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PubMed1989

The suitability of a new index for the evaluation of dental wear.

The suitability of a new index for rating dental wear by different observers was tested. Four dentists, who were first calibrated using the scoring system and then subjected to an inter-examiner agreement test before and after a field study, rated 167 individuals in total in their private dental practices. The incisal/occlusal state of the teeth with regard to restorations and dental wear was recorded. The inter-examiner agreement test proved satisfactory when rating main groups of wear but not so good when rating subcategories. However, a marked improvement in agreement developed between the first and the second test. The individuals composing the field study group are probably not representative of Scandinavian populations in general. Relatively few teeth were missing, and the teeth were well restored. Only the highest age group (80-89 years) displayed the most severe degree of wear to any extent. However, wear into the dentin was observed in 20% of the teeth already in the youngest age group (20-29 years). These teeth were solely incisors and canines of both jaws. In conclusion, we found that the index should be well suited for the evaluation of dental wear in large groups of people by different investigators after adequate training in use of the system has been provided and that tooth wear may be a relatively small problem in urban Scandinavian populations with regular dental care.

Adult↗

PubMed2003

Non-carious cervical lesions in a Nigerian population: abrasion or abfraction?

OBJECTIVES: To determine the proportion of non-carious cervical lesions (NCCL) that were either abrasion or abfraction like and to test the validity of the assumption that right-handed patients cause more abrasion on the cervical surfaces of teeth on the left side of the mouth. SETTING: Ile-lfe, Southwestern Nigeria. PARTICIPANTS: 106 first time patients diagnosed as having any form of NCCL. DESIGN: Patients were subjected to intra-oral examination followed by the administration of a questionnaire. The cervical lesions were examined and scored using the tooth wear index designed by Smith & Knight 1984. NCCL was diagnosed as abrasion or abfraction like based on established clinical features plus positive history of possible associated aetiological factors. OUTCOME MEASURES: Abrasion and abfraction like lesions. RESULTS: Abrasion was the diagnosis in 630 (62.3%) of the 1,012 tooth sites with NCCL that had no associated occlusal surface wear facet. This constituted about two-thirds of the NCCL. Three hundred and eighty two (37.7%) of the NCCL occurred in association with an occlusal surface wear facet and presented the typical wedge shaped defects with sharp margins characteristic of abfraction. These abfraction like lesions constituted about one-third of the NCCL. 50.8% of abrasive NCCL in right-handed brushers were located on the left side of the mouth. CONCLUSIONS: About one-third of NCCL in the present study presents an abfraction component, and two-thirds abrasion. Although, right-handed brushers had more severe lesions on the opposite side of the mouth, the difference was not statistically significant.

Adult↗

PubMed2004

Orthodontic extrusion: periodontal considerations and applications.

Human teeth erupt naturally to compensate for tooth wear and tear. When a subgingival lesion such as crown fracture occurs, the general practitioner must consider orthodontic extrusion of the tooth to allow for prosthetic rehabilitation. However, because this therapeutic approach is not appropriate in all cases, each tooth must be carefully analyzed before treatment. The amount of force applied depends on the desired effect. Orthodontic extrusion can also be used to augment bone and tissue in the course of preparing an implant site. In most cases, endodontic treatment must be completed first, with close attention being paid to the contour of the final restoration. The benefits of extrusion are clear, but patients must nonetheless be informed of the disadvantages.

Alveolar Bone Loss↗

PubMed2005

Tooth loss, denture wearing and oral health-related quality of life in elderly Chinese people.

OBJECTIVES: To investigate the relationship between tooth loss, denture wearing and oral health-related quality of life (OHQoL) among community-dwelling elderly people in Hong Kong. METHODS: A questionnaire study of elderly people aged 60-80 years who were recruited at neighborhood social centres for the elderly. The Chinese version of the General Oral Health Assessment Index (GOHAI) was used and information about natural tooth number and denture wearing were obtained. RESULTS: 233 elderly subjects were recruited and interviewed. Around 20% of the partially dentate subjects had their last tooth loss within the previous year and a quarter within the last five years. Significantly fewer edentulous subjects had their last tooth loss within the previous year (3%) and within the last five years (12%, p < 0.001). Twenty two percent of the subjects had difficulty in accepting tooth loss. More edentulous subjects (69%) were satisfied with their dentures than partially dentate denture wearers (37%, p < 0.001). Edentulous elderly subjects had a higher mean GOHAI score (53.0) than partially dentate denture wearers (49.1, p < 0.001). Results from a multiple factor ANOVA revealed that elderly subjects who had loose teeth, difficulty in accepting tooth loss and were not satisfied with their removable dentures had a lower mean GOHAI score. CONCLUSIONS: In general, tooth loss and denture wearing did not have a major impact on OHQoL in elderly Chinese people. However, partially dentate denture wearers experienced a greater adverse impact on OHQoL than edentulous subjects most probably due to less satisfaction with their dentures and discomfort associated with loose teeth.

