The rise of dentine hypersensitivity and tooth wear in an ageing population.

Our understanding of the aetiology of dentine hypersensitivity (DH) has changed dramatically over the past few decades. It is no longer an enigma, but other problems exist. The prevalence of DH in the world and in particular in the UK is increasing, predominately due to increases in tooth wear and the erosive dietary intake in the younger population. DH is increasingly reported in all age groups and is shown to provide clinical indication of an active erosive tooth wear. As the population ages and possibly retain teeth for longer, the likelihood of tooth wear and DH could increase. This paper describes the prevalence, aetiology, diagnosis and management of DH in relation to tooth wear, which work together through a surface phenomenon. The aim is to raise awareness of the conditions and to help inform a prevention strategy in an ageing population, which starts from younger age groups to reduce disease into older age.

Observational study investigating tooth extraction and the shortened dental arch approach.

The shortened dental arch (SDA) provides a cost-effective dentition, considering the population is ageing and retaining teeth for longer. The aims were to observe the reasons and sites of tooth extraction and assess the functional dentition over 15 years in dental practice. Subjects were recruited who required permanent tooth extractions between 2000 and 2015. The reasons for extractions were chosen from twelve extraction codes. Data were also collected for demographics, tooth position, root treated teeth and functional pairs remaining. Patient-centred factors on reasons for tooth extraction and comments on chewing ability and aesthetics following extractions were recorded. Nine hundred and fifty-one teeth were extracted in 900 patients. The mean age was 60 years (SD 20, SE 7, 95% CI 46, 74). Reasons for extraction were periodontal disease (n = 361, 38%), periapical infection (n = 288, 34%) or tooth and tooth-root fractures (15%). Extractions included 201 (21%) second molars, 179 (19%) first molars, 152 (16%) second premolars, 95 (10%) first incisors, 86 (9%) second incisors, 76 (8%) canines and 67 (7%) first premolars. Following extractions, median functional pairs were 12, interquartile range (IQR) 19-7. Individuals with ≥10 functional pairs including anterior teeth (60%, n = 571) had no complaints with chewing ability or aesthetics. They did not require additional prostheses. Periodontal disease and periapical infection were the main causes for the extraction. First and second molars followed by second premolars were the most commonly extracted teeth. This study supports the SDA in creating a cost effective, functional dentition in an aging population, provided remaining teeth and restorations are preserved/maintained, oral health is promoted, and anterior aesthetic tooth replacement is ensured.

Effects of tooth-brushing force with a desensitising dentifrice on dentine tubule patency and surface roughness.

OBJECTIVES: To investigate the effects of a 5% NovaMin containing dentifrice on dentine tubule patency and surface roughness at 100g and 400g tooth brush abrasion forces. METHODS: 75 polished human dentine samples were prepared and randomly allocated into one of five groups; control (1), Na2PFO3 100g abrasion force (2), NovaMin 100g (3), Na2PFO3 400g (4) and NovaMin 400g (5). The control group underwent two 2-min cycles of artificial saliva (AS), one 2-min erosion cycle; the rest underwent two toothbrush abrasion cycles in an AS/dentifrice slurry and one 2-min erosion cycle. All samples were imaged at baseline and post intervention using Tandem Scanning Microscopy and Profilometry to analyse tubule patency and roughness. RESULTS: Mean tubule patency increased significantly between baseline and post intervention in groups 1,2 and 4 and decreased significantly post intervention in groups 3 and 5 (p<0.01). Post intervention, there were statistically significant differences in mean patent tubules between NovaMin and the Na2PFO3 and control groups (p<0.001). Surface roughness increased for all groups between baseline and post interventions (P<0.001); mean (SD) roughness increases for groups 1, 2, 3, 4 and 5 were 0.14 (0.05) µm, 0.18 (0.04) µm, 0.16 (0.06) µm, 0.19 (0.07) µm and 0.21 (0.02) µm respectively. Differences between group 1 and 5 were significant (p<0.01). CONCLUSIONS: Brushing with NovaMin resulted in significant dentine tubule occlusion at 100g and 400g, but brushing with Na2PFO3 resulted in increased tubule patency. Surface roughness increased significantly at 400g brushing with NovaMin. There was no correlation between tubule patency and surface roughness. CLINICAL SIGNIFICANCE: A NovaMin desensitising dentifrice resulted in tubule occlusion even at high brushing forces. There was minimal increase in surface roughness at the lower (100g) brushing force.

