Biologically Based Restorative Management of Tooth Wear

Abstract

The prevalence and severity of tooth wear is increasing in industrialised nations. Yet, there is no high-level evidence to support or refute any therapeutic intervention. In the absence of such evidence, many currently prevailing management strategies for tooth wear may be failing in their duty of care to first and foremost improve the oral health of patients with this disease. This paper promotes biologically sound approaches to the management of tooth wear on the basis of current best evidence of the aetiology and clinical features of this disease. The relative risks and benefits of the varying approaches to managing tooth wear are discussed with reference to long-term follow-up studies. Using reference to ethical standards such as “The Daughter Test”, this paper presents case reports of patients with moderate-to-severe levels of tooth wear managed in line with these biologically sound principles.

Minimum intervention dentistry and the management of tooth wear in general practice

“…Restoration and rehabilitation of worn dentitions using direct and semi-direct tooth coloured adhesive restoratives have been shown to be a very successful and conservative option for many cases, and these less invasive treatments when implemented following on from the initial stabilization phase may be used to evaluate long-term patient compliance prior to undertaking more complex and costly indirect procedures. 4,5,8,9,11,13,44 …”

“…Options exist for the use of direct adhesive restorative materials to address the immediate functional and aesthetic concerns of the patient and minimize further damage. 7,[9][10][11]44 In a well stabilized oral environment these treatments provide an intermediate restorative option aiming toward the long-term occlusal and functional rehabilitation of the worn dentition. Indeed it has been suggested that there may be a tendency in dental practice to place more full crowns than may be necessary, and that the numerous advances that have become available to make conservative dentistry easier and more attractive for dentists and patients.…”

“…Despite the overall trend towards improved oral health and reduced dental caries incidence over the last decades, epidemiological evidence is supporting the contention that tooth wear is increasing in severity and prevalence, not only amongst older people who are living longer and retaining more teeth, but also amongst those in the early decades of their adult life. [1][2][3] This rising incidence of tooth wear has increased the demand on dental practitioners to provide a range of treatment options for the replacement of the lost tooth structure to cater for the range of individuals presenting with varying degrees of tooth wear.…”

“…7 In recent years there has been an increasing trend towards the restoration of severely worn and broken down dentitions using more conservative approaches with adhesive restorative materials. [7][8][9][10][11] These approaches aim to preserve as much remaining tooth structure as possible and provide a cost-effective management option for patients.…”

“…While dental caries is a localized event with plaque producing relative weak acids which demineralize tooth tissue over a prolonged period of time, tooth erosion is predominantly linked with stronger extrinsic or intrinsic acids over relatively short periods of time and the tooth surface loss can be quite extensive. [9][10][11] Prevention of this acidic demineralization in the absence of plaque is very dependent on the ability of saliva to stabilize and buffer the acidic challenges in the mouth. Patients with reduced salivary flow or reduced salivary buffering capacity will be at greater risk, and frequently are those demonstrating signs of tooth erosion.…”