Prevalence of pathological tooth wear in patients with chronic alcoholism

Use of AUDIT-C alcohol screening tool in NHS general dental practices in North London

Background The numerous health risks of excessive alcohol consumption are well documented. Individuals at risk of harm from alcohol consumption can be identified through alcohol screening tools; however, there is limited research regarding their use in general dental practices.Methods Data were collected as part of a feasibility trial evaluating delivery of brief alcohol advice in general dental practices in North London. Patient demographics and health-related behaviours were collected, and the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) tool was used to assess alcohol consumption patterns.Results The analytical sample comprised 552 dental patients, of whom approximately half (46%) were drinking alcohol at hazardous levels. Males, younger adults, those who consumed red meat weekly and smokers all had significantly increased risks of excessive alcohol consumption. Smokers were more likely to consume excessive levels of alcohol irrespective of smoking frequency. Notable sex differences in alcohol consumption were identified, with males being more likely to consume alcohol frequently and in larger quantities than females.Conclusion The AUDIT-C tool can be used in general dental practice to screen for harmful levels of alcohol consumption. Clear associations exist between patient demographics, health behaviours and excessive alcohol consumption.

Alcohol Screening and Brief Advice in NHS General Dental Practices: A Cluster Randomized Controlled Feasibility Trial

AIM

To assess the feasibility and acceptability of screening for alcohol misuse and delivering brief advice to eligible patients attending NHS dental practices in London.

METHODS

A two-arm cluster randomized controlled feasibility trial was conducted. Twelve dental practices were recruited and randomized to intervention and control arms. Participants attending for a dental check were recruited into the study and were eligible if they consumed alcohol above recommended levels assessed by the AUDIT-C screening tool. All eligible participants were asked to complete a baseline socio-demographic questionnaire. Six months after the completion of baseline measures, participants were contacted via telephone by a researcher masked to their allocation status. The full AUDIT tool was then administered. Alcohol consumption in the last 90 days was also assessed using the Form 90. A process evaluation assessed the acceptability of the intervention.

RESULTS

Over a 7-month period, 229 participants were recruited (95.4% recruitment rate) and at the 6 months follow-up, 176 participants were assessed (76.9% retention rate). At the follow-up, participants in the intervention arm were significantly more likely to report a longer abstinence period (3.2 vs. 2.3 weeks respectively, P = 0.04) and non-significant differences in AUDIT (44.9% vs. 59.8% AUDIT positive respectively, P = 0.053) and AUDIT C difference between baseline and follow-up (-0.67 units vs. -0.29 units respectively, P = 0.058). Results from the process evaluation indicated that the intervention and study procedures were acceptable to dentists and patients.

CONCLUSIONS

This study has demonstrated the feasibility and acceptability of dentists screening for alcohol misuse and providing brief advice.

Evaluation of an alcohol screening and brief advice training programme for NHS general dental practitioners

INTRODUCTION

Primary care dentists are in a unique position to screen for alcohol misuse and provide brief advice to patients; however, lack of knowledge and confidence are some of the barriers cited for their reluctance to do so.

AIMS

This study describes the evaluation of a novel brief alcohol advice training programme specifically designed and tailored to the needs of NHS general dental practitioners.

MATERIALS AND METHODS

The training programme was developed as part of a feasibility trial and included a mixture of theoretical and practical elements. During 8 h of highly interactive sessions, participants took part in role-plays, including scenarios of patients of varying age groups, oral health status, dental attendance and different levels of motivation. Training manuals and other resources were also given. Knowledge, attitudes and confidence scores were assessed before and after the sessions. Wilcoxon matched-pairs signed-ranks and McNemar's tests were used to compare participants' performance before and after the completion of the programme.

RESULTS

Significant positive changes were observed in all training objectives. There was an overall improvement of 23% in levels of knowledge, a 40% increase in positive attitudes towards alcohol screening and intervention and 80% increase in confidence scores. Fidelity assessments of the implementation of the intervention in the trial showed that dentists who completed the training successfully went on to screen for alcohol misuse and provide brief advice to patients.

CONCLUSION

NHS dentists can be successfully trained with the relevant knowledge, attitudes and confidence needed to deliver alcohol screening and brief advice to patients.

