Dental attrition

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Loss of tooth characteristics Loss of tooth characteristics.jpg
Loss of tooth characteristics

Dental attrition is a type of tooth wear caused by tooth-to-tooth contact, [1] resulting in loss of tooth tissue, usually starting at the incisal or occlusal surfaces. Tooth wear is a physiological process and is commonly seen as a normal part of aging. Advanced and excessive wear and tooth surface loss can be defined as pathological in nature, requiring intervention by a dental practitioner. The pathological wear of the tooth surface can be caused by bruxism, which is clenching and grinding of the teeth. If the attrition is severe, the enamel can be completely worn away leaving underlying dentin exposed, resulting in an increased risk of dental caries and dentin hypersensitivity. It is best to identify pathological attrition at an early stage to prevent unnecessary loss of tooth structure as enamel does not regenerate.

Contents

Signs and symptoms

Typical appearance of attrition Typical Appearance of Attrition.JPG
Typical appearance of attrition

Attrition occurs as a result of opposing tooth surfaces contacting. The contact can affect cuspal, incisal and proximal surface areas. [2]

Indications of attrition can include: [3]

Causes

Dental attrition is tooth wear caused by tooth to tooth contact. Well-defined wear facets appear on tooth cusps or ridges. This can be caused by several factors, including parafunctional habits such as bruxism or clenching, developmental defects, hard or rough-textured diet, and absence of posterior teeth support. If the natural teeth oppose or occlude with porcelain restorations, then accelerated attrition of the natural teeth may result. Similarly, when an edge to edge class III incisal relationship is present dental attrition can occur. [4] The underlying cause of attrition may be related to the temporomandibular joint as a disruption or dysfunction of the joint can result in compromised function and complications such as bruxism and clenching of the jaw may arise [5]

The etiology of dental attrition is multifactorial one of the most common causes of attrition is bruxism, one of the major causes being the use of MDMA (ecstasy) and various other related entactogenic drugs. Bruxism is the para-functional movement of the mandible, occurring during the day or night. It can be associated with presence of audible sound when clenching or grinding the teeth. This is usually reported by parents or partners if the grinding occurs during sleep. In some cases, dental erosion is also associated with severe dental attrition. Dental erosion is tooth surface loss caused by extrinsic or intrinsic forms of acid. Extrinsic erosion is due to a highly acidic diet, while intrinsic erosion is caused by regurgitation of gastric acids. [6] Erosion softens the dental hard tissues making them more susceptible to attrition. Thus, if erosion and bruxism both exist, surface loss due to attrition is faster. Severe attrition in young patients is usually associated with erosive factors in their diets. [7] The different physiological processes of tooth wear (abrasion, attrition and erosion) usually occur simultaneously and rarely work individually. Therefore, it is important to understand these tooth wear processes and their interactions to determine causes of tooth surface loss. [8] Demineralization of the tooth surface due to acids can cause occlusal erosion as well as attrition. Wedge-shaped cervical lesions are commonly found in association with occlusal erosion and attrition. [9]

Tooth wear is typically seen in the elderly and can be referred to as a natural aging process. Attrition, abrasion, erosion or a combination of these factors are the main reasons for tooth wear in elderly people who retain their natural teeth. This tooth wear can be pathological or physiological. [10] The number of teeth with incisal or occlusal wear increases with age. [11] [12] Attrition occurs in 1 in 3 adolescents. [12]

In addition to other occlusal factors, independent variables such as male gender, bruxism, and loss of molar occlusal contact, edge-to-edge relation of incisors, unilateral buccolingual cusp-to-cusp relation, and unemployment have been identified in affecting occlusal wear. [13] Similarly, anterior cross-bite, unilateral posterior cross-bite, and anterior crowding have been found to be protective factors for high occlusal wear levels.

Prevention and management

To manage the condition, it is important to first diagnose it, describing the type of tooth surface loss, its severity and location. [14] Early diagnosis is essential to ensure tooth wear has not progressed past the point of restoration. [14] [15] A thorough examination is required, because it might give explanation to the aetiology of the TSL. [16]

The examination should include assessment of:

It is important to record severity of tooth wear for monitoring purposes, helping to differentiate between pathological and physiological tooth surface loss. It is essential to determine whether the tooth wear is ongoing or has stabilized. [17] However where generalised, the underlying cause can be assumed to be bruxism. In fast-progressing cases, there is commonly a coexisting erosive diet contributing to tooth surface loss. [17]

Prevention

When a diagnosis of bruxism has been confirmed, it is recommended that the patient buy a full-coverage acrylic occlusal splint, such as a Michigan Splint or Tanner appliance, to prevent further bruxism. Patients must be monitored closely, with clinical photographs 6–12 monthly to evaluate if the tooth surface loss is being prevented.

