Download IFDEA Erosion - Tooth Wear Educational Teaching Resource

Occlusion. Factors of occlusion. The
clinical significance of restoring individual
occlusion, tools and steps to achieve it.
Dental Erosion: Etiology
Tooth Wear
Destruction of the dental tissues (enamel, dentin, cementum)
can occur as a result of physical loss, chemical dissolution,
and/or multifactorial etiology.
Dental Erosion: Etiology
Tooth Wear
Destruction of the dental tissues (enamel, dentin, cementum) can
occur as a result of:
• Physical Loss
– Abrasion—mechanical
– Attrition—tooth-to-tooth contact
– Abfraction—lesions
• Chemical dissolution
• Multifactorial etiology
Dental Erosion: Etiology
Tooth Wear
Destruction of the dental tissues (enamel, dentin, cementum) can
occur as a result of:
• Physical Loss
• Chemical dissolution
– Erosion
-- Extrinsic acids
-- Intrinsic acids
• Multifactorial etiology
Dental Erosion: Etiology
Tooth Wear
Destruction of the dental tissues (enamel, dentin, cementum) can
occur as a result of:
• Physical Loss
• Chemical dissolution
• Multifactorial etiology
– Erosion
– Abrasion
– Attrition
– Abfraction
Dental Erosion: Etiology
Abrasion
The pathological wearing away of hard dental tissue through abnormal mechanical
processes involving foreign objects or substances repeatedly introduced in the
mouth and contacting the teeth.
•
Oral hygiene habits
 Excessive brushing/flossing
 Abrasives in dentifrices/toothpastes
•
Personal habits
 Putting foreign objects in the mouth
•
Demastication
 Wear from chewing food
Dental Erosion: Etiology
Attrition
The pathological wearing away of hard dental tissue as a result of tooth-to-tooth
contact, with no foreign substance intervening.
•
Enamel wearing enamel
 Occlusal wear
 Malocclusion (buccal, lingual, and interproximal surfaces)
Dental Erosion: Etiology
Abfraction
Wedge-shaped defects at the cementoenamel junction of a tooth caused by
eccentrically applied occlusal forces leading to tooth flexure that results in
microfracture of enamel and dentin.
•
Loss of tooth in the cervical area
 Tooth flexure
– Chewing
– Grinding (bruxism)
Dental Erosion: Etiology
Erosion
The physical results of a pathologic, chronic, localized loss of hard dental
tissue that is chemically etched away from the tooth surface by acid and/or
chelation without bacterial involvement.
•
Extrinsic acids—ingested
 Food, beverages, medicine
•
Intrinsic acids—internal
 Originate in the stomach
Dental Erosion: Etiology
Multifactorial
Tooth wear is multifactorial
• One process typically impacts the other
• Erosion and abrasion
Dental Erosion: Epidemiology
Tooth erosion was described as a condition distinct from
caries as early as the 18th century.
Dental Erosion: Epidemiology
Change in Perception
In 1995, the European Journal of Oral Science stated that “dental erosion is an
area of research and clinical practice that will undoubtedly experience
expansion in the next decade.”
Dental Erosion: Epidemiology
Global Prevalence
Global data on the prevalence of dental erosion is building. “Erosive tooth
wear is a common condition in the developed countries.”
Iceland
UK
The
Netherlands
Canada
Sweden
Turkey
United States
Japan
Ireland
Germany
China
Malaysia
Brazil
Switzerland
Saudi Arabia
India
Dental Erosion: Epidemiology
Global Prevalence
• European studies suggest prevalence of:
• Up to 50% if all preschool children
• Between 24% to 60% of school-aged children
• As high as 82% in 18 to 88 years of age
• Emerging prevalence studies providing data on gender, socio-economic
status, ethnic, and culture difference in addition to the age factor will prove to
be invaluable
Dental Erosion: Diagnosis
“Diagnosis is the intellectual course that integrates information obtained by
clinical examination of the teeth, use of diagnostic aids, conversation with the
patient, and biological knowledge. A proper diagnosis cannot be performed
without inspection of the teeth and their immediate surroundings.”
Dental Erosion—
Diagnosis
Check list to unveil etiological
factors for erosion
Dental Erosion:
Diagnosis
Interaction of the different
factors for the development of
erosive tooth wear
From: Lussi A. Dental Erosion: From Diagnosis to Therapy. Karger; 2006.
Dental Erosion: Diagnosis
Clinical Appearance
There is no device available for the specific detection of dental erosion in routine
practice. Therefore, the clinical appearance is the most important feature for
dental professionals to diagnosis dental erosion.
