A cross‐sectional study: non‐carious cervical lesions,cervical dentine hypersensitivity and related risk factors

The present survey aims to study the prevalence and clinical characteristics of non‐carious cervical lesions (NCCLs) and cervical dentine hypersensitivity (CDH), as well as their possible risk factors in a general population in China. A total of 1023 subjects were included in the present study. Each subject completed a structured interview, and all teeth of each subject were examined by a practitioner to determine NCCLs and CDH. Teeth with NCCLs and CDH were diagnosed according to the tooth wear index and by a blast of air from a triple syringe, respectively. Binary logistic regression was completed by analysing the association of risk factors with the occurrence of NCCLs and CDH. Loss of attachment (LOA) and gingival recession (GR) of teeth with NCCLs and/or CDH were measured using Williams periodontal probe. The diagnoses of NCCLs and CDH established following a clinical assessment yielded an overall prevalence of 61·7% and 27·1%, respectively. The 60–69 age group had the greatest proportion of subjects with NCCLs or CDH. The pre‐molars were the most commonly affected teeth type with NCCLs or CDH. The proportion of teeth with CDH associated with NCCLs increased significantly with age, but the proportion of teeth with CDH only associated with LOA or GR decreased slowly with age. The single variables and interactive effects of variables associated with the occurrence of NCCLs include the following: age group, occupation type, method of toothbrushing, frequency and method of toothbrushing, and method of toothbrushing and duration of a toothbrush used. Gender, age group, occupation type and frequency of toothbrushing were associated with the occurrence of CDH. The current study presented higher prevalence of NCCLs and CDH in a general Chinese population. Both diseases were closely associated with age and periodontal status. The portion of the population with NCCLs or CDH had different risk factors.     

Epidemiological evaluation of the multifactorial aetiology of abfractions

The purpose of this study was to determine risk indicators for the aetiology of abfractions (cervical wedge-shaped defects) on teeth using dental and medical variables obtained in a population-based sample of the cross-sectional epidemiological 'Study of Health in Pomerania' (SHIP). Medical history, dental, and sociodemographic parameters of 2707 representatively selected subjects 20-59 years of age with more than four natural teeth were checked for associations with the occurrence of abfractions using a two-level logistic regression model on a tooth and a subject level. The estimated prevalence of developing abfractions generally increased with age. The following independent variables were associated with the occurrence of abfractions: buccal recession of the gingiva, odds ratio (OR) = 6.7; occlusal wear facets of scores 1, 2 and 3, OR = 1.5, 1.9, 1.9; tilted teeth, OR = 1.4; inlays, OR = 1.6; toothbrushing behaviour, OR = 1.9 to 2.0 (two and three times a day versus once a day). First premolars had the highest estimated risk for developing abfractions, followed by the second premolars. Maxillary and mandibular teeth behaved similarly in terms of abfractions, with the exception of mandibular canines, which had a much lower estimated risk of incurring abfractions than did maxillary canines. The results of this analysis indicated that abfractions are associated with occlusal factors, like occlusal wear, inlay restorations, altered tooth position and tooth brushing behaviour. This study delivers further evidence for a multifactorial aetiology of abfractions.     

中老年人群牙颈部非龋性缺损与（牙合）面磨损的临床分析

目的：调查中老年人群牙颈部非龋性缺损（NCCL）与（牙合）面磨损发生情况,并对两者的发病因素和相互关系进行探讨。方法：对568名45岁及以上机关干部,使用Smith和Knight牙齿磨损指数（TWI）进行牙颈部非龋性缺损与（牙合）面磨损的患病情况调查。结果：该研究人群NCCL的患病率为73．24％,（牙合）面磨损患病率为87．50％。NCCL和（牙合）面磨损的患病率和严重程度与性别和年龄相关,发生（牙合）面磨损的患牙更易发生NCCL,反之亦然（P〈0．05）。该人群的磨牙症史、饮食习惯及刷牙方法与NCCL和（牙合）面磨损的发生没有明显相关性。结论：牙颈部非龋性缺损与（牙合）面磨损在中老年人中较常见,两者的发生有一定的联系,（牙合）力、机械摩擦和时间为其发生的共同因素,但加重原因不尽相同。     

