Erosive Tooth Wear, Presence of Parafunctional Habits and Tooth Injuries-Occurrence in a Group of Children and Adolescents Exposed to Domestic Violence.

OBJECTIVES: To compare the prevalence of parafunctional habits, erosive tooth wear and occurrence of tooth injuries among children being under the care of Social Welfare Centre and children treated in the Department of Children's Dentistry of the Medical University of Warsaw. STUDY DESIGN: The study contains environmental and medical interviews, record-based analysis and clinical examination. Parafunctional habits were rated on the base of dental interviews and clinical examinations. The occlusal surfaces were evaluated by visual examination using modified tooth wear index (TWI). Tooth injuries were reported from a medical interview labeled using Andreasen classification. The consent of the bioethics committee and guardians of children participated in the study was obtained. RESULTS: The study involved 782 patients, including 404 children from dysfunctional families (average age 11,4 ± 3,7) and 378 from ordinary families-control group (8,53 ± 3,92). In the study group we observed higher prevalence of erosive tooth wear (44,66% vs 18,02% p=0,000), dental trauma (9,4% vs 3,44% p=0,001) and a presence of parafunctional habits (67,8% vs 20,4 % p=0,000). CONCLUSION: The occurrence of parafunctional habits, erosive tooth wear and tooth injuries may be an indicator of domestic violence and a component of maltreated child syndrome.

Socio-economic characteristics, acid drinking patterns and gastric alterations associated with erosive tooth wear in children: a cross-sectional study.

AIMS: Assessing the influence of socio-economic characteristics, acid drinking patterns and gastric alterations considering erosive tooth experience in children. METHODS: Cross-sectional study to assess 08-10-year-old children enrolled in the primary education in public schools in Florianopolis, Brazil (n = 1085). Caregivers have answered questionnaires comprising independent variables (head of the household education frequency consumption of sports drinks, acid juice/soda, chewing gum, recurrent vomiting, gastric disorders and vomiting after overeating). Four trained dental surgeons have examined the children for the erosive tooth wear-dependent variable (O'Sullivan index), as well as collected dental caries (DMFT) and dental crowding (DAI index) information. A two-stage cluster-sampling plan was conducted. Unadjusted and adjusted logistic regression models were applied (Odds ratio, OR; 95% Confidence interval, CI and 5% significance level). RESULTS: The prevalence of erosive tooth wear was 15.67%. Erosive tooth wear was positively associated with high consumption of sports drinks (OR 3.42; 95% CI: 1.18-9.23). Children whose caregivers' educational level was equal or less than four years of study were less likely to have erosive tooth wear (OR 0.39; 95% CI: 0.17-0.88). CONCLUSION: High consumption of sports drinks is positively associated with erosive tooth wear. Children whose caregivers' educational level is low are less likely to present erosive tooth wear.

The Influence of Behavioural and Sociodemographic Risk Indicators on Erosive Tooth Wear in Flemish Adolescents, Belgium.

Although Belgium has recently been ranked as the second highest consumer of soft drinks in Europe, no data on erosive tooth wear (ETW) are currently available. Therefore, the aim of this cross-sectional study was to determine the prevalence and associated risk indicators of ETW in adolescents residing in the region of Flanders, Belgium. Convenience sampling was used to recruit participants from different types of Belgian schools: general and vocational/technical education. Three calibrated dentists performed the dental examinations and a self-reported questionnaire was applied to evaluate risk indicators related with ETW. ETW was classified using the Basic Erosive Wear Examination (BEWE) index, and the overall prevalence was calculated using BEWE sum >0. The Kruskal-Wallis test, the Mann-Whitney U test, and logistic regression analysis were performed to evaluate frequencies and risk associations. From a total of 613 recruited adolescents (mean age: 15.1 years, SD: 0.8), 48.6% presented at least one affected tooth surface by ETW (BEWE sum >0), 14.4% (n = 88) scored BEWE sum >2, and the highest score obtained was BEWE sum = 8. Two predictive variables were found to have an association with ETW: vocational/technical type of education (OR: 1.49; 95% CI: 1.03-2.13) and frequent consumption of soft drinks (OR: 2.08; 95% CI: 1.38-3.14). In conclusion, ETW is a common condition presented with low severity among Flemish adolescents. Additionally, the frequent consumption of soft drinks and being part of a vocational/technical education appear to be risk indicators for ETW in this population. The latter indicates the need for specific orientated oral health promotion programmes for the prevention of ETW in Flemish adolescents.

