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

Dental needs in patients with Sjögren's disease compared to the general population: A cross-sectional study

OBJECTIVES

To describe the dental health status of patients with Sjögren's disease (SD), particularly as concerns care needs, coronal restoration quality, the prevalence of caries and wear lesions, relative to the general population from the RESTO DATA study.

MATERIALS AND METHODS

Thirty-eight patients with SD were recruited during specialist consultations at Brest University Hospital and Charles Foix Hospital in Paris between December 2020 and December 2021. A questionnaire was used to record data for dental risk factors. Dental health status was assessed with the DMF-T index, ICDAS score, and the BEWE coding system, and oral health-related quality of life was assessed with the OHIP-14. The Xerostomia Inventory was used to evaluate xerostomia symptoms. Unstimulated and stimulated salivary flows were measured, together with saliva pH and buffering capacity.

RESULTS

The SD patients had more visible heavy dental plaque on teeth, a high prevalence of non-cavitated carious lesions, a large number of restored teeth, a high prevalence of cervical lesions, secondary caries, restoration failure, and a high percentage of wear lesions, despite regular attendance and correct eating habits. In the SD population, the characteristics of carious and wear lesions and the status of restorations were influenced by salivary flows. The SD population had a significantly poorer oral quality of life.

CONCLUSIONS

These results confirm that SD is associated with oral health issues, with increases in the risks of carious lesions, wear lesions, and restoration failures. These findings could serve as early warning signs for oral healthcare professionals in the context of Sjögren's disease diagnosis.

Predisposing Factors for Erosive Tooth Wear in Permanent Teeth Among Asthmatic Children and Adolescents

OBJECTIVES

Epidemiological studies indicate that erosive tooth wear (ETW) is a common threat of tooth surface loss. The etiology of ETW is multifactorial. The prevalence of asthma is increasing in developed countries, especially in children. Studies evaluating ETW in asthmatic children are conflicting. With our study, we aimed to investigate the association between general and asthmatic factors and the presence of ETW.

METHODS

Population of this cross-sectional observational study consisted of children aged 6-17 years under treatment for asthma at University Medical Centre. ETW was determined using the Basic Erosive Wear Examination index. Questionnaires completed by parents and data from patients' medical records provided information on demographics, medical history, medication use, dietary habits, oral hygiene, fluoride exposure and type, dose, frequency, duration, and mode of asthma medication use.

RESULTS

379 asthmatic children participated in the study. The prevalence of ETW was 17.2% (n = 379). The mean total BEWE score was 0.76 ± 2.12. A statistically significant higher presence of ETW and higher total BEWE index were found in the group consuming acidic sports drinks (OR = 3.318), in the group aged 12-17 years (OR = 6.233), in the group using asthma medication for more than 3 years (OR = 3.379) and in the group using medication in the dry powder inhaled form (OR = 2.447).

CONCLUSIONS

Asthmatic children should avoid drinking acidic drinks since longer duration of asthma medication use is already associating them with higher ETW presence. From the ETW point of view, metered-dose inhaled medications are more tooth-friendly than dry powder inhaled forms.

Remineralizing Treatments for Dental Erosion and Sensitivity in Patients Suffering from Gastroesophageal Reflux Disease (GERD): Randomized Clinical Trial

Background: Gastroesophageal reflux disease (GERD) is a chronic condition that causes an abrupt decrease in salivary pH in the oral cavity, which can lead to demineralization, erosion, hypersensitivity, functional impairment, and possibly fracture of dental elements. The aim of this clinical study is to compare two types of treatment in patients with dental erosion diagnosed with gastroesophageal reflux. Methods: Thirty patients were enrolled in this randomized clinical trial. Each patient underwent clinical evaluation and esophageal pH measurement, in order to diagnose GERD. After an initial examination and assessment by an experienced dentist, the Trial group (15 patients) was assigned to home treatment with a zinc hydroxyapatite-based toothpaste and a hydroxyapatite-based paste, while the Control group (15 patients) was assigned to home treatment with zinc hydroxyapatite-based toothpaste only. The following indices were measured: Basic Erosive Wear Examination Index (BEWE); Schiff Air Index (SAI); Plaque Index (PI); and Bleeding Score (BS). Each index was assessed at T0 during the first visit, one month (T1), three months (T2), six months (T3), nine months (T4), and 12 months (T5). The Kolmogorov-Smirnov test was used to analyze the normality of the data, while Friedman's test followed by Dunn's post hoc test were used to compare the two groups (significance threshold: p < 0.05). Results: The results showed no statistically significant change in the BEWE and SAI indexes (p > 0.05). However, an improvement in dentin sensitivity and BS was observed. Plaque control also improved. Conclusions: The results of this study indicate that the additional hydroxyapatite paste did not significantly improve the outcomes of the study in respect to hydroxyapatite toothpaste alone. However, there was an improvement in the oral health of GERD patients using hydroxyapatite-based remineralizing treatment in terms of oral and periodontal indices calculated.

Comparative effectiveness of injecting botulinum toxin type A in the masseter muscle with or without injection in the lateral pterygoid muscle in patients with bruxism: A randomized controlled trial

INTRODUCTION

Bruxism is a common problem defined by the involuntary grinding or clenching of teeth. This study aimed to compare the treatment outcomes of Botulinum toxin type A (BTX/A) injections into the masseter and lateral pterygoid muscles with injections into the masseter muscle only in patients with bruxism.

MATERIALS AND METHODS

Thirty patients with bruxism aged 18-45 years were randomly divided into two groups. Group 1: Bilateral BTX/A injections in the masseter and lateral pterygoid muscle. Group 2: bilateral BTX/A injections in the masseter muscle only. Electromyography (EMG) of the muscles was measured before treatment (t0) and two weeks after treatment (t1). The bruxism questionnaire has four close-ended questions. Patients' answers were recorded five times: t0, t1, six weeks after (t2), three months after (t3), and six months after (t4).

RESULTS

Regarding the bruxism questionnaire scores, group 1 was not superior to group 2 (p > 0.05), and there was an improvement over time (p < 0.05). Both groups were equally effective in improving the EMG scores in the masseter muscle (p > 0.05). However, group 1 outperformed group 2 in improving the lateral pterygoid muscle EMG scores (p < 0.05). indicating that injection of BTX/A in the lateral pterygoid muscle could benefit patients with bruxism.

DISCUSSION

The bruxism scores were notably decreased when BTX/A was administered to the masseter muscle alone or in conjunction with the lateral pterygoid muscle. It suggests hyperactivity in the lateral pterygoid muscle may occur when the BTX/A is solely injected into the masseter muscle.

Oral Health in Individuals After Bariatric Surgery: A Systematic Scoping Review

This scoping review appraises the available literature that investigates oral health after bariatric surgery (BS). Forty-two records were included (33 original studies and 9 systematic reviews). Bariatric surgery had a negative impact on the oral health related quality of life (three out of six studies). Relatively few studies found improvement following BS, probing pocket depth (2/10), clinical attachment level (1/9), bleeding on probing (3/10) and plaque (3/8). Conversely, BS was negatively associated with the DMFT (4/6), tooth wear (4/6) and oral radiographic findings (1/1). There was conflicting evidence regarding salivary parameters. To conclude, the literature on oral health in bariatric surgery patients is continuously growing. Positive as well as negative associations between oral health parameters and bariatric surgery are observed.

Disadvantage starts early: academy football has high levels of oral disease

ABSTRACT

Objectives

We have previously reported high levels of oral disease in professional senior team footballers in England and Wales. In this study, we aimed to determine the prevalence of oral disease in professional academy footballers, to identify if problems start earlier and to inform health promotion strategies.

Method

Professional academy football clubs in England (footballers aged 16-18 years) were invited to participate. Questionnaires were used to collect oral health behaviours and self-reported impacts and validated clinical outcomes to assess oral health.

Results

160 academy footballers were recruited from 10 English academy football clubs, of whom 86.8% (n=139) were men and 13.2% (n=21) were women, with a median age of 16.9 years. We identified high levels of oral disease: 31.2% (n=50) had dental caries requiring treatment; 76.8% (n=123) had gingivitis; and 22.5% (n=36) had periodontitis. Tooth wear affecting up to at least 50% of tooth structure was present in 15.5% (n=25) of participants. While 76.2% (n=122) self-reported brushing their teeth twice a day, 15.5% (n=25) brushed once or less a day and 21% (n=34) had not attended the dentist for >2 years. There was a general perception that oral health issues impacted the sporting performance of participants.

Conclusion

In this study, the prevalence of oral diseases among professional academy footballers in England was high and greater than found in national surveys of a similar age demographic. Urgent action is needed to embed oral health promotion in development and youth football, to reverse and prevent the disadvantages that will have lifelong consequences for treatment burden, quality of life and sporting performance.

The One-step No-prep technique for non-invasive full-mouth rehabilitation of worn dentition using PICN CAD-CAM restorations: Up to 9-year results from a prospective and retrospective clinical study

OBJECTIVES

To report up to 9-year results of a prospective and retrospective study on non-invasive full-mouth rehabilitation of worn dentition with PICN CAD-CAM restorations using the One-Step No-Prep technique. The secondary objective is to evaluate the influence of restoration thickness on fracture of restorations.

METHODS

A total of 580 Vita Enamic restorations (218 anterior and 362 posterior; 260 monoblock (MO) and 320 multiColor (MC)) in 24 patients were clinically evaluated once a year (up 9 months to 9 years) according to FDI criteria. Patient data and prosthetic parameters were registered. The minimum thickness of restorations was measured in 15 patients.

RESULTS

The Kaplan-Meier survival rate of restorations at 9 years was 98.4 % (100 % for anterior and 96.7 % for posterior) and the success rate was 79.7 %, while the success rate excluding minor chipping requiring only polishing as failure was 86.7 %. Actually, minor chipping was the leading cause of failure and significantly more fractures were observed in the posterior region (9.2 times higher risk), particularly in the first and second molars or when the restoration thickness was less than 0.56 mm. Except for fracture, FDI evaluation showed clinically acceptable results for all restorations, mostly rated as excellent. Results remained consistent over time, including material luster and color, with no staining. MC showed superior esthetics compared to MO. Patient satisfaction was high.

