Anne B. Skaare

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.

Skin Reactions and Irritation Potential of Four Commercial Toothpastes

Skin reactions to 4 toothpastes were tested in 19 healthy dental students in a double-blind study. The hypothesis was that common toothpaste brands with and without sodium lauryl sulfate (SLS) and triclosan and with different additives/emulgators differ in irritation potential. An occlusion test system on human skin was used. The toothpastes tested were A) Zendium (non-ionic detergent), B) Solidox F (SLS/polyethylene glycol), C) Colgate Total (triclosan/copolymer/SLS/propylene glycol), and D) Solidox G (triclosan/zinc citrate/SLS/polyethylene glycol). Toothpaste C was the greatest irritant, causing skin erythema in 16 of the 19 subjects, whereas toothpaste D gave no reactions. Toothpaste B provoked three reactions (two severe), whereas toothpaste A caused only one mild reaction. Although this study was carried out on skin and hence not directly applicable to the oral cavity, these and previous results may indicate that a toothpaste without propylene glycol and SLS may be preferred by susceptible persons.

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.

Enamel defects in permanent incisors after trauma to primary predecessors: inter-observer agreement based on photographs

UNLABELLED Trauma to primary teeth may cause mineralization disturbances in the permanent successors. OBJECTIVE To study the distribution and type of enamel defects in permanent incisors after trauma to primary teeth and to examine inter-observer agreement when registrations were based on photographs. MATERIAL AND METHODS Of 266 children who suffered an oral injury to primary teeth in one county of Norway in 2003, 193 were included in a follow-up study to record enamel defects in the permanent successors 7 years later (age, 8-15 years). Clinical examination and intraoral photographs were undertaken by the principal investigator. The photographs were evaluated twice for enamel defects by three paediatric dentists. Evaluation 1: age at the time of injury, traumatized teeth and diagnoses were kept unknown to the examiners. Evaluation 2: age and trauma diagnoses were known to the examiners. Inter-observer agreement was calculated using Cohens kappa and chi-square test. RESULTS Of 338 successor teeth, 42% exhibited enamel defects. In neighbouring teeth (339) with non-injured predecessors, 30% were registered with defects. The most common enamel disturbance in successors was demarcated opacities, recorded in 18% of the teeth. Enamel defects owing to a previous trauma were registered in 37% of the children in Evaluation 1, kappa 0.88-0.93 and in 21% in Evaluation 2, kappa 0.63-0.84. The examiners disagreed on a higher proportion of the children when all information on the injury was available (P < 0.001). CONCLUSION Demarcated enamel opacities were the most common defects in permanent successors. Although the inter-examiner agreement was good, the results indicated that recordings of enamel disturbances following trauma is associated with uncertainty.

Management of a 9-year-old boy experiencing severe dental injury--a 21-year follow-up of three autotransplants: a case report.

The replacement of missing anterior teeth is a particular challenge in children and adolescents. This report describes the management of a 9-year-old boy suffering a severe dental injury. The treatment included three autotransplantations and orthodontic space closure to replace four maxillary teeth. A follow-up period of 21 years demonstrated a successful outcome. Autotransplantation of premolars in growing individuals is a predictable method for replacement of missing teeth and for re-establishment of the alveolar process after traumatic bone loss. This case report shows that a multidisciplinary approach is essential for the management and outcome of severe dental injuries in children.

Awareness and attitudes related to dental erosive wear among 18-yr-old adolescents in Oslo, Norway

The aim of the present study was to describe awareness and attitudes related to dental erosive wear among 18-yr-old adolescents in Oslo and to explore attitudinal differences between participants with and without the condition. All 18-yr-old subjects scheduled for their routine examination at the Public Dental Service clinics during 2008 (n = 3,206) were invited, and 1,456 agreed to participate (a response rate of 45%). The data were collected using structured questionnaires and by clinical examination of the participants. Dental erosive wear was assessed using a pictorial manual - the Visual Erosion Dental Examination scoring system - as a guide. Overall, 88% of participants had heard about dental erosive wear; however, of participants with erosive lesions only 56% were aware of, and only 47% could recall their dentist mentioning, the condition. Participants with erosive wear were more likely to have low or moderate positive attitudes towards acidic drink consumption and to be reluctant to change. In multivariate analyses controlling for gender and behavioural variables, weak or moderate positive awareness of acidic drinks remained significantly associated with higher erosion risk. This study emphasizes the importance of assessment and understanding of awareness and attitudinal aspects in relation to dental erosive wear.

Effects of nutrition and hygiene education on oral health and growth among toddlers in rural Uganda: follow-up of a cluster-randomised controlled trial

To examine the effect of a nutrition and hygiene education intervention on oral health behaviour and whether early onset of caries was related to child growth in rural Uganda.