Tooth wear is an increasingly prevalent condition in the UK leading to the loss of enamel and dentine. The condition affects patients of all ages, and 77% of the UK population have evidence of wear. 15% of all adults in the country have moderate wear exposing large areas of dentine, and 2% have tooth-wear so severe that pulp or secondary dentine is exposed.[i]

Treatment for tooth wear aims to conserve as much healthy dental tissue as possible while achieving optimal restorative outcomes. A preventative approach is essential to address the causes of wear, and treatment requires precise diagnosis and early intervention for the best chances of success.[ii]

An overview of the causes

Although tooth wear is multifactorial, it usually occurs due to erosion, attrition or abrasion.[iii] It is important to determine which cause or combination of causes might be involved before planning treatment.[iv]

In the UK and Europe, the most prevalent cause of tooth wear is generally believed to be erosion due to an increasing consumption of sugary, acidic, or acid-producing foods and drinks.iv Certain aggressive teeth whitening treatments can also be an extrinsic cause of erosion.[v] Wear due to over-exposure to substances like chlorine in pool water is rare, but remains a possible factor.i

Intrinsic causes of dental erosion include the eating disorder, bulimia, as well as morning sickness, chronic vomiting, or acid reflux disorders such as gastroesophageal reflux disease (GERD).[vi]

Attrition is caused by tooth to tooth contact. Bruxism is another common cause of dental wear. Generally, psychosocial factors, such as stress and anxiety are thought to be the primary cause. Other contributory factors include genetic predisposition, alcohol or caffeine consumption, smoking and some medications.[vii]

Abrasion is the loss of tooth substance from factors other than tooth contact, such as brushing too hard, using a hard toothbrush, using a hard toothpick, nail-biting, chewing on abrasive goods or sharp objects. Tongue and lip piercings have also been identified as a contributing factor in tooth wear due to dental abrasion.[viii]

Restorative treatment for severely worn teeth

While restoration can be complex and often necessitates a multidisciplinary approach, the enhancement of patients’ quality of life can be substantial.[ix] After addressing the underlying causes through lifestyle changes, interdisciplinary treatment, or, in the case of bruxism, the use of mouthguards and splints, various methods can be employed to achieve restorative treatments for tooth wear.

Materials used to restore teeth and limit further damage include direct composite, indirect composite, veneers, dentine bonded crowns, metal alloys like nickel-chromium, precious metal alloys, and canine risers.xii

Treatment to restore severely worn teeth requires careful planning, is technically demanding and can take a great deal of time. Depending on the cause, a number of interventions may be required before restorative treatment can begin, which can require a high level of commitment from patients.[x]

The Dahl approach

Dento-alveolar compensation, enabling patients to maintain occlusal contacts, often accompanies severe tooth-wear, making restoration of localised wear, especially in the aesthetic zone, challenging. Tooth preparation of such worn teeth to create interocclusal space for the planned restorations may endanger pulp vitality.[xi]

The Dahl approach is a highly successful procedure, developed nearly 30 years ago to address this complex set of circumstances in the most conservative and minimally invasive way possible. The process involves gradually introducing a splint to address limited occlusal space while restorative treatment takes place.[xii]

The original design – comprised of a series of removable metal bite platformsxii  – is minimally invasive and highly effective; however, it is gradual, requires high patient compliance, and may require a commitment of several months to complete.[xiii] Direct composite resin is now commonly used as a splint due to its affordability, bondability, robustness, and ease of modification.xii

Brilliant composite

Although once considered a temporary material in Dahl procedures, composite is now recommended as the material of choice for treating worn mandibular incisors, particularly in cases of severe erosion. With excellent aesthetics and predictability, composite can serve both as the fixed Dahl appliance and the definitive restorative material.xii

BRILLIANT EverGlow® from COLTENE is a direct composite with incredible aesthetics as well as high flexural strength to work perfectly as a minimally invasive restorative treatment for tooth wear. Based on the same technology, EverGlow® Flow additionally benefits from low viscosity with high stability. BRILLIANT EverGlow® and EverGlow Flow are available in 7 universal shades and 3 translucencies to match with natural teeth. The submicron hybrid composite is immediately smooth, with simplified polishability, allowing highly aesthetic restorations to be performed quickly and efficiently.

