Increased abrasion of hard dental tissues. Pathological (accelerated) tooth wear: causes and consequences

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 purpose, 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

What causes tooth wear?

Increased tooth wear may occur as a result of overload after tooth loss, if incorrectly selected teeth turn out to be harmful effects related to professional activities, as well as in case of 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 the 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. from this kind pathological phenomenon often required by those with Stainton-Capdepont syndrome and endocrine disorders.

Pathological abrasion, typically can be caused by a pattern of chewing that places excessive stress on certain teeth (groups of teeth). As a result of this impact, complications arise:

periodontium,
pathological abrasion due to lack of functionality of hard dental tissues.

It is not uncommon for individual teeth to wear away, which antagonize teeth filled with composite materials. As a rule, due to the abrasive properties of such materials, fillings begin to protrude, affecting neighboring teeth, subjecting them to wear.

When should treatment begin?

In the early stages, pathological abrasion of teeth manifests itself as a decrease in the occlusal height of the teeth. As a rule, the patient does not experience any discomfort or unpleasant sensations. However, treatment is necessary to prevent progression of the process. Depending on the degree of advanced pathological abrasion, the treatment plan may differ according to individual needs and the 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:

metal crowns can wear out over time
can move into the gingival pocket, destroying the circular dental ligament,
can cause chronic inflammation of the marginal periodontium of teeth if the circular ligament is damaged.

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 them anatomical shape With vestibular side, treatment is prescribed using tabs. This material covers the worn occlusal surface. In this regard, tabs can be of various shapes. Areas for strengthening inlays can be:

retention pins,
pits in dentitis,
cavities affected by caries.

For minor abrasions, treatment can be carried out using artificial crowns of all types.

If the patient has pathological increased abrasion sank 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:

front
chewing right
chewing lefts.

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 detailed video about tooth wear :

Crowns as a way out

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.

Restoration and normalization of the dental system

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:

normalize the occlusal height,
establish occlusal-articulatory relationships between rows of teeth,
restore the functioning of the neuromuscular system,
relieve the temporomandibular joint from overload, as well as eliminate complications.

To do this, at the first stage, the doctor restores the functioning of the temporomandibular joint and muscles by returning to normal mode interalveolar height. 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 according to different methods. Each doctor chooses a technique depending on the specific case.

If a patient has increased pathological abrasion of teeth that has formed big 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 with increased pathological abrasion, the doctor can use both conventional stamped crowns and crowns with a soldered or cast onlay designed for chewing surfaces 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.

Manufacturing of metal-ceramic crowns

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 the 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 core inlays, since increased pathological abrasion of teeth at 2/3 or more of the length of the crown significantly reduces the volume 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 there is no possibility of using root canals for such teeth.

Orthopedic treatment - nuances

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 functional load, which occurs in the area of worn teeth. Thus, there will be enough space for the prosthesis after 3-4 months. Dental treatment for mature patients is not performed 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 :

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.

Teeth wear is a pathological process characterized by a decrease in upper layers crown of the tooth and a decrease in the height of the elements of the dentition.

This leads to increased sensitivity, changes in the shape of the coronal part and disruption of occlusion. Increased tooth wear requires immediate treatment.

Physiology

Abrasion of hard dental tissues is diagnosed in 12% of patients. The risk group includes men, since most often they have bad habits, and professional activity associated with being in harmful conditions.

The degree of abrasion depends on the age group:

Surface of teeth by age thirty limited only to the enamel and does not affect dentin, which is normal condition body.
By fifty dentin injury is established, as a result of which the molars become yellowish or brown tint. This leads to painful sensations and large changes in the shape of the teeth.
At the age of 60 There is a strong change in the front teeth, and by 70 the pathological process may affect the crown. Often the contours of a cavity are visible, which is filled with tertiary dentin.

But, in some cases, abrasion of the upper layers of the surface of the elements of the dentition is noted in at a young age. If this problem exists, treatment is required.

Reasons

There are several reasons for tooth wear. Changing the shape of units can occur against the background various diseases or when exposed to external factors.

The causes of pathological abrasion include:

The pressure on the teeth may be distributed incorrectly due to the absence of some units.

Bruxism. A disease characterized by grinding sounds. Most often, patients are not aware of the presence of pathology, since uncontrollable grinding of teeth appears at night.

Profession. Workers in certain professions are forced to be in hazardous conditions when performing their job duties.

Constant exposure to chemicals and toxic substances negatively affects the condition of the skin and surface of the teeth, destroying their structure. Wear of enamel and dentin occurs much faster.

Insufficient tissue hardness. With certain diseases of the oral cavity, deterioration of the upper layers of teeth is observed. The enamel becomes thinner, as a result of which it begins to wear off faster.

Systemic pathologies. Pathologies such as metabolic disorders and the functioning of the endocrine system can reduce the resistance of hard tissue. They have a negative effect on tissue structure.

