Prevalence of dental erosion and association with lifestyle factors in Swedish 20-year olds

Influence of bottled salad dressings on the development of enamel erosion in the presence or absence of salivary pellicle - An in vitro study

Background

Acidic beverages are believed to elevate the risk of enamel surface erosion. In addition to the intake of soft drinks, the increased consumption of salad dressings has been linked to a higher prevalence of dental erosion. Therefore, the current study aimed to investigate the influence of bottled salad dressings on the development of enamel erosion in the presence or absence of pellicle through in vitro experiment.

Methods

Preliminary pH and calcium analyses of solutions were performed. Highest pH and calcium content was found for sandwich spread i.e., 4.69 and 55.4 mg/100 g grams, respectively. Eighty tooth specimens (measuring 4 × 4 × 3 mm) were prepared from extracted human premolars and randomly assigned to four groups (group 1: orange juice; group 2: eggless plain mayonnaise; group 3: sandwich spread; and group 4: thousand island dressing) with 20 samples in each group. Ten tooth specimens from each group were immersed in 20 ml of the respective solutions for 5 min (control group). The remaining ten tooth specimens from each group were submerged in 5 mL saliva vials for 3 min to facilitate salivary pellicle formation before being immersed in their respective solutions for 5 min (saliva-covered group). Pre and post-experimental assessments of enamel roughness and hardness were conducted using a surface roughness tester and Knoop Hardness indenter, respectively.

Results

Overall, enamel roughness was notably elevated in the control group, with the eggless plain mayonnaise (0.52 ± 0.38) and thousand island dressing groups (0.57 ± 0.29) showing a significant increase in surface roughness post-test (p = 0.05). Nevertheless, there was no significant difference in the enamel roughness between the groups. On the other hand, regardless of the presence/absence of the salivary pellicle, a marked decrease in enamel hardness was observed among all groups except for group 3 (sandwich spread) with a mean score of 311.5 ± 82.6 (p < 0.05).

Conclusion

A significant increase in surface roughness and reduction in enamel hardness was observed with salad dressings. However, in vitro formed salivary pellicle showed a protective effect against tooth 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.

Caries Experience and Erosive Tooth Wear in Finnish Men Conscripts 2021: A Cross-Sectional Study

Background: In Finland, the development of oral health in young, 19- to 21-year-old males regarding restorative treatment need seems to have slowed down according to cross-sectional conscript studies between 1976 and 2011. At the individual level, the mean number of decayed teeth (DT > 0) has also steadily continued to decline. In Finland, military service is mandatory, and around 85% of males complete it. The aim of this cross-sectional study was to investigate the oral health status of young men at the beginning of the 2020s. Methods: The data were collected in July 2021 in the eight biggest Finnish Defence force garrisons by ten calibrated dentists serving in the ranks. The inclusion criteria for this study were a year of birth between 2000 and 2002 and male gender (n = 508). Third molars were included. Restorative treatment need was evaluated using ICDAS scoring. The study was designed according to the STROBE guidelines. Results: Mean DT value was 1.13 when third molars were included and 1.03 when they were excluded. Mean DMFT value was 3.23 and 2.98, respectively. The proportion of conscripts with DT > 0 was 36.4% and 34.8%, respectively. The prevalence of caries was concentrated among a small number of conscripts. Most (76.5%) had BEWE (basic erosive wear examination) of 0–2. Conscripts in the moderate and severe ETW (erosive tooth wear) groups (BEWE 3–13) comprised 23.5% of the cohort. None of the conscripts fell into the most severe group (BEWE 14–18). Conclusions: The oral health of conscripts has improved over the last ten years, and restorative treatment need has decreased significantly. Compared to previous studies, restorative treatment need was concentrated on an even smaller proportion of conscripts.

Knowledge about caries and erosive tooth wear is confused among Norwegian high school students

OBJECTIVES

This study investigated differences in high school students' subjective and objective knowledge- and concerns about preventing caries and/or erosive tooth wear and the associations between these variables.

MATERIALS AND METHODS

A survey was conducted among students at 16 high schools in Norway. The survey included a range of fact-based questions to measure objective knowledge about caries and erosive tooth wear, as well as questions about students' perceptions of his/her own knowledge (subjective knowledge) and concerns about preventing the two conditions.

RESULTS

There were small differences in subjective knowledge about caries and erosive tooth wear among the 784 students who completed the survey (p < .01). However, students scored significantly higher on objective knowledge about caries (mean 2.99) than about erosive tooth wear (mean 1.45), p < .01, and seemed to confuse the two conditions. By contrast, students scored significantly worse on questions about beverages' potential to cause caries (mean 5.18) than to cause erosive tooth wear (mean 6.30), p < .001. Finally, objective knowledge about caries was positively associated with subjective knowledge about caries, but corresponding associations could not be found for erosive tooth wear.

CONCLUSIONS

Knowledge about caries and erosive tooth wear seemed to be confused among Norwegian high school students.

Effects of Remineralizing Agents Based on Calcium Phosphate, Sodium Phosphate, or Sodium Fluoride on Eroded Cervical Dentin

OBJECTIVES

To evaluate the effect of remineralizing agents on collagen matrix pattern, precipitate formation, and dentinal tubule obliteration in eroded cervical dentin.

