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 Table of Contents  
Year : 2020  |  Volume : 5  |  Issue : 2  |  Page : 39-43

Tooth erosion and its relationship with dietary habits in 6-18 year old schoolchildren in bangalore-A cross sectional study

Department of Pediatric and Preventive Dentistry, V.S. Dental College and Hospital, Bengaluru, Karnataka, India (Rajiv Gandhi University Of Health Sciences), India

Date of Submission15-Jul-2020
Date of Decision03-Feb-2021
Date of Acceptance16-Feb-2021
Date of Web Publication17-Mar-2021

Correspondence Address:
Yasin Salman
No. 13, 2nd Cross Rajappa Block, J. C. Nagar, Bengaluru - 560 006, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijpr.ijpr_25_20

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Introduction: Dental erosion is the most common chronic disease in both children and adolescents. It is a progressive, irreversible loss of dental hard tissues by a chemical process. There is a limited literature with regard to the prevalence of dental erosion in school-going children in India. Hence, this study was undertaken to assess the prevalence and severity of dental erosion in school-going children in Bangalore. Aims: To assess tooth erosion and its relationship with dietary habits in 6–18-year-old schoolchildren. Methods and Materials: The present cross-sectional study was conducted in Bangalore, India. A sample of 1000 schoolchildren, aged 6–18 years answered questionnaire containing information about dietary habits, gastric disorders, and oral hygiene and dental erosion was recorded using Modified O'Brien index. Results: Of the 1000 participants, 77 (7.7%) had erosive tooth wear. Frequent consumption of soft drinks and citrus fruit intake were strongly associated with dental erosion (P = 0.001). The posterior surface (5%) was most commonly affected by erosive lesions and milk was considered to be a protective indicator for erosion (P = 0.001). Conclusions: The findings give an inference that a low prevalence on dental erosion but a significant relation exists between diet and dental erosion and there is a need for enhancing awareness about dental erosion among the schoolchildren, their parents and should be recognized and treated early.

Keywords: Dental erosion, diet, school children

How to cite this article:
Salman Y, Suma G, Kotecha V, Khurana I. Tooth erosion and its relationship with dietary habits in 6-18 year old schoolchildren in bangalore-A cross sectional study. Int J Pedod Rehabil 2020;5:39-43

How to cite this URL:
Salman Y, Suma G, Kotecha V, Khurana I. Tooth erosion and its relationship with dietary habits in 6-18 year old schoolchildren in bangalore-A cross sectional study. Int J Pedod Rehabil [serial online] 2020 [cited 2022 Nov 26];5:39-43. Available from: https://www.ijpedor.org/text.asp?2020/5/2/39/311463

  Introduction Top

In past decades, there is decline in the prevalence of dental caries[1] and increase in dental erosion.[2] Five studies per year were published in 70's, fifty in the current scenario.[3] Dental erosion is irreversible loss of hard tissues by a chemical process.[4] According to Pindborg, “superficial loss of dental hard tissue by a chemical process that does not involve bacteria.”[5] It is the most common chronic disease of children aged 5–17 years.[6] Worldwide, prevalence is 30% in a systematic review.[7] Moreover, 5%–100% has been reported globally.[8] Dental erosion results from more than one factor acting together.[9]

  Methods and Materials Top

The present observational study was done among randomly selected 1000 schoolchildren from Bangalore which included 544 boys and 456 girls aged between 6 and 18 years using convenient sampling. Institutional ethical clearance was obtained before conducting the study. Prior informed consent was obtained from the parents and the school authorities for participation in the study.

Inclusion criteria

  • Children within the age group of 6–18 years
  • Children from whom written consent has been obtained from their parents/guardian
  • Assent of children will be taken.

Exclusion criteria

  • Children suffering from systemic disorders and special children.

Using a previously validate index proposed by O'Brien (1994),[4] a single examiner under standardized condition conducted the dental examination using sterile gauze, Prepacked sterilized oral examination kits containing a plain mouth mirror and a blunt probe to detect dental erosion by removing food debris on both primary and permanent dentition.

Modified O'Brien index used for scoring erosive lesions [Table 1] and [Table 2].
Table 1: Lesion depth

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Table 2: Lesion area

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A self-completion questionnaire containing information regarding patient identification, dietary habits, gastric disorder symptoms, oral hygiene habits, and tooth grinding habits was provided aimed to establish association between diet and dental erosion. Children and adolescents were supervised during the questionnaire completion, followed by clinical examination.

The data obtained were subjected to descriptive statistical analysis and mean and standard deviation were obtained. Odds ratio with confidence interval was calculated for different variables related to outcome, to determine whether any statistically significant differences are present (P < 0.05).

