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Ashley M, Leven AJ. The opinions of GDPs on the challenges of managing tooth wear in primary dental care. Br Dent J 2023; 234:459-462. [PMID: 36964377 PMCID: PMC10037362 DOI: 10.1038/s41415-023-5582-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/15/2023] [Accepted: 01/18/2023] [Indexed: 03/26/2023]
Abstract
As patients access most of their dental care within the primary care setting, it is relevant to consider how the experience and opinions of general dental practitioners (GDPs) influence the diagnosis, monitoring and treatment of their patients with tooth wear. This paper records the agreed outcomes of semi-structured discussions with three experienced GDPs. The aim is to continue the broader debate about how patients with tooth wear currently are and ideally could be managed within the primary care settings in England. The outcomes are also likely to be applicable to other countries, regardless of the local funding models for routine patient care.
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Affiliation(s)
- Martin Ashley
- Consultant and Honorary Professor in Restorative Dentistry and Oral Health, University Dental Hospital of Manchester, Manchester, UK.
| | - A Johanna Leven
- Consultant in Restorative Dentistry, University Dental Hospital of Manchester, Manchester, UK
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Calvert G, Cocozza PG, Elsayed Ahmed K. Clinical factors to consider in definitive treatment planning for patients with tooth wear. Br Dent J 2023; 234:375-384. [PMID: 36964358 DOI: 10.1038/s41415-023-5618-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 01/25/2023] [Accepted: 01/28/2023] [Indexed: 03/26/2023]
Abstract
Diagnosis, disease control and prevention are the precursors to successful definitive restorative treatment of pathological tooth wear. This case series illustrates how proposed key clinical features can influence treatment complexity and provide the clinician with a logical sequence of treatment options for definitive management of tooth wear.
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Affiliation(s)
- Gareth Calvert
- Glasgow Dental Hospital and School, Department of Restorative Dentistry, Glasgow, G2 3JZ, UK
| | - Paul Guerino Cocozza
- Glasgow Dental Hospital and School, Department of Restorative Dentistry, Glasgow, G2 3JZ, UK.
| | - Khaled Elsayed Ahmed
- School of Medicine and Dentistry, Griffith University, Queensland, 4215, Australia
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Avila V, Díaz-Báez D, Beltrán EO, Castellanos J, Martignon S. Validation of an erosive tooth wear risk factors questionnaire for adolescents. Clin Oral Investig 2022; 26:3573-3584. [DOI: 10.1007/s00784-021-04325-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/27/2021] [Indexed: 11/03/2022]
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Lieffers JRL, Vanzan AGT, Rover de Mello J, Cammer A. Nutrition Care Practices of Dietitians and Oral Health Professionals for Oral Health Conditions: A Scoping Review. Nutrients 2021; 13:3588. [PMID: 34684589 PMCID: PMC8539677 DOI: 10.3390/nu13103588] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/02/2021] [Accepted: 10/02/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Oral health conditions, such as dental caries, pose a substantial burden worldwide. Although there are many risk factors for poor oral health, diet is often implicated as a cause of these issues. The purpose of this scoping review was to identify and map studies that have captured information on the "real-world" nutrition care practices of oral health professionals (OHPs) and dietitians to optimize oral health, and specifically the dentition and periodontium. METHODS A search of peer-reviewed articles was conducted using MEDLINE, CINAHL, and Embase. Articles that addressed the review objective and met the following criteria were included: English language, published since 2000, and study conducted in a high-income country. RESULTS Overall, 70 articles were included. Most articles reported on cross-sectional survey studies and provided self-reported data on OHP practices; few articles reported on dietitians. Most articles reported only general/unspecific information on assessment and intervention practices, such as dietary analysis, nutrition counselling, and diet advice, and lacked specific information about the care provided, such as the dietary assessment tools used, type of information provided, and time spent on these activities. Barriers to the provision of nutrition care by OHPs were common and included time and lack of remuneration. Few studies reported on collaboration between dietitians and OHPs. CONCLUSIONS Several studies have captured self-reported information on nutrition care practices of OHPs related to oral health; however, there is limited information available on the details of the care provided. Few studies have examined the practices of dietitians.
