Erosion, Abrasion, and Attrition Flashcards
what is tooth wear
the general term used for the surface loss of dental hard tissues from cause other than developmental ones, dental caries, and trauma
normal vertical loss of enamel resulting from natural wear is about _____
65 micrometers per year
what are the categories of tooth wear
- attrition
- abrasion
- abfraction
- erosion or corrosion
what is attrition
the mechanical wear resulting from mastication or parafunction, limited to contacting surfaces of the teeth
attrition is related to:
the aging process
what is the etiology of attrition
due to many factors and is accelerated by extrinsic factors such as coarse diet, chewing tobacco, parafunctional habits of clenching and bruxism, traumatic occlusion in the partially edentulous dentition, anterior open bite, and anterior teeth in edge to edge relationship or crossbite
what is abrasion
an abnormal wearing of the tooth substance by some unusual or abnormal mechanical process of independent of mastication and occlusion
what is the etiology of abrasion
foreign objects or substances repeatedly contacting the tooth surface
what is an example of abrasion
overzealous horizontal tooth brushing with an abrasive dentrifice produces a rounded or v-shaped ditch on the facial aspects of teeth at the CEJ
what is the clinical presentation of abrasion
- most commonly effected: canines and premolars
- biting on hard objects
- partial clasps
- fishermen or tailors
what is abfraction
the pathologic loss of hard tooth substance caused by biomechanical loading forces; which is the result of flexure and chemical fatigue degradation of enamel and/or dentin at some location distant from the actual point of loading
what is the etiology of abfraction
stress
stresses that lead to abfraction are transmitted by:
occlusal loading forces such as occlusal interferences, premature contacts, habits of bruxism and clenching
what are the appearances of abfraction lesions
- wedge shaped abfraction lesions
- saucer shaped abfraction lesion
- mixed shaped abfraction lesion
what are the intraoral findings for bruxism
- scalloping of the tongue
- cheek biting
- fractured porcelain restoration
- cupping or cratering of occlusal surfaces
- teeth are worn down, or chipped
- increased tooth sensitivity (non- endo or caries related)
what are the reasons believed to exist as to why people clench and grind their teeth
- undiagnosed sleep apnea patients are believed to clench/grind teeth as a subconscious alert to keep breathing
- stress processing at night (night time activity)
- stress during the day (day time activity)
- there are the top 3 in literature, but others can and do exist to a lesser degree
- occlusal malalignment
what are the tips to stop clenching your teeth
- night guard aka bite guard
- ice packs or warm compressses on your face
- limit or stop drinking alcohol and caffeine
- correct teeth misalignment
- reduce stress
- deep breathing techniques, meditation, yoga, or stretching
- address underlying physical and mental health concerns
- exercise
what are the treatments for bruxism
- lucia jig anterior midpoint contact permissive splint
- occlusal splints protect teeth against the harsh effects of clenching and grinding
what is erosion
the progressive loss of tooth substance by chemical processes that do not involve bacterial action, producing defects that are wedge shaped depressions often in occlusal, facial and cervical areas
what is the etiology for erosion
acids from external and internal sources
what are the extrinsic factors of erosion
- acidic foods such as citrus fruit, pickle, vinegar, sucking lemons, fruit juice and carbonated drinks, yogurt, herbal tea and spicy food
- medicines such as effervescent and chewable vitamin C preparations
- significant time swimming in chlorinated pools
what are the surfaces involved in erosion
labial surface of maxillary teeth affected
- usually lingual and occlusal surfaces of mandibular teeth
what is the clinical appearance of erosions
scooped out depressions
what are the intrinsic factors for erosion
anorexia and bulimia nervosa or regurgitation of gastric contents because of abnormalities in the GI tract, pregnancy morning sickness, and chronic alcoholism
- drugs that cause nausea and vomiting
- reduced salivary secretion and calcium and phosphorus levels
what drugs can cause nausea or vomiting
estrogens, opiates, tetracyclines, levodopa, aminophylline, digitalis, and disulfiram
what is the appearance for erosion
concave depression involving the entire surface
describe the attrition-abfraction combined mechanism
