Managing Dental Erosive Tooth Wear: Current Understanding and Future Directions
Course Number: 517
Preventing and Managing Dental Erosive Tooth Wear
Once a diagnosis of dental erosion is made, an overall preventive management program is needed. ETW management focuses on oral hygiene practices, home care, professional care, and individually tailored advice, depending on the level of severity found, to prevent further erosion and to manage the condition effectively.
Routine maintenance and observation
Clinicians have used clinical notes, photographs, and study models to record the past and present tooth wear and use these to compare with previous records to determine if the wear is progressing faster than an expected physiological rate. Although there is no consensus in the scientific literature on a “gold standard” for the clinical evaluation of wear, the contribution of the indices to diagnosis is undeniable,83 commonly used is the BEWE as described above or more detailed ones such as the Smith and Knight visual index.
Today, intraoral scanners are steadily becoming essential in dental practices.84 An intraoral scanner is a non-invasive tool that can detect small scale changes. Ranges of 200 microns can be achieved, as opposed to classic indexes such as the Smith and Knight visual index, where the scale jump is 1 mm(16). If the rate of tooth wear that is higher than the average physiologic rate of approximately 0.02 to 0.04 mm per year is discovered, the dentist can promptly conduct a more thorough examination and update of the patient’s history and oral habits. Once the cause can be defined, a comprehensive course of management can be offered to the patient. Patients appear to find intraoral scanning software to be an effective communication tool due to the simplicity with which the colors show the teeth and associated wear.83,84
Digital 3D scanning, superimposition and comparison, has been used to quantify changes in orthodontics, periodontics and tooth wear measurements, with varying degrees of accuracy. Clinicians need to bear in mind that the accuracy of superimposing and aligning two scans is complex and be prone to error due to the mathematical complexities of dataset alignment which are often hidden from the operator to make software easier to use.85
In summary, this new era of digital dentistry is quickly evolving. Currently detection and monitoring of early erosive tooth wear can be reliably aided by intraoral scanning supported by specific software. The measurement error and uncertainty involved in this method should be taken into consideration when interpreting the tooth substance loss measurements.86 The intraoral scanner also provides an excellent route of communication85 for patients to contextualise the diagnosis and understand management pathways.
There are a number of suggestions that can be made to all patients, and particularly to those in some of the higher risk categories. These categories are best defined as those individuals with a high consumption of dietary acids, such as colas (diet or regular are no different), fruit juices, wine, acidic fruits such as oranges, grapefruit, berries, apples, acidic vegetables such as rhubarb, tomatoes, any vegetables processed in vinegar such as canned beets, pickles, sauerkraut, and a host of other dietary components.
From the standpoint of Management Strategies, there are two main approaches. One is directed to the patient, while the other is geared toward the Dental Professional.