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.

Dental erosion prevalence and associated risk indicators among preschool children in Athens, Greece.

OBJECTIVES: The aims of the study were to investigate dental erosion prevalence, distribution and severity in Greek preschool children attending public kindergartens in the prefecture of Attica, Greece and to determine the effect of dental caries, oral hygiene level, socio-economic factors, dental behavior, erosion related medication and chronic illness. MATERIAL AND METHODS: A random and stratified sample of 605 Greek preschool children was clinically examined for dental erosion using the Basic Erosive Wear Examination Index (ΒΕWE). Dental caries (dmfs) and Simplified Debris Index were also recorded. The data concerning possible risk indicators were derived by a questionnaire. Zero-inflated Poisson regression was generated to test the predictive effects of the independent variables on dental erosion. RESULTS: The prevalence of dental erosion was 78.8 %, and the mean and SE of BEWE index was 3.64 ± 0.15. High monthly family income was positively related to ΒΕWE cumulative scores [RR = 1.204 (1.016-1.427)], while high maternal education level [RR = 0.872 (0.771-0.986)] and poor oral hygiene level [DI-s, RR = 0.584 (0.450-0.756)] showed a negative association. CONCLUSIONS: Dental erosion is a common oral disease in Greek preschool children in Attica, related to oral hygiene and socio-economic factors. CLINICAL RELEVANCE: Programs aimed at erosion prevention should begin at an early age for all children.

Novel methods of balancing covariates for the assessment of dental erosion: a contribution to validation of a synthetic scoring system for erosive wear.

OBJECTIVES: The purpose of the study was to balance several potential erosive covariates, using traditional and novel epidemiological approaches, in order to assess the relative risks of dental erosion more precisely. METHODS: Traditional (univariate and logistic regression analysis) and novel techniques (propensity scores and Inverse Probability Weighting-IPW) were applied for evaluating the effect of twenty covariates on dental erosion among 502 adolescents. RESULTS: Different approaches gave different estimates of the relative risks of dental erosion. The increased consumption of carbonated soft drinks had the major erosive effect, when traditional analyses were used (unadjusted: OR=3.475 and CI: 1.499-8.052, logistic regression: OR=3.219 and CI: 1.373-7.547). On the other hand, IPW method indicated that the consumption of erosion drinks immediately after intense physical exercise had the highest odds ratio (OR=1.363 and CI: 0.963-1.929), followed by the increased consumption of citrus fruit juice (OR=1.326 and CI: 1.004-1.752). This method also demonstrated a marked improvement in balance, with the 95% CIs for each OR being considerably narrower than those reported in the initial analysis. CONCLUSIONS: Standardization of the potential aetiological criteria of erosive wear is a considerably difficult process. Nevertheless, novel methods revealed that the increased consumption of carbonated soft drinks and citrus fruit juices could be included as aetiologic factors in a synthetic scoring system for erosion. Parameters which are related to salivary protective mechanisms (e.g. consumption of erosion drinks immediately after intense physical exercise) could also be a part of such an index. Further research is required in order to achieve the maximum validation of the potential erosive risk factors.

Risk indicators for erosive tooth wear in Brazilian preschool children.

