David william Bartlett

King's College London | KCL · Department of Restorative Dentistry

The aim of this in vivo study was to compare total protein present in the salivary films (F) and acquired enamel pellicle (AEP) on eroded and non-eroded surfaces in patients suffering from GORD symptoms with and without GORD diagnosis (GORD, No-GORD). Thirty-nine patients suffering from GORD symptoms and erosive tooth wear on lower first molars and...

Human enamel is one of the strongest and hardest substances in the body. However, in the presence of repeated and regular exposure to acids, damage occurs at an increased rate of progression, potentially affecting aesthetics and reducing the restorability of the teeth. This article provides an update on the extrinsic and intrinsic chemical factors...

Objectives: This study compared the surface change on natural and polished enamel exposed to a joint mechanical and chemical wear regimen. Methods: Human enamel samples were randomly assigned to natural (n=30) or polished (n=30) groups, subjected to erosion (n=10, 0.3% citric acid, 5min), abrasion (n=10, 30s), or a combination (n=10). Wear in th...

Statement of problem: Whether polyvinyl siloxane impressions are capable of reproducing 5-μm changes on natural freeform enamel and potentially enabling clinical measurements of early surface changes consistent with wear of teeth or materials is unclear. Purpose: The purpose of this in vitro study was to investigate and compare polyvinyl siloxan...

Objectives To assess the differential early wear susceptibility of cementum, enamel and dentine at a micron level. Methods Whole human molar buccal surfaces incorporating natural enamel and cementum (n = 20) confirmed by imaging (digital microscopy: Keyence, VHX-7000 Milton Keynes, UK), were mounted, scanned (profilometry: XYRIS 4000, Taicaan, Sou...

Objectives: To investigate the threshold and accuracy of intraoral scanning in measuring freeform human enamel surfaces. Methods: Software softgauges, ranging between 20 and 160 µm depth, were used to compare four workflow analysis techniques to measure step height on a freeform surface; with or without reference areas and in combination with su...

Objectives The aim of this study was to determine predictors of erosive tooth wear (ETW) progression, using novel primary-care quantitative analysis techniques. Methods In a single-centre, prospective, observational cohort longitudinal study, adolescents, aged 11-18 years, underwent a baseline BEWE examination, validated risk factors questionnaire...

Purpose This investigation aimed to compare the protective role of saliva against erosion and attrition challenges. Method Polished enamel and dentine samples (n=160) were prepared and randomly assigned to either the saliva or saliva-free group (n=40 enamel and n=40 dentine/group). Within each subgroup, they were allocated to four subgroups: negat...

Objectives : To determine if superimposition of sequential scans can discriminate between different fluorides at step heights less than 5 μm on natural human enamel surfaces. Materials and methods : Natural, unpolished, human enamel specimens (n = 60) were randomly assigned to one of three pre-treatment toothpaste slurries with a calcium silicate/...

Objectives To compare the frequency of patients’ oral health problems and prevention needs among Slovenian and international dentists with the aim to validate the four oral health-related quality of life (OHRQoL) dimensions across six clinical dental fields in all World Health Organization (WHO) regions. Methods An anonymous electronic survey in t...

Purpose: To measure step height change, using profilometry on dentin, after pre-treatment with sodium fluoride at 1,450 and 5,000 ppm and then erosion with citric acid. . Methods: Dentin specimens (n= 150), sectioned from the coronal aspect of extracted human molars were randomly divided into three groups of 60 samples each and fully immersed in...

Objective : Digital microscopy offers ability to scan surfaces to produce 3D reconstructions, allowing step height measurements with high accuracy. The aims of this study were to compare the step heights from the gold standard, non-contact profilometry, to digital microscopy in an erosion/abrasion model. Methods : Dentine specimens (n = 60) were i...

Objective: To estimate the prevalence and distribution of tooth wear among groups of adolescents and adults in Shanghai, China through an epidemiological survey, and explore the associated factors. Methods: Multistage, stratified, constant volume and cluster sampling methods were used in an epidemiological survey conducted in Shanghai in 2014. T...

