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PubMed2004

Eruptive tooth movement--the current state of knowledge.

How the dentition erupts, and what controls it, is fundamental to almost all aspects of clinical dentistry, yet the mechanisms behind this have not yet been fully elucidated. When the process continues into space that has been created through toothwear or tooth loss, problems in placing restorations can be encountered. This review examines the possible mechanisms of tooth eruption. Differences between processes in animals and humans are highlighted. The limitations of conclusions drawn from animal studies are then discussed with reference to human dental conditions. The differing forms of overeruption in humans are described and the treatment options for overerupted teeth, including prevention of the situation arising, are provided with a discussion of the quality of the evidence base behind these.

Animals↗
PubMed2004

Epidemiological studies of tooth wear and dental erosion in 14-year-old children in North West England. Part 1: The relationship with water fluoridation and social deprivation.

OBJECTIVE: The effect of water fluoridation upon dental erosion/tooth wear in the UK has not been investigated. This study aimed to compare the prevalence of tooth wear in 14-year-old schoolchildren in non-fluoridated and fluoridated districts of North West (NW) England. The influence of deprivation and tooth brushing was also investigated. DESIGN: A random sample of 10% of the 14-year-old population in NW England was selected and stratified according to fluoridation status as determined from water authority postcode listings. METHODS: Tooth wear was scored on the labial, incisal and palatal/lingual surfaces of the 12 anterior teeth and the occlusal surfaces of the first molars. Enamel wear was scored 0, dentine was scored 1 or 2, dependent on whether less than or more than a third of the surface had exposed dentine. Secondary dentine or pulpal exposure scored 3. Townsend deprivation scores were gained from residential post codes. RESULTS: A total of 2,351 children were examined, of which 637 (27%) lived in the one fluoridated district of South Cheshire and 1,714 (73%) lived in 11 non-fluoridated districts. Fifty-three per cent of the children had exposed dentine with significantly more males affected than females (p<0.001). In the fluoridated district, significantly fewer children had exposed dentine on labial and palatal smooth surfaces (p<0.001) but no differences were found for incisal and occlusal surfaces. The interaction of fluoridation and tooth brushing twice per day resulted in a significant (30%) reduction in erosion. Smooth surface wear was more prevalent in children resident in affluent areas. CONCLUSION: Children in non-fluoridated districts are 1.5 times more likely to have smooth surface wear compared with children in fluoridated districts. Fluoridation and use of fluoridated toothpaste twice a day provide added protection from dental erosion. The risk of tooth wear is greater with increasing affluence.

Adolescent↗
PubMed2005

The Dahl Concept: past, present and future.

The Dahl appliance was described nearly 30 years ago. This removable metal bite platform was used to create inter-occlusal space, in a localised part of the mouth, to facilitate the placement of restorations on worn anterior teeth. The Dahl concept is traditionally associated with the management of worn teeth. However, the same principles can be successfully and safely applied to a variety of clinical situations. This has simplified the management of historically complex problems. The advantages are the preservation of tooth tissue and the long-term benefits that brings. This paper reviews the literature related to the Dahl concept and how the concept has developed. There is a discussion regarding possible future applications and research.

Dental Restoration, Permanent↗
PubMed2006

Aesthetic changes with four anterior units.

Cosmetic dentistry has evolved with the advent of more robust porcelain materials and ever-stronger bonding agents. This series of three articles aims to provide a practical overview of what is now possible both functionally and cosmetically from the preparation of a small number of teeth, through a whole smile, to full mouth rehabilitation. A complete diagnosis is the starting point to planning any cosmetic or functional changes. Guidance is given on the techniques used but adequate training must be considered essential before embarking upon modification in occlusal schemes or even minor adjustments in smile design. Conservative use of porcelain laminate veneers can result in significant aesthetic improvements to a patient's smile and it is not always necessary to prepare all the teeth visible in a smile.

Cementation↗
PubMed2006

Non-carious tooth conditions in children in the UK, 2003.

