Dental erosion: a widespread condition nowadays? A cross-sectional study among a group of adolescents in Norway

Anamnestic risk factors for erosive tooth wear: Systematic review, mapping, and meta-analysis

OBJECTIVES

Erosive tooth wear is a multifactorial condition. The aim of this systematic review and meta-analysis was to identify key risk factors for erosive tooth wear in permanent dentition.

STUDY SELECTION

Observational studies reporting anamnestic risk factors for erosive tooth wear. Methodological quality and risk of bias were assessed using the modified Newcastle-Ottawa scale for cross-sectional studies. Risk factors were visually presented in a heatmap, and where possible, random-effects meta-analyses were performed for the odds ratios (ORs) of risk factors.

SOURCES

Electronic databases (MEDLINE, Embase, Scopus, and Web of Science) and manual searches in February 2023. The protocol was registered in PROSPERO (CRD4202339776).

DATA

A total of 87 publications reporting on 71 studies were included in the systematic review. The studies examined a variety of anamnestic risk factors (n = 80) that were categorized into ten domains (socio-demographics, socio-economics, general health, oral diseases, medication, oral hygiene, food, beverages, dietary habits, and leisure-related risk factors). Meta-analyses revealed significant associations between erosive tooth wear and male gender (padj.<0.001; OR=1.30, 95 % CI: 1.16-1.44), regurgitation (padj.=0.033; OR=2.27, 95 % CI: 1.41-3.65), digestive disorders (padj.<0.001; OR=1.81, 95 % CI: 1.48-2.21), consumption of acidic foods (padj.=0.033; OR=2.40, 95 % CI: 1.44-4.00), seasoning sauces (padj.=0.003; OR=1.28, 95 % CI: 1.13-1.44), nutritional supplements (padj.=0.019; OR=1.73, 95 % CI: 1.28-2.35), and carbonated drinks (padj.=0.019; OR=1.43, 95 % CI: 1.17-1.75). Most included studies exhibited low bias risk.

CONCLUSIONS

Observational studies investigated a variety of anamnestic risk factors for erosive tooth wear. Future studies should employ validated questionnaires, particularly considering the most important risk factors.

CLINICAL SIGNIFICANCE

Erosive tooth wear is a prevalent condition. Clinicians should concentrate primarily on symptoms of gastroesophageal reflux disease and dietary factors when screening patients at risk for erosive tooth wear.

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.

Relationship Between Dental Caries and Erosive Tooth Wear in Adolescents

Background

Our aim was to investigate the relationship between caries experience and erosive tooth wear of adolescents.

Methods

We compared the Decayed, Missing, and Filled Teeth (dmft/DMFT) data of 795 adolescents to their erosive tooth wear scores using diet as a covariate and determined if dental caries and erosive tooth wear scores are associated using linear regression analysis. Diet data and oral hygiene habits were collected using self-reported surveys and erosive tooth wear scores were previously collected. We also compared patients' genotypes and phenotypes and looked for an association between erosive tooth wear experience and different single nucleotide polymorphisms (SNPs). A Bonferroni correction was implemented to correct multiple comparisons. Two-group comparisons were made depending on the phenotype definitions implemented, and both chi-square and linear regression analyses were used to test association between genetic variants and caries definitions. All covariates were included in each model.

Results

For four SNPs (rs17159702, rs10246939, rs1800972, and rs1676303), there was an association between a spike in caries experience of DMFT 4 or more between two time points and increased frequency of fruit juice intake. A fifth SNP rs2860216 was shown to be a protective factor toward a spike in caries when coupled with more frequently eating yogurt. We did not find significant associations between our dental caries phenotypes or our demographic data and erosive tooth wear status in our linear regression.

Conclusions

Dental caries and erosive tooth wear are two diseases that differ in mechanism and heritability.

The association between erosive tooth wear and diet, hygiene habits and health awareness in adolescents aged 15 in Poland

Purpose

The aim of the study was to assess the prevalence of erosive tooth wear (ETW) and risk indicators in the population of adolescents aged 15 in Poland.

Methods

Erosive tooth wear in 2639 participants was determined by calibrated examiners according to the BEWE scoring system, and the prevalence of risk factors was assessed on the basis of a survey.

Results

Erosive tooth wear was reported in 24.3% of participants. Initial loss of surface (BEWE 1) was the predominant finding, observed in 21.3% of participants. Hard tissue loss (BEWE 2 and 3) occurred very rarely, only in 3% of participants. Acidic diet, masculine gender and lower socio-economic status were associated with higher prevalence and severity of erosive lesions in the examined population.

