What is non-carious tooth substance loss?
- physiological or pathological loss of dental hard tissues by any means other than the carious process or traumatic injury
What are forms of toothwear?
- attrition
- abrasion
- erosion
- abfraction
What is attrition?
- the loss of tooth substance as a result of mastication, or of occlusal or proximal contact between the teeth
What are clinical signs of physiological attrition?
- disappearance of incisor mamelons
- flattening of occlusal cusps
- exposed dentine may be dark brown in colour and lesions may be cup shaped
What is bruxism?
- a parafunction
- involves grinding and clenching the teeth
- cause is unclear but thought to be associated with stress or occlusal interferences
- can be a nocturnal habit
- pathological attrition
What are some signs and symptoms of bruxism?
- visible wear facets
- abnormal rate of attrition
- hypertrophy of masticatory muscles
- muscle tenderness
- TMJ pain
- tooth mobility
- pulpal sensitivity to cold
How is bruxism managed?
- can lead to a reduced occlusal vertical dimension (OVD), restorative consideration to build bite back up again
- may need to remove occlusal interferences
- acrylic hard or soft splint may be worn to protect from further wear
What is abrasion?
- pathological wearing away of tooth structure that results from a repetitive mechanical process or habit
- most commonly seen on exposed root surfaces
- wear facets appear at the cervical margins
What are the types of abrasion?
Cervical: horizontal brushing most common, may be accelerated by abrasive dentrifice and/or hard toothbrush, more likely if recession already present
Habitual: localised to area of habit, e.g. pipe smoking, wind instrument, flossing with too much pressure, holding needles in teeth
Iatrogenic: opposing teeth grinding to accommodate restorations/ceramic crowns
Industrial: workers exposed to abrasive particles in the atmosphere created during certain industrial processes e.g. sand blasting
How is abrasion diagnosed and treated?
- assess clinical picture and thorough history
- preventative advice in order to limit further damage
- restorative treatment if function or aesthetics affected
What is abfraction?
- the pathological loss of tooth substance caused by biomechanical loading forces, resulting in flexing and failure of enamel and dentine
- v-shaped notches at cervical margin
- thought to be related to tooth flexure at the cervical areas from occlusal loading
- leads to micro-fractures in enamel
- cavitation occurs
- does not explain teeth not in occlusion
What is erosion?
- progressive loss of hard dental tissue by an acidic chemical process without bacterial action i.e. not related to caries
What are the signs of erosion?
- can be seen on any surface
- smooth, glossy/polished appearance
- eventually shallow depressions occur
- proud restorations
- fractures of the incisal edges
- cervical area most severely affected
- surface may have criss-cross appearance
- hollows bear no relationship to occlusion
- cupping of lower molar cusps
What is the classification of erosion?
- extrinsic: source of acid outwith the body (diet/environment) acidic foods/drinks, carbonated drinks, fruit teas, sucking citrus fruits, swimming in heavily chlorinated water
- intrinsic: gastric juice from within body, reflux/vomiting
What treatment options are there for NCTSL?
- prevention/monitor/study models/radiographs/clinical photographs
- fluoride therapy: varnish or high strength F TP
- acrylic hard/soft splints to break bruxism habit
- restorations: sensitive, aesthetics, pulp becomes compromised
