Tooth wear: Difference between revisions

'''Tooth wear''' refers to loss of [[tooth]] substance by means other than [[dental caries]].<ref name="ReferenceB">{{cite journal | vauthors = Kaidonis JA | title = Oral diagnosis and treatment planning: part 4. Non-carious tooth surface loss and assessment of risk | journal = British Dental Journal | volume = 213 | issue = 4 | pages = 155–61 | date = August 2012 | pmid = 22918343 | doi = 10.1038/sj.bdj.2012.722 | url = | doi-access = free }}</ref> Tooth wear is a very common condition that occurs in approximately 97% of the population.<ref name="ReferenceA">{{cite journal | vauthors = Suchetha A | year = 2014 | title = Tooth Wear -— A Literature Review | url = | journal = Indian Journal of Dental Sciences | volume = 5 | issue = 6| pages = 116–120 }}</ref> This is a normal physiological process occurring throughout life; but with increasing lifespan of individuals and increasing retention of teeth for life, the incidence of non-carious tooth surface loss has also shown a rise.<ref name="ReferenceC">{{cite journal | vauthors = Bhushan J, Joshi R | year = 2011 | title = Tooth Wear -— An Overview With Special Emphasis On Dental Erosion | url = | journal = Indian Journal of Dental Sciences | volume = 5 | issue = 3| page = 89 }}</ref> Tooth wear varies substantially between people and groups, with extreme attrition and [[enamel fracture]]s common in archaeological samples, and [[Acid erosion|erosion]] more common today.<ref name="ReferenceC" /><ref>{{Cite journal|lastlast1=Towle|firstfirst1=Ian|last2=Irish|first2=Joel D.|last3=Groote|first3=Isabelle De|date=2017|title=Behavioral inferences from the high levels of dental chipping in Homo naledi|journal=American Journal of Physical Anthropology|language=en|volume=164|issue=1|pages=184–192|doi=10.1002/ajpa.23250|pmid=28542710|s2cid=24296825 |issn=1096-8644|url=http://researchonline.ljmu.ac.uk/6367/3/Towle%20et%20al%20Homo%20naledi%20chipping%20%282%29.pdf}}</ref><ref>{{Cite journal|last=Smith|first=B. Holly|date=1984|title=Patterns of molar wear in hunter–gatherers and agriculturalists|journal=American Journal of Physical Anthropology|language=en|volume=63|issue=1|pages=39–56|doi=10.1002/ajpa.1330630107|pmid=6422767|issn=1096-8644|hdl=2027.42/37625|url=https://deepblue.lib.umich.edu/bitstream/2027.42/37625/1/1330630107_ftp.pdf|hdl-access=free}}</ref>

Tooth wear is majorlypredominantly the result of a combination of three processes; [[attrition (dental)|attrition]], [[Abrasion (dental)|abrasion]] and [[Erosion (dental)|erosion]].<ref name="ReferenceC"/> These forms of tooth wear can further lead to a condition known as [[abfraction]],<ref name="ReferenceC"/> where by tooth tissue is 'fractured' due to stress lesions caused by extrinsic forces on the enamel. Tooth wear is a complex, multi-factorial problem and there is often difficulty identifying a single causative factor.<ref name="ReferenceC"/> However, tooth wear is often a combination of the above processes. Many clinicians, therefore, make diagnoses such as "tooth wear with a major element of attrition", or "tooth wear with a major element of erosion" to reflect this. This makes the diagnosis and management difficult.<ref name="ReferenceB"/> Therefore, it is important to distinguish between these various types of tooth wear, provide an insight into diagnosis, risk factors, and causative factors, in order to implement appropriate interventions.<ref name="ReferenceB"/> ToothewearTooth indexwear canevaluation providesystem checklists(TWES) tomay help determine the most likely diagnosisaetiology of tooth wear.<ref>{{Cite journal|lastlast1=Wetselaar|firstfirst1=P.|last2=Lobbezoo|first2=F.|date=January 2016|title=The tooth wear evaluation system: a modular clinical guideline for the diagnosis and management planning of worn dentitions|url=http://doi.wiley.com/10.1111/joor.12340|journal=Journal of Oral Rehabilitation|language=en|volume=43|issue=1|pages=69–80|doi=10.1111/joor.12340|pmid=26333037}}</ref> Heavy tooth wear is usuallycommonly found on the occlusal (chewing) surface, but [[non-carious cervical lesions]] from tooth wear are also common in some populations.<ref name="sciencedirect.com">{{Cite journal|date=2018-09-01|title=Root grooves on two adjacent anterior teeth of Australopithecus africanus|journal=International Journal of Paleopathology|language=en|volume=22|pages=163–167163–7|doi=10.1016/j.ijpp.2018.02.004|pmid=30126662|issn=1879-9817|last1=Towle|first1=Ian|last2=Irish|first2=Joel D.|last3=Elliott|first3=Marina|last4=De Groote|first4=Isabelle|s2cid=52056962|url=http://researchonline.ljmu.ac.uk/id/eprint/8352/1/Root%20groove%20article%20JDI.pdf}}</ref>

