The progression of tooth erosion in a cohort of adolescents of mixed ethnicity

Evaluation of three different scoring systems for dental erosion: a comparative study in adolescents

OBJECTIVES

The purpose of the study was to evaluate and compare three scoring systems for dental erosion representing different approaches: the recently proposed Basic Erosive Wear Examination (B.E.W.E.), the Simplified Tooth Wear Index (S-T.W.I.), and the Evaluating Index of Dental Erosion (EV.I.D.E.), which are introduced and calibrated in the present study, in order to contribute to the development of a standardised and validated erosion index.

METHODS

A cross-sectional study was conducted, in which a random and stratified sample of 502 adolescents aged 14-16 years was examined using the aforementioned scoring systems.

RESULTS

A significant number of Greek adolescents had experienced dental erosion: 58%, 51.6% and 45.2%, according to the B.E.W.E., S-T.W.I. and EV.I.D.E. scores, respectively. Additionally, 22.7-24.3% of the subjects had lesions into dentine (according to the EV.I.D.E. and S-T.W.I. scores respectively), whereas the B.E.W.E. classified all subjects with erosion in the "none" and "low" risk level categories. However, the use of the B.E.W.E. cumulative scores was important for avoiding the overestimation of the prevalence of erosion. The aetiological criteria of the EV.I.D.E. seemed to reduce the false positive cases.

CONCLUSIONS

The S-T.W.I. appeared to have the lowest content validity, while the B.E.W.E. was a convenient to use index, with sufficient sensitivity and specificity. Nevertheless, the B.E.W.E. cut-off values have to be reconsidered in order to reflect the severity of the erosive lesions. The B.E.W.E. could also be supplemented with a group of sufficient validated aetiological criteria, which are necessary to establish a more accurate differential diagnosis of dental erosion.

Dynamics of tooth erosion in adolescents: a 3-year longitudinal study

OBJECTIVES

The aim of the present study was to estimate the prevalence, incidence and progression of tooth erosion on both mouth and tooth level over a 3-year period in a sample of adolescents. The study also aimed to investigate age, gender and socio-economic influences.

METHODS

Tooth erosion was recorded three times with 1.5 years intervals in a sample of 622 children, aged 10-12 years at baseline.

RESULTS

Tooth erosion was present in 30.4% of the 11-year-olds, and 44.2% in 15-year-olds. Deep enamel or dentin was eroded in 1.8% of the 11-year-olds and in 23.8% of the 15-year-olds. Significantly more boys than girls showed tooth erosion as did children from a low socio-economic background compared with other children. The incidence of new tooth surfaces exhibiting erosion, in erosion-free children, decreased significantly with age, while the progression in children with erosion did not change. The incidence of tooth erosion in upper incisors and lower first molars decreased significantly with age. In upper incisors, a statistical significant relationship between SES and incidence was found, with lower incidences for higher SES. For first molars, only a relationship between gender and incidence was found, with a lower incidence for girls.

CONCLUSIONS

The incidence of new tooth surfaces exhibiting erosion, in erosion-free children, decreased significantly with age. In children with tooth erosion the condition progressed steadily. On tooth level the incidence decreased significantly with age for upper incisors and lower first molars. There was a difference in influence of background variables on the incidence of tooth erosion between molars and upper incisors.

A longitudinal study of tooth erosion in adolescents

Incidence studies on tooth erosion among adolescents are scarce. This longitudinal study aimed at estimating the prevalence, incidence, progression, and distribution of erosion in young adolescents over a 1.5-year period. Erosion at baseline was present in 32.2% of the 622 children (mean age, 11.9 +/- 0.9 yrs) and increased to 42.8% over 1.5 yrs. The prevalence of deep enamel or dentin erosion increased from 1.8% to 13.3%. It was hypothesized that more boys will suffer from erosion than girls. At baseline, no difference was found (p = 0.139), whereas 1.5 yrs later, more boys showed erosion than girls (p = 0.026). Of the erosion-free children, 24.2% developed erosion. Progression of erosion in terms of lesion depth and/or in number of lesions was 61.0% and was found more frequently in boys than in girls (p = 0.034). The distribution of erosion showed a predominance of occlusal surfaces of molars, especially the mesiobuccal cusp top, and palatal surfaces of upper anterior teeth.

