A 4 year prospective longitudinal study of progression of dental erosion associated to lifestyle in 13-14 year-old Swedish adolescents

Intraoral scanner-based monitoring of tooth wear in young adults: 36-month results

OBJECTIVES

The study continues our longitudinal observation of wear aiming to further monitoring of progression and lesion morphology and to identify relationships with assumed aetiological factors.

MATERIALS AND METHODS

Molars (FDI #36 or #46) of 74 participants (23.8 ± 2.2 years) were scanned (Trios 3, 3Shape) at the third follow-up (T3; observation period 1,111 ± 10 days). Data sets from T3, T2 (24-month follow-up) and T1 (12-month follow-up) were superimposed with baseline in a 3D analysis software (GOM Inspect). Wear was quantified as maximum vertical tissue loss (µm; median, 95% CI) in various occlusal areas (4/5 cusps and 2 ridges). Morphologies were classified into cupping (C), facet (F), and combined cupping-facet (CF). Aetiological factors were assessed with questionnaires.

RESULTS

Wear increased at T3 significantly at low rates in all areas of the occlusal surface (median between 7.0 (4.0;10.5) and 9.5 (6.0;15.0) µm). There was a clear trend for higher loss values in males, but no association with other factors such as nutrition. C and CF showed significantly higher loss values than F. Areas without initial wear developed F first, which either persisted or developed into C and CF.

CONCLUSIONS

Wear continued at low rates with C/CF morphology and sex as significant factors. Cupped lesions seem to develop from facets and thus may not be a valid diagnostic criterion for erosive tooth wear.

CLINICAL RELEVANCE

Wear is a cumulative process that apparently follows complex mechanisms that cannot be conceptualized in simplified terms; C and CF may be indicators for higher progression rates.

Anamnestic risk factors for erosive tooth wear: Systematic review, mapping, and meta-analysis

OBJECTIVES

Erosive tooth wear is a multifactorial condition. The aim of this systematic review and meta-analysis was to identify key risk factors for erosive tooth wear in permanent dentition.

STUDY SELECTION

Observational studies reporting anamnestic risk factors for erosive tooth wear. Methodological quality and risk of bias were assessed using the modified Newcastle-Ottawa scale for cross-sectional studies. Risk factors were visually presented in a heatmap, and where possible, random-effects meta-analyses were performed for the odds ratios (ORs) of risk factors.

SOURCES

Electronic databases (MEDLINE, Embase, Scopus, and Web of Science) and manual searches in February 2023. The protocol was registered in PROSPERO (CRD4202339776).

DATA

A total of 87 publications reporting on 71 studies were included in the systematic review. The studies examined a variety of anamnestic risk factors (n = 80) that were categorized into ten domains (socio-demographics, socio-economics, general health, oral diseases, medication, oral hygiene, food, beverages, dietary habits, and leisure-related risk factors). Meta-analyses revealed significant associations between erosive tooth wear and male gender (padj.<0.001; OR=1.30, 95 % CI: 1.16-1.44), regurgitation (padj.=0.033; OR=2.27, 95 % CI: 1.41-3.65), digestive disorders (padj.<0.001; OR=1.81, 95 % CI: 1.48-2.21), consumption of acidic foods (padj.=0.033; OR=2.40, 95 % CI: 1.44-4.00), seasoning sauces (padj.=0.003; OR=1.28, 95 % CI: 1.13-1.44), nutritional supplements (padj.=0.019; OR=1.73, 95 % CI: 1.28-2.35), and carbonated drinks (padj.=0.019; OR=1.43, 95 % CI: 1.17-1.75). Most included studies exhibited low bias risk.

CONCLUSIONS

Observational studies investigated a variety of anamnestic risk factors for erosive tooth wear. Future studies should employ validated questionnaires, particularly considering the most important risk factors.

CLINICAL SIGNIFICANCE

Erosive tooth wear is a prevalent condition. Clinicians should concentrate primarily on symptoms of gastroesophageal reflux disease and dietary factors when screening patients at risk for erosive tooth wear.

Long-term occlusal tooth wear at the onset of permanent dentition

OBJECTIVES

This study quantified the long-term occlusal wear in the natural posterior teeth and the associations per tooth type within the dentition.

METHODS

The sample included 70 orthodontically treated subjects (52 females and 18 males; median age, 14.3 years), followed for a 12.7-year period. They were consecutively selected with no tooth wear-related criteria. Post-treatment (T1) and follow-up dental casts (T2) were scanned and superimposed through three-dimensional methods. Occlusal wear volume of posterior teeth and tooth wear patterns were investigated through non-parametric statistics and analysis of covariance.

RESULTS

There were no significant differences between contralateral teeth. The average occlusal wear per posterior tooth was 2.3 mm3, with 65.2% of teeth showing values greater than 1 mm3. Males, mandibular teeth, and first molars exhibited slightly greater wear levels than females (median, 2.57 and 2.21 mm3, respectively; p = 0.005), maxillary teeth, and first or second premolars, respectively. In all first premolars and in the mandibular second premolars, the buccal cusps were primarily affected with no other distinct patterns. There were weak to moderate correlations between tooth types, apart from certain strong correlations detected in males.

CONCLUSIONS

Posterior tooth wear was highly prevalent after a 13-year period starting at the onset of permanent dentition. The detected patterns are in accordance with the concept of canine guidance occlusion that is transforming into group synergy through function.

CLINICAL RELEVANCE

The widespread tooth wear occurrence and the high intra- and inter-individual variability underline the need for individual patient monitoring to identify high-risk patients at early stages.

Risk factors of tooth wear in permanent dentition: A scoping review

BACKGROUND

Tooth wear (TW) prevalence is high and increasing and has important consequences on the patient's quality of life. Knowledge of risk factors is crucial to promote diagnosis, prevention strategies and timely interceptive treatment. Many studies have identified TW risk factors.

OBJECTIVE

This scoping review aims to map and describe suspected available factors associated with TW in permanent dentition based on quantitative measurement.

METHODS

The scoping review was conducted using the PRISMA extension of the Scoping Reviews checklist. The search was conducted in October 2022 from the Medline® (PubMed® interface) and Scopus® databases. Two independent reviewers selected and characterised the studies.

