Dental erosion prevalence and associated risk indicators among preschool children in Athens, Greece

Systematic review and meta-analysis on prevalence and anamnestic risk factors for erosive tooth wear in the primary dentition

BACKGROUND

Erosive tooth wear is a multifactorial and common condition in children.

AIM

This systematic review and meta-analysis aimed to determine the prevalence and key risk factors for erosive tooth wear in the primary dentition of children up to 7 years of age.

DESIGN

Electronic databases (PubMed, Embase, Scopus, and Web of Science) were searched in February 2023 for observational studies reporting prevalence and anamnestic risk factors. Additionally, a manual hand search was performed. Meta-analyses were conducted for the prevalence and odds ratios of identified risk factors. Risk of bias was assessed using the Newcastle-Ottawa scale modified for cross-sectional studies.

RESULTS

A total of 26 sources, reporting on 23 studies, were included in the systematic review. The overall estimated prevalence of children with erosive tooth wear in the primary dentition amounted to 35.6% (95% CI: 24.8-48.1). Anamnestic factors were structured into domains. Meta-analyses revealed gastroesophageal reflux disease (GERD; padj. = .008; OR = 1.98, 95% CI: 1.37-2.87), consumption of acidic food (padj. < .001; OR = 5.14, 95% CI: 3.56-7.42) and acidic drinks (padj. < .001; OR = 6.90, 95% CI: 4.64-10.25), holding beverages in the mouth while drinking (padj. = .035; OR = 1.82, 95% CI: 1.26-2.63), and snacking regularly (padj. = .041; OR = 1.58, 95% CI: 1.18-2.10) to be significantly associated with erosive tooth wear.

CONCLUSION

Future research should use standardized questionnaires to assess erosive tooth wear and its underlying risk factors (PROSPERO: CRD4202339776).

Soft drinks and dental erosion during pediatric age: a clinical investigation

BACKGROUND

Dental erosion is an irreversible condition of loss of teeth hard tissues caused by intrinsic or extrinsic acids attack, without bacterial involvement. Common soft drinks have an acid pH and they release hydrogen ions and act as chelating agents, dissolving teeth mineral component. The aim of the study was to investigate the correlation between the consumption of soft drinks in children and the degree of dental erosion.

METHODS

A questionnaire of 15 multiple choice questions was addressed to the parents of the 231 children needing different dental treatments. Responses were compared with the level of dental erosion of their child, that was clinically investigated using the Basic Erosive Wear Examination (BEWE) index.

RESULTS

About 26.8% of subjects fall into a high-risk category of dental erosion while 24.2% in a low risk level. Socioeconomic status and oral hygiene habits are able to affect the degree of dental erosion. Toothpastes containing fluoride have not proved effective in preventing this phenomenon and no significant correlations were found between the type of toothbrush used and its frequency of use.

CONCLUSIONS

It is necessary to apply preventive measures such as information on the processes and causes of erosion, instruction about right home oral hygiene maneuvers and the possible use of specific products, to avoid the development of problems related to severe dental wear.

Risk prediction models for erosive wear in preschool-aged children: a prospective study

Background

Despite increasing prevalence, age-specific risk predictive models for erosive tooth wear in preschool-age children have not been developed. Identification of at-risk groups and the timely introduction of behavioural change or treatment will stop the progression of erosive wear in the permanent dentition. This study aimed to identify age-specific risk factors for erosive wear. Distinct risk prediction models for 3-year-old and 5-year-old children were developed.

Methods

A prospective cohort study included school-based clinical examinations and parent administered questionnaires for consented 3 and 5-year-old healthy children. Calibrated examiners measured the following health parameters under standardised conditions: erosion, using the Basic Erosive Wear Examination Index (BEWE), caries using the International Caries Detection and Assessment System (ICDAS), plaque and calculus according to the British Association for the Study of Community Dentistry (BASCD) scores, dental traumatic injuries and soft tissue lesions, salivary testing and BMI. Other health conditions were collected via a parent-administered questionnaire that explored oral- and general-health. Non parametric tests were utilised to explore the temporal relation of erosion with, demographic factors, oral hygiene habits, general health and dietary habits. Variables showing significance with a difference in BEWE cumulative score over time were utilised to develop two risk prediction models. The models were evaluated by Receiver Operating Characteristics analysis.

Results

Risk factors for the 3-year-old cohort (N = 336) included erosive wear (χ²(1, 92) = 12.829, p < 0.001), district (χ²(5, 92) = 17.032, p = 0.004) and family size (χ²(1, 92) = 4.547, p = 0.033). Risk factors for the 5-year-old cohort (N = 441) also included erosive wear (χ²(1, 144) = 4.768, p = 0.029), gender (χ²(1, 144) = 19.399, p < 0.001), consumption of iced tea (χ²(1, 144) = 8.872, p = 0.003) and dry mouth (χ²(1, 144) = 9.598, p = 0.002).

Conclusions

Predictive risk factors for 3-year-old children are based on demographic factors and are distinct from those for 5-year-old children based on biological and behavioural factors. Erosive wear is a risk factor for further wear in both age cohorts.

