Dental erosion: Prevalence and severity among 16-year-old adolescents in Troms, Norway.

AIM: To study the prevalence, distribution and severity of dental erosion among 16-year-old adolescents in the Troms region of Norway. MATERIALS AND METHODS: Study design: The participants were recruited through the Tromsø-study ("Fit Futures"), and 392 16-year-olds were examined for dental erosion using clinical intraoral photographs. Three calibrated clinicians used the Visual Erosion Dental Examination (VEDE) system to register and grade the dental erosive wear. RESULTS: More than one third (38%) of the participants showed dental erosion on at least one tooth surface, 18% were limited to the enamel, while 20% of the adolescents showed erosive wear extending into the dentine. The occlusal surfaces of the lower first molars, and the palatal surfaces of the maxillary incisors were the most often and most severely affected. Of the participants showing dental erosion, 93% exhibited "cuppings" on the molars, with 48% limited to the enamel and 52% extending into the dentine. The highest prevalence of "cuppings" (73%) was found on the first lower molars, especially the mesiobuccal cusp of the teeth. The prevalence and severity of dental erosion was found to be higher in male than in female participants (p < 0.0001). CONCLUSION: The results from this study indicate a high prevalence and severity of dental erosion among adolescents in Troms and stress the importance of information, early and effective diagnostics and implementation of prevention strategies.

Functional occlusal patterns during lateral excursions in young adults.

STATEMENT OF PROBLEM: A valid system for assessing and classifying functional occlusion has not been established. The prevalence of anterior protected articulation is not known. PURPOSE: The purpose of this study was to quantify the prevalence of various functional occlusal contact patterns, including anterior protected articulation, among dental students. MATERIAL AND METHODS: Occlusal contacts were examined during lateral excursions from the maximal intercuspal position to the canine-to-canine position in 100 young adults. A combination of 3 common clinical methods was used: a visual examination, articulating paper, and feedback from the participants. RESULTS: Data from 3 classification systems were analyzed: (1) Occlusal contacts on the working side only ­ canine protected articulation was present in 25% of laterotrusions; anterior protected articulation was present in 18.5% of laterotrusions. Group function was present in 56% of laterotrusions. Other schemes were present in 0.5% of laterotrusions. (2) Contacts on both the working and the nonworking side. (3) Contacts on the working and nonworking side during both right and left laterotrusion. Nonworking side contacts were present in 33% of the participants. Nonworking side interference was present in 1 participant. CONCLUSIONS: The prevalence of anterior protected articulation found in this study was high enough to allow anterior protected articulation to be considered one of the fundamental working side occlusal contact patterns. More studies will be necessary to confirm this finding.

Validation of the Basic Erosive Wear Examination.

The Basic Erosive Wear Examination (BEWE) is a practical index for screening tooth wear, using a 4-point ordinal scale (0-3). The highest score is recorded in each sextant and a total score (or BEWE sextant cumulative) is calculated per subject. This study aims to investigate if the BEWE sextant cumulative score compares to one comprising a percentage score from all tooth surfaces and as a highest BEWE per subject. The aim is to assess the validity of this score. A total of 350 subjects were recruited from hospital and general practice in south-east England. Buccal, occlusal and lingual/palatal BEWE scores were collected and percentages calculated based on scores 1, 1 and above, 2 and above and 3. BEWE sextant cumulative scores and highest BEWE scores were also recorded per subject. Spearman's correlation coefficients (p values) assessed the relationship between BEWE sextant cumulative scores, BEWE percentages and BEWE highest score per subject. The BEWE sextant cumulative score correlates significantly to a BEWE score taken as a percentage score from all tooth surfaces (Spearman's r > 0.5, p < 0.001) and especially to BEWE surface scores of 1 and above and 2 and above (r > 0.8, p < 0.001) and as a highest surface score per subject (r > 0.8, p < 0.001). BEWE sextant score provides a representation of tooth wear on all tooth surfaces. This study validates a tooth wear index, which provides clinicians with risk indicators of a patient's level of tooth wear and may help to guide clinical management.

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.

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.

Prevalence of dental erosion in young adults aged 18 years in Poland.