Abnormal bite. If the jaws are not positioned correctly, rapid wear of the edges of the incisors and canines is observed.

Poor nutrition. Eating carbonated drinks, sweets, flour products and hard foods causes deterioration in the health and condition of tooth enamel.

Drinking alcohol and smoking. Nicotine and alcohol have a negative impact primarily on enamel, causing the development of caries and other oral diseases.

Bad functional habits. These include holding in the mouth foreign objects eg pens, toothpicks, fingers. As a result, cracks and chips appear on the enamel.

Use of certain groups of medications. Preparations based on hydrochloric acid lead to destruction of enamel and dentin.

Pathological abrasion is established in people whose professional activities involve lifting heavy objects. This is due to the tight closure of the jaws when performing work.

Areas of application, their alloys, characteristics, advantages and disadvantages.

Come in if you are interested in modern types of impression materials used in orthopedic dentistry.

At this address we will tell you about the technology for making porcelain crowns.

Symptoms

With pathology, tooth sensitivity first increases. Discomfort and pain occur when consuming hot and cold foods or drinks. Associated symptoms also include:

Painful sensations. They can be sharp, strong, and appear at night.
Bite change as a result of reducing the height of the crowns.
Soft tissue injury. Small chips and sharp edges of teeth can damage the lining of the gums and oral cavity.
Feeling of sand in the mouth. Most often occurs in the morning.
Dysfunction temporomandibular joint.
Reducing crown height teeth to varying degrees.
Spread of caries.
Increasing the gaps between elements of the dentition.

At the initial stage, the symptoms are not pronounced, but over time they become more aggressive.

The patient feels pain carious lesion spreads to unprotected areas, and other oral diseases develop.

Classification

Dentists highlight physiological appearance pathology, when the process of tooth wear is natural, and pathological, provoked by lifestyle and the influence of various factors.

Depending on the plane of abrasion of enamel and dentin, several forms of the disease are distinguished. These include:

Vertical. Diagnosed in patients with abnormal bite. Only subject to erasure outer surface teeth.
Horizontal. There is a decrease in crown height.
Mixed. It is characterized by the presence of signs of vertical and horizontal shape.

There are also stepped, patterned, cellular and feticular types of abrasion. Depending on the complexity of the pathological process, the following are distinguished:

Local abrasion. The process of enamel destruction affects only a certain area and does not spread to other areas.
Generalized. The entire surface is susceptible to injury.

Stages

In medicine, there are four stages of tooth wear. Each of them is characterized by the presence of certain lesions and symptoms.

1st degree. Only the enamel is injured. Dentin is not subject to change. Increased sensitivity and discomfort when eating food occur.
2nd degree. The enamel is completely erased, dentin is exposed. Patients often complain of increased pain.
3rd degree. The dentin is completely erased, the pathological process affects the crown. When talking or eating, the cavity of the element is visible. The third stage is also accompanied by severe pain, changes in bite, and dysfunction of the TMJ.
4th degree. The tooth is worn down to the neck. In this case it is required urgent treatment, since the function of the dentition is impaired, the load is not distributed evenly, which leads to the development of many oral diseases.

Diagnostics

First of all, the doctor determines the presence of symptoms, conducts an examination of the oral cavity, and examines the medical history. To some extent this helps to determine the cause this state and establish the form and stage of the disease.

The following diagnostic methods are also carried out:

Study of symmetry, proportionality, external examination. Necessary for analyzing the degree of destruction, level of abrasion, condition of hard and soft tissues, identifying complications and determining the method of treatment.
Electromyography. Appointed for research purposes masticatory muscles.
Examination of the temporal and mandibular joints. Helps determine the presence of various concomitant pathologies.
Electroodontodiagnostics. Indicated when establishing the second and third degrees of abrasion. It is carried out to identify the presence of unaffected pulp.

Only comprehensive diagnostics helps to establish a correct diagnosis. Data driven various studies the doctor determines the degree, form and type of the disease, and also determines the treatment regimen.

Treatment options

The treatment method depends on the stage of tooth wear. At the initial stage it is used conservative therapy and patients are prescribed medications to improve the condition and strengthen tooth enamel.

In order to avoid further damage, together with medicines wearing a mouthguard is indicated. It will protect your teeth from further destruction.

Most often, when pathology is diagnosed, restoration of the dentition is required. For this, various materials are used, for example, acrylic, cement with silver ions or gold.

For significant lesions and changes in shape, treatment involves the following methods:

Installation of crowns. The main material is metal ceramics. It is strong enough, and the restored tooth will not differ from natural organs.
The crown completely covers the problem element and helps reduce the load on it. Cast crowns made of gold, ceramic or zirconia can also be used.
Stump inlays. The treatment method is used for large lesions. The doctor expands the root canal and installs a pin. This significantly reduces the time required to restore the affected unit.
Microprosthetics. Modern technology involving the use of veneers and inlays. They are used in cases where it is not possible to fill a tooth or almost all dentin is missing.

