Aida Mulic

Reliability of Two Clinical Scoring Systems for Dental Erosive Wear

The aim of the study was to evaluate and compare two dental erosive wear scoring systems, the Visual Erosion Dental Examination (VEDE) and Basic Erosive Wear Examination (BEWE). Seventy-four tooth surfaces (photographs) and 562 surfaces (in participants) were scored by 5 (photographs) or 3 (in participants) clinicians using both scoring systems. The surfaces in the photographs were scored twice. The level of agreement was measured by weighted kappa (ĸw). Inter- and intraexaminer agreement showed small variations between the examiners for both systems when scoring the photographs. Slightly higher mean ĸw values were found for VEDE (ĸw = 0.77) compared with BEWE (ĸw = 0.69). When scoring the surfaces in the clinical examination the mean ĸw values for the two systems were equal (ĸw = 0.73). Interexaminer agreement using VEDE was calculated to see how differentiation between enamel and dentine lesions influenced the variability. The highest agreement was found for score 0 (sound, 86%) and score 3 (exposure of dentine, 67%), while the smallest agreement was shown for score 1 (initial loss of enamel, 30%) and score 2 (pronounced loss of enamel, 57%). The reliability of the two scoring systems proved acceptable for scoring the severity of dental erosive wear and for recording such lesions in prevalence studies. The greatest difficulties were found when scoring enamel lesions, especially initial lesions, while good agreement was observed when examining sound surfaces (score 0) and dentine lesions (score 3).

Dental erosive wear and salivary flow rate in physically active young adults

BackgroundLittle attention has been directed towards identifying the relationship between physical exercise, dental erosive wear and salivary secretion. The study aimed i) to describe the prevalence and severity of dental erosive wear among a group of physically active young adults, ii) to describe the patterns of dietary consumption and lifestyle among these individuals and iii) to study possible effect of exercise on salivary flow rate.MethodsYoung members (age range 18-32 years) of a fitness-centre were invited to participate in the study. Inclusion criteria were healthy young adults training hard at least twice a week. A non-exercising comparison group was selected from an ongoing study among 18-year-olds. Two hundred and twenty participants accepted an intraoral examination and completed a questionnaire. Seventy of the exercising participants provided saliva samples. The examination was performed at the fitness-centre or at a dental clinic (comparison group), using tested erosive wear system (VEDE). Saliva sampling (unstimulated and stimulated) was performed before and after exercise. Occlusal surfaces of the first molars in both jaws and the labial and palatal surfaces of the upper incisors and canines were selected as index teeth.ResultsDental erosive wear was registered in 64% of the exercising participants, more often in the older age group, and in 20% of the comparison group. Enamel lesions were most observed in the upper central incisors (33%); dentine lesions in lower first molar (27%). One fourth of the participants had erosive wear into dentine, significantly more in males than in females (p = 0.047). More participants with erosive wear had decreased salivary flow during exercise compared with the non-erosion group (p < 0.01). The stimulated salivary flow rate was in the lower rage (≤ 1 ml/min) among more than one third of the participants, and more erosive lesions were registered than in subjects with higher flow rates (p < 0.01).ConclusionThe study showed that a high proportion of physically active young adults have erosive lesions and indicate that hard exercise and decreased stimulated salivary flow rate may be associated with such wear.

Dental erosive wear among Norwegian wine tasters

Abstract Objective. To assess the prevalence and severity of dental erosive wear among a group of professional wine tasters. Material and methods. Eighteen wine tasters currently employed at AS Vinmonopolet, Norway (3 women, 15 men; mean age 39 years) and 30 comparison participants (9 women, 21 men; mean age 39 years) were included in the study. The wine tasters were examined by four calibrated clinicians using the Visual Erosion Dental Examination system. Data concerning medical and dietary history, oral hygiene habits and occupational background were obtained from a self-completed questionnaire. Data were analyzed using Fishers exact test, and examiner agreement was determined by means of linear-weighted kappa and the intra-class correlation coefficient. Results. Nine (50%) of the wine tasters and six (20%) of the comparison group showed clinical signs of dental erosion. Among the wine tasters, 39% had dentine involvement, compared to just 7% of the comparison group. The erosive lesions were mainly found on the occlusal surfaces of mandibular first molars in the wine tasters, whereas for the controls, the palatal surfaces of upper centrals were most often affected. Conclusions. There was a significant difference in the prevalence of dental erosive wear between the two groups, the wine tasters having a higher prevalence and more severely affected surfaces than the comparison group. Half of the wine tasters had no erosive wear and, for the other half, there was no relationship between the duration of their professional life and the extent of erosive wear.

