Erosion, Abrasion, Attrition

Question 1

What is tooth wear?

Answer 1

Tooth wear is the general term used for the surface loss of dental hard tissues from causes other than developmental ones, dental caries, and trauma

Question 2

The normal vertical loss of enamel resulting from natural wear is about ____ µm per year

Answer 2

65

Question 3

What are the categories of tooth wear?

Answer 3

Attrition
Abrasion
Abfraction
Erosion or Corrosion

Question 4

What is attrition?

Answer 4

• Attrition is the mechanical wear resulting from mastication or parafunction, limited to contacting surfaces of the teeth
• Attrition is related to the aging process

Question 5

What is the etiology of attrition?

Answer 5

Etiology is due to many factors and is accelerated by extrinsic factors such as…
- coarse diet
- chewing tobacco
- parafunctional habits of clenching and bruxism
- traumatic occlusion in the partially edentulous dentition
- anterior open bite
- anterior teeth in edge to-edge relationship or crossbite

Question 6

Answer 6

attrition

Question 7

What is abrasion?

Answer 7

Abrasion is an abnormal wearing of the tooth substance by some unusual or abnormal mechanical process independent of mastication and occlusion

Question 8

What is the etiology of abrasion?

Answer 8

Abrasion is caused by foreign objects or substances repeatedly contacting the tooth surface

Overzealous horizontal tooth brushing with an abrasive dentifrice produces a rounded or V-shaped ditch on the facial aspects of teeth at the cemento-enamel junction

Question 9

What is the clinical presentation of abrasion?

Answer 9

• Most commonly effected: Canines and Premolars
• Biting on hard objects
• Partial Clasps
• Fishermen or Tailors (anterior teeth)

Question 10

Answer 10

abrasion

Question 11

What is abfraction?

Answer 11

Abfraction is the the pathologic loss of hard tooth substance caused by biomechanical loading forces; which is the result of flexure and chemical fatigue degradation of enamel and/or dentin at some location distant from the actual point of loading

Question 12

What is the etiology of abfraction?

Answer 12

Stress
- Stresses that lead to abfractions are transmitted by occlusal loading forces such as occlusal interferences, premature contacts, habits of bruxism and clenching

Question 13

Answer 13

abfraction

Question 14

What are the intraoral findings of bruxism?

Answer 14

• Scalloping of the tongue
• Cheek biting
• Fractured porcelain restorations
• Cupping or cratering of occlusal surfaces
• Teeth are worn down, or chipped
• Increased tooth sensitivity (non-endo or caries related)

Question 15

What are the extraoral findings of bruxism?

Answer 15

• Jaw pain or tightness in jaw muscles
• Earache
• Dull morning headache
• Chronic facial pain
• Deviation of jaw on opening without TMJ pathology

Question 16

Many reasons believed to exist as to why people clench and grind their teeth such as:

Answer 16

• Undiagnosed sleep apnea patients are believed to clench/grind teeth as a subconscious alert to keep breathing
• Stress processing at night (night time activity)
• Stress during the day (day time activity)
• These are the top 3 in literature, but others can and do exist to a lesser degree
• Occlusal malalignment

Question 17

What are treatments for bruxism?

Answer 17

• night guard aka bite guard
• ice packs or warm compresses on face
• limit or stop drinking alcohol and caffeine
• correct teeth misalignment
• reduce stress
• deep breathing techniques, medidation, yoga, or stretching
• address underlying physical and mental health concerns
• exercise

Question 18

What is erosion?

Answer 18

Erosion is defined as the progressive loss of tooth substance by chemical processes that do not involve bacterial action, producing defects that are wedge-shaped depressions often in occlusal, facial and cervical areas

Question 19

What is the etiology of erosion?

Answer 19

Acids from external and internal sources

Question 20

What are the extrinsic factors of erosion?

Answer 20

• Acidic foods such as citrus fruit, pickle, vinegar (acetic acid), sucking lemons, fruit juice and carbonated drinks, yogurt, herbal tea, spicy food.
• Medicines such as effervescent and chewable
  vitamin C preparations
• Significant time swimming in chlorinated pools

Question 21

What surfaces are involved erosion (extrinsic)?

Answer 21

• Labial surface of maxillary teeth affected
• Typically, occlusal and lingual surfaces of mandibular teeth

Question 22

What is the appearance of erosion (extrinsic)?

Answer 22

Scooped-out depressions

Question 23

What are the intrinsic factors of erosion?

Answer 23

• Anorexia and bulimia nervosa or regurgitation of gastric contents because of abnormalities in the gastrointestinal tract, pregnancy morning sickness, and chronic alcoholism
• Certain drugs may cause nausea or vomiting such as estrogens, opiates, tetracycline, levodopa, aminophylline, digitalis, and disulfiram
• Other factors such as reduced salivary secretion and calcium and phosphorus levels

Question 24

What is the appearance of erosion (intrinsic)?

