Skip to main content

Advertisement

SpringerLink
Log in

Multicenter study to develop and validate a risk assessment tool as part of composite scoring system for erosive tooth wear

  • Original Article
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Objectives

(i) To develop, validate, and apply in practice a new risk assessment tool for erosive tooth wear (ETW) including a risk factors questionnaire and a saliva secretion evaluation, which combined with a clinical index, can be part of an ETW composite scoring system; (ii) to assess ETW lesions and current and past erosive challenges in younger age groups.

Methods

The Tooth Surface Loss/Erosion Working Group of the European Association of Dental Public Health consisted of an international panel of experts designed the survey component of the new tool (Erosive Wear Assessment of Risk—EWAR) and confirmed its construct and content validity. After receiving ethical approvals and informed consents, the EWAR tool (questionnaire + saliva secretion evaluation) was applied in a multicenter cross-sectional study with 207 participants aged 15–21 years old from four countries (Finland, Greece, Romania, the USA). BEWE score was used for the clinical assessment of ETW.

Results

A total of 58.5% of participants had ETW. 10.9% and 20.3% of participants had low secretion of stimulated (< 1 ml/min) and unstimulated saliva (< 0.25 ml/min), respectively. The following factors were bivariately significantly associated with ETW: energy drink consumption, low secretion of stimulated saliva, juices consumption, erosive drink consumption for quenching thirst between meals, erosive drink kept in the mouth, feeling pain/icing after consuming something acidic or cold, and co-existence of other type of tooth wear. In regression analysis, only energy drink consumption (OR = 3.5, 95% CI: 1.39, 8.9), low secretion of stimulated saliva (OR = 36.3, 95% CI: 4.71, 78.94), and feeling pain/icing (OR = 8.8, 95% CI: 1.92, 40.04) remained significant.

Conclusions

The examiners of the study reported that the EWAR tool appeared to be an affordable and easy-to-use instrument. Some challenges occurred during the saliva collection process. Inferential analysis revealed that the risk factors/indicators of low stimulated salivary flow, energy drink consumption, and pain/icing with ETW were considered the most important in ETW occurrence.

Clinical relevance

EWAR tool combined with the BEWE clinical index can be used for ETW risk assessment for epidemiological studies and chairside use.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Schlueter N, Amaechi BT, Bartlett D, Buzalaf MA, Carvalho TS, Ganss C, Hara AT, Huysmans M-CDNJM, Lussi A, Moazzez R, Vieira AR, West NX, Wiegand A, Young A, Lippert F (2019) Terminology of erosive tooth wear: consensus report of a workshop organized by the ORCA and the Cariology Research Group of the IADR. Caries Res. 54:2–6. https://doi.org/10.1159/000503308

    Article  PubMed  Google Scholar 

  2. Jaeggi T, Lussi A (2014) Prevalence, incidence and distribution of erosion. In: Lussi A, Ganss C (eds) Erosive Tooth Wear, Monographs in Oral Science, vol 25. Karger, Basel, pp 55–73

    Google Scholar 

  3. Margaritis V, Nunn J (2014) Challenges in assessing erosive tooth wear. In: Lussi A, Ganss C (eds) Erosive Tooth Wear, Monographs in Oral Science, vol 25. Karger, Basel, pp 46–54

    Google Scholar 

  4. Bartlett D, Ganss C, Lussi A (2008) Basic erosive wear examination (BEWE): a new scoring system for scientific and clinical needs. Clin Oral Investig 12(Suppl. 1):S65–S68

    Article  Google Scholar 

  5. Holbrook WP, Furuholm J, Gudmundsson K, Theodors A, Meurman JH (2009) Gastric reflux is a significant causative factor of tooth erosion. J Dent Res 88:422–426

    Article  Google Scholar 

  6. Margaritis V, Mamai-Homata E, Koletsi-Kounari H (2011) Novel methods of balancing covariates for the assessment of dental erosion: a contribution to validation of a synthetic scoring system for erosive wear. J Dent 39:361–367

    Article  Google Scholar 

  7. Young A, Stenhagen KR, Mulic A, Amaechi BT (2015) Dental erosive wear risk assessment. In: Amaechi B (ed) Dental Erosion and Its Clinical Management. Springer, Cham, pp 121–132

    Chapter  Google Scholar 

  8. European Association of Dental Public Health-Special Interest Working Group on Tooth Surface Loss/Erosion; 2016 report (2016). https://www.eadph.org/course/tooth-surface-loss-erosion. Accessed 14 Dec 2019

  9. Buzalaf MA, Hannas AR, Kato MT (2012) Saliva and dental erosion. J Appl Oral Sci 20(5):493–502. https://doi.org/10.1590/S1678-77572012000500001

