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A surface loss of dental hard tissues other than by caries or trauma

and its a natural consequence of ageing so everyone gets old he or she

will suffer from tooth wear and it may happen in children or adults

The Doctor was talking about tooth loss of several pictures but

unfortunately theresno soft copy I tried my best forgive me if

theres a picture that is not clear ..

there are different things that can cause damage to theteeth ..

dental caries, tooth caries involves the action of bacteria tooth wear , it doesnt involve the action of bacteria traumatic injuries because of accidents causes fractured of

the tooth and causes tooth loss

sometime during development the teeth can be damaged

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the difference between dental caries and the rest

both causes damage to the teeth and lossof dental tissue

dental caries involves the action ofbacteria, if bacteria acts on sweets the end

result will be acids

tooth wear doesnt involve the action ofbacteria

if tooth wear is associated with acid thentooth wear will be worse, but not with the

action of bacteria which makes the tooth

wear worse

o Components of tooth wear Erosion Abrasion Attrition

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Erosion

It means something eroding the surfaces of your teeth andcausing damage ,minerals loss or tooth substance loss

So its the loss of dental hard tissue as a result of a chemicalprocess not involving bacteria

The cause is acid ,but itsnot coming from bacteria you are takingthe acid directly in your mouth from citrus fruit for example

The sources of acids ..It can be

Extrinsic acids like dietary Intrinsic acids like the acids associated with the

stomach

1. Dietary including :

- foods such as citrus fruits ,pickles and other items containing

vinegar ( )-carbonated and acid containing drinks such

- acidic medications is occasionally implicated

- occupational and recreational acids.

those who works as painter are subjected sometimes to erosion.

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2. stomach acids associated with : ..

o anorexia nervosa (this is a psychological effect, whenpeople eat too much and they are worry about their

weight ,they try to vomit himself, by inducing vomiting,

All of the acids in the stomach comes out to erode and

flush the palatal surfaces of the front teeth causing

tooth loss

o hiatus herniao peptic ulcers ( keeping the acid in your mouth, so the

acidity in your mouth directed to the palatal surface

of your teeth so demineralization of the palatal teeth

occur)

o pregnancy with prolonged morning sickness ( the pregnantwoman will vomit in the morning, when the stomach is empty

usually she vomits acidic fluids and this is can cause damage

to the palatal surface of the teeth)

o digestive disturbances which cause recurrent vomiting ( anystomach, GIT problems that may cause vomiting, then you

are subjected to dental erosion

The clinical appearance-clean, non-tarnished appearance of amalgams

- loss of surface characteristics of enamel in young children

- preservation of enamel "cuff inthe gingival crevice is common

- hypersensitivity in teeth

- pulp exposure especially in deciduous teeth

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- broad concavities within smooth surface enamel

- cupping of occlusal surface,, (incisal grooving) with dentinexposure

- increased incisal transluency

- wear on non-occluding surfaces

- "raised" amalgam restorations or crowd amalgam restorations

Examples

1**this is 14-year old female exhibits total LOSS OF SURFACE

CHARACTERISTICS and polished appearance of enamel on her

maxillary incisors, the enamel layer was also very thin.

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2** Gastroesaphageal reflux disease(GERD) was discovered in this 19

years old boy who exhibited early, GENERALIZED EROSION (arrow

A)..Note the preservation of the enamel (cuff) at the gingival

crevice (arrow B),, because of acids ..

3**. when you see a cuff on enamel itsnot due to crown preparation

then you should think of erosion...the blue arrow indicates a cuff of

enamel

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4**. The fissure sealant in this 14-year old boy stands "raised" from

surronding eroded occlusal enamel ,the acids eroded the tooth

substance without eroding the fissure sealant because its made of

resin ,notice that there is no any anatomical landmarks on the occlusal

surface ,they have been eroded

the acids will leave the resin or amalgam without erodingalso the surface of the amalgam will be shiny because ofcontinuously washed with acids (non tarnished)

5**. here we have erosion due to soft drinks ,erosion of the left side

mandibular molars of female who habitually enjoyed holding a cola

beverage in this area here which is the left side for several minutes

before swallowing..

as we know that the ph of the cola is above 3 which is very acidic

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6.** here a two years of continual consumption of canned citrus drinks

in a hot country led to this erosion of the cervical areas of posterior

teeth.

