Med Oral Patol Oral Cir Bucal. 2009 Aug 1;14 (8):e377-84.
ies and an associate risk increase of missing teeth (12). The Hede’ study suggests that the average prevalence of dental caries in these risk patients is 3 to 5 times higher than that of the general population (13). In this cross-sectional study, all chronic alcoholic pa- tients undergoing rehabilitation in the CRAN registered dental erosion experience, with 49.4% teeth showing enamel and/or dentin erosion lesions. The results showed a high experience of dental erosion and a severity ero- sive surface wear, located in maxillary anterior teeth, with 1.9% of palatine surface teeth having severity level 3 erosion lesions, classified by Eccles and Jenkins (10), as illustrated in (Fig.1). The observed surface teeth patients (Fig.1), in average, had a higher severity ero- sion wear in maxillary teeth than those located in the mandibular arch. In average, considering the maxillary teeth erosion lesions in all dental surfaces, the erosion severity was the highest in anterior teeth palatine sur- faces followed by posterior teeth occlusal surfaces and anterior teeth incisal edges. In the mandibular teeth, and considering all inferior dental surfaces, severity of den- tal erosion lesions was more evident in posterior teeth occlusal surfaces, followed by those in anterior teeth lingual surfaces. These results are in agreement with the results related by some authors (7,10,13), that state that injuries of dental erosion are predominantly found in palatine surfaces of maxillary anterior teeth. Robb and Smith (1990) studied 37 chronic alcoholic beverag- es patients concerning the pathological dental structure loss prevalence, having verified that alcoholic beverages consumption patients presents more significantly dental wear lesions in comparison with the controls, being this wear of erosive nature, which in 40% of the cases affects the palatine surfaces of the maxillary anterior teeth (14). The oral health effect of alcoholic beverage consumption is associated with a high risk of dental erosion lesions, being the alcoholic patients, particularly susceptible to tooth wear lesions as result of vomits and frequent acidic beverages ingestion (5-7). In this study (Fig.1) results were similar to those obtained in the study carried out by Simmons et al. (1987), through which the authors had concluded that the maxillary anterior teeth palatine sur- faces were more seriously affected by dental erosion le- sions, in alcoholic patients. However, according to these authors the mandibular teeth and the buccal surfaces of maxillary teeth are hardly affected by tooth wear namely, dental erosion lesions (7). In this study data colleted from questionnaires were used to assess the association of covariates (Table 1) obtained from these questionnaires with dental erosion. For the occlusal dental surface, the following variables were found to be positively independently associated with dental erosion (level >0): the maxillary and poste- rior teeth, age over 40 years, academic education higher than 9 years, being unemployed or retired, having more
Analytic cross-sectional study on dental erosion experience
than 10 years of daily alcohol abuse, smoking, to drink before sleeping and having gastro-oesophageal reflux. As for the palatine dental surface, dental erosion was found to be positively independently associated with maxillary and anterior teeth, having less than 40 years, being single/divorced, academic education higher than 9 years, being unemployed or retired, having a daily al- cohol intake higher than 240 g, not using heroine but using cocaine, to drink before breakfast, having gastro- oesophageal reflux and to brushing teeth less than 2 times per day. Quite strangely to drink before breakfast was negatively correlated to palatine dental erosion. Re- garding the buccal dental surface, dental erosion was found to be positively independently associated with maxillary and anterior teeth, being single/divorced, academic education higher than 9 years, not using hero- ine, smoking habits, to drink before breakfast and hav- ing gastro-oesophageal reflux and to brushing teeth less than 2 times per day. Out of the ordinary, vomiting due to alcohol intoxication was found to be negatively cor- related to palatine dental erosion. The three multivariate models (Table 2) have a good quality. Applying a ROC analysis the area under the curve (AUC) derived from the model was 0.73 (95% CI: 0.70-0.78), 0.83 (95% CI: 0.81-0.85) and 0.70 (95% CI: 0.65-0.75), for occlusal, palatine and buccal dental erosion surfaces, respectively, which means that these models can be considered useful for predicting surface dental erosion wear (an AUC of 0.8 to 0.9 indicates ex- cellent diagnostic accuracy). Authors recognize a limitation regarding the results obtained, which is due to the sampling design, cluster sampling, and the fact that this sampling design increas- es the standard error when compared to simple random sampling, therefore reducing precision of estimate, which may possibly lead to type II errors (to not reject the null hypothesis when the null hypothesis is false, e.g., false positives). Clustering produces correlated ob- servations, which violates the assumption of independ- ently sampled cases. In this case the complex design module should have been used. Nonetheless, it should be noted that it is common practice to treat data from cluster sampling as if it were randomly sampled data. Overall, alcohol-dependent patients undergoing an ad- diction rehabilitation therapy presented high experience and low severity of dental erosion lesions. Palatine sur- faces of maxillary teeth, followed by occlusal surfaces of posterior teeth and incisal edges of anterior teeth, in average, were the more severe dental surfaces affected by erosion wear. In these patients, the mandibular teeth and maxillary teeth buccal surfaces were the less af- fected by erosion wear. In Portugal, no available data studies about dental erosion in this risk population were found, which justifies the deepening in this area.