Tooth wear | |
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Other names | Non-carious tooth substance loss |
Lower teeth shows signs of tooth wear likely caused by erosion | |
Specialty | Dentistry |
Tooth wear refers to loss of tooth substance by means other than dental caries.[1] Tooth wear is a very common condition that occurs in approximately 97% of the population.[2] 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.[3] Tooth wear varies substantially between people and groups, with extreme attrition and enamel fractures common in archaeological samples, and erosion more common today.[3][4][5]
Tooth wear is predominantly the result of a combination of three processes; attrition, abrasion and erosion.[3] These forms of tooth wear can further lead to a condition known as abfraction,[3] where by tooth tissue is 'fractured' due to stress lesions caused by extrinsic forces on the enamel. Tooth wear is a complex, multi-factorial problem and there is often difficulty identifying a single causative factor.[3] However, tooth wear is often a combination of the above processes. Many clinicians, therefore, make diagnoses such as "tooth wear with a major element of attrition", or "tooth wear with a major element of erosion" to reflect this. This makes the diagnosis and management difficult.[1] Therefore, it is important to distinguish between these various types of tooth wear, provide an insight into diagnosis, risk factors, and causative factors, in order to implement appropriate interventions.[1] Tooth wear evaluation system (TWES) may help determine the most likely aetiology of tooth wear.[6] Heavy tooth wear is commonly found on the occlusal (chewing) surface, but non-carious cervical lesions from tooth wear are also common in some populations.[7]
Multiple indices have been developed in order to assess and record the degree of tooth wear, the earliest was that by Paul Broca.[8] In 1984, Smith and Knight developed the tooth wear index (TWI) where four visible surfaces (buccal, cervical, lingual, occlusal-incisal) of all teeth present are scored for wear, regardless of the cause.[8] A more recent index Basic Erosive Wear Examination (BEWE) from 2008 by Bartlett et al., is now also in use.[9]