Human tooth wear, tooth function and cultural variability.
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Anthropology, Cultural↗
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Interaction between attrition,abrasion and erosion in tooth wear.
Tooth wear is the result of three processes: abrasion (wear produced by interaction between teeth and other materials), attrition (wear through tooth-tooth contact) and erosion (dissolution of hard tissue by acidic substances). A further process (abfraction) might potentiate wear by abrasion and/or erosion. Both clinical and experimental observations show that individual wear mechanisms rarely act alone but interact with each other. The most important interaction is the potentiation of abrasion by erosive damage to the dental hard tissues. This interaction seems to be the major factor in occlusal and cervical wear. The available evidence seems insufficient to establish whether abfraction is an important contributor to tooth wear in vivo. Saliva can modulate erosive/abrasive tooth wear through formation of pellicle and by remineralisation but cannot prevent it.
Dental Pellicle↗
Some facets of tooth wear.
Tooth wear seems to be an increasing problem, particularly amongst older patients who are retaining their teeth for longer. Having survived the ravages of caries and periodontal disease, they are then at risk of wearing out their dentition. Diagnosis and a full understanding of the aetiology is crucial to the effective management of unacceptable levels of tooth wear. Monitoring over a long period is helpful in planning life long management. There are specific treatment techniques which are useful in restoring badly worn teeth.
Humans↗
Wear now? An update on the etiology of tooth wear.
Tooth wear is an ever-increasing problem, and younger patients are particularly at risk. The problem is likely to continue as patients' demands and expectations rise and as more natural teeth are retained into old age. The etiology of tooth wear is reviewed, with emphasis on those factors that appear to be major contributors to the problem at the moment. The clinical appearance of tooth wear is also discussed. It would appear that erosive factors are a significant cause of tooth wear. The prominence of acidic damage of tooth tissue is probably a reflection of society's concern with healthy eating and appearance.
Humans↗
A new approach to the study of tooth wear.
Human tooth wear occurs so slowly that traditionally it has needed months or years to be measurable. This study showed that microscopic changes in wear patterns on human teeth could be detected in a matter of days and could be used as indicators of rates of wear. Thus, daily or weekly changes in rates of wear can be documented for specific locations on teeth. For instance, through this new approach, rates of wear of human teeth were shown to be significantly slower than rates of wear of the teeth of laboratory monkeys raised on hard or soft diets. Similar techniques may ultimately be used to monitor subtle changes in tooth use--including those associated with growth and development and those occurring in response to various dental clinical procedures.
Adult↗
Diet and tooth wear.
Extensive tooth wear is the normal finding in human skeletal remains uncovered in Britain prior to the 18th century. There is little evidence as to the aetiological factors involved in this wear and this article is a suggestion as to a possible causative agent. It is one that appears to have been overlooked in the literature so far.
Diet↗
Tooth wear patterns in the deciduous dentition.
Tooth wear is common in the deciduous dentition. A recent study suggests that tooth wear in the deciduous dentition is related to subsequent tooth wear in adults, so that early identification of factors related to tooth wear could be of long-term benefit. The purposes of this study were to describe patterns of tooth wear in the deciduous dentition and to relate tooth wear to occlusal characteristics and longitudinal dietary patterns. Data were collected as part of a longitudinal study of a cohort of children recruited at birth from Iowa hospitals. Stone casts were obtained in the deciduous dentition stage, and 355 children, 4 to 5 years old, met the selection criteria. Tooth wear was categorized for each tooth as none, mild, moderate, or severe, and related to occlusal characteristics and longitudinal data on fruit juice and soft drink consumption. All children exhibited some tooth wear on at least 1 tooth, and nearly 16% of them had at least 1 tooth with severe wear. Tooth wear was generally more severe in the maxillary arch and the anterior teeth. Severe tooth wear on the molars was significantly related to posterior crossbites, but severe tooth wear on the incisors was related to Class III canine relationships. There were no statistically significant relationships between tooth wear and soft drink or fruit juice consumption. Based on our results, we concluded that mild tooth wear is universal in the deciduous dentition, but only a few occlusal factors are related to severe tooth wear. Tooth wear was not related to any dietary patterns we investigated.