AIM: The aim of this study was to assess the prevalence of tooth wear in young adults in Poland. METHODS: A total of 1,886 persons aged 18 years, selected on a basis of multistage sampling, were examined within the Nationwide Dental Health Monitoring Programme. Previously calibrated dentists measured tooth wear using the BEWE-scoring system (Basic Erosive Wear Examination). RESULTS: Out of 1,886 young adults, 42.2% presented the signs of dental erosion. Considered the severity of erosion, it was graded as 1, 2 and 3 in 28.9%, 11.9% and 1.5% of 18-year-olds, respectively. CONCLUSIONS: Results of clinical assessment of dental erosion in 18-year-old young adults revealed that erosive tooth wear is an important problem in this age group. Of them, 13.4% had signs of advanced tooth wear which may lead to serious clinical problems in the future.

Eating disorders and oral health: a matched case-control study.

The aim was to compare the oral health status of patients with eating disorders (EDs), with sex- and age-matched controls, with a view to identify self-reported and clinical parameters that might alert the dental healthcare professional to the possibility of EDs. All patients who entered outpatient treatment in an ED clinic during a 12-month period were invited to participate. Of 65 ED patients who started psychiatric/medical treatment, 54 agreed to participate. Eating disorder patients and controls answered a questionnaire and underwent dental clinical examinations. Multivariate analysis identified significantly higher ORs for ED patients to present dental problems (OR = 4.1), burning tongue (OR = 14.2), dry/cracked lips (OR = 9.6), dental erosion (OR = 8.5), and less gingival bleeding (OR = 1.1) compared with healthy controls. Sensitivity and specificity for the correct classification of ED patients and controls using the five variables was 83% and 79%, respectively. The ED patients with vomiting/binge eating behaviors reported worse perceived oral health (OR = 6.0) and had more dental erosion (OR = 5.5) than those without such behavior. In ED patients with longer duration of the disease, dental erosion was significantly more common. In conclusion, oral health problems frequently affect ED patients, and this needs to be considered in patient assessment and treatment decisions.

Full-mouth minimally invasive adhesive rehabilitation to treat severe dental erosion: a case report.

Dental erosion is increasing, and only recently are clinicians starting to acknowledge the problem. A prospective clinical trial investigating which therapeutic approach must be undertaken to treat erosion and when is under way at the University of Geneva (Geneva Erosion Study). All patients affected by dental erosion who present with signs of dentin exposure are immediately treated using only adhesive techniques. In this article, the full-mouth adhesive rehabilitation of one of these patients affected by severe dental erosion (ACE class IV) is illustrated. By the end of the therapy, a very pleasing esthetic outcome had been achieved (esthetic success), all of the patient's teeth maintained their vitality, and the amount of tooth structure sacrificed to complete the adhesive full-mouth rehabilitation was negligible (biological success).

Multifactorial analysis of factors associated with the incidence and progression of erosive tooth wear.

To prevent erosive tooth wear, early diagnosis and identification of causative factors are essential. The aim of the present 3-year longitudinal study was to investigate the association between a broad collection of biological and behavioural factors and the incidence and progression of erosive tooth wear among adolescents. The study sample consisted of 656 attendees of a dental clinic with at baseline a mean age of 11.9 years (SD = 0.9). The criteria for the assessment of erosive wear were a modification of the erosion criteria developed by Lussi [Eur J Oral Sci 1996;104:191-198]. Information on biological and behavioural factors was gathered by clinical examinations (at baseline, after 1.5 and 3 years) and by self-reported questionnaires (completed semi-annually). Of the erosion-free children at baseline, 24.2% developed erosive wear. In children with erosion at baseline, 68.3% showed progression. Multivariate analyses showed significant associations between the incidence of erosive tooth wear and alcoholic mixed drinks (odds ratio, OR = 1.82), sour vegetables (OR = 1.16) and tooth grinding (OR = 4.03). The intake of yoghurt products was significantly negatively associated with the incidence of erosive wear (OR = 0.79). The interaction of acidic products and tooth grinding showed a significant extra risk (OR = 1.2). The intake of vitamins was positively associated with progression (OR = 2.03). Erosive wear was less likely to progress in subjects who consumed milk and yoghurt products (OR = 0.89 and 0.76, respectively). The present study showed that the aetiology of erosive tooth wear is complex. Possible aetiological factors include more than acidic drinks, and factors such as tooth grinding play a large role.

