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)
21945448Scaramucci/201180 bovine enamel specimens in various solutions undergoing erosion, demineralization and remineralization.In vitro animal study
Key resultsThe 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.
18056104Davis/200764 extracted uncavitated molars and premolars with enamel and root surface “windows” created and exposed to various juice solutions.in vitro study
Key resultsThe 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)
21332600Wegehaupt/201196 freshly extracted bovine lower incisors exposed to pure orange juice, water, and calcium-tablet modified orange juice.In vitro animal study
Key resultsThe 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) 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
None available