Teeth Wear

Etiology and Management

SDS 320

Definition:
Wear is a natural process that occurs
whenever two or more surfaces move in
contact. It is, therefore, considered that
wear of human natural dentition, to a
certain extent, is a predictable
physiological process result from
continuous sliding contact between
opposing teeth.

Acceptable and pathological levels of wear.

Tooth wear can be regarded as pathological in the following
conditions:
1

Loss in vertical dimension

Pulpal symptoms or pulp exposure.

Change in appearance of teeth.

Accelerated and high wear rate relative to age.

Loss in posterior occlusal stability resulting in

a- Increased tooth wear
b- Mechanical failure of teeth restorations
c- Hypermobility and drifting

Etiology
The terms tooth surface loss and tooth
wear are interchangeable and embrace all the
etiological conditions that cause tooth wear
which occur in the absence of dental plaque
and caries and trauma. Conditions that cause
tooth wear include attrition, abrasion, erosion
and abfraction.

Attrition
Attrition is defined as the loss/wear of tooth structure
or restoration caused by mastication or contact
between occluding or a proximal surfaces (tooth to
tooth contact).

Predisposing factors:
1- Parafunctional habits
2 Developmental defects
3- Coarse diet
4- Coarse porcelain restorations
5- Lack of posterior support

Attrition of lower incisor teeth that match palatal

surfaces of maxillary incisors in excursive
movements

Abrasion
Abrasion is the wear of tooth substance through
biomechanical friction process other than tooth contact.
Predisposing factors
1- Vigorous horizontal tooth brushing
2- Nail biting, pen biting and pipe smoking.
4- Abrasive tooth pasts and powders
3- Denture clasps in RPD.
5- Hard tooth brushes

Clinical appearance
Angular V shaped cervical lesion.
May affect teeth with prominent in the left side of
right handed patients and vice versa.
Affect labial surfaces of prominent teeth .
canines

Occlusal stresses (Abfraction)

Defined as non carious cervical lesions
caused by tensile stress generated from
occlusal loading, and micro fracture of
cervical enamel rods

Mechanism (Stress corrosion theory)

Flexure and ultimate fatigue of enamel and dentine
of susceptible teeth away from the point of loading.
Occlusal stresses explain why cervical lesion not
present on teeth adjacent to primary site which
seem to discount tooth-brushing abrasion or
chemical erosion as sole causes of tooth loss.
The loss of tooth substance may depend on the
direction, magnitude, frequency, duration and
location of the force on the teeth.

 If occlusion is not ideal or if heavy occlusal

trauma is present, significant lateral forces are
generated, which cause the tooth to bend and
create compressive and tensile stresses on tooth
structure. The region under greatest tensile
stresses is the fulcrum located around the
cementoenamel junction. Tensile forces disrupt
chemical bonds between hydroxyapatite crystals
in enamel.

Erosion
Erosion is the progressive loss of hard dental
tissues by chemical process not involving bacterial
action.
Factors that cause erosion:
1- Dietary
2- Regurgitation
3- Environmental
4- Flow of saliva
5- Medications

Causes of erosion
Extrinsic factors
Intrinsic factors
Idiopathic factors

Dietary Erosion:
Citric

acid in soft drinks and fruit juices.

Slimness: acidic sugar free drinks

healthy eating: fruits

Regurgitation:
Involuntary regurgitation:
1- Gastrointestinal problems
2- Chronic alcoholism
Voluntary regurgitation
1- Anorexia nervosa
2- Bulimia nervosa

Chemicl pH

Environmental

Tooth wear caused by acid exposure in the

environment or under occupation
circumstances such as battery-making workers,
picklers, miners

Usually affect labial surfaces of maxillary and

mandibular incisors

Saliva flow rate

Saliva has a buffering and lubricating effect
Reduced flow and rate: Xerostomia, Sogren
syndrom, radiotherapy

Clinical Features
Rounded less well defined margins than attrition

Enamel has matted surface

Dentine may be exposed with continuous erosion
(Cupping)
Palatal erosion related to intrinsic and extrinsic acids
Increase in translucency of anterior teeth
Cervical surfaces may be more prone to erosion
because these areas close to the gingiva are less selfcleaning and food and beverages may be harbored on
the tooth surface for longer periods of time

Clinical Problems associated with tooth wear

Aesthetics
Conservation of tooth structure
Sensitivity and pain
Inter-occlusal space: dento-alveolar compensation
occurs in 80% of patients with tooth wear. i.e, free
way space and resting facial height unaltered
Patient compliance and expectations

Management
Immediate Therapy
Aimed to:
1. Relieve sensitivity and pain
2. Identify etiological factors
3. Protect remaining tooth tissue

Aims can be achieved by:

Diet analysis and counseling
Consumption of erosive beverages in a proper manner
Prescription of neutral sodium fluoride mouth rinse or gel
Close fitting occlusal splint
Restoration with composite or glass ionomer

Clinical Indications for Restorative management:

Biological
- Loss of tooth substance leading to irregular margins
- Pulpal exposure
- Weakening of tooth structure
Functional
- Reduced masticatory function
Aesthetic
- Aesthetically unacceptable

Cervical Tooth Wear Management

Not all lesions require restorations.
Restore if esthetic, sensitivity or structural concerns
prevail.
Composite vs. glass ionomer.
Lesion margins in enamel-microfine composite.
Lesion margins involve cementum or dentine-Dentine
bonding with composite or GI.
Deep cervical lesion-layered technique (GI and
composite)