Tooth Wear in Children & Adolescents

1. Tooth Wear in Children & Adolescents Dr FedaZawaideh

2. Is a general term used to describe the non-carious loss of dental hard tissuesCan occur as a result of Physical Loss, Chemical Dissolution &/or Multifactorial Etiology Tooth Wear Ganss, 2006

3. Is a general term used to describe the non-carious loss of dental hard tissues.Can occur as a result of: Physical Loss Abrasion Attrition AbfractionChemical DissolutionMultifactorial Etiology Tooth Wear Ganss, 2006

4. Is a general term used to describe the non-carious loss of dental hard tissues.Can occur as a result of: Physical LossChemical DissolutionErosion Extrinsic acids Intrinsic acids Multifactorial Etiology Tooth Wear Ganss, 2006

5. Is a general term used to describe the non-carious loss of dental hard tissues.Can occur as a result of: Physical LossChemical DissolutionMultifactorial EtiologyAbrasion Attrition Abfraction Erosion Tooth Wear Ganss, 2006

6. Physical wear of dental hard tissue as a result of mechanical processes involving foreign objects or substances repeatedly contacting the teethOral hygiene habits Excessive brushing/flossing Abrasives in toothpastesPersonal habits Biting on hard objects Demastication A special form of abrasion, which means wear from chewing food Occupational Tailors, shoemakers and musicians who play wind instruments Abrasion Ganss, 2006

7. Abrasion Clinical Features Wedge-shaped, sharp & well defined margins, lesion surface may exhibit scratches & depth of the defect exceeds its width Defects can be diffuse or localized depending on the predominant impact

8. Attrition Physical wear as a result of tooth-to-tooth contact, with no foreign substance interveningFactors predisposing / accelerating to attrition:Parafunctional activity (bruxism and clenching) Coarse diet (vegetarians)Natural teeth opposing coarse porcelain Ganss, 2006

9. Attrition • Clinical Features Well-defined facets, shine & sharp edges, flattening of the cusp tip &/or incisal edge & shine facets on amalgam & composite restorations Characteristic features are antagonistic facets with sharp margins Spear, 2008

10. Abfraction Physical wear as a result of tensile or shear stress in the cemento-enamel region, provoking microfracture in enamel & dentinStress generated from: Occlusal interferences Premature contacts Bruxism & Clenching Ganss, 2006

11. Deep Narrow Wedge-shaped defect Abfraction Clinical Features Grippo et al., 2004

12. Irreversible loss of dental hard tissue due to a chemical process of acid dissolution but not involving bacterial plaque acid, and not directly associated with mechanical or traumatic factors, or with dental caries Dental Erosion O'Sullivan and Milosevic, 2008

13. ErosionClinical Features in Smooth Surfaces Smooth , shine, absence of perikymata, plaque & stain free & intact enamel band Lussi et al., 2007

14. ErosionClinical Features in Smooth Surfaces Concavity, lesion width exceeds its depth with smooth glazy surface, round edge with the surrounding enamel , teeth may appear translucent, lesions surrounded by sound enamel band which appears as a pseudo-chamfer line at the gingival margin Lussi, 2006 Lussi et al., 2007

15. ErosionClinical Features in Smooth Surfaces In more advanced lesions, pulp may involved Lussi, 2006

16. ErosionClinical Features in Incisal / Occlusal Surfaces Translucent incisal edge, smooth glazed occlusal surface & rounding of cusps Lussi et al., 2007

17. Grooving of the incisal edges & cupping lesions on the cusps of the occlusal surfaces ErosionClinical Features in Incisal / Occlusal Surfaces Lussi et al., 2007

18. ErosionClinical Features in Incisal / Occlusal Surfaces Restorations are not affected by erosion and therefore appear “proud’’ of the surrounding dental tissues Gandara & Truelove,1999 Lussi & Jaeggi, 2008

19. Source of Acids Extrinsic Acids Intrinsic Asdic

20. Fruits Beverages

21. Condiments Medications

23. Interaction of Different Factors for the Development of Erosive Tooth Wear Lussi, 2006

24. Epidemiology of Dental Erosion “Erosive tooth wear is a common condition in the developed countries”

25. Epidemiology of Dental Erosion Epidemiological studies suggest prevalence of dental erosion:Up to 50% among pre-schoolchildren Between 11% to 100% of school-aged children

26. Complications of Dental Erosion Tooth wear could result in • an aesthetic problem, • loss of tooth structure, • sensitivity and pain, • pulpal exposure and • loss of vertical dimension which is thought to lead to temporomandibular joint problems.

27. Management of Dental Erosion • The first step in the management of dental erosion is to determine the cause of the dental erosion and to identify the associated risk factors and where possible eliminated. The management of dental erosion involves a preventive and a restorative part and in this seminar it will be discussed in three phases; immediate, provisional and long term

28. Management of Dental Erosion • Immediate management-Diagnosis, saliva testing, Education regarding aetiology, presentation and complications of dental erosion, counseling, prevention • Remineralizing agents • Restorative treatment-onlays