Aged↗

PubMed2002

Dental erosion in asthma: a case-control study from south east Queensland.

BACKGROUND: Asthma medication places patients at risk of dental erosion by reducing salivary protection against extrinsic or intrinsic acids. But patterns of lesions in asthmatics may differ from patterns in non-asthmatics, because gastro-oesophageal reflux (GOR) is found in 60 per cent of asthmatics. METHODS: The lesions in 44 asthma cases were compared to those of age and sex match controls with no history of asthma or medications drawn from the dental records of 423 patients referred concerning excessive tooth wear. The subjects were 70 males age range 15 to 55 years and 18 females age range 18 to 45. Anamnestic clinical data were compared between the two groups. Models of all 88 subjects were examined by light microscopy, and wear patterns were recorded on permanent central incisor, canine, premolar and first molar teeth. RESULTS: Clinical differences were a higher incidence of tooth hypersensitivity, xerostomia, salivary gland abnormalities, gastric complaints, and self induced vomiting in the cases. No differences were found between the cases and controls on citrus fruit and acid soft drink consumption. More occlusal erosion sites were found in cases, whereas more attrition sites were found in the controls. There were no significant differences in palatal erosion on maxillary anterior teeth found between cases and controls. Lingual erosion of the mandibular incisors, found only in GOR patients, was not observed. CONCLUSIONS: A higher incidence of erosion was found in asthmatics. Gastro-oesophageal reflux symptoms were not associated with the sign of lingual mandibular incisor erosion. The clinical significance is that asthmatics are at risk of dental erosion from extrinsic acid, but GOR does not appear to contribute in a site-specific manner.

Adolescent↗

PubMed1997

The clinical evolution of the 'Dahl Principle'.

The restorative management of patients with localised tooth wear is a major challenge to the dental profession. There is rarely adequate interocclusal space available to place restorations without the need for extensive tooth preparation or the involvement of many unaffected teeth. In 1975, a method was described which created interocclusal space by the use of a partial coverage appliance made of cobalt chromium alloy. The technique reduced the need for more invasive palatal reduction. This paper, with the aid of clinical case examples, highlights the development and evolution of the original removable appliance. However, there remains a need for further clinical studies to evaluate fully these techniques.

Adolescent↗

PubMedDate not supplied

Management of tooth tissue loss from erosion.

Erosive tooth wear appears to be no less frequent in the United States than in the United Kingdom and Europe and is of increasing concern as a significant cause of tooth destruction in younger persons. Consumption of numerous dietary sources of acids is increasing in modern societies. In addition, involuntary regurgitation may be a significant cause of tooth erosion. These primary causes can be exacerbated by xerostomia, which is induced by many drugs. Initial preventive treatments are directed at neutralizing the effects of the acids, and initial restorative treatments should be conservative, using adhesive materials. Treatment of advanced tooth tissue loss is difficult and expensive, and preventive management is emphasized.

Acids↗

PubMed2006

Dental wear study in a 14th century skull of the Sao tribe, Cameroon.

The aim of this work was to study the wear affecting the almost complete dentition of a Sao individual fossil from Cameroon prehistory (XIVth century). Occlusal surfaces of the fossil fragile pieces were plaster replicated with an original technique adapted from usual dental impression methods (silicon elastomer polymerising by addition). Axial macro-photographs of both sectional dental casts and original pieces made it possible to produce drawings of the occlusal areas on transparencies in order to superimpose the lateral hemiarch counterparts in their optimal intercuspal position. The study of interarch contacts was completed by confronting and observing the occluding position of hemiarch replicas. The occlusal analysis revealed that the wear extent was equivalent on left and right molars. Hall's occlusal wear index and Van Reenen and Reinach's classification of proximal wear allow assessment of the degree of wear extent on premolar and molar sections in relation to the side or the arch observed. The even bilateral proximal and occlusal wears observed on the different kinds of homologous teeth appeared as the main contributor to this well-balanced interarch occlusion. The mandibular incisor losses and the particular type of wear affecting lower canines led to the conclusion of the presence of a labret, a great number of which was found in the area. According to Miles' method of age assessment based on tooth wear, the pieces studied belonged to an individual between 30 and 40 years old.