Dental Erosion—
Diagnosis
Tooth Wear—Clinical Appearance
Dental Erosion: Diagnosis
Erosion is multifactorial
•
Chemical factors—erosive potential of intrinsic and extrinsic acids
•
Biological factors—involve properties and characteristics of the oral cavity
•
Behavioral factors—personal and oral habits
Dental Erosion: Diagnosis
Chemical Factors
•
•
•
•
•
•
•
pH and buffering capacity of the product
Type of acid (pKa values)
 Intrinsic (gastric origin)
 Extrinsic (environmental, dietary, medicinal)
Adhesion of the products to the dental surface
Chelating properties of the products
Calcium concentration
Phosphate concentration
Fluoride concentration
Dental Erosion: Diagnosis
Biological Factors
•
•
•
•
•
•
Saliva: flow rate, composition, buffering, capacity, and stimulation capacity
Acquired pellicle: diffusion-limiting properties, composition, maturation, and
thickness
Type of dental substrate (permanent and primary enamel, dentin) and
composition (eg, fluoride content as FHAp or CaF2-like particles)
Dental anatomy and occlusion
Anatomy of oral soft tissues in relationship to the teeth
Physiologic soft tissue movements
Dental Erosion: Diagnosis
Behavioral Factors
•
Unusual eating and drinking habits
•
Healthy lifestyle: diets high in acidic fruits and vegetables
•
Unhealthy lifestyle: frequent consumption of “alcopops” and designer drugs
•
Alcoholic disease
•
Excessive consumption of acidic foods and drinks
•
Nighttime baby bottle feeding with acidic beverages, including milk
•
Oral hygiene practices: frequent toothbrushing, abrasive oral care products
Dental Erosion: Diagnosis
Prevention
Loss of tooth surface is a multifactorial process and education
is the first step in the line of defense.
Dental Erosion: Diagnosis/Management
Dynamics of Dental Erosion
Before
During
After
Time (Frequency)
Interactions between Behavioral and
Biological Factors
21. Lussi A, Kohler N, Zero D, et al.
Dental Erosion:
Management/Etiological Factors
Awareness/Association/Education
Dietary factors
•
Avoid radical changes in dietary habits
•
Reduce acid exposure by reducing frequency and contact
time of acid
•
Avoid acidic foods and drinks late at night
•
Avoid high-acidity liquids via baby bottle for infants
•
Avoid low pH values in food and beverages
Dental Erosion
Management/Etiological Factors
Awareness/Association/Education
Dietary factors: generally, a pH
value of 5.5 or lower is capable of
softening the surface of enamel
in only a few minutes.
3. Strassler HE, Drisko CL, Alexander DC.
Dental Erosion:
Management/Etiological Factors
Awareness/Association/Education
Behavioral/habits
•
Do not hold or swish acidic drinks in your mouth
•
Avoid sipping acidic drinks—use a straw
•
Avoid toothbrushing immediately after an erosive challenge
(vomiting, acidic diet)
•
Avoid toothbrushing immediately before an erosive
challenge, as the acquired pellicle provides protection
against erosion
•
Use a soft toothbrush
Dental Erosion:
Management/Etiological Factors
Awareness/Association/Education
Behavioral/Habits
•
Use a low-abrasion fluoride-containing toothpaste; highabrasive toothpaste may destroy pellicle
•
Avoid toothpastes or mouthwashes with too-low pH
•
After acid intake, stimulate saliva flow with chewing gum or
lozenges
•
Use chewing gum to reduce postprandial reflux
•
Refer patients or advise them to seek appropriate medical
attention when intrinsic causes are involved
Dental Erosion:
Management/Etiological Factors
Awareness/Association/Education
Gastroesophageal Origin
•
Heartburn and other symptoms of reflux
•
Regurgitation
•
Dysphagia
•
Asthma
•
Rumination
•
Eating disorders (anorexic or bulimia)
Dental Erosion:
Management/Etiological Factors
Awareness/Association/Education
Medicinal factors associated with dental erosion
•
Some medicines can potentially induce GERD
 theophyline
 progesterone
 anti-asthmatics
 calcium channel blockers
•
Aspirin (especially in chewable format)
•
Medicines that decrease salivary flow
 antihistamines
 anticholinergics
 antidepressants
 antipsychotics
Prosthodontic Treatment of Tooth
Wear
Before and after treatment
Before and after treatment
Before and after treatment
Before and after treatment
Vertical type of abrassion
Horizontal type of abrassion
Dental Erosion/Toothwear
Prevention is better than a cure… Education is the key!