Tooth Wear Evaluation Research Articles

Reliability of the Assessment of Tooth Wear Severity on Dental Hard Tissues and Dental Restorations, Using the TWES 2.0, by Nonexperts.

Tooth wear is a multifactorial process resulting in the loss of dental hard tissues. For its assessment, the tooth wear evaluation system (TWES) 2.0 has been published. Previous studies on the TWES involved well-trained practitioners, rather than nonexperts. The first aim of this study was to investigate the reliability of the assessment of tooth wear severity on dental hard tissues, using the TWES 2.0, by nonexperts. The second aim was to investigate the reliability of assessment of wear severity on dental restorations, using a third scale. Forty-seven dental students evaluated at least 9 of 14 possible patient cases on dental casts and intraoral photographs. Cohen's kappa (agreement with sample solution) and Fleiss' kappa (Inter-rater reliability) were calculated. The agreements of the operators' ratings compared to the sample-solution resulted in Cohen's kappa between 0.02 and 0.9. The agreements were 0.34 for occlusal; 0.43 for vestibular; 0.57 for oral surfaces. Inter-rater reliability (Fleiss' kappa) was 0.35 for occlusal, 0.17 for vestibular and 0.24 for oral assessment. The inter-rater reliability of the ratings on tooth surfaces with restorations was lower with 0.21 (occlusal), 0.14 (vestibular) and 0.39 (oral). The agreement on different restorations differed tremendously. The ability to correctly assess the cases varied considerably between individual examiners. Within the limits of this study, assessment of restorations was slightly more challenging compared to natural teeth, particularly in occlusal regions or when the restorative material is gold. Subsequent studies should address whether enhanced training and improved definition of tooth wear grades result in higher reliability scores.

Dental Erosive Wear Assessment amongst Different Age Groups Utilising Basic Erosive Wear Examination: An Epidemiological Study

Introduction: The study aims to assess the prevalence of erosive tooth wear and risk levels amongst different age groups utilising Basic Erosive Wear Examination (BEWE) amongst the population of South West Coastal India. Materials and Methods: One hundred and sixty healthy people participated in the research (n = 32 per group). Using sextants and the BEWE, index (0–18) allowed for the evaluation of erosive tooth wear. Questionnaires supplemented clinical data. Each participant was assigned to groups based on the severity of their erosive wear: high (BEWE sum ≥ 14), moderate (BEWE sum 9–13), low (3–8) and none (0–2). Results: There is no significant difference in the degree of erosive tooth wear across different age groups (χ2– 20.11, P – 0.067 [not-significant]). There is a significant difference in response to questions across different age groups (χ2 – 487.21, P – 0.01 [significant]). Conclusion: The prevalence of erosive tooth wear grows as individuals age. Older age groups, patients who are at a higher risk level require a more comprehensive form of treatment. The aetiology of dental erosion remained unknown to the patients, indicating a deficiency in their understanding of erosive tooth wear.

Diagnostic accuracy of clinical signs to detect erosive tooth wear in its early phase.

Agreement exists about most of the clinical features of erosive tooth wear, though no evidence supports their validity in diagnosing the condition. This study aimed to determine the accuracy of clinical signs for diagnosing erosive tooth wear in a young adult general population. We conducted a cross-sectional study of dental students. In the first session, two examiners independently determined the presence of erosive tooth wear based on glazed enamel surfaces, morphological changes on non-occlusal surfaces, flattening of convex areas, or any type of concavity. In the second session, one examiner recorded the presence of clinical signs according to the Tooth Wear Evaluation System. The diagnostic accuracy of each clinical sign, both alone and combined, was assessed by calculating their sensitivity and specificity for detecting erosive tooth wear and performing multivariate logistic regression models. Of the 147 participants (78 women and 69 men; median age, 22 years) we included, 76.2% had erosive tooth wear. The single clinical signs with greatest balance between the sensitivity and specificity were 'convex areas flatten' (63% and 71%, respectively) and 'dull surface' (47% and 89%, respectively). Multivariate logistic regression revealed that 'preservation of the enamel cuff' (odds ratio, 22) and the combination of 'smooth silky shining, silky glazed appearance, and dull surface' (odds ratio, 68) had the best predictive values. The most accurate clinical signs for detecting early erosive tooth wear were dull surface, flattened convex areas and preservation of the enamel cuff.

