Tooth wear: Difference between revisions
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Section added on tooth wear indices including TWI and BEWE with references. References and additions made to introduction. |
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Tooth wear is majorly the result of three processes; [[attrition (dental)|attrition]], [[Abrasion (dental)|abrasion]] and [[Erosion (dental)|erosion]].<ref name="ReferenceC"/> These forms of tooth wear can further lead to a condition known as [[abfraction]],<ref name="ReferenceC"/> where by tooth tissue is 'fractured' due to stress lesions caused by extrinsic forces on the enamel. Tooth wear is a complex, multi-factorial problem and there is difficulty identifying a single causative factor.<ref name="ReferenceC"/> However, tooth wear is often a combination of the above processes. Many clinicians therefore make diagnoses such as "tooth wear with a major element of attrition", or "tooth wear with a major element of erosion" to reflect this. This makes the diagnosis and management difficult.<ref name="ReferenceB"/> Therefore, it is important to distinguish between these various types of tooth wear, provide an insight into diagnosis, risk factors, and causative factors, in order to implement appropriate interventions.<ref name="ReferenceB"/> |
Tooth wear is majorly the result of three processes; [[attrition (dental)|attrition]], [[Abrasion (dental)|abrasion]] and [[Erosion (dental)|erosion]].<ref name="ReferenceC"/> These forms of tooth wear can further lead to a condition known as [[abfraction]],<ref name="ReferenceC"/> where by tooth tissue is 'fractured' due to stress lesions caused by extrinsic forces on the enamel. Tooth wear is a complex, multi-factorial problem and there is difficulty identifying a single causative factor.<ref name="ReferenceC"/> However, tooth wear is often a combination of the above processes. Many clinicians therefore make diagnoses such as "tooth wear with a major element of attrition", or "tooth wear with a major element of erosion" to reflect this. This makes the diagnosis and management difficult.<ref name="ReferenceB"/> Therefore, it is important to distinguish between these various types of tooth wear, provide an insight into diagnosis, risk factors, and causative factors, in order to implement appropriate interventions.<ref name="ReferenceB"/> |
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Multiple indices have been developed in order to assess and record the degree of tooth wear, the earliest was that by [[Paul Broca]].<ref name=":0">{{Cite journal|last=Lopez-Frias|first=FJ.|last2=Castellanos-Cosano|first2=L.|last3=Martin-Gonzalez|first3=J.|last4=Llamas-Carreras|first4=JM.|last5=Segura-Egea|first5=JJ.|title=Clinical measurement of tooth wear: Tooth Wear Indices|url=http://www.medicinaoral.com/odo/volumenes/v4i1/jcedv4i1p48.pdf|journal=Journal of Clinical and Experimental Dentistry|pages=e48–e53|doi=10.4317/jced.50592}}</ref> In 1984, Smith and Knight |
Multiple indices have been developed in order to assess and record the degree of tooth wear, the earliest was that by [[Paul Broca]].<ref name=":0">{{Cite journal|last=Lopez-Frias|first=FJ.|last2=Castellanos-Cosano|first2=L.|last3=Martin-Gonzalez|first3=J.|last4=Llamas-Carreras|first4=JM.|last5=Segura-Egea|first5=JJ.|title=Clinical measurement of tooth wear: Tooth Wear Indices|url=http://www.medicinaoral.com/odo/volumenes/v4i1/jcedv4i1p48.pdf|journal=Journal of Clinical and Experimental Dentistry|pages=e48–e53|doi=10.4317/jced.50592}}</ref> In 1984, Smith and Knight developed the tooth wear index (TWI) where four visible surfaces (buccal, cervical, lingual, occlusal-incisal) of all teeth present are scored for wear, regardless of the cause.<ref name=":0" /> A more recent index Basic Erosive Wear Examination (BEWE) from 2008 by Bartlett et al., is now also in use. <ref name=":1">{{Cite book|url=https://www.worldcat.org/oclc/875630033|title=Erosive tooth wear : from diagnosis to therapy|others=Lussi, Adrian,, Ganss, Carolina,|isbn=9783318025538|edition=2nd, revised and extended edition of "Dental erosion - from diagnosis to therapy", vol. 20|location=Basel|oclc=875630033}}</ref> |
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==Attrition== |
==Attrition== |
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==Abfraction== |
==Abfraction== |
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[[Abfraction]] is loss of tooth substance at the [[cervical margins]], purportedly caused by minute flexure of teeth under occlusal loading.<ref>{{cite journal|last=Sarode|first=GS|author2=Sarode, SC |title=Abfraction: A review.|journal=Journal of Oral and Maxillofacial Pathology|date=May 2013|volume=17|issue=2|pages=222–227|pmid=24250083|doi=10.4103/0973-029X.119788|pmc=3830231}}</ref> The term is derived from the Latin words ''ab'' and ''functio'' meaning ‘away’ and ‘breaking’ respectively.<ref name="ReferenceA"/> Abfraction presents as triangular [[lesions]] along the [[Cervical margins]] of the [[buccal space|buccal]] surfaces of the teeth where the enamel is thinner and therefore, in the presence of occluding forces, is prone to fracture.<ref name="ReferenceB"/> Whether abfraction exists or not is debated. |
[[Abfraction]] is loss of tooth substance at the [[cervical margins]], purportedly caused by minute flexure of teeth under occlusal loading.<ref>{{cite journal|last=Sarode|first=GS|author2=Sarode, SC |title=Abfraction: A review.|journal=Journal of Oral and Maxillofacial Pathology|date=May 2013|volume=17|issue=2|pages=222–227|pmid=24250083|doi=10.4103/0973-029X.119788|pmc=3830231}}</ref> The term is derived from the Latin words ''ab'' and ''functio'' meaning ‘away’ and ‘breaking’ respectively.<ref name="ReferenceA"/> Abfraction presents as triangular [[lesions]] along the [[Cervical margins]] of the [[buccal space|buccal]] surfaces of the teeth where the enamel is thinner and therefore, in the presence of occluding forces, is prone to fracture.<ref name="ReferenceB"/> Whether abfraction exists or not is debated. |
