There is very little published evidence on the prevalence or severity of tooth wear in
children. In 1993 the National Child Dental Health Survey included an assessment of
the prevalence of erosion of both primary and permanent incisor teeth for the first
time. The survey reported that 52% of 5-year-old children had erosion of the palatal
surfaces of their primary incisors, with 24% showing progression into the pulp (561HFig.
10.15). The prevalence of erosion of the palatal surfaces of permanent incisors was
also alarmingly high⎯27% of 15 year olds; however, only 2% showed progression
into the pulp. What is unclear at the present time is whether the problem of tooth
surface loss is actually increasing or whether these figures reflect an increased
awareness.
562H
Fig. 10.15 Primary incisors showing
pathological wear and pulp exposure.10.4.2 Aetiology
In young patients there are three main causes of tooth surface loss:
(1) dietary;
(2) gastric regurgitation; and
(3) parafunctional activity.
In addition to these three factors certain environmental factors have been linked to
tooth wear. However, with the exception of frequent use of chlorinated swimming
pools, most environmental and occupational hazards do not apply to children.
Dietary causes of tooth surface loss
The most common cause of erosive tooth surface loss is an excessive intake of acidic
food or drink. 563HTable 10.5 shows the types of foodstuffs implicated in erosive tooth
surface loss in young patients.
Acidic drinks, in particular, are available to all age groups of children. Pure 'baby'
fruit juices are marketed for consumption by infants and these have been shown to
have pH values below the critical pH for the dissolution of enamel (pH = 5.5). Many
of these drinks are given to infants in a feeding bottle, and the combination of the
highly acidic nature of the drink and the prolonged exposure of the teeth to the acidic
substrate may result in excessive tooth surface loss as well as dental caries. While a
wide range of foods and drinks are implicated in the aetiology of tooth surface loss,
soft drinks make up the bulk of the problem. Soft drink consumption has increased
dramatically over the past 40 years to a staggering 151 litres per capita of the
population in the United Kingdom in 1991, with adolescents accounting for up to 65%