Comparison of pattern of failure of resin composite restorations in non-carious cervical lesions with and without occlusal wear facets

Objectives

Many studies have reported the clinical problems associated with resin composite restorations in NCCLs. None has compared these clinical problems in NCCLs with and without occlusal wear facets. The present study sets out to determine the proportion of NCCLs that presents occlusal wear facets, and to compare the failure pattern of resin composite restorations in NCCLs with and without occlusal wear facets.

Methods

Teeth with NCCLs were classified into two groups, those with and without occlusal wear facets. Both groups were restored using micro hybrid resin composite. The restorations were evaluated at the end of 2 years concerning post-operative sensitivity, retention, marginal integrity, marginal discolouration, wear, and secondary caries, using the USPHS criteria. Statistical analysis compared the ratings of each criterion between the two groups using Pearson's χ² or Fisher's exact test.

Results

About one-third (33.8%) of teeth with NCCLs presented with occlusal wear facets, more NCCLs with occlusal wear facets in mandibular teeth (44.7%) than maxillary teeth (24.5%). Retention rate of composite resin restorations in NCCLs with and without occlusal wear facets was 63.9% and 74.4% respectively at the end of 2 years. More marginal discolouration and defects were observed in restorations in NCCLs with occlusal wear facets, the differences were not statistically significant (p > 0.05).

Conclusions

The decline in ratings of marginal discolouration and defects, and the lower retention rate of restorations in NCCLs with occlusal wear facets may support the role of occlusal stress and tooth flexure as a cause of failure of restorations in NCCLs.

Clinical significance

The ability to distinguish between stress induced lesions (with occlusal wear facets) and other cervical lesions will have important ramifications for the success of their restorations because they are not subjected to the same physical forces that are responsible for the deterioration of the restoration.     

Clinical features and factors associated with non‐carious cervical lesions and dentin hypersensitivity

Determining the factors associated with NCCLs and DH in populations could guide the implementation of specific preventive measures. This study evaluated the clinical features and factors associated with non‐carious cervical lesions (NCCLs) and dentin hypersensitivity (DH) in a Brazilian population. The participants were 118 patients at the Dentistry Clinic of our dental school. They completed an interview to obtain personal information and determine the possible factors associated with NCCLs and DH. Clinical examination was undertaken to record the NCCLs, shape of the lesion and certain occlusal factors. DH was diagnosed by air and probe tests. Data were analysed with the multilevel Poisson regression and prevalence ratios, and the respective 95% confidence intervals were calculated. The prevalence of NCCLs and DH among patients was 67·8% and 51·7%, respectively. Of a total number of 2902 teeth examined, 9·65% had NCCLs and 5·82% were sensitive to air. The most affected teeth for both conditions were the premolars. Most of the NCCLs were wedge‐shaped and located in the maxilla. The factors associated with NCCLs and DH were age and presence of premature occlusal contacts. NCCLs were also significantly associated with consumption of wine and alcoholic beverages, and DH with consumption of acidic fruits and juices. NCCLs were a common finding, with higher frequency in more advanced age groups, the maxilla and premolars. A significant association occurred between NCCLs, premature contacts and consumption of wine and alcoholic beverages. DH was associated with NCCLs, premature contacts and with the consumption of acidic fruits and juices.     