METHODS AND MATERIALS

One hundred bovine cervical dentin specimens were previously eroded (0.6% hydrochloric acid, pH 2.3, 5 minutes) and then randomized into five groups (n=20): G1, control (without treatment); G2, Desensibilize Nano P (FGM); G3, MI Paste Plus (Recaldent); G4, Regenerate (NR-5); and G5, Desensibilize KF 2% (FGM). These treatments were applied in four sessions with 7-day intervals. During this period, the samples were subjected to an erosive challenge with orange juice (pH 3.8, 5 minutes). The specimens were analyzed by polarized light microscopy with picrosirius red staining, scanning electron microscopy (SEM), and energy-dispersive X-ray spectroscopy (EDX).

RESULTS

The G3 showed a higher concentration of type I collagen than G2 and G5 (p<0.05). The G3 showed greater formation of surface precipitates than that of G1 and G5 (p<0.05). In addition, G4 and G5 showed a greater number of open dentinal tubules than that of G3 (p<0.05).

CONCLUSIONS

Calcium phosphate-based remineralizing agents have shown to be a promising alternative treatment for preventing deleterious effects on the eroded dentin collagen matrix. In addition, they promoted precipitate formation and dentinal tubule obliteration on the eroded dentin.

Tooth wear and socioeconomic status in childhood and adulthood: Findings from a systematic review and meta-analysis of observational studies

OBJECTIVES

To evaluate the association and level of evidence between socioeconomic status (SES) and tooth wear (TW) in children, adolescents, and adults.

DATA

Eligibility criteria comprised population-based observational studies assessing the association between SES and TW in permanent dentition of adolescents and adults. Interventional and descriptive studies or those without an internal comparison between exposed and nonexposed groups were excluded. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied where applicable. Risk of bias (RoB) was assessed using the Newcastle-Ottawa scale. Meta-analyses were conducted to estimate the pooled effect measures. Q-statistic, I²statistic, subgroup and sensitivity analyses assessed study heterogeneity.

SOURCES

PubMed/Medline, Embase, Scopus, Web of Science, LILACS, SciELO, Cochrane Library, and Google Scholar databases were searched for articles published in English between 1st January 1980 and 31st March 2021.

RESULTS

Sixty-five studies were included, involving 63,893 participants in over 30 countries. A positive association was found between TW and education (OR=1.25 [0.96; 1.62]), family income (OR=1.18 [0.91; 1.53]), and private school (OR= 1.24 [0.90; 1.72]) among adolescents. Higher educated adults had a lower risk for TW (OR=0.70 [0.52; 0.93]). Most included studies had a moderate RoB. Limitations relating to population representation and assessment methodologies were identified in the included studies.

CONCLUSIONS

SES was associated with TW with its direction depending on the individuals' age. The overall quality of evidence was moderate.

CLINICAL SIGNIFICANC

SES should be included as part of the routine screening and risk assessment for tooth wear.

Knowledge on and treatment practices of erosive tooth wear among Finnish dentists

OBJECTIVES

To investigate Finnish dentists' knowledge on and means of recording, detecting and diagnosing erosive tooth wear (ETW). Treatment options and possible differences in treatment decisions between general and specialized dentists were also evaluated.

MATERIALS AND METHODS

An electronic questionnaire was sent by e-mail to 3664 Finnish dentists. Respondents' gender, age, work experience, field of specialty, and practice location were requested. The questionnaire also included a patient case where the dentists were asked about their choice of treatment. Statistical analyses were performed using means, proportions, and cross tabulations.

RESULTS

Response rate was 24% (n = 866). Almost all respondents (98.0%) recorded ETW in patient files, but only 4.1% used a detailed scoring system. Of the respondents, 64.4% usually found the cause of ETW. Use of carbonated beverages (84.3%), energy drinks (57.0%), and reflux disease (53.1%) were reported to be probable causes. The majority of the respondents (80.9%) usually assessed patient's dietary history while 1.9% evaluated saliva secretion rate. When asked about treatment decisions of ETW patients, the differences between general dentists and specialized dentists were not as obvious as hypothesized.

CONCLUSIONS

This study suggests that the Finnish dentists who participated in this survey are able to detect and/or diagnose erosive tooth wear, but there is variation in recording it. The differences in treatment decisions between general dentists and specialized dentists seem to be moderate. The treatment practices for ETW are not established and further research to create clinical guidelines seems to be needed.

Prevalence and progression of erosive tooth wear among children and adolescents in a Swedish county, as diagnosed by general practitioners during routine dental practice

Objectives

To investigate the prevalence and four-year progression of erosive tooth wear (ETW) recorded in general dental practice, and to evaluate the usefulness of a simplified grading scale.

Methods

Four cohorts (aged 3, 7, 11 and 15 years at baseline; n = 735) were followed from 2008 to 2012 during their routine dental examinations. Grading of ETW was performed on permanent upper incisors and first molars, using the scales of Johansson et al. 1996 and Hasselkvist & Johansson 2010.

Results

Valid data were available for 641 individuals, 7-19-years of age, of whom 326 had data allowing analyses of progression. The prevalence of ETW increased with age, although at a lower level than in comparable studies. Progression was found in one-third of the subjects, with higher proportions and higher grades noted among the older cohorts. The simplified scale, that graded only four surfaces, resulted in just a few missed, mainly mild, cases of ETW.