SIGNIFICANCE

The One-Step No-Prep technique exhibits successful long-term outcomes, and PICN (hybrid ceramic) is an appropriate material for this non-invasive treatment of tooth wear. Nevertheless, the minimum thickness of posterior restorations should be 0.6 mm, particularly at occlusal contact points. MultiColor blocks are recommended for esthetics.

Dental Caries and Erosive Tooth Wear Among 12-Year-Old Hong Kong Children

OBJECTIVE

This study is to investigate the dental caries, erosive tooth wear status, and oral health-related habits of 12-year-old Hong Kong children.

METHODS

This cross-sectional survey recruited 12-year-old children using clustered random sampling from three main districts. The trained examiner examined the children's caries status using the criteria recommended by the World Health Organization and recorded their caries experience using the decayed, missing, and filled tooth (DMFT) index. The children's tooth wear status was determined using the Basic Erosive Wear Examination (BEWE) index. Their oral hygiene practice was collected using a self-administered questionnaire.

RESULTS

We recruited 445 children and 396 children participated (response rate: 89%). Their mean DMFT was 0.29 ± 0.73. Seventy children (18%, 70/396) had caries experience (DMFT > 0) and they had 116 teeth suffered from caries. Among these 116 carious teeth, 75 teeth (65%, 75/116) were filled (FT), one tooth (1%, 1/116) was extracted (MT), and 40 teeth (34%, 40/116) were carious (DT). Five children had more than one decayed tooth (DT > 1), and one child had the highest number of decayed teeth (DT) at 4. BEWE results showed 284 (72%, 284/396) children had no erosive tooth wear (BEWE = 0). No child had severe erosive tooth wear (BEWE = 3). However, children consuming lemon tea or lemonade and vitamin C drinks 3 times a week or more showed significantly higher BEWE scores. Additionally, 380 (96%, 380/396) children brushed their teeth daily and 116 children (29%, 116/396) flossed their teeth.

CONCLUSION

Most 12-year-old Hong Kong children had neither caries experience nor tooth wear, and their oral health-related habits were satisfactory.

SIGNIFICANCE

This study updated the caries status of the permanent dentition of 12-year-old Hong Kong children. The information offers updated oral health data for the local, regional, and global authorities for planning effective public health programmes to improve the oral health of children.

Tooth Wear and Salivary Factors: Insights from a Cohort of Dental Students

Background/Objectives: Tooth wear is a progressive and multifactorial condition influenced by mechanical and chemical factors. Saliva plays a crucial role in modulating erosive wear through its buffering capacity and remineralization potential. This study aimed to assess the prevalence and severity of erosive tooth wear among dental students and explore its correlation with salivary factors such as flow rate and pH. Methods: A cross-sectional study was conducted on 96 individuals from the Egas Moniz School of Health & Science. Erosive wear was evaluated using the Basic Erosive Wear Examination (BEWE) index. Unstimulated and stimulated saliva samples were collected to measure salivary flow rate and pH. Statistical analyses included Spearman's correlation and multinomial logistic regression. Results: All individuals were classified as no risk (BEWE Score 0-2) or low risk (BEWE Score 3-8). The most affected teeth were the lower first molars and the 4th and 6th sextants. Salivary analysis showed a mean unstimulated flow rate of 0.5 mL/min and stimulated flow of 1.7 mL/min. A significant negative correlation (rho = -0.224, p = 0.029) was found between stimulated salivary pH and BEWE score, indicating that higher acidity contributes to greater erosive wear. Conclusions: This study highlights the impact of salivary properties on erosive tooth wear, emphasizing the protective role of higher salivary pH. Regular monitoring of saliva and preventive strategies should be integrated into early diagnosis and management of erosive wear in young adults.

Digital Approach Provides Predictability in Increasing the VDO in Erosive Wear: Clinical Technique and 9-Year Follow-Up

OBJECTIVE

This clinical case describes a digital workflow using face scans and CAD/CAM technology for a full-mouth rehabilitation with increased vertical dimension of occlusion (VDO) with adhesive lithium disilicate restorations after 9 years.

CLINICAL CONSIDERATIONS

A healthy, 46-year-old man displaying severe tooth wear, underwent an extensive full-mouth rehabilitation involving an increase of the VDO through laminate veneers and adhesive partial coverage lithium disilicate restorations. Anatomical landmarks of the face and reference planes were captured using a digital face scanning system. The anatomical position of the maxilla was registered with a transfer device. Digital data sets of the intraoral situation combined with a facial scan enabled precise virtual planning, guiding minimally invasive preparations. Long-term provisional restorations, milled from high-performance polycarbonate, were used to test the novel VDO before the final lithium disilicate restorations were fabricated. This approach provided a time- and cost-efficient treatment solution. No failures were observed at the 9-year follow-up.

CONCLUSIONS

Utilizing face scans and design software enable a virtual visualization and comprehensive quality control for patients with dental wear, resulting in significant time savings and increased predictability for the dental technician, dentist and patient.

CLINICAL SIGNIFICANCE

The described digital workflow optimizes the planning and implementation of a comprehensive adhesive full-arch rehabilitation with an increase of the VDO. The clinical long-term follow up result of CAD/CAM assisted minimally invasive lithium disilicate restorations after 9 years demonstrates to clinicians a reliable treatment concept for patients with dental wear.

Indirect Restorations for Increasing the Vertical Dimension of Occlusion

OBJECTIVE

This article presents a clinical case of erosive tooth wear, in which the vertical dimension of occlusion (VDO) has been restored using defect oriented posterior onlays and anterior veneers respecting minimal invasive treatment approaches.

CLINICAL CONSIDERATION

A 44-year-old female with the history of bulimia nervosa and bruxism expressed the desire to improve the aesthetic appearance and reestablishment of function of her worn dentition. After a 3-month functional therapy to ease myofunctional problems using a Michigan splint, a diagnostic phase revealed the necessity for a full mouth prosthetic rehabilitation. A slight increase of the VDO of 1 mm at the incisal point was determined. Veneered lithium disilicate ceramic restorations of 0.3-0.5 mm in thickness were produced for the incisors and monolithic lithium disilicate restorations of 0.8-1.0 mm in thickness for posterior teeth.

CONCLUSIONS

Functional and aesthetic prosthodontic rehabilitation of severely worn teeth can be achieved satisfactory with minimal invasive procedures using defect oriented, indirect lithium disilicate ceramic restorations with increasing the VDO to its original state.

CLINICAL SIGNIFICANCE

Indirect, minimal invasive lithium disilicate ceramic restorations are suitable to restore the VDO of severe dental erosions.

Oral Health and Oral Health-Related Quality of Life in Professional Soccer Players in Southern Italy: A Cross-Sectional Study

OBJECTIVES

To evaluate the oral health of professional footballers and to investigate possible determinants of oral health as well as the self-reported impacts on well-being, quality of life (QoL), and performance.

METHODS

This cross-sectional study was carried out on professional soccer players of the Calabria region, Italy. The outcome measures were the following: DMFT (decayed, missing and filled permanent teeth), DMFS (decayed, missing and filled permanent teeth surfaces), BEWE (basic erosive wear examination), CPI (community periodontal index), CPITN (community periodontal index of treatment needs), Oral Health Impact Profile-14 (OHIP-14).

RESULTS

One hundred and sixty footballers were recruited from seven clubs. The median age of the players was 25 years (19-39) years. The mean DMFT was 2.8 ± 2.9, and the multiple logistic regression analyses showed a positive association with frequent intake of drinks rich in sugar (OR = 3.69, 95% CI = 1.59-8.56) and sports drinks (OR = 3.73, 95% CI = 1.09-12.75). Dental erosions were present in 48.1% of footballers and periodontal diseases in 50%, with a positive association with frequent intake of energy drinks (OR = 2.86, 95% CI = 1.09-7.51). The OHIP-14 showed that 30.6% of participants reported having had pain in their teeth/mouth/dentures occasionally.

CONCLUSIONS

Results from the present study showed that the oral health of professional soccer players in Southern Italy was poor, especially regarding caries, erosion, and periodontal diseases. Moreover, OHIP-14 showed an impact on oral health in soccer players' QoL, revealing that poor oral health negatively affected professional well-being and performance. Results suggest the need for prevention interventions for professional athletes.

Sports dentistry intricacies with season-related challenges and the role of athlete-centered outcomes

Sports dentistry is an emerging field focusing on the prevention, treatment, and management of oral health issues in athletes. This review critically examines the current state of sports dentistry, emphasizing the integration of oral health care into athletes' overall health management. The high prevalence of dental caries, erosion, and periodontal problems among athletes is linked to diet, habits, and increased risk of orofacial injuries. Routine oral health evaluations, particularly during the preseason, are recommended to tailor prevention strategies and address potential issues early on. The recently proposed Universal Screening Protocol for Dental Examinations in Sports is discussed, noting its potential limitations in terms of time and complexity. The review explores the challenges posed by athletes' demanding training and competition schedules, stressing the importance of incorporating oral health care into the medical team. Future research should investigate the feasibility and validity of self-reported questionnaires for screening oral health conditions, potentially simplifying the process for athletes. The review highlights the use of athlete-reported outcomes and self-reporting in sports dentistry as crucial for evaluating dental care effectiveness and monitoring long-term health outcomes. It concludes by emphasizing the need for streamlined, universally applicable protocols that fit athletes' schedules while providing comprehensive care, and the importance of further research to explore innovative screening tools and self-reported measures to transform routine care practices and reduce barriers to dental health for athletes.

