The tooth wear evaluation system: a modular clinical guideline for the diagnosis and management planning of worn dentitions

Wear Properties of Different Additive Restorative Materials Used for Onlay/Overlay Posterior Restorations

The purpose of this laboratory study was to compare the two-body wear resistance of different restorative materials commonly used for the indirect restoration of posterior teeth. The tested materials, based on ceramic (Imagine Press X, IPS e.max CAD, Milled Celtra Duo, Glaze-Fired Celtra Duo, Vita Mark II) and composite (Enamel Plus HRi, Enamel Plus HRi Bio-Function, Filtek Supreme XTE, Lava Ultimate), were compared with the wear properties of a type III gold alloy (Aurocast 8). Flat samples were prepared with a 6-mm thickness (n=10). Composite samples were tested after a heat polymerization cycle. All samples were exposed to a two-body wear test in a dual axis chewing simulator performing over 120,000 loading cycles. The opposing abrader cusps were fabricated from yttria-stabilized tetragonal zirconia polycrystal. The vertical substance loss (mm) and the volume loss (mm3) were recorded, as was the wear of the antagonist cusp (mm). Mean values were analyzed by one-way analysis of variance. Significant differences among materials were detected. The heat-cured resin-based composite material Enamel Plus Bio-Function and the type III gold alloy demonstrated similar mean values for wear depth and volumetric loss.

Tooth wear as an indicator of acculturation process in remote Amazonian populations

Riverine populations are typical of the Amazon region that depend on nature for subsistence. These people are considered an intermediate population between the urban and indigenous, the original Amazon habitants. The aim of this cross-sectional study was to evaluate the relationship between tooth wear and age in a remote riverine population from the Amazon, located by the Tucumanduba River (n = 94), and to compare them to previous findings obtained from semi-isolated indigenous (n = 223) and urban populations (n = 40) from the Amazon region, which were examined using the same methodology. Using linear regression, tooth wear explained 54.5% of the variation in the ages of the riverine subjects (p<0.001). This coefficient is mid-way between those obtained in semi-isolated indigenous populations (65–86%) and urban subjects (12%) living in the Amazon. Our findings suggest that tooth wear, a direct evidence of what an individual ate in the past, may be an indicator of the acculturation process in remote populations.

A methodology for evaluating tooth wear monitoring using timed automata modelling

OBJECTIVES

Tooth wear is a multifactorial condition leading to the loss of dental hard tissues. A counselling/monitoring protocol is of importance in order to keep that loss as limited as possible. Since many factors are involved and a time span of decades is included, research to disentangle all these processes in patients is difficult. Instead, a modelling technique was used that is able to deal with time, costs and probabilistic and stochastic information. The aim was to shed light on the question: does a yearly or a once-in-five-years counselling/monitoring protocol yield better outcome measures?

METHODS

A so-called timed automata model was adopted, analysed with the tool UPPAAL. To our knowledge, this is the first time that formal modelling is applied in dentistry. In this article, a UPPAAL model for the evaluation of tooth wear is described.

RESULTS

Using the UPPAAL model, it was calculated that with a yearly counselling/monitoring protocol the severity of tooth wear at age 74, the total costs per person and the number of restorative treatments were less, and the number of so-called "good years" was higher.

CONCLUSIONS

With the use of the UPPAAL model, it may be concluded that a yearly counselling/monitoring protocol can yield better outcome measures.

CLINICAL SIGNIFICANCE

Regarding dentistry in general and tooth wear in particular, with the use of a timed automata model in UPPAAL, actual research questions can be answered, factors of influence in a multifactorial condition like tooth wear can be clarified, and future research topics can be determined.

The effect of tooth wear, age and sex on facial height assessed by soft tissue analysis

AIM

The aim of the study was to evaluate the effects of tooth wear, age and sex on facial height measurements based on soft tissue analysis.

METHODS

One hundred and twelve subjects (45 males and 67 females), 19-80 years of age (mean 43 ± 0.9 years), which were divided into three age groups, met the inclusion criteria. Tooth wear was assessed using a 5-point ordinal scale (0-4). Based on the tooth wear score, three groups were defined: mild, moderate and severe wear. Facial height was evaluated based on soft tissue measurements using frontal facial photographs. The dimension of the upper facial height (UFH) and lower facial height (LFH) and the ratio between the two (R-U-L) were measured.