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Affiliation(s)
- Jessica R. L. Lieffers
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada; (A.G.T.V.); (J.R.d.M.); (A.C.)
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Kangasmaa H, Tanner T, Laitala ML, Mulic A, Kopperud SE, Vähänikkilä H, Anttonen V, Alaraudanjoki V. Knowledge on and treatment practices of erosive tooth wear among Finnish dentists. Acta Odontol Scand 2021; 79:499-505. [PMID: 33689559 DOI: 10.1080/00016357.2021.1896031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
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.
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Affiliation(s)
- Hanna Kangasmaa
- Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland
| | - Tarja Tanner
- Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland
- MRC, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Marja-Liisa Laitala
- Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland
- MRC, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Aida Mulic
- Nordic Institute of Dental Materials, NIOM, Oslo, Norway
| | | | - Hannu Vähänikkilä
- Faculty of Medicine, Infrastructure for Population Studies, University of Oulu, Oulu, Finland
| | - Vuokko Anttonen
- Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland
- MRC, Oulu University Hospital and University of Oulu, Oulu, Finland
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Mortensen D, Mulic A, Pallesen U, Twetman S. Awareness, knowledge and treatment decisions for erosive tooth wear: A case-based questionnaire among Danish dentists. Clin Exp Dent Res 2021; 7:56-62. [PMID: 33124776 PMCID: PMC7853886 DOI: 10.1002/cre2.339] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine the knowledge and experience of erosive tooth wear (ETW) among Danish dental practitioners and, based on two cases, explore their treatment decisions. METHODS We sent a validated questionnaire electronically to all active members of The Danish Dental Association and The Association of Public Health Dentists in Denmark. The questionnaire had two parts; the first focused on scoring, recordkeeping, knowledge and experience of ETW. The second part presented two patients with different severity of erosive lesions to explore the dentists preventive and restorative treatment decisions. RESULTS We received 442 answers from 4,490 potentially eligible dentists in Denmark (response rate 9.8%). The majority (78%) was female and the median age was 44 years. Nearly all respondents (97%) registered ETW in the charts and 49% recorded "always" or "often" the patients' diet history, most commonly with aid of interviews. The respondents perceived the prevalence of ETW to be higher today than 10-15 years ago and male patients (15-25 years) appeared more affected than females. The majority (82%) thought that they usually found the probable cause of the condition with carbonated beverages being the most common factor. The treatment included dietary guidance, soft tooth brushing with non-abrasive fluoride toothpaste, topical fluoride applications and direct composite restorations. CONCLUSION The majority of Danish dentists taking part of this survey had adopted a minimally invasive approach for the management of erosive tooth wear in young adults. There was however room for improvements in diagnosis, scoring and case documentation.
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Affiliation(s)
- Diana Mortensen
- Department of Odontology, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Aida Mulic
- Institute of Dental Materials (NIOM)OsloNorway
| | - Ulla Pallesen
- Department of Odontology, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Svante Twetman
- Department of Odontology, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
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Kanaan M, Brabant A, Hara AT, Carvalho JC. Diagnosis, risk assessment, and treatment decisions for tooth wear in daily practice: a case presentation survey among Belgian dentists. Eur J Oral Sci 2021; 129:e12764. [PMID: 33460476 DOI: 10.1111/eos.12764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 11/28/2022]
Abstract
This survey assessed the use of current concepts for tooth wear diagnosis, risk assessment, and treatment decisions in daily practice, and identified factors of significance for treatment decisions. A total of 104 dentists were presented with 10 cases representing varying degrees of tooth wear. The dentists were asked to answer six questions pertaining to the diagnosis, risk assessment, and treatment of each case. A benchmark was established by three experts and the agreement between dentists and the benchmark was calculated. At dentition level, the agreement was moderate for diagnosis (κ = 0.55) and risk assessment (κ = 0.54). At tooth/surface level, the agreement for clinical and radiographic severity of wear was moderate (κ = 0.57) and substantial (κ = 0.65), respectively. The agreement for treatment decision was fair (κ = 0.35). Multivariate logistic regression analysis showed that treatment decisions for operative treatment were associated with moderate to high case risk (OR = 10.1; 95% CI: 5.4-18.9). Belgian dentists performed reasonably well in applying current concepts and strategies for tooth wear diagnosis and risk assessments at dentition level, as well as for assessment of wear severity at tooth/surface level. Improvement is warranted concerning treatment decisions. This survey could be a useful tool for disseminating and improving current knowledge of tooth wear, and for training dentists in daily practice.