Reliability of the Assessment of Tooth Wear Severity on Dental Hard Tissues and Dental Restorations, Using the TWES 2.0, by Nonexperts

BACKGROUND

Tooth wear is a multifactorial process resulting in the loss of dental hard tissues. For its assessment, the tooth wear evaluation system (TWES) 2.0 has been published. Previous studies on the TWES involved well-trained practitioners, rather than nonexperts.

OBJECTIVE

The first aim of this study was to investigate the reliability of the assessment of tooth wear severity on dental hard tissues, using the TWES 2.0, by nonexperts. The second aim was to investigate the reliability of assessment of wear severity on dental restorations, using a third scale.

METHODS

Forty-seven dental students evaluated at least 9 of 14 possible patient cases on dental casts and intraoral photographs. Cohen's kappa (agreement with sample solution) and Fleiss' kappa (Inter-rater reliability) were calculated.

RESULTS

The agreements of the operators' ratings compared to the sample-solution resulted in Cohen's kappa between 0.02 and 0.9. The agreements were 0.34 for occlusal; 0.43 for vestibular; 0.57 for oral surfaces. Inter-rater reliability (Fleiss' kappa) was 0.35 for occlusal, 0.17 for vestibular and 0.24 for oral assessment. The inter-rater reliability of the ratings on tooth surfaces with restorations was lower with 0.21 (occlusal), 0.14 (vestibular) and 0.39 (oral). The agreement on different restorations differed tremendously.

CONCLUSIONS

The ability to correctly assess the cases varied considerably between individual examiners. Within the limits of this study, assessment of restorations was slightly more challenging compared to natural teeth, particularly in occlusal regions or when the restorative material is gold. Subsequent studies should address whether enhanced training and improved definition of tooth wear grades result in higher reliability scores.

Qualitative and quantitative assessment of tooth wear in young individuals

OBJECTIVES

To assess the degree of tooth wear in children and adolescents by application of a qualitative wear index and by quantitative measurement on digital models. The hypothesis was that the quantitative method would be sensitive to reliably measure tooth wear.

METHODS

Existing digital models (n = 24) gathered from a prospective clinical study were analysed. The models were obtained at two time points (11-17 months apart) from a cohort of young individuals (11-16 years old) with permanent dentition. Dental wear was scored per sextant on the models according to the qualitative criteria by two examiners and was then quantified on reference teeth (central incisors, canines and first molars). Data were analysed using Cohen's kappa coefficient, Kruskal-Wallis tests followed by Mann-Whitney U, and correlation tests, all with a significance level of 0.05.

RESULTS

According to the qualitative assessment, all subjects showed signs of tooth wear and the severity of scores was higher in the anterior dentition (P ≤ 0.003). Inter-examiner reliability was 0.652 (P < 0.001) while intra-examiner reliability was 0.618 and 0.571 (P < 0.001), respectively. The quantitative analysis showed median tooth wear of 0.09 mm (range: 0 - 0.56 mm). There was no significant correlation between the quantitative measurements of tooth wear and age, sex assigned at birth, time span between scans, or sum of index scores.

CONCLUSIONS

The quantitative method was sufficiently sensitive to reliably measure tooth wear on digital models in ≥ 92 % of the investigated teeth. The use of the qualitative wear index on digital models proved dubious due to moderate intra- and inter-reliability ratings.

CLINICAL SIGNIFICANCE

Our results show increased prevalence and severity of tooth wear in children and adolescents, which raise concern about the current lifestyle habits in our society. Intraoral scanning can be used to quantify tooth wear at an early stage and thus help design individual strategies to prevent further tooth loss.

Dental Caries, Tooth Erosion and Nutritional Habits in a Cohort of Athletes: A Cross-Sectional Study

BACKGROUND/OBJECTIVES

this study aimed to study the association of dental caries and erosion in athletes with dietary and oral health habits.

METHODS

An observational cross-sectional study was conducted at the Sports Dentistry department of a university clinic. Intraoral examination included the International Caries Detection and Assessment System (ICDAS II) index and the Basic Erosive Wear Examination (BEWE). A questionnaire was completed with sociodemographic data, and dietary and oral hygiene habits. An inferential and multivariable regression analysis was performed to study the association of dental caries and erosion with confounding variables.

RESULTS

A total of 80 athletes were included. The prevalence of dental caries and erosion was 50.0% and 40%, respectively. Significant associations were observed between self-perceived oral health and caries lesions, with "Good" (-5.01, p < 0.001) and "Very good" (-5.46, p < 0.001) perceptions linked to fewer lesions. BEWE scores revealed significant associations with meal frequency uncertainty (-12.56, p = 0.014) and uncertainty about the last dental visit (8.82, p = 0.014). Self-perceived oral health as "Good" or "Very good" was associated with lower dental erosion (p < 0.010). Other demographic and behavioral factors were not significantly associated with caries or erosion.

CONCLUSIONS

this cohort of athletes exhibited a high prevalence of dental caries and erosion, with associated dietary and oral hygiene habits. These results highlight the need for targeted dietary counseling and oral health education for athletes, whose nutritional needs may lead to increased consumption of sugar-rich diets.

Dental Caries, Erosive Tooth Wear, and Periodontal Status of Military Student Pilots in Finland: A Comparative Cross-Sectional Study

INTRODUCTION

Oral health is a crucial factor for service safety among military pilots, but studies specifically on pilots are still very few in Finland. The aim of this study was to assess the oral health status of military student pilots compared to other conscripts of the same age group.

MATERIALS AND METHODS

The data were collected during the oral health examinations of the annual class of the Pilot Reserve Officer Course students at the beginning of their duty at the Air Force Academy (N = 38). A voluntary random sample of conscripts' oral health data (N = 574) collected from the 8 largest garrisons was used as a peer group. The study included males born between 2000 and 2002. The examinations were conducted in accordance with the WHO guidelines. Values of decayed (DT), missing, and filled teeth as well as the combined decayed, missing, and filled teeth value were recorded along with Basic Erosive Wear Examination scoring and Community Periodontal Index. The study was designed in accordance with the STROBE guidelines.

RESULTS

The proportion of student pilots without any decayed teeth (DT = 0) was 42.1% with third molars and 44.7% without third molars. Among other conscripts, the proportions were 29.1% and 30.8%, respectively. Mean DT values among student pilots were 1.16 (third molars included) and 1.11 (third molars not included) (P = .543), and among other conscripts 1.10 and 1.00 (P = .429), respectively.The mean decayed, missing, and filled teeth values were 2.50 among student pilots and 3.34 among others (third molars included), and 2.18 and 3.10 (without third molars), respectively (P = .289 and .211).The proportion of student pilots with at least moderate erosive tooth wear (Basic Erosive Wear Examination sum > 2) was 68.4%, while for other conscripts it was 22.1% (P = .000). None of the student pilots fell into Community Periodontal Index class 3 or 4, whereas 9.9% of other conscripts did (P = .006).

CONCLUSIONS

The student pilots exhibited good overall oral health, which differed from that of other conscripts, mainly in terms of erosive changes. Continuous monitoring is crucial, as maintaining optimal oral health is vital for reducing the risk of barodontalgia and thus improving flight safety. Therefore, it is important to be aware that those who aspire to be military pilots are at an increased risk of erosive changes to their teeth.

Non-Instrumental and Instrumental Tools Validity in Bruxism Diagnostics

Background/Objectives: The study aimed to validate the diagnostic system proposed by the Standardized Tool for the Assessment of Bruxism (STAB) by correlating the results obtained based on questionnaire and non-instrumental and instrumental tools. Methods: The study had three stages (questionnaire, clinical examination, and electromyographic study). The subjects completed a questionnaire and clinical exam. Positive signs of bruxism included oral mucosal signs and the presence of dental wear according to the BEWE index. In stage three, sEMG was performed after allocating subjects into four groups according to the questionnaire and clinical exam results: sleep bruxism (SB), awake bruxism (AB), sleep and awake bruxism (SB AB), and no bruxism (no B). After the third stage, a new selection was made, and the subjects were divided into four groups, according to sEMG results. Diagnostic accuracy was computed for possible bruxism SB and grinding and clenching sound diagnosis, possible bruxism AB and AB acknowledgment, possible bruxism SB AB, and tooth wear index. Results: For SB, the sensitivity and specificity of the tools were the highest. The non-instrumental questionnaire and clinical assessment identified 67% of SB cases and 89% without SB. For AB, the specificity was higher (84%), while the sensitivity was lower (55%), as almost half of the subjects were not aware of the presence of AB. The tests showed a low sensitivity (15%) but a high specificity (83%) for tooth wear. The absence of tooth wear was frequently associated with the absence of bruxism, while the presence of tooth wear did not necessarily imply the existence of bruxism. Conclusions: Non-instrumental evaluation of bruxism through questionnaires and clinical exams is valuable, especially for SB. Instrumental evaluation through electromyography remains a gold standard for bruxism diagnosis.

Association of socio-demographic characteristics, comorbidities, lifestyle habits, and saliva parameters with dental caries in adults with obesity

OBJECTIVE

To describe the oral health status of patients with obesity and to explore the socio-demographic characteristics, comorbidities, lifestyle habits (tobacco, alcohol, sweet/acidic diet), and saliva parameters most associated with the dental caries experience.  Material and methods: We conducted a cross-sectional analysis of 204 patients' data with obesity attending a therapeutic education programme. Caries experience (number of decayed, missing, and filled teeth [DMFT]), periodontal status, oral hygiene, occlusal tooth wear, masticatory inefficiency, and saliva parameters were recorded.

RESULTS

Mean DMFT was 12 ± 7 and was independently associated with age (mean 47 ± 14 years; for 1 standard deviation (SD) increase: β = 0.22, 95% confidence interval [CI] = 0.16-0.29), female sex (72%; β = 3.76, 95% CI = 1.65-5.87), brushing <2 times/day (35%; β = 2.86, 95% CI = 0.81-4.90), salivary buffering capacity (low [46%] vs. normal [40%]: β = 2.02, 95% CI = 0.08-3.95; very low [10%] vs. normal: β = 3.34, 95% CI = 0.31-6.37), and salivary consistency (bubbly [30%] vs. clear [57%]: β = 2.45, 95% CI = 0.52-4.38).

