Association of Oral Hygiene and Related Risk Factors with Non-Carious Tooth Surface Loss in Adults: A Cross-sectional Study

Objective: To determine the association of Oral Hygiene and Related Risk Factors with Non-Carious Tooth Surface Loss in Adults. Methods: This descriptive cross-sectional study was carried out at Khyber College of Dentistry, Peshawar. A total of 213 patients aged 18 years and above were enrolled through non-probability consecutive sampling after obtaining written informed consent. Individuals with at least 20 natural teeth, irrespective of the presence of TSL, were included, whereas patients with carious, fractured, restored, or missing teeth, developmental defects, prostheses, or ongoing orthodontic treatment were excluded. Tooth surface loss was identified clinically as irreversible non-carious loss of dental hard tissue, including attrition, abrasion, erosion, and abfraction. Information on parafunctional habits, dietary patterns, aggressive toothbrushing, gastroesophageal reflux disease (GERD), and oral hygiene status assessed using the Oral Hygiene Index–Simplified (OHI-S) was obtained through clinical examination and structured history-taking by a calibrated examiner. Association was evaluated using chi-square test. Results: A total of 213 patients were examined, comprising 124 males (58.2%) and 89 females (41.8%). Tooth surface loss (TSL) was detected in 43.0% (n = 92) of the participants. The prevalence of TSL increased with deteriorating oral hygiene, being highest in those with poor oral hygiene (59.1%), followed by fair (46.7%) and good oral hygiene (29.2%), with a statistically significant association (p = 0.007). Among patients with TSL, bruxism was the most common risk factor (31.5%), followed by an acidic diet (27.2%), aggressive toothbrushing (23.9%), and GERD (17.4%); 13.0% reported more than one contributing factor. Chi-square analysis demonstrated a significant overall association between TSL and exposure to risk factors (p = 0.021), with significant associations observed for bruxism (p < 0.001), acidic diet (p = 0.011), poor oral hygiene (p = 0.004), and GERD (p = 0.048). Conclusion: TSL is common and significantly associated with poor oral hygiene, bruxism, acidic diet, and aggressive toothbrushing, with a weaker but still significant association with GERD.