In vivo effect of fluoride combined with amoxicillin on enamel development in rats

Some evidence in vitro suggested that amoxicillin and fluoride could disturb the enamel mineralization. Objective: To assess the effect of amoxicillin and of the combination of amoxicillin and fluoride on enamel mineralization in rats. Methodology: In total, 40 rats were randomly assigned to four groups: control group (CG); amoxicillin group (AG - amoxicillin (500 mg/kg/day), fluoride group (FG - fluoridated water (100 ppm -221 mg F/L), and amoxicillin + fluoride group (AFG). After 60 days, the samples were collected from plasma and tibiae and analyzed for fluoride (F) concentration. The incisors were also collected to determine the severity of fluorosis using the Dental Fluorosis by Image Analysis (DFIA) software, concentration of F, measurements of enamel thickness, and hardness. The data were analyzed by ANOVA, Tukey’s post-hoc test, or Games-Howell post-hoc test (α=0.05). Results: Enamel thickness of the incisors did not differ statistically among the groups (p=0.228). Groups exposed to fluoride (AFG and FG) have higher F concentrations in plasma, bone and teeth than those not exposed to fluoride (CG and AG). The groups showed a similar behavior in the DFIA and hardness test, with the FG and AFG groups showing more severe fluorosis defects and significant lower hardness when compared with the AG and CG groups, with no difference from each other. Conclusion: The rats exposed to fluoride or fluoride + amoxicillin developed dental fluorosis, while exposure to amoxicillin alone did not lead to enamel defects

Evidence Linking PPARG Genetic Variants with Periodontitis and Type 2 Diabetes Mellitus in a Brazilian Population

The peroxisome proliferator-activated receptor gamma (PPARG) gene encodes a transcription factor involved in the regulation of complex metabolic and inflammatory diseases. We investigated whether single nucleotide polymorphisms (SNPs) and haplotypes of the PPARG gene could contribute with susceptibility to develop periodontitis alone or together with type 2 diabetes mellitus (T2DM). Moreover, we evaluated the gene–phenotype association by assessing the subjects’ biochemical and periodontal parameters, and the expression of PPARG and other immune response–related genes. We examined 345 subjects with a healthy periodontium and without T2DM, 349 subjects with moderate or severe periodontitis but without T2DM, and 202 subjects with moderate or severe periodontitis and T2DM. PPARG SNPs rs12495364, rs1801282, rs1373640, and rs1151999 were investigated. Multiple logistic regressions adjusted for age, sex, and smoking status showed that individuals carrying rs1151999-GG had a 64% lower chance of developing periodontitis together with T2DM. The CCGT haplotype increased the risk of developing periodontitis together with T2DM. The rs1151999-GG and rs12495364-TC were associated with reduced risk of obesity, periodontitis, elevated triglycerides, and elevated glycated hemoglobin, but there was no association with gene expression. Polymorphisms of the PPARG gene were associated with developing periodontitis together with T2DM, and with obesity, lipid, glycemic, and periodontal characteristics

Abordagem ortopédica funcional dos maxilares no tratamento de mordida cruzada unilateral em criança com overjet acentuado

As más oclusões resultam da adaptação da região buco-facial a vários fatores etiológicos, causando diversas implicações funcionais e estéticas, como problemas na fala, mastigação, deglutição, disfunções da ATM e dor buco-facial. O objetivo deste estudo é relatar o caso clínico de uma paciente infantil com mordida cruzada posterior unilateral, do lado direito, apresentando overjet, desvio da linha média e comprometimento estético-funcional. Além disso, busca-se destacar a importância dos aparelhos ortopédicos no período de crescimento craniofacial para o tratamento precoce e eficaz das más oclusões. Uma paciente de 7 anos e 7 meses foi atendida na clínica-escola do curso de Odontologia da Universidade Federal de Pernambuco com o diagnóstico de Mordida Cruzada Posterior Unilateral. Ao exame extra-oral, notou-se que a paciente apresentava perfil braquifacial e assimetria facial. No exame intra-oral, observou-se uma mordida cruzada posterior unilateral no lado direito, com desvio da linha média para o lado esquerdo e overjet. Na vista lateral, foi observada uma classe II de Angle nos primeiros molares permanentes em ambos os lados. Como conduta, decidiu-se iniciar o tratamento ao longo de 18 meses utilizando o aparelho expansor superior encapsulado, com mordida construtiva do lado não cruzado (esquerdo). Em seguida, o tratamento prosseguiu com o uso do aparelho ortopédico bimaxilar ativador elástico aberto de Klammt, indicado para classe II-1, por 6 meses, visando corrigir a má oclusão de classe II de Angle. O presente relato de caso destaca a eficácia da Ortopedia Funcional dos Maxilares no tratamento de más oclusões e centralização da linha média, especialmente durante o período de crescimento craniofacial. O uso de aparelhos ortopédicos mostrou-se fundamental para corrigir a mordida cruzada posterior unilateral e restaurar a função e estética bucais da paciente, enfatizando a importância do diagnóstico precoce e do tratamento adequado para o bom desenvolvimento do indivíduo

