Treatment for dental erosion: a systematic review of in vitro studies

Abstract

Background Dental erosion is a chemical loss of the mineralized dental tissue caused by exposure to nonbacterial acids. Different treatment protocols have been adopted with the use of fluoride compounds to promote the formation of a layer of mineral precipitation in eroded lesions. Aim This systematic review aimed to evaluate the main treatments for dental erosion. Methodology This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and recorded in the Open Science Framework database (OSF) under DOI 10.17605/OSF.IO/XMFNZ. The searches were conducted in six electronic databases (Pubmed, Embase, Web of Science, Cochrane, Scopus, Lilacs) and two grey literature sources (Google Scholar and OpenGrey). The eligibility criteria included in vitro studies that evaluated eroded teeth under treatment with some topical agent. Risk of bias assessment and qualitative synthesis were performed using the Cochrane collaboration’s tool for assessing risk of bias modified for in vitro studies. Results A total of 522 studies were identified, and only four studies that fulfilled our eligibility criteria were included in this review. Among these studies, three were considered to have a low risk of bias, and one to have a high risk of bias. Two studies evaluated the anti-erosion effect of fluoride toothpaste, and the other two assessed the action of casein phosphopeptide–amorphous calcium phosphate (CPP-ACP) on the surface of human teeth. Among the products analyzed, CPP-ACP was the only one that promoted a significant increase in enamel microhardness and reduced tooth wear. Conclusion Based on the in vitro studies included in this review, there was no anti-erosion effect after using different fluoride toothpaste. However, it should be considered that one of these studies presented a high risk of bias. On the other hand, studies with CPP-ACP showed anti-erosion efficacy when applied before or after erosive wear.

Assessment of the Remineralizing Potential of Biomimetic Materials on Early Artificial Caries Lesions after 28 Days: An In Vitro Study

“…Indeed, CPP-ACP can provide effective remineralization against erosion caused by orange juice [ 51 ], increasing the hardness and density of the erosive surface of the tooth [ 52 ] and reducing the depth of lesions [ 53 ]. Furthermore, the CPP-ACP-containing mousse tested in our study may be more effective in erosion lesions due to its very low pH, in agreement with other reports [ 54 , 55 ]. Since F-ACP and NaF varnish are used for the prevention of enamel loss due to tooth erosion in primary teeth, parents can turn to CPP-ACP mousse or NaF-containing varnish for their children, instead of opting for less-effective fluoride-containing toothpastes.…”

Remineralization effect of three different agents on initial caries and erosive lesions: a micro-computed tomography and scanning electron microscopy analysis

“…Devadiga et al [18] found that agents containing CPP-ACP and β-TCP increased hardness of erosive tooth surface. Findings of our study, which agreement with the literature [13][14][15], it is stated that GC-ToothMousse cream may be more effective against Sensodyne Promine and Agarta in erosion lesions due to its very low pH. It is thought that our study will be a reference on the micro-CT studies on the remineralization effect of CPP-ACP-containing creams on demineralization lesions caused by erosion.…”

“…Although there was no statistical difference, Agarta provided the least decrease in the lesion area, and the maximum decrease was in the Sensodyne promine against the initial caries group. In many studies, the effectiveness of fluoride and CPP-ACP have been proven [6,13]. Nowadays, many parents tend to prefer herbal agents because of their chemical content.…”

“…There are many in-vitro studies examining the efficacy of remineralization agents against initial caries with different methods as an alternative to sodium fluoride [7][8][9][10][11][12]. In addition, the remineralization processes of initial caries and erosion lesions with different etiologies also differ [13]. Although fluoride products are frequently used, fluoride has a limited preventive effect against tooth erosion, because the effect is limited to demineralized enamel layers near the surface, the very low pH, and the absence of biofilm in erosion lesions [14,15].…”