Introduction
Tooth surface loss can arise as a result of erosion, abrasion or attrition. These processes are rarely seen in isolation and often cause patients to seek help for problems of pain, altered function and compromised appearance. Individuals of all ages can present with the condition: in this series attention will not only be given to the older patient but also to younger individuals affected by pathological tooth surface loss which is well in advance of their chronological age.
Emphasis is given to presenting practical clinical techniques which should help dentists to identify the aetiological factors responsible for tooth surface loss and assist in planning and delivering appropriate patient care. The authors include not only restorative dentists but other specialists: this reflects the fact that the management of some patients will require inter-disciplinary care.
Management of individuals suffering from tooth surface loss remains difficult but developments in materials and techniques have made the delivery of restorative care easier. The central difficulties that will be addressed in the series are:
- The difficulties of diagnosis and prevention
- The difficulties of controlling tooth surface loss
- The difficulties of restoration.
Difficulties of diagnosis
The three types of tooth surface loss each have their own characteristic appearance. However, the wear of an individual's teeth is rarely from a single cause although one is likely to predominate. The articles in this series define the characteristics of each and allude to the significant difficulties that the clinician frequently encounters in determining the dominant aetiology. There is emphasis on the need for thorough histories supported by diet sheets and sometimes assistance from medical colleagues in determining some of the intrinsic causes of tooth surface loss.
Difficulties in controlling the tooth surface loss
Identification of the causative factors is imperative. This can prove difficult or even occasionally disappointingly impossible. In the latter instances the likelihood of controlling the destruction of the teeth is low. However, many of the changes that we may be asking our patients to make represent significant changes in habits or lifestyle. The difficulty in achieving this should not be underestimated: patients often will require considerable support, encouragement and advice. The series repeatedly emphasises the fundamental importance of prevention and the available measures that can be used.
There also remains the difficulty of detecting slowly progressive tooth wear. Study casts, indices and photographs are all helpful. However, as the teeth generally continue to erupt as they wear, small amounts of further loss of hard tissue remain very difficult to detect. This makes monitoring the effectiveness of any preventive measures equally difficult.
Difficulties of restoration
In previous decades patients suffering from marked tooth surface loss would frequently have been provided with multiple crowns and bridges to restore appearance and comfort. Such treatment is complex and generally highly invasive. Consequently there has therefore always been a tendency to defer its provision if at all possible, with the consequence that tooth wear was usually well advanced before definitive restorative treatment was commenced. Patients were probably also deterred from undergoing long complicated and expensive courses of treatment until it became absolutely essential.
Developments in dentistry mean that this approach is no longer the only one available. While traditional crowns and fixed and removable prostheses still have a significant part to play, many conservative strategies can now be used to provide restoration and protection for damaged teeth. The continued eruption of teeth as they wear creates a major restorative difficulty. If restorations are needed, space must be created to permit an aesthetic and occlusally stable result. A number of articles in the series will describe the ways in which the problem of lack of space may be minimised or overcome. These apply the results from more recent research and developments in clinical practice that have simplified many of the restorative procedures for both patient and dentist.
The series will discuss the following subject areas:
- The causes of tooth surface loss
- The prevention and control of wear
- The restoration of worn teeth using both fixed and removable prostheses
- Maintenance and monitoring
- Dealing with failures.
