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PubMed2001

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.

Asthma↗
PubMed1985

Dental occlusal wear and degenerative disease of the temporomandibular joint: a correlational study utilizing skeletal material from a contemporary population.

Forty crania and mandibles with intact dentition exceeding twenty-six teeth and bilaterally intact condyle-fossa apparatus were evaluated for attrition and degenerative joint disease. The skeletal specimens all represent a twentieth-century contemporary American population from the Atkinson Skull Collection at the University of the Pacific School of Dentistry. While 23.1% of this sample exhibited some degree of erosive osseous degenerative wear involving the condyle or articular fossa and 76.3% exhibited occlusal tooth wear, no significant correlation between the degree of attrition and the severity of degenerative joint disease could be documented.

Adult↗
PubMed1990

[A clinical study on the changes in interocclusal contact caused by attrition, especially on the closely occluding area of upper molar region].

Changes caused by attrition in interocclusal contact were investigated in 11 subjects with natural dentition showing no or only slight attrition and 6 subjects with natural dentition showing moderate attrition. Interocclusal spaces in the molar region in the maximally intercuspidated position of each subject were recorded in White Silicone impression material. Light-transmittance measurements of interocclusal records were made to determine differences in interocclusal spaces. Results 1. Mean values of the most closely occluding area in the upper molar region Tooth kind I B II B I M II M Slight-attrition group 0.6 0.9 3.2 2.5 (mm2) Moderate-attrition group 7.2 11.0 30.4 26.8 (mm2) 2. Mean values of ratios between most closely occluding areas and occlusal-surface projecting areas in the upper molar region Tooth kind I B II B I M II M Slight-attrition group 1.1 1.7 3.1 2.7 (%) Moderate-attrition group 13.1 21.0 28.4 27.5 (%) Conclusions 1. Differences in interocclusal spaces between the slight- and moderate-attrition groups were apparent only in the most closely occluding areas. 2. When load on supporting tissues is proportionate to the size of the closely occluding area, the supporting load probably increases as attrition progresses, although the ratio of increasing load changes little among different kinds of teeth.

Dental Occlusion↗
PubMed1981

Form and patterning of anterior tooth wear among aboriginal human groups.

Form and severity of dental attrition was assessed in aboriginal human groups including hunter-gatherers (Eskimos, Australians) and those with dependence to a varying degree on food production (Southwest U.S. and Ohio American Indians). Wear on anterior teeth was both relatively and absolutely greater in the hunter-gatherers, as indicated by comparisons of wear on anterior and posterior teeth which come into occlusion at roughly the same time. Distinct differences in form of anterior wear were also apparent: The hunter-gatherers exhibited steadily increasing incidences of labially rounded wear with greater functional age, while the food-producing groups showed little or no rounding but instead high frequencies of heavily cupped wear (especially in those with premature loss of posterior teeth). These differences were attributed to nonmasticatory utilization of the front teeth in hunter-gatherers and to employment of the anterior teeth in masticatory (grinding) activities necessitated by large-scale molar loss in food producers.

Age Factors↗
PubMed1991

Regurgitation erosion as a possible cause of tooth wear in ancient British populations.

Clinically, in modern populations, tooth wear can be differentiated into three main types--attrition, abrasion and erosion, acting either separately or together. Anthropologists generally have not recognized erosion as a factor affecting the teeth of past populations. This study compares the patterns of wear known to be associated with erosion in present-day dental patients with those found in some British, pre-Conquest, skeletons. It is concluded that erosion may have been a major factor causing the extensive tooth wear in some 20 of 151 individuals.

Adolescent↗
PubMed1989

[Chronic loss of dental hard substance in early and middle adulthood].

In a clinical study non-cariogenic chronic dental surface losses were registered in 300 patients, aged 16-35 yr. Nearly in all patients attrition could be stated especially in the anterior tooth area. Wedge-shaped defects occurred in 13% and erosions in 4% of the examined patients. Early recognition, dynamic observation, search for pathogenic moments as well as the preventive and curative early intervention with simple methods are recommended.

Adolescent↗
PubMed1997

The esthetics of anterior tooth aging.

As generations proceed to reinvent themselves in an effort to achieve and maintain youth, cosmetic dentistry faces one of its greatest and most persistent challenges: the restoration of an aging smile. Although the need for this restorative therapy has not yet been adequately studied, the momentum continues to build as aging teeth exhibit physical characteristics that affect their function as well as appearance. This review presents the most common factors influencing the esthetics of anterior tooth aging: coloration; wear and the effects of erosion, attrition, abrasion, and abfraction; and position of teeth relative to each other and surrounding tissues. While dental science seeks to understand how well age-specific restorative procedures can affect patients, the question of the necessity of this therapy remains. Should a healthy smile require treatment? Only time will reveal at what cost and to what extent a younger appearance plays a role in dental science.

Adult↗
PubMed1989

Dental erosion in patients with chronic alcoholism.

Tooth wear attributed to the physical wear of teeth by clenching and grinding (attrition) has been described previously in alcoholic patients. However, the pattern of wear seen in the series of cases reported here is more consistent with chemical damage (erosion) than attrition. A possible mechanism for this process is suggested, and it is further suggested that erosion is likely to play a more important role in the wear of the teeth in chronic alcoholic patients than attrition.

Adult↗
PubMed1985

Quantitative assessment of tooth wear, alveolar-crest height and continuing eruption in a Romano-British population.

