective was to examine unadjusted sex-stratified score distributions. Methods: This retrospective study included 246 anonymized intraoral scans obtained using Medit i700 and iTero Element 2 systems. All scans were independently evaluated by two calibrated examiners using the BEWE, simplified TWI (sTWI), and TWES 2.0 indices. Scoring was performed through visual assessment of the digital models, without applying automated measurements or software-assisted analysis tools. Unadjusted sex-stratified patterns were explored using mixed-effects linear models, with a significance threshold set at p < 0.05. Estimated marginal means were calculated, and graphical approaches, including heatmaps, were used to present score distributions and inter-examiner variability. Results: The indices exhibited different scoring characteristics. BEWE produced the most consistent sextant-based patterns, with low variability between examiners. TWES 2.0 showed generally stable scoring, although with slightly greater dispersion, particularly in posterior sextants. In contrast, sTWI demonstrated the highest variability and more pronounced surface-specific differences, especially on occlusal and palatal surfaces. Sex-stratified analyses indicated minor and inconsistent variations. Although isolated statistically significant findings were observed (BEWE Sextant 6; TWES 2.0 Sextant 5), they did not form a consistent or interpretable pattern. Conclusions: Assessment based on digital intraoral scans highlighted differences in scoring behavior depending on the index used. BEWE demonstrated the most stable scoring patterns, TWES 2.0 showed moderate consistency, while sTWI was associated with the greatest variability. Differences observed in sex-stratified analyses were minor and lacked consistency. Clinical significance: BEWE enables consistent scoring when applied to digital scans and may be appropriate for monitoring purposes. TWES 2.0 provides a structured approach to screening. The higher variability observed with sTWI indicates that caution is warranted when it is used exclusively on digital models. Overall, the choice of index has a substantial impact on the assessment of tooth wear in digital workflows. Full article

Background: Severe obesity is associated with chronic low-grade inflammation, dysglycemia, and higher periodontitis risk. Sleeve gastrectomy (SG) is now a dominant bariatric procedure and reliably improves weight and metabolic status yet reported oral and periodontal trajectories after surgery remain heterogeneous. Objective: To synthesize SG-centered evidence on periodontal outcomes, oral and gut microbiome remodeling, and mechanistic pathways that may link postoperative physiology to the gut–oral axis. Methods: We conducted a structured narrative review guided by SANRA principles using targeted searches of PubMed/MEDLINE, Web of Science, Scopus, and Embase, complemented by citation chaining of key reviews and mechanistic anchor papers; evidence was organized into clinical, oral microbiome, gut microbiome, and mechanistic gut–oral axis streams and interpreted with a pragmatic evidence hierarchy. Results: Small prospective SG cohorts suggest bleeding on probing (BOP), gingival indices, and sometimes probing depth (PD) may improve in some patients, particularly alongside weight loss, improved glycemic control, and lower systemic inflammatory burden, whereas clinical attachment level (CAL) and longer-term structural trajectories remain mixed; mixed-procedure syntheses also report early deterioration in some settings. Oral microbiome findings after bariatric surgery are site- and time-dependent, and salivary signals do not necessarily mirror subgingival plaque, whereas gut microbiome remodeling and bile acid signaling changes are more consistently reported and provide plausible but indirect mediator candidates. At the same time, reflux, vomiting, salivary changes, diet patterning, medications, and periodontal care can modify or counteract potential periodontal benefits and may increase competing risks such as caries or erosive tooth wear. Conclusions: The SG–gut–oral axis-periodontal pathway is a biologically plausible working hypothesis rather than a proven causal pathway in humans. The present evidence for any periodontal benefit relies mainly on small observational cohorts and is most credibly demonstrated for inflammatory, not structural, endpoints. Full article