Prevalence and Associated Factors of Erosive Tooth Wear among Preschool Children-A Systematic Review and Meta-Analysis

The prevalence of dental erosion among preschool children and its associated factors range widely between studies. The aims of this review are to evaluate the literature and to determine the prevalence and associated factors of dental erosion among children below 7 years old. An electronic search was undertaken to identify observational studies evaluating the prevalence of dental erosion and its associated factors in children below 7 years old. Dual independent screening, data extraction, risk of bias assessment, meta-analysis, meta-regression, and evaluation of quality of evidence were performed. Twenty-two papers were included. The overall estimated prevalence of dental erosion in children was 39.64% (95% CI: 27.62, 51.65; I2 = 99.9%), with very low certainty of evidence. There was also low-quality evidence suggesting that the likelihood of (1) boys having dental erosion was significantly higher than girls (p < 0.001) and (2) children with digestive disorders having dental erosion was significantly higher than those without such digestive disorders (p = 0.002). Qualitative synthesis identified that more frequent intake of fruit juices and soft drinks correlated with erosive tooth wear. Dental erosion is prevalent among over one-third of preschool children. Digestive disorders and dietary factors are the main potential contributing factors.

Evaluation of the Erosive and Cariogenic Potential of Over-the-Counter Pediatric Liquid Analgesics and Antipyretics

To evaluate the cariogenic and erosive potentials of over-the-counter pediatric oral liquid antipyretics and analgesics, we tested nine over-the-counter pediatric oral liquid medications classified as antipyretic or analgesic medicines available in Korea. For each substance, we measured the pH with a pH meter and the sugar content with a sugar content meter. We determined the titratable acidity (TA) levels based on the volumes of NaOH solution that had to be added to reach a pH of 7.0. We also evaluated the dental erosion potentials with an International Organization for Standardization method based on observing changes in the pH of a CaPO₄ solution upon introducing a small volume of the solution to be tested. The oral liquid medications had pH values of 3.40–5.68. In the TA assessments, several oral liquid medications required greater volumes of NaOH solution to reach a pH of 7.0. The dental erosion potentials varied but correlated strongly with the NaOH volumes needed to reach a neutral pH (r = 0.84; p < 0.0001). Many oral liquid antipyretics and analgesics have features that can promote dental erosion. A correct understanding of pediatric antipyretics and analgesics is required in dentistry for children’s oral health.

Dental erosive wear in primary teeth among five-year-olds - Bergen, Norway

OBJECTIVE

To estimate the prevalence of dental erosive wear among five-year-olds in Bergen, Norway, and to investigate associations between background factors and the condition.

METHODS

A total of 387 children received a dental examination in five Public Dental Service clinics in Bergen, Norway. The parents responded to items about the children's dental hygiene and drinking habits, type of beverage container, diet, and other habits, and about their own age, educational level and country of origin. We explored background variables for possible associations with the outcome status as worst affected by erosive wear (19.4%, n = 75). Chi-squared statistics and logistic regression (Odds Ratios (OR): 95% Confidence Intervals (CI), served as statistical tools).

RESULTS

Approximately 80% showed erosive wear (by SEPRS and by adopted diagnostic instrument (78.5% vs 79.8%)). The condition affected maxillary anterior teeth in 13.9% (n = 54), and cuppings in molars in 79.3% (n = 307) of cases. Grinding teeth during the day and/or night (OR: 1.87, CI: 1.07-3.25) and male sex (OR: 1.76, CI: 1.05-2.96) significantly related to outcome status as worst affected by erosive wear, respectively.

CONCLUSION

Dental erosive wear was widespread. Grinding teeth and male sex associated with outcome status as worst affected by erosive wear.

Erosive Tooth Wear and Erosive Esophagitis in Children: An Observational Study in Porto Alegre, Brazil

The aim of this study was to establish and compare the prevalence and severity of erosive tooth wear (ETW) in children with and without erosive esophagitis. Children aged 5-12 years, scheduled for upper digestive endoscopy at the Pediatric Gastroenterology Service of the Children's Hospital Santo Antonio, Porto Alegre, Brazil, were eligible to participate in this study. Patients who presented erosive esophagitis at endoscopy were defined as gastroesophageal reflux disease (GERD) carriers, and the severity was described according to the Los Angeles classification. The oral cavity examination was performed by a trained and calibrated dentist and ETW was classified using the Basic Erosive Wear Examination (BEWE) index. Parents/guardians answered a questionnaire about the patients' diets and frequency of consumption of acidic foods and beverages. A total of 110 children were included in the study. Erosive esophagitis was observed in 24 patients (21.8%) and all of them (100%) presented ETW, showing a statistically significant association between these 2 conditions (p < 0.05). Among children who did not present with erosive esophagitis (n = 86), 54 (64.3%) had an ETW risk level of none according to their BEWE scores (0-2). The results of this study showed a statistically significant association between erosive esophagitis and ETW, thus it can be concluded that it is important to recognize groups at risk of ETW and act together with medical professionals to ensure adequate oral health for these patients.

Monitoring of simulated occlusal tooth wear by objective outcome measures

OBJECTIVES

This in vitro study explored quantitative outcome measures as clinical indicators of simulated occlusal tooth wear progression.

METHODS

Ten sound, extracted human premolars were selected and submitted to occlusal tooth wear simulation in 0.5-mm steps (0/0.5/1.0/1.5 mm). At each step, enamel thickness on the buccal cusp tips was evaluated using cross-polarization optical coherence tomography (CP-OCT) and micro-computed tomography (μ-CT). The occlusal surface of each premolar was also scanned at each step using a 3D digital intraoral scanner, followed by morphological characterization using standard topography attributes (Slope, Relief, RFI, OPCr). Repeated measures ANOVA assessed differences in simulated wear levels for the μ-CT and CP-OCT data as well as the topography values. Correlations were also calculated between the μ-CT/CP-OCT and topography data.

RESULTS

Significant differences were observed for enamel thickness at each simulation wear stage, for both CP-OCT (p < 0.001) and μ-CT (p < 0.001), with good agreement between methods (intraclass correlation: 0.89). For topography analysis, as wear increased, the average Slope, RFI, and Relief values decreased, and average OPCr values increased, with more significant differences shown for Slope. Slope showed significant (p < 0.05) positive correlations with CP-OCT. OPCr showed significant negative correlations with μ-CT, and CP-OCT (p < 0.05). RFI and Relief were not correlated with either μ-CT or CP-OCT (p > 0.05).

