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 Table of Contents  
Year : 2015  |  Volume : 18  |  Issue : 4  |  Page : 188-191

Risk factors for tooth wear lesions among patients attending the dental clinic of a Nigerian Teaching Hospital, Benin City: A pilot study

1 Department of Preventive Dentistry, Community Dentistry Unit, University of Benin Teaching Hospital, Benin City, Nigeria
2 Department of Preventive Dentistry, Paediatric Dentistry Unit, University of Benin Teaching Hospital, Benin City, Nigeria

Date of Web Publication16-Feb-2016

Correspondence Address:
Okeigbemen A Sunny
Department of Preventive Dentistry, University of Benin Teaching Hospital, Benin City
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1118-8561.176587

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Aims: This study was to evaluate the risk factors associated with tooth wear lesions in patients attending a dental clinic. Context: Tooth wear lesions entail the loss of dental hard tissues in the absence of caries or trauma. They include abrasion, attrition, and erosion. The etiology is often related to habits leading to insidious symptoms with similar presentations in both community and hospital patients. Materials and Methods: This cross-sectional study involved patients attending the outpatient dental clinic of a Nigerian Teaching Hospital over a 3-month period. A semi-structured questionnaire was used to elicit information from the respondents. Results: A total of 152 respondents aged 17–80 years and above, comprising 86 males (56.6%), and 66 females (43.3%) constituted the study population. The Binis were the most represented 34.2%, followed by the Esans 21.1%, while the least represented were the Yorubas (6.6%). The occupations represented in this study include civil servants (30.3%), unskilled workers (23.7%), and non-medical professionals (7.9%). Tooth wear lesions were present in 55.3% of the respondents. Attrition accounted for 29.6%, Abrasion (11.8%), combination of attrition and abrasion (4.6%), and abfraction (2.0%). There was a statistically significant association between tooth wear lesions and age, occupation, sensitivity or pain, tooth cleaning aids, toothbrush texture brushing technique, intake of carbonated beverages, and method of intake. Conclusion: Tooth wear lesions such as attrition and abrasion were prevalent among the respondents in this hospital setting and, therefore, represent an important group of dental problems among this population. It is, therefore, important to direct the appropriate oral health awareness program for the prevention, early detection, and management of these conditions.

Keywords: Risk factors, sociodemographic, tooth wear lesions

How to cite this article:
Sunny OA, Philip OU, Amaechi UA. Risk factors for tooth wear lesions among patients attending the dental clinic of a Nigerian Teaching Hospital, Benin City: A pilot study. Sahel Med J 2015;18:188-91

How to cite this URL:
Sunny OA, Philip OU, Amaechi UA. Risk factors for tooth wear lesions among patients attending the dental clinic of a Nigerian Teaching Hospital, Benin City: A pilot study. Sahel Med J [serial online] 2015 [cited 2022 Jun 26];18:188-91. Available from: https://www.smjonline.org/text.asp?2015/18/4/188/176587

  Introduction Top

Tooth wear is the loss of hard dental tissues in the absence of caries or trauma and is a response to chemical or mechanical damage presenting as erosion, abrasion, and attrition.[1],[2],[3] Attrition is the mechanical wearing away of the hard dental tissues due to tooth-to-tooth contact with no foreign substance intervening. Abrasion denotes the wearing of hard dental tissue by mechanical processes involving foreign objects or substances repeatedly introduced into the mouth while contacting the teeth. Dental erosion is refers to the loss of dental hard tissue by a chemical process that does not involve bacteria.[4] Etiological factors include oral hygiene habits such as the use of abrasive toothpaste, aggressive tooth brushing or prolonged duration of time excessive flossing; personal habits such as frequently putting foreign objects between teeth such as tailors holding needles between teeth, occupational exposure to abrasive in detersive food (demastication), erosion in battery chargers, and automobile mechanics.[5]

Abfraction occurs as a result of shear stress in the cemento-enamel junction of the tooth, leading to tooth flexure that causes tiny fractures in enamel and dentine.[6] Stress that leads to tooth flexure can be caused by chewing or by tooth grinding commonly referred to as noncarious-cervical lesions.[7],[8]