Age Determination by Teeth↗

PubMed2003

The Down syndrome patient in dental practice, part I: Pathogenesis and general and dental features.

Down syndrome (DS) is an autosomal chromosomal anomaly which results from trisomy of all or part of chromosome 21. It is the single most common genetic cause of mental retardation affecting approximately 1 in 700 live births. Since its first description in 1866 by John Langdon Down, much research has focused on this condition. In the past two decades there has been a significant increase in information about its causes, diagnosis and medical and dental consequences. In this, the first of two articles, we pay tribute to the work of Harvey Brown, and we review the pathogenesis, general and cranio-dental features of Down Syndrome. The cause of DS is usually non-dysjunctive trisomy 21, with 91 percent of cases being maternally derived. Uncommon causes are mosaicism or translocation from other chromosomes. DS patients suffer from congenital cardiopathies, growth retardation, endocrinopathies, sleep apnoea, neoplasias and early-onset Alzheimer's disease. Typically, craniofacial features include midfacial hypoplasia with a resultant flattened face, ocular hypotelorism and mandibular prognathism. The universal characteristic of the DS face is the upward slanting of the palpebral fissures and epicanthic folds. Dental features include tooth size reduction, hypodontia, reduced root lengths, changes in tooth shape and excessive tooth wear.

Craniofacial Abnormalities↗

PubMedDate not supplied

Comparative study of wear of enamel induced by alternating and simultaneous combinations of abrasion and erosion in vitro.

Two types of interaction of erosive and abrasive forces with human enamel were analysed in an in vitro study. To simulate toothbrushing or chewing after an acidic challenge, enamel specimens were eroded in 0.3% citric acid (pH 3.2), then brushed with or without silica abrasive. To simulate simultaneous erosion and abrasion, as would occur during chewing of abrasive acidic food, enamel specimens were abraded in a toothbrushing machine, with and without silica abrasive, while immersed in citric acid. Enamel wear was measured by profilometry. In both experiments the combination of erosion and abrasion resulted in significantly greater wear than erosion alone, but no significant differences in wear after brushing with or without abrasive were found. Simultaneous erosion and abrasion resulted in about 50% more wear than alternating erosion and abrasion. It is concluded that softened enamel is highly unstable and potentially easily removed by short and relatively gentle physical action. Chewing of acidic foods with some abrasive properties might cause enhanced tooth wear.

Citric Acid↗

PubMed2001

A question of space: options for the restorative management of worn teeth.

The prevalence of tooth surface loss has increased in recent years. The essence of management is an effective preventive regime; however, in many instances restoration may also be necessary. A number of strategies is available for creating sufficient space to enable restoration and several techniques for restoration known. This article reviews the significance of the vertical dimension of occlusion and describes the restorative management of a patient affected by severe tooth wear.

Adult↗

PubMed2005

Microcomputerised tomography evaluation of 10% carbamide peroxide applied to enamel.

OBJECTIVES: There is still some controversy in the dental literature whether carbamide peroxide bleaching causes demineralization of teeth. One of the reasons for this controversy is that there is as yet no reliable, non-destructive in vitro method for assessing mineral loss in bleached teeth. The objective of this study was to investigate the possible demineralization effect of 10% carbamide peroxide bleaching agent on enamel and dentine non-destructively. METHODS: microCT images were obtained of 12 human molar tooth sections. These sections had 10% carbamide peroxide applied for eight hours a day over a period of 15 days. Further tomographic images were obtained and the mineral content prior to and post bleaching assessed. RESULTS: A total of 144 regions were evaluated using the image processing language available in the work station. The application of 10% carbamide peroxide was found to cause demineralization of the enamel extended to a depth of 50 microm below the enamel surface (Paired t-test, p<0.05). CONCLUSIONS: This study confirmed that microCT was indeed a highly suitable method for assessing mineral content of dental enamel after bleach application. It is recommended that application of bleaching agents should be carefully considered in patients susceptible to caries and tooth wear.

Carbamide Peroxide↗

PubMed1975

Incisor size and diet in anthropoids with special reference to Cercopithecidae.

In 57 species of anthropoids relative size of incisors in highly correlated with diet. Anthropoids that feed primarily on large food objects (large fruits) have larger incisors than those that feed on smaller food objects (berries or leaves). This difference reflects a need for more extensive incisal preparation of larger food objects before mastication. Extensive incisal preparation causes increased tooth wear, therefore, enlarged incisors are probably an adaptive response to increase their wear potential.

