Variation in tooth wear in young adults over a two-year period

Maria R. Pintado, MPH/Gary C. Anderson, DDS, b Ralph DeLong, DDS,

MS, PhD, c and William H. Douglas, BDS, MS, PhD d
School of Dentistry, University of Minnesota, Minneapolis, Minn.

Statement o f p r o b l e m . Although all the processes of loss of hard tissue are important, attrition on the
occlusal surfaces commands our attention.
Purpose of study. The enamel wear rate of 18 young adults over 2 consecutive years was measured
independently by volume loss and mean depth loss. Any significant differences in tooth wear resulting
from gender and a clinical diagnosis of bruxism were identified.
Material a n d m e t h o d s . A strict protocol for dental impressions provided epoxy models, which were
digitized with a null point contact stylus. AnSur software provided a complete morphologic description of
changes in the wear facets.
Results. The mean loss for all teeth measured was 0,04 mm 3 by volume and 10.7 pm by depth for the
first year.
Conclusions. These numbers were approximately doubled at 2 years of cumulative wear. (J Prosthet
Dent 1997;77:313-20.)

P i n d b o r g t reserved the term "am'ition" for the surface loss of hard tissue resulting from tooth-to-tooth contact, either occlusal or interproximal. Although all the
processes o f loss of hard tissue are important, attrition on
the occlusal surfaces commands our attention for a number o f reasons. (1) Dental attrition probably has articular
significance for the temporomandibular joint and, in extreme cases, it may be responsible for loss ofocclusal vertical dimension. 2,3 (2) Attrition leads to the loss of essential anatomic form and possibly to a change in masticatory efficiency.4 (3) Continued dental attrition can lead
to a breach ofocclusal enamel, exposing dentin. This may
lead to an acceleration o f the loss o f hard tissue because
of the inferior wear-resistant properties o f dentin. The
pulp may become involved in extreme conditions, s

The substance of this report was delivered at the annual meeting of

the American Equilibration Society, Chicago, Ill., February 1996.
Supported by the MN Dental Research Center for Biomaterials and
Biomechanics and the Minnesota Clinical Dental Research Center, National Institutes of Health No. P30-DE09737.
~Associate Professor, Department of Oral Science.
bAssociate Professor, Department of Restorative Sciences.
cChairman and Associate Professor, Department of Restorative Sciences.
dProfessor, Department of Oral Science, and Director, Minnesota
Dental Research Center for Biomateria[s and Biomechanics.
MARCH 1997

More generally, the study o f dentai attrition fits into

the broad anthropologic studies o f mammalian tooth
wear, with particular reference to the primitive culture
studies ofBeyron, 6 the anatomic studies ofGreaves, 7 the
microscopic studies o f Teaford and Tylenda, s and the
mechanistic studies o f Young and Robson. 9 Luke and
Lucas 4 believed that a low physiologic rate o f enamel
wear was optimal because it favored the retention o f the
cusp form in the human dentition. This was in contradistinction to the flat plane views o f Berry and Poole. ~0
Pronounced tooth wear has also long been associated
with parafunctional bruxing activity, ~-~3 and in the same
vein parafunctional bruxism was t h o u g h t to be the result o f occlusal triggers. ~4 More recent investigations
suggest that bruxism is a behavioral pattern generated
in the central nervous system. 15,~6 Regardless o f etiology, however, there is little disagreement that bruxing
activity can contribute to tooth wear. There is also some
evidence o f gender effect on dental attrition, with greater
attrition reported in males than in females. ~7,~8
M e t h o d is also an issue in dental attrition in the quest
for a more quantitative database. Molnar et al. 19found a
loss o f cusp height o f 800 pm at 18 years o f age in a
group of contemporary Australian aborigines.
Lambrechts et al. 2 reported a steady annual wear rate
0 f 2 9 gm for molars and 18 pm for premolars in 21
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subjects extending over 48 months. In a smaller study