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== Indices == |
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Tooth wear indices are useful tools for carrying out epidemiological studies and for general use in dental practices <ref name=":1" />. |
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=== Basic Erosive Wear Examination (BEWE) === |
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The Basic Erosive Wear Examination was first described in 2008 by Bartlett et al. The partial scoring system is based on the surface area affected. Within a sextant (i.e. teeth in mouth divided into 6 parts), the most severely affected tooth surface (buccal, occlusal or lingual/palatal) is recorded according to the severity of the wear (see Table 1). A cumulative score is then matched to a risk level and guidance for its management by a clinician. The management includes steps which identify and eliminate main aetiological factors, preventative treatment and also any operative and symptomatic intervention required by the patient. The frequency of repeating the index ranges from 6-12 months depending on the risk level of patients.<ref>{{Cite journal|last=Bartlett|first=D.|last2=Ganss|first2=C.|last3=Lussi|first3=A.|date=2008-3|title=Basic Erosive Wear Examination (BEWE): a new scoring system for scientific and clinical needs|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2238785/|journal=Clinical Oral Investigations|volume=12|issue=Suppl 1|pages=65–68|doi=10.1007/s00784-007-0181-5|issn=1432-6981|pmc=PMC2238785|pmid=18228057}}</ref> |
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{| class="wikitable" |
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|+Table 1: Basic Erosive Wear Examination Scoring |
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!BEWE Score |
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!Clinical appearance description |
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|- |
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|0 |
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|No erosive tooth wear |
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|- |
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|1 |
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|Initial loss of surface texture |
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|- |
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|2 |
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|Distinct defect, hard tissue loss <50% of the surface area |
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|- |
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|3 |
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|Hard tissue loss ≥50% of the surface area |
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|} |
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=== Tooth Wear Index (TWI) === |
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Developed by Smith and Knight in 1984. TWI scores each visible surface (buccal/B, cervical/C, lingual/L and occlusal-incisal/I) (see Table 2).<ref>{{Cite journal|last=Smith|first=B. G.|last2=Knight|first2=J. K.|date=1984-06-23|title=An index for measuring the wear of teeth|url=https://www.ncbi.nlm.nih.gov/pubmed/6590081|journal=British Dental Journal|volume=156|issue=12|pages=435–438|issn=0007-0610|pmid=6590081}}</ref> This index has been widely used in epidemiological studies. <ref>{{Cite journal|last=Bardsley|first=Penny Fleur|date=March 2008|title=The evolution of tooth wear indices|url=https://www.ncbi.nlm.nih.gov/pubmed/18228055|journal=Clinical Oral Investigations|volume=12 Suppl 1|pages=S15–19|doi=10.1007/s00784-007-0184-2|issn=1432-6981|pmid=18228055}}</ref> |
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{| class="wikitable" |
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|+Table 2: Tooth Wear Index Scoring |
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!Score |
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!Surface |
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!Criteria |
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|- |
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| rowspan="2" |0 |
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|B/L/O/I |
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|No loss of enamel surface characteristics |
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|- |
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|C |
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|No loss of contour |
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|- |
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| rowspan="2" |1 |
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|B/L/O/I |
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|Loss of enamel surface characteristics |
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|- |
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|C |
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|Minimal loss of contour |
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|- |
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| rowspan="3" |2 |
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|B/L/O |
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|Loss of enamel exposing dentine for less than one third of surface |
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|- |
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|I |
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|Loss of enamel just exposing dentine |
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|- |
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|C |
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|Defect less than 1mm deep |
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|- |
