Tooth wear is a problem that everyone can face. This is a pathology that affects all surfaces of a tooth (or group of teeth) in the form of intense loss of its hard tissues. More often this problem occurs in men, less often in women. In general, it is observed in almost 13% of the population and occurs in people over 30 years of age. If you seek help from a specialist in time, tooth decay can be prevented and cured early stages.
Increased tooth wear may occur due to various reasons. Therefore, first a specialist must determine the nature of its origin and fully diagnose the pathology. For this, patients are prescribed clinical examination, both complex and sequential. The patient's sensations are recorded, as well as the diagnostic results of other specialists. This will help determine which treatment option is needed in a particular case.
Increased tooth wear
Increased tooth abrasion can occur as a result of overload after tooth loss, if incorrectly selected, there are harmful effects associated with professional activity, as well as for malocclusion and fragility of dental tissues (hypoplasia, fluorosis).
The overload of the teeth occurs, for the most part, on the canines and incisors in the absence of molars. Typically, tooth wear occurs evenly over several years, so that by the age of 40, the length of the teeth is reduced by 20-30%. With a correctly formed bite from childhood, the main wear occurs on the front teeth ( cutting edges) and chewing areas of the lateral teeth.
Increased tooth abrasion is observed among persons employed in the production of inorganic and organic acids. People whose work involves the release of metal particles into the air are also most susceptible to this disease.
The resistance of teeth to abrasion is reduced in people who suffer from systemic diseases. this type of pathological phenomenon is often required by those with Stainton-Capdepont syndrome and endocrine disorders.
Pathological abrasion, as a rule, can be caused by characteristic chewing, in which excessive load affects some teeth (groups of teeth). As a result of this impact, complications arise:
It is not uncommon for individual teeth to wear out, which antagonize those sealed with composite materials teeth. As a rule, due to the abrasive properties of such materials, fillings begin to protrude, affecting neighboring teeth, subjecting them to wear.
In the early stages, pathological abrasion of teeth manifests itself as a decrease in the occlusal height of the teeth. Discomfort and discomfort the patient, as a rule, does not experience it. However, treatment is necessary to prevent progression of the process. Depending on the degree of neglect of the increased pathological abrasion, the treatment plan may vary according to individual needs and etiological factor.
For patients with little pronounced signs selective grinding is prescribed as a preventive measure against abrasion. Physiotherapy and drug treatment recommended for patients with dentin hyperesthesia. When conservative methods do not have the desired effect, patients are prescribed, the action of which is mainly aimed at restoring the functions of the teeth thanks to their prosthetics.
Metal stamped crowns are not a popular material at the moment. Treatment of increased pathological wear of teeth with the use of such crowns can aggravate the destructive process that has begun. This is due to the disadvantages of the material:
Therefore, now they occupy a leading position in the prosthetics market.
Solid metal crowns.
The type of prosthesis is selected individually, according to examination indications. If the abrasion of hard dental tissues at the time of examination is about 2-3 cm and does not disturb their anatomical shape on the vestibular side, treatment using inlays is prescribed. This material covers the worn occlusal surface. In this regard, tabs can be of various shapes. Areas for strengthening inlays can be:
For small amounts of abrasion, treatment can be carried out using artificial crowns all types.
If the patient has pathological increased abrasion has sunk hard tissues teeth in a generalized form, treatment may involve the use of both inlays and crowns. Typically, this form of treatment involves covering the teeth of the opposite row. It concerns teeth, which are located in 3 groups:
In situations where increased wear is noticed in children or adolescents, treatment is prescribed using one of the types of artificial crowns. This system, created by T.V. Sharov in 1990, is a combined cap-loop design. It is used if patients have experienced a fracture of a corner or the entire cutting edge of a tooth, as well as loss of half or ¾ of the length of the crown. The name of the design is related to the principle of its fastening, since the cap covering the chip is secured by a loop, and an individual cast is subsequently made. Such a system is produced following simple technology. It can be performed in any dental laboratory using titanium and titanium wire.
Below is a detailed video about tooth wear
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Treatment in the form of restoration of the anatomical natural form chewing teeth is produced using one of the variants of cap-occlusion crowns, in which the fixing part is made of metal in the form of a thin-walled cap. And the restoring part can be represented by three varieties:
1) cast metal,
2) plastic,
3) combined.
