Donia Abd El Lattif V year, Group 14 Relationship between diet, lifestyle, health issues and dental erosion development in children: A systematic review Master’s thesis Supervisor Sandra Petrauskiene Kaunas, 2020 1 FINAL MASTER‘S THESIS IS CONDUCTED 2 LITHUANIAN UNIVERSITY OF HEALTH SCIENCES MEDICAL ACADEMY FACULTY OF ODONTOLOGY CLINIC FOR PREVENTIVE AND PEDIATRIC DENTISTRY Relationship between diet, lifestyle, health issues and dental erosion development in children: A systematic review Master’s thesis The thesis was done by student …………………………………… Supervisor ………………………….. (signature) (signature) ……………………………………………….. …………………………………………….. (name, surname, year, group)(degree, name, surname) …………………….20……….. ………………….20………………. (day/month) (day/month) Kaunas, 2020 3 TABLE OF CONTENTS SUMMARY: ...................................................................................................................................6 INTRODUCTION: ..........................................................................................................................7 1. SELECTION CRITERIA OF THE STUDIES. SEARCH METHODS AND STRATEGY ........9 1.1 LITERATURE SEARCH STRATEGY .................................................................................. 9 1.2 INCLUSION AND EXCLUSION CRITERIA ....................................................................... 9 2. SYSTEMISATION AND ANALYSIS OF DATA .....................................................................14 3. DISCUSSION ...............................................................................................................................19 4. CONCLUSIONS ..........................................................................................................................20 REFERENCES ..................................................................................................................................22 ANNEXES ........................................................................................................................................27 4 ABBREVIATIONS: DE- Dental erosion ETW- Erosive tooth wear GERD- Gastroesophageal reflux disease BEWE- Basic Erosive Wear Examination WIMD- The Welsh Index of Multiple Deprivation TWI- Tooth Wear Index CS- Cross-sectional study Gr- grade SG- Study group CG- Control group 5 SUMMARY Objective: To evaluate relationship between diet, lifestyle, health issues and DE development in children. Materials and Methods: According to the PRISMA guidelines, publications of this systematic review were selected through PubMed and ResearchGate. The comprehensive search was restricted to English language articles, published from 2009 to 2019. Finally, 11 articles were selected in this systematic review. Results: The size of samples varied from 112 to 3812 subjects aged 3-18-year-old. Prevalence of DE varied from 3.9% to 98.1%. Grade 1 and 2 were the most prevalent of various indexes and while dental erosion were affected enamel structure, while dentine was not exposed in majority of subjects. Regular consumption of carbonated soft drinks, sport beverages or dietary acids were strongly associated with DE (OR: 3.42; 95% CI: 1.18-9.23; OR: 4.0; 95% CI: 2.1-7.6; OR: 3.99, 95% CI=1.37-11.59 (p=0.011)). Regular tooth brushing increases the risk for DE (OR = 1.7, CI 1.1–2.6). Visible dental plaque is a risk factor (OR: 2.0; 95 % CI: 1.2–3.4) of DE as well. Biological factors such as GERD, frequent vomiting and intake of certain medication are significantly related to DE development. Conclusion Improper dietary habits as daily consumption of carbonated drinks, sports drinks and sour sweets were the most commonly investigated and were significantly associated with DE development in children and adolescents. Moreover, biological and background related factors like GERD or asthma, lifestyle related factors (swimming in the pools) or background related factors such as gender, socioeconomic factors and parental education tend to increase the risk for DE development. Keywords: dental erosions, diet, GERD, soft drinks, acidic food, carbonated drinks, adolescents 6 INTRODUCTION Tooth erosion is a chronic irreversible loss of tooth structure such as enamel and dentine which can be distinguished depending on the type of acid involved and its´ origin [1]. The worldwide prevalence of dental erosion in children and adolescents remain unclear with rates ranging from 7.5% to 95%. Worldwide dental erosion is common in children and young people, and that, when present, it progresses rapidly [2]. The rates can be explained by various indices including age, type of examined tooth and geographic factors [3]. During the last decade there has been a significant increase in the prevalence and severity of erosive tooth wear, particularly in