DENTAL ATTRITION Etiology and pathogenesis This nosology has multifactorial nature The causes which lead to dental attrition can divide into 3 groups functional insufficiency of tooth hard tissues High abrasion affection on tooth hard tissues functional overloading of the teeth Functional insufficiency of tooth hard tissues can be caused by endogen factors exogen factors Endogen causes are a)inherent eg. Capdepon’s displasia, disorders of amelogenesis and dentinogenesis b) acquired – as a result of different endocrinopathyes such as functional disorders of hypophysis, sexual glands, thyroid gland etc. when mineral and protein metabolism is impaired. Exogen factors They can have physical character chemical character alimentary character. For example, radionecrosis, chemical necrosis, insufficiency of vitamins and mineral soles in the meal etc. High abrasion affection on tooth hard tissues Very-solid food non rational use of hygienic manipulation aimed for dental care factory dust occlusal disharmony caused by not correct work when making ceramic or metal-ceramic crowns and bridges, disturbances of technological process etc. Functional overloading of the teeth can be local generelized The causes of local overloading pathological bites anomalies of location and form of separate teeth partial loss of teeth not rational prosthesis not correct choice of prosthesis- construction occlusial disharmony during prosthesis-making etc. The causes of generelised dental attrition dysfunction of masticator muscles (bruxizm). Approximately 30 -40 % of patients suffering from bruxizm have pathological dental attrition. Early recognition of dental erosion is important to prevent serious irreversible damage to the dentition. Classification of dental attrition According to the plane of affection According to the extension according to the depth of attrition According to the plane of affection horizontal vertical complex According to the extension local generalized According to the depth of attrition first degree – defect of tissues till 1/3 of crown height second degree - defect of tooth tissues till 2/3 of crown height third degree- defect of tooth tissues till the gingival edge Dental attrition can be also Compensate - vertical extension doesn’t decrease not compensative have a diminution of vertical extension Clinical image of dental attrition Attrition of dental surfaces which can be flat or concave hyper sensitivity regardless the depth of affection diminution of interdental height. During the local form of dental attrition we can observe a diminution in crown’s sizes and interdental height. The changing of dental crown sizes is compensated by hypertrophy of alveolar bone. That’s why when we have saved molars occlusal height remains unchanged. Clinical image of dental attrition During the generelised form of dental attrition the occlusal height can diminish, but can be also saved owing to vacant (free) hypertrophy. Different variation in dental attrition is related to the following factors Sex Age tooth position in some cases, dental caries. The sex of the individual is found to be a major factor in tooth wear and a higher degree of attrition is found among females. Tooth position is also an important variable in determining the degree of wear. The diminution of vertical dimension can lead to the dysfunction of masticatory muscles and esthetic changing dysfunction of temporo-mandibular joint decompensation of dental attrition can lead to Costen’s syndrome developing which is characterized by pains of TMJ, face, temporal region, headaches, earaches PROSTHODONTIC TREATMENT OF DENTAL ATTRITION The goal of prosthodontic treatment of dental attrition to make stable the attrition of tooth hard tissues to restore the anatomical shape, esthetics and function to restore the occlusial dimension if necessary The treatment plan depends on degree of affection form of the disease popularity conditions of the maxillo-facial system The treatment of first degree dental attrition The treatment is realized in one step using cast metal and metal-ceramic crowns and bridges. If the patient suffers from bruxism or other muscle dysfunctions the preparing of metal-ceramic constructions is contraindicated to avoid fractures of ceramic lays. During these nosologies we can make jacket crowns or bridges (not completely covered, the occlusal surface must be made from metal) The treatment of second degree dental attrition The treatment is realized in 2 steps During the first step we must regulate myotatic reflexes (it lasts 3 months). The second step is the rational prostheses-making by stable construction, such as post-core covering by fused (cast) crowns or movable prosthesis (dentures). The treatment of third degree dental attrition The treatment is also realized in 2steps. The first step is regulation of myotatic reflexes. The second step is also the rational prostheses- making by stable construction, such as post-core covering by fused (cast) crowns or movable prosthesis (dentures). If we have dental attrition of