Fluid Intake and the Occurrence of Erosive Tooth Wear in a Group of Healthy and Disabled Children from the Małopolska Region (Poland)

{"Background": "Children with disabilities are at increased risk of oral diseases due to barriers to dental care, difficulties with dietary and hygienic habits, and conditions such as Down syndrome that affect swallowing, salivation, and chewing. Dental erosion is the dissolution of dental hard tissues by non-bacterial acids, and erosive tooth wear has serious long-term implications. While previous studies have reported dental erosion in 42.3% of young adults and 24.3% of 15-year-olds in Poland, no prior study had evaluated factors influencing erosive tooth wear among children with disabilities in Poland. The aim of this study was to analyze the relationship between the type and amount of fluid intake and the incidence of erosive tooth wear in healthy children and children with disabilities.", "Methods": "This observational cross-sectional study was conducted between June and October 2019 among children aged 6\u201317 years at a private dental practice in Krak\u00f3w. After applying exclusion criteria (medication affecting saliva secretion, lack of consent, lack of cooperation), 86 children were included: 44 healthy and 42 with disabilities (73.8% Down syndrome). Parents completed a questionnaire on dietary behavior (modeled after the KomPAN Questionnaire), oral hygiene, general health, and socioeconomic characteristics. Dental examination assessed erosive tooth wear using the BEWE index (categorizing risk as 0\u20132 no risk, 3\u20138 low, 9\u201313 moderate, \u226514 high) and dry mouth via the mirror test (3-point scale). BMI was calculated from parent-reported height and weight and classified per WHO criteria. Statistical analysis used \u03c7\u00b2 test and Mann-Whitney U test, with significance set at p < 0.05. No power calculation or calibration between examiners was performed.", "Key Results": "The mean age was 10.78 \u00b1 2.96 years. Mothers of disabled children were significantly more likely to be unemployed (64.3% vs. 18.2%, p < 0.0001). None of the children had diabetes, asthma, Sj\u00f6gren's syndrome, xerostomia, or salivary gland inflammation. Gastroesophageal reflux and eating disorders were reported in single cases among disabled children. Significantly more disabled children took regular medications (45% vs. 9%, p = 0.0002). Overall, 26% of children had erosive tooth wear. The mean BEWE index was significantly higher in disabled children (2.60, SD = 1.98) than healthy children (1.39, SD = 2.16, p = 0.0003). Erosive tooth wear was non-significantly more common in disabled children (31.0%) than healthy children (20.5%), but was significantly more common in children with eating disorders (p = 0.02). Lesions were of low severity in both groups. The mirror test showed 97.7% of healthy children had no oral dryness vs. 42.9% of disabled children; 57.1% of disabled children showed slight resistance (p < 0.0001). Disabled children consumed flavored waters or waters with syrup/juice (p = 0.0337) and fruit tea (p = 0.0468) significantly more frequently. Erosive tooth wear was significantly associated with higher consumption of sweetened non-carbonated beverages (median 100 mL/day in risk group vs. 0 mL/day in no-risk group, p = 0.0079), sweetened carbonated beverages (median 200 mL/day vs. 0 mL/day, p = 0.0133), black tea (median 200 mL/day vs. 0 mL/day, p = 0.0102), and higher total fluid intake (median 2200 mL/day vs. 1800 mL/day, p = 0.0290). Flavored waters approached significance (p = 0.0590). No significant differences were found for water, 100% juices, fruit tea, milk, or isotonic beverages.", "Clinical Implications": "The study demonstrates that inappropriate drinking behaviors, particularly consumption of acidic and sugary beverages, are associated with erosive tooth wear in children, with a higher burden in children with disabilities. The significantly higher rate of oral dryness in disabled children (57.1% showing slight resistance on mirror test) may further increase erosion risk due to reduced salivary clearance. Given that disabled children cannot independently perform hygiene procedures or make dietary decisions, parental education on the relationship between fluid intake, oral hygiene, and general health should be intensified. The study's limitations include the small sample size, lack of power calculation, no calibration between examiners, and absence of caries prevalence data. Nonetheless, it provides rare quantitative data on fluid consumption in children with special needs."}