An audit of bone crushing and its consequences

Method: Fifty successive patients of African and Afro-Caribbean origin aged between 20-50 were examined in a general dental practice in south east London prospectively.

Result: In this study 80% of the patients had a score of 2 or more, on the Smith and Knight tooth wear index. 66% indicated that they crush chicken bones in their diet. In 26% of the patients other risk factors such as teeth grinding and acid erosion were found. In 64% of the patients tooth wear was not the presenting complaint. In 24% the major presenting complaint was aesthetic concerns (short teeth), followed by 12% with teeth sensitivity. 82% of the patients were not aware that crushing bones is an important risk factor in tooth wear.

Conclusion: In this audit the majority of patients suffering from tooth wear had a habit of crushing bones. The majority of the patients did not have any complaint resulting from tooth wear and were not aware of the relationship between tooth wear and bone crushing.

The association between tooth wear and bone crushing in patients from African and Afro-Caribbean origin has been known for years but the prevalence of the habit may have been underestimated. This audit demonstrates the high prevalence of tooth wear related to bone crushing. It is important that dentists educate patients and discourage them from the bone crushing habit. Specific questions need to be asked when taking a history from patients about their dietary habits and specifically about bone crushing. One important consequence of this problem is an association with failure of prosthodontic and restorative treatments.