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PubMed2003

Prevention. Part 3: prevention of tooth wear.

Non-carious destruction of teeth has been observed in archaeological material from various parts of the world and clearly pre-dates the first appearance of dental caries. Attrition, abrasion and erosion are also described in the classic text of Pindborg on the pathology of the dental hard tissues. Whilst the dental profession, at least in affluent parts of the world, was engaged in diagnosing, treating and later preventing dental caries these other causes of tooth destruction were largely ignored.

Humans↗
PubMed2005

Tooth wear in the mixed dentition: a comparative study between children born in the 1950s and the 1990s.

The aim of this study was to evaluate the degree of tooth wear in posterior deciduous teeth of 100 subjects in the second phase of mixed dentition who were born in the 1950s (50sG) and 100 subjects born in the 1990s (90sG). The degree of abrasion for each posterior deciduous tooth was scored ranging from 0 to 3. The comparison of the degree of abrasion showed significant differences between the two groups for all examined teeth (upper and lower deciduous canines and first and second primary molars) all of which appeared to be more abraded in the 50sG. The findings of the present study indicate that subjects who were born in the 1950s exhibited a significantly greater degree of tooth wear on the posterior deciduous teeth when compared with contemporary subjects, along with a well-recognized lower prevalence of malocclusions. Changes in dietary habits and a diet based on processed foods may be postulated as factors involved with a decrease of dental attrition in contemporary populations. An increase in the prevalence of mouth breathing (tested in the present study) appears to be associated with a decrease in tooth wear in the contemporary population as well.

Child↗
PubMed2001

Abattoir survey of dental defects in cull cows.

The teeth in the severed heads of 501 cull cows, all over 30 months of age, were examined at an abattoir in the north of England in 1997/98; 80 per cent of them were Friesians or Holsteins. Seventy-three animals (14.6 per cent) had one or more missing incisors, most of which were acquired losses. Rotation and overlapping of rostral teeth were also common, as was attrition. Congenitally absent first lower premolars, other missing teeth, large and often multiple interdental spaces, and a few cases of macrodontia, cavitation, multiple defects and fractures were observed in the cheek tooth arcades. There were some unusual patterns of premolar and molar attrition, often attributable to malocclusion, one result of which was the formation of a hook at the posterior extremity of the third maxillary molar.

Abattoirs↗
PubMed1998

Factors affecting the lifespan of the human dentition in Britain prior to the seventeenth century.

OBJECTIVE: To confirm that compensatory eruption (supereruption) of teeth past a stable periodontium occurs in response to severe occlusal attrition. DESIGN: Regression analysis study from radiographs and direct measurements. SETTING: Archaeological material at the University of Aberdeen. SUBJECTS: 47 individuals > 21 years old and dating from Late Mediaeval times (1300-1600 AD). MAIN OUTCOME MEASURES: Occlusal attrition was recorded on the first permanent mandibular molars. Measurements on radiographs of the teeth from the fixed point of the inferior dental canal were taken to the occlusal surface, the alveolar crest and the tooth apex. Regression analysis was undertaken between these variables and related to attrition (age). RESULTS: Continuous eruption of the permanent human dentition past a stable periodontium does occur in response to tooth height lost by wear, despite the fact that supereruption may lead to the eventual self destruction of the dentition. This mechanism was primarily responsible for the early loss (at 40-45 years of age) of dentitions in Mediaeval times. CONCLUSIONS: Stability of occlusal height appears to be an important function of the dentition and if triggered by severe wear will lead to increasing root exposure and eventual exfoliation of the teeth. It is important not to confuse bone loss due to periodontitis with root exposure due to supereruption of the teeth.

Adult↗
PubMed2002

Dental erosion patterns from intrinsic acid regurgitation and vomiting.