Answer 24

Concave depression involving the entire surface

Question 25

What is the combination attrition-abfraction?

Answer 25

is the joint action of stress and friction when teeth are in tooth-to-tooth contact, as in bruxism or repetitive clenching

Question 26

What is the combination abrasion-abfraction?

Answer 26

is the loss of tooth substance caused by friction from an external material on an area in which stress concentration is due to loading forces. May cause tooth substance to break away

Question 27

What are the consequences of tooth wear?

Answer 27

- Sensitivity to temperature - Collapsed Vertical Dimension of Occlusion - Chipping/breaking of tooth structure - Higher incidence of caries due to exposed dentin - Difficulty in restoring teeth without opening VDO - Esthetic appearance - Supra-eruption of teeth, bone, and gingiva

Question 28

What is amelogenesis imperfecta?

Answer 28

- Hereditary defect of dental enamel - Characterized by early loss of enamel with rapid attrition of tooth structure

Question 29

What are the three distinct classifications of amelogenesis imperfecta?

Answer 29

- Hypoplastic: The enamel has only 1/8 to 1/4 of the normal thickness - Hypomaturation: The enamel has normal thickness but is softer than normal and tends to fracture away from dentin - Hypocalcified: The enamel is normal thickness but is extremely friable and frequently lost soon after tooth eruption

Question 30

What is hypoplastic amelogenesis imperfecta?

Answer 30

The enamel has only 1/8 to 1/4 of the normal thickness

Question 31

What is hypomaturation amelogenesis imperfecta?

Answer 31

The enamel has normal thickness but is softer than normal and tends to fracture away from dentin

Question 32

What is hypocalcified amelogenesis imperfecta?

Answer 32

The enamel is normal thickness but is extremely friable and frequently lost soon after tooth eruption

Question 33

What is dentinogenesis imperfecta?

Answer 33

- Hereditary trait - Characterized by short roots and lack of pulp chambers and yellow appearance of teeth

Question 34

What are the three distinct classifications of dentinogenesis imperfecta?

Answer 34

- Type 1 – Associated with osteogenesis imperfecta, lack of pulp, and no family history - Type 2 – NOT associated with osteogenesis imperfecta, lack of pulp, and no family history - Type 3 – NOT associated with osteogenesis imperfecta, large pulps, positive family history

Question 35

What about type 1 dentinogenesis imperfecta?

Answer 35

Associated with osteogenesis imperfecta, lack of pulp, and no family history

Question 37

What about type 3 dentinogenesis imperfecta?

Answer 37

NOT associated with osteogenesis imperfecta, large pulps, positive family history

Question 38

What information do you need to gather to diagnose tooth wear?

Answer 38

- Accurate patient health history - Clinical examination - Radiographs - Mounted Diagnostic casts - Intra-oral photographs - TMJ Evaluation - Follow up questions such as: --- Are you aware of any clenching or grinding? --- Do you drink acidic drinks frequently? --- Do you have acid reflux issues? --- Do you vomit frequently? --- Are your jaw muscles sore when you wake up? --- Are your teeth cold sensitive when you are stressed? --- Do you have a lot of stress happening in your life? --- Can you show me how you hold your tooth brush?

Question 39

What are the main 5 factors to consider for management of tooth wear?

Answer 39

- Pattern of tooth wear and the surfaces involved - Available inter occlusal space - Available restorative space for dental restorations proposed - The quantity and quality of available hard tissue and enamel respectively - Esthetic demands of the patient

Question 40

What are the three main consequences of tooth wear?

Answer 40

1) Loss of Vertical Dimension of Occlusion 2) Compromised Esthetics 3) Occlusal discrepancies

Question 41

What types of materials cause restorative wear?

Answer 41

- Gold wears most similar to natural enamel - Glass reinforced ceramics caused the greatest amount of wear on opposing teeth - Polished Zirconia causes less wear than glazed Zirconia - Polishing of Zirconia, ceramics, or gold is vital to reduce tooth wear

Question 42

___________ of Zirconia, ceramics, or gold is vital to reduce tooth wear

Answer 42

Polishing

Question 43

What are the reasons to treat tooth wear areas?

Answer 43

- Tooth has temperature sensitivity - Dentin discoloration is unesthetic - Plaque accumulation

Question 44

With an understanding as to HOW these defects in the Class 5 area were created will help you ensure your treatment is successful by asking questions such as...

Answer 44

- Is your patient an aggressive brusher? --- Work on techniques to minimize brushing pressure - Is you patient a clencher/grinder? --- Occlusal Splint needs to be made before to soon after treatment - Does your patient drink liquids which erode the teeth? --- Tell them to STOP IT! And find some other beverage - Does your patient have reflux? --- Do they need to see their M.D. first to address this with medication?