Conclusions

Clinically significant signs of ETW and patterns of progression can be reliably detected if the erosion index used includes a few selected surfaces of permanent teeth as part of the routine dental examination. Early signs of ETW, however, seem to be more difficult to detect and evaluate.

Clinical significance

It is both possible and beneficial to introduce the diagnosing of ETW in routine dental examinations. To reduce the time involved in grading every patient, the simplified 4-surface application, seems to be a useful tool, but which is to be augmented with more extensive grading in individuals considered to be at risk.

Associations between obesity, dental caries, erosive tooth wear and periodontal disease in adolescents: a case-control study

PURPOSE

To compare oral health [dental caries, periodontal status, and erosive tooth wear (ETW)], diet and oral hygiene habits between obese and normal weight adolescents, and to explore possible risk associations.

METHODS

In this case-control study, a convenience sample of 71 obese adolescents (age range 11-18) from a rehabilitation centre, and 54 age-sex-matched normal weight adolescents were selected for this study. Groups were defined using the Body Mass Index and growth curves for Flemish adolescents. Oral health was measured using DMFT, gingival, plaque and BEWE index. A validated questionnaire was utilized to assess diet and oral hygiene habits. Mann-Whitney U test was used to compare oral health between groups. Multivariate Firth's logistic regression analysis, conditional regression analysis and classification trees were used to detect associations between oral health and potential risk factors.

RESULTS

Prevalence of ETW did not differ significantly between groups, although obese adolescents presented a significantly higher caries experience, gingivitis, presence of plaque and periodontal problems, compared to normal weight adolescents. After adjusting for age and sex, obesity was associated only with the presence of dental plaque (p ≤ 0.001). Obese participants reported a significantly higher intake of sugar-rich and caloric food items than normal weight group. The consumption of acidic drinks, however, was similar.

CONCLUSION

Obese adolescents presented significantly higher caries experience, gingivitis and plaque, although after adjusting, obesity became significantly associated only with the presence of dental plaque.

Mechanical Characterization of Two Dental Restorative Materials after Acidic Challenge

The aim of this study was to determine the effect of acidic beverages on the mechanical characteristics of a nanofilled composite resin and of a glass ionomer. Thirty specimens of each restorative material were produced and were evaluated at three different time points: before immersion (T0), after a 7 day immersion (T1) and after a 14 day immersion (T2) in water, beer and a soft drink. The studied parameters were microhardness and surface roughness. At T2, composite resin and glass ionomer specimens immersed in water, beer and the soft drink showed a statistically significant decrease in microhardness compared to T0 results. The surface roughness of composite resin specimens decreased between T0 and T1/T2 after immersion in beer and soft drink. A statistically significant increase was found between the roughness of glass ionomer specimens immersed in each one of the beverages at T0 and T1/T2. It is essential that clinicians are aware not only of available restorative materials, its characteristics and best handling techniques but also of the importance of performing an adequate assessment of patients’ dietary habits, thus making it possible to offer patients quality treatments with a predictable prognosis and longevity.

Consumption of acidic drinks, knowledge and concern about dental erosive wear in Norwegian high school students

OBJECTIVES

The objectives of the present study were to assess the consumption of acidic beverages, knowledge and concern about preventing dental erosive wear, and to examine potential associations between these variables, in a sample of high school students.

MATERIALS AND METHODS

A survey measuring acidic beverage consumption, knowledge and concern about erosive tooth wear was conducted at 13 high schools in Rogaland county, Norway.

RESULTS

Of the 850 students who completed the questionnaire, 26% reported that they drink acidic beverages every day. There were significant gender differences for the consumption of acidic drinks. The survey also demonstrated that a high proportion of students lacks basic knowledge of what erosive tooth wear is, and that this lack of knowledge is associated with a more frequent intake of acidic beverages. However, students who responded that they are concerned about preventing dental erosive wear reported that they drink soft drinks and energy drinks less frequently than students who are not concerned about this.

CONCLUSIONS

Results from this study support assumptions about a lack of knowledge about dental erosive wear in youth, and that this lack of knowledge is associated with a more frequent intake of acidic drinks.

Fracture load of CAD/CAM ultrathin occlusal veneers luted to enamel or dentin

OBJECTIVES

To evaluate, in vitro, the fracture load of IPS e.max CAD occlusal veneers at thicknesses of either 0.3 or 0.6 mm luted to enamel or dentin.

MATERIALS AND METHODS

Fifty human molars were randomly distributed into five groups (n = 10): G1 - healthy teeth (control); G2-0.3-mm-thick veneers luted to enamel; G3-0.6-mm-thick veneers luted to enamel; G4-0.3-mm-thick veneers luted to dentin; and G5-0.6-mm-thick veneers luted to dentin. After the luting procedures, the specimens were immersed in distilled water at 37°C for 24 hours and then subjected to mechanical loading (10⁶  cycles at 200 N load). The specimens were subjected to a fracture load test in a universal testing machine. Two-way ANOVA and Tukey's test (α = 0.05) were used to analyze data.

