TEERTHANKER MAHAVEER DENTAL COLLEGE AND RESEARCH CENTRE

DEPARTMENT OF ORAL PATHOLOGY

:-Seminar Topic:-

REGRESSIVE ALTERATIONS OF THE TEETH

Guided by:Presented by Dr. Kunal shah Sharib ali khan

MDS BDS 3rd year

INTRODUCTION:

Regressive changes in the dental tissues include a variety of alterations that are not necessarily related either etiologically or pathologically. Some of the changes to be considered here are associated with the general aging process of the individual.

Others arise as a result of injury to the tissues. Still other regressive changes of teeth occur with such frequency that there is some doubt whether they should actually be considered pathologic.

ATTRITION, ABRASION AND EROSION
 Mechanical wear and tear of tooth substance is a consequence pathological situation. of means both and physiological therefore and different

adaptive strategies have evolved to tackle this

night grinding ). and producing immensely variable patterns degrees of wear. masticating food) or the use of teeth as ‘tools. each acting at different intensity and duration in a continuously hanging salivary medium.  These mechanisms most often occur together.g. effects of acid from various sources or from a highly acidic diet). A disease state arises when this delicate balance goes away resulting in early dissolution and loss of tooth substance with subsequent involvement of pulpal and periapical tissues.  These include abrasion resulting from the friction of exogenous material forced over tooth surfaces (e.  It is currently acknowledged that there are several mechanisms that contribute to there are several mechanisms that contribute to tooth wear. ‘ erosion resulting from the chemical dissolution of tooth surfaces (e.g. and attrition from tooth-to-tooth contact (e.g. ATTRITION .

 Attrition commences at the time contact or occlusion occurs between adjacent or opposing teeth. not other surfaces unless a very unusual occlusal relation or malocclusion exist. children may suffer from either dentinogenesis imperfecta or amelogenesis imperfecta. incisal. the more attrition is exhibited. and it is associated with the aging process. and proximal surfaces of teeth.  This phenomenon is physiologic rather than pathologic. however.”  This occurs only on the occlusal. as in mastication. and in both diseases . Definition:Attrition may be defined as. but severe attrition is seldom seen in primary teeth because they are not retained normally for any great period of time Occasionally.  The order a person becomes. “the physiologic wearing away of a tooth as a result of tooth-totooth contact.  It may be seen in the deciduous dention as well as in the permanent.

o Because of the slight mobility of the teeth in their sockets. there is gradual reduction in cusp height and consequent flattening of the occlusal inclined planes.pronounced attrition may result from ordinary masticatory stresses.  Clinical features o The first clinical manifestation of attrition may be the appearance of a small polished facet on a cusp tip or ridge or a slight flattening of an incisal edge. of a the manifestation periodontal of the resiliency ligament. o According to Robinson and his associates. . o As the person becomes older and the wear continues. there is also shortening of the length of the dental arch due to reduction in the mesiodistal diameters of the teeth through proximal attrition. similar facets occur at the contact points on the proximal surfaces of the teeth.

also are important in the etiology of severe attrition. o Men usually exhibit more severe attrition than women of comparable age. probably as a result of the greater masticatory force of men. in which the person is exposed to an atmosphere of abrasive dust and cannot avoid getting the material into his mouth.o Only minor variation in the hardness of tooth enamel exists between individuals. o Advanced attrition. . in which the enamel has been completely worn away in one or more areas. sometimes results in an extrinsic yellow or brown staining of the exposed dentin from food or tobacco. o Variation also may be a result of differences in the coarseness of the diet or of habits such as chewing tobacco or bruxism either of which would predispose to more rapid attrition. o Certain occupations. nevertheless considerable variation in the degree of attrition is observed clinically.

but this extreme degree is unusual even in elderly persons. In some cases the teeth may be worn down nearly to the gingiva. attrition may progress to the point of complete loss of cuspal interdigitation. o The rate of secondary dentin deposition is usually sufficient to preclude the possibility of pulp exposure through attrition alone. pulpal to the primary dentin. and this serves as an aid to protect the pulp from further injury. ABRASION  Definition:Abrasion is the pathologic wearing away of tooth substance through some abnormal mechanical process. . o The exposure of dentinal tubules and the subsequent irritation of odontoblastic processes result in formation of secondary dentin .o Provided there is no premature loss of the teeth.

