J Bagh College Dentistry Vol. 26(1), March 2014 Distribution of tooth wear
Orthodontics, Pedodontics and Preventive Dentistry 180
Distribution of tooth wear among institutionalized
residents (50-89 years old) in Baghdad city\ Iraq
(Cross-sectional study)
Mohammed G. Al-Azawi, B.D.S. (1)
Sulafa K. El-Samarrai, B.D.S., M.Sc., Ph.D. (2)
ABSTRACT
Background: Tooth wear is one of the most common problems in the older dentate population which results from the
interaction of three processes (attrition, abrasion and erosion) and it affects all societies, different age groups, and all
cultures. This study was achieved to evaluate the prevalence and distribution of tooth wear among institutionalized
residents in Baghdad city\ Iraq.
Subjects and Methods: This survey was accomplished on four private and one governmental institution in Baghdad
city. One-hundred twenty three (61 males, 62 females) aged 50-89 years were participated in this study. The diagnosis
and recording of tooth wear were according to criteria of Smith and Knight.
Results: The prevalence of tooth wear was 100% with a mean (30.79± 19.39) and median (28). The highest grade of
tooth wear recorded was grade 2 (56.9%), followed by grade 3 (26%), grade 4 (17.1%). There was no statistically
significant difference of total tooth wear among age groups (P>0.05), astatistically significantdifference was seen
regarding the severity of tooth wear among different age groups; for grade 2 and grade 4 (P <0.05), while a
statistically highly significant difference recorded for both grade 1 and grade 3. A statistically highly significant
difference of the total tooth wear was recorded between the total males and females (P <0.01).
Conclusion: The occurrence of tooth wear among those subjects was high thus they need oral health policy makers
for promotion, prevention and restorative care.
Key words: Tooth wear, institutionalized elderly. (J Bagh Coll Dentistry 2014; 26(1):180-183).
INTRODUCTION
Older people suffer from many oral health
problems as studied by previous Iraqi studies like
coronal and root caries (1,2), edentulism(1),
periodontal diseases (2), dry mouth, soft tissue
lesions and age related odontometric changes as
tooth wear (3).
Tooth wear describes the non-carious loss of
tooth tissue, and is one of the most common
problems in the older dentate population which
results from the interaction of three processes
(attrition, abrasion and erosion) (4, 5). Tooth wear
seems to affect all societies, different age groups,
and all cultures (6, 7). The clinical significance of
this increase negatively impacts on aesthetics
and/or function (8). As available, this is the first
Iraqi cross-sectional study to determine the
prevalence, distribution of tooth wear among
institutionalized residents in Baghdad city. Such a
study may provide a baseline data aids for future
comparison with other studies, as well as putting
strategies for monitoring, prevention and
treatment of tooth wear among this group of
adults.
(1) M.Sc student Department of Pedodontics and Preventive
Dentistry, College of Dentistry, University of Baghdad.
(2) Professor Department of Pedodontics and Preventive
Dentistry, College of Dentistry, University of Baghdad.
SUBJECTS AND METHODS
This study was conducted during the period
between the fourth of November on 2012 and
twelfth of January on 2013 among five institutions
in Baghdad city. There were about 214
institutionalized residents (91males, 123 females)
distributed in four private and one governmental
institution, with age range about 50-89 years old
according to the report of Ministry of Labor and
Social Affairs. After getting approval of the
Ministry of Labor and Social Affairs to carry out
this study, contacts with institution’s authorities
were made to explain the purpose of the study.
The exclusion criterion was cognitive impaired
individuals who were 13 subjects (5 males, 8
females). The initial step and before data
collection, examiners explained to the participants
the aims and details of the study to participate for
a detailed interview and a clinical examination.
Every subject was informed of his or her right to
refuse participation or to withdraw from the study
at any moment. The authority of Dar Anya totally
refused the examination with unexplained reasons
thus the number of residents who refused was 45
(9 males, 36 females) thus the participants was
156 (77 males, 79 females) and those 33 subjects
were divided into completely edentulous (17, 51.5%)
and those with complete denture wearers (16,
48.5%) were excluded thus the net number of
individuals for tooth wear examination was 123
subjects.
