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Contents lists available at ScienceDirect

Journal of Dentistry
journal homepage: www.intl.elsevierhealth.com/journals/jden

A new in situ model to study erosive enamel wear, a clinical pilot study
Jan Ruben* , Gert-Jan Truin, Ewald. M. Bronkhorst, Marie Charlotte D.N.J.M. Huysmans
Department of Dentistry, Preventive and Restorative Dentistry, Radboud University Medical Center, Thomas van Aquinostraat 4, 6525 GD Nijmegen, The
Netherlands

A R T I C L E I N F O A B S T R A C T

Article history: Objectives: To develop an in situ model for erosive wear research which allows for more clinically relevant
Received 4 July 2016 exposure parameters than other in situ models and to show tooth site-specific erosive wear effect of an
Received in revised form 16 November 2016 acid challenge of orange juice on enamel.
Accepted 5 December 2016
Methods: This pilot study included 6 edentulous volunteers wearing full dentures with 13 embedded
Available online xxx
enamel samples The study consisted of two control runs: habitual diet only for 30 days, and two
experimental runs: habitual diet plus 125 ml orange juice four times per day (consumed over 4 m). In the
Keywords:
first experimental run subjects were instructed to take the drink in their mouth and promptly swallow it.
Erosive tooth wear
In situ model
In the second experimental run subjects take the drink in their mouth and hold each 25 ml for 30 s,
Fruit drink moving it around their mouth before swallowing. Sample enamel surface loss was measured using non-
Clinical study contact surface profilometry.
Enamel Results: Drinking of orange juice additional to the habitual diet, caused significant but low increased
erosive wear at buccal, palatal and lingual specimens. Significantly higher levels of tissue loss were found
on all surfaces in the swishing experiment but molars (especially occlusal specimens in mandibular
molars), palatal specimens sited in upper anterior teeth and lingual specimens in lower anterior teeth
were most affected.
Conclusion: The model showed clinically relevant patterns of erosive tooth wear as seen clinically in
erosive wear patients.
Clinical significance: The model could have many applications to study clinically erosive wear for specific
diets or consumption patterns and to test preventive measures.
© 2016 Elsevier Ltd. All rights reserved.

1. Introduction
In situ models have been used extensively in dental erosive
wear research to study the potential erosive effect of acidic
beverages, mainly soft drinks, but also fruit juices [1–6]. Most,
however, have considerable limitations in modeling the clinical
situation. Appliances with the samples are usually worn only part-
time, not during normal eating and drinking or during the night.
Acid exposures are usually short and/or performed extra-orally, so
as not to endanger the natural dentition of the volunteers. Also, in
in situ studies volunteers wear an intra-oral appliance where
enamel samples are placed either at the roof of the palate or in the
buccal vestibule of the lower jaw. However, erosive-abrasive tooth
wear can be observed on all tooth surfaces but is most common on
occlusal and facial surfaces of maxillary and mandibular teeth and
on palatal surfaces of the maxillary anterior teeth [7]. Ideally,
sample placement would have been at those locations to mimic the
clinical situation most closely.
The aim of the study was to develop an in situ model for erosive
wear research which allows for more clinically relevant exposure
circumstances than most in situ models and to demonstrate the
site-specific erosive wear effect of an acid challenge of orange juice
on enamel, as seen in erosive wear patients. Two hypotheses were
proposed for the study: 1) daily drinking of orange juice in addition
to a daily diet will show site-specific erosive wear as seen in erosive
wear patients and 2) swishing of orange juice, compared to
drinking, would cause progressive erosive wear distribution over
tooth sites.

2. Materials en methods
* Corresponding author.
E-mail addresses: Jan.Ruben@radboudumc.nl (J. Ruben),
This study consisted of a four phase, single center clinical trial
Gert-Jan.Truin@radboudumc.nl (G.-J. Truin), Ewald.Bronkhorst@radboudumc.nl involving subjects attending a prosthetic dental clinic in Arnhem,
(E. M. Bronkhorst), Marie-Charlotte.Huysmans@radboudumc.nl the Netherlands and who met the following inclusion criteria: aged
(M.C.D.N.J.M. Huysmans).

http://dx.doi.org/10.1016/j.jdent.2016.12.002
0300-5712/© 2016 Elsevier Ltd. All rights reserved.

