Emerging techniques for the

analysis of tooth wear

DEPARTMENT OF FORENSIC ODONTOLOGY FACULTY OF DENTAL MEDICINE UNIVERSITAS AIRLANGGA

INTRODUCTION
INTRODUCTION

 Tooth wear can be caused by various mechanical and chemical

processes.

 ‘Attrition’ (bruxism or tooth grinding) and ‘abrasion’ (wear from foreign

bodies such as coarse food or tools) are mechanical wear processes.

 ‘Erosion’ refers to chemical demineralization of tooth structure without

bacterial involvement.
INTRODUCTION

 Severe abrasive wear was a common occurrence before agricultural

development and the industrial revolution, but is not a common
problem in modern humans

 Attrition is a universal wear mechanism in humans living both

industrialized and non-industrialized ways of life

 Erosive tooth wear has become a topic of growing interest in recent

decades
INTRODUCTION

 Changing patterns of tooth wear have been used extensively to obtain

information about the lifestyle and culture of pre-historic and modern
humans.

 The assessment of tooth wear in previous anthropological studies has

been largely based on quantitative analysis of wear indices and
qualitative analysis of micrographs
TRADITIONAL METHODS OF
ASSESSING TOOTH WEAR
Visual Examination & Wear Indices

Visual examination can provide qualitative information about the causes of

tooth wear and can reflect the lifestyle and occupation of pre-contemporary
populations, such as yarn production, weaving and basketry.

Numerous wear indices have been proposed to quantify gross wear features
in skeletal materials, living humans and dental models. For example, the
Smith and Knight (1984) index is commonly used to quantify the severity of
enamel and dentine wear in humans.
Visual Examination & Wear Indices

Visual examination and wear indices are non-destructive and can be used
directly on teeth or models.

However, wear indices can be subjective and have low reliability and
unsuitable in dietary reconstructions in anthropological studies
Microwear assessment

 Microwear features of wear facets in anthropological research are

commonly assessed by using scanning electron microscopy, typically at a
resolution of x40 to x500.

 Microwear features better reflect dietary regimes than macrowear features,

and are more useful in dietary reconstructions of primates and hominins

 Varying degrees of abrasive tooth wear are also associated with different
stages of human evolution.
Microwear assesment

 Some of the major disadvantages of micrographic assessment of tooth

wear are high subjectivity and low reliability, related to:

 microscopy settings

 scoring method

 intra and inter-examiner error

 quality of the micrograph

 EMERGING TECHNIQUES OF
TOOTH WEAR ASSESSMENT

There are some new methods that have been developed for tooth wear analysis, include a new wear index (Basic Erosive Wear
Examination (BEWE) Index to assess macro-wear on teeth), 3D surface profilometry (scanning confocal microscopy combined with
fractal analysis to assess microwear details), physical analytical techniques (nanohardness testing, micro-computed tomography
and nanocomputed tomography to assess physical wear characteristics at micro- and nano-levels), and chemical analytical
technique (mass spectrometry to assess surface changes in the first few atomic layers of teeth)
Basic erosive wear examination (BEWE) index

 BEWE index was proposed by Bartlett et al (2008)  to develop a

simple, valid, and repeatable tool to measure erosive tooth wear.

 Tooth wear is graded into 4 levels according to the degree of severity:

0 : no erosive tooth wear
1 : initial loss of tooth surface
2 : distinct defect, hard tissue loss < 50% of the surface area
3 : hard tissue loss ≥ 50% of the surface area, with scores of 2
and
3 often involving dentine
Basic erosive wear examination (BEWE) index

How to measure the BEWE index

1. Teeth are divided into six sextants (anterior teeth, left and right
posterior, in both maxillary & mandibular arches).

