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This part of the series is devoted to tooth surface loss (TSL) not caused by caries or trauma. The management of this form of generalised TSL is included in this series because knowledge of occlusion is needed for both the diagnosis and, when indicated, treatment. There are, however, many other factors involved in the management of generalised TSL other than those associated with 'occlusion'. These will also be discussed.
Resin-bonded metal restorations is the final part of the series. Cast metal restorations which rely on adhesion for attachment to teeth are attractive because of their potential to be much more conservative of tooth structure than conventional crowns which rely on preparation features providing macromechanical resistance and retention.
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The effect of the presence of fluoride in toothpaste on tooth wear was investigated in extracted human premolar teeth collected from two geographic areas with different fluoride concentrations in the public water supply. Nine teeth from each area were divided bucco-lingually into matched pairs and subjected to a wear regime in vitro. The regime consisted of 5 minutes immersion in 6% citric acid buffered at pH 3.5, followed by 200 cycles of linear tooth-brushing in a slurry of either a fluoride or a non-fluoride toothpaste, the whole process repeated 720 times. Teeth collected from subjects in Birmingham (public water supply fluoridated at 1 ppm) had a higher fluoride concentration in the surface enamel (P < 0.01) and greater hardness (P < 0.001) than teeth collected from subjects in London (non-fluoridated water supply). The results showed that less wear was produced in the presence of the fluoride toothpaste than in the presence of the non-fluoride toothpaste with an otherwise identical formulation (P < 0.001), and that the amount of tooth wear in vitro was not significantly affected by differences in fluoride concentration and hardness of enamel.
A clinical technique is presented for the use of all-porcelain additions to the surfaces of teeth as part of the management of the worn or fractured tooth. This technique could be regarded as an adjunct to conventional techniques for management of the worn dentition.
Twelve subjects took part in a study of the use of adhesively bonded all-porcelain restorations in the management of worn and fractured anterior teeth. A total of 54 restorations were placed in function against natural teeth, porcelain fused to metal crowns, and acrylic denture teeth. They have been assessed over up to a 5-year period for failure, wear, marginal stain and effect upon gingival status of the teeth concerned. Eleven restorations were lost to follow-up during the 5-year period. Two restorations have failed completely and four partial failures have occurred. There has been a tendency for the margins of the restorations to exhibit stain after 3-4 years in service. There has been no significant alteration in the periodontal or gingival status of the teeth involved in the study.
A random sample of 2280 subjects aged 60 years or over from three areas of England were examined clinically in order to assess their dental health and needs. Between 33% (south of England) and 57% (north of England) were edentulous. Twenty per cent of all dentate subjects were edentulous in one arch and thus still required a complete denture. Amongst the dentate subjects geographical differences were small, but social class and behavioural differences were large. Dental non-attenders were the group who stood out as having much poorer oral health, averaging six fewer natural teeth than attenders. Nearly 50% of all teeth either had coronal fillings or needed them. Root caries was common, 20-22% of vulnerable teeth were affected and there was an age related increase in disease risk. The mean number of teeth with decayed roots per subject (0.8) was similar to the mean number with decayed coronal surfaces (0.9). Moderate tooth wear and moderate periodontal disease were both widespread. A minority of subjects had a functional dentition of 21 or more teeth. Major changes in the dental status of older adults have taken place in the last 30 years and these will continue, resulting in lower levels of edentulousness but a large need for maintenance of existing restorations.
This article aims to address the issues arising out of the increasing concern by general dental practitioners of erosion-related tooth wear. The prevalence, common presentation, differential diagnosis, likely aetiology, prevention and management of suspected cases of this form of tooth wear are considered.
The restorative management of patients with localised tooth wear is a major challenge to the dental profession. There is rarely adequate interocclusal space available to place restorations without the need for extensive tooth preparation or the involvement of many unaffected teeth. In 1975, a method was described which created interocclusal space by the use of a partial coverage appliance made of cobalt chromium alloy. The technique reduced the need for more invasive palatal reduction. This paper, with the aid of clinical case examples, highlights the development and evolution of the original removable appliance. However, there remains a need for further clinical studies to evaluate fully these techniques.
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