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| rowspan="3" |3 |
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|B/L/O |
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|Loss of enamel exposing dentine for more than one third of surface |
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|- |
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|I |
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|Loss of enamel and substantial loss of dentine |
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|- |
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|C |
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|Defect less than 1-2mm deep |
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|- |
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| rowspan="3" |4 |
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|B/L/O |
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|Complete enamel loss- pulp exposure- secondary dentine exposure |
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|- |
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|I |
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|Pulp exposure or exposure of secondary dentine |
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|- |
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|C |
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|Defect more than 2mm deep- pulp exposure- secondary dentine exposure |
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|} |
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==References== |
==References== |
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Revision as of 17:08, 25 February 2018
| Tooth wear | |
|---|---|
 | |
| Lower teeth shows signs of tooth wear likely caused by erosion | |
| Specialty | Dentistry |
Tooth wear (also termed non-carious tooth substance loss) refers to loss of tooth substance by means other than dental caries or dental trauma.[1] Tooth wear is a very common condition that occurs in approximately 97% of the population.[2] This is a normal physiological process occurring throughout life, but accelerated tooth wear can become a problem.[3]
Tooth wear is majorly the result of three processes; attrition, abrasion and erosion.[3] These forms of tooth wear can further lead to a condition known as abfraction,[3] where by tooth tissue is 'fractured' due to stress lesions caused by extrinsic forces on the enamel. Tooth wear is a complex, multi-factorial problem and there is difficulty identifying a single causative factor.[3] However, tooth wear is often a combination of the above processes. Many clinicians therefore make diagnoses such as "tooth wear with a major element of attrition", or "tooth wear with a major element of erosion" to reflect this. This makes the diagnosis and management difficult.[1] Therefore, it is important to distinguish between these various types of tooth wear, provide an insight into diagnosis, risk factors, and causative factors, in order to implement appropriate interventions.[1]
Multiple indices have been developed in order to assess and record the degree of tooth wear, the earliest was that by Paul Broca.[4] In 1984, Smith and Knight developed the tooth wear index (TWI) where four visible surfaces (buccal, cervical, lingual, occlusal-incisal) of all teeth present are scored for wear, regardless of the cause.[4] A more recent index Basic Erosive Wear Examination (BEWE) from 2008 by Bartlett et al., is now also in use. [5]
Attrition
Attrition is loss of tooth substance caused by physical tooth-to-tooth contact.[2] The word attrition is derived from the Latin verb attritium, which refers to the action of rubbing against something.[2] Attrition mostly causes wear of the incisal and occlusal surfaces of the teeth. Attrition has been associated with masticatory force and parafunctional activity[2] such as bruxism. A degree of attrition is normal, especially in elderly individuals.[6]
Abrasion
Abrasion is loss of tooth substance caused by physical means other than teeth.[6] The term is derived from the Latin verb abrasum, which means ‘to scrape off’.[2] It tends to present as rounded ditching around the cervical margins of teeth, commonly described as ‘shallow’, concave or wedge shaped notches.[1] Causative factors have been linked to this condition and include vigorous, horizontal tooth brushing, using toothpaste with a too high RDA value, pipe smoking or nail biting. It has also been shown that improper use of dental floss or Toothpicks can lead to wear on the interproximal (in-between) surfaces of the teeth.[2]
Erosion
Erosion is chemical dissolution of tooth substance caused by acids, unrelated to the acid produced by bacteria in dental plaque.[1] Erosion may occur with excessive consumption of acidic foods and drinks, or medical conditions involving repeated regurgitation and reflux of gastric acid.[6] derived from the Latin word erosum, which describes the action ‘to corrode’.[2] This is usually on the palatal (inside) surfaces of upper front teeth and the occluding (top) surfaces of the molar teeth.
- Gastroesophageal reflux disease (GERD)
- Vomiting, e.g. bulimia, alcoholism
- Rumination
- Eructation (burping)
This article needs additional citations for verification. (May 2015) - Dietary - liquids of low pH and high titratable acids.
Abfraction
Abfraction is loss of tooth substance at the cervical margins, purportedly caused by minute flexure of teeth under occlusal loading.[7] The term is derived from the Latin words ab and functio meaning ‘away’ and ‘breaking’ respectively.[2] Abfraction presents as triangular lesions along the Cervical margins of the buccal surfaces of the teeth where the enamel is thinner and therefore, in the presence of occluding forces, is prone to fracture.[1] Whether abfraction exists or not is debated.
Indices
Tooth wear indices are useful tools for carrying out epidemiological studies and for general use in dental practices [5].
