The document summarizes a journal club presentation on the efficacy of hydroxyapatite and silica nanoparticles for remineralizing erosive lesions. It provides definitions and classifications of dental erosion, as well as risk factors, clinical appearance, evaluation methods, and current management strategies. The study aimed to compare the mineral gain and penetration of hydroxyapatite and silica nanoparticle infiltrates into artificially-created erosive enamel and dentin lesions. Results showed hydroxyapatite infiltrate resulted in greater remineralization of enamel and similar remineralization of dentin compared to silica nanoparticles.

1. JOURNAL CLUB :EFFICACY OF
HYDROXYAPATITE AND SILICA
NANOPARTICLES ON EROSIVE LESIONS
REMINERALIZATION
Aneetinder Kaur
PG-1stYear
Department of Conservative
Dentistry & Endodontics

2. CONTENTS
 Erosion
 Definition
 Classification
 Prevalence
 Aetiology
 Clinical appearance
 Management
 Prevention
 Nanomaterials
 Journal club
 Aim
 Material & methods
 Sample preparation
 Analysis of samples
 Results
 Conclusion
 References

3. DEFINITION
 The loss of surface tooth structure by chemical action in the continued presence of
demineralizing agents with low pH is defined as erosion.
Sturdevant's Art and Science of operative dentistry 7th edition
 Erosion is the wear or loss of tooth surface by chemicomechanical action
Sturdevant's Art and Science of operative dentistry 5th edition
 Erosion — A loss of tooth substance by a chemical process without bacteria.
Glossary of EndodonticTermsTenth Edition
 Dental erosion is defined as irreversible loss of dental hard tissue by a chemical process that
does not involve bacteria.
Shafers textbook of oral pathology 7th edition

4. Classification based on
etiology
Extrinsic erosion
intrinsic erosion
Idiopathic erosion
Classification based on
pathogenetic activity
(Mannerberg)
Manifest erosion
Latent erosion
Classification based on
clinical severity
(1979 Eccles)
Class I:involving
enamel only
Class II:< 1/3 of
surface involving
dentin
Class III: >1/3 of
surface involving
dentin
Classification based on
appearance/ severity
( Mahasweta 2016)
0- no surface loss
1- initial loss of
enamel surface
texture
2- distinct defect,
hard tissue loss
dentine less than50%
surface area
3- hard tissue loss
more than 50% of
surface area
IinfeldT: Dental erosion. Definition, classification and links. Eur Journal Sci
1996: 104: 1.5-155. 0, 1996
Pickard’s Manual of Operative Dentistry, Eighth
edition
CLASSIFICATION

5. PREVALENCE
Amaechi BT , 2004 Dental erosion: possible approaches to prevention and control Journal of Dentistry (2005) 33, 243–252

6. CAUSES
 Exposure to acidity from dried fruits, fruit drinks,sports drinks, herbal
teas, and vomiting associated with chemotherapy, and alcoholism.
Sturdevant'sArt and Science of operative dentistry 7th edition
 Regurgitated acid is the most common cause of erosion and causes
the most damage.
Pickard’s Manual of Operative Dentistry, 8th edition
 Food substances with a critical pH value of less than 5.5 becomes a
corrodent and demineralizes the teeth.
( Stephan RM, JADA 1940) ,( Gray JA, J Dent Res 1962) , (Zero DT.Cariology. Dent Clin NorthAm 1999)
 Holding ,swilling or retaining acidic drinks and foods in the mouth
prolongs the acid exposure on the teeth increasing the risk of
erosion .
(Mossazzez R ,Smith BGN,Barlett DW,Oral Ph and drinking habit during the ingestion of carbonated drink in a
group of adolescents with dental erosion ,J Dent 2000)
(MillerWD ,1907 )

7. Kanzow et al 2016
Li et al , 2012 Dietary FactorsAssociated with Dental
Erosion: A MetaAnalysis , plos one vol7 issue 8
Clark DC,Woo G, Silver JG, et al.The infl uence of frequent ingestion of acids in the diet on
treatment for dentin sensitivity. J Can DentAssoc, 56: 1101–1103, 1990.

