A Picture of Dental Attrition of the Teeth

What is dental attrition?

What is dental attrition?

Typical Appearance of Dental Attrition of the Teeth

The definition of dental attrition is the mechanical wearing of the incisal or occlusal surfaces of teeth as a direct result of functional or parafunctional tooth-to-tooth contact.

The process is usually slow and rarely results in pulpal disease as secondary dentine is laid down to protect the pulp.

Tooth pain is rarely associated with attrition, and men typically show a greater degree of attrition than women.

Most attrition occurs during sleep, and its rate is faster in patients with inadequate salivary lubrication of the teeth.

Related Reading: How to Perform an Occlusal Analysis

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Are there different types of attrition of teeth?

Normal attrition is slow tooth wear associated with chewing, and there is faster dental wear related to sleep disorders like sleep bruxism. Sleep Bruxism causes dental attrition from the lateral motion of the teeth. We also find tooth-to-tooth wear when natural teeth are opposing porcelain crowns.

Sleep Bruxism & Dental Attrition

There have been several articles on this topic. Baba K, Haketa T, Ohyama T, and I sought to answer the question, “does tooth wear status predict ongoing sleep bruxism in 30- year-old Japanese subjects?

In our study comparing tooth wear and bruxism levels, we observed 16 subjects (8 bruxers & 8 age- and gender-controls) with a mean age of 30 years. We used Murphy’s method to form dental casts and measured bruxism level with EMG recordings for five nights.

We found Murphy’s scores and duration of bruxism levels were not correlated. In conclusion, tooth wear status is not predictive of ongoing bruxism level in 30-year-old Japanese subjects.

Why do some bruxers have tooth wear and some do not?

Lubrication is critical to the rate of wear. Johansson A, Kiliaridis S, Haraldson T, Omar R, Carlsson GE in their study, “Covariation of some factors associated with occlusal tooth wear in a selected high-wear sample,” investigated co-factors associated with occlusal tooth wear by studying 59 subjects with a mean age of 35 years, ranging from 16 to 70-year-olds. All subjects had a full or nearly full complement of natural teeth, and all had the presence of definite clinical signs of occlusal wear.

Results

  1. Men > women on wear of the teeth
  2. Greater age = greater wear
  3. Greater bite force = greater wear
  4. Decreased occlusal tactile sensitivity = greater wear
  5. Increased endurance time = greater wear
  6. Low buffer capacity and low rate of secretion = greater wear

In conclusion, the greater the force and inadequate lubrication produces more attrition!

Age Appropriate Attrition

Age% LifeMax Expectmm
0-2025%5%0.5
20-4050%10%1mm
40-6075%20%2mm
60-80100%30%3mm

How is the severity of attrition scored?

  • #0 = no wear at all
  • #1 = small enamel wear (physiologic)
  • #2 = large enamel wear (accelerated but no dentin exposed)
  • #3 = large enamel & dentin exposed (<1/3 of crown).
  • #4 = > 1/3 of crown lost

Dentist’s should also describe the region: Maxillary; Mandibular; Anterior; Posterior, or Generalized.

Is Bruxism strong enough to damage other tissue beyond the teeth?

Yes, we think Bruxism can stretch the TMJ tissues causing disk displacement.

Correlating TMJ Signs & Symptoms with Bruxism Level

In our article, Association between masseter muscle activity levels recorded during sleep and signs and symptoms of temporomandibular disorders in healthy young adults, we studied 103 healthy adult subjects (age 22-32 yrs). Each subject filled out questionnaires and were examined. Each subject had six consecutive nightly masseter EMGs.

We found that gender was significantly related to the duration of EMG, and that joint sound scores were significantly associated with the duration of the EMG activity. In conclusion, the results suggest that both gender and clicking are significantly related to
duration of the masseter EMG activity during sleep.

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This content was originally prepared by Dr. Glenn Glark, DDS, MS as part of course, “Systems Physiology, Motor Disorders and Sleep Apnea for Dental Residents.” Are you interested in earning a dental specialization like Geriatric Dentistry? Check out our program page for more details on the course curriculum and admission process.

 

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About Dr. Glenn Clark

Glenn Clark, DDS, MS is an expert on sleep apnea, orofacial pain and oral medicine, and Temporomandibular Joint Disorder (TMJ). Dr. Clark serves as the Director for the Advanced Program in Orofacial Pain and Oral Medicine at the Herman Ostrow School of Dentistry of USC.