The use of index teeth vs. full mouth in erosive tooth wear to assess risk factors in the diet: A cross-sectional epidemiological study

Abstract

Objective: To assess common dietary erosive-tooth-wear (ETW) risk in university students from an exotic-fruit country comparing index teeth vs. full mouth ETW assessment.

Methods: A risk factors' questionnaire was applied on 601 18-25 years old subjects in Bogotá-Colombia. Trained examiners assessed clinically: ETW (BEWE) on all buccal, occlusal and lingual surfaces and ICDAS caries experience (ICDAS-DMFS). Full-arch and index-teeth (buccal of upper-central incisors and occlusal of lower-first molars) maximum-BEWE score categorized patients into: with- (2-3) and without wear (0-1). These were compared in terms of demographic, clinical, dietary and other factors with crude and logistic regression models.

Results: Students' mean age was 20.0 ± 1.9 (77.7% females). Most consumed fruits were erosive/extremely erosive (57%). Prevalence of wear was 73% (full-mouth) vs. 19.6% (index-teeth). Full-mouth-BEWE correlated significantly with teeth-index-BEWE score but low (0.31, p < 0.001). Besides anterior-teeth incisal surfaces, occlusal of lower molars (16%) and buccal of upper central incisors (3.3%) showed highest wear frequency. Straw use or 1 -h waiting for toothbrushing didn't show a protective effect. ETW was significantly associated on index teeth with frequent intakes of dietary acids (≥3 daily-acidic drinks and ≥4 daily-fruit portions) (single-variable-logistic regression: OR 4.41, p = 0.22 and OR 1.60, p = 0.035; multivariable-logistic regression: OR 4.47, p = 0.022 and OR 1.63, p = 0.036 respectively). No significant differences were noticed between groups when the full-mouth maximum score was used.

Conclusion: This young cohort showed dietary ETW associated with frequent dietary acids' intakes and grading ETW on index teeth vs. full mouth was a more sensitive measurement method to assess underlying ETW risk factors. The teeth index has promising usefulness for the clinic and epidemiology.

Clinical significance: Using index teeth (buccal of upper central incisors and occlusal of lower first molars) for ETW (BEWE) assessment allowed to show association in young adults between frequent daily exotic fruits/fruit juices dietary-acid consumption and ETW, representing a less time consuming clinical/epidemiological method of ETW measurement than a full mouth examination.

Keywords: Diagnosis; Diet; Epidemiology; Risk factor; Tooth erosion; Tooth wear.