Abnormal tooth erosion

Pathological tooth abrasion is a dental disease characterized by the fact that hard dental tissues are lost at an abnormally high rate.

The development of this pathological process affects both one tooth and several teeth at once. It also disrupts the anatomical shape of the tooth crown.

This dental pathology is quite common and occurs even more often than in every tenth person. Moreover, men are mainly susceptible to this disease.

It is necessary, however, to take into account that the process of teeth abrasion as such is not something completely alien to the human body. Throughout life, tooth tissue gradually decreases due to natural physiological abrasion.

Thus, in the period from 25 to 30 years, the molar cusps are smoothed out and the incisor teeth are worn down.

Before reaching the age of 40-50 years, teeth wear down within their enamel.

In those who have crossed the 50-year mark, dental tissue wears down to the limits of the enamel-dentin border, with partial abrasion of the latter.

In cases where there is a reduction in tooth tissue with a degree of severity exceeding existing age norms, this serves as a basis for saying that pathological abrasion of teeth is present.

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Causes of pathological tooth wear

The causes of pathological tooth wear are often rooted in the presence of an abnormal bite in a person. The factor that largely determines the development of this disease can be the presence of a direct and deep bite, in which the tooth enamel wears off especially quickly and the dentin is exposed.

Wear of dental hard tissues can occur as a result of increased stress on the remaining teeth after one or more teeth have been lost.

Improperly performed dental prosthetics can lead to this dental pathology.

Bruxism is one of the most common causes of abnormal tooth wear. This disorder is characterized by abnormal chewing activity with involuntary clenching of the jaws and friction of the teeth against each other. This happens mainly when a person is sleeping, so this phenomenon can also be considered one of the sleep disorders.

Pathological abrasion of teeth can manifest itself as a negative concomitant phenomenon associated with a person's professional activity. This happens when he works for a long time in conditions in which the air in the room contains a large number of small particles that can produce a mechanical abrasive effect on the teeth. Or if you have to deal with acids, the fumes of which also negatively affect the condition of the teeth.

The cause of tooth wear is often disturbances in the development of teeth that can occur due to hereditary factors, and in addition, the presence of dental diseases such as hypoplasia, fluorosis, etc.

Pathological abrasion of teeth can also occur against the background of various disorders of the endocrine system, thyroid gland, pituitary gland, etc. This dental anomaly can be provoked by diseases of the central nervous system, and it often occurs as a result of chronic intoxication of the body.

The causes of pathological abrasion of teeth, depending on the strength of the negative impact and the intensity of the unfavorable factor, determine various degrees of loss of hard dental tissues, each of which is classified based on its inherent characteristics of pathological changes.

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Symptoms of pathological tooth wear

The symptoms of pathological tooth wear have as their main manifestations the formation of sharp edges of the enamel shell of the teeth due to the abrasion of enamel and dentin. Because of this, in many cases the mucous membrane on the inner surface of the cheeks and lips is injured.

If timely measures are not taken to treat this disease, the teeth become shortened, the bite is disturbed. Adverse phenomena occur with the face - it decreases in the lower third, and pronounced nasolabial folds appear in the corners of the mouth.

The position of the temporomandibular joint changes, which is why pain symptoms are observed in its area, also spreading to the tongue. In some cases, hearing loss may even occur.

Teeth subjected to pathological abrasion processes begin to acquire increased sensitivity to various types of mechanical, chemical and temperature irritants. This manifests itself in a painful reaction of teeth to hot or cold, sour, sweet food, etc.

Pathological abrasion to a large extent conceals the threat of increased probability of occurrence and development of carious cavities in the affected teeth. In turn, this can provoke pulpitis. Activation of protective mechanisms by the pulp can trigger the mechanisms of formation of secondary dentin. If this happens, then hypersensitivity of teeth may not be observed.

All the above symptoms of pathological tooth wear in their totality can indicate the need to begin appropriate treatment. However, in order to select the necessary rational measures of medical intervention in relation to this dental pathology, it must be preceded by appropriate diagnostic measures.

Classification of pathological tooth wear

The classification of pathological abrasion of teeth is carried out, first of all, on the basis of division into groups of physiological and pathological abrasion.

Physiological tooth wear is classified by its manifestations specific to each specific age of a person throughout life.

Thus, from 25 to 30 years of age, the cusps of the molars and premolars are smoothed out, and the teeth of the incisors are worn down.

Teeth, in the process of wear, reach the limits of enamel by the age of 45-50.

In people over 50 years of age, tooth wear reaches the enamel-dentin border and to some extent extends to the dentin.

Pathological abrasion of teeth can be characterized by localized (from 1 to 2 teeth) or generalized (many teeth, up to an entire row of teeth) coverage of abrasion of hard tissues.

At the 1st degree, abrasion does not extend beyond the enamel, sometimes only partially affecting the dentin.