The choice of treatment method depends on the degree of tooth decay, shape and type of disease. The materials used for restoration can be different and used depending on the tasks, function and financial capabilities of the patient.

Prevention

To reduce the risk of pathology and slow down the process, it is recommended to follow a number of simple rules:

eliminate the consumption of alcoholic beverages, coffee, quit smoking;
limit the intake of solid foods, sour, sweet foods and flour products;
include foods high in calcium in your diet;
get rid of bad habits;
promptly treat all oral diseases;
Maintain hygiene, brush your teeth daily, use dental floss.

Following the rules of prevention will help slow down the development of pathology. If symptoms occur, you should immediately contact a specialist.

Price

When diagnosing pathological tooth abrasion the cost of treatment directly depends on the method of restoration, material used and degree of damage:

The most expensive is ceramics(from 20,000 rubles) and zirconium dioxide (from 40,000 rubles).
Plastic is considered the cheapest, but unreliable. Its cost varies from 400 to 700 rubles.
Price for stump inlays starts from 5000 rubles. The cost depends on the material and manufacturer.
Microprosthetics- a complex and labor-intensive process, the price of which starts from 6,000 rubles.

From the video, learn about the most common causes of increased tooth wear and methods of getting rid of the problem.

We all know that teeth are a reflection of the body, however modern world cruel, and the environment does not affect the condition of the teeth in the most in the best possible way. Constant stress, irregular sleep, poor nutrition, all this has a detrimental effect on the body and even leads to early mortality, all this makes us think about our health and the condition of our teeth. Modern technologies have stepped far forward, and if 50 years ago the word “dentist” evoked quiet horror, now this doctor does not cause any fear, since latest technologies allow you to treat teeth almost painlessly. Today, fewer and fewer people are afraid to go to dentists, not only for consultations, but also for dental treatment. Recently, quite often, dentists are approached with the problem of teeth abrasion, but how does this happen and how to deal with such an unpleasant situation? Today, in order to be successful you must have beautiful smile, A bad smell from the mouth or a decayed tooth may interfere with climbing career ladder or cause unpleasant situations in personal life. However, an unpleasant odor is not the only problem of our time; dentists are increasingly being asked what to do if their teeth wear out?

Why do teeth wear down?

This problem has become much younger; if previously it was mainly 50-year-olds who addressed similar issues, today you can even find teenagers with worn-out enamel. The whole point is that modern man I’m used to a variety of sweet carbonated drinks and candies, and they contain quite a lot of acid, which gradually destroys the structure of the tooth. It is increasingly observed that in stressful situation people clench their teeth tightly, which is also one of the factors in the rapid wear of teeth, and often this same stress is transferred to sleep and then the person grinds his teeth in his sleep.

However, you should not immediately give up delicious drinks and sweets and drink handfuls of sedatives. It will be enough to drink acidic drinks not from a glass, but through a straw, and in a stressful moment control yourself as much as possible. If you work in production, then you should use protective equipment, for example, respirators, which will prevent abrasive particles from getting into the oral cavity, but if the production involves acids, then you need to regularly rinse your mouth with a soda solution. And of course, visiting a qualified dentist increases the chances that the problem of teeth wear will affect you as late as possible. Therefore, if your teeth wear out, go to the doctor immediately.

stomatologforall.ru

All about pathological tooth wear

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 the enamel wears off and how to restore the ideal appearance with the help of modern dentistry.

Physiological aspect

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 the 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.

Until the age of 30, the front teeth wear down slightly, the cusps of slightly worn premolars and molars become smoother.
By the age of 50, only the enamel wears off without damaging other tissues.
In old age, the situation becomes more serious - you will erase not only fragments of enamel, but also dentin. Sometimes the dentin itself can be damaged.

If physiological processes accelerate, then this is pathological abrasion of teeth. It is accompanied by unpleasant symptoms and requires serious recovery.

Why do teeth start to wear out faster?

Increased tooth wear can be caused by dozens of factors. Only a doctor can determine why the enamel on 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.

Poor bite – teeth begin to wear away due to uneven load. The most negative impact is from a direct and deep bite.
Loss of several teeth, leading to uneven distribution of the load.
Bruxism – involuntary contraction and grinding of teeth mainly at night.
Incorrectly performed prosthetics.
Professional costs. For example, if a person works in production with constant contact with acid or in rooms with polluted air a large number abrasive particles.
With some diseases, the enamel becomes soft, so the teeth can wear away much faster.
The presence of a hereditary factor cannot be ruled out.
If the enamel on your teeth has worn away prematurely, this may indicate some systemic diseases. This happens when you get sick endocrine gland, central nervous system, frequent or constant intoxication.

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.

What are the symptoms?

Pathological tooth wear never goes unnoticed, as patients begin to notice a number of very unpleasant symptoms, accompanying worn-out enamel.