Validation of the Basic Erosive Wear Examination.

The Basic Erosive Wear Examination (BEWE) is a practical index for screening tooth wear, using a 4-point ordinal scale (0-3). The highest score is recorded in each sextant and a total score (or BEWE sextant cumulative) is calculated per subject. This study aims to investigate if the BEWE sextant cumulative score compares to one comprising a percentage score from all tooth surfaces and as a highest BEWE per subject. The aim is to assess the validity of this score. A total of 350 subjects were recruited from hospital and general practice in south-east England. Buccal, occlusal and lingual/palatal BEWE scores were collected and percentages calculated based on scores 1, 1 and above, 2 and above and 3. BEWE sextant cumulative scores and highest BEWE scores were also recorded per subject. Spearman's correlation coefficients (p values) assessed the relationship between BEWE sextant cumulative scores, BEWE percentages and BEWE highest score per subject. The BEWE sextant cumulative score correlates significantly to a BEWE score taken as a percentage score from all tooth surfaces (Spearman's r > 0.5, p < 0.001) and especially to BEWE surface scores of 1 and above and 2 and above (r > 0.8, p < 0.001) and as a highest surface score per subject (r > 0.8, p < 0.001). BEWE sextant score provides a representation of tooth wear on all tooth surfaces. This study validates a tooth wear index, which provides clinicians with risk indicators of a patient's level of tooth wear and may help to guide clinical management.

A novel method to quantify dentine tubule occlusion applied to in situ model samples.

OBJECTIVES: To develop an innovative computerised routine, in conjunction with a minimally destructive imaging technique, to quantify dentine tubule occlusion. METHODS: Polished human dentine samples (n = 480) were brushed during a 4-day in situ study with two occlusion-based dentifrices, a sodium fluoride control dentifrice (1,450 ppm) or water. Samples were imaged with tandem scanning microscopy (TSM) and conventional scanning electron microscopy (SEM). The level of dentine patency was then assessed using a visual ordinal scale ('standard') or quantitatively using a specially designed computational routine. RESULTS: The occlusion-based dentifrice resulted in significantly less patent dentine than controls for the 'standard' (p = 0.01) assessment, but not for computer analyses (p = 0.10). The correlation of the number of individual patent tubules counted visually and by the computational routine in calibrations and in the in situ study was ≥ 0.8. CONCLUSIONS: This study identified a new computer-based routine, capable of objectively quantifying the patency of dentine imaged by SEM and TSM.

Why are children still having preventable extractions under general anaesthetic? A service evaluation of the views of parents of a high caries risk group of children.

Introduction Despite overall improvements in oral health, the number of children admitted to hospital for extraction of teeth due to caries under general anaesthesia (GA) has been reported as increasing dramatically in England. The new UK government plans to transform NHS dentistry by improving oral health.Aim To evaluate the dental care received by children who required caries-related extractions under GA and obtain the views of their parents or guardians on their experiences of oral health services and the support they would like to improve their child's oral health, to inform future planning.Method An interview questionnaire was designed and piloted to collect data from a consecutive sample of 100 parents or guardians during their child's pre-operative assessment appointment. This took place at one London dental hospital between November 2009 and February 2010.Results Most children were either white (43%) or black British (41%); the average age was seven years (range 2-15, SD 3.1, SE 0.31) and the female:male ratio was 6:5. Most (84%) had experienced dental pain and 66% were referred by a general dental practitioner (GDP). A large proportion of parents or guardians (47%) reported previous dental treatment under GA in their children or child's sibling/s. Challenges discussed by parents in supporting their child's oral health included parenting skills, child behaviour, peer pressure, insufficient time, the dental system and no plans for continuing care for their child. Three out of four parents (74%) reported that they would like support for their child's oral health. Sixty percent of all parents supported school/nursery programmes and 55% supported an oral health programme during their pre-assessment clinic.Discussion These findings suggest that the oral health support received by high caries risk children is low. Health promotion programmes tailored to this cohort are necessary and our findings suggest that they would be welcomed by parents.