DR.

APPLU ATREY PG PART I DEPT OF CONSERVATIVE DENTISTRY AND ENDODONTICS

INTRODUCTION DIFFERENT TYPES OF NON CARIOUS LESIONS CONSEQUENCES OF TOOTH WEAR TREATMENT MODALITIES OF TOOTH SURFACE LOSS CONCLUSION REFERENCES

Normal physiologic process that occurs throughout life.

Problems arise when the rate of loss becomes
excessive causing functional or esthetic problems or sensitivity for the patient.

Enamel is one of the few tissues in the body that
does not regenerate or replace itself in the way that skin, blood cells, and fractured bones do. Fortunately, the dentine does show some reparative mechanisms as reactionary or reparative dentine which is laid down in the pulp chamber as a response to tooth wear

Traditionally, the terms erosion, abrasion and attrition were used to describe non carious pathologic loss of tooth structure.

 Smith and Knight advocated the use of term tooth wear .  Tooth wear is defined as the surface loss of dental hard tissues other them by caries or trauma . Clinically tooth wear appears to progress very slowly over years  .  Tooth wear is a cumulative lifetime process which is irreversible .

but certain clinical features may suggest a major contributory factor. The lesion may become more rounded and shallow if there is an element of erosion present   . hard surface. cervical lesions caused purely by abrasion have sharply defined margins and a smooth. Traditionally. Tooth wear has the multi-factorial aetiology.

 Flattening of cusps or incisal edges and localized facets on occlusal or palatal surfaces would indicate a primarily attritional aetiology. Erosive lesions cause „cupping‟ to form in the dentin. Once dentine is exposed. If wear is primarily attritional. then dentine tends to wear at the same rate as the surrounding enamel. the clinical appearance is determined by the relative contribution of the etiological factors.   .

     Change in appearance of teeth Exposure of dentin normally covered by enamel Dentin Hypersensitivity Loss in occlusal vertical dimension Loss in posterior occlusal stability resulting in   Mechanical failure of teeth or restorations Hypermobility and drifting   Exposure of pulp Pulpitis and loss of vitality .

In-vitro measurement • Macroscopic changes • Polarized light microscopy • Surface profilometry • Microhardness tests • Scanning electron microscopy In-vivo • Microradiography measurement • Digital image analysis • Iodine permeability • Macroscopic • Synthetic hydroxyapattite changes powders/discs • Replica • Calcium and phosphorus technique dissolution • Intra-oral carcinogenicity test Newer methods •Scanning tunneling microscope •Atomic force microscope •Finite element analysis .

3. 10. 6. 2. 5. 13. 11. 7. Attrition Erosion Abrasion Abfraction Localized non hereditory Enamel hypoplasia Localized non hereditory enamel hypocalcification Localized non hereditory dentin hypoplasia Localized non hereditory dentin hypocalcification Discolourations Malformations Amelogenesis imperfecta Dentinogenesis imperfecta Trauma . 4. 8. 12. 9.1.

ATTRITION Derived from Latin word ATTRITIM meaning “action of rubbing against something” .

 The physiologic wearing of the teeth resulting from tooth to tooth contact as in mastication. 1998 .  Every (1972)  Loss by wear of surface of tooth or restoration caused by tooth to tooth contact during mastication or parafunction  Milosevic.  Shafer  Wear caused by endogenous material such as microfine particles of enamel prisms caught between two opposing tooth surfaces.

  Attrition occurs at an ultra structural level It can be caused by direct contact between surfaces or the action of an intervening slurry  Attrition can be hastened by coarse diet and abrasive dust  Some para-functional habits like Bruxism may also contribute to attrition .

it is considered pathologic.  If occlusal wear occurs at a rate faster than compensatory physiologic mechanisms. the geometry of stomatognathic system and grinding pattern of the individual. Vertical loss of enamel of 50-68 µm/year is considered physiologic  . Distribution of attrition is influenced by the type of occlusion.

ATTRITION  PROXIMAL SURFACE ATTRITION (PROXIMAL SURFACE FACETING) OCCLUDING SURFACE ATTRITION (OCCLUSAL WEAR)  .

3. 5. Shiny wear facets with well defined borders The surface of wear facet is flat and flush with the opposing tooth on contact Enamel and dentin wear at the same rate Possible fracture of cusps or restorations Pure attrition shows equal wear on both arches. 2.1. 4. (unlike erosion) .

1981 .SCORE 0 1 2 CLINICAL FEATURE NO WEAR MINIMAL WEAR NOTICIBLE FLATTENING PARALLEL TO OCCLUDING PLANES 3 4 FLATTENING OF CUSPS AND GROOVES TOTAL LOSS OF CONTOUR AND/OR DENTIN EXPOSURE Richard and brown.

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EROSION Derived from Latin verb EROSUM meaning “to corrode” .

 Erosion is defined as superficial loss of hard tissue due to chemical process not involving bacteria.  Imfeld T (1996)  Erosion is defined as the chemical dissolution of teeth by acids  Martin . usually by a chemical or electrolytic process.  Every (1972)  Erosion is process of gradual destruction of tooth surface.

of Contemporary Dental Practice 1999. Dental erosion is defined as the progressive. irreversible loss of hard dental tissues due to a chemical process not involving bacteria Gandara BK. J. Diagnosis and management of dental erosion. Truelove EL. 1(1): 1-17 .

