Contemporary Issues in the Management of Tooth Wear

Fifty question-and-answer flashcards covering definitions, epidemiology, causes, clinical features, effects, prevention, and management of tooth wear, designed for efficient exam review.

What term did Eccles propose for pathological tooth tissue loss when the exact cause is unclear?

‘Tooth surface loss’ (TSL).

Why did Smith & Knight advocate using the term “tooth wear” rather than “TSL”?

They felt 'TSL' belittled the severity of the problem, so ‘tooth wear’ should encompass all three main aetiologies.

What is the general definition of ‘tooth wear/tooth surface loss’?

Pathological loss of tooth tissue by a process other than dental caries.

Name the four principal processes that can cause tooth wear.

Attrition, abrasion, erosion, and abfraction.

Define attrition.

Loss of tooth substance caused by tooth-to-tooth contact during mastication or parafunction.

Define abrasion.

Loss of tooth substance caused by interaction between teeth and external materials (e.g., toothbrush).

Define erosion.

Progressive loss of hard tissues by chemical (acidic) processes not involving bacteria; physicochemical dissolution.

Define abfraction.

Pathological loss of tooth substance from biomechanical loading that causes flexure and failure at a site away from the load.

According to Oginni & Olusile (2002), what was the combined prevalence of tooth wear in Nigeria?

24.9 % of patients surveyed.

In the same Nigerian study, which type of tooth wear was most common?

Attrition (54.4 %).

What percentage of erosion cases was reported in the Nigerian data?

Only 1.3 %—the least common form.

What was the combined prevalence of tooth wear in the London study by Poynter & Wright (1990)?

82 % of subjects examined.

Among Europeans, which process is the major cause of tooth wear?

Dental erosion, linked to lifestyle, habits, and diet.

Which popular Nigerian dietary habit may increase occlusal attrition?

Crushing “biscuit bones.”

What parafunctional habit frequently contributes to attrition?

Bruxism (teeth grinding).

Which tooth-brushing motion creates two to three times more abrasion than vertical brushing?

Horizontal scrubbing technique.

What proportion of patients in Oginni’s study used hard-bristle toothbrushes?

About 72 %.

In right-handed subjects, on which side were more abrasion lesions observed (though not statistically significant)?

Left side.

Give two common extrinsic dietary acids that cause erosion.

Citric acid and phosphoric acid (found in fruit juices and soft drinks).

List two intrinsic medical conditions that can lead to dental erosion.

Bulimia nervosa and gastro-oesophageal reflux disease (GORD).

Which occupation is specifically linked to environmental dental erosion in Nigeria?

Road-side battery technicians (acidic aerosol exposure).

Environmental erosion most commonly affects which tooth surfaces?

Labial surfaces of maxillary and mandibular incisors.

Which tooth surfaces are primarily affected by attrition?

Occlusal and incisal surfaces (sometimes approximal contacts).

When attrition exposes dentine, how is the shape of the wear facet determined?

By the movement and anatomy of the opposing tooth.

How does an early abrasion lesion typically appear?

Small horizontal groove near the cementoenamel junction.

What characteristic shape does a mature abrasion lesion display?

V-shaped with walls meeting at an acute angle axially.

What is the classic clinical appearance of an abfraction lesion?

Sharp, angular, wedge-shaped defect often slightly subgingival with adjacent wear facets.

Extrinsic erosion usually damages which surfaces of the upper anterior teeth?

Labial surfaces, with severity decreasing posteriorly.

Intrinsic erosion typically affects which surfaces of maxillary anterior teeth?

Palatal surfaces (protected labially by lips/tongue).

How can intrinsic erosion make teeth appear on the palatal surface?

As if lightly prepared for full-coverage crowns with a chamfer margin.

Name two common clinical problems produced by advanced tooth wear.

Dentine hypersensitivity and pulpal inflammation/necrosis.

What vertical change may occur in rapidly advancing tooth wear?

Reduced occlusal vertical dimension (OVD).

What overarching principle should guide management of tooth wear?

A lifelong, preventive, cause-oriented approach rather than short-term fixes.

State one practical tip to reduce frequency/severity of acid challenges.

Drink acidic beverages quickly or through a straw, rather than sipping.

How does increased salivary flow help protect against erosion?

Raises buffering capacity and supplies Ca and P ions that inhibit demineralization.

Which daily home-use product enhances remineralization of eroded enamel?

Topical fluoride (e.g., fluoride toothpaste or gels).

What calcium-rich snack can neutralize and buffer oral acids post-challenge?

Hard cheese held in the mouth.

Why should patients avoid brushing immediately after an acidic challenge?

Enamel is softened; brushing increases abrasive loss—rinsing with water is preferable.

Which appliance can both protect against acid exposure and help bruxism patients?

Custom mouthguard (can also carry fluoride gel).

What is the primary appliance used to control nocturnal bruxism-related attrition?

Hard acrylic resin occlusal splint.

List two brushing-related recommendations to prevent abrasion.

Use a soft-bristle brush and adopt a vertical (not horizontal) technique with light force.

How can clinicians objectively monitor the stability or progression of tooth wear over time?

Periodic study casts or clinical photographs compared at recalls.

Give one criterion that justifies restorative intervention for tooth wear.

Progressive, uncontrollable wear altering the OVD or complicating future restoration.

Name two chemical agents used to desensitize exposed dentine.

Sodium fluoride and potassium oxalate (others include Sensodyne paste, varnish, etc.).

Why are bonded composite restorations often preferred for worn teeth?

They are conservative, predictable, and preserve remaining tooth structure.

What is the essence of the Dahl concept introduced in 1975?

Use an anterior bite plane to create inter-occlusal space by allowing posterior tooth eruption.

During direct composite build-up, where is composite first added to raise the OVD?

Cingulum of both canines; patient closes into uncured resin to set new vertical dimension.

Name two contraindications for extensive direct composite build-ups.

Severe periodontal bone loss and short root length.

After anterior bonding raises the OVD, how can clinicians secure posterior space while planning molar restorations?

Place fast-setting contrasting-colour glass ionomer cement on molars at the new VD.

What key message summarizes the conclusions on managing tooth wear?

Because etiologies overlap, management must be multifactorial, minimally invasive, and patient-centred.