The effect of gastric juice on the development of erosive changes in hard dental tissue

Abstract

Introduction Gastroesophageal reflux disease (GERD) is an esophageal disorder where the refluxed gastric contents enters first into the esophagus followed by the pharynx, oral cavity, larynx, airway and middle ear, causing a range of disorders and symptoms. Hydrochloric acid from the gastric contents is responsible for the demineralization of dental hard tissues and release of matrix metalloproteinase from the dentin. Objective The aim of this study was to verify the SEM (scanning electron microscopy) analysis of the surface enamel, the enamel-dentin border and dentine after the exposure of intact teeth to filtrate of gastric contents obtained during routine endoscopy. Methods Material used in the research was 10 extracted human impacted third molars. The coronal part of the tooth was divided into two parts, and then the two halves of teeth were exposed to the filtrate of gastric juice obtained during routine gastroscopy, which had been frozen until the moment of the experiment initiation. All samples of teeth were immersed in the filtrate of the content at a temperature of 20°C for 60 minutes. The prepared samples were observed by the SEM in the area of the enamel, the enamel-dentin border and in the area of dentin at different magnification. Results The SEM analysis showed that both enamel and dentin had a significant demineralization of these tissues. Enamel surface resembled a demineralization similar to that of acid conditioning before the application of composite restorations. The degree of mineralization was more intense towards the enamel - dentin border, and at this area the enamel prisms were not fully recognizable. The dentin had a complete loss of peritubular dentin, the entry points of the dentin tubules were expanded and intertubular dentin demineralization was also registered. Conclusion SEM analysis showed a significant degree of destruction of enamel and dentin. Significant changes in the surface structure of enamel and dentin were also registered. The filtrate of the gastric juice degrades enamel pellicle and the dentin organic component.

Uvod Gastroezofagealna refluksna bolest (GERB) je ezofagealni poremećaj gde refluktovani želudačni sadržaj dospeva najpre u jednjak, potom u ždrelo, usnu duplju, grkljan, vazdušne puteve i srednje uvo, izazivajući mnoštvo drugih poremećaja i simptoma. Hlorovodonična kiselina refluksata odgovorna je za demineralizaciju čvrstih zubnih tkiva i oslobađanje matriksnih metaloproteinaza iz dentina. Cilj rada Cilj rada je bio da se skening elektronskom mikroskopijom (SEM) analiziraju površina gleđi, gleđno dentinska granica i dentin nakon izlaganja intaktnog zuba filtratu želudačnog sadržaja dobijenog tokom rutinske gastroskopije. Metode rada Kao materijal u istraživanjima korišćeno je 10 ekstrahovanih humanih impaktiranih trećih molara. Krunični deo zuba je podeljen na dva dela, a potom su obe polovine zuba izlagane filtratu želudačnog soka dobijenom tokom rutinske gastroskopije koji je bio zamrznut do početka eksperimenta. Uzorci zuba su potapani u filtrat ovog sadržaja na temperaturi od 20°C tokom 60 minuta. Pripremljeni uzorci su posmatrani skening- elektronskim mikroskopom u predelu gleđi, gleđno-dentinske granice i dentina pri različitom uveličanju. Rezultati SEM analiza je pokazala da je i u gleđi i u dentinu došlo do znatne demineralizacije ovih tkiva. Površina gleđi podsećala je na demineralizaciju sličnu onoj kod kondicioniranja kiselinom pre primene kompozitnih ispuna. Stepen demineralizacije je bio intenzivniji prema gleđno-dentinskoj granici i ovde gleđne prizme nisu bile jasno prepoznatljive. Na dentinu je uočen potpuni gubitak peritubularnog dentina, prošireni su bili ulazi u dentin tubule, a uočena je i demineralizacija intertubularnog dentina. Zaključak SEM analiza je ukazala na značajan stepen oštećenja gleđi i dentina i znatne promene u njihovoj površinskoj strukturi. Filtrat želudačnog soka degradira pelikulu gleđi i organsku komponentu dentina.