Roulet et al.21 found a loss of 33 ~am for mandibular
molars.
The literature seems to suggest that the number of
studies on quantitative enamel wear remains quite small,
which indicates that there is a need to increase the knowledge base in this respect. Furthermore, it is common,
even in quantitative studies, to measure wear and divide
by the number of years to give an annualized clinical
wear. Although this is useful, it would be interesting to
know the rate of change of tooth wear in consecutive
years. In addition, there appears to be little quantitative
information on the extent of tooth wear resulting from
gender differences and parafunctional bruxism at a quantitative level. Knowledge of such effects on wear would
be useful in the assessment of diagnosis, prognosis, and
treatment outcomes.
The objective of this report was to expand the clinical
database of enamel wear by studying 18 young adults over
a 2-year period. The secondary objectives were to identify any significant differences in tooth wear caused by
gender differences and a clinical diagnosis of bruxism.
MATERIAL

AND METHODS

This study protocol was submitted and approved by

the University Committee on the Use of H u m a n Subjects in Research. Eighteen subjects, dental students between 22 to 30 years old, were examined clinically. The
choice of candidates was constrained by availability for a
period of 2 years.
Clinical criteria
All subjects had a full complement of maxillary and
mandibular teeth. All postcrior teeth had occlusal contact with their antagonists, which was confirmed by
shimstock. 22The presence and location of all dental restorations were recorded during clinical examination.
Teeth restored with crowns were excluded from the
study. Thc test teeth to be measured were free of caries
and significant periodontal attachment loss at the time
of baseline data collection. These included the maxillary and mandibular canines, second premolars, and the
first molar teeth, which provided three major tooth types
in the dental arch at which measurements could be made.
The current clinical diagnosis of bruxism behavior is
principally dependent on history, tooth wear, tooth fracture, tooth mobility, and clinical evidence of masticatory
muscle pain--although this process is still the subject of
debate26,23 Tooth wear was the dependent variable to be
measured. None of the subjects exhibited evidence of
tooth fracture or mobility. Bruxers and nonbruxers were
clinically identified through a history and clinical examination of the masticatory system.24 No effort was made
to distinguish diurnal and nocturnal activity.
The historical questionnaire included six items traditionally believed to suggest bruxing activity. 1~,16,2sSub314

PINTADO ET AI.

jects who were classified as bruxers gave a positive response to at least two of the six items:
1. Has anyone heard you grinding your teeth at night?
2. Is your jaw ever fatigued or sore on awakening in the
morning?
3. Arc your teeth or gums ever sore on awakening in
the morning?
4. Do you ever experience temporal headaches on awakening in the morning?
5. Are you ever aware of grinding your teeth during the
day?
6. Are you ever aware of clenching your teeth during
the day?
The teeth were divided by subject's gender (male, female), parafunctional habit (bruxer, nonbruxer), and
tooth type (canine, premolar, molar) for analysis with a
three-way analysis of variance (ANOVA) with i2 groups
(2x2x3).
Impression technique
The measurement of wear was accomplished through
impression procedures performed at baseline, 1 year, and
2 years. At baseline and subsequent appointments, irreversible hydrocolloid scavenger impressions were made
to remove plaque and any other substance that covered
the teeth. Immediately after, impressions were made with
polyvinyl siloxane (Express, 3M, St. Paul, Minn.) supported in a quadrant metal tray. Baseline ("before") and
follow-up ("after") impressions were taken at the agreed
intervals. Impressions from the 18 young adult subjects
were washed in a soap solution, rinsed, air dried, and
boxed in the traditional manner (Express, 3M). The
impressions were used to make epoxy replicas (EpoxyDie, Ivoclar, Schaan, Liechtenstein), which were then
digitized.
Digitization a n d analysis
The epoxy replicas were digitized on a profiling system that uses a null point contact stylus as described
by DeLong et al. 2a and Pintado et al. 27 The precision
and accuracy of this profiling system (digitized data
plus computer alignment) was determined by following a m e t h o d similar to that suggested by Hewlett et
al. 28 The upper hemisphere of a grade 5 precision ball
bearing with a diameter of 4.0000 mm _+ 0.0002 mm
was profiled with two different spherical-tipped styli: a
ruby stylus (R) with a diameter of 300 _+2.5 pm and a
tungsten carbide stylus (T) with a diameter of 110 -+ 5
gm. Six digital images of the ball were created, three
for each stylus, by measuring the Z height of the ball
every 50 pm in the X and Y directions. The images
were aligned to an image of the ball mathematically
generated on the same XY grid with AnSur software
(Regents, University o f M i n n e s o t a , Minneapolis,
Minn.). Precision is defined as the root-mean-squared
difference between the aligned digital images. AccuVOLUME 77 NUMBER3

