Tooth Wear: Causes, Types, Clinical Signs, and Treatment Explained

AIM OF THE TOPIC:
Discover the causes, clinical features, and best treatment options for tooth wear—including attrition, abrasion, erosion, and abfraction. Learn expert dental prevention tips and solutions.

🦷 Introduction to Tooth Wear

Tooth wear, also called tooth surface loss (TSL), refers to the gradual loss of tooth tissue from non-carious causes. It is a growing concern affecting both young and older populations. Unlike dental caries, tooth wear results from mechanical, chemical, or biomechanical processes—such as attrition, abrasion, erosion, or abfraction.

🔍 Definitions of Tooth Wear Types

1. Attrition

Attrition is the loss of tooth structure due to tooth-to-tooth contact—commonly caused by chewing or grinding (bruxism). It primarily affects the biting surfaces.

2. Abrasion

This type of wear results from external mechanical forces—like improper brushing, hard-bristled toothbrushes, or abrasive toothpaste. Abrasion often appears near the gum line as V-shaped grooves.

3. Erosion

Erosion is the chemical dissolution of enamel and dentin by acids not involving bacteria. It can be extrinsic (diet, acidic drinks) or intrinsic (vomiting, GERD, eating disorders).

4. Abfraction

Abfraction refers to the wedge-shaped lesions at the gum line caused by stress and flexure of the tooth structure—usually from biting forces.

📊 Epidemiology of Tooth Wear

Nigerian Data (Oginni & Olusile, 2002):

  • Attrition: 54.4%
  • Abrasion: 19.4%
  • Erosion: 1.3%

UK Data (Poynter & Wright, 1990):

  • Combined: 82%
  • Attrition: 2%
  • Abrasion: 14%
  • Erosion: 2%

🔎 Common Causes of Tooth Wear

  • Attrition: Normal chewing, bruxism, or habits like bone-crushing.
  • Abrasion: Overzealous brushing, hard bristles, abrasive toothpaste.
  • Erosion (Extrinsic): Citrus fruits, soft drinks, acidic medications.
  • Erosion (Intrinsic): GERD, bulimia, chronic vomiting.
  • Environmental: Acid fumes (battery factories), chlorinated pools.

🧪 Clinical Presentations

✨ Attrition

  • Flattened cusps or incisal edges
  • Matching wear facets between opposing teeth
  • Cupping or grooves in dentin

✨ Abrasion

  • Horizontal grooves near the gum line
  • Sharp V-shaped lesions
  • Angular demarcation from adjacent surfaces

✨ Abfraction

  • Wedge-shaped lesions below the gum
  • Accompanied by other wear facets

✨ Erosion

  • Smooth, polished surfaces
  • Labial surface affected (extrinsic)
  • Palatal surface worn (intrinsic)
  • Yellowish dentin exposure and translucent incisal edges

⚠️ Effects of Tooth Wear

  • Tooth sensitivity and pain
  • Dull, shortened teeth
  • Yellow discoloration due to exposed dentin
  • Pulp inflammation or necrosis
  • Decreased occlusal vertical dimension (OVD)
  • Bite collapse or tooth drifting

🛡️ Prevention and Management of Tooth Wear

✅ General Approach

  • Identify the specific cause
  • Patient education and lifestyle modification
  • Regular monitoring using photos or dental casts

✅ Preventing Erosion

  • Reduce acidic foods and drinks
  • Use a straw, avoid sipping
  • Don't brush immediately after acidic exposure
  • Use fluoride toothpaste and varnishes
  • Chew sugar-free gum or cheese for saliva stimulation
  • Use antacids or mouthguards if needed

✅ Preventing Attrition

  • Use hard acrylic occlusal splints for bruxism

✅ Preventing Abrasion

  • Switch to soft toothbrushes
  • Brush vertically, not horizontally
  • Avoid brushing right after meals
  • Use non-abrasive toothpaste

🦷 Restorative Treatment Options

Treatment is advised when:

  • Aesthetics are compromised
  • There’s persistent pain/sensitivity
  • Uncontrolled wear changes occlusion

💡 Conservative Solutions

  • Desensitizing pastes (Sensodyne, fluorides, oxalates)
  • Adhesive resin composites for minor defects
  • Porcelain veneers/crowns for severe damage

🦷 The Dahl Concept

Used to regain space in worn anterior teeth:

  • A bite-raising appliance separates posterior teeth
  • Teeth adapt and new restorations can be added with minimal tooth reduction

🛠️ Composite Build-up Techniques

  • Start with canines to re-establish bite
  • Build incisal edges using matrix strips
  • Layer labial surfaces and polish
  • Use study casts to evaluate occlusal changes
  • Avoid in patients with poor periodontal support or short roots

🦷 Molars and Severe Wear Management

  • Open the bite anteriorly using composites
  • Restore molars with GIC or adhesively retained onlays
  • Full metal crowns for extreme cases

✅ Conclusion

Tooth wear is a multifactorial condition. Its successful management demands a patient-centered, minimally invasive, and preventive approach. The earlier it is detected, the easier it is to manage—and save your natural teeth for life!

Want to keep your teeth healthy and strong?
Don’t ignore the signs of tooth wear. Visit your dentist regularly and follow a preventive routine. 🦷✨

Tags: #ToothWear #Attrition #Erosion #Abrasion #DentalHealth #PreventiveDentistry #ToothSensitivity #ToothErosion #OralCare


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