Please cite this article in press as: J. Ruben, et al., A new in situ model to study erosive enamel wear, a clinical pilot study, Journal of Dentistry
(2016), http://dx.doi.org/10.1016/j.jdent.2016.12.002
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between 40 and 75 years, edentulous in the upper and lower jaw
and wearing full dentures, healthy with no relevant medical status,
which could interfere with the conduct of the study. All
participants had to have an unstimulated and stimulated whole
mouth saliva flow rate of > 0.25 and >0.75 ml/m, respectively.
Potential subjects who met any of the following criteria were
excluded from participation: use of medication which could
influence salivary flow, self reported or observed grinding of
clenching habit, symptoms of gastro-oesophageal reflux (heart-
burn, regurgitation), vegetarian diet and abnormal drinking habits
(e.g. swishing or holding of drinks before swallowing). Six subjects
were included in the study. All volunteers wear a full denture in the
upper jaw and an implant-supported full lower denture. As there
was no information at all available on the rate of erosive enamel
loss under the proposed circumstances, a sample size calculation
was impossible.
The study protocol was approved by Radboud University’s
research committee (CEOM: NL: 47343.091.14). Subjects were
given verbal and written information concerning the study and
gave and signed consent to participate. An incentive of 150 Euros
per each month of participation was given.
2.1. Design of full dentures and sample preparation
Before the start of the study, for each volunteer copies of
subjects’ full dentures were made by a dental technician. After
enamel sample preparation, the samples were embedded in PMMA
in metal holders and inserted into different (tooth) surfaces of the
subjects’ upper and lower denture.
2.2. Enamel specimen preparation
Sound human teeth (extracted third molars) were collected.
One specimen was cut from the buccal surface of each tooth.
Enamel specimens were cut with a diamond blade (Buehler
diamond wafering blade nr.11-4244) with an average dimension of
3  3 x 2 mm and were sterilized in ethylene oxide gas (Wimac
Kliniekdiensten BV, Rotterdam, The Netherlands).
After sterilization the enamel specimens were embedded in
stainless steel rings in PMMA (Auto Plast, Candulor AG, Wangen,
Switzerland; see Fig. 1). After embedding, the specimens were
ground with SiC paper with the ring serving as reference area. The
enamel surface was polished as little as possible, just enough to
create a flat surface to profile. Each specimen was inspected for
surface defects with a stereomicroscope (magnification 10) and
rejected if cracked. The thickness of the enamel samples was
between 500 and 800 micrometers after polishing.
In the subjects’ upper and lower denture 6 and 7 enamel
specimens, respectively, were inserted into occlusal, buccal, palatal
and lingual tooth surfaces (Fig. 2). The specimen locations were in
posterior sextants (upper and lower (pre)molar area of the full
Fig. 1. Enamel specimens embedded in stainless steel reference ring. The height mean difference was calculated from the reference areas A and B compared to enamel area C.
Please cite this article in press as: J. Ruben, et al., A new in situ model to study erosive enamel wear, a clinical pilot study, Journal of Dentistry
(2016), http://dx.doi.org/10.1016/j.jdent.2016.12.002
dentures), one enamel specimen in occlusal position, one
specimen sited on the buccal surface of the upper molars (16–
17 or 26–27, respectively) and one enamel specimen on the lingual
surface of the lower molars (36–37 or 46–47) and one specimen
located on the buccal surface of the 34 and 44. In anterior sextants
two specimens (palatal surface of the 11 and 21) were positioned
and one sample in the middle of the lingual surface of the 31 and
41.
During the study subjects had to wear their dentures for 24 h
per day, except during cleaning. Twice a day (in the morning and in
the evening) the appliances and specimens were cleaned by gently
brushing (soft tooth brush) with fluoride toothpaste (Prodent
SoftmintR).
2.3. Experimental design
The design consisted of 4 30-days runs including one control
run before the start of experimental run 1 (drinking of orange
juice) and one before the start of experimental run 2 (swishing of
orange juice). In the control runs the subjects only followed their
habitual diet. During the two experimental runs the volunteers
additionally consumed 125 ml orange juice four times per day.
After each run enamel surface loss measurements were performed.
After control measurements the enamel samples were polished
until they again had a flat surface. After the first control/
experimental run combination new enamel samples were
inserted.
For 30 days, 125 ml orange juice (brand: AldiR; pH 3.7) 4 times a
day was taken during 4 m at 09.00, 11.00, 13.00 and 15.00 h, at
refrigerator temperature (4–5  C). Each subject was issued a
measuring beaker and stopwatch and asked to drink in 25 ml
mouthfuls.The 125 ml orange juice was consumed in 5 mouthfuls
at 1 m intervals (at start, after 1, 2, 3 and 4 m respectively). In the
first experimental run subjects were instructed to take 25 ml of the
drink in their mouth and promptly swallow it. In the second
experimental run subjects were instructed to take the drink in
their mouth and hold each 25 ml mouthful for 30 s, moving it
around their mouth in a rinsing motion before swallowing.
Subjects were always allowed to spit out the drink instead of
swallowing it, in order to prevent gastro-intestinal problems.
The subjects were asked to fill in a questionnaire about their
diet. They had to report on the daily intake of dietary products
during each run. Overall consumption of acidic food and beverages
per day were calculated by counting the number of potential
erosive foods and drinks. A pH <5,5 was used to consider the
potential erosiveness of a product. Tables of the pH and/acidity of
foods and food products from the FDA/CFSAN [8] were used, as
well as tables from the website Gezondheidsnet [9]. For
determining pHs of drinks (waters, juices, soft drinks, alcoholic
drinks) several sources were used. [10,11] Milk-based products
were considered non erosive irrespective of their pH.
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Fig. 2. Full dentures with enamel specimens in position. The specimens were embedded in PMMA in stainless steel rings, providing a reference.

