There is an increasing awareness in clinical dentistry of the need to better understand the aetiology and management of tooth wear, as increasing numbers of elderly patients are retaining their natural teeth to a stage when they present with extensive wear. In addition, more younger patients are presenting with wear of both primary and permanent teeth. In order to comply with the philosophy of minimal intervention dentistry, clinical management of tooth wear should focus on early detection and prevention before a restorative approach is considered. Fluoride is a commonly used agent in the management of tooth wear, with previous studies showing that it can protect teeth against erosion (at around pH 2.0 and 3.0) and toothbrush abrasion in an acidic environment (at around pH 3.0). However, it does not reduce attritional wear between opposing tooth specimens. Nightguards are commonly used to prevent attritional wear but there is still a need to improve preventive strategies to manage the risk of erosive tooth wear. Previous in vitro studies have shown that a remineralizing agent in the form of CPP-ACP (casein phosphopeptide – amorphous calcium phosphate) can reduce erosion of both enamel and dentine by white wine. A recent study has also highlighted the potential lubricating and remineralizing properties of a CPP-ACP containing paste (Tooth Mousse®, G C Asia Pty Ltd) in reducing dentine wear in both an acidic environment (pH 3.0) and a near neutral environment (pH 6.1). In this context, it is desirable to investigate the effect of CPP-ACP on enamel wear under conditions simulating various clinical situations and to better understand the nature of third-body components at the wear interface. The aims of the present study were: (i) to determine the effect of CPP-ACP on enamel wear under conditions simulating three clinical situations: heavy attrition with gastric regurgitation (at pH 1.2); toothbrush abrasion after an erosive episode (at pH 3.2); and erosion from gastric regurgitation (at pH 1.2), and (ii) to clarify its mode of action by characterizing the enamel surface treated with CPP-ACP. Electro-mechanical tooth wear machines were used to simulate attrition and toothbrush abrasion in combination with erosion, but no machine was used in experiments investigation erosion alone. The effect of paste containing CPP-ACP in reducing erosive tooth wear was also compared with that without CPP-ACP. Enamel surfaces with and without treatment with CPP-ACP were then characterized by using Time of Flight – Secondary Ion Mass Spectrometry (ToF-SIMS). CPP-ACP was found to reduce enamel wear under conditions simulating heavy attrition combined with gastric regurgitation, and toothbrush abrasion after an erosive episode. However, it did not protect enamel from erosion under conditions simulating gastric regurgitation alone, indicating that its lubricating effect was more pronounced than its remineralizing effect. Silicone and ethyl siloxane were present in trace amounts on the enamel surface treated with Tooth Mousse®, thus they were found to be included in its formulation. These findings imply that CPP-ACP nanocomplexes and silicon can act as third body components to lubricate the wear interface. The findings presented in this thesis have implications for clinical management of tooth wear and may lead to new strategies of tooth wear prevention. Although some caution is needed in extrapolating these findings to the in vivo situation, it should be noted that in vitro studies provide valuable insights into separate components of the tooth wear process that are often difficult to distinguish in clinical situations. Overall, this thesis provides new information about the role of CPP-ACP in reducing erosive enamel wear and provides a basis for future experimental and clinical studies focussing on tooth wear prevention. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1379897 / Thesis (Ph.D.) -- University of Adelaide, School of Dentistry, 2009
| Identifer | oai:union.ndltd.org:ADTP/288464 |
| Date | January 2010 |
| Creators | Ranjitkar, Sarbin |
| Source Sets | Australiasian Digital Theses Program |
| Detected Language | English |
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