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Tooth Erosion in Children US Perspective
How prevalent is tooth erosion?
Tooth erosion was described as a condition distinct from caries as early as the 18th Century.16 However, the first in-depth surveys into the condition, particularly in children and adolescents, did not emerge until the 1990's.
Britain's 10-yearly surveys of children's oral health first provided prevalence data on non-carious tooth surface loss in 1993,3 with the second UK-wide survey in 2003.3 This found that, with the exception of buccal tooth surface loss in eight year olds, there had been an increase in the proportion of children with TSL in all age groups in the decade since 1993.
Specifically, the survey found that in five year olds, over half (53%) were affected with palatal TSL, while 22% of children had TSL in dentin or pulp on palatal incisal surfaces. TSL was less common and less severe on permanent incisors, compared to primary dentition, but the data demonstrated that incidence increases as the child ages. At age eight, TSL was found on 14% of palatal surfaces increasing to 33% at age 15.3
Research from other countries indicates the UK is not alone. Studies from elsewhere in Europe17 reflect a similar prevalence. The differences in the composition of primary and permanent enamel explain the high rates recorded in pre-school children.18
It is not just age that is a factor in erosion, gender, socio-economic status and ethnic and cultural differences have also been investigated:
- A Dutch longitudinal study found overall prevalence of tooth erosion was 32.2% at a mean age of 11.9 years (with the mean number of affected teeth affected being 1.73 involving 1.74 tooth surfaces).19 This increased 18 months later to 42.8% (with the mean number of affected teeth now 3.63 involving 4.01 tooth surfaces). Marked differences were now apparent with a higher incidence in boys than in girls, as was the incidence in children with a low or medium socio-economic status (SES), compared to those considered to have a high SES.
- A UK study compared erosion among 1,308 white and Asian adolescents across the county of Leicestershire revealed at 12 years of age 56.3% had signs of erosion.2 Some two years later this had increased to 64.1%, with white children exhibiting significantly more erosion than their Asian peers at both time points. As with the Dutch study, gender differences were seen among the the Asian children, with an increase in erosion noted in the boys, but not among Asian girls. Lower socio-economic groups in both the white and Asian populations showed the greatest increase at 16% over the 18 months.
- In China, where pre-school prevalence is still relatively low at around 4.5-6.9%, data showed a positive correlation between parental education status and erosion prevalence in their children's teeth.20 The researchers point out that children from a more economically-developed province had a higher prevalence of erosion, as did children in urban areas, compared to rural.
While data from the US are limited, a recent Texas/Indiana/California multi-centre study, puts prevalence at about 30 per cent, which suggest dental professionals should be mindful of future studies.11 Other recent data also shows prevalence in North America can vary:
- A recent review of prevalence of dental erosion among American teenagers looked at the data in the National Health and Nutrition Examinations Survey. It found that 45.9% of children had dental erosion in at least one tooth, with erosion more prevalent in the lower than the upper teeth.21 Furthermore, it noted dental erosion was significantly associated with being female, African-American, having had a dental visit in the previous year and being underweight. It did not find an association with income and dental insurance.
- In Canada, sampling of data collected as part of the Dental Indices Survey found a prevalence of 6.9%.22 There were no significant differences between genders or in the four age groups sampled between 5 and 13 years, however erosion was highest in females of all ages. The researchers noted that this study provided the first evidence of dental erosion and its severity among school children in Ontario, and called for longitudinal studies to determine incidence, progression and risk factors.
In summary, it is important to remember that dental erosion is something that affects all sectors of society, but its detection and prevalence may vary. Incidence will be apparent as the patient cohort gets older, but as soon as the tooth breaks through the gum, it is at risk of acid erosion.
Tooth erosion indices
When it comes to considering tooth erosion indices, there is inconsistency with the indices used and the teeth examined in different studies. This makes determining true prevalence of tooth erosion difficult.
Current indices are research and not practice-based, and focus on late stage tooth wear into dentin. Recently two new indices have sought to address this. Both were first presented at the International Association of Dental Research in Toronto in 2008. The first, developed by Professor David Bartlett of the King's College Dental Institute, London, is a full scoring system that specifically looks at toothwear in enamel as well as in dentin.
The second was developed by Professor Adrian Lussi at the University of Bern. It is a practitioner based partial mouth scoring system - Basic Erosive Wear Examination (BEWE) - enables practitioners to help with identification, monitoring and prevention as well as eventual treatment of tooth wear.
Both these indices will help build understanding of erosion and its impact.26