2096 https://www.journal-imab-bg.org J of IMAB. 2018 Jul-Sep;24(3)

Original article

STUDY OF THE RELATIONSHIP BETWEENORAL-HYGIENE HABITS AND THE PRESENCEOF DENTAL EROSION IN PRESCHOOL ANDSCHOOL CHILDREN

Tanya Nihtyanova1, Maria Kukleva1, Tsonka Miteva-Katrandzhieva2, SvetlaPetrova1, Ani Belcheva-Krivorova1

1) Department of Paediatric Dentistry, Faculty of Dental Medicine, MedicalUniversity of Plovdiv, Bulgaria2) Department of Social Medicine and Public Health, Faculty of Public Health,Medical University of Plovdiv, Bulgaria.

Journal of IMAB - Annual Proceeding (Scientific Papers). 2018 Jul-Sep;24(3)Journal of IMABISSN: 1312-773Xhttps://www.journal-imab-bg.org

ABSTRACT:Background: Dental erosion is defined as irrevers-

ible loss of hard dental tissues as a result of the action ofendogenous and exogenous acids of non-bacterial origin.Its severity and extend depends on different behavioralfactors.

Aim: This study examined the relationship betweenoral hygiene habits and the presence of dental erosion inchildren aged 3 to 5 and 11 to 12 years of age.

Material and methods: The study included 429children aged 3 to 5 years and 487 children aged 11 to 12years. The presence of erosive changes was detected by anintraoral examination and oral hygiene habits were inves-tigated by a direct individual questionnaire. The influenceof oral hygiene habits on the presence of dental erosionwas tested using the chi-square test. The level of signifi-cance was set at 5%.

Results: Frequency of oral hygiene procedures andtooth brushing immediately after consumption of erosivefoods or beverages were considered as significant risk fac-tors for erosion occurrence in primary teeth. Tooth brush-ing more than twice a day had a significant impact on thepresence of dental erosion in permanent teeth as well.

Conclusion: Oral hygiene habits are related to thedevelopment of erosive changes and the frequency and tim-ing recommendations must be tailored to the risk assess-ment for erosive lesions.

Key words: dental erosion, oral hygiene habits,childhood

INTRODUCTIONDental erosion is a chronic loss of hard dental tis-

sue as a result of the action of acids of non-bacterial ori-gin. Some behavioural factors like the oral hygiene prac-tises can modify the extent of erosive tooth wear [1]. Theerosion process can be aggravated and accelerated by theabrasive effect of brushing the teeth. Though thetoothbrushing is accepted to be a prerequisite for maintain-ing good oral health, it is well known that it also has the

potential to influence the tooth wear, especially regardingtooth erosion. Experimental studies show that tooth abra-sion can be caused by a number of factors, including notonly the physical properties of the toothpaste and tooth-brush, but also factors like brushing frequency and forceof brushing that are patient-related factors. While abrasionresulting from routine oral hygiene can be considered asphysiological wear over time, intensive brushing can fur-ther damage eroded surfaces by removing the demineralisedenamel surface layer. It is approved that force and frequencyof tooth brushing as well as toothbrush hardness act asetiological co-factors in regard with cervical non-cariouslesions. The benefits of the normal oral hygiene procedurefar outweigh the possible side effects, but excessive toothbrushing - especially of eroded teeth - can cause some harm-ful effects. [2].

The purpose of this study is to investigate the rela-tionship between the oral hygiene habits and the presenceof dental erosion in children from two age groups - pre-school and school age.

MATERIALS AND METHODSThe study included 429 children aged 3 to 5 years

and 487 children aged 11 to 12 years randomly selected.The children attended educational institutions – kindergar-tens and schools in the city of Plovdiv. The choice of agegroups was based on the need to investigate specific pri-mary or permanent teeth with such a period of functioningin the mouth which provides sufficient time for the effectsof erosive factors to occur. The participation of the chil-dren in the study was with a prior written parents’ informconsent. The presence of dental erosion was established byan intraoral examination using the index developed for theChildren‘s Dental Health Survey of 1993 and modified byDugmore and Rock [3] to assess erosive loss. All the chil-dren were examined clinically at their schools under stand-ard illumination from a portable light source using indi-vidual mouth mirrors for single use. The vestibular andpalatal surfaces of the upper incisors and the occlusal sur-faces of the first molars of the respective dentition were ex-

https://doi.org/10.5272/jimab.2018243.2096

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amined for dental erosion. The children’s oral hygiene hab-its were assessed by a questionnaire. It was filled in by thepreschool children parents at home and by the school chil-dren themselves in a classroom before the clinical exami-nation was undertaken. The frequency of oral hygiene pro-cedures and their conduct immediately after erosive foodsor beverages ingestion was studied. All data were analyzedusing SPSS with Chi-squared test. Significance was ac-cepted at the P<0.05 level. Odds ratios with 95% confi-dence intervals were used to assess the univariate relation-ships between the variables.

