Erosive tooth wear and associated factors in Northern Finland Birth Cohort 1966

Abstract The aim of this study was to investigate the status of erosive tooth wear (ETW) in Finnish middle-aged adults and its association with dental caries and sociodemographic and intrinsic factors. In addition, we performed a genome-wide association study (GWAS) to identify whether genetic polymorphism (single nucleotide polymorphism) could explain some of the individual variance in the ETW status. Another aim of the study was to validate the use of the erosion index, the Basic Erosive Wear Examination (BEWE), on 3D models. Of the total Northern Finland Birth Cohort (NFBC1966), a convenience sample of 3,181 people was invited for an oral health examination in 2012–2013, of whom 1,962 participated, thus comprising the study group for the present study. ETW was assessed by sextants using the BEWE index. The clinical data was supplemented by information collected by means of postal questionnaires in 1997–1998 and 2012–2013, blood samples, and 3D models of the dentition. Of those clinically examined, 586 participants were randomly selected for the validation study of the BEWE index on 3D models. ETW was a common finding among the Finnish adult population, and almost half of the population needed at least preventive measures against the condition, and almost one in ten had severe ETW. Male gender and restorative treatment need due to dental caries were associated with ETW, unlike sociodemographic factors. Of the intrinsic factors, daily reflux symptoms and hyposalivation were the most significantly associated with severe ETW. According to the results from the GWAS, susceptibility to ETW could be partly explained by genetic polymorphism. The BEWE index was found reliable for recording ETW clinically and on 3D models, and 3D models were especially sensitive in detecting initial ETW. In conclusion, ETW seems to be common among Finnish adults, especially among males. In addition to risk factors, individual susceptibility should be kept in mind when assessing the risk for the condition. Early diagnosis of ETW is important in maintaining good oral health, and the BEWE seems to be a reliable index for that purpose both clinically and on 3D models.Tiivistelmä Tutkimuksen tavoitteena oli selvittää hampaiden erosiivisen kulumisen yleisyyttä ja vakavuutta suomalaisilla keski-ikäisillä aikuisilla, sekä erosiivisen kulumisen yhteyttä hampaiden reikiintymiseen sekä sosiodemografisiin ja sisäisiin tekijöihin. Lisäksi selvitettiin koko genomin kartoitusta hyödyntäen, voidaanko geneettisellä polymorfismilla (yksittäisillä emäsparin vaihdoksilla) selittää yksilön alttiutta erosiiviselle kulumiselle. Tutkimuksen tavoitteena oli myös validoida erosiivista kulumista arvioiva indeksi (The Basic Erosive Wear Examination, BEWE) 3D-malleilla. Koko Pohjois-Suomen vuoden 1966 syntymäkohortista kutsuttiin 3 181 henkilöä suun terveystarkastukseen vuosina 2012–2013. Kutsutuista 1 962 osallistui tutkimukseen muodostaen lopullisen tutkimusjoukon. Erosiivista kulumista arvioitiin käyttäen BEWE-indeksiä. Kliinistä tutkimusta täydensivät vuosina 1997–1998 ja 2012–2013 tehdyt postikyselyt, verinäytteet ja hampaiston 3D-mallit. Kliinisesti tutkituista osallistujista yhteensä 586 henkilöä valittiin satunnaisesti BEWE-indeksin validointitutkimukseen 3D-malleilla. Erosiivinen kuluminen oli yleistä suomalaisilla aikuisilla, ja lähes puolella oli erosiivista kulumista, joka vaatisi vähintään ennaltaehkäiseviä toimia. Vakavaa erosiivista kulumista on lähes joka kymmenennellä. Miessukupuoli ja korjaavan hoidon tarve hampaiden karioitumisen vuoksi olivat yhteydessä erosiiviseen kulumiseen, toisin kuin sosiodemografiset tekijät. Sisäisistä tekijöistä päivittäiset reflux-oireet ja vähäinen syljeneritys olivat vahvimmin yhteydessä vakavaan erosiiviseen kulumiseen. Koko genomikartoituksen perusteella vaikuttaa siltä, että alttius erosiiviselle kulumiselle saattaa selittyä osittain geneettisellä polymorfismilla. BEWE-indeksi näyttää olevan luotettava menetelmä niin kliinisessä arvioinnissa kuin arvioitaessa erosiivista kulumista 3D-malleilla. Alkava erosiivinen kuluminen oli helpommin havaittavissa 3D-malleilta kliiniseen arviointiin verrattuna. Tutkimuksen perusteella voidaan sanoa, että erosiivinen kuluminen on yleistä suomalaisilla aikuisilla, etenkin miehillä. Jo tiedettyjen riskitekijöiden lisäksi yksilöllinen alttius erosiiviselle kulumiselle tulisi pitää mielessä riskikartoitusta tehdessä. Erosiivisen kulumisen aikainen diagnosointi on tärkeää hyvän suun terveyden ylläpitämiseksi, ja BEWE-indeksi vaikuttaa soveltuvan diagnosointiin niin kliinisesti kuin 3D malleillakin

