Tooth Wear

By Karun Dewan, Restorative Consultant Specialist in Prosthodontist, Periodontist & Endodontist

Tooth Wear Restorative Management

What is tooth wear?

Pathological, non-carious loss of tooth tissue is an increasing problem to the dental profession, with young individuals especially at risk. The management of tooth surface loss (TSL) demands a full understanding of its aetiology and presentation. Non-carious loss of tooth tissue is a normal physiological process and occurs throughout life. If the rate of loss is likely to prejudice the survival of the teeth, or is a source of concern to the patient, then it may be considered ‘pathological’ and restorative intervention may be required early.

Causes

Traditionally, the terms ‘erosion’, ‘abrasion’ and ‘attrition’ have been used to describe the non-carious, pathological loss of tooth tissue.

1. Dietary Erosion
   Dietary erosion may result from food or drinks containing a variety of acids, especially citric acid which may chelate as well as dissolve calcium ions.
2. Regurgitation
   Results in gastric acid entering the mouth. The regurgitation may be involuntary or self-induced as in bulimia nervosa.
   
3. Attrition
   Attritional (physical tooth to tooth contact) wear primarily affects the occlusal and incisal surfaces of teeth although slight loss may occur at the approximal contact areas.
4. Abrasion
   Is caused by abnormal rubbing of tooth tissue or restoration by a non-dental object eg pipe-smoking, hair-grips etc. However, the most common cause is probably incorrect or over vigorous toothbrushing.

Often the wear is multifactorial and misdiagnosed. Correct diagnosis and early treatment strategy are required otherwise the prognosis of the teeth becomes poorer with severe cases. Complex treatment could be avoided with robust treatment plan.

Problems caused by tooth wear

• Aesthetics
  Often a patient is only aware of Tooth Wear when there has been a deterioration in the appearance of the teeth. The earliest changes are because of the loss of enamel.
• Function / chewing ability
  Severe Tooth Surface Loss could result in loss of multiple teeth in the mouth therefore resulting in function and poorer quality of life.
• Sensitivity and pain
  Exposure of dentinal tubules and their subsequent bacterial colonisation can lead to both pulpal inflammation and sensitivity
• Lack of space for restoration
  Tooth Surface Loss is compensated by bone growth which maintains the occlusal vertical dimension (Bite). However, if the rate of loss is greater than the compensatory mechanism then the Bite is reduced. The effect on the bite is neither predictable nor uniform. Due to this, often there is lack of space available to have a predictable restoration.

Restorative Treatment for tooth wear

Restorative treatment is indicated when stabilisation techniques have failed to resolve the patient’s dental problems. It is a widely-held view that restorative treatment in the presence of ongoing wear is unwise. Nevertheless, there are occasions when control proves impossible and, to preserve the teeth, restoration becomes essential. The patients should be aware of both the advantages and disadvantages of any proposed treatment. Restoration should be based on protecting and conservation of remaining tooth structure, Resolution of pulpal sensitivity/pain and Improvement in appearance.

Different types of tooth surface wear / loss

Severe Tooth Wear due to Attrition (physical wear)

Tooth Surface Loss due to erosion (acid regurgitation)

Tooth Wear due to Aggressive Tooth Brushing Trauma (Abrasion)