The aim of this study was to assess the prevalence and risk indicators for erosive tooth wear (ETW) in Brazilian preschool children. A total of 967 children aged 3-4 years were examined. ETW was assessed using a modified version of the index recommended by O'Brien [London, Her Majesty's Stationary Office, 1994]. The 16 examiners were trained and calibrated. Hierarchical logistic regression was applied to investigate the association between ETW and socio-economic, environmental, nutritional and behavioural factors, as well as factors related to the child's characteristics. ETW was present in 51.6% of children. Most lesions were confined to enamel (93.9%) and involved over two thirds of the tooth surface's area (82%). There were no significant associations between ETW and socio-economic, environmental and nutritional variables. ETW was significantly associated with soft drink intake twice or 3 or more times a day (p = 0.043 and 0.023, respectively), frequent reported gastro-oesophageal reflux (p = 0.005) and age (p = 0.003). In conclusion, there was a high prevalence of ETW in the preschool children examined, and the risk indicators were frequent consumption of soft drinks, reported gastro-oesophageal reflux and age.

[Assessment of tooth wear depending on Smith and Knight index]. / Evaluarea leziunilor dentare necariogene în functie de indicii Smith si Knight.

UNLABELLED: For the clinical diagnosis of tooth wear Smith and Knight have been suggested the index with the same name, the criteria for the quantification of the hard tissue loss being the size of the area affected and the depth of the defect. The aim of this study was to assess tooth wear depending on Smith and Knight index, on a group of 614 patients. MATERIAL AND METHOD: The criteria for the selection of the patients were the age more than 18 years old and the Smith and Knight index >0. RESULTS: The biggest proportion of tooth wear (47.3%) presented the value 2 of the Smith and Knight index. Most of the tooth wear with Smith and Knight index 3 (54.4%) are abrasions, 71.4% of the tooth wear with Smith and Knight index 1 are attritions, and 20.3% of the tooth wear with Smith and Knight index 3 are erosions. High alcohol consumption is associated with deep tooth wear, exposing dentine (value 2 and 3 of the Smith and Knight index). Currently, various indices are used, making the comparison of the results of prevalence studies difficult.

Inequalities in health and oral health in the UK.

UNLABELLED: New legislation is increasingly recognizing that addressing diversity is a crucial issue, in order that the health and social service needs of the whole population can be better met by equitable access, experience, and outcome. This paper aims to: describe the evolution of the UK inequalities agenda together with some of the governmental responses; consider aspects of oral and general health in this context; and reflect on the implications for general dental practice. CLINICAL RELEVANCE: Practitioners should be aware of the patient's background--social, physical and mental--as these can all impact on that person's oral and general health status, as well as his/her norms and values. This in turn can influence the capacity of that patient to accept specific care regimes and advice and hence has key implications for treatment and care.

Dental erosion amongst 13- and 14-year-old Brazilian schoolchildren.

OBJECTIVES: To assess the prevalence of dental erosion in a sample of 13- and 14-year-old Brazilian schoolchildren and to assess the relationship of dental erosion and socio-demographic characteristics. METHODS: A convenience sample of 458 children (190 boys and 268 girls) from 14 schools in Três Corações, south east Brazil, was examined. Socio-demographic data were collected by self-completion questionnaires. RESULTS: Dental erosion was observed in 34.1% of subjects, involving enamel only and showing a symmetrical distribution. The palatal surfaces of the upper incisors were the most commonly affected surfaces. Erosion experience was higher in boys; pupils from Government funded schools; those resident in rural areas and those from the high economic class, but none of these were statistically significant. CONCLUSION: These data are the first to show that in a cohort of 13-14-year old Brazilian schoolchildren, approximately one third of those examined showed mild erosion, requiring clinical preventive counselling. No statistically significant association was observed between erosion, gender and socioeconomic factors.

The effect of socio-economic status and ethnicity on the comparative oral health of Asian and White Caucasian 12-year-old children.