Tooth Wear Evaluation System 2.0-Evaluation of diagnostic reliability in the assessment of signs and symptoms for tooth wear by non-experts.

Tooth wear is a multifactorial condition that manifests through various signs and symptoms. These individual signs and symptoms were described in multiple studies, leading to the inclusion in TWES 2.0 (Tooth Wear Evaluation System 2.0) and the forthcoming DC-TW (Diagnostic Criteria for Tooth Wear). However, a study evaluating their reliability has yet to be conducted. The aim of the study was to examine the reliability in the assessment of 6 signs of pathological tooth wear and 18 clinical signs and symptoms determining aetiology, all of which are included in the TWES 2.0/DC-TW. 48 dental students (operators) evaluated patient cases from a patient pool of 14 patients on dental casts and high-resolution intraoral photographs. The agreement between all operators for each sign and symptom was calculated based on ICC (Intraclass Correlation Coefficients). Additionally, the agreement of each operator's evaluation with a predefined sample solution was calculated based on Cohen's kappa. Inter-user agreement ranged from near perfect (0.91) to poor (0.02) for the various pathology signs or aetiology symptoms of tooth wear (mean 0.32). The agreements of the operator's ratings compared to the sample solution resulted in Cohen's kappa from 0.18 to 1 (mean 0.59) for the pathology signs and ranged from 0.02 to 0.51 for the aetiology signs (mean 0.38). The reliability of the signs and symptoms examined and the ability of individual investigators to correctly identify and assign signs and symptoms varied widely. The current assessment tools for the qualification of tooth wear need further refinement, and examiners need intensive training in tooth wear assessment.

Total Rehabilitation Using Adhesive Dental Restorations in Patients with Severe Tooth Wear: A 5-Year Retrospective Case Series Study.

Currently, there is little clinical evidence to support the medium- and long-term survival and clinical performance of ultraconservative approaches using adhesive restorations in full-mouth restorations. The aim of this case series study was to evaluate the medium-term clinical performance of anterior and posterior adhesive restorations applied with direct and indirect techniques using resin composites and glass-ceramic-based materials. The inclusion criteria were an esthetic problem as the main reason for consultation and severe generalized wear of grade 2 to 4 according to the Tooth Wear Evaluation System (TWES 2.0). In addition, at each follow-up appointment, patients were required to submit a clinical-parameter-monitoring record according to the modified United States Public Health Service (USPHS) criteria. Eight patients with severe tooth wear were treated through full rehabilitation in a private dental clinic in Spain by a single operator (AFC). A total of 212 restorations were performed, which were distributed as follows: 66 occlusal veneers, 26 palatal veneers and 120 vestibular veneers. No signs of marginal microleakage or postoperative sensitivity were observed in any occlusal, vestibular and/or palatal restoration after the follow-up period. The estimated survival rate of the 212 restorations was 90.1% over 60 months of observation, with a survival time of 57.6 months. Only 21 restorations had complications, which were mostly resolved with a direct composite resin. The dichotomous variables of the restoration type (posterior veneer, anterior veneer) and the type of restored tooth (anterior, posterior) were the risk predictors with statistically significant influences (p < 0.005) on the survival of the restorations. According to the results of this study, there is a significantly higher risk of restorative complications in posterior teeth compared to anterior teeth. Also, it can be concluded that the indication of adhesive anterior and posterior restorations is justified in the total oral rehabilitation of patients with severe multifactorial tooth wear, as they are associated with a low risk of failure.