Multiple indices have been developed in order to assess and record the degree of tooth wear, the earliest was that by [[Paul Broca]].<ref name=":0">{{cite journal | vauthors = López-Frías FJ, Castellanos-Cosano L, Martín-González J, Llamas-Carreras JM, Segura-Egea JJ | title = Clinical measurement of tooth wear: Tooth wear indices | journal = Journal of Clinical and Experimental Dentistry | volume = 4 | issue = 1 | pages = e48–53 | date = February 2012 | pmid = 24558525 | pmc = 3908810 | doi = 10.4317/jced.50592 }}</ref> In 1984, Smith and Knight developed the tooth wear index (TWI) where four visible surfaces (buccal, cervical, lingual, occlusal-incisal) of all teeth present are scored for wear, regardless of the cause.<ref name=":0" /> A more recent index Basic Erosive Wear Examination (BEWE) from 2008 by Bartlett et al., is now also in use.<ref name=":1">{{cite book | title=Erosive tooth wear : from diagnosis to therapy | last1 = Lussi | first1 = Adrian | last2 = Ganss | first2 = Carolina | name-list-formatstyle = vanc |isbn=9783318025538978-3-318-02553-8|edition=2nd | volume = 20 |publisher=Karger |location=Basel|oclc=875630033| date = 2014-06-24 }}</ref>

[[Abrasion (dental)|Abrasion]] is loss of tooth substance caused by physical means other than teeth.<ref name="Odell 2010" /> The term is derived from the Latin verb ''abrasum'', which means ‘to scrape off’.<ref name="ReferenceA"/> It tends to present as rounded ditching around the [[cervical margins]] of teeth, commonly described as ‘shallow’, concave or wedge shaped notches.<ref name="ReferenceB"/> Causative factors have been linked to this condition and include vigorous, horizontal [[tooth brushing]], using [[toothpaste]] with a toorelatively high [[Relative dentin abrasivity|RDA]] value (above 250),<ref>{{Citation|last1=Shellis|first1=R. Peter|title=The Interactions between Attrition, Abrasion and Erosion in Tooth Wear|date=2014|url=https://www.karger.com/Article/FullText/359936|journal=Monographs in Oral Science|volume=25|pages=32–45|editor-last=Lussi|editor-first=A.|place=Basel|publisher=Karger |doi=10.1159/000359936|isbn=978-3-318-02552-1|access-date=2021-07-23|last2=Addy|first2=Martin|pmid=24993256|editor2-last=Ganss|editor2-first=C.|author-link2=Martin Addy}}</ref> [[pipe smoking]] or [[nail biting]]. It has also been shown that improper use of [[dental floss]] or [[Toothpicks]] can lead to wear on the interproximal (in-between) surfaces of the teeth.<ref name="ReferenceA"/>

[[Erosion (dental)|Erosion]] is chemical [[Dissolution (chemistry)|dissolution]] of tooth substance caused by acids, unrelated to the acid produced by bacteria in dental plaque.<ref name="ReferenceB"/> Erosion may occur with excessive consumption of acidic foods and drinks, or medical conditions involving repeated regurgitation and reflux of gastric acid.<ref name="Odell 2010">{{cite book|editor-last=Odell EW (Editor)|title=Clinical problem solving in dentistry|year=2010|publisher=Churchill Livingstone|location=Edinburgh|isbn=9780443067846978-0-443-06784-6|pages=285–287285–7|edition=3rd}}</ref> It is derived from the Latin word ''erosum'', which describes the action ‘to [[corrode]]’.<ref name="ReferenceA"/> This is usually on the palatal (inside) surfaces of upper front teeth and the occluding (top) surfaces of the [[Molar (tooth)|molar]] teeth.<ref>{{Cite web |title=Dental Erosion {{!}} American Dental Association |url=https://www.ada.org/resources/ada-library/oral-health-topics/dental-erosion |access-date=2024-04-19 |website=www.ada.org}}</ref> Dental erosion is rarely seen in the archaeological record, but certain cases have been described suggestingwhich suggested acidic fruits and/or plants were regularly consumed.<ref name="sciencedirect.com"/>

* [[Eructation]] (burping){{mcnmedcn|date=May 2015}}

* Dietary -— liquids of low pH and high titratable acids.