2.4. Profilometric analysis 2.5. Data analysis

Surface loss measurements were made using a non-contact
surface profilometer (Proscan 2100, Scantron, Taunton, UK). The
sensor with a measuring range of 300 mm (S11/03) was used, for
scans including both the stainless steel reference and the enamel
surface. Using dedicated Proscan 2000 software (ver.2.1.1.15A,
Scantron, Taunton, UK) the mean height of the enamel area was
calculated in relation to the reference surfaces. A warpage filter
(warpage 1) was applied to eliminate the noise of the scanning
table and sensor. The specimen was leveled on the reference area
on the metal ring with a three point leveling method (Fig. 1). The
mean height difference was calculated with the three point height
from the reference areas A and B compared to enamel area C. The
area size for the references A and B was 0.5 mm x 2 mm and the
area for the enamel C was 2 mm x 2 mm.
In the first control run, surface loss measurements were
performed and subtracted before sample insertion and after the
run. In all other runs, the samples were polished flat before
insertion into the dentures with a self-made jig in such a way that a
standardized baseline height difference between the stainless steel
reference and the enamel surface was obtained. This baseline
height difference was subtracted from the measured surface loss of
each tooth specimen after each run. Where very little enamel
surface loss occurred, this might result in a small negative value for
wear due to random measurement variation. In such cases a wear
of 0 mm was recorded.
Repeated measurements of enamel tissue loss of 15% randomly
chosen enamel specimens (n = 34) were carried out, to assess
reproducibility. Mean difference between repeated measurements
including sample variation, measuring instrument (profilometer)
and data processing was 0.21 mm (p = 0.32). The reliability as
expressed by the Pearson correlation coefficient was 0.99, while
the duplicate measurement error (DME) was 0.63 mm.
Mean tissue loss and mean standard deviation for each tooth
site, and total tissue loss per person were calculated over each
study run. All differences in mean tissue loss were compared
between runs using paired t-test. Statistical comparisons were
performed by paired t-tests for each combination of control vs
experimental run. The level of significance was 0.05.
At the end of the study the data of one male subject were
excluded for statistical analysis. The daily food questionnaires of
this volunteer showed an extraordinarily high intake of sour
jawbreakers, of up to seven times a day.
To study patterns of symmetry of erosive wear distribution over
tooth sites, Spearman’s correlation coefficients between all
specimen locations in left and right jaw were calculated from all
4 runs.
The results of the daily diet questionnaires were independently
assessed by two examiners (inter-examiner agreement, kappa
0.88).
All analyses were performed using the software SPSS (IBM
version 2.2).
3. Results
The results presented are based on the data of 5 subjects: 3
females and 2 males with a mean age of 69.8 years (67.1–74.1) at
the start of the study. Mean unstimulated and stimulated saliva
flow rate and pH were respectively, 0.46 ml/m (range 0.4–0.6), pH
6.8 (range 6.5–7.2) and 1.7 ml/m (range 0.9–2.6), pH 7.4 (range 7.1–
7.9). No adverse events were observed or reported. Due to loss of
samples (n = 13) and presence of calculus (n = 9) on samples the
number of enamel samples analysable for paired comparison of
tissue loss varied slightly between runs. Analysis of enamel surface

Table 1
Mean enamel surface loss (in mm) and standard deviation (sd) for all groups (total) and for occlusally, buccally, palatally and lingually located samples in control (Ctr) and
experimental (Exp) runs. No of pairs: number of paired samples for comparison.

