This document discusses tooth wear management. It defines tooth wear and describes the main causes as erosion, attrition, and abrasion. It notes that tooth wear is becoming more prevalent, especially in younger people, and is now the third most common oral condition after caries and periodontal disease. The document outlines physiological and pathological tooth wear and provides guidance on conducting a tailored preventive treatment plan that identifies etiology, eliminates risks, and uses remineralization and monitoring. It emphasizes a minimally invasive approach to management focusing on preservation and maintenance over time.

1. Tooth Wear Management
Why, When, What, How
Dr Neil Pande
BDS MFGDP(UK) MFDSRCS(Ed) MOI(UCAM)
General Dental Practitioner, Healthy Smiles
Kathmandu, Nepal
Update 2022

2. Tooth Wear
Definition
• Cumulative loss of mineralised tooth substances
• Occurring over time
• Complex Process
• May be slow, steady or episodic
• Affecting both permanent and deciduous teeth
• Due to chemical and / or mechanical factors
Loomans B, Opdam N, Attin T, Bartlett D, Edelhoff D, Frankenberger R, Benic G, Ramseyer S, Wetselaar P, Sterenborg B, Hickel R, Pallesen U, Mehta S, Banerji
S, Lussi A, Wilson N. Severe Tooth Wear: European Consensus Statement
on Management Guidelines. J Adhes Dent. 2017;19(2):111-119. doi: 10.3290/j.jad.a38102. PMID: 28439579.
EROSION
ATTRITION
ABRASION
Abfraction

4. Oral Diseases
Trend
Periodontal Disease
Tooth Wear
Awareness
Tooth Brushing
Better Overall Care
Living Longer
Acidic Food
Stress
May develop at any age
Multifactorial
Comparison of Adult Dental
Health Survey of UK
between 1978 -2009
revealed:
Prevalence of Decay has
fallen from 46% to 28%
Prevalence of Periodontal
Disease has fallen from
55% to 45%
Tooth Wear has increased
by 10%
More significantly in 16-44
age group.

5. 3 Most Common Oral Diseases
CARIES
PERIO
TOOTHWEAR
RISING
CHALLENGING
CONFUSING
NEGLECTED
Erosive tooth wear
is now the third
most commonly
observed oral
condition, after
caries and
periodontal
disease.
Bartlett et al.
BDJ June 2019

7. Toothwear
Physiological Pathological
Age Related Phenomenon
Normal Physiological Wear
Incisors : 18 Microns per year
Premolars : 25 Microns per year
Molars : 38 Microns per year
Age Incisor Premolar Molar
20 >0.18mm >0.25mm >0.38mm
30 >0.36mm >0.5mm >0.76mm
40 >0.54mm >0.75mm >1.14mm
50 >0.72mm >1mm >1.52mm
60 >0.9mm >1.25mm >1.9mm
70 >1.08mm >1.5mm >2.28mm
TY - JOUR AU - Yu, Haiyang AU - Zhao, Yuwei AU - Li, Junying AU - Luo, Tian AU - Gao, Jing AU - Liu, Hongchen PY - 2019/09/18 SP - T1 - Minimal invasive
Microscopic Tooth preparation in esthetic restoration: a specialist consensus VL - 11 DO - 10.1038/s41368-019-0057-y JO - International Journal of Oral ScienceER -
Lambrechts
P,
Braem
M,
Vuylsteke-Wauters
M,
Vanherle
G.
Quantitative
in
vivo
wear
of
human
enamel.
J
Dent
Res.
1989
Dec;68(12):1752-4.
doi:
10.1177/00220345890680120601.
PMID:
2600255
Ray
DS,
Wiemann
AH,
Patel
PB,
Ding
X,
Kryscio
RJ,
Miller
CS.
Estimation
of
the
rate
of
tooth
wear
in
permanent
incisors:
a
cross-sectional
digital
radiographic
study.
J
Oral
Rehabil.
2015
Jun;42(6):460-6.
doi:
10.1111/joor.12288.
Epub
2015
Mar
10.
PMID:
25756187.