Clinical examination was performed inside the
institution with the aid of dental mirror and
J Bagh College Dentistry Vol. 26(1), March 2014 Distribution of tooth wear
Orthodontics, Pedodontics and Preventive Dentistry 181
explorer. Teeth were dried using cotton rolls. The
exclusion criteria were as follows: any
participants received restorative treatment for
tooth surface loss, badly carious tooth and teeth
received fixed prosthesis Al-Zarea, (12). The
surfaces of all teeth were scored according to
tooth wear index by Smith and Knight (9).
Intra and inter calibration were performed to
overcome any problem that could be faced during
the research, and to ensure proper application of
diagnostic criteria used in recording dental status
through inter calibration. Statistical Analysis and
processing of the data were carried out using
SPSS version 18. The statistical tests that were
used in are Pair sample T-test, Z-test, Mann-
Whitney U- test, Kruskal- Wallis H test,
Spearman correlation coefficient and Chi-square.
The level of significance was accepted at P< 0.05,
and highly significance when P< 0.01.
RESULTS
In this study, not all the elderly individuals were
involved in the diagnosis and recording of tooth
wear as those 33 subjects were divided into
completely edentulous (17, 51.5%) and those with
complete denture wearers (16, 48.5%) were
excluded. Concerning the remaining dentate
individuals as those 123 subjects (61 males, 62
females), the percentage of individuals with tooth
wear in this study was 100% with a mean (30.79±
19.39) and median (28) as all the elderly
examined were having one or more types of tooth
wear. Results illustrate that the distribution of
subjects by their highest grades of tooth wear was
grade 2 and seen in 56.9% (70 subjects) of the
examined subjects followed by those with grade 3
(26%, 32 subjects), the lowest was those with
grade 4 (17.1%, 21 subjects) followed by those
with grade 1 which was completely absent.
Regarding age; results in Table 1 show that rating
of total tooth wear among age groups was found
to be statistically not significant (P >0.05) when
Kruskal-Wallis H test was applied. Tooth wear by
grades of severity according to age groups is
demonstrated in Table 2. Results indicate that the
differences in the severity of tooth wear among
age groups were found to be statistically
significant for grade 2 and grade 4 (P <0.05) and
highly significant for grade 1 and grade 3 (P
<0.01).
Table 3 illustrates that tooth wear according to
gender in different age groups. Males
demonstrated a high tooth wear values compared
to females in all ages, however differences were
found to be statistically not significant (P >0.05),
while the difference was statistically highly
significant between the total males and females (P
<0.01) according to Mann-Whitney U test.
DISCUSSION
The prevalence of tooth wear among elderly
population as seen by this study was 100% which
is higher than that found by Taiwo et al (11) 92.8%
among Nigerian individuals, aged 65 years and
above. In this study, results demonstrate that
grade 2 was the highest score, while the least was
grade 1, this is in agreement with Al-
Zarea(12)whose sample’s age was from 15-65
among Saudian adults, and disagree with Daly et
al (13) who found that the highest grade was grade
1 (81%), among 18-80 years Malizian adults.
Results in this study demonstrated that rating or
ranking total tooth wear among age groups was
not significant although all tooth wear values
decreased with the increase of age, except at the
last age group, a tooth wear increased. Previous
Studies, concluded that tooth wear was an
accumulative process throughout life and was an
age-related phenomenon (10, 14-16); but severe tooth
wear is not and could happen during any period of
life (17). Many studies recorded that severe levels
of wear could be observed in each age group, and
it could be argued that this was independent of
age (7,18,19). The increase teeth exposure to
environmental factors (local or systemic, erosive,
attritive or abrasive factors) may cause more tooth
wear rather than age per say (16,20,21). Further
longitudinal studies are needed among single age
group to explore the effect of aging and determine
the accumulation of tooth wear throughout their
life.
