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Although we are increasingly recognising the need to assess patients for accelerated rates of tooth wear progression, it is often difficult to do so within a feasible diagnostic window. This paper aims to provide evidence-based timelines which a diagnosing clinician can expect to assess tooth wear progression in study models, clinical indices, clinical photographs and visually with intraoral scans. It also discusses new technologies emerging for the quantitative assessment of tooth wear, timelines for diagnosis, and caveats in the 3D scan registration and analysis process., (© 2023. The Author(s).)

Tooth wear is a commonly reported finding globally; however, many patients are unaware of having tooth wear. Identifying early signs of erosion, abrasion or attrition and determining the risk factors contributing to a patient's tooth wear may help to prevent further loss of enamel and dentine in the future. Appropriate prevention should be instigated, or appropriate referral made to other health professionals, when conditions such as gastroesophageal reflux or eating disorders are suspected. This paper presents the epidemiology and aetiological factors for tooth wear, as well as identifying the common clinical presentations of tooth wear. Patient perspectives on tooth wear and preventive techniques that can be utilised are also discussed., (© 2023. The Author(s), under exclusive licence to the British Dental Association.)

Gastro-oesophageal reflux disease (GORD) is a relatively common condition that occurs in adults and less commonly in children. It develops when the reflux of stomach contents into the oesophagus causes troublesome symptoms and/or complications. Signs and symptoms include heartburn, retrosternal discomfort, epigastric pain and hoarseness, dental erosion, chronic cough, burning mouth syndrome, halitosis and laryngitis. A proportion of patients will, however, have silent reflux. Strongly associated risk factors include family history, age, hiatus hernia, obesity and neurological conditions, such as cerebral palsy. There are different treatment options which may be considered for GORD, consisting of conservative, medical and surgical therapy. Dentists should be aware of the symptoms of GORD and dental signs of intrinsic erosion indicative of possible GORD so that they can question patients about this and, if appropriate, initiate a referral to a general medical practitioner., (© 2023. The Author(s).)

A review of the literature on night guards left questions unanswered about the risk and possible causes of occlusal derangement linked to night guard design and use. Cases are presented where night guard use resulted in anterior open bite and associated occlusal derangement. The aetiology of the occlusal changes observed is discussed. It is concluded that adverse occlusal effects linked to the use of night guards may be found to be more common than anticipated from existing literature. Patient follow-up is essential to monitor the use and effects of night guards, and regardless of appliance type, unintended occlusal changes may result. The use and effects of partial coverage appliances require very careful monitoring. Suggestions are provided for information and written instructions to be given to patients provided with night guards and removable orthodontic retainers.

Objective To assess charting, risk assessment and treatment-planning of tooth wear between recently qualified and experienced dentists in general dental practice.Design Service evaluation.Setting Multi-setting evaluation of three mixed NHS/Private general dental practices in North-East London.Methods The clinical notes of new patient examinations on dentate adults presenting from the 1 October 2016 to 31 December 2016 were audited collecting data on tooth wear charting, risk assessment and treatment planning. Data were analysed using descriptives, chi square and logistic regressions in SPSS. Significance was inferred at p <0.05.Results Foundation dentists and experienced dentists performed 85 and 200 new patient examinations, respectively, during the evaluation period. Tooth wear was charted for 48% of those attending foundation dentists and 5% of those attending experienced dentists. Diet was assessed in 50.6% of patients examined by foundation dentists and 1.0% of patients examined by experienced dentists. Foundation dentists were more likely to chart tooth wear, risk assess and preventively manage tooth wear compared to experienced dentists (p <0.001).Conclusion This service evaluation highlights that improvements are required in recording, risk assessing and preventive treatment planning of erosive tooth wear. Experienced dentists were less likely to risk assess tooth wear and less likely to provide preventive treatment. Experienced GDPs may benefit from re-training in this area.

An acidic diet has been associated with erosive tooth wear. However, some people who consume dietary acids develop erosive tooth wear and some do not. This review paper provides an overview of the risk factors of dietary acid consumption which increase the likelihood of developing severe erosive tooth wear. Increased frequency of dietary acid consumption, particularly between meals appears to be the predominant risk factor. However, habitually drinking acidic drinks by sipping them slowly or swishing, rinsing or holding acidic drinks in the mouth before swallowing will also increase risk of progression. Consuming fruit over long time periods at a single sitting and dietary acids being served at increased temperatures have also been implicated. Additions of fruit or fruit flavourings to drinks and regular consumption of vinegars, pickles, acidic medications or acidic sugar-free sweets are potential hidden risk factors that should be discussed with patients at risk of erosive tooth wear progression. Behaviour change is difficult to achieve but specific, targeted behavioural interventions and offering alternatives may increase success.

