Signs and symptoms of dental attrition:
- Loss of tooth anatomy, including rounding or sharpening of incisal edges, loss of cusps, and fracturing of teeth
- Sensitivity and pain, often due to dentin hypersensitivity or tenderness of the periodontal ligament
- Tooth discoloration, with a yellow appearance due to worn enamel exposing the darker dentin layer
- Altered occlusion, resulting in decreasing vertical height or occlusal vertical dimension
- Compromised periodontal support, leading to tooth mobility and drifting of teeth
Causes and risk factors of dental attrition:
- Tooth-to-tooth contact, often caused by parafunctional habits like bruxism or clenching
- Developmental defects and hard or rough-textured diet
- Absence of posterior teeth support
- Occlusion with porcelain restorations
- Temporomandibular joint dysfunction leading to bruxism and clenching
- Age as a significant risk factor for dental attrition
- Bruxism, malocclusion, and poor oral hygiene as risk factors
Prevention and management of dental attrition:
- Early diagnosis and description of tooth surface loss type, severity, and location
- Thorough examination including temporomandibular joint function, orthodontic examination, and analysis of soft and hard tissues
- Recording severity of tooth wear for monitoring purposes
- Identification of underlying causes, such as bruxism or erosive diet
- Use of full-coverage acrylic occlusal splint to prevent further bruxism
- Recommendation of full-coverage acrylic occlusal splint for patients with confirmed bruxism
- Close monitoring of patients with clinical photographs to evaluate prevention of tooth surface loss
Treatment options for dental attrition:
- Managing associated conditions like fractured teeth or sharp cusps
- Application of desensitizing agents and use of desensitizing toothpastes
- Restorative options such as direct composite restorations, bonded cast metal restorations, removable partial dentures, orthodontic treatment, crown lengthening procedures, and protective splints
- Decision to restore dentition based on patient's wants and needs, severity of tooth surface loss, and activity of tooth wear
- Use of adhesive materials as a conservative and cost-effective approach before considering crowns or veneers
Consequences, diagnosis, and overall management of dental attrition:
- Dental attrition can lead to tooth sensitivity, fractures, changes in bite, TMJ disorders, and difficulties with chewing and speaking
- Diagnosis through visual examination, dental X-rays, bite analysis, occlusal examination, and additional diagnostic tests if necessary
- Management includes conservative approaches, dental restorations, occlusal splints or night guards, and in severe cases, orthodontic treatment or full mouth rehabilitation.
Dental attrition is a type of tooth wear caused by tooth-to-tooth contact, resulting in loss of tooth tissue, usually starting at the incisal or occlusal surfaces. Tooth wear is a physiological process and is commonly seen as a normal part of aging. Advanced and excessive wear and tooth surface loss can be defined as pathological in nature, requiring intervention by a dental practitioner. The pathological wear of the tooth surface can be caused by bruxism, which is clenching and grinding of the teeth. If the attrition is severe, the enamel can be completely worn away leaving underlying dentin exposed, resulting in an increased risk of dental caries and dentin hypersensitivity. It is best to identify pathological attrition at an early stage to prevent unnecessary loss of tooth structure as enamel does not regenerate.
