Treatment of increased tooth wear. Physiological and increased wear of natural teeth

Teeth begin to wear out almost immediately after erupting. This is a natural process that allows all systems and organs to adapt to constant stress. Thanks to the physiological abrasion of teeth, the work of the entire dentofacial apparatus occurs evenly, without local overload and with normal periodontal activity. As a result of this natural process, there is a gradual change in contacts from point to plane, the angle of inclination of the teeth changes to make these contacts as physiological as possible. Physiological abrasion affects only the enamel, does not extend to dentin and is localized in the area of the contact planes of the teeth.

Baby teeth are just as susceptible to wear as molars. By the age of three or four years, the teeth of the incisors and cusps of the fangs and molars are worn away, and by the age of six, deep abrasion of the enamel is acceptable, up to partial exposure of the dentin. From the age of six until the complete change of teeth, which on average is completed by the age of thirteen to fourteen years, abrasion of the dentinal layer of milk teeth is permissible. Increased abrasion of primary teeth is diagnosed if the tooth cavity becomes visible or the entire crown is lost, which is indicated by degrees IV and V of abrasion.

Diagnosis of pathological tooth abrasion

If the crowns of your teeth wear down faster than the population average, this may indicate that you have increased, or pathological, tooth wear. During the examination upon consultation, the doctor not only assesses the condition of the enamel, the reduction in the volume of dental tissues and exposure of dentin, but also checks the functioning of the temporomandibular joint (TMJ), the skin, the condition of the mucous membranes of the cheeks and tongue, the severity of the nasolabial folds, and palpates the masticatory muscles for signs of soreness. The doctor checks the symmetry of the opening of the mouth and the position of the jaws in central occlusion. In addition, the lower part of the face is examined and its height is assessed. The sound heard when the teeth are closed in a central position is also diagnosed. Normally, this sound should be clear, sonorous and short, but if it is dull and prolonged, then there is a gradual movement of the teeth to a normal position after premature contact, while creaking indicates disturbances in the functioning of the TMJ or problems with the nervous system.

Tooth hypersensitivity is often considered the first sign of increased wear of tooth enamel. The severity of pain depends on the rate of enamel thinning, dentin abrasion, pulp reactivity, the rate of formation of secondary dentin, as well as the number of open dentinal tubules.

Causes of tooth wear

Among the causes of pathological abrasion of teeth, the central place is occupied by the presence of bad habits in a person, such as holding objects in the mouth (needles, paper clips, mouthpieces of pipes and musical instruments), love of seeds, consumption of drinks and foods with high acidity (citrus fruits, lemonades, vinegar and etc.), bruxism, expressed in the habit of clenching teeth during the day and grinding teeth at night. Increased abrasion of tooth enamel can be caused by taking certain medications, diseases of the gastrointestinal tract associated with the reverse release of stomach contents, reflux or frequent vomiting, diseases of the cardiovascular, endocrine, and nervous systems. In addition, pathological abrasion of hard dental tissues can be caused by the nature of the work: in metallurgical, granite, cement production, mining, and so on. Poorly manufactured orthopedic structures and malocclusion also cause wear. In this case, the antagonist tooth of the one that was restored with crowns or composite materials suffers.

Classification of tooth abrasion - degrees and forms

The most current classification of pathological tooth abrasion is considered to be that of the authors A.G. Moldovanov and L.M. Demner, who took into account the natural abrasion of dental tissues, which is normally up to 0.042 millimeters per year. As a rule, by the age of fifty it reaches the border of the enamel and more fragile dentin and makes it possible to diagnose the naturalness of the process if ten pairs of teeth interacting during chewing are preserved. In addition, an age norm was identified - there are three degrees of tooth abrasion:

First degree observed by the age of twenty-five to thirty and corresponds to the smoothing of the tubercles, as well as the cutting edges.

Second degree is achieved by the age of forty-five to fifty and reflects the wear of the enamel.

Third degree , as mentioned above, manifests itself by the age of fifty.

In Russian clinical practice, the Bushan classification has gained the greatest popularity. It distinguishes between physiological tooth wear (affects only enamel), transitional (enamel + dentin) and pathological, or increased (dentin), it also considers surfaces that have undergone changes (vertical, horizontal, mixed), the prevalence of the disease (limited or generalized) and emerging increased sensitivity of teeth.

Treatment of tooth wear

If you have been diagnosed with tooth wear, what should you do? Depending on the complexity of the individual case, the doctor may offer one of two options for treating tooth wear: therapeutic or orthopedic. The first is the application of drugs to strengthen enamel and dentin, as well as reduce tooth sensitivity. These are all kinds of pastes, gels, solutions and foams, as well as desensitizers and dentin adhesives. This also includes dental restoration, which involves restoring the dental surface with composite materials.