CONCLUSIONS

Improving patients' competencies for oral care, such as teeth brushing twice daily, is necessary to limit the burden of dental caries in individuals with obesity. Acting on salivary composition may also be of interest, and further studies are required to explore the underlying mechanisms.

Erosive tooth wear, dental decay, and periodontal health in obese and normal weight children and adolescents

AIM

This study aimed to compare the oral health status between normal weight (NW) and obese weight (OW) children/adolescents.

METHODS

Eighty-two participants aged 6-16 years were included in this cross-sectional study. The children/adolescents were classified according to the body mass index (BMI): NW (n = 41) and OW (n = 41). Caries experience was assessed by the International Caries Detection and Assessment System (ICDAS-II), decay, missing, filling teeth (dmft) for the primary teeth and (DMFT) for the permanent teeth, erosive tooth wear using Basic Erosive Wear Examination (BEWE), Plaque Index (PI) and Gingival Index (GI), probing depth (PD). Also, the relationship between procalcitonin (PCT), C-reactive protein (CRP), parathyroid hormone (PTH), and 25(OH)D blood biochemistry and oral health was evaluated in obese children/adolescents.

RESULTS

Evaluation was made of a sum of 82 children/adolescents, comprising 43 females and 39 males, with a median age of 14 years in the obese group and 13 years in the NW group. Significant differences were determined between patients with NW and those who were obese, particularly in BMI, family income level, and tooth brushing habits. The results of the study indicate that individuals with obesity tend to exhibit significantly higher scores for PI, and GI as compared to those with NW (p < .05) CONCLUSION: Oral hygiene in children with systemic diseases should be treated with a multidisciplinary approach and under regular control by a pediatrician and pediatric dentist, as it may also affect the medical health of the children/adolescents.

Establishment and evaluation of a deep learning-based tooth wear severity grading system using intraoral photographs

Background/purpose

Artificial intelligence (AI) can assist in medical diagnosis owing to its high accuracy and efficiency. This study aimed to develop a diagnostic system for automatically determining the degree of tooth wear (TW) using intraoral photographs with deep learning.

Materials and methods

The study included 388 intraoral photographs. A tooth segmentation model was first established using the Mask R-CNN architecture, which incorporated U-Net and SGE attention mechanisms. Subsequently, 2774 individual tooth images output from the segmentation model were included into the classification task, labeled and randomized into training, validation, and test sets with 6.0:2.0:2.0 ratio. A vision transformer model optimized using a mask mechanism was constructed for TW degree classification. The models were evaluated using the accuracy, precision, recall, and F1-score metrics. The time required for AI analysis was calculated.

Results

The accuracy of the tooth segmentation model was 0.95. The average accuracy, precision, recall, and F1-score in the classification task were 0.93, 0.91, 0.88, and 0.89, respectively. The F1-score differed in different grades (0.97 for grade 0, 0.90 for grade 1, 0.88 for grade 2, and 0.82 for grade 3). No significant difference was observed in the accuracy between different surfaces. The AI system reduced the time required to grade an individual tooth surface to 0.07 s, compared to the 2.67 s required by clinicians.

Conclusion

The developed system provides superior accuracy and efficiency in determining TW degree using intraoral photographs. It might assist clinicians in the decision-making for TW treatment and help patients perform self-assessments and disease follow-ups.

Sleep hygiene measures combined with mindfulness meditation in the management of sleep bruxism in children: A randomized controlled clinical trial

BACKGROUND

Sleep hygiene measures and meditation may reduce stress and improve sleep quality, but their effect on the occurrence of sleep bruxism in children has not yet been investigated.

AIM

To explore the effects of sleep hygiene measures combined with mindfulness meditation (relaxation audio) in the management of probable sleep bruxism (SB) in children.

DESIGN

This clinical trial (no. NCT04501237) randomized 36 children with 3-8 years of age. Probable SB detection was performed according to the criteria established by the International Consensus on The Assessment of Bruxism-2018. Intervention group was instructed to practice sleep hygiene measures and mindfulness meditation (i.e., the use of a digital app to broadcast audio relaxation) each night before bedtime for 5 weeks; control group did not receive guidance for therapies. Parents completed a bruxism diary for 5 weeks, and the outcome was the number of SB episodes-day reported in the week (ranging from 0 to 7) in each period. A multilevel mixed-effects Poisson regression model was performed.

RESULTS

A total of 32 children (mean age: 6.1 years) completed the study. The children who received the therapies related to sleep hygiene measures and mindfulness meditation had a reduction in the SB incidence rate ratio (IRR) of 46% (IRR = 0.54 [Confidence Interval 95%, 0.45-0.65]) during a 5-week observation period. The sensitivity analyses did not show relevant changes in the measure of the effect.

CONCLUSION

Sleep hygiene measures combined with mindfulness meditation reduced the SB in children.

Prevalence and risks of sleep bruxism in children and adolescents presenting for orthodontic treatment

OBJECTIVES

This study determined the prevalence and risks of definite sleep bruxism (SB) among children and adolescents presenting for orthodontic treatment.

METHODS

This was a cross-sectional study of 7-16-year-old subjects pursuing orthodontic treatment for the first time. The presence or absence of SB was determined using an overnight mandibular movement monitoring inertial measurement sensor, worn by each participant for two consecutive nights. Data from the sensor were extrapolated, then processed and analyzed to automatically identify rhythmic masticatory muscle activity for SB assessment. SB risks were evaluated from previously validated questionnaires, clinical examinations, lateral cephalometric radiographs, and digital study models.

RESULTS

A total of 87 subjects with a mean age of 12.82 years ± 2.24 and body mass index of 21.45 ± 5.49 participated in the study. The prevalence of SB was 60.7%. Multiple linear regression analysis revealed that SB had statistically significant association with microarousals (events/h) (β=0.31, 95% Confidence Interval [CI] 0.25-0.36, P < .001) and maxillary 6-6 dimension (mm) (β = 0.08, 95% CI 0.02-0.13, P = .008). A second model excluding microarousals showed that SB had a statistically significant association with sleep efficiency (SE) percentage (β = -0.15, 95% CI -0.28 to -0.01, P = .026) and obstructive respiratory disturbance index (ORDI) (events/h) (β = 0.33, 95% CI 0.15-0.51, P < .001).

CONCLUSIONS AND IMPLICATIONS

In a growing orthodontic population, definite SB is very common. SB is related to microarousals, maxillary intermolar width, SE percentage, and ORDI.

A Pilot Investigation Into the Use of Teledentistry and Artificial Intelligence to Assess Dental Erosion in Competitive Swimmers

OBJECTIVE

The aim of the study was to assess the prevalence of dental erosion in competitive swimmers using teledentistry and artificial intelligence.

MATERIALS AND METHODS

An opportunistic sample of 20 competitive swimmers was recruited. The participants reported that they carried out an average of 2.40 h of training per day, 4.45 days per week. Data gathering was carried out remotely. The subjects completed a digital questionnaire and uploaded three photos of their mouth. Intraoral photographs were analyzed using the "Intact-Tooth" application to assess dental erosion. A statistical analysis was carried out to verify a possible correlation between the collected data.

RESULTS

The average calculated Basic Erosive Wear Examination (BEWE) index was 13.95, and 11 subjects (55%) had a severe BEWE (≥ 14). More than 40% of the participants disagreed about having social issues related to tooth hypersensitivity. Considering only subjects with a severe total BEWE value, we have observed an indirect correlation between the degree of dental erosion and diet (Pearson coefficient r = -0.57), whereas a direct correlation was observed between dental erosion and age (r = 0.493) and between BEWE and weekly training hours (r = 0.217).

CONCLUSIONS

Because of their lifestyle, competitive swimmers can be considered at a higher risk of developing dental erosion. In this context, teledentistry and AI tools can be effectively used to intercept those at the highest risk and prevent the occurrence of conditions.

SUMMARY

Dental erosion assessment in competitive swimmers using teledentistry and AI.

Is There an Increase in Possible Sleep Bruxism in Children Over Time? A Longitudinal Study

BACKGROUND

Bruxism is a behaviour that has several consequences in an individual's life, especially when it starts in childhood. However, bruxism can be a potential protective factor, which is an attribute that reduces the chance of a negative health outcome.

OBJECTIVES

To evaluate the incidence of sleep bruxism (SB) and dental wear in children and adolescents.

MATERIALS AND METHODS

This longitudinal study began in 2014 and 2016 (baseline) with initial 1816 children followed for 5 and 3 years, respectively. The follow-up data collection started in 2019. The diagnosis of SB was parents report (baseline) and self-report (follow-up) due to age groups of each phase, and questions related to symptoms of SB were collected. Five calibrated examiners (kappa >0.7) collected the clinical data. The clinical variables were dental erosion and dental wear. Contextual, individual, behaviour and clinical characteristics were collected. A multilevel logistic regression model was used to investigate the association of contextual, individual, behaviour and clinical characteristics with SB. Poisson regression for repeated measures was performed to evaluate the incidence of SB and dental wear (incidence rate ratio-IRR and confidence interval-95% CI).

RESULTS

Two hundred and fifty-three children and adolescents answered questionnaires and were clinically examined. The mean age of the follow-up in 2019 was 11.25 years old (±2.19). There was no increase in the incidence of SB (95% CI: 0.74-1.35). Children/adolescents had a 2.2 higher risk to present dental wear (95% CI: 1.89-2.60). SB at the follow-up was associated with the contextual variable, earache, erosion and awake bruxism.

CONCLUSIONS

In this population, children with SB remained with this behaviour and showed higher dental wear over the years.

