ATTRITION
ATTRITION
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Dental
attrition can
be defined as "tooth-to-tooth wear of the dentition",resulting
in loss of tooth tissue, usually starting at the incisal or occlusal
surfaces. It is a natural process to see teeth wearing away from
opposing tooth contact and commonly seen as part of the aging
process, however excessive wear causing extremely attrition can be
defined as a pathology within the oral cavity. If the attrition is
severe, the enamel can be completely worn away to leave underlying
dentine exposed, leading to an increased risk of dental caries.
Attrition
occurs as a result of opposing tooth surfaces contacting. The contact
can affect cusps, incisal surfaces and proximal areas.
Indications
of attrition can include:
- Sensitive teeth
- Tooth discoloration
- 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
In
dental attrition, the tooth wear occurs by tooth to tooth contact.
The influence of tooth wear can affect the quality of life. The
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 the
attrition in natural teeth. The class III incisal relationship in
which anterior teeth come in edge to edge relationship can be another
cause of dental attrition.The temporomandibular joint is made up of
several different structure 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.
Bruxim
is
one of the main causes of attrition. It is a para-functional movement
of the mandible during 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 says that in some cases
erosion is also associated with severe dental attrition. The erosion
causes the tooth tissue loss because of erosive acids. The erosion
softens the dental hard tissues which become more susceptible to
attrition. That is why habit of bruxism accelerates the tooth-tissue
loss due to attrition in an erosive environment. It has been found
that severe attrition in young patients is usually associated with
erosive factors in their diets.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.
- Cosmetic or functional intervention may be required if TSL is pathological in nature and there has been advanced TSL.
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The first stage of treatment involves the management of any associated conditions such as fractured teeth, or sharp cusps/incisal edges. These can be resolved via restoration of and polishing of sharp cusps- . At this stage desensitizing fluoride agents such as Duraphat can be applied, and at home desensitising toothpastes recommended.
- 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.
- 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.
- 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.
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