    Article  PubMed  PubMed Central  Google Scholar 

  10. Ganss C (2008) How valid are current diagnostic criteria for dental erosion? Clin Oral Investig 12(Suppl. 1):S41–S49

    Article  Google Scholar 

  11. Margaritis V, Mamai-Homata E, Koletsi-Kounari H, Polychronopoulou A (2011) Evaluation of three different scoring systems for dental erosion: a comparative study in adolescents. J Dent 39:88–93

    Article  Google Scholar 

  12. Plemons J, Al-Hashimi I, Marek C (2015) Managing xerostomia and salivary gland hypofunction. A Report of the ADA Council on Scientific Affairs, http://www.ada.org/~/media/ADA/Science%20and%20Research/Files/CSA_Managing_Xerostomia.pdf?la=en, 2015. Accessed 14 Dec 2019.

  13. Edgar M, Dawes C, O’Mullane D (2012) Saliva and Oral Health, Eds. 4th Ed, https://pdfs.semanticscholar.org/e483/571214ba40121071a143f100e2fe9f7fc7d8.pdf. Accessed 14 Dec 2019

  14. Anderson MH, Bratthall D, Einwag RJ et al (1994) Professional Prevention in Dentistry. Williams and Wilkins, Baltimore

    Google Scholar 

  15. Pitt NB (1997) Diagnostic tools and measurements: impact on appropriate care. Community Dent Oral Epidemiol 25:24–35

    Article  Google Scholar 

  16. Bowling A (2005) Mode of questionnaire administration can have serious effects on data quality. J. Public Health (Oxf) 27(3):281–291. https://doi.org/10.1093/pubmed

    Article  Google Scholar 

  17. Tourangeau R, Smith TW (1996) Asking sensitive questions: the impact of data collection mode, question format, and question context. Pub Opin Quart 60:275–304

    Article  Google Scholar 

  18. Presser S, Stinson L (1998) Data collection mode and social desirability bias in self-reported religious attendance. Am Sociol Rev 63:137–145

    Article  Google Scholar 

  19. Ramsay DS, Rothen M, Scott J, Cunha-Cruz J (2015) Tooth wear and the role of salivary measures in general practice patients. Clin Oral Investig 19(1):85–95. https://doi.org/10.1007/s00784-014-1223-4

    Article  PubMed  Google Scholar 

  20. Milosevic A, Dawson LJ (1996) Salivary factors in vomiting bulimics with and without pathological tooth wear. Caries Res 30:361–366

    Article  Google Scholar 

  21. Johansson A, Kiliaridis S, Haraldson T, Omar R, Carlsson GE (1993) Covariation of some factors associated with occlusal tooth wear in a selected high-wear sample. Scand J Dent Res 101:398–406

    PubMed  Google Scholar 

  22. Jarvinen VK, Rytomaa II, Heinonen OP (1991) Risk factors in dental erosion. J Dent Res 70:942–947

    Article  Google Scholar 

  23. Agostini BA, Cericato GO, da Silveira ER, Nascimento GG, Costa FDS, Thomson WM, Demarco FF (2018) How common is dry mouth? Systematic review and meta-regression analysis of prevalence estimates. Braz Dent J 29:606–618

    Article  Google Scholar 

  24. Modéer T, Blomberg CC, Wondimu B, Julihn A, Marcus C (2010) Association between obesity, flow rate of whole saliva, and dental caries in adolescents. Obesity 18:2367–2373. https://doi.org/10.1038/oby.2010.63

    Article  PubMed  Google Scholar 

  25. Stensson M, Wendt LK, Koch G, Oldaeus G, Lingström P, Birkhed D (2010) Caries prevalence, caries-related factors and plaque pH in adolescents with long-term asthma. Caries Res 44:540–546. https://doi.org/10.1159/000321566

    Article  PubMed  Google Scholar 

  26. Frydrych F (2016) Dry mouth: xerostomia and salivary gland hypofunction. J Aust Fam Physician 45(7):488–492

    Google Scholar 

  27. Lussi A, Carvalho TS (2015) Analyses of the erosive effect of dietary substances and medications on deciduous teeth. PLoS One 10(12):e0143957

    Article  Google Scholar 

  28. Jeong MJ, Jeong SJ, Son JH, Chung SK, Kim AR, Kang EJ, Kim EJ, Kim HI, Jang KE, Cho MH, Cheon YJ, Choi HJ, Lim DS (2014) A study on the enamel erosion caused by energy drinks. J Dent Hyg Sci 14:597–609

    Article  Google Scholar 

  29. Shah SA, Szeto AH, Farewell R, Shek A, Fan D, Quach KN, Bhattacharyya M, Elmiari J, Chan W, O'Dell K, Nguyen N, McGaughey TJ, Nasir JM, Kaul S (2019) Impact of high volume energy drink consumption on electrocardiographic and blood pressure parameters: a randomized trial. J Am Heart Assoc 8(11):e011318. https://doi.org/10.1161/JAHA.118.011318