8. Scheutzel P: Etiology of dental erosion - intrinsic
factors. Eur J Oral Sci 1996: 104: 178-190. ©
Munksgaard. 1996.

9. RISK FACTORS FOR DENTAL EROSION
0- LussiA. Erosive tooth wear - a multifactorial condition of growing
concern and increasing knowledge. Monogr Oral Sci. 2006;20:1-8.
Addy M, Shellis RP. Interaction between attrition, abrasion and erosion in tooth wear.
Monogr Oral Sci. 2006;20:17-31.

10. JarvinenVK, Rytomaa II, and Heinonen OP. Risk factors in dental erosion. J Dent Res 70: 942–947, 1991

11. APPEARANCE
 defective surface is usually
smooth
 Exogenous acidic agents such as
lemon juice cause crescent-
shaped or dished defects
(rounded as opposed to angular)
 Endogenous acidic agents, such
as gastric Fluids, cause
generalized erosion
 clinical presentation of “cupped-
out” areas on occlusal surfaces.
are associated with the binge–
purge syndrome in bulimia, or
with gastroesophageal relux
disease (GERD)
Sturdevant'sArt and Science of operative dentistry 7th edition

12. Pickard’s Manual of Operative Dentistry, 8th edition

13. Magalhaes et al , 2009 Insights Into Preventive Measures For Dental Erosion J ApplOral Sci. 2009;17(2):75-86

14. Pickard’s Manual of Operative Dentistry, 8th edition

15. Abrahamsen:The worn dentition International Dental Journal (2005)Vol. 55/No.4

17. Johansson, A.K., Omar, R., Carlsson, G.E. and Johansson, A., 2012. Dental erosion and its growing
importance in clinical practice: from past to present. International journal of dentistry, 2012.

18.  It is necessary to document the
erosion process as it progresses
over time through the use accurate
study models, photography, and/or
digital scanning technology.
Sturdevant'sArt and Science of operative dentistry 7th edition

19. .
Joshi et al 2016,Techniques to Evaluate Dental Erosion: A Systematic Review of Literature Journal of Clinical and Diagnostic Research.
2016 Oct,Vol-10(10): ZE01-ZE07
EVALUATION OF EROSION

20. Pickard’s Manual of Operative Dentistry, 8th edition

21. MANAGEMENT
The lesions are not carious but may need to be
managed provided one or more of these
factors are present:
the patient is
concerned
with
esthetics
substantial
tooth
sensitivity
the lesion is
progressing
and there is
risk of pulpal
exposure,
tooth
integrity is at
risk
Abraded or eroded areas should be considered for
restoration only if one or more of the following is
true:
the area is affected by
caries
the defect is sufficiently
deep to compromise the
structural integrity of
the tooth
intolerable sensitivity
exists and is
unresponsive to
conservative
desensitizing measures
the defect contributes to
a periodontal problem
the area is to be involved
in the design of a
removable partial
denture
the depth of the defect
is judged to be close to
the pulp
the defect is actively
progressing
Sturdevant'sArt and Science of operative dentistry 7th edition Sturdevant'sArt and Science of operative dentistry 5th edition

22. Sturdevant'sArt and Science of operative dentistry 7th edition

23. Sturdevant'sArt and Science of operative dentistry 7th edition

24. PREVENTION OF PROGRESSION OF
EROSION
1. Diminish the frequency and severity of acid challenge.
2. Treating the underlying medical disorder or disease.
3. GERD ,anorexia ,bulimia → refer to a physician/psychologists
4. Enhance the defense mechanisms of body
5. Enhance acid resistance, remineralization and rehardening of the tooth surfaces.
6. Decrease abrasive forces.
7. Improve chemical protection
8. Provide mechanical protection
(Beatrice K Gandara, Edmond LTruelove.The Journal of Contemporary Dental Practice, Volume 1, No. 1, Fall Issue, 1999.)
• No brushing should be done immediately after consuming acidic food and drink as teeth will be
softened.Rinsing with water is better than brushing after consuming acidic foods and drinks.
(Gandara, B.K; E.LTruelove ,Diagnosis and management of dental erosion Journal of Contemp.Dental Practice 1999)