Correlations of noncarious cervical lesions and occlusal factors determined by using pressure-detecting sheet

OBJECTIVES: The purpose of this clinical study was to examine the relationships of v-shaped noncarious cervical lesion (NCCL) formation with occlusal factors. METHODS: A total of 159 male self-defense force officials with a mean age of 36.2 years participated in this study. All present teeth were examined for the presence and type of NCCL using the Tooth Wear Index (TWI). The subjects were then interviewed about bruxing and toothbrushing habit. Finally, occlusal force, occlusal contact area and average pressure were measured using a pressure-detecting sheet. Subject-level logistic regression was carried out to assess the associations of factors with presence of v-shaped NCCL teeth. Subjects without v-shaped NCCL were designated as control subjects. RESULTS: Totally, 4518 teeth were examined. Seventy-eight subjects (49.1%) had one or more teeth with typical v-shaped NCCL (259 teeth). The number of teeth with v-shaped NCCL of grade 2 (defect less than 1mm in depth) was 195 (4.3%), and the number of teeth with v-shaped NCCL of grade 3 (defect 1-2mm in depth) was 54 (1.2%). The prevalence of teeth with v-shaped NCCL was significantly higher in the maxilla than in the mandible. Most of the NCCL teeth were premolars. There was no significant difference between teeth with NCCL on the right side and those on the left side. Subject-level logistic regression analysis revealed that age (OR=1.11), toothbrushing pressure (400g, OR=2.43) and occlusal contact area (>23.0mm(2), OR=4.15) were associated with the presence of NCCL teeth. CONCLUSIONS: It is concluded that aging, toothbrushing pressure and occlusal contact area are associated with the presence of NCCLs.     

The prevalence of non-carious cervical lesions (NCCLs) with or without erosive etiological factors among adults of different ages in Tokyo

Clinical Oral Investigations - To evaluate the prevalence of non-carious cervical lesions (NCCLs) on teeth with or without erosive etiological factors across a broad range of ages of Japanese...     

Gingival recession: epidemiology and risk indicators in a university dental hospital in Turkey

Abstract: Objective: Gingival recession is a common manifestation of periodontal disease, but is also associated with several risk factors. In this study, we investigated prevalence of gingival recession and assessed various risk indicators in a university dental hospital in Turkey. Materials and methods: The study group consisted of 831 persons (537 females, 294 males). Gingival recession, dental plaque, calculus, tobacco consumption, toothbrushing frequency, traumatic toothbrushing and high frenum were assessed. Gingival recession scored as present whenever the free gingival margin was apical to the cemento‐enamel junction and root surface was exposed. Results: Overall, the prevalence of gingival recession was 78.2%. The gingival recession for buccal surfaces measured approximately between 1 and 2 mm was 17.4%. The number of gingival recession site of male subjects was significantly higher than that of the female ones (P < 0.05). The dental calculus and plaque levels of mandibular teeth were significantly higher than those of the maxillary teeth (P < 0.05). The multiple regression analyses showed that age, smoking duration, traumatic toothbrushing and high frenum are significant contributors to gingival recession. Conclusions: Periodontal condition is very high in this population. High level of gingival recession in this population is significantly associated with a high level of dental plaque and calculus, male gender, smoking duration, toothbrushing frequency, traumatic toothbrushing and high frenum.     

Coronal and apical lesions, environmental factors: study in a modern and an archeological population

Apical periodontitis (AP) are frequent findings in contemporary dental practice in association with dental pathology or dental care. They have also been studied from an anthropological background. The purpose of this study was to compare the prevalence of apical and dental lesions in an archeological Middle Ages sample and a modern population, and to evaluate the influence of environmental factors. Both the archaeological sample group and dental practice subjects were from southern France. The study included full mouth surveys of 252 individuals (2,780 teeth) from a historic necropolis and 223 subjects (5,678 teeth) randomly selected from the Gard area. Tooth wear, caries, and AP were accounted for clinically and radiographically according to specific indexes. Significant differences were found between period and age in the archeological sample as regards the main risk factors for AP. Antemortem teeth loss and dental wear had been reduced, whereas caries rates and AP had increased between archaeological and modern population. The AP ratio was associated with the level of dental care in the modern population. Although significant variations could be observed between archaeological periods, the rupture in E3 (sixteenth and seventeenth centuries) leads to consider the associated population as a premodern. However, it was found that although cultural and alimentary factors seemed to be the main risk factors in an archeological population, dental care seemed to have a strong influence on AP ratio in modern ones.     