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THE JOURNAL OF PROSTHETIC DENTISTRY

Table I. Mean volume loss (in cubic millimeters), enamel-to-enamel tooth wear
All teeth

Canines

Premolars

Molars

196

72

66

58

Mean

0,044

0.093

0.016

0.016

0.073

0.019

0.022

0,061

SD

0.251

0.409

0.030

0.045

0,365

0.040

0.038

0.329

Number

Bruxers

91

Nonbruxers

Females

Males

83

113

105

Year 1 annual

Year 2 annual
Mean
SD
2 Year cumulative
Mean
SD
A%

0.054

0.080

0.031

0.047

0.073

0.037

0,037

0.065

0.216

0.337

0.055

0.085

0.307

0.059

0,078

0.275

0.098

0.173

0.047

0.063

0.146

0.056

0.059

0./26

0,331

0.530

0.063

0.096

0.477

0.071

0.087

0.429

22.7

-14.0

93.8

193.8

0.0

94.7

68.2

6.6

Females

Males

83

113

A%, Percentageannual change in wear from first to second year,

Table II. Mean depth (in micrometers), enamel-to-enamel tooth wear

All teeth

196

Canines

Premolars

72

66

Molars

Bruxers

58

91

Nonbruxers

105

Year 1 annual
Mean

10.74

16.74

8.90

5.38

12,32

9,37

8,94

12.06

SD

24.25

36.39

12.46

10.30

32.82

12.89

12.73

30.02

9.34

10.94

6.59

10.50

10.64

8.22

6.93

11.12

16.96

24.65

7.88

10.94

23.88

6.02

8.98

20.57

Year 2 annual
Mean
SD
2 Year cumulative
Mean

20.08

27.68

15.49

15,88

22.96

17.59

15.87

23.18

SD

29.59

43.96

14.74

15.02

40.59

14.23

15.57

36.39

A%

-13,0

-34.7

-25.9

95.1

-13.6

-12.3

-22,6

-7.8

/k%, Percentageannual change in wear from first to second year.

racy is defined as the magnitude o f the root-meansquared difference between the aligned digital images
and the mathematic image. Both the precision and accuracy depend on the surface angle. The mean accuracy and precision in micrometers for the surface angles
from 0 degrees (horizontal) to 60 degrees are R = 4, T
= 5 and R = 3, T = 3, respectively. For all angles less
than 60 degrees the accuracy is better than 7 btm and
the precision is better than 5 ~am with either stylus.
Approximately 25,000 coordinate points were collected from each occlusal surface by use o f a tungsten
carbide stylus. "Before" and "after" images were aligned
with AnSur software in three dimensions and with 6
degrees o f freedom by minimizing the r o o t - m e a n squared difference between the two images. The aligned
occlusal surfaces were rendered with use o f gray scaling
to produce a near photographic quality image o f the
numeric database in which the wear facets could be
clearly seen. Individual profiles were used to tag the wear
areas and the following morphologic measurements were
made: volume loss (in cubic millimeters) and mean depth
loss (in micrometers). The anatomic location o f the
morphologic change on the occlusal surface was automatically outlined by the software.
MARCH

