Toothbrushing and erosive tooth wear

Erosive tooth wear, also called dental erosion, defines the loss of dental hard tissue (enamel and dentin) caused by acids from food and beverages or from gastric reflux. Tooth wear can also be caused by tooth-to-tooth contact (attrition) or by friction (abrasion), for example from toothbrushing.

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SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

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Published: Report no: ut202216 Registration no: SBU 2022/124
Errata
https://www.sbu.se/ut202216e

Question

What scientific studies or systematic reviews are there on delayed toothbrushing after intake of acidic food and beverage compared to immediate toothbrushing?

Identified literature

No relevant systematic review based on clinical prospective studies were identified. One case control study was identified that investigated the association between timing of dietary acid intake and erosive tooth wear [1].

One systematic review on enamel wear was identified and it summarized in vitro and in situ studies comparing human enamel brushed at different time points after an acid challenge (Table 1) [2]. In addition to the six relevant studies [3-8] included in the systematic review, one relevant in vitro study not included in the systematic review was also identified [9]. The primary studies were not assessed for risk of bias and therefore the results are not presented here.

Table 1. Systematic reviews with low/moderate risk of bias

Included studies Population/Intervention Outcome and Results
Hong et al, 2020, [2]
Does delayed toothbrushing after the consumption of erosive foodstuffs or beverages decrease erosive tooth wear? A systematic review and meta-analysis
6 relevant studies on human enamel (3 in situ, 3 in vitro) Population:
Blocks of human enamel exposed to acid challenge (demineralization)
Intervention:
Storage in saliva or in the mouth before acid exposure, and before toothbrushing (10 to 120 minutes)
Control:
Toothbrushing immediately after acid exposure		 Erosive toothwear Profilometer or indentation measurements
Storage in saliva 30 to 60 minutes (5 studies):
SMD −0.15
(95% CI, −0.54 to 0.24)
Not significant
Authors' conclusion:
“Delayed toothbrushing after an erosive attack was not effective at decreasing the ETW of human enamel compared to immediate toothbrushing […].”…..”Moreover, since the present findings were based on in vitro and in situ studies, the results must be interpreted with caution. Further randomized controlled clinical trials are necessary to confirm the present findings.”

References

  1. O'Toole S, Bernabe E, Moazzez R, Bartlett D. Timing of dietary acid intake and erosive tooth wear: A case-control study. J Dent. 2017;56:99-104. Available from: https://doi.org/10.1016/j.jdent.2016.11.005.
  2. Hong DW, Lin XJ, Wiegand A, Yu H. Does delayed toothbrushing after the consumption of erosive foodstuffs or beverages decrease erosive tooth wear? A systematic review and meta-analysis. Clin Oral Investig. 2020;24(12):4169-83. Available from: https://doi.org/10.1007/s00784-020-03614-9.
  3. Soares GG, Magalhaes PA, Fonseca ABM, Tostes MA, Silva EMD, Coutinho TCL. Preventive Effect of CPP-ACPF Paste and Fluoride Toothpastes Against Erosion and Erosion Plus Abrasion In Vitro - A 3D Profilometric Analysis. Oral Health Prev Dent. 2017;15(3):269-77. Available from: https://doi.org/10.3290/j.ohpd.a38160.
  4. Ferreira MC, Ramos-Jorge ML, Delbem AC, Vieirac Rde S. Effect of Toothpastes with Different Abrasives on Eroded Human Enamel: An in situ/ex vivo Study. Open Dent J. 2013;7(1):132-9. Available from: https://doi.org/10.2174/1874210601307010132.
  5. Ganss C, Schlueter N, Friedrich D, Klimek J. Efficacy of waiting periods and topical fluoride treatment on toothbrush abrasion of eroded enamel in situ. Caries Res. 2007;41(2):146-51. Available from: https://doi.org/10.1159/000098049.
  6. Jaeggi T, Lussi A. Toothbrush abrasion of erosively altered enamel after intraoral exposure to saliva: an in situ study. Caries Res. 1999;33(6):455-61. Available from: https://doi.org/10.1159/000016551.
  7. Lopes RM, da Silva JSA, Joao-Souza SH, Maximiano V, Machado AC, Scaramucci T, et al. Enamel surface loss after erosive and abrasive cycling with different periods of immersion in human saliva. Arch Oral Biol. 2020;109:104549. Available from: https://doi.org/10.1016/j.archoralbio.2019.104549.
  8. Lussi A, Lussi J, Carvalho TS, Cvikl B. Toothbrushing after an erosive attack: will waiting avoid tooth wear? Eur J Oral Sci. 2014;122(5):353-9. Available from: https://doi.org/10.1111/eos.12144.
  9. Soares GG, Magalhaes PA, Fonseca ABM, Tostes MA, Silva EMD, Coutinho TCL. Preventive Effect of CPP-ACPF Paste and Fluoride Toothpastes Against Erosion and Erosion Plus Abrasion In Vitro - A 3D Profilometric Analysis. Oral Health Prev Dent. 2017;15(3):269-77. Available from: https://doi.org/10.3290/j.ohpd.a38160.

Literature search

Medline via OvidSP 24 September 2019

Title: Erosive tooth wear and toothbrushing
The final search result, usually found at the end of the documentation, forms the list of abstracts.

