Non-carious loss of tooth structure

 

Types, clinical features, Causes prevention & treatment


Non-carious loss of tooth structure is a problem that is often found in senior citizens and is a cause of many complaints. It is not a new entity but has acquired more attention in recent time.

Types of tooth wear

  1. Abrasion
  2. Attrition
  3. Erosion
  4. Demastication
  5. Abfraction

Abrasion

It is loss of tooth substance by the friction with a foreign substance. These are smooth and usually C shaped, more wide than deeper.


Clinical Features

These are usually facio-cervical concavities that are more broad than deep and can be associated with an abrasive diet. They are usually found on prominent teeth in the arch (i.e., canines, premolars, and mesio-buccal aspects of first molars). They may affect several teeth in a row with a “band” of abrasive damage. Sometime they may cause hypersensitivity.

Figure 1. Abrasion: note the concave smooth cavities in the cervical regions of upper and lower teeth.




Causes of Abrasion

It is mostly located in the cervical area of the teeth. The reason may be one or a  combination of the following  factors:
  • Excessive tooth brushing for longer period
  • Use of hard tooth brush
  • Use of tooth paste containing highly abrasive material
  • Use of locally prepared tooth cleaning powder or paste like Gul, Gulak or Lal Manjan
  • Repeatedly putting foreign objects in the mouth like pipe smoking, pen, bobby pins and any other occupational material.


Prevention of Abrasion

Use of common sense is the best way of preventing the abrasion. If the cause is a hard tooth brush or brushing the teeth for a longer duration or use of an excessively abrasive tooth paste. Then correcting the hardness of the tooth brush, adjusting the time, and changing the tooth paste will be sufficient. If the cause is abrasive food or any occupational factor, this may be difficult to treat but not impossible. 


Treatment of Abrasive Lesions

 The treatment of the cavities created by abrasion is the restoration of teeth by Glass Ionomer or tooth coloured composite filling material. These types of fillings or restoration fall under the category of 'Cosmetic' or 'Aesthetic' 'Restorations'. 
Sometimes, the depth of the abrasive lesion is so deep that it affects the pulp in an adverse way. In this stage, it is better to get the 'Root Canal Treatment' before going for aesthetic restoration. But, if the lesion had been there since long, the involved tooth may need extraction. 


Attrition

It is the loss of tooth material due to tooth to tooth contact. It usually occurs on occlusal and incisal  surfaces.                                


Clinical Features

They show matching occlusal wear between arches and shiny wear facets on restorations. There is an increased risk for fracture of teeth and restorations.
Figure 2. extreme attrition of teeth leading to loss of complete crown of mandibular teeth
 



Figure 3.  attrition of varying extent of maxillary teeth in the same case of figure 2.



Causes of Attrition

The main reason is para-functional habits like nocturnal bruxism or any other disease causing uncontrolled grinding movement of jaw.

Prevention of Attrition

Excessive attrition may cause sensitivity as well as TMJ pain or myofacial pain dysfunction syndrome. It has been found that the males suffer more from attrition than females. Adjustment of occlusion so hat areas best suited to bear the forces come in contact helps a lot. Occlusal splints also protect the teeth.
Occasionally medical treatment like tricyclics anti-depressants also helps in reducing the intensity of para-functional habits by reducing the REM period.


Treatment of the Attrition

Treatment of attrition mainly depends on the extent to the damage of the teeth.  If the Attrition is limited to the Maxillary and mandibular first molar teeth, then a crown made up of metal or Porcelain Fused to Metal will be sufficient. These Crowns will help the affected teeth in getting damaged further and protect them also. But when all the teeth of the oral cavity are affected then the treatment becomes more complicated. In this case if we observe that the whole of the occlusion has been badly affected and in turn it has affected temporomandibular joint movement also in the worst way causing pain in the temporomandibular joint. Such cases may develop myofascial pain dysfunction syndrome.  To treat these kind of cases we need to establish the original vertical dimension of occlusion of the patient in an incremental way and when patient feels comfortable with the original vertical dimension of occlusion then we provide suitable crowns over all of the teeth maintaining that occlusion. Remember, in these cases, we need to assess accurately the original occlusion and we also need to transfer all the maxillo-mandibular relationship of the patient to the articulator. For person affected by this kind of problem it is suggested that he or she should contact a Prosthodontist so that his total assessment can be done and a proper treatment can be provided.



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