Professional Documents
Culture Documents
By Christopher CK Ho, BDS HONS (SYD), GRAD DIP CLIN DENT (ORAL IMPLANTS)
5. Dietary erosion: may occur from food 7. Environmental erosion: patients that • Reduced clearance of dietary acids;
and beverages like fruit juices and soft are exposed to acids in the workplace, • Reduced pH of saliva;
drinks, which are highly acidic. The e.g. battery factory workers have shown • Reduced buffer capacity, preventing
potential for erosive damage by these a higher prevalence of erosion in Ger- both dietary and also endogenous
beverages may not be well understood many and Finland (Tuominen M 1989). acids from being neutralized;
by the public. Another source of dietary Exposure to high levels of hydrochloric • Reduced remineralisation of surfaces;
acids are orally administered drugs like acid can also occur in improperly main- and
chewable vitamin C tablets, aspirin, iron tained swimming pools. • Softening of tooth structure leading
tonics and replacement HCl used by to accelerated wear from normal
patients with gastric achlorhydria 8. Abfraction: are cervical abrasive wear and tear under occlusal and
(Levith et al, 1994). Winetasters also lesions thought to be caused by occlusal incisive forces, and labial wear from
often present with significant. stresses. The tooth can flex causing ten- tooth brushing.
sile and compressive forces at the necks
6. Regurgitation erosion (Voluntary and of teeth resulting in cracks in the 11. Body image: Attempts to control body
involuntary): is the return of gastric enamel (Figure 5). weight may influence patients to con-
contents to the mouth. This is highly sume acidic foods, such as fruit and diet
acidic (pH 2) and erosive. Repeated 9. Restorative materials: the use of drinks. This struggle to achieve the
episodes may be more problematic. porcelain can accelerate tooth wear, ideal body weight may also increase the
a. Involuntary regurgitation: or gae- especially if this porcelain is unglazed prevalence of eating disorders.
stroesophageal reflux can occur due and rough/unpolished (Mahalick JA et
to hiatus hernia or as a consequence al, 1971). Newer materials have been 12. Loss of posterior support: It has been
of pregnancy or chronic alcoholism. developed like the low-fusing porce- suggested that there is an increase in
b. Voluntary regurgitation: is usually lains, which have a finer particle size force per unit area in the remaining
associated with an underlying psycho- and exhibit similar wear as natural dentition, thereby causing an increase
logical problem. Eating disorders tooth structure. Metal occlusal surfaces in tooth wear. A review of the literature
commonly associated are anorexia are also recommended for those does not support this assumption
nervosa and bulimia nervosa. The patients with severe wear or bruxism. (Kayser and Witter, 1985).
effect of acid regurgitation in bulimic
patients often exhibits perimolysis - 10. Saliva and dry mouth: Xerostomia 13. Drug use: can be another cause of
erosive lesions localized to the palatal may follow radiotherapy, medications, bruxism and has an effect on attrition
aspect of maxillary teeth (Figure 4). etc, and may produce both rapid caries and dehydration leading to possible
Often the pattern of tooth wear in and dental erosion. Because the acids erosive conditions.
these patients is additionally affected are not well-buffered and not diluted by
by other factors like consumption of saliva, patients may suffer from erosion. Diagnosis
diet beverages and erosive foods (as In those patients who displayed acceler- Diagnosis involves a need to identify
patients strive to control their weight), ated tooth wear, there is strong evidence the factor(s) contributing to tooth wear.
xerostomia, caused by vomit-induced for a critical role of saliva, particularly This is to preserve the remaining
dehydration or drugs such as diuretics, of resting salivary pH. There are several dentition and to improve the long-
appetite suppressants and antidepres- reasons for a link between salivary dys- term prognosis of any restorative
sants (Hellstrom 1977). function and tooth wear: treatment completed.
also be changed like pipe smoking, tions like saliva testing may provide infor- 5. Kayser AF, Witter DJ. Oral Functional needs and its
aggressive use of interdental sticks, etc. mation to prevent dehydration and help consequences for dentulous older people. Community
Dent Health 1985;2:285-291.
Erosive effects may require change in stimulate salivary flow. Chewing sugar 6. Smith BGN, Knight JK. An index for measuring the
dietary intake to minimize acidic free gum may help in boosting saliva flow. wear of teeth. Br Dent J 1984:156:435-438.
drinks/foods. Regurgitation erosion is dif- Bruxism and attrition may be pre- 7. Turner KA, Missirlian DM. Restoration of the
ficult to prevent and some chronic cases vented with the use of occlusal splints extremely worn dentition. J Prosthet Dent.
1984;52(4)467-474.
require referral. Milder cases are normally and stress management. Occlusal adjust-
8. Smith BGN, Bartlett Dw, Robb ND. The prevalence
controlled with self-medication and ment and addition with restorations may and management of tooth wear in the United
dietary control. Counseling may be also be required. Kingdom. J Prosthet Dent 1997;78:367-372.
offered for those concerned with body Monitoring of all preventive measures 9. Eccles JD. Tooth surface loss from abrasion, attri-
tion and erosion. Dental Update 1982;373-81.
image or suffering from eating disorders. needs to be performed even if no restora-
10. Hellsrom I. Oral complications in anorexia ner-
Patients must be advised to not brush tive treatment is performed as to the vosa. Scand J Dent Res 1977;85:71-86.
immediately following acid intake or effectiveness of the program to ensure 11. Tuominem M, Tuominem R. Association between
regurgitation but to rinse their mouth care- long-term success and maintenance for acid fumes in the work environment and dental ero-
fully. These patients may also benefit from patients suffering from tooth surface loss. sion. Scand J Work Environ Health 1989;15:335-338.
12. Dahl BL, Krogstad O, Karlsen K. An alternative
a fluoride mouth rinse and/or higher fluo- treatment in cases with advanced localized attrition. J
ride concentration toothpaste. There has References Oral Rehabil 1975;2:209-214.
also been reports that the use of Tooth 1. S. Molnar, J. K. McKee, I. M. Molnar and T. R. 13. Bishop K, Kelleher M, Briggs P, Joshi R. Wear
Mousse (GC) helps neutralize acid chal- Przybeck. Tooth wear rates among contemporary Aus- now? An update on the aetiology of tooth wear.
tralian Aborigines. J Dent Res 1983; 62, 562-565. Quintessence Int 1997;28:305-313.
lenges from acidogenic bacteria in plaque
2. Addy M, Shellis RP. Interaction between attrition, 14. Mahalick JA, Knap FJ, Weiter EJ. Occlusal wear in
and other internal and external acid prosthodontics. J Am Dent Assoc 1971;82:154.
abrasion and erosion in tooth wear. Monogr Oral Sci.
sources. The CPP-ACP molecule binds to 15. Rivera-Morales WC, Mohl ND. Restoration of the
2006; 20:17-31.
biofilms, plaque, bacteria, hydroxyapatite 3. Barbour ME, Rees GD. The role of erosion, abra-
vertical dimension of occlusion in the severely worn
and surrounding soft tissue, localizing dentition. Dent Clin Nth Am 1992;36(3)651-664.
sion and attrition in tooth wear. J Clin Dent. 2006; 16. Levith LC, Bader JD, Shugars DA, Heymann HO.
bio-available calcium and phosphate. 17(4):88-93. Non-carious cervical lesions. J Dent 1994;22:195-207.
Erosion can often be exacerbated by a 4. Smith BGN. Toothwear: Aetiology and Diagnosis. 17. Lussi A. Dental Erosion from diagnosis to therapy.
reduction in salivary flow and investiga- Dental Update 1989; June:204-211. Karger. Switzerland 2006.