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PubMed1994

Case report: the use of indirect composite for the management of extensive erosion.

Erosive tooth surface loss due to acidic soft-drinks has been well documented. Unfortunately, the erosive danger, especially to young patients, of low calorie beverages seems less well appreciated. A clinical case is reported to highlight the problems that can occur with excessive exposure to such beverages. A method of restoring the damaged dentition using indirect composite is described. It is concluded that indirect composite may be particularly suited for the restoration of eroded dentitions, especially in young patients where aesthetics and repairability are important. Further clinical studies are necessary to assess the performance of these and other materials currently used in the management of erosive tooth wear.

Adolescent↗

PubMed1997

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.

Animals↗

PubMed1994

Erosion in children: an increasing clinical problem?

Tooth wear is becoming more common in both adults and children. The triad of attrition, abrasion and erosion has been known for many years, but the contribution of erosion (irreversible loss of dental hard tissue due to a chemical process not involving bacteria, or the loss of tooth surface not directly associated with mechanical or traumatic factors or caries) to excessive loss of tooth tissue is now being emphasized. The authors of this paper examine the problem and suggest ways of overcoming it.

Beverages↗

PubMed1994

Treatment approaches to bruxism.

Bruxism, or the grinding and clenching of teeth, occurs in approximately 15 percent of children and in as many as 96 percent of adults. The etiology of bruxism is unclear, but the condition has been associated with stress, occlusal disorders, allergies and sleep positioning. Because of its nonspecific pathology, bruxism may be difficult to diagnose. In addition to complaints from sleep partners, signs of teeth grinding include masticatory pain or fatigue, headaches, tooth sensitivity and attrition, oral infection and temporomandibular joint disorders. Signs of bruxism include tooth wear and mobility, as well as tender or hypertrophied masticatory muscles and joints. Children with bruxism are usually managed with observation and reassurance. Adults may be managed with stress reduction therapy, alteration of sleep positioning, drug therapy, biofeedback training, physical therapy and dental evaluation. If significant tooth attrition, mobility or fracture occurs, dental referral is mandatory.

Bruxism↗

PubMed1993

Geriatric prosthodontics: an overview. Part II. Treatment considerations.

This two-part paper discusses treatment considerations for geriatric patients--a population that is on the rise. The first part of this paper examined the effects of aging on general health and on the oral environment. The second part discusses restorative treatment options for geriatric patients with caries, tooth wear, or missing teeth.

Aged↗

PubMed1997

Neandertal incisor beveling.

In discussions of the Neandertals, there has been repeated emphasis on the accelerated rate of attrition and the frequent presence of labial beveling of their incisors. Interpretations of this dental attrition have related it to paramasticatory and dietary uses of their anterior teeth as well as to aspects of their facial morphology. In light of this, we examined the rate of beveling (the angle between the labial and incisal surfaces) of central incisors relative to tooth wear in samples of Neandertals, Inuits and Puebloan Amerindians. I1s show little change in the beveling angle with wear and no significant differences between the samples. I1s, however, exhibit a consistent pattern of increased beveling with dental attrition, progressing rapidly until the crown height approximates its labiolinguinal cervical diameter, and then proceeding at a slower rate. All three samples exhibit a similar pattern. However, the Neandertals have significantly greater beveling in more worn teeth than either recent human sample, and the Inuits have nonsignificantly increased beveling relative to the Puebloans in these more worn I1s. In this, it is the degree of development of beveling, not the pattern of beveling, which differentiates the Neandertals. It is hypothesized that the differences between the Neandertals and recent samples could be the product of: (1) contrast in initial incisor procumbency, (2) a labial separation of the maxillary and mandibular incisal occlusal surfaces during edge-to-edge bite, and/or (3) a greater degree of interproximal wear promoting increased "posterior tipping" of the maxillary incisors. The last appears most likely.

Animals↗

PubMed1991

Reasons given for tooth extraction in Hong Kong.

