Tooth surface loss: Tooth surface loss: an overview

Pathological, non-carious loss of tooth tissue is an increasing problem to the dental profession, with young individuals especially at risk. This paper provides an overview of the problem with an emphasis on the possible causes, particularly those factors which may account for the increased incidence. The clinical appearance produced by the various aetiological factors is discussed and recommendations made on the objectives of the immediate and long-term management of the problem. Introduction The management of tooth surface loss (TSL) demands a full understanding of its aetiology and presentation. This paper provides the introduction to the series and an overview of pathological, non-carious loss of tooth tissue. Emphasis is placed on the aetiological factors which are currently thought to be major causes of this problem. This directs the paper toward those agents that produce erosive tooth surface loss. This is appropriate given the increasing incidence and severity of this type of tooth wear. The article attempts only relatively brief descriptions of the presentation and aetiology of attritional and abrasive tooth surface loss. This does not imply that they are less important but rather reflects the increased concern over the need for prevention, early detection and control of acid erosion. Later articles in the series will return to the presentation and management of the other types of TSL. The preventive management of bruxism is described in the third and sixth paper. Non carious loss of tooth tissue is a normal physiological process and occurs throughout life.1 If the rate of loss is likely to prejudice the survival of the teeth, or is a source of concern to the patient, then it may be considered 'pathological'.2 The dental management of patients with such loss of tooth tissue has provided difficulties for the dental profession for many years and it is generally agreed that the problem is increasing. This can only partly be explained by the fact that the population is retaining more natural teeth into old age.2, 3 It is not only the middle-aged and elderly who exhibit pathological loss of tooth tissue, but also younger age groups (fig. 1).4 Robb reported that the prevalence of pathological loss of tooth tissue in patients less than 26 years of age was greater than in many older age groups.5 The Child Dental Health Survey (1994)6 confirmed this when 32% of 14-year-olds had evidence of erosion affecting the palatal surfaces of their permanent incisors. This cannot be explained as an age-related phenomenon. It may, however, be the result of changing lifestyles and social pressures which have led to the increased prominence of particular aetiological factors. Figure 1: Palatal view of maxillary teeth of a 16-year-old female who had drunk a litre of 'diet' carbonated drinks a day for the past two years. There is marked tooth surface loss affecting the anterior teeth, particularly the central incisors where the pulps are visible Full size image (29 KB)