Lindsay Richards

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.

Molar Intercuspal Dimensions: Genetic Input to Phenotypic Variation

Molecular studies indicate that epigenetic events are important in determining how the internal enamel epithelium folds during odontogenesis. Since this process of folding leads to the subsequent arrangement of cusps on molar teeth, we hypothesized that intercuspal distances of human molar teeth would display greater phenotypic variation but lower heritabilities than overall crown diameters. Intercuspal distances and maximum crown diameters were recorded from digitized images of dental casts in 100 monozygotic and 74 dizygotic twin pairs. Intercuspal distances displayed less sexual dimorphism in mean values but greater relative variability and fluctuating asymmetry than overall crown measures. Correlations between intercuspal distances and overall crown measures were low. Models incorporating only environmental effects accounted for observed variation in several intercuspal measures. For those intercuspal variables displaying significant additive genetic variance, estimates of heritability ranged from 43 to 79%, whereas those for overall crown size were higher generally, ranging from 60 to 82%. Our finding of high phenotypic variation in intercuspal distances with only moderate genetic contribution is consistent with substantial epigenetic influence on the progressive folding of the internal enamel epithelium, following formation of the primary and secondary enamel knots.

INCREASED TOOTH CROWN SIZE IN FEMALES WITH TWIN BROTHERS : EVIDENCE FOR HORMONAL DIFFUSION BETWEEN HUMAN TWINS IN UTERO

In rodents, the position of a fetus in utero is associated with the expression of sexually dimorphic traits. This phenomenon has been explained by prenatal diffusion of sex hormones among litter mates. To test for such effects in humans, female‐male twin pairs provide a natural experiment. The size of dental crowns is a sexually dimorphic trait which can be measured with a high degree of reliability. Thus, two crown diameters of 28 permanent teeth were recorded for 56 opposite‐sexed (OS) and 242 same‐sexed (SS) twin pairs, and 150 singletons. Comparisons of OS twins with SS twins and singletons within each sex reveal that OS females have consistently larger teeth (on average) than other females, while there is no consistent difference between OS and SS twin males. It is proposed that diffusion of sex hormones from male to female co‐twins in utero may account for the increased tooth size in OS females. This study is one of the first to report such an effect on a morphological variable in humans. The finding that the maxillary canine, one of the most sexually dimorphic teeth, exhibits the least effect in OS female twins, suggests that prenatal sex hormone levels may have less impact on sexual dimorphism in the maxillary canines than in other permanent teeth. Am. J. Hum. Biol. 11:577–586, 1999.

Strong Genetic Control of Emergence of Human Primary Incisors

Our understanding of tooth eruption in humans remains incomplete. We hypothesized that genetic factors contribute significantly to phenotypic variation in the emergence of primary incisors. We applied model-fitting to data from Australian twins to quantify contributions of genetic and environmental factors to variation in timing of the emergence of human primary incisors. There were no significant differences in incisor emergence times between zygosity groups or sexes. Emergence times of maxillary central incisors and mandibular lateral incisors were less variable than those of maxillary lateral incisors and mandibular central incisors. Maxillary lateral incisors displayed significant directional asymmetry, the left side emerging earlier than the right. Variation in timing of the emergence of the primary incisors was under strong genetic control, with a small but significant contribution from the external environment. Estimates of narrow-sense heritability ranged from 82 to 94% in males and 71 to 96% in females.

Relationship Between Attachment of the Superficial Masseter Muscle and Craniofacial Morphology in Dentate and Edentulous Humans

Previous studies have described the importance of the interaction between the masticatory muscles and the craniofacial skeleton in the control of craniofacial growth. This study describes the attachment and orientation of the superficial masseter muscle and its relationship -with craniof acial morphology in dentate and edentulous subjects. Data were obtained from lateral cephalometric radiographs of a total of 31 cadavers in which the superficial masseter muscle had been defined with liquid barium. The results provide evidence that the morphology of the superficial masseter muscle in the gonion region differed significantly between dentate and edentulous subjects, with the masseter being 2.7 mm wider and the gonion-anterior muscle border distance being 4.0 mm greater in dentate subjects. The complex relationship between craniofacial morphology and the dimensions and inclination of the superficial masseter muscle were most clearly evident in dentate subjects where the position of the anterior border was related to ramus dimensions and mandibular and occlusal plane angles. The association is much less clear in edentulous subjects where normal function was disturbed. In general, age was not a significant determinant of variation in superficial masseter muscle dimensions and orientation.

