Monographs in oral science最新文献

For the first-line restorative management of worn dentition, direct composite restorations offer several advantages. However, the selection of this material and its method of application may not consistently provide a satisfactory longer-term treatment solution, particularly at molar teeth. This clinical approach is neither mutually exclusive, as there are various alternative dental materials available for similar clinical purposes, often applied using indirect fabrication techniques. These alternatives may offer benefits such as enhanced aesthetics and superior mechanical properties. It is essential for clinicians to have a comprehensive understanding of the various dental materials and techniques that may be suitable for a given clinical presentation. This involves evaluating the risks, benefits, costs and likely prognosis of each option. A thorough grasp of application protocols, along with an evidence-based approach, is crucial with the attainment of informed consent. In this chapter, the role of indirect restorations - ranging from resin-based composites to ceramic materials - will be discussed, along with the supporting evidence. The use of both partial and full-coverage indirect restorations will be reviewed, as well as the performance of more novel dental materials. An overview of the key stages in planning the rehabilitation of worn dentition will also be provided, including occlusal considerations, occlusal treatment concepts and smile design - critical factors for achieving optimal treatment outcomes. Additionally, this chapter will cover the steps involved in preparing diagnostic mock-ups used for the treatment of worn dentition.

Erosive tooth wear, characterized by the impact of non-bacterial acids as the predominant primary causal factor, has become a growing concern in dentistry. This review explores the diagnostic challenges associated with erosive tooth wear, its distinction from other forms of tooth wear such as attrition and abrasion and the need for early detection to prevent severe damage. The morphological features of erosive wear, the clinical assessment methods, including the use of indices like the Basic Erosive Wear Examination, and modern technological advancements, such as intraoral scanners, for monitoring wear progression are outlined. What also is addressed is the ongoing debate over whether erosive tooth wear constitutes an oral disease, suggesting that while it may be considered pathological when accompanied by symptoms like pain or functional impairment, minor wear may be a normal ageing process. Further research and discussion are needed to refine diagnostic criteria and determine the threshold at which erosive tooth wear becomes pathological in order to avoid medicalization, wish-fulfilling dentistry and disease mongering.

The aim of this chapter is to discuss current evidence and clinical protocols for recall and maintenance in patients who have undergone non-invasive and/or invasive treatment for erosive tooth wear. There is a paucity of research and evidence for some of the suggested protocols, and some sections are based on clinical experience. Recall for patients who have undergone non-invasive treatment is either for behavioural change and/or monitoring of progression of tooth wear. Behaviour change needs to be patient centred and holistic, with an individualised plan. Recall is essential to assess adherence to any behavioural change plans and advice, as well as any change in the patient's risk category. If the patient has active signs or symptoms associated with erosive tooth wear progression, such as dentine hypersensitivity, symptomatic reflux or an active eating disorder, it is prudent to review the patient after 3 months. If the recall visit is mainly cantered around assessing progression of the wear, periods between 1 and 3 years depending on the presumed aetiology of the patient are appropriate with the current methods of assessing progression, including intraoral scans and various indices. The main aims are to identify the risks, reduce the risks and ensure the progression of wear is stabilised. In cases where invasive treatment has been carried out, the non-invasive recall and maintenance still apply. In addition, the recall visits entail repair or replacement of restorations. In general, the most minimally invasive approach that is accepted by the patients should be attempted, such as monitoring stained margins, repair of restorations to prolong the lifespan of the restoration or in some cases progression to more invasive restorations, all depending on the patient's wishes and the goal of improving quality of life.

