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

Abstract

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 Award	23 Jun 2020
Original language	English
Awarding Institution	University of Bristol
Supervisor	Nicola X West (Supervisor), Maria Davies (Supervisor) & Joon Seong (Supervisor)