Tooth Wear

Tooth Wear 1

• 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.

Alternative Terms

• 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).

Clinical Appearance of Severe Tooth Wear

• Images of severe tooth wear are included.

Aetiology of Tooth Wear

• Tooth wear factors include attrition, erosion, and abrasion.

Dental Erosion

• 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.

Extrinsic Acids

• 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.

Intrinsic Acids

• 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.

Saliva and its Impact

• 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

• 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

• 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.

Multifactorial Aetiology

• 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

• 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.

Epidemiology of Tooth Wear

• 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.