Calcium’s Impact on Preventing Erosive Tooth Wear: A Comprehensive Systematic Review and Meta-Analysis

Objectives:
Erosive tooth wear (ETW), characterized by the loss of hard dental tissue due to recurrent acid challenges and mechanical stresses without bacterial involvement, is a significant concern. Numerous studies have explored variables that may influence the ETW process, aiming to prevent its occurrence or mitigate its progression. However, there has been a notable absence of a comprehensive systematic review specifically assessing the role of calcium in preventing ETW. This study sought to address this gap by critically reviewing the scientific evidence surrounding the contribution of calcium formulations to the prevention of ETW.

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

Results:
The search yielded 869 studies, out of which 21 were deemed eligible. The quality assessment indicated that 5 studies were at low risk, 12 at unclear risk, and 4 at high risk of bias. The study findings revealed that the addition of calcium to juice drinks resulted in reduced enamel loss, with blackcurrant juice demonstrating statistically significant 2.6 times less enamel loss compared to orange juice (p = 0.0001, I2 = 89%). No statistically significant difference in mean surface microhardness of eroded enamel was observed between chewing gum with or without casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) (p = 0.31, I2 = 71%). However, conflicting results were obtained regarding the impact of milk and CPP-ACP pastes on the prevention of ETW.

Conclusions:
The review concludes that calcium formulations, particularly when added to acidic drinks, play a crucial role in preventing ETW.