Basic Erosive Wear Examination (BEWE)
The Basic Erosive Wear Examination was first described in 2008 by Bartlett et al. The partial scoring system is based on the surface area affected. Within a sextant (i.e. teeth in mouth divided into 6 parts), the most severely affected tooth surface (buccal, occlusal or lingual/palatal) is recorded according to the severity of the wear (see Table 1). A cumulative score is then matched to a risk level and guidance for its management by a clinician. The management includes steps which identify and eliminate main aetiological factors, preventative treatment and also any operative and symptomatic intervention required by the patient. The frequency of repeating the index ranges from 6-12 months depending on the risk level of patients.[8]
| BEWE Score | Clinical appearance description |
|---|---|
| 0 | No erosive tooth wear |
| 1 | Initial loss of surface texture |
| 2 | Distinct defect, hard tissue loss <50% of the surface area |
| 3 | Hard tissue loss ≥50% of the surface area |
Tooth Wear Index (TWI)
Developed by Smith and Knight in 1984. TWI scores each visible surface (buccal/B, cervical/C, lingual/L and occlusal-incisal/I) (see Table 2).[9] This index has been widely used in epidemiological studies. [10]
| Score | Surface | Criteria |
|---|---|---|
| 0 | B/L/O/I | No loss of enamel surface characteristics |
| C | No loss of contour | |
| 1 | B/L/O/I | Loss of enamel surface characteristics |
| C | Minimal loss of contour | |
| 2 | B/L/O | Loss of enamel exposing dentine for less than one third of surface |
| I | Loss of enamel just exposing dentine | |
| C | Defect less than 1mm deep | |
| 3 | B/L/O | Loss of enamel exposing dentine for more than one third of surface |
| I | Loss of enamel and substantial loss of dentine | |
| C | Defect less than 1-2mm deep | |
| 4 | B/L/O | Complete enamel loss- pulp exposure- secondary dentine exposure |
| I | Pulp exposure or exposure of secondary dentine | |
| C | Defect more than 2mm deep- pulp exposure- secondary dentine exposure |
References
- ^ a b c d e f Kaidonis, J. A. "Oral diagnosis and treatment planning: part 4. Non-carious tooth surface loss and assessment of risk". British Dental Journal 2012; 213:155-161.
- ^ a b c d e f g h Suchetha, A (2014). "Tooth Wear - A Literature Review". Indian Journal of Dental Science. 5 (6): 116–120.
- ^ a b c d Bhushan, J; Joshi, R (2011). "Tooth Wear - An Overview With Special Emphasis On Dental Erosion". Indian Journal of Dental Sciences. 5 (3): 89.
- ^ a b Lopez-Frias, FJ.; Castellanos-Cosano, L.; Martin-Gonzalez, J.; Llamas-Carreras, JM.; Segura-Egea, JJ. "Clinical measurement of tooth wear: Tooth Wear Indices" (PDF). Journal of Clinical and Experimental Dentistry: e48–e53. doi:10.4317/jced.50592.
- ^ a b Erosive tooth wear : from diagnosis to therapy. Lussi, Adrian,, Ganss, Carolina, (2nd, revised and extended edition of "Dental erosion - from diagnosis to therapy", vol. 20 ed.). Basel. ISBN 9783318025538. OCLC 875630033.
{{cite book}}: CS1 maint: extra punctuation (link) CS1 maint: others (link) - ^ a b c Odell EW (Editor) (2010). Clinical problem solving in dentistry (3rd ed.). Edinburgh: Churchill Livingstone. pp. 285–287. ISBN 9780443067846.
{{cite book}}:|last=has generic name (help) - ^ Sarode, GS; Sarode, SC (May 2013). "Abfraction: A review". Journal of Oral and Maxillofacial Pathology. 17 (2): 222–227. doi:10.4103/0973-029X.119788. PMC 3830231. PMID 24250083.
{{cite journal}}: CS1 maint: unflagged free DOI (link) - ^ Bartlett, D.; Ganss, C.; Lussi, A. (2008-3). "Basic Erosive Wear Examination (BEWE): a new scoring system for scientific and clinical needs". Clinical Oral Investigations. 12 (Suppl 1): 65–68. doi:10.1007/s00784-007-0181-5. ISSN 1432-6981. PMC 2238785. PMID 18228057.
{{cite journal}}: Check date values in:|date=(help)CS1 maint: PMC format (link) - ^ Smith, B. G.; Knight, J. K. (1984-06-23). "An index for measuring the wear of teeth". British Dental Journal. 156 (12): 435–438. ISSN 0007-0610. PMID 6590081.
- ^ Bardsley, Penny Fleur (March 2008). "The evolution of tooth wear indices". Clinical Oral Investigations. 12 Suppl 1: S15–19. doi:10.1007/s00784-007-0184-2. ISSN 1432-6981. PMID 18228055.