Prevalence of non-carious cervical lesions among the general population of the Republic of Srpska, Bosnia and Herzegovina

Acidic/abrasive challenges on simulated non-carious cervical lesions development and morphology

OBJECTIVES

This in vitro investigation assessed how frequency of erosive challenges and duration of toothbrushing abrasion influenced non-carious cervical lesions (NCCLs) development and morphology.

DESIGN

Experimental units were prepared using extracted human premolars assigned to four erosive-abrasive frequency protocols (n=16): F0. No acid exposure (negative control), F2.5 K. Acid exposure (1 % citric acid at natural pH) every 2500, F5K. 5000 and F15K. 15000 brushing-strokes. All groups were brushed for 55000 total brushing-strokes. Three-dimension images of the teeth were captured at baseline, after 15000, 35000 and 55000 brushing-strokes, using an intraoral scanner (TRIOS4, 3Shape). WearCompare software (Leeds Digital Dentistry) was used to analyze volumetric tooth loss (mm3) by superimposition followed by subtraction analysis. Lesion angle was measured (ImageJ, NIH) and morphology visually classified. Data were analyzed using ANOVA and Fisher's Exact tests adopting two-sided 5 % significance level.

RESULTS

Tooth loss increased with brushing-strokes overall (p<0.001) and for each erosive-abrasive protocol (p<0.001). Acid exposure significantly increased tooth loss (p<0.001), regardless of brushing interval (p<0.001), however by 35000 strokes no tooth loss difference was observed among acid-exposed groups (p>0.05). Control had significantly sharper mean lesion angle (59°) than all acid-exposed groups (∼145°) (p<0.001), and significantly different lesion shape with 94 % wedge-shaped lesions versus 0 %, respectively (p<0.001). In contrast to the control, acid exposure was associated to more striated lesions.

CONCLUSIONS

Simulated NCCLs developed and progressed differently and more rapidly in the presence of acidic challenges, regardless of their frequency. Exposure to acid impacted the morphology of lesions.

Effects of occlusal wear on 16-year progression of non-carious cervical lesions-Results of the study of health in Pomerania (SHIP-START)

BACKGROUND

It is still discussed whether occlusal wear (OW) affects the formation of non-carious cervical lesions (NCCLs).

OBJECTIVE

To estimate effects of OW on the presence and development of NCCLs, using 16-year follow-up data from a cohort study.

METHODS

Occlusal and cervical defects were measured in 728 cast models (one from the upper jaw and one from the lower jaw) of 364 participants. Adjusted mixed-effects ordinal logistic models analysing estimated cross-sectional (N = 1308 teeth/291 subjects) and longitudinal (N = 718 teeth/226 subjects) associations of OW with NCCLs using tooth level data.

RESULTS

OW size was cross-sectionally (OR = 1.74; 95% CI: 1.27-2.38 for OW size; OR = 0.97; 95% CI: 0.94-0.99 for squared OW size), but not longitudinally (OR = 1.14; 95% CI: 0.99-1.30) associated with odds of higher NCCL sizes. For cross-sectional analyses, predicted probabilities of an NCCL size of 0 decreased from about 0.996 to 0.010 for OW sizes of 0 to 25.

CONCLUSION

Results suggest an association between OW and NCCL size. However, as longitudinal results were non-significant, while consistent in direction, large-scaled cohort studies are demanded to more precisely estimate effect strength.

Risk factors for noncarious cervical lesions: A case-control study

OBJECTIVES

Noncarious cervical lesions (NCCLs) are multifactorial and can be caused by the anatomical structure of the teeth, erosion, abrasion and abnormal occlusion. The aim of this case-control study was to explore the risk factors for NCCLs.

METHODS

Cone-beam computed tomography was used to determine whether a wedge-shaped defect existed at the cementoenamel junction. We compared 63 participants with NCCLs with 63 controls without NCCLs, matched for sex, age (±1 year) and toothbrushing-related factors (e.g., type of bristle and brushing patterns, frequency and strength). All participants were asked to complete a questionnaire about self-administered daily diet habits and health condition. Univariate and multivariate logistic regression analyses were conducted to determine the risk factors for NCCLs.

RESULTS

Significant variables in the univariate analysis (i.e., p < .2) included frequency of carbonated beverage consumption, sella-nasion-point B angle (SNB) and Frankfort-mandibular plane angle (FMA). Multivariate logistic regression demonstrated that the consumption frequency of carbonated beverages (odds ratio [OR] = 3.147; 95% confidence interval [CI], 1.039-9.532), FMA (OR = 1.100; 95% CI, 1.004-1.204) and SNB (OR = 0.896; 95% CI, 0.813-0.988) was independent influencing factors. The area under the receiver operating characteristic curve (AUC) value of regression Model 1 (established with the frequency of carbonated beverage consumption, FMA, SNB and sleep bruxism) was 0.700 (95% CI, 0.607-0.792; p < .001), and that of regression Model 2 (established using the frequency of carbonated beverage consumption, FMA and SNB) was 0.704 (95% CI, 0.612-0.796; p < .001).

