Risk Assessment and Preventive Measures

Abstract

A prerequisite for preventive measures is to diagnose erosive tooth wear and to evaluate the different etiological factors in order to identify persons at risk. No diagnostic device is available for the assessment of erosive defects. Thus, they can only be detected clinically. Consequently, erosion not diagnosed in the early stage may render timely preventive measures difficult. In order to assess the risk factors, patient should record their dietary intake for a distinct period of time. Then a dentist can determine the erosive potential of the diet. Particularly, patients with more than four dietary acid intakes have a higher risk for erosion when other risk factors (such as holding the drink in the mouth) are present. Regurgitation of gastric acids (reflux, vomiting, alcohol abuse, etc.) is a further important risk factor for the development of erosion which has to be taken into account. Based on these analyses, an individually tailored preventive program may be suggested to the patients. It may comprise dietary advice, optimization of fluoride regimes, stimulation of salivary flow rate, use of buffering medicaments and particular motivation for nondestructive toothbrushing habits with a low abrasive toothpaste. The frequent use of fluoride gel and fluoride solution in addition to fluoride toothpaste offers the opportunity to reduce somewhat abrasion of tooth substance. It is also advisable to avoid abrasive tooth cleaning and whitening products, since they may remove the pellicle and may render teeth more susceptible to erosion. Since erosion, attrition and abrasion often occur simultaneously all causative components must be taken into consideration when planning preventive strategies.

Effects of enamel abrasion, salivary pellicle, and measurement angle on the optical assessment of dental erosion

“…The degree of abrasion of demineralized teeth, in turn, depends on the applied force, 31 filament stiffness and end-rounding of the toothbrush, 32 abrasive properties of the dentifrice, 32 brushing frequency and number of applied strokes, and demineralization extent of the enamel. 33 Because patients suffering from erosive tooth wear are usually recommended to use toothbrushes with relatively soft filaments, 34,35 soft brushes (Trisa Ultra®) with a load of 200 g 36,37 and 20 strikes were applied in the present study for the abrasive treatment. No dentifrice or slurry was used in experiment 1 to avoid side remineralization effects by the components of dentifrice (Ca 2þ , F − , phosphates, etc).…”

Dental approach to erosive tooth wear in gastroesophageal reflux disease

“…30 Saliva contains buffers to resist changes in pH and provides a constant supply of ions to the tooth surface. 31 Saliva, with its buffering capacity and its ability to form a protective enamel pellicle, can control dental decalcification.…”

“…32 Once the erosive agent is neutralized and/or cleared from the tooth surface, the deposition of salivary calcium and phosphate can lead to remineralization of some of the softened tissue. 30 Any reduction in the loss of the salivary buffering capacity contributes to the process of enamel erosion. 33 Assessing salivary parameters, such as pH and buffering capacity, in the dental office is possible using commercially available diagnostic kits.…”

“…For those at high risk of dental erosion, it is advisable to consume in moderation by decreasing the frequency of ingestion of potentially harmful drinks and food, restricting them to main meals, and minimizing their contact time with teeth. 18,30,31 Frequent chewing of sugar-free antacid medications will help to reduce the acidity and to improve salivary flow rates. 16 Patients can take antacids immediately after heartburn or a sensation of acid reflux into the oral cavity.…”

Minimal intervention dentistry: part 4. Detection and diagnosis of initial caries lesions

“…Some authors agree that this system has better sensitivity than visual or radiographic examination. [18][19][20][21] Its specificity is acceptable but its reproducibility remains controversial. [22][23][24] Using the DIAGNOdent pen® is easier than its predecessor because the hand piece is no longer connected to a monitor by an optical cord.…”