There are many reasons why it is vital that dental professionals identify signs and symptoms that suggest that an individual's erosive tooth wear (ETW) may be linked to a broader medical problem than just poor diet. Primarily, spotting an underlying medical cause for ETW increases the likelihood that further deterioration in the individual's oral health will be prevented. However, perhaps more importantly, many of the medical conditions which are commonly related to ETW can have serious and even possibly fatal consequences if left untreated or not diagnosed. This paper reviews the nature of the most common and serious medical conditions related to ETW, such as gastro-oesophageal reflux disease (GORD), laryngo-pharyngeal reflux (LPR) and eating disorders. This article also covers the role of the dental team in the diagnoses, prevention and management of these conditions.

Erosion is a common phenomenon in the general population of developed countries. However, due to variations in indices, sample sizes and general study designs, it is difficult to compare the various studies and to estimate actual global prevalence. Therefore, the aim of this present paper is to give a narrative overview on the data available on the global prevalence of erosion. Information on prevalence is not available from each country; in particular, data from Asia, Africa, South America, North America and large parts of South-Eastern Europe are unavailable. There is a large variation in global prevalence ranging between 0 and 100%. Calculating a rough mean from the data available, a mean prevalence in deciduous teeth between 30% and 50% and in permanent teeth between 20% and 45% can be estimated. There seems to be a gender difference and an increase in prevalence with age. Prevalence studies on erosion risk groups show comparable variation. Only in patients with gastro-oesophageal reflux disease (GORD) and eating disorders associated with vomiting can a clear impact on erosion prevalence be found. In people who consume acidic foods and drinks, a higher risk can be found for some specific comestibles. However, there is a lack of controlled epidemiological studies, making it difficult to generalise. There is a clear need for well-designed studies on this issue.

Aim: To determine the prevalence of signs and symptoms in a group of tooth wear patients referred to a hospital-based consultant clinic., Method: The clinical records of 290 patients referred to the Liverpool University Dental Hospital for tooth wear were reviewed retrospectively. A systematic sampling technique was used to select every alternate patient held on the consultant database., Results: There were significantly more males than females in a ratio of 2.3:1. Significantly more males (56%) presented with severe tooth wear compared with females (31%) (p <0.001). Aesthetic concerns were the most prevalent presenting complaint (59%) and sensitivity was the second most common presenting complaint (40%). Functional problems and pain were less prevalent at 17% and 14% respectively. Subjects who had lost posterior support had more severe wear and more worn anterior teeth, which was statistically significant (p = 0.001). The proportion of subjects with undiagnosed apical pathology on worn teeth was 13%., Conclusions: Tooth wear predominated in males in this study. Patient dissatisfaction with appearance is the most common complaint and endodontic signs and symptoms are low in prevalence. Contrary to previous studies, lack of posterior support resulted in greater severity of wear, therefore restoring support is recommended.

The aim of this series of four articles on tooth wear management is to provide the reader with the necessary information in order to be able to successfully manage cases of tooth wear, regardless of the cause, severity and location of the wear pattern seen. The content will largely focus on contemporary clinical techniques, illustrated where possible by case examples. Emphasis will be placed on 'additive adhesive techniques' utilising fixed prosthodontic protocols; however, cases of tooth wear amongst partially dentate patients involving the use of removable prostheses will also be described. The importance of patient consent and contingency planning will also be discussed. Paper 1 will describe the assessment of the wear patient, including the rationale for the planning of dental care. Also discussed will be the administration of preventative and passive management strategies for cases displaying tooth wear.

Aims and Objectives: This audit was carried out to assess the level to which recall intervals were individually and appropriately selected for patients attending dental practices across a primary care trust (PCT) area in Essex., Method: A retrospective audit was carried out by reference to patient records to assess various criteria, including whether patients were categorised according to risk of oral disease, whether an appropriate recall had been selected and whether a discussion regarding a recall interval had been undertaken. An educational event highlighting the issue of recall intervals was held. Subsequent to this a prospective audit was undertaken to assess relevant criteria., Results: Prospective audit data showed a marked increase in the use of patient risk assessments for caries, periodontal disease, oral cancer and non-carious tooth surface loss (NCTSL). Recall intervals were also more often selected based on a patient's risk status and discussed with the patient compared to that observed in the retrospective audit data., Conclusion: This audit was successful as a tool to bring about change in the behaviour of dentists regarding their determination of appropriate recall intervals for patients. Whether that change in behaviour is long-term or transient requires further investigation.