ORIGINAL ARTICLE

Knowledge and Association of Dental Erosion with Age and

Gender in Local OPD of Pakistan
Hasan Baber

BDS, MSc(Uk), Pg. Dip(UK)

Zia Abbas

BDS, MCPS

Shahida Maqsood

BDS, MPhil

OBJECTIVES: This quantitative study was designed to record the knowledge and association about dental erosion by patients
attending OPD of Dow Dental College, Karachi and influences on their choice of acidic drinks resulting in dental health
problems.
METHODOLOGY: Dow Dental Patients aged 12-70 years were randomly selected and investigated. A questionnaire was
administered to obtain information on knowledge of dietary habits and presence of esophageal related disease. The sample size
calculated was 400 patients. Tooth wear was analyzed via visual oral examination by use of mouth mirror. SPSS 20.0 was used
for interpretation of collected data. Level of significance and association among different variables was determined by use of
Chi square test.
RESULTS: In total 400 participated in the focused group and results suggested that choice of drink and esophageal related
disease was found to be associated with dental erosion. Dental knowledge was confused regarding tooth erosion and its
association with acidic drinks especially among younger age groups and females.
CONCLUSION: Knowledge of patients (attending dow dental opd) regarding dental erosion and the effect of drinks and
esophageal related disease was confused. The factors that influence drink choice appear to change with age and gender.
HOW TO CITE: Baber, H; Abbas, Z. Maqsood, S. Comparative Study on Emergence Pattern of Permanent Teeth among four
Communities of Nepal. J Pak Dent Assoc 2016; 25(1): 32-37.
Received: 20 February 2016, Accepted: 25 March 2016
severe form, with common complain of sensitivity(11). Early
detection of dental erosion is only possible when general
population have adequate knowledge of dental erosion and
its causative factors. However, a study conducted in Brazil
showed that knowledge regarding tooth erosion among
general population is notwidely known(8). A study conducted
in Belgaum, India in showed prevalence of dental erosion
among local population to be 22%(12). A study in Karachi,
among children of private schools determined prevalence of
tooth erosion in different age groups and came to conclusion
that it was very much common among younger age groups
with most of dental erosion observed in mandibular anterior,
without them being aware of it(13).Our study targets patients
aged 20 to 70 attending Dow dental Opd, while this study
targeted school children.

INTRODUCTION

ooth erosion has gained much popularity by

researchers in last 20 years(2, 3). A variable, but
increased occurrence of tooth erosion is reported
in populations around the world(4, 5).Modern researches
suggest that tooth erosion is an oral health issue having many
etiologic factors(2, 6).Thus it is necessary for dentists to
identify the possible causes of tooth erosion and also to
understand specific host factors in every case. This in turn
requires a complete and systematic evaluation of every case
by dentist. There is not only a need for dentist, but for the
patient to have sound knowledge of dental wear and its
associated factors. In this aspect, studies from Brazil and
United Kingdom have shown inadequate awareness of dental
erosion among its population(7, 8).

Thus it is need of the hour to determine knowledge and

association of dental erosion with age and gender among
local community and promote knowledge-based programmes
to make them more aware of dental erosion and its causative
factors and methods of reducing and preventing tooth
erosion.

Clinical diagnosis of tooth erosion has over the past years

been difficult because of the fact that it was not well known
among general public(9, 10). Due to this reason patients often
seek treatment when condition has progressed and is in its
1 Department of Oral Biology, DUHS, Karachi, Pakistan

METHODOLOGY

2 Department of Oral Surgery, DUHS, Karachi, Pakistan

Cross sectional study design was used and random type

of sampling technique was adopted. Sample size was

3 Department of Oral Biology, DUHS, Karachi, Pakistan

Corresponding author: Dr. Hasan Baber < relicpassion@yahoo.com >
JPDA Vol. 25 No. 01 Jan-Mar 2016

32

Dental Erosion in Local OPD

Baber H / Abbas Z / Maqsood S

Table 1.