RESULTS

Facial height dimensions (UFH, LFH) were significantly different between the three age groups and between the three tooth wear groups. Both the UFH and LFH measurements had a weak positive correlation with age (r = .40; r = .41, respectively) and with tooth wear (r = .40; r = .41, respectively). The R-U-L showed a significant difference (P < .001) between sexes as males showed slightly lower ratio compared with females; however, the R-U-L was not dependent upon age or tooth wear.

CONCLUSIONS

This study demonstrated that although facial height is affected by age and tooth wear, the proportion between the upper to lower facial segments is constant and is not affected by the same parameters. A statistically significant difference in the R-U-L relative to sexes was noted.

Clinical presentation of two phenotypes of tooth wear patients

OBJECTIVE

To assess the clinical presentation of wear lesions in two phenotypes of tooth wear (TW) patients based on distribution and morphological features of wear.

MATERIALS AND METHODS

103 patients (mean age = 43.1 years) were divided into two groups based on cluster analysis; cluster A (61 patients) and cluster B (42 patients). The distribution of wear lesions, scores of presence or absence of 10 defined morphological TW criteria and number of teeth fulfilling each criteria were compared between groups. Intra- and inter-examiner reliability of the 10 TW criteria was determined by Cohen's kappa and intraclass correlation coefficient.

RESULTS

While cluster A had more wear in maxillary anterior teeth and mandibular molars compared with the same opposing tooth groups (p < 0.001, p < 0.007 respectively), there were no differences for cluster B. Cluster A was characterized by higher prevalence of 4 chemical morphological criteria and the highest number of teeth affected by one chemical criteria, whereas cluster B had a higher prevalence of one mechanical criteria and higher number of teeth affected by an additional mechanical criteria. Both intra- and inter-examiner values for the defined TW criteria were fair to excellent.

CONCLUSION

The results may indicate a more chemical background for TW in cluster A and mechanical background in cluster B. Furthermore, clinicians may use certain clinical features of TW to distinguish between individuals who belong to a specific TW cluster with a presumed chemical or mechanical etiology. These preliminary findings need to be confirmed in future studies.

Associations between tooth wear and dental sleep disorders: A narrative overview

Objectives

Tooth wear is a common finding in adult patients with dental sleep disorders. The aim of this paper was to review the literature on the possible associations between tooth wear and the following dental sleep disorders: sleep‐related oro‐facial pain, oral moistening disorders, gastroesophageal reflux disease (GERD), obstructive sleep apnoea syndrome (OSAS) and sleep bruxism.

Methods

A PubMed search was performed on 1 June 2018 using MeSH terms in the following query: Tooth Wear AND (Facial Pain OR Temporomandibular Joint Disorders OR Xerostomia OR Sialorrhea OR Gastroesophageal Reflux OR Sleep Apnea Syndrome OR Sleep Bruxism).

Results

The query yielded 706 reports on tooth wear and the mentioned dental sleep disorders. Several associations between tooth wear and the dental sleep disorders were suggested in the literature. It could be concluded that: (a) tooth wear is associated with dental pain and/or hypersensitivity; (b) oral dryness is associated with tooth wear, oro‐facial pain and sleep bruxism; (c) GERD is associated with tooth wear, oro‐facial pain, oral dryness, OSAS and sleep bruxism; (d) OSAS is associated with oral dryness, GERD and sleep bruxism; and (e) sleep bruxism is associated with tooth wear.

Conclusions

Tooth wear is associated with the dental sleep disorders oro‐facial pain, oral dryness, GERD and sleep bruxism. The dental sleep disorders are interlinked with each other, which leads to indirect associations as well, and makes the consequences of each single condition difficult to disentangle. Knowledge of these associations is clinically relevant, but more research is needed to confirm their validity.

A survey on the prevalence and risk indicators of erosive tooth wear among adolescents in Guangzhou, South China

BACKGROUND

Erosive tooth wear (ETW) has become a crucial oral health problem over the decades in China.

OBJECTIVES

To explore the prevalence and risk indicators of ETW among adolescents in Guangzhou, south China.