Different risk factors for erosive tooth wear in rural and urban Nepal:a national study

Abstract Background: Erosive tooth wear (ETW) is of growing concern, but data on ETW among Nepalese children are scarce. The main aim of the study was to investigate the prevalence and severity of ETW among Nepalese schoolchildren. We also aimed to analyse the risk indicators for ETW according to location (rural/urban) and the role of obesity in the risk for ETW. Methods: This national study was conducted among 5–15-year-old Nepalese schoolchildren from different regions. Altogether, 1137 out of 1151 schoolchildren participated in both a clinical examination and a survey. ETW was recorded using the Basic Erosive Wear Examination. Results: The prevalence of ETW was 65%. One-fifth of the examined subjects were in need of preventive or restorative treatment. Living in an urban area and studying in a private school were protective factors for ETW, whereas consuming fruits frequently and using charcoal for tooth cleaning increased the odds for ETW. Central obesity was the strongest risk indicator for ETW among urban residents. Conclusions: ETW of low severity is common among Nepalese children and adolescents. Socio-demographic factors influence the prevalence of ETW in Nepal and there seems to be different factors that play a role in the ETW process according to location of residence

Hampaiden erosiivinen kuluminen suomalaisilla nuorilla

Tiivistelmä Lähtökohdat: Tutkimuksen tavoitteena oli selvittää hampaiden erosiivisen kulumisen esiintyvyyttä, vakavuutta ja taustatekijöitä suomalaisilla ­15-vuotiailla nuorilla. Menetelmät: Tutkimukseen osallistui yhteensä 147 15-vuotiasta nuorta Sievin (n = 66) ja Vaasan Variskan (n = 81) yläkouluista. Kaksi hammaslääkäriä teki yhdessä jokaiselle tutkittavalle kliinisen tutkimuksen, jossa arvioitiin hampaiden eroosiovaurioita BEWE-indeksillä. Tutkittavat haastateltiin käyttäen strukturoitua ja validoitua lomaketta, jossa kartoitettiin erosiivisten juomien ja ruokien kulutustottumuksia sekä eroosiolle mahdollisesti altistavia tapoja. Taustatekijöiden ja eroosion yhteyttä tutkittiin ristiintaulukoinnilla ja logistisella regressioanalyysilla. Tulokset: Vähintään kohtalaista eroosiota (BEWE-summa 3 tai enemmän) esiintyi 56,8 %:lla tutkituista, vakava eroosio oli kuitenkin harvinaista (2,8 %). Tärkeimpiä eroosioon liittyviä tekijöitä olivat happamien juomien käyttö aterioiden välissä ­(p = 0,025) sekä limsojen runsas kulutus (p = 0,021) ja hedelmien ja marjojen kulutus vähintään päivittäin (p = 0,021). Johtopäätökset: Erosiivinen kuluminen on yleistä 15-vuotiailla suomalaisilla nuorilla. Eroosion havainnointi ja siihen puuttuminen olisi tärkeä huomioida suun terveydenhuollon vastaanotoilla hoidettaessa nuoria potilaita.Abstract Erosive Tooth Wear Among Finnish Adolescents Behavioural factors such as drinking and eating habits as well as intrinsic factors including e.g. gastro-esophageal reflux-disease and vomiting are suggested to be important etiological factors in the pathogenesis of erosive tooth wear (ETW). A healthy lifestyle diet containing lots of fruits and vegetables may also increase the risk for ETW. Globally, the prevalence rate of ETW among adolescents is reported to be 30 % and the prevalence seems to be increasing. However, no data on the prevalence and the severity of ETW among Finnish adolescents has been published so far. Altogether 147 voluntary 15-year-old teenagers from Vaasa (n = 81) and Sievi (n = 66) participated the study. Clinical examinations were performed in the school premises by two experienced clinicians together and erosive tooth wear was registered by using the BEWE index. To evaluate factors associated with ETW, the participants were interviewed by using a structured and validated questionnaire. More than half (54%) of the participants had at least mild ETW (BEWE sum score 3–8). However, severe ETW was very rare (2.8%). The most common factors associated with ETW were a habitual consumption of acidic drinks between meals and (p = 0.025), a high consumption of fizzy drinks (p = 0.021) and consumption of fruits and berries at least daily basis (p = 0.021). Erosive tooth wear among Finnish adolescents seems to be frequent. Diagnosing, registering, and controlling ETW is important already with teenage patients

