Management Tree Dentistry Peer Reviewed Dental Wear: Attrition & Abrasion Tooth wear no pulp exposure no radiographic Radiographic evidence evidence of endodontic pathology of endodontic pathology • Chronic gradual wear • extensive wear— structural weakness • Rapid or acute wear • very smooth surface • smooth or rough surface • smooth or rough surface • Reparative dentin • ± Reparative dentin • no reparative dentin • Periodic reassessment Dentin bonding agent Composite restoration • ± Follow-up radiographs extraction • ± Odontoplasty to smooth any rough ± crown placement q6-12mo surfaces • ± Composite restoration Address/correct underlying source Chewing on excessively Abrasion (ie, external Orthodontic malocclusion hard objects source of wear) • eliminate access strategic extraction(s) Orthodontic movement • Limit or eliminate source • substitute with soft chew • substitute with less item abrasive item • Behavior modification • Periodic reassessment • Follow-up radiographs q6-12mo 10 cliniciansbrief.com • January 2013 Donald E. Beebe, DVM, DAVDC Apex Dog & Cat Dentistry Englewood, Colorado TOOTH WEAR TYPES Fast Facts • Abrasion is mechanical wear • Dental explorers have a sharp tip of teeth from external forces Pulp exposure that helps determine whether a (eg, brushing, dental instru- worn surface is smooth from ments), also defined as wear gradual wear or rough from minor from chewing on abrasive fractures; it can also probe for pulp extraction objects (eg, tennis balls, hair). exposure. its use is mostly reserved for anesthetized patients; diligent • Attrition is gradual physio- caution should be used with logic wear resulting from nonanesthesized patients. natural mastication. Root canal ± crown placement • Reparative dentin is denser than • Pathologic attrition is regular dentin, lacks organized excessive wear caused by tubules, is produced during tooth heavy chewing, biting, or wear, and acts as a protective grinding against other teeth barrier. Pulp recedes behind the (eg, orthodontic malocclusion). deposited mineralized layer and remains shielded from exposure. • Intraoral radiographs are essential for evaluating compromised teeth. • Odontoplasty is the adjustment of tooth contours. sharp edges can be smoothed with hand or powered instrumentation. small surface defects can be restored with dental composite. • Signs of endodontic pathology Dermatitis may include wider-than-normal pulp canals from odontoblast death and delayed maturation, strictured or obliterated pulp canals from accel- erated calcification (can occur investigate and treat dermatologic disorder during pulpitis), periapical radio- lucency, or internal or external root resorption. Differential Treatment Diagnosis investigation Results See Aids & Resources , back page, for references & suggested reading. January 2013 • clinician’s brief 11.