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