RESULTS

2702 articles were identified for assessment of titles and abstracts, and 273 articles were included in the review. The results show a need to standardise TW measurement indices and the study design. The included studies highlighted various factors, classified into nine domains: sociodemographic factors, medical history, drinking habits, eating habits, oral hygiene habits, dental factors, bruxism and temporomandibular disorders, behavioural factors, and stress. Results related to chemical TW (erosion) risk factors underline the importance of eating disorders, gastroesophageal reflux and lifestyle, particularly drinking and eating behaviours, which supports developing public health information campaigns and interventions. Besides chemical, this review identifies evidence of several mechanical TW risk factors, such as toothbrushing and bruxism; the influence of this last factor needs to be further explored.

CONCLUSIONS

TW management and prevention require a multidisciplinary approach. Dentists are in the first line to detect associated diseases such as reflux or eating disorders. Consequently, practitioners' information and guideline diffusion should be promoted, and a TW risk factors checklist (the ToWeR checklist) is proposed to help diagnostic approaches.

Intraoral scanner-based monitoring of tooth wear in young adults: 24-month results

OBJECTIVES

Tooth wear causes irreversible cumulated surface loss and already occurs at a young age. Therefore, the objective of this clinical prospective observational study was to monitor the occlusal surface of a mandibular first molar in young adults for a period of 24 months. Furthermore, potential aetiological factors obtained by a questionnaire were considered.

MATERIALS AND METHODS

The study teeth (FDI #36 or #46) of 81 participants (mean age 22.8 ± 2.2 years) were scanned with the intraoral scanner (IOS, Trios 3, 3Shape) at the second follow-up (T2) after an observation period of 24 months. Standard-tessellation-language datasets were superimposed with baseline (T0) and T2 scans in 3D analysis software (GOM Inspect). The maximum vertical substance loss was measured between T0 and T2 at 6/7 areas (4/5 cusps and 2 ridges) of each study tooth and data compared to the already published data of the first follow-up (T1) after 12-month observation period. The morphology of tooth wear was classified into three groups: cupping (C), facet (F) and combined cupping-facet (CF). The analysis of aetiological factors, such as acid impacts, was based on a questionnaire filled out by participants at time points T0, T1 and T2. Non-parametric tests were used for statistical analysis (p < 0.05).

RESULTS

The buccal load-bearing cusps (mesiobuccal: median 15 μm, 95%CI 11/18 μm; mesiolingual 8 μm, 0/11 μm) were most affected by tooth wear. Loss values increased significantly at T2 compared to T1 for all areas, although significantly less than in the first 12 months (T0-T1). Areas that already exhibited F at T0 mostly displayed them also at T2 and only rarely developed further into C or CF. The only association between aetiological factors and loss values could be detected for sex as males had significantly higher loss values than females.

CONCLUSIONS

Progression of tooth wear could be clearly shown with high interindividual variations in loss values among participants. This indicates the need for individual monitoring with IOS.

CLINICAL RELEVANCE

IOSs show the potential for patient-specific monitoring to detect the progression of tooth wear. Thus, data of 24 months fills the gap of tooth wear data for young adults in literature. Further studies over a longer observation period are highly recommended to gain more information about the dynamic of tooth wear and aetiological factors.

Fluid Intake and the Occurrence of Erosive Tooth Wear in a Group of Healthy and Disabled Children from the Małopolska Region (Poland)

Background: The aim of this study was to analyse the relationship between the type and amount of fluid intake and the incidence of erosive tooth wear in a group of healthy children and children with disabilities. Methods: This study was conducted among children aged 6-17 years, patients of the Dental Clinic in Kraków. The research included 86 children: 44 healthy children and 42 children with disabilities. The prevalence of erosive tooth wear using the Basic Erosive Wear Examination (BEWE) index was assessed by the dentist, who also determined the prevalence of dry mouth using a mirror test. A qualitative-quantitative questionnaire on the frequency of consumption of specific liquids and foods related to the occurrence of erosive tooth wear, completed by the children's parents, was used to assess dietary habits. Results: The occurrence of erosive tooth wear was determined for 26% of the total number of children studied, and these were mostly lesions of minor severity. The mean value of the sum of the BEWE index was significantly higher (p = 0.0003) in the group of children with disabilities. In contrast, the risk of erosive tooth wear was non-significantly higher in children with disabilities (31.0%) than in healthy children (20.5%). Dry mouth was significantly more frequently identified among children with disabilities (57.1%). Erosive tooth wear was also significantly more common (p = 0.02) in children whose parents declared the presence of eating disorders. Children with disabilities consumed flavoured water or water with added syrup/juice and fruit teas with significantly higher frequency, while there were no differences in quantitative fluid intake between groups. The frequency and quantity of drinking flavoured waters or water with added syrup/juice, sweetened carbonated, and non-carbonated drinks were associated with the occurrence of erosive tooth wear for all children studied. Conclusions: The group of studied children presents inappropriate drinking behaviours regarding the frequency and amount of beverages consumed, which, especially in a group of children with disabilities, may contribute to the formation of erosive cavities.

The Suitability of Questionnaires for Exploring Relations of Dietary Behavior and Tooth Wear

Tooth wear is a relevant oral health problem, especially at a young age. Although ongoing acid exposures may contribute to tooth wear, the role of acidic dietary components in this context remains unclear. To date, in tooth wear studies, dietary behavior has been assessed using traditional questionnaires, but the suitability of this approach has not been investigated so far. In our longitudinal study, we followed 91 participants (21.0 ± 2.2 years) over a period of 1 year (373 ± 19 days) and monitored tooth wear with an intraoral scanner. At baseline (T0) and at the end (T1), we assessed dietary behavior with questionnaires asking about the consumption frequencies of acidic dietary components and the acid taste preferences. Complete data were available from 80 subjects. The consumption frequencies of T0 and T1 correlated weakly to moderately. Taste preferences seem to be a more consistent measure, but there was predominantly no significant correlation with the corresponding consumption frequencies. None of the dietary parameters showed a significant relation with tooth wear. The suitability of dietary questionnaires to assess tooth-relevant dietary behavior seems to be limited.

