Diet and wear
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along with a history of recent dental treatments, symptoms experienced before diving, pain onset and/or cessation on ascent or descent, and characteristics of the pain. Clinicians should be alert to faulty restorations and secondary caries, perform a vitality test, obtain needed periapical radio- graphs, and rule out sinusitis or pain originating from TMJ or masticatory muscles. Mouthpiece-Related Conditions.—SCUBA divers are supplied with air from a compressed air tank delivered to the mouth via a regulator with a mouthpiece that is held in place by the teeth, usually the canines and premolars. An airtight seal is needed between teeth and lips. Complete or partial edentulism makes it impossible to hold the mouthpiece and is a contraindication to SCUBA diving. Three mouthpiece designs are available: commercial, semi-customized, and customized. Most are made from sil- icone or soft acrylic resins. Dental restorations may also be subject to increased clenching on the mouthpiece as a result of emotional stress and the cold environment. The result may be deleterious to the restorations. Other prob- lems identified that involve mouthpieces are the transmis- sion of herpes simplex virus between partners when the mouthpiece is exchanged during underwater drills; mouthpiece-associated pharyngeal (gag) reflex during depth diving that can cause DCS; and an elevated preva- lence of temporomandibular disorder (TMD), especially among women who dive. Pre-existing TMDs may be exacer- bated by diving as well. Symptoms include muscle pain, joint pain, internal derangement of the TMJ-disk, and head- ache. Fully customized mouthpieces cause the least mandibular displacement from normal resting position and produce the least discomfort, muscle pain, fatigue, and effort. Dentists should restrict divers from diving for at least 1 week after oral surgery, and healing should be confirmed before dives are undertaken. Diver patients must be educated about the infectious potential of sharing a mouth- piece and encouraged to maintain mouthpiece hygiene af- ter each use. Divers should not dive when they are ill. Primary herpetic gingivostomatitis should be readily identi- fied by the dentist. If the diver has a prominent pharyngeal reflex, he or she should avoid factors that contribute to gagging, undergo desensitization training, trim the intraoral trigger parts in the mouthpiece, or use a full-face mask. Divers should not use antigagging medications. TMD symptoms must be differentiated from barotitis symptoms. A custom mouthpiece with a bite platform at least 4-mm thick may help divers who experience diving- related TMD symptoms. The interdental bite platform can be extended to cover the molars as well as the canines and premolars, thus balancing the weight of the regulator and relieving stress on the TMJ. All mouthpieces must be readily removable and compatible with the diving mate’s use in emergency situations. Any custom mouthpiece should be tested in a training pool before use in an open- water diving situation. If custom mouthpieces are not an option, the diver should test out a number of mouthpieces through trial dives lasting at least 15 minutes plus a rest period of 15 minutes to ensure the design causes the fewest joint symptoms. Clinical Significance.—General dental practi- tioners must be prepared to manage problems related to SCUBA diving. They must also be able to advise patients about possible complica- tions and what they should do to prevent or manage them. Zadik Y, Drucker S: Diving dentistry: A review of the dental implica- tions of scuba diving. Austral Dent J 56:265-271, 2011 Reprints available from Y Zadik, Dept of Oral Medicine, Hebrew Univ – Hadassah School of Dental Medicine, PO Box 91120, Jerusalem, Israel; e-mail: [email protected] Tooth Wear Diet and wear Background.—Tooth wear in children and adolescents is common, most likely the result of acidic foods and drinks based on laboratory studies. Few studies have assessed risk factors for tooth wear in adults. Known risk factors in tooth wear were investigated in a convenience sample of univer- sity students in London. Methods.—The mean age of participants was 21.9 years, and 70% of the 1010 subjects were women. All had a tooth wear index recorded and completed a validated question- naire consisting of 50 questions about current and historical dietary habits (covering the previous 2 months). Data were analyzed at the tooth level using odds ratios. Volume 58 Issue 5 2013 279
Transcript of Diet and wear
along with a history of recent dental treatments, symptomsexperienced before diving, pain onset and/or cessation onascent or descent, and characteristics of the pain. Cliniciansshould be alert to faulty restorations and secondary caries,perform a vitality test, obtain needed periapical radio-graphs, and rule out sinusitis or pain originating from TMJor masticatory muscles.
Mouthpiece-Related Conditions.—SCUBA divers aresupplied with air from a compressed air tank delivered tothe mouth via a regulator with a mouthpiece that is heldin place by the teeth, usually the canines and premolars.An airtight seal is needed between teeth and lips. Completeor partial edentulism makes it impossible to hold themouthpiece and is a contraindication to SCUBA diving.Three mouthpiece designs are available: commercial,semi-customized, and customized. Most are made from sil-icone or soft acrylic resins. Dental restorations may also besubject to increased clenching on the mouthpiece as aresult of emotional stress and the cold environment. Theresult may be deleterious to the restorations. Other prob-lems identified that involve mouthpieces are the transmis-sion of herpes simplex virus between partners when themouthpiece is exchanged during underwater drills;mouthpiece-associated pharyngeal (gag) reflex duringdepth diving that can cause DCS; and an elevated preva-lence of temporomandibular disorder (TMD), especiallyamong women who dive. Pre-existing TMDs may be exacer-bated by diving as well. Symptoms include muscle pain,joint pain, internal derangement of the TMJ-disk, and head-ache. Fully customized mouthpieces cause the leastmandibular displacement from normal resting positionand produce the least discomfort, muscle pain, fatigue,and effort.
