Erosive Tooth Wear Among Different Tooth Types and Surfaces in Japanese Adults 15 to 89 Years Old.

PURPOSE: To evaluate the prevalence of erosive tooth wear on buccal, incisal/occlusal and palatal/lingual surfaces in a wide age range of Japanese adults. MATERIALS AND METHODS: The study included a total of 1108 adults aged 15 to 89 years in Tokyo, Japan. The subjects were asked to complete a self-administered nutrition-related questionnaire. Two examiners evaluated tooth wear on the buccal, occlusal/incisal and palatal/lingual surfaces in a full-mouth recording, using a modified Smith and Knight tooth-wear index. Subjects who frequently consumed acidic beverages or food, or had gastric reflux and at least one tooth with an initial enamel smooth-surface wear facet were placed in an erosion-positive group, and the rest of subjects were placed in the erosion-negative group. RESULTS: 26.1% of the participants were placed in the erosion-positive group. For buccal surfaces, advanced wear progression was predominantly observed on maxillary and mandibular anterior teeth, especially in the youngest age group (15-39 years). On incisal/occlusal surfaces, early dentin exposure was observed in the middle age group (40-49 years) in the erosion-positive group. For palatal/lingual surfaces, wear progression was mainly observed on maxillary anterior teeth among 30- to 39-year olds and 50- to 59-year-old in the erosion-positive group, but that prevalence was lower than for the other tooth surfaces. CONCLUSIONS: For all age groups of Japanese adults, the prevalence of erosive tooth wear depended on tooth types and surfaces.

[A PhD completed 6. Tooth Wear Evaluation System: development and applications]. / Hora est 6. Het Gebitsslijtage Beoordelingssysteem: ontwikkeling en toepassingen.

Numerous ranking systems exist for the quantification of tooth wear, each unfortunately with its own particular shortcomings. In this dissertation a new and very comprehensive tooth wear evaluation system is described. In it, the existing terminology is adapted to distinguish among mechanical-intrinsic (formerly attrition), mechanical-extrinsic (formerly abrasion), chemical-intrinsic (formerly erosion) and chemical-extrinsic (formerly erosion). In order to indicate the degree of wear, the terms mild, moderate, serious and severe are used. On the basis of previous systems, the terms, 3 degree-of-wear systems were developed and tested for reliability for use in the dentist's clinic, on dental models and oral imaging. The ranking scales were shown to be reliably applicable intra-orally, on the dental models and on the oral images, particularly on occlusal/incisal surfaces. The findings of this research have resulted in the formation of a modular Tooth Wear Evaluation System in order to quantify, qualify, monitor and establish the sources of tooth wear. The evaluation system can also be used to determine treatment options.

Ritual tooth modification among the Baka pygmies in Cameroon.

INTRODUCTION: Ritual tooth mutilation is a relatively understudied human body mutilatory practices. The purpose of the study was to examine the effects of ritual tooth modification, teeth cleaning measures and herbal medications for their oral health problems among the Baka pygmies in Cameroon. MATERIALS AND METHODS: This cross-sectional study was conducted between January and March, 2012 using semi-structured questionnaire as the tool of data collection. Intra-oral examinations were carried out to determine the dental hard tissue loss using Smith and Knight Tooth Wear Index (TWI). RESULTS: Fifty-six pygmies with ritual tooth modification made of 34 males (60.7%) and 22 females (39.3%) with a mean age of 31 years were interviewed and had oral health examination. The reported age at which the tooth modification was done was between 10 and 15 years with mean age as 12 ± 1.66 years. More than half (58.9%) of the participants reported the tooth filing as painful and nearly two-thirds (64.3%) of the participants reported having persistent pain afterwards. The upper right central and lateral incisors were the most commonly modified teeth. A total of 42.9%, 12.5% and 7.1% of the participants had Smith and Knight TWI scores of 2, 3 and 4 respectively. All the participants reported cleaning their teeth at least once-daily with about two-thirds (66.1%) of them doing so with chewing stick. The majority (67.9%) of the participants reported cleaning their teeth for cosmetic reasons [to remove dirt' (60.7%) and 'to remove stains' (7.1%)]. The oral health problems among the participants in form of tooth sensitivity, toothache and dental abscess were treated with plant-based traditional medicines from Irvingia gabonensis, Ricinodendron heudoletti, Pterocarpus soyauxii, Alchornea cordifolia and Piptadeniastrum africanum. CONCLUSION: Ritual tooth modification is a painful mutilatory practice which is culturally significant for the Baka pygmies without health benefit. There is need for intervention to stop this harmful traditional practices among the pygmies. Further studies is recommended to elucidate the medicinal and pharmaceutical benefits of plants used for tooth sensitivity and other oral health problems by the pygmies.