Toothbrushing is considered as a prerequisite for maintaining oral health, but might also impact the process of tooth wear, particularly with regard to erosive tooth wear. Principally, the eroded surface of enamel and dentin is more prone to abrasion by toothbrushing than sound tooth surfaces. Toothbrushing conditions, such as time point of brushing after an erosive attack, toothbrushing frequency per day, and brushing force, seem of minor importance, as long as performed under conditions reflecting the clinical situation. The kind of toothpaste seems to be relevant as potential erosion-protective ingredients can be delivered, while on the same time, abrasive particles and other ingredients might impact on the eroded surface and the interaction between active ingredients and the eroded surface. The toothbrush mainly acts as a carrier, modifying the effects of the toothpaste. Most information so far is coming from well-controlled laboratory and in situ studies, limiting the extrapolation in the clinical situation. Based on the current knowledge, toothbrushing to a certain extent can be considered a physiological wear mechanism.

Different agents have been discussed as potential alternatives to fluoride in the prevention and treatment of erosive tooth wear (ETW). These agents may act by (1) forming an acid-protective layer on the tooth surface, such as through the use of sealants, polymers or the modification of the acquired pellicle; (2) enhancing mechanisms of (mineral) precipitation; and/or (3) preserving the organic matrix of dentine. The application of adhesives, sealants or flowables is considered to be an effective alternative to fluoride, but requires a re-sealing of the surface every several months depending on the products used. Studies testing film-forming products, such as artificial polymers as well as engineering of acquired pellicle, have suggested the potential effectiveness of some of these approaches, such as chitosan and some salivary or saliva-derived proteins. Products designed to deliver calcium and/or phosphate have not been successful at providing a significant anti-erosive effect. In advanced ETW, the demineralised collagenous dentine matrix can be degraded by host enzymes, such as matrix metalloproteinases (MMPs). Epigallocatechin gallate and chlorhexidine as well as fluorides have been identified as effective MMP inhibitors, with the potential to reduce the progression of dentine erosion. While fluoride compounds have clearly been shown to have an anti-erosive potential, particularly those containing tin, alternative approaches that provide even greater protective capacity still need to be developed and proven to be effective clinically.

Assessing erosive tooth wear (ETW) using qualitative, semiquantitative, and quantitative measurements is a challenging process. Indices as semiquantitative tools must have simple, clearly defined scoring criteria to ensure reproducibility, accurately reflect the condition's etiology, and categorize the shape, area, and depth of the wear both at a single point in time (prevalence) and over time (incidence/increment). New technologies, such as direct three-dimensional image capture from intraoral scanners and automated monitoring using artificial intelligence, may offer more reliable quantitative methods for assessing and monitoring ETW; however, they still have limitations. Additionally, the differential diagnosis of ETW is complex, as it often coexists with other types of tooth wear. While new technological achievements hold promise, reaching a valid assessment of ETW at both the individual and population levels remains challenging without a comprehensive history of general health, diet, and habits. This chapter aims to describe the potential methodological challenges in assessing ETW, discuss recent developments in addressing these challenges, critique the strengths and limitations of existing ETW indices and other assessment systems, and propose the adoption of a validated ETW assessment system suited to its intended purpose.

Erosive tooth wear (ETW) is a common phenomenon in the general population. Furthermore, people with eating disorders or reflux, special diets, regular consumption of acidic foods and beverages, some medications or drugs, and occupational exposure to acids, including athletes, are at high risk for ETW. Differences in indices, sample sizes, study designs, in case of risk groups, small sample sizes and heterogeneous study groups, and lack of calibration of observers make it difficult to compare studies and estimate the true global prevalence. This chapter provides a narrative overview of data on ETW in the primary and permanent dentition of children, adolescents, and adults. There is an enormous variability in prevalence, ranging from 1 to 100% in the primary dentition (rough mean 30-50%), from <1 to 97% in the permanent dentition of children/adolescents (rough mean 20-40%), and from 2 to 100% in adults (rough mean 30-50%) over the world. Eating disorders are associated with increased prevalence, severity, and risk, although not all patients have pathological levels of ETW. There also seems to be a tendency for ETW to be more frequent and severe in case of reflux. Regarding exogenous causes, many studies, but not all, document a positive association between consumption of acidic drinks and ETW. Similar was found for use of drugs/medication and special diets. Although some associations between acid exposure and prevalence of ETW appear clear, the number of studies with large sample sizes is small. There is a lack of controlled prevalence studies, making it difficult to draw definitive conclusions for all (risk) groups.