Development of horizontal tooth wear in maxillary anterior teeth from five to 18 years of age

Sizes of horizontal wear facets of maxillary anterior teeth were studied longitudinally from the primary dentition at age five to the young adult dentition at the age of 18 years. By a planimetric method, we calculated the wear areas on dental casts taken at the ages of five, ten, 14, and 18 years from the dentition of 39 healthy, orthodontically untreated subjects with good morphological occlusion. For young adults, we also studied the association between the amount of wear and reported parafunctions, maximal bite force, salivary buffer capacity, salivary flow rate, and some cephalometric variables. Size of wear facets on all anterior teeth increased with age. Significant correlations were found between the total wear areas of the six anterior primary teeth at five years of age and those of their permanent successors at age 14 (r = 0.44) and 18 (r = 0.39). For an individual, tooth wear at five years of age was, however, of low predictive value for tooth wear in young adulthood, whereas tooth wear at 14 years of age predicted it well (r = 0.89). Highest correlations between tooth wear and background factors at 18 years of age were found for maximal anterior bite force (r = 0.44) and for the size of the gonial angle (r = -0.31). Wear of anterior teeth was not associated with reported parafunctions in young adulthood.     

Characteristics of noncarious cervical lesions: a clinical investigation

BACKGROUND: The purpose of the authors' in vivo investigation was to analyze the characteristics of noncarious cervical lesions, or NCCLs, in adult patients who had a high incidence of them. METHODS: The patient pool consisted of a total of 57 patients and 171 teeth (three teeth per patient), with one NCCL per tooth. The characteristics the authors evaluated were shape, dimensions, sensitivity, sclerosis and occlusion. RESULTS: In terms of lesion characteristics, 91 percent of the lesions had axial depths of 1 to 2 millimeters, 49 percent had occlusogingival widths of 1 to 2 mm, 74 percent had an angular shape of 45 to 135 degrees, 76 percent had mild or moderate sclerosis, and 73 percent had no or mild sensitivity. In terms of occlusion, 75 percent of teeth had an Angle Class I occlusion on the involved side, 60 percent had group function or mixed excursive guidance, 82 percent had wear facets, and 99 percent had Type 0 or I mobility. In terms of tooth location, 70 percent of NCCLs were on posterior teeth, 65 percent were on maxillary teeth, and 46 percent were on premolars. CONCLUSIONS: The evaluated NCCLs were found mainly to have small dimensions of depth and width (< 2 mm) and to be roughly right-angled in shape, and many had sclerosis and low sensitivity. A majority of the dentitions studied had Class I occlusion, with group function, prevalent wear facets, and little or no mobility. Cervical lesions were more common with posterior maxillary teeth and premolars, especially first premolars, which had the highest prevalence of lesions. Older patients were more likely to exhibit noncarious cervical lesions, but no great difference in incidence was found between men and women. Clinical Implications. A knowledge of the NCCL characteristics and etiologic covariables aids in proper case selection for treatment, aids in selection of appropriate treatment protocols and improves assessment of prognosis.     

Tooth wear in maxillary anterior teeth from 14 to 23 years of age

Using a planimetric method, the size of horizontal wear facets on maxillary anterior teeth was studied longitudinally in the permanent dentition of 35 subjects at ages 14, 18, and 23?years. The study subjects had not previously undergone any orthodontic treatment and had Class I occlusion. We studied the association between the amount of wear and reported parafunctions and maximal bite force. Total wear areas in age groups 14, 18, and 23 years were 29.5 mm2 (SD 11.4), 39.1 mm2 (SD 12.7), and 45.0 mm2 (SD 13.0), respectively. The total wear area increased significantly both from 14 to 18 years of age and from 18 to 23 years of age (p <0.0001). Between 18 and 23?years of age, the maxillary canines showed strongest wear, although the central incisors had largest wear facets. It can be concluded that wear of permanent anterior teeth is a continuous phenomenon in adolescence and young adulthood.     