The 2nd degree is limited to the area of abrasion covering the boundaries of the main dentin. The cavity of the tooth is not visible.

The 3rd degree is characterized by the fact that the replacement dentin is subject to abrasion, in which case there is a translucence of the dental cavity.

At the 4th degree, the entire crown of the tooth is worn away.

As we can see, the classification of pathological tooth wear involves dividing this disease into subgroups according to the criteria of the number of teeth affected by this pathological process, the degree to which the teeth have been worn down, and the form of wear of hard dental tissues.

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Forms of pathological tooth wear

The main forms of pathological tooth wear are horizontal and vertical.

The horizontal form of abrasion can manifest itself in the occurrence of this pathological process on the teeth of both the upper and lower jaws. It is characterized by the fact that the hard tissues of the tooth decrease mainly in the horizontal plane. This process is accompanied by the loss of cutting edges and tubercles in the chewing teeth, and subsequently there is a decrease in the height of the crowns. When the negative progress of the disease continues for a long time, practically nothing remains of the crowns except small stumps slightly protruding above the gum.

In the vertical form of pathological abrasion, there is a kind of grinding down of the teeth of the upper and lower rows at the points of their contact. This form is characterized by the loss of hard tissues of the teeth, which occurs on the side of their surface, which is on the side of the palate on the upper front teeth, and on the lower ones - on the side facing the lips.

In some cases, only one jaw is subject to increased abrasion. This form of this dental pathology is characterized by the formation of horizontal zones in which abrasion facets similar to craters are observed. On molars, their edges may be limited by residual fragments or dentin, forming a kind of crown.

In addition to the basic forms that tooth abrasion can take, there are also mixed, stepped, patterned, and cellular forms.

Regardless of the form of pathological tooth wear that a person may have, it should be noted that as a result of this disease, sharp edges of the enamel covering the tooth are eventually formed, and they can act as a traumatic factor for the oral mucosa, which is very vulnerable to all mechanical influences.

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Diagnosis of pathological tooth wear

Diagnosis of pathological tooth wear is carried out through a comprehensive examination of the patient, adhering to a certain existing scheme.

First of all, the patient’s medical history and anamnesis are carefully studied, his complaints are listened to, after which a general external examination is carried out, paying special attention to the examination of the oral cavity.

As a further diagnostic measure, the masticatory muscles, temporomandibular joint, etc. should be palpated by a medical specialist. This action makes it possible to detect pain, the presence of muscle swelling, and to identify a state of hypertonicity. And if there is a suggestion that there is a parafunction, to prescribe additional diagnostics, such as electromyography. In addition, palpation of the temporomandibular joint helps to identify pathologies that are common in pathological abrasion of teeth of a generalized or localized type, which is aggravated by partial adentia.

Next, auscultation of the temporomandibular joint is performed, and if necessary, the patient is sent for diagnostics using methods of targeted and panoramic teeth and jaw radiography, electroodontodiagnostics, X-ray cephalometry, arthrography, tomography, electromyotonometry.

Thus, diagnostics of pathological tooth wear involves both examination of the patient, especially the maxillofacial area, and subsequent use of all possible technical diagnostic methods in order to most accurately determine the patient's objective condition and, based on the data obtained, prescribe the required treatment. Accurate diagnostics in many cases is an absolute guarantee of successful treatment.

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Treatment of pathological abrasion of teeth

Treatment of pathological tooth wear is based on an individual approach to each patient based on the reasons for which the disease arose, at what stage of pathological progress it is, its nature, as well as the characteristics of the patient's body.

The primary task in the treatment of this dental disease is to establish what, first of all, provokes pathological abrasion of teeth, and, based on this, take appropriate measures aimed at eliminating this negative factor.

In this regard, it may be necessary to carry out a complete sanitation of the oral cavity, which becomes especially relevant in the process of treating hypoplasia, dental fluorosis, etc.

One of the required conditions may be the option in which it is necessary to first cure bruxism, or it is necessary to wear special mouth guards for some time.

Correction of malocclusion and timely dental prosthesis can be of great importance for the treatment of pathological tooth wear.

Perhaps, in some cases, it makes sense for a person to think about the possibility of changing jobs or optimizing working conditions if, due to the nature of his work, he has to deal with acids, soda solutions, and abrasive substances.

The actual process of treating pathological tooth wear consists of grinding all the sharp edges of worn teeth in order to make them safe for the mucous membranes of the cheeks, lips, and tongue. At the initial stages, when the disease does not exceed the 1st and 2nd degree, prosthetics are performed using crowns made of metal ceramics and metal alloys. The 3rd and 4th stages require prosthetics in combination with orthodontic treatment of the bite.

Orthopedic treatment of pathological tooth wear

Before starting orthopedic treatment of pathological tooth wear, it is necessary to determine what should be considered the main etiological factor with the most probable justification, to identify in what form and at what stage this disease is - generalized or localized, compensated or decompensated. It is also necessary to give an objective assessment of the condition of the crowns of the teeth and periodontium based on their radiography, as well as to conduct orthodiagnostics of the pulp, to state the presence of possible changes in the appearance and joint.