Background Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact are the four oral health-related quality of life (OHRQoL) dimensions (4D) or areas in which oral disorders impact pediatric patients. Using their dentists' assessment, the study aimed to evaluate whether pediatric dental patients' oral health concerns fit into t...

Objectives: Our ability to detect dental wear on sequential scans is improving. This experiment aimed to determine if widely used surface registration methods were sufficiently accurate to distinguish differences between intervention groups on early wear lesions. Methods: Baseline measurements were taken on human molar buccal enamel samples (n=9...

Natural human enamel (NHE) is a complex freeform surface which has presented significant difficulties in measuring surface form change using non-contacting laser profilometry (NCLP). Measuring surface form change on NHE is a metrology proxy for measuring dental tooth structure loss, and characterising this using non-ISO parameters (volume, surface...

Objective To investigate the measurement threshold of an intra-oral scanner (IOS) on polished human enamel. Methods The optical performance of an IOS was compared to a gold-standard non contacting laser profilometer (NCLP), on a painted microscope slide, compared to increasing particle size of silicon-carbide papers (21.8–269.0 μm) and separately...

Non-carious dental lesions such as developmental defects of enamel (DDE) and erosive tooth wear (ETW) are the subject of intensive research. This paper aims to give perspectives on both DDE, including dental fluorosis and molar incisor hypomineralization (MIH), and ETW, presenting epidemiological data from the Americas and associated diagnostic asp...

Purpose The purpose of this Best Evidence Consensus Statement was to evaluate the impact of wear on teeth. Materials and Methods A search updated last on the 07th October 2020 using the terms tooth wear, dental erosion, dental abrasion or dental attrition yielded 11,694 results. Limiting the search to clinical trials, cross‐sectional investigation...

Background: The Clinical Oral Disorder in Elders (CODE) index was proposed in 1999 to assess the oral health status and treatment needs of older people who typically were edentate or had few natural teeth. Since then, more people are retaining natural teeth into old age and have oral disorders similar to younger adults. In addition, there has been...

Background Three-dimensional scans are increasingly used to quantify biological topographical changes and clinical health outcomes. Traditionally, the use of 3D scans has been limited to specialized centers owing to the high cost of the scanning equipment and the necessity for complex analysis software. Technological advances have made cheaper, mor...

Objective To investigate the impact of an e-training resource with the consistency of tooth wear scoring using the Basic Erosive Wear Examination (BEWE). Methods Gold standard (GS) BEWE scores were attained from a trained examiner using the photographic and dental cast records for three conveniently selected cases representing low, medium and seve...

Background The dimensions of oral health-related quality of life (OHRQoL) Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact are the major areas where patients are impacted by oral diseases and dental interventions. Aim The aim of this study was to evaluate whether dental patients’ reasons to visit the dentist fit the fou...

Objectives The aim of this systematic review was to assess intervention rates of direct composite restorations in the worn dentition based on data published in clinical trials. Methods Searches of electronic data bases, grey Literature and hand searches were completed, and selection criteria were applied at the title, abstract and full paper stage...

Objective To investigate the relationship between levels of tooth wear scored using the Basic Erosive Wear Examination (BEWE) and the impact on the quality of life of adult dental patients. Methods BEWE assessments were performed on 319 new dentate adult patients attending the practices of 5 trained recruiters based in primary care in Malta (120),...

Objectives Recent software advancements have facilitated quantification of erosive tooth wear progression using intraoral scans. This paper investigated if wear on commonly affected surfaces (central incisors and first molars) was representative of wear on the full arch. Methods Bimaxillary digital intraoral scans (True Definition, 3 M, USA) of pa...

Tooth wear is the multifactorial process where acids and mechanical challenges either act alone or together remove enamel and then dentine. The interaction of acids and mechanical processes, attrition and abrasion, has led to increasing adoption of the term “erosive tooth wear”. This term acknowledges that most tooth wear is multifactorial, often w...

