Management Of Tooth Wear Research Articles

The role of orthodontics in the management of tooth wear.

Pathological tooth wear is a dental problem that affects all age groups and appears to be increasing in prevalence. A subset of these patients may benefit from a combination of orthodontic and restorative care which will be discussed in this article. Orthodontics can help to create the necessary vertical, anterior-posterior and mesio-distal space for restorative work, reducing the need for tooth reduction and lessening the biological costs of restorative care, helping to reposition the gingival margins where this impacts upon aesthetics, as well as correcting co-existing malocclusion.

Tooth surface loss: causes, management, and prevention.

Tooth wear, also referred to as tooth surface loss, occurs due to causes other than caries. This involves the loss of hard tissues, namely enamel, dentin, and/or cementum. Types of tooth wear/tooth surface loss are abrasion, abfraction, attrition, and erosion. These multifactorial conditions can be caused by factors such as lifestyle, diet, or even habits, and may not be symptomatic. The focus of this article is to provide clinicians with detailed examples and explanations of the causes of tooth loss to aid in early diagnosis. Through early identification, the preventive measures outlined can be implemented to avoid excessive tooth wear. The provision of a treatment flowchart and general treatment recommendations aims to help clinicians determine when to restore these lesions and the most appropriate treatment measures for the four types of wear. The PubMed (MEDLINE) search engine was used to gather information on teeth restricted to a 5-year period (26 August 2018 to 25 July 2022). Only English-language studies and reviews with the best balance of sensitivity and specificity were considered. A Boolean search of the PubMed dataset was implemented to combine a range of keywords: ("tooth wear" OR tooth attrition OR tooth erosion OR tooth abrasion OR tooth abfraction). Additional articles were selected through Google Scholar. By this process, many articles and studies were obtained, and the 48 most relevant published studies were chosen and used in the current review. Tooth wear affects an increasing number of individuals and can have detrimental effects physically, mentally, and emotionally. It is important to stress early diagnosis and management of tooth wear through monitoring, prevention, and treatment where indicated.

Tooth Wear in Older Adults: A Review of Clinical Studies.

Tooth wear is a prevalent dental condition among older adults, leading to pain and adversely affecting aesthetics, functionality, and their overall quality of life. This review aims to update the information on tooth wear in older adults from the past five years and to provide guidance on the clinical management of tooth wear in older adults. A literature search was conducted in three electronic databases, Scopus, Pubmed, and Embase, for English publications from January 2019 to December 2023 on clinical studies with participants aged 65 or above on tooth wear. A total of 307 articles were retrieved and 14 articles were finally included as references for this study. This review highlights the common causes of tooth wear and various risk factors, such as medical conditions, hyposalivation, dietary habits, oral hygiene practices, parafunctional habits, and occlusal factors, associated with tooth wear. It is crucial for oral health care professionals to diagnose and manage tooth wear at an early stage through a risk assessment and a clinical examination to avoid complex restorative procedures. Tooth wear management should prioritize prevention, aiming to control etiological and risk factors while employing non-restorative treatments. Restorative intervention, if indicated, should be simple, minimally invasive, and cost-effective. Tooth wear progression should be monitored regularly to determine if a further intervention is needed. Since the clinical studies on tooth wear in older adults over the past five years are limited and mainly cross-sectional, more interventional clinical studies are warranted to provide more clinical guidance on tooth wear management in older adults.

Tooth wear in children: prevalence, presentation and prevention

Tooth wear in children is a multifactorial process that can be due to either physiological or pathological processes. The most frequent type of tooth wear in children is erosion, and its contribution to overall tooth wear is explained. The prevalence, aetiology, presentation and management of tooth wear, especially erosion, are discussed in this article, with practical clinical advice for the treating clinician and families. The challenges to giving practical preventive advice, and the complexities involved in overcoming dietary and lifestyle changes in an environment of powerful advertising, peer pressure and social media influencers are discussed in detail. CPD/Clinical Relevance: Erosive tooth wear is common in children, so understanding the aetiology and giving families practical and relevant preventive advice is important.