Risk indicators for dental erosive wear among 18-yr-old subjects in Oslo, Norway

The aim was to investigate risk indicators associated with dental erosive wear among 18-yr-old subjects in Oslo, Norway. Of 3,206 adolescents invited to participate in a screening examination for erosive wear, 1,456 were examined (giving a response rate of 45%). As part of the examination all participants completed a self-administered questionnaire. Associations between the presence of erosive lesions and the possible risk indicators were assessed by logistic regression analyses, taking into account the hierarchical relationships between the independent variables. Of all 18-yr-old subjects examined, 38% had at least one tooth with erosive lesions. Multivariate analyses showed significant associations between the presence of erosive wear and being male, brushing teeth once per day or less, episodes of vomiting, daily/weekly episodes of gastro-oesophageal reflux, consumption of fruit juice and sugary soft drinks several times per day, as well as consumption of sugary soft drinks daily to once per week. In conclusion, in addition to gender, dietary habits such as frequent consumption of fruit juice and sugary soft drinks, and the occurrence of reflux and vomiting, appear to be risk indicators for erosive wear. When counselling adolescents at risk, the gender-specific risk indicators should be taken into account.

Sour Sweets and Acidic Beverage Consumption Are Risk Indicators for Dental Erosion

This study aimed to investigate the association between dental erosive wear and potential background, behavioural and dietary risk indicators and to assess whether there is a dose-response relationship between the level of acidic beverage consumption and dental erosive wear among adolescents. Of 846 adolescents (aged 16-18 years) scheduled for dental recall examinations, 795 (94%) accepted to participate. All participants completed a self-administered questionnaire regarding their background (gender and age), tooth-brushing frequency and dietary habits (the amount and frequency of acidic food and beverage consumption as well as the chosen method and manner of consuming acidic drinks). The association between the presence of erosive lesions and the possible risk indicators was assessed by logistic regression analyses. Of all participants examined, 37% had ≥3 surfaces with dental erosions and were considered to be affected individuals. In the present study, multivariate logistic analyses revealed a significant association between the dental erosive wear and high consumption of sour sweets and sports drinks. The tooth-brushing frequency was not significantly associated with dental erosive wear. Additionally, to the best of our knowledge, the results are the first to indicate a dose-response relationship between the daily consumption of acidic drinks and dental erosive wear.

Prevalence and severity of dental erosive wear among a group of Norwegian 18-year-olds

Abstract Objective. The aim was to study prevalence, distribution and severity of erosive wear in a group of 18-year-olds. Materials and methods. A total of 1456 adolescents were screened for erosive wear as part of their regular visit at the Public Dental Health Service (PDHS) clinics in Oslo. Of 554 (38%) registered with erosive wear, 267 accepted a second examination to record lesion distribution and severity, performed by one previously calibrated clinician. A tested erosive wear system (VEDE) was used. Occlusal surfaces of the first and second molars in both jaws and the labial and palatal surfaces of the upper incisors and canines were selected as index surfaces. Results. Of the 267 individuals with erosive wear, 13.5% were without lesions, 54.3% had erosive wear in enamel only, whereas 32.2% had at least one lesion extending into dentine. The upper central incisors (46%) and first lower molars (44%) were the most affected teeth with the highest presence on the palatal surfaces. Cuppings were registered in 62% of the individuals, usually in addition to erosive lesions on other surfaces. Eighty-five per cent of the cuppings were on first molars and 34% on the mesio-buccal cusp. Males had significantly more lesions into dentine compared with females (p = 0.03). There was a significant association between presence of erosive lesions and DMFT (p < 0.01), but no association between lesions and socio-economic or national background. Conclusions. A high proportion of adolescents had erosive wear. Cuppings were a common finding.

Dental erosion: a widespread condition nowadays? A cross-sectional study among a group of adolescents in Norway

Abstract Objective. This study aimed to investigate the prevalence, distribution and severity of erosive wear in a group of 16–18-year-olds in the western part of Norway. A second aim was to describe possible associations between caries experience, socioeconomic background and origin of birth. Materials and methods. Adolescents (n = 795) attending recall examinations at Public Dental Service (PDS) clinics were also examined for dental erosive wear on index surfaces, using the Visual Erosion Dental Examination scoring system (VEDE). Results. In total, 795 individuals were examined. Dental erosive wear was diagnosed in 59% of the population (44% erosive wear in enamel only, 14% combination of enamel and dentine lesions, 1% erosive wear in dentine only). The palatal surfaces of upper central incisors and occlusal surfaces of first lower molars were affected the most (33% and 48% of all surfaces, respectively). Cuppings on molars were registered in 66% of the individuals with erosive wear. Erosive wear was significantly more prevalent among men (63%) than women (55%) (p = 0.018). Conclusions. There were no significant associations between dental erosive wear and caries experience, socioeconomic background or origin of birth.