The relevance of alcohol to dental practice

Alcohol is a very widely used drug which can cause dental disease and influence dental treatment. It is therefore important that dental professionals take an alcohol history from all patients and are aware of how to give alcohol reduction advice. This article discusses the impact of alcohol on oral health, including oral cancer, trauma, halitosis, tooth wear, periodontal disease and caries, with reference to the available literature. It also outlines current alcohol risk level advice and guidance regarding giving alcohol reduction advice in a dental setting.

Tooth wear and sleep quality: A study of police officers and non-police officers

OBJECTIVE

A cross-sectional study was performed to assess the prevalence of tooth wear facets and sleep disorders.

METHODS

The sample was divided into two groups: Group I: police officers (n = 144), and Group II: industrial workers (n = 142). A self-reported questionnaire, a clinical examination recorded in the dental records, and the Brazilian version of the Pittsburgh Sleep Questionnaire Index were used for data collection. Descriptive analysis, chi-squared and multiple logistic regression were used as statistical tests at a 5% significance level.

RESULTS

Group I was almost twice as likely to have tooth wear facets as was Group II (OR = 1.88 95% CI = 1.03-3.44). Sleep disorders were worse among the participants of Group I.

CONCLUSIONS

The type of profession exerted an influence on sleep disorders and the presence of wear facets among the groups, with police officers most likely to suffer from these disorders.

Risk Assessment for Tooth Wear

Tooth wear has an increasing prevalence in the UK population. The aetiology is commonly multifactorial, and the aetiopathology is through a combination of erosion, attrition, abrasion and abfraction. Erosion is associated with intrinsic or extrinsic acids, and therefore subjects with reflux disease and eating disorders are at increased risk. Fruit juice, fruits and carbonated drink consumption, frequency of consumption and specific habits are also risk factors. Attrition is more prevalent in bruxists. Other habits need to be considered when defining the risk of tooth wear. Abrasion is usually associated with toothbrushing and toothpastes, especially in an already acidic environment. Patients with extensive lesions that affect dentin may be at higher risk, as well as those presenting with unstained lesions. Monitoring of the progress of tooth wear is recommended to identify those with active tooth wear. Indices for tooth wear are a helpful aid.

Assessing the feasibility of screening and providing brief advice for alcohol misuse in general dental practice: a clustered randomised control trial protocol for the DART study

INTRODUCTION

Alcohol misuse is a significant public health problem with major health, social and economic consequences. Systematic reviews have reported that brief advice interventions delivered in various health service settings can reduce harmful drinking. Although the links between alcohol and oral health are well established and dentists come into contact with large numbers of otherwise healthy patients regularly, no studies have been conducted in the UK to test the feasibility of delivering brief advice about alcohol in general dental settings.

METHODS AND ANALYSIS

The Dental Alcohol Reduction Trial (DART) aims to assess the feasibility and acceptability of screening for alcohol misuse and delivering brief advice in patients attending National Health Service (NHS) general dental practices in North London. DART is a cluster randomised control feasibility trial and uses a mixed methods approach throughout the development, design, delivery and evaluation of the intervention. It will be conducted in 12 NHS general dental practices across North London and will include dental patients who drink above the recommended guidance, as measured by the Alcohol Use Disorders Identification Test (AUDIT-C) screening tool. The intervention involves 5 min of tailored brief advice delivered by dental practitioners during the patient's appointment. Feasibility and acceptability measures as well as suitability of proposed primary outcomes of alcohol consumption will be assessed. Initial economic evaluation will be undertaken. Recruitment and retention rates as well as acceptability of the study procedures from screening to follow-up will be measured.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the Camden and Islington Research Ethics Committee. Study outputs will be disseminated via scientific publications, newsletters, reports and conference presentations to a range of professional and patient groups and stakeholders. Based on the results of the trial, recommendations will be made on the conduct of a definitive randomised controlled trial.

TRIAL REGISTRATION NUMBER

ISRCTN81193263.

Developing dental services for homeless people in East London

OBJECTIVE

The aim of this study was to describe the dental services delivered by the Community Dental Service (CDS) of Tower Hamlets (TH) and City and Hackney (CH) for adult homeless people in 2009-2011, to assess if the service met its planned objectives and to report the outcomes of the dental care provided.

METHOD

TH and CH CDS provided a nine tier dental service for homeless people during April 2009 to September 2011, in which the dedicated mobile dental service (MDS) and the dedicated dental clinic (DDS) provided 3,102 dental appointments for homeless people. Data collection from a random sample (n = 350) of record cards of adult patients who were homeless and offered oral care from these services was conducted, in collaboration with an analysis of appointment books, service delivery rotas and day sheets. Patients' oral findings, treatments, challenges as well as feedback received from the service users were recorded and evaluated against the planned objectives.