Two hundred and seventy dentists, systematically selected from the membership lists of the Hong Kong Dental Association, were sent forms on which they were invited to record the reasons for tooth extraction in all patients aged 16 years and above over a period of five to six weeks. Third molars were excluded. Fifty-five per cent of the recording sheets dispatched were returned with usable data. Data were provided on 8516 extractions performed for 6331 patients. Overall caries was the reason given for 60 per cent of extractions; periodontal disease for 28 per cent; prosthetic indications for six per cent; trauma (which included tooth wear) for four per cent; and orthodontic and other reasons for two per cent. Extractions for periodontal reasons were more common in those aged 40 years and above, but periodontal disease did not exceed caries as a reason for extraction even in those aged 60 years and over. The tooth type most frequently extracted was the first molar. Mandibular incisors were the teeth most commonly extracted for periodontal reasons. In this community, which has benefited from water fluoridation since 1961, caries was the dominant reason given by dentists for tooth extractions in all age groups of the subjects studied.

Adolescent↗

PubMed2004

Prediction of demand for treatment of temporomandibular disorders based on a 20-year follow-up study.

The purpose was to test the hypothesis that signs and symptoms characteristic of temporomandibular disorders (TMD) at age 15 would predict demand for treatment during a 20-year follow-up period. Of originally 135 examined 15-year-old subjects, 103 completed a questionnaire and 84 were examined clinically at the 10-year follow-up (at age 25). After 20 years (at age 35), 114 completed a questionnaire and 100 were also examined clinically. During the 20-year follow-up period, 21 subjects received some kind of treatment of TMD. At baseline (age 15), the treated group reported tooth grinding at night more often than the non-treated group (P = 0.0042). At the 10-year follow-up (at age 25), the treated group reported more symptoms of TMD and oral parafunctions than the non-treated group. Among the clinical registrations, there was only one significant difference between the groups: anterior tooth wear was more extensive in the treated group. At the 20-year follow-up (at age 35), the treated group reported significantly more symptoms of TMD and oral parafunctions than the non-treated group. The clinical dysfunction index was also higher in the treated group. Logistic regression revealed tooth grinding at night as a significant predictor of received treatment of TMD. However, the positive predictive value was low whereas the negative predictive value was high (90%). The findings indicate that nocturnal tooth grinding is related to demand for treatment of TMD.

Adolescent↗

PubMed1995

Brief communication: Tigaran (Point Hope, Alaska) tooth drilling.

In a sample of 48 adult Tigarans (1300-1700 A.D.) from Point Hope, Alaska, 33 exhibited various degrees of periodontal disease, which, in 25, resulted in tooth loss (Schwartz, unpublished data). Although extreme examples of tooth wear were prevalent in the sample, carious infection was noted in only one individual, in whom the lower central incisors (I1S) had been affected. In the left I1, infection had spread through the root's apex into the alveolar bone, causing an abscess. The buccal (labial) side of the root of this tooth, just below the crown, bears a shallow, relatively flat-bottomed depression, with a small perforation into, as well as a second hole that fully penetrates, the root canal. Both of these features appear to have been produced by an implement, and, as they are associated with a diseased tooth, and ritualistic tooth shaping or drilling of any sort was, and is, not practiced among Arctic groups, their purpose was probably therapeutic. As such, this specimen appears to represent a case of precontact New World Arctic dentistry.

Alaska↗

PubMed2004

Effects of occlusal load on cervical lesions.

Toothbrush abrasion has been considered to cause cervical lesions. However, some investigators have proposed that occlusal loading factors direct tensile stresses at the cervical area, resulting in wedge-shaped abfraction defects. The purpose of this study is to investigate the role of axial and non-axial load on the development of cervical lesions. Matched paired premolars, extracted for orthodontic purposes, were used in a custom-fabricated toothbrushing apparatus. A periodontal sulcus width of 0b1 mm with 1 mm gingival recession was simulated with denture base resin. In phase 1, eight matched premolar pairs were subjected to 80 h (1b4 million strokes) of brushing and 300 g of toothbrush force. Toothpaste slurry was applied continuously through the toothbrush. One specimen in each pair was subjected to 250 h and 45 kg of continuous axial load, while the other unloaded tooth served as a negative control. In phase 2, 10 matched premolar pairs were subjected to the same conditions; however, the experimental teeth were subjected to 250 h and 45 kg of intermittent non-axial load, directed at a 45 degrees angle to the buccal cusp. Rubber impressions were made of the cervical lesions, then trimmed, weighed, and compared to determine the amount of tooth material lost. When teeth were loaded axially, there was significantly less tooth material loss (P < 0b02); however, when teeth were loaded non-axially, there was no significant difference (P =0b80) when compared with controls. Optical and scanning electron microscopy did not reveal any significant differences in the morphology between pairs. Our data suggest that the application of occlusal load may not necessarily play a significant role in the progression of cervical tooth wear commonly referred to as abfraction.

