On the matter of tooth wear – Mark Allen Coltene

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  Posted by: Dental Design      16th May 2019

Dentists are seeing more cases of tooth wear, which has been reflected in the increase in literature around this topic.[i]

Over time, chemical and mechanical activity will cause non-carious surface loss, which is both normal and expected. Cumulative with age, increased numbers of patients are presenting with long-term physiological tooth wear. This is because in the UK, not only are people living longer, but more people are retaining more of their natural teeth as they age.[ii],[iii]

Tooth wear can lead to a range of situations which can – either in isolation, or in combination – affect the dentition and smile aesthetics. Aesthetic issues include teeth that have taken on a dull, discoloured and pitted appearance. Functional complaints may be inefficient mastication, pain (including pain in the jaw) and increased sensitivity.[iv]Non-carious surface loss may lead to teeth becoming short or fractured. All of the above will impact on a patient’s quality of life.

Accelerated tooth wear – at a level that is unexpected for the patient’s age – is also becoming a common problem. Pathological, excessive surface loss is being seen in children, teenagers and younger adults. In the worst cases, it can mean the destruction of the dentition, prematurely compromising the prognosis of the teeth. The UK Child Dental Health Survey (1993) found 52 per cent of five-year-olds had erosion of their primary incisors (25 per cent showing dentinal/pulpal involvement); 28 per cent of 11 to 14-year-olds were found to have erosion of their upper incisors.[v]The last Children’s Dental Health Survey, (2013), found that 25 per cent of 12-year-olds had tooth surface loss on the molars and buccal surface of the incisors. Tooth surface loss on permanent incisors was more common (38 per cent of children affected).[vi]

As for what causes tooth wear, there are a multitude of factors, which are often subdivided into attrition, abrasion or erosion. For example, habitual bruxists will wear down their surface enamel, as will those who have a poor brushing technique. Scrubbing away too vigorously, thinking this gives the teeth a more thorough clean, can permanently damage the surface of the teeth. Long-term nail biters, or those who like to chew pens can suffer from increased tooth wear too. In addition, food and drink choices can lead to enamel loss, and what must also be considered in this area is how modern eating habits have changed. Smaller, snack-type meals and eating more frequently throughout the day, as opposed to a ‘traditional’ breakfast, lunch and dinner structure – this can put the enamel under attack for longer. In 2017, a survey about soft drink consumption found that 24 per cent of adult respondents (age 18 and over) drank soft drinks every day.[vii]A cancer charity found that “teenagers are drinking the equivalent of a bathtub of sugary drinks” on an annual basis[viii]– since this research was published, the so-called Sugar Tax was introduced, but time will tell what kind of impact this has (if any) on oral health and, more specifically, on tooth wear.


A recent paper from Dr Rupert Austin of King’s College Dental Institute outlined how young people are losing tooth enamel in troubling amounts, and focused on the increase in eating disorders as well as the consumption of citrus fruits within this age group.[ix]Tooth wear and worn enamel can be the result of repeated forced vomiting, which has exposed the teeth to harmful and corrosive stomach acid. Highly acidic citrus fruits will damage the enamel over time, despite being considered a healthy choice.


In cases of pathological tooth wear, solutions can range from crowns to whole mouth rehabilitation. The patient may request treatment for aesthetic reasons, or because they are in pain. Dentists will have to ensure that both the techniques and the materials used not only offer a predictable outcome, but will also not lead to any more damage or injury to this vulnerable area which has already been compromised. Treatment planning will have to take into consideration the factor(s) that led to the tooth wear in order that re-occurrence can be prevented. Successful treatment for enamel loss must be comprehensive and prevention on-going: “the importance of consent and contingency planning” for these cases cannot be overstated.[x]

Regarding material selection, high-quality materials are a dentist’s weapons in all complex restorative cases. COLTENE has a range of products for strong and resistant restorations, which also give excellent natural aesthetics. These include the BRILLIANT Crios, a reinforced composite bloc, ideal for single tooth restorations andparticularlyrecommended for bruxism patients.

Tooth wear, the loss of enamel for reasons excluding “caries, trauma and developmental disorders”[xi]is on the rise and is an enemy to a beautiful smile. Prevention and early inception are key, as are ethical and predictable methods to restore worn teeth, bringing back their form and function.


To find out more visit www.coltene.com, email info.uk@coltene.comor call  01444 235486


[i]Spijker AV, Rodriguez JM, Kreulen CM, Bronkhorst EM, Bartlett DW, Creugers NH. Prevalence of tooth wear in adults. International Journal of Prosthodontics. 2009 Jan 1; 22 (1).

[ii]Office for National Statistics. Overview of the UK population. November 2018. Release date 1 November 2018. Link: https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/articles/overviewoftheukpopulation/november2018#the-uk-population-is-ageing(accessed December 2018).

[iii]The Information Centre for Heath and Social Care. Adult Dental Health Survey 2009 (Executive Summary). Published 24 March 2011. Link: https://files.digital.nhs.uk/publicationimport/pub01xxx/pub01086/adul-dent-heal-surv-summ-them-exec-2009-rep2.pdf(accessed December 2018).

[iv]Mehta SB, Banerji S, Millar BJ, Suarez-Feito JM. Current concepts on the management of tooth wear: part 1. Assessment, treatment planning and strategies for the prevention and the passive management of tooth wear. British Dental Journal. 2012 Jan 14; 212 (1): 17-27.

[v]Harley K. Tooth surface loss: Tooth wear in the child and the youth. British Dental Journal. 1999 May 22; 186 (10): 492.

[vi]Health & Social Care Information Centre. Children’s Dental Health Survey 2013, Report 2: Dental Disease and Damage in Children (England, Wales and Northern Ireland). Published 19 March, 2015. Link: https://files.digital.nhs.uk/publicationimport/pub17xxx/pub17137/cdhs2013-report2-dental-disease.pdf(accessed December 2018).

[vii]Statistica. Frequency of drinking soft drinks in the United Kingdom (UK) in 2017. Link: https://www.statista.com/statistics/681550/soft-drinks-consumption-frequency-united-kingdom-uk/(accessed December 2018).

[viii]Cancer Research UK. Teenagers drink a bathtub of sugary drinks a year. Published 22 November, 2016. Link: https://www.cancerresearchuk.org/about-us/cancer-news/press-release/2016-11-22-teenagers-drink-a-bathtub-of-sugary-drinks-a-year(accessed December 2018). 

[ix]Why young people are losing their tooth enamel. iNews, 5 October 2017. Link: https://inews.co.uk/essentials/news/health/young-people-losing-tooth-enamel/

(accessed December 2018).

[x]Mehta SB, Banerji S, Millar BJ, Suarez-Feito JM. Current concepts on the management of tooth wear: part 4. An overview of the restorative techniques and dental materials commonly applied for the management of tooth wear. British Dental Journal. 2012 Feb; 212 (4):169.

[xi]Hanif A, Rashid H, Nasim M. Tooth surface loss revisited: classification, etiology, and management. Journal of Restorative Dentistry. 2015 May 1;3 (2): 37.


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