CONCLUSIONS

Our findings suggest the potential of PS-OCT for measuring enamel thickness changes in the cusp tips of the occlusal surface. Similarly, conventional intraoral scanners can serve effectively for monitoring overall tooth wear when combined with dental topographic analyses of resultant point clouds.

CLINICAL SIGNIFICANCE

CP-OCT measures of enamel thickness and dental 3D topographic attributes showed potential as objective outcomes for the clinical monitoring of occlusal tooth wear. Their combination provided a comprehensive understanding of the tooth wear development process.

In vitro effect of children's toothpaste on brushing abrasion of eroded primary enamel

PURPOSE

Emerging data have suggested that acid erosion has become an increasing clinical problem in pediatric dentistry. This study aimed to investigate the abrasive effects of two commercial toothpastes on primary enamel eroded by orange juice using an in vitro model.

METHODS

Thirty enamel slabs were obtained from primary teeth and then randomly assigned to three groups (n = 8) comprising two different toothpastes: G1-control-distilled water; G2-Dentifrice A (containing no fluoride); and G3-Dentifrice B (1.100 ppmF-NaF). Each slab had one half protected to provide a control side, and the other one was subjected to treatments. The slabs were submitted to daily erosive challenges (3×/day, 2 min) in concentrated orange juice (pH 3.38) associated with abrasive challenges using a tooth-brushing machine (150 brush movements for each cycle). During the experimental period, the slabs were kept in 37 °C artificial saliva, and the experiment was carried out for 5 days. The depths of the resulting eroded areas were measured by stylus profilometry. The data were analyzed using ANOVA and the Tukey-Kramer test (α = 5%).

RESULTS

Tooth loss (µm, mean ± SD) was 2.46 ± 1.18 for G1, 3.32 ± 2.12 for G2 and 2.14 ± 1.03 for G3. Therefore, the NaF dentifrice (Dentifrice B) produced significantly less mineral loss (p = 0.04) than dentifrice A.

CONCLUSIONS

The findings suggest that fluoride toothpaste could protect primary enamel against erosion.

[Dental erosion in a sample of Valencian children. Prevalence and evaluation of eating habits]

Introduction

Introduction: dental erosion is the pathological, chronic, localized and painless loss of dental tissues, produced by the chemical action of acids, where the action of microorganisms is not involved. In recent years, a significant increase in the prevalence of this pathology has been observed, especially in children and adolescents. Objectives: to determine the prevalence of dental erosion in temporary dentition using the Basic Erosive Wear Examination Index (BEWE) in children between 5 and 12 years of age, and to determine the eating habits that may favor the development of these lesions. Methods: a cross-sectional study was carried out on a sample of 391 children. A survey was conducted where eating habits were analyzed and a clinical examination of the temporary teeth was performed using the BEWE index. Results: the prevalence of dental erosion in the studied sample was 19.7 %, with mild lesions being most common. Conclusions: in all, 30.62 % of the studied population had a low risk of dental erosion, and risk was seen to increase with consumption of acidic beverages (soft drinks, isotonic drinks and fruit juices) and acidic fruits such as oranges, grapes and apples.

Tooth wear among five-year-old children in Jakarta, Indonesia

Background

This study aimed to evaluate the prevalence of tooth wear among preschool children in Jakarta, Indonesia, and examine the risk factors associated with its occurrence.

Methods

An epidemiological survey was conducted with a cross-sectional study design. The participants were recruited via cluster sampling. Tooth wear was clinically assessed by one examiner using the Basic Erosive Wear Examination (BEWE) criteria. The children’s caries experience was also recorded. The parents of the participating children completed a self-administered questionnaire to answer demographic questions about the children and gather information about the children’s diet and oral health behaviors as well as the parents’ dental health-related knowledge. The data were analyzed using the Chi-square test and binary logistic regression.

Results

A total of 752 five-year-old children were invited to participate, with 691 (92%) enrolling in the study. Tooth wear occurred in 23% (161/691, BEWE > 0) of the participants, in which 78% (125/161) had at least one moderate tooth wear status (BEWE = 2). The consumption of citrus drinks, fruit juice, and vitamin C supplement drinks, together with the child’s caries experience, the father’s education level, and the family’s socioeconomic status, were significantly associated with tooth wear.

Conclusions

The five-year-old preschool children in Jakarta had a relatively low prevalence of tooth wear. Those consuming more acidic drinks, those with a higher socioeconomic status, and those with an absence of caries experience had a higher risk of tooth wear.

Electronic supplementary material

The online version of this article (10.1186/s12903-019-0883-5) contains supplementary material, which is available to authorized users.

Oral diseases and oral health related behaviors in adolescents living in Maasai population areas of Tanzania: a cross-sectional study

Background

Oral diseases, such as dental caries, tooth wear, dental erosion and periodontal diseases are major health problems in many societies. The study aim was to explore the association between oral health related behaviors and the presence of oral diseases in adolescents living in Maasai population areas in the northern part of Tanzania.

Methods

A cross sectional study was conducted in 2016 using one stage cluster sample design. A total of 989 adolescents were invited and 906 (91.6%; (Maasais n = 721, non Maasais n = 185) accepted the invitation and completed an interview and clinical oral examination in a school setting (mean age 13.4 years, SD 1.2, range 12–17 years). Chi-square test, bivariate analysis and logistic regression were performed to analyze data.