The specialist faces two tasks at the same time: restoring and creating the correct shape of the occlusal height, if the patient has pathological abrasion, accompanied by abrasion of the lower and upper teeth– a rapid decrease in occlusal height in the dental system. Treatment of abrasion in this case will be orthopedic. Prosthetics are created by technicians based on individual diagnostic models.
If a patient is diagnosed with pathological increased wear of teeth, rapidly changing the bite, he is prescribed step-by-step treatment. The main task for the specialist is:
To do this, at the first stage, the doctor restores the functioning of the temporomandibular joint and muscles by returning the interalveolar height to normal. The second step is to restore the correct shape of the teeth through prosthetics.
Dental prosthetics - a panacea for abrasion
Treatment of abrasion in stages can be carried out using different methods. Each doctor chooses a technique depending on the specific case.
If a patient has increased pathological abrasion of teeth and has formed a large difference (6 mm) between the height of 1/3 of the lower part of the patient’s face when the jaws are closed in a resting position without the formation of a distal shift, treatment to restore and increase the interalveolar height can be carried out simultaneously. To do this, the author uses removable mouthguards to increase the height to the normal position. If within 2-3 weeks the patient does not have other pathologies and there is no disorder of the temporomandibular joint, the doctor proceeds with the final prosthetics using the method he has chosen. In cases where during this period of time the patient complains of pain in the joint, the specialist carries out work to reduce the height in order to bring it to the required level by raising it again after some time.
Treatment of abrasion, which has led to a height violation of 8 mm or more, should be carried out in several stages. Thus, it will be possible to exclude unwanted reactions muscles of the jaw system in response to the new position of the joints. Increased pathological abrasion, reaching 8 mm, is treated using a method that includes the use of bite blocks with therapeutic effect. In such situations, before treatment, the patient is prepared by monitoring the movements of the jaws and their condition under x-ray control.
To restore and fix the occlusal height in case of increased pathological abrasion, the doctor can use both conventional stamped crowns and crowns with a soldered or cast onlay intended for the chewing surfaces of the teeth. In addition to the fact that such structures are able to withstand loads, they are quite wear-resistant, which ensures a long service life. Such crowns are recommended to be used if pathological tooth wear is accompanied by bruxism. They are also used by doctors when the use of other structures (cast, metal-ceramic, etc.) is excluded. When installing stamped crowns on the front teeth, the occlusal surface of which is cast, they should be additionally veneered.
Before proceeding with the manufacture of individual models of metal-ceramic crowns for the anterior teeth, the specialist must first restore the occlusal height and carry out procedures to stabilize the correct bite. Prosthetic designs are selected based on clinical indications. This creates space for installing metal-ceramic crowns on the front teeth. In such situations, if the bite is straight, the cutting edges of the front teeth cannot be ground.
A specialist will have more difficult work if pathological abrasion has affected more than half (2/3) of the crown of the teeth. The main challenge for the author in such situations is that it is necessary to set the occlusal height to normal level to restore the anatomical shape of the teeth. To do this, stump-shaped cast pinned inlays are strengthened on the front and side teeth that have been affected by abrasion. The solid crowns that will later be placed on top can be plastic, porcelain, or veneered. The difficulty of the work lies mainly in the manufacture of stump inlays, since increased pathological abrasion of teeth by 2/3 or more of the length of the crown significantly reduces the volume of the oral cavity. This happens because replacement dentin is deposited in the lower incisors or premolars (molars). Often, obliteration (partial or complete) of the root canals also occurs in these areas.
Treatment and prosthetics of teeth, if the length of the crowns has been erased by more than 2/3, occurs using removable structures with onlays, if possible root canals There are no such teeth.
Orthopedic treatment of pathological abrasion, if the integrity of the dentition is preserved and the pathology is organic, also presents certain difficulties. As a rule, in this case, in teeth susceptible to abrasion, contact with antagonists is maintained, due to vacant hypertrophy of the alveolar process. But there is no violation of the interalveolar height. Specialists treat patients with this pathology in two stages. The first is to create space for the prosthesis. The second is the installation of a prosthesis. In most cases, pathological abrasion affects the front teeth. At the first stage, they are covered with a plastic mouth guard when the lateral teeth are separated. Restructuring in the alveolar process is stimulated by the functional load that occurs in the area of worn teeth. Thus, there will be enough space for the prosthesis after 3-4 months. Dental treatment for patients mature age is not produced using this method. This is due to the fact that in old age it is almost impossible to achieve restructuring. Therefore, increased tooth wear is prevented in such patients by increasing the interalveolar height in accordance with the height of the crowns within the optimal height at rest.
