Table Of ContentBDJ Clinician’s Guides
Andrew Eder · Maurice Faigenblum
Editors
Tooth Wear
An Authoritative Reference for
Dental Professionals and Students
Third Edition
BDJ Clinician’s Guides
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Andrew Eder • Maurice Faigenblum
Editors
Tooth Wear
An Authoritative Reference for Dental
Professionals and Students
Third Edition
Editors
Andrew Eder Maurice Faigenblum
UCL Eastman Dental Institute UCL Eastman Dental Institute
and Harley Street London, UK
Dental and Implant Clinic
London, UK
2nd edition: © BDJ Books 2002
ISSN 2523-3327 ISSN 2523-3335 (electronic)
ISBN 978-3-030-86109-4 ISBN 978-3-030-86110-0 (eBook)
https://doi.org/10.1007/978-3-030-86110-0
© Springer Nature Switzerland AG 2002, 2022
Originally published by BDJ Books, London, 2002
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Foreword
In his foreword to the first edition of this acclaimed book in 2000, Sir Ian Gainsford
highlighted the problems of tooth wear as being a ‘major challenge’ to our profes-
sion. A little over 20 years later, these challenges continue to grow, particularly due
to erosive wear across the generations and our increasingly elderly population
thankfully keeping their teeth for longer.
As a consequence, the profession should welcome the third edition of this
authoritative clinical guide for dental professionals and students. Each of the 32
authors is actively involved in clinical research or management of patients present-
ing with worn teeth. This multidisciplinary group of contributors have drawn upon
relevant research complemented by their own clinical experience.
The result is a significantly expanded text that is accessible to the entire dental
team and covers the problematic presentation and multifactorial aetiology of tooth
wear. Various management options are considered, and clinical examples guide the
reader through practical approaches to care for patients in an effective and contem-
porary manner. The emphasis throughout is on diagnosis and prevention as well as
minimal intervention wherever appropriate and possible.
This book will serve as the recommended text for the first blended learning
course on the management of tooth wear developed by the Faculty of Dental Surgery
at the Royal College of Surgeons of England. I congratulate the editors and authors
for this comprehensive clinical guide that will be invaluable to dental professionals
across the globe as they care for increasing numbers of patients with tooth wear.
Matthew Garrett
Dean, Faculty of Dental Surgery
Royal College of Surgeons of England
London, UK
vii
Tooth Wear: Editors’ Introduction
Abstract
Alongside dental caries and periodontal diseases, tooth wear is an increasingly
important area of clinical dentistry. Raising awareness of tooth wear and its early
identification, just as all dental professionals would wish to do for all primary dental
diseases and particularly oral cancers, are essential aspects of providing effective
oral healthcare for our patients. Here, we introduce the latest edition of this multi-
author textbook on tooth wear.
Introduction
Anthropologists have regarded tooth eruption in humans as being genetically prede-
termined and with us since the beginning of humanity. Its aim, seemingly, is to
compensate for natural wear of the incisal edges and occlusal surfaces [1].
However, the types of tooth wear that had remained unchanged since the origins
of life have undergone profound changes in a very short space of time. Today’s tri-
bochemical pathological model has replaced the abrasive physiological model of
the past [2].
Several synonyms have been used to describe this model. In 1997, Smith et al.
made a cogent suggestion that the term ‘Tooth Wear’ should be used exclusively
with the aim of drawing the patient’s attention to the potentially irreplaceable
destruction of the hard dental tissues [3]. This recognises the essential need to obtain
the patient’s cooperation through counselling and monitoring.
Another metonym that has been widely used to describe tooth wear is ‘bruxism’.
From the perspective of the dental practitioner or patient, bruxism has always been
considered the act of nocturnal grinding of the teeth and the resultant damage [4].
However, there is now a view that the bruxism construct has shifted from pathology
to a motor activity with possibly even physiological or protective relevance [5].
Thus, it may in fact be a risk or a protective factor for any single individual (with
solar radiation being cited as a similar example) [6]. Hence, using ‘harmless behav-
iour’, ‘risk factor’ and ‘protective factor’ as terms describing the various possible
consequences of bruxism ‘is still the best option’ [6].
ix
x Tooth Wear: Editors’ Introduction
Defining Tooth Wear
In the latest Delivering Better Oral Health evidence-based toolkit [7], tooth wear is
included in the summary guidance for the first time alongside dental caries, peri-
odontal diseases, oral cancer and behaviour change. In this document, tooth wear is
defined as the cumulative loss of mineralised tooth tissue due to chemical and/or
mechanical factors with plaque not being involved in the aetiology.
Tooth wear is normally multifactorial (Fig. 1) and involves a combination of ero-
sion (chemical loss due to extrinsic or intrinsic acids), attrition (physical loss due to
tooth-to-tooth contact) and abrasion (physical loss caused by objects other than
teeth) [7]. Abfraction (a tooth wear defect near a gingival margin) is mentioned, but
there is a lack of clinical evidence to support this as a separate cause of tooth wear
[7]. In the earliest stages, enamel remineralisation may be possible [7]. Once tissue
has been lost from a tooth, leading to a change in its shape or form, tooth wear
becomes irreversible [7].
Multiple widely accepted descriptors of tooth wear have been used in recent
years and include chronological, non-age-related, pathological and accelerated
tooth wear [7]. The use of the term ‘Tooth Surface Loss’, which was the title of
previous editions, has been superseded by ‘Tooth Wear’ which is internationally
recognised [7].
As described by Loomans et al. in the European Consensus Statement of 2017,
the age of a patient and the amount of tooth tissue lost together define the tooth wear
status of any particular patient [8]. With progression over time, wear may become
severe with substantial loss of tooth structure, dentine exposure and significant loss
Fig. 1 Common
Erosion resulting in loss of Abrasion of the softer
presentations of tooth wear
surface anatomical detail dentine once the protective
and volume of tooth tissue enamel has been lost
Attrition, normally of opposing occlusal contacting
surfaces, seen here as a result of many years of inter-
dental contact in this elderly patient has resulted in
contact points becoming broader contact areas
Tooth Wear: Editors’ Introduction xi
(≥1/3) of the clinical crown [8]. Tooth wear which is atypical for the age of the
patient has been described as pathological tooth wear and can cause pain or discom-
fort, functional problems or deterioration of the appearance, which, if progressing,
may give rise to undesirable complications of increasing complexity [8].
Setting the Scene
Tooth wear (Fig. 2) has become a key feature of national dental surveys in England
[9, 10]. Within each of these aetiological factors of erosion, attrition and abrasion
will be a wide range of possible causes. Most challenging is that these processes are
rarely seen in isolation, and identifying the individual causes within a multifactorial
aetiology is essential if care strategies are to be successful (Fig. 3). Commonly, one
of the aetiological factors will be dominant (Fig. 4).
Patients will most often present with problems of altered function or a compro-
mised appearance, but this may be quite a late presentation with symptoms of sen-
sitivity and sharpness of teeth developing sooner. At the more advanced stages of
wear, quality of life may also be negatively impacted, and how this can be improved
should increasingly be considered as an essential aspect of planning care.
Fig. 2 56-year-old male
with tooth wear due to
erosion, attrition and
abrasion
Fig. 3 78-year-old female
with tooth wear of
multifactorial aetiology
