Tooth wear and the "design" of the human dentition: a perspective from evolutionary medicine.

Worn, flat occlusal surfaces and anterior edge-to-edge occlusion are ubiquitous among the dentitions of prehistoric humans. The concept of attritional occlusion was proposed in the 1950s as a hypothesis to explain these characteristics. The main aspects of this hypothesis are: 1) the dentitions of ancient populations in heavy-wear environments were continuously and dynamically changing owing to life-long attritional tooth reduction and compensatory tooth migration, 2) all contemporary humans inherit these compensatory mechanisms, and recent reduction in wear severity has resulted in failure to develop attritional occlusion, and 3) this failure leads to an increased frequency of various dental problems in modern societies. Because of the potential significance of this concept, we review and synthesize relevant works and discuss attritional occlusion in the light of current knowledge. Available evidence, on balance, supports the first and second points of the hypothesis. As noted by many workers, the human dentition is basically "designed" on the premise that extensive wear will occur, a conclusion that seems reasonable when one realizes that humans evolved in heavy-wear environments until relatively recently. Some dental problems in contemporary societies appear to reflect the disparity between the original design of our dentition and our present environment, in which extensive wear no longer occurs, but this possibility still needs further investigation.