Run Groups No of pairs A: mean (sd) B: mean (sd) diff (B-A) 95% CI p
Control runs A = Ctr1 vs B = Ctr2 53 0.30 (0.69) 0.52 (0.90) 0.23 [ 0.11–0.56] 0.184
Drinking A = Ctr1 vs B = Exp1 53 0.30 (0.69) 1.22 (1.33) 0.92 [0.51–1.33] <0.001
Swishing A = Ctr2 vs B = Exp2 55 0.59 (0.91) 4.31 (3.83) 3.72 [2.60–4.84] <0.001
Drinking
Occlusal A = Ctr1 vs B = Exp1 55 0.59 (1.05) 4.31 (3.83) 0.35 [ 0.77–1.48] 0.514
Buccal A = Ctr1 vs B = Exp1 13 0.16 (0.33) 1.31 (1.21) 1.15 [0.43–1.48] 0.004
Palatal A = Ctr1 vs B = Exp1 15 0.22 (0.58) 1.41 (1.16) 1.19 [0.66–1.72] <0.001
Lingual A = Ctr1 vs B = Exp1 10 0.15 (0.45) 1.21 (1.31) 1.06 [0.59–2.07] 0.040
Swishing
Occlusal A = Ctr2 vs B = Exp2 18 0.43 (0.54) 5.61 (5.00) 5.18 [2.63–7.74] <0.001
Buccal A = Ctr2 vs B = Exp2 11 0.97 (0.77) 2.68 (2.24) 1.71 [0.60–2.82] 0.006
Palatal A = Ctr2 vs B = Exp2 15 0.75 (1.40) 4.19 (2.82) 3.44 [1.31–5.57] 0.004
Lingual A = Ctr2 vs B = Exp2 11 0.26 (0.54) 3.98 (3.82) 3.71 [1.06–6.37] 0.011