1997

RESULTS
The descriptive statistics for clinical tooth wear by
volume and by mean depth are presented in Tables I
and II, categorized by tooth type, clinical bruxism, and
gender. The wear data are shown for each year, and the
percentage annual change (A%) from the first to the second year o f wear is indicated. The cumulative wear for
the 2-year period is also shown.
The mean loss for all teeth measured was 0.04 m m 3
by volume and 10.7 ~am by depth for the first year o f
m e a s u r e m e n t . These n u m b e r s were approximately
doubled at 2 years o f cumulative wear. The canines appear to have experienced the heaviest wear at both I
year and 2 years.
A three-way ANOVA was performed on volume wear
and depth wear to identify differences between simple
effects such as tooth type, bruxers/nonbruxers, and gender type. Interactive effects between different factors
were also examined. All F values and corresponding p
values were calculated. The 1-year results for the post
hoc multirange testing o f the ANOVA are shown for
the simple effects o f tooth type, bruxism, and gender in
Table 11I by volume and in Table IV by mean depth.
Similar results for 2 cumulative years o f wear are shown
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THE JOURNAL OF PROSTHETIC DENTISTRY

PINTADO ET AL

Table III. Fisher's PLSD* at 1 year: volume

Effect

Mean difference

Critical difference

0.076
0.077
0.001
0.053
-0.039

0.085
0.082
0.087
0.069
0.070

Canine, molar
Canine, premolar
Molar, premolar
Bruxer, nonbruxer
Female, male

Table V. Fisher's PLSD* at 2 years (cumulative): volume

p Value

0.080
0.068
0.990
0.130
0.267

(NS)
(NS)
(NS)
(NS)
(NS)

Effect

Mean difference

Canine, molar
Canine, premolar
Molar, premolar
Bruxer, nonbruxer
Female, male

0.110
0.126
0.016
0.091
-0.068

Critical difference

0.111
0.107
0.113
0.090
0.091

p Value

0.052
0.021
0.777
0.048
0.144

(S)
(S)
(NS)
(S)
(NS)

NS, Not significant.

*Significance level 5%.

5, Significant; NS, not significant.

*Significance level 5%.

Table IV. Fisher's PLSD* at 1 year: mean depth

Table VI. Fisher's PLSD* at 2 years (cumulative): mean depth

Effect

Mean difference

Critical difference

11.362
7.846
-3.516
2.951
-3.116

8.151
7.873
8.315
6.617
6.678

Canine, molar
Canine, premolar
Molar, premolar
gruxer, nonbruxer
Female, male

p Value

0.007
0.051
0.405
0.380
0.359

(S)
(S)
(NS)
(NS)
(NS)

Effect

Mean difference

Criticaldifference

11.795
12.189
0.394
5.375
-7.308

9.939
9.549
10.138
8.068
8.143

Canine, molar
Canine, premolar
Molar, premolar
Bruxer, nonbruxer
Female, male

pValue

0.020
0.013
0.939
0.190
0.078

(S)
(S)
(NS)
(NS)
(NS)

5, Significant; N5' not significant.

*Significance level 5%.

5, Significant; NS, not significant.

*Significance level 5%.

in Tables V and VI. Most o f the significant differences

emerged after 2 years o f cumulative wear: between canines on the one hand and molars and premolars on the
other and between bruxers and nonbruxers. Illustrations
o f wear with particular reference to occlusal anatomy
are shown as gray-scaled renditions o f the numeric database in Figures 1 and 2.

where V is the volumc o f material removed as two surfaces, pressed together by a normal force (F), slide against
each other over a distance L; H is the hardness o f the
softer o f the two materials; and K is a constant that depends on the type o f wear and the geometry involved. I f
this equation is applied to chewing, V would be the volume of tooth structure removed, F would be the mean
force of mastication, H would be the hardness o f enamel,
and L would be the mean excursive path multiplied by
the total number of chewing cycles during the test period. For healthy individuals with stable diets and stable
dentitions, it is reasonable to assume that the hardness of
enamel, the mean force of mastication, the mean excursive path, and the n u m b e r o f chewing cycles are relatively
constant over time intervals o f a few months or years.
This means that H , F, and L will be relatively constant
during the test period; thus the volume o f enamel removed year by year is relatively constant.
The most c o m m o n m e t h o d o f reporting wear rates in
dentistry is by depth. This is most likely because of historic reasons (it was easier to measure depth) and because o f the direct relationship of depth to the vertical
dimension o f occlusion or facial height. Wear rates by
volume and wear rates by depth are related. The volume
o f material removed is equal to the area o f wear (A)
times the mean change in depth (D) in the wear area.
Thus equation (1) can be rewritten in terms o f D:

DISCUSSION
The fairly low annualized clinical t o o t h wear rates in
this study o f 0.04 m m 3 by volume and 10 p m by mean
depth are somewhat lower than those o f L a m b r e c h t s et
al. 2 and Roulet et al., 2~ w h o made individual measurements on selected parts o f the occlusal surface. The different sets o f data are probably compatible because the
mean depth is integrated over the entire contact area in
this study. The low wear rate is also in agreement with
the longitudinal findings o f Carlsson ct al. 29 and the
cross-sectional findings o f H u g o s o n et at.17 These data
are also consistent with the arguments of Luke and Lucas 4
for a biologic advantage o f cusp retention. At this rate it
would not be expected that the depth o f enamel would
be breached by wear during the life o f the tooth. H o w ever, these are average values and that individual cases
can far exceed this wear rate and should be considered
separately. The high SDs in this study are reflections o f
true biologic variation.
As previously stated, the c o m m o n practice o f calculating an annualized wear rate assumes that the actual
wear rate is constant year by year. This can be shown in
a simple way by considering the general equation for
wear30:

V/L = KF/H
316

(1)

V/L = DA/L = KF/H

rearranging to
D = K F L / ( H A ) = C o n s t / A (2)
O n the basis o f the preceding argument K, F, L, and
H are constant; thus the wear rate by depth can only be
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Fig. 1. Gray-scaled computer image of incisal aspect of maxillary right canine. Brighter colors
represent greater wear depth in micrometers and uneven depth of wear across wear facet.
Profile view 46 shows [abiopalatal extent of wear (green, baseline; red, 2 years).

constant if the wear area is constant. Intuitively, the area

o f wear on teeth is expected to increase with time. F r o m
equation (2) this means that the change in depth (D) is
expected to decrease in time; namely, the mean depth o f
the wear region should increase at a decreasing, not a
constant, rate.
I f the preceding arguments are true, then the relative
change in wear by volume between two consecutive years
(A%) would be zero or near zero and the change by mean
depth would be less than zero. The value turned out to
be +22.7% (Table I) when measured by volume and 13.0% when measured by mean depth (Table II). Although there is not perfect agreement, the trends are
supported. It must be r e m e m b e r e d that the preceding
arguments apply to wear over all o f the teeth, whereas
this study only considered the canines, second premolars,
and first molars. Still, this cautions against the use o f
annualizing procedures and also indicates that there are
important differences in wear when measured by volume and depth, which have m u c h to do with the meaning of occlusion.
There was a modest reduction in the volume rate o f
MARCH 1997

wear (A%) in canines in the second year (-14.0%) (Table

I). However, there was a great increase in the annual
volume wear rate (A%) for the premolars and molars (94%
and 194%, respectively) at the second year. Clearl)% on
the basis o f tooth type, the annual rate o f wear when
measured by volume is not constant, even for 2 consecutive years.
The most interesting differences in Tables I and I I lie
in the comparisons between wear measured by volume
loss and wear measured by mean depth on the same
tooth. These differences are explained by changes in the
area o f contact during the wear process. When the area
o f contact increases, the wear measured by depth is less
than that measured by volume, for the simple reason
that the larger area requires a smaller depth to express
the same volume.
As an example, during the first year, if 0.1 m m 3 o f
enamel was lost with a mean depth o f 0.010 m m , then
the area o f wear is I 0 . 0 m m 2. I f another 0.1 m m 3 o f
enamel was lost during the second year and the area o f
wear covered 20.0 m m 2, then the change in the mean
depth during the second year would be 0.005 mm. Thus
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PINTADO ET AL

Fig. 2. Occlusal view of mandibular right second premolar. Gray-scaled computer image represents baseline data, and color overlay represents wear facet at 2 years from baseline. Uneven
wear is noted across buccal wear facet, and coronal profile shows goodness-of-fit and wear
facet at 2 years.

