Monitoring of erosive tooth wear: what to use and when to use it.

Although we are increasingly recognising the need to assess patients for accelerated rates of tooth wear progression, it is often difficult to do so within a feasible diagnostic window. This paper aims to provide evidence-based timelines which a diagnosing clinician can expect to assess tooth wear progression in study models, clinical indices, clinical photographs and visually with intraoral scans. It also discusses new technologies emerging for the quantitative assessment of tooth wear, timelines for diagnosis, and caveats in the 3D scan registration and analysis process.

Associated risk factors with quantitative erosive tooth wear progression.

OBJECTIVES: The aim of this study was to determine predictors of erosive tooth wear (ETW) progression, using novel primary-care quantitative analysis techniques. METHODS: In a single-centre, prospective, observational cohort longitudinal study, adolescents, aged 11-18 years, underwent a baseline BEWE examination, validated risk factors questionnaire and baseline intraoral scan (IOS, TRIOS 3.0, 3Shape, Copenhagen, Denmark). One year later a repeat scan was taken. Quantitative analysis of wear progression (volume loss) on first permanent molars and upper central incisors was performed using previously published protocols. Multilevel linear regression was used to investigate the associations between baseline predictors and volume loss per mm2. RESULTS: A total of 295 dental surfaces (131 incisors and 164 molars) in 70 patients were analysed for this study. The mean age of participants at baseline was 15.0 years (SD: 0.79), and the average time between scans was 11.8 months (1.61 SD; range 10-13). The mean volume loss per mm2 of dental surfaces was -0.013 mm3 (SD: 0.009). Greater volume loss was observed amongst adolescents with higher baseline BEWE scores and those whose parents had lower education as well as on molar than incisor surfaces. No associations were found with dietary acid intake and intrinsic acid exposure when baseline levels of tooth wear, parental education and other factors were controlled for. CONCLUSIONS: The findings help to characterise groups at greater risk of ETW and would indicate that improved screening and upstream preventative measures should form the basis of a preventative program. CLINICAL SIGNIFICANCE: Intra-orals scans and registration software might improve the ability to diagnose, monitor and prevent the early loss of dental hard tissue.

Quantifying increased rates of erosive tooth wear progression in the early permanent dentition.

OBJECTIVES: To investigate if quantitative analysis of intraoral scans of study models can identify erosive tooth wear progression. METHODS: Data were collected from a retrospective longitudinal study, using pre-and post-orthodontic treatment casts of 11-13 year olds, recorded at two consecutive appointments 29 months apart. Casts were digitised with intra-oral scanner TRIOS™ (3Shape, Copenhagen, Denmark) and first molar scan pairs used for analysis. Occlusal surfaces of each molar pair were visually assessed using the BEWE index as having no BEWE progression (n = 42) or BEWE progression (n = 54). Scan pairs were aligned and analysed for volume loss, maximum profile loss and mean profile loss in WearCompare (Leedsdigitaldentistry.com/wearcompare) using previously published protocols. Data were analysed in SPSS and not normal. Mann-Whitney U test with a Bonferroni correction assessed differences between progression groups. Receiver-operating-characteristic (ROC) curves were used to identify the sensitivity and specificity of quantified wear progression rates at determining visual wear progression. RESULTS: Surfaces with visible progression demonstrated a median volume loss of -2.19 mm3 (IQR-3.65, -0.91) compared to a median volume loss of -0.37 mm3 (IQR -1.02, 0.16) in the no visible progression group (p < 0.001). Mean profile loss was -75.2 µm (IQR-93.9, -61.0) and 63.2 µm (IQR -82.5, -49.7) for the progression and no-progression groups respectively (p = 0.018). Volume loss of -1.22mm3 represented a 79 % sensitivity and 61 % specificity. The estimated area under the curve for volume loss was 0.80 (95 %CI 0.71-0.89, p < 0.001). CONCLUSIONS: This is the first study to propose rates of high wear progression in adolescents. Limited sensitivity and specificity confirms that quantitative analysis is an adjunct tool to be used alongside history taking and clinical judgement. CLINICAL SIGNIFICANCE: The rapid advancement of digital technologies may result in improved diagnosis in erosive tooth wear (ETW). Intra-oral scans and registration software are a promising adjunct for monitoring ETW progression in clinical practice.

School Food Policies Related to Soft Drink and Fruit Juice Consumption as a Function of Education Type in Flanders, Belgium.

Recent data on erosive tooth wear (ETW) in Belgium have associated a vocational/technical type of education with ETW risk. Since the role of schools is essential to the promotion of healthy diets, this study aimed to investigate school food policies (SFP) related to soft drink and fruit juice consumption and to detect differences among schools in Flanders, Belgium (BE-F). An online questionnaire related to the control of acidic beverages and promotion of healthy drinking habits was sent to all Flemish secondary schools. For analysis, schools (n = 275) were grouped by type of education (vocational secondary education (VSE) and general secondary education (GSE)), and by socioeconomic status. Multiple factor analyses (MFA) were performed to identify schools with a similar SFP profile. Additionally, descriptive analyses were performed to determine other associations. Overall, 44% of schools in BE-F claimed to have written SFP related to the consumption of soft drinks. SFP expressly prohibiting or limiting acidic beverages were significantly more frequent in GSE schools (p < 0.05), where a higher economic status was present. This study shows that a considerable group of schools in BE-F have no or incomplete rules concerning acidic beverage consumption. Such rules differ between types of education, with VSE schools reporting less control regarding the consumption of drinks.

Monitoring the progression of erosive tooth wear (ETW) using BEWE index in casts and their 3D images: A retrospective longitudinal study.

OBJECTIVE: To determine if the Basic erosive tooth wear index (BEWE index) is able to assess and monitor ETW changes in two consecutive cast models, and detect methodological differences when using the corresponding 3D image replicas. METHODS: A total of 480 pre-treatment and 2-year post-treatment orthodontic models (n = 240 cast models and n = 240 3D image replicas) from 120 adolescents treated between 2002 and 2013 at the Gent Dental Clinic, Belgium, were scored using the BEWE index. For data analysis only posterior sextants were considered, and inter-method differences were evaluated using Wilcoxon Signed Rank test, Kappa values and Mc Nemar tests (p < 0.05). Correlations between methods were determined using Kendall tau correlation test. RESULTS: Significant changes of ETW were detected between two consecutive models when BEWE index was used to score cast models or their 3D image replicas (p < 0.001). A strong significant correlation (τb: 0.74; p < 0.001) was shown between both methods However, 3D image-BEWE index combination showed a higher probability for detecting initial surface changes, and scored significantly higher than casts (p < 0.001). Incidence and progression of ETW using 3D images was 13.3% (n = 16) and 60.9% (n = 56) respectively, with two subjects developing BEWE = 3 in at least one tooth surface. CONCLUSIONS: BEWE index is a suitable tool for the scoring of ETW lesions in 3D images and cast. The combination of both digital 3D records and index, can be used for the monitoring of ETW in a longitudinal approach. The higher sensibility of BEWE index when scoring 3D images might improve the early diagnosis of ETW lesions. CLINICAL SIGNIFICANCE: The BEWE index combined with digital 3D records of oral conditions might improve the practitioner performance with respect to early diagnosis, monitoring and managing ETW.

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.