Sir, we are concerned about tooth wear in patients from African and Afro-Caribbean origin and in particular the prevalence of a bone crushing habit as a risk factor for tooth wear. There is a cultural habit of crushing chicken and fish bones as part of their daily diet.

We prospectively audited 50 successive patients of African and Afro-Caribbean origin aged between 20–50 years who were examined in a general dental practice in southeast London to determine the prevalence and symptoms of bone crushing. We found that 80% of the patients had a score of 2 or more on the Smith and Knight tooth wear index. Sixty-six percent indicated that they crush chicken and fish bones with their teeth. In 26% of the patients other risk factors such as teeth grinding and acid erosion were found. In 64% of the patients tooth wear was not the presenting complaint. In 24% the major presenting complaint was aesthetic concerns (short teeth), followed by 12% with teeth sensitivity. Eighty-two percent were not aware that crushing bones is an important risk factor in tooth wear.

The association between tooth wear and bone crushing in patients from African and Afro-Caribbean origin has been known for years but the prevalence of the habit may have been underestimated. This audit demonstrates the high prevalence of tooth wear related to bone crushing. It is important that dentists educate patients and discourage them from bone crushing habits. Specific questions need to be asked when taking a history from patients about their dietary habits and specifically about bone crushing. One important consequence of this problem is an association with failure of prosthodontic and restorative treatments. Hence these patients tend to attend regularly for repair and replacement of their dental restorations and fractured cusps.

1. London