In orthopedic treatment of pathological tooth wear, the doctor selects prostheses: crowns, bridges, removable and fixed dentures, which will adjust the height of the bite and stop the progression of the disease. It is especially important to choose the right dentures when there is increased abrasion as a result of the absence of molars and premolars in a row. Such cases lead to the fact that the entire dentition changes position, incisors and fangs are worn out, the temporomandibular joint suffers, and hearing loss is observed. Properly reproduced dentures help preserve the dentition and prevent the development of associated complications.

Mouth guards for tooth wear

If the disease progresses significantly, it is necessary to restore the bite height before installing permanent crowns, otherwise the treatment will not be effective and the dentures will have to be restored after a short period of time. During the adaptation period, which usually lasts three months, all tissues involved in chewing get used to the new bite height: muscles, periodontium, temporomandibular joint. Making a mouth guard against tooth wear during bruxism is a method that significantly slows down the process of destruction.

Tooth wear is a process that affects all people. However, if abrasion becomes excessive, you should definitely consult a doctor, since the consequences of this disease lead not only to aesthetic problems. Improper muscle function leads to dislocation of the temporomandibular joint, which can cause headaches, loss of hearing and vision. And the inability to chew food well is fraught with gastrointestinal diseases. Therefore, do not neglect regular preventive examinations with a dentist, especially if your relatives have experienced increased tooth wear.

– rapidly progressive loss of enamel and dentin with a decrease in the height of the crown of individual or all teeth. Pathological abrasion of teeth is accompanied by a change in the anatomical shape of dental crowns, increased sensitivity of teeth, impaired occlusion, and dysfunction of the temporomandibular joint. Pathological abrasion of teeth and its severity are determined during a dental examination, study of diagnostic models of jaws, electroodontodiagnosis, targeted radiography and orthopantomography, electromyography. To treat pathological tooth wear, mouthguards, fillings, inlays, crowns, and veneers can be used.

General information

Pathological abrasion of teeth is an intensive decrease in hard dental tissues, exceeding the physiological abrasion of enamel and dentin and leading to morphological, aesthetic and functional disorders. In dentistry, pathological tooth wear is diagnosed in 12% of the population, of which more than 60% are men. At the age of 25-30 years, pathological abrasion of teeth is rare (in 4% of cases); the highest peak incidence occurs at the age of 40-45 years (35%). More often, the chewing cusps of premolars and molars, as well as the cutting edges of the front teeth, are subject to pathological abrasion.

Gradual abrasion of dental tissue occurs throughout life and is a physiological process that is compensated, slowly flowing. As a result of regular natural wear and tear, by the age of 40, the dental crown becomes approximately a quarter shorter than its original height. With pathological abrasion, the rate and severity of loss of hard tooth tissues significantly exceeds the physiological norm, which is accompanied by pronounced changes in the periodontium, dysfunction of the TMJ and masticatory muscles.

Causes of pathological tooth wear

Pathological abrasion of teeth has a polyetiological character and can be caused by the following groups of reasons: morphological inferiority and functional insufficiency of hard dental tissues; functional overload of teeth; harmful effects on hard dental tissues.

Morphofunctional defects of hard dental tissues can be congenital or acquired. The former are often found in various hereditary pathologies: Stanton-Capdepont syndrome, marble disease, osteogenesis imperfecta, etc. Acquired causes of pathological tooth abrasion are represented by diseases and conditions leading to disruption of mineral (phosphorus-calcium) and protein metabolism. These include panhypopituitarism, hypoparathyroidism, rickets, colitis, nutritional deficiency, profuse diarrhea, etc.

Irrational functional load on the teeth, as a factor in pathological tooth wear, can occur due to partial edentia, malocclusion, errors in prosthetics of dentition defects, parafunctions of the masticatory muscles (bruxiomania and bruxism), bad oral habits, etc.

Adverse effects on the hard tissues of teeth (fluorosis, alkaline, acid, radiation necrosis) may be associated with occupational hazards, taking certain medications (for example, hydrochloric acid), and radiation therapy to the head and neck area. The cause of pathological abrasion of teeth can be the use of fixed dentures made of metal ceramics and porcelain with a poorly glazed surface, the use of products with abrasive particles, hard toothbrushes, etc. for cleaning teeth.