Results

Logistic regression revealed that: adolescents with low frequency of tooth cleaning (OR = 10.0, CI 4.3–20.0) was associated with poor oral hygiene and that more regular tooth cleaning (OR = 0.1, CI 0.04–0.14) and the use of plastic type of tooth brush (OR = 0.7, CI 0.53–0.99) were associated with less gingival bleeding. High consumption of biscuits (OR = 2.5, CI 1.7–3.8) was associated with presence of dental caries and the use of magadi (OR = 24.2, CI 11.6–50.6) as a food additive was the covariate for more severe dental fluorosis (TF grade 5–9). Regular intake of carbonated soft drinks (OR = 1.6, CI 1.1–2.5) and regular tooth cleaning (OR = 1.7, CI 1.1–2.6) were independently associated with dental erosion. Using teeth as a tool for: biting nails (OR = 1.9, CI 1.4–2.4), opening soda (OR = 1.8, CI 1.4–2.4) and holding needles (OR = 1.6, CI 1.3–2.1) were covariates for tooth wear. Adolescents who reported to clench/grind their teeth (OR = 2.3, CI 1.5–3.7) was the only covariate for TMD. In several of the investigated factors, there were significant differences between the Maasai and non Maasai ethnic groups.

Conclusion

Oral health related behaviors have a significant impact on oral diseases/conditions among adolescents attending primary schools in Maasai population areas with obvious differences in behavior between the Maasai and non Maasai ethnic groups. There is a need for addressing oral health and to encourage behaviors that promote good oral health and dental care service utilization in this society.

Risk factors associated with oral manifestations and oral health impact of gastro-oesophageal reflux disease: a multicentre, cross-sectional study in Pakistan

OBJECTIVE

Gastro-oesophageal reflux disease (GORD) is a relatively common disorder and manifests with extraoesophageal symptoms, such as dental erosions (DE), cough, laryngitis, asthma, and oral soft- and hard-tissue pathologies. This study aimed (1) to identify oral soft and hard-tissue changes in patients with GORD and (2) to evaluate these oral changes as indices for assessing GORD and its severity.

SETTING

This cross-sectional study was conducted at four major tertiary care government hospitals, in two metropolitan cities of Pakistan.

PARTICIPANTS

In total, 187 of 700 patients who underwent oesophago-gastro-duodenoscopy and having GORD were included in the study. Patients with GORD were divided according to the presence of DE into group A (with DE, chronic/severe GORD) and group B (without DE, mild GORD). Patients who were unconscious and had extremely limited mouth opening were excluded.

PRIMARY AND SECONDARY OUTCOME MEASURES

Abnormal conditions and lesions of the oral mucosa were recorded. The impact of oral hard and soft-tissue changes on the oral health-related quality of life was assessed using the Pakistani (Urdu) version of the validated Oral Health Impact Profile-14 (OHIP-14) instrument.

RESULTS

Oral submucous fibrosis (66.3%), ulceration (59.4%) and xerostomia (47.6%) were significantly more common in group A (p<0.05). The prevalence of GORD was 26.7%, within which the prevalence of DE was 35.3%. Unhealthy dietary pattern, nausea/vomiting, oesophagitis, xerostomia, ulceration, gingivitis and angular cheilitis showed a statistically significant association with chronic GORD and DE. All subscales of OHIP-14 were positively correlated (p<0.05) in patients with GORD and DE, with notable impact on psychological discomfort (rs=0.30), physical disability (rs=0.29), psychological disability (rs=0.27) and functional limitation (rs=0.20).

CONCLUSION

Patients with GORD and DE presented with more severe oral manifestations than did those with GORD and no DE. We recommend timely dental check-ups to assess the severity of both systemic and oral disease.

The use of fluoride for the prevention of dental erosion and erosive tooth wear in children and adolescents

BACKGROUND

Erosive tooth wear (ETW) has gained increasing clinical relevance. It is estimated that worldwide 30-50% of deciduous and 20-45% of permanent teeth are affected. One of the most important nutritional factors causing ETW is the overconsumption of soft drinks, but also patient-related factors like reflux or eating disorders can lead to erosive lesions. Whether acids lead to erosive demineralisation depends on their degree of saturation with respect to tooth mineral at their actual pH.

REVIEW

Fluoride compounds like sodium or amine fluoride seem to be of limited efficacy against erosion, the main reason for this is the missing biofilm in the erosive process as well as the lower pH of the acids compared to bacterial acids. This means that to achieve some kind of preventive effect it would be necessary to use products with higher fluoride concentration, which is not an appropriate option for small children, and/or to increase the frequency of application. In addition, the fluoride compound plays a role as promising effects were found when fluoride is combined with titanium or stannous ions. TiF₄ can cause acid-resistant surface coatings and when Sn²⁺/F^- formulations are applied, Sn is not only found on the surface but is also incorporated into enamel and dentine. Both effects make the tooth surface more resistant against acid demineralisation. Different fluoride-containing vehicles have been tested to prevent erosion/ETW, such as toothpastes, rinses, gels and varnishes. Toothpastes offer some degree of protection, especially Sn²⁺-containing formulations, but effects of the active ingredients are sometimes counteracted by the presence of abrasives.

CONCLUSION

Detecting associated factors and influencing them is the main instrument in arresting erosive tooth wear. Additionally, patients at risk for dental erosion should always use an additional fluoride source preferably containing Sn²⁺.

Erosive tooth wear among preschool children in Hong Kong

OBJECTIVE

This study aimed to assess the prevalence of erosive tooth wear among 3- to 5-year-old children in Hong Kong and to determine the effect of socio-economic factors, dental habits, and oral hygiene on their dental erosive wear status.

