Non-carious cervical lesions in a Nigerian population: Abrasion or abfraction?

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.

Progression of non-carious cervical lesions: 3D morphological analysis

OBJECTIVES

This longitudinal study aimed to investigate morphologically and quantitatively the progression of non-carious cervical lesions (NCCLs) using a confocal laser scanning microscope (CLSM) and replica models.

MATERIALS AND METHODS

The samples examined comprised sets of replicas annually obtained from 83 lesions in 16 participants over 3 to 5 years. All lesions were visually categorized as wedge-shaped, saucer-shaped, or mixed-shaped lesions. CLSM images of the replicas were analyzed in terms of axial depth, occlusogingival width (height) in the buccolingual cross-section, and estimated volume using a custom code of the image analysis software to estimate the progression of the NCCLs over time. The morphological characteristics of the NCCLs were also objectively divided into three groups according to the depth to height ratio (D/H ratio). Fisher's exact test and the Cochran-Armitage trend test were used for statistical analysis.

RESULTS

Saucer-shaped lesions progressed mainly in height, whereas wedge-shaped lesions increased both in height and depth. Annual progression in depth and volume significantly increased as the D/H ratio increased. More than half of the NCCLs with a small D/H ratio progressed 50 μm or more in height, whereas none of them progressed more than 50 μm in depth. Annual progression in depth significantly increased as the lesion depth at baseline increased.

CONCLUSIONS

Progression patterns significantly differed between NCCLs of different shapes. Most NCCLs progressed slowly in depth regardless of their shape. Moreover, NCCLs may progress through active and inactive stages.

Association of Non-Carious Cervical Lesions with Oral Hygiene Habits and Dynamic Occlusal Parameters

Dentists routinely encounter non-carious cervical lesions (NCCLs) in daily clinical practices. The dental literature is contradictory regarding the occlusal etiology of NCCLs. NCCL is defined as the loss of dental structure at the cemento-enamel junction, with no association of bacteria. The aim of this study was to evaluate the association of dynamic occlusal factors and dental hygiene practices with NCCLs. In total, 100 participants were selected by the random stratified sampling method, 50 each for control and NCCL groups. Information regarding oral hygiene practices, including frequency, duration, force, and technique of brushing, was recorded. Dynamic occlusal parameters like initial contact, occlusion time (OT), disocclusion time (DT), and center of force were recorded with T-scan analysis. The obtained data were analyzed with Pearson's correlation and binary logistic regression. We found that 68% of participants in the NCCL group and 31% in the control group utilized the horizontal brushing technique; 46% of NCCL group participants used hard brush against 7% of participants in the control group. The mean OT was 0.727 and 0.516 s for NCCL and control groups, respectively. The OT and left and right lateral DT were strongly related to NCCL, with r-values of 0.661, 0.642, and 0.534, respectively, with p ≤ 0.001. Using a hard toothbrush was found to be associated with NCCL. The NCCL group had extended mean occlusion time and disocclusion time in all eccentric mandibular movements.

Root grooves on two adjacent anterior teeth of Australopithecus africanus

Tooth root grooves and other ante-mortem dental tissue loss, not associated with caries found on or near the cementoenamel junction (CEJ), are commonly termed non-carious cervical lesions. Three main processes are implicated in forming these lesions: abrasion, dental erosion, and abfraction. As yet, these lesions have not been described in non-Homo hominins. In this study, South African fossil hominin collections were examined for evidence of any type of non-carious cervical lesion. Only one individual shows ante-mortem root grooves consistent with non-carious cervical lesions. Two teeth, a mandibular right permanent lateral incisor (STW 270) and canine (STW 213), belonging to the same Australopithecus africanus individual, show clear ante-mortem grooves on the labial root surface. These lesions start below the CEJ, extend over a third of the way toward the apex, and taper to a point towards the lingual side. The characteristics of these grooves suggest the predominant aetiology was erosive wear. In addition, they are extremely similar to clinical examples of dental erosion. These are the oldest hominin examples of non-carious cervical lesions and the first described in a genus other than Homo. Further, the lesions suggest that this individual regularly processed and consumed acidic food items.

