Prevalence of tooth wear on buccal and lingual surfaces and possible risk factors in young European adults
TL;DR: There was no evidence that waiting after breakfast before tooth brushing has any effect on the degree of tooth wear, and fresh fruit and juice intake was positively associated with tooth wear.
About: This article is published in Journal of Dentistry.The article was published on 2013-11-01. It has received 259 citations till now. The article focuses on the topics: Tooth wear & Tooth brushing.
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TL;DR: The European Federation of Conservative Dentistry (EFCD) considered ETW as a relevant topic for generating this consensus report as discussed by the authors, based on a compilation of the scientific literature, an expert conference, and the approval by the General Assembly of EFCD.
Abstract: Due to an increased focus on erosive tooth wear (ETW), the European Federation of Conservative Dentistry (EFCD) considered ETW as a relevant topic for generating this consensus report. This report is based on a compilation of the scientific literature, an expert conference, and the approval by the General Assembly of EFCD. ETW is a chemical-mechanical process resulting in a cumulative loss of hard dental tissue not caused by bacteria, and it is characterized by loss of the natural surface morphology and contour of the teeth. A suitable index for classification of ETW is the basic erosive wear examination (BEWE). Regarding the etiology, patient-related factors include the pre-disposition to erosion, reflux, vomiting, drinking and eating habits, as well as medications and dietary supplements. Nutritional factors relate to the composition of foods and beverages, e.g., with low pH and high buffer capacity (major risk factors), and calcium concentration (major protective factor). Occupational factors are exposition of workers to acidic liquids or vapors. Preventive management of ETW aims at reducing or stopping the progression of the lesions. Restorative management aims at reducing symptoms of pain and dentine hypersensitivity, or to restore esthetic and function, but it should only be used in conjunction with preventive strategies. Effective management of ETW includes screening for early signs of ETW and evaluating all etiological factors. ETW is a clinical condition, which calls for the increased attention of the dental community and is a challenge for the cooperation with other medical specialities.
212 citations
TL;DR: The results demonstrated that prevalence rate of erosive wear was influenced by methodological and diagnosis factors, and the correct choice of a clinical index for dental erosion detection and the geographic location play an important role for the large variability of erOSive tooth wear in permanent teeth of children and adolescents.
183 citations
TL;DR: A narrative overview on the data available on the global prevalence of erosion is given, finding a large variation in global prevalence ranging between 0 and 100%, and there seems to be a gender difference and an increase in prevalence with age.
Abstract: Erosion is a common phenomenon in the general population of developed countries. However, due to variations in indices, sample sizes and general study designs, it is difficult to compare the various studies and to estimate actual global prevalence. Therefore, the aim of this present paper is to give a narrative overview on the data available on the global prevalence of erosion. Information on prevalence is not available from each country; in particular, data from Asia, Africa, South America, North America and large parts of South-Eastern Europe are unavailable. There is a large variation in global prevalence ranging between 0 and 100%. Calculating a rough mean from the data available, a mean prevalence in deciduous teeth between 30% and 50% and in permanent teeth between 20% and 45% can be estimated. There seems to be a gender difference and an increase in prevalence with age. Prevalence studies on erosion risk groups show comparable variation. Only in patients with gastro-oesophageal reflux disease (GORD) and eating disorders associated with vomiting can a clear impact on erosion prevalence be found. In people who consume acidic foods and drinks, a higher risk can be found for some specific comestibles. However, there is a lack of controlled epidemiological studies, making it difficult to generalise. There is a clear need for well-designed studies on this issue.
142 citations
TL;DR: Saliva plays a role in the formation of the acquired dental pellicle, a perm-selective membrane that prevents the contact of the acid with the tooth surfaces and may represent the biological expression of an individual's risk for developing erosive lesions.