Conclusion

Two modifiable factors—acidic diet and low health awareness—were found to be highly unsatisfactory in the adolescents aged 15 in Poland. Accordingly, to prevent the deterioration of the functionality and aesthetics of the teeth in young people, certain measures, such as routine clinical examination, education, dietary consulting and prophylaxis, should be implemented as early as possible, focusing predominantly on families with lower socio-economic status.

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.

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.

Updates in association of gastroesophageal reflux disease and dental erosion: systematic review

Introduction: Dental erosion occurs by dissolving dental apatite when exposed to non-bacterial acids. One of the factors that predispose to dental erosion is gastroesophageal reflux disease (GERD) due to chronic regurgitation of gastric contents to the oropharynx. Thus, in addition to other extraesophageal symptoms, individuals with GERD may have erosive dental lesions.Areas covered: The objective of this systematic review was to evaluate the association and prevalence of erosive wear in patients with GERD. The bibliographic search was performed in the Pubmed and Web of Science databases, using the descriptors 'gastroesophageal reflux disease' AND 'dental erosion', considering clinical studies recently published from 2012 to 2020.Expert opinion: GERD can be considered a risk factor for the development of erosive dental lesions, whose prevalence was significantly higher in this group. However, several other factors can be commonly associated with the prevalence and severity of dental erosion among the world population, such as dietary habits, lifestyle, abrasion and bruxism. Thus, the prevalence and distribution of erosive lesions among healthy and GERD subjects varied widely among studies, which denotes the etiological complexity of dental erosion and reinforces the importance of careful and detailed anamnesis in order to establish an accurate diagnosis.

Dental erosive wear in primary teeth among five-year-olds - Bergen, Norway

OBJECTIVE

To estimate the prevalence of dental erosive wear among five-year-olds in Bergen, Norway, and to investigate associations between background factors and the condition.

METHODS

A total of 387 children received a dental examination in five Public Dental Service clinics in Bergen, Norway. The parents responded to items about the children's dental hygiene and drinking habits, type of beverage container, diet, and other habits, and about their own age, educational level and country of origin. We explored background variables for possible associations with the outcome status as worst affected by erosive wear (19.4%, n = 75). Chi-squared statistics and logistic regression (Odds Ratios (OR): 95% Confidence Intervals (CI), served as statistical tools).

RESULTS

Approximately 80% showed erosive wear (by SEPRS and by adopted diagnostic instrument (78.5% vs 79.8%)). The condition affected maxillary anterior teeth in 13.9% (n = 54), and cuppings in molars in 79.3% (n = 307) of cases. Grinding teeth during the day and/or night (OR: 1.87, CI: 1.07-3.25) and male sex (OR: 1.76, CI: 1.05-2.96) significantly related to outcome status as worst affected by erosive wear, respectively.

CONCLUSION

Dental erosive wear was widespread. Grinding teeth and male sex associated with outcome status as worst affected by erosive wear.

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.

Aquaporins' Influence on Different Dental Erosive Wear Phenotypes in Humans

Dental erosive wear is a multifactorial condition of high prevalence. Nowadays, there is an emphasis on discovering individual genetic predisposition for the development of this condition. Aquaporins (AQPs) are water channel proteins expressed in salivary glands, as well as during tooth development. They are involved in salivary secretion and composition and linked to physiological protection of the oral cavity. The aim of this study was to explore the relationship between different dental erosive wear phenotypes, AQP genes, and selected environmental factors. Data from 705 dental patients were used to investigate the association between dental erosive wear phenotypes and AQPs' single-nucleotide variants. Phenotypes were further analyzed considering diet and oral hygiene data, using logistic regression analysis, as implemented in PLINK, with the assumption that dental erosive wear is a complex gene-environment model. Associations were found between severe erosive tooth wear and rs2878771 (AQP2) for the genotypic (p = 0.02) and dominant (p = 0.03) models, and rs3736309 (AQP5) for the allelic model (p = 0.02). Logistic regression analyses, after implementing the Bonferroni correction, showed that several significant associations were present when covariates were included, suggesting that a strong environmental component is present. Our results show that dental erosive wear establishes under a gene-environmental complex model.