Influence of Surface Treatment on Composite Adhesion in Noncarious Cervical Lesions: Systematic Review and Meta-analysis

The purpose of this study was to analyze the influence of dentin surface treatments on the retention rate of resin composite restorations in non-carious cervical lesions (NCCLs). Seven randomized clinical trials were included in this review. Data regarding retention rate, type of surface treatment, and the main characteristics of studies were analyzed. Two reviewers performed a literature search up to December 2016 in eight databases: PubMed (Medline), Lilacs, Ibecs, Web of Science, BBO, Scopus, Scielo and The Cochrane Library. Only clinical trials evaluating dentin surface treatments in resin composite restoration in NCCLs were included. Noncontrolled clinical trials, reviews, editorial letters, case reports, case series and studies published in a language other than English, Portuguese, or Spanish were not included. The included studies evaluated different surface treatments, such as using an adhesive system with a frictional technique, drying the dentin, and removing sclerotic dentin by using a bur and applying EDTA before primer use. The analysis considering the mechanical removal of dentin surface with a bur and the application of an adhesive system in a frictional mode showed these treatments improved retention rates of the resin composite restorations in NCCLs ( p<0.05). There is evidence in the literature suggesting that the mechanical removal of dentin surface with a bur and the application of an adhesive system in a frictional mode could improve the retention rates of resin composite restorations in NCCLs. However, the studies showed high heterogeneity, and additional clinical trials are needed to determine the best dentin treatment option in NCCLs.

Non-carious cervical lesions (NCCLs) in a random sampling community population and the association of NCCLs with occlusive wear

This study investigated the prevalence, risk factors and association of occlusive wear with non-carious cervical lesions (NCCLs) in the general Chinese population. A total of 1320 subjects were recruited, and multistage and random sampling methods of survey spots were performed. All age groups comprised similar numbers of participants and equal numbers of males and females. Each subject completed a structured interview, and all teeth of each subject were examined by a practitioner to determine NCCLs and occlusive wear. Binary logistic regression was conducted by analysing the association of risk factors with the occurrence of NCCLs. Bivariate correlation analysis was performed by determining the association of NCCLs dimension or depth with the range of occlusive wear facets. Clinical assessment showed that the overall prevalence of subjects diagnosed with NCCLs was 63%. The proportion of subjects or teeth with NCCLs significantly increased with age. Pre-molars were the most commonly affected teeth. Single variables and interactive effects of variables associated with the occurrence of NCCLs include the following: age group, intensity of toothbrushing, frequency of fresh fruit consumption and interactive effect between intensity of toothbrushing and frequency of fresh fruit consumption. A weak positive correlation of the grading index was found between NCCLs dimension, size or depth and range of occlusive wear facets. This study reported the higher prevalence of NCCLs in the general Chinese population. Implementation of a combined strategy to reduce risk factors of NCCLs could be more effective than individual techniques; meanwhile, the occurrence of NCCL could be related to the wear degree of occlusive defects in the population studied.

A cross-sectional study of dentine sensitivity in periodontitis patients in Trinidad and Tobago

OBJECTIVE

This cross-sectional study aimed to determine the prevalence, distribution and associated factors of dentine sensitivity (DS) among periodontitis patients in Trinidad.

METHODS

Sequential patients meeting the periodontitis criteria (BPE 4/4*) were included and completed a questionnaire on DS prior to a full periodontal examination. Clinically elicited symptoms of DS and presence of cervical tooth wear were recorded.

RESULTS

DS prevalence was 73.1% (n = 130; mean age 50 years). Mean number of sensitive teeth increased with increased severity of gingival recession. Most common initiating factors of DS were cold stimuli (70.5%), brushing (25.3%) and sour food (11.6%). Correlations were obtained for DS and race, toothbrush texture hardness, cervical tooth wear and gingival recession severity (P < 0.05; binary logistic regression). Cervical tooth wear was recorded in 46.3% of DS patients. Full-mouth plaque scores (FMPS) and full-mouth bleeding scores (FMBS) were statistically significantly (P < 0.05; Mann-Whitney U) test lower for DS versus non-DS patients. Patients reported a low usage (27.4%) and satisfaction (53.8%) rating for desensitizing agents.

CONCLUSIONS

The high prevalence of DS was comparable to other studies on periodontitis patients. Progressive periodontal disease and toothbrush abrasion were possible aetiological factors for DS in this study. Knowledge of local dietary practices and the role of acidic (sour) foods in eliciting DS may aid in management. The high prevalence of cervical tooth wear and the lower FMPS and FMBS among DS patients may reflect more aggressive tooth brushing. DS does not seem to be a limitation to plaque control in DS versus non-DS patients in this study.

Factors influencing the progression of noncarious cervical lesions: A 5-year prospective clinical evaluation

STATEMENT OF PROBLEM

The etiology (chemical, friction, abfraction) of noncarious cervical lesion (NCCL) progression is poorly understood.

PURPOSE

The purpose of this 5-year prospective clinical trial was to measure the relationship between NCCLs and various etiologic factors.