The edges of the teeth are destroyed, forming very sharp forms, constantly damaging the delicate membranes of the mouth and tongue.
The teeth become shorter, which inevitably leads to malocclusion. The contours of the lower part of the face may also change.
The position of the TMJ changes, often leading to various injuries or simply painful sensations in this area.
Attacks of toothache can occur from any irritant: cold, hot and spicy food, or minor mechanical impact.

Stages of pathology development

Pathological abrasion of teeth, depending on the intensity of damage, is divided into four stages. Each of them requires specific treatment.

At the first stage, there is not very strong abrasion of the enamel and a small part of the dentin. The enamel is mainly damaged on the front teeth, canines, cusps of molars and premolars.
At the second stage, the chewing mounds are completely erased. This exposes dentin tissue, but without creating cavities.
At the third stage, the height of the crown decreases by a third of its original volume. The replacement dentin tissues are damaged and the dental cavities begin to show through.
In the fourth stage, the entire dental crown is completely worn away.

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.

Diagnostic methods

Increased tooth wear requires detailed diagnosis in order to determine what to do and which ones to choose. therapeutic measures to fix the problem.

First of all, the dentist will assess the condition of the enamel, the degree of reduction in its volume and dentin.
This will be followed by checking the operation of the TMJ.
The skin, nasolabial folds, mucous membranes of the tongue and cheeks will be examined. It is necessary to palpate the masticatory muscles to identify possible soreness.
The position of the jaws is checked central occlusion and symmetry of mouth opening.
The doctor will ask you to clench your teeth in a central position to listen to the sound that is heard at this moment. A creaking will tell him about the degree of dysfunction of the temporomandibular joint, a dull and prolonged sound - about problems of a different nature. Normally, a ringing, clear and short sound should be heard.
Hypersensitivity of teeth almost always indicates pathological abrasion.

Based on the findings, the doctor may order additional tests to determine the cause of the problem.

Treatment methods

Depending on the nature and degree of the pathology, treatment for tooth abrasion will vary. In general, this is a rather complex process due to the fact that there can be many reasons for the 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:

correction of malocclusion;
carrying out complete reorganization oral cavity with treatment for all concomitant diseases;
prosthetics for damaged teeth;
treatment of bruxism using special mouthguards;
if the disease is associated with working conditions, then it is recommended to change professional activities.

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.

In the initial stages, after eliminating the main 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.

How to prevent pathological abrasion?

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.

Contact your dentist promptly if you experience hypersensitivity teeth, pain in the temporomandibular joint and other unpleasant symptoms.
Periodically carry out the procedure of strengthening tooth enamel with fluoride-containing preparations.
If you have even minor malocclusions, contact an orthodontist to correct them.
If you lose a tooth, do not hesitate to install a denture. This will help avoid malocclusion.
Don't ignore bruxism. This is a disease that requires compulsory treatment and wearing special mouth guards.

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 see a dentist in time. In conclusion, we recommend that you watch an informative video in which a specialist will talk about this pathology.

tvoibreketi.ru

Classification and symptoms of pathological tooth wear - treatment and prevention of increased wear

A person’s health, as well as his attractiveness, largely depend on the condition of his teeth. Nowadays, dentists are increasingly diagnosing pathological tooth wear. The risk group includes men over 30 years of age, but no one is immune from developing the disease. If the doctor has detected increased abrasion, the disease cannot be ignored, as it can lead to tooth loss. Why does the abrasion process develop? What to do if symptoms appear? How to stop grinding and prevent abrasion of dental elements? Let's figure it out together.

Symptoms of pathological tooth wear

Pathological abrasion of teeth makes itself felt nearby characteristic symptoms. If the patient ignores the signs of the initial stages of pathology, then over time the situation worsens, and restoring dental health becomes much more difficult. The main symptoms of pathological abrasion:

frequent “biting” of the cheeks and lips from the inside;
pain while eating;
change in the lower part of the face (if the maximum degree of abrasion has developed, it decreases);
with serious abrasion, the chewing process and speech are disrupted;
if you clench your teeth, the patient will feel as if the jaws are “stuck together”;
the patient feels that due to abrasion, the surface of the tooth has become rough;
the shade of the enamel changes;
sensitivity to temperature and subsequently chemical irritants increases;
observed wedge-shaped defect(increased tooth wear is sometimes accompanied by this symptom);
pathological changes in the jaw joints and facial muscles develop.

Causes of pathology

Tooth wear can develop due to the influence of various factors - both external and internal.

READ IN DETAIL: How can you get rid of grinding your teeth in your sleep?

Increased tooth wear caused by internal causes is considered more dangerous and more difficult to treat. Sometimes dental elements are worn down due to congenital reasons. In cases where the wear of dental elements becomes a consequence pathological changes in the body, the disease is usually detected in early age. To the number endogenous causes include:

osteogenesis, marble disease and other hereditary diseases;
disruption of the process of mineralization and formation of hard tissues (due to a lack of vitamins and microelements in the mother’s diet during pregnancy or a deficiency of essential substances in the baby’s diet in the first year of life);
in adults, pathology can lead to increased tooth wear thyroid gland, unbalanced diet, insufficient absorption of calcium.