Please cite this article in press as: J. Ruben, et al., A new in situ model to study erosive enamel wear, a clinical pilot study, Journal of Dentistry
(2016), http://dx.doi.org/10.1016/j.jdent.2016.12.002
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tissue loss in control runs 1 and 2, and experimental runs 1 and 2
was performed on 54, 64, 63, and 56 enamel samples, respectively.
The subjects had a mean intake frequency of 4.5 (SD  1.2) and
4.4 (SD  1.6) acidic food and beverages per day in their habitual
diet in control runs 1 and 2, respectively. The mean intake did not
significantly differ between both runs. This number increased to
8.3 (SD  1,8) and 8.1 (SD  1.2) in experimental runs 1 and 2,
respectively.
The mean loss of enamel in control and experimental runs are
shown in Table 1. Statistical analysis showed a significant
difference in mean tissue loss (0.92 mm; p < 0.001) between
control run 1 and experimental run 1. Also a significant difference
of enamel tissue loss (3.72 mm; p < 0.001) between control run 2
and experimental run 2 was found. The mean loss of enamel in
control run 1 vs control run 2 (both habitual diet) did not differ
significantly (0.23 mm; p = 0.184).
The model showed significant differences in mean buccal
(p = 0.004), palatal (p < 0.001) and lingual (p < 0.04) tissue loss
between control 1 and experimental run 1 (drinking). Swishing of
orange juice not only showed a significant increase in mean tissue
loss of all enamel samples (experimental run 2 compared to
control run 2) but also showed most tooth tissue loss on the
occlusal and palatal/lingual surfaces (Table 1). In particular, in the
lower jaw substantial increase in mean tissue loss of occlusally
located samples was observed (Fig. 3).
Table 2 shows the difference in mean tissue loss for the drinking
(experimental run 1) and the swishing run (experimental run 2).
Swishing yielded a significantly larger surface loss compared with
drinking (difference 2.92 mm; p < 0.001). This difference in tissue
loss was caused mainly by a significant difference in tissue loss of
occlusally located enamel samples (5.43 mm; p = 0.002).
Significant Spearman correlation coefficients for symmetry of
erosive tooth wear (left/right) were found for occlusally located
samples in lower molars (36–37 and 46–47; 0.556; p = 0.025),
palatally located enamel samples in upper incisors (11 and 21;
0.825; p < 0.001) and buccally located samples (34 and 44; 0.530;
p = 0.029).
10
8
Enamel Loss (µm)
0
Mandible Maxilla
Occlusal
Habitual diet (Crt1)
Fig. 3. Mean tissue loss (mm) from enamel specimens (occlusal, buccal and palatal/lingual in upper and lower jaw) in control run 1 (Crt1) and 2 (Ctr2) and experimental run 1
(Exp 1) and 2 (Exp 2).
Please cite this article in press as: J. Ruben, et al., A new in situ model to study erosive enamel wear, a clinical pilot study, Journal of Dentistry
(2016), http://dx.doi.org/10.1016/j.jdent.2016.12.002
4. Discussion
In this study we present a new in situ model for studying
erosive wear. The model had two main objectives. Firstly, to locate
specimens in clinically relevant positions, and secondly, to enable
erosive challenges to take place intra-orally.
The mean age of the participants was 70 years. Despite the fact
that only healthy volunteers were included, it may be questioned
whether the clinical parameters in this group are similar to those of
the target population and to the dentate, and usually younger,
volunteers in most other erosive wear studies. Saliva and pellicle
formation are relevant biological factors for the prevention of
erosion. There are changes in the structure of the salivary glands
due to age, but it seems that these changes are not sufficient to
significantly influence the three components (water, electrolytes,
and organics) in such a way that the susceptibility for erosive wear
increases. [12–14]
The model demonstrated no or relatively small amounts of
additional enamel loss due to drinking of orange juice 4 times per
day, but substantial amounts due to the swishing of orange juice.
The variation between individuals was also markedly higher in the
swishing period. It is well established that individual susceptibly to
erosion is variable and biological variation in etiological factors
could influence how much erosive wear occurs. It is unlikely that
individual susceptibility changed throughout the present study
and although the variation may be the result of larger specimen
variation, the intra-individual consistency leads us to assume that
probably the swishing technique and intensity varied between the
subjects.
If we compare the level of erosive tooth wear due to drinking
found in this study with other in situ studies, we should
concentrate on those models where intra-oral exposure was
included. West and co-workers found an average of 2.77 mm loss of
enamel after 15 days of exposure to orange juice (4 times per day,
250 ml, sipping over 10 m, with a total exposure of 15 l over 600 m)
(West et al., 1998). In another study from the Bristol group studying
the protective effect of toothpaste with the same model
parameters, the benchmark toothpaste resulted in 2.25 mm and
the negative control in 3.23 mm loss of enamel. [4] In the present
study an average of 0.92 mm of enamel was lost after 30 days of
Mandible Maxilla Mandible Maxilla
Buccal Palatinal/Lingual
Drinking (Exp1) Habitual diet (Ctr2) Swishing (Exp2)
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Table 2
Difference in mean tissue loss (in mm) and standard deviation (sd) for drinking and swishing experimental run (total) and for occlusally, buccally, palatally and lingually