Longevity and performance of materials used for the restorative management of tooth wear: a review

This article provides an overview of the available evidence on the performance, with particular consideration of the longevity of restorative materials used in the management of tooth wear. Different materials can be employed depending on whether a subtractive or additive strategy is used. Preference should be given to the latter to help preserve remaining tooth tissue. The use of both direct and indirect materials may yield acceptable survival results when considering data with at least 5 years of follow-up. Patients should be informed that because tooth wear is a continuous process, a certain level of maintenance of the restorations will be necessary and that this may impact on the success of the treatment. CPD/Clinical Relevance: Conservative, adhesive strategies are suitable for the restorative management of tooth wear.

Prevalence of tooth wear diseases in patients with diabetes and its impact on the quality of life in Dakshina Kannada population: a cross sectional study.

Early detection and management of tooth wear (TW) has not been given due consideration in the dental profession. Thus, this study aimed to explore the prevalence of TW in adults with diabetes in Dakshina Kannada population using the Basic Erosive Wear Examination (BEWE) and recording its impact on quality of life using the Oral Health Impact Profile (OHIP-14). In total, 236 dentate adults with diabetes and TW, who visited the Manipal College of Dental Sciences, Mangalore were recruited to the study. Assessment of TW was done using BEWE during examination of each participant and was categorized as none, mild, moderate, and severe. Impact of TW on quality of life was assessed using the OHIP-14. Overall, 81 (34.30%) individuals had a poor score on the basic erosive tooth index, 82 (34.70%) had a medium score, . The level of TW, both moderate and severe (high), affected quality of life. Erosion, abrasion and attrition were seen in a large proportion of the study population. The diabetic status of the individual was collected from their medical file. The HbA1C level was found to range from good, fair and poor control. The quality of life among the study population was affected because of TW and diabetes. Few participants had hypertension along with diabetes. The majority of study participants were on oral hypoglycaemic agents. Participants used tooth brushes and tooth paste and brushing frequency varied between once or twice daily. In the study population, there were moderate and severe TW patterns. Quality of life was found to be impacted by TW. Dental professionals must give proper consideration to the influence of TW on quality of life in addition to clinical findings. This will make it easier to offer preventive or restorative management depending on the situation.

Mandibular Distalisation for Tooth Wear in Patients Requiring Mandibular Protrusion for Sleep Apnoea.

Pathological tooth wear is an increasing concern and may require intervention and occlusal rehabilitation. Often the treatment includes distalisaton of the mandible to restore the dentition in centric relation. Obstructive sleep apnoea (OSA) is another condition treated my mandibular repositioning but in this case by an advancement appliance. The authors have a concern that there could be a group of patients with both conditions where distalisation for their tooth wear management would be contrary to their OSA treatment. This paper aims to look at this potential risk. A literature search was carried out using the following keywords (OSA or sleep apnoea or apnea or snoring or AHI or Epworth score) and for tooth surface loss (TSL or distalisation or centric relation or tooth wear or full mouth rehabilitation). No studies were identified which considered the effect of mandibular distalisation on OSA. There is a theoretical risk that dental treatment involving distalisation may adversely affect patients at risk of OSA or worsening their condition due to the modification of airway patency. Further study is recommended.

Injectable composites in modern practice

The improvement in bonding protocols has allowed composite to be a viable alternative to indirect restorations in the management of tooth wear. Although highly conservative of tooth structure, the literature would describe composites as a ‘medium-term’ treatment option, with high patient satisfaction. Their survival has been quoted at five years when used in the treatment of tooth wear at an increased OVD.4 The evidence relates to paste composites, which were not nano-filled. It is clear that there is plenty of scope for research on nano-filled injectable composites in tooth wear cases. They offer a truly conservative treatment option and allow for a highly predictable aesthetic and occlusal outcome through the injection moulding technique.

Risk factors of tooth wear in permanent dentition: A scoping review.