RESULTS

One thousand two hundred and twelve (39.1%) of these appointments went to the 350 patients whose record cards were examined as part of this audit. One of the record cards randomly selected had incomplete date and was excluded from the results, so data was presented on the 349 complete record cards. The age range of these patients was 18-74 years, with a mean age of 38.46 years ± 9.1 standard deviation (SD) with 80% of the patients (n = 281) under 50 years of age. Forty percent of these patients presented in pain with a further 5% complaining of swelling and infection, 99% of people required treatment and only nine people had no decay, three of whom were edentulous. Two hundred and thirteen (61%) patients completed their treatments, which took between 1 to 18 appointments, but only 97 (27.8%) patients did so without any failed or cancelled appointments. Of the 128 (36.7%) patients who were lost after the first appointment, only 15 (11.7%) did not receive any treatment; most had been treated for pain with temporary fillings, extractions, permanent fillings and management of swelling. Sixty-seven band 1, 16 band 1.2 (emergency only), 148 band 2 and 52 band 3 courses of treatment were submitted.

CONCLUSION

This study showed a significant need for services providing oral healthcare for this population and highlighted that flexibly delivered dental services, embedded in local health and social networks, seemed to promote uptake in these clients who normally find it extremely difficult to find dental care services elsewhere.

The psychology of tooth wear

AIM

To review the main psychological and mental conditions that are manifested dentally in the form of tooth wear. These conditions include depression, eating disorders, and alcohol and drug use disorders. The paper will also review the comorbidity of these conditions and the relevance of other medical conditions and lifestyle factors, such as gastroesophageal reflux disorder, smoking and diet, in the expression of tooth wear.

CONCLUSION

A holistic, multidisciplinary, healthcare approach is required in management of tooth wear patients with underlying mental health disorders. Dentists and Dental Care Professionals can have an important role in identifying these mental disorders through the observed tooth wear. They can also play a key role in monitoring patients' response and compliance to medical treatment through the monitoring of tooth wear progression and expression.

Erosive lesions in patients with alcoholism

BACKGROUND

The authors conducted a study to determine the occurrence of erosive tooth lesions in patients with alcoholism and to establish the influence of salivary flow rates and pH levels on their appearance.

METHODS

The authors conducted a cross-sectional study in 140 participants (70 with clinically diagnosed alcoholism who were undergoing therapy for their addiction were in the test group and 70 who did not consume alcohol were in the control group). The authors determined the participants' salivary statuses by measuring the flow rates and pH levels of both unstimulated and stimulated saliva.

RESULTS

The authors found more erosive lesions in the test group (P < .01). They detected a higher number of erosive lesions in participants in the test group who had a pH range of 5 to 6 compared with a pH range of 6 to 7 (P = .01). They found a significant correlation between alcoholism and unstimulated salivary flow rate (P < .05).

CONCLUSIONS

The salivary flow rate was similar in control and test groups. The prevalence of erosion in the test group was higher than that in the control group, which may be related to the decrease in salivary pH of both stimulated and unstimulated saliva in this group. The results of the study showed no connection between erosion prevalence and pH levels and stimulated salivary flow rates.

CLINICAL IMPLICATIONS

Patients with alcoholism may be at risk of developing erosive lesions on their teeth owing to the low pH level of their oral environment and decreased saliva levels.

Dental Erosion

There is some evidence that dental erosion is steadily spreading. To diagnose erosion, dental professionals have to rely on clinical appearance, as there is no device available to detect it. Adequate preventive measures can only be initiated if the different risk factors and potential interactions between them are known. When substance loss, caused by erosive tooth wear, reaches a certain degree, oral rehabilitation becomes necessary. Prior to the most recent decade, the severely eroded dentition could only be rehabilitated by the provision of extensive crown and bridgework or removable dentures. As a result of the improvements in composite restorative materials and in adhesive techniques, it has become possible to rehabilitate eroded dentitions in a less invasive manner.