Abstract: Saliva is the most relevant biological factor for the prevention of dental erosion. It starts acting even before the acid attack, with an increase of the salivary flow rate as a response to the acidic stimuli. This creates a more favorable scenario, improving the buffering system of saliva and effectively diluting and clearing acids that come in contact with dental surfaces during the erosive challenge. Saliva plays a role in the formation of the acquired dental pellicle, a perm-selective membrane that prevents the contact of the acid with the tooth surfaces. Due to its mineral content, saliva can prevent demineralization as well as enhance remineralization. These protective properties may become more evident in hyposalivatory patients. Finally, saliva may also represent the biological expression of an individual's risk for developing erosive lesions; therefore, some of the saliva components as well as of the acquired dental pellicle can serve as potential biomarkers for dental erosion.
118 citations
TL;DR: The future of fluoride alone in erosion prevention looks grim, but the combination of fluoride with protective agents, such as polyvalent metal ions and some polymers, has much brighter prospects.
Abstract: The effectiveness of fluoride in caries prevention has been convincingly proven. In recent years, researchers have investigated the preventive effects of different fluoride formulations on erosive tooth wear with positive results, but their action on caries and erosion prevention must be based on different requirements, because there is no sheltered area in the erosive process as there is in the subsurface carious lesions. Thus, any protective mechanism from fluoride concerning erosion is limited to the surface or the near surface layer of enamel. However, reports on other protective agents show superior preventive results. The mechanism of action of tin-containing products is related to tin deposition onto the tooth surface, as well as the incorporation of tin into the near-surface layer of enamel. These tin-rich deposits are less susceptible to dissolution and may result in enhanced protection of the underlying tooth. Titanium tetrafluoride forms a protective layer on the tooth surface. It is believed that this layer is made up of hydrated hydrogen titanium phosphate. Products containing phosphates and/or proteins may adsorb either to the pellicle, rendering it more protective against demineralization, or directly to the dental hard tissue, probably competing with H(+) at specific sites on the tooth surface. Other substances may further enhance precipitation of calcium phosphates on the enamel surface, protecting it from additional acid impacts. Hence, the future of fluoride alone in erosion prevention looks grim, but the combination of fluoride with protective agents, such as polyvalent metal ions and some polymers, has much brighter prospects.
114 citations
Cites background from "Prevalence of tooth wear on buccal ..."
...This could explain the high prevalence of dental erosion still commonly found in various populations [Bartlett et al., 2013; Jaeggi and Lussi, 2014]....
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References
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TL;DR: The interplay between erosion and abrasion may be the main driver leading to the clinical manifestation of this disorder and recommendations for patients at risk for dental erosion will be discussed.
Abstract: Acids of intrinsic and extrinsic origin are thought to be the main etiologic factors for dental erosion. There is evidence that acidic foodstuffs and beverages play a role in the development of erosion. However, the pH of a dietary substance alone is not predictive of its potential to cause erosion as other factors modify the erosive process. These factors are chemical (pKa values, adhesion and chelating properties, calcium, phosphate and fluoride content), behavioural (eating and drinking habits, life style, excessive consumption of acids) and biological (flow rate, buffering capacity, composition of saliva, pellicle formation, tooth composition, dental and soft tissue anatomy). The interplay between erosion and abrasion (specially oral hygiene practices) may be the main driver leading to the clinical manifestation of this disorder. Recommendations for patients at risk for dental erosion such as reducing acid exposure by reducing the frequency and contact of acids will be discussed.
551 citations
TL;DR: The BEWE allows re-analysis and integration of results from existing studies and, in time, should initiate a consensus within the scientific community and so avoid continued proliferation of indices.
Abstract: A new scoring system, the Basic Erosive Wear Examination (BEWE), has been designed to provide a simple tool for use in general practice and to allow comparison to other more discriminative indices. The most severely affected surface in each sextant is recorded with a four level score and the cumulative score classified and matched to risk levels which guide the management of the condition. The BEWE allows re-analysis and integration of results from existing studies and, in time, should initiate a consensus within the scientific community and so avoid continued proliferation of indices. Finally, this process should lead to the development of an internationally accepted, standardised and validated index. The BEWE further aims to increase the awareness of tooth erosion amongst clinicians and general dental practitioners and to provide a guide as to its management.
425 citations
TL;DR: Dental erosion starts by initial softening of the enamel surface followed by loss of volume with a softened layer persisting at the surface of the remaining tissue, thus altering its strength and structure.