located samples in drinking (Exp1) and swishing (Exp2) run. No of pairs: number of paired samples for comparison of tissue loss in both runs.
Run Groups No of pairs
Drinking vs Swishing A = Exp1 vs B = Exp2 47
Drinking vs Swishing
Occlusal A = Exp1 vs B = Exp2 13
Buccal A = Exp1 vs B = Exp2 9 1.11 (1.22)
Palatal A = Exp1 vs B = Exp2 15
Lingual A = Exp1 vs B = Exp2 10
drinking/sipping orange juice (4 times per day, 125 ml, over 4 m,
with a total exposure of 15 l over 480 m). Mean enamel loss on
samples located palatally in the upper denture, the location most
resembling that of Bristol model, was 1.19 mm.
It was initially expected that the present model would result in
higher wear. Surface loss in this study was a combination of tissue
loss due to erosion, attrition and abrasion as found in dentate
persons The erosive challenges were superimposed onto a normal
diet, with already an average number of about 4 erosive challenges,
and also an added mechanical effect of chewing possibly abrasive
food. However, the erosive wear due to drinking was lower than in
the Bristol model. Several factors may be involved in this lower
erosive effect. Orange juice in the Bristol studies was consumed at
room temperature, whereas is the present study the juice was used
straight from the refrigerator. It has been shown that the erosive
effect of a beverage is reduced at lower temperatures. [15] In this
study the dentures with the specimens were worn 24 h per day,
whereas the appliances in the Bristol model were worn only during
working hours. This may have resulted in a more maturated
pellicle, with more protective capacity. [16]
One research question was whether the present model showed
similar erosive wear distribution over tooth sites as seen clinically
in erosive wear patients. Drinking of orange juice additional to the
habitual diet, caused significant but low increased erosive wear at
buccal, palatal and lingual specimens. Significantly higher levels of
tissue loss were found on all surfaces in the swishing experiment
but molars (especially occlusal surfaces of mandibular molars),
palatal specimens sited in upper anterior teeth and lingual
specimens in lower anterior teeth were most affected. This largely
reflects the distribution as most frequently seen clinically in
children and adolescents, [7] with exception of the lingual surfaces
in the lower anterior region. Surface loss of lingual surfaces of
lower front teeth is seldom found in dentate subjects. One can
speculate as to the explanation for this difference, which may be a
limitation of the present model. In the swishing experiment
subjects were instructed to hold each 25 ml sip in their mouth for
30 s, moving it around their mouth before swallowing. This
(extreme) manner of consumption may create a high flow rate of
orange juice along the lingual surfaces in combination with tongue
pressure on the lingual surfaces of the teeth by the swishing
movements of the cheeks. Possibly the normal saliva flow from the
submandibular and sublingual glands cannot counteract the severe
acid challenge 4 times per day during 30 days,
The interpretation of food diaries to evaluate erosive challenges
in the habitual diet is not straightforward. There is overwhelming
evidence that the erosive potential of different foods and beverages
is not only dependent on their pH, but is also influenced by other
factors such as buffering capacity, type of acid, calcium, phosphate
and fluoride concentration and chelating properties of the product.
[17] Moreover, there is no clear-cut critical pH for erosion. [18]
However, arbitrarily the pH of <5.5 was chosen for calculating the
number of potential acidic foods and beverages per day. Due to
long duration of the clinical phase of study (120 days) dietary
habits could change over the course of the study, for instance as a
Please cite this article in press as: J. Ruben, et al., A new in situ model to study erosive enamel wear, a clinical pilot study, Journal of Dentistry
(2016), http://dx.doi.org/10.1016/j.jdent.2016.12.002
5
A: mean (sd) B: mean (sd) diff (B-A) 95% CI p
0.93 (1.52) 3.85 (4.35) 2.92 [1.63–4.21] <0.001
0.40 (2.20) 5.83 (5.70) 5.43 [2.47–8.39] 0.002
1.51 (1.70) 0.40 [ 1.07–1.88] 0.546
1.19 (0.96) 3.43 (3.84) 2.24 [ 0.06–4.55] 0.056
1.06 (1.40) 3.99 (4.04) 2.92 [ 0.28–4.55] 0.069
result of seasonal changes. Such a shift could not be observed in the
present study. Therefore it is assumed that the increase of erosive
tooth wear in the experimental runs was predominantly caused by
the additional consumption of orange juice.
5. Conclusion
It can be concluded that the model using intra-oral erosive
challenges showed clinically relevant patterns of erosive tooth
wear and offers the opportunity for studying specific diets or a
specific consumption pattern and to test preventive measurements
such as mouth rinses and toothpastes in a more realistic clinical
setting.
Acknowledgements
The authors wish to thank the volunteers for their willingness
to participate in the study and Theo Jetten, director of the dental
clinic in Arnhem, for selecting the patients. The study was funded
by the Department of Dentistry, Radboud University Medical
Center, Nijmegen and by the Dutch association for Soft drinks,
Waters, Juices (FWS), The Hague, The Netherlands. The authors
declare no potential conflicts of interest with respect to the
authorship and/or publication of this article.
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Please cite this article in press as: J. Ruben, et al., A new in situ model to study erosive enamel wear, a clinical pilot study, Journal of Dentistry
(2016), http://dx.doi.org/10.1016/j.jdent.2016.12.002