A. Milosevic

Epidemiological studies of tooth wear and dental erosion in 14-year-old children in North West England. Part 1: The relationship with water fluoridation and social deprivation

Objective The effect of water fluoridation upon dental erosion/tooth wear in the UK has not been investigated. This study aimed to compare the prevalence of tooth wear in 14-year-old schoolchildren in non-fluoridated and fluoridated districts of North West (NW) England. The influence of deprivation and tooth brushing was also investigated.Design A random sample of 10% of the 14-year-old population in NW England was selected and stratified according to fluoridation status as determined from water authority postcode listings.Methods Tooth wear was scored on the labial, incisal and palatal/lingual surfaces of the 12 anterior teeth and the occlusal surfaces of the first molars. Enamel wear was scored 0, dentine was scored 1 or 2, dependent on whether less than or more than a third of the surface had exposed dentine. Secondary dentine or pulpal exposure scored 3. Townsend deprivation scores were gained from residential post codes.Results A total of 2,351 children were examined, of which 637 (27%) lived in the one fluoridated district of South Cheshire and 1,714 (73%) lived in 11 non-fluoridated districts. Fifty-three per cent of the children had exposed dentine with significantly more males affected than females (p<0.001). In the fluoridated district, significantly fewer children had exposed dentine on labial and palatal smooth surfaces (p<0.001) but no differences were found for incisal and occlusal surfaces. The interaction of fluoridation and tooth brushing twice per day resulted in a significant (30%) reduction in erosion. Smooth surface wear was more prevalent in children resident in affluent areas.Conclusion Children in non-fluoridated districts are 1.5 times more likely to have smooth surface wear compared with children in fluoridated districts. Fluoridation and use of fluoridated toothpaste twice a day provide added protection from dental erosion. The risk of tooth wear is greater with increasing affluence.

Dental erosion, oral hygiene, and nutrition in eating disorders

OBJECTIVE To determine the influence of oral hygiene practices and additional fluoride on erosive tooth wear in eating disorders. The proportional dietary intake of carbohydrates, fats, and proteins was also investigated. METHOD Tooth wear was measured with the use of the tooth wear index (TWI). All subjects completed a questionnaire on past dental history as well as a 1-week diet sheet. A total of 33 subjects participated in the study, 20 of whom were follow-ups, allowing the progress of dental erosion to be made. All subjects were referred from the Department of Clinical Psychology. RESULTS Oral hygiene practices between subjects with and without severe erosion were not significantly different. Only 8 bulimics spent more time brushing after vomiting than at other times. The pH of vomitus from 6 subjects ranged between 2.9 and 5.0, with a mean of 3.8, well below the critical pH for enamel demineralization to occur. Of the 20 follow-up subjects, 12 (60%) exhibited worsening tooth wear. The mean values for daily carbohydrate, protein, and fat intake were not significantly different at baseline and at recall, and the proportional dietary intake was similar to recommended energy provision at 47%, 40%, and 13%, respectively. DISCUSSION The contribution by toothbrush abrasion to the overall wear in the eroded dentition of bulimics is not significant. Therefore, immediate post-vomiting oral hygiene practices can be recommended. The proportional nutritional intake values of carbohydrates, fats, and proteins in this group of bulimics are acceptable.

The orodental status of anorexics and bulimics.

This study aims to assess the dental status of anorexics and bulimics by comparison to age-matched controls. One hundred and eight individuals participated, of which 58 had an eating disorder. This group were further subdivided into bulimics who induced vomiting (33), bulimics who did not vomit (7), and anorexics (18). The caries experience (DMFS), plaque levels, gingival inflammation and buffering capacity of saliva were assessed and total vomiting episodes estimated from the product of vomiting frequency and duration. Statistical analysis (one way ANOVA) revealed no significant differences with most of the dental variables between the eating disorder groups and the controls. A linear association (Pearson correlation coefficient) between vomiting frequency, duration or total vomiting episodes and tooth wear was not found, although the frequency of pathological tooth wear is significantly high in the vomiting bulimic group, especially if the total number of vomiting episodes is greater than 1100

Epidemiological studies of tooth wear and dental erosion in 14-year old children in North West England. Part 2: The association of diet and habits.