The association between erosive tooth wear and diet, hygiene habits and health awareness in adolescents aged 15 in Poland

Purpose

The aim of the study was to assess the prevalence of erosive tooth wear (ETW) and risk indicators in the population of adolescents aged 15 in Poland.

Methods

Erosive tooth wear in 2639 participants was determined by calibrated examiners according to the BEWE scoring system, and the prevalence of risk factors was assessed on the basis of a survey.

Results

Erosive tooth wear was reported in 24.3% of participants. Initial loss of surface (BEWE 1) was the predominant finding, observed in 21.3% of participants. Hard tissue loss (BEWE 2 and 3) occurred very rarely, only in 3% of participants. Acidic diet, masculine gender and lower socio-economic status were associated with higher prevalence and severity of erosive lesions in the examined population.

Conclusion

Two modifiable factors—acidic diet and low health awareness—were found to be highly unsatisfactory in the adolescents aged 15 in Poland. Accordingly, to prevent the deterioration of the functionality and aesthetics of the teeth in young people, certain measures, such as routine clinical examination, education, dietary consulting and prophylaxis, should be implemented as early as possible, focusing predominantly on families with lower socio-economic status.

Knowledge on and treatment practices of erosive tooth wear among Finnish dentists

OBJECTIVES

To investigate Finnish dentists' knowledge on and means of recording, detecting and diagnosing erosive tooth wear (ETW). Treatment options and possible differences in treatment decisions between general and specialized dentists were also evaluated.

MATERIALS AND METHODS

An electronic questionnaire was sent by e-mail to 3664 Finnish dentists. Respondents' gender, age, work experience, field of specialty, and practice location were requested. The questionnaire also included a patient case where the dentists were asked about their choice of treatment. Statistical analyses were performed using means, proportions, and cross tabulations.

RESULTS

Response rate was 24% (n = 866). Almost all respondents (98.0%) recorded ETW in patient files, but only 4.1% used a detailed scoring system. Of the respondents, 64.4% usually found the cause of ETW. Use of carbonated beverages (84.3%), energy drinks (57.0%), and reflux disease (53.1%) were reported to be probable causes. The majority of the respondents (80.9%) usually assessed patient's dietary history while 1.9% evaluated saliva secretion rate. When asked about treatment decisions of ETW patients, the differences between general dentists and specialized dentists were not as obvious as hypothesized.

CONCLUSIONS

This study suggests that the Finnish dentists who participated in this survey are able to detect and/or diagnose erosive tooth wear, but there is variation in recording it. The differences in treatment decisions between general dentists and specialized dentists seem to be moderate. The treatment practices for ETW are not established and further research to create clinical guidelines seems to be needed.

Prevalence and progression of erosive tooth wear among children and adolescents in a Swedish county, as diagnosed by general practitioners during routine dental practice

Objectives

To investigate the prevalence and four-year progression of erosive tooth wear (ETW) recorded in general dental practice, and to evaluate the usefulness of a simplified grading scale.

Methods

Four cohorts (aged 3, 7, 11 and 15 years at baseline; n = 735) were followed from 2008 to 2012 during their routine dental examinations. Grading of ETW was performed on permanent upper incisors and first molars, using the scales of Johansson et al. 1996 and Hasselkvist & Johansson 2010.

Results

Valid data were available for 641 individuals, 7-19-years of age, of whom 326 had data allowing analyses of progression. The prevalence of ETW increased with age, although at a lower level than in comparable studies. Progression was found in one-third of the subjects, with higher proportions and higher grades noted among the older cohorts. The simplified scale, that graded only four surfaces, resulted in just a few missed, mainly mild, cases of ETW.

Conclusions

Clinically significant signs of ETW and patterns of progression can be reliably detected if the erosion index used includes a few selected surfaces of permanent teeth as part of the routine dental examination. Early signs of ETW, however, seem to be more difficult to detect and evaluate.

Clinical significance

It is both possible and beneficial to introduce the diagnosing of ETW in routine dental examinations. To reduce the time involved in grading every patient, the simplified 4-surface application, seems to be a useful tool, but which is to be augmented with more extensive grading in individuals considered to be at risk.

Intraoral scanner-based monitoring of tooth wear in young adults: 12-month results

OBJECTIVES

To investigate tooth wear in young adults, intraoral scanning was used for digital monitoring of the mandibular first molar over 12 months. A possible influence of aetiological factors obtained by a questionnaire on tooth wear was investigated.

MATERIALS AND METHODS

A total of 109 participants (mean age at the start of the study: 21.0 ± 2.2 years) were included in this clinical study. At baseline (T0), an intraoral scan (Trios 3, 3Shape) of the study tooth (FDI # 36 or #46) was conducted. After a mean observation period of 373 ± 19 days, a second intraoral scan (T1, n = 94) of the same tooth as at T0 was performed and standard tessellation language datasets were superimposed with 3D analysis software (GOM Inspect). The occlusal surface of the study tooth was divided into 7 areas (5 cusps, 2 ridges) and maximum vertical substance loss was measured between T0 and T1 (n = 91). Three types of tooth wear were defined: cupping (C), facet (F) and combined cupping-facet (CF). Furthermore, a questionnaire on aetiological factors, such as dietary behaviour, was filled out at T0. Data were analysed with non-parametric tests (p < 0.05).

RESULTS

Only one study tooth exhibited no tooth wear at T0, whereas 3 teeth showed C, 47 teeth F and 40 teeth CF. A progression of vertical substance loss for all three types was shown. Most affected were the mesiobuccal cusps (43, 38/47 µm; median, 95%CI) followed by distobuccal (36, 33/39 µm), mesiolingual (35, 26/40 µm), distolingual (34, 27/36 µm) and distal (31, 25/34 µm). On mesial and distal ridges, only F was detected with the lowest vertical substance loss of all areas (mesial ridge: 0, 0/0 µm; distal ridge: 0, 0/0 µm). An association between aetiological factors and loss values could not be shown.

CONCLUSIONS

All study teeth showed clear signs of wear, and after only 1 year, further substance loss was detectable. This result is of significance for young adults.

CLINICAL RELEVANCE

Since data of young adults regarding tooth wear are scarce, the results give a first idea of the amount of vertical loss per year and its relation to aetiological factors such as dietary behaviour. Therefore, further studies over a longer observation period are highly recommended.