BACKGROUND: The 2003 Children's Dental Health Survey is the fourth of the 10-yearly surveys of children's oral health. AIM: To report the prevalence of three non-carious tooth conditions in children in the UK. METHOD: A representative sample of children five, eight, 12 and 15 years of age were examined by calibrated examiners in schools across the UK. The dental examination included accidental damage to incisors, tooth surface loss (TSL) and enamel opacities (age 12 only). A postal questionnaire sought parental and child views on marks on teeth which could not be removed by brushing. RESULTS: The proportion of children sustaining accidental damage to permanent incisors decreased to 11% of 12 and 13% of 15-year-olds, but the majority of accidental damage remained untreated. TSL was found on 53% of five-year-olds and on approximately a third of 12 and 15-year-olds. There was a statistically significant change for TSL on permanent teeth at age 15 where 27% upper incisors had TSL palatally in 1993 compared to 33% in 2003. Thirty-four per cent of 12-year-old children had enamel opacities on one or more of their teeth compared with 36% in 1993. CONCLUSIONS: Tooth surface loss remains a common finding in children in the UK. A large proportion of accidental damage to teeth remains untreated.

Adolescent↗
PubMed2004

The prevalence of non-carious cervical lesions in permanent dentition.

A non-carious cervical lesion (NCCL) is the loss of hard dental tissue on the neck of the tooth, most frequently located on the vestibular plane. Causal agents are diverse and mutually interrelated. In the present study all vestibular NCCL were observed and recorded by the tooth wear index (TWI). The aim of the study was to determine the prevalence and severity of NCCL. For this purpose, 18555 teeth from the permanent dentition were examined in a population from the city of Rijeka, Croatia. Subjects were divided into six age groups. The teeth with most NCCL were the lower premolars, which also had the largest percentage of higher index levels, indicating the greater severity of the lesions. The most frequent index level was 1, and the prevalence and severity of the lesions increased with age.

Adolescent↗
PubMed1998

The role of cuspal flexure in the development of abfraction lesions: a finite element study.

A tooth flexure mechanism has been proposed over the past 15 yr to explain non-carious cervical tooth loss. It is well established that cavity preparation weakens a tooth, resulting in more cuspal movement under occlusal load. The aim of this study was to investigate the effect that an occlusal restoration would have on the stress profile in the cervical region of a lower second premolar using two-dimensional finite element stress analysis. Under an eccentric 100 N occlusal load, a premolar with an occlusal amalgam restoration showed peak tensile and shear stresses in the buccal cervical region that were in excess of the known failure stress for enamel. Increases in the cavity depth of the occlusal amalgam restoration were found to increase cervical stress more than increases in cavity width. It was concluded that the weakening effect of cavity preparation may contribute to the development of non-carious cervical tooth loss.

Bicuspid↗
PubMed2001

The pattern of toothwear amongst 12-18-year-old students in a Nigerian population.

The purpose of this study was to investigate the pattern of toothwear in the permanent teeth of 12-18-year-old Nigerian students. The study group comprised 176 individuals (67 males and 109 females) who had no carious cavity, restoration or fracture on any of their permanent teeth. Within the group, 86% had tooth surface loss that was limited to enamel and dentine. No statistically significant differences were observed between the sexes. The most commonly affected tooth was the lower first molar, while the occlusal surface was the most frequently involved. One student had toothwear with a predominantly erosive component as a result of frequent ingestion of low pH drinks, while another displayed toothbrush abrasion. Of those with toothwear, two (13.4%) had parafunctional activities. The cause of toothwear in 73.2% of the study population could not be ascertained. Some of it may be connected with the coarse, abrasive diets that many of the students admitted to consuming on a regular basis.

Adolescent↗
PubMed2001

An in vitro wear study of posterior denture tooth materials on human enamel.