BACKGROUND: The distribution of lesions from dental erosion due to intrinsic acid regurgitation and vomiting may be different from patterns of dental erosion due to extrinsic acids. To date studies have failed to validate this assumption. This study described the sites and nature of lesions from dental erosion in cases of intrinsic acid regurgitation, and compared them with the distribution of lesions occurring in age and sex matched controls, whose lesions are due to extrinsic acids. METHODS: The University of Queensland tooth wear clinic patients were screened to select 30 cases, 21 self-identified bulimics and nine medically diagnosed chronic gastric acid regurgitators, and 30 controls. Epoxy resin models of the subjects' dentition were examined under stereoscopic light microscope at magnification 16 to 40. The patterns and sites of tooth wear were recorded for teeth representative of 20 tooth sites in every subject. RESULTS: While the incisal edges of maxillary and mandibular anterior teeth of acid regurgitators were more frequently affected by erosion, incisal attrition was more common on controls' teeth. Cervical lesions were more commonly found in association with incisal attrition in the controls, and in association with incisal erosion in the cases. In 10 per cent of sites in case subjects, cervical lesions associated with incisal erosion were found on the lingual aspects of their mandibular incisors, canines and premolars. These lesions were almost exclusive to the case subjects. CONCLUSIONS: These results validate that lingual cervical lesions associated with incisal erosion on the mandibular anterior teeth are strong discriminators between tooth wear in patients with bulimia nervosa or chronic gastro-oesophageal reflux and those whose dental erosion is due to extrinsic acids.

Adult↗
PubMed2000

Buccal alveolar exostoses: prevalence, characteristics, and evidence for buttressing bone formation.

BACKGROUND: Buttressing bone formation has been described as the development of thickened or exostotic buccal alveolar bone in response to heavy occlusal forces. Little supporting evidence for this model has been found in previous literature, however, and there is little seen on the prevalence or characteristics of buccal alveolar exostoses. METHODS: A sample of 416 selected teeth and investing bone in 52 modern skeletal specimens at the National Museum of Natural History were examined. Two measures of heavy occlusal function--periodontal ligament (PDL) width and occlusal attrition--were analyzed for their relationship to three parameters of buccal alveolar bone (exostoses, lipping, and overall thickness). RESULTS: Buccal alveolar bone enlargements were found in 25% of all teeth examined: 18% were expressed as marginal bony lippings and 7% as buccal exostoses. Exostoses were mainly seen around maxillary molars and bicuspids, especially in males, while lippings were seen in molars, bicuspids, and mandibular incisors, with even gender distribution. When findings were controlled for arch and tooth type, no significant correlations were found between wider PDL spaces or occlusal attrition and exostotic, lipped, or thicker alveolar bone. CONCLUSIONS: These results indicate a lack of anatomic evidence for the theory of buttressing bone formation and suggest that other factors may be of greater importance in the etiology of buccal bone enlargements. Incidentally, no correlation was found between widened PDL spaces or severe occlusal attrition and the presence of cervical loss of tooth structure, which casts doubt on the currently popular concept of abfraction.

Adult↗
PubMed1999

Abrasion, erosion, and abfraction combined with linear enamel hypoplasia: a case report.

Linear enamel hypoplasia is a developmental disturbance of enamel resulting in clinically visible horizontal defects in enamel that are present on eruption of the tooth. Nondevelopmental lesions of the hard tissues of the tooth, including carious, abrasion, erosion, attrition, and abfraction lesions, require varying amounts of time after tooth eruption to develop. Because linear enamel hypoplasia lesions are present on eruption and are exposed to the factors responsible for abrasion, erosion, and abfraction, nondevelopmental lesions could occur within them in any combination. This report describes a patient with multiple teeth with linear enamel hypoplasia lesions containing nondevelopmental defects as well as nondevelopmental defects that occurred separately. Severe pain and a unique lesion morphology were associated with the linear enamel hypoplasia defects. Affected teeth were extracted because of advanced periodontitis and were sectioned to determine the nature of the enamel and dentin lesions.

Aged↗
PubMed2004

The natural history, including orofacial features of three patients with Ehlers-Danlos syndrome, dermatosparaxis type (EDS type VIIC).

