Tooth Wear Overview and Assessments

Tooth Wear 1

• Tooth wear defined by the European Federation of Conservative Dentistry as the cumulative loss of mineralised tooth tissue (enamel, dentine, and cementum) due to physical or chemical-physical processes.
• Tooth wear is not a result from biofilm-induced diseases (like caries) or trauma/resorption.
• Formative assessments include: workbooks, quizzes, and case studies.
• Summative assessments include e-assessments and/or case studies.

Lectures and Assessments

• Tooth Wear 1: pre-recorded lectures and workbook.
• Tooth Wear 2: pre-recorded lectures and quizzes
• Tooth Wear 3: live lectures and case studies to apply theory.

Intended Learning Outcomes

• Define tooth wear.
• Describe key aetiological factors of tooth wear.
• Outline the significance of tooth wear for oral health.
• Relevant 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

Definition of Tooth Wear

• Tooth wear is the progressive loss of tooth structure, typically from a combination of processes: erosion, attrition, and abrasion.

Alternative Terms

• Erosive tooth wear (chemical-physical).
• Combined erosion, attrition, and abrasion.
• Accelerated tooth wear - rates significant for a patient's age.
• Severe tooth wear - impactful on patient's life (self-esteem, chewing, sensitivity).

Epidemiology: Prevalence

• Globally, 20-45% of permanent teeth show tooth wear.
• 30.4% of children and adolescents have permanent teeth affected.
• In the U.K., 77% of adults have some tooth wear; 2% have severe tooth wear.

Aetiology of Tooth Wear

• Tooth wear occurs due to a combination of erosion, attrition, and abrasion.

Erosion

• Dental erosion, also known as erosive tooth wear (ETW), is defined as the chemical loss of mineralised tooth tissue caused by exposure to acids not derived from oral bacteria.

Sources of acids that can contribute to dental erosion

• Intrinsic acids (stomach acid, GERD, eating disorders, pregnancy).
• Extrinsic acids (acidic drinks, fruit juices, snacks).

Extrinsic Acids - Evidence

• Carbonated drinks, acidic snacks, and fruit juices are associated with increased erosion, especially in children and adolescents.
• Milk and yogurt intake have been shown to reduce tooth erosion.

Extrinsic Acids

• pH values are low in some popular energy drinks (e.g. Lucozade, Red Bull, Monster, Rockstar, Relentless).
• Significant amounts of free sugar are found in these energy drinks.

Intrinsic Acids

• Stomach acid.
• Gastroesophageal Reflux Disease (GERD).
• Eating disorders (frequent vomiting).
• Pregnancy (severe morning sickness).

Saliva and its Impact

• Reduced saliva quality or quantity increases the erosive potential of intrinsic and extrinsic acids.
• Saliva quality and quantity impacts the risk of erosion.

Attrition

• Dental attrition is defined as the physical loss of mineralised tooth tissue caused by tooth-to-tooth contact.
• Causes of attrition include bruxism (teeth grinding) and malocclusion (misaligned teeth).

Abrasion

• Dental abrasion is the physical loss of mineralised tooth tissue caused by physical factors other than teeth (e.g., toothpastes).
• Often co-exists with erosion.
• Sources include: occupational/environmental (e.g., construction workers, musicians, nail biting), lifestyle habits (e.g., pen chewing, piercings), and oral hygiene practices (e.g., abrasive toothpastes).

Multifactorial Aetiology

• Tooth wear is a result of living and using teeth (which is normal).
• Tooth wear becomes significant when accelerated due to a patient's age or impact on functioning.

Abfraction

• Abfraction is a loss of tooth structure in the cervical region, often shaped like a wedge.
• Caused by complex flexure forces during functioning.
• Clinically evident as a distinct wedge shape in the cervical region.

Epidemiology

• Tooth wear affects all ages and dentitions.
• Tooth wear has a high impact on patients.
• Difficult to detect early signs.
• Not systematically recorded.

Summary

• Definitions of tooth wear and alternative terms; prevalence.
• Multifactorial aetiology including dental erosion, attrition, abrasion.
• Significance of tooth wear, impact on patients.