Erosion--diagnosis and risk factors

Dental erosion is a multifactorial condition: The interplay of chemical, biological and behavioural factors is crucial and helps explain why some individuals exhibit more erosion than others. The erosive potential of erosive agents like acidic drinks or foodstuffs depends on chemical factors, e.g. pH, titratable acidity, mineral content, clearance on tooth surface and on its calcium-chelation properties. Biological factors such as saliva, acquired pellicle, tooth structure and positioning in relation to soft tissues and tongue are related to the pathogenesis of dental erosion. Furthermore, behavioural factors like eating and drinking habits, regular exercise with dehydration and decrease of salivary flow, excessive oral hygiene and, on the other side, an unhealthy lifestyle, e.g. chronic alcoholism, are predisposing factors for dental erosion. There is some evidence that dental erosion is growing steadily. To prevent further progression, it is important to detect this condition as early as possible. Dentists have to know the clinical appearance and possible signs of progression of erosive lesions and their causes such that adequate preventive and, if necessary, therapeutic measures can be initiated. The clinical examination has to be done systematically, and a comprehensive case history should be undertaken such that all risk factors will be revealed.

A New Look at Erosive Tooth Wear in Elderly People

BACKGROUND

The author describes the clinical appearance of and the outcomes associated with erosive tooth wear, particularly that in older people.

TYPES OF STUDIES REVIEWED

The author conducted a traditional clinical review that was based on a synopsis of the current literature on dental erosion. He found that intrinsic and extrinsic acids are known to be associated with acid erosion and tooth wear. He also explored the etiology and pathogenesis of tooth wear and compared the longevity of restorations to the option of monitoring and preventing tooth wear. He found that preventive measures, which included limiting the frequency of acid exposure and using fluoride toothpastes and dentin-bonding agents, could prolong tooth life.

RESULTS

Tooth wear and acid erosion are common clinical findings in patients of all ages. The results of tooth wear can cause significant damage to teeth, which can require complex and costly prosthodontic treatment.

CLINICAL IMPLICATIONS

Diagnosing the cause of a patient's tooth wear can help prevent further damage.

Tooth surface loss in adult subjects attending a university dental clinic in Trinidad

OBJECTIVES

To determine the prevalence of tooth surface loss (TSL) in a sample of subjects attending a university dental clinic in Trinidad and to investigate the relationship to tooth brushing, medical history, parafunction and dietary habits.

DESIGN

Tooth surface loss was measured clinically by the index used in the 1998 UK, Adult Dental Health Survey.

SETTING

Trinidad, West Indies.

PARTICIPANTS

Convenience sample of adult subjects attending The University of the West Indies Dental School Polyclinic, Mount Hope.

METHODS

A questionnaire was administered and tooth surface loss measured clinically.

MAIN OUTCOME MEASURES

mild, moderate and severe tooth surface loss.

RESULTS

155 subjects were examined (mean age 40.6 years) of whom 72% had some degree of TSL with the majority (52%), exhibiting mild, 16% with moderate and 4% with severe TSL. There were associations found between TSL and age (OR=3.14), reflux (OR=1.37), parafunction (OR=1.06), weekly consumption of citrus fruits (OR=1.31) and soft drinks (OR=1.78), daily consumption of alcohol (OR=1.40) and a vegetarian diet (OR=2.79).

CONCLUSIONS

Tooth surface loss in this Trinidadian population group appears to be common. Data supports an association between TSL and age, reflux parafunction and certain dietary patterns.

Dental erosion: possible approaches to prevention and control

OBJECTIVES

To discuss the key elements for establishment of a preventive programme for dental erosion.

DATA AND SOURCES

The data discussed are primarily based on published scientific studies and reviews from case reports, clinical trials, epidemiological, cohort, animal, in vitro and in vivo studies. References have been traced manually or by MEDLINE.

STUDY SELECTION

The aetiology, pathogenesis and modifying factors of dental erosion were reviewed. Strategies to either prevent the occurrence or limit the damage of dental erosion or protect the remaining tooth tissues from further erosive destruction were reviewed and discussed. These includes: (A) measures to (1) enhance remineralisation and acid resistance of enamel surface softened by erosive challenge, (2) reduce the erosive potential of acidic products, (3) enhance salivary flow, (4) protect and restore erosively damaged tooth, and (5) provide mechanical protection against erosive challenge. (B) Health education geared towards (1) diminution of frequency of intake of dietary acids, and (2) change of habits and lifestyles that predispose teeth to erosion development.