Dental erosion is the chemical dissolution of dental tissue and can be caused by extrinsic acids ingested acidic food, carbonated drinks, and beverages; or from intrinsic hydrochloric acid from the stomach the erosive process goes through enamel softening, mineral loss from dissolution to expose the underlying dentine.[7]

Epidemiologic studies suggest that between 5% and 50% of the general population have tooth wear lesions. Prevalence varies across different age and occupational groups, geographic areas, and cultures. Studies from the Caribbean and Nigeria have shown that sex and age are associated with the prevalence of tooth wear.[9],[10]

The information obtained in this study will stimulated further research in this area and improve diagnosis, clinical care, and prevention. The aim of this study was, therefore, to evaluate the risk factors associated with tooth wear lesions in patients attending our dental clinic.

  Materials and Methods Top

This cross-sectional study was carried out to determine the risk factors for tooth wear lesions among patients attending the outpatient dental clinic of University of Benin Teaching Hospital, Benin City, Edo State. Benin City, the state capital of Edo State, in the South-South geopolitical zone of Nigeria; is a Cosmopolitan city located within the tropical rain forest. Though dominantly a Bini-speaking city, virtually other ethnic groups are represented in and around Benin City. Christians and the African traditional religion are significantly common. There are 18 local government areas in Edo State among which are Egor. The inhabitants are multi-ethnic-mainly the Binis, Esans, Ibos, Urhobos, Etsakos, and Yorubas. New patients aged 17 years and above attending the outpatient dental clinic of the University of Benin Teaching Hospital over a 3-month period constituted the study population. Exclusion criteria included patients with more than one missing an opposing pair of premolars or molars, restorations covering the entire surface of incisors, canines, premolars, and molar. Ethical approval was obtained from the Ethics and Research Committee of the University of Benin Teaching, Benin City while the informed consent was obtained from the participants. A 12-item semi-structured questionnaire was administered to elicit information on sociodemography, oral habits/antecedent risk factors, and respondents' feeling of discomfort from tooth wear.

An intraoral examination was carried out on well-illuminated dental chairs at the dental clinic, using wooden spatulas for initial screening then hand gloves, dental mirrors, and dental probes to assess the teeth for tooth wear lesions. The two examiners (UP and AU) had been calibrated on the diagnostic criteria for tooth wear lesions. Prior to examination, the teeth were dried using cotton wool rolls. Tooth wear examination guidelines as described by Kelleher and Bishop [11],[12] were used, tooth surfaces were examined; occlusal or incisal for attrition, cemento-enamel junction for abrasion and labial, buccal, palatal, and lingual surfaces for erosion.

An inter-examiner reliability of 88% was obtained by the two examiners. Data were analyzed using the SPSS version 16.0 (SPSS 2007). Chi-square test of association was used for categorical variables. The level of significance was set at 5%.

  Results Top

A total of 152 respondents with age range 17–80 years and with a mean age of 37.9 years (standard deviation = 13.5), comprising 86 males (56.6%) and 66 females (43.3%) were involved in the study. A significant proportion (32.2%) were aged 26–35 years, 23.0% were aged 36–45 years, while the least age category belonged to the age group of 66–80 years 2.0%. The Bini's were the most represented ethnic group (34.2%), with civil servants being the most represented occupation (30.3%), unskilled workers 23.7%, students 25.0%, and medical professionals 13.2%. Tertiary level of education accounted for the highest category (63.2%) [Table 1].
Table 1: Sociodemographic characteristics of the dental patients

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Eighty-four (55.3%) respondents had at least one tooth wear lesion of which 45 (29.6%) had attrition, 18 (11.8%) abrasion, 11 (7.2%) erosion, 3 (2%) abfraction [Table 2], and 7 (4.6%) a combination of abrasion and attrition [Figure 1].
Table 2: Frequency distribution of study participants by age

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Figure 1: Prevalence of tooth wear lesions among the study participants

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The association between age, gender, occupation, oral related habits/antecedent factors and discomfort in form of pain and sensitivity, and tooth wear lesions [Table 3].
Table 3: Relationship between oral health-related habits/antecedent factors and tooth wear

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  Discussion Top

Tooth wear, a loss of dental hard tissues in the absence of caries or trauma can present with pain, the problem with chewing, speech, and facial appearance 1. This will ultimately have a major impact on the individuals' quality of life and by extension, their social wellbeing.

