Current concepts on the management of tooth wear: part 3. Active restorative care 2: the management of generalised tooth wear

Paper 3 of this series on the current concepts of tooth wear management will focus on the provision of active restorative intervention for cases presenting with generalised tooth wear. The use of both contemporary adhesive and traditional conventional techniques applied to treat cases of generalised tooth wear will be discussed, including a consideration of the merits and drawbacks of each approach respectively.     

Current concepts on the management of tooth wear: part 4. An overview of the restorative techniques and dental materials commonly applied for the management of tooth wear

This final article of the four part series on the current concepts of tooth wear will provide the reader with an evaluation of the data available in the contemporary literature with regards to the survival analysis of differing restorative materials, and their respective methods of application to treat tooth wear. It is vital that the dental operator is familiar with the role of differing materials which may be used to restore the worn dentition, some of which may prove to be more suitable for the management of particular patterns of tooth wear than others. The active management of tooth wear unfortunately commits the patient to a lifelong need for considerable maintenance, and it is imperative that this is understood from the outset.     

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

The aim of this series of four articles on tooth wear management is to provide the reader with the necessary information in order to be able to successfully manage cases of tooth wear, regardless of the cause, severity and location of the wear pattern seen. The content will largely focus on contemporary clinical techniques, illustrated where possible by case examples. Emphasis will be placed on 'additive adhesive techniques' utilising fixed prosthodontic protocols; however, cases of tooth wear amongst partially dentate patients involving the use of removable prostheses will also be described. The importance of patient consent and contingency planning will also be discussed. Paper 1 will describe the assessment of the wear patient, including the rationale for the planning of dental care. Also discussed will be the administration of preventative and passive management strategies for cases displaying tooth wear.     

Repair of tooth wear; restorative-prosthetic aspects

Tooth wear is considered to be the third major threat to dental health in the industrialized parts of the world next to caries and periodontal disease. Bruxism can be a cause for excessive tooth wear. Thanks to the successes in the prevention and early treatment of the infectious dental diseases, dentitions last longer as result of which tooth wear is becoming more and more of a problem in the preservation of a physiologic dentition throughout live. Furthermore there seems to be an increasing tendency for the occurrence of severe tooth wear at very early ages. Early recognition of possible contributing factors for tooth wear by the dental team is of utmost importance to enhance success in treating the problem. Prevention of ongoing damage to the remaining tooth structure must be the starting point of every treatment plan. Repair of tooth wear is in many cases a challenge from a restorative/prosthetic perspective: esthetic and phonetic aspects play an important role along with the restorative and prosthetic choices as well as functional considerations the clinician has to deal with.     

A model for the prediction of tooth wear in individuals

BACKGROUND: Easily applied, age-specific standards are useful in assisting clinicians to decide whether the extent of tooth wear observed in a given patient at a specific age is acceptable or whether intervention is indicated. METHOD: A simple method of scoring tooth wear and previously established mathematical relationships between tooth wear scores and age, provide the basis of a method for predicting tooth wear scores. In its most specific form, the method can be used to predict tooth wear scores for individual patients at subsequent ages. Alternatively, tables or graphs can be consulted to provide a less precise prediction of tooth wear that can assist clinicians to decide whether the amount of wear reflects high, moderate or low rates of wear at the specified age. CONCLUSION: In cases where there is no reason to believe that aetiological factors have changed significantly over time, data obtained from the methods described can assist clinicians to plan appropriate management for patients presenting with unacceptable levels of tooth wear.     

Differential wear of teeth and restorative materials: clinical implications

PURPOSE: This study reviewed the wear of commonly used dental restorative materials and their effects on the opposing dentition. MATERIALS AND METHODS: Key words were used with PubMed to retrieve pertinent references to publications on tooth and restoration wear. RESULTS: The wear resistance of newer esthetic restorative materials has generally improved, and the damage caused by several materials to the opposing dentition has been reduced. However, the different structures and physical properties of tooth substance and restorative materials will eventually lead to varying degrees of differential wear. The extent and rate of wear are influenced by many intraoral factors. CONCLUSION: Selection of restorative materials must be based on knowledge of their wear behavior and the individual needs of each patient. The lowest wear rates for restorations and the opposing dentition occur with metal alloys, machined ceramics, and microfilled and microfine hybrid resin composites.     

