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www.jdt.tums.ac.ir September 2013; Vol . 10, No. 5 1

Original Article

Effect of a Common Diet and Regular Beverage on

Enamel Erosion in Various Temperatures:

An In-Vitro StudyZahra Khamverdi 1, Mohammad Vahedi 2 , Shermin Abdollahzadeh 3, Mohammad Hosein Ghambari 4

1Associate Professor, Operative Dentistry Department, Dental Research Center, School of Dentistry, Hamadan University of Medi-cal Sciences, Hamadan, Iran2Associate Professor, Oral Medicine Department, Dental Research Center, School of Dentistry, Hamadan University of Medical

Sciences, Hamadan, Iran3Assistant Professor, Oral Medicine Department, School of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran.4Dentist, Private practice

Corresponding author:M. Vahedi, Department of OralMedicine, Dental ResearchCenter, School of Dentistry,Hamadan University ofMedical Sciences, Hama-dan, Iran

[email protected]

Received: 14 March 2013Accepted: 26 May 2013

Abstract Objective : This study compared diet and regular Coca-Cola on enamel erosion in coldand room temperatures . Materials and Methods : Seventy five enamel specimens were prepared and dividedinto 5 equal groups (N=15) as follows: Group 1: regular beverage at room tempera-ture, Group 2: regular beverage at refri-gerator temperature, Group 3: diet beverage atroom and Group 4: diet beverage at refrige-rator temperature. The specimens wereimmersed in the regular or diet beverage (Coca-Cola, trade mark regd. KhoshgovarCo., Tehran, Iran) at room (20°C) or refrigerator (2°C) temperatures for 20 minutes, 3times per day for 7 days. Specimens in the control subjects (group 5) were placed insynthetic saliva at room temperature for 7 days. The hardness of specimens was testedusing Vickers test under 500 gr loads for 5 seconds. The data were analyzed usingtwo-way ANOVA and Tukey tests . Results : The mean and standard deviations of micro-hardness values of the studiedgroups were as follow: G1: 304.26±29.71, G2: 285.53±42.14, G3: 279.06±39.52, G4:266.80±23.98 and G5: 319± 30.79. There was a significant difference in the beveragetype as the main factor (p0.05). Tukey tests showed thatthere were significant differences between control and diet groups as well as regularand diet groups . Conclusion : Diet Coca-Cola is more erosive than the regular type and the temperatureof the beverages used had no significant influence on enamel erosion.

Key Words: Beverages; Cola; Tooth Erosions; Enamel

Jour nal of Denti stry, Tehr an Uni versity of M edical Sciences, Tehran, I ran (2013; Vol. 10, No. 5)

INTRODUCTION Nowadays, a remarkable increase has beenreported in the incidence of non-carious le-sions in the general population [1]. Dental ero-

sion is one of these lesions. Factors such as bulimia, gastric acid reflux and frequent acidicdiet exposure play an important role in the de-velopment of dental erosion [2-5].

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There is a global increase in the ingestion ofacidic beverages, such as soft drinks and fruit

juices especially by young children [6,7].A high drinking rate of non-alcoholic beve-rages in Iran is one of the main causes of den-

tal erosion. It was reported that the annualdrinking of beverages in Iran is 48 litres per

person per year that is equal to 144 bottles per person which is relatively a high rate [8].Attempts were performed to decrease the sideeffects of these beverages and to introducetypes of light and regular drinking. The abilityof acidic soft drinks in producing dental ero-sion is related to factors such as acid type con-taining, titratable acid, buffered capacity andthe temperature of the drink [9].The solubility of solutes depends on the tem-

perature. It appears that this factor may influ-ence the loss of hard tissues of the tooth at thecervical third [10]. There are various evalua-tion techniques, such as profilometry, atomforce microscopy, scanning electron micro-scopy, micro-radiography, iodide permeabilityand the micro-hardness test for measuring theloss of dental hard structures and softening oftooth tissues by erosive processes, [11-14].

The micro-hardness technique is often usedfor measuring surface hardness of dental hardtissues. Early stages of dental hard tissue dis-solution that result in tooth surface weakeningcan be well determined by hardness measure-ment techniques [15].Since there is no definitive information aboutthe effects of varied temperatures of beveragesin dental erosion; therefore, the present studywas designed to evaluate the effect of commondiet and regular Coca-Cola on enamel erosionin cold and room temperatures.