Fluorescence devices for the detection of dental caries

BACKGROUND: Caries is one of the most prevalent and preventable conditions worldwide. If identified early enough then non‐invasive techniques can be applied, and therefore this review focusses on early caries involving the enamel surface of the tooth. The cornerstone of caries detection is a visual and tactile dental examination, however alternative methods of detection are available, and these include fluorescence‐based devices. There are three categories of fluorescence‐based device each primarily defined by the different wavelengths they exploit; we have labelled these groups as red, blue, and green fluorescence. These devices could support the visual examination for the detection and diagnosis of caries at an early stage of decay. OBJECTIVES: Our primary objectives were to estimate the diagnostic test accuracy of fluorescence‐based devices for the detection and diagnosis of enamel caries in children or adults. We planned to investigate the following potential sources of heterogeneity: tooth surface (occlusal, proximal, smooth surface or adjacent to a restoration); single point measurement devices versus imaging or surface assessment devices; and the prevalence of more severe disease in each study sample, at the level of caries into dentine. SEARCH METHODS: Cochrane Oral Health's Information Specialist undertook a search of the following databases: MEDLINE Ovid (1946 to 30 May 2019); Embase Ovid (1980 to 30 May 2019); US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov, to 30 May 2019); and the World Health Organization International Clinical Trials Registry Platform (to 30 May 2019). We studied reference lists as well as published systematic review articles. SELECTION CRITERIA: We included diagnostic accuracy study designs that compared a fluorescence‐based device with a reference standard. This included prospective studies that evaluated the diagnostic accuracy of single index tests and studies that directly compared two or more index tests. Studies that explicitly recruited participants with caries into dentine or frank cavitation were excluded. DATA COLLECTION AND ANALYSIS: Two review authors extracted data independently using a piloted study data extraction form based on the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS‐2). Sensitivity and specificity with 95% confidence intervals (CIs) were reported for each study. This information has been displayed as coupled forest plots and summary receiver operating characteristic (SROC) plots, displaying the sensitivity‐specificity points for each study. We estimated diagnostic accuracy using hierarchical summary receiver operating characteristic (HSROC) methods. We reported sensitivities at fixed values of specificity (median 0.78, upper quartile 0.90). MAIN RESULTS: We included a total of 133 studies, 55 did not report data in the 2 x 2 format and could not be included in the meta‐analysis. 79 studies which provided 114 datasets and evaluated 21,283 tooth surfaces were included in the meta‐analysis. There was a high risk of bias for the participant selection domain. The index test, reference standard, and flow and timing domains all showed a high proportion of studies to be at low risk of bias. Concerns regarding the applicability of the evidence were high or unclear for all domains, the highest proportion being seen in participant selection. Selective participant recruitment, poorly defined diagnostic thresholds, and in vitro studies being non‐generalisable to the clinical scenario of a routine dental examination were the main reasons for these findings. The dominance of in vitro studies also means that the information on how the results of these devices are used to support diagnosis, as opposed to pure detection, was extremely limited. There was substantial variability in the results which could not be explained by the different devices or dentition or other sources of heterogeneity that we investigated. The diagnostic odds ratio (DOR) was 14.12 (95% CI 11.17 to 17.84). The estimated sensitivity, at a fixed median specificity of 0.78, was 0.70 (95% CI 0.64 to 0.75). In a hypothetical cohort of 1000 tooth sites or surfaces, with a prevalence of enamel caries of 57%, obtained from the included studies, the estimated sensitivity of 0.70 and specificity of 0.78 would result in 171 missed tooth sites or surfaces with enamel caries (false negatives) and 95 incorrectly classed as having early caries (false positives). We used meta‐regression to compare the accuracy of the different devices for red fluorescence (84 datasets, 14,514 tooth sites), blue fluorescence (21 datasets, 3429 tooth sites), and green fluorescence (9 datasets, 3340 tooth sites) devices. Initially, we allowed threshold, shape, and accuracy to vary according to device type by including covariates in the model. Allowing consistency of shape, removal of the covariates for accuracy had only a negligible effect (Chi(2) = 3.91, degrees of freedom (df) = 2, P = 0.14). Despite the relatively large volume of evidence we rated the certainty of the evidence as low, downgraded two levels in total, for risk of bias due to limitations in the design and conduct of the included studies, indirectness arising from the high number of in vitro studies, and inconsistency due to the substantial variability of results. AUTHORS' CONCLUSIONS: There is considerable variation in the performance of these fluorescence‐based devices that could not be explained by the different wavelengths of the devices assessed, participant, or study characteristics. Blue and green fluorescence‐based devices appeared to outperform red fluorescence‐based devices but this difference was not supported by the results of a formal statistical comparison. The evidence base was considerable, but we were only able to include 79 studies out of 133 in the meta‐analysis as estimates of sensitivity or specificity values or both could not be extracted or derived. In terms of applicability, any future studies should be carried out in a clinical setting, where difficulties of caries assessment within the oral cavity include plaque, staining, and restorations. Other considerations include the potential of fluorescence devices to be used in combination with other technologies and comparative diagnostic accuracy studies

