Risk Assessment: Tooth Wear

Abstract

Tooth wear is the multifactorial process where acids and mechanical challenges either act alone or together remove enamel and then dentine. The interaction of acids and mechanical processes, attrition and abrasion, has led to increasing adoption of the term “erosive tooth wear”. This term acknowledges that most tooth wear is multifactorial, often with acids having some role in the progression. Risk assessment of tooth wear should focus on the frequency, duration and interplay of the causes. This chapter provides an overview of risk factors and discusses their individual and synergistic role in tooth wear progression. Risk characteristics are categorised by severity and existing clinical presentation. The basic erosive wear examination (BEWE) is advocated as a basic tool to screen for tooth wear. Patient health and behaviours can change which may necessitate repeating risk assessments on a regular basis when uncontrolled wear is diagnosed. Patients need to be informed not only of the risk of progression but also on the risks of restorative treatment. There is evidence that progression can be slowed to physiological levels with elimination of risk factors. Practitioners are reminded that tooth wear is a slow process and preventive approaches are encouraged.