RESULTS

Only the thickness factor was significant (P = .002). Values of fracture load followed by distinct letters represent significant differences (P < .05): G1 (3204 N ± 730)^ab ; G2 (3144 N ± 729)^ab ; G3 (2489 N ± 606)^b ; G4 (3591 N ± 776)^a ; and G5 (2770 N ± 598)^ab .

CONCLUSION

IPS e.max ultrathin occlusal veneers luted to enamel or dentin obtained fracture load comparable to that of the healthy tooth.

CLINICAL SIGNIFICANCE

IPS e.max CAD ultrathin occlusal veneers at 0.3 or 0.6-mm-thick seem to provide good perspectives in relation to the clinical use.

Erosive Tooth Wear among Adults in Lithuania: A Cross-Sectional National Oral Health Study

INTRODUCTION

Erosive tooth wear has a multifactorial origin, where multiple risks contribute to its initiation and subsequent progression. The prevalence of tooth wear varies among countries; therefore, national studies are needed to examine the prevalence of this condition and its associated determinants.

MATERIALS AND METHODS

A sample of this national study included a total of 1,397 adults (response rate of 52%). Severity and number of teeth with erosive tooth wear, caries experience (D3MFS), and fluorosis were assessed clinically. A self-reported questionnaire inquired about sociodemographics, oral health behavior, diet, and general health. Fluoride levels in drinking water at the recruitment areas were also recorded. Data were analyzed by bivariate and multivariate methods.

RESULTS

The prevalence of erosive tooth wear in enamel and dentin combined was 59% among 35- to 44-year-old, 75% among 45- to 54-year-old, 70% among 55- to 64-year-old, and 66% among 65- to 74-year-old males. The prevalence among females in the respective age groups was 44, 60, 63, and 59%. Erosive tooth wear in enamel was associated with a lower fluoride level (≤1 ppm) in the drinking water (OR 2.1, 95% CI 1.1-4.2). Erosive tooth wear in dentin was positively associated with male gender (OR 1.7, 95% CI 1.1-2.5), periurban/rural residency (OR 1.6, 95% CI 1.1-2.4), older age (OR 1.6, 95% CI 1.3-1.9), presence of reflux (OR 3.3, 95% CI 1.0-10.9), and negatively with higher D3MFS scores (OR 0.7, 95% CI 0.5-0.9).

CONCLUSIONS

The prevalence of erosive tooth wear in enamel and dentin was relatively high in Lithuania; the erosive tooth wear in enamel and dentin combined was 52% among 35- to 44-year-olds, 68% among 45- to 54-year-olds, 67% among 55- to 64-year-olds, and 63% among 65- to 74-year-olds. Lower fluoride level in drinking water was associated with erosive tooth wear in enamel. Male gender, residency in periurban/rural areas, older age, and presence of acid reflux were associated with higher odds, while higher D3MFS scores were associated with lower odds for erosive tooth wear in dentin. These results can be used to plan dental public health prevention.

Regular Physical Activity as a Potential Risk Factor for Erosive Lesions in Adolescents

Tooth erosion is becoming an increasingly common dental problem among teenagers. The study aimed to determine risk factors for erosive lesions in young sports professionals. Participants were 155 students—102 physically active and 53 controls. The method included dental examination (including Basic Erosive Wear Examination) and a questionnaire concerning sports activity, dietary and hygienic habits. The sporting activity significantly correlated with erosive lesions (R_Spearman = 0.344). The regression model incorporating the kind of sports activity, special diet and (non-)drinking water was statistically significant (p = 0.922 for the Hosmer–Lemeshow test) and strong enough to predict erosive lesions in young athletes (AUC = 0.758). Water sports professionals were almost 14 times more likely to suffer from erosive lesions than control students. Drinking water as the main beverage decreased the odds by about 70%. The graphical interpretation of multidimensional correspondence analysis confirms the predictive value of these factors. The kind of sports activity adjusted by the main beverage and a special diet was the best variable to predict erosive lesions among teenagers. Early proper diagnosis with defined risk factors leads to better prevention and successful treatment.

Oral health in children and adolescents with juvenile idiopathic arthritis - a systematic review and meta-analysis

BACKGROUND

Observational studies examining the association between oral health and juvenile idiopathic arthritis (JIA) among children and adolescents have reported inconsistent findings. The aims of this systematic review and meta-analysis were to ascertain a potential difference in oral health and oral health-related quality of life (OHRQoL) among children and adolescents with JIA and healthy peers, and to assess the association of prevalence of oral diseases/conditions, temporomandibular disorders (TMD), including temporomandibular joint (TMJ) diseases, in relation to activity and severity of JIA.

METHOD

Medline Ovid, Embase, CINAHL, SweMed+ and Cochrane Library were searched up to 25 November 2018. All articles published in English, German and Scandinavian languages focusing on children and adolescents with JIA and without JIA in relation to oral health measures, were considered. Two authors independently evaluated observational studies for inclusion. The study quality was assessed using modified Newcastle Ottawa Scale. Meta-analysis was performed for studies focusing on dental caries as an outcome.