Prevalence of dentine hypersensitivity, erosive tooth wear, gingival recession and periodontal health in seven European countries

OBJECTIVES

To determine the prevalence and associated risk indicators for dentine hypersensitivity (DH), erosive tooth wear (ETW), gingival recession (GR), and gingival inflammation (bleeding on probing, BOP), with clinical and questionnaire data from seven European countries.

METHODS

A cross-sectional, observational, seven-European country, epidemiological study in systemically healthy adults. Participants completed a questionnaire regarding oral hygiene, diet and lifestyle factors. A clinical examination, by calibrated examiners, measured DH (Schiff; participant yes/no), ETW (basic erosive tooth wear examination, BEWE), GR (mm), and BOP (yes/no).

RESULTS

3551 participants completed the study, mean age 44 ± 17.4, 43.6 % male, 26.1 % rural dwellers. DH (Schiff ≥ 1) was seen in 75.9 % of participants, ETW (BEWE ≥ 1) in 97.6 %, GR (≥1 mm) in 87.9 %. 65.7 % participants had BOP ≥ 10 % sites, 34.3 % BOP<10 % with probing depths ≤3 mm. DH, ETW, GR and BOP increased markedly during young adult life. Thereafter, GR and ETW continued to increase, DH declined after around age 38-47, and BOP plateaued after age 48. DH was significantly associated with ETW (p < 0.001) and GR (p < 0.01); GR was significantly associated with BOP on lingual surfaces (p = 0.017). There were significant associations between increased full mouth BOP ≥ 10 % and reduced brushing duration and exercise frequency (p < 0.001); increased DH and heartburn (p < 0.001); decreased DH (p < 0.001), ETW (p < 0.001) and BOP ≥ 10 % (p = 0.002) with powered toothbrush use.

CONCLUSIONS

Prevalence of oral conditions assessed was high, greater than in the majority of the GR, DH and ETW literature. Periodontal health was seen in a third of sampled individuals. All these conditions varied markedly by country and age.

CLINICAL SIGNIFICANCE

Oral diseases and conditions were highly prevalent throughout the seven European countries investigated. For the majority, these conditions are eminently preventable and treatable by changing behaviours. Upstream policy changes are needed to address these health challenges, to raise awareness and to empower individuals with oral health education and support.

Oral health services in prison settings: A global scoping review of availability, accessibility, and model of delivery

This review aimed at evaluating the state of availability, accessibility and model of delivery of oral health services in prisons, globally. Five databases of peer-reviewed literature and potential sources of grey literature were systematically searched. Inclusion criteria encompassed oral health papers related to prisons globally, with exclusion of certain article types. Selection involved independent evaluations by two researchers, followed by quality assessment. Data on the availability of oral health interventions in prisons came from 18 countries, while information on the model of delivery of the services is scarce. In addition, two sets of individual and organizational barriers toward oral health service uptake in prisons were revealed and discussed in the text. Lack of oral health services in prisons affects people living in prisons and jeopardizes their reintegration. Urgent and concrete international actions are required to ensure the availability, accessibility, and quality of oral health services among people living in prisons.

Automated monitoring of tooth wear progression using AI on intraoral scans

OBJECTIVES

This study aimed to develop and evaluate a fully automated method for visualizing and measuring tooth wear progression using pairs of intraoral scans (IOSs) in comparison with a manual protocol.

METHODS

Eight patients with severe tooth wear progression were retrospectively included, with IOSs taken at baseline and 1-year, 3-year, and 5-year follow-ups. For alignment, the automated method segmented the arch into separate teeth in the IOSs. Tooth pair registration selected tooth surfaces that were likely unaffected by tooth wear and performed point set registration on the selected surfaces. Maximum tooth profile losses from baseline to each follow-up were determined based on signed distances using the manual 3D Wear Analysis (3DWA) protocol and the automated method. The automated method was evaluated against the 3DWA protocol by comparing tooth segmentations with the Dice-Sørensen coefficient (DSC) and intersection over union (IoU). The tooth profile loss measurements were compared with regression and Bland-Altman plots. Additionally, the relationship between the time interval and the measurement differences between the two methods was shown.

RESULTS

The automated method completed within two minutes. It was very effective for tooth instance segmentation (826 teeth, DSC = 0.947, IoU = 0.907), and a correlation of 0.932 was observed for agreement on tooth profile loss measurements (516 tooth pairs, mean difference = 0.021mm, 95% confidence interval = [-0.085, 0.138]). The variability in measurement differences increased for larger time intervals.

CONCLUSIONS

The proposed automated method for monitoring tooth wear progression was faster and not clinically significantly different in accuracy compared to a manual protocol for full-arch IOSs.

CLINICAL SIGNIFICANCE

General practitioners and patients can benefit from the visualization of tooth wear, allowing quantifiable and standardized decisions concerning therapy requirements of worn teeth. The proposed method for tooth wear monitoring decreased the time required to less than two minutes compared with the manual approach, which took at least two hours.

Bibliometric Analysis of Peer-Reviewed Literature on Erosive Tooth Wear From 1945 to 2023

Erosive tooth wear (ETW) is a prevalent oral condition with varying etiology, including erosion, abrasion, abfraction, and attrition. It is reported in the literature in different nomenclatures, hindering the ability to identify the emerging trends and influential scholarly works and bodies within this field. Using a bibliometric analysis approach, this study aims to evaluate the trends, themes, and productivity of the research on ETW condition while respecting its different terminologies. The Web of Science database was utilized to obtain the publication records on ETW to implement a retrospective bibliometric study. The data were retrieved on September 10, 2024, with the search terms "Dental erosion" OR "enamel erosion" OR "erosive tooth" OR "dental abrasion" OR "tooth abrasion" OR "toothbrush abrasion" OR "enamel abrasion" OR "non-carious cervical lesion" OR "non carious cervical lesion" OR "abfraction" OR "abfractions" OR "Tooth wear" OR "erosive tooth wear". We identified 6,069 records, and after applying inclusion/exclusion criteria, we removed 679, and the remaining 5,390 papers were considered for the analysis. The bibliometric indicators include types and accessibility modes, year of publications with citations, publishing sources, most contributing countries, institutions, authorship patterns, top authors, keywords, and the characteristics of the 15 most cited articles were examined. For the data analysis, Microsoft Excel (v.16; Microsoft® Corp., Redmond, WA), VOSviewer (v.1.6.10; https://www.vosviewer.com), and Statistical Product and Service Solutions (SPSS, v.27; IBM SPSS Statistics for Windows, Armonk, NY) software were utilized. The outcome illustrated that 5,390 papers on ETW were contributed by the authors of 127 countries and published in 1,112 journals between 1945 and 2023. The Journal of Dentistry published the most papers (n=290), while the European Journal of Oral Sciences had the most impactful papers (54.91 citations/paper). Authors from 3,904 institutions participated. The University of São Paulo became the most productive institution with 336 papers, while the University of Bristol's papers had the maximum citation impact (55.32 citations/paper). About 81.49% of the total authors had produced one paper each. The percentage of average authors for each paper was found to be 4.41, and David Bartlett was the most productive author. The most cited top 15 papers got an average of 297.26 citations per paper. About 77% of research on ETW was published in the last two decades. This bibliometric evaluation provides direction for future research and data regarding the present state of research on ETW.

Development and content validation of the Childhood Early Oral Aging Syndrome (CEOAS) index for the deciduous dentition: Research protocol

Premature, non-physiological tooth wear in childhood has numerous repercussions for oral health. This is a growing problem with multifactorial causes and associated with the current lifestyle. The introduction of new concepts and indices is crucial for enhancing the understanding and management of dental conditions. In this context, we present the Childhood Early Oral Aging Syndrome (CEOAS) and the associated index, which aim to assess early enamel wear in the primary dentition. Rather than focusing solely on isolated etiologies, the index proposes a comprehensive evaluation of signs and symptoms, considering various factors that contribute to the premature and non-physiological loss of dental structure, including wear of both intact and hypomineralized enamel. Indices that evaluate the main factors of early oral aging in childhood and their interactions are fundamental for understanding the condition and developing effective control and treatment strategies, particularly given that there is currently no global index encompassing this information. The aim of the present study was the development and determination of content validity of the Childhood Early Oral Aging Syndrome (CEOAS) index for the primary dentition as a diagnostic and epidemiological survey tool. Trial registration: ClinicalTrials.gov ID: NCT06378385.

Proteome of the 2-h in vivo Formed Acquired Enamel Pellicle of Adolescents with Erosive Tooth Wear, Caries, or Sound

INTRODUCTION

Acquired pellicle (AP) acts as a membrane preventing acids from coming into direct contact with the tooth. Possibly, individuals with different dental health status present changes in its composition that could disrupt this function. Thus, the aim of this study was to compare the protein composition of the AP in adolescents with erosive tooth wear (ETW), caries, or sound.

METHODS

Calibrated examiners in BEWE index and ICDAS-merged Epi criteria assessed ETW and caries in a sample of 454 systemically healthy adolescents aged 12-15 years old. Thirty subjects from that sample were selected for this study: ETW group (n = 10; total BEWE ≥9 and absence of dentinal caries lesions); caries group (n = 10; total BEWE <9 and with at least one dentinal caries lesion), and sound group (n = 10; total BEWE <9 and absence of dentinal caries lesions). Two-hour-formation AP samples were taken from buccal, occlusal/incisal, palatal/lingual tooth surfaces. Protein composition was analysed by liquid chromatography-tandem mass spectrometry. Using mean reporter ion values, relative abundances of proteins were compared among the three groups to calculate for fold changes. Twofold protein increases or decreases were reported (t test, p < 0.05). Gene Ontology (GO) of included proteins was assigned.

