All the types are different and distinct processes, each of which results in loss of tooth structure.

  •  ATTRITION
It is defined as physiologic wearing away of tooth as a result of tooth to tooth contact a as in mastication. Everyone wears down their teeth in one way or another during a lifetime, thus everyone suffers at least some attrition.
 
Factors: Diet, Dentition, jaw musculature, and chewing habits influence the pattern and extent of attrition.
 
Occurs on:  Occlusal, incisal and proximal surfaces of teeth. Not on other surfaces unless a very unusual occlusal relation or malocclusion is present.
 
Phenomenon: It is a physiologic process.
 
Association with Age: Older a person becomes, the more attrition is exhibited.
 
 
 
Present : Both in primary and permanent dentition. But severe attrition is seldom seen in primary (Deciduous teeth) teeth because they are not retained normally for any great period of time.
 
Clinical Features: First clinical manifestation is the appearance of small polished facet on a cusp tip or ridge or a slight flattening of an incisal edge.
  • Slight mobility of teeth in sockets.
  • Facets at the contact points on the proximal surface.
  • As the patient becomes older the attrition becomes severe and the cusp height is reduced, resulting in   flattening of occlusal inclined plane.
  • Shortening of length of dental arch due to decrease in mesio-distal width.
Sex commonly Involved: Male more than females, probably due to more occlusal forces than women, also due to difference in diet or habits such as chewing tobacco, or bruxism (night grinding of teeth).
 
If attrition is advanced enamel has been completely worn away results in extrinsic staining of teeth, from food or tobacco. In some cases tooth are worn down till gingiva.
 
Treatment: No treatment is required as secondary dentin proceeds at a rate commensurate with the attritional wear. When the crowns are worn down to the gingival margin, an over denture may be constructed to improve function.
  •   ABRASION 
It is defined as pathological wearing of tooth substance, through some abnormal mechanical process, like from misuse of toothpaste on virtually any surface exposed to toothbrush bristles or toothpaste.
 
Factors: Pipe smoking, tobacco chewing, aggressive tooth brushing, and use of abrasive dentrifrices, Bruxism, Tooth paste abuse.
 
Occurs: usually on the root surface, it depend on the cause e.g.in aggressive tooth brushing wear is on the cemento-enamel junction, abrasion caused by tooth paste results in V shaped or wedge shape ditch on the root side of CEJ.
 
Phenomenon: It is a pathologic process.
 
Clinical features
  • The exposed dentin appears highly polished.
  • Some degree of root exposure is common clinical finding.
  • Abrasion is more common on left side in right handed persons and vise-versa.
  • Habits related to abrasion are-opening of bobby pins by the teeth results in notching of maxillary incisor tooth, similar notching in carpenters, shoemakers or tailors who hold nails, tacks or pins between the teeth. Habitual pipe smokers have notching of teeth.
  • Improper use of dental floss causes lesions on proximal surface. The exposures of dentinal tubules results in secondary dentin formation same as in attrition.
  • Tooth paste abuse: using tooth paste in conjunction with very aggressive, prolonged, frequent,and hard brushing using a wide back and fourth ‘sawing ‘motion with the tooth brush. Most commonly on occlusal and buccal surfaces of teeth.

Sign and Symptoms:

  • Sandblasted teeth: anatomy of tooth surface is lost.
  • Cupping and crate ring.
  • Teeth are very sensitive to cold.
  • Polished amalgams fillings.
  • Damage to buccal tooth structure is severe.  
TREATMENT
 
 Limited forms of abrasion require elimination of the habit and restoration of normal tooth contour if the function or esthetic is a problem.Abrassion related to malocclusion may require occlusion rehabilitation and a complete periodontal evaluation.Nightguard appliance may limit abrasion in patients with bruxism.   
  
EROSION
 
It is defined as a loss of tooth structure by a chemical process that does not involve known bacterial action. As in bulimia or acid reflux disease (called as GERD), Erosion also happens because of acidic solution or food kept in mouth for longer duration.
 
 
 
 
Causes
 Acids are involved are from either external or internal sources
 
External is acid found in work environment (e.g. battery manufacturing) or in diet (e.g. citrus fruits or acid containing soft drinks) Persons who drink soft drinks have erosion of labial surfaces of the teeth due to highly acidic carbonated beverages or lemon juice or who habitually suck lemons or other acid citrus fruits. Industries where acids are used e.q.plating, galvanizing, acid packing, and sanitary cleanser manufacture, soft drinks manufacture, process engraving, crystal glassworks, and enamel manufacture.
 
Internal is from regurgitation of gastric contents, in cases of chronic vomiting, the lingual surfaces of the teeth, particularly of the anterior teeth, may exhibit complete loss of enamel through dissolution by gastric hydrochloric acid, seen in bulimia or Anorexia nervosa: This is a psychosomatic disease mainly affecting young women. It is chacterised by induced chronic vomiting, often after bouts of uncontrolled eating that are interspersed between periods of starvation because of an inner rejection of food. Oral manifestation is erosion of teeth from chronic vomiting and also from excessive intake of fruits and juices by many of these patients in an attempt to relieve their thirst after vomiting. Severe dental caries is also seen in these patients because of excessive intake of carbohydrates.
 
Occurs on: labial and buccal surface of teeth, also on proximal surface.
 
Phenomenon: It is a chemical process.
 
Clinical features

 

  • The loss of tooth structure is usually manifested by a shallow, broad, smooth highly polished, scooped out depression on the enamel surface adjacent to cementoenamel junction.
  • Mostly it is confined to the gingival 3rd of the labial surfaces of the anterior teeth; erosion may affect the labial surface of any teeth.   
  • Usually involve several teeth.
  • Smooth lesions, which exhibit no chalkiness, occur most commonly on the labial and buccal surface.

TREATMENT

Areas of erosions may be sensitive and should be restored with conventional operative procedures. 

ABFRACTION

It is a wedge shaped defect limited to cervical area of teeth. It may resemble cervical abrasion or erosion. There is loss of cervical tooth structure secondary to repeated flexure of tooth caused by occlusal stress. It is thought that lateral occlusal forces bend the tooth with tensile stress concentrated in cervical fulcrum area, leading to disruption of enamel and dentin bonds. Once damaged the area may be enlarged secondary by abrasion, attrition, erosion.

CLINICAL FEATURES:

 Such lesions often involve the facial surface of mandibular dentition   as, deep, narrow, and Vshaped.

            

Often these lesions affect a single tooth and exhibit a greater prevalence in patient with bruxism.

In some cases, the lesions may be subgingival.

The lesion may be deep and narrow U or wedge shaped cervical concavity in enamel or dentin that exhibits sharp line angles and is located on the facial surfaces of the tooth. 

TREATMENT

Restoration is not mandatory, most teeth benefit from appropriate intervention. Primary importance is elimination of the abnormal occlusal forces, without such intervention, the restorative failure rate is high. The restorative materials used are micro filled resins and composite, glass ionomer restorative materials have been used in restoration of the defects.

 

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  • ASHISH PATHODE

    ASHISH PATHODE 10 - December - 2011, at 07:14 AM

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