Dr. Shahzadi Tayyaba Hashmi DNT 243 TOOTH WEAR Dr. Shahzadi Tayyaba Hashmi

TOOTH WEAR Definition: ‘Tooth wear is defined as loss of tooth tissue due to causes other than caries’ Types: Physiological ( occurs with age) Pathological ( excessive tooth wear) Three types have been described, Attrition Abrasion Erosion

Causes of tooth wear

ATTRITION Definition: Attrition is tooth wear caused by tooth-to-tooth contact Occurs as a normal part of aging and it is usually the incisal edges which wear away first, followed by the occlusal surfaces of molar teeth Excessive occlusal wear may occur in the following situations: Patients with Bruxism ( excessive grinding of teeth by patients) Patients who have lost several posterior teeth may show excessive attrition of the anterior teeth, especially if these are used for chewing Patients who suffer from developmental disturbances of tooth structure, such as Amelogenesis and Dentinogenesis Imperfecta

Examples of attrition

ABRASION Definition: Causes: It is always pathological Abrasion is frictional tooth loss caused by extrinsic agents Causes: It is always pathological and may be caused by Tooth brushing Biting on a pipe or a pencil Tooth brush abrasion is caused by poor tooth brushing technique

Characteristics of abrasion It has following characteristics: Particularly affects the labial and buccal surfaces of the maxillary incisor, canine and premolar teeth Resulting cavity is wedge-shaped The problem is often compounded by the use of hard tooth brushes and abrasive toothpaste

Tooth brush abrasion

EROSION Erosion is the loss of tooth substance caused by chemical agents and is non-bacterial and therefore does not include loss by caries Most erosion is caused by acids and is seen in following groups: Those with gastric reflux and with bulimia and anorexia. Regurgitation of acid from the stomach particularly affects the palatal surfaces of the maxillary teeth

EROSION 2. As an occupational hazard: Those who work in an acidic environment e.g in factories making batteries Erosion in these groups is relatively rare but because the acid is in the environment the erosion is particularly seen on the labial surfaces of both upper and lower incisor teeth 3. Those who consume excessive amounts of carbonated soft drinks or fruit juices. The teeth which are most commonly affected are the palatal surfaces of the upper anterior teeth. Teeth may appear yellow due to reduction in the thickness of enamel. Typically cavities are shallow and broad

Acid erosion by bulimia

Erosion

TREATMENT Diagnose the most likely cause In many cases the causes may be multiple Abrasion caused by tooth brushing may be reduced by improving brushing technique A careful history and detailed notes on the position of erosion are important in order to determine the exact cause Dietary analysis and advice are essential for those suffering from erosion due to dietary causes