RESULTS

Nineteen articles met the inclusion criteria, covering a range of oral diseases/conditions and OHRQoL. Eighteen studies had cross-sectional design. No mean difference of dmft/DMFT indices (decayed/missed/filled teeth) was observed between the JIA - and healthy group. None of the oral health measures including dental erosive wear, enamel defects, dental maturation and OHRQoL, indicated better oral health among children and adolescents with JIA compared to healthy group. However, periodontal conditions and TMD were more predominant among children and adolescents with JIA compared to healthy peers.

CONCLUSIONS

Based on the cross-sectional studies, periodontal diseases and TMD were found to be more frequent in children and adolescents with JIA compared to healthy peers. Furthermore, more high-quality studies with large sample size are needed before we infer any concrete conclusion regarding the association between the prevalence of oral and TMJ diseases or oral conditions in relation to activity and severity of JIA.

Obesity and tooth wear among American adults: the role of sugar-sweetened acidic drinks

BACKGROUND

To explore the association between obesity and tooth wear among American adults and the role of sugar-sweetened acidic drinks consumption in explaining that association.

METHODS

We analyzed data from 3541 adult participants in the National Health and Nutrition Examination Survey. Obesity was determined using the body mass index and tooth wear was assessed using the modified tooth wear index. Daily intake of four categories of drinks was estimated as the average (drinks/day) of two consecutive 24-h dietary recalls. The association between obesity and number of surfaces with moderate-to-severe tooth wear was assessed in hurdle models adjusting for sociodemographic factors, acid reflux medication, and dental insurance.

RESULTS

Overweight and obese adults had more surfaces with moderate-to-severe tooth wear than those with normal body size, after adjusting for confounders. The consumption of sugar-sweetened acidic drinks explained part, but not all the above association. More specifically, the estimate for obesity was fully attenuated, whereas the estimate for overweight was slightly attenuated but remained significant.

CONCLUSION

Obesity was positively associated with tooth wear in American adults. This association was only partially accounted for by the consumption of sugar-sweetened acidic drinks, a common risk factor for both conditions.

PRACTICAL IMPLICATIONS

Dentists must be aware of the health consequences of sugar-sweetened acidic drinks and advocate for reduction in consumption and/or substitution with healthier alternatives.

Erosive tooth wear and caries experience in children and adolescents with obesity

CLINICAL SIGNIFICANCE

A large consumption of fermentable carbohydrates, for instance the high intake of sweetened beverages, is an important risk factor for overweight and obesity. As lemonades and fruit juices present high sugar content and quite low pH-values, overweight and obese children might also have an increased risk for dental caries and erosive tooth wear.

OBJECTIVES

The aim was to analyze the prevalence and severity of erosive tooth wear and caries experience in children and adolescents with overweight, obesity and extreme obesity compared to children with normal weight and to determine a possible association between erosive tooth wear and caries experience.

METHODS

223 children (4-17 years, n = 1476 primary and n = 4110 permanent teeth) were examined using standardized dental indices (BEWE, ICDAS, DMFT). Demographic and socio-economic data, eating habits, oral hygiene, fluoride supply and details of medical history were obtained from a questionnaire. Weight classification was based on age- and gender-specific relative body mass indices (BMI). Statistical analyses were done by Chi²-tests, Kruskal-Wallis tests, logistic and linear regressions. To determine a possible association between erosive tooth wear and caries experience Chi²-tests (prevalence to prevalence) and Spearman correlations (severity to severity) were performed (p < 0.05).

RESULTS

Erosive tooth wear and caries experience in primary and permanent teeth were significantly increased in children with obesity and extreme obesity compared to normal weight children (p < 0.05). Higher BMI, age, gender, and the consumption of erosive snacks/beverages were identified as statistically significant risk factors for erosive tooth wear. Higher BMI, age, socio-economic factors, poor toothbrushing habits, and consumption of cariogenic beverages were identified as significant caries risk factors. Erosive tooth wear and caries showed a weak correlation in children with (extreme) obesity (Φ = 0.110 to 0.248).

CONCLUSIONS

Higher BMI of children and adolescents is significantly associated with a higher risk for erosive tooth wear and caries.

Opinions and Treatment Decisions for Dental Erosive Wear: A Questionnaire Survey among Icelandic Dentists

Dental erosive wear (DEW) is common among children and adolescents, and a survey of Icelandic children showed that 30.7% of 15-year-olds were diagnosed with the condition. Objective. To gain knowledge about dental practitioners' experiences, opinions, and treatment decisions. Materials and Methods. A precoded questionnaire, previously used among Norwegian dentists, was sent electronically to all dentists in Iceland (n = 341). Results. The response rate was 64.2%, and 58% of dentists were male. More than half of the clinicians (54%) thought that prevalence had increased the last 10-15 years, and 67% reported it to be more common in male. Most (96%) recorded presence of DEW, but only 4% used a detailed scoring system. Lesions were mostly on occlusal surfaces of first mandibular molars (73%), on palatal in upper anterior teeth (61%), and on occlusal of maxillary first molars (36%). Most dentists (74%) reported a probable cause, e.g., high consumption of carbonated beverages (98%), acidic juices (68%), sport drinks (58%), reflux (54%), and eating disorders (20%). Dietary history was often recorded by 38%, and 65% never measured saliva. Most of the dentists (88%) treated patients themselves, and half of them preferred prevention with high fluoride and resin sealants. While some dentists wanted to restore teeth more invasively, most considered to restore with a filling. Conclusion. Icelandic dentists seem to be well educated for diagnosis and treatment of dental erosion, and dentists are aware of a minimally invasive approach. Clinical Significance. It is challenging for dentists to make the best treatment decision for patients with DEW, both in a short perspective and long perspective. At present, little is known about their knowledge and treatment approach, and there is no standard treatment which can be recommended. Therefore, the present study investigated dental practitioners' treatment decisions, as well as knowledge, experiences, and awareness of DEW.