CONCLUSIONS

It may be easier to gain patients' compliance with the advice that immediately following an acidic challenge, a remineralising agent, such as fluoride mouthrinses, fluoride tablets, fluoride lozenges or dairy milk, should be administered to enhance rapid remineralisation of the softened tooth surface as well as serve as a mouth refresher, or an alternative, a neutralising solution should be used. Effective counselling on erosion preventive regimes should involve all healthcare personnel, dentists, doctors, pharmacist, nurses/hygienists and clinical psychologists.

Attrition, abrasion, corrosion and abfraction revisited

OVERVIEW

The authors propose updated and revised nomenclature, definitions and classification for tooth surface lesions. Their objective is standardization, clarity and clinical utility for the dental practitioner. The article presents a schema of the pathodynamic mechanisms in the formation of tooth surface lesions--three basic physical and chemical mechanisms, their interactions and their dental manifestations.

CONCLUSIONS AND CLINICAL IMPLICATIONS

The use of precise definitions will assist the practitioner in determining the etiology of various tooth surface lesions. Understanding the pathodynamic mechanisms and their many possible interactions, as set forth in the schema, will enable the practitioner to make an accurate differential diagnosis and to provide effective prevention and treatment. It also will assist dentists in communicating more effectively with their colleagues as well as with their patients. In addition, the schema helps identify areas in which future research is indicated.

The prevalence of non-carious cervical lesions in permanent dentition

A non-carious cervical lesion (NCCL) is the loss of hard dental tissue on the neck of the tooth, most frequently located on the vestibular plane. Causal agents are diverse and mutually interrelated. In the present study all vestibular NCCL were observed and recorded by the tooth wear index (TWI). The aim of the study was to determine the prevalence and severity of NCCL. For this purpose, 18555 teeth from the permanent dentition were examined in a population from the city of Rijeka, Croatia. Subjects were divided into six age groups. The teeth with most NCCL were the lower premolars, which also had the largest percentage of higher index levels, indicating the greater severity of the lesions. The most frequent index level was 1, and the prevalence and severity of the lesions increased with age.

A review of the atypical manifestations of gastroesophageal reflux disease

Manifestations of atypical gastroesophageal reflux disease (GORD) are varied, and the presentation of atypical symptoms may occur in the absence of typical symptoms. The most sensitive and specific investigation for GORD is pH monitoring, and its application in atypical disease is utilized throughout this paper as a basis for correlating disease and pathogenesis. The less well-known areas of laryngeal manifestations, particularly chronic hoarseness and globus, are discussed in addition to recent work on orodental manifestations. Well-known areas of cardiac and respiratory manifestations, which include chronic cough and asthma, are also reviewed. Evidence from clinical trials indicates that aggressive anti-reflux therapy in patients with atypical symptoms can be effective. Where appropriate, medical therapy may involve long-term proton pump inhibitor, although further research outlining the roles of other therapies such as surgery is awaited.

Oral and dental health in the alcohol misuser

This review explores the relationship between oral and dental health and disease in substance misusers. Although it focuses on oral cancer, we also examine the relationship of misuse with dental caries and periodontal diseases. It is difficult to separate out the inter-related aetiological factors such as the use of alcohol and tobacco (smoked and chewed). They probably act in a synergistic manner.

Alcohol abuse and dependence: psychopathology, medical management and dental implications

BACKGROUND

The authors review the clinical features, epidemiology, pathophysiology, medical management, dental findings and dental treatment of patients with alcoholism.

LITERATURE REVIEWED

The authors conducted a MEDLINE search for 1995 through 2001 using the key terms of alcoholism, epidemiology, pathophysiology, treatment and dentistry. Reports selected for further review included those published in English in peer-reviewed journals. The authors gave preference to articles reporting randomized, controlled trials.

CONCLUSIONS

Alcoholism is a chronic and progressive psychiatric illness that afflicts more than 14 million Americans. It is characterized by a loss of control over the use of alcohol, resulting in impaired social functioning, and the consequent development of medical illnesses. The disease arises in genetically vulnerable people when they are overwhelmed by their cravings for the alcohol-associated euphoria that results from the actions of several neurotransmitter systems in the brain's pleasure center. New medications to counteract alcohol-induced neurotransmission imbalance may assist patients in reducing their craving.

CLINICAL IMPLICATIONS

The prevalence of dental disease usually is extensive because of a disinterest in performing appropriate oral hygiene techniques and diminished salivary flow. Concurrent abuse of tobacco products worsens dental disease and heightens the risk of developing oral cancer. Identification of the alcohol-abusing patient, a cancer-screening examination, preventive dental education, and use of saliva substitutes and anticaries agents are indicated. Special precautions must be taken when performing surgery and when prescribing or administering analgesics, antibiotics or sedative agents that are likely to have an adverse interaction with alcohol or psychiatric medications.