Prevalence of dental attrition and its relationship with dental erosion and salivary function in young adults.

The aim of this study was to estimate the prevalence of dental attrition in a young adult population and to explore associated factors. Dental students aged 18-40 years old with a minimum of 24 natural teeth were invited to take part in this cross-sectional study. Their demographic information, medical history, perceived stress, frequency of dietary acid intake, and frequency of oral habits were obtained through several questionnaires. Assessment of each type of tooth wear (erosion, attrition, and abrasion) was performed according to Tooth Wear Evaluation System (TWES 1.0). All participants underwent salivary tests. Statistical analysis was performed by chi-squared or Mann-Whitney tests and logistic regression models. In total, 178 participants (88 women and 90 men) with a median age of 22 years were included and of those 74.7% (95% confidence interval [CI] 68%-81%) had dental attrition. Univariate analysis revealed positive associations for male gender, age, body mass index, awake bruxism frequency, and erosive tooth wear with the presence of dental attrition. Multivariable logistic regression (Nagelkerke r2 = 0.31) indicated that dental attrition was associated with erosive tooth wear (adjusted odds ratio [aOR], 6.3; 95% CI, 2.8-14.2), body mass index (aOR, 1.3 [95% CI 1.1-1.5]), and age (aOR, 1.2 [95% CI 1.0 to 1.3]). Dental attrition is present in most young adults of Catalonia. The associated factors were erosive tooth wear, body mass index, and age. Slight alterations of salivary parameters do not seem to predict dental attrition.

Sex-specific reference values for the crown heights of permanent anterior teeth and canines for assessing tooth wear

Objective We propose sex-specific reference values for the clinical crown height of anterior teeth and canines. Material and methods In this cross-sectional study, 1426 teeth were analysed from 169 undergraduate and postgraduate dental students (83 women and 86 men, median age 22 years). Teeth with worn or totally restored incisal edges, or gingival inflammation were excluded. Age, gender and body height were recorded and the degree of tooth wear was scored according to the quantification module of the Tooth Wear Evaluation System. The clinical crown heights of all anterior teeth and canines were measured from the gingival margin to the incisal edge with a digital calliper. Reference values for tooth groups were obtained at the percentiles 10, and expressed by sex if there was a significant difference between men and women. Results Mean crown heights were bigger in men than in women for each tooth group (p = .028). Clinical crown heights showed sexual dimorphism at the 10th percentiles for all tooth groups except for mandibular anterior teeth. Conclusions For assessing tooth wear, the sex-specific reference values for the clinical crown height of young adults Caucasoids range from 7.5 mm to 9.0 mm in women and from 7.5 mm to 9.5 in men.

Evaluation of Tooth Wear and its Causative Risk Factors Amongst Patients Attending Dental Hospital of Karachi

OBJECTIVE: Tooth wear is a term defined as the loss of dental hard tissue in a damaged tooth if there is no existing dental caries or trauma. Tooth wear rarely exists alone and is observed clinically and experimentally in combination. Excessive tooth wear leads to hypersensitivity and exposed dentin. Tooth wear can be classified as attrition, erosion, abrasion. The frequency of normal tooth preservation is greater than ever, thus a better prevalence of tooth wear is experiential in the population. Therefore, the objective of the present cross-sectional study was to evaluate tooth wear and its causative risk factors amongst patients attending the Dental Hospital of Karachi. METHODOLOGY: The current study was a cross-sectional study conducted on adult patients recruited from the Out-Patient Department of Oral Diagnosis from May 2018 - December 2018. A consecutive sampling method was used and 250 adult patients aged 18-45 years were included. Tooth wear was assessed by using Smith and Knight Tooth Wear Index (TWI index).Data was entered and analyzed by using SPSS, frequency, percentages were calculated, and a chi-square test was performed to find the association between gender and risk factors. RESULTS: The subject populations of 250 were assessed. Out of which 178 were male (71.2%) and 72 (28.8%) were female with age ranging between 18 to 48 years old. In this study, 92.4% of them were suffering from tooth wear and only 31.2% have extended to the severe stage of the tooth surface loss. CONCLUSION: The present study concluded that there is an association between tooth wear and its risk factors. KEYWORDS: Tooth Wear; Dental Wear; Tooth Wear Indices; Sensitivity and Specificity; Risk Factors.