Ehlers-Danlos syndrome (EDS) dermatosparaxis type (type VIIC) and the related disease of cattle dermatosparaxis, are recessively inherited connective tissue disorders, caused by a deficient activity of procollagen I N-proteinase, the enzyme that excises the N-terminal propeptide in procollagen type I, type II, and type III. Although well documented in cattle, to date only seven human cases have been recorded, most of them aged under 2 years. We document the natural history of three patients with EDS dermatosparaxis type, two of whom have been reported before the age of 2 years, and one new patient. The phenotype of the patients, and especially the facial resemblance, is striking, making this a clinically recognizable condition. The most consistent anomalies during the first years of life are premature rupture of the membranes, extreme skin fragility and easy bruising, large fontanels, blue sclerae, puffy eyelids, micrognathia, umbilical hernia, and short fingers. Joint hypermobility becomes more important with age. The children are at risk for rupture of internal organs due to soft tissue fragility, as is illustrated by different internal events in two of the three patients described here. Orofacial features include micrognathia, a frontal open bite, and gingival hyperplasia with varying degrees of hyperkeratosis. The deciduous dentition shows abnormal morphology of the molars, obliteration of the tooth pulp, and severe enamel attrition. The permanent dentition shows agenesis and microdontia of several teeth. Tooth discoloration, dysplastic roots, and tooth pulp obliteration are present in a restricted number of permanent teeth.

Child↗
PubMed1988

Measurements of tooth wear among Australian aborigines: II. Intrapopulational variation in patterns of dental attrition.

The possible implications of variations in dental attrition patterns have necessitated a detailed assessment of the types, ranges, and causes of tooth wear. Hear we employ measurements of postcanine occlusal wear facets from a sample population of extant Australian aborigines. A principal components analysis was applied as a tool in determining common types of attritional patterns. It was concluded that the range of intrapopulational variation in dental wear patterns must be attributed to a multiplicity of sources in addition to such commonly cited causes as dietary variations, gender, age, and developmental eruption sequences.

Adolescent↗
PubMed2003

Endodontic sequelae of dental erosion.

BACKGROUND: The incidence of pulp involvement in patients with excessive wear has not been extensively documented. METHODS: Clinical records of 448 patients with excessive tooth wear were reviewed and 52 cases (11.6 per cent) with near or frank pulp exposures or root canal treatments were found and their numbers and sites were tabulated. Light microscopy of study models was used to determine aetiology at each site of exposure as attrition, erosion or abrasion, scanning electron microscopy (SEM) was performed on some individual teeth. RESULTS: Forty sites of near exposure and 57 sites of frank exposures or root canal treatments were found, some cases had both types of exposure. The commonest sites exposed by erosion were the palatal surfaces of maxillary, and the incisal surfaces of mandibular anterior teeth. Posterior teeth were not commonly affected. Toothbrush abrasion had exacerbated some lesions as shown by SEM. CONCLUSIONS: Endodontic sequelae were found in 11 per cent of tooth wear patients as late stages of dental erosion. Near and frank exposures of the pulp thus constitute a small but significant, problem for the Australian dental profession's concern in the management of the tooth wear cases.

Adolescent↗
PubMed2002

Dental erosion in asthma: a case-control study from south east Queensland.

BACKGROUND: Asthma medication places patients at risk of dental erosion by reducing salivary protection against extrinsic or intrinsic acids. But patterns of lesions in asthmatics may differ from patterns in non-asthmatics, because gastro-oesophageal reflux (GOR) is found in 60 per cent of asthmatics. METHODS: The lesions in 44 asthma cases were compared to those of age and sex match controls with no history of asthma or medications drawn from the dental records of 423 patients referred concerning excessive tooth wear. The subjects were 70 males age range 15 to 55 years and 18 females age range 18 to 45. Anamnestic clinical data were compared between the two groups. Models of all 88 subjects were examined by light microscopy, and wear patterns were recorded on permanent central incisor, canine, premolar and first molar teeth. RESULTS: Clinical differences were a higher incidence of tooth hypersensitivity, xerostomia, salivary gland abnormalities, gastric complaints, and self induced vomiting in the cases. No differences were found between the cases and controls on citrus fruit and acid soft drink consumption. More occlusal erosion sites were found in cases, whereas more attrition sites were found in the controls. There were no significant differences in palatal erosion on maxillary anterior teeth found between cases and controls. Lingual erosion of the mandibular incisors, found only in GOR patients, was not observed. CONCLUSIONS: A higher incidence of erosion was found in asthmatics. Gastro-oesophageal reflux symptoms were not associated with the sign of lingual mandibular incisor erosion. The clinical significance is that asthmatics are at risk of dental erosion from extrinsic acid, but GOR does not appear to contribute in a site-specific manner.