Desempenho de sistema de diagnóstico óptico para detecção de lesões de cárie

O objetivo deste trabalho foi avaliar o desempenho de sistemas de diagnóstico óptico para detecção de lesões de cárie. No estudo in vitro, a viabilidade da transiluminação com laser infravermelho próximo (TI-NIR) para o diagnóstico de lesões iniciais de cárie foi avaliada. Dois examinadores avaliaram 94 sítios na superfície oclusal de molares e pré-molares humanos recém extraídos, classificados com escore 0, 1, 2 ou 3 ICDAS, utilizando um protótipo TI-NIR, a radiografia (RX), o DIAGNOdent Pen (DDPen) e o Quantitative Light-induced Fluorescence (QLF). Para validação, a análise histológica foi considerada como o padrão ouro. A reprodutibilidade intra e interexaminador foi avaliada com o coeficiente Kappa. Concluiu-se que o desempenho da TI-NIR bom, e constitui-se como uma alternativa válida e confiável para o diagnóstico de lesões iniciais na superfície oclusal de dentes permanentes. No segundo estudo, in vivo, o objetivo foi avaliar o desempenho do exame visual com os critérios Nyvad (EV), radiografia interproximal (RX), dispositivo de fluorescência a laser (DIAGNOdent Pen - DDPen) e suas associações no diagnóstico de lesões proximais em dentes decíduos. Para isso, foram selecionadas 45 crianças (n=59 superfícies) de ambos os sexos com idades entre 5 e 9 anos que apresentavam molares deciduos com sinais sugestivos da presença de lesão de cárie ou hígidos. As superfícies foram avaliadas clinicamente e codificadas segundo os critérios Nyvad, e logo depois com o DDPen. O exame radiográfico foi realizado apenas naquelas superfícies codificadas com os escores Nyvad 2, 3, 5 ou 6. Lesões de cárie ativas e/ou com superfície descontinuada foram restauradas, considerando-se a profundidade da lesão como padrão de referência. O desempenho do exame visual, radiográfico e DDpen e suas associações...The aim of this study was to evaluate the performance of optical diagnostic systems for detection of caries lesions. In the in vitro study, the viability of the near infrared laser transillumination (TI-NIR) for diagnosis of incipient carious lesions was evaluated. Two examiners evaluated 94 sites in occlusal surface of molars and premolars freshly extracted, selected with score 0, 1, 2 or 3 ICDAS using the TI-NIR prototype, bitewing radiographs (RX), the DIAGNOdent Pen (DDPen) and Quantitative Light-induced Fluorescence (QLF). For validation, histological analysis was considered as the gold standard. The performance of TI-NIR was good, and its constitutes as a reliable and valid alternative for the diagnosis of early lesions in the occlusal surface of permanent teeth. In the second study, in vivo, the performance of the visual examination with the criteria Nyvad (EV), radiographs (RX), laser fluorescence device (DIAGNOdent Pen - DDPen) and their associations in the diagnosis of proximal lesions in deciduous teeth was evaluated. Were selected 45 children (n = 59 surfaces) of both sexes aged between 5 and 9 years who had deciduous molars with signs suggestive of the presence of caries or sound. The surfaces were evaluated clinically and scored with the Nyvad criteria, and DDPen. Radiographic examination was performed only on those surfaces scored with Nyvad 2, 3, 5 or 6. Caries active and / or discontinued surface were restored, considering the depth of the lesion as a reference standard. The performance of visual examination, and radiographic DDpen and their associations was good, but the use of the criteria NYVAD proved sufficient for the diagnosis of interproximal lesions. It could be observed that optical technologies appear to contribute positively in the diagnosis process in the diagnosis of caries. However, they should be considered as adjuncts to conventional methods in this proces