Trend of Consumption of Citrus Fruits

Consume Citrus Fruits

Age Range

Total

P-Value

0.047

12-20

21-29

30-39

40-49

50-59

60-69

Count

16

12

46

% of Total

1.5%

4.0%

3.0%

1.5%

1.5%

0.0%

11.5%

Count

20

32

10

10

82

% of Total

5.0%

8.0%

2.5%

2.5%

2.0%

0.5%

20.5%

Count

14

10

10

46

% of Total

3.5%

2.5%

2.5%

1.5%

1.5%

0.0%

11.5%

Count

42

48

48

38

40

10

226

% of Total

10.5%

12.0%

12.0%

9.5%

10.0%

2.5%

56.5%


Daily

2/3times/week

Multiple times/month

Once a month

calculated by reviewing different literatures (3,4,5,13,15) and

determining number of participants with multi-variant
factors (like intake of acidic drinks, GERD and use of citrus
fruits) found to be associated with dental erosion, with
respect to age and Gender. The mean value was then put into
the following formula:

university students by asking responders direct questions

related to dental erosion such as I think dental erosion is
cause by, bruxism, acidic drinks, forceful tooth brushing etc
and modifications were done according to local culture.
Analysis of data was done by using SPSS 20.0. Chi-Square
test was used to detect statistically significant association of
dental erosion with fizzy, citrus fruits and GERD with
respect to age and gender. Permission for undertaken the
study was taken by Dean of dentistry of Dow University of
Health Sciences.

Where Z1-a/2= Is standard normal variant (At 5% type I

error) (P<0.05), it is 1.96 at type I error (p<0.01) it is 2.58,
p= Expected proportion in population based on previous
studies, d=Absolute precision of error taken as 5%. The
calculated size was 420.

RESULTS
Distribution of Sample and Respondents
Out of 420 patients interviewed,400 agreed or were
within the inclusion criteria and returned their questionnaire,
giving an overall response rate of 95%(400/420). Five were
unable to complete the questionnaire. Respondents
comprised of both male and female, having age ranges from
12 to 69 years old.

The study was conducted in Dow Dental Opd, during

Nov-Dec 2015. Personal consent was also acquired from
participants. Inclusion criteria included participants above
the age of twelve, consisting of both males and females.
Exclusion criteria consisted of patients under the age of
twelve, having had mental problems or any type of physical
disability like Parkinsons disease etc that might hinder in
interview process, patient wearing prosthesis, patient with
edentulous mouth, patient with multiple teeth restoration.
Collection of data was undertaken via questionnaire, adapted
from Al Ashtal et al(1). Accurate diagnosis of erosion and
erosive tooth wear begins with in-depth assessment of risk
factors, which in our study include consumption of acidic
drinks and underlying esophageal disease like GERD.
Gastroesophageal reflux disease was also included along
with consumption of drinks, because of the fact that lingual
dental erosion is very common in patient with GERD, along
with erosion patterns seen when consuming frequent acidic
drinks. Visual inspection of tooth surfaces and wear patterns
provided direct evidence of dental erosion.

Table 1 demonstrates trend of consumption of citrus

fruits among respondents of different age groups. A
statistically significant association (P= 0.047) was observed
among individuals consuming citrus fruits from different age
groups (daily, 2/3 times, multiple times and once in a
month). Highest number of individuals consumed citrus
fruits at least once a month with majority of them from 21 to
40 years old group. It was also observed that trend of intake
decreased with increasing age. Least number of respondents
consumed citrus fruits on daily basis.
Table 2 demonstrates frequency of participants from
different age groups consuming fizzy drinks (carbonated cola
etc). A statistically significant association was observed
(p=0.024) among this group. Majority of individuals
consumed fizzy drinks at least once in a month, with highest
intakes reported in participants from age groups 21-29 years
old. A linear pattern was also observed in this result, with
number of consumption decreasing with progression in age.

The questionnaire for this study was adopted by review

of literature (Awareness and knowledge of dental erosion
among Yemeni processionals and students) that focused on
33

JPDA Vol. 25 No. 01 Jan-Mar 2016

Baber H / Abbas Z / Maqsood S

Table 2.