Longitudinal 3D Study of Anterior Tooth Wear from Adolescence to Adulthood in Modern Humans

Simple Summary

Tooth wear is the loss of tooth substance during everyday functioning by means other than dental caries. It is expected at a certain level in every person, and it increases with age. In the last decades, due to the increased life expectancy and high patient demands, it has become an important problem modern dentistry has to face. However, the average amount of tooth wear among individuals remains controversial. The purpose of this clinical study was to precisely detect the extent of anterior tooth wear over a thirteen-year period, from adolescence to adulthood. The present study revealed the very high tooth wear occurrence in the population already at early adulthood and showed that wear monitoring at an individual level is important for dentists to enable the better understanding of the problem and allow timely targeted interventions for patients in need. These might be preventive, such as the prescription of mouth guards to limit grinding and the cessation of harmful habits that lead to tooth wear, or interceptive, such as the restoration of the lost tooth substance to stop the progress of the condition and improve esthetics and function.

Abstract

In modern humans, tooth wear can easily be observed as a loss of tooth substance, but its precise measurement is problematic. The aim of this longitudinal cohort study was to determine the precise amount of occlusal tooth wear in the anterior permanent dentition from adolescence to adulthood. Corresponding tooth crowns from serial 3D digital dental models of 72 individuals were best fit-approximated by applying novel, highly accurate 3D superimposition methods. The superimposed crowns were simultaneously sliced on intact structures, and the differences in the volumes of the subsequent occlusal parts were calculated. Over a thirteen-year period, there was an average loss of anterior occlusal surfaces of 1.58 mm³ per tooth. Tooth surface loss in at least one tooth was higher than 1 mm³ in 93.1% of the human subjects. Tooth wear severity differed by sex and tooth type, with males showing higher values versus females and upper canines versus other anterior teeth. The study revealed the endemic occurrence of occlusal anterior tooth wear, highlighting the need for monitoring of the condition in the population to identify high-risk patients and enable timely interventions. The novel methods applied here on 3D digital models are recommended for this.

A systematic review of dietary acids and habits on dental erosion in adolescents

BACKGROUND

Dental erosion is the dissolution of dental hard tissues caused by acids of a non-bacterial origin. Dietary acids are considered the predominant and most controllable factor.

AIM

To synthesise the literature on the effects of dietary acids and habits on dental erosion in the permanent dentition of 10- to 19-year-old adolescents.

MATERIALS AND METHODS

An electronic literature search was undertaken in Cochrane, MEDLINE, CINAHL, Dentistry & Oral Sciences Source via EBSCOhost, and Embase with no restriction on the date of publication.

RESULTS

The initial search identified 449 articles, and 338 remained after removal of duplicates. Seventy-seven articles remained after screening of titles and abstracts, and 52 were eligible for the full-text review. A considerable variety of beverages, food, and dietary habits were reported as risk factors for dental erosion. The most consistent findings implicated the erosive potential of carbonated beverages and the consumption of acidic drinks at bedtime.

CONCLUSIONS

Although results were not consistent between cohort and cross-sectional studies, this review suggests certain dietary risk factors may contribute to dental erosion in adolescents. There is a need for more high-quality cohort studies to establish more conclusive evidence on the role of dietary acids and habits on dental erosion.

Quantitative tooth wear analysis of index teeth compared to complete dentition

OBJECTIVES

Recent software advancements have facilitated quantification of erosive tooth wear progression using intraoral scans. This paper investigated if wear on commonly affected surfaces (central incisors and first molars) was representative of wear on the full arch.

METHODS

Bimaxillary digital intraoral scans (True Definition, 3 M, USA) of patients (n = 30) from the monitoring arm of the Radboud Tooth Wear Project, were taken at baseline and at 3 years (+/-10months). The occlusal/incisal surface of each tooth (excluding 3rd molars) was analysed for volume change and volume change per mm of analysed surface area in WearCompare (www.leedsdigitaldentistry.com/Wearcompare) following previously published protocols. Data were normal, descriptives and multi-level linear regression analysis was performed in Stata v15.1 taking patient level and surface type data into account.

RESULTS

Data from 556 surfaces in 29 patients were included in analysis. Per patient, mean volume loss (95 % CI) was -0.91mm³(-1.28,-0.53) on all surfaces, -1.85mm³(-2.83,-0.86) on index surfaces, -2.53mm³(-3.91,-1.15) on molar surfaces and -0.83 mm³(-1.34,-0.31) on upper central incisal surfaces. Statistical differences were observed between analysing all surfaces and index teeth(p = 0.002) in addition to molar surfaces(p < 0.0001). Mean volume loss per mm² of surface analysed was -0.024 mm³ (-0.031,-0.017), -0.028mm³ (-0.041,-0.014), -0.030mm³ (-0.046,-0.013) and -0.025mm³ (-0.041,-0.010) for all surfaces, index surfaces, first molar surfaces and central incisor surfaces respectively with no statistical differences between groups.

CONCLUSIONS

Wear on upper central incisors was not statistically different to full arch wear analysis. If the surface area is standardised, wear on both index surfaces are statistically similar to wear on the full arch.

CLINICAL SIGNIFICANCE

These results suggest that analysing rates of wear on index teeth can be a resource-saving substitute for analysing rates of wear on the entire dentition, provided the surface area is standardised. If whole surfaces are analysed, the molar surfaces will show greater rates of wear.

Independent Variables of Dental Erosion among Tertiary Care Hospital Patients of a Developing Country

Background and Aim

Dental erosion is a multifactorial condition, which is mostly influenced by environmental factors. The aim of this study was to determine the prevalence of dental erosion, its associated risk factors, and their correlation with severity of the condition.

Materials and Methods

A total of 430 patients who attended the outpatient section of Government Dental College, Thiruvananthapuram, Kerala, India, were selected by systematic sampling method. Erosion was diagnosed by clinical examination and graded using Basic Erosive Wear Examination (BEWE) index. A pretested structured questionnaire on age, gender, medical history, medication history, and food habits was used.

