John Kaidonis

Sequencing ancient calcified dental plaque shows changes in oral microbiota with dietary shifts of the Neolithic and Industrial revolutions

The importance of commensal microbes for human health is increasingly recognized, yet the impacts of evolutionary changes in human diet and culture on commensal microbiota remain almost unknown. Two of the greatest dietary shifts in human evolution involved the adoption of carbohydrate-rich Neolithic (farming) diets (beginning ∼10,000 years before the present) and the more recent advent of industrially processed flour and sugar (in ∼1850). Here, we show that calcified dental plaque (dental calculus) on ancient teeth preserves a detailed genetic record throughout this period. Data from 34 early European skeletons indicate that the transition from hunter-gatherer to farming shifted the oral microbial community to a disease-associated configuration. The composition of oral microbiota remained unexpectedly constant between Neolithic and medieval times, after which (the now ubiquitous) cariogenic bacteria became dominant, apparently during the Industrial Revolution. Modern oral microbiotic ecosystems are markedly less diverse than historic populations, which might be contributing to chronic oral (and other) disease in postindustrial lifestyles.

Wear of Human Enamel: A Quantitative in vitro Assessment:

Many factors influence the extent and rate at which enamel wears. Clinical studies in humans are limited by difficulties in the accurate quantification of intra-oral wear and by a lack of control over the oral environment. The purpose of this study was to determine the wear characteristics of human dental enamel under controlled experimental conditions. An electro-mechanical tooth wear machine, in which opposing enamel surfaces of sectioned, extracted teeth were worn under various conditions, was used to simulate tooth grinding or bruxism. Enamel surface wear was quantified by weight to an accuracy of 0.1 mg, with water uptake and loss controlled. The variables considered included the structure and hardness of enamel, facet area, duration of tooth contact, relative speed of opposing surfaces, temperature, load, pH, and the nature of the lubricant. Enamel wear under non-lubricated conditions increased with increasing load over the range of 1.7 to 16.2 kg. The addition of a liquid lubricant (pH = 7) reduced enamel wear up to 6.7 kg, but when the load increased above this threshold, the rate of wear increased dramatically. With the viscosity of the lubricant constant and pH = 3, the rate of wear was further reduced to less than 10% of the non-lubricated rate at 9.95 kg, after which the rate again increased substantially. Under more extreme conditions (pH = 1.2, simulating gastric acids), the wear was excessive under all experimental loads. When saliva was used as a lubricant, the amount of wear was relatively low at 9.95 kg, but rapid wear occurred at 14.2 kg and above. These results indicate that under non-lubricated conditions, enamel wear remains low at high loads due to the dry-lubricating capabilities of fine enamel powder. Under lubricated conditions, low loads with an acidic lubricant lead to little enamel wear, whereas very low pH results in a high rate of wear under all loads.

Abfraction: separating fact from fiction

Non-carious cervical lesions involve loss of hard tissue and, in some instances, restorative material at the cervical third of the crown and subjacent root surface, through processes unrelated to caries. These non-carious processes may include abrasion, corrosion and possibly abfraction, acting alone or in combination. Abfraction is thought to take place when excessive cyclic, non-axial tooth loading leads to cusp flexure and stress concentration in the vulnerable cervical region of teeth. Such stress is then believed to directly or indirectly contribute to the loss of cervical tooth substance. This article critically reviews the literature for and against the concept of abfraction. Although there is theoretical evidence in support of abfraction, predominantly from finite element analysis studies, caution is advised when interpreting results of these studies because of their limitations. In fact, there is only a small amount of experimental evidence for abfraction. Clinical studies have shown associations between abfraction lesions, bruxism and occlusal factors, such as premature contacts and wear facets, but these investigations do not confirm causal relationships. Importantly, abfraction lesions have not been reported in pre-contemporary populations. It is important that oral health professionals understand that abfraction is still a theoretical concept, as it is not backed up by appropriate clinical evidence. It is recommended that destructive, irreversible treatments aimed at treating so-called abfraction lesions, such as occlusal adjustment, be avoided.

