Tooth Wear

Study Notes

Tooth wear is defined as the cumulative loss of mineralised tooth tissue (enamel, dentine, and cementum) due to physical or chemical-physical processes.
Tooth wear is not the result of biofilm-induced diseases (e.g., caries) or trauma or resorption.
Lectures and Assessments include pre-recorded materials with workbooks, and live sessions using case studies.
Formative assessments are workbooks, quizzes, and case studies.
Summative assessments consist of e-assessments or cases.
Intended learning outcomes include defining tooth wear, describing aetiological factors, and outlining its significance for oral health. Relevant GDC learning outcomes are also covered.
Globally, 20-45% of permanent teeth show some degree of wear. In the UK, 77% of adults exhibit some wear; 2% have severe tooth wear.

Other terms for tooth wear include erosive tooth wear (chemical-physical), combining erosion/attrition/abrasion, accelerated tooth wear (where the rate is higher than expected in a patient's age), and severe tooth wear (significant impacts on quality of life).

Dental erosion is defined as the chemical loss of mineralised tooth tissue.
It is caused by exposure to acids not derived from oral bacteria.
Sources of acid contributing to dental erosion include intrinsic (stomach acid, gastro-oesophageal reflux disease, eating disorders) and extrinsic (acidic drinks, fruit intake, alternative drinking habits).
Dietary factors strongly influence erosive wear, excessive acidic intake is directly related.

Carbonated drinks, acidic snacks/sweets/fruit juices are examples of extrinsic acids.
Increased erosion in children and adolescents (aged 8-19 years) is linked to extrinsic acids. Milk and yogurt consumption is associated with reduced erosion.
The pH of energy drinks is relevant to wear.

Stomach acid (hydrochloric acid; HCl) is a key intrinsic acid (pH 1-2).
Gastro-oesophageal reflux disease (GORD) is linked to dental erosion.
Eating disorders are also associated with dental erosion.
Frequent vomiting and pregnancy-related severe morning sickness also contribute.

Reduced saliva quality or quantity increases the erosive potential of intrinsic and extrinsic acids.
Saliva function is crucial in mitigating the effects of acids.

Dental attrition is the physical loss of mineralized tooth tissue caused by tooth-to-tooth contact.
Bruxism and malocclusion are common causes of attrition.

Dental abrasion is the physical loss of mineralized tooth tissue by non-tooth physical sources.
Common sources of abrasion include occupational/environmental factors (e.g., miners, construction workers), lifestyle habits (e.g., nail biting, pen chewing), and oral hygiene routines (e.g., aggressive toothbrushing, abrasive toothpastes). This is often co-existent with erosion.

Tooth wear is a combination of erosion, attrition, and abrasion. These factors can contribute in various degrees to tooth wear and have implications for severity and impact on a patient's life.

Abfraction is described as a tooth structure loss in the cervical area related to occlusal and cervical/flexure forces during functioning.
It's characterized clinically by a distinct wedge shape in the cervical region.

Tooth wear affects all ages and dentitions.
Modern lifestyles and diets (acidic) affect tooth wear.
Living longer, keeping teeth longer contribute to the prevalence of tooth wear.
Difficulty in detecting early signs is an issue.
Tooth wear is not always systematically recorded, making comprehensive data collection difficult.