Dental tooth surface loss and quality of life in university students.

AIM: To determine the relationship between toothwear into dentine and oral health-related quality of life impacts in a sample of university students not attending for dental treatment. METHODS: A cross-sectional survey of 1010 university students was undertaken. Clinical examination, including the Smith & Knight (1984) index of tooth erosion, was performed and completion of the Oral Health Impact Profile-49 (OHIP-49) measure of oral health-related quality of life was arranged. RESULTS: Seventy-seven per cent of the students had at least one tooth with tooth surface loss into dentine. Overall OHIP scores were similar for individuals with different levels of severity of tooth surface loss. Individuals with severe tooth surface loss were more likely to report that their appearance had been affected by, and that they had felt self-conscious because of, the condition of their mouth and teeth. CONCLUSIONS: Tooth surface loss into dentine was prevalent among the young adults who were examined in this study. They reported that it had little impact on oral health-related quality of life at the non-clinical levels seen in this study.

[Tooth wear, a proposal for an evaluation system]. / Een beoordelingssysteem voor gebitsslijtage.

The present-day terminology and definitions of tooth wear are not unambiguous. For diagnosing tooth wear, however, it is essential that they are unambiguous. In this article a proposal is presented for a tooth wear evaluation system with simplified definitions. This system consists ofa number of modules and can be used for various aspects of the diagnostic procedure. It can be used for the quantification of tooth wear, both for periodic screening and for the monitoring of tooth wear in individual patients. The scoring of occlusal/incisal tooth wear as well as of non-occlusal/non-incisal tooth wear is possible. The evaluative system is also suitable for determining which type of tooth wear, such as attrition, abrasion and erosion, is most likely to have caused any observed loss of hard tooth tissue.

Reliability of two clinical scoring systems for dental erosive wear.

The aim of the study was to evaluate and compare two dental erosive wear scoring systems, the Visual Erosion Dental Examination (VEDE) and Basic Erosive Wear Examination (BEWE). Seventy-four tooth surfaces (photographs) and 562 surfaces (in participants) were scored by 5 (photographs) or 3 (in participants) clinicians using both scoring systems. The surfaces in the photographs were scored twice. The level of agreement was measured by weighted kappa (kappa(w)). Inter- and intraexaminer agreement showed small variations between the examiners for both systems when scoring the photographs. Slightly higher mean kappa(w) values were found for VEDE (kappa(w) = 0.77) compared with BEWE (kappa(w) = 0.69). When scoring the surfaces in the clinical examination the mean kappa(w) values for the two systems were equal (kappa(w) = 0.73). Interexaminer agreement using VEDE was calculated to see how differentiation between enamel and dentine lesions influenced the variability. The highest agreement was found for score 0 (sound, 86%) and score 3 (exposure of dentine, 67%), while the smallest agreement was shown for score 1 (initial loss of enamel, 30%) and score 2 (pronounced loss of enamel, 57%). The reliability of the two scoring systems proved acceptable for scoring the severity of dental erosive wear and for recording such lesions in prevalence studies. The greatest difficulties were found when scoring enamel lesions, especially initial lesions, while good agreement was observed when examining sound surfaces (score 0) and dentine lesions (score 3).

Classification and treatment of the anterior maxillary dentition affected by dental erosion: the ACE classification.

Erosive tooth wear is a serious problem with very costly consequences. Intercepting patients at the initial stages of the disease is critical to avoid significant irreversible damages to their dentition and to benefit from still favorable conditions when it comes to clinical performance of the restorative measures proposed. In this article, a new classification is proposed to quantify the severity of the dental destruction and to guide clinicians and patients in the therapeutic decision-making process. The classification is based on several parameters relevant for both the selection of treatment and the assessment of the prognosis, such as dentin exposure in the palatal tooth contact areas, alterations at the level of the incisal edges, and ultimately, loss of pulp vitality.

Clinical features and differential diagnosis of erosion lesions: systemic etiologies.