MATHERIALS AND METHODSThirty eight intact human maxillary premolarsthat were extracted during the previous twomonths were collected from dental centers and

private offices. The teeth were cleaned with pumice-water slurry using bristle brushes in alow-speed handpiece. The teeth were stored in

0.5% Chloramine-T solution at room tempera-ture to prevent bacterial growth until the nextstep. Then, they were examined with a ste-reomicroscope to discard those with cracks,fractures or structural abnormalities that could

interfere with the results. The crown of eachtooth was removed at the cement-enamel junc-tion with the water-cooled diamond saw of a

precision sectioning machine (Miniton; Stru-ers A/S, Copenhagen, Denmark). Subsequent-ly, the crowns of the teeth were sectioned intotwo labial and palatal parts. The prepared spe-cimens were fixed in self-cured acrylic resin(Acropars, Kaveh, Tehran, Iran) so that thecomplete tooth was embedded in acrylic resinexcept for the enamel area leaving a circularenamel area (3 mm in diameter) on the flattestregion. To prevent dehydration, the teeth werekept in de-ionized water until the beginning ofthe tests. The mounted species were dividedinto 5 equal groups randomly. Four groupswere considered as experimental and the re-maining one group as control. The specimensin groups 1 and 2 were immersed in the regu-lar beverage (Coca-Cola trademark regd.,Khoshgovar co., Tehran, Iran) at room (20° C)

and refrigerator (2° C) temperatures, respec-tively for 20 minutes, 3 times per day for 7days. The interval time between each immer-sion cycle was 1 hour. Enamel surfaces werekept in synthetic saliva (Potassium: 20 meq/lit,Chloride: 27.4 meq/lit, Sodium: 0.22 mg,Magnesium: 1.5 mg, Calcium: 0.6 mg, Fluo-ride: 0.5 mg, Phosphorous: 0.21 mg, Hydroxy

propyl methyl cellulose 3%) between eachimmersion cycle as well as the complete rest-ing time. In groups 3 and 4, the specimenswere immersed in diet beverage (Diet cokeTrademark regd., Khoshgovar Co., Tehran,Iran) in room and refrigerator temperatures,respectively similar to groups 1 and 2. Speci-mens in control subjects (group 5) were placedin synthetic saliva at room temperature for 7days. In this study, Vickers test was appliedfor at least 3 points with 500 gr force for 5seconds by micro-hardness tester (Micrometer

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1, Buehler, Lake Bluff, IL, USA). The meanof micro-hardness values for points were con-sidered for the micro-hardness value of eachsample. The PH value of regular and diet be-

verages were measured with a digital pH me-ter (Accumet 925 pH/ion meter, Fisher Scien-tific, Pittsburgh, PA) and acid titration for both

beverages was performed. SPSS software(version 13) was used to categorize the data.Data were analyzed by using two-wayANOVA and Tukey tests. The level of confi-dence was set at 95% (α =0.05).

RESULTSThe mean and standard deviations of micro-hardness values of the studied groups aresummarized in Table 1. Group 2 showed thehighest microhardness values and the lowestones were seen in group 4.

Two-way ANOVA for the studied groupsshowed a significant difference in the beve-rage type as the main factor (p=0.017), buttemperature factor (p=0.089) and its interac-

tion effect on enamel hardness showed no sig-nificant difference (p=0.719).Tukey test showed that there were significantdifferences between control and diet groups aswell as regular and diet groups (p0.05).Results of pH measuring are showed in Table2.

DISCUSSION In the present study, the effect of diet and reg-ular Coca Cola beverages on enamel micro-hardness in room and cold temperature wasevaluated.

Beverage pHPhosphoric Acid

(mg/ml) Citric Acid (mg/ml)

Regular Coca-Cola 2.75 0.51 0

Diet Coca-Cola 2.98 0.36 0.25

Group N Micro-Hardness (Mean ± SD)

1. (room temp., regular) 15 304.26± 29.71 a

2. (cold temp., regular) 15 285.53±42.14 a

3. (room temp., diet) 15 279.06±39.52 b

4. (cold temp., diet) 15 266.80±23.98 b

5. (control) 15 319± 30.79 a

Table 1. Mean Values of the Micro-Hardness of the Studied Groups

Superscripts indicate statistically significant differences between values a and b.