Adolescent↗
PubMed1991

Biomechanical association of dental and temporomandibular pathology in a medieval Nubian population.

An analysis of the relationship between oral pathology and degenerative change at the temporomandibular joint (TMJ) was undertaken on an archaeological sample of 122 adult crania from the Medieval site of Kulubnarti in Sudanese Nubia. The crania were sorted into 2 groups: those demonstrating clearly visible bony changes at the joint (TMJ+) and those without visible change (TMJ-). These groups were compared according to 1) age; 2) sex; 3) active dental pathologies (abscesses, caries, partial socket resorption); 4) tooth loss with complete socket resorption; and 5) dental attrition. No statistically significant association was evident between degenerative change at the TMJ and age, active dental pathologies, or dental attrition; however, sex differences and posterior tooth loss with complete socket resorption revealed a significant correspondence to degenerative TMJ changes. Both of these factors agree with the clinical literature and with biomechanical models (most notably that of Hylander) based upon modern populations. Furthermore, the results support the contention that paleopathological conditions can be analyzed from a clinical and functional biomechanical perspective.

History, Medieval↗
PubMedDate not supplied

The mandibular speech envelope in subjects with and without incisal tooth wear.

PURPOSE: The purpose of this study was to describe a mandibular envelope of motion during speech for 2 subject groups. One subject group had experienced no tooth wear and the other had incisal tooth wear. The speech envelope was to be described with regard to its maximal dimensions in the vertical, anteroposterior, and lateral directions, and its most superior and anterior positions in relation to intercuspal position. MATERIALS AND METHODS: An electromagnetic method of jaw tracking was employed to record mandibular speech movements for 60 subjects whose teeth exhibited no tooth wear and 30 subjects with incisal dental attrition. The test speech exercise contained all of the word sounds that occur in the English language. The test was recorded 3 times, and mean values for parameters were reported. RESULTS: The speech envelope of the tooth wear group was significantly smaller (Student's t test, P < 0.01) in all 3 dimensions than that of the normal group. The tooth wear group speech envelope was also located closer to the intercuspal position in the vertical dimension (P < 0.01) and was not as anteriorly placed (P < 0.01). In the normal group, correlations were found between the vertical incisor overlap and the most superior speech position (r = 0.48, P < 0.0001), and between the horizontal incisor overlap and the most anterior mandibular speaking position (r = 0.63, P < 0.0001). CONCLUSION: The envelope of mandibular movement during speech differed in dimension and position between the 2 groups investigated.

Adult↗
PubMed2005

Mandibular facial talon cusp: case report.

BACKGROUND: Talon cusp is a supernumerary structure projecting from the dento-enamel junction to a variable distance towards the incisal edge of an anterior tooth. Studies have shown that it consists of enamel, dentine and a variable amount of pulp tissue. Hyperactivity of the enamel organ during morphodifferentiation has been attributed to its formation. Most previous reports have been made concerning the occurrence of this structure on primary and permanent teeth and mostly on the palatal aspect. Only few have been reported on the facial aspect of the teeth. When it occurs, the effects are mainly aesthetic and functional and so early detection and treatment is essential in its management to avoid complications. CASE PRESENTATION: An unusual case of talon cusp on the facial aspect of a mandibular central incisor is reported. Its presence resulted in attrition of the opposing tooth. Reduction of the cusp and topical application of fluoride gel was initiated. CONCLUSION: The management and treatment outcome of talon cusp depends on the size, presenting complications and patient cooperation.