Analysis of Variance↗
A cross-cultural study of occlusal tooth wear.
Occlusal and incisal tooth wear were evaluated for the purpose of assessing their prevalence, severity and distribution in a selected Swedish high-wear patient sample and in a young adult Saudi non-patient population. Furthermore, an attempt was made to investigate, by means of a questionnaire and a clinical examination, the association of various factors with wear; any observed associations were further analyzed with reference to possible cause and effect relationships. The scales used for evaluating the severity and the progression of wear provided high inter- and intra-observer concordances. The results revealed a high wear experience in the Saudi population compared to Western equivalents. Dietary, para-functional, anamnestic, occlusal and salivary factors exhibited certain correlations with wear. Progression of tooth wear was shown to be a slow process in the Swedish sample. The common element of a harsh desert terrain in the Saudi sample may constitute the dominant passive abrasive etiological factor in this population. While progression of wear seems to be of a "linear" nature in the Saudi population, it is postulated that wear in Western populations may, in addition to a "linear" deterioration, occur in "bursts", coinciding with the presence of certain causative factors. The results from this study also indicate that the effects of excessive function, including that of wear, on certain dentoalveolar morphological features are similar in modern man and his ancestors. On the basis of the findings, not only is the multifactorial etiology of occlusal tooth wear a reality, but so too is the complex interdependence of these factors in the prevalence, severity, distribution and progression of wear.
Adult↗
Retrospective long term monitoring of tooth wear using study models.
OBJECTIVE: Tooth wear is recognised as a common feature of European dentitions. However, little is known about its progression in susceptible patients. The aim of this study was to assess the degree and progression of tooth wear in patients by examining study casts taken of their teeth on two separate occasions. DESIGN: Over 500 sets of study casts taken during an 18-year period from patients referred for a variety of restorative procedures, were examined at Guy's Dental Hospital. Of these, 34 cases were found to have consecutive models taken at two time intervals and these were used to assess the progression of tooth wear. Study models from 19 females and 16 males, with an average age of 26 years (range 18-60) at the time of their first presentation and were all examined by a single operator. The Smith and Knight tooth wear index was used to assess the degree of tooth wear at presentation and then at another time which was a median of 26 months (interquartile range 14 - 50 months) later. RESULTS: The most common initial TWI score per surface was 1, with 54% of surfaces affected at the first assessment and 57% at the second. Score 2 was less common (14% at both assessments) and the scores for 3 and 4 combined were relatively uncommon with 5% of surfaces effected. Minimal progression of tooth wear was observed on study casts with only 7.3% of surfaces involved. CONCLUSION: In this sample, tooth wear was a slow, minimally progressive process.
Adolescent↗
[Repair of tooth wear; restorative-prosthetic aspects].
Tooth wear is considered to be the third major threat to dental health in the industrialized parts of the world next to caries and periodontal disease. Bruxism can be a cause for excessive tooth wear. Thanks to the successes in the prevention and early treatment of the infectious dental diseases, dentitions last longer as result of which tooth wear is becoming more and more of a problem in the preservation of a physiologic dentition throughout live. Furthermore there seems to be an increasing tendency for the occurrence of severe tooth wear at very early ages. Early recognition of possible contributing factors for tooth wear by the dental team is of utmost importance to enhance success in treating the problem. Prevention of ongoing damage to the remaining tooth structure must be the starting point of every treatment plan. Repair of tooth wear is in many cases a challenge from a restorative/prosthetic perspective: esthetic and phonetic aspects play an important role along with the restorative and prosthetic choices as well as functional considerations the clinician has to deal with.
Bruxism↗
Decelerating and sex-dependent tooth wear in Norwegian red deer.