Methods for classifying tooth wear

There are several main ways to classify tooth wear. One type of classification is based on the form of the disease. There is local abrasion, when the process affects small areas of a row, and generalized, in which absolutely all the teeth in the jaw are abraded to one degree or another.

From the perspective of planes subject to erasure, the classification looks like this:

horizontal – during the process of abrasion, the height of the crown of the tooth decreases;
vertical abrasion - damage occurs to the back of the upper teeth and the front of the lower dental elements (usually due to malocclusion);
mixed - teeth are worn in two planes at the same time.

There is also a classification of the pathological process according to the degree of destruction of tooth tissue:

If the surfaces of several teeth (usually incisors) are slightly worn down, then we're talking about about stage I.
Stage II is characterized by almost complete destruction of the enamel and exposure of the dentin of the crown part of the tooth.
When the affected teeth are ground down by half or more and visualization open cavity, then stage III is diagnosed.
Stage IV is characterized by almost complete abrasion of the hard tissues of the tooth, which is destroyed almost to the base.

Diagnosis of the disease

To establish the causes, degree and form of tooth wear, the following diagnostic methods are used:

visual examination of the patient’s oral cavity;
survey - the doctor should inquire about lifestyle, clarify the presence or absence of metabolic disorders, hereditary diseases, ask questions about the specifics of work activity;
electroodontodiagnostics;
X-ray;
if necessary, identify serious illnesses palpation is often performed;
Additional consultation may be required narrow specialists, including a neurologist.

Treatment of the disease

You should be prepared for the fact that the process of treating tooth wear will be labor-intensive, time-consuming and require frequent visits to the doctor. You may have to visit not only the dentist, but also other specialists. Everything will depend on the characteristics of the course of the disease and the reasons that provoked it. IN general case The stages of treatment for pathological tooth abrasion will look like this:

stopping the process of tooth decay;
eliminating the causes of increased abrasion;
restoration of the protective layer of enamel;
return to the original level of the crown part of the teeth;
if necessary, replacement of the prosthesis;
adaptation to the updated position of the jaw.

Dental restoration can be carried out using various devices and techniques. The dentist will select the best option based on the individual characteristics of the patient’s jaw structure, as well as the course of the disease. These can be braces, dentures (temporary), mouthguards, inlays or other structures.

The initial height of the restored crown is higher than what the patient is accustomed to. For this reason, he is given several weeks to adapt. If the patient complains of pain that does not subside, the crown is ground down a couple of millimeters. The adaptation period is counted from the moment the pain is eliminated.

The doctor selects a prosthesis that the patient will use constantly only after the work of the masticatory muscles has been corrected and the jaw has “accustomed” to its new position. The best option Dentures are considered to be a fixed type. When installing a removable structure, the patient often takes it out and puts it in, which can disrupt the course of the therapeutic process.

Selecting the optimally suitable prosthesis is a task for a qualified and experienced doctor, since it is necessary to take into account many factors: from the state of the opposing dental elements to the facts of the presence of concomitant pathologies. For example, with constant high loads on the dentofacial apparatus, metal structures are more suitable, and if we are talking about chewing elements, then it is not recommended to use plastic.

Prevention of increased tooth wear

The main preventive measures aimed at prevention and early diagnosis dental diseases, remains to observe the rules of oral hygiene and regular preventive examinations from a specialist. In order to reduce the likelihood of developing pathological tooth wear, it is also recommended to follow the recommendations listed below:

giving up bad habits (if possible);
soda rinses for people who work with aggressive chemicals;
balanced diet;
regular intake of vitamin and mineral complexes;
protection of teeth with special devices - for those who work in conditions of high vibration or in hazardous work;
treatment of bruxism (for patients suffering from this disease);
urgent restoration of teeth lost for any reason;
correction of bite defects.

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Honestly, it was surprising to read the previous answer and realize that it was written by a dental technician. Most likely, it was written by an artist-pianist. How will the grinding of teeth “be interfered with by their natural height”? And what about the neighboring ones, aren’t they teeth? Don't they wear off? Or are only some teeth ground down, every other one, for example?)) The reason for my sarcasm is that my grandmother will soon be 82 years old, and her teeth have ground down... the upper ones, yes, about half (I’m talking about the front ones), but the lower ones are pits, and they are below the gums. We can say that, in fact, only the roots remain. And they didn’t chip, didn’t crumble, they just ground down, and I saw this whole process... over many, many years (more than 20) the teeth became shorter, shorter, shorter... then they became flush with the gums... and the process continues .. We have a small dental clinic, and Grandmother was constantly observed there and is still being observed.. Moreover, the upper teeth caused more discomfort - they made metal-ceramics, she does not want to do anything with the lower ones.. It is worth noting that the 5s, 6s, 7s were preserved better, it was the front teeth that were so sharply ground down. Let's talk about health? How to get rid of acne if you've already tried everything? Get an answer to your medical question How do biorhythms affect the quality of sleep?