Objective To determine the strength of association (expressed as Odds Ratios) of potential risk factors with erosion and tooth wear in 14-year-old schoolchildren.Design A random sample of 2,385 children were selected by a stratified two-stage technique based on schools and children.Setting Schools in NW England.Methods Tooth wear was assessed by one examiner on three surfaces of all 12 anterior teeth (labial, incisal and palatal) and the occlusal surface of all four first molars using a four-point scale. Enamel wear was scored 0, dentine exposure <1/3 scored 1, >1/3 scored 2 and secondary dentine or pulpal exposure, scored 3. A questionnaire enquired about general health, dental health, habits and the frequency of intake of a wide range of foods and drinks.Results The Odds Ratios for tooth wear on any surface for habits, reflux and certain foods were: bruxism, 1.10; stomach upset, 1.45; pickles 1.86; vinegar 1.36; salt and vinegar crisps 1.33; brown/other sauces 1.57. Similarly, the odds ratios for potentially erosive drinks were: fizzy drinks 1.32; sport drinks 1.58; herbal/lemon tea 3.97. The frequency of intake was bi-modal with 397 children drinking a can per day and 207 drinking two cans per day. A significant number drank acidic beverages at bedtime but this was not associated with dental erosion.Conclusion Although odds ratios greater than unity indicate an association, this was not high for carbonated beverages and many other acidic foods or drinks. Examining at fourteen years may not be ideal, as the determinants of erosion/tooth wear have not acted for long, the indices do not discriminate sufficiently and proportionately few subjects have dentine exposed on smooth surfaces.

Sports drinks hazard to teeth.

OBJECTIVE: To determine the dental hazards associated with sports supplement drinks by investigating the chemicophysical properties of eight brands of sports drinks. METHODS: The pH and titratable acidity against 0.1 M NaOH was measured. Calcium, phosphate, and fluoride concentrations and viscosities of Carbolode, Gatorade, High Five, Isostar, Lucozade Sport Lemon, Lucozade Sport Orange, Maxim, and PSP22 were determined. RESULTS: The pH values of the drinks ranged from 4.46 (Maxim) to 2.38 (Isostar) and therefore were below the critical pH value (5.5) for enamel demineralisation. Both Lucozade varieties had high titratable acidities (16.30 ml 0.1M NaOH to neutrality) with Gatorade, High Five, and Isostar displaying intermediate titratable acidity, although Isostar had 74.5 ppm calcium and 63.6 ppm phosphate. The fluoride concentration of all drinks was low, and none of the drinks was particularly viscous (range 3.1-1.4 mPa.s). CONCLUSIONS: The chemicophysical analyses indicate that all the sports drinks in this study have erosive potential. However, drinks with higher pH, lower titratable acidity, and higher concentrations of calcium, phosphate, and fluoride will reduce this erosive potential.

Eating disorders and the dentist.

Dentists are likely to encounter patients who have eating disorders. The paper explains the various types and considers both the risk factors, and the psychological and medical complications. The effect on oral health and the principles of dental management are outlined. Dentists have an important part to play in the overall care of these patients.

