title: Timing of dietary acid intake and erosive tooth wear: A case-control study.
abstract: There is a lack of clinical data on the impact of timing of dietary acid intake and toothbrush abrasion when attempting to control erosive tooth wear progression. The aim of this study was to estimate the association of theoretical causative factors with erosive tooth wear to inform evidence-based guidelines.
  
  
  
  Using case-control study design, 300 participants with dietary erosive tooth wear and 300 age-matched controls were recruited from the restorative clinics of King's College London Dental Institute. A previously validated questionnaire was adapted to be interviewer-led and to assess frequency, timing and duration of dietary acid intake in addition to alternate drinking habits prior to swallowing. Timing of toothbrushing in relation to meals and dietary acid intake was investigated. Associations with erosive tooth wear were assessed in crude and adjusted logistic regression models.
  
  
  
  Fruit intake between meals (p<0.001), but not with meals (p=0.206), was associated with erosive tooth wear and contrasted with acidic drinks which maintained a strong association regardless of timing of intake (OR up to 11.84 [95% CI: 5.42-25.89], p<0.001). Prolonged fruit eating and alternate drinking habits prior to swallowing (OR 12.82 [95% CI: 5.85-28.08] and 10.34 [95% CI: 4.85-22.06] respectively) were as strongly associated with erosive tooth wear as three or greater daily acid intakes (OR 10.92 [95% CI: 4.40-27.10]). Toothbrushing within 10min of acid intake was not associated with erosive tooth wear following adjustments for dietary factors (OR 1.41 [95% CI: 0.82-2.42], p=0.215]).
  
  
  
  Significantly increased odds ratios were observed when acids were consumed between meals in this cohort of patients. Universal advice to delay brushing after meals may not be substantiated.
  
  
  
  Prevention should be focused on avoiding dietary acids between meals, eliminating habits which increase contact time with the acid and reducing daily intake of acidic drinks. Toothbrushing after meals was not associated with erosive wear. Toothbrushing immediately after an acid challenge requires further investigation.
authors.affiliation: Department of Prosthodontics, King's College London Dental Institute, Floor 25, Tower Wing, Guy's Hospital, London Bridge, London SE1 9RT, UK. Electronic address: saoirse.otoole@kcl.ac.uk.
authors.forename: Saoirse
authors.initials: S
authors.lastname: O'Toole
authors.affiliation: King's College London, Dental Institute, Denmark Hill Campus, Bessemer Road, London SE5 9RS, UK. Electronic address: eduardo.bernabe@kcl.ac.uk.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bernabé
authors.affiliation: Department of Prosthodontics, King's College London Dental Institute, Floor 25, Tower Wing, Guy's Hospital, London Bridge, London SE1 9RT, UK. Electronic address: rebecca.v.moazzez@kcl.ac.uk.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Moazzez
authors.affiliation: Department of Prosthodontics, King's College London Dental Institute, Floor 25, Tower Wing, Guy's Hospital, London Bridge, London SE1 9RT, UK. Electronic address: david.bartlett@kcl.ac.uk.
authors.forename: David
authors.initials: D
authors.lastname: Bartlett
mesh_terms: D000143:Acids / Q000009:adverse effects*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001628:Beverages / Q000009:adverse effects / Q000706:statistics & numerical data; D016022:Case-Control Studies; D015331:Cohort Studies; D004032:Diet / Q000009:adverse effects* / Q000706:statistics & numerical data; D004327:Drinking Behavior; D004435:Eating; D005247:Feeding Behavior; D005260:Female; D005638:Fruit; D000067030:Fruit and Vegetable Juices / Q000009:adverse effects; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008131:London; D008297:Male; D062407:Meals; D008875:Middle Aged; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D014077:Tooth Erosion / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D057085:Tooth Wear / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D014099:Toothbrushing / Q000009:adverse effects / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D000143:Acids
keywords: Epidemiology; Erosive tooth wear; Risk factors; Toothbrush abrasion