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.

Impact of bariatric surgery on oral health conditions: 6-months cohort study.

OBJECTIVES: We evaluate oral health conditions before and after bariatric surgery. METHODS: The sample was composed of 59 patients who had undergone Roux-en-Y gastric bypass (RYGB). Salivary flow, periodontal pocket depth and dental wear were evaluated before and after 6 months of surgery. Body mass index (BMI), C-reactive protein (CRP) and glucose levels were obtained from the patient's medical files. A t-test was used for dependent samples. RESULTS: The mean BMI decreased from 49.31 ± 8.76 to 35.52 ± 8.12 kg/m(2) in 6 months after surgery (P < 0.000). Before surgery, 67% of patients had high levels of CRP and 38% higher blood glucose levels and after surgery there were significant reductions in these levels (P < 0.001). Salivary flow ranged from 0.84 to 0.95 ml/min. There was increased prevalence of periodontal pockets (P = 0.022) and mean pocket depth increased to about 0.5 mm (P < 0.001). The percentage of surfaces with dental wear in dentine was significantly higher after bariatric surgery (P = 0.002), while dental wear in enamel decreased (P = 0.019). CONCLUSIONS: Bariatric surgery may improve systemic conditions. However, it had a negative impact on oral health conditions because of an increase in periodontal disease and dental wear.

Clinical effectiveness of a one-step self-etch adhesive in non-carious cervical lesions at 2 years.

A 2-year randomized, controlled prospective study evaluated the clinical effectiveness of a one-step self-etch adhesive and a "gold-standard" three-step etch-and-rinse adhesive in non-carious Class-V lesions. The null hypothesis tested was that the one-step self-etch adhesive does perform clinically equally well as the three-step etch-and-rinse adhesive. A total of 161 lesions in 26 patients were restored with Clearfil AP-X (Kuraray). The restorations were bonded either with the "all-in-one" adhesive Clearfil S3 Bond (Kuraray) or with the three-step etch-and-rinse adhesive Optibond FL (Kerr). The restorations were evaluated at baseline and after 6 months, 1 and 2 years, regarding their retention, marginal adapation, marginal discoloration, caries occurrence, preservation of tooth vitality and post-operative sensivity. Retention loss, severe marginal defects and/or discoloration that needed intervention (repair or replacement) and the occurrence of caries were considered as clinical failures. The recall rate at 2 years was 93.8%. Only one Clearfil S3 Bond restoration was lost at the 2-year recall. All other restorations were clinically acceptable. The number of restorations with defect-free margins decreased severely during the 2-year study period (to 6.7% and 25.3% for Clearfil S3 Bond and Optibond FL, respectively). The Clearfil S3 Bond restorations presented significantly more small marginal defects at the enamel side than the Optibond FL restorations (Clearfil S3 Bond: 93.3%; Optibond FL: 73.3%; p = 0.000). Superficial marginal discoloration increased in both groups (to 53.3% and 36% for Clearfil S3 Bond and Optibond FL, respectively) and was also more pronounced in the Clearfil S3 Bond group (p = 0.007). After 2 years, the simplified one-step self-etch adhesive Clearfil S3 Bond and the three-step etch-and-rinse adhesive Optibond FL were clinically equally successful, even though both adhesives were characterized by progressive degradation in marginal integrity. Clearfil S3 Bond exhibited more small enamel marginal defects and superficial marginal discolorations.