Salivary Factors in Vomiting Bulimics with and without Pathological Tooth Wear

The increased occurrence of dental erosion from self-induced vomiting in bulimia nervosa is not linearly associated with the frequency or the duration of vomiting. Possible changes in the buffering and lubricating role of saliva in bulimia nervosa and their relationship to erosion have not been previously investigated. Chewing-gum-stimulated salivary flow rate, pH, bicarbonate concentration and viscosity were compared between two groups of vomiting bulimics and with 10 healthy controls. One bulimic group (n = 9) had pathological tooth wear present according to the criteria of the Tooth Wear Index and the other bulimic group (n = 10) did not. The influence of salivary pellicle on enamel acid dissolution by perchloric acid was also assessed by an enamel biopsy method. Bicarbonate was measured in a Natelson microgasometer. Both the bulimic groups had mean initial 3-min flow rates and overall 9-min flow rates significantly lower (p < 0.01) than the healthy subjects. The mean pH values were not significantly different between the two bulimic groups or the control group. However, the mean bicarbonate concentration in both bulimic groups was significantly less (p < 0.01) than in the control group. The mean salivary viscosity of 7.4 centipoise (cP), measured by a DV1 Brookfield viscometer, was significantly greater (p < 0.05) in the pathological tooth-wear-present group than in the tooth-wear-absent group (4.5 cP) and the control group (4.1 cP). Slightly more calcium was released from the pellicle-free surface in both groups but this was not statistically significant, whilst the dissolved calcium in enamel biopsies was significantly lower (p < 0.05) in the tooth-wear-present group.

Sports supplement drinks and dental health in competitive swimmers and cyclists

Aim: To assess dental status and sports supplement uptake in swimmers and cyclists. To determine chemico-physical properties of the most popular sports drinks.Design: Descriptive, prevalence study of tooth wear and caries experience. Questionnaire analysis of sports drinks usage.Setting: Two public swimming pools in Liverpool and three cycle clubs in North West England.Subjects and Method: A convenience sample of swimmers and cyclists was examined for caries and tooth wear. A questionnaire ascertained which sports drinks were consumed and their pattern of consumption. pH and titratable acidity, concentrations of calcium, phosphate and fluoride, and viscosity were analysed. Salivary flow rate in response to these drinks and water was also determined.Results: 25 swimmers and 20 cyclists participated. Caries experience and tooth wear into dentine (excluding incisally exposed dentine) was significantly more frequent among cyclists (P < 0.05). Cyclists had significantly more upper palatal wear (P < 0.001). Pattern of sport drink consumption between the two groups was significantly different (P < 0.001). pH range of the most popular sport drinks was 2.4-4.5. Salivary flow rate after a 1-minute rinse was significantly lower (P < 0.05) with one drink (0.47 ml/min) and water (0.41 ml/min) compared with the other drinks.Conclusions: An association between caries or erosive tooth wear and sport drink consumption was not found. However, the erosive potential of sport drinks is real and must be borne in mind as an aetiological factor for erosion in young people

Prevalence and Risk Indicators of Erosion in Thirteen- to Fourteen-Year-Olds on the Isle of Man

Aims: The aim was to determine the prevalence of erosion in 13- to 14-year-old children on the Isle of Man and to investigate the strength of association with dietary risk factors. Methods: Exposed dentine was assessed on smooth surfaces of incisors/canines and occlusal surfaces of first molars. A questionnaire assessed the consumption frequency of foodstuffs. Results: Of 629 children examined, 124 (20%) had dentine exposed labially, palatally or occlusally. More males had dentine exposed on these surfaces (OR = 1.7, 95% CI = 1.2–2.6). Palatal dentine exposure was present in 3% of the children and occlusal dentine exposure in 18%. In bivariate analyses, drinking fizzy drinks more than once a day was associated with erosion (OR = 1.6, 95% CI = 1.1–2.3). The mean DMFT scores were not statistically different for the children with smooth surface/occlusally exposed dentine (1.37) compared to those without (1.58). Multiple regression analysis showed age, gender and toothbrushing to be significant predictors of erosion. Conclusion: This study has found a higher proportion of 13- to 14-year-old children with exposed dentine in molars than previous studies. The results corroborate previous reports that males have more erosion than females.

Tooth surface loss: Eating disorders and the dentist

Dentists are likely to encounter patients who have eating disorders. The paper explains the various types and considers both the risk factors, and the psychological and medical complications. The effect on oral health and the principles of dental management are outlined. Dentists have an important part to play in the overall care of these patients.