The Susceptibility to Dental Erosion Differs among Individuals.

Studies of wine tasters and patients with self-induced vomiting have revealed that 30-50% of individuals at high risk do not develop erosive lesions. The aim was to investigate this apparent individual susceptibility to enamel erosion. Two enamel specimens were made from each of 3 premolars from 8 persons (donors). Six acrylic mouth appliances were worn by 6 volunteers (carriers). One specimen from each donor was mounted on each appliance. The carriers wore the appliances for 9 days. The appliances were immersed in 0.01 M HCl for 3 min twice per day to imitate a vomiting/reflux situation. The enamel specimens were analysed by a white-light interferometer to measure enamel loss (in micrometres). The enamel loss varied significantly both between the donor teeth (p = 0.009) and the carriers (p = 0.004). The lesion in the specimen with the largest amount of enamel loss was 4 times as deep as in the specimen with the lowest. In 1 carrier, all specimens displayed enamel loss above the mean, including the specimen from the donor with the most resistant enamel. The variation in susceptibility to erosion among individuals appears to be influenced both by the sustainability of the enamel and by factors in the oral environment. This could explain the variation in prevalence and severity of dental erosions among patients exposed to similar acidic challenges. The results suggest that for certain individuals, only minimal acidic challenges may be sufficient to cause damage to the teeth, while others may never develop dental erosions despite extensive exposure to acid.

May caries-preventive fluoride regimes have an effect on dental erosive wear? An in situ study.

Abstract Objective. High and low concentration NaF regimes have shown caries protective properties, but the preventive effect against erosive/abrasive wear is unclear. Aim. To measure the inhibiting effect on enamel wear of low and highly concentrated sodium fluoride (NaF) toothpastes and a stannous (SnF2) fluoride gel in a single-blind, randomized in situ study, using a White Light Interferometer. Materials and methods. Sixteen human molars were each divided into four specimens, mounted on acrylic mouth appliances and worn by eight volunteers for 9 days. Experimental procedures were performed in the laboratory. The enamel specimens were brushed every day with fluoride-free toothpaste. Treatments; group 1: no fluoride treatment (control), group 2: SnF2 gel 2500 ppm F (5 min) every third day, group 3: NaF toothpaste 5000 ppm F 5 min every third day and 2 min the other days, group 4: NaF toothpaste 1450 ppm F (2 min) every day. In order to mimic gastric reflux/vomiting, the specimens were etched with 0.01 M HCl for 2 min twice a day. Results. The mean step height (µm) for the control specimens was −32.9 (SD = 6.8). The mean values for the other groups were −22.2 (SD = 8.4) (group 2), −30.8 (SD = 7.8) (group 3) and −31.4 (SD = 7.7) (group 4). Compared with the control, the SnF2 treated specimens showed significantly lower wear. The NaF toothpastes gave no significant protective effect. Conclusions. Application of SnF2 gel every third day gave protection against erosive–abrasive challenges. Daily application of both low concentration and high concentration NaF toothpaste provided no protection.

Enamel Formation Genes Associated with Dental Erosive Wear

Dental erosive wear is a multifactorial condition that is greatly affected by environmental factors. So far, no study has investigated how dental erosive wear is influenced by variations in enamel formation genes. The aim of the present study was to investigate polymorphisms in genes involved in enamel formation and their influence on enamel susceptibility to dental erosion. DNA samples were collected from 795 Norwegian adolescents aged 16-18 years. Five single-nucleotide polymorphism markers were genotyped in selected candidate genes (ameloblastin, amelogenin, enamelin, tuftelin 1 and tuftelin interacting protein 11), reported to influence enamel formation. Allele and genotype frequencies were compared within two patient groups with dental erosions; all participants with dental erosion and only those with severe dental erosion (erosion extending into dentine). Overrepresentation of the G allele of the enamelin marker was seen in the erosion group compared to the unaffected group (p = 0.047). When erosion severity was considered, statistical significant difference in allele frequency was observed for amelogenin, with the C allele suggesting a protective role (p = 0.02). A suggestive overrepresentation of the TT genotype of the amelogenin marker was also seen in cases with severe erosion (p = 0.049) when compared to cases with no dentine erosion. Amelogenin was also associated with severe erosion in the recessive model; the TT genotype was significantly more frequent in the affected group than in the unaffected group (p = 0.01). The present study suggests that polymorphisms in enamel formation genes are statistically associated with an individuals susceptibility to dental erosive wear.