Desempenho de sistema de diagnóstico óptico para detecção de lesões de cárie

O objetivo deste trabalho foi avaliar o desempenho de sistemas de diagnóstico óptico para detecção de lesões de cárie. No estudo in vitro, a viabilidade da transiluminação com laser infravermelho próximo (TI-NIR) para o diagnóstico de lesões iniciais de cárie foi avaliada. Dois examinadores avaliaram 94 sítios na superfície oclusal de molares e pré-molares humanos recém extraídos, classificados com escore 0, 1, 2 ou 3 ICDAS, utilizando um protótipo TI-NIR, a radiografia (RX), o DIAGNOdent Pen (DDPen) e o Quantitative Light-induced Fluorescence (QLF). Para validação, a análise histológica foi considerada como o padrão ouro. A reprodutibilidade intra e interexaminador foi avaliada com o coeficiente Kappa. Concluiu-se que o desempenho da TI-NIR bom, e constitui-se como uma alternativa válida e confiável para o diagnóstico de lesões iniciais na superfície oclusal de dentes permanentes. No segundo estudo, in vivo, o objetivo foi avaliar o desempenho do exame visual com os critérios Nyvad (EV), radiografia interproximal (RX), dispositivo de fluorescência a laser (DIAGNOdent Pen - DDPen) e suas associações no diagnóstico de lesões proximais em dentes decíduos. Para isso, foram selecionadas 45 crianças (n=59 superfícies) de ambos os sexos com idades entre 5 e 9 anos que apresentavam molares deciduos com sinais sugestivos da presença de lesão de cárie ou hígidos. As superfícies foram avaliadas clinicamente e codificadas segundo os critérios Nyvad, e logo depois com o DDPen. O exame radiográfico foi realizado apenas naquelas superfícies codificadas com os escores Nyvad 2, 3, 5 ou 6. Lesões de cárie ativas e/ou com superfície descontinuada foram restauradas, considerando-se a profundidade da lesão como padrão de referência. O desempenho do exame visual, radiográfico e DDpen e suas associações...The aim of this study was to evaluate the performance of optical diagnostic systems for detection of caries lesions. In the in vitro study, the viability of the near infrared laser transillumination (TI-NIR) for diagnosis of incipient carious lesions was evaluated. Two examiners evaluated 94 sites in occlusal surface of molars and premolars freshly extracted, selected with score 0, 1, 2 or 3 ICDAS using the TI-NIR prototype, bitewing radiographs (RX), the DIAGNOdent Pen (DDPen) and Quantitative Light-induced Fluorescence (QLF). For validation, histological analysis was considered as the gold standard. The performance of TI-NIR was good, and its constitutes as a reliable and valid alternative for the diagnosis of early lesions in the occlusal surface of permanent teeth. In the second study, in vivo, the performance of the visual examination with the criteria Nyvad (EV), radiographs (RX), laser fluorescence device (DIAGNOdent Pen - DDPen) and their associations in the diagnosis of proximal lesions in deciduous teeth was evaluated. Were selected 45 children (n = 59 surfaces) of both sexes aged between 5 and 9 years who had deciduous molars with signs suggestive of the presence of caries or sound. The surfaces were evaluated clinically and scored with the Nyvad criteria, and DDPen. Radiographic examination was performed only on those surfaces scored with Nyvad 2, 3, 5 or 6. Caries active and / or discontinued surface were restored, considering the depth of the lesion as a reference standard. The performance of visual examination, and radiographic DDpen and their associations was good, but the use of the criteria NYVAD proved sufficient for the diagnosis of interproximal lesions. It could be observed that optical technologies appear to contribute positively in the diagnosis process in the diagnosis of caries. However, they should be considered as adjuncts to conventional methods in this proces

