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Salivary factors in vomiting bulimics with and without pathological tooth wear.

The increased occurrence of dental erosion from self-induced vomiting in bulimia nervosa is not linearly associated with the frequency or the duration of vomiting. Possible changes in the buffering and lubricating role of saliva in bulimia nervosa and their relationship to erosion have not been previously investigated. Chewing-gum-stimulated salivary flow rate, pH, bicarbonate concentration and viscosity were compared between two groups of vomiting bulimics and with 10 healthy controls. One bulimic group (n = 9) had pathological tooth wear present according to the criteria of the Tooth Wear Index and the other bulimic group (n = 10) did not. The influence of salivary pellicle on enamel acid dissolution by perchloric acid was also assessed by an enamel biopsy method. Bicarbonate was measured in a Natelson microgasometer. Both the bulimic groups had mean initial 3-min flow rates and overall 9-min flow rates significantly lower (p < 0.01) than the healthy subjects. The mean pH values were not significantly different between the two bulimic groups or the control group. However, the mean bicarbonate concentration in both bulimic groups was significantly less (p < 0.01) than in the control group. The mean salivary viscosity of 7.4 centipoise (cP), measured by a DV1 Brookfield viscometer, was significantly greater (p < 0.05) in the pathological tooth-wear-present group than in the tooth-wear-absent group (4.5 cP) and the control group (4.1 cP). Slightly more calcium was released from the pellicle-free surface in both groups but this was not statistically significant, whilst the dissolved calcium in enamel biopsies was significantly lower (p < 0.05) in the tooth-wear-present group.

Adult↗

Development of horizontal tooth wear in maxillary anterior teeth from five to 18 years of age.

Sizes of horizontal wear facets of maxillary anterior teeth were studied longitudinally from the primary dentition at age five to the young adult dentition at the age of 18 years. By a planimetric method, we calculated the wear areas on dental casts taken at the ages of five, ten, 14, and 18 years from the dentition of 39 healthy, orthodontically untreated subjects with good morphological occlusion. For young adults, we also studied the association between the amount of wear and reported parafunctions, maximal bite force, salivary buffer capacity, salivary flow rate, and some cephalometric variables. Size of wear facets on all anterior teeth increased with age. Significant correlations were found between the total wear areas of the six anterior primary teeth at five years of age and those of their permanent successors at age 14 (r = 0.44) and 18 (r = 0.39). For an individual, tooth wear at five years of age was, however, of low predictive value for tooth wear in young adulthood, whereas tooth wear at 14 years of age predicted it well (r = 0.89). Highest correlations between tooth wear and background factors at 18 years of age were found for maximal anterior bite force (r = 0.44) and for the size of the gonial angle (r = -0.31). Wear of anterior teeth was not associated with reported parafunctions in young adulthood.

Adolescent↗

Associated factors of tooth wear in southern Thailand.

The purpose of this study was to evaluate the possible risk factors connected with tooth wear. Using the Tooth Wear Index (TWI) and the charting of pre-disposing factors tooth surface loss was recorded in 506 patients, of the Dental Hospital, Prince of Songkla University. We found that age, sex, number of tooth loss, frequency of alcohol, sour fruit and carbonate intake were significant risk factors. Regarding the tooth position, the first molar showed the greatest degree of wear, while the canine and premolar showed the least, respectively. The occlusal surface showed the greatest wear and the cervical, lingual and buccal surfaces showed the least, respectively.

Adult↗

Fixed prostheses in the treatment of tooth wear.

The restorative implications of tooth wear are often complicated by the age of the patient, the destructive nature and aesthetic compromise of conventional fixed restorations and the lack of inter-occlusal space. This paper focuses on the fixed prosthetic treatment options for such patients and the utilisation of fixed restorations to create inter-occlusal space.

Ceramics↗

Investigation of an index to measure tooth wear in primary teeth.