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Affiliation(s)
- Mireille Kanaan
- Faculty of Medicine and Dentistry, School of Dentistry, UCLouvain, Brussels, Belgium
| | - Alain Brabant
- Faculty of Medicine and Dentistry, School of Dentistry, UCLouvain, Brussels, Belgium
| | - Anderson T Hara
- School of Dentistry, Indiana University, Indianapolis, Indiana, USA
| | - Joana C Carvalho
- Faculty of Medicine and Dentistry, School of Dentistry, UCLouvain, Brussels, Belgium
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Bartlett D, O'Toole S. Tooth Wear: Best Evidence Consensus Statement. J Prosthodont 2020; 30:20-25. [PMID: 33350551 DOI: 10.1111/jopr.13312] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 11/24/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The purpose of this Best Evidence Consensus Statement was to evaluate the impact of wear on teeth. MATERIALS AND METHODS A search updated last on the 07th October 2020 using the terms tooth wear, dental erosion, dental abrasion or dental attrition yielded 11,694 results. Limiting the search to clinical trials, cross-sectional investigations, randomized controlled trials, reviews, systematic reviews and meta-analysis yielded 1,769 results. Mechanistic in vitro studies were also added to the list of abstracts supplying additional information of the impact of wear on teeth. All abstracts were reviewed by two authors. Those relating to the focus question formed the evidence base which was used to formulate the response. RESULTS From the search results, 212 articles were related to the research question and 60 were included in this paper. Although tooth wear prevalence is over 30% of the population in early adulthood and increases as individual's age, the impact on the dentition is poorly investigated in longitudinal clinical studies. Wear on teeth can result in alterations in shape and potentially dentine hypersensitivity depending on the etiology. However, the process is slow and pulpal death is rare. The impact that tooth wear has on the patient depends on patient characteristics to a greater extent than the severity of wear. CONCLUSIONS Tooth wear is a common condition and part of the ageing process. Erosive tooth wear is a term which acknowledges that acids are normally linked to progression, but mechanical actions of attrition and abrasion will cause visible damage. The changes to the shape of teeth on the macro and micro levels are used to investigate the progression, prevention, etiology, and management. The biological impact of wear on teeth is relatively innocuous and management is often a patient driven process. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- David Bartlett
- Professor of Prosthodontics, Head of Centre for Clinical Oral and Translational Sciences, Faculty of Dentistry, Oral & Craniofacial Sciences, Kings College London, UK
| | - Saoirse O'Toole
- Clinical Lecturer in Prosthodontics, Centre for Clinical, Oral and Translational Sciences, Faculty of Dentistry, Oral & Craniofacial Sciences, Kings College London, UK
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The impact of e-training on tooth wear assessments using the BEWE. J Dent 2020; 100:103427. [DOI: 10.1016/j.jdent.2020.103427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 11/21/2022] Open
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Mehta SB, Loomans BAC, Bronkhorst EM, Banerji S, Bartlett D. A study to investigate habits with tooth wear assessments among UK and non-UK dental practitioners. Br Dent J 2020; 228:429-434. [PMID: 32221446 DOI: 10.1038/s41415-020-1326-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Aim To assess the habits of tooth wear risk assessment and charting using a tooth wear index, by UK and non-UK dental practitioners.Design A questionnaire-based evaluation.Methods Three hundred and two completed questionnaires were returned and the outcomes