METHODS

Stratified random sampling was adopted. Their parents were asked to complete a questionnaire regarding their children's backgrounds. A single examiner evaluated the children for erosive tooth wear using Basic Erosive Wear Examination (BEWE) criteria. Multiple logistic regression was used to determine the relationship between erosive wear and the children's socio-economic factors, dental habits, and oral hygiene.

RESULTS

1204 children participated in this study. Prevalence of erosive tooth wear (BEWE score > 0) was 14.9%. Among these, 153 children (12.8%) had initial wear, 21 children (1.8%) had distinct tooth loss, and five (0.4%) had severe erosive wear. Prevalence of erosive wear among the 3-, 4-, and 5-year-old children was 10.7%, 15.0%, and 17.7%, respectively. Increasing age, the low education of mother and high plaque scores were risk factors of erosive wear (P < 0.05).

CONCLUSION

Prevalence of erosive tooth wear is low among preschool children in Hong Kong. The erosive tooth wear prevalence increased with increasing age, lower education of mother, and poorer oral hygiene.

Erosive wear of the primary dentition: who is aware of it?

AIM

To determine the influence of erosive tooth wear in the primary dentition on parental perceptions of oral health.

METHODS

This cross-sectional study involved a standardised clinical examination of 775 preschool aged children and a parent-administered questionnaire. Erosive tooth wear was measured using the Basic Erosive Wear Examination Index.

RESULTS

71% and 81% of 3 (n = 256) and 5 year-old children (n = 337) respectively exhibited signs of erosive tooth wear. Prevalence was influenced by region (p = 0.049) (p = 0.007) in both age cohorts (χ², p < 0.05) respectively and by parental level of education (p = 0.012) in the 5-year-old cohort. Parental perception of oral health was significantly associated (χ², p < 0.05) with parental level of education in the 5-year-old cohort and with the presence of dental caries, reports of pain and dental appearance of the child in both age cohorts. Parental perceptions were unaffected by the degree of erosive tooth wear their child exhibited (p = 0.0564), (p = 0.739) in both age cohorts respectively.

CONCLUSIONS

Erosive dental tooth wear is increasingly observed in the primary dentition however is not perceived as an oral health issue by parents. Its diagnosis and management therefore, fall heavily within the remit of the dental practitioner.

Tooth wear during orthodontic treatment with fixed appliances: a systematic review

OBJECTIVES

Tooth wear, additional to the physiologic alterations of the dentition, may occur during orthodontic treatment. The objective of the present review was to investigate systematically the literature relevant to its progression in patients having undergone comprehensive orthodontic treatment.

DATA SOURCES

Search without restrictions in eight databases since inception and hand searching until October 2017 was performed.

DATA SELECTION

Studies evaluating tooth wear immediately before and after the completion of orthodontic treatment with fixed appliance were evaluated independently and in duplicate.

DATA EXTRACTION

Following study retrieval and selection, data on volumetric and surface tooth wear was extracted. Individual study risk of bias assessment was performed using the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool, and the overall quality of the evidence was assessed with the Grades of Recommendation, Assessment, Development and Evaluation approach.

DATA SYNTHESIS

All three finally included studies reported wear of teeth during the period of treatment but were at serious risk of bias. Two of them investigated tooth wear by 3D volumetric measurements and one used grading scales. The mean volume reduction was 1.02 mm³ per tooth for the incisor group [95% Confidence Interval (CI): 0.84-1.20], 1.62 mm³ for the canines [95% CI: 0.8-2.38; I²= 96%; random effects method] and 0.95 mm³ for premolars and molars [95% CI: 0.84-1.07]. The overall quality of evidence limited the confidence in the observed estimates.

CONCLUSIONS

Varying degrees of tooth wear were reported after comprehensive orthodontic treatment. Further studies are needed in order to elucidate how much is associated with orthodontic treatment and/or physiologic alterations of the dentition.

The influence of frequently consumed beverages and snacks on dental erosion among preschool children in Saudi Arabia

Background

To determine the prevalence of dental erosion and its association to commonly used beverages and snacks among 3 to 5 year old preschool children in Riyadh, Saudi Arabia.

Methods

Three hundred eighty-eight preschool children between 3 and 5 years old were selected from 10 different schools using a cluster random sample selection; there were 184 (47%) boys and 204 (53%) girls. The surfaces of each tooth were examined for erosion, and the level of tooth wear was recorded. Data on the frequently used beverages and snacks were obtained by questionnaires completed by the parents of the preschool children.

Results

Among the 388 children examined, 47% exhibited low erosion, 10% exhibited moderate erosion and 4% exhibited severe erosion. There was no statistically significant difference between boys and girls in terms of the prevalence of erosion. Sixty percent of the children regularly consumed juice drinks. Among daily consumers, 84% of children showed erosion prevalence with strongly significant association (p < 0.005). Holding the drink in the mouth also showed a significant association with erosion (p < 0.02).

Conclusion

It was concluded that an association was found between the prevalence of dental erosion and the frequency of citrus and carbonated juice consumed by the preschool children in Saudi Arabia.

Prevalence and factors associated with dental erosion in individuals aged 12-30 years in a northeastern Brazilian city

Background/Purpose

Dental erosion in young individuals has increased significantly in recent years, due to changes in lifestyle. Thus, the present study investigated the prevalence and factors associated with dental erosion in individuals aged 12–30 years in the city of Imperatriz of Maranhão, Brazil.

Materials and methods

A cross-sectional study was conducted on 335 individuals who answered a questionnaire consisting of variables related to dental erosion. Afterwards, the individuals were subjected to clinical examinations and the basic erosive wear examination index was used to classify their teeth according to the presence and severity of dental erosion.

