Tooth wear is defined as the progressive loss of hard dental tissue not caused by caries, trauma or developmental disorders. The causes can be mechanical or chemical. The mechanical causes are attrition, abrasion, abfraction. The main chemical cause is erosion.
Attrition is caused by excessive functional (chewing) or parafunctional (bruxism) forces. It is mainly seen on the occlusal faces of the teeth. It is an exaggerated functional or parafunctional force caused by contact of one tooth with another tooth.
Abrasion is caused by materials, objects, or substances (not related to the mouth itself) that repeatedly contact the surface of the teeth (brush, toothpaste, pens, food, and other objects). The morphology of the defect can be generalized or localized depending on the action of the object on the teeth. It is a type of wear caused by the contact of an object with teeth.
Abfraction is the pathological loss of dental hard tissue caused by biomechanical loading forces. The load of forces is concentrated on the tooth’s neck causing the enamel to peel off and creating a non-carious cervical injury.
Erosion is the progressive loss of dental tissue caused by chemical (acid) processes. It can be intrinsic, that is, caused by acids produced by the body itself (reflux, bulimia) or extrinsic, caused by a diet based on acid products (pH <5.5).
In general, the origin of dental wear is usually multifactorial, or is caused by a combination of causes.
In order to establish the correct treatment plan, it is very important to know for sure what is the etiology of the failure and thus be able to make a correct diagnosis.
Treatment depends on the degree of dental wear. If the affectation is slight, with a correction of habits and a correct dental prevention the problem can be solved easily; teaching dental hygiene, use of fluoride, reduce the acid diet.
When the case is moderate or severe, we can restore correct dental aesthetics and function to the patient by performing a fixed prosthesis restoration with crowns or an adhesive restoration with veneers and onlays. The difference between the two techniques depends on the preservation of the residual tooth structure. When we make crowns we carve the teeth to leave a stump where the crown will be cemented. It is a type of mechanical retention because the cover is cemented to a tooth transformed into an abutment. In adhesive restorations, the residual dental structure is kept longer (more conservative technique) and the missing part of the tooth is added to this through a chemical bonding process. That is why we use onlays and veneers. Usually the ceramic material is the best choice since it offers us better aesthetics and resistance.
Once the treatment is finished, it is essential to correct or prevent the causes that have caused dental wear. The use of a mouth guards prevents wear caused by attrition of the teeth. It is very important to correct dietary habits to block chemical erosion of teeth and to get fluoride treatment to remineralize enamel.