Tooth Wear Evaluation System (TWES) 2.0-Reliability of diagnosis with and without computer-assisted evaluation.

Tooth wear is a multifactorial process, leading to the loss of dental hard tissues. Therefore, it is important to detect the level of tooth wear at an early stage, so monitoring can be initiated. The Tooth Wear Evaluation System (TWES) enables such a multistage diagnosis of tooth wear. The further developed TWES 2.0 contains a complete taxonomy of tooth wear, but its reliability has not yet been validated. The aim of the study was to examine in a randomised controlled trial (RCT) whether diagnoses made based on the TWES 2.0 are reproducible and whether this reproducibility is also achieved with computer-assisted diagnostics. 44 dental students received extensive training in TWES 2.0 assessment and taxonomy. The students each evaluated at least 10 (of the present 14) anonymised patient cases using gypsum models and high-resolution intra-oral photographs according to TWES 2.0. One half initially evaluated on paper; the other half used dedicated software (CMDfact / CMDbrux). After half of the patient cases (5), the evaluation methods were switched (AB/BA crossover design). The diagnoses were then evaluated for agreement with the predefined sample solution. Evaluation of agreement with the sample solution according to Cohen's kappa indicated a value of 0.46 for manual (traditional) evaluation; and 0.44 for computer-assisted evaluation. Evaluation of agreement between examiners was 0.38 for manual and 0.48 for computer-assisted evaluation (Fleiss' kappa). The results of this study proved that the taxonomy of the TWES 2.0has acceptable reliability and can thus be used by dentists. Accordingly, the system can be learned quickly even by untrained practitioners. Comparable results are achieved with computer-assisted evaluation.

Estimation of Age by Evaluating the Occlusal Tooth Wear in Molars: A Study on Dakshina Kannada Population.

PurposeAssessment of teeth to estimate age in the living as well as the dead is well documented in the literature. Though applied in conjunction with other parameters in Gustafson’s technique, attrition of teeth solely is an underexplored indicator for age estimation mainly in India. Most of the studies using attrition of teeth have been conducted in bioarchaeology, and in populations where studies are being conducted in forensic contexts, the results are debatable. Thus, the present study aimed to evaluate the accuracy of age estimation using the Average Stage of Attrition (ASA) method by Li and Ji in adults of the Dakshina Kannada region.Materials and MethodsThis cross-sectional study assessed the degree of attrition in both maxillary and mandibular first and second molars of 136 adults of Dakshina Kannada origin (age range: 20–70 years) according to the 10 stages given by Li and Ji to derive population-specific linear regression equations.ResultsUnivariate analysis of prediction of age with attrition showed a significant association of attrition score with age, stratified by sex, arch as well as in total (p-value <0.001) with a standard error of estimate of 9.231 years. The estimated age was within ±5 years of the actual age in 44.2% of the females and 50.0% of the males. A comparative review of 23 studies done to estimate age from attrition score clinically is documented in the manuscript.ConclusionThe findings of this study suggest that evaluation of tooth wear by the Average Stage of Attrition (ASA) method can be used as a non-invasive means to aid in the determination of age in adults of Dakshina Kannada origin. Although the error increases with age, this method provides a measurable means of seriation into older and younger categories.

The effect of pre-treatment levels of tooth wear and the applied increase in the vertical dimension of occlusion (VDO) on the survival of direct resin composite restorations.