Erosive tooth wear among South Brazilian adolescents, and its association with sociodemographic variables

The aim of this study was to assess the occurrence of erosive tooth wear (ETW) among 15-19-year-old South Brazilian adolescents, regarding prevalence, extent, severity, intraoral distribution, and sociodemographic risk indicators. A population-based cross-sectional survey was conducted in Santa Maria, southern Brazil, and included a representative sample of 15-19-year-old adolescents. Data collection included the application of a questionnaire and a clinical examination. A questionnaire was sent to the parents/legal guardians of the selected students, containing questions on demographic information, socioeconomic characteristics, and living conditions. After tooth cleaning and drying, all erupted permanent teeth were clinically assessed by two calibrated examiners, and classified according to the Basic Erosive Wear Examination (BEWE). The association between explanatory variables and the outcomes (ETW prevalence and extent) was assessed using Poisson regression models (both unadjusted and adjusted). A total of 1,197 adolescents were included in the study (participation rate of 72.3%). The overall prevalence of ETW was 57%. Severe ETW affected 16% of the sample. Overall, this adolescent population presented 13.3 affected surfaces, and 8.34 affected teeth. In the risk assessment analysis, gender, skin color, socioeconomic status, and family income were significantly associated with ETW. Boys, white adolescents, and those with higher socioeconomic status were more affected by ETW. This population-based cross-sectional study revealed that the prevalence of ETW was high, and that it was associated with sociodemographic variables in this South Brazilian population of adolescents.

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.

A survey on the prevalence and risk indicators of erosive tooth wear among adolescents in Guangzhou, South China

BACKGROUND

Erosive tooth wear (ETW) has become a crucial oral health problem over the decades in China.

OBJECTIVES

To explore the prevalence and risk indicators of ETW among adolescents in Guangzhou, south China.

METHODS

A cross-sectional survey of 720 participants was conducted in Guangzhou, using an equal-sized, stratified, multistage random sampling approach. The participants were from two different age groups (12- and 15-year-olds), 360 per group. The ratio of males to females was 1:1 in each group. ETW was recorded utilising the basic erosive wear examination (BEWE) index as the dependent variable. Independent variables included age, gender, region, socioeconomic status, dietary factors, oral health measures and others.

RESULTS

The prevalence rates (weighted) of ETW and dentin exposure (DE) were 56.1% and 26.2% among adolescents in Guangzhou, with mean teeth (weighted) of 1.8 ± 2.5 and 0.6 ± 1.5, respectively. No matter the prevalence or the mean teeth, the 15-year-olds were higher than the 12-year-olds; the mean teeth of ETW of males was higher than that of females; the mean teeth of ETW and DE of the adolescents of low socioeconomic status were higher than those of high socioeconomic status. Medium to high risk levels were found for 10.1%. In the multiple regression model, age, gender and taking acidic foods/drinks before sleep were associated with ETW.

CONCLUSIONS

Moderate ETW in the permanent dentition was common among adolescents in Guangzhou. However, the teeth involved were low. Dietary factors and demographics were the main risk indicators.

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.

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.

Bond strength and interfacial morphology of orthodontic brackets bonded to eroded enamel treated with calcium silicate-sodium phosphate salts or resin infiltration

OBJECTIVE

 To investigate the shear bond strength (SBS) of orthodontic brackets bonded to eroded enamel treated with preventive approaches and to examine the enamel/bracket interfaces.

MATERIALS AND METHODS

 Ninety-one brackets were bonded to seven groups of enamel samples: sound; eroded; eroded+treated with calcium silicate-sodium phosphate salts (CSP); eroded+infiltrated by ICON^®; eroded+infiltrated by ICON^® and brackets bonded with 1-month delay; eroded+infiltrated by an experimental resin; and eroded+infiltrated by an experimental resin and brackets bonded with 1-month delay. For each group, 12 samples were tested in SBS and bond failure was assessed with the adhesive remnant index (ARI); one sample was examined using scanning electron microscopy (SEM).

RESULTS

 Samples treated with CSP or infiltration showed no significant differences in SBS values with sound samples. Infiltrated samples followed by a delayed bonding showed lower SBS values. All of the values remained acceptable. The ARI scores were significantly higher for sound enamel, eroded, and treated with CSP groups than for all infiltrated samples. SEM examinations corroborated the findings.

CONCLUSIONS

 Using CSP or resin infiltration before orthodontic bonding does not jeopardize the bonding quality. The orthodontic bonding should be performed shortly after the resin infiltration.

