Tooth wear

Attrition is loss of tooth substance caused by physical tooth-to-tooth contact. The word attrition is derived from the Latin verb attritium, which refers to the action of rubbing against something. Attrition mostly causes wear of the incisal and occlusal surfaces of the teeth. Attrition has been associated with masticatory force and parafunctional activity such as bruxism. A degree of attrition is normal, especially in elderly individuals.

Abrasion is loss of tooth substance caused by physical means other than teeth. The term is derived from the Latin verb abrasum, which means ‘to scrape off’. It tends to present as rounded ditching around the cervical margins of teeth, commonly described as ‘shallow’, concave or wedge shaped notches. Causative factors have been linked to this condition and include vigorous, horizontal tooth brushing, using toothpaste with a relatively high RDA value (above 250),{{Citation|last1=Shellis|first1=R. Peter|title=The Interactions between Attrition, Abrasion and Erosion in Tooth Wear|date=2014|url=https://www.karger.com/Article/FullText/359936|journal=Monographs in Oral Science|volume=25|pages=32–45|editor-last=Lussi|editor-first=A.|place=Basel|publisher=Karger |doi=10.1159/000359936|isbn=978-3-318-02552-1|access-date=2021-07-23|last2=Addy|first2=Martin|pmid=24993256|editor2-last=Ganss|editor2-first=C.|author-link2=Martin Addy|url-access=subscription}} pipe smoking or nail biting. It has also been shown that improper use of dental floss or Toothpicks can lead to wear on the interproximal (in-between) surfaces of the teeth.

Erosion is chemical dissolution of tooth substance caused by acids, unrelated to the acid produced by bacteria in dental plaque. Erosion may occur with excessive consumption of acidic foods and drinks, or medical conditions involving repeated regurgitation and reflux of gastric acid.{{cite book|editor-last=Odell EW|title=Clinical problem solving in dentistry|year=2010|publisher=Churchill Livingstone|location=Edinburgh|isbn=978-0-443-06784-6|pages=285–7|edition=3rd}} It is derived from the Latin word erosum, which describes the action ‘to corrode’. This is usually on the palatal (inside) surfaces of upper front teeth and the occluding (top) surfaces of the molar teeth.{{Cite web |title=Dental Erosion {{!}} American Dental Association |url=https://www.ada.org/resources/ada-library/oral-health-topics/dental-erosion |access-date=2024-04-19 |website=www.ada.org}} Dental erosion is rarely seen in the archaeological record, but certain cases have been described which suggested acidic fruits and/or plants were regularly consumed.

• Gastroesophageal reflux disease (GERD)
• Vomiting, e.g. bulimia, alcoholism
• Rumination
• Eructation (burping){{medcn|date=May 2015}}
• Dietary — liquids of low pH and high titratable acids.

Abfraction is a form of noncerious cervical lesion, where there is a loss of tooth substance at the cervical margins, purportedly caused by minute flexure of teeth under occlusal loading. This occlusal loading is one factor that interacts with chemical, biological,and behavioral factors in which result in this abfraction. {{cite journal |vauthors=Nascimento MM, Dilbone DA, Pereira PN, Duarte WR, Geraldeli S, Delgado AJ |title=Abfraction lesions: etiology, diagnosis, and treatment options |journal=Clin Cosmet Investig Dent |volume=8 |issue= |pages=79–87 |date=2016 |pmid=27217799 |pmc=4861607 |doi=10.2147/CCIDE.S63465 |doi-access=free}} The term is derived from the Latin words ab and functio meaning ‘away’ and ‘breaking’ respectively. Abfraction presents as triangular lesions along the cervical margins of the buccal surfaces of the teeth where the enamel is thinner and therefore, in the presence of occluding forces, is prone to fracture. Whether abfraction exists or not is debated.

Tooth wear indices are useful tools for carrying out epidemiological studies and for general use in dental practices.

The Basic Erosive Wear Examination was first described by Bartlett et al. in 2008. The partial scoring system is based on the surface area affected. Within a sextant (i.e. teeth in mouth divided into 6 parts), the most severely affected tooth surface (buccal, occlusal or lingual/palatal)(see dental terminology) is recorded according to the severity of the wear (see Table 1). A cumulative score is then matched to a risk level and guidance for its management by a clinician. The management includes steps which identify and eliminate main aetiological factors, preventative treatment and also any operative and symptomatic intervention required by the patient. The frequency of repeating the index ranges from 6–12 months depending on the risk level of patients.{{cite journal | vauthors = Bartlett D, Ganss C, Lussi A | title = Basic Erosive Wear Examination (BEWE): a new scoring system for scientific and clinical needs | journal = Clinical Oral Investigations | volume = 12 | issue = Suppl 1 | pages = S65–8 | date = March 2008 | pmid = 18228057 | pmc = 2238785 | doi = 10.1007/s00784-007-0181-5 }}

