Tooth erosion was described as a condition distinct from caries as early as the 18th Century.16 However, the first in-depth surveys into the condition, particularly in children and adolescents, did not emerge until the 1990's.
Britain's 10-yearly surveys of children's oral health first provided prevalence data on non-carious tooth surface loss in 1993,3 with the second UK-wide survey in 2003.3 This found that, with the exception of buccal tooth surface loss in eight year olds, there had been an increase in the proportion of children with TSL in all age groups in the decade since 1993.
Specifically, the survey found that in five year olds, over half (53%) were affected with palatal TSL, while 22% of children had TSL in dentin or pulp on palatal incisal surfaces. TSL was less common and less severe on permanent incisors, compared to primary dentition, but the data demonstrated that incidence increases as the child ages. At age eight, TSL was found on 14% of palatal surfaces increasing to 33% at age 15.3
Research from other countries indicates the UK is not alone. Studies from elsewhere in Europe17 reflect a similar prevalence. The differences in the composition of primary and permanent enamel explain the high rates recorded in pre-school children.18
It is not just age that is a factor in erosion, gender, socio-economic status and ethnic and cultural differences have also been investigated:
While data from the US are limited, a recent Texas/Indiana/California multi-centre study, puts prevalence at about 30 per cent, which suggest dental professionals should be mindful of future studies.11 Other recent data also shows prevalence in North America can vary:
In summary, it is important to remember that dental erosion is something that affects all sectors of society, but its detection and prevalence may vary. Incidence will be apparent as the patient cohort gets older, but as soon as the tooth breaks through the gum, it is at risk of acid erosion.
Tooth erosion indices
When it comes to considering tooth erosion indices, there is inconsistency with the indices used and the teeth examined in different studies. This makes determining true prevalence of tooth erosion difficult.
Current indices are research and not practice-based, and focus on late stage tooth wear into dentin. Recently two new indices have sought to address this. Both were first presented at the International Association of Dental Research in Toronto in 2008. The first, developed by Professor David Bartlett of the King's College Dental Institute, London, is a full scoring system that specifically looks at toothwear in enamel as well as in dentin.
The second was developed by Professor Adrian Lussi at the University of Bern. It is a practitioner based partial mouth scoring system - Basic Erosive Wear Examination (BEWE) - enables practitioners to help with identification, monitoring and prevention as well as eventual treatment of tooth wear.
Both these indices will help build understanding of erosion and its impact.26
