Principles

The irreversible wearing away of the dental hard tissues is a consequence of the natural ageing process. The condition of tooth wear (TW) is used to describe the surface loss of the dental hard tissues from conditions other than caries, trauma or developmental disorders.

Where the observed level of TW for any given patient is considered to be extensive so as to be associated with concerns relating to the presence of symptoms of pain or discomfort, aesthetic or functional compromise, or indeed the rate of wear exceeds what may be considered normal for the age of the patient (perhaps better termed physiological), the suffix pathological may be added.

With an ageing population, lifestyle and habit changes, it is not uncommon in the developed world to encounter patients presenting with pathological wear on a regular basis across the entire age spectrum, ranging from younger children to the geriatric patient.

TW often has a multifactorial aetiology. Individual factors include erosion, abrasion, abfraction and attrition. It would appear that erosion is a factor in the majority of patients with TW. Acidic substrates, which lead to erosive wear, may be derived intrinsically or extrinsically. A sevenfold increase in the rate of consumption of soft beverages in the UK between the 1950s and 1990s has been reported as taking place, with adolescents accounting for 65% of all purchases.¹ In more recent times, with more individuals pursuing a healthier lifestyle and consuming copious quantities of fresh fruits and vegetables, it is also likely that this will have an aetiological impact. Table 9.1.1 provides a list of the typical pH values of commonly consumed beverages.

The successful management of a patient presenting with TW requires the clinician not only to derive an accurate diagnosis based on a recording of a contemporaneous dental history and to undertake a meticulous patient assessment (as described in Part 2), but also to understand the processes involved in passive management (prevention and monitoring) and to possess a suitable level of knowledge of how to successfully restore cases where active intervention is indicated.

This chapter will focus on the passive management phase.