Objectives to investigate how the composition of the acquired enamel pellicle (AEP) affected a laboratory model of Erosive tooth wear (ETW) on human enamel by comparing whole mouth saliva (WMS) to parotid saliva (PS). Methods 60 enamel specimens were prepared from extracted human teeth and were randomly assigned to 4 experimental groups: WMS (n =...

Aim To assess the habits of tooth wear risk assessment and charting using a tooth wear index, by UK and non-UK dental practitioners. Design A questionnaire-based evaluation. Methods Three hundred and two completed questionnaires were returned and the outcomes analysed using descriptives, Chi-squared test and Fisher's exact test in SPSS. Significanc...

This paper explains how to screen tooth wear in general practice using the Basic Erosive Wear Examination (BEWE) index. It explains how stakeholders in the UK acknowledged the convenience of the BEWE and that it could be recorded at the same time as the Basic Periodontal Examination (BPE). The article contains examples of anterior and posterior too...

Objectives: To investigate if quantitative analysis of intraoral scans of study models can identify erosive tooth wear progression. Methods: Data were collected from a retrospective longitudinal study, using pre-and post-orthodontic treatment casts of 11-13 year olds, recorded at two consecutive appointments 29 months apart. Casts were digitised...

Objectives: The aim of this study was to investigate variations in the interaction between enamel, that is, the acquired enamel pellicle (AEP) and citric or hydrochloric acid. Materials and methods: A 24-h AEP was formed on natural enamel specimens (n = 40) from pooled whole mouth human saliva. Samples were randomly allocated to citric (0.3%, pH...

Introduction Abfraction is a theoretical term used that has been classified as a type of non-carious cervical lesion (NCCL) and characterised by the microstructural loss of hard dental tissue in areas of high stress concentration. There is a lack of consensus among researchers and clinicians as to whether occlusal loading, particularly interference...

Background: Dentine hypersensitivity is a frequent oral complaint that is usually associated with several factors including diet and oral hygiene practices. Objective: The aim of this study was to assess the prevalence, severity and correlates of dentine hypersensitivity and dentine exposure related risk indicators in a sample from six Arab coun...

BACKGROUND Digital scanners are being increasingly used to quantify biological topographical changes and clinical health outcomes in primary care settings. However, measurements obtained using these rapidly developing systems are rarely compared with previous precision measurements in tertiary laboratory-based settings. OBJECTIVE This investigatio...

Our understanding of erosive tooth wear and its contributing factors has evolved considerably over the last decades. New terms have been continuously introduced, which frequently describe the same aspects of this condition, whereas other terms are being used inappropriately. This has led to unnecessary confusion and miscommunication between patient...

Objectives: The use of surface matching software with intraoral scanners is developing rapidly which increases the need for accessible, accurate and validated measurement software. This investigation compared the current gold-standard Geomagic Control software to a purpose-built software "WearCompare". Methods: Artificially created occlusal defe...

Objective: To assess common dietary erosive-tooth-wear (ETW) risk in university students from an exotic-fruit country comparing index teeth vs. full mouth ETW assessment. Methods: A risk factors' questionnaire was applied on 601 18-25 years old subjects in Bogotá-Colombia. Trained examiners assessed clinically: ETW (BEWE) on all buccal, occlusal...

Global task on denture adhesives guidelines

Background In an ageing population, tooth wear is likely to increase. It is increasing in prevalence in the younger population and a greater number of patients are retaining their teeth into old age. Methods This paper is a narrative review of the clinical presentation, the epidemiology and the restorative intervention for erosive tooth wear. The...

Erosive tooth wear is the third most commonly observed oral condition after caries and periodontal disease, with a prevalence similar to that of dentine hypersensitivity. However, it is not a condition that is routinely screened, or monitored, as part of the standard dental examination. Following a meeting held in 2018, this paper considers the out...

Introduction Some patients with GORD develop ETW referred to as GE(GORD-Erosion group) whereas others don’t and these are referred to as GNE(GORD-no-erosion group).The latest gold standard reflux monitoring is impedance-pH monitoring to identify the type of reflux and correlate the symptoms to each type of reflux. Basic Erosive Tooth Wear Examinati...

