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Essay: Dental erosion

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  • Published: 24 September 2015*
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Introduction
Dental erosion is the process in which the rapid, inevitable dental tissue loss tissues occurs derived by a chemical process without involvement any bacteria and is a greater clinical challenge. Acids which cause the erosion are from dietary, occupational or intrinsic sources. Clinical problems associated with the dental erosion are dentine hypersentivity ,altered occlusion ,eating difficulties, poor aesthetics, pulp exposure.1
As there is rapid involvement in mankind there is rapid change in dietary patterns .Variation in dietary pattern and modern lifestyle are the large component of the extrinsic factors involved in dental erosion. The healthy diet containing large amount of acidic drinks and fruit juices has become vitally important for many people. Today’s diet is more refined with increased fruit juices and in between meals high frequency of snacking .with addition to fruit juice carbonated juices are also added in normal diet.2
Carbonated beverages ,fruit juices have low pH and high buffering capacity hence they are highly potential .
Saliva is the main buffer which keeps demineralization and remineralization process continuously available at the enamel surface. Drop in pH occurs due to acidulated an juices . The sweeter a food or a drink is there will be rapid drop in pH .2
Studies have proved that carbonated drinks have low pH and hence can be responsible for dental erosion.3 However, many in vitro studies have shown that fruit juices not only have low pH and but also great buffering capacity which makes them potentially erosive
Materials and methods
In this present study , 4 commercially available juices (Fruity, Appy,Tropicana orange , Nimbooz)were selected were purchased from local market just prior to the test. The samples were directly poured into the collecting container to estimate pH and neutralizable acidity. No funneling device was used. Tap water was used as a control group. Samples of water were taken from the Pimpri-Chinchwad Municipal supply in a container which was washed with distilled water to avoid contamination. This was used as a control (Group A). Specimens of primary enamel (n=50) were from extracted ,caries free primary canines. These were collected from children of either gender undergoing extraction for the relief of crowding and exfoliated teeth.
1.Measurement of pH –
The initial pH of each drink was measured by using a digital pH meter. At the start of each session, 50ml of each freshly opened drink was placed in a glass beaker on a thermostatically controlled electric hotplate at 37??c.Before reading the pH, each sample was agitated for 1 min each drink will be tested for 3 times to give a mean measurement
2. Meaurment of neutralizble acidity ‘
The neutralizable acidity of drink was measured by placing 50 ml of the product in glass beaker on thermostatically controlled electric hotplate at 37??c. Then 0.1 M sodium hydroxide solution was gradually pipetted into the beaker until the pH reached neutrality. Each sample stirred continuously. The volume of sodium hydroxide required to increase the pH of the sample was recorded; process was repeated for 3 times for each drink to give a mean measurement.
3.Method of preparing a sample
Following extraction, each tooth was rinsed in copious amounts of distilled water and were stored in thymol.For preparing a sample, the crown portion was sectioned from the root and cut vertically to produce two sections of enamel.Each section was then embedded in a cold cure acrylic resin. When the resin was cured , automatic lapping and polishing of the acrylic
block was done using carbide emery papers (Grit 220,320 ,400 ,600) and alumina paste and
a smooth flat area of enamel was exposed.This was specifically done to hold the specimen precisely during profilometry and to ensure that a stable horizontal platform was maintained.
Then , thermo cycling of the samples was done at temp 5?? c to 55 ??c ,dwell time for 30 secs.500 cycles were completed. After its baseline profile was achieved, a unique reference no. was given for each sample which was recorded on the reverse side of acrylic block.Before immersing into the juices, profilometry was employed to record initial surface roughness.Then, 10 samples of enamel were allocated for each product .They were placed in a large glass beaker with 250 ml of drink. The beaker was placed in a thermostatically controlled water bath at 37??c and samples were immersed for 25 hrs in solution, drinks were replaced in every 5 hrs. Following exposures, specimens were removed from the drink and rinsed in distilled water .Then profilometry was employed for each samples.
Results :
Statistical Analysis
Data analysis was done using the SPSS (statistical package for the social science) version 16 for windows.Descriptive statistics (mean, standard deviation) were calculated for 5 stydy group. Intergroup comparison of the average surface roughness was done using TUKEY’S POST HOC test.Intergroup comparison of the average surface roughness in the study groups was done using one way analysis of variance. Intragroup comparison of the surface roughness in the study groups was done using paired T test .