 Abrasion usually occurs on the exposed root surfaces of teeth. but under certain circumstances it may be seen elsewhere. such as on incisal or proximal surfaces.  Although modern dentifrices are not sufficiently abrasive to damage intact enamel severely. in teeth with some gingival . • Clinical features:o Abrasion caused by a dentifrice manifests itself usually as a V-shaped or wedge-shaped ditch on the root side of the cementoenamel junction recession. particularly in a horizontal rather than vertical direction.  Robinson stated that the most common cause of abrasion of root surfaces is the use of an abrasive dentifrice. they can cause remarkable wear of cemented and dentin if the toothbrush carrying the dentifrice is injudiciously used.

and a 66 per cent incidence of abrasion among 1252 patients examined was reported by Ervin and Bucher. which also should be considered a form of abrasion. and vice versa. . is a rather sharp one. shoemakers. as well as that at the enamel edge. o Abrasion was more common on the left side of the mouth in right-handed people. o It has been shown by Kitchin and by Ervin and Bucher that some degree of tooth root exposure is a common clinical finding. suggested that improper tooth brushing caused abrasion.o The angle formed in the depth of the lesion. their teeth. Habitual pipe smokers may develop the pipe stem o The improper may use of dental floss on and the toothpicks produce lesions proximal exposed root surface. and the exposed dention appears highly polished. o The habitual opening of bobby pins with the teeth may result in a notching of the incisal edge of one maxillary central incisor o Similar notching may be noted in carpenters.

EROSION . o Unless the form of abrasion is an extremely severe and rapidly progressive one. the rate of secondary dentin formation is usually sufficient to protect the tooth against pulp exposure. o The loss of tooth substance that occurs by one means or another is certainly pathologic but should present no problem in diagnosis o The exposure of dentinal tubules and the consequent irritation of the odontoblastic processes stimulate the formation of secondary dentin similar to that seen in cases of attrition.o It is apparent that pathogenesis under these different conditions is essentially identical.

g. vomiting) or extrinsic sources (e. which also consists of attrition. Definition:Dental erosion is defined as.  There could be either extrinsic or intrinsic sources of acid that could cause this mode of tooth substance loss.  This form of tooth surface loss is part of a large picture of tooth wear.  Dissolution of mineralized tooth structure occurs upon contact with acids that are introduced into the oral cavity from intrinsic (e. abrasion and possibly abfraction. CAUSES Extrinsic causes. gastroesophageal reflux. citrus fruits).g. . “irreversible loss of dental hard tissue by a chemical process that does not involve bacteria”. acidic beverages. :  Erosion of tooth substance is mainly due to contact with acidic media either by way of food stuff or by iatrogenic exposure.

may lessen erosive potential .  Several studies have found that the frequency of consumption of acidic drinks was significantly higher is patients with erosion than without. .  The erosive potential of beverages does not depend on pH alone.acidic.  With consumption of acidic drinks identified as a risk factor in erosion. Examples of extrinsic acids.  Also. factors such as frequency and method of intake of acidic beverages as well as the tooth brushing frequency after intake may influence susceptibility to erosion. phosphates.  This finding is of concern. and fluoride. (Source outside the body ) are acidic beverages. medications or environmental acids.  The most common of these are dietary acids. particularly since children and adolescents are the primary consumers of these drinks. this amount of soft drink consumption will likely lead to an increase in prevalence of erosion. foods. Other components of beverages. It can be seen that most fruits and fruit juices have a very low pH (high acidity). such as calcium.

Dental erosion has been reported in swimmers who work out . the role of confounders like oral hygiene status.  Chromic.  Medications that the acidic in nature can also cause erosion via direct contact with the teeth when the medication is chewed or held in the mouth prior to swallowing. hydrochloric. complicate the role of acids per se which necessitates further investigation to clarify the relationship between acidic beverage intake and dental erosion.  However current work safety standards make this type of erosion very rare.  They are released into the work environment during industrial electrolytic processes.  Numerous case reports exist describing extensive erosion secondary to chewing vitamin C preparations or hydrochloric acid supplements. Less common sources of extrinsic erosive acids are related to occupational and recreational exposure. Therefore. sulfuric and nitric acids have been identified as erosion-causing acid vapors.

inappropriate relaxation of the lower esophageal .regularly in pools with excessive acidity as well as individuals who are occupational wine-tasters.  This is caused by increased abdominal pressure. with pH levels that can be less than 1. INTRINSIC CAUSES  Intrinsic causes (acid source inside the body).  The association of gastroesophageal reflux disease (GERD) with dental erosion has been established in a number of studies in adults is a common condition estimated to affect 7 %of the adult population on a daily basis and 36 % at least one time a month. for erosion are gastric acids regurgitated into the esophagus and mouth.  In this condition gastric contents pass involuntarily into the esophagus and can escape up into the mouth.  Gastric acids. reach the oral cavity and come in contact with the teeth in conditions such as gastroesophageal reflux and exessive vomiting related to eating disorders.