An accurate diagnosis is essential for successful treatment, making it critical that dentists recognize the differences among erosion lesions and the numerous etiologies that cause them. Erosion lesions may result from various factors, including intrinsic etiologies. The similarities among the intrinsic types of lesions and those caused by noncarious destructive mechanisms in the oral cavity may lead to conflict over their etiologies; as a result, these lesions may be ignored, undiagnosed, or misdiagnosed. This article identifies the many systemic etiologies that propel stomach acid into the oral cavity, thereby causing dental erosion. Specific descriptions of the clinical characteristics of dental erosion lesions associated with the identified etiologies are provided and the differential diagnoses are outlined.

Dental erosion in workers exposed to sulfuric acid in lead storage battery manufacturing facility.

Dental erosion, and specifically its symptoms, has long been studied in Japan as an occupational dental disease. However, in recent years, few studies have investigated the development of this disease or labor hygiene management aimed at its prevention. As a result, interest in dental erosion is comparatively low, even among dental professionals. Our investigation at a lead storage battery factory in 1991 found that the work environmental sulfuric acid density was above the tolerable range (1.0mg/m(3)) and that longterm workers had dental erosion. Therefore, workers handling sulfuric acid were given an oral examination and rates of dental erosion by tooth type, rates of erosion by number of working years and rates of erosion by sulfuric acid density in the work environment investigated. Where dental erosion was diagnosed, degree of erosion was identified according to a diagnostic criterion. No development of dental erosion was detected in the maxillary teeth, and erosion was concentrated in the anterior mandibular teeth. Its prevalence was as high as 20%. Rates of dental erosion rose precipitously after 10 working years. The percentages of workers with dental erosion were 42.9% for 10-14 years, 57.1% for 15-19 years and 66.7% for over 20 years with 22.5% for total number of workers. The percentages of workers with dental erosion rose in proportion to work environmental sulfuric acid density: 17.9% at 0.5-1.0, 25.0% at 1.0-4.0 and 50.0% at 4.0-8.0mg/m(3). This suggests that it is necessary to evaluate not only years of exposure to sulfuric acid but also sulfuric acid density in the air in factory workers.

[An interface between pediatrics and oral medicine: oral manifestations of gastroesophageal reflux in children]. / Lésions buccales du reflux gastro-oesophagien de l'enfant: des réalités et quelques mythes.

Gastro-oesophageal reflux (GOR) is a common disorder in the pediatric population. In association with esophagitis, GOR may impair children's quality of life. Extra-oesophageal manifestations are of specific interest in oral medicine because the refluxate may reach impair both oral mucosa and hard dental tissues. Some oral symptoms are so specific that they should raise the attention for other GOR symptoms. Dental erosion is a potential risk in children with gastroesophageal reflux: the pediatrician should routinely refer children with gastroesophageal reflux to a pediatric dentist to diagnose erosions and if needed restore the teeth. Conversely, in the presence of unexplained dental erosions the dentist and/or the pediatrician should discuss the possibility of an occult GOR.

An animal model of intrinsic dental erosion caused by gastro-oesophageal reflux disease.

OBJECTIVES: To explore the association between dental erosion and gastro-oesophageal reflux disease (GORD), we used an animal model of GORD. MATERIALS AND METHODS: We performed an operation to force gastro-duodenal contents reflux in male Wistar rats, and examined the teeth in the reflux rats at 15 or 30 weeks postoperatively. Dental erosion was evaluated based on a slightly modified index from a previous report. Estimation of pH was employed in the oesophageal and gastric contents. RESULTS: Macroscopically, dental erosion was only detected in the reflux rats. Histopathologically, dentin exposure was detected in three of the seven cases after 30 weeks. Alveolar bone destruction and osteomyelitis were also noted in severe cases. The pH of the oesophageal and stomach contents was 6.93 +/- 0.15 and 3.7 +/- 0.39, respectively. CONCLUSIONS: We confirmed the relationship between dental erosion and GORD. First step of dental erosion caused by GORD is the loss of surface enamel induced by regurgitation of an acidic liquid and acidic gas. Subsequently, further destruction of dental hard tissues and tooth supporting structure is accelerated by mixed juice with gastric and duodenal contents. The reflux animal model is a useful tool to examine the mechanism of dental erosion in GORD.

