Tooth Wear – Physiological or Pathological?

Earlier this year, a group of key opinion leaders published European Consensus guidelines on the management of severe tooth wear, focusing, in part, on the difference between physiological and pathological wear.1

As Loomans and colleagues (2017) wrote, it is important to be able to differentiate between these two types of tooth wear, since physiological surface loss is to be expected with age, while pathological describes ‘unacceptable levels of progressive wear’.1

To help dentists recognise which is which, the group merged the results of a number of studies into physiological tooth wear, revealing that over a time span of six decades the molars show the greatest level of wear (1740 μm), the mandibular incisors come next (1460 μm), then the maxillary incisors (1010 μm), and, lastly, the premolars (900 μm).1

For dental professionals, the signs that indicate pathological tooth wear may be occurring and preventive action is, therefore, needed include:

• Tooth sensitivity
• Discolouration, including yellowing and loss of shine (where some of the outer enamel layer has been lost)
• Sharp or chipped anterior teeth
• Occlusal surfaces wearing flat and taking on a shiny, pitted appearance
• Altered occlusion as vertical height changes
• Restorations standing proud of the teeth
• Abfraction lesions developing cervically
• V-shaped notches or shallower cupping present cervically

 

Reference

Loomans B et al. Severe tooth wear: European consensus statement on management guidelines. J Adhes Dent 2017; 19: 111-119

 

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