Abstract: The quality of dental care and modern achievements in dental science depend strongly on understanding the properties of teeth and the basic principles and mechanisms involved in their interaction with surrounding media. Erosion is a disorder to which such properties as structural features of tooth, physiological properties of saliva, and extrinsic and intrinsic acidic sources and habits contribute, and all must be carefully considered. The degree of saturation in the surrounding solution, which is determined by pH and calcium and phosphate concentrations, is the driving force for dissolution of dental hard tissue. In relation to caries, with the calcium and phosphate concentrations in plaque fluid, the 'critical pH' below which enamel dissolves is about 5.5. For erosion, the critical pH is lower in products (e.g. yoghurt) containing more calcium and phosphate than plaque fluid and higher when the concentrations are lower. Dental erosion starts by initial softening of the enamel surface followed by loss of volume with a softened layer persisting at the surface of the remaining tissue. Dentine erosion is not clearly understood, so further in vivo studies, including histopathological aspects, are needed. Clinical reports show that exposure to acids combined with an insufficient salivary flow rate results in enhanced dissolution. The effects of these and other interactions result in a permanent ion/substance exchange and reorganisation within the tooth material or at its interface, thus altering its strength and structure. The rate and severity of erosion are determined by the susceptibility of the dental tissues towards dissolution. Because enamel contains less soluble mineral than dentine, it tends to erode more slowly. The chemical mechanisms of erosion are also summarised in this review. Special attention is given to the microscopic and macroscopic histopathology of erosion.
396 citations
TL;DR: Present data does not allow the ranking of different acids with regard to their potential of causing erosion, nor is there consensus as to how effective fluorides are in preventing the progression of erosive lesions, or how the chemical and structural factors of tooth tissue in general might modify this pathological process.
Abstract: Dental erosion is caused by acidic solutions which come into contact with the teeth. Because the critical pH of dental enamel is approximately 5.5, any solution with a lower pH value may cause erosion, particularly if the attack is of long duration, and repeated over time. Saliva and salivary pellicle counteract the acid attacks but if the challenge is severe, a total destruction of tooth tissue follows. Ultrastructural studies have shown that erosive lesions are seen in prismatic enamel as characteristic demineralization patterns where either the prism cores or interprismatic areas dissolve, leading to a honeycomb structure. In aprismatic enamel the pattern of dissolution is more irregular and areas with various degrees of mineral loss are seen side by side. In dentin the first area to be affected is the peritubular dentin. With progressing lesions, the dentinal tubules become enlarged but finally disruption is seen also in the intertubular areas. If the erosion process is rapid, increased sensitivity of the teeth is the presenting symptom. However, in cases with slower progression, the patient may remain without symptoms even though the whole dentition may become severely damaged. Regarding the role of causative agents, present data does not allow the ranking of different acids with regard to their potential of causing erosion. Neither is there consensus as to how effective fluorides are in preventing the progression of erosive lesions, or how the chemical and structural factors of tooth tissue in general might modify this pathological process.
304 citations
TL;DR: Data from interviews and multiple regression analyses revealed that acids from beverages are significantly associated with presence of erosion.
Abstract: The purpose of this study was to determine the prevalence of dental erosion in an adult population in Switzerland. 391 randomly selected persons from two age groups (26-30 and 46-50 yr) were examined for frequency and severity of erosion on all tooth surfaces. Information was gathered by interview about lifestyle, dietary and oral health habits. For facial surfaces 7.7% of the younger age group and 13.2% of the older age group showed at least one tooth affected with erosion with involvement of dentin (grade 2). 3.5 teeth per person in the younger and 2.8 teeth per person in the older age group were affected. Occlusally, at least one severe erosion was observed in 29.9% of the younger and 42.6% of the older sample with 3.2 and 3.9 erosion-affected teeth per person, respectively. 3.6% of the younger age group and 6.1% of the older age group showed slight lingual erosion on the maxillary anterior teeth. Severe lingual erosions were scarce. Data from interviews and multiple regression analyses revealed that acids from beverages are significantly associated with presence of erosion.
295 citations