Attrition

Attrition is mechanical wear of the incisal or occlusal tooth structure as a result of functional or parafunctional movements of the mandible. Although a certain degree of attrition is expected with age, it is important to note abnormally advanced attrition. If significant abnormal attrition is present, the patient’s functional movements should be evaluated, and inquiry needs to be made about any habits creating this problem, such as tooth grinding, or bruxism, usually resulting from stress, airway issues, or sleep apnea. In some older patients, the enamel of the cusp tips (or incisal edges) is worn off, resulting in cupped-out areas because the exposed, softer dentin wears faster than the surrounding enamel. Sometimes, these areas are an annoyance because of food retention or the presence of peripheral, ragged, sharp enamel edges. Slowing such wear by appropriate restorative treatment is indicated. The sharp edges can result in tongue or cheek biting; rounding these edges does not completely resolve the problem but does improve comfort.

View from above of an anterior (front) tooth showing severe tooth wear which has exposed the dentin layer (normally covered by enamel). The pulp chamber is visible through the overlying dentin. Tertiary dentin will have been laid down by the pulp in response to the loss of tooth substance. Multiple fracture lines are also visible.

Treatment

Abraded or eroded areas should be considered for restoration only if one or more of the following is true:

• the area is affected by caries,
• the defect is sufficiently deep to compromise the structural integrity of the tooth,
• intolerable sensitivity exists and is unresponsive to conservative desensitizing measures,
• the defect contributes to a periodontal problem,
• the area is to be involved in the design of a removable partial denture,
• the depth of the defect is judged to be close to the pulp,
• the defect is actively progressing, or
• the patient desires esthetic improvements.

Areas of significant attrition that are worn into dentin and are sensitive or annoying should be considered for restoration. Before indirect restorations are used, however, a complete occlusal analysis and an in-depth interview with the patient regarding the etiology should be conducted to reduce contributing factors. Also, occlusal guard therapy should be considered.

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  Occlusal guard

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  Occlusal guard

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