Dental Erosion – incidence and progression high in adolescents


There are concerns that the levels of dental erosion, defined as, the irreversible loss of tooth tissue by chemical processes not involving bacteria are increasing with estimates of prevalence of about 30% in children and adolescents.

The aim of this study was to evaluate the progression of dental erosion over four years in a group of 13–14 year-old adolescents, and its association with some lifestyle and oral health factors.


A random sample of Swedish 13-14 year olds were invited to participate. Clinical examination for caries/gingival/plaque status and grading of dental erosion at the tooth surface and participant levels in ‘marker teeth’, including buccal/palatal surfaces of 6 maxillary anterior teeth and occlusal surfaces of first molars was undertaken. Drinking habits and other lifestyle factors were assessed by interview and questionnaire. Investigations were conducted at baseline and at 4 year follow up. In addition to scoring the severity of dental erosion on the marker teeth, Simplified Erosion Partial Recording System (SEPRS) was calculated. The participants were divided into high and low progression erosion groups and logistic regression statistics were applied.


  • 227 patients were recruited at baseline
  • 175 were available at the 4-year follow up (22.9% drop out)
  • The incidence of dental erosion was 76%.
  • Progression occurred in 35% of the 2566 tooth surfaces. 32% of the surfaces had deteriorated by one severity grade (n=51 individuals) and 3% by two grades (n=2 individuals).
  • Boys showed more severe erosion than girls at the follow-up.
  • Frequency distribution of SEPRS were not significantly different between boys and girls at baseline but was at follow up.
  • The prevalence of severe/very severe erosion according to SEPRS for boys was 9.5% at baseline and 14.9% at follow-up with the corresponding figures for girls 2.5% and 6.3% respectively.
  • Among the variables predicting greater progression, a lower severity of erosive wear at baseline had the highest Odd ratio (OR=13.3), followed by a “retaining” drinking technique (OR= 6.3), more frequent intake of drinks between meals (OR=5.96), low Gingival bleeding index (OR= 6.02) and lesser sour milk intake (OR= 4.81), with reference to the baseline recording.
  • Using these five variables, the sensitivity and specificity for predicting progression of erosion were 87% and 67% respectively,


The authors concluded

Both the incidence and progression of dental erosion are high between 13–14 and 17–19 years of age. The hypothesis that progression was associated with certain lifestyle factors was fulfilled; that it was higher in boys was not confirmed, although boys developed more severe erosion than girls during the follow- up period.


Previously we have looked at a review of the incidence of dental erosion, which involved a large number of studies (Dental Elf-27th Nov 2014). The majority of the included studies were cross sectional with only two prospective cohort studies. This new prospective study from Sweden adds to the available evidence. Given the 4 year follow up period the 23% drop out rate was considered good but it is interesting to note that the drop outs had a greater severity of erosion at baseline. The drinking habits and lifestyle data was collected at two time points which does raise the questions as to whether these habits were maintained through the whole 4 year time period.


Primary paper

Hasselkvist A, Johansson A, Johansson AK. A 4 year prospective longitudinal study of progression of dental erosion associated to lifestyle in 13-14 year-old Swedish adolescents. J Dent. 2016 Apr;47:55-62. doi: 10.1016/j.jdent.2016.02.002. Epub 2016 Feb 8. PubMed PMID: 26867982.

Other references

Dental Elf – 15th Jul 2015 – Tooth erosion: carbonated drinks associated with higher risk

Dental Elf  – 27th Nov 2014 – Dental erosion: information about incidence of erosive wear worldwide remains unclear


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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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