Development and application of a novel cervical index in an epidemiological investigation of tooth wear, recession and dentine hypersensitivity

Student thesis: Master's ThesisMaster of Science (MSc)


Objective: This thesis designed and validated a novel index to assess tooth wear and gingival recession (GR) in the cervical region, for use both in research studies and general dental practice. The index was implemented in a UK epidemiological study which investigated the prevalence of GR, tooth wear, dentine hypersensitivity (DH) and investigated risk factors for severe tooth wear.
Methods: Codes reflecting the clinical presentations of the cervical region in health and disease were defined. The index was validated by 3 trained examiners who scored buccal and palatal surfaces of eligible teeth in 42 adults. Each volunteer underwent 4 identical clinical examinations, the first and last completed by the same examiner. Subsequently, a cross-sectional observational epidemiological study recruited healthy adults who completed a questionnaire and underwent clinical assessments to determine the distribution of the codes of the index, together with the prevalence of tooth wear, GR and DH.
Results: The ‘Cervical Localisation Code’ was defined and focused management strategies provided for each score. For validation, 2073 tooth surfaces were scored with good intra- and inter-examiner reliability demonstrated (57 within and 201 between examiner disagreements). 791 volunteers aged 18-86 years were recruited to the epidemiological study. Participants had good oral hygiene and low levels of periodontitis but high prevalence of DH (60.5% participant-reported), GR (94.7% GR ≥1mm) and tooth wear (78% BEWE 2/3) as determined by whole mouth maximum scores. GR and tooth wear were significantly positively correlated whereas weak/no association was detected between DH and tooth wear/GR, respectively. Age was the only risk factor that was significantly associated with severe tooth wear (p<0.001).
Conclusions: In this large adult population tooth wear, GR and DH were highly prevalent and tooth wear was strongly associated with age. The Cervical Localisation Code presents a valuable tool for researchers and aids general dental practitioners with the diagnosis and management of these common conditions.
Date of Award23 Jun 2020
Original languageEnglish
Awarding Institution
  • The University of Bristol
SupervisorNicola X West (Supervisor), Maria Davies (Supervisor) & Joon Seong (Supervisor)


  • Dentine hypersensitivity
  • Tooth wear
  • Gingival recession
  • Clinical Index
  • Epidemiology
  • Cervical

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