A person’s appearance and overall health largely depend on the condition of the teeth and oral cavity. And if the doctor has discovered pathological tooth wear, the symptoms and treatment of which we will tell you more about, then such a problem should not be ignored.

Even caries malocclusion, darkening of the enamel and can become an obstacle to communication and provoke unpleasant sensations. As for the disease described, it can be either a symptom of more serious disturbances in the functioning of the body or the cause of new troubles.

What is pathological tooth abrasion and is this phenomenon normal?

In the course of normal life, the enamel surface is gradually worn away - from chewing, from age, and others. natural causes. Normally, by the age of 30, only the top of the crown and chewing tubercles can be worn away. And by the age of 50, the enamel on the teeth is almost completely worn away. True, the dentin is not affected. And yet, when the abrasion of the tooth surface reaches a critical and noticeable degree, it is worth visiting the dentist.

If the problem becomes delayed, long-term, without therapeutic intervention, then the consequences will be irreversible - deformation of the jaw will begin, pathology will occur in the functioning of the masticatory muscles, and even the pulp will die. The result is complete destruction or loss of a tooth or an entire row.

Sometimes physiological changes may appear that will be noticeable externally - folds around the mouth, the lower part of the face will decrease, the bite and normal color of the teeth will be disrupted. More severe damage will lead to complete removal of tissue right down to the gums.

Therefore, in a situation where teeth are worn out, you need to know exactly what to do. And the very first thing is to visit a doctor who can carry out correct diagnosis, establish the degree and type of disorders and select adequate treatment. If you see a doctor every six months or at the first unpleasant sensations, then you can prevent the problem from getting worse and restore your health in a short time.

Causes

To understand why it happened this pathology for a specific patient, you need to carry out full analysis his life activity and even learn about family diseases. After all, the reasons can be both external negative influences and internal health problems, as well as congenital or acquired characteristics.

The most dangerous and serious reasons relate to internal problems. The etiology and pathogenesis of the disease is established at a young age. These include:

From birth, the processes of formation and mineralization of hard tissues are disrupted. This can also happen during pregnancy, when the mother’s body does not have enough microelements to form the fetus. And also if these same vitamins are not enough for the full growth of teeth in the first year of a child’s life.
Hereditary pathologies such as marble disease, osteogenesis, etc.
Problems can also arise in later life - poor nutrition, thyroid dysfunction, low calcium absorption, etc.

External influence on dental tissue can be quite aggressive:

Heavy production, work in a factory or in a mine often leads to excessive abrasion due to vibration and tension of the masticatory muscles.
Bad habits as a factor in tooth decay.
Partial loss of units, installation of prostheses.
Bruxism, .

If it is possible to change bad habits or protect your teeth in some way from negative impact, then this should be done. In another case, all that remains is to restore the erased surface using artificial methods and try to stop the destructive process.

Photo

Classification of the disease

The classification of tooth abrasion is considered from several perspectives.

Depending on the extent of destruction of enamel or dentin, the degrees of the disease are distinguished:

I – the problem affects only a minor surface, most often the incisors.
II – the crown of the tooth is destroyed down to the dentin itself, almost no enamel remains.
III – the dental unit is worn away by half or even more. At clinical examination an open cavity is clearly visible.
IV – there is practically no hard tissue left. The destruction reaches all the way to the base of the tooth.

There are also different planes that have been erased:

Vertical - happens with an incorrect bite. With this option, the front of the lower and rear of the upper units are damaged.
Horizontal – the height of the crown decreases.
Mixed – parallel tooth decay in both planes.

The forms of the disease can be:

Local – only small areas of the dentition can be abraded.
Generalized - the process affects the entire jaw. However, the degree of damage in each part may vary.

In reality, the disease occurs in the most different forms and options. There are also combinations of several degrees of destruction throughout the jaw, and minimal ones in a limited area. There may also be an option to erase the surface in both horizontal and vertical planes.

The most dangerous situation is when the destruction reaches the inside. If the pulp dies and dentin is affected, the process becomes rapid and irreversible.

Symptoms

The more serious the damage to the dental tissue and the longer the patient ignores it, the more complex and noticeable the signs of the disease become. Among them are:

Increased sensitivity to, and subsequently a reaction to the chemical composition.
Changing the shade of enamel.
The patient feels the appearance of roughness on the tooth surface.
When squeezed, there is a feeling of stuck jaws.
As a result of more severe abrasion, speech and chewing problems may be noticed.
With maximum degrees of damage, the lower part of the face will change, it will seem smaller.
Pain appears while eating.
They often bite their lips and cheeks from the inside.

