Prevalence of erosive tooth wear and associated risk factors in Colombian adolescents

AVILA, Viviana; BETLRÁN, Edgar Orlando; CORTÉS, Andrea; USUGA-VACCA, Margarita; CASTELLANOS PARRAS, Jaime Eduardo; DIAZ-BAEZ, David; MARTIGNON, Stefania

doi:10.1590/1807-3107bor-2024.vol38.0050

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Original Research/Pediatric Dentistry • Braz. oral. res. 38 • 2024 • https://doi.org/10.1590/1807-3107bor-2024.vol38.0050 copy

Prevalence of erosive tooth wear and associated risk factors in Colombian adolescents

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Accurate determination of the prevalence of erosive tooth wear (ETW) and associated risk factors in adolescents can inform clinical management guidelines. The aim of this analytical cross-sectional study was to estimate the prevalence, severity, and risk factors of ETW in adolescents aged 12–15 years in the municipality of Usaquén in Bogotá, Colombia. Two calibrated examiners clinically assessed ETW using Basic Erosive Wear Examination (BEWE) Index (range: 0–3). All tooth surfaces (excluding proximal) were scored to allow estimation of the Highest (0–3) and Total BEWE (sum of Highest BEWE score per sextant: 0–18) scores per patient. Sociodemographic characteristics, ETW risk factors, and caries severity (ICDAS-epi-merged) were evaluated, and their association with the presence of ETW (indicated by a Highest BEWE score of 2–3) was examined using preliminary analyses and logistic regression models. The study sample included 454 adolescents (mean age: 13.5±1.1 years; female: 61.7%), and the prevalence of ETW was 71.6%. The majority of participants exhibited a Highest BEWE score of 3 (58.0%) and a Total BEWE score ≤8 (84.3%). The preliminary analysis showed an association between the presence of ETW and age, caries, and brushing teeth before eating (p-value < 0.05). Risk factors for ETW included always brushing teeth before eating [adjusted Prevalence Ratio (PRa) 1.31, p-value=0.014], presence of extensive carious lesions (PRa 1.23, p-value = 0.024), male gender (PRa 1.14, p-value = 0.028), and age > 14 years (PRa 1.17, p-value = 0.009). Although ETW was highly prevalent, most Colombian adolescents exhibited low Total BEWE scores. ETW was associated with frequent fruit intake, age, toothbrushing habits, caries lesions, and sex.