METHODS

A cross-sectional survey of 720 participants was conducted in Guangzhou, using an equal-sized, stratified, multistage random sampling approach. The participants were from two different age groups (12- and 15-year-olds), 360 per group. The ratio of males to females was 1:1 in each group. ETW was recorded utilising the basic erosive wear examination (BEWE) index as the dependent variable. Independent variables included age, gender, region, socioeconomic status, dietary factors, oral health measures and others.

RESULTS

The prevalence rates (weighted) of ETW and dentin exposure (DE) were 56.1% and 26.2% among adolescents in Guangzhou, with mean teeth (weighted) of 1.8 ± 2.5 and 0.6 ± 1.5, respectively. No matter the prevalence or the mean teeth, the 15-year-olds were higher than the 12-year-olds; the mean teeth of ETW of males was higher than that of females; the mean teeth of ETW and DE of the adolescents of low socioeconomic status were higher than those of high socioeconomic status. Medium to high risk levels were found for 10.1%. In the multiple regression model, age, gender and taking acidic foods/drinks before sleep were associated with ETW.

CONCLUSIONS

Moderate ETW in the permanent dentition was common among adolescents in Guangzhou. However, the teeth involved were low. Dietary factors and demographics were the main risk indicators.

The prevalence of awake bruxism and sleep bruxism in the Dutch adult population

Background

Awake bruxism and sleep bruxism are common conditions amongst adult populations, although prevalence data are scarce.

Objective

This study aimed to assess the prevalence of awake bruxism and sleep bruxism in the Dutch adult population.

Methods

As part of a large epidemiologic survey on oral health of the general Dutch adult population, a total of 1209 subjects were asked about their bruxism behaviour during the day and during their sleep. The collected data were subjected to stratified analysis by five age groups (25‐34, 35‐44, 45‐54, 55‐64 and 65‐74 years), socioeconomic status, and gender.

Results

A prevalence of 5.0% of the total population was found for awake bruxism and of 16.5% for sleep bruxism. Regarding the five age groups, prevalence of 6.5%, 7.8%, 4.0%, 3.2% and 3.0%, respectively, were found for awake bruxism, and of 20.0%, 21.0%, 16.5%, 14.5% and 8.3%, respectively, for sleep bruxism. Women reported both awake bruxism and sleep bruxism more often than men. These differences were statistically significant. Concerning socioeconomic status (SES), both awake bruxism and sleep bruxism were more often found in high SES groups, being statistically significant for awake bruxism only.

Conclusion

Sleep bruxism is a common condition in the Dutch adult population, while awake bruxism is rarer.

Effect of zirconia polycrystal and stainless steel on the wear of resin composites, dentin and enamel

This study evaluated the effect of two antagonist substrates (Y-TZP/zirconia or stainless steel) on the wear rate and surface alterations of different composite materials and bovine tooth substrates (enamel and dentin). The wear rate of different composite materials (n = 20; two direct composite resins: HelioMolar - HM; Clearfil AP-X - CAP, three indirect composite resins: Estenia C&B - EST; Adoro - ADO; Sinfony - SFY, and one composite resin for direct/indirect restorations: Filtek Z250 - Z250), bovine enamel and dentin against two different antagonist materials (zirconia or stainless steel) into two mediums (two-body and three-body wear) were collected. After wear tests on ACTA wear machine, Scanning Electron Microscopy (SEM) analysis was performed to access the surface alterations. The wear data were evaluated by three-way ANOVA and Tukey post-hoc test (α = 0.05). The factors 'antagonist', 'medium', 'restorative materials', and the interaction of all factors grouped by two and integrated showed statistical significance on the wear rates. A two-body test depicted no difference among all composites and enamel for wear rate, while a three-body test depicted differences among composites directly related to the filler content: EST < Z250 = CAP < ADO = HM < SFY. Dentin always showed the highest wear rates and enamel the lowest rates. The presence of food bolus (three-body test) led to higher wear rates in comparison to an only aqueous medium (two-body test). SEM analysis showed that different materials present specific wear patterns, regardless of the medium and the antagonist considered. Differently from enamel, dentin substrate was intensively prone to wear, regardless of the antagonist/medium. Resin composite substrates presented intermediate wear rates, depending directly on their filler content (% in weight).