CONCLUSIONS

The consumption frequency of carbonated beverages and FMA was risk factors for NCCLs; the higher the frequency of carbonated beverage consumption and FMA, the higher was the probability of NCCLs. SNB was a protective factor for NCCL occurrence; the larger the SNB, the lower was the probability of NCCL occurrence. These findings have further clarified the aetiology of NCCLs and provided clinicians with valuable insights into strategies for preventing the loss of dental tissue.

Tooth wear and bruxism: A scoping review

OBJECTIVE

This study presents a scoping review to determine the association between tooth wear and bruxism.

DATA

A protocol was developed a priori (Open Science Framework (DOI 10.17605/OSF.IO/CS7JX)). Established scoping review methods were used for screening, data extraction, and synthesis. Risk of bias was assessed using JBI tools. Direct associations between tooth wear and bruxism were assessed.

SOURCES

Embase, SCOPUS, Web of Science, Cochrane, and PubMed were searched.

STUDY SELECTION

Any clinical study containing tooth wear and bruxism assessment done on humans in any language was included. Animal, in-vitro studies and case reports were excluded.

CONCLUSIONS

Thirty publications reporting on the association between tooth wear and bruxism were included. The majority of publications were cross-sectional studies (90%) while only three were longitudinal (10%). Eleven papers assessed definitive bruxism for analysis (instrumental tools), one paper assessed probable bruxism (clinical inspection with self-report) and eighteen assessed possible bruxism (self-report). Of the eleven papers assessing definitive bruxism, eight also reported outcomes of non-instrumental tools. Tooth wear was mostly scored using indexes. Most studies reported no or weak associations between tooth wear and bruxism, except for the studies done on cervical tooth wear. When bruxism assessment was done through self-report, more often an association was found. Studies using multivariate analyses did not find an association between tooth wear and bruxism, except the cervical wear studies. Evidence shows inconclusive results as to whether bruxism and tooth wear are related or not. Therefore, well-designed longitudinal trials are needed to address this gap in the literature.

CLINICAL SIGNIFICANCE

Based on the evidence, dental clinicians should not infer bruxism activity solely on the presence of tooth wear.

The Stresses and Deformations in the Abfraction Lesions of the Lower Premolars Studied by the Finite Element Analyses: Case Report and Review of Literature

BACKGROUND

The purpose of the study was to investigate the behavior of hard dental structures of the teeth with abfraction lesions when experimental occlusal loads were applied.

METHODS

A 65-year-old patient came to the dentist because she had painful sensitivity in the temporomandibular joints and the lower right premolars. The patient was examined, and cone-beam computed tomography (CBCT) of the orofacial area was indicated. The data provided from the CBCT were processed with Mimics Innovation Suite 17 software to create the desired anatomical area in 3D format. Then, the structural calculation module was used in order to perform a finite element analysis of the lower right premolar teeth. A focused review of articles published between 2014 and 2023 from specialty literature regarding the FEA of premolars with abfraction lesions was also conducted.

RESULTS

The parcel area and the cervical third of the analyzed premolars proved to be the most vulnerable areas under the inclined direction of occlusal loads. The inclined application of experimental loads induced 3-4 times higher maximum shears, stresses, and deformations than the axial application of the same forces.

CONCLUSIONS

FEA can be used to identify structural deficiencies in teeth with abfractions, a fact that is particularly important during dental treatments to correct occlusal imbalances.

Noncarious cervical lesions: Response from a 25-year clinical follow-up study

STATEMENT OF PROBLEM

The etiology and diagnosis of noncarious cervical lesions (NCCLs) remain poorly understood.

PURPOSE

The purpose of this clinical study was to examine NCCL progression in an existing group of participants, establish the incidence of new NCCLs in a 25-year follow-up study, and relate them to possible risk factors, including occlusal factors.

MATERIAL AND METHODS

Thirty-three participants who had completed a questionnaire about their habits, diet, and personal information were evaluated in this observational retrospective study. Impressions were made, and casts from 3 time periods (Phase I in 1996, Phase II in 1999, and Phase III in 2021) were scanned to obtain digital casts. The casts were then evaluated in a 3-dimensional analysis software program (Geomagic Control; 3D Systems) to establish digital comparisons between NCCLs and occlusal wear. Furthermore, data from an occlusal analysis device (T-Scan; Tekscan) collected in Phase I was used to analyze occlusal interferences relating to the progression of NCCLs. The statistical analysis applied nonparametric tests, followed by the assessment of the association between NCCLs and risk factors, including occlusal wear, through binary logistic regression (α=.05).

