Prevalence

Prevalence studies have used different indices of measurement and often address tooth wear in general and not erosion specifically.  In addition, most have been conducted in Europe, therefore, extrapolation of results to the US population must be guarded.  However, these studies do give an approximation of the problem in general populations.  In a Swiss study, 391 adults underwent dental examinations in their own homes.⁵  In subjects aged between 26 and 30 years, 7.7% had facial erosive lesions into dentin and 29.9% had occlusal tooth wear into dentin.  In the 46-50 year old group, 13.2% exhibited facial erosive lesions into dentin and 42.6% had occlusal erosion involving dentin.  In a study of 1007 patients in England, an index known as the Tooth Wear Index (TWI) was utilized.^6,7  This index records tooth wear by number and degree of involved tooth surfaces.  It takes into account that a degree of wear is natural and normal in certain age groups.  The results indicated that 5.7% of tooth surfaces were worn to an unacceptable degree in the 15-26 year old group.  In the 56-65 year old group, 8.2% of the tooth surfaces were unacceptably worn.

Several prevalence studies have been conducted in children.  Dental erosion was included in the examination for the first time in the 1993 National Survey of Child Dental Health conducted in the United Kingdom.⁴  In this study, 17,061 children were examined.  Over half of the 5 and 6 year olds had erosion, 25% with dentinal involvement of the primary dentition.  In the 11+ year age group, almost 25% had erosion, 2% with dentinal involvement in the mixed dentition.  In a study of 1035 14-year-old children randomly selected from a Liverpool population, 30% had exposed incisal dentin.⁸  Another 8% had exposed dentin on occlusal or lingual surfaces.  Data such as these have caused oral health care providers in the United Kingdom to consider dental erosion as a public health problem, citing high consumption of acidic beverages as the major etiologic agent.⁹  Figure 9, (Courtesy, Dr. Donald Milton, University of Washington), illustrates erosion in a 5-year-old child caused by frequent consumption of an acidic fruit juice at bedtime.

Figure 9.

These studies suggest that the incidence of dental erosion ranges from 5 to 50% in various populations and age groups.

Comparable studies have not been conducted in the United States.  One study that surveyed incoming patients to dental schools in Los Angeles and Boston examined 527 patients in the age range of 14 to 80 years old.¹³  Lesions that may have been abrasion rather than erosion were included.  Approximately 25% of all teeth surveyed exhibited tooth wear, with a slightly higher rate in the Los Angeles population.

It is clear from a review of existing epidemiological studies that more population-based studies are needed.  These studies should clearly delineate erosion, attrition, and abrasion with identification of etiologic factors.  Since most of the studies have been conducted in Europe, it is important to also conduct studies in the United States, to determine if there are regional differences related to diet or other etiologic factors of erosion.  The effects of mechanical forces (occlusal attrition, abfraction, cervical abrasion) have garnered much attention in the US.  However, recent evidence indicates that erosion may play a significant role in susceptibility to these mechanical forces.¹⁴  Based on informal communications, it is apparent that once a practitioner recognizes erosion and is aware of its etiologies, increasingly more patients are identified who have the problem.  Well-designed studies are necessary to determine the true magnitude of the problem.

Click Here To Navigate Within Article >> ABSTRACT INTRODUCTION PREVALENCE CAUSES .....Extrinsic Causes .....Intrinsic Causes .....Saliva as a Modifying Factor .....Risk Factors PATIENT ASSESSMENT .....Medical History .....Dietary Questionnaire .....Dental History .....Occupational/Recreational History .....Head and Neck/Oral Examination .....Salivary Function Assessment MANAGEMENT EROSION .....Treatment of Etiology .....Resorative Treatment SUMMARY REFERENCES