Antagonist enamel wear of tooth-supported monolithic zirconia posterior crowns in vivo: A systematic review

STATEMENT OF PROBLEM

An assessment of the evidence for the antagonist enamel wear of tooth-supported monolithic zirconia posterior crowns is lacking.

PURPOSE

The purpose of this systematic review was to identify and summarize clinical studies related to the antagonist enamel wear of tooth-supported monolithic zirconia posterior crowns.

MATERIAL AND METHODS

PubMed, Embase, and Cochrane library searches were performed and complemented by manual searches from database inception to December 25, 2017, for title and abstract analysis.

RESULTS

Initially, 198 articles were obtained through database searches. Twenty-one articles were selected for full-text analysis, and 5 studies met the inclusion criteria. Because of the heterogeneity in design, surface treatment, measurement methods, and wear parameters, a meta-analysis was not possible. The selected studies were analyzed regarding the antagonist natural enamel wear of zirconia, measurement methods, and surface treatment. The results of the antagonist enamel wear varied widely, which made comparing them scientifically with absolute values difficult.

CONCLUSIONS

This review indicated that the antagonist enamel wear of zirconia was similar to or more than that of natural teeth but less than that of metal-ceramics. Additional properly designed, longer follow-up clinical trials with larger sample sizes are needed to evaluate the antagonist enamel wear of monolithic zirconia crowns in vivo.

International consensus on the assessment of bruxism: Report of a work in progress

In 2013, consensus was obtained on a definition of bruxism as repetitive masticatory muscle activity characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible and specified as either sleep bruxism or awake bruxism. In addition, a grading system was proposed to determine the likelihood that a certain assessment of bruxism actually yields a valid outcome. This study discusses the need for an updated consensus and has the following aims: (i) to further clarify the 2013 definition and to develop separate definitions for sleep and awake bruxism; (ii) to determine whether bruxism is a disorder rather than a behaviour that can be a risk factor for certain clinical conditions; (iii) to re-examine the 2013 grading system; and (iv) to develop a research agenda. It was concluded that: (i) sleep and awake bruxism are masticatory muscle activities that occur during sleep (characterised as rhythmic or non-rhythmic) and wakefulness (characterised by repetitive or sustained tooth contact and/or by bracing or thrusting of the mandible), respectively; (ii) in otherwise healthy individuals, bruxism should not be considered as a disorder, but rather as a behaviour that can be a risk (and/or protective) factor for certain clinical consequences; (iii) both non-instrumental approaches (notably self-report) and instrumental approaches (notably electromyography) can be employed to assess bruxism; and (iv) standard cut-off points for establishing the presence or absence of bruxism should not be used in otherwise healthy individuals; rather, bruxism-related masticatory muscle activities should be assessed in the behaviour's continuum.

Methadone maintenance treatment may be associated with bruxism in male prisoners

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Methadone treatment, bruxism, and temporomandibular disorders among male prisoners. Enguelberg-Gabbay JV, Schapir L, Israeli Y, Hermesh H, Weizman A, Winocur E. Eur J Oral Sci 2016;124(3): 266-71.

SOURCE OF FUNDING

None TYPE OF STUDY/DESIGN: Cross-sectional study.

A guide to managing tooth wear: the Radboud philosophy

This paper explains a conservative, pragmatic and minimally invasive intervention concept for the treatment of severe tooth wear patients based on the Radboud Tooth Wear Project in the Netherlands. Guidelines and flowcharts for management of severe tooth wear patients and rehabilitation in increased vertical dimension of occlusion are presented. We concluded that: (a) Restorative treatment is not always indicated, even for patients with severe tooth wear. (b) If the patient has no complaints, counselling and monitoring is probably the best option. (c) Minimally invasive and adhesive restorative strategies are preferred when severe tooth wear patients are to be treated in increased vertical dimension, especially when young patients are involved. (d) Clinical evidence for a suitable restorative treatment protocol is limited to five-year follow up for direct composites. This material seems to be suitable for rehabilitation in increased vertical dimension on the middle long term. Clinical results for indirect techniques are not available yet. (e) Restorations, including those that are considered 'definitive' may prove to have a limited lifetime in patients with severe tooth wear due to bruxism and erosion. Explanation of the possible treatment options and expected complications should be included in the informed consent.