Below is a video about the fight against tooth wear, through the eyes of a specialist
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Pathological tooth wear can be eliminated in the early stages of manifestation. Therefore, at the first concern and signs of malocclusion, contact your dentist. Specialists will conduct full diagnostics, will advise and help you choose the best treatment option.
Abrasion is the process of loss of hard dental tissues. Tooth wear occurs both in the temporary and permanent dentition; both occlusal and proximal surfaces; both at reduced speed and at increased speed. Depending on the severity of this process, physiological and pathological abrasion are primarily distinguished.
Physiological tooth wear is adaptive in nature and occurs as a result of regular contacts of antagonist teeth. The process begins from the moment teeth enter occlusal relationships and, being slow-moving, continues throughout life. The adaptive moment lies in the fact that the teeth adapt to various movements of the lower jaw, causing the smoothness of its movements, reduces the load on the periodontium and helps to increase the integrity of the dentition.
Due to the impact of the contact points of antagonizing teeth on each other, platforms are formed in these places that increase the contact (or chewing) surface of the teeth, facilitating the sliding of these teeth, reducing the range of movements of the lower jaw and reducing the load on the temporomandibular joint.
Periodontal functions gradually decline over the course of a person’s life. This is caused by a decrease in the trophic abilities of the neurovascular component of the periodontium, which causes gradual atrophy of the alveolar bone, a decrease in the elasticity of the fibers and a change in the ratio between the intra- and extraosseous parts of the tooth. The tooth in the socket is a lever, and the larger its extraosseous part, the stronger the impact this tooth transmits to the periodontal tissue. Considering that there is a gradual loss of the bone part of the periodontium, the process should worsen over the years, even in people who do not have any pathological changes in the periodontium. But this does not happen normally. And it doesn't happen because physiological erasure hard tissues of teeth reduces the height of the extraosseous part of the tooth. Thanks to this, the ratio of intra- and extraosseous parts of the tooth remains constant, and the load on the periodontium is adequate for age.
In addition to the occlusal surfaces, the proximal surfaces of the teeth are also subject to natural wear. Interdental papillae also undergo atrophy and a decrease in their height over time. But due to the transition of point contact between teeth to planar contact, an increase in the area of this area and an approach bottom edge platforms to the gum, no gaps are formed between the teeth and the gum. This allows the body to carry out adequate self-cleaning of the oral cavity and preserves the natural appearance of the teeth. Also, an increase in the contact surface increases stability in the dentition, and its shortening is compensated by the medial displacement of the teeth.
Thus, we can make a well-founded conclusion that physiological abrasion is interdependent with the state of human health, an indispensable property of the human masticatory apparatus, contributing to the preservation of its functional and morphological integrity.
Pathological abrasion of teeth or, as it is also called, increased abrasion appears when tooth abrasion occurs according to a scenario different from physiological abrasion. With pathological abrasion, the process ceases to be slow, abrasion of other surfaces of the teeth occurs and, in addition to the enamel, dentin and, accordingly, the pulp of the tooth are involved in abrasion. Very often, pathological abrasion is accompanied by discomfort in the patient and the appearance of corresponding complaints, which almost never happens during a natural process.
At the moment when abrasion becomes a decompensated state, the height of the lower third of the face gradually decreases. This process is accompanied by dystrophic disorders in the temporomandibular joint, the appearance of pain in it and in the masticatory muscles, and decreased chewing function. Outwardly, this is manifested by the severity of nasolabial and chin folds, a decrease in the lower third of the face, protrusion of the chin, and the person acquires a so-called senile facial expression.
Further, due to the displacement of the lower jaw upward, it also shifts posteriorly. In this case, the breathing function also suffers. The volume of the oropharynx decreases due to the distal displacement of the jaw, and, accordingly, the ability to pass the required volume of air. A person reflexively begins to stoop, dystrophic disorders occur in the spine, and accordingly, primarily in the human musculoskeletal and nervous systems, as well as in the digestive, respiratory, cardiovascular and others.
