Management of Tooth Wear Flashcards
What are the 4 forms of Tooth wear?
- Attrition
- Abrasion
- Abfraction
- Erosion
- Tooth wear can be multifactorial*
- i.e. more than one type of tooth wear can occur simultaneously and can be exacerbated e.g. faster rates of attrition when erosion also present*
What is Attrition?
Attrition : The loss of tooth substance as a result of mastication, or of occlusal or proximal contact between the teeth.
What are the 2 classifications of Attrition?
- Physiological attrition
- Pathological attrition
What is Physiological attrition tooth wear ?
- Happens in every individual with age, therefore more noticeable in older patients
- Most commonly affects occlusal surfaces or incisal edges
- Approximal wear occurs with mastication – contacts between adjacent teeth
- Affects deciduous and permanent teeth, although deciduous teeth are more susceptible, as the enamel is thinner
- Rate is reported to be higher in men than in women
What are clinical signs of Physiological Attrition?
- Disappearance of incisor mamelons
- Flattening of occlusal cusps
- Exposed dentine may be dark brown in colour and lesions may be “cup-shaped”
What is Pathological attrition cause by?
Can be localised or generalised
Caused by a parafunction (abnormal habit e.g bruxism) or malocclusion
What is Bruxism?
- A parafunction
- Involves grinding and clenching the teeth
- Cause is unclear, but thought to be associated with stress, or ‘occlusal interferences’
- Can be a nocturnal habit
What are Signs and symptoms of bruxism?
- Visible wear facets
- Abnormal rate of attrition
- Hypertrophy of masticatory muscles
- Muscle tenderness
- TMJ pain
- Tooth mobility
- Pulpal sensitivity to cold
How do you manage Bruxism?
- Can lead to a reduced Occlusal-Vertical Dimension (OVD) – therefore, restorative considerations if attempting to ‘build-up’ the bite again
- May need to remove occlusal interferences
- Acrylic hard or soft splint may be worn to protect the teeth from further wear
What happens in dentine attration?
Dentine rate of attrition is higher than enamel, as it is less mineralised
Dentine attrition usually results in the faster formation of secondary/tertiary dentine, which prevents sensitivity
What is Abrasion?
Abrasion : Pathological wearing away of tooth structure that results from a repetitive mechanical process or habit
What are Signs of abrasion?
Most commonly seen on exposed root surfaces
Wear facets appear at the cervical margins
What are the 4 Categories of abrasion?
- Cervical abrasion
- Habitual abrasion
- Iatrogenic abrasion
- Industrial abrasion
What is Cervical abrasion and what is its most common cause?
Appearance of cervical grooves
Horizontal brushing technique most common cause
What is Horizontal Brushing?
- Over-zealous toothbrushing technique
- ‘Scrubbing’ – using excessive pressure
- May be accelerated by abrasive dentifrice and/or a hard toothbrush
- More likely if gingival recession already present (exposed dentine)
What is Habitual abrasion?
- Clinical appearance depends upon cause
- Usually localised to the area of the ‘habit’
- Causes include:
- Pipe smoking
- Wind instruments
- Opening pins with teeth or holding needles
- Flossing with too much pressure
What is Iatrogenic abrasion?
Opposing teeth grinding to accommodate restorations
Ceramic crowns
What is Industrial abrasion?
Uncommon nowadays due to health and safety legislation
Workers exposed to abrasive particles in the atmosphere created during certain industrial processes (mining, sand blasting etc)
What is Abrasion – diagnosis and treatment?
Diagnosis by assessing clinical picture, and by thorough history taking
Treatment is given mostly in the form of preventative advice, in order to limit further damage – find cause and remove
-If function or aesthetics affected, restorative treatment may be appropriate
What is Abfraction?
Abfraction : the pathological loss of tooth substance caused by biomechanical loading forces…resulting in flexing and failure of enamel and dentine…
What is seen on a tooth with Abfraction?
- ‘V’ shaped notches at the cervical margin
- Thought to be related to tooth ‘flexure’ at the cervical areas from occlusal loading
- Leads to ‘micro-fractures’ in enamel
- Cavitation occurs
- Does not explain teeth not in occlusion
What is Erosion?
Erosion : Progressive loss of hard dental tissue by an acidic chemical process without bacterial action
i.e. NOT related to caries
What are signs of Erosion?
- Can be seen on any surface
- Appears smooth and polished or ‘glossy’
- Eventually shallow depressions occur
- ‘Proud’ restorations
- Fractures of the incisal edges
- Cervical area usually most severely affected
- Surface may have “criss-cross” appearance
- Hollows bear no relationship to occlusion
- ‘cupping’ of lower molar cusps
What are the 2 classifications of Erosion?
Extrinsic – source of acid outwith the body (diet, environment)
Intrinsic – source of acid from within the body (gastric juices)
