Risk Prediction Models for Erosive Wear in Preschool-aged Children: A Prospective Study

Background: Despite increasing prevalence, age specific risk predictive models for erosive tooth wear in preschool age children have not been developed. Identification of at risk groups and the timely introduction of behavioural change or treatment will stop the progression of erosive wear in the permanent dentition. The aim of this study was to identify age specific risk factors for erosive wear. Distinct risk prediction models for three year old and five year old children were developed. Methods: A prospective cohort study included clinical examinations and parent administered questionnaires for three and five-year-old children. Chi-square tests explored categorical demographic variables, Spearman Rank Order correlation tests examined changes in BEWE scores with changes in food frequencies while Wilcoxon signed rank tests evaluated the temporal effect of frequencies of consumption of dietary items. Mann-Whitney U tests compared changes in BEWE scores over time for the twenty-six bivariate categorical variables and Kruskall-Wallis tests compared changes in BEWE scores over time across the remaining 55 categorical variables representing demographic factors, oral hygiene habits and dietary habits. Change in BEWE scores for continuous variables was investigated using Spearman Rho correlation coefficient Test. Those variables showing significance with a difference in BEWE cumulative score over time were utilised to develop two risk prediction models. The models were evaluated by Receiver Operating Characteristics (ROC) analysis. Results: Risk factors for the three-year-old cohort included the erosive wear (χ2 (1, 92) = 12.829, p < 0.001), district (χ2 (5, 92) = 17.032, p = 0.004) and family size (χ2 (1, 92) = 4.547, p = 0.033). Risk factors for the five-year-old cohort also included erosive wear (χ2 (1, 144) = 4.768, p = 0.029) gender (χ2 (1, 144) = 19.399, p <0.001), consumption of iced tea (χ2 (1, 144) = 8.872, p = 0.003) and dry mouth (χ2 (1, 144) = 9.598, p = 0.002). Conclusions: : Predictive risk factors for three-year-old children are based on demographic factors and are distinct from those for the five-year-old cohort, which are based on biological and behavioural factors. The presence of erosive wear is a risk factor for further wear in both age cohorts.