Dental erosion patterns from intrinsic acid regurgitation and vomiting

BACKGROUND

The distribution of lesions from dental erosion due to intrinsic acid regurgitation and vomiting may be different from patterns of dental erosion due to extrinsic acids. To date studies have failed to validate this assumption. This study described the sites and nature of lesions from dental erosion in cases of intrinsic acid regurgitation, and compared them with the distribution of lesions occurring in age and sex matched controls, whose lesions are due to extrinsic acids.

METHODS

The University of Queensland tooth wear clinic patients were screened to select 30 cases, 21 self-identified bulimics and nine medically diagnosed chronic gastric acid regurgitators, and 30 controls. Epoxy resin models of the subjects' dentition were examined under stereoscopic light microscope at magnification 16 to 40. The patterns and sites of tooth wear were recorded for teeth representative of 20 tooth sites in every subject.

RESULTS

While the incisal edges of maxillary and mandibular anterior teeth of acid regurgitators were more frequently affected by erosion, incisal attrition was more common on controls' teeth. Cervical lesions were more commonly found in association with incisal attrition in the controls, and in association with incisal erosion in the cases. In 10 per cent of sites in case subjects, cervical lesions associated with incisal erosion were found on the lingual aspects of their mandibular incisors, canines and premolars. These lesions were almost exclusive to the case subjects.

CONCLUSIONS

These results validate that lingual cervical lesions associated with incisal erosion on the mandibular anterior teeth are strong discriminators between tooth wear in patients with bulimia nervosa or chronic gastro-oesophageal reflux and those whose dental erosion is due to extrinsic acids.

Analyzing the etiology of an extremely worn dentition

Patients requiring extensive restorative care frequently exhibit significant loss of tooth structure. Specific clinical findings in an extremely worn dentition may vary widely and are often confusing. Severe wear can result from a mechanical cause, a chemical cause, or a combination of causes. The location of the wear, the accompanying symptoms and signs, and information gained from the patient interview are essential components in determining the etiology. A diagnostic decision tree facilitates a systematic analysis and diagnosis of dental wear.

The oral medicine of tooth wear

This review illustrates, through a series of case histories, how oral medicine insights aid the diagnosis and management of patients with excessive tooth wear. The cases reviewed are drawn from the records of 500 southeast Queensland patients referred to the author over a 12 year period. Patients most at risk of dental erosion have work and sports dehydration, caffeine addiction, gastro-oesophageal reflux, asthma, diabetes mellitus, hypertension or other systemic diseases or syndromes that predispose to xerostomia. Saliva protects the teeth from the extrinsic and intrinsic acids which cause dental erosion. Erosion, exacerbated by attrition and abrasion, is the main cause of tooth wear. These cases illustrate that teeth, oral mucosa, salivary glands, skin and eyes should be examined for evidence of salivary hypofunction and attendant medical conditions. Based on comprehensive oral medicine, dietary analyses and advice, it would seem patients need self-management plans to deal with incipient chronic tooth wear. The alternative is the expensive treatment of pain, occlusal damage and pulp death required to repair the effects of acute severe tooth wear.

Oral health status of workers exposed to acid fumes in phosphate and battery industries in Jordan

OBJECTIVES

To investigate the prevalence and nature of oral health problems among workers exposed to acid fumes in two industries in Jordan.

SETTING

Jordan's Phosphate Mining Company and a main private battery factory.

DESIGN

Comparison of general and oral health conditions between workers exposed to acid fumes and control group from the same workplace.

SUBJECTS AND METHODS

The sample consisted of 68 subjects from the phosphate industry (37 acid workers and 31 controls) drawn as a sample of convenience and 39 subjects from a battery factory (24 acid workers and 15 controls). Structured questionnaires on medical and dental histories were completed by interview. Clinical examinations were carried out to assess dental erosion, oral hygiene, and gingival health using the appropriate indices. Data were statistically analysed using Wilcoxon rank-sum test to assess the significance of differences between results attained by acid workers and control groups for the investigated parameters.

