Clinical Oral Investigations

, Volume 17, Issue 2, pp 585–593 | Cite as

Dental erosion prevalence and associated risk indicators among preschool children in Athens, Greece

  • Magdalini Mantonanaki
  • Haroula Koletsi-KounariEmail author
  • Eleni Mamai-Homata
  • William Papaioannou
Original Article



The aims of the study were to investigate dental erosion prevalence, distribution and severity in Greek preschool children attending public kindergartens in the prefecture of Attica, Greece and to determine the effect of dental caries, oral hygiene level, socio-economic factors, dental behavior, erosion related medication and chronic illness.

Material and methods

A random and stratified sample of 605 Greek preschool children was clinically examined for dental erosion using the Basic Erosive Wear Examination Index (ΒΕWE). Dental caries (dmfs) and Simplified Debris Index were also recorded. The data concerning possible risk indicators were derived by a questionnaire. Zero-inflated Poisson regression was generated to test the predictive effects of the independent variables on dental erosion.


The prevalence of dental erosion was 78.8 %, and the mean and SE of BEWE index was 3.64 ± 0.15. High monthly family income was positively related to ΒΕWE cumulative scores [RR = 1.204 (1.016–1.427)], while high maternal education level [RR = 0.872 (0.771–0.986)] and poor oral hygiene level [DI-s, RR = 0.584 (0.450–0.756)] showed a negative association.


Dental erosion is a common oral disease in Greek preschool children in Attica, related to oral hygiene and socio-economic factors.

Clinical relevance

Programs aimed at erosion prevention should begin at an early age for all children.