In some cases, it may appear that accompanies this disease or other pathologies of the oral cavity may arise. If you do not pay attention to tooth wear and do not correct the bite height in time, then pathology of the masticatory muscles and honest joints will occur.

Diagnostics

The doctor must establish contact with the patient to find out all the possible causes and concomitant diseases that led him to the problem. After all, only after understanding the whole picture can you correctly prescribe treatment. Sometimes, in addition to orthodontic manipulations, changes are necessary in other areas.

So, the following apply diagnostic procedures to establish the degree, cause and forms of tooth abrasion:

Questioning the patient about life, hereditary diseases, specifics of work and possible violations in metabolism.
Visual examination of the oral cavity.
Palpation of soft tissues and the entire jaw joint to identify serious pathologies.
Radiography and electroodontodiagnosis.
In some cases, consultation with a neurologist or other doctors is also necessary.

The main thing in the process of communicating with the patient is to attune him to the fact that the disease is a serious problem, and the entire healing process can be long and laborious, but it must be completed. After all modern methods corrections are available and give good results.

Treatment of pathological tooth abrasion

Only with the correct diagnosis is it possible to achieve complete healing. In this case it is important:

Stop the destructive process.
Be sure to eliminate the cause of the disease.
Restore worn enamel and restore the original level of crowns.
Replace dentures, if necessary.
Give the patient the opportunity to adapt to the new position of the jaw and its work.

Each stage can take a long time, and during this time the patient should often visit the dentist, especially if any unpleasant sensations appear.

In some cases, it will be necessary to visit another doctor at the same time. For example, if the disease has developed due to night grinding of teeth, then the neurologist is obliged to conduct targeted consultations to eliminate this psychological cause.

If the disease develops as a consequence of other internal problems, then they also need to be influenced. What exactly will have to be done during the treatment process will strictly depend on the patient’s health, the causes of tooth wear, and the degree and form of the disease.

Restoration of a damaged crown can occur using various devices:

Temporary prostheses or a special diagnostic and treatment device.
Permanent structures.
Stamped crowns.
Special caps, etc.

The treatment itself goes through the following stages:

Restores the height of the dentition. This can be done by raising the bite and using temporary dentures. If there is an incorrect position of the jaws as the cause of pathological abrasion, additional braces are installed. The whole process of selecting the right tabs, the right size and correction of the position of the jaws occurs with the help of a radiograph.
The adaptation period can last 2-3 weeks or longer. The fact is that initially the height of the crown is set much higher than what is usual for the patient. And if he notices increasing pain, then this height is quickly removed by 2-3 mm. When getting used to it, artificial crowns are built up again using special means. If the patient is absolutely unable, for some reason, to get used to and feel comfortable with the required bite height, then the doctor should make it as tolerable as possible. Only after the pain has been eliminated does the adaptation period begin.
When completely correcting the work of the masticatory muscles and getting the jaw accustomed to the new position, the doctor must choose suitable look prosthesis that will be used on on an ongoing basis. These could be options. In the first case, the patient may struggle with the problem for a long time, since frequent removal of the prosthesis will aggravate it rather than eliminate it. The best option is a non-removable design, since a person will not have the opportunity to disrupt the healing process.

When selecting dentures, it is important to take into account the material from which the artificial teeth will be made, as well as the method of their creation. There are many factors that influence the choice - the condition of opposing teeth, already installed implants or crowns, the presence of concomitant diseases, the degree of the problem, etc.

For example, it is not recommended to use plastic on chewing units with installed bridges. When creating permanent removable dentures You can choose porcelain or other materials, but always in cast form. If a person experiences constant increased load on the jaw apparatus, then the use of metal structures may be adequate.

Video: causes of pathological tooth wear.

Preventive measures

Whatever dental problem a person has, it is much easier to eliminate it if detected early. And for this you need to visit the dental office once every six months. In this case, the doctor will immediately detect the very beginning of the disease and help prevent the problem from getting worse.

If we are talking about the prevention of pathological tooth wear, then in addition to visiting a doctor and doing the right thing, you need to:

Correct the bite as soon as possible in case of malocclusion.
In case of removal or loss of teeth, immediately restore them with the help of dentures or implants.
Cure bruxism if you suffer from it.
In case of hazardous work or vibration during work, protect the dentition with special devices.
Proper nutrition and additional vitamin and mineral complexes will help replenish the missing microelements in the body.
When working with acids and other chemicals, be sure to rinse your mouth with a soda solution.
Give up bad habits whenever possible.

About increased abrasion

It has been established that pathological erasure is spreading more and more. Today this is already 12% of the world's population, and men suffer from this more often.

Already at a young age, wear of the enamel can be diagnosed and even part of the dentin can be affected, which leads to accelerated process destruction of hard tissues. Most often, this disease affects people aged 30 years and above, but there are also cases when a teenager’s teeth begin to actively wear out.

Additional questions

ICD-10 code

According to the International Classification of Diseases, it can be found under the number K03.0 as increased tooth abrasion. In this case, it is divided into approximal and occlusal.