Tooth wear: the view of the anthropologist

Anthropologists have for many years considered human tooth wear a normal physiological phenomenon where teeth, although worn, remain functional throughout life. Wear was considered pathological only if pulpal exposure or premature tooth loss occurred. In addition, adaptive changes to the stomatognathic system in response to wear have been reported including continual eruption, the widening of the masticatory cycle, remodelling of the temporomandibular joint and the shortening of the dental arches from tooth migration. Comparative studies of many different species have also documented these physiological processes supporting the idea of perpetual change over time. In particular, differential wear between enamel and dentine was considered a physiological process relating to the evolution of the form and function of teeth. Although evidence of attrition and abrasion has been known to exist among hunter-gatherer populations for many thousands of years, the prevalence of erosion in such early populations seems insignificant. In particular, non-carious cervical lesions to date have not been observed within these populations and therefore should be viewed as ‘modern-day’ pathology. Extrapolating this anthropological perspective to the clinical setting has merits, particularly in the prevention of pre-mature unnecessary treatment.

The effect of casein phosphopeptide–amorphous calcium phosphate on erosive enamel and dentine wear by toothbrush abrasion

OBJECTIVE In addition to its role as a remineralizing agent in preventing dental caries, calcium product (CPP-ACP) delivered as a mousse (Tooth Mousse, TM) can reduce erosion of enamel and dentine. The aim of this study was to determine whether CPP-ACP could also reduce erosive tooth wear involving toothbrush abrasion. METHODS Flat, polished enamel and dentine specimens (n=72) were subjected to 10 wear regimes, with each regime involving erosion in 0.3% citric acid (pH 3.2) for 10 min followed by toothbrush abrasion in a slurry of fluoride-free toothpaste and artificial saliva (1:3 ratio by weight) under a load of 2N for 200 cycles. The specimens were immersed in artificial saliva for 2h between wear regimes. In the experimental group 1, TM (containing CPP-ACP) was applied at the beginning of each wear episode for 5 min whereas TM- (without CPP-ACP) was applied in the experimental group 2. No mousse was applied in the control group. RESULTS TM significantly reduced enamel wear (mean+/-S.E., 1.26+/-0.33 microm in the experimental group 1 vs 3.48+/-0.43 microm in the control group) and dentine wear (2.16+/-0.89 microm in the experimental group 1 vs 10.29+/-1.64 microm in the control group), and dentine wear was significantly less in the experimental group 1 than in the experimental group 2 (5.75+/-0.98 microm). CONCLUSION The finding that TM reduced erosive tooth wear involving toothbrush abrasion, probably by remineralizing and lubricating eroded tooth surfaces, may have implications in the management of tooth wear.

Neanderthal behaviour, diet, and disease inferred from ancient DNA in dental calculus

Recent genomic data have revealed multiple interactions between Neanderthals and modern humans, but there is currently little genetic evidence regarding Neanderthal behaviour, diet, or disease. Here we describe the shotgun-sequencing of ancient DNA from five specimens of Neanderthal calcified dental plaque (calculus) and the characterization of regional differences in Neanderthal ecology. At Spy cave, Belgium, Neanderthal diet was heavily meat based and included woolly rhinoceros and wild sheep (mouflon), characteristic of a steppe environment. In contrast, no meat was detected in the diet of Neanderthals from El Sidrón cave, Spain, and dietary components of mushrooms, pine nuts, and moss reflected forest gathering. Differences in diet were also linked to an overall shift in the oral bacterial community (microbiota) and suggested that meat consumption contributed to substantial variation within Neanderthal microbiota. Evidence for self-medication was detected in an El Sidrón Neanderthal with a dental abscess and a chronic gastrointestinal pathogen (Enterocytozoon bieneusi). Metagenomic data from this individual also contained a nearly complete genome of the archaeal commensal Methanobrevibacter oralis (10.2× depth of coverage)—the oldest draft microbial genome generated to date, at around 48,000 years old. DNA preserved within dental calculus represents a notable source of information about the behaviour and health of ancient hominin specimens, as well as a unique system that is useful for the study of long-term microbial evolution.

