Chronic injuries to teeth

• Conditions that are taking place over a long period of time especially in the elderly and include attrition, abrasion and erosion.

Attrition

• Wearing a way of teeth substance due to mastication
• Causes:
• Coarse gritty diet
• Nervous habit (grinding teeth in anxiety)
• If at night, known as bruxism
• Chewing pipe
• Sites
• Anterior: incisor edges
• Posterior: occlusal surface of teeth
• Affected sites appear smooth and polished but in advanced attrition, incisor edges and cusps are worn away and become peg like, occlusal surface becomes flat and even hollows out
• Attrition is a slow process so even in advanced cases pulp may not be exposed due to dentine formation
• Attrition is not compatible with caries and periodontal problems because the latter two leads to destruction and mobility of teeth because of which attrition does not occur
• Attrition helps in preventing caries by destroying stagnation areas of occlusal surface

Abrasion

• It is defined as the wearing away of teeth by foreign substances e.g. chewing tobacco, vigorous tooth brushing using tooth powered, certain professions like cutting thread, etc.
• Hard tooth brushing with horizontal sweeping action is the commonest cause of abrasion
• Site: neck of teeth near cervical margin (because cememtoenamel junction is the most susceptible to abrasion)
• A major degree of gingival recession is also seen but no gingivitis occurs due to effective plaque removal
• Corner teeth are the most severely affected
• First cementum and then dentine are exposed: groove is found

Erosion

• It is progressive dissolution of tooth usually by acid solution but sometimes due to unknown causes
• Causes
• Occupational: common among workers of battery/acid factories due to exposure to acid fumes
• Habitual sucking of citrus fruits for long duration
• Soft drinks have high H3PO4. Excessive intake of carbonated drinks: developmental caries
• Chronic regurgitation of acidic gastric juice e.g. in APD, GERD, 1st trimester of pregnancies. erodes especially the palatal surface of teeth
• Erosion of unknown caries: shallow, highly polished in labial surface
• Treatment:
• Identification of course (occupational, etc.) and its avoidance
• Coatings
• Fluorinated tooth paste
• Inotophorosis (Na , F)