wear measured by volume increased 100% in the second

year, whereas wear measured by mean depth increased
only 50%; or by use o f the above terminology, A% for
volume is zero and A% for depth is -50%. The wear measured by volume is perceived to be occurring at a m u c h
faster rate than wear measured by depth. This is a simple
requirement o f geometry or, to put it in clinical terms, a
matter o f simple anatomy.
I f the area o f contact is reduced during the second
interval, then the converse is true and the wear measured by volume is less than that measured by depth.
Intuitively, the wear area is expected to always increase
with time, at least until the t o o t h has worn so severely
that it has worn beyond its heights o f contour so that
the cross-sectional area is now decreasing. However, the
area o f wear can decrease with substantially less than
catastrophic wear on the tooth. It is dangerous to focus
only on one t o o t h or one area when evaluating wear.
Wear is a p h e n o m e n o n under control o f the masticatory
system, and all the teeth must be considered. As one
318

area wears, it changes the relationship o f the teeth, bringing other areas into contact. These other contacting areas can alter the functional path and thus the wear area
on the t o o t h under consideration. Figures 1 and 2 illustrate this p h e n o m e n o n and demonstrate that not all the
wear facets were actively wearing at the same rate and
that the area o f wear became less with time. This is a
salutary lesson to those engaged with clinical occlusal
studies not to assume that the entire visible wear facet is
actively losing contour. A wear facet can express uneven
activity, reduced activity, or become completely inactive.
Some o f these differences between wear measured by
volume and by depth are highlighted in Table II. H e r e
the percentage of change (A%) by depth was negative in
almost every case (except the molar), although we know
that the volume loss as a result o f wear was increasing.
The answer to this apparent discrepancy has already been
alluded to and lies in the fact that as the volume wear was
increasing the area o f contact also was increasing, leading
to a smaller increase in loss from depth alone. These are
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important features that need to be incorporated into a

common understanding o f the clinical wear o f teeth.
Wear measured by volume loss is perhaps best regarded
as a material property o f enamel. Any volume can be
expressed by an infinite number o f area x depth combinations. Thus volume is unconstrained geometrically and
may assume any shape, whereas wear reported as depth
is a morphologic parameter because the facet is described
in one direction. As a result, depth measurements alone
cannot describe the total amount o f wear that the tooth
has undergone, although generalized wear expressed as
depth may be an indicator o f loss o f facial height. For
these reasons, reporting wear by volume and by mean
depth is particularly useful because it describes the entire process o f occlusal wear.
H a l f the subjects ( 9 / 1 8 ) in this study were classified
as bruxers by the stated criteria. Although reports o f the
prevalence o f bruxism vary greatly, the 50% prevalence
identified in this sample does not seem unreasonable in
a group o f dentally aware young adults.
The statistical results for wear at the end o f 1 year are
shown by volume and by mean depth in Tables III and
IV. By volume, no statistical differences were noted in
any o f the categories. This is the consequence o f relatively low wear over 1 year and a high biologic variation. As far as simple effects are concerned, there was a
weak significance between the higher wear rate o f the
canine over the molar (p = 0.080) and the canine over
the premolar teeth (p = 0.068). By depth o f wear after 1
year, the canines showed significantly more change than
the molars and premolars (p = 0.007 and p = 0.051,
respectively; Table IV) because o f the smaller variation
with depth measurements. There was no difference on
the basis o f either gender or bruxism after 1 year o f wear.
After 2 years o f cumulative wear the greater loss by
volume and by depth o f the canines over the molar and
premolar teeth show stronger significance (Tables V and
VI). Also at 2 years the difference between bruxers and
nonbruxers is now significant by volume (p = 0.048).
However, when the same wear data are analyzed by
depth, certain similarities and differences emerge (Table
VI). The higher wear rates o f the canines over molars
and premolars are even more marked (p = 0.020 and
p = 0.013, respectively). However, the differences between bruxers and nonbruxers in depth o f wear are not
significant (p = 0.190) (Table VI). This is a reconfirmation o f the essential difference between wear loss as
measured by depth and that measured by volume. The
significant difference in volume o f wear loss between
bruxers and nonbruxers in Table V was accompanied by
a large increase in the surface area o f wear facets. When
this large area was divided into the volume increase, the
results indicated a relatively minor increase in depth o f
wear, which did not reach significant levels. Thus volume is more sensitive than depth when wear is assessed.
Regarding the investigation o f the impact o f bruxism
MARCH 1997