Dental Erosion in Local OPD

Consumption of Fizzy Drinks

Consume Fizzy Drinks

Age Range

12-20

21-29

30-39

40-49

50-59

60-69

Count

6

16

18

8

4

% of Total

1.5%

4.0%

4.5%

2.0%

Count

24

22

14

% of Total

6.0%

5.5%

Count

18

% of Total

Total

P-Value

0

52

0.024

1.0%

0.0%

13.0%

8

12

4

84

3.5%

2.0%

3.0%

1.0%

21.0%

14

10

6

10

0

58

4.5%

3.5%

2.5%

1.5%

2.5%

0.0%

14.5%

Count

34

54

38

38

34

8

206

% of Total

8.5%

13.5%

9.5%

9.5%

8.5%

2.0%

51.5%

Daily

2/3times/week

Multiple times/month

Once a month

Table 3.

Frequency of GERD

Have GERD

Total

P-Value

0.004

12-20

21-29

30-39

40-49

50-59

60-69

Count

18

16

22

24

22

2

104

% of Total

4.5%

4.0%

5.5%

6.0%

5.5%

0.5%

26.0%

Count

64

90

58

36

38

10

296

% of Total

16.0%

22.5%

14.5%

9.0%

9.5%

2.5%

74.0%


Yes

No

Table 4.

Age Range

Consumption of Fizzy Drinks According to Gender

Consume Fizzy Drinks
Daily

What is Your Gender

What is Your Gender

P-Value
0.004

Count

20

32

52

% of Total

5.0%

8.0%

13.0%

Count

30

54

84

% of Total

7.5%

13.5%

21.0%

Count

12

46

58

% of Total

3.0%

11.5%

14.5%

Once a month

Count

96

110

206

% of Total

24.0%

27.5%

51.5%

2/3times/week

Multiple times/month

Table 3 demonstrates participants having GERD from

different age groups. A highly significant value P=0.004 was
observed among individuals in this group. Out of 400
participants 26% responded of having GERD, with most of
them from 40 to 50 years old age groups. Out of 12 elderly
respondents (60-69) only two of them reported of having
GERD.

(P=0.004) in this group with increasing number of

participants consuming fizzy drinks at least once in a month,
with frequency of female drinkers being more than males.
Only 3% of males reported to have consumed fizzy drinks
multiple times in a week.
Table 5 demonstrates Frequency of consumption of citrus
fruits with respect to gender. Out of 400 participants 34.5%
females and 22% males reported to have at least consumed
citrus fruits once a month, making it the highest number of

Table 4 demonstrates participants consuming fizzy drinks

with respect to gender. A correlation was observed
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34

Dental Erosion in Local OPD

Baber H / Abbas Z / Maqsood S

Table 5.

Consumption of Citrus Fruits According to Gender

Consume Citrus Fruits

Daily

2/3times/week

Multiple times/month

Once a month

Table 6.

What is Your Gender

Total

P-Value

0.194

Male

Female

Count

24

22

46

% of Total

6.0%

5.5%

11.5%

Count

32

50

82

% of Total

8.0%

12.5%

20.5%

Count

14

32

46

% of Total

3.5%

8.0%

11.5%

Count

88

138

226

% of Total

22.0%

34.5%

56.5%

Frequency of GERD According to Gender

Have GERD

Yes

No

What is your

Total

P-Value

0.801

Male

Female

Count

40

64

104

% of Total

10.0%

16.0%

26.0%

Count

118

178

296

% of Total

29.5%

44.5%

74.0%

all other frequency intakes. Least number of males (only

3.5%) reported of consuming citrus fruits multiple times in a
month.

Fizzy and cola drinks have many oral health related

issues like dental erosion and caries(14). Most common source
of acid present is in fizzy drinks such as cola(15) .Comparing
effect of oral health problems, tooth erosion has a strong
association with consumption of fizzy drinks, when
compared with dental caries(14). Erosive capabilities in fizzy
drinks are represented by degree of PH and its buffering
capacities. Researches have determined PH values of some
known fizzy drinks, with respect to their buffering
capabilities, such as Coca Cola having ph. of 2.52, Pepsi
2.53, Coke Zero 3.18, Diet Pepsi 3.03, Mountain Dew
3.22 and 7UP 3.20(30). These values are alarming due to the
fact that Enamel dissolves below critical Ph of 5.5.
Interestingly carbonated drinks have low PH than fresh fruit
juices. Order of buffer is in the order of citrus drinks > fruit
based carbonated drinks > Carbonated drinks (Non fruit
based)(16, 17). Carbonated drinks have shown to reduce
surface hardness of micro filled composites, dentin and
Enamel. Further studies have demonstrated that tooth erosion
has strong association with methods of drinking (31), which
current study have not taken into consideration and can be
evaluated in further studies.

