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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 14  |  Issue : 4  |  Page : 409-412

Prevalence of dental erosion in 12-year-old schoolchildren of Lucknow city


1 Department of Public Health Dentistry, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
2 Department of Public Health Dentistry, Azamgarh Dental College, Azamgarh, Uttar Pradesh, India

Date of Web Publication15-Dec-2016

Correspondence Address:
Pooja Sinha
C-1258, Arawali Marg, Indira Nagar, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-5932.195830

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  Abstract 

Introduction: Dental erosion is tooth surface loss caused by chemical processes without bacterial involvement, which can affect children because of various dietary and other lifestyle factors. Aims: The aim of this study was to assess the prevalence of dental erosion in 12-year-old schoolchildren in Lucknow city. Materials and Methods: A total of 212 schoolchildren were selected through multistage cluster random sampling method. A pretested self-administered pro forma was used to record demographic data, medical history, and dietary habits. The clinical examination was done to evaluate dental erosion of children using dental erosion index by O'Sullivan. Descriptive analytical tests were used including distribution of erosion, its extent and severity. The findings were compared across the study participants using Chi-square test. Results: The overall prevalence of dental erosion was 34.12% with no significant sex difference. Dental erosion was significantly related to the frequency of consumption of fruit juices (67.07%) followed by carbonated drinks (64.47%). In most of the cases, more than half of their surfaces were diagnosed as affected by erosion (26.25% central incisors, 4.83% lateral incisors). Conclusions: Dental erosion among the study group was found to be 34.12%, providing evidence that dental erosion is becoming a significant problem in Lucknow schoolchildren.

Keywords: Dental erosion, fruit juice, labial surface, prevalence, risk factors


How to cite this article:
Sinha P, Abdullah S, Saha S, Verma A. Prevalence of dental erosion in 12-year-old schoolchildren of Lucknow city. J Indian Assoc Public Health Dent 2016;14:409-12

How to cite this URL:
Sinha P, Abdullah S, Saha S, Verma A. Prevalence of dental erosion in 12-year-old schoolchildren of Lucknow city. J Indian Assoc Public Health Dent [serial online] 2016 [cited 2019 Jun 24];14:409-12. Available from: http://www.jiaphd.org/text.asp?2016/14/4/409/195830


  Introduction Top


Erosion has been identified as an important cause of the loss of tooth tissues for adults, children, and adolescents. Tooth erosion has been defined as the physical result of a localized, chronic, pathologic, and irreversible loss of dental hard tissue caused by acids or chelates without bacterial involvement.[1] The etiology of tooth erosion is multifactorial and could be due to intrinsic factors (vomiting or regurgitation, such as gastro-esophageal reflux, anorexia and bulimia nervosa, or illnesses that cause reduction in salivary flow) and extrinsic factors (dietary habits such as acidic drinks and foods, lifestyle habits, etc.). These factors seem to influence the erosive process, making it difficult to identify the risk factors, and if it is not controlled and stabilized, the child may suffer from severe tooth loss, tooth sensitivity, overclosure, poor esthetics, or even dental abscesses in the affected teeth.[2] It is necessary to identify this pathological process as early as possible to prevent further progression.[3]

A number of epidemiological studies have investigated the development of erosive lesions in children; however, there is no data available on the prevalence of dental erosion in Lucknow children. Hence, the present cross-sectional study was undertaken to explore the prevalence and severity of dental erosion and its associated risk factors in 12-year-old schoolchildren of Lucknow.


  Materials and Methods Top


A descriptive cross-sectional survey was designed to estimate the prevalence and severity of dental erosion from March to May 2015 in 12-year-old schoolchildren of Lucknow city. Ethical clearance was obtained from the Institutional Ethical committee. Approval was obtained from the principals of the concerning schools. A written consent was obtained from the parents of the participating schoolchildren.

A pilot study was conducted on twenty children to assess the feasibility of the study and to assess the validity and accuracy of the predesigned pro forma. The questionnaire items were analyzed for difficulty in understanding, interpreting, and answering correctly. Cronbach's alpha was applied for measuring the intraexaminer reliability, which was found to be 0.86.

