The problem with an epidemiological index for dental erosion

A Systematic Review Evaluating Methods for Diagnosis, Treatment and Prevention of Dental Erosions

AIM

The aim of this systematic review was to investigate the quality of evidence for methods used to diagnose, restore and prevent dental erosions, by evaluating and summarising clinical controlled studies and in situ studies covering this field.

MATERIAL AND METHODS

Three databases, PubMed, Embase and Cochrane database, were searched for studies published until October 2023. Studies fulfilling the selection criteria were selected, and the risk of bias of the included studies was assessed. Two authors independently reviewed the studies, evaluated their risk of bias and extracted data from the included studies. The certainty of evidence of the findings in the studies was determined using GRADE.

RESULTS

The literature search identified 7176 records. Out of these, 19 studies were included in this review, three revolving diagnostics, three revolving treatment and 13 revolving prevention. However, due to the fact that only few studies with a small number of participants have investigated the same methods on the same outcome, the studies do not constitute any body of evidence.

CONCLUSION

This systematic review highlights the shortage of data on methods used for diagnostics, restorative treatment and prevention of dental erosions. More knowledge is needed to strengthen the scientific evidence regarding methods used for dental erosions.

Dental care staff's experience with risk assessment of dental erosion: a qualitative study

BACKGROUND

The risk assessment of dental erosion among children and adolescents is an important aspect of dental care, as dental erosion constitutes a rapidly growing, global problem. Dental professionals rely solely on their own perception, as the current risk assessment process is not completely automatized, which affects the risk assessment reliability.

AIM

To explore dental professionals' experiences with risk assessment of dental erosion among children and adolescents.

METHOD

In-depth interview was used as data collection method. A total of 11 dental professionals were interviewed. The interviews were analyzed using qualitative content analysis.

RESULTS

The findings were summarized in the categories Professionals' responsibility, Systematic approach , and Collaboration and communication. Dental staff perceived that their basic knowledge regarding erosion should be improved, and skills development was desired to reduce the knowledge gaps around the risk assessment of dental erosion. They alleged that the systematic approach could be improved by reducing workplace stress, implementing a universal dental erosion index, improving the existing risk assessment software, and automating the risk assessment of the condition. Dental professionals also experienced a need to calibrate and collaborate with each other and with other healthcare professionals to improve patient care.

CONCLUSION

Dental professionals experienced their basic knowledge of dental erosion and their risk assessment as good, but a more advanced skill development was required. Furthermore, they experienced the risk assessment software as a good tool that should be improved to compile more objective risk assessment. A universal erosion index was also requested.

Application of the Intraoral Scanner in the Diagnosis of Dental Wear: An In Vivo Study of Tooth Wear Analysis

In recent years, there has been an increase in the incidence of dental wear; thus, an early diagnosis is important. Conventional methods of diagnosis are based primarily on the visual abilities of the dentist, and therefore the use of new technologies for the detection of dental wear may be very useful. The aim of the study was to analyze the sensitivity and specificity of the intraoral scanner for measuring dental wear, as well as to evaluate patients' satisfaction with the use of the scanner. The study was conducted with 46 volunteers who underwent three intraoral analyses: a first baseline scanning, a second scanning after 6 months and a final scanning after one year performed by four operators divided into two groups. One of the operators performed the visual analysis of dental wear, and the other performed the analysis using the intraoral scanner 3M™ True Definition intraoral scanner (ESPE, Seefeld, Germany). The data obtained from the intraoral scanner showed levels of specificity and sensitivity that enable the intraoral scanner to be used as a diagnostic tool in the assessment of tooth wear. The participants also showed a high degree of satisfaction with the scanner as a communication tool.

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.

Dental erosion in French adolescents

Background

Since the 2000s, different epidemiological studies focusing on the prevalence or the aetiology of DE in adolescents recognised them as an at-risk population due to their eating behaviours. None was carried out in French adolescents.

