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Tooth wear is predominantly 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"/> Tooth wear evaluation system (TWES) may help determine the most likely aetiology of tooth wear.<ref>{{Cite journal|last1=Wetselaar|first1=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 commonly 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=163–7|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-style = vanc |isbn=
==Causes==
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===Erosion===
[[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|title=Clinical problem solving in dentistry|year=2010|publisher=Churchill Livingstone|location=Edinburgh|isbn=
* [[Gastroesophageal reflux disease]] (GERD)
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* Modified TWI <ref>{{Cite journal|last1=Millward|first1=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=151–7|issn=0960-7439|pmid=7811669|doi=10.1111/j.1365-263X.1994.tb00124.x}}</ref>
* Linkosalo and Markkanen <ref>{{Cite journal|last1=Linkosalo|first1=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=
* 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=191–8|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|journal=Eur J Paediatr Dent|volume=1|pages=69–74}}</ref>
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