Although measurements from cement-enamel junction (CEJ) to alveolar crest (AC) have been used in assessing changes in alveolar-crest height as age or chronic inflammatory periodontal disease (CIPD) progresses, there is evidence from ancient populations that the position of AC remains almost constant throughout life and continuing eruption to compensate for attrition may explain why CEJ-AC measurements increase with age. Measurements of occlusal attrition and relationship of CEJ to AC were made on the cheek teeth of 500 Romano-British skulls by direct measurement or by reference to the fixed line of the inferior alveolar canal (IAC) on radiographs. Direct measurements indicated that there were usually no statistical differences between the vertical amounts of tooth substance lost by attrition and the change in the distance CEJ-AC as age progressed. Measurements on radiographs showed that posterior teeth continued to erupt to compensate for attrition and the AC remained static as age progressed. Bone deposition at the AC was seen in the majority of ground sections. Thus tooth wear appears to be compensated by continuing movement of teeth in an occlusal direction. The position of the AC remained almost constant throughout life; AC bone lost by CIPD seemed to be replaced during continuing tooth eruption.

Age Factors↗
PubMed1995

Importance of clinical examination and diagnosis. A case of dens invaginatus.

A case report is presented that shows a radiolucent lesion between the maxillary left lateral incisor and canine tooth, both of which were vital. The cause of the lesion was initially unclear. The patient was to be treated surgically, however, precise examination made it clear that the cause of the radiolucent lesion was due to the exposure of a second canal because of attrition of the lateral incisor crown. The final diagnosis of the tooth was dens invaginatus. This case highlights the importance of careful examination and correct diagnosis.

Child↗
PubMed1975

Natural selection on the dentition of an Arikara population.

The tooth crowns of most mammals do not change in size except by attrition. Therefore, by comparing age groups within a population and finding differences in size or variation, the effects of such agencies as directional or stabilizing selection can be demonstrated. Mesiodistal and buccolingual measurements were taken on the maxillary and mandibular permanent dentition of a protohistoric Arikara Indian population from South Dakota. The tooth sizes of juveniles ages 6 through 15 were compared to those of adults ages 16 through 20. The two age groups were also compared by the cross-sectional areas of the posterior teeth. When a difference between age groups was demonstrated in either size or variation, a selection intensity was estimated using published graphs. Results from the comparisons show that adults, in general, have larger and less variable teeth than juveniles. The data suggest the possibility that both directional and stabilizing selection were operating on the Arikara dentition. Furthermore, the selection intensities suggest that selection was operating not on the individual teeth but on functional complexes such as the posterior teeth. It appears that in populations like the Arikara where crown attrition is severe, selection will be in the direction of large teeth.

Adolescent↗
PubMed1976

Attrition: possible mechanisms of compensation.

Attrition, or wear of the occlusal surfaces of the teeth, may not only be physiologically normal, but necessary for function. Since occlusal wear must lead to reduction in tooth length, significant dimensional changes in facial morphology are inevitable unless mechanisms exist to compensate for attrition. Secondary dentine formation, alveolar growth, and adaptive changes in the masticatory muscles can provide this compensation, and may be part of a complex system by which an effective level of masticatory function is maintained even when attrition is extreme.

Adult↗
PubMed1990

[Application of composite resin inlays to deciduous molars--a clinical observation of the resin onlay].

Although composite resin has been used as an aesthetic restorative material, wear and fracture of the resin of fracture of the tooth structure are likely to occur when the size of the dental cavities are large. In addition to the lack of the aesthetic value, clinical results of prefabricated metal crown revealed several problems which were caused by the wear of the metal and the ill-adaptation of the cervical margin. In the present study, 50 devitalized deciduous molars were treated with composite resin onlays which were designed to cover the entire occlusal surface of the deciduous molar, and the clinical results were evaluated for a 6 month period. Additionally, for the purpose of simplification of the laboratory process for making resin onlays, ready-made occlusal shells were fabricated. The variety of the prepared shell size consisted of 7 sizes for the first deciduous molar, 9 sizes for the upper second deciduous molar and 10 sizes for the lower deciduous molar. The following results were obtained. 1) A partial resin fracture at the peripheral area of the mesio-buccal cuspid was found in five cases out of 50. 2) A glossy appearance on the surface of the onlay which was created by coated unfilled resin disappeared after 6 months of observation. 3) In relation to the resin onlay, when the antagonistic tooth was restored with prefabricated metal crowns, holes were made by attrition on all the crowns within a 3-4 month period.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1997

Effects of gastroesophageal reflux on the oral cavity.

The effects of chronic exposure of the oral cavity to gastric acid can be many and varied. Soft tissue symptoms (nonspecific burning and sensitivity) have been mentioned in the literature, but pathognomonic soft tissue lesions have not been documented. Dental erosion can be considered to be the predominant oral manifestation of gastroesophageal reflux disease. Erosion begins with subtle changes in the surface enamel and can progress to severe loss of tooth substance. Because the causes of such tooth lesions may be multifactorial, combining the effects of erosion, attrition, and abrasion and because of the subtle changes present in the beginning stages of such lesions, diagnosis may be difficult. Although the basic mechanism of erosion in gastroesophageal reflux patients is the dissolution of enamel and dentin due to acid exposure, a multitude of other factors can modify the effects of gastric acid. Salivary parameters, in particular, may play an important role in affecting oral pH after reflux episodes. Once dental erosion is diagnosed, thorough evaluation is necessary to document the extent of damage and to detect a cause, which may have both intrinsic and extrinsic components. Treatment goals include eliminating the causes of acid exposure, preventing the effects of acid exposure when it is not controllable, treating symptoms of soft tissue irritation and dental erosion, and restoring the dentition to an esthetically and functionally acceptable level.

Gastric Acid↗