Toothwear

Question 1

Attrition

Definition

Answer 1

wear caused by endogenous material such a microfine particles of enamel prisms caught between two opposing tooth surfaces

• This can be tooth to tooth or tooth to dental materials is made worse with parafunction

Question 2

Attrition

Clinical Features of Attrition

Answer 2

1. Flattening of cusp tips or incisal edges with associated wear facets on occlusal or palatal surfaces. (Horizontal wear)
2. Similar facets occur or occlusal contact areas on restorations should they be in direct contact with an antagonist.
3. Exposure of dentine will cause cupping due to the preferential wear of the softer dentine (in comparison with enamel).
4. Can be associated with TMD and muscle hypertrophy as part of parafunction.
5. Attrition can cause a decrease in tooth dimensions and a decrease in inter- arch widths .
6. Pathological attrition is often a long-term issue and as a result, the affected tooth/teeth often respond to the traumatic insult through the deposition of secondary dentine and sclerosis of the root canal.

Question 3

Abrasion

Definition

Answer 3

the wearing of tooth substance that results from friction of exogenous material forces over the tooth surface ’. However, it can also be wear on a restorative material too e.g. a denture tooth.

• Usually caused due to overzealous brushing.

Question 4

Abrasion

Clinical features

Answer 4

1. Often seen at the cervical margin of teeth where the enamel is thin and formed in a less regular pattern.
2. The patient may be using a hard toothbrush and / or abrasive dentifrice e.g. smokers
3. Can be seen as indentation with some habits such as wrapping hair around teeth .
4. Most susceptible teeth are upper canines and premolars where the buccal plates are thick and therefore the gingiva is thin and stretched and thus prone to gingival recession, exposure of the root surfaces and consequent cervical nothin

Question 5

Acid dissolution / Erosion

Definition

Answer 5

progressive loss of tooth substance by chemical processes , that does not involve bacterial action, producing defects that are sharply defined, wedge-shaped depressions often in facial and cervical areas ’.

Question 6

Acid dissolution / Erosion

Types

Answer 6

Question 7

Acid dissolution / Erosion

Clinical Features

Answer 7

1. Tooth surface not involved in articulation
2. Cupping of incisal edges or cusps tips
3. Smooth Rounded polished lesions with a rim of enamel left around the tooth (known as perimolysis).
4. Restorations can be standing proud of tooth structure

Question 8

Acid dissolution / Erosion

Clinical Features

Extrinsic factors

Answer 8

1. The buccal surfaces are worn on the upper anterior and the occlusal and palatal surfaces of the posteriors (may vary if patient uses a straw.
2. The wear is smooth and rounded and often shiny .

Question 9

Acid dissolution / Erosion

Clinical Features

Intrinsic factors

Answer 9

1. The palatal surfaces of the upper anteriors are worn and the occlusal surfaces of the posteriors .
2. The wear is smooth , rounded and often shiny

Question 10

Abfraction

Cause

Answer 10

Due to excess force transmitted to the cervical area from biting .

• Evidence has shown there is an increase in stress at the cervical area and that the tooth undergoes a barrelling effect under this stress which may in turn break away the thin cervical enamel and cause a lesion similar to abrasion.
• Often there are signs of wear on the cusp tips of the affected teeth .