ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Fluoride Reduces Dental Erosion
Clinical Question In patients with dental erosion, does the use of fluoride effectively reduce the amount of dental erosion as compared to no treatment?
Clinical Bottom Line For patients experiencing dental erosion, fluoride treatment is effective in protecting the enamel and decreasing surface loss. Three laboratory studies prove that fluoride treatment reduces enamel wear and erosion; while two of these trials specifically address SnF2 as displaying the greatest amount of enamel protection.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 24571700Faller/2014Unspecified number of extracted human enamel specimens.Lab Study
Key resultsEnamel samples treated with SnF2 had the greatest amount of surface protection and showed the lowest amount of dye adherence. SnF2 specimens averaged 0.25 dye deposition, while NaF had 3.4, SMFP had 3.4 and AmF had 3.7 score of dye deposition. With P<0.05, SnF2 had a statistically significant amount of enamel protection when compared to NaF, SMFP, and AmF.
#2) 23006823Stenhagen/201316 molars cut into 4 specimens.Lab Study
Key resultsTeeth rinsed with stannous or titanium tetrafluoride reduced enamel wear and erosion. SnF had a mean surface loss of 1.8 µm after 9 days; TiF(4) had a mean surface loss of 3.1 µm; NaF had a mean surface loss of 26.3 µm. The control that was left untreated had a mean surface loss of 32.3 µm. Thus rinsing with SnF2, TiF4, and NaF decreased the abrasion and enamel wear by 94, 90, and 18%, respectively, when evaluated against the control (p=0.05).
#3) 21780973Magalhaes/2012Unspecified number of bovine dentin specimens. Lab Study
Key resultsAll fluoridated varnishes were proven by the ANOVA/Turkey’s test to significantly decrease dentin tissue loss. TiF(4) 6.5 +/- 1.0, NaF 7.2+/- 1.9, Duofluorid 6.8 +/- 1.1 and Duraphat 7.5 +/- 1.1 fluoride varnishes reduced dentin tissue loss by 40.7% when compared to the control.
Evidence Search (( "Tooth Erosion/analysis"[Mesh] OR "Tooth Erosion/epidemiology"[Mesh] OR "Tooth Erosion/pathology"[Mesh] OR "Tooth Erosion/physiology"[Mesh] OR "Tooth Erosion/physiopathology"[Mesh] OR "Tooth Erosion/prevention and control"[Mesh] )) AND "Fluorides"[Mesh]
Comments on
The Evidence
All of these studies were laboratory studies. In the Faller article, extracted teeth were soaked in saliva, etched with citric acid, and treated with either SnF2, NaF, SMFP, or AmF. After each of the specific fluoride treatments, the teeth were exposed to a calcium dye and rinsed again. The ability of the fluoride to leave a barrier layer was calculated by the amount of dye attachment to the enamel. SnF2 demonstrated the highest level of enamel protection by showing the least amount of dye attachment. Based off of a scale where 0 represents no dye deposition and 4 indicates complete coverage of the dye, SnF2 was 0.25. This study demonstrates that SnF2 leaves a barrier over the enamel that protects the tooth. In the Stenhagen study, 16 molars were cut into four pieces. Each of the four pieces had an amalgam present. Two teeth (represented by eight different piece) were mounted bilaterally on mandibular appliances and worn by eight volunteers. Each day, all samples were brushed manually. Three pieces of the same tooth were then exposed to different types of treatment, including SnF2, TiF, and NaF. The fourth piece was the control. Twice each day, the samples were etched with hydrochloric acid and rinsed with water. SnF2 demonstrated that least amount of surface loss after 9 days. Thus, SnF2 reduces the amount of tooth structure lost due to acid exposure. In the Magalhaes study, bovine dentin studies were treated with NaF- Duraphat, NaF/CaF2-Duofluorid, experimental NaF, experimental TiF4, and placebo varnishes. The teeth were then exposed to a soft drink for 90 seconds, four times a day and to toothbrushing for 10 seconds, 2 times a day. ANOVA test indicated that all of the fluoride varnishes reduced dentin loss. Thus, the fluoride varnishes were proven to protect the teeth against the damaging effects of acid.
Applicability The external validity for these studies is low because these laboratory studies used either extracted human teeth or animal teeth to test the effectiveness of fluoride treatment. However, based on this evidence, fluoride treatment effectively protects the enamel and reduces the amount damage caused by erosion. SnF2 has been proven to display the greatest amount of enamel protection. Thus, based off of these studies, fluoride can be used by the dentist to help prevent tooth damage from erosion in patients with GERD. Patients at risk of erosion would benefit from fluoride treatment.
Specialty/Discipline (General Dentistry) (Restorative Dentistry)
Keywords Dental erosion and fluoride
ID# 2933
Date of submission: 11/12/2015spacer
E-mail allinsonelizabeth@gmail.com
Author Elizabeth Allinson, DDS
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Adriana Green, DDS
Faculty mentor/Co-author e-mail greenav@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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