Vegetarian children and dental erosion

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.

Plant-based diets for children as a means of improving adult cardiometabolic health

Cardiovascular disease (CVD) is the largest contributor to global mortality, and this trend is expected to continue. Although mortality rates have been falling, adverse developments in obesity and diabetes threaten to reverse this. It has been estimated that the only viable strategy to reduce the epidemic is to focus on population-wide risk factor reduction. Primordial prevention, a strategy aimed at avoiding the development of risk factors before the disease onset, has been shown to reduce the CVD epidemic substantially. Plant-based diets appear beneficial for prevention of cardiometabolic diseases, with adult vegetarians and vegans having lower CVD risk than omnivores. Atherosclerosis starts in childhood and progresses in relation to classical CVD risk factors, which, along with dietary habits, track to adulthood. Based on this evidence, it is proposed that plant-based diets in childhood could promote cardiometabolic health in adults and thereby reduce CVD and promote longevity and health. However, the need for additional research to establish the safety of predominantly or exclusively plant-based diets in children is noted.

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

BACKGROUND

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

REVIEW

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

CONCLUSION

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

Prevention of erosive tooth wear: targeting nutritional and patient-related risks factors

This article provides an overview of the nutritional and patient-related risk factors involved in the aetiology of erosive tooth wear (ETW) and the preventive strategies to counteract them. The first step is to diagnose clinical signs of ETW and to recognise causal factors. Low pH and high buffer capacity of foods/drinks are the major risk factors, while the calcium concentration is the main protective factor. Reduction of frequency of consumption and contact time of erosive foods/drinks with the teeth, use of straws appropriately positioned and consumption of dairy products are advisable. Oral hygiene has a role in the development of ETW, however, postponing toothbrushing is not clinically advisable. In cases of drug abuse, chronic alcoholism, GERD or bulimia, the patient must be referred to a doctor. Immediately after vomiting, patients might be advised to rinse the mouth. Saliva has an important protective role and patients with reduced salivary flow can benefit from the use of chewing gum. Recent studies have focused on improving the protective capacity of the acquired pellicle as well as on the role of protease inhibitors on dentine erosion. However, the degree of evidence for these preventive measures is low. Clinical trials are necessary before these measures can be recommended.

Association of dietary habits and parental-reported sleep tooth grinding with tooth wear in children with mixed dentition

BACKGROUND

Tooth wear has a multifactorial etiology, thus it should be assessed within a multiple-variable framework. The objective of this investigation was to assess the association of dietary habits and parental-reported sleep tooth grinding (STG) with tooth wear in children with mixed dentition.

METHODS

One hundred twenty-one (N = 121) subjects (mean age 9.6 years) participated in a cross-sectional study. Wear of 1637 teeth was evaluated using the screening module of the Tooth Wear Evaluation System (TWES). Parental-report of STG was evaluated by means of the Children's Sleep Habits Questionnaire (CSHQ), whilst dietary habits were investigated by means of the Health Behaviour in School-Aged Children Food-Frequency Questionnaire (HBSC-FFQ). Data were analyzed with the Spearman correlation test and ordinal-multiple-variable regression analyses. Odds Ratio (OR) and ordinal OR were obtained for the independent variables included in the models.

RESULTS

Parental-report of STG is not associated with tooth wear in the mixed dentition; some dietary habits were found to be correlated with specific tooth wear patterns, but the correlation values were weak. Associations were found between dietary habits and the increase-to-increase severity of occlusal/incisal and non-occlusal/non-incisal tooth wear of some teeth (OR > 2).

CONCLUSIONS

A strong correlation of dietary habits and sleep tooth grinding with tooth wear in the mixed dentition was not demonstrated. However, dietary habits showed to have effects in terms of increase-to-increase severity.

Nutrient intake and dietary patterns of relevance to dental health of 12-year-old Libyan children

OBJECTIVE

There are few data on the dietary intake of children in Libya, and none on free sugars intake. The present study aimed to report the intake of macronutrients and eating habits of relevance to dental health in a group of Libyan schoolchildren and to investigate any gender differences for these variables.

DESIGN

Dietary information was obtained from a randomly selected sample using an estimated 3 d food diary. Dietary data were coded using food composition tables and entered into a Microsoft® Access database. Intakes of energy, macronutrients, sugars and the amount of acidic items consumed were determined using purpose-written programs.

SETTING

Benghazi, Libya.

SUBJECTS

Schoolchildren aged 12 years.

RESULTS

One hundred and eighty children (ninety-two boys and eighty-eight girls) completed the study. Their mean age was 12·3 (sd 0·29) years. The average daily energy intake was 7·01 (sd 1·54) MJ/d. The percentage contributions to energy intake from protein, fat and carbohydrate were 16 %, 30 % and 54 %, respectively. Total sugars contributed 20·4 % of the daily energy intake, and free sugars 12·6 %. The median daily intake of acidic items was 203 g/d, and of acidic drinks was 146 g/d. There were no statistically significant differences in nutrient intakes between genders. Intake of acidic items was higher in girls (P < 0·001).

CONCLUSIONS

The contribution to energy intake from macronutrients was in accordance with global nutrition guidelines. The acidic drinks intake was low compared with other populations, while free sugars intake was above the recommended threshold of 10 % of energy intake.