MATERIAL AND METHODS

After review board approval, 29 participants with NCCLs were enrolled. Polyvinyl siloxane impressions were made of each NCCL, and casts were poured at baseline, 1, 2, and 5 years. The casts were scanned with a noncontact profilometer, and 1-, 2-, and 5-year scans were superimposed over baseline scans to measure volumetric change in NCCLs. T-scan and Fujifilm Prescale films were used to record relative and absolute occlusal forces on teeth with NCCLs at the 5-year recall. Participant diet, medical condition, toothbrushing, and adverse oral habit questionnaires were given at the 5-year recall. Occlusal analysis was completed on mounted casts to determine the presence of wear facets and group function. Volumetric lesion progression from 1 to 5 years was correlated to absolute and relative occlusal force using mixed model analysis. The Kruskall-Wallis and Mann-Whitney analyses compared lesion progression with diet, medical condition, toothbrushing, adverse oral habits, wear facets, and group function.

RESULTS

The NCCL progression rate over 5 years was 1.50 ±0.92 mm(3)/yr. The rate of progression of NCCLs was related to mean occlusal stress (P=.011) and relative occlusal force (P=.032) in maximum intercuspation position. No difference was seen in NCCL progression between participants with any other factors.

CONCLUSION

Heavy occlusal forces play a significant role in the progression of NCCLs.

Restoration of noncarious tooth defects by dentists in The Dental Practice-Based Research Network

BACKGROUND

The authors conducted a study to quantify the reasons for restoring noncarious tooth defects (NCTDs) by dentists in The Dental Practice-Based Research Network (DPBRN) and to assess the tooth, patient and dentist characteristics associated with those reasons.

METHODS

Data were collected by 178 DPBRN dentists regarding the placement of 1,301 consecutive restorations owing to NCTDs. Information gathered included the main clinical reason, other than dental caries, for restoration of previously unrestored permanent tooth surfaces; characteristics of patients who received treatment; dentists' and dental practices' characteristics; teeth and surfaces restored; and restorative materials used.

RESULTS

Dentists most often placed restorations to treat lesions caused by abrasion, abfraction or erosion (AAE) (46 percent) and tooth fracture (31 percent). Patients 41 years or older received restorations mainly because of AAE (P < .001). Premolars and anterior teeth were restored mostly owing to AAE; molars were restored mostly owing to tooth fracture (P < .001). Dentists used directly placed resin-based composite (RBC) largely to restore AAE lesions and fractured teeth (P < .001).

CONCLUSIONS

Among DPBRN practices, AAE and tooth fracture were the main reasons for restoring noncarious tooth surfaces. Pre-molars and anterior teeth of patients 41 years and older are most likely to receive restorations owing to AAE; molars are most likely to receive restorations owing to tooth fracture. Dentists restored both types of NCTDs most often with RBC.

Non-carious cervical lesions and occlusion: a systematic review of clinical studies

Non-carious cervical lesions (NCCLs) are a group of lesions that affect the cervical area of the teeth. Different aetiological factors have been reported, among them tooth brushing force, erosive agents and occlusal forces. The aim of this study was to ascertain, by means of a systematic review, the association between NCCLs and occlusion. A search was performed in the MEDLINE database, retrieving a total of 286 articles. After title and abstract screening, the clinical investigations were read in full to select those that evaluated the occlusal aspects of NCCL aetiology. This systematic review describes the results of three prospective and 25 cross-sectional studies. As there is an extreme heterogeneity in design, diagnostic criteria, forms of analysis and associated factors, a meta-analysis was not possible. The wide variety of classification and diagnostic criteria reflects a high range of reported prevalence. An extensive heterogeneity of independent variables was noted, even in occlusal analysis, which helps to mask any conclusion about the role of occlusion in NCCL aetiology. The literature reveals that studies on this topic are subject to a substantial amount of bias, such as evaluation (use of non-blinded examiners) and confounding bias (no control of others aetiological factors). Up to now, it has been impossible to associate NCCLs with any specific causal agent, and the role of occlusion in the pathogenesis of non-carious cervical lesions seems as yet undetermined. Therefore, additional studies, properly designed to diminish bias, are warranted.

Left-to-right distribution of periodontal disease

AIM

Symmetry is a property established in many human biological systems and it is reasonable to expect that it may also exist in the mouth. The objective of this study was to examine whether there is a similar left-to-right distribution in periodontal disease.

METHOD

Records of 197 patients from the Periodontics department of The Royal Dental Hospital of Melbourne were analysed. The clinical parameters recorded were pocket probing depth, recession, bleeding on probing, mobility and furcation involvement.

RESULTS

The average age of our sample group was 47.5 years old, with 34.5% men and 65.5% women. The results demonstrated significant left-to-right distribution with all the periodontal indices recorded.

CONCLUSION

The findings support previous studies that show that a similar left-to-right distribution exists in the population studied.