adolescents [4]. The increased morbidity that has been observed in recent years may be an indication that dental erosion has become an oral health problem that cannot be ignored in industrialized and developing countries [5]. From the clinical point of view, dental erosions can range from broad concavities in smooth tooth enamel or loss of enamel surface anatomy, cupping out of occlusal surfaces with dentine exposure [6]. Consequently, dental erosions may result in sensitivity, pain or discomfort, functional problems, or deterioration of aesthetic appearance [7], thus the child may suffer from severe tooth surface loss, tooth sensitivity, over closure, poor aesthetics, or even dental abscesses in the affected teeth [8]. This chemical–mechanical process may affect both the primary and the permanent dentitions [9]. The presence of dental erosion in the primary dentition may be a risk for erosive tooth wear in the permanent dentition [10]. Primary teeth are more susceptible to DE than permanent teeth due to the structural differences between both dentitions. Dentine involvement of DE may evolve more rapidly in primary dentition than permanent dentition due to the thinner enamel layer and higher content of water by volume [11]. In addition, the slower salivary sugar clearances and the lower salivary flow rates in children may contribute to increased susceptibility for erosion in children [12]. The causes of dental erosions are multifactorial and the subtle changes are present in the beginning stages, thus diagnosis of risk factors may be difficult [13]. Clinical appearance is the most important factor for diagnosing the condition, especially in the early stages [14]. There are different predisposing factors and etiologies of the erosive condition. The interplay of chemical, biological and behavioral factors is crucial and helps explain why some individuals exhibit more erosion than others, even if they are exposed to the same acid challenge in their diets [15]. Extrinsic factors include the consumption of acidic foods and carbonated beverages, citrus fruits, low pH medications and, to a lesser degree, occupational exposure to acidic environments 7 (occupation around acidic/chlorinated industrial environment), sports (swimming in heavily chlorinated pools), lifestyle habits (swallowing and drinking habits, consumption of acidic beverage at bedtime). [16]. Most clinical research has focused on the impact of diet and lifestyle [17]. Sports drinks contain both free sugars and acids and have the ability to cause both dental caries and erosion [18]. The intrinsic factors include diseases that cause vomiting or regurgitation, such as gastro- esophageal reflux, anorexia and bulimia nervosa, or illnesses that cause a reduction in saliva flow [19]. In GERD patients, gastric acids with low pH reach the oral cavity and leads to teeth wear [8]. Biological factors such as saliva and its contribution to pellicle formation are considered the most important. Unstimulated salivary flow rate and buffering capacity were proven that they were associated with dental erosion [12]. The buffering capacity of saliva is dependent on flow rates and is responsible for neutralizing and clearing acids that cause dental erosion. [20, 21]. A low pH has also been proven to be associated with DE. Thus, pH of 5.5 (below 7) was proven to be a potential cause of DE [22]. Moreover, dentine is more susceptible to erosion than enamel, and it can be eroded at a relatively high pH (∼6.0) [23]. In addition, behavioral factors such as eating and drinking habits, regular exercise with dehydration and decrease of salivary flow, excessive oral hygiene and, on the other side, an unhealthy lifestyle, e.g. chronic alcoholism, are predisposing factors for dental erosion.[15]. Child’s oral-health status is often related to social dimensions, such as parental income and education, family structure and parenting quality. These factors have impact not only on oral health status, but also they influence psychological and psychosocial attributes in children. [24,25] The fact that DE seems to be an increasing problem in children and adolescents and may cause extensive loss of tooth substance that require complicated and expensive restorative treatments, makes it essential for clinicians to pay attention to this condition [26]. Aim: To evaluate relationship between diet, lifestyle, health issues and dental erosion development in children. Objectives: 1. To search and analyze which risk factors are related to dental erosion development in children and adolescents. 2. To assess the prevalence and most prevalent severity of dental erosion in this systematic review. 3. To evaluate associations between risk factors and dental erosions in this systematic review. 8 1.SELECTION CRITERIA