THE JOURNAL OF PROSTHETIC DENTISTRY

on tooth wear in this study, it must be acknowledged

that the criteria used for the diagnosis ofbruxism, which
included clinical diagnosis through tooth wear, is still
subject to controversy and discussion. 16,23However, the
addition o f quantifiable measures o f tooth wear, as offered in this study, may significantly improve current
diagnostic criteria for bruxism.
Although the means for males were higher after 2 )rears
o f cumulative wear, the difference when measured by
depth was still not quite significant on the basis o f gender (p = 0.078) (Table VI). On the basis o f the histologic features o f the hard tissues alone, there is probably
no reason to suppose any difference in the inherent wear
rates o f females and males. However, the greater upper
body strength o f males may be consistent with a greater
strength o f the muscles o f mastication and a greater
masticatory force, 3~,32which would be consistent with a
greater rate o f enamel wear. But, as noted, the higher
mean wear rates for males in this study did not reach
significant levels. This may be more o f a problem with
the high rate o f variation.

CONCLUSIONS
There were significant differences between wear measured by volume and wear measured by mean depth over
a 2-year period in a population o f 18 young adults. A
steady wear rate o f 0.04 m m 3per year by volume and 10
}am per year by depth, averaged over all teeth, was experienced. However, there were important differences on
the basis o f anatomic position in the arch, with the canines showing the most wear. When measured by volume, the greater wear o f bruxers over nonbruxers became significant after 2 years. There was no significant
difference in tooth wear on the basis o f gender in this
young, but small, population.
It was noted that high-wearing enamel couples wore
out o f trouble, as evidenced by the decreasing loss when
measured by mean dcpth. This may indicate that facial
height is highly conserved, even in a young population
with a high wear rate. In high-wearing situations a large
increase in the area o f contact was observed. This increase in area is consistent with a loss o f contour and
progress toward a fiat cuspal morphologic structure.
Therefore it might be said that, although facial height is
conserved, the price to be paid is loss ofcuspal structure
in high-wearing occlusions. In a progressive situation,
when all cuspal structure is gone and the teeth are relatively fiat, wear loss by volume and depth will be more
closely correlated again and facial height will be more
quickly lost. This is the situation typical o f older age,
and it will be exacerbated if the enamel is breached and
occlusal dentin is exposed.

REFERENCES
1. Pindborg J]. Pathology of the dental hard tissues. Philadelphia: Saunders,
1970:294-311.

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THE JOURNAL OF PROSTHETIC DENTISTRY

