On dental erosion among Yemeni children, adolescents, dentists and dental students. Prevalence, scoring system, risk indicators and awareness

Background: Dental erosion is a multifactorial oral health problem with an increasing prevalence among children and adolescents in many countries. Awareness of the condition among lay people is generally lacking, and methods for its clinical grading also need further improvements. Aim: The aims of this thesis was to investigate various aspects of dental erosion including prevalence and risk indicators, to evaluate the recording system used, and to assess the awareness of dental erosion in children, adolescents, and dental professionals in Sanaa, Yemen. Methods: From a total of 6163 individuals, a random selection of 668 individuals aged 5-6, 13-14 and 18-19 years agreed to participate in the study. Participants underwent questionnaire and clinical examination. Dental erosion was graded using an erosion partial recording system (EPRS) which was subsequently modified (EPRS-M). General dental practitioners (n=323) in Sanaa and all final year dental students (n=97) at the University of Science and Technology Dental College, completed a different questionnaire. Results: Advanced dental erosion into dentin was found in 6.8%, 3.0% and 14.6% within the three age groups. Prevalence rates by EPRS and EPRS-M were not significantly different. Advanced dental erosion was associated with higher frequencies of lime sucking and teeth sensitivity in the first age group, and with greater consumption of carbonated soft drinks in the second age group. In the third age group, it was associated with greater total consumption of acidic beverages, higher intake of cola-type soft drinks/pure fruit juices, absence of fluorosis and not having been breastfed. Advanced dental erosion was significantly more common in the oldest age group (OR=5.6). Only 17.4% of all participants stated they had heard about dental erosion, 4.8% had received information about it from their dentists and 7.5% knew how to prevent it. Acidic drinks were reported as a causative factor for dental erosion by 52% of students and 41% of dentists. The use of an index for grading dental erosion was reported by 27% of the students and dentists, while 51% considered reduction of acidic drink intake to be a preventive measure. Conclusions: Advanced dental erosion was common in the 5-6 and 18-19 year age groups but not in the 13-14 year group. EPRS-M showed to be a reasonable tool and is recommended for future research. Information campaigns targeting negative life style habits and risk factors for dental erosion are advocated. Awareness of dental erosion among children, parents and adolescents as well as within the Yemeni dental profession was poor and needs to be improved. Knowledge about the causative factors of dental erosion, diagnosis and prevention were insufficient among dental students and dentists indicating a need for educational improvement