In this study, the prevalence of tooth wear lesions was 55.3%. This finding is similar to the 53% and 58.6% reported by Ibiyemi et al.[14] and Taiwo et al.,[9] respectively but contrasts with the 26% reported by Saerah et al.[10] This disparity might be related to differences in an age which was 16 years compared to the current study which had 38 ± 13 years. In the Nigerian population, attrition has been reported to be the most common type of tooth wear.[8],[9],[15] A similar trend was observed in the present study in which attrition was the predominant form of the tooth wear lesion. This may be due to the study being conducted in the hospital setting as against community-based studies. The preponderance of attrition has been attributed to the high fibrous diet and forceful masticatory activity of the Nigerian populace.[14] In contrast, Daly et al.,[16] found abrasion to be the most common form of tooth wear in Kelantan, Malaysia. Erosion on the other hand was the most common in the etiology of tooth wear in an European population,[17] where this has been related to their contemporary lifestyle habits and diet such as high consumption of acidic drinks and beverages.

The occurrence of wear lesions was observed to be influenced by age and gender and thought to increase with increasing age in susceptible patients.[10],[18] In this study, males developed more tooth wear lesions than females similar to previous studies This may either be due to males having a higher bite force than females or different dietary patterns which is how foods and other nutrients are consumed in combinations.[19],[20]

There was a significant difference in the presence of tooth wear between occupations. Donachie and Walls [19] in their study on an ageing population observed variation between subjects of different social class backgrounds which is similar to our findings. In the present study, tooth wear was significantly associated with occupation, tooth cleaning aid, toothbrush texture, frequency of intake of carbonated soft drinks, and the drinking method [22] also observed that oral hygiene practices such as brushing techniques, toothbrush texture, and frequency of tooth brushing were associated with tooth wear lesion. Incidence of tooth wear was higher in those who combined different tooth cleaning methods, use hard texture brushes, took soft drinks, and pooled the soft drinks than those did otherwise. Addy [23],[24] reported that tooth brushing techniques and tooth brushing frequency were independent risk factors for increasing tooth wear. The observed positive relationship between material for cleaning and tooth wear in this study might be due to the application of too much pressure on the tooth or toughness of the brush bristles.

Discomfort following tooth wear was also a significant finding. Most of the participants with tooth wear lesions also reported pain discomfort. This is similar to the study by Daly et al.,[16] where most respondents had discomfort. Dentine sensitivity despite the exposure of extensive areas of dentine which was attributed to the formation of sclerosed dentine and smear layers on the surface of the tooth.[25]

  Conclusion Top

In conclusion, this study has provided data on the prevalence of tooth wear lesions in an adult Nigerian population within an urban area. Tooth wear lesions were also associated with social class, age, discomfort, tooth cleaning aids, type of toothbrush bristle, and brushing technique as well as frequency and method of intake of carbonated drinks.

Knowledge of these risk factors of the tooth is important, and there is a need for enhanced awareness for tooth wear prevention among the population. Emphasis on the importance of good dietary intake, habits, and ways of food intake is essential.