Tooth brushing habits in uninstructed adults--frequency, technique, duration and force

Professional recommendations for individual oral hygiene mostly include tooth brushing at least twice daily for 2-3 min with gentle force using the Bass technique or modifications of it. This study evaluated whether habitual tooth brushing actually meets these standards. Uninstructed adults (n = 103; mean age 31 +/- 6 years; 61 female, 42 male) with habitual manual tooth brushing were given a self-administered questionnaire about the frequency of brushing and a computer system recorded their brushing technique, duration and force. The majority (79.6%) of participants brushed twice daily. The mean brushing duration was 96.6 +/- 36.0 s, the mean brushing force was 2.3 +/- 0.7 N (max. 4.1 N), and no significant differences were found for quadrants. Most subjects (73.8%) brushed with circling, 8.7% with horizontal/scrubbing, 13.6% with horizontal/circling and 3.9% with vertical/sweeping movements. Modified Bass technique was not observed. When appropriate brushing habits were defined as brushing at least twice daily for 120 s with a brushing force of less than 3 N and with circling or vertical sweeping movements, only 25.2% of the participants fulfilled all criteria, emphasising the ongoing need for oral hygiene education.

The prevalence and severity of non-carious cervical lesions in a group of patients attending a university hospital in Trinidad

Non-carious cervical lesions (NCCLs) are often encountered in clinical practice and their aetiology attributed to toothbrush abrasion, erosion and tooth flexure. This paper aims to determine the prevalence and severity of NCCLs in a sample of patients attending a university clinic in Trinidad and to investigate the relationship with medical and dental histories, oral hygiene practices, dietary habits and occlusion. Data were collected via a questionnaire and clinical examination. Odds ratios were used to determine the association of the presence of lesions and the factors examined. One hundred and fifty-six patients with a mean age of 40.6 years were examined of whom 62.2% had one or more NCCLs. Forty five per cent of the lesions were sensitive to compressed air. Younger age groups had a significantly lower correlation with the presence of NCCLs than older age groups. Other significant factors included patients who reported heartburn, gastric reflux, headaches, bruxism, sensitive teeth and swimming or had a history of broken restorations in the last year. There was also significant correlation of NCCLs in patients who brushed more than once a day or used a medium or hard toothbrush. Patients with vegetarian diets and those who reported consuming citrus fruits, soft drinks, alcohol, yoghurt and vitamin C drinks were associated with the presence of lesions. Significant associations were also found in patients with group function, faceting, clicking joints or those who wore occlusal splints.

A critical review of non-carious cervical (wear) lesions and the role of abfraction, erosion, and abrasion

The terms 'abfraction' and 'abrasion' describe the cause of lesions found along the cervical margins of teeth. Erosion, abrasion, and attrition have all been associated with their formation. Early research suggested that the cause of the V-shaped lesion was excessive horizontal toothbrushing. Abfraction is another possible etiology and involves occlusal stress, producing cervical cracks that predispose the surface to erosion and abrasion. This article critically reviews the literature on abrasion, erosion, and abrasion, and abfraction. The references were obtained by a MEDLINE search in March, 2005, and from this, hand searches were undertaken. From the literature, there is little evidence, apart from laboratory studies, to indicate that abfraction exists other than as a hypothetical component of cervical wear.

Noncarious cervical lesions in adults: prevalence and occlusal aspects

BACKGROUND

The factors that induce the formation of noncarious lesions are not understood fully, particularly those that are related to occlusal aspects. The authors conducted a study to evaluate the prevalence of noncarious cervical lesions in adults and their association with occlusal aspects.

METHODS

The authors examined 70 people (35 men and 35 women) aged 25 to 45 years to determine the presence and type of noncarious cervical lesions, wear facets, tooth contacts in maximal intercuspal position, and lateral and protrusive movements. The assessment involved a questionnaire and clinical examination.

RESULTS

Among the teeth the authors evaluated, 17.23 percent had cervical lesions, 80.28 percent of which had wear facets (P < .01). The authors found a significant difference between the prevalence of noncarious lesions and the presence of wear facets (P = .0484).

CONCLUSIONS

The authors found that cervical lesions were related significantly to wear facets. These findings strengthen evidence for the role of occlusal forces as an etiologic factor for noncarious lesions.

CLINICAL IMPLICATIONS

The presence of wear facets should be considered in the treatment of noncarious cervical lesions.

The biomechanics of abfraction

The role of occlusal loading in the development of non-carious cervical lesions is becoming increasingly prominent. It is suggested that high occlusal loads result in large stress concentrations in the cervical region of the teeth. These stresses may be high enough to cause disruption of the bonds between the hydroxyapatite crystals, eventually resulting in the loss of cervical enamel.

This article reviews the evidence to support the thesis that occlusal loading can contribute to the process of non-carious cervical tooth loss or abfraction. It also reviews the potential interactions between occlusal loading and erosion that may contribute to non-carious cervical tooth loss.