Cervical wear and occlusal wear from a periodontal perspective

Summary The aim of this study was to investigate whether cervical wear was associated with occlusal wear and clinical periodontal parameters in relatively older adults. A total of 30 patients, with multiple non‐carious cervical lesions (NCCLs) and without a disease or condition that could cause heavy tooth wear, were included in the study. The periodontal parameters including plaque index, probing pocket depth, gingival recession (GR) and tooth mobility were obtained from 641 teeth of which 475 (74·1%) displayed NCCLs. The levels of cervical wear and occlusal wear were determined according to a tooth wear index. Premolars were more likely to develop cervical wear than canines, molars and incisors. Cervical wear was significantly associated with less plaque accumulation and the presence of shallow pockets. The teeth with advanced GR and without increased mobility were 2·583 and 1·715 times more likely to develop deeper cervical lesions, respectively. Age and the level of occlusal wear were not linked to the bucco‐lingual depth of cervical wear. In conclusion, the significant association of advanced cervical wear with the relatively healthy periodontal status suggested the role of abrasion and its possible combined action with erosion in the aetiology of NCCLs. The rate of GR and the lack of tooth mobility could constitute predisposing factors for the progression of cervical wear because the exposed root surfaces could be more susceptible to abrasion and/or erosion, and the non‐mobile teeth resisting strongly against frictional forces, thus abrasive effects, could possibly develop cervical wear.     

Tooth wear: prevalence and associated factors in general practice patients

Cunha‐Cruz J, Pashova H, Packard JD, Zhou L, Hilton TJ for Northwest PRECEDENT. Tooth wear: prevalence and associated factors in general practice patients. Community Dent Oral Epidemiol 2010; 38: 228–234. © 2010 John Wiley & Sons A/S Abstract – Objectives: To estimate the prevalence of tooth wear and to investigate factors associated with tooth wear in patients from general practices in the Northwest United States. Methods: Data on the diagnosis and treatment of oral diseases during the previous year were collected in a survey with a systematic random sample of patients (n = 1530) visiting general dentists from the Northwest Practice‐based REsearch Collaborative in Evidence‐based DENTistry (PRECEDENT) (n = 80). Prevalence ratios (PRs) of moderate to severe occlusal and incisal tooth wear by patient characteristics were estimated using cluster‐adjusted multiple binomial regression for adults (18+ years) and children/adolescents (3–17 years). Results: For adults, the mean number of teeth with wear facets was 5.4 [95% confidence interval (CI) = 4.6–6.2] and 51% of the adults had four or more teeth with wear. Participants 45–64 and 65+ years old were 1.3 (95% CI = 1.1–1.6) and 1.4 (95% CI = 1.1–1.8) times as likely to have 4+ teeth with moderate to severe wear facets as participants 18–44 years old. Adult males had a 20% (PR = 1.2; 95% CI = 1.1–1.4) higher prevalence of wear than adult females. Adults who were using, or had ever used occlusal splints had higher prevalence of tooth wear compared to those who never used such appliances (PR = 1.3; 95% CI = 1.0–1.5). Adults with any periodontal bone loss also had a 20% higher prevalence of wear than adults without periodontal disease (PR = 1.2; 95% CI = 1.0–1.4). For children/adolescents, the mean number of teeth with moderate to severe wear facets was 1.6 (95% CI = 0.9–2.6) and 31% of the children had one or more teeth with wear facets. The adjusted prevalence ratio of tooth wear (1+ teeth with wear facets) for boys was 1.6 times as high (95% CI = 1.1–2.4) as compared with girls. The prevalence of wear for children 12+ years old was 50% (PR = 0.5; 95% CI = 0.3–0.8) lower than that of children <12 years old. Angle’s class II was associated with higher tooth wear prevalence (PR = 1.8; 95% CI = 1.3–2.6) than class I. Children with posterior or anterior open bite had lower prevalence of wear than their counterparts (PR = 0.6; 95% CI = 0.3–1.0). No associations were observed between tooth wear and orthodontic treatment, missing teeth, and race/ethnicity. Conclusion: Tooth wear is a prevalent condition in this population. Among adults, higher prevalences of tooth wear were observed among those who were older, males, had used occlusal splints and had periodontal disease. Among children, higher prevalences were associated with younger age, male gender, class II malocclusion and the absence of open bite. Submitted on behalf of the Northwest PRECEDENT network, with support from NIDCR grants DE016750 and DE016752.     

