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News Bulletin : ADA News Bulletin August 2010
30 AUGUST 2010 committee report GUIDELINES Based on existing evidence, the following guidelines have been prepared for self application of erosion-inhibiting agents and oral habit regimes for wine tasters at high risk of erosive tooth wear. To request brochures containing more detailed information, please contact the authors. THE NIGHT BEFORE EXTENSIVE WINE TASTING: • Brush with concentrated fluoride toothpaste (5000ppm) and apply CPP-ACP paste (or CPP-ACP paste combined with fluoride) for five minutes, preferably in custom-made plastic trays. Spit out without rinsing with water; • Wear a nightguard if tooth grinding or clenching has been diagnosed. IN THE MORNING OF EXTENSIVE WINE TASTING: • Refrain from brushing teeth -- leave 'protective' film of dental plaque/pellicle; • Use fluoride mouthrinse (around 1000ppm) or apply CPP-ACP paste (or CPP-ACP paste combined with fluoride) for five minutes; • Chew sugar free, non-acidic gum to freshen mouth. DURING THE DAY OF EXTENSIVE WINE TASTING: • Drink water frequently and rinse the mouth to dilute wine acids; • For snacking, consider milk-based products (e.g., cheese) that will stimulate saliva flow and supply calcium and phosphate to the oral environment; • The use of fluoride mouthrinses, CPP-ACP pastes or bicarbonate mouthrinses could be beneficial between wine tasting sessions, but further studies are needed to investigate their effect on sensory perception of wine. AFTER AN INTENSIVE SESSION OF WINE TASTING: • Refrain from brushing teeth for at least two hours after wine tasting to avoid removal of the softened tooth surface and 'mineral rich' dental plaque. Instead, use fluoride mouth rinse or CPP-ACP paste and refrain from rinsing with water for about an hour; • Chew sugar free, non-acidic gum to increase saliva flow and neutralize acids in the dental plaque. FURTHER INFORMATION RELEVANT TO MANAGEMENT OF WINE EROSION: • Erosion prone areas can be protected with resin coating during periods of intensive wine tasting; • Consider treatment with a high concentration fluoride at a dental office every 6-8 weeks during intensive tasting season; • If sore spots develop in the mouth and on the tongue, application of chlorhexidine (alcohol free) gel will soothe the symptoms and promote healing; • Prophylaxis may be needed to remove extrinsic staining caused by wine tannins. Use of home or professional bleaching can be considered but they can exacerbate existing dentinal hypersensitivity; • Advanced cases of erosive tooth wear may require complex restorative treatment; • Signs of dental erosion should be monitored in long-term using wear indices, study models and photographs. CHALLENGES IN RECOGNIZING WINE EROSION AS AN OCCUPATIONAL HAZARD Wine erosion has been recognized as a potential occupational hazard, but there is a lack of local and national guidelines to assess this. Our attempts to promote education in this area over the past 15 years appear to have had some degree of success as some large wine companies in Australia now supply remineralizing agents such as CPP-ACP and fluoride in the tasting rooms for their employees. However, the occupational risk of wine erosion remains generally under-recognized within the industry. It is not known whether severe tooth wear and dentinal hypersensitivity affect the quality of life of wine tasters, leading to premature retirement from the profession. Apart from dental erosion, the wine industry workers face many other serious occupational hazards. Accidental death from hypoxia in wine storage tanks appears to be a major safety concern in the industry.23 A long list of other occupational hazards include adverse outdoor working conditions; excessive noise from machinery and equipment; snake and spider bites; asthma from mite exposure; chronic exposure to pesticides and toxic chemicals and skeleto-muscular disorders associated with poor stooping posture from working within confined spaces.23 Based on the data of occupational health claims made by Canadian wine industry workers over the past 15 years, it would appear that dental erosion receives less attention compared to traumatic injuries and occupational diseases (i.e., irritant contact dermatitis and carbon dioxide poisoning). Given the extent of occupational health and safety issues confronting the industry, it is not surprising that smaller wineries may regard the issue of occupational erosive tooth wear in their employees as a low occupational hazard to address. A challenge for our profession is to educate people in the wine industry about the adverse effects of intensive wine tasting and the importance of maintaining good oral health in the long-term. Obviously, further research and education are required to raise awareness and address these issues. CONCLUSION Professional wine tasting can result in severely worn dentition and is now recognized as a potential occupational hazard. Dental professionals have a responsibility to help identify individuals at risk of erosive tooth wear and to offer appropriate preventive and restorative treatment options conforming the paradigm of minimal intervention philosophy. There has been some improvement in the awareness of hidden hazards of wine tasting in the industry over the past decade, but this occupational risk remains generally under-recognized and further promotion of education must continue. Well-designed clinical and epidemiological studies are needed to verify the extent of erosive tooth wear in professional wine tasters, and to develop evidence- based approaches to manage this condition. REFERENCES References supplied by the authors are available on request from firstname.lastname@example.org Sarbin Ranjitkar, Diane Hunt, John McIntyre School of Dentistry, The University of Adelaide On behalf of the Oral Health Committee DISCLAIMER The statements made in the above article are published on the authority of the authors and have not been peer reviewed. They do not necessarily reflect the views of the ADA and publishing them is not to be regarded as an endorsement of them by the ADA.
ADA News Bulletin September 2010