FACING THE FUTURE OF TOOTH WEAR
PROFESSOR ANDREW EDER BDS , MSC ( CONSERVATIVE DENTISTRY ), LDS RCS , MFGDP , MRD RCS RCPS , FDS RCS , FHEA
Professor Andrew Eder Specialist in Restorative Dentistry and Prosthodontics and Clinical Director of the London Tooth Wear Centre ®, a specialist referral practice in central London . He is also Professor / Honorary Consultant at the UCL Eastman Dental Institute and Pro-Vice-Provost and Director of Life Learning at UCL .
P revention is better than cure . How many time have we dental professionals read that now ? The same adage reflects the needs of patients suffering with tooth wear beyond that which we would consider normal for their age as we look to the future .
The Oxford Dictionary of Dentistry defines tooth wear as : ‘ The non-bacterial loss of tooth substance by abrasion , attrition or erosion .’ In clinical terms , what does this terminology mean for the practising dentist ?
• Abrasion is tooth wear caused by excessive rubbing away of enamel and dentine as a result of , for example , vigorous tooth brushing , porcelain crowns rubbing against the natural dentition , or the consumption of a roughly textured diet .
• Attrition occurs when there is contact between the teeth over and above what we would consider ‘ normal ’ use . Such patients generally suffer from bruxism or parafunctional activity – grinding their teeth and clenching the jaw at night – which is often linked to a stressful lifestyle .
• Erosion is tooth wear resulting , for example , from the consumption of acidic food and drinks or stomach acid regurgitation , which is often found to be a result of conditions such as bulimia , pregnancy sickness or hiatus hernia .
THE SITUATION AMONG ADULTS There is no doubt that tooth wear is on the increase ; over three-quarters of adults show signs of abrasion , attrition and / or erosion . Comparing the most recent Adult Dental Health Survey ( ADHS ) with its predecessor , figures suggest that in just 11 years the incidence of tooth wear in England has increased by 10 %. 1
The growth of moderate wear in young adults over the last few years , also highlighted by the latest ADHS , is particularly worrying because it is indicative of destruction beyond that which we would expect for our patients at that stage of life .
The ADHS states : ‘ The greatest increase was in the youngest three age groups ; 15 percentage points , 10 percentage points and 13 percentage points for those aged 16 to 24 , 25 to 34 and 35 to 44 years respectively … While the increase in moderate tooth wear is small , moderate tooth wear in 16 to 34 year olds is of clinical relevance as it is suggestive of rapid tooth wear .’ 1
TOOTH SURFACE LOSS IN CHILDREN As for our children , a third ( 33 %) of 5-yearolds have evidence of tooth surface loss ( TSL ) on one or more of the buccal surfaces of the primary upper incisors , according to the Children ’ s Dental Health Survey . 2
In addition , a quarter of 12-year-olds were reported to have TSL on molars and the buccal surfaces of incisors , while the proportion of children with any TSL at age 15 on the occlusal surface of molars was higher than that at age 12 ( 31 % compared to 25 %). 2
The authors of the report state : ‘ The proportions of children affected by tooth surface loss into dentine and pulp are low and consistent over time , although any such damage is a significant burden to have at the age of 15 .’ 2
A STARK REALITY It would seem fair to state that the majority of the UK population is better educated about their oral health than ever before , so why is this increase in tooth wear occurring ? The truth is , while modernday medicine and preventive dentistry help many people to live extended lives and keep their dentition for longer , the latter through an improved understanding of the management of dental caries and periodontal diseases , this longevity can result in some health issues becoming more widespread , including that of tooth wear .
Tooth wear is multi-factorial , affecting people from all walks of life and at all ages , but there is a particularly worrying trend
64 Dental Practice Magazine