Tooth wear among tobacco chewers in the rural population of Davangere, India.

PURPOSE: In India, people chew tobacco either alone or in combination with pan or pan masala, which may cause tooth wear. The purpose of this study was to assess and compare tooth wear among chewers of various forms/combinations of tobacco products in the rural population of Davangere Taluk. MATERIALS AND METHODS: A cross-sectional study was conducted on 208 subjects selected from four villages of Davangere Taluk. Tooth wear was recorded using the Tooth Wear Index by a calibrated examiner with a kappa score of 0.89. The chi-square test was used for statistical analysis. RESULTS: The subjects chewing tobacco had significantly greater tooth wear as compared to the controls (P < 0.001). It was also observed that the frequency and duration of chewing tobacco was directly proportional to the number of pathologically worn sites. CONCLUSION: The abrasives present in the tobacco might be responsible for the increased tooth wear among tobacco chewers.

Severe tooth wear in Prader-Willi syndrome. A case-control study.

BACKGROUND: Prader-Willi syndrome (PWS) is a rare complex multsystemic genetic disorder characterized by severe neonatal hypotonia, endocrine disturbances, hyperphagia and obesity, mild mental retardation, learning disabilities, facial dysmorphology and oral abnormalities. The purpose of the present study was to explore the prevalence of tooth wear and possible risk factors in individuals with Prader-Willi syndrome. METHODS: Forty-nine individuals (6-40 years) with PWS and an age- and sex-matched control group were included. Tooth wear was evaluated from dental casts and intraoral photographs and rated by four examiners using the Visual Erosion Dental Examination (VEDE) scoring system and the individual tooth wear index IA. In accordance with the VEDE scoring system, tooth wear was also evaluated clinically. Whole saliva was collected. RESULTS: Mean VEDE score was 1.70 ± 1.44 in the PWS group and 0.46 ± 0.36 in the control group (p < 0.001). Median IA was 7.50 (2.60-30.70) in the PWS group and 2.60 (0.90-4.70) among controls (p < 0.001). In the PWS group tooth wear correlated significantly with age (VEDE; r = 0.79, p < 0.001, IA; r = 0.82, p < 0.001) and saliva secretion (VEDE; r = 0.46, p = 0.001, IA; r = 0.43, p = 0.002). Tooth grinding was also associated with tooth wear in the PWS group, as indicated by the mean VEDE 2.67 ± 1.62 in grinders and 1.14 ± 0.97 in non-grinders (p = 0.001) and median IA values 25.70 (5.48-68.55) in grinders and 5.70 (1.60-9.10) in non-grinders (p = 0.003). Multivariate linear regression analysis was performed with tooth wear as the dependent variable and PWS (yes/no), age, tooth grinding and saliva secretion as independent variables. PWS (yes/no), age and tooth grinding retained a significant association with tooth wear, VEDE (p < 0.001) and log IA (p < 0.001). The only factor significantly associated with tooth wear in the control group was age. CONCLUSIONS: Our study provides evidence that tooth wear, in terms of both erosion and attrition, is a severe problem in Prader-Willi syndrome. There is therefore considerable need for prosthodontic rehabilitation in young adults with PWS.

[Considerations in the treatment of tooth wear]. / Overwegingen bij de behandeling van gebitsslijtage.

Since the origin of tooth wear (attrition, abrasion and erosion) is multi-factorial, its diagnosis is complicated but vital. The so-called Tooth Wear Evaluation System, introduced earlier, makes a systematic diagnostic approach possible. The system consists of various modules, which can be used by the practitioner depending on the goal. Two new modules have been added to the Tooth Wear Evaluation System. The Therapy Start Module can be used to determine which one of the possible treatment modalities (counseling, monitoring, or restorative treatment) should be chosen. The Level of Difficulty Module gives the practitioner indications of the level of difficulty that may be encountered during a restorative treatment.

