Attrition (dental)

From Wikipedia, the free encyclopedia
Jump to: navigation, search
Loss of tooth characteristics

Dental attrition is "tooth-to-tooth wear of the dentition"[1] resulting in loss of tooth tissue, usually starting at the incisal[jargon] or occlusal[jargon] surfaces. Tooth wear is a physiological[jargon] process and is commonly seen as a normal part of aging. Advanced and excessive wear and tooth surface loss can be defined as pathological in nature, requiring intervention by a dental practitioner. The pathological wear of the tooth surface can be caused by bruxism which is clenching and grinding of the teeth. If the attrition is severe, the enamel can be completely worn away leaving underlying dentin exposed, resulting in an increased risk of dental caries and dentin hypersensitivity. It is best to identify pathological attrition at an early stage to prevent unnecessary loss of tooth structure, as this tooth structure does not regenerate.

Signs and symptoms[edit]

Typical Appearance of Attrition

Attrition occurs as a result of opposing tooth surfaces contacting. The contact can affect cusps, incisal and proximal surface areas.[2]

Indications of attrition can include:[3]

  • Sensitive teeth
  • Tooth discoloration; yellow appearance of the tooth surface
  • Loss of tooth characteristics; rounded or sharp edges, loss of cusps and chipped teeth
  • Altered occlusion as vertical height changes
  • Teeth appear the same height - no difference in height of anterior teeth
  • Enamel of molars appears thin and flat
  • Aesthetic concerns related to the height of teeth
  • Compromised periodontal support can result in tooth mobility
  • Loss in posterior occlusal stability
  • Mechanical failure of restorations
  • Hypermobility
  • Drifting

Causes[edit]

In dental attrition, the tooth wear occurs by tooth to tooth contact. Dental attrition represents the well-defined wear facets on cusps or ridge of teeth. This can be caused by several factors i.e. Para functional habits such as bruxism or clenching, developmental defects, hard or rough textured diet as well as absence of the posterior teeth support. If the natural teeth oppose or occlude the porcelain restorations in opposing teeth then it can also result in the attrition of the natural teeth. Similarly when there is a class III incisal relationship in which anterior teeth contact edge to edge dental attrition can occur.[4] The underlying cause of attrition may be related to the temporomandibular joint which is made up of several different structures including bone, muscle and ligaments that all work together to produce masticatory movement. If there is a disruption or dysfunction in anyone of these structures, function can be compromised and complications such as bruxism and clenching of the jaw may arise, which can result in attrition of the tooth tissue.[5]

Dental attrition has a multifactorial etiology however bruxism is one of the most common causes of attrition. Bruxism is the para-functional movement of the mandible, occurring during the day or night. It can be associated with presence of audible sound along with clenching or grinding of teeth. This is usually reported by parents or partners while the patient grinds during their sleep. The research states that in some cases erosion is also associated with severe dental attrition. Dental erosion is tooth surface loss caused by excessive consumption of low pH beverages and can also be associated with conditions such as gastroesophageal reflux disorder and bulimia. In these conditions the acidic contents of the digestive system enter the oral cavity, results in tooth tissue loss due to the low pH of the stomach content. Erosion softens the dental hard tissues, making them more susceptible to dental attrition. When dental erosion is present in conjunction with bruxism the tooth-tissue loss due to attrition is accelerated due to the erosive environment. Research shows that severe attrition in young patients is usually associated with erosive factors in their diets.[6] The evidence and reviews represent that the physiological processes of tooth wear (abrasion, attrition and erosion) mostly interact with each other and rarely work individually. That is why it is important to obtain knowledge of these tooth wear processes and their interactions.[7] The demineralization of the tooth surface because of acids causes the occlusal erosion as well as attrition. According to a research the wedge-shaped cervical lesions are commonly found in association with occlusal erosion and attrition.[8]

Recently it has been established that tobacco products can cause oral soft tissue lesions but the research shows that they can directly affect the teeth as well. The study suggests that tobacco may also cause dental attrition as it contains abrasive particles which can contribute to the occurrence of dental attrition. The insoluble particles in an average tobacco sample make up about 0.5 percent of the weight and these can be abrasive to the teeth which results in attrition.[9]

