Severity of Dental Abrasion and Its Association with Oral Hygiene Behaviors

Dental abrasion (DA) is an erosive activity that wears away the surface of teeth. Due to the use of abrasive dentifrices and incorrect brushing techniques, it is a multifactorial phenomenon. Objective: To assess the severity of dental abrasion in association with oral hygiene behaviors. Methods: A total of 278 undergraduate students aged 18 to 25 years were enrolled in this study who were having abrasion of permanent dentitions. Mouth mirror and CPITN probe were used to detect abrasion on the labial surface of front teeth and conducted a questionnaire. The Smith and Knight's Tooth Wear Index was used to measure the severity and frequency of dental abrasion in the patients. SPSS version-22 was used to analyze the data. Results: From 278 participants, females were 163 (58.6%) and males were 115 (41.4%). Majority 132 (47.5%) were using medium type of brush, most of the cases 122 (43.9%) brushing twice a day. About 107 (38.5%) using brushing methods in combination, 137 (49.3%) were using brush for 1-2 minutes. Tooth sensitivity was reported in 133 (47.8%) of the cases. Out of all, DA was found in 160 (58%) of the cases. According to severity, minimum loss of surface characteristics was in 220 (79.1%). A highly signi�cant association (p=<0.001) was found between the type of brush and dental abrasion. A non-signicant association (p=0.816) was found between both frequency of brushing and dental abrasion. Conclusions: Brushing parameters did not affect abrasive lesions. Further study and long-term follow-up are required to distinguish oral hygiene routines from tooth abrasion.

by far the most common etiological variable for the onset of non-cervical lesions (NCCL), and is most typically caused by improper tooth-brushing technique [2].TSL (tooth surface loss) is a complicated damaging process.It is a term that mostly refers to non-carious TSL, which has no association with bacteria, and it is de ned by non-carious loss of dental tissues around the cement-o-enamel junction, where enamel is thinnest [3].There are many recorded causes of hard tooth structure loss; some could be reversible and others are irreversible.The TSL can in uence tooth sensitivity, caries incidence, plaque Severity of Dental Abrasion

I N T R O D U C T I O N
Dental abrasion (DA) is an erosive activity that wears away the surface of teeth.Due to the use of abrasive dentifrices and incorrect brushing techniques, it is a multifactorial phenomenon.Objective: To assess the severity of dental abrasion in association with oral hygiene behaviors.Methods: A total of 278 undergraduate students aged 18 to 25 years were enrolled in this study who were having abrasion of permanent dentitions.Mouth mirror and CPITN probe were used to detect abrasion on the labial surface of front teeth and conducted a questionnaire.The Smith and Knight's Tooth Wear Index was used to measure the severity and frequency of dental abrasion in the patients.SPSS version-22 was used to analyze the data.Results: From 278 participants, females were 163 (58.6%) and males were 115 (41.4%).Majority 132 (47.5%) were using medium type of brush, most of the cases 122 (43.9%) brushing twice a day.About 107 (38.5%) using brushing methods in combination, 137 (49.3%) were using brush for 1-2 minutes.Tooth sensitivity was reported in 133 (47.8%) of the cases.Out of all, DA was found in 160 (58%) of the cases.According to severity, minimum loss of surface characteristics was in 220 (79.1%).A highly signi cant association (p=<0.001)was found between the type of brush and dental abrasion.A non-signi cant association (p=0.816) was found between both frequency of brushing and dental abrasion.Conclusions: Brushing parameters did not affect abrasive lesions.Further study and long-term follow-up are required to distinguish oral hygiene routines from tooth abrasion.

A R T I C L E I N F O
A B S T R A C T them at a higher risk of tooth surface loss (TSL) [15].Tooth brushing is much more common in current times, which enhances the community's oral hygiene conditions while also making the harm in icted more visible in severity and occurrence [16].Early identi cation of tooth surface loss (TSL) is critical because tooth wear can result in dental hypersensitivity, loss of tooth shape and function, or even an underlying abscess.This study could be bene cial to arrange the awareness programs for the population to teach correct tooth brushing techniques and other oral hygiene behaviors to prevent this issue from becoming even worse and a burden on dental professionals and our society.[10].According to the literature, tooth brushing habit has a crucial impact in the development of TSL.The source of the increase in TSL occurrence is unknown; it could be owing to developments in restorative and preventative dentistry, or it could be due to improved awareness among dental and patient care professionals [11].People can protect their teeth; however, this contributes to additional concerns, TSL being one of them.Patients who cleaned their teeth more frequently had higher rates of tooth surface loss than patients who brushed once a day.Abrasive TSL on the occlusal surface can also be caused by diet, chewing abrasive substances such as cigarettes, or frequent exposure to grit and dust [12].Eating unwashed veggies that still contain trace amounts of soil may also be caused.Thread chewing, pipe smoking, and grasping hair pins in between the teeth can all produce abrasion on the tooth surface.Consuming dried sun ower seeds may cause abrasion sores [13].It has been discovered that tooth surface loss becomes more common as one gets older.This is not surprising given that older patients, along with their teeth, are exposed to the key etiological variables for a longer length of time than younger patients, and so are expected to have higher tooth structure loss