Sample size was calculated using the standard formula: n = z2 (p [1 − p])/e2 where n = sample size; P = approximate prevalence rate; z = critical value at a specified level of confidence; e = difference between sample proportion and population proportion. According to this equation and results of the pilot study, a sample size of 290 schoolgoing children was obtained. The estimated sample was selected by multistage cluster random sampling method from the schools. All the schoolchildren who were present on the day of examination and whose parents gave consent were included in the study. Children with orthodontic appliances, extensive restorations, and enamel defect accompanied by a loss of tooth substance, and fractured or missing incisors were excluded from the study.

A pretested study pro forma was used to record the information about the participants. The first part of the pro forma consisted of structured questionnaires, including demographic details, general medical history with reference to medications and chronic disorders, drink and food items which have erosive potential, and the consumption of intake, which was classified as once, twice, and thrice per week. The second part of the pro forma consisted of assessment of dental erosion using O'Sullivan index (2000),[4] which was recorded by a single trained and calibrated investigator. The arrangement of different levels of erosion was used in the calibration exercise, which was based on the diagnosis of photographic images. Intraexaminer reliability was assessed through the kappa statistics estimated to be 0.83.

The schoolchildren were clinically examined as per the American Dental Association Type 3 criteria using mouth mirrors while seated on the chair under natural light. The four upper incisors were examined. Each examination lasted for 30 s.

The data retrieved from precoded survey pro forma were tabulated and subjected to statistical analysis using Statistical Packages for the Social Sciences Version 21.0 (IBM Corporation Armonk, New York, United States). Data analysis included descriptive statistics, location, distribution and extension of affected area, and severity of dental erosion. The results were statistically analyzed by Chi-square test. P < 0.05 was considered statistically significant.


  Results Top


A total of 212 schoolchildren were examined; the response rate obtained was 94%. The main reasons for nonresponse were absence on the day of the examination and lack of parental consent.

Among the 212 schoolchildren enrolled in the study, 63.03% were males and 36.97% were females. A total of 72 children had dental erosion giving an overall prevalence of 34.12% [Graph 1]. There was no significant difference in the prevalence of dental erosion between males (21.80%) and females (12.32%) [Graph 2].



From a total of 82 children who consumed fruit juice, it was observed that 55 (67.07%) had dental erosion. A significant association was recorded between the intake of fruit juice (P < 0.05*) and occurrence of dental erosion [Graph 3]. From a total of 76 children who consumed carbonated drinks, it was observed that 49 (64.47%) had dental erosion. The frequency of consumption of carbonated drinks was significantly related (P < 0.05*) to dental erosion in the present study. Mild association was reported between the prevalence of dental erosion and gastric disorder (8.5%). However, no association was found between dental erosion and individual's medical history.



The frequency of erosion (35.5%) observed in maxillary central incisors was high when compared to maxillary lateral incisors (7%). The predominance of erosion sites on the labial surfaces was noted for both the maxillary central and lateral incisors [Table 1].
Table 1: Distribution of erosion site on maxillary permanent incisors among study children

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Matt appearance of the enamel was the most prevalent type of dental erosion (23.4% for central incisors and 7.9% for lateral incisors) [Table 2]. The surface area affected by erosion was 26.25% for central incisors and 4.83% for lateral incisors.
Table 2: Distribution of the grade of erosion severity on maxillary permanent incisors among study children

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  Discussion Top


Over recent decades, dental erosion has become a significant factor when the long-term health of the dentition is taken into account.[5] The use of maxillary incisors in evaluating dental erosion in 12-year-old children is considered appropriate since by this age these teeth have been exposed in the oral environment for a considerable period of time when compared to other teeth present at the age,[6] and also the examination of incisors is easier.

In the recent decades, due to modern lifestyle, there has been change in the quality of dietary habits resulting in an increase in the consumption of acidic beverages. The frequent consumption of carbonated drinks and fruit juices was shown to be strongly associated with dental erosion.

The prevalence of dental erosion of 34.12% in the current study was similar to the results of Chrysanthakopoulos (33.8%).[2] A slightly lower prevalence (28%) of dental erosion was observed in the study by Caglar et al.[7] Variation in the prevalence of dental erosion among the studies might be due to the differences in the diagnostic criteria and indices used to measure the same. Furthermore, other factors such as geographic, socioeconomic, and cultural could have also influence the outcome of prevalence data.