Knowledge on and treatment practices of erosive tooth wear among Finnish dentists

Abstract Objectives: To investigate Finnish dentists’ knowledge on and means of recording, detecting and diagnosing erosive tooth wear (ETW). Treatment options and possible differences in treatment decisions between general and specialized dentists were also evaluated. Materials and methods: An electronic questionnaire was sent by e-mail to 3664 Finnish dentists. Respondents’ gender, age, work experience, field of specialty, and practice location were requested. The questionnaire also included a patient case where the dentists were asked about their choice of treatment. Statistical analyses were performed using means, proportions, and cross tabulations. Results: Response rate was 24% (n = 866). Almost all respondents (98.0%) recorded ETW in patient files, but only 4.1% used a detailed scoring system. Of the respondents, 64.4% usually found the cause of ETW. Use of carbonated beverages (84.3%), energy drinks (57.0%), and reflux disease (53.1%) were reported to be probable causes. The majority of the respondents (80.9%) usually assessed patient’s dietary history while 1.9% evaluated saliva secretion rate. When asked about treatment decisions of ETW patients, the differences between general dentists and specialized dentists were not as obvious as hypothesized. Conclusions: This study suggests that the Finnish dentists who participated in this survey are able to detect and/or diagnose erosive tooth wear, but there is variation in recording it. The differences in treatment decisions between general dentists and specialized dentists seem to be moderate. The treatment practices for ETW are not established and further research to create clinical guidelines seems to be needed

TUFT1, a novel candidate gene for metatarsophalangeal osteoarthritis, plays a role in chondrogenesis on a calcium-related pathway

Abstract Osteoarthritis (OA) is the most common degenerative joint disorder and genetic factors have been shown to have a significant role in its etiology. The first metatarsophalangeal joint (MTP I) is highly susceptible to development of OA due to repetitive mechanical stress during walking. We used whole exome sequencing to study genetic defect(s) predisposing to familial early-onset bilateral MTP I OA inherited in an autosomal dominant manner. A nonsynonymous single nucleotide variant rs41310883 (c.524C>T, p.Thr175Met) in TUFT1 gene was found to co-segregate perfectly with MTP I OA. The role of TUFT1 and the relevance of the identified variant in pathogenesis of MTP I OA were further assessed using functional in vitro analyses. The variant reduced TUFT1 mRNA and tuftelin protein expression in HEK293 cells. ATDC5 cells overexpressing wild type (wt) or mutant TUFT1 were cultured in calcifying conditions and chondrogenic differentiation was found to be inhibited in both cell populations, as indicated by decreased marker gene expression when compared with the empty vector control cells. Also, the formation of cartilage nodules was diminished in both TUFT1 overexpressing ATDC5 cell populations. At the end of the culturing period the calcium content of the extracellular matrix was significantly increased in cells overexpressing mutant TUFT1 compared to cells overexpressing wt TUFT1 and control cells, while the proteoglycan content was reduced. These data imply that overexpression of TUFT1 in ATDC5 inhibits chondrogenic differentiation, and the identified variant may contribute to the pathogenesis of OA by increasing calcification and reducing amount of proteoglycans in the articular cartilage extracellular matrix thus making cartilage susceptible for degeneration and osteophyte formation

