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TOOTH WEAR
1. The university of georgia
Therapeutic Dentistry II
Atheer Ahmed Abed 1330129
TOOTH WEAR
2. What is tooth wear?
Tooth wear has been defined as loss of tooth
substance resulting from abrasion, attrition and
erosion acting singly or concurrently i.e. abfractions.
When wear is due to more than one predominant
etiological factor, special terms have been suggested
to highlight the multiplicity of causes. For example:
abrosion
demastication
3. Types of tooth wear
Abrasion
Wear process involving foreign objects sliding or
rubbing against the tooth surfaces.
Attrition
Wear process of the tooth substance by tooth-to tooth
contact.
4. Abfraction
Non-carious cervical lesions caused by tensile stress
generated from occlusal loading, and micro fracture of
cervical enamel rods.
Erosion
Loss of dental hard tissues by non-bacteriogenic acid
etching.
5. ABRASION
The combination of a hard toothbrush, an abrasive
toothpaste and an intensive horizontal brushing
technique is believed to cause well-defined, V-
shaped notches in the cervical regions of one or
more facial tooth surfaces, where the dentine and
cementum are less wear-resistant than coronal
enamel.
6. ATTRITION
Attrition resulting from tooth-to-tooth contact (two-
body wear) produces well defined wear facets on the
functional surfaces of teeth in one jaw which match
corresponding lesions on teeth in the other jaw
Para functional habits such as bruxism and
clenching were also believed to be important factors
in causing accelerated attrition.
7. Attrition of incisal edges of 1/1 and pseudo-Class
III incisal malocclusion.
Attrition of 1/ because of lack of posterior support.
8. ABFRACTION
The concept of ‘stress-induced cervical lesions’ was
introduced to explain how wedge-shaped Class V
lesions can be created by repeated compression and
flexure of the teeth under occlusal loading. Dentine
is more elastic than enamel and enamel rods can be
fractured in such situations. In older adults, enamel
crazing and micro fractures are more common.
9. o The term abfraction was used to describe this ‘stress
corrosion’ mechanism
o The ‘stress corrosion’ theory has been supported by a
number of observations:
• in vitro evidence of tensile stresses created in the
cervical region under occlusal loading
• a high incidence in bruxists
• lesions can be found on only one tooth in one segment
• lesions found in subgingival regions
• the presence of such lesions in animals.
10. Erosion
Erosion of tooth substance may be caused by
intrinsic or extrinsic acids, and modified by changes
of salivary flow and constituents.
Acid erosion
Flow of Saliva
11. Patterns of Tooth wear in
Erosion
Erosion can lead to old amalgam restorations becoming
outstanding
Erosion of palatal surfaces of 321/123 in a patient with
bulimia nervosa.
12. DIAGNOSIS
Before any intervention or restorative treatment, the
nature and duration of patient’s chief complaints and
expectations must be ascertained.
Apart from using a routine medical questionnaire,
emphasis may be placed on medical conditions
predisposing to erosion due to gastro-esophageal
reflux or reduced salivary flow.
Evaluation of the family and social history can
reveal if the patient is under unusual stress, which
may be related to bruxism, changes of diet and
regurgitation.
13. Clinical examination of the dentition has two
primary objectives:
• To document and record the location, appearance and
degree of tooth wear.
• To evaluate the progress of tooth wear over time.
Clinical examination can supplemented with high-
density stone study casts, intra-oral photographs,
radiographs and salivary tests.
14. Restorative management of tooth wear
Tooth wear can be classified as physiological or
pathological, but no universally accepted guidelines are
available to differentiate the two entities; the same loss
of tooth substance may be regarded as physiological in
an elderly person, but pathological in young one.
Clinical indications for restorative management:
Biological
• Loss of tooth substance could lead to irregular tooth surfaces
which may enhance plaque retention
• Pulpal exposure
• Weakening of tooth structure
15. Functional
• Loss of tooth substance cannot be compensated by
continuous eruption, and there is reduced masticatory
efficiency because of occlusal wear.
Esthetic
• Loss of tooth substance is esthetically unacceptable to
the patient.
16. A systematic treatment approach should be used to
manage characteristic worn dentitions involving
different tooth surfaces and degree of severity. For
practical reasons, the worn dentition can be classified
according to location:
• Localized anterior tooth wear
• Localized posterior tooth wear
• Generalized tooth wear
