Tooth wear: an increasingly present problem

The loss of tooth surface can be only physiological as a natural consequence of aging.

However, this loss of tooth structure can be pathological through phenomena such as erosion, abrasion and friction.

Tooth wear is a pathology that has a multifactorial origin.

Changes in behaviour, unbalanced diet (acidic drinks), various medical or drug conditions that induce gastric reflux or influence the composition of saliva or its flow rate, trigger tooth erosion.

Day or night bruxism induces attrition and abrasion.

Classification of tooth surface loss

There are 3 reasons for tooth structure loss (no cariogenic relation), however abfraction can also be considered a cause of non-cariogenic tooth surface loss.

Erosion – is a chemical process that occurs in the loss of the tooth surface without the presence of bacterial plaque. The factors associated with this erosion can be intrinsic (gatro-esophageal reflux and eating disorders) or extrinsic (natural fruit juices, carbonated drinks, alcoholic beverages and some foods).

Abrasion – these are external factors such as toothbrushes with hard bristles or dietary factors.

Attrition – attrition is a process in which dental tissue is lost as a result of contact with the tooth surfaces of antagonist teeth during their function or parafunction. This contact occurs mainly in the proximal areas, on the support cusps and on the guide surfaces during the chewing process.

Abfraction (stress injuries) – is a consequence of eccentric forces and movements in the natural dentition. Abfraction promotes fatigue, flexion and deformation of the teeth through the biomechanical loads of the tooth structure, mainly at the level of the cervical regions. The magnitude of the injury depends on the size, duration, direction, frequency, and location of the forces. Abfraction injuries are caused by flexion and fatigue of susceptible teeth in areas that are normally far from the point of load.

The dental consequences of abrasion and erosion are manifold:

• Loss of enamel with progressive exposure of tooth surfaces;
• Loss of occlusal, vestibular and lingual anatomy;
• Decreased tooth size with aesthetic and functional impairment;
• Discoloration of exposed dentin surfaces;
• Tooth sensitivity and pulp complications;
• Increased risk of caries;
• Loss of marginal adaptation of the restorations as well as fracture of the same.