the joint action of stress and friction when teeth are in tooth-to-tooth contact, as in bruxism or repetitive clenching
describe abrasion-abfraction combined mechanism
the loss of tooth substance caused by friction from an external material on an area in which stress concentration is due to loading forces. may cause tooth substance to break away
what are the multifactorial etiologies for erosion, abrasion and attrition
- stress
- corrosion
- friction
what are the consequences of tooth wear
- sensitvity to temperature
- collapsed vertical dimension of occlusion
- chipping/breaking of tooth structure
- higher incidence of caries due to exposed dentin
- difficulty in restoring teeth without opening VDO
- esthetic appearance
- supra eruption of teeth, bone, and gingiva
what are the 3 main consequences of tooth wear
- loss of vertical dimension of occlusion
- compromised esthetics
- occlusal discrepancies
describe amelogenesis imperfecta and what its characterized by
- hereditary defect of dental enamel
- characterized by early loss of enamel with rapid attrition of tooth structure
what are the 3 distinct classifications of amelogenesis imperfecta
- hypoplastic
- hypomaturation
- hypocalcified
describe hypoplastic amelogenesis imperfecta
the enamel has only 1/8 to 1/4 of the normal thickness
describe hypomaturation amelogenesis imperfecta
the enamel has normal thickness but is softer than normal and tends to fracture away from dentin
describe hypocalcified amelogenesis imperfecta
the enamel is normal thickness but is extremely friable and frequently lost soon after tooth eruption
describe dentinogenesis imperfecta
- hereditary trait
- characterized by short roots and lack of pulp chambers and yellow appearance of teeth
what are the 3 distinct classifications of dentinogenesis imperfecta
- type 1
- type 2
- type 3
describe type 1 dentinogenesis imperfecta
associated with osteogenesis imperfecta, lack of pulp and no family history
describe type 2 dentinogenesis imperfecta
NOT associated with osteogenesis imperfecta, lack of pulp, and no family history
desribe type 3 dentinogenesis imperfecta
NOT associated with osteogenesis imperfecta, large pulps, positive family history
what information do you need to gather to treat tooth wear
- accurate patient health history
- clinical examination
- radiographs
- mounted diagnostic casts
- intra-oral photographs
- TMJ evaluation
- follow up questions
what causes chemical tooth wear
- fruit sucking
- chronic regurgitation, eating disorders, gastric acid reflux, chronic alcoholism
- soda swishing
- fruit mulling
where is tooth wear found from fruit sucking
facial surface of maxillary anterior- anterior tooth wear greater than posterior
where is tooth wear seen with chronic regurgitation, eating disorder, gastric acid reflux, chronic alcoholism
lingual surface of maxillary anterior
- anterior tooth wear greater than posterior
where is tooth wear found from soda swishing
occlusal surface of mandibular first molars
- posterior tooth wear greater than anterior
where is tooth wear found from fruit mulling
occlusal surface of all posterior teeth
- posterior tooth wear greater than anterior
what are the causes of mechanical tooth wear
- inadequate/unstable posterior occlusion
- chronic bruxism
- toothbrush or dentrifice misuse
- miscellaneous causes, environmental, parafunctional habits
where is inadequate/unstable posterior occlusion seen with tooth wear
- posterior tooth loss, malposition or interferences
- anterior tooth wearr
where is chronic bruxism seen in tooth wear
-occlusal incisal wear facets match on the cast
- progressively greater occlusal wear from anterior to posterior
what are the 5 important factors to consider in tooth wear
- pattern of tooth wear and the surfaces involved
- available inter occlusal space
- available restorative space for dental restorations proposed
- the quantity and quality of available hard tissue and enamel respectively
- esthetic demands of the patient
what material wears most similar to natural enamel
gold
what material causes the greatest amount of wear on opposing teeth
glass reinforced ceramic
______ causes less wear than glazed zirconia
polished zirconia
polishing of _______ is vital to reduce tooth wear
zirconia, ceramics, or gold
what are the reasons to treat non carious cervical lesions
- tooth has temperature sensitivity
- dentin discoloration is unesthetic
- plaque accumulation
what are the treatment considerations for NCCL
- bruxing
- clender/grinder
- liquids that erode the teeth
- does patient have reflux