Tooth wear in maxillary anterior teeth from 14 to 23 years of age

Using a planimetric method, the size of horizontal wear facets on maxillary anterior teeth was studied longitudinally in the permanent dentition of 35 subjects at ages 14, 18, and 23?years. The study subjects had not previously undergone any orthodontic treatment and had Class I occlusion. We studied the association between the amount of wear and reported parafunctions and maximal bite force. Total wear areas in age groups 14, 18, and 23?years were 29.5?mm² (SD 11.4), 39.1?mm² (SD 12.7), and 45.0?mm² (SD 13.0), respectively. The total wear area increased significantly both from 14 to 18?years of age and from 18 to 23?years of age (p<0.0001). Between 18 and 23?years of age, the maxillary canines showed strongest wear, although the central incisors had largest wear facets. It can be concluded that wear of permanent anterior teeth is a continuous phenomenon in adolescence and young adulthood.     

The prevalence and severity of non-carious cervical lesions in a group of patients attending a university hospital in Trinidad

Non-carious cervical lesions (NCCLs) are often encountered in clinical practice and their aetiology attributed to toothbrush abrasion, erosion and tooth flexure. This paper aims to determine the prevalence and severity of NCCLs in a sample of patients attending a university clinic in Trinidad and to investigate the relationship with medical and dental histories, oral hygiene practices, dietary habits and occlusion. Data were collected via a questionnaire and clinical examination. Odds ratios were used to determine the association of the presence of lesions and the factors examined. One hundred and fifty-six patients with a mean age of 40.6 years were examined of whom 62.2% had one or more NCCLs. Forty five per cent of the lesions were sensitive to compressed air. Younger age groups had a significantly lower correlation with the presence of NCCLs than older age groups. Other significant factors included patients who reported heartburn, gastric reflux, headaches, bruxism, sensitive teeth and swimming or had a history of broken restorations in the last year. There was also significant correlation of NCCLs in patients who brushed more than once a day or used a medium or hard toothbrush. Patients with vegetarian diets and those who reported consuming citrus fruits, soft drinks, alcohol, yoghurt and vitamin C drinks were associated with the presence of lesions. Significant associations were also found in patients with group function, faceting, clicking joints or those who wore occlusal splints.     

Noncarious cervical lesions in adults: prevalence and occlusal aspects

BACKGROUND: The factors that induce the formation of noncarious lesions are not understood fully, particularly those that are related to occlusal aspects. The authors conducted a study to evaluate the prevalence of noncarious cervical lesions in adults and their association with occlusal aspects. METHODS: The authors examined 70 people (35 men and 35 women) aged 25 to 45 years to determine the presence and type of noncarious cervical lesions, wear facets, tooth contacts in maximal intercuspal position, and lateral and protrusive movements. The assessment involved a questionnaire and clinical examination. RESULTS: Among the teeth the authors evaluated, 17.23 percent had cervical lesions, 80.28 percent of which had wear facets (P < .01). The authors found a significant difference between the prevalence of noncarious lesions and the presence of wear facets (P = .0484). CONCLUSIONS: The authors found that cervical lesions were related significantly to wear facets. These findings strengthen evidence for the role of occlusal forces as an etiologic factor for noncarious lesions. CLINICAL IMPLICATIONS: The presence of wear facets should be considered in the treatment of noncarious cervical lesions.     