Results and Conclusion

Among the study population, 44% (95% confidence interval, 39.3%-48.7%) had dental erosion. Age above 45 years (79.7%, P = 0.000), male population (50%, P = 0.032), residents of rural area (49.1%, P = 0.000), patients with asthma (84.2%, P = 0.000), diabetes (90.9%, P = 0.000), gastroesophageal reflux disorder (91.7%, P = 0.001), and frequent consumption of orange (68.9%, P = 0.000) were identified as factors associated with erosion. The prevalence of dental erosion in the community was high. Results of the study established that better awareness of the condition, better facilities for its early diagnosis in the community, and development of proper preventive strategies are required to reduce the severity of dental erosion.

Dietary assessment and counseling for dental erosion

BACKGROUND AND OVERVIEW

Dental erosion occurs after exposure to intrinsic or extrinsic acids. Exposure to intrinsic gastrointestinal acids is associated with anorexia nervosa, bulimia nervosa, rumination syndrome, or gastroesophageal reflux. Extrinsic dietary acids from foods or beverages also can cause erosion, particularly when exposure is prolonged by holding or swishing behaviors.

CONCLUSIONS

Clinicians should screen patients exhibiting dental erosion for anorexia nervosa, bulimia nervosa, rumination syndrome, and gastroesophageal reflux disease. Clinicians should screen patients without a medical explanation for their erosion for exposure to acidic foods and beverages, particularly for habits that prolong exposure.

PRACTICAL IMPLICATIONS

Identification of intrinsic and extrinsic acid exposures and recommendations to minimize exposures are important to prevent erosion and maintain oral health.

Antierosive Effect of Topical Fluorides: A Systematic Review and Meta-Analysis of In Situ Studies

BACKGROUND:

The effectiveness of the application of topical fluorides in prevention of erosive tooth wear has been an issue of controversy in the literature. The objective of this systematic review was to assess in situ studies investigating the effects of using topical fluorides on prevention of erosive tooth wear

MATERIAL AND METHODS:

Two electronic databases PubMed/MEDLINE and Cochrane Central Register of Controlled Trials were searched. Eligibility criteria included in situ-controlled studies that assessed the effect of the erosive process without additional tooth brushing. The search involved English-written articles only. A total of 684 potentially relevant titles and abstracts were found after removal of duplicates, of which 22 full-text articles were selected. Seventeen studies were included in the qualitative synthesis of which 6 studies included in the meta-analysis. The following data were obtained for each study: authors, year of publication, country, study design, periods of study, duration, blinding, interventions (type/concentration/form), tooth substrate, location of the intraoral appliance, number of samples attached to each appliance, type of acidic media used for erosive challenge, duration of erosive challenge, subjects (number/age/sex), reported side effects -if any-, measuring device, amounts of tissue loss.

RESULTS:

The risk of bias of the included studies was assessed using the Cochrane Collaboration tool for assessing the risk of bias. A meta-analysis of the present study was performed using Comprehensive Meta-Analysis version 2.2.048 software.

CONCLUSION:

The use of oral hygiene products containing AmF/NaF/SnCl2 or NaF may be effective in the prevention of erosive tooth wear.

Opinions and Treatment Decisions for Dental Erosive Wear: A Questionnaire Survey among Icelandic Dentists

Dental erosive wear (DEW) is common among children and adolescents, and a survey of Icelandic children showed that 30.7% of 15-year-olds were diagnosed with the condition. Objective. To gain knowledge about dental practitioners' experiences, opinions, and treatment decisions. Materials and Methods. A precoded questionnaire, previously used among Norwegian dentists, was sent electronically to all dentists in Iceland (n = 341). Results. The response rate was 64.2%, and 58% of dentists were male. More than half of the clinicians (54%) thought that prevalence had increased the last 10-15 years, and 67% reported it to be more common in male. Most (96%) recorded presence of DEW, but only 4% used a detailed scoring system. Lesions were mostly on occlusal surfaces of first mandibular molars (73%), on palatal in upper anterior teeth (61%), and on occlusal of maxillary first molars (36%). Most dentists (74%) reported a probable cause, e.g., high consumption of carbonated beverages (98%), acidic juices (68%), sport drinks (58%), reflux (54%), and eating disorders (20%). Dietary history was often recorded by 38%, and 65% never measured saliva. Most of the dentists (88%) treated patients themselves, and half of them preferred prevention with high fluoride and resin sealants. While some dentists wanted to restore teeth more invasively, most considered to restore with a filling. Conclusion. Icelandic dentists seem to be well educated for diagnosis and treatment of dental erosion, and dentists are aware of a minimally invasive approach. Clinical Significance. It is challenging for dentists to make the best treatment decision for patients with DEW, both in a short perspective and long perspective. At present, little is known about their knowledge and treatment approach, and there is no standard treatment which can be recommended. Therefore, the present study investigated dental practitioners' treatment decisions, as well as knowledge, experiences, and awareness of DEW.

Anti-erosive effect of calcium carbonate suspensions

Background

This study aimed to investigate the ability of different concentrations of calcium carbonate (CaCO3) suspensions to control enamel surface loss.

Material and Methods

Seventy-five enamel slabs were embedded, ground and polished in a pneumatic grinder-polisher machine. Reference areas were created with UPVC tape and the specimens were randomly allocated into five groups (n = 15) for exposure to hydrochloric acid solution to simulate gastric juice (0.01 M, pH 2) for 2 minutes. The samples were then exposed to suspensions containing 0.0001, 0.001, 0.01 or 0.1 mmol/L CaCO3 for 1 minute. Artificial saliva was used as control. The samples were subjected to a total of five erosive cycles followed by treatment with CaCO3 suspension. Surface loss was measured (in µm) using optical profilometry.

Results

One-way ANOVA (p = 0.009) and Tukey's test showed a significant reduction in surface loss when compared to the group not exposed to CaCO3 (0.74, +/- 0.23 µm), and the 0.01 mmol/L (0.40; +/- 0.23 µm) and 0.1 mmol/L suspensions (0.37; +/- 0.26 µm).

Conclusions

The lower concentrated suspensions were incapable of significantly reducing enamel surface loss. Rinsing with 0.01 and 0.1 mmol/L calcium carbonate suspensions was revealed as a potentially promising strategy to prevent enamel erosion. Key words:Tooth erosion, gastric acid, calcium carbonate, prevention and control.