In older people with dentition, the tooth wear is typically seen. The attrition, abrasion, erosion or the combination of any of these factors are the main reasons of tooth wear in old people who retain their natural teeth. This tooth wear can be pathological or physiological in nature.[10] Another study considers the influence of age on tooth wear and shows that in primary as well as permanent dentition the number of teeth with incisal or occlusal wear increases with the age.[11]

According to a pilot study the results point to the presence of dental attrition in 1 of every 3 adolescents. The results of this research show the association of dental attrition with older age, Class II malocclusion, presence of stress and defective restorations in teeth.[12]

Bernhardt et al.[13] reported in their research that gender is also one of the factors which are associated with occlusal tooth wear. The research represents that in addition to other occlusal factors some independent variables such as male gender, bruxism, and loss of molar occlusal contact, edge-to-edge relation of incisors, unilateral buccolingual cusp-to-cusp relation, and unemployment are related with the high occlusal wear in different extent. It was also stated in this research that anterior cross-bite, unilateral posterior cross-bite, and anterior crowding are the protective factors for high occlusal wear levels. The self-reported bruxism was found to be the risk factor for only men in this study.

Al-Hiyasat et al.[14] stated in their study that retirement, unemployment, masseter muscle pain, depression, age and anxiety has been found in association with tooth wear in psychiatric patients. Psychiatric condition and prescribed medication in psychiatric patients may have influence upon occurrence of tooth wear. It was found in the study that younger psychiatric patients between 16 to 25 years of age had lower prevalence of tooth wear in comparison to the older psychiatric patients. According to this study, occlusal and incisal surfaces of teeth are more affected by tooth wear in comparison to the other surfaces as well as mandibular teeth are more affected in comparison to the maxillary teeth.

Prevention and management[edit]

To manage the condition it is first important to arrive at a diagnosis, describing the type of tooth surface loss, the severity and location.[15] An early diagnosis is essential to ensure tooth wear has not progressed past the point of restoration.[16][17] A thorough examination is required, as it might give explanation to the aetiology of the TSL.[18][19]

The examination should include assessment of

  • Temporomandibular joint function and associated musculature
  • Orthodontic examination
  • Intra oral soft tissue analysis
  • Hard tissue analysis
  • Location and severity of tooth wear
  • Social history – particularly diet

The severity of tooth wear is important to record for monitoring, helping to differentiate between pathological and physiological TSL. If the TSL is localised it is possible that the occlusion is causing the attrition opposed to pathological bruxism. It is essential to determine whether the tooth wear is ongoing or has stabilized.[20] However where generalised one can assume the underlying cause is bruxism. In fast progressing cases there is commonly a coexisting erosive diet contributing to tooth surface loss.[20]

Prevention[edit]

Patient Wearing Occlusal Splint

When a diagnosis of bruxism has been confirmed it is recommended that the patient purchase a full coverage acrylic occlusal splint such as a Michigan Splint or Tanner appliance.[18] Patients must be monitored closely, with clinical photographs 6–12 monthly.[18]

Treatment[edit]

Cosmetic or functional intervention may be required if TSL is pathological in nature and there has been advanced TSL.[21] The first stage of treatment involves the management of any associated conditions such as fractured teeth, or sharp cusps/incisal edges.[18] These can be resolved via restoration of and polishing of sharp cusps.[18] At this stage desensitizing fluoride agents such as Duraphat can be applied, and at home desensitising toothpastes recommended.[18] There are many different treatment options which have been proposed such as direct composite restorations, bonded cast metal restorations, removable partial dentures, orthodontic treatment, crown lengthening, protective splints.[21][22] The decision to restore the dentition depends on the needs of the patient, the severity of tooth surface loss and whether tooth surface loss is active.[19] The use of adhesive materials to replace lost tooth structure can be performed as a conservative and cost effective approach, before a more permanent solution of crowns or veneers is considered.[20]

Tooth surface loss[edit]

Tooth wear is a very common condition that occurs in approximately 97% of the population.[23] Non-caries tooth surface loss refers to loss of tooth structure as a result of tooth wear mechanisms other than Dental caries itself.[24] This is a normal physiological process occurring throughout life, but accelerated tooth wear can become a problem.[25] Tooth wear is majorly the result of three processes; attrition, Abrasion and Erosion.[25] These forms of tooth wear can further lead to a condition known as Abfraction,[25] 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.[25] It is also important to note that tooth surface loss is almost never caused by any one of these processes alone and are often coexistent, making the diagnosis and management increasingly difficult.[24] 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.[24]

Attrition[edit]

The word attrition is derived from the Latin verb attritium, which is descriptive of the action of rubbing against something.[23] It is descriptive of the action of tooth on tooth contact resulting in physical wear[23] on the Incisive and Cuspid surfaces of the teeth. Attrition has been associated with Masticatory force and Parafunctional activity activity[23] which inevitably leads to flattening of these surfaces.

