Tooth Wear and Erosion in Dentistry

Tooth wear may be caused by attrition, abrasion or erosion, or by any combination of the three processes. Attrition is caused by tooth-to-tooth contact; abrasion by object-to-tooth contact (e.g. tooth brushing); and erosion by a chemical process not directly associated either with mechanical or chemical traumatic factors, or with dental caries.
Tooth Wear and Erosion

Dental Erosion

The prevalence of dental erosion was measured for the first time on a national scale in a survey of children's dental health in the United Kingdom in 1993. Over 50% of 5- and 6-year-old children were reported to have eroded surfaces on one or more primary incisors, and in almost a quarter of these children erosion had progressed into dentine or pulp. Erosion generally involved two-thirds or more of the affected surfaces. Erosion was also found in the permanent dentition, 51 % of 14-year-old children being affected. These findings, however, should be considered with caution, because it was stated that the dentists who examined the children had difficulty in agreeing whether or not erosion was present, and in differentiating between erosion and attrition. Since attrition of primary teeth is normal in the late primary dentition, it is possible that a proportion of the lesions  reported as erosion were in fact attrition.
Dental erosion may be caused by extrinsic or intrinsic factors. Extrinsic factors include acidic foods  and drinks, especially fruit drinks and carbonated beverages, the consumption of which has increased dramatically since the 1950s. A high proportion of soft drinks consumed in the UK is consumed by young children, 42% being drunk by those aged below 9 years. Excessive consumption of acidic foods and drinks is especially hazardous in the primary dentition because the enamel and dentine are thinner than in the permanent dentition. Intrinsic causes of dental erosion include recurrent vomiting resulting from an abnormality of the gastrointestinal tract or from psychological disorders such as anorexia or bulimia nervosa.

Treatment

Vigilance is needed to detect early subtle changes in the enamel that are indicative of erosion, so that appropriate intervention can be made.
l. Take a careful social, dental and medical history, and ask the parent to complete a 3-day diet record.
2. If dietary factors are identified, give appropriate advice: to reduce the frequency of intake of erosive food and drink, to confine drinks to mealtimes, and to drink acidic beverages through a straw to reduce the erosive effect on anterior teeth, which arc usually the most severely affected.
3. Give oral hygiene instruction. Ensure that an appropriate toothbrush and a correct technique are used. Advise against brushing immediately after consuming an acidic food or drink as this is likely to accelerate loss of enamel by abrasion.
4. lf gastric regurgitation is a problem the patient should be under the care of a physician. Advise the
use of an alkaline mouthwash, to be used immediately after regurgitation to neutralize the gastric acid. Alternatively, make a mouthguard, to be worn at times of high risk, which can be loaded with an alkali such as magnesium hydroxide or sodium bicarbonate. At other times the mouthguard can be used for self-application of fluoride gel.
5. lf tooth sensitivity is a problem, advise use of a fluoride mouthrinse and a toothpaste containing  strontium chloride and fluoride, and apply topical fluoride varnish.
6. The arrest or progress of erosion can be monitored using standardized photographs and study models cast from silicone impressions.
7. Only when it is certain that the cause has been identified and removed should consideration be given to restoring the affected teeth, otherwise erosion will merely continue around the restorations. Restoration of anterior teeth usually involves the use of  veneers, either composite resin or porcelain. However, if buccal and lingual surfaces of teeth are affected full coverage crowns may be indicated.

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  1. Thanks a lot for great information.

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  2. Thanks. you are doing great work.

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