   . The critical pH of enamel is 5. erosion is primarily a surface phenomenon The solubility of enamel is pH dependent The rate at which apatite precipitates depends on factors such as calcium binding in saliva.5. Clinically. any solution with a lower pH may cause erosion if the attack is lengthy and intermittent over time.

glazed surfaces In advanced cases. increased incisal translucency Rapid process may lead to sensitive teeth due to dentin exposure while slower progressive lesions may be asymptomatic   . erosion effects enamel resulting in smooth. In early stages. restorations may project above the occlusal surfaces and exhibiting concavities known as cupping.

1979   . Class I – superficial lesion involving enamel only Class II – localized lesions that involve dentin or less than 1/3rd of the surface Class III – generalized lesions involving dentin and more than 1/3rd of the surfaces Eccles et al.

swimmers Diet – citrus fruits. calcium chelators Life style – fruits and diet drinks. vit-C. carbonated drinks. Extrinsic (exogenous)  Environmental – by acid fumes and aerosols in occupational. vinegar Medication – aspirin. bleaching agents     Intrinsic – conditions that lead to chronic vomiting or persistent gastroesophageal reflux    Anorexia and bulimia nervosa Chronic alcoholism Morning sickness associated with pregnancy .

 Clinical severity    SUPERFICIAL EROSION Superficial Localized Generalized  Activity of progression   Active or manifest Inactive or latent GENERALISED SEVERE EROSION .

Mannerberg described 2 types of erosive lesions as viewed under SEM  Active lesions – shows distinctive etched enamel prisms resembling honeycomb  Inactive or latent lesions – faint with unrecognizable characteristics .

  (incisal grooving) with dentin exposure   Increased incisal translucency Wear on non-occluding surfaces  There is a difference in wear in opposing arches . Enamel erosion appears smooth and rounded and the surface contour is lost Broad concavities within smooth surface enamel Cupping of occlusal surfaces.

pH Acquired pellicle – diffusion limiting properties and thickness Tooth composition and structure Dental anatomy and occlusion Physiologic soft tissue movements    . buffering capacity. composition.  Saliva – flow.

   pH Total acid level Type of acid (pKa)    Calcium chelating properties Calcium phosphorus and fluoride content Physical and chemical properties affecting adherence to the enamel surface and stimulation of saliva flow. .

swallow?)  Dental History     Dietary History   . Medical History     Excessive vomiting. rumination Gastroesophageal reflux disease (Symptoms of reflux) Frequent use of antacids Alcoholism History of bruxism (grinding or clenching) Morning masticatory muscle fatigue or pain? Use of occlusal guard Acidic food and beverage frequency Method of ingestion (swish.

 Occupational/Recreational History     Regular swimmer? Wine-tasting? Environmental work hazards? Sports energy drinks Tooth brushing method and frequency Type of dentifrice (abrasive?) Use of mouthrinses Use of topical fluorides  Oral Hygiene Methods     .

Early recognition of erosion is important to successfully manage and prevent disease progression. Identification of the etiology Preventive measures Patients compliance.    .

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 Diminish the frequency and severity of the acid challenge.   Decrease amount and frequency of acidic foods or drinks. which inhibits demineralization of tooth structure . If undiagnosed Gastroesophageal reflux is suspected. refer to a physician.   Saliva buffering capacity resists acid attacks. A patient with alcoholism should be assisted in seeking treatment in rehabilitation programs.   Enhance the defense mechanisms of the body (increase salivary flow and pellicle formation). Saliva is also supersaturated with calcium and phosphorus.

Dietary components such as hard cheese (provides calcium Improve chemical protection.   Daily topical fluoride at home.   and phosphate) can be held in the mouth after acidic challenge . Neutralize acids in the mouth by dissolving sugar-free antacid tablets. remineralization and rehardening of the tooth surfaces.   A fluoride varnish is recommended. Enhance acid resistance. Apply fluoride in the office 2-4 times a year.

 Decrease abrasive forces.  Use soft toothbrushes and dentifrices low in abrasiveness in a gentle manner.  Provide mechanical protection. Do not brush teeth immediately after an acidic challenge to  the mouth. as the teeth will abrade easily.  .  Consider application of composites and direct bonding where appropriate to protect exposed dentin. Construction of an occlusal guard is recommended if a Bruxism habit is present. Rinsing with water is better than brushing immediately after an acidic challenge.

ABRASSION Derived from Latin verb ABRASUM meaning “ Scrape off ” .

 Imfeld T (1996)  Abrasion is the wearing of tooth substance that results from friction of exogenous material forced over the surface by incisive. 1998 . Abrasion is wearing away of tooth substance or structure through mechanical process. masticatory and grasping functions  Every (1972)  Loss by wear of dental tissue caused by abrasion by foreign substance  Milosevic.

nail biters. musicians  Proximal tooth abrasion due to improper flossing and use of tooth picks .The location and pattern of abrasion may be dependent on the cause  Most common area is cervical area. related to improper tooth brushing technique. zealous and vigorous methods. hair pin biting  Notching of incisors in Tailors.  Notching of incisal edges in pipe smokers. carpenters. and use of abrasive dentrifice.

Abrasion tends to round off or blunt tooth cusps or cutting edges. An abrasion area is generally not well defined unlike in attrition. it may be scooped out because it is softer than enamel. Where dentin is exposed.   PIPE SMOKERS .

Microscopically an abraded surface shows haphazardly oriented scratch marks and numerous pits . .  Tooth surface will have a pitted appearance.