Genome-Wide Association Study of Erosive Tooth Wear in a Finnish Cohort

Erosive tooth wear is defined as irreversible loss of dental tissues due to intrinsic or extrinsic acids, exacerbated by mechanical forces. Recent studies have suggested a higher prevalence of erosive tooth wear in males, as well as a genetic contribution to susceptibility to erosive tooth wear. Our aim was to examine erosive tooth wear by performing a genome-wide association study (GWAS) in a sample of the Northern Finland Birth Cohort 1966 (n = 1,962). Erosive tooth wear was assessed clinically using the basic erosive wear examination. A GWAS was performed for the whole sample as well as separately for males and females. We identified one genome-wide significant signal (rs11681214) in the GWAS of the whole sample near the genes PXDN and MYT1L. When the sample was stratified by sex, the strongest genome-wide significant signals were observed in or near the genes FGFR1, C8orf86, CDH4, SCD5, F2R, and ING1. Additionally, multiple suggestive association signals were detected in all GWASs performed. Many of the signals were in or near the genes putatively related to oral environment or tooth development, and some were near the regions considered to be associated with dental caries, such as 2p24, 4q21, and 13q33. Replications of these associations in other samples, as well as experimental studies to determine the biological functions of associated genetic variants, are needed.

Monitoring the progression of erosive tooth wear (ETW) using BEWE index in casts and their 3D images: A retrospective longitudinal study

OBJECTIVE

To determine if the Basic erosive tooth wear index (BEWE index) is able to assess and monitor ETW changes in two consecutive cast models, and detect methodological differences when using the corresponding 3D image replicas.

METHODS

A total of 480 pre-treatment and 2-year post-treatment orthodontic models (n = 240 cast models and n = 240 3D image replicas) from 120 adolescents treated between 2002 and 2013 at the Gent Dental Clinic, Belgium, were scored using the BEWE index. For data analysis only posterior sextants were considered, and inter-method differences were evaluated using Wilcoxon Signed Rank test, Kappa values and Mc Nemar tests (p < 0.05). Correlations between methods were determined using Kendall tau correlation test.

RESULTS

Significant changes of ETW were detected between two consecutive models when BEWE index was used to score cast models or their 3D image replicas (p < 0.001). A strong significant correlation (τb: 0.74; p < 0.001) was shown between both methods However, 3D image-BEWE index combination showed a higher probability for detecting initial surface changes, and scored significantly higher than casts (p < 0.001). Incidence and progression of ETW using 3D images was 13.3% (n = 16) and 60.9% (n = 56) respectively, with two subjects developing BEWE = 3 in at least one tooth surface.

CONCLUSIONS

BEWE index is a suitable tool for the scoring of ETW lesions in 3D images and cast. The combination of both digital 3D records and index, can be used for the monitoring of ETW in a longitudinal approach. The higher sensibility of BEWE index when scoring 3D images might improve the early diagnosis of ETW lesions.

CLINICAL SIGNIFICANCE

The BEWE index combined with digital 3D records of oral conditions might improve the practitioner performance with respect to early diagnosis, monitoring and managing ETW.

Effects of fluoride and epigallocatechin gallate on soft-drink-induced dental erosion of enamel and root dentin

BACKGROUND/PURPOSE

Fluoride and epigallocatechin gallate (EGCG) have been proven to prevent dental caries. The purpose of this study was to evaluate the effects of fluoride and EGCG on soft-drink-induced dental erosion in vitro.

METHODS

Forty enamel and dentin specimens were prepared from extracted human teeth. The specimens were divided into 4 groups and treated separately with distilled water (as control), 0.5 M sodium fluoride (NF), 400 μM EGCG (EG), and a solution containing 0.5 M NaF and 400 μM EGCG (FG). Cyclic erosive treatment was performed according to the experimental procedures. The specimens were analyzed using laser scanning confocal microscopy, scanning electron microscopy, and a microhardness tester. The data were analyzed using ANOVA and Bonferroni's post hoc test. The significance level was set at 5%.

RESULTS

The amount of substance loss was lower in the NF and EG groups than in the control group (p < 0.05). The erosion-caused substance loss was more pronounced in the dentin than in the enamel specimens. Surface microhardness loss was lower in the NF and EG groups than in the control group (p < 0.05). The diameter of the dentinal tubule was wider in the control group than in the NF and EG groups (p < 0.05). No combined effects were observed in the FG group.

CONCLUSION

Both fluoride and EGCG are effective in preventing soft-drink-induced erosion compared with the control group. Fluoride and EGCG may interfere with each other. The mechanisms of the anti-erosive effect need to be explored in the future.

Dental erosion, prevalence and risk factors among a group of adolescents in Stockholm County

Aims

To investigate the prevalence and risk factors of dental erosion (DE) among a group of adolescents in Stockholm County.

Materials and methods

This cross sectional cohort study was conducted at three clinics of the Public Dental Service in Stockholm County. Fifteen and 17 year old adolescents (1335) who scheduled their regular dental health examination were asked to participate. After drop-outs a sample of 1071 individuals, 547 males and 524 females were enrolled in the study. Presence of erosive wear was diagnosed (yes/no) on marker teeth by trained dentists/dental hygienists and photographs were taken. The adolescents answered a questionnaire regarding oral symptoms, dietary and behavioural factors. Two calibrated specialist dentists performed evaluation of the photographs for severity of DE using a modified version of the Simplified Erosion Partial Recording System (SEPRS).

Results

DE was clinically diagnosed in 28.3% of 15 years old and 34.3% of 17 years old. Severe erosive wear (grade 3 and 4 according to SEPRS) was found in 18.3% of the adolescents based upon the intra-oral photographs. DE was more prevalent and severe among males than females. Clinically diagnosed erosive lesions correlated significantly with soft drink consumption (p < 0.001), the use of juice or sport drinks as a thirst quencher after exercise (p = 0.006) and tooth hypersensitivity when eating and drinking (p = 0.012). Furthermore, self-assessed gastric reflux was a factor strongly associated with DE (p < 0.001).

Conclusion

The study indicated that DE was common among adolescents in Stockholm County and associated with both internal and external risk factors.