This in vitro study evaluated the wear effects of five posterior denture tooth materials on human enamel. The tooth specimen was cusp shaped and enamel specimen was formed as a 10 C 10 C 5 mm plate. All material-enamel combinations were tested using a machine designed to produce sliding contact 20 C 104 times at 60 cycles min-1 and a 4-mm sliding distance per stroke in the bucco-lingual direction under a load of 1 kg. Wear analysis was measured as the total height loss of each combination. In addition, the surface roughness (Ra) of each worn specimen was also evaluated. The least total height loss occurred with poly (methyl methacrylate) (PMMA) enamel pair, and the greatest did with porcelain (Po)-enamel pair. The lowest compound Ra value was measured in high-strength resin (HR)-enamel pair, and the highest in Po-enamel pair. These findings suggest that the best combination is PMMA-enamel, and the poorest combination is Po-enamel.

Acrylates↗
PubMed2001

A study of the effects of chewing patterns on occlusal wear.

The chewing cycle is a functional movement, closely related to occlusion, the neuromuscular system and the central nervous system. Although actual chewing paths are complicated and vary from individual to individual, there are two typical patterns. One is more vertical in nature and is similar to a chopping movement. The other is a more lateral type that is similar to a grinding movement. The purpose of this study was to evaluate the effects of chewing patterns on occlusal wear. Fifteen subjects exhibiting a chopping-chewing pattern and 15 subjects exhibiting a grinding-chewing pattern were selected using a jaw tracking device. The occlusal wear values, obtained by both ordinal and Woda's arbitrary scales, and frequencies of non-working facets were calculated for each group. The occlusal wear values in all teeth and in each segment, obtained by the use of the ordinal scale did not vary significantly between the chopping and the grinding type group. However, the occlusal wear values of the grinding type group in all teeth and in posterior teeth segments, obtained by the use of Woda's arbitrary scale, were significantly greater than those of the chopping type group. Frequencies of non-working facets in posterior teeth showed no significant differences between the groups.

Adult↗
PubMed2002

The effect of variation in occlusal loading on the development of abfraction lesions: a finite element study.

Abfraction or non-carious cervical tooth loss is poorly understood and one factor thought to contribute to the development of these lesions is the effect of occlusal loading. The aim of this study was to examine the effect that varying the position of an occlusal load would have on the stress contour in the cervical region of a lower second premolar using a two-dimensional plane strain finite element model. A 500 N load was applied vertically to either of the cusp tips or in various positions along the cuspal inclines. It was found that loads applied to the inner aspects of the buccal or the lingual cuspal inclines produced maximum principal stress values of up to 358 MPa that exceed the known failure stresses for enamel.

Bite Force↗
PubMed2003

A comparison of the erosive susceptibility of cuspal and cervical enamel using an ultrasonic technique.

The aim of this study was to compare the erosive susceptibility of cuspal and cervical enamel from human premolar and molar teeth. Small blocks of cervical and cuspal enamel were immersed in either orange juice or Coca-Cola at 37 degrees C and the surface enamel loss was measured by surfometry at 1, 2, 3 and 4 h. Additionally, once-hourly enamel loss was measured, specimens were placed in an ultrasonic bath containing water and ultrasonicated for 5 s to determine the degree of surface demineralization. A further set of enamel specimens were prepared that had 100 microm of the enamel surface removed. This was done to remove the hypermineralized surface enamel layer. Surface enamel loss in orange juice at 4 h, following ultrasonication, ranged from 13.2 to 16.9 microm. The surface enamel loss in Coca-Cola at 4 h, following ultrasonication, ranged from 21.7 to 27.5 microm. Subsurface enamel loss in orange juice at 4 h, following ultrasonication, ranged from 10.7 to 16.1 microm. The subsurface enamel loss in Coca-Cola for 4 h, following ultrasonication, ranged from 36.8 to 37.2 microm. Overall, little difference was found in the erosive susceptibility of cervical and cuspal enamel to the effects of orange juice or Coca-Cola.

Bicuspid↗
PubMed2002

Tooth wear patterns in the deciduous dentition.