Objectives: To determine the detection threshold of non-contacting laser profilometry (NCLP) measuring surface form and surface roughness change in natural human enamel in vitro, characterise how ambient scanning thermal variation affects NCLP measurement, and calculate bulk enamel loss in natural human enamel. Methods: NCLP repeatability and re...

This paper discusses the presence of, and interplay between, erosion, abrasion and attrition as risk factors of tooth wear progression. The Basic Erosive Wear Examination is recommended as a simple practice-based screening tool to integrate into a risk assessment. Finally, the risk indicators are summarized and categorized using a high, medium or l...

Objectives: Alignment procedures have yet to be standardised and may influence the measurement outcome. This investigation assessed the accuracy of commonly used alignment techniques and their impact on measurement metrics. Methods: Datasets of 10 natural molar teeth were created with a structured-light model-scanner (Rexcan DS2, Europac 3D, Cre...

Objectives: To investigate the sensitivity of intraoral scanners to quantitatively detect early erosive tooth wear. Methods: Natural buccal enamel samples were mounted in acrylic and scanned at baseline with an intraoral scanner (3 M True Definition Scanner, 3 M, USA). Samples were then exposed to 0.3% citric acid pH 3.2 at intervals of 10 min u...

Objective: This study evaluated the capability of profilometry, microhardness, Optical Coherence Tomography (OCT) and Tandem Scanning Confocal Microscopy (TSM) in characterising the early erosive lesion in polished and natural human enamel in vitro. Methods: Polished (n=60) and natural (n=60) human enamel surfaces, were immersed and agitated in...

Aim To establish the average treatment need and cost of prosthodontic rehabilitation of severe erosive tooth wear within an NHS hospital setting. Methods The clinical notes of patients referred and accepted for treatment to King's College London Dental Institute specialist restorative clinics by their GDP between 1 January 2014 and 1 January 2016...

Objectives: Prevalence of gingival recession (GR) and associations with dentine hypersensitivity (DH), erosive toothwear (BEWE), gingival bleeding (BOP) and periodontal pocketing (PPD) in young European adults. Materials and methods: This is a secondary analysis using data collected from 350 UK participants enrolled in a European cross sectional...

There is a perceived gap between dietary advice given by health practitioners and adherence to the advice by patients. We investigated whether a behaviour change technique (implementation-planning) was more effective than standard-of-care diet advice at reducing dietary acid intake using quantitative erosive tooth wear progression as an objective c...

Objective To assess charting, risk assessment and treatment-planning of tooth wear between recently qualified and experienced dentists in general dental practice. Design Service evaluation. Setting Multi-setting evaluation of three mixed NHS/Private general dental practices in North-East London. Methods The clinical notes of new patient examination...

The rationale for using crowns when composites continually fail. Indications and management for crown lengthening of worn teeth. Material options for definitive crowns in the treatment of tooth wear.

Objectives: To investigate the differences in susceptibility of the surface of native and polished enamel to dietary erosion using an in-situ model. Methods: Thirty healthy volunteers (n = 10 per group) wore mandibular appliances containing 2 native and 2 polished enamel samples for 30 minutes after which, the samples were exposed to either an e...

Objectives: To assess the precision of optical profilometry for characterising the 3D surface roughness of natural and polished human enamel in order to reliably quantify acid mediated surface roughness changes in human enamel. Methods: Forty-two enamel samples were prepared from extracted human molars and either polished flat or left unmodified...

Erosive wear undermines the structural properties of enamel resulting in irreversible enamel loss. A thin protein layer formed from natural saliva on tooth surfaces, acquired enamel pellicle (AEP), protects against erosive wear. The exact components in saliva responsible for such protection are not yet known. We prepared three solutions containing...

The aim of this in-vivo study was to compare total protein and four key salivary proteins present in the acquired enamel pellicle (AEP) on eroded and non-eroded surfaces in participants with erosive tooth wear. Participants with erosive tooth wear of dietary non-intrinsic origin, present on the occlusal surfaces of the lower first molars and an una...