  Results Top

Of the 1000 participants, 77 (7.7%) had erosive tooth wear. Shows the distribution of participants regarding dental erosion prevalence according to gender and type of dentition. The variables gender (P = 0.791) and type of dentition (P = 0.062) were not significantly associated with dental erosion (P > 0.05). Concerning dietary habits, frequent consumption of soft drinks and temperature (P = 0.016) were strongly associated with dental erosion (P = 0.001). Other types of drinks (P = 0.999) and the method of drinking (P = 0.999) were not significantly associated with erosion [Table 3].
Table 3: Effect of different variables on erosion of teeth: Logistic regression

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In both primary and permanent dentitions, the posterior surface 67 (5%) was most commonly affected by erosive lesions [Table 4]. Lesions involving over one-third to two-thirds [Table 5] of the surface 43 (4%) and loss of enamel characterization 72 (7%) were most commonly seen [Table 6].
Table 4: Lesion location

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Table 5: Lesion area

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Table 6: Lesion depth

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Significant association was seen with citrus fruit intake (P = 0.001). Regarding general health problems, the presence of gastric disorders and frequent vomiting were not significantly associated with dental erosion. Milk was considered to be a protective indicator for erosion (P = 0.001). Furthermore, it was possible to observe that older children with permanent dentition had a higher prevalence of erosive tooth wear than younger children with primary or mixed dentition [Table 3].

The variables such as tooth brush (P = 0.383), mouth wash (P = 0.732), and tooth grinding habit were also not statistically significant with dental erosion [Table 3].

  Discussion Top

Data regarding prevalence of dental erosion are the basic foot hole in understanding scope and magnitude of the problem.[10] The first study on the prevalence of tooth erosion began in the UK (1993) under the National Survey of Children's Dental Health in the age group ranging from 1.5 to 18 years. It was also worth noticing that there was variation in the prevalence of dental erosion within the same sample in different studies.[11]

One of the important factors to be considered in the long-term oral health of children and adolescents is dental erosion, especially in industrialized countries as its seen affecting more than 80% of the children.[6] Frequent consumption of acidic drinks or foods, environmental exposure to acids or reflux of gastric acid into the mouth along with lifestyle, and behavior differences play a significant role in the development of dental erosion. It is of uttermost importance to detect this condition as early as possible as the tooth tissue loss is insidious in nature and may not be apparent until the patient reports of sensitivity or the fracture of thinned incisal edges which would eventually lead to severe sensitivity to pain associated with pulp exposure, altered occlusion, and poor esthetics.[12]

A modified version of the O'Brien (1994) index was chosen for this study owing to the fact that there is no universally accepted or validated index to classify erosive lesions. It is the most commonly used index in the primary dentition, and it possesses most of the ideal characteristics of an index, as listed by Nahás Pires Corrêa MS (2011).[4]

In the present study, the prevalence of dental erosion was found to be 7.7%. This was in accordance with the study done by Vargas-Ferreira et al. and Kumar et al. reported the prevalence of 7.2% and 8.9%, respectively. However, studies done by Mangueira et al. and Deery et al. have reported a very high prevalence up to 60% of dental erosion affecting the schoolchildren in the US and UK, respectively.[5] However, low prevalence of dental erosion in the present study can be attributed to the fact that the children have less exposure to fizzy and erosive drinks than in other countries such as the USA and UK.[5]

In the present study, no difference was observed in the prevalence of dental erosion between boys and girls similar to study by Aguiar et al. (2007) and Nikolas Andreas (2012). However, other studies have recorded a significantly higher prevalence in boys than in girls El Aidi et al. (2010) and Chrysanthakopoulos NA (2012).[9] However, in a study by Wang et al. (2010), more girls than boys had tooth erosion.[9] It has been suggested that a higher rate of tooth erosion could be attributed to differences in the strength of musculature and biting forces and also to a higher consumption of acidic drinks among boys.[13]

The permanent dentition was more affected by dental erosion than the primary dentition similar to study done by Dugmore et al. (2010). However, most reports show higher prevalence of dental erosion in primary dentition Ganss C et al. (2001) and Al-Majed et al. (2002). Primary teeth have a higher risk for erosion lesions because their enamel and dentin layers are thinner and less mineralized than permanent teeth.[14] Erosion was found to be greater in posterior teeth (5%) than anterior teeth (2%) in this study, similar to the findings of Ganss et al. (2006), who reported that mandibular first molars were most affected by dental erosion.[5] Loss of enamel surface characterization (7%) was observed in most of the cases, followed by loss of enamel exposing dentin (1%), which was similar to findings obtained by Talebi et al. (2009). In most of cases, more than half of the tooth's surface was affected (4%), similar to the findings of Peres et al. and Kumar S et al. (2010).[5]

Due to low cost and high availability, the consumption of carbonated drinks has increased substantially among children and adolescents in the last years in all around the world.[15] Statistically significant relation was seen between the ingestion of carbonated drinks and dental erosion also as reported by Moazzez et al. (2000) and Al-Daligan et al. (2001). Whereas Bartlett et al. (1998), Deery et al. (2000), and Arnadottir et al. (2003) did not find any relation.[5] The major reason being carbonated drinks has lower pH than fruit juices. Besides causing erosion on tooth surfaces, carbonated drinks could reduce surface hardness of enamel, dentin, microfilled composite, and resin-modified glass ionomer cements.[5]