Genetic variation may explain why females are less susceptible to dental erosion

Not all individuals at risk for dental erosion (DE) display erosive lesions. The prevalence of DE is higher among male subjects. The occurrence of DE may depend on more than just acidic challenge, with genetics possibly playing a role. The aim of this study was to investigate the association of enamel-formation genes with DE. One premolar and a saliva sample were collected from 90 individuals. Prepared teeth were immersed in 0.01 M HCl (pH 2.2), and enamel loss (μm) was measured using white light interferometry. DNA was extracted from saliva, and 15 single-nucleotide polymorphisms were analysed. Allele and genotype frequencies were related to the enamel loss of the specimens. Single-marker and haplotype analyses were performed using sex as a covariate. Mean enamel loss was higher for male donors than for female donors (P = 0.047). Significant associations were found between enamel loss and amelogenin, X-linked (AMELX), tuftelin 1 (TUFT1), and tuftelin-interacting protein 11 (TFIP11). Analyses showed significant associations between variation in enamel-formation genes and a lower susceptibility to DE in female subjects. The results indicate that susceptibility to DE is influenced by genetic variation, and may, in part, explain why some individuals are more susceptible than others to DE, including differences between female subjects and male subjects.

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.

Awareness and knowledge of dental erosion among Yemeni dental professionals and students

BACKGROUND

This study explored Yemeni dentists' and dental students' knowledge about the associated factors, approaches to diagnosis and preventive methods of dental erosion (DE), as well as any associations between DE awareness and some potentially related variables.

METHODS

A self-administered questionnaire was distributed to general dental practitioners (n = 323) in Sanaa and to fifth year dental students (n = 97) at the University of Science and Technology, Sanaa, Yemen during the period from July to November 2013. Descriptive and logistic regression analyses were conducted.

RESULTS

Overall response rate was 79 %. Results indicated that 61 % of respondents learned about DE from dental school, 27 % from their own studies and the rest from continuing education courses and the media. DE was reportedly most frequently seen on incisors by 46 % of respondents and on premolars and molars by 24 %. While 48 % reported DE to be more common in male patients, no gender differences were reported by 20 % of respondents. Acidic drinks were believed to be causative factors for DE by 41 % of dentists and 52 % of students, while 90 % of respondents believed that patients' dietary history is important during DE diagnosis. As preventive measures for DE, reduction of acidic drink consumption was advised by 51 % of respondents while only 37 % advised their patients to use fluoridated toothpastes. Younger respondents (≤35 years) were more likely to identify the commonly-known causative factors for DE (P = 0.024). Twenty-seven percent of the respondents reportedly used an index to grade DE. Dental students were more likely than dentists to use such an index (P <0.001) and to more frequently advise their patients to reduce intake of acidic drinks (P = 0.02) compared to dentists.

CONCLUSIONS

In-depth knowledge about causative factors, diagnosis and preventive methods of DE was apparent among only half the respondents and approaches to early diagnosis were insufficient. There would appear to be an urgent need for enhancing awareness and knowledge about DE within the Yemeni dental community.

The relationship between consumption of beverages and tooth wear among adults in the United States

OBJECTIVES

To investigate the prevalence and severity of tooth wear (TW) and its relationship with consumption of beverages among adults in the United States.

METHODS

The National Health and Nutrition Examinations Survey data for 2003-2004 was analyzed. TW was defined as "wear on at least one surface of at least one examined tooth." Drink/juice consumption was ascertained via a Food Frequency Questionnaire processed with Diet*Calc software to obtain the average daily consumption frequency for all queried drinks and juice categories including milk. Survey-weighted descriptive and multivariable analyses with interaction terms were performed.

RESULTS

Our study sample consisted of 3,773 adults (aged 20 and above). Eighty percent of the subjects had evidence of TW, and soft drinks were the most consumed beverage. Significant interactions between the effects of age, gender, and race/ethnicity on TW were found (P < 0.001). After adjustment for demographic factors, consumption of fruit drinks was found to be significantly associated with the severity [odds ratio (OR) = 1.32 and 1.42], but not prevalence of TW. However, this trend was reversed for grape juice consumption (OR = 0.34, 0.41).

CONCLUSIONS

This study demonstrates that a substantial proportion of adults had evidence of TW, which was affected by demographic factors in a complex way. Fruit drinks consumption in adults was associated with the severity of TW, but not with the prevalence of TW after adjusting for demographics. These findings are important for the development of appropriate treatment guidelines, public policy, and programs aimed at reducing TW in adults.