8. Maxillary Incisors 18 microns/yr = 0.9mm in 60 yrs
Mandibular Incisors
24 microns/yr=1.46mm in 60 yrs
Molar
38 microns/yr=
1.9 mm in 60 yrs
Premolars
25microns/yr=
1.25mm in 60 years
Lambrechts
P,
Braem
M,
Vuylsteke-Wauters
M,
Vanherle
G.
Quantitative
in
vivo
wear
of
human
enamel.
J
Dent
Res.
1989
Dec;68(12):1752-4.
doi:
10.1177/00220345890680120601.
PMID:
2600255Sandeep
N,
Satwalekar
P,
Srinivas
S,
Reddy
CS,
Reddy
GR,
Reddy
BA.
An
Analysis
of
Maxillary
Anterior
Teeth
Dimensions
for
the
Existence
of
Golden
Proportion:
Clinical
Study.
J
Int
Oral
Health.
2015
Sep;7(9):18-21.
PMID:
26435610;
PMCID:
PMC4589712.
80%
100%

9. Toothwear
Mild
Moderate
Severe
BEWE Basic Erosive Wear Examination

10. Toothwear
Chemical Mechanical
Intrinsic Extrinsic Extrinsic
Intrinsic
Salivary Deficiencies
Gastric Reflux
Heartburn
Vomitting
Rumination
Acidic Drinks
Carbonated or fizzy drinks
Pure Fruit Juices
Smoothies
White Wine
Cider
Herbal Tea
Sport Drinks
Swimmers
Acidic Food
Fruits
Sauces
Salt and Vinegar Chips
Vinegar and Pickles
Kimchi
Normal Chewing
Parafunction
Sleep Bruxing / Clenching
Awake Clenching
Incorrect Brushing
Abrasive Toothpaste
Biting Pen / Clips
Occupational
Sphincter incompetence
• Oesophagitis
• Alcohol
• Hiatus hernia
• Pregnancy
• Diet (eg spicy/fatty foods)
• Drugs (eg diazepam)
• Neuromuscular (eg cerebral palsy)
Increased gastric pressure
• Obesity
• Pregnancy
• Ascites
Increased gastric volume
• After meals
• Obstruction
• Spasm
Erosion
Attrition Abrasion

12. Key Principles of Management
Early recognition and patient education
Preventive strategies in place
Minimally invasive care
moderate or severe tooth wear, without functional or aesthetic concerns, counselling and monitoring is the tre

13. patient commitment can be secured. The temptation to undertake complex rehabil
ve’ nature rather than ‘subtractive’, thereby reducing the need for the further loss o
permit the ease of modification, whereby further restorative material may be adde
Chapter 9 A Pragmatic Philosophy of Tooth Wear Management by Bas Loomans and Shamir Mehta June 2022

14. vs
कटुवा भरुवा
WHICH APPROACH?
↓ Biological Cost
↓ Economic Cost
↓ Time

16. Tailored Preventive Treatment Plan
1. Identification of Etiology and Risks
2. Elimination of Etiology
3. Fluoride and Remineralization
4. Monitor
1. Active or inactive at present?
2. Physiological or Pathological?
3. Aesthetic or Functional Concerns?
4. Mild, Moderate, Severe?
5. Class I, II-1, II-2, III, Open / Deep
POSSIBLE TREATMENTS
Splint Therapy
Orthodontics
Adhesive Restorations
Fixed Prosthodontics
Removable Prosthodontics
Dental Implants
Maintenance
Dealing with Failures

17. pFMR
Monitor
OCCLUSION

18. VIRGIN
RE-ENDO/RE-CROWN
EXTRACTION
RESIN BONDED
IMPLANT
BRIDGE
RPD/CPD/CD
TRUST
&
CONSCIEN
CE
DO
NO
HARM
S
K
I
L
L
S
Naturomimetic
Minimally
Invasive
Comprehensive
Dentistry
DYNAMIC RESTORATIVE CYCLE

21. pFMR
Preserve
Maintain

22. +9779801053532
@neilpande

23. What to do tomorrow morning at the clinic?
Start looking for signs of demineralisation / Toothwear
Find the cause of that with history and diet chart
Apply Fluoride Varnish
Recommend Remineralising agents and pastes
Habit modification
Fill the facets and unsupported enamel with composites
Monitor
Note age and wear activity
If the existing anterior and lateral guidance is lost, try to restore and re-create with composites
Plan for Additive Adhesive Rehabilitation if needed
Long Term Monitoring
Splint Therapy if Intrinsic Mechanical Cause