    Article  PubMed  PubMed Central  Google Scholar 

  30. Breda JJ, Whiting SH, Encarnação R, Norberg S, Jones R, Reinap M, Jewell J (2014) Energy drink consumption in Europe: a review of the risks, adverse health effects, and policy options to respond. Front Public Health 14(2):134. https://doi.org/10.3389/fpubh.2014.00134

    Article  Google Scholar 

  31. Berger L, Fendrich M, Fuhrmann D (2013) Alcohol mixed with energy drinks: are there associated negative consequences beyond hazardous drinking in college students? Addict Behav 38:2428–2432. https://doi.org/10.1016/j.addbeh.2013.04.003

    Article  PubMed  PubMed Central  Google Scholar 

  32. Bulut B, Beyhun NE, Topbas M, Can G (2014) Energy drink use in university students and associated factors. J Community Health. 39:1004–1011. https://doi.org/10.1007/s10900-0149849-3

    Article  PubMed  Google Scholar 

  33. West NX, Lussi A, Seong J, Hellwig E (2013) Dentin hypersensitivity: pain mechanisms and aetiology of exposed cervical dentin. Clin Oral Invest 17(Suppl 1):9–19. https://doi.org/10.1007/s00784-012-0887-x

    Article  Google Scholar 

  34. Absi EG, Addy M, Adams D (1992) Dentine hypersensitivity. The effects of toothbrushing and dietary compounds on dentine in vitro: a SEM study. J Oral Rehab 19:101–110

    Article  Google Scholar 

  35. Ganss C (2014) Is erosive tooth wear an oral disease? In: Lussi A, Ganss C (eds) Erosive Tooth Wear, Monographs in Oral Science, vol 25. Karger, Basel, pp 16–21

    Google Scholar 

  36. Peutzfeldt A, Jaeggi T, Lussi A (2014) Restorative therapy of erosive lesions. In: Lussi A, Ganss C (eds) Erosive Tooth Wear, Monographs in Oral Science, vol 25. Karger, Basel, pp 253–261

    Google Scholar 

Download references

Acknowledgments

The authors would like to thank Professor Carolina Ganss for her support and commentary on this research.

Funding

The study was not funded by any institution or company.

Author information

Authors and Affiliations

  1. School of Health Sciences, Walden University, 100 Washington Av. South. Suite 1210, Minneapolis, MN, 55401, USA

    Vasileios Margaritis

  2. Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland

    Viivi Alaraudanjoki, Marja-Liisa Laitala & Vuokko Anttonen

  3. Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland

    Marja-Liisa Laitala & Vuokko Anttonen

  4. Faculty of Dental Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, Romania

    Andreea Bors & Melinda Szekely

  5. School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

    Panagiota Alifragki

  6. Department of Prosthodontics, Faculty of Dentistry, Semmelweis University, Budapest, Hungary

    Máté Jász, Ildikó Berze & Péter Hermann

  7. Oral Health Services Research Centre, Cork University Dental School and Hospital, University College Cork, Cork, Ireland

    Mairead Harding

Authors
  1. Vasileios Margaritis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Viivi Alaraudanjoki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marja-Liisa Laitala
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vuokko Anttonen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andreea Bors
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Melinda Szekely
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Panagiota Alifragki
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Máté Jász
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ildikó Berze
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Péter Hermann
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Mairead Harding
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All 11 authors contributed to the study conception and design. Material preparation and data collection were performed by VM, VA, M-LL, VA, AB, MS, and PA. Formal statistical analysis and report was supervised by VM and PA. The first draft of the manuscript was written by VM and all authors commented on previous versions of the manuscript. All 11 authors read and approved the final manuscript.

Corresponding author

Correspondence to Vasileios Margaritis.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee of each research site (in Finland by the Ethical Committee of the Northern Ostrobothnia Hospital District (11.9.2017, #70/2017 240§); in Romania, by the Research Ethics Committee of the University of Medicine and Pharmacy of Tirgu-Mures (27.09.2017, #312); in the USA/Greece by the Walden University Institution Review Board (#03-01-17-6274274)) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent forms were received from all the participants and parents/guardians when needed and confidentiality of the data was confirmed.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Margaritis, V., Alaraudanjoki, V., Laitala, ML. et al. Multicenter study to develop and validate a risk assessment tool as part of composite scoring system for erosive tooth wear. Clin Oral Invest 25, 2745–2756 (2021). https://doi.org/10.1007/s00784-020-03589-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-020-03589-7

Keywords

Search

Navigation