Relationship between Erosive Tooth Wear and Consumption of Beverages among Children in the United States

Objective: Laboratory studies have identified differences in the physiochemical properties and the effect of dilution of beverages on the etiology of erosive tooth wear (ETW). Not enough is known from epidemiological studies about the relationship between ETW and the consumption of beverages available in the United States. This study examined the association of consumption of different beverages with ETW in children in United States. Methods: The National Health and Nutrition Examinations Survey data for 2003-2004 was analyzed. Trained and calibrated examiners used the modified Smith and Knight tooth wear index from the 1998 United Kingdom Adult health survey to measure ETW. Beverage consumption collected via a Food Frequency Questionnaire was processed with DietCalc software to obtain average daily consumption frequency for all queried juice categories, milk, and carbonated beverages. Survey-weighted descriptive and multivariable analyses were performed. Results: Prevalence of erosive tooth wear was highest in 18-19 year olds (56%), males (49%) and among whites (48%). After adjusting for age, gender, and race/ethnicity, more frequent apple juice consumption was found to be associated with a higher likelihood of erosive tooth wear (OR=1.24, 95% CI 1.08-1.43, p=0.003). No association was found for grape, orange/grapefruit, tomato/vegetable juice, juice drinks, soda, or milk. Conclusions: This study demonstrates that erosive tooth wear was associated with frequent intake of apple juice, thus confirming laboratory studies of the risk of apple juice on ETW.