Enamel formation genes associated with dental erosive wear

Dental erosive wear is a multifactorial condition that is greatly affected by environmental factors. So far, no study has investigated how dental erosive wear is influenced by variations in enamel formation genes. The aim of the present study was to investigate polymorphisms in genes involved in enamel formation and their influence on enamel susceptibility to dental erosion. DNA samples were collected from 795 Norwegian adolescents aged 16-18 years. Five single-nucleotide polymorphism markers were genotyped in selected candidate genes (ameloblastin, amelogenin, enamelin, tuftelin 1 and tuftelin interacting protein 11), reported to influence enamel formation. Allele and genotype frequencies were compared within two patient groups with dental erosions; all participants with dental erosion and only those with severe dental erosion (erosion extending into dentine). Overrepresentation of the G allele of the enamelin marker was seen in the erosion group compared to the unaffected group (p = 0.047). When erosion severity was considered, statistical significant difference in allele frequency was observed for amelogenin, with the C allele suggesting a protective role (p = 0.02). A suggestive overrepresentation of the TT genotype of the amelogenin marker was also seen in cases with severe erosion (p = 0.049) when compared to cases with no dentine erosion. Amelogenin was also associated with severe erosion in the recessive model; the TT genotype was significantly more frequent in the affected group than in the unaffected group (p = 0.01). The present study suggests that polymorphisms in enamel formation genes are statistically associated with an individual's susceptibility to dental erosive wear.

Sour sweets and acidic beverage consumption are risk indicators for dental erosion

This study aimed to investigate the association between dental erosive wear and potential background, behavioural and dietary risk indicators and to assess whether there is a dose-response relationship between the level of acidic beverage consumption and dental erosive wear among adolescents. Of 846 adolescents (aged 16-18 years) scheduled for dental recall examinations, 795 (94%) accepted to participate. All participants completed a self-administered questionnaire regarding their background (gender and age), tooth-brushing frequency and dietary habits (the amount and frequency of acidic food and beverage consumption as well as the chosen method and manner of consuming acidic drinks). The association between the presence of erosive lesions and the possible risk indicators was assessed by logistic regression analyses. Of all participants examined, 37% had ≥3 surfaces with dental erosions and were considered to be affected individuals. In the present study, multivariate logistic analyses revealed a significant association between the dental erosive wear and high consumption of sour sweets and sports drinks. The tooth-brushing frequency was not significantly associated with dental erosive wear. Additionally, to the best of our knowledge, the results are the first to indicate a dose-response relationship between the daily consumption of acidic drinks and dental erosive wear.

Self-induced vomiting and dental erosion--a clinical study

Background

In individuals suffering from eating disorders (ED) characterized by vomiting (e.g. bulimia nervosa), the gastric juice regularly reaches the oral cavity, causing a possible risk of dental erosion. This study aimed to assess the occurrence, distribution and severity of dental erosions in a group of Norwegian patients experiencing self-induced vomiting (SIV).

Methods

The individuals included in the study were all undergoing treatment at clinics for eating disorders and were referred to a university dental clinic for examinations. One calibrated clinician registered erosions using the Visual Erosion Dental Examination (VEDE) system.

Results

Of 72 referred patients, 66 (63 females and three males, mean age 27.7 years) were or had been experiencing SIV (mean duration 10.6 years; range: 3 – 32 years), and were therefore included in the study. Dental erosions were found in 46 individuals (69.7%), 19 had enamel lesions only, while 27 had both enamel and dentine lesions. Ten or more teeth were affected in 26.1% of those with erosions, and 9% had ≥10 teeth with dentine lesions. Of the erosions, 41.6% were found on palatal/lingual surfaces, 36.6% on occlusal surfaces and 21.8% on buccal surfaces. Dentine lesions were most often found on lower first molars, while upper central incisors showed enamel lesions most frequently. The majority of the erosive lesions (48.6%) were found in those with the longest illness period, and 71.7% of the lesions extending into dentine were also found in this group. However, despite suffering from SIV for up to 32 years, 30.3% of the individuals showed no lesions.

Conclusions

Dental erosion commonly affects individuals with ED experiencing SIV, and is more often found on the palatal/lingual surfaces than on the buccal in these individuals, confirming a common clinical assumption.