[[Abfraction]] is a form of noncerious cervical lesion, where there is a loss of tooth substance at the [[cervical margins]], purportedly caused by minute flexure of teeth under occlusal loading. This occlusal loading is one factor that interacts with chemical, biological,and behavioral factors in which result in this abfraction. <ref>{{cite journal | vauthors =Nascimento Sarode GSMM, SarodeDilbone SCDA, |Pereira titlePN, =Duarte Abfraction:WR, AGeraldeli reviewS, |Delgado journalAJ |title=Abfraction Journallesions: ofetiology, Oraldiagnosis, and Maxillofacialtreatment Pathologyoptions |journal=Clin volumeCosmet =Investig 17Dent |volume=8 |issue = 2 | pages = 222–779–87 | date = May 20132016 | pmid = 2425008327217799 | pmc = 38302314861607 | doi = 10.41032147/0973-029XCCIDE.119788S63465 |doi-access=free}}</ref> The term is derived from the Latin words ''ab'' and ''functio'' meaning ‘away’ and ‘breaking’ respectively.<ref name="ReferenceA"/> Abfraction presents as triangular [[lesions]] along the [[cervical margins]] of the [[buccal space|buccal]] surfaces of the teeth where the enamel is thinner and therefore, in the presence of occluding forces, is prone to fracture.<ref name="ReferenceB"/> Whether abfraction exists or not is debated.

The Basic Erosive Wear Examination was first described in 2008 by Bartlett et al. in 2008.<ref name=":3" /> The partial scoring system is based on the surface area affected. Within a sextant (i.e. teeth in mouth divided into 6 parts), the most severely affected tooth surface (buccal, occlusal or lingual/palatal)(see [[dental terminology]]) is recorded according to the severity of the wear (see Table 1). A cumulative score is then matched to a risk level and guidance for its management by a clinician. The management includes steps which identify and eliminate main aetiological factors, preventative treatment and also any operative and symptomatic intervention required by the patient. The frequency of repeating the index ranges from 6–12 months depending on the risk level of patients.<ref name=":3">{{cite journal | vauthors = Bartlett D, Ganss C, Lussi A | title = Basic Erosive Wear Examination (BEWE): a new scoring system for scientific and clinical needs | journal = Clinical Oral Investigations | volume = 12 Suppl 1 | issue = Suppl 1 | pages = S65–8 | date = March 2008 | pmid = 18228057 | pmc = 2238785 | doi = 10.1007/s00784-007-0181-5 }}</ref>

The Tooth Wear Index (TWI) (see Table 2) was developed by Smith and Knight in 1984. TWI scores each visible surface (buccal/B, cervical/C, lingual/L and occlusal-incisal/O/I) (see [[dental terminology]]).<ref>{{cite journal | vauthors = Smith BG, Knight JK | title = An index for measuring the wear of teeth | journal = British Dental Journal | volume = 156 | issue = 12 | pages = 435–8 | date = June 1984 | pmid = 6590081 | doi = 10.1038/sj.bdj.4805394 | s2cid = 35419496 }}</ref> This index has been widely used in epidemiological studies.<ref>{{cite journal | vauthors = Bardsley PF | title = The evolution of tooth wear indices | journal = Clinical Oral Investigations | volume = 12 Suppl 1 | pages = S15–9 | date = March 2008 | issue = Suppl 1 | pmid = 18228055 | pmc=2238784| doi = 10.1007/s00784-007-0184-2 | doi-access = free }}</ref>

* Modified TWI <ref>{{Cite journal|lastlast1=Millward|firstfirst1=A.|last2=Shaw|first2=L.|last3=Smith|first3=A. J.|last4=Rippin|first4=J. W.|last5=Harrington|first5=E.|date=September 1994|title=The distribution and severity of tooth wear and the relationship between erosion and dietary constituents in a group of children|journal=International Journal of Paediatric Dentistry|volume=4|issue=3|pages=151–157151–7|issn=0960-7439|pmid=7811669|doi=10.1111/j.1365-263X.1994.tb00124.x}}</ref>