OBJECTIVE: To investigate the oral health of 12-year-old children of different deprivation but similar fluoridation status from South Asian and White Caucasian ethnic groups. DESIGN: An epidemiological survey of 12-year-old children using BASCD criteria, with additional tooth erosion, ethnic classification and postcode data. CLINICAL SETTING: Examinations were completed in schools in Leicestershire and Rutland, England, UK. Participants A random sample of 1,753 12-year-old children from all schools in the study area. MAIN OUTCOME MEASURES: Caries experience was measured using the DMFT index diagnosed at the caries into dentine (D3) threshold, and tooth erosion using the index employed in the Children's Dental Health UK study reported in 1993. RESULTS: The overall prevalence of caries was greater in White than Asian children, but varied at different levels of deprivation and amongst different Asian religious groups. There was a significant positive association between caries and deprivation for White children, but the reverse was true for non-Muslim Asians. White Low Deprivation children had significantly less tooth erosion, but erosion experience increased with decreasing deprivation in non-Muslim Asians. CONCLUSIONS: Oral health is associated with ethnicity and linked to deprivation on an ethnic basis. The intra-Asian dental health disadvantage found in the primary dentition of Muslim children is perpetuated into the permanent dentition.

Clinical and photographic assessment of erosion in 2-5-year-old children in Saudi Arabia.

OBJECTIVE: To compare findings from photographs of incisor teeth in pre-school children in Jeddah, Saudi Arabia to those on clinical examination for dental erosion. BASIC RESEARCH DESIGN: Cross sectional study of 2-5-year-old Saudi Arabian children using two methods of examination. MEASUREMENT: of erosion was carried out clinically using a scoring system and criteria based on those used in the United Kingdom national surveys. Photographs of labial and palatal surfaces of maxillary primary incisors were taken for each child and scored in the same way. SETTING: Kindergarten schools in Jeddah, Saudi Arabia. PARTICIPANTS: 987 children from 17 randomly selected schools in Jeddah, Saudi Arabia. RESULTS: Readable photographs were available for 727 children. Two hundred and twenty (30%) had photographic evidence of tooth tissue loss. Prevalence estimates derived from clinical examination were higher than those for photographs (36% compared to 30%). Agreement was seen between the two methods for 93% of the surfaces included. CONCLUSIONS: Photographs have been employed in research in dentistry as well as for documentation and illustration. In epidemiology they have proved to be valuable in measuring enamel defects but have not been used for other conditions. Photographs have potential in measuring erosion, but may benefit from refinement.

The prevalence of caries and of tooth tissue loss in a group of children living in a social welfare institute in Jeddah, Saudi Arabia.

AIM: To measure the prevalence of caries, rampant caries and erosion in a group of 4-5-year-old children living in an institution in the city of Jeddah in the West Province of Saudi Arabia. DESIGN: Descriptive, cross sectional. SAMPLE AND METHODS: A total of 80 children (51 boys, 29 girls) living in the Institute were examined visually for caries using BASCD criteria. Erosion of palatal and buccal surfaces of maxillary incisors was scored: 0 (no erosion), 1 (erosion into enamel), 2 (erosion into dentine) and 3 (erosion involving the pulp). RESULTS: Twenty-four of the Children (30 per cent) had caries and two had rampant caries. Mean dmft was 0.95 (+/- 2.03) and mean dmfs was 3.2 (+/- 6.51). These values are lower than other estimates for children of this age in Saudi Arabia. Ten children (12.5 per cent) had erosion affecting buccal or palatal surfaces of their maxillary incisor teeth. In seven, erosion was confined to enamel but in three it extended into dentine. CONCLUSION: The lower caries levels seen in this group of children may be at least partly attributable to the effectiveness of strict dietary control and regular oral hygiene measures.

A rapid epidemiological assessment of dental erosion to assist in settling an industrial dispute.