Understanding wear in dentistry

Tooth wear is an increasing problem in dentistry. Traditionally, it has been divided into three categories: abrasion, attrition, and erosion. However, most clinical cases of tooth wear involve more than one of these processes. It is often easier to make a diagnosis by looking for the signs of the fundamental wear processes rather than trying to categorize the individual case. Wear can be caused by direct surface-to-surface wear, an intervening slurry, or a corrosive environment. Wear occurs during mastication, but also at other times, often at night. Although it may be possible to institute a preventive regimen, this will not always help the patient if his or her prime concern is esthetics. The same processes that cause tooth wear will cause wear to restorative materials. To diagnose and prevent wear, its processes must be understood.     

The tooth wear evaluation system: a modular clinical guideline for the diagnosis and management planning of worn dentitions

Tooth wear is a multifactorial condition, leading to the loss of dental hard tissues, viz. enamel and dentine. Tooth wear can be divided into the subtypes mechanical wear (attrition and abrasion) and chemical wear (erosion). Because of its multifactorial aetiology, tooth wear can manifest itself in many different representations, and therefore, it can be difficult to diagnose and manage the condition. A systematic approach is a sine qua non. In the below‐described tooth wear evaluation system (TWES), all necessary tools for a clinical guideline are present in different modules. This allows the dental clinician, in a general practitioner setting as well as in a referral practice setting, to perform a state‐of‐the‐art diagnostic process. To avoid the risk of a too cumbersome usage, the dental clinician can select only those modules that are appropriate for a given setting. The modules match with each other, which is indispensable and essential when different modules of the TWES are compared. With the TWES, it is possible to recognise the problem (qualifying), to grade its severity (quantifying), to diagnose the likely causes and to monitor (the progress of) the condition. In addition, a proposal for the classification of tooth wear is made. Further, it is possible to determine when to start a treatment, to make the decision which kind of treatment to apply and to estimate the level of difficulty of a restorative treatment.     

The oral medicine of tooth wear

This review illustrates, through a series of case histories, how oral medicine insights aid the diagnosis and management of patients with excessive tooth wear. The cases reviewed are drawn from the records of 500 southeast Queensland patients referred to the author over a 12 year period. Patients most at risk of dental erosion have work and sports dehydration, caffeine addiction, gastro-oesophageal reflux, asthma, diabetes mellitus, hypertension or other systemic diseases or syndromes that predispose to xerostomia. Saliva protects the teeth from the extrinsic and intrinsic acids which cause dental erosion. Erosion, exacerbated by attrition and abrasion, is the main cause of tooth wear. These cases illustrate that teeth, oral mucosa, salivary glands, skin and eyes should be examined for evidence of salivary hypofunction and attendant medical conditions. Based on comprehensive oral medicine, dietary analyses and advice, it would seem patients need self-management plans to deal with incipient chronic tooth wear. The alternative is the expensive treatment of pain, occlusal damage and pulp death required to repair the effects of acute severe tooth wear.     

Tooth wear: attrition, erosion, and abrasion.

Attrition, erosion, and abrasion result in alterations to the tooth and manifest as tooth wear. Each classification acts through a distinct process that is associated with unique clinical characteristics. Accurate prevalence data for each classification are not available since indices do not necessarily measure one specific etiology, or the study populations may be too diverse in age and characteristics. The treatment of teeth in each classification will depend on identifying the factors associated with each etiology. Some cases may require specific restorative procedures, while others will not require treatment. A review of the literature points to the interaction of the three entities in the initiation and progression of lesions that may act synchronously or sequentially, synergistically or additively, or in conjunction with other entities to mask the true nature of tooth wear, which appears to be multifactorial.     