Dentists should restrict divers from diving for at least 1week after oral surgery, and healing should be confirmedbefore dives are undertaken. Diver patients must beeducated about the infectious potential of sharing a mouth-piece and encouraged to maintain mouthpiece hygiene af-ter each use. Divers should not dive when they are ill.
Primary herpetic gingivostomatitis should be readily identi-fied by the dentist.
If the diver has a prominent pharyngeal reflex, he or sheshould avoid factors that contribute to gagging, undergodesensitization training, trim the intraoral trigger parts inthe mouthpiece, or use a full-face mask. Divers shouldnot use antigagging medications.
TMD symptoms must be differentiated from barotitissymptoms. A custom mouthpiece with a bite platform atleast 4-mm thick may help divers who experience diving-related TMD symptoms. The interdental bite platform canbe extended to cover the molars as well as the caninesand premolars, thus balancing the weight of the regulatorand relieving stress on the TMJ. All mouthpieces must bereadily removable and compatible with the diving mate’suse in emergency situations. Any custom mouthpieceshould be tested in a training pool before use in an open-water diving situation. If custom mouthpieces are not anoption, the diver should test out a number of mouthpiecesthrough trial dives lasting at least 15 minutes plus a restperiod of 15 minutes to ensure the design causes the fewestjoint symptoms.
Clinical Significance.—General dental practi-tioners must be prepared to manage problemsrelated to SCUBA diving. They must also beable to advise patients about possible complica-tions and what they should do to prevent ormanage them.
Zadik Y, Drucker S: Diving dentistry: A review of the dental implica-tions of scuba diving. Austral Dent J 56:265-271, 2011
Reprints available from Y Zadik, Dept of OralMedicine, HebrewUniv –Hadassah School of DentalMedicine, PO Box 91120, Jerusalem, Israel;e-mail: [email protected]
Tooth WearDiet and wear
Background.—Tooth wear in children and adolescentsis common, most likely the result of acidic foods and drinksbased on laboratory studies. Few studies have assessed riskfactors for tooth wear in adults. Known risk factors in toothwear were investigated in a convenience sample of univer-sity students in London.
Methods.—Themean age of participants was 21.9 years,and 70% of the 1010 subjects were women. All had a toothwear index recorded and completed a validated question-naire consisting of 50 questions about current and historicaldietary habits (covering the previous 2 months). Data wereanalyzed at the tooth level using odds ratios.
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Results.—A total of 96,960 surfaces were examined,with 2033 (2.1%) surfaces having more than 25% of the sur-face restored. All subjects had evidence of wear on enamelof grade 1; 20.1% had enamel wear over grade 2. Dentinexposure was found at less than grade 1 on 5.3% of surfaces.Nearly 8% of participants had at least one tooth surface withexposed dentin. Most of the enamel wear was found onanterior teeth and first molars. Dentin wear was more com-mon on the incisal surfaces of the upper and lower incisors.
For enamel, associations were noted between drinkingfrom a glass on the buccal surface and beer and wine con-sumption on the occlusal and incisal surfaces. For dentin,associations were observed with eating apples, drinking or-ange drinks and fruit juices, and recently changing toorange-containing drinks. Swilling and heartburn alsoshowed significant relationships with dentin wear charac-teristics. Fifty-eight percent of the respondents reporteddentin sensitivity, with 11.3% saying they experiencedsymptoms daily.
Discussion.—This sample of university students is notrepresentative of all young adults, but the finding thatstrong acids are associated with tooth wear is consistentwith current clinical thinking. Patterns of wear differed forenamel and dentin, which complicated the analysis. Wearof enamel was universal at grade 1, but few subjects hadmore severe levels. The analysis shows a relationship be-tween dietary intake and the surface where tooth weardeveloped. Eating apples and other fruits had high odds ra-tios indicative of tooth wear in dentin. Drinks often associ-ated with dietary erosion, such as colas, showed no odds
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ratios or statistical relationships with tooth wear. Frequencyof consumption was more important than the underlyingacidic nature of the food. Drinking habits, such as swillingbefore swallowing, was also associated with occlusal andpalatal dentin exposure. Dentin exposure was related tothe consumption of apples, fruit-based drinks, and heart-burn, but enamel wear was not. Higher odds ratios werealso associated with intake of beer and wine for enamelwear and drinking fruit-based drinks for dentin wear.
Clinical Significance.—Dietary advice shouldtarget the intake of foods and drinkswith strongacidic content. Frequency of consumption is themost important component in developing toothwear. In addition, drinking habits appear to in-fluence dentin and enamel wear. Gastric acidsare also an important contributor towear. Thesefacts should be conveyed to young adults in thehope of altering their habits before extremedamage is produced.
Bartlett W, Fares J, Shirodaria S, et al: The association of tooth wear,diet and dietary habits in adults aged 18-30 years old. J Dent39:811-816, 2011
Reprints available from DW Bartlett, King’s College London DentalInst, Flr 25, Guy’s Tower, London, Bridge SE1 9RT, United Kingdom;fax: þ44 01207 188 5390; e-mail: [email protected]