GERD can also be silent with the patient unaware of his or her condition until dental changes elicit assessment for the condition. . pregnancy. diabetes or nervous system disorders.  Chronic.sphincter or increased acid production by the stomach.  The patient with an eating disorder such as anorexia example. Other causes of vomiting that may cause erosion include gastrointestinal disorders such as peptic ulcers or gastritis.  Erosion associated with alcoholism is caused by frequent vomiting. the cause of erosion cannot be reliably determined from its location.  nervosa or bulimia is the classic The addition. treatment for bulimia may include use of antidepressants or other psychoactive medications hypofunction.  However. drug side effects. excessive vomiting has long been recognized as causing erosion of the teeth. that may cause salivary  Therefore.

salivary flow rate increases.SALIVA AS A MODIFYING FACTOR.  minutes. when an acid enters the mouth. buffering capacity and flow rate increases.  The fluctuations in pH of saliva are mainly kept in balance by the buffering capacity of saliva. Therefore.  Within normal.  Normally. whether from an intrinsic or extrinsic source. along with pH and buffer capacity. there is a relationship between salivary pH. the acid is neutralized and cleared from the oral cavity and the pH returns to Patients with erosion were found to have lower salivary buffer capacity when compared with controls in several studies.  Bicarbonate concentration also regulates salivary pH. .  This property is largely due to the bicarbonate content of the saliva which is in turn dependent on the salivary flow rate.

both whole and stimulated.  Therefore. RISK FACTORS FOR DENTAL EROSION   Soft drinks consumed (4-6 or more per week) Eating disorder (weekly or more often)  Bruxism habit  Whole saliva unstimulated flow rate (0.  Since many common medications and diseases can lower salivary flow rate (xerostomia). it is important to assess salivary characteristics when evaluating a patient with erosion. In other studies. low whole salivary flow rates in patients with erosion were determined to be the major difference.1ml/min)  Sports drinks intake (weekly or more often)   Excessive attrition Vomiting Symptoms or history of gastroesophageal reflux disease . salivary function is an important factor in the etiology of erosion.

 If excessive dietary intake of acidic foods or beverages is discovered.PREVENTION OF PROGRESSION OF EROSION  Diminish the frequency and severity of the acid challange  Enhance the defense mechanisms of the body (increase salivary flow and pellicle formation  Enhance acid resistence. patient education and counseling are important. .remineralization and rehardening of the tooth surfaces  Improve chemical protection  Decrease abrasive forces  Provide mechanical protection  Moniter stability MANAGEMENT OF EROSION  Treatment of the etiology.  Identification of the etiology is important as a first step in management of erosion .

such as the problem of alcoholism. the etiologic agent may be difficult to control.  In some cases.  The use of oral pilocarpine (Salagen) may be beneficial in patients with dry mouth caused by Sjogren’s syndrome or post-therapeutic head and neck radiation.  A patient with salivary hypofunction may benefit with the use of sugarless chewing gum of mints to increase residual salivary flow. There are several preventive measures that can be taken to control tooth erosion.  Much of erosion prevention depends on the compliance of the patient with dietary .  A patient suspected of an eating disorder should be referred to a medical doctor for evaluation. regardless of the cause.  In other cases. then he/she should be referred to a medical doctor for complete evaluation and institution of therapy if indicated. an etiologic agent is not identifiable. However. If the patient has symptoms of GERD. it is important to follow preventive measures to prevent the progress of erosion.

use of topical fluorides. . etc. use of occlusal splints.modification.

.BIBILOGRAPHY:- Robinson HBG. Rudolph CE A Comparative study in root resumption in permanent teeth J am Dent Assoc. Attrition and erosion of the tteth. Health Center j Ohio State Univ. 23:822. 3:21.1936. 1949. Abrasion.