A new index of tooth wear. Reproducibility and application to a sample of 18- to 30-year-old university students.

A modified wear index, in which the wear of enamel and dentine are recorded separately, is described. The index was applied to estimating the prevalence and extent of tooth wear in a single convenience sample of 18- to 30-year-old students attending a university in London. The subjects were examined under good lighting in a dental chair away from a dental school. A total of 707 females and 303 males were recruited with a mean age of 21.9 years (standard deviation = 0.1, range = 18-30) and examined by 3 trained and calibrated examiners. Intra-examiner intra-class correlation coefficients showed a range of 0.44-0.88. The unweighted kappa scores were above 0.88 for enamel and dentine. The presence of enamel wear was common to all subjects, but 6.1% of the participants had more than one third of the tooth surface affected. Dentine was exposed on 5.3% of all surfaces, with the largest proportion accounting for less than 10% of the tooth surface (grade 1). The proportion of subjects with at least 1 surface with dentine exposed was 76.9% of the total population. The males had significantly more wear in dentine than the females (p = 0.001). The inter-examiner intra-class correlation coefficients for enamel and dentine were 0.87 and 0.92, respectively. The reproducibility of the index was comparable to other analyses and provides an opportunity to assess the prevalence of enamel wear in large population-based studies.

Correlations of noncarious cervical lesions and occlusal factors determined by using pressure-detecting sheet.

OBJECTIVES: The purpose of this clinical study was to examine the relationships of v-shaped noncarious cervical lesion (NCCL) formation with occlusal factors. METHODS: A total of 159 male self-defense force officials with a mean age of 36.2 years participated in this study. All present teeth were examined for the presence and type of NCCL using the Tooth Wear Index (TWI). The subjects were then interviewed about bruxing and toothbrushing habit. Finally, occlusal force, occlusal contact area and average pressure were measured using a pressure-detecting sheet. Subject-level logistic regression was carried out to assess the associations of factors with presence of v-shaped NCCL teeth. Subjects without v-shaped NCCL were designated as control subjects. RESULTS: Totally, 4518 teeth were examined. Seventy-eight subjects (49.1%) had one or more teeth with typical v-shaped NCCL (259 teeth). The number of teeth with v-shaped NCCL of grade 2 (defect less than 1mm in depth) was 195 (4.3%), and the number of teeth with v-shaped NCCL of grade 3 (defect 1-2mm in depth) was 54 (1.2%). The prevalence of teeth with v-shaped NCCL was significantly higher in the maxilla than in the mandible. Most of the NCCL teeth were premolars. There was no significant difference between teeth with NCCL on the right side and those on the left side. Subject-level logistic regression analysis revealed that age (OR=1.11), toothbrushing pressure (400g, OR=2.43) and occlusal contact area (>23.0mm(2), OR=4.15) were associated with the presence of NCCL teeth. CONCLUSIONS: It is concluded that aging, toothbrushing pressure and occlusal contact area are associated with the presence of NCCLs.

Comparison between a profilometer and a measuring microscope for measurement of enamel erosion.

The aim of this study was to measure the difference in the erosion depth of enamel measured by profilometry (PM) and a measuring microscope (MM). Sixty enamel specimens were divided into ten groups. Each specimen group was exposed to 50 ml of a carbonated drink with pH 2.38 or orange juice with pH 3.67 for 15, 30, 60, 120, and 180 minutes. Depths of eroded areas were measured with a profilometer and a measuring microscope. Data of average enamel loss were measured by PM and MM for all erosion times and were scatter plotted on a graph with regression fit. Correlations between the enamel loss measured by PM and MM were analyzed with a paired sample t-test to compare the discriminatory abilities of the two methods of analysis for all erosion times. The regression fit in all study cases showed a high linear relationship (R(2) = 0.90) between measurements by PM and MM, but in cases where the erosion depth was lower than the depth of focus (DOF) of the MM objective lens, there were weak correlation coefficients (-0.007 - 0.303) for comparison between the two measurement methods.