UNLABELLED: Tooth wear, in particular erosion, has been reported to be widespread in children in the UK. Wear may affect either dentition, but epidemiological measurement has proved difficult. OBJECTIVES: The objectives of this study were: (a) to investigate use of a simple index of wear in primary teeth; and (b) to compare findings from visual examination and from photographs with those at histological examination of the same teeth. SAMPLE AND METHODS: Forty-one exfoliated or extracted primary anterior teeth were assessed visually and using photographs. Ground sections of the teeth were prepared and examined using polarised light microscopy. RESULTS: On visual examination, 31 of the 41 teeth had evidence of wear. In 14 teeth, tissue loss was confined to enamel and in 17 it extended into dentine. Findings on photographs were very similar to those on visual examination. Of the 10 teeth without erosion visually, two had evidence of loss on histological examination. Of the 14 with visual evidence of erosion confined to enamel, dentine was exposed in 11 cases. Diffuse demineralisation was evident histologically in 11 of the 31 teeth with evidence of erosion. CONCLUSIONS: It was concluded that clinical assessment of erosion may underestimate the extent of the condition. Under the conditions of the study, photographs gave results similar to those on visual examination.

Child↗

The oral medicine of tooth wear.

This review illustrates, through a series of case histories, how oral medicine insights aid the diagnosis and management of patients with excessive tooth wear. The cases reviewed are drawn from the records of 500 southeast Queensland patients referred to the author over a 12 year period. Patients most at risk of dental erosion have work and sports dehydration, caffeine addiction, gastro-oesophageal reflux, asthma, diabetes mellitus, hypertension or other systemic diseases or syndromes that predispose to xerostomia. Saliva protects the teeth from the extrinsic and intrinsic acids which cause dental erosion. Erosion, exacerbated by attrition and abrasion, is the main cause of tooth wear. These cases illustrate that teeth, oral mucosa, salivary glands, skin and eyes should be examined for evidence of salivary hypofunction and attendant medical conditions. Based on comprehensive oral medicine, dietary analyses and advice, it would seem patients need self-management plans to deal with incipient chronic tooth wear. The alternative is the expensive treatment of pain, occlusal damage and pulp death required to repair the effects of acute severe tooth wear.

Asthma↗

The development of a new index for measurement of incisal/occlusal tooth wear.

A number of indices have been developed for the measurement of tooth surface loss but they have not achieved universal acceptance. The aim of this study was to develop a new index suitable for the monitoring of incisal/occlusal tooth wear on serial study models. The new index recorded incisal/cuspal wear for individual teeth. Each tooth was scored on a six-point scale ranging from 0-5. Six assessors evaluated the index and it was applied to baseline and sequential models taken after 20 years. The study demonstrated the value of maintaining long-term dental records in the form of study models for monitoring progressive tooth wear.

Adult↗

Regurgitation erosion as a possible cause of tooth wear in ancient British populations.

Clinically, in modern populations, tooth wear can be differentiated into three main types--attrition, abrasion and erosion, acting either separately or together. Anthropologists generally have not recognized erosion as a factor affecting the teeth of past populations. This study compares the patterns of wear known to be associated with erosion in present-day dental patients with those found in some British, pre-Conquest, skeletons. It is concluded that erosion may have been a major factor causing the extensive tooth wear in some 20 of 151 individuals.

Adolescent↗

Occupational tooth-wear in clothing industry workers.

A research on tooth-wear was done in a clothing factory, focusing on the teeth of the inter-canine sector in 59 workers who had volunteered for the research. The subjects were in the habit of cutting the thread with their teeth instead of using scissors as was prescribed in the production process. In 53 (89.83%) of the subjects, damages of the incisal portion of the tooth were found, whereas in the remaining 6 (10.17%) there were no such changes. No significant difference could be established in the incidence of tooth-wear between the women workers who cut the thread with their teeth constantly and those who only did that occasionally (p > 0.05). Because of the action of pulling a thread across the incisal edge of the incisor, defects--in the form of solitary, oval or multiple cuts (attributed the values 1, 2 and 3)--had been inflicted on the incisal portion of the teeth. Most frequently those were the defects of the enamel (type 2, 1), but in some cases dentin (type 3), also was affected. A somewhat more severe degree of damage was observed from workers biting the purely polyester-made thread (p < 0.05) than from biting the regular sewing type of thread. Education of the workers seems to be the only useful prevention, since we are dealing with only a bad habit. Therefore, the workers should be warned that the seemingly innocent cutting of thread with their teeth could lead to esthetic, functional and restorative problems.