Classification of pathological tooth abrasion

As already indicated, physiological tooth wear occurs gradually; Normally, the natural loss of dental tissue ranges from 0.034-0.042 mm per year. There are 3 stages in the course of physiological erasure:

Stage I (up to 25-30 years) – the teeth of the incisors are erased, the cusps of premolars and molars are smoothed out
Stage II (45-50 years) – hard tooth tissues are worn away within the enamel
Stage III (over 50 years) - hard tooth tissues are worn away within the enamel-dentin border and partially the dentinal layer

Pathological abrasion of teeth is classified according to the extent, plane and depth, and shape of the lesion.

Depending on the plane of decrease of hard tissues, horizontal, vertical and mixed forms of pathological abrasion of teeth are distinguished; according to the prevalence of the process - localized (limited) and generalized.

Based on the depth of the lesion, there are 3 degrees of pathological tooth abrasion:

I degree - abrasion within the enamel of the cutting edges (for incisors and canines) or chewing cusps (for premolars and molars)
II degree - abrasion of up to 1/3 of the height of the dental crown with exposure of the dentinal layer
III degree – erasing up to 2/3 of the height of the dental crown
IV degree - abrasion of hard tissues of more than 2/3 of the dental crown.

Both permanent and temporary teeth are susceptible to physiological and pathological abrasion. To characterize the abrasion of hard tissues of primary teeth, the following classification is used:

I form – erasing of incisor teeth, canine tubercles and molars by 3-4 years of age
Form II – complete erasure of enamel with a point opening of the enamel-dentin junction by the age of 6 years
III form - abrasion within the dentin in children over 6 years old before replacing temporary teeth with permanent ones
IV form – abrasion of the dentinal layer with translucency of the tooth cavity
V form – erasing the entire dental crown

The first three forms relate to the physiological abrasion of the hard tissues of primary teeth, the last two - to the increased (pathological) abrasion of primary teeth.

Symptoms of pathological tooth wear

Manifestations of pathological tooth wear are morphological, aesthetic and functional disorders. The loss of hard dental tissues primarily leads to a change in the anatomical shape of the dental crown and the appearance of the dentition. The decrease in the height of the dental crown depends on the degree of pathological abrasion of the teeth; in especially severe cases, the teeth are worn down to the level of the neck. The pathological process can involve individual units, groups of teeth or all teeth, on one or both sides, in the area of one or both jaws. The worn surfaces of teeth can be smooth, polished, or have a cellular, faceted, patterned, stepped shape.

Aesthetic dissatisfaction with one's appearance can be caused by the fact that when smiling, the upper teeth become invisible, which creates the effect of a “toothless mouth.” In this regard, patients with pathological tooth wear try to smile without opening their lips. Pathological abrasion of teeth is accompanied by phenomena of hyperesthesia under thermal, chemical, and mechanical influences.

Sharp edges of teeth often cause injuries to the mucous membrane of the cheeks and lips. As the abrasion of hard tissues progresses, malocclusion develops, the height of the lower third of the face decreases, the corners of the mouth droop, and the nasolabial and chin folds become sharply defined. With TMJ dysfunction, a symptom complex occurs, characterized by pain in the joint, facial muscles, cervical and occipital region, and head; clicking and crunching in the joint; visual and hearing impairment, xerostomia, glossalgia, etc.

Diagnosis of pathological tooth abrasion

Correct diagnosis is facilitated by a complete clinical and instrumental examination: survey, analysis of complaints, clarification of the etiology of pathological tooth abrasion. During a dental examination, attention is paid to the shape of the face, the nature of the occlusion, the condition of the hard tissues of the teeth, the extent and degree of abrasion of enamel and dentin.

To study the condition of the masticatory muscles and the temporomandibular joint, electromyography, radiography and tomography of the TMJ are used. To properly plan the treatment of pathological tooth abrasion, assess the condition of the root canals, pulp chamber, etc., electroodontodiagnosis, radiography of individual teeth, and orthopantomography are performed. Based on the study of diagnostic models of jaws, the type, shape, degree of pathological abrasion of teeth, as well as the occlusal relationships of the dentition are clarified.

Treatment of pathological tooth abrasion

Treatment of pathological tooth abrasion, depending on the severity of the process, is carried out by dental therapists or orthopedists. The main efforts of specialists should be aimed at eliminating the etiological factors of pathological abrasion of teeth, restoring lost hard tissues, and normalizing occlusal relationships.