TiF4 varnish protects the retention of brackets to enamel after in vitro mild erosive challenge

The effect of fluoride agents on the retention of orthodontic brackets to enamel under erosive challenge is little investigated. The aim of this study was to evaluate the effect of titanium tetrafluoride (TiF4) and sodium fluoride (NaF) agents on the shear bond strength of brackets to enamel and on the enamel microhardness around brackets under erosive challenge. Brackets were bonded to bovine incisors. Five groups were formed according to fluoride application (n=10): TiF4 varnish, TiF4 solution, NaF varnish, NaF solution and control (without application). The specimens were submitted to erosive challenge (90 s cola drink/2h artificial saliva, 4x per day for 7 days). Solutions were applied before each erosive cycle and varnishes were applied once. Vickers Microhardness (VHN) was obtained before and after all cycles of erosion and the percentage of microhardness loss was calculated. Shear bond strength, adhesive remnant index and polarized light microscopy were conducted after erosion. The data were analyzed by ANOVA, Tukey, Kruskal-Wallis and Mann-Whitney U tests (α=0.05). The %VHN had no statistically significant differences among the experimental groups. However, considering the comparisons of all groups with the control group, TiF4 varnish showed the highest protection from enamel demineralization (effect size of 2.94, while the effect size for the other groups was >2.4). The TiF4 varnish group had significantly higher shear bond strength compared to other groups. There was no difference among groups for adhesive remnant index. Polarized light microscopy showed higher demineralization depth for the control group. Application of NaF and TiF4 agents during mild erosive challenge minimized the enamel mineral loss around brackets, however only the experimental TiF4 varnish was able to prevent the reduction of shear bond strength of brackets to enamel.

Dental erosion, prevalence and risk factors among a group of adolescents in Stockholm County

Aims

To investigate the prevalence and risk factors of dental erosion (DE) among a group of adolescents in Stockholm County.

Materials and methods

This cross sectional cohort study was conducted at three clinics of the Public Dental Service in Stockholm County. Fifteen and 17 year old adolescents (1335) who scheduled their regular dental health examination were asked to participate. After drop-outs a sample of 1071 individuals, 547 males and 524 females were enrolled in the study. Presence of erosive wear was diagnosed (yes/no) on marker teeth by trained dentists/dental hygienists and photographs were taken. The adolescents answered a questionnaire regarding oral symptoms, dietary and behavioural factors. Two calibrated specialist dentists performed evaluation of the photographs for severity of DE using a modified version of the Simplified Erosion Partial Recording System (SEPRS).

Results

DE was clinically diagnosed in 28.3% of 15 years old and 34.3% of 17 years old. Severe erosive wear (grade 3 and 4 according to SEPRS) was found in 18.3% of the adolescents based upon the intra-oral photographs. DE was more prevalent and severe among males than females. Clinically diagnosed erosive lesions correlated significantly with soft drink consumption (p < 0.001), the use of juice or sport drinks as a thirst quencher after exercise (p = 0.006) and tooth hypersensitivity when eating and drinking (p = 0.012). Furthermore, self-assessed gastric reflux was a factor strongly associated with DE (p < 0.001).

Conclusion

The study indicated that DE was common among adolescents in Stockholm County and associated with both internal and external risk factors.

Prevalence of erosive lesions with respect to risk factors in a young adult population in Poland-a cross-sectional study

OBJECTIVE

The study was conducted to investigate the prevalence of erosive lesions and related risk factors in the population of 18-year-old young adults in Poland.

MATERIALS AND METHODS

Calibrated examiners measured erosive tooth wear according to Basic Erosive Wear Examination (BEWE) scoring system in 1869 patients and assessed the impact of risk factors with a questionnaire.

RESULTS

Erosion was present in 42.3% of the patients. Early damage to the enamel was the most frequent finding (BEWE 1)-28.9%. More advanced lesions (BEWE 2) were observed in 12% of the patients. Advanced damage to the teeth (BEWE 3) was diagnosed rarely-1.4% of the examined population. Acidic diet, hygienic habits, and medical conditions such as asthma, eating disorders, and esophageal reflux showed statistical significance, as associated with erosion in the examined population.

CONCLUSIONS

The present study indicates that dental erosion is a common oral disease in the 18-year-old population with prevalence of frequency and intensity in males. However, on the basis of observations carried out in recent years, it may be assumed that the prevalence of this type of lesion is increasing.

CLINICAL RELEVANCE

Present findings support other longitudinal studies toward evaluation of the BEWE system as a valuable standard for assessing erosive and related risk factors among different populations.

Dental erosion in groups of Yemeni children and adolescents and the modification of an erosion partial recording system

BACKGROUND

The prevalence of dental erosion is rising especially among children and adolescents and its grading needs further investigation.