The Tooth Wear Index (TWI) (see Table 2) was developed by Smith and Knight in 1984. TWI scores each visible surface (buccal/B, cervical/C, lingual/L and occlusal-incisal/O/I) (see dental terminology).{{cite journal | vauthors = Smith BG, Knight JK | title = An index for measuring the wear of teeth | journal = British Dental Journal | volume = 156 | issue = 12 | pages = 435–8 | date = June 1984 | pmid = 6590081 | doi = 10.1038/sj.bdj.4805394 | s2cid = 35419496 }} This index has been widely used in epidemiological studies.{{cite journal | vauthors = Bardsley PF | title = The evolution of tooth wear indices | journal = Clinical Oral Investigations | volume = 12 | pages = S15–9 | date = March 2008 | issue = Suppl 1 | pmid = 18228055 | pmc=2238784| doi = 10.1007/s00784-007-0184-2 | doi-access = free }}

• Eccles-Index {{Cite journal|last=Eccles|first=J. D.|date=December 1979|title=Dental erosion of nonindustrial origin. A clinical survey and classification|journal=The Journal of Prosthetic Dentistry|volume=42|issue=6|pages=649–653|issn=0022-3913|pmid=292776|doi=10.1016/0022-3913(79)90196-3}}
• Modified TWI {{Cite journal|last1=Millward|first1=A.|last2=Shaw|first2=L.|last3=Smith|first3=A. J.|last4=Rippin|first4=J. W.|last5=Harrington|first5=E.|date=September 1994|title=The distribution and severity of tooth wear and the relationship between erosion and dietary constituents in a group of children|journal=International Journal of Paediatric Dentistry|volume=4|issue=3|pages=151–7|issn=0960-7439|pmid=7811669|doi=10.1111/j.1365-263X.1994.tb00124.x}}
• Linkosalo and Markkanen {{Cite journal|last1=Linkosalo|first1=E.|last2=Markkanen|first2=H.|date=October 1985|title=Dental erosions in relation to lactovegetarian diet|journal=Scandinavian Journal of Dental Research|volume=93|issue=5|pages=436–441|issn=0029-845X|pmid=3864217|doi=10.1111/j.1600-0722.1985.tb01336.x}}
• O'Brien Index {{Cite book|title=Children's dental health in the United Kingdom, 1993 : a survey carried out by the Social Survey Division of OPCS, on behalf of the United Kingdom health departments, in collaboration with the Dental Schools of the Universities of Birmingham and Newcastle|last=Maureen.|first=O'Brien|date=1994|publisher=H.M.S.O|others=Great Britain. Office of Population Censuses and Surveys. Social Survey Division., University of Birmingham. Dental School., University of Newcastle upon Tyne. Dental School.|isbn=978-0-11-691607-5 |oclc=32250617}}
• Lussi Index {{Cite journal|last=Lussi|first=A.|date=April 1996|title=Dental erosion clinical diagnosis and case history taking|journal=European Journal of Oral Sciences|volume=104|issue=2 ( Pt 2)|pages=191–8|issn=0909-8836|pmid=8804886|doi=10.1111/j.1600-0722.1996.tb00067.x}}
• O'Sullivan Index {{Cite journal|last=O’Sullivan|first=EA|date=2000|title=A new index for the measurement of erosion in children|journal=Eur J Paediatr Dent|volume=1|pages=69–74}}
• Simplified Tooth Wear Index (STWI) {{Cite journal|last1=Bardsley|first1=P. F.|last2=Taylor|first2=S.|last3=Milosevic|first3=A.|date=2004-10-09|title=Epidemiological studies of tooth wear and dental erosion in 14-year-old children in North West England. Part 1: The relationship with water fluoridation and social deprivation|journal=British Dental Journal|volume=197|issue=7|pages=413–6; discussion 399|doi=10.1038/sj.bdj.4811722|issn=0007-0610|pmid=15475904|s2cid=2186540}}
• Exact Tooth Wear Index {{Cite journal|last1=Fares|first1=J.|last2=Shirodaria|first2=S.|last3=Chiu|first3=K.|last4=Ahmad|first4=N.|last5=Sherriff|first5=M.|last6=Bartlett|first6=D.|date=2009|title=A new index of tooth wear. Reproducibility and application to a sample of 18- to 30-year-old university students|journal=Caries Research|volume=43|issue=2|pages=119–125|doi=10.1159/000209344|issn=1421-976X|pmid=19321989|s2cid=46065628}}
• Visual Erosion Dental Examination (VEDE) {{Cite journal|last1=Mulic|first1=A.|last2=Tveit|first2=A. B.|last3=Wang|first3=N. J.|last4=Hove|first4=L. H.|last5=Espelid|first5=I.|last6=Skaare|first6=A. B.|date=2010|title=Reliability of two clinical scoring systems for dental erosive wear|journal=Caries Research|volume=44|issue=3|pages=294–9|doi=10.1159/000314811|issn=1421-976X|pmid=20516691|hdl=10852/34967|s2cid=21372549|hdl-access=free}}
• Evaluating Index of Dental Erosion (EVIDE) {{Cite journal|last1=Margaritis|first1=Vasileios|last2=Mamai-Homata|first2=Eleni|last3=Koletsi-Kounari|first3=Haroula|last4=Polychronopoulou|first4=Argy|date=January 2011|title=Evaluation of three different scoring systems for dental erosion: a comparative study in adolescents|journal=Journal of Dentistry|volume=39|issue=1|pages=88–93|doi=10.1016/j.jdent.2010.10.014|issn=1879-176X|pmid=21035516}}