Background/Objectives: Tooth wear (TW) is a prevalent multifactorial condition resulting from chemical erosion and mechanical forces, yet the contributions of risk-group status and salivary factors remain insufficiently characterized. This study aimed to investigate the relationship between salivary characteristics and the severity of chemical and mechanical TW in at-risk groups, including gastroesophageal reflux disease (GERD), sleep bruxism (SB), eating disorders (EDs) and gambling disorder (GD). Methods: This cross-sectional observational study enrolled adults categorized into the four mutually exclusive at-risk groups and an age and sex-matched healthy control group. Demographic information, medical history, oral hygiene, diet, stress, and parafunctional habits were obtained through questionnaires. TW was assessed by a single examiner using TWES 2.0. Maximum bilateral force and salivary pH, flow and buffer capacity was measured. Correlations, multivariate linear regression, and mediation models were used to explore the relationships between the different variables and TW. Results: In total, 147 participants, divided into five groups (34 with GERD, 28 with SB 20 with GD, 20 with ED, and 45 controls) were included. The lowest resting salivary pH was observed in the GERD and ED groups (GERD: 6.63 ± 0.61; ED: 6.62 ± 0.52). The GERD group also exhibited the highest chemical (1.51 ± 0.58) and mechanical (1.08 ± 0.58) TW. Chemical and mechanical wear were strongly correlated, and mechanical wear increased with age. Risk-group status and salivary pH explained 47% of chemical wear, while age and bite force explained 54% of mechanical wear. Conclusions: Chemical TW was strongly linked to risk-group status—particularly GERD/ED—and low salivary pH, while mechanical TW related to age and bite force. Further longitudinal studies with larger samples, employing standardized methodologies and criteria are needed. Full article

Background: Dental erosion is the irreversible loss of tooth structure from acid exposure. Its prevalence is rising globally, making it an important oral health concern. However, longitudinal data from Eastern Europe are scarce, especially in Romania. This pilot study aimed to assess the 10-year incidence of dental erosion in Romanian young adults and to compare clinical index scoring with digital scanning. Methods: A 10-year prospective study followed 540 Romanian adults (aged 18–30) selected with no erosive lesions at baseline (Basic Erosive Wear Examination BEWE = 0). Erosive wear was assessed at the 10-year follow-up using BEWE, with 40 participants also undergoing digital intraoral scanning to measure enamel loss (μm). Gender differences were analyzed. Chi-square tests, relative risk, and correlation analyses were performed. Results: After 10 years, 23.2% of participants developed dental erosion. Males exhibited a higher incidence than females (29.9% vs. 17.2%; RR = 1.74, p < 0.001). Among the scanned subset (n = 40), the mean enamel loss was 137 ± 79 µm, with greater wear on palatal vs. buccal surfaces (p = 0.002). BEWE scores were moderately correlated with digital enamel loss (r = 0.58, p < 0.001). Conclusions: Erosion progressed over time in this cohort, with males at higher risk. Digital scanning detected subtle enamel loss not captured by BEWE, indicating greater sensitivity to early changes. BEWE and digital methods provided complementary information; their combined use offers a more comprehensive assessment. Full article