Significant association was seen between citrus fruit intake and dental erosion possibly because of its chelating action on enamel surface which continues despite increase in the pH level as described in other studies by Al-Daligan et al. (2001), Millward A et al. (1994), and Milosevic A et al. (2004). Many authors, Waterhouse et al. (2008) and Deery C et al. (2000), have also found that citric fruits and their juices have no impact in the occurrence of erosive lesions.[15] Consumption of milk was seen to have a protective action against dental erosion. This can be explained by the presence of remineralizing proteins in milk such as casein, which justifies the use of milk in the prevention of dental erosion.[4] According to O'sullivan et al. (2000), low consumption of milk has been considered a risk factor for dental erosion. However, Waterhouse et al. (2008) and Milosevic et al. (2004) did not find a difference in the consumption of milk between the groups with and without erosion.[15]

No association was seen between dental erosion and bruxism, oral hygiene habits, drinking methods, and gastric disorders. Diseases such as anorexia nervosa and bulimia, in which vomit is the main symptom, are causative factors of erosion according to previous studies by Mahoney EK et al. (2003) and Chrysanthakopoulos NA et al. (2006).[12]

Dental erosion is a multifactorial condition and there are many factors that were not investigated in the present study and could be associated with dental erosion such as the protective effect of saliva and the association between dental erosion and abrasion/attrition. It could be assumed also that other factors such as cultural, social, occupational, and inter and intra individual host factors might be relevant in the occurrence of dental erosion.

  Conclusions Top

Within the limits of the present study, it can be concluded that a low prevalence on dental erosion is seen in the study population, but a significant relation exists between diet and dental erosion. The prevention of dental erosion requires a multifaceted approach as it is a major group health problem effecting children of all age groups. Schools have a plausible impact on the oral health as significant time is spent in school. Therefore, educating and motivating children regarding oral health awareness, dietary habits, and lifestyle is a major step in accomplishing good oral health. Furthermore, parent's awareness and knowledge regarding dietary habits and oral health play a pivotal role in accomplishing good oral health status.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Peres KG, Armênio MF, Peres MA, Traebert J, De Lacerda JT. Dental erosion in 12-year-old schoolchildren: A cross-sectional study in Southern Brazil. Int J Paediatr Dent 2005;15:249-55.  Back to cited text no. 1
Aguiar YP, dos Santos FG, Moura EF, da Costa FC, Auad SM, de Paiva SM, et al. Association between dental erosion and diet in Brazilian adolescents aged from 15 to 19: A population-based study. ScientificWorldJournal 2014;2014:1-7.  Back to cited text no. 2
Serra MC, Messias DC, Turssi CP. Control of erosive tooth wear: Possibilities and rationale. Braz Oral Res 2009;23 Suppl 1:49-55.  Back to cited text no. 3
Nahás Pires Corrêa MS, Nahás Pires Corrêa F, Nahás Pires Corrêa JP, Murakami C, Mendes FM. Prevalence and associated factors of dental erosion in children and adolescents of a private dental practice. Int J Paediatr Dent 2011;21:451-8.  Back to cited text no. 4
Kumar S, Acharya S, Mishra P, Debnath N, Vasthare R. Prevalence and risk factors for dental erosion among 11- to 14-year-old school children in South India. J Oral Sci 2013;55:329-36.  Back to cited text no. 5
Shahbaz U, Quadir F, Hosein T. Determination of prevalence of dental erosion in 12 – 14 years school children and its relationship with dietary habits. J Coll Physicians Surg Pak 2016;26:553-6.  Back to cited text no. 6
Muller-Bolla M, Courson F, Smail-Faugeron V, Bernardin T, Lupi-Pégurier L. Dental erosion in French adolescents. BMC Oral Health 2015;15:147.  Back to cited text no. 7
Alves LS, Brusius CD, Damé-Teixeira N, Maltz M, Susin C. Dental erosion among 12-year-old schoolchildren: A population-based cross-sectional study in South Brazil. Int Dent J 2015;65:322-30.  Back to cited text no. 8
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. 9
Chu CH, Pang KK, Lo EC. Dietary behavior and knowledge of dental erosion among Chinese adults. BMC Oral Health 2010;10:13.  Back to cited text no. 10
Dugmore CR, Rock WP. The prevalence of tooth erosion in 12-year-old children. Br Dent J 2004;196:279.  Back to cited text no. 11
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. 12
Vargas-Ferreira F, Praetzel JR, Ardenghi TM. Prevalence of tooth erosion and associated factors in 11-14-year-old Brazilian schoolchildren. J Public Health Dent 2011;71:6-12.  Back to cited text no. 13
Mangueira DF, Sampaio FC, Oliveira AF. Association between socioeconomic factors and dental erosion in Brazilian schoolchildren. J Public Health Dent 2009;69:254-9.  Back to cited text no. 14
Gurgel CV, Rios D, Buzalaf MA, da Silva SM, Araujo JJ, Pauletto AR, et al. Dental erosion in a group of 12-and 16-year-old Brazilian schoolchildren. Pediatr Dent 2011;33:23-8.  Back to cited text no. 15


  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]


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