Table 6 demonstrates participants having GERD with

respect to their Gender. Number of females (16%) reported
of having GERD was more than males (10. 0%).This number
was reported to be more with respect to age group also.
During visual examination it was observed that participants
with increased consumption of carbonated and acidic drinks
had dental erosion on lingual aspect of their anterior teeth,
with increase in severity as number of intakes increased.
DISCUSSION
Our study has shown knowledge about association of
dental erosion with causative factors such as citrus, fizzy
drinks and GERD to be more in females and young
individuals, it is still inadequate when compared with other
similar studies in similar settings. Gastro esophageal reflux
has most of the time been associated with dental erosion as a
result of regurgitation of stomach acid.
The study has revealed that although participants who
were consuming frequently acidic drinks and those who had
GERD demonstrated signs of dental erosion, but they seem
to be oblivion regarding any association of their current
dietary habits and gastric disease with dental erosion.

Holding carbonated drinks in oral cavity for long period

have shown to produce a drop in PH(18). Depth of surface
affected by dental erosion is also dependent on increase in
flow of consumed acidic drink within the oral cavity(19). The
35

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Baber H / Abbas Z / Maqsood S

Dental Erosion in Local OPD

effect becomes much more pronounced, when temperature of

acid becomes higher, as a result of temperature of oral
cavity(20).

age and gender. We have shown increase consumption of

these drinks in females and younger age groups. Increase in
knowledge regarding association of dental erosion with
intake of fizzy, citrus fruits and gastroesophageal reflux
syndrome among. For awareness of effects of acidic drinks
and GERD on teeth among people of Pakistan, different
strategies have to be adopted. These include knowledge base
programmes by advertisements, through social media,
billboards and outreach programmes especially in Rural
areas of Pakistan.

Reports from England and China have demonstrated that

awareness of dental erosion among general population is
inadequate. It was further revealed that dental erosion was
not very well known in the community(9, 21, 22).
Epidemiological studies in the last decade in Britain and
other parts of the world have elucidated prevalence of tooth
erosion. Cross sectional data from Britain demonstrated
prevalence of tooth erosion to increase in different age
cohorts in young individuals with passage of time(23, 24).Our
study also revealed increased consumption of fizzy and
citrus fruits resulting in dental erosion among younger age
groups. A study among 1,149 Leicestershire students found
association of dental erosion with intake of fizzy and citrus
drinks among individuals aged 12-25 years old(25) . In studies
by S Kumar have showed definite evidence of dental erosion
to be associated with younger age (11-14 yrs.) group(12). This
can be explained as a result of increased intake of fizzy
(carbonated and citrus drinks) in younger population.

AUTHORS CONTRIBUTIONS
Dr. Hasan Baber: Conceived the idea, collection of Data,
Interpretation of Data on SPSS
Dr Zia Abbas: Writing of discussion and conclusion
Dr Shahida Maqsood: Writing of Introduction, proof
reading and correcting any grammatical mistakes
DISCLOSURE
Declared none.

In 2008, a systematic review by Pace et al analyzed

seventeen studies including case-control and observational,
demonstrating a strong association between tooth erosion
and GERD. Median of incidence for tooth erosion in patients
having GERD was around 24% and median prevalence in
adults having tooth erosion came out to be 32.5% and in
children it was 17%(26). In 2011, Wild et al(21) in his report
demonstrated a cross sectional study consisting of 59
children in age range of 9-17 years with symptoms of GERD
and 20 asymptomatic children being in control group(27).

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[5]

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This confines with our study, with individuals reported of

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[13]

Our study has demonstrated knowledge and association

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JPDA Vol. 25 No. 01 Jan-Mar 2016

36

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