TABLE 1 : MEASUREMENT OF pH
GROUPS
pH
pH
pH
Mean
S.D
TAP WATER
(CONTROL GROUP A ) 7.0 6.5 7.2 6.9 +/-0.3
TROPICANA ORANGE JUICE
( GROUP B ) 3.8 3.7 3.6 3.7 +/- 0.06
NIMBOOZ
(GROUP C ) 3.2 3.3 3.2 3.2 +/-0.09
APPY
( GROUP D ) 4.0 3.8 3.9 3.9 +/-1.01
FRUITY
( GROUP E ) 3.4 3.3 3.5 3.4 +/-0.09
TABLE 2 : MEASUREMENT OF NEAUTRALIZABLE ACIDITY (N.A)
GROUPS
N.A (ml)
N.A(ml)
N.A(ml)
Mean(ml)
S.D
TAP WATER
(CONTROL GROUP A ) 8 9 8 8.33 +/-0.47
TROPICANA ORANGE JUICE( GROUP B ) 18 17 18 17.7 +/-0.47
NIMBOOZ(GROUP C )
23 24.5 24 23.8 +/-0.9
APPY( GROUP D ) 19 18 17.5 18.1 +/-0.63
FRUITY( GROUP E ) 20 22 23.5 21.6 +/-0.7
TABLE 3: AVERAGE SURFACE ROUGHNESS IN THE STUDY GROUPS
STUDY GROUPS MEAN STD. DEVIATION MINIMUM MAXIMUM
BEFORE NIMBOOZ 0.0237 0.006783 0.015 0.034
ORANGE 0.0300 0.003771 0.024 0.036
APPY 0.0259 0.006297 0.019 0.036
FRUITY 0.0363 0.004668 0.030 0.044
WATER 0.0302 0.005224 0.022 0.040
AFTER NIMBOOZ 0.1700 0.028612 0.136 0.221
ORANGE 0.1345 0.015806 0.113 0.173
APPY 0.1312 0.026469 0.103 0.186
FRUITY 0.1854 0.038012 0.154 0.267
WATER 0.0955 0.014073 0.075 0.114
TABLE 4: INTERGROUP COMPARISON OF THE AVERAGE SURFACE ROUGHNESS IN THE STUDY GROUPS USING ONE WAY ANALYSIS OF VARIANCE
STUDY GROUPS SUM OF SQUARES DF MEAN SQUARE F SIG.
BEFORE BETWEEN GROUPS 0.001 4 0.000 7.820 0.000
WITHIN GROUPS 0.001 45 0.000
TOTAL 0.002 49
AFTER BETWEEN GROUPS 0.050 4 0.012 18.295 0.000
WITHIN GROUPS 0.031 45 0.001
TOTAL 0.081 49
Table 1
Table 1 represents the mean and standard deviation of pH of all the groups .The lowest pH is seen with nimbooz group(3.2) followed by fruity group(3.4).The highest pH is observed with tap water (6.9).
Table 2
Table 2 represents the mean and standard deviation of neautralizable acidities of all the groups .The highest neautralizable acidity is seen with Nimbooz group(23.8ml) follwed by fruity group (21.6ml) .The lowest neautralizable acidity is seen with tap water (8.33ml).
Table 3
Table 3 shows the diffrences in the surface roughness of enamel samples before immersing the samples into the juices and after immersing the samples into the juices. The samples allocated for fruity group shows maximum surface roughness (0.0363) before immersing into the juices.The samples allocate for nimbooz ,tropicana orange ,Appy , Fruity show surface roughness (0.0237), (0.03),(0.025),(0.03) accordingly before immersing into the juices .The nimbooz group shows the minimum surface roughness (0.023).
The highest surface roughness was seen with fruity group after immersing into the juices (0.18) followed by nimbooz group (0.17). The orange and appy group shows the surface roughness ( 0.134) and ( 0.131)accordingly.The water group shows the minimum surface roughness after immersing into the juices (0.09)
Table 4
Table 4 shows Intergroup comparison of the average surface roughness in the study groups.
Table 5
Table 5 shows the intergroup comparison of the average surface roughness in the study groups before and after immersing into the juices .The mean diffrence was stastistically significant at the level of 0.05 for fruity group before immersing into the juices (-0.0126 and -0.0104)
The ststistical significant results after immersing into the juices were seen with orange ,appy and fruity group.