Adult↗

Assessment of tooth wear in an ageing population.

A random sample of 2222 adults aged 45 years and over was taken from the age/sex registers of two general medical practices in Newcastle upon Tyne, and asked to take part in a dental health survey. A total of 1002 individuals agreed to take part and were visited in their homes. Five hundred and eighty-six subjects were dentate and able to undergo an assessment of tooth wear using the Tooth Wear Index (TWI). Increasing wear with increasing age was observed for all cervical and occlusal/incisal tooth surfaces. Occlusal/incisal surfaces displayed some of the highest mean wear scores, especially in the older age cohorts. With the exception of lingual surfaces of maxillary anterior teeth, no significant variation in tooth wear with age was noted for buccal or lingual surfaces. Greater mean wear scores were observed among males than females, but there was little variation between subjects of different social class backgrounds. The threshold levels of wear suggested for use with the TWI may require modification for use among elderly populations.

Age Factors↗

Identification and management of tooth wear.

The etiology and treatment of occlusal tooth wear remain controversial. Longer tooth retention by the aging population increases the likelihood that clinicians will be treating patients with worn dentitions. A careful approach to interventional clinical procedures is advocated but should not curtail definitive management of patients having identifiable and potent causative agents that produce a rapid deterioration of the dentition. This article describes the epidemiology and etiology of occlusal wear and presents a conservative approach to its management.

Crowns↗

Accuracy and precision of a system for assessing severity of tooth wear.

PURPOSE: The purpose of this study was to introduce a computer-assisted quantitative tooth wear-analyzing system and test its accuracy and precision. MATERIALS AND METHODS: An image of a horizontally projected dental arch was captured, and the facet area of each tooth was calculated using a digital image analyzer. For normalization, the facet area of the individual tooth was divided by the total area of the corresponding tooth; this result was the tooth wear score. The accuracy and precision of this method were determined through the intraclass correlation coefficient using 10 dental casts. Tooth wear on the dental casts of 50 subjects was actually measured. RESULTS: The accuracy of the tooth wear score determined by a newly trained examiner was greater than 0.85 of the intraclass correlation coefficient; this was tested against the score determined by consensus of three experienced examiners. The reproducibility within a 1-week interval was also greater than 0.85. With regard to the tooth wear score from 50 sets of dental casts, the distribution of tooth wear was generally consistent with data reported in the literature. CONCLUSION: The results suggest that the newly trained examiner can exhibit adequate accuracy and precision after appropriate training in identifying tooth wear facets. Recorded data from 50 subjects added face validity to this new system.

Adult↗

An audit of study casts used to monitor tooth wear in general practice.

OBJECTIVE: To assess the outcome of compliance of advice sent to patients and dentists about monitoring tooth wear in general practice. METHOD: Postal questionnaires were sent to 70 patients and their dentists requesting information on the outcome of letters of advice sent to general dental practitioners regarding monitoring tooth wear with study casts. They also requested information about the reasons for the patients' referral, the outcome of treatment and whether study models had been taken. RESULTS: Replies were received from 60 dentists (87%) and 53 patients (75%). Of these, 16 patients and 16 dentists had moved from their recorded address. Study casts were reported as having been taken by 23 dentists (38%) and reported by 18 patients (34%). The most common reason for referral was advice about monitoring the wear and the appearance of their teeth. CONCLUSIONS: The compliance of the patients and dentists in monitoring tooth wear by using study casts in general practice was not successful. It raises issues regarding the value of consultant advice letters to this common clinical problem.

Adult↗

Changes in mandibular condyle morphology related to tooth wear in a prehistoric human population.

The exact relationship between tooth wear and changes in the shape of the articulating surface of the mandibular condyles is unknown. It is assumed that to some degree these changes are in response to the loads on the joint generated during chewing. Excavated skeletal remains from sites of primitive human habitation provide an opportunity to study the masticatory system of human beings in their natural context, with the features of form and function expressed to their full potential. Accurate measurements of the condylar head can also be made on such remains. A collection of skulls from an excavation site known as Oakhurst on the South African coast provided material for this study. Occlusal wear was measured using the scale devised by Molnar; approximal wear was assessed by measuring the size of the wear facet between the first and second molars. The width of the condyles were measured directly, and a method was devised to measure changes in the proportion of medial and lateral articulating facets. An increase in the size of the lateral facet of the condyle was found to be associated with increased tooth wear. It is suggested that the direction of condylar remodelling may give an indication of the reaction at the joint to optimal mastication.