RESULTS

Mean age of participants was 13.1 ± 1.14 years and 56.6% were females. The prevalence of ETW was of 66.6% and of dentinal caries of 33.3%. The GO analyses showed that the majority of detected proteins were stress response related. The ETW group disclosed upregulated relative abundance of antileukoprotease (2.85-fold in ETW vs. sound and 2.34-fold in ETW group vs. caries group); histatin (2.42-fold in ETW group vs. sound group and 2.20-fold in ETW group vs. caries group), and prolactin-induced protein (2.30-fold in ETW group vs. sound group and 2.06-fold in ETW group vs. caries group) (p < 0.05). Hemoglobin subunits alpha (HBA) and beta (HBB) showed decreased relative abundances in the ETW and caries groups when compared to the sound group (HBA: 0.42-fold in ETW group and 0.40-fold in caries group; HBB: 0.45-fold in ETW group and 0.38-fold in caries group; p < 0.05).

CONCLUSION

AP from individuals with ETW showed differences when compared to other dental conditions, with relative abundance increasing of some stress response-associated proteins in ETW and a decrease in proteins related to salivary protection against acid challenges.

Minimally invasive prosthodontics using the concept of prosthetically guided orthodontics

OBJECTIVE

This case report aims to present how digital technology can be employed to plan the orthodontic movement of teeth into their final positions for prosthodontic rehabilitation. An interdisciplinary approach to treatment planning and the result of prosthodontic treatment involves the cooperation of an orthodontist and a prosthodontist. When planned to achieve optimal results for a minimally invasive and functional prosthodontic treatment, orthodontic pretreatment provides superior esthetic results and favorable long-term success.

CLINICAL CONSIDERATIONS

The orthodontic movements of the teeth were planned so that the prosthodontist could reconstruct an optimally functional and esthetic occlusion while preserving the hard dental tissues. The orthodontic pretreatment minimized the need to prepare the teeth, avoiding any mucogingival surgery to improve the gingival architecture.

CONCLUSIONS

In complex clinical cases, it is essential to evaluate the advantages of an orthodontic pretreatment before starting a prosthodontic treatment. This pretreatment can help preserve dental tissues, reduce or eliminate the need for surgical intervention, and achieve long-term stability and esthetic results.

CLINICAL SIGNIFICANCE

This case clearly shows the benefits of orthodontic pretreatment for prosthodontic outcomes. With modern digital tools, such an orthodontic pretreatment should become standard clinical practice when planning a complex clinical case.

Dental Erosion in Competitive Swimmers and Preventive Treatments: An In Vitro Study

The aim of this in vitro study was to evaluate the effectiveness of highly concentrated fluoride products and remineralizing products (F-APC) in preventing erosive dental lesions in competitive swimming patients. A total of 48 teeth were extracted, preserved in saline solution and divided into three groups. In G1 (control group), each tooth was half-immersed in chlorinated pool water; in G2 (fluoride-treated group), after being totally immersed in chlorinated water, each tooth had half of its surface treated with a highly concentrated fluoride product once a week; in G3 (remineralization product-treated group), each tooth was totally immersed in chlorinated water and half of its surface was treated with a remineralizing product after each immersion. The study was conducted over a 4-week period, immersing the teeth for 4 h per day. In G1, statistically significant differences were observed in submerged versus non-submerged tooth surfaces at week 3 (T3) (p = 0.019) and week 4 (T4) (p = 0.0007), with four and eight surfaces showing erosive tooth wear (ETW), respectively. In G2, a difference was observed between fluoride-treated and non-fluoride-treated surfaces at T4 (p = 0.039), with three surfaces with ETW among the non-treated ones. In G3, the difference was observed between portions treated with F-APC and those not treated at T4 (p = 0.019), with four surfaces with ETW among the untreated ones. Chlorinated pool water is a potential erosive agent for teeth if water pH values reach a critical value. Treating the teeth surface with highly concentrated fluoride products, once a week for 5 min, and F-APC are effective in protecting teeth against tooth erosion.

Erosive Tooth Wear and Associated Risk Indicators in Schoolchildren from Rural and Urban Areas of the State of Mexico: A Cross-Sectional Study

BACKGROUND AND OBJECTIVE

Limited access to health services and low educational levels are factors in the rural population that are associated with the development of oral pathologies. However, the specific risk indicators contributing to erosive tooth wear (ETW) in these populations remain unclear. The objective of this study was to identify risk indicators associated with the prevalence of erosive tooth wear (ETW) in schoolchildren aged 8-12 years from rural and urban areas in the State of Mexico.

METHODS

A cross-sectional study was carried out in public schools in rural and urban areas. The prevalence of ETW was evaluated using the Basic Erosive Wear Examination (BEWE). The risk indicators studied were gastroesophageal reflux, vomiting, vitamin C, food, beverages, dental hygiene, bruxism, and hyposalivation. Logistic regression models were used to calculate odds ratios (OR) and 95% confidence intervals (CI).

RESULTS

The prevalence of ETW was higher in the rural area (77.3%) compared to the urban area (51.2%) (p = 0.001). The odds of presenting ETW were more than twice in schoolchildren from rural areas compared to those from urban areas (OR: 2.25, 95% CI: 1.11-3.98). Risk indicators varied between rural and urban populations, with different factors such as the consumption of fresh tomato sauce, orange, tangerine, atole (artisanal corn-based drink), and teeth grinding in the rural area, and lemon, soft drink, fruit juice consumption, and the simplified oral hygiene index in the urban area (p < 0.05).

CONCLUSIONS

To prevent ETW, strategies offering tailored dietary and hygiene advice should be proposed, considering the specific conditions of each geographic area.

A standard set of outcome measures for the comprehensive assessment of oral health and occlusion in individuals with osteogenesis imperfecta

BACKGROUND

Osteogenesis imperfecta (OI) is a group of inherited connective tissue disorders of varying severity characterized by bone fragility. The primary objective of this international multidisciplinary collaboration initiative was to reach a consensus for a standardized set of clinician and patient-reported outcome measures, as well as associated measuring instruments for dental care of individuals with OI, based on the aspects considered important by both experts and patients. This project is a subsequent to the Key4OI project initiated by the Care4BrittleBones foundation which aims to develop a standard set of outcome measures covering a large domain of factors affecting quality of life for people with OI. An international team of experts comprising orthodontists, pediatric dentists, oral and maxillofacial surgeons, and prosthetic dentists used a modified Delphi consensus process to select clinician-reported outcome measures (CROMs) and patient-reported outcome measures (PROMs) to evaluate oral health in individuals with OI. Important domains were identified through a literature review and by professional expertise (both CROMs and PROMs). In three focus groups of individuals with OI, important and relevant issues regarding dental health were identified. The input from the focus groups was used as the basis for the final set of outcome measures: the selected issues were attributed to relevant CROMs and, when appropriate, matched with validated questionnaires to establish the final PROMs which represented best the specific oral health-related concerns of individuals with OI.

RESULTS

Consensus was reached on selected CROMs and PROMs for a standard set of outcome measures and measuring instruments of oral health in individuals with OI.

CONCLUSIONS

Our project resulted in consensus statements for standardization oral health PROMs and CROMs in individuals with OI. This outcome set can improve the standard of care by incorporating recommendations of professionals involved in dental care of individuals with OI. Further, it can facilitate research and international research co-operation. In addition, the significant contribution of the focus groups highlights the relevance of dental and oral health-related problems of individuals with OI.

Validation of clinically related aging models based on enamel wear

PURPOSE

Physiological and erosive wear reported in clinical studies were reviewed, and in vitro aging models were developed to simulate and compare the effect of aging on human teeth with the review data obtained from clinical studies.

METHODS

A review of clinical studies and randomized clinical trials that quantify enamel wear was performed in the PubMed database. The first in vitro analysis evaluated the effect of mechanical chewing simulation only. Enamel specimens were aged in the chewing simulator (up to 1.2 million cycles) with two occlusal loads (30 and 50 N). In the second in vitro analysis, specimens were aged in two aging models. The first model (MT) simulated mechanical and thermal oral challenges: MT1- 240,000 chewing and 10,000 thermal cycles, MT2- 480,000 chewing and 20,000 thermal cycles, MT3- 1.2 million chewing and 50,000 thermal cycles. The second model (MTA) simulated mechanical, thermal, and acidic oral challenges as follows: MTA1- 240,000 chewing, 10,000 thermal and 3-h acidic cycles; MTA2: 480,000 chewing, 20,000 thermal and 6-h acidic cycles, MTA3- 1.2 million chewing, 50,000 thermal and 15-h acidic cycles.

RESULTS

The review included 13 clinical studies evaluating tooth wear (eight physiological and five erosive). The results estimated the annual average physiological wear as 38.4 µm (9.37-51). In comparison, the MT1 showed wear of 60 (24) µm. Also, the average annual erosive wear in the literature was 179.5 µm (70-265) compared to MTA1-induced wear of 209 (14) µm.

CONCLUSION

There was wide variation in tooth wear reported in clinical studies, suggesting a critical need for more accurate studies, possibly based on scanning technologies. Despite this, the data reported using the novel aging models are within a range to be considered consistent with and to simulate tooth wear measured in vivo.

Prevalence of Dental Erosive Wear and Possible Risk Factors among Adolescents and Adults in Poland - A National Survey

PURPOSE

To investigate the prevalence and severity of erosive tooth wear (ETW) and evaluate the determinants of ETW among adolescents and adults in Poland.

MATERIALS AND METHODS

The study covered three age groups of patients: 15 years old, 18 years old, and adults aged 35-44 years. Calibrated examiners measured ETW according to the Basic Erosive Wear Examination (BEWE) scoring system in 6091 patients. The clinical examination of patients was preceded by a socio-medical study based on a questionnaire consisting of items identifying potential risk factors for ETW.

RESULTS

In all age groups, erosive lesions were most common in the form of initial enamel damage; more advanced lesions (BEWE 2 and 3) were rarely observed among 15-year-olds, while in the group of older adolescents and adults, the percentages were 13% and 20%, respectively. Acidic diet, gender, level of education, and medical conditions were statistically significantly associated with ETW in the examined population. The analysis showed that, depending on age, multiple and statistically significant risk factors for ETW become most apparent in the 35-44 age group, especially with regard to general health. This suggests that the long-term impact of factors and their cumulative effects are critical to the development of ETW.