2. Score are assigned to each of the surfaces of each tooth in a sextant.

3. The highest score is recorded for the sextant

The cumulative scores are graded into four risk levels, including no risk (i.e.
cumulative score ≤ 2); low risk (cumulative score = 3-8); medium risk
(cumulative risk = 9-13) and high risk (cumulative risk ≥ 14)
 2
Example:
Sextant Erosion
Grade
1 3
1 3
2 2
3 3
4 3
5 1
6 3
Total 15

Conclusion : high risk of tooth erosion

6 4 (cumulative score > 14)

5
Basic erosive wear examination (BEWE) index

 Bartlett et al. (2008) also indicated that the BEWE index would be ideal
for screening subjects for erosive tooth wear research.

 BEWE index would be useful for anthropological studies on erosive tooth

wear, but some modification will be required to include the assessment of
attrition and abrasion.

 An international index specific for use in anthropological research would

enable consistency in data collection and facilitate comparisons by
different research groups throughout the world
Scanning confocal microscopy & fractal analysis

 This is essentially a three-dimensional (3D) profilometry method of

assessing tooth wear objectively and it overcomes some of the problems
relating to subjectivity with scanning electron microscopy.

 It is capable of conducting sophisticated mathematical calculations

compared with standard profilometry methods that quantify tooth wear
in the form of depth or volume loss.

 The characteristics of the worn surface were assessed by measuring

microwear complexity (i.e. surface roughness) and microwear
directionality (i.e. surface anisotropy).
Scanning confocal microscopy & fractal analysis

Confocal microscope
Scanning confocal microscopy & fractal analysis

 Overall, scanning confocal microscopy combined with fractal analysis

have been shown to be a powerful method to discriminate microwear
topographies between different diets. It has also been used to detect
wear patterns on stone tools used on different materials (for example,
hide, shell and wood)

 This method requires some training but is user friendly and is usually
more economical than most scanning electron microscopy analysis
Nanohardness testing

 The mechanical properties of tooth structure, including compressive and

tensile strengths at both macro- and micro-levels, provide information
about a tooth’s fracture resisting properties and have some relevance to
the understanding of tooth wear by attrition, abrasion, and erosion.

 Microhardness testing is a more reliable method in detecting the degree

of tooth softening by erosive demineralization and of hardness recovery
by remineralization
Nanohardness testing

 Nanohardness testing is relatively new method that has been used by

researchers to investigate biomechanical properties of sound tooth
structure, carious tooth structure, and eroded tooth structure.

 Nanohardness testing holds promise for anthropological studies of

erosion in modern humans.

 However, this is technically demanding and requires preparation of highly

polished, flat specimens.
Micro-CT and nano-CT

 Micro-computed tomography is a sensitive technique that uses high-

resolution x-ray slices of a hard material to create its three-dimensional
model.

 Micro CT can provide quantitative information on structural dimensions

and material density

 Although micro CT reconstruction can provide a high resolution surface

topography of an eroded surface, its resolution does not allow
reconstruction of softened zone associated with an erosion lesion.
Micro-CT and nano-CT

 Nano CT is a sophisticated technique and it is not surprising that the

sample preparation is highly expensive and technically demanding.

To scan a sample at a resolution of around 50nm, it has to be milled into a

cylindrical shape of around 50µm length and 20µm diameter.

 Although its application is limited to in vitro, it is likely to provide insights

into the fundamental mechanisms of tooth wear.
CONCLUSION
Conclusion

 Various methods are now available to investigate the physical and

chemical changes associated with tooth wear at the macro-, micro- and
nano-levels both quantitatively and qualitatively.

 The BEWE index is an internationally standardized, visual method

designed to assess macrochanges associated with erosive wear in clinical
situations.

 Some of the limitations with wear indices, including subjective

assessment, can be overcome by conducting objective assessment of
microwear details using three-dimensional profilometry (such as scanning
confocal microscopy combined with fractal analysis)
Conclusion

 Each method assesses a specific aspect of tooth wear, and one size does
not fit all.

 To address the limitations inherent in each method, a combined

assessment of tooth wear may be indicated depending on the scope of
the project.
DEPARTMENT OF FORENSIC ODONTOLOGY FACULTY OF DENTAL MEDICINE UNIVRSITAS AIRLANGGA