Desempenho de sistema de diagnóstico óptico para detecção de lesões de cárie

O objetivo deste trabalho foi avaliar o desempenho de sistemas de diagnóstico óptico para detecção de lesões de cárie. No estudo in vitro, a viabilidade da transiluminação com laser infravermelho próximo (TI-NIR) para o diagnóstico de lesões iniciais de cárie foi avaliada. Dois examinadores avaliaram 94 sítios na superfície oclusal de molares e pré-molares humanos recém extraídos, classificados com escore 0, 1, 2 ou 3 ICDAS, utilizando um protótipo TI-NIR, a radiografia (RX), o DIAGNOdent Pen (DDPen) e o Quantitative Light-induced Fluorescence (QLF). Para validação, a análise histológica foi considerada como o padrão ouro. A reprodutibilidade intra e interexaminador foi avaliada com o coeficiente Kappa. Concluiu-se que o desempenho da TI-NIR bom, e constitui-se como uma alternativa válida e confiável para o diagnóstico de lesões iniciais na superfície oclusal de dentes permanentes. No segundo estudo, in vivo, o objetivo foi avaliar o desempenho do exame visual com os critérios Nyvad (EV), radiografia interproximal (RX), dispositivo de fluorescência a laser (DIAGNOdent Pen - DDPen) e suas associações no diagnóstico de lesões proximais em dentes decíduos. Para isso, foram selecionadas 45 crianças (n=59 superfícies) de ambos os sexos com idades entre 5 e 9 anos que apresentavam molares deciduos com sinais sugestivos da presença de lesão de cárie ou hígidos. As superfícies foram avaliadas clinicamente e codificadas segundo os critérios Nyvad, e logo depois com o DDPen. O exame radiográfico foi realizado apenas naquelas superfícies codificadas com os escores Nyvad 2, 3, 5 ou 6. Lesões de cárie ativas e/ou com superfície descontinuada foram restauradas, considerando-se a profundidade da lesão como padrão de referência. O desempenho do exame visual, radiográfico e DDpen e suas associações...The aim of this study was to evaluate the performance of optical diagnostic systems for detection of caries lesions. In the in vitro study, the viability of the near infrared laser transillumination (TI-NIR) for diagnosis of incipient carious lesions was evaluated. Two examiners evaluated 94 sites in occlusal surface of molars and premolars freshly extracted, selected with score 0, 1, 2 or 3 ICDAS using the TI-NIR prototype, bitewing radiographs (RX), the DIAGNOdent Pen (DDPen) and Quantitative Light-induced Fluorescence (QLF). For validation, histological analysis was considered as the gold standard. The performance of TI-NIR was good, and its constitutes as a reliable and valid alternative for the diagnosis of early lesions in the occlusal surface of permanent teeth. In the second study, in vivo, the performance of the visual examination with the criteria Nyvad (EV), radiographs (RX), laser fluorescence device (DIAGNOdent Pen - DDPen) and their associations in the diagnosis of proximal lesions in deciduous teeth was evaluated. Were selected 45 children (n = 59 surfaces) of both sexes aged between 5 and 9 years who had deciduous molars with signs suggestive of the presence of caries or sound. The surfaces were evaluated clinically and scored with the Nyvad criteria, and DDPen. Radiographic examination was performed only on those surfaces scored with Nyvad 2, 3, 5 or 6. Caries active and / or discontinued surface were restored, considering the depth of the lesion as a reference standard. The performance of visual examination, and radiographic DDpen and their associations was good, but the use of the criteria NYVAD proved sufficient for the diagnosis of interproximal lesions. It could be observed that optical technologies appear to contribute positively in the diagnosis process in the diagnosis of caries. However, they should be considered as adjuncts to conventional methods in this proces

Immune-related genes polymorphisms are associated with Molar- Incisor Hypomineralization (MIH)