25. Magalhaes et al , 2009 Insights Into Preventive Measures For Dental Erosion J ApplOral Sci.

26. NANOMATERIALS
 Nanomaterial’ means a natural, incidental or manufactured
material containing particles, in an unbound state or as an
aggregate or as an agglomerate and where, for 50% or more
of the particles in the number size distribution, one or more
external dimensions is in the size range 1 nm–100 nm
. European Commission (EU). Commission recommendation of 18 October
2011 on the definition of nanomaterial (2011/696/EU). Off J. 2011;L 275:38–40
Types
Nanoparticles
Nanorods
nanofilms

27. : S. Priyadarsini, et al., Nanoparticles used in dentistry:A review, J Oral Biol Craniofac Res. (2017)

28. : S. Priyadarsini, et al., Nanoparticles used in dentistry:A review, J Oral Biol Craniofac Res. (2017)

29. : S. Priyadarsini, et al., Nanoparticles used in dentistry:A review, J Oral Biol Craniofac Res. (2017)

30. EFFICACY OF HYDROXYAPATITE AND
SILICA NANOPARTICLES ON EROSIVE
LESIONS REMINERALIZATION
Srujana Karumuri, Jyothi Mandava, Sahithi Pamidimukkala, LakshmanVarma Uppalapati, Ravi
Kumar Konagala, Lohita Dasari
December 2020 Journal of Conservative Dentistry

31. AIM
 :The aim is to assess and compare the mineral gain and penetration depth of
hydroxyapatite and silica nanoparticle infiltrates into artificially created erosive
lesions of enamel and dentin.

32. MATERIALS AND METHODS
 Sixty sound, freshly extracted mandibular molars
 nHA aqueous paste (Sigma Aldrich, St. Louis, Missouri USA)
 colloidal nanosilica infiltrate-Ludox HS-40 (Sigma Aldrich, St. Louis, Missouri USA)

33. SAMPLE PREPARATION
Each tooth was decoronated approximately 1 mm below the cementoenamel
junction
Sectioned mesiodistally along the central groove of the occlusal surface
embedded in acrylic resin molds
erosive enamel lesions, the buccal surfaces of samples immersed in the
freshly prepared 1%W/V citric acid (pH 2.3) solution six times daily for 2 min
at 37°C for 6 days
dentin erosive lesions on lingual surfaces, a straight fissure bur was used to
remove the enamel, and the dentin underneath was exposed. Later, the
samples were completely immersed in a 4N formic acid solution for 48 h.

34. INFILTRATION OF SPECIMENS
 Infiltrants were applied at 3, 6, 8 10, 12 h Intervals and were immersed in artificial
saliva during the interim phase.

35. SCANNING ELECTRON MICROSCOPY/ ENERGY-
DISPERSIVE X-RAY SPECTROSCOPY ANALYSIS
 Two readings were taken on each half of the sample, and elemental values of
silica, calcium, and phosphorus were obtained
 .The gain in mineral content after the infiltrants application was analyzed by
peaks in weight % and volume % for calcium and phosphorus elements.