Basic Erosive Wear Examination (BEWE): a new scoring system for scientific and clinical needs

A new scoring system, the Basic Erosive Wear Examination (BEWE), has been designed to provide a simple tool for use in general practice and to allow comparison to other more discriminative indices. The most severely affected surface in each sextant is recorded with a four level score and the cumulative score classified and matched to risk levels which guide the management of the condition. The BEWE allows re-analysis and integration of results from existing studies and, in time, should initiate a consensus within the scientific community and so avoid continued proliferation of indices. Finally, this process should lead to the development of an internationally accepted, standardised and validated index. The BEWE further aims to increase the awareness of tooth erosion amongst clinicians and general dental practitioners and to provide a guide as to its management.

Erosion--diagnosis and risk factors

Dental erosion is a multifactorial condition: The interplay of chemical, biological and behavioural factors is crucial and helps explain why some individuals exhibit more erosion than others. The erosive potential of erosive agents like acidic drinks or foodstuffs depends on chemical factors, e.g. pH, titratable acidity, mineral content, clearance on tooth surface and on its calcium-chelation properties. Biological factors such as saliva, acquired pellicle, tooth structure and positioning in relation to soft tissues and tongue are related to the pathogenesis of dental erosion. Furthermore, behavioural factors like eating and drinking habits, regular exercise with dehydration and decrease of salivary flow, excessive oral hygiene and, on the other side, an unhealthy lifestyle, e.g. chronic alcoholism, are predisposing factors for dental erosion. There is some evidence that dental erosion is growing steadily. To prevent further progression, it is important to detect this condition as early as possible. Dentists have to know the clinical appearance and possible signs of progression of erosive lesions and their causes such that adequate preventive and, if necessary, therapeutic measures can be initiated. The clinical examination has to be done systematically, and a comprehensive case history should be undertaken such that all risk factors will be revealed.

Pathological or physiological erosion--is there a relationship to age?

This conventional literature review discusses whether pathological tooth wear is age dependant. It briefly reviews the components of tooth wear and the prevalence of tooth wear in children, adolescents and adults. The emphasis on terminology relating to tooth wear varies. In some countries, the role of erosion is considered the most important, whereas others consider the process to be a combination of erosion, attrition and abrasion often with one being more dominant. The importance of tooth wear or erosion indices in the assessment and the evidence for progression within subject and within lesions is described. The data from the few studies reporting pathological levels of wear reported in children and adults are discussed, in particular its relationship with age. There is little evidence to support the concept that pathological levels of erosion or wear are age dependant. There is, however, some evidence to suggest that normal levels of erosion or wear are age dependant.

Dental erosion amongst 13- and 14-year-old Brazilian schoolchildren

OBJECTIVES

To assess the prevalence of dental erosion in a sample of 13- and 14-year-old Brazilian schoolchildren and to assess the relationship of dental erosion and socio-demographic characteristics.

METHODS

A convenience sample of 458 children (190 boys and 268 girls) from 14 schools in Três Corações, south east Brazil, was examined. Socio-demographic data were collected by self-completion questionnaires.

RESULTS

Dental erosion was observed in 34.1% of subjects, involving enamel only and showing a symmetrical distribution. The palatal surfaces of the upper incisors were the most commonly affected surfaces. Erosion experience was higher in boys; pupils from Government funded schools; those resident in rural areas and those from the high economic class, but none of these were statistically significant.

CONCLUSION

These data are the first to show that in a cohort of 13-14-year old Brazilian schoolchildren, approximately one third of those examined showed mild erosion, requiring clinical preventive counselling. No statistically significant association was observed between erosion, gender and socioeconomic factors.

