Tooth Wear 1 Quiz

Tooth Wear 1

• Tooth wear is the cumulative loss of mineralised tooth tissue (enamel, dentine and cementum) due to physical or chemical-physical processes (Schlueter et al 2020).
• Tooth wear is NOT the result of biofilm-induced diseases (e.g., caries) nor a consequence of trauma or resorption.

Lectures and Assessments

• Tooth Wear 1: Pre-recorded lecture + workbook

• Tooth Wear 2: Pre-recorded lecture + quiz

• Tooth Wear 3: Live lecture + case studies to apply theory

• Formative assessments: workbook, quiz, and case studies

• Summative assessments: e-assessment and/or cases

Intended Learning Outcomes

• Define tooth wear

• Describe key aetiological factors of tooth wear

• Outline the significance of tooth wear for oral health

• GDC Learning Outcomes: 1.1.2, 1.1.4, 1.1.8, 1.7.7, 1.10.1, 1.10.2, 1.10.3, 1.10.4, 1.10.6

Alternative Terms

• Erosive tooth wear (chemical-physical)
• A combination of erosion (chemical), attrition (physical), and abrasion (physical)
• Accelerated tooth wear
• Severe tooth wear, where the rate of wear is significant for a patient's age, impacting self-esteem, chewing ability and sensitivity
• Tooth surface loss - clinically discouraged as other reasons for loss of tooth structure.

Clinical Appearance of Severe Tooth Wear

• Images of severe tooth wear are presented (clinical examples)

Epidemiology: Prevalence

• Globally, 20-45% of permanent teeth show wear (Schlueter and Luka 2018).
• In the UK, 77% of adults have some degree of tooth wear, and 2% have severe wear (Bartlett et al 2013, ADHS 2009).
• 30.4% of permanent teeth among children and adolescents exhibit wear (Bartlett et al 2013).
• Prevalence difficult to determine due to inconsistent recording methods, varying definitions, and unsystematic monitoring.

Aetiology of Tooth Wear

• Tooth wear results from three main factors: Erosion, Attrition, and Abrasion.

Erosion

• Dental erosion is the chemical loss of mineralised tooth tissue caused by acids not derived from oral bacteria (Schlueter et al 2020)
• Acids can be intrinsic (e.g., stomach acid) or extrinsic (e.g., acidic drinks).

Sources of Acids

• Intrinsic Acids: Stomach acid (HCl, pH 1-2), Gastro-oesophageal reflux disease (GORD), eating disorders (frequent vomiting), pregnancy (severe morning sickness).

• Extrinsic Acids: Acidic drinks (regardless of meal or in between meals), multiple intakes of fruit juice, alternate drinking habits (swishing, holding in mouth), high quantity acid intake.

Extrinsic Acids – Evidence

• Carbonated drinks, acidic snacks/sweets, and fruit juices are associated with increased erosion occurrence, particularly in 8-19 year-olds.
• Milk and yogurt consumption may reduce erosion.

Extrinsic Acids

• A recent review of top 5 UK energy drinks showed acidic pH values & high sugar content.
• Critical pH values and free sugar levels of these drinks are presented.

Attrition

• Dental attrition is the physical loss of mineralized tooth tissue caused by tooth-to-tooth contact (Schlueter et al 2020)

• Bruxism (teeth grinding) and malocclusion (misalignment) are key causes.

• Images of dental attrition are shown

Abrasion

• Dental abrasion is the physical loss of mineralized tooth tissue caused by physical factors other than teeth (Schlueter et al 2020).
• This often co-exists with erosion
• Common sources include occupational factors (e.g., construction workers), lifestyle habits (e.g., nail biting), oral hygiene routines (e.g., abrasive toothpaste) and diet (e.g., chewing bones).
• Images of dental abrasion clinical examples are shown

Multifactorial Aetiology

• Tooth wear typically occurs gradually and naturally with living and using teeth
• It becomes significant when it's accelerated or affects patient function.

Abfraction

• Often described as tooth wear but not generally accepted as an aetiology in the modern literature.
• Loss of tooth structure in cervical region due complex cervical and occlusal forces.
• Distinctive wedge shape is clinically observed in the cervical region.

Saliva and its impact

• Reduced salivary quality or quantity will increase risk of erosion
• Reflect on the functions of saliva

Epidemiology

• Tooth wear affects a wide range of ages
• Modern lifestyles and diets pose a higher risk
• Early detection challenges
• Generally not consistently tracked/recorded

Summary

• Definitions of tooth wear, including alternative terms
• Prevalence of tooth wear globally & in specific populations
• Multifactorial aetiology of tooth wear (erosion, attrition, abrasion)
• Significance of tooth wear's impact

Test your understanding of tooth wear, including its definition, aetiological factors, and significance for oral health. This quiz covers material discussed in the Tooth Wear 1 lecture, providing insights into the physical and chemical processes involved in the phenomenon. Prepare to assess your knowledge on erosive tooth wear and its implications for dental practice.