In approaching the increasing problem of dental wear, conservative treatments that prioritise prevention and the preservation of function while maintaining healthy dental tissue are to be embraced by clinicians wherever possible. Not only do they reduce the need for more extensive interventions in the future, they enhance the overall quality of life for patients.

 

For more on COLTENE, visit https://colteneuk.com/BRILLIANT-EverGlow

email info.uk@coltene.com or call 0800 254 5115.

 

Author: Nicolas Coomber COLTENE  National Account & Marketing Manager

 

[i] Tooth Wear. Gov.UK. Guidance. November 2021. Available at: https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention/chapter-7-tooth-wear#tooth-wear-in-the-uk. Accessed May 2024

[ii] Alyahya Y. A narrative review of minimally invasive techniques in restorative dentistry. Saudi Dent J. 2024 Feb;36(2):228-233. doi: 10.1016/j.sdentj.2023.11.005. Epub 2023 Nov 4. PMID: 38419994; PMCID: PMC10897608.

[iii] David W Bartlett, The role of erosion in tooth wear: aetiology, prevention and management, International Dental Journal, Volume 55, Supplement 4, 2005, Pages 277-284, ISSN 0020-6539, https://doi.org/10.1111/j.1875-595X.2005.tb00065.x.

[iv] Paryag A, Rafeek R. Dental Erosion and Medical Conditions: An Overview of Aetiology, Diagnosis and Management. West Indian Med J. 2014 Sep;63(5):499-502. doi: 10.7727/wimj.2013.140. Epub 2014 May 15. PMID: 25781289; PMCID: PMC4655683.

[v] Carey CM. Tooth whitening: what we now know. J Evid Based Dent Pract. 2014 Jun;14 Suppl:70-6. doi: 10.1016/j.jebdp.2014.02.006. Epub 2014 Feb 13. PMID: 24929591; PMCID: PMC4058574.

[vi] Cengiz S, Cengiz MI, Saraç YS. Dental erosion caused by gastroesophageal reflux disease: a case report. Cases J. 2009 Jul 22;2:8018. doi: 10.4076/1757-1626-2-8018. PMID: 19830044; PMCID: PMC2740145.

[vii] Bruxism. National Institute of Dental and Craniofacial Research. July 2022. Available at: https://www.nidcr.nih.gov/health-info/bruxism Accessed September 2024.

[viii] Malcangi G, Patano A, Palmieri G, Riccaldo L, Pezzolla C, Mancini A, Inchingolo AD, Di Venere D, Piras F, Inchingolo F, Dipalma G, Inchingolo AM. Oral Piercing: A Pretty Risk-A Scoping Review of Local and Systemic Complications of This Current Widespread Fashion. Int J Environ Res Public Health. 2023 May 8;20(9):5744. doi: 10.3390/ijerph20095744. PMID: 37174261; PMCID: PMC10177791.

[ix] Li MHM, Bernabé E. Tooth wear and quality of life among adults in the United Kingdom,. Journal of Dentistry, Volume 55, 2016. Pages 48-53, ISSN 0300-5712, https://doi.org/10.1016/j.jdent.2016.09.013.

[x] Kumar V, Reddy S, Kumari V S, Basha R, Mitra N. Restorative Rehabilitation of a Patient With Tooth Wear: A One-Year Clinical Follow-Up Report. Cureus. 2023 Apr 18;15(4):e37798. doi: 10.7759/cureus.37798. PMID: 37213952; PMCID: PMC10195644.

[xi] Wong TL, Botelho MG. Restorative Management of Severe Localized Tooth Wear Using a Supraoccluding Appliance: A 5-Year Follow-Up. Case Rep Dent. 2018 May 27;2018:9864782. doi: 10.1155/2018/9864782. PMID: 29977627; PMCID: PMC5994272.

[xii] Poyser, N., Porter, R., Briggs, P. et al. The Dahl Concept: past, present and future. Br Dent J 198, 669–676 (2005). https://doi.org/10.1038/sj.bdj.4812371

[xiii] Tew IM, Ho EHT. Minimally Invasive Rehabilitation of Posterior Erosive Tooth Wear: Two Case Reports of the One-Stage Dahl Approach. Cureus. 2022 Feb 15;14(2):e22235. doi: 10.7759/cureus.22235. PMID: 35340518; PMCID: PMC8929473.

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