Tooth Wear by mikeholy

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									      Tooth Wear
may be defined as the surface
loss of dental hard tissues
other than by caries or
trauma, and it is a natural
consequence of ageing.
  Components of tooth wear

• Erosion
• Attrition
• Abrasion
• is defined as the loss of dental hard tissue
  as a result of a chemical process not
  involving bacteria.
• The causative agent is usually acid.

What are the sources of acid?
            Extrinsic Acids
1. Dietary including :
• foods such as citrus fruits, pickles and
   other items containing vinegar.
• Carbonated and acid-containing drinks.
• Acidic medications is occasionally
• Occupational and recreational acids.
Extrinsic Acids
            Intrinsic acids
2. Stomach acids associated with:
• anorexia nervosa
• Hiatus hernia
• Peptic ulcers
• Pregnancy with prolonged morning
• Digestive disturbances which cause
  recurrent vomiting
   Clinical features of Erosion
• Clean, non-tarnished appearance of
• Loss of surface characteristics of
  enamel in young children
• Preservation of enamel "cuff" in
  gingival crevice is common
• Hypersensitivity
• Pulp exposure in deciduous teeth
   Clinical features of Erosion
• Broad concavities within smooth surface
• Cupping of occlusal surfaces, (incisal
  grooving) with dentin exposure
• Increased incisal translucency
• Wear on non-occluding surfaces
• "Raised" amalgam restorations
• This 14-year-old female exhibits total loss of
  surface characteristics and polished appearance
  of enamel on her maxillary incisors. The enamel
  layer was also very thin.
• Gastroesophageal reflux
  disease (GERD) was
  discovered in this 19 year
  old boy who exhibited early,
  generalized erosion (arrow
  A). Note the preservation of
  the enamel at the gingival
  crevice (arrow B).
          Cuff of enamel

• Blue arrow
  indicates a cuff
  of enamel.
• The fissure sealant in this 14-year-old boy stands
  "raised" from surrounding eroded occlusal
• This 33-year-old male
  with GERD had
  severe asymptomatic
  erosion. Note the
  raised amalgams
  "rising" above the
  adjacent eroded
  occlusal surfaces.
     Erosion due to soft drinks
• erosion of the left side
  mandibular molars of
  a 20-year old female
  who habitually
  enjoyed holding a
  cola beverage in this
  area for several
  minutes before
  swallowing. Other
  parts of the dentition
  were not affected.
• Two years of
  consumption of
  canned citrus drinks
  in a hot country led to
  this erosion of the
  cervical areas of the
  posterior teeth.
• Restoration of eroded
  teeth in this patient
  will require crown
  procedures and full
• Extreme
  example of tooth
  erosion in patient
  who suffered
  repeated gastric

Attrition: is the mechanical Loss of
tooth surface or restoration caused by
tooth to tooth contact during
mastication or parafunction.
  Clinical features of attrition
– Shiny facets on amalgam contacts

– Enamel and dentin wear at the same rate

– Possible fracture of cusps or restorations
• This 42-year old female has a bruxism habit and
  no other known risk factors for erosion,
  demonstrating moderate to severe attrition.
Attrition in eccentric occlusion
Cusp facets

• Abrasion is the wearing away of tooth
  substance by mechanical means other
  than by opposing teeth, such as over-
  vigorous tooth-brushing or holding pipe.
 Clinical features of abrasion

– Usually located at cervical areas of teeth

– Lesions are more wide than deep

– Premolars and cuspids are commonly
• Pipe smoking
• Nail biting
Abrasion / vigorous tooth brushing
• Loss of tooth surface at the cervical areas
  of teeth caused by tensile and
  compressive forces during tooth flexure.

• (Studies needed to prove this hypothetical
  Clinical features of abfraction
• Affects buccal / labial cervical areas of
• Deep, narrow V-shaped notch
• Commonly affects single teeth with
  excursive interferences or eccentric
  occlusal loads
      Abrasion and abfraction
• This patient's canines
  and bicuspids have
  characteristics    that
  can be attributed to
  both abrasion and
 Diagnosis and monitoring of tooth

• View teeth clean and dry
• Take study models at six months interval
  to determine the rate of progress.
• Take sympathetic history to elicit the
• The history might include:
      Taking history for Erosion
•   Past and present diet
•   Digestive disorders
•   Past and present slimming habits
•   Alcohol intake
•   Is the patient under any medications?
•   Occupation.
      Taking history for Attrition &

•   Clenching and grinding habits
•   Periods of stress or anxiety
•   Square face? Or over developed muscles?
•   Pipe smoking, opening hairgrips…etc
        Preventing tooth wear
• Diminish the frequency and severity of the acid
• Enhance the defence mechanisms of the body
  (increase salivary flow and pellicle formation).
• Enhance acid resistance, remineralization of the
  tooth surfaces.
• Decrease abrasive forces.
• Provide mechanical protection. BRA.
• Monitor stability ( casts and recall visits)
When are restorations necessary?

• A. Patient decision:
  – patient’s appearance
  – tooth becomes sensitive
• B. Dentist’s decision:
  – Decrease in occlusal vertical dimension
  – Pulp exposure
  – In advance cases crowns are required.

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