Background: Pulp stones are discrete calcified bodies found in the dental pulp. The aims of this study were to calculate the prevalence of pulp stones in young Australian adults using radiographs, and to report any associations between occurrence of pulp stones and sex, tooth type, dental arch, side and dental status. Methods: From 217 undergraduate dental students, comprising 123 males and 94 females aged between 17-35 years, 3296 teeth were examined under 2x magnification on bitewing radiographs. Pulp stones were scored as present or absent, and associations with sex, tooth type, dental arch, side and dental status noted. Results: Pulp stones were found in 100 (46.1 per cent) of the subjects and 333 (10.1 per cent) of the teeth examined. Occurrences were rare in premolars (0.4 per cent) but significantly higher in molars (19.7 per cent). Pulp stones were significantly more common in first molars than in second molars, and in maxillary first molars than in mandibular first molars. Carious and/or restored maxillary right first molars and maxillary left second molars displayed higher prevalences of pulp stones than unrestored and intact molars. Conclusion: Pulp stones may provide useful forensic information when examining dental records to identify deceased persons.Key words: Pulp tissue, calcification, dental arches, dental status.(Accepted for publication October 2000.) and the latter being degenerative pulp calcifications. Other studies have noted problems with the above classification and new histologic classifications have been proposed. [2][3][4]

The increasing prevalence of gastroesophageal reflux disease (GERD) in children and adults, and of “silent refluxers” in particular, increases the responsibility of dentists to be alert to this potentially severe condition when observing unexplained instances of tooth erosion. Although gastroesophageal reflux is a normal physiologic occurrence, excessive gastric and duodenal regurgitation combined with a decrease in normal protective mechanisms, including an adequate production of saliva, may result in many esophageal and extraesophageal adverse conditions. Sleep-related GERD is particularly insidious as the supine position enhances the proximal migration of gastric contents, and normal saliva production is much reduced. Gastric acid will displace saliva easily from tooth surfaces, and proteolytic pepsin will remove protective dental pellicle. Though increasing evidence of associations between GERD and tooth erosion has been shown in both animal and human studies, relatively few clinical studies have been carried out under controlled trial conditions. Suspicion of an endogenous source of acid being associated with observed tooth erosion requires medical referral and management of the patient as the primary method for its prevention and control.

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Numerous case-control and other studies involving confirmation of gastroesophageal reflux disease (GERD) by esophageal pH-metry and the assessment of dental erosions have shown significant associations between the two conditions in both adults and children. By contrast, when asked to vote on whether GERD may cause dental erosions, only 42% of physicians strongly agreed that such an association existed in adults, and just 12.5% strongly agreed for children, respectively in two global consensus reports. Part of this divergence between the perceptions of physicians and the findings of research publications may reflect a general lack of oral health education during medical training, and cursory oral examinations being made under less-than-ideal conditions. Adequate salivary secretions are essential for the protection of the teeth and the oropharyngeal and esophageal mucosa. The quantity and quality of the saliva require monitoring as many drugs, including several of the proton pump inhibitors (PPIs), can cause hyposalivation. In addition, PPIs do not always result in adequate acid suppression. Therefore, collaboration between physicians and dentists is strongly advocated to prevent or ameliorate possible adverse oral effects from both endogenous and exogenous acids, and to promote adequate saliva production in patients with GERD.

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