Area deprivation and oral health in Scottish adults: a multilevel study

OBJECTIVES

To explore the association between area deprivation and adult oral health.

METHODS

Multilevel regression analysis of data taken from the 1998 Adult Dental Health Survey in the UK comprising 632 participants living in 346 households located in 31 postcode sectors in Scotland. Three oral health outcomes were investigated: number of sound (including restored) teeth; has one or more unsound teeth; has periodontal pocketing 4 mm or more in one or more teeth.

RESULTS

In the most deprived areas, individuals had a mean of 4.6 fewer sound teeth than those in the least deprived areas. The difference in normalised number of sound teeth between least and most deprived areas was -0.707 (95% CI -1.164, -0.250), P = 0.024. After adjusting for age, sex, qualification status, head of household social class and household income, the estimated difference was -0.238 (-0.591 to 0.115) (P = 0.164). Area deprivation was not associated with having one or more unsound teeth or periodontal pocketing 4 mm or more in one or more teeth.

CONCLUSIONS

There is a univariate association of area deprivation with the number of sound teeth. This association is largely explained by household and individual level socioeconomic variables. A small area deprivation effect cannot be excluded in these data. The findings challenge current understanding of the relationship between area deprivation and oral health. Further multilevel research exploring the relationship between area deprivation and oral health is required using a larger sample and a prospective longitudinal design.

Protein buffering in model systems and in whole human saliva

The aim of this study was to quantify the buffer attributes (value, power, range and optimum) of two model systems for whole human resting saliva, the purified proteins from whole human resting saliva and single proteins. Two model systems, the first containing amyloglucosidase and lysozyme, and the second containing amyloglucosidase and α-amylase, were shown to provide, in combination with hydrogencarbonate and di-hydrogenphosphate, almost identical buffer attributes as whole human resting saliva. It was further demonstrated that changes in the protein concentration as small as 0.1% may change the buffer value of a buffer solution up to 15 times. Additionally, it was shown that there was a protein concentration change in the same range (0.16%) between saliva samples collected at the time periods of 13:00 and others collected at 9:00 am and 17:00. The mode of the protein expression changed between these samples corresponded to the change in basic buffer power and the change of the buffer value at pH 6.7. Finally, SDS Page and Ruthenium II tris (bathophenantroline disulfonate) staining unveiled a constant protein expression in all samples except for one 50 kDa protein band. As the change in the expression pattern of that 50 kDa protein band corresponded to the change in basic buffer power and the buffer value at pH 6.7, it was reasonable to conclude that this 50 kDa protein band may contain the protein(s) belonging to the protein buffer system of human saliva.

Prevention of erosion and abrasion by a high fluoride concentration gel applied at high frequencies

The aim of this study was to determine maximum attainable protection of enamel from erosion and erosion abrasion using a highly fluoridated gel with and without additional fluoride from toothpaste. Thirty-six bovine enamel specimens were subjected to six erosive attacks per day (1% citric acid with pH 2.3 for 30 s), while the rest of the day the specimens were in artificial saliva. There were four treatment groups (9 specimens in each group): fluoride-free toothpaste/saliva slurry twice daily (group T0), fluoride-containing toothpaste/saliva slurry twice daily using 1,250 ppm F toothpaste (group TF), fluoride-containing toothpaste/saliva slurry twice per day plus application of a highly fluoridated gel (12,500 ppm F) twice a day for 120 s (group 2F) and a group with gel application 8 times a day (group 8F). Additionally, half of each specimen in all groups was subjected to brushing abrasion during application of the toothpaste/saliva slurry. Brushing abrasion alone led to no observable enamel loss measured with profilometry. After 14 days of cycling of erosion without toothbrushing abrasion, high-fluoride gel application 2 or 8 times daily showed significantly less enamel loss (median 24/19 microm) than with toothpaste with or without fluoride (41/45 microm). After 14 days of cycling of erosion and toothbrushing abrasion, gel application 2 or 8 times daily (33/29 microm) showed significantly less enamel loss than toothpaste with or without fluoride (57/62 microm). We conclude that a highly fluoridated acidic gel is able to protect enamel from erosion and toothbrushing abrasion while fluoridated tooth paste provides little protection.