CONCLUSIONS

This is the first large, representative study of ETW in Central and Eastern Europe among adolescents and adults, which indicates the relatively rare occurrence and severity of erosive lesions. The present findings support other longitudinal studies supporting the use of the BEWE system as a valuable standard for assessing erosive lesions and related risk factors among different populations at different ages.

Practical training using BEWE aimed at improving the diagnosis ability of erosive tooth wear for dental students-A randomized trial

INTRODUCTION

Erosive tooth wear (ETW) has been gaining attention due to its high prevalence. However, ETW clinical diagnosis is difficult and may go unnoticed by many professionals. The present study aimed to develop, implement and evaluate a theoretical-practical training using active methodologies in the development of undergraduate students' skills for the diagnosis of ETW compared to the traditional teaching method.

MATERIALS AND METHODS

This randomized controlled study involved two parallel groups: control group (n = 22), with learning based only on theoretical content and test group (n = 24), learning by theoretical-practical activity mediated by monitors/tutors. The theoretical class covered the current concepts of ETW, aetiology, diagnosis, use of the BEWE index, prevention and treatment. The practical training included exercises and discussions based on the diagnosis using BEWE scores of a collection of images and extracted teeth. To evaluate the efficacy of the teaching-learning methods, a theoretical multiple-choice questionnaire and a practical test using images and extracted teeth were applied. The outcome was the number of correct answers. Groups were compared by Mann-Whitney (theoretical knowledge) and T tests (practical ability in diagnosis) (p < .05).

RESULTS

There was no significant difference between groups in the theoretical evaluation (p = .866). The test group showed higher ability to diagnose ETW lesions compared to the control group in the practical tests (p = .001). The performance of ETW diagnosis was similar when images were used in comparison to extracted teeth (p = .570).

CONCLUSION

The practical activity associated with theoretical classes can be a promising strategy to improve the development of undergraduate students' skills in the diagnosis of ETW.

The Oral Health Status and Anthropometric Measurements of Children at Early Childhood Development Centers in an Informal Settlement in Pretoria, South Africa

Objectives

Early childhood caries (ECC) continue to increase, especially among low socioeconomic communities. This study was conducted in an informal settlement comprising mostly foreigners who have settled in the area. Given the limited dental and medical services available to these communities, this study aimed to determine the dental and medical disease profile of these inhabitants. The objective was to determine the oral health status and the body mass index (BMI) of children attending crèches in an informal settlement.

Materials and methods

Oral health data, including dental caries (DC), soft tissue lesions, fluorosis, erosion, and trauma, were recorded using the World Health Organization (WHO) recommended methods. The examiners were calibrated, and all examinations took place at the crèches under natural sunlight. The BMI was calculated by a team of dieticians who were blinded to the oral health status. The height and weight were measured by calibrated examiners under standardized conditions.

Results

There were a total of 169 participants; the mean age was 4.02 years (±1.13; 1-7) and there was an equal distribution of males and females (49.7% females and 49.3% males). The prevalence of DC was 39.1%, with 19% having 4 or more carious teeth. The mean decayed, missing, and filled teeth (dmft) and plaque scores [Simplified Oral Hygiene Index (OHI-S)] were 1.58 (±2.70) and 0.65 (±0.43), respectively, and the mean dmft score increased with increasing age. The mean d component contributed 99% of the total mean dmft score (1.56). The mean BMI was 15.44, and this decreased significantly (p = 0.009) while the OHI increased significantly (p < 0.001) as the number of carious teeth increased.

Conclusion

The prevalence of caries was relatively high, and those with caries had multiple decayed teeth. The d component contributed almost 100% to the mean score, indicating a lack of access to dental care. The mean BMI score was inversely proportional to the number of carious teeth, which could imply that those with caries had difficulty eating.

How to cite this article

Bhayat A, Madiba TK, Beeforth M, et al. The Oral Health Status and Anthropometric Measurements of Children at Early Childhood Development Centers in an Informal Settlement in Pretoria, South Africa. Int J Clin Pediatr Dent 2024;17(8):903-906.

Piloting an intraoral pH device to track gastroesophageal reflux in adults

This study evaluated in vivo, an intraoral device against the gold standard esophageal device for gastroesophageal reflux disease (GERD) monitoring. Subjects scheduled for a catheter-based esophageal pH/impedance testing at a gastroenterology clinic were recruited. They were screened using the GerdQ questionnaire, demographics and dental conditions recorded. A prototype intraoral device, consisting of a Bravo™ capsule embedded in an Essix-style retainer fabricated for each subject, monitored intraoral pH. Concurrently, subjects underwent 24-h esophageal pH-impedance monitoring. A self-administered survey elicited the comfort and acceptance of both devices. The study recruited ten adult subjects (23 to 60-years-old) with a median GerdQ score of 9.5 corresponding to a 79% likelihood of GERD. Subjects with severe dental erosion had significantly (p < 0.05) higher acid exposure time and more non-meal reflux events. No adverse events were associated with the intraoral device while one was recorded for the esophageal device. The intraoral device was significantly more comfortable to place, more comfortable to wear, and interfered less with daily routine compared to the esophageal device. Accuracy of the intraoral device ranged between 86.15% and 37.82%. Being more tolerable than traditional esophageal pH monitoring, intraoral pH monitoring may be a useful adjunct for the diagnosis and management of GERD.

Evaluating the Role of Inorganic Elements of Camelus Dromedarius Saliva in Protecting Enamel Against Tooth Surface Loss

The aim of this study was to provide insight into the role of camel's saliva in protecting enamel against erosion and to evaluate the levels of salivary sodium, potassium, calcium, and phosphate ions among 2 groups of camels, those with low-grade tooth surface loss and those with high-grade tooth surface loss. Twenty-eight healthy camels, 5 males and 23 females, aged 20 months to 10 years, were divided into 2 groups. Group I comprise camels with "low-grade tooth surface loss" and Group 2 with "high-grade tooth surface loss." Unstimulated saliva was collected by a draining method. The samples were then analyzed for sodium, potassium, calcium, and phosphate concentrations using automated chemistry analysis. Data were then statistically analyzed using the unpaired Student's t-test and Pearson correlation coefficient test. The study found the salivary calcium and phosphate concentrations were significantly lower in the "high-grade" erosion group, in comparison with the other group (P < .0001 and P  =  .0257, respectively). The results also revealed that the more extensive the tooth surface loss, the more carious lesions the subject had (P  =  .023), and that caries are more common in the anterior teeth, particularly the incisors. The authors conclude that alterations in inorganic elements of saliva, particularly the calcium and phosphate ions, play a major role in the development of resistance to tooth surface loss. This work may represent a direction for future research to develop custom-made preventive supplements, which can protect camelid teeth against tooth surface loss.

Prevalence of erosive tooth wear and associated risk factors in Colombian adolescents

Accurate determination of the prevalence of erosive tooth wear (ETW) and associated risk factors in adolescents can inform clinical management guidelines. The aim of this analytical cross-sectional study was to estimate the prevalence, severity, and risk factors of ETW in adolescents aged 12-15 years in the municipality of Usaquén in Bogotá, Colombia. Two calibrated examiners clinically assessed ETW using Basic Erosive Wear Examination (BEWE) Index (range: 0-3). All tooth surfaces (excluding proximal) were scored to allow estimation of the Highest (0-3) and Total BEWE (sum of Highest BEWE score per sextant: 0-18) scores per patient. Sociodemographic characteristics, ETW risk factors, and caries severity (ICDAS-epi-merged) were evaluated, and their association with the presence of ETW (indicated by a Highest BEWE score of 2-3) was examined using preliminary analyses and logistic regression models. The study sample included 454 adolescents (mean age: 13.5±1.1 years; female: 61.7%), and the prevalence of ETW was 71.6%. The majority of participants exhibited a Highest BEWE score of 3 (58.0%) and a Total BEWE score ≤8 (84.3%). The preliminary analysis showed an association between the presence of ETW and age, caries, and brushing teeth before eating (p-value < 0.05). Risk factors for ETW included always brushing teeth before eating [adjusted Prevalence Ratio (PRa) 1.31, p-value=0.014], presence of extensive carious lesions (PRa 1.23, p-value = 0.024), male gender (PRa 1.14, p-value = 0.028), and age > 14 years (PRa 1.17, p-value = 0.009). Although ETW was highly prevalent, most Colombian adolescents exhibited low Total BEWE scores. ETW was associated with frequent fruit intake, age, toothbrushing habits, caries lesions, and sex.

Oro-dental manifestations of eating disorders: a systematic review

BACKGROUND

Eating disorders (EDs) pose a significant risk to health, especially when not diagnosed early. For several years EDs and oral health has been extensively studied, and now it is quite clear the existence of a correlation between specific oral manifestations and these disorders. While these oral signs could potentially aid early diagnosis of EDs, their identification and the eventual establishment of a correlation is currently heavily limited to the clinician's experience. The present systematic review critically examines existing literature, offering an updated overview of oro-dental manifestations associated with EDs.

METHOD

MEDLINE (via PubMed), Web of Science, Scopus, and grey literature were searched, and relevant epidemiological comparative studies were screened using the Rayyan software. No limitations have been imposed on the research regarding oro-dental outcomes, encompassing all medically diagnosed EDs. The quality of the studies was valuated using AXIS appraisal tool for cross-sectional studies.

RESULT

Out of 3990 studies, 32 fulfilled the eligibility criteria and were included in the synthesis. The identified eating disorders include Anorexia Nervosa, Bulimia Nervosa and/or Eating Disorders Not Otherwise Specified, predominantly among female subjects, primarily originating from Europe. The evaluated oro-dental outcomes include dental erosion, caries, saliva assessment, hygiene-periodontal parameters, and mucosal tissue appearance. The association with erosion is confirmed while gingival recession, dentinal hypersensitivity, salivary flow thresholds and aspects relating to oral pathology are receiving increasing support from emerging evidence.