Treatment

Cosmetic or functional intervention may be required if tooth surface loss is pathological or if there has been advanced loss of tooth structure. [18] The first stage of treatment involves managing any associated conditions, such as fractured teeth or sharp cusps or incisal edges. These can be resolved by restoring and polishing sharp cusps. Then, desensitizing agents such as topical fluoride varnishes can be applied, and at home desensitising toothpastes recommended. Many restorative options have been proposed, such as direct composite restorations, bonded cast metal restorations, removable partial dentures, orthodontic treatment, crown lengthening procedures and protective splints. [18] [19] The decision to restore the dentition depends on the wants and needs of the patient, the severity of tooth surface loss and whether tooth surface loss is active. [16] The use of adhesive materials to replace lost tooth structure can be performed as a conservative and cost-effective approach before a more permanent solution of crowns or veneers is considered. [17]

See also

Related Research Articles

<span class="mw-page-title-main">Human tooth</span> Calcified whitish structure in humans mouths used to break down food

Human teeth function to mechanically break down items of food by cutting and crushing them in preparation for swallowing and digesting. As such, they are considered part of the human digestive system. Humans have four types of teeth: incisors, canines, premolars, and molars, which each have a specific function. The incisors cut the food, the canines tear the food and the molars and premolars crush the food. The roots of teeth are embedded in the maxilla or the mandible and are covered by gums. Teeth are made of multiple tissues of varying density and hardness.

<span class="mw-page-title-main">Bruxism</span> Disorder that involves involuntarily grinding or clenching of the teeth

Bruxism is excessive teeth grinding or jaw clenching. It is an oral parafunctional activity; i.e., it is unrelated to normal function such as eating or talking. Bruxism is a common behavior; reports of prevalence range from 8% to 31% in the general population. Several symptoms are commonly associated with bruxism, including aching jaw muscles, headaches, hypersensitive teeth, tooth wear, and damage to dental restorations. Symptoms may be minimal, without patient awareness of the condition. If nothing is done, after a while many teeth start wearing down until the whole tooth is gone.

<span class="mw-page-title-main">Tooth enamel</span> Major tissue that makes up part of the tooth in humans and many other animals

Tooth enamel is one of the four major tissues that make up the tooth in humans and many other animals, including some species of fish. It makes up the normally visible part of the tooth, covering the crown. The other major tissues are dentin, cementum, and dental pulp. It is a very hard, white to off-white, highly mineralised substance that acts as a barrier to protect the tooth but can become susceptible to degradation, especially by acids from food and drink. Calcium hardens the tooth enamel. In rare circumstances enamel fails to form, leaving the underlying dentin exposed on the surface.

<span class="mw-page-title-main">Mouthguard</span> Protective device for the teeth and gums to avoid injury to them

A mouthguard is a protective device for the mouth that covers the teeth and gums to prevent and reduce injury to the teeth, arches, lips and gums. An effective mouthguard is like a crash helmet for teeth and jaws. It also prevents the jaws coming together fully, thereby reducing the risk of jaw joint injuries and concussion. A mouthguard is most often used to prevent injury in contact sports, as a treatment for bruxism or TMD, or as part of certain dental procedures, such as tooth bleaching or sleep apnea treatment. Depending on the application, it may also be called a mouth protector, mouth piece, gumshield, gumguard, nightguard, occlusal splint, bite splint, or bite plane. The dentists who specialise in sports dentistry fabricate mouthguards.

<span class="mw-page-title-main">Crown (dental restoration)</span> Dental prosthetic that recreates the visible portion of a tooth

In dentistry, a crown or a dental cap is a type of dental restoration that completely caps or encircles a tooth or dental implant. A crown may be needed when a large dental cavity threatens the health of a tooth. A crown is typically bonded to the tooth by dental cement. They can be made from various materials, which are usually fabricated using indirect methods. Crowns are used to improve the strength or appearance of teeth and to halt deterioration. While beneficial to dental health, the procedure and materials can be costly.

<span class="mw-page-title-main">Dental abrasion</span> Medical condition

Abrasion is the non-carious, mechanical wear of tooth from interaction with objects other than tooth-tooth contact. It most commonly affects the premolars and canines, usually along the cervical margins. Based on clinical surveys, studies have shown that abrasion is the most common but not the sole aetiological factor for development of non-carious cervical lesions (NCCL) and is most frequently caused by incorrect toothbrushing technique.