* Linkosalo and Markkanen <ref>{{Cite journal|lastlast1=Linkosalo|firstfirst1=E.|last2=Markkanen|first2=H.|date=October 1985|title=Dental erosions in relation to lactovegetarian diet|journal=Scandinavian Journal of Dental Research|volume=93|issue=5|pages=436–441|issn=0029-845X|pmid=3864217|doi=10.1111/j.1600-0722.1985.tb01336.x}}</ref>

* O'Brien Index <ref>{{Cite book|title=Children's dental health in the United Kingdom, 1993 : a survey carried out by the Social Survey Division of OPCS, on behalf of the United Kingdom health departments, in collaboration with the Dental Schools of the Universities of Birmingham and Newcastle|last=Maureen.|first=O'Brien|date=1994|publisher=H.M.S.O|others=Great Britain. Office of Population Censuses and Surveys. Social Survey Division., University of Birmingham. Dental School., University of Newcastle upon Tyne. Dental School.|isbn=978-0116916075|location=London0-11-691607-5 |oclc=32250617}}</ref>

* Lussi Index <ref>{{Cite journal|last=Lussi|first=A.|date=April 1996|title=Dental erosion clinical diagnosis and case history taking|journal=European Journal of Oral Sciences|volume=104|issue=2 ( Pt 2)|pages=191–198191–8|issn=0909-8836|pmid=8804886|doi=10.1111/j.1600-0722.1996.tb00067.x}}</ref>

* O'Sullivan Index <ref>{{Cite journal|last=O’Sullivan|first=EA|date=2000|title=A new index for the measurement of erosion in children|url=|journal=Eur J Paediatr Dent|volume=1|pages=69–74|via=}}</ref>

* Simplified Tooth Wear Index (STWI) <ref>{{Cite journal|lastlast1=Bardsley|firstfirst1=P. F.|last2=Taylor|first2=S.|last3=Milosevic|first3=A.|date=2004-10-09|title=Epidemiological studies of tooth wear and dental erosion in 14-year-old children in North West England. Part 1: The relationship with water fluoridation and social deprivation|journal=British Dental Journal|volume=197|issue=7|pages=413–416413–6; discussion 399|doi=10.1038/sj.bdj.4811722|issn=0007-0610|pmid=15475904|s2cid=2186540}}</ref>

* Exact Tooth Wear Index <ref>{{Cite journal|lastlast1=Fares|firstfirst1=J.|last2=Shirodaria|first2=S.|last3=Chiu|first3=K.|last4=Ahmad|first4=N.|last5=Sherriff|first5=M.|last6=Bartlett|first6=D.|date=2009|title=A new index of tooth wear. Reproducibility and application to a sample of 18- to 30-year-old university students|journal=Caries Research|volume=43|issue=2|pages=119–125|doi=10.1159/000209344|issn=1421-976X|pmid=19321989|s2cid=46065628}}</ref>

* Visual Erosion Dental Examination (VEDE) <ref>{{Cite journal|lastlast1=Mulic|firstfirst1=A.|last2=Tveit|first2=A. B.|last3=Wang|first3=N. J.|last4=Hove|first4=L. H.|last5=Espelid|first5=I.|last6=Skaare|first6=A. B.|date=2010|title=Reliability of two clinical scoring systems for dental erosive wear|journal=Caries Research|volume=44|issue=3|pages=294–299294–9|doi=10.1159/000314811|issn=1421-976X|pmid=20516691|hdl=10852/34967|s2cid=21372549|hdl-access=free}}</ref>

* Evaluating Index of Dental Erosion (EVIDE) <ref>{{Cite journal|lastlast1=Margaritis|firstfirst1=Vasileios|last2=Mamai-Homata|first2=Eleni|last3=Koletsi-Kounari|first3=Haroula|last4=Polychronopoulou|first4=Argy|date=January 2011|title=Evaluation of three different scoring systems for dental erosion: a comparative study in adolescents|journal=Journal of Dentistry|volume=39|issue=1|pages=88–93|doi=10.1016/j.jdent.2010.10.014|issn=1879-176X|pmid=21035516}}</ref>