Results recorded that total tooth wear values
were higher among males than those of females
with a highly significant difference. This may due
to increased muscle mass and muscular strength
seen in males in general (5, 17), other results found
that males had higher magnitude of bite forces
than females (15, 22, 23). Studies of tooth wear
among adults revealed that tooth wear is also
significantly more prominent in men than women
(9, 24), due to different dietary patterns between the
two genders (25). Females may care more about
their dentition and visit dentists more than males
and this allows early detection with possible
preventive program being introduced to stop
progression (12).
Institutionalized older adults suffer from tooth
surface loss thus they need public health campaigns
aimed at reducing the incidence of and progression
of tooth wear lesion among them.
J Bagh College Dentistry Vol. 26(1), March 2014 Distribution of tooth wear
Orthodontics, Pedodontics and Preventive Dentistry 182
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Table 1: Descriptive and statistical results of tooth wear according to age
^= Not significant at P >0.05.
Age group NO. Mean ±SD Median Mean rank Chi-square Df P-value
50-59 26 32.04 17.12 32.00 66.71
1.093 3 0.779^
60-69 34 30.94 18.31 31.500 63.97
70-79 35 30.09 21.78 21.00 57.81
80-89 28 30.36 20.48 27.00 60.46
Total 123 30.79 19.39 28.00
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J Bagh College Dentistry Vol. 26(1), March 2014 Distribution of tooth wear
Orthodontics, Pedodontics and Preventive Dentistry 183
Table 2: Descriptive and statistical results of tooth wear by grades of severity according to age
Table 3: Descriptive and statistical results of tooth wear according to gender
# = mean rank, ##=sum rank, ^ =Not significant at P>0.05, **=highly significant at P<0.01.
G
r
a
d
e
1
Age groups (years) NO. Mean ±SD Median Mean rank
Chi-square df P-value
50-59 26 6.89 6.55 5.00 83.02
17.947 3 0.000**
60-69 34 3.62 4.99 1.00 62.82
70-79 35 1.34 2.59 0.00 45.87
80-89 28 3.00 4.11 1.00 61.64
G
r
a
d
e
2
50-59 26 12.15 8.86 11.00 72.13
7.911 3 0.048*
60-69 34 11.29 7.47 9.50 69.46
70-79 35 7.05 5.11 6.00 49.87
80-89 28 8.31 5.39 7.00 58.70
G
r
a
d
e
3
50-59 26 0.30 0.97 0.00 43.60
13.690
3 0.003**
60-69 34 1.26 3.00 0.50 60.59
70-79 35 4.23 6.09 2.00 72.71
80-89 28 2.18 3.22 1.00 67.41
G
r
a
d
e
4
50-59 26 0.00 0.00 0.00 52.00
9.798 3 0.020*
60-69 34 0.23 0.78 0.50 59.19
70-79 35 0.48 1.24 1.00 65.83
80-89 28 0.82 1.94 2.00 69.91
Age group
(years)
Gender No. Mean ±SD Median MR# SR## Z-value P-value
50-59
Males 14 34.57 4.39 34.00 15.25 213.50
-1.262 0.207^
Females 12 29.08 18.17 27.50 11.46 137.50
60-69
Males 22 31.68 14.42 33.00 18.66 410.50
-0.920 0.358^
Females 12 29.58 24.62 22.50 15.38 184.50
70-79
Males 19 36.95 25.86 28.00 20.50 389.50
-1.577 0.115^
Females 16 21.94 11.93 19.00 15.03 240.50
80-89
Males 6 44.00 25.19 47.50 19.33 116.00
-1.625 0.104^
Females 22 26.63 17.90 23.50 13.18 110.34
Total
Males 61 35.19 19.95 33.00 70.55 4303.50
-2.639 0.008**
Females 62 26.47 17.97 23.50 53.59 3322.50