Background: In recent years, thanks to the improvement of adhesive techniques, patients affected by tooth wear, related to erosion and/or parafunctional habits, can undergo restoration by adding only what has been lost of their dentition (additive approach). However, since not all clinicians are convinced that dental rehabilitation should be proposed in the early stages of exposed dentin, several treatments are often postponed. It is important to emphasize that, in the early stages, the clinical approach should remain conservative, focusing on dietary counseling, the modification of harmful habits, fluoride application, and risk factor management. Only when these preventive and non-invasive strategies prove insufficient, and the condition continues to progress, should invasive restorative treatments be considered. Unfortunately, epidemiological studies are reporting an increase in the number of young patients affected by erosive tooth wear, and not intercepting these cases earlier could lead to a severe degradation of the affected dentition. In addition, parafunctional habits are also becoming more frequent among patients. The combination of erosion and attrition can be very destructive, and may progress rapidly once dentin is exposed and the risk factors remain unaddressed. The aim of this report was to present a conservative full-mouth rehabilitation approach for severe erosive lesions and to provide a 10-year follow-up assessing the biological, functional, and esthetic outcomes. Methods: In this article, the postponed restorative treatment of a patient, suffering from severe tooth wear, is illustrated. The patient had sought dental treatment in the past; however, due to the already very compromised dentition, a conventional but very aggressive treatment was proposed and refused. Four years later, when the patient finally accepted an alternative conservative therapy, the tooth degradation was very severe, especially at the level of the maxillary anterior teeth. The combination of three different approaches, Speed-Up Therapy, BOPT (Biologically-Oriented Preparation Technique), and the 3 Step Technique, however, improved the capacity to successfully complete the difficult therapeutic task. Results: The biological goals (maintenance of the pulp vitality of all of the teeth and the minimal removal of healthy tooth structure) were accomplished, relying only on adhesive techniques. Conclusions: The overall treatment was very comfortable for the patient and less complicated for the clinician. At 10-year follow-up, biological, functional, and esthetic success was still confirmed. Full article

Background/Objective: With a prevalence linked to modern lifestyle, erosive tooth wear (ETW) is a growing clinical problem among children and adolescents. The aim of this cross-sectional study was to record the awareness and knowledge of ETW among Greek dentists and to explore their preferred treatment decisions. Methods: A case-based digital questionnaire was distributed to a stratified sample of dentists practising in Athens (n = 218). We collected data regarding clinical scoring, possible aetiological factors, and clinical management of ETW and used descriptive statistics, chi-square tests, and odds ratio calculations to process the outcome. Results: The response rate was 92%. The majority (71%) recorded ETW among their patients, but only 5% used an established and validated scoring system. Almost 1/3 registered only the location of the lesions. Over 70% disclosed the possible causes of ETW, with frequent consumption of fizzy soft drinks (67%) and acidic foods (56%) being the most common. Most respondents managed the ETW patients in their own clinic, while 23% referred them to another dentist or a university clinic. The respondents focused on secondary prevention (dietary advice, oral hygiene, and fluoride exposure) and preferred less invasive options for anterior teeth, with restorative care restricted to the lower molars. Conclusions: The majority of the dentists participating in this survey registered ETW and its possible causes and seem to have adopted a preventive and minimally invasive approach for the management in children and adolescents. For the case documentation, a minority took advantage of standardised scoring systems for lesions and dietary habits, and very few performed salivary diagnostics. The findings underscore the need of continuing education to offer updates on the most current guidelines and focusing on patients’ needs and expectations. Full article

Background/Objectives: Tooth wear is a progressive and multifactorial condition influenced by mechanical and chemical factors. Saliva plays a crucial role in modulating erosive wear through its buffering capacity and remineralization potential. This study aimed to assess the prevalence and severity of erosive tooth wear among dental students and explore its correlation with salivary factors such as flow rate and pH. Methods: A cross-sectional study was conducted on 96 individuals from the Egas Moniz School of Health & Science. Erosive wear was evaluated using the Basic Erosive Wear Examination (BEWE) index. Unstimulated and stimulated saliva samples were collected to measure salivary flow rate and pH. Statistical analyses included Spearman’s correlation and multinomial logistic regression. Results: All individuals were classified as no risk (BEWE Score 0–2) or low risk (BEWE Score 3–8). The most affected teeth were the lower first molars and the 4th and 6th sextants. Salivary analysis showed a mean unstimulated flow rate of 0.5 mL/min and stimulated flow of 1.7 mL/min. A significant negative correlation (rho = −0.224, p = 0.029) was found between stimulated salivary pH and BEWE score, indicating that higher acidity contributes to greater erosive wear. Conclusions: This study highlights the impact of salivary properties on erosive tooth wear, emphasizing the protective role of higher salivary pH. Regular monitoring of saliva and preventive strategies should be integrated into early diagnosis and management of erosive wear in young adults. Full article

