Tooth wear is a widespread dental concern with implications for both function and aesthetics, causing discomfort and potential complications for individuals. In groundbreaking research, a systematic review has delved into the associations between salivary characteristics and tooth wear, shedding light on potentially valuable insights for dental practitioners. The study, carried out by a team of researchers, analyzed a wealth of data from various sources to uncover the links between salivary factors and this prevalent dental condition.
Methodology
The research, conducted under the PROSPERO CRD42022338590 protocol, employed rigorous systematic review methods for the screening, data extraction, and synthesis of relevant studies. The team utilized well-established tools, such as the JBI (Joanna Briggs Institute) and GRADE (Grading of Recommendations Assessment, Development, and Evaluation), to assess the risk of bias and the certainty of evidence.
The sources consulted included MEDLINE, Embase, SCOPUS, Web of Science, CINAHL, and additional relevant databases. The selection criteria encompassed studies reporting salivary characteristics in patients with tooth wear or related models, while excluding animal and in-vitro studies as well as case reports.
Results
The research encompassed a comprehensive review of 111 studies, offering valuable insights into the relationship between salivary characteristics and tooth wear. Qualitative analyses revealed a negative association between tooth wear and salivary pH and flow rate in numerous studies. Remarkably, the analysis suggested that larger studies were more likely to identify these associations with pH and flow rate.
Furthermore, the study unveiled that xerostomia, buffer capacity, and salivary consistency/viscosity showed some degree of association with tooth wear, though to a lesser extent. Associations with the 39 salivary components examined were less frequent.
In an attempt to quantify these associations, random effects meta-analyses were conducted on seven studies, demonstrating that pH levels in stimulated whole saliva were lower in patients with tooth wear compared to controls, with a difference of -0.07 [-0.10 to -0.04]. However, the available evidence did not provide enough support for establishing a quantitative association with flow rate.
Despite these findings, the research team noted that the general risk of bias across the studies was unclear, and the certainty of evidence was deemed low or very low due to the diverse methodologies employed, limiting the inclusion of all studies in quantitative synthesis.
Conclusion
The study’s findings suggest that among the potential risk factors examined, stimulated whole saliva pH exhibited a negative association with tooth wear, both qualitatively and quantitatively, hinting at the potential utility of pH monitoring in these patients. Additionally, qualitative observations hinted at associations between flow rate and tooth wear.
However, the research team emphasized that despite these intriguing findings, the lack of clarity regarding the risk of bias and the low certainty of evidence underscored the need for further research in this area. No causal associations between salivary characteristics and tooth wear could be definitively established.
Clinical Significance
Tooth wear is a common condition that can lead to functional, aesthetic, and pain-related issues. Understanding potential risk factors like salivary pH or flow rate and their dynamics could prove invaluable for monitoring tooth wear and implementing appropriate interventions, particularly in conditions like gastroesophageal reflux disease.
While this research provides valuable insights into the potential associations between salivary characteristics and tooth wear, it also highlights the need for more robust and standardized studies to establish causal links definitively. Dental practitioners and researchers alike can now focus on refining diagnostic and preventive measures based on these preliminary findings, potentially improving patient outcomes in the future.
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