Erosion Abrasion Attrition and Abfrcation1Erosion Abrasion Attrition and Abfrcation1

8/18/2019 Erosion Abrasion Attrition and Abfrcation1Erosion Abrasion Attrition and Abfrcation1

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Tooth Tissue Loss - Erosion,Abrasion, Attrition and

Abfraction; we wonder whyour teeth are sensitive!

Sonia Jones RDH ETSouth "est #ost $raduate Denta% Deanery

D# Advisor Devon&ornwa%%

soni'ones(hot)ai%*co*u+www*bristo%*ac*u+&denta%

mailto:[email protected]

http://www.bristol.ac.uk/dentalpg

http://www.bristol.ac.uk/dentalpg

mailto:[email protected]



Ai)s and .b'ectives

Ai)/ to ensure de%eates understand how tooth tissue%oss can be detri)enta% to dentine hyersensitivity

.b'ectives/

0y the end of the session you shou%d be ab%e to/ Distinuish between erosion, abrasion, attrition and

abfraction Deter)ine the causative factors of tooth tissue %oss Describe how to revent further tooth tissue %oss Discuss sensitivity theories and e1%ain the way they

wor+ List toica% )edica)ents avai%ab%e to re%ieve sensitivity



Tooth tissue %oss

Tooth surface %oss can arise as theresu%t of/

Erosion Abrasion Attrition Abfraction



Erosion



Abrasion



Attrition



Abfraction





Tooth tissue %oss

The 2 tyes of tooth tissue %oss a%% havetheir own characteristic aearance

However, the wear of a ersons teeth is

usua%%y fro) a )i1ture of a%% 2, with onetye of TTL redo)inatin*

So)eti)es di3cu%ty in deter)inin thedo)inant aetio%oy

The thic+ness of the e%%ic%e and theressure of the tonue contribute to thee1tent of the condition





Erosion

Described as ear%y as 789: a)on Sici%ian%e)on ic+ers

Denition/ <The %oss of tooth tissue by ache)ica% rocess that does not invo%vebacteria, acids are )ost co))on%yinvo%ved in the disso%ution rocess=

>on carious atho%oica% %oss of toothtissue

#%a?ue not invo%ved in the rocess



%inica% #resentation .ccurs )ost fre?uent%y on the a%ata%

and %abia% surfaces of the incisorteeth

The e6ected surfaces aear s)oothand hih%y o%ished with a scooedout deression

The %esion ri)ari%y occurs in theena)e% 4n )ore severe cases the dentine

beco)es e1osed As ena)e% %oss roresses sensitivity



Erosion



Erosion



auses of erosion

E1trinsic factors 4ntrinsic factors 4dioathic factors



E1trinsic causes of erosion

Habitua% consu)tion of hih%yacidic, %ow H carbonated drin+s,sorts drin+s or concentrated fruit

'uices A%co os, fruit avoured a%coho%ic

beveraes and stron ciders ausin a wide sha%%ow %esion

e6ectin the %abia% and a%ata%surfaces of the uer teeth




Swishin or ho%din drin+s in the)outh

@odern ac+ain has a%so beenb%a)ed, tetra ac+, %astic bott%esand cans B directiona% ow onto teeth

an e1tend fro) the %abia% and

a%ata% %esions of the uer teeth toa%% surfaces of a%% teeth



he)ic% H







Tota% Titratab%e Acidity



Titratab%e acidity

How %on it ta+es for the sa%iva toco)ensate

How )uch sa%iva Cow 0u6erin caabi%ities of the sa%iva itric acid the biest cu%rit

Thic+ness of the e%%ic%e can rotectto a deree

Hiher te)eratures increase

titratab%e acidity



E1trinsic causes of erosion Habitua% suc+in of citrus fruits The %esion )ay occur in either the uer

or %ower anterior teeth

Deendin on the way the fruit is eatenCRe)e)ber fruit eaten as a who%e unitdoes not enera%%y cause a rob%e)

