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The prevalence of tooth wear in children Critical Summary Prepared by: Priyanshi Ritwik BDS, MS; Alika Yu DDS 

OVERVIEW

  • Systematic Review Conclusion:

    From the majority of included studies, prevalence of tooth wear ranges from 10 to 30 percent in primary teeth and increassd with age but for children up to 18 years old, wear into dentin of permanent teeth was considerably less frequent, with a prevalence of less than 10 percent.

  • Critical Summary Assessment:

    A systematic review summarizing 29 clinical studies that assessed tooth wear in children of ages between 1.5 to18 years indicates that a significant relationship exists between age and tooth wear in the deciduous dentition, but wear into dentin of permanent teeth of children up to 18 years old is less prevalent and does not exhibit this relationship with age.

  • Evidence Quality Rating:

    Poor

A Critical Summary of:

Systematic review of the prevalence of tooth wear in children and adolescents

Kreulen CM, Van 't Spijker A, Rodriguez JM, Bronkhorst EM, Creugers NH, Bartlett DW, Creugers NHJ. Caries Research. 2010;44(2):151-9

  • Clinical Questions:

    What is the prevalence of tooth wear in children and adolescents?

  • Review Methods:

    The authors searched one database for published articles between 1980 to 2008 using four search strategies. They included studies which reported on tooth wear in children up to 18 years old without distinguishing for the etiology of wear, such as erosion, abrasion and attrition. The search was limited to papers in English. Inter-observer agreement was established. Tooth wear data from included studies were converted into prevalence numbers of dentin exposure.

  • Main Results:

    The authors identified a total of 2230 records, from which they selected 29 studies. The age of children in the studies ranged from 1.5-18 years, with equal distribution between the two genders. There was a wide variation in the tooth wear indices used in the included studies. Prevalence of tooth wear into dentin in deciduous teeth ranged from 0 to 82 percent, and it ranged from 0 to 54 percent in permanent teeth. Meta regression analysis performed to study the relationship between tooth wear and age showed a linear increase in tooth wear into dentin of deciduous teeth with increasing age; however, this relationship was not established for permanent teeth. The included studies reported conflicting information on the relationship of tooth wear and gender, socioeconomic status and water fluoridation status. Data on diet in the included studies was obscure to study a relationship between tooth wear and diet.

  • Conclusion:

    The results of this systematic review indicate that there was a difference in the prevalence of tooth wear in primary and permanent teeth of children. Wear into dentin of primary teeth was reported to range from 10-30 percent in 11 of 19 included studies. Wear into dentin of permanent teeth was reported to be less than 10 percent in 25 of 29 studies.

  • Source of funding:

    None stated

Commentary:

  • Importance and Context:

    An increasing number of studies report prevalence of tooth wear in children. It is important to review the prevalence of and contributing factors to tooth wear in children and adolescents because of the cumulative nature of tooth wear over an individual’s lifetime and to understand whether contemporary diet and habits contribute to tooth wear in children. This review also examines the wide variety of tooth wear scores used in literature, which interferes in consolidating data from reported studies. It also provides an estimate about the magnitude of the problem by estimating the prevalence of wear in deciduous and permanent teeth.

  • Strengths and Weaknesses of the Systematic Review:

    the authors used acceptable methods to identify the included studies. Their search was limited. They included studies reporting on tooth structure loss in deciduous and permanent dentition, however they did not discriminate between the cause of tooth substance loss or clinical grading criteria used to quantify the amount of tooth loss. Inter-examiner reliability was established as being satisfactory. The authors used clearly stated inclusion and exclusion criteria. they performed quality assessment of the included studies. Also, the authors used adequate statistical methods to analyze and synthesize the collected data.

  • Strengths and Weaknesses of the Evidence:

    The authors tried to incorporate the age of the subjects from each study when analyzing the prevalence of wear in deciduous and permanent dentition. Even without using the author’s results from a meta-regression, a substantial difference in wear between the two groups was obvious. According to the author’s graphs, 58 percent of studies on deciduous teeth reported a wear prevalence above 10 percent, whereas only 14 percent of the studies on permanent teeth reported a wear prevalence above 10 percent. This comparison shows the difference of wear in the primary and permanent dentition. Substantial wear in the primary dentition is frequently observed, whereas it is rare in the permanent dentition. This finding is supported by a previous study by the same authors. They showed that prevalence of wear in permanent teeth increases from 3 percent at age 20 years to 17 percent at age 70 years.1 This implies that the process of wear in permanent teeth, although cumulative, is relatively slow.

  • Implications for Dental Practice:

    This systematic review provides clinicians with an estimate of how frequently tooth wear is observed in children and adolescents. Wear into dentin of primary teeth is a frequent (normal) phenomenon; on the other hand, wear into dentin of permanent teeth in children/ adolescents is rare. When evaluating the tooth wear in children and adolescents, the information from the present systematic review on what the latitude of normal findings are, is clinically useful. Clinicians involved in providing dental care for children should be cognizant of this problem in children, and use appropriate indices to document tooth wear. The management of tooth wear should not only take into account the severity of tooth wear but more importantly the accompanying clinical signs and self-reported symptoms.


    Reference:
    1. Sprijker VA, Rodriguez JM, Kreulen CM, Bronkhorst EM, Barlett DW, Creugers NH Prevalence of tooth wear in adults. Int J Prosthondont 2009; 22(1):35-42

  • Critical Summary Publication Date: 9/7/2011

These summaries are not intended to, and do not, express, imply, or summarize standards of care, but rather provide a concise reference for dentists to aid in understanding and applying evidence from the referenced systematic review in making clinically sound decisions as guided by their clinical judgment and by patient needs. American Dental Association ©

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