AIMS

To determine the prevalence and severity of dental erosion in groups of Yemeni children and adolescents, and to clinically compare an erosion partial recording system (EPRS) with a proposed modified-simplified version (EPRS-M).

DESIGN

Of 6163 individuals aged 5-6, 13-14 and 18-19 years, 911 were randomly selected, of which 668 participated in the study. Dental erosion was graded using EPRS. EPRS-M was proposed, and its sensitivity and specificity was calculated in relation to EPRS.

RESULTS

Prevalence of erosion extending into dentine on at least one tooth was 6.8% among 5- to 6-year-olds, 3.0% among 13- to 14-year-olds and 14.6% among 18- to 19-year olds. The highest prevalence was 19.2% among girls aged 18-19 years which was significantly higher than boys (10.4%) in the same age group (P = 0.044). Sensitivity and specificity for EPRS-M in relation to EPRS were 85.7% and 100% for primary teeth, and 84.1% and 100% for permanent teeth.

CONCLUSIONS

Dental erosion was common among children and older teenagers and highest among older girls but less common among younger teenagers. The tested accuracy of EPRS-M qualifies it to be used as an initial quick detection tool in future dental erosion research.

Tooth wear: a cross-sectional investigation of the prevalence and risk factors in Beijing, China

Objectives:

The aim of this study was to evaluate the epidemiology of tooth wear in Beijing and to establish appropriate preventive measures.

Materials and Methods:

This cross-sectional analysis involved a questionnaire survey conducted for 1,812 individuals aged 12–74 years in Beijing. Subjects were local residents living in the region for >6 months before the survey. Subjects were evaluated using clinical examinations with the basic erosive wear examination index and a self-administered questionnaire. Statistical analyses were performed using SPSS software.

Results:

The prevalence of maxillary tooth wear was 84.9% for the molars, 68.9% for the premolars, 74.1% for the canines and 97% for the incisors. In the mandible, the corresponding prevalence rates were 85.2%, 59.3%, 78.6% and 97.4%, respectively. The occlusal, incisal and cervical surfaces showed more frequent wear compared with the other surfaces. Age, acidic beverages, xerostomia and brushing habits were identified as risk factors for tooth wear (P<0.05).

Conclusions:

Tooth wear is common in Beijing. Specific preventive measures should be recommended for individuals reporting excessive consumption of fruits and/or acidic beverages, and those with xerostomia. In particular, incisor wear should be carefully monitored in individuals of all age groups.

Association of erosive tooth wear and dental caries in Northern Finland Birth Cohort 1966 - an epidemiological cross-sectional study

BACKGROUND

The main aim of this cross-sectional study was to investigate the prevalence and severity of erosive tooth wear and its association with dental caries and socio-demographic factors among middle-aged Finnish adults.

METHODS

Of the total Northern Finland Birth Cohort 1966 (n = 12,058), a convenience sample (n = 3181 adults) was invited for an oral health examination of which 1962 (61.7 %) participated, comprising the final study group. Clinical examinations were carried out by trained and calibrated dentists. Erosive tooth wear was assessed by sextants using the Basic Erosive Wear Examination Index (BEWE, 0-18) and dental caries at surface level using the ICDAS criteria (0-6). Socio-demographic data were obtained from a postal questionnaire. A logistic regression model was generated to test the association of the variables.

RESULTS

The prevalence of erosive tooth wear was 75 % and the mean of the BEWE sum score was 3.4 (SD 3.30). Almost half of the members needed non-invasive or invasive measures to prevent further progression of the condition. Of those with erosive lesions, 14.6 % suffered from severe erosive tooth wear. There was a strong positive relationship between the presence of severe erosive tooth wear (BEWE sum score ≥9) and male gender and restorative treatment need.

CONCLUSIONS

Erosive tooth wear is a common finding in Finnish adult population; almost one in ten suffer from severe erosive tooth wear. Restorative treatment need seems to be associated with severe erosive tooth wear.

A 4 year prospective longitudinal study of progression of dental erosion associated to lifestyle in 13-14 year-old Swedish adolescents

OBJECTIVES

To evaluate the progression of dental erosion in 13-14 year-olds after 4 years, and its association with lifestyle and oral health.

METHODS

227 randomly selected 13-14 year-olds from a Public Dental Clinic, Örebro, Sweden, were investigated. A clinical examination was performed which included dental caries/gingival/plaque status, as well as grading of dental erosion at the tooth surface and participant levels in "marker teeth", including buccal/palatal surfaces of 6 maxillary anterior teeth (13-23), and occlusal surfaces of first molars. An interview and a questionnaire regarding drinking habits and other lifestyle factors were completed. All investigations were repeated at follow-up. The participants were divided into high and low progression erosion groups and logistic regression statistics were applied.

RESULTS

175 individuals participated at follow-up. Progression occurred in 35% of the 2566 tooth surfaces. 32% of the surfaces had deteriorated by one severity grade (n=51 individuals) and 3% by two grades (n=2 individuals). Boys showed more severe erosion than girls at the follow-up. Among the variables predicting greater progression, a lower severity of erosive wear at baseline had the highest OR (13.3), followed in descending order by a "retaining" drinking technique, more frequent intake of drinks between meals, low GBI and lesser sour milk intake, with reference to the baseline recording. Using these five variables, sensitivity and specificity were 87% and 67% respectively, for predicting progression of erosion.