O objetivo deste estudo foi avaliar a possível associação entre a Hipomineralização Molar-Incisivo (HMI) e polimorfismos em genes da resposta imune, e sua interação com polimorfismos em genes relacionados a amelogênese. Amostras de DNA foram coletadas de 101 núcleos familiares que apresentavam pelo menos uma criança diagnosticada com HMI. Onze polimorfismos de base única (SNP) relacionados a resposta imune foram genotipados por meio de PCR em tempo real com ensaio TaqMan. A análise da associação foi realizada com o teste de desequilíbrio de transmissão (TDT), levando-se em consideração a severidade da HMI. A interação gene-gene entre os polimorfismos da resposta imune e da amelogênese foi realizada por meio da observação da transmissão dos alelos referentes aos marcadores pelos pais heterozigotos para ambos os marcadores, e o teste Qui quadrado foi utilizado a fim de determinar se ambos os alelos são transmitidos mais frequentemente em associação, do que individualmente. O nível de significância adotado foi de 5%. Resultados significantes foram obtidos para o SNP rs10733708 (gene TGFBR1, OR = 3.5, 95% IC = 1.1 – 10.6) para os casos severos de HMI. As interações gene-gene foram significativas entre o SNP rs6654939 (AMELX) com os SNPs rs2070874 (IL4), rs2275913 (IL17A), rs1800872 (IL10), rs1800587 (IL1A) e rs3771300 (STAT1). O SNP rs2070874 (IL4), quando associado com os marcadores rs7526319 (TUFT1) e rs2355767 (BMP4) também demonstrou resultados significativos, sugerindo um efeito sinérgico da transmissão destes alelos com a susceptibilidade à HMI. Este estudo baseado em família demonstrou uma associação entre a variação no gene do TGFBR1 e a HMI, sendo que os polimorfismos em genes da resposta imune e da amelogênese podem apresentar um efeito aditivo no risco de desenvolver HMI.The aim of this study was evaluate the possible association between immune-related genes polymorphisms and Molar-Incisor Hypomineralization (MIH), and its interaction with amelogenesis-related genes polymorphysms. DNA samples were obtained from 101 nuclear families that had at least one MIH affected children. Eleven single nucleotide polymorphisms (SNP) were investigated in immune response candidate genes using the TaqMan method. Association analysis was performed by the transmission/disequilibrium test (TDT) considering the MIH severity. The gene-gene interaction between the immune-related and amelogennesis-related polymorphisms was performed by observing the transmission of markers alleles from parents heterozygous for both of the markers. The Qui squared test was used to determine whether both alleles are transmitted more often in association than individually. Significant result was observed for the SNP rs10733708 (TGFBR1 gene, OR = 3.5, 95% CI = 1.1 - 10.6) for severe cases of HMI. Gene-gene interactions were significant between SNPs rs6654939 (AMELX) and SNPs rs2070874 (IL4), rs2275913 (IL17A), rs1800872 (IL10), rs1800587 (IL1A) and rs3771300 (STAT1). The SNP rs2070874 (IL4) was significant when associated with SNPs rs7526319 (TUFT1) and rs2355767 (BMP4), suggesting a synergistic effect of the transmission of these alleles with susceptibility to HMI. This family-based study demonstrated an association between variation in the TGFBR1 gene and HMI. The polymorphisms in immune response and amelogenesis genes may have an additive effect on the risk of developing HMI.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)CNPq: 454300/2014-

Contribution of dentistry in the diagnosis of systemic disorders related to erosive tooth wear

Erosive tooth wear (ETW) is the irreversible loss of dental hard tissue resulting from the chemical-mechanical process. The aim of the present case report was to present two clinical cases of patients affected by ETW arising from different etiological factors. The patients, of the male gender, 9 and 10 years of age presented to the pediatric dental clinic, for routine evaluation. On clinical exam, both patients had no caries lesions, but some lesions suggestive of ETW, which had aspects such as a translucent halo around the occlusal surface of teeth, in addition to "cupping” lesions - mainly in the cusp region, and loss of tooth enamel (by volume). The lesions were restricted to enamel, and the patients showed no dental hypersensitivity. From the dental clinical exam and anamnesis, the two patients were found to have similar tooth structure loss, with diagnosis of ETW. However, in one patient the etiology was extrinsic due to diet, and in the other, it was intrinsic due to gastroesophageal reflux disease (GERD). The latter patient was referred to a specialist for evaluation of the systemic condition, and GERD was diagnosed. It was concluded that dentists play an important role, as coadjuvant in the diagnosis of health problems related to ETW. Therefore, meticulous clinical exams must be performed to establish the correct diagnosis, because swift intervention in the clinical cases presented had a positive impact on halting the erosive process.</jats:p