Which doctor should I contact?

At the first signs of pathological or natural but excessive tooth wear, you should contact your dentist or orthodontist.

Tooth enamel is the hardest tissue human body. However, many people do not even suspect that their teeth do wear down and by the age of forty they have lost about a quarter of their original height. Unfortunately, in some cases this process goes much faster and can affect not only appearance, but also health. So, why do teeth wear down, how dangerous is this process and can it be stopped?

Natural process

In general, the process of tooth wear is completely natural. After all, teeth bear a significant load: when chewing and biting, the jaw can create a force of up to 20 kg, and during the day, when talking and clenching teeth, a load of up to 3 kg occurs. Since the enamel does not have living cells and cannot be restored, its layer is gradually erased. However, this process is quite slow and compensated, since the dentin located under the enamel is able to grow, and the teeth change their position over time.

Compared to enamel, dentin has a yellowish tint. Therefore, with age, as the enamel wears away, teeth often turn yellow.

The process of natural wear and tear begins immediately after teething and lasts for decades. Normally, teeth wear down by only 0.034 mm per year, while the thickness of the enamel is upper parts crown reaches 2 mm. Thus, if the process occurs naturally, you may notice changes in the teeth only after 50 years, when the wear of the enamel reaches the border with dentin.

At the same time, the rate of physiological abrasion of enamel is different people may vary significantly - it depends on factors such as:

hereditary strength of enamel and dentin;
correct bite and position of teeth;
nutritional features;
lifestyle.

Not only permanent teeth, but also baby teeth are subject to wear. Their protective layer is much thinner, so wear occurs much faster: by the age of 7, not only enamel, but also dentin can be worn away in children. As a rule, this process itself does not require medical intervention, but it is important for parents not to confuse tooth abrasion with carious destruction, so it is necessary to show the child to the dentist at least once every six months.

Pathological wear and its causes

Unfortunately, the process does not always correspond physiological standards. Dentists note that at least 12% of the population suffers from pathological wear of enamel. In some cases, you can notice signs of pathological wear even up to 30 years. This pathology is somewhat more common in people aged 30–40 years. And the peak occurs at the age of 40–45 years, and men suffer more.

Pathological tooth wear can be caused by a variety of reasons:

hereditary factor (insufficiency or special structure of hard dental tissues, disorders of mineral and protein metabolism, endocrine system);
non-physiological load on the teeth (missing one or more teeth, malocclusion, medical errors for prosthetics, low-quality prostheses);
bad habits: bruxism, the habit of biting nails or biting hard objects (pencils, pens);
unbalanced diet, deficiency of vitamins D and E;
diseases of the digestive system that cause increased acidity (achylic gastritis);
harmful effects on hard tissues (fluorosis, radiation therapy, taking certain medications).

Pathological abrasion of teeth: symptoms

With increased tooth wear, you can pay attention to a decrease in the height of the crowns of the front teeth or incisors, the appearance of irregularities and chips on them, or the smoothing of the chewing surfaces of the “molars” of the teeth. If the process is not stopped in time, further teeth will be erased to the contact areas (lateral contacting surfaces), and then to the gums.

In addition to the visual reduction of crowns, increased abrasion of the enamel makes itself felt with symptoms such as:

increased tooth sensitivity (occurs if the growth of replacement dentin “does not keep pace” with the rate of enamel abrasion);
yellowing of teeth (dentine becomes noticeable);
change in bite;
the appearance of sharp edges on teeth that can injure soft fabrics oral cavity;
pain in the facial muscles and temporomandibular joint (occurs due to excessive load on the jaw);
crunching in the jaw joint;
headaches;
aesthetic changes in the face (the lower part of the face is shortened, the corners of the mouth droop, the cheeks sag, which creates a tired and aged appearance).

Increased tooth abrasion can be localized or generalized:

in the localized form, individual teeth are affected, most often the anterior ones (although sometimes also found on premolars and molars);
in the generalized form, the process affects the entire dental arch.

With pathological abrasion of teeth, a kind of vicious circle is created. Changing the surfaces of the teeth requires more jaw force when chewing and biting food, and increasing the load, in turn, leads to even faster grinding of the enamel.

What to do if your teeth wear out?

If you notice signs of this unpleasant disease, you need to consult a doctor as soon as possible. The specialist will confirm the diagnosis based on visual and instrumental examination data and prescribe a panoramic image of the jaw or computed tomography.

Next, you will be offered therapy based on the causes of the pathology. For example, if the cause of tooth wear is bruxism (grinding teeth during sleep), the doctor will prescribe the use of special protective pads. In case of metabolic disorders, it will be necessary to take vitamins and mineral supplements. Problems that arise as a result of tooth loss are solved with the help of prosthetics and implantation. If main reason If your teeth are worn out prematurely due to malocclusion, you will need the help of an orthodontist.