Abrasion[edit]

Abrasion is derived from the Latin verb abrasum, which means ‘to scrape off’.[23] It is characterised by rounded ditching around the Cervical margins of the teeth and are commonly described as ‘shallow’, concave or wedge shaped notches.[26] Causative factors have been linked to this condition and include vigorous horizontal Tooth brushing, 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.[23]

Erosion[edit]

Erosion is derived from the Latin word erosum, which describes the action ‘to corrode’.[23] It has been defined as the chemical dissolution of tooth structure without the presence of plaque.[27] This is essentially a result of Corrosion of enamel caused by an endogenous agent[28] (i.e. From inside the body). The exact cause of erosion is distinguished by the location of the head when the wear is taking place.[23] This is usually on the palatal (inside) surfaces of upper front teeth and the occluding (top) surfaces of the molar teeth. It is for this reason that erosion has long been linked to conditions such as Bulimia nervosa and has been a common result of the following conditions:[29]

Abfraction[edit]

Abfraction is derived from the Latin words ab and functio meaning ‘away’ and ‘breaking’ respectively.[23] It defines an action where there is loss of hard tooth structure from the Cervical margins as a result of minute fracturing due to extrinsic forces and flexure of the tooth.[23] 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.[30]

See also[edit]

References[edit]

  1. ^ Darby, M., Walsh, Margaret, & EBL ebook Library. (2009). Dental Hygiene Theory and Practice. (3rd ed.). London: Elsevier Health Sciences.
  2. ^ Davies, SJ; Gray, RJM (2002). "Management of tooth surface loss". British Dental Journal 192 (1): 11-12
  3. ^ Wazani BE, BE; Dodd, MN; Milosevic, A (2012). "The signs and symptoms of tooth wear in a referred group of patients". British Dental Journal 213 (6): 17-27
  4. ^ Meshramkar R, Lekha K, Nadiger R (Jan–Mar 2012). "Tooth wear, etiology, diagnosis and its management in elderly: A literature review". International Journal of Prosthodontics and Restorative Dentistry 2 (1): 38–41.
  5. ^ Yadav, S. (2011). A study on prevalence of dental attrition and its relation to factors of age, gender and to the signs of TMJ dysfunction. Journal of Indian Prosthodontist Society, 11 (2), 98-105.
  6. ^ Khan F, Young W G, Daley TJ. Dental erosion and bruxism. A tooth wear analysis from South East Queensland. Aust Dent J. 1998. 43 (2):117-27.
  7. ^ Shellis RP, Addy M. The interactions between attrition, abrasion and erosion in tooth wear. Monogr Oral Sci. 2014;25:32-45. doi: 10.1159/000359936.
  8. ^ Khan F, Young WG, Shahabi S, Daley TJ. Dental cervical lesions associated with occlusal erosion and attrition. Aust Dent J. 1999 Sep;44(3):176-86.
  9. ^ Bowles WH, Wilkinson MR, Wagner MJ, Woody RD. Abrasive particles in tobacco products: a possible factor in dental attrition. J Am Dent Assoc. 1995 Mar;126(3):327-31; quiz 348.
  10. ^ Burke FM, McKenna G. Toothwear and the older patient. Dent Update. 2011 Apr;38(3):165-8.
  11. ^ Hugoson A1, Ekfeldt A, Koch G, Hallonsten AL. Incisal and occlusal tooth wear in children and adolescents in a Swedish population. Acta Odontol Scand. 1996 Aug;54(4):263-70.
  12. ^ Casanova-Rosado JF, Medina-Solís CE, Vallejos-Sánchez AA, Casanova-Rosado AJ, Maupomé G, Avila-Burgos L. Dental attrition and associated factors in adolescents 14 to 19 years of age: a pilot study. Int J Prosthodont. 2005 Nov-Dec;18(6):516-9.