In ungulates, tooth wear is often suggested as a proximate cause of senescence. Tooth wear is expected to be sex-dependent since energetic requirements and food selection varies largely between sexes in sexually dimorphic ungulates. Furthermore, tooth wear may lower mastication efficiency, and we predict a negative correlation between tooth wear and body weight or condition. We tested these predictions on data on tooth wear (estimated as height of first molar) of 1,311 male and 1,348 female red deer ( Cervus elaphus) aged 3-25 years and harvested along the west coast of Norway. The rate of tooth wear decreased with age. Males wear teeth at a higher rate (from 0.61 mm/year in 4-year olds to 0.45 mm/year in 11-year olds) than females (from 0.52 mm/year in 4-year olds to 0.39 mm/year in 11-year olds). Molar height correlated positively with body weight in both sexes, but not after adjusting for body size. Molar height was strongly dependent on body size in 3-year-old individuals (when tooth wear is minimal). Earlier reports in the literature of a positive correlation between tooth height and body weight may therefore be due to initial size differences rather than differences in condition due to tooth wear.
Aging↗
Tooth wear and some factors influencing its severity.
Tooth wear has been studied in a dentally attending population, aged 46-85 years. The level of tooth wear was recorded for 100 persons using the tooth wear index of Smith and Knight. Aetiology was assessed using a history/questionnaire/examination. Erosion/attrition were postulated in 98 persons while abrasion was present in 82. All demonstrated some tooth wear and in 6.93% of 7,822 surfaces this was defined as pathological according to the threshold levels associated with the index. 84 persons had pathological wear on some surfaces but this was predominately cervical, only 12 persons showing pathological wear on the occlusal/incisal surfaces. Occlusal contact area was measured using imprints in soft opaque wax, transmitted light and a charge-coupled linear scanning array. The array is moved at 90 degrees to its axis by a linear translator to produce an image consisting of 1,600 lines, each of 2,048 pixels. This image is converted to hard copy using a DEC DDP 11/23 computer which will also give area measurements. Occlusal contact area ranged from 3.16 to 194.40 sq mm with a mean of 59.23 sq mm. Tooth wear is a significant clinical problem in this population. Wear on the occlusal/incisal surfaces is more common in older age groups and in males but could not be related to occlusal contact area or denture status by the methods used.
Aged↗
Retrospective survey of resin-retained cast-metal palatal veneers for the treatment of anterior palatal tooth wear.
Anterior palatal tooth wear is easily recognized, but its precise pathogenesis remains unknown. Treatment of this condition with cast-alloy palatal veneers used in combination with an adhesive cement is described. Forty-eight patients, aged 11 to 71, were treated with a total of 210 cast metal veneers over a period of 56 months. Twenty-three of the restorations failed, resulting in an overall success rate of 89%. All failures were confined to 13 patients. A glass polyalkenoate cement was less effective than a chemically active resin composite luting agent. Nickel-chromium veneers cemented with activated resin composite recorded a survival probability of 0.74 at 56 months. Adhesive cast-alloy veneers provided a useful method of restoring maxillary anterior teeth affected by acid erosion.
Acrylic Resins↗
No association between incisal tooth wear and temporomandibular disorders.
STATEMENT OF PROBLEM: Incisal tooth wear may be a sign of long-term bruxing behavior. Bruxism is purported to be a risk factor for temporomandibular disorders (TMD). PURPOSE: The purpose of this clinic-based case-control study was to investigate whether the wear of anterior teeth is associated with TMD. MATERIAL AND METHODS: Two hundred eight TMD patients and 172 control subjects were selected for participation. After exclusion of subjects with more than 1 missing premolar or molar zone in opposite arches, as well as subjects with missing or severely restored anterior teeth, 154 TMD patients and 120 control subjects were included in the study (age 31.2 +/- 13.4 years; range 13 to 76 years). Anterior tooth wear was assessed on casts with a 0 to 5 scale. A multiple logistic regression analysis, controlling for the effects of age and gender, was performed to investigate the relationship between tooth wear and TMD. RESULTS: An odds ratio of 0.76 (95% confidence interval: 0.51 to 1.15) indicated that after adjusting for gender and age, the odds in favor of TMD decreased an estimated 24% for each additional unit of the mean tooth wear score. This result was not significant (P=.20). CONCLUSION: Within the limitations of this study, incisal tooth wear (assessed on dental casts) was not significantly associated with TMD when the influence of age and gender was controlled. Based on these findings, a clinically relevant risk for TMD from incisal tooth wear can be excluded. Hence, the presented evidence does not support the idea that treatment of incisal tooth wear is indicated to prevent TMD.
