Dental Attrition

Study Notes

Physiologic wearing away of tooth substance due to tooth-to-tooth contact during mastication
Most common cause: bruxism
Clinical features:
- Initial stage: small polished facet in cusp tips or ridges, flattening of incisal edges
- Middle stage: gradual reduction of cusp height, flattening of occlusal inclined planes, shortening of dental arch
- Advanced stage: wearing away of all enamel thickness, loss of intercuspal digitations, teeth may be worn down to the gingiva

Pathologic wearing away of tooth substance through abnormal mechanical processes
Etiology:
- Incorrect use of a toothbrush
- Use of abrasive dentifrice
Clinical features:
- Enamel and dentin worn away to produce a 'V' shaped notch at the neck of the tooth
- Areas most affected: labial and buccal surfaces of canines and premolars

Pathological loss of enamel and dentin due to occlusal stresses
Etiology:
- Occlusal forces causing the tooth to flex, leading to small enamel flecks breaking off
Clinical features:
- Usually wedge-shaped lesions with sharp angles found at the cervical margins
Differential diagnosis:
- Abrasion: abfraction has sharp angles, unlike abrasion

Loss of tooth substance by non-bacterial chemical processes
Plaque is not involved in the process
Clinical features:
- Shallow, broad, smooth, scooped-out depression on the enamel surface near the cemento-enamel junction
- Mostly affects the cervical third of facial surfaces of teeth, with lingual surfaces affected if the cause is internal acid source

Calcification or deposition of calcium ion in dentinal tubules of primary dentine
Sclerosis decreases conductivity of dentine and slows advancing carious process

Dentin formed after root completion
Two types:
- Physiologic or regular type:
  - Due to aging process
- Pathologic or irregular type (Reparative Dentin):
  - Due to caries, attrition, abrasion, erosion, tooth fracture, and cavity preparation
Histopathological features:
- Physiologic secondary dentin: fewer tubules, similar in appearance to primary dentin
- Reparative secondary dentin: few tubules, tortuous in appearance

Physiologic form: shedding of deciduous teeth
Pathologic form:
- External resorption: on the external surface of the root
- Internal resorption (Pink Spot): on the wall of the root canal
Clinical features:
- No early clinical symptoms
- Crown: pink-hued area
- Root: no symptoms until fracture
- Mostly single tooth, rarely multiple teeth
Histopathological features:
- Variable degree of resorption of the inner or pulpal surface of the dentin
- Proliferation of the pulp tissue filling the defect
- Chronic inflammatory reaction in the pulp tissue