The primary objective of this study was to assess the prevalence of dental erosion (DE) using the total BEWE score among adolescents in the department of Alpes Maritimes, France. The secondary objectives were to observe changes in prevalence estimates depending on both the cutoffvalue of total BEWE score with different teeth/dental surfaces examined, and to identify the related risk factors.

Methods

A cross-sectional study in a multistage random sample of 339 14-yr-old schoolchildren was carried out in 2014. The children completed a self-administered questionnaire concerning diet and oral habits. Caries was assessed with ICDAS-II (International Caries Detection and Assessment System-II) criteria and erosion with BEWE (Basic Erosive Wear Examination) index. The total BEWE score was calculated to assess the DE prevalence with two cutoff values (3 and 1). Data were analysed using descriptive statistics and logistic regression models.

Results

The 331 children were aged 14.4 ± 0.5 years. The DE prevalence was 39 % using a total BEWE score ≥ 3. With a cutoff total BEWE score of 1 (at least one affected tooth), the prevalence varied from 3.9 to 56.8 % depending on the teeth/surfaces that were used for the analysis. The DE prevalence, assessed with only first molars and maxillary incisors, was about 54 %. The risk factors for DE (total BEWE score ≥ 3) were daily consumption of acidic beverages (OR: 4.0; 95 % CI: 2.1–7.6) and acidic sweets (OR: 3.2; 95 % CI: 1.2–8.0), low socio economic category (OR: 2.4; 95 % CI: 1.1–5.0) and visible dental biofilm (OR: 2.0; 95 % CI: 1.2–3.4).

Conclusion

Depending on the method chosen, the prevalence varied from 3.9 to 56.8 % among these adolescents. Thus, a consensus on choice of index, teeth to examine and age at assessment is necessary to standardise measurement of DE prevalence.

The tooth wear evaluation system: a modular clinical guideline for the diagnosis and management planning of worn dentitions

Tooth wear is a multifactorial condition, leading to the loss of dental hard tissues, viz. enamel and dentine. Tooth wear can be divided into the subtypes mechanical wear (attrition and abrasion) and chemical wear (erosion). Because of its multifactorial aetiology, tooth wear can manifest itself in many different representations, and therefore, it can be difficult to diagnose and manage the condition. A systematic approach is a sine qua non. In the below-described tooth wear evaluation system (TWES), all necessary tools for a clinical guideline are present in different modules. This allows the dental clinician, in a general practitioner setting as well as in a referral practice setting, to perform a state-of-the-art diagnostic process. To avoid the risk of a too cumbersome usage, the dental clinician can select only those modules that are appropriate for a given setting. The modules match with each other, which is indispensable and essential when different modules of the TWES are compared. With the TWES, it is possible to recognise the problem (qualifying), to grade its severity (quantifying), to diagnose the likely causes and to monitor (the progress of) the condition. In addition, a proposal for the classification of tooth wear is made. Further, it is possible to determine when to start a treatment, to make the decision which kind of treatment to apply and to estimate the level of difficulty of a restorative treatment.

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.

Dental erosion and its growing importance in clinical practice: from past to present

Since the mid-1990s, the focus of studies on tooth wear has steadily shifted from the general condition towards the more specific area of dental erosion; equally, a shift has occurred from studies in adults to those in children and adolescents. During this time, understanding of the condition has increased greatly. This paper attempts to provide a critical overview of the development of this body of knowledge, from earlier perceptions to the present. It is accepted that dental erosion has a multifactorial background, in which individual and lifestyle factors have great significance. Notwithstanding methodological differences across studies, data from many countries confirm that dental erosion is common in children and young people, and that, when present, it progresses rapidly. That the condition, and its ramifications, warrants serious consideration in clinical dentistry, is clear. It is important for the oral healthcare team to be able to recognize its early signs and symptoms and to understand its pathogenesis. Preventive strategies are essential ingredients in the management of patients with dental erosion. When necessary, treatment aimed at correcting or improving its effects might best be of a minimally invasive nature. Still, there remains a need for further research to forge better understanding of the subject.