STEPS TO ADDRESS THE CHALLENGES IN ASSESSING EROSIVE TOOTH WEAR

Abstract

Aims: Assessing erosive wear is a challenging process; an ideal dental erosion index should be simple with defined scoring criteria, reflective of the aetiology of the condition, accurately categorizing shape, area and depth of affect, and finally be able to assess only erosive wear as it usually co-exists with other types of tooth wear. With the exception of the Basic Erosive Wear Examination (B.E.W.E.), no index appear to meet most of the above criteria; however B.E.W.E. is a clinical index which does not provide information on the aetiology of the assessed worn lesion, therefore it does not contribute to the differential diagnosis neither to the secondary prevention of dental erosion. A combined index using both clinical and dietary/behavioural/biological criteria could be significantly more accurate to record erosive lesions. The aim of this presentation is to inform the audience on the steps that have and will be taken towards this direction, including the design and content validation of a survey for Diagnosis and (Secondary) Prevention of Erosive Wear (DI.P.E.WE.).

Methods: In the last EADPH Special Interest Working Group Tooth Surface Loss/Erosion meeting (Budapest , September 2016), the following decisions has been made: a) the B.E.W.E. was suggested as the most reliable and convenient clinical index to assess dental erosion; b) to address the difficulty to differentiate erosion from other wear types, such as abrasion, it was decided to generate a valid survey of basic erosive risk factors. This survey can be used additionally to B.E.W.E. to assess erosive wear with the best possible accuracy. Therefore, a panel of experts on dental erosion from six countries (U.S.A., Finland, Romania, Hungary, Ireland and Greece) worked between October- December 2016 to formulate and confirm the content validity of the DI.P.E.WE. survey Also, the next steps were determined in order to validate this survey in clinical setting; i) Random sampling of 50-100 participants from institutions/universities from each country; ii) Record of B.E.W.E. score and saliva flow, and completion of the DI.P.E.WE. survey. The age of the participants should be 14-20 years to avoid co-existence with other tooth wear types. The B.E.W.E. examiners should be one or two for each group of researchers and they must confirm and report their intra and inter examiner agreement (Cohen’s kappa) in scoring B.E.W.E. Socioeconomic data can be also collected, such as gender, age, educational level. Please note that the purpose of this survey (after validation) is to be used when someone has B.E.W.E.>0, but in order to validate it, for this study we need also participants with no erosion (B.E.W.E.=0) for comparison. Also, to have the best possible results, these two groups (erosion, no erosion) should be equal or at least with 1:2 ratio; iii) Multivariate analysis and ROC curves will be used to assess the sensitivity and specificity of the survey.

Results: An adequately validated survey instrument will be produced to be used additionally to B.E.W.E. in order to assess erosive wear as accurately as possible and to contribute to the secondary prevention of this type of wear. Specific steps will be described and discussed in this presentation on designing, validating and eventually implementing this survey.

Conclusions: With this presentation, the audience can become familiar with the process of designing and validating a survey instrument which can be used additionally to a clinical index for the accurate assessment of erosive wear.