Table 6
Table 6 shows the intragroup comparison of the study groups. The mean differnce is highest in fruity group followed by nimbooz group .The lowest mean differnce is seen with water that is control group.
GRAPH 1: AVERAGE SURFACE ROUGHNESS IN THE STUDY GROUPS BEFORE TREATMENT
GRAPH 2: AVERAGE SURFACE ROUGHNESS IN THE STUDY GROUPS AFTER TREATMENT
GRAPH 3: COMPARISON OF THE AVERAGE SURFACE ROUGHNESS IN THE STUDY GROUPS
Graph 1:
Graph 1 shows the diffrences in the surface roughness of enamel samples before immersing the samples into the juices. The samples allocated for fruity group shows maximum surface roughness (0.0363) .The nimbooz group samples show (0.0237)surface roughness and the orange, appy and control group showed (0.03),(0.025),(0.03) accordingly.The nimbooz group shows the minimum surface roughness (0.023).
Graph 2 :
Graph 2 shows the diffrences in the surface roughness of enamel samples after immersing the samples into the juices. The highest surface roughness was seen with fruity group after immersing into the juices (0.18) followed by nimbooz group (0.17). The orange and appy group shows the surface roughness ( 0.134) and ( 0.131)accordingly. The water group shows the minimum surface roughness after immersing into the juices (0.09)
Graph 3
Graph 3 shows the comparison of the average surface roughness in the study groups.
Discussion
Erosion due to acidic beverages is major concern for dentists .increase in contact time between tooth and beverage increases the risk of erosion. Salivary flow clears tartness , acid and hence decrease erosion. Hence persons with decreased flow of saliva are at increased risk oferosion.4
Diet , environmental, lifestyle, and medication and all may act either singly or in combination and cause erosion .
Lifestyle, as well as oral hygiene practices are the most fundamental factor impacting dental erosion development. overzealous brushing and consumption of acidic foods and drinks may result erosion . different studies have been carried out to analyze the link between soft drink consumption and positive result has been found.
The erosion potential of beverages has been associated with pH, neutralizable acidity. Beverage pH is considered a stronger predictor of erosion potential than titratable acidity.
Different studies have shown buffering capacity of the juice has a markable impact on the erosive potential. Another important factor which can impact the erosive potential of a juice is their adhesiveness and displacement .Based on thermodynamic properties of beverages erosion is dependent .5
Surface profilometry allows measurements of surface loss of an area with a high precision. It is a quick and simple technique . The profilometer used in this study is a contact profilometer in which a diamond stylus first moved vertically in contact with a sample and then it is moved vertically across the sample. Profilometer can measure specified distance and minute variations.6
In this study , surface roughness of the samples before and after immersing into the juice was measured .This surface roughness was measured by Surface profilometry. ( Make:Mitutoyo,Japan. Model:SJ210)
Time is a critical factor in assessment of dental erosion. The increase in the level of erosion is measured by mineral loss and lesion depth but it also dependent on increased duration of exposure.7
In this study, the immersion time of samples in the juices was 25 hrs which was similar to the study done by Leslie A. Ehlen, Teresa A. Marshall in 2008 and Rachael E. Davis et al in 2007. In the study done by Larsen and Nywad in which enamel exposure time was 24 hrs, similar study carried out by Jensdottir et al in 2010 with the same exposure time of 24 hrs. Exaggerated results in studies is due to prolonged exposure to beverages .5
The Present study has emphasized on the chemical properties of the beverages like pH ,neutralizable acidity but physical factors of the beverages (Viscosity, turbidity ,Fluidity) also influences the erosive potential which are not considered in this study .
Hence further research emphasizing on both physical and chemical properties of the beverages is needed.
Conclusion
As there is change in mankind there is change is dietary pattern . In today’s diet there is special emphasis on ‘healthy food and healthy eating’ .Fruit juices are considered as healthy juices. But these healthy drinks can affect the healthy status of the teeth because of their erosive potential .Primary enamel is more susceptible to erosion as compared to permanent enamel because of their properties. Hence the present study was carried out to evaluate and compare erosive potential of the juices popular in children by evaluating their erosive potential on primary enamel. The results obtained from the study indicates that the beverages having low pH and high neutralizable acidity shows the maximum surface roughness (Fruity and Nimbooz groups).Thus this study indicates that the juices taken for the study are erosive and maximum erosive potential is seen in fruity group followed by nimbooz group. Hence the develpoment of potentially safer beverage to minimize the eroisve potential is necessary .

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