Tooth wear and erosion: methodological issues in epidemiological and public health research and the future research agenda.

BACKGROUND: This paper addresses methodological issues in the field of tooth wear and erosion research including the epidemiological indices, and identifies future work that is needed to improve knowledge about tooth wear and erosion. METHODS: The paper is result of the work done at the meetings of the Special Interest Group "Tooth Surface Loss and Erosion" at the 2008, 2009 and 2010 conferences of the European Association for Dental Public Health, and the Workshop "Current Erosion indices- flawed or valid" which took place in Basel in 2007. RESULTS: Although there is consensus about the definition and the diagnostic criteria of various forms of tooth wear, gaps in research strategies have been identified. A basic problem is that fundamental concepts of wear and erosion as an oral health problem, have not yet been sufficiently defined. To a certain extent, tooth wear is a physiological condition, and there is no consensus as to whether it can be regarded as a disease. Furthermore, the multitude of indices and flaws in existing indices, make published data difficult to interpret. CONCLUSION: Topics for the research agenda are: the initiation of a consensus process towards an internationally accepted index, and the initiation of data collection on the prevalence of various forms of wear on a population-based level. There should be an emphasis on promoting communication between basic and clinical sciences, and the area of Public Health Dentistry. Furthermore, the question of whether tooth wear is a public health problem remains open for debate.

A new index to measure tooth wear--methodolgy and practical advice.

A new tooth wear index, designed to measure stages of tooth wear in enamel and dentine is presented. The index measures the lateral spread of wear in enamel and the depth of tooth wear in dentine. The index scores enamel loss at 5 levels and 6 levels in dentine and provides a more sensitive index for monitoring the progression of wear than older indices. The protocols and methods of the index are described and incorporate refinements based on the combined experiences of two independent studies conducted on adults and children. The findings of both studies are summarised and recommendations are made for future studies which investigate the prevalence of tooth wear in adults or children.

Interdisciplinary treatment of cervical lesions.

Soft tissue grafting is an integral part of treatment of cervical lesions due to the common lack of adequate attached gingiva and root exposure associated with these lesions. Complete root coverage is a predictable outcome for Miller Class I and II recession defects, and partial root coverage can be achieved in Miller Class III defects. In the esthetic zone, it is desirable to cover as much of the root as possible, and all sites require an adequate zone of attached gingiva, especially adjacent to a restoration. Restorations are required for cervical lesions with excessive depth and significant involvement of the enamel, but they should be avoided where the lesion is shallow and the enamel involvement is minimal. Of course, some sites will require both soft-tissue grafting and placement of a restoration. An interdisciplinary approach to treating cervical lesions will create the most biologically appropriate, stable, and esthetic outcome. Establishing the appropriate tooth form first in treatment planning and sequencing will determine the gingival level and extent of periodontal procedures necessary to achieve the desired outcome.

Toothwear and the older patient.

UNLABELLED: Toothwear is commonly observed in dentate older patients and may be physiological or pathological in nature. Toothwear can be caused by abrasion, attrition, erosion or a combination of aetiologies. Where treatment is required, a number of options exist, including the use of adhesive materials and fixed and removable prosthodontics. CLINICAL RELEVANCE: With patients retaining natural teeth into old age, physiological and pathological toothwear amongst dentate older patients is an increasingly common presentation.

Risk indicators for tooth wear in Sri Lankan adolescents.

