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EP7
A service evaluation investigating the use of tooth wear risk assessment and the use of screening tools in general dental practice

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Background:

  • Regarding erosion, there is ‘evidence that the presence of this condition is growing steadily’. [1]

  • Many adults are mainly seen with moderate tooth surface loss where values have risen from 11% in 1998 to 15% in 2009. [2][3]

To prevent or reduce non-carious tooth wear, it is important to recognise, grade, diagnose and monitor the severity, cause and progression of tooth wear. [4]

BEWE:

Basic Erosive Wear Examination (BEWE) is a  recently developed screening tool for general dental practitioners to assess and record the severity of tooth wear [5].

Objectives:

  • Identify risk assessment, charting and use of a screening tool for erosive tooth wear in general practice

 
Results:
  • The most common risk assessment performed by associate dentists and experienced practice owners was TMD assessment (8% of associate dentists or experienced dentists assessed TMD) and least common was assessing for intrinsic sources of acid (0.5%).

  • Foundation dentists were statistically significantly more likely to assess dietary sources of acid, intrinsic sources of acid, TMD and soft tissue signs of parafunction (p<0.001).

Associate dentists and trainers were 97% less likely to chart erosive tooth wear than foundation trainees controlling for practice type, age and exemption status (AOR 0.03, 95% CI 0.00-0.16, p<0.001).

Discussion:
  • A higher percentage of risk assessments were carried out by foundation dentists compared to educational supervisors and associate dentists.

  • A high percentage of educational supervisors and associates did not record tooth wear on the dental charts.

  • Overall there is little or no use of a screening tool such as the BEWE.
Conclusion:
  • Erosive tooth wear screening and a comprehensive risk assessment is not routinely performed in audited dental practices.

  • Foundation dentists are more likely to perform risk assessments but an increase in sample size and statistical analysis is required to confirm this.

Overall, record keeping for erosive tooth wear and management is poor among all three dentist groups. It would be beneficial for dentists to use a screening tool as part of their examinations and may benefit from being provided with guidelines or a toolkit on risk assessment of erosive tooth wear.


UNDERLYING DISEASES WHICH PRESENT WITH EROSIVE TOOTHWEAR
  • Intrinsic sources of erosive toothwear include: gastro-oesophageal reflux disease (GORD), hiatus hernia, rumination, morning sickness, eating disorders anorexia, bulimia, orthorexia. [6].

  • Conditions that induce reduced salivary flow and therefore reduced buffering capacity against acid - Sjogrens syndrome and other autoimmune diseases, medications e.g. anti-depressants can show increased risk of toothwear [6].

  • GI cancer is becoming increasingly prevalent. In 2012, more than 12,000 people died of gastro-intestinal cancers –more than twice the combined total for breast and prostate cancers. [7].
Pilot hybrid BPE/BEWE
A simple custom screen created on EXACT (SOE)(layout to be finalised), for use in routine dental examinations, allowing a sextant by sextant screening of periodontal and erosive wear diseases.



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