The association of tooth wear, diet and dietary habits in adults aged 18-30 years old.

OBJECTIVE: The association of acidic foods and drinks to the development of erosive tooth wear was investigated in a single cohort of adults aged 18-30 years. METHOD: A tooth wear index was recorded on 1010 participant's who had a mean age of 21.9 years (SD 0.1) and of which 70% were female and 30% males. Participant's completed a previously validated questionnaire containing 50 questions about current and historical dietary habits. Data were analysed at the tooth level using odds ratio. RESULTS: Tooth wear was statistically significantly associated to acidic foods and drinks with high titratable acidity and dietary habits, including drinking from a glass and holding drinks, (OR 5 and 6.5 respectively). A history of heartburn was statistically significantly associated to palatal dentine exposure (p≤0.05 and OR 7.6). CONCLUSION: In this sample of adults, tooth wear was associated to a number of acidic dietary products and drinking habits.

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.

Investigating the relationship between hyposalivation and mucosal wetness.

BACKGROUND: Mucosal wetness (MW) reflects the layer of residual saliva that covers the oral mucosal surfaces. OBJECTIVES: The aim of this study was to determine MW at different oral mucosa sites and to investigate the relationship between MW, unstimulated whole salivary flow rates (UWS) and Clinical Oral Dryness Score (CODS). METHOD: A total of 100 dry mouth patients and 50 healthy subjects participated in the study. MW was sampled with filter paper strips at four sites inside the mouth; anterior hard palate (AHP), buccal mucosa (BUC), anterior tongue (AT), lower lip (LL) and measured with a micro-moisture meter. Reproducibility was assessed by repeated sampling and diurnal variation was examined. RESULTS: Mucosal wetness in healthy subjects differed according to site and means±SD were; AHP (11± 11.7µm), BUC (32±14.8µm), AT (65±17.2µm), and LL (25 ±13.5µm). Dry mouth patients with reduced UWS showed increased CODS. MW at all four sites was significantly reduced (P<0.05) in dry mouth patients compared with the healthy subjects. Reproducibility of MW measurement using the intra-class correlation coefficient showed agreement at different visits within subject. MW of the AT showed a positive correlation with UWS (P<0.05). CONCLUSION: Mucosal wetness is a reliable measure of oral dryness and had a positive correlation with UWS.

Is tooth wear in the primary dentition predictive of tooth wear in the permanent dentition? Report from a longitudinal study.

OBJECTIVES: To determine the prevalence of tooth wear in the permanent dentition of a sample of 12-year-old school children and establish whether an association exists between tooth wear recorded now and tooth wear recorded in their primary dentition at age five. DESIGN: A prospective cohort study. METHODS: At follow-up to a previous study complete data were available for 123 children; fieldwork was conducted in the child's primary school. Measurement of tooth wear used a scoring system modified from the Smith and Knight Tooth Wear Index (TWI). Tooth wear which had progressed to dentine was assessed on the occlusal surfaces of the four first permanent molars, the labial, lingual/palatal and incisal surfaces of the six upper and six lower anterior teeth; a total of 40 scoreable surfaces. Demographic data were collected from the parents, and a questionnaire on oral hygiene habits, diet and behaviours was completed by each child. RESULTS: In total 38% (n = 47) of subjects had tooth wear, if incisor teeth only were included, 33% (n = 40) had tooth wear and similarly if the occlusal surfaces of molar teeth only were included 10% (n = 12) had signs of tooth wear. Gender was significantly associated with tooth wear: males had more tooth wear. The presence of tooth wear with dentine exposed in the primary dentition was significantly associated with tooth wear on the occlusal surfaces of the first permanent molars. CONCLUSION: Males had more tooth wear than females. An association existed between tooth wear recorded at age 5 and molar tooth wear recorded at age 12. Tooth wear is a lifelong cumulative process and should be recorded in both the primary and permanent dentitions.

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.

Clinical study to compare the effectiveness of a test whitening toothpaste with a commercial whitening toothpaste at inhibiting dental stain.

AIMS: A single centre, randomised single-blind, three-way crossover study was performed, to compare the effect of an experimental test toothpaste with a commercially available whitening toothpaste and water control at inhibiting extrinsic stain promoted by repeated chlorhexidine/tea rinses. METHODS: This study used 23 subjects. During the week before the study the subjects received a prophylaxis to remove all staining, plaque and calculus deposits. On the Monday of the following week subjects returned to the clinic to receive their rinses and to check their dentition was stain free. Under direct supervision at both 09:00 and 13:00 hours they rinsed with either a toothpaste slurry or water control that was repeated daily up to and including the following Thursday. Additionally from the Monday to the Thursday each subject rinsed with a 0.2% chlorhexidine mouthrinse, immediately followed by a rinse with a warm black tea solution. This cycle was repeated hourly eight times throughout the day and on the following days until the Friday. Throughout this period volunteers omitted all other forms of oral hygiene except rinsing with the chlorhexidine mouthwash. On the Friday the level of stain on the teeth and dorsum of tongue was assessed using the Lobene stain index for both stain area and intensity. At the end of each trial period each subject received a thorough prophylaxis to remove all plaque, calculus and staining before starting the second and third period of the study. RESULTS: As expected appreciable amounts of extrinsic stain accumulated on the teeth over each study period. The amount of stain following use of the toothpastes and water control was least with the experimental toothpaste, followed by water control and lastly the commercial whitening paste. For all sites combined there was evidence that the experimental paste was significantly superior to both the commercial paste and water control at reducing stain area (p<0.001), a product of stain area and intensity (p<0.001 and 0.05, respectively) but not stain intensity (p>0.05). CONCLUSIONS: In this stain-prevention model the use of an experimental paste showed a significant reduction in stain accumulation on the teeth compared with a (placebo) negative water control and a commercially available whitening paste. As such the experimental paste would be expected to be of benefit in controlling extrinsic dental staining.

Polymorphisms in the IL-1A gene are correlated with levels of interleukin-1alpha protein in gingival crevicular fluid of teeth with severe periodontal disease.

Interleukin-1 (IL-1) is a potent stimulator of bone resorption and is strongly implicated in the destruction due to bystander damage seen in periodontal disease. Recent studies suggest that polymorphisms of the (IL-1) gene complex may be significant risk factors for a number of chronic inflammatory diseases. The severity of periodontal disease has been positively associated with carriage of allele 2 at position -889 of the IL-1A gene in conjunction with allele 2 of the IL-1B gene at position +3953. In this study, we tested the hypothesis that allele 2 of the IL-1A gene at position -889 might act to elevate levels of IL-1alpha protein in patients with periodontal disease. Since levels of IL-1alpha protein are low in healthy individuals, we used a group of patients with severe periodontal disease to investigate if levels of IL-1alpha protein in gingival crevicular fluid can be correlated to patient genotype. IL-1alpha levels were measured by enzyme immunoassay in 46 patients with severe periodontal disease. These patients were genotyped by PCR and allele-specific restriction digests. The carriage rate for allele 2 in the diseased population was 68%. Overall, the carriage of allele 2 was associated with almost a four-fold increase in IL-1alpha protein levels. Differences were most pronounced in non-smokers, while heavy smokers showed reduced levels of IL-1alpha protein regardless of genotype. These results suggest a mechanism whereby this genetic polymorphism acts to modulate IL-1alpha protein production and may influence the pathogenesis of periodontal disease by affecting the extent of IL-1-associated bystander damage.