Hardness of enamel exposed to Coca-ColaR and artificial saliva

The purpose of this study was to determine the rate of change in indentation hardness of enamel in permanent teeth exposed to Coca-Cola. In a further experiment, the ability of a commercially available artificial saliva to remineralize enamel treated with Coca-Cola was tested. Ten enamel specimens were randomly chosen to be treated with Coca-Cola (experimental groups) and seven with water (control group). The fluids were applied for 1, 2, 3 h and overnight (15 h), washed off with a few drops of water and the moist enamel indentation hardness tested after each interval. With Coca-Cola treatment, the mean enamel hardness was 92.6% (s.d. = 7.9) of the original baseline hardness after 1 h, 93.25% (s.d. = 10.15) after 2 h, 85.7% (s.d. = 12.03) after 3 h and 80.3% after 15 h. The mean indentation hardness of control specimens treated with water was 108.7% (s.d. = 16.09) of the original hardness after 1 h, 99.09% (s.d. = 18.98) after 2 h, 98.97% (s.d. =11.24) after 3 h and 98.42% (s.d. = 22.78) after 15 h. In a separate experiment, the hardness of 9 enamel specimens was tested, as previously described, before and after treatment with Coca-Cola overnight and again after application of artificial saliva for 3 min. Coca-Cola reduced the mean indentation hardness of enamel in the teeth, but the hardness was partially restored with artificial saliva (Salivart) and increased by 18% from the demineralized enamel hardness.

The role of erosion in tooth wear: aetiology, prevention and management

Tooth wear is a universal experience. The cause is usually a combination of erosion, attrition and abrasion. Attrition usually presents with flattened incisal and occlusal tooth surfaces which accurately inter-digitate. Erosion from dietary or gastric acids forms smooth lesions which typically appear as cupped occlusal/incisal and concave buccal/facial surfaces. When combined with attrition or abrasion, acids have the potential to cause significant wear. Wear reduces the thickness of enamel exposing the underlying dentine and changing the colour from the white of enamel to yellow of dentine. Acids causing erosion originate from the stomach or from the diet. Gastric acid is associated with reflux disease and eating disorders. The frequency of acidic foods and drinks and how they are consumed is important in dietary erosion. The progression of tooth wear is recognised to be slow with periods of activity and inactivity. Although restorations can be indicated, prevention and monitoring remain important strategies in maintaining the life of the teeth.

Dental erosion in 12-year-old schoolchildren: a cross-sectional study in Southern Brazil

OBJECTIVE

The aim of this study was to assess the prevalence and severity of dental erosion among 12-year-old schoolchildren in Joaçaba, southern Brazil, and to compare prevalence between boys and girls, and between public and private school students.

METHODS

A cross-sectional study was carried out involving all of the municipality's 499, 12-year-old schoolchildren. The dental erosion index proposed by O'Sullivan was used for the four maxillary incisors. Data analysis included descriptive statistics, location, distribution, and extension of affected area and severity of dental erosion.

RESULTS

The prevalence of dental erosion was 13.0% (95% confidence interval = 9.0-17.0). There was no statistically significant difference in prevalence between boys and girls, but prevalence was higher in private schools (21.1%) than in public schools (9.7%) (P < 0.001). Labial surfaces were less often affected than palatal surfaces. Enamel loss was the most prevalent type of dental erosion (4.86 of 100 incisors). Sixty-three per cent of affected teeth showed more than a half of their surface affected.

CONCLUSION

The prevalence of dental erosion in 12-year-old schoolchildren living in a small city in southern Brazil appears to be lower than that seen in most of epidemiological studies carried out in different parts of the world. Further longitudinal studies should be conducted in Brazil in order to measure the incidence of dental erosion and its impact on children's quality of life.