Objectives Dental erosion, the chemical dissolution of enamel without bacterial involvement, is a rarely reported manifestation of gastroesophageal reflux disease (GERD), as well as of recurrent vomiting and dietary habits. It leads to loss of tooth substance, hypersensitivity, functional impairment, and even tooth fracture. To date, dental erosions have been assessed using only very basic visual methods, and no evidence-based guidelines or studies exist regarding the prevention or treatment of GERD-related dental erosions. Methods In this randomized, double-blind study, we used optical coherence tomography (OCT) to quantify dental tissue demineralization and enamel loss before and after 3 weeks of acid-suppressive treatment with esomeprazole 20 mg b.i.d. or placebo in 30 patients presenting to the Berne University Dental Clinic with advanced dental erosions and abnormal acid exposure by 24-h esophageal pH manometry (defined as >4% of the 24-h period with pH < 4). Enamel thickness, reflectivity, and absorbance as measures of demineralization were quantified by OCT before and after therapy at identical localizations on teeth with most severe visible erosions as well as several other predefined changes in teeth. Results The mean±s.e.m. decrease of enamel thickness of all teeth before and after treatment at the site of maximum exposure was 7.2±0.16 μm with esomeprazole and 15.25±0.17 μm with placebo (P =0.013), representing a loss of 0.3% and 0.8% of the total enamel thickness, respectively. The change in optical reflectivity to a depth of 25 μm after treatment was −1.122 ±0.769 dB with esomeprazole and +2.059±0.534 dB with placebo (P = 0.012), with increased reflectivity signifying demineralization. Conclusions OCT non-invasively detected and quantified significantly diminished progression of dental tissue demineralization and enamel loss after only 3 weeks of treatment with esomeprazole 20 mg b.i.d. vs. placebo. This suggests that esomeprazole may be useful in counteracting progression of GERD-related dental erosions. Further validation of preventative treatment regimens using this sensitive detection method is required, including longer follow-up and correlation with quantitative reflux measures.

Abstract.A preliminary study to assess noninvasive optical coherence tomography ͑OCT͒ for early detection and evaluation of chemotherapy-induced oral mucositis in five patients. In five patients receiving neoadjuvant chemotherapy for primary breast cancer, oral mucositis was assessed clinically, and imaged using noninvasive OCT. Imaging was scored using a novel imaging-based scoring system. Conventional clinical assessment using the Oral Mucositis Assessment Scale was used as the gold standard. Patients were evaluated on days 0, 2, 4, 7, and 11 after commencement of chemotherapy. OCT images were visually examined by one blinded investigator. The following events were identified using OCT: ͑1͒ change in epithelial thickness and subepithelial tissue integrity ͑beginning on day 2͒, ͑2͒ loss of surface keratinized layer continuity ͑beginning on day 4͒, ͑3͒ loss of epithelial integrity ͑beginning on day 4͒. Imaging data gave higher scores compared to clinical scores earlier in treatment, suggesting that the imaging-based diagnostic scoring was more sensitive to early mucositic change than the clinical scoring system. Once mucositis was established, imaging and clinical scores converged. Chemotherapyinduced oral changes were identified prior to their clinical manifestation using OCT, and the proposed scoring system for oral mucositis was validated for the semiquantification of mucositic change.

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