  13. ^ Bernhardt O, Gesch D, Splieth C, Schwahn C, Mack F, Kocher T, Meyer G, John U, Kordass B. Risk factors for high occlusal wear scores in a population-based sample: results of the Study of Health in Pomerania (SHIP). Int J Prosthodont. 2004 May-Jun;17(3):333-9.
  14. ^ Al-Hiyasat AS, Khasawneh SF, Khader YS. Tooth wear among psychiatric patients: prevalence, distribution, and associated factors. Int J Prosthodont. 2006 Jul-Aug;19(4):403-9.
  15. ^ Mehta, SB; Banerjji, S; Millar, BJ; Suarez-Feito, JM (2014). "Current Concepts on the Management of Tooth Wear: Part 1". British Dentistry Journal 212 (1): 17–27. 
  16. ^ Mehta, SB; Banerjji, S; Millar, BJ; Suarez-Feito, JM (2014). "Current Concepts on the Management of Tooth Wear: Part 1". British Dentistry Journal 212 (1): 17–27
  17. ^ Arie Van't, S; Cees, MK; Nico, HJC (2007). "Attrition, Occlusion, (Dys)Function and Intervention: a Systematic Review". Clinical Oral Implants Research 18 (3): 117–126. 
  18. ^ Cite error: The named reference one was invoked but never defined (see the help page).
  19. ^ a b David, WB (2005). "The Role of Erosion in Tooth Wear: Aetiology, Prevention and Management". International Dental Journal 55 (4): 277–284. 
  20. ^ a b c Myeyers, I (2012). "Attrition and Erosion: Assessment and Diagnosis". Annals of the Royal Australasian College of Dental Surgeons 21: 94–96. 
  21. ^ a b Sato, S; Hotta, TH; Pedrazzi, V (2000). "Removable Occlusal Overlay Splint in the Management of Tooth Wear: A Clinical Report". The Journal of Prosthetic Dentistry 83 (4): 392–395. 
  22. ^ refcontent4
  23. ^ a b c d e f g h i j Suchetha.A. “Tooth Wear - A Literature Review”. Indian Journal of Dental Science 2014; 5(6): 116 – 120.
  24. ^ a b c 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.
  25. ^ a b c d Bhushan, J; Joshi, R. "Tooth Wear - An Overview With Special Emphasis On Dental Erosion". Indian Journal of Dental Sciences 2011; 5(3): 89.
  26. ^ Kaidonis. J. A. “Oral diagnosis and treatment planning: part 4. Non-carious tooth surface loss and assessment of risk”. British Dental Journal 2012; 123(4): 155 – 161
  27. ^ Kaidonis. J. A. “Oral diagnosis and treatment planning: part 4. Non-carious tooth surface loss and assessment of risk”. British Dental Journal 2012; 123(4): 155 – 161
  28. ^ Kaidonis. J. A. “Oral diagnosis and treatment planning: part 4. Non-carious tooth surface loss and assessment of risk”. British Dental Journal 2012; 123(4): 155 – 161
  29. ^ Kaidonis. J. A. “Oral diagnosis and treatment planning: part 4. Non-carious tooth surface loss and assessment of risk”. British Dental Journal 2012; 123(4): 155 – 161
  30. ^ Kaidonis. J. A. “Oral diagnosis and treatment planning: part 4. Non-carious tooth surface loss and assessment of risk”. British Dental Journal 2012; 123(4): 155 – 161
  • Davies, SJ; Gray, RJM (2002). "Management of tooth surface loss". British Dental Journal. 192 (1): 11-12. 
  • Wazani BE, BE; Dodd, MN; Milosevic, A (2012). "The signs and symptoms of tooth wear in a referred group of patients". British Dental Journal. 213 (6): 17-27. 
  • Meshramkar R, Lekha K, Nadiger R (Jan–Mar 2012). "Tooth wear, etiology, diagnosis and its management in elderly: A literature review". International Journal of Prosthodontics and Restorative Dentistry 2 (1): 38–41. 
  • Walsh, Darby (2009). Dental Hygiene Theory and Practice. London: Elsevier Health Sciences. 
  • Yadav, S. "A study on prevalence of dental attrition and its relation to factors of age, gender and to the signs of TMJ dysfunction". Journal of Indian Prosthodontist Society 11 (2): 98–105.