Once the cause of tooth wear has been identified and a preventative regime has been put in place, the patient should be reviewed for 6–12 months to establish that the intervention has been successful before any active management is carried out. Once this has been achieved a decision needs to be made whether or not it is necessary to carry out restorative treatment or if it can simply be managed by non-invasive methods.{{Cite journal|last1=Mehta|first1=S. B.|last2=Banerji|first2=S.|last3=Millar|first3=B. J.|last4=Suarez-Feito|first4=J.-M.|date=January 2012|title=Current concepts on the management of tooth wear: part 1. Assessment, treatment planning and strategies for the prevention and the passive management of tooth wear|journal=British Dental Journal|volume=212|issue=1|pages=17–27|doi=10.1038/sj.bdj.2011.1099|pmid=22240686|issn=1476-5373|doi-access=free|hdl=10651/7466|hdl-access=free}}

Where restorative treatment is necessary, it must be decided whether to conform to the existing occlusion (typically for moderate wear, where only a few teeth are affected) or reorganise the occlusion (severe wear, unstable occlusion). Where the occlusion is reorganised, it can first be tested using a reversible method (i.e. a hard occlusal splint). A decision is made after full occlusal assessment including assessment of contacts in intercuspal position (ICP) and retruded contact position (RCP) as well as analysing casts articulated in a semi-adjustable articulator to use for a diagnostic wax up of any proposed restorative work.{{Cite journal|last1=Mehta|first1=S. B.|last2=Banerji|first2=S.|last3=Millar|first3=B. J.|last4=Suarez-Feito|first4=J.-M.|date=February 2012|title=Current concepts on the management of tooth wear: part 3. Active restorative care 2: the management of generalised tooth wear|journal=British Dental Journal|volume=212|issue=3|pages=121–7|doi=10.1038/sj.bdj.2012.97|pmid=22322760|issn=1476-5373|doi-access=free|hdl=10651/23889|hdl-access=free}}

Active restorative management depends upon the location of the wear (localised or generalised), the severity of the wear, and the patient's occlusal vertical dimension (OVD), which may have changed as a result of tooth wear. There are three potential scenarios of tooth wear:{{Cite journal|last1=Dyer|first1=K.|last2=Ibbetson|first2=R.|last3=Grey|first3=N.|date=April 2001|title=A question of space: options for the restorative management of worn teeth|journal=Dental Update|volume=28|issue=3|pages=118–123|issn=0305-5000|pmid=11819971|doi=10.12968/denu.2001.28.3.118}}

1. Excessive wear with loss of OVD
2. Excessive wear without loss of OVD but with space available
3. Excessive wear without loss of OVD but with limited space available

Scenario 1 is relatively common, whereas scenario 2 is quite rare and tends to occur when the wear is rapidly occurring. Scenario 3 occurs due to a phenomenon called dentoalveolar compensation whereby the dentoalveolar tissues compensate for wear of teeth by increasing the bony support in order to maintain a constant OVD. This makes things difficult as there is no room to build the teeth back up to their original height without increasing the OVD.

The options for restoring this loss in tooth height are: {{Cite journal|last=Ibbetson|first=R|date=June 1999|title=tooth surface loss: Treatment planning|journal=British Dental Journal|volume=186|issue=11|pages=552–8|doi=10.1038/sj.bdj.4800167|pmid=10405470|s2cid=11008538|issn=1476-5373}}

1. Increasing the OVD — this is the traditional approach and involves restoring all teeth to an increased height in order to create a new ICP at an increased OVD
2. Occlusal adjustment — this is typically used for anterior teeth only, whereby the patient's occlusion is reorganised into the RCP position to utilise increased space in this position
3. Crown lengthening or orthodontic extrusion — this is useful when crowns are to be placed in a worn dentition but there is inadequate crown height and you do not want to change the OVD
4. Relative axial tooth movement — this is the most commonly used method and can be used for localised or generalised wear, the idea is to prop the bite open thereby causing the extrusion of worn teeth to provide extra crown height for restoration, this can be done using simple direct restorations or more complex indirect restorations, this idea was first established by Dahl and is often referred to as the Dahl effect

Pulp vitality must also be taken into consideration prior to treatment, when teeth have severe wear it is possible that they have become non-vital.

• Attrition
• Abrasion
• Erosion
• Abfraction
• Bruxism

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{{Oral pathology}}

Category:Dentistry

Category:Acquired tooth pathology