The Influence of Behavioural and Sociodemographic Risk Indicators on Erosive Tooth Wear in Flemish Adolescents, Belgium

Although Belgium has recently been ranked as the second highest consumer of soft drinks in Europe, no data on erosive tooth wear (ETW) are currently available. Therefore, the aim of this cross-sectional study was to determine the prevalence and associated risk indicators of ETW in adolescents residing in the region of Flanders, Belgium. Convenience sampling was used to recruit participants from different types of Belgian schools: general and vocational/technical education. Three calibrated dentists performed the dental examinations and a self-reported questionnaire was applied to evaluate risk indicators related with ETW. ETW was classified using the Basic Erosive Wear Examination (BEWE) index, and the overall prevalence was calculated using BEWE sum >0. The Kruskal-Wallis test, the Mann-Whitney U test, and logistic regression analysis were performed to evaluate frequencies and risk associations. From a total of 613 recruited adolescents (mean age: 15.1 years, SD: 0.8), 48.6% presented at least one affected tooth surface by ETW (BEWE sum >0), 14.4% (n = 88) scored BEWE sum >2, and the highest score obtained was BEWE sum = 8. Two predictive variables were found to have an association with ETW: vocational/technical type of education (OR: 1.49; 95% CI: 1.03-2.13) and frequent consumption of soft drinks (OR: 2.08; 95% CI: 1.38-3.14). In conclusion, ETW is a common condition presented with low severity among Flemish adolescents. Additionally, the frequent consumption of soft drinks and being part of a vocational/technical education appear to be risk indicators for ETW in this population. The latter indicates the need for specific orientated oral health promotion programmes for the prevention of ETW in Flemish adolescents.

Longitudinal study of gastroesophageal reflux and erosive tooth wear

Background

Approximately 60% of patients presenting to dentists with erosive tooth wear have significant gastroesophageal reflux (GERD), despite minor reflux symptoms. No longitudinal studies of reflux-associated erosive tooth wear and of reflux characteristics have been reported to date.

The aim of this study was to characterize the longitudinal course of GERD and of associated erosive tooth wear, as well as factors predictive of its progression, in a large group of patients.

Methods

Seventy-two patients presenting to dentists with clinically significant erosive tooth wear and increased esophageal acid exposure by 24-h multichannel intraluminal pH-impedance measurement (MII-pH) were re-assessed clinically and by MII-pH after 1 year treatment with esomeprazole 20 mg twice-daily. Predictive factors for erosive tooth wear were assessed by logistic regression.

Results

At follow-up, no further progression in erosive tooth wear was observed in 53 (74%) of patients. The percentage of time with a pH < 4, the number of acid reflux episodes and the percentage of proximal esophageal reflux off-PPI did not change significantly after one year, but the number of weakly acidic reflux episodes decreased significantly in the large subgroup without progression. None of the baseline demographic, clinical, endoscopic or esophageal acid exposure characteristics were significantly associated with progression of erosive tooth wear at follow-up.

Conclusions

In this longitudinal study in patients with erosive tooth wear and oligosymptomatic GERD receiving esomeprazole for one year, erosive tooth wear did not progress further in the majority of patients. Background acidic esophageal reflux exposure appeared stable over time, whereas weakly acidic exposure decreased significantly in patients without erosion progression. MII-pH measurements on-PPI and with healthy controls will be useful in the further elucidation of the causal role of reflux in erosive tooth wear.

Trial registration

ClinicalTrials.gov, retrospectively registered: NCT02087345.

Dental erosion among South Brazilian adolescents: A 2.5-year longitudinal study

OBJECTIVES

This population-based longitudinal study investigated the incidence, progression and risk factors for dental erosion among South Brazilian adolescents.

METHODS

Eight hundred and one schoolchildren attending 42 public and private schools were clinically examined at 12 years of age; clinical examinations were repeated after 2.5 years (SD=0.3). After tooth cleaning and drying, permanent incisors and first molars were classified using the Basic Erosive Wear Examination (BEWE) scoring criteria. Questionnaires were used to collect data on socio-demographic characteristics, dietary habits, toothbrushing frequency and general health. Poisson regression analysis was used to assess the association between dental erosion incidence and explanatory variables, with adjusted incidence risk ratios (IRR) and 95% CI estimated.

RESULTS

Among those who did not have dental erosion at baseline, 49 of 680 schoolchildren (7.1%; 95% CI=5.2-9.1) developed erosive lesions over the follow-up period. Among schoolchildren who had dental erosion at baseline, 31 of 121 (25.4%; 95% CI=17.6-33.3) had new or more severe lesions. Boys were more likely to develop dental erosion than girls (IRR=1.88; 95% CI=1.06-3.32).

CONCLUSIONS

A moderate incidence of dental erosion was observed among South Brazilian adolescents, with boys being at higher risk. The high progression rate of 25% observed here is very concerning, and it should be taken in consideration when designing preventive strategies for dental erosion.

Dental erosion in groups of Yemeni children and adolescents and the modification of an erosion partial recording system

BACKGROUND

The prevalence of dental erosion is rising especially among children and adolescents and its grading needs further investigation.

AIMS

To determine the prevalence and severity of dental erosion in groups of Yemeni children and adolescents, and to clinically compare an erosion partial recording system (EPRS) with a proposed modified-simplified version (EPRS-M).

DESIGN

Of 6163 individuals aged 5-6, 13-14 and 18-19 years, 911 were randomly selected, of which 668 participated in the study. Dental erosion was graded using EPRS. EPRS-M was proposed, and its sensitivity and specificity was calculated in relation to EPRS.

RESULTS

Prevalence of erosion extending into dentine on at least one tooth was 6.8% among 5- to 6-year-olds, 3.0% among 13- to 14-year-olds and 14.6% among 18- to 19-year olds. The highest prevalence was 19.2% among girls aged 18-19 years which was significantly higher than boys (10.4%) in the same age group (P = 0.044). Sensitivity and specificity for EPRS-M in relation to EPRS were 85.7% and 100% for primary teeth, and 84.1% and 100% for permanent teeth.

CONCLUSIONS

Dental erosion was common among children and older teenagers and highest among older girls but less common among younger teenagers. The tested accuracy of EPRS-M qualifies it to be used as an initial quick detection tool in future dental erosion research.