Background/Objectives: To assess and compare the knowledge of and attitudes toward erosive tooth wear (ETW) among university students at the Portuguese University Fernando Pessoa (UFP). Methods: Cross-sectional, prospective pilot study approved by the UFP-Ethics Committee for a bilingual (English and Portuguese) online self-administered questionnaire displayed to all UFP students of the 2023–2024 academic year. Two groups were recruited, dental students (DSs) and non-medical students (NMSs), based on a convenience sample of 344 students. Participants voluntarily answered demographic questions, 15 true/false/do not know questions between knowledge of ETW, and 10 positive statements to score the attitude toward ETW based on a 5-point Likert scale. Differences in scores for DSs and NMSs groups by non-parametric tests and the correlation between knowledge of and attitudes by the Pearson coefficient were considered significant for p < 0.05. Results: A total of 251 (72.9%) students participated, but only 245 (71.2%) fulfilled the survey. The knowledge and attitude scores of the DSs (Md = 12.0; IQR 11.0–13.0 and Md = 43.0; IQR 40.0–48.0) were higher (p < 0.001; p = 0.019) than those of NMSs (Md = 8.0; IQR 6.0–10.0 and Md = 41.0; IQR 38.0–46.0). The attitudes score showed similar (p > 0.05) results for gender, age, nationality, and curricular year. Moderate level of knowledge was higher (p < 0.001) for DSs (Md = 12.0, IQR 11.0–12.0) than for NMSs (Md = 10.0, IQR 9.0–10.0) students. DSs and NMSs revealed differences in attitude level distribution (p < 0.001). Conclusions: This survey highlighted the need for knowledge on ETW among NMSs, but especially the high need for measures to promote more positive attitudes toward ETW among all university students, DSs, and NMSs. It provided valuable insights into the demographic characteristics, response rate, knowledge, and attitude scores of ETW with the implementation of multicenter designs applied to similar populations being important for future research. Full article

Background/Objectives: Early tooth wear (TW) assessment prevents challenging and costly dental treatments. Knowledge of data on the prevalence and risk factors is crucial for developing preventive guidelines. This retrospective cross-sectional study aims to study the prevalence of TW in a sample of patients seeking a Screening and Emergency appointment at Egas Moniz Dental Clinic (EMDC) and its associated risk factors. Methods: Descriptive and logistic regression analysis were applied to data from a sample of 2266 patients, collected between 2021 and 2023, to ascertain the presence of tooth wear, its different types and its correlation with potential risk factors. Results: The prevalence of dental wear was found to be 54.7%, with attrition (24.1%) being the most prevalent lesion and erosion (2.7%) the least prevalent. Concerning the risk predictors for tooth wear, age (OR = 1.01–1.05, p < 0.05), decreased DVO (OR = 2.16, p = 0.028), antacids (OR = 7.07, p = 0.003), mastication difficulties (OR = 1.87, p = 0.039), drugs (OR = 2.38, p = 0.032) and use of mouthwash (OR = 1.47, p = 0.008) were positively associated. Gender (OR = 0.7, p = 0.015) was negatively associated, with females showing a 30% less risk than males. Conclusions: It was concluded that TW is prevalent and increases with age, underscoring the necessity for timely and accurate diagnosis to minimize its progression. Additionally, it is crucial to conduct a thorough evaluation of the risk factors involved to implement effective preventive measures and treatment strategies. Full article