ObjectivesTo investigate the effects of the level of pre-treatment tooth wear and increasing the VDO on the performance of direct resin composite restorations for the rehabilitation of pathological tooth wear. MethodsFull-mouth (pre-treatment) grading was performed on digital greyscale scan records for 34 participants (35.3 ± 8.4 years) with signs of moderate-to-severe generalised tooth wear, using the Tooth Wear Evaluation System and the Basic Erosive Wear Examination. Each participant received full-mouth direct resin composite restorations, with increased VDO. The post-treatment increase in the VDO was determined. Recalls were planned after 1 month, and after 1, 3, and 5 years. Three ‘levels’ of restoration failure were described. The effects of the variables on the frequencies of restoration failure were calculated with a multivariable Cox regression, (p < 0.05). Results1269 restorations were placed with a mean observation period of 62.4 months. Increasing the VDO by 1 mm significantly reduced the risks of all levels of anterior restoration failure (HR ≤ 0.62, p ≤ 0.025). A higher anterior BEWE surface score was associated with increased risks of Level 2- & 3- failures, (HR ≥ 1.29, p ≤ 0.019). Premolar restorations showed lower risks of Level 2- & 3- failure, compared to the molar restorations, (HR ≤ 0.5, p ≤ 0.005). ConclusionLevels of pre-treatment wear and the applied change in the VDO significantly affected failure risk. Clinical relevanceDirect resin composite restorations for the rehabilitation of wear should be made as voluminous as possible, respecting the presenting biological, functional, and esthetic constraints.

Reliability of qualitative occlusal tooth wear evaluation using an intraoral scanner: A pilot study.

Dental wear analysis through the use of an intraoral scanner is a reality of modern dentistry. This study aimed to investigate the reliability of qualitative tooth wear evaluation through three-dimensional images captured with an intraoral scanner and compared to clinical and photographic examinations. Eighteen adult volunteers of both genders (18 to 55 years old) were submitted to clinical exams, intraoral photographs and intraoral scanning protocol using an optical scanner (TRIOS® Pod, 3Shape, Copenhagen, Denmark). Occlusal tooth wear, from second to second premolars, was measured by two evaluators and reevaluated after 30 days, according to a slight modification of the method described by Mockers et al. Weighted Kappa was used to measure intra and inter-examiner agreement. The Friedman test was used to verify the differences among methods. Random and systematic errors were assessed using Bland-Altman plots. All statistical analysis was performed with p<0.05. There was a substantive agreement for clinical (K = 0.75) and photographic exams (K = 0.79) and a moderate agreement for intraoral scanner analysis (K = 0.60) for inter-examiner evaluation. A substantial intra-examiner agreement was obtained for both evaluators. No significant difference between the methods was observed (p = 0.7343 for examiner 1 and 0.8007 for examiner 2). The Bland-Altman plot confirmed no systematic errors between the methods and a random error of 0.25 with the scanner method when compared to clinical assessment. All three methods showed reliability in qualitative occlusal tooth wear evaluation. Intraoral scanning seems to be a sound and reliable tool to evaluate tooth wear when compared to traditional methods, considering the lower inter-examiner agreement and the inherent limitations of this pilot study. Further research will be necessary in order to achieve more robust evidence.

A comparative evaluation between the reliability of gypsum casts and digital greyscale intra-oral scans for the scoring of tooth wear using the Tooth Wear Evaluation System (TWES).