According to various estimates, due to dysfunction and condition of the masticatory apparatus and the changes described above, a decrease in human life expectancy can occur by 15 years or more. Against this background, smoking becomes harmless entertainment.
The causes of pathological tooth wear are very diverse. All of them can be combined into the following groups.
Resistance to abrasion in teeth depends on the processes of calcification of hard dental tissues in the pre- and post-eruptive periods. The leading role in the processes of mineralization is occupied by the neurohumoral regulation of the body. The usefulness of the function is especially important parathyroid glands, responsible for the balance of calcium and potassium in the body.
Capdepont–Stanton syndrome
Disorders of amelo- and dentinogenesis
Pathology can be caused or aggravated in cases where there are defects in the dentition and parafunction of the masticatory muscles. Missing teeth assign their functions to the remaining teeth, and, accordingly, to their periodontium, causing its functional overload. Due to this, the adaptive capabilities of the supporting apparatus of the tooth are reduced, unable to compensate for the decrease in the height of the lower third of the face. With pathological abrasion, secondary cement is deposited on the surface of the tooth root, restructuring in bone tissue alveoli and deformation of the periodontal fissure.
At the same time, a decrease in height may be accompanied by parafunctions of the masticatory muscles, manifested in the form of bruxism, hypertonicity, etc. A decrease in altitude will certainly lead to dystrophic changes in the temporomandibular joint. Since these processes are interconnected, a so-called “vicious circle” develops, when each of its elements aggravates the other and the entire process as a whole. In this case, establishing cause-and-effect relationships and creating prevention and treatment plans becomes very difficult.
Increased abrasion can also be caused by iatrogenic factors, for example, the high hardness of some ceramic materials used in prosthetics and poor-quality polishing of restorations. Even in cases where the hardness of materials does not exceed the hardness of tooth tissue, their aggressive surface turns out to be incomparable with the endurance of enamel, and even more so, tooth dentin.
If it is often not difficult for a doctor to distinguish a physiological process from a pathological one, then the manifestations of pathological abrasion are very diverse and require classification and specification in each specific case. Therefore, the classification of pathological tooth abrasion is as follows:
Physiological abrasion always occurs within dentin, but in at a young age increased abrasion of only the enamel along with the etiological factor can be diagnosed by a doctor. Dentin wear is characteristic feature pathological abrasion. Dentin involvement may cause hypersensitivity and changes in the pulp, such as deposits of replacement dentin, narrowing of the lumen of root canals up to obstruction of the canals and pulp atrophy and the formation of calcifications (denticles) in the tooth cavity.
In the absence of other factors contributing to periodontal disease, pathological abrasion is rarely accompanied by changes in the supporting apparatus of the tooth. This is due to a decrease in the extraosseous part of the tooth and a decrease in the length of the lever, which reduces the load on the periodontium when the teeth are loaded.
With the horizontal form of abrasion, there is a loss of hard dental tissues in the horizontal plane with the formation of horizontal abrasion facets. The process most often occurs both on the bottom and on upper jaw. The vertical type of abrasion is most characteristic and obvious on the frontal group of teeth: on the palatal surface of the upper frontal teeth and the labial surface of the antagonists, which is determined by occlusal relationships. However, with, for example, a progenic relationship between the jaws and dentition, wear facets on the upper frontal teeth are observed on the labial side and on the lingual side of the antagonists.
Forms of increased tooth abrasion: a - horizontal; b - vertical; in - mixed
The dentofacial system has relatively high compensatory capabilities. Following the loss of hard dental tissues, a restructuring of the alveolar process of the jaws occurs and the teeth are displaced into the area of the defect or the area of absence of occlusal relationships. The so-called dento-alvelar lengthening, or the Popov-Godon phenomenon. Depending on the degree of such restructuring, pathological abrasion of teeth is differentiated into compensated, when tooth displacement prevents a decrease in the height of the lower third of the face, and decompensated, when compensatory restructuring is not able to fully eliminate the defect or is completely absent.
Localized abrasion is more often observed in the frontal part of the dentition, for example, with a deep bite. This type of abrasion is also locally compensated by the body due to local hypertrophy of the alveolar process. In this case, the support points of the height of the lower third of the face falling on chewing teeth, remain intact, without disturbing the occlusal relationships and the position of the elements of the temporomandibular joint.
