The rise and rise of toothwearology

Welcome to this special issue of Dental Update on tooth wear. First, we had cariology, then we had periodontology, so I suggest that we now need ‘toothwearology’, given that this is something that general dentists will see in their patients, young and old, on a regular basis. There are worldwide scientific data to back up this statement, with van't Spiker and colleagues collecting data from 10 different countries and concluding that the percentage of adults with severe tooth wear (TW) increased from 3% at 20 years to 17% at 70 years.¹ More recently, Schluter and Luka² used an innovative approach to measure the prevalence and relevance of tooth wear, by counting the number of publications on the subject from 1965 to 2017. In total they searched 168 articles, finding that, globally, TW affected between 20% and 45% of adults' permanent teeth, in the UK between 3% and 100% in permanent teeth were affected. The number of publications increased from almost zero in 1965 to over 350 in the period between 2010 and 2017. Moreover, there are medical implications. A recent study³ has shown that individuals with gastro-oesophageal reflux disease (GORD) have a two-to four-fold increased odds of also presenting with erosive TW, compared with individuals who do not have GORD. Turning that on its head, patients who present with erosive TW and/or GORD should have timely referrals to gastroenterology services.

Other recent research has shed light on individuals who might be most affected, with Entezami and co-workers⁴ carrying out a meta-analysis involving over 63,000 participants from 30 countries. Their data indicated that greater prevalence of TW was positively associated with adolescents whose parents had higher levels of education (perhaps because more educated adults may consume a healthier diet) and with higher socio-economic status being correlated with more consumption of erosive drinks compared with low- and middle-income countries. There was a higher association of TW in adults with lower education. Other factors were also involved, for example, consumption of acidic foods such as tamarind, baobab, hibiscus and citrus teas were positively associated with TW.

Finally, results of recent research from Indiana, USA,⁵ has indicated that dentists had difficulty in correctly diagnosing and managing erosive TW, across all severity levels and particularly in its early stages. Hopefully, from this and the above, I have convinced you that there is a rise and rise in the incidence and relevance of TW, and that this special issue is well worth reading!

Many thanks are due to the Guest Editors for this special issue, Profs Subir Banerji and Shamir Mehta who are authorities in the field of TW and its treatment. They have spent much time and energy on its contents and have invited a worldwide team of experts in the subject to contribute, and to whom Dental Update also owes much gratitude. In addition, we publish verbatim the groundbreaking Dental Update article from 1997 by Drs Darbar and Hemmings that introduced the now accepted way of treating a large proportion of patients with TW, the so-called ‘composite Dahl’ technique, with an introduction from one of the authors, Ken Hemmings, himself a member of the Dental Update Editorial Board.

I hope that you enjoy this special issue and find it of value in your everyday clinical practice.