RESULTSThe study of the relationship between dental erosion

and oral hygiene habits of the younger age group showedthat with the increasing frequency of the oral hygiene pro-cedures the relative share of the children affected by ero-sion also increased and this trend was statistically signifi-cant (P <0 , 05; χ2 = 9.29). The likelihood of erosive le-sions occurrence by more than two oral hygiene proceduresper day was more than three times higher (OR = 3.14; 95%CI 1.42 - 6.91) than by two or less procedures daily (Dia-gram 1).

Diagram 1. Distribution of children with dental erosion in primary teeth according to the frequency of toothbrushing

There was an over 7 times (OR = 7.19; 95% CI 2.94- 17.58) increased risk of erosion of the primary teeth ofchildren whose parents have indicated that they wash theteeth after each erosive food and drink consumption. Nearly

two-thirds of these children had symptoms of erosive lossof hard dental tissues compared to a quarter of children whodidn‘t brush their teeth immediately after taking fruits,juices and carbonated beverages (Diagram 2).

Diagram 2. Distribution of children with dental erosion in primary teeth depending on the conduct of oral hygieneprocedure immediately after ingestion of erosive food / beverages

2098 https://www.journal-imab-bg.org J of IMAB. 2018 Jul-Sep;24(3)

The results for oral hygiene habits in the older agegroup were similar. Oral hygiene procedures more thantwice a day were statistically significant in relation to thepresence of erosion of the permanent teeth of the exam-ined school children (c2 = 11.78; P <0.01) (Diagram 3).

DISCUSSIONWhile good oral hygiene has a proven preventive

role in periodontal disease and dental caries, frequent tooth-brushing with abrasive oral hygiene agents can aggravatedental erosion, especially in combining brushing with re-cent intake of acidic beverages or food [1]. It was foundthat the quantity of biofilm is smaller in children with meandental erosion, as compared to those with no dental ero-sion [4].

Although not all epidemiological studies authorshave found a relationship between oral hygiene habits andthe presence of erosive lesions [5, 6], a number of experi-mental studies have shown that the loss of hard dental tis-sue was greater in the combination of erosive impacts andbrushing of the teeth, rather than only by erosive action[7, 8]. While active ingredients like fluorides or agents with

There was also a twice higher risk of erosive lesions (OR =2.10; 1.37 – 3.24). A similar relation, but not statisticallysignificant, was established with regard to the brushing ofteeth immediately after consumption of erosive foods orbeverages (c2 = 3.01, P> 0.05) (Diagram 4).

Diagram 3. Distribution of children with erosion of permanent teeth depending on the frequency of tooth brushing

Diagram 4. Distribution of children with erosion on permanent teeth depending on tooth brushing immediatelyafter consumption of erosive foods or beverages

special anti-erosive properties were shown to offer somedegree of protection against erosion and combined erosion/abrasion, the abrasive effects of dentifrices may increasethe surface loss of eroded teeth [9]. The reason is the re-moval of the salivary pellicle layer during brushing, whichleads to a direct exposure of the tooth surface to erosiveimpacts. The co-destructive effect of the processes of abra-sion, attrition and erosion was experimentally proven [10,11, 12].

Al-Dlaigan et al. [13] found a significant correlationbetween tooth erosion and some oral hygiene habits suchas tooth brushing before bedtime, after meals, brushing tech-nique, brush type and brushing frequency. Nayak et al. [14]found that brushing frequency was a significant prognos-tic risk factor for dental erosion in primary teeth. A recentstudy of erosive tooth wear among 12-year-old schoolchil-

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dren has established that the extent of severe dental ero-sion depends on brushing frequency [15]. The results ofthese studies are consistent with the findings of the presentstudy and demonstrate the association between the oral hy-giene practices and the presence of erosive lesions in chil-dren.

CONCLUSIONThe recommendations for the frequency and timing

of the oral hygiene procedures in children should be con-sistent with the risk assessment of dental erosion.

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Address for correspondence:Tanya Nihtyanova,Department of Pediatric Dentistry, Faculty of Dental Medicine, Medical Uni-versity – Plovdiv3, Hristo Botev Blvd., 4000 Plovdiv, BulgariaE-mail: drnihtianova@gmail.com

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Please cite this article as: Nihtyanova T, Kukleva M, Miteva-Katrandzhieva T, Petrova S, Belcheva-Krivorova A. Studyof the Relationship between Oral-hygiene Habits and the Presence of Dental Erosion in Preschool and School Children.J of IMAB. 2018 Jul-Sep;24(3):2096-2099. DOI: https://doi.org/10.5272/jimab.2018243.2096

Received: 30/04/2018; Published online: 16/07/2018