TOOTH WEAR Dr.Huda Y K

Introduction Non carious tooth tissue loss is defined as surface loss due to a disease process other than dental caries.

Non Carious lesions can be broadly classified as: A. Tooth wear : C. Non-carious lesion of dentin 1. Attrition 1. Localized non-hereditary dentin 2. Abrasion 3. Erosion 2. Localized non-hereditary dentin 4.Abfraction 3. Dentinogenesis imperfecta B. Non-carious lesions of enamel 4. Dentin sclerosis 1. Localized non-hereditary enamel 6. Dead tracts hypoplasia 2. Localized non-hereditary enamel D. Non-carious lesion of cementum hypocalcification 1. Cementum hypoplasia 3. Amelogenesis imperfecta. 2. Cementicle E. Pulp calcification F. Resorption

Tooth wear The term ‘tooth wear’ (TW) is a general term that can be used to describe the surface loss of dental hard tissues from causes other than dental caries, trauma or as a result of developmental disorders

Tooth wear’s multi-factorial aetiology ABRASION EROSION ATTRITION ABFRACTION Clinically however, it is difficult (if not at times impossible) to isolate a single aetiological factor when a patient presents with tooth wear

ABRASION Can be defined as the surface loss of tooth structure resulting from direct frictional forces between the teeth and external objects or from frictional forces between contacting components in the presence of an abrasive medium

Tooth Brush Abrasion Hard Toothbrush Abrasive Toothpaste Intensive Horizontal brushing technique “well-defined, V-shape notches” in the regions of one or more facial cervical tooth surface sometimes with some gingival recession Location of the abrasion lesions depends on tooth alignment and/or which hand is holding the toothbrush

Occupational/Oral Habits causing Abrasion : Pipe smoking Betel nut Nail biting Bobby pin opening Holding Musicians-Instruments mouthpieces

ATTRITION Defined as the mechanical wear of the incisal or occlusal surface as a result of functional or parafunctional movements of mandible (tooth to tooth contacts). It is an age dependent ,continuous process usually physiologic, and commonly occurs in combination with erosion.

(vertical loss of enamel rarely exceeds 50 m / year) Dental attrition has been used in archaeology and forensic sciences to estimate human age

Causes of Attrition • Patients with accelerated parafunctional mandibular movements- e.g. bruxims. • Diet—persons with habit of chewing tobacco or having a coarse diet are more predisposed to attrition. • Certain occupations, in which worker is exposed to abrasive dust and cannot avoid getting the material in to his mouth, can have attrition. OCCLUSAL PARAFUNCTIONAL HABIT May be: Sleep bruxism or Awake bruxism

MILD MODERATE SEVERE OCCLUSAL PARAFUNCTIONAL HABIT May be: Sleep bruxism or Awake bruxism It is defined as the grinding of teeth during non functional movements of the masticatory system: it is a mandibular parafunction Mechanical wear resulting from bruxism often results in progressively greater wear towards the anterior teeth ( with open bite as exception) SEVERE

Attrition can predispose to or precipitate any of the following : A) Proximal surface attrition (proximal surface facets) The proximal surface wear at the contact area because of the physiologic tooth movement Mesiodistal dimension of the teeth is decreased, leading to drifting , with the possibility of overall reduction in the dental arch.

B) Occluding surface attrition ( OCCLUSAL WEAR) It is the loss ,flattening or faceting of the occluding elements. In severe cases, dentine wears faster than enamel leaving scooped area “reverse cusping” surrounded by peripheral rim of enamel

Clinical Features Of Attrition If wear is severe ,generalized and accomplished in relatively shorter time →vertical loss on face as well as loss of vertical dimension If wear is over a long period of time alveolar bone can grow occlusally →vertical dimension loss is seen but not imparted to face. Deficient masticatory capabilities ,blunting of cusps may compel patient to apply more force on teeth. Cheek biting is sequelae of occlusal surface attrition. vertical overlap between the inclined planes will be lost. Tooth sensitivity

EROSION Loss of tooth structure resulting from chemico mechanical acts in the absence of specific microorganisms If it is not abrasion or attrition, it must be erosion”

Causes Of Erosion Extrinsic factors Intrinsic factors Idiopathic factors

Extrinsic Causes Of Erosion Habitual sucking of citrus fruits The lesion may occur in either the upper or lower anterior teeth Depending on the way the fruit is eaten (If the fruit eaten as a whole unit that does not generally cause a problem) Chlorine, from chlorinated swimming pools (Professional swimmers)

Coke swishing Lemon sucking Wine-tasters

Intrinsic causes of erosion From within the body Usually hydrochloric acid from the stomach (pH 2) Regurgitation Vomiting Rumination is characterized by the voluntary or involuntary regurgitation and rechewing of partially digested food that is either reswallowed or expelled. This regurgitation appears effortless, may be preceded by a belching sensation, and typically does not involve retching or nausea.

Regurgitation and Vomiting of gastric contents due to: Anorexia nervosa Bulimia Hiatus Hernia Pregnancy/Hormones

Idiopathic causes of erosion Unknown cause Patient will not admit to or be aware of intrinsic or extrinsic causes An idiopathy is any disease with unknown pathogenesis or apparently spontaneous origin

Clinical Features Of Erosion Frequently, erosion is seen affecting the palatal surfaces of four maxillary incisor teeth. Erosion in the molar and premolar teeth may present as dish-like depressions on the occlusal surfaces, usually extending into dentine. If teeth have been restored prior to erosion occurring, the restorations stand proud of the surrounding enamel

ABFRACTION Definition: ‘The pathological loss of enamel and dentine due to occlusal stresses’ Theory of abfraction is a theory explaining non-carious cervical lesions (NCCL). It suggests that they are caused by flexural forces, usually from cyclic loading; the enamel, especially at the cementoenamel junction (CEJ), undergoes this pattern of destruction by separating the enamel rods. Controversy Some Clinicians do not believe that this is the reason and that erosion and abrasion cause the wear facets, so research continues…

Clinical Features Of Abfraction Usually wedge shaped lesions with sharp angles found at the cervical margins These lesions can occur with occlusion alone or as multi factorial, can be associated with toothbrush abrasion These lesions are often diagnosed as toothbrush abrasion, but they differ as their angles are sharper

Abfraction

Treatment of Tooth Tissue Loss Relieve sensitivity and pain – fluoride, desensitising agents/toothpastes Identify aetiological factors – modify diet/habits, eliminate acidic foods/drinks, stop habitual practices, gentle tooth brushing techniques Protect the remaining tooth tissue – reconstruct the effected teeth, restorations, inlays/onlays, crowns, endodontic treatment or extraction Check occlusion Bite raising devices/splints

THE END