RESULTS

Differences in the erosion scores between acid workers in both industries and their controls were highly significant (P<0.05). In both industries, acid workers showed significantly higher oral hygiene scores, obtained by adding the debris and calculus scores, and gingival index scores than their controls (P<0.05). The single most common complaint was tooth hypersensitivity (80%) followed by dry mouth (77%) on average.

CONCLUSION

Exposure to acid fumes in the work place was significantly associated with dental erosion and deteriorated oral health status. Such exposure was also detrimental to general health. Findings pointed to the need of establishing appropriate educational, preventive and treatment measures coupled with efficient surveillance and environmental monitoring for detection of acid fumes in the workplace atmosphere.

A look at forensic dentistry--Part 1: The role of teeth in the determination of human identity

Forensic dentistry can be defined in many ways. One of the more elegant definitions is simply that forensic dentistry represents the overlap between the dental and the legal professions. This two-part series presents the field of forensic dentistry by outlining two of the major aspects of the profession: human identification and bite marks. This first paper examines the use of the human dentition and surrounding structures to enable the identification of found human remains. Conventional and novel techniques are presented.

Dentine hypersensitivity — an enigma? a review of terminology, mechanisms, aetiology and management

Dentine hypersensitivity is a relatively common problem experienced in clinical dental practice. This condition may disturb the patient during eating, drinking, brushing and sometimes even breathing. Therapeutic intervention by desensitising agents may provide only partial pain relief and recurrence is common. Much remains unknown about dentine hypersensitivity, even the terminology can be questioned. Most of the literature over decades has been concerned with reporting clinical trials proving the efficacy of numerous treatments for dentine hypersensitivity. Indeed, besides haemorrhoids, there can be few other diseases or conditions known to man that can apparently be successfully treated by so many and extremely varied agents and formulations applied topically. This paper will discuss the epidemiology, mechanisms of pain production and aetiological factors for the condition in the hope of developing ideas for more realistic prevention and management strategies.

Erosion caused by gastroesophageal reflux: diagnostic considerations

Dental erosion occurs with a high prevalence in the general population, but its impact on prosthodontic care is often unrecognized. The etiology of dental erosion is difficult to establish because it may result from a variety of causes and may have different presentations. Our purpose was to review the literature relevant to dental erosion and to report a patient presentation in which an unusual pattern of severe erosion was the dental manifestation of asymptomatic gastroesophageal reflux disease.

The prevalence, etiology and management of tooth wear in the United Kingdom

STATEMENT OF PROBLEM

Recent epidemiologic evidence suggests that tooth wear is now a significant problem in both children and adults. There is growing evidence that a major cause of severe wear in patients is regurgitation erosion due to a variety of factors including gastroesophageal reflux disease.

PURPOSE

The purpose of this article is to discuss the prevalence of tooth wear in the United Kingdom. Emphasis in management should be on accurate diagnosis, and in some patients, long-term monitoring before embarking on any irreversible, interventive treatment. Even when treatment is necessary, a period of monitoring is helpful to assess the rate of progress of the wear, the effectiveness of preventive measures, and therefore the extent of the treatment necessary.

Determinants of oral health in a group of Danish alcoholics

The purposes of this survey were to describe dental health in a group of alcoholics and to analyze the influence of social background, dental health behavior and alcohol-related variables on dental health among alcoholics. The dental health in a group of consecutively admitted alcoholics (n = 195) was described with respect to number of teeth present, DMFS, DS and the prevalence of dental erosion, removable dentures, edentulousness, and untreated dental decay. No major differences were found with respect to number of teeth and dental caries (DMFS), when compared to reference figures of the general population. As to untreated decay, however, 3-5 x more actual decayed surfaces were found among the alcoholics. In the multivariate analyses, neither DMFS, nor untreated decay were found to be associated with alcohol-related indicators. These variables were, however, related to variables of social background and dental health behavior. As to number of teeth present, an association was found with duration of alcoholism, but this relationship was eliminated, when the analysis was controlled with respect to social situation. In contrast, dental erosion was related to duration of alcoholism irrespective of confounding control of dental health behavior and social situation. Hence, the study indicates that oral health in alcoholics can be explained mainly by social situation and dental health behavior and not by variables associated directly with alcohol consumption. An exception was the presence of dental erosion, which was associated with the exposure to alcohol.