The prevalence,etiology and management of tooth wear in the United Kingdom

Statement of problem. Recent epidemiologic evidence suggests that tooth wear is now a significant problem in both children and adults. There is growing evidence that a major cause of the severe wear in patients is regurgitation erosion due to a variety of factors including gastroesophageal reflux disease.Purpose. The purpose of this article is to discuss the prevalence of tooth wear in the United Kingdom. Emphasis in management should be on accurate diagnosis, and in some patients, long-term monitoring before embarking on any irreversible, interventive treatment. Even when treatment is necessary, a period of monitoring is helpful to assess the rate of progress of the wear, the effectiveness of preventive measures, and therefore the extent of the treatment necessary.(J Prosthet Dent 1997;78:367-72.)     

Tooth wear and wear investigations in dentistry

Tooth wear has been recognised as a major problem in dentistry. Epidemiological studies have reported an increasing prevalence of tooth wear and general dental practitioners see a greater number of patients seeking treatment with worn dentition. Although the dental literature contains numerous publications related to management and rehabilitation of tooth wear of varying aetiologies, our understanding of the aetiology and pathogenesis of tooth wear is still limited. The wear behaviour of dental biomaterials has also been extensively researched to improve our understanding of the underlying mechanisms and for the development of restorative materials with good wear resistance. The complex nature of tooth wear indicates challenges for conducting in vitro and in vivo wear investigations and a clear correlation between in vitro and in vivo data has not been established. The objective was to critically review the peer reviewed English-language literature pertaining to prevalence and aetiology of tooth wear and wear investigations in dentistry identified through a Medline search engine combined with hand-searching of the relevant literature, covering the period between 1960 and 2011.     

Dental erosion: part 2. The management of dental erosion

Dental erosion is an important cause of tooth tissue loss in both children and adults. An earlier article (Mahoney and Kilpatrick, 2003) discussed the prevalence and causes of dental erosion. This second article will discuss the management of this condition which is often complicated by the multifactorial nature of tooth wear. Management of dental erosion can be considered in three phases: immediate, interim and long-term. Immediate management includes the early diagnosis of dental erosion, recording the status of the disorder at baseline and implementing appropriate preventive strategies including those aimed at reducing the acidic exposure as well as those that attempt to increase an individual's resistance to erosive tooth tissue loss. Interim and long-term treatment includes the provision of temporary diagnostic restorations, ongoing monitoring of disease progression, definitive restorative work where appropriate, and modification and reinforcement of preventive advice. Each phase will be discussed in light of current evidence.     

Retrospective long term monitoring of tooth wear using study models

OBJECTIVE: Tooth wear is recognised as a common feature of European dentitions. However, little is known about its progression in susceptible patients. The aim of this study was to assess the degree and progression of tooth wear in patients by examining study casts taken of their teeth on two separate occasions. DESIGN: Over 500 sets of study casts taken during an 18-year period from patients referred for a variety of restorative procedures, were examined at Guy's Dental Hospital. Of these, 34 cases were found to have consecutive models taken at two time intervals and these were used to assess the progression of tooth wear. Study models from 19 females and 16 males, with an average age of 26 years (range 18-60) at the time of their first presentation and were all examined by a single operator. The Smith and Knight tooth wear index was used to assess the degree of tooth wear at presentation and then at another time which was a median of 26 months (interquartile range 14 - 50 months) later. RESULTS: The most common initial TWI score per surface was 1, with 54% of surfaces affected at the first assessment and 57% at the second. Score 2 was less common (14% at both assessments) and the scores for 3 and 4 combined were relatively uncommon with 5% of surfaces effected. Minimal progression of tooth wear was observed on study casts with only 7.3% of surfaces involved. CONCLUSION: In this sample, tooth wear was a slow, minimally progressive process.     

A new approach to the study of tooth wear

Human tooth wear occurs so slowly that traditionally it has needed months or years to be measurable. This study showed that microscopic changes in wear patterns on human teeth could be detected in a matter of days and could be used as indicators of rates of wear. Thus, daily or weekly changes in rates of wear can be documented for specific locations on teeth. For instance, through this new approach, rates of wear of human teeth were shown to be significantly slower than rates of wear of the teeth of laboratory monkeys raised on hard or soft diets. Similar techniques may ultimately be used to monitor subtle changes in tooth use--including those associated with growth and development and those occurring in response to various dental clinical procedures.     