BackgroundThe Tooth Wear Evaluation System (TWES) is a type of tooth wear index. To date, there is the lack of data comparing the reliability of the application of this index on gypsum cast records and digital greyscale intra‐oral scan records.ObjectivesA comparative evaluation between the use of gypsum cast records and digital greyscale intra‐oral scan records with the reliability of tooth wear scoring using the TWES amongst a group of patients with tooth wear.MethodsRecords for 10 patients with moderate to severe tooth wear (TWES ≥ 2) were randomly selected from a larger clinical trial. TWES grading of the occlusal/incisal, buccal and palatal/lingual surfaces was performed to determine the levels of intra‐ and interobserver agreement. Intra‐observer reproducibility was based on the findings of one examiner only. For the interobserver reproducibility, the findings of two examiners were considered. One set of models/ records were used per patient. Cohen's weighted kappa (κW) was used to ascertain agreement between and within the observers. Comparison of agreement was performed using t tests (P < .05).ResultsFor the scoring of the of the total occlusal/incisal surfaces, the overall levels of intra‐ and interobserver agreement were significantly higher using the gypsum cast records than with the digital greyscale intra‐oral scan records, (P < .001) and (P < .001), respectively. For the overall buccal surfaces, only a significant difference was found in the intra‐observer agreement using gypsum casts, (P = .013). For the palatal/lingual surfaces, a significant difference was only reported in the interobserver agreement using gypsum casts, (P = .043). At the occlusal/incisal surfaces, grading performed using gypsum casts, culminated in significantly higher TWES scores than with the use of the digital greyscale intra‐oral scans (P < .001). At the buccal and palatal/lingual surfaces, significantly higher wear scores were obtained using digital greyscale intra‐oral scan records (P < .009).ConclusionsThe TWES can offer a reliable means for the scoring of wearing occlusal/incisal surfaces using gypsum casts. The reliability offered by digital greyscale intra‐oral scans for consecutive scoring was in general, inferior.

Clinical Quantitative Evaluation of Tooth Wear: A 4-year Longitudinal Study.

This study investigated the progression of incisal tooth wear clinically for 4-years, using various diagnostic methods. Effectiveness of occlusal splints (night guards) for patients with nocturnal bruxism was also evaluated. Forty maxillary incisors from 10 patients with nocturnal bruxism were selected. Group 1 (n=5) wore occlusal splints for 6 months, whereas group 2 (n=5) didn't. Ultrasound, cast-model analysis (control), digital radiography, FluoreCam and colorimeter were used for measurements. Clinical progression of incisal wear monitored at baseline, 3, 6, 12, 24 and 48 months, respectively. Ultrasound, cast-model analysis and FluoreCam readings gradually and statistically significantly decreased during the overall evaluation period for both groups (p<0.001). Regarding colorimeter, statistically significant differences in periodical measurements were observed from 24 months and 12 months, for group 1 and group 2, respectively (p<0.001). There were no statistically significant differences in readings at evaluation periods, between the groups, for ultrasound, digital radiography and cast-model analysis (p≥0.05); however, statistically significant differences were observed for colorimeter at 24 months (p=0.010) and 48 months (p<0.001), and for FluoreCam at 12, 24, 48 months (p<0.001). Annual decrease in mean crown length was determined as 20-30 µm for group 1 and 40-50 µm for group 2. The decreases in mean crown length were statistically significantly lower for group 1 compared to group 2, regarding the assessments for 1 year, 2 years and 4 years (p<0.001). Positive and good correlations were observed between ultrasound, cast-model analysis and FluoreCam measurements (p<0.001). Ultrasound, FluoreCam and colorimeter showed promising results for monitoring any change and progression of incisal tooth wear clinically. Ultrasound might be considered as a quantitative, reliable and repeatable method. Precision of the measurements varied among the diagnostic methods used. Occlusal splints may have a potential preventive effect for progressive tooth wear.

Prevalence and severity of tooth wear and risk factors among young adults in Southern Brazil

