Tooth Surface Loss Management

It is loss of dental hard tissues by causes other than caries, trauma or developmental defects. These include attrition, abrasion, erosion and abfraction.

Attrition: It is the loss of tooth structure caused by tooth-to-tooth contact which may be normal functional or parafunctional. Parafunction habits like clenching and bruxism are cause of attrition. Bruxism is the parafunction habit of the teeth grinding, occurring during the day or night so called day bruxism or night bruxism respectively. It is associated with presence of audible sound when clenching or grinding teeth.

Abrasion: It is loss of tooth structure from interaction with objects other than tooth–tooth contact. Use of hard brush and heavy brushing force are most common cause. Soft brush with light force is enough to remove plaque and clean teeth. Habits such as nail biting, chewing paan and tobacco, chewing on pen or hard objects are also contributory factors.

Abfraction: It is loss of tooth structure in cervical area of tooth due to abnormal lateral excursion forces. These forces concentrate of cervical area of tooth resulting in loss of tooth structure.

Erosion: It is loss of tooth structure by acids other than bacteria plaque origin. It has two types:

Extrinsic Erosion:  It is caused by extrinsic acids like cola drinks, acids citrus juices, and medication like vitamin C tablets use.

Intrinsic Erosion: It is caused by gastric acids like gastroesophageal reflux disease (GERD), gastric Regurgitation and eating disorders like, anorexia nervosa, and bulimia nervosa. Palatal surfaces of upper anterior teeth are more affected in intrinsic erosion.

Treatment of non-carious tooth surface loss:

Early diagnosis: Early diagnosis is key for control of disease and prevent     further loss of tooth structure. These cases present with tooth sensitivity, loss of surface characteristics of tooth, tooth surface loss and enamel chipping. Patient may have chewing difficulties and aesthetic concerns.

Elimination of Etiological Factors: Elimination of etiological factors is key for successful treatment of disease. Overzealous brushing, parafunction habits, bruxism, teeth clenching, acidic diet are controlled to prevent tooth surface loss. Fluoride and remineralization therapy increase tooth resistance against tooth surface loss. Refer to physician for gastric disease like gastroesophageal reflux disease and eating disorder is mandatory to control disease.

Follow up: History, examination, Photograph, diagnostics cast are basis records to check disease progress. Patient kept on follow up after every 3 to 6 months to see disease progression.

Restorative Treatment indications: Restoration (filling or crown) is indicated:

• Sensitivity not controlled by preventive measures.
• Deep lesion so chances for pulp involvement and tooth fracture.
• Aesthetic demand of patient
• Functional difficulty like chewing problem and loss of vertical dimension of face.
• Rapid progression of tooth loss.
• Unfavorable undercuts that need to be eliminated for dental prosthesis.