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Objectives: The objectives of this study were two-fold: (1) to determine (by surfometry) loss of deciduous and permanent enamel and dentine following consumption of a single low pH orange drink for 15days; and (2) to determine (by surfometry) loss of deciduous and permanent enamel and dentine following consumption of the product 2 versus 4 times per day for 15days., Methods: Sixteen healthy volunteers participated in a single centre, single blind, 2-phase crossover study, conducted according to Good Clinical Practice, and employing the validated model described by West and co-workers (Journal of Dentistry 1998; 26:329-335)., Results: In all tissues, erosion was progressive over time, the pattern being more linear in enamel than in dentine. In general, erosion of deciduous enamel was greater than that of permanent enamel, though this difference was significant only for those specimens exposed to 4 drinks per day. Conversely, erosion of dentine was generally greater in the permanent tissue, though differences rarely reached conventional levels of statistical significance. Increasing frequency of consumption resulted in increased loss of tissue, but this difference was neither proportional nor consistently statistically significant., Conclusions: It is concluded that statistically significant differences in susceptibility of deciduous and permanent enamel to erosion appear to emerge over time and with increasing frequency of consumption. This is of importance clinically given the reduced dimensions of the deciduous dentition and the element of 'abuse' of soft drinks by the child population. Further development of soft drinks with low erosive potential is recommended.

Objective: Dental erosion associated with soft drink consumption probably results from the contained dietary acids in the formulations. The pH value of any formulation is an important variable in acid erosion but not necessarily the only important factor. The aim of this study was to measure enamel erosion by citric, malic and lactic acids at pH values and acid concentrations representative of a range found in soft drink formulations and to determine the effect of adding calcium to citric acid., Methods: Flat ground enamel samples were prepared from unerupted human third molar teeth. Groups of five specimens were placed in citric, malic and lactic acid solutions of different pH and acid concentration for three by 10 min exposures at 35 degrees C. Enamel loss was measured by profilometry. Enamel specimens were also exposed to citric acid solutions containing calcium at different pH values and at the same pH with different concentrations of calcium., Results: Numerical data and contour plots for each acid showed a similar pattern for increasing erosion with decreasing pH and increasing acid concentration and vice versa for decreasing erosion. Increasing the concentration of calcium in a fixed pH citric acid solution resulted in decreased erosion. This effect was most marked at higher pH., Conclusions: This study has shown that under highly controlled conditions the erosion of enamel by solutions of dietary acids is influenced by the interplay of pH, acid concentration and presence of calcium. These variables and in particular the concentration of calcium could be manipulated to produce soft drinks with reduced erosivity to enamel.

Objective: A previous study demonstrated that an experimental low pH blackcurrant juice drink with calcium was markedly less erosive to enamel both in situ and in vitro than orange juice. Further development of the experimental blackcurrant juice drink formula has occurred and the aims of the present studies were two fold. Firstly, to confirm the low erosivity of the modified formulation and secondly, to provide more comparative data with other acidic fruit drink products., Method: The study was a single centre, single blind, randomised placebo controlled 4 cell crossover design involving 12 healthy volunteers. The test drinks were orange juice, water, experimental blackcurrant juice drink with calcium and a proprietary blackcurrant juice drink. Enamel samples were retained in situ at the mid palatal regions using intraoral appliances and exposed to 250 ml volumes of the drinks 4 times per day during 15 working days. Measurements of enamel loss were made by profilometry. The same method was modelled in vitro., Results: By day 15 the mean losses of enamel in situ for orange juice, water, experimental blackcurrant juice drink with calcium and blackcurrant juice drink were 1.70, 0.05, 0.44 and 2.75 microns respectively. At all bar one measurement, the loss of enamel was significantly greater for all fruit drinks compared to water. Losses caused by the blackcurrant juice drink with calcium were significantly less than the other two fruit drinks at all time points. Losses of enamel by day 15 in the study in vitro were 13.02, 0.00, 1.78 and 39.02 microns respectively. The blackcurrant juice drink with calcium was not significantly different from water at days 3 and 6, otherwise all pairwise comparisons for differences between the 4 drinks at each time period were significant., Conclusions: The methodologies in situ and in vitro again appear to correlate in ranking the order of erosivity of drinks. The data particularly from the study in situ allude to the very low comparative erosivity of the further modified experimental blackcurrant juice drink with calcium and support the further development of such drinks for public consumption.

