Title	Fortification of Juices with Calcium Helps Decrease the Risk of Dental Erosion
Clinical Question	In the adult population, does the fortification of calcium to fruit juice reduce enamel erosion as compared to those without calcium?
Clinical Bottom Line	Results show juices fortified with a calcium compound have the potential to significantly lower the chances of enamel erosion compared to pure juices; however, more evidence is needed to support application clinically.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 21945448 Scaramucci/2011 80 bovine enamel specimens in various solutions undergoing erosion, demineralization and remineralization. In vitro animal study Key results The specimens in solutions of calcium lactate modified orange juice had significantly (p <.05) lower surface loss numbers as well as significantly higher surface micro hardness numbers as compared to the specimen in orange juice alone. 18056104 Davis/2007 64 extracted uncavitated molars and premolars with enamel and root surface “windows” created and exposed to various juice solutions. in vitro study Key results The extracted teeth submerged in juices modified with calcium had significantly less enamel erosion and smaller surface lesion depths compared to the samples challenged with unfortified juices (P = .010) 21332600 Wegehaupt/2011 96 freshly extracted bovine lower incisors exposed to pure orange juice, water, and calcium-tablet modified orange juice. In vitro animal study Key results The bovine teeth immersed in calcium-tablet modified orange juice had significantly lower numbers on enamel wear than the teeth submerged into pure orange juice (P <.0001). Compared to the teeth in water, these teeth also did not show higher loss in enamel surface (P = .9236).
Evidence Search	(("Tooth Erosion"[Mesh] AND "Calcium"[Mesh]) AND (("Dental Enamel"[Mesh] AND "prevention and control"[Subheading]) AND "Tooth Erosion"[Mesh]))
Comments on The Evidence	The first study was a in vitro animal study carried out in three phases to measure the surface loss and surface micro hardness of bovine enamel and dentine samples. The study is strong since the sample size was large; however, the study was done in vitro, which doesn’t take other factors, such as how much fluid a person consumes or salivary production into consideration. Additionally, the teeth used were bovine not human. In the second study, the effect of fortification of different juices with calcium on enamel erosion was reviewed. The weakness for this study is that it also was done in vitro, however, human teeth were used. The third study was an in vitro animal study. This comparative study involved teeth being submerged into various solutions as well as facing abrasion from tooth brushing, which could possibly sway the results. It is hard to conduct such studies on actual patients’ teeth, so perhaps running more trials on extracted human teeth would be the best option to seek.
Applicability	The evidence found that the potential for enamel erosion is decreased with the addition of calcium to juices. This information is relevant to the practice of dentistry in the arena of prevention as patients may be counseled about dietary intake.
Specialty	(Public Health) (General Dentistry) (Dental Hygiene) (Interprofessional CATs)
Keywords	Enamel erosion, calcium, juice fortification, nutrition
ID#	2663
Date of submission	03/17/2014
E-mail	pateltg@livemail.uthscsa.edu
Author	Tanvi G. Patel
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Georgiana S. Gross, MPH
Faculty mentor e-mail	GROSSG@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?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available