analysed using descriptives, Chi-squared test and Fisher's exact test in SPSS. Significance was inferred at p <0.05.Results Based on a sample of 297 responses, 81% agreed to the need to undertake risk assessment for all dental patients attending for a first-time consultation. Fifty-nine percent undertook risk assessments for 'new patients' previously identified with signs of severe tooth wear. The routine use of a clinical index to perform tooth wear charting was described by 13.5%, with 5% documenting the frequent use of the BEWE tool. While specialist dental practitioners or those with further post-graduate training were more likely to use a tooth wear index (p <0.05), there were no other significant relationships between any of the variables in the sample and the practising habits assessed.Conclusion This investigation alludes to good levels of professional awareness of tooth wear. However, the need for improvement with the actual undertaking of risk assessments for tooth wear and consistency with tooth wear assessment and charting was determined. The need for appropriate professional guidance for the undertaking of tooth wear assessments is supported by the outcomes of this investigation.
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Affiliation(s)
- Shamir B Mehta
- Department of Dentistry, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands; King's College London Faculty of Dentistry, Oral & Craniofacial Sciences, Guy's Campus, London, MSc in Aesthetic Dentistry, UK.
| | - Bas A C Loomans
- Department of Dentistry, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Ewald M Bronkhorst
- Department of Dentistry, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Subir Banerji
- King's College London Faculty of Dentistry, Oral & Craniofacial Sciences, Guy's Campus, London, MSc in Aesthetic Dentistry, UK
| | - David Bartlett
- Head of Prosthodontics, King's College London Faculty of Dentistry, Oral & Craniofacial Sciences, Guy's Campus, London, UK
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O'Toole S, Lau JS, Rees M, Warburton F, Loomans B, Bartlett D. Quantitative tooth wear analysis of index teeth compared to complete dentition. J Dent 2020; 97:103342. [PMID: 32360512 DOI: 10.1016/j.jdent.2020.103342] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/11/2020] [Accepted: 04/13/2020] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Saoirse O'Toole
- Centre of Clinical Oral and Translational Sciences, King's College London Faculty of Dental, Oral and Craniofacial Sciences, Floor 17 Tower Wing, Guy's Hospital, London, SE1 9RT, UK.
| | - Jia Shang Lau
- King's College London Faculty of Dental, Oral and Craniofacial Sciences, Floor 25 Tower Wing, Guy's Hospital, London, SE1 9RT, UK.
| | - Morgan Rees
- King's College London Faculty of Dental, Oral and Craniofacial Sciences, Floor 25 Tower Wing, Guy's Hospital, London, SE1 9RT, UK.
| | - Fiona Warburton
- Statistics, The Oral Clinical Research Unit, Floor 25, Tower Wing, Guy's Hospital, London, SE1 9RT, UK.
| | - Bas Loomans
- Radboud University of Nijmegen, Ph. van Leydenlaan 25, 6525 EX, Nijmegen, Netherlands.
| | - David Bartlett
- Centre of Clinical Oral and Translational Sciences, King's College London Faculty of Dental, Oral and Craniofacial Sciences, Floor 25 Tower Wing, Guy's Hospital, London, SE1 9RT, UK.
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Campaign launched to drive routine screening for erosive tooth wear. Br Dent J 2019. [DOI: 10.1038/s41415-019-0689-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Bartlett D, Dattani S, Mills I, Pitts N, Rattan R, Rochford D, Wilson NHF, Mehta S, O’Toole S. Monitoring erosive toothwear: BEWE, a simple tool to protect patients and the profession. Br Dent J 2019; 226:930-932. [DOI: 10.1038/s41415-019-0411-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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