Smith and Knight identified dental findings associated with pathologic tooth wear. The distinction between normal and pathologic wear may be subtle when mild, but when severe pathologic wear can result in loss of chewing function and can be disfiguring. The authors are from Guy's Hospital in London and High Wycombe in England.


Features of pathological tooth wear:

(1) pulp exposure (noncarious)

(2) exposure of secondary dentine

(3) loss of vitality to the tooth attributable to tooth wear

(4) exposure of dentine on buccal or lingual surfaces

(5) notched cervical (neck) surfaces

(6) cupped incisal or occlusal surfaces

(7) wear in one arch more than in the other

(8) inability to make contact between worn incisal or occlusal surfaces in any excursion of the mandible

(9) restorations projecting above the tooth surface

(10) wear producing persistent sensitivity

(11) reduction in the length of incisor teeth so that the length is out of proportion to the width


Causes of pathologic wear:

(1) grinding of the teeth during stress (bruxism)

(2) gastroesophageal reflux or bulimia

(3) acidic drinks (may occur in patients on diet ingesting large quantities of citrus fruit juices or constant ingestion of acidic soft drinks)

(4) malpositioning of teeth

(5) abrasive teeth cleaning agents

(6) abrasive debris in diet


Findings related to cause:

(1) limited to buccal surface – abrasive cleaning agents

(2) limited to occlusal surfaces – grinding teeth, debris in food, malocclusion of teeth

(3) diffuse – acid in diet or from gastric acid


Differential diagnosis:

(1) caries

(2) dental trauma and fracture


To read more or access our algorithms and calculators, please log in or register.