10.4 TOOTH SURFACE LOSS
10.4.0 Introduction
Dentists have been aware of the problem of tooth wear or non-carious loss of tooth
tissue for a long time. However, it is only more recently that it has been increasingly
associated with our younger population. There are three processes that make up the
phenomenon of tooth wear:
(1) attrition⎯wear of the tooth as a result of tooth-to-tooth contact;
(2) erosion⎯irreversible loss of tooth substance brought about by a chemical process
that does not involve bacterial action;
(3) abrasion⎯physical wear of tooth substance produced by something other than
tooth-to-tooth contact.
In children, abrasion is relatively uncommon. The most frequent cause of abrasion is
overzealous toothbrushing, which tends to develop with increasing age. Attrition
during mastication is common, particularly in the primary dentition where almost all
upper incisors show some signs of attrition by the time they exfoliate (558HFig. 10.14).
However, over the past decade the contribution of erosion to the overall process of
tooth wear in the younger population has been highlighted. While erosion may be the
predominant process, attrition and abrasion may be compounding factors, for
example, toothbrush abrasion may be increased if brushing is carried out immediately
after the consumption of erosive foodstuffs or drinks. It is often difficult to identify a
single causative agent in a case of tooth wear so the general term 'tooth surface loss'
may be more appropriate.
559H
Fig. 10.14 Primary incisors showing
physiological wear.10.4.1 Prevalence
The problem with trying to assess the prevalence of tooth wear is that a degree of
tooth tissue loss is a part of the normal physiological process of ageing; however,
when it is likely to prejudice the survival of the teeth it can be said to be pathological.
Smith and Knight in 1984 described a Tooth Wear Index (TWI), which included
certain features that they felt were diagnostic of pathological tooth wear. These
features are shown in 560HTable 10.4.