The influence of management of tooth wear on oral health-related quality of life

Objective

The purpose of this study was to identify the level of oral health-related quality of life and orofacial appearance in patients with moderate to severe tooth wear. Patients with and without a request for restorative treatment were included.

Methods

One hundred twenty-four patients (98 men, 26 women, mean age: 40.5 ± 8.8 years) with moderate to severe tooth wear were included. Patients without a request for help received a non-restorative treatment of counseling and monitoring. Patients with a request for restorative treatment were treated with a full rehabilitation using composite resin restorations. Oral Health Impact Profile (OHIP-NL) and Orofacial Esthetic Scale (OES-NL) questionnaires were filled in at baseline and after 1 year.

Results

Counseling and monitoring group: baseline OHIP-NL score was 0.4 ± 0.3, baseline summary score of OES-NL was 48 ± 7.0, and baseline impression score was 7.1 ± 1.2. Scores had not changed significantly after 1 year (p = 1.00 after Bonferroni correction).Restoration group: baseline OHIP-NL score was 0.8 ± 0.6, baseline summary score of OES-NL was 38 ± 10, and baseline impression score was 5.9 ± 1.5. Scores had improved significantly after 1 year (p < 0.001 after Bonferroni correction).

Conclusions

Counseling and monitoring did not result in a significant deterioration and restorative treatment resulted in a significant improvement of oral health-related quality of life (OHRQoL) and orofacial appearance in this patient group.

Clinical significance

In patients with moderate to severe tooth wear, without functional and esthetical problems, counseling and monitoring may be an appropriate treatment option. Restorative treatment in patients with a need for treatment results in an improved OHRQoL. OHIP and OES questionnaires may be used to monitor changes in clinically relevant symptoms.

Association of dietary habits and parental-reported sleep tooth grinding with tooth wear in children with mixed dentition

BACKGROUND

Tooth wear has a multifactorial etiology, thus it should be assessed within a multiple-variable framework. The objective of this investigation was to assess the association of dietary habits and parental-reported sleep tooth grinding (STG) with tooth wear in children with mixed dentition.

METHODS

One hundred twenty-one (N = 121) subjects (mean age 9.6 years) participated in a cross-sectional study. Wear of 1637 teeth was evaluated using the screening module of the Tooth Wear Evaluation System (TWES). Parental-report of STG was evaluated by means of the Children's Sleep Habits Questionnaire (CSHQ), whilst dietary habits were investigated by means of the Health Behaviour in School-Aged Children Food-Frequency Questionnaire (HBSC-FFQ). Data were analyzed with the Spearman correlation test and ordinal-multiple-variable regression analyses. Odds Ratio (OR) and ordinal OR were obtained for the independent variables included in the models.

RESULTS

Parental-report of STG is not associated with tooth wear in the mixed dentition; some dietary habits were found to be correlated with specific tooth wear patterns, but the correlation values were weak. Associations were found between dietary habits and the increase-to-increase severity of occlusal/incisal and non-occlusal/non-incisal tooth wear of some teeth (OR > 2).

CONCLUSIONS

A strong correlation of dietary habits and sleep tooth grinding with tooth wear in the mixed dentition was not demonstrated. However, dietary habits showed to have effects in terms of increase-to-increase severity.

Quantitative light-induced fluorescence technology for quantitative evaluation of tooth wear

Various technologies used to objectively determine enamel thickness or dentin exposure have been suggested. However, most methods have clinical limitations. This study was conducted to confirm the potential of quantitative light-induced fluorescence (QLF) using autofluorescence intensity of occlusal surfaces of worn teeth according to enamel grinding depth in vitro. Sixteen permanent premolars were used. Each tooth was gradationally ground down at the occlusal surface in the apical direction. QLF-digital and swept-source optical coherence tomography images were acquired at each grinding depth (in steps of 100  μm). All QLF images were converted to 8-bit grayscale images to calculate the fluorescence intensity. The maximum brightness (MB) values of the same sound regions in grayscale images before (MBbaseline) and phased values after (MBworn) the grinding process were calculated. Finally, 13 samples were evaluated. MBworn increased over the grinding depth range with a strong correlation (r=0.994, P<0.001). In conclusion, the fluorescence intensity of the teeth and grinding depth was strongly correlated in the QLF images. Therefore, QLF technology may be a useful noninvasive tool used to monitor the progression of tooth wear and to conveniently estimate enamel thickness.

