Prevalence, Clinical Patterns, and Multifactorial Etiology of Non-Carious Tooth Surface Loss in a Libyan Population: A Cross-Sectional Study

Abstract

Non-carious tooth surface loss (NCTSL) is an irreversible, Non-carious tooth surface loss (NCTSL) is an irreversible, multifactorial condition characterised by pathological loss of dental hard tissues through attrition, abrasion, erosion, and abfraction. Despite increasing global prevalence, data on NCTSL among Libyan adults remain limited. This cross-sectional study investigated the prevalence, clinical patterns, and multifactorial aetiology of NCTSL in 96 adult patients attending Attahaddi Hospital, Department of Oral Medicine and Diagnosis, Libya. Data were collected using a structured, self-administered questionnaire and standardized clinical examination. Severity was graded using the Basic Erosive Wear Examination (BEWE) index. Patient awareness of tooth surface changes was 96.9%. Clinical examination confirmed NCTSL in 93.8% of patients, with mild wear predominating (46.9%). Anterior teeth were most affected (46.9%), particularly mandibular central incisors (~70%). Multiple aetiological patterns coexisted in 41.7%. The leading risk factors were bruxism (52.1%), weekly/daily fruit juice consumption (52.1%), horizontal brushing (46.9%), and carbonated drinks (41.7%). Bruxism was strongly associated with attrition (OR=4.5, 95% CI: 2.8–7.2, p<0.001). All patients combining horizontal brushing, hard force, and hard bristles exhibited cervical lesions (p<0.001). Daily fruit juice consumption was associated with erosion (OR=5.8, 95% CI: 2.9–11.6). Among GERD patients, 80% had palatal/lingual erosion. Patients with ≥5 risk factors were 18 times more likely to have severe wear (RR=18.2, 95% CI: 6.5–51.0). Although 41.7% expressed moderate-to-severe concern, only 15.6% had a previous diagnosis and 10.4% had a night guard. NCTSL is a common yet also under-recognised oral health issue in Libyan adults, strongly associated with modifiable risk factors. Routine screening, patient education, and preventive management are urgently needed.