Commentary

The levels of dental erosion defined as the irreversible loss of tooth tissue by chemical processes not involving bacteria are increasing in children and adolescents worldwide. While rates ranging between 7.2% to 95% have been reported in studies, a recent meta-analysis undertaken by the same group as this current review has estimated the overall prevalence to be 30.4% (95%IC 23.8–37.0).1

Table 1

A wide range of databases have been searched for this review and there were no restrictions on date or language. The included studies came from a wide range of countries; England, Brazil, The Netherlands, India, USA, China, Jordan, Libya, Sri Lanka and Sudan, with sample sizes ranging from 605 to 3812. All but two of the included studies were cross-sectional, and one concern here is whether the information collected on diet at any particular point in time is reflective of diet over a longer period. The review authors themselves also question the potential of the various methods being used to gather the dietary data influencing findings. As most of the instruments also required participants to recall consumption there is also the issue of recall bias.

While the analysis demonstrates support for an association between the carbonated drinks, natural acidic fruit juices and confectionery and snacks and a higher risk of tooth erosion, and a reduced risk in those with high consumption of milk and yogurt, all the analyses demonstrate a high degree of heterogeneity. The authors also indicate that there may be the possibility of publication bias in particular related to carbonated drinks, as studies with negative associations were poorly published. Although the data suggest an association between these diet items and erosion there are limitations to the evidence and higher quality longitudinal studies with robust collection of diet data would be helpful in clarifying the position further. However, diet is not the only factor and another recent review by Hermont et al.2 suggests that patients with eating disorders had more risk of tooth erosion (OR = 12.4, 95%CI = 4.1–37.5) and those who also self-induced vomiting had a higher risk (OR = 19.6, 95%CI = 5.6–68.8). While these odds ratios are considerably higher, the data are based on meta-analysis of case-controlled studies so should be viewed with caution.