Med Oral Patol Oral Cir Bucal. 2009 Aug 1;14 (8):e377-84.
Analytic cross-sectional study on dental erosion experience
Introduction Alcohol is an allowed drug therefore its consumption is socially accepted. However, it is a toxic substance having medical and social side effects. According to WHOROE (2006) the European Region has the highest alcohol intake in the world. Alcohol is the third-largest risk factor for death and disability in the Region and the largest risk factor among young people (1). Yip and Burt (2006) revealed that patients present related problems and side effects due to alcohol consumption and bever- ages, and in approximately 15% of patients with estab- lished cirrhosis, hepatocellular carcinoma develops (2). The detrimental effect of alcohol seems also to be more pronounced in interaction with poverty and malnutri- tion (1). Alcoholic patients are a risk group for dental erosion injuries, because alcohol consumption has the potential for increasing the degradation rate mechanisms and by the direct and indirect ethanol effects in the organic sys- tems (3,4). These drug addition patients have high risk for dental erosion lesions, being particularly susceptible to that dental chemistry wear, as indirect and direct re- sults of vomits and frequent acidic beverages consump- tion (5-7). The dental erosion is defined as a gradual structure dental wear caused by a chemical process, that does not involve bacteria activity (6,8). Published studies concerning the alcoholic patient oral health are rare, as well as that about the etiologic and risk factors associations between oral health indicators, particularly dental erosion and the alcohol beverage consumption. The aim of this study was to determine the experience and severity of dental erosion lesions in alcoholic pa- tients under an addiction rehabilitation therapy in one centre (CRAN) located in Porto, north of Portugal, and to assess socioeconomic and behavioural covariates of dental erosion experience.
Material and Methods Before implementation, this study was approved by the Ethics Committee of the Faculty of Health Sciences, University Fernando Pessoa (FCS-UFP).
This cross-sectional study about dental erosion experi- ence and severity was carried through a population of 50 patients, 15 (30%) women and 35 (70%) men, which were interned for alcoholic addiction detoxification pro- gramme in the CRAN, between February and May of 2006. After signature of the informed consent, data were collected through the fulfilment of a questionnaire, dur- ing a personal interview to each participant and by vis- ual dental examination (dental erosion lesions location by arch (maxillary, mandibular), tooth type (anterior, posterior) and surface (Palatine/lingual, Buccal, occlu- sal/incisal)). A sample of 1064 teeth was constituted and
examined. To assure standardization criteria during data collection, questionnaires and visual examination data were always carried through by the same examiner. At the beginning of the study, intra-examiner calibration was done, by repeating the visual dental examination of 10 patients’ teeth and fulfilling the questionnaire of the first 10 patients, with a one week interval between two collecting moments, showing an intra-examiner agree- ment coefficient Kappa of Cohen of 0.90.
Non-clinical data were registered (questionnaire) and included information about patient gender, age and so- cio-demographic characteristics as education level, civil and employment status. Education levels were classified according to UNESCO, by the International Standard Classification of Education (ISCED) (9). This data was dichotomized as level “2” or less (academic education ≤ 9 years), and more than level “2” (academic education > 9 years). This questionnaire also gathered information about alcohol beverages consumption, quantities and qualities of consumption, as well as behaviour related to smoking and drugs of abuse history and oral health promotion. The daily consume of pure alcohol (pure al- cohol dose) was calculated through equation 1 (Eq.1), by using the amounts of different drinks reported for each patient, where k is the number of different types of alcohol beverages.
dose g / day
Volume mL i u Alcohol content % or gL i u 0.8
Eq.1 Clinical data Tools for clinical examinations were of visual assess- ment (with the aid of a mirror, clamp, cotton rolls, air gauzes and air spray) and a CPI probe inspection, slid- ing the probes end gently across a tooth surface to con- firm the presence of a cavity or discontinuity, apparent- ly confined to enamel, both done through natural light. The dental erosion lesions were classified by means of severity and anatomic localization, according to dental erosion indicators, namely Eccles and Jenkins criteria (10). For this classification the occlusal, palatine/lingual and buccal surfaces in all teeth had been observed, and a severity level was attributed according to: level 0 (zero) “Normal surface, without enamel wear”, level 1 (one)“ Surface with enamel wear, but without dentin wear”, level 2 (two) “Surface with dentin wear, less than 1/3 of the surface” and the highest severity, level 3 (three) “Surface with dentin wear, more than 1/3 of the sur- face”. Teeth dental erosion experience was considered when at least one tooth surface showed enamel or den- tin structures erosion wear (levels one, two or three of severity). Teeth dental severity was classified as low if at least one surface of the teeth showed enamel erosion wear (severity level of one) and moderate to high sever-