Tooth Surface Loss: Types, Causes, and Treatments in Dentistry

Loss of tooth structure (post-developmental)

Loss of tooth structure after complete tooth development by influences beyond caries and traumatic fractures; includes tooth wear and tooth surface loss

Interrelated processes of tooth surface loss

Attrition, abrasion, erosion, abfraction

Attrition

Wearing away of tooth structure during tooth-to-tooth contact or mastication

Attrition — physiologic vs pathologic

Physiologic: slow process starting as soon as teeth contact; becomes pathologic when tooth loss is extensive and affects appearance and function

Attrition — surfaces affected

Incisal, occlusal, and interproximal surfaces; occurs in both primary and permanent dentition

Attrition — clinical appearance

Flattening of mamelons on anterior teeth and occlusal cusps on molars; wear facets match opposing teeth; large, flat, smooth, and shiny

Factors that accelerate rate of attrition

Poor quality or absent enamel, premature occlusal contacts, abrasives, erosion, grinding, acidic diet

Bruxism

Grinding of teeth together for nonfunctional purposes

Bruxism — features

Severity related to intensity of grinding; visible wear facets; may cause muscle problems, cheek biting, TMJ issues, tooth mobility and sensitivity; causes unclear

Bruxism — treatment

Occlusal interferences (adjustment) and acrylic splint

Abrasion

Pathologic wearing away of tooth structure or restoration due to a repetitive mechanical habit

Abrasion — location and process

Most common on exposed root surfaces; slow process — dentin responds by laying down secondary dentin

Demastication

Accelerated tooth loss due to both attrition and abrasion combined

Abrasion — clinical description

Horizontal wear of cervical aspect or root surface in areas of gingival recession

Abrasion — causes

Toothbrushing with toothpaste and horizontal movements; habits like bobby pins, needles/pins, musicians, pipe smokers

Abrasion — consequence

Can lead to exposed dentin and hypersensitivity; requires clinical correlation and restorative dental treatment

Erosion

Loss of tooth structure resulting from chemical action without bacterial involvement

Erosion — surfaces affected

Smooth facial or lingual surfaces, proximal and occlusal surfaces; areas appear smooth and polished, affecting several teeth; tooth structure lost around restorations

Erosion — dietary/occupational causes

Seen in patients who work with acids; low pH diet such as soft drinks and lemons

Bulimia and erosion

Erosion caused by vomiting

Perimolysis

Erosion due to gastric secretions

Erosion — diagnosis note

Patient history must be correlated; location of erosion will not always identify the cause

Susceptibility to erosion

Quality of enamel, composition of saliva, protective effect of salivary pellicle

Acid sources causing erosion

Foods and drinks; medications (chewable vitamin C, aspirin); poorly monitored swimming pool pH; involuntary/voluntary regurgitation (hiatal hernia, esophagitis, GERD, alcoholism, pregnancy, bulimia, anorexia); industrial environmental exposure

Erosion from bulimia — treatment

Minimize effects with acid-fluoride rinse, rinse with water after vomiting, avoid brushing right after vomiting, full-coverage dental restorations

"Meth mouth"

Severe tooth destruction and erosion pattern associated with methamphetamine use

Abfraction

Loss of tooth structure from occlusal stresses that create repeated tooth flexure, causing failure of enamel and dentin at a location away from the point of loading

Abfraction — mechanism

Occlusal forces applied eccentrically to the tooth concentrate tensile strength at the cervical fulcrum; flexure disrupts chemical bonds in enamel

Treatment and prognosis of tooth surface loss

Multifactorial; failure to recognize interrelationship of these pathoses can lead to inappropriate therapy and failure of repair

Steps in treatment approach

1. Detailed diagnosis, 2. Preventive measures, 3. Long term monitoring; pain and sensitivity require immediate therapy

Natal teeth

Teeth present in newborns

Neonatal teeth

Teeth arising within the first 30 days of life

Natal/neonatal teeth — origin

Prematurely erupted deciduous teeth

Natal teeth — distribution

85% mandibular incisors, 11% maxillary incisors, 4% posterior teeth

Natal teeth — treatment considerations

Mobility creates risk for aspiration (may require extraction); if not mobile, can be retained but may cause soft tissue ulcerations known as Riga-Fede disease