Etiology of dental erosion--intrinsic factors

Dental erosion due to intrinsic factors is caused by gastric acid reaching the oral cavity and the teeth as a result of vomiting or gastroesophageal reflux. Since clinical manifestation of dental erosion does not occur until gastric acid has acted on the dental hard tissues regularly over a period of several years, dental erosion caused by intrinsic factors has been observed only in those diseases which are associated with chronic vomiting or persistent gastroesophageal reflux over a long period. Examples of such conditions include disorders of the upper alimentary tract, specific metabolic and endocrine disorders, cases of medication side-effects and drug abuse, and certain psychosomatic disorders, e.g. stress-induced psychosomatic vomiting, anorexia and bulimia nervosa or rumination. Based on a review of the medical and dental literature, the main symptoms of all disorders which must be taken into account as possible intrinsic etiological factors of dental erosion are thoroughly discussed with respect to the clinical picture, prevalence and risk of erosion.

The tooth wear index: a flawed epidemiological tool in an ageing population group

With a greater number of people living longer and tending to retain many natural teeth, the problems associated with tooth wear are likely to place greater demands upon dental professionals in the future. Several attempts have been made to develop an index to measure tooth wear, for use at both the individual and population level. A review of these indices is undertaken, and difficulties experienced with the tooth wear index (TWI) of Smith & Knight (1984) in a large adult dental health survey is discussed. In the elderly population the scoring criteria of the TWI proved to be difficult to apply without additional qualification, and in cases of extreme wear a five-point ordinal scale was found to be inadequate to describe the range of wear observed. The concept of "pathological" levels of wear proposed by the TWI are challenged and modification to the index suggested for use among the elderly population.

Chronic alcoholism: an important condition in the dentist-patient relationship

OBJECTIVES

This paper aims to give the dental practitioner an insight into the impact of chronic alcoholism on sufferers.

METHODS

A review of the psychiatric and dental literature covering the aetiology, prevalence and complications is presented.

CONCLUSIONS

Chronic alcoholism has a number of serious medical and social problems which may affect the provision of dental treatment. It is important for the dental practitioner to be aware of the impact of this condition on patients as he or she may be in an ideal position to stop the alcoholic before a medical consultation has been sought.

The interface between orthodontics and restorative dentistry in the management of anterior tooth surface loss

Anterior tooth surface loss is a significant problem, ideally requiring early recognition, diagnosis and prevention of progression. However, when first noted it is often sufficiently advanced to warrant treatment. Management should be aimed at minimizing further tooth surface loss and frequently benefits from an integration of treatment procedures. The problems, aims of treatment, and relevant treatment modalities are discussed, and two illustrative cases presented.

Conservative management of erosion-abrasion: a system for the general practitioner

This final article in a series of three covering general practice aspects of erosion-abrasion presents a three-phase system for clinical management of erosive-abrasive damage. The first phase comprises pre-restorative case evaluation, initial measures to control factors predisposing to continued erosion-abrasion and where necessary the provision of acrylic overlays to restore facial height. In the second phase the teeth are systematically restored using an acid-etch composite resin technique; guidance for comfortable occlusion is provided by the patient acceptance method. The third phase comprises follow-up, including monitoring of salivary and bacteriological parameters, maintenance of the restorations and modifications of preventive measures necessary to preserve the dentition restored by multiple composite therapy. Modern oral physiological concepts and recent developments in multiple composite therapy and erosion control are discussed.

Occlusal wear of teeth and restorative materials. A review of classification, etiology, mechanisms of wear, and some aspects of restorative procedures

This paper is a literature review of various aspects of the wear of occluding tooth surfaces. It presents classification and terminology of occlusal tooth wear, and discusses etiology and differential diagnosis. It may be difficult to differentiate among abrasion, attrition, and erosion because there is nearly always a combination of the various processes. These processes of wear are described, and the in vitro and in vivo wear of some restorative materials is discussed. Treatment of severe tooth wear is considered difficult; prophylactic measures are therefore important. Some guidelines for restorative treatment of patients with extensive occlusal tooth wear are given, with special emphasis on the type of treatment, the vertical dimension of occlusion, the space available, and choice of material for the restorations.

Wear in dentistry--current terminology

There is some confusion in the dental literature concerning the phenomenon of wear which is usually considered in terms of its clinical manifestations rather than its underlying processes. The parent discipline for the study of these processes is tribology. The terms attrition, abrasion and erosion are common to both dentistry and tribology; however their meanings are different. Even within the various disciplines of dentistry there are differences in the understanding of the same terms. This article relates the dental appreciation of wear to the underlying processes.