Acidic foods #ic+%es, sauces, vinears, yohurts,

roasted veetab%es




4ndustria% at)osheric o%%ution he)ica% wor+ers, battery

)anufacturers, crysta% %ass wor+ers Less co))on now due to stricter

wor+in conditions and reu%ationsCHS at wor+ act 79F8

Acidic fu)es e6ect the %abia% surfacesof the uer and %ower anterior teeth

"hen ta%+in or the )outh is at rest




h%orine, fro) as ch%orinatedswi))in oo%s

#rofessiona% swi))ers 4f the che)ica%s are not roer%y

reu%ated Less co))on now due to reu%ations



4ntrinsic causes of erosion

ro) within the body Gsua%%y hydroch%oric acid fro) the

sto)ach CH : Reu1 Reuritation 5o)itin Ru)ination



Ru)ination

The ter) ru)ination is derived fro)the Latin word ruminare, which)eans to chew the cud* Ru)ination

is characteried by the vo%untary orinvo%untary reuritation andrechewin of artia%%y diested food

that is either reswa%%owed ore1e%%ed* This reuritation aearse6ort%ess, )ay be receded by a

be%chin sensation, and tyica%%y



Reu1, Reuritation and 5o)itinof astric contents

Anore1ia 0u%i)ia Hiatus Hernia #renancy&Hor)ones @otion sic+ness .besity Eatin too )uch Drin+in too )uch A%coho%is)



Anore1ia



0u%i)ia



Saturday >ihtI



Habitua% reuritation of astriccontents

Heavi%y acidic diet increases astricerosion

The a%ata% surfaces of the uer

anteriors and re)o%ars are eroded #roduces wide sha%%ow %esions Ena)e% )ay be co)%ete%y %ost

Tac+%e the rob%e) with care! #atient )iht not ad)it to

unattractive asect of sycho%oica%

i%%ness

4dioathic causes of



4dioathic causes oferosion

Gn+nown cause #atient wi%% not ad)it to or be aware

of intrinsic or e1trinsic causes 5iorous tooth brushin can

contribute to an over o%ishedaearance - shiny



Abrasion

Denition/ <The abnor)a% wearinaway of tooth tissue by a )echanica%rocess=

The %ocation and attern of abrasionis direct%y deendent uon its course

4t usua%%y occurs on the e1osed root

surfaces when iniva% recession hase1osed the ce)entu)

4t )ay be seen on the incisa% or

intero1i)a% surfaces of the teeth



auses of Abrasion

4ncorrect or destructive use of a toothbrushGse of an abrasive detrice

The ena)e% and dentine is worn away to roduce a<5= shaed notch at the nec+ of the toothAreas )ost a6ected are the %abia% and bucca%surfaces of the canines and re)o%ars#owerfu% bac+ hand, RHS of riht handed ersonLHS of Left handed erson

#ara functions, habits, occuations @ain%y a6ects the incisa% edes of the anterior teeth

%inica% aearance of



%inica% aearance ofAbrasion

"orn, shiny often ye%%ow&brown areasat the cervica% )arin

"orn <notches= on the incisa% surfaces

of the anterior teeth



Abrasion



Abrasion



auses of Abrasion

Sea)stresses B ins, arenters Bnai%s, Hairdressers B hairris

#ie s)o+ers, nai% biters, causin<notchin=



Attrition

Denition/ <The hysio%oica% wearin awayof the tooth surface as a resu%t of tooth totooth contact= as in )astication

.cc%usa% and incisa% surfaces of the teeth)ost co))on%y a6ected

@ay a%so a6ect the ro1i)a% surfaces ofthe teeth due to s%iht )ove)ent of the

teeth in their soc+ets durin )astication Ae re%ated rocess 5aries fro) erson to erson



%inica% aearance of



%inica% aearance ofAttrition

#o%ished facets on ena)e% surfaces uin B dentine is e1osed .ccasiona% fu%% %oss of ena)e%,

dentine is e1osed and stains heavi%y



Attrition



Attrition

Ranes fro) art of the ena)e%bein worn away in the ear%y staesto the fu%% thic+ness of the ena)e%

wearin away in advanced attrition The dentine )ay be e1osed and

stained

4n e1tre)e cases the teeth )ay beworn down to the inivae



Attrition



Attrition #rocess of attrition is s%ow Secondary dentine is %aid down to rotect the

u% cha)ber and the u% cha)ber narrows #ain is rare%y associated with attrition @en usua%%y show a reater deree of attrition

than wo)en Severe attrition is se%do) seen in deciduous

teeth, Cnot retained for %on However if a chi%d su6ers fro) dentinoenesis

i)erfecta Can hereditary disorder of thedentine ronounced attrition )ay resu%t fro))astication