second or third degree during the treatment it will be good to make post-core or crowns on antagonist teeth for saving vertical dimension and averting dental-wearing process. Acid Wear Acid wear is a form of tooth wear that is caused by acid softening the surface of the tooth enamel. When tooth enamel (the tooth’s hard surface) is exposed to acids (from food, juice of the stomach e.g. due to sickness or regurgitation), it temporarily softens and loses some of its mineral content. Saliva will help neutralise acidity, restore the mouth’s natural balance and slowly re-harden the tooth enamel. However, because the tooth recovery process is slow, if the acid attack happens frequently, the tooth does not have a chance to repair. When the enamel surface is soft and we brush our teeth, the enamel can be worn away more easily, become thinner over time, and lead to the following reduced thickness of enamel, surface texture changes shape and appearance changes may also cause teeth to become sensitive. The acid wear’s effects are: Sensitivity - As tooth enamel is worn away, the underlying dentin may be exposed. This is a softer part of the tooth and as it becomes exposed, teeth may be more sensitive. A slight twinge can be felt when consuming cold, hot or sweet foods or drinks. Severe Sensitivity - As dentin continues to become exposed over time, patients can suffer from a severe case of sensitive teeth Discolouration - Teeth can have a slight yellow appearance as enamel becomes thinner, the darker dentin shows through or may show a darker yellow appearance due to the exposed dentin showing through Rounded Teeth - rounded ‘sandblasted’ look on the surface and edges of the teeth Transparency - Front teeth may appear slightly transparent near their biting edges Cracks Small cracks and roughness may be present at the edges of the teeth Cupping - Small depressions may appear on the chewing surface of the teeth – at this stage any fillings may appear raised You must protect your teeth because once tooth enamel is lost, it cannot be replaced. There are several steps that can be taken To help protect your teeth against the effects of dietary acids Allow acidic foods and drinks to pass through your mouth quickly to reduce the time they are in contact with your teeth. Strong evidence suggests that the manner in which the acidic food or drink is consumed is more important than the overall quantity. If possible, drink soft drinks through a straw directed into your mouth and not directly at your teeth. Avoid brushing your teeth immediately after consuming acidic foods and/or drinks, as this is when enamel is at its softest and most likely to be damaged. Dentists recommend you brush teeth gently, but thoroughly, with a medium or soft toothbrush. This will help to minimize the risks of abrasion and tooth wear. The difference between decay and acid wear is When foods containing sugar or starches are eaten, the bacteria in the mouth (in plaque) convert these products to acids that can lead to localized dissolving of the tooth enamel. Over time, this can cause the enamel to break down and a cavity to form, which may require filling by a dentist. While decay is a localized process (ie. it does not effect all of the teeth at one time), wear occurs across the whole tooth surface that has been exposed to acid. It does not involve bacteria or dietary sugars, but is the result of direct action of acids (either from food, drinks or the stomach juice e.g. due to sickness or regurgitation) on the tooth's enamel surface. Frequent consumption of food and drinks with a high acid content can cause enamel erosion. Some causes of acid wear Highly acidic Grapefruit Strawberry jam Honey Salad with vinegar dressing Tomato salad with balsamic dressing White or red wine Fresh orange juice Fresh grapefruit juice Fresh apple juice Soft drinks Slightly acidic Bananas Tomato soup Hamburger Chicken and fries Beer Neutral English Breakfast (bacon, sausage and egg) Toast Lobster and rice Cheese Chocolate cake Milk English tea Fruit tea Partial destruction of tooth hard tissues. Prosthetic treatment with inlays and onlays To repair damage involving over ½ of the tooth’s biting surface, rather than using a simple filling, or a crown, a dentist will often use an inlay, or an onlay. Inlay and onlay are the intracoronal restorations . Intracoronal restorations are those that fit within the anatomical contours of the clinical crown of a tooth The causes of tooth partial destruction . carious . noncarious Non carious causes . Increased attrition . Erosion . Trauma (acute and chronic) . Hypoplasia of enamel and dentin . Scratches of enamel and dentin The clinical picture of tooth partial destruction depends on sizes and localization of the defect. Complaints . can be absent or they can be: . pains caused by physical and chemical factors . inflammation of interdental papilla and food deposit in interdental space Symptoms of partial absence of the tooth crown . disorder of tooth anatomical form and as a result disorder of its function .