36. PENETRATION DEPTH ANALYSIS
 0.1% ethanolic solution of tetramethyl rhodamine isothiocyanate dye was added
to the infiltrants before application.
 Then, infiltrated enamel and dentin specimens were sectioned to a size of 150 µm
thickness using a hard tissue microtome and were visualized under confocal laser
scanning microscope

37. STATISTICAL ANALYSIS
 The intergroup comparisons were made using one-way ANOVA followed byTukey
post hoc test for pairwise comparisons for both penetration depth and mineral
gain.To compare the overall values of mineral gain between groups, a dependent
t-test was applied.The level of significance was set to P ≤ 0.05

38. RESULTS
 The overall mineral content gain was not different in enamel samples between
nHA and nSiO2 infiltrants (P = 0.9950) [Table 1].The difference in mineral gain
was highly significant in dentin samples between the two infiltrants tested (P =
0.0001)
 Dentin samples gained more Ca and P than enamel samples for both the
infiltrants (P < 0.05).
 In dentin, both the infiltrants presented similar penetration depths without any
difference statistically
 However, in enamel, the nHA infiltrant exhibited a statistically higher depth of
penetration than the nSiO2 infiltrant

39. CONCLUSION
 The present study arrives at the conclusion that nHA infiltrant was better at
regaining lost mineral content and have shown greater penetration into the
enamel and dentin erosive lesions when compared to nanosilica infiltrant.

40. REFERENCES
1. Sturdevant'sArt and Science of operative dentistry 7th edition
2. Sturdevant'sArt and Science of operative dentistry 5th edition
3. Shafers textbook of oral pathology 7th edition
4. Glossary of EndodonticTermsTenth Edition
5. IinfeldT: Dental erosion. Definition, classification and links. Eur Journal Sci 1996: 104: 1.5-155. 0, 1996
6. Amaechi BT , 2004 Dental erosion: possible approaches to prevention and control Journal of Dentistry (2005) 33, 243–
252
7. Mossazzez R ,Smith BGN,Barlett DW,Oral Ph and drinking habit during the ingestion of carbonated drink in a group of
adolescents with dental erosion ,J Dent 2000)
8. Scheutzel P: Etiology of dental ero.'sion - intrinsic factors. Eur J Oral Sci 1996: 104: 178-190. © Munksgaard. 1996.
9. Li et al , 2012 Dietary FactorsAssociated with Dental Erosion: A MetaAnalysis , plos one vol7 issue 8
10. 0- LussiA. Erosive tooth wear - a multifactorial condition of growing concern and increasing knowledge. Monogr Oral
Sci. 2006;20:1-8.

41. 11. Addy M, Shellis RP. Interaction between attrition, abrasion and erosion in tooth wear. Monogr Oral Sci. 2006;20:17-31.
12 Magalhaes et al , 2009 Insights Into Preventive Measures For Dental Erosion J Appl Oral Sci. 2009;17(2):75-86
13 Abrahamsen:The worn dentition International Dental Journal (2005)Vol. 55/No.4
14 Johansson, A.K., Omar, R., Carlsson, G.E. and Dental erosion and its growing importance in clinical practice: from past to
present. International journal of dentistry, 2012.
15 Joshi et al 2016,Techniques to Evaluate Dental Erosion: A Systematic Review of Literature Journal of Clinical and Diagnostic
Research. 2016 Oct,Vol-10(10): ZE01-ZE07
16 Beatrice K,Edmond L ,J Contemp.Dental practise ,1999)
17 Gandara, B.K; E.LTruelove ,Diagnosis and management of dental erosion Journal of Contemp.Dental Practice 1999)
18 European Commission (EU). Commission recommendation of 18 October 2011 on the definition of nanomaterial
(2011/696/EU). Off J. 2011;L 275:38–40
19 S. Priyadarsini, et al., Nanoparticles used in dentistry:A review, J Oral Biol Craniofac Res. (2017)
20 JarvinenVK, Rytomaa II, and Heinonen OP. Risk factors in dental erosion. J Dent Res 70: 942–947, 1991
21 Clark DC,Woo G, Silver JG, et al.The influence of frequent ingestion of acids in the diet on treatment for dentin sensitivity. J
Can DentAssoc, 56: 1101–1103, 1990.
22 Pickard’s Manual of Operative Dentistry, 8th edition