Objective: Two previous studies demonstrated that a blackcurrant juice drink with added calcium produced little erosion of enamel in vitro and in situ by comparison with other low pH fruit drinks. The primary aim of this study was to demonstrate that the final formulation drink and concentrate were of similar low erosivity. Secondary aims were to provide more data on the erosivity of other fruit drink concentrates and whether erosion was influenced by anterior and posterior palate siting of enamel specimens., Method: The study was a single centre, single blind, randomised placebo controlled 5 cell crossover design involving 15 volunteers. The test drinks were blackcurrant juice/calcium concentrate, blackcurrant juice/calcium drink, proprietary apple & blackcurrant juice concentrate, proprietary orange drink concentrate and water. Four enamel samples were retained in situ, 2 anterior palate and 2 mid/posterior palate, on upper removable acrylic appliances. Drinks were 250 ml volumes consumed 4 times per day during 15 working days. Concentrates were diluted 50 ml in 200 ml water. Measurements of enamel loss were made on one anterior and one posterior sample on days 2, 5, 10 and 15 by profilometry., Results: One subject approached the 20 microns erosion limit by day 10 on the orange drink and was withdrawn from that cell. Differences in mean erosion between anterior and posterior sites were variable and small. By day 15 the mean losses of enamel averaged over anterior and posterior were blackcurrant/calcium concentrate 0.28 micron, blackcurrant/calcium drink 0.35 micron, apple & blackcurrant concentrate 2.04 microns. orange concentrate 8.29 microns and water 0.08 micron. Except at day 15 for the blackcurrant/calcium drink the erosion by the blackcurrant/calcium formulations was not significantly different from water at any time point. Erosion by the apple & blackcurrant and orange concentrate drinks was highly significantly greater than the blackcurrant/calcium drinks at all but the 2 day time point for the apple & blackcurrant concentrate drink compared to the blackcurrant/calcium drink., Conclusions: All data thus far indicate that dependant on tooth site susceptibility and the specific drink, the consumption of standard low pH fruit drinks could result in 1 mm loss of enamel in periods ranging from as little as 2 years to 20 years. Similar erosion by the low pH blackcurrant drinks with added calcium would take in excess of 100 years.

Objective: The aim of this study was to determine whether an experimental blackcurrant juice drink with added calcium was less erosive to enamel both in vitro and in situ compared with a proprietary orange juice product., Methods: The study was a single centre, blind, randomised, placebo controlled three cell crossover design. An intra oral appliance capable of retaining one enamel sample in situ was constructed and worn by 12 volunteers. The drinks under test were orange juice, the experimental blackcurrant juice drink with calcium and water. Drinks were consumed as 250 ml volumes four times during the working day under supervision for 15 days. The same methodology was modelled in vitro. Measurements of enamel loss were made by profilometry., Results: Water, the experimental blackcurrant juice drink and orange juice produced 0.19, 0.41 and 2.54 microns loss of enamel respectively in situ and 0.0, 5.2 and 22.18 microns loss of enamel respectively in vitro. All differences between pairs of drinks in situ and in vitro were statistically significant., Conclusions: Data using this model in situ were only available for orange juice and this was therefore considered as a positive control with water a placebo control. The results have demonstrated that the experimental blackcurrant juice drink with calcium is markedly less erosive than orange juice, particularly and importantly in situ. The experimental blackcurrant juice drink has limited erosive potential to teeth and deserves further comparative investigation and development as a low pH fruit drink for public consumption.

Objective: Acidic soft drinks are frequently implicated in dental erosion, but there are limited supporting data. Research is problematic due to the insidious nature of erosion and accuracy in assessing tissue loss. The aim of this study was to develop and validate, using a negative control, a model to accurately measure erosion in situ due to a single aetiological agent over a relatively short time period., Methods: An intra-oral appliance capable of retaining an enamel sample was designed in order to assess the effect of orange juice consumption on enamel. The study was a single centre, randomized, placebo controlled, blind, crossover design., Results: Ten subjects, each consuming 11 of orange juice per day for 15 days, showed significantly more erosion on the enamel specimens than the same subjects consuming 11 of water per day over the same time period, measurements undertaken with surfometry. The same investigation was performed in vitro. Again, orange juice was significantly more erosive; indeed, it was in the order of 10 times that produced in situ. Surface microhardness testing in situ and in vitro demonstrated statistically significant differences between exposed and unexposed areas after orange juice treatment., Conclusions: Changes produced by water either in situ or in vitro were always well within the baseline measurement parameters (+/- 0.3 micron) set down for the method and hence validated the clinical model in terms of reproducibility and accuracy in measurement. It is concluded that this method has confirmed the erosive potential of orange juice in situ. The method could have many applications to study dental erosion under highly controlled conditions and over realistic time periods.

A considerable number of varied agents are apparently effective in the treatment of dentine hypersensitivity. In particular, the literature supports the efficacy of strontium, potassium and fluoride containing toothpastes. This study was a double-blind, randomised, parallel group comparison of three products, namely strontium- and potassium-based desensitising toothpastes both containing fluoride, and a conventional fluoride toothpaste. A total of 131 subjects entered a 4-week wash-in phase using the conventional fluoride toothpaste, of whom 120 entered a 6-week treatment phase. Sensitive teeth were evaluated at wash-in baseline, treatment baseline and after 2 and 6 weeks use of the treatment pastes. Dentine hypersensitivity was assessed with tactile and cold air stimuli together with an overall subjective assessment. Analysis of the findings was performed using non-parametric statistical methods. Of the original 120 subjects, 112 completed the trial. All 3 toothpaste groups showed reductions in sensitivity over the 6 weeks; however, no significant differences were found between the three products at any given time. Interestingly, there was no significant change in sensitivity between wash-in baseline and treatment baseline for the cold air stimulus with the fluoride-only-based paste. However, for the group using the same fluoride toothpaste, there was significant improvement between wash-in baseline and week 6, and treatment baseline and week 6 for this stimulus, suggesting a substantial placebo effect occurred. There is a need for further investigation of a wash-in period and examination of the placebo effect when evaluating dentine hypersensitivity trials.