7**. restoration of eroded teeth in this patient will require crown

,here you got something very damaged you start talking aboutdifferent solution you will put composite it will stick to the surface no

problem, but if you dont stop the causative agent the lesion will

continue

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8**. extreme example of tooth erosion in patient who sufferedrepeated gastric regurgitation.., here the palatal surfaces are eroded

with thin enamel labialy

9.**Here the tooth tissue has been eroded and the amalgam setting

thereundisturbed, the surface of the amalgam its shiny because its

continuously being washed with acid so its non-tarnished ,raised

Whats a proud amalgam restoration? , the amalgam seen inthe case of erosion

The amalgam and fissure sealants will be setting proudly inthe eroding surfaces ..

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Attrition

The lower jaw is occluding with the upper jaw for chewing forexample so teeth are rubbing against each other during this

dynamic contact throughout life this will cause tooth loss

mechanical loss of tooth surface or restoration caused by toothto tooth contact during mastication or parafunction (bruxism) .

so againEROSION : due to acidsATTRITION : due to tooth to tooth contact

CLINICAL FEATURES OF ATTRITION:

- shiny facets on amalgam contacts

- enamel and dentin wear at the same rate

- possible fracture of cusps or restorations

and you may have a condition called ABFRACTION

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Examples

1. this 42- years old female has a bruxism and no other known riskfactors for erosion ,demonstrating moderate to severe attrition

2. this is attrition in eccentric occlusion

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3. this is Cusp facets,, cusp tips have been eliminated and the result is

a crack areas show yellowish color which is dentin ,,The buccal of the

lower cusps tend to suffer more because they are functional

Sever attrition may cause problem to the lower teeth,andteeth may become non vital

Abrasion

pipe smokers for example this will cause abrasive lesion in theteeth

so itsthe wearing a way of tooth substance by mechanicalmeans of other than by opposing teeth, such as over-vigorous

tooth brushing or holding pipe..

- usually located at cervical areas of teeth

- lesions are more wide than deep

- premolars and cuspids are commonly affected

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Just to remind you ;P ,,

EROSION : acids to tooth contact

ATTRITION : tooth to tooth contact

ABRASION : foreign bodies to tooth contact (mechanical)

Examples

1. this abrasion due to pipe smoking , holding the pipe will cause rubbing

to the teeth

2. this abrasion due to nail biting

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3. this abrasion due to vigorous tooth brushing (hard

toothbrush ) here lower and upper incisors are the teeth

that suffer most

ABFRACTION:

Is the loss of tooth surface at the cervical areas of teeth

caused by tensile and compressive forces during tooth

flexure

Clinical features of ABFRACTION :

Affects buccal/labial cervical areas of teeth deep, narrow V-shaped notch commonly affects single teeth with excursive

interferences or eccentricocclusal loads

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this patients canines and bicuspids have characteristics that can

be attributed to both abrasion and abfraction.It started with abfraction then because of tooth brushing

it will increase so its a combination

By the way this is not class five , its not caries!

Note , class five can be buccaly or labialy (facially ) and

lingually ..

o You can ask the patient ,, how long has it beenAlso was it small and got larger

So by this you can rule out caries

o If you want to rule out abfraction you can askWhats thejob ?

Do they get angry ?

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some examples ..

A painter , paints contain acids so we expect erosion in the

anterior teeth in the labial surfaces

A finical leader we expect attrition because of stress

A carpenter we expect abrasion because of holding foreign

objects in the mouth

Diagnosis and monitoring of tooth wear:-view teeth clean and dry

- take study models at six months interval to determine the

rate of progress ( this is ver imp.) its still the same or its

deteriorating

- take sympathetic history to elicit the cause

Taking history for Erosion:- past and present diet

- digestive disorders

- past and present slimming habits

- alcohol intake

- is the patient under any medications?

- occupation

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Taking history for Attrition and Abrasion- clenching and grinding habits

- periods of stress or anxiety

- square face which because of over developed muscles

Seen usually in leaders ..

- pipe smoking ,opening hairgrips...etc

Preventing tooth wearo diminishing the frequency and severity of the acid

challenge

o enhance the defense mechanisms of the body (increase salivary flow

and pellicle formation)

o enhance acid resistance , remineralization of the toothsurface

o decrease abrasive forceso provide mechanical protection.byBRA.. its the bight raising appliance that protect the

teeth like (night guard)

o monitor stability (casts and recall visits)

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When are restorations necessary? this is a very imp.

question

A. patientsdecision :

-patient appearance

- tooth becomes sensitive

B. Dentists decision:

- decrease in occlusal vertical dimension

- pulp exposure- in advance cases crowns are required

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