Causes of Tooth Wear
– Tooth wear is a normal physiological process that occurs in approximately 97% of the population.
– Tooth wear can be caused by attrition, abrasion, and erosion.
– Attrition is loss of tooth substance caused by physical tooth-to-tooth contact.
– Abrasion is loss of tooth substance caused by physical means other than teeth.
– Erosion is chemical dissolution of tooth substance caused by acids.
– Attrition is associated with masticatory force and parafunctional activity such as bruxism.
– A degree of attrition is normal, especially in elderly individuals.
– Vigorous, horizontal tooth brushing and using toothpaste with a high RDA value can cause abrasion.
– Pipe smoking, nail biting, and improper use of dental floss or toothpicks can also lead to abrasion.
– Excessive consumption of acidic foods and drinks can cause erosion.
– Medical conditions involving repeated regurgitation and reflux of gastric acid can also contribute to erosion.
Assessment of Tooth Wear
– Importance of assessing tooth wear
– Methods of assessing tooth wear, such as clinical examination and diagnostic tools
– Identification of etiological factors contributing to tooth wear
– Assessment of tooth wear severity and classification
– Documentation and recording of tooth wear findings
Prevention and Passive Management of Tooth Wear
– Importance of preventive measures in managing tooth wear
– Strategies for preventing tooth wear, such as oral hygiene practices and dietary modifications
– Use of protective measures, such as mouthguards, to prevent tooth wear
– Role of fluoride in preventing tooth wear
– Importance of patient education in passive management of tooth wear
Treatment Planning and Active Restorative Care for Tooth Wear
– Importance of individualized treatment planning for tooth wear
– Factors to consider in treatment planning, such as patient’s age, severity of tooth wear, and patient’s expectations
– Selection of appropriate treatment options based on the extent and location of tooth wear
– Integration of interdisciplinary approaches in treatment planning
– Importance of regular follow-up and maintenance after treatment
– Role of restorative techniques in managing tooth wear
– Different restorative materials and their suitability for tooth wear treatment
– Techniques for restoring vertical dimension in tooth wear cases
– Considerations for occlusal rehabilitation in tooth wear patients
– Importance of a multidisciplinary approach in active restorative care
Management of Generalized Tooth Wear
– Definition and characteristics of generalized tooth wear
– Diagnostic criteria for generalized tooth wear
– Treatment options for managing generalized tooth wear, such as direct and indirect restorations
– Role of adhesive techniques in managing generalized tooth wear
– Long-term outcomes and prognosis of treatment for generalized tooth wear
Tooth wear refers to loss of tooth substance by means other than dental caries. Tooth wear is a very common condition that occurs in approximately 97% of the population. This is a normal physiological process occurring throughout life; but with increasing lifespan of individuals and increasing retention of teeth for life, the incidence of non-carious tooth surface loss has also shown a rise. Tooth wear varies substantially between people and groups, with extreme attrition and enamel fractures common in archaeological samples, and erosion more common today.
|Non-carious tooth substance loss
|Lower teeth shows signs of tooth wear likely caused by erosion
Tooth wear is predominantly the result of a combination of three processes; attrition, abrasion and erosion. These forms of tooth wear can further lead to a condition known as abfraction, where by tooth tissue is 'fractured' due to stress lesions caused by extrinsic forces on the enamel. Tooth wear is a complex, multi-factorial problem and there is often difficulty identifying a single causative factor. However, tooth wear is often a combination of the above processes. Many clinicians, therefore, make diagnoses such as "tooth wear with a major element of attrition", or "tooth wear with a major element of erosion" to reflect this. This makes the diagnosis and management difficult. Therefore, it is important to distinguish between these various types of tooth wear, provide an insight into diagnosis, risk factors, and causative factors, in order to implement appropriate interventions. Tooth wear evaluation system (TWES) may help determine the most likely aetiology of tooth wear. Heavy tooth wear is commonly found on the occlusal (chewing) surface, but non-carious cervical lesions from tooth wear are also common in some populations.
Multiple indices have been developed in order to assess and record the degree of tooth wear, the earliest was that by Paul Broca. In 1984, Smith and Knight developed the tooth wear index (TWI) where four visible surfaces (buccal, cervical, lingual, occlusal-incisal) of all teeth present are scored for wear, regardless of the cause. A more recent index Basic Erosive Wear Examination (BEWE) from 2008 by Bartlett et al., is now also in use.