Worn is born: The role of the maxillo-mandibular relation in management of worn dentition

Worn dentition, often accompanied by occlusion changes such as reduced vertical dimension, poses a big challenge to both diagnosis and treatment. Current established causes fail to explain the observed tooth wearing patterns, and the treatments based on the documented pathogeneses are often unpredictable and require frequent maintenance. From the perspective of stomatognathic system, we postulate that the role of maxillo-mandibular relation is a crucial part in the tooth wear progression patterns, and should be well addressed in treatment planning. Incompatible occlusion with the inherent tendency of maxillo-mandibular relation has a profound effect on either wearing of natural teeth or failures of restorations. With the aid of cephalometrics and analysis of occlusion it is now possible to reduce this fallacy and achieve a harmony by re-designing the occlusion. According to our treated worn dentition cases, the restoring treatment guided by the tendency of maxillo-mandibular relation showed very promising results.

The Prevalence of Tooth Wear in the Dutch Adult Population

This study aimed to assess the prevalence of tooth wear in different age groups of the Dutch adult population and to determine this tooth wear distribution by gender, socioeconomic class, and type of teeth. Results were compared with the outcomes of a previous study in a comparable population. As part of a comprehensive investigation of the oral health of the general Dutch adult population in 2013, tooth wear was assessed among 1,125 subjects in the city of 's-Hertogenbosch. The data collected were subjected to stratified analysis by 5 age groups (25-34, 35-44, 45-54, 55-64, and 65-74 years), gender, socioeconomic class, and type of teeth. Tooth wear was assessed using a 5-point ordinal occlusal/incisal grading scale. The number of teeth affected was higher in older age groups. Men showed more tooth wear than women, and subjects with low socioeconomic status (low SES) showed on average higher scores than those with high SES. Tooth wear prevalence found in this study was higher in all age groups than in the previous study. The present study found prevalences of 13% for mild tooth wear and 80% for moderate tooth wear, leading to the conclusion that these are common conditions in the Dutch adult population. Severe tooth wear (prevalence 6%) may however be characterized as rare. A tendency was found for there to be more tooth wear in older age groups, in men as compared with women, in persons with lower SES, and in the present survey as compared with the previous one.

Assessment of the amount of tooth wear on dental casts and intra-oral photographs

Tooth wear is a multifactorial condition, leading to the loss of dental hard tissues. Many grading scales are available to assess the amount of tooth wear, one of which is the tooth wear evaluation system (TWES). A grading scale can be used chairside, on casts and on photographs. The aim was to test whether the grading scales of the TWES, used on casts and on photographs, resulted in comparable scores. In addition, it was tested whether these scales can be used to assess tooth wear reliably on photographs. Of 75 tooth wear patients, sets of casts and series of photographs were obtained and graded. Comparison of the grading on casts and on photographs revealed equal median values and percentiles for both occlusal/incisal grading and non-occlusal/non-incisal grading. The grading on casts and on photographs showed a high correlation for the occlusal/incisal grading and a low correlation for the non-occlusal/non-incisal grading (Spearman's rho = 0·74 and rho = 0·47; P < 0·001). Concerning the grading on photographs, the interexaminer reliability was fair-to-good (ICC = 0·41 to ICC = 0·55) while the intra-examiner reliability was fair-to-good to excellent (ICC = 0·68 to ICC = 0·86) for the occlusal/incisal grading. For the non-occlusal/non-incisal grading, the interexaminer reliability was poor to fair-to-good (ICC = 0·22 to ICC = 0·59), while the intra-examiner reliability was fair-to-good to excellent (ICC = 0·64 to ICC = 0·82). It was concluded that the scores obtained with the grading scales of the TWES on casts and on photographs are comparable. The grading scales can be used in a reliable way on photographs, which is especially the case for occlusal/incisal grading.