In order to eliminate the causative factors of pathological tooth wear, mineral metabolism is corrected, endocrine pathology is treated, bad habits are combated, and dentures are installed or replaced. To eliminate dental hyperesthesia, complex remineralizing therapy is prescribed: taking mineral and vitamin complexes, electrophoresis, applications of fluoride-containing drugs. The sharp edges of the teeth, which can damage the surrounding soft tissues, are ground down; prosthetics of end defects of the dentition using bridges and partial removable dentures

Treatment for physiological tooth wear is not required. In case of increased loss of hard dental tissues, an individual plan of treatment and preventive measures should be drawn up, taking into account the causes, nature and degree of pathology. Wearing teeth are more susceptible to chipping of the enamel and tooth wall, and the development of pulpitis and periodontitis. With the help of modern methods of orthopedics and orthodontics, in all cases it is possible to eliminate aesthetic and functional disorders caused by increased tooth wear.

Preventive measures should include timely correction of malocclusion, bruxism, adentia; changing working conditions, combating pathological habits; normalization of metabolic processes in the body.

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 abrasion of teeth

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, areas 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. But it does not occur due to the fact that physiological abrasion of hard dental tissues 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 the teeth into a plane one, the increase in the area of this area and the approach of the lower edge of the area 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

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.

Causes of pathological tooth wear

The causes of pathological tooth wear are very diverse. All of them can be combined into the following groups.

Functional inferiority of hard dental tissues , caused by a decrease in the qualitative and quantitative characteristics of enamel and dentin. In this case, the process can be:

Hereditary (eg Capdepont-Stanton syndrome);
Congenital (disorders of amelo- and dentinogenesis);
Acquired (metabolic disorders of various etiologies, as well as dysfunctions of the endocrine, vascular, nervous and other systems)

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 full function of the parathyroid glands, which are responsible for the balance of calcium and potassium in the body, is especially important.

Capdepont–Stanton syndrome

Disorders of amelo- and dentinogenesis

Functional overload of teeth , which can occur when:

Partial loss of teeth;
Parafunctions (eg bruxism);
Hypertonicity of the masticatory muscles of various origins;
Chronic dental trauma;
Bite disorders;

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 the bone tissue of the 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 height 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.

Occupational hazards may occur at work with the release of acids, alkalis and other substances, taking certain medications, etc. For example, acids reduce the quality characteristics of enamel and dentin, and fine dust is the most common abrasive, which, in combination with an adequate dental system, becomes aggressive, accelerating the processes of physiological abrasion.

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.

Classification of pathological tooth abrasion

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:

By stage(M.R. Bhushan):

Physiological – within the enamel;
Transitional – within the enamel with partial involvement of dentin;
Pathological – within the dentin.

Physiological abrasion always occurs within the dentin, however, at a young age, increased abrasion of only the enamel, together with the etiological factor, can be diagnosed by a doctor. Abrasion of dentin is a characteristic sign of pathological abrasion. Involvement of dentin can cause increased sensitivity 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.

By degree(M.R. Bhushan):

I – wear down 1/3 of the length of the tooth crown;
II – wear on 2/3 of the length of the tooth crown;
III – wear of the tooth crown by more than 2/3.

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.

By shape(A.L. Grozovsky):

Horizontal;
Vertical;
Mixed.

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 on both the lower and upper jaws. 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

By degree of compensation(E.I. Gavrilov):

Compensated – without reducing the height of the lower third of the face;
Decompensated – with a decrease in the height of the lower third of the face;

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.

By length(V.Yu. Kurlyandsky):

Localized – increased wear of individual teeth or a group of teeth;
Generalized.

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, which fall on the 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

Tooth enamel is the hardest tissue of the 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 in the upper parts of the 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 erasure of enamel in different people can differ significantly - it depends on such factors 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 to 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 (the absence of one or more teeth, malocclusion, medical errors during prosthetics, poor-quality dentures);
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, the teeth will subsequently wear down to the contact areas (side 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 the teeth, which can injure the soft tissues of the oral cavity;
pain in the facial muscles and temporomandibular joint (occurs due to excessive load on the jaw);
crunching in the jaw joint;
headache;
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 discover signs of this unpleasant disease, you should 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. If you have metabolic disorders, you will need to take vitamin and mineral supplements. Problems that arise as a result of tooth loss are solved with the help of prosthetics and implantation. If the main reason for premature tooth wear is an incorrect bite, you will need the help of an orthodontist.