Abfraction

Denition/ <The atho%oica% %oss of ena)e%and dentine due to occ%usa% stresses=

Recent%y interest has rown in the

deve%o)ent of cervica% abrasive %esions The ter) abfraction has been used to

describe these cervica% %esions

So)e %inicians do not be%ieve that this isthe reason and that erosion and abrasioncause the wear facets, research continues



Abfraction



auses of Abfraction

.cc%usa% forces which cause the tooth to e1,cause s)a%% ena)e% ec+s to brea+ o6, inducinthe abrasive %esions

Gsua%%y wede shaed %esions with shar an%es

found at the cervica% )arins However can be found on the occ%usa% surfaces,

resentin as circu%ar areas These %esions can occur with occ%usion a%one or

as with )ost TTL cases which are )u%ti factoria%,can be associated with toothbrush abrasion

These %esions are often dianosed as toothbrushabrasion, but they di6er as their an%es aresharer



Abfraction

o))on in atients with oor tootha%in)ent

an be associated with/ Anterior oen bite .cc%usa% restorations that chane the

cusa% )ove)ents

Abnor)a% tonue )ove)ent

Treat)ent of Tooth Tissue



Treat)ent of Tooth TissueLoss

7* Re%ieve sensitivity and ain B uoride,desensitisin aents&toothastes

:* 4dentify aetio%oica% factors B )odifydiet&habits, e%i)inate acidic foods&drin+s,

sto habitua% ractices, ent%e toothbrushin techni?ues

* #rotect the re)ainin tooth tissue Breconstruct the e6ected teeth, restorations,in%ays&on%ays, crowns, chec+ occ%usion

2* 0ite raisin devices&s%ints

K* Referra% to TTL E1ert* #revention of further eisodes



Treat)ent #%an

Ta+e a detai%ed history fro) theatient

E1a)ination Radiorahs 5ita%ity testin #atients wishes&needs

Study )ode%s #hotorahs 4ndices



4ndices 0E"E

0asic Erosive "ear E1a)ination

M >o Erosive "ear

7 4nitia% %oss of Surface te1ture: Distinct defect, hard tissue NKMO of

the surface area

Hard tissue %oss PKMO of thesurface area

Q C:, dentine invo%ved



Tooth wear index according to Smith and Knight Score Surface Criteria

M 0&L&.&4 >o %oss of ena)e% surface characteristics >o %oss of contour7 0&L&.&4 Loss of ena)e% surface characteristics @ini)a% %oss of contour: 0&L&. Loss of ena)e% e1osin dentine for %ess than one-third of

the surface 4 Loss of ena)e% 'ust e1osin dentine Defect %ess than 7)) dee 0&L&. Loss of ena)e% e1osin dentine for )ore than one-third of the surface 4 Loss of ena)e% and substantia% %oss of dentine

Defect %ess than 7-:)) dee2 0&L&. o)%ete %oss of ena)e%, or u% e1osure, or e1osure of secondary dentine 4 #u% e1osure or e1osure of secondary dentine Defect )ore than :)) dee, or u% e1osure, or e1osure of secondary dentine



Sensitivity

Dentine Hyersensitivity B Dentine is the hih%ysensitive art of the tooth

#atients su6erin fro) dentine hyersensitivityoften thin+ that they have deve%oed a cavity or%ost a %%in

.n e1a)ination there is often no obvious reason for

their ain, iniva% recession is so)eti)es evident The a)ount of recession does not see) to corre%ate

with the a)ount of ain they are e1eriencin

c&o short shar eisodes of ain caused byte)erature, touch by )eta%, sweet foods&drin+s