In the present study, there were no differences in the prevalence of dental erosion between males (12.32%) and females (21.80%). which is in agreement with a study carried out by Yaseen et al.[5] It might be attributed to the fact that both boys and girls are exposed to similar risk factors in this population.

The frequency of consumption of fruit juices was significantly related to dental erosion in the present study, similar findings were observed in a study conducted by Al-Malik et al.[8] The main component of citrus fruits is citric acid, and fruit juices have higher potential to cause dental erosion than other types of acids, possibly because its chelating action on calcium enamel continues with the increase in pH. Dental erosion was significantly related to the frequency of consumption of carbonated drinks in the present study. Similar findings were observed in the study conducted by Al-Malik et al.[8] This might be attributed to the fact that these carbonated drinks have a high buffering capacity, which has a strong erosive potential on teeth.

Matt appearance of the enamel was the most prevalent type of dental erosion (23.4% for central incisors and 7.9% for lateral incisors), which is in agreement with the study by Talebi et al.[9]

The predominance of erosion on the labial surface (18.3% for central incisors and 2.2% for lateral incisors) seen in this study is in agreement with a previous study by Yaseen et al.[5] The surface area affected by erosion in the present study was in agreement with the study conducted by Talebi et al.[9] It could be due to the fact that children are exposed to more risk factors for a longer duration.

The cross-sectional design of the study can be considered as an important limitation. Hence, further longitudinal studies are needed to better understand and interpret dental erosion among children and identification of etiological factors associated with it for the establishment of adequate preventive measures.

Dental erosion should receive more attention that promotes awareness among dentists to make an early diagnosis. A strategy of offering preventive care, including more campaigns promoting a healthier lifestyle for those at a risk of dental erosion and a regular dental follow-up, should be conducted for schoolchildren.


  Conclusions Top


Dental erosion among 12-year-old children was found to be 34.12. It provides evidence that dental erosion is becoming a significant problem in Lucknow schoolchildren. In this study, labial surfaces were the most affected and matt appearance of the enamel was the most prevalent type of dental erosion. In most of the involved cases, more than half of their surfaces were diagnosed as affected by erosion, which is frequently associated with the increased consumption of fruit juices and carbonated beverages.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Gandara BK, Truelove EL. Diagnosis and management of dental erosion. J Contemp Dent Pract 1999;1:16-23.  Back to cited text no. 1
    
2.
Chrysanthakopoulos NA. Prevalence of tooth erosion and associated factors in 13-16-year old adolescents in Greece. J Clin Exp Dent 2012;4:e160-6.  Back to cited text no. 2
    
3.
Lussi A, Jaeggi T. Erosion – Diagnosis and risk factors. Clin Oral Investig 2008;12 Suppl 1:S5-13.  Back to cited text no. 3
    
4.
O'Sullivan EA. A new index for measurement of erosion in children. Eur J Paediatr Dent 2000;2:69-74.  Back to cited text no. 4
    
5.
Yaseen SM, Togo RA, Meer Z, Al-Dheer AM, Al-Futaih MA, Al-Jalal AA, et al. Dental erosion among 12-15 year old school boys in Southern Saudi Arabia. Arch Orofac Sci 2013;8:14-9.  Back to cited text no. 5
    
6.
Ganss C, Klimek J, Lussi A. Accuracy and consistency of the visual diagnosis of exposed dentine on worn occlusal/incisal surfaces. Caries Res 2006;40:208-12.  Back to cited text no. 6
    
7.
Caglar E, Kargul B, Tanboga I, Lussi A. Dental erosion among children in an Istanbul public school. J Dent Child (Chic) 2005;72:5-9.  Back to cited text no. 7
    
8.
Al-Malik MI, Holt RD, Bedi R. The relationship between erosion, caries and rampant caries and dietary habits in preschool children in Saudi Arabia. Int J Paediatr Dent 2001;11:430-9.  Back to cited text no. 8
    
9.
Talebi M, Saraf A, Ebrahimi M, Mahmodi E. Dental erosion and its risk factors in 12-year-old schoolchildren in Mashhad. Shiraz Univ Dent J 2009;9 Suppl 1:13-8.  Back to cited text no. 9
    



 
 
    Tables

  [Table 1], [Table 2]



 

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