The aim of the study was to determine the risk indicators for tooth wear in Sri Lankan adolescents. A total of 1,200 17-year-olds were selected using a two-stage cluster sampling technique from schools in the Colombo district. The data were collected by means of a self-administered questionnaire and a clinical examination. A modified version of Smith and Knight's index of tooth wear was used to record tooth wear on occlusal/incisal, buccal and lingual/palatal surfaces of teeth excluding the third molars. Tooth wear was present in 22% of the adolescents, while nearly 9% had at least 1 wear lesion extending up to the dentine. In the multivariate logistic regression analysis, the consumption of Coca Cola(R) (OR: 2.60; 95% CI: 1.41-4.78), apples (OR: 1.63; 95% CI: 1.04-2.58), the father's occupation (OR: 2.20; 95% CI: 1.29-3.74) and chewing vitamin C tablets (OR: 1.68; 95% CI: 1.03-2.75) were significantly associated with dentinal wear, while tooth wear was associated with the consumption of oranges (OR: 1.60; 95% CI: 1.09-2.37) and apples (OR: 1.38; 95% CI: 1.06-1.80), the father's occupation (OR: 1.81; 95% CI: 1.22-2.68) and chewing vitamin C tablets (OR: 1.44; 95% CI: 1.04-2.00). As the father's occupation could be considered as a proxy measure of socioeconomic status, the findings suggest that tooth wear in Sri Lankan adolescents is a disorder of affluence.

Degenerative changes in human temporomandibular joints in relation to occlusal support.

OBJECTIVE: Controversy exists concerning the etiological factors behind degenerative changes in the temporomandibular joints (TMJs). Tooth attrition, occlusal support, food consistency, ageing, gender and genetics are some possible causative factors that have been discussed in the literature. The aim of this study was to examine contemporary human skull material for possible relations between degenerative form and surface changes in the TMJs in relation to occlusal support. MATERIAL AND METHODS: The material consisted of 259 human skulls from 170 males and 89 females, with an age range of 18-100 years. RESULTS: Dental status was in general poor, and 22% of skulls were edentulous. Form and surface changes of both the condyles and the temporal components were more common in the present material compared to that in most previous studies. In males, irrespective of age, only weak and clinically insignificant correlations could be found between degenerative TMJ changes and occlusal support. In women, however, the correlations between these variables were in general much stronger, especially at higher ages. CONCLUSIONS: The present findings do not lend support to the hypothesis that loss of occlusal support is a causative factor for degenerative changes in the TMJs in male subjects. In women, such a correlation was obvious in the present sample, at least at higher ages. It can be speculated that hormonal factors play a role in the sex difference found.

Dietary differences in archosaur and lepidosaur reptiles revealed by dental microwear textural analysis.

Reptiles are key components of modern ecosystems, yet for many species detailed characterisations of their diets are lacking. Data currently used in dietary reconstructions are limited either to the last few meals or to proxy records of average diet over temporal scales of months to years, providing only coarse indications of trophic level(s). Proxies that record information over weeks to months would allow more accurate reconstructions of reptile diets and better predictions of how ecosystems might respond to global change drivers. Here, we apply dental microwear textural analysis (DMTA) to dietary guilds encompassing both archosaurian and lepidosaurian reptiles, demonstrating its value as a tool for characterising diets over temporal scales of weeks to months. DMTA, involving analysis of the three-dimensional, sub-micrometre scale textures created on tooth surfaces by interactions with food, reveals that the teeth of reptiles with diets dominated by invertebrates, particularly invertebrates with hard exoskeletons (e.g. beetles and snails), exhibit rougher microwear textures than reptiles with vertebrate-dominated diets. Teeth of fish-feeding reptiles exhibit the smoothest textures of all guilds. These results demonstrate the efficacy of DMTA as a dietary proxy in taxa from across the phylogenetic range of extant reptiles. This method is applicable to extant taxa (living or museum specimens) and extinct reptiles, providing new insights into past, present and future ecosystems.

Is a Basic Erosive Wear Examination (BEWE) reliable for recording erosive tooth wear on 3D models?