Gastroesophageal Reflux Disease and Tooth Erosion

The increasing prevalence of gastroesophageal reflux disease (GERD) in children and adults, and of “silent refluxers” in particular, increases the responsibility of dentists to be alert to this potentially severe condition when observing unexplained instances of tooth erosion. Although gastroesophageal reflux is a normal physiologic occurrence, excessive gastric and duodenal regurgitation combined with a decrease in normal protective mechanisms, including an adequate production of saliva, may result in many esophageal and extraesophageal adverse conditions. Sleep-related GERD is particularly insidious as the supine position enhances the proximal migration of gastric contents, and normal saliva production is much reduced. Gastric acid will displace saliva easily from tooth surfaces, and proteolytic pepsin will remove protective dental pellicle. Though increasing evidence of associations between GERD and tooth erosion has been shown in both animal and human studies, relatively few clinical studies have been carried out under controlled trial conditions. Suspicion of an endogenous source of acid being associated with observed tooth erosion requires medical referral and management of the patient as the primary method for its prevention and control.

The effect of CPP-ACP on enamel wear under severe erosive conditions.

OBJECTIVE In addition to its role as a remineralizing agent in preventing dental caries, recent evidence has shown that casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) can protect teeth against erosion. The aim of this study was to determine whether CPP-ACP could reduce enamel wear rates under severe erosive conditions simulating heavy attrition and gastric regurgitation. DESIGN Enamel specimens were subjected to 10,000 wear cycles at a load of 100 N and pH 1.2 in a tooth wear machine. The machine was stopped every 2 min (160 cycles), and CPP-ACP in the form of a paste was applied for 5 min in experimental group 1. A paste with the same formulation but without CPP-ACP was applied in experimental group 2. No paste was applied in the control group. RESULTS A linear mixed model analysis indicated that the mean wear rates in experimental group 1 (0.44+/-0.05 mm(3) per 1000 cycles) and in experimental group 2 (0.63+/-0.06 mm(3) per 1000 cycles) were significantly lower than that in the control group (0.92+/-0.11 mm(3) per 1000 cycles) (p<0.05). The mean wear rate in experimental group 1 was also lower than that in experimental group 2 (p<0.05). Wear facets in experimental groups 1 and 2 were noted to be smoother and more polished than those in the control group. CONCLUSIONS Both remineralizing and lubricating properties of the paste containing CPP-ACP appear to contribute to wear reduction in enamel. These findings may lead to new strategies for the clinical management of tooth wear.

Oral manifestations of gastroesophageal reflux disease

Numerous case‐control and other studies involving confirmation of gastroesophageal reflux disease (GERD) by esophageal pH‐metry and the assessment of dental erosions have shown significant associations between the two conditions in both adults and children. By contrast, when asked to vote on whether GERD may cause dental erosions, only 42% of physicians strongly agreed that such an association existed in adults, and just 12.5% strongly agreed for children, respectively in two global consensus reports. Part of this divergence between the perceptions of physicians and the findings of research publications may reflect a general lack of oral health education during medical training, and cursory oral examinations being made under less‐than‐ideal conditions. Adequate salivary secretions are essential for the protection of the teeth and the oropharyngeal and esophageal mucosa. The quantity and quality of the saliva require monitoring as many drugs, including several of the proton pump inhibitors (PPIs), can cause hyposalivation. In addition, PPIs do not always result in adequate acid suppression. Therefore, collaboration between physicians and dentists is strongly advocated to prevent or ameliorate possible adverse oral effects from both endogenous and exogenous acids, and to promote adequate saliva production in patients with GERD.

The effect of casein phosphopeptide‐amorphous calcium phosphate on erosive dentine wear

BACKGROUND Erosive tooth wear is a growing concern in clinical dentistry. Our aims were to assess the effect of Tooth Mousse (TM) in managing erosive dentine wear in vitro. METHODS Opposing enamel and dentine specimens from 36 third molar teeth were worn under a load of 100 N for 75 000 cycles in electromechanical tooth wear machines. In experiment 1, TM was applied continuously at the wear interface and the mean dentine wear rate was compared with those of specimens subjected to continuous application of hydrochloric acid (HCl, pH 3.0) and deionized water (DW, pH 6.1) as lubricants. In experiment 2, specimens were subjected to TM application every 1600 cycles at both pH 3.0 and 6.1, and the mean dentine wear rates were compared with those of specimens worn with continuous application of HCl and DW lubricants. RESULTS Dentine wear was reduced significantly with continuous application of TM compared with HCl and DW lubricants. Specimens prepared with continuous TM application displayed smooth wear facets, whereas more pronounced microwear details were observed with HCl and DW lubricants. CONCLUSIONS Both remineralization and lubrication seem to contribute to reduction in dentine wear associated with TM application, although lubrication appears to have a more pronounced effect.