Tooth wear is common in the deciduous dentition. A recent study suggests that tooth wear in the deciduous dentition is related to subsequent tooth wear in adults, so that early identification of factors related to tooth wear could be of long-term benefit. The purposes of this study were to describe patterns of tooth wear in the deciduous dentition and to relate tooth wear to occlusal characteristics and longitudinal dietary patterns. Data were collected as part of a longitudinal study of a cohort of children recruited at birth from Iowa hospitals. Stone casts were obtained in the deciduous dentition stage, and 355 children, 4 to 5 years old, met the selection criteria. Tooth wear was categorized for each tooth as none, mild, moderate, or severe, and related to occlusal characteristics and longitudinal data on fruit juice and soft drink consumption. All children exhibited some tooth wear on at least 1 tooth, and nearly 16% of them had at least 1 tooth with severe wear. Tooth wear was generally more severe in the maxillary arch and the anterior teeth. Severe tooth wear on the molars was significantly related to posterior crossbites, but severe tooth wear on the incisors was related to Class III canine relationships. There were no statistically significant relationships between tooth wear and soft drink or fruit juice consumption. Based on our results, we concluded that mild tooth wear is universal in the deciduous dentition, but only a few occlusal factors are related to severe tooth wear. Tooth wear was not related to any dietary patterns we investigated.

Analysis of Variance↗
PubMed2001

A reliability study of clinical tooth wear measurements.

STATEMENT OF PROBLEM: Most studies examining tooth wear severity have been performed on dental casts. This indirect approach has limited applicability to dental practice because during the assessment of the casts, the identification of dentin exposure is difficult or even impossible. PURPOSE OF STUDY: The purpose of this study was to assess occlusal and incisal tooth wear clinically to determine the reliability of the assessment procedure and to establish the influence of selected relevant clinical variables (dental quadrant, tooth type, and severity of wear) on the reliability. MATERIAL AND METHODS: Forty-five volunteers (17 men, 28 women; mean age 33.7 +/- 10.7 years), 32 with temporomandibular disorders and 13 free from signs and symptoms of such disorders, were evaluated on 4 occasions. Two trained observers graded tooth wear at 2 different points in time with a 5-point ordinal scale developed for use in this study. The inter-rater and intra-rater reliability of the scale was expressed as Cohen's kappa. The influence of 2 clinical variables, dental quadrant and tooth type, on the values of kappa was tested with 1-way analysis of variance and post hoc Bonferroni tests. Probability levels of P< .05 were considered statistically significant. The influence of the final clinical variable, severity of wear, was assessed qualitatively. RESULTS: The overall values of the inter-rater and intra-rater reliability were substantial (kappa = 0.632 to 0.678). The clinical variable dental quadrant did not influence the kappa values, whereas the inter-rater reliability during the first session was better for incisors and canines than for premolars (1-way analysis of variance: F(3,23)=4.577, P=.012; post hoc Bonferroni tests: P=.030 and.036). Qualitative assessment of severity of wear indicated that the more advanced the tooth wear, the more reliably it could be graded. CONCLUSION: By means of the developed 5-point ordinal scale and within the limitations of this study, it was concluded that tooth wear can be assessed reliably in the clinical dental setting.

Adult↗
PubMed1998

Bulimia and tooth erosion.

Eating disorders are often associated with regurgitation of gastric contents into the mouth and dental erosion. In this study the dental status was evaluated in bulimic patients. Thirty-five bulimics, diagnosed in the Outpatient Departments of Psychiatry and Adolescent Psychiatry of the University Central Hospital in Helsinki, and 105 controls matched for age, sex, and educational level were examined clinically, and the factors associated with dental erosion and caries were evaluated in an interview. Severe dental erosion and dental caries were significantly commoner among bulimics than controls. Bulimics commonly had a low salivary flow rate, but other apparent risk factors of dental erosion did not differ from those of controls. A feeling of dry mouth was commoner among bulimics than controls, and bulimics had an increased tooth sensitivity to cold and touch. More should be done to protect teeth from dental erosion among bulimics, because loss of tooth tissue remains even if the eating disorder disappears.

Adult↗