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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

Erosion
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 are occasionally implicated. Occupational and recreational acids.

Intrinsic acids
2. Stomach acids associated with:
anorexia nervosa Hiatus hernia Peptic ulcers Pregnancy with prolonged morning sickness Digestive disturbances which cause recurrent vomiting

Clinical features of Erosion

Clean, non-tarnished appearance of amalgams 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 enamel Cupping of occlusal surfaces, (incisal grooving) with dentin exposure Increased incisal translucency Wear on non-occluding surfaces "Raised" amalgam restorations

Erosion
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.

Erosion
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.

Erosion
The fissure sealant in this 14-year-old boy stands "raised" from surrounding eroded occlusal enamel.

Erosion
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 it. Other parts of the dentition were not affected.

Erosion
Two years of continual consumption of canned citrus drinks in a hot country led to this erosion of the cervical areas of the posterior teeth.

Erosion
Restoration of eroded teeth in this patient will require crown lengthening procedures and full coverage restorations.

erosion
Extreme example of tooth erosion in patient who suffered repeated gastric regurgitation

Attrition
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

Attrition
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

Abrasion is the wearing away of tooth substance by mechanical means other than by opposing teeth, such as overvigorous 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 affected

abrasion
Pipe smoking

abrasion
Nail biting

Abrasion / vigorous tooth brushing

abfraction
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 phenomenon)

Clinical features of abfraction

Affects buccal / labial cervical areas of teeth 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 abfraction.

Abfraction

Diagnosis and monitoring of tooth wear

View teeth clean and dry Take study models at six months interval to determine the rate of progress. Take sympathetic history to elicit the cause. 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 & abrasion

Clenching and grinding habits Periods of stress or anxiety Square face? Or over developed muscles? Pipe smoking, opening hairgripsetc

Preventing tooth wear

Diminish the frequency and severity of the acid challenge. 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:
patients appearance tooth becomes sensitive

B. Dentists decision:
Decrease in occlusal vertical dimension Pulp exposure In advance cases crowns are required.

Bite

raising appliance