Table 2. PH and Acid Titration Values for Tested Beverages

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The micro-hardness test, a valid test in the previous studies [16-18], was used to measureenamel loss. Enamel and dentin dissolutionand surface softening in early stages may bedetermined by this test. The main reason for

choosing this technique was the availabilityand accessibility. The micro-hardness methodhas been previously used in several studies todetermine enamel erosion [1, 16, 19]. In thisstudy, Vickers test was designed using a di-amond tip indentation and known geometricaldimensions for a special load and duration[14]. Micro-indentations for determining ero-sive variations in the surfaces have been per-formed with different forces. Because of thecapability of the loading machine used, 500gram force was selected for testing in the

present study while different forces have beenused in other studies [1, 19, 20]. Due to pres-ence of slight variations in the nature of sub-stra, micro-hardness was measured from 3 to 5

points [21]. Regarding immersion and rinsingcycles, Torres immersed the specimens for 5minutes in 75 ml of the beverage, 3 times aday with 4-h intervals between the immersioncycles, during a 60-day experimental period

[1]. In another study, the specimens were placed in several containers of beverages for14 days continuously [9]. Van Eygen im-mersed the enamel surfaces in the groups inCoca-Cola at different frequencies: 1, 2, or 3times per day for 20 minutes each for 7 days[19]. Three times soaking increases the possi-

bility to obtain a measurable result. The spe-cimens in the experimental groups in thisstudy were immersed in diet and regular Coca-Cola for 7 days. The frequency was 3 times

per day for 20 minutes each time. This is theapproximate total exposure time in the mouth

per each year for everyone except those whosip soft drinks continuously [9]. The findingsof the present study showed that both studied

beverages can potentially erode the enamelsurfaces after immersion cycles. Regular beve-rage did not show any significant difference incomparison with the control group, but the

diet type showed a considerable significantdifference in terms of enamel softening. Theseresults are in opposition with the study per-formed by Rios et al. who indicated diet cola

promoted less enamel wear than regular cola

[22]. It can be explained that erosion might berelated to some of its characteristics, such asits lower pH, buffering capacity and titratableacidity [21,23]. PH measurement of both be-verages showed that there were no considera-

ble differences between this value. Althoughregular beverages contain more phosphoricacid, the erosive potential of diet coke is more

pronounced due to the presence of citric acid.Citric acid acts as a chelator that binds to theminerals of the hydroxyappetite such as cal-cium [24,25]. It seems that in the oral envi-ronment, the greater the titratable capacity ofthe beverage, the longer it causes saliva toneutralize the acid [21]. It is predicted thaterosion is more severe at high temperaturesand reduced at low temperatures, because thesolubility of solutes depends on temperatureand heat is required to break the bonds holdingthe molecules in the solid together [26]. Bananand Hedge observed that frozen and refrige-

rated acidic juices caused more decrease in plaque and salivary pH than juices in roomtemperature [27]. Ferreira concluded that witha decrease in the temperature of dairy beve-rages, their pH is reduced [28]. Eisenburgerand Addy also confirmed the results of thestudy conducted by Ferreira and Pozzobon[29]. Temperature had no considerable effecton hardness in all experimental groups of the

present study. It seems that under the condi-tions of this study, temperature did not alter

pH beverages significantly. arbour, alsoshowed there were no significant differences

between enamel softening and erosion caused by soft drinks at a range of temperatures [30].In the present study, a cycling model for simu-lation of physiological conditions was used.On the other hand, complete simulation of oralcondition is difficult since pellicle on toothsurfaces affects the erosive destruction in-

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duced by acidic solutions [31]. Furthermore;some factors such as tooth brushing or tonguemovement in the oral cavity may have an ad-ditive abrasive influence on erosively altered

dental hard tissues [32]. Therefore, it should be noted that the findings observed in the present study may not reflect the in vivo situa-tion, which was a limit for this study. Never-theless, it is possible to make certain projec-tions. In the present study, the cycling modelwas compatible with the study performed byVan Eygen et al. [19]. In order to simulate theoral cavity conditions, future in vivo studiesare recommended. In addition, the exposuretime was limited,; therefore, we recommendother studies with long term exposure times inorder to obtain more accurate findings.

CONCLUSIONWithin the limits of this study, it may be con-cluded that:

1. The diet Coca-Cola is more erosivethan the regular type.

2. Temperature of the used beverages hadno significant influence on enamel ero-sion.

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