Adult↗

Tooth wear and temporomandibular joint change in Australian aboriginal populations.

The masticatory system consists of teeth, temporomandibular joints, and the supporting craniofacial skeleton. The form and function of each of these components of the system can be understood only within the overall context of the system. In a series of studies, the complex relationships between tooth wear and temporomandibular joint morphology and pathology were considered in samples consisting of a total of 58 male and 54 female crania from two Australian Aboriginal populations. The extent and buccolingual direction of tooth wear were assessed using established techniques. Both metric and nonmetric descriptions of temporomandibular joint morphology and pathology were developed. Significant differences in patterns of tooth wear and in the frequencies of various temporomandibular joint changes were evident between sexes and between populations. Furthermore, significant correlations between a number of tooth and joint variables were also evident. In addition, there was clear evidence of relationships between both tooth wear and temporomandibular joint changes and craniofacial morphology. The results of this study provide additional evidence of the complex relationships between the form and function of the masticatory system.

Adult↗

Prevalence, distribution and background variables of smooth-bordered tooth wear in teenagers in the hague, the Netherlands.

The purposes of the study were: (1) to assess the prevalence and distribution of smooth-bordered tooth wear in teenagers, and (2) to investigate the relationship between smooth-bordered tooth wear and social background, dietary pattern, drinking habits, oral hygiene practices and caries prevalence. In The Hague, The Netherlands, a sample of 345 10- to 13-year-olds and 400 15- and 16-year-olds was clinically examined. The criteria for the assessment of smooth-bordered tooth wear ('smooth wear') were in line with the diagnostic criteria for erosion developed by Lussi (1996). In the age group 10-13 years, the percentage of subjects with visible smooth wear (SW1 threshold) was 3% and in 1 subject (0.3%), deep smooth enamel wear was found. Due to the low prevalence, the results for this age group were not analysed further. In the age group 15-16 years, the proportion of subjects with visible smooth wear (SW1 threshold) was 30% and that with at least deep smooth enamel wear (SW2 threshold) 11%. Smooth wear into dentine was found in 1 subject. First molars and upper anterior teeth were affected predominantly. A significant effect on visible smooth wear (SW1 threshold) was found for gender and social background. At mouth level, no significant influence was found for dietary patterns, drinking habits or oral hygiene practices. The caries prevalence was similar in subjects with and without smooth wear.

Adolescent↗

Mathematical shape matching as a tool in tooth wear assessment--development and conduct.

The quantitative assessment of restoration and tooth wear usually requires fixed reference points from which measurements are made. In longitudinal patient follow-up the loss or erosion of such points may preclude measurement and an alternative approach is to seek regions of coincidence and conflict in digital models of before and after wear surfaces, with a continuous refinement of the parameters of the coordinate transformations, until the closest correspondence between them is found. A computer program has been written to implement the algorithm and assess the technique's capacity to find the match between surfaces both artificially generated and from tooth replicas recorded from patients at different epochs. The program was able to achieve the desired ends, demonstrating the utility of the technique in tooth wear assessment but identifying the need to refine the program further to enhance both its difference detection capabilities and level of automation. Examination of the theory and practical experience highlighted certain situations when user understanding is invaluable to ensure a satisfactory solution. This strengthened the investigators' resolve against reliance upon commercially based surface fitting programs whose basis may not be fully understood. Notwithstanding this surface matching is a powerful tool in the investigation of dental wear.

Algorithms↗

Partial dentures for patients with advanced tooth wear.

Many patients attend their dentist for advice, and often treatment, for tooth wear. Poor appearance and inadequate function are the most common presenting complaints but occasionally treatment is needed for acute or chronic pain or sensitivity. Although patients often prefer a fixed replacement for the missing tooth structure this is not always possible or appropriate. This article presents the practical aspects of managing patients with advanced tooth wear using removable partial dentures.

Dental Restoration Failure↗