Community Dent Oral Epidemiol 2000; 28: 211–7 Copyright C Munksgaard 2000 Printed in Denmark . All rights reserved ISSN 0301-5661 Inge Birk Larsen 1 , Jytte Westergaard 2 , Kaj Stoltze 2 , A clinical index for evaluating and Anders Ingemann Larsen 1 , Finn Gyntelberg 3 and Palle Holmstrup 2 monitoring dental erosion 1 Occupational Health Service, Novo Nordisk A/S, Bagsværd, 2 Department of Periodontology, School of Dentistry, University of Copenhagen and 3 Clinic of Occupational and Environmental Medicine, University Hospital, Bispebjerg, Copenhagen, Denmark Larsen IB, Westergaard J, Stoltze K, Larsen AI, Gyntelberg F, Holmstrup P: A clinical index for evaluating and monitoring dental erosion. Community Dent Oral Epidemiol 2000; 28: 211–7. C Munksgaard, 2000 Abstract – This study describes a new fine-scaled system for classifying initial and advanced dental erosions. The system includes the use of study casts of the teeth in an epoxy resin with an accurate surface reproduction. The severity of erosion on each tooth surface is scored according to six grades of severity. In addi- tion, the presence of a Class V restoration and dental erosion on the same surface Key words: clinical index; dental erosion; oral epidemiology increases the erosion score, as it is assumed that the need for restorative treatment can be caused by the erosion. A high inter-examiner agreement was found when Jytte Westergaard, Department of Periodontology, School of Dentistry, the present scoring system was used by two examiners on the same sample. With University of Copenhagen, Nørre Alle ´ 20, this prerequisite it is proposed that an index value for facial, oral, incisal/occlusal DK-2200 Copenhagen N, Denmark and cervical surfaces is calculated as the mean value of scores for the respective Tel.: π45 35326693 surfaces. The index values represent the severity of tooth substance loss in vari- Fax: π45 35326699 e-mail: jytte.westergaard/odont.ku.dk ous locations of the oral cavity and are furthermore suitable for data analysis. The system is thereby well-suited for determining etiologic factors and monitoring Submitted 18 February 1999; accepted 13 the progression of erosion over time. December 1999 In modern society further research is required for an improved understanding of the etiology and pathogenesis of dental erosion, because new life styles (1) and new technologies (2) may give rise to hitherto unnoticed or unknown lesions. Dental erosion has always been defined by cause, namely as loss of dental hard tissue due to a chemi- cal process as distinct from the process that leads to the bacterially induced carious lesion (3). The acidic components of diets and beverages (4–7), medications (8, 9) and occupational exposures (10– 13) have been mentioned as some of the chemical agents responsible for dental erosion. Regurgita- tion and acidic vomiting are other possible causes of dental erosion (14–16). As the surface undergoing erosion softens (17), it becomes more susceptible to further breakdown by mechanical influences (18), e.g., attrition due to 211 contacts between opposing teeth, and abrasion caused by toothbrushing and/or coarse diet (19, 20). What appears in the clinic as erosive loss of tooth substance is therefore often caused by a com- bination of factors. It is mandatory for an increased understanding of dental erosion to develop systems enabling eval- uation and surveillance of loss of dental hard tissue caused by erosive processes. Systematic registra- tion of effect parameters described in classification systems is a common basis for determining etiolog- ic and pathogenic factors behind pathologic changes. The effect parameters thus registered are often based on morphologic characteristics, which may in fact be related to several causes. This basic problem, which applies to the classification of his- tologic (21) as well as clinical features (22), gen- erally renders most classification systems inaccu-