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The role of calcium in the prevention of erosive tooth wear: a systematic review and meta-analysis

Evidence-Based Dentistry volume 25, page 55 (2024)Cite this article

Subjects

Abstract

Objectives

The loss of hard dental tissue due to recurrent acid challenges and mechanical stresses without bacterial involvement is known as erosive tooth wear (ETW). Many studies in the literature have concentrated on variables that may affect the ETW process and prevent its occurrence or reduce its advancement. However, to date, no previous systematic review has evaluated the role of calcium in preventing ETW. Therefore, the purpose of the present systematic review was to review and critically appraise the scientific evidence regarding the role of calcium formulations in the prevention of ETW.

Methods

The review protocol was registered in the PROSPERO international prospective register of systematic reviews (Ref: CRD42021229819). A literature search was conducted in electronic databases to identify in situ randomized controlled trials evaluating the prevention of ETW following the application of calcium formulations. The outcomes studied included mean enamel loss, surface microhardness, surface roughness, mean erosion/softening depth, mineral loss/precipitation and remineralization. Study characteristics and outcomes of included studies were summarized. Cochrane’s risk-of-bias tool 2.0 was used to assess the quality of eligible studies, and meta-analysis using a random effects model was performed.

Results

The search retrieved 869 studies of which 21 were considered eligible. Regarding the results of the quality assessment for potential risk of bias in all included studies, overall, 5 studies were considered as being at low risk, another 12 at unclear risk and 4 at high risk of bias. The findings of the studies showed that the addition of calcium in juice drinks led to reduced enamel loss, with blackcurrant juice presenting 2.6 times statistically significant less enamel loss compared to orange juice (p = 0.0001, I2 = 89%). No statistically significant difference in mean surface microhardness of eroded enamel was recorded between chewing gum with or without casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) (p = 0.31, I2 = 71%). Contradictory were the results regarding the effect of milk and CPP-ACP pastes on prevention of ETW.

Conclusions

Calcium formulations play an important role in ETW prevention, mainly through their addition to acidic drinks.

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The authors confirm that the data supporting the findings of this study are available within the article.

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Authors and Affiliations

  1. Department of Preventive & Community Dentistry, National and Kapodistrian University of Athens, School of Dentistry, 2 Thivon Str, 115 27, Goudi, Athens, Greece

    Konstantina Chatzidimitriou & William Papaioannou

  2. Department of Paediatric Dentistry, National and Kapodistrian University of Athens, School of Dentistry, 2 Thivon Str, 115 27, Goudi, Athens, Greece

    Kyriaki Seremidi & Sotiria Gizani

  3. Department of Orthodontics and Dentofacial Orthopedics, University of Bern, CH-3012, Hochschulstrasse 4, Bern, Switzerland

    Dimitrios Kloukos

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  1. Konstantina Chatzidimitriou
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Contributions

CK: conceptualization, methodology, investigation, formal analysis, writing—original draft, visualization. SK: conceptualization, methodology, investigation, formal analysis, writing—review and editing. KD: conceptualization, methodology, investigation, formal analysis, writing—review and editing, visualization. GS: conceptualization, methodology, formal analysis, writing—review and editing. PW: conceptualization, methodology, investigation, formal analysis, writing—review and editing, supervision.

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Correspondence to Konstantina Chatzidimitriou.

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Chatzidimitriou, K., Seremidi, K., Kloukos, D. et al. The role of calcium in the prevention of erosive tooth wear: a systematic review and meta-analysis. Evid Based Dent 25, 55 (2024). https://doi.org/10.1038/s41432-023-00966-5

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