Monitoring salivary pH valuable for management of tooth wear, especially in GERD

A protocol was developed a priori (PROSPERO CRD42022338590). Established systematic review methods were used for screening, data extraction, and synthesis. Risk of bias and the certainty of evidence were assessed using the JBI tools and GRADE, respectively. Direct and indirect association between tooth wear and salivary components and characteristics were assessed.

Results

One-hundred eleven studies were included. Qualitative analyses showed a negative association between tooth wear and salivary pH and flow rate in many studies. The higher the study size the higher the chances that an association with pH and flow rate was found. Xerostomia, buffer capacity and salivary consistency/viscosity had also some degree of association with tooth wear in fewer studies. Associations with the 39 salivary components were scarcer. Random effects meta-analyses (7 studies) showed that pH levels in stimulated whole saliva were lower in patient with tooth wear compared to controls (−0.07 [−0.10 to −0.04]). However, there was not enough evidence to establish a quantitative association with flow rate. The general risk of bias was unclear and the certainty of evidence was low or very low. A large diversity of methodologies limited the inclusion of all studies in quantitative synthesis.

Conclusion

From all potential risk factors, stimulated whole saliva pH showed a negative association, both quantitatively and qualitatively with tooth wear, indicating potential usefulness of pH monitoring in these patients. Moreover, associations between flow rate and tooth wear were observed qualitatively. However, in both cases the risk of bias was mostly unclear, and the certainty of evidence was low. No causal associations could be observed. Tooth wear is a prevalent condition that may lead to functional or esthetic impairments and pain. Knowing the potential risk factors like salivary pH or flow rate and their dynamics could be relevant during tooth wear monitoring and to intervene accordingly, especially in conditions like gastroesophageal reflux disease.

Reference:

Víctor I. Madariaga, Tatiana Pereira-Cenci, X. Frank Walboomers, Bas A.C. Loomans,

Association between salivary characteristics and tooth wear: A systematic review and meta-analysis, Journal of Dentistry, Volume 138, 2023, 104692, ISSN 0300-5712,

https://doi.org/10.1016/j.jdent.2023.104692.

(https://www.sciencedirect.com/science/article/pii/S0300571223002786)

Keywords:

Monitoring, salivary, pH, valuable, assessment, management, tooth wear, especially, GERD, Journal of Dentistry, Saliva; Risk factors; Tooth wear; Tooth erosion; Physiological phenomena; Secretome, Víctor I. Madariaga, Tatiana Pereira-Cenci, X. Frank Walboomers, Bas A.C. Looma