term bingeing and purging can compromise the vertical dimension of occlusion. Although there has been a significant decrease in caries over time, there has been an increase in tooth erosion, even Documenting the progression of erosion Comparing clinical photographs of tooth surfaces may help in estimating loss of tooth structure due to erosion over time, and additional information can be gleaned through clinical
in plaque-free areas (Noble & Faller, 2018). Furthermore, preservation of a cuff of enamel within the gingival crevice is common (Warreth, et al., 2019).
examination and the use of indices that provide a quantitative assessment of the amount of tooth structure lost to the erosive process (Joshi et. al., 2016).
PREVENTION OF EROSION
The management of dental erosion consists of immediate, interim, and long-term phases. Immediate management consists of early diagnosis, baseline measurements, and appropriate prophylactic approaches, including reducing acidic exposure and increasing resistance to tooth tissue loss due to erosion. Following are recommendations for patients who have extrinsic causes of erosion (Delgado & Olafsson, 2019; Guignon, 2020; Nor & Harun, 2018): ● Reduce the frequency of consumption of the identified erosive foods and beverages. ● Avoid eating and drinking habits that extend the contact time of the acid with the teeth. ● Choose safer food alternatives, such as calcium-enriched (sports) drinks and foods, or water and milk products. These authors further recommend the use of protective products such as toothpastes or mouthwashes that contain stannous fluoride or stannous chloride. The incorporation of stabilized stannous fluoride into a daily oral hygiene regimen has proven to be the most effective protocol in protecting teeth against the risk of tooth wear (Sakae et. al., 2018). The chief strategy for managing erosion is the implementation of prophylactic measures followed by restorative or prosthodontic intervention when required (American Dental Association, 2021). Although eliminating causative factors such as bruxism and GERD may not be easy, preventive measures such as splint therapy and diet modification or medication can be taken (Sengupta, 2018). The dental literature notes that from
5% to 47.5% of GERD patients are affected by dental erosion (Alshahrani et al., 2017). Collaboration between the patient’s physician or gastroenterologist is advisable to treat this underlying medical condition that adversely affects the teeth and ultimately oral and systemic health. In addition, lifestyle changes may be needed for effective preventive strategies, especially when sources of extrinsic erosion are present in the diet (Delgado & Olafsson, 2019). In children, this may involve the entire family. Nevertheless, even in very severe cases, control of progression of the tooth wear may be enhanced by information and prophylaxis. Fluoride treatments have long been available to prevent dental caries, but fluoride’s role in the erosion process is more limited (Erpacal et. al., 2018). Nevertheless, it appears that topical fluoride application can positively affect the tooth-wear process (Noble & Faller, 2018). In addition, the erosive potential of different beverages has been found to be inversely correlated with their fluoride content (Shroff et al., 2018). Interim and long-term treatment options include temporary restorations for diagnostic purposes, monitoring of disease progression, definitive restorative work when appropriate, and modification and reinforcement of preventive advice (Erpacal et al., 2018). The treatment of teeth in each treatment classification depends on identifying the factors associated with each etiology. Some cases may require specific restorative procedures, whereas others will not require treatment (Alshahrani et al., 2017).
RESTORATIVE TREATMENT
The choice of restorative treatment depends on the degree of tooth wear and can range from isolated placement of bonded composites to full-mouth reconstruction. Sealing of the tooth surfaces and small composite fillings are minimally invasive treatments for erosive lesions (Alshahrani et al., 2017). Regardless of the type of restorative therapy provided, preventing the progression of erosion should be the basis of management (Chockattu, 2018; Sengupta, 2018). This strategy will increase the likelihood of successful long-term outcomes. Restoration material A decision that is crucial to successful restoration is the choice of material. As mentioned previously, the type of restorative material used depends on the severity of the defect. The materials selected can range from bonded composites to full- coverage restorations. However, each and every case has its own set of limitations and specific requirements. For example, selection of the type of restoration material can depend on whether there are natural teeth in the opposing arch or if the patient is a heavy bruxer. In cases of an opposing occlusion of tooth enamel, a metal occlusal surface—one of high noble metal Adhesive strategies Conventional fixed and removable prosthodontics are the foundation of rehabilitation of extensively worn dentition. However, such treatment is also complex and generally highly invasive. In children, especially when wear affects permanent teeth in the mixed dentition, resin-based restorations are the treatment of choice (Sidhu & Nicholson, 2016). Adhesive
The need for treatment should be established after considering the degree of wear relative to the age of the patient, the etiology, the symptoms, and the patient’s wishes (Erpacal, et al., 2018). Definitive restorative procedures should not be performed before identifying the etiological factors, in conjunction with adequate preventive measures and advice (Alshahrani et al., 2017). In people with bulimia, for example, definitive treatment cannot begin until the patient has ceased purging. content, if possible—is preferable to porcelain to minimize wear of the natural dentition (Daou, 2015). In cases of heavy occlusal load that might be found, for example, in people who brux, it is necessary to consider not only the risk for wear of the restorative material itself and the opposing dentition but also the demand for strength in all the components to withstand the applied load. In addition to mechanical failures under conditions of excessive load, biological failures are even more likely, including caries, marginal degradation, endodontic problems, and loss of retention. technologies and materials also offer promise as a less invasive option for the older patient. Systems available for restoring cervical erosive lesions include resin-modified glass ionomer cements (RMGIC), polyacid- modified resin-based composites, and resin-based composites. Most studies of these adhesive materials have focused on restoration of noncarious cervical lesions without identifying the
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