Adolescent↗
The prevalence, aetiology and clinical appearance of tooth wear: the Nigerian experience.
OBJECTIVE: To establish the prevalence and severity of tooth wear among Nigerians and to compare the pattern and aetiology with findings of earlier studies in Western populations. DESIGN: Clinical examinations for tooth wear using the tooth wear index (TWI). SETTING: The Federal Republic of Nigeria. PARTICIPANTS: Patients attending the Dental Hospital, Obafemi Awolowo University Teaching Hospital's Complex Ile-Ife. OUTCOME MEASURES: Attrition, abrasion and erosion. RESULTS: Of the 126 patients with tooth wear 81 had attrition, 20 had abrasion, 9 had erosion and 16 had attrition and abrasion combined. A total of 15,480 tooth surfaces were examined. 2,229 (14.4%) surfaces had tooth wear out of which 1,007 (6.5%) were pathologically worn down. The frequency of tooth wear increased with the age of patients. Most of the pathologically worn surfaces were just one point above maximum acceptable value. CONCLUSIONS: The aetiological factors associated with tooth wear are not different from those encountered in Western cultures but the pattern of wear differs. Pathological tooth wear presents as an age related phenomenon and is probably more severe in Nigerians.
Adult↗
[Tooth wear. Classification and terminology].
Tooth wear rarely occurs as a result of one factor alone. Non-carious loss of tooth tissue can be subdivided into attrition, demastication, abrasion, fractionation, and erosion. Clinically, the tooth tissue loss may result from any combination of these types of wear. The first essential principle in the management of tooth wear is, as far as possible, to remove the cause. Secondly, restoration may be indicated.
Adult↗
Psychosocial factors and tooth wear with a significant component of attrition.
Pathological tooth wear is often associated with bruxism, which appears in turn to be influenced by psychosocial factors. This study investigated putative relationships between psychosocial factors (total and average perceived stress, state and trait anxiety) and tooth wear, comparing 45 patients exhibiting tooth wear with a significant component of attrition to 45 controls. Groups were matched for gender and age. Subjects completed the Modified and Perceived Stress Scale and the State-Trait Anxiety Inventory. A between-groups multivariate analysis of variance indicated that the two groups did not differ significantly on the combined psychosocial factors, F(4,85) = 1.16, P > 0.05. However, a univariate F-test showed that tooth-wear patients presented significantly more trait anxiety than controls, F(1,88) = 4.15, P < 0.05. Further research is indicated to clarify the importance of trait anxiety and other psychosocial factors in the progression of tooth wear with a significant component of attrition.
Adult↗
Dental arch shape and tooth wear variability.
The rapid rate of tooth wear frequently reported among certain contemporary aboriginal populations has often been attributed to dietary form and abrasives. Several investigators have reported a close correlation between food bulk and the wear planes formed over the dental arches, i.e., steep oblique wear vs. flat horizontal planes. In this investigation we demonstrate that arch shape is an additional and a significant factor influencing the distribution of wear facets and exposed dentin over occlusal surfaces. We examined 64 dental stone casts of Aboriginals from Yuendumu, Central Australia, born between 1900 and 1940. These casts offer a record of the variety of tooth wear and arch forms and their interrelationships. This group of individuals, some subsisting on abrasive and some on soft diets, have dentition which exhibit various wear rates and wear patterns probably due to the diversity of arch shape, size, and occlusal relationships. Hypsiloid or U-shaped maxillas had a more buccally directed wear in contrast to the parabolic or hyperbolic forms, which exhibit a heavier lingual loading. Varying occlusal conditions also contribute to differing wear patterns over the arches. Individuals with alternate intercuspation, for example, have a more horizontally directed wear. These and other conditions of shape, size, and occlusion emphasize the importance of morphological factors in the production of tooth wear rates and patterns in addition to dietary abrasives.
Adolescent↗