A brief overview of tooth wear

Umair Afzal shares a guide to understanding tooth wear, including the different types, preventative measures and what causes it.

Tooth wear is a topic I found interesting as a student.

Cases like these are increasing in prevalence and can occupy large amounts of a dental professional’s time. This can be complex to manage in later stages, but early treatment can be simple and effective.

Below, I’ll outline the critical areas of knowledge about tooth wear that helped me understand this topic while I was at dental school and discuss what preventative advice can be provided to manage tooth wear in general.

What is tooth wear?

Tooth wear can be called non-carious tooth tissue loss or non-carious tooth surface loss. It is a normal physiological process that occurs throughout life, and it becomes pathological when the rate of loss or degree of destruction is excessive. This can lead to problems with function, aesthetics or sensitivity.

The three main types of tooth wear can be defined as:

Erosion – the irreversible, progressive loss of dental hard tissue by an acidic chemical process not involving bacteria
Abrasion – the wearing away of tooth substance or restoration by a mechanical process other than tooth contact
Attrition – the loss of tooth substance or a restoration caused by tooth-to-tooth contact.

Each subsection can then be described in terms of its aetiology, severity and overall distribution within the oral cavity.

As you get older, evidence of cumulative effects of tooth wear increases. Erosion is also becoming more prevalent in younger age groups through dietary changes, such as increased consumption of acidic drinks.

What does tooth wear look like?

Attrition

This is a slow process, so secondary dentine forms, and is not usually sensitive.

Here, we’d often see things like:

Enamel and dentine wearing at the same rate
Localised facets, flattened cusps and incisal edges
Shiny amalgam in areas of contact
Possible masseteric hypertrophy
Possible fractured cusps and/or restorations
Increased risk of tooth mobility.

Abrasion

This can present as:

Mainly cervical
Sharply defined-margins with a smooth, hard surface
More rounded and shallow if associated with erosion.

This can be caused by:

Toothbrushing with abrasive dentifrices or eating abrasive food particles
Piercings or habits include nail biting, tobacco chewing, pen chewing, pipe smoking or wire stripping
Iatrogenic factors (such as unglazed porcelain).

Erosion

This can present anteriorly as:

Loss of surface anatomy, smooth enamel surface
Increased incisal translucency
Chipping of incisal edges or palatal hollows
Areas where the enamel is absent
Exposure of the pulp
Intrinsic/extrinsic erosion.

This can present posteriorly as:

Loss of surface anatomy
Cuspal cupping
‘Proud’ restorations
Darkening of colour.

Resources to develop your understanding

Some resources that helped me develop my understanding of tooth wear throughout dental school included:

These sources of information (as well as many others) recommend preventative advice linked to the following areas:

Relating to fluoride

Higher fluoride toothpaste
Fluoride varnish, if required
Fluoride mouth rinses (such as those that contain stannous fluoride).

Relating to toothbrushing habits

Correct patients’ brushing techniques
Provide clear instructions on brush type, pressure, frequency and duration
Recommend a medium-bristle brush with a small head
Use low-abrasive toothpastes.

Relating to diet

Minimise nuts, seeds and other snacks between teeth
Avoid harmful habits like nail-biting, chewing on objects and holding hairpins
Eat smaller meals before bed and avoid smoking
Be cautious with coffee and spicy foods.

Relating to drinks

Reduce acidic beverages, including fruit juices and sports drinks
Offer a diet sheet with information on drink acidity and buffering capacity
Encourage water or milk as alternatives
Consume cooled acidic drinks and avoid swirling them in the mouth
Limit the number of fruit drinks to once a day
Refrain from taking small sips to complete the beverage over a prolonged period
Refrain from retaining the drink for a period before swallowing it
Consider the use of a wide-bore straw placed towards the back of the mouth to ensure the drink does not contact the teeth.

Final thoughts

Tooth wear is a common dental issue is caused by various factors, including erosion, abrasion and attrition. Early detection and treatment can prevent serious complications.

Preventive measures like reducing acidic drink consumption and maintaining good oral hygiene are essential for preventing tooth wear.

I’d recommend reading through the guidance documents available online, but I hope this provides a good outline to help you learn more about this area of dentistry!