In the generalized form of the process, the crowns of all teeth are captured, with a violation of the bite height. In this case, the degree of compensation depends on the individual characteristics of the organism.
The article was written by N.A. Sokolov. Please, when copying material, do not forget to provide a link to the current page.
Teeth wear updated: February 25, 2018 by: Valeria Zelinskaya
From the very moment of teething, gradual grinding of the upper layers of hard tissue begins. This is a completely normal physiological phenomenon that continues throughout life. But sometimes under the influence of some internal or external factors, habits or other reasons, teeth begin to wear out faster. Today we will tell you what pathological tooth abrasion is, why enamel wears off and how to restore an ideal appearance with the help of modern dentistry.
Even children's teeth wear down very slowly. This is a natural process necessary for the body in order to adapt to the loads on dental system, distribute them evenly. So partial dental abrasion is not a critical problem. Thanks to this, the dentofacial apparatus is not overloaded in certain areas, and the periodontium does not suffer.
Partial abrasions slowly lead to a change in contacts when closing the jaws from point to planar. Even the inclination of the teeth may change. Normally, only a certain amount of enamel in the area of the contact planes is worn away without affecting the dentin. This happens gradually from birth to old age.
If physiological processes accelerate, then this is pathological abrasion of teeth. It is accompanied by unpleasant symptoms and requires serious recovery.
Increased tooth wear can be caused by dozens of factors. Only a doctor can determine why the enamel on the teeth is worn away based on a visual examination and a detailed conversation with the patient. We can only give a list of the most common reasons.
As you can see, probable causes so many. Therefore, only a qualified doctor who knows the classification of pathological tooth abrasion will be able to find out why the acceleration of natural processes occurred in your case.
Pathological abrasion of teeth never goes unnoticed, as patients begin to notice a number of very unpleasant symptoms, accompanying worn-out enamel.
Pathological abrasion of teeth, depending on the intensity of damage, is divided into four stages. Each of them requires specific treatment.
Depending on the location, only a few teeth or the entire row can be damaged. The form of abrasion can also be different: horizontal, vertical, patterned, cellular, faceted, stepped or mixed.
Increased tooth wear requires detailed diagnosis in order to determine what to do and which ones to choose. therapeutic measures to fix the problem.
Based on the findings, the doctor may prescribe additional research to determine the cause of the problem.
Depending on the nature and degree of the pathology, treatment for tooth abrasion will vary. Overall it's quite complex process due to the fact that there can be many reasons that cause rapid erasure of enamel. In each individual case, treatment will be selected individually, based on the identified causes, the nature and extent of the disease, and the characteristics of the patient himself. First of all, they try to eliminate the reasons that could lead to this unpleasant phenomenon. This may require:
In any case, measures are taken to strengthen the enamel by treating them with fluoride-containing preparations. Before proceeding directly to the treatment of increased tooth wear, carefully smooth out all sharp edges so that they cannot injure the mucous membranes of the cheeks, tongue and lips. After this, depending on the degree of the disease, appropriate treatment is prescribed.
On initial stages after eliminating the root cause, they establish metal-ceramic crowns. In some cases, teeth are restored not with crowns, but with composite materials. But if the root cause is not eliminated, the enamel will continue to wear off. On late stages Prosthetics are also used, but in combination with orthodontic treatment, thanks to which the correct bite is restored.
Throughout the entire treatment period, it is often recommended to wear special mouth guards that will create the desired bite height. After dental prosthetics, all tissues that take part in the chewing process must get used to the new position: the temporomandibular joint, muscles, and periodontium.
If you have pathological tooth wear, then you will not completely stop it, but you can quite slow down this process if you carefully monitor your health.
Even if you have a predisposition to increased enamel wear, you can very well slow down this process and maintain healthy teeth. The main thing is to contact your dentist in time. In conclusion, we recommend that you watch an informative video in which a specialist will talk about this pathology.
Beautiful teeth are nature's best reward. But what to do if the enamel begins to thin out? Most likely, your dentist will joke that this happens to everyone. However, when the problem becomes noticeable not only to you, real panic begins, because no one will put up with the fact that their teeth are simply “melting” every day.