Impact of tooth wear on daily living

PURPOSE: The aim of this study was to identify the effects of tooth wear on patients' quality of life and satisfaction with their dentition. MATERIALS AND METHODS: Seventy-six tooth wear patients and 76 control subjects were recruited for the study. A Dental Impact on Daily Living questionnaire was used to assess the affect of tooth wear on daily living and satisfaction with the dentition. An ordinal scale was used to assess the severity of tooth wear in a patient cohort. RESULTS: The results showed that tooth wear has a measurable impact on patients' satisfaction with their appearance, pain levels, oral comfort, general performance, and chewing and eating capacity (P < .001). CONCLUSION: Tooth wear has an impact on patients' satisfaction with their dentition regardless of tooth wear severity or personal factors.     

Treatment of localized anterior tooth wear with a glass-fiber-reinforced composite resin: a clinical report

Developments in adhesive dentistry have provided the dental profession with new restorative materials and technology to restore esthetics and function to the worn anterior dentition. This clinical report describes treatment of localized anterior tooth wear with fiber-reinforced composite resin restorations as an alternative treatment method.     

The role of erosion in tooth wear: aetiology,prevention and management

Tooth wear is a universal experience. The cause is usually a combination of erosion, attrition and abrasion. Attrition usually presents with flattened incisal and occlusal tooth surfaces which accurately inter‐digitate. Erosion from dietary or gastric acids forms smooth lesions which typically appear as cupped occlusal/ incisal and concave buccal/facial surfaces. When combined with attrition or abrasion, acids have the potential to cause significant wear. Wear reduces the thickness of enamel exposing the underlying dentine and changing the colour from the white of enamel to yellow of dentine. Acids causing erosion originate from the stomach or from the diet. Gastric acid is associated with reflux disease and eating disorders. The frequency of acidic foods and drinks and how they are consumed is important in dietary erosion. The progression of tooth wear is recognised to be slow with periods of activity and inactivity. Although restorations can be indicated, prevention and monitoring remain important strategies in maintaining the life of the teeth.     

Minimally invasive rehabilitation of the worn dentition: a case report utilising adhesive additive techniques and digital technologies

The management of the worn dentition presents an increasing challenge that is encountered more frequently in daily dental practice. The consequences of tooth wear tend to be multifactorial and while they may initially only involve the loss of surface enamel it can progressively lead to significant destruction of the dentition. This paper discusses the management of a tooth wear case where a significant amount of tooth structure has been lost from both the anterior and posterior teeth. Protocols for assessment, treatment planning and restorative management of the tooth wear case are presented demonstrating the use of adhesive additive techniques and digital technologies to achieve functional and aesthetic rehabilitation of the dentition.     

Prevalence and severity of incisal and occlusal tooth wear in an adult Swedish population

The material consisted of 585 randomly selected dentate individuals from the community of J?nk?ping, Sweden, who in 1983 reached the age of 20, 30, 40, 50, 60, 70, or 80 years. The degree of incisal or occlusal wear was evaluated for each single tooth in accordance with the following criteria: 0 = no wear or negligible wear of enamel; 1 = obvious wear of enamel or wear through the enamel to dentin in single spots; 2 = wear of dentin up to one-third of the crown height; 3 = wear of dentin more than one-third of the crown height and/or excessive wear of tooth restorative material. Among the 20-year-olds 35% of the subjects had no or slight incisal or occlusal wear. The corresponding figures for the 30- to 80-year age groups were 20%, 32%, 18%, 14%, 26%, and 23%, respectively. For the age groups 20-80 years, the percentage of teeth with incisal or occlusal wear in accordance with criteria 1-3 was 13%, 20%, 16%, 24%, 23%, 23%, and 23%, respectively. Men presented more teeth with wear than women, the difference being significant for all age groups except the 20- and 60-year-olds. Among the 20-year-olds 6% had one or more teeth with wear scored 2. Among subjects aged 30 and 70 years 10% and 31%, respectively, showed tooth wear with score 2. Wear with score 3 was only found in 2% of the total population. There was an increase in the number of teeth with incisal or occlusal wear with age. With increasing age, there was also a change in distribution of wear within the dentition.