Prevalence of tooth erosion and associated factors in 13-16-year old adolescents in Greece

OBJECTIVES

The aim of this study was to estimate the prevalence of dental erosion and to investigate possible associations among dental erosion and medical history, dietary and lifestyle habits in a sample of adolescents in Greece.

STUDY DESIGN

The study sample consisted of 770 adolescents, 374 boys and 396 girls aged 13 to 16 years. All individuals were clinically examined and answered questions regarding their medical history, rate and frequency of drinks and food consumption and lifestyle habits. Statistical analysis of the questionnaire items was performed by using the multiple logistic regression analysis model.

RESULTS

Two hundreds and sixty adolescents were diagnosed as having dental erosion, giving a prevalence rate 33.8%. The habit of holding drinks in the mouth before swallowing [OR=2.85, 95% CI=1.45-5.58] (p=0.002), the ingestion of acidic drinks at bedtime [OR=0.24, 95% CI=0.11-0.53] (p=0.000), the consumption of car- bonated drinks [OR=3.99, 95% CI=1.37-11.59] (p=0.011) and fruit juices [OR=0.12, 95% CI=0.04-0.38] (p=0.000) were the most important associated factors of dental erosion.

CONCLUSIONS

The prevalence of dental erosion in the study sample was 33.8% while dental erosion experience was associated with frequency and habits of consumption of some dietary components. Key words:Prevalence, tooth erosion, risk factors, adolescents.

Epidemiological studies of tooth wear and dental erosion in 14-year old children in North West England. Part 2: The association of diet and habits

OBJECTIVE

To determine the strength of association (expressed as Odds Ratios) of potential risk factors with erosion and tooth wear in 14-year-old schoolchildren.

DESIGN

A random sample of 2,385 children were selected by a stratified two-stage technique based on schools and children.

SETTING

Schools in NW England.

METHODS

Tooth wear was assessed by one examiner on three surfaces of all 12 anterior teeth (labial, incisal and palatal) and the occlusal surface of all four first molars using a four-point scale. Enamel wear was scored 0, dentine exposure <1/3 scored 1, >1/3 scored 2 and secondary dentine or pulpal exposure, scored 3. A questionnaire enquired about general health, dental health, habits and the frequency of intake of a wide range of foods and drinks.

RESULTS

The Odds Ratios for tooth wear on any surface for habits, reflux and certain foods were: bruxism, 1.10; stomach upset, 1.45; pickles 1.86; vinegar 1.36; salt and vinegar crisps 1.33; brown/other sauces 1.57. Similarly, the odds ratios for potentially erosive drinks were: fizzy drinks 1.32; sport drinks 1.58; herbal/lemon tea 3.97. The frequency of intake was bi-modal with 397 children drinking a can per day and 207 drinking two cans per day. A significant number drank acidic beverages at bedtime but this was not associated with dental erosion.

CONCLUSION

Although odds ratios greater than unity indicate an association, this was not high for carbonated beverages and many other acidic foods or drinks. Examining at fourteen years may not be ideal, as the determinants of erosion/tooth wear have not acted for long, the indices do not discriminate sufficiently and proportionately few subjects have dentine exposed on smooth surfaces.

Association between functional dental state and dietary intake of Chinese vegetarian old age home residents

OBJECTIVE

To examine the association between dental functional status and dietary intakes of Chinese vegetarian old age home residents.

SUBJECTS AND METHODS

A cross-sectional survey was performed in a group of 76 older vegetarian Chinese women living in an old age home. Oral examination was performed by a dental surgeon. Sixty-eight of them had a 24-hour food record by direct observation, analysed by a Chinese food composition table. Nutritional status was measured by Body Mass Index (BMI), and the functional status by modified Barthel Index (BI).

RESULTS

Forty-two subjects (55.3%) were edentulous; 59 subjects (77.6%) had chewing difficulties; 35 subjects (46%) had poor dental functional status defined by having five or less functional teeth unit (FTU). When compared with those older people with better dental functional status, the poor dental functional status group was more likely to have chewing difficulties, tolerate soft diet only, and be functionally dependent (BI < 15/20). Poor dental functional status was associated with lower mean daily fibre intake, but not with intakes of macronutrients and micronutrients, after adjustment by BI categories.

CONCLUSION

Poor dental functional status is associated with impaired chewing and lower fibre intake in Chinese vegetarian old age home residents, but it is not associated with reduced intakes of macronutrients or micronutrients.

Relationship between dental erosion, soft drink consumption, and gastroesophageal reflux among Icelanders

The aim of this study was to determine the prevalence of dental erosion in young Icelandic adults (19-22 years old) and patients with gastroesophageal reflux disease (GERD), in relation to their soft drink consumption and gastroesophageal reflux. Eighty subjects (40 males and 40 females), comprising 57 young adults (mean age 21 +/- 2 years) and 23 GERD patients (mean age 35 +/- 10 years), were enrolled in this study. All subjects answered a detailed frequency questionnaire of soft drink consumption and participated in a clinical examination. Erosion was scored for incisor and molar teeth separately. No significant difference was observed in the prevalence of dental erosion between young adults and GERD patients. However, by combining the two study groups a three-fold higher risk of having erosion in molars or incisors was found for subjects drinking Coca-Cola three times a week or more often ( p < 0.05). Additionally, significantly higher erosion scores were found in molars among subjects drinking more than 1 litre of carbonated drinks (all brands) per week ( p < 0.05). It is concluded that the frequency of soft drink consumption is a strong risk factor in the development of dental erosion.