Bicuspid↗

PubMed1990

[Pre- and post-eruption effects on the functional morphology of the articulating structures].

Profile traces of latero- and protrusive facets of subjects with class-I-occlusion showed characteristic regular patterns in curvature and angle to the occlusal plane. There was no significant correlation between the laterotrusive surface profiles and the corresponding transversal movement of the condyle which was recorded electronically in 3 dimensions. Curvature morphology was plotted as a function of tooth eruption, development of the dental hard tissues, and tooth wear. In conclusion the results were applied to comprehensive occlusal restorations.

Dental Arch↗

PubMed1983

Relationships between attrition and lingual tilting in human teeth.

Associations between occlusal dental attrition and the lingual tilting of human teeth were investigated in two aboriginal California populations. A literature survey suggests lingual tilting is related geographically and temporally to the helicoidal occlusal plane in humans; if true, lingual tilting should be expected throughout the Homo osteological record. Buccal alveolar abscesses, exposed pulp chambers, extent of tooth attrition, angle of lingual tilt, and amount of overjet were observed for lingually tilted teeth. These attributes were analyzed statistically, leading to a conclusion that lingual tilting is slight and infrequent unless tooth attrition is pronounced. It is suggested that lingual tilting is due in part to masticatory stress. A feedback model considers lingual tilting as one conspicuous manifestation of a more complex "severe attrition syndrome," the initial stimulus for which may derive from heavy occlusal tooth wear. Untested possibilities should be examined- e.g., age-related changes, the impact of the helicoidal occlusal plane, and the role of masticatory forces.

California↗

PubMed2004

Dental erosion: part 2. The management of dental erosion.

Dental erosion is an important cause of tooth tissue loss in both children and adults. An earlier article (Mahoney and Kilpatrick, 2003) discussed the prevalence and causes of dental erosion. This second article will discuss the management of this condition which is often complicated by the multifactorial nature of tooth wear. Management of dental erosion can be considered in three phases: immediate, interim and long-term. Immediate management includes the early diagnosis of dental erosion, recording the status of the disorder at baseline and implementing appropriate preventive strategies including those aimed at reducing the acidic exposure as well as those that attempt to increase an individual's resistance to erosive tooth tissue loss. Interim and long-term treatment includes the provision of temporary diagnostic restorations, ongoing monitoring of disease progression, definitive restorative work where appropriate, and modification and reinforcement of preventive advice. Each phase will be discussed in light of current evidence.

Beverages↗

PubMed2001

Dental erosion in a group of British 14-year-old, school children. Part I: Prevalence and influence of differing socioeconomic backgrounds.

OBJECTIVES: To establish the prevalence of erosion in a cluster random sample of 14- year-olds in Birmingham UK. To determine whether socioeconomic group influences the prevalence of erosion. METHODS: The study group consisted of a cluster random sample of 14-year-old school children in Birmingham UK: 418 children were examined from 12 different schools; 209 were male and 209 female. The level of tooth wear was recorded using a modification of the (TWI) index of Smith and Knight (1984). The ACORN classification was used to assess the socioeconomic status of all children. RESULTS: Results showed that 48% of the children had low erosion, 51% had moderate erosion and only 1% had severe erosion. There were statistically significant differences between males and females; more males had buccal/labial and lingual/palatal tooth surface erosion than females (Chi-square analysis P < 0.001). There was also significantly more erosion observed in teenagers in the lowest socioeconomic categories. CONCLUSION: It was concluded that moderate levels of dental erosion are common in 14-year-old school children and this may lead to increasing clinical problems. There was significantly more erosion in children from low socioeconomic groups. Possible aetiological factors need to be investigated further.

