Early diagnosis and daily practice management of erosive tooth wear lesions

Key Points

  • Explores some of the most relevant questions faced by dental practitioners when diagnosing early erosive tooth wear (ETW) and implementing non-operative management of this condition over time.

  • Early diagnosis and risk assessment should be implemented at younger ages

  • The non-operative management strategies arrest and/or reduce the rate of ETW progression and avoid its advance to pathological stages.

Abstract

This paper explores some of the most relevant questions faced by dental practitioners when diagnosing early erosive tooth wear (ETW) and implementing non-operative management of this condition over time. It focuses on the identification of clinical signs and common locations of ETW lesions, the assessment of individual risk and the implementation of non-operative management strategies, aiming to arrest and/or reduce the rate of ETW progression and avoid its advance to pathological stages. To this end, we present a novel and comprehensive approach that considers the whole dentition of patients rather than individual groups of teeth or dental surfaces only, illustrating it with a series of clinical photographs. Dental practitioners may find this approach particularly helpful as it closely simulates the clinical examinations of patients of all age groups carried out in daily practice. The clinical signs of early ETW lesions are subtle and often not perceived as relevant by unaware clinicians. However, the early diagnosis and implementation of non-operative management strategies, especially at younger ages, is fundamental for the proper control of ETW over time.

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Figure 1: Early clinical signs of erosive tooth wear.
Figure 2: Facial and palatal aspects of deciduous maxillary incisors showing erosive wear (arrows) and attrition at incisal edges (a).
Figure 3: The buccal surface of the dentition has a very shine appearance as a result of combined erosive and abrasive wear (a).
Figure 4: Shortening of maxillary incisors with irregular incisal edges (a).
Figure 5: A 14-year-old girl with early erosive lesions mostly located on the occlusal surfaces of first permanent first molars in which the groove-fossa-system is eroded, particularly in the mandibular molar, in contrast to that of the second molars which appears almost intact.

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Correspondence to A. T. Hara.

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Carvalho, J., Scaramucci, T., Aimée, N. et al. Early diagnosis and daily practice management of erosive tooth wear lesions. Br Dent J 224, 311–318 (2018). https://doi.org/10.1038/sj.bdj.2018.172

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