Cross-sectional study Erosion BEWE Preschool children Risk indicators 



The authors would like to thank the Ministry of Education, the teachers, the children and their parents in all the participating kindergartens for their cooperation.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Dugmore CR, Rock WP (2003) The progression of tooth erosion in a cohort of adolescents of mixed ethnicity. Int J of Peadiatr Dent 13:295–303CrossRefGoogle Scholar
  2. 2.
    Barbour ME, Rees GD (2006) The role of erosion, abrasion and attrition in tooth wear. J Clin Dent 17:88–93PubMedGoogle Scholar
  3. 3.
    Jaeggi T, Lussi A (2006) Prevalence, incidence and distribution of erosion. Monogr Oral Sci 20:44–65PubMedCrossRefGoogle Scholar
  4. 4.
    Pindborg JJ (1970) Pathology of the dental hard tissues. Munskgaard, Copenhagen, pp 312–321Google Scholar
  5. 5.
    Millward A, Shaw L, Smith A (1994) Dental erosion in four-year-old children from differing socioeconomic backgrounds. ASDC J Dent Child 61:263–266PubMedGoogle Scholar
  6. 6.
    Imfeld T (1996) Dental erosion. Definition, classification and links. Eur J Oral Sci 104:151–155PubMedCrossRefGoogle Scholar
  7. 7.
    Linnett V, Seow WK (2001) Dental erosion in children: a literature review. Peadiatr Dent 23:37–43Google Scholar
  8. 8.
    Bartlett D, Dugmore C (2008) Pathological or physiological erosion—is there a relationship to age? Clin Oral Investig 12(Suppl 1):27–31CrossRefGoogle Scholar
  9. 9.
    Wiegand A, Muller J, Werner C, Attin T (2006) Prevalence of erosive tooth wear and associated risk factors in 2-7-year-old German kindergarten children. Oral Dis 12:117–124PubMedCrossRefGoogle Scholar
  10. 10.
    Ganss C, Klimek J, Giese K (2001) Dental erosion in children and adolescents—a cross-sectional and longitudinal investigation using study models. Community Dent Oral Epidemiol 29:264–271PubMedCrossRefGoogle Scholar
  11. 11.
    Chadwick BL, White DA, Morris AJ, Evans D, Pitts NB (2006) Non-carious tooth conditions in children in the UK, 2003. Br Dent J 200:379–384PubMedCrossRefGoogle Scholar
  12. 12.
    Harding MA, Whelton HP, Shirodaria SC, O’Mullane DM, Cronin MS (2010) Is tooth wear in the primary dentition predictive of tooth wear in the permanent dentition? Report from a longitudinal study. Community Dent Health 27:41–45PubMedGoogle Scholar
  13. 13.
    Taji S, Seow K, Townsend G, Holcombre T (2010) A controlled study of dental erosion in 2- to 4-year-old twins. Int J Paediatr Dent 20:400–409PubMedCrossRefGoogle Scholar
  14. 14.
    Luo Y, Zeng XJ, Du MQ, Bedi R (2005) The prevalence of dental erosion in preschool children in China. J Dent 33:115–121PubMedCrossRefGoogle Scholar
  15. 15.
    Al-Majed MA, Murray J (2002) Risk factors for dental erosion in 5–6 year old and 12–14 year old boys in Saudi Arabia. Community Dent Oral Epidemiol 30:38–46PubMedCrossRefGoogle Scholar
  16. 16.
    O’Brien M (1994) Children’s dental health in the United Kingdom 1993. Her Majesty’s Stationery Office, LondonGoogle Scholar
  17. 17.
    Jones SG, Nunn JS (1995) The dental health of 3-year-old children in East Cambria 1993. Community Dent Health 12:161–166PubMedGoogle Scholar
  18. 18.
    Hinds K, Gregory J (1995) National Diet and Nutrition Survey: children aged 1½ to 4½ years. Report of the dental survey. HMSO, LondonGoogle Scholar
  19. 19.
    Al-Malik MI, Holt RD, Bedi R (2001) The relationship between erosion, caries and rampant caries and dietary habits in preschool children in Saudi Arabia. Int J Paediatr Dent 11:430–439PubMedGoogle Scholar
  20. 20.
    Harding MA, Whelton H, O’Mullane DM, Chronin M (2003) Dental erosion in 5-year-old Irish school children and associated factors: a pilot study community. Dent Health 20:165–170Google Scholar
  21. 21.
    Murakami C, Oliveira LB, Sheiham A, Nahas Pires Correa MS, Haddad AE, Bonecker M (2011) Risk indicators for erosive tooth wear in Brazilian preschool children. Caries Res 45:121–129PubMedCrossRefGoogle Scholar
  22. 22.
    Lussi A, Schlueter N, Rakhmatullina E, Ganss C (2011) Dental erosion—an overview with emphasis on chemical and histopathological aspects. Caries Res 45(suppl 1):2–12PubMedCrossRefGoogle Scholar
  23. 23.
    Petersen EP (2003) The Oral Health Report 2003. Continuous improvement of oral health in the 21st century—the approach of the WHO Global Oral Health Programme. World Health Organization, Geneva, publication no. WHO/NMH/NPH/ORH/03.2Google Scholar
  24. 24.
    Lussi A, Jaeggi T (2008) Erosion-diagnosis and risk factors. Clin Oral Investig 12(Suppl 1):S5–S13PubMedCrossRefGoogle Scholar
  25. 25.
    Nunn JH, Gordon PH, Morris AJ, Pine CM, Walker A (2003) Dental erosion—changing prevalence? A review of British national children’s surveys. Int J Paediatr Dent 13:98–105PubMedCrossRefGoogle Scholar
  26. 26.
    Gatou T, Homata H (2011) Tooth wear in the deciduous dentition of 5–7-year-old children: risk factors. Clin Oral Investig. doi: 10.1007/s00784-011-0586-z
  27. 27.
    Margaritis V, Mamai-Homata E, Koletsi-Kounari H, Polychronopoulou A (2011) Evaluation of three different scoring systems for dental erosion: a comparative study in adolescents. J Dent 39:88–93PubMedCrossRefGoogle Scholar
  28. 28.
    Prodromidis PI (2006) Greece in terms of the 2001 disaggregated data. In: A regional analysis of declared incomes in Greece. Centre of Planning and Economic Research, Athens, pp 31–53Google Scholar
  29. 29.
    Green JC, Vermillion JR (1964) The simplified oral hygiene index. JADA 68:7–13Google Scholar
  30. 30.
    World Health Organization (1997) Oral health surveys. Basic methods, 4th edn. WHO, GenevaGoogle Scholar
  31. 31.
    Bartlett D, Ganss C, Lussi A (2008) Basic Erosive Wear Examination (BEWE): a new scoring system for scientific and clinical needs. Clin Oral Investig 12(Suppl 1):S65–S68PubMedCrossRefGoogle Scholar
  32. 32.
    Long JS (1997) Regression models for categorical and limited dependent variables. Sage, Thousand OaksGoogle Scholar
  33. 33.
    Greene JC (1967) The simplified oral hygiene index—development and uses. J Periodontol 38:625–637PubMedGoogle Scholar
  34. 34.
    Johansson AK, Lingström P, Birkhed D (2002) Comparison of factors potentially related to the occurrence of dental erosion in high- and low-erosion groups. Eur J Oral Sci 110:204–211PubMedCrossRefGoogle Scholar
  35. 35.
    Cheung A, Zid Z, Hunt D, McIntyre J (2005) The potential for dental plaque to protect against erosion using an in vivo–in vitro model—a pilot study. Aust Dent J 50(4):228–234PubMedCrossRefGoogle Scholar
  36. 36.
    Honório HM, Rios D, Santos CF, Buzalaf MA, Machado MA (2010) Influence of dental plaque on human enamel erosion: in situ/ex vivo study. Oral Health Prev Dent 8(2):179–184PubMedGoogle Scholar
  37. 37.
    Lussi A, Jaeggi T, Zero D (2004) The role of diet in the aetiology of dental erosion. Caries Res 38(Suppl 1):34–44PubMedCrossRefGoogle Scholar
  38. 38.
    Hara AT, Lussi A, Zero DT (2006) Biological factors. Monogr Oral Sci 20:88–99PubMedCrossRefGoogle Scholar
  39. 39.
    Moss SJ (1998) Dental erosion. Int Dent J 48:529–539PubMedCrossRefGoogle Scholar
  40. 40.
    Al-Malik MI, Holt RD, Bedi R (2002) Erosion, caries and rampant caries in preschool children in Jeddah, Saudi Arabia. Community Dent Oral Epidemiol 30:16–23PubMedCrossRefGoogle Scholar
  41. 41.
    Mulic A, Tveit AB, Wang NJ, Hove LH, Espelid I, Skaare AB (2010) Reliability of two clinical scoring systems for dental erosive wear. Caries Res 44:294–299PubMedCrossRefGoogle Scholar
  42. 42.
    Young A, Amaechi BT, Dugmore C, Holbrook P, Nunn J, Schiffner U, Lussi A, Ganns C (2008) Current erosion indices—flawed or valid? Summary. Clin Oral Investig 12(Suppl 1):S59–S63PubMedCrossRefGoogle Scholar
  43. 43.
    Morton LM, Cahill J, Hartge P (2006) Reporting participation in epidemiologic studies: a survey of practice. Am J Epidemiol 163:197–203PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Magdalini Mantonanaki
    • 1
  • Haroula Koletsi-Kounari
    • 1
    Email author
  • Eleni Mamai-Homata
    • 1
  • William Papaioannou
    • 1
  1. 1.Department of Preventive and Community Dentistry, Dental SchoolUniversity of AthensAthensGreece

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