As a result of orthopedic treatment, the restoration of normal functionality of the jaws is achieved, which is manifested in the improvement of chewing function, and it is also a factor that positively affects the aesthetic aspects of the patient's appearance. Prosthetics carried out in case of pathological abrasion of teeth also plays an important role in prevention in order to protect hard tissues of teeth from further abrasion. In addition, it is of no small importance for the prevention of diseases that can develop in the temporomandibular joint.

At the early stages of pathological tooth wear, the main task is to minimize the possibility of its further progression. Treatment in this case is mainly preventive. Treatment measures are prescribed using appropriate medications and physiotherapeutic methods.

If conservative medical interventions are not effective enough, indications for orthopedic treatment arise. Its essence consists in restoring the shape and functionality of teeth that have been damaged using removable or non-removable prostheses, based on the appropriateness of using one or another type.

In the presence of minor occlusion disorders, the edges of the teeth, protruding and thinned by pathological abrasion, are selectively ground down.

The degree of loss of dental hard tissues determines which type of prosthesis is most suitable in a particular case. So, if the hard tissues of the teeth are worn out from 2 to 3 millimeters and the anatomical shape is not violated from the vestibular side, inlays are used. They should cover the entire occlusal surface on which abrasion occurred, as a result of which the shape of such inlays can be very diverse. Cavities formed by caries, depressions present in dentin, as well as retention pins are used as retention points for inlays. Artificial crowns of all types are allowed for use at these scales of pathological tooth wear.

Pathological tooth decay, generalized with a loss of dental hard tissue by 2-3 mm, suggests that it is possible to use both inlays and crowns covering the teeth in the opposite dental row - chewing on the right and left sides, and the front ones.

Regarding the material of the crowns, it should be noted that the best ones are cast metal ones, since metal stamped ones can shift deep into the gum pocket, leading to the destruction of the circular ligament of the tooth and provoking inflammatory processes in the marginal periodontium. They also wear out in a shorter time.

Orthopedic treatment of pathological tooth wear is thus regulated by a number of various factors. It is aimed at achieving two main goals - therapeutic to ensure normal chewing functions, and preventive to prevent further wear of hard dental tissues.

Prevention of pathological abrasion of teeth

Prevention of pathological abrasion of teeth consists of the need to protect them as much as possible from the effects of all kinds of negative factors.

If a person has to work with acids or in conditions where there are a lot of abrasive particles in the air in the room, they should wear a thick mask or respirator. Such a protective device will prevent them from getting into the oral cavity. Regular rinsing of the mouth with a soda solution can act as a preventive measure against the negative effects of acid fumes.

If wear of the front teeth is detected, which becomes obvious first of all in pathological wear, you should not postpone a visit to a medical specialist. In this regard, you should also remember that you should trust only a highly qualified dentist.

The reason for an immediate visit to him should be the appearance of symptoms inherent to this disease. And this is the appearance of yellow areas on the tooth enamel, increased sensitivity of the teeth to hot or cold, etc.

Proper organization of a person's diet is also an important preventive factor. A person needs to pay due attention to what and how he eats. In particular, it is better to drink acidic drinks through a straw.

When pathological tooth wear is at an early stage, a preventive measure can be the use of silicone or acrylic mouth guards. The mouth guards are put on at night before going to bed, or they can be worn constantly.

In cases where the hard tissues of the tooth have been subjected to significant abrasion, the mouth guards often prove ineffective. Then it becomes advisable to use veneers, ultra-veneers, crowns.

Prevention of pathological tooth wear, for which all that is required of a person is to adhere to simple and not very complicated rules, is aimed at preventing this disease. After all, it is easier to prevent any disease than to subsequently deal with its many negative consequences.

Prognosis of pathological tooth wear

Physiological tooth wear is a natural process and does not require any medical measures against it. However, if the loss of hard tooth tissues becomes large, you need to seek medical help. When a medical specialist draws up an individual treatment and preventive measures plan, the causes of this dental pathology, its nature, and the degree that the disease has acquired during its development are taken into account. The prognosis for pathological tooth wear with the current level of dental treatment in most cases seems favorable.

Among the fundamental factors contributing to the successful treatment of this disease is the timely correction of malocclusion, treatment of bruxism, and the implementation of necessary dental prosthetics. In some cases, in order to eliminate the negative impact on the condition of the teeth, a person may need to change jobs, or optimize the working conditions of his current activity, take care of personal protective equipment from unfavorable production factors.

To be sure that the prognosis of pathological tooth wear will be positive, give grounds for existing progressive orthopedic and orthodontic methods. Thanks to their application, it becomes possible to restore both the impaired functionality of teeth and ensure the aesthetics of the patient's appearance.