Adolescent↗

PubMedDate not supplied

Oral rehabilitation of young adults with amelogenesis imperfecta.

PURPOSE: This article describes the restorative management of two patients in whom the diagnosis of amelogenesis imperfecta was not made until young adulthood. MATERIALS AND METHODS: Amelogenesis imperfecta is a variable developmental abnormality of the tooth enamel that affects relatively few persons. Previous case reports have focused largely on the early management of children and young adolescents. However, some patients may not be diagnosed correctly or may not request dental treatment until they are older, as with the two cases presented. In some instances, parents fail to appreciate the importance of early intervention. RESULTS: Both patients required intensive preventive therapy and extensive restorative treatment over several years. The correct sequencing of treatment phases was required to achieve relief of pain and provide satisfactory function and esthetics. CONCLUSION: The two cases presented illustrate the degree of complexity that extended restorative treatments can involve, especially following severe tooth wear and poor bonding of restorations to the affected enamel.

Adolescent↗

PubMed1979

Cusps or no cusps--that is not the question.

Current views of the significance of cusps to oral health range from an emphasis on meticulous recusping of the restored teeth to a recommendation of gradual prophylactic elimination of natural cusps by grinding. Cusps, their morphology and mutual arrangement are associated with masticatory function. The adaptive value of efficient mastication has diminished along with advancing cultural evolution. Industrialization marks a turning point as seen from the almost total disappearance of functional tooth wear. Restoring cusps to achieve maximum structural efficiency thus lacks a rational basis. But the occlusal morphology is also associated with the swallow reflex: retrusive occlusal interferences tend to disturb it. These interferences can be avoided by establishing the freedom in centric or by restoring the occlusion to the retruded position. The prophylactic grinding of teeth also lacks a rational basis. The consequences of artificial wear are not likely to be the same as those of functional wear because the function has changed, the oral environment is different. It seems advisable, therefore, to try to eliminate only unquestionably harmful factors, and to leave the rest of the morphology as unchanged as possible.

Dental Occlusion↗

PubMed1997

[Comparison of two methods of age determination in teeth of known age from wild carnivores].

Two age-determining methods were conducted on representatives of known age from the Order Carnivora (4 red foxes, 3 tree martens, 3 stone martens, 2 racoons, 2 badgers, 2 polecat and one otter). Age determination employed with the aid of tooth wear nearly agrees with the real age of the animals. Dating based on the formation of the age-dependent cement zone coincided well with the known ages of the individual specimens. However, in real foxes the figure one must be added to the number of cementum layers counted determining the definitive age of individuals. For representation of the cementum layers transverse sections of the apical part of the tooth root of canini, P2 and P3, stained with methylene blue, should be used. It is important to note that the dentino-cemental line should not be considered when counting the year rings in the cement.

Age Determination by Teeth↗

PubMedDate not supplied

Effect of time on the remineralisation of enamel by synthetic saliva after citric acid erosion.

The aim of this in vitro study was to determine the influence of remineralisation time on rehardening of surface-softened enamel after citric acid erosion. Seven groups of 13 samples of human enamel were eroded in 0.3% citric acid at pH 3.2 for 2 h followed by profilometric measurements. Individual groups of specimens were placed in artificial saliva for 1, 2, 4, 6, 9 or 24 h. A control group was placed in isotonic saline for 24 h. After new profilometric measurements samples were ultrasonicated stepwise up to 480 s with profilometric measurements performed at 5, 30, 120, 240 and 480 s to measure the depth of surface softening. The control group had a softened surface layer of mean thickness 2.9 microm. Mineral deposition was seen at all remineralisation times by scanning electron microscopy. Exposure to artificial saliva for 1, 2 or 4 h produced a partial rehardening of the softened enamel; the additional surface losses produced by ultrasonication were lower and time delayed compared to the control group. Specimens remineralised for 6, 9 and 24 h showed little evidence of surface loss after ultrasonication. The data suggest that a complete rehardening of the softened enamel in vitro is reached after a remineralisation time of 6 h. These data are of clinical relevance to tooth wear. However, there is a need for studies in situ of enamel demineralisation and remineralisation.

Analysis of Variance↗