Once the cause of tooth wear has been identified and a preventative regime has been put in place, the patient should be reviewed for 6–12 months to establish that the intervention has been successful before any active management is carried out. Once this has been achieved a decision needs to be made whether or not it is necessary to carry out [[Restorative dentistry|restorative]] treatment or if it can simply be managed by non -invasive methods.<ref>{{Cite journal|lastlast1=Mehta|firstfirst1=S. B.|last2=Banerji|first2=S.|last3=Millar|first3=B. J.|last4=Suarez-Feito|first4=J.-M.|date=January 2012|title=Current concepts on the management of tooth wear: part 1. Assessment, treatment planning and strategies for the prevention and the passive management of tooth wear|journal=British Dental Journal|volume=212|issue=1|pages=17–27|doi=10.1038/sj.bdj.2011.1099|pmid=22240686|issn=1476-5373|doi-access=free}}</ref>

Where restorative treatment is necessary, it must be decided whether to conform to the existing occlusion (typically for moderate wear, where only a few teeth are affected) or reorganise the occlusion (severe wear, unstable occlusion). Where the occlusion is reorganised, thisit can first be tested using a reversible method (i.e. a hard occlusal splint). A decision is made after full occlusal assessment including assessment of contacts in [[Occlusion (dentistry)|intercuspal position (ICP)]] and [[Occlusion (dentistry)|retruded contact position (RCP)]] as well as analysing casts articulated in a [[Articulator|semi-adjustable articulator]] to use for a diagnostic wax up of any proposed restorative work.<ref>{{Cite journal|lastlast1=Mehta|firstfirst1=S. B.|last2=Banerji|first2=S.|last3=Millar|first3=B. J.|last4=Suarez-Feito|first4=J.-M.|date=February 2012|title=Current concepts on the management of tooth wear: part 3. Active restorative care 2: the management of generalised tooth wear|journal=British Dental Journal|volume=212|issue=3|pages=121–127121–7|doi=10.1038/sj.bdj.2012.97|pmid=22322760|issn=1476-5373|doi-access=free}}</ref>

Active restorative management depends upon the location of the wear (localised or generalised), the severity of the wear, and the patient's [[Vertical dimension of occlusion|occlusal vertical dimension (OVD)]], which may have changed as a result of tooth wear. There are three different potential scenarios. of tooth wear:<ref name=":2">{{Cite journal|lastlast1=Dyer|firstfirst1=K.|last2=Ibbetson|first2=R.|last3=Grey|first3=N.|date=April 2001|title=A question of space: options for the restorative management of worn teeth|journal=Dental Update|volume=28|issue=3|pages=118–123|issn=0305-5000|pmid=11819971|doi=10.12968/denu.2001.28.3.118}}</ref>

# excessiveExcessive wear with loss of OVD

# excessiveExcessive wear without loss of OVD but with space available

# excessiveExcessive wear without loss of OVD but with limited space available

TypeScenario 1 is relatively common, whereas typescenario 2 is quite rare and tends to occur when the wear is rapidly occurring. TypeScenario 3 occurs due to a phenomenon called [[dentoalveolar compensation]] whereby the dentoalveolar tissues compensate for wear of teeth by increasing the bony support in order to maintain a constant OVD. This makes things difficult as there is no room to build the teeth back up to their original height without increasing the OVD.<ref name=":2" />

The options for restoring this loss in tooth height are the following: <ref>{{Cite journal|last=Ibbetson|first=R|date=June 1999|title=tooth surface loss: Treatment planning|journal=British Dental Journal|volume=186|issue=11|pages=552–558552–8|doi=10.1038/sj.bdj.4800167|pmid=10405470|s2cid=11008538|issn=1476-5373}}</ref>

# increasingIncreasing the OVD -— this is the traditional approach and involves restoring all teeth to an increased height in order to create a new ICP at an increased OVD

# occlusalOcclusal adjustment -— this is typically used for anterior teeth only, whereby the patient's occlusion is reorganised into the RCP position to utilise increased space in this position

# [[crownCrown lengthening]] or orthodontic extrusion -— this is useful when crowns are to be placed in a worn dentition but there is inadequate crown height and you do not want to change the OVD

# relativeRelative axial tooth movement -— this is the most commonly used method and can be used for localised or generalised wear, the idea is to prop the bite open thereby causing the extrusion of worn teeth to provide extra crown height for restoration, this can be done using simple direct restorations or more complex indirect restorations, this idea was first established by Dahl and is often referred to as the [[Dahl effect]]