Introduction: In studies on the prevalence of tooth wear, few publications related to young adults are found. Objectives: To explore the associations of behavioral, medical, and socio-demographic variables with prevalence and severity of tooth wear of the whole dentition, in a sample of young adults, using a modified version of the Tooth Wear Index (TWI). Methods: Sample consisted of 116 university dental students with an average age of 23 years, who answered a questionnaire related to sociodemographic variables, self-perception and health behaviors. In addition, individuals underwent a clinical evaluation of tooth wear by one trained examiner using the TWI modified by Smith and Knight. Logistic regression was carried out at individual level. Results: A total of 9,906 dental surfaces in 116 individuals were examined, 72.27 % dental surfaces had no tooth wear (grade 0), but all individuals had at least one worn surface. Among the individuals, 78,4 % had grade 1 (enamel) as the highest level and 21.6% grade 2 (dentin) as the highest level. The presence of grade 2 tooth wear was mainly prevalent in the following individuals: male; smoker; with bruxism, and among those who reported having undergone orthodontic treatment. Analyzing the relevant factors that affect tooth wear by multiple regression analysis, it was found that smoking (OR 6.67; IC 1.73- 25.76) and bruxism (grinding) (OR 4.05; IC 1.29- 12.7) had the greatest effect on tooth wear. Conclusions: Our results suggest that being male, being a current smoker, having grinding bruxism and having previous orthodontic treatment are associated with tooth wear.

Diagnosing tooth wear, a new taxonomy based on the revised version of the Tooth Wear Evaluation System (TWES 2.0).

BackgroundTooth wear is a multifactorial condition, leading to the loss of dental hard tissues. Physiological tooth wear is a slow process that normally does not lead to any subjective symptoms. When the condition progresses, it can become pathological, and several signs and symptoms may occur. The Tooth Wear Evaluation System (TWES) was described to implement a systematic diagnostic and management approach. Recently, management guidelines were presented in a European Consensus Statement (ECS) as well.ObjectivesTo evaluate the TWES in practice and to integrate the principles described in the ECS in order to compose a renewed TWES 2.0 and a new taxonomy.MethodsThe TWES and the recommendations of the ECS were used by dental clinicians, in order to test its applicability in practice.ResultsAgreement was reached that the TWES 2.0 will use a stepwise approach, with a straightforward Tooth Wear Screening part and a more detailed Tooth Wear Status part. Also, the assessment of pathology from the ECS is incorporated in the TWES 2.0 (both classification and taxonomy).ConclusionsIn the TWES 2.0 is described that tooth wear is pathological if moderate/severe/extreme tooth wear is present, in combination with one or several described signs and symptoms. Aetiology can be assessed by findings that indicate a chemical and/or a mechanical cause. The taxonomy may help to identify situations in which preventive (restorative) interventions in early stages of tooth wear can be indicated. The reliability and validity of the adapted parts must be proven.

Probable Sleep Bruxism in Children and its Relationship with Harmful Oral Habits, Type of Crossbite and Oral Breathing.

Objective: To establish the prevalence of Probable Sleep Bruxism (PSB) and its association with gender, breast or bottle-feeding, posterior and anterior crossbite, oral habits and oral breathing. Study Design: Consists of a cross-sectional study in which 151 children were submitted to a clinical oral examination for the evaluation of tooth wear, muscle discomfort and the presence of anterior and/or posterior crossbite. Parents/caregivers were asked about the frequency of teeth grinding during the child's sleep and the occurrence of harmful oral habits, as well as the type of childbirth and breastfeeding. Data were statistically analyzed through Chi-square or Fisher's exact tests at a 5% level of significance to determine an association among variables. Results: The prevalence of PSB was of 27.8% among the examined children. Among the analyzed variables, only oral breathing was statistically associated to PSB (p < 0.001), and it was verified that children with oral breathing are 2.71 times more likely to present sleep bruxism. Conclusions: The prevalence of PSB in schoolchildren was high and the disorder was associated with oral breathing. Thus, pediatric dentists have an important role in the diagnosis of sleep bruxism and in monitoring breathing-related disorders.

