Matabdin, Hesham; (2022) The natural history of the dental pellicle and its relationship to dental erosion. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Oral health is integral to general health, wellbeing and quality of life. Based upon the findings that dental erosion is highly prevalent in elite athletes, the aim of this PhD was to investigate the potential of the salivary dental pellicle to prevent dental erosion in the athlete population. Four studies were conducted: 1) development of an in vitro dental erosion model which would be able to detect early erosive lesions, 2) a systematic review and meta-analysis on the impact of intense physical training on saliva parameters, 3) a systematic review on the impact of dental pellicle modification on the magnitude of dental erosion, and 4) the effects of micellar casein on the structural and functional properties of the dental pellicle against dental erosion. Study 1 concluded that optical coherence tomography was not a promising tool to detect early erosive lesions. The systematic review and meta-analysis from study 2 found the evidence neither clearly supported nor refuted a relationship between intense physical activity and alterations in the qualitative and quantitative parameters of saliva which were hypothesised to cause dental erosion in athletes. Methodological issues including the high heterogeneity and low certainty of evidence contributed to the inconclusive overall findings. The systematic review from study 3 found that dental pellicle modification could offer a therapeutic approach to prevent dental erosion. However, the absence of a meta-analysis could not confirm the magnitude of dental erosion protection resulting from the interventions into the dental pellicle. The results from study 4 provided some indication that micellar casein might be protective for DE by reducing the decrease in surface microhardness of bovine enamel surfaces during erosion, although the effect did not quite achieve statistically significant difference. Similarly, there were no statistically significant differences in calcium ion concentration in citric acid and % calcium ion content following dental erosion. Overall, the results were inconclusive as the dental pellicle was not observed to be adsorbed on to polished enamel surfaces raising questions about the possibility of pellicle modification occurring in previous studies. There were no statistically significant effects of micellar casein on the ultrastructural properties of the dental pellicle, suggesting that pellicle modification may not occur with micellar casein indicating that micellar casein may not be an effective intervention. Therefore, with the limitations of the experiments mentioned, further research is required to confirm the findings and come to a conclusive result. The results from these studies suggest that further evaluation of the role of saliva in maintaining the oral health of elite athletes is needed. In addition, investigation of the dental pellicle in laboratory and clinical studies and its potential for modification would appear to have value for development of interventions to reduce dental erosion.

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