DISCUSSION

This trend emphasizes the critical role of the complete intraoral examination to detect significant oro-dental signs that may indicate the onset of an ED.

Hard drugs use and tooth wear: a scoping review

OBJECTIVES

This study aims to map evidence on the relationship between hard drug use and dental wear. The scoping review is guided by the question: What is the relationship between hard drug consumption and dental wear?

MATERIALS AND METHODS

Adhering to PRISMA-ScR guidelines, searches were conducted across PubMed, Embase, and four databases in March 2024. Inclusion criteria included studies investigating the association between hard drug use and dental wear, regardless of publication date or language. Data were presented through narrative exposition, tables, and a conceptual framework.

RESULTS

Twenty-eight studies (four case-control, three cross-sectional, five case reports, and sixteen literature reviews) were included. Among case-control studies, 75% observed an association between drug use and dental erosion; however, no cross-sectional studies demonstrated this association. Despite questionable quality, reviews established connections between drug use and dental erosion. Studies aimed to elucidate potential causes for dental erosion.

CONCLUSIONS

Analysis suggests a potential link between hard drug use and dental wear, though indirect. Factors like bruxism and reduced salivary pH may contribute to dental wear among drug users. Further investigation through primary studies exploring this relationship is necessary.

CLINICAL RELEVANCE

Dentists should focus not only on clinical characteristics of dental wear but also on mediating factors such as bruxism and decreased salivary pH associated with drug use. This holistic approach allows for a deeper understanding of dental wear mechanisms, enabling targeted preventive and therapeutic interventions.

Evaluation of Oral and Dental Health Results and Competition Stress Levels of Adolescent Athletes in Different Winter Sports Branches

BACKGROUND

 The aim of the present study was to examine the findings of the intraoral examinations of the 12-16 years old novice (control) and elite athletes across the winter sports branches, which were alpine discipline skiing, snowboarding, biathlon, ski jumping, and ice hockey. Besides, the study aimed to determine the intra- and inter-group relationships by comparing the athletes salivary stress biomarker levels at precompetition, during-match, and post-competition stages.

METHODS

 Ninety-one athletes (71 elite, 20 novice) participated in our study. Oral health status of the athletes were evaluated. In addition, cortisol levels in the saliva samples obtained at pre-competition (rested before the competition), during-match (just before the start), and post-competition (competition ending moment) stages were measured. The data were analyzed statistically with a significance level of 0.05.

RESULTS

 Ice hockey athletes were the most affected by untreated dental caries (27.3%). No signs of dental trauma caused by sports activities were found in the winter sports branches. Basic erosive wear examination scores of the ice hockey athletes were similar to the ski jumping athletes and lower than other groups (P=.034). The mean cortisol values between sports branches were listed as: biathlon alpine skiing < ice hockey < ski jumping (P < .001). Test results of the winter sports athletes' saliva samples revealed that their salivary stress levels might vary in accordance with the sports branches, and there was a negative relationship between the levels of salivary stress biomarkers in competitions and oral health.

CONCLUSION

 In winter sports activities, measures for improving oral health should be disseminated.

[Risk analysis Erosive Tooth Wear (ETW): checklist for a quick assessment of the risk factors for ETW in the dental practice]

Erosive Tooth Wear (ETW) is the loss of tooth structure without bacterial involvement. As the resulting loss of tooth structure is irreversible, an early evaluation of the multifactorial etiology, accurate diagnosis and regular follow-up are essential. The ETW is dynamic and its progression should be continuously monitored. A risk analysis table was developed to systematically record risk factors for ETW (Fig. 2). This allows ETW management to be integrated more efficiently into clinical practice and the progression to be documented over the years. If ETW is assumed, the risk analysis should be performed and updated at least every two years. In the assessment, risk-promoting and risk-inhibiting factors are marked, added together and compared. If the negative factors pre-dominate, measures should be taken to minimize the risk for ETW. The main purpose of the risk analysis is therefore to evaluate the individual etiology, coun-teract negative factors, promote positive factors and prevent progression.

Evaluation of oral health status in pregnant women and its correlation with calcium and phosphate levels

AIM

This study aimed to analyze the oral health conditions of pregnant women. The analysis involves evaluating two key indices: the decayed, missing, and filled teeth (DMFT) index and the basic erosive wear examination (BEWE) index. Furthermore, this study investigated potential correlations between calcium (Ca) and phosphate (P) levels within specific time intervals and the aforementioned oral health indices.

Pilot clinical study to evaluate the efficacy of a professionally delivered high fluoride varnish on erosive tooth wear in an in-situ model

OBJECTIVES

The aim for this pilot study was to investigate the effect of a sodium fluoride varnish on step height measured by a profilometer from human enamel worn by healthy volunteers with a novel in situ/ex vivo erosion design.

METHOD

Healthy volunteers aged 18-70 years wore a palatal splint containing 8 human enamel samples and underwent two 3-day treatment periods for 6 h a day with a varnish containing sodium fluoride at 22,600 ppm and the control with the same ingredients but without fluoride. Each splint contained 4 polished and 4 unpolished samples. The interventions were applied to the surface of the enamel samples in randomised order, removed after 6 h, then immersed ex-vivo in 1 %, pH 2.7 citric acid for 2 min, repeated 4 times a day, over 2 days. Measurements of enamel were assessed blindly by microhardness on day 2 and by non-contact laser profilometry on day 3 for the two treatments.

RESULTS

24 volunteers, 2 males and 22 females aged 27-54 years, were screened and recruited. The delta microhardness, from polished samples removed at the end of day 2, for the control and fluoride treatment was 95.7 (22.9) kgf/mm2 and 123.7 (28.9) kgf/mm2, respectively (p < .005). The mean (SD) step height for the control polished enamel surfaces was 3.67 (2.07) µm and for the fluoride varnish was 1.79 (1.01) µm (p < .0005). The control unpolished enamel surfaces had a mean 2.09 (1.53) µm and the fluoride varnish was 2.11 (1.53) µm but no statistical difference was detected.

CONCLUSIONS

The results from this pilot study, utilizing an in-situ model where enamel was exposed to acid over the course of 2 days, demonstrated that a high fluoride varnish containing sodium fluoride at 22,600 ppm prevented erosive wear compared to a control on the polished enamel surfaces.

CLINICAL SIGNIFICANCE

Intra-oral study demonstrated that a high fluoride varnish containing sodium fluoride at 22,600 ppm reduced erosive tooth wear.

Tooth Wear Evaluation System 2.0-Evaluation of diagnostic reliability in the assessment of signs and symptoms for tooth wear by non-experts

BACKGROUND

Tooth wear is a multifactorial condition that manifests through various signs and symptoms. These individual signs and symptoms were described in multiple studies, leading to the inclusion in TWES 2.0 (Tooth Wear Evaluation System 2.0) and the forthcoming DC-TW (Diagnostic Criteria for Tooth Wear). However, a study evaluating their reliability has yet to be conducted.

OBJECTIVE

The aim of the study was to examine the reliability in the assessment of 6 signs of pathological tooth wear and 18 clinical signs and symptoms determining aetiology, all of which are included in the TWES 2.0/DC-TW.

METHODS

48 dental students (operators) evaluated patient cases from a patient pool of 14 patients on dental casts and high-resolution intraoral photographs. The agreement between all operators for each sign and symptom was calculated based on ICC (Intraclass Correlation Coefficients). Additionally, the agreement of each operator's evaluation with a predefined sample solution was calculated based on Cohen's kappa.

RESULTS

Inter-user agreement ranged from near perfect (0.91) to poor (0.02) for the various pathology signs or aetiology symptoms of tooth wear (mean 0.32). The agreements of the operator's ratings compared to the sample solution resulted in Cohen's kappa from 0.18 to 1 (mean 0.59) for the pathology signs and ranged from 0.02 to 0.51 for the aetiology signs (mean 0.38).

CONCLUSIONS

The reliability of the signs and symptoms examined and the ability of individual investigators to correctly identify and assign signs and symptoms varied widely. The current assessment tools for the qualification of tooth wear need further refinement, and examiners need intensive training in tooth wear assessment.

Erosive tooth wear among non-institutionalised older adults in Hong Kong: a cross-sectional study

BACKGROUND

Non-institutionalised older adults is the majority of older adults in Hong Kong. The study aimed to examine erosive tooth wear (ETW) and its association with dental conditions and oral hygiene habits among non-institutionalised older adults in Hong Kong.

METHODS

This cross-sectional study recruited dentate adults aged 60 or above from nine elderly daycare centres in the five main districts of Hong Kong. The study consists of a questionnaire survey and a clinical examination. A researcher used a questionnaire to collected the participants' demographic information, oral hygiene habits such as toothbrushing habits and dental visit behaviour. A calibrated examiner performed an oral examination in the daycare elderly centre to assess the ETW using basic erosive wear (BEWE) criteria. Oral hygiene was recorded using visible plaque index. Prosthetic status was recorded using the World Health Organization criteria. Logistic regression was used to examine the correlation between ETW and the dental conditions and oral hygiene habits.

RESULTS

This study recruited 433 dentate adults and 333 adults were female (77%). Their age ranged from 60 to 99 years and their mean age was 74 years (SD = 7). They all had ETW (BEWE > 0). Over half of them (57%) had BEWE score of 3, indicating severe ETW. Analysis showed increasing age (OR = 1.030, p = 0.029) and older adults with untreated dental caries had higher odds (OR = 1.822, p = 0.002) of presenting severe ETW. No other associations were found between the ETW and the factors studied.

CONCLUSION

Hong Kong non-institutionalised older adults aged 60 or above had ETW and more than half of them had severe ETW. Increasing age and having untreated dental caries were associated with severe ETW.