Tooth wear (TW) prevalence is high and increasing and has important consequences on the patient's quality of life. Knowledge of risk factors is crucial to promote diagnosis, prevention strategies and timely interceptive treatment. Many studies have identified TW risk factors. This scoping review aims to map and describe suspected available factors associated with TW in permanent dentition based on quantitative measurement. The scoping review was conducted using the PRISMA extension of the Scoping Reviews checklist. The search was conducted in October 2022 from the Medline® (PubMed® interface) and Scopus® databases. Two independent reviewers selected and characterised the studies. 2702 articles were identified for assessment of titles and abstracts, and 273 articles were included in the review. The results show a need to standardise TW measurement indices and the study design. The included studies highlighted various factors, classified into nine domains: sociodemographic factors, medical history, drinking habits, eating habits, oral hygiene habits, dental factors, bruxism and temporomandibular disorders, behavioural factors, and stress. Results related to chemical TW (erosion) risk factors underline the importance of eating disorders, gastroesophageal reflux and lifestyle, particularly drinking and eating behaviours, which supports developing public health information campaigns and interventions. Besides chemical, this review identifies evidence of several mechanical TW risk factors, such as toothbrushing and bruxism; the influence of this last factor needs to be further explored. TW management and prevention require a multidisciplinary approach. Dentists are in the first line to detect associated diseases such as reflux or eating disorders. Consequently, practitioners' information and guideline diffusion should be promoted, and a TW risk factors checklist (the ToWeR checklist) is proposed to help diagnostic approaches.

The management of tooth wear: past, present and future

Over the decades, the management of tooth wear has changed significantly. With the development in the materials available and an understanding of certain occlusal concepts, a minimally invasive strategy is now the preferred option. This article outlines these developments within an evidence-based framework. Contemporary research is referenced to support the clinical approaches to current management strategies and possible future expectations. CPD/Clinical Relevance: Knowledge of current concepts of tooth wear management in general dental practice should facilitate good treatment decisions

Indications for the use of direct composite restorations in the management of tooth wear.

The increasing prevalence of tooth surface loss has been widely reported. Patients present with varying degrees of tooth wear and consideration is given to whether a prevention and monitoring approach, or a treatment and restoration approach, is appropriate. A missed diagnosis or excessively prolonged monitoring risks progression to the detriment of a successful outcome, with the potential compromise on the quality and quantity of tooth structure available for predictable adhesive dentistry. Direct composite resin (DCR) restorations can be considered as a viable treatment option for all extents of tooth wear, including cases that have progressed to a severe degree. This paper aims to review the indications for DCR restorations in the management of tooth wear, using clinical cases to demonstrate their effectiveness.

Relationships between tooth wear, bruxism and temporomandibular disorders.

This article will provide an overview of the diagnosis of common temporomandibular disorders (TMDs) and bruxism, along with their relevance in management of tooth wear. When assessing and managing a tooth wear case, the teeth should not be considered in isolation, but as part of the articulatory system, which has three inter-related elements: the teeth, the temporomandibular joints and the masticatory muscles. The presence/absence of bruxism and TMD are highly relevant, although there may not be a causal relationship between these. A consideration of TMD and bruxism, together with the potential impact these may have on the patient during and after any management of tooth wear, will form part of patient education and the informed consent process.

Managing tooth wear with respect to quality of life: an evidence-based decision on when to intervene

Patients with more severe forms of tooth wear may require restorative rehabilitation. The decision to commence treatment must be taken carefully and there are a multitude of factors to consider. Alongside the clinical signs and symptoms typically associated with tooth wear, there is also the need to assess the impact of the condition on the patient's oral health-related quality of life. As part of the discussions relating to the attainment of informed consent for the restoration of the worn dentition, not only is it relevant to appropriately appraise the risks, benefits, costs, reasonable alternatives and likely prognosis of the proposed treatments, but to also elaborate on the expected impact of the intervention on the patient's oral health-related quality of life. The aim of this article is to review the evidence relating to the impact of the quality of life with the management of tooth wear, with the introduction of the concept of an evidence-based approach to decision-making when planning care.

Rehabilitating a severely worn dentition with removable prosthodontics

In the next part of this series on tooth wear management, we discuss the indications and clinical stages for the provision of removable prostheses for the treatment of severely worn and depleted dentitions. The general design features of a complex prosthesis are described for reorganised occlusal schemes and maintenance guidelines are explained. In addition, the clinical stages for three different situations are described: removable-only approaches, and combined fixed and removable in the same arch and separate arches. The value of providing removable prostheses in worn dentitions allows the immediate rehabilitation of severely worn teeth taking a non-invasive and retrievable approach when the remaining dentition is of poor quality or structure and/or there are missing teeth.