P I N T A D O ET AL

2. Mongini F. Dental abrasion as a factor in remodeling of the mandibular

condyle. Acta Anat 1975;92:292-300.
3. Owen CP, Wilding RJ, Morris AG. Changes in mandibular condyle morphology related to tooth wear in a prehistoric human population. Arch
Oral Biol 1991 ;36:799-804.
4. Luke DA, Lucas PW. The significance of cusps. J Oral Rehabil 1983;10:197206.
5. ingle Jl. Alveolar osteoporosis and pulpal death associated with compulsive bruxism. Oral Surg 1960; 13:1371-81.
6. Beyron H. Occlusal relations and mastication in Australian aborigines. Acta
Odontol Scand 1964;22:597-678.
7. Greaves WS. The inference of jaw motion from tooth wear facets. J
Paleontol 1973;47:1000-1.
8. Teaford MF, Tylenda CA. A new approach to the study of tooth wear. J
Dent Res 1991 ;70:204-7.
9. Young WG, Robson SK. Jaw movements from microwear on the molar
teeth of the koala Phascolarctos cinereus. J Zool (Lond) 1987;213:51-61.
10. Berry DC, Poole DFG. Masticatory function and oral rehabilitation. J Oral
Rehabil 1974;1:191-205.
11. Black GV. Abrasion and erosion of the teeth. In: Litch WF, editor. American system of dentistry. Philadelphia: Lea,'1886;1:993-1010.
12. Thoma KD. Oral diagnosis. 2nd ed. Philadelphia: Saunders, 1943:173-6.
13. Glaros AG, Rao SM. Effects of bruxism: a review of the literature. J Prosthet
Dent 1977;38:149-57.
14. Ramfjord SP. Bruxism, a clinical and electromyographic study, J Am Dent
Assoc 1961 ;62:35-58.
15. Rugh JD, Harlan J. Nocturnal bruxism and temporomandibular disorders.
in: Jankovic J, Tolosa E, editors. Facial dyskinesias: advances in neurology.
New York: Raven Press, 1988;49:329-41.
16. Lavigne GJ, Montplaisir JV. Bruxism: epidemiology, diagnosis, pathophysiology, and pharmacology. In: Fricton JR, Dubner R, editors. Orofacial pain
and temporomandibular disorders: advances in pain research and therapy.
New York: Raven Press, 1995;21:387-404.
17. Hugoson A, Bergenda[ T, Ekfe[dt A, Helkimo M. Prevalence and severity
of incisal and occlusal tooth wear in an adult Swedish population. Acta
Odonto[ Scand 1988;46:255-65.
18. Johansson A. A cross-cultural study of occlusal tooth wear. Swed Dent J
1992;86(suppl):1-59.
19. Molnar S, McKee JK, Molnar IM, Przybeck TR. Tooth wear rates among
contemporary Australian aborigines. J Dent Res 1983;62:562-5.
20. Lambrechts P, Braem M, Vuylsteke-Wauters M, Vanherle G. Quantitative
in vivo wear of human enamel. J Dent Res 1989;68:1752-9.

21. Roulet JF, Mettler P, Friedrich U. Ein klinischer vergleich dreier komposits
mit amalgam for Klasse-II-fQllungenunter besonderer berL~cksichtigung der
abrasion: Resultate nach 2 jahren [English abstract]. Schweiz Monatsschr
Zahnheilkd 1980;90:18-30.
22. Anderson GC, Schulte JK, Aeppli DM. Reliability of the evaluation of occlusal contacts in the intercuspal position. J Prosthet Dent 1993;70:320-3.
23. Marbach JJ, Raphael KG, Dohrenwend BP, Lennon MC. The validity of
tooth grinding measures: etiology of pain dysfunction syndrome revisited.
J Am Dent Assoe 1990;120:327-33.
24. Fricton JR, Schiffman EL. Reliability of a craniomandibular index. J Dent
Res 1986;65:1359-64.
25. Okeson JP, Philips BA, Berry DT, Cook Y, Paesani D, Galante J. Nocturnal
bruxing events in healthy geriatric subjects. J Oral Rehabil 1990;17:411-8.
26. DeLong R, Pintado M, Douglas WH. Measurement of change in surface
contour by computer graphics. Dent Mater 1985;1:27-30.
27. Pintado MR, Conry JP, Douglas WH. Measurement of sealant volume in
vivo using image~processing technology. Quintessence Int 1988;19:6137.
28. Hewlett ER, Orro ME, Clark GT. Accuracy testing of three-dimensional
digitizing systems. Dent Mater 1992;8:4943.
29. Carlsson GE, Johansson A, Lundqvist S. Occlusal wear: a follow-up study
of 18 subjects with extensive worn dentition. Acta Odontol Scand
1985;43:83-90.
30. Rabinowicz E. Friction and wear of materials. New York: Wiley, 1965:16779.
31. Tate GS, Throckmorton GS, El]is E Ill, Sinn DP, Blackwood DJ. Estimated
masticatory forces in patients before orthognathic surgery. J Oral Maxillofac
Surg 1994;52:130-6.
32. Tate GS, Throckmorton GS, Ellis E Ill, Sinn DP. Masticatory performance,
muscle activity, and occlusal force in preorthognathic surgery patients. J
Oral Maxil[ofac Surg 1994;52:476-81.
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