The prevalence of tooth wear in a cluster sample of adolescent schoolchildren and its relationship with potential explanatory factors

Dental erosion in a group of British 14-year-old, school children. Part I: Prevalence and influence of differing socioeconomic backgrounds

OBJECTIVES

To establish the prevalence of erosion in a cluster random sample of 14- year-olds in Birmingham UK. To determine whether socioeconomic group influences the prevalence of erosion.

METHODS

The study group consisted of a cluster random sample of 14-year-old school children in Birmingham UK: 418 children were examined from 12 different schools; 209 were male and 209 female. The level of tooth wear was recorded using a modification of the (TWI) index of Smith and Knight (1984). The ACORN classification was used to assess the socioeconomic status of all children.

RESULTS

Results showed that 48% of the children had low erosion, 51% had moderate erosion and only 1% had severe erosion. There were statistically significant differences between males and females; more males had buccal/labial and lingual/palatal tooth surface erosion than females (Chi-square analysis P < 0.001). There was also significantly more erosion observed in teenagers in the lowest socioeconomic categories.

CONCLUSION

It was concluded that moderate levels of dental erosion are common in 14-year-old school children and this may lead to increasing clinical problems. There was significantly more erosion in children from low socioeconomic groups. Possible aetiological factors need to be investigated further.

Oral pH and drinking habit during ingestion of a carbonated drink in a group of adolescents with dental erosion

OBJECTIVES

To investigate the relationship between dental erosion, oral pH and drinking habit in a group of adolescents.

METHODS

Oral pH was measured simultaneously at the surface of four teeth in 11 patients, aged 10-16 years, with erosion and in 10 controls subjects without erosion using antimony electrodes. Measurements were made before, during and after drinking 330 ml of a carbonated drink. The method and timing of drinking the beverage, reported dietary intake of acidic foods and flow rate and buffering capacity of saliva were recorded.

RESULTS

The erosion patients reported drinking more carbonated drinks (p<0.01) and drinking directly from a can more frequently than the controls (p<0.05). They also drank twice as quickly (p<0.05). The pH at the buccal surface of a molar remained lower for longer in the erosion patients than in the patients without erosion (p<0.01), whilst the labial surface of the upper central incisor had a longer exposure to low pH in the controls subjects (p<0.05).

CONCLUSION

The pattern of oral pH differed between subjects with and without erosion after drinking an acidic beverage. This may be related to observed differences in drinking habit, which could have influenced the pattern of erosion in these subjects.

Relative susceptibility of deciduous and permanent dental hard tissues to erosion by a low pH fruit drink in vitro

OBJECTIVES

The objectives of this study were two-fold: (1) to determine (by surfometry) loss of deciduous and permanent enamel and dentine following 15days' exposure to a single low pH orange drink; and (2) to determine (by surfometry) loss of deciduous and permanent enamel and dentine following exposure to the product 2 versus 4 times per day for 15days.

METHODS

This in vitro study employed the validated methodology described by West and co-workers [Journal of Dentistry, 1998;26:329-335.]

RESULTS

In all four tissues, erosion was progressive over time, though this pattern was more linear in enamel than in dentine. In general, erosion of enamel was greater in the deciduous tissue, while erosion of dentine was greater in the permanent tissue. However, these differences were rarely of statistical significance. Increasing frequency of exposure resulted in a non-proportional increase in tissue loss.

CONCLUSIONS

Differences in susceptibility of deciduous and permanent tissues to erosion by a low pH drink in vitro appear to exist, though these may not be of statistical significance. Care may be indicated in the delivery of dietary advice, since reduced frequency of exposure to a low pH drink does not appear to result in a proportional reduction in tissue loss.

Thickness of acquired salivary pellicle as a determinant of the sites of dental erosion

Dental erosion shows a typical distribution pattern within the dental arches. Tooth protection from erosion by salivary pellicle has been shown in vitro, but the hypothesis that pellicle may differ quantitatively at sites of erosion has not been investigated. This study aimed to determine the thickness of acquired salivary pellicle within the dental arches, investigate the possible relationship of this thickness to the distribution and severity of erosion within the arches, and confirm the protective effect of pellicle against dental erosion. Eight enamel blocks were produced from each of 5 bovine incisors assigned to five volunteers. Each block was further cut into 2 slabs, producing control and experimental slabs. Pellicle developed on experimental slabs located on 8 intra-oral sites after 1 hr of exposure was stained by "sheep anti-human IgGAM-FITC". Slabs were then visualized, and pellicle thickness measured, by confocal laser scanning microscopy. Eroded enamel lesions were produced in experimental and control slabs by means of pure orange juice. The degree of erosion was quantified by transverse microradiography. Pellicle thickness varied significantly within the dental arches and among individuals. An inverse relationship (r = -0.96, p<0.001) was observed between the degree of erosion and pellicle thickness. Significant differences in erosion were observed between slabs with and those without pellicle. This study has shown that the thickness of acquired salivary pellicle varies within the dental arches, which may be responsible for the site-specificity of dental erosion, and that pellicle does protect the teeth from erosion.

Dental erosion--the problem and some practical solutions

There has been a clinical impression among dental practitioners, particularly those working with children, that the problem of dental erosion is increasing. Is this really the case or are we more aware of the problem? What is causing this increase, if it really exists? Perhaps more importantly, what can we do about it? This article looks at the prevalence, and aetiology of dental erosion, particularly in children, and makes some practical suggestions for possible control.