Dental Asia Nov/Dec 2018

Clinical Feature NOVEMBER / DECEMBER 2018 DENTAL ASIA 33 Fig. 4: Abfraction lesion anorexianervosaandbulimianervosa (Fig. 3). The effect of acid regurgitation in bulimic patients often exhibit perimolysis (erosive lesions localised to the palatal aspect of maxillary teeth). In general, the pattern of tooth wear in bulimic patients is additionally affected by other factors such as consumption of diet beverages and erosive foods (as patients strive to control their weight) xerostomia, caused byvomit-induceddehydrationordrugs such as d i u re t i cs , appe t i t e suppressants and antidepressants (Hellstrom 1977). 5. Abfraction These are cervical lesions caused by occlusal stresses. The tooth can flex, causing tensile and compressive forces at the necks of teeth that result in cracks in the enamel (Fig. 4). Fig. 3: Patient suffering from eating disorder with loss of teeth and erosion of teeth due to gastric acids. 6. Restorative materials The use of porcelain can accelerate tooth wear (Fig. 5) especially if the porcelain is unglazed and rough/unpolished (Mahalick JA et al, 1971). Newly developed ceramic materials have finer particle size and exhibit wear similar to natural tooth structure. Metal occlusal surfaces are recommended for those patients with severe wear or bruxism. 7. Saliva and xerostomia Xerostomia or more commonly known as dry mouth may follow radiotherapy, medications, producing both rapid caries and dental erosion. Patients suffer from erosion whenever the acids are not well- buffered and not diluted with saliva. In patients who displayed accelerated tooth wear, there is a strong evidence of the critical role of saliva, particularly of resting salivary pH. These are several reasons linked between salivary dysfunction and tooth: • Reduced clearance of dietary acids • Reduced pH of saliva • Reduced buffer capacity, preventing both dietary and also endogenous acids from being neutralised • Reduced remineralisation of surfaces • Softening of tooth structure leading to accelerated wear from normal wear and tear under occlusal and incisive forces, and labial wear from tooth brushing. It is noted that chewing sugar-free gum can help boost salivary flow. 8. Body image The attempt to control body weight can influence patients to consume acidic foods, such as fruit and diet drinks. The struggle to achieve the ideal body weight increases the prevalence of eating disorders. 9. Loss of posterior support It has been suggested that there is an increase in force per unit area in the Fig. 5: Localised wear of teeth on 31 & 41 due to porcelain restorative material. remaining dentition, thereby causing an increase in tooth wear. A review of the literature does not support this assumption (Kayser and Witter, 1985). 10. Drug use This could be another cause of bruxism and other possible erosive conditions as drug use has an effect on attrition and dehydration. Diagnosis Diagnosis involves identifying the factor(s) contributing to tooth wear. This is to preserve the remaining dentition and to improve the long-term prognosis of any completed restorative treatment. An initial comprehensive examination is performed, which includes a thorough medical and dental history with an orofacial and dental clinical exam. Questions regarding diet, lifestyle, medications, stress, brushing habits and consumption of sports drinks can help in aiding diagnosis. Saliva testing is appropriate; a food diary may also be required. A classification of wear is made from clinically observed features, habits and careful collation of all information. Thereafter, the risk factors will be determined and patients will be educated accordingly in order to help minimise long term damage of tooth wear. Diagnosis is necessary to know whether the toothwear is physiologic or pathologic. If wear has produced an unsatisfactory appearance, sensitivity, reduction in facial height and vertical dimension of occlusion, then tooth wear is considered pathologic and this constitutes the need for treatment. A period of monitoring is required to decide on appropriate management. This monitoring may be carried out by: • Photographic records • Measurements of teeth • Use of putty indexes (lingual silicone keys) • Study model comparison • Tooth wear index