Tooth Erosion; Tooth Wear; Adolescent; Prevalence; Risk Factors

Variable	Categories	Absence of ETW		ETW		p-value

		n	%	n	%
General and oral health status
Presence of heartburn	No	121	93.8	314	96.6	0.176
Presence of heartburn	Yes	8	6.2	11	3.4	0.176
Presence of vomiting	No	127	98.4	318	97.8	0.677
Presence of vomiting	Yes	2	1.6	7	2.2	0.677
Presence of regurgitation or return of food/liquids to the mouth	No	125	96.9	306	94.2	0.229
	Yes	4	3.1	19	5.8	0.229
Presence of bruxism, grinding, or clenching of teeth	No	122	94.6	295	90.8	0.181
Presence of bruxism, grinding, or clenching of teeth	Yes	7	5.4	30	9.2	0.181
Dry mouth or decreased salivary flow in the mouth	No	112	86.8	295	90.8	0.213
Dry mouth or decreased salivary flow in the mouth	Yes	17	13.2	30	9.2	0.213
Dietary habits
Frequency of consumption of whole fruit/glasses of natural fruit juice per day	≤1 time per day	42	32.6	111	34.2	0.147
	2 times per day	71	55.0	192	59.1
	≥3 times per day	16	12.4	22	6.8
Total time (in minutes) spent per day eating fruits/drinking natural juices	1–10 minutes	52	40.3	158	48.6	0.259
	11–30 minutes	67	51.9	148	45.5
	>30 minutes	10	7.8	19	5.8
Frequency of chewing sour jellybeans/gum or sour candy	≤1 time per day	74	57.4	167	51.4	0.243
	2times per day	38	29.5	94	28.9
	≥3 times per day	17	13.2	64	19.7
Frequency of consumption of milk, yoghurt, cheese, or other dairy products	≤times per day	47	36.4	109	33.5	0.161
	2times per day	50	38.8	153	47.1
	≥3 times per day	32	24.8	63	19.4
Frequency of consumption of acidic products such as lime/lemon with meals.	≤1 time per day	116	89.9	282	86.8	0.367
	2times per day	9	7.0	22	6.8
	≥3 times per day	4	3.1	21	6.5
Frequency of consumption of fruits with erosive potential
Strawberry	≤1 time per day	114	88.4	297	91.4	0.599
	2 times per day	8	6.2	14	4.3
	≥3 times per day	7	5.4	14	4.3
Lime	≤1 time per day	109	84.5	282	86.8	0.149
	2 times per day	15	11.6	22	6.8
	≥3 times per day	5	3.9	21	6.5
Lulo fruit	≤1 time per day	118	91.5	302	92.9	0.591
	2 times per day	5	3.9	14	4.3
	≥3 times per day	6	4.7	9	2.8
Tangerine	≤1 time per day	110	85.3	293	90.2	0.298
	2 times per day	13	10.1	20	6.2
	≥3 times per day	6	4.7	12	3.7
Green mango	≤1 time per day	122	94.6	303	93.2	0.141
	2 times per day	3	2.3	18	5.5
	≥3 times per day	4	3.1	4	1.2
Green apple	≤1 time per day	116	89.9	301	92.6	0.590
	2 times per day	9	7.0	18	5.5
	≥3 times per day	4	3.1	6	1.8
Passion fruit	≤1 time per day	124	96.1	319	98.2	0.418
	2 times per day	3	2.3	3	0.9
	≥3 times per day	2	1.6	3	0.9
Blackberry	≤1 time per day	123	95.3	309	95.1	0.977
	2 times per day	4	3.1	10	3.1
	≥3 times per day	2	1.6	6	1.8
Orange	≤1 time per day	114	88.4	298	91.7	0.384
	2 times per day	12	9.3	24	7.4
	≥3 times per day	3	2.3	3	0.9
Pineapple	≤1 time per day	121	93.8	316	97.2	0.118
	2 times per day	7	5.4	6	1.8
	≥3 times per day	1	0.8	3	0.9
Oral care habits
Time elapsed since last dental appointment	≤1 year	99	76.7	224	68.9	0.097
Time elapsed since last dental appointment	>1 year	30	23.3	101	31.1	0.097
Toothbrushing frequency	<2 times per day	20	15.5	47	14.5	0.244
	=2 times per day	75	58.1	166	51.1
	>2 times per day	34	26.4	112	34.5
Toothbrushing before going to sleep	No	36	29.5	77	23.7	0.203
Toothbrushing before going to sleep	Yes	91	70.5	248	76.3	0.203
Toothbrushing before eating	Never or rarely	121	93.8	276	84.9	0.028*
	Frequently	5	3.9	22	6.8
	Always	3	2.3	27	8.3

Variable	Absence of ETW		Presence of ETW		p-value

	n	%	n	%
Sex
Male	41	31.8	133	40.9	0.071
Female	88	68.2	192	59.1	0.071
Age (years)
12–13	96	74.4	202	62.2	0.013*
14–15	33	25.6	123	37.8	0.013*
Type of school
Private	94	72.9	218	67.1	0.230
State funded	35	27.1	107	32.9	0.230
Body mass index
Risk of low weight	17	13.2	47	17.5	0.594
Appropriate weight	101	78.3	249	76.6
Overweight or obese	11	8.6	19	5.8
Socio-economic strata
Low	19	14.7	63	19.4	0.325
Middle	83	64.3	220	67.7
High	9	7.0	9	2.7
No information	18	14.0	33	10.2
Presence of ICDAS Initial caries lesions
No	21	16.3	63	19.4	0.442
Yes	108	83.7	262	80.6	0.442
Presence of ICDAS Moderate caries lesions
No	93	72.1	220	67.7	0.361
Yes	36	27.9	105	32.3	0.361
Presence of ICDAS Extensive caries lesions
No	123	95.3	286	88.0	0.018*
Yes	6	4.7	39	12.0	0.018*

Variable	PRa [95%CI]	p-value
Age (years)
12–13 years	1	0.009*
14 to 15 years	1.17 [1.04–1.33]	0.009*
Toothbrushing before eating
Never or hardly ever	1	0.168
Frequently	1.18 [0.93–1.49]	0.168
Always	1.31 [1.05–1.63]	0.014*
Presence of ICDAS Extensive carious lesions
No	1	0.024*
Yes	1.23 [1.02–1.48]	0.024*
Sex
Female	1	0.028*
Male	1.14 [1.01–1.28]	0.028*
Time elapsed since last dental appointment (year)
≤ 1	1	0.877*
> 1	1.01 [0.88–1.15]	0.877*

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[1] Corresponding Author: Stefania Martignon E-mail: martignonstefania@unbosque.edu.co