RESULTS

At the end of Phase III, 7 new individuals with NCCLs were detected compared with Phase II. The median percentage progression of NCCLs per participant was 0.0% in Phase I, 7.1% in Phase II, and 35.7% in Phase III (P<.005). Occlusal wear in Phase I was associated with 5.02 times the occurrence of NCCLs in Phase III; occlusal wear in Phase II was associated with 4.73 times the occurrence of NCCLs in Phase III; and occlusal wear in Phase III was associated with 1.94 times the occurrence of NCCLs in Phase III (P<.001). Occlusal interference in border movements of the mandible was associated with a 3.55 times greater chance of presenting NCCLs in Phase III (P<.001). Additionally, statistically significant risk factors for the presence of NCCLs in Phase III were an acidic diet (P=.043) and alcohol consumption (P=.021).

CONCLUSIONS

The 25-year data showed an association between NCCLs and specific risk factors, including occlusal wear and occlusal interferences.

Evaluation of Abfraction Lesions Restored with Three Dental Materials: A Comparative Study

BACKGROUND

Abfraction lesions are manifested as damage to hard tissues in the cervical area of dental crowns. The study aimed to assess the direct restoration of abfraction lesions according to the modified United States Public Health Service (USPHS) criteria for 24 months. The restorations were accomplished with Fuji Bulk-GC, Omnichroma Flow-Tokuyama, and Beautifil® II-Shofu dental materials, and the therapy was or was not associated with wearing thermoformed mouthguards.

METHODS

From the 53 selected and analyzed patients (n = 53), 28 patients (with restorations of abfraction lesions) belonged to the 1st group and 25 patients (with 105 restorations, who also wore mouthguards) belonged to the 2nd group. Blind determination assessments were effectuated at baseline and after 2, 6, 12, 18, and 24 months. Results showed that, regardless of the rating score, there are no significant statistical differences in the evaluation criteria between the two groups of patients Conclusions: For each material, the scores of USPHS criterion presented good clinical performances after 24 months, with no significant statistical differences between the fillings and the applied therapy in the two groups of patients.

Morphological and Optical Coherence Tomography Aspects of Non-Carious Cervical Lesions

Non-carious cervical lesions (NCCLs) are considered the irreversible losses of dental hard tissues at the cemento-enamel junction, in the absence of acute trauma and dental caries. The aim of this study was to highlight the presence of NCCLs in cervical areas based on specific macroscopic aspects in order to establish their clinical form, size and location and to confirm the role of optical coherence tomography (OCT) examination in the early diagnosis of these lesions. For this study, 52 extracted teeth were used, which did not have endodontic treatments, fillings or carious lesions in the cervical area. All teeth were examined macroscopically and OCT was used to evaluate the degree of occlusal wear, the presence and clinical form of NCCLs. Most NCCLs were identified on the buccal surfaces of the premolars. The most frequently encountered clinical form was the wedge-shaped form, with a radicular location. NCCLs present most frequently in the wedge-shaped form. Teeth that presented several NCCLs were identified. The OCT examination is an adjunct method to evaluate the clinical forms of NCCL.

Modifications of the Dental Hard Tissues in the Cervical Area of Occlusally Overloaded Teeth Identified Using Optical Coherence Tomography

Background and objectives: Occlusal overloads produce a series of manifestations in teeth, especially attrition and non-carious cervical lesions (NCCL). Optical Coherence Tomography (OCT) can highlight and evaluate tooth lesions. The aim of this study was to examine the changes of dental hard tissues in the cervical area because of occlusal overload by macroscopic examination and using in vitro Swept Source OCT examination. Materials and Methods: The study was performed on 21 extracted teeth with occlusal trauma. After macroscopic and OCT examination, the 2D OCT images were transformed into 3D images using ImageJ software. Statistical analysis of macroscopic and OCT images was performed with Statistical Package for Social Sciences. Results: On 21 teeth, 88 cervical lesions (cracks) were identified. Upper premolars with an occlusal Smith and Knight tooth wear score of 2 had the most NCCL. Statistical analysis revealed significant differences in the median widths of cervical lesions between teeth with score 1 and score 3. Additionally, we obtained statistically significant differences in median widths between the buccal and oral surfaces. Conclusions: These cracks can be considered precursors of NCCL. NCCL can be located on dental surfaces in the cervical area other than the buccal one. A 3D reconstruction of OCT images emphasized that cracks are located especially at enamel level, evolving towards the enamel-dentin junction, with multiple ramifications.

Prevalence and severity of non-carious cervical lesions and dentin hypersensitivity: association with oral-health related quality of life among Brazilian adults

Objectives

To assess the association between dentin hypersensitivity (DH) (with or without non-carious cervical lesions (NCCL)) and physical and psychosocial oral health impact.