CONCLUSIONS

Progression of erosive lesions in Swedish adolescents aged 13-14 years followed up to age 17-18 years was common and related to certain lifestyle factors.

CLINICAL SIGNIFICANCE

In permanent teeth, dental erosion may develop early in life and its progression is common. Dental health workers should be made aware of this fact and regular screenings for erosion and recording of associated lifestyle factors should be performed.

Dental erosion among 12-year-old schoolchildren: a population-based cross-sectional study in South Brazil

OBJECTIVE

To assess the epidemiology and risk indicators for dental erosion among 12-year-old schoolchildren in South Brazil.

METHODS

A population-based cross-sectional survey was conducted in Porto Alegre, Brazil, using a representative sample of 12-year-old schoolchildren (n = 1,528). Dental erosion was recorded according to the Basic Erosive Wear Examination (BEWE) index. Parents answered questions on socio-economic status, brushing frequency and general health. Schoolchildren answered questions on dietary habits. Anthropometric data were collected. Statistical analysis included logistic and Poisson regression models.

RESULTS

The prevalence of dental erosion was 15% [95% confidence interval (95% CI): 13.6-16.5], being mainly mild erosion. Boys [odds ratio (OR) = 1.57, 95% CI: 1.17-2.10], private school attendees (OR = 1.45, 95% CI: 1.01-2.06) and schoolchildren reporting the daily consumption of soft drinks (OR = 5.04, 95% CI: 1.17-21.71) were more likely to have at least one tooth with dental erosion. Gender [boys, rate ratio (RR) = 1.66, 95% CI: 1.28-2.17], type of school (private, RR = 1.89, 95% CI: 1.53-2.35), the consumption of soft drinks (sometimes: RR = 5.27, 95% CI: 1.46-19.05; daily: RR = 6.82, 95% CI: 1.39-33.50) and the daily consumption of lemon (RR = 1.49, 95% CI: 1.11-2.00) were significantly associated with the number of affected surfaces.

CONCLUSIONS

The present study found a moderate prevalence of dental erosion among young schoolchildren, with mild erosion being the most prevalent condition. Socio demographic variables and dietary habits were associated with dental erosion in this population.

Association between soft drink consumption, oral health and some lifestyle factors in Swedish adolescents

OBJECTIVE

The aim was to investigate the relationship between soft drink consumption, oral health and some lifestyle factors in Swedish adolescents.

MATERIALS AND METHODS

A clinical dental examination and a questionnaire concerning lifestyle factors, including drinking habits, oral hygiene, dietary consumption, physical activity and screen-viewing habits were completed. Three hundred and ninety-two individuals completed the study (13-14 years, n = 195; 18-19 years, n = 197). The material was divided into high and low carbonated soft drink consumption groups, corresponding to approximately the highest and the lowest one-third of subjects in each age group. Differences between the groups were tested by the Mann-Whitney U-test and logistic regression.

RESULTS

Intake of certain dietary items, tooth brushing, sports activities, meal patterns, screen-viewing behaviors, BMI and parents born outside Sweden differed significantly between high and low consumers in one or both of the two age groups. Dental erosion (both age groups) and DMFT/DMFS (18-19 years group) were significantly higher in the high consumption groups. Logistic regression showed predictive variables for high consumption of carbonated soft drinks to be mainly gender (male), unhealthy dietary habits, lesser physical activity, higher BMI and longer time spent in front of TV/computer.

CONCLUSION

High soft drink consumption was related to poorer oral health and an unhealthier lifestyle.

Prevalence of Dental Erosion among the Young Regular Swimmers in Kaunas, Lithuania

OBJECTIVES

To determine prevalence of dental erosion among competitive swimmers in Kaunas, the second largest city in Lithuania.

MATERIAL AND METHODS

The study was designed as a cross-sectional survey, with a questionnaire and clinical examination protocols. The participants were 12 - 25 year-old swimmers regularly practicing in the swimming pools of Kaunas. Of the total of 132 participants there were 76 (12 - 17 year-old) and 56 (18 - 25 year-old) individuals; in Groups 1 and 2, respectively. Participants were examined for dental erosion, using a portable dental unit equipped with fibre-optic light, compressed air and suction, and standard dental instruments for oral inspection. Lussi index was applied for recording dental erosion. The completed questionnaires focused on the common erosion risk factors were returned by all participants.

RESULTS

Dental erosion was found in 25% of the 12 - 17 year-olds, and in 50% of 18 - 25 years-olds. Mean value of the surfaces with erosion was 6.31 (SD 4.37). All eroded surfaces were evaluated as grade 1. Swimming training duration and the participants' age correlated positively (Kendall correlation, r = 0.65, P < 0.001), meaning that older swimmers had practiced for longer period. No significant correlation between occurrence of dental erosion and the analyzed risk factors (gastroesophageal reflux disease, frequent vomiting, dry mouth, regular intake of acidic medicines, carbonated drinks) was found in both study groups.

CONCLUSIONS

Prevalence of dental erosion of very low degree was high among the regular swimmers in Kaunas, and was significantly related to swimmers' age.