.ab. = Abstract; .ab,ti. = Abstract or title; .af. = All fields; Exp = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; .sh. = Term from the Medline controlled vocabulary; .ti. = Title; / = Term from the Medline controlled vocabulary, but does not include terms found below this term in the MeSH hierarchy; * = Focus (if found in front of a MeSH-term); * or $ = Truncation (if found at the end of a free text term); .mp = Text, heading word, subject area node, title; " " = Citation Marks; searches for an exact phrase; ADJn = Positional operator that lets you retrieve records that contain your terms (in any order) within a specified number (n) of words of each other
Search terms Items found
Population: tooth wear
1. exp Tooth Wear/ 6 379
2. ((tooth or dental or enamel or dentin*) adj (erosion* or wear)).tw,kw. 3 592
3. (erosive or abrasive) adj wear)).tw. 678
4. or/1-3 7 968
Exposure: diet, toothbrushing, timing
5. exp Beverages/ or exp Acids/ 348 102
6. (beverage* or acid* or diet* or juice* or fruit* or soda* or soft drink*).tw,kw. 2 747 873
7. (erosive adj3 food*).tw,kw. 19
8. or/5-7 [diet] 2 971 528
9. Toothbrushing/ 7 963
10. (toothbrush* or brush*).tw. 39 719
11. or/9-10 [brushing] 42 179
12. (timing or habit$1 or immediate* or delay*).tw [timing] 1 142 000
Combined sets
13. 4 and 8 and 11 [wear AND diet AND brushing] 413
14. 4 and 8 and 12 [wear AND diet AND timing] 353
15. 4 and 11 and 12 [wear AND brushing AND timing] 116
16. or/13-15 700
Final result
17. 16 700

Embase via Elsevier 24 September 2019

Title: Erosive tooth wear and toothbrushing
The final search result, usually found at the end of the documentation, forms the list of abstracts.

/de = Term from the EMTREE controlled vocabulary; /exp = Includes terms found below this term in the EMTREE hierarchy /mj = Major Topic; :ab = Abstract; :au = Author; :ti = Article Title; :ti,ab = Title or abstract; * = Truncation; ' ' = Citation Marks; searches for an exact phrase; NEAR/n = Requests terms that are within 'n' words of each other in either direction; NEXT/n = Requests terms that are within 'n' words of each other in the order specified
Search terms Items found
Population: tooth wear
1. 'tooth disease'/de 37 838
2. (((tooth OR dental OR enamel OR dentin*) NEXT/1 (erosion* OR wear)):ti,ab,kw) OR toothwear:ti,ab,kw 4 099
3. ((erosive OR abrasive) NEXT/1 wear):ti,ab,kw 620
4. #1 OR #2 OR #3 39 214
Exposure: diet, toothbrushing, timing
5. 'beverage'/exp 260 144
6. 'acid'/exp 159 786
7. beverage*:ti,ab,kw OR acid*:ti,ab,kw OR diet*:ti,ab,kw OR juice*:ti,ab,kw OR fruit*:ti,ab,kw OR 'soda*or soft drink*':ti,ab,kw 3 346 879
8. (erosive NEAR/3 food*):ti,ab,kw 21
9. #5 OR #6 OR #7 OR #8 3 564 685
10. 'tooth brushing'/exp 12 925
11. toothbrush*:ti,ab OR brush*:ti,ab 46 467
12. #10 OR #11 52 471
13. (timing OR habit?1 OR immediate* OR delay* ):ti,ab  
Combined sets
14. #4 AND #9 AND #12 563
15. #4 AND #9 AND #13 277
16. #4 AND #12 AND #13 108
17. #14 OR #15 OR #16 848
Final result
18. 17 848

Cochrane Library via Wiley 24 September 2019 (CDSR, Cochrane Protocols & CENTRAL)

Title: Erosive tooth wear and toothbrushing
The final search result, usually found at the end of the documentation, forms the list of abstracts.

:au = Author; MeSH = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; this term only = Does not include terms found below this term in the MeSH hierarchy; :ti = Title; :ab = Abstract; :kw = Keyword; * = Truncation; " " = Citation Marks; searches for an exact phrase; CDSR = Cochrane Database of Systematic Review; Cochrane Protocols = Protocols of systematic reviews registered in Cochrane Library; CENTRAL = Cochrane Central Register of Controlled Trials, “trials”
Search terms Items found
Population: tooth wear
1. MeSH descriptor: [Tooth Wear] explode all trees 362
2. ((tooth OR dental OR enamel OR dentin*) NEAR (erosion* OR wear)):ti,ab,kw 737
3. ((erosive OR abrasive) NEAR wear):ti,ab,kw 60
4. #1 OR #2 OR #3 784
Exposure: diet, toothbrushing, timing
5. MeSH descriptor: [Beverages] explode all trees 7 002
6. MeSH descriptor: [Acids] explode all trees 3 871
7. ((beverage* OR acid* OR diet* OR juice* OR fruit* OR soda* OR "soft drink*")):ti,ab,kw 203 447
8. ((erosive OR acid*) NEAR/2 (food* OR beverage*)):ti,ab,kw 350
9. #5 OR #6 OR #7 OR #8 207 229
10. MeSH descriptor: [Toothbrushing] explode all trees 1 420
11. (toothbrush* OR brush*):ti,ab,kw 6 316
12. #10 OR #11 6 316
13. (timing OR habit OR habits OR immediate* OR delay*):ti,ab,kw 132 302
Combined sets
14. #4 AND #9 AND #12 38
15. #4 AND #9 AND #13 99
16. #4 AND #12 AND #13 54
17. #14 OR #15 OR #16 115
Final result
18. 17 CDSR/1
Cochrane Protocols/0
CENTRAL/114
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