The aim of this in vitro study was to evaluate the effectiveness of highly concentrated fluoride products and remineralizing products (F-APC) in preventing erosive dental lesions in competitive swimming patients. A total of 48 teeth were extracted, preserved in saline solution and divided into three groups. In G1 (control group), each tooth was half-immersed in chlorinated pool water; in G2 (fluoride-treated group), after being totally immersed in chlorinated water, each tooth had half of its surface treated with a highly concentrated fluoride product once a week; in G3 (remineralization product-treated group), each tooth was totally immersed in chlorinated water and half of its surface was treated with a remineralizing product after each immersion. The study was conducted over a 4-week period, immersing the teeth for 4 h per day. In G1, statistically significant differences were observed in submerged versus non-submerged tooth surfaces at week 3 (T3) (p = 0.019) and week 4 (T4) (p = 0.0007), with four and eight surfaces showing erosive tooth wear (ETW), respectively. In G2, a difference was observed between fluoride-treated and non-fluoride-treated surfaces at T4 (p = 0.039), with three surfaces with ETW among the non-treated ones. In G3, the difference was observed between portions treated with F-APC and those not treated at T4 (p = 0.019), with four surfaces with ETW among the untreated ones. Chlorinated pool water is a potential erosive agent for teeth if water pH values reach a critical value. Treating the teeth surface with highly concentrated fluoride products, once a week for 5 min, and F-APC are effective in protecting teeth against tooth erosion. Full article

Background and Objective: Limited access to health services and low educational levels are factors in the rural population that are associated with the development of oral pathologies. However, the specific risk indicators contributing to erosive tooth wear (ETW) in these populations remain unclear. The objective of this study was to identify risk indicators associated with the prevalence of erosive tooth wear (ETW) in schoolchildren aged 8–12 years from rural and urban areas in the State of Mexico. Methods: A cross-sectional study was carried out in public schools in rural and urban areas. The prevalence of ETW was evaluated using the Basic Erosive Wear Examination (BEWE). The risk indicators studied were gastroesophageal reflux, vomiting, vitamin C, food, beverages, dental hygiene, bruxism, and hyposalivation. Logistic regression models were used to calculate odds ratios (OR) and 95% confidence intervals (CI). Results: The prevalence of ETW was higher in the rural area (77.3%) compared to the urban area (51.2%) (p = 0.001). The odds of presenting ETW were more than twice in schoolchildren from rural areas compared to those from urban areas (OR: 2.25, 95% CI: 1.11–3.98). Risk indicators varied between rural and urban populations, with different factors such as the consumption of fresh tomato sauce, orange, tangerine, atole (artisanal corn-based drink), and teeth grinding in the rural area, and lemon, soft drink, fruit juice consumption, and the simplified oral hygiene index in the urban area (p < 0.05). Conclusions: To prevent ETW, strategies offering tailored dietary and hygiene advice should be proposed, considering the specific conditions of each geographic area. Full article

The aim of this in vivo study was to compare total protein present in the salivary films (F) and acquired enamel pellicle (AEP) on eroded and non-eroded surfaces in patients suffering from GORD symptoms with and without GORD diagnosis (GORD, No-GORD). Thirty-nine patients suffering from GORD symptoms and erosive tooth wear on lower first molars and an unaffected posterior occlusal surface in the same quadrant were recruited from Guy’s hospital, London. Salivary film and AEP were collected from the eroded and uneroded occlusal surfaces, using 0.5% sodium dodecyl sulphate (SDS)-soaked filter papers. Total protein concentration was analysed using bicinchoninic acid assay (BCA). Statistical analysis was conducted using Shapiro–Wilk, ANOVA, and Tukey’s tests (p < 0.05), comparing four GDS sample types and GORD vs. No-GORD groups. The level of significance was set as p < 0.05. Data were compared between eroded and uneroded surfaces in the same patient with GORD symptoms, as well as between those with or without a GORD diagnosis (GORD, No-GORD). The AEP total protein concentration from the eroded [2.17 (0.49) mg/mL] and uneroded surfaces [2.24 (0.66) mg/mL] of the GORD group were statistically significantly lower than those on eroded [3.27 (1.01) mg/mL] and uneroded [3.33 (1.57) mg/mL] surfaces in the No-GORD group (p = 0.007) (p = 0.008), respectively. No statistically significant differences were observed for film and AEP between eroded and uneroded surfaces (p > 0.05). Full article