Diagnosis and Management of

Dental Wear

Erosion in a patient with a history of bulimia.

Note the enamel erosion on both the functional and
nonfunctional surfaces

Attrition in conjunction with erosive

changes

The destruction of the lower anterior

teeth
involved both erosion and attrition. The
interaction can be so destructive as to
expose pulp chamber of tooth

Abfractions, in the form of

wedge-shaped lesions,
starting in the cervical
enamel of the two premolars

Cervical abfraction on
the mandibular left
incisor.

Abrasive changes on teeth

Clinical Management of Dental Wear

The damaging effects of attrition and
abrasion are often associated with
gingival changes. Some of these changes
can be prevented through behavioral
modification, oral hygiene instruction,
and occlusal adjustment, but correction
of the structural damage usually involves
gingival grafting and/or the placement of
a class V composite restoration.

 The focus of clinical management will

be on identifying patients who are at
risk for dental erosion, the associated
risk factors, and preventive measures.
Four main groups of patients are at risk
for dental erosion.
The first group includes adolescent
males because of their large
consumption of acidic beverages

 The second group consists of adolescent

females affected by bulimia.
The third group involves patients with
gastroesophageal reflux disease (GERD).
The fourth group includes elderly patients
who are taking medication(s) that may
decrease salivary flow, resulting in
xerostomia.

 After identifying the cause of the erosion and

providing necessary counseling, dental professionals
should consider the following preventive strategies in
their patients treatment plans:
1) Reduce acid intake
2)Reduce acidity in the oral environment.
3) Increase salivary flow rate.
4) Remineralize eroded areas with fluoride
and amorphous calcium phosphate
5) Reduce abrasion
6)Protect exposed dentin with filled resin.
7) Fabricate an occlusal nightguard
8) Restore as necessary.