Tooth wear
Tooth wear | |
---|---|
Other names | Non-carious tooth substance loss |
Lower teeth shows signs of tooth wear likely caused by erosion | |
Specialty | Dentistry |
Tooth wear refers to loss of
Tooth wear is predominantly the result of a combination of three processes;
Multiple indices have been developed in order to assess and record the degree of tooth wear, the earliest was that by Paul Broca.[8] In 1984, Smith and Knight developed the tooth wear index (TWI) where four visible surfaces (buccal, cervical, lingual, occlusal-incisal) of all teeth present are scored for wear, regardless of the cause.[8] A more recent index Basic Erosive Wear Examination (BEWE) from 2008 by Bartlett et al., is now also in use.[9]
Causes
Attrition
Abrasion
Erosion
- Gastroesophageal reflux disease (GERD)
- bulimia, alcoholism
- Rumination
- Eructation (burping)[medical citation needed]
- Dietary - liquids of low pH and high titratable acids.
Abfraction
Diagnosis
Tooth wear indices are useful tools for carrying out epidemiological studies and for general use in dental practices.[9]
Basic erosive wear examination
The Basic Erosive Wear Examination was first described by Bartlett et al. in 2008.
BEWE Score | Clinical appearance description |
---|---|
0 | No erosive tooth wear |
1 | Initial loss of surface texture |
2 | Distinct defect, hard tissue loss <50% of the surface area |
3 | Hard tissue loss ≥50% of the surface area |
Tooth wear index
The Tooth Wear Index (TWI) (see Table 2) was developed by Smith and Knight in 1984. TWI scores each visible surface (buccal/B, cervical/C, lingual/L and occlusal-incisal/O/I) (see
Score | Surface | Criteria |
---|---|---|
0 | B/L/O/I | No loss of enamel surface characteristics |
C | No loss of contour | |
1 | B/L/O/I | Loss of enamel surface characteristics |
C | Minimal loss of contour | |
2 | B/L/O | Loss of enamel exposing dentine for less than one third of surface |
I | Loss of enamel just exposing dentine | |
C | Defect less than 1mm deep | |
3 | B/L/O | Loss of enamel exposing dentine for more than one-third of surface |
I | Loss of enamel and substantial loss of dentine | |
C | Defect less than 1-2mm deep | |
4 | B/L/O | Complete enamel loss- pulp exposure- secondary dentine exposure |
I | Pulp exposure or exposure of secondary dentine | |
C | Defect more than 2mm deep- pulp exposure- secondary dentine exposure |
Other indices
- Eccles-Index [17]
- Modified TWI [18]
- Linkosalo and Markkanen [19]
- O'Brien Index [20]
- Lussi Index [21]
- O'Sullivan Index [22]
- Simplified Tooth Wear Index (STWI) [23]
- Exact Tooth Wear Index [24]
- Visual Erosion Dental Examination (VEDE) [25]
- Evaluating Index of Dental Erosion (EVIDE) [26]
Treatment
Once the cause of tooth wear has been identified and a preventative regime has been put in place, the patient should be reviewed for 6–12 months to establish that the intervention has been successful before any active management is carried out. Once this has been achieved a decision needs to be made whether or not it is necessary to carry out restorative treatment or if it can simply be managed by non-invasive methods.[27]
Where restorative treatment is necessary, it must be decided whether to conform to the existing occlusion (typically for moderate wear, where only a few teeth are affected) or reorganise the occlusion (severe wear, unstable occlusion). Where the occlusion is reorganised, it can first be tested using a reversible method (i.e. a hard occlusal splint). A decision is made after full occlusal assessment including assessment of contacts in intercuspal position (ICP) and retruded contact position (RCP) as well as analysing casts articulated in a semi-adjustable articulator to use for a diagnostic wax up of any proposed restorative work.[28]
Active restorative management depends upon the location of the wear (localised or generalised), the severity of the wear, and the patient's occlusal vertical dimension (OVD), which may have changed as a result of tooth wear. There are three potential scenarios of tooth wear:[29]
- Excessive wear with loss of OVD
- Excessive wear without loss of OVD but with space available
- Excessive wear without loss of OVD but with limited space available
Scenario 1 is relatively common, whereas scenario 2 is quite rare and tends to occur when the wear is rapidly occurring. Scenario 3 occurs due to a phenomenon called dentoalveolar compensation whereby the dentoalveolar tissues compensate for wear of teeth by increasing the bony support in order to maintain a constant OVD. This makes things difficult as there is no room to build the teeth back up to their original height without increasing the OVD.[29]
The options for restoring this loss in tooth height are: [30]
- Increasing the OVD - this is the traditional approach and involves restoring all teeth to an increased height in order to create a new ICP at an increased OVD
- Occlusal adjustment - this is typically used for anterior teeth only, whereby the patient's occlusion is reorganised into the RCP position to utilise increased space in this position
- Crown lengthening or orthodontic extrusion - this is useful when crowns are to be placed in a worn dentition but there is inadequate crown height and you do not want to change the OVD
- Relative axial tooth movement - this is the most commonly used method and can be used for localised or generalised wear, the idea is to prop the bite open thereby causing the extrusion of worn teeth to provide extra crown height for restoration, this can be done using simple direct restorations or more complex indirect restorations, this idea was first established by Dahl and is often referred to as the Dahl effect
Pulp vitality must also be taken into consideration prior to treatment, when teeth have severe wear it is possible that they have become non-vital.
See also
- Attrition
- Abrasion
- Erosion
- Abfraction
- Bruxism
References
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- ^ a b c d e f g h Suchetha A (2014). "Tooth Wear - A Literature Review". Indian Journal of Dental Sciences. 5 (6): 116–120.
- ^ a b c d e Bhushan J, Joshi R (2011). "Tooth Wear - An Overview With Special Emphasis On Dental Erosion". Indian Journal of Dental Sciences. 5 (3): 89.
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- PMID 24993256, retrieved 2021-07-23
- ^ "Dental Erosion | American Dental Association". www.ada.org. Retrieved 2024-04-19.
- ^ Template:Nascimento MM, Dilbone DA, Pereira PN, Duarte WR, Geraldeli S, Delgado AJ. Abfraction lesions: etiology, diagnosis, and treatment options. Clin Cosmet Investig Dent. 2016 May 3;8:79-87. doi: 10.2147/CCIDE.S63465. PMID: 27217799; PMCID: PMC4861607.
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- ^ O’Sullivan, EA (2000). "A new index for the measurement of erosion in children". Eur J Paediatr Dent. 1: 69–74.
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