  References Top

Litonjua LA, Andreana S, Bush PJ, Cohen RE. Tooth wear: Attrition, erosion, and abrasion. Quintessence Int 2003;34:435-46.  Back to cited text no. 1
Mulic A, Tveit AB, Skaare AB. Prevalence and severity of dental erosive wear among a group of Norwegian 18-year-olds. Acta Odontol Scand 2013;71:475-81.  Back to cited text no. 2
Osborne-Smith KL, Burke FJ, Wilson NH. The aetiology of the non-carious cervical lesion. Int Dent J 1999;49:139-43.  Back to cited text no. 3
Imfeld T. Dental erosion. Definition, classification and links. Eur J Oral Sci 1996;104:151-5.  Back to cited text no. 4
Barbour ME, Rees GD. The role of erosion, abrasion and attrition in tooth wear. J Clin Dent 2006;17:88-93.  Back to cited text no. 5
Grippo JO. Abfractions: A new classification of hard tissue lesions of teeth. J Esthet Dent 1991;3:14-9.  Back to cited text no. 6
Afolabi AO, Shaba OP, Adegbulugbe IC. Distribution and characteristics of non carious cervical lesions in an adult Nigerian population. Nig Q J Hosp Med 2012;22:1-6.  Back to cited text no. 7
Ibiyemi O, Taiwo JO. Some socio-demographic attributes as covariates in tooth wear among males in a rural community in Nigeria. Ethiop J Health Sci 2012;22:189-95.  Back to cited text no. 8
Taiwo JO, Ogunyinka A, Onyeaso CO, Dosumu OO. Tooth wear in the elderly population in South East Local Government area in Ibadan, Nigeria. Odontostomatol Trop 2005;28:9-14.  Back to cited text no. 9
Saerah NB, Ismail NM, Naing L, Ismail AR. Prevalence of tooth wear among 16-year-old secondary school children in Kota Bharu Kelantan. Arch Orofac Sci 2006;1:21-8.  Back to cited text no. 10
Kelleher M, Bishop K. Tooth surface loss: An overview. Br Dent J 1999;186:61-6.  Back to cited text no. 11
Smith BG, Knight JK. An index for measuring the wear of teeth. Br Dent J 1984;156:435-8.  Back to cited text no. 12
SPSS Inc. Released 2007. SPSS for Windows, Version 16.0. Chicago, SPSS Inc.  Back to cited text no. 13
Ibiyemi O, Oketade IO, Taiwo JO, Oke GA. Oral habits and tooth wear lesions among rural adult males in Nigeria. Arch Orofac Sci 2010;5:31-5.  Back to cited text no. 14
Esan TA, Olusile AO, Akeredolu PA, Esan AO. Socio-demographic factors and edentulism: The Nigerian experience. BMC Oral Health 2004;4:3.  Back to cited text no. 15
Daly RW, Bakar WZ, Husein A, Ismail NM, Amaechi BT. The study of tooth wear patterns and their associated aetiologies in adults in Kelantan, Malaysia. Arch Orofac Sci 2010;5:47-52.  Back to cited text no. 16
Smith BG, Robb ND. The prevalence of toothwear in 1007 dental patients. J Oral Rehabil 1996;23:232-9.  Back to cited text no. 17
Oginni O, Olusile AO. The prevalence, aetiology and clinical appearance of tooth wear: The Nigerian experience. Int Dent J 2002;52:268-72.  Back to cited text no. 18
Donachie MA, Walls AW. Assessment of tooth wear in an ageing population. J Dent 1995;23:157-64.  Back to cited text no. 19
Nunn JH. Prevalence of dental erosion and the implications for oral health. Eur J Oral Sci 1996;104:156-61.  Back to cited text no. 20
Harnack L, Stang J, Story M. Soft drink consumption among US children and adolescents: nutritional consequences. J Am Diet Assoc 1999; 99: 436-41.  Back to cited text no. 21
Addy M, Hunter ML. Can tooth brushing damage your health? Effects on oral and dental tissues. Int Dent J 2003;53 Suppl 3:177-86.  Back to cited text no. 22
Addy M. Tooth brushing, tooth wear and dentine hypersensitivity – Are they associated? Int Dent J 2005;55:261-7.  Back to cited text no. 23
Hunter ML, Addy M, Pickles MJ, Joiner A. The role of toothpastes and toothbrushes in the aetiology of tooth wear. Int Dent J 2002;52:399-405.  Back to cited text no. 24
Pashley DH, Tay FR, Haywood VB, Collins MC, Drisko CL. Dentin hypersensitivity: Consensus-based recommendations for the diagnosis and management of dentin hypersensitivity. Inside Dent 2008;49:1-35.  Back to cited text no. 25


  [Figure 1]

  [Table 1], [Table 2], [Table 3]


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