Digital workflows for the management of tooth wear.

For patients affected by tooth wear who require treatment to restore their dentition, the methods chosen can increasingly involve digital technology, with potentially less use of traditional, analogue treatment methods. Digital technology has transformed clinical photography and dental radiology, and is now available for most of the stages required for managing these patients. Continuous development of these digital technologies, both in the system capability and in the clinician interface, has brought the digital workflow within reach of more clinicians and therefore, for the treatment of more patients. While it is recognised that the comprehensive use of digital technologies is currently most likely to be used in clinical practice by specialist and private practitioners, it is expected that interest in and understanding of digital workflows will increase throughout the dental profession.This paper provides a step-by-step overview of the digital workflow, for both simple and complex cases.

Clinical factors to consider in definitive treatment planning for patients with tooth wear.

Diagnosis, disease control and prevention are the precursors to successful definitive restorative treatment of pathological tooth wear. This case series illustrates how proposed key clinical features can influence treatment complexity and provide the clinician with a logical sequence of treatment options for definitive management of tooth wear.

Matrix transfer techniques for direct paste composite resins

This article discusses potential concerns and important considerations when selecting and using matrix transfer techniques for the direct, definitive addition of composite resin to teeth. It also provides guidance to aid these processes with the use of case studies, primarily focusing on the management of tooth wear.

Life changing dentistry with Full Mouth Rehabilitation – a case report

Tooth wear is caused by a variety of reasons, many of which are unknown. Tooth wear management is difficult and complex. For effective treatment, accurate measurement of occlusal vertical dimension (OVD), interocclusal rest space, and centric relation records are required. The analysis of facial soft tissue contours is very crucial. A clinician must remember two things before treating a case with full mouth rehabilitation; severe wear does not always cause loss of OVD and it also does not eliminate all defective occlusal interferences. A systematic method may be beneficial in achieving a predictable and desirable result. This paper describes the step-by-step treatment of a 63-year-old patient who had lost occlusal vertical dimension due to parafunctional habits. Making occlusal overlay bilateral splints in acrylic resin and provisional restorations in mandibular teeth for the healing of the intermaxillary distance was the first strategy for oral rehabilitation. The ultimate rehabilitative therapy evolved into direct composite resin restorations associated with all-ceramic crowns fortified by lithium disilicate after the patient's adaption and muscle stability to the new occlusal situation. We established that all teeth had solid connections with similar intensity in centric relation, as well as anterior guiding in line with functional jaw movement. Update Dent. Coll. j: 2022; 12(1): 40-44

Management of erosive tooth wear

Erosive tooth wear is an oral health problem that worries clinicians and researchers worldwide. The aim of this study is to describe, through a literature review, the erosive tooth wear management. This problem is a challenge for dental surgeons, especially when it reaches more advanced stages, which can cause loss of dental and aesthetic function, as well as generate hypersensitivity to the patient. To prevent the progression of this problem focusing into preventive measures, such as guidelines for feeding and oral hygiene, the dental surgeon must perform early diagnosis to minimize erosive tooth wear damage.

Teeth wear of piglets in lactation phase: performance and injuries aspects

Piglets are born with a total of eight teeth and on the second day of life, teeth wear management is carried out to avoid lesions on the sows' ceilings and on the faces of the piglets. For this, an electric wearer is used that only wears the apex of the teeth. In this experiment, a comparison of twelve litters divided into: a control group (CG) was performed, which the intact teeth were kept ; with the management of tooth wear and treatment group (TG). The animals were followed from the first day of life until weaning. The weighing was carried out on the respective days of life: second, seventh, fourteenth and twenty-first. It was observed that the fights between piglets and for the ceilings did not present significant difference, on the other hand the injuries caused by the teeth and the dirt injuries had significant difference with greater presence in the group without wear. In the comparison of the piglets€™ daily weight gain, there was noted that no significant difference between two groups was observed, which can state that the non-wear of the teeth does not interfere in the daily weight gain, however it was concluded that the animals without wear (CG) had a higher incidence of dirt lesions.