#atients can be very distressed by the ain ofdentine hyersensitivity and often avoid the

causative sti)u%i as )uch as ossib%e



Sensitivity

"o)en )ore re disosed than )en Ae :M-2M Ranes fro) 7K-FM



Dentine

@ade u of dentina% tubu%es Loo+s %i+e honeyco)b under the

)icroscoe Si)i%ar in co)osition to bone an re)ode% itse%f and %ay down

rearative and secondary dentine

"hen e1osed to the ora%environ)ent can be sensitive



Dentine

Larer tubu%es )ore ain @ore oen tubu%es )ore sesitivity



Dentina% tubu%es

Dentine Hyersensitivity



Dentine Hyersensitivity Theories

theories as to how we fee% the ainof dentine hyersensitivity

7* Dentine 4nnervation Theory:* .dontob%ast recetor theory* Hydrodyna)ic theory

Dentine 4nnervation



Dentine 4nnervation Theory

>erve bres fro) the >erve #%e1us ofRasch+ow Cne1t to the dentine &u%boundary, a%on side the .dontob%ast

activity enetrate the dentina%tubu%es and cause i)u%ses

>ot the )ost %i+e%y theory/ whi%st the

nerve bres do enetrate thetubu%es, there are not enouh ofthe) and they do not enetrate

dee%y enouh into the tubu%es to

.dontob%ast Recetor



.dontob%ast Recetor Theory

#rooses that .dontob%asts receiveand ass on i)u%ses and that whenthey are touched cause the sensation

of ain>ot the )ost %i+e%y theory/ as there are

no synases between the

.dontob%asts and the >erve #%e1us ofRasch+ow

CSynases B 'unctions between

neurones where che)ica%s trans)it



Hydrodyna)ic Theory

@ost %i+e%y theory/ Answers )ore ?uestionsLy)h %i+e uid inside the dentina% tubu%es is

sti)u%ated by te)erature, touch and sweetsensations, causin it to ow bac+wards and forwardswithin the tubu%es, this ives the sensation of ain

Hot&co%d causes e1ansion&contraction causin theuid to ow

Sa%t&sweet causes os)otic ressure, ows towardsthe concentrate

Tacti%e&E%ectrica% CTouch I! B contraction of the uidI

Research continues, what they do +now is how to treatit

Dentine Hyersensitivity



Dentine Hyersensitivity Treat)ents

@ost co))on%y treated by/ @echanica% 0arriers Sti)u%ation of #eritubu%ar or Reactive

Dentine 4ncreasin otassiu) concentrations



@echanica% 0arriers

A%ied over the oen ends of theDentine Tubu%es

Restorations B $%ass iono)ers,

o)osites, 4n%ays&.n%ays, Dentinebondin aents that for) a che)ica%bond with the dentine %oc+in into

the tubu%es, Resins&Adhesives Tubu%e occ%udin toothastes B need

to be re%aced dai%y

Sti)u%ation of #eritubu%ar or



Sti)u%ation of #eritubu%ar orReactive Dentine

The dentine %ays down a rotective%ayer

Hih concentration uoride B

Durahat 5arnish, $e% a)C%uoriard e%

Si%o1ane Esters B Tresio%an, Sensitro%

etc0oth wi%% wear o6 so need to be

rea%ied



%uoride %uoride irritates the dentine 4t irritates the dentine su3cient%y for it to

%ay down a secondary %ayer and thereforerotect the tooth fro) further sti)u%i

4t does this by occ%udin the tubu%es @outhwashes dai%y M*MKO and wee+%y

M*:O so%utions

Hih uoride toothastes - Durahat:8MM, KMMM

5arnishes B Durahat :*:O ::,MMM) $e%s B M*2O stannous uoride



4ncrease #otassiu) oncentrations

>erve Deo%arisin #otassiu) ch%oride, #otassiu)

>itrate, #otassiu) itrate found in

desensitisin toothastes increasethe otassiu) concentrations aroundthe nerve %e1us

This revents action otentia%s beintrans)itted Cnerve i)u%ses

0y +eein the sodiu) outside the

ce%% wa%%



>erve 4)u%ses

Sodiu) is attracted to #otassiu) 0y increasin the #otassiu) %eve%s

outside the nerve ce%% wa%%s, the

Sodiu) stays outside and doesn=tdi6use in

This stos the nerve i)u%se

Deo%arisation



Action #otentia%s B >erve 4)u%ses

Sodiu) #otassiu)