Journal Article↗
PubMed2002

Tooth wear in children with Down syndrome.

BACKGROUND: Several studies have described the impact that dental caries and periodontitis may have on the dentitions of individuals with Down syndrome, but there are few reports about the effects of tooth wear. This investigation aimed to compare the aetiology, prevalence and severity of tooth wear in 49 cytogenetically confirmed Down syndrome children with 49 non-Down syndrome controls. METHODS: This study involved three aspects: an oral examination, including obtaining dental impressions; a dietary analysis spanning three days; and a questionnaire seeking information about habits, medical problems and medications. Tooth wear severity was scored on a 4-grade scale (none-to-little; moderate; severe; very severe), while aetiology was classified as being due to attrition mainly, erosion mainly, or a combination of both. Double determinations established scoring method reliability and chi-square tests assessed associations between samples. RESULTS: Tooth wear was significantly more frequent (p<0.01) in the Down syndrome than the non-Down syndrome sample (67.4 per cent cf 34.7 per cent), with more of the Down syndrome children showing severe to very severe wear (59.2 per cent cf 8.2 per cent). Significantly more Down syndrome children (p<0.05) displayed a multifactorial aetiology of tooth wear, i.e., both attrition and erosion (46.7 per cent cf 28.6 per cent), although no particular dietary link was established. Gastric reflux and vomiting were reported in over 20 per cent of the Down syndrome sample. CONCLUSIONS: Given the potential consequences of high levels of tooth wear, associated with tooth grinding and an acidic oral environment in Down syndrome children, educational programmes aimed at increasing awareness of carers and health professionals are needed urgently.

Adolescent↗
PubMed2006

Tooth brushing, tooth wear and dentine hypersensitivity--are they associated?

Evidence suggests that patients suffer the painful symptoms of dentine hypersensitivity when dentine is exposed and the dentinal tubule system is opened to the oral cavity to allow stimuli to trigger a neural response in the pulp via a hydrodynamic mechanism. The processes needed to localise lesions of dentine hypersensitivity include loss of enamel and/or gingival recession. Whilst tooth brushing with or without toothpaste appears to cause minimal wear to enamel (in the absence of acids), circumstantial evidence implicates tooth brushing with gingival recession and exposure of dentine. Other tooth wear processes, notably attrition and acid erosion, cause loss of enamel and can expose dentine. Therefore, sensitivity may result. How lesions of dentine hypersensitivity are initiated is a matter of conjecture and based on extrapolating data from studies, mainly in vitro, to effect in vivo. Again, this circumstantial type of evidence suggests that abrasion by some toothpastes and erosion by dietary acid could open the tubule system. Little is known about the actual effect of de-sensitising toothpastes on lesions of dentine hypersensitivity even though they are formulated to either occlude dentinal tubules or block the neural response in the pulp. Clinical studies have produced contradictory findings for the efficacy of products and there have been extremely few evidence-based reviews. In conclusion, available evidence supports a probable link of tooth brushing, with or without toothpaste and an acidic diet, to both tooth wear and dentine hypersensitivity, and also suggests that dentine hypersensitivity is a tooth wear phenomenon. Although there is a need for more direct clinical and scientific evidence for these associations, it is recommended that they be taken into consideration when planning management strategies for the dentine hypersensitivity sufferer.

Journal Article↗
PubMed2003

Differential mesowear in occluding upper and lower molars: opening mesowear analysis for lower molars and premolars in hypsodont horses.