A rapid epidemiological assessment (REA) of industrial dental erosion was undertaken with the aim of formulating a range of treatment strategies which could be used to settle an industrial dispute. This dispute concerned compensation for a group of adult male metalworkers who had complained of dental sensitivity and that their teeth had been "eaten by acid" at their workplace, an electroplating factory in Springs near Johannesburg, South Africa. The REA methods employed included a clinical examination, a structured socio-demographic questionnaire and colour photographs of each subject. Sixty per cent of the subjects reported pain and/or sensitivity to eating and/or drinking, 76 per cent showed varying degrees of loss of tooth structure, and 25 per cent reported teeth had been lost as a result of the industrial erosion. The project involved negotiating with mine management and trade union representatives, each with conflicting interests, and with people's oral health and large sums of money at stake. In this context, the aim of the research was to design an instrument to resolve conflict and to promote oral health at an industrial site, while retaining scientific objectivity and rigour. As a result of the REA, the workers who were examined are in the process of being compensated, while the National Union of Mineworkers and mine management are engaged in reaching a settlement. Preventive measures have been initiated at the factory. The area has been declared a "respiratory zone", which makes the wearing of respiratory masks obligatory.

The prevalence, etiology and management of tooth wear in the United Kingdom.

STATEMENT OF PROBLEM: Recent epidemiologic evidence suggests that tooth wear is now a significant problem in both children and adults. There is growing evidence that a major cause of severe wear in patients is regurgitation erosion due to a variety of factors including gastroesophageal reflux disease. PURPOSE: The purpose of this article is to discuss the prevalence of tooth wear in the United Kingdom. Emphasis in management should be on accurate diagnosis, and in some patients, long-term monitoring before embarking on any irreversible, interventive treatment. Even when treatment is necessary, a period of monitoring is helpful to assess the rate of progress of the wear, the effectiveness of preventive measures, and therefore the extent of the treatment necessary.

The national diet and nutrition survey of 1.5 to 4.5 year old children: summary of the findings of the dental survey.

A dental health survey was included as part of a large scale study of nutrition in preschool children. The survey was carried out in 1992/93 and was published in spring 1995. Information on dental health status and on dietary intake was gathered from a total of 1658 children from 100 geographical sectors in the United Kingdom. This article summarises the main findings and highlights some of the most important findings regarding dental health and its relationship to dietary factors. Seventeen per cent of children had some caries experience and in 83% of cases this was untreated. Dental decay was most strongly related to social background. The factors most strongly related to caries prevalence were: receipt of income benefits, in the 1.5-2.5-year-old children; the educational status of the mother in the 2.5-3.5-year-old children and social class of the head of household in the 3.5-4.5-year-old children. Consumption of sugary drinks at bedtime, children being left to brush their teeth themselves, household expenditure on confectionery and geographical region were also strongly associated with caries prevalence.

The tooth wear index: a flawed epidemiological tool in an ageing population group.

With a greater number of people living longer and tending to retain many natural teeth, the problems associated with tooth wear are likely to place greater demands upon dental professionals in the future. Several attempts have been made to develop an index to measure tooth wear, for use at both the individual and population level. A review of these indices is undertaken, and difficulties experienced with the tooth wear index (TWI) of Smith & Knight (1984) in a large adult dental health survey is discussed. In the elderly population the scoring criteria of the TWI proved to be difficult to apply without additional qualification, and in cases of extreme wear a five-point ordinal scale was found to be inadequate to describe the range of wear observed. The concept of "pathological" levels of wear proposed by the TWI are challenged and modification to the index suggested for use among the elderly population.

Assessment of tooth wear in an ageing population.

A random sample of 2222 adults aged 45 years and over was taken from the age/sex registers of two general medical practices in Newcastle upon Tyne, and asked to take part in a dental health survey. A total of 1002 individuals agreed to take part and were visited in their homes. Five hundred and eighty-six subjects were dentate and able to undergo an assessment of tooth wear using the Tooth Wear Index (TWI). Increasing wear with increasing age was observed for all cervical and occlusal/incisal tooth surfaces. Occlusal/incisal surfaces displayed some of the highest mean wear scores, especially in the older age cohorts. With the exception of lingual surfaces of maxillary anterior teeth, no significant variation in tooth wear with age was noted for buccal or lingual surfaces. Greater mean wear scores were observed among males than females, but there was little variation between subjects of different social class backgrounds. The threshold levels of wear suggested for use with the TWI may require modification for use among elderly populations.