E1chane



Toothaste %ai)s

>erve Deo%arisin Toothastes Tubu%e .cc%udin Toothastes

Each )anufacturer c%ai)s that theirtoothaste has the best techno%oy

Do they wor+I



Sensodyne Traditiona%%y >erve deo%arisin

toothastes Active inredients /- #otassiu) >itrate Sodiu) %uoride- #otassiu) h%oride Sodiu) uoride #otassiu) +ees the sodiu) outside the

ce%% wa%%

0y addin the uoride to the newer tyesof Sensodyne you et the tubu%e occ%usionheno)enon caused by dentine irritationand %ayin down of a secondary %ayer



Sensodyne #rona)e%

%ai)s to B reharden softened ena)e% - be %ow in abrasives to

revent further tooth tissue %oss

Active inredient B #otassiu) >itrate

Sodiu) %uoride

I

Sensodyne new .cc%udin



Sensodyne new .cc%udintoothaste

Sensodyne Raid Re%ief Active 4nredient Strontiu) Acetate

Sodiu) @ono-uorohoshate

#ub%ished studies suort the )ode ofaction and tubu%ar occ%usion occurs

but/ Strontiu) h%oride B Sensodyne .riina%,

occ%udes tubu%es! However as it reactswith uoride beca)e %ess ou%ar

o%ate Sensitive #ro



Re%ief



#ro BArin Techno%oy Active 4nredients/ Arinine, a%ciu)

arbonate, Hydro1yaatite, Sodiu) @ono-uorohoshate

The Arinine co)%e1 binds to the tooth

surface, it is ositive%y chared this isattracted to the neative%y chared dentine

4t encouraes a ca%ciu) rich )inera% %ayerinto the oen Ce1osed dentine tubu%es

This acts as an e6ective %u Ctubu%arocc%ude

Resistant to acid attac+s

>eeds to be rea%ied twice dai%y



.ther 0rands

Ena)e% are toothaste - A)orhous a%ciu)#hoshate A# Cso%ub%e sa%ts of a%ciu) and#hoshate/ hih%y so%ub%e and there is %i)iteddata in the treat)ent of Dentine Hyersensitivity

Reca%dent CTooth)oose B #-A# asein#hoshates, derived fro) )i%+ roteins )i1ed withthe ca%ciu) and hoshate sa%ts/ no aarentub%ished c%inica% data on its e6ects of reducin

Dentine Hyersensitivity0%an1, 0ioreair- Hydro1yaatite Sodiu) @ono-uorohoshate/ tubu%ar occ%usion but %i)itedub%ished data



@onitorin

Treat)ent of active tooth tissue %oss %uoride toothastes&

)outhwashes&e%s De sensitisin toothastes Study )ode%s #hotorahs

4ndices 4dentify causative factors



#revention

Li)it acidic food and drin+ to )ea% ti)es E%i)inate fro) diet ut down on carbonated beveraes Eat citrus fruits who%e not suc+ed in 7&2s Do not ho%d&swish drin+s Gse a straw Refer to secia%ist Refer to counci%%or for eatin

disorders&a%coho% addiction Refer to $# B astric rob%e)s @i%+ or cheese after )ea%s to neutra%ise acids Avoid toothbrushin after an acid attac+



Ai)s and .b'ectives

Ai)/ to ensure de%eates understand how tooth tissue%oss can be detri)enta% to dentine hyersensitivity

.b'ectives/

0y the end of the session you shou%d be ab%e to/ Distinuish between erosion, abrasion, attrition andabfraction

Deter)ine the causative factors of tooth tissue %oss Describe how to revent further tooth tissue %oss

Discuss sensitivity theories and e1%ain the way theywor+

List toica% )edica)ents avai%ab%e to re%ieve sensitivity



Than+ you

Date post:	07-Jul-2018
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Erosion Abrasion Attrition and Abfrcation1Erosion Abrasion Attrition and Abfrcation1

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