Erosiivisen kulumisen diagnosointi ja hoito Suomessa

Tiivistelmä Lähtökohdat: Eroosiovaurioiden esiintyvyys on lisääntynyt erityisesti teini-ikäisillä sekä nuorilla aikuisilla. Toistaiseksi ei ole tutkimustietoa siitä, kuinka suomalaiset hammaslääkärit diagnosoivat ja hoitavat eroosiota. Menetelmät: Tutkimusaineisto kerättiin Webrobol-kyselyllä, joka lähetettiin Suomen Hammaslääkäriseura Apolloniaan kuuluville hammaslääkäreille (n = 3 664). Kyselyssä kartoitettiin eroosion diagnosointia ja dokumentointia sekä näkemyksiä eroosion yleisyydestä ja aiheuttajista. Lisäksi tiedusteltiin hoitokeinoja erikseen esitettyyn potilastapaukseen. Kyselyyn vastasi 866 hammaslääkäriä (24 %). Tulokset: Lähes kaikki vastaajat (98 %) ilmoittivat kirjaavansa eroosiolöydökset potilasasiakirjoihin, mutta 62 % ei käyttänyt eroosion vakavuutta kuvaavia luokittelujärjestelmiä. Yli puolet (65 %) koki saavansa selville eroosiovaurioiden syyn; yleisimpinä syinä pidettiin virvoitus- (85 %) ja energiajuomia (60 %). Lähes puolet (45 %) selvitti aina eroosiopotilaan dieettihistorian. Näkemyksissä sen suhteen, millaisia neuvoja ja hoitoa potilastapauksen potilaalle pitäisi antaa, oli hajontaa, mutta kaikki vastaajat antaisivat ruoka- ja juomatottumuksiin liittyviä ohjeita. Johtopäätökset: Eroosiovaurioiden dokumentointiin, seurantaan ja hoitolinjauksiin kaivataan yhtenäistä ohjeistusta

Prevalence of erosive tooth wear and associated dietary factors among a group of Finnish adolescents

Abstract The aim of this study was to investigate the prevalence and severity of erosive tooth wear (ETW) among Finnish adolescents and to evaluate how frequency as well as amount of the use of erosive products are associated with ETW. The study population consisted of 328 voluntary, >15-year-old secondary school students (males 49.1%, females 50.9%) in three municipalities in Finland. Clinical examination to measure erosive tooth wear (BEWE index) was carried out by trained and calibrated dentists. Piloted questionnaires included questions on consumption of drinks, fruits and berries, as well as tooth brushing frequency. Means and medians of frequencies and amounts of consumed erosive products were calculated and associations with ETW severity were analysed by logistic regression models. One third (36.9%) of the participants were in need of at least preventive measures for ETW (BEWE sum score ≥ 3), but severe ETW (BEWE sum score > 9) was rare (2.1%). Boys had severe ETW significantly more frequently than girls (p < 0.001). Habitual consumption of erosive drinks was common especially among boys compared to girls (p = 0.001). ETW was significantly associated with the amount of consumed erosive drinks, fruits or berries. The prevalence of ETW among adolescences in Finland seems to be at the same level as in other Nordic and European countries. Consumption of erosive products is common and thus, the risk for tooth erosion is high, especially in boys. In addition to erosive drinks, also berries and fruits are associated with ETW and should be included in individual dietary counselling when early signs of ETW are clinically detected

Genome-wide analysis of dental caries and periodontitis combining clinical and self-reported data

Abstract Dental caries and periodontitis account for a vast burden of morbidity and healthcare spending, yet their genetic basis remains largely uncharacterized. Here, we identify self-reported dental disease proxies which have similar underlying genetic contributions to clinical disease measures and then combine these in a genome-wide association study meta-analysis, identifying 47 novel and conditionally-independent risk loci for dental caries. We show that the heritability of dental caries is enriched for conserved genomic regions and partially overlapping with a range of complex traits including smoking, education, personality traits and metabolic measures. Using cardio-metabolic traits as an example in Mendelian randomization analysis, we estimate causal relationships and provide evidence suggesting that the processes contributing to dental caries may have undesirable downstream effects on health