OBJECTIVES: To assess the reliability of the BEWE index on 3D models and to compare 3D-assessed erosive tooth wear scores with clinically detected scores. METHODS: In total, 1964 members of the Northern Finland Birth Cohort 1966 participated in a standardized clinical dental examination including the Basic Erosive Wear Examination (BEWE) and dental 3D modelling at the age of 45-46 years. Of those examined, 586 were randomly selected for this study. 3D models were assessed using the same BEWE criteria as in the clinical examination. Calculated kappa values as well as the prevalence and severity of erosive wear according to the clinical examination and 3D models were compared. Re-examinations were performed to calculate intra- and inter-method and -examiner agreements. RESULTS: The BEWE index on 3D models was reproducible; the mean intra- and inter-examiner agreement were 0.89 and 0.87, respectively, for sextant level, and 0.64 and 1, respectively, for BEWE sum scores. Erosive tooth wear was recorded as more severe in 3D models than in the clinical examination, and inter-method agreement was 0.41 for severe erosive wear (BEWE sum>8). The biggest inter-method differences were found in upper posterior sextants. CONCLUSIONS: The BEWE index is reliable for recording erosive tooth wear on 3D models. 3D models seem to be especially sensitive in detecting initial erosive wear. Additionally, it seems that erosive wear may be underscored in the upper posterior sextants when assessed clinically. Due to the nature of 3D models, the assessment of erosive wear clinically and on 3D models may not be entirely comparable. CLINICAL SIGNIFICANCE: 3D models can serve as an additional tool to detect and document erosive wear, especially during the early stages of the condition and in assessing the progression of wear. When scoring erosive wear clinically, care must be taken especially when assessing upper posterior sextants.

The Octagon Model: a clinical tool for assessing marginal tissue recession.

The Octagon Model is a clinical assessment tool designed to assess marginal tissue recession (MTR) and estimate the level of difficulty in achieving root coverage. It evaluates eight patient- and siterelated factors: patient's expectations, smoking status, width of keratinized tissue, absence/presence of cervical lesion, interproximal soft tissue/bone level, depth and width of recession defect, and buccal bone thickness. The model is presented in a three-colored diagram to facilitate communication between clinicians and between clinicians and their patients, and to assist clinicians in optimizing treatment plans at both site and patient levels.

Is erosive tooth wear an oral disease?

Erosive tissue loss is part of the physiological wear of teeth. Clinical features are an initial loss of tooth shine or luster followed by flattening of convex structures; with continuing acid exposure, concavities form on smooth surfaces, or grooving and cupping occur on incisal/occlusal surfaces. Dental erosion must be distinguished from other forms of wear, but can also contribute to general tissue loss by surface softening, thus modifying physical wear processes. The determination of dental erosion as a condition or pathology is relatively easy in the case of pain or endodontic complications, but is ambiguous in initial stages and in terms of function or esthetics. The impact of dental erosion on oral health is discussed. However, it can be concluded that in most cases dental erosion is best described as a condition, with the acid being of nonpathological origin.

Occlusal tooth wear in patients of a dental school's prosthodontic department in Xi'an, China.

PURPOSE: To assess the relationships between occlusal tooth wear and occlusal conditions, chewing side preference, and occlusal guidance scheme. MATERIALS AND METHODS: A total of 257 Chinese adult dental school patients were categorized according to a hierarchical functional classification system. Occlusal tooth wear was assessed using a modified Smith and Knight index. Occlusal tooth wear index (OTWI) scores were analyzed using multivariate regression models, including four specific occlusal conditions (≥10 teeth in each arch, complete anterior regions, sufficient premolar regions, and sufficient molar regions) adjusted for age and sex. RESULTS: Occlusal tooth wear was observed in all participants; older participants and men had significantly higher mean OTWI scores. The occlusal condition of having fewer than 10 teeth in each arch was significantly associated with occlusal tooth wear; participants with fewer than 10 teeth in each arch had higher mean OTWI scores in anterior and premolar teeth. OTWI scores for the different tooth types were highly correlated with chewing side preference. OTWI scores for the molar region (including third molars) were significantly higher at the preferred chewing side. The same effect was seen for OTWI scores of all teeth combined. OTWI scores were not associated with occlusal guidance scheme. CONCLUSIONS: The occlusal condition of having fewer than 10 teeth in each arch appears to be a risk factor for increased occlusal tooth wear. Occlusal wear was more severe at the chewing side. Occlusal tooth wear was significantly associated with the nondental factors of age and sex.