A new approach of reconstructing ungulate diet, the mesowear method, was recently introduced by Fortelius and Solounias ([2000] Am Mus Novitat 3301:1-36). Mesowear is based on facet development on the occlusal surfaces of the teeth. Restricting mesowear investigation to maxillary cheek teeth would allow mesowear investigation only in assemblages of large numbers of individuals and therefore would generally restrict this method to relatively few assemblages of recent and fossil ungulates. Most of the fossil, subfossil, and recent ungulate osteological assemblages that may be assigned to a single taxon have smaller numbers of individuals. This results in a demand to extend the mesowear method to further tooth positions in order to obtain stable dietary classifications of fossil taxa. The focus of this article is to test if a consistent mesowear classification is obtainable for mandibular as well as for maxillary teeth. For statistical testing, large assemblages of isolated cheek teeth of the Vallesian hipparionine horse Hippotherium primigenium and of the recent zebra Equus burchelli were employed as models. The upper tooth positions P4, M1, M2, and M3 as suggested by Kaiser and Solounias (2003) as the model for the "extended" mesowear method and the lower tooth positions P4-M3 were tested for their consistency in classification of the mesowear variables. We found a considerable shift of the mesowear signature towards the grazing edge of the mesowear continuum in lower cheek teeth. In order to adjust the signal of lower teeth to the signal of the upper teeth, a calibration factor was introduced which allowed incorporation of lower cheek teeth into the same model of mesowear investigation together with upper cheek teeth. We propose that this model is particularly suited for the reconstruction of paleodiets in hypsodont hipparionine and equine equids. We further investigated the functional relation between the mesowear profiles and the distribution of dental tissues along the course of the occlusal contact. We therefore correlated mesowear profiles with enamel distribution profiles and found the mesowear profile to be strongly controlled by the attritional environment encountered by a given apex area. The differential signal observed in cusp apex morphology between upper and lower cheek teeth was found to be more closely related to attrition by the antagonistic tooth than to the distribution of dental tissues in the tooth under consideration. The results suggest a general extension of the mesowear method of paleodiet reconstruction and a basic scenario for the evolution of anisodont dentitions.

Animals↗
PubMed2002

The dental health status of dialysis patients.

BACKGROUND: The number of patients with kidney failure who require dialysis is growing by 10% to 15% annually, and the likelihood that dentists will treat such patients is also increasing. The dental care of patients undergoing dialysis can be complex, given the prevalence of comorbid conditions such as diabetes, hypertension, renal osteodystrophy and immunosuppression, the presence of nondental prosthetic devices, and the use of antihypertensives and anticoagulants or antiplatelet agents. These patients appear to be predisposed to a variety of dental problems such as periodontal disease, narrowing of the pulp chamber, enamel abnormalities, premature tooth loss and xerostomia. Dental care, as well as primary preventive measures, seems to have been neglected in these patients. Therefore, a study of the dental health of dialysis patients was undertaken. METHOD: Completion of a questionnaire and a noninvasive oral examination was obtained from hemodialysis and peritoneal dialysis patients registered in the dialysis program at St. Paul's Hospital in Saskatoon, Saskatchewan, as of March 1, 1999. Information was also gathered from the medical chart. Medication history as well as history of diabetes, hypertension, and nondental prosthetic devices were also recorded. RESULTS: Of 226 dialysis patients in central and northern Saskatchewan, 147 were interviewed and examined. Of these, 94 (64%) were dentate, and the same number had been on dialysis for a mean of more than 2 years; about a third were diabetic, almost all were hypertensive and all had nondental prosthetic devices or arteriovenous fistulae, or both. Sixty (64%) of the dentate patients were candidates for kidney transplantation. Most of the dentate patients reported brushing once or more daily, but they flossed infrequently or never. Dental visits were infrequent, less than every 5 years in 59 (63%) of the dentate patients. Findings in the dentate group included increased tooth mobility, fractures, erosion, attrition, recession, gingivitis and a high plaque index. A patient's dentist was contacted if the patient had seen him or her since starting dialysis (31 of the 94 dentate patients). Most (81%) of the dentists were aware that they were treating a dialysis patient. Medication records were incomplete for 29% of the patients, and only 2 (6%) of the patients had received antibiotic prophylaxis despite the fact that all had prosthetic devices or arteriovenous fistulae. CLINICAL SIGNIFICANCE: We conclude that the dental health of dialysis patients is poor and requires greater attention.

Adolescent↗