Surface-Sensitive Microwear Texture Analysis of Attrition and Erosion

Scale-sensitive fractal analysis of high-resolution 3-dimensional surface reconstructions of wear patterns has advanced our knowledge in evolutionary biology, and has opened up opportunities for translatory applications in clinical practice. To elucidate the microwear characteristics of attrition and erosion in worn natural teeth, we scanned 50 extracted human teeth using a confocal profiler at a high optical resolution (X-Y, 0.17 µm; Z < 3 nm). Our hypothesis was that microwear complexity would be greater in erosion and that anisotropy would be greater in attrition. The teeth were divided into 4 groups, including 2 wear types (attrition and erosion) and 2 locations (anterior and posterior teeth; n = 12 for each anterior group, n = 13 for each posterior group) for 2 tissue types (enamel and dentine). The raw 3-dimensional data cloud was subjected to a newly developed rigorous standardization technique to reduce interscanner variability as well as to filter anomalous scanning data. Linear mixed effects (regression) analyses conducted separately for the dependent variables, complexity and anisotropy, showed the following effects of the independent variables: significant interactions between wear type and tissue type ( P = 0.0157 and P = 0.0003, respectively) and significant effects of location ( P < 0.0001 and P = 0.0035, respectively). There were significant associations between complexity and anisotropy when the dependent variable was either complexity ( P = 0.0003) or anisotropy ( P = 0.0014). Our findings of greater complexity in erosion and greater anisotropy in attrition confirm our hypothesis. The greatest geometric means were noted in dentine erosion for complexity and dentine attrition for anisotropy. Dentine also exhibited microwear characteristics that were more consistent with wear types than enamel. Overall, our findings could complement macrowear assessment in dental clinical practice and research and could assist in the early detection and management of pathologic tooth wear.

The Prevalence of Tooth Wear in the Dutch Adult Population

This study aimed to assess the prevalence of tooth wear in different age groups of the Dutch adult population and to determine this tooth wear distribution by gender, socioeconomic class, and type of teeth. Results were compared with the outcomes of a previous study in a comparable population. As part of a comprehensive investigation of the oral health of the general Dutch adult population in 2013, tooth wear was assessed among 1,125 subjects in the city of 's-Hertogenbosch. The data collected were subjected to stratified analysis by 5 age groups (25-34, 35-44, 45-54, 55-64, and 65-74 years), gender, socioeconomic class, and type of teeth. Tooth wear was assessed using a 5-point ordinal occlusal/incisal grading scale. The number of teeth affected was higher in older age groups. Men showed more tooth wear than women, and subjects with low socioeconomic status (low SES) showed on average higher scores than those with high SES. Tooth wear prevalence found in this study was higher in all age groups than in the previous study. The present study found prevalences of 13% for mild tooth wear and 80% for moderate tooth wear, leading to the conclusion that these are common conditions in the Dutch adult population. Severe tooth wear (prevalence 6%) may however be characterized as rare. A tendency was found for there to be more tooth wear in older age groups, in men as compared with women, in persons with lower SES, and in the present survey as compared with the previous one.

Association of erosive tooth wear and dental caries in Northern Finland Birth Cohort 1966 - an epidemiological cross-sectional study

BACKGROUND

The main aim of this cross-sectional study was to investigate the prevalence and severity of erosive tooth wear and its association with dental caries and socio-demographic factors among middle-aged Finnish adults.

METHODS

Of the total Northern Finland Birth Cohort 1966 (n = 12,058), a convenience sample (n = 3181 adults) was invited for an oral health examination of which 1962 (61.7 %) participated, comprising the final study group. Clinical examinations were carried out by trained and calibrated dentists. Erosive tooth wear was assessed by sextants using the Basic Erosive Wear Examination Index (BEWE, 0-18) and dental caries at surface level using the ICDAS criteria (0-6). Socio-demographic data were obtained from a postal questionnaire. A logistic regression model was generated to test the association of the variables.

RESULTS

The prevalence of erosive tooth wear was 75 % and the mean of the BEWE sum score was 3.4 (SD 3.30). Almost half of the members needed non-invasive or invasive measures to prevent further progression of the condition. Of those with erosive lesions, 14.6 % suffered from severe erosive tooth wear. There was a strong positive relationship between the presence of severe erosive tooth wear (BEWE sum score ≥9) and male gender and restorative treatment need.

CONCLUSIONS

Erosive tooth wear is a common finding in Finnish adult population; almost one in ten suffer from severe erosive tooth wear. Restorative treatment need seems to be associated with severe erosive tooth wear.

Assessment of the amount of tooth wear on dental casts and intra-oral photographs

Tooth wear is a multifactorial condition, leading to the loss of dental hard tissues. Many grading scales are available to assess the amount of tooth wear, one of which is the tooth wear evaluation system (TWES). A grading scale can be used chairside, on casts and on photographs. The aim was to test whether the grading scales of the TWES, used on casts and on photographs, resulted in comparable scores. In addition, it was tested whether these scales can be used to assess tooth wear reliably on photographs. Of 75 tooth wear patients, sets of casts and series of photographs were obtained and graded. Comparison of the grading on casts and on photographs revealed equal median values and percentiles for both occlusal/incisal grading and non-occlusal/non-incisal grading. The grading on casts and on photographs showed a high correlation for the occlusal/incisal grading and a low correlation for the non-occlusal/non-incisal grading (Spearman's rho = 0·74 and rho = 0·47; P < 0·001). Concerning the grading on photographs, the interexaminer reliability was fair-to-good (ICC = 0·41 to ICC = 0·55) while the intra-examiner reliability was fair-to-good to excellent (ICC = 0·68 to ICC = 0·86) for the occlusal/incisal grading. For the non-occlusal/non-incisal grading, the interexaminer reliability was poor to fair-to-good (ICC = 0·22 to ICC = 0·59), while the intra-examiner reliability was fair-to-good to excellent (ICC = 0·64 to ICC = 0·82). It was concluded that the scores obtained with the grading scales of the TWES on casts and on photographs are comparable. The grading scales can be used in a reliable way on photographs, which is especially the case for occlusal/incisal grading.