Pathological abrasion is the loss of hard dental tissues: enamel and dentin. Most often, the occlusal (chewing) surface is erased, less often - the cervical and palatal areas. The defect can extend either to one chewing unit or to the entire row. Treatment of the disease is aimed at restoring aesthetic and physiological functions.
Throughout life, a person’s enamel is constantly worn away: the bumps and teeth gradually smooth out. This process intensifies after 30 years. However, normally, the loss of hard tissue should not exceed 0.034 - 0.042 mm per year. When a similar condition is observed in children, young people, or the enamel and dentin are destroyed too quickly, they speak of pathological tooth wear.
According to statistics, pathology occurs in 12% of patients. Moreover, more often in men (62.5%) than in women (22.7%). Among the causes, mechanical factors of damage are considered the main ones. The disease develops due to:
Important! Increased tooth wear also develops with intense physical activity or hard work. Athletes, builders, and loaders can strongly clench their jaws while lifting weights, which leads to tissue loss.

Symptoms
Typically, patients seek medical help in the later stages of development of pathological abrasion, when there is significant loss of bone tissue. The reason for the visit is the loss of aesthetic and chewing functions.
At the initial stage, hyperesthesia is observed - increased sensitivity of the enamel. Later, changes in the appearance of the teeth begin. At first it is faintly noticeable, but as the pathology develops it progresses.
As a rule, patients discover the problem when destruction reaches the inner layer - dentin. Due to its lower strength than enamel, chips, sharp corners, and nicks form on the crowns. In some cases, abrasion helps to reduce carious processes at the initial stage.
At the initial stage, increased sensitivity of the enamel is observed.
Subsequently, speech is impaired. In particular, difficulties are noted when pronouncing the sounds “z” and “s”. At the deep stage, there is a change in the outline of the lower third of the face, facial expressions and symmetry, deformation of the temporomandibular joint, malocclusion, mobility of incisors, canines or molars.
Important! Some of the signs of the disease are difficulty chewing food and the formation of folds in the corners of the mouth.

Classification
Increased tooth wear is classified according to several criteria:
Degrees of hard tissue loss:

Stage 1 – abrasion within the cutting surface of incisors and canines and chewing cusps of molars;
Stage 2 – the dentinal layer is exposed, the crown is worn away by a third;
Stage 3 – up to 2/3 of tissue is lost;
Stage 4 – loss of bone tissue reaches the neck of the tooth.

2. Localization of the abraded surface:
horizontal – the tooth is erased from the cutting or occlusal surface;
vertical – tissue loss occurs from the lateral parts: palatine, cervical;
mixed - the tooth is worn out simultaneously from all sides.

3. Prevalence of the pathological process:
localized – one or more teeth are worn out, caused by the removal or incorrect installation of prosthetic structures;
generalized – uniform loss of tissue on all chewing and cutting units.

This is what worn teeth look like.
Important! Pathological abrasion is characteristic of both permanent and baby teeth.

Diagnostics
Initial diagnosis involves taking a history and visual examination:
The causes of the development of the disease are determined, whether there is a hereditary factor, the patient’s lifestyle and habits.
The condition of the contact surfaces and the degree of their abrasion are assessed.
The oral mucosa is examined and soft tissues are palpated. Possible changes in the functioning of the temporomandibular joint are excluded.

Important! To assess the degree of abrasion, impressions of the dentition are made using wax or silicone material - an occlusiogram. Normally, the impression will show marks where the jaws meet.

Additionally, the following examination methods are used:

Treatment of pathological abrasion
When tooth wear is detected, treatment is carried out using one of the following methods, depending on the degree of development of the disease:
Conservative. A set of measures is being carried out aimed at eliminating the causative factor, restoring mineral metabolism, etc. Remineralization therapy, vitamin and mineral complexes, physiotherapeutic procedures, and pastes that help reduce hypersensitivity are prescribed.
Composite restoration. The sharp edges of the crowns are ground, and the lost tissue on the cutting edges and occlusal surfaces is restored with light-curing materials.
Orthodontically. The dentition is restored using core inlays, crowns, bridges and dentures.

Important! There is no single opinion on when treatment for pathological tooth wear should begin and how exactly to carry it out. The general clinical picture, reasons and habits of the patient play a big role.

If increased tooth wear is accompanied by bruxism, a protective mouthguard is made. It is worn while sleeping. In severe cases, preliminary increase in occlusion with dentogingival systems may be required.
When identifying problems with the digestive or endocrine system, first of all it is necessary to treat the diseases that led to tooth wear.

An important role in therapy is played by the patient’s trust in the doctor and his willingness to comply with the specialist’s requirements. If the patient cannot, due to certain circumstances, follow the chosen method, it is adjusted within reasonable limits, taking into account personal preferences.
Abrasion of dental tissue cannot be reversed. All therapeutic measures are aimed at slowing down the process and restoring the anatomical shape of the jaw row. To prevent the disease, it is necessary to promptly correct bite defects, bruxism, replace lost chewing units, and use protective measures when working in production.