Prediction of mandibular incisor and canine crowding changes in the mixed dentition

To test the hypothesis that preeruptive tooth positions and dental arch parameters might forecast crowding changes, a sample of 47 aboriginal children (26 males, 21 females) was selected stringently on the basis of Class 1 characteristics and an untreated dentition unaffected by caries or attrition. Crowding scores, radiographic relationships of 765E, and dental arch dimensions were evaluated for the mixed dentition (Stage 1, 8.91 +/- 1.05 years) and earliest emergence of the permanent dentition (Stage 2, 12.48 +/- 0.97 years). Changes between the stages were calculated and the sample was divided into two groups, according to an increase (Group 1) or decrease (Group 2) in incisor and canine crowding. Multivariate and multiple regression analyses were used to identify predictors (Stage 1 radiographic and dental arch parameters) of incisor and canine crowding behavior. Dental arch form and tooth size were important factors in measuring the amount of incisor or canine crowding at Stage 1 and Stage 2. Neither the radiographic nor the dental arch predictors proved useful in forecasting crowding changes. Group 2 dental arches tended to be initially narrower, shallower, and more crowded; however, they showed greater molar and canine width expansion and lessened arch depth reduction than Group 1 cases. Many cases showed a reduction in canine crowding from mixed to permanent dentition. This appeared to be largely independent of the observed incisor crowding. Sexual, racial, and individual variations in dentofacial pattern reinforce the need to carefully consider interceptive extraction or space-regaining therapy for each patient because of the unpredictability of crowding behavior during the transition from mixed to permanent dentition.

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.

Dental arch morphology in south Australian twins.

Fourth-order polynomials were used to represent dental arch morphology in 29 monozygous and 19 dizygous like-sexed twin pairs, and in 45 unrelated individuals. The polynomial coefficients provided an accurate description of dental arch morphology with the quadratic (chi 2) and quartic (chi 4) terms reflecting arch shape and the linear (chi) and cubic (chi 3) terms summarizing asymmetry. There were no significant differences between the groups in either the quadratic or quartic terms. Values of correlations between polynomial terms indicated that there was no consistent relationship between maxillary and mandibular arch shape or asymmetry. Intraclass correlations between twins suggested that genetic factors contributed to variation in maxillary arch shape and to a lesser extent to variation in mandibular arch shape but not to arch asymmetry.

Genetic analysis of deciduous tooth size in Australian twins.

Investigations of permanent dental crown size in twins and family groups indicate a high degree of transmissible control, but little is known about the relative contributions of genetic and environmental factors to variation in size of the deciduous (primary) teeth. Here, maximum mesiodistal and buccolingual crown dimensions of maxillary and mandibular primary teeth were measured from dental models of 602 individuals, including 99 monozygous (MZ) twin pairs, 81 dizygous (DZ) same-sex pairs, 41 DZ opposite-sex pairs, and 160 singletons. Data were subjected to univariate genetic analysis with the structural-equation-modelling package, Mx using the normal assumptions of the twin model. A model incorporating additive genetic (A) and unique environmental (E) variation was found to be the most parsimonious for all tooth-size variables. Estimates of heritability for deciduous crown size ranged from 0.62 to 0.91. This study shows that variation in deciduous crown size has a strong genetic component, similar to that observed in the permanent dentition. Further studies are required to determine whether the underlying genetic mechanisms are the same for both deciduous and permanent teeth.

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.