An Investigation Into The Relationship Between Dietary Acid Intake, Oral Hygiene Procedures And The Progression Of Erosive Tooth Wear

Abstract

This thesis investigated conveniently selected factors that may influence the progression of erosive tooth wear. The designs were a laboratory study, casecontrol study and a RCT evaluating the influence of dietary advice on progression. The effect of timing of fluoride application with a previously reported erosive challenge was investigated in vitro. Human enamel samples (n=80) were treated with 225ppm stannous or sodium fluoride, either before or after a citric acid challenge (0.3%). The mean step heights (SD) for stannous fluoride applied before and after erosion were 3.2μm (0.57) and 4.2μm (0.7) respectively and these were statistically significantly lower than sodium fluoride application (before: 8.2μm (0.65) and after: 7.5μm (0.85), p<0.001). Stannous fluoride resulted in least step height when applied before erosion and sodium fluoride after erosion. A validated questionnaire assessed commonly reported dietary and tooth brushing habits on a convenient sample of 300 participants with severe erosive tooth wear and 300 controls in a case-control study. The frequency of dietary acid intake between meals had the strongest association with erosive wear (OR 3.83-14.86, p<0.001). No association was observed with tooth brushing after an erosive challenge when dietary factors were controlled for. A randomised controlled trial assessed the impact of enhanced dietary advice (n=28) on severe erosive tooth wear progression compared to standard of care advice (n=29). Addition-silicone impressions and questionnaires were taken at baseline and 6 months later. Impressions were cast in dental stone, scanned using laser profilometry and superimposed using surface matching software. The dietary intervention group reduced daily frequency of acid intake between meals by three intakes (IQR 1, 3) compared to one intake (IQR 0, 3) for controls, p=0.048. The intervention group also demonstrated reduced volume loss per surface (0mm3 (IQR -0.18, 0.18)) compared to controls (-0.06mm3 (IQR -0.24, 0.11), p=0.045). These studies suggest that prevention should focus on limiting dietary acid consumption between meals.

Date of Award	2017
Original language	English
Awarding Institution	King's College London
Supervisor	David Bartlett (Supervisor) & Rebecca Moazzez (Supervisor)