Tooth Wear Flashcards
Tooth wear also referred to as
Non carious tooth tissue loss (NCTTL)
Or
Non carious tooth surface loss (NCTSL)
Describe tooth wear
- normal physiological process
- occurs throughout life
- pathological when rate of loss or degree of destruction is excessive (particularly in relation to pt age)
- may lead to problems with function, aesthetics or sensitivity
Tooth wear due to a non carious process
Erosion, abrasion, attrition
Defined by;
- aetiology
- severity (mild, moderate, severe)
- distribution (localised, generalised)
Dental health in the uk
- ageing dentate population with increasing evidence of cumulative effects of tooth wear
- erosion on the increase especially in the younger population
- NCTTL increasing in prevalence and occupying large amounts of practitioner time
- can be complex to manage in later stages but early treatment simple and effective
Prevalence
2009 dental health survey
2009 dental health survey
- moderate tooth wear has increased from 11% in 1998 to 15% in 2009, although severe wear remains rare
- increase in moderate tooth wear in younger adults
UK child dental health survey 2013
33% of 5yr olds had evidence of tooth surface loss (TSL) on 1 or more of the buccal surfaces of the primary upper incisors, 4% involving dentine or pulp
57% of 5yr olds had TSL of the lingual surfaces, 16% progressing to dentine or pulp
Pathological loss of tooth tissue
Attrition
Abrasion
Erosion
Define attrition
The loss of tooth substance or a restoration caused by tooth-to-tooth contact
Define abrasion
The abnormal wearing away of tooth substance or a restoration by a mechanical process other than tooth contact
Eg, toothbrushing, restorations
Define erosion
The irreversible, progressive loss of dental hard tissue by an acidic chemical process not involving bacteria
- due to acid not involved in the breakdown of sugars
Clinical presentation - attrition
- enamel and dentine wearing at the same rate
- localised facets, flattened cusps/incisal edges
- worn surfaces ‘mate’ in closed eccentric movements (when pt bites together / moves jaw side to side - surfaces will meet)
- shiny amalgam in areas of contact
- attrition is a slow process so secondary dentine forms and usually not sensitive
- possible masseteric hypertrophy
- possible fractured cusps and/or restorations
- increased risk of tooth mobility (under force)
Bruxism
Common para functional activity on response to stress
Associated tongue scalloping and/or cheek ridging in active cases
Masseteric hypertrophy in severe cases
Abrasion causes
- tooth brushing (abrasive toothpaste)
- abrasive denitrifies (food particles)
- abrasive food particles
- piercings
- habits (eg, nail biting, tobacco chewing, pen chewing, pipe smoking, wire stripping)
- iatrogenic - unglazed porcelain / fractured porcelain - can cause abrasion of the opposing teeth
Clinical presentation - abrasion
- mainly cervical
- sharply defined margins
- smooth, hard surface
- more rounded and shallow if associated with erosion
Theory of abfraction
Theory of Abfraction (Grippo 1991) supposes that occlusal forces cause compressive and tensile stresses, which are concentrated at the cervical region of the tooth (Heymann et al, 1993) and cause micro fracture of cervical enamel rods
Abfraction
- deep V shaped notch
- may be a single tooth affected
- toothbrush unable to contact base of defect
- defects may be subgingival
How is erosion classified
Classified according to source of the acid
- Intrinsic
- Extrinsic
(Erosion is loss of tooth substance due to acid wear not bacterial acid or mechanical wear)
