Definition :

Wear is a natural process that occurs

whenever two or more surface move in
contact .
It is , therefore, considered that wear of
human natural dentition, to a certain
extent, is a predictable physiological
process result from continuous sliding
contact between opposing teeth .
Time in contact is an important factor in
determining the extent of wear, the
possibility for wear is, therefore, greater
among patients who retain natural teeth
for many more years .
Factors affecting wear
1. Force of mastication .
If the force of mastication (chewing )
increased the wear will increase .
e.g. bruxism and Para functional habits .
2. Sliding distance between opposing teeth.
If the sliding distance increased the wear
will
increase .
3. Contact area.
Contact area ----- stress from opposing
teeth -------- tooth wear .
4.Surface roughness and friction .
The real contact area represented by the
sum of the protruding surface spots,
which are susceptible to deformation
under load and reduce the actual contact
area .
The rough surface has a higher
coefficient of friction and increase
the wear rate .
5. Frequency and time of contact .
The increase of time and or frequency of
occlusal contacts will lead to an increase
in wear rate and volume e.g. bruxism and
elderly patients .
6.Environmental factors .
Low salivary PH , exposure to an
abrasive atmosphere, and lack of salivary
flow all increase tooth wear .

Dental terminology
The term tooth surface loss embrace
all the conditions that cause tooth wear
which
occur in the absence of dental plaque and
caries and trauma.
conditions that cause tooth wear include
attrition , abrasion , erosion and
abreactions.

Attrition
Attrition is defined as the loss by wear of
tooth structure or a restoration caused by
mastication or contact between occluding
or approximal surfaces (tooth to tooth
contact ) .
All surface in contact, suffer from
attrition including occlusal surfaces,
incisal edges, palatal surfaces of
maxillary anterior , and labial surfaces of
mandibular anterior teeth.
It is suggested , however that proximal
contact areas may exhibits slight wear
too.
Attrition (as mentioned earlier) is a
physiological phenomenon, unless it is
sever and extensive in relation to age,
where it will be considered pathological .
It is proposed in cases of loss of tooth
substance due to attrition there appeared
to be a compensatory mechanism
generalized alveolar bone growth .
Abrasion
Abrasion is the pathological wear of tooth
substance through biomechanical friction
process other than mastication .

E.g. vigorous tooth brushing ,nail biting ,
pen biting, denture clasps in RPD .
The use vigorous tooth brushing with
abrasive toothpaste or against exposed
dentine is the most common cause of
cervical tooth loss.

Patients suffering from abrasion usually
have good oral hygiene but have multiple
abrasion lesions .
Abrasion is more common in the left
quadrant of right handed patients and
the right quadrant of left-handed people.
It is also more common on the labial
surfaces of teeth prominent in the arch (
e.g canines) .

Erosion
Erosion is the progressive loss of hard
dental tissues by chemical process not
involving bacterial action .
Tooth substance loss usually occur as a
result of erosion in coexistence with
either attrition or abrasion .
Erosion in usually associated with
exposure of dentine on the buccal or
lingual surfaces .
Cervical surfaces may be more prone to
erosion because these areas close to the
gingival are less self- cleaning .
Another indication of erosion is the
presence of exposed dentine on incisal or
occlusal surfaces despite the young age of
the patient .
Lesions caused by erosion tend to be
smooth and rounded, in contrast to
attrited surfaces, which tend to leave
sharp edges.

Erosion can be classified to regurgitation
erosion due to pregnancy sickness or
sickness or digestive and psychological
problems erosion , and medication
induced erosion .
Occlusal stresses ( Abfraction)


Defined as the loss of dental hard
substance caused by biomechanical
loading forces .

These lesions are caused by flexure and
ultimate fatigue of enamel and dentine of
susceptible teeth away , from the point of
loading . Occlusal stress explain why
cervical lesion not present on teeth
adjacent to primary site; which seem to
discount tooth-brushing abrasion or
chemical erosion as sole cause of tooth
loss .

The loss of tooth substance may depend
on the direction, magnitude, frequency,
duration and location of the force on the
teeth. If occlusion is not ideal or if heavy
occlusal trauma is present, significant
lateral forces are generated, which cause
the tooth to bend and create compressive
and tensile stresses on tooth structure .
The region under greatest tensile stresses
is the fulcrum located around the cement
enamel junction .
Tensile forces disrupt chemical bonds
between hydroxyapatite crystals in
enamel.
Pilot study (Bevenius et al , 1993)
showed no correlation between brushing
habits and the location and severity of
cervical lesion .
Their findings indicated a possible
correlation between irregular lateral
excursions and the severity and location
of lesions .
Aetiological factors of tooth wear
It may be impossible to identify a specific
a etiological agent even after elborate
history taking , examination and special
diagnostic tests .
Extensive cases of tooth wear are often
caused by a combination of factors . It is
also difficult to say with certainty when
the loss of tooth substance happened,
whether it is a continuing process or
whether it stopped long time ago
1. Age
The prevalence and severity of tooth
wear lesions increase with age due to
prolonged exposure to oral environment
and increase of frequency of tooth
contact .
And development of unfavorable occlusal
forces due to loss of teeth, management,
reduce occlusal table .. Rtc .
2. Gender .
Tooth wear is more extensive in males
probably because they have greater bite
force.
3. Bite force .
Increased bite force tends to increase
tooth wear rate, as in males and
bruxists.
4. Occlusal factors .
The number of ( occluding teeth) may
cause wear due to excessive loading on
the remaining teeth.
Occlusal relationship (edge- to-edge and
occlusal interferences ) may accelerate
tooth wear .


5. Para functional activities and habits .
Bruxism : compulsory grinding and
clenching of teeth for nonfunctional
purposes, where the frequency and the
bite force increase dramatically and cause
tooth substance loss force increase
dramatically and cause tooth substance
loss and increase tooth wear rate .
Vigorous horizontal tooth brushing with
abrasive toothpaste causes cervical
notched abrasion lesions .
Pen biting, pipe smoking, chewing
tobacco, musicians (wind instrument),
nail biting , occupations that involve
holding objects between teeth like tailors
and carpenters .

6. Dietary factors .
High consumption of citrus fruits or
juice, carbonated drinks ( Cock , pepsi,
sprite and all fuzzy drinks), herbal tea,
alcoholic drinks, natural yogurt, vitamine
C tablets and vinegar due to their low PH.
However, low PH alone may be not as
good indicator of a products erosive
potential as its buffer capacity .
7. Digestive problems.
Regurgitation of gastric acids or partially
digested gastric contents into the oral
cavity due to :
A- Morning sickness during pregnancy .
B- Hiatus hernia, gastro-esophageal reflux,
gastro ulcer .
C- Chronic alcoholism with gastritis.
D- psychological disorders such as
anorexia and bulimia nervosa .
Regurgitation erosion commonly affects
the palatal surfaces of the upper anterior
teeth and the occlusal and buccal surfaces
of lower posterior teeth .
While , dietary erosion usually affects the
labial surfaces of upper anterior teeth.
This may results in thinning of maxillary
enamel and dentine hypersensitivity .
8. Environmental and occupational factors .
Tooth wear caused by acid exposure in
the environment or under occupation
circumstances such as battery-making
workers, pickers, miners.
9. Low salivary flow.
Low salivary flow can results from
obstruction of the salivary duct, surgical
excision , radiotherapy (dry mouth) .
Low salivary flow reduces the lubrication
effect, and reduces the buffering effect.

10. Medications .
- Vita mine C tablets .
- Aspirin tablets .
- Effervescent vitamin C preparations .
- Medications that reduce salivary flow
such as tricycles antidepressants and
antihypertensive .