Animals↗

PubMed1996

Management of dental staining: can low-abrasive dentifrices play a role?

Dental staining, while always a significant problem, has become more important in recent years with the introduction and increased use of chlorhexidine-based mouthrinses. Not only do these rinses themselves cause staining, they also enhance staining from other sources, such as diet or tobacco use. An understanding of the etiologies of dental stains will help today's practitioners become more effective in managing dental stains in their practices. Important strategies for managing stain are patient education about the causes of staining, careful consideration of product recommendations for home use, and routine office visits for prophylaxis. Ideal products for patient use are those with effective stain-removal properties and low abrasivity, which minimizes tooth wear.

Anti-Infective Agents, Local↗

PubMed2004

Dental erosion in children : an increasing clinical problem.

Epidemiological studies carried out on dental erosion have established that the prevalence is high in young people and adolescents. The objective of this study was to look at the prevalence and etiology of dental erosion, particularly in children, and its practical management for its possible control. The children between 5-6 yrs were examined and findings recorded, and this study has shown that approximately 1/3rd of 5-6 yrs old children have appreciable tooth wear and dental erosion.

Acetic Acid↗

PubMed1975

A long term clinical study evaluating the effect of two dentifrices on oral tissues.

1. A long term (54 months) supervised, double-blind human clinical study has been conducted to ascertain whether the routine use of a commercially available cosmetic dentifrice, with purported stain removal and flavor impact characteristics, would cause adverse manifestations in the oral tissues, as compared to the similar use of a more conventional type of commercially available dentifrice. 2. One hundred and twenty male and female subjects (aged 12 to 70) were randomly assigned to the use of one of the two dentifrices under investigation, after which they used the assigned dentifrices twice daily (1 min each brushing) under supervised conditions for a period of 54 months. 3. Clinical examinations were conducted on all subjects initially (base line), and at 3-month intervals throughout the 54-month course of the study. This examination included a complete and thorough inspection of the oral soft and hard tissues. 4. The results after 54 months of continuous use of the dentifrices (representing a total dentifrice/oral tissues exposure time of approximately 45 hours per subject) indicated that neither of the two dentifrices caused any adverse reactions of the oral soft tissues and that both dentifrice groups had similar patterns and levels of cervical abrasion and/or erosion. 5. The results also indicate a lack of direct correlation between laboratory abrasivity values (as determined by a radioactive dentin abrasion procedure) and the clinical situation, thus suggesting that factors other than dentifrice abrasivity may play an important role with regard to tooth wear.

Adolescent↗

PubMed2002

Development of a method in situ to study toothpaste abrasion of dentine. Comparison of 2 products.

BACKGROUND/AIMS: The abrasivity of toothpastes is usually determined using in vitro methods; as such, the clinical significance of the findings is uncertain. The aim of the present study was to develop and evaluate a method in situ to study abrasion of dentine by two toothpastes of different Relative Dentine Abrasivity (RDA). METHOD: The study was a single blind, randomised, 2 way cross over design involving 10 healthy dentate volunteers. Subjects wore an maxillary removable acrylic appliance containing two flat human dentine specimens, taped to expose a window of tissue, from 9 am to 4 pm during the two 10 working day study periods. No food or drink was consumed when the appliance was in place. On five occasions each day, the appliances were removed and the dentine windows brushed ex vivo with the allocated paste for 60 s each. Dentine abrasion at days 5 and 10 was measured using a profilometer. RESULTS: Both toothpastes produced measurable abrasion in all subjects and the depth increased in most subjects between 5 and 10 days. There was significant subject and specimen variation both within and between toothpastes. There was significantly increased abrasion by the toothpaste with the higher RDA value and in mean terms the ratio of abrasion between the two pastes was similar to the ratio of the RDA values. CONCLUSION: The method in situ, already used to study dental hard tissue erosion, appears ideally suitable to study dental abrasion alone and the interaction between aetiological factors involved in tooth wear.

Cross-Over Studies↗

PubMed1989

Dental erosion in patients with chronic alcoholism.

Tooth wear attributed to the physical wear of teeth by clenching and grinding (attrition) has been described previously in alcoholic patients. However, the pattern of wear seen in the series of cases reported here is more consistent with chemical damage (erosion) than attrition. A possible mechanism for this process is suggested, and it is further suggested that erosion is likely to play a more important role in the wear of the teeth in chronic alcoholic patients than attrition.

Adult↗