<span class="mw-page-title-main">Dental erosion</span> Medical condition

Acid erosion is a type of tooth wear. It is defined as the irreversible loss of tooth structure due to chemical dissolution by acids not of bacterial origin. Dental erosion is the most common chronic condition of children ages 5–17, although it is only relatively recently that it has been recognised as a dental health problem. There is generally widespread ignorance of the damaging effects of acid erosion; this is particularly the case with erosion due to consumption of fruit juices because they tend to be considered as healthy. Acid erosion begins initially in the enamel, causing it to become thin, and can progress into dentin, giving the tooth a dull yellow appearance and leading to dentin hypersensitivity.

<span class="mw-page-title-main">Abfraction</span> Loss of tooth structure not caused by tooth decay

Abfraction is a theoretical concept explaining a loss of tooth structure not caused by tooth decay. It is suggested that these lesions are caused by forces placed on the teeth during biting, eating, chewing and grinding; the enamel, especially at the cementoenamel junction (CEJ), undergoes large amounts of stress, causing micro fractures and tooth tissue loss. Abfraction appears to be a modern condition, with examples of non-carious cervical lesions in the archaeological record typically caused by other factors.

<span class="mw-page-title-main">Dentinogenesis imperfecta</span> Medical condition

Dentinogenesis imperfecta (DI) is a genetic disorder of tooth development. It is inherited in an autosomal dominant pattern, as a result of mutations on chromosome 4q21, in the dentine sialophosphoprotein gene (DSPP). It is one of the most frequently occurring autosomal dominant features in humans. Dentinogenesis imperfecta affects an estimated 1 in 6,000-8,000 people.

Dens evaginatus is a rare odontogenic developmental anomaly that is found in teeth where the outer surface appears to form an extra bump or cusp.

<span class="mw-page-title-main">Talon cusp</span> Rare dental anomaly resulting in teeth having more than one cusp

Talon cusp is a rare dental anomaly resulting in an extra cusp or cusp-like projection on an anterior tooth, located on the inside surface of the affected tooth. Sometimes it can also be found on the facial surface of the anterior tooth.

Dental anatomy is a field of anatomy dedicated to the study of human tooth structures. The development, appearance, and classification of teeth fall within its purview. Tooth formation begins before birth, and the teeth's eventual morphology is dictated during this time. Dental anatomy is also a taxonomical science: it is concerned with the naming of teeth and the structures of which they are made, this information serving a practical purpose in dental treatment.

Occlusion, in a dental context, means simply the contact between teeth. More technically, it is the relationship between the maxillary (upper) and mandibular (lower) teeth when they approach each other, as occurs during chewing or at rest.

Dental pertains to the teeth, including dentistry. Topics related to the dentistry, the human mouth and teeth include:

<span class="mw-page-title-main">Cracked tooth syndrome</span> Medical condition

Cracked tooth syndrome (CTS) is where a tooth has incompletely cracked but no part of the tooth has yet broken off. Sometimes it is described as a greenstick fracture. The symptoms are very variable, making it a notoriously difficult condition to diagnose.

The Dahl effect or Dahl concept is used in dentistry where a localized appliance or localized restoration is used to increase the available interocclusal space for restorations.

<span class="mw-page-title-main">Tooth wear</span> Medical condition

Tooth wear refers to loss of tooth substance by means other than dental caries. Tooth wear is a very common condition that occurs in approximately 97% of the population. This is a normal physiological process occurring throughout life; but with increasing lifespan of individuals and increasing retention of teeth for life, the incidence of non-carious tooth surface loss has also shown a rise. Tooth wear varies substantially between people and groups, with extreme attrition and enamel fractures common in archaeological samples, and erosion more common today.

<span class="mw-page-title-main">Tooth mobility</span> Medical condition

Tooth mobility is the horizontal or vertical displacement of a tooth beyond its normal physiological boundaries around the gingival area, i.e. the medical term for a loose tooth.

<span class="mw-page-title-main">Non-carious cervical lesions</span> Dental condition

Non-carious cervical lesions (NCCLs) are a group of lesions that are characterised by a loss of hard dental tissue at the cementoenamel junction (CEJ) region at the neck of the tooth, without the action of microorganisms or inflammatory processes. These lesions vary in shape from regular depressions that look like a dome or a cup, to deep wedge-shaped defects with the apex pointing inwards. NCCLs can occur either above or below the level of the gum, at any of the surfaces of the teeth.