Methods

A cross-sectional population-based study with one-stage random sample of adults living in a Brazilian municipally was conducted between 2018 and 2019. Interviews and oral examinations were performed by calibrated examiners (Kappa ≥0.7). The participant was considered as having physical and psychosocial impact if at least one item of the Oral Health Impact Profile (OHIP-14) was experienced fairly often or very often. NCCL was assessed by the Tooth Wear Index (codes 2 to 4) and DH was evaluated by a tactile test with a probe in the cervical area of teeth. The combination of these clinical variables resulted in categories of the independent variable: without DH or NCCL, NCCL without DH, DH without NCCL, and both DH with NCCL. The covariables were sociodemographic and economic factors, health habits, and oral conditions. Associations were investigated by Poisson Regression models using Direct Acyclic Graph (Stata 17).

Results

Of 197 adults, 59.3% had oral health impact and 31.3% had DH with NCCL. Higher frequency of oral health impact was observed in adults with DH alone. A higher impact on the physical pain dimension of the OHIP-14 was observed in adults with DH and NCCL (PR: 2.46; 95% CI: 1.21–5.00) and with DH alone (PR: 2.03; 95% CI: 1.21–3.41).

Conclusion

NCCL and DH are common conditions in adults and the presence of DH is associated with higher oral health impact. Regardless the presence of NCCL, DH is associated with the physical pain dimension of OHRQoL.

Objective assessment of simulated non-carious cervical lesion by tridimensional digital scanning

OBJECTIVE

To explore the use of 3D intraoral scanner/image analysis for the detection and monitoring of simulated non-carious cervical lesions (NCCLs) in vitro.

MATERIALS AND METHODS

A total of 288 NCCLs of different severities and simulated using a laboratorial model associating toothbrush stiffness (soft, medium, and hard) and toothpaste abrasivity (low, medium, high, and negative control) were analyzed. Dental impressions were taken from specimens before and after 35K and 65K brushing strokes, and then scanned with a CEREC Omnicam scanner. 3D models were analyzed for volumetric tooth loss. 3D optical profilometry was considered as the gold standard. Data were analyzed using ANOVA and Fisher's PLSD tests (alpha = 0.05), and agreement between methods by using intraclass correlation coefficient.

RESULTS

Toothbrushes of hard and mid stiffness caused higher tooth loss than soft when associated with the highest abrasive, at 35K and 65K strokes (p < 0.001). Variation in slurry abrasivity led to differences in tooth loss (with control < low < medium < high, p < 0.0001) after both 35K and 65K strokes, regardless of the type of toothbrush used, except at 35K, wherein control = low (p = 0.55). 35K strokes caused less tooth loss than 65K for all abrasive slurries (p < 0.0001) except controls. The intraclass correlation coefficient for agreement between the test and gold standard methods was 0.85.

CONCLUSIONS

Analysis of 3D images from intraoral scanner could detect and monitor NCCL progression, although this ability was limited on incipient lesions. Overall good agreement was found between the test method and optical profilometry.

CLINICAL RELEVANCE

The suggested method may be applicable to detect and monitor NCCLs clinically.

Prevalence and risk indicators of non-carious cervical lesions in male footballers

Background

Non-carious cervical lesions (NCCLs) have shown a significant incidence and prevalence and have been increasingly associated with people’s lifestyles and youths. This cross-sectional study aimed to determine the prevalence of NCCLs in footballers and to address potential risk indicators.

Methods

Fourty-three male semi-professional footballers with an average of 27 years old completed a questionnaire and were subjected to intraoral examination in terms of cervical tooth wear, morphological characteristics of NCCLs, tooth sensitivity, occlusal/incisal wear, and malocclusion classification. Also, laboratory assays were performed to determine salivary parameters: flow rate, pH, buffer capacity, level of Ca (calcium), Na (sodium), and K (potassium) ions, and level of cortisol. The data obtained from the questionnaire and intraoral examinations were subjected to Chi-square and Poisson regression models while the data obtained from the laboratory assays were analyzed by using analysis of variance (p <  0.05).

Results

The prevalence of NCCLs was 39.5%. The participants presented predominantly initial lesions with signs of mechanical stress. The daily training time was found as a significant risk indicator (p = 0.028). The multivariate analysis showed a significant difference in the variables daily training time (p = 0.023), lemon water intake while fasting (p = 0.002), toothpaste type (p = 0.004), tooth sensitivity (p = 0.006); previous orthodontic treatment (p = 0.003), and occlusion type (p = 0.008). All participants presented normal salivary parameters and levels of cortisol.

Conclusion

The prevalence of NCCLs among footballers was remarkable. The premolars were the most affected teeth and presented symptoms/signs of initial lesions. The daily training time was a dominant risk indicator of NCCLs development. Footballers presented adequate salivary parameters and cortisol levels.