Occurrence and risk indicators of increased probing depth in an adult Brazilian population

BACKGROUND/AIMS: There is little information about the occurrence and risk indicators for periodontal diseases in Latin America. The present study describes the prevalence, extent and severity of periodontal probing depth (PPD) and assesses the association between demographic, behavioural and environmental risk indicators and the extent and severity of PPD in this population. MATERIALS AND METHODS: The target population was urban adults aged > or =30 years in Rio Grande do Sul state in South Brazil. A representative sample was selected using a multi-stage, probability, cluster sampling strategy and included 853 dentate subjects 30-103 years of age. A full-mouth clinical examination was carried out at six sites per tooth on all permanent teeth, excluding third molars, and was conducted in a mobile examination centre. RESULTS: Approximately 65% and 25% of the subjects and 19% and 5% teeth per subject had PPD > or =5 and > or =7 mm, respectively. 31.6%, 33.7% and 34.7% subjects had generalized, localized or no PPD > or =5 mm, respectively. Probing depth increased in prevalence with increasing age, and leveled off at around 50 years of age and beyond. PPD > or =5 mm was significantly higher in males than in females, and in non-Whites than in Whites. Cigarette smokers had a significantly higher occurrence of PPD > or =5 mm than non-smokers, and this relationship was dose dependent. A multivariate model showed that generalized PPD > or =5 mm was associated with subjects aged > or =40 years, males, non-Whites and moderate or heavy cigarette smokers (relative risk ratios: 2.0, 2.0, 2.2, 2.4 and 6.8, respectively). CONCLUSION: Moderate and deep probing depth was a common finding in this urban adult Brazilian population. Older age, male gender, non-White race and moderate and heavy cigarette smoking were significant risk indicators of increased PPD, and these may be useful indicators of periodontal disease high-risk groups.     

Risk factors for dental fluorosis in a fluoridated community

We conducted a case-control study to determine the sources of fluoride which are particular risk factors to dental fluorosis. Cases and non-cases were identified by the screening of 8-, 9-, and 10-year-old schoolchildren in the fluoridated community of East York, Ontario. Parents were interviewed about the child's first five years of residence and about diet and preventive caries practices. The Mantel-Haenszel odds ratio and associated chi-square tests were used to assess the association of fluorosis with several potential sources, controlling for other sources of fluoride and mother's education. The prevalence of mild fluorosis [1-4 on the Thylstrup and Fejerskov (1978) Index] was 13%. Those who brushed their teeth before the age of 25 months had 11 times the odds of fluorosis compared with those beginning toothbrushing later; prolonged use of infant formula (greater than or equal to 13 months) was associated with 3.5 times the risk of fluorosis, compared with no, or shorter duration of, formula use. We estimate that these factors were responsible for 72% and 22%, respectively, of the cases in our population. Dental fluorosis is not a public health problem in East York, but parents should be advised to supervise toothbrushing by children under 2 years of age.     

Tooth wear among psychiatric patients: prevalence, distribution, and associated factors

PURPOSE: The purpose of this study was to evaluate the prevalence, distribution, and associated factors of tooth wear among psychiatric patients. MATERIALS AND METHODS: Tooth wear was evaluated using the tooth wear index with scores ranging from 0 to 4. The presence of predisposing factors was recorded in 143 psychiatric patients attending the outpatient clinic at the Prince Rashed Hospital in northern Jordan. RESULTS: The prevalence of a tooth wear score of 3 in at least one tooth was 90.9%. Patients in the age group 16 to 25 had the lowest prevalence (78.6%) of tooth wear. Increasing age was found to be a significant risk factor for the prevalence of tooth wear (P < .005). The occlusal/incisal surfaces were the most affected by wear, with mandibular teeth being more affected than maxillary teeth, followed by the palatal surface of the maxillary anterior teeth and then the buccal/labial surface of the mandibular teeth. The factors found to be associated with tooth wear were age, retirement and unemployment, masseter muscle pain, depression, and anxiety. CONCLUSION: Patients' psychiatric condition and prescribed medication may be considered factors that influence tooth wear.