Speech changes in patients with a full rehabilitation for severe tooth wear, a first evaluation study

ObjectiveThe aim of this study was to evaluate changes in speech characteristics and self-perceived quality of speech in tooth wear patients, after occlusal rehabilitation.Materials and methodsPatients with tooth wear were included in this study after informed consent. The amount of tooth wear was scored with Tooth Wear Evaluation System (TWES). To assess the perspective of the patient, the Dutch Speech Handicap Index was used (SHI). Acoustic analysis was performed to evaluate changes with the use of voice recordings. These were made before treatment, T0; directly after treatment, T1; 1 month after treatment, T2. With the use of PRAAT software, the spectral characteristic centre of gravity (COG) was evaluated for the sounds /s/, /f/, /v/, /d/, /t/, /m/.ResultsRecordings of 17 patients (14 men, 3 women, mean age 41.2 ± 10.4 years) were included. SHI scores did not change significantly between T0 and T2 (p = 0.054). A multiple regression model showed that for all sounds the intercept was negative, but statistically significant only for /s/ and /f/ between T0 and T1. The effect of the initial change (between T0 and T1) on the change between T1 and T2 was clearly negative for all sounds (p < 0.001), showing a rebound effect ranging between 29 and 68% of the initial change.ConclusionTooth wear patients perceive improvement in speech function after treatment.Clinical significanceClinicians may explain to patients that speech is likely to alter for a short period due to treatment but that there will be a good adaption to the new situation.

A methodology for evaluating tooth wear monitoring using timed automata modelling.

ObjectivesTooth wear is a multifactorial condition leading to the loss of dental hard tissues. A counselling/monitoring protocol is of importance in order to keep that loss as limited as possible. Since many factors are involved and a time span of decades is included, research to disentangle all these processes in patients is difficult. Instead, a modelling technique was used that is able to deal with time, costs and probabilistic and stochastic information. The aim was to shed light on the question: does a yearly or a once‐in‐five‐years counselling/monitoring protocol yield better outcome measures?MethodsA so‐called timed automata model was adopted, analysed with the tool UPPAAL. To our knowledge, this is the first time that formal modelling is applied in dentistry. In this article, a UPPAAL model for the evaluation of tooth wear is described.ResultsUsing the UPPAAL model, it was calculated that with a yearly counselling/monitoring protocol the severity of tooth wear at age 74, the total costs per person and the number of restorative treatments were less, and the number of so‐called “good years” was higher.ConclusionsWith the use of the UPPAAL model, it may be concluded that a yearly counselling/monitoring protocol can yield better outcome measures.Clinical SignificanceRegarding dentistry in general and tooth wear in particular, with the use of a timed automata model in UPPAAL, actual research questions can be answered, factors of influence in a multifactorial condition like tooth wear can be clarified, and future research topics can be determined.

Evaluation of tooth wear by estimating enamel thickness with quantitative light-induced fluorescence technology.

Various techniques have been suggested to quantitatively assess tooth wear; most have limited clinical application. The first aim of this in vitro study was to estimate the residual enamel thickness of teeth with various degrees of occlusal wear using quantitative light-induced fluorescence (QLF). The second aim was to identify relationships between the fluorescence parameters of QLF and the conventional tooth wear index (TWI) system. Sixty-nine extracted permanent premolars and molars with initial stages of tooth wear (TWI score 1a-2: enamel wear to dentin exposure) were used. Two blinded and trained examiners participated in evaluation procedures. Occlusal QLF-digital (QLF-D) images were acquired for selecting area of interest (AOI) and calculating fluorescence for occlusal tooth wear (ΔFwear) of the AOI by the first examiner. Each specimen was cross-sectioned in the buccal-lingual direction. Enamel thickness from images obtained by stereomicroscopy and TWI of each sample was determined by the second examiner. Spearman correlation was used to determine the relationship of ΔFwear with enamel thickness and TWI. ΔFwear values were compared between histological scores with the Mann-Whitney U test. Seventy-six AOIs were analyzed. As enamel thickness decreased, ΔFwear values significantly increased and strongly correlated with enamel thickness (Spearman rho = -0.825, P < 0.001). There were significant differences in ΔFwear values among TWI scores (P < 0.001); ΔFwear strongly correlated with TWI (Spearman rho = 0.753, P < 0.001). ΔFwear values, which denote fluorescence difference by using QLF, showed a strong correlation with residual enamel thickness and tooth wear severity.