Standard curves of the purified proteins of standards. (A) Curves were generated from volume intensities (mean±SD) against the absolute quantity in nanogram (n = 15) and were used to quantify the absolute quantity of proteins in the AEP samples. (TIF)

Objectives To determine if Sa roughness data from measuring one central location of unpolished and polished enamel were representative of the overall surfaces before and after erosion. Methods Twenty human enamel sections (4x4 mm) were embedded in bis-acryl composite and randomised to either a native or polishing enamel preparation protocol. Ename...

Expanded raw data for unpolished enamel. (XLSX)

Summarised and raw data for unpolished and polished enamel. (XLSX)

Expanded raw data for polished enamel. (XLSX)

Statistical report. (DOCX)

Objectives The aim of this audit was to monitor the outcome of composite restorations placed at an increased vertical dimension in patients with severe tooth wear. Methods This convenience sample of patients were treated by 11 specialist trainees in prosthodontics, and restored with direct composites. Exclusion criteria included bruxism, poor medic...

Objective: To investigate the measurement performance of a chromatic confocal profilometer for quantification of surface texture of natural human enamel in vitro. Methods: Contributions to the measurement uncertainty from all potential sources of measurement error using a chromatic confocal profilometer and surface metrology software were quanti...

This paper presents European expert consensus guidelines on the management of severe tooth wear. It focuses on the definition of physiological vs pathological tooth wear and recommends diagnosis, prevention, counseling, and monitoring aimed at elucidating the etiology, nature, rate and means of controlling pathological tooth wear. Management decisi...

Objectives: To assess the effect of implant angulation on the retention of two different attachment systems for implant-supported overdentures after a simulated fatigue period of 5.5 years. Material and methods: Two test set-ups were constructed. A two-implant mandibular implant-supported overdenture design was simulated using acrylic resin bloc...

Objectives: To investigate the effects of a 5% NovaMin containing dentifrice on dentine tubule patency and surface roughness at 100g and 400g tooth brush abrasion forces. Methods: 75 polished human dentine samples were prepared and randomly allocated into one of five groups; control (1), Na2PFO3 100g abrasion force (2), NovaMin 100g (3), Na2PFO3...

Objectives: 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. Methods: Using case-cont...

Background: Clinical experience suggests that there is a difference in survival between anterior and posterior all ceramic restorations. Objectives: This systematic review compared the difference in survival for full coverage all-ceramic materials used in adults to restore anterior or posterior vital teeth, not involved with fixed dental prosthe...

The management challenge with erosive tooth wear is that the condition involves erosion and contributions from attrition and abrasion, both of which impact on the longevity of restorations. Severe erosive tooth wear results in visibly shorter teeth, exposure of dentine and adaptive changes which complicate restorative management. There is increasin...

Tooth wear has been recognised as an increasing problem over the past 10 years. Recent data from epidemiological studies indicate that the condition is common with prevalence of dentine exposure in adults ranging between 2% and 10% and visible surface changes on teeth observed up to 30% of European adults. The Basic Erosive Wear Examination (BEWE)...

Background: Application of fluoride mouthrinse before an acidic challenge may decrease enamel erosion. This paper compares the efficacy of stannous (SnF2 ) and sodium (NaF) fluoride when facing single and multiple erosive cycles in vitro. Methods: Human enamel samples (n=60) were randomly assigned to groups testing SnF2 and NaF mouthrinses (225p...

Objectives: This paper investigates the application of confocal laser scanning microscopy to determine the effect of acid-mediated erosive enamel wear on the micro-texture of polished human enamel in vitro. Methods: Twenty polished enamel samples were prepared and subjected to a citric acid erosion and pooled human saliva remineralization model....

Aims: To identify students' perceptions of barriers to effective study and the relationship between these and demographic characteristics, levels of perceived stress and examination performance. Materials and methods: A questionnaire was distributed to first (BDS1) and final year (BDS5) King's College London dental undergraduates, during Spring...