Attrition is the physiological wearing away of the tooth as a result of the contact between two tooth such as chewing or grinding of tooth. It can happen in all tooth, along the biting surfaces and on the proximal or adjacent surfaces of the tooth. It is seen in both deciduous or milk teeth as well as in permanent teeth. It is also a part of the normal aging process. Attrition occurs because of the physiological contact of the two opposing tooth or the 2 adjacent tooth and the mechanical wearing away of the tooth. When attrition happens sometimes it involves the tooth in the entire quadrant as it is a collective process. Attrition is seen more on the older population where teeth wearing has occurred after years of chewing food and it is seen more in men than women.
The causes of tooth attrition includes heavy pressure during chewing, heavy built muscles of the jaws, malalignment of tooth, coarseness of the diet, habits such as tobacco chewing or bruxism, and occupations exposed to dust and sand.
The symptoms of attrition includes flattening of the biting surface of tooth, appearance of a polished facet on the tooth surface, decrease in width of the tooth due to interproximal attrition, and as it continues in older people there is gradual reduction in height of the tooth and the tooth reduced to a stump with a flat biting surface. In advanced stage due to attrition, there will be exposure of the dentin and it will be stained yellow or brown with the food and there will be sensitivity of teeth to heat and cold foods. The level of attrition may reach nearly the point of the gingival margin in extreme cases . The exposure of the dentinal tubules may lead to protective secondary dentin deposition at the side of the pulp, which prevents and protects the pulp from any further injury or subsequent seepage of materials into the pulp. The appearance of the tooth is compromised with bad esthetics to the face.
The treatment of mild attrition involves repair of the tooth using filling materials such as cements can be undetaken. In severe attrition, restoration of the tooth is done by placing crowns and onlays. The restoration helps to restore the length of the tooth, stops the sensitivity of tooth by closing the dentinal tubules, the bite relationship of the tooth are maintained, and the overall esthetics are improved.
Abrasion of Teeth
Abrasion is the wearing away of the tooth due to abnormal mechanical process. Abrasion is commonly seen on the exposed root surfaces along the gum margin of the teeth and also on the proximal surfaces of the tooth. It is seen at the junction where the enamel and cementum part of the tooth meet. Usually the abrasion of the root surface is marked by a wedge shaped or a v-shaped mark or notch along the exposed tooth root with some gingival recession. The wedge is a sharp one when there is more abrasive wear of the tooth leaving behind a portion of the tooth missing. Abrasion is also seen at the tips of the anterior teeth and also the biting surfaces of the posterior teeth.
The abrasion of the root surfaces occurs by indiscriminate use of abrasive dentifrice, incorrect tooth brushing in a horizontal direction rather than vertically, incorrect application of toothpicks, etc. Other forms of abrasion occurs due to occupational and habitual actions such as holding nails or pins using the front tooth, opening bobby pins, opening of bottles or cans using the teeth, habitual pipe smoking etc. The tooth of people involved in occupations such as tailoring, shoe making, carpentry etc. exhibit this type of abrasive wearing away.
The treatment of abrasion is done through conservative repair of the abraded area filled with a tooth colored cement. Fluoride application also helps to prevent further abrasion of an area already abraded. Prevention also involves making sure that the loss of tooth substance does not involve deep inside the pulp and immediate steps taken to prevent any irreversible damage to the pulp.
Erosion of Teeth
Erosion is the loss of the tooth substance due to a chemical process. It is seen on the inside, outside, and proximal surfaces of the tooth. It is characterized by a shallow, broad, and polished surface with a scooped out appearance on the enamel. It may involve multiple teeth especially the anterior teeth. Shallow areas are noted on the junction between the enamel and cementum or root portion of the tooth. Whenever the dentine is exposed there will be sensitivity to sweet, hot, and cold foods and drinks.
Causes of the erosion may be due to increased usage or overuse of acidic foods such as lime juice, carbonated drinks, citrous fruits, fruit juices, etc. It is also seen in persons who has chronic vomiting, the inner surface of the tooth will be lost due to dissolution by hydrochloric acid. Dental erosion has been found among those working in industries that involves dealing with acids, such as plating, galvanizing, acid pickling, battery manufacture, sanitary cleanser manufacture etc.
Treatment depends on the severity of erosion. If the erosion is not wide or serious enough, it does not need any specific treatment. When the erosion is more, tooth colored restorative materials such as cements are used to replace the area worn off by the acid. Alternatively fluoride application may also be done to prevent dissolution of enamel by the acids. The fluoride application forms an insoluble complex with the enamel surface protecting it from acids.
Prevention includes avoiding of foods and drinks that has acidic content. Treatment of underlying disease that involves chronic vomiting. Alteration in work conditions in occupations which involves working with acids.