Cervical tooth wear and sensitivity: erosion, softening and rehardening of dentine; effects of pH, time and ultrasonication.

BACKGROUND: Cervical dentine wear is commonly observed and may be associated with dentine hypersensitivity. Erosion is thought to play a part in both conditions but compared to enamel has been little studied in dentine.

AIM: The aims of these studies in vitro were to: (i) determine the effects of citric acid on dentine at different pH values and over time; (ii) measure the depth of dentine demineralisation or softening using ultrasonication; (iii) determine whether softened dentine can be remineralised or rehardened using artificial saliva.

METHODS: Groups of flat dentine specimens prepared from unerupted human third molar teeth were: (a) exposed to citric acid at pH 3.2 for periods up to 4 h with mineral water as control; (b) exposed to citric acid at pH 2.54, 3.2, 4.5, 5.5 and 6.0 for 2 h and then subjected to ultrasonication stepwise up to 480 s; (c) exposed to citric acid at pH 2.54, 3.2, and 4.5, placed into artificial saliva for 24 h and then subjected to ultrasonication as in (b). Loss of dentine was measured by profilometry, after, each phase of erosion, ultrasonication and immersion in artificial saliva.

RESULTS: Depth of erosion significantly increased non-linearly with time and significantly decreased with increasing pH. Ultrasonication had minimal albeit significant effects on control specimens. Removal of softened dentine increased with ultrasonication time. Depth of softening significantly increased with increasing erosion time to 2 h, plateauing at 2 microm. Depth of softening increased to 2 microm from pH 2.54 to pH 3.2 and decreased at higher pH values thereafter. 24 h in artificial saliva provided no protection to the soften zone against ultrasonicaion. Citric acid at all pH values and exposure times removed the dentine smear layer to expose tubules. Ultrasonication did not remove the smear layer on control specimens but removed all deposits formed after exposure to artificial saliva.

CONCLUSION: It is concluded that dentine is susceptible to erosion even at relatively high pH, the tubule system is readily exposed and dentine, unlike enamel, shows little propensity to remineralise.