Tooth wear is not always negative. For example, physiological abrasion is adaptive process associated with changes in the periodontium. It is needed to improve chewing of food and prevent overload of teeth. Pathological form characterized by an earlier and significantly more pronounced course.
A decrease in the volume of hard dental tissues is usually observed in people over 40 years of age, mainly in men. Less commonly, the pathology is observed in children and adolescents.
Except external signs, such as a violation of the anatomical shape of the crown, a decrease in interalveolar height, aesthetic changes in the face, periodontal damage, the problem may also be accompanied by physiological disorders. These include pain in the facial muscles, in the temporomandibular joint, frequent headaches, and discomfort in the neck. There may also be deterioration in hearing or vision, a characteristic crunch in the jaw joint, and impaired salivation.
Dentists identify 3 main groups of factors:
Increased acid exposure due to certain gastrointestinal diseases (for example, Achilles gastritis), enamel sensitivity, occupational health hazards (work in chemical production), frequent consumption of very hard foods, and use of low-quality toothbrushes.
Incorrect bite, partial adentia (absence of some teeth), peculiarities of chewing food, production of low-quality dentures, medical errors during prosthetics or filling, bruxism (grinding teeth in sleep).
According to localization, erasure can be horizontal, vertical or mixed.
According to the flow of the process, they are distinguished:
Bracco classification (degrees of pathology):
It is very important to stop the progression of the pathology, and for this the doctor must find out individual reasons its occurrence. To restore the anatomical shape of already worn-out crowns, veneers, inlays, and crowns are used. To increase the height of the bite, filling is performed with metal ceramics or photopolymers.
If one or more teeth are missing, it is advisable to undergo dental implantation or removable dentures.
At malocclusion you should definitely go through the full orthodontic treatment(as a rule, vestibular brace systems are used for this). If you are worried about bruxism, then everything is much simpler - the dentist will make a special mouth guard that you will need to wear at night.
In case of increased exposure to acid on the enamel, it is recommended to rinse oral cavity soda solution.
The best prevention of increased enamel abrasion is proper nutrition, refusal bad habits and, of course, regular dental checkups. You can choose a competent specialist on our website. We have collected a complete database of dentists.
Dental health is the most important component of overall health human body generally. Today this dogma is known even to a young child. Modern life is much more demanding than 100 or even 50 years ago. Bad ecology, poor-quality nutrition, constant stress - the main causes of many diseases and early mortality among the population - do not allow us to be negligent about our own health in general and force us to carefully monitor the condition of the oral cavity in particular. And the latest developments in the field of dentistry, which have made the process of dental treatment absolutely painless, have turned a dentist from worst enemy V best friend, which will help, cure, correct, or simply answer a question of interest about, for example, why teeth wear out.
In addition to influencing general condition health, teeth play an important aesthetic role in the life of every person. Modern life is so demanding that bad breath caused by tooth decay or a damaged tooth can cause setbacks in your career or personal life. However, caries is not the only dental scourge modern man. Very often today, many of us wonder what to do if our teeth wear out? After all, unaesthetic yellowish spots and stripes on chipped enamel can also serve as a reason for refusal to provide a workplace, for example. In addition, such manifestations of tooth wear will sooner or later lead to painful sensations that will certainly ruin your quality of life.
It should be noted that the problem of tooth enamel abrasion in lately became dramatically younger. If previously it was mainly 40-50 year olds who went to the dentist with such complaints, today you can often find teenagers and even children with signs that the enamel on their teeth has worn away. And in older people, such processes occur much faster than before. The reasons for this trend lie in the same pace of modern life. There are several reasons why teeth wear out:
It's no secret that preventing any disease is much easier than restoring lost health. The problem of erasing tooth enamel is no exception. Stick to the simple ones preventive measures, and you will never encounter such trouble:
At the first signs that the front teeth are wearing away (this is the most noticeable) or the appearance of any other symptoms characteristic of problems with tooth enamel abrasion (yellow spots on the surface, hypersensitivity), you should immediately consult a specialist. Modern dentistry offers several methods for restoring teeth damaged as a result of such a misfortune:
The use of composite materials is the simplest and cheapest method of restoring damaged enamel. However, over time they may change color. This is their main drawback. Using ceramic veneers will provide you with durability and preservation of the original color, but this method is much more time-consuming and expensive. Prosthetics ceramic crowns used for serious damage when both of the above methods are unable to help.