Dental erosion is caused by repeated short episodes of exposure to acids. Dental minerals are forms of hydroxyapatite containing impurity ions, which mostly increase solubility, so dentine or cementum mineral is more soluble than enamel mineral and all are more soluble than hydroxyapatite. Solubility is an important factor in erosion because it determines whether a solution is in equilibrium with the solid ('saturated') or is capable of dissolving or precipitating the solid ('undersaturated' or 'supersaturated'). In vitro, the dissolution rate is influenced by the degree of saturation of an erosive solution and also by other properties of the solution, such as pH, calcium concentration, buffering, fluoride and the presence of inhibitors. Furthermore, dissolution rate is influenced by the distinct structures of dentine and enamel, which modulate interactions between the tissue and the solution. Data on a wide range of beverages and other products, such as medications, indicate that the degree of saturation with respect to hydroxyapatite and fluorapatite contributes to erosivity, but that pH is probably the most useful single factor in predicting erosive potential. The role of buffering in erosive potential is not fully established and little is known of the role of naturally occurring inhibitors. Temperature, flow rate and dilution, as determined by the method of consumption of a product, are likely to have a strong influence on erosion in vivo. Prospects for prevention of erosion by product modification and for repair of erosive lesions by remineralization are reviewed.

Fluoride plays a crucial role in preventing erosive tooth wear, with varying effectiveness depending on the fluoride compound and dental tissues involved. Fluoride combined with stannous (F/Sn) and titanium tetrafluoride (TiF4) shows superior effects compared to other fluoride compounds, mainly due to the formation of acid-resistant layers (TiF4 and F/Sn), and by the incorporation of metal cations into dental tissues (F/Sn), thus enhancing resistance to erosive demineralisation. However, methodological differences in study designs, such as variations in exposure times, acid concentrations and mechanical forces like toothbrushing, as well as the variety of formulations such as toothpastes, mouthrinses or higher concentrated fluoride preparations, introduce significant variability in study outcomes. While extensive research generally supports the benefits of fluoride compounds, clinical trials are missing. Future research should prioritise clinical validation of the protective effects of fluoride, especially regarding different patient risk groups.

Hypomineralisation defects with demarcated opacities are also observed in the deciduous dentition and have been found to be a predictive factor for hypomineralisation defects in the permanent dentition. Deciduous molar hypomineralisation (DMH) represents a qualitative enamel defect primarily afflicting deciduous second molars, albeit its presence is not limited solely to deciduous second molars, as it can manifest in deciduous canines and first molars. Thus, the presence of demarcated hypomineralisation defects in deciduous teeth could be called as deciduous teeth hypomineralisation. Clinically, these defects are characterized by demarcated opacities, posteruptive enamel breakdown, atypical caries lesions, and atypical restorations. The accurate diagnosis of DMH continues to present a clinical challenge, and the reported prevalence of this defect exhibits notable variability across different countries. Its precise etiology remains elusive; however, there is a prevailing suspicion that events occurring during the prenatal, perinatal, or early postnatal periods, particularly those unfolding during the perinatal phase, are intricately linked to DMH development. Factors such as delivery complications, neonatal complications, prematurity, and low birth weight have been associated with DMH. Notably, there exists a possibility that, the more health-related events occur during this critical period, the greater the likelihood of a child presenting with this enamel defect. Nevertheless, the establishment of these associations warrants further investigation through prospective studies. Acquiring knowledge regarding the factors associated with this defect holds paramount importance for effective diagnosis, guidance for families with affected children, and the formulation of strategies to mitigate the incidence of these contributory factors.