Occlusion according to The Glossary of Prosthodontic Terms Ninth Edition is defined as 'the static relationship between the incising or masticating surfaces of the maxillary or mandibular teeth or tooth analogues'.

References

  1. ↑ Darby, M., Walsh, Margaret, & EBL ebook Library. (2009). Dental Hygiene Theory and Practice. (3rd ed.). London: Elsevier Health Sciences.
  2. ↑ Davies, SJ; Gray, RJM (2002). "Management of tooth surface loss". British Dental Journal 192 (1): 11-12
  3. ↑ Wazani BE, BE; Dodd, MN; Milosevic, A (2012). "The signs and symptoms of tooth wear in a referred group of patients". British Dental Journal 213 (6): 17-27
  4. ↑ Meshramkar R, Lekha K, Nadiger R (Jan–Mar 2012). "Tooth wear, etiology, diagnosis and its management in elderly: A literature review". International Journal of Prosthodontics and Restorative Dentistry 2 (1): 38–41.
  5. ↑ Yadav, S. (2011). A study on prevalence of dental attrition and its relation to factors of age, gender and to the signs of TMJ dysfunction. Journal of Indian Prosthodontist Society, 11 (2), 98-105.
  6. ↑ Brunton, P.A. (2003). Prevention in the Older Dentate Patient. British Dental Journal, 195 (5), 239.
  7. ↑ Khan F, Young W G, Daley TJ. Dental erosion and bruxism. A tooth wear analysis from South East Queensland. Aust Dent J. 1998. 43 (2):117-27.
  8. ↑ Shellis RP, Addy M. The interactions between attrition, abrasion and erosion in tooth wear. Monogr Oral Sci. 2014;25:32-45. doi : 10.1159/000359936.
  9. ↑ Khan F, Young WG, Shahabi S, Daley TJ. Dental cervical lesions associated with occlusal erosion and attrition. Aust Dent J. 1999 Sep;44(3):176-86.
  10. ↑ Burke FM, McKenna G. Toothwear and the older patient. Dent Update. 2011 Apr;38(3):165-8.
  11. ↑ Hugoson A1, Ekfeldt A, Koch G, Hallonsten AL. Incisal and occlusal tooth wear in children and adolescents in a Swedish population. Acta Odontol Scand. 1996 Aug;54(4):263-70.
  12. 1 2 Casanova-Rosado JF, Medina-Solís CE, Vallejos-Sánchez AA, Casanova-Rosado AJ, Maupomé G, Avila-Burgos L. Dental attrition and associated factors in adolescents 14 to 19 years of age: a pilot study. Int J Prosthodont. 2005 Nov-Dec;18(6):516-9.
  13. ↑ Bernhardt O, Gesch D, Splieth C, Schwahn C, Mack F, Kocher T, Meyer G, John U, Kordass B. Risk factors for high occlusal wear scores in a population-based sample: results of the Study of Health in Pomerania (SHIP). Int J Prosthodont. 2004 May-Jun;17(3):333-9.
  14. 1 2 Mehta, SB; Banerjji, S; Millar, BJ; Suarez-Feito, JM (2014). "Current Concepts on the Management of Tooth Wear: Part 1". British Dentistry Journal. 212 (1): 17–27.
  15. ↑ Arie Van't, S; Cees, MK; Nico, HJC (2007). "Attrition, Occlusion, (Dys)Function and Intervention: a Systematic Review". Clinical Oral Implants Research. 18 (3): 117–126. doi:10.1111/j.1600-0501.2007.01458.x. PMID   17594376.
  16. 1 2 David, WB (2005). "The Role of Erosion in Tooth Wear: Aetiology, Prevention and Management". International Dental Journal. 55 (4): 277–284. doi:10.1111/j.1875-595X.2005.tb00065.x. PMID   16167606.
  17. 1 2 3 Myeyers, I (2012). "Attrition and Erosion: Assessment and Diagnosis". Annals of the Royal Australasian College of Dental Surgeons. 21: 94–96. PMID   24783839.
  18. 1 2 Sato, S; Hotta, TH; Pedrazzi, V (2000). "Removable Occlusal Overlay Splint in the Management of Tooth Wear: A Clinical Report". The Journal of Prosthetic Dentistry. 83 (4): 392–395. doi:10.1016/s0022-3913(00)70032-1. PMID   10756287.
  19. ↑ Sameni A, Borzabadi-Farahani A, Moshaverinia A (2016). "Rehabilitation of Worn Dentition Using Adhesive and Implant Dentistry". Dentistry Today. 35 (6): 110–111. PMID   27424397.
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