R E S U L T S
A total 278 participants were included in the study, among them females were 163 (58.6%) and males were 115 (41.4%).
According to severity, minimum loss of sur face characteristics was in 220 (79.1%) and loss of enamel exposing dentin for < 1/3 of surface was seen in 58 (20.9%) of the cases shown in Figure 2. According to brush types, 132 (47.5%) using medium type of brush, 125 (45%) using soft type and 21 (7.6%) using hard type brush.Most of the cases 122 (43.9%) brushing twice a day, 109 (39.2%) brushing once a day, 27 (9.7%)occasionally using brushing, 15 (5.4%) not brushing continuously and only 5 (1.8%) cases brushing thrice a day.According to methods of brushing, 61 (21.9%) using brushing horizontally, 26 (9.4%) using vertically, 84 (30.2%) brushing circular and 107 (38.5%) using brushing methods in combination.Majority of the participants 137 (49.3%) were using brush for 1-2 minutes, followed by 100 (36%) for more than 2 minutes, and 41 (14.7%) for only one minute.Tooth sensitivity was reported in 133 (47.8%) of the cases, while 118 (42.4%) had not any sensitivity and 27 (9.7%)do not know regarding it shown in Table 2. Out of all, dental abrasion was found in 160 (58%) of the cases while 118 (42%) of the cases reported no dental abrasion shown in Figure 1.A non-signi cant association (p=0.432) was found between both genders, frequency of brushing, methods of brushing and brushing time with dental abrasion.While a highly signi cant association (p=<0.001)was found between the type of brush (soft, medium and hard) and dental abrasion shown in Table 3.
ascribed to dissimilarities in sample size and methodology.
The study did not investigate the potential interaction between non-carious cervical lesions and other degrading processes such as tooth erosion and abfraction, as these lesions are known to arise from factors beyond abrasive phenomena.Furthermore, a review of the literature reveals that the pathogenesis of non-carious cervical lesions is multifactorial, which may also be responsible for the present investigation's low frequency rate [23,24].The Smith and Knight Index of tooth surface loss was used in the present investigation to assess the grade 2 abrasive severity score in the sample group.Similar to the results of the present study, Mushtaq and Ahmed found a mean tooth wear index of 1.70 ± 1.22 for the right mandibular lateral incisor [25].In addition, our research discovered a negligible correlation between characteristics related to tooth brushing behaviour and abrasive cervical lesions.
Comparable cross-sectional research looking at tooth surface loss in connection to dental care and soft drink intake among adults was done in Karachi [26].One-day tooth brushing by females resulted in localized tooth surface loss of 55.0% and generalized tooth surface loss of 60%.70.4% of those who brush their teeth for a minute reported anterior tooth surface loss of 70.4% 66.7% of men reported tooth surface loss.The comparison study's output contradicts the present one.Dissimilarities in outputs might be attributed to soft drink intake, which was not measured in the current study.The favorable results of the comparative research may have been in uenced by elderly participants, while the present study only comprises participants from a small age range who received less stimulus overall.An Indian study by Bhardwaj on the relationship between hard tissue abrasion and teeth brushing practices among Shimla inhabitants was conducted [27].Similar to our results, the study discovered no signi cant association between dental abrasions and variables such tooth brush type and brushing technique.In contrast to the current conclusion, a signi cant relationship was discovered between frequency of dental brushing and abrasive lesions.This might be because the bulk of the sample group only brushes their teeth once a day for one minute.Brushes are classi ed as soft (0.2 mm), medium (0.3 mm), or hard based on the diameter of the bristles (0.4 mm).However, in this case, the force employed may have an additional consequence.The abovementioned ndings have been described in research exercises by Borcic et al.,and Yadav et al.,[20,28].Our research indicated no signi cant connection, which may be because the majority of the sample population used a medium tooth brush, while Mushtaq and Ahmed discovered a signi cant link between participants using various kinds of tooth brushes and hard tissue abrasive lesions (p=0.05)

Table 1 :
Distribution of study participants on the basis of Demographics

Table 2 :
Distribution of study participants on the basis of Oral Hygiene Behaviors

Table 3 :
Association of study variables with Dental AbrasionThe study was performed on 278 participants and among them 58.6 was females and 41.4% were males.Most of the participants were from rural areas 53.2%, medium type of brush was most prevalent 47.5%, brushing twice a day's frequency of brushing was reported in majority 43.9%, around 38% of the participants used combined method of brushing (circular, vertical and horizontal) and majority 49.3% were doing tooth brushing for 1-2 minutes.Those who brushed more often had greater wear rates than patients who brushed once a day, as shown by study conducted bySangnes and Gjermo [17].This might be due to abrasives in the tooth paste, extended brushing time, or poor brushing technique.The etiology of cervical abrasion is essentially multifactorial and is a mix of numerous kinds of wear variables that are connected, such as age, diet, gingival recession, periodontal health, dentifrice, speed, and pressure utilized when brushing.This is consistent with the incidence of cervical abrasion reported by Sud, which was 13%, as well as Sexena et al., (68.6%) and Borcic et al., (60-70%), which were both higher than the present research[18][19][20].David and Bhat reported 6.1%, which is lower than the current investigation rate[21].While investigating the etiologies of tooth surface loss, research in Romania discovered that abrasion (55.7%) affects the natural dentition more often than the other etiologies related with non-cervical tooth surface loss[22].The variation observed in research ndings could potentially be