Results

Descriptive statistics, the chi-square test, Poisson univariate and multivariate regression were performed at 5% level of significance. The sample was characterized by 204 females (60.9%), the majority of whom were from 12 to 19 years of age (78.5%), among whom 28.7% presented dental erosion. Their monthly family income was from 1 to 3 minimum wages (56.4%). The variables that were significantly associated with the outcome were family income, chewing gum, and consumption of soft-drinks/juices before going to sleep (p=0.03, p=0.001, and p=0.04, respectively). Individuals who chewed chewing gum were 2.27 times (95% CI =1.43–3.60) more likely to present dental erosion than those who did not chew gum. Individuals who ingested soft drinks or juices were 2.30 times (95% CI =1.30–4.10) more likely to present dental erosion.

Conclusion

The prevalence of erosion reflected the need for programs of prevention and guidance for patients about the etiological factors of the disease.

Are grape juices more erosive than orange juices?

AIMS

To evaluate the chemical characteristics of grape and orange juices, and their erosive potential in the decrease of microhardness and the loss of enamel structure.

METHODS

Five grape and orange juices were evaluated for pH, titratable acidity, calcium, phosphate, and fluoride concentration. De-ionised water and Cola soft drink were used as a negative and positive control, respectively. Twelve specimens of bovine enamel were immersed in beverages for 10 min at 37 °C, 3 times/day for 7 days. Erosive potential was quantified using microhardness and loss of enamel structure. Anova One Way, Student's t test, Multiple Regression and Spearman Correlation (p < 0.05) were used to analyse the results.

RESULTS

Powdered grape juice showed the lowest pH (3.18 ± 0.03) and pure grape juice presented the highest titratable acidity (5.48 ± 0.06 mL NaOH/100 mL). Fresh orange juice and soya-based grape juice revealed the lowest calcium (0.77 ± 0.12 mmol/L) and phosphate concentrations (0.35 ± 0.06 mmol/L), respectively. Among juices, powdered orange juice caused the greatest decrease in surface microhardness (SMH) (127.99 ± 40.47 ΔSMH) and grape juice from concentrate caused the greatest loss of enamel structure (13.30 ± 3.56 μm).

CONCLUSIONS

All of the evaluated juices contributed to dental erosion. Grape juices presented greater erosive potential than orange juices. Pure, powdered and concentrated grape juices showed similar loss of enamel structure to the Cola soft drink. The erosive potential of beverages was statistically correlated to pH, titratable acidity, calcium, phosphate and fluoride concentrations.

Paediatric Over-the-Counter (OTC) Oral Liquids Can Soften and Erode Enamel

This study investigated the softening and erosive effects of various paediatric over-the-counter (OTC) oral liquids on deciduous teeth. Twenty sectioned and polished deciduous enamel blocks were ground on the buccal surface (2 × 2 mm²) and randomly divided into five groups, immersed into four commercially-available paediatric OTC oral liquids (two for paracetamol, both sugared; and two for chlorpheniramine, one sugared and one sugar-free), with deionized water as control. The pH of the oral liquids ranged from 2.50 to 5.77. Each block was immersed into the test or control groups for 15 s, rinsed with deionized water, and Vickers micro-hardness (n = 5) was measured. After twenty cycles of immersion and hardness measurements, Scanning Electron Microscope (SEM) and Energy Dispersive X-ray Spectrometry (EDS) were used to evaluate the surface morphology and chemistry of the tooth blocks, respectively. The pH values of the liquids were also recorded. Rapidly descending trends in the micro-hardness ratios of the four test groups were observed that were statistically different from the control group (p < 0.001). EDS showed an increase of Ca/C ratio after drug immersion, whereas SEM showed an enamel loss in all the test groups. Paediatric OTC oral liquids could significantly soften the enamel and render them more susceptible to caries, such that the formulation of the oral liquids is the major factor.

Prevalence and risk factors of erosive tooth wear in 3-6 year old German kindergarten children-A comparison between 2004/05 and 2014/15

OBJECTIVES

The aims of this study were (1) to investigate prevalence, severity and distribution of erosive tooth wear in German kindergarten children aged 3-6 years in 2014/15 in comparison to an earlier survey from 2004/05 and (2) to identify and compare possible risk factors.

METHODS

775 children aged 3-6 years from 27 kindergartens were examined in 2014/15 and compared to the data from 2004/05 (432 children/21 kindergartens). Erosive tooth wear was examined using the O'Sullivan-Index. Additionally, data were converted into the Basic Erosive Wear Examination (BEWE)-index. Information about dietary habits, chronic illness and oral hygiene practices were obtained by questionnaires. Statistical analyses were done by Chi(2)-, Mann-Whitney U Tests and regression analyses (p<0.05).

RESULTS

Compared to 2004/05 (31.3%) prevalence of erosive tooth wear was significantly increased in 2014/15 (45.4%). In 2004/05 and 2014/15, prevalence increased significantly with increasing age of the children: 3-year-olds: 22.5%/14.2%; 4-year-olds: 27.4%/32.9%; 5-year-olds: 30.5%/58.8%; 6-year-olds: 38.1%/71.7%. Children with erosive tooth wear presented more affected teeth and a higher severity of erosive tooth wear, respectively, in 2014/15 compared to 2004/05. The BEWE score sum was significantly higher in 2014/15 (3-year-olds: 3.4±2.1, 4-year-olds: 4.2±3.1, 5-year-olds: 4.6±2.9, 6-year-olds: 5.9±3.3) than in 2004/05 (3-year-olds: 2.0±1.2, 4-year-olds: 2.7±1.8, 5-year-olds: 2.7±2.4, 6-year-olds: 4.2±4.2). In 2014/15, age and male gender were significant with respect to the presence of erosive tooth wear. Severity of erosive tooth wear was dependent on the regular consumption of fruit juices and lemonade/coke.

CONCLUSION

The prevalence of erosive tooth wear in German kindergarten children has increased in the last ten years.

Erosive Tooth Wear and Related Risk Factors in 8- and 14-Year-Old Greek Children

The aim of the present study was to investigate the erosive tooth wear of primary and permanent teeth and its association with related risk factors. Two groups of Greek children aged 8 (n = 329) and 14 years (n = 263) were examined in the classroom using the Basic Erosive Wear Examination (BEWE) index. Data concerning risk factors were collected using questionnaires. Dental caries (DMFS/dmfs) was also recorded. The data were analyzed using the t test, one-way ANOVA, multiple regression analysis, Fisher's exact test, and the χ2 test. In the 8-year-olds, the primary teeth showed a predominantly medium level of wear and the permanent teeth no wear. A majority of the 14-year-olds exhibited low risk levels of wear. The most frequently affected dental surface in both age groups was the occlusal surface of the mandibular posterior teeth. In the 8-year-olds, BEWE scores and the prevalence of wear in the primary teeth was influenced by gender (p = 0.020). In their permanent teeth, soft drink consumption (p < 0.0001) and preference for lemon/vinegar (p = 0.041) significantly affected wear prevalence and BEWE scores, while habitually retaining soft drinks in the mouth influenced wear prevalence (p = 0.008), risk (p = 0.004), and BEWE scores (p = 0.022). In the 14-year-olds, wear prevalence was significantly affected by the consumption of lemon-flavored candies (p = 0.016) and soft drinks (p = 0.050). BEWE scores were significantly affected by gender (p = 0.022) and soft drink consumption (p = 0.030). Gender influenced tooth wear risk in both age groups (p = 0.010 and p = 0.021, respectively). The results of this study indicate that erosive tooth wear differed between primary and permanent teeth and was influenced by gender and dietary factors.

Awareness and knowledge of dental erosion among Yemeni dental professionals and students

BACKGROUND

This study explored Yemeni dentists' and dental students' knowledge about the associated factors, approaches to diagnosis and preventive methods of dental erosion (DE), as well as any associations between DE awareness and some potentially related variables.

METHODS

A self-administered questionnaire was distributed to general dental practitioners (n = 323) in Sanaa and to fifth year dental students (n = 97) at the University of Science and Technology, Sanaa, Yemen during the period from July to November 2013. Descriptive and logistic regression analyses were conducted.

RESULTS

Overall response rate was 79 %. Results indicated that 61 % of respondents learned about DE from dental school, 27 % from their own studies and the rest from continuing education courses and the media. DE was reportedly most frequently seen on incisors by 46 % of respondents and on premolars and molars by 24 %. While 48 % reported DE to be more common in male patients, no gender differences were reported by 20 % of respondents. Acidic drinks were believed to be causative factors for DE by 41 % of dentists and 52 % of students, while 90 % of respondents believed that patients' dietary history is important during DE diagnosis. As preventive measures for DE, reduction of acidic drink consumption was advised by 51 % of respondents while only 37 % advised their patients to use fluoridated toothpastes. Younger respondents (≤35 years) were more likely to identify the commonly-known causative factors for DE (P = 0.024). Twenty-seven percent of the respondents reportedly used an index to grade DE. Dental students were more likely than dentists to use such an index (P <0.001) and to more frequently advise their patients to reduce intake of acidic drinks (P = 0.02) compared to dentists.

CONCLUSIONS

In-depth knowledge about causative factors, diagnosis and preventive methods of DE was apparent among only half the respondents and approaches to early diagnosis were insufficient. There would appear to be an urgent need for enhancing awareness and knowledge about DE within the Yemeni dental community.

A randomised clinical study to measure the anti-erosion benefits of a stannous-containing sodium fluoride dentifrice

Background:

To compare the enamel protection efficacy of stannous-containing sodium fluoride and sodium monofluorophosphate (MFP)/triclosan dentifrices marketed in India in an in situ erosion model with acidic challenge.

Materials and Methods:

This randomised and controlled, in situ, supervised, double-blind clinical trial employed a two-treatment, four-period crossover design, wherein subjects wore an appliance fitted with human enamel samples 6 h/day during each 10 day treatment period and swished twice daily with their assigned dentifrice slurry: Oral-B^® Pro-Health (maximum 1,000 ppm F as sodium fluoride with stannous chloride) or Colgate^® Strong Teeth with Cavity Protection (maximum 1,000 F as sodium MFP and triclosan). Subjects swished with 250 ml of orange juice over a 10 min period after each treatment and twice daily for the acidic erosive challenge. Enamel samples were measured for tooth surface loss using contact profilometry at baseline and day 10.

Results:

A total of 34 subjects were randomised to treatment; 32 subjects completed the final visit. Baseline profilometry measurements of the specimen surfaces were near zero within ± 0.3 μm, and no statistically significant difference (P > 0.48) on average was observed between the two test dentifrices. At day 10, the stannous-containing dentifrice demonstrated 88% less erosion (P < 0.0001) relative to the MFP/triclosan dentifrice. Estimated medians (95% confidence intervals) were 0.21 μm (0.17, 0.25) for the stannous-containing dentifrice versus 1.66 μm (1.39, 1.99) for the MFP/triclosan dentifrice. Both dentifrices were well-tolerated.

Conclusions:

Compared with MFP/triclosan toothpaste, a stabilised stannous-containing sodium fluoride dentifrice gave statistically significantly greater protection against tooth enamel surface loss in situ following repeated acid erosive challenge.

Association of erosion with timing of detection and selected risk factors in primary dentition: a longitudinal study

OBJECTIVE

The aims of this study were to determine the prevalence of erosion in a birth cohort at 24, 36, and 48 months and to investigate risk factors for erosion.

METHODS

One hundred and fifty-four children from a birth cohort were followed at 24, 36, and 48 months of age.

RESULTS

Of the 154 children examined, 0% (0/154), 7% (11/154), and 28% (40/154) had erosion detected for the first time at 24, 36, and 48 months, respectively (P < 0.001). A cumulative total of 51 (33%) children and 256 (8%) teeth had erosion by the age of 48 months. There were no significant associations between erosive lesions first detected at 36 months and oral hygiene behaviour, medical conditions, or dietary habits reported at the 24- or 36-month examinations (all P > 0.05). In contrast, erosive lesion first detected at 48 months was positively associated with the use of a feeding bottle reported at the 36-month examination (P = 0.026).

CONCLUSIONS

The prevalence of dental erosion in young children increased with age, with clinically detectable lesions forming between 24 and 36 months of age. Erosive lesions first detected at 48 months were positively associated with the use of a feeding bottle reported at 36 months.

Age-specific prevalence of erosive tooth wear by acidic diet and gastroesophageal reflux in Japan

OBJECTIVES

To evaluate the age-specific prevalence of erosive tooth wear in Japanese adults.

METHODS

The study sample consisted of a total of 1108 adults aged 15-89 yrs in Tokyo, Japan. The subjects were asked to complete a self-administered nutrition-related questionnaire. Two examiners evaluated tooth wear in a full-mouth recording, using a modified tooth wear index developed based on the Smith and Knight Tooth Wear index. Subjects who had frequent acid consumption or gastric reflux and at least one tooth with an initial enamel wear were placed in an erosive wear positive group, and the rest of subjects were placed in the erosive wear negative group.

RESULTS

The median (IQR) prevalence of erosion was 19.1 (1.8) at enamel level and 6.5 (3.7) with dentin exposure. There were statistical differences in prevalence of erosive wear among different age groups (p<0.05). Dietary habits found to be frequent in erosive wear positive group included acidic juices for younger subjects (15-39 yrs), and acidic fruits for older subjects (60-89 yrs). The prevalence of gastroesophageal reflux and eating disorder was 3.5%. A severe loss of dental tissue was observed on labial and incisal surfaces of anterior teeth in the erosive wear positive group.

CONCLUSIONS

In the studied sample of Japanese adults, 26.1% had signs of erosive wear.

CLINICAL SIGNIFICANCE

Erosive wear, in combination with abrasion and attrition, results in severe loss of tooth tissue. Frequent consumption of acidic fruits and drinks was significantly associated with erosive tooth wear at different age groups.

Dental caries and erosion status of 12-year-old Hong Kong children

Background

This study aimed to assess the dental caries and erosion status of 12-year-old Hong Kong children and study the determinants of dental caries and dental erosion of these children.

Methods

The survey was performed from 2011 to 2012 with ethics approval. Stratified random sampling was adopted to select 12-year-old children in 7 primary schools in Hong Kong. The participating parents were asked to complete a self-administered questionnaire concerning their children’s diet and oral health habits. The children were examined for caries status with WHO criteria by 3 calibrated examiners. Detection of dental erosion followed Basic Erosive Wear Examination (BEWE) criteria.

Results

A total of 704 children were recruited and 600 (316 boys, 53%) participated in the survey. There were 124 children (21%) with caries experience (DMFT > 0) and their DMFT was 0.34 ± 0.76. About half of their decay was unfilled (DT = 0.16 ± 0.52) The DMFT of girls and boys were 0.45 ± 0.89 and 0.23 ± 0.61, respectively (p = 0.001). Girls also had a higher DT (0.21 ± 0.62 compared with 0.11 ± 0.41, p = 0.013) and FT than boys (0.23 ± 0.63 compared with 0.12 ± 0.44, p = 0.016). Most children (75%) had at least some sign of erosion (BEWE > 0), but no severe erosion (BEWE = 3). Logistic regression showed girls who consumed soft drinks and took vitamin C supplements had higher caries risk. Dental erosion was more severe among the children who had caries experience and consumed fruit juice.

Conclusions

The 12-year-old Hong Kong children had low caries experience, and almost half of the decay was left untreated. Although severe erosion was not found, many children had early signs of erosion.

In Vitro Erosive Effect of Pediatric Medicines on Deciduous Tooth Enamel

This study evaluated, in vitro, the erosive potential of pediatric liquid medicines in primary tooth enamel, depending on the exposure time. Sixty deciduous incisors were randomly assigned to 4 groups (n=15), according to the immersion solutions: guaifenesin; ferrous sulfate; salbutamol sulfate and artificial saliva. The immersion cycles in the medicines were undertaken under a 1-min agitation, which wasperformed three times daily, during 28 days. Surface microhardness was measured at 7,14, 21 and 28 days. The titratable acidity and buffering capacity of the immersion media were determined. Data were analyzed by Analysis of Variance and Tukey's test (α=0.05). Salbutamol sulfate caused a gradual loss in enamel microhardness deciduous, observed at all times (p<0.005). Exposure to guaifenesin or ferrous sulfate resulted in significant decrease of enamel microhardness only after 28 days (p<0.005). In the control group (artificial saliva), microhardness did not